HomeMy WebLinkAbout10-10176 r
CITY OF ZEPHYRHILLS
5335 - 8T1-1 STREET
(813) 780 -0020 10176
ANNUAL ASSEMBLY PERMIT
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Permit Number: 10176 Address: 38231 5TH AVE
Permit Type: FIRE PLACE OF ASSEMBLY ZEPHYRHILLS, FL.
Class of Work: FIRE - PLACES OF ASSEMBLY Township: Range: Book:
Proposed Use: CHURCH Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11- 26 -21- 0010 - 15600 -0060
Improv. Cost: 77- i , e
Date Issued: 3/02/2010'`
g Name: FIRST BAPTIST CHURCH
Total Fees: 50.00 Address: 38231 5TH AVE
Amount Paid: �- - ZEPHYRHILLS, FL. 33542
Date Paid: 3/02/2010 ► Phone:
Work Desc: PLACES OF ASSEMBLY F'R 1ST BAPTIST CHURCH
I E - RNA E 50.00
(DC5
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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
• I: 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
s Permit Application Fax- 813 - 780 -0021
Date Received 1 °g�� w
Received •�• = I Phone Contact for Permit
Owner's Name V 1`= / R igg -ST
,/l /PGH I Own er's Ph
t�f'� � one Number
Owner's Address �S'g.3/ 3 ' 4y-1 J
Fee Simple Titleholder Name I I
Titleholder Phone Number
Fee Simple Titleholder Address 1
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Job •, =t., .., ,.� .. N . �. ,� ��.a ,
Address
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Lot #
Sub Division
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Parcel #
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Blo- Hazard Waste Storage - ANNUAL r�1
I I Fumigation Tent
Comm Exhaust Kitchen Hood /Duct I 1 Hazardous Material (Tier II or RQ Facility) ANNUAL
n Controlled Bum I Hood Installation
Emergency Generator < 30 kw I I LP /Natural Gas - Installation
I 1 Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale
I - I Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL
Jutrlyf 1Semi1 JfT1 rther I
Sprinkler 71 ❑ ❑ ❑ 1 Recreational Bum
Fire Alarm n ❑ ❑ ❑ I I I
Sparklers
Hood Cleaning 71 ❑ ❑ ❑ I I I 1 Sprinkler System Installations
Hood Suppression I ❑ ❑ ❑ I I I Standpipes (Sprinkler Sys)
Fire Alarm Installation I I Torch Roofing/Tar Kettle
Fire Pumps
I I Waste Tire Storage ANNUAL
Fire Works
Flammable Application- ANNUAL f I
Fuel Tanks
! Valuation of Project
7 Other: I
Contractor .. . _lm $_:
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Company
Signature / .. L P Y 1/
Registered Y / N ] Fee Current I Y / N
Address I
License #
ELECTRICIAN
Signature Company
Registered Y / N j Fee Current I Y / N j
Address)
License #
PLUMBER
Signature ( Company
Registered Y / N j Fee Current I Y / N I
Address I
License #
MECHANICAL
Signature Company
Registered Y / N j Fee Current 1 Y / N j
Address ( I
License #
OTHER
Signature I Company
Registered Y / N J Fee Current I Y / N
Addressj
License #
Directions:
Fill out
�..:;w..._ T..0 ..
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 hit //a
( P� ppraiser.pascogov.com)
NOTICE OF 'DEED RESTRICTIONS: The undersigned understands that this permit may be subjectto "deed "restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for 'compliance with 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 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 7.27 -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 (Chapter713, 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 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 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
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 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, 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 swom to (or affirmed) before me this Subscribed and swom to (or affirmed) before me this
b by
Who is /are personally known to me or has /have produced Who is /are personally known to me or has /have produced
as identification. as identification.
Notary Public Notary Public
Commission No. Commission No.
Name of Notary typed, printed or stamped Name of Notary typed, printed or stamped