HomeMy WebLinkAbout10-11022 CITY OF ZEPHYRHILLS "
5335 - 8TH STREET 11022
(813) 780-0020
ANNUAL FIRE PROTECTION 'MAINTENANCE
° 7:,:,;fS.Z'ZVjfarSiiirifPrrll, 77'
" ` � - Address: 4330 20TH ST
Permit Number: 11022
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: N/A
Est. Value: Parcel Number: 13-26-21-0070-07400-0000
Improv. Cost: . A
Date Issued: 10/06/2010 Name: ZEPHYRHILLS CORP.
Total Fees: 25.00 Address: 777 W. PUTNAM AVE
Amount Paid: 25.00 GREENWICH, CT 068305091
Date Paid 10/06/2010 Phone:
Work Desc: FPM SUPPRESSION SEMI- ZEPHYRHILLS WATER
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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."
/i 11
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
530u
813-780-0020 City of.Zephyrhills Fire 0 /' b ZZ
Fax - 813-780 -0021
Permit Application
Date Received
P one Contact for Perm
�.:•,��a .. :.Y .: a.
Owner's Name Z Pi-ri hI-4( LL S (A ) pa r Owner's Phone Number ) I I
Owner's Address I
Fee Simple Titleholder Name Titleholder Phone Number l I
Fee Simple Titleholder Address
Job Address LI 3 3 0 D 7-11 S i R f ■ Pei `f R ("k I -k. ,s 1^ L _ 3 3 53' . Lot #
Sub Division Parcel #
Bio -Hazard Waste Storage - ANNUAL I I Fumigation Tent
n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
I Controlled Bum n Hood Installation
I - 1 Emergency Generator < 30 kw n LP /Natural Gas - Installation
I Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
iUtrlyI !Semi"' (ai Uther
Sprinkler ❑ ❑ ❑ 17 Recreational Bum
Fire Alarm n ❑ ❑ ❑ 1 1 Sparklers
Hood Cleaning 17 ❑ ❑ ❑ 1 I 1 Sprinkler System Installations
Hood Suppression I Standpipes (Sprinkler Sys)
FT Fire Alarm Installation n Torch Roofing/Tar Kettle ,
n Fire Pumps I I Waste Tire Storage ANNUAL
Fire Works
Flammable Application- ANNUAL ) •I Valuation of Project
Fuel Tanks
Other: I
Contractor
7/Y / - -- Company 54 f `( f fQ)h/ A/ Af Signature � S� t7 ✓S
Registered Y/ N _ Fee Current I Y / N N
Address I 1 License #
ELECTRICIAN
Company
Signature Registered Y/ N I Fee Current I Y/ N j
Address I I License*
PLUMBER Company
Signature Registered Y/-1\1 j Fee Current I Y/ N
Address 1 1 License #
MECHANICAL Company
Signature Registered Y/ N Fee Current I Y/ N j
Address License # I
OTHER Company
Signature Registered Y/ N Fee Current I Y/ N j
Address
License*
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 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com)
•
NOTICE OF 'DEED RESTRICTIONS: The undersigned understands that this permit may be 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 RESPONSIBILITIES: If the owner has - hired :a or
contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. 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 for 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 to 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 I, 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. I certify
that no work or installation has commenced prior to issuance of a permit and that 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 I
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 construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed 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 shall 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 OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT (F.S. 117.03)
OWNER OR AGENT CONTRACTOR
Subscribed -and sworn to (or affirmed) before me this Subscribed and sworn to (or affirmed) before me this
by . b y
Who is /are personally known to me or 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
2010 -2011 HILLSBOROUGH COUNTY BUSINESS TAX RECEIPT EXPIRES 9-30 -2011 FOLIO NO
FACILITIES OR MACHINES ROOMS SEATS EM PLOYEES
0 0 0 20 RENEWAL 179817.0000
• H. WASTE TAX
OCC. CODE BUSINESS TYPE SURCHARGE
280.065 FIRE EXTINGUISHER SERVICE /SAFETY INSPECTION /DATA PROCESSING 40.00 112.00
340.000 TRAINING I ; , y °q 40.00 30.00
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BUSINESS 3338 PORTER RD
LOCATION LITHIA 33547
NAME STC INC DBA SAFETY TRAINING & CONSULTING
MAILING PO BOX 5770
ADDRESS LAKELAND FL 33807 -5770
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BUSINESS TAX RECEIPT DOUG BELQEN, PAID - 7292 - 85
H13- 635 -5200 TAX COLLECTOR
HAS HEREBY PAID A PRIVILEGE TAX TO ENGAGE 07/16/2010 *** 182.00
IN BUSINESS, PROFESSION, OR OCCUPATION SPECIFIED HEREON. THIS BECOMES A TAX RECEIPT WHEN VALIDATED,
POLIO COUNTY LOCAL BUSINESS TAX RECEIPT
ACCOUNT Na 25447
et ASS: A EXPIRES: 9/30/2011
OWNER 'NAME
RICE, BENNtE R LOCATION.
2361 CHESTERFIELD CIR
BUSINESS NAME AND MAILING ADDRESS LAKELAND
CODE
S T C INC ; ACTIVITY TYPE
SAFETY TRAINING & CONSULTING 540000 LTD PROFESSIONAL TECHNICAL
v,,,,,-1...0 c
P O BOX 5770
LAKELAND, FL 3 3807 -5770 ,` ,
PROFESSIONAL LICENSE (IF APPLICABLE)
•
OFFICE OF JOE G. r / 'a /� * ��( /� * �KfiH COUNTY LOCAL F `DQER� { F{� T^it COLLECTOR TONSPOCUOSLY D SPLAYED AT THE BUSINESS TAX RECEIPT MUST BE
BUSINESS LOCATION
PAID- 4097531•0001 -0001 09/17/2010 09 f17/2010 PJN 412 3
SAFETY TRAINING AND CONSULTING