HomeMy WebLinkAbout13-13789 CITY OF ZEPHYRHILLS
5335-8TH S1REEf
_ . �sis)�so-oozo �3789
ANNUAL FIRE PROTECTION MAINTENANCE /
Permit Number: 13789 Address: 38130 PRETTY POND RD
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: 35-25-21-0010-07100-0000
Improv. Cost:
Date Issued: 1/22/2013 Name: LOAN FUNDING SOLUTIONS II LLC
Total Fees: 25.00 Address: 4600 WELLS FARGO CNTR 90S 7TH ST
Amount Paid: 25.00 MINNEAPOLIS, MN 55402-3903
Date Paid: 1/22/2013 Phone: (612)851-3026
Work Desc: FPM- SUPPRESSION ANNUAL -THE COMMONS AT PRETTY POND
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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
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���aso-oc2e City ofZephyrhilis Fire Fax-8'3-780-0021
Permit Application
Dace Receiv=d I Phone Co�tact for Permit '7� o�e5 �jc�
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Owner's Name �C7Y\rt! LUTZON � �. L-� Owner's Phon=Number � � �
Owner's Address y o� I.J��.►.� F�nr�U �ti�T�J° - �(� 5 7 rH �T
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Fee Simple Titiehofd=r Name Titleholder Phone Number C� � �
Fee Simple l'itlenolder Address
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Bio-Hazard Was'te Storege-ANNUAL � rumigation Tent
� Comm Exhaust Ki'tchen Hood/Duct , � Hazardous Material(Tier 11 or RQ r=acility)ANNUAL
� Controlled Bum � Hood Installation
� cmergency Generetor<30 kw � LP/Natural Gas-Installafion
� Emergency G=nere'tor>30 kw � LP/Natural Gas-ANNUAL Sale
� Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL � p/(�j�
ny emi �n ner � ' G �
Sprinkier � ❑ ❑ O � � Recreauonal Bum !
Fire Atarm � ❑ p ❑ � � Sparklers �
Hood Cieaning � �, C ❑ � � Spnnkler System Installations
Hood 5uppression � ❑ ❑ �, � � Standpipes(Sprinkler 5ys)
� Fire Alarm Instalfation a Torch Roofing/Tar Kettle
� Fire Pumps � Waste Tire Storage ANNUAL
� Fire Works
Flammable Application-ANNUAL
Valuation of Project
� Fuel Tanks
� Other�
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Contractor
Company
Signature Registered Y/N Fee Current Y/N
Address
License#
ELECTRICIAN Company
Sigrature Registered Y/N Fee Current Y/N
Address
License�
PLUfviBER Company
Signature Registered Y/N Fee Current Y/N
Address
License�
McCHANICAL Company
Signature Registered Y/N ree Current Y/N
Addr=ss
License#
OTH�R 1 � _ Company 7P�/Z F'Y��' ,�jTL C7 Z� �iJ<
Signature �J Registered � Y/N Fee Curreni Y/N �
Address ,� � License� �
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Directions: "'' .. O �Q .3 c. .:....... :�,
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Fill out applicafion completely
Owner&Contractor sign back of aoplication,notarized(Or,copy of signed contract with owner)
t�over�2500,a Notice o`Commencement is required(Mechanical work over W5000)
Suoply two(2)sets of drewing�with applicable documentaiion
Aliow 1 G-�4 days for revi=w after submittai date Paroel r-obtained from Praperty Tax Notice(nttp:/iappraissr.pascoaov.com)
NOTICE OF QEED RESTRICTIONS i he undersigned understands that this permi� may.be subject to-°deed"TPSifICtI0i15��
wnich may be more restrictive than County regulations. The undersigned assumes responsibifity for compi�ance with any
applicable deed restrictions
UNLICENSFD CONTRACTORS AND CONTRACiOR RESPONSlBIL(TIES: 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 reguiations Ir the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdertieanorivio�lat�he
under state law If the owner or intended contractor are uncertain as to whai iicensing requirements may.app y
intended work, they are advised to contact the Pasco Counry Building Inspection Division—Licensing �ection at 727-u47-
8009 Furthermore, if thesoc k rof hishapplicationtfor whi�h th yrwil�be respons�bleeaftyouaas the wnteasigrn asSthe
poriions of the "contractar
contractor that may be an indication tha'. he is not properly (icensed and is not entitled io permitting privileges in Pasco
County
CQhI$'`i�ljl.1{UiV LtCN LA'VV (�haN�cr713, Fbr��a Sta.;s#es,-a�Uf��'��o�ridla C,onstruction/ L en LawO��omeownr°s
ce!-tify that I; the applicant, have been provided with d ��pY
Protection Guide" prepared�by thatFlhav�e obta ned anc p yof Ithetabove des�r bed docum'ent and prompsean�good •a th to
other than the "owner", I ce y
deliver it to the "owner" prior to commencement.
CONTRACTOR'SIOWNER'S AFFIDAVIT I certify that all the information in this appiication is accurate and
that all work will be done in compliance with all applicable laws regulating construction, zoning and land
development. kppiication is hereby made to obtain a aerrnit to do work and installation as indicated. 1 c�rtify
that no work or installation has commenced prior to issuance of a permit and that all work wiil be performed to
meet standards of all laws �h9ulurisdi tionstr��allso certify thatdl ulnde sa nd that heeegulatonsaof other
development regulations in )
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 AGEN7 FOR THE OWNoR t(P t°o is i �u de�stand that a�separate permit ma ybe req u ed for felectri al work.
this affidavit prior to commencing
plumbing, signs, wells, poofs, air conditioning, gas, �r other irstallations not specifically included in the application
permit issued shall bs construed to bcal c'odesenor shaii ssua'ncehof a pe mit�prevent thehB i ding Officeal from therteafter
set aside any provisions of the tech
requiring a correction of errors in plans, co�ssrcommenrcedlwithin si amonthseof perm P s alnce, or�if wofr kauthorizedaby
unless the work authorized by such perm
the permit is suspended or abandro the Buildn g'Ofr�fall fo6a per ohd not to excleedtn netyr(90) days andewill demons rate
may be requested, in writing, fro
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandone .
WARNING TO OWNER: YOUR FAILURO YOtl.R ?ROPERTY.�IF YOt1 INTOEND TO OBTAIN FINANC NG,�CORlSULR
PAY�hG T1NICE FOR lMPROVcM_NTS T
WtTH YOIiR LcNDcR OR Afv ATTORNEY BEFQRE RECORDlNG YOUR NOT�GE OF C�MMENCEMENT.
FLORIDA JURAT(F.S 117 03)
CONTRACTOR
OWNER OR AGENT Subscribed and swom to(or affirmed)before me this
Subscribed and sworn to(or affirmed)before me this by
bY Who is nally kno��m to me or has/have produced
NJho is�— �a�e personally known to me or nas/have produced as identificafion.
as identification.
Natary?ubUc
Notary?ublic _
Commission No
Commissior,Nc
Name of Notary typed, �nnted or s:amped
Name ot Notary rypeo, printed or stampad
Piper Fire Protection , Inc.
� POST OFFICE BOX 9005,LARGO,FLORIDA 33771
PINELLAS PH.(727)581-9339 Email:pfpmail@pipefire.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
November 08, 2012
I, Christopher R. Johnson, 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, 33607100012003. 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
Tony A. Lopes - FDL L120-001-61-250-0
Ben Ward FDL W630-066-53-257-0
Sheri Bergstrom - FDL B623-792-63-727-0
Bianca Hartz- FDL H632-068-80-594-0
Ray Cole FDL C400-196-66-205-0
Christ her R.J n on,President
Piper Fir Pr tection
33607100012003
State License
STATE OF Florida
COUNTY OF Pinellas
The foregoing instrument was acknowledged before me this 8�h Dav of Novembery, 2012 by Christoqher R.
Johnson He is personally known to me -
"� 1 �`�°� Nota p
_°i �, �' �a��atate of Floride
. Alicia Hornak
+' ° � My Commissia�EE009621
Notary and Commission
�oF n� Expires 07l18i?.014
o wnen`yow.�ar anm,w�rw,.�oi nirom.y-a.r�om.o�-.��...io�ao�
Fire Sprinklers Extinguishers Fire Alarm