HomeMy WebLinkAbout15-16598 CITY OF ZEPHYRHILLS
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ANNUAL ASSEMBLY PERMIT
PERMIT INFORMATION I LOCATION INFORMATION
Permit Number: 16598 Address: 39602 AMETHYST WAY LOT 5
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: EMERALD POINTE RV RESORT
Est. Value: Parcel Number: 24-26-21-0020-00000-0050
Improv. Cost: I OWNER INFORMATION
Date Issued: 9/17/2015 Name: EMERALD POINT RV
Total Fees: 50.00 Address: 39602 AMETHYST WAY LOT 5
Amount Paid: 50.00 ZEPHYRHILLS, FL. 33542
Date Paid: 9/17/2015 Phone: (920)840-7890
Work Desc: PLACES OF ASSEMBY- EMERALD CLUBHOUSE POINTE RV- EXP 9/2016
CONTRACTOR S I APPLICATION FEES
FIRE PERMIT FEES 50.00
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Ins ections I e ired
FIRE SITE INSPECTION-Final
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� 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
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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
813-780-0020 City of Zephyrhills Fire Fax-813-780-0021
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Permit Application
Date Received Phone Contact for Permit 1�— JI
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�Owners Name /� �'�
��('/T L1J ��'`U l I Owner's Phone Number � � �
�Qwner's Address ��-�o� %� ��1�7� -J�% ��j
Fee Simple Titleholder Name Titleholder Phone Number � � �
Fee Simple Titleholder Address � f
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Job Address 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 Faciliry)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
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Sprinkler � ❑ ❑ ❑ � Recreational Bum ��
Fire Alarm � ❑ ❑ ❑ � � Sparklers
Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations
Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
� Fire Alarm Installation � Torch RoofinglTar Kettle
� Fire Pumps � Waste Tire Storage ANNUAL
� Fire Works I
� FlammableApplication-ANNUAL Valuation of Project ��I
� Fuel Tanks
Q Other: �
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ntractor� �b 4 Company
Signature ��L�2�'`�� 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
Signature Registered Y/N Fee Current Y/N
Address � License#
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Directions:
Fill out application completely.
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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 worl��over$5000)
Supply two(2)sets of drawings with applicable documentation i
Allow 10-14 days for review after submittal date. Parcel -obtained from PropeRy Tax Notice(http://appraiser.pascogov.com) i
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NOTICE OF DEED RESTRICTIONS: The undersignl d understands that this perntit may be subject to"deed"restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsib(lity for compliance with any `` °
� applicable deed restrictions. �
UNl(CENSED 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 appiy 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 to have the contractor(s) sign
portions of the"contractor Block°of,this application far which they will be responsible. If you, as the owner sign as the
contractor,that may be an indication that he is not properly Iicensed and is not entitled to permitting privileges in Pasco
County. ;
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction'of new buildings,change of
use in existing buildings, or expansion of existing buildings, 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 fdentified at the time of
permitting. It is further understaod that Transportation Impact Fees and Resource Recovery Fees must be paid prior to •
receiving a'certificate of occupancy"or flnal power release. If the project does not involve a cert�cate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due,they must be pald prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter 773,Florida Statutes,as amended): If valuation of work is$2,500.00 or more,I
certify that I, the applicant, have been provlded wlth a copy of the 'Florida Construction Lien 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 certNy tNat all the informatian in this application is accurate and that all work
will be done in compliance with ali applicable laws regulating construction,zoning and land development. Application is
hereby made to obtain a permit to do work and InstallaUon as indicated. I cerlify that no work or instatlation has
oommenaed prior to issuance of a permit and that all work wlll 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
certity that I understand that the regulations of otfier govemment agencies may apply to the intended wark,and that it is
my responsibility to identffy what actions I must take to be in compiiance. Such agencies include but are not limited to:
- Department of Environmental Protection-Cypress Bayheads, Weiland Areas and Environmentally Sensitive
Lands,Water/Wastewater Treatment. �
- Southwest Florida Water Management District-Wells, Cypress 8ayheads, Wetland Areas, Altering
Watercourses. 'i
- Army Corps of Engineers-Seawalls,Docks,Navigable Waterways.
- Department of Health 8 Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
Federal Aviatian Authority-Runways.
I understand that the following restrictions apply to the use of fill:•
- Use of fill is not allowed in Flood Zone'V°unless expressly permitted.
- If the flll material is to be used in Floo�d Zone 'A", it is understood that a drainage plan addressing a
°compensating volume"will be submilted',at time of permifling which is prepared by a professional engineer
� licensed by the State of Florida.
- If the flll material is to be used in Flood Zone'A° in connection with a peFmitted buiiding using stem wall
construction,I certNy that fill wlll be used only to fill the area within the stem wall. �
- If flll material is to be used in any area, I certlfy that use of such fill will not adversely affect adjacent '
properties. If use of fill Is found to adversely affect adjacent properties,the owner may be cited for violating
the conditions of the building permit issued under the attached permit applicalion,for lots less than one(1)
' acre which are elevated by flll,an enginee�ed drainage plan is required.
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 affldavit prior to commencing construcQon. I understand that a separate permit may be required for electrical work,
plumbing, signs,wells, pools, afr conditioning, gas, or other installations not speci�cally inciuded in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authordy to violate,cancel,alter,or
set aside any provisions of tha technical codes,nor stiall issuance of a permit prevent the Buildirig Official from thereafter
requiring a�orrection of errors in plans,construction o�violations of any codes. Every pem►it issued shall become invalid
unless the work authorized by such permit is commenced within six months of permft 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. An extension
may be requested, in writing,from the Building Official for a period not to exceed ninety(90)days and will demonstrate
jusiifiable cause for the extension. If work ceases for ninety(90)consecutive days,th�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) I
OWNERORAGENT � CONiRACTOR
Subsal6ed and svuom to(or aRirmed)before me this I Subsaibed and swom to(or aflirtned)betore me thls
bY Y
Who Is/are personalty known lo me or haslhave produced i Who Islare personally known to me or has/have produced
asidentlficatlon. I asidentificatlon.
Notary Public I Notary Pubiic
Commisslon No. ' Commisslon No.
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Name of Notary typed,pr(nted or slamped '�Name oi Nobry typed,printed or stamped
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