HomeMy WebLinkAbout12-13115 � • CITY OF ZEPHYRHILLS
5335-8TH STREET ���
(si3)�so-oozo 13115
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 13115 Address: 38422 VALLEY OAKS CR
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: GRAND RESERVE
Est. Value: Parcel Number: 35-25-21-0010-09200-0000
Improv. Cost:
Date Issued: 5/30/2012 Name: GRAND RESERVE APARTMENTS LTD
Total Fees: 50.00 Address: 580 VILLAGE BLVD STE 360
Amount Paid: 50.00 WEST PALM BEACH FL 33409
Date Paid: 5/30/2012 Phone:
Work Desc: FPM-ANNUAL SPRINKLER&FIRE ALARM- GRAND RESERVE
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PIPER FIRE PROTECTION INC
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Chapter 633, Florida Statutes,authorizes the City to charge and collect user fees to pay for the wsts 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$100.00, whichever is greater. All
work shall be performed in accordance with Ciry Codes and Ordinances.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMNT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECO IN Y R NOTICE
OF COMMENCEMENT." '
PERMIT OFFICER
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT- 813-780-0041
. a��aao-oo2o City of Zephyrhills Fire Fax-813-780-0021
Permit Application
Date Received I Phone Contact for Permit �Jv� -1 ' �j S�t L ('=�,-r�„S'�„
Owner's Name �f-1� 1 �S(- V C T�1��T�rIG/t�75 LT� Owner's Phone Number � C� �
Owner's Address ��C) � Z L �j,E- L,V(J �7� J�� ��j�f� Y LKt�F1 � ��yD�j - � �J(o(�
Fee Simple Titleholder Name Titleholder Phone Number � C�
Fee Simple 7iileholder Address
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`�' �'.^Fyi ',axate#5:x�'>ai7;7:yso }?$%:°' :!C 3d.':i{��„'' '�'f"�?�r..�,+..;
,..�<. :e�{,Ft�.Y�..�6''a"-...+s+a:�+Rxe�'z{'Ncs:��' �:;'k�.`"'.�"l.;:
Job Address � `Y �� ti(A L � � �Z�C �,, C Lot� ��
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Sub Division Parcel� �`� -�`j -�► -bp� (�j -�c� d - ��,� ,
. ,r ._ix ..�,_<...a.o< ��. . .�:'v..,,,':.�^i:v..�..zw.�d:.a:w..:."Y:.�_>=v.of.o-?:k�.�..�:y`�..r.._.. ... .. " ........ ........�.....'�u;.,. .+.., tia.r ��:r.rAx� ....-... , ,.e.�. ......i"b,
� Bio-HazardWastsStorege-ANNUAL � FumigationTent
� Comm Exhaust Kitchen HoodlDuct � Hazardous Material(Tier tl or RQ Facility}ANNUAL
� Controlled Bum � Hood Installation
Emergency Generator<30 kw � LPlNatural Gas-Instaliation (�
� Emergency Generetor>30 kw � LP/Natural Gas-ANNUAL Safe � ����
�-- Fire Protection Maintenance-ANNUAL a Places of Assembly-ANNUAL
r y emi � er
Sprinkler � Q ❑ �4- � � Recreational Bum
Fire Alarm � ❑ ❑ -�` � � Sparklers
Hood Cleaning � ,_; ,� ❑ � � Sprinkler System tnstaflations
Hood Suppression � � _, ❑ � � Standpipes(Sprinkier Sys)
� Fire Alarm Installation � Torch Roofing/Tar Kettle
� Fire Pumps � Waste Tire Storage ANNUAL
Fire Works
r( Flammabie Application-ANNUAL �— � Valuation of Project
u
Fuei Tanks
� Other:
_°°:� �°.;�
. „ ., ` . .. ... .__..tt. ..< . " .� ....':�'.. . ..... .,o�.. ..::5ki. �_�:y;'. .a.>r., �. .. ... :>'�:.,�,.;..s.: .p-��v:. ��F;- "s^:'l>;..:',� z�:zz°::.'�S'e*:�_r.x�'<`y:�.�,.,3.;:�£�M:�`a.
Contractor
Company
Signature Registered Y/N Fe=Current Y/N
Address
License#
ELECTRICIAN Company
Sigrature Registered Y/N Fee Current Y/(V
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 � Com an � ` 5��,� �ti,�
Signature �l��,(_ � -� �-c�—' Registered � /N ` Fee Current Y/N
Address <"d I C'G rr vr t- .e' i =-L -3,�'7 7('i License# --,(=("j p p } � �
Directions: 4 - �-.` "„ . ; "
Fill out appiication completely 1 j � �� y(`j� �j � , � �1�� `
Owner&Contractor sign back of application,�otarized(Or,copy of signed contract with owner)
If over�2500,a Notice o`Commencement is required(Mecharncal work over$5000)
Supply two(2)sets of drawings with applicable documentation
Ailow 1 C-14 days for r=view after submittai date. Parcel#-obtained from Property Tax Notice(http./iappraiser.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. 'fhe undersigned assumes responsibility for complian�e 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 misdemeanorl�if�lat{he
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may app y
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 proper{y licensed and is not entitled to permitting privileges in Pasco
Counry
CONSTRUCTIOiV LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more,
certify that I, the applicant, have been provided with a copy of the "rlorida 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 ! have obtained a copy of the above described document and promise in good faith to
deliver it to the"ownern prior to commencement.
CONTRACTOR'SIOWNER'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 will be performed to
meet standards of all laws regulating construction, Counry 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.
tf I am the AGENT FOR THE OWNER, 1 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 ee��;{�{�eawork and not as au't or'ty t�o�violateecanplelaallter, or
permit issued shall be construed to be a license to proc
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: YOVE�E 'TS TO YOUR PROPERTY.TIF YOU INTEND TO OBTA N F NANCING CO SULT
PAYING TWICE FOR IMPRO
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT(F.S 117 03)
C�NTRACTOR
OWNER OR AGENT Subscribed and swom to(or affirmed)before me this
Subscribed and swom to(or affirmed)before me this —_bY __ _
bY Who islare personally kno�nm te me er has/have produced
Who islare personally known to me or has/have produced as identification.
as identification.
Notary Public
Notary?ub!ic ___ ___
Commissian No — —
Commissior.Ne --
Name of Notary typed,printed or stamped
Name of Nolary typed,Printed dr stamped
BUSINESS TAX RECEIPT
City of Largo
2011 — 2012 FILE # 2�,�2op�365
DBA: orpER �'IR� PRQT�C''_'�C^i T�IC.
Business Name & Mailing Address Physical Address, Owner, Phone
F�?�R FI�.� PF�`:�^TIOV Tti�.
N`T_P.�C FO�i STOE�ET; 521 C0�?r1�RC� DR �
521 CO^�I��'_E�C� �F. ��1 LARGO, F� 337?Q
i.�?G0, r� 3�??0-1���i
i`^.h�K RON SiOErEN
727-501-9339
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.�b•. „tkt��4�'. � s•' = r.,,..k�ra} . �.,- z ...'n'�'t,s.�.a��a.P.+. ,w..... ...,,,.adt.,s.uEo-bSt t., ,�.:-:aa,.,e, . ::E.r f..,t e . t,'r( � �. .
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ALARM SYSTEM CONTRACTOR I
Classi£ication NAICS No. Qty• Amount
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PCCLB: REG 9/30/2011 STATE: EF0001219 8/31/2012
Certificate Number: 28710
�r.gaging in Gr.y busir.ess occupaticn is subject to zoning restric�ions. Tn� co�lecti:.r. o�
th-_s Business Tax/�dminis�rative Service Charge does not auti-:orize the nolder tc oNera'te
in viclatier. cf aa� City ordinar.�e, la�a or regulatior, Eacn rolder is sciely resporsible
iGT' riOLiSj%':.:1CJ LI':e COITI?T1U'11ty' L'i2'7EiCCTe11t �2�dT'tITt271t.� li'i W�1t1P:Ct� Cf dI1y' C�";d;1�2 1^ StatliS�
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o= record. Issuance is ir. r.o way intended as a:, approval or disapproval o� tne ho�ders
co^toetence or skill .
�^15 �L'S1T'i2SS idX R2CP1�} exp_res �� tier-'��°?RbG� Z�ZL. Pe:ldl'�=eS 3�? pr'OViC�� r'i1' �.S . zil� li
no� °er.ewe� b�fore � Octcber 2p12 . Addi*_ior.a'_ penalites o� up to $250 ma� ap�l,� r.c�
rane�;ed b; �? De�ember 2Ji2. '_
THIS IS NOT A BILL NO REFUNDS
POST IN A CONSPICUOUS PLACE
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CCP�3026.R?T
�s�� °,.� STATE OF FLORIDA
a� = = o,� —
�'� =_�_; -�-�� DEPARTMENT OF BUSINESS AND PROFESSION�iL REGULATION
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�" j ELEC`I'RICAL CONTRACTORS LICENSING BOARD (850) 487-1395
'.ti ._� �.;� 1940 NORTH MONROE STREET
�b,,,�t� T�,LLAHASSEE FL 32399-0783
STOEFEN, MARK RON
PIPER FIRE PROTECTION INC.
521 COMMERCE DRIVE SOUTH
LARGO FL 33770
Congratulations! With this license you become one of the nearly one miNion - ST!!�OFF�pR��� ;- .���',;;'� ; `-
Flcridiars!icer.sed b the De^art^,er,t� - � �' �����&�:
Y r f Busir.ess ar,� Professi n +:,, � ,--�, �� �Q$�;,;t'���_=E3U5,�I�ES��-;�D.;,`:;`?y
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cvery day we•acrx to�mprcva*ne�roay Ne do business in orCer to serve ou better��,-::.";�<;;;" ,; ;' ��-�-:,._ '���- '` " • :.
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ror iniarmation aoout our serwces eiease Icg onto www.myfloridalicense.com "'`'k
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There you can fird more�nformation about our divisions and the regulations that ..,���,��; ; ; - -,����'_" .,.,,':;�:;'� . .
im ac2 ou,subscribe to de artmen ; a . �'�' "�h�= -`��� '��='�?��
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Our mission at the Department is_ License Efficientiy, Regulate Fairly We = -_ ��T`���; ��"t,,'�:°�``-:`:'- � ''T?���+F � �^�� " ,'���•,
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constantly strive to serve you better so that you can serve your customers T � � � -`- -'rr t��,�Y�.,^;,�'��� .,;,'",- ,.....,--�,,4.
Thank you for doing business in !=lorida and congratulations on your new licerse! .� '` �'rs?_eERTiF2�D�i�};��c�yjr'ttt8'�pr�novis$onS:�Ofi,efi;?��,.9 'as ,
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Pi er Fire Protection Inc.
POST OFFICE BOX 9005,LARGO, FLORIDA 33771
PINELLAS PH (727)581-9339 Email•pfpmail@piperfire.com SARASOTA PH.(941)365-2303
PINELLAS FX. (727)581-8332 SARASOTA FX.(941)365-0936
HILLSBOROUGH(813)221-5101 STATE-WIDE 1-800-327-7604
January 26, 2011
I, Mark R. Stoefen, license holder do hereby authorize the following employees of Piper Fire
Protection, Inc., to act as my agent in all matters concerning securing permits and registering of
my license, EF0001219. I understand I am responsible for any and all work performed by my
agent. I am also aware that I will be responsible for the renewal of this form annually. These
authorized agents are as follows:
Jennifer H. Plouffe - FDL H236-426-73-915-0
Dimitrios Fotopoulos - FDL F314-160-62-176-0
Sheri Bergstrom - FDL B623-792-63-727-0
Matt Ahlersmeyer- FDL A462-541-74-243-0
April Oberle FDL 0164-004-75-528-0
?
ark oe , iw ' n Manager
Piper Fire Protection
EF0001219
State License
STATE OF: Florida
COUNTY OF. Pinellas
The foregoing instrument was acknowledged before me this 26th Dav of Januarv 2011 by Mark R. Stoefen He is
personally known to me.
a,r*r°�y_ Notary Public State of Florfda
G,7lj'/{ r = F LeAnne Downing
�_ 1 3` �i5 N,,c_ ., o� My Commission EE059842
'?o�f�o� Expires 01/31/2015
Notary and Commiss� —'-
D VaXaslO�er o(ettaney�POwer d Attorney-Mrk Stoefm 2 d«
Fire Sprinklers Extinguishers Fire Alarm
— —---
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,���L;�t�U C-�� �; 4 f` ' `{ THIS CERTIF[ES TH.4T blark Ron Stoefen
` ` ��"`''-�•�� �I�e/ DB.4 Pip¢r Fire Protectlon Inc
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ST,�I'E CERT# [-EF0001219 $
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DATE OF ISSli A�CE pF/?q/�p70
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Stoefen,;Ylark Ron *Please cut out ticense along lines �
521 Commerce Drive South �
Largo, FL 33770
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