HomeMy WebLinkAbout15-16357 CITY OF ZEPHYRHILLS
5335-8TH STREET
, (sis)�so-oozo � 357
f� �� � ANNUAL ASSEMBLY PERMIT
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PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 16357 Address: 6851 WIRE RD
Permit Type: FIRE PLACE OF ASSEMBLY ZEPHYRHILLS, FL.
Class of Work: FIRE-PLACES OF ASSEMBLY Township: Range: Book:
Proposed Use: COMMERCIAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 02-26-21-0010-01200-0000
Improv. Cost: OWNER INFORMATION
Date Issued: 6/11/2015 Name: ZEK INC
Total Fees: 50.00 Address: 6851 WIRE RD
Amount Paid: 50.00 ZEPHYRHILLS, FL. 33542
Date Paid: 6/11/2015 Phone: (813)782-4604
Work Desc: PLACES OF ASSEMBLY- ELKS LODGE#2731 EXP 6/2016
CONTRACTOR S APPLICATION FEES
OWNER FIRE PERMIT FEES 50.00
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Ins ections Re u'
FIRE ITE INSPECTION-Final
OCCUPANCY LOAD:
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ccupancy by ore than the number of persons above shall be onsidered
dangerous and unlawful. Occupant load determined by Florida Fire
Prevention Code, NFPA101, Section 7.3.1.2
PERMIT OFFIC
PERMIT EXPIRES IN ONE (1) YEAR FROM DATE OF ISSUANCE
THIS PERMIT NEEDS TO BE POSTED IN VISIBLE LOCATION IN MAIN ASSEMBLY AREA
ZEPHYRHILLS FIRE RESCUE DEPT - 6907 Dairy Rd, Zephyrhills, FL 33542
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ZEPHYRHiLLS FIRE RESCUE
6907 DAlRY RD.ZEPHYRHILLS, FL.33542 WORK(813)-780-0041 FAX: (813)780-0044
Business:�� �����' Em.Contact:
Rddress: ���� ��� �� • Ernergency contact phone#: �
Tel No: Other Information:
Th�fire safety inspection has been completed utilizing the Fforida Fire Prevention Code and any
applicable NFPA code and/or standard.Should you have any questions, you may contact the
Fire Marshal at the telepiione number above. �
, Y/N/NA Y/N/NA/Date
1.Address,front/rear("6"inch minimum) 13.Emergency L9ghts
2. Knox Box(keys inside,labeled) ' 14.Fire Extinguishers '
3. Lightweight Truss Sign 15. Electrical(other)
4.Fire Lane Access(marked-unobstructed) 16.Storage Issues
5.Hydrants Accessible 17.Mech/Elect Rms Labeled
6. FDC Accessible 18.Hood Cleaned/Tagged
7. Private Hydrant(painted/fiagged/test) 19. Fire Alarm/Tagged
8. Exit Doors Open Freely 20. Hood Suppression/Tagged
9.Egress Unobstructed 21. Fire Sprinkler/Tagged
10.Extension Cords/Multi-plug Adapter 22.Suppression(other)
11.GFI's by Water Source 23.Occupancy Load sign posted
12.Exit Lights 24.Other
Violation comments shall be noted base on the corre ponding number above. Place date af
last inspection for fire protection items ir�space provided above.
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~.�'� No Violations ` U�
Your fire safety inspection determined there were some violations.
The Fire Marshal will be contacting you to advise of the time frame in which the violations noted
shalJ be corrected. A re-inspection will then be conducted after that time frame. Failure to
correct in time frame given may result in fees being assessed. Reinspect Dat :
Re ort Com leted B : l���-`-1 y�` - V��'�� Date: ��� 2��
P P Y S_
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�lccompanied By: � VL . � Time: �,
Inspection Acknow� dged By: Date:
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5335 - 5TE-1 S?REr r .I n,J2�
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ANNUAl. ASSEM�LY PERi�1IT
� - P�RMIT tNFOF�MATlt]N �_�_-- — LOCAT[GC� 4N��?F�������{�+{ ,
Scrrnit hlumber: 10�?7 � � Address: 68�1 VUfR� RD
IPermiti�Type: F4f�E PLACE OF ASSEtv1BLY ZEPHYRHiLLS, FL.
Class �f Work: FIR�-PtACES OF ASSEMBLY Township: Range: S �����' '
;Prc���osed Use: COMMERC1f�L Lot{s): Block: ;
; 5c�uare Feet: � Subdivision: CITI' O� Z�PHYR�t-iILLS
' Est.Ualue: � Parcel Numder: 02-?6-21-CU1C-�i2Q�-��OC�
( Improv. Cost; � 01NNER ENFC?R!4'�Tl�f�f '
�. Date l�sued: �al28i2�10 � � ; � j, Name: ELKS LODGE , '
TotalFees:_ ?Q.Q�.�__..�-'�:�__�;�1_ �� Address: 6851 WIRERD r R_ ; -. �,�
} -._Rmount .�.ct1,_�.��.- --�------.��_(lt�_ � ,�'� ' i,�,� ZEPHYRHILLS, rL. ���-2 "<,:...
`' ---'- ate Patd: 6121(2C10 ��'��^'~�� " ��"'.�
I , �-�' - - - - -- --�`�� - - - -- --Phone: (81�)782-�60�-- ;'
� Work Desc: PI_ACES OF_ASSENiBLY � OR ELKS LODGE �2731 _ ' ,E� :�-;
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�a�s-7so-oa2o City of Zephyrhills Fire Fax-s�3-7�0-0023
\ Permit Application
,,, • ��_� Phone Contacf for Permit C_� ��_��
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..ne�s Name � ��C�^�j Oumer's Phone Numher
Owner's Address
Fee Simple Titleholder Name Titleholder Phone Number � � �
Fee Simple Titlehotder Address
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Jab Address - - - - - � — �Lat# ��
Sub Division Parcel#
c:-�_�.V.�..<aw__..__._ �_....::�._�._._,.��,-�:��._....._��.�_°:�w_.._._..�_--W._-..:...�_�..._��,_»�a�_____�.._��_.--_.__..�___.�.�_. __�... .___...�_;�..____�
� Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
o Com�Exhaust Kitchen NoodlDuct Q Nazardous Maferial(Tier II or RQ Facility}ANNUAL
� Controlled Bum � Hood Installation
� Emergency Generator<30 kw o �PlNa#ural Gas-Instal]aGon
� Emergency Generatar>30 kw � LP/Natural Gas-ANNUAL Sale
� Fire Protectian Maintenancs-ANNUAI �Places af Assembly ANHUAE. ,,�
t y emi �ln` t er �- �
Spri�kier � O ❑ ❑ � � Recreational Bum l���
Fire Alartn � ❑ ❑ ❑ � � 8parklers
� Hood Gleaning � � ❑ ❑ C� � Sprinkler System Ens#allations
Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
� Fre Alarm Installation � Torch RoofingtTar Kettls
� Fire Pumps � Waste Tire Storage ANNUAL
� Flammab(e App3ication-ANNUAl. � � Va(uation of Project
� Fuel Tanks
Q Cl#her: �
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Contractor � � � Company
Signature � Registered Y/N Fee Current Y/N
' Address �icense#
ELECTRIGIAN Company
� Signature Registered Y 1 N Fee CurrenE Y 1 N
Address License#
.
P�Utv1BEF2 Company
5ignature Registered Y/N Fee Current Y/N
Address License#
MECHANICAL Company
Signafure Registered Y 1(�! Fee CuRenf Y/N
Address Lice�se#
OTHER Gompany
Signature Registered Y/N Fee Current Y/N
Address License#
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Directions: pt3 �_�.-____ ....__._._ ,...... _ a_._._.�-r...___«_...�_._
Fill aut application completely.
Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner)
if over$25Q0,a Notice of Commencement is required{f4lecha�ical work over$540Q)
Supply two(2}sets of drawings with appiicable documentation
Allaw 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com)
NOTiCE OF DEED RESTRICTlONS: The underslgned understands that thls permit may be subject to"deed"restrictions"
which may ba more restrictive than Caunty regulations. The undersigned sssumes responsiblllty for comptiance with any
applicable deed restrictlans.
UNUCENSED CONTRACTORS ANp CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or ' • +r
cantractors to tsnderfa4ce wark,fhey may be required ta be licensed in accordance wlth state and tacaE regu3at(ons. [f the - „
contraator is not licensed as required by law, both the owner and contractor may be clted for a misdemeanor vfolation
under state law. !f the owner ar intended contractor are uncertain as to what licensing requirem�nts may apply for the '
intended work,they are advised#o cantact the Pasco Cnunty Buifding Inspection Divis�on—L�censing 5ection at 727-847- ' ' �
8009. Furthermore, if the owner has hired a conhactor or contractors, he is advised fo have the contractor(s) sign
portions of the"contractor Block"of ihis application for which they will be responsible. If you, as the awner s(gn as the
contractor,that may be an Indlcatian#hat he 1s no#propedy iicensed and ts nof entiflsd fo permifting priv�leges in Pasco
Counry.
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
fhat'iransportation lmpact Fees and Recourse Recavery Fees may app#y to ti�e consiruction of new buildings,change of
use in existing buifdings,or expansion of existing buildings, as spec�ed in Pasco County Ordinance number 89-07 and
90-07, as amended. The undersigned also understands,that such fees,as may be due,will be idenCrtied at the time of
permlNing. it Is iurther understood thaf Transportation lmpact Fees and Resource Reeovery Fees mast be pa3d pria�to
receiving a°ce�kificate of occupancy"ar finat power release. ff the project does nof involve a oertificate of occupancy or
final pawer release,the fees must be paid prior to permit issuance. Furthermore,if Pasco Caunty WatedSewer Impact
fees are due,they must be pald prlor ta permit issuance in accordance with appitcable Pasco County ordinances.
CONSTRUCTION LFEM LAW{Chapter 713,Florida Statutes,as amended}; If valuaGon of work is$2,5dd.00 ar mare,1
certify that I, the applicant, have bean provided with a capy of the "Florida ConstrucHon Lien Law—Homeowner's
Protectlon 6uide°prepared by the Fiacida Depettment of Agriculture and Consumer Affairs. if the appficant is someone
other fhan the°owner",t cerfify that i have obfained a oopy of the above descrfibed document and promise in good fatth fo
deliver it to the"owner"prior ta commencement.
CONTRACTQE2'S/OWNER'S AFFIDAVIT: !cerUfy that aii the tnfirmation in thls application is accurate and that all wark
wiH ba done in compliance with a11 appficabfe laws regulafing consfruction,zoning ar�d land deve)opment. Appiicafion is
hereby made to obtaln a permit to do work and inskallatian as indicated. i certiFy that na work or instailation has
commenced prior to tssuance of a permit and that all work will be performed to mest standasds of a{I laws regulating �
canstruction, Connty and C'sty cades, zoning regulatians, and Iand devetopment regutations in fhe jurisdfictton. ! al'so
certify that I understand that the regula#ions of attier gavemment agencies may apply to the intended work, and that it is
my responstbility ta identify what aotions I must take to tae ln compliance. Such agencies include but are not limited to:
- Deparfinent of Environmenta(Frotectian-Cypress 8ayheacfs, VHetland Areas and Enviranmentally Sensitive
Lands,WaterlWastewater Treatment.
- Southwest Florida Water Management Distric#-Wells, Cypress Bayheads, WeUand Areas, Altertng
Watercourses.
- Anny Corps of Engineers-Seawails,Docks,Navigable Waterways.
- Department of Health & Rehabllltative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- U5 Enviranmental Protectlon Agency-Asbestos abatement.
- Federal AvPation Authority-F2unways.
1 understand that fhe failawing restricfions apply fo fhe use af fill:�
- Use of fill is not allawed in Flood�one'V"unless expressly permitted.
- If the flll material is to be used in Flood Zone "A", ft is understood that a drainage plan addressing a ,
°compensatEng volume"wriil be submifted af fime of perm3tting wtttch is prepared by a professional engineer '
licensed by khe Stake af Florida. '•�� .,. 1; , � .� •
- If the fill materlal is to be used in Flood Zone"A" in connec6on with a permitted building using stem wall
construetiort,l certlfy that fEtl wlll be used onEy to filE the area withln the sfem wall. '
- If ftli material is ko be used in any area, I cerfiry that use of such filt wilt not adversely affect adJacent �'
properties. If use of fili is found to adversely affect adjacent properties,the owner may be cited for violating
fhe condifions of the buiiding permit Issued ur�dec the attached permit application,far tofs less than one{9}
aare which are elevated by fiil,an engineered drafnage plan Is required. r ~
If I am the AGENT FQFt THE OWNER,I promise in gaod faith to inform the owner of the permitting conditions set forth in
thls aftidavtt prlor#a cammencing consfruc6on. !understand that a separate permit may be tequired for electricai work,
plumbing, signs,welts, poots, air condifioning, gas, ar other instaliations not specificaily inefuded"m the appiication. A
permik issued shali be construed to be a license to proceed wikh the wark and not as authority to violake,cancel,alter,ar
set aside any provisions a#fhe technicai codes,nor shafi issuance of a permtt prevent the Su(Idirig Off�ciai from thereafter
requiring a correcfion of errors in plans,construction or violafions of any codes. Every permif issued shati become invatid
unless the worlc autharized by such permit is commenced within six months of permit Issuance,or ff work authorized by
the perm[E(s suspended or abandaned for a period of six(8}months after the time the work is commenced. Art eactension
may be requested, in writing,from fhe Building Ofticiat for a period nof#o exceed ninefy{90j days and will demonstrate
' justifiable cause for the extension. If work ceases for ninety(90)consecutive days,the job is considered abandoned.
I
WARNIN�TO OWNER: YOUR FAi�.URE'f0 RECORD A fi20TICE OF COMflIiENCENfENT MAY F2ESULT tN YOt7R
� PAYING TWICE FOR IMPROVEMEN7S TO YOUR RROPERTY. IF YOU INTEND TQ OBTAIN FINANCING,CONSULT
( WiTH YOUR l.EAtDER OR AN ATTt}RNEY BEFORE RECORpING YOUR NOTICE OF COMMENCEMENT.
FLORIDA dt?RJiF(�:5.117.43)
� OYYNER OR AGBNT CON7RACTOR
� Snbsa{bed and swom ta{or afiirmed)be[ore me thfs Subscrtbed and swom to{or afftrmed)before me thls
by bY
Who Is/are personalty known to me or haslhave produced Who Is/are personally Imown to me or haslhave produced
as Identlfipdon, as identlficatlon.
Notary Public Notary Pu6iic
Commission No, Commission No.
Name o!Notary typed,printed er stamped �Name of Natary typed.Printed or stamped
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