Form FDACS-03560 "Weighing and Measuring Device Permit Application" - Florida

What Is Form FDACS-03560?

This is a legal form that was released by the Florida Department of Agriculture and Consumer Services - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2018;
  • The latest edition provided by the Florida Department of Agriculture and Consumer Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form FDACS-03560 by clicking the link below or browse more documents and templates provided by the Florida Department of Agriculture and Consumer Services.

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Download Form FDACS-03560 "Weighing and Measuring Device Permit Application" - Florida

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Florida Department of Agriculture and Consumer Services
Division of Consumer Services
Check or Money Order
WEIGHING AND MEASURING DEVICE
payable to FDACS and remit
with form to:
PERMIT APPLICATION
NICOLE "NIKKI" FRIED
FDACS
COMMISSIONER
Section 531.62, F.S.; Rule 5J-22.006, F.A.C.
PO Box 6700
Tallahassee, FL 32314-6700
(850) 921-1590 (850) 410-3804 Fax
CSCompliance@FDACS.gov
FACILITY ID#:
(For FDACS Use Only)
BUSINESS NAME: ________________________________________________________________________________
DOING BUSINESS AS: ____________________________________________________________________________
DEVICE LOCATION ADDRESS: _____________________________________________________________________
CITY:
STATE:
ZIP: ________________
BILLING ADDRESS
: _____________________________________________________________________
(if different)
CITY:
STATE: _________ ZIP: ________________
BUSINES S OWNERSHIP INFORMATION
BUSINESS TYPE: (CHECK ONE)
Corporation
LLC
Partnership
Limited Partnership
LLP
Sole Proprietor
Other
FEDERAL EMPLOYER ID (FEID):
EMAIL: _______________________________________
BUSINESS PHONE #:
______________________________
DEVICE LOCATION PHONE #: ____________________
IS THIS A NEW PERMIT?
YES
NO
IS THIS APPLICATION BEING USED FOR NEW DEVICES TO BE ADDED TO AN EXISTING W&M PERMIT?
YES
NO
If yes, please indicate the existing permit number __________________.
This application for permit applies only to the total number of specific device types listed on page 2. I certify that this
applicant is aware of and complies with all of the requirements of ss. 531.60 - 531.66, F.S., and Rule 5J-22.006,
F.A.C., and I am authorized to execute this application on behalf of the above named entity or individual.
PRINT/TYPE NAME OF APPLICANT: ________________________________________________________________
SIGNATURE*: __________________________________________
DATE: _______________________________
TITLE: _______________________________________________
PERMIT WORKSHEET ON PAGE 2 MUST BE
COMPLETED AND SUBMITTED WITH APPLICATION.
*PERMIT WILL NOT BE ISSUED WITHOUT A SIGNATURE.
F&A Use Only
Org. Code: 42 10 06 25 000
EO:
A2
varies
Object Code: 002301
012030
$100
FDACS-03560 Rev. 02/18
Page 1 of 2
Florida Department of Agriculture and Consumer Services
Division of Consumer Services
Check or Money Order
WEIGHING AND MEASURING DEVICE
payable to FDACS and remit
with form to:
PERMIT APPLICATION
NICOLE "NIKKI" FRIED
FDACS
COMMISSIONER
Section 531.62, F.S.; Rule 5J-22.006, F.A.C.
PO Box 6700
Tallahassee, FL 32314-6700
(850) 921-1590 (850) 410-3804 Fax
CSCompliance@FDACS.gov
FACILITY ID#:
(For FDACS Use Only)
BUSINESS NAME: ________________________________________________________________________________
DOING BUSINESS AS: ____________________________________________________________________________
DEVICE LOCATION ADDRESS: _____________________________________________________________________
CITY:
STATE:
ZIP: ________________
BILLING ADDRESS
: _____________________________________________________________________
(if different)
CITY:
STATE: _________ ZIP: ________________
BUSINES S OWNERSHIP INFORMATION
BUSINESS TYPE: (CHECK ONE)
Corporation
LLC
Partnership
Limited Partnership
LLP
Sole Proprietor
Other
FEDERAL EMPLOYER ID (FEID):
EMAIL: _______________________________________
BUSINESS PHONE #:
______________________________
DEVICE LOCATION PHONE #: ____________________
IS THIS A NEW PERMIT?
YES
NO
IS THIS APPLICATION BEING USED FOR NEW DEVICES TO BE ADDED TO AN EXISTING W&M PERMIT?
YES
NO
If yes, please indicate the existing permit number __________________.
This application for permit applies only to the total number of specific device types listed on page 2. I certify that this
applicant is aware of and complies with all of the requirements of ss. 531.60 - 531.66, F.S., and Rule 5J-22.006,
F.A.C., and I am authorized to execute this application on behalf of the above named entity or individual.
PRINT/TYPE NAME OF APPLICANT: ________________________________________________________________
SIGNATURE*: __________________________________________
DATE: _______________________________
TITLE: _______________________________________________
PERMIT WORKSHEET ON PAGE 2 MUST BE
COMPLETED AND SUBMITTED WITH APPLICATION.
*PERMIT WILL NOT BE ISSUED WITHOUT A SIGNATURE.
F&A Use Only
Org. Code: 42 10 06 25 000
EO:
A2
varies
Object Code: 002301
012030
$100
FDACS-03560 Rev. 02/18
Page 1 of 2
ID#:
(For FDACS Use Only)
FACILITY
Permit Fee Worksheet Directions: Insert the number of each device type and calculate fee.
NUMBER
FLAT RATE
OF
DEVICE TYPE
AMOUNT
FEE
DEVICES
1a) RETAIL SCALES - 0 to 100 lb. capacity:
1 to 5 at location
$ 40.00
1b) RETAIL SCALES - 0 to 100 lb. capacity: 6 to 10 at location
$125.00
1c) RETAIL SCALES - 0 to 100 lb. capacity: 11 to 30 at location
$175.00
1d) RETAIL SCALES - 0 to 100 lb. capacity: 31 or more at location
$225.00
2a) VOLUMETRIC METERS Max flow rate < or = 10 gal per minute 1 to 5 at location
$ 40.00
2b) VOLUMETRIC METERS Max flow rate < or = 10 gal per minute 6 to 10 at location
$125.00
2c) VOLUMETRIC METERS Max flow rate < or = 10 gal per minute 11 to 30 at location
$175.00
2d) VOLUMETRIC METERS Max flow rate < or = 10 gal per minute > 30 at location
$225.00
NUMBER
FEE PER
OF
DEVICE TYPE
AMOUNT
DEVICE
DEVICES
3a) SCALES – Greater than 100 lb. up to & including 250 lb. capacity
X
$ 40.00 ea =
3b) SCALES – Greater than 250 lb. up to & including 5,000 lb. capacity
X
$ 75.00 ea =
4) SCALES – Greater than 5,000 lb. up to and including 20,000 lb. capacity
X
$150.00 ea =
5) SCALES – Greater than 20,000 lb.
X
$200.00 ea =
X
6) DIESEL EXHAUST FLUID MEASURING DEVICES
$ 40.00 ea =
X
7) COMPRESSED AND LIQUEFIED NATURAL GAS MEASURING DEVICES
$100.00 ea =
8) MASS FLOW METERS Max flow rate < or = 150 lb. per minute
X
$100.00 ea =
9) MASS FLOW METERS Max flow rate > 150 lb. per minute
X
$250.00 ea =
10) VOLUMETRIC METERS Max flow rate >10 < or = 20 gal per minute
X
$ 40.00 ea =
11) VOLUMETRIC METERS Max flow rate > 20 gal per minute
X
$ 80.00 ea =
12) LP GAS BULK DELIVERY VEHICLES WITH A METER
$150.00 ea =
X
SUBTOTAL
LATE FEES - All late fees will be due immediately upon expiration of permit.
$100.00
TOTAL DUE
TWO YEAR
Check here if applying for a TWO YEAR permit. Multiply
PERMIT FEE
subtotal X2, adding late fee, if applicable.
TOTAL
FDACS-03560 Rev. 02/18
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