HomeMy WebLinkAbout09-9052 CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813) 780 -0020 9052
ANNUAL ASSEMBLY PERMIT
Permit Number: 9052 Address: 38518 CR 54 EAST
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: 02- 26 -21- 0060 -00000 -0010
Improv. Cost: ' . .,.,.. ; 'Z,; 77 , tA Y...,tZ. ,a
Date Issued: 4/21/2009 Name: LIBERTY PROFESSIONAL INC
Total Fees: 50.00 Address: 12603 LAKE HILLS DR
Amount Paid: 50.00 RIVERVIEW, FL
Date Paid: 4/21/2009 Phone:
Work Desc: PLACES OF ASSEMBLY- THE LOCAL GYM
3
0,0 0 1
FIRE PERMIT FEES 50.00
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FIRE SITE INSPECTION -Final
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, N FPA101, Section 7.3.1.2
FIRE MARSHAL OFFICE: 813 - 780 -0041
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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
City of Zephyrhills rire• Fax -813 -780 -0021
s1 Tao -o02o p Application
Phone Contact for Permit 1 0 3
D ate Received ar :swum . i•: s...._.- ..w x................•.,T... T ,.,.,._........
/ N.. L OG e y ex Owners Phone Number
Owner's Name
Owner's Address
1 385/ C/1. S`i ZGtlf)S RL 335y 2
Titleholder Phone Number
Fee Simple Titleholder Name
Fee SimpleTitleholderAddress 1 t a "�M.t&_ . �' .. �`...w ...s`
.. -. W x,... a :w.....,.,..w�»�..a6:�..�:,�x nip �z3'"v'�'.,,!,y„5{'.�.",�.Ar� . �a a
Lot #
Job Address
Sub Division
Parcel
Fumigation Tent
1 1 BID- Hazard Waste Storage - ANNUAL J ANNUAL
Hazardous Material (Tier II or RQ Facility)
1 Comm Exhaust Kitchen Hood /Duct
Hood Installation
- Controlled Burn
LP /Natural Gas - Installation
Emergency Generator < 30 kw
I Emergency Generator > 30 kw LP/Natural Gas - ANNUAL Sale
Places of Assembly - ANNUAL
Fire Protection Maintenance - ANNUAL
•
lutnyl )bemrl JKnT] Utner
Sprinkler
0 0 Recreational Burn
Fire Alarm 1 i 0 0 0 1 Sparklers
Hood Cleaning 1 � � ED C J Sprinkler System installations
Ho
C 0 ❑ 0 1 Standpipes (Sprinkler Sys)
Hood Suppression
n Fire Alarm Installation 1' 1 Torch Roofing/Tar Kettle
1 1 1 Waste Tire Storage ANNUAL
Fire Pumps
1 Fire works Valuation of Project
I Flammable Application- ANNUAL IIIIIIIIIIIIIIIIII
I Fuel Tanks
1 Other: 1
Company
Contractor / Registered } Y / N I Fee Current ( Y / N
Signature
Address 1 -.
License # 1
•
Company
ELECTRICIAN nature
Registered Y / N 1 Fee Current Y / N
•
Signature
Address I 1 License # 1
1 Company
PLUMBER
Registered Y / N I Fee Current 1 Y/ N
Signature
Address 1 1 License # 1
1 Company l
MECHANICAL
ALI I L
Registered Y / N I Fee Current L Y/ N
Signature
Address I 1 License # 1
OTHER Company
Registered 1 Y / N 1 Fee Current I Y/ N
Signature
Address License #
Directions:
F81 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 55000)
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)
'NOTICE "DEED RESTRICTIONS: The undersigned understands that this permit maybe subjectto "deed":restrictions
which may be more restrictive than County regulations. 'The assumes responsibility .for:compiiance +with any
.applicable deed restrictions.
UNLICENSED 'CONTRACTORS AND-CONTRACTOR RESPONSIBILITIES: If the owner has - hired - 7a- contractor or -
contractors to undertake work, they may be required to be licensed in accordance with state and local 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 Sectionat 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 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 permitting .privileges in Pasco
County.
CONSTRUCTION. LIEN LAW (Chapter713, Florida Statutes,.as:amended): If valuation of work is $2;500.00 or more,
certify that I, the applicant, have .been provided with a copy of the "Florida Construction Lien Law— Homeowner's
Protection Guide" prepared by Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the "owner", I certify 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.
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 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
government agencies may apply to the intended work, and that it is my responsibility to identify what actions I
must take to be in compliance.
If I am the AGENT FORTHE 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, signs, 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 work 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.
'WARNING TO 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 JURAT (F.S. 117.03)
OWNER OR AGENT CONTRACTOR
Subscribed and sworn to (or affirmed) before me this Subscribed and swom to (or affirmed) before me this
by by
y Who is/are personally known to me or has/have produced
Who is/are personally known to me
identification. on. produced as identification.
as ipti
Notary Public
Notary Public
Commission No.
Commission No.
Name of Notary typ ed, P stamped or stam ed Name of Notary typed, printed or stamped