HomeMy WebLinkAbout2451 Old Lake Mary Rd 17-2665; ELCTRICAL AND WATERPP '44
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
1
Application No: 7 a` (O (o
L!'7 /a
Documented Construction Value: $
00(0010005
Job Address: 2451 Old Lake Mary Road, Sanford, FL, 32771 Historic District: Yes No X
Parcel ID: 35-19-30-300-030C-0000 Residential Commercial X
Type of Work: New Addition Alteration El Repair Demo Change of Use Move
Description of Work: Upsizing water line and electrical equipment
Plan Review Contact Person: Jeremy Morton Title:
Phone: 407-322-6841 Fax: 407-330-0639 Email: jmorton@cphcorp.com
Property Owner Information
Name: Jax Ice Machine Equipment 8t Leasing Co. Inc.
Street: 5849 Commonwealth Ave
City, State Zip: Jacksonville, FL 32254
Phone: 404-379-7313
Resident of property?:
Contractor Information
Name T I rg Phone;
359 a-79 oIs$ 1
904-654-6372
Street: 19J) 9 76PLo t I I It;? r -Fax: 3 SO % q 9- 90 93
City, State Zip: FwmkSy, ) le 1 C// / State License No.: EC13003930
Architect/Engineer Information
e 15 kate)
Name: Jeremy Morton - CPH, Inc. Phone: 407-322-6841
Street: 500 West Fulton Street
City, St, Zip: Sanford, FL, 32771
Bonding Company:
Address:
Fax: 407-330-0639
E-mail: jmorton@cphcorp.com
Mortgage Lender:
Address:
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.
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. 1 understand that a separate permit must be secured for electrical work, plumbing, signs, wells, pools,
furnaces, boilers, heaters, tanks, and air conditioners, etc.
FBC 1053 Shall be inscribed with the date of application and the code in effect as of that date: 5'° Edition (2014) Florida Building Code
Revised: June 30, 2015 Permit Application
PR 40L
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 at the time of permit submittal. A copy of the executed contract is required
in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal.
The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in
accordance with local ordinance. Should calculated charges figured off the executed contract exceed the actual construction value,
credit will be applied to your permit fees when the permit is issued.
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.
Signature of Owner/Agent
Print Owner/Agent's Name
Date
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
Signature of Contractor/Agent Date
Print Contractor/Agent's Name
Signature of Notm-StaL"f—Florida
MY ^i•,; DEBBIE BLANTON
MY COMMISSION it FF 17e848
a, EXPIRES: February 25, 2019
Boded Toru Notary Pubrx Underwriters
Contractor/Agent is Personally K own to Me or
Produced ID Type of ID F I
ekv-
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas[] Roof
Construction Type: Occupancy Use: Flood Zone:
Total Sq Ft of Bldg: Min. Occupancy Load: # of Stories:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes No
APPROVALS: ZONING:
COMMENTS:
Revised: June 30, 2015
ENGINEERING:
Plumbing - # of Fixtures
of Heads Fire Alarm Permit: Yes No
UTILITIES: WASTE WATER:
FIRE: BUILDING:
Permit Application
The Ice Man
5849 Commonwealth Ave
Jacksonville, F132254
904-384-2013
ATTN: David Bryant
RE: Sanford Project
2451 Old Lake Mary Rd.
Dear Mr. Bryant,
19118 Powell Rd.
Brooksville, Florida 34604
Cell: 352-279-2581
Fax: 352-799-9093
Email: CFLS 1127 OcAOL.com
Central Florida Land Services, INC., ("CFLS"), is pleased to quote you the scope of the job for
the above reference site. The following is our scope of work and proposal.
1) We will pull a GC Permit for which all of the permits will work under our company andbetheGCforthedurationoftheproject.
2) Electrical work will be done by 5 Star Electric; their proposal is included, for the total
sum of $47,000.00. 1 understand you have met with them and have gone over electrical
requirements for this project. 5 Star Electric will be responsible for pulling their own
electrical permit.
3) We will install approximately 200 feet of three inch schedule 40 waterline with three feet
of coverage for the service to the ice makers in the building, then we will connect service
at Old Lake Mary Road.
Total lump sum $8,600.00.
Exclusions: Engineering, Testing, Repair of unknown existing utilities, and Live tap.
We appreciate this bidding opportunity. If we can be of further assistance to discuss this matter,
please feel free to contact me.
spectful .tte , --
Chris Parrish, President Owner Signature for Appro
THIS NSIRUMENT PRRED BY- GRANT MALOY r SEMINOLE COUNTY
Name:
Address:((.=
YY`
liq wc% CLERV OF CIRCUIT COURT h COMPTROLLER
EK 8994 P9 1556 (1P9s)
CLERK'S 0.2017096496
NOTICE OF COMMENCEMENT RECORDED 09/26/2017 01:00:38 PM
RECORDING FEES $10.00
State of Florida
RECORDED BY ,ietkenro
County of Seminole
Permit Number. 1 M v'dP IY Parcel ID Number. 3t 's \ ' J 6 6 — 036 e-- 0 000
The undersigned hereby gives notice that Improvement will be made to certain. real property; and In accordance with
Chapter 713, Florida Statutes, the following Information Is provided In.this Nogcb of Commencement.
OF PROPERTY: (Legal descj1ppon of the property and street address if avalitible)
GENERAL DESCRIPTION OF IMPROVEMENT:
L3DSiZttvc u3'P-C'[2 Gt ae r V: \(2 -Y.* -1
M
Address:
Fee Simple Title Holder (if other then owner) Name:
Address:
OIZI 0 4 LA^.)b SePU iee-_
Address: V* I I X F -O Cwt l J!_t tV 6lz6a %.,&U 0 is . f-4— 5`t l9 u 1
Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served
as provided by Section 713.13(1)(b). Florida tatutes.
Name: (% L'fl_ _ 1Z-1 ta1 -
a. %4 1;1 ('k l) tJ 1+V, E MPry-4 tA Ztc,
In addition to himself, Owner Designates of
To receive a copy of the Lienors Notice as Provided in
Section 713.13(1)(b), Florida Statutes.
Expiration Date of Notice of Commencement (The expiration date is 1 year from 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 1, 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. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true
stofkno and tef.
Qw. V SDN i'
C,mers a Owners PAnted Name
Statute 713.13(1)(g): • The owner must sign the notice oroommencemom and no ons else may be pemtided to sign In his or her stead.'
i J f3
ur31a,7 Ao
County ofStateofY ` L'
The foregoing instrument was -acknowledged before me this dayday of rnr r
zo=
8
o
by bhlii oo d IIU Who Is personally known to me _0
Nerve of porson making statement Z
OR who has produced Identification type of Identification produced: =3 c "-
J
d LuL N pvr, , "•'. SHM ASH
NotarySignstws
u a
MY COMMISSION tr FF 0217,
t o U.
OvEXPIRES: October 9,
eondedThnrlbhryWplkUndennAen
z
L.3 JCtn rXi
AW 4 P 0 5 2017 I
CITY'.01F SANFORD
BUILDING &FIRE PREVENTION
PERMITAPPLICATION
Applkiifiob No:. / 7- 24 to 5
II)ocumented-Construciion-'Va'iue: S $50,880
job Address: 1451 'Old Lake Mary Road, Sanford, FL,:3277i 14is.torie Disbict:* YesEl No. El
im_ -.ffy% ar—lo in_qnn_nanr% nnnn
Type, pf-Wo r*k:. New,E].Addition *0 Al.teraiiblnT "Rep air-El;Dem
PeKr'iption of Work:. UlDsizilngvatie'r,iinle and electrical equipment
miden avLJCommercial
Change * Use ll Move El
Plan Review ContaqfPerson: Jeremy.Morfon 'Title:
viil:'jMqfton@:phcorp.comPhone: 407=322=6841_7=- 407.-330-0639. Em
Property 6Wh6rIn*cierW36bh
X_ Ice Machine Leasing co: Inc.. Name: Jai Phone:, 404-379-7313
gtreot: 5849 Commonwealth A%i6MI ident of property?
City, State Zip: Jacksonville, FL 32254
Gontractorinforrhation;
Nai" Th6rrias Pow6r§ Sr. - -5 Star Electric.. 54-6372,
Street:. .#ax:.
City -.,State Zip:-, 9faie1AC-ente.No-.: EC13003938
Arch ite.WEn.gi neer Inforrr#,tion.
Name: JerernV Morton - CPH',. Inc.. Phone: 407-322-6841
407-330-0639Street: 500'West Fulton Street Flx:,
C.jty,.'St, Zip:., 8anf6rd,'FL, 327.71 E ; mail: jrhdrt6ri@qphdqfp.dom*
Bonding Coffipanyi. Mort L - 'dMortgage. ep er:
Address:
M.A-MING -TO OWNER:AOM.PAILURETO RECORD ANOT4CE bFXOMMEKC- EMENT MAYRESULT IN YOUR
PAYING T%VICE.FQR IMPROYEMENTS. TOYOUR 'PROPERTM A- NOTICE' OF,COMMENCEMENT MUST BE
RECORDED. AND:POSTED ON THE JOB,SITE BEFOREJHE FIRST INSPECTION. 'IF YOU INTEND TO OBTAIN.
FINANCING; COOCONSULTWITHYOURLENDER RAN ATTORNEYBEFORE RECORDING YOUR NOTICE- OF
MENT.
Applicition..'is,hereby made to;obiain apermit to do the-wo&and installations as.indicaied. 'I certify that no work or insiallition.has
comiIiince.cl prior i4i,Ifiejsisuanci, of a permit and that all work-vnll*b.e perfoftned to`iiiik iiafidardsW-all laws iegulating"vohstructidli
in thishi . sjhrisdictioh. l'understand,that-.A separate pdhnit must be *uir6djor ilicificiii -iioflil plumbing, signs,; wells, pools-
fqrjfaces, tobileles, h.elbte' ,lipiks.'andair conditioners, etc.;
FBc1o53 96Wbe-instribed'With the d0e of appi . katio.n.and the'.6ftin,'iffect is*oftbat.date: Sib Edi6o"n-(2014).F166di Rud4i6g Code
Re3ised'.;June 30, 2015 Permit Application
146TICE'An additic;n io the. requirements of -this perniif,,.Ihm,.inay-:es ddditiojial i6Widh&.- applicable to this oiplierty.
thatI
jnay 06
found in tbepublicmeordsofibis county, ittid.theiem'iy be efititiO.Such,;L5 water
management.,districts,.staie.-agendies,,6r;fediiAI'4eicie'§.
Acceptance"f i',Vefift&W that-TwilFfidtif Whei-.bf tlic.prb requirements; Lien L' FS 713. o. permit y-ftb rWiStihereigii'mmen of Flbiida*1.
T}ie`City of
lip
Safiiofdi
tHrir;'04Me4t of . klita n-ryiew fee . eeaitthe.ttime of permit submittal. Axopy-oftheexecutW.contract is required
h order t " estimated - const"on value of the j6baf the time of-stibinittal. to plaifre*Jc W Aarg ##4 Will be considercid'the in
The',actua . I co . nsiruction'vtilue will -befigured'based on1he' current'. ICC Vitluation Table.Jn iffe6t,ai.thiD-tiite--th'e*'p'q'r'Tni't it i9siied, in
accordance W'Ith'loc:dl. ordinance. Shoaj calculated 6harges,figured -off the executed c6.ntrka,,ex*&ed.`the adual"66tistructidfi yaltie;
credit will be applied to your perrniffies.when the.permi( is issued.
OWNER,, ;AOFi-DAV-I'T:.I,c6rtify'.ttiait all dtheJorie-go"in9 iiifdrivati6it'it*acetira.te--ik.nd thiki-alf work will
ber.done in co.mpji.atkee.,vii.t'b,all,appli.cable,,Iaws regulating pqitstruction, and zoning.
pW1
T?4 'T 71j
Date
1 -
IMMM - .
000MMSSMORM17.
EXPIRES: O*Wi 9- 2017,
90*Twi iiiip* -
Qwfied;k&fitis C, 'Personally khoWfi-toMe or,
Produced 1D TypepffD
9i -of Comiuctbr/Agent- Dutiipuft1. 1 ..
Pard Caiirador/Aqsies Nam
Siwii*,6fNotary-State -6rFlorida We
Contractor/Agent is 'hrsoiially-known-toMeor
Produce .JD Type. -df -ID.
BELOW FOR OFOICEV'S9 ONLY
Pirmi6.Reiluiredt Bifflaitng[j E1e&ica1[:1 MethihicMEJ Pluhib'16,9E1- 04(:1 koof-E]
Coni-
stfuition Tyk;. L(/ Occdowlcjuse:. Flood Zone:
Miti. Occupancy Load:
Wof Am Plowbing.-4.0flixturesNe*Cbh9trdcti6h: Electric10 & rzo
Fire 8.pr'Wkte ,O -emit, Yes []'No, 4 of.He?ids Fire- Alarm Permit:; Yese
APPROVALS:, -ZONING: UTILITIES;. %WASTE WATEF;V.
ENQENEEM..Or .FIRE: 'BUILDING:
Revised: lune 30, 2015 Permit Application
b... z SANCIT1(OF.. F DOR
E(,._%' ` a : '
BUILDING &-.FIRE;,PREVENTION- -
PERMIT'APP.LICAT10..
APPl ca . ori oto:.. / Z l0 5
Documents ?ConstrucYionTalu9
Job AdillrpssX245;1 :Old Lake Mary .Road,, Sanford, ;FL, :3771 Histor..c Distjr; ct=Xes:.O
P rre1ID: 35=19=30=300-03QC=0000 Res eritial Commercial X
fWork: New;.t ddition Alteration: Repair ;Demo; Change,;gf Use` 1Vlove
D scr ption;of Work: Uji"siz';r ,Wcl 'line. and piectricei, equipment
PIan Review .Contact Pcrson::Jeremy'Mtiton • 'Title: _
Phiilie • 407=::322=6841 Fax 40.TZ30-0639 _ Email: `1!P•or`ton@cpl corP com
N.6odrty'Owner Inforlriation
Plione: 4;04=3.79-731:3
Resident:of;propexty?
Nsa : J4X.:Ice M-achihde Equipment•&Leasing=Co: anc:;
Street.;5849.C,;orririnonwealth 'Ave
C ty1-,Sioklip: Jacksonville.; FL. .3.2-2.54
C:ontractor l6f6hnatioti
Name 'TWM6m PowersSh. =5: Star Electiic° . _ _ .Phone .904=6.54;6372•
Street;
CiyS#ate Zli;' State;Ycene•;To E013003938:
Architetzt/Engi'neerl'nformation;
Name: :lererriy. Morton:_ CRH Inc:. P;lione , 407-'322-6841
Street:_ 500' West: F6lton:sM_-bt:. Fax:; 4.07=330=0639 _
City;;St Zip:•. Sanford, ;FL, 32771 _ E--miil; .lrngrtoii@cpfico P -COM'
Donjo Compahy'.,. Mortgage:Iepde.'r.:...
WARNII!(G TO OWNEit: OWE ItMET RECORD A:NOTICE OV C.iDMMENGENIENT':MAY':RES.iJL•TIN V- 100t
R*YWp-, TWICE ,FO,R: IMMOVEMENT. 'TO 'YOUR; TROPT V:' W. -NOTICE= OF ;CQlVi1VIENCEMENT' MU$T.:BE
RECORDED;AND :P.OSTED :ON THE:7O•B :SI`TE;:BEFORE:; TItE FIRST ;IIVSPEGTION ,IF YOU INTEND' TO'=OBTAIN..
FUVAI!TCINGr. ;CONSUL; i' W1Tji, YOUR GENDER :O t; AN',ATI'O1tNE ;BEFORE RECORDIl!JG `YOrUJ<i NO'T'ICE .OF.
CO1MU ANC-4MOT=
Application s, -hereby made to;obtain.a permit:,{o:do:the;-workand instillationsass.,indibiied::IcceriifyThat•,no;work•'or_insiallati' n bas
commenced grior.to440.ssuance ofa perinil .'aria that.all.;wb will;lie pertoimed io meet standaids:of,allcaws iegiilatiDg=coristiuciioji..
iii this; ifrisdiction;; 'I uud`ii;tirid ttiat;a_scpaTate peririit most lie secuced;foi 'e)ec_tfical-work;'p1um ing; sigri.'s;;wells;..pools;
furnace, lw lers,:heaters;'tanks;'and air conditioeis;etc _
TBC:1053,Sba1l licinsc ilied:ivitb:t6c d te•`of applicatiou'Sod itis' codg,•io;ct%ef O'ofttiit•dite: 5!xEclition:(2014)',Tio:rida:Building;Codc
ReJised: June''30; 11J5• ,pe (,Applicalioe
C
AdEe00h-&,()f :.,t.L e'qOfty t00 . utpe. .0). (q . a i'ieri Law; FS 713.
T" e" C y 'P f A,copy--b-f,the'.executed co3tmet,js reqgirdd
yit tO ad estimated c fitm va"'.of-ifiej6b.0 ihe-Ctme oftuWiw.
The actua current Viluation-,Table.:in iff ime"?th" pkm
rdance figureA`4fflhc-xecuied.db&O 66 " a 'constnctiog value;
reditvilbe
te and Mwotk rvillolqgdtlhNEWSmkdleiotit, 0.9 -r -aO.W -AFFIDAVIT laft*-i
b ii --ii, a livable; la r Matin construction anil tonin . '
4:s Narie° A -AqafirsNa-ne, n
4
j"
Pot or
Pib,dd.c6d. D Tyoe..OJD
Sigiahire oEMotarj%%-State4f Florida
Go it toi/Agofitjg;. o Nle'..or
BELOW 'Y5; :` ONLYPICE -V`89 --, 0
0c. difgtftai, n y vcxipanc
To"tal''gq Ft d M&.. dcupaucy-Load:
W ifigtfueidM.'. ]QedA,e. 4- c
kpX(j,-, Yes El, jFjtrgAArAre, , gon Y I -
ATP.RQV-AL-S- -ZONING: unLJTEES.,WASTE
ENGINEERING;: :FIKE BUILDING; UIL
Revised;lungj0 2015: ;pi:kmlt--Ap
CI71(';OF SANFORDV
BUILDING -&';FIRE::PREVENTION•
D /
PEFtIUIIT'i4PPLICATION
Appl catiol N`6:1.. 77 Zb to 5
Documc tedrConstruction'Value:. $.. ,$50,8 _
tJoli: Address• 1245==1 'Old Lake Mary :Road,. Salford, ;FL; :3277'1 Historic Distrct=;'Yes
35=,1 9=30=3 0=030C=0000TarcelID ,.Q,. _ Res"i enta Comir ercial .
Type;of Woxk::New; ,A d tion-+ Alteratiop 0 'Repa r ::Deriio 0; Change;of Use O: Move' 0'
tJDescriptionofWork:....ps rig w r'li a and':electrical equipme'rit _ izi ate : n .•_. _, , ,,,,._ ..
PlanfReview Cuntacf'•Pcrson::Jeremy`Mortoh. ''Title:
Phone,:• 407=322=6841:. Fa-33x:-. 4070-0639 _ Emsiil:1!i!or'ton@cphcorp;com
Property-Owner Information ow9
ame: Jax.:lee Machine E ui' menf'&;Leasin Co::lrlc:14
Strcet: ;5849,..C;ommonwealfl Ave y:• Residenf_ofpxbpe
City ;St te.Zip; Jacksonville; F;L 32254 DA ib
t'ontractor;Irifo lmat on.,
Name TFigmai Powers S:=>S::Sta r :Electric _ :phone:: g,04=6'54=6.372: _
Street:
0y.;:Sxate Zili:;; . : Stafe;T icelise;No:; EC1300393$
ArchifectlEngnee r lnform ation;
Name: Jeremy: Morton:- CPH;;Inc: Phone: 407=322-684'1
Street:: 500'"West.:FOlt6n:Stteetl. 407=330:0639
City; Std Zip. -Sanford, :FL, 32771 _ jniortgri@cphcocp.comE-mail:
oo ngrCoinpatiy:: _. .--. ... ... ........ Mtirtgage:sepder::;•:.. .. . - ,_....- .- .-.-. _
aaa resnis:
AN 'G ;TO .QWNEIt: YOURAILURE'TO RECORD A:NOTICE' OF. GOIGIMENGEMENT MAY•:RESUI;T ;IN YOUR
1plAYlp,' TWYCE• .700.YMk.90YEMEN`I'S TO 'Y',OUlk,, TROPRRTY.' W KOTI-C9--' Of ;COMMEINCEMENT'MUS.T ;SE
77RECORDED:•AND P•..OSTED ON THE'70B;.SITE;:BEFORE;'HE FIRST INSP)GTION::IF'YOU 'INTEND_9BTAII!i..
FINATTCING , ;CONSULT W177I• YOUR. GENDER 'O t; AN" A`ITORNE ;BEFORE;: RECOF,DING YQUI A.1VOTIC , .OF.
CO1vIMEL fCE1VIENT: ..• . ... .• _ ... . _ .. . .
A ,plicationis;hereby;made•to;ob'tain,a,perT!t:•to:do.the;:woik2and installations;as''indicated.:L,certify.that•,noNwoik or installation;has
comirienced no>toitfieissuance 6f—.tbat°all workwill:be per[oririedto'meet standards:of,all'laws iegiilating coiislruc(ioji.
an this, unsdictiori., 'I; undcr3tand. tl at:a separate ""runt must lie sccu cd for 'elec'tncal"'wo lmm Ing;= si u.'s .well§'•. ools
furnace ;`boilers; li'eaters;ttaaks;'ikp. air,con., tiomcrs, etc: ;
tTBC1053,Sliblltic4dscribid:*vitb:th d"te`ofa"p;licatioo'and!tlie'eodc,inei%et:as'ofttist':date:5!"'Edition (2014)Tldrida:i3ulding:6odc
Wevised'. Ju ipl*7-0) _Pai iii ApPlieat on
Acceptance'.gfpermit:is`Everificatigri:ttiatI,will ngtify he:gwiie ;oftfie,propeity`oftheieA!kt cets;bfFloridai ien'1 aw;,FS713.
77ie':C'ity of Sanj d'Fegoirgs payinent:of a'.p]an xev ewdee at the tiiue;o perm t:submittal: A;copy of•the executed.conin ct is requved
in bider :calcutate'a plan _review ctiarge and'will be considered -*0 estimated oonsbvefibn valbe of•the, job.-at ihe time of'su>imittal.
Tlieactual-cons[ruction'alue will beifigured*based ontlie'current:lGC :VialuatiomTafle';i effeaf=attlie'timeatfie:pe`rmit::isrissiied,:iii,
accordancerwith local:ordinance. ;Sliould'calculated cliarges;figured`off`the executed, :contract eicceed'Ah" actual 'construction value;
credit:wjll be;applied to:yourpeTmit;fees,w)lenthe;permit;is issued, 1,
O1IVNEF l--KFI`DAVIT I;certifyat$`at all`of tlie'>loregoing iriforinaf on'is accurate and that:aD'work vi:i
tiedone n,;complian'ce; wtli`allapplicablelawsegulatng_construction anil;zoning:
Owner%Agent is;Pe soni4- , , OWN IVJe of
Prodliced:TD ; T—ype..6f;JD
nefGonUnctci/f gair Dare
Q'CurtWor/Aq?WsNeme '
Sigiafuie•oFNotiiry-Sfatb'of.Florida • • Dete
Coriti'actoT/Agent iso. _ :•Peisbiially,'Known•to''Me.or "
Produced.ID
SLLOW'YS FOR OF'FICE:IfiSEONLY;
Pent§; t4Wred: Building; ;Electrical : 1Viecfiaiii*0; -14utriliiri 0- ;GasO: Roof
Couswructiou TY -0i :Occupancy Use;: Flood. Zone: _
To'tal`'Sq Ft of'Bldg;' _ • 1VIiri::Occii alri Load:, - _
r . __
p cy; . #`of:5tories•
New':Consfructoii Electric;= # of:Ao ps Pluuibiug'-:##of Figtures.
Fi'n'e.' Sprinkler Permit,•'; Y.es 0 'IJo # of XIead's ;Fire Ayarm Permit:; .Xes Q No.
APPROVALS: -'ZANING: UTIL'ITIES. 9 /7 1N'AS.TE WADER:. .
E IGINEERIN FIRE:.BUIL ING - •
Revised; June30;2015: Pdtir-Apoliicauon
JL-
I'fl( CF SANFORD
BUILDING &-•.FIRE::PREVENTI'ON.
PERMI .-A LICATION
Application N I 77
Documen_tcd'Constructioo'Value' $, $50,880 _
245;1 Old Lake, oad SanforMaRd -37 X' Joli:Ad ress: _ rY , ';FL Historic Distrcts Xes.O No
Parcel ID 35=,19=30-300-030'C-000.0= ommercial XRes".iden..tal C
W'oi-k New., . iid ttoni Alterat op • Repair . ,:Demo G7iange of Use 0` Move 0°
Description:o> Work:. Upsizirig water :line. and =electrical equipment .
Plan:Review Contacf;•Persori:, :Jereliny'Morton
Phone:; ..407=:322?6841` Fax: 407-330=0639 _......:...;Email:.'1!orton@cpFcorpcom
Properly-Owner•Information• '
dame: Jax..lce Machine Equipment &Leasing: Go::llic.: Pl oii'ei 4:04r379-.731:3:
6trcet.5849. C;ommonwealth'"ASe i `deiit of; p pResro...e
C ty;;St Jacksonville; F.L.32254
C:ontractor l rifoi`linatiori
Name "Tfomas Powers Sr:=nS::Star:Elett ic° . 904=654=6,372; homes.- - - - -
City' :State Zip;', . Stateicen.e;,No' EC13003938:..._ .. ... _
Architect%Enginee•r lnformation;
Name:. Jeremy: Morion= CF'H;:1nc:. 407-`322-6841P>ione:. _ .
Street:_ 500`W-:Stteet: Fax:; 407=330=0639 _
City; St; Zip: Sanford, :FL. '327.71 _ E-mail:Jrnorton@;cpti'corp.coiin°
oni ng Coiiipatiy _•_. : =--:. J ex der:.:• . . _... _. ..:. • ...... Mortgage. • - -
A:ddress:: Address:.
W,AR14103 ;T,O OWNER:,, Uk.EAILURE`TO'RECURD A:NOTICE' OF,:Gb1ViME1!LGEMENT°IViAY •RESULT"[lY X OUIt
PAYING: TRICE .FOli: Y1VI1'itOVEME4S TO 'YOUR; PROPk1tTY: A NOTICE' 0F. -COMMENCEMENT' MUST. BE
RECOJ2DED.,AND POSTED ON THE:7O•B;:SITE,:BEFORE; E FIRST;IIySPECTION; :IF'YOU 1NTENP"TO:=OBTAIN
FjNANCING . ;CONSULLT "To YOUR. LENDER :O i; AV ATTORNEY B1;FORE ftECORD l!iG 'YOUR` NOTICE" ;OF
COIVUV1EI iCE1VIENT: •• • . .. - .. ,.. . - • .
Applicationas,:hereby;made to;obtain.a•pemiit:,to:do.the;woikand installations as'inilicated: l: cerfifjr4hat,no;woik or insiallaticn;}ias '
wmmenced pnorto:the issuance of a,perinit and--*it:all;woikwil1U-&6oiided io, meet standards=of,all'laws "regiilatiDgscorislructioji:.
fin .this; jurisdiction;, I"Iiiiidcr?:taud: tbat:a_sepaiate pcimit most%lie secured°ion'elec_'trical"'woik;'pluro6iug sigq's;;wells;..pools; .
furnaces, boilers, heaters;'tapli§, and aid cbudihomers;etc
17BC105:3,S6a11bcinsit i6ed witb:t6c date of application.nd!tlireodc, in+eflfeet as'of///tti at date: 5!'Edition (2014) ;I Itirida;Bulding:Codc
ReJisod'.=June 30; 20J 5
A _
I'crmii•Applicatiori
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Rqy
m a.n agem eiit,, d i stridi ili t*e.:a'-ge n ei es", federil,;4cies.
t- . — ... - , . , .. - . -
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nIVsubmittal:" A opy;&AeeiecufCN: 0nim iU-req p ired
in t'0a' 6orki"cfibn value of-ibe jdbO-ifiv.eme
The.—actual0structl ivit VkltatiowTAle.,n
0anmwiWj ca figuival4ff"ib execuied q .jiu value;
credit -will eappited
N A 'P "ifJWA - ti b A Y, gilitotffiO ic-M"w cui a.
tiedone g' ngfructioxi,,and--,zoning:. j.a liaw§ Keg COpp
0" -A6. gents M. or
Typ of JDP-ib,duced
4I- ).a Ock'I &"r.
iRird =radcdAq?6rs Nam.
c b 1, Wor
r.
BELOW 'IS; 10,89;ONLY. C,
rg
rdifstftetio-Ii Type: .Flood• Zone:
twv ohoflkld, V, Oia- fo ......
C -'IfledA-6- #4f -A
4 0 #-0 sIF (Off. 1-0 , T.
A'P,P.ROVAL,S.-,,.'ZONING: -UTILITIES:;- 1Ni4STEW.,
ENGINEERING;BUILDING; ING*
Retised'Juue 30;.2015: PbimitApplI 'ion
7017
Y'OF NORF•
FIREPKtVD
SUILDING' ENTION.
1m4u PERMI,
p! 21 -57- VAP
Vocuukqnt C -qctiqq=Valuq;
Wo'k xr -Y, ,Road,, 8.-4 r4,':F.L -271' 0id'Lake.
iaA -3 Residential 'C".00(oro I Q. tc.
an-ge'-, VA'q'O" mo'QWoifA-4e TWO CiRik: -Now"n O'
Otk..0PSIZ-Ing waier j-ine pie equipment _
Plaw-Review Q.9nit JQPeM' fl
Phi ne:-,FAX.t. 40T330,-0639...'.Ema;il:..j.mqitqn@cphpp(p.pprn-
P-,h '4447'Mr731:3-
Street: ;5849. C;orrimonwealth Ayei&M-wwi f;propei y
Cw.0y,,8.iotie_.2io,- Jacksonville; FL. ,2-2$4
C. oO ract rith m 1611,
Now 1>ho.V
7.0y;..; ie 'I XQ
Arqhife,dtlert i'n pf' __ g.oq .1nfOrrowtiOn"
Name? 407 .61841
freei:t- 500.'W&stFO1t6fi-stt6dt'. FA
City; St Zip: 'Sanford, ,FL,
3277X.—
mail' JYhWO@,c'ph'. p.bt"bml
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MAYVRECORDA-,NO'.T-I;-C & 1DV,GJDMM19-WCErA9NT'.AkSOMIN
VS$TSE
RECORDED ,AND `POSTED ON 'THE' 70,B' SITE.;BEFORE 'HE FIRST ;INSP CTIOIV: ;IF 'YOU iW B IINT; T 0 TA N -
NAX Mi TJ,(f;'Y1QVR 09 YOUR :1VOTICE OI?
CUMNiE iCE1VIEIVT:
a fhe, ik d instiflatioits; d" 3' '1' ritt-.ihat,,nv wotk,,Orriniia-)Iiti" %asApplicationo. wo an .8S.M icate ,:.'Ce on'---
a . 46" en djels uafi&-6f-A- 0Tperou :ib luzioff ilii ;d ii slanda,&. JA ii gU ---bqi90 661i. W.
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PCMR-Applicaliori
iiio'n,-t'o ihe..req'uixements
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ous kageppies,
A DO iv0rfio t.hb.VWfiei pfoppqqc(f.re qtpr ksg. F1'oiida eV.UWA j.
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j- I :A,,copy,-'df,,the executed.contra6ii" required
orderin ` rtd-ihe es6matdZoitib n value of.ihe*j6b.atible-CimeO i4V6iM.
z.
The ctu ntitt -VdtaiiorTaWe.iin iffdd.,AitWq."I epqrmlt,.i& issued,: iii
an figurea'Off"ibe executed:cpntract;`ex'ceed the uctiial'ccjiistriictign value;
edit.v bd.
40g,.qpe io_o pfia# -K..e U W,.6.L,-congtruciion.,and--,zonine; -
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T am s; : APPROVALS: ZONING: ING: - -U--•WASTE WATER:..
ENGINEERING;; :.FIRE: `BUILDING;
Letter of Transmittal
Date: September 5, 2017
To: City of Sanford
Building and Fire Prevention Division
300 N. Park Ave
Sanford, FL 32771
407-688-5150
Re: The Ice Man
Permit Application
CPH Job No. I4601
WE ARE SENDING YOU THE ATTACHED ITEM(S):
500 West Fulton Street
Sanford, FL 32771
Phone: 407.322.6841
Fax: 407.330.0639
NO. OF COPIES DESCRIPTION
5 Signed and Sealed Plan Set
1 Permit Application
1 Contract for Proposed Work
1 Check No. 300723 for $152.64 to the City of Sanford for Plan
Review Fee
THESE ITEMS ARE TRANSMITTED AS INDICATED BELOW:
For Your Use
As Requested
REMARKS:
X For Review and Comment
For Bids Due
COPY TO: File SIGNED: Jeremy Morton. P.E.
f enclosures are not as noted, kindly notify us at once.
w w w. c p h c o r p. c o m
8/18/2017
The jce'-Man.
5849 C6mmonwealfh goad
j ckson -i i dri6a 32254
A#n-.,e "Oavidjorytip
Re: 11 Vater-coniiO!cti6ri,%r'ietil'inik46i
2451 Old Lake Mary' -Road.
Dear Sir,
Central Florida' WnOemiceSljpt..-( . TFLS")'is.pWised.16 quotelhe above refirence;site, !he f6lloWing' !s-'-ou-r-'sc-o'p.*e*
Wpikand. oI.o-dW;
All Install approximately Z..
qWI
df. 3-a Nku WA'Witei.line with'31 of"coverage' seryl q lice-mi-k6ft in
building. -4kkMa rViload.;
TOTAL-WrO.'Surn'
lladysion.s: lfqgiqee6h-g,;rosiin'Rig0aif.',df.'.tirikii6ivn.exiiting..diilities,'U veff6p
We.boprOciate",'his-bidding ,oppo"nit and if -Kg, q?!R-bq Pf'f,4r.thi6r-,-assistance,Ad-diieust-,thii KAW(, 'pWas'efeelt'freefo
contact me..,
Aespectfuljwsubm!4e
Chris Pam,ish, OrleiidOnt
O.vVp&.-S!gRatur0,.f6V A,606val"
a g e;
f.;. . it;.
PROPOSAL
Conimonwedlth Ave
Iristall:l 660.'ahp--277/480 Service
5;S -tar Electric Me,
4'Q 66-su7?n*se.,,-F,gm. Road'
MiddleburgF!. 1100
Install -customersiomer provi4c4 600 amp MDP
Main -P
MDP to be 2. section: f,* W—M--b 'alcers. w9vistoliv o g re
40 amp 3,,Oha*se
4 'IqOA11- " Mp phase
441 0,0.au!p.'3,,'p* hase
T.o'ihC16&.'P.kimaiy 0i0ihg, forM."wfqrmer iq P,.4k,
To on -,f"f0zmdrl6cifionAo middle of building.
0 to -MDP
Meter
Gr6iindin 9 for transformer -and. Service.
ia.l.l,atio—nIofcustomer provided -pafidl-s,:Wczer:-. a"b bolcf,,.&ea
InstallaIdh.6f,iiotbf:,disconnects i6r,,;crew'.PQIRYPYqjA
Installation, Ofcustomer,prpy.i4ed'lights; incooler and 1)reezer
Our price :$48;780:05'
oThomasPowerst
5 StarElediric
Revision W
Response to Comments o ECE1VE
SEP 18 201?
City of Sanford
Building & Fire Prevention Division
Ph: 407.688.5150 Fax: 407.688.5152
Email: building@sanfordfl.gov
B1f• y
Permit # Submittal Date T
ProjectAddress: ')AS-/ O I d lake r'u
Contact:
Ph: 4 01- 31) - Q%q
Email:
Trades encompassed in revision:
Building
Plumbing
13 Electrical
Mechanical
Life Safety
MLR L
Waste
r!
Water _
Fax:
General description of revision:
6
e
ROUTING INFORMATION
building -(9-(?
ApprovalsDepartment
Utilities
Waste Water
Planning
Engineering
Fire Prevention
Fax:
General description of revision:
6
e
ROUTING INFORMATION
building -(9-(?
Approvals
Revision O C C V City of Sanford
Response to CommentsSEP Building & Fire Prevention Division
3 ?Ph: 407.688.5150 Fax: 407.688.5152
6r Email: building@sanfordfl.gov
Permit # - a
SJ
Submittal Date 1 !2 11 7
Project Address: a N S I 01A Lt Le KA,, ,-J KI
Contact:
Ph:
Department
Email: cod G
Trades encompassed in revision:
Building
Plumbing
Electrical
Mechanical
Life Safety
Waste Water
Fax:
General description of revision:
ROUTING INFORMATION
Approvals
OMNI
Department
Utilities
Waste Water
Planning
Engineering
Fire Prevention
Building
Fax:
General description of revision:
ROUTING INFORMATION
Approvals
OMNI
City of Sanford
Building Division
P.O. Box 1788
Sanford, Florida 32771
Phone: 407.688.5150
Fax: 407.688.5152
PLAN REVIEW COMNIENT
Date: September 12, 2017 Project: U sizing water line and electrical
Contact Person: Jeremy Morton Job Address: 2451 Old Lake Mary Road
Contact Phone Number: Application Number: 17-2665
Contact E-mail: jmorton@cphcorp.com Contact Fax Number:
ARCHITECTURAL
1. No comment.
STRUCTURAL
1. No comment.
MECHANICAL
1. No comment.
PLUMBING
1. No comment.
ELECTRICAL
1. Sheet E201, Wire sizes not indicated.
2. Submit two revised sheets E201 indicating all wire sizes.
Please direct any questions you may have to Joy Deen at 407.688.5064 or fax to 407.688.5152.
You may also contact me by e-mail at joy.deen@sanfordfl.gov.
Respectfully,
Joy Deen, Plans Examiner
Deen, Joy
From:
Sent:
To:
Subject:
Attachments:
Joy Deen
City of Sanford
Plans Examiner
PH: 407.688.5064
Fax: 407.688.5152
Deen, Joy
Tuesday, September 12, 2017 11:20 AM
jmorton@cphcorp.com'
comment letter
comment letter.pdf
INSPECTION SEQUENCE
BP# 17-2665
ADDRESS: 2451 Old Lake Mary Road
BUILDING PERMIT
Min Max Inspection Description
Footer / Setback
Stemwall
Slab / Mono Slab
Lintel / Tie Beam / Fill / Down Cell
Sheathing — Walls
Sheathing — Roof
Roof Dry In
Frame
Insulation Rough
Firewall Screw Pattern
Drywall / Sheetrock
Lath Inspection
Building Ceiling Air Barrier
Insulation Roof (Com'l)
Building Ceiling Grid
Final Roof
Final Stucco / Siding
Final Insulation
Final Firewall
Final Door
Final Window
Final Utility Building
Final Screen Structure
Final Pool Screen Enclosure
Pre -Demo
Final Demo
Final Single Family Residence
Final Commercial —
Final Commercial — Addition / Alteration
Final Commercial — Change of Use
Final Building (Other)
REVISED: June 2014
ELECTRICAL PERMIT
Min Max Inspection Description
10 Electric Underground
Footer / Slab Steel Bond
Electric Ceiling Rough
Electric Wall Rough
10 Electric Rough
Pre -Power Final
Temporary Pole
1000 Electric Final
7B R
Min Max Inspection Description
Rough Plumb
Plumbing Underground
Plumbing 2"d Rough
Plumbing Tubset
Plumbing Sewer
Plumbing Grease Trap Rough
Plumbing Steam / Chill Water Rough
Plumbing Final
MECHANICAL PERMIT
Min Max Inspection Description
Mechanical Rough
Mechanical Fire Damper Framing
Mechanical Ceiling Rough
Mechanical Fire Damper Annular Space
Mechanical Insulation Wrap
Mechanical Fire Damper Angle
Light / Water Test Ck Welds
Mechanical Grease Duct Wrap
Mechanical Final
COUNTY OF SEMINOLE
IMPACT FEE STATEMENT
STATEMENT
PPJLICATIONI#
0007BUILDINGA -10000725
BUILDING PERMIT NUMBER: 17-10000725
UNIT ADDRESS: OLD LAKE MARY RD 2451 STE 111
TRAFFIC ZONE:022 JURISDICTION•
SEC: TWP: RNG: SUF:
SUBDIVISION:
PLAT BOOK: PLAT BOOK PAGE:
OWNER NAME:
ADDRESS:
APPLICANT NAME: JAX ICE MACHINE EQUPT
ADDRESS: 5849 COMMONWEALTH AVE
LAND USE: MANUFACTURING - THE ICE MAN
DATE: October 05, 2017
35-19-30-300-030C-0000
PARCEL:
TRACT:
BLOCK: LOT:
o
TYPE USE•
WORK DESCRIPTION: CITY-SANFORD
SPECIAL NOTES: 2451 OLD LAKE MARY RD SUITE 111
CHANGEOFUSEWHSE TO MFG 12,500 SQ.FT.
FEE BENEFIT RATE UNIT CALC UNIT - TOTAL DUETYPEDIST-----SCHED------RATE------UNITS----TYPE------------------
ROADS -ARTERIALS CO -WIDE ORD
Manufacturing*
ROADS -COLLECTORS N/A
519.00 12.500 1000gsft 6,487.50
Manufacturing*
FIRE RESCUE N/A
00 .000 1000gsft 00
LIBRARY N/A 00
SCHOOLS N/A 00
PARKS N/A 00
LAW ENFORCE N/A 00
DRAINAGE N/A 00
CREDIT FEES: 00
SCI ROAD ARTERIALS C
warehousing* 358.00 12.500 1000gsft 4475.00-
AMOUNT DUE 2,,012.50
STATEMENT M
RECEIVED BY: v 1fls 5, SIGNATURE:
PLEASE PRINT NAME)
DATE:
NOTE TO RECEIVING SIGNATORY/APPLICANT• FAILURE TO NOTIFY OWNER ANDENSURETIMELYPAYMENTMAYRESULTINYOURLIABILITYFORTHEFEE. ***
DISTRIBUTION: 1 -BLDG DEPT 3 -APPLICANT2 -FINANCE 4 -LAND MANAGEMENT \f
NOTE** \Q,
PERSONS ARE ADVISED THAT THIS IS A STATEMENT OF FEES DUE UNDER THESEMINOLECOUNTYROAD, FIRE/RESCUE, LIBRARY AND/OR EDUCATIONALISSUANCEOFABUILDINGPERMIT.
PERSONS ARE ALSO ADVISED T
TO APPEAL THE CALCULATION
MUST BE EXERCISED BY FILIN
DAYS OF THE RECEIVING SIGN
CERTIFICATE OF OCCUPANCY 0
MUST MEET THE REQUIREMENTS
COPIES OF RULES GOVERNING
FROM THE PLAN IMPLEMENTATI
SANFORD FL, 32771; 407-66
AT ANY RIGHTS OF THE APPLICANT, OR OWNER,
F ANY OF THE ABOVE MENTIONED IMPACT FEESAWRITTENREQUESTWITHIN45CALENDAR
TURE DATE ABOVE, BUT NOT LATER THANOCCUPANCY. THE REQUEST FOR REVIEW
DF THE COUNTY LAND DEVELOPMENT CODE.
PPEALS MAY BE PICKED UP OR REQUESTED, N OFFICE: 1101 EAST FIRST STREET,
7356.
PAYMENT SHOULD BE MADE TO: SEMINOLE COUNTY OR r7mv nF CDTQT:l1AT,
of
CITY OF
S,A NFORD
FIRE DEPARTMENT
Building & Fire Prevention Division
PERMIT APPLICATION
Application No:
5 f Mkp C(10 tr -6 too "5 3 Documented Construction Value: $ a o 000
Job Address: 2u51 NA (aU, Historic District: Yes[ --]Nog]
Parcel ED: ResidentialD Commercial
Type of Work: New Addition® Alteration Repair Demo Change of Use Move
Description of Work: 2fl lboX
t Z2I
X
ZOl `
vQ,f1.U)CIL Ma rodow MN
Plan Review Contact Person: QM N1 OOt(1Q Title:PC
7Phone: Q04' Zl9 -iD a y Fax: 904 - 2 - 10 7 Email: S(_08:4@2UJ N`te.Ook.Yt uS`l e'$. C YYI
0
Mary '
nn,__
IR 17 Property Owner Information
Cv I ! Name Lci 1ia bfqa,4 Phone: 90 1 - 3q ' Zc7l 3
Street: 544 9 Commmt kya l n 44Q.., Resident of property?
City, State Zip: LfL[5(lU1 . `L29J
Contractor Information
Name W\% - Phone: 9t)4- M 40 QUI
Street: 1b'3 Fax: Q'04 - (A 2 - (077
City, State Zip• State License No.: C V) C I ZS 0 5,9!4
Architect/Engineer Information
Name: Phone:
Street:
City, St, Zip:
Bonding Company:
Address:
Fax:
E-mail:
Mortgage Lender:
Address:
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.
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.
FBC 1053 Shall be inscribed with the date of application and the code in effect as of that date: 6t° Edition (2017) Florida Building Code
Revised: January I, 2018 Permit Application
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 at the time of permit submittal. A copy of the executed contract is required
in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal.
The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in
accordance with local ordinance. Should calculated charges figured off the executed contract exceed the actual construction value,
credit will be applied to your permit fees when the permit is issued.
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.
Signature of Owner/Agcot Date
Print Owncr/Agent's Name
Signature of Notary -State of Florida rate
qe2!!6agent Date
an a," S EnShe 1
Print Contmctor/Agcnt's Name
Rl - Affi(k Lu. , - Ra"
Signature of Notary -State of Florida Date
Keyshmarle tapares-Bonilla
4 Commission 1 GGM9186
Expires: Oct. 28, 2020
V Bonded thru Aaro
Owner/Agent is Personally Known to Me or Conti d or/Agent is ersonally Known to a or
Produced ID Type of ID Produced ID Type of
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas[] Roof
Construction Type: Occupancy Use: Flood Zone:
Total Sq Ft of Bldg: Min. Occupancy Load: # of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Revised: January I, 2018 Permit Application
r ik-iia frees r:f .r gf;e 9 l ra t itl a . y i r . nfgr.4 FG. HIS abor
fee for this prolog is $2000,01
me
irec r i r