HomeMy WebLinkAbout16-17689 I
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� CITY OF ZEPHYRHILLS
; 5335-8TH SiREET
� (813)780-0020 17689
� -�I �ANNUAL ASSEMBLY PERMIT
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�PERMIT INFORMATION LOCATION INFORMATION
Permit �lumber: 17689 Address: 38333 COTTONWOOD PL
Perr�nit Type: FIRE PLACE OF ASSEMBLY ZEPHYRHILLS, FL.
Class 'of Work: FIRE-PLACES OF ASSEMBLY Township: Range: Book:
Propo�ed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: DRIFTWOOD
Est. Value: Parcel Number: 02-26-21-021B-OOR00-0000
• Improv. Cost: OWNER INFORMATION
Date Issued: 8/25/2016 Name: DRIFTWOOD CONDO ASSOC
Total Fees: 50.00 Address: 38333 COTTONWOOD PL
Amount Paid: 50.00 ZEPHYRHILLS, FL. 33542
Date Paid: 8/25/2016 Phone:
Wo;rk Desc: PLACES OF ASSEMBLY- DRIFTWOOD CLUBHOUSE EXP 8/2017
CONTRACTOR S APPLICATION FEES
FIRE PERMIT FEES 50.00
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Ins ections Re uired
FIRE S TE INSPECTION-Final
OCCUPANCY LOAD:
Occupancy by more than the number of persons above shall be considered
dangerous and unlawful. Occupant load determined by Florida Fire
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Prevention Code, NFPA101, Section 7.3.1.2
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PERMIT OFFIC
� PERMIT EXPIRES IN ONE (1) YEAR FROM DATE OF ISSUANCE
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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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813-786-0020 City of Zephyrhills Fire Fax-813-780=002'1
Permit Application
Date Received �l�� Phane Gantactfar Permit T��_�����
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Owne�s Name s ��" . Qwner's Phane IJumber E� � �
Owners Address �J p � � � L '�a �
Fee Simple Titlehol�er Name Titleholder Phone Number � � �
Fee Simple Titleho�der Address
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Job Address Lot# �..�
Sub Division Parcel#
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�� �� Bia-Hazard Waste�Storage-ANNUAL �����l� ��� Fumigatian Tent��Y � ���
Q Gomm Exhaus#Kitchen HoodlDuct � Hazardaus Ma#erial{Tisr 11 or RQ Facility)ANNUA�
� Cantrolled Bum � Hood Installation
� ,� �mergency Generator<34 kw � LPINatural Gas-Installation �
� Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale
� Fire Protectian Maintenance-ANNllAI � Places af Assembiy-ANNUA!
try emi � t er
Sprinkier � ❑ ❑ � , � RecreaYiona!Bum
Fire Alarm � ❑ ❑ O � � Sparklers
Haod Gieaning � � ❑ ❑ � � Sprinkler System Instailations ����`
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Haod Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
� Fire Alarm Instai{ation � Tarch RoofinglTar Kett{e °
� Fire Pumps , Waste Tire Storage ANNUAL
Q FlammableApplication-ANNUAL �--� Valuation of Project .
� Fuel Tanks
- Q t�ther:
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Confractor� � ' Company
Signature � Registered Y/N Fee Current Y/N
Address E �icense# ��
ELECTRICIAN Company
- Signature � Registered Y/f�l Fee Gurrent Y!N
Address � License#
PLUMBER �I Company
Signature " Registered Y/N Fee Current Y/N
Address � �icense#
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MECHANICAL � Company
8ig�ature Registered Y l N Fee Gurrent Y 1 Ct)
Address � License#
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OTHER � Company
Signature Registered Y/N Fee Current Y/N
Address License#
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Directions:
Fi(f auf applicatian completely.
Chnmer&Contractor sign back of application,notarized(Or,capy of signed contract with owner)
tf over$250Q a Notice of Commencement is required(Mechanicat work over$5004)
Supply twa(2)sets of drawings with applicabie documentation
Allow 10-14 days for reviaw after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pescogov.com)
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�IOTICE C1F OEED RESTRIGT{ONS: The undersigned understands that ttrls permit may be subject ta"deed"restrictlons"
which may be more resirictive than County regulations. The undersigned assumes responsibiiity for compliance with any
applicable deed res#rictions. � ,
tlCdLtGEtrtSED GQ1dTRACTORS AAtD GOPITRi�G1'OR RESPONSl�ILiTtES: if the owner has hired a cantractor or
contracfors to undertake work,:they may be required to be 13censed in accordance with state and tocat regutations. (f fhe '�r .'�-...�
contractor Is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation c
under sfate law. 1f the owner or intended contraetot are uncertain as to what Hcensing requirements may appty for the ' ,
intended work,they are advised to con#act the Pasoo Caunty Building tnspect3on Division—�icensing Section at 727-847- �
8009. Furthermore, ff the owner has hired a cantractor ar contractors, he is advised to have the con#ractor(s) sign
portions of the"contractor Block"of this appfication for which they wtl!be responslble. If you,as the owner sign as the
contractar,that may be an findication that he is not psoperly fiicensed and is not entit{ed to permitting privileges in Pasco
County.
7RANSPORTATlON IMPACTlUT!!.lTIES IMPAC7 ANQ RESOURCE RECOYERY FEES: The undetsigned understands
that Transportafion impact Fees and Ftecourse Recovery Fees may apply to the consfsvction af new buildings,change of
use In existing bulidings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
94-07,as amended. The underslgned aiso understands,that such fees,as may be due,wUl be Identified at the#ime of
permif#ing. lt is further undersfood thaf Transportation impact Fees and Resource Reeavery Fees must be paid prior to
receiving a°certficate 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,iF Pasco County WatedSewer Impact
fees are due>fhey must be pald priar ta permlt issuance 3n accordance wifh appltcable Pasao CaunEy ordinances.
CONSTRUCTION LIEtd LAW(Chapter 713,Florida Statutes,as amendeda: If valuation cff work is$2,5q0.00 or more,I
certify that 1, the appiicant, have been provided with a copy of the °Florida Construction Lien Law—Homeow�er's
Protection Gaide"prepared by the Flarlda Deparfinenf of Agriculture and Cansumer Affairs. If tfie appiicant ts someone =.
other than the°owner",I cerfify 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.
COiVTRACTOR'SIOWNER'S APFIDAVIT: 1 cert3fy tha#all the inform�tion En fhls appiication is accurate and that all work
witl'be done in compliance with all applicable laws regutating constnuction,zoning and land devetopment. Apptication is
hereby made to obtain a permit to do work and installation as indicated. I certify that no wark or installation has
commenced prior ta issuance o#a permit and fhat a11 work wli] be perFarmed to meat standasds of a!S laws regutaking
construction, County and Cify codes, zon(ng regulafions, and land development regulations in the jurisdicfion. ( atso
certify that I understand that the regulations of ottier govemment agencies may apply to the intended work,and that it is
my respansibiiity to idenflfy what acfions i must fake to be In cotnptiance. Such agencles€nclude buf are nat limlted to:
- Department of EnvironmentaY Protection-Cypress Hayheads, iNetland Areas and Ernironmentatly Sen"sitrve
Lands,Water/Wastewater Treatment. '
- Southwesf Ftorida Water Management Dlstric#-Welts, Cypress Bayheads, Wetiand Area's, Aitering .
Watercourses.
- Army Corps of Engineers-Seawalls,Docks,Navigable Waterways.
- Qepartment of Health & Rehabilitafive 5ervicestEnvironmentat Health Unit-WeNs, Wastewater Treatmertt,
Septic Tanks. '
- US Environmental Protection Agency-Asbestos abatement.
- Federa!AvlatEan Authorlty-Runways.
1 understand fhat the fotlowing resMctions apply fo fhe use of fill:� -
- Use of fill is not allowed in Flood Zone"V°unless expressly permftted.
- It the f311 materiai is to be used 'sn Ffood Zone "A°, It is u�derstoad that e drainage plan addressing a
"compensating voiume"witl be submitfed at time of permttting which is prepared by a professianal engineer '
licensed by the Sta1e of Florida. � • `�
- if the ft!! materfai is to tae used in Flood Zone°A"in cannec�ion with a permitted building using stem wall �
consfn.�ction,1 certKy that fltl wiii be used on[y ta fiil the area withtn the stem walt.
- If flll material is to be used in any area, I certffy that use of such fill will not adversely affiect adjacent
propestfes. !f use of fill!s found to advetsely affect adJacent properties,the owner may be cited for vialating
fiie condifions of the building psrmit issued under fhe attaahed permif application,for lots less than one{1}
acre which are elevated by flll,an engineered drainage plan is required.
tf 1 am the AGENT FOR TtiE OWNER,!promise in good faith to inform the owner of the permitting conditions set fiorth in
this affidavit prior ta oommencing consiruction. 1 understand thaf a separate perm3t may be requlred#ar elecErical work,
plumbing, signs,wells, poals, air conditioning, gas, or other fnstallations not specffically included in the application. A
permit 9ssued shall be construed to be a license tp proceed with the work and not as authority to violate,cancel,al#er,or
set aside ar�y provisions of the fechntcal codes,nor shalt issuance of a permit prevent fhe 8ulfdirig Official�tom thereafter
requiring a correction of errors in plans,construction or vialations af any codes. Every perntit fssued shaft become invalid
unless the work authorized by such permlt is commenced withfn six months of permit issuance,or if work authorized by
the petmit is suspended ar abandaned far a periad of s3ac(6}months after the#ime the work is commenced. An extension
may be requested, in writing,from the Building Ofticial for a period not to exceed ninety(90j days and witi demonstrate,
justifiable cause for the extension. If work ceases far ninety(90)consecutive days,the job is considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO ftECORD A NOTiCE OF CONiMENCEM�tdT HAAY RESULT IN YdUR
PAYING TWICE FOR IMPROVEMENTS T4 YOUR PROPERTY. IF YOU INTEPID TO OBTAIN FINpNCING,CONSULT
WITli YOUR LENDER OR AN A7TC9Rt�EY BEFORE l2ECORd}N�YQUR NOTICE OF GOMMENCEMENT.
Fi.OF21DA JGRAT(F:S.117.03)
OWNER UR AGEMT CONTRACTOR
Subscribed and swnm io(or atfirtned}6etore me fhfs Subscri6ed and swom to{or aflirmed}before me this
by �Y
VYha Islare personaliy knovm to me or haslheve produced Who Islare personally known to me or has/Fiave produced
as tdentlficaHon. as identiflcafion.
Notary Pu6llc Notary PubOc
Commisslon No. Cqmmission No.
Name of Notary typed,printed or stamped �Name of Notary typed,pdnted or stamped
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