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HomeMy WebLinkAbout11-11486 CITY OF ZEPHYRHILLS ✓ 5335 - 8TH STREET (si3) �so-oozo 11486 � ANNUAL FIRE PROTECTION MAINTENANCE Permit Number: 11486 Address: 37908 DAUGHTERY RD Permit Type: FIRE PROTECTION MAINTENANC ZEPHYRHILLS, FL. Class of Work: FIRE-PROTECTION MAINTENAN E Township: Range: Book: Proposed Use: MEDICAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 03-26-21-0010-00100-002A Improv. Cost: Date Issued: 2/07/2011 Name: DAUGHTERY ROAD PROFESSIONAL CN R Total Fees: 25.00 Address: 6719 GALL BLVD STE 106 Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542 Date Paid: 2/07/2011 Phone: (813 973-2657 Work Desc: FPM-FIRE ALARM ANNUAL- FLORIDA GASTROENTERLOLGY r� , .� � ` ,- \` n �l� G ina 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 wsts 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." a.. 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 .� J I`1 � � Fax-813-780-0021 Permit Application Date Received s '� Phone Contact for Pertnit ���_i� k C� �v Owner's Name � C �/JfiP C7�0 � Owners Phone Number Owner's Address �f � ' f�{ e �� Fee Simple Titleholder Name TiUeholder Phone Number C� �� Fee Simple Titleholder Address , •:�Y °:..�x���:.<;s��.�:�����a.�. ..� .�.. -��':.r�a a.�'�m . , y . Job Address t � � � Lot # Sub Division Paroel # -� � � . .m� . ,. , at.e:��^:c'� ._ � . . .. . >o. . . ...:�:� .... „ q . . . ._.t,. .. . .,.. r., ,.� � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL � Controlled Bum � Hood Installation � Emergency Generator < 30 kw � LP/Natural Gas-Installation a Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL � emi � er Sprinkler � ❑ ❑ ❑ � � Recreational Bum Fire Alarm � ❑ ❑ p � � Sparklers Hood Cleaning � O ❑ ❑� � Sprinkler System Installations Hood Suppression � ❑ ❑ O� � Standpipes (Sprinkler Sys) a Fire Alarm Installation � Toroh RoofinglTar Kettle � Fire Pumps � Waste Tire Storage ANNUAL Fire Works Flammable Application-ANNUAL �- � Valuation of Project Fuel Tanks Q Other: � , � � , , . �.r . . . ;�z c ;x" ;;�. _<�»e. , �. , ... . . . �• :..., , � ��. �. , .• .,�.,..;; .., .. . .' . - .. ,<.� "�� , . . .... . .. �e,.; , ..:n�:.». :a4R��'S&a��.:. .. : .a.r'. >:. . .. Contractor Company Signature C(..� N� `-- Registered Y/ N Fee Current Y/ N Address � License # � - (7Q�j J ELECTRICIAN Company Signature � Registered Y/ N Fee Current Y/ N Address License # PLUMBER Company Signature Registered Y/ N Fee Curtent Y/ N Address License # MECHANICAL Company Signature Registered Y/ N Fee Current Y/ N Address License # OTHER Company Signature Registered Y/ N Fee Current Y/ N Address License # Directions: - - ., .. � . . . , , _ .. ..u. x .,. , _ . . . _ . F� .. Fiil 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 Ailow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com) Feb 07 11 11:OOa p � 20'10-207'! HtLLSBOROi3GH COUN7y BUSiNESS TAX RECElPT EXPIRFS 9�0-Z0�1 FouaNO. � 0 U g RENEW,4� 7709.0000 OcC. CoDE BUSII�'SS TYpE K 28D•4D2 PUBLIC SERVIC�,qLqRM SYSTBIAS REPAN2 8 INSTALIATIOi�! � 22.00 ! eusw�ss 221 C1NDY LN �OCA71oI�t �RANDON 33510 � SECURIN CONCEP'I'S oF TnMPa �Nc nnan.nro PO BOX 906 � BRA�+iDOPI Ft 33�pg.pgp6 BUSfNESS TAX RECEIPT DOUGBELDEN,TAXCOLLECTpR Pa� -85 w�s►+Eireavn�io� wuva� ruc �Er+ou+E 813��635-6200 07l23/'L01Q "" 22.00 n �' ��� ���w� � M�. 'I�S BECOMES A 7AX RECEfPT WF1EN VALIDATEO. � 02/07/2011 12:09 FAX 81a8793505 ADRIt1N_.FERNANDEZ INS I�j001 `. .���r, / ��r � .. .......:.... .. . ` . . Si� Y: •; .7k:�:;.'. ::i: C :r4�Y s�ad:e . ,� � I"f V � ' •,���} 'r' {H a : 'ri�; y . y . '��..''�' < o- es`:<>'a" ��� {" �frn .� . �a�,..;; . �� ....: c � �� t a� � PfiODYCEA �„ ..., .. ..,... i;'r�. . >.9i:.�:...'Y�fi2 +�a< .�.. + !:::� ° •:.`:.s:+":.. e ° ' F Q!. 07f 11 THIS CERTIFICATE 1S (SSUED A� A MATTER OF INFORMATION Adrian �'ernandez Ins ., Inc . ONLY AND CONFEFIS NO RIGHTS UPON THE CERTIFICATE 6115 N. Armeni a A'cTe . A LTER THE COVE QE ORDE BY T E OLCI�S BEL WR GOMPANIFS AFFORDING COVEFIAGE Tampa FL 33604- � •� (813) 872-8481 � , (813) 879 A CFNTURY SUR�TY utsuaeo ' --� COMPANY Wayne C. Stzohaker and �BRIDGEFiELD I Security Concepts of Tampa, Inc �p "- Post Offic� Box 906 c Brandon FL 3 3 5 0 9- �,,, ' ' (813) 684-6877 D ... . * ' �" a>£kr °e'° �* ' o. a... .m' seb .,� aa a<wo :, a .. .. .'.': .,{} � .�,G s s � ,�} � e ao ,�`5i.'�F•�'S4SY�.O�C..f+.>4���i���'�'<�'�� + } 6 . 0 {����:���i�.ii� . •7 9{}O4 i • . . • . ri THIS IS TO CER7IFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE 9EEN ISSUED TO THE INSURED NAMED A80VE FOR THE POLICY PERIOD INDICATED, NONVITHSTANDING ANY REQUIREMENT, TEFiM Of100NDITION OF ANY CONTRACT OR O7NER DOCUAAENT WRFi RESPECT TO WHICH 7NI3 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, TFIE IN8URANCE AFFORDED BY TH� POLICIE3 DESCRIBED HEREIN 1S SUBJECT TO ALL 7HE TERMS, D(CLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS 5Y10WN MAY NAVE BEEN REDUCED BY PAID CLAIMS. �.� TYPE OF INSURANCE POI.ICY NUMBEN POUCY EFFECTNE POLICY p�IRI�TICN ,, LlNITS a►TE (NIM/DC/1M OATE (YM/on,rvr) A OENEM� 4n01LTY GENERALA(iRPfiGA7E S1 , O O O, O O O X COMMEHCIAL GENEFAL LUBIl17Y C C P 6 5 0 2 0 4 0 5/ 13 / 10 0 5/ 13 / 11 PAOpUC7g . 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