HomeMy WebLinkAbout12-12768 � CITY OF ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 12768
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 12768 Address: 7838 GALL BLVD
Permit Type: FIRE PROTECTION MAINTENANC ZEPHYRHILLS, FL.
Class of Work: FIRE-PROTECTION MAINTENAN E Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 35-25-21-0010-00700-0000
Improv. Cost:
Date Issued: 2/09/2012 Name: PRIMERICA GROUP ONE
Total Fees: 50.00 Address: 3629 MADACA LN
Amount Paid: 50.00 TAMPA FL 33618
Date Paid: 2/09/2012 Phone: (813)933-0629
Work Desc: FPM- SPRINKLER QUARTERLY/SUPPRESSION SEMI- PUBLIX
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Chapter 633, Florida Statutes,authorizes the City to charge and oollect user fees to pay for the aosts 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."
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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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MAR/28/2007/WED 07:20 AM ZEPHYRHILLS BUILDING FAX No, 813-780-0021 P. 001
813-784-0a20 City ofZephyrhiltsFiiie= Fax-�»-�eo-oo21 't;
permtt Appltcation ._.
. �—.
Date}�aelved �Phone Cbntactior Pem►1t
Umera Name • Owners PhonB Number .� � ��]'1
Owner'e Addresa ' ' ��
Fee Simple Tideholder Name ' - 7ltleholder PhonA Numbar � � �]
KaeSimpleTideholdtrAddrsss ' � �
Job Addreas ' Lvt# • ��
5ub Divlslon Par�e{#
� 910-Hazard Weate Storage–ANNUAL � �� Fumlga0on 7ent .
�., Comm Exhaust K�#�sn Hood/�ucl �• Hamrdous Meterfa((fier 11 or RQ Fadtlry)ANNUAL
� CantroBed Bum � Hcod fnstallaUon
� �mergency G�nerator<3U kw � Q LP/Natursl GAS•InalaUatlon '
•� �Emergency Generalor}80 kw � !PMaturql Gas-ANNUAL Sele ,
Flre Protec6an Malr�tenance=ANNUAL . � Places d Assembly-ArtNUAL
�' emr �� �
Sprinkler D ❑ Reoreatlonsl Bum • ^Q�..�.,
� Fre Alartn �. ❑ t]' ❑ � � Spwidars . ��S}�L.:.11�.il 1
Hood Cleaning p� ❑ p � 3pri�lder'3y51am Installafions .(/� ��U 1� .�{.�,[�/
/ L.1LJ► ILL� 1(>I
Haod 5uppreaslon p fl ❑ � � $(endpipes(Sprintclersys) �
� Fire Alartn Inata�a6an � Tonch Roofing/Ta1'Ketlle , 2� $ I '2
Flre PumPa � � Weate TIre Storage ANNUAL �'
Flre Woilce •
Flammable Applicatlon-ANNUAL � Valuatiof►of PCOjeCt
Fuef Tanks
Q • Other. .
conuaclor _ � ComP�Y
Signaturo ' Regist�rod Fee Curtent N •
Address I� License#
�L.EC7RICIAN � � Compeny �
Signature Regisiered • Y/N Fee Curtent. Y/N r
Add►eee LicanBC# �
PIUMeER ��py
Slgnature Ftegtstered Y/'N Fee Curtent Y/N
nddross � Llcarrea# � •
MECHANICAI_ ���Y
sisnature ►zegtstered Y/N Fae C�xrent Y!N
address •Licanee#
OTH�R , Compeny '
signature Regietered Y/N Fae Curtent Y 1 N
Addreae Llcenea#
Directions;
FlA out application tomp►etaly. '
Owner 8 Con4actor aign baok of application,notarized(Or,copy of eigned contrect wnh ovimer)
If over S�oO.a Notice of Cammencement ie requlred.(Mechenical work wer$6000)
Supply two(2)ee0;of drswlnpe with appllcabte dxumentadon
AlioW 10-14 daye for revlaW afler submiltal dale. Percel#-obtalned irom Property Tax Nodce(httpJ/appreiaer.pascogov.com)
�AR/28/2007/WED 07:20 AM ZEPHYRHILLS BUILDING FAX No, 813-780-0021 P. 002
. 'NOTIG�OF:DE�a�RESTRICTIONS: The.underslgned und'erstands•that this pErmit may-be•subJecf:to�"de�d".�restrictlans"�
which may be more restrictive than Gounty�regulations. The:�ndersigned.assumes responsibility:for:�ompltarace+uvith any .
.applicabla deed restrlotions. ' '
�UNLiC�NSED�CONTE2p►CTORS •AND•CONTRACTOR,RE5P.QNSIBIUTIES: If the owner has•hired•:aycorrtractor-or
contraators rto undertake work,they may be reqwired�to be lficensed in accordance wifh sfate and local-regulations. If the
contractor ls not licensed as required by law, both the owner and•contractor may be cited`for a misdemeaner vlolation
.under st�te law. If�the owner or Intended�cantractor are uncertafn�as to what licensing�requirements may app(y for the
intended work,they Are advlsed'to contact the•Pasco County Bullding Inspection Dlvtsion—Licensing 5ection.at 727-847-
8009. Furthermore, ff the owner has hlred.a contractor or contt'actors, he Is advised'to•have�the cor�t-actor(s) sign
portions o�the"contractor 61ock" of thls application�for which"theY wlll be responslbie. tf you, �'s�the owner�sign'as the
cordracto�, that may be an indication�that he is�not properly(laensed and Is not en6tJed�to�permitting.privileges in Pasco
County. � '
CONSTRUC'TION•L.tEN.LAW(Chapter713,�Florida Stetutes,•as•amended): Ifvaluation of Work(s'$2;500.00 or more, I
certify'that I, �he appl'►cant, have .been provided with a copy of'the °Florida Gonsfivetion.l.ien. Law—Homeowner's
Protection Gulde°prepared by�the Florlda pepartment of Agriculture and Consumer Affairs. If the applicant is�someone
other than the°owner", I certify thaE!have obtained a copy of the above descrlbed document and promise in good faRh to
deliver it to the"owner"prior to comrnencement. • '
- CONTRACTOR'SlOWNER'S�AFFIAAVIT: 1 certify that all the information fn�this applicaElon is accurate and
that all work will be dbne In compllance with al! applicabte laws regulattng constru�tion; zor�ing and land
development. App(ication Is hereby made to�obtain a permit to do wnrk and installation as fndicafed_ I cert�fy
that no work or installation has comrnenced prior to issuance of a perrnit and•that all work wlU be performed to
meet standards of all laws regulattng oonstruction, Cpunty and Clty codes.�zoning regulatlons, and land
development regulations In the jurisdiction. I also certtfy that I underst-and that the regulatlons of other
government agenaes tnay apply to the intended worl�and that it is my responsibilliy to identlfy what act{ons I
must fake�to be In compliance. '
if I am the AGEN'C fORTH�OWfJER, I promise Iri good faith to Inform the owner of the permitting conditions set forth in
thts affldavlt priar io commencing cortstruction. �I understand that a separata permit may be required for electrical work,
plumbing, signs, wells, poals, air conditioning, gas,.or other Installatlons not specifically Included in the application. A
permit lssued shall be construed to.be a Ilcense to proceed with the work and nof as authority to violate, cancel, alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the�uilding.Official f�orn thereafter
requiring a correction of errors in plans,construction or violations af any codes. Every permlt Issued shall become invalid
unless the work authorized by such permlt is commenced within six months of permit Issuanre, or If worlc authorized by
the permft Is suspended or abandoned for a period aF slX(�)months after the tlme the wark Is commenced. An extension
may be requested, in wrlting,from tha Bullding Offlcia)for a period not to exceed ninety(90) days and will demonstrate
)ustifiable cause for tHe extenslon. lf work ceasas for niriety(s0)conseciitive days,the)ob is cor►sldered abandoned.
'WARNING TO OWNER: YOUR �AIL'URE TO RECORD A'PICIrTTICE'OF.COMM�NCEM�NT M741('R�SULT lN'YUUR " '
PAYING TWIC�FOR IMPR01/EMENTS�TO YOUR PROp�RTY. IF YOU lNTENDTO�BTAIN�INANCING,CONSULT
WITH OUR LENDER O1�AN ATT'ORNEY�EFORE RECORDING YdUR NO'fICE OF CpMMENC�MENT.
FLOR{DA JURRT{F.S.117.03) ' '
OWN�RORAGENT CPIJIRAGTOR -� �
e��`�svw to( )b� e me this S and ol'afflrtned efore this
by .
Who I a oYne krwwn to me or h ave produced Who slar ersor ly known to me or asThave producad
_ �� as Identification. _��� � as idenUflCadon.
Vt---� Notary Public NoC�ry P�{iC
Commlesl No. �"t l��(� Commisslon No. 1 ��,�„`�t_� ��-J —
�1�?� �� . , �1 i.�QrY�P
N8m'e of Notary�ped;pnn ed of stamped Name'of Notary typed,pnnted or stamped
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