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Home My WebLink About11-11729 � CITY OF ZEPHYRHILLS � 5335 - 8TH STREET ` (si3) �so-oo20 11729 ANNUAL FIRE PROTECTION MAINTENANCE Permit Number: 11729 Address: 7643 GALL BLVD Permit Type: FIRE PROTECTION MAINTENANC ZEPHYRHILLS, FL. Class of Work: FIRE-PROTECTION MAINTENAN E Township: Range: Book: Proposed Use: COMMERCIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 34-25-21-0010-03100-0000 Improv. Cost: Date Issued: 4/04/2011 Name: CHILI'S BAR 8� GRILL Total Fees: 25.00 Address: 7643 GALL BLVD Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542 Date Paid: 4/04/2011 Phone: Work Desc: FPM- QUARTERLY HOOD- CHILI'S 5. � l/"� �' �f �� -[( A A inal 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 O COMMEN CEMENT." �.. 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-'�',`J20 City of Zephyrhills Fire Fax-813-780-0021 Permit Application Date Received Phone Contact for Pertnit �� Owner's Name Chtr� S B�4+e ��G� Owners Phone Number �� Owner'sAddress bti3 C>M« B Z.Epti"�{R�`��S ( �L Fee Simple Titleholder Name Titleholder Phone Number �] �� Fee Simple Titleholder Address Job Address Lot # � Sub Division Parcel # � BiaHazard Waste Storage - ANNUAL � Fumigation Tent a Comm Exhaust Kitchen HoodlDuct a Hazardous Material (Tier II or RQ Facility) ANNUAL � Controlled Bum � Hood Installation � Emergency Generator < 30 kw � LP/Naturai Gas-Installation � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL �y e �n er Sprinkler � ❑ ❑ ❑ � � Recreational Bum Fire Alarm � ❑ ❑ � � Sparklers Hood Cleaning � O ❑� � Sprinkler System Instaliations Hood Suppression � ❑ ❑ ❑ � � Stand i p'pes (Sprinkler Sys) � Fire Alarm Installation � Toroh Roofing/Tar Kettle � Fire Pumps a Waste Tire Storage ANNUAL � Fire Works � Flammable Application-ANNUAL r � Valuation of Project Fuel Tanks Q Other: Contractor Company Signature Registered Y/ N Fee Current Y/ N Address License # ELECTRICIAN Company Signature I Registered Y/ N Fee Current Y/ N Address License # PLUMBER Company Signature Registered Y/ NI Fee Current Y/ N Address License # MECHANICA Company Signature Registered Y/ N Fee Current Y/ N Address License # OTHER Company Signature Registered Y/ N Fee Current Y/ N 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 10-14 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 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 Counry. CONSTRUCTION LIEN LAW (Chapter 713, 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 ce�tify 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 responsibiliry 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 swom to (or affirmed) before me this Subscribed and swom to (or affirmed) 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 � �_�.......•.......... .._._._._.�.�.._.�.._ _.__ __w.�..........�...-.a, ._ _...__...�,.�....�, ,_ .. From:Sherry t0`�Iver FaxID:863,967-7592 Page 1 of 1 Date:02/� 1/11 10�19 AM Page.1 of 1 �� OP ID: SM '4`_°R°� CERTIFICATE OF LIABILITY INSURANCE °"�`""'°°"""", 02/11/11 THIS CERTiFiCATE IS ISSUED AS A MATTER OF INFORMA710N ONLY AND CONFERS NO RIGHTS UPON THE CERTiFICATE HOLDER. THIS CERTIFlCATE DOES NOT AFFIRMATiVELY QR NEGATiVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLIdES BELOW. THIS CER7IFlCATE OF INSURANCE DOES NOT CONS7ITUTE A CONTRA�CT BETWEEN THE ISSUING INSURER(S�, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTiFiCATE HOLDER. IMPORTANT: If the certfficate holder is an ADDITIbNAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIYED, subjed to the terms and cordkions of the policy, ce►tain policies may require an endorsemerK. A atatement on this certificate does not confer rights to the certificate holder in lieu oi such endorsemeM s PRODUCER ��967�� CONTA NAME: Mulling Insurance Agency, Inc. 863.96T-�592 PNO F^X P O Box 308 208 E Park Street "'�• "° � E AIL Aubumdale, FL 33823-0308 ADO'�S� rao°u�R SU NS-13 Brien Spann, AAI w �nr. INSURER(S) AfFORDING COVERAGE Np�C s wsu�o Sunshine Pressure Cleaning, In ,NSU�Rn. United Fire Grou 13021 Dale Dombrowsky INSUFtERB PO Box 5836 iNS�R c. Lakeland, FL 33807 iNSUr�R o . INSIAtER E . INSURER F . COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEU ABONE FOR THE POLICY PERIOD INDiCATED. NO7WITH5TANDING ANY REQUIREMENT, TERM OR CONDRION OF ANY CONTRACT OR OTHER DOCUMENT WfTFi RESPECT TO WHICH THIS CERTIFlCATE MAY BE ISSUED OR MAY PERTAIN, THE NSURANCE AFFORDED BY 7HE POLIGES DESCR79E0 HEREW !S SU9JECT TO A1L TME TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMffS SHOWN MAYHAVE BEEN REDUCED SY PAID CLAIMS. �� TYPE OF pVSURANCE POLICY NUMBER MMIDD� MMADMYYV LRARS GENERAL LIABILITY EACFiOCCURRENCE § 'I,OOO,O A X COMMERCIAL GEN£RAL LIABIIITY GO3�s�O 01/07111 O�/OT/�2 pREM�SES Es omrrence E 'IOO,O CLAIMS-rAADE aOCCUR I MEDF�W(Myoneperson) E �O,O PERSONRL BADV INJURY a 'I,OOO,O GENERAI AGGREGATE S 2,QOO,O GEN'L AGGREGAT£ lIM1T APPLIES PER� PRODUCiS- COMP/OPAGG ; Y,OOO�OO POLICY PRO- LOC S AUfOMOBILE LIABILITY COMBINED SNGLE LMIT (EeacadeM) S 7,0��,� A �Y�7o oa9ss�o ovoTr�� o�ro�nz ALL OWNEpAUTOS BOU1lY IN.IJRY (Per person) S X SCNEWLEDAUTOS BODIIYWJURY(Pereccident} S PROPERTY DAMAGE a X H82EDAU70S (PeracdderM) X NON-OWNEDAUTOS S X UMBRELLA LIAB X OCCUR a EACH OCCURRENCE § 1,000,0 EXCESS LIAB aqp�qS{,��E AGGREGATE S 'I,OOO,OO A 60399610 01107N 1 01l07112 DEDUCTIBLE g X REfENT10N S �O,OOO WORKERS COMPENSATiON f WC STATU- OTH- AND EMFLOVERS' LUBILITY Y � N TORY L ITS ER AM' PROPRIETORRAR7NERIE�CUTIYE S OFFICERMIEtdBER EXGLUDED9 ❑ N i A El. EAG-1 ACCIDENT (Manddory in NH) E.L. DISEP„SE - EA EMPLOYEE Nye s, desaibe under E DESCRIPTIONOFOPERATIONSbelow E.L.OISEASE-POLICYLIMR S DESCRPTION OF OPERq71pN5 / LpCqT10NS / VEMCLES (Attath ACORD 101, AddioonY R�marlts ScAedW�, If mon spK� la r�qulnd) "BIDDING PURPOSES ONLY" CERTIFICATE HOLDER CANCEILATION SNOUL� AM' OF iHE ABCVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA'T10N DA'�E 7FiEREOF, N0710E 1Ndt BE DEt.IVERED iN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHpRIZED REpREgENTATI4E ��1F� B 1888-2009 ACORD CORPORATION. All rights reserved ACORD 25 {2009/09) The ACORD name and togo are registered marks of ACORD from: Oi1211201� a0:a9 #464 P.D01/001 Aco � CERTIFICATE OF LIABILITY INSURANCE DATE(MN/DDIYYYY) 1 PRODUCER Alliance Insuranoe Salutions LLC TFtIS CERTIFICATE IS tSSUED AS A lMATTER OF INFORNlATiON P� BOX 1777 ONLY AND COMFERS NO RIGHTS UPOPI THE CERTIFICATE St Petersbur , FL 33731 HOLQER. TMIS CERTIFtCATE DOES NOT AMEND, EXTEND OR 9 ALTER THE COVEfiAGE AFFORDED BY THE POLICIES BELOW. 727�97-1247 www.ins4biz.com 727�g7-1280 INSURERS AFFORDING COVERAGE NAIC # INSURED progressive Employer Management Company, Inc. wsu�Ra suN ins+, c � 3a7 Progressive Employer Management Company II, inc. ,,,��,� 6407 Parkland Dr ,NSU�R c: Sarasota FL 34243 INSURER D: 1NSURER E: COVEf2AGES THE POIICIES OF INSURANCE LISTED BELCHM HAYE BEEN ISSUED TO T HE INSUREO NRMED ABOVE FOR THE POLICY PERI00 �NDICATED. NOTWITHSTANDING ANY REQUIREMENT, TEf�t OR CONOITION OF ANY CANTRACT OR OTHER OOCUf�M WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE tNSURANCE AFFOROED BYTHE POLlCIES DESCRlBEO HEREIN iS SUBJECT T0,4L1. THE TERINS, EXCIUSIONS ANO CONDITIONS OF SUCH POLICIES. AGGREGATE LpNITS SHOWN MAY HAVE BEEN REDUCED BY PAIO CLAMS. INSK DD POtiCY EFFECTIVE POLICY EXPIRATpN T N TY POLICY NUNBER LINUTS GENERAL�U&UTY EACN aCCURRENCE � COMMERCIAL GENERAL UABiLJTY DAMA TO NT D PREMISES a oavaence 3 CLAIMS MADE � OCCUR MED EXP me persan S PERSONAL&AQVtNJURY S c�ENERflI aGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPfOP AGG S POl1CY P � �OC AUTOMOBILE 1N61LITY COMBUVEUSAIC�E LIM1T $ ANY AUTO (Ea accdem) ALL OWNED AUTOS BOOILY WJURY $ SCHEDULED AU70S (� DB5m1 HIRED AUTOS BODILY INJURY $ NON-OWNED AUTQS (Per acdtleng PROPERTY OAMAGE 3 (Per act3danq GARAGE1.iAH1LtTY ALtiODNLY-£AACCIOENT S ANYAIlCO EAACC S OTHERTHAN AUTO ONLY• AGG $ EXCESSI UMBREILA LINBWTY fACH OCCURRENCE $ OCCUR � CLALMS MApE qC,�Gp� S a DE�UGTIBLE 5 RE7ENTION S $ A WORKERSGOMPENSATION WCPE0000�5401 11/1/2010 11Hl2011 ✓ wCSTATU• OTH- ANDEMCLOYER$•11ABWTY �� ANV PROPRIETORIPAKTNER1EJfECUTVE ❑ E.L £ACH ACCIOEM' S 1 OOO O00 OPFlCEHIMpABQtEX(1UDED? { �� ° � O7 �^ � E.L OISEASE - EA EMP�OYE 3 � Q Ifye s, dewibe uMa E.L OISEASE - POLICY ULtIT 5 1,000,000 SPECULL PROMSIDNS bdaw O7HER QESCRIPTION OF OPHtRT10NS! LOCATIONS 1 YEHICIE$ / EXCLUSIONS ADDED BY ENDORSEMEIQT I SPECIAL PROVtS10N$ Coverage Provided for all teased empioyees but not subcontractors of- Sunshine Pressure Cleaning, In Cliern EffeCtive: 11t1/ZU10 fax 888-267-6475 and to 663-701-2329 CERTIFICATE HOLDER CANCELLATION 8317 -- ---- --_ - - - SHOU1,p/WypFTNEpgpyEDESCR�EDPOUCIESBECANCELLED6EFORETHEEIU'IRATION DA75 T1ffREOF, 71iE 55tll16 115URER WlIL ENDEAYOR TO!'UIL , 3O � DAYS YVRifTEN NOTICE TO THE CERTiFICATE HOIDER NNNEp TOTfE LEiT, BUT F/1lURE TO Dp SO SHALL MAPOSE NO OBLIGATION OR UABIlRY OF ANy !WD UPON TNE WSURER, ITS AGENTS OR REPRESfNTAT1VES. ' 1Q Days tar NomPaymmt d Premium. AUTMORIZEp REPRESENTATIVE -'///��'� Glen J Distefarro ,� �� ACORD 25 (2009I01) m 1968 2409 ACORD CORPORATiON. AII rights reserved. C2£T ilC. 9�cid9� CLI@3T CCCE PEMCC :en 9aart 1j2C/2�11 6:C9 :o W. Page 1 ot 1