HomeMy WebLinkAbout11-12063 CITY OF ZEPHYRHILLS
. , _ 5335 - 8TH STREET i''�
. (si3) �so-oozo 12063
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 12063 Address: 6251 FORT KING RD
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: 03-26-21-0010-09500-0000
Improv. Cost:
Date Issued: 6/24/2011 Name: ALLIANCE CHURCH OF ZEPHRYHILLS
Total Fees: 25.00 Address: 6251 FORT KING RD
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542
Date Paid: 6/24/2011 Phone: (813)782-8865
Work Desc: FPM-SEMI SUPPRESSION - ALLIANCE CHURCH
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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. 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."
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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
s�s-�so-oo2o City of Zephyrhills Fire Fax-813-780-0021
Permit Application
Datr Received �T Phone Contact for Permit 727-687-1285 �
Owner's Name Alliance Church of Ze h erhills Owner's Phone Number 813-782-886� ��
Owner's Address 6251 Fort Kin Rd. Ze h rhills, Florida 33542
Fee Simple Titleholder Name Alliance Church of Ze h �hIIIS Titleholder Phone Number 813 ��
Fee Simple Titleholder Address 6251 Fort Kin Rd. Ze h rhills, Florida 33542
Job Address 6251 Fort Kin Rd. Ze h rhills, Florida 33542 �ot # �
Sub Division Parcel # 03-26-21-0010-09500-0000
� Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent
� Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or R� Facility) ANNUAL
� Controlled Burn � Hood Instailation
� Emergency Generator < 30 kw � LP/Natural Gas-Installation
� Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale
� Fire Protection Maintenance - ANNUAL n Places of Assembly-ANNUAL ^
ry emi �n t er
Sprinkler � ❑ ❑ ❑ B � Recreational Burn �," n �
� ❑ ; ��
Fire Alarm � ❑ ❑ ❑ Sparklers �
Hood Cleaning ❑ ❑ ❑ ❑ � ❑ Sprinkler System Installations : �;�+� ,�
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Hood Suppression X� ❑ X ❑� � Standpipes (Spnnkler Sys)
� Fire Alarm Installation � Torch Roofing/Tar Kettle
� Fire Pumps � Waste Tire Storage ANNUAL
� Fire Works
� Flammable Application- ANNUAL 175 Valuation of Project
Fuel Tanks
Q Other
concractor Kevin Hoch Company Fire S stems Inc.
Signature Registered Y/ N Fee Current Y/ N
Address P O Box 48741 St. Petersbur , Florida 33743-8741 �icense # _CDL/S'�/a2BB�J/�1t90
ELECTRICIAN Company
Signature Registered Y/ N Fee Current Y/ N
Address
License #
PLUMBER
Company
Signature Registered Y/ N Fee Current Y/ N
Address Licen�e #
t
MECHANICAL 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 $5000)
Supply two (2) sets of drawings with applicable documentation
Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com)
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ACORL7 CERTIFICATE OF �lABlLITY INSURANCE OATE iMM�aLStriYVi
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THIS CERTiPIGATE IS 4SSUED AS A MATTER O� INFORMATION ONLY AND CONFERS NO RlGHTS UPON THE CERTIFICATE HOLDER. THIS
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the terms and canditions of the policy. certain policies may require an endorsemeni. A statement on this certificate doas nat confer rights to the
certiflcate holder in iieu of such endorsement(sy.
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CERTtFlCATE HOLDER CANCELLATIQN
Fire Systams, tnc. SMOULD ANY OF THE ABOYE DESCRIBED POLICIES BE CANCEL�ED BEFORE
TtFE EXP�RA710N OATE T}fEREOF, NOTICE WILI BE DELlVERED tN
ACCORDANGE WfTH THE PQLICY PROVISIONS.
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Attention:
AGORD 25 {2009/08) � 188$-2008 ACORD COR?ORATION. Aii rights reserved.
The ACORD name and iogo are regis#ered marks of ACORD