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Home My WebLink About10-10549 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813) 780 -0020 10549 ANNUAL FIRE PROTECTION MAINTENANCE 3 — E M Y i Pad. . ?. g r e.E,i. 7 `, 7 , aas ;j Permit Number: 10549 Address: 38634 HWY 5 ° ;'�r'. Fy EAST 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: Improv. Cost: Awz E7' a ;_ 7 1 e w Date Issued: 6/17/2010 Name: FAITH BAPTIST CHURCH Total Fees: 25.00 Address: 38634 HWY 54 EAST Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542 Date Paid: 6/17/2010 Phone: Work Desc: FPM- FIRE ALARM ANNUNAL -FIRST BAPTIST CHURCH -BACK PERMT TA ALARM N - PERMI F 25.00 2 FIRE A P TAN 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 $100.00, whichever is greater. All work shall be performed in accordance with City Codes and Ordinances. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMNT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." erg 1i P IT OFFICER PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION CALL FOR INSPECTIONf - 8 HOUR NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813 - 780 -0041 813- 780-0020 City ofZephyrhills Fire (Q `f \ Fax- 813- 780 -0021 Permit Application ''(/tom, 1( Pt Date Received Phone Contact for Permit MEM QA 1 1S ' 6 Owner's Name I /- 4 4 I fY f f s f C h t), , Owner's Phone Number l d l3 I ) 7 0 Z I O S( I Owner's Address 1386 ` , 3 '1 ("}W� cc{ 6 Z-e13It9le k0 1$ / , 33SY 7 '" ( &c..E /)o lied ,e,-....‘ /1- c/aftd /lc) Fee Simple Titleholder Name Titleholder Phone Number I I I Fee Simple Titleholder Address I I Job Address I Lot # Sub Division Parcel # , ,, ,. arc,. . ._ , .. • Bio- Hazard Waste Storage - ANNUAL ( Hazardous Material (Tier II or RQ Facility) ANNUAL E Comm Exhaust Kitchen Hood /Duct n Hood Installation n Controlled Bum I] LP /Natural Gas - Installation Q Emergency Generator < 30 kw El LP /Natural Gas- ANNUAL Saie Emergency Generator > 30 kw 1 Places of Assembly- ANNUAL Fire Protection Maintenance - ANNUAL I� Recreational Burn ❑ ry 'Semi Other Sprinkler ❑ ❑ ❑ n Sparklers Fire Alarm M ❑ ❑ A I I n Sprinkler System Installations Hood Cleaning ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) Hood Suppression 0 ❑ ❑ ❑ I 0 Torch Roofing/Tar Kettle n Fire Alarm Installation 1] Waste Tire Storage ANNUAL 7 Fire Pumps 0 Fire Works 1] Flammable Application- ANNUAL f ( Valuation of Project Fuel Tanks Q Other: I Contractor Company) Signature Registered Y / N I Fee Current I Y / N I Address I 1 License # I ELECTRICIAN Company Signature Registered Y / N J Fee Current I Y / N I Address ( I License # I PLUMBER I Company I 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 1 Y/ N I Address I 1 License # OTHER / Company _ A ' k k Signature / 1/ ��1.-� Registered 2101Ill Fee Current ran Address �� /7 pR' i I �O i/`. 4 P L 335:8 License # G1� �' 1 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) 06/17/2010 14:57 7 r / = STATE ALARM PAGE 01/01 NESS TAX RECEIPT " I ill 10. , • , ]` i rrssi Y A 1ia4:0ck o <FtOhda Stgtutgs and rice: Conntij, Ofdviarice!s>; caii4•es'* ti iiir cs:Sv hi'',' , f -c�r aphi igottigr,18 [ 1iiS receipt riu,i b ptastAO 4onspic06.0f 'Wa ; i is 11.*'s 5xP7?*".Sei R::-' , s r , . h ,, : ' // , . r > e r / /,, !:,'•:' •r • ° -. .m, � ~ '� ✓ / , / (.. / / ' /-' kip �II ,!...'; ri ,n t x ) 4 5 , / .. / ' ( / 6 ' r J. 0a 4 : . AF B` i ,i,;:,71.,.. , t , l " ! `k „ -,r P t 1tT3''t i�bR 111111 ,, STATE :AJ A M'%r� �:. .r. 1 i 7 /: 1 ^ it r ;4ltTx' , o,_, � i °z'F4; !$$5 8r , 'S'; , * •,, °:' : ",,< :�:.': t ;#`'-,r ;. ';R.EGE.IP1 C .. T ' 4 yr G '� r ` -, r ' ' r ' y : ; C.�.,, ; „ror v ?aL ;,.:r) r ° /; " . 1 fii l 'ilit%if . i' Lifi.1 Ui I1rw11, r 2s14�.5:,. , � ` ` ;:% g • r •' 1 —, 7 T g L 0e7.Z n'l /A-te . • • 06/17/2010 14:31 7272261084 STATE ALARM PAGE 05/05 4 � ' STATE ALARM, INC. si,n v«„ , Corporate Offices: 5956 Market St, • Youngs own, OH 44512 In Also offices in: Cleveland, Dayton, Winte le, OH East Coast Office - Coral Springs, FL & West Centre/ ce - Lutz, FL 1- 888 -726 -8111 Customer Service • 1- 800 -321 -7400 Central Station • 330- 726 -8104 Fax FL CERTIFICATION LICENSE # EF20000780 OH F RE LICENSE #53 501007 June 16,2010 City of Zephyrhills (Florida) Building Department Re: Permit Agent Authorization Please be advised I, Brenda M. Dull, license # EF20000780 authorizle the following to act as my agent in obtaining permits from Zephyrhills Building Department. Paul Warren Scott Worton Karen Flores The authorization is to remain in effect, unless cancelled in writing, t4y the undersigned. 4.14 Le a__ C 7 2 277 - bt..,./ Contractor State of Florida, County of Pasco sworn to and subscribed before mle this 16 day of June, 2010 by Brenda M. Dull EF20000780. NOTAR PUBLIC Karen Flores Art yift,. KAREN FLORIO :Ai MY COMMISSION # D )969€03 i z_ X• /2 n ' � �� I •; �' EXPIRES March 09, 2014 My Commission expires: '7 (4O7 a 0163 FlandsNotary•etvicucem Personally known or Produced identification Type of identification produced: • 06/17/2010 14:31 7272261084 STATE ALARM PAGE 01/05 State Alaun Inc 17953 Hunting Row Circle B1dg.9Unit102 • • State \kin ii I11( • Lutz, F1ooda. 33558 • 'Phone: 313-926-9391 Fax: 813-926-9542 • lb: City of Zephyrhills Buidling Dept- Froth: Scott Wortnn • Fax: Pages: Phone: Date: 6/17/2010 Re: Pemuts CC: O Urgent g For Review ❑ Please Comment ❑ Please Reilly CI Please Recycle • • Comments: Hello, • Here is are the following documents your requested to update our info. Someone from the office will bring the $30.00 check that is required tomorrow. • i If anything else is need please let hie know. • 'hank you, Scott Worton Stale Alarm Inc. Confidential Business Communication i Created by Evan M. Soltoff 06/17/2010 14:31 7272261084 STATE ALARM PAGE 02/05 Ir. � '°; .\, : i C:i , ' Lwk'y'; 4x' S< ! ! D' A A E , C I? :' t-3 � . • - '' ,p er= `, iT0iNiSSS ;AM A ',SR2000.�9$ , ?; ":. ablia ' � 087 .1'12741 CE1 T y : ` C' PACT R 1 • STATE : itVgC • ' i9 1CSRTYFIim tandar rb psvvialona of h.489 re • 'Expiration date= AUG 31, 203.0 - L0810 300127 i 1 I t 1 1 I r 06/17/2010 14:31 7272261084 STATE ALARM PAGE 03/05 , ' DATE(INGODIYYY1) coR;s� CERTIFICATE OF LIABILITY INSURANCE SP IIDD�P 8 06/16/10 PR DOU THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Fedali Group ONLY AND CONFERS O RIGHTS UPON THE CERTIFICATE P. O. Box 318003 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 5005 Rockside Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Independence OH 44131 -8003 Phone:216- 328 -8080 Fax:216 -328 -8081 INSURERS AFFORDING COVERAGE NAIC# • rINSURED INSURER A; Zvera+t National Z.eosinea co_ INSURER D INSURER_ C: I State Alarm Inc 5956 Market St. INSURER 0: Youngstown OH 44512 -2991 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 CERTIOIICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE ROUGES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIEB, AGGREGATE LIMITS SMOVN'I MAY HAVE PEEN REDUCED BY PAID CLAIMS. HNLR • • , • TYPE OF POLICY NUMBER DATE • • DATE • • • I , UNITS LTR GENERAL UABIUTY I EACH OCCURRENCE S 1,000=1000 _ UAMAIah IUIr.NTtU s50 000 A X COMMERCIAL GENERALUARIUTI 51GL0 07/01/09 07/0./10 PREMISE8(Eoomuenc ) CLAIMS MADE C OCCUR 1 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY s 1,00o, 000 --^ i GENERAL AGGREGATE s 5, 000, 000 GEN L AGGREGATE UNIT APPLIES PEiL ! PRODUCTS- COMP/OP $ 5,000,000 POLICY JET . LOC AUTOMOBILE LIABILITY COMBINED SINOLE LIMIT s — ANY AUTO I (Ea accident) ALL OWNED AUTOS — BODILY INJURY s SCHEDLLEO AUTOS (Per person) — HIRED AUTOS BODILY INJVRY s (Per accident) NON -OWNED AUTOS _. .. PROPERTY DAMAGE s .._ (Pc' madam) • GARAGE UAWLITY AUTO ONLY - EA ACCIDENT $ R ANY AUTO OTHER THAN EA ACC $ AUTO ONLY. AGG 5 EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE a 2,000,000 A E OCCUR n CLAIMS MADE 51E0000542091 07/01/09 07/011/10 AGGREGATE s 2,000,000 � s — DEDUCTIBLE S RETENnON a 1 - S. WORKERS COMPENSATION I I TORY u TU- 1 AIdD EMPLOYERS' uAeIUTY A ANY PROPRIETORMARTNERIExECUTIV I " 5300001321101 05/27/10 05/27/11 EL. EACH ACCIDENT x1,000,000. OFF LJ r SPECIAL PROVISIONS Mow E.LDISEASE - EA EMPLOYEE $ 1,000.000 If yes describe Wider E.L. DISEASE- POLICY LIMIT $ 1,000,000 . • t OTHER . DESCRIPTION OP OPERATIONS 1 LOCATKINS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS ! 1 1 ( . CERTIFICATE HOLDER CANCELLATION S HOULD ANY OF THE A �DESCRIBED POUCHES BE CANCELLED BEFORE THE EXPIRATION • ZEPH -ZE DATE THEREOF. THE issuepe INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFIC4E HOLDER NAMED TO THE LEFT, BUT FAIW RE TO DO SO SWILL City of ZaphyrhiUs IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INS URER TTS AGENTS OR . Building Department LK- EPAIENTATREPRESENTATIVES. REPRESENTATIVES. L� 5335 8th 9t R E REPRE$ENTAL Zephyrhills FL 33542 ( ��/1� ACORD 26 (2009/01) / elect Zwa )gRD CORPORA. Ad ( rights reserved. The ACORD name and logo are registered marks of ACORD i 06/17/2010 14:31 7272261084 STATE ALARM PAGE 04/05 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) Must be endorsed. A statement on this certificate does not confer rights to the certificate holder in IieU of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions olf the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. • ACORD 26 (2009/01)