HomeMy WebLinkAbout15-16586 I
f _ � CITY OF ZEPHYRHILLS �
5335-8TH STREET
(sis)�e'I-oozo �g5$6 '�
ANNUAL ASSEMBLY PERMIT '�
PERMIT INFORMATION ! LOCATION INFORMATION
Permit Number: 16586 Address: 38545 5TH AVE
Permit Type: FIRE PLACE OF ASSEMBLY ZEPHYRHILLS, FL.
Class of Work: FIRE-PLACES OF ASSEMBLY Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11-26-21-0010-15100-0140 �
Improv. Cost: j OWNER INFORMATION
Date Issued: 9/15/2015 Name: CITY OF ZEPHYRHILLS
Total Fees: 50.00 Address: 5335 8TH ST
Amount Paid: 50.00 ZEPHYRHILLS, FL. 33542
Date Paid: 9/15/2015 Phone:
Work Desc: PLACES OF ASSEMBLY- THE WOMANS CLUB OF ZEPHYRHILLS EXP 9/2016-FEE WAI�
CONTRACTOR S � APPLICATION FEES
FIRE PERMIT FEES 50.00
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Ins ections Re uired
FIRE SITE INSPECTION-Final
OCCUPANCY LOAD:
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Occupancy by more than the number of persons above shall be considered
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 VISI�BLE LOCATION IN MAIN ASSEMBLY AREA
ZEPHYRHILLS FIRE RESCUE DEPT - 6907 Dairy Rd, Zephyrhills, FL 33542
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813-780-0020 City of ZephyrhiEls Fire F�-sT�-�so-oo2� f
i ' Permik Application
Date Received � � Phone Confact for Permit �� C� �
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. . ..- -� �- ___._---..._.__ _>_ _.________...__---.,...---- - � ---..,.._____..____ _ .__..__,__---____._.
Owne�s Name .Y. - . "_-. ._...__--f--._�C�_� .--- - ---°�•- .f I Owne�s Phone Number � � �
Ovmers Address �
Fee Simple Titleholder Name Titleholder Phone Number [� � �
Fee Simple Titlehalder Address �
_.----.. .�._.:..— .-__ __ _ _.__ __..._ - -- — -- - - — - -- -- --
�_------'�- -_ �.. _ - - ---- - -- -
Job Addsess - - - — -- - -- -- - - --- - -- - - m '"lot# C�
Sub Divisio� Parcel#
-- ____..,_...___.. . - __-__,n_.-,._..____ �._,__.
._ ._�,�.�,_�.__
�_.-.--_. �____._. ____..___.,�._,_ ,.__..__�...__.____..___.v....._.._.._.__._ ._�.__,..�._._�._..____ ...._v_._ __�._w.._.._._.,_.----y_._ __._..__ ___.....---_._.�__._._.r.__
� Bio-Hazard Waste Storage-ANNUAI. � Fumigation Tent
� Gomm Eachaust Kitchen Eloodtduct � Hazardous Material{Tier iI ar RQ Facility}ANNUAL
� Controlled Bum a Hood Installation
� Emergency Generator<30 kw Q �P/Natura!Gas-Installatian
� Emergency Generator>30 kw � �P/Natural Gas-ANNUAL Sale
� Fire Protection Maintenance-ANNl1AI.. Q Places of Assemb(y-ANNUAL I
tr y emi � t er .�� I
Sprinkier � O O ❑ � � Recrea#iana!Bum '"� t ;
J+ � �
Fire Alarm � ❑ ❑ Cl � Q Sparklers ��1� I
Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System installations ���
Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
� Fre Alarm installation Q Torch RoofinglTar Kettle
� Fire Pumps o Waste Tire Storage ANNUAL
� Flammabie Application-ANNUAL �r— � Valuation of Projec#
� Fuel Tanks
Q C?fher: �
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Contractor Company
Signature Registered Y/N Fee Current �(/N
Address ( �icense#
ELECTRICIAN Company
Signature Registered Y/Iti! Fee Current Y 1 R4
' Address � License#
P�UMSER Company
� 8ignature Registered Y/N Fes Current Y/N
iAddress � �icense#
MECHANICAL Company
Signature ftegistered Y 11V Fee Current Y 1 N
Address � License#
C7THER Company
Signature Registered Y/N Fee Current Y/N
� Address
� 4icense#
�..:_----�.._. .___. _.._ -__---:-__.. � .:��,__._._._ __ .___..•-.._w.,.._..----_-...__.__.�,_... _ _._ .__.,
Directions: -- --- -- -------.,._ _. _. .-----._ _ __,_-._ .___-._..__ __._ .
F's(I aut application completely
Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner)
If over$2540,a Notice of Gommencement is required{tvtechanica3 work over$50Q4)
Supply two(2)sets of drawings with applicable documentation
Allow 10-14 days far review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.comJ
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NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be su6ject to"deed"restrictions°
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
app(icable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILIYIES: 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 requfred 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, ff the owner has hired a contractor or contractors, he is advised`� tiave the contractor(s) sign
portions of the"contractor Block°of this application for which they will be responsible. If you, as the owner s(gn as the
contractor,that may be an indication that he is not properiy licensed and is not entiUed to permitting privileges in Pasco
County.
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transpo�tation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings,change of
use in existing buildings, or expansion of existing buiidings, as specified 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 identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a°certificate of occupancy"or final power release. If the project does not involve a certificate of occupancy or
final power release,the fees must be paid prior to permit issuance. Furthermore, ff Pasco County Water/Sewer Impact
fees are due,they must be paid prior to permit Issuance in accordance with appiicable Pasco County ordinances.
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 Department of Agriculture and Consumer Affairs. If the appiicant is someone
other than the°owner",1 certify that I have obtained a copy of the above described document and promise in good faith to
deliver lt to the"owne�'prior to commencement.
CONTRACTOR'SIOWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that ail work
will be done in compliance with all applicable laws regulating construction,zoning and land development. Application is
hereby made to obtain a permft 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 pertormed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I al"so
certify that i understand that the regulations of ottier govemment agencies may apply to the intended work, and that it is
my responsibility to identiiy what actions I must take to be in compliance. 5uch agencies include but are not limited to:
- Department of Environmental Protection-Cypress Bayheads, Vlletland Areas and Environmentally Sensitive
Lands,WaterNVastewater Treatment. '
- 5outhwest Florida Water Management District-Welis, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of EngineersSeawaiis,Docks,Navigable Waterways.
- Department of Health 8 Rehabilitative Services/Environmental Health Unit-Weils, Wastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of flll:�
- Use of fili is not allowed in Flood Zone°V°unless expressly permitted.
- If the flll materlal is to be used in Flood Zane "A", it is understood that a drainage plan addressing a
°compensating volume"will be submftted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
- If the fill material is to be used in Flood Zone°A" in connection with a permitted building using stem wall
construction,I certify that fill will be used only to fill the area within the stem wall.
- If flll material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill fs found to adversely affect adjacent properties,the owner may be cited for violating
the conditions of the building permit issued under the attached pertnit application,for lots less than one(1)
acre which are elevated by flll,an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER,I pramise in good faith to inform the owner of the pertnitting condifions set forth in
this affidavit prfor to commencing construction. I understand 4hat 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 Buildirig 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 permlt issuance,or'rf work authorized by
the permit is suspended or abandoned for a period of six(6)months after the time the work is commenced. M extension
may be requested, in writing,from the Building Qfficial for a period not to exceed ninety(90)days and will demonstrate
justifiable cause for the extension. If work ceases for nineiy(90)consecutive days,the job is considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A idOTICE 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 COMMENCEMEMT.
FLORIDA JURAT(F:S.117.03)
OWPIER OR AGENT CONTRACTOR
Subscrlbed and swom to(ar affirtned)befare me this Subscribed end swom to(or affirmed)bafore me thls
by Y
Who Is/are personally knovm to me or hasRiave produced Who Islare personally imovm lo me or haslhave produced
as Identlficadon. as Idendfiddon.
Notary Public Notary Public
Commission No. Commission No.
Name of Notary typed,printed or stemped �Name of Nohary typed,printed or stamped
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