HomeMy WebLinkAbout11-11851 � CITY OF ZEPHYRHILLS 1
5335 - 8TH STREET
(si3) �so-oozo 11851
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 11851 Address: 7838 GALL BLVD
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: 35-25-21-0010-00700-0000
Improv. Cost:
Date Issued: 5/13/2011 Name: PRIMERICA GROUP ONE
Total Fees: 25.00 Address: 3629 MADACA LN
Amount Paid: 25.00 TAMPA FL 33618
Date Paid: 5/13/2011 Phone: (813)933-0629
Work Desc: FPM-QUARTERLY FIRE SPRINKLER FOR PUBLIX
, . 5.
�
�
J ( ��
.. i� �
�
�\ �
�
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
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 O�ce - 813-780-0041
Wi in�an
� Fihe S�rSt+�ms
5912-D Breckenridge Pkwy � Tampa � FL • 33610
plrone: ($13) 623-2333 • Fax; (813) 620-0333
To: City of Zephyrhills From: Mitzi Vance
Attn; Bullding pepartment Re: Sprinkler inspe�tion permit
�ax: (813) 78o-0021 Pages; 3
Date: 5/6/2011
Urgent �� Please Reply �� For Re�iew �X�
Please se� the follovving application for pemtit. �Jur technician will bring payment to your office
on 5/13111 8 pPck up permit.
Thank You,
Mitzi
Phone: (8],3) 623 ext 1201
Fax: (813) 6Z0
Email: miv@wiginton.net
, r
• �A�7,28/2007/1NED 07, 20 A�( ZEPHYRHILLS BUiLD1NG FAX No. 8! 3-780-D02! P. 001
813y8aoo�0 C�Ly Of�lyI�1�SF11� •. � Fa�t1�7BO.oDZ1 '1�
F�em'Mt App1f�9Uon . a:
CaEe i�eesMd � r•Phetr �ptfer PA1mlk �'t ��j �
Owrte� Nan►e � OMnsrti Phons Nuniber ��
Dw�ere Addresa . .
FeselmpeTptel+e�deri+�n+e " ' ' , • ' �1UeiWWerPbvlro N�miber � I:._�J �J
�oe�'�lpeheld.rA�a ' ' '
JobAddissa �1�. � • ��I.o��
�pb �IOf1 PllOd11►
• [� ate.r�a�dw�esron�oo-,Mwua. • • `. '� wnaoenonYoac ' . � , ' .�j
� Camm E�9�su[t 1a6d+�+ HOOd/�! � HRa�tlOtrt M�ItiI (lia' M ot RQ �edptYl ANMUp1. �� �
Ca�tralfed Eum � Heed kl�lloq � � �
. . ''� P.�ne�pen�y �enerata' � 80 kw • . . � LP1NSW�l 0eeinsdllelon ' ' '
F�ifalosiivy C�+�.ra�} 9n kw .tpA�lund C�aAl1NUAL SeM �
� Flro AIpbCGen M�hAeneros;ANllWtl. O Pl�ees pf M�dolY-AMlNAL � . .
���� • ���1
� � A ; � • � � � . • • c���{ K�tL.a� �
� ' Fre almro , o q• a'
• , 0
�� ❑ � d o � . �j s�•�c��� ' 'S � 13� 11,
• � ni�m i;ima�.ao� , . , Tad, Roonn�+r.� w+� ; . �
Pae P� . . ' ' � • � w.ea 11te sla�ax ANNUai. ' , , . ,
Fke wo►ha ` • • . . , .
, ' fiennsWe Applkatlan. ANNt1r►l, ; . .�+�� � ValuetioM of P[oJeCt .
Fvel 71arAce ' ' - ,
. p . o�,�: • • . .
� � � �. � � �
sr� � �aa r�. a�,.nc �t •
�dd�o _. i�'�o°,�e _
�t.ECrntcu� ' . • ' p canpn�r .
s9+�ure ' ' R�o�rd' •. Y Fae C�nent• Y/ N
nddreaa uean�ef • • '
PLUM�t • . CnmpanY
s�wa� . � . � � Rep�aaea Y r " Fa cunent Y � N
nddneaa ' IacenaeM��
I�CFN�BCAI. Qenqw�ly !
sla�iue ' Reqlste�oa Y 1 N Fa Q,meM Y
Addre�s � I.Ieepss M ,
0'TiiFR . � Ca�pary , --
s�orelure � � ' �• Y N Fer C�en! N
' +5d�ees ' . • . Lk�po*
, F�II out uPVlla�on oortpiMah�. • �
ONhtor 8 Cvn4�al�alpn bsdc oF«ppAwCen, r►Ws�ed (G: eoP7r o� r'Ip++d Co1NAec wRh o�4ne� . .
Kavaril�O,eNctlpeoPCs�:emantlerequlnedaMeo►+erri�dlwoileoveri0D00) •
Apaw 1a14 daye 1br �vvluw � bn � d11M. AOO � ItnCltitMlon Pemal A�. �
obleh�ed imm P1ope�iY TsX NotlCe (hdp7/9pprales�.pesao9��1
• �
�fJ►A/28/2007/4Y�D 07:20 AM ZEP�ILtS Bl1ILDING FAX No, B1'3-780-0021 P. 002
,�pTIC� OF��RES�ICTtoNS. 'Che,underslgned und'erat�mds tJ1st t�� permit m�ybe•aubJec�ta•"de�d"a�,e�trlCeions�� �,
�rhfch maY be moo� rasirk�ve than Count'y�e9ulatlor�s. 7he��ndetslsned.�ssumes respons�Dny'.forroomp„ar�e+�uuith any .�.
�pptloeble de0d reeq�fottotm.
�t!lVLfC�ISED �CVNTRAC7'ORS .ANp �'CONTfiACTC�R.R�SA+�MSIBIL•iTIES: (f �tlie �wwner has �hEred'��conhractor �or• . .. .
contrsotor� fio u�ertak�e wvrK, ihey tnay be reqt�ked to be lb�enead � acGOr{dacica vvkh sEete and looai•t+�qulattens. if thg
cOt1d�a0tor ls not Ilaeeeed � r+Cqub�ad by i�w, bokh the o�er �nd •a�dr�a n�e�y he c(�ed Yar � mledsme�nor vlode6on
.under slade law. N�tltie dwner or I�ended �cartihactar erca unoertatn.e� to wltat Iroenain9'req�+ireme►�ts meY apPly tor the
, liltended work. they �e �dvlsed�lo contact the•Paceo CMar�y �ulldhl0 Inepedion Diviebn 6ec�ton,at 727
8009. Fu A�etrno�, tf ownet hss htrecE .e contrac�or or '�nb�nctors� he is ad�sed ��hsve �lhe contrac�o�r(s) sipn .
�cto� th�t may ba �n Bndk�tlon ��r+at is hot Ptope�iY Ilae��+.se snd Is na�t enfl�ed•to � i!6'ng �pes � Rasco
County �I�
Cpt�ST1{UC?ION.L.IEN .LAW (Gh$pber7'13, •Flo�rlda Statutss,.�s.amsnd�: If wdtusGon of Wo�k Is "j2,�00.D0 or mars, I
, rr,� •�eat i, �he �P�io�nt, heve .been pfwided wlth � copy of �t11e 'Fiwid� Consfrua�on .Lien. Lew—Homeovrnet"6
Pro�acqon Gulde' prapat�ed by•ti�e FI� Depertme�n# of A9riculture and Con�umer A1�ks. !f iAe epp�nt le'eomeone
otlter Shmn the'"aavrie�', I�tity that ! have ot�ained � copy o# the sbove deacrlbed clacurnent �trui promlae iR pood fcttt� io
delh/8f' It to tfie'aNmef" p�1o� b CoA11s1e11G9me�i�, � '� � '
_ CON1'R,ACTbR'Sl�WN?�R'�S.AFFlDAY1T:.1 oactlfy that �1i the infprm�tioe Irrthle �pplk�Non is�gccurete snd
fhat all woH� nn�f �be'dbiie In compli�t�ce w�th aG appilcable laws repulaifig oons6'uctlon mr�ing and land
dewdopntee�.. ApPil�ion Is hereby m�lde io'ebtain a pemit �e do .wdrk ant! it�stal141bn � N1dk�bed. 1 cartly .
• that no workIar ir�llatton has comrnenced prior to Issuanoe nP a pevmic and•that a11 wark wqt be Petfotmed to
n�eet stand�s of qll I�us regulaltng potmhnw�t}on, �nty end Ci�► codeg. ,�aanin9 re�ons, and land
dev�iapment negule�ons in tho jwisdlcMon. t atso certtfy that I wndershand that •the re�ulaqons of other
. pove11�11rlent �genales tnay apply to the i�,Eended tNOfl� sncS ttlat 1t la my I�espnns�►lllly to idenilfy Whst acHof�s 1 .
must feke�to ba in compllance. ' �
If I am the ACFM FoR� � oYVNER, I prdmise tn good fefth to iMrnm the ovmer of,lne pertri�tinp c�or�di�an6 s�t forih in
H�ts affWa�lt prlar � cor►�mencing r:o't�roGfln. �I ur�ders�arnd tf�t � separate petmit may be requked Tix elechicai work,
plyRlbih9� 9igtte� Weq6, 8k o011dliiqnillg� 9as •or ottter Mstalladons not apea�fiaalty h�ittded in the ePplic�attion A
peimtt fssued sheA be c�ttstrued to .be a 11cer�e to pr�ooeed wkh tfie work and not as auMerlq► to vloi�te; can�:el� ake�', or
set esidB ar�! pt�oa+isfa�s of the technicaf codea� nar shaA Issuance o�F a permit prevenR ths�u�a Oft'bia�'fl'om thetesiter
requinng a oorreo�on af in plair�s, oon�truobion or vlolaqons aF snY codes. �very pa�mlt Issued shall beoame irnrolld
untess fhs vwrk suthor try sucf� permR is c�nmenaad wlthle aht months a1 perm� fseu�e� or ff worit authorltsd by
1he �mN Is s�.�spende�lor abandoned iar a period oF's1x�tGj moriti�s aRer the tlrne the w'orlc le comm��wed. An extensfon
may ke reAuesked� in w�tirig, from the euqding O�cial for a Rerbd not to e�xceed nMebl (90) ,d�ys aiul wIN demansh+ate �
'' �UBiiF18k1I9 GaIISE � N'IC �BIOR� I� W01'IS 06S,SHB fC� �U1�9lS/ (9O� COfl9�Ct1tIV8 dd�/S �b is c�nalelered abandoned.
'WARNMCr TO OWM��I: 'YOUR �A�I:URi�''i0 �RECCRD A'NOTIC�'O,� ;COMM�NC�M�NT Mi4'Y`"R'R�SULT Mi'Y6UiZ� . .. �
PAYlNG 'i1MC� FCR �IPROVEM�NTS "�O YOUIt PRO�R7"Y. !F YOU lNT�ND TO OBTAMI �INANCING� GONSUL�'
W• RN 0!NG U OF CG ' ,
FUORIDA JURAT (F .117 � .
/ � ' ' ' . . '
' OrVM�R ORJAiGEIfT `� CpNiRAC ,
��� � � dP � m ltlls
y�y��y knaiwn m�ne or ve prod�wod Wlw pe�,o�eyr 1� me or are pradueed
• N1A�` • �s Id�tE��s6oe� , �'� . .
� , � ' '. .
��, jVo�ary Pub1lc � � Nobwy p�Uc ,
Oomn+teslon o. l CanNnbrlon I�w. 1 ,
1 _ � �' ' � � �'C�ylLn'e = • .
Name of Nolmy bpeel'� QrY�ctl or cLamAed .� • Neme� No�' OiP� PriMoa'or alsmpod .
. ,., , f
� QOMINM�fld�l 10b�� �
OOIM��01� • t00i � ! �CCT '�
� l�ANli4CT0��018 amwa
� I�HNCIA�'�I�111U ■M��M�OC�IN
MAR728/2007/WED G7:20 AM ZEPHYRHILLS BUILDING EAX No.813 P.001
8137$0-�0 Cfly Of28p�lYif11116Fd9: Fax-813-780-0021 k
permit Applicetion . _.
Data Recelved •Phone Co �r PBrmR P�� I ZO (
Owner'e Name • Owner', Phone Number .� ��
Ownera Addresa
Fee Simple T1Ueholder Name � ' Titleholdar Phone Numbar ���
Kee SlmpleTltlehaldtfAddreas ' '
� �L . � �
Job Address Lot #
5ub DivEslon Parael #
� Blo-Hazard Waste Storaes —ANNUAL Q Fumlga0on 7ent ,
� Comm Exhaust i(itchen Hood/ouct : •�• Hamrdous Metedal �er II or RQ Faclliry) /WNUAL .
� Conlrolled Bum � Noul Inslaltetlon
� �mergency Generator < 30 kw � � LP%Naturel Gas-Inatallatlon '
•.� '�mBrgency Generator> 3a kw � LPMatural Gas-ANNUAL Sele .
{� Flre Protec6on Mahttenence = ANNUAL . � Places vf Assembly-ANNUAL •
` y � emi e
��� �
Sprinkler � � � ' � � � ReoreaUonal Bum • . �^��
� Fre Alartn � . ❑ l7' ❑ � � SpwWew . `� '�
Hood Cleaning �[] � ❑ fJ � � 3Arinlder'3ystam Installa6ons
Haod 5uppresslon � {7 O ❑ �� _ � Stendpipes (Sprinlcler5ys) � � `' �1 � 1
� Fre Alartn Inetalls6on . � TotcFl Ronfingffar KeB1e . .
�� p� -' � Weste Tire Storage ANNUAL
Flro Worlte ' •
Flammable Appfica0on-ANNUAL • • •� Valuation of Pfoject .
Fuel Tankb '
Q • Other. ' '
Contraclor � � " � ' Comparry �—
Signawre � ' Reg�st�red Fee Cuirent N�
Address License #
�LEGTRICIA � d Comp�rry
Signature � Reglsierarl Y/ N• Fee Curtent Y/ N
Addre�e license # ' �
PIUMeER Company ��
Slgnalure Reglstered Y/N Fee Current Y/ N
Addross ' Llcenaa # �
MECHANICA� Company ��
sienature Ftegistared Y/ N Fae current ,Y / N
Address � Licepse �
OTH�R , Compeny � '
signature ' Registered Y! N Fee Curtent Y/ N
Addreea • Llcenes #
Oirection&:
Flll oU[ applica0on tomplataly.
Ovmer & Coniractor sign baok of application, nolatized (Or, copy of eigned contract wlth otimet) ,
It over 425D0. a Notice of Commancemant ia required.(Mechanical work over $6000)
Supply two (2) aets of drawinge wilh appllcab�e documentatlan
AlloW 10-14 daye for revloW afler submittal date. Percel #- obtainsd irom Property Tax NoUce (h[tpJ/apprsieer_paSCOgov.com)
, '
MAR/28/2007/WED 07:20 AM ZEPHYAHILLS BUILDING FAX No,813 P.002
. 'PIOTIC� c�F:DEEU�RESTRICTIONS: 'fhe.underslgned und'erstands•thatthis permit ma�.be�subJect:to'"de�d"�restrfctlans"'
which may be more resfrict'sve than County�regulations. 'The�.undersigned.assumes responsibility for:compliara�e+anrith any ..
.appiicable deed rastrfotions. - ' ' _
UNLiCENSED �CONTRi4CTOR5 �AND •CONTRACTOR.RESP•9NSIBILiTtES: If fhe owner has �hired�:aY��nfractor �or -
conttaotors�o undertake work, they may be required be licensed in accordance with state and local�regulations. If the
contraotor ls not lica�sed as required by law, both the owner and •contracior may be cited'for � misdemeanvr v►olation
.under st�te law. If �the owner or tntanded �cantracfor are uncertain •.as to whaf licensing �requirements may app(y for the
intended work, they are advlsed�to oontact the•PasBo County Bullding Inspection Division—l.icensing 5ection,at727-847-
8009. Furthermore, ff the owner has hired -a cantractor or eontl'aetors, he is advised �to •have �the cordractor(s) sign
portions of the "cvntractor Block" o# this appllCation�fot which�they wlll be responslbte. If you, a's�the owner�sign �as the
corrtractor, that may be an indication'ihat he is'not properly licensed and is not enEitled'to•permitting.privlleges in Pasco
County. •
CoNSTRUC'fION•L.IEN.LAW (Chap#er713,•Florida Ststutes,.as.amended): lf valuation of work is'$2;500,00 or more, I
certify'that I, 'the appticant, have .been provided wlth a copy af'the °Florida. Consfivction .Lien. Law—Homeowner's
Protection Gufde" prepared by�the Florida Depar.tme�t of A of the above d s� ibed docum nt nd promps�e�ln aith to
other than the� owner", I certify that ! have obtained a copy
deliver it to the "awner" prior to commencement. •
� CONTRACTOR'S/OWNER'•S •AFFIDAVIT: I certify that all the information !n� thls appiicatlon is accurate and
fhat all work will�be�dbne In compllance with all appl"�cabte laws regulating construction zoning and land
deveiopment. Application Is hereby made to�obtain a permlt to do work and instal�ation as Indicafed_ 1 certify
that ho Work or installation has commenced prior to issuance of a per•mit and�that alt work w1U be performed to
rneet standa�ds of all laws regutatfng oonstruction, Cpunty and City codes..zoning regulatlons, and land
development regulations in the jurisdiction. l also �ertfiy that I understand that tt►e regulatlons of other
. government agencies lnay apply to the intended work, and that it is my responslblllty to identify what actlons I
mustfake�to be in comp�lance.
tf I am the AGEN7 fOR"THE oWiJER, t promise iri good faith to Inform the owner of the permitting conditions set forth in
thts affidavit priar to commencing construction. �I understand that a separate permit may bs required for electrical work,
piumbing, signs, wells, pools, air conditianing, gas, •or oiher lnstallatlons not specific�lly Included in the application. A
permlt [ssued shall be construed to be a Iicense to proceed with the wQrk and nof as authot'ity to violate, cancel, alfer, or
set aside any provisions of the technical codes, nor shalf issuance of a permit prevant the �uildtng. dfficiat from thereafter
requiring a correction o# errors in plans, construction or violatlons of any codes. Ev�ry permlt Issued shall becoms invalid
unless the work authorized by such permit is commenaed within slx months of permit Issuanre, or If work authorized by
the permft Is suspended or abandoned for a period oF slx�(6) months after the tlme the work Is cammenced, An extension
may be requested, in writing, from tha B�illding Offlcial for a period not to exceed ninety (90) days and will demonstrate
' )ustifiabte cause for the extenslon. lf work ceases fior niriety (so) consecut�ve days, the Job is considered abandoned.
'WARNING TO OYVNER: YOUR �AIL'URE TO RECORD A'NOrTICE'OF ;COt1AM�NGEM�NT Mi41(�R�SULT IN'YC1UR ''
PAYING'iWIC� FOR IMPROVEMENTS�TO YOUR PROF'ERTY. IP YOU INTEIVD TO OBTAlN �INANCING, GONSULT
WITH UR LE ER 0 N ATT RNEY EFOR� RECO ING dUR NO ICE OF COMMENC�MENT.
FLORIDA,JURAT(F.5.1 � ' : ,
OWN�R �RAGENT CpNTRAG70
s �sc�t bed and swom (or , ihis S�sy (or afflrtne�� ihis
51 b I Zo� t Jyy `�nc'QCl f •
Who Is/are ersona known to me or has ave produced Who Is/are peYSOnall �� to me or hasltlave roduced
• as Identification. y N 1 Ft as idenUflcaqon.,
�
Nvtary Public �"�----� NoOAry Public
Comm(sslon o. .� ( Commissfon No. l.�� �� �
� ' � �' � i-) zi �,(�nr�`
Name of Notary aped; printed o� stamped Name of No�ry q�ped, prinled�or stamped
�'i
MI"fZl VANCE - HI�'ZI VANCE
co�oH � ooq�aoeo ra�w,r. oo�v�,sa�oH �r ooq»aeo
n�ieuc E�O�IES OCT 09 2013 � �(KT��� t!
��� � � � /f1 NlNIMICt 1�GAMMN