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HomeMy WebLinkAbout2594 W Airport Blvd 08-2046 Underground tankApplication # • S ✓ (� .101 ego] X9: 1�N1 01R•]»:75M_1r:1»4Col:v1(01�I Submittal Date: RECEIVED JUN 8 0 2008 Job Address: J' f94 ILpoeT Alkyls 11). Value of Work: $ 122, DbD. opop Parcel ID: 4-k- - 1 2-3n - .5' A F - -7 3 D A - Q b Q o Zoning: Historic District: Description of Work: [' ,in DEP_bf0(l A n r ItEL I n eA(oG / A n011 /C Elm Square Footage: ........................................................................................... ............................... Permit Type: Building Electrical ❑ Mechanical ❑ Plumbing Pi Fire Sprinkler /Alarm ❑ Pool ❑ Sign ❑ Electrical: New Service - # of AMPS Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑ E 1C(STIA(6- ESC . Mechanical: Residential ❑ Non - Residential ❑ Replacement ❑ New ❑ (Duct Layout & Energy Calc. Required) Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines Plumbing/New Residential: # of Water Closets Occupancy Type: Residential ❑ Commerci.11zr Industrial ❑ Construction Type: # of Stories: # of Dwelling Units: Plumbing Repair- Residential ❑ Commercial ❑ Occupancy Use Group(s): Flood Zone: (FEMA form required) .................................................................................©......... ............................... Property Owner: `�i�/(Fir n �iL .ENT. INN . Contractor: f ETtO�� -li/Iti V E [ lJ/�( /L /A.NS /JJG , Address: 276 1 JJ 1 . /:5 T ;3 7- Address: l 7 7� IA MI / )r V ii OF KFI)rb (-L 37-771 hF_L -AtfA FL 2-7 7-Lk Phone: E -mail: Phone: 3K !fit to License Number: PC A Bonding Company: n(TA Mortgage Lender: ACA Address: Address: Architect/Engineer: 1)A v;,-, -t 0 LEA TAnI - AI/,InfFr--ki l,- Phone: 386 73%• 74f75' Address: I6-3 /j). 11)i /ilu5in AvE %FljAU1 FL 37-770 Fax: 3FIG 7-38. 7791 Plan Review Contact Person: _5Ar,rq L E/YI I5 N Phone: On Fax: J Sr/ 7--3T. 7 777 E -mail: ` /00 Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and AIR CONDITIONERS, etc. OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY 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 RECORDING YOUR NOTICE OF COMMENCEMENT. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities suc as ater mana ement dis icts, state agencies, or federal agencies. Acceptance of pe is verification that I will notify the owner oft r p f the quirem t of F rids e a� 13. Signature of Owner /Agent Date Signature of Contractor Agent ILI 6k �( IU , c kl Q, 1 4�. C 1 g 1 PrinA en a e _', Print Contractor /Azent's Name,. G' - ela"" rry a • Obit d Flat *0VXW8ftElip WJ030,1 COMalttial / 00 763814 Owner /Agent is V/ Personally Known to Me or Produced ID APPROVALS: ZONING: Special Conditions: Rev 07.07 UTIL: FD: of Contractor /Agent is Produced ID ENG: Commk*n M 00 753614 ,/Personally Known to Me or BLDG: 25 Aug 2008 1:56PM r 0 rt� � V "1 HP LASERJET FAX POL E p. RUG- 25 -20 08 13 :07 95% P. 03 Storage Tankicontamination Tracking - Discharge Information Z X Co t Facility Facility Name and Address Manager I Role 59 F— ISANFORD SUNOCO Facility Cleanup Status REPT Facility Status 12594W AIRPORT BLVD Highest Discharge Score F 26 OPEN SANFORD Florida Discharge Record 1 Cleanup Info Source IO DISCHARGENOTIFICATI Discharge Score CO2)20Q008 Info Lead Agency ALP LOCAL PROGRAM Score Effective Date INACTIVE Clean Required ,[R JCLEAHUP REQUIRED Discharge Discharge Date 103t26M991 Inspection Date o-zi 991 Info Combined With F^ Cleanup Status /Date ONR IIOJ0912000 Eligibility Application Cleanup Determination and Received Program Lead Status Letter Sent Redetermined? Application ! =' l — Info l i F F^ I F- F F F F',- .CT DBDNAPGE 6cn- f) w ('.u; I t,!Irnliiil nI fdnIIII r .Slli_r.i11_ tS r_ 1 n f s il ,16- 19 - f)n- 5Af - 73LIA -GV&4) 1111f 11111 If 111 1111111111111111111111111 if 11111 fit 11 III 1 1111 MARYANNE M()R;E, CLERK fk= CIRCUIT WORT SEMINOLE COUNTY BK 0XIb Pq 1929; (1 pg ) CLERK'S # 20081 1 4353 REC0Q1-'0 10/09/t?008 11:Sf;:11 Am RECOND I N8 i-"H -li 10,00 j RECORDED BY L McKinley t" ILIrU1.r_NYIt aTI- PHMIL')A -N5, INC 17 %L l RIJGLf �� Avc. tAN12, FL 3e72 1 TICE OF COMMENCEMENT ��l�.lr:r.icln+�r +1 ljolob,, �)Iv,>is notice, that Imprbvement(s) will be made to certain real property, and its arrordanco % ,ith Ch;i!)ter I I,:rld,i ;t uulr's, the following information is provided in this Notice of Commencement. Description of property (1t)ctal description of the property, and street address ifavai(abie) .I >q tij. q,rpe rr r11V6 >>jNfirA P r Li LL- 1 FL inr.T J Ly .K.�w_1t:zL crllcbEn[�ia— *icy_ �' l,, I f.Pa ,.v„ «_ AYE_11�t._ r.cL.y_._l�nt_ _._..f'.PI r 1'i "55 General description of iniprovement(s) 11EL' tiP- LU1] h .__.F.(I.EL.._�T11iR(��_B.L�I.pp ,�9hA.q Fm -Cp(T "-ter I T I r r ov:Iler llitorn �l latio - -- - -- -------- - - - - -- - - -- qtr ?,.Fii rii COPY -t,L- �t.iE�L r_TelephoneNumber !j - r ^. +ft'r,1i: ?•(r I ?hU_I Lu. l.. ?.T _. T__.oJBeLEUe h._.fl)merest in Properly � nl� .- ._---- -_ - -_- -- �.�[.r r r r U;;I fee Simple Title Holder (if other than owner shown above ) Telephone Number '? ' Co�1ntractor �y-- ;W' P-4 rtv4.l t - Ltp[.�k�,r_.r_��_L�� /_LQL[L1., Surety of any) IR'tis Leniler tit any) Telephone Number amount of bond $ —...— -- — ... .... ..... - . - . —__- Li., trr Telephone N Lin) ber_., _K�_7�_7,.Lu___ Ile' k. %,,. .___. _. __. ------- _...__. -- Telephone Number Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by §713.13(1)(a)7, Florida Statutes. Telephone Number ----- - - - - -- In addition to himself or herself, Owner designates the following to receive a copy of the Lienor's Notice as provided in §713.13(1)(b), Florida Statutes. Telephone Number -- _ Expiration date of notice of commencement (the expiration dale is one year from the date of recording unless a dtfierent !ate Is RIIN(; rl) MVNER: ANY PAYiMEN' I:: S MADE I3YI• IIEOIYNERAI�-TERTItL •'L•'XPIRA'I- IONOFTI- IENO- 1'ICEOFCONIAIENCENIFNT AM. - -- "''SIPFR1•.11 IRI PROPER P:11'ivltiN'l:S UNDER CHAI'•1'LR 713, PART [,SECTION 71).13, FLORIDA STATIrI•ES, AND CAN RESUI.T IN YOUR P.AYI,NI, It li 1:014 YOUR PROPERI -Y. A NO•l'ICE OF CONIIvIE'NCEIIIENI• h1UST 13E RECORDED AND POS -rED ON -t 111:.1011 Srl7. Intl 1111. 1•I10;I INSPF.(-I'10414, IF YOU INTEND -1.0 OBTAIN FINANCINC,CONSULT yrni YOUR LENDER OR AN AT•I.ORNEY 1 KFOR1 11 \IFNt'lNG 1 ' IR; --t- F.C'l I i, F� LiR N6rIC r.OF CONIMENCENIENT. I� Signature of Owner / Signatory's Printed NameffitlelOffice , •:.nei'a •lutiullire+l 01hceNDfreclprrPannerlMana9er §7'13.13(1)(dJ) I )reLluuly InsUulnenl was acknowledged before me this '77,qday of LC -04,Ee 2�% /)1 /jNIeA ICNAAf (year) (nanie of person) - U11%Aiz for AMI"FLP& / }it. EmT e 4rl--,r'j� pl• 01 al. o lyl, e y , oflicer, tru �ee, itlornpy in lad) (Name of party on behalf of whom instru �nt was executed) SignaltiXf Notary Pllhllc - State of Florida (Print, type, or stamp commissioned name of Notary Public) isonally Known ✓ OR Produced ID pa of If) Produced ification pursuant to Section 92.525, Florida Statutes tare true to the best of my knowledge and belief. inatur -4L "t Natural ni I ?evisow I ll'10107 1g on Line 11 -Above Under penalties of perjury, I declare that I have read the foregoing and that the facts stated SHERYL A 11iE1M8H NO" ►MWC • SM of 1hC.1��11w1i�rlr,wFso CMe1�fiMt10 0 DO TSM1 1 d MMlMf11M1%ttYli"NOY CITY OF SANFORD FIRE DEPARTMENT FEES FOR SERVICES PHONE # 407 - 302 -2516 • FAX # 407 - 302 -2526 DATE: a//s-/,) PERMIT #: BUSINESS NAME / PROJECT::: ADDRESS: asgv f�7%L/tj/I / /Jlti�• PHONE NO.: _3 �(, — '731- -71(-30 FAX NO.: CONST. INSP. [ ] C / O INSP.:[ ] REINSPECTION [ ] PLANS REVIEWI F. A. [ ] F. S. [ ] HOOD [ ] PAINT BOOTH [ ] BURN PE I j TENT PERMIT k ] TANK PERMIT [ ] OTHER [ ] TOTAL FEES: $ 75 � 0 COMMENTS: Address / Bldg. # / Unit # 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. (PER UNIT SEE BELOW) Square Footage Fees per Bldg. / Unit Fees must be paid to. Sanford Building Department, 300 N. Park Ave., Sanford, FI. 32771 Phone #. -4q7- 330 -5656. Proof of Payment must be made to Fire Prevention division before any further services can take place. I certify that the above is true and correct and that I will comply with all applicable codes and ordinances of the City of Sanford, Florida. SanfoVrle Preve ion Division Applicant's Signature APPLICATION FOR CLOSURE OF POLLUTANT STORAGE TANK SYSTEMS This application is to detail the work and persons involved in the closure of a storage tank system subject to the provisions of Chapter 62 -761, F.A.C. The application should be submitted to the Seminole County Permitting Office and the Storage Tank Compliance Program. (STOP) of Seminole County, Department of Public Safety, Emergency Management Division at least 30 days prior to the initiation of the closure activities. Contact the STCP at (407) 665-23' )3 or (407) 665 -2330. The STCP must also be given notice at least 48 hours prior to the initiation of the closure to confirm the date and time of the activities (as per Chapters 62 -761 and 62 -762, F.A.C.) There is no fee for review of the closure application. Directions: Complete the following as indicated. Please note incomplete applications cannot be processed by this office. One application is sufficient for more than one tank system at the same facility involved in the closure, as long as the means of closure is identical for all tanks. 1. Facility Information: DEP Facility # $51 6 r7/ p Facility Name: rut u'h j,& � Facility Address: 9 '�5 "W# AieFcc -r , j-rt, Js+nrFC e t, 0 771 �q nFO L ENEProperty Owner Name: G p e i S G5 . L t- c Name /Phone Number of Owner Contact: mo Nl,q A khiq g qD 7617 • 5 zg i Operator's Name: Operator's Address: Name /Phone Number of Operator Contact: 2. Facility Diagram: A facility diagram (preferably 81/2" x 11 ") should be attached. The diagram does not have to be to scale, but should clearly illustrate the following: a. Location and orientation of storage tank system(s) to be closed. b. Location and approximate lengths of piping. c. Location of vents and dispensing systems. d. Location of monitoring wells in proximity to storage tank system(s). e. Location of landmarks, such as roads (labeled), and buildings. Indicate North Direction. f. Description of any overburden, or any other condition that would affect the closure of the storage tank system(s). Storage Tank Registration Form: A completed and signed STRF should be submitted as an attachment. 4. The information in this application perta .ns to (check all that apply): Closure Assessment ❑ Removal 9 Closure In Place ❑ 5. Tank System(s) Information (complete only for those systems to be closed): Tank Capacity Contents Tank Piping Remaining June 20, 2006 revision Page 1 Number (gal) Construction Construction Liquid /Sludge (gal) 6. Pollutant Storage Systems Specialty Contractor (PSSSC) to be on site: required only for the removal of underground storage tank systems. A copy of the license should be attached to this application. Individual Licensed as PSSSC: MVNALL- E . CLA.4I1-- PSSSC# Pee O Gv 'q4 Site Foreman: %n1 /o Y Company Name: PEltOLEUA- �aiit4lCJAI SS, I acPhone #: 3 81. 73 -R. pica Address I776 LA146-GE\l AYE. � & -LAND FL 32-72-Lf Email Address: p e�ro)eumtcc,hn / P-/ lN, u Yad o.o trn 7. The following applies to the physical closure of the tank system: Method for inerting tank(s): Integral pipin to be: Capped ❑ Grouted ❑ Removed R1 Company emov nl g/ illing Tank(s): pETe0 LEG nk- -rE0 /J N 1 C I AN5, /rrC . Contact Name: -7-pm , o J Phone #: 6 F& 7'a 3 - 7J o 0 Company Transporting Ta (s) `T-o 6F- D t-TE Om IVE,A Contact Name: Phone #: Company Receiving Tank(s) for Disposal: Tonm6 Contact Name: l\(A7ALtE. Phone #: g� 8. Indicate Company(s) to transport /dispose of residual liquid /product /sludge (L/P /S): Note: if hazardous waste is involved, please also supply the EPA ID# for HazWaste Transporter. Transport Company: PETeo 7-6 c N 5 U T f! t Contact Name: MiKEANbaSon Phone #:813t17g 7t, Company Receiving L /P /S for Disposal: &-rco E- c l l 4o u-TN c-P, s i Contact Name: JA M E A �, AhoYg- Phone #: 9. The field sampling will be performed by: Company Name: )ENV. 1YULU -r1OAr 5 FDEP QA /QC Contact Name: (,'op Phone #: 5 g"o 76 p Field Technician Names: June 20, 2006 revision Page 2 Equipment to be used for Soil Screening (specific make and model) 10. The laboratory analysis of soil analysis of soil and groundwater samples will be performed by: 10E &EiEtnt//\tLA Contact Laboratory: Phone #: Address: Contact Name: FDEP QA/QC #: 11. Indicate Company(s) to transport /dispose of excavated contaminated soils: NOTE: pursuant to Rule 62- 770.300(2)(a)5: excavated contaminated soil (including excessively contaminated soil) is not stored or stockpiled on site for more than 60 days unless it is being land farmed in accordance with Rule 62- 770.00(2)(b), F.A.C., at which time the soil must be returned to the original excavation or removed and properly treated or properly disposed. Contaminated soil (including excessively contaminated soil) may be containerized in water tight drums and stored on site for 90 days, after which time proper treatment or proper disposal of the contaminated soil shall occur in accordance with applicable rules of the Department, or land farmed as specified in Rule 62- 770.300(2)(b), F.A.C. Transport Company: Contact Name: Phone #: Company Receiving Soil For Disposal: Contact Name: Phone #: Method of Disposal: Dewatering: If dewatering is necessary and effluent is discharged off site, the contractor must obtain an Industrial Wastewater Short Term Generic Dewatering Permit from the Department of Environmental Protection. Contact DEP- Central District Industrial Waste Section at XXX -XXX- XXXX, for more information. Please include a copy of the Permit or approval with this application. If the contractor did not obtain a NPDES permit regardless of what phase the construction is in, the STCP inspector has the authority to shut down the dewatering activities. June 20, 2006 revision Page 3 COMPLETE THIS PAGE FOR USTs - Underground Storage Tanks EQUIPMENT CHECKLIST (All of the following questions must be answered. If any are not applicable, state so. Do not leave blank.) a. What is the minimum spacing between tank(s)? / -T Nnc. b. How many inches of backfill will be placed under the tank(s)? �u, : T;�re, f-IL- c. What is the burial depth of the tank(s) (depth to top of tank)? /Q//v JD d. What is overburden dimension (length *width *thickness)? e. Will dead men be used to anchor tank(s)? E5 If yes, list dimensions / V- i L What type of backfill will be used for tank(s)? FCC,. -,, f; 11 L-L g. What type of backfill will be used for piping? C- Kt ST /nt & Fi t_t- h. What is the minimum spacing between piping? 6 ,, i. What is the piping burial depth? .3c" What is the slope from dispenser back to sump? o j. Buoyancy safety factor? /- ­6 s Buoyancy calculations must be sealed by a State of Florida licensed Professional Engineer. Submit buoyancy calculations with this application. June 20, 2006 revision Page 4 Qi r Q J R 1 r� CITY OF SANFORD PERMIT APPLICATION Application ti :J "� C q \ Submittal Date - Job Address: A C y f1t r'�r n `� l I J C Value of Work: S Parcel ID: Zoning: Historic District. Description of Work: r-,,C,—, — (scts �vt.- �, , t k t-1'1y1�' Square Footage: Y Permit Type: Building ❑ Electrical El— ivfechanical ❑ Plumbing ❑ Fire Sprinkler /Alarm ❑ Pool ❑ Sign ❑ Electrical: New Service - 0 of AMPS AdditioniAlteration ❑ Change of Service ❑ Temporary Pole ❑ Mechanical: Residential ❑ Non - Residential ❑ Replacement ❑ New ❑ (Duct Layout & Energy Calc. Required) Plumbing/ New Commercial: :f of Fixtures _ K of Water & Sewer Lines Plumbing/New Residential: h of Water Closets Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑ 9 of Gas Lines Plumbing Repair - Residential ❑ Commercial ❑ Occupancy Use Group(s): Construction Type: ft of Stories: # of Dwelling Units: Flood Zone: (FENIA form required) ........................................................................................... ........1...................... Property Owner: Contractor: A °' � Q�,L -V r Address: address: I l `i7 41? )t car i".O,1 L _DaQr,�_ , l�L 3_4_7A L Phone: E -mail: Phone `7� 1�O1 rate License Number: Bonding Company: Address: Architect/Engineer: Address: Plan Review Contact Person: Mortgage Lender: Address: Phone: Fax: Phone: Fax: E -mail: Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING. SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and AIR CONDITIONERS. etc. OWNER'S AFFIDAVIT-: I cenity that all of the foregoing information is accurate and that all work will be done In compliance with all applicable laws regulating construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY_ A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE TILE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RE--CORDING YOUR NOTICE OF COMMENCEMENT. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional pennit_i required from other governmental entities such as water management districts, state agencies, or federal agencies- Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713. u Signature ofOw-ner /Agent Date St nature o ContractorfAgent Date C C r_'l Print Owner /Agent's Name Print ttactor /Agent's Name Signature of Notary-State of Florida Date Signature ofN8rNi ta1e`ofFlor_ida Date y TJEB3IE h'fY C0!v1MISSI0N s DDti29096 CPIRES: February 25, 2011 Fl. N.twy Diswmi As w. Co. ` G .., 1:an C +F.tia�..stA.siflfK9lihb @li,b'� Owner /Agent is _ Personally Known to Me or Contractor /Agent is onally Known to Me or Produced fD Produced ID V C' C1�1 .• I �/j APPROVALS: ZONING: UTfL: FD: ENG: BLDG: Special Conditions: Rev 07.07 1147 Heartwood Dr. Deland, FL 32720 386 717 -8681 A&MELECTRIC LIMITED POWER OF ATTORNEY DATE Location: a 5 94 Qom, p o f, ;T A Y. Know by all men by these presents, That I John W. Matthews Jr. A resident of the State of Florida and State Certified Electrical Contractor EC0002815, do hereby make and appoint Michael E. Clark of Petroleum Technicians, Inc. as my true and lawful attorney in fact for me and in my name, to execute any and all documents relating to but not limited to the application for an electrical permit at the above referenced location. John W. Matthews Jr. The oregoing instrument was acknowledged before me this ?y'-H day of 200 by 2-o WN 11). A1,47—In c4u5_ip is personally known to me. .•�"' a SFIERY BE M *My PA k • WAb d Florid• py E*0JA 020,201 C"w"m S W 75.1614 ftMwlhp*NdcndNdxy `Notai T,, ii �'Ein�s t