HomeMy WebLinkAbout12-13201 CITY OF ZEPHYRHILLS
5335-8TH STREET
�sis��so-oo20 13201
�r ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 13201 Address: 6020 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: 03-26-21-0010-12800-0000
Improv. Cost:
Date Issued: 6/26/2012 Name: GALL BOULEVARD LAND TRUST
Total Fees: 25.00 Address: 350 HARBOR PASSAGE
Amount Paid: 25.00 CLEARWATER, FL 33767
Date Paid: 6/26/2012 Phone: 727 43-8922
Work Desc: FPM-ANNUAL FIRE SPRINKLER FOR GALL BLVD LAND TRUST
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Chapter 633, Florida Statutes,authorizes the City bo charge and aollect user fees bo pay for the oosts of fire
preventlon and protection related activities such as inspections,plan review,administrative fees,and other
costs relabed bo the aforementloned.
Complete Pians, Specifications and Fee Must Acoompany Application. Commencement of work without written approval of
the Fire DepartmenYs 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 shail be performed in aaordance with City Codes and Ordinanoes.
"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
'���•-�so-oczo Ci'ry ofZephyrhilis Firs Fax-8',3-780-OC21
� l�� Permit Appiication
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Date Received � .i
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Phone Contact for Pertnit �o��j
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Owner's Name �}LL Up ��� Owner's Phon>Number �_� C� �
Owner's Address �6 JC' (�L L ���� �� r'L �
Fee Simple Titleholder Name Titleholder Phone Number � C� �
Fee Simple Titienolder Address
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Job Address � l?�� v Lot t �
Sub Division Parcel# � _
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� Bio-Hazard Waste Storege-ANNUAL � Fumiaation Tent � K
� Comm Exhaust Kiichen Hood/Duct � Hazardous Material(Tier II or R(1 Facility)ANNUAL
� Controlled Bum � Hood Installation
� �mergency Generator<30 kw � LP/Natural Gas-Installafion j `
� Emergency G=neretor>30 kw � LP/Naturai Gas-ANNUAL S e r
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Fire Protection Maintenance-ANNUAL Places of Assembly-AN AL �
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Sprinkler L� ❑ Recreauonal Bum r
Fire Alarm � p ❑ 'L� � � Sparklers
Hood Clearnng � i, ❑ O � Sprinkler System Install 'ons
Hood Suppression � ❑ ❑ ❑ � � 5tandpipes(Sprinkler Sys) '^-- ._
� Fire Alartn Installation � Torch Roofing/Tar Kettle
n Fire Pumps � Waste Tire Storege ANNUAL
� Fire Works
� Flammable Application-ANNUAL V�luation of Project
Fuei Tanks
� Other:
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Contrector "
Company
Signature Registered Y/N Fe=_Current Y/N
Address License#
ELECTRICIAN Company
Signature Registered Y/N Fea Current Y/N
Address
License#
PLUNIBER �
Company
Signature Registered Y/N Fee Current Y/N
Address
Licensz# -�
McCHANICAL Company
Signature Registered Y/N Fee Current Y/N
Addr=ss License� -�
OTHER � • Company QL�.� (--si�� pRO r�C r��A> �_x��_
Signature � Registered N Fee Current Y/N
Address
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License# ( �Qi�� � � ��
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Fill out application completely
Owner&Contractor sigr,back o�application,notarized(Or,copy of signed contract with owner)
if over�250G 2 Notice of Commencement is required(Mechanical work over W5000)
Supply two f2)sets of drawings with applicable documentation
Allow 1 G-14 days for rewew after submittal date Parcel�-obtained from Property Tax Notice(http.//appra�ser.pzscogov.com)
NOTICE OF DEED RESTRiCTiONS• unt red ulations� The undersigned a's umes espons b Iby for�mp!ance tw tho�Y
which may be more restrictive than Co y 9
applicable deed restrictions
UNLICENSED CONTRACTORheAN1Dy b0�eq Aed oRbs�ePsOedSiBactco dance th s ate and localeeguiationrscjl�rthe
contractors to undertake wo , Y
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor`�if�latthe
under state law. If the owneed to con a c the Pasco County Buadingslnspection'Div s'on feLi ens ngtS ct on ap727-847-
intended work, they are adv�s
8009. Furthermore, if the ownerof thishaediicationtfor whi�h theyrwil�be espo sablePaftyouaas the ownteasign asSthe
portions of the "contractor Block PP
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in asco
County.
CQNSTRUC i iuiv LicFi �A'vJ ���►�����"713� Flarida Statutes,_asof �e �,�,e o)rida C�onst uct on L en LawooNomeow.�r°'s
certify that I the applicant, have besn provided with a copy licani is someone
Protection Guide° prepared by the Florida Department of Aoflthetabove des�ribed docum'ent and prompse in good faith to
other than the "owner", I certify that I have obtained a copy
deliver it to the "owner" prior to commencement.
CONTRACTOR'SIOWNER'S AFFIDAVIT: I certify tha calbleeaws r egu'atingteonst�rPct on� zon ng and land
that ail work will be done in compliance with all app�
development. Hpp�ication is hereby made to obtain a permit to do work and instaltation as indicaied. I certify
that no work or instaliation has commenced prior to issuance oa dPCitlltcodeshazonli g regullatio Ps,rfand eand
meet standards of all laws regulating construction, County Y
development regulations in the to�the'initended workCand thatat iIs my eespo n bility toeidenffy twhat actiotns l
government agencies may apply
must take to be in compliance.
If i am the AGENT FOR THE OWNER, i pro nise iU derstan�d thatna�separate permit ma ybe req u ed for'electrical�norA
this afFidavit prior to commencing constructio licati
pfumbing, signs, wells, pools, air o be a'lice n e to p oceed with the work and not a's author ty tlo�viofateecappel, alter, or
permit issued shall be construed t
set aside any provisions of the technical codes, nor shall issuance of a permit prevent therB�'d�s ed shall be ome invaf d
requiring a correction of errors in plans, construction or violations of any codes. Every p
unless the work authorized by such permit is c o� of s x d6 mhonths a er the t meethetworlcas commenced Anhexte s on
the permit is suspended or abandoned for a peri � )
may be requested, in writing, from the Building Of�icial for a per od secutive days the]ob isOconsydee d bal donedst
justifiable cause for the extension. If work ceases for ninety (90)
WARNING TO OWNER: YOUR FAILURc TO REpO�ROPE,TM��F YOU INTOEND T� OETA N F NAN�NG CO�lSOULR
PAYiNG TWICE FOR lMPROVcMENTS TO YOUR
WiTH YOUR LENDcR OR AN ATTORNEY BEFQPE RECOR�lNG YQUR NOTICE OF C�MMENCEM_NT.
FLORIDA JURAT(F.S.117.03)
CONTRACTOR
OWNER OR AGENT Subscribed and swom to(or affirmed)before me this
Subscribed and swom to(or affirmed)before me this by
by Who is%ere personally known to me or has/have produced
Who is%are personally known to me or has/have produced as idsntification.
as identifica6on.
Notary Pubhc
Notary Public
Commission No_
Commission Nc
Name of Notary typed,Printed or stamped
Name ot Notary rypeo� Printed ar stamped