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OWNER’S NAME: Phone FORM PS01 Code in effect 8th Edition Florida Building Code APPLICATION FOR POLLUTANT STORAGE SYSTEM Address: PROJECT ADDRESS: Parcel ID Proposed use of site: Commercial Projects, please list name of business: CONTRACTOR’S NAME: Address: Contact Phone Cell E-mail: State License Competency Card: INTENDED OCCUPANCY: Public Lodging Establishment* Single Family Residence Commercial TANK INFORMATION: LP Diesel Valuation of Work: $ New Addition Alter/Repair Other: *Pursuant to Fla. Stat. §509.013, public lodging establishment means any unit, group of units, dwelling, building, or group of buildings within a single complex of buildings which is rented to guests more than three times in a calendar year for periods of less than 30 days or 1 calendar month, whichever is less, or which is advertised or held out to the public as a place regularly rented to guests. Included in this definition are vacation rentals. Page 1 of 2 Revised 05/24 Master Permit Date: Other (describe) Manufacturer Capacity gallons Gasoline Above Ground Underground PROVIDE SITE PLAN WITH SET BACKS TO PROPERTY LINES, ROADS, DRIVEWAYS, BUILDINGS BAY COUNTY FIRE & LIFE SAFETY INSPECTION BUREAU 2913 Thomas Drive, Panama City Beach, FL 32408 Telephone (850)248-5130 FAX: (850) 236-3232 Existing Tank Removal ---PAGE BREAK--- A change of occupancy or use of a building may require the owner to make application to the Building Department FORM PS01 and obtain the required permit for the new occupancy. The enforcing agency shall require each building permit for the demolition or renovation of an existing structure to contain an asbestos notification statement which indicates the owner's or operator's responsibility to comply with the provisions of Section 469.003, Florida Statutes, and to notify the Department of Environmental Protection of his or her intentions to remove asbestos, when applicable, in accordance with state and federal law. IMPORTANT: The building permit is valid as long as there is construction progress and an approved inspection is For improvements to real property with a construction cost of $2,500 or more, a certified copy of the Notice of Commencement is required to be submitted to Builders’ Services when application is made for a permit or the applicant may submit a copy of the Notice of Commencement along with an Affidavit attesting to its recording. A certified copy of the Notice of Commencement must be provided to Builders’ Services and posted on the jobsite before t he first inspection can be performed. recorded within each 180 days (6 months) period. Owner/Agent/Contractor Affidavit I certify that all statements, drawings, and other information submitted on and with this application are true and correct and that all work will be done in compliance with all applicable laws. I further certify that I have reviewed the applicable regulations associated with the proposed construction and intended use. I understand that the submittal of incorrect information or any changes which vary from the approved plans will result in the revocation of this permit. (Signature of Owner) Date (Signature of Contractor) Date (Signature of Notary Public – Stamp or Seal) Date (Signature of Notary Public – Stamp or Seal)Date NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other government entities such as water management districts, state agencies, or federal agencies. Page 2 SIGN SIGN SIGN SIGN ---PAGE BREAK--- Form PS02 Revised 05/24 REQUIREMENTS FOR POLLUTANT STORAGE SYSTEM PERMIT Removal Installation Underground Aboveground 1 2 3 4 Design Professional with tank dimensions, capacity, manufacturer) Complete Permit Application (PS01) Development Order from Planning Department Flood review from floodplain administrator Two Sets of Plans (For Tank Installation must be Signed & Sealed by 5 6 7 Site plan showing set backs, roads, buildings, driveways Legal description Permit request must be reviewed by Bay County Fire Inspector 8 Is Structure 30 feet from any body of water? Yes No 9 Trees, Wetlands, and Land Clearing Form (completed) (Form B04) 10 Contact ECHD/Bay County Branch Petroleum Program at [PHONE REDACTED] 11 Removal/Install Job Foundation Job Cost Applicant Signature Date Phone Number Cell Number BAY COUNTY FIRE & LIFE SAFETY INSPECTION BUREAU 2913 Thomas Drive, Panama City Beach, FL 32408 Telephone (850)248-5130 FAX: (850) 236-3232 escambia.floridahealth.gov SIGN ---PAGE BREAK--- FORM PS03 APPLICATION FOR DEMOLITION PERMIT Code in effect 8th Edition Florida Building Code OWNER’S NAME: Phone Address: PROJECT ADDRESS: Parcel ID Commercial Projects, please list name of business: CONTRACTOR’S NAME: Address: Contact Phone Cell E-mail: State License Competency Card: BUILDING INFORMATION: Residential Commercial Valuation of Work: $ Number of Stories Number of Units Square Ft. – U.R.: The enforcing agency shall require each building permit for the demolition or renovation of an existing structure to contain an asbestos notification statement which indicates the owner's or operator's responsibility to comply with the provisions of Section 469.003, Florida Statutes, and to notify the Department of Environmental Protection of his or her intentions to remove asbestos, when applicable, in accordance with state and federal law. If you are renovating or demolishing a commercial, industrial or government owned building or residential structures with more than four units, the Federal EPA regulations concerning asbestos apply to your project. These are the asbestos rules in the National Emission Standards for Hazardous Air Pollutants (NESHAP), 40 CFR 61, Subpart M. Your obligations to comply with these regulations are not satisfied by meeting the requirements of the local building official to obtain a building or demolition permit. (Signature of Owner or Contractor) Date (Signature of Notary Public – Stamp or Seal) Date NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other government entities such as water management districts, state agencies, or federal agencies. Page 1 of 1 Revised 05/24 Master Permit Date: BAY COUNTY FIRE & LIFE SAFETY INSPECTION BUREAU 2913 Thomas Drive, Panama City Beach, FL 32408 Telephone (850)248-5130 FAX: (850) 236-3232