HomeMy WebLinkAbout107 Skogen 12-1898li4z
CEIVED
D JUN 2 8 201712 CITY OF SANFORD
BY: BUILDING & FIRE PREVENTION
7BY-
PERMIT APPLICATION
Application No: Documented Construction Value:$ /QS6 - 0 0
Job Address:/ 0:2 r4-
ParcelID: '�_2,-19-3n
9epj&ce_ & t i,A
Description of Work: �as)e 4:_10
Plan Review Contact Person:
Historic District: YesEl NoR
Zoning:
LU �f h S C4V"P_ co-,�-f etv� P_
Title: pecf!�L&
Phone: Fax: E-mail: :51,ruA, aL.-
Property Owner Information
Name gef4jesf WM-9 Phone:
Street:.-,,gn A4 hl_-erin P Resident of property?
City, State Zip:
Contractor Information
Name Phone: V67-(��(6-926Q
Vin-Iffi!2C &.C�ak)
Street: Ave'- Fax: 4,16 ;7 - j!::�
City, State Zip: LA ItIler 0brLi State License No.: EEC 000 3326
Architect/Engineer Information
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Building Permit 0
Square Footage:
No. of Dwelling Units:
Electrical 0
New Service — No. of AMPS:
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
PERMIT INFORMATION
Construction Type:
Flood Zone:
No. of Stories:
Plumbing 0
New Construction - No. of Fixtures:
Mechanical 0 (Duct layout required for new systems) Fire Sprinkler/Alarm 0 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 requ ' ires 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.
n, 46 6 leez 6
TigAture of Owner?ggifnt Date
SIgnature of Co�iractor/Agent Date
7-2�-_�,5;7111 Scc>]� F7ce&43Ec"k=
Print Owner/Agent's Name Print Contractor/Agent's Name
/ - - ' e�:11 F% &
Sigz�h
S i�a itu re6if �l &ta i�-_S ta t e 6-f F I a? i d a D—ate a e of Notary -State of Florida Date
pA�:Ok, MAN S WHEELER
MY COMMISSION # EE 125999
EXPIRES: December 29,2015
Boled Thru Budget Notary SeMm
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
ow P Notary Public biale of Honda
Jessica Mitchell
My Commission DD835877
Expires 11/09/2012
Contracl-oMnent is — Personally Known to Me or
Produced ID _ Type of ID
UTILITIES: WASTE WATER:
FIRE:
BUILDING:
Rev 11.08
CITY OF SANFORD
AUG 0 6 201Z UILDING & FIRE PREVENTION
r PERMIT APPLICATION
ApplicationNo: 15ocumented Construction Value: $ o cD
JobAddress: /Ne::� &oo-d 91AQA= C-T- Historic District: Yes El No;&
V
Parcel ID:
Zoning:
Description of Work: jAj 1. M Ad IQ t 1-10^'
Plan Review Contact Person: Caj1zj,,_"' Title:
Phone:M Z28 0G7& Fax:
E-mail:
Property Owner Information
Name epr�� 0
Street: IM tl
City, State Zip: _4�2 �_�6rd (7L 3-Z-77/
Phone:
Resident of property?: ye'5
Contractor Information
Name (rjkl�� e_�eclnc_ 71&c Phone: ZIO-) 37-1911/1
Stree':'Z2-5 0 Wtkbur P
t k(,e Fax: ZIP-2 328 0031�1
City, State Zip: C.--ro 0��r�,j PL -z,-z -I q 6 State License No.: 60?0015�,211A
11
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Building Permit 0
Square Footage: —
No. of Dwel ling Units:
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
PERMIT INFORMATION
Construction Type:
Flood Zone:
Electrical 9
New Service - No. of AMPS: U&Armyw
Mechanical 13 (Duct layout required for new systems)
No. of Stories:
Plumbing 11
New Construction - No. of Fixtures:
Fire Sprinkler/Alarm 0 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, o it flees when the
_Y�
permit is released. 'I/,
/9'
Signature of Owner/Agent Date Si-gVMTrr-e of ConTrbacit-or/Apbt '-' Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID TypeofID
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Print Contractor/Agent's Name
(L ;az LA La(±
Signature of Notary -State offlorida Date
Contractor/Agent is Personally Known to Me or
Produced ID _ Type of ID
WASTE WATER:
BUILDING:
Rev 11.08
Ma
8-2-2012
Walters Electric Inc
Commercial and Residential
225 E. Wilbur Ave
Lake Mary, FL 32746
407.321.8444 Office
407.321.2729 Fax
MS West Const
Cameron Residence
106 Quail Ridge Ct. Sanford, FL. 32771
14- 15 amp outlets
1- 15 amp VYT outlet
I — std flood with sw
1 - Wall mount fixture prewire
2- P. fan prewires
5- sp toggle sw
3- 3way toggle sw
1 -pool table light outlet
I - Cable tv outlet
Feed new circuits (2) from existing spa sub panel(currently not used).
Devices to be white toggle.
Includes City of Sanford electrical permit
$1,100.00
Calvin
Walters Electric Inc.
4073218444
OP ID: TH
'44CC>Jzix
CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD1YYYY)
1 04106111
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER 407-869-0962
SIHLE INSURANCE GROUP, INC. 407-774-0936
P. 0. BOX 160398
ALTAMONTE SPRINGS, FIL 32716
Dave Zeldwig/U rseth Split acct
CONTACT
NAME:
PHONE 1FAX
LAIC, No Ext): (A/C, No):
-h-MAJL'
ADDRESS:
PRODUCE R
CUITIMER,,,WALTE-9
INSURER(S) AFFORDING COVERAGE
NAIC
INSURED Walter's Electric Inc
225 Wilbur Avenue
Lake Mary, FL 32746
INSURER A: Association Insurance Co.
INSURER E:
-INSURERC:
D:
-INSURER
E:
[INSURER
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 13ELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TY EOFINSURANCE
ADDL
INSR
SUBM
WVD
POLICY NUMBER
POLICY EFF
(MMIDDIYYYY)
POLICY EXP
(MWDDNYYY)
LIMITS
GENERALLIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FlOCCUR
EACH OCCURRENCE
$
7--
PREMISES(Ea occurrence)__
MED EXP (Anyone person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
LAGGREGATE LIMIT APPLIES PER:
PRO-
MPOLICY FIJECT 17 LOC
PRODUCTS- COMPICIPAGG
$
$
AUTOMOBILE
LIABILITY
ANYAUTO
ALL OVVNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OVVNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
$
UMBRELLA LIAB
EXCESS LIAB
HOCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
$
A
WO RKERS COMPENSA71ON
AND EMPLOYERS'IJABILITY YIN
ANY PROPRIETORIPARTNERIEXECUTIVE —]
OFFICER/MEMBER EXCLUC r
(Mandatory In NH)
Ife nder
,� describe U
ID , RIPTION OF OPERATIONS below
NIA
CVOO1668302
01/01/11
01/01/12
x I WC STATU- I x NTH -
TORYLIMITS ER
E.L. EACH ACCIDENT
$ 500,000
E.L. DISEASE - EA EMPLOYEO
$ 500,000
E.L. DISEASE POLICY LIMIT
fl
$ 600,000
DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
CERTIFICATE HOLDER CANCELLATION
SANFOCI
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES� BE CANCELLED BEFORE
CITY OF SANFORD BUILDING DEPT.
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
FAX# 407-246-3420
PO BOX 1788
AUTHORIZED REPRESENTATIVE
SANFORD, FIL 32772
1
C��,,A W,64,,
@ 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 26 (2009109) The ACORD name and logo are registered marks of ACORD
RE: Permit#
3-11111"IN"jo
Inspection Affidavit
kV4q4-FC -5, _,licensed as a(n) Contractor* [Engineer/Architect,
(please print name and circle Lic. Type) FS 468 Building Inspector*
License#; U-co(0-00)v
Onorabout 4v& I -ao I I did personally inspect the roo
f
(Date & time)
deck nailing andlor secondan water barrier work at IM; 90411— F—t>& 67:- 0—
(circle one) (Job Site Address)
e-' 4 il -,e 32-7-7-'-7
"', �- V
Based upon that examination I have determined the installation was done according to the
H
SignAture (Based on 553.844 F.S.)
STATE OF FLOR-EDA
COUNTY OF
Sworn to and subscribed bef6ie me this4q day of &e 20
By
DEBBIE BLANTON
Notary Public - State of Florida
My Comm. Expires Feb 25, 2015
M
Commission # EE 60182
Bonded Through National Notary Assn.
otary Public, State of Florida
type or stamp name)
Commission No.:
Personally known or
Produced Identification
Type of identification produced. r6 L' K
* General, Building, Residential, or Roofing Contractor or any individual certified under 468 F.S. to *make such an
inspection. Include photographs of each plane of the roof with the pern-dt If or address # clearly shown marked on the
deck for each inspection.