HomeMy WebLinkAbout15-16708 CITY OF ZEPHYRHILLS
5335-8TH STREET
�sis��so-oozo 16708
'`' ANNUAL ASSEMBLY PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 16708 Address: 5658 GALL BLVD
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: 11-26-21-0010-05700-0252
Im rov. Cost: OWNER INFORMATION -
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Date Issued: 11/03/2015 Name: ERIC HOOPER INC/WENDYS
Total Fees: 50.00 Address: 5658 GALL BLVD
Amount Paid: 50.00 ZEPHYRHILLS, FL. 33542
Date Paid: 11/03/2015 Phone: (813)782-5442
Work Desc: PLACES OF ASSEMBLY-WENDY'S EXP 11/2016
CONTRACTOR S APPLICATION FEES
OWNER FIRE PERMIT FEES 50.00
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Ins ections Re uired -
FIRE SITE INSPE T ON-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
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a��-�So-oa2o Cify af Zephyrhills Fire Fa�c-813-780-4021
Permit Application
Date Received �— � Phone Contact for Perm t �
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Owners iVame ,� �y�} Q� �' Owne�s Phone Number
Owner's Address ,>( S6 s � �a l� 1U'
Fee Simple Titleholder Name Titleholder Phone Number � � ��
Fee Simpie Tif{eholder Address
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Jab Address Lot# ��
Sub Division Paroel#
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� Bio-Hazard Waste Storage-ANNUAL �'' Fumigatian Tent
� Comm E�chaust Kitchen HoodlDuct Q Hazardous Material{Tier 11 or!2Q Facility}AtaHUAI
� Controlled Bum � Mood Installation
` � Emergency Generator<3Q ktnr � �P1Natural Gas-Instaltation
� Emergency Generatnr>30 kw LP/Natural Gas-ANNUAL Sale
� Fire Frotection MainYenance-ANNllAL Places of Asserrib(y-ANNUAL
� t�r y' emi ALT�n er �
SprinWer O GI ❑ Recreatianai Sum
Fire Alartn � ❑ ❑ ❑ � � 5parklers
Ftood Gieaning � p C} O �� � Sprfnkter System Insfalfations
Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
� Fire Alsrm Ins#allatian � Torch RaofinglTar Kettle
� Fire Pumps � Waste Tire Storage ANNUAL
Flammable Application-ANNI3AL !��
Valuation of Project
� Fuel Tanks ������
Q Oth6C.
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_G`o,1ntractor .t--� � Company
�gnature 1�"� �
/�,,, Registered Y/N, Fee Current Y/N
Address License# �
ELECTRICIAN Campany
Signature Registered Y 1 N Fee Current � Y J Itj
Address License# ,
P�UMB�F2 Company
Signature Registered Y/N Fee Current Y/N
Address Cicense#
MECHANICAL Campany
Signature Registered Y 1�) Fee Current Y 1 N
Address License#
OTHER �
Company
Signature Registered Y/N Fee Current Y/N
Address License#
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Directions:�_._� . ...,.._.1.�.. :`..�,.A,u�:��._...;�,i.,-.,._�.,.>,.��_.__. ._...,.x.=r�;�....:;4:�.�.a�..,_n.� _w.,..,::�x.>,,.z: .._� :__:_,�:_.�.t.�-_�_,..�3.w�_�::w�..�,�«uaa
Fiil out application camplefely.
Owner&Cantractor sign back of application,notarized(Or,capy of signed contract with owner)
!f over$2500,a NoUce of Commencernen2 is required{Mechanicai work over$5p00}
Supply two(2}sets of drawings with applicable documentation
Allaw 10-14 days for review after submittal date. Parcel#-obtained from Properly Tax Notice(http://appraiser.pascagov.com)
NOTiCE OF DEED RESTRiCTtOtdS: The nnderslgned understands tt�at th€s pern�it may be subject to"deed°restrictions°
which may be more restrictive than Cvunty regulation$. The undersigned assumes responsibifiiy for comptiance wifh any
appliqble deed restrictions.
UNLtCENSED CONif2ACTORS AND GONiRACTOR RESPONStBILPiIES: if the owner has hired a contractor ar
contractors ta underfake work,they may be reqvired fo be licensed in accordance wifh stafe and tacal reguiations. tf the
contractor is not licensed as reqaired by law, both the owner and contractbr may be cited for a misdemeanor violation
under state law. !i the owner or[ntended contractor are nncertain as#o what licensing requirements may appty for the
intended work;they are advised to contacf the Pasco Counfy 8uilding inspec#tan Divisian—Licensing Section at 727-847-
8009. Furthermore, ff the owner has hired a contraotor or aontractors, he is advised to have the contrackor(s) sign
por@or�s of the"contractoc elock"af this appNcation for which they will be responsibis. If you,as the awner slgn as the
contractor,fhaf may be an indicafian that he Es nof properiy#icensed ancf!s not entiBed to permi�ing privlleges in Pasco
County.
TRANSPOI2TAT10N IMPACTtUl7Lt7iES IMPACT AND RESOURCE REC4VERY FEES: The undersigned understands
fhat Transporfation 4mpact Fees and Recourse itecovery Fees may appiy to fhe conshuc6on af new buildings,change of
use in exisNng buildings,or expansion af exisNng buildings, as specified in Pasco County OMinance number 89-07 and
84-07,as amsnded. The underslgned also understands,that such fees,as may be due,will be Ident�ted at tfie time of
permifting. If Is turther undersfood thaf Transporfafion Impact Fees and Resource Recovery Fees must be paid pr�or ta
receiving a'certificate of occupancy"or flnai power release. If the project does not involve a certificate of occupancy or
final power release,the fees must 6e paid priar to permit issuance. Furthermore,If Pasco County Water/Sewer Impaot
fess are due,they mast be pald prlor ta permit Issuance in accordance witFi applicabte Pasco Coun#y ordlnances,
CONSTRUCTION LIEN LAW(Chapter 713,Flarida Statutes�as amended); (f valuation of work is$2,500.00 or more,I
certify that 1, the appllcant, have been provided with a capy of the 'Florida Consttvction Lien Law—Homeowner's
Pratectlon Gulde"prepared by the Flortda Department of AgricuEteire and Gonsumer Ai3airs. If the appt9cant€s someone
other than the"owner",I certify that i have obtained a capy of the above described document and promise in good faith to
deliver!t to the"owner"prior to commencement.
CQMRAGTOlt'3lOWNER'S AFFIDAVIT: 4 cettify that all the lnformaflon In this apptteatian is accurate and that ail wotk
wilf be done in compliance with all applicabte laws regulating consfriicfion,zoning and iand devetopment Apptication is
hereby made to obtain a permit to do work and instaila6on as indfcated. I certify that nn work or installation has
cornmenced p�or to issuance of a permlt and#hat a1C work wilt be pet#armed to meet standards af ai(laws regutating
construc6on, County and Ciiy codes, zoning regulafions, and land development regulaftons in tfie jurisdicfion. 1 afso
certify that I Understand that ihe regulations of atFier gavemment agencies may apply to the intended work,and that it is
my responsibilify to tdenttfy what actlons 1 tnusE#ake to be In compliance. Such agenales tnclude bnt are nak Iimited to:
- Department of Environmentai Protectidn-Cyipress Bayheads, VUeBand Areas and Environmenfaliy Senslfive
Lends,WaterMlastewater Treatrnenk '
- SouthwesE Ftorlda Water Management Dlstrict Wells, G�rpress Bayheads, Wetland Areas, Aiterfng
Wa#ercourses.
- Army Corps of Engineers-Seawalls,Docks,Nayigable Watetuvays.
- Departme»t of HeaEth 8� i'tehatillitative SertirlcestEnvtronmentat Fleatth Unit Weils, Wastewater Trsakment,
Septic Tanks. � ��
- US Environmental Protectlan Agency-Asbestos abatement.
- Pederai Aviation Authodty-Runways.
I undetstartd that the following resfrictions app{y#o fhe use of fill:�
- Use offill is not allowed In Flood Zone'V°unless expressly permitted.
- !f the fltl mate�lal Is to be used in Flood Zone "A", it is understood that a drainage pian addressing a
`campensating vatume"will be submifted at fime of permitting wh�ch is ptepared by a professional engineer
I'icensed by the State of Flarida. ,
- tf the fitt material is to be used in.Elaod Zone A" in connection with a permitted building using stem wail
construatian,l cerFity tf�at filf w1tC be used onty ta filt the area within the stem wal[.
- If flll material is to be used�(n any area,-I certify that use of such fill will not adversely affect adjacent
prope�ties. if use of fill is fnund to adversely affeck adJacent properties,the owner may be cfted far violating
the conilitians of fhe buitding perm[#'Essueci underathe attached permft appiica#on,for lats tess than one{1}
acre which are elevated by fill,an erigineered drainage plan Is required.
!f 1 am the AGENT FOR THE OWNER,I promise tq good fa'dh to;inform the owner of khe permitting conditions set forth in
� this afl3davft ptior to commencl�g consiru�fian. !undetsfand that a separate permlt may be requtred for etecMcal work,
plumbing, signs,.wells, pools, afr conditioning, gas, ar other Instaltations not specfficalfy fnduded in fhe apptication. 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 pro�isions of the techn3ca�codes,riat stiail lssuance af a permlf prevent the Buttdfrig OEficia{fris`�ri thereafter �.
� requiring a coRection of errors in plans,construction or violatians of any codes. Every permit issued shalt become finvalid
unless the work authorized by such pertnit is commenced within six months of permit issuance,or ff work authorized by
the permit Is suspended or abandoned tor a peciod af s6c(6}monfhs aBer the tfine the work is commenced. An extensian
i may be requested,in wrfting,from the Building Ofliciat for a periad not to exceed nine#y(90)days and witl demonstrafe
justffiable cause for the extensian. If wark ceases for ninety(90)consecutive days,the Jab is cansidered abandoned.
WARNIMG TQ OWHER: YOUR FAILURE TO RECORD A NO'TICE OF COMMENCEMENT MAY RESULT iN YQUR
PAYING 1WICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TQ 08TAIN FINANCING,GONSUL7
WITFf YOUR LENOEEt QR AN ATTQRNEY BEFORE t2ECORDIN�YOUR NOTtCE OF GOMMENCEMENT.
FLORIDA JURAT(F:S.117.03)
OWNER OR AGENT CONTRACTOp�,
� Subsaltred arsd stiwm to{or aEfhmed}6eiare me th� Suhseribed and'swom to{or at�rmed)6efore me thEs
I by bY
Who Is/are personaly known to me or hasRiave produeed Who fslare persanally imown to me o�haslhave produced
as IdentlficaHon, as IdentlficaUon.
1lotary Pubilc Notaty Public
ICommission No. Commtsston No.
Name o�f Notary typed,Printed or stsmped �tJame ot Nohary typed.Pdrited ar stamped
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