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HomeMy WebLinkAbout10-10053 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813) 780 -0020 10053 ANNUAL FIRE PROTECTION MAINTENANCE Permit Number: 10053 Address: 37914 DAUGHTERY RD Permit Type: FIRE PROTECTION MAINTENANCE ZEPHYRHILLS, FL. Class of Work: FIRE - PROTECTION MAINTENANCE Township: Range: Book: Proposed Use: MEDICAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 03 26 - 0010 - 00100 - 0030 Im rov. Cost: ; : V i zi? Date Issued: 1/28/2010 Name: DAUGHTERY ROAD PROFESSIONAL CNTI Total Fees: 25.00 Address: 6719 GALL BLVD STE 106 Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542 Date Paid: 1/28/2010 Phone: (813)973 - 2657 Work Desc: FPM -FIRE ALARM ANNUAL- AMERICAN HEART INSTITUTE -SCH 1/28/10 r p .r 6 1... A & A ALA• Y EMS, IN FIRE P - MIT E 25.00 C 0 1(L LO ( b \ , : 7_ .. .:i a°F �N. _. � ... 11 1, FIRE A EP AN 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 $100.00, whichever is greater. All work shall be performed in accordance with City Codes and Ordinances. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMNT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." WW 1 47 P � IT OFFICER PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813- 780 -0041 2009 -2010 HILLSBOROUGH COUNTY BUSINESS TAX RECEIPT EXPIRES 9 - - 2010 FOLIONO. FACILITIES OR MACHINES ROOMS SEATS EMPLOYEES 0 0 0 1 RENEWAL 27104.0000 H. WASTE TAX OCC: CODE BUSINESS TYPE SURCHARGE 090.000 CONTR R R S YT S INST TI• �� O � � �� . �� H • 40.00 18.00 g Iii. 5 � �3e 3 1 5 i ' P sew ' , t ltgO Aka V .x, BUSINESS 11810 ROSELAWN AVE LOCATION SEFFNER 33584 NAME A & A ALARM SYSTEMS INC MAILING PO BOX 1955 ADDRESS SEFFNER FL 33583 -1955 BUSINESS TAX RECEIPT DOUG BELDEN, TAX COLLECTOR PAID -12534 - 85 HAS HEREBY PAID A PRIVILEGE TAX TO ENGAGE 813- 635 -5200 07/21 /2009 58.00 IN BUSINESS, PROFESSION, OR OCCUPATION SPECIFIED HEREON. THIS BECOMES A TAX RECEIPT WHEN VALIDATED, i 813-780 -0020 City of Zephyrhills Fire /0 o 5 Fax -813- 780 -0021 Permit Application r • Date Received I V 09 43 - 17 1 Phone P ermit / . . M Contact for P Owner's Name - 1/21,- t L4yw u - e "' - 7 i rid T- Owner's Phone Number '/3 7 1 Qq d Owner's Address 37 y! 'DA u5 - Fee Simple Titleholder Name Titleholder Phone Number Fee Simple Titleholder Address I "*x. ,.aS ...i Wite'. . rit a,...,.g tr.d.a .#`rgu.;:P g.- Job Address Lot # Sub Division Parcel # ....: , _. m.,:, , .. , m ,, . mwE.. �. �r v.. u. w ,o.awe4k >axea:;":2.,mu$u..� ,/.Yx.,�. MMAKRu...= < Y x*M., „W_�: -. .:Y'i,. :3.46.*:;,,. ..d,50.. ..at. x, .....R7bw4W.Z.4- s`:M:. I Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier 11 or RQ Facility) ANNUAL n Controlled Bum n Hood Installation F - 7 Emergency Generator < 30 kw I I LP /Natural Gas - Installation n Emergency Generator > 30 kw Ti LP /Natural Gas - ANNUAL Sale DR" Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL 1Qtrly1 )Semi' 1 I Other Sprinkler I ❑ ❑ ❑ I Recreational Bum Fire Alarm E ❑ ❑ ❑ I 1 n Sparklers Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations Hood Suppression n ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) n Fire Alarm Installation n Torch Roofing/Tar Kettle FT Fire Pumps n Waste Tire Storage ANNUAL I Fire Works Flammable Application- ANNUAL I I Valuation of Project Fuel Tanks I Other: I imoorazommvotagnmex ,,' • -sz.,irgammaz•::',.(0-aommAimmaimivatraammomtimagiu,gcl-N,Azzazi,Limaka,=:.i.azgual,:amta:ABgazzakagalmtlanmaimmaz,23,, Contractor I Company 64- :.1"/ 4 �(P�. ' s ' Signature Registered N j Fee Current 1 / N Addrele Off, 84-k, L 4 s 5;1ci4 --„L toc 3 ,35 5 I License # ELECTRICIAN Company Signature Registered Y / N I Fee Current I Y / N I Address I ( License # PLUMBER Company Signature Registered Y / N I Fee Current Y / N Address License # MECHANICAL Company Signature Registered Y / N ] Fee Current I Y / N - I Address 1 I License # I OTHER Company Signature Registered Y / N I Fee Current I Y / N j Address I 1 License # 1 :d�.:..._:"S: - t,:...�'° 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) NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject' to "deed ":restrictions" which may be more restrictive than County regulations. The undersigned assumes responsibility for -compliance with any applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired - a contractor or contractors to undertake work, they may be required to be licensed in accordance with state and local 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 Section at 727 -847- 8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the "contractor Block" of this application for which they 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 to permitting privileges in Pasco County. CONSTRUCTION LIEN LAW (Chapter713, Florida Statutes, as 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 ", I certify that I have obtained a copy of the 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. I 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 government agencies may apply to the intended work, and that it is my responsibility to identify what actions I must take to be in compliance. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air 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 Official for a period not to exceed ninety (90) days and will demonstrate 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 WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. FLORIDA JURAT (F.S. 117.03) OWNER OR AGENT CONTRACTOR Subscribed and swom to (or affirmed) before me this Subscribed and swom to (or affirmed) before me this by by Who is /are 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 • From Alvina Davis At Roe Insurance FaxID: To: City of Zephyrhills Date: 1/27/2010 05:02 PM Page: 2 of 2 • ACORD CERTIFICATE OF LIABILITY INSURANCE DATE YVYY) 1/27/2027 /20 10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Roe Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 985' State Rd. 54 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. New Pt. Richey, FL 34655 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA :Scottsdale Insurance Co 41297 A & A Alarms Systems, Inc. INSURER B: P.O. Box 1955 INSURER C: INSURER 0: Seffner, 33583 -1955 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. INSRADD'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR /NSRtp TYPE OF INSURANCE , DATE IMMJDDWYI DATE IMM/OD/VV A GENERAL LIABILITY CPS0983912 3/21/2009 3/21 /2010 EACH OCCURRENCE $ 2,000.000 DAMAGE TO X COMMERCIAL GENERAL LIABILITY PREMISES (Ea E occurencel $ 100,000 J CLAIMS MADE X OCCUR MED EXP (My one person) $ 5,000 PERSONAL SADVINJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 � I POLICY n , n LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _ ANY AUTO (Ea accident) $ - l ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS . in!� In:r,: ,S�CE !$ !a "s:': L•'0'� L! r ; Ua to the 1 0�! BODILY INJURY $ NON•OWNED AUTOS Ll ri I ' 1 J e rn r i rsurti'i , I r+T i;'iL 0o 3urpi $ • E r C ion �� " C !! rier s do PROPERTY DAMAGE $ snr M c I )C: ? ; (Per accident) r r E IAra+7+r, GARAGE LIABILITY ' 5 )h , AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG I $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE 1 J OCCUR 1 CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH- — TORV I IMITS FR EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE El. EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ U yes descri under SPECIAL PROVISIONS below E.L. DISEASE • POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Zephyrhills DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 DAYS WRITTEN 5335 Eighth St NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Zephyrhills, FL 33542 ENTATIVES. A • , ED REPRESENTATN� / ACORD 25 (2001/08) ©ACORD CORPORATION 1988