HomeMy WebLinkAbout09-9563 CITY OF ZEPHYRHILLS �✓
5335 - 8TH STREET
(813) 780 -0020 9563
ANNUAL ASSEMBLY PERMIT
Permit Number: 9563 Address: 5157 GALL BLVD
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 - 16600 -0100
Improv. Cost:,, A5 v €I ;, Wi t"ti . ;
Date Issued: 9/21/2009 Name: DEUEL C. FRED & ASSOC. INC
Total Fees: 50.00 Address: 5157 GALL BLVD
Amount Paid: 50.00 ZEPHYRHILLS, FL. 33542
Date Paid: 9/21/2009 Phone: (727)560 -2841
Work Desc: PLACES OF ASSEMBLY PERMIT FOR KA NKA ACADEMY OF KYOKUSHIN KAIKAN INC
•WN R 'MI 50.00
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OCCUPANCY LOAD:
Occupancy by more than the number of persons above shall be considered
dangerous and unlawful. Occupant Toad determined by Florida Fire
Prevention Code, NFPA101, Section 7.3.1.2
FIRE MARSHAL OFFICE: 813 - 780 -0041
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.7-41 . IC 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 City of Zephyrhills Fire Fax- 813 -780 -0021
Permit Application
Date Received I v'l / 09 I Phone Contact for Permit j I I
Owner's Name �C nth .;Q V 3 77 i7S L/
Owner's Address 57 .5 7 64/l /g /vrt/. 2ep4, - 4 //1 f/. 3.5 -1 //
Fee Simple Titleholder Name Titleholder Phone Number
Fee Simple Titleholder Address
Job Address S /S 7 64/1 ?/yc < 2' A r j,, / f/, 33r�// Lot#
Sub Division Parcel #
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n Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent
n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier 11 or RQ Facility) ANNUAL
7 Controlled Bum I ( Hood Installation
n Emergency Generator < 30 kw n LP /Natural Gas - Installation --
n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale ` j ' 3
n Fire Protection Maintenance - ANNUAL Places of Assembly - ANNUAL y (r �
lOtrry1 !Semi' Other �
Sprinkler n ❑ ❑ ❑ n Recreational Bum
Fire Alarm n ❑ ❑ ❑ I 1 1 Sparklers ,r 7C #' 1 ' ° Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations iil /
Hood Suppression CI ❑ ❑ ❑ I I I Standpipes (Sprinkler Sys)
n Fire Alarm Installation n Torch Roofing/Tar Kettle
n Fire Pumps I I Waste Tire Storage ANNUAL
n Fire Works
I I Flammable Application- ANNUAL
1 I Valuation of Project
I I Fuel Tanks
n Other: I I
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Contractor e' 'J�
_ /j Company � ,/ I
Signature �2-,�� ./.7.--. ,C' Registered Y / N I Fee Current I Y / N
Address I License # ( I
ELECTRICIAN Company I
Signature Registered Y/ N I Fee Current I Y/ N j
Address I I License # I
PLUMBER Company I
Signature Registered Y/ N . 1 Fee Current I Y/ N I
Address ( ( License #
MECHANICAL Company
Signature Registered Y/ N I Fee Current I Y/ N I
Address I I License # ( I
OTHER Company I
Signature Registered Y/ N J Fee Current I Y/ N j
Address J I License # I I
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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Y 3 u ` � Print Date: 8/26/2009
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I E', Assembly Inspection
E \ - 1 Zephyrhills Fire Rescue Activity Date: 8/26/2009 12:50:40PM
Fire Prevention Bureau ' ctivity Number: 1- 113 -09 -0196
flan 16; �\
6907 Dairy Rd
) Activity Cause: Periodic
Zephyrhills, FL 33542
Phone: 813 - 780 - 0041 Inspector Name: Kerry Barnett
Fax: 813 780 - 0044 Inspector Phone:
Party: Occupancy Type: Assembly
KEN KYOKOSHIN Property Use: Athletic Facility
(000353) Total Violation: 0
5157 GALL BLVD Corrected Violation: 0
ZEPHYRHILLS, FL 33542
Hours: 0.08
813 - 779 -9756 Total Fees: $ 0.00
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No New Violation
1 3 # r" , �5 = = �, f r .� y si"�u a A t . ,93r � : q, , # �` ;�
No Pre - existing Outstanding Violation
Comments:
ANNUAL ASSEMBLY PERMIT HAS EXPIRED. PLEASE RENEW THIS PERMIT AT THE BUILDING DEPARTMENT WITHIN 30
DAYS.
Re- Inspection to be performed on or before: September 28, 2009 12:00 am
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