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HomeMy WebLinkAbout10-11078 CITY OF.ZEPHYRHILLS 5335 - 8TH STREET • (813) 780 -0020 11 078 ANNUAL FIRE PROTECTION MAINTENANCE Permit Number: 11078 Address: 7422 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: 35- 25 -21- 0010 - 07200 -0011 Improv. Cost: „ �t gq Date Issued: 10/25/2010 Name: K -MART Total Fees: 25.00 Address: 7422 GALL BLVD Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542 Date Paid: 10/25/2010 Phone: Work Desc: FPM- SEMI SUPPRESSION- KMART -OWE $25.00 FOR CONTRACTOR AL A I I - C ,( A - anal 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." Stria Ar. 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 813-780 -0020. City of Zephyrhills Fire Fax- 813- 780 -0021 Permit Application Date Received Phone Contact for Permit l Owner's Name 1 K i ttx 1 # 3% 1 I Owner's Phone Number I 1 1 Owner's Address Fee Simple Titleholder Name I Titleholder Phone Number I Fee Simple Titleholder Address I .4 i 1� ads 6 v ( Pc. 33Sw Lot# Job Address � K�1� � Q �������`� 1 Sub Division I Parcel # n Bio- Hazard Waste Storage - ANNUAL [1 Fumigation Tent n m Comm Exhaust Kitchen Hood /Duct (] Hazardous Material (Tier II or RQ Facility) ANNUAL El Controlled Burn In Hood Installation F - 7 Emergency Generator < 30 kw n LP /Natural Gas - Installation n Emergency Generator> 30 kw In LP /Natural Gas - ANNUAL Sale n Fire Protection Maintenance - ANNUAL nI Places of Assembly- ANNUAL IQtriy l (Semi I 'Anil Other Sprinkler ❑ ❑ ❑ n Recreational Burn Fire Alarm n ❑ ❑ ❑ I 1 n Sparklers Hood Cleaning n ❑ - ❑ I I n Sprinkler System Installations / Hood Suppression ❑ �" ❑ I 1 n Standpipes (Sprinkler Sys) n Fire Alarm Installation In Torch Roofing/Tar Kettle E Fire Pumps In Waste Tire Storage ANNUAL n Fire Works n Flammable Application - ANNUAL I I Valuation of Project 0 Fuel Tanks El Other: I I Contractor ,4J /,suit F, r r e 4 cA Company I Signature f- Registered Y / N 1 Fee Current I Y/ N I Address 500 PAS, 64 1/61 e Jew t ce k'�- a-gS I License # ( I , ELECTRICIAN Company I Signature Registered Y/ N I Fee Current I Y / N I Address I License # I PLUMBER Company I Signature Registered Y / N I Fee Current I Y/ N I Address I I License # ( I MECHANICAL Company I Signature Registered Y/ N I Fee Current I Y / N 1 Address I I License # ( I OTHER Company I Signature Registered Y / N I Fee Current I Y/ N 1 Address I I 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 (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: / /appraiser.pascogov.com) STATE OF FLORIDA *r> DEPARTMENT OF FINANCIAL SERVICES fi i {t DIVISION OF STATE FIRE MARSHAL n TALLAHASSEE, FLORIDA FIRE EQUIPMENT DEALER LICENSE THIS CERTIFIES THAT: ALLIANCE FIRE & SAFETY, INC DBA/ALLIANCE FIRE & SAFETY 500 BASE AVENUE EAST VENICE, FL 34285 - QUALIFIER: MICHAEL R WILLIS SR. HAS COMPLIED WITH FLORIDA STATUTES AND HAS QUALIFIED FOR THE TYPE AND CLASS SHOWN HEREON TO SERVICE, REPAIR, INSTALL OR INSPECT ALL TYPES OF PRE - ENGINEERED FIRE EXTINGUISHING SYSTEMS a jj?"4 Chief Financial Officer 01 101 12010 07 04 Sarasota 48254100012004 1755730001 12131!2011 Issue Date Type Class County License/Permit Number Application # Expire Date • • • • Building Department 5385 8thy Street Zephyrhills, FL 33542 813 - 780 -0020 - option 2 Alternate contact: Kerry Barnett, Fire Marshall 813 - 780 -0078 kbarnett@fire. zephyurhills. fl.us 1. Up to Date: Certificate of Liability 2. City of Venice, Business Tax Receipt 3. State License holder, current ( Mike Willis, Qualifier) 4. $30.00 Registration Fee, current permit. A LI CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 04/26/10 PRODUCER 1- 727 - 797 -4190 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher Risk Management services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2600 McCormick Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 300 Clearwater, FL 33759 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Zurich American Ins Co 16535 A -1 Contract Staffing Group INSURER 8: 3829 Coconut Palm Dr. INSURER C: Tampa, FL 33619 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LIMITS _• . • POLICY NUMBER 11 ,, ,, •I 4 1 , c ■A 1/P•1��� GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ CLAIMS MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ — 7 POLICY PRO- LOC JFCT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION WC343478607 01 /01 /10 01 /01 /11 X TOSTATU- LIMITS X O ER AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE N N E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Alliance Fire & Safety Inc dba Alliance Fire & Safety is an alternate employer. Coverage is for contracted employees of A -1 Contract Staffing not subcontracted labor. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Zephyrhills DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 5335 8th Street REPRESENTATIVES. � Zephyrhills, FL 33542 AUTHORIZED REPRESENTATIVE USA ACORD 25 (2009/01) betraik © 1988 -2009 ACORD CORPORATION. All rights reserved. 15398522 The ACORD name and logo are registered marks of ACORD • ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/19/2010 PRODUCER D080720 1 -407- 332 -0033 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Insurance Solutions of America, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 910 Belle Avenue, Suite 1140 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Winter Springs, FL 32708 Scott E. Lugering INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Everest Indemnity Insurance Company Alliance Fire & Safety, Inc. Alliance Protective Systems Inc., dba Alliance Fire & Safety INSURER B: Saf Co P.O. Box 637 INSURER C: Venice, FL 34284 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY 51GL002413 - 101 04/27/10 04/27/11 EACHOCCURRENCE $1,000,000 DAMAGE X COMMERCIAL GENERAL LIABILITY PREMISES a $ 50,000 CLAIMS MADE X OCCUR MED EXP (Any one person) _ $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE _ $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PRO - PRO- LOC B AUTOMOBILE LIABILITY 01CI35908110 04/27/10 04/27/11 COMBINED SINGLE LIMIT $1,000,000 ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY X NON -OWNED AUTOS (Per accident) $ X Comp Ded $1000 PROPERTY DAMAGE X Coll Ded $1000 (Per accident) GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS' LIABILITY TORYIIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Zephyrhills DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 5385 8th Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Zephyrhills, FL 33542 AUTHORIZEDREPRESENTATWE y � t J USA t ON k u ACORD 25 (2001/08) cleopoldl © ACORD CORPORATION 1988 17945204 , r ~� CITY OF VENICE -' 401 W. Venice Ave. IJ 1 Venice, FL 34285 :1 LOCAL BUSINESS TAX RECEIPT ;• 1r BUSINESS NAME: MIKE FIRE & SAFETY " ,;;,--' .. ` ` , ti BUSINESS LOCATION: 500 E BASE AV Y 1 ', BUSINESS OWNER: ` . . a` . . LOCAL BUSINESS TAX RECEIPT ` I NUMBER: 0005222 /11-00018682 o 1 , -".1 EXPIRES: MIKE'S FIRE & SAFETY . 1 4 ' fi 4 September 30, 2011 (ALLIANCE FIRE & SAFETY) ; • ' P.O. BOX 208 . Y " j O lts..z. : (...... VENICE FL 34284 •. I : .1 ''' . ;. f"':::,.:1 . 1: . BUSINESS CLASS: MERCHANTS, RETAIL AND W •. ' , F' ' CITY CLERK JEUMBEIROSIEEMINDUCONSRICUOUSIREA€ _ - 4 1-: ,.. 4 ..C ; _