HomeMy WebLinkAbout13-13998 _ . CITY OF ZEPHYRHILLS ,,'
5335-8TH STREET ,�,,,(�$
(813)780-0020 j�`�y
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 13998 Address: 38300 11TH AVE
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: 11-26-21-0010-06600-0011
Improv. Cost:
Date Issued: 3/20/2013 Name: THOMAS, CATHY A
Total Fees: 25.00 Address: 3606 AUTUMN PALM DR
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542
Date Paid: 3/20/2013 Phone: (813)782-4894
Work Desc: FPM- HOOD CLEAN QUARTERLY- LOS CHICOS
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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
Permit Application --
Date Received ^ Phone Contact for Permit �3 �t 7� ��
Owners Name �LSS �/�Q'J� Owners Phone Number �` � �,2 [����
Owners Address
�O_�(r�� � �' �c �i f°�� f�� r� ,
Fee Simple Titleholder Name Titleholder Phone Number C� � ��
Fee Simple TiUeholder Address
•�.;�'�'�::.
� � �Lot#
Job Address
Sub Division
Parcel f�
� ��;�;--- °���.�.�- �- - - - - ��•c���.:._�;��.� .
� Bio-Hazard Waste Storage-ANNUAL a Fumigatio�Tent
aComm Exhaust Kitchen Hood(Duct � Hazardous Matenai(Tier II or RQ Facility)ANNUAL
� Controlled Bum a Hood Installation
aEmergency Generator<30 kw � LP/Natural Gas-Installation
aEmergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale
aFire Protection Maintenance-ANNUAL a Places of Assembly-ANNUAL
❑�r y em� �n er � � 3 ! ! �/
Sprinkler ❑ ❑ ❑ � Recreational Bum (
Fire Alarm � ❑ ❑ ❑ � � Sparklers
Hood C�eaning � �I ❑ ❑ �� a Sp�nkler System Installations
. �
Hood Suppressio� � t ❑ O � a Standpipes(Spnnkler Sys)
aFire Alartn Installation a Torch Roofingffar Kerile
� Fire Pumps � Waste Tire Sforage ANNUAL
� Fire Works
❑ Flammable Application-ANNUAL �_--� Valuation of Project
� Fuel Ta�ks
� Other:
�w '�
Contractor �' Company m � - �• � 'F�r��'� �
Signature Registered Y/N Fee C�rrent Y/N
Address �-/�("i/ !"sG �-fc�r �4- - 'T ( License# � /Y�3�1 ���t��=0`f
ELECTRICIAN Company '
Signature Registered Y/N Fee CuRent Y/n)
Address License#
PLUMBER Company
Signature Registered Y/nl Fee Curtent Y/N
Address License#
MECHANICAL Company -�
Signature Registered Y/N Fee C:urrent Y/N .
Address License# _
OTHER Company r-
Signature Registered Y/N Fee Current Y/N
Address License#
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Directions:
Fil out application completely
Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner)
tf over 52500,a Notice of Commencement is required(fvlechanical woric over$5000)
Supply two(2)sets ot drawings with applicable documentation
Allow 10-14 days for review after submittal date. Parcel#-obtained from Prnperty Tax Notice(httpJ/appraiser.pascogov.com)
NG 1�Ct� �F DEED RESTRICTIONS: The undersigned understands that this permit may.be subject to-"dee:d":restnctions"
wf ic' ����ey : �• n?ore restrictive than County regulations. The.undersigned assumes responsibility for:complian�e with any
applicGl,fe d�ad 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 lnspection 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(Chapter713, Florida Statutes,.as amended)� If valuation of work is $2;500.00 or more, 1
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
tleliver 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 laws regulating construction, zoning and �and
development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify
that no work or instalfation has commenced prior to issuance of a permit and that all work wiH be performed to
meet sfandards of all laws regulating construction, County and City codes, zoning regulations, and land
development regulations in the jurisdiction. I also ce�fify that 1 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 understantl 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 Suifding 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 Tf RNEY BEFORE RECORDING YOUR NOTICE OF MENCEMENT.
FLORIDA JURAT(F.S 117.0}3,1
il ,
OWNER OR AGENT CONTRACTOR
Subscribed and swom to(or a ed)before me his Subscribed and swom to( 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 ryped,printed or stamped Name of Notary typed,printed or stamped