HomeMy WebLinkAbout13-14010 CITY OF ZEPHYRHILLS ,.
5335-8TH STREET
(si3)�so-oozo 14 0
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 14010 Address: 7350 DAIRY 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: 35-25-21-0010-06900-0020
Improv. Cost:
Date Issued: 3/21/2013 Name: ADVENTIST HEALTH SYSTEM
Total Fees: 25.00 Address: 7050 GALL BLVD
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542
Date Paid: 3/21/2013 Phone: (407)975-3000
Work Desc: FPM- SPRINKLER ANNUAL-ZEPHYRHILLS HEALTH & REHAB
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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
eia�soono City ol2ephyAvns Fre Fat813760L021
Pomdt App9cauon
Date Receivad .r, , . 3H312013 , _, . - ' .' - -- - ,_ . = ---_-- . phone Contactfor Pem1{t Sf3 313 1611
Owner's TJeme Ze h rhi8s Health S Rehab Owners Phone Number ���
Owners Address 7350 DAIRY RD ZEPHYRHILL FL 33540.1354
Pee Slmpla TlUehofder Name TiUeholder Phone Number ���
Fee Simple TItleMolder Address
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� BiaHazaid Waale Sforage-ANNUAL � Fumtgatlon Tent
� Comm E�auat{Qtchen HoodiDuct � Hazardous A3alarial(Tier II or RQ faciliiy)ANkUAI
❑ Controlled 8urn � Fiood Insiellalion
❑ Emergency Generator<30 kw � LP/Natural Gas-tnslaAadon
� Emergency Gene�ator>30 kw � LPINatural OasANNElAI.Sala I /�/�/�h I �
Fire Protectlon Mefntenance-ANNUAi Placea of Assembty-ANMUAL �/ `�����
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Sprinkkr ❑ X � � RecreaUonal Bum
FiroAlarm ❑ o � Q Sparklers
Hood Cleaning ❑ a o a � Spdokler Sysiem Insta9ationa
Hood Suppreaslon ❑ ❑ a ❑ � � $tandpfpes(SprloWet Sys)
❑ Fire Alatm lastallatlon � Torch Roofinp/Tar KetBe
fire PumAs Q Wasie Tite Stofage ANNUAL
Ffre Watics
Flammable Application-ANNUAl. Velualion oi Project
FuelTenks
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Contractor Wende Paredls Comp�Simpiex GAnne9 �---�
Signature Regist� Y I M Fee Cu Y/N
Address 470t Oak Falr BMd Tam FL 33610 Lfcense p
EIECTRICIAN Compan
Signafure � Repist Y/N Fea Cu Y 1 N
Address license�
PLUiNB�R Cnmpan —�
Sfgneture ReAfs Y/N Fee Cu Y/N
Addreas License# �
MECHANICAL Compart
Sfgnetura � Regist Y!N Fee Cu Y!N
Address Ltcense� —�
07HER Compan
Signalure Regis Y!N fae Cu Y!N
Address licenae#
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Directloas: - - - .._.. ------'-• '-°-._, _._.__<_. , . . �
Fifl out appl(catlon completety.
Owner d.ConMaciar sign back af applicetlan,notadzed(Or,copy of aipned contract vaith owner)
tt over$26fl0,a Notica of Commencemenf ia required(Mechanicat work over$5000)
Suppty lwo{2)sels of dra+Mngs w(Ih applfcable documenlatton
Allow 10-14 deys far review aker submittal date. Parcel q-obtalned from Property Tax NoUce(htlpJ/appralaer.pascogov.corrt)
. ,��mp►d��r�ss�i�ns��i'Y e�sA��
A7yco lnfernetivnal Comp�ny
P ment Re uisNfon Fonn
?h{s torm is to be used p�when paymenl is requtrect�j an involce{s pp�avaAabte(i.o.pormite,dra►�ngs,blds).lf you have an imolca,
foflow ihe inslrocUons supplled ln ihe towsr dpfit fiand oorner of thta fam
Complele arM save thfs forrr►In Excel formal. "FMs torm Is no!to be pAnted oul. Click J-tet�for fufther lnsiruCiions
P�ovkle a daleNed resson tor ihis p�yment.
Tha oorrect vendor number,oost diatribuUon InFomtalion and approvaEs mual be snpplted. Requesls aubmltied w11h lnconoclAncomplete _
deteils or inadequate approval will be returned.
Related bactc-up Is to be aupplEed in a seperaEa PD�document
This corn�Jotc+d form and u�r relatad back•up is to ba emalled b a+nanager(or hisA�er emalled approval �
Payment wlil be made based on Payment Terms ln the Vendor Master syalem.Exceptfone wifl requlre addllfo»af approval.(RM<$26k or
VP>S26k)
Note:Purnhases ot non-inventary ltems ot$500 or less ahould be chargad lo Ihe Putchasing Card.See Purchasing Gerd Marn�a1/ound at Ihe
�nk belavr for delaUs.
�lk.lc here a�the Purchasin��Manual for f��rihet detatls
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Requesf Date: 03/93t13 os s r ut on • -
Requeator: �Wanda paradis Ail Componsnls of Selected Cociing Type
Must be Supp)led-Form w111 be Retumed if
Telephone No. a13-313-7811 Incorreci or lncom lete
Fax Number: 813-68�1-7731 Pro Num Ctri D[st $Amt
:a�:s r•s;c•r�::F;Fi c ;c':'c,r :s't':': : .• •.
Vendor Number: OG6313 •,:€:i:,:::,��i:;.....,�l�:=1=:::,:,:�;�Fi:::i:�:i:lI�9�3`•s,3;�::i:i.�:::i s;
Acct Num De t Dlst Amt
82447 852 292 ' 75.00' "
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Aay-to Vendor Nsme: City af Zephyrhlils Canada 7ax$Amount:
Remit Address Llne 1: &33B Sth Street
Rernit Address Ltna 2: � Mulliple Ilne dlslr(butlon.
City I State I Ztp: Zeghyrhil3s,FL 33642 See noxt page for breakdown.
Pay[nentAmount; $ 76.00 ��
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Reason for Aa ment do not su I an Custaner or Pro ect names
)ns eclion fea for Ze ty rhills Florida.
Check wil!f�a cut an tho next 7uesday or ThursQay untess a detalted buslness jusfificatEon is supplled below
!t check must be aut and sent to you the same day the request ls submNted,auppty the detalted reason in fhe
"Reason for Same t3ay Paymont"fleid below.-Request needs to be recetved by AP by 10:00 AM ET to ensure -
noxt da doltvo
Det(ve Malhod: Mall ❑ FEDEX �
� Daltver to Dleirtct lf an Ir�volce is available,ptease scan lhe
D(strlct Number: 292 one tnvoice to a PDF documsnt lhen entalt to ..
FedEx Contacf: Scott prackelt almptexgrEnnellUSA@nadocs.com for Ihe US or
Perm�nent!1 per Distrlct lo sEmplexgrinnelicanada�nedcos.com for
Dellver to Vendor Cansda. Do Not atlow the N!e to be Zlpped.
Ve�dor Name:
Confact: -
Maf!-to Address Ltne 1:
Mal}-to Address L1ne 2:
Cily/Siate!21p:
Tele hone: