HomeMy WebLinkAbout15-16699 i`
CITY OF ZEPHYRHILLS
5335-STH STREET
j � (si3)�so-oozo 1 6 9
LP/NATURAL GAS PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 16699 Address: 5538 GALL BLVD
Permit Type: LP/NATURAL GAS ZEPHYRHILLS, FL.
Class of Work: GAS TANK/LINES-NEW Township: Range: Book:
Proposed Use: COMMERCIAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11-26-21-0010-05700-0250
Improv. Cost: OWNER INFORMATION
Date Issued: 10/27/2015 Name: WELLESLEY DEVELOPMENT CORP
Total Fees: 125.00 Address: 34619 SR 54 W
Amount Paid: 125.00 ZEPHYRHILLS, FL. 33542
Date Paid: 10/27/2015 Phone:
Work Desc: INSTALL GAS LINE @ LITTLE CEASARS
CONTRACTOR S APPLICATION FEES
AMERICAN PL MB NG SER I ES OF FL GAS FEE 50.00 FIRE PLAN REVIEW FEES 50.00
FIRE INSPECTION FEES 25.00
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Ins ections Re uired
F RE SITE INSPECTION-Final
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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
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 COMME ENT "
,
.
O � R SIG ATURE PERMIT OFFIC
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOURS NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT- 813-780-0041
a��-7so-oo2o City of Zephyrhills Fire Fax-893-780-0621
Permit Application
Date Received �`
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Qwrae�s Name - Owners Phone Number �� [� ��
Qwners Address �� ,
Fee Simple Titleholder Name Titleholder Phone Number � �� �
Fee Simple Tif(ehaEder Address
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Job Address Lot# C�
Sub Division Parcel#
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Bio-Hazard Waste Storage-ANNUAL Fumigation Tent
� Comm Exhaust Kitchen FloodlDuct Q Hazardous Nlaferia!{Tier It or RQ Facility)AFtNt1Al.
� Controlled Bum Hood Installation
' � Emergency Generator<34 kw � �P1Naturai Gas-Installa6an
� Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale
� .Fre Protection Maintenance-ANNUAL o Places of Assembly-ANNUAk
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Sprinkler ❑ l� � Recreatianai Bum
Fire Alarm � ❑ ❑ ❑ � � gparkiers
Ftood Gleaning � O ❑ ❑ � � Sprinkler Sysfem Instaliafions
Hood Suppression � C] ❑ ❑ � � gxandpipes(Sprinkler Sys)
� Fire Alarm Insiallation � Toroh RoofinglTar Kettie
� Fire Pumps � Waste Tire Storage ANNUAL
� Flammable Application-ANNUAI ''' Valuation of Project
� Fuel Tanks �
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�` ComPanY "� vc u.._...._...a. ��
Signafure ' Registered Y/N Fee Current Y N
Address l.icense# �„ -�
EI.ECTRICIAN Campany
Signature - Rsgistered Y 1(ti1 �ee Current l'I N
Address License# -.
PZt1MBER Company - °
Signature Registered Y/N Fee Gurrent Y/N
Address License#
MECHANICAL Campany
Signature Registered Y I N Fee Current Y/N
Address Lioense#
OTHER Company
Signature Registered Y/N Fee Current Y/N
Address
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FiII out applicatian completely.
Owner 8�Contractor sign back of application,notarized(Or,copy of signed contract with owner)
tf over$2500,a Notice of Commencemenf is required(Mechanieai warEc over$5004)
Supply iwo(2)sets af drawings wifh appiicable documentafion
Ailow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.comJ
IVDTlCE QF UEED RESTRiCT[ONS: 't"he undersigned understands that lhis permtt may be subject to"deed°restrictions"
which may be more restrictive than County reguEations. TFte tcnderslgned assvtttes responsibility for compliance with any
applicable deed restrictions.
UNLIGENSED CONTRACTORS ANd COHTRACTOR RESPONSIBILPCIES: If the owner has hi�ed a contractor or
contractors to underfake work,they may be required to bs Ifcansed in accordance wIth stafe and loca4 reguiatians. tf the
contractor Is not licensed as required by law, both the owner and conkractor may be cited for�a misdemeanor violaaon
under stake taw. Ii the owner or intended contractor are uncertain as to what licensing requlrements may apply for the
intended wark,they are advised fo cantacf the Paseo Counfy Buitding inspec#lan Divistott=f_icensing Sectlon at 727-847-
8009. Furthermore, ff the owner has hired a contractor or contrackors, he is advised to have the contractor(s) sign
portions of the"contractor Bloak"of this appl(cation for which they will be responsible. !f you,as!he owner sign as the
confracfor,that may be an tndica#ion that he Es not properiy#icensed and Is not en#itled fo pertnitting prlvileges In Pasco
County.
TRANSPORTA'TION IMPACT/Ul1LlTIES IMPACT AND RESOURCE RECOVEItY FEES: The undersig�ed understands
that Transpocfa#ton impact Fees and Recourse i2ecovery Fees rt►ay apply#o fhe conshuction of new btt3ldings,change of
use in e�cisting buildings, or expansion of exisNng 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 ident�ied at the fime of
permlfttng. tt is iurffier understood-thaf Transpartatlon Impact�ees and Resaarce Recovery Fees musk be peid priar fo
receiving a'certificate of occupancy°or flnai power'release. if the project does not involve a certificate of occupaney or
final power�elease,the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due,fbey musf be paid p�or to permit lssusnce in acxordance with applioabte Pasco Cactrtty ordinances.
CONSTRUCTION LIEN LAW(Chapte��13,Flotida Statutes.as amended): ff valuation of work is$2,500.Oq or more,I
certify that I, the appflcant, have been provtded with a copy of the 'Florid� Construction Lien Law—Homeowner's
Pro#ectlan�oide°prepared by the Flotida Department of Agriculture and Gonsumer.AfFairs. tf the apPl�t�nt is someane
other than the'awner",f cerfify that 1 have obtained a copy of ihe above described documenf and promise in good faith to
deliver ft to the"owner°prior to commenc:ement.
CQMRAGTQR'StOWNER'S AFFlDAVIT: 4 certify Ehat ail fhe informafion In this appllcation is accttrate and that atl work
wili'be done in compilance wiih ali appiicabie laws regulating consfructian,zoning and land developmen� Application is
hereby made ta obtaln a permit to do worlc and inshallaUon as indfcated. I certify that no wark or installation has
coramenced prtor ta issuance of a petmlt and#hat a1i work w1Ei be perFarmed to meet standards of aE! laws regafating
construc4on, Couniy and City cades, zoning regulaiions, and tand development regula8ons in the jnrisdiction. 1 a!'so
certify that I Understand that the regula#ions of otFier govemment.agencles may apply to the intended work,and that it is
my responsibilfty to identfty what ac#lons 1 must iake to be In compl]ance. Siich agenctes fnclttde but are noE limited to:
- Department of Emironmenfat Protec#ion=Cypre"ss Bayheads, ViteBand Areas and Environmenfatly Sensitive
Lands,WeteNWastewater Treatment. '
- Southwest Ftorida Water Management Distrtct Welis, Gypress Bayheads, Wetland Areas, Alkertng ,
Watercourses.
- Army Corps of Englneers-Seawalls,Docks,Navigable Waterways.
- Departmen# af Health � Ftehatiliftative Servtces/Env►ronmen#al Nealth Unit Wells, Wastewater Treatment,
Septic Tanks. � �
- US Environmental Protechon Age�cy-Asbes#as abatement.
- Federat AviaGon Authority-Runways.
!understand thaf the foltowing resMcUans apply#o the use of fit1:
- Use offitl is not allowed in Flood Zone'V°unless e�ressly permltted.
I - If the fll! material is to be used in Flaod Zone "A", it is understood that a drainage pian addressing a
� 'cornpensating votume'will be snbm3fted at fime of permit#ing whlch is prepared by a professlonal engineer
Ifcensed by the State af Florida.
- if th0 8A.materia! is to be used.in Flood Zone 'A' in connection with a permitted building using stem wall
canstruGtion,t cetFit}+ti�at ii11 wil!be usecf onSy t�fiEt the area w�1n tt�e stem wat[.
- If flll material is ta be used (n any area, I certify that use of such fill w111 not adversely affect adjacent
properties. !f use af fil!is fnund to adversely affect adjacent properties,the owner may be cited for violating
the conditions of the 6uitding perinit.Issued under the attached perm�#appltcation,for lots iess than one(1}
acre which are elevated by.flil,an erigineered drainage plan is required.
!f 1 am the AGENT FOR THE OWNER,1 promise in gaad fa'ith ta inform the owner of the pertnitting conditions set forth in
thls afftdavit prior to cammencing tt�nsinsction. E isnderstand tha#a separate permlt-may be required for elecfrical work,
plumbing, signs,weils, poois,afr conditioning, gas, ar other Instaliatians not specfficaqy induded in the appticafion. A
permfk issued shall be construed to be a Itcense to proceed wtth the wark and not as authority to violake,oancel,alter,or
set aside ar�y pravlsions�of the fechnlcat cades,nar st�alE issuance af a perml�prevent fhe Sultdirig Offscfat iram thereaiter „
requiring a conection af errors tn plans,construction or violations of any codes. Every permtt tssued shal(beoome invaiid
unless the work authorized by such permit is cammenced withtn six months of permft Issuance,ar ff work authorized by
the permlt ts suspended or abandoned for a pedod af si�c{6}morrihs after the time the work is commenced. An eactensian
may be requesked,in wri#ing,ftom the Buifding Official for a period no#fo exceed ntnety(90)cfays ancf witl demansfrafe
� justifiable cause for the extension. If work ceases for ninety(90)conseoutive days,th 4Jab is considered abandoned.
�
WARNING TO OWNER: YOUit FAII.tDRE TO RECORD A NO'FICE OF COMMEN�EMENT MAY RESULT IN YOR1R
PAYING TWIGE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
WITH YOUR LENDER OR AN A'FTORNEY BEFORE 12EGORDlNG YOtlR NC?TtGE dF COMMENCEMENT. '
FLORIQA JURAT(F:S.t17.p3j i `*
� OWNERORAGEN7 CONTRACTO ` � �'�_..
Subssxlbed arsd swom fa{oraffhmedj before me Ut(s Sub�ibed and { aift ) re ma is ��
yy by
Who Islare personally knoum lo me,or hasR�ave produced Who Islare personally rnm to me or haslhav produced
asidentlficaHan, ' asl nNflcation.
Notary Pu611c Notary Puhlic
Commlasion No. Commisston No.
Name of Nafary iyped,pdnted or stamped �Name af Nohary typed,printed ar stamped
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ZE�HYRHI��S FIRE D�PARTN[ENT
�, i 38410 6th Ave Zephyrhills, FL 33542
FIRE SERVtCE USER FEES
Occupancy No.: - ,
Pian No.: Contractor: ;
Business Name: rC�9h � Billing Address: '
Business Address:
Business Phone No.: Billing Phone No.:
Business Fax No.: Billing Fax Na.:
Contact: Contact:
PLAN REVlEW FEES INSPEC7'ION FEES PE12MtT FEE FALSE ALARM FEE
8 Site Plan N/C Annual N/C Sprinkler $50 1stAlarm N/C
Multi-FamilyiCommerciai .06 sf 1st Re-inspection N1C Standpipes $50 2nd Atarm N!C
(Minimum Charge$25.00 2nd Re-inspection $100 Fire Pump $50 3rd Alarm N/C
�Plan Revisions DBL 3rd Re-inspection $250 Haads $50 4th Aiarm $9Q0
4th Re-Inspection $500 Fire Alarm $50 5th Atarm $15Q
SPRlNKLER SYSTEMS {Business closed wtil LP Gas $50 6th Alarm $200
0-25 Heads $50 violations corrected) Natural Gas $50 NON COMPLlANCE $150
26 plus Heads $100 SPRINKLER SYSTEMS Fuel Tanks- per�ank $50
STANDPIPE SYSTEM Hydro Undergrounds $45 Sparklers $100
� Per Riser $50 Hydros#atic Test $65 per system Fire Works $500
F[RE PtlNiP Acceptance Test $45 persystem Gamp�ire $25
� Per Pump $100 Hydrant Flow $75 Con#rolled Bum $100 �
FIRE ALARM SYSTEM HoodiDuct $50
8 0-28 bevices $50 FIRE ALARM SYSTEM Place of Assembly $5Q annuai
26 pfus Devices $100 System Acceptance $54 Ffre Pratectian $25
SUPPRESSION SYSTEMS . Recall Acceptance $50 Flammab�e Application $50 nnnua� '
Wet $50 OTHER Waste Tire Storage $5p Mnua! '
Dry $SO Fire WalUSmoke Walt $15 per wa�� Generator<KW $100
CO2 $50 LP Gas $25 per tank Generator}30 KW 150 �
Qther $50 Nafural Gas $25 per sy�stem Bio-Hazard Wasfe $100 nrsnuai
KITCHEN EXHAUST Fumigation Tenting $50
�HaodlDucts $50 Tent 90'x1d'or greater $15 pettent Torch Pa#lApplied $50
OTHER Fire Pump $45 Haz.Materials $100 annuai
�P lnstaE�atian per tank $50 Fire Suppression $3Q
Fuel Tank Installation $50 System Acceptance
{Per Tank) $50 8 Exhaust HoodlDuct $34
�Naturai Gas Instatiat�on $50 Re-inspection DBL
(Per System) (other than annual)
�Spray Booth $5d � Inspecfion scheduled DBL e
and cancelled less than
24 hours
Constn�ction Insp. N/C
Emergency Vehicte As .$50 FAE.SE ALARM
PLANS TOTAL� INSPECTION TCITAL� PERMI7 TOTAL� TOTAL�_--7
GRAND TOTAL �
Comments:
Date: •
Inspector.
n�n
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