HomeMy WebLinkAbout08-7538
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813) 780-0020
ANNUAL ASSEMBLY PERMIT
7538
Permit Number: 7538
Permit Type: FIRE PLACE OF ASSEMBLY
Class of Work: FIRE-PLACES OF ASSEMBLY
Proposed Use: COMMERCIAL
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
Address: 39248 B A V
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number:
50.00
50.00
2/22/2008 Phone:
FPM-CHADDYSHACK GOLF BANQUET ROOM-ASSEMBLY ROOM
Name: ZEPHYRHILLS
Address: 39248 B AVE
ZEPHYRHILLS, FL. 33542
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
FIRE MARSHAL OFFICE: 813-780-0041
~
- - I Ie R-
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
813-780-0020
Date Received.
Owner's Name -
Owner's Address
City of ZephyrhillsFire
Permit Application
Fee Simple Titleholder Name
Fee Simple Titleholder Address
Job Address
Sub Division
Fax-813-780-0021
Phone Contact for Permit
11018 I JG,s;-7f-) I
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Titleholder Phone Number
II
II
..t!lllIIlm1it~_'1J~lmi1,'lJm!
Parcel #
fe,
I
(Ul:S I AIN~U f-KUM I-'KUI-'~K I Y I AX. NU J Il,;~)
5~~1.[2
Lot #
D
D
D
D
D
D
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Contractor
Signature
Address
ELECTRICIANI
Signature .
Address I
PLUMBER
Signature
Address I
MECHANICALI
Signature .
Address I
Bic-Hazard Waste Storage - ANNUAL
Comm Exhaust Kitchen Hood/Duct
Controlled Bum
Emergency Generator < 30 kw
Emergency Generator> 30 kw
Fire Protection Maintenance - ANNUAL
Sprinkler 0
Fire Alarm 0
Hood Clean/Suppression 0
Fire Alarm Installation
Fire Pumps
Fire Works
Flammable Application- ANNUAL
Fuel Tanks
---
OTHER
Signature
Address
D Fumigation Tent
D Hazardous Material (Tier II or RQ Facility) ANNUAL
D Hood Installation
D LP/Natural Gas-Installation
D LP/Natural Gas-ANNUAL Sale
~Iaces of Assembly-ANNUAL
D Recreational Bum
D Sparklers
D Sprinkler System Installations
D Standpipes (Sprinkler Sys)
D Torch Roofing
D Waste Tire Storage ANNUAL
Valuation of Project
llb~_ '-~"'_F
Company I
Registered
License # I
Company I
Registered
License # I
Company I
Registered
License # I
Company I
Registered
License # I
Company I
Registered
License #
Y I N I Fee Current
Y/N
Y I N I Fee Current
Y/N
Y I N Fee Current
Y/N
. Y I N I Fee Current
Y/N
Y/N
Fee Current
Y/N
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.
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed"rrestrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance-Nith any
applicable deed restrictions.
'UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired' a contractor or
contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division-Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law-Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the "owner", I certify that 1 have obtained a copy of the above described document and promise in good faith to
deliver it to the "owner" prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and
that all work will be done in compliance with all applicable laws regulating construction, zoning and land
development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify
that no work or installation has commenced prior to issuance of a permit and that all work will be performed to
meet standards of all laws regulating construction, County and City codes, zoning regulations, and land
development regulations in the jurisdiction. I also certify that I understand that the regulations of other
I government agencies may apply to the intended work, and that it is my responsibility to identify what actions I
I must take to be in compliance.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, ~igns, wells, pools, air conditioning, gas, or other installations not specifically included in the application. 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 provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
requiring a ;correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid
unless the ~ork authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension
may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned.
WARNING1TO 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 COMMENCEMENT.
FLORIDA JUo/-T (F.S. 11~.O))
OWNER OR AGENT :t.... CONTRACTOR
Sub;iCribed and sworn 0 (0 affirmed) before me this Subscribed and sworn to (or affirmed) before me this
Q.. +An;;n",S, by ~ ,("\-,,<>-"; '4",\-.,v~ by
JNn.o is/are. personally known to me or has/have produced Who is/are personally known to me or has/have produced
~ ,r--.-, \)'''A' > L~ '~" as identification, as identification.
c;;X..^>- ~. . Notary Public
Commissi~~ ~,-?)V:::>f5""d-
. i ' r'. KYMBERi.Y'j.'~'''''''1
Name of prin 5
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Notary Public
Commission No.
Name of Notary typed, printed or stamped
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