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HomeMy WebLinkAbout10-10459 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813) 780 -0020 10459 ANNUAL FIRE PROTECTION MAINTENANCE E K Permit Number: 10459 Address: 7810 GALL BLVD Permit Type: FIRE PROTECTION MAINTENANCE ZEPHYRHILLS, FL. Class of Work: FIRE - PROTECTION MAINTENANCE Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 35- 25 -21- 0010 - 00700 -0000 Improv. Cost: V 9,= .` ..,e Date Issued: 5/12/2010 Name: PRIMERICA GROUP ONE Total Fees: 25.00 Address: 3629 MADACA LANE Amount Paid: 25.00 TAMPA FL 33618 Date Paid: 5/12/2010 Phone: (813)933 -0629 Work Desc: FPM- FIRE ALARM ANNUAL- ZEPHYR COMMONS it , , z C _ . 9 k l,.aw• : v,s &e .. , s .� • ';a :> ' . $ ., °- : a::i" r .. a.,a'°i: ,42 r , �y , sT AVOr A APR• Y M IN FIRE •ERMIT FEES 25.00 ( •a^E IR • B'0, 0 \'-•" e . I A PAN inal 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." AI •� 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 1 1 Received Phone Contact for Permit 11cc�7 I 1 suy b 1 I a-9051 Owner's Name �LIA... * n L- Owner's Phone Number I g) 3 1 '73 6( Owner's Address 1 3(, a 9 /Y)c da.ca. Lr) a/ r»P•L fL 3 / 8' - g x a OG I Fee Simple Titleholder Name I Titleholder Phone Number I 1 1 1 1 Fee Simple Titleholder Address I &Ct. / / /VCI 7P—Oh Job Address I i / 6 rhi /J'S & 3 A Sil Lot # I ( Sub Division Parcel # I � ^ 5 b/3 ID 00000 QPP n Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL T1 Comm Exhaust Kitchen Hood /Duct n Hood Installation n Controlled Burn n LP /Natural Gas - Installation n Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale 2 Emergency Generator > 30 kw n Places of Assembly- ANNUAL Fire Protection Maintenance - ANNUAL n Recreational Burn (Qtrly) ISerni ) MI Other Sprinkler 0 ❑ ❑ ❑ n Sparklers Fire Alarm 10" t ❑ ❑ 2 I 1 n Sprinkler System Installations Hood Cleaning n ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) Hood Suppression n ❑ ❑ ❑ I 1 I-1 Torch Roofing/Tar Kettle n Fire Alarm Installation n Waste Tire Storage ANNUAL IT Fire Pumps n Fire Works Flammable Application- ANNUAL 1 I Valuation of Project pi Fuel Tanks ri Other: I Contractor Company Signature Registered Y/ N I Fee Current I Y/ N I Address I I License # I ELECTRICIAN /7 /2 Company "I fy:y p f s 2 r. I Signature /' Svc `f Registered Y / N I. Fee Current Y / N Address 1 /3/ ("/ 6(G rH Coos- N. Ste AO, derv. ate ?3ikit, License # E- r 000L PLUMBER Company Signature Registered Y/ N I Fee Current I Y/ N I Address I J License # MECHANICAL Company Signature Registered Y/ N J Fee Current I Y/ N j Address I License # I OTHER Company Signature Registered Y/ N . 1 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. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com) • b P o .61t� o ...4 N. - o1-+�x Pi n al i ce „ W � N;t o pr > co i�'H rtcr�' m Crn dziR r' c4.0- 'dg m c H H GL M K o - on VII OM° F. 0.1 C m y o Co x. w Da+ F. m n: ° s H to �'t�1g C0 HO w 3 b Pig w W Hg t" m 1.4 m CI N!'ht�J H H as n 0 L 0 a NI v 2 WC Q u O c w N in Fitt b o F+- P1 7 �� egi CO 0 Oh - CO 0 1 V > ?� �° [/! XI ut r 0 . c rn (35 "r1 0 Fri C H X `+ WV - X XI n CD t+0 a M > Caw HO 0)' ti w OX N 0 mg Hid .7►� H nd - M x fil JD No qo qt r O 04 as d r w 0 N M 0 f. L. / o ƒ 5 jf - / = i2� =4 w = A r -3 § ) a 9 /} § (/ ti § m . a m E k�r > -� 't :7 z§ P§ > n2= -c m� ( ® ' 2 m ; ) o ■ C r »¥ 3z m ° ° °° - a =x 2 - E row_- a' 2 Z" ' n � 2 2 � e fi o §_, 2 ,„z § d $q ®E E / / k( 3 hl 2 $ ƒ G / TO'd SOEG at L t SW3ISAS 311'10310dd b I _ G :&T 5O-9?- , ACOID CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 5/4/2010 PRODUCER Phone: 516- 869 -8666 Fax: 1 -516- 869 -8765 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION GENATT ASSOCIATES, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 3333 NEW HYDE PARK RD HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR SUITE 400. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NEW HYDE PARK NY 11042 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:FirSt Mercury insurance Compan AFA PROTECTIVE SYSTEMS, INCORPORATED INSURERB:Lexington Insurance Company 19437 1255 LAQUINTA DRIVE ORLANDO FL 32809 INSURERC: Insurance Company of State of 19429 INSURER D: 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. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM /DD/YYl DATE (MMIDD/YY) LIMITS A GENERAL LIABILITY FMMI0128344 2/12/2010 2/12/2011 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) $300,000 CLAIMS MADE X OCCUR MEDEXP(Anyoneperson) _ $ PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OPAGG $ 2,000,000 PRO- POLICY JECT LOC C AUTOMOBILE LIABILITY CA8263499 2/12/2010 2/12/2011 COMBINED SINGLE LIMIT C X ANY AUTO CA8263500 2/12/2010 2/12/2011 (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY X NON -OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ — AUTO ONLY: AGG $ 3 EXCESS /UMBRELLA LIABILITY 014550196 2/12/2010 2/12/2011 EACH OCCURRENCE $25,000,000 X OCCUR I I CLAIMS MADE 1AGGREGATE $ 2 000, 000 DEDUCTIBLE RETENTION $ $ WC STATU- C WORKERS COMPENSATION AND WC20634854 2/12/2010 2/12/2011 X TORY O ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER _ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER City of Zephyrhills- Building Dept. WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE 5335 8th Street CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO Zephyrhills FL 33542 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATI ACORD 25 (2001/08) © ACORD CORPORATION 1988 T0'd 1U101 dim dim ... CN O O j. C D CN - - 0 "1 . d nn ∎ a � � � � + ho c o 0"' a « D � _ o Cr X g 6 z c g { CfiC A p ° p mr- M D sd 0 • QQNip p m ° p p m O . el: N r G• ! 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TO!TO'd SEEr rT8 Loh SW3IS2,S 3nII0310; d b VP: ET 600E- VO -1.JU AFA Protective Systems, Inc. 13161 56th Court Suite 201 SINCE 1873 Clearwater, FL 33760 Lic.# EF0001 1 16 727.556.2905 Fax 727.540.0791 City of Zephyrhills — Building Dept. 5335 8 Street Zephyrhills, FL 33542 For any of the following personnel: E.S.(Uchi) Azpiazu Dennis Shannon James Johnson Paula Cuthbert Mark Bairam Ryan Shannon Mike Woolley Please be advised that I have authorized the above mentioned person(s) to pull a permit for AFA PROTECTIVE SYSTEMS, INC under License number EF- 0001116. Thank you for your cooperation, Osvaldo R. Molina Operations Manager AFA Protective Systems, Inc Signed before me in Pinellas County, Florida, this /a day of • 2 o/c., By Osvaldo R. Molina, who is personally known to me and did not take a o . r: .... yvy•e•II Paula M. Cuthb rt : 44 . PAULA M. CUTHBERT coMNASSION Notary Public County of Pinellas o �2220p34 State of Florida TM��" ' kt1 tAILIANCECONA www.afaprotectivesystems.com Connecticut . Delaware . Florida . Georgia . Maine . Maryland . Massachusetts . North Carolina . New Hampshire New Jersey . New York . Pennsylvania . Rhode Island . South Carolina . Vermont . Virginia