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Home My WebLink About14-15005 ° � CITY OF ZEPHYRHILLS 5335-8TH STREET (si3)�so-oo20 15005 ANNUAL FIRE PROTECTION MAINTENANCE Permit Number: 15005 Address: 38107 MARKET SQUARE DR Permit Type: FIRE PROTECTION MAINTENANC ZEPHYRHILLS, FL. Class of Work: FIRE-PROTECTION MAINTENAN E Township: Range: Book: Proposed Use: MEDICAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: Improv. Cost: Date Issued: 2/25/2014 Name: FLORIDA MEDICAL CLINIC Total Fees: 25.00 Address: 38107 MARKET SQUARE Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542 Date Paid: 2/25/2014 Phone: Work Desc: FPM- SPRINKLER ANNUAL - FLORIDA MEDICAL CLINIC 5. �`�� i i1� �� / 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 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." . ., „ , - , �� , ,�. �l�.��J �>�� ' PERMIT OFFICE PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT- 813-780-0041 ais-�eo-oo2o City of Zephyrhills Fire Fax-B13-780-0021 Permit Appfiqtion Date Received Phone Contact tor Permit 813 621 1357 owners Name FLORIDA MEDICAL CLINIC Owners Phone Number C� �� owner's Address 38107 MARKET SGIUARE DR.,ZEPHYRHILLS, FL 33542 Fee Simple Titlehotder Name Titleholder Phone Number C� � C� Fee Simple Titleholder Address Job Address 38107 MARKET SOUARE DR.,ZEPHYRHILLS, FL 33542 �ot# �� Sub�ivision CITYOFZEPHYRHILLS Perce�tt a Bio-Hazard Waste Storage•ANNUAL O Fumigation Tent a Comm Exhaust Kitchen Hood/Duct � Hazardous Maleriai(Tier il or RQ Facilily)ANNUAL a Controlled Bum O Hood Installation aEmergency Generator<30 kw O LPlNatural Gas-Installation � Emergency Generator>30 kw O LPlNatural Gas-ANNUAL Sale � Fire Protection Maintenance-ANNUAL Q Places of Assembly-ANNUAL t y emi �n t er Sprinkler � ❑ ❑ � � � Recreational Burn �1 � FireAlarm � ❑ ❑ ❑ � � Sparklers � /��`JlJ Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) � Fira Alarm Installation � Torch Roofing/Tar Kettle o Fire Pumps � Waste Tire Storage ANNUAL QFire Works OFlammable Applicalion-ANNUAL $25.00 Valuation of Project Fuel Tanks O Other: Contractor ' Company Signature Regislered Y/N Fee Gunenl Y/N Address License# ELECTRICIAN Company Signature Registered Y/N Fee Current Y/N Address License#t PLUMBER I"� Company � Slgnature Registered Y/N Fee Current Y/N Address License# MECHANICAL Company Signature Registered Y/N Fee Current Y/N Address License# OTHER compa�y RODAN FIRE SPRINKLERS, INC. signature JEFFERY D. BURNHAM � Registered Y/N Fee Curtent Y/N Address License# y Directions_ Fill oul application completely. Owner&Contractor sign back of application,notarized(Or,copy o(signed contract with owner) H over 52500,a Notice of Commencement is required(Mechanical work over 55000) Supply lwo(2)sets of drawings with applicable documentation Allow 10-14 days for review arier submittal date. Parcel#-obtained from Property Tax Notice(htlp:Uappraiser.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 applicabie deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBtLITIES: 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 Llen 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 deliver it to the"owner"prior to commencement. - CONTRACTOR'SIOWNER'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 musi 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 a�davit 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 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 ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. FLORIDA JURAT(F.S. 117.03) OWNER OR AGENT CONTRACTOR// �"`—'-- 5ubscribed and swom to(or affirmed)before me this S�ubscri�edfa�n'd orn.�(o rmed)l�fore this bY —�=�J�bY�_�1r 4' 4-� • � �N.�/nn Who is/are personally known to me or has/have produced Who is/are person Ilv knnwn to me r has/have produced as identification. as identification. Notary Public Notary Public Commission No. Commission No. �j2 �� Name of Notary typed,printed or stamped Name of Notary ryped,printe or d o ry u ic ,eo onue Cheryt A Duffeb �= . s W1Y Commission EESi0a2A '+a�d� Exptres1111212a'(3,'