HomeMy WebLinkAbout11-11795 /
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CITY OF ZEPHYRHILLS ✓"
5335 - 8TH STREET
(si3) �so-oozo 11795
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 11795 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: 4/19/2011 Name: ZEPHYR HAVEN NURSING HOME
Total Fees: 25.00 Address: 38250 A AVE
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542
Date Paid: 4/19/2011 Phone: (407)975-3000
Work Desc: FPM- SPRINKLER QUARTERLY ZEPHYRHAVEN NURSING
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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. Ail
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 Office - 813-780-0041
813=�80-0020 CI{y OfZcPfly�fllllS FIF2 Fax-3i�780-0021
Permii Applica�ion
Date Re .- Phon� ConfactforPermit
e..�.�- �,.+;-.�, a. " _ ��� .. - . a�,..�xe��•.,.:a�-� -:
Owners hiame \j Owners Phone Numb g � 3 6 2 6 5 4 8 2
OwnersAdd 4701 Oak Fair Blvd T1�MPA FL 33610
Fee Simpie ,Tiflehalder Hame - Tr�leholdar Phone Flumb=r ��� C
Fee SimpfeTifieholderFiddrross
�� . - ' �
Job Address � i � r �1 Y 1 hS � 3 J�J "r � � � '+ r ��`F/Yl �(� ! Lbt �# �C
Sub Division Paroel �
�^,.--�x^•^ ��.,"'� - - _ - - - -
� Bio-Hazard Wasfe Storage -ANNUAL � Fumigation Tenf
� C�mm �haust'Ffitchen Hood/Duct � Hazardous Maferial (fier !f or RQ Facility) AHt�tUAL
� Controfled Bum � Hood Insfaffa4ion
,� Emergency Generator <30 kw � LP/�Iatural Gas-fnsfaflafion
_ , � _ •Emergency Generator � 30 �kw � LP/�tafural Gas-AHPtUAL Sa(e
•: ..�' Fire Protection Maintenance - ANPIUAL � Places of Assembly AhINUAL ���
(� emi An er � I �
. , , Sprinkler. � ��� � ❑ p � � Recreafional Bum !
� -, Fire Alarm � ❑ ❑ ❑• � � Sparkfe[s •
� � �'�� � Hood Cfeaning � p ❑ ❑ � � Sprinkler'Sysfem Instal[a6ons
_ __ _ . _ � - - :., , .. Hood Suppression - - .� ❑ ❑ , _ p � � Standpipes (Sprinkler Sys)_
.____....:__°� �: . , . .,._ ,.._, . ,
- +.• --. _ . .._._.._� ...,. - , �. ,
- � � _ ` =° � Fire Alarm Instatlation � � � � � ` � � ` � " "" � - To'rcfi Robfing/Tar Keftle = = ' = � - �
.. ., z .., ... _ ... . . . _ _..
_.____.. .--- ....__.... � ...:..: -�_;....,........ , ,. .._ _. ..: . _ _ ..._ ..... .,.
.. . . _ . ._.__._.._ . _.�_ ._ �._.,...---...___._ �_ '
. . - ... ., ._
.. ...._. , .___ _. _ ._ _ __._�__ -- - --
_ � :;. � Fire Pumps . Waste Tire Storage AIdNUAL -
� , .� �, Fre Works • • �
,-,;; �• ,- FfammabteAppticason-AHNU,aL . . Va(uation of Project .
• , ° � ` - Fuef �anks � - - • - , . . . � - - - -
� ' � 0 Ofher: . .
�- - - - �
Confractor � Company ! �Y�'`'� �n.,•ti f.�
Signafure Registered Y/ I� Fee �urrenf Y/ N
Add�es� _ _ _ " _ � License # -
ELECTRICIAN'::.. , : = _ - ! • , , ` - , Company , � -_..
Sighaftare - • -- ' � • - � Registered - � Y ��N � , �, Fee,Current> Y / N ' •
�;
Address License # ' - _
PLUMBER � Company ., u`. , • . . -
Signaivre ' .,� Regisfered Y( N� Fee Currenf Y �_�'� •
Address License #� `
MECHAN[CAL Company
Signafure Registered Y/ N Fee Current Y/[1I
%lddress , License #
OT[-fER • Company _ .
Signafure Registered Y/ N Fee Current Y/�
Address License #
Directions: ' - • . -
. FF[[ out appiicafion compfefely_ _
___. _ Owner Yx Contracforsign 6ack of appfieauon, notarized (Qr, copy of signed cortttacf with owner) .
ff over $Z500, a t�fofice of Commencement is reqt�ired.(NEechanic.a[ woric over $5000) .
----: " - Supp[y fwo (2) sefs of dr�wings with appficable docamenfa8on
�_ _ _. -- _ AlfoHt 10-'f4 days for review after submitta[ daf=_ Rarcef �- obfained fiom Property 7ax t�fouce (ft�fpl/appraiser.pascogov.cnmj
=E�l�TICE OF=€3EED F��ST€ZEC [ IOi�IS: I he.undersigned understands.that this permit maybe subject:to
v�thich rriay be more restr�ctive than Couny regulations. The_undersigned assumes responsibiliy for:�omPlian�e��rvith any
_app[�cabfe deed restrictions. _
UNL[CE�ISED `CO�ITRACTOf�S AhfD �COI�ITRACTOR RESP.OI�S[B[LiT[ES: [f �the owner has - hired - :a°coniracfor or
contracfors �to under�ake work, fhey rnay be required io be Iicensed in accordance with sfate and foca( If fhe
confracfor is not ficensed as required by [aw, bofh tf�e owner .and contractor may be cited �for _a �misdemeanor vio[a�ion
under sfafe law. If the owner or intended contracfor are �ncer�ain .as �fo what licensing �requirements may �apply ior the
intended r�vork, tfiey are advised�fo contact fhe-Pasca County Bui[ding [nspection D'[vision—Licens[ng Section_at 7_27-847-
8QQ9. F�tr�hermbre, if fhe owner� has hired _a contracfor or contractors, F�e is adviser� �to have �the confractor(s} sign
portions of fhe "contractor Bfoc[c" af fhis appfica�ion�for which�they wi[[ be responsible. [f you, as�the owner sign as fhe
contrac�or, that may be an indicatian'that he is nof properly ficensed and is not enEiffed�to permit�ing privileges in Pasco
Counfy.
COHSTRUCT[ON_L[EN LAW (GE�apfar713, Florida S�afufes,_as.atr�endeci}: ff vafuafion ofvdork is $2;500.00 or more, (
cerEify tha� [, �the appiicant, ha�re been provided w�th a copy of �the "Florida Construcfion Lien Law—Homeowner's
ProtecEion Guide" prepared by�fhe Fforida Department af Agriculture and Consumer Affafrs. If the app[icanf is �someone
off�er fhan fhe "owner ( certify that I have obtained a copy of the above described document and pr6mise in good faifh to
de(iver it �o ff�e "oirvne�' prior ta commencemenf.
CONTf2aCTOR'SIOWNER'S-AFF[DAVIT: ( cerEify fhat aif fhe informaEion in this applicafiQn is accurate and
� fhat all work wi(I be done in cornp(ianc.e wifh a(f applicabfe I,aws regu(ating construcfion, zoning and land
deve(oprr�ent. App(icafian is hereb� made to obfain a permit to do wor[c and installation as indicated_ -f certify
fhat no work or instalfation has commenced prior to issuance of a perinit and�thaf aIf work wi(I be performed fo
meet standards of af( laws� regulating construction, Counfy and Gity codes, .zoning regulafions, and [and
de�e[opment regulafions in the jurisdiction. f als.o certify tk�at I understand that fhe regulations of ofher
_ government agencies may apply�fo fF�e intended wor[c, and that it is my respons�bifity to idenfify what acfions l
must take to be in compfiance. '
If t°am the ACENT FORT'HE OW[VER; I prornise--in good faith to inform fhe owner. of the perrrtitfing._conditi.ons sef for�h. in ,_...
... _. .. .. .. __ _ - - - _m._.._�.. ._,.,_..__- __ . _ �_ . - -- - -
---tE�is-�affidavit--prior-to comme�c«g-consfrucfion:..__.Gunde'"r."stac�cl�ha�:.a:.se,�arate_p�rmif may__be reguired_for electricaf ,wor[c, __ _ _ _
pfumbing, signs, wel(s, pools, air conditioning,� gas, .or ofher instal[ations not specifica(ly included in fihe app[ication. A
perm�f issued sha[I be construed to be a license to proceed witfi �the work and nof as aufhorify to vio{ate, cancel, after, or
sef aside any piovisions of fhe technical codes, nor shall issuance of a permif prevent ffie Buifding Official from ffiereaf�er
. re�urring a correction of errors in p[ans, construction or violations of any codes. Every.permit.issued. shatl.,becorne.inva(id
unless tfie work authorized by sucE� permit is commenced w�thin s�x mont[�s of permit issuance, or if work aufhorized by
fhe perm�t is suspended or abandoned for a period of six (6) months afEer the time fhe work is commenced. An ex�ension
may be requested, in wrifing, fram fhe Build�ng Official for a period not fo exceed nineiy (90) days and wil[ demonstrate
justifiab(e cause for the exfension. ff wo�k ceases for ninety (90) consecutive days, fhe job is considered abandoned.
{�1/qRN(NG "TO. OWNER: 'YOUF2 FAILURE TO RECORD A`NOTtCE OF��COMMEHGEiVIENT M7AY°REStlLT IC� YOUR ''
PAY(NG�TW[C� FOR�_[MPROVEMENTSTQ YOUR PROPEfRTY. IF YOU WTEHD Ta OBT N F[I�ANCI[�G, COIVSULT� -=:;''-,
WITHYOUR LENDER OEz'AN ATTO BEFORE RECORQWG YOUR HOTICE C ' ENCEMEHT.
FLDRIDAJURAT (F.S: 1'(7.
OWNER ORMAC3ENT ___ CO�F�CTOR � - - `
Subscribed and s om to or �crned) before me th�s
Subscribed�arid Swom . (dr �. ed) befnre me fhis bY
b y � Who islare srsonall known to me or haslhave produced
WF�o is/are persoRaf[y known fo me or has/have produced p y as idenfification.
- as idenfificaUori.
' Notary Pubiic Nqfary Pubfic
Commission t�to_ . Commission Na. � ,
ed; rinted or sYamped Name af Nofary typed, printed ot sfamped
f�fame of Notary fyp R .