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Home My WebLink About10-10253 CITY OF ZEPHYRHILLS 5335 - 8T1-1 STREET (813) 780 -0020 10253 ANNUAL FIRE PROTECTION MAINTENANCE Permit Number: 10253 Address: 38410 6TH AVE Permit Type: FIRE PROTECTION MAINTENANC ZEPHYRHILLS, FL. Class of Work: FIRE - PROTECTION MAINTENAN eE Township: Range: Book: Proposed Use: COMMERCIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: Improv. Cost: ,.. m Date Issued: 3/17/2010 Name: ZEPHYRHILLS FIRE DEPT. Total Fees: 50.00 ` ; ,t%ca c Address: 38410 6TH AVE Amount Paid: 50.00 s�e.l3zc�rk- ZEPHYRHILLS, FL. 33542 Date Paid: 3/17/2010 Phone: Work Desc: FPM- SEMI SUPPRESSION /HOOD- FIRE STATION -SCH 3/17/10 -FEE WAIVED H' - 7 -7 177:774 no . , .), ° a� E U I - •� - LL -E -E- Y F 50.00 ...... ; / ' ` ► t b C Ve IRE A C AN Final r_ 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." -r 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 Phone Contact for Permit I 1 1 Owner's Na` .._ . �� me I , j��/ // 'C S�.ri70Ai I Owners Phone Number I 1 1 1 I I Owner's Address 1 38'x/ /O 6 Z�hy/A /4 t_/ w l I Fee Simple Titleholder Name .. Titleholder Phone Number I 1 1 I Fee Simple Titleholder Address Job Address Lot Sub Division Parcel # ..., lixi wa w. i'lzxx .firasgisifiv.,:;ss ., iAmo ,. ,— m _ , or , .,. :ate w. w^T :.. w xzz =z7 =ma,II. >4s",,,.,:i.Qo m- e. ,. e+ -.'v., 'h. 4 vka6o ., s.x' ..»w enw ,ggH4...JE.,.i.,. a. ✓..: • Bio- Hazard Waste Storage ANNUAL J ] Fumigation Tent Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL I Controlled Bum I Hood Installation I Emergency Generator < 30 kw I LP /Natural Gas - Installation I Emergency Generator> 30 kw r--- LP/Natural Gas - ANNUAL Sale Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL ILitrlyl lbemil Fri 1 Uther Sprinkler ❑ ❑ ❑ I Recreational Bum Fire Alarm n ❑ ❑ ❑ I I I Sparklers Hood Cleaning 7 ❑ 0 ❑ I Sprinkler System Installations Hood Suppression IX ❑ A ❑ I I I Standpipes (Sprinkler Sys) Ii Fire Alarm Installation I I Torch Roofing/Tar Kettle Fire Pumps I Waste Tire Storage ANNUAL Fire Works Flammable Application- ANNUAL ! ( Valuation of Project I - Fuel Tanks n Other: I Contractor �_. ,., st. s ..E. cox *;•: Company Signature Registered Y / N .. Fee Current I Y / N Address I I License # ELECTRICIAN Company I Signature Registered Y / N I Fee Current I Y / N I Address I I License # PLUMBER Company Signature Registered Y / N j Fee Current ( Y / N Address I 1 License # MECHANICAL Company Signature Registered Y / N I Fee Current I Y / N Address I I License # OTHER Company ' 4....• /7 /� Signature Registered ram= 9 r�� Fee Current Address Directions: �x ro Lice ns s,. 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 htt //a P Y ( p: ppraiser.pascogov.com) NOTICE OF•DEED RESTRICTIONS: The undersigned understands that this permit may be subject:to ' restristions" which may be more restrictive than County regulations. The undersigned assumes responsibility forrcompliance-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 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 sworn 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 Mar 1710 09:39a p.1 • ACORD CE RTIFICATE OF LIABILITY INSURANCE 1 DATE(MMIOD/YYYY TM I 03/17/2010 PRODUCER Phone_ (407) 332033 Fax: (407) 332-0030 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INSURANCE SOLUTIONS OF AMERICA, INC. ONLY AND CONFERS NO RN;HTS UPON THE CERTIFICATE 910 BELLE AVENUE, SUITE 1140 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR WINTER SPRINGS FL 32708 ALTER THECOVERAGE AFFORDED BY THE POLICIES RFLOW. ■ INSURERS AFFORDING COVERAGE NAB 1 INSURED INSURERA. Interstate Fire and Casualty Company SECURITY FIRE EQUIPMENT, LLC & SECURITY FIRE EQUIPMENT INSURER B: CO. INSURER C: 18330 LAWRENCE ROAD . INSURER D: DADE CITY FL 33523 ; 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 CF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERM' N, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWY MAY HAVE BEEN REDJCED BY PAID CLAIMS. 1 „„ ADOL INSURANCE i POLICY LTR �INSRL TYPE OF IN SY' NUNtTER POLICY Faun EXPIRATION LIMITS OATS UeWpONY) DATE IYlUtO/YTT GENERAL LIABILITY RFS1001624 03/16/10 03/16/11 EACH OCCURRENCE $ 1,000,000 OPMAGE TO REAM X COMMERCIAL GENERAL LIABILITY . PREMISES eowrmw) 3 50,000 CLAIMS MADE X I OCCUR 1 MED. EXP (My one person) 5 5,000 A I_ PERSONAL a, ADV INJURY 5 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'LAGGREGATE UNIT APPUES PER: • PRODUCTS-COMP/OP AGG. 5 2,000,000 71—IC cucv JECT PR n LOC AUTOMOBILE LIABILITY ANY AUTO COMBINE° SINGLE UNIT 1 (Ea accident) S I ALL OWNED AUTOS BOO LYINJURY SCHEDULED AUTOS ! ( person) S II HIRED AU NON-OWNED AUTOS ' BODILY INJURY (Per accident) S PROPERTY DAMAGE I (Per accident) 1 GARAGE LIABILITY 1111 ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC 1 AUTO ONLY: AGG t E7XC CESS I UMBRELLA LIABILITY ! EACH OCCURRENCE OCCUR • + 1 LAIRS MADE I AGGREGATE 3 5 — i DEDUCTIBLE $ I RETENTION S $ WORKERS COMPENSATION AND I WIC SATU- � EMPLOYERS' LIABILITY TOR UNITS I "' 5 OFFlCEIYYE 9 AE =cLUOEmW E.L. EACH ACCIDENT 1 It yes, desnihe ee,er E.L. DISEASE-EA EMPLOYEE 3 SPECIAL ORD1Ml0 G eater E.L. DISEASE - POLICY LIMIT 3 OTHER: DESCRIPTION OF OP ERATIONS/LOCATIONS/VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION - City of Zephyrhills SHOULD ANY OF THE ABOVE DESCRIBED POUCES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER HALL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE 510 OBLIGATION OR LIABILITY OF ANY KINO UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ' Attention: - Scott Lugering ACORD 25 (2001/08) Certificate # 5493 ® ACORD CORPORATION 1988 7 b''G - )