HomeMy WebLinkAbout12-13002 CITY OF ZEPHYRHILLS J
� 5335-8TH STREET
�si3��so-oozo 13002
FIRE SPRINKLER SYSTEM PERMIT
Permit Number: 13002 Address: 7910 GALL BLVD
Permit Type: FIRE SPRINKLER SYSTEM ZEPHYRHILLS, FL.
Class of Work: FIRE-SPRINKLER SYS 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: 515.00
Date Issued: 4/30/2012 Name: PRIMERICA GROUP ONE
Total Fees: 50.00 Address: 3629 MADACA LANE
Amount Paid: 50.00 TAMPA FL 33618
Date Paid: 4/30/2012 Phone: (813)933-0629
Work Desc: REPLACEMENT PART FOR BACK FLOW STAPLES
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FIRE ACCEPTANCE Final
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
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO BTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN O BEFORE
RECORDING YOUR NOTICE OF COMM
ONTRACTOR SIGNATURE PERMIT OFFICER
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOURS NOTiCE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT- 813-780-0041
b13-io�-0020 City of Zephyrhills Fire Fax-813-780-0021
Permit Application �� �
late Received / Phone Contact for Pertnit �( �
..�.� :..w .r�.�,��.:,�, ..� �+�i���,��,�n�s��a
Nvner's Name Owner's Phone Number C� �� ��
Tnrner's Address 79/b l�
ee Simple Titleholder Name Titleholder Phone Number C� �� �
ee Simple Titleholder Address
_ tl�F`�..'S.t' _
���,_'r".-.«!r�L�«
ob Address � /l Lot# C�
iub Division Parcel#
�::�n�._�r.w.^.�°- . _ _ . . _ ac-�ssv . ,. _ �
� Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent � �
� Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier ii or RQ Facifity)ANNU/� �
� Controlled Bum � Hood Installation W Q
� Emergency Generator<30 kw � LP/Natural Gas-Instaltation W �
Pp a
aEmergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale � Q
� Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL a �
�y emi �n er 't x �
Sprinkler � ❑ ❑ ❑ B � Recreational Bum ,�/ .�G�v � � ��
z �,N
Fire Alarm � ❑ ❑ ❑ � � Sparklers �
a �
Hood Cleaning � ❑ � ❑ � Sprinkler System Installations A
Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) w �"
� Fire Alarm Installation � Torch Roofing/Tar Kettle � W 3
� Fire Pumps � Waste Tire Storage ANNUAL � � � '"ti�'
aFire Works `� � � ��
� Flammable Application-ANNUAL -� Valuation of Project
� Fuel Tanks
Other: �C{,tG,� � c � w
E _�.� � � �. ����- �� � �.�.���.��.t . n�-.
Contractor Company
5ignature �L Registered Y/N Fee C�urrent 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 two(2)sets of drawings with applicable documentation
Allow 10-14 days for review after submittal 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(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 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 taws 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
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 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 affirmed)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
Apr, 16. 2012 10:55AM INTERNATIONAL FIRE PROTECTION No. 1133 P, 1
FiRE PROTECTION, INC.
� JASON G. DEAN LIC�NS� #20080000012010
"COMPL E TE FIRE PRO TEC TION SER V1 CE" �
1402 MERCANTILE COURT
PLANT CITY, FL. 33563—t 151
PMONE: 813-754-7383
FAX: 813-754-1638
E—MAIL: wayne.lenigan�ifpinc.us
NUMBER OF PAGES S�Nt ��__ (INCLUDING TWIS COVER SHEET)
IF YOU DO NOT RECEIVE ALL PAGES, PLEAS£ CALL ABQVE NUM6ER.
To: C" �T`C a F �.�c4+�.�'�� +���.� s ►`�7 V a Cr . �EP�-,
Company: � �� � '� $ r � �f Ll
From: Wayne Lenigpn, District Design Monoger �iA-�,2� K-�R,,,� w _ ,
Date: � "' ` �Q r , F � �G� ���GL1�(�+�
R e: r3 P►c�.F�.�w P R.���ea�� o N. B FP ��' P�s
Messoge:
S P�C. � Nrcrc� ��-r4-���E-'a.�. �'�Q....
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Original: ❑ Will 8e Sent Vio: ❑ US Moil ❑UPS ❑ FedEx D Other_____�^
ill Not Be Sent nless Requested
cc:
Apr, 16, 2012 10: 55AM INTERNATIONAL FIRE PROTECTION No. 1133 P, 2
• • ' � �
SPEGIFI�ATIQN SUBMITTALSHEET
APPi.ICATION
Designed inr insfallaGon on potable water lines to protect
�n, , agalnst both backsiphonage and backpressure of paliuted
water into the potable water supply.Assembly shafl provide
protection where a potential health hazard does not exEst.
STANDARDS COMPLIANCE
(All sizes approved horizontal. Vertical epprovals as
Ilsted belvw.)
FEA7URE8 • ASSE�i Llsted 1015(vertfcal 314", 1 1/4',1 1/2"&2'}
• IApMO�Listed(vertical 1 1/4"-2")
Sizes: �3/4" 01" q 1-1/4" O 1-112" O 2" ' CSA� Llsted(vertical 3/4", 1 1/d",1 1/2"8�2u)
• AWWA Compliank C510(vertica!3/4")
Mexlmum working water pressure 175 PSI • UL�Class�led(les$shut-off valves only)
Maximum working water temperature 180°F • C-Ul.�Classlft�d(leas shut-off vahres onl�
Hydrostafic test pressure 350 PSI . Approved by the Foundation for Cross Connoction
�nd connections Threaded ANSI B1.20.1 Control and Hydraulic Research at the Universlty of
OPTIONS Southern Californla(verlical 3/4'}
(Sufflxes can be combined) • Gity of L.os Angeles Approved(vertical 1-1/4"-2")
• NYC MEA 428-89-M VOL 3
� - with tull port QT bali valves(standard) �yAT�RIALS
G] L - less ball valves M a i n v a lv e b o d y C a st B ron z e ASTM B 584
d U - w i t h u n r o n b a f l v a l v a s Access covers Cast BronzeASTM B 584
O S - with bronze"Y"type strainer Internals Stainless Steel,300 Series
O TCU - With test cocks"vertical"up
❑ V - with unlon swlvel elbows(3/4"& 1°) Elastomers Sificone(FbA approved)
0 d5Y - with QS 8�Y gste valves Buna Nitrile(FDA approved)
0 FDC - with fire hydraht connection(2"only) Polymers Noryl ,NSF Llgted
O FT - wlth Integre�l mate 45°flare SAE test fltting Springs Stainiess steel,300 serles
ACCES80RIES
�E
[7 Repalr kit(rubber only)
Ct 7hermal expanslon tank(Model WXTP) F c�
O Q7-SET Quick Test Fitting Set
O Test Cock Lock(Modei TCL24)
p c a
A�
DIMEN310NS 8�WEIGHTS(do not Include pkg.) G
pIM�NSIONS a roxlmate WEIGH7
MODEL A UNION B LESS BALL LESS WITM
SIZE A BAII VALVES C b E F G �ALL BALL
VALVES VAI.V�S VAWES
In. mm in. mrn in. mm in. mm in. mm in. mm in. mm in. mm in, mm Ibs Iba.
3/4 20 11 1/4 266 !21/2 31 S 7 178 1 1/2 38 3 76 31/2 69 3 76 15 381 5 2.3 7 3.2
1 26 121/4 311 13 7/8 353 7 979 1 9/2 38 3 76 31/2 69 3 76 17 3/4 451 8 3.6 12 5.4
1 1/4 32 151/2 416 161l2 470 10 9/16 288 2 51 31/2 89 4 112 114 4 112 114 21 1/2 546 76 7. 2 10
1 1/2 40 171/8 435 19 1/8 486 10 8/16 268 z 51 31/2 89 4 1/2 114 4 1/2 114 22 3J4 578 i8 7.3 22 10
2 50 181/4 aG0 20 5os �0 9�16 268 2 51 3112 89 41/2 114 4 1/2 114 251/8 638 16 r,3 28 12.�
. �
page 9 of 2 WiLKIN3 a Zurn compeny,1747 Comma�ce VMay,Paso Roblos,CA93�46 Phone:e05/238�100 Fax;806/298-6766
In Canada:2UttN INDUSTRIeS��MITED,3544 Nashua Dr.,Missies�uga,Onlairio l4V 1L2 Phone:906l406•8272 Fax:906l405-1292
Product 9upport Help Llne:1•877•BACKFLOW(1•er�-�sz•6866) � 1Nobslta:htlp:llwww.zurn.corn
Apr, 16, 2012 10:55AM INTERNATIONAL FIRE PROTECTION No. 1133 P. 3
FLOW CHARACTERISTIC$
MODEL 850X�4",1",9 11b",1 1l2"&2"(STANDARD 8 METRIC)
R�ow�YES N6>
1.26 2.52 3.8 5,0 3.2 �! 8.5 1 15.103 �
��5 3/�°(2ornm} 1•( m) �6 tl4"(s2mm 1 '(�
� 10 10 �„��mm� 69 �
w
6 5 � �
0 0 �
0 20 40 BO 60 D 60 04 130 00 250
FLOW RATES(GPM)
0 Ratsd FSow(EslebNshed by approvel apanclee)
TYPICAL INS7ALLA7IGN CapacKy thru Schedule 40 Pipe
Local codes shall govern installation requlrements. To bo piAe size 5 fVsec 7.5 iUsec 9 0 Rlsec 15 ff/sec
installed in accordancewith the manufscturer's instructions 1!8" 'f 1 2 3
and the latest edition of the Uhitorm E'lumbing Code.Unless 114" 2 2 3 5
otherwise specifled,the assembly shall ba mounted at a 3/8" 3 4 6 8
mihlmum of 12*(305mm)and a maximum of 30"(762mm) �/2 5 7 8 14
above �dequate dralns v�Ilh sufficient side ctearance for � 3/A" 8 12 17 25
testing and mainten�nce. The installation shall be made 1" 13 20 27 40
so that no part of the unit can be submerged. 1 1la" 23 35 47 70
11/2" 32 48 63 95
2" 52 78 105 167
PRO�cnve�
ENCIOSURE �'�
S'M.
' :.
b e�
� �.�:
. �
:�
1 z°MIN. �r'MIN
30"AAAX. �: . 30"MAX
"•�• •'!" '�• ..�� ' . . . .
.� ' ,.r r., �. '•
DIRECTION OF FLOW � DIRECTION OP fLOW �
OUTDOOR INSTALLATION INDOOR iNSTA��AYION
SPECIFICATIONS
7he Doubte Check Va4ve Backflow Preventer shall be ASS�� Llstad 1075 approved, and supplied with tull port ball
valves.The main body and access cavers shall be bronze(ASTM g 584),the seat�Ings and sll Internaf polymers shall
be NSF�l.lsted NoryITM' and the seat dlse elastomers shall be sllicohe. The first and second checks shall be actes-
slble for maintenance wlthout removing the device Nom the Iltte.Tho Double Check Valve Backflow Preventer shall ba
a WILKINS Model 850XL.
WILKINS a Zum wmparry,1747 Commerce Way,Paso Robles,CA 03446 Phone:80S1238-7700 Fex:8051Z38�7fi6
!N CANADA:ZVaN INDUSTRI�S�IMIT�P,3544 Nashua Dr.,Mississauga.Onla�o L4V 7L2 Phone:9061406•8272 Fax:9061405-1292
Produot 9uppo�t Help Llne:9-877-BACKFLOW(1•877•222-5868) � Wobslto:hltp:llwww.zurn.com
Page 2 of 2
� � INTERNATIOI�JAL
�
FIRE PROTECTION INC .
"Complete Fire 1'rotection Service"
March 13, 2012
City of Zephyrhills
To Whom It May Concern:
This letter is authorization for the following persons to act on my behalf in all matters pertaining to
submitting plans and picking up permits:
Wayne W. Lenigan FL DL#L525-899-52-367-0
Ovidiu Mate FL DL#M300-640-78-246-0
Matthew H. McGuire FL DL#M260-548-75-269-0
Robert Fredrickson FL DL#F636-774-65-444-0
Harry Harm FL DL#H650-373-65-054-0
My Florida State Competency License number is: 20080000012010
Sincerely,
International Fire Protection, Inc.
��---,
Jason G. Dean
District Manager
State of Florida
County of Hillsborough
+h- `
Subscribed and sworn before me this � � day of '��J \ �� l�-
By Jason G. Dean, who is personally known to me.
Notary Public: �--� `- `� .�'l , ^
Printed Name: Karen D. Hernnann ••�;i;:'���., KAREN D HERRMANN
:;�� �;: Notary Public,State of Florida
n.�:,,; My Comm.Expires July 13,2013
My Commission Expires: Julv 13, 2013 Seal: �,� •• a� Commission Nc;.DD 887115
.P,!'..,y.
1402 Mercantile Court� Plant City, FL 33563-1151 Office (813) 754-1383 � (813) 754-1638
Certificate#56212700012005
24 HOUR EMERGENCY SERVICE
Zephyl-hills Fit°e Rescue
69U7 Dairy Roaci, Zephyrhills, FL, i>j42
F'ire Chicf Bus (8]�) 78Q-004(
Keith w'illiams F��1 (8]�) 7$0-0044
23 Apri12012 .� - _.... __� �.__.�.�..__._..__......_________________.._______.__._._._.._._.�.,�_....
Plan Number 12-015
Project: Back Flow Bypass Repair on Fire Sprinkler System, 7910 Gall Blvd, Zephyrhills
Number of Pages: 1 page application with supporting documents
Date received by this Office: 4-23-2012
This Officer has reviewed the sprinkler system modification plans for repair to the back
flow preventer bypass valve on the fire sprinkler system for Staples Store #1899, located
at 7910 Gall Blvd. Following the review, a conditional approval to proceed is given.
Payment for permit acknowledges acceptance and compliance of the conditions noted
herein. The following items shall be considered:
1. All renovation work to Fire Sprinkler System must be performed by
Florida Licensed Fire Sprinkler Contractor. One has been identified on
the application.
2. Replacement part, or equivalent, meets specification on provided detail
sheet.
3. Permit required.
Inspections Required:
1. Post repair inspection needed to clear permit.
Review and approval of the submitted plans does not relieve the contractor frc�m the
responsibility of correcting any deficiencies noted during inspection.
Respectfully submitted on 23 Apri12012 by,
_ ��;�..�--�
�
Keith A. Williams, EFO, CFO, CMO, MIFireE
Fire Chief
Fire Safety Inspector, #148104
, ZE��iYRF�iLLS FIRE DEPARTMENT
6967 Dairy Road, Zephyrhills, FL 33542
Fire Chief Keith Williams Bus (813)780-0041 Fax (813)780-0044
FIRE SERVICE USER FEES
Occupancy No.:
Plan No.: �-G s Contractor. �w'�ri�� rK. ��l�= "' ��.;.- �,c
Business Name: �U " ' Billi�Address:/4�d Z /h�,��._l�,
Business Address: r o G !ad - ��%�S ,�y��,��� �,r� �3S ;3-�j,�l
Business Phone No.: Billing Phone .: _ �/3 t�,Sy-/3ff,3
Business Fax No.: Billing Fax No.:
Contact: Corrtact: �,��� � �c.�•
PLAN REVIEW FEES INSPECTION FEES PERMIT FEE FALSE AtARM FEE
8 Site Plan N/C Annual WC Sprinlder S50 1st Alarm N/C
MuRi-Famiy/Commercial .O6 sf 1st Re-inspection N/C Standpipes a50 2nd Alarm N/C
(Minimum Charge�25.00 2nd Re-inspection a100 Fire Pump a50 3rd Alarrn N/C
� Plan Revisions DBL 3M Re-inspection a25p Floods �5p qm A�� $��
4th Re-Inspectan a500 Fire Alarm a50 5th qlarm $�Sp
SPRINKLER SYSTEMS (Business closed urrtil LP Gas y�p �A�� $�
8 O-25 H28dS �50 VIOI�IOIIS Cp�ffE�CtEd� NBtUfdl G8S a50 NON CpINPLIANCE a150
26 plus Heads $100 SPRINKLER SYSTEMS Fuel Tanks-
per tank �,'S0
STANDPIPE SYSTEM Hydro Undergrounds a45 Spatiders a100
�Per Risef 350 Hydrostatic Test 365 per system Fire Wo11c5 a50p
FIRE PUMP Acceptance Test S45 per�ysaem Camp Fire y�
�Per Pump a100 Hydrard Fbw $75 Contrdled Bum a100
FIRE ALARM SYSTEM H�p� �
�-25 Devices $50 FIRE ALARM SYSTEM Place of Assembly a50 n,,,,,,,i
26 plus Devices a100 System Acceptance E50 Fire Protection a25
SUPPRESSION SYSTEMS ReCell Accepterlce y50 Flemmable qpplicatian �$Q pnnual
Wet S50 OTHER Waste Tire Storage t50 Annuai
��Y S50 Fre wa�usmoke wan 3t 5 ��� Generata<KW a100
CO2 350 LP Gas �25 p„w„k Ger�erator>3p Kyy 150
Other S50 Natural Gas 325 ae.sySo�m Bio-HazaM Waste 3100 ,�,���
KITCHEN EXHAUST Fumigation TeMing s50
�Hood/Duds S50 Tent 10'x10'or gr�ter a15 �,.e� Twd�Pd/Apptied s50
OTHER Fire Pump S45 Haz.Materials a100 a,nwi
LP Insiallation pe►tank a50 Flre Supp�lOr1 s3p
Fuel Tank Inst�allation �50 System Acceptance
(Per Tank) a50 8 E�aust Hoodlpuct �3p
�Naturat Gas Installation S50 Retinspedion DBL
{Per System) (other than annual)
�Spray Boath S50 �Inspection sct�eduled DBL 8
and cancelled less than
24 hours
8��,��. �,�
Emergency V�icle Aa a50 r
PLANS TOTAL� INSPECTION TOTAL� PERMIT TOTAL f F�SE ALARM
� TOTAL C�
GRAND TOTAL
Comments:
Date: ,z Z�/Z
5
Ins�ctor: -