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Home My WebLink About11-12637 • CITY OF ZEPHYRHILLS 5335 - 8TH STREET (si3) �so-oozo 12637 ANNUAL FIRE PROTECTION MAINTENANCE Permit Number: 12637 Address: 4330 20TH ST 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: N/A Est. Value: Parcel Number: 13-26-21-0070-07400-0000 Improv. Cost: Date Issued: 12/20/2011 Name: ZEPHYRHILLS CORP. Total Fees: 25.00 Address: 777 W. PUTNAM AVE Amount Paid: 25.00 GREENWICH, CT 068305091 Date Paid: 12/20/2011 Phone: Work Desc: FPM-SEMI SUPPRESSION FOR ZEPHYRHILLS BOTTLED WATER 5. �f d"~- �,�,-(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 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." � 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 sis-�so-oozo c,ity ot �ephyrnuis rire raX-ei�-iao-uuz� , Permit Application Date Received '� Phone Contact for Permit ' � .,. . . , . . _ _ � �.. . . . . � _ .. Owner's Name � Owner's Phone Number �� C� � Owner's Address Fee Simple Titleholder Name Titleholder Phone Number � C� �� Fee Simple Titleholder Address 6 _ c:: ..�s.a� _:�-�e�� _ �:��."��.7�,s:�.�.�at:�:.°.zt- as".�= .:�� .�""�"2T,'-_ _ . ":u3':�"":�,.'�«^"�.`+�` Job Address � Q `� � �� Lot # Sub Division Parcel # e „.. .� . ra,e�c:�:;,: av v.sa . - - - - - -- '.. - - - - ..�--��rrm. --v - _ _ "m .vn.�:»m,PK�;- ._ � ��.. a Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent d � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL � Controlled Burn � Hood Installation a Emergency Generator < 30 kw � LP/Natural Gas-Installation � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL ❑ �y emi �n er ❑ Sprinkler ❑ ❑ ❑ Recreational Bum Fire Alarm � ❑ ❑ p � � Sparklers Hood Cleaning � ❑ � ❑� � Sprinkler System Installations Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) � Fire Alarm Installation � Torch Roofing/Tar Kettle � Fire Pumps a Waste Tire Storage ANNUAL � Fire Works � Flammable Application- ANNUAL Valuation of Project Fuel Tanks Q Other � <.:��. . __ . �Kt �� F� �.��,�� :�:�.�� ,:. , .�-�.�:��,., . � u,�.�>�.a.,. ,. --�- . ��;. � 'K.. 6"tF"?�L.�s.wh':.e4'J. Contractor Company Signature Registered Y/ Fee Current / 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 # MECHANICAL Company Signature Registered Y/ N Fee Current Y/ N Address License # OTHER Company Signature Registered Y/ N Fee Current Y/ N Address License # k 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 lwo (2) sets of drawings with applicable documentation Allow 10-14 days for review after submittai date. Parcel #- obtained from Property Tax Notice (http:/lappraiser.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 (Chapte� 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 wi�l 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 I.ENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. FLORIDA JURAT (F.S. 117.03) OWNER OR AGENT CONTRACTOR Subscribed and swom to (or affirtned) before me this Subscribed and swom to (or affirtned) 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 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 ��_��a�� °�� i�� ss��a �ys#+e�s ��r�t � r --- - -- ----- 3E3V'C'=G.,.,1P�,P, --- --------, , i.a,rJf'SE ��cE ------rir�,— -- — a.n��. err ' � � � ` ��-----+ � � '_ � I —r-- �J � I�.�; V.JAL i SEMI-ANPIUA� RECHARGE ; iNSTALLr`T,OP! RENpVATION I � --- --- _ � � -------- � ( _ �:SA?lc�N C� SYS i ENi CYUNDERS UL 300 7 _ : . � _ , " QYES ❑ NO I � ViANUFACT�F,ER MQCEL MUMBER � WET DRY CMED/ICAL � i �- � � ; - =- -- , „' " -� i � CYLINDER SIZE UtASTEa ' CYLINDER 5! I � , i Zc SLAVE � CYLINDER 3iZE SLAVE � i _ .. ' ' -- ' FUSc L3MKS 3&0" F FUSE LINtC$ 450` F. FUSE L1NKS S00° T O7HER CUSTQ(�1ER ; I�Ic1tTt8 . • I _ ` FUEL SHUT-OFF ELECTRIC GAS S32E � Address � ` - ` '> , �, - `" SERIAL NUMBER LAST HYDRO TEST DATE traST RECHARGE QATE C��,�.- ; _ ° - z ; State� i - . ZIP , � � : :� �'� rr f' --� ' �`° ' � ..�L� - - �s'f,, f`r x:,. _ . . n_,�:�. ; J -c„ •: � •, " tvIANUFACTURER'S MANUAL REFERENCE " � ,�' ? �i Tefephone_.� ' � � Store No. ,,, -, PAGf NUMBER: pFAWWG NUIv18ER DATE Owner or Manager _ - . COOKING APPLIAPICE LOCATIONS. LEFT TO RIGHT , -- . � , ' ' y` & J ¢ - � ,- � �7 f Ali appliances pr�perly covered w/correct nozzles "`� 20. Replaced fuse links �� _ 2. Duct and pienurr covered w/correct nozz es �`"� 21. Check travel of cable nuts/S-hooks 3. Check positionin � of all nozzles. °° 22. Piping & conduit secure(y bracke#ed �-- ` 4 System installed in accordance w/MFG UL listin �-�` �,. F 9 23. Proper separation be#ween fryers & flame � ��:= � 5 Hood/duct penet�ations sealed w/weld or UL device ��°" 24 Proper clearance-flame to filters r� � :� 6. Check if seals intact, evidence of tamperi�g --'� � 25_ Exhaust fan in operating order �� •-�` 7. If system has been discharged, report saine �"' 26. Ali filters in place / �,:=� 8. Pressure gauge �n proper range (If gauged) --' 27. Fuel shut-off in on position 9 Check cartridge �veight (if applicable) ` � 28. Manuaf & remote seUseals in piace ~ 10. Hydrostatic test clate ` �'�: ' ' 29. Replace systems covers 's _ y ,, 11. 6 year maintenarce date =`-�'�` 30. System operationai & seals in place ��' 12. Inspect cylinder �nd mount �..�' 31. Slave system operationa! ,� ��;' 13. Operate system from terminal link �;.-' 32. Ciean cylinder & mount 14. Test for proper operation from remote 33. Fan warning sign on hood ,�" 15. Check operation of micro switch �--°' 34. Personnel instructed in manual operation of system ' 16. Check operation of gas valve ,r'f ��'" 35 Proper hand portable extinguishers .�.-•� 17. Clean nozzles 36. Portable extinguishers properly serviced �--- 18. Proper nozzle covers in place >.�-_' 37. Service & Certification tag on system 19. Check fuse links and clean �'',-''� NOTE DISCREPANiCES OR DEFICIENCIES BELOW COMMENTS: On this date, this pre-engineered fire suppression system was inspected and operationally tested in accordance with the fire suppression system requirements of NFPA17 or 17A, 96 and the manufacturer's manual with the results indicated above js f y ;l j i .f X � f '^ , - � :' �_ � " J f '� ,;' l #- �� ; .: t t / ,-� r° �,.^ r r, ,. � fi � ` � f � � �j r . ' ; /:' � _ .a� �� ;� f �{ ,3' �/ •�' � �l 4 ffi i � . �' ! . SER1%ICE TECHNICIAN PERMIT NO. DATE: TIME: AM PM CUSTOMER'S AUTHOR�ZED AGENT The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report. DlST'R1�UTOR TRANSMISSION VERIFICATION REPORT TIME : �6I1312�11 �7:23 NAME : STC FAX : 8137375543 TEL : 5137375543 SER.# : 000M9N268692 DATE,TIME 06I13 �7:22 FAX N0./NAME 7800044 DURATION ��.@� PAGE(S) 0� RESULT OK MODE STANDARD ECM