HomeMy WebLinkAbout10-10570 CITY OF ZEPHYRHILLS
5335 - 8TH STREET 10570
(813) 780-0020
ANNUAL FIRE - PROTECTION MAINTENANCE
Permit Number 10570 Address: 3820 HENRY DR
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: 02- 26 -21- 0000 - 00100 -0000
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Improv. Cost: ... , ;
Date Issued: 6/11/2010 ( Name: DISTRICT SCHOOL BOP COUNTY
Total Fees: 25.00 NO ek t r Address: 38203 HENRY DR
Amount Paid: 25.00 �` ZEPHYRHILLS, FL. 33542
Date Paid: 6/11/2010 - P hone: . �
Work Desc: FPM- FIR ALARM ANNUAL - WOODLAND ELEMENTARY 4)0
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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." derr
P ;T, 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
813780-e020 City of Zephyrhills`Fire.
ft/05 Fax - 813 -780 -0021
Permit Application
Date Received -# _ � -- ;max _ Contact for Permit j N
- Phone it
� �6 2 �,�.,.
j Owners Phone Number 813 626 5482
Owner's Name STMPLEXCRZNNELL 11/ IciAJ c..\ pfm,✓tk +ryl -
Owners Address 4701. Oak Fair Blvd TAMPA FL 33610 -
• Titleholder Phone Number
Fee Simple Name L Fee Simple Titleholder Address I - _ _ - _
_, - .
Job Address
1?7 K 0- D'a- . Z--(7,9v1 -16/ 1115 L "S35`42- Lot#
Sub Division Parcel #
1 1 Bio- Hazard Waste Storage - ANNUAL I Fumigation Tent
1 1 Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier II or RQ Facility) ANNUAL
Controlled Burn I Hood Installation
I l Emergency Generator < 30 kw LP /Natural Gas - Installation
1 1 Emergency Generator> 30 kw I LP /Natural Gas - ANNUAL Sale
Fire Protection Maintenance - ANNUAL Places of Assembly ANNUAL ..
_ lutrIyl'Semi' 'Anil '
Sprinkler. I I ❑ ❑ ❑.. ` f • 1 (- Recreational Burn
- Fire Alarm ❑ ❑ 6 , 1 1 I Sparklers . •
Hood Cleaning 1 1 ❑ ' ❑ ❑ I I 1 I Sprinkler' System InstaUatioris
Hood Suppression. 1 ❑ 0 0 Standpipes (Sprinkler Sys) .
finglTar Ke ettl -
(i Fire Alarm Installation pp r Torch Roo . -.. _ . -
Fire Pumps • • Waste Tire Storage ANNUAL .
1 ' Fire .
Fire Works UAL
I Valuation f Project
.. _ , � � Flammable Application- ANN / • ... .... -... , , , .. .. .
Fuel Tanks
I Other I
S ... ...,w. i.,.Lti'r L: �.�'.'.s+1tv,+",r'�:� "?a5..:v _'- �"r "d:�'£''"'aG'.xYi's�. _:�"�.r.�k'n- �c3�.:�.•:]� i - _t�'+'..X ,'e•. t;: :^e::. 1� 3':+35 .l,;w'h+._'_ 't-��^ - ,�k'tn ,:;s_k�? �.a�'ei'ti'FLK{'b:
Contractor Company c K1•^iv^"t- t-+(
Signature Yr`'/A � Registered Y/ NI I Fee Current I. Y/ N 1
Address I . . , . , . ::, -
License #
ELECTRt IA -
Signature :' ' : Registered . i Y / Nt I • Fee Current I Y / N:. I Y
Address 1 , . 1 License # . , . ' 1
PLUMBER . , Company ..
Signature - ' Registered L Y / NI I Fee Cun I Y / N'
Address' . I License* • I - 1
MECHANICAL Company
Signature Registered Y/ N I Fee Current 1 Y/ N I
- Address I, :;.: . .. - ( License # I (
OTHER - Company . •
Signature - Registered Y / N I Fee Current I Y / N • .I
Address 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 .(Mechanieal 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.J /appraiser.pascogov.com)
'NOTICE OF DEED "RESTRICTIONS: The undersigned understands that this permit may_be•subjectao "deed ":restrictions' -
which may be more restrictive than County regulations. The undersigned assumes responsibility for-:complianoe%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 focal regulations. if the
contractor is not licensed as required by law, both the owner and contractor may be cited :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 Biock" of this application which will be responsible. If you, as owner - sign as the
contractor, that may be an indication that he is not properly licensed and is not entitfed 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 ", 1 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: t certify that all the information in this application' is accurate and
that all work will be done in compliance with all applicable taws regulating construction, zoning and land
development. Application is hereby made to obtain a permit to do work and installation as indicated.. . certify
that no work or installation has commenced prior to issuance of a permit and alt 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 appl•to the intended work, and that it is my responsibility to identify what actions I
must take to be in compliance.
If 1 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 commcnCing- eonstructlon : understand_that a:s paratepjrmit,may required for electrical work
plumbing, signs, wells, pools, air conditioning,• gas, or other installations not specifically included in the application. A
permit issued shalt 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.beconle 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.
:WARNINGTO.OWNER: YOUR FAILURE TO RECORD A NOTICE` OF' COMMENCEMENT MAY` RESULT IN YOUR
PAYING: TWICE FORIMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBT N FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTO' 'BEFORE RECORDING YOUR NOTICE e' C% :- ENCEMENT.
FLORIDA JURAT (F S 117. • •
OWNER OR AGENT CONTRACTOR /..■ •
Subscribed and sworn • (or - • ed) before me this Subscribed and om to or .'imied) before me this
by. by
Who is /are personally known to me dr 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
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