HomeMy WebLinkAbout10-10930 CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813) 780 -0020 10930
ANNUAL FIRE PROTECTION MAINTENANCE
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Permit Number: 10930 Address: 7350 DAI RD
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: 35-25-21-0010-06900-0020
Improv. Cost: <.A , . 1
Date Issued: 9/15/2010 Name: ADVENTIST HEALTH SYSTEM
Total Fees: 25.00 Address: 7050 GALL BLVD
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542
Date Paid: 9/15/2010 Phone: (407)975 -3000
Work Desc: FPM - SPRINKLER QUARTERLY- ADVENTIST HEALTH
25.00
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- A - inal
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 Zephyrhiiis Fire, 4 107 50 Fax -313- 780 -0021
Permit Application
Date Received ,:-
eceiv d _ _ R y _..
_ _ _ _._-_ Kam: : rF:
Phone Con�acttorPerni
Owner's Name y 8 TMPT,FXGRT. NNFTJL Owner's Phone Number 813 626 5 4 8 2
Owner's Address 4701 Oak Fair Blvd TAMPA FL 33610 -
Fee Simple ,Titleholder Name ' Titleholder Phone Number
Fee SimpleTitfeholderAddress
_ z, .pr, 111 h r�l5
Job Address 733 �Ci K= ' Z011\401iIIS 3 1.- eci14-h (' Lot#
Sub Division Parcel #
sfrr- : - x: s,: .a . ::kc: e x .:-. _ w --.. _.. -°.,t. .: -_ ... . `. _ : "aca:.;, ' r ; :.•..,.a_:. _1( .'egge . -A.. :..:.:ac _s
1 Bio- Hazard Waste Storage - ANNUAL Fumigation Tent
Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier If or RQ Facility) ANNUAL
1 . I Controlled Bum Hood Installation
1 1 Emergency Generator < 30 kw LP /Natural Gas - Installation
1" 1 Emergency Generator> 30 -kw I LP /Natural Gas - ANNUAL Sale
1. - 1' Fire Protection Maintenance - ANNUAL I Places of Assembly- ANNUAL
"sal ISemi11AnII Other
Sprinkler, rrA i' ❑ ❑. I ( Recreational Bum
Fire Alarm I ❑ ❑ ❑- [ , I I Sparklers
• Hood Cleaning I 0 • ❑ ❑ 1 I Sprinkler System InstaflationS
Hood Suppression I ❑ ❑ 0 1 I I I Standpipes (Sprinkler Sys);
['•::.:* 1'r Fire Alarm Installation ofinglTa
Torch Ra r Kettle
1 • 1 Fire Pumps • 1 I . Waste Tire Storage ANNUAL
...- I Fire Works .
Flammable Application- ANNUAL 1 .1 Valuation of Project ,
I ''' Fuel Tanks
1 1 Other
: - _ :: Acti,:e,:,a,.'u; _2 we t" gm._` = • ".-- u"' r.W21 _" *^m _.4TECIM ` s' ., ..r: E = .,NAMIM
Contractor Company -• 4 '1 Ks.-ii,-- t
Signature / Registered Y / N Fee Current Y / N
Address I _ :. I- : ... L - . ' I
icense #
ELECTRICIAN - Company ,. - .
Signature _ Registered . Y / N I .Fee Current I . -� / N I :,
Address I 1 License # I
PLUMBER Company
Signature Registered Y / N ' I Fee Current• I Y / N I: •
- Address 1 • 1 License # , • . . 1
MECHANICAL • Company
Signature - . Registered Y / N Fee Current I Y / N
Address 1., .._. 1 License # I 1 - OTHER • - Company . -
Signature Registered Y / N I Fee Current Y / N - .
Address
. Lic � es ��:_.� � -_,... = ���:� -.. •�<_:�.: , -!�: -.ate.
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: /fappraiser.pascogov.com)
•
NOTICE OF :DEED RESTR[CTIONS: The undersigned understands -that this permit may subject'to "deed" :restrictions '
which may be more restrictive than County regulations. The_undersigned assumes responsibility for.compliance with any
_applicable deed restrictions.
UNLICENSED `CONTRACTORS AND - CONTRACTOR RESPONSIB[LITIES: If the owner has - hired - .a contractor or - -
contractors to undertake work, they may be required to be licensed in accordance with state and local if the
contractor is not licensed as required by law, both the owner and contractor may be cited for :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 Block" of this application which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled 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 1, the applicant, have been provided with a copy of the "Florida Construction Lien Law— Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the "owner ", i 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 I certify that all the information in this application is accurate and
that all work will be done in compliance with all applicable laws regulating construction, zoning and land
development. Application is hereby made to obtain a permit to do work and installation as indicated. .1 certify
that no work or installation has commenced prior to issuance of a perrnit and all 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 apply to the intended work, and that it is my responsibility to identify what actions 1
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 to commencing constructiori_..;_ understand_ that a separate permit y may berequired for electrical work
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be 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 . shaft become 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.
-. .WARNING 'TO, OWNER: 'YOUR FAILURE TO RECORD A NOTICE OF' COMMENCEMENT MAY': RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBI N FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTO" BEFORE RECORDING YOUR NOTICE e1 Ca ENCEMENT.
FLORIDA JURAT (F S _117.1.
OWNER OR AGENT CONTRACTOR 446( `
/
Subscribed and sworn • (or . r ed before me this Subscribed and om to or - 'rmed) before me this
oy 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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