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2. $50 fee will be due upon approval
4. NFPA and City of Oldsmar LDC 14.4 Applies
   Municode
6. Property Owner's Name*
7. Property Owner's Address*
9. Email Address:
10. Phone
12. Business Name*

    If none type N/A

13. Contractor's Name
14. Business Address
16. Email Address:
17. Phone
19. Contractor's State Registration No.
20. PCCLB No.
21. Total Job Valuation
23. Job Address*
24. Legal Description (Parcel ID)
25. Tent size*
27. Event Dates and Times*
    Event Dates and Times Start Date

    Event Dates and Times Start Time

    —

    Event Dates and Times End Date

    Event Dates and Times End Time
29. Bonding Company
30. Address
31. Architect/Engineer's Name
32. Address
34. Applicants’ certification for installation of a tent
    Assembly Occupancy Use for Large Tents

    1. I certify that the tent is made of flame resistant fabric in accordance with NFPA 701 and a Certificate of Flame Resistance is provided and the Certificate matches the label permanently affixed on the tent in accordance with NFPA 1-25.2.3.1, 101-11.11.2.1 and 101-11.11.2.2.

    2. I certify the tent stakes provide a minimum of 10’ distance o.c. in accordance with NFPA 1-25.2.5.3; 25.1.6.4 and 101-11.11.3.1, and that the guy wires will be clear of means of egress at a height of less than 7 Feet.

    3. I certify a layout of the use of the tent has been provided with this application in accordance with NFPA 1-3.2.2.

    4. I certify a minimum of one (1) approved 2A:10BC fire extinguisher will be provided. Portable fire extinguishers will be provided as applicable with the hazard in accordance with NFPA 1-25.2.5, 1-3.2.2, and 101-11.11.5. (Size of tent may require additional fire extinguishers).

    5. I certify NO generators or flammable products (gasoline, oil, etc.) shall be stored/kept under the tent. Any portable generator shall be a minimum of 5’ from the tent and protected in accordance with NFPA 1-25.1.12.1 and 101-11.11.4.1.

    6. I certify all electric shall comply with NFPA 70.

    7. I certify the ground enclosed by the tent and an additional 10’ around the perimeter will be cleared of all combustible and flammable materials or vegetation prior to erection of the tent in accordance with NFPA 1-25.1.5.2 and 101-11.11.4.1.

    8. I certify NO SMOKING signs will be provided and visible from all areas of the tent in accordance with NFPA 1-25.2.4.2 and 101-11.11.4.2.

    9. I certify EXIT signs will be provided and visible from all areas of the tent and a 44” clear path to each exit, so as to permit unobstructed egress from any location within the tent (based on the size of the tent) at the fire departments direction in accordance with NFPA 1-3.2.2. If the tent is open to the public after sunset, EXIT signs will be illuminated and the tent will have emergency lighting.

36. Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction.
    I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING WORK, SIGNS, HEATERS, AIR CONDITIONERS, ETC.
38. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning.
    OWNER'S ELECTRONIC SUBMISSION OF STATEMENT: Under penalty of perjury, I declare that all of the information contained in this building permit application is true and correct.
40. Building Permit Applications shall be submitted on paper and PDF format/ CD, for review and contain all the items listed. For tents, copies of a plot plan and base diagram plus tie down diagram with manufacturers name and model number must accompany application. In addition, plumbing, electrical, mechanical and environmental plans shall be submitted to secure these permits, when applicable. The tent permit fee is based on a $40.00 fee, plus additional fees for electrical, plumbing and mechanical if applicable.
    Application is valid for 180 days.Permit is extended for 6 months after each successful inspection. Permit expires after 1 year. Permit fee is non-refundable.
42. Contractors must maintain, State License, PCCLB License, General Liability and Workman's Compensation Insurance.
44. Signature:*

    By typing your name here, you are signing this form electronically. You agree you are submitting this application for processing and is the legal equivalent of your manual signature on this form. You must be the legal property owner, qualifier or authorized agent which match our registration records. Note: A notarized Letter of Authorization is required for an agent to sign the application or any other correspondence that calls for an agent signature.

46. Check One *

    1. Owner
    2. Authroized Agent
    3. Contractor
47. Certificate of flame retardant *
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field