HomeMy WebLinkAbout93-3068
jiI
BUILDING PERMIT
J-N'~
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CITY OF ZEPHYRHILLS
(813) 788-6611 ~
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Permit
N~ _ 3068,6'
&- :3-9?J
"...
, 1:35'
~
Date
Water Conn:
Job Address:
Zoning:
tvt..: .
o;11/1/;=!241/}. 7JW/AJE55 aJlf)wJV4mJR$ W)
o OCCUPANCY BEFORE C.O. I< G./tPr: ti..F5T/1I/25
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances,
DATE
V
Valuation or d, __ . 2--..
Contract Price ""r' / ~ . {/ iJt)
. ,
Permit
Signatur
Company
Address
Telephone#
C;ty Ucense Reg;s".t;on · (, ~ -;:;?1::J .
St.te Ce,';!;ed ~,. ~ _ ~/
~a.:~~. ~w. Uo &;g.
ELECTRICAL t:t.5D
{?/!Au: 3r;J/>>
BUILDING
PLUMBING .,- S1
- 57:~
- MEC NICA~~
Tp. Servo
Rough In .~;P_ct3 8~
Meter Can
Const. Pole
Pool
Pre-Meter
Final
SLB
Tub Set 3 ~ -q3 ~.1J;
Water
Sewer
Final
Breakers
Ducts Insl. 3--ID "'~3 {5~
Compressor
Final
Ftr.
Pre SLB
Lintel
~RM' ~ -\c!>"'t13 ~:oj_
Insul. CL
WL
D~~
~O~
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Fifteen and 00/100 Dollars ($15.00) shall be made for each trip for each trade:
a. Wrong Address
b. Condemned work resulting from faulty construction.
c. Repairs or corrections not made when inspection called.
d. Work not ready for inspection when called.
e. Permit not posted on job site.
f. Plans not at job site.
g. Work not accessible,
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
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APfllLICATIC'1i rO)L PE.'RIifiT
CI'IY ~fl' ~.I.I.s
BlJIIlilI5G DEPARIlIIE'Nl'l'
OWNER'S RAIlE D U)~~ ~ ~ \---\ ~k, ,~ }
OWNER'S ADDRESS ~ D \5 c))' , ~ : ~g.t1,ti-d 5 t..f
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LEGAL DESCRIPTION: WI'(S)_. .__ __ _ _BI.OCK
PH05E~ '7 '::) ~ Lf.-l.3 1
tv r-- s + We: c. LF-. '( C' en- f IS L
Z ~ 10 h y (L h t ':'c s
I I
S1JIBDIVISIOM_.
JOB ADDRESS
PARCEL I. D. f
WORK PROPOSED:_riev Construction --.-Jl.ddition v-Alteration _Repair _Install
_Sign
_!!love
_Deaolish
PROPOSED USE:
Single F3IIily
~/F
-2.., of llJnits
_K/H
_~rcial
_IndUst.
_Swia. Pool
Other
_Rest:aurant &: Health Depan:.ent Approval
BUILDING SIZE: ~ (J X J 4 ,
I 'i ~'o
Square Feet,
( I
4
Height
RESIDENTIAL :
COttKERCIAL :
ATTACH (2) PLOf Pi..MiS &: (2) SEIS OF B1JIILDIMG PLArmS &: (1) SET
ATTACH (3) SETS OF BUTI.DlllG PI.~S &: (1) SET EOOERGY FORMS. **
**COFY OF CONTRACT RIlQm:RED.
PERKITS REQUESTED
ENERGY FORKS. ** L/'ES>
L pO:A ,,-
r tde~ ~O(~l{
6~ ':f-- ~ 1
~/p-
yI' BUILDING
VELECTRICAL
V HECHAlUCAL
v/ PLUMBING
$
\ 0 \ 0 <J Q J7aloation of Tot:a1 Construction
I
I {) 0 AHP Service _~_Florida Power Corp.
W.R.E.C.
$
1'1.
0.0 ,
... :>
Valuatioc, of Kechanical Installation
GAS
/B10<:k
___ROOFIliG
SPECIALTY
TYPE OF CONSTRUCTION!:
_FraIIIe
_Steel
Other
FINlISHED FLOOR ELEVATIONlS:
FI' .
IS PRUJECT IN FLOOD zmm AREA?
YES NO
*********...... ~...*...*...-Al'.,,***""*******************
ornnKACIOR SECI'ION
BUILDER, '4 ~ COI!tPMUY c.. rL 0 sse 0 {'" s f' Co.
n "'" " J.. A 'State Cert. or Regist. f
Signatu~ W ~~ ' \:' i \ ~_ City License Registration f C 'd..
******v***it**it*iI:*:i:'f:************************
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ELECTRICIAlI fi::.E; E.L..Ec.::r~l Co ' COIIPMiY -~, C-- ':..:::- /-~ ,/ ,,~ /i?, <:::::...
J J~ . .)~ Sta'" ,,,.,ft:. or Regisr.' /'" 1! c'(',('-s<///d
Silmaturd//.c;; . /1/ 't:< L- City }i.icense Registration f~ /J
***.... **.......*~*4*...*******.******************
PL1DtBER C.f.+~;f 1'!>A-~ ~(..'41!!>>a.. COlIPMY
Signature (j(/l~/l2. ~, ~~,~e,~,~~e o~e:~;~:~~i:n
*********",,,,**"~iI::irof::--I/J:,""'*' ,',*, '*'f1i:***************
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KEGlJAlfiCAL
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Signature
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**.:::':I'",:Ao ~~_.;'. lo\.-.;.. J:'i::~
'~m>>Ali~Y
')t:at:t' Cert. or Regist. #
C:,:j,t::ir I.icense Registration t
',hd~1: ';- "'****,ll-*****;:***,t*~
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otHER_ '~
Signa~-\/~ ~' '..J-.:.. ~
+ *.....* 2'''''''''.
c.._!P,@:_,(~f
S~at~ Cert. or Regist. j
';h~ License Registration f
,'", '***'ll',I:-*******************
APPLICATION APPROVED BY
PERKIT OFFICER.
CONDITIONS OF F~RMIT AFFIDAVIT
A. 'NOT I CE OF DEED RESTR I CT IONS
The undersigned understands that this pertit 'lay be ~ub~e~t to "deed restrictions" which lay be lore restrictive than ~ily
regulations. The undersigned assules responsibility for cOlpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS A!~D CONTRACTOR RESPONSIBILITIES
If the OMner has hired a cor.tracto~ or fontracturs to undertake work, they lay be required to be licensed in accordance with
state and local regulations. If the contractor it not iicensed as required by laM, both the owner and contractor tay be
cited for a lisdeleanor violation under state law. If the owner Dr intended contractor are uncertain as to what licensing
reQuiretents lay apply for the intended Hork, they are advis~d to contact the City of Zephyrhills Building Departlent, (813)
799-6611.
Furtherlore, if the owner has hired a contractor or contractors, he is advised to have the contractor{sl sign portions of the
"Contractor Sections" of this application for which they will be responsible. If you, as the owner sign as the contractor,
you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wishes you to sign
as contractor that lay'be an'indication that he is not properly licensed and is not entitled to perlitting privileges in the
City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEE~
D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES~ AS AMENDED)
I certify that I, the applicant, have been provided Mith a copy of "Florida's Construction Lien Law - HOleowner's Protection
Guide" prepared by the Florida Departlent of Agriculture and Consuler Affairs. If the applicant is sOleone other than the
'owner", I certify that I have obtained a copy of the above described doculent and promise in good faith to deliver it to the
"owner" prior to cOI.encelent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the inforlation in this application is accurate and that all work will be done in cOlpliance with all
applicable laws regulating construction, zoning, and land developtent.
Application is hereby lade to obtain a perlit to do Mork and installation as indicated. I certify that no Mork or
installation has cOllenced prior to issuance of a perlit and that all work will be perforled to leet standards of all laws
regulating constructi,on, City codes, zoning regulations, and land developlent regulations in the jurisdiction. I also
certify that I understand that the regulations of other governlental agencies lay apply to the intended work, and that it is
ty responsibility to identify what actions I Dust take to be in co.pliance. Such agencies include but are not liaited to:
f Departlent of Environlental ReQulation - Cypress Bayheads, Wetland Areas and Environlentally Sensitive Lands,
Water/Wastewater Treatment
f Southwest Florida Water "anaQelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
f ArlY Corps of EnQineers - Seawalls, Docks, Navigable Waterways '
f Departlent of Health ~ Rehabilitative Services, Environlental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
f US Environlental Protection AQency - Asbestos abatement
I also certify that, it fill lateriill is tr. ,,,:: "'tC~ ~" ;:liloJ Zo,;" "r,' ur "A,i?tc,", it is under~~~od that J drainage plan
addressing a "colpensating volule" will be sublitted which is prepared by a professional engineer registered in the State of
Florida prior to perlit issuance.
A perlit 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 provisions of the technical codes, nor shall issuance of a per.it prevent the Building Official frot thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every perlit issued shall becole invalid
unless the work authorized by such perlit is r.JM~ellced within six Bonths of issuance, or if work authorized by the perlit is
suspended or abandoned for a period of six lorths ariel' the tile the Mork is coslenced. One 90 day extension of tile, lay be
allowed for the perlit with fee charge of $I~.O'). The extension shall be requested in writing to the Building Official. An
approved inspection lust be logged durinq each six lon~t. period, or the project will be considered abandoned.
WARNING TO OWNER: fOUR FAILURE TO RECORD A NOTICE OF ~OH"ENCEHENT HAY 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
COHMENCEMENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
SIGNATURE: OWNER OR AGENT
SIGNATURE: CONTRACTOR
STATE OF~FLORIDA
COUNTY OF
The foregoing instrument
before me this
was acknowledged
, 19_ by
STATE OF FLORIDA
COUNTY OF
Th2 foregoing instrument
befctl-e me th i s
was acknowledged
19_ by
who is persDnally known to me or who has
produced
as identification and who did/did not
take an oath.
who IS persDnally known to me or whD has
produced
as identification and who did/did not
tak2 an oath.
(Signature)
(Signature)
(Name Typed, Printed Dr Stamped)
NOTARY PUBLIC
(Name Typed, Printed Dr Stamped)
NOTARY PUBLIC
.-ENERGY
For detailed information
of the EPI rating number
or for any ITEM listed,
ask your Builder for
DCA Form 600A-93
Or Form 600B-93
EPI=I'~VI
GUIDE
excellent good acceptable
o 10 20 30 40 50 60 70 80 90 100
I I I I I I I I I I ==:J
The maximum allowable EPI is 100. The lower the EPI the more efficient the home.
RESIDENTIAL ENERGY PERFORMANCE RATING SHEET
I certify that these energy saving features required for the Florida Energy Code have been installed in this house.
Builder
Signature:
ITEM
WINDOWS ......J).i "'/.." ............... .......
INSULATION .........................................
Ceiling R-Value .........1.7.............
Wall R-Value ..........~..,........
Floor R-Value ..........................
CO' A/1 << It- !
AIR CONDITIONER ...............................
/ j) . 00
SEER / EER .......................................
HEATING SYSTEM ../:f.R.~.J..l'!..~.r.....
Electric COP / HSPF ...7..':..~.......
Gas AFUE .............................
WATER HEATER ....~.L~..1................
Electric E F ..........: ..9..r................
Gas EF ..................................
Solar EF ..................,...............
OTHER FEATURES ..............................
...........................................................
...........................................................
Address:
HOME VALUE
Low Efficiency
High Efficiency
SINGl ClR
I I
DBl TINT
I
R,10
I
R.O
I
R.O
I
R,30
I
R.7
I
R,19
I
10,0 SEER 17,0
I I I
9,7 EER 16,0
6,8 HSPF 12,0
I I I
.78 AFUE ,90
I I I
,88
I
,54
I
.40
I
,96
I
.90
I
,80
I
Date:
City/Zip
Florida Energy Code for Building Construction-1993 Florida Department of Community Affairs FL -EPL CARD 93
FLORIDA ENERGY EFFICIENCY ,CODE F~ BUILDING CONSTRUCTION
. FORM 600B-93 Residential Component Pres'criptive Method B CENTRAL 4 5 6
Department of Community Affairs
Compliance with Method 8 Chapter 6 of the Flonda Energy Efficiency Code may be demonstrated by the use of Form 6008.93 for single and multifamily residences of 3 stories or less In height, and
additions to existing residential buildings, To comply, a building must meet or exceed all of the energy efficiency prescriptives in any one of the prescriptive component packages and comply with the
prescriptive measures listed in Table 68,1 of this form, Compliance by this method will be, in most cases, equivalent to an EPI of 100 points or less, An alternative method is provided for additions of
600 s uare feet or less b use of Form 600C,93, If a buildin does not compl with this method, it ma still com I under other sections in Cha ter 6 of the Code,
PROJECT NAME: C ~ C> sse 0 A.i 'Sf . I( () ~> e~ 0 AI '7
AND ADDRESS: CLIMATE D D
OFFICE: ZONE: 4 5 6
OWNER: PERMIT NO.o=JIIIII] JURISDICTION NO.: ITIn=o
GENERAL DIRECTIONS
1. New construction including additions which incorporates any of the following features cannot comply using this method: raised wood floors without continuous stem walls,
steel stud walls, single assembly roof/ceiling construction, or skylights or other non.vertical roof glass,
2. Choose one of the component packages "A" through "F" from Table 6B.1 by which you intend to comply with the Code. Circle the column of the package you have chosen,
3, Fill in all the applicable spaces of the "To Be Installed" column on Table 6B.1 with the information requested, All "To Be Installed" values must be equal to or more efficient
than the required levels,
4, Complete page 1 based on the "To Be Installed" column information,
5, Read "Minimum Requirements for All Packages", Table 6B,2 and check each box to indicate your intent to comply with all applicable items,
6, Read, sign and date the "Prepared By" certification statement at the bottom of page 1, The owner or owner's agent must also sign and date the form,
Please Print CK
1. Compliance package chosen (A-F)
2. New construction or addition
3. Single family detached or Multifamily attached
4. If Multifamily-No. of units covered by this submission
5. If Multifamily, is this a worst case (yes / no)
6. Conditioned floor area (sq. ft.)
7. Predominant eave overhang (ft.)
8. Porch overhang length (ft,)
9. Glass area and type:
a. Clear glass
b. Tint, film or solar screen
10. Percentage of glass to floor area
11. Floor type and insulation:
a. Slab on grade (R-value)
b. Wood, raised (R-value)
c. Wood, common (R-value)
d. Concrete, raised (R-value)
e. Concrete, common (R-value)
12. Wall type and insulation:
a. Exterior:
1. Masonry (Insulation R-value)
2. Wood frame (Insulation R-value)
b. Adjacent:
1. Masonry (Insulation R-value)
2. Wood frame (Insulation R-value)
13. Ceiling type and insulation:
a. Under attic (Insulation R-value)
b. Single assembly (Insulation R-value)
14. Cooling system
(Types: central, room unit, package terminal A.C., none)
15. Heating system:
(Types: heat pump, elec. strip, nat. gas, L.P. gas, room or PTAC, none)
16. Hot water system:
(Types: elec" nat. gas, L.P. gas, solar, heat rec., ded. heat pump, other, none)
OWNER AGENT:
I hereby certify that th
Florida Energy Code,
1.
2.
3.
4.
5.
6.
7.
8.
C
/1Jr"W
In. <J I '1 .-
;)..
\./ ("':> '
'1 :+ ')$
~
9a.
9b.
10.
Single Pane
sq. ft.
sq. ft.
e; %
Double Pane
sq. ft.
'" , ,_:, sq. ft.
11a. R= D 7 ;;.t sq. ft.
11b. R= sq. ft.
11c. R= sq. ft.
11d. R= sq. ft.
11e. R= sq. ft.
12a-1 R= 5" 7r; 7 sq. ft.
12a-2 R= sq. ft.
12b-1 R= _sq. ft.
12b-2 R= sq, ft.
13a. R= Ie, 1).t[ sq. ft.
13b. R= sq. ft.
14. Type: C e Ni ~ (t- (
SEERlEER: 10 . (..I D
15. Type: I'-{ fl d f (Ju ,.Tl ~
HsPF/COP/AFUE: "71.
16. Type: E/e f1.
EF: ( C) I
DATE$-J' 93
ergy Code,
DATE:
Review of plans and specifications covered by this calculation indicates compliance with
the Florida Energy Code, Before construction is completed, this building will be inspected
for compliance in accordance with Section 553.908, F.S.
PREPARED BY:
I hereby certify that this bu
-1-
BUILDING OFFICIAL:
DATE:
TABLE 6Q-1
MINIMUM ~")UIREMENTS
. .,
COMPONENTS PACKAGES FOR NEW CONSTRUCTION
A B C D E F
Max. %of glass to Floor Area 15% 15% 20% 20% 25% 25%
en Type Single Clear (SC) Single Tint (ST)
en Single Tint (ST) Single Tint (ST) Double Tint (DT) Double Tint (DT)
:5
c:l Overhang 2' 2' 2' 2' 2' 2'
Masonry EXTERIOR AND ADJACENT MASONRY WALLS R-5
en COMMON MASONRY WALLS R-3 EACH SIDE,
..J
..J
<(
:: Wood EXTERIOR, ADJACENT, AND COMMON WOOD FRAME
Frame WALLS R-11
CEILINGS CEILINGS UNDER ATTIC R-30. FRAME COMMON CEILINGS R-11.
(NO SINGLE ASSEMBLY CEILINGS ALLOWED)
en Slab-On-Grade R-O
a:
0 Raised Wood R-11 (ONLY STEM WALL CONSTRUCTION ALLOWED)
0
..J Raised Concrete R-5
u.
DUCTS R-6 R-6 CONDo R-6 R-6 R-6
SPACE COOLING (SEER) 11.1 10.0* 10.0* 10.5 10.0* 10.9
~ Elect. (HSPF) STRIP 6.8* 6.8* 7.3 6.8* 7,6
w Gas/Oil (AFUE) MINIMUM OF .73 (Direct heating) or .78 (Central)
:c
a: Electric EF .90 EF ,90 EF ,90 EF .90 NOT ALLOWED EF ,90
w:::!: Resistance** (SEE BELOW)
~w Gas & Oil ** MINIMUM EF OF .54 NATURAL GAS ONLY
::tl
1->- (SEE BELOW)
Oen
::I: Other Any of the following are allowed: dedicated heat pump,
heat recovery unit or solar system.
Climate Zones 4 5 6
TO BE INSTALlEn.
~ %
DC: D DT: tKl
~ FEET
EXT: R= ~
ADJ: R=
COM: R=
EXT: R=
ADJ: R=
COM: R-
UNDER ATTIC: R =
COMMOM: R= If
.
R= t!J
R-
R=
R- COND, 00
SEER = / /).O-f:)
.
cOP= _ or HSPF= "2.!.Q
AFUE =
EF- -Iff
EF=
DHP: B EF= -
HRU:
SOLAR: 0 EF= -
Single package units minimum SEER=9,?, HSPF = 6,6.
Minimum efficiencies for gas and electric hot water systems apply to to 40 gallon water heaters, Refer to Table 6,11 for minimum Code efficiencies for oil water heaters and other sizes,
DESCRIPTION OF BUILDING COMPONENTS USTED
Percent of Glass to Floor Area: This percentage is calculated by dividing the total of all glass areas by the total condrtioned floor area.
OVerhang: The overhang is the distance the roof or soffit projects out horizontally from the face of the glass, All glass areas shall be under an overhang of at least the prescribed length with the following exceptions: 1) glass
on the gabled ends of a house and 2) the glass in the lower stories of a multi-story house,
Wall. Ceiling and Floor Insulation Values: The R-values indicated represent the minimum acceptable insulation level added to the structural components of the wall. ceiling or floor. The R-value of the structural building
materials shall not be included in this calculation, 'Common" components are those separating condrtioned tenancies in a multifamily building, 'Adjacenf components separate conditioned space from unconditioned but
enclosed space, 'Exterior" components separate conditioned space from unconditioned and unenclosed space,
Floor: Sleb'on-grade floors wrthout edge insulation are acceptable, Raised wood floors shall have continuous stem walls with insulation placed on the stem wall or under the floor,
Ducts: 'COND" indicates that the ducts must be installed within the condrtioned space; that is. the ductwork shall be located on the conditioned side of the insulation, Ducts in conditioned space are acceptable for any
prescriptive package,
Space Cooling System: Cooling systems shall have a Seasonal Energy Efficiency Ratio (SEER) for central unrts or Energy Efficiency Ratio (EER) for room units or PTAC's equal to or greater than the prescribed value,
Electric Space Heating Option: Heat pump systems shall be rated with a Heating Seasonal Performance Factor (HSPF) equal to or greater than the prescribed HSPF, Heat pump systems may contain electric strip bacllups
meeting the crrteria of section 608.1.ABC.3.2.2, No electric resistance space heat is allowed for these packages.
Electric Resistance Hot Water Option: For pacllages designated 'Not Allowed", an electric resistance hot water system may be installed only in conjunction with one of the 'Other Hot Water System Options", See below,
Other Hot Water System Options: Any dedicated heat pump, heat recovery unit, or solar hot water system with an EF of 1,5 or higher may be installed, Solar systems must be designed to provide at least 40% of the total
hot water, Electric resistance systems having an EF of ,88 or greater, or natural gas systems wrth EF .54 or greater may be used in conjunction with these systems,
TABLE 6B-21 MINIMUM REQUIREMENTS FOR ALL PACKAGES
COMPONENTS SECTION REQUIREMENTS CHECK
Exterior Joints & Cracks 606.1 To be caulked, gasketed, weather-stripped or otherwise sealed. X
Interior Joints & Cracks 606.1 All openings in interior surfaces of ceilings and exterior walls must be sealed. .,t
Sole & Top Plates 606.1 Sole plates and penetrations through top plates of exterior walls must be sealed. )\
Infiltration Barrier 606.1 Infiltration barrier must be installed in exterior walls & raised wood floors. x:
Fireplaces 606.1 Fireplaces must have flue dampers. glass doors and outside combustion air intakes. 1/ "
Exhaust Fans 606.1 Exhaust fans vented to unconditioned space shall have dampers, except for combustion "X
devices with integral exhaust ductwork.
Water Heaters 612.1 Comply with efficiency requirements in Table 6-12. Switch or clearly marked circuit breaker (electric) 't\
or cutoff (gas) must be provided. External or built-in heat trap required.
Swimming 612.1 Spas & heated pools must have covers (except solar heated), Non-commercial pools must have a I.ttJ
Pools & Spas pump timer. Gas spa & pool heaters must have minimum thermal efficiency of 78%.
Hot Water Pipes 612.1 Insulation is required for hot water circulating systems, (including heat recovery units) and the first '}.
8' of piping from the water heater (or until piping enters an insulated wall or slab).
Shower Heads 612,1 Water flow must be restricted to no more than 3 gallons per minute at 80 PSIG. 'A
HV AC Duct 610.1 All ducts, fittings, mechanical equipment and plenum chambers shall be mechanically attached.
Construction, sealed, insulated and installed in accordance with the criteria of Section 610.1. Ducts in attics must be X
Insulation & Installation insulated to a minimum of R-6, Air handlers shall not be installed in attics unless in mechanical closets,
HV AC Controls 607.1 Separate readily accessible manual or automatic thermostat for each system. .)-.
-2-
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ZEPHYRHILLS FIRE DEPT
7121.5' rYL
B. N --j)~, /~'> /
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Zephyrhills Florida 33540
FIRE CODE INSPECTION
Classification
Owner/Manager /// / {~~ //>~:::'fi i5~
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Business Phone
Emergency Contact phone
....
Occupancy Load
TYPE OF INSPECTION 'CONDUCTED
o QUARTERLY
ORE-INSPECTION
o APPROVED
>D FINAL 0 ANNUAL
o OTHER
o NOT APPROVED
OBI-ANNUAL
o COMMERCIAL CHECK
Listed below are items which must be complied with before this occupancy can be approved by the Fire
Department.
o CODE VIOLATIONS
This inspection report specifies code violation(s) which if not corrected could cause a fire, contribute to the
spread of fire. or prevent safe egress during a fire. Your immediate attention to the correction of these
violations shall b~ required, as failure to do so is a violation of the city of Zephyrhills Fire Prevention Code.
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Inspect. Date 112 ,;;1-1 :;. Inspect. Time //J ~ (::) Fire Dept. 10 # l' 5- j-
Re-Inspect Date d. In';ll"?/ J-t} f. ,v',;;' F
Owner/Manager Signature __ ~ ~, Title
This building has been checked by the Zephyrhills Fire Dept. under the codes & regulations of the NFPA minimum
standards, the State Fire Marshall's Uniform Fire Safety rules and other local fire safety codes.
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