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The Dbpr Hr 5021 103 form plays an important role in the regulation of food service establishments in Florida. When a restaurant or similar establishment considers expanding its seating capacity, it must first ensure that its facilities are equipped to handle the increased demand for sewage and fire safety services. This is where the form comes into play. By completing it, the establishment initiates an evaluation process that is critical for public safety and compliance. The form requires various details like the establishment's name, license number, current and proposed seating numbers, and contact information. It also includes sections for both wastewater system evaluation and fire safety assessment, which are necessary for local authorities to determine if the establishment meets the required safety standards. Ultimately, submitting the form helps protect not only the establishment’s interests but also the well-being of its patrons and employees.

Dbpr Hr 5021 103 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

File Breakdown

Fact Name Description
Purpose The DBPR HR 5021 103 form is used to evaluate public food service establishments for adequate sewage and fire services before they can expand their seating capacity.
Submission Completed forms must be submitted to the local Division of Hotels and Restaurants district office in Florida.
Section 1 Details This section gathers establishment-specific information, including name, license number, current and proposed seating, and contact information.
Wastewater System Evaluation A qualified authority like the Department of Health, Department of Environmental Protection, or Utility Authority must evaluate the wastewater disposal systems used by the establishment.
Fire Safety Requirement The form includes a requirement for fire safety evaluation, which checks the number of exits and ensures compliance with fire safety standards.
Results of Evaluation After evaluation, the form indicates whether the permit is issued, final approval is granted, or the request is denied, often with accompanying comments.
Comments Section Both wastewater and fire safety evaluations include a section for officials to provide comments or additional conditions related to the approval.
Florida Regulatory References The form reference includes Florida Administrative Code, specifically cited as 61C-1.002.
Form Accessibility The DBPR HR 5021 103 form can be accessed online at the Florida Department of Business and Professional Regulation website.

Guide to Using Dbpr Hr 5021 103

Upon comprehending the significance of the Dbpr Hr 5021 103 form, it is essential to proceed with filling it out accurately to ensure that your establishment meets local regulations regarding sewage and fire services when increasing seating capacity. Following these steps will guide you through the completion of the form and facilitate its submission to the appropriate authority.

  1. Section 1 – Establishment Information:
    • Write the Establishment Name at the top of this section.
    • Enter your License Number associated with your food service establishment.
    • Indicate the Current Number of Seats you have.
    • Provide the Proposed Number of Seats you wish to add.
    • Fill in the Address of Establishment. Include the street address, city, county, and zip code.
    • List the Contact Person’s Name along with their Phone Number.
    • Finally, enter the Contact Person’s E-Mail Address.
  2. Section 2 – Wastewater System:
    • Select the type of wastewater disposal system your establishment uses. Choose from Municipal/Utility, Grease Trap, or Septic Tank.
    • If a municipal system is used, provide the Name of Provider.
    • Indicate if a Grease Trap is Required, and specify its location.
    • If using a septic tank, enter the Permit Number, Tank Size, and Drainfield Size.
    • Also, include the Grease Trap Size if applicable.
    • Review and complete the System Evaluation Result section. Mark whether it is Permit Issued, Final Approval, or Denied, and provide comments if necessary.
    • Sign and date this section and include the Name & Title of the reviewing agency.
  3. Section 3 – Fire Safety:
    • Indicate the Number of Exits, separating public and employee exits.
    • Complete the Fire Safety Evaluation Result by marking whether it is Approved or Denied, with additional comments if needed.
    • Provide the Name & Title of the reviewing authority, followed by the agency's Signature, Date, Address, and Phone Number.

After finishing these steps, review the form for accuracy. Ensure that all necessary signatures are in place before submitting it to your local Division of Hotels and Restaurants district office. Completing the process with due diligence will help ensure compliance with state regulations, facilitating your establishment’s expansion smoothly.

Get Answers on Dbpr Hr 5021 103

What is the DBPR HR 5021 103 form used for?

The DBPR HR 5021 103 form is utilized to evaluate public food service establishments in Florida for adequate sewage and fire services. This assessment is necessary when a business intends to expand its seating capacity. The completed form must be submitted to the local Division of Hotels and Restaurants district office for review.

Who is responsible for completing the different sections of the form?

The form consists of multiple sections that require input from different authorities. Section 1, which pertains to the establishment’s information, should be completed by the food service establishment itself. Sections 2 and 3 are designated for completion by the Department of Health (DOH), Department of Environmental Protection (DEP), or the local Utility Authority, and the local authority having jurisdiction for fire safety, respectively.

What information is required in Section 1 of the form?

Section 1 gathers essential details about the establishment. Specifically, it requires the following information:

  • Establishment Name
  • License Number
  • Current Number of Seats
  • Proposed Number of Seats
  • Address of Establishment
  • Contact Person Name and Phone Number
  • City
  • County
  • Zip Code
  • Contact Person E-Mail Address

What happens if the seating expansion is denied?

If the proposed seating expansion is denied, comments explaining the denial will be provided on the evaluation result section of the form. This feedback will inform the establishment of the reasons for the decision, which may include limitations related to sewage capacity or fire safety concerns.

How is fire safety evaluated on the DBPR HR 5021 103 form?

Fire safety evaluation is conducted by the local authority having jurisdiction. Information gathered includes the proposed increase in seating capacity and the number of exits for both public and employee access. The authority will indicate whether the expansion is approved or denied, along with any relevant comments.

What types of wastewater systems might be evaluated?

The evaluation will focus on several types of wastewater disposal systems, such as:

  1. Municipal systems, where the name of the provider must be included.
  2. Grease traps, requiring information on their location and specifications (e.g., in-ground, undersink).
  3. Septic systems, which entail providing permit numbers and sizes for the septic tank and drainfield.

Where should the completed DBPR HR 5021 103 form be submitted?

The completed form must be submitted to the local district office of the Florida Division of Hotels and Restaurants. It is essential to ensure that the submission reaches the appropriate office to prevent delays in the evaluation process.

Common mistakes

Filling out the DBPR HR 5021 103 form can feel daunting, but many common mistakes can lead to delays or denials. One frequent error occurs in Section 1, where individuals sometimes provide incomplete or inaccurate establishment information. It is essential to include the establishment name, license number, and accurate contact details. Without this fundamental information, the processing authority may struggle to identify or reach your establishment, ultimately leading to a stalled evaluation.

In Section 2, concerning the wastewater system, selecting the correct type of system is crucial. Many people inadvertently choose the wrong disposal method, which can result in an improper evaluation. For instance, if your establishment uses a septic tank, selecting “municipal” instead will mislead the review process, causing unnecessary complications. Each checkmark must reflect reality to ensure accuracy.

Furthermore, some applicants overlook providing the necessary permit numbers or tank sizes. Incomplete information about grease traps or septic systems can hinder the evaluation process. Take the time to double-check these details before submission. Documentation, such as the septic tank permit number, is vital for a smooth approval process. This information supports your case and demonstrates compliance with crucial health and safety regulations.

Another common mistake involves misunderstandings around the fire safety evaluation section. Applicants sometimes fail to provide correct counts for the number of exits or misrepresent the proposed change in seating capacity. Incorrectly assessing these figures not only affects safety compliance but can also lead to significant scrutiny from local authorities. Ensure that all numbers are accurate and properly represent your establishment's layout.

Finally, neglecting to attach the necessary forms and documentation can lead to significant delays. Applicants may forget to include the H&R Change Record Form, which the authorities might require for processing. Ensure every document is included to facilitate a quick evaluation. By avoiding these common pitfalls, food service establishments can streamline their form filling experience and move closer to achieving their seating expansion goals.

Documents used along the form

The completion and submission of the DBPR HR 5021 103 form are often accompanied by various other documents and forms. Each plays a specific role in ensuring compliance with local regulations and safety standards for food service establishments in Florida. Below is a list of forms typically used alongside the DBPR HR 5021 103 form.

  • DBPR HR 5030: This form requests additional information regarding the food service establishment’s layout and operational conditions. It may include specifics about kitchen facilities and patron areas, which are essential for layout evaluation.
  • Menu Change Notification: A document that notifies the local health department about any significant changes to the menu. This ensures that any new dishes comply with health regulations and dietary guidelines.
  • Fire Safety Inspection Report: Before expanding seating, establishments must secure a fire safety inspection report from the local authority. This report verifies that the establishment meets fire safety requirements for the proposed capacity.
  • Food Service License Application: A form that needs to be submitted if the establishment plans to serve food to the public. A valid license is critical for legal operation and includes compliance checks.
  • Septic System Permit: If the establishment is using a septic system, a permit verifies the system's compliance with state regulations. This document is crucial for ensuring that the wastewater disposal system meets health and environmental safety standards.
  • Site Plan Approval: This document outlines the physical layout of the establishment, including seating arrangements and emergency exits. Approval is vital for evaluating capacity changes and ensuring customer safety.
  • Health Inspection Report: Conducted by local health officials, this report assesses the overall hygienic conditions of the establishment. It’s generally required before any changes in operations can be authorized.
  • Change of Ownership Disclosure: If the establishment is under new ownership, this document is necessary to inform the Department of Business and Professional Regulation. It maintains transparency and ensures continuity of regulatory compliance.

Acquiring and submitting the mentioned documents can streamline the process and minimize delays when expanding a food service establishment's seating capacity. Properly addressing all requirements not only fosters compliance but also ensures the safety and satisfaction of patrons.

Similar forms

The Dbpr Hr 5021 103 form is critical for food service establishments in Florida, evaluating sewage and fire services before any increase in seating capacity. Similar forms serve specific regulatory and safety purposes across various fields. Below are four documents that are comparable in nature:

  • Health Department Permit Application: This document is required for food service establishments to legally operate. Like the Dbpr Hr 5021 103 form, it assesses compliance with health regulations, ensuring safe food handling and sanitation practices.
  • Fire Marshal Inspection Report: Conducted by local fire authorities, this report evaluates a business’s compliance with fire safety codes. Both forms ensure safety standards are met before changes can be implemented, such as expanding seating or making significant renovations.
  • Building Permit Application: Required when making structural changes to a building, this application assesses if proposed changes meet local building codes. Both the Dbpr Hr 5021 103 form and the building permit application focus on ensuring that any expansions do not compromise safety or regulatory standards.
  • Septic System Permit Application: Essential for establishments using septic systems, this application assesses the capacity and compliance of the system. Much like the Dbpr Hr 5021 103 form, it ensures that changes in operations will not strain existing infrastructure and adhere to relevant health codes.

Each of these documents plays a vital role in ensuring that public safety and health standards are maintained in various establishments. Understanding their similarities can provide clarity on the regulatory landscape surrounding business operations.

Dos and Don'ts

When filling out the Dbpr Hr 5021 103 form, it's essential to follow best practices to ensure your submission is complete and accepted smoothly. Here are some dos and don'ts to guide you:

  • Do provide accurate information in all required fields, including the establishment name and license number.
  • Do double-check the amounts for current and proposed seating to ensure they match the specifications.
  • Do include the contact person’s phone number and email address for ease of communication.
  • Do submit the form to the correct local Division of Hotels and Restaurants district office.
  • Do obtain any necessary evaluations from local authorities regarding fire safety and wastewater systems.
  • Don't leave any mandatory fields blank; incomplete submissions can delay processing.
  • Don't mix different contact details; be consistent with names and the contact method used.
  • Don't forget to attach any required additional documentation related to the seating change.
  • Don't submit the form without ensuring it has been signed off by the appropriate authority.
  • Don't ignore the comments section; provide any necessary context to avoid confusion during evaluation.

Misconceptions

When tackling the Dbpr Hr 5021 103 form, several misconceptions may arise. Understanding what the form entails can help prevent confusion. Here are five common misunderstandings regarding this important document:

  • This form is only needed for new establishments. In reality, existing food service operations must also complete the form if they plan to expand their seating. It ensures that all establishments meet health and safety standards regardless of their operational history.
  • Filling out the form guarantees seating expansion approval. This is not the case. The completion of the form initiates an evaluation process. Authorities assess whether infrastructure, like sewage and fire safety systems, can handle the increased capacity.
  • Only one section of the form requires completion. The form consists of multiple sections that address both wastewater and fire safety evaluations. Both sections must be filled out to ensure compliance with local regulations.
  • The form must be submitted in person. Submission methods can vary. Depending on local rules, it may be possible to submit the form electronically or via mail, making it more accessible for many operators.
  • Once submitted, the process is quick. Evaluations may take time. Local authorities must carefully review the submitted information, which can lead to delays in approval. Operators should plan accordingly and allow sufficient time for processing.

Being aware of these misconceptions can help food service operators navigate the requirements associated with expanding their seating capacity more effectively. Understanding the purpose and process of the Dbpr Hr 5021 103 form is essential for successful compliance.

Key takeaways

Here are some key takeaways about filling out and using the DBPR HR 5021 103 form:

  • Ensure accurate completion of all sections, especially establishment information and wastewater system details.
  • Submit the completed form to your local Division of Hotels and Restaurants district office to ensure compliance.
  • Expect evaluations by the Department of Health, Division of Environmental Protection, or Utility Authority for wastewater systems.
  • Fire safety evaluations must be conducted by the applicable local authority to assess exit requirements accurately.
  • Be aware of potential limitations on your establishment’s operations, such as maximum seating capacity and menu restrictions.