HomeMy WebLinkAbout10-10890 CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813) 780 -0020 10890
ANNUAL FIRE PROTECTION MAINTENANCE
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Permit Number: 10890 Address: 6701 DAIRY RD
Permit Type: FIRE PROTECTION MAINTENANC ZEPHYRHILLS, FL.
Class of Work: FIRE - PROTECTION MAINTENAN.E Township: Range: Book:
Proposed Use: COMMERCIAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 02 26 - 0010 - 03900 - 0060
Improv. Cost: ; 7,.
Date Issued: 9/03/2010 Name: FLORIDA S ENIOR PROPERTI
Total Fees: 25.00 Address: 6701 DAIRY RD
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542
Date Paid: 9/03/2010 Phone:
Work Desc: FPM- SUPPRESSION SEMI- WESTBROOKE MANOR
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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 $100.00, whichever is greater. All
work shall be performed in accordance with City Codes and Ordinances.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMNT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE
OF COMMENCEMENT."
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P �• IT OFFICER
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813- 780 -0041
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813.7840020 City 01 ZAphyrhills fir.Ohltrztt Fax -013 - 7840021
Permit Application
Date Received Fhons C« for Permit 1 (I I I J
co.n.rs .. - i r - ref -, ��sen,r/�:� . Number l I 1
ownera /lddress ,, 11,Ai:t T�1.ZT`!ri�Wi:F
Fee Simple 'Titleholder Name Titleholder Phone • I 1 1 I
Fee Sk1;dre11tl,hold$IMdrss
Job Address J / _ -___ -- IIEIIE
Sub Division Parcel #
Q Rio-Hazard Waste Storage - ANNUAL a Fumigation Tent •
El Ccm m Exhaust Kitchen HoodlDuct = Hmr Materiel (Tier ilex RO Facer) ANNUAL
0 Controlled Bum = Hood installation
Emergency Generator < 30 kw LPMaGral Gss = ti on
Emergency Generator> 30 kw LpMatural Gee^/ ftWLL Sale
Re Proleellorr Makrlerrence - ANNUAL a Places or Assembly ANNUAL
i — n IMEI ES EM V. B Sp/bider Li O O O _ Recreatlonn Burn
Fete Ahern 0 O 0 _ Seedier*
Hood Clearing O O 0 SpNrlder8yMem Installations
Hood Suppression 0 e 0 � Sri)
Fire nn InstMatlan El _ Torch Rooting/far Kettle
Fire pumps -
- - Waste lire Storage ANNUAL •
Are Woks
Remittable - 1 Valuation of Project
• - Fuel Tanks
® e
Contractor �y V - :—V4ar it-A1C �`1_�' .I� =A°��,
ssignature � A �i lin rT ,... w [ __.. ed 11 KOWA
Address I f� ;l ,1 &F ®.� ,:- : ° °• �:: z ri^`� ®.. Mom* : "# ,.rofi.r, s a ;
ELE - r Company
Signature Registered Y/ N Fee c unurd ( Y/ N 1
Address I License # 1 I
PLUMBER s . Company (
Signature Registered I Y/ N) Fes anent 1 Y/ N 1
Address I license I I
MECHANICA1 Company
Reglelered I Y/ N 1 Fee CUMIN 1 Y/ N I 1
Address 1 License iT I
OTHER
. Company
Signature I ( Reglelsred I Y / N• I Fee G u mi 1 Y /N 1 I
Address 1 1 U ens .. 1
ok Ctlons: _
f�MoutappMoatian
Omer *i Conbador tiraIRO40 On, Or - el signed =Wad Wei owner)
if over $3000 a Notice , , work over $5000)
Supply two Moots at p
AM -,
OW 10.14 days for a stdatif al,dde ' ' , 4 Parcel * - obtained from Property Tax Notice (httpdhppralser.Wscogov )
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'NOTICE OF:DEEDRESTRICTIO `understands-.that this permit may.beautd oodesld". modrtdio`he°
which may be ,more • restrictive thanl'Ooutripregutations. The:undersigned assumes responsibility pjiAprnptiaaee 'with any .
.applicable deed restrictions.
• 'UNLICENSED cO CTORS ►°ND7 CTOR :RESPONSIBILITIBS: tf - the owner - harchkxs a ,ntnactor or •
contractors to undertake work, they may be required to be licensed In accordance with state and .local iegulatlons. If the
contractor Is not licensed as required oby law, both the owner and contractor may be cited for a - misdemeanor violation
under - state law.. if the owner or Intended contractor are uncertain .ea 10 what licensing -requirements may apply for the
intended work, they ere advised to contact the Pasco County Building Inspec tIon •D ng SeCtion.at 727 -847-
8009. Fug, tf the owner has *hired :a contractor or • contractors, he Is advised to .have the .contractor(s) sign
portions ns of lice► `for Block" of this application ler which 'they will be responsible. If you, as - the owner *lgn as the
contra tor, that may be an indication that' he Is not property licensed is - not enttlletto'petmitting Iry In Pasco
County. •
• CONSTRUCTION .UEN LAW (Chapter713, Florida Statutee ed): If valuation of work Is $2,`500.00 or more, l
cify'ahat I the applicant, have been provided with a copy of the 'Florida Construction Lien Law
b the 'Merida Deponent of ire and Constirner Mess. I f thee! appliF�t.1* •son .
Protection Guide' prepared y'
other than the owner, I certify that I have obtained a copy of the above described document and promise In goodlafth to
deliver It to the 'ow.ner' prior to commencement.
.CONTRACTOR'S/OWNER'S DAVIT: 1 certify that all the information in this application Is accurate and
that all work will be done in compliance wkh 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 permft andthat all work will be performed to
meet standards of all laws reguing construction, County and City codes, :zoning. regulations, end land
development regulations in the jurisdiction. I also certify that I understand that the regulation* of other
. government agendas may appty to the. Intended work,, and that It Is my responsibility to Identikwhat actions I
must take•to be in compliance.
If I am the AGENT FORTHE OWNER, t promise in good faith to inform the owner of the permitting conditions set forth In
this affidavk prior to commencing construction. I understand that a separate permit may be reqairedler electrical work,
plumbing, signs, wells, pools, air condoning, gas, or other installations not specifically included in-the°apptkxtion. A
permit issued shall be construed to be a doers to proceed with the work and not as authority to violate, cancel; . Fetter, or
set aside any provisions of the technical codes, nor shall is*uanoe of a permit prevent the Building OrncI d from thereafter
requiring a correction of errors in plans, construction or violation of any codes. Every permk Issued Full become invalid
unless the work authortzed by such permit Is Commenced within sbc months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of ski (8) months after the time the work is commenced. An extension
maybe requested, In writing, from the Building Official for a period not to exceed ninety (90).,days will demonstrate
.meraeatr the-extension. If work ceases°for ninety aaos ve days, the .job. is considered abandoned.
WARNING TO
NT MAY RESULT IN 'YOUR
Olflt: ` lf0'liR *LURE TO RECORD A tIOTI I�i4��
PAYIN CONSULT
3 10 YOUR � ' , ��
9 ' �1,. .. ` ',
tttil pr 11 .43)
E in4tire
C oltrtorEttr r ;.:: mitts . �
ItY
v+RiO i /w OWlettilly kfwwn to me or hosittiOto oroduood - ...:.+ as identifies
as
Notary Public _ „SI:' – ® ./ Notary Pubic
commisokink n =NO.• Commh. No.
.. or stamped
IoM of riEit , paid` or **MOW
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Nsme of Nc, t
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COe r88IOr
MY` lt> s
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iikiiii6iiii4 VQkii 1109 Ponce De Leon Blvd.
Brooksville, FL 34601
AND SAFETY EQUIPMENT CO., INC. (352) 796 - 4433
SYSTEM SERVICE REPORT: NEW ❑ ANNUAL ❑ SEMI- VRECHARGE ❑
E • ` , agar / Owner & Phone Store No
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q.. -ss ,410 .r rr AI
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P' - _ _ , oc � , j �+ . err f �- ' fg. i Alf f! . A
L. - -I Authority to be filed with Fu= r ' ■ ❑ Elecir ic Shunt -Trip
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1 *Contactor Gas: r, ec . ❑ Elect.
System Diagram
Initials
Customer received the informational letter addressing NFPA -96 and operational instructions = ' Y-...---"-2
Customer given the UL -300 letter if applicable
. ...- l
1. Appliances correctly protected ke"....- 20. Test from terminal link •
2. Correct duct/plenum nozzles 1.- 21. Test operation from remote pull L" --
3. Check position of all nozzles L.--- 22. Test operation of micro switch
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4. Correct pipe,size /limitations /...- 2 Test operation of gas valve
5. Penetrations sealed, GT N'' 4. Proper nozzle covers /caps 1�
6. Pipe & conduit secure 25. Clean nozzles
7. Separation fryers to flame 16" 2 All filters replaced _____1 ,,,r
8. Separation -flame to filters L . •. 27 Fuel shut-oft in on position ", ^^
9. Inspect cylinder and mount j.. 28. Replace system cover(s) L---
10. Clean cylinder and mount "- 29. Exhaust fan operational 1------
11. Evidence of tampering V 30. Manual and remote set f--
12. Has system been discharged 31. Tamper seals installed
13. Clear piping �""' 32. Slave system operational
4 Pressure gauge within range w >< 33. System operational
5. Cartridge weight: «�li. 34. Personnel briefed on system y'"
16. Hydrostatic test due date .,,/�'` 35. Proper portable extinguishers
17. Six -year maintenance due date 2 36. Extinguishers serviced
18. Check fusible links /• --'''" 37. Fan warning sign on hood 022
19. Replace below links dated: 38. Installed per 4A21.303
1 39. Safety pin inserted /removed /mfg. Specs. -
165 280 360 450 ,, 500 40. Meets manufacturer's specifications ,�
,� . , J / . C ■ mnlies w " .33 01 ; .-^
,...• •mu�en . /U• c -.- ci -s: __. /�" �,,'' J' 1
Atf24" .,�7!'' Iw 0 2 I VA . /�� . /Il lAiNfiter.�r! AZeff,�'�r fii .
, ` J�' J lJ''l/ WarAlli r.;G ? dr ral/FPi i!r �/. i
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Pyro Chem Ansul Amerex Kidde Range Guard Safety First FSI
1. pin removed 1, link lever set 1. pin removed 1. pin removed 1. reconnect head 1. reconnect union 1. pin removed
2 cartridge inserted 2. cartridge replaced 2. cartridge replaced 2. cover replaced 2. pin removed 2. link lever cocked 2. cover replaced
3 copper tube tightened 3. cover installed 3. cover installed 3. Peer tube tightened 3. pins removed 3. m- switch reset
I$I,4 '94 Pt/ /j, L__
Technician Permit Number Da a ' ' Time customer'S�7Aufliorized Agent 1'
Copies To: Customer, Distributor, Fire Marshall, if applicable. ., ' .----`