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Home My WebLink About10-10240 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813) 780 -0020 10240 ANNUAL ASSEMBLY PERMIT Permit Number: 10240 Address: 5626 20TH ST Permit Type: FIRE PLACE OF ASSEMBLY ZEPHYRHILLS, FL. Class of Work: FIRE - PLACES OF ASSEMBLY Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 12- 26 -21- 0020 - 00400 -0110 Improv. Cost: - Date Issued: 3/12/2010 Name: OUR SAVIOUR LUTHERN CHURCH Total Fees: 50.00 J-� Address: 5626 20TH ST Amount Paid: 50.00 7j ZEPHYRHILLS, FL. 33542 Date Paid: 3/12/2010 Phone: (813)782 -1369 Work Desc: PLACE OF ASSEMBLY OUR SAVIOUR LUTHERN CHURCH -FEE WAIVED PER FM • _ - - - 50.f0 40 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 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"60 -0020" City of. Zephyrhills s Fax -813 -780 -0021 Permit Application Date Received Phone Contact for Permit ,, Dwner's Name S ! Owner's Phone Number Pt Owner's Address -- _ap Fee Simple Titleholder Name Titleholder Phone Number Fee Simple Titleholder Address I pe Job Address Lot # Sub Division Parcel # ..w:i;`., ra�� ,:. �'w< ._a..;:. , �#€ z.4. va' �, ..,...,: �;a,±£.tie:&r..�.>::'iw"�"'r� ". ". •-�- _ �"«"" -.,�"" ..'.r....,., a:^�,x.�.,u.a,m»;,��3w_,� ._..... �::�� .,,. �v..,ak sue. .- „�.. ,-, .,w.,r� 4,.,.;�,�s,a��.rv,.,. Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier II or RQ Facility) ANNUAL Controlled Bum I I Hood Installation I Emergency Generator < 30 kw n LP /Natural Gas - Installation n Emergency Generator > 30 kw LP /Natural Gas - ANNUAL Sale I I Fire Protection Maintenance - ANNUAL tal Places of Assembly- ANNUAL 1Lttrly1 1Semr1 � Other -w Sprinkler n ❑ ❑ ❑ rze a roc nr aTl um Fire Alarm n ❑ ❑ ❑ I I I I Sparklers Hood Cleaning ❑ ❑ E l l I Sprinkler System Installations Hood Suppression I ❑ ❑ ❑ I I I Standpipes (Sprinkler Sys) Fire Alarm Installation n Torch Roofing/Tar Kettle I I Fire Pumps I I Waste Tire Storage ANNUAL Fire Works Flammable Application- ANNUAL ( Valuation of Project I I Fuel Tanks n Other: I L ..,...x_.�a.... .,.. s�:x.. . �s$ F.�•'��..cF..�.s? +:.. <.�- .f�.. "�;..:_M'*.�sa :. - tip ,;� , .. �t ��r �:, 3� r.Z °,..,C.� �,;,..?a F.»'E � _LtMM- .w1..�.. Contractor Company Signature _ _ - - / Lam* 4 .11/1111 Registered Y / N I Fee Current I Y / N j Address 1 I License # I ELECTRICIAN Company Signature Registered Y/ N I Fee Current I Y N j Address I I License # PLUMBER Company Signature Registered ` Y/ N I Fee Current I Y/ N1 I Address I I License # MECHANICAL Company Signature Registered Y / N Fee Current Y / N - Address I License # OTHER Company Signature Registered Y/ N J Fee Current I Y/ N I Address License # 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) NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may subject.to "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 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 (Chapter7l3, 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 by 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