HomeMy WebLinkAbout10-10628 CITY OFZEPHYRHILLS
5335 - 8TH STREET
(813) 780 -0020 10628
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 10628 - ..,•. � • T ,, s • ,
Address: 7446 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:
Improv.Cost: �7 4,:I� �� 7 e<
Date Issued: 6/21 /2010 � . .'
N SYBEA,INC.(ARBY'S)
Total Fees: 25.00 Address: 7446 GALL BLVD
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542
Date Paid: 6/21/2010 Phone:
Work Desc: FPM- HOOD CLEAN SEMI- ARBYS
FI' P-_ N I� F - - R I 25700
( (tta.e
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I A - A 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."
/� AOSZY
P � IT OFFICER
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - rE HOUR NOTICE REQUIRED -
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813- 780 -0041
COMMON POLICY DECLARATIONS
Ccft" y Insura C o m p a n 0 a °O4
POLICY UMBER
8720 Stony Point Parkway, Suite 300 y FA x8 0 y S6 1193y GL 3679 82 -1
Richmond, VA 23235 RENEWA OF
Underwritten By Colony Management Services, Inc. PDQ CO 82 -
PDQ CO �
91F
1. NAMED INSURED and MAILING ADDRESS: - PRODUCER: 09002
FIRE PREVENTION SYSTEMS - —•,,\ Amelia Underwriters, Inc.
DWIGHT R. TEATER, JR. DBA 'N 2384 Sadler Road
413 BROWARD TERRACE Fernandina Beach,
WINTER HAVEN FL 33884 FL 32034 3127
•
2. POLICY PERIOD: From 01 /08/ 010 to 01/08/2011 12:01 A.M. Standard Time at your M. ling Address above.
IN RETURN FOR THE PAYMEN OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF HIS POLICY, WE
AGREE WITH YOU TO PROVID \THE INSURANCE AS STATE() IN THIS POLICY.
3 . THIS POLICY CONSISTS OF THE' OLLOWING COVERAGE PATS FOR WHICH A PREMIUM IS I DICATED. THIS
PREMIUM MAY BE SUBJECT TO ADJUSTMENT.
COV'ERAGE PARTS PREMIUM
Commercial General Liability
Liquor Liability $ 1,174.00
Commercial Property $ OT COVERED
Commercial Crime $ OT COVERED
Commercial Inland Marine $ OT COVERED
Commercial Farm and Ranch $ OT COVERED
Owners And Contractors Protective $ OT COVERED
$ OT COVERED
Coverage for Certified Acts of Terrorism Rejected; Exclusion Attached. $ OT COVERED
(Per Policyholder Disclosure TRIA2002Notice attached.)
Florida Hurricane CAT Fund Assessment TOTAL $ 1,174.00
$ 13.34
POLICY FEE $ 35.00
INSPECTION FEE $ 125.00
FLSO FEE $ 1.33
FLSL TAX $ 66.70
$
$
$
$
Premium shown is payable at inception.
-rota olicy Premium: $ 1,415.37
4. FORMAPPLICABLE TO ALL COVERAGE PARTS:
See Schedule of Forms and Endorsements - 001
5. BUSINESS DESCRIPTION: KITCHEN HOOD & EXHAUST CLEANING
HIS INSURANCE IS ISSUED PURSUANT TO THE FLORIDA SURPLUS UNE. LAW. PERSONS INS RED BY SURPLUS
NE$ CARRIERS DO NOT HAVE THE PROTECTION OF THE FLORIDA INSURANCE GUARANTY ACT • THE EXTENT 0
NY RIGHT OF RECOVERY FOR THE OBLIGATION OF ANY INSOLVENT UNLICENSED INSURER.
Countersigned: 01/26/10
Date
By:
A uth rized Representative
X16550 (07/05) Copyright, copyrighted material of Insurance Services Once, Inc. with its permission.
Copyright, insurance Services Office, Inc., 1984
Insured
�, '. v /
.74,s j CI GENERAL LIABILITY COVERAGE PART DECLARATIONS
.� o 0 g, frerage Part consists of this Declarations Form, the Common Policy Conditions, the Commercial General Liability
r o ,,fiend the Endorsements indicated as applicable. (See "COMMON POLICY DECLARATIONS" for Items 1 and 2)
, LICY NO. GL 3679182
NAMED INSURED FIRE PREVENTION SYSTEMS
DWIGHT R. TEATER, JR. DBA
3. LIMITS OF INSURANCE
General Aggregate Limit (Other Than Products - Completed Operations) $ 2,000,000
Products Completed Operations Aggregate Limit $ INCLUDED
Personal & Advertising Injury Limit
$ 1,000,000
Each Occurrence Limit $1,000,000
Damage To Premises Rented To You Limit $ 100,000 Any One Premises
Medical Expense Limit $ 5,000
Any One Person
RETROACTIVE DATE (CG 00 02 only) - Coverage A of this insurance does not apply to "bodily injury" c r "property
damage" which occurs before the Retroactive Dae, if any, shown below.
Retroactive Date: NONE (Enter Date or "None" if no Retroactive Date applies.)
Location of All Premises You Own, Rent or Occupy (Same as Item 1 unless shown below):
CLASSIFICATION CODE NO. PREMIUM BASIS RATE PR / C ADVANCE PREMIU OTHER
JANITORIAL SERVICES 334 96816 P 16,700 64.29 1074
(P) PAYROLL 336 96816 INCLUDED
PRESSURE APII'NARATUS 334 96816 "IF ANY"
336 INCLUDED
I R41NG�P(BMW
EGA? LIMI '
ADDITIONAL INSURED (1) 100
4. FORMS / ENDORSEMENTS APPLICABLE: TOTAL PREMIUM
SEE SCHEDULE OF FORMS AND ENDORSEMENTS - FORM 0001 FOR THIS $ 1,174.00
COVERAGE PART I
5 J=ORM OF BUSINESS: n Individual ❑Joint Venture Partnershi ❑ Organization ❑ P g (Other than Partnership or Joirt Venture) ❑ Corporation
Audit riod: Annual unless otherwise stated:
DCJ6553 (07 -02) Includes Copyright material of Insurance Services Office, Inc. with its permission.
Copyright, Insurance Senrices Office, Inc., 1984
Insured
Harland Clarke
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