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Home My WebLink About11-11770 CITY OF ZEPHYRHILLS 5335 - 8TH STREET 1 (si3) �so-oo20 11770 ANNUAL FIRE PROTECTION MAINTENANCE Permit Number: 11770 Address: 38250 A AVE 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: 14-26-21-0010-01300-0010 Improv. Cost: Date Issued: 4/14/2011 Name: ZEPHYR HAVEN NURSING HOME Total Fees: 25.00 Address: 38250 A AVE Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542 Date Paid: 4/14/2011 Phone: (407)975-3000 Work Desc: FPM- SUPPRESSION SEMI- ZEPHR HAVEN - 5. �� V / � .r 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 aosts 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 Of�ice - 813-780-0041 813 780-0020 City of Zephyrhills Fire Fax-aisago-ooz� Permit Application Date Received �/��.3'��j/ Phone Contact for Pertnit l 3 �t ?� �� Owners Name L' �/~ - � Owners Phone Number �� Owners Address O � .�V �V� - � � r lll� � � �'�/ Fee Simple Titleholder Name Titleholder Phone Number C� �� Fee Simple Tilleholder Address � Job Address � Lot # Sub Division Parcel # � Bio-Hazard Waste Storege - ANNUAL � Fumigation Tent a Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Faciliry) ANNUAL a Controlled Bum a Nood Installation a Emergency Generator < 30 kw a LP/Natural Gas-Installation a Emergency Generator > 30 kw a LP/Natural Gas-ANNUAL Sale a Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL �y emi �n er Sprinkler � ❑ ❑ p � � RecreaUonal Bum Fire Alarm � ❑ ❑ O C� a Sparklers �! j/�" 1 Hood Cleaning � p p O� a Sprinkler System Installations Hood Suppression � t ❑ X ❑� a Standpipes (Sprinkler Sys) � p, �( � � � � � Fire Alartn Installation � Toroh Roofing(Tar Kettle � Q Fire Pumps � Waste Tire Storage ANNUAL a Fire Works � Flammable Application-ANNUAL D• � Valuation of Project Fuel Tanks Q Other: Contractor � Company � - � /.1- - �� r� f;yL�,� Signature Registered Y/ N Fee Current Y/ nl Address �?p/ .,�sG �rcrr �4'" - "�' � License# � �y�3�1 �v� (' c�oc� �o � ELECTRICIAN Company Signature Registered Y/ N Fee CuRent Y/ N Address License # PLUMBER Company Signature Registered Y/ N Fee Current Y/ N Address License # MECHANICAL Company 5ignature 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 & Co�tractor sign 6ack of application, notarized (Or, copy of signed contract with owner) ff over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentafio� Allow 10-14 days for review after submittal date. Paroel #- obtained from Property Tax Notice (httpl/appraiser.pascogov.com) NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may.be subjecYto�"deed"Testrictions" which may be more restrictive than County regulations. The-undersigned assumes responsibility for:�omplianre with any applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESP.ONSIBILITIES: If the owner has hired 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 misdem�an�opyiolation under state law. If the owner or intended contractor are uncertain .as to what licensing �requirements ma a I for the intended work, they are advised to contact the �Pasco County Building Inspection Divisian—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 (Chapter713, Florida Statutes,-as�fm�endF orid�a C L en $awO owner's certrfy that I, the applicant, have been provided with a copy P�otection 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'S10WNER'S AFFIDAVIT: I ce�tify 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 ce�tify that no work or installation has commenced prior to issuance of a permit and that all work will be performed to meet sfandards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also ce�tify 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 FORTHE 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, poo �uec3 be a license t S p oceed with the work and not a authorty to �violateecanP o permit issued shall be const set aside any provisions of the technical codes, nor shall issuance of a permit prevent th erm t iss ed shall become inval d requiring a correction of errors in plans, construction or violations of any codes. Every p unless the work authorized bY �doned for d of sCx (6) m after�the time kas commenced. An nsion the permit is suspended or aba may be requested, in writing, from the Building O�Ficial 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: YOU �EN TO YOUR PROPERTY. r IF YOU INT OBTAIN NG, PAYING TWICE FOR IMPROVE WITH YOUR LENDER OR AN TT RNEY BEFORE RECORDING YOUR NOTICE OF MENCEMENT. FLORIDA JURAT (F.S. 117.0 CONTRACTOR OWNER OR AGENT Subscribed and swom to ( affirmed) before me this Subscribed and swom to (or a ed) before m his --by bY Who is/are personally known to me or has/have produced Who islare personally known to me or has/have produced as identifica6on. as identifiption. Notary Public Notary Public Commission No. Commission No. Name of Notary typed, printed or stamped Name of Notary typed, printed or stamped �,_. ..�....._�...._.,.�...��...� - _.m..__ �.�.�.J.�..._.__., DETACH BEFORE DEPOSITING NO 3101851 INVOICE piSCOUNT AMOUNT pq�-� NUMBER 04082011 PERMIT 709 0408 1 0.00 25.00 � 05B313 0.00 25.00