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Home My WebLink About12-12689 . CITY OF ZEPHYRHILLS �, , 5335 - 8TH STREET (si3) �so-oo20 12689 ANNUAL FIRE PROTECTION MAINTENANCE Permit Number: 12689 Address: 7643 GALL BLVD Permit Type: FIRE PROTECTION MAINTENANC ZEPHYRHILLS, FL. Ciass 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: 3425-21-0010-03100-0000 Improv. Cost: Date Issued: 1/12/2012 Name: CHILI'S BAR & GRILL Total Fees: 25.00 Address: 7643 GALL BLVD Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542 Date Paid: 1/12/2012 Phone: Work Desc: FPM- HOOD CLEAN QUARTERLY- CHILI'S 11� �/-�� ma Chapter 633, Florida Statutes, authorizes the City to charge and wllect 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." �.. P IT OFFICER PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal OfFce - 813-780-0041 $13- t;it ot �e h rnnis rire Y P Y fax-s�e-isu-uul� Permit Application Date Received � �� Phone Contact for Permit �s�' . ... � v � � Owner's Name ( G � �� Owner's Phone Number Owner's Address Fee Simple Titleholder Name Titleholder Phone Number �� Fee Simple Titleholder Address � - " . .:.r .i�Bs4+3°' ��', ab`:.:d;��`. _..�,L;_ - _ . ' - - - - - _:rt:��€s4.�'�'C4�"��.�a «�.>.m'A�"�t"zTxFf^8c_ _ ° � », Job Address �j� E Vu 1r c.� �Y Lot # � Sub Division Paroel # a t �. .< m..�,a:�� • . . �''��_�� : �. „ - . ` - .: . _ . , . .. _ - il�ae�.:*�:_ .,,, �7»p:,, ._ ��lm _ 'C�.s�.�ne�caa:, ,s�.�....r.+tx �r;,.r..s:,^_M: a.',�> �..r � Bio-Hazard Waste Storage - ANNUAL � 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-Instaltation � Emerge�cy Generator > 30 kw � LP/Natural Gas-ANNUAL Sale � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL ❑ � emi � er ❑ Sprinkler ❑ O ❑ Recreational Bum Fire Alarm � ❑ ❑ ❑ � � Sparklers Hood Cleaning � q ❑ p C� � Sprinkler System Installations Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) � Fire Alarm Installation � Torch RoofinglTar Kettle � Fire Pumps � Waste Tire Storage ANNUAL � Fire Works � Flammable Application- ANNUAL Valuation of Project � Fuel Tanks Q Other: Z , >f'v�F" ...., n . .,..y.�:.0 re.�-. ..°YtYr_'�""':.'"as:o.?'."�_ eo_: -,�s i .. ° . .. .. , Q: ::.X'�"9cT -� - t_ r:" '+«l,,� `Y'XA�++^:'.xz>c=�� ' @�..- .v ,�,_ Y,rv ....: � : 'T!:S..roL" t!, 4FF'r; e, Contractor �� Company � Signature Lq ✓ 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 # MECHANICAL Company Signature Registered Y/ N Fee Current Y/ N Address License # OTHER Company Signature Registered Y/ N Fee Current Y/ N Address License # �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 Mro (2) sets of drawings with applicable documentation Allow 10-14 days for review after submittal date. Parcei #- obtained from Property Tax Notice (hrip://appraiser.pascogov.com) NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restFictions'° which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with arty 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 Lav�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 atl 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. Apptication 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 wo�k will be performed to meet standards of atl 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 justfiable 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 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 haslhave produced as identification. as identification. Notary Public Notary Public Commission No. Commission No. Name of Notary ryped, printed or stamped Name of Notary typed, printed or stamped qC Q• OP ID: SM �.,...- CERTIFICATE OF LIABILITY INSURANCE �A�IMM/DD/YYYY) 01/11/12 THIS`CERTiFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRAAATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certif�cate holder is an ADDITIONAL INSURED, the policy(fes) must be endorsed. If SUBROGATtON IS WAIVED, subject to the tertns and conditio� of the policy, certain policies may requi�e an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorseme s). PRODUCER 8�_967�� CONTACT Mulling Insurance Agency, Inc PHONE P O Box 308 208 E Park Str+eet $��s�"�592 Fax No : Auburndale, FL 33823-0308 E �� Brien Spann, AA1 � ° M�i ; SUNS-13 INSURE 3 AFFpRDING COVERAGE NAIC # INSURED Sunshine Pressure Cleaning, In iNSUr�n: United Fire 8� Casual 13021 Joseph Zarbo �NSUr� e : PO Box 5836 Lakeland, FL 33807 INSURER C: INSURER D • INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WiTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SI;BJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOVIM MAY HAVE BEEN REDUC€D BY PAID CLAIMS. IN LTR TYPE OF INSURANCE POLJCY NUMBER MM�fDD � M�p � tJM1T8 OENERAL LUIBILITy EACH OCCURRENCE $ ') �OOO�OO A X COMMERCIAL GENERAL LU181LIN 0399610 01/07/12 01/07/13 pREMISES Ea aoaurence $ ��Q� CLAIMS-MADE a OCCUR MED EXP (Nriy one per�p�� g §�(a PERSONAL&ADVINJURY $ 'I,OOO,OO GENERALAGGREGATE $ Z�OOO�O GEN'L AGGREGATE LIMfT APPLIES PER: POLICY PR �p� PRODUCTS - COMP/OP AGG S Z,OOO,OI) AUTOMOBILE LIABItJTY S COMBINED SINGI.E LIMR A ANYAUTO 60399610 o�ro��12 01/07/13 �Ee�'a�"`> $ �,000,00 ALL OWNED AUTOS BODILY INJURY (Per pergon) $ X SCHEDULED AUTOS BODILY INJURY (Per apcidern) g X HIRED AUTOS PROPERTY DAMAGE $ (Per accident) X NON-0WNEDAUTOS S X � � X OCCUR $ �xcESS uae encH occuwzENCe s 1,000,00 A CLAIMSaVMDE AGGREGATE $ 'I,OOD DEDUCTIBIE 60399610 01/�T/�2 �1/�7/13 X RETENTION S �O�OOO $ WORKERS COMPENSATION S AND EMPLOYERS' LIA8161Ty OC STATU- 07}{- OFFIC UDE� Y ❑ N/ A r (Mandatory in NN) E.L. EACHACCIDEN, g yes E.L DISEASE - EA EMPLOYE $ DESCRIP�TIO�N pF ppERATIONS below E.LDISEASE-POLICYLIMIT $ DESCRIPTION OF OPERATIONS! LOCATION8 / VEHICLES (Nhch ACORD 101, Additlonal Remarks SehedWe, K moro space is requked) CERTIFICATE HOLDER CANCELLATION CITYZEP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE YYILL BE DELNERED IN City of Zephyrhitis ACCORDANCE WITH THE POLICY PROV1310N3. Building Department 5335 8th Street �UJTNORIZED REPREgENTATIVE Zephyrhills, FL 33542 !��? � �-- � 1988-2009 ACORD CORPORATION. AII Hghts reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD � O D� > ' apOC c�n m z p� e �1 �oo Z � � cn t � aX� v��i p D �c o m �wO Z o m�� O �, P' � � � m m A O � L W � D �n Q a C � p O � D f '�' ° p m u, m � C O � �ij n r N � o, r m Z o m Z D � ° v ° � � � � o m m � � � � nn o n r� �' D -� o n � w �. r * . �' -� D o � � � ° O � m � �° o a � o t ° ., � 8 v � o n n � � o rn Z> � -+i � o z 3 � D r D �Z � �� Z � � -� � � � v R1 Z u m � � � x W �� r � � "� m �° � �^ y o � � m 171 o �� D � N v _ � � fn � r r V) (Q D� n W < n � r � �� m O 1 y m m �i C � N fp - y � m X "'�°"'°�z�:.--a'�- / � m t €�' �„..«.. ,� ?:k� r � �+ � � 'T � �� o �" C� � � � 'r' D� � �`J . .` i3 Oc �- ' s w'� Z � q :� : - _ . , " i .+ $ m � ; �`�..- .•��-'� � . ,r' � '�.., '�....�.,- , . �, --.,��r°.=-"� .� A �,. °Rp� CERTIFICqTE OF LIABIL ITY I N S U RAN C E �ATE (MM/DD/YYyY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE7WEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certiticate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Risk Transfer Programs, LLC �A 219 East Livingston Street NAME: Orlando, FL 32801 PHONE gg�qg�_9363 FAx — A/C No Ext : NC No : E-MAIL ADDRESS: — INSURER S AFFORDING COVERAGE NAIC # INSURED INSURER A:CastlePOint National Insurdnce Com an CoAdvantage Corporation 40134 iNSUrteR e.Tower tnsurance Com an of New York 3350 Buschwood Park Drive 44300 SUite 200 INSURER C : Tampa, FL 33618 INSURER D -- INSURER E : --- COVERAGES INSURER F ; — CERTIFICATE NUMBER:P�sctsMNY THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAM D E T P OLICY PERIOD INDICATED. NOTWITHSTAND�NG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AD U LTR TYPE OF INSURANCE POLICY EFf POLICY EXp GENERA� LIABILITY POLICY NUMBER MMlDD MM/DD — LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE � OCCUR PREMISES Ea occurrence $ MED EXP (Ariy one person) $ PERSONAL a ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PR� LOC PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY $ COMBINED SINGL LIMIT ANY AUTO Ea accident $ AUTOS NED SCHEDULED BODILY INJURY (Per person) $ AUTOS NON-OWNED BODILY INJURY (Per accident) $ HIRED AUTOS AUTOS PROPERTY DAMAGE -- Per accident $ UMBRELLA LIAB g -- OCCUR EXCESS LIAB CLAIMS-MADE EACH OCCURRENCE $ DED RETENTION $ AGGREGATE $ A WORKERS COMPENSATION WSLTHPE00008208 $ B AND EMPLOYERS' LIABILITY WSLTHPE00030002 01/01/2012 01/01l2013 X ORY LIM T � R ANY PROPRIETOR/PqRTNER/EXECUTIVE Y! N OFFICER/MEMBER EXCLUDED? ❑ N/ A E.L. EACH ACCIDENT (Mandatory In NH) $ 1,000,000 If yes, describe under DESCRIPTtON OF OPERATIONS below E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 $ a s DESCRIPTION OF OPERATiONS / LOCAilONS / VEHICLES (Attach pCORD 107, Additional Remarks Sehadufe, if more s ace is $ Coverage is extended to the leased employees of alternate employer in all states except in monopolistic stat (ND,�OH, WA, WY): Sunshine Pressure Cleaning, Inc #4103507 (Effective 9/25/11) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PRONISIONS. AUTHORIZED REPRESENTATNE �rnon �c i�n�n�ns� Page 1 of 1 OO 1988-2010 ACORD CORPORATION. All rights reserved. T►... wrnor� ......... .....� �...... .,... .....:��......� ......�� ..s nrnon