HomeMy WebLinkAbout12-12798 ' CITY OF ZEPHYRHILLS
5335-8TH STREET
�sis��so-oo20 12798
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 12798 Address: 38107 MARKET SQUARE DR
Permit Type: FIRE PROTECTION MAINTENANC ZEPHYRHILLS, FL.
Class of Work: FIRE-PROTECTION MAINTENAN E Township: Range: Book:
Proposed Use: MEDICAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number:
Improv. Cost:
Date Issued: 2/16/2012 Name: FLORIDA MEDICAL CLINIC
Total Fees: 25.00 Address: 38107 MARKET SQUARE
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542
Date Paid: 2/16/2012 Phone:
Work Desc: FPM-ANNUAL FIRE SPRINKLER FOR FLORIDA MEDICAL CLINIC
�<�'�—
.�-
l �/
��
inal
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
W�TH 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 �ce- 813-780-0041
� sis-�ao-oo2o City of Zephyrhills Fire Fax-813-780-0021
Permit Application
Date Received � � Phone Contact for Permit 813 621 1357
, _ ,. �;�.s.,.� . . .r..
owner's Name FLORIDA MEDICAL CLINIC Owner's Pnone Number C� � �
owner'sAddress 38107 MARKET SQUARE I�R., ZEPHYRHILLS, FL 33542
Fee Simple Titleholder Name Titleholder Phone Number C� � �
Fee Simple Titleholder Address
. � 's'. �f�-,g,:�',a'w'i°.�.�» - , ,ts:� �r:Y::�a'.�.. '9"�S'a�+q�.F:'.qs�g,^:*j:r r�n ' :4�';�`:'�.�:�k € a
�_ �'^��:._..:
JobAddress 38107 MARKET SQUARE DR., ZEPHYRHILLS, FL 33542 � �ot# �
sub oivision CITY OF ZEPHYRHILLS Parce�#
- . • r , t . a:�:�,�,�:�-�-,. ,.� , .,r .:..��
� Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
� Comm Exhaust Kitchen HoodlDuct � Hazardous Material(Tier II or RQ Far,ility)ANNUAL
� Controlled Burn � Hood Installation
� Emergency Generator<30 kw � LP/Natural Gas-Installation
� Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale
� Fire Protection Maintenance-ANNUAL � Piaces of Assembly-ANNUAL
r y emi �n er
Sprinkler � ❑ ❑ � � Recreational Burn ���
Fire Alarm � ❑ ❑ ❑ � � Sparklers � �
Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Install tions
Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys \
� Fire Alarm Installation � Torch Roofing/Tar Kettle � , i r� ��
�1 v
� Fire Pumps � Waste Tire Storage ANNUAL � �,"I
� Fire Works
� Flammable Application-ANNUAL $25 QQ Valuation of Project
� Fuel Tanks
Q Other
». � . ._rv . . '� .. . "'.•^5.°.k�:-r.a, a :"$P'4 a p,�<�Ma�� .. t .°`:Y'x:'`��'T`i'W1k��'!���`at't'i1'^�'E5°�' .. ..• .."�'. .�
Contractor Company
Signature Registered Y/N Fee Curcent Y/N
Address License#
ELECTRICIAN Company
Signature Registered Y/N Fee Current Y/N
Address �icense#
PLUMBER Company
Signature Registered Y/N Fee Current Y!N
Address License#
MECHANICAL Company
Signature Registered Y/N Fee Curcent Y!N
Address License#
OTHER JEFFERY D BURNHAM �_ /t—�'— Company R AN FIRE SPRINKLE , INC
Signature Registered /N Fee Current Y N
Address 2 1 N. 7 TH T. TAMPA FL 19 �icense# 1531 12
, ... . . . . _ .... . . . .<�__;. „ � , - u.. ., , _ . - . . . ,.�,x ,
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 two(2)sets of drawings with applicabie documentation
Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser pascogov.com)