The URL can be used to link to this page

Home My WebLink About11-11733 CITY OF ZEPHYRHILLS 5335 - 8TH STREET � (813) 780-0020 ` 1173 ANNUAL FIRE PROTECTION MAINTENANCE Permit Number: 11733 Address: 37930 MEDICAL ARTS CT Permit Type: FIRE PROTECTION MAINTENANC ZEPHYRHILLS, FL. Class of Work: FIRE-PROTECTION MAINTENAN E Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 34-25-21-0080-00000-0010 Improv. Cost: Date Issued: 4/04/2011 Name: DAIRY QUEEN Total Fees: 50.00 Address: 37930 MEDICAL ARTS CT Amount Paid: 50.00 ZEPHYRHILLS, FL. 33542 Date Paid: 4/04/2011 Phone: (813)780-2826 Work Desc: FPM- SEMI SUPPRESSION/ HOOD- DAIRY QUEEN � 5. V_ � C • \7-' , -�� -� � A 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 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 $100.00, whichever is greater. All work shall be performed in accordance with City Codes and Ordinances. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMNT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." � P IT OFFICER PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal �ce - 813-780-0041 813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 PeRnit Application Date Received �--� Phone Contact for Pertnit �� - , - ...., .. .. r_ . . .... �.:lr.» � .._. . .,. s . ., . , , Ovmer's Name p� Owner's Phone Number �„� [� �� ' 37 Owners Address � ,y � � � � G Fee Simple Titleholder Name Tideholder Phone Number �� C� Fee Simple Titleholder Address . � , s.��:�;::�r �€�% - �s�$=.� a�.: -�.� a - G:�:� .•3"4Y:�9:>�4r . ��s'� ra:° ,.�� . �. ,:: . Job Address L �� Lot # Sub Division Paroel # . ., , . .. , �i.�+ , w.�°&t�-�°acp^=�c'33r�.t�a:s..��;>�azr,�a�.,�,s�b ;`s. ,. , w ... .. < _. .. � �s .... _: . . - , s-�,.: . ' . .,..,x � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent � � ' ' -w K , � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL � Controlled Bum � Hood Installation � Emergency Generator < 30 kw a LP/Natural Gas-Installation � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL ❑ (3FTr em� �n er ❑ Sprinkler ❑ ❑ ❑ Recreationai Bum Fire Alartn � ❑ ❑ ❑ � � Sparklers Hood Cleaning � ❑ � ❑� � Sprinkler System Installations Hood Suppression � ❑ ,1(1 ❑ �� Standpipes (Sprinkler Sys) � Fire Alartn Installation � Toroh Roofing/Tar Kettle � Fire Pumps � Waste Tire Storage ANNUAL a Fire Works � Flammable Application- ANNUAL Valuation of Project Fuel Tanks Q Other: < .. , , c�; .� .. � ,. ,. -:r�.�.E�< .:fi<:m , . . � . . .. , , ' �- .` < a.:z"G'. .`«:d'". F�.Y�.�`.A?:aS�;:X::d?.iti�,... ''�k<'a::R'4Y�k:...rz.Y.' .. � . t Contractor Company Signature Registered Y/ N Fee Current Y/ N Address License # ELECTRICIAN Company Signature � Registered Y/ N Fee CurreM Y/ N Address License # PLUMBER Company Signature Registered Y/ N Fee Curnent Y/ N Address License # MECHANICA Company Signature Registered Y/ N Fee Current Y/ N Address License # OTHER Company vr�7 ,Rc v psnew ,� C Signature Registered N Fee Current N Address License # DirecUons: . ,. .. .. . _ ., , _ ,. . _�..,.. �,... .<. - ,. , .. Fill out application completely. Owner 8 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 drewings with appiicable documentation Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (httpJlappraiser.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 ,� contcactor or contractors to undertake work, they may be requared 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 contracto�(s) sign portions of the "contractor Block° of this apptication 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, 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 swom to (or affirmed) before me this Subscribed and bwom to (or affirmed) before me this by Y Who islare personally knovm 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 Apr 0511 09:23a p � .-�^'..1 ACORO CERTIFICATE OF LfABILITY I�SURANGE °"� �"°°"""' o�r,sno„ THIS CERTIFiCATE IS ISSUF.D pg A NIATIER OF INFOf�AAT[ON ONLY AND CONFERB NO RIGHT'S tlPON THE CERTIFICAtE HOLDER TH15 CEfiTiFICATE'� DOES 1�+ OT AFFlRNUITNELY OR NEGATNELY AMENp, EXTEND OR AI.TER 7FkE COVERAGE AFFORD� BY 7HE POLICIES BEL�W. THtS CERT�iCA7E OF MSURANCE DOES NO�T CONST�TU'fE A CONTRACT BETWEEfiI THE ISSUNG IN8URER(S], AtITHORI2ED E ESE A C R N H R, YytPORTANT: IF eha ceeliiicMe hold�r is sn ADDIi10NAL NiSURED, fha Do�Yl�asl must be ondara�d. If SUBROGA7fON IS WAIVED, su6lecl to the larms and oondlMons o( the poi�Y. esrtdn polides tnay nquiro an andonement Aatabam�nt on this wAlNeab� does not cwnhr dpbFs �o the arltlieab Aoldor in INu of sueh �ndors�m�ed(s). ar+ooucat Phone: �401> 332-0033 Fax: (I0� 332-0030 oo�rnc�r ,,,, : Insunnee Solutions of America, l»c, INSURANCE SOlUT10NS OF IWERICA, INC. rHONE �-- �� ---- 910 BE�LE AYENUE, SUI'CE 1140 "° � 3 � -0 � _..___ N� •- — Ew,a WINTER SPRINGS FL 32T08 !�D�� i,��r��, 158U -------- - - -� -- - - - �.._�...^ _ ----- -----------� -- - �tsl �I�oROirG Co►�w�sE __rNc s Nffi1R� "'__'^ ' ' _-' N A : ��5�@ FI�O *Ild C �'rOI11 -' SECURITY FIRE EQIIIPMENT, LLC & SEqlRITY F[RE EQUTAMENT CO. wu�as : CastlePoh�t EbNde Insiranos Co. 18330 LAWRENCE ROEAp �asurt�nc : W1�H CITY FL 33523 Msu�a o NSUi�RE - �W!lRERF COVERAGES CERTIpCATE NUMBER: 10813 REVISION NUMBER: THIS IS 70 CERTIFY THATlHE POLICES OF INSI�iANCE US7ED BELAW HAVE BEEN ISSUED 70 THE IF�ED NAMED ABOYE FOR THE POLICY PERIpp INOICATED. lSOTW1THST/WDIf�a ANY RE�UIREMENT. TBtM OR OOf�IT10N UF ANY OONTRACT OR OTHER DOCUMEN7 WITH RESPEC'f TO VYFYCH 7t11S C�TIF�C.ATE N7AY BE RSSUED OFt MAY PERTAIN, THE INSURANCE AfFORDED BY TFE Pq.IqES pF_SCRBED HEREiN IS SUBJECT Tp A�I.THE TERMS, IHID'L� BUBR �rR rwe oF x�suwwcE NsR � wvn rouc,w Nur�e ' roucw ew ra.�er oP i urrts q a� -u�eurr —!-oMwioo�rr� p� __ _ .._. _.._ ---°---- RFS1002322 ; 03/16J11 03NBi12 ;e�oCCUaREnCE S 1,000,000 X 1 CO�AMERCIAL GENERAI lIABILTTY ' . ------- - �-- '-" I _ � # �_PRB�119E8(Ei M� S �� .._ _� CCAIIISMADE I �C I OCCt3R i � � MED. £XP �My one pason) --- S __5,�0 I PERSONa. a �ov w�u�y S 1 ,000,000 � 4ENE AGGREGATE S_ Z,OOO,OOO GENIAUGRE6A7EpM�RA?PUESPE(L• � I PROOU CTS-COAP/OPA6G ._ g .._ Z,O OO.00O X i p01.ICY LOC --'.--• --- _-"-_ �ura�tosn.E u�siurr ____--, - --- i - COYBINED $NGLE LWR 5 --- � --- — ANY AUTO I I (� �dln,� __ � . .-- ALLOVINEOAUTOS E I BOOILYtNJURY(Petpason) S --- SCHEOIxEO AiJrpS � : 800lLY INJURY (Per acddsnq 5 - HRED AUTOS � PROPERIY Ou41NAGE � '� I P�raaudenlj S ' ^ NON-0WNEDAUTOS ..,_ ! � — S _ _ ��.__. 1MB�.4A 4W ---_"-. ' -'.----- '- " -'.- -- S- ,-- OCCUR EAp1 pCCURRENCE oaCHS u�¢ ��p� i � AGGREGATE -_._ __ ._- �__ DEDUCItBLE ` °--.� _.__ .__ .___ RErEHrK]lu S "_ ---- $ -------- ---- - -_.__ __ 5 g ; xroACete cawre�siaN --�-- --- "' �rc erw - rwo erv�.or�s� u�awn r � w WCP760748900 02125l11 i 0212SM2 X. roixr��rs °n ' s -._- ��°� �� N,� El.EACHACCIOENT , i s ._- , �.nmm�,��»n _..-- - r,«,,�.�.. E1. OISEA3E-E4 BdPLOYEE s _ 100,000 oescaNPrnNOFOrEanra+se.w. � �.o�s�sE-POUCruMrr s 500,000 --- -- ---- ---- - -- -- -�— uEacsrr� a� oneiwiiows � wc.�►no�s � vEHw�s �ae►.a� acoRO �or AddMlonal R�msAa SclNAUI►. M morc sp�ce Is teqdr�d) _.- ---- �'-- CERTIFlCATE HOi.flER GANC�LLp'T�ON C ity pf 26pFly�t1 fl!i SFiOI�D /1NY OF 7HE ABOVE DESCRIBED POLIpES BE CMICBd.ED BEFOltE THE EXFMRATiON OATE TiiEREOF, NOTICE yYILL 8£ OEUVEREp kN ACCORDANCEYIffTN 7l�E POLtC1� PROy181pNS. AUl}IOR�D R�FESBdfA711iE —"-"'. "'-_"'—_ Attention: ----- --.. ._. _. ACORD 2S (ZaOglOg) � 7988-2009 AC COR T10N. All Nghts ros�rved. The ACORD name and logo aro rogicbened rnarks of ACpRp