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Home My WebLink About2280 Old Lake Mary Rd 12-118:CEIVEI-.)l . Vq T MW 4 SALFORD BUI & FIRE PREVENTION ATION Application No: r �v — � 1' 8 Documented Construction Value: $ ;/ y4y/ Job Address: Curb In U Lake Mary 9. Historic District: Yes ❑ No ❑ Parcel ID: Zoning: Description of Work: f e, P1 OPuv,,- IL-14s Runo),`ne, 6ia-S 1;g_ 7-o e!5�,Wt- � Plan Review Contact Person: Phone: Fax: Title: E -mail: Property Owner Information Name `C 4 &kWeWAten Icc'- Street: 2 2�D &1d, �_,,Ae, vim( City, State Zip: Phone: Resident of property? : Contractor Information Name Phone:— /T1d�� Street: Fax: City, State Zip: Ld'wd , 3,'-w State License No.: Architect/Engineer Information Name: Phone: Street: Fax: City, St, Zip: Bonding Company: Address: Building Permit ❑ Square Footage: No. of Dwelling Units: Electrical ❑ New Service — No. of AMPS: E -mail: Mortgage Lender: Address: PERMIT INFORMATION Construction Type: Flood Zone: Mechanical ❑ (Duct layout required for new systems) Plumbing ❑ No. of Stories: New Construction - No. of Fixtures: Fire Sprinkler /Alarm ❑ No. of heads: 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 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. The City of Sanford requires payment of a plan review fee. A copy of the executed contract is required in order to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the plan review fee based on past permit activity levels. Should calculated charges exceed the documented construction value when the executed contract is submitted, credit will be applied to your permit fees when the permit is released. Signature of Owner /Agent Date Print Owner /Agent's Name Signature of Notary-State of Florida Date Owner /Agent is Personally Known to Me or Produced ID Type of ID APPROVALS: ZONINGA 10 UTILITIES: ENGINEERING: FIRE: COMMENTS: od, f °r p F(2eE!,,e f,,.,A, q,- 0e e_,,_ "✓ Rev 11.08 Signature of Contractor /Agent Date Print Contractor /Agent's Name Signature of Notary-State of Florida Date Contractor /Agent is Personally Known to Me or Produced ID Type of ID WASTE WATER: BUILDING: .10146111 Fax 7) ,§51 -1297 13 � - SAMS4NGAS P.O. Box 593641 8222 S. Orange Ave. Orlando, Florida 32859 -3641 WWW.SAMSGAS.COM OFFICE OFFICE (407) 855 -1903 d y 3 � q O kA�' A M o� J SAMS4NGAS P.O. Box 593641 8222 S. Orange Ave. Orlando, Florida 32859 -3641 WWW.SAMSGAS.COM OFFICE OFFICE (407) 855 -1903 s C� 3 v o 'j Residential • Commercial • Industrial Since 1964 IL d 3 � q O J s C� 3 v o 'j Residential • Commercial • Industrial Since 1964 IL — ——--A - -- uzuji-I SAMS06AS P.O. BOX 593641 8222 S. Orange Ave. Orlando, Florida 32859-3641 Orlando, Florida 32809-6733 (407) 855-1903 - (407) 855-1906 • (407) 855-6506 www.samsgas.com ❑ SERVICE ORDER ❑ INSTALLATION ORDER ACCOUNT NUMBER CALL DATE PROMISE DATE NAME "'-c MAILING ADDRESS CITY STATE ZIP CITY COUNTY APPLIANCE INFORMATION COOKTOP/RANGE DRYING TYPE (FILL IN COMPLE% 6 TYPE GRILL POOL/SPA HOME PHONE WORK PHONE TANK INF6_UW10N PERCENT SIZE TANK j GALLONS IN TANK DESCRIPTION MATERIALS CELL CODE 22 PHONE AM qU_Nj J- FORKLIFT GENERATOR LABOR CHARGE 23 FIREPLACE FIRE PIT COND. SERIAL NUMBER TRAVEL CHG 74 HEATING I I WATER HEATER HIGH PRESSURE START r-7 PT END P R TEST TIME [--=7 17P GAS CHECK 25 GAS LIGHTS KITCHEN PERMIT 47 PARTNO.1 CITY I DESCRIPTION/MATERIALS PRICE AMOUNT LOW PRESSURE bIAKI VH END VH TEST I TIME LOCK mr—, GAS CUSTOMER/PRESSURE TEST OK X SALES TAX 60 TECHNICIAN /PRESSURE TEST X UTILITY TAX TANK RENTAL KEEP FILL: Y or N RATE CODE ZONE TAXES -fX-1 TX2- -TT3- -TT4- —TX-5 CUST. TYP DEL FRED DEPOSIT 46 TOTAL RECEIVED • TANK LOCATION N W E El THE L.P. GAS INSTALLATION DESCRIBED HEREON HAS BEEN RECEIVED AND INSTALLED TO MY COMPLETE SATISFACTION AND I HAVE BEEN INSTRUCTED IN ITS USE. I HAVE BEEN INSTRUCTED AS TO ODOR OF L.P. GAS AND HOW TO TURN THE GAS SERVICE VALVE OFF IN THE EVENT OF AN EMERGENCY. I HAVE ALSO READ THE GAS SERVICE AGREEMENT AND THE INSTALLATION ORDER AND AGREE TO ALL REQUIREMENTS, RESTRICTIONS AND POLICIES OF THE GAS COMPANY. NOTICE TO PURCHASER (A) DO NOT SIGN THIS BEFORE YOU READ IT, OR IF IT CONTAINS ANY BLANK SPACES. (B) YOU ARE ENTITLED TO AN EXACT COPY OF THE PAPER YOU SIGN. (C) YOU HAVE THE RIGHT TO PAY IN ADVANCE THE FULL AMOUNT DUE, AND UNDER CERTAIN CONDITIONS TO OBTAIN A PARTIAL REFUND OF THE TIME PRICE DIFFERENTIAL. (D) WE WILL HONOR ESTIMATES FOR 30 DAYS ONLY. CUSTOMER'S SIGNATURE X DATE %,kint-m- i in e-/-%nv Fax 7) k511 -1297 'b � "\ \o � v M 'z, o� SAMS6GAS P.O. Box 593641 8222 S. Orange Ave. Orlando, Florida 32859 -3641 WWW.SAMSGAS.COM O � 4 l� i � s cz� _ l � 4 Residential • Commercial • Industrial _ Since 1964 ' 0 -� 3 OFFICE OFFICE (407) 855 -1903 r� _t a� \o � M 'z, o� SAMS6GAS P.O. Box 593641 8222 S. Orange Ave. Orlando, Florida 32859 -3641 WWW.SAMSGAS.COM O � 4 l� i � s cz� _ l � 4 Residential • Commercial • Industrial _ Since 1964 ' 0 -� 3 OFFICE OFFICE (407) 855 -1903 r� _t a� Fax T y" 7) K51-1297 1j � - AMS(,)GAS P.O. Box 593641 8222 S. Orange Ave. Orlando, Florida 32859 -3641 WWW.SAMSGAS.COM PERNil 8T #r az. B q cam: `�� t•N" - -� ,� '� ILI- w � vi j ) Residential • Commercial • Industrial Since 1964 OFFICE (407) 855 -1903 \n V t 'o a� \1 Iv 0 C°' N AMS(,)GAS P.O. Box 593641 8222 S. Orange Ave. Orlando, Florida 32859 -3641 WWW.SAMSGAS.COM PERNil 8T #r az. B q cam: `�� t•N" - -� ,� '� ILI- w � vi j ) Residential • Commercial • Industrial Since 1964 OFFICE (407) 855 -1903 \n V t 'o a� \1 Iv LIMITED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: "^,- '-9 / — / % I hereby name and appoint: fu-f! "9 an agent of: ff'ofi)JI of Company) to be my lawful attorney -in -fact to act for me to apply for, receipt for, sign for and do all things necessary to this appointment for (check only one option): 2'- All permits and applications submitted by this contractor. ❑ The specific permit and application for work located at: (Street Address) Expiration Date for This Limited P-'�wer of Attorney: License Holder Name: /'7 d"q State License Numbe Signature of License STATE OF FLORIDA COUNTY OF lR 1-2 t? The foregoing inA u �nt v as ac wledged before me this�/ day of YLI 204 , by yjt aII�� who is rersonally known to me or ❑ who has produced identification and who did (did not) t3-tke an oath. (Notary Seal) (Rev. 3/27/07) or type name Notary Public - State of _ Commission No. My Commission Expires: as CYNTHIA J DOW P46fic • State of Florida OUW29, 201,, 792910 c x SAMRD ELECTRIC CO II. WC 2522 PARK DRIVE S,MMRD, FL 3Z713 sting Culvert Pipe w/ Curb Gut �+ K r///69 185' I Site to Remain '?As -Is" 1 -ended Outside Storage i I 1, , vzpl�e;A !,Ti' ,in• in YT,- :n' 'I yTi' 511' yTi' ; ?: r �\• MEN 701 i Cj G Q r � N � � p W � Qf � J � G �a❑ C Q N uJ N �Q n n O U U Kevin J. Spclski o-ea® Kevin J. S plskl 30 June 2004 woe w. X w.r a X �itv i�lnn