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HomeMy WebLinkAbout200 Park Ave 12-1073` MAR 0 ,7 2012 _ 1ti'4.z l i CIT OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: I D, l Documented Construction Value: $ Job Address: (3_ oc) Sy . ?(-,r /, A\tQ- `s.� Q, \00 �S(gr1w Historic District: Yes ❑ No ❑ Parcel ID ©�J-- k'{y - s(j `- 5 A G - oL'o4 - 001(loving: Description of Work: l Vii W- ' CUs i Plan Review Contact Person: Title: Phone: Fax: E -mail: Property Owner Information Name Phone: Street: i_ ks r 6 a O G U G_ Resident of property? City, State Zip: ()L',Q-Ck.0 8X76 -4 • ' -�^ Contractor Information . Name _ AO 1 Phone: �i-C3�1 - ga(7 - 3aa )'s Street: U50 t k 11 Fax: City, State Zip: Ock" AC) L :� -AR \;), State License No.: E oo t1a) Name: Street: City, St, Zip: Bonding Company: Address: Building Permit GY Square Footage: 0 No. of Dwelling Units: Electrical ❑ ArchitectlEngineer Information Phone: Fax: E -mail: 4 ' Mortgage Lender: Address: PERMIT INFORMATION Construction Type FIood Zone: New Service - No. of AMPS: Mechanical ❑ (Duct layout required for new systems) No. of Stories: Plumbing ❑ 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, beaters, 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 Tim 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 Owner /Agent's Name Signature ofNotary-State Owner /Agent is Produced ID Date Personally Known to Me or Type of ID APPROVALS: ZONING: UTILITIES: ENGINEERING: COMMENTS: Rev. 11.08 1e m Signature of ^ ntmctor /Agent Date Z( Print C trac Agent's ame 3i7l1o�� Signature ofNotary -St of Florida Date LAUREN RAJNAUTH MY COMMISSION ;f EE 118072 h } 'ti EXPIRES. August 2, 2015 Bonded Th tu Notary Public Underwriters Contractor /Agent is Personally Known to Me or Produced ID Type of ID WASTE WATER: BUILDING: Section • • ADT Security Services, Inc. ( "ADT ") Business Name ( "Customer" or "I" or "me" or "my ") Office Address b 30 r� _/fc �v �� e s �5 Address 1/4-4k4 J -e /,af /�j �1n� r G a77� CIS State ZIP Responsible p , Protected Premises' Party J Telephone / � 0'4 O Traditional Phone (ii -Other (Qualified) O Other (Non - Qualified) www.MyADT.com 1.800.ADT.ASAP® (1.800.238.2727) Alternate s Telephone 1 O Home O Cell O Work Alternate IF FAMILIARIZATION PERIOD IS REJECTED INITIAL HERE Telephone 2 O Home O Cell O Work (see Paragraph B3 of the Terms and Conditions for explanation) EMAIL Communications Authorization: I authorize ADT to provide me with information and updates about the security system and new ADT and third -party products and services to the contact information provided by me. I may unsubscribe or opt out by emailing donotcontact @ADT.com or by calling 888.DNC4ADT (888.362.4238). Initial here Confirmation of Appointments: I authorize ADT to call me using an automated calling device to deliver a pre- recorded message to set/co i m ° appointments and provide other information or notices about the alarm system at the telephone number(s) provided by me. Initial her Ownership of System and Equipment: O Customer -Owned (WADT -Owned m m Automotive/ m Verticals Retail: Business Services: Personal Services: Transportation: Grocery /Food: m m m m m Health Services; Restaurants: Wholesale: Other: I ACKNOWLEDGE AND AGREE TO EACH OF THE FOLLOWING: (A) THIS CONTRACT CONSISTS OF SIX (6) PAGES. BEFORE SIGNING THIS CONTRACT, I HAVE READ, UNDERSTAND AND AGREE TO EACH AND EVERY TERM OF THIS CONTRACT, INCLUDING BUT NOT LIMITED TO PARAGRAPHS C AND E OF THE IMPORTANT TERMS AND CONDITIONS. (B) THE INITIAL TERM OF THIS CONTRACT IS THREE (3) YEARS. (C) NO ALARM SYSTEM CAN PROVIDE COMPLETE PROTECTION OR GUARANTEE PREVENTION OF LOSS OR INJURY. FIRES, FLOODS, BURGLARIES, ROBBERIES, MEDICAL PROBLEMS AND OTHER INCIDENTS ARE UNPREDICTABLE AND CANNOT ALWAYS BE DETECTED OR PREVENTED BY AN ALARM SYSTEM. HUMAN ERROR IS ALWAYS POSSIBLE, AND THE RESPONSE TIME OF POLICE, FIRE AND MEDICAL EMERGENCY PERSONNEL 15 OUTSIDE THE CONTROL OF ADT.-ADT MAY NOT RECEIVE ALARM SIGNALS IF COMMUNICATIONS OR POWER IS INTERRUPTED FOR ANY REASON. (D) ADT RECOMMENDS THAT I MANUALLY TEST THE ALARM SYSTEM MONTHLY AND ANY TIME I CHANGE TELEPHONE SERVICE, BY CALLING 1.800.238.2727. (E) THIS CONTRACT REQUIRES FINAL APPROVAL BY AN ADT AUTHORIZED MANAGER BEFORE ADT MAY PROVIDE ANY EQUIPMENT OR SERVICES, AND IF APPROVAL IS DENIED, THEN THIS CONTRACT WILL BE TERMINATED, AND ADT'S ONLY OBLIGATION WILL BE TO NOTIFY ME OF SUCH TERMINATION AND REFUND ANY AMOUNTS 1 PAID IN ADVANCE. ADT Representative- Name hilj S Rep. License No. Rep. (If Required) ID No. Customer _A_pproval: Original Sign ture Required �•_;. INSTALLER -NO (Saecial Ins ru Ions /Directio s Cross°�Street) ' 4 Section to be Provided Alarm Monitoring and Notification Services -- Monthly Service Charge I Monthly Service t:harge 408Urglary(BA) !$ 99 7, — — �u On Site Services n/ O Hold -up (HUA) -- �_ ----- c O Guard Response O Interfor O Exterior Duress - _ $ -- -- O Other O Two -way voice $ _ Total Monthly Service Charge $ O Critical Condition Monitoring (CCM) Q O Flood OTemperature — , Initial Fee O Paraliet Protection _ O Annual UL Certificate Fee .F y, 'r 0ADT Select' DataSource 1 $ -- I A QDTto obtain electrical permit O Open/Close Login O Customer to obtain and pay for initlallannual municipal alarm use permit Failure to obtain and provide ADT with the municipal alarm use permit registration number could result in no munidpal firelpolloe'response to an alarm from tf a premises andlor a fine. O Supervised Scheduled Open /Close I $ O.Other O ADT Select Entry i Installation Price aTD Other Services GO Quality Service Plan (Q5P) $ O If Quality Service Plan (QSP) is Declined Customer C X must Initial here O Preventative Maintenancellnspections Per Year 01' 02 03 04 06 012 _ -_ -- _ OTraining N — $ O Direct Connection Services $ O Monthly Recurring Municipal Fee (Subject to change based on local lav4 0 Customer to obtain and pay for municipal alarm use permit Taxable Amount (Leave blank if ADT - Owned) Non- Taxable Amount (Leave blank If ADT - Owned) __ Ts Connect ion Fee Sales Tax on Installation* — f� Tax Exempt No: WAI Tax Expiration Date Total Installation Charge* — �7G a�- Deposit Received: 100% deposit required < $500 0� Minimum 50% deposit required $500+- JGGr a O Money Order O Check O Credit/Debit Card d` J� *If applicable sales Section —QuantJjDevi - -_ tax not shown, It will be added to the first invoice. Balance Due* • • to be Installed ce Description / 1"7 O- 9 7`7� _20/917e rSi t� � . /CIO 770 /) __ fG'rlSDr We- G�oor Device Location' I�; ---- I. -C - ad l USf 9 re k- _ - 0o o _ �P c e. i✓ e r �� i A/0&0,) �r Sir - e�T Estimated Installation Start Date v r v 02011 ADT. All rights reserved. (04/11) I I I I 1 CITY OF SANFORD INSPECTION CARD F FAX/EMAIL RESIDENTIAL PERMITS ONLY INSPECTION REQUEST LINE - 407.688.5151 PERMIT ## ADDRESS ZOOS • zw Ag-,%elyo PROPERTY OWNER CONTRACTOR DESCRIPTION `MANUFACTURE SPECIFICATIONS OR INSTALL INSTRUCTIONS NEED TO BE ON SITE* BUILDING ELECTRICAL PLUMBING HVAC* * Florida energy code requires verification of matched systems FINAL SIDING TEMP POLE ROUGH -IN / PRESSURE TEST ROUGH IN FINAL SOFFIT /FASCIA ROUGH IN SEWER TEST FINAL RE - ROOF FINAL IRRIGATION SHEATHING /DECKING CHANGE OF SERVICE FINAL DRY -IN INSULATION MITIGATION AFFIDAVIT FINAL INSPECTION CARD SHALL BE DISPLAYED ON STREET SIDE OF LOT DO NOT REMOVE CARD UNTIL FINAL INSPECTION IS APPROVED SANITARY FACILITIES REQUIRED ON SITE "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 OF COMMENCEMENT REQUIRED: YES 00*' NO rn. � 3 BUILDING OFFICIAL TECH INITIALS ISSUED 0, 612 Issued permits must have an approved inspection within 6 months of the date of issuance or they will expire. An extension must be requested in writing, approved and paid for prior to expiration.