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Home My WebLink About14-14975 CITY OF ZEPHYRHILLS ' 5335-8TH STREET (sis)�so-oo20 4975 LP/NATURAL GAS PERMIT � Permit Number: 14975/14789 Address: 37815 SR 54 WEST Permit Type: LP/NATURAL GAS ZEPHYRHILLS, FL. Class of Work: FIRE-LP/NATURAL GAS Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 10-26-21-0010-12600-0020 Improv. Cost: 900.00 Date Issued: 2/18/2014 Name: EVERS CINDY LAWSON 8� BURGES AMB Total Fees: 125.00 Address: 34132 SAINT JOE RD Amount Paid: 125.00 DADE CITY FL 33525-7846 Date Paid: 2/18/2014 Phone: 813-263-2366 Work Desc: INSTALLATION LP/GAS LINE , I . A 5 . 5. FIRE PLAN REVIEW FEES 50.00 � � � , � � � . � =/`� � �-� � - 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 shall be perFormed in accordance with City Codes and Ordinances. "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 �BTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." �� } �' ,.. �, 1.�,�-�t:,. � � 'J '� -c�.i�� CON GNATURE PERMIT OFFICE r ` PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOURS NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT- 813-780-0041 813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 Permit Application Date Received �Z—� Phone Contact for Permit 8l� 78 . _ L .s'O! Owner's Name J- �/p ��y S' Owner's Phone Number � � �� 7 ��J Owner's Address �J 7��..� S,� ,S y Lt� Fee Simple Titleholder Name Titleholder Phone Number �� Fee Simple Titleholder Address Job Address J /Q.tit �- - _ Lot# �� Sub Division Parcel# �. .... ,�.� u . . _ -�. ,... ,, _ ._ ,_. .., � , y,,.�. . . . s� ,. � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL � Controlled Burn � Hood Instaliation � Emergency Generator<30 kw LP/Natural Gas-Installation � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL ��y emi �n er ❑ Sprinkler ❑ ❑ ❑ Recreational Burn Fire Alarm � ❑ ❑ ❑ C� � Sparklers Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) � Fire Alarm Installation � Torch Roofing/Tar Kettle � Fire Pumps � Waste Tire Storage ANNUAL � Fire Works � Flammable Application-ANNUAL QD Valuation of Project � Fuel Tanks Q Other: F r ::� �:� . - :. •:�. �.. ;, _ ,,. Contractor Company Signature Registered Y/N Fee Current Y/N Address License# ELECTRICIAN Company Signature Registered Y/N Fee Current Y/N Address License# PLUMBER Company Signature Registered Y/N Fee Current Y/N Address License# MECHANICAL Company Signature Registered Y/N Fee Current Y/N Address License# OTHER � � Company n rl.L.S p�e ,ro.-L 6,6se C Signature Registered Y/N Fee Current Y/N Address License# 3 � Directions _ _ Fill out application completely. Owner 8 Contractor sign back of application,notarized(Or,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) NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed" restrictions" which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any applicable deed 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 Inspection 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(Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I 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 Depa�tment 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 deliver 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 land development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I 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 understand 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 Building Official from thereafter requi�ing 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 ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. FLORIDA JURAT(F.S. 117.0 OWNER OR AGENT �~ CONTRACTOR Subscribed and swom to(or a ed)before me this Subscribed and swom r affirtned)before me this by by Who islare personally known to me or haslNave 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 typed,printed or stamped Name of Notary typed,printed or stamped ZEPHYRFflLL� F[RE F3EP/�RTME�ET 6907 Dairy Road, Zephyrhilis, FL 33542 FIRE SERVICE USER FEES Occupancy No.: Ptan No.: � Contractor: ��7r S�nl,�y,-�,� Business Name: t�., � ..I � _��' Biiling Address Business Address: �� , Business Phone No.: Bifling Phone No.: 8usiness Fax No.: Billing Fax No.: Contact: Contact: FLAN REVIEW FEES INSPECTION FEES PERMIT FEE FALSE 8 Site Plan N/C Annual �M FEE N/C Sprinkler �50 1st Alarm N/C Multi-Family/Commercial .06 Sf 1st Re-inspection WC (Minimum Charge 525.00 2�R�� Standpipes a50 2nd Alarm N/C pection $100 Fire Pump S50 3rd Alarm N/C �Plan Revisions DBL 3rd Re-inspedion a250 Hoods S50 4th Alarm a100 4th Re-Inspeqiun �5pp fire Alarm �50 5th Alarm SPRlNKLER SYSTEIAS (Business dosed until a�� 0-25 Heads �'�S 6fh Alarm $�00 550 violations coRected) tural Gas 5p r�� 26 plus Heads a100 SPRINKLER SYSTEMS Fuel Tanks- pertadc 5150 STANDPIPE SYSTEM Hydro Undergrounds a45 ❑ Per Riser SParlclets $100 S50 Hydrostatic Test a65 per system Fire Works $5pp FIRE PUMP Acceptance Test a45 pe�system Camp Fire �Per Pump a100 Hydrant Flow $75 S25 FIRE ALARM SYSTEM ��Bum E100 Hood/Duct a50 0-25 Devices a5p FlRE q�qRM SYSTEM Place of Assetnb�y $5p �rcw� 26 plus Devices 5100 8 System Acx�eptance $50 SUPPRESSION SYSTEMS ��PfOt�O� S25 Recall Acceptance S50 ��,a,�� Wet S50 OTHER Waste Tire Storage S50 �uai �ry S50 Rre WalUSmoke Wa8 S15 per wan Generator<KW 5100 CO2 350 Gas r k Generator>30 KW 150 Other a50 Natural Gas � 5 � ys�ee,,, Bto-Hazarcl Waste KITCHEN EXHqUgT E�� ^^"� Fumigation Tentlng S50 ❑H°°d/Duc� $50 Tent 10Sc10'or greater �15 per tent Torch PoUApplied �5p OTHER Fire Pump a45 Haz Materials P Insqllafion perfa�k a50 Fire Su a1� �"� Plxessbn �30 - ueI Tank Installation a50 System Acoeptance (Pe�Tank) E�aust Hood/Duct a30 �`Natural Gas�nstaqatan 50 Re-inspec;tion DBL �� (Per System) ❑ (other than annual) ❑SPraY Booth S50 Inspection scheduled DBL a�d qncelled less than 8 24 hours Construcdon Insp. WC Emergency Vehide A� $50 FALSE ALARIy� ------Pb4i�IS Tt�T�1i�— �--1NSi�fCT10M-�t��4i�--- _ ----.___._i�E1tM1��'�� —___—._._.��i�4t --- _ ___� �--- GRAND TOTAL Comments: Date:_ z Inspector: .t��,c �� r /Ilh . i � O C�--�'� �� T --r �,IBN1I'1'fEfi� PL.AN(S}�f�4V� t�EEt, ::�.� :._ , ��:. � � '��' "LF.FH i,HI [.�FI� v1ARSHAL'C t)FFi`t.'- � a �,�, Date: `� ` � � , —�------ .Se � .,_-n�r.eu'�X: � ��.��,� ��"� �__. � �N � �-��- ---- � � � � e� M M � Q � � � � ��. � � 1 c�. c� C �� v\ � � • PROPANE GAS Gas Service �j]� AND AIC �NC. Tankless Water �7ce �988 8'13-782-50i3 �s.�c��f ,::_�r;>r_;r_::;-:��:��,;�.:�<:��.r. �:::r��-�,r=. Heaters �-- � `.74'�",; ; i,-�r�F.. '-i�:_�"I-[:::;�T :C t�lE:: 'I"F::;i-:��:;; SALES•SERVICE•REPAIR• INSTALLATION -r�;- � �,.; �:�C�;' i i:: .�' .7.��¢ .E�.�+C : ..., y!:_. 4441 Allen Rd. •Zephyrhilis, FL 33541 {��i��;�:t., ", ' `_"' �_ai`�I 1-:: 1-I�11:=:: 1=�1��'t:);�i;ti=:�-;.; _..•.. ii�J. (813) 782-5013 (:�!..i�:::"C��;t��1E:-?:q:r�_r:C:�F.��..� l:�_lt�.l �� r:: «�, . ...:R:y:.,�-- NOTES: f?t:?i_J�:'i:::;''::;;:;:i l�!i=-;::.. r-,� :•.. �_...... .��. . , t...�r..._�..; ............... ,...i__I.., ,��I:::.t�: i . 1 �� i • _ . �..i�.,�',r c`.r' . .._....._. ��'l.._!�•1i��I'�.)�'. 1_i [:::��:::.1 {"'�1,!(.it_i 3r��s-s n syw ,...f�,.,�,�� r-,.,, �.r.��:r,�.a,,.�:..�:� r.�....,_�:: �....,_ 3 7��s—s�e .�'y�/ .__.. ,.:.�::,:a i !-�t T! 1— .. irt=:.i—il...isi'CT'F'�l.i._i..-`-r T""?_..:�:�...1'�f.4 � .�w . ' _. _�_ t ..L.�'.f...i�...��... �.ii..:.'F_l'�4� ' �...��!T i_��r'�j F�� .��5.._!_�, Start End Time Flow Pressure Pressure Held Pressure P essure SYstem Regulator Regulator Regulator Regulator Single Stage �K Code Condition Manuf. Model In. W.C. In. W.C. In. W.C. Two - Stage 1st PSIG PSIG PSIG PSIG 2nd In. W.C. In. W.C. In. W.C. Work Pertormed: .��!/.ST�6�� L � GN J ` i� Description Amount Service Appliance Material Tax QtY• Part# Description Gas Hazmat 0 Permit Tank Lease Total Due I have authorized and have authority to order the work as outlined above. I agree to pay all costs as represeAMOUNT�REmE�IVEDese charges are turne over for collection, I agree to pay reasonable attorney's fees if this invoice is placed in the hands of an attorney or collection agency for collection. d Customer Signature Date Technician's Signature Tech# FILE COPY GAS APPLIANCE SYSTEM CHECK I ._ _ _ __.- __ __ _ . _- ___ -— ' Nome Heating � '_ Range ,__ ; _ _ - , performance Check._Item ; ____ __ - � Water Heater Y _ � �, _-- _ _ - - i - ,� � 'Maitufacturer _ _ _ _ _ __ ___ _ _ _ �Model # _ --_. . _ _ , _ __ _ _ _ SeXiai �` _ _ __ __ _ , . _ _ ._ , _, __ t-ur;� _ � . - - - . �,�,�, OC� __ _ _ fV/r`�. Jt: _ . _ 'gTn.J _ _ , _ _ . _ �9�' _ _ _ _ . __. _ _ _ _ — _ __: �'�,Mc`3i"iL1G't� `~J'�1Ut0� i i:�nc a F� .ti i,:; . _._ _. ._ . _. .. _ .._ .... _._ _ _!... ...._. . ..._. � -__ __._. ._ ,� �''�.. _—_-__. _... _ -._ ,' ___. .......� �� _, .. ; ...... _ , _....._ . � �E:C�i(11�11� i i`S� :__ __ _, _ _ _. _ , -- , . _ _ �- I C,oflfi'G+� Mft��MC1dE'.�#t _ --_ i ___ _ _ . _ _ i F�liot�s) _ _ - -_ _ __ _ _ , i Ignit?�s,� System(s} Mfc� _ _ . _ _ _ _ _ , Tk�errnc�st�t(s} Ntfa _ _ > _ , __ Pil�t Safety :�ysterr? _ _ _. __ ' _ ._ . _ , �3urr,�rtsi _ _ h�,p, Nit� _ _ +_ C::arnb��stian Chamber _ __ _ _ _ , _ _ N!A NiA _ __ - _ �Fifters . _ _ _ ___ _ _ _ _ ; ,__ _ -- f`�;�� IV;P ._ _ __ Motor/Rfower�+�Eamp _ _ _ _ Nrt`, : - _ ��N P1;f�, _ __ _ ,Suffic�ent Rett�rr�/�er , _ _ __ _ _ I,l�r�ft D`�E=.rtcy� _ ! _ . _ Ver,tir�rs _ _ _ ' __ _._ '�;os�i��.astio�i E=yir . ! _. _ _ . _ _. _.. . -_ {�21� �ciC� i.�rn ,t.r �n ,� e.�; + __ _ _ _ ___ r Aut« Fr31 Sch�clu4e _ _ ; __ ' _ _ _ . _ _ _ � __ _ . ___ _ iyon � Candit�on I�Ccnd�U�n lief Valve � ��ttings I Tank � � li�der __��o�d -- ___ ,__ i --�- _ _ M�r &DatF 1 ate Test T�3nk C,nnclitic>r Fittin s � Gauge I.el �ate _'_ Ca Le�k Test � i_or,atu�r + S�r'ea� - Da�e - , _ { I , ' _____ _i ', __ � .__ fecks. the intern�?wcrking of seaied eqi:ipment. cr siructurai components. and cannot �fhis mspeetion covers (propanelL�-g�s) items a��d equipment visible ana aceessit�le tn th� �ervice tecY�nVcian and represents the conditior�s exisiing or� the date of inspection. It does not cover iatent or manufacturing de be constriiecf tc�;�ver f��ture def�cts or unf�reseen happeni�7q"� i _..._ __._.. __ _ _ _ __ __ __ L ___ __-- _ - _ , ,p�A�se Print} - (Please Printl Certify that I trave cc�rnpleted the Systerr'i C,heck as prescnbed. . Knu��huw to turn cff g�s fn case of emergency Perfarmzd Qdor Test �I Yes F'erformed Pressure Test U Yes • Have smelleci propane and can delect fts odor piaced Safety Decal '.�Yes Leffi Ct�nsumer Safety Info �Yes � Have raceived the Consumer Safety informatior,. - Had gas system deficiencies and i or corrections,if any.cleariy expiained to m�.. •Am satisfied �tth th.e service work per�orrn�d . . ____ ----- _ - ---- _ ____. --- -- - Serv�ce Techrncian Signattire Customer Signature�