HomeMy WebLinkAbout124 Alder Ct #11-2305; FIRE REPAIRPERMIT ADDRESS
CONTRACTOR
ADDRESS
PHONE NUMBER
PROPERTY OWNER 6a_vlt
ADDRESS
PHONE NUMBER
ELECTRICAL CONTRACTOR
MECHANICAL CONTRACTO
PLUMBING CONTRACTOR
MISCELLANEOUS CONTRACTOR
PERMIT NUMBER FEE
MISCELLANEOUS CONTRACTOR
PERMIT NUMBER FEE
S I 6CA I r® 04
102/
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SUBDIVISION• el i
PERMIT # -,J 3 0-, DATE 09 1'. /1
PERMIT DESCRIPTION Qom.
t
PERMIT VALUATION
SQUARE FOOTAGE
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R,ECE1VF,D
F 'SANFOMPIIISEP122011
CITY
B ILIDIRG FIRE REV NTI,@,,N
PERMIT APPLICATION
Application No: Documented Construction Value:
Job Address: Historic District: Yes No
Parcel ID: 11-dO_30_50-0000' _1 q,)-() Zoning:` f
Description
of Work: ReS`Jre (-eStjeej —id prs--6_55 LEA'4`;( Plan
Review Contact Person: Title: Phone:
Fax: Yo -2-111 9f-3 Vff E-mail: Pr6'
erty Owner Information Name
Phone: Street:
i4ljy Resident of property? City,
State Zip: ,,dvr 2 3 773 Contractor
Information Name
treM (lre Street: -,
S /0-7 AAdrif Ave City,
State Zip: P Name:
Street:
City,
St, Zip: Bonding
Company: Address:
Z
Building
Permit ff Square
Footage: Phone:
Y07'dfp-pry Fax:
State
License No.: Architect/
Engineer Information Phone:
Fax:
E-
mail: Mortgage
Lender: Address:
PERMIT
INFORMATION C
g ( , 0 576 a- 7 Construction
Type: No. of Stories: No.
of Dwelling Units: Flood Zone: Electrical
0 New
Service - No., of AMPS: Mechanical
0 (Duchlayout required for new systems) Plumbing 13
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 your permit fees when the
permit is released.
Signature of Owner/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
APPROVALS: ZONING: film - I a • 11 UTILITIES:
ENGINEERING: FIRE:
COMMENTS: ou 4,crQ'r i.a cRyye Icss 1•.1
Rev 11.08
ST ature o Contractor/Agent Date
Print Contractor/Agent's Name
q-r2-li
Si a`ture of Notary -State of Florida Date
Contractor/Agent is Per g¢'a
01
sr.
to Me or
Produced ID Typ,el • • • ° , L----.
WAS W tI • ?
y=
J
a.
RestorationPremiere
V i ei
POWER OF ATTORNEY
To: C.. - - Date:
I hereby name and appoint Brian Kirby; Tim O'Malley; Erick DeDios to be my lawful
attorney in fact to act for me and apply for work to be performed at a location
described as:
Section Township —Range —Lot Block Subdivision
Parcel ID: 1\ -._3o --s`1z 000 n .1y2o
Project Location 1 I *',I A A (-C + — Q rLk F 1--- 3 7.-) -)
Owner's Name-
Owner's Address TN 3-)°3T-
And sign my name and do all thi gs necessary to this appointment.
GASignatureofContractor :9
Michael A. Morgan tgC056687
Acknowledge:
Michael A. Morgan is personally known to me.
Sworn and subscribed before me this 7 day of 5 c 2011.
Notary Public, State of Florida
tiPar r B,, MARTHA Y. HALL
My commission expires _ Public - State of Florida
MY Commission Expires Feb 1, 2012
Commission # DD 720365
Bonded Through National Notary Assn.
www.restoreteam.com
5107 Andrus Ave. • Orlando, FL 32804 • Tel (407)292-9744 • Fax (407)292-8425
Lic. Number CBC056687 • Lic. Number CCC057594
08/22/2011 13:52 FAX 4072928425
CITY OF SANFORO PERMIT APPLICATION
14002/004
Application # : Submittal Date: _
lob Address:.12y' )w C'i' TC",4P-,b' F-L- 3 2--7D3 Value of Work: S
Tarcel ID: ~G J -S l .-- O
Zoning:.
p _•• .__
Historic District:
Description of Work: f`'e ','e r e S. ^fnce --= ft ) i/ C'22A;krs -P, Square ootoge:
1......... ................... I............ .........................
I .............. .... ....
Permit Type: Building* lilectrical Mechanical Plumbing 0 Fire Sprinkler/Alarm Pool Sign
Flectrical: New Service - # of AMPS Addition/Alteration Change Uf STTVICC Tempurary Pale
Mechanical: Residential Non -Residential 11 Replacemenl New Q (Duct Layout & Energy Cale. Re( uired)
Plumbing/ New Commercial: # of Fixtures _ _ fl of Water & Sewer Lines_ • - tt of Otis Lines
Ylumbing/New Residential: # of Water Closets Plumbing Repair •• Residential 17 Commemiul
Occupancy Type: kesiderttiFtr Rr Corntncrcinl Industrial Occupancy Use Group(s): __.,• _ _
Construction 'Type: # of Storles: _, # of Dwelling Units: Flood Zone: (FEMA form required )
Property Owner: t,-t^ o r.^} t•) I Contractor: rr.. 4-l` t d Sr V - L ('\ a
Address; .: 1 c _- Address S _ I /4\A.r-c
A --g rA rCr 3 L ?_3 fit% r\ate L 3 Z.POy
Ph®n E-mail
a _..
C t! OSbs3J-` - Ph ? 32.)?' V State License Number: _ ("k2
Bonding Company: Mortgage Lender:
Address: - Address: - -
Archilect/Engineer:
Address: Fax: -- -•-
Plan Review Contact Person: Phone: Fax; E-mail.
Application is hereby made to obtain a hermit to do the work and installations us indicated. I certify that no work or installation has Comr Iet,cod prior to the
issuance of u 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 nntst be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOhS, FURNACES, 13011.FRS, HFATERS, TANKS, and
AIR CONDITIONERS, ctc. _
OWNF.R'S AFFIDAVIT: I certify that all o1' Ibe foregoing information is aeouiate and that all work will be done in compliance with all applicable laws regulating
construction and zoning.
WARNING TO OWNER; YOUR FAILURE 7-0 RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING 7-WICF FOR
1MPROVFMFNTS TO YOUR PROPERTY. A NOTICE OF COMMF,NCEMI NT MUST 8E. RECORDED AND POSTED ON THE 1UH Nil-F BEFORE TkIE
FIRST rNSPUCTION. IF YOU INTENT) TO OBTAIN FINANCrNG, CONSULT WITH YOUR LENDER OR AN AITORNF.'Y BEFORE, RECORDING YOUR
NOTICE OF COMMI:N(-FME.NT.
Nl,)T1 F: ]it addilion to the requirements of this permit, there may be addiliunul restrictions applicable to this property that may be found in the public records of
this county; and there tnuy be additional permits required t'rum other govermnentul entities such as water rnMntgemr.nt districts, slate agencies, or federal agencies.
Acecptancc of psi nit s verification that I will notify tht owner of the proper) of the roqu' emenls f Florida Lia Law, l S 717.
41- r/(/ .... .: Z3 ?jolt
Siggjn-uti-re o- f(wner A cot Date Signature of Corlhttctur/Agent DatC
Print Owner/Agent's Name Print Contramor/Agcni s Name
Signature afNota -Sta tisla e- Signature of Notary -Stale F ri Datc
MARTHAY. HALL
Notary Public -Stale of Florida -,PA- a, MARTHAY. HALL
c My Commission Expires Feb 1, 2012 r=°, +`c" Notary Public - State of Florida
Commission # DD 720365 « : • c My Commission Expires Feb 1, 2012F
ari,.P` S. nded Through National Notary Assn. .F:•' .Commission # DD 720365i Owucr/Agent is Por C:ontrac[OrfAgcnl is _ .rsoCIW[ K0Wl$W*kTbrough National Notary Assn.
Produced ID _ Produced 1D-....,., .....
APPROVALS: ZONING; ......-- --- U'I II.: _-_.. _-- FD: GNG . -., ..-_...._.._ BLDG: .
Special C,ondiUons: . •
Rev.07.07
CBC056887 CCCO57594 -
5107 Andrus Avenue Orlando, Florida 32804
407-292-9744 FAX 407-292-8425
www.restoreteam.com
9/8/20112:39 PM
Insured: SANTILLI, MARIO Estimate: 59-OGOO-294
Property: 124 Alder Ct Claim Number: 59-OG00-294
Sanford, FL 32700 Policy Number:
Home: (615) 533-3010 Price List: FLOR9F_JULI I
Fax: (615) 350-6463 Restoration/Service/Remodel
Type of Loss: Fire F = Factored In, D = Do Not Apply
Deductible:
Date of Loss: 8/21/2011
Date Inspected: 8/25/2011
Summary for Dwelling
Line Item Total 39,581.31
Material Sales Tax @ 7.000% x 15,324.25 1,072.70
Subtotal 40,654.01
General Contractor Overhead @ 10.0% x 40,654.01 4,065.40
General Contractor Profit @ 10.0% x 40,654.01 4,065.40
Replacement Cost Value (Including General Contractor Overhead and Profit) 48,784.81
Less Deductible 0.00)
Net Payment 48,784.81
Morgan, Mike
ALL AMOUNTS PAYABLE ARE SUBJECT TO THE TERMS, CONDITIONS AND
LIMITS OF YOUR POLICY.
Seminole County Property Appraiser Get Information by Parcel Number Page 1 of 1
PARCEL DETAIL
121
4
0"m JOHNSON, CFA, ASA
PROPERTY
L1)
I I: fi 14
3 " '° 11
118 13 /
143 142 1:f3
13a
141 1dn
APPRAISER
SEMINOLE COUNTY FL_
1 t01 E. FlRsT sT
C
SANFORD, FL 32771-1468 407-665-
7506 14.; 147
s3 14t
tt?
VALUE SUMMARY
VALUES 2011
Working
2010
Certified
Value
Method
Cost/Market Cost/Market GENERAL Numberof
Buildings 1 1 Parcel Id: 11-20-30-512-0000-1420 Depreciated Bldg
Value 64705 71,019 Owner: SANTILLIMARIOADepreciatedEXFT
Value 1,620 1,620 Mailing Address: 1746 BUCK HOLLOW RD Land Value (
Market) 15,000 18,000 City,State,ZipCode: CHAPMANSBORO TN 37035 Land Value
Ag 0 0 Property Address: 124 ALDER CT SANFORD 32773 Subdivision Name:
HIDDEN LAKE PH 3 UNIT 5 Just/Market Value 81,325 90,639 Tax District:
S1-SANFORD Portablity Adj 0 0 Exemptions: Save
Our Homes Adj 0 0 Dor: 01-
SINGLE FAMILY Amendment 1 Adj 0 0 Assessed Value (
SOH) 81,325 90,639 Tax Estimator
2011 Notice
of Proposed Property Tax 2011 TAXABLE
VALUE WORKING ESTIMATE Taxing Authority
Assessment Value Exempt Values Taxable Value County General
Fund 81,325 0 81,325 Amendment 1
adjustment is not applicable to school assessment) Schools 81,325 0 81,325 City Sanford
81,325 0 81,325 SJWM(Saint
Johns Water Management) 81,325 0 81,325 County Bonds
81,325 0 81,325 The taxable
values and taxes are calculated using the current years working values and the prior years approved millage rates. SALES 2010
VALUE
SUMMARY Deed Date
Book Page Amount Vaclimp Qualified WARRANTY DEED
01/1999 03577 0185 $100 Improved No WARRANTY DEED
11/1984 01597 0173 $65,400 Improved Yes 201Tax Bill
Amount: $1,821 2010 Certified T
a axable Value andTaxes DOES NOT INCLUDE
NON -AD VALOREM ASSESSMENTS Find Comparable Sales
within this Subdivision LAND LEGAL DESCRIPTION
Land Assess Method
Frontage Depth Land Units Unit Price Land Value PLATS: Pick... LOT 0 0
1.000 15,000.00 $15,000 LEG LOT 142 HIDDEN LAKE PH 3 UNIT 5 PB 29 PGS 40 & 41 BUILDING INFORMATION Bid
Num Bid
Type Year Bit Fixtures Base SF Gross SF Living SF Ext Wall Bid Value Est. Cost New
Buildin 1
SINGLE
FAMILY
1984 6 1,300 11760 1,300 CONC BLOCK $64,705 $72,702 Sketch Appendage / Sgft
OPEN
PORCH FINISHED / 20 Appendage I Sgft
GARAGE FINISHED / 440 NOTE: Appendage Codes
included in Living Area: Base, Upper Story Base, Upper Story Finished, Apartment, Enclosed Porch Finished, Base Semi Finshed EXTRA
FEATURE Description
Year Bit
Units EXFT Value Est. Cost New FIREPLACE 1984 1
600 $1,500 ALUM SCREEN PORCH
W/CONC FL 1991 300 1,020 $2,550 NOTE: Assessed values
shown are NOT certified values and therefore are subject to change before being finalized for ad valorem tax purposes. I/ you recently
purchased a homesteaded property your next ear's property tax will be based on Just/Market value. http://www.scpafl.
org/web/re—web.seminole_county—title?parcel=l 1203051200001420&c... 9/ 12/2011
PERMIT # 4 0_f,-
GENERAL NOTES
DESIGN REQUIREMENTS
DESIGN LIVE LOADS (MINIMUM):
A) ROOFS - 20 PSF
WIND DESIGN LOAD INFORMATION -
PER FBRC & FBC EXISTING 2007 W 2009 SUPPLEMENTS SECTION R301,
REF. ASCE 7-05 CHAPTER 6)
BASIC WIND SPEED = 120 MPH (3 SECOND GUST)
WIND IMPORTANCE FACTOR = 1.00 (ACSE 7-05)
BUILDING CATEGORY = II (ASCE 7-05)
WIND EXPOSURE (ALL SIDES) =B (ASCE 7-05)
INTERNAL PRESSURE COEFFICIENTS (ASCE 7-05)
ENCLOSED BUILDINGS = a/-0.18
PARTIALLY ENCLOSED BUILDINGS=+/-0.55
NOTE: COEFFICIENTS FOR PARTIALLY ENCLOSED STRUCTURES ARE
APPLIED WHEN DESIGN OF MEMBER(S) FALLS UNDER ASCE 7-05
DEFINITIONS CLASSIFYING AS SUCH)
WOOD CONSTRUCTION
1. WOOD CONSTRUCTION SHALL CONFORM TO THE NFPA "NATIONAL DESIGN
SPECIFICATION FOR WOOD CONSTRUCTION", LATEST EDITION. (NDS)
2. ALL EXTERIOR WOOD STUD WALLS, BEARING WALLS. SHEAR WALLS AND MISC.
STRUCTURAL WOOD FRAMING MEMBERS. (I.E. BLOCKING OR GABLE END
BRACING), SHALL BE SPRUCE PINE FOR OR EQUIVALENT. NO.2 GRADE SHALL BE
USED REGARDLESS OF SPECIES.
NEW/EXIST.
2x4 TRI15S
CHO.
2x4 SPLICE W/ (3 2x4 SPLICE
ROWS OF RODS OF
STAGGERED 10dx3' STAGGERED 10dx3'
NAILS 2' O.C. NAILS 2' OL.
OSPLICEDETAIL 3/4"=1'-0"
SANTILLI RESIDENCE
124 ALDER CT.
SANFORD, FL 32773
BUILDING DATA
FLORIDA BUILDING CODE RESIDENTIAL 2007 w/
2009 SUPPLEMENTS
FLORIDA BUILDING CODE 2007 EXISTING
NATIONAL ELECTRICAL CODE (NEC) 2008 EDITION
FBC 2007 RESIDENTIAL - PLUMBING
FBC 2007 RESIDENTIAL - ELECTRICAL
CLASSIFICATION TYPE: REPAIR
SCOPE OF WORK
FIRE DAMAGE:
REPAIR DAMAGED TRUSSES PER PLAN.
REMOVE & REPLACED DAMAGED NON-BRG WALL
AS REQ'D r
APPROX.
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1 (
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IOB SF MARIO
SCALE AS NOTED
DATE 0&31.2011
SHT 1 OF 2
01
EXIST. SHINGLES 4 ROOF
DECKING TO REMAIN (TTPJ \ i \
REFER TO DETAIL1/01
2.4 (3' LOW,) SPLICECE (ONE EA.
SIDE) W/ (3) ROWS STAGGEREDSIDE) 10dz3'NAIL9-2'OL, PROVIDE
MINIMUM OF 12 NAILS ON EA.
Z _ SIDE OF JOINT, EA SIDE
EXIST. PRE-ENGINEERED
TRIISSE5 TO REMAIN
NEW 2.4
SACK OF HOUSE WEB 4.
IOWWEBi
EXIST. STRAP TO i i EXIST. 2z4 NEW 2x4
REMAIN i BOY. CHD. BOY. CHD. 7
J/ - - - - - - - - -
i I
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R-30 MIN INSULATION REFER TO DETAIL V01
1/2' PLYWOODGUSSET (ONE EA.
EXIST. WALL 2z4 (3' LONG) SPLICE (ONE EA
SIDE) W/ (3l RO'J' 10dX1-1/2'
NAILS STAGGERED 2' Ot. TO
TO REMAIN REMAIN
SIDE) W/ l3) ROWS STAGGERED EA. CHORD (IO NAILS MINIMUM
NAILS • 2' PROVIDE BOY. CHORD i 8 NAILS MINIMUMMINMUl0dxVSOMINIMUMOFQNAILSONEA. EA WEB, EA. SIDE)
SIDE OF JOINT, EA SIDE .
OTRUSS 'T1'
REPAIR
EXIST. STRAP TO
REMAIN
OTRUSS 'T2'
REPAIR
3/8"=V-0"
EXIST. SHINGLES A ROOF
DECKING TO REMAIN (TYPI
EXIST. ED
TRUSSESS TOTO REMAIN
BACK OF HOUSE
EXIST. 2x4 NEW 2x4
BOY. CHD. BOY. CFI.
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EXIST- GIRDERREMAIN I
FRONT OF HOUSE
TO
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1/2' PLYWOOD GUSSET (ONE EA I
SIDE) W/ (3) ROWS IOdXI-IR'
NAILS STAGGERED • 2' O.C. TO
EA. CHORD (S NAILS MINIMUM TOP
CHORD - S NAILS MINIMUM WEB,
EA. SIDE)
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BOT. CHD: BOT. CHD. \ I I I
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REFER TO DETAIL I/01 EXIST. HANGER TO
2.4 (3' LONG) SPLICE. (ONE EA REMAIN
SIDE) W/ (3) ROWS STAGLERED
10dx3' NAILS • 2' O.C, PROVIDE -
MINIMUM OF 12 NAILS ON EA -
SIDE OF JOINT, EA SIDE
REMOVE ( REPLACE
IR' CLG GYP. AS
REO'D (TTPJ
NOTE:
G.C. TO WIRE BRUSH & SEAL
CHARRED LUMBER AS REQ'D. TO
REMOVE ODORS.
REFER TO DETAIL 1101
2.4 (3' LONG) SPLICE (ONE EA
SIDE) W/ (3) ROWS STAGGERED
10dz3' NAILS s 2' OL, PROVIDE
MINIMUM OF 12 NAILS EA.
SIDE OF JOINT, EA SIDE
r1n
FRONT OF HOUSE
EXIST. GIRDER
TO REMAIN
REFER TO DETAIL 1101
2x4 (3'LONG)5_AT (ONE EA III
SIDE) W/ f3) ROWS STAGGERED I I I
10dx3' NAILS • 2' OL., PROVIDE
MINIMUM OF 12 NAILS ON EA
SIDE OF JOINT, EA SIDE I I
III
NEW 2x4WESIIIZ
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R-30 MIN. INSULATION --TO DETAIL 1/01
1/2' PLYWOOD GUSSET (ONE EA
EXIST. CMU WALL 2.4 (LO) SPLICE (ONE EA NAILS STAGGERED (I- 3' N3 OZ. TO
TO REMAIN SIDE) W/ (3) ROWS STAGGERED EA. CHORD (10 NAILS MINIMUM
10dx3' NAILS • 2' O.C, PROVIDE BOT. CHORD 4 S NAILS MINIMUM
MINIMUM OF 12 NAILS ON EA EA WEB, EA SIDE)
SIDE OF JOINT, EA. SIDE
3/8"= V-0"
NEW 2x4 EXIST. 2.4
BOY. CHD. BOY. D.
w 2.4B
REFER TO DETAIL 1/01 EXIST. HAWSER TO
2.4 (3' LONG) SPLICE (ONE EA. REMAIN
SIDE) W/ (3) ROWS STAGGERED
I0dx3' NAILS • 2' O.C, PROVIDE
MINIMUM OF 12 NAILS ON EA.
SIDE OF JOINT, EA. SIDE
REMOVE ( REPLACE
1/2' CLG GYP. AS
REQ'D (TTPJ
NOTE:
G.C. TO WIRE BRUSH & SEAL
CHARRED LUMBER AS REQ'D. TO
REMOVE ODORS.
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DESIGN
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oB SF MARIO
BCAEE AS NOTED
DATE 0&31.2011
SHT 2 OF 2
02
I Oti/'L'L!'LU 11 13 : 5G 1" 8A 4U ('L82842b
Permit Number I ) 23(!'_5
Parcel Identification Number
Raturn to; S /' tA,Zt,> ,t
Vrk,,)d r( 3 4-0y
NOTICE OF COMMENCEMENT
State of Florida
County of Orange
The undersigned hereby gives notice that improvement(s) will be made to
certain real property, and in accordance with Chapter 713, Florida Statutes,
the following Information is provided in this Notice of Commencement,
HAMM MORSE, MERK OF CIRCMI T CST
WHINE COUNTY
iK 07630 P9 1483g (1p4)
CLERK' S 0 24D1 1097679
RECORDED 09/13/21011 10.-c()j j6 AN
KCM, I% FFn 10.00
RECORDED BY T Smith
C c0' 1
SEM\Noo
1. Description of property (legal description of the property• and street address if available)
2. General description of Improvement(s)
lnforma \ / /
Name & Address 1 0.r t o —"f' i I I I ) y 1.c; G"/ SGr- ^° L_ Z -)
Telephone & Fax Number a 1
Interest in Property:
4, Fee Simple Tltla Holder (if other than owner ehown above)
Name & Address
Telephone & Fax Number "
5. Contractor r-c —" <t-t Ai_, 0 r-\,
Name & Address S` 1 "7 d1 r„1 A,,.-t
Telephone & Fax Number
6. Surety (if any)
Name & Address
Telephone & Fax Number `
Amount of bond $ / !A "
7. Lender (if any)
Name & Address
Telephone & Fax
8. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as
provided by 713.13(1)(a)7, Florida Statutes.
Name & Address %
Telephone & Fax Number _ //1
9. In addition to himself or herself, Owner designates the following to receive a copy of the Llenor's Notice as provided in
7,13.13(1)(b), Florida Statutes.
Name & Address
Telephone & Fax Number
10. Expiration date of notice of commencement (the expiration date is one year from the date of recording unless a
different date is specified):
WARNING TO OWNER: ANY :PAYMENTS MADE BY THE OWNER AH I*k R THE EXPIRATION OF THE
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDF..R CHAPTER 713.
PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT 1N YOUR PAYING TWICE F'OR
IMPROVk;WN'CS •I.O YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE T11E FIRST INSPECTION. TF -YOLI INTEND -TO -OBTAIN
FINANCING, CONSULT VOUk tIrNI).FR OR AN ATTORNEY BEFORE COMMENC'INC WORK OR
RVCORDING YOUR NOTI OF COMMENCEMENT.
t c n
Signature of Owner or Owner's Auftiized Officer/DirectodP2rtnedM2nagar Prrgt N MO
Swom to (or afflrmecO and subscribed before me this Ay +` day of - 20 _
by i o +,cf as 0+-q-' (type of authority, a.g. officer, t.rut 1
attorney In fact) for (name of party on behalf of whom instn,r l tlI H • SM/l ///iceaxeed. personal own tom OR produced a 2` 1=9
tlilcallorr. • •, y i
3lgnaluro of Notary i i , r f r t
t -
yj • SEAL = µy
nu
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Namn (pant) '
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Verification pursuant to Section 92.525, Florida Statutes, Under penalties of pe 'ury, I decl a that I hav r d Sfje'for.4
and that the facts staled In It are true to the best of my knowledge an b 4 / F OF
Slgnature of Ne u I Perso Sloning.(kh line
23,20 (7/07)