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Home My WebLink About10-10543 CITY OF ZEPHYRHILLS 5335 - 8T1-1 STREET • (813) 780 -0020 10543 ANNUAL FIRE PROTECTION MAINTENANCE Permit Number: 10543 Address: 6429 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: 03- 26 -21- 0020 - 00000 -0030 Improv. Cost: Date Issued: 6/03/2010 Name: WALGREENS Total Fees: 25.00 Address: 6429 GALL BLVD Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542 Date Paid: 6/03/2010 Phone: Work Desc: FPM- ANNUAL SPRINKLER- WALGREENS LE: , :447211411rballa 14e = 1 AU • `A Y FI' E ' F E 25.00 Vvv (.95/c- F ' A • final ,,I 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 .11 ". IT OFFICER PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - >s HOUR NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813- 780 -0041 . 813-780 -0020 City of Zephyrhills '.. u C(y Fax-813-780-0021 Permit Application f I J f _ Date Received i Phone Contact for Permit Owner's Name W • a '� =C ' \5 Cos-.. Owners Phone Number _ Owners Address Fee Simple Titleholder Name Titleholder Phone Number Fee Simple Address 1 Job Address 11.\ Co 5f<De.Lk Cottal Gaal ' k 33Sk 1 Lot# Sub Division Parcel # n Bio- Hazard Waste Storage - ANNUAL Fumigation Tent I I Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL l I Controlled Burn n Hood Installation I -1 Emergency Generator < 30 kw n LP /Natural Gas - Installation El Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale I I Fire Protection Maintenance - ANNUAL • n Places of Assembly - ANNUAL )UtriyI )Semi) Will other Sprinkler T7t ❑ ❑ )5‹ n Recreational Bum Fire Alarm n ❑ ❑ ❑ I ( I Sparklers Hood Cleaning n ❑ ❑ ❑ I 1 Sprinkler System Installations Hood Suppression n ❑ ❑ ❑ 1 n Standpipes (Sprinkler Sys) n Fire Alarrn Installation I-1 Torch Roofing/Tar Kettle I I Fire Pumps n Waste Tire Storage ANNUAL n Fire Works I I Flammable Application- ANNUAL 1 ( Valuation of Project FT Fuel Tanks jn Other: I �. Contractor 1 /' — ►`i _ Company G CLX(\OV.L COCt Signature Re 1 `( N I Fee Current f Y �N I Address 1 ( License # I ELECTRICIAN Company Signature Registered _ Y/ N I Fee Current 1 Y/ N I Address I License # PLUMBER Company Signature Registered Y/ N I Fee Current I Y / N I Address I I License # MECHANICAL Company Signature Registered Y / N I Fee Current 1 Y / N Address 1 I • License # I OTHER Company Signature Registered Y / N I Fee Current 1 Y / N Address License # Mita Directions: Fill out application completely. Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over 32500, 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) 'NOTICE OF:DEED RESTRICTIONS: The undersigned understands that this permit may_be "dead" rrestrictions which may be more restrictive than County regulations. The.undersigned.assumes responsibility for:compliarrcelwith 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 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 will be responsible. If you, as the ownersign as the contractor, that be an indication that he is not properly licensed and is not entitled 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 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 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 govemment 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 swom 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 06/03/2010 09:22 FAX 4078559064 GRUNAU FLORIDA L21003 .PI 1 f%. 'f �VVM� IPA VVIIGV�VI +11.1.1%.011 1.fb10111G. 1 QA 1 1,061101. VI EII 11 �i •VVM11 \'� 1 IV /.IMH ils local buSinesS tix receipt is in addition to and not in lieu of any other tax required by law or municipal ordinance. businesses arc subject to regulation of zoning, health and othe wful authorities. This receipt is valid from October through September 30 of receipt year, Delinquent penalty is added October 1. ."'ORIGINAL*** 2009 EXPIRES 9/3012010 3121- 0509185 3121 ALARM/FIRE SYSTEMS $225.00 100 EMPLOYEES. PETERS MARK W QUALIFIER TOTAL TAX $225.00 • PREVIOUSLY PAID $225.00 TOTAL DUE $0.00 GRUNAU COMPANY INC PETERS MARK W QUALIFIER 11300 SPACE BLVD STE 4 & 5 ORLANDO FL 32637 -9209 11300 SPACE BV #45 11- ORLANDO, 32837 PAID: $225.00 99- 435813 8/10/2009 • • • . :arl lfloo Tax'•Collector' `Lac l Bu roes ax R� xt' =Aral e C ,#�dxl a ��. °.. :'. -_: �:� : ° � , ...,:,..., •:oral » :'` . ..... �slnaddnio .ta anili3Otir Iietkti otti er' xax�qukedbylaw :or.muaicjpaloriitaan e4.4 l n i eises.11NA. 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GRVNA .1 06/03/2010 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Alternative Risk Resources T.LC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 12660 W. North Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Brookfield WI 53005 Phone : 262-754-9100 Fax : 262-754-9114 INSURERS AFFORDING COVERAGE NAIC* INSURED INSURER Zurich - American Ins. Co. 16535 INSURER B: Grunau Company Inc. . Ted Angelo INSURER C: • 1100 West Anderson Court INSURER D: Oak Creek WI 53154 — I INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CON Orr IONS OF SUCH POLICIES. AGGREGATE LIM SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. • INWK 71,WU L - POLICY EFFECTIVE POLICY EXPIRATION LTR N$RC 'TYPE OF INSURANCE POLICY NUMBER DATE (MMI00/YYYYI GATE (MM /DDIYYYYI UMITS GENERAL UABILITY EACH OCCURRENCE $ UAMAVC ItJRCNI COMMERCIAL GENERAL LIABILITY PREMISES (ED omimncn) $ CLAIMS MADE El OCCUR MED F.XP (My ova Perm') 1 — PERSONAL & ADV INJURY $ GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP A3 G $ POLICY n ,EC' n LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A X ANYAUro BAP 8196144 -11 03/01/10 03/01/11 (Eaexloentl 51,00 0,000 ALL OWNFO AUTOS BODILY INJURY SCHEDULED AUTOS (Porpnr,.on) 1 A X HIREOAUTOS BODILY INJURY A X NON -OWNED AUTOS (Per accident) A X Comp 250 ded PROPERTY DAMAGE A X Coll 500 ded (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ R ANY AUTO OTHER THAN EA ACC 1 AUTO ONLY: AGG 1 EXCESS 1 UMBRELLA LIABILITY EACH OCCURRENCE 6 OCCUR E CLAIMG MADE AGGREGATE 1 — S DEDUCIBLE 5 RETENTION 6 $ WORKERS COMPENSATION X TORY LIM U- I l AND EMPLOYERS' LIABIUTY A ANY PROPRIETORiPARTNERIECUTIVG /N WC 8196143 -11 03/01/10 03/01/11 E.L. EACH ACCIDENT 51,000,000 (Mandatory HR E XCLUDED9 I EL DISEASE` EA EMPLOYEE $ 1,000,000 I( �• dreAe under SPECIAL PROVI$IO NS below E.L. DISEASE - POLICY LIMIT 11,000,00 0 OTTER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS To cover work performed by Grunau Company, Inc. in the City ofZephyrhills, Florida. CERTIFICATE HOLDER • CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Zephyrhills DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Building Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SMALL 5335 8th Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY HIND UPON THE INeUREE, ITS AGSNTS OR Gephvrhills, F7., 33542 AUTO Z E e T p �C ACORD 25 (2009/01) ®1968.2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD