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5335 - 8T11 STREET
(813)780 -0020 10891
LP /NATURAL GAS PERMIT
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Permit Number: 10891 Address: 6005 GALL BLVD
Permit Type: LP /NATURAL GAS ZEPHYRHILLS, FL.
Class of Work: FIRE -LP /NATURAL GAS Township: Range: Book:
Proposed Use: COMMERCIAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 03- 26 -21- 0010 - 11200 -0041
Improv. Cost: 1,000.00
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Date Issued: 9/08/2010 Name: SHIVA 6005 GALL LLC
Total Fees: 125.00 Address: 8100 SW 178TH ST
Amount Paid: 125.00 PALMETTO BAY FL 33157 -6163
Date Paid: 9/08/2010 Phone:
Work Desc: INSTALLATION OF NATURAL GAS
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A 'I '=•'AN L' 50.00 - 1 - •� 5.
FIRE PERMIT FEES 50.00
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Chapter 633, Florida Statutes, authorizes the City to charge and collect user fees to pay for the costs of fire
prevention and protection related activities such as inspections, plan review, administrative fees, and other
costs related to the aforementioned.
Complete Plans, Specifications and Fee Must Accompany Application. Commencement of work without written approval of
the Fire 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
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.”
-� /
CONTRA TOR SIGNATURE �3 I • IC R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOURS NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813 - 780 -0041
Jacqueline Boges
To: Kerry Barnett
Subject: PERMIT FOR AMERIGAS
Kerry I spoke with amerigas this morning and they mentioned that the permit for 6005 gall blvd was called in to be
cancelled months ago. So I am closing the permit .
Jackie Boges
Code Support Specialist
ext. 35
1
813 -780 -0020 City of.Zephyrhills Fire / C; /
Fax- 813 - 780 -0021
Permit Application t
Date Received Phone Contact r Pe `
Owner's Name I2.-ty ( 1 b�_ (ty) Owner's Phone Number
Owner's Address r � _
Fee Simple Titleholder Name Titleholder Phone Number
Fee Simple'Titleholder Address 1
4._
Job Address [ 'CD S 1.7c.-I 1 IS vd . Lot #
Sub Division Parcel # O''' Lk („ dp i) -1 Gob- OD '4 1
Bio-Hazard Waste Storage - ANNUAL ED Fumigation lent
n Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
El Controlled Bum n Hood Installation
n Emergency Generator < 30 kw IP /Natural Gas - Installation
n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale
n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL.
r y print j Other /-p L %p /-/ �.
Sprinkler n ❑ ❑ ❑ n Recreational Bum �A /C C��� `
ile. Fire Alarm ID ❑ ( I n Sparklers / " -6 6
Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations v
Hood Suppression 0 ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) �
Fire Alarm Installation n Torch Roofing/Tar Kettle CV Z Se. //a
Fire Pumps n Waste Tire Storage ANNUAL
n Fire Works
Flammable Application- ANNUAL I 1 Valuation of Project
Fuel Tanks
Q Other. 1
Contractor Company
Signature Registered Y / N I Fee Current I Y/ N 1
Address I I License # I
ELECTRICIAN Company
Signature I Registered Y/ N 1 Fee Current I Y / N j
Address I I License #.
PLUMBER Company
Signature Registered Y/ N J Fee Current I Y/ N I
Address I 1 . License #
MECHANICAL Company
Signature Registered Y / N I Fee Current 1 Y/ N 1
Address l I License # I
11
OTHER /1 Company 1i %��Mir���3J1C�i'
Signature Registered MEE ee Current [ EI
Address ewi S ri Ijo _ 1 License# �� �,-
Directions: ,
Fill out application completely.
Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner)
If over $2500, a Notice of Commencement is required (Mechanical work over $5000)
Supply two (2) sets of drawings with applicable documentation
Allow 10-14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (httpthappraiser.pascogov.com)
NOTICE OF DEED :RESTRICTIONS: The undersigned understands that this permit maybe :subject to "deed "
which may be more restrictive-than County regulations. The undersigned assumes - responsibility - for corfipliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired .a contractor or
contractors undertake work, they may be 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.
CONSTRUCTION LIEN LAW (Chapter713, 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 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 performed 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
govemment agencies may apply to the intended work, and that it is my responsibility to identify what actions I
must take to be in compliance.
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
PAYING FOR IMPROVEMENTS TO YOUR "PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT (F.S. 117.03) � �j
OWNER OR AGENT `( CONTRACTOR /2 1
Subscribed and svyolv (or a ed) befo a this Subscribed and swo r ) before me
by AN.✓ e � by
• re personal) ,rrke or has/have produced • i - 9 ` ` ej has/have produced
ryas identification. ` as identification.
Notary Public _.. go Notary Public
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Commission No. Comm ssi. JACQUELINE BOGES
E x fi r es December 12.2010
Name of Notary typed, printed or stamped Name of Nota lrettatflffeMmia
4 . ZEPiYRHILLS FIRE DEPARTMENT
6907 Dairy Road, Zephyrhills, FL 33542
Fire Chief Keith Williams Bus (813)780 -0041 Fax (813)780 -0044
FIRE SERVICE USER FEES
Occupancy No.:
Plan No.: / 7 7 Contractor: iG7 Cie 2 S
Business Name: = �A-Al feD "i iet -0-C Billing Address: .600 "14.-- r/c
Business Address: Co C , C
Business Phone No.: Billing Phone No.: r
Business Fax No.: Billing Fax No.:
Contact: Contact:
PLAN REVIEW FEES — INSPECTION FEES PERMIT FEE _ FALSE ALARM FEE
Site Plan N/C ^ Annual N/C Sprinkler $50 — 1st Alarm N/C
Multi Family /Commercial .06 sf _ 1st Re- inspection N/C Standpipes $50 —
2nd Alarm N/C
(Minimum Charge $25.00 _ 2nd Re- inspection $100 Fire Pump $50 —
3rd Alarm N/C
0 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 Heads $50 violations corrected) Natural Gas $5 0 NON COMPLIANCE $150
_ 26 plus Heads $100 _ SPRINKLER SYSTEMS I Tanks - per tank
STANDPIPE SYSTEM _ Hydro Undergrounds $45 Sparklers $100
0 Per Riser $50 _ Hydrostatic Test $65 per system Fire Works $500
FIRE PUMP _ Acceptance Test $45 per system Camp Fire $25
0 Per Pump $100 _ Hydrant Flow $75 Controlled Burn $100
— FIRE ALARM SYSTEM Hood /Duct $50
0 - 25 Devices $50 FIRE ALARM SYSTEM Place of Assembly $50 Annual
— 26 plus Devices $100 — System Acceptance $50 Fire Protection $25
SUPPRESSION SYSTEMS _ Recall Acceptance $50 Flammable Application $50 Annual
— Wet $50 _ OTHER Waste Tire Storage $50 Annual
_ Dry $50 Fire Wall /Smoke Wall $15 per wall Generator < KW $100
_ CO2 $50 Gas per tank Generator >30 KW 150
Other $50 r Natural Gas per system Bio -Hazard Waste $100 Annual
KITCHEN EXHAUST _ Fumigation Tenting $50
E l Hood /Ducts $50 _ Tent 10'x10' or greater $15 per tent Torch Pot/Applied $50
OTHER — Fire Pump $45 Haz. Materials $100 Annual
lj LP Installation per tank $50 Fire Suppression $30
Fuel Tank Installation $50 System Acceptance
(Per Tank) 50 Exhaust Hood /Duct $30
Ei Natural Gas Installation $50 _ Re - inspection DBL
(Per System) (other than annual)
0 Spray Booth $50 11 Inspection scheduled DBL
and cancelled less than
_ 24 hours
Construction Insp. N/C
_ Emergency Vehicle Acs $5 0 FALSE ALARM
PLANS TOTAL � INSPECTION TOTAL , O PERMIT TOTAL 1 --11 ] TOTAL
GRAND TOTAL I / Vic' — I
Comments:
Date: 9 /2/,
Insinctor: i - .,- y n (
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STORA,GE C..APAC TY O /OW TANiOB_ l - TOTAL 9TORACIS CAPACITY: 1: ► _
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_ Date:
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Bureau of LP Gas inspection
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`� CHARLES H. BRONSON, COMMISSIONER OF AGRICULTURE 3125 Conner Blvd., Suite N
DEPARTMENT OF AGRICULTURE & CONSUMER SERVICES Attention: • FL 32399 Field Adminitra tra tor
+ .'= BUREAU OF LP GAS INSPECTION
Attention:
Phone: 850021- 8001
State of Honda FACILITY INSPECTION REPORT Fax: 8504921 - 8079
`Inspector ID: 33 Iltnspection Type: S'' l fracility Type:62 IICounty Code: g j JTotal Storage: /0 Q 0 I
BUSINESS NAME: 21/ /n �LI f toto %y7 ST } ATUS STATUS DATE: i - __ I _ LICENSE #:
PHYSICAL LOCATION: 4 D 0. a A� C /QIV Q .2 / » /J'll //1 .1BUSINEs& 1oNE: ( _ ) -- FAX: L_ --
OWNERSHIP CHANGE? NE
GE? YES NO BUSSS OWNERSHIP VERIFIED BY: x
SUPPLIER NAME: A 2 l / - s SUPPLIER LICENSE #: 0 D�,,,2
SUPPLIER LOCATION: L I ' a? / ' L I b rxrn71,0 itt/wk PAZ INSURANCE EXPIRATION DATE:
Qualifier Name - . to Tyype&CIass Test Date Expiration Date
OWNED BY: 0 SUPPLIER 0 LICENSE/OPERATOR 0 OTHER CONTAINER SIZE (WATER CAPACITY):
r'ONTALNER MFG. & SERIAL NUMBER: pc) Aviv CD / D O $', L D J
An inspection of the LP gas facility listed above was conducted on this date. The following code deficiencies were noted and must be
corrected within the time frames) specified. A reinspection may be conducted at the end of the designated time period to verify
correction. Any deficiencies not corrected at the time of reinspection will be subject to administrable fines pursuant to Chapter 527,
Flonda Statutes. NOTE: REQUESTS FOR TIME EXTENSIONS MUST BE SUBMITTED TO THE ADDRESS IN THE UPPER RIGHT
HAND CORNER OF THIS FORM IN WRITING STATING THE REASON(S) AND LENGTH OF THE REQUESTED EXTENSION. Such
requests are subject to approval of the Bureau of LP Gas Inspection.
CORRECT PREVIOUS
REFERENCE DESCRIPTION OF CONDITION BY' f CFfE?
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All conditions identified as "past due" must be corrected immediately before further use or operation of the equipment. An
administrative fine may be imposed for any violation cited. REMOVAL OF A RED TAG LS PROHIBITED BY LAW unless
authorized by the Bureau of LP Gas Inspection.
O
DATE OF THIS REPORT: 8 71 a LP GAS INSPE • OR NAME: FRED HOOVER
I ACKNOWLEDGE RECEIPT OF THIS REPORT (SIGNATURE): 1 t t , ,' , .. ,
PRINTED NAME /TITLE OF SIGNEE: x ' ' �� - �' )
INSPECTOR TIME OF ARRIVAL: / I I SS` ATTACHMENTS: DATE: ?4 7 kO
t r.1 CS -03522
COI Distribution: Original - Tallahassee; Gold - Licensee; Pink b Yellow - Field inspector
Pasco County Parcel: 03- 26 -21- 0010 -11200 -0041 001 Page 1 of 1
Data Current as Of: Weekly Archive - Saturday, September 04, 2010
Parcel ID 03- 26 -21- 0010 - 11200 -0041 (Card: 001 of 004)
Classification 11 - Retail Stores, One Story, All Types
Mailing Address Property Value
SHIVA 6005 GALL LLC Ag Land $0
8100 SW 178TH ST Land $574,036
PALMETTO BAY FL 33157 -6163 Building $782,343
Physical Address - See All 6 addresses (First Extra Features $21,785
Shown)
6005 GALL BLVD Market Value $1,378,164
ZEPHYRHILLS FL 33542-2501 Assessed (Non - School Amendment
Legal Description (First 4 Lines) 1) $1,378,164
COM AT SW COR OF SE1 /4 OF
SE1 /4 OF SEC 3 TH S89DEG 08' Taxable Value $1,378,164
22 "E ALONG SOUTH LINE OF SEC 3
ALSO BEING C/L OF GEIGER RD
Land Detail (Card: 001 of 004)
Line Use Description Zoning Units Type Price Condition Value
1 1100 STORE 1FLR 00C2 11,000.00 SF $14.25 0.90 $141,075
2 1100 STORE 1FLR 00C2 39,000.00 a $10.00 0.90 $351,000
3 1100 STORE 1FLR 00C2 18,141.00_ SF $5.02 0.90 $81,961
Additional Land Information
Acres 1.56 I Area 302H Code I X Residential Code ZHCCLU4 Commerical Code CMAJ2ED
Building Information - Use 95 - Convienience Stores (Card: 001 of 004)
Year Built 2008 Stories 1.0
Exterior Wall '1 Cut Block Exterior Wall 2 None
Roof Structure Rigid Frame w /Bar Joist Roof Cover Metal
Interior Wall 1 Drywall Interior Wall 2 None
Flooring :1 Ceramic Clay Tile Flooring .2 None
Fuel Electric Heat Forced Air - Ducted
A/C Central Baths 2.0
Line Description Sq. Feet Repl. Cost New
1 BAS 2,610 $295,191
2 -- - -- - - - - --
fI 90 $5,090
3 CSC 3,840 $43,430
4 FDU 700 $47,502
Extra Features (Card: 001 of 004)
Line Description Year Units Value
1 PAV ASP 2008 23,080 $17,137
2 PAV CON 2008 2,860 $4,648
Sales History
Previous Owner SYNOVUS BANK
Year _ Month Book /Page Type Amount
2010 04 8324 / 0025 WD $1,650,000
2010 04 8319/ 1721 CT $0
2006. 11 7294 / 0902 WD $0
http: / /appraiser.pascogov. com/ search /parcel. aspx ?sec =03 &twn= 26 &mg=21 &sbb= 0010 &bl... 9/7/2010