HomeMy WebLinkAbout16-17752 i
- ' CITY OF ZEPHYRHILLS "
5335-8TH STREET
` (sis)�so-oozo ,17752
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FUEL TANK PERMIT �'
PERMIT INFORMATION ` LOCATION INFORMATION
Permit''Number: 17752 Address: 6512 GALL BLVD
Perr�it Type: FUEL TANKS ZEPHYRHILLS, FL.
Class of Work: GAS TANK/LINES-NEW Township: Range: Book:
Propo�ed Use: COMMERCIAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 02-26-21-001A-00000-0010
Improv. Cost: 3,600.00 - OWNER INFORMATION
Date Issued: 9/23/2016 Name: RADIANT GROUP LLC
Tofal Fees: 652.00 Address: 6512 GALL BLVD
Amo�unt Paid: 652.00 ZEPHYRHILLS, FL. 33542
Date Paid: 9/23/2016 Phone: (813)247-4731
Work Desc: INSTALL NEW FUEL CANOPY 6 GAS DISPENSERS 2 FUEL PIPING
CONTRACTOR S . ' APPLICATION FEES �
GUARDIA FUELING TECHNO OGIES LL FIRE PERMIT FEES 100.00 ELECTRICAL FEE 60.00
ARON ELECTRIC FIRE PLAN REVIEW FEES 492.00
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"Cl-a'F"�='��
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� Ins ections Re uired
FIRE DEPT.FINAL
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' Chapter 633, Florida Statutes,authoriaes the City to charge and collect user fees to pay for the costs of fire
revent�on and rotection related activities such as ins ections lan review administrative fees and other
P P P � P . �
� costs related to the aforementioned.
Complete Plans, Specifications and Fee Must Accompany Application. Commencement of work writhout written approval of
the Flire Department's Fire Marshal or required permits or opening up for commercial activity without an approved final '
, inspection shall be charged double permit fee per day of operation or a minimum of$100.00, whichever is greater. All ,
� work shall be performed in accordance with City Codes and Ordinances.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF '
' � COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
; IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN �
F�NANCING, CONSULT WITH YOUR LENDER OR AN .ATTORNEY BEFORE ;
! RECORDING YOUR NOTICE OF COMME ENT "
�� '
CONTRACTOR SIGNATURE PERMIT OFFIC
PERMIT EXPIttES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT- 8f3-780-0041
I
' � 813-780-0020 City of Zephyrhills Permit Application Fax-813-780.0021
Buiiding Department �i� _L;�l�y�1 n�
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Date Received Phone Contact far Pertnitting 479 877 _3499
Owners Name Radiant Group,LLC Owner Phone Number 813-918-1963
Owners Address 1320 E 9th Ave,Tampa,FL 33605, Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple TiUeholder Address
JOB ADDRESS 6512 Gall Blvd LOT# �
SUBDIVISION PARCEL ID# 02 26 21 OOlA 00000 0010
(OBTAINED FROM PROPERN TAX NOTICE)
WORK PROPOSED e NEW coNSTR e �,ADDlALT X� SIGN Q Q DEMOLISH
INSTALL �REPAIR
PROPOSED USE Q SFR Q COMM � OTHER Cano ;dis ensers;UST's
TYPE OF CONSTRUCTION Q BLOCK Q FRAME � STEEL Q
DESCRIPTION OF WORK Installation of a new fuel canopy;installation of(6)dispensers;Installation of(2)UST's;all fuel piping
BUILDING SIZE n/a SQ FOOTAGE 8'200 HEIGHT �
� ;
� �B�IILDING $ � r VALUATION OF TOTAL CONSTRUCTION
—i-\l (�
�ELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C. I
QPLUMBING $
OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION � �� ���
QGAS Q ROOFING Q SPECIALTY � OTHER /�����
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO � 1���
BUILDER � COMPANY � ���'�1 (:ZiN����C
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# l.J�.� �
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`/�,5�� � ELECTRICIAN COMPANY I
� v SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
�,p,�� Address License#
Sl�'�`�eJn
(�� �1 PLUMBER COMPANY
�...MK'� SIGNATURE - REGISTERED Y/ N FEE CURRE� Y/N
�� Address License#
� MECHANICAL COMPANY I
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
OTHER COMPANY '
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII1111111111110 � 111111111111111 �
RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Pertnit for new construction,
' Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster;Site Work Permit for subdivisionsAarge projects
i COMMERCIAL Attach(2)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Fortns.R-O-W Permit for new construction.
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stortnwater Plans w/Silt Fence installed,
Sanitary Facilities 8 1 dumpster.Site Work Permit for all new projects.Ail commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
""PROPERTY SURVEY required for all NEW construction.
Directions:•
Fill out application completely
Owner 8 Contractor sign back of application,notarized
If over$2500,a Notice of Commencement is required. (AIC upgrades over$7500)
" Agent(for the conVactor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (copy of contract required)
Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW ,
�
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� NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed"restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
UIdLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
j contractors to undertake work,they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
, under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work,they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847-
8009 Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the"contractor Block"of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County
� TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
� that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings,change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
90-07, as amended. The undersigned also understands,that such fees, as may be due,will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
', receiving a"certificate of occupancy"or final power release. If the project does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
' fees are due,they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter 713,Florida Statutes,as amended): If valuation of work is$2,500.00 or more,I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's
Protection Guide"prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the"owner", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the"owner"prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction,zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be pertormed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other government agencies may apply to the intended work,and that it is
my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to:
- Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands,Water/Wastewater Treatment.
- Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls,Docks,Navigable Waterways.
- Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
- Use of fill is not allowed in Flood Zone"V"unless expressly permitted.
- If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume"will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
- If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction,I certify that fill will be used only to fill the area within the stem wall.
- If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties,the owner may be cited for violating
the conditions of the building permit issued under the attached permit application,for lots less than one (1)
acre which are elevated by fill,an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel,alter,or
set aside any provisions of the technical codes,nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans,construction or violations of any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six(6)months after the time the work is commenced. An extension
may be requested, in writing,from the Building Official for a period not to exceed ninety(90)days and will demonstrate
justifiable cause for the extension. If work ceases for ninety(90)consecutive days,the job is considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR I
PAYING TWICE FOR PROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
WITH YOUR LENDE R A TT�RNEY BEFORE RECORDING YOUR NOTI�E OF COMMENCEMENT.
FLORIDA JURAT(F.S. .03)
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OWNER OR A T CONTRACTOR .i
G ��ubs ed an o or affi ,befo e is Subscribed and swom to ifirmed be e this
-by 1-zja� �����,s• �Tg��� �
�Who is/re per Ilu wn to me or has/have produced Who is/ e perso Ily known to me or has/have produced
�ry as iden6fication. as identification.
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ZE��BI�RF�ILLS F�F�E DEP�aRI`�fEIVT° '�
38410 6th Ave Zephyrhills, FL 33542 _ �/.��,p�`�-L.
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� FIRE SERVICE USER FEES
Occupancy No.:
Plan No.: Contractor:
Business Name: � � Billing Address:
Business Address: �'L ��.
Business Phone No.: Billing Phone No.:
Business Fax No.: Billing Fax No.:
Contact: Contact:
PLAMI REVIEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM FEE
Site Plan N/C Annual N/C Sprinkler $50 1stAlarin N/C
Multi-Family/Commercial .O6 sf 1st Re-inspection N/C Standpipes $50 2nd Alarm N/C
(Minirr�um Charge$25.00 2nd Re-inspection $100 Fire Pump $50 3rd Alarm N/C
� Plan Revisions DBL 3rd Re-inspection $250 Hoods $50 4th Alarm $100
4th Re-Inspection $500 Fire Alarm $50 5th Alarm $150
SPRINKLER SYSTEMS (Business closed until LP Gas $50 6th Alarm $200
�0-25 IHeads $50 violations corrected) Natural Gas $50 NON COMPLIANCE $150
26 plus Heads $100 SPRINKLER SYSTEMS Fuel Tanks- per tank $50
ST�DPIPE SYSTEM Hydro Undergrounds $45 Sparklers $100
� Per Ri�ser $50 Hydrostatic Test $65 per system Fire Works $500
FIRE PUMP AcceptanceTest $45 persystem Camp Fire $25
� Per P I mp $100 Hydrant Flow $75 Controlled Bum $100
FIRE ALARM SYSTEM Hood/Duct $50
0-25 Devices $50 FIRE ALARM SYSTEM Place of Assembly $50 Mnual
26 plus Devices $100 B System Acceptance $50 Fire Protection $25
SUPPRESSION SYSTEMS Recall Acceptance $50 Flammable Application $50 annuai
Wet $50 OTHER Waste Tire Storage $50 Mnual
Dry $50 Fire WalllSmoke Wall $15 perwall Generator<KW $100
� CO2 $50 LP Gas $25 pertank Generator>30 KW 150 I
Other $50 Natural Gas $25 persystem Bio-Hazard Waste $100 ano�ai I
KITCHEN EXHAUST Fumigation Tenting $50
� Hood/Ducts $50 Tent 10'x10'orgreater $15 pertent Torch PoUApplied $50 �
OTHER Fire Pump $45 Haz. Materials $100 Mnual
� BLP Installation pertank $50 Fire Suppression $30
Fuel Tank Installation $50 System Acceptance
�Per Tank) $50 Exhaust Hood/Duct $30
�Natural��Gaslnstallation $50 Re-inspection DBL
I �
(Per SyStem) (other than annual)
� Spray Booth $50 � Inspection scheduled DBL �
and cancelled less than �
� , 24 hours ���
` ��,�L,v Construction Insp. N/C `���
�T�� Emergency Vehicle A� $50 FALSE ALARM
' PLANS TOTAL� INSPECTION TOTAL� PERMIT TOTAL TOTAL� �
GRAND TOTAL ��� �:.�
Comments:
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Date: � / � `y
Inspector: �
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� --ro-- ,Cflessec�rr• -- --_- ! .-�•- . __ •.`---�,, . ... ,- ._ -.._.. --- rcvsn?;:r - - -
To protect,promote&improve the health
, ,..�•.,.�„���_.,;�..;
of all people in Florida through integrated ��°k�'�y�;�-;w`T�=��' Ceies4e�hilip,Wi D,Wi6�w
afate,county&community efforts. = �°�°� ���b�
���°x �v? Surgeon General and 9ecrotary
, �'c�.r.w`f�'�E��S h
�/esiora:To be the Healthiest State in ihe Nalion
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CONSTRUCTION PLAN REVIEW
i PROVlSO LETTER
Facilitya 519'i02567
Rat�iant Food Stou�e#'9204
65�2 Gall B[vd B
� Zephyrhiils � ��
PASCO
I he Florida Department of Health in Pineflas County (DOH-Pinellas) has been authorized by contract
with the Florida Department of Environmental Protection (FDEP) to conduct Petroleum Storage Tank
Compliance Program work in Pasco County. On June 22, 2016, plans submifted by Core Sfiates
Group we�e reviewed for compliance with Chapter 62-761, Florida Administrative Code. The plans
�describe:
' CLOSURE ',
Closure, by removal, of three 12,000 gallon double wall Underground Storage Tank(UST) systems.
lease discuss wi h in ec
t sp tor the level of closure required.
NSTALLATIOPJ �
�
Installation of fwo (2}Vehicular Fuel USTs and associated equipment; to include in part:
• Dauble wall Xerxes fiberglass USTs (1 —20,000 galfon and 1 —20,000 gallon split �
12,00018,000}. [EQ-200]
• Installation of Xerxes fibergfass containmenf sump(s). [EQ-397]
� Installation of Smith Fibercast Redthread II Double Walled fiberglass piping. [EQ-252]
� Installation of Vaporless line leak detector(s). [EQ-329]
� Installation of OPW Edge Double Walled Spill Containment Devices. [EQ-708]
o Installation o.f OPW 71 SO overfill prevention valves. [EQ-697]
; � Installation of OPW dispenser sump liners. [EQ-439]
• Installation of TLS-350 and associated sensors. [EQ-197I EQ-614]
, he following items are required: ;
� • Submission of a Closure Report within 60 days for removal, in accordance with Storage Tank
� System Closure Assessment Requirements(April 1998).
Florida Department og EtealEtr
in Pinellas County
8759 Ulmerton Rd.�Largo,FL 33771 �CC��t���23�'��'i�Q(�t'�€�teCl$
�PHON E:(727)524-4410•FAX(727)507-4333 ' e ���1���=�Accreclitation Baat�d
FloridaYiea(4h.gov
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CO�lSTRUCTIQN PLAN R�VIEU�J Ra��ant Food Store#1204
_. ... _ . _��.. ---.•:�. ,�:;,_.�, r...,�,.�.
P��OVISC�`���T?`ER "'�,._ . Fa�,�tfiy�G#�519 iv�5t�l � •-
P;age 3 of 3 June 22, 2016
� In addition, a final inspection will be performed upon completion of all construction. At the final
inspection the facility must be able to confirm registration updates for the closure and
i installafiion have been submitted to the FDEP's registration section Additionally, the facility
j must demonstrate tha#the new tark systems have the appropriate 3rd Party Petroleum Liability
& Corrective Action coverage.
�� , � �� C. , acting as a representative of Core States Group have
�eviewed this ocument with the DOH-Pinellas, Petroleum Storage Tank Compliance Program staff,
and am aware of the specified conditions and notification timeframes
� �- �o
re Stat Group Date '
l.
� �
Uoseph Sowers
Environmental Supervisor II
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To protect,promote&improve the health ' - �� Gcvo�r.,;i " - �
�••::��_.<-w:»:>,�=.:
of all people in Florida through integrated w���='s:n:^�:%�;�'
, �=-�k.<,�:'ae,��� CeBes4e�InB9i 6Yi� fl1�8�F0
state,couniy&community efforts. u�f; ��.=-�<-� P+ �
�� ���r P { Sur eon General and Secrota
e�+.f, .� 9 �Y
{ . t:"�.""c?�B G c [
i9osi�av:To be the Healthiesl State in Ihe Nalion
I CONSTRUCTION PLAN REVIEW
PROVISO LETTER
Facili�y: 5'V 9'@ 02567
Rateiang Food Sto¢�e#�204
65�2 GaB� Blvd d -
Zep�uyrhilis
PASCO '
Tre Florida Department of Health in Pineflas County (DOH-Pinellas) has been authorized by contract
with the Florida Deparkment of Environmental Protection (FDEP) to conduct Petroleum Storage Tank
C�ompliance Program work in P�sco Counfy. On June 22, 2016, plans submitted by Core Sfates
Group were reviewed for compliance with Cha ter 62-761 Florida Administrative Code The lans '
P , p
describe
CL.OSURE
�
Glosure, by removal, ofi three 12,000 gallon double wall Underground Storage Tank (UST) systems.
Pfease discuss with inspector the level of closure required.
INSTALL,4'TIO� �
Installation of fwo (2) Vehicular Fuel USTs and associated equipment; to include in part:
o Double wall Xerxes fiberglass USTs (1 —20,000 gallon and 1 —20,000 gallon split
12,00018,000) [EQ-200]
� (nstallation of Xerxes fibergfass containment sump(s). [EQ-397]
o lnstallation of Smith Fibercasf Redthread II Double Walled fiberglass piping. [EQ-252]
o Installation of Vaporless fine leak detector(s). [EQ-3�9]
o Installation of OPW Edge Double Walled Spill Containment Devices. [EQ-708]
o Installation of OPW 71SO overfill prevention valves [EQ-697]
o Installation of OPW dispenser sump liners. [EQ-439] '
� Installation of TLS-350 and associated sensors. [EQ��97/ EQ-6�4]
The following items are required: �
o Submission of a Cfosure Report within 60 days for removal, in accordance with Storage Tank �
System Closure Assessment Requirements (April 1998).
i._.�...�.,..�.._ — -_-�..-.
�loruc7��ep�e�4mere4 og Cil�algPo
lin Pinellas County
8751 Ulmerton Rd.•Largo,FL 33771 �CCY�C�2C��{23���'i dC�P"�E�"tef�'�
PHONE:(727)524-4410•FAX(727)507-4333 ' e Pub(ic Heafth Accreditation Board
Florida�7ea(4h.gov
'
�
C0�lSTRUCTION PLAN R�VIEUJ Ra�?ant Food Store#1204
� � PR.OV�I�G`��'��}ER�' >_ - .__._ : -- n-- �Fa;�ifiy'�D#;519it�25C;1 �-
Page 3 of 3 June 22, 2016
� (n addition, a final inspection will be performed upon compietion of all construction. At fhe final
� inspection the facility must be able to confirm registration updates for the closure and
� insta(lation have been submitted to the FDEP's registration section. Additionally, the facility
must demonstrate that the new fark systems have the appropriate 3�d Party Petroleum Liabilify
& Corrective Action coverage
I, , �. �� C� , acting as a representative of Core States Group have
reviewed this ocument with the DOH-Pinellas, Petroleum Storage Tank Compliance Program staff,
and am aware of the specified conditions and notification timeframes
� � �o
� re Stat Group `Dat�eJ `
I �
�
.loseph Sowers
Environmental Supervisor II
�
._,%
�'�-=rr���°f�'f E�fL/
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--�- ,C�iEs�ioir• -- •-> - � ._ _ . , ---,� - _.. r:r _� .. - -.. _ . �cvem;:r - -
To protect,promote&improve the health ( _ ,
of all people in rlorids through integrated { ;="z F;�',,;.�`�::>���'�'
state,county 8 community efforM. � .:-,=�� �:-:��.;�- � CeBes4e P9eiRip,fYl D,fUiPF4
� G>�'�ph;"���,�� � Surgeon General and Secrolary
, S k���� c3`•a,� �% c
� V9osu�uv:To be the Healthiest State in lhe Nalion
..a.,n..a - - - -- �__..�.,..r-a,_-.,...�—_ W.._. _ _ ..._.. ...
�
; CONSTRUCTION PLAN REVIEW ,
! PROVISO LETTER ;
Facil6�y: 5�9'9 02567
Rac6ian$ Food Sto�e#'920� ,
65'V2 GaIV �fvd °
ZephyrhiEls
' P�4SCQ
Tre Florida Department of Health in Pinellas County (DOH-Pinellas) has been authorized by contract
with the Florida Department of Environmental Protection (FDEP)to conduct Petroleum Storage Tank
C�ompliance Program work in Pasco Coian�y. On June 22, 2016, plans submitted by Core States
Group were reviewed for compliance with Chapter 62-761, Florida Administrative Code The plans
describe�
I
GLOSURE
� '
Closure, by removal, of three 12,000 gallon double wall Underground Storage Tank (UST) systems.
Please discuss with inspector the level of closure required
I STALLA'�"10� -
I stallation of two (2) Vehicular Fuel USTs and associated equipment; to include in part:
o Double wall Xerxes fiberglass USTs (1 —20,000 galfon and 1 —20,000 gallon split
12,000/8,000) [EQ-200]
� fnstallation of Xerxes fiberglass containment sump(s). [EQ-39'P]
� fnstallation of Smith Fibercast Redthread II Double Walled fiberglass piping. [EQ-252]
i o Installation of Vaporless [ine leak detector(s). [EQ-329]
_ � Installation of OPW Edge Double Walled Spill Containment Devices [EQ-708]
o Installation of OPW 71SO overfill prevention valves. [EQ-69'1]
� Installation of OPW dispenser sump liners. [EQ--439] ;
o Installation of TLS-350 and associated sensors. [EQ�1971 EQ-6�4]
�The following ifems are required: �
o Submission of a Closure Report within 60 days for removal, in accordance with Storage Tank '
�i System Closure Assessment Requirements(April 1998).
Florida Depar�eeeen4 off C�ealgh ��
in Pinellas County �CCC�t�L'C�EfE3���"!DE 8'f[Tlet��
8751 Ulmerton Rd.•Largo,FL 33771 a p�blEc Health Accreditation�Board
�PHONE:(727)524-4410•FAX(727)507-4333
�lor6da9�9eal�h,gov
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; �.� CO�JSTRUCTION PLAN R�VIEW Rad�ant Food Store#1204
� ,- PR.OV�ISC7`��T�'ER�' .- � .�_ _ - w- Fa�i�ity�D#�519iu25C�� •
Page 3 of 3 June 22, 2016
o ln addition, a final inspection wiil be performed upon compietion of all construction. At the final
inspection the facility must be able to confirm registration updates for the closure and �
installation have been submi#ted to the FDEP's registration section. Additionally, the facility
� must demonstrate that the new tark systems have the appropriate 3�d Party Petroleum Liability
& Corrective Action coverage
f, � �. ern C. , acting as a representative of Core States Group have
reviewed this ocument with the DOH-Pinellas, Petroleum Storage Tank Compliance Program staff,
a'� d am aware of the specified conditions and notification timeframes.
� re Stat Grou 'Dat�e� �
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P
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,loseph Sowers
Environmental Supervisor II
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20 � 09/28/2016 J. R. , Dpty Clerk
Permit No. 1 �� `� y Parcel ID No �2-�P' Z-� '�IPt "���—���
NOTICE OF COMMENCEMENT
State of ��OY 1 C.t A Counry of PG1$C O ,
• THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property,and in accordance with Chapter 713,Florida Statutes,
the tollowing information is provided in this Notice of Commencement:
1. Description af Property: Parcel IdenCitication No.(�2'ZO'`2�� �(��14 ^ ��� " ����
• Street Address: �5�2. �-�A�� g��Cf• � c�hur h i 11�
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2. General Description of Improvement Ta n k- Ret�la t.e meq-t �u�ErG�rp� sfiarc�e
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3. ( Owner Information or Lessee infortnation if the Lessee contracted for the improvement:
�jpP (Zat.dia►�-t- �ro�o, LLc � '
� 13�� �Nam�'�h I't-V�• �Q f1'l p a ' �- �
i'Address City State
; Interest in Property: FP� S�M� e-
�
I Name of Fee Simple Tftleholder: '
(If different from Owner listed above)
I �
� Address /� C • City State
4. Contractor: l��.tr�rd 1Ct n 1 uC��(14 ��C� n0��Q�es �
Name �
� Address _ Ciry State �
' CantrectorsTelephoneNo,: _ pAULA S.0'NEIL,Ph.D.PR5C0 CLERK 6 COMPTROLLEk
5. � surety: �A 09/2R8/K01g Q�� ,pm PG 27 !Z
Name �4 ��
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Address , City State
� Amount of Bond: $ Telephone No.:
6. Lender N) � �
� Name
I
Address City State �
Lender's Telephone No.: ���� • �
7. Persons within 1he State of Florida designated by the owner upon whom notices or other documents may be served as provided by
Section 713.13(1)(a 7),Florida Statutes:
ZP h ee. �a l�e�!
Name �
� 132z� E �h �-�e. i a rnp a �- ;
Address p City State �
i Telephone Number of Designated Person: ��3'3 b 2. 32'b 1 ;
I
8. � In addition to himself,the ovmer designates ��n�1 V1 �V e�� of ;
�h f.[.u,a(Q11't'" (�"OLLp��-�-C _to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes. �
; Telephone Number of Person or Entity Designated by Owner: [!13• -1�g. �Q 103
9. ! Expiration date of Notice of Commencement(the expiration date may not be before the completion of construction and final payment to the
� contractor,but will be one year from the date of recording unless a different date is specified): IZ-I3 � I(e
� WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT
� ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE
� RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalty of perjury,I declare that I have read the foregoing notice of commencement and that the facts stated therein are true to the best
oT my knowledge and belief.
STATE OF FLORIDA � �
COUNTY OF PASCO
Signature of Owne or Lessee, r Owner's or Lessee's Authorized
Officer/Director/Partner/Manager ,
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Signatory's Printed Name/Title/Office
OR BK 9434 P� 2573
Z of 2
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:�`, .GOM��O�'���
STATE OF FLORIDA ` . :
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GOUNTY OF�����CLI, 1'� y�:,. Sepf,1�7,�1g��:�?
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The foregoing instrument was acknowledged before me this�day of r' (year), by
�A nl� �p� iN � =�G���
I-,-.---,�--�
Sig ature of Notary Public tate of Florida)
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(Print,Type,or Stamp Commissioned Name of Notary Public)
ersonally Known_�OR Produced Identification
�
Type of Identification Produced
��g5 g:
�TATE OF FLORIDA,COUBdTI'OF PA+SCO '�� a ' ; o �'0�
T H I S I S T 0 CE R T I FY THATTHE FOREGOING ISA � ��� '�°
� • � G �
TRUE AND CC�RRECT COPY�F THE DOCUMENT . a►
� ON FILE OR OF PUBLIC RECORD IN THIS OFFICE � � In���,e���r . �
WITN `Y HAND AND FFIC L SEAL THIS � . o
DAY OF ROLLER � �� �� , �r
S.O R &COMPT � �
PAULA , ,��g� �
BY DEPUTY CLERK °��' o� o
� ��9l��0�`��
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813-780-0020 City oi Zephyrhilis Permit Application Fax�13-780-0021
BwlUing Oepa�menl �-.
�13 � f�3' ��1��
DMaRocotvod � phoneContactfnrPermfttin 4�9 ) 877 _3499
-ic-7'1•7'YT'T'T'
OwneYs Nama Radiant GrouG,lLC Umer Phone Num6er 613-918-1963
Ownors Addross 7320 E 91h Ave,Tampa,FL 33605 Ownar Phone Number ._�
Fee Simple TiUe�older Name � .�� Owner Phone Numher
Fee Simpla TiUehvlder Address �
JOB ADDRESS 6512 Gall Blvd LOT if �
SUBD�NSION PARCEL IDt� `., `- "�'t r :�:;nn:� oai a
(08iAIN W FR�'.1 PROPERTY TAX NOTIL�) �
WORK PROPOSED B NE1Y CANSTR e A�DlALT � SIGN O � DEMOLISH
INSTALL REPAIR
PROPOSEDUS£ [� SFR Q COMM � OTHER ano ;d�s ensers; s
IYPE OF CONSTRUCTION Q BLOCK Q FRAME � STEEL Q
OESCRIPTION OF WORK Inslall�tion oi a new fuel canopy;inslallation o((6}dispensers;insiallation oi(2)UST's;all fue{piping
BUILDING512E "'i3 SQf00TAGE � '��� HEIGHi �
"1"I"T1�I�TTrrlTTTRT/�Tf"1"fIT1"TTI'7TrTIT7�T�. tITPPY'rlTTrrTI"1"fTTe"t"rrY'rT�
�LJILDING $ VALUATION OF TOTAL CONSTRUCTION
1
�ELECTRICAL S AMP SERVICE Q PROGRE55 ENERGY Q W.R.E.C.
QPLUM9ING 5
� �� �.�y
QMECHANICAL S VA�UATION OF MECHANICAL INSTALLATION �
QGAS Q ROOFING Q SPECIALTY Q OTHER �/v-' �1�
FINISHED FLOOR ELEVA710NS FLpOD ZONE AREA QYES NO
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�.-..�:.1 1-�1�' 1 1 I i 7 'i.� - - - N-�iTri-r
BUILDER /� COMPANY � L�1/b1) �Z-b�li • EC"
SIGNATURE Lv' tL ReGISTR°D Y I N FEE CUfiREt� Y/N
_Atltlress License�
� t��I�
� .i"'" - 7
;•�;� � '� ELECTRIClAN �� COMPANY tr. r���'���",
V '; t��� ; SIGNATURE RcGI57ERED YI N FEEC:IRRE� Y!N .S.
�,� • Address Licen;e� ��� _�
• �._.v-
PLUMBER COMPANY
SIGNATURE REGI37ERED Y I fv FEc CUFL7E� Y 1 N
qddress �ic¢nse p
MECHAMCAL COMPANY
SIGNATURE FEG�STERE'J Y! N FEE CURRE� Y/N
Address License e
OTHER CpMPANY �
SIGNATURE FtEGIS7ERE0 Y!N FEECURRE� Y!N
dddress Licc,nse#
i7G176f1liTilI1111flili1t11171011li ? 1p111113111111ff91i11it0 ( I3lfll '
RESIUENT1dL Attach(2)Piot Plans;(2)sets af Buifdng Plans;(1)set e(Energy homts;R-U-W Pertnit!or new const�uctio�,
Mnimum ten(5�)vrorking days aRe�submtttal date. Req�red onsite.Cansauclion Plans.Storm�rafer Plans w!S�t Fence insfalled,
SBtlitary Faalltles$1 dump5tef;Si1e Work Permitforsubdivisions/large projects
COMMERCIAL Atlath�2)camplete sets of Building Plans plus a Life Salety Page;(1)set oi Energy Forms.R-0-W Permit Tor naw construCion.
M�imum ten(10)wwking days efter su0mipel date. Requiretl msite,Coretruction Plans,Stormwater Plans v�/S�lt Fence insYalled,
Santtary Fac�Yties&7 dumpster Site Work Pertnil for all new projects.All crommercial requireme�rts mus[meet compdance
SIGN PERMIT Atta�(2}sets of Engineered Plans.
""PROPERTY SURVEY required tor eii NEtv construction.
�..�-' S-a-s-i..1_:-.-.-.-.�-..r�
Oirections: ,
Fi9 out epplfcafion completely.
Qwnet 8 Contractor sign back ot apqical'ron,rrotarized �
If over 52500,m Notice o}CommencemBnt is requlrnd. (AIC upgfades over S750U�
" Agent(for tfie conVactor)or Po,mer of Attamey(for the amel)would be Someone with notadzed letler from ownef authorizing same
OVER THE COUNTER PERMI7TING (copy of conUact raquire0)
Reraafs if shinqles Se�vers Service Upgrades A1C Fenees(PIoUSwveylFootege)
Drlreways-Not nwr Counler if on puhlfc roadvrays..needs ROW
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