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HomeMy WebLinkAbout10-10059 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813) 780 -0020 10059 ANNUAL FIRE PROTECTION MAINTENANCE 7777:7717 7rCZCZ1k Permit Number: 10059 Address: 5435 GALL BLVD Permit Type: FIRE PROTECTION MAINTENANCE 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: 11- 26 -21- 0010 - 09900 -0010 Improv. Cost: F:,. aAF *M Date Issued: 1/28/2010 Name: SUNTRUST BANK Total Fees: 25.00 Address: 5435 GALL BLVD Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542 Date Paid: 1/28/2010 Phone: Work Desc: FPM- FIRE ALARM ANNUAL- SUNTRUST BANK -SCH 1/28/10 t <'i .€€ k :•:t r { m g :... tt ..,: . # _.. a : M'::; t . _ : _. < - A _ .,,. z . t.. -. _ .,: .!'N :ZAIfh � . E .. y ; ° ($. tt z; k LINU ALA-M •RP FIR ` RMIT FEES 25.00 C LO (D ..f.: ti 3' , s `` 7 4 & 9. �, ""� a (0 a c F ° ar s .. r s" a E� C� � : FIR A E E 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." ITACY 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 -0(520 City of Zephyrhills Fire 0 / J c., Fax- 813 - 780 -0021 Permit Application : Date Received I 1 Phone Contact for Permit NEM I `'‘6 1 6 20 j Owner's Name .Sr f/04,1 Pori , � l 1'd V L L G Owner's Phone Number / Owner's Address ?/ L' /v / 'j ^ s f /i rzo,A. t)€kn o R. cko,o,id ,. V'. 232/f Fee Simple Titleholder Name N ill Titleholder Phone Number Fee Simple Titleholder Address I _ MI Ir Job Address 5 7' ' ' ?-Ail %i ci zclitw/t i (1S Ft 33 /-? Lot# / - 7 Sub Division Cit o f Z e ?I, Hi7I S. Parcel # ii-," — 001O 0? QO(J -00( 0 / (OB PAINED FROM PROPER 1 Y TAX NO] ICE) n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL F - 1 Controlled Burn n Hood Installation I - 7 Emergency Generator < 30 kw n LP /Natural Gas - Installation T7 E mergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale ler Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL Sprinkler I Recreational Burn Fire Alarm tg I I Sparklers Hood Clean /Suppression i n Sprinkler System Installations T7 F ire Alarm Installation 1 I Standpipes (Sprinkler Sys) n F ire Pumps I I Torch Roofing I F ire Works n Waste Tire Storage ANNUAL n Flammable Application- ANNUAL Fl Fuel Tanks 1 I Valuation of Project n O ther: 1 Contractor 11 �( Company G . " "5 P4 1a' i"` C O z — Signature Registered WEN F ee Current m Address I 3/ s /3�e! c -r Sfti vie, / /fi l/ / ( 57 License # ELECTRICIAN Company Signature Registered Y / N I Fee Current I Y / N I Address I I License # I PLUMBER Company Signature Registered Y / N 1 Fee Current I Y/ N - I Address I I License # MECHANICAL Company Signature Registered Y / N 1 Fee Current I Y / N I Address 1 I License # OTHER Company Signature Registered Y/ N Fee Current I Y/ N I Address I I License # 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. • 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 (Chapter 713, 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) a � tam /17/1A (I OWNER AGENT CONTRACTOR (c.l w< < `'�(�� Subscribed and sworn to (or affirmed) before me this Su scri ed and s n tosor affirmed) before me this by / /o by ,gL h et D / , DD /CI Who is /are personally known to me or has /have produced o is /are personally known to me or has/have produced as identification. /SNOW N as identification. Notary Public Y ct c l� Notary Public 0 Commission No. Commissio No. �,L) S/ 7 ` S� 4 r l ;e / /oA I Jt D Name of Notary typed, printed or stamped Name of Notary typed, printed or stamped r — ANOEUNA DAVID Noisy Ptak - st sow �! �` OommluionapiellOra • ` ' ' Awwluloa t OD NMI iMA tr► e - 311"g voloar xl non 001 asinim 10 BLANKET SECURITY DATE: -- 73 LI TO: ATTN: ALARM CORPORATION FROM: 0 I' A 318 Beverly Court. e( ap a,) Spring Hill, FL 34606 FAx #' ___z 352 -666 -3620 # PAGES (INOVER): St. Lic # EF0001200 % �; °' Closed Circuit TV CLUDING C �" > ' Fire Alarm Systems . �, ` : Medic Alert Vacuum r Intercom 1\ Gates , %Ikli ri ti Safes & Locks rj `. y Door Closures ; Long Range Radio , , , ,,47 4 : .. Beepers & Pagers . - COMMENTS: • IF ENTIRE TRANSMISSION IS NOT RECEIVED OR BLURRED, PLEASE CONTACT US IMMEDIATELY. THANK YOU. • P.O. Box 5159, Spring Hall, FL 34611 -5159 Tel: 352- 666 -3620 Fax: 352- 666 -3222 From:DARLENE SULLIVAN FaxID:Sihle Insurance Grou Date:1/28/2010 10:49 AM Page: 2 of 3 R CERTIFICATE OF LIABILITY INSURANCE OP ID DS DATEI/MIDD/Y.1M LIN= -1 01/28/10 PRODUCCR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE STELE INSURANCE GROUP, INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR P. O. BOX 160398 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ALTAMONTE SPRINGS FL 32716 Phone: 407 869 - 0962 Fax:407 -774 -0936 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA Sentinel Insurance Company 11000 INSURERS: Hartford Casualty 29424 Linus alarm Corporation INSURER C: lechnol.py •n°. Col P. O. Box 5159 Spring Hill FL 34611 -5159 INSURER D: _ INSURER E: COVERAGE THE POLICIES OF INSURANCE LISTED BELOW RAVE BEEN ISSUED TO TIE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY RECUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT wrIN RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED PY PAID CLAIMS. mw w m t.' r V LT ►t4l,v PVUI.T t I AIRJN LT it 1NBRC TYPE OF INSURANCE POLICY NUMBER DATE (MIM IDDNYY Y ) DATE IMM/DDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE 51000000 B X CoMMERCIALOENNEINAI. 21UENQD66S1 07/14/09 07/14/10 PREMI S(Eaooiu S 100000 — CLAIMS MADE © OCCUR MED T7kP (Any on person) s 5000 PERSONAL 8 ADV INJURY 51000000 ^ GENERALAGGREGATE 52000000 6E141 AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGO $ 1000000 000 0 7 POLICY n & n LOC AUTOMOBILE LIABILITY COMBINED SINGLE UNIT A X ANY AUTO 21uENoD6681 07/14/09 07/14/10 (Eeaccident) $ 500000 _ ALL OWNED AUTOS BODILY INJURY Ei X SCHEDULEOAUTOS (Per person) X HIRED AUTOS — BODILY INJURY S X ro+OWNED AUTOS (Per eccloern) PROPERTY DAMAGE S (Per.oddont) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S — . AUTO OTHER THAN EA ACC 5 — *um ONLY: AGG S EXCESS 1 UMBRELLA LIABILITY EACH OCCURRENCE 5 I l l OCCUR CLAIMS MADE AGGREGATE S _ _ $ OEOVCTIBLE S RETENTION $ $ IA - WO CO Pt Pt RATION W�blAI(Y UII+ AND EMPLOYERS' LA Y I N X (TORY LIMITS I ER C ANY C PR � a � SINUS ❑ TWC3190958 03/01/09 03/01/10 El EACH ACCIDENT 5 100000 IMaedakery EA, .DISBASe EAEMPLOVEE 5100000 It yos, dw.oribo under SPECIAL PROvISIONS Mow El, DISEASE - POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES / EXCLuEIONE ADDED EY ENDORSEMENT /SPECIAL PROVISIONS • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTNE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ZEPH]t:RH OATS THERSOF. Tic ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRI TSN NOTICE TO THE CERTIFICATE HOLDER NAMEDTO THE LEFT, BUT FAILURE TO 00 50 SWILL City of ZephySh1115 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS ACENT$ OR Fax: 813 788 3293 5335 8th S tzeet REPRESENTATIVES. Zephyrhills FL 32540 -4312 A RED err 1 rxV— ACORD 25 (2009101) el 1988.2008 ACORD CORP RATION. All rights reserved. The ACORD name and logo are reglstered marks of ACORD