HomeMy WebLinkAbout11-12314 CITY OF ZEPHYRHILLS
- 5335 - 8TH STREET
(813) 780-0020 12314
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 12314 Address: 38107 MARKET SQUARE DR
Permit Type: FIRE PROTECTION MAINTENANC ZEPHYRHILLS, FL.
Class of Work: FIRE-PROTECTION MAINTENAN E Township: Range: Book:
Proposed Use: MEDICAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number:
Improv. Cost:
Date Issued: 9/02/2011 Name: FLORIDA MEDICAL CLINIC
Total Fees: 25.00 Address: 38107 MARKET SQUARE
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542
Date Paid: 9/02/2011 Phone:
Work Desc: FPM- QUARTERLY SPRINKLER- FLORIDA MEDICAL
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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 pertormed 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
a�s-�ao-oo2o City of Zephyrhills Fire Fax-813-780-0021
Permit Application
Date Re tP'vetl Phone Contact for Permit 813 621 1357
Owner's Name FLORIDA MEDICAL CLINIC Owner's Phone Number �� C� C�
owner's Address 38107 MARKET SQUARE DR , ZEPHYRHILLS, FL 33542
Fee Simple Titleholder Name Titleholder Phone Number �� �� ��
Fee Simple Titleholder Address
L.�
JobAddress 38107 MARKET SQUARE DR., ZEPHYRHILLS, FL 33542 �
Lot #
Sub �ivision CITY OF ZEPHYRHILLS Parce� #
� Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent
� Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL
� Controlled Burn � Hood Instailation
� Emergency Generator < 30 kw � LP/Naturai Gas-Installation
� Emergency Generator> 30 kw � LP/Natural Gas-ANNUAL Sale
� Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL
� r y emi � er ❑
Sprinkler � ❑ ❑ Recreational Burn
Fire Alarm � ❑ p ❑ C� � Sparklers
Hood Cleaning � ❑ ❑ O C� � Sprinkler System Installations
Hood Suppression � ❑ ❑ ❑ �� � Standpipes (Sprinkler Sys)
� Fire Alarm Installation � Torch Roofinglfar Kettle
� Fire Pumps � Waste Tire Storage ANNUAL
� Fire Works
� Flammable Application- ANNUAL $25.QQ Valuation of Project
� Fuel Tanks
Q Other�
Contractor ' '
Company
Signature Registered Y/ N Fee Current Y/ N
Address
License #
ELECTRICIAN
Company
Signature Registered Y! N Fee Current Y/ N
Address
License #
PLUMBER
Company
Signature Registered Y/ N Fee Current Y/ N
Address
License #
MECHANICAI
Company
Signature Registered Y/ N Fee Current Y/ N
Address
License #
OTHER
Signature
JERRY T. BARROW Company R AN FIRE SPRINKLE , INC.
tered N Fee Current N
Address 2 � T T A P License # q 4 2 �
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 applicabie documentation
Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com)