HomeMy WebLinkAbout711 Hickory Ave"r�1a 17r 3
JAN 18 2018
By: 7
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: g
Documented Construction Value: $ S DOD
Job Address: C(C- L,14 -jf, SaiAfyyA- , �1 �Z� �� Historic District: Yes ❑ No ❑
Parcel ID: Z 1- (01 - ?j 0 - S Ab •- OG a D _ f?08,'0 Residential N Commercial ❑
Type of Work: New ❑ Addition ❑ Alteration ❑ Repair emo��jhange of Use ❑ Move ❑
Description of Work: WhQ)L\. Q.-P,ir1-%AYe fl VoiaeVAIA
Plan Review Contact Person: �/A.h C' kaA UAII Title: ,(-; W A 4pl--
Phone: 4M 302.1S4q X108 Fax: dal -302 91DI Email: -Cow►
Property Owner Information
Name !) byV4-(( W?6" Phone: 140 - tag& 510-
Street: Pd gaA. 1_789 Resident of property? : 11Q
City, State Zip:A.YI 3277 Z'.. :_,,:nu:-,.. • :. . .
Contractor Information
Name
�'yh' `S Si �i/ElDdfyllti'l"F Phone 40
Street: 4 0 �NVAA WhIRa y"e— Fax: 4QJ * 3 u')_ -g.1 a 1
City, State Zip: S641&�d _�i?_7� State License No.: ( C, 05& �q2
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, heaters, tanks, and air conditioners, etc.
FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 51' Edition (2014) Florida Building Code
Revised: June 30, 2015 P Q O Permit Application
1
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 ink ation is accurate and that all work will
be done in compliance with all applicable laws regulating canr`str ction an onin .
Signature of Owner/Age t ate S atur Co tractor/Agent Date
Print Own gent's Name Print ractor/Agent's Name
%� IiLM
Signatu of Notary -State of Florida Date .,r P.W�-�Laf_Vkl i ,. o� Date
— — — e 00 A � Notary Public Stalr aiFlorida
Lori YOUSIf
;: ANNETTE M BLAND y �< My Commission FF 201661
Notary Public - State of Florida Gov flo° Expires 03/25i2019
Commission # GG 170900
q Ni.� Comm. Ex iras Jan 16, 2022
Owner/Ag ni` 7' ' IlCc ebQlp � z a?dht?WA ,S o e or Contractor/Agent is Personally Known to Me or
Produced ITIT R Produced ID Type of ID
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:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
# of Stories:
Plumbing - # of Fixtures,
Fire Alarm Permit: Yes ❑ No ❑
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Permit Application
DATE: 12/05/17 PURCHASE ORDER
CITY OF SANFORD
P.O. BOX 1788
PURCHASING OFFICE: 407,688.5030 (300 NORTH PARK AVENUE)
ACCOUNTS PAYABLE: 407.688.5020 SANFORD, FLORIDA 32772
FACSIMILE: 407.688.5021 FLORIDA TAX EXEMPT NO.: 858012621681C-8
VENDOR NO.: 11189
TO:
WHITE SITE DEVELOPMENT,INC
4000 NYAHWHITE COVE
SANFORD, FL 32771
PO NUMBER 035742
SUBMIT INVOICES TO: ACCOUNTS PAYABLE
FINANCE DEPT.
P.O. BOX 1788
.SANFORD, FL 32772
SHIP TO:
CITY OF SANFORD
300 N. PARK AVENUE
SANFORD, FL 32771
DELIVER BY TERMS F.O.B. DESTINATION BID OR QUOTATION NO. REQUISITION NO.
UNLESS OTHERWISE INDICATED 66308
12/04/17 NET/30
ACCOUNT NO.: PROJECT NO.:
001-1103-519.34-02
NO DEVIATION FROM THIS PURCHASE ORDER WILL BE ALLOWED UNLESS AUTHORIZED BY THE PURCHASING MANAGER - CITY OF SANFORD
UNIT OF UNIT COST EXTENDED COST
ITEM NO, DESCRIPTION QUANTITY ISSUE
1 DEMO OF CONDEMNED PROP 711 7000.00 NA 1.00 7000.00
HICKORY/1214 CRESCENT
VENDOR ITEM NO.- 11189
SUB TOTAL 7000.00
TOT L 7000.00
V I APPROVED BY:
APPROVED BY: CITY MANAGER
PURCHASING AG NT
All packages and Invoices applicable to this P. .must bear this P.O. Number. The Vendor shall comply with all specified and
referenced herein before and after. Any attempts to insert language to change these terms and conditions are hereby rejected
and will be resolved in favor of the City of Sanford. Standard terms and conditions hereby incorporated into this purchase
order may be found at http://www.sanfordfl.gov/index.aspx?page=879 Terms and conditions applicable to P.O.'s
and at Additional Terms and conditions http://www.sanfordfI.gov/index.aspx?page=883
PURCHASE ORDER TERMS AND CONDITIONS
1. By accepting this Purchase Order (PO) the Vendor accepts all of the Terms and Conditions included herein. The Buyer is the City of Sanford,
Florida, hereinafter referred to as the "City". The term "City" is used in a broad sense to include its employees, directors, officers, agents,
volunteers, etc.
2. All information referenced is hereby incorporated into the PO. These Terms and Conditions may be varied only by written amendment signed
by the parties. All modifications in performance, including but not limited to, extensions of time, renewal, or substitution are void absent
dually signed amendment by the parties. Time is of the essence of the lawful performance of the duties and obligations contained in the
Purchase Order. The Vendor agrees that Vendor shall diligently and expeditiously pursue Vendor's obligations.
3. Cancellation rights reserved by the City. The City may cancel this PO in whole or in part at any time for default by written notice to the
Vendor. The City shall have no liability to the Vendor beyond payment of any balance owing for Material purchased hereunder and delivered to
and accepted by the City prior to the Vendor's receipt of the notice of termination.
4. Terms of shipping are F.O.B. the City's delivery location unless otherwise noted within the terms of this PO. Regardless of the indicated F.O.B.
point, the City does not accept title until the delivery is acknowledged by an authorized City representative"
5. Prices stated on this PO are firm, all inclusive and consistent with applicable negotiations, bid(s) and/or quotations. The City is exempt from
the Florida Sales and Use Tax and will furnish the Vendor with proof of tax exemption upon request. Extra charges for any purpose will not be
allowed unless explicitly indicated on the PO. This order is hereby cancelled, if pricing is omitted.
6. The Vendor warrants that any material or equipment supplied hereunder is new, unused condition and free from defects in title,
workmanship, defects in design and in full compliance with the specifications defined by the City in the order. The goods or services furnished
under this PO are covered by commercial warranties for such goods or services and that the rights and remedies provided therein are in
addition to and do not limit those available to the City. A copy of these warranties and all applicable manufacturers' warranties shall be
furnished at the time of delivery.
7. The City reserves the right to conduct any inspection or investigation to verify compliance of the goods and/or services with the requirements
of this purchase order and to reject any delivery not in compliance If any deficiency is not visible at the time of delivery the City reserves the
right to take and/or require appropriate corrective action upon the discovery of any deficiency, non-compliance, or defect
8. All tools or property furnished to the Vendor by the City shall remain the property of the City, be subject to removal upon the City's demand,
be used only on behalf of the City, be maintained in good order, and be clearly identified as property of the City. The Vendor assumes any and
all liability of whatsoever type or nature for loss or damage to such property.
9. The Vendor agrees to comply with all Federal, State of Florida, Seminole County, City laws, ordinances, regulations, authority and codes and
authority having jurisdiction over the purchase.
10. To the fullest extent permitted by law, the Vendor shall indemnify, hold harmless and defend the City, its agents,, servants, officers, officials
and employees, or any of them, from and against any and all claims, damages, losses, and expenses including, but not limited to, attorney's
fees and other legal costs such as those for paralegal, investigative, and legal support services, and the actual costs incurred for expert
witness testimony, arising out of or resulting from the performance or provision of services required under this Agreement, provided that
same is caused in whole or in part by the error, omission, act, failure to act, breach of contract obligation, malfeasance, officers, officials,
employees, or agents. Additionally, the Vendor accepts responsibility for all damages resulting in any way related to the procurement and
delivery of goods or services contemplated in this purchase order. Nothing herein shall be deemed to affect the rights, privileges, and
immunities of the City as set forth in Section 768.28, Florida Statutes.
11, The Vendor shall not assign this PO, any rights under this PO or any monies due or to become due hereunder nor delegate or subcontract any
obligations or work hereunder wi thout the prior written consent of the City.
12. The Vendor shall not disclose the existence of this PO without prior written consent of the City except as may be required to perform this PO.
13. All Material purchased hereunder must be packaged to ensure its security and delivery in accordance with the City's shipping and packaging
specification and good commercial practice. Each package shall be labeled indicating the addressee of each package or shipment and the'
applicable PO number. All shipments shall comply with HAZMAT requirements including, but not limited to, (DOT) regulations published in
49CFR 1399, OSHA regulations 29 CFR 4999.
14. The Vendor shall perform the obligations of this PO as an independent contractor and under no circumstances shall it be considered as agent
or employee of the City.
15. The Vendor ensures that its personnel shall comply with reasonable conduct guidelines and City policies and procedures.
16. After each delivery, the Vendor shall provide to the "bill to address" an original, "proper invoice" (single copy) which includes: a) Vendor's
name(dba), telephone number, mailing address; b) City's P.O. Number; c) Date of invoice; d) Shipping date; e) Delivery date; f) Payment
terms; g) Description of goods/services; h) quantity; i) Unit price; j) Extended price; k) Total. The City has the right to reconcile invoice with
the PO and adjust payment accordingly to comply with the PO. Payment will be made only to the Vendor identified on the PO and for received
and accepted goods/services. The City shall have right at any time to set-off any amounts due to the Vendor against any amounts owed to
the City by the Vendor and shall in the case of Vendor default retain the right to further adjust payments as consistent with the best interests
of the City.
17. Payment of invoices will be in compliance with Chapter 218, Part VII of Florida Statutes, City Ordinance No. 3029, Purchasing Policy of the
City and the stipulations, terms and conditions of this PO. Any cash discount period will date from receipt of invoice, receipt of actual delivery
or date of invoice, which ever is later.
18. If this PO involves the Vendor's performance on the City's premises or at any place where the City conducts operations, the Vendor shall
request information from the Purchasing Manager regarding insurance coverage requirements. In circumstances where insurance is required,
Vendor shall provide proofs of insurance required by the City, or City reserves the right to cancel this Purchase Order, immediately suspend
performance by the Vendor at Vendor's expense and prohibit access to City premises until such proofs of insurance is verified. Noncompliance
with this item shall place the Vendor in default and subject to disbarment from the City's Vendor List.
19. The failure of the city to enforce any provision of this PO, exercise any right or privilege granted to the City hereunder shall not constitute or
be construed as a waiver of any such provision or right and the same shall continue in force.
20. The Vendor shall notify the Purchasing Manager of any inherent hazard and applicable precautions, protective measures and provide any
additional relevant information, including MSDS, related to the Material being purchased herein.
21. The City shall have the right at no additional charge to use all or portions of material found in the Vendor's applicable literature relevant to
the purchase. The Vendor agrees to advise the City of any updated information relative to the foregoing literature and documentation with
timely written notice.
22. A person or affiliate who has been removed from the City's Vendor List may not submit a bid or transact business with the City in excess of
Category Two for a period of thirty-six (36) months from the date of being removed from the City's Vendor List.
23. In compliance with 8 U.S.C. Section 1324a(e) [Section 274A(e) of the Immigration and Nationality Act (INA)], the City will not intentionally
make an award or upon discovery of a violation will unilaterally cancel this PO with any contractor who knowingly employs unauthorized alien
workers.
24, This PO shall be governed by and interpreted in accordance with the laws of the State of Florida. In any action or proceeding required to
enforce or interpret the terms of this Agreement, venue shall be of the Eighteenth Judicial Circuit in and for Seminole County, Florida
Purchasing Dept., Tel 407.688.5028 or 407.688.5030 Fax: 407.688.5021
Finance Dept 407.688.5020
Purchasing Division
Requisition Form
Department
Contact Person
Vendor
Address
Contact Person
Email Tel 407-302-1549
Requisition # 66308 PO #
,w
�t.
p
l t
City of Sanford
PO Box 178E
Sanford, FL
Seminole
32772
Phone: 407-688-5030
Fax: 407-688-5021
www.sanfordfl.gov
Date 12-4-17
n; Line lteiri ^ I
t ccounCade
—„Descriptlonh^
A V4� `^ N Quanttty� Unit ;
Extended Pnce
1
001-1103-519-34-02
Demolition of Condemned Property
Demolition of Condemned Property
$3000.00
$4000.00
$7000.00
$3,000.00
2
001-1103-519-34-02
$4,000.00
$7,000.00
Delivery Instructions:
Finance Manager
Budget Transfer
Override
Accounts (initials)
Additional Comments:
Internal Use Only
Amount Paid
Check Nod_*
Date
r-t
- ('61.-
9 r
CITY OF SANFORD, FLORIDA - INFORMAL BID REQUEST Appendix 4-A-1
Return Bid(s) To: Darrel Presley
Telephone: (407) 688-5162
DATE OF REQ.
P.O. Box 1788
FAX: (407) 688-5161
11/112017
Sanford, FL 32772
Email: darrel.presley@sanfordfl.gov
REQUEST NO.
RESPOND BY
1. Bids may be submitted via Email, FAX, Mail or Hand Delivery
Date: Time:
I
2. Bids received late will not be considered
CE2018-02
11/30/2017 5:00PM
Bidder Information:
Company Name and Address:
White's Site Development
4000 Nyah White Cove
Sanford, FL 32771
Telephone No: 407-302-1549 FAX No.: 407-302-9101
Contact Person: Evan Shelley Title: Project Manager/Estimator
TERMS AND CONDITIONS:
1. The City of Sanford reserves the right to reject any and all bids in entirety or in part, to waive informalities and to make the award which
is in its best interests.
2. Terms and or conditions indicating a time frame(s) for payment other than in accordance to Chapter 218, part VII of the Florida Statutes
are objected to and shall not be accepted unless agreed to, in writing, by the City of Sanford.
3. Bid pricing must be F.O.B. Destination. If so indicated by the P.O., prior notification of delivery shall be required.
4. These terms and conditions, the bid, and any resulting Purchase Order shall constitute the entire agreement of any order resulting
thereof, unless agreed upon, in writing, by the Purchasing Agent of the City of Sanford. Also, if this bid involves service, the bidder
warrants that if awarded the project he/she will provide an insurance certificate In compliance with the attached requirements.
5. The City of Sanford shall be responsible only for items which are actually ordered, via a City of Sanford Purchase Order, regardless of
quantities or estimates indicated herein.
6. Time is of the essence with regard to delivery of this bid and any goods or services ordered as a result of this bid. Also, the City of
Sanford will consider only timely bids received. Timely delivery is the responsibility of the bidder.
7. The bidder is responsible to identify exactly what is being bid by indicating brand, model, as relevant, size, packaging, quantities
included, delivery and warranty information.
LINE
DESCRIPTION AND SPECIFICATIONS
QTY
UNIT AND
UNIT PRICE
EXTENDED COST
ITEM
1
Scope of Work: Demolition of residential structure at
n/a
711 Hickory Avenue, Sanford, Florida
Parcel #25-1930.5AG-09OD-0080
Supply Equipment, Labor, Insurance, and Dump Fees to
n/a
complete the Project in a timely and workman like manner.
Disconnect all Utilities
n/a
$3000
Obtain Permitting by City of Sanford & Inspections per local codes
n/a
Demolish all residential structures including all foundations, concrete
n/a
slabs, driveway's and bushes
n/a
The sites will be left in a good workmanlike manner, clean of all
n/a
debris, and rough graded
Signature of Person Submitting Bid
Printed Name Date:
Evan K . Shelley 11/29/2017
Demolition Companies
• L & L Demolition & Salvage, Inc.
® Lenny Linares, owner
• 407-295-0875
• Ildemolition(aD-gmail.com
•- Troy Building Company, LLC.
• Tony Troy, owner
• 386-804-9579
• troybuilding(a-embargmail.com
• Creative Environmental Services
• Shelby Powers, Lead Estimator
• 888-351-3755
• spowers.creative(a-)-gmail.com
• White's Site Development
• Evan Shelley, Estimator
• 407-302-1549
• estimating a-whites-site.corn
• Central Environmental Services Inc
a Nicole Stefan, Estimator
• 407-295-7005
• Nicolestefan.ces@gmail.com
• Pro Demoliton
• 407-383-9739
• info@prodemoliton.com
PURCHASE ORDER TRACKING AND PROCESSING REVIEW
PURCHASE ORDER NUMBER:�S-]y2
Total Dollar Amount of Purchase Order $ 1006 .00
Vendor: -
Competitive Requirements for $49,999.99 or under:
8 $10,000-$24,999.99-three written quotes attached to PO
$25,000-$49,999.99- Per Purchasing Manager (PM)
Action Required and Performed:
Competitive Requirements for $50,000 or higher
❑ Formal Solicitation No. IFB, RFP, or RFQ
D
Sole Source justification attached
Emergency justification attached
Approved by City Commission Date
City of Sanford Contract Date and Info
If Piggy Back -Contract Information#
Entity holding coexisting, number and date
❑ Certificate of Insurance in Compliance with Requirements.
❑ Purchasing Office Notes:
[] Finance Director Approval
❑ Supporting Documents Attached
[P Miscellaneous Information and Comments_ _L1312 C.gWly" M
T:1Finance/PurchasinglA-purchdocslFORMS AND TEMPLATES; Revised 12.3.15
' CITY Of
Sk�40RD
°f Building &Fire Prevention Division
FIRE DEPARTMENT DEMOLITION PERMIT GUIDELINES
All permit application packages must be complete prior to acceptance. You must check each box to the
left or indicate n/a on this submittal. A complete application package shall include the following:
pr Building Permit Application completed, signed and notarized. Application must include correct address
and complete parcel I.D. number.
Copy of a contract, signed by the contractor and the property owner, indicating the documented
construction value
Copy of applicable contractor's license issued by the State of Florida
❑ A site specific notarized power of attorney shall be required from the licensed contractor if
he/she appoints an employee of his/her company to sign the permit application as the contractor.
�l Certificate of insurance indicating worker's compensation insurance coverage and naming the City of
Sanford as certificate holder, or a copy of a worker's compensation exemption issued by the State of
Florida (must be submitted with each application if contractor is the applicant).
❑ A copy of an onsite sewage disposal system abandonment permit that has been issued by the Seminole
County Health Department. ( if applicable)
"Please Note: A licensed General, Building or Residential Contractor is required for issuance of a Demolition
Permit, as required by and limited under 489.105 Florida Statutes
Partial Demolitions (Commercial & Residential)
"The partial interior or exterior demolition of existing commercial or residential spaces will not be issued as a
Demolition Permit. This type of work will require an Alteration permit including at least an existing and
proposed floor plan indicating the extent and location of the demolition — in addition to required submittal
documents for any alterations or renovations.
❑ Existing Floor Plan, indicating area of demolition (must specify structural or non-structural)
❑ Proposed Floor Plan
These guidelines were compiled to assist the applicant in preparing a demolition permit application and may not be complete. The
applicant is required to meet all City of Sanford, state, and federal code requirements.
Effective: August 1,2017
��O�NPAO1Y11Gy
t
FLORIDA
March 2013
NOTICE OF
DEMOLITION
RENOVATION
Florida Department of
Environmental Protection
Division of Air Resource Management
TYPE OF NOTICE (CHECK ONE ONLY): ❑ ORIGINAL
TYPE OF PROJECT (CHECK ONE ONLY): EZ DEMOLITION
IF DEMOLITION, IS IT AN ORDERED DEMO ITION?
IF RENOVATION:
IS IT AN EMERGENCY RENOVATION OPERATION?
IS IT A PLANNED RENOVATION OPERATION?
❑ REVISED ❑ CANCELLATION
❑ RENOVATION
❑YES Y.NO
❑YES NO
❑YES NO
DEP Form 62-257.900(1)
Effective 10-12-08
Page 1 of 2
OR ASBESTOS
❑ COURTESY
1. Facility Name_ / r�
Address -7 11 -T -!GAC-1- 0610 D - 009 Q
City <1)12&-1-1i State_ zip 3 Z'7 7 1 County &eM ir1b U
Site Consultant Inspecting Site
Building Size ZS 00 (Square Feet) # of Floors Building Age in Years
Prior Use: ❑ School/College/University '91 Residence ❑ Small Business ❑ Other
Present Use: ❑ School/College/University ❑ Residence ❑ Small Business Other ;-Al I. fly! ke 'rt2_
II. FacilityOwner DAQ Kett 2t S (.r j Phone (4,0 (.09� - S I V Z
Address
City _SwAa State LL Zip �ZZ72
III. Contractor's Name JN K, (_ C_ l4e- D(,V�_IOdwori Phone A6, ) '1(� - I Acl
Address N skik uvt
City S 6to State Zip 3l?71
Is the contractor exempt from licensure under section 469.002(4), F.S.? ❑ YES NO
IV. Scheduled Dates: (Notice must be postmarked 10 working days before the project start date)
Asbestos Removal (mm/dd/yy) Start: Finish: Demo/Renovation (mm/dd/yy) Start: Finish:
V. Description of planned demolition or renovation work to be performed and methods to be employed, including demolition or renovation techniques
to be used and description of affected facility components.
Procedures to be Used (Check All That Applv):
Strip and Removal
❑
Glove Bag
❑
Bulldozer
❑
Wrecking Ball
❑
I Wet Method
Dry Method
❑
Explode
❑
Burn Down
OTHER:
VI. Procedures for Unexpected RACM: _
VII. Asbestos Waste Transporter: Name
Address
Citv
State
Phone ( )
Zip
Vill. Waste Disposal Site: Name Class
Address
City State Zip
IX. RACM or ACM: Procedure, including analytical methods, employed to detect the presence of RACM and Category I and II nonfriable ACM.
Amount of RACM or ACM* X. Fee Invoice Will Be Sent to Address in Block Below: (Print or Type)
square feet surfacing material
linear feet pipe
cubic feet of RACM off facility components
square feet cementitious material
square feet resilient flooring
square feet asphalt roofing
Name:
Address:
City:
State/Zip:
'Identify and describe surfacing material and other materials as applicable:
I certify that the above information is correct and that an individual trained in the provisions of this regulation (40 CFR Part 61, Subpart M) will be on -site
during the demolition or renovation and evidence that the required training has been accomplished by this person will be available for inspection during
normal business hours_ ,
of
ONU
(Date)
(Date)
Instructions
DEP Forth 62-257.900(1)
Effective 10-12-08
Page 2 of 2
The state asbestos removal program requirements of s. 376.60, F.S., and the renovation or demolition notice
requirements of the National Emission Standards for Hazardous Air Pollutants (NESHAP), 40 CFR Part 61, Subpart M, as
embodied in Rule 62-257, F.A.C., are included on this form.
Check to indicate whether this notice is an original, a revision, a cancellation, or a courtesy notice (i.e., not required by
law). If the notice is a revision, please indicate which entries have been changed or added.
Check to indicate whether the project is a demolition or a renovation.
If you checked demolition, was it ordered by the State or a local government agency? If so, in addition to the
information required on the form, the owner/operator must provide the name of the agency ordering the demolition, the
title of the person acting on behalf of the agency, the authority for the agency to order the demolition, the date of the
order, and the date ordered to begin. A copy of the order must also be attached to the notification.
If you checked renovation, is it an emergency renovation operation? If so, in addition to the information
required on the form, the owner/operator must provide the date and hour the emergency occurred, the description of the
sudden, unexpected event, and an explanation of how the event caused unsafe conditions or would cause equipment
damage or an unreasonable financial burden. If you checked renovation and it is a planned renovation operation,
please note that the notice is effective for a period not to exceed a calendar year of January 1 through December 31.
I. Complete the facility information. This section describes the facility where the renovation or demolition is scheduled.
This address will be used by the Department inspector to locate the project site. Provide the name of the consultant
or firm that conducted the asbestos site survey/inspection. For "prior use" check the appropriate box to indicate
whether the prior use of the facility is that of a school, college, or university; residence, as "residential dwelling" is
defined in Rule 62-257.200, F.A.C.; small business, as defined in s. 288.703(1), F.S.; or other. If `other" is checked,
identify the use. Please follow the same instructions for "present use."
II. Complete the facility owner information.
III. Complete the contractor information.
IV. List separately the scheduled start and finish dates (month/day/year) for both the asbestos removal portion of the
project and the renovation or demolition portion of the project.
V. Describe and check the methods and procedures to be used for a planned demolition or renovation. Include a
description of the affected facility components. (Note: The NESHAP for asbestos, which is adopted and incorporated
by reference in Rule 62-204.800, F.A.C., requires obtaining Department approval prior to using a dry removal method
in accordance with 40 CFR section 61.145(3)(c)(i).)
VI. Describe the procedures to be used in the event unexpected RACM is found or previously nonfriable asbestos
material becomes crumbled, pulverized, or reduced to powder after start of the project.
VII. Complete the asbestos waste transporter information.
wm
Form Request for 'Taxpayer
(R" October2007' Identification Number and Certification
Daparbtrert of tho Treasury
In WW Revenue Service
u$
N
name tas sown on your income tax return)
White's Site Development, inc
ausiness name, n car►erent trom above
Give form to the
requester. Do not
send to the IRS.
Check appropriate box: ❑ Indivldual/Sole proprietor ❑ Corporation ❑ Partnership
❑ limited Oati ty company. Enter the tax GasaHEcation (D=disregarded entity. C=corporotion. P=partnership) ► ....... ❑ t
❑payee
oft (sae (nstrudbrrs) I.
Address (number, street, and apt. or suite no.)
4000 NyahWhite Cave
City, state, and ZIP code
Sanford, FL 32771
Ust account number(s) here (oprionaq
Requester's name and address (optionali
Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid social security number
backup withholding. For Individuals, this Is your social security number (SSN). However, for a resident
alien, sole proprietor. or disregarded entity, see the Part I instructions on page 3. For other entities, it is
your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Employer Identification number
number to enter. 59 3218002
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be Issued to me), and
2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) i have not been notified by the Internal
Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has
notified me that I am no longer subject to backup withholding, and
3. 1 am a U.S. citizen or other U.S. person (defined below).
Certification instructions. You must cross out item 2 above If you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all Interest and dividends on your tax return. For real estate transactions, item 2'dDes not apply.
For mortgage interest paid, acquisition abandonment of secured property, cancellation of debt, contributions to an individual retirement
arrangement (IRA), and generally, pa a is other than interest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN. See the_irlst tlojis o9Jage-4.
Sigh I Signature of
Here U.S. person 10,
GenerallnstruWbiis `" e
Section references are to the Internal Revenue Code unless
otherwise noted.
Purpose of Form
A person who is required to file an information return with the
IRS must obtain your correct taxpayer identification number (TIN)
to report, for example, income paid to you, real estate
transactions, mortgage Interest you paid, acquisition or
abandonment of secured property, cancellation of debt, or
contributions you made to an IRA.
Use Form W-9 only if you are a U.S. person (including a
resident alien), to provide your correct TIN to the person
requesting it (the requester) and, when applicable, to:
1. Certify that the TiN you are giving is correct (or you are
wafting for a number to be Issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S.
exempt payee. If applicable, you are also certifying that as a
U.S. person, your allocable share of any partnership Income from
a U.S. trade or business Is not subject to the withholding tax on
foreign partners' share of effectively connected income.
Note. If a requester gives you a form other than Form W-9 to
request your TIN, you must use the requester's form If It is
substantially similar to this Form W-9.
Date t►
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person it you are:
• An individual who Is a U.S. citizen or U.S. resident alien,
• A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United
States,
• An estate (other than a foreign estate), or
• A domestic trust (as defined In Regulations section
301.7701-7).
Special rules for partnerships. Partnerships that conduct a
trade or business in the United States are generally required to
pay a withholding tax on any foreign partners' share of income
from such business. Further, in certain cases where a Form W-9
has not been received, a partnership Is required to presume that
a partner is a foreign person, and pay the withholding tax.
Therefore, if you are a U.S. person that is a partner In a
partnership conducting a trade or business in the United States,
provide Form W-9 to the partnership to establish your U.S.
status and avoid withholding on your share of partnership
Income.
The person who gives Form W-9 to the partnership for
purposes of establishing its U.S. status and avoiding withholding
on its allocable share of net income from the partnership
conducting a trade or business in the United States is in the
following cases:
• The U.S. owner of a disregarded entity and not the entity,
Cat. No. 10231X Form W-9 (Rev. 10-2007)
SCPA Parcel View: 25-19-30-5AG-09OD-0080
Page 1 of 2
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Parcel Information
... .......... ....
Property Record Card
Parcel: 25-19-30-5AG-090D-0080
Property Address: 711 HICKORY AVE SANFORD, FL 32771-2039
Parcel
25-19-30-5AG-090 D-0080
Owner
ABNEY, FLOSSIE H & ABNEY, REGINA & HARPER, JAMES
HARPER, JOHN & HARPER, JEROME
Property Address
711 HICKORY AVE SANFORD, FL 32771-2039
Mailing
2200 CORDOVA DR SANFORD, FL 32771
Subdivision Name
SANFORD TOWN OF
Tax District
S1-SANFORD
DOR Use Code
01-SINGLE FAMILY
Exemptions
r
G v�
K,
Seminole County
Legal Description
LOT 8 (LESS S 4 FT) BLK 9
TR D
TOWN OF SANFORD
PB 1 PG 56
Taxes
Taxing Authority
Assessment Value
Exempt Values
Taxable Value
County General Fund
$9,679
$0 (
$9,679
Schools
_w.�___ $9,679
$0
$9,679
City Sanford
$9,679
$0 (
$9,679
SJWM(Saint Johns Water Management)
�T $9,679
$0
$9,679
County Bonds
$9,679
$0
$9,679
Sales
Description
Date
Book
Page
Amount Qualified
Vac/Imp
WARRANTY DEED
3/1/1980
01270
0634
$100 No
Improved
Find Comparable Sales
Land
Method Frontage Depth Units Units Price Land Value
FRONT FOOT & DEPTH 1 60.001 117.00 1 01 $175.00 $9,345
Building Information
Is Bed/Bath count incorrect? Click Here.
# Description
Year Built Fixtures Bed Bath Base Area
I j
Total SF Living SF
I
Ext Wall Adj Value
I
Rep[ Value Appendages
Actual/Effective
1 SINGLE
FAMILY
1951 3 2 1 5 i 1,088
j
1,256 } 1,088
SIDING $334
GRADE 3
$668 =
Description
Area
OPENFlNISHEDRCH
114.00
http://parceldetail. scpafl.org/ParcelDetailInfo.aspx?PID=2519305AGO9ODOO8O 1 / 18/2018