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Home My WebLink About11-12370 . . CITY OF ZEPHYRHILLS ,,, 5335 - 8TH STREET �..•' �si3> >so-oozo 12370 ANNUAL FIRE PROTECTION MAINTENANCE Permit Number: 12370 Address: 38635 5TH AVE Permit Type: FIRE PROTECTION MAINTENANC ZEPHYRHILLS, FL. Class of Work: FIRE-PROTECTION MAINTENAN E Township: Range: Book: Proposed Use: CHURCH Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 11-26-21-0010-15000-0090 Improv. Cost: Date Issued: 9/22/2011 Name: UNITED METHODIST CHURCH Total Fees: 25.00 Address: 38635 5TH AVE Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542 Date Paid: 9/22/2011 Phone: Work Desc: FPM- HOOD CLEAN ANNUAL- FIRST UNITED MED CHURCH 5. ; �,� � � �, ,� I �_Z , ina 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." 4 P IT OFFICER PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal �ce - 813-780-0041 813-780-0020 City of Zephyrhilis Fire Fax-813-780-0021 �' ' Permit Application : Received Phone Contact for Pertnit �� ier's Name i(if i+�,� d J C�inmers Phone Number �� r ier's Address � ,� - � � L - (�� - �� Simple Titleholder Name Titleholder Phone Number �� Simple TiUeholder Address Address Lot # � Division Parcel # Q Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent �� FYh��.�+ K�t�en Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL D Controlled Bum � Hood Installation � Emergency Generator < 30 kw � LPlNaturel Gas-Installation � Emergency Generator > 30 kw � LP/Naturel Gas-ANNUAL Sale � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL � emi � er Sprinkler � ❑ ❑ ❑ � Recreational Bum Fire Alartn O ❑ � � Sparklers Hood Cleanin ❑ a SprinklerSystem Installations o Suppression ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) � Fire Alarm Installation � Torch RoofinglTar Kettle � Fire Pumps � Waste Tire Storage ANNUAL � Fire Works a Flammable Application- ANNUAL Valuation of Project � Fuel Tanks Q Other. tractor Company - ' /��s' L/ iature Regis�ered Y/ N Fee Current / Address G.!',<✓�/,r'„�c � G ' ense# :CTRICIAN Company iature Registered Y/ N Fee Current Y/ N Address License # IMBER Company �ature Registered Y/ N Fce Current Y/ N Address License # :HANICAL Company iature Registered Y/ N Fee Current Y/ N Address License # �ER Company iature Registered Y/ N Fee Current Y/ N Address License # ctions: Fill out appfication completely. Owner 8 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) 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 with 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 application 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 detive� 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 invatid 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 affirmed) before me this by by Who is/are personally known to me or has/have produced Who is/are personally known to me or has/have produced as idendfication. as identification. Notary Public Notary Public Commission No. Commission No. Name of Notary ryped, printed or stamped Name of Notary ryped, printed or stamped Date: 9/22/2011 Time: 2:55 PM To: Odioxne Insurance Page: O1 A �� I N SU RAN CE BI N DATE (MMADNYYY) �„�- DER 9�22,20�� THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON REVERSE 31DE OF THIS FORM AGENCY Old Dominion IS15. CO. B�NDERf George H Odiorne Insurance Agency Inc 1192222966 PO BOX H3O pA � EFFECTiVE 7�ME DATE XPIRATION nME X o,rn X i2 oi ,Qrn Brandon FL 33509 9/20/2011 12:01 PM 10/20/2011 NOON PH C N ert : (813) 685-7731 q/� ryo ; (813) 685-1823 TH�S BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY CODE: SUB CODE: PER EXPIRING POLICY #'j'$D AGEN 00016949 DESCWPTION OF OPERATIONSfVEHICLEBIPROPERTY Includin Locdlon CUSTOMER ID: ( Q 1 MISURED Tampa Bay Pressure Washing, Inc. 5051 Windingbrook trail SLEY CHAPEL FL 33544 COVERAGES LIMITS TYPE OF INSURANCE COVERAGEIFORMS DEDUCTIBLE COINS % AMOUNT PROPERTY CAUSES OF LOSS BASIC � BROAD ❑ SPEC GENERAL LIABILITY EACH OCCURRENCE $ 1�000�000 X COMMERCIAL GENERAL LIABILIT �l DAMAGE TO $ 100 � 000 RENTED PREMISES CLAIMS MADE a OCCUR MED EXP (My one person) $ 5, 000 PERSONAL&ADVINJURY $ 1�000�000 GENERALAGGREGATE $ 2�000�000 RETRO DATE FOR CLAIMS MADE PRODUCTS - COMP/OP AGG 2� 000 � 000 VEHICLE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY (Per person) ALL OWNEDAUTOS BODILY INJURY (Peracadent) SCHEDULEO AUTOS PROPERTY DAMAGE HIREDAUTOS MEDICAL PAYMENTS NON-OV�iVED AUTOS PERSONAL INJURY PROT UNINSURED MOTORIST VEHICLE PHYSICAL DAMAGE DED ALL VEHICLES SCHEDULED VEHICLES ACTUAL CASH VALUE COLLISION STATEDAMOUNT $ OTHER THAN COL GARAGE LIABILITY AUTO ONLY - EAACCIDENT ANY AUTO OTHER THAN AUTO ONLY EACH ACCIDENT AGGREGATE E%CE33 LIABILITY EACH OCCURRENCE UMBRELLAFORM AGGREGATE OTHER THAN UMBREILAFORM RETRO DATE FOR CLAIMS MADE SELF-INSUREDRETENTION WC STATUTORY L IM ITS WORKER'S COMPENSATION AND E.L EACH ACCIDENT EMPLOYER'3 LIABILITY E L DISEASE-EA EMPLOYEE EL DISEASE-POLICYLIMIT SPECIAL FEES CONDITIONS/ OTHER TAXES COVERAGES ESTIMATED TOTAL PREMIUM NAME � ADDRESS MORTGAGEE ADDITIONAL INSURED LOSS PAYEE LOAN # AUTHORIZED REPRESENTATiVE Steven Roberts (C) /JSH d �...�y� t ACORD 75 (2007/01) Page 1 of 2 �ACORD CORPORATION 1993-2007. All rights reserved. INS075 �zoo�o��e The ACORD name and logo are registered mazks of ACORD Date: 9/22/2011 Time: 2:55 PM To: Ddiorne Insurance Page: 02 CONDITIONS This Company binds the kind(s) of insurance stipulated on page 1 The Insurance is subject to the terms, conditions and limitations of the policy(ies) in current use by the Company This binder may be cancelled by the Insured by surrender of this binder or by written notice to the Company stating when cancellation will be effective This binder may be cancelled by the Company by notice to the Insured in accordance with the policy conditions. This binder is cancelled when replaced by a policy If this binder is not replaced by a policy, the Company is entitled to charge a premium for the binder according to the Rules and Rates in use by the Company Applicable in California When this form is used to provide insurance in the amount of one million dollars ($1,000,000) or more, the title of the form is changed from "Insurance Binder" to "Cover Note" Applicable in Colorado With respect to binders issued to renters of residential premises, home owners, condo unit owners and mobile home owners, the insurer has thirty (30) business days, commencing from the effective date of coverage, to eva�uate the issuance of the insurance policy Applicable in Delaware The mortgagee or Obligee of any mortgage or other instrument given for the purpose of creating a lien on real property shall accept as evidence of insurance a written binder issued by an authorized insurer or its agent if the binder includes or is accompanied by• the name and address of the borrower; the name and address of the lender as loss payee; a description of the insured real property; a provision that the binder may not be canceled within the term of the binder unless the lender and the insured borrow�er receive written notice of the cancel- lation at least ten (10) days prior to the cancellation; except in the case of a renewal of a policy subsequent to the closing of the loan, a paid receipt of the full amount of the applicable premium, and the amount of insurance coverage. Chapter 21 Title 25 Paragraph 2119 Applicable in Florida Except for Auto Insurance coverage, no notice of cancellation or nonrenewal of a binder is required unless the duration of the binder exceeds 60 days. For auto insurance, the insurer must give 5 days prior notice, unless the binder is replaced by a policy or another binder in the same company Applicable in Nevada Any person who refuses to accept a binder which provides coverage of less than $1,000,000.00 when proof is required: (A) Shall be fined not more than $500 00, and (B) is liable to the party presenting the binder as proof of insurance for actual damages sustained therefrom. Applicable in the Virgin Islands This binder is effective for only ninety (90) days. Wdhin thirty (30) days of receipt of this binder, you should request an insurance policy or cert'rficate ('rf applicable) from your agent and/or insurance company ACORD 75 (2007/01) Page 2 of 2 INS075 �2oo�oi�a