HomeMy WebLinkAbout91-1843
...
STATE OF FLORIDA
City of Zephyrhills
;//J
184a.j)
Date /'P -:1' - 7/
PASCO COUNTY
BUILDING DEPARTMENT
1-813-788-6611
E~R(CAL
, /;")( /7.1,.
~~:P:::r~s:~ers Name: ~~ ~i f7; U; :4-'/ i:rd~(-;Z~
.I
v' Lot
Type of Permit
( BUILDING,')
\..,,'::::.::c ,-,-" ,/
~NG
Legal Description:
Sub.Div.
PermitN~
~'[.
Blk.
Zoning CI: ,'---........
DescriPlionOfwork_':-1~.P'...Av<.-- (~ )C. Y 0 ucJ /,,,, i-r-I0~-5 S<--
~(LJt,/ Cy ~HAl II . L~/71J..A 'y.J~~ -~L1~./
r ,i k--'" _, /21 / ~
-~~,,--.t ,aJ<1><'-fi~tJi - · . _
Energy Code Readout: OJ( 10 - I ')- 9/ ~
Complete Plans, Specifications and Fee Must Accompany Application
Estimated Cost: I ~ 4 f () .
tF)
All work shal! be performed in accordance
with the above and all City Codes
and Ordinances,
( ( BUILDINg)
----. ,. --~-
PIJJ.MBiNG '
,-
Ftr.
Pre SLB
Lintel
FRM.
Insul.CL
WL
SLB
Tub Set
Water
Sewer
Final
Driveway
Fee:" ~
SIGNATURE' . I ____ '
COMPANY
ADDRESS
TELEPHONE #
E~CAL
Tp.Serv.
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
M~
--
Breakers
Ducts Insl.
Compressor
Final
Relnspectlons: When extra inspection trips are necessary due to anyone of the following reasons, a charge of ten ($10.00)
dollars shall be made for each trip.
(a) Wrong Address
(b) Condemned work resulting from faulty construction
(c) Repairs or corrections not made when inspection called for
(d) Work not ready for inspection when called.
The payment of reinspection fees shall be made before any further permits will be issued to the person owning same.
APPLICATION FOR PERN"IT
CI.TY OF ZEPHYRHILLS
BUILDI.NG DEPART~1ENT
APPLICANT
;",
ADDRESS 3008 Orange Ave., Ft. Pi~rce, Fl. 34947
Richard T.St:llr.klpn/Ali:J~ C'npm;r.rll, Trlr.
PHONE 407 - 464 - 9544
OWNER
Circle K Corp.
"
JOB LOCATION 1201 Hwy 54 A east
Tra9t~ 45,51, 52,
LEGAL DESCRIPTION: LOT~SJ el 8. G2
PARCEL 1. D. ~t
LOT SIZE
x
AREA SQ. FT.
BLOCK
SUBDIVISIONZephyrhills Colony r.ompany
Lands
WORK PROPOSED:____New Construction ~Addition ____Alteration ____Repair ____Install
_Sign/Temp.
_Sign
__Hove
____Demolish
PROPOSED USE: ~Single Family
~M/F
____~t of Units
, .____H / H
_Commercial
_Indust.
____Swim. Pool
Upqrade
Other
____Restaurant & Health Department Approval
BUILDING SIZE:
x
Square Feet,
Height
RESIDENTIAL:
COMMERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.**
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORNS.H
**COPY OF CONTRACT REQUIRED.
EEEMITS REOUESTED
_BUILDING
$
/1 L/{Jo
Valuation of Total Construction
_ELECTRICAL
AMP Service
Florida Power Corp.
_H.R.E.C.
____MECHANICAL
$
Valuation of Mechanical Installation
_PLUMBING
GAS
ROOFTNG
SPECIALTY
TYPE OF CONSTRUCTION: ____Block
_..Frame ____s teel
x
Other
FINISHED FLOOR ELEVATIONS: FT.
******************************************
.~..,. ,~CTPR SEGTTQNcL" ~ ~
BUILDE ' Company a AM ' ,
. J ' State Cert. or Rcgist. ii' e.t"?oIf9,-r-tJ:3
Signatur City License Registr,ttion ii =-.Z;-/ 0.:5 PE'clJiLrr
******************************************
Sirmature
Company
State Cert. or Regist. 0
City License Registration 0
******************************************
ELECTRTCTAN
Signature
Company
State Cert. or Regist. 0
City License Registration 0
******************************************
. PLUMBER
MECHANICAL
Company
State Cert. or Regist. #
Signature
******************************************
City L~ccnsc Rccistrntion j~
Signature
OTHER Richard T. Stucklen
PERtlIT OFF leER.
APPLICATION APPROVED BY
11'":
CONDITIONS:OF,PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
.
The ,undersigned understands that this per.it lay be subject to 'deed restrictions' which ~ay b~ ~ore restr,ictive than City
regulations. The undersigned assules responslbllity~for,co.pllance with any applicable d~cd restrictions.
"
B. UNLICENSED CONTRACTORS AND CdNTRACTOR RESPONSIBILITIES
If the owner has hired a c~ntractor or contractors to undertake wor~, they lay be requircd to bc licensed in accordance with
state and local regulations. If the contractor is not licensed as required by law, both thc OMner and contractor ~ay be
cit~d for a .isdemeanor violation under state law., If the ~wner or intended contractor are unCErtain as to what licensing
",.;,.."t, "y .pply f" 'h' ;,t,,'" ",t, th,y ." .";,,, i, ",t.,' 'h, Ci'y ,f "phy,hill' '.;ldi" D.p.,t..", \'131
788-6611.
Furtherlore, if the owner has hired a contractor or contractors, he is advised to have the contractor(sl sign portions of the
'Contractor Sections' of this application for which they will be responsible. If you, as the owner sign as the contractor,
y" ." ;,'i,.t;', th.t y", ,.th" th., th' ",t,."", ." "'p,,,ibl, f" 'h, ",k. If th, ",t,.,t" ,;,h., y" t, ';9'
as contractor that lay be an indication that he is not properly licensed ~nd is not entitled to per~itting privileges in the
City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILlfV CONN~CTION F~ES
D.
CONSTRUCTION LIEN LAW
(CHAPTER 713~ FLORIDA STATUTES, AS AMENDED)
I ",tify th.t I, 'h' .ppI;,"', h." b'" p,""" ,i'h . "py ,f 'Fl";"" C"",.";,, l;.' l., - ",.,.",,', p"t"ti.,
Guide' prepared by the Florida Departlent of Agriculture and Consuler Affairs. If the applicant is sOleCne other than the
,,,,oc', I w\lfy \h.t 1 hm ,bI';'" " '0" ,f th, .b,,' "",lb" ,,,.,,,, .eo' pn,,'" ;, good hi\h t, d,li,,' i\ to 'b,
.owner' prior to co..encement.
;',';(.".1':
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the information in this application is accurate and that all Hork Hill be done in co~pliance with all
applicable laws regulating construction, zoning, and land development.
Appl;,.'i" i, h",by ..d' t, ,bt.;, . p".it t,'" ."t .,d ;"t.ll,t;" ., i,d;,.t.d. I ".t;fy 'h.t '0 ",k "
installation has cOllenced prior to issuance of a per.it and ihat all work will be performed to roeet standards of all laws
"9.i.t;'9 ""t,.,ti,', C;'y ,'d", "';'9 "9.1.,;"" .,d 1.,d d",i'p.'" ",.I.t'", ;, th' i.,;,';,t;". 1 .1,.
",tify Ih" I .,d.,.t.od Ih.1 Ih, ,'q.i,t;oo. ,f ,Ih,' 9.""."t.t .q"';" "Y .,ply '0 th' "t,o"d "rk, ." th.t ;t "
.y mp'''' lb il i\ Y t, "" ti f Y ,h.' "ti ,os I '"' \ lot, I. be " coop ti ."". S. d, · ,.",;" ,,,d. d, h'" '" 'w I ti. i\., to'
. D".rt.'~t ,I E,y'r;"r,t.l R".I.,;" - r.'r';" B.yh,.d', ".tl." A".. .nd E";"",,t.lly s.,.ili,' l,"'"
Water/Wastewater 1reatl~nt
~ South~est Florida Water'ManaQetent District - Wells; Cypress Bayheads, Wetland Ar~as, Altering Hat~rcourses
I Arty Corps ~f EnQineers - Seawalls, Docks, Nav~gable Waterways
. ",.,t.", of ",.IIh , R,h.b;tit.I;" s",I".. E";"",,t.l ",.Ith U,;' - ,.11" H"""'" T".t..... S.,t;, I..k'
I ~S Environcental Protection AQenct - Asbestos abatement
I ,I" codify th.t, if fi\1 "t.d.1 ;, to b' .", ;, Flood '''' 'A' " 'A"".', i\ i, ""'ers'"'' \1,,\ , d";,,g' ploo
.d""';'9 . ',o."",t;'q "I..,' ,ill h, "b.itl" ,h;,h i, p,.,."d by . p,.."."..I ,,,g;"'" ,.",t.." i. th. St.t, ,f
Florida prior to permit issuance.
A p"';' i".,d ,h.ll b, ",.t,.,' t, h' . ""'" I. p""" ,;th the ,.,t "d o,t ., ..'h,rity " ",1,1., ,.".1 .It,,, or
"t .,;" ,'y p"';"'" ,f th. t"h,;,,1 "d,., '" ,h.11 i""'" ,f . p.",t pr.,.,' th. ,.iI"o, O"i,;" f'" th.".ft"
",.;" '9 . cor'" ti" "f ""OS i' ploo,; ""'f'" '''' " vi .1.ti", .f '" ",d.. ,,,,y P'" i\ ; ",oe' ,h. \1 'oc"" ; ". lid
"' 1m \h, '" k '" thoc i ,,' by ",h p'" il i, ""''' ,d ,ilhi' . " '" \h' . f i "'" "CO, '" if "',,' or, \I,., ,,,, by \h, "" i\ i'
,,'p,,',d ., ...,d,," ." . ",;., .f ,i. ."th, ,ft" th, ,;., th' ",t ;, ,.......d. ,,,' " d" ..t..,i., .f "", "y b.
.ll",d f,' th, p"';' ,;th f" ,h.", of lt5.00. Ih, ,.t",;., ,h.ll b, ",.",.d ;, .,'li', ,. '0' O.'l'i" "fi".t. A'
." m" ;" p" ti" '" t b' I."" ,.,; '9 ",h ,i. .., \h p",.d, oc th, pc<' i'" ,ill b' "" id',," ,b ."",;", ,
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 FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORD 1 NG YOUR NoTI CE OF Cu";iiENCEMCm. ,"-' n s UN OER $ 2 ,500 I N VALUE
DO NOT NE 0 RECORD AND POST A "NOTICE OF COMMENCEMENT".
~./~/{I....:..-
SIGNATURE~~~~~ -~~~~~~--
CONTRA" TOR
DATE_________Sl~~~~-?7~------------
" /lfA7
_____-----------c---Y0--
SIGNATUR
NOTARY AS 10
C1\-lNEP. OR AGEN
NOTARY AS
CONTRACTOR
NOTARY PUBLIC STATE OF FLORIDA
MY COMMISSION ~~~~~$12~~!~-~~-~~~4---
~ONDED THRU GENERAL INS. UNln
DATE
MY COMMISSION
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ALAN CHEMICAL INC.
7U-L~{ 3 k.IA 6( If 1-141
3008 Orange Avenue
Fort Pierce, Florida 34947
( 407) 46419544
(813) 628~0872
CJfi~
v')~!
April 5, 1991
PROPOSAL
TO: Circle K Corp.
STORE NO: 7130
DIST. NO: 1130
LOCATION:
1201 Hwy. 54 A. E,~
Zephyrhills, Fl,
NUMBER OF TANKS:
( 2) 8,000
Reline (2) 8,000 gal. tanks per DE~ Regulation 17-61;
Repipe product lines with double wall fiberglass piping
Repipe vent lines with double wall fiberglass piping
Install OPW 61-80 overfill pr~vention on vent lines with
vapor recovery
Install OPW-1 overspi11 containment manhole below dispen-
sers on top of tanks and product line
Test tanks and lines with Florida approved'EZ-Chek equip,
Price
$14,480.00
All'Engineers Drawings and permits will be supplied by Alan
Chemical,Inc.
All work to be completed before Dec. 31, 1991.
-;
. -
THE CIRCLE K CORPORATION
MISCELLANEOUS BID AND WORK CONTRACT
CIRCLE K CORPORATION INC.
1601 N. 7TH STREET
PHOENIX, AZ 85606
STORE #
ADDRESS
#7130
ZEPHYRHILLS, FL.
CONTRACT DATE
AUGUST 7, 1991
Gentlemen:
For, and in consideration of FOURTEEN THOUSAND FOUR HUNDRED EIGHTY & 00/100
dollars, ($14,480.00 ), the "Contract Sum" to be paid by Circle K
Corporation, Inc., hereinafter called "Owner", and ALAN CHEMICAL CO.
hereinafter called "Contractor", a person, firm or corporation duly licensed
as a contractor in the State of FLORIDA hereby agree to do and perform
the following described work in accordance with and subject to the terms and
conditions printed and/or written below on the attached sheet hereof:
1) DESCRIPTION OF WORK (hereafter the "Work")
LINE (~TANK(S) WITH FIBERGLASS LINING AND Crn1PLETE DOUBLEWALL PIPING
WITH OVERFILL/OVERSPILL DEVICE ACCORDING TO FLORIDA RULES AND REGULATIONS
2) DRAWINGS AND/OR SPECIFICATIONS:
A. O~mer shall supply the following material and equipment:
NONE
B. Manner and Time of Doing Work:
Contractor agrees to commence the Work within THREE days
after acceptance of this bid by Owner, aand complete the same in good
and workmanlike manner, satisfactory and acceptable to Owner, within
14 day(s) thereafter (the" Contract Time ") Contracotr shall be
responsible to Owner for faithful completion of the Work covered
hereby in a good and workmanlike manner in accordance with all
applicable Federal, State and Local laws and regulations.
C. Contractor warrants to the Owner that all materials and equipment
incorporated in the Work will be of good quality, free from faults and
defects.
D. Contractor shall pay all sales, consumer use and other similar taxes
and shall secure and pay for all licenses and inspections necessary
for the proper execution and completion of the Work.
E. Contractor shall,at all times,keep the premises free from accumulation
of waste or ~ubbish caused by his operations.
F. To the fullest extent permitted by law, Contractor shall indemnify and
hold harmless Owner and the Owners agents and employees from
and against all claims, damages losses and expenses.
G.
Contractor is aware of all codes and ordiances
authorities and has incorporated costs of compliances
the contract sum.
of governing
therewith into
H. Contractor shall complete the Work free and clear of mechanics liens
and, when request~d, deliver to the Owner , lien waivers and
satisfactory proof that all outstanding bills incurred for material
fu~nished or services performed have, been paid, and hold Owner
harmless against: all claims, liens and damages in connection
therewith and against all consequent eost, expense and damages.
I. Contract shall be governed by law of the place where the project
is located.
HISCELLANEOUS WORK CONTRACT
PAGE TWO
3. Contractor shall furnish Owner with proof of insurance to protect
Owner from claims under worker's compensation acts and other
employee benefit acts, claims for damages because of bodily injury
including death, and from claims for damages, other than to the
work itself, to property which may arise out of or result from the
Contractor's operations under this contract, whether such operations
be by Contractor or by any subcontractor or anyone directly or
indirectly employed by any of them. This insurance shall be written
for not less than any limits of liability as specified by Owner or
required by law, whichever is the greater. Certificates of such
insurance shall be filed with the Owner prior to the commencement of
the Work.
4.
Contractor has visited site and is aware
surface conditions existing at the time of
of surface and sub -
submitting this bid.
5. Owner, without invalidating this contract, may order changes in the
Work consisting of additions, deletions or modifications, the
Contract Sum and the Contract Time being adjusted accordingly, All
such changes in the Work shall be in writing signed by Owner
(a " Change Order" ).
6. The Contract Sum and the Contract Time may be changed only by a
Change Order.
7.
8.
Executed
(signed)
(Title)
Address
If a Contractor defaults, persistently fails or neglects to carry
out the Work in accordance with the terms of this Contract, or fails
to perform any provision of the Contract, the Owner, after seven
days written notice to Contractor and without prejudice to any
any other remedy it may have,may make good such deficiencies and may
deduct the cost thereof from the payment then, or thereafter, due
Contractor or, at its option, may terminate the Contract and take
possession of the site and of all materials, eqUipment, tools and
construction equipment and machinery thereon owned by the Contractor
and may finish the Work, by whatever method it may deem expedient.
If the unpaid balance of the Contract Sum exceeds the expense of
finishing the Work, such excess shall be paid to Contractor; but if
such expense exceeds unpaid balance Contractor shall pay the
difference to Owner.
In the event of bringing any action by either party hereto as
against the other, by reason of breach of any agreement contained in
this contract, the party in whose favor final judgement shall be
entered shall be entitled to have and recover from the other party
reasonable attorney's fees to be fixed by the court together with
the courts costs.
19 9/
,-
(Contractor)
Phone
CIRCLE K
ACCEPTED.
BY:
DATE:
THE CIRCLE K CORPORATION
MISCELLANEOUS WORK CONTRACT
EXHIBIT A
1). Contractor shall be required to insure that all safety precautions are
strictly adhered to during all phases of the Work.
ISSUE DATE (MMIDDIYY)
9/11/91 al
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
At~t.lllt&
c
CERTIFICATE OF INSURANCE
PRODUCER
CRUMP E & S OF FLORIDA, INC.
1211 Semoran Blvd., Suite 227
Casselberry, Fl 32707
COMPANY A
LETTER
Mt. Hawle Insurance
f~~~NV B
INSURED
ALAN CHEMICAL, INC.
3008 Orange Avenue
Ft. Pierce, Fl 33450
COMPANY C
LETTER
f~T~~~NY D
f~~~NY E
COVERAGES ' , , " ", " .'," ',.. . '>' , , ' , "'" _'.' " ,
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
et:RTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,
CO
LTR
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MMIDDIYY) DATE (MM!DDIYY)
TYPE OF INSURANCE
A
GENERAL LIABILITY
COMPREHENS~EFORM
PREMISES/OPERA TIONS
UNDERGROUND
EXPLOSION & COLLAPSE HAZARD
PRODl:CTS!Cor~PLETED OPER,
I BODIL Y INJURY OCC,
BODIL Y INJURY AGG,
PROPERTY D,AMAGE OCC,
PROPERTY DAMAGE AGG, $
5/12/91
5/12/92
BI & PO COMBiNED OCC, S 500 000.00
BI & PC> COMBINED AGG, S 500 000.00
PERSONAL INJURY AGG, I s 500 000.00
MOL008038
CONTRACTUAL
INDEPE'mENT CGIHRACTORS
BROAD FORM PROPERTY DAMAGE
PERsor...':'.l INJURY
SURPLUS LINES AGENT Frances l. 8ro In
Lie, Il 0118267237 1211 Semoran 81'J,
SUite 227 I
Casselberry FL 32707 . 'I;
PROD AGT Sid Banack Insurance
I
CITY Vp,.n 'Reach. Fl I
" ....... I
,.. I
F1o"da Su'p1"s Ltr1cs L,w, Persons tns~r,
cd ty Surplus Llr;,~~ Ca'ners do not have
the protection of nc" Florida Insurance I
- . , '1 he e'l::pnt of any rt ht of
recovery tor the cbllgation ot any InSOIVlnt
uni;(ens~d Insurer
FILE 1/ 1001-91 3rd
~2 y l? f7 3~/f '/9 A
D:SEt,SE-PO,-,CY LIf,'.!T
, EASE-~AC~ ErJPLCYEE I s
AUTOMOBILE L1ABILlTV
ANY AUTO
BODILY It,JURY
(Per person)
All OWNED AUTOS I Prlv Pass. )
ALL owr'~=D AUTOS 1 Ot~er Tha:"l l
Pr.:v. Pass.
I BODILY INJU=iY
(Per acctoentj
HIRED ,"'JTOS
NOf>,j.OV~'~ED I-UiOS
i PR:)PE=iTY DAI.~AGE
I
l =-rt'\:: v 't1JUcv &.
I P~,3PEF'T\- OAt\"!,GE
I COMei~,;ED
: E.,A:~ OCCURPEr"CE
f-----
\'::"'3GP.::Cl..7::
GARAGE :"';;',8JLiTY
EXCESS LIABILITY
UMBRE,-Lt.. FORI~
OTHER 1~,t..r-..: UMBi=:ElLA FORt..~
WORKER'S COMPENSATION
! S"T t..:LiTOFY Uto'll,S
AND
EMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERA TlONS'LOCATIONSIVEHICLESISPECIAL ITEMS
LIMITS
s
Is
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Is
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Is
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,. t) C:l (,) (:>
CERT'FICATEJtOLOERi~...~~~f~\,_ '~;J,:..~",:~~~1;'::\~"~~~'::~' .~.2-. '.;,.~~~~~:'" I ~~l~1:'~~~CEltAnoN .~ "'~:';, . '~~1~~i..:'?,~~~~~~'~~i~~-ib~~f<..1..~~~...~~r.~:'>~ ~~"l~'~" .....:~>:.)_ ~l'~:, .~~!~;(:._
CITY OF ZEPHYRHILLS BUILDING
DEPARTMENT
5335 8th St
Attn: Roy Burnside
Zephyrhills, Fl 33540
SHOULD "",NY OF THE A30\'E DESCRIBED ?OLlCI"S BE CAr.;CELLED BEFORE ThE
EXPIRATIOI'-,! DATE TH~REOF, THE !SSU!~\G COtAPA"':Y \\'ILL E~JDE.:"VOR TO
MAIL _-1.0 DAYS VVC:l"T7Er..; i~f.)lt2E TO THE CEq"'IFtC';:E HOLDEq rJAr.~EJ TO THE
LEFT EUT FAILUr:.E TO r;",A.=L SUCH NCTIC'E SH4L~ 'r'.~;::OSE ~'JO C1BllG.:OTION G=1
LI.A.Bll1TY OF ..~t~y K!~":~ U:)ON THE (,;)t ~~." ',~
AUl HORIZED qf pr1(S~!\j7 t.. rIVE
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