Dbpr Form Hr 5021 103 PDF Details

When public food service establishments in Florida aim to expand their seating capacity, the DBPR HR 5021 103 form becomes a crucial document. This form, provided by the State of Florida Department of Business and Professional Regulation Division of Hotels and Restaurants, serves as a comprehensive evaluation tool to ensure that such establishments receive the necessary assessment for adequate sewage and fire services before any expansion plans are executed. It requires detailed information about the establishment, including its current and proposed number of seats, and encompasses evaluations by the Department of Health (DOH), Department of Environmental Protection (DEP), or Utility Authority on the establishment's wastewater system. Furthermore, it includes a fire safety evaluation by the local authority having jurisdiction, ensuring all aspects of public safety are taken into consideration. By submitting this completed form to the local Division of Hotels and Restaurants district office, food service establishments take the first step towards attaining approval for their seating expansion, while simultaneously adhering to state regulations and safety protocols. This document underscores the importance of a systematic approach to capacity expansion, highlighting the necessity for establishments to engage with multiple regulatory bodies to secure the wellbeing of their patrons and the broader community.

QuestionAnswer
Form NameDbpr Form Hr 5021 103
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names5021_103 seating change evaluation form

Form Preview Example

State of Florida

Department of Business and Professional Regulation

Division of Hotels and Restaurants

SEATING CHANGE EVALUATION

Completion of this form ensures that public food service establishments are evaluated for adequate sewage and fire services before expanding seating operations. Submit the completed form to the local Division of Hotels and Restaurants district office.

SECTION 1 – ESTABLISHMENT INFORMATION

Establishment Name:

License Number: Current No. Seats: Proposed No. Seats:

Address of Establishment:

Contact Person Name / Phone No.:

City:

County:

Zip:

Contact Person E-Mail Address:

SECTION 2 – WASTEWATER SYSTEM

(To Be Completed By DOH, DEP or Utility Authority)

The above named food service establishment uses the following wastewater disposal system (choose one type):

Municipal / Utility

Name of Provider:

 

 

Grease Trap Required

Location

 

 

 

 

 

Yes

No

In-ground

Undersink

 

 

 

 

Package Plant

Name of Provider:

 

 

Grease Trap Required

Location

 

 

 

 

 

Yes

No

In-ground

Undersink

 

 

 

 

Septic Tank

Permit #:

 

Tank Size:

Drainfield Size:

 

Grease Trap Size:

System

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SYSTEM EVALUATION RESULT:

 

 

 

 

 

 

Permit Issued

Final Approval

Denied (see comments)

 

 

 

 

 

 

 

 

 

 

LIMITATIONS ON SYSTEM

 

Comments:

 

 

 

 

 

Single-Service Only

Other Conditions

 

 

 

 

 

 

 

Maximum Number of Hours of Operation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Maximum Number of Seats Permitted

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Menu Restricted (see comments)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name & Title

Agency

Signature

Date

Address

Phone

SECTION 3 – FIRE SAFETY

(To Be Completed By Local Authority Having Jurisdiction)

The above named food service establishment proposes to increase the seating capacity

Number of Exits

Public:

Employee:

Total:

FIRE SAFETY EVALUATION RESULT:

Approved

Denied (see comments)

Comments:

Name & Title

Agency

Signature

Date

Address

Phone

H&R Change Record Form Attached

DBPR Form HR 5021-103

www.MyFloridaLicense.com/dbpr/hr 61C-1.002, FAC

2008 October 22

How to Edit Dbpr Form Hr 5021 103 Online for Free

Quite a few things are quicker than creating files with the help of our PDF editor. There isn't much you have to do to enhance the Dbpr Form Hr 5021 103 document - just follow these steps in the next order:

Step 1: Choose the button "Get Form Here".

Step 2: You can now edit the Dbpr Form Hr 5021 103. The multifunctional toolbar will let you include, delete, adapt, and highlight content or perhaps undertake other sorts of commands.

In order to fill in the form, enter the data the application will require you to for each of the next sections:

Dbpr Form Hr 5021 103 gaps to consider

Enter the appropriate data in the space Menu Restricted see comments, Name Title, Signature, Address, Agency, Date, Phone, SECTION FIRE SAFETY To Be, The above named food service, Employee, Public, Total, Approved, Denied see comments, and Name Title.

Dbpr Form Hr 5021 103 Menu Restricted see comments, Name  Title, Signature, Address, Agency, Date, Phone, SECTION   FIRE SAFETY To Be, The above named food service, Employee, Public, Total, Approved, Denied see comments, and Name  Title blanks to insert

Step 3: After you hit the Done button, the finished document is conveniently exportable to each of your gadgets. Alternatively, you may send it by means of email.

Step 4: It may be better to have duplicates of your file. There is no doubt that we are not going to disclose or read your particulars.

Watch Dbpr Form Hr 5021 103 Video Instruction

Please rate Dbpr Form Hr 5021 103

5Excellent1 Votes
If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .