HomeMy WebLinkAbout13-14750 CITY OF ZEPHYRHILLS
5335-8TH STREET
(si3)�so-oo20 14750
ANNUAL ASSEMBLY PERMIT
Permit Number: 14750 Address: 5718 6TH 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: 11-26-21-0010-02700-0170
Improv. Cost:
Date Issued: 11/21/2013 Name: GRINDLE, FREDERICK
Total Fees: 50.00 Address: 5718 6TH ST
Amount Paid: 50.00 ZEPHYRHILLS, FL. 33542
Date Paid: 11/21/2013 Phone: (813)788-7057
Work Desc: FPM-ASSEMBLY PERMIT FOR EARTHWAY WELLNESS
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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
813-780-0020 City of Zephyrhilis Fire Fax-813-780-0021
Permit Application
ate RECeived Phone Contact for Pertnit � C� �
wners Name Owners Phone Number C� �� �
wner's Address J��
�e Simple Titleholder Name TiUeholder Phone Number � �� �
se Simple Titleholder Address
>b Address �7/ �' � �J - �
Lot#
�b Division Parcel#
� BiaHazard Waste Storage-ANNUAL � Fumigation Tent
� Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL
� Controlled Bum � Hood InstallaUon
� Emergency Generator<30 kw � LP/Natural Gas-Installation � i� % +� I�
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Emergency Generator>30 kw �LP/Natural Gas-ANNUAL Sale _
� Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL T � ^ ����
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Sprinkler � ❑ ❑ ❑ � � Recreational Bum h/ '`
Fire Alartn � ❑ ❑ ❑ Sparfclers �- / I
� �
Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Install ' s
Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
� Fire Alartn Installation � Toroh Roofing/Tar Kettle
� Fire Pumps � Waste Tire Storage ANNUAL
� Fire Works
� Flammable Application-ANNUAL Valuation of Project
Fuel Tanks
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mtractor � �' Company �
gnature �/ Registered Y/N Fee Curren Y/N
Address License#
_ECTRICIAN Company
gnature � Registared Y/N Fee Current Y/N
Address License#
.UMBER Company
gnature Registered Y/N Fee Current Y/N
Address License#
=CHANICA Company
�nature Registered Y/N Fee Current Y/N
Address License#
fHER Company
�nature Registered Y/N Fee Current Y/N
Address License#
rections:
Fill out applicaGon completely.
Owner&Contrector sign back of application,notarized(Or,copy of signed contrect with owner)
If over$2500,a Notice of Commencement is required(Mechanical work over E5000)
Supply two(2)sets of drawings with appiicable dxumentation
Ailow 10-14 days for review after submittal date. Paricel#-obtained from Property Tax Notice(http:l/appraiser.pascogov.com)
NOTICE OF DEED RESTRICTIONS The undersigned understands that this permit may be 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 ZChapter 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'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 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 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