HomeMy WebLinkAbout11-12309 . � CITY OF ZEPHYRHILLS
5335 - STH STREET
'. (sis) �so-oozo 12309
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 12309 Address: 7441 GALL BLVD
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: 34-25-21-0000-00300-0040
Improv. Cost:
Date Issued: 8/31/2011 Name: LONG JOHN SILVERS,INC.
Total Fees: 25.00 Address: 7441 GALL BLVD
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542
Date Paid: 8/31/2011 Phone:
Work Desc: FPM- HOOD CLEAN SEMI- LONG JOHN SILVER
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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
08/31/2011 12:20 3217831516-1 NEW FAX! SPACE COAST PAGE 01/04
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� , BREVARD GOUNTY BUSINESS TAX RECEIpY ACCOUNT N0.
, �Q 1�,� �O''� 1 SUBJECT'FO COUNTY ZONING RESTRICTIONS 9510056
7AX RECEiPT SHQUTA � DtSPLAYED ON PREMIS�S
T+�E dERSON(s�, oR �xr►rv a��.ow: BtJS1NESS PEFt10D: pGTOBER 1, 2410 - SEPTEMBER 30�, 2011
� F�CPIRES: SEPI`��IIBER 30, 201 �
SPAC� COAST FIRE & SAFE'IY iNC
ISSUF� PURSl14NT AND SUBJECTTO FLOR{DA STAMES AND BFiEVAf� CWKiY CODE ISSIfANCE
azo MANOR DR b0E& NOT CEflTiFY COMPI.LWCE WC�N ZOMNG OR OTF�R LAWS
MERRiT7 IS LANO FL 32952 aUSINF.SS TAX RECEIP't iS SUBJECTTO REVI�CATIOM FOR 20NINQ VIOLA110NS, ANC I OR FAllllRE
7o klAN�ITAIk REGIAAI:�RY PRE•REQU�iIT'ES AS P£QIJIii�D fS3R B�31h�5 qASStFlGAT10N(b�� �R
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A PERMIT 1S RC-GRRF�D N AONERI'IS� Qndudmg wah signage) "GOING OUT OF BUSWESS'
LlSA CULLEN, CFC, Brevard County Tax Golle�or
�ocq�ora: P 0 Bar 250a, Tllusville, Florida 32781-2500
420 MANOR DR (321} 264-6914
UNIf1CORP. S. MERR. ISL., FL 32952 UPOk A CiiANGE 0� OWNEpSNIP OR LOCATION,
BUSiNESS TAX RECEIPT SHOULt� BE TRANSFERRED YIRTHIN 30 bAYS.
4WNED BY;
SPAC� COAST ��RE & SA���Y 1�vC EF2p00063
TNpMAS SPINA ETAL, QUALIFIERS
BUSINESS CLAS5IFICATlON6, pISCLAIMFRS, AN� REJITm FEES�
FJCEMPTIONS: NON EXEMPT
F'ENALTY: 5.00
300005 ALARM SYSTEM C�tdTR. I
300240 �1.ECTRICAL CONTRACTOR
300275 FIRE PROTECTION SYST COI�ETR
470240 FIRE EXTINGUISHER S�RV�C6
4802fi5 FIRE PROT�CTION PROUIICTS
5g05p7 NA2 WAST6 GEN. SURCNARGE
820005 2D70 - 20'f 1 RECEIPT AMT $37,00
2011 H,4z WqSTE 40 340.00
RCT. NUM TILL DATE AMT PAID
PAIb-82283f)2.0001-0D01 HST07/931201077.00
BRANCN OFFlGES: Merritt lsland Office, 1450 N. Cou�tanay Pkwy, Merrit4 Isfand, FL 32953 (321) 455-1413
Melbourne Office, i515 Sarno Road, Me1b0Ume, FL 32935 (321) 255-4453
Pafm Bay �ifice, 450 Cogan Dr, SE, Palm Bay, FI. 32909 (321) 952
MAIN QFFICE: 400 South St., 6th Floor, Tdusville, FL 32780 (321) 264-8910, (321) 633-2989, ext 46910
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s��-�ao-oo20 • City of Zephyrhilts Fire Fax-813-780-0021
Permit Application
� Received - Phone Contact for Pertnit ���
� �✓�/'
�er's Name ��� L(//�J /% S Owners Phone Number ���
ier's Address Ob �
Simple Titleholder Name Titleholder Phone Number �� �
Simple Titleholder Address
Address Lot # �
Division Paroel #
� Bio-Hazard Waste Storege - ANNUAL � Fumigation Tent
� Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL
� Controlled Bum � Hood Installation
� Emergency Generator < 30 kw � LP/Natural Gas-Installation
� Emergency Generator > 30 kw Q LP/Natural Gas-ANNUAL Sale
� Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL
� emi �n er
5prinkler � ❑ ❑ ❑ � Recreational Bum
Fire Alarm � ❑ ❑ ❑ � � Sparklers
Hood Cleaning �❑ � ❑� � Sprinkler System Installations
Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys)
� Fire Alartn Installation � Torch RoofinglTar Kettle
� Fire Pumps � Waste Tire Storage ANNUAL
� Fire Works
a Flammable Application- ANNUAL Valuation of Project
� Fuel Tanks
Q Othef:
tractor /f Company /'� � .e a �,�
iature �ibr//d /p�P� Registered Y/ N Fee Current / N
Address License #
:CTRICIAN Company
iature I Registered Y/ N Fee Current Y/ N
Address License #
IMBER Company
iature Registered Y/ N Fee Current Y/ N
Address License #
:HANICA Company
iature Registered Y/ N Fee Current Y/ N
Address License #
iER Company
iature Registered Y/ N Fee Current Y/ N
Address License #
ctions:
Fill out application compietely.
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:l/appraiser.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 witFi any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a 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 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 contractor(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 swom to (or affirtned) before me this
by b
Who is/are personally known to me or has/have produced Who isJare 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 ryped, printed or stamped
'IH Result Reqort P �
08/31/2011 10:30
� Serial No. Aomwiiooi4ss
TC: 39552
Addressee Start Ti�e Tin�e Prints Result Note
913217831516 08-31 10:17 00:05:20 001/002 C011t
913217831516 08-31 10:26 00:04:44 U01/002 OK
T►�: Timer TX. POL p ilinq ORG: Ori ina� Sg FME Eras TX.
Note MBNpX? M po iX ub 1 B Si ea a Bil7dil19 D ire�onl SP: SpC�Cia C 1 S O�'ig if�181. rEa�FP ��S�FaX,TX.
RLY: Relay NB%: Confidentiai. BUL: Builetin. SIP: SIP Fax. IPADR: IP A
i-FAX: Incernet Fax
Result OK: Communication OK, S-OK� Stop Communication, Pw-OFF: Power Switch OFF,
TEL: Rx from TEL, NG: Other Error, Cont: Continue, No Ans: No Answer,
Refuse� Receipt Refused, BusY� Busy, M-Fu11:MemorY Full,
LO�R:Receiuing length Ouer, POUR:Receiuin9 pa9e Ouer, FIL:File Error,
DC:Decode Error, MDM:MDN Response Error, DSN:DSN Response Error.
BB/31/2811 12=20 321783�516-1 NELJ FAX! SPACE COA9T PAOE B1/04
Space Coast Fire and Safety, 1 nc_
�ou>sdfesy rs o,�r
�R20 Maaor Dr_ Merritt Islaad, FL 32952
www.apaceconatsaf�ty.com �
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