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HomeMy WebLinkAbout10-10050 1� CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813) 780 -0020 10050 ANNUAL FIRE PROTECTION MAINTENANCE g 8 . , ,---r • a i- 1 ! 1' ; &� C , ° � . E : . :. : ° ,.: Permit Number: 10050 Address: 5963 GALL BLVD Permit Type: FIRE PROTECTION MAINTENANC ZEPHYRHILLS, FL. Class of Work: FIRE - PROTECTION MAINTENANCE Township: Range: Book: Proposed Use: COMMERCIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 10- 26 -21- 0020 - 00000 -0021 Improv. Cost:` M 777 s ,. Date Issued: 1/27/2010 Name: ABC Total Fees: 25.00 Address: 5963 GALL BLVD Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542 Date Paid: 1/27/2010 Phone: Work Desc: FPM -SEMI HOOD SUPPRESSION FOR ABC PIZZA - 1/27/2010 EA '6 ,... „<.$f4s C•M RCIAL 1 EPUIP 1 0. Fl PERMI ES 25.00 ps FIRE ACCEPTANCE Final 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." 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 • 813 - 780 -0020 City of Zephyrhills Fire Fax- 813 -780 -0021 Permit Application Date Received A v�- y 0 Phone Contact for Permit I � W IUI Owner's Name 4zk h 2 14 1 Owner's Phone Number 1, j 1 7S 2 - I I9�a(� Z1 Owner's Address 1 9 3 6 %/U u Fee Simple Titleholder Name I ( Titleholder Phone Number Fee Simple Titleholder Address I I ''.,+ �Xx„✓.°' x>""" k`+' s1:°`!' aZh#'#° YZa' 6`. r` .4e.3?.+r`;S.YA.�fri'Fr'F:.i+E 4, s. 4:;;'. r:: iSr)+ N. ex "3R`.".S'+3.:`(,2,.kr.:dYw4.l kay s =.ie .1+ °a..: '�.. '£ s7° isf? KJ. ?l�X».-' 2'., k' Y: dFF: S^ m„ rria.""`+'°.,'.^ Y'°`.:4k':',.3kd°i"`{£d";•':'. Job Address �/7///- Lot # I Sub Division I I Parcel # ;+?>w'w"f.*+'.ruT at.:[a._'«;k3>`rf.�:,'- c,`�x.0 rx .,...x:?.3,.r✓[,_.s..<S. ».,...x �, ..r...3:a ^�'::d..�t��.?#'.. ?4s7,".,.;" Irx:. �rx:==±» ra'.: a*,. xi_,: 3;:; ::a:.a5} °c3 »f= *..z,o",kcxa`°,. .t�,e'. ,. r§s:..rm;Y.�,r..nPr E Bio-Hazard Waste Storage - ANNUAL Hazardous Material (Tier II or RQ Facility) ANNUAL . El Comm Exhaust Kitchen Hood /Duct ED Hood Installation Controlled Bum = LP /Natural Gas - Installation El Emergency Generator < 30 kw = LP /Natural Gas - ANNUAL Sale n Emergency Generator > 30 kw ED Places of Assembly- ANNUAL / 1 El Fire Protection Maintenance - ANNUAL = Recreational Burn f ,G/ // ! rY EMU (:T✓� Other ° '/ ,- Sprinkler E ❑ ❑ ❑ I I n Sparklers (-- ❑ ❑ Sprinkler System Installations - -- Fire Alarm � ❑ I l Hood Cleaning El ❑ ❑ ❑ I I = Standpipes (Sprinkler Sys) Hood Suppression ❑ K ❑ I 1 El Torch Roofing/Tar Kettle Fire Alarm Installation [] Waste Tire Storage ANNUAL Fire Pumps Fire Works Flammable Application- ANNUAL I Valuation of Project Fuel Tanks 7 Other: I I Contractor Company I Signature Registered Y/ N I Fee Current I Y/ N I Address I I License # ( I ELECTRICIAN Company I Signature Registered Y / N I Fee Current I Y/ N I Address I I License # I PLUMBER Company I Signature Registered Y/ N I Fee Current I Y/ N Address I I License # I MECHANICAL Company I Signature Registered Y / N I Fee Current 1 Y / N I Address I I License # I OTHER Co /II At c. /14 / i L /4 G 6:... Co Company � I Signature . Registered (. 1 N Fee Current I Y / N 4. Address C'�� License# /,I / 0 V "d , r ., Directions: Fill out application completely. Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com) • NDTICE;;OF :DEED RESTRICTIONS: The undersigned understands that this permit maybe• subject :to - "deed ":restrictions" .which may more restrictive than County regulations. The.undersigned.assumes responsibility .for compliarme'with any .applicable deed restrictions. UNLICENSED 'CONTRACTORS AND - O TRA O R cen ante with owne and local d-re -cont ct if th required corttractorsto• undertake work, they may h contractor is not licensed: as required by law, both the owner .and contractor may be cited - fora misdemeanor iolation under state law. If owner or intended contractor are uncertain .as to what licensing - requirements may :apply for the intendedawork, they are advised to contact the Pasco County Building Inspection Division — Licensing Section_at 727-847 - 8009. Furthermore, if the owner has hired l'a �coon���ich - th e contractors, espons responsible. If you, as the owneasign as the sign portions ,,of the "contractor Bloch' of this app ' Y in Pasco contractor, that may be an indication that he is not properly licensed and is riot entitled - permitting .privileges County. CONSTRUCT ION. LIEN LAW ( ChapterTl3, Florida S, as amended): If valuation of work is 32;500.00 or more, I certify that 1, - the applicant, have .been. provided -with a copy o f •the Florida Construction Lien Law— Homeowner's Protection Guide" prepared by Florida ve obtained a of the above described document and prom Psean faith to other than the "owner I certify that I h deliver itatothe `owner" prior to commencement. CONTRACTOR'S/OWNERS-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. I certify that no annd a rd s of all laws regulating has commenced ting �ctoissuance , County -and City codes, _zoning work will lions, and performed land meet stadrd of ll al g developmen rod n m ay y in apply jurisdiction. o the intended also workcand that it is my responsibility toeidentify regulations what actions I . government agenci Y must take to be in compliance. if I am the AGENT'FORTHE OWNER, I promise in de � d tha inform separate h pe may be required for electrical set work, this affidavit prior to commencing construction. plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A olate, cancel, alter, or permit issued p construed be a a codes, norproceed shall ss ante of a permit prevent the Building i Of ial from thereafter work and not as authority to set aside any y provisions ns of the technical permit issued shall become invalid a correction of errors in plans, construction or violations of. any codes. Every p unless the work authorized by such permit is commenced within. n.ssi after moon the o me r mit iss c , or if work authort extension b y the permit is suspended or abandoned for a period of six (6) may be requested, in writing, from the Building Official. for agperiod o n to ve days, ni n job i9 ens s a ed dal demonstrate j ustifiable cause for the extension. If work ceases for ninety ( ) 'WARNING TO OWNER: YOUR FAILURE TO RECORD A'NO1 ICE'OF 'COMMENCEMENT MAY "RESULT IN 'YOUR - PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. CORDING YOUR NOTICE OF © N G, CONSULT WiTH YOUR ENDER OR AN ATTORNEYBEFORE FLORIDA JURAT (F.S. 117.03) CONTRACTOR OWNER DR AGENT Subscribed and swam to (or affirmed) before me this Subscribed and sworn to (or affirmed).before me this by by Who is� re personally known to me or has/have produced Who is/are personally known to me or has/have produced as identification. as identification. Notary Public Notary Public Commission No. Commission No. Name of Notary typed; printed or stamped Name of Notary typed, printed or stamped - • • • • STATE OF FLORIDA c.= 1. DEPARTMENT OF FINANCIAL SERVICES ti E A.- -- DIVISION OF STATE FIRE MARSHAL _ i z, T FLORIDA : ' Q dq FIRE EXTINGUISHER PERMIT THIS CERTIFIES THAT: BRUCE W VARNADOE EMPLOYER: COMMERCIAL FIRE EQUIPMENT CO 10236 FISHER AVE TAMPA, FL 33619 - LICENSE NUMBER: 38504200021988 - FIRE EQUIPMENT CLASS D LICENSE HAS COMPLIED WITH FLORIDA STATUTES AND HAS QUALIFIED FOR THE TYPE AND CLASS SHOWN HEREON TO SERVICE, REPAIR, INSTALL, INSPECT ALL TYPES OF PRE - ENGINEERED FIRE EXTINGUISHING SYSTEMS. Chief Financial Officer i t : itie..., • 01 101 12010 09 04 Manatee 39463700021988 1726440002 1213112011 Issue Date Type Class County License/Pennit Number Application # Expire Date i ._Jan. 20. 2010_ 8:48AM_---- No. 0253 P. 1 /1 .ACORD E oiioioio " ` CERTIFICAT E OF LIABILITY INSURANCE PRODUCER Phone: (727) 865-3456 Fax: (727) 8652762 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ASSOCIATES INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P 0 BOX 530157 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ST. PETERSBURG FL 33747-0157 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. , INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: ALL RISKS LIMITED COMMERCIAL FIRE EQUIPMENT CO. INSURERS: AUTO OWNERS INSURANCE CO. CIO B. WAYNE ENTERPRISES, INC. INSURER C: SUMMIT /BRIDGEFIELD EMPLOYERS INSURANCE C O. PO BOX 2442 INSURER 0: BRANDON FL 33509 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADO'I, POUCY EFFECTIVE POUCY EXPIRATION LTR INSRO TYPE OF INSURANCE POLICY NUMBER DATE IMD(VYI DATE IMDD1YYI LIMITS MID AIV GENERAL LIABILITY RFS1001200 09/08/09 09/08/10 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY WM�GE To RENTED PREIISES(Ea $ 100,000 I CLAIMS MADE © OCCUR MED. EXP (My one person) $ 5,000 A PERSONAL & ADV INJURY .. $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEM AGGREGATE LIMIT APPLIES PER: PRODUCTS- CCMP /OPAGG. $ 1,000,000 7 POLICY n , P 4 nLOC $ AUTOMOBILE LIABILITY 4815247300 09/08/09 09/08110 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY — SCHEDULED AUTOS (Per person) $ B X HIRED AUTOS _ BODILY INJURY $ X NON-OWNED ALfTOS (Per accident) — PROPERTY DAMAGE $ (Per accident) GARAGE LIABLITY AUTO ONLY - EA ACCIDENT $ ANY AUTO 011-ER THAN TEA ACC $ . AUTO ONLY: AGG $ EXCESS 1 UMBRELLA LIABLITY EACH OCCURRENCE $ _ — OCCUR Ej CLAIMS MADE AGGREGATE $ i , DEDUCTIBLE $ RETENTION $ i WORKERS COMPENSATION AND 830 -28471 01/14/10 01/14/11 X IT RY 1 ' OTHER EMPLOYERS' LABILITY C Aber PROPRIETOR/PARTNERIExECVTIVE / E.L. EACH ACCIDENT $ 1,000,000 OFFICE EXCLUDED? I ` / / E.L. DISEASE -EA EMPLOYE $ 1,000,000 • describe under S PECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Pasco ID #008012 -Bruce Vamadoe CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS Pasco County Contractor Licensing WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 7530 Little Road DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS New Port Richey, Fl 34654 AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE / Attention: A� ACORD 25 (2001/08) Certificate # 24630 0 ACORD CORPORATION 1988