HomeMy WebLinkAbout10-10206 CITY OF ZEPHYRHILLS
5335 - 8TH STREET 10206
(813) 780 -0020
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 10206
Address: 38220 HENRY DR
Permit Type: FIRE PROTECTION MAINTENANC ZEPHYRHILLS, FL.
Class of Work: FIRE - PROTECTION MAINTENAN •E Township: Range: Book:
Proposed Use: COMMERCIAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number:
Improv. Cost: x:
Date Issued: Name: HCR MANOR CARE
Total Fees: 50.00 Address: 38220 HENRY DR
Amount Paid: 50.00 ZEPHYRHILLS, FL. 33542
Date Paid: 3/05/2010 Phone:
Work Desc: FPM- SPRINKLER ANNUAL /FIRE ALARM ANNUAL- HCR MANOR CARE
A • AL •L •N, IN IRE PERMIT EE 50.00
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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
u13- 780 -0020 I � Fax -813- 780 -0021
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City of Zephyrhills Fire W t 0"
Permit Application
Date Received I 1 Phone Contact for Permit I} 21- . 1q 1 -I. 1 I g a 3
Owner's Name t' r .fi"t"" " (' C It 1'144/0 / C01, Owner's Phone Number q/ 3 7t L 7h/ Y
Owner's Address
`6 ?) Tf y z D u t. z f l r A.'/ s I f. 33 5
[
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Fee Simple Titleholder Name I / + T Titleholder Phone Number
Fee Simple Titleholder Address 1 I
Job Address 3 7f ??■1 1444. Pr. Zr. / NIA • 3 35V Lot#
Sub Division Parcel #
pi B io - Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL
n Comm Exhaust Kitchen Hood /Duct n Hood Installation
El Controlled Burn ri LP /Natural Gas - Installation
r i Emergency Generator < 30 kw I I LP /Natural Gas - ANNUAL Sale
I ,t i E mergency Generator > 30 kw [J Places of Assembly- ANNUAL
I x I Fire Protection Maintenance - ANNUAL r Recreational Burn
(Qtrlyl Semi' FT, l Other
C Sprinkler x ❑ ❑ ( I I Sparklers
Fire Alarm C ❑ ❑ ❑ I I I Sprinkler System Installations
Hood Cleaning 0 ❑ ❑ ❑ I 1 1 1 Standpipes (Sprinkler Sys)
Hood Suppression 7 ❑ ❑ ❑ I I I I Torch Roofing /Tar Kettle
[ ] Fire Alarm Installation I I Waste Tire Storage ANNUAL
I I Fire Pumps
1 I Fire Works
n F lammable Application- ANNUAL 1 I Valuation of Project
[] I Fuel Tanks
0 Other: I
Contractor Company A -r- 11 3 64_i o
Signature ) Fee Current
9 � 1 � Registered Y N �
Si Y/ N I
Andress 1 3531 Viett54-or►t , I License # 4 Q 35 3 8000 I a 00 2. I
ELECTRICIAN Company I
Signature Registered Y / N I Fee Current 1 Y / N
Address I
1 License # I-- I
PLUMBER Company
Signature Registered Y / N ! Fee Current I Y / N I
Address I I License #
MECHANICAL Company
Signature Registered Y / N 1 Fee Current I Y / N I
Address I License #
OTHER I
Company
Signature 1 Registered Y/ N Fee Current I Y / N I
Address I I License #
Directicns.
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)
813- 780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021
Permit Application
Date Received r (_. Phone Contact for Permit 721 I, 144 2 I t q
q 3
Owners Name .j I ii "A, r f : /4 Owners Phone Number l t/3 1 7 -7/,7 I
Owner's Address 're,k Q Awr Pr. Zer y (A'/i' s PI s3sy�.
Fee Simple Titleholder Name f / Titleholder Phone Number
Fee Simple Titleholder Address I
Job Address 7 7g»0 ir/(/, pc. Zf A f I /' /S , /• 3 .Fs a Lot #
Sub Division j I Parcel # I
D Bio- Hazard Waste Storage - ANNUAL a Hazardous Material (Tier 11 or RQ Facility) ANNUAL
r i Comm Exhaust Kitchen Hood /Duct n Hood Installation
I I Controlled Burn = LP /Natural Gas - Installation
n Emergency Generator < 30 kw I 1 LP /Natural Gas - ANNUAL Sale
n Emergency Generator> 30 kw n Places of Assembly-ANNUAL
I XI Fire Protection Maintenance - ANNUAL a Recreational Burn
a IQtrlyI !Semi, (J Other
Sprinkler ❑ ❑ ❑ 0 Sparklers
Fire Alarm ® ❑ ❑ Ix I I n Sprinkler System Installations
Hood Cleaning ED ❑ ❑ ❑ I 0 Standpipes (Sprinkler Sys)
Hood Suppression ❑ ❑ ❑ I I n Torch Roofing/Tar Kettle
n Fire Alarm Installation a Waste Tire Storage ANNUAL
1J Fire Pumps
El Fire Works
a Flammable Application- ANNUAL ' ( Valuation of Project
Fuel Tanks
n Other:
- -=.t max_ _
Contractor Company A -'- 4v so ( j,•pn knew. I
Signature c.,, Registered Y/ N Fee Current I Y/ N I
Address I 3531 1'iQ 4 -one Rd. I License # I EF0000 A IM ; I
ELECTRICIAN Company
Signature Registered Y/ N I Fee Current I Y/ N I
Address I
I License # I I
PLUMBER Company
Signature Registered Y/ N I Fee Current I Y/ N I
Address I I License # i
MECHANICAL Company
Signature Registered Y/ N I Fee Current I Y/ N I
Address I I
License #
OTHER Company
Signature Registered Y / N . 1 Fee Current I Y / N I
Address I
License # I
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)
A TOTAL SOLUTION, INC.
City Of Zephyrhills 3/2/2010 14452
4999999 • Cost of Goods Sold:5049999 •
4999999 - Cost of Goods Sold:5129999 -
4999999 - Cost of Goods Sold:5299999 • Inspection Permits 6 total 150.00
5999999 • Administrative Expenses:6420 License Renewal 30.00
Cash in Bank - Bank o Permit 180.00