HomeMy WebLinkAbout13-14115 - - CITY OF ZEPHYRHILLS
5335-8TH SIREET
(si3)�so-oo20 14115
ANNUAL ASSEMBLY PERMIT
Permit Number: 14115 Address: 5327 GALL BLVD
Permit Type: FIRE PLACE OF ASSEMBLY ZEPHYRHILLS, FL.
Ciass 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: 11-26-21-0010-13300-0010
Improv. Cost:
Date Issued: 4/23/2013 Name: ABBOTT STATION LLC
Total Fees: 50.00 Address: 5327 GALL BLVD
Amount Paid: 50.00 ZEPHYRHILLS, FL. 33542
Date Paid: 4/23/2013 Phone:
Work Desc: PLACES OF ASSEMBLY FOR ABBOTT STATION LLC
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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
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PERMIT OFFICE
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
slsaao-oo2o City of Zephyrhilis Fire Fax-813-780-0021
Permit Application
�ate iteceived� Phone Contact for Permit � U ��
Mmer's Name � L L Owners Phona Number � C� ��
Mmers Address � � f /(I �� S
ee Simple Titleholder Name Titleholder Phone Number C� � ��
ee Simple Titleholder Address
ob Address � �9 c. ! l � �/` � {� 3 �`(Z Lot# �
ub Division Parcel#
� Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
� Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL
� Controlled Bum � Hood Installation ��"�� ��--
� Emergency Generator<30 kw � LP/Natural Gas-Installation �_�,-�!/
� Emergency Generator>30 kw � LPlNatural Gas-ANNUAL Sale
Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL
❑�y em� � er
Sprinkler ❑ ❑ ❑ Recreational Bum
Fire Alartn � ❑ ❑ ❑ � � Spa�lclers
Hood Cleaning � ❑ ❑ � � � Sprinkler System Installations
Hood Suppression � � ❑ ❑ � � Standpipes(Spri�kier 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:
, i
:ontractor Company
�ignature � Registered Y/N Fee Current Y/N
Address License#
:LECTRICIAN Company
�ignature � Registered Y/N Fee Curtent Y/N
Address License#
'LUMBER Company
;ignature Registered Y/N Fee Current Y/N
Address License#
�ECHANICA Company
�ignature Registered Y/N Fee Current Y/N
Address License�
ITHER Company
;ignature Registered Y/N Fee Current Y/N
Address License#
�irections:
Fill out application completely
Owner 8�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 applicabla 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"��estrict�ons"
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 Depa�tment 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 1 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 sworn to(or affirmed)before me this
bY bY --
Who is/are personally known to me or haslhave produced Who islare personally known to me or haslhave produced
as identification. as identification.
Notary Public Notary Public
Commission No. Commission No --
Name of Notary ryped,printed or stamped Name of Notary typed,printed or stamped