HomeMy WebLinkAbout13-14164 CITY OF ZEPHYRHILLS
, 5335-8TH SIREET
(sis)�so-oo20 14164-
ANNUAL FIRE PROTECTION MAINTENANCE l'
Permit Number: 14164 Address: 38250 A 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: 14-26-21-0010-01300-0010
Improv. Cost:
Date Issued: 5/10/2013 Name: ZEPHYR HAVEN NURSING HOME
Total Fees: 25.00 Address: 38250 A AVE
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542
Date Paid: 5/10/2013 Phone: (407 975-3000
Work Desc: FMP- SPRINKLER QUARTERLY-ZEPHYR HAVEN NURSING
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Chapter 633, Florida Statutes,authorizes tl�e 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
aosts 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 RECORDING YOUR NOTICE
OF COMMENCEMENT."
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PERMIT OFFICER'�`
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT- 813-780-0041
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D�ate Recei:�ed � 5/7/2013 � ,w�. - Phone Contact for Pertnit 813 313 1611
Owner's Name Ze h Haven Nursi Home � pwr�er's Phone Number �� �
Owner"s Address 38250 A AVE ZEPHYRHILL FL 33542
Fee Simple TiUeholder Name Titlehokler Phone Number ����
Fee Simple Titlehol�r Address
Job Address Lot# �
Sub�Division Parcel#
������ BiaHazard Waste Storage-ANNUAL �a� � Fumigation Tent
� Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL
❑ Controlled Bum 0 Hood Installation
❑ Emergency Generator<30 kw 0 LP/Natural Gas-InsTallation
� Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale
� Fire Protection Maintenance-ANNUAL ��m� � p��s of Assembly-ANNUAL ��, (((��� /�/�'/
Sprinkler � o � 0 Recreational Bum � `%
Fire Alarm 0 0 Sparklers
Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations
Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
❑ Fire Alarm Installation 0 Torch RoofinglTar Kettle
Fire Pumps � Waste Tire Storage ANNUAL
Fire Works
Flammable Application-ANNUAL Valuation of Project
FuelTanks
❑ Other
Contractor ���Wanda Paradis � Com Sim lex Grinnell ������
Signature Regist Y/N Fee Cu Y!N
Address 4701 Oak Fair Blvd Tam FL 33610 License#
ELECTRICIAN Companv
Signature �
Repistd_Y!N Fee Cu Y/N
Address
License#
PLUMBER Company
Signature
Regist�_Y/N Fee Cu Y!N
Address License#
MECHANICAL Company
Signature �
Regist�__Y/N Fee Cu Y/N
Address License#
OTHER Company
Signature Regista_Y/N Fee Cu Y J N
Address License#
Directions: a,w=,M
Fill out application completely.
Owner&Contractor sign back of application,notarized(pr,copy of signed contract with owner)
If over$2500,a Notice of Commencement is required(Mechanical work over$5000)
Supply two(2)sets of drawings with applicable documentation
Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http:!/appraiser.pascogov.com)
*y►C� N�• 3153383
Tho Dank of rew York Meqon
S�mp/exGr/nne// Aittsbur�,PA ]5?59 �1�
433
NOT VALID AFTER 8 MONTHS
DATE CHECK NUMBEH � DOLLARS CENTS
05072013 3153383 50 00
�-------------- ---------- ------
Fifty and NO/100 Dollars
TOTHE ZEPHYRHILLS CITY OF
ORDER 5335 8TH ST
oF ZEPHYRHILLS FL 33542
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AUTFlORIZED SIONATURE
��' 3i� 5338 ���' i:0�, 330L6pL�: 003��� 5959��"
DETACH BEFdRE IIEPOSITING N0. 31b3383
INVaICE
DATE NUMBER DISCOUNT AMOUNT
05062013 PERMIT 292 OS07 3 Q,qp 60.00
OS6313 Q.OQ 50.00