HomeMy WebLinkAbout14-15510 ; CITY OF ZEP YRHIL,LS
; 5335-8TH STREET
(si�)�s -oozo 1 1 Q
ANNUAL FIRE PRQTEC�I{}N MAINTENANCE
"�"`�T � � `PERMIT�INFORMATiOhf - LQCATION'INFORMATlUN
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Permit Number: 15510 Address: 36841 CLUBHOUSE DR
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: 5ubdivision: SILVER QAKS
Est. Value: Parcel Number: 04-26-21-p000-00100-0020
, improv. Cost: OVitNER INF4RMAT14N- . � `
Date Issued: 7/22/2014 Name: S & R DEVELOPMENT LLC
Total Fees: 25.00 Address: 36841 CLUBHOUSE DR
Amount Paid: 25.00 ZEPNYRHI�LS, FL. 33542
Date Paid: 7/22/2014 Phane:
Work Desc: FPM- SUPPRESSI(�N ANNUAL-SI�U RADO GO�F CUURSE
CONTRACTOR S APPLICATION FEES
FlREMAS ER FIRE PEF2 IT FE 25.40
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���• ' Ins ections Re uired r ` Y . :ry w:
� FIR ACCE TANCE Fina
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Chapter 633, Florida Statutes,authorizes the City fio harge and collect user fees to pay for the costs of fire
prevention and pratectian related activifiies such as i�spections,plan review,administrative fees,and other
' costs related to t e aforementianed.
Complete Plans, Specificatians artd Fee Must Accompany Ap licatian. Cammencement af worEc without written approval of
the Fire Department's Fire Marshal or required permits ar pening up for commercial activity without an approved final
� inspection shall be charged dauble permit fee per day of a eration or a minimum of$100.Q0, whichever is greater. All
work shall be performed in accord nce with City Codes and Ordinances.
"WARNING TO 01NNER: YOUR F ��URE TO RECORQ A NOTICE OF
COMMENCEMNT MAY RESULT IN YOU PAYING TWICE FOR TMPROVEMENTS
TO YOUR PROPERTY. IF YQU INTE D TO OBTAIN FINANCING, CCtNSULT
WITH YOUR LENDER 4R AN ATTORN�Y BEFQRE RECORDING YOUR NOTICE
OF C4MM�NCEMENT."
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� PERMIT QFF[CER=� `
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION
CALL POR INSPECTION -8 HOUR NQTICE REQUIRED
ZEPHYRHILLS FIRE RE CUE DEPT- 813-780-0041
I
813-780-0020 CI of Ze h�rhills Fire Fax-813-780-0021
tY P
i Permit Ap �lication
Date Received _ Phone Contact for Permit_Y��� �
�--��_-�_� ._.__ _... __...__.,._,�� __.�......-....._a�._..._._-.��_ _ _ ��
Owner's Name ��" O �I Owner's Phone Number p� � �� 2.� "
Owner's Address 3 1 UI f1.�r/1. " � � �� !�
Fee Simple Titleholder Name Titleholder Phone Number � � �
Fee Simple Titleholder Address �
�.;1____�..e..__ ' _ �-m - - - - �.r_4._. -•�
Job Address v Lot# ��
Sub Division Parcel#
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� Bio-Hazard Waste Storage-ANNUAL �� Fumigation Tent
� Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL
� Controlled Bum � Hood Installation
� 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
tr y emi � t er �\
Sprinkler � O ❑ ❑ � Recreational Bum /�//U
Fire Alarm � ❑ ❑ ❑ � � Sparklers �`J (
1
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
� FlammableApplication-ANNUAL Valuation of Project
� Fuel Tanks
Q Other:
�.::�:_,.�.v,:..-�-- .m........� ._..._...�,_._. .�,�.._....�, .,._._ - � - - --
Contractor �I�� J�/���' �r `�� � — ' pj � /S' Company
v�'
Signature Registered Y/N Fee Current Y/N
Address � Q Q � �!�- (�c� �j 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
Signature Registered Y/N Fee Current Y/N
Address License#
t� .�___�__-.�.�..,...___.._._ _._._..,___.,�...- ,�.,...v___.��,.."._...__�_..,.�.._....._._._^ ,:a__.w.._.._._....a.�..._-,_.�._. _..-..�y- •--.�-.,_�.___.._,_._._._.._.�..,.�� __..
Directians:
Fill out application completely.
Owner&Contractor sign back of application,notarized(Or,copy of signe contract with owner)
If over$2500,a Notice of Commencement is required(Mechanical work �ver$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)
PIOTICE OF DEED REST121CTIONS: The undersigned understands that this permit may be subject to"deed"restrictions"
which may be more restrictive than County regnlatiotts. The undersigned assumes responsibility for compliance with any �
appficabte deed restrictions, `
UNLICEPlSED CONTRAC'fpRS AND COMTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contraotors to eandettaice work,#hey may be required to be Ifcensed ia accordance with state and local regulat3ans. If fhe
contractor is not fieensed as required by law, both the owner and contractor may be cited for a misdemeanor violatton
under state law. Ifi the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended wark,they are advlsed to contact the Pasca Gounty Building lnspection Division--�icensing 8ectiort ai 727-847-
8009. Furthermore, ifi the awner has hired a confractor or contractors, he is advised ta have the contractor(s) sign
portlans of the"contractor Block"of this application for which they will be responsible. If you, as the owner sign a�s the
contractor,thaf may 6e an indication that he is not properly ifcensed and is not entitled to permitting pr9vileges i� Pasco
County.
TRANSPORTATIOPd IMPEACT/UTILITIES IRflPACT AtdD RE50URCE RECOVERY FEES: The undersigned understands
that Transportatlon lmpact Fees and Racourse Recavery Fees may apply to the conshucfion o£new bu(ldings,change of
use in exisfing bUiidings, or expansion of exisfing buildings,as specified in Pasco Counfy Ordinance number 89-07 and
90-07, as amended, The undersigned also underst�nds,that such fees,as may be due,will be identified at the time of
permltting. It is furiher undersiood that Transpnrtatlon Impact Fees and Resource ftecovery Fees must be paid prior to
rece3ving a°cert�cate ai occupancy"or final power release. If the projec#does nat involve a cert�cate af occupancy or
final power release, the fees must 6e paid prlor to permit issuance. Furthermore, ff Pasco County Water/Sewer Impact
fess are due,they must be pafd prior to permit issuance in accordance with applicable Pasco Coun#y ordinances.
CQNSTRUGTtOM�iEFd LJAV4t{Chapter 7i3,Florfda Statates.as amended}: (f ualuation af work is$2,50Q.flQ or more,1
ce�tify that I, the applicant, have been prav(ded with a copy of the "Flarida Constructian Lien Law—Homeowner's
Protection Guide°prepared by the Florida Department of Agticulture and Consumer Affairs. If the applicant is someone
other tFean the"awner",I cerfi€y that!have obtained a copy o#the above described document and promise in goad falth to
deliver it to the"owner"priar to commencement.
COMTRACTpR'SIOWNER'S AFFIDAYIT: !certify that all the information in this application is accurate and that all work
will be done in complianee with a!1 applicable laws regutating construction,zan'sng and tand developmenf. Applicatfon is
hereby made to obtain a permit to do work and installation as indicated. I certffy that no work or instaliation has
commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating
construcfion, County and City codes, zonit�g regula6ons, and land development regulafions in fhe jurisdicfton. 1 also
certify that I understand that the regulations of other govemment agencies may apply to the intended work,and that it is
my responsibility to identffy what actians I must take to be in compliance. Such agencies inciude but are not limited to:
- Department of Environmentat Protection-Gypress Bayheads, We#tand Ateas and Environmentatly Sensifive
Lands,Water/Wasiewater Treatment.
- Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetl�nd Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalis,Docks,Navigabte Wakerways.
- Department of Health & Rehabilitative ServiceslEnvironmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Environmentai Proteation Agency-Asbestos abafement.
- Federal Aviation Authority-Runways.
1 undersfand that fhe fotlawing restricttons apply#o fhe ase of f�ilr
- Use of fiii is not atlowed in Fiood Zone`V"unless expressiy permitted.
- If the fiil material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
°compensating volume"wtl!be submltted at time af permltting whfch is prepared by a professiona!engineer
licensed by fhe State of F(orida.
- If ihe fiil material is to be used in Flaod Zone "A" in cannectlon with a permitted building using stem wall ,
constntction,t certrFy that fili vriil be used onty to fi(t the area withln fhe stem wal1.
- Ifi fili materia( is #o be used tn any area, t certify that use of such fili will nat adversety afEecf adjacenf
properties. If use of fill is found to adversely affect adJacent properties,the owner may be cited for vialating �
the conditions of the building permit issued under the atkached permit application,far lots fess than one{1)
acre which are elevated By fsl1,an engineered drainage plen is required.
If I am the AGENT FOR YF9�OWNER,I promise in good faith to inform ihe owner of the permitting conditians set farth in
thls affldavlt priar to commencing construotion. !understand that a separate permlt may be required for electrical work,
plumbing, signs,wetts, pools, air eanditioning, gas, ar o#fier instaltations not sgeciflcalty included i�the applicaf3on A
permit issued shall be construed to be a license to proceed with the work and not as autharity to violate,cancel,alter,or
se#aside any provisions of the technicaf codes,nor shal!issraance of a permlt prevent the Buildirig Official from thereafter
requSring a coRection of errors in plaos,canstruc#ton or violations of any codes. Every permlt tssued shaA became tnvalid
unless the work authorized by such permit is commenced wiihin six months of pertnit issuance,or if work authorized by
the permit is suspended or abandoned for a period of six(S)months after the kime the work is commenced. An extension
may be requssted, in wrifing,from the 8uilding Official for a period not to exceed ninety(90)days and uuill demonstrate
just�able cause for the extension. If work ceases for ninety(90)consecutive days,the job is considered abandoned.
WARNIi�G Tq OWNER: Y4)UR FAIl.URE TO RECORD A t�OTICE 4F COMMENCEMEN7 MAY RESlILT ltd Yt}UR
P�4YIMG TWICE FOR INYPROVEMENTS TQ YOUR PROPERTY. IF YOU I1�TEND TO OBTAIN FWANCING,COMSULT
WITH YOUR LER!DER OR P.N ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDAJURAt{F5.i17.63j
ONMER OR AQENT COfd7RACTpR
Subscrtbed and svlam to{or aftlrmedj before me lhis Suhscribed end swom to(or atfirmed)before ma thls
by �Y
Who Is/are personalty known to me or haslhave produced Who ts/are petsonaily icnown io me or hesfiave produced
asidentlficatlon. asldenHH�adon.
Notary Public Notary Public
Cammission No. Commission No.
Nama o1 Notary typed,prfnted or stamped �Name of Nobry typed,printed or stamped
a
For Information Regarding t is Report ���_����������
� � Please Call ������ �������0�� ������
800-522-7150
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�fP'�lbfastE�I�` t
MNSTERPF07ECTION,IP SRO# � (� Date � — � 2 ` 1�
❑QUARTERLY ❑ANNU�.L ❑SEMI-AfdNUAL ❑ EW IN TALLATIOM ❑ FIRST IMSPECTION ❑ CHANGES MADE
Customer �' (f e[�� �°j p I p V��- . Cusfomer#
/�
Address � � 0 , , d Gl.� � � d� " � / .f. � � s�
Manager/Owner hone f J? � � �,2 �
System Location �� C �''/t/ fVlanufacturer ��`j'Cf�� nllodel C � #Cylinders
Cylinder size(s) /' � NAethod of Actuation � ,� Number Degree ���
List main cylinder size first ('
Last Hydro � ;� Last Recharge � Seri I fdumber �� ��j S Fuel Type
Restaurant nAarine❑ Industrial❑ Inspected per I stallation Elec❑ Gas❑
f�l nual Date Size � �
. 4 � I .
. �
,. ..... ... ...... ... ... ... .. ..................................................................................................................... ... ...... ..... .... ......... .. .,
: ... .. .. ..... ............ ................ .............................. s............ ..............�........................................... .. ... ... ... ... ....... ..
... ... ..... ......... ....... . ....... ... �.. . ...... ....�. .��. ... .. ......... ... ........ ... .... .. ... ....... ,
.:. ......... ... ..... ........... .. ...... .. ..... ... .. ... ... ... ... ......... ... .... :
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... ... ... ... ...... ... ....... . . ..... ......... .... ..... ... ... ...
. .
. ... ......... .. .. ....
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.... ... .... .. ... ... . ...... . .. .
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���/' � ��t""� �� �j YES NO N/A
� Is system mounting bracket in accessible location and soundly mounted? ./.. , 4 / ❑ �
I - ❑ ■
2. Is piping tight,secured and checked for blockage?.. ......... ........... ...... ............ ............. ............. .... ...
3. Are grease tights installed at all hood penetrations? ..... ........... .... ....... ........ ...t............. ....... ... ❑ �
4. If multiple systems,did all systems operate satisfactory? ...... ... ......... ..... ... ...... ........... ... ....... .... ... ...
5. Is system properly installed to properly protect hazard(s)?... ... .......... ... ... ..... ... ..... ............ .... ❑ ❑ �
�
6. Are all nozzles properly located and proper type?..... ......... ............. .............. ... ... .... ...
7 Is manual pull operational and in proper location? ... ..... ... ................ .... ... ...... ... ....... ... ... .... ❑ ❑
', 8. Are all fusible links or HAD's of proper temperature rating? ... ............ ....... ....... ... .... .... ........ .............. ...
9. Were fusible links replaced? ... .... ... .... ..... ... .......... .... ... .......... ....... .... ❑ ❑
10. Is automatic detection operational?... ....... ... ... ... ........ .... .......... ......... ... ......... ... .................. ..... ...... ❑ ❑
� 11 Did fuel shut off properly?.... ..... ... ....... ..... ... ....... ...... ...... ... ...... ... ... ........ ...... ... .. ❑ ❑
12. Did all electric shut down under hood(s)and alarms operate?.... ......... .............. ... ... .... ... ...... ... ...... ...... ................. ' ❑ ❑
13. Are bursting disc and chemical in good condition?... .... ....... ........ .. ..... ... ... ......... ... ....... .......... ............. ....... . ❑ ❑
14 Is cartridge within proper weight? .............. ... ................. ...... ......... ... ... ...... ...... ..... ... ... ..... ......... ❑ �
15. Are all nozzles clean and caps/seals properly installed? ..... ...... ...... .... ... .... ..... ..... ... .......... ..... .... � ❑ ❑
16. Is cylinder pressure in operational range? ... ... ........... ........... .. ..... ...... ...... ... ...... ..... ....... .............. ......... .... � ❑ ❑
17 Are filters clean and in good condition?........ .... ... .......... .. ... ............ ... ... ... ....................... ... ... � ❑ ❑
18. Was system placed back in service and in normal operation condition? ........... .... ... ...... ...... ... ......... ... ... ..... ... ......... ❑ ❑
19. Have persons working in area been instructed on proper operation of system?...... ........... ........ ... .... .... ........ ... ... ..... ❑ �
20. Was the inspection/maintenance performed in accordance with NFPA 77,17A and 96? ...... .................. ... ............... .... .......... ❑ ❑
21 Was inspection/maintenance performed in accordance with manufactures sp cifications?...... ... ......... ....... ... ... .... ..
❑ ❑
22. Does system comply with UL300?... ... ........ ... ......... .... .... ............ ... ..... ....... ... ..... ....... ... .. ❑ ❑
23. Was system tagged in accordance with 69A-21?(Florida only) ... ...... .. .... ...... .......... ... .... ..... .... ......... ..... � ❑ ❑
Comments � r,y�
.�
1,THE UNDERSIGNED,CERTIFY THAT I PERSONALLY INSPECTED THE ABOVE PREMISES ND FOUND CONDITIONS AS NOTED
PermiVLicense N
Service Technician Date Time C to r S� nature Date
`-' •• ,�, L � CJ AM Z' �
FL 10 (9/12 Form X-P$I l�Ut I C(Ji-� COPY