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Home My WebLink About12-13622 CITY OF ZEPHYRHILLS 5335-8TH STREET �sis>�so-oozo 13622 ANNUAL ASSEMBLY PERMIT K:V, sk* t�yi Permit Number: 13622 Address: 6440 12TH 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: 02-26-21-0060-O0000-1001 Improv. Cost: .�,,�,„. _ �:, Date Issued: 11/19/2012 Name: LIBERTY PROFESSIONALS LLC Total Fees: 50.00 Address: 6440 12TH ST Amount Paid: 50.00 ZEPHYRHILLS, FL. 33542 Date Paid: 11/19/2012 Phone: (813)782-9520 Work Desc: FPM-PLACE OF ASSEMBLY/LOVE MISSION MINISTRIES-FEE WAIVED �: . �;�� ,�,�,.,� 7 n 5��9 e� ,� �� ''�� / � . ;O " � . �(v y �� .,��7�i� �..��.�-� � �� 1 , , � a� � , . �;� y � �K� , ,�.' 'A 'I"Y�I w -y,"', -,9 y, 'ir�� .8;, ,�,'r i• :.1� �?..a w ,�°�t v� � f" �'��y. ina � , 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. .1.2 • � PERMIT OFFICER 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 Appfication �ate Received —� Phone Contact for Permit � �� wmer's Name ;/ — Owners Phone Number �� j �� Mmer's Address �,�''� ��.5 � �� ee Simple Titleholder Name Titl Ider Phone Number � C� � ee Simple Titleholder Address ��J ob Address � � l • � � Lot# ub Division Parcel# � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent � Comm Exhaust Kitchen Hood/Duct a Hazardous Material(Tier II or RQ Facility)ANNUAL � Controlled Bum � Hood Installation � Emergency Generator<30 kw � LP/Natural Gas-Installation � Emergency Generator>30 kw LP/Natural Gas-ANNUAL Sale � Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL ❑ 3Fr y emi � er Sprinkler ❑ ❑ ❑ Recreational Bum Fire Alartn � ❑ ❑ ❑ �� Sparklers Hood Cleaning � ❑ ❑ ❑ �� Sprinkler System Installations Hood Suppression � ❑ ❑ ❑ � a Standpipes(Sprinkler Sys) � Fire Alarm installation � Torch Roofing/Tar Kettle � Fire Pumps � Waste Tire Storage ANNUAL aFire Works � Flammable Application-ANNUAL � Valuation of Project Fuel Tanks Q Other: :ontractor , �` � � �c J�; Company -� � � ,ignature ��.� _` Registered Y/N Fee Current Y/N Address License# :LECTRICIAN ,ignature Company Registered Y/N Fee Current Y/N Address License# 'LUMBER ,ignature Company Registered Y/N Fee Current Y/N Address License# �ECHANICAL �ignature Company Registered Y/N Fee Current Y/N Address License# 1THER �ignature Company Registered Y/N Fee Current Y/N Address License# iirections: 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 be subject to"deed" restricticns" 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(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 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'SIOWNER'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 �aws 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��CENDER'O ANVATTORNEYO EFORE RECORDING YOUR NOT CE O COMMENCEMENT.' CONSULT WITH Y�UR L 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 Who is/are personally known to me or has/have produced Who islare personally known to me or has/have produced as identification as identification. Notary Public Notary Public Commission No. Commission No ed, rinted or stamped Name of Notary typed,Printed or stamped Name of Notary ryp P �k�°V1��,� �'� � �1�� " ��l � , ' , -r-� �� -� c. y � � � � �1,� r � Jac ueline Bo es �'' `�"" To: Keith Williams ,�� Subject: RE:waiver of Assembly fee 6440 12th Street �� Email acknowledged Chief From: Keith Williams Sent: Thursday, August 30, 2012 6:26 PM To: Jacqueline Boges; Bobbie Swetland Subject: waiver of Assembly fee 6440 12th Street Evening all, I am in receipt of a request to waive the$50.00 Places of Assembly fee for Love House Mission Ministries,644012tn Street.They have documented they are a non-profit entity. Please waive the fee when they apply for their Assembly permit.Thanks, Keith �F Keith A.Williams � j Fire Chief, EFO, CFO, CEMSO, MlFireE L i ,� Zephyrhills Fire Rescue /�� I � �� 6907 Dairy Road ( � Zephy�hills, Florida 33542 \, �, 813-780-0041 813-780-0044 fax Email: kwilliamsCa�fire.zephvrhills.fl.us 1