Loading...
HomeMy WebLinkAbout2939 Orlando Dr 09-205CITY OF SANFORi PERMIT APPLICATION Application # : `� c ' r /T Submittal Date: /2-2, /0 Job Address: 2_(0 Value of Work: S Parcel ID: Zoning: Historic District: Description of Work: f1 etj rr -11 + V i%.ar i- j I Square Footage: Permit Type: Building ❑ Electrical ❑ Mechanical ❑ Plumbing 15--' Fire Sprinkler /Alarm ❑ Pool ❑ Sign ❑ Electrical: New Service - # of AMPS Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑ Mechanical: Residential ❑ Non- Residential ❑ Replacement ❑ New ❑ (Duct Layout & Energy Cale. Required) Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines Plumbing/New Residential: # of Water Closets Occupancy" Type: Residential ❑ Commercial ❑ Industrial ❑ Construction Type: # of Stories: # of Dwelling Units: Plumbing Repair- Residential ❑ Commercial ❑ Occupancy Use Group(s): Flood Zone: (FEMA form required ) .Property Owner•••• (�•L�t4�Pr.n•• "Ts1C•• •••••••••••••••••••Contractor:• Z••Tu• •• "1• •lt/tJP•LC 1.� wiC Address: 3 O O Le e 12,A Address: 7,z 3 2— 6­1 e- - 3� !v Phone:YJ]- 5 "'/L E -mail: Phone,VLt?� '(c State License Number: Bonding Company: t; Mortgage Lender: Address: Architect/Engineer: Address: Plan Review Contact Person: 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: l certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable law's regulating construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR [,AYING 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 such as water management districts, state agencies, or federal agencies. Acceptance of permit u verification that I will notify the owner of the property of the,' ui menuof-Florida Lien Law. FS .713. SignatureofOwner /Agent Date `' SigrfatuteofConttactor /Agentt / 'Date "01, 4i4lf-lk Print Owner /Agent's Name Print n r /Agent's Name c Signature of Notary-State of Florida Date Si ature of Notary-State of Florida Date 2otcYa�a��:, 'IDEB3iE= I�V:'1 "C��1 fX. -!!!} NiY COMMISSION ;: DD629096 "C ,� EXPIRES: February 25, 2011 Fl. Notary Uisccunt Assn. Co. Lxaa- :+- rnrnav �,aurrtna'�tus6+6'`/'' Owner /Agent is _ Personally Known to Me or Contractor /Agent is _ Personally Known to Me or % n _ Produced ID —Produced ID 1, L APPROVALS: ZONING: UTIL: FD: ENG: BLDG: Special Conditions: Rev 07.07 Application for the Installation or Upgrade of Pollutant Storage Tank Systems This application details the work involved in the installation or upgrade of regulated pollutant storage tank systems. Please submit this completed application with the site diagram, certified buoyancy calculations and a check or money order payable to the Seminole County Board! of County Commissioners for $000.00. This application must be submitted to the Building Department (if applicable) and the Storage Tank Compliance Program of Seminole County Department of Public Safety, at least 30 days prior to initiation of the installation/upgrading activities. We are located at 1101 East First St and Storage Tank Compliance Program (STCP) 540 West Lake Mary Blvd Sanford, FL 32773. Please provide the Storage Tank Compliance Chief Inspector with at least 48 hours notification prior to the initiation of the installation or upgrade per 62- 761/762, Florida Administrative Code (F.A.C.). Contact Storage Tank personnel at (407) 665 -2333 /Fax (407) 665 -2341. Directions: Complete the following as indicated. Please note that this office cannot process incomplete applications. 1. Facility Intormation: FDEP FACILITY# PROPERTY FOLIO # FACILITY NAME: 32,'96V FACILITY ADDRESS: -5. �� 'j'�•'��� A,-.- OWNER NAME: -7 -C1-- ue--7 PHONE# z/a7- 5-32 - ,9C) PHONE# 2. The information in this application pertains to: (check all that appl ) UST AST Upgrade New Installation Repair Note: If you are closing or removing existing tanks, a Closure Application must be submitted with this application. 3. A comprehensive scope of work must be submitted with this application. 4. Site plan/Facility diagram: The diagram should clearly show the following: a. Location of landmarks such as roads and buildings (indicate north arrow). b. Location of the storage tank system to be installed or upgraded c. Location and layout of facility, tanks, piping, and dispenser island placement, generators, etc., as applicable. d. Cross section details of tank(s), dispenser liners, and piping sumps. e. Tank and piping excavation; cross section indicating spacing, burial depth, and tank anchoring. 5. A completed and signed Storage Tank Registration Form (STRF) must be submitted with this application. June 20, 2006 revision Page 1 6. A tank and line tightness test as well as a line leak detector test (as applicable) must be performed prior to placing the system in service. 7. Pollutant Storage Systems Specialty Contractor (PSSSC): Required for the installation/upgrading of underground storage tank systems. NAME OF LICENSEE: ni k t- PSSSC# P6cos-1, 7 Z-3 COMPANY: P�7 yl�tl,L +� � �aa,s�rw� vk -���c. PHONE# &1d7 -0 f0 3O'io ADDRESS: "72.-3.-Z— 0 v- ,- /Ct" -Xv{ ON Dr /C"d o rL EMAIL ADDRESS: P(? c/� SITE FOREMAN: PHONE# 8. Dewatering Information: If dewatering is necessary and effluent is discharged off site, the contractor must obtain a National Pollution Discharge Elimination System Permit from the Department of Environmental Protection. Contact Wanda Parker- Garbin at (407) 894 -7555, for more information. Please include a copy of the permit or approval with this application. If the contractor did not obtain a permit regardless of what phase the construction is in, the Storage Tank Compliance Program has the authority to shut clown the dewatering activities. 9. Siting for the Installation or Upgrade of Pollutant Storage Tank Systems: 62- 761.500 (1) (a)/ 62- 762.501 (1) (a) Florida Administrative Code (F.A.C.) Siting (Check the applicable paragraph below) Persons are advised that, pursuant to Rule 62- 521.400(1) (1) -(n) and (2), F.A.C., no storage tank shall be installed within 500 feet of any existing community water supply system or any existing non - transient non - community water supply system. No Category-C system (AST or UST) shall be installed within 100 feet of any other existing potable water supply well. _These prohibitions shall not apply to the replacement of an existing storage tank system within the same excavation or dike field area, or the addition of new storage systems meeting the standards for Category-C systems at an existing facility. Signature Statement I have investigated and surveyed all available sou ces of information concerning siting for this installation. I hereby certify that the siting for he storage nk ystem installation or upgrade is in accordance with Chapter 62- 761/62 -762, F.A.C. and ' i Vc ra te plete to the best of my knowledge. � /6_g Print name of contractor Signature Date or authorized agent June 20, 2006 revision Page 2 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.) STORAGE TANK EQUIPMENT: i a. Tank(s) manufacturer's name and model #? 0 EQ# b. Tank(s) construction (primary & secondary)? ' c. Tank size(s), if compartmented specify? OVERFILL PROTECTION: d. Will Stage I vapor recovery be coaxial or dual point? e. Manufacturer name and model # of overfill protection? EQ# Type of overfill protection? (i.e. shut -off valve in drop tube, ball float in vent line, high level alarm) SPILL CONTAINMENT: v1C o 13 Aiafon f. Manufacturer name and model # of spill containment bucket? I Dd A EQ# '% S PIPING SUMPS: g. Manufacturer name and model # of STP sump? EQ# Manufacturer name and model # of submersible pump? (� PIPING: h. Manufacturer name and model # of integral piping? i, EQ# i. Pipe construction (primary & secondary)? / �} j. Piping construction (if portion is above ground) 10- DISPENSER LINERS: k. Manufacturer name and model # of dispenser liner? ii1f EQ# 1. Manufacturer name and model # of shear valve? AA RELEASE DETECTION: m. Will the tank interstice be monitored by visual inspections? A) 4 if not, list the manufacturer's name, model # and EQ# of the interstitial sensor Ny and the manufacturer name and model # of the control panel lJ A n. Will the STP sump be monitored by visual inspect }}ion ?t� if not, list the manufacturer's name, model # and EQ# of the sensor iV A o. Will the dispenser liner be monitored by visual inspection? if not, list the manufacturer's name, model # and EQ# of the sensor �k p. Manufacturer's name and model # of line leak detector? EQ# Storage tank equipment installed in the State of Florida must be listed on FDEP's Approved Storage Tank System Equipment, Chapter 62- 761.850 F.A.C. For reference a copy of this list can be accessed on the following website: http: / /www.dep.state.fl.us /waste /quick topics /publications /pss /tanks/EQLST May3_2006.doc 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)? Iola' b. How many inches of backfill will be placed under the tank(s)? AA c. What is the burial depth of the tank(s) (depth to top of tank)? �j 10( d. What is overburden dimension (length*width*thickness)? AM e. Will dead men be used to anchor tank(s)? N)a If yes, list dimensions f. What type of backfill will be used for tank(s)? IJ 11 g. What type of backfill will be used for piping? h. What is the minimum spacing between piping? /j R ,k314 i. What is the piping burial depth? .. hIIWhat is the slope from dispenser back to sump? j. Buoyancy safety factor? 1" 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 COMPLETE THIS PAGE FOR ASTs — Aboveground Storage Tanks INSTALLATION/EQUIPMENT CHECKLIST (All of the following questions must be answered. If any are not applicable, state so. Do not leave blank.) STORAGE TANK EQUIPMENT: a. Tank(s) manufacturer name and model #? EQ# b. Number & size(s) of regulated tanks that will be installed? )J a c. If day tank(s) are being installed, list sizes. 0- d. Tank(s) construction (primary & secondary)? e. Tank size(s), if compartmented specify? E For double wall tank's: • Foundation • Concrete pad dimensions For single wall tank's: f Tanks) manufacturer name and model #? �) EQ# Secondary containment: • Dimension of secondary containment A • Is containment large enough to contain 110% of largest . tank volume (taking into account the base of any other tanks within the containment)? N lk • Include a diagram of secondary containment detailing floor & wall construction including rebar and thickness, pipe penetrations, low point sumps, tank pedestals, drains, etc. • Manufacturer and name of sealant for secondary containment EQ# t4 A OVERFILL PROTECTION: g. Manufacturer's name and model # of overfill protection? EQ# k. Type of overfill protection? (i.e. shut -off valve, sight gauge, high level alarm, secondary containment) SPILL CONTAINMENT: 1. Manufacturer's name and model # of spill containment bucket? '14to 06-1014 ti-I EQ# 7 PIPING: n. Manufacturer's name and model # of integral piping? L,f A- EQ# o. Primary pipe construction? p. Secondary pipe construction (if in contact with soil)? q. Diameter of piping? PIPING SUMPS: r. Manufacturer's name and model # of transition sump? EQ# June 20, 2006 revision Page 5 DISPENSER LINERS: s. Manufacturer's name and model # of dispenser liner? EQ# t. Manufacturer's name and model # of shear valve? Vk COMPLETE THIS PAGE FOR ASTs INSTALLATION/EQUIPMENT CHECKLIST (All of the following questions must be answered. If any are not applicable, state so. Do not leave blank.) VALVES: u. Manufacturer(s) name and model # of anti - siphon valve? 10 A v. Manufacturer(s) name and model # of manual valve? N h RELEASE DETECTION: -II w. Will the tank system be monitored visually for release detection? N �� If not, list the manufacturer(s) name, model # and EQ# of the leak sensor(s) t�- and the manufacturer(s) and model name of the control panel. pa x. Manufacturer(s) name and model # of line leak detector? f\) A- EQ# TANKS EXTERIOR: y. Tanks fills must be properly labeled. z. Proper exterior coating must be applied for tanks and piping. Storage tank equipment installed in the State of Florida must be listed on FDEP's Approved Storage Tank System Equipment, Chapters 62- 762.851 F.A.C. For reference a copy of this list can be accessed on the following website: http: / /www.dep.state.fl.us /waste /quick topics /publications /pss /tanks /EQLST May3_2006.doe Storage Tanks Compliance Program (STCP) of Seminole County Installation Inspection Protocol - A 48 -hour notice is required for all inspections. To schedule an inspection, contact STCP Bureau at (407) 665 -2333 or (407) 665 -2330 - Be ready for your scheduled appointment. STCP inspectors will not wait for glue to dry, sumps to be filled, lines to be aired, etc. - If you cannot keep your scheduled appointment, you must call the Storage Tank Compliance Program office prior to your appointment to cancel or reschedule. - storage Tank Compliance Program is not the contractor's quality control. All items scheduled to be inspected should have been tested and all necessary corrections /repairs should have been made by the contractor prior to STCP's inspection. Failed inspections must be rescheduled for no earlier than the next business day. - Prior to placing the system in service, a final inspection fnust be perfornaecl on the. following (if applicable): Operability check on the sensors, probes, and shear valves; in -line leak detector, spill bucket, product labels, overfill protection and drop tube installed; shear valves anchored; secondary piping boots pulled back; and dispenser liners and tank sumps cleaned out. Copies of tank and /or line tightness tests must be made June 20, 2006 revision Page 6 available at final inspection. The contractor and the owner /operator must be present for this inspection. For new facilities, a copy of the Financial Responsibility must be provided at final inspection. • STCP sign off sheet must be available on site for the STCP inspector to sign. Upon completion of installation, a PSSSC Form must be submitted to STCP. ALL ELECTRICAL, CONCRETE, AND FIRE SAFETY INSPECTIONS WILL BE PROVIDED THROUGH THE BUILDING DEPARTMENT OF THE LOCAL JURIZDICTION OF THE FACILITY. Signature Statement • I hereby certify that the information provided on this form and attached with this application is accurate and complete to the best of my knowledge, and that I have investigated all available sources of information before indicating that any details are unknown or unavailable. I hereby certify that the storage tank system installation or upgrade will be performed in accordance with Chapter 62- 761/62 -762, F.A.C., and with its adopted reference standards and documents for storage tank systems. Print name of contractor /audlorized Signature Date Agent Print name of owner /operator Signature Date June 20, 2006 revision Page 7 Permit No. Tax Folio No. Q (-)D - -- 1 Z - VC100 •- ©347 NOTICE OF COMMENCEMENT State of Florida County of Seminole I IN 111111111111111111111111111111111111111111111111111111111111 MARYANNE MORSE, CLERK OF CIRCUIT COURT SEMINOLE-COUNTY BK 07081 Pg 1544; Opg) CLERK'S # 2OCt81 19385 RECORDED 10/22/2008 12130:11 PM RECORDING FEES 10.00 CERTIFIED COPY The undersigned hereby gives notice that improvement RECORDED BY T SMith will be made to certain real property, in accordance A"NF MORSE p p e m'' CLLERK ERK OF" RCUIT COURT with Chapter 713, Florida Statutes, the following SEMI E CO TY, FLORII information is provided in this Notice of Commencement. 1. Description of property: (legal description of the property, and street address if available) -7 -I1 L_ 10-z I E . 2. General description of improvement: k) CvJ 2 I ( d- L!c °y/Jtsi 3. Owner information: Name: 1 c. Address: % 300 L c ti�� r b. Interest in property: V&,, ap;r c. Name and address of fee simple titleholder (if other than Owner): Name: Address: 4: Contractor Name: c. Address: "-7 0 Phone number: W-7 - F-c- 3)- 2 2 2008 5. Surety Name Address: b. Amount of bond: $ 6. Lender: Name: Address: b. Lender's phone number: 7.a. Persons within the State of Florida designated by Owner upo whog;� tices or other - documents may be served as provided b Section 713.13 1 a 7. o , da C�atute : Na e: � Ad dress: Y L() j�f Gl�%�G� 'c-�I 8.a. In addition to himself or herself, Owner designates of to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. b. Phone number of person or entity designated by owner: 9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different date is specified) 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 I, 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. AM24MCING END TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN.- T,TOR?�BEFORE. WORK OR RECORDING YOUR NOTICE OF Signature of_O er's Au orized Officer irector/Partner/Manager Signatory's Title /Office The foregoing instrume t was acknowledged before me this day of 0 Ci (year) , by (name of person) as (type of au .. ority, . e.g. + ice IE , trustee, attorney in fact) for trument was executed) . I Z_ =gtdiY's'_' -,, JENNIFER BATH -,: MY COMMISSION # DD 733242 EXPIRES: November 8, 2011 ��gnature o Notary Publ c iR f4 ` Boat Thru Notary Pubk Undetw hers Xsonally own %/ OR Produced Identification Type of Identification Produced Verification pursuant to Section 92.525; Florida Statutes: Under penalties of perjury, I declare that I have read the foregoing and that the fa is stated ' 't are a to e best of my knowledge and�belie£ A-1 dLQ Its INrUME,tl PREPARED BY: Sign a ' of Na al Person Slening Above Rev. date 3/2008 i�Ai1! i= _..._J_....._,._� ADDR. 2 j /D, e-r �._ C1 (w> -9-6s Zoe _ M,,Z `, 69:695 W ,� - 5'6L E I S3NOHd Add II / .Z 6 x.E 1 E � f t o t in I ff i W OVd NNVI 3138ONOD f i E D-, Z NOIS ft .� o 310d -+ 0 g f z A -°� it -- -- - n 07 i i r - -- - z / I m °4O ©° z I m � co,�, _j g C_ �,� ,el 3! \� I f p 1� c I OrVd N 3210NOO f � o a I I I� •du E ✓s g � _ I I f� C { ° 01 i E Lam. - " -- N91S p0 N AZ:LW3 f/ 00 Lt,= � OLLVA313 •�•� I U rn g P_ � I I 11 Ys 0 ?6 "Z = V38V 'Qi® a I I 1 -6*09 'ON 38015 33N31N3ANO3 SV9 g S q o N I MOV813S AdONVO f o� IV -- - - - - -- o° :U< a � ® _ OVd AdONVO 'q MONOO E n , f I S63H10 ,O -,ZT f �'1NI ,0, 3 o C0 VI0SV3 AdONVO 30 3903 0 -166 jo b � 1 V