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HomeMy WebLinkAbout10-10058 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813) 780 -0020 10058 ANNUAL FIRE PROTECTION MAINTENANCE Permit Number: 10058 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 -21- 0010 - 00100 -0030 Improv. Cost: � 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 - SPRINKLER ANNUAL - AMERICAN HEART INSTITUTE -SCH 1/28/10 N ASAP AUT• MA 1 - RI KL - AND PI FIRE PE - M T E 25.00 10 ())\ 33 az d F�.E i1, €jP;,B•• J .e ,. 5 � � �<. __�. e A &E � ..0 e Z » 1�� .. . .... .. ...... .. .... .. .. .. ,.�� �7`.s. , ��"'. FIRE A CEPTAN 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." �! /i 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 i W6' y Fax- 813 - 780 -0021 Permit Application 1 Date Received II one Contact ontact for Permit Owner's Name IAmgRvtAN 14 LTA ■Vsrirurc., TNd Owner's Phone Number 1813 I :0 1 iioo 1 Owner's Address 13 DAu. r 4r I! ky (kb. 2 EA►-(YF/141‘LY ri.. 23 Sci / Fee Simple Titleholder Name Titleholder Phone Number I f Fee Simple Titleholder Address Job Address ( 37 9/41 . Au.t 'rER RO. 2£ pi-( yP 1=1 15'y 1 Lot # Sub Division ra _ _ Parcel # 0 _6— t- O O O - O0 00-0030 „ : „,E.,,.. ., € ..., -r 2.? ?,a _ r`TW"tFu'. +01 m•E •• = .4.', ? : •:x 4 4 • 4ra ` , - ' •KRs " S §s .... 440"4s . 4 ,x.,W •'i • n Bio- Hazard Waste Storage - ANNUAL I= Hazardous Material (Tier II or RQ Facility) ANNUAL n Comm Exhaust Kitchen Hood /Duct n Hood Installation Controlled Burn n LP /Natural Gas - Installation E Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale I - 7 Emergency Generator > 30 kw EJ Places of Assembly- ANNUAL n Fire Protection Maintenance - ANNUAL n Recreational Burn try (SemiI WU Other Sprinkler ® ❑ ❑ Ix n Sparklers Fire Alarm 0 ❑ ❑ ❑ I 1 n Sprinkler System Installations Hood Cleaning n ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) Hood Suppression El ❑ ❑ ❑ I 1 n Torch Roofing/Tar Kettle n Fire Alarm Installation n Waste Tire Storage ANNUAL El Fire Pumps Fire Works n Flammable Application- ANNUAL l I Valuation of Project n Fuel Tanks 0 Other: 1 I a e 3;E, h< sF>. K:4:1 ;a • a -4. mom' AMi i O« K;a rrt; 2;n .'..MEe;".4 V .. Contractor a ^ Company A SF} ►- ItTy MAT 1 C S 1r.? f4fllf o Qi90 - 1 Signature l J CO C 9f3u..>r (L Registered Y / N l J Fee Current Y / N Address 1.2191 11 rG'CttiAG¢ Sr. ,LA a Co 1°1. 3 3)) / 1 License # I I ELECTRICIAN Company I Signature Registered Y / N I Fee Current I Y / N I Address I I License # I I PLUMBER Company I Signature Registered Y/ N I Fee Current 1 Y / N I Address 1 I License # I MECHANICAL Company I Signature Registered Y/ N I Fee Current I Y / N I Address I I License # I OTHER Company I Signature Registered Y/ N I Fee Current I Y / N I Address) License # ,. .. x's^v •• � ... ,,,,:,:7 . «... *€ eesEx ... ; ..;.., ,x %..,...,F, E i a ; mia.z�. _, . ..... ..> ,,..,.� .eaWat z lgT.. :: :, : ._ ._. , a . ... ,.w ... _._ .. .__ ..,, _.� is 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) • STATE OF FLORIDA : DEPARTMENT OF FINANCIAL SERVICES 4 DIVISION OF STATE FIRE MARSHAL y fi r_ ~ TALLAHASSEE, FLORIDA CERTIFICATE OF COMPETENCY THIS CERTIFIES THAT: JED C SAUER 298 -21ST TERRACE SE LARGO, FL 33771 - BUSINESS ORGANIZATION: ASAP AUTOMATIC SPRINKLERS AND PIPING INC CONTRACTOR II IS LIMITED TO THE EXECUTION OF CONTRACTS REQUIRING THE ABILITY TO LAYOUT, FABRICATE, INSTALL, INSPECT, ALTER, OR SERVICE WATER SPRINKLER SYSTEMS, WATER SPRAY SYSTEMS, FOAM -WATER SPRINKLER SYSTEMS, FOAM -WATER SPRAY SYSTEMS, STANDPIPES, COMBINATION STANDPIPES AND SPRINKLER RISERS, ALL PIPING THAT IS AN INTEGRAL PART OF THE SYSTEM BEGINNING AT THE POINT OF SERVICE, SPRINKLER TANK HEATERS, AIR LINES, THERMAL SYSTEMS USED IN CONNECTION WITH SPRINKLERS, AND TANKS AND PUMPS CONNECTED THERETO, EXCLUDING PRE - ENGINEERED SYSTEMS. al Chief Financial Officer 07 101 12008 07 16 Pinellas 11947600011993 0665210074 150.00 061 301 2010 Issue Date Type Class County License/Permit Number Application ti Taxes & Fees Expire Date • BUSINESS TAX RECEIPT City of Largo 2009 - 2010 FILE # 2010000168 DBA: ASAP AUTOMATIC SPRINKLERS & PIPING INC Business Name & Mailing Address Physical Address, Owner, Phone ASAP AUTOMATIC SPRINKLERS & PIPING INC ATTN: J C SAUER 298 21ST TERR SE PO BOX 20968 LARGO, FL 33771 -2317 SAINT PETERSBURG, FL 33742 -0968 JED C SAUER 727 - 521 -2727 Business DescrL P Lion: FIRE SPRINKLER CONTRACTOR II Classification NAICS No. Qty. Amount OLD OL DESCRIPTION HOCLIC 50 $50.00 STATE: 11947600011993 6/30/2010 Certificate Number: 12590 Engaging in any business occupation is subject to zoning restrictions. The collection of this Business Tax /Administrative Service Charge does not authorize the holder to operate in violation of any City ordinance, law or regulation. Each holder is solely responsible for notifying the Community Development Department, in writing, of any change in status, location or ownership. Renewal notices will be sent to the last known address and owner of record. Issuance is in no way intended as an approval or disapproval of the holders competence or skill. This Business Tax Receipt expires 30 September 2010. Penalties are provided by F.S. 205 if not renewed before 1 October 2010. Additional penalites of up to $250 may apply if not renewed by 31 December 2010. THIS IS NOT A BILL NO REFUNDS POST IN A CONSPICUOUS PLACE CDPR3026.RPT Wells , B,rgo 1/2U/2010 10 :0 /::.j;3 AM PAUL Z /OC;3 rax berver Cert ID 21617 p CORDTN CERTIFICATE E OF LIABILITY I ILU YY Y INSURANCE I DATE IMDDYY) 1/26/2010 UCea THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 1 ls xa.rga ins services southeast, inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P u 9nx 3' 6 ,E HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Tampa SL 33631 - 3666 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (7271 796 - 6666 (727) 799 - 5117 INSURERS AFFORDING COVERAGE NAIC # ',NSURED INS LRER A. Indian Harbor Irauxance COmpan j 36940 ASAP Automatic Sprinklers & Piping, Inc- 'N3JRER E, AUTO Insurance company 13933 P.O. Box 20962 I�n'-aE c: -- A st. Petersburg FL 33742 iNS JRERD 'I AS USER E- 1 COVERAGES THE POLCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOME INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN31 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. E W PO INSR IACO'' POLICY NUMBER I DA7EYME�FDD6 ECLCYIEXgiRT,6N; LIMITS LTA jwsoni TYPF OF INFI TRANCE /1V pDAATTEE IIJJIIMW '� 1 j GENERAL UABILTY EACH OCCURRENCE ' $ 1, 000, 000 I i DAMAGE TO RENTED A X I CJ'ONIERC'ALGENERA' RmG640001602 ! 2/27/X09 2/27/2010 � :MEUSE3 (Ea onourence, ; $ 100, : J ^^ — — 'SLAMS MADE I X .■ GCCUn M_D E %P :Any ens persen'I I f 5 PERSONAL 6 ADV INJUR):' :; $ 1, 000, 000 r-1I GENERALAGSAEu'ATE d 2, 000, 000 . A'i3REG t Mrr APPLIES PER j PRCDUCT3- CQMP.. .A33 I $ 2, 000, 000 PC.iCV ! PRO_ , : LOC ! AUTOMOBILE LIABILITY , L_ COMBINED SAGLE LIM7 -. E a a. e, 'dent' t ' $ B M X ' ANY ? = 9542753901 2/27/X09 2/27/2010 300,000 I ALL OWNED AUKS B 71L R^! 3 :: HECULED AUTOE 1 'Per pe wn; I HE I K RED A'JTO'a BODILY INJURY S ( X rION .OWNED AUTOS • Per aoddent) ( � I — P ROPERTY DAMAGE 3 ( Per aoaderY.` AUTO ONLY - EA ACCIDENT $ QARAOE UABI LiTY I I ANY AU?. EA AC $ • THEn THAN i I i AUTC • nNL' AGu $ EXCESS/UMBRELLA LIABILITY EACH C OCURRENCE $ 1 . ! j OCCUR , CLAIMS MADE I AGGREGATE $ I $ 1 i DEDJDTIELE I $ RETENTION $ 1 $ WORKERS COMPENSATION AND iNC 3TAT'U• ?N- XTR L.TSI u ER EMPLOYERS' LIABILITY ! -- ANYPPCPR IETCR�'PARTNERIF.XC:;.,TIVE E!. EACH ACCIDENT � $ CFF,CEPL'MEMEE ?EXCLUDED? E DJ SEAS! - !A EMPLOYEE'$ ' yyes descibe der 1 SPECIAL PROVISIONS ceIn, E L. DISEASE - POLICY LIMIT IS OTHER I DESCRIPTION GE OPERATIONS I LOCATIONS ; VEHICLES t EXCLUSIONS ADDED BY ENDORSEMENT: SPECIAL PROVISIONS Florida statute mandates 10 day cancellation notice for nonpayment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED PQUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30_ DAYS WRITTEN zephyxhilla Building Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 7,P L+ 5_:�' ><h 5t IMPOSE NO +79LIuA'IQN OR LABILTY OF AM KIND UPON THE ! NSURER. 75 A7EN75 OP REPRESENTATIVES. zephyxhille FL 33540 AUTHORZEDREPRE3ENTATIVE % ACORD 25 (2001;08) a ACORD CORPORATION 1988 sage 1 of 2 01/26/2010 Tue 06:49 Wells Fargo Insurance Services ID: #61876 Page 2 of 3 ACORM CERTIFICATE OF LIABILITY INSURANCE DATE `"""01NYYT" 1/26/2010 PRODUCER Commercial Lines - (727) 796-6666 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Wens Fargo Insurance Services USA, !Me. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE OOVERAGE AFFORDED BY THE POLICIES BELOW. 311 Park Place Boulevard, Suite 400 Clearwater, FL 33759 -3923 INSURERS AFFORDING COVERAGE NAIL # W4SORED ASAP Automatic Sprinklers & Piping, Inc. INSuRER A Florida Retail Federation SIF 10700 P.O. Box 20968 INSURER B INU^URER c' INSURER D St. Petersburg FL 33742 INSUREP COVERAGES THE POLICIES Cr INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIRENIENT, TERM -R 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 LDA1TS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LR ADD TYPE S P I NSURANCE POLICY NUMER ' ROUEY M /DDITY, POUCY 1MADD/ y T10N LTA -NS LINE Rf� _ DATE IMWDt]tYY) GENERAL LIABILITY EACH OCCURRENCE $ CTOMMERC:UL DENFRAI LIAPUJTY DAMAGE TO RENTED 5 PRF !SFS Ea ,�rurienca: CLAMS MADE j_J OCCUR MED EXP one •arse '... -. _ PERSONAL 8 ABV INJURY $ _GENE ^RE,GATE GEIN'L. ACRIREGATE LIMIT APPLIES PER' PRODUCTS - COMPIOPAGG $ POLICY n PRO• ( O „ AUTOMOBILE UABIUTY r^C SINCE LIMIT _ ANIYALITO (Eaweldet) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON -OWNED AUTOS (Per accia°.-:t) PROPERTY DAMAGE (Per acddent) GARAGE LIABILITY AUTO P,. ! Y : EAAQCIDENT $ ANY AUTO OTHER THAN EA ACC- $ -- - AUTO ONLY: AGO $ - EXCESS,UMBRELLA LIABILITY EACiOCC RRZN $ OCCUR El CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ .. - _. A COMP ENSATION AND 52035076 1/1/2010 1/1/2071 - _ x _ 1T q'i ACT; { �� FRk $` UABILfiY 1 E L EACH ACCIDENT $ 1 00, ANY PROPRIETOR:PARTNER/EXECJTiS(_ ,. O+FrERNIRMBER FXCI..UOFO? E1. DISEASE - EA EMPLOYE' $ 700,000 ye !lesait�e under GPE CIALPROVi61;46 below E. L. DISEASE- POLICY LIMIT $ 580,000 OTHER DESCRIPTION OP OirrruAeNS 1 L OtAYHjNe: VEHICLES/ E S+ XCLUSIONS ABBEB EY ENDORSEMENT! SPECIAL PRowSoNJ Proof of coverage CERTIFICATE HOLDER CANCELLATION Ten Day Notice for Non- Payment - , SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEL LED BEFORE THE EXPIRATION DATE THEREOC. THE IEBVMIO MEURER WILL ENDEAVOR TO MAIL 30 DATE WRITTEN Zettyrttllts Buffeting Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 1m SO SHALL 5335 ael Street IMPOSE NO OSLIGATfop1 OR UAIRUTY OF ANY KIND UPON THE INSURER, ITS AGENTS 011 Zephyrhilte FL 33540 REPRESENTATIVES. AVTMAAIMREPRFDEHTATIVB ACORD 26 (2001/08) 1 of 2 1149243 © ACORD CORPORATION 1988