HomeMy WebLinkAbout13-13939 i CITY OF ZEPHYRHILLS
5335-8TH STREET
' " (813)780-0020 ��
� ANNUAL FIRE PROTECTION MAINTENANCE
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Permit Number: 13939 Address: 37411 EILAND BLVD
Permit Type: FIRE PROTECTION MAINTENANC ZEPHYRHILLS, FL.
Class of Work: FIRE-PROTECTION MAINTENAN E Township: Range: Book:
Proposed Use: COMMERCIAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 03-26-21-0010-05300-0000
' improv. Cost:
I Date Issued: 3/04/2013 � � � �� ���� �� � �
Name: KOENIG WEST WINDS LLC
Total Fees: 50.00 Address: 37411 EILAND BLVD
Amount Paid: 50.00 ZEPHYRHILLS FL 33542
Date Paid: 3/04/2013 Phone: (813)783-8100
Work Desc: FPM- FIRE ALARM ANNUAL SPRINKLER ANNUAL- WEST WIND
' Fi i z5.o i - '" - 2s.00
PIPER FIRE PROTECTION INC
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I A 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 shafl 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 YO 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
81�-780-OG20 Ciry of�ephyrhills Fire FaX-a�aaac-oo2i
Permit Application
Daie R=ceived. �� � Phone Contact for Fertnit �] � ��� ��
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Owner's Name ���/lf� �t��,5 j ���/� 5 L�� Owner's Phone Number � � �
Owner'sAddress ��� � ` � 1 �(� �L� z � ..�� �_� � JC � _ � �
Fee Simole Titieholder Name Titleholder Phone Number �� � �
ree Simple i itienolder Address
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Job Address 3'14 I �.V v� Z�P+�Y � - L 335� Lot� "��
Sub Division Parcef� b3�a�' �� —(j 01 D• Uvr' �b b- DO C'O
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� Bio-Hazard Waste Sioreoe-ANNUAL � Fumiaation Tent
� Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL
� Controlled Bum � Hood Installation
� tmergency Generetor<30 kw � LP/Naturai Gas-Installafion
� Emergency Generetor>30 kw � LP/Natural Gas-ANNUAL Sale
-.� Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL
tny emi Hni ner
Sprinkler � p G ,� B � Recreauonal Bum
Fire Alarm � O ❑ ❑ � � Sparklers
Hood Cieaning � C, ❑ ❑ � � Sprinkier System Ins.ailations
Hood Suppression � ❑ ❑ ❑ � a Standpipes(Sprinkler Sys)
� Fire Alartn fnstallation � Torch RoofinglTar Kettle
� Fire Pumps � Waste Tire Storage ANNUAL
� Fire Works
Flammable Application-ANNUAL
Valuation of Project
� Fuei Tanks
� Other
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Contrector
Company
Signature Registered Y/N ree Current Y/N
Address License#
ELECTRICIAN Company
Sigra�ure Registered Y/N Fee Current Y/N
Address
License�
PLUMBER Company
Signature Registered Y/N Fee Current Y/N
Addr=ss
License#
McCHANICAL Company
Signature Registered Y/N ree Current Y/N
Address
License#
OTH�P, Company Z L� �Z,eG' D 7"!�'C 7"rcw�
Signature Registered /N ree Current Y/N
Address - .
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/ License�
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Directions: ,.. _._ _ .�,,.._....�.__ :+ _. _ ._._ _._�..__....._..��... .. .. .._._,_...__,_- . . ....... :...
Fill out appiication completely
Owner&Contractor sign back of application,notarized(Or,copy of signed contrect with owner)
I�ove;�250G,a Notic=o;Commencemen;is required(Mechanical work over W5000)
Suppiy iwo(2)s=ts of drewings with applicabl=documenta[ion
Alio��1 C-14 days for roview after submittal date. Parcel�-obtained from Proper,y Tax,Notioe(http://appraiser.p2soogo�.com)
NOTICE OF DEED RESTRiCTION Count regulations The �ndersigned alssumes espons b I�y for�ompi a�nce wchoa y
which may be more restnctive t Y
applicable deed restrictions
UNLICENSED CONTRACTORS AND CONTRAC i OR RESPONSISILITIcS: If the owner has hired-:a-conirac or or
contractors to under�ake woskf�thei d byblaw, boththe ownar and ontractoamay behc'ted for aim sldemeanor viollation
contractor is not licensed a q I for the
under state law. If the owner or intended contractor are uncertain as to what ficensing requirerr�ents may.app y
intended work, they are advised e� hast hiredea contractor org ontractlors he��s advis d to'have he cont actor(s) s�gn
8009 Furthermore, if the ow
portions of the "contractor snd catiof n that Pe'is n�ot p operfy I censed fla d is not entitled t Ypermitting pri ilegesgn �asco
contractor, that may be an
County
CCINST�LC i IUIV L1C�1 Ll�vv (ChdN►cr'�3, Fl�ri�a Statutes,-�sv��c �,�,�o�ridla Constructon Lien Lav��ooH meow�r°s
ce�tify that l the applicant. have been provided with a copy
Protection Guide" prepared by thatF'hav�e obta ned ancopy of'thetabove des�r bed docum'�nt and promRsean�good {a th to
other than the "owner", I certi y
deliver it to the "owner" prior to commencement.
- CONTRACTOR'SIOWNER'S AFFIDAVIT: ! certi'ry thai alble laws r egu'latingtconstruci otn, zon ng and land
that all work will be done in compliance with all app�
development. F�pplication is hereby made to obtain a permit to do work and installation as indicated. I c�rtify
that no work or install�iti�a�sa ecu at ng constructionS County�a dPCitytcodeshazonli g regu'latio ps,rfand eand
meet standards of a 9
development regulations in the jurisdiction. I also certify that I understand that the regulations of ot er
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 OWNoR,t�P t°o�S I tu derstanld�thatna�separate permit may be equg d for Ielectric I work.
this afridavit prior to commencing c lication A
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specificall_y included in the app�
permit issued shall be construed to bcal c'odesenor shall ssua�ncehof a pe mit�prevent thehBu Iding Ofr ceal from therteafter
set aside any provisions of the tech
requiring a correction of errors in plans, m'�ssrcommencedlwithin si amonths of perm pssua'nce Uor�if wor bauthorizedaby
unless the work authorized by such per
the permit is suspended or abandoned fBoU adPerio�dfr°ia'�To6a perlohd not to excleed tn netyr(90) days andewill demonstrate
may be requested, in writing, from the 9
justifiable cause for the extension. If work ceases for ninety(90) consecutive days, the job is considered abanaone
WARNING TO OWNER: YOUR FAILURO YOUR ?ROPERTY.T�F YOt1 INOEND TO OE�TAIN FINANC NG COh'SOUL�
PAYiNG '�WICE FO4 lMPROVcM_l�TS .
WtTH YOUR LEND'cR OR AN �T�'ORI��Y sEFQP.E REC�RQ![�G YQUR NOTICE OF C�MMENCEMENT.
FLORIDA JURAT(F.S. 117.D3)
CQNTRACTOR
OWNER OR AGENT Subscribed and swom to(or a;�irmed)before me th;s
Subscribed and sworn to(or affirmed)betore me this by
�_by Who is%are person211y kno�Nn to me or has/have produced
V�Jho is/are personally known to me or nas/have produced as identificafion.
as identification.
Notary?ublic
Notary Publir
Commission No
Commission No
Name of Notary tyPed, pnnted or stamped
Name ot Nocary rypeo, princed or stamped
a��-7ao-oozo Ci'ry of Zephyrhilis Fire Fax-8;3-780-0021
, Permi±Application
Dat=Received I^
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Phone Contact ro 7
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G�vner's Name - '1'C � C�'7 �- �IU p 5 L�.., Owner's Phone Number � C] �
Owner's Address � � Zl/�1� LV� H 4'�f-F1 L� r 3� �y� , (���
Fse Simple Titiehold=r Name Titleholder Phone Number �� �� ��
ree Simple 7itl=holder Address
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Lot t
Sub Division
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� Bio-Hazard Waste 5torege-ANNUAL � Fumioation Tent �� +
� Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ racility)ANNUAL
� Contro�led 8um a Hood Installaiion
� cmergency Generetor<30 kw � LP/Natural Gas-Installafion
� Emergency G>neretor>30 kw � LPlNatural Gas-ANNUAL Sale
� Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL
❑ my emi Hni ner „(1,
_�
Sprinkler � p ❑ ❑ � � Recreational Bum � �j �j� �
Fire Alarm ❑ ❑ ,� Sparklers �
Hood Cieaning � r ❑ u � � Spnnkler 5ystem fnstailations
Hood Suppression � ❑ ❑ ❑ C� � Standpipes(Sprinkler Sys}
� Fire Alarm installation � 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 �.<.._...,:�T'�;._ .<�;.�t<*;.A..�:s':�;����;,'s.�.�.�x r%�_�;��;h��:^�:,�M�.���^-.....
Company
Signature Registered Y/N ree Current Y/N
Address
License�
ELECTRICIAN Company
Signaiur= Registered Y/N Fee Current Y/N
Address
License�
PLUMBER
Company
Signature Registered Y/N Fee Current Y/N
Address
Licens2#
McCHANICAL Company
Signature Registered Y/N rse Current Y/N
Address
License#
OTH�P, �
Signatur= � - Compan} ���C:r� — �,v .DT�- T 7t�,J
Reg�stered Y N Fee Current /N
Address � . � s
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v "ense�
Directions: -., ..-- :;... _... ,., .., __ - _ - ., .- - ...__ _��....... .w. .,_.. ,. -
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Fill out applicaiion completely - --_......_._. . . ,.,
Owner&Contractor sign back oi application,notarized(Or,copy of signed contract with owner)
If over�2500,a Notice o`Commencement is required(Mechanica!work over W50D0)
Supply two(2)sets o`drawings with appiicable docum=ntaiion
Ailow 1C-1�days for review after submittal date. °aroel r-ob,ained from Property Tax.Notice(http:/iappraise-.pascogov.com)
NOTICE OF DEED RESTRICTIONS i he u e ula g ns� The unde�rsigned a'ssumes�espo s b iby for�ompl ance wch�ny
which may be more restrictive than County r g
applicable deed restrictions
UNLICENSED CONTRACTORS�ANID C�ONeR Aed O be E ePOedS!Bac'co dance th s ate and Socale egufatior,s c I?rthe
contractors to undertake work, y Y
I for ihe
contractor is not licer,sed as required �ed cont�racto hare uncertatl asnto what licensengte qu�emen�ts may app y iolation
under state law. tf the owner or inte
intended work, they are advised to cont �redea contr c�or orB o n rag to sP he'�s �advssed to I havel he co�nt actor(s) s i9�
8009 Furthermore, if the owner has
portions of the "contractor Bloc!<" of thi aahells�n,ot properiy ficen ed�Ia d is not enfitled t ypermitting prvlegesgn Pasco
contractor, that may be an indication th
County. ,.. �--7,3 Flo�i�a ��at�t�es,.a� zmerd°'�)' If valt!atipn p`�,Nnrk IS �2,500�0 or more �
�Q�ISTRUC.I IUfV LICP1 LH`Y1I (�.ila�i►eti � uf tl�e "�lorida Construction Lien Lati�—�-!omeawner s
certify that !; the applicant. have been provided with a copy
Protection Guide" prepared by the Florida Department of Aof'thetabove d s�r bed docum'ent and prompsean�good fa th 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: ! cer±ify th`iC�ble laws r egu'latingtconst�rPlct otn zon ng and land
that all work wifl be done in compliance with all app�
development. tippiication is hereby made to obtain a permit to do w�rk and instaltation as indicated. i c°rtifY
that no work or instaliation has commenced prior to issuance °andPCit��tcodeshazonli g regu�fatio Ps,rfa d and
meet standards of a l l laws re g u l atin g construction, Countythat I u derstand that the regu{a tions o f other
development regulations in the jurisdiction. I also certify
government agencies may apply to the intended work, and that i; is my responsibility to identify what actions I
must take to be in compliance.
If I am the AGENT �OR THE OWNER, I promise �Understand that a�separate permit may be req g ed for'electri al nork�.
this afridavit prior to commencing construction. licatio
plumbing, signs, welis, pools, air c be a+license t Sp oceedewith the work a�d not a's ault or�y t�o�violateecanPel, alter, or
permit issued shali be construed to ermit revent the Building Ofricial from thereafter
set aside any provisions of the technical codes, nor shall issuance of a p P
requiring a correction of errors in plans, constructionencedlwithin si amontn�seof perm t pssua'nce o aif woir bauthorized by
unless the work authorized by such permit is comm
the permit is suspended or abandoned for a periood�of a'�for�a per o�d not to excleedtn netYf(9�) d Ys andewill d onedS ��t°
may be requested, in writing, from the Buildi g consecutive days, the job is considered aband
justifiable cause for the extension If work ceases for ninety(90)
WARNING TO OWNER: YOUR FAILURc TO RcPROPERTY.j�F YOt1 iNTOEN TO O TAIN FINANCSNG�COh'SOULR
p,a,y;{���W'10E FC4 IMPP.OVcMENTS TO YOIR
WiTH YOUR L�NDcR OR AN�'.TTORN�� s��'QP` ��C�RD!!VG YOUR NOT�CE OF COMMENCEMENT.
FLORIDA JURAT(r S 117.03)
CONTRACTOR
OWNER OR AGEN7 Subscribed and swom to(or affirmed)before me t7is
Subscribed and sworn to(or affirmed)before me this by
by Who isja;e personally knoNm to me or has/have produced
Who is�ersonally known to me or nas/have produced
2s identification.
as identificafion.
tiotary?ublic
Notary Public __-
Commissior.No
Commission Nc —
Name of Notary rype�, Printed or stamped
Name o�Notary ryped printed or stamped
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