HomeMy WebLinkAbout11-12607 CITY OF ZEPHYRHILLS �
5335 - 8TH STREET '
(813) 780-0020 12607
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 12607 Address: 5538 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: 11-26-21-0010-05700-0250
Improv. Cost:
Date Issued: 12/09/2011 Name: WELLESLEY DEVELOPMENT CORP
Total Fees: 25.00 Address: 34619 SR 54 W
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542
Date Paid: 12/09/2011 Phone:
Work Desc: FPM-QUARTERLY HOOD CLEANING FOR LITTLE CAESAR'S
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Chapter 633, Florida Statutes, authorizes the City to charge and collect user fees M 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 $100.00, whichever is greater. All
work shall be pertormed in accordance with City Codes and Ordinances.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMNT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE
OF COMMENCEMENT."
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P IT OFFICER
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041
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Permit Application
Date Received — ' �'
` ,.,.. Phone Contact for Permit , Q a
Owner's Name .� � l 3-- �� 1��
'� Owner's Phone Number
Owner's Address 5 3 y
Fee Simple Titlehoider Name � � ��
Titleholder Phone Number
Fee Simple TitieholderAddress
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Job Address °,��d�ar�:--�-�.._r._ x _..$�� .�
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Lot # �
Sub Division
F Parcel #
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Bio-Hazard Waste Storage - ANNUAL �
a Fumigation Tent
Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL
� Controlled Burn Hood Installation
� Emergency Generator < 30 kw �
� LP/Natural Gas-instailation
Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale
� Fire Protection Maintenance - ANNUAL �
Places of Assembly-ANNUAL
❑ � emi � er ❑
Sprinkler ❑ ❑ ❑ Recreational Bum
Fire Alarm � ❑ ❑ ❑ C] � Sparklers
Hood Cleaning �� ❑ ❑� � Sprinkler System Installations
Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys)
� Fire Alarm Installation � Torch Roofing/Tar Kettle
� Fire Pumps � Waste Tire Storage ANNUAL
� Fire Works
� Flammable Application- ANNUAL
a Valuation of Project
Fuel Tanks
Q Other:
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Contractor - , .,,�.:,. :�:ti.��:.,- . .�,
Signature Company ¢ � .
Registered Y/ N Fee urtent Y
Address
License #
ELECTRICIAN
Signature Company
Registered Y/ N Fee Cument Y/ N
Address
License #
PLUMBER
Signature Company
Registered Y/ N Fee Current Y/ N
Address
License #
NECHANICAL
iignature Company
Registered Y/ N Fee Current Y/ N
Address
License #
)THER
�ignature Company
Registered Y/ N Fee Current Y/ N
Address
iirections: License #
Fill out application completely
Owner & Contractor sign back of application, �otarized (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 htt //a
� P� Ppraiser.pascogov.com)
NOTICE OF DEED Re STRI�eTtON C unty r gulat9ons. The undersigned a umes spons b Ity for compl a e th any
which may be mo
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work, they may be �equired 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 tnspection 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,
certify that t, 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 "owne�" 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
untess 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
P ITH YO R AN ATTORNEY EFORE RECORDING UR NOTICE O COMMENC MENT.' CONSULT
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FLORIDA JURAT (F.S. 117.03)
OWNER OR AGENT CONTRACTOR
Subscribed and swom to (or affirmed) before me this Subscribed and swom to (or afflrtned) before me this
by bY
Who is/are personally known to me or haslhave produced Who is/are 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 typed,. Printed or stamped