HomeMy WebLinkAbout11-11456 CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813) 780 -0020 11456
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 11456 Address: 38233 DAUGHTERY 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 - 12300 -0000
Improv. Cost:
Date Issued: 1/28/2011 Name: ADVENTIST HEALTH SYSTEM
Total Fees: 25.00 Address: 7050 GALL BLVD
Amount Paid: 25.00 ZEPHYRHILL FL 33541
Date Paid: 1/28/2011 Phone: (813)783 -6189
Work Desc: FPM - QUARTERLY FIRE SPRINKLER FOR FLORIDA HOSPITAL
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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 $100.00, whichever is greater. All
work shall be performed in accordance with City Codes and Ordinances.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMNT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE
OF COMMENCEMENT."
Ir
P � IT OFFICER
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813- 780 -0041
313 =780 -0020 J! �� - ,j[-, City of Zephyrhills iF Fax- 313 -730 -0021
/aDJ� ��**��" Permit Application
- J Phone Contact for Permit
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Owner's Name S TM ?T,F;XGR T NNFT,L Owners Phone Number 813 626 `5 4 8 2
Owner's Address 4701. Oak Fair Blvd TAMPA FL 33610
•
Fee Simple Titleholder Name - - ' Titleholder Phone Number
Fee Simple Address .
F :,. -� <�.!" e M=� :-�. _ � ". _ A:A � , r: �r��- y...tir.- r,,.�_:�..."$ ... .__ ...:�_- ,'mss.... �,...._ �_S�.mi�..� _c�.. ��:L:.�s 5.
. .._� . ` S2?z3 Dal nl� I`Z � , � 3��IO y L sP , t INL�`J11
Job Address l 2 en yrh; ip L i:, ye, Lot #
Sub Division Parcel #
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Bio- Hazard Waste Storage - ANNUAL 1 Fumigation Tent
I Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier If or RQ Facility) ANNUAL •
• Controlled Bum Hood Installation
I ` Emergency Generator < 30 kw ! LP /Natural Gas - installation
_ Emergency Generator> 30 -kw LP /Natural Gas - ANNUAL Sale - - -Th
Fire Protection Maintenance - ANNUAL I Places of Assembly ANNUA .. /
� (ltrl I Semi l' Ant I Other c�
Sprinkler: El ❑. - I Recreational Bum CJ
Fire Alarm ❑ ❑ ❑• I- , I , I Sparklers
' Hood Cleaning b ' ❑ ❑ I I l Sprinkler System Install '
Hood Suppression - - ! ( 0 O _ , - O l 1 Standpipes (Sprinkler Sys);.
I ; ( Fire Alarm Iristallation - Torch Roofing/TarKettle`
I '' r ` Fire Pumps pi Waste Tire Storage ANNUAL • . I • Fire Works • ,
Flamrnabfe Application- ANNUAL I Valuation of Project • { Fuel Tanks
I L . Other:
Fa r. ^_ .^s_�,. - * .:'F m: �?• ?:L .- ";."4su:. - ,:o^,r.: -.c ='rg .,� . m'., -m5 '•g :t6Fj.. r `rdv�__"4: 3rM arirr.MS ^-. ":_"�` -irTZ = a . x "-:
Contractor Company 3 CYi"� K.R, -. -°t 1(
Signature Registered Y/ N Fee Current Y/ N I
Address I I. License # ..I I
ELECTRICIAN : ' •• . Company ,
Signature - - : Registered Y / N I Fee Current I -.. Y / N, I
Address I License # I
PLUMBER ... . Company '
Signature Registered Y / N j Fee Current- Y f N':' 1: • •
Address I . . . I License # ` I
MECHANICAL • Company
Signature . Registered Y / N j Fee Current Y / N -
. Address I.,,- ::.. . I License # I I
OTHER • Company • . .
Signature Registered Y / N , Fee Current I Y / N
Address License # - I
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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 app[icab(e documentation -. - 10 -44 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http:fiappraiser.pascogov.com)
`NOTICE OF -DEED RESTRICTIONS: [ he.undersigned understands that this permit maybe subject to "deed": etrictions'
which may be more restrictive than County regulations. - The _undersigned assumes responsibility for:compliance any I
.applicable deed restrictions.
t1NL[CENSED'CONTRACTORS AND - CONTRACTOR RESPONSIBILITIES: If the owner has - hired - :a contractor or -
contractors to undertake work, they may be required 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 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: Furthermbre, 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 will be responsible. If you, as 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.
CONSTRUCTIDN.LUEN 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 Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the !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 'SIOWNER'S AFF[DAViT:• 1 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 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 applyto the intended work, and that it is my responsibility to identify what actions 1
must take to be in compliance.
If (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. co rnrne T L r understand_ that aseparate permit may be requtred_ 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 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 [N ,YOUR - •
PAYING,TWICI; FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBT N FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTO BEFORE RECORDING YOUR NOTICE r . C0 :: ENCEMENT. •
FLORIDA' 40 . (F .S: `I '17_ ii. `
OWNER OR AGENT CONTRAC TOR / i- '
Subscribed and swam . (or . r• ed) before me this Subscribed and s om to, or !rated) before me this
by by
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