HomeMy WebLinkAbout09-9435 CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813) 780 -0020 9435
ANNUAL FIRE PROTECTION MAINTENANCE
:1122) 1
Permit Number: 9435 Address: 6548 GALL BLVD
Permit Type: FIRE PROTECTION MAINTENANCE ZEPHYRHILLS, FL.
Class of Work: FIRE - PROTECTION MAINTENANCE Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 02-26-21-0010-05600-0010
Improv. Cost: 3- . £i..,;P • 3 .a,,.$
Date Issued: 8/17/2009 Name: PIZZA HUT
Total Fees: 25.00 Address: 6548 GALL BLVD
Amount Paid: 25.00 � ZEPHYRHILLS, FL. 33542
Date Paid: 8/17/2009 0,CFF1/11/ - Phone:
Work Desc: FPM - ANNUAL HOOD _,,e j � �; FOR PIZZA HUT WORK DONE 8/12/09
f - +� y -� Cry: a Cd . ° ° „ d a a �z °•. �> °� : i..i
SIM■•NS •V N - TAU T LEANII Fl PE FEE 25.00
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- A - AN inal
Chapter 633, Florida Statutes, authorizes the City to charge and collect user fees to pay for the costs of fire
prevention and protection related activities such as inspections, plan review, administrative fees, and other
costs related to the aforementioned.
Complete Plans, Specifications and Fee Must Accompany Application. Commencement of work without written approval of
the Fire Department's Fire Marshal or required permits or opening up for commercial activity without an approved final
inspection shall be charged double permit fee per day of operation or a minimum of $100.00, whichever is greater. All
work shall be performed in accordance with City Codes and Ordinances.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMNT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE
OF COMMENCEMENT." err
P ' IT OFFICER
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813 - 780 -0041
AUG /14 /2008 /THU 11:25 AM ZEPHYRHILLS BUILDING FAX No. 813-780-0021 P. 001
813 - 780-0020 City of ZGphyrhills tka4P Fax-813.780.0021 , ;t
. • Permit Application . .: a is
Date Received • (:' 'Pho Contactfor Permit
Owner's Name Owners Phone Number i(D�l $' 1 I L} g$ 1 EMI
•
Owners Addreaa o2 - .sr e 1 • . 1 r. 1. _ O O �i
Fee Simple Titleholder Name _ „I Titleholder• Phone Number I , I . _,--I I ' I
Fee SImple Address
Job Address . ■ g : • ! V
Lot �J
Sub dvi.Ion Ze . y ; 1 ! � 3 354-? . Paro/s1 # ) I
0 Elio-Hazard Waste Storage -ANNUAL El Fumigation Tent
D . Comm Exhaust Kitchen Hood/Duct E *Hazardous Material (Tier II or RD Facility) ANNUAL /
•
Conbaged Bum- 0 Hood Installation l '"p O
• n Emergency Generator•< 30 kw n LP /Nattxai Gas - Installation �i a ` e- ``L7 1
.....
Emergency Generator > 30 kw t LP/Natural Gas - ANNUAL Sale , f
I
Fire Protection Maintenance - ANNUAL Places of Assembly - ANNUAL �
Sprinkler ❑ ❑ ❑ a Reore/stionai Bum jf � j '
Fire Alarm ❑ ❑ ❑ l ..1 Spenders
. Hood Cleaning ❑ t? t] n Spdnkler'Systerm Installations
Hood Suppreaaion 2r ❑ ❑ re El Standpipes ( Spdnkler Sys)
Fire Alarm Installation . n Torch J oafrkglrar Kettle Fire Pumps n Waste Tiro Storage ANNUAL
Fire Works
Flammable Application - ANNUM, - 1 ' Valuation of Protect
Fuel Tanks
p Other: • I
Contractor , u Company ' „ „ ^ r • , 00a w 0.. r
Sigr�ture � kczi Y' , . .. Registered riMall Fee Currant lffijllnll •
1 Address , - aE .M11/1_ i�t'L -- !:rcenae #_._i .. .... —1 ..
ELECTRICIAN 'Company
1 Signature � _ . - . 1 Registered Fee Current IIW jai
Address J - I License# - -- I
I PLUMBER Company
Signature • Registered I Y/ N 1 Fee Current I Y/ N 1 .
Address F ----- J License* J I .
6ECHANCAL Company
Signature Registered Fee Current
Address I - -. -License # J I
OTHER - Company r I
Signature Registered ¥/ N J Fria Current L/�
.Addmsa License#
Directions.
FIA out application completely. .
Owner & Contractor /sign back of application, notarized (Or, copy of signed contract with owner)
If over $2800, a Notice of Commencement is raquired.(Mec hand work over $5000)
Supply two (2) sets of drawings with applicable documentation • ,
AIIow 10-14 days for review after submittal date. Parcel # - obtained from Property Tax Notion (http:l /appraiser.paecogov.com)
•
I
i
1
AUG /14 /2008 /THU 11:25 AM ZEPHYRHILLS BUILDING FAX No. 813-780-0021 P.002
'NOTICE OFDEED.RESTRICTIONS: The.undersigned understands that this permit maybersubjectt 'to: "deeetrestdctions "
.which may be more restrictive than-County The•. undersigned .assumes - responsibility Tor:compiianceewith any .
applicable deed restrictions. '
UNLICENSED : CONTRACTORS .AND 'CONTRACTOR RESPONSIBILITIES: if 'the owner has 'hireha- contractor . or - -
contractors lo undertake work, they may required be licensed in aocordanoe with state and Ioca1•regulations. If the
contractor is not licensed as required by law, both the owner and contractor may. be cited - for :a - misdemeanor violation
under state law. If the owner or Intended "contractor are uncertain :as to what licensing - requirements may apply for the
intended work, they are advised to contact the-Pasco County Building Inspection Division- LIcensing•Seotion-at 727 -847-
. 8009. Furthermore, if the owner has hired :a contractor or • contractors, he is advised to .have *the contractors) sign
portions of the " contractor Blook" of this application for which will be responsible. If you as - the owner sign as the
contractor, that may be an indication that he Is not properly licensed and is not entitled Ito permitting ,privileges in .Pasco
County.
CONSTRUCTION LAW (Chapter 713,:Florlda Statutes,-es -amended): If valuation of work is $2;500.00.or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Construction .Lien Law — Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture: and Consumer Affairs. If the applicant is'someone
other than the "owner", t certify that I have obtained a copy ofthe above described document and promise In good faith to
deliver it to the owner" prior to commencement.
- CONTRACTOR'S/OWNER'S -AFFIDAVIT: I certify that all the Information in this application is accurate and
that all work will be done In compliance with all applicable laws regulating construction, zoning and land
development. Application is hereby made to obtain a permit to do work and installation as indicated. 1 certify
that no work or installation has commenced prior to issuance of a permit and"that all work will be performed to
meet standards of all laws regulating construction, County and City codes, .zoning regulations, and land
development regulations In the jurisdiction. I also certify that I understand that the regulations of other
. govemment agencies may apply to the intended work, and that it is my responsibility to Identify what actions t
must take to be in compliance.
If I am the AGENTfOR•THE OWNER, I promise in good faith to inform the owner of permitting conditions set forth in
this affidavit prior commencing construction. 1 understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, alr conditioning, gas, or other installations not specifically included in the application. A
permit Issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension
may be requested, in writing, from the Building Offlciai, for a period not to exceed ninety (90) days and will demon:Arale
Justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned.
WARNING TO OWNER: YOUR 'FAILURE TO RECORD 'A"NOTICE - OF 'COMMENCEMENT MAY 'RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
/it • , ' _ I • s - ■ .' RNEY BEFORE RECORDING YO R OTICE OF C • MENCEMENT
FLORIDA JURAT (F.S. 117.03)
OWNER OR AGENT - i CONTRACT') ` /i '
Subscribed and sworn to (or affl _ before meths Subscribed and swum to or affirmed before me this bY
Who ie/are personalty known to me or has/have produced Who is /are personally known to me or has/have produced .
as Identification. as Identification.
Notary Publio Notary Public •
Commission No. Commission No.
Name of Notary typed; printed or stamped Name of Notary typed, printed or stamped
•
Aug. 17.2009 01:21 PM SIMMONS *OVEN *CLEANING 6783778552 PAGE. 1/ 2
• COMMON POLICY DECLARATIONS
CLS1503822 ik SCOTTSDALE INSURANCE COMPANY' /� Policy
Renewal of Number Home Office; CPS0986576
One Nationwide Plaza Columbus, Ohio 43215
Administrative Office:
8877 North Gainey Center Drive Scottsdale, Arizona 85258
1- 800 -423 -7675
A STOCK COMPANY ADVANCED INSURANCE SERVICES
ITEM 1. NAMED INSURED AND MAIUNG ADDRESS 200 MARKET PLACE, STE 220
S= 'IMONEI OVEN CLEANING, INC. 14 r
ROSWELL. GA 30075
35O ARBOR HTI,r. COURT
::AWHH ;NC:EVILLE, GA 3004, If property coverage is afforded
AGENT NAME AND ADDRESS by this policy, the POLICY IS A
- - - — - CO- INSURANCE CONTRACT.
Tapco Underwriter,
PC) BOX 286
BURLINGTON, NC 272,i6 Agent No. 32 001 Program No,:
ITEM 2. POLICY PERIOD From June la , 2009 To June 18, 2010 Tern 365 DAYS
12:01 A.M. Standard Time at your mailing address.
BUSINESS DESCRIPTION OVRN CLEANING
In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the
Insurance as stated In this policy. This pollcy consists of the following coverage parts for which a premium Is Indicated.
Where no premium Is shown, there is no coverage. This premium may be subject to adjustment.
COVERAGE PART(S) PREMIUM
Commercial General LiabIllty Coverage Part $ 600.0
Commercial Property Coverage Part $ No- s. cnvxFn,..
Commercial Crime Coverage Part $ NO'1 COVERED _
Commercial Inland Marine Coverage Part GEORGIA SURPLUS LINES BROKER
William P, Pinson Jr. $ NOT COVERED
Commercial Auto (Business Auto or Truckers) Coverage Part $ NOT COVERED
Commercial Garage Coverage Part $ NOT COVERED
Professional Liability Coverage Part -- - -- -- --
. , , X w+ , . : µw 7 N
«r� NOT COVERED
`°" ' '� Total Polley Premium: $ . coo, o0
Total Taxes, Surcharges or Fees: $ 128.00
., /;Siin,:::1 „ays.v ,••` -w. ``:: w.�;'. ;ail'd7Y_?.<i`'x,w ?"..•
w« °r °tom &.'^`"`s •> S
a < s . Grand Total Policy Premium $ •728.00_
> With Fees and Taxes :
... >;�,. EMPA Fee $
orm(s) and Endorsement(s) made a pert of this policy at time of issue • -- - ----
See Schedule of Forms and Endorsements
Countersigned: BURLINGTON, NC - 07/06 /2009 KKH
(Dste) GA By ...
( or z Re
epresents
THIS COMMON POLICY DECLARATION AND THE SUPPLEMENTAL DECLARATION(S), TOGETHER WITH
THE COMMON POLICY CONDITIONS, COVERAGE PART(S), COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY,
OPS - - (12 - 00) COMPLETE THE ABOVE NUMBERED POLICY,
ORIGINAL opsdlg.lap
Aug.17.2009 01:21 PM SIMMONS *OVEN *CLEANING 6783778552 PAGE. 2/ 2
APPLICATION FOR B1.ISINESS TAX RECEIPT
• PASCO COUNTY FLORIDA •
TAX YEAR: 2009 -2010 ACCOUNT NUMBER: 074783 sic ('OI)H:
CLEANING SERVICE 7349.06
01IR FILES (.1 1RREN'I'I.,Y REFLECT THE I'OLLOWIN(, INFORMA'I'ION RIiI,ATIN(J'l'O'11IF BUSINESS IL)ENCII'IIiI) BELOW.
PLEASE ('I IANGE INCORRECT INFORMATION.
th Itu;aness Nano• Or I' oitin(IS Name: SIMMONS OVENS RESTAURANT CLEANING INC
Il'Fictitious Name, Registration Number: EXEMPT Expires:
• (. nrporatt; Name (II OiIIeient from Abovel:
• Owner /Manager's Name: SIMMONS WILLIAM llontc Phone: 678 488 - 7847
P Date Business Opened In Pasco County: 01-18-08
• Physical l,ocailon 01 Business: PHYSICAL ADDRESS OF BUSINESS
R E QuURID �/ "I.5 I el P/c et
w mailin AtIdrts,: �Lj7' l� oz
. 0 �I
m Federal deral IE:mployer 11) ()r Social Sccurily Number: 582507749 Raciness Phone: 866 377 - 9225
I. S..:U$.US.iiI,) ItJ (ohas III) 11) 111111 SWIM SWIM' 11,' 11111.8 WV ISSI !NG I41l(
• Sales Tax Registration Number:
• Shoo Or ('onnly 1(04001nr'' License Numht' I :chires:
• Fees: 7as 13.75 Pcnalte :b Other "'SO(; $ 20.00
('Small ()tidal ny (iencrn)ta ill Il;rillrllous Maucri,(l)
m Number OF EMPLOYEES t 1 1f "Number O1 Changed. See Fee Schedule Belot:
(employees. seat' ;, =chino. CIc.)
1 — 5 13.75 16 — 20 70.00
1 — 10 33.75 21 —9999 93.75
1 A'I°1AC'I I ( •(II'U :S OF:
RI {'l'11RN Tills I Ol(M IN'IA( 1' W1 APPROPRIATE FEE AND ('(PINS OF ABOVE 1)I {S( WIWI) 1)O(IIMI ?NT . BUSINESS 'FAX
RECEIPTS I ?XPIRF. SEPTEMBER 31111 I, OCTOBER THROUGH JANUARY AMOUNTS INCLUDE LA'I'N RENEWAL PENALTY,
DO NOT DETACIj - RETURN ENTIRE FORM INTACT Poo_ • a (R O4I )fO1
BUSS TAX NOTICE • pAsco COUNTY FLORIDA
2009 -2010 LICENSE YEAR ACCOUNT 07 EXPIRES 9/30/10
TOTAL DUE BY: (PENALTY AFTER SEP 30TH)ODE 7349.06
L SEP 30 OCT 31 NOV 30 DEC 31 JAN 30 JAN AMOUNT
33.75 35.13 35.81 36.50 37.19 APPLIES THEREAFTER
PAYABLE TO: MIKE OLSON, TAX COLLECTOR/ P.O. BOX 276, DADE CITY FL 33526 -0276
SIGN HERE -> I CEHTII :YINA ALL INF.ORMATIONPROVID/1) 1H1; AitOvt
APPLICATION FOR THIS BUSINESS TAX HECEIPT IS TRUE AND
CORRECT
I 'IIII.0 1111 III'lllu" Iyll
AUTHORIZED SIGNATURE DATE
SIMMONS OVENS RESTAURANT CLEANING INC
1458 GREAT SHOALS CIR
LAWRENCEVILLE GA 30045 -7092
ntc /17 .no c .nn4 c inn inn 2000000000137520000020008000747839