HomeMy WebLinkAbout14-15745 • - -'� CITY OF ZE HYRHILLS
5335— SCREET
�si3��s -oa2o 157 5
BUIL.DIN PERMIT
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` % PERMIT�lNFQ,RMATION �.. ' - `, � � ` ""µ�' � �LC?CA�TI.ON�INFORMA�TION�`�� ���� -_.��?�
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Permit Number: 15745 Address: 6126 GALL BLVD
' Permit Type: DEMOLITION ZEPHYRHILLS, FL.
Class ofi V1/ork: 636-DEMQLITION Township: Range: Boak:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Eeet; Subdivision: CITY QF ZEPHYRHII�LS
Est. Value: � �S"po, ao Parcel Number: 03-26-21-Q010-11200-001Q
tmprov. Cast: ' ; f�'�_��,,�.};.r�._. - q- �- � - e
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.�__�,_�.�� �;��QitifNER�INFORMATf:C?N ,�. �;.,.�.�
' Date Issued: 10I29/2014 Name: HUPP RETAIL ZEPHYRHiLLS LLC
Total Fees: 105.00 Address: 907 S FORT HARRISON AVE STE 102
Amount Paid: 105.�0 CLEARWATER FL 33756-3937
� Date Paid: 10/29/2014 Phane: 727-210-19Q0
Work Desc: DEMO�.ITITI{�N �21C�
� C.ONTRACTOR S � ' " APPLICATION'F�EES �"��:`��°,� .`-.�f;' � °';:�;�=���
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� REINSPECTION FEES: Reinspection fees will camply ith Florida Statute 553.80 (2)(c)when extra inspection
j trips are necessary due to any one of the fallowing re sans: a)wrong address b)condemned work resulting
from faulty constructian c) repairs or corrections no made when inspections called d) work not ready for
' inspection when called e) permit not posted on ja sifie� ptans nat at ja6 site g}work nat accessible.
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tVOTICE: In addition to the requirements af this permit, ther may be additianal restrictions app{icable to this property that
may be found in the public records of this county, and ther may be additional permits required from other governmentai
entities such as water manageme t, state agencies or federal agencies.
i "Warning to awner: Yaur failure to record a notice f cammencement may resuit in your paying twice for
' improvements ta your property. If you intend to ab in financing,consult with your lender or an attorney
befare recarding your otice of cammencement,°
' Comple#e Plans, Specifications Must Accampany Appl cation.All work shall be pertormed in accordance with
Ci Cades and Ordinances. NO OCCUPANCY BEFO C,4.
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O T CTOR SlGNATURE PERMIT OFFI R
PERMIT EXPIRES IN fi MONTHS ITHOUT APPROVED INSPECTION
CALL PQR INSPECTION - HOUR NOTICE REQUIRED
PRO'�ECT CAR FROM WEATHER
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' ' e���so-oozo City of Zephyrhills ermit Application Fax-e�a-�eaaoz�
' ' Building D partrnent
Date Received Phone Contact for P itting Z 1 - /���
Owners Name 1����IL � A' Owner Phone Number '7 Z7' 2�Q- ��O G7
Owners Address 0 S• r �� d!I S 0.� P/L= �L Owner Phone Numher
Fee Simple TiUeholder Name �d'/37 C Owner Phone Number
Fee Slmple TiGeholderAddress
JOBADDRESS LIZG� G�LL /JL�G ZEPH /I /I�S FL ��5�-17- LOT# �
i SUBDIVISION �1�f��S �oloN �-o1h �Iw NDS'pARCEL I �,��Z�s" z j- 00/O- � �00 ' �'�D J Q
(08TAINED FROM PROPERTY TAX NO710E)
WORK PROPOSED B NEW CoNSiR e ADD/ALT 0 SIGN Q � DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM Q OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME Q STEEL Q
DESCRIPTION OF WORK EI o OG CG 6YLU N U/��. R i vb'
BUILDING SIZE �i d� � � SQ FOOTAGE ��� HEIGHT N�
�BUI G $ Q a Sr� VALUA N OF OTAL CONSTRUCTION
l
i QELEC $ AMP SERVICE Q PROGRESS ENERGY Q W.R�C.
' OPLUMBING $ ��S
QMECHANICAL $ VALUATION OF ECHANICAL INSTALLATION �1' ��
QGAS Q ROOFING Q SPECIALTY Q OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZO E AREA QYES NO
BUILDER COMP NY
SIGNATURE �cis o Y/ N F�cuw�n Y/N
Address License�
ELECTRICIAN COMP
SIGNATURE REGIS D Y/ N �cuRREn Y/N
Address License#
PLUMBER COMP
SIGNATURE REGIS RED Y/ N FEE CuRrtEn Y/N
Address License#
MECHANICAL COMP
I SIGNATURE REGIS RED Y/ N F�cuwtEn Y/N
Address License�
OTHER COMP �ay+}yt�O !C'���cX1Bt fl:.x/�L- Q�10(�/� Q
SIGNATURE r�Gls r�o Y/ N F�cuw�n Y/N
Address �07��G�/olsco�ST CLcvTrt �'� 3 3��' License# ' D�' �f�o
1111111111111111111111111111111111111111111111111111111111111111111
RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of nergy Fortns;R-O-W Pertnit for new construction,
Minimum ten(10)woriting days after submittal date. Requ d onsite,ConsWCtion Plans,Stortrnvater Plans w/Silt Fence installed,
Sanitary FaciliGes 8 1 dumpster,Site Wark Pertnit for sub visions/large projects
COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safe Page;(1)set of Energy Fartns.R-O-W Pertnit for new construcdon.
Minimum ten(10)working days after submittal date. Requ ed onsite,Construction Plans,Stortnwater Plans w!Silt Fence fnsfalled,
Sanitary Faalities&1 dumpster.Site Work Permit for all n w projects.AII commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
'""PROPERTY SURVEY required for all NEW conswctio .
Directions:
Fill out applicaUon completely.
Owner&ConUactor sign back of application,notarized
� If over Sz500,a Notlee of Commeneement is required. (A/C upgrad over 57500)
" Agent(for the contractor)or Power of Attomey(for the owner)would be s meone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITf1NG (Front of Application Onry)
Reroofs if shingles Sewers Service Upgrades A/C Fences(PI USurvey/Footage)
Driveways-Not over Counter iF on public roadways..needs ROW
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NOTICE OF DEED RESTRICTIONS: The undersigned unde tands that this permit may be subject to"deed"restrictions°
which may be more resVictive than County regulations. The ndersigned assumes responsibility for compliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RE PONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work,they may be required to be li nsed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the own r and contractor may be cited for a misdemeanor violation
under state law. If the owner or intended contractor are un rtain 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 o contractors, he is advised to have the conVactor(s) sign
portions of the"contractor Block"of this application for whic they will be responsible. If you,as the owner sign as the
contractor,that may be an indication that he is not properly icensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACTNTILITIES IMPACT AND RE OURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fe s may apply to the construction of new buildings,change of
use in existing buildings, or expansion of existing buildings, s specified in Pasco County Ordinance number 89-07 and
90-07,as amended. The undersigned also understands,th t such fees,as may be due,will be identified at the time of
permitting. It is further understood that Transportation Impa Fees and Resource Recovery Fees must be paid prior to
receiving a"certificate of occupanc�'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 is uance. Furthermore, if Pasco County WatedSewer Impact
fees are due,they must be paid prior to permit issuance in a rdance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter 713,Florida Statut ,as amended): If valuation of work is$2,500.00 or more,I
certify that I, the applicant, have been provided with a py of the "Florida Construction Lien Law—Homeowner's
Protection Guide°prepared by the Florida Department of A riculture and Consumer Affairs. If the applicant is someone
other than the"owne�',I certify that I have obtained a copy o 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 e information in this application is accurate and that all work
will be done in compliance with all applicable laws regulatin construction,zoning and land development. Application is
hereby made to obtain a permit to do work and installati n as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all wo will be pertormed to meet standards of all laws regulating
construction, County and City cades, zoning regulations, nd land development regulaUons in the jurisdiction. I also
� oertify that I understand that the regulations of other govem ent agencies may apply to the intended work,and that it is
my responsibility to identify what actions I must take to be in mpliance. Such agencies include but are not limited to:
- Department of Environmental Protection-Cypre s Bayheads, Wetland Areas and Environmentally Sensitive
Lands,WatedVllastewater Treatment.
- Southwest Florida Water Management Dis 'ct-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Artny Corps of Engineers-Seawalls,Docks,Navi able Waterways.
- Department of Health 8 Rehabilitative Servi /Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos batement.
- Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use o fill:
- Use of fill is not allowed in Flood Zone"V"unles expressly permitted.
- If the fill material is to be used in Flood Zo e "A", it is understood that a drainage plan addressing a
"compensating volume"will be submitted at tim 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 II the area within the stem wall.
- If fill material is to be used in any area, I rtify that use of such flll will not adversely affect adjacent
properties. If use of fill is found to adversely a ect adjacent properties,the owner may be cited for violating
the conditions of the building permit issued un er the attached permit appliqtion,for lots less than one(1)
acre which are elevated by fill,an engineered dr inage plan is required.
If I am the AGENT FOR THE OWNER,I promise in good fa th to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understa that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or oth r installa6ons 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 is ance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans,canstruction or viol 'ons of any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced 'thin 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 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 NOTICE OF COMMENCEMENT MAY RESULT IN YOUR `
PAYING TWICE FOR IIV,P OVEMENTS TO YOUR PROP RTY. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
WITH YOUR LENDE AN ATTORNEY BEFORE REC RDING Y N TIC OF C MMENCEMENT.
FLORIDA JURAT(F.S.11 .03 ---- -
OWNERORAGENT CO TRACT
Sub bed and swo to r a}fi � efore 'fhi 1 Su 'b d and t (or affi e efore me this
/d by � � /0 0 / d i?. .77�saA+rE
o is/are person Ity known to me or h is/are ersonall kno e or has/have produced
asidentification. asidentificafion.
\��2��LL,4G1� Notary Public Notary Public
Commission No. ��7�f`� Co mission No. �� D��/1�7.5� �
/ !;�'CK% �it/LTLL'��
o , mped Ne e of Notary typed,printed or stamped
���+q� Notary Public Ssate of Ftorida
jo�r°��n Notary Public State of Florida Peter T Ba�+�ett
. , Rosalie M Gallina � ,� My Commiss�on FF 054295
� ����� MyCommissionEE080868 �o�ao� Expires09J�E�2017
'�or f�° Ex�irea 9�/16/�91�
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014171371
Pertnit No. � S T�� P ID Na �J 'Z�O -2 �- �O l O-�� Z b O- d C�� d
/ NOTiCE OF COM ENCEMENT
StateM �L D2�Q�1 C ntyof ��'T� e Q
. THE UNDERSIGNED hereby Bivea notice fhet fmprovement wi0 ba made to n real propeAy,end tn exartence with Chepter 713,Floride SfsWtes,
the faUowing IMormatlon Is provlded tn this Notice of Cmnmancement
7. DesufpBon oT Properry:Parcel IdenUflcaUan No. O 3 'Z C Z�' 00/O - �( '1-00 � O O f O
s+ree�naa��: 6 � 2 � GA(.L 8�v D. e��N Y� ���c.�s L 3 s 4 2._
2. Genrlal Desaiptlon of Improvement C�M �C'TE Q G o 1�I Io�t/ O�' ON GS j T02 ���
Co•n,MC�c„�� STRULfu�E �o2,��a gc Lrauoa I ��!'�
N s�
3. Oxmer IMortnetlon or Lessee iMonnetion if tha Lessea conhacted}o the improuemer� �m'•
u'"� . �mW
e �ft'irce�+�' �-337�(v , ° N
Addre � Cfty Stete � r+
Interest in P�operty: d O
i Neme of Fee Simple lltleholder. .S�r►''L
N
pf d'rtTerent irom Owner Iisted ebo ) ,~..�...��
F- p
Address /� /� Stete N �..
Contrednr. Olti !L i � � G /J MO [0 AL o� � ��
o �e t S on! S�' C L 81�2 w.�!=TG R _� �p��
Addreu CRY Slete �C �
ConireCafs Telephone No.: 1'Z Z- y�'3 -I�I 4$
A
5. Surety. �
Neme , , �
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Address Gry State
Amamt of Boml:E Telephone No.:
6. Lender.
- Neme
�i�� S� �3��
dresa 3 d
„ Lenders Telephone No.: ' — � 8
7. Parsons within the State of Florida desfgnated by the ovmer up n whom notices or other documents may be served as pmvlded by
Sedion T13.13(1)(a)(!),flmida Stetutea , �+D
�c
Name / �N D
(O N
��
Address Cih Sfete �~�
p
Telephone Number of Designated Person: �r M
e. In eddition to himself,the owner designates �_ �r
to re�iva a aopyr tha Llenors NoBce as ~w�
provided In Secdan 713.13(1)(b).Florlda Stetutes. ��o
Tetephone Number of Pason ar Entity peslgnated by Owner, �3 �
a
9. E�iretion date ot Nottce o}CanmencemeM(the e�irallon dete m not•be betae the completlon af corutruWon end ftnel paymW to Ihe c"'i
eantrector.bul wN be one year fran the deta ai reeor�n8�dess e reirt dete is spedfiedg �~o
t�
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWN R AFfER THE EXPIRATION OF THE NOTiCE OF COMMENCEMENT �p m
ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTE 713, PART 1, SECTION 773.13, FLORIDA STATUTES, AND CAN .A�
RESULT IN YOUR PAYINCa T1MCE FOR IMPROVEMENTS T YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON 7HE JOB SITE BEFORE THE FIR T�1 SPECTION. IF YOU INTEND TO 08TAIN FIM/WCING,CONSULT �r�°
iMTH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCIN RK CR RECORDINO YOUR NOTICE OF COMMENCEMENT. �
•` , o
Under penelty of pe�Jury,I dedere that I heva reed tlie foregotng o encement end thet fhe tec{s atet'ed therein ere trua to fhe besl -r� �
ot my knowledge and heGeL M �
STATE OF FLORIDA � �
r
COUNTY OF7+R9C�U /N�1/� � i �
m
Si of Lossee,a s ar 's Authorized �
' Offlem lredor/P ag�
Ow,v� �
Sipne s TitlafOlfi�e
The foregotng ins�umentwas admoxAedped before me this,'�day ot • ' ,20�n„ � dre.,��.�jp
r e$ (type of eulhmity,e.g.,afflcer,hustee,ariamey In fatl)for ,
, (n T parry on behelf oT Instrument was ezearted).
Personally Knwm�f�$produced IdeMKceUon❑ Natery Ign
Typo M IdenCfieadon Pmdueed � Neme( rd)_ �L��� �i e
,
� � �Mpr v�� Notery Public State oi Floride
; Roselie M Gallina
� My Commiesion EE08C858
. �'�orn� �pires6W1e/2016
wpdeta/bcs/noBcecortnnencement�C053W8 �
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, THIS IS T��CcRTIFY THA7 TM�Ff�RE�C�IN"�.-�1�A *s�
TRUE AND CURRECT GOPY OF TME�iO�UMENT � '
ON F1E.E OR 4F PUBk.IC RECORD I#�TH1S OFF(CE • ', �
WIT E�S MY MAND AN 0 FI IAL SEAL THIS � ° r"�°`��"�•r'�"�r °
'��" �
�� DAY C?F � 2 f � � � �� .
PAULA . O'NEIL, G PTRpL� �
�X 1�$y
BY PUTY CLERK S',�,���������'"
10-22-74,Q3 46PM;Fram hupprealty To.4614756 ;7272101801 # 1f 4
, ��0l221�024 14:$6 7274514755 HOWARD �YMhiIE st�G P�GE 01181
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f��J'�»1�1�fA Fcac(7?7J I�-175d pC:�f{Cd976
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' �'�eiiy Z.acatian ���6 Gai1 Blvd,(�wY� 1),Z�pS�yz�i3ls,�'I�3�42
• �egal Des��i�Ori 03-26-21�-U(��U-12�0{�-Q �0 tfq�er ABC I..zquorl
i C}c�er cn Persa�t to Ca�t�t �upp��il ephy�'�S�s,�LC �!o I1r��dz�w�up;�
�07�.�"�.� 'saa�.v�.,Sui�e 3�2
��,earwater, �3'�56
�'S�#727-21�0 90d!�'a�,?27 2�Q-3 941
Squa��'eeL �,2XQ�q,ft. ..
��xdaus NYatcri�.l 7�!D Ty�,e- B�?
Dcs�pdar�a� zk
�e�ce�to do a co��►�ete demoJaia+��.��'�e comme�rci�struct�;cT�rive�vay�d
�a�c�lo�at tlle�bove li�tecl$�dx�ss-�t'e `1 c���'cd��t��se�rer�e�s r�,ufx�d.
We t�i�urav�d��d z�ist��1 silt barriefi t e�o��+�cantrol�eza,c�and t�ee l�axxicad��,as
zE��r��..�e w�.t o�Y��ze demolitiazz pe 't ar��t�ase costs are iz�c�ude�ars t�e
�t�ntr�+ct pri�e.A�il cienac�lit�cas�d�brs�vvs.��ae tz�s�orted to��land�.tl..�1 cc�aaczet�
sla�b�s,:�texs a3td asghai�t c1�zv'ewap�nd�sr lot���i�ls will gQ���he xec�+c�
�l�t1t.'S'�e laad��'ees�wai�t b�ourres�oz�s�b liiy and�re z�.cluded iu tha r,o�.ttact price,
Th�aa�:a wi11 b�xougli graded,�aUowing th �te�ak#zar�.�o�ii.�z�tion fees to and from
k'as�o Co�aty�re xnciuded, '��t tt�car�,;tb� �ppros.�?)�tt�are to ba re�aaved,
accorc�i,ng tio the de�mo�i�ia�,s��te piap,.'�3ae c s�far o�.e i�ee a�.d stam�xe�o^va3 is zte,v��
�rel�w:
�ners',�,,,x�es,�nsiba�itiss;H'av��1 `a�wer,and utilii�es t�el�t�ti��,��
�ttv,e�rc;�Xt►�c�e alI requized l�s6estos S� ey,A��tc�z��ta�`�,g�'�i�.P�sr�
C��ty; *R�t�nsxb�e fax Coc�,ty't�'ee insp tiozt a��lor remflva�petmit f�e(��.
**,��sce�,ta�ce Qf�nt�a�:"sXr��ave az��l t�nd�rstz�c�tb;e sco�e o����GxS:and
desc�iptiou as�st.�ct abova.I�oward T�tt�ze�c,�s b:�xaby�tt.thorized to pe=foYm�e5�
sexviceB as writt�a.'We re�sa al�st�ciura�. va;�e ri�its,fz.e.oa�p�r v�,�xs,pi�e,
ali�aaa�mc�,st�el an,d�xechani+c�syst�m,s cv tai�o;�d�vif�sn tne�n.tcttzre). �
� Faym.e�t due%t�o,�dia�e�y upo�com Ie�c�zx c�fc��z�tol��zc�n.�vit�S�a� f`��°�f
. . �io�c� �o�r�s}
Date a�'Quot� 1011�/14
�a ��15,3�0.{� Pezsos�Quotira� Hav�iar��t 3��
TFees c�stu�oa.�s{7} l,�fl�.0
Sitt feuce Tucl,utled
Se�x c�p • �SSC�ud�d
i�e�,a�ermit �c��td�cl
Mo��uatio��ee �;aXudecl
Tot�l�'l�t� $�.���DO.
. �rapased Completian���te, 4 wor� d'sys
j l�` � � ,,�'
�waerJ,A.gen�Pr�nt�d rram,� �✓ , � A.ge��z 7�$re
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Confractox � c zs i�ia�cts�
�D n0odifi!r�dOri e£lhis Conira�wilt bC effi�ctivc t�ss9 it is tA�ii�uhd ic is sigp�d by hoth parciw.'�his conu�t 4irjds w2d
bcae5t�6c�hpacttcs and smy 9ucCi�toc0.�ttt�ia af tlso c�eace tHis ca�#act 7t2i5 dGCtuacFSt,iqe3uSin�uay u�ehmenks,is tho
�ti�egcezm�t brtwem thc patHes. �
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■Immediat Response
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■ Fungal a d Bacterial Sampling
■ Mold Re ediation Design
■ Remedia ion Monitoring
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` CITY O ZE�'�.�YRHILL�
6 �
"Ci of Pure Water'•
Buil ing Department
� = 5335 Eighth Stre t•Zephyrhills,Flarida 33542-4312
(813 78 -0020•Fax(813)780-0021
W.A."Bill"Bargess
D'uectar of Building
Licensing&Zaning
Contracto� A►.sbestos No 'fica�ion Statement
Per Fiarida Buildin Code 105.9 Asbestas. The enfor in a enc shall r uize each buildin ermit for
tlie demalition or renovarion of an existin structure to c ntain an asbestos notification statement which
iudicates the owner's or o erator's res onsibili to co�n l with the rovisions of Section 469,003
Florida Statutes and to noia the De artment of En ' onmenta�Protection of his or her inte�ntions to
reffiave asbestas when� Yic�bi in accorclance wi state�nd feder�I law.
46�.OQ3 I.icense Require,�l—
1. No person may conduct an asbestos s ey,develop an opera�ion and maintenance plan,
ar monitor and evaluate asbestos abate ent vuless trained and licensed as an asbestos
consultant as required by this chapter.
2.(�) No person rnay prepare asbestos abate nt specifications unless trained and licensed as
an asbestas consultant as required by chapter.
(Y�) Any person engaged in the business af sbestos swrveys prior ta October 1, 1987,who
has been certified by the Departrnent of abor and Employment Securily as a certified
asbestos surveyor and who has compli with the training requarements of S.
469.013(1)(b),may provide survey se ces as described in S.255.553(2),(2)and(3}.
Tf�e Department of Labor and Emplo ent Security may,by rule,establish violations,
disciplinary procedures,and penalties f r certified asbestos surveyors.
3. No person may conduct asbestos abate ent work unless licensed by the department
under this chapter as an asbestos cantra tor,except as otherwise provided in this chapter.
I certi£y that I have read and understaud and will compl with the provisions of this asbestos notification
s ement and that I 'll comply with all state and fieder 1 regulations pertaining to asbestos.
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` nse Hold 1 ontractor Signature Date
��/� � �' �9 6��
icense HolderlContractor Printed Name License Numbex
�i� � � ��Zt.. t��U�. �e t �`��t�S �� ��S-�I �
Address of Construction Site
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Pennit Numbez'
I
s
ENl�IRO�1 f�TAL SERVICES, LLC
PR DEMOLITION
ASBESTOS NSPECTION REPORT
FOR
FORMER BC LIQUOR STORE
6126 G LL BOULEVARD
ZEPH HILLS, FLORIDA
repared for
HUPP EALTY ADVISORS
907 S FOR HARRISON AVENUE
SUITE 102
CLEARW TER, FLORIDA 33756
ATTENTION: MS. ROSALIE GALLINA
.
, repared by
EE�G
EE8�G Envi onmental Services, LLC
5005 West aurel Street, Suite 110
Tam a, Floritla 33607
( 13)287-1005
.eeandg.com
O tober 7, 2014
EE&G roject No. 2014-4494
EE�G: Asbestos Surve October 7 2014
CONT NTS
Section Paae
1.0 - INTRODUCTION ....................................... .................................................................... 1-1
2.0 - BUILDING DESCRIPTION......................... .................................................................... 2-1
3.0- METHODS AND LIMITATIONS ................. .................................................................... 3-1
3.1 ASBESTOS SURVEY METHOD ................................................................... 3-1
3.2 LABORi4TORY ANALYSIS MET ODS............................................................ 3-1
3.3 LIMITATIONS ............................. .................................................................... 3-1
4.0-SURVEY RESULTS........................................................................................................4-1
4.1 ASBESTOS ANALYSIS RESUL S.................................................................. 4-1
4.2 ADDITIONAL OBSERVATIONS.......................................................................4-1
5.0- RECOMMENDATIONS................................�................................................................... 5-1
5.1 RECOMMENDATIONS FOR RE ULATED (FRIABLE)ACM.......................... 5-1
5.2 RECOMMENDATIONS FOR CA EGORY I NONFRIABLE ACM .................... 5-1
5.3 RECOMMENDATIONS FOR CA EGORY II NONFRIABLE ACM ................... 5-1
5.4 GENERAL RECOMMENDATIO S.................................................................. 5-1
5.5 SPECIFIC RECOMMENDATION ................................................................... 5-1
6.0-SIGNATURE PAGE.................................. ..................................................................... 6-1
TABLES
TABLE1 Survey Results........................... ..................................................................... 4-2
APPENDICES
APPENDIX A General Terms: Types of Asbe tos-Containing Materials
Types of Asbe tos-Containing Roofing Materials
NESHAP Cat ories
APPENDIX B Laboratory Report
APPENDIX C Certificates
HUPP ZHILLS GALL BLVD SURVEY REPORT I
EE�G: Asbestos Surve October 7 2014
SECTI N 1.0
INTROD CTION
An asbestos inspection was conducted at a for er ABC Liquors located at 6126 Gall Boulevard,
Zephyrhills, Florida. The inspection was conduc ed on September 24, 2014 by AHERA-certified
inspector Michael Reid of EE&G Environmental ervices, LLC (EE&G).
The purpose of this asbestos inspection was t identify the presence, extent, and condition of
asbestos-containing materials (ACM) in the su eyed areas of this facility. The areas surveyed
during this inspection include all areas associ ted with the former ABC Liquors. All observed
suspect materials were either sampled to dete mine asbestos content or assumed to contain
asbestos.
Terms used in this report are defined in the. eneral Terms section located in Appendix A.
Additional information on the classification o ACM for National Emissions Standards for
Hazardous Air Pollutants (NESHAP) is also loc ted in Appendix A. These NESHAP categories
are helpful in determining the need for asbesto abatement and must be used in the NESHAP
notification of intent to renovate or demolish.
HUPP ZHILLS GALL BLVD SURVEY REPORT -"I
I
EE�G: Asbestos Surve October 7 2014
SECTI N 2.0
BUILDING D SCRIPTION
The structure was observed to be constructed f concrete block and wood. Interior walls were
finished with drywall. Ceilings were finished wit drop-in ceiling tile panels and limited areas of
drywall. Floors were finished with vinyl floor til or linoleum. The HVAC duct was uninsulated
sheet metal, fiberglass-insulated sheet metal, or fiberglass flex-duct. -
HUPP ZHILLS GALL BLVD SURVEY REPORT -�
EE�G: Asbestos Surve October 7 2014
SECTI N 3.0
METHODS AN LIMITATIONS
, 3.1 ASBESTOS SURVEY METHODS
The demolition areas were inspected for suspe t ACM, unless otherwise noted. Each observed
suspect material was assigned a homogenous area number, described, and measured. Each
observed suspect material was either sampled r assumed to be asbestos-containing. Samples
of suspect ACM were collected using proce ures established by the United States (US)
Environmental Protection Agency (EPA) Code f Federal Regulations (CFR) Title 40 Part 763
Subpart E,Asbestos-Containing Materials in Sc ools.
3.2 LABORATORY ANALYSIS METHODS
Samples were delivered to American Asbestos aboratories, Inc. in Tampa, Florida for analysis.
Upon arrival at the laboratory, the samples w re logged-in and stored for analysis. Analyses
were performed using the polarized light micro copy (PLM) method of asbestos detection using
, guidelines and procedures established in the ethod for the Determination of Asbestos in Bulk
Building Materials (EPA-600/R-93-116 July, 19 3).
3.3 LIMITATIONS
This asbestos ins ection re ort has been re red b EE&G in a manner consistent with that
P p P P Y
level of care and skill ordinarily exercised by members of the profession currently practicing
under similar conditions. No other warranty, e pressed or implied is made. The intent of this
survey report is to assist the owner or client i locating ACM. Under no circumstances is this
survey to be utilized as a proposal or a proje t specification document without the expressed
written consent of EE8�G.
The survey was conducted to identify suspect CM in accessible areas of the structure. If other
areas at this location are to be impacted du ing planned or future renovations, a separate
asbestos survey of these areas will be required Some ACM may not have been discovered due
to inaccessibility or missing/incomplete plans. ny suspect materials discovered subsequent to
the issue of this survey report should be samp ed and analyzed to determine asbestos content
and to initiate appropriate responses.
Analyses were carried out by PLM. While the most commonly accepted analytical method for
detecting asbestos in bulk materials, PLM is known to have limited resolution and may not
detect extremely small asbestos fibers. Certai materials, notably vinyl floor tiles, may contain
extremely fine asbestos fibers that are beyond he resolution of PLM.
EE&G's interpretations and recommendations are based upon the results of sample collection
and analyses in compliance with environme tal regulations, quality control and assurance
standards, and the scope of work as indicated in EE&G's proposal, dated September 19, 2014.
The results, conclusions, and recommendatio s contained in this report pertain to conditions
observed at the time of the survey. Other co ditions elsewhere in the subject building(s) may
HUPP ZHILLS GALL BLVD SURVEY REPORT -�
EE�G: Asbestos Surve October 7 2014
differ from those in the inspected/surveyed loc tions and, such conditions are unknown, may
change over time, and have not been considere .
This report was prepared solely for the use of E &G's client, and is not intended for use by third
party beneficiaries. The client shall indemnify a d hold EE&G harmless against any liability for
any loss arising out of or relating to relianc by any third party on any work performed
thereunder, or the contents of this report. EE8�G will not be held responsible for the
interpretation or use by others of data develope pursuant to the compilation of this report, or for
use of segregated portions of this report. .
HUPP ZHILLS GALL BLVD SURVEY REPORT 3-Z
_
EE�G: Asbestos Surve October 7 2014
SECTI N 4.0
SURVEY ESULTS
4.1 ASBESTOS ANALYSIS RESULTS
The results of the PLM analyses and assessm t of suspect ACM are summarized in Table 1.
The original laboratory report is attached as App ndix B.
4.1.1 Asbestos-containinq materials
Asbestos was not identified in the sampled mat rials.
4.1.2 Nonasbestos-containina materials
Asbestos was not detected in the following sam led materials:
. Tan sheet vinyl.
. White drywall system.
. White 2'x2' ceiling tile.
• White exterior stucco.
• Gray concrete slab.
• White 2'x4' ceiling tile.
• Tan 12"x12"vinyl floor tile(VFT).
Refer to Table 1 for the location of these materi Is.
4.2 ADDITIONAL OBSERVATIONS
In addition to the results presented in Section 4.1, EE&G observed the following:
. No suspect friable pipe thermal stem insulation (TSI)was observed.
• No suspect fireproofing was obs rved.
HUPP ZHILLS GALL BLVD SURVEY REPORT -'I
I
� '
EE�G: Asbestos Survey October 7, 2014
TABLE 1. SURVEY RESULTS FOR FORMER ABC LIQUOR, 6126 GALL BLVD, ZEPHRHILLS, FL
HA Material Description Sample ID HA Location Approx. Asbestos Friability Condition NESHAP
Quantity Content Category
01 Tan sheet vinyl 001-003 Dance floor area NA NAD NA NA NA
02 White drywall system 004-006 Interior walls NA NAD NA NA NA
02 White 2'x2' CT 007-009 Interior ceiling NA NAD NA NA NA
03 White exterior block stucco 010-012 Exterior walls NA NAD NA NA NA
013-015 Slab/subfloor NA NAD NA NA NA
05 White 2'x4' CT 016-018 Interior ceiling NA NAD NA NA NA
06 Tan 12"x12"VFT 019-021 Bar area NA NAD NA NA NA
NA=Not Applicable NAD=No Asbestos Detected VFT=Vinyl Floor Tile SF=Square Feet CT= Ceiling Tile
HA=Homogenous Area TSI =Thermal System Insulation VCB=�nyl Cove Base _ LF=Linear Feet
All quantities are approximate. All asbestos detected is chrysotile unless otherwise noted.
HUPP ZHILLS GALL BLVD SURVEY REPORT 4-2
EE�G: Asbestos Suroe October 7 2014
SECTI N 5.0
RECOMME DATIONS
5.1 RECOMMENDATIONS FOR REGULAT D ACM (RACM)
None of the surveyed materials were identified a RACM.
5.2 RECOMMENDATIONS FOR CATEGO I NONFRIABLE ACM
None of the surveyed materials were identified Category I Nonfriable ACM.
5.3 RECOMMENDATIONS FOR CATEGO II NONFRIABLE ACM
None of the surveyed materials were identified s Category II Nonfriable ACM.
5.4 GENERAL RECOMMENDATIONS
. If other specific areas at this location are to be impacted during planned
renovations or demolition, an as estos survey of these areas will be required.
• Suspect materials discovered iter this inspection should be sampled and
analyzed to determine asbestos ntent and to initiate appropriate responses.
• Prior to demolition activities, the property should be inspected for all potentially
hazardous materials. The iden ified materials should be removed from the
property, and properly disposed of in accordance with federal, state, and local
regulations.
• This report should,.be updated i demolition of buildings covered in this survey
does not take place within six m nths of the date of this survey, i.e. by April 2015
5.5 SPECIFIC RECOMMENDATIONS
Based on the results of this demolition survey, EE&G has the following specific
recommendations:
. Demolition activities shall be conducted in accordance with 40 CFR 61
(NESHAP). It is recommended t at contractor personnel receive a copy the EPA
guidance document on demolitio practices under NESHAP.
. EE&G recommends a walk-th ough of the property with the owner/owner's
representative and the dem lition contractor prior to commencement of
demolition activities. The dem lition contractor should be provided the Pre-
Demolition Survey Report, and hould inspect the property for unidentified ACM.
� Any unidentified suspect ACM s ould be sampled and analyzed prior to the start
of demolition activities.
HUPP ZHILLS GALL BLVD SURVEY REPORT -'I