HomeMy WebLinkAbout16-17586 ,, , CITY OF ZEPHYRHILLS
5335-8TH STREET
(si3)�so-oo20 1758
ANNUAL ASSEMBLY PERMIT
PERMIT INFORMATION � ` - - - � � � �LOCATION INFORMATION " � ° �
Permit Number: 17586 Address: 38112 15TH AVE
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: 11-26-21-0010-01200-0250
Improv. Cost: OWNER INFORMATION - '
Date Issued: 7/19/2016 Name: NYE, McALVANAH & HENSON
Total Fees: 50.00 Address: 38112 15TH AVE
Amount Paid: 50.00 ZEPHYRHILLS, FL. 33542
Date Paid: 7/19/2016 Phone: (813)715-0228
Work Desc: PLACES OF ASSEMBLY- BRIGHT BEGINNINGS TOO EXP 7/17
, - � CONTRACTOR S � APPLICATION FEES
FIRE PERMIT FEES 50.00
Ins ections Re uired - ' - � -
FIR SITE I PECTION-Final
OCCUPANCY LOAD:
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 VISIBLE LOCATION IN MAIN ASSEMBLY AREA
ZEPHYRHILLS FIRE RESCUE DEPT - 6907 Dairy Rd, Zephyrhills, FL 33542
s�aaao-oo2� City of Zephyrhills Fire Fax-813-780-OD21
� , . ,Permit Application
Date Received Phone Contact for Permit �„���,�
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Owner's Name ��� � {'7� 'r� ;� Owner's Phone Number �). � �o�
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Ovmers Addres� /'1 �`
Fee Simple Titleholder Name Titleholder Phone Number � � �
Fee Simple Titleholder Address
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Job Address Lot# �
Sub Division PaFcel# ' '
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Ili � �. Bio-Hazard Waste Storage-ANNUAL ,� a Fumigation Tent�
� � Comm Exhaust Kitchen Hood/Duct � fHaiardous Material(Tier II or RQ Faci'y}ANNIfk
�� � Controlled Bum ' � Hood Instaliation
' � � Emergency Generator<30 kw � CPlNatural Gas-Installatio =�
0 Emergency Generator>30 kw � � LP/Natural Gas-ANNU Sale ��
' � Fire Protection Maintenance-ANPIUAL Places of Assembly-A UAL
t y emi � �er,;- ,
Sprinkler �' �❑ ❑ ❑;' t-�" �Recreational Bum
Fire Alartn � ❑ ❑ ❑�?�� � Sparklers
� Hood Cleaning � ❑ ❑ ❑ � � Sprinkler Sy§tem installation � �(„
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Hood Suppression �❑ ❑ ❑ O � � Standpipes(Spririkler Sys) � i �
� Fire Alarm Installation � Torch Roofing/Tar Kettle �
� Fire Pum s `' � Vilaste Tre Storage`'ANMUAL
P
�, � Fire Works
� FlammableApplication-ANtdUAL VelUBtlOf1 Of PfOJ@Ct
Fuel Tanks
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Contract�o�� ' _ � . � Company - � - �
Signatufe�l' Registered Y/N Fee:Cu��ent Y/'N
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Address � " License# - � ` � -
ELECTRICIAN Company _ -
Signature Registered Y'/N Fee Gurrent ' '- Y/`N
Address ' License# '
PLUMBER • � ' Company . • .
Signature ' Registe�ed 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. -
Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner)
If over$2500,a Notice of Commencement is required(Mechanical work over$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)
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NOTICE OF DEED RESTRICTIONS: The undersigned understands that,this permit.may be subject to"deed°restrictions° • ,, - �
whtch�snay.be more resttictive than Gaunty reguiatian's. The undersigned assumes resporislbllity for compllance with ar�y_
appiicabte`deed restrictions. ` • :: ,
UNLICENSED CONTRACTORS AND CONTRACTOR�RESPONSIBILITIES: !f the owner has hired a contractor or
conirac#ats fo undettake work,#hey r►iay be required to be itcensed in.accofdance with siate and tocal regulat3ans. if the � .
contractor is not.licensed•as required by taw,`tioth tfie owner and contractor may be cited for a misdemeanor vtotatton ,
under state lew. it'tFie owne�or inten'ded�cantracko"r are"uncerlain'as''to what licensing re�uiremenfs may apply for"the
intended wosk,they are advised to can#act the Pasca Gounty 8uildfng lnspect9on Divislon�—!_icens3ng Sectton at 727-847-
8Q09: Futthermore; if the ovmer tias hireif a cont"reatdT or-confractors, he is advised to have fhe contractor(s) sign
portions of the"contractor Block"of this appiicatian for which they will be responsible. If you, as the owner sign es the
coniraefor,.that-may be.an indicafion.that fie Is nqt pigperiy itcerised and,is.nof entltied to,permitting priv€leges in Pasca
County. � ,
TRANSPORTATION IMPACTNTILIT�ES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Tsansportation lmpact Fees and Recourse Recovery Fees may appiy to the construclion of new'bulldtngs,change ai
use in exlsting buildtngs, or expansion of enisiing bvitdings,as spec�ed in Pasca County Ordinance number 89-0�and
90-07;"as amended. The�undersigned also under5kands;�that suah'fees,as may be due;.will be(dentified'at�the time of '
permltting. it Es#arther ty�derstood that Transportatlon Impact�ees and Resourae Recovery Fees rtiust be paid prior to
receiv'ing a"ceitificate b�occupa'ncy"'or.flrrat Power release. #f the,p[oject,daes no#invohre a certifica#e of occupanoy or
final power release,the fees must be pald prior to perniit Issuance. Furth'ermore,fF Pasco County Water/Sewer Impact
fees are due,they.must be paid priar to permtt issuance In accordance wilh;app!lcable Pasco County ordinances.. � ,
GONSTRUCTtON l.tEl+ir�:AW..(Ghapter?13,.Flortda Statule�,as ameiidedj: 4�valuation otwork is$2,5d0.00 or.more,1
certify that I, the appUcant, have been provldei! inrilFi a copy of the, '�forida Construcflon Lien Law--Homeauvner's
Protection Guide°prepared by the Florida Depa�tment of Agriculture and Consumer Affairs. If the applicant is someone
ather than the"ow»er�,l cerf3fy fhat 1 have gE�tained a copy c�f the above described documeaf and prom3se In goad fa�th fa >'
delfuer tt ta the"owner"pripr to commencement: ' ' � � • ' , �
CpNTRACTOR'SlOYIINER'S AFFIpAVlTt l.certity that all,the Information in thls appllcatlon Is accurate and that ell,work
wi{I'be dane in complEance witta a11 appltcable#svrs regulating cons#ructEon,zpning and land development. Applicat4on Is '
hereby made to o6tain a pertnit to do Vvo�k and ins#alletion as lndipted. I certify;that.no work or'installation has
commenced prior to issuance of a permit and tfiet all work wlll be perf,ormed to meet;sfendards:.of eli la4vs regulatlng
• cans#rucfian, Caur�#y and Ci#y codes, zonfng regulalions, and.land;�Ievelopment reg�la#lans tn the jorlsc3tctlon. ! also
certify that I understand that the negulations of otfier govemment agencies may apply�to,lhe intended worli,and thal it is
� my responsibility to Identffy what actions I must take to be In compliance. Such agencles;include buk are not Iimited,�o:
� - Department afi Environmental Profection-Gypress Bayhe�ds;'tlUeHand Aceas and Environmenfai�y"Sensltive
Landa,Water/Wasiewater Trea'tmen� " ' ' ' �
- Southwest Florida Water Management Dtslrict-YVells; �Cypress Bayheads, WeUand Area"s, Altering
VIl2t@iCOU[SBs. , , . .. 'J
- Army Corps of Engineers-Seaweifs,.Docks,Navigabie Waterways.
- Department af Health 8 Rehabilitetive Services/Enviroiimen4al Nealkh Unit Welis, Wastewater Treatment,
Sepfic Tanks. ' � '
- US Environmental Protection Agency-�isbestos abafement.
Federal Aviatian,Aulhority-Ruiiways: " � ''"' -`.'`
1 understand thef the iatlornrjng res#i3i:fions�apply to.the,use M flll:_ : s
- Use af.flU Is not atlowed in Fiaod Zone`V"vnless express{y petmitted.
- if ttie�flil'mafeHal�(s°to'�be Used�in Flood 'Zane 'A", ft is understood that a drainage plan address(ng e
- 'compens,atingFvp]ume*_inilit.=be anbmtited at t(me of_permftting whlch 1s prepared by a professlonal enginesr ,
.., .� � - -
. iicensed�by,ttie Staie of Fiorida. °`_- �� � •
_ If,ih� fill,material_is to be used In Flaad Zone'A;;in.connectlon viritfi a permilted�buiid'ing using stem walF
• � ':constructfon,l ceitiEy that;fli iriilil be u'sed oniy to fit thetatea within the stem walt. .
- �if:f111:ma{erial4is:to.,�be._ysed�in._any�area, 1 certify that use.af.such.f�tt�will,.nat advarsely a,ffect adjacent
"p.ropertios,, If use of fll_Is found to adversely,effect adjacent properties,the�owner may be dted for violaUng
•- -•the�ciciaditioii`s=of-�ttiei.6utid�ng"}aer�riit.issised under the attached:perrh8.app!lcaiion,for(ots less than,.one{1)
, ,,acrewhTcli.are�etepated.by.fltl,.an.e.nglneeied dtainage.ptan ls;requtrecl.� � .,,. �
If I am the AGEf�1T�FOR:THE�O111iNER;I promi'se,in good,fafth 1o.inform tfie owner af ihe permifling condftians set forth in . �
thls a�davit=prior to'commencfig:construation;�`t understand thel'a separate,perrnit.,may..be;tequfred for electrical work,
,, piumbing, signs,;weiis.:po,als,.air.candi#ion(ng,,8as,or ather.:frisfaliations riof speciflaalljr irictuded in the eppllcafion. A
permit issued�stiall be construed ta be.a license to proceed wrih lhe work„and nof as.:auttibrit`y.:b violate,cancel,atier,or �.,
set aside sny=pfoV4stpns}of the teahnical,codes,nar shall Issuance of a permit prevent tfie Bulldirig Offic(al from thereaFter '�
requtring ra caifectton.of.errors�ln�plans;consfructlon or-v1a1�6ans of ar►y cc�des. Every permtt Issued sha11 become invaltd
unless the work`euthorized-by suah perriiit i's-commenced within sbc montFis of{iermif issuence,or,tf work authotized by
the permft is syspended oT abandoned.for a.pedod of six(8)�months after;the�time�the work�is`commenced. An extension
mey tie reqeesfed;Iri'witf3ng;#ibin fhe Building Clfticlat for a period nat to exi�ed nlnety„(9,0�_days end wlfl demonstrate
ju'stHiable cause for,the eutension, If work ceases for nfnety(90)'cansecutive days,fh�job is considered abandoned:
'i . ; : ,..,;
, : _;.� _ ._. � - ;:
WARNING'TO OWNEtt:•Y4UR PAILUi2E TO 12EGORD A NOTICE OF..COMMENCEMENT,_MAY RESULT-{N YOtIR -
PA1fING TYYICE,FOR�IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OB'fAtN FiMANCING,COFISULT
YUITH YOUR LENpER�012 AN ATTORNEY BEFOI2E RECORDING YOUR NOTI�E OF CCIMMENCEMENT'
F1:C}RtDAJtTRAT{F:S:1'l7.43) -• '
OWNER OR AOENT. , , CONTRAC'TOR� , .
Subsalbed end swom to(or eftirmed}before me Ihls Suhspibed and s�+om to(or eifirmed)betote me]hfs .
by:-.-:'�-:z.. .. ... . .., . . � . . ' bY .
i Who islare personetiy known to me or has/heve produced Whe islare petsona�ty ienorm te me or hasthave pmduced
as 1denHfiwdon. �s IdenNflcaBon.
i
Nat�ry Publlc Notary Public
Gommisslon No. Commtsstbn No. ,
�. '
tJarne ot NatBsy typed,pdnted ar sffimped �Name oi Notary typed,pdnted or smmped
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