HomeMy WebLinkAbout11-11420 CITY OF ZEPHYRHILLS
• 5335 - 8TH STREET
(813) 780 -0020 11420
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 11420 Address: 5435 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: 11- 26 -21- 0010 - 09900 -0010
Improv. Cost:
Date Issued: 1/20/2011 Name: SUNTRUST BANK
Total Fees: 25.00 Address: 5435 GALL BLVD
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542
Date Paid: 1/20/2011 Phone:
Work Desc: FPM- FIRE ALARM ANNUAL- SUNTRUST BANK
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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."
5_10
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 4 1 73
W
City of Zephyrhills Fire �� Fax- 813 - 780 -0021
Permit Application
Date Received } Phone Contact for Permit 13,S ? 166k I ffi
Owner's Name J 4-41 I l ■S r 0 ck 4 (L_ Owner's Phone Number 1 ,?..""15. '112 I
/ ( iiv I
Owner's Address yj S ry 1 d '
Fee Simple Titleholder Name •.. /4-- Titleholder Phone Number I I
Fee Simple Titleholder Address I /-) 1 /i"
Job Address S — Y. i. c // J /U
/ v Lot #
Sub Division ei 'TX C l 2q4/ ,
" �.5 � Parcel # ( // -x( -? r 00i o - 070 0 — Oa/ 0 I
� (OBTAINED FROM PROPER rY TAX NOT ICE)
I I Bio- Hazard Waste Storage - ANNUAL I 1 Fumigation Tent
I I Comin Exhaust Kitchen Hood /Duct Hazardous Material (Tier II or RQ Facility) ANNUAL
n Controlled Burn I I Hood Installation
I J Emergency Generator < 30 kw I I LP /Natural Gas - Installation
Emergency Generator > 30 kw LP /Natural Gas - ANNUAL Sale
II
Fire Protection Maintenance - ANNUAL I I Places of Assembly - ANNUAL
Sprinkler I Recreational Burn
Fire Alarm �I / Sparklers
Hood Clean /Suppression '`� Sprinkler System Installations
I Fire Alarm Installation 1 I Standpipes (Sprinkler Sys)
I Fire Pumps I I Torch Roofing
I Fire Works I I Waste Tire Storage ANNUAL
Flammable Application- ANNUAL
Fuel Tanks I I Valuation of Project
I Other:
Contractor L _ Company G j! (/ S /1 / air -t C.-
Signature Registered ram Fee Current
Address 3/ ( Cr S i r ;i7y WPM �� \Gei � � �/ /����� License# I FC,tyc� ��CiQ
ELECTRICIAN Company
Signature Registered Y / N I Fee Current I Y / N I
Address I
License #
PLUMBER Company J
Signature Registered Y/ N I Fee Current I Y/ N I
Address License #
MECHANICAL Company
Signature Registered Y / N I Fee Current I Y/ N I
Address I
License #
OTHER Company
Signature Registered Y/ N I Fee Current 1 Y / N I
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_
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 contractor 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 (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, 1
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
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 NOTIC OF COMMENCEMENT
FLORIDA JURAT (F.S. 117.03)
OWNER OR AGENT _ CONTRACTOR
Subscribed and sworn to (or affirm, ;i) before me this ubbscrribed and swo to or affirmed) before m 's .C40 C
by— l b • t • ilk _ •_I_ • IV
Who is /are personally known to me or has /have produced 110 is /are perso Ily know is me or has/have produced
as identification, as identification.
_Notary Public .401 L!J IL.; % ' A - Notary Public
Commission No Commission No. b� - 1
Va
Name of Notary typed, printed or stamired en L� bVr✓
Name of Notary typed, printed or stamped
roar;! • N, KAREN LEA
* MY COMMISSION, DD 971677
EXPIRES: April 15, 2014
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FrOm:Michele Mason FaxID:Sihle Insurance Grou Date:1 /20/2011 09:12 AM Page: 2 of 2
ACORO "" OP ID: MM
4.,......---- CERTIFICATE OF LIABILITY INSURANCE I DATE(MMIDONYYY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER 407-869 -0962 CONTACT
NAME:
SIHLE INSURANCE GROUP, INC. 407 - 774 -0936 PHONE f pax
P. O. BOX 160398 (A/C. No. Exag (A/C, No):
ALTAMONTE SPRINGS, FL 32716 ADIAIL
ADDRESS:
PROD - _ -
PRODUCER
CUSTOMER ID*: LINUS-1
INSURED Li INSURER(S) AFFORDING COVERAGE NAIC :F
Lin us Alarm Corporation INSURER A : Sentinel Insurance Company
P. O. Box 5159 R B P _ — Y 11000
INSURE Hartf Casualty _._ — - - --
Spring Hill, FL 34611 ty 299424
INSURER C : echnology Insurance Company - - -
INSURER D: --- -- I - -- - -- ---- - --
INSURER E :
COVERAGES CERTIFICATE NUMBER: INSURER F
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED N D ABOV OR 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,
INSR EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ADDL 3UBR
LTR TYPE OF INSURANCE POLICY EFF POLICY EXP ' -- -- _-- - _- --- -- --
SR I MD POLICY NUMBER (MMfDDNYYY) (MMfDD/YYYY) LIMITS
GENERAL LIABILITY I
EACH OCCUPRENE $ 1,000,000
B X COMMr1 :IA 11 - PAL uABI1 IrY 21 UENQD6681 07/14/10 07114/11 r g A , �TF') r TED
PHEMI F�Fac cueice) $ 300,000
I/` IM9 MADE 1X1 - -
U7.IR
MED EXP (Any one pars, - o) $ 10,000
PER ICINAL 8 ADV INJURY $ 1,000,000
CEFER $ 2,000,000
GL N'I A(CIFGAI F I. IMII APPL EC PLR - -- - - -.
F R,� _ l pi; r.Ll ICI ..
X POLICY ,IF-I-1 _coMFOrA�.,r_ $ 2,000,000
AUTOMOBILE LIABILITY
COMBINED SING! E LIMIT
(Fa accident) $ 500,000
A X ANY AU it 21 UENQD6681 07/14/10 07/14/11
ALL OWN ED AUTOo BODIL'I INJJEI' per )
SCHEDULED AUTOo F ^DIE f Rd.A1R. __-
Y (R r a iLELT) $
HIRED AU D) S 1'ROF ER r Y DAMA_ E
' (Per a , ItlFnt)
NON OMINFUAUTO
$
UMBRELLA LIAB $
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EXCESS LIAB I j EACH CICCJI ?HENCE
ROOD _ II
AIM: - tv1.4DF __.. __ -.
CELL I�' H _. Af.C.,PEGATF $
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1 .1LFLNT I $ ' _ $
WORKERS COMPENSATION r.
C A LIABILITY
ERIE. <EC'Ji�,yc TWC3230922 03/0
Y/N X �T iPi 1 11 I I'_'l11
1 /10 03/01/11 F
ii (Mandatory tER FXCL IDFG%
(M N/A L L FP t AC (-ADEN T 100,000
andatry in NH) - -
Iv_. desc IPTI Le unae F I EI FA; E FA FMPL 0YFF x 100,000
T F C N OE e ; PFPATIONS holovr
E o1 EA_:E POLCYLIMIT $ 500,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VENCLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
CERTIFICATE HOLDER CANCELLATION
ZEPHYRH
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Zephyrhills THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Fax: 813 788 3293 ACCORDANCE WITH THE POLICY PROVISIONS.
5335 8th Street
Zephyrhills, FL 33540-4312 AUTHORIZED REPRESENTATIVE
2
ACORD 25 (2009/09) The ACORD name and logo are registered mar sof D CORPORATION. All rights reserved.
ACORD