HomeMy WebLinkAbout10-10574 CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813) 780 -0020 10574
ANNUAL FIRE PROTECTION MAINTENANCE
$ 4
Permit Number: 10574 s . a ,>
tuber: Address: 7350 DAIRY RD w : 'x.••
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: 3 5 - 25 -21- 0010 - 06900 -0020
Improv. Cost:,7 .
Date Issued: 6/11/2010 Name: ADVENTIST HEALTH SYSTEM
Total Fees: 25.00 Address: 7050 GALL BLVD
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542
Date Paid: 6/11/2010 s Phone: (407)975 -3000
Work Desc: FP SPRINKLER QUARTEREY- ZEPHYRHILLS HEALTH REHAB
M' X - I AN L L' R - SIT 25.00
(C)`5f-
IR A E� A final . T.:
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 �. 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 -0020 City of Zephyrhills Fire. ( 0 y Fax - 813 - 780 -0021
Permit Application
Date Received
�s °° �_ - Phone Contact Permit
P tact for P
Owner's Name U • • : N ' , 4 . e u • . . Owner's Phone Number - 813 i I 626 115 4 8 2
Owner's Address 1 4701. Oak Fair Blvd TAMPA FL 33610
Fee Simple Titleholder Name 1 • E Titleholder Phone Number I 11 11
Fee Simple Titleho !der Address i
� .... �`?� -: - -4,...t, ` gi°. _ : °�..
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Job Address 7,r'5Q -°''�, �.'t +11 - - �r " hiy�1��is VI— 3 i )3Ltc Lot #
Sub Division I 1 Parcel #
t, -r.._ '- r ,s,. 1,;,, h ,._.ro .•
I I Bio- Hazard Waste Storage - ANNUAL Fumigation Tent
I 1 Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier If or RQ Facility) ANNUAL
I . f - Controlled Bum Hood installation
I ' Emergency Generator < 30 kw .
LP /Natural Gas-Installation
I. I Emergency Generator > 30 kw LP /Natural Gas - ANNUAL Sale
•
I" " I Fire Protection Maintenance - ANNUA ... _ - Places of Assembly- ANNUAL
•I Mr 'Smri jAnl ( Other
� J f
Sprinkler. ❑ ❑. • Recreational Bum
,' Fire Alarm f 1 ❑ ❑ ❑• 1 I 1 ' Sparklers
I 1=1 El I
Hood Cleaning p Sprinkler System lnstaflationJ
Hood Suppression o O ❑
Standpipes _I ( Sprinkl dprp r Sys)
F e
Fire Alarm Installation f " Torrfi Roofing/T ar Kettle
i l Fire Pumps __ . _ .
I • j • Waste Tire Storage ANNUAL -
I I " Fire Works
I Fue Tankls Application- ANNUAL
/ . f f Valuation of P roject •
: `
.... ... _
I • 1 " . Other:
•
Contractor / Company • (Hti
Signature A.:41...; r'^"`t C
/ �i Registered Y / N Fee Current • Y / N •
Address i
Li # • ELECTRICIAN Company _ s. Signature
Registered Y/ N I ,Fee Current I Y/ N I Y
Address
' 1 License # i 1
PLUMBER ,
Company
Signature ) - I Registered Y N '
g / Fee Current Y / N . '• ': •
Address I i License # , I • i
MECHANICAL l - i Company
Signature Registered 1 Y/ N j Fee Current I Y/ N
Address -
I- ' 1 License # I
OTHER I
I Company
Signature Registered Y/ N j Fee Current I Y/ N . J
Address
License #
Directions:
• - - Filf 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 (httpf /appraisecpascogov.com)
'NOTICE OF:DEED RESTRICTIONS: T he.undersigned underst at a perm s y-be su b} foro ' d e d T ti any
which may be more restrictive than County regulations. The un g
applicable deed restrictions.
UNLICENSED 'CONTRACTORS e AmD � b ON eg R A ed"to be � ce n s O ed s i lg ac i co dance with state and [ocal�egu[ations.
contractors-to n of li c en undertake work, they Y
contractor is not licensed as required by law, both the owner and contractor may be cited :a - misdemeanor violation what licensing Tequirements
upen s tate w r aw. I the advised d t intended o contact contractor
he Pasco County Building Inspection Division—Licensing S ction at 727 -847-
8 009; ed work, they are advised t
8009: Furthermore, if the owner has
ishaedli anon { for which- they be responsible. If you�as"the own as the sign portions of the 'contractor Block of th pp
contractor, that may be an indication that he is not properly licensed and is not entitled permitting privileges in Pasco
County.
CONSTRUCTION N -LIEN LAW (Chapter71 Florida Statutes,.as.amended): If valuation of work is $2, =500.00 or more, I
certify that [, the applicant, have been provided with a copy of the "Florida Construction Lien Law— Homeowner's
Protection ti by-the (ve Agriculture above described document and promise in good other than good fa th to
other than the e "owner", I certify t hat I have obtained a copy of the
deliver it to the "owner" prior to commencement.
C all work will b b e d on e in 'S compliance l:w l aws information egu[ this
nstructi zoning accurate
and land
that a!( wk will be done
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 and pCmit and-that .z on work wil la e ns, a land t o permed
meet standards of all laws regulating construction, County City codes,
• govet over nment a geg en cies ons in may ap pl Y to intended work, and thatat is my esponsibili y toeidentfy regulations
_ what actions 1
gnment gcies p
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 m
- to :co C Ut der."sta that a perm
parate . it, r ay_be required_for electrical work,
plumbing, signs, wells, pools, air conditioning,. gas, or other installations not specifically included in the application. A
permit
as i issued shah s ion be
technical s codes, nor shall issuance of of a permit prevent the Building Official from thereafter
set aside any Previsions the � codes. Every.pe..rmit.'issued.shatl becorCie invalid.
requiring a correction of errors in plans, construction or violations of any
unle by
ss the work authorized b y such permit is commenced within six months of issu in commenced. a uth or ized
by
the permit is suspended or abandoned for a period of six (6) months . (90) days and will demonstrate
may be re cause in extension. If work ceases period
ninety (90) consecutive day the job is considered abandoned.
justifiable cause for the ext -
..:WARNG T is F R IM P R O VE MEN LURE STO YOUR PROPERTY. r IF YOU INTEND TO OBTN N FINANCING,
PAYIN ONSU T -
G TWICE FO IMRVET T
WITH �YbUft LENDER OMAN ATTO' - 'BEFORE RECORDING YOUR NOTICE !' C!111. ENCE
FLORIDA JURAT (F S. 117.'
/ CONTRACTOR
CONTRA
O
� 70.
OWNER R AGENT Subscribed and om to or - 'armed) before me this
Sub §cribed and Swum .
ar _ i • ed) before me this by
by Who is /are personally known to me or has /have produced
as identification.
Who is/are ersonally known to me or has /have produced as identification
Notary Pubic
Notary Public
Commission No.
Commission No.
Name of Notary typed; printed or stamped
Name of Notary typed; printed or stamped -