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3601 Orlando Dr 16-2700 (a) INTERIOR REMODEL
a v F CI 11b at.N CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: 1p GICO Documented Construction Value: $ 69, 500.00 Job Address:3601 S Orlando Drive W750279 Historic District: Yes No 0 Parcel ID: 11-20-30-300-036B-0000 ResidentialEl Commercial El Type of Work: NewEl Addition Alteration 0 Repair Demo Change of Use move El Description of Work: Interior and Exterior Upfit of existing KFC Restaurant. Signage to be submitted separately. No work in kitchen or restro.oms. Plan Review Contact Person: Victoria Benham, Lendlease Title: Assistant Zoning 312. 248.1448 Manager Phone: Fax.: Email: _ vi. ctoria.beniam@lendlease.com- Property OWner Information KFC Corporation Name Phone: Street: 1900 Colonel Sanders Lane Resident of property? Louisville, KY 40213 City, State Zip: Contractor Information Name Darryl L. Riley Phone:. (863)967-517.7 Street: 4100 Recker Highway Fax: (863)965-8504 City, State Zip: Winter Haven: FL 33880 State License No.: CGCA36042 Architect% Engineer Information Name: CESO Phone: 937.435.8584 8539' Yankee Street Street:. ]+' zs: City, St, Zip: Dayton, OH 45458 E-mail:; Bonding Company: Mortgage; Lender: Address: 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 insta llatioti 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: 511' Edition (2014) Florida Building Code Rr icvrl.' lime in 701 S b 9). 95 Pennit Application 9 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,rand there may be additional pemtits required from other governmental entities such as water manatzement 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 tlta job at the time of stibmittal. The actual construction value will be figured based on the current 1CC 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. be done i Smnaturc of 9 VIT: I certify that all of the foregoing information is accurate and -that all work will e withall applicable laws regulating constructio an zon g, John Van Lenten; Director Construction & Facilities Print Owner/Agent's Name 14 LE,ILANI L SCHLADAND NOTARY'PUBLIC STATE AT LARGE, KENTUCKY ID. # 446920 MY COMMIS N EXPIRES JULY 14 2019 Own to Me or Produced ID Type of ID r?:yt DEIRDRAEDMONDS Y COMMISSION # FFW50 o iaES; August 3; 2019,. oe iNo Pub6cUndeFWr Vs Contrac or gent is Personally Known to Me or Produced ID Typc 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: Al of Stories: New Construction:. llectric - # of Amps: _ Plumbing, - # of Fixtures Fire Sprinkler Permit: Yes No # of Heads; Fire Alarm Permit: Yes No APPROVALS: ZONING: UTILITIES:: WASTE WATER: ENGINEERING:_ FIRE: BUILDING. - COMMENTS: Revised: June30.2015 Permit Application ATE: Iv USINESS/PROJECTrAM i ADDRESS: I :ONTACT NAME: CITY OF SANFORD BUILDING AND FIRE PREVENTION DIVISION FIRE PLAN REVIEW SERVICE FEES PHONE: 407-688 5052 FAX: 407-5885051 PER `- PHONE PLAN REVIEW INFORMATION Construction C/O Fire Alarm 0 Fire Sprinkler 0 Hood OTank 0 Paint Booth M REDUCTION IN FIRE IMPACT FEES APPLY: AYES NO I TOTAL FEES: v y '- 7 J CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: Documented Construction Value: $ 69,500.00 Job Address: 3601 S Orlando Drive Q Historic District: Yes No 11-20-30-300-036B-0000 UUU!v`fl . Parcel ID: ., U Residential Commercial Type of Work: New Addition 0 Alteration Repair Demo 0 Change of Use Move Description of Work: Interior and Exterior Upfit of existing KFC Restaurant. Signage to be submitted separately. No work in kitchen or restrooms. Plan Review Contact Person: Victoria Benham, Lendlease I Title: Assistant Zoning 3-12 -3-9f-5'-8-- Manager Phone: -Fax: Email: 3 I a - d Lf /q Y victoria.benham@lendlease.com Property Owner Information KFC US Properties, Inc. Name Phone: Street: 9229 Delegates Row, Ste 375 City, State Zip: Indianapolis, IN 46240 Contractor Information Resident of property? : Name TBD Street: City, State Zip: Name: C E S 0 8534 Yankee Street Street: City, St, Zip: Phone: Fax: State License No.: Architect/Engineer Information Dayton, OH 45458 Bonding Company: Address: Phone: 937.435.8584 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, lumbing, signs, wells, pools, furnaces, boilers, heaters, tanks, and air conditioners, etc. FBC 105.3 Shall be inscribed with 2 a date of application and the code in effect as f that date. 5 Edition (201 )Florida Building Code Revised: June 30, 2015 l c Permit Application S ` 5 t 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 1CC Valuation Table in effect at the time the permit is issued, inF accordance with local ordinance. Should calculated'6hafges figufedlo ff the executed contract exceed the actual construction value, credit will be applied to your permit fees when the p&i iit.' s issued .I1(,r l 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 TBD Signature of Contractor/Agent Date Print Contractor/Agent's Name Signature of Notary -State of Florida Date Contractor/Agent is Personally Known to Me or Produced ID Type of ID BELOW IS FOR OFFICE USE ONLY Permits Required: Building Electrical Mechanical Plumbing[] Construction Type: Occupancy Use: Total Sq Ft of Bldg: Min. Occupancy Load: New Construction: Electric - # of Amps Fire Sprinkler Permit: Yes No # of Heads APPROVALS: ZONING: ENGINEERING: COMMENTS: Revised: June 30, 2015 UTILITIES: FIRE: Gas[] Roof Flood Zone: of Stories: Plumbing - # of Fixtures Fire Alarm Permit: Yes No WASTE WATER: BUILDING: Permit Application i 411! I I II I 91111 I III III! I 01 I i GRANT MALOYr SEMINOLE COUNTY CLERK OF CIRCUIT COURT & COMPTROLLER BK 5861 Pa 1172 (1F'9s) CLERK'S 2017015777 RECORDED 02/14/2017 i11:I?5- t3 PM NOTICE OF COMMENCEMENT REC:ORDEDGBYEhdevfreUU Permit Nu , .20 Parcel u : ( ab- c-i )(-" The unde h eby gives notice that improvement wiil be made to certain real property, and in accordance with Chapter 713. Florda Statutes. the following in Klis provided in this Notice of Commencement. 1. DESCRIP F PROPERTY: (L al description of the property and street address if available) W750279 2. GENERAL DESCRIIPTIQQN OF 3. OWNER INFORMA LESSEE INFORMATION IF THE Name and address: Interest in property: 1 Fee Simple Title Holder (if an owner listed above) Nar AAm-, 11 4. CONTRACTOR: Name: L Address: z CiYY1 5. SURETY (If applicable, a copy of 6. LENDER: Address: 7. Persons within the State of Florida 713.13(1)(a)7., Florida Statutes. bond is attached): 8. In addition, Owner designates to receive a copy of the Lienor's Notice as provided in 9. Expiration Date of Notice of Commencement (The exl D FbR THE IMPROVEMENT: S i.::". 3'i S r c i r ;nc.nc-ilt 1 r y:w Phone Number i2D ' .; r D Amount of Bond: Phone Number upon whom notice or other documents may be served as provided by Section Phone Number. of 13(1)(b), Florida Statutes. Phone number. ear 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 COMMENCTQkWORK OR RECO90ING YOUR NOTICE OF COMMENCEMENT mature or Owner tt nerLeSsee, Or Jw's or Le: i:UlhpIi28C fJfficerfJireGt(7rlPaftrl8r?rAOna.eri John Van Lenten, Director, Construction & Facilities Pr.nt Narne ano Pmwitn Srsnazory s udz/Omm) state of Kentucky county of _Jefferson _ The foregoing instrument was acknowledged before me this 8 T day of -nP CeXMA eAr 0_ by. John Van Lenten . Who Is personally known to mex OR Narne or person making statement who,,IdeVeatlon type of Idendfication produced: r. Not%Public, Jc X;r We at LaW. M6A ,. NOtay Signature LEGIBILITY USAT NGCTORYFORSC Book8861/Page1172 CFN#2017015777 Page 1 of 1 Bland, Annette From: Riley, Sandra <SRiley@seminolecountyfl.gov> Sent: Thursday, November 03, 2016 9:08 AM To: Benham, Victoria Cc: Blanton, Deborah; Bland, Annette; Johnson, JoAnn Subject: RE: KFC Refresh - 3601 S Orlando Drive, Sanford, FL - Road Impact Fees Good Morning, With the information you provided, there will not be any additional Seminole County impact fees, since you are not changing the use or adding square footage, and you are not adding any outdoor seating. _ Thank you, Sandy From: Benham, Victoria[mailto:Victoria.Benham@lendlease.com] Sent: Wednesday, November 02, 2016 10:06 AM To: Riley, Sandra <SRiley@seminolecountyfl.gov> Subject: KFC Refresh - 3601 S Orlando Drive, Sanford, FL - Road Impact Fees Good morning Sandy, Thank you very much for taking the time to speak with me this morning regarding the proposed KFC Refresh located at 3601 S. Orlando Drive in Sanford. I was instructed to contact your offices by the City of Sanford to confirm whether or not a Road Impact Statement was necessary for the proposed commercial upfit. I have attached a plan set outlining the proposed changes. There will be no changes to the building footprint and no site work proposed apart from updating the Drive-Thru menu board. The scope of work on the exterior entails, painting the building, replacing awnings and updating lighting. On the interior, work will only be done in the dining room (no work in kitchen or restrooms) and include replacement of fixtures and updates to decor/furniture. If you need any additional information or have any questions, please do not hesitate to contact me. Thank you very much for your assistance. Sincerely, Victoria Benham Assistant Zoning Manager, Multi -Site Group, Construction 125 S. Clark Street, 1711 Floor, Chicago, Illinois 60603 T 312.248.1448 - victoria. ben ham CD- lend lease. com I www.lendlease.com eas 15060013643 Subcontract Project Number 210716.76371341 Subcontract Number 8568 PO # - W750179 Date March 22, 2017 Vendor #: 53348 CONTRACTOR: Attention:' Contractor") Lendlease (US) Construction Inc. Michael R. Lentz One North Wacker Drive Suite 870 Operations Director Chicago, IL 60606 SUBCONTRACTOR: Attention: Subcontractor") Darryl Riley Frasier Contracting, Inc. 4100 Recker Hwy President Winter Haven, FL 33880 WORK: Remodel of existing KFC PROJECT: KFC Corporation (KFC01-030000) - W750279-3601 S. Orlando D Project') 3601 S. Orlando Dr. Sanford, FL 32773 OWNER: KFC Corporation (KFC01-030000) Owner") P.O. Box 35910, KFCC Louisville, KY 40232 ARCHITECT -ENGINEER: N/A Architect') PRIME CONTRACT: KFC Corporation (KFC01-030000) Contract Dated: November 19, 2015 SUBCONTRACT PRICE: 44,981.00 ) , Price") Description Scheduled Value Budget Code Subcontractor Site Genera $10,559.00 1440.0122.000 Demolition 3,725.00 1440.0200.000 Woods & Plastics 820.00 1440.0600.000 Exterior Finishes 7,538.00 1440.0910.000 Flooring 7,011.00 1440.0955.000 Specialties 1,080.00 1440.1000.000 Signage 943.00 1440.1040.000 Equipment 980.00 1440.1100.000 Furnishings 6,085.00 1440.1200.000 Electrical 800.00 1440.1600.000 Lighting 3,650.00 1440.1650.000 Ceilings 1,040.00 1440.0950.000 Hardscape 750.00 1440.0260.000 MONTHLY BILLING DATE: 75% at Construction Start and 25% at Closeout Monthly Billing Date") Complete LG02 (Rev: 6/08/16 (prolog) 210716.76371341- 8568 Page 1 CITY OF SANFORD BUILDING.& FIRE PREVENTION PERMIT APPLICATION Application No: & d Documented Construction Value: $ 69,500. 00 Job Address: 3601 S Orlando Drive _ HistoricDistrict: Yes No 11-20'l i. v; Parcel ID: n It o-30-300-036B-0000-( Z -1 % ; I Residential Commercial El Type of Work: New Addition N Alteration Repair Demo Change of Use Move Description of Work• Interior and Exterior Upfit of existing KFC Restaurant. Signage to be submitted separately. No work in kitchen or restrooms. Plan Review Contact Person: Victoria Benham, Lendlea'se Title: Assistant Zoning Phone: 312.3 9 6.55 7 8 Fax: Email: Manager victoria.benham@lendlease.com Property Owner Information KFC US Properties, Inc. Name Phone: Street: 9229 Delegates Row, Ste 375 Resident of property? City, State Zip• Indianapolis, IN 46240 Contractor Information Name TBD- TBD- Phone:' Street: Fax: City, State Zip: State License No.: Architect/Engineer Information Name: CESO Phone: 937 .435 .5584 8534 Yankee Street Street: Fax: City, St, Zip: Dayton, OH 45458 E-mail: Bonding Company: Mortgage Lender: Address: 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: 51h Edition (2014) Florida Building Code Revised: June 30, 2015 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/Agent Print Owner/Agent's Name Date Signature of Notary -State of Florida Date TBD Signature of Contractor/Agent Date Print Contractor/Agent's Name Signature of Notary -State of Florida Date Owner/Agent-is - Persorially Known to Meor ---- -Contractor/Agent i"s — -Personally Known to Meor --- Produced ID Type of ID Produced ID Type of ID Permits Required: Construction Type: BELLOW IS FOR OFFICE USE ONLY Building Electrical Mechanical Occupancy Use: Plumbing Gas Roof 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 Fire Alarm Permit: Yes No APPROVALS: ZONING: UTILITIES: WASTE WATER: ENGINEERING: FIRE: BUILDING: a COMMENTS: d Revised: June 30, 2015 Permit Application 6 II CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No:- & Documented Construction Value: $ 69,500.00 Job Address: 3601 S Orlando Drive Historic District: Yes No 0 Parcel ID: 11-20-30-300-036B-0000 Residential Commercial© Type of Work: New Addition 0 Alteration Repair Demo Change of Use Move Description of Work: Interior and Exterior Upfit of existing KFC Restaurant. Signage to be submitted separately. No work in kitchen.or restrooms. Victoria Benham, Lendlease Assistant ZoningPlanReviewContactPerson: Title: g Phone: 312.396.5578 Fax: Email: Manager victoria.benhafn@lendlease.com Property Owner Information KFC US Properties, Inc. Name Phone: l7 (1r ra 9229 Delegates Row Ste 375Street: Resident of property? : L J City, State Zip: Indianapolis, IN 46240 Contractor Information Name TBD ---^ —-_-- Phone: Street: Fax: City, State Zip: State License No.: Architect/Engineer Information Name: CESO 8534 Yankee Street Street: City, St, Zip: Dayton, OH 45458 Bonding Company: Address: Phone: 937.435.8584 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. M FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 5" Edition (2014) Florida Building Code I Revised: June 30, 2015 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/Agent Owner/Agent's Name Date Signature of Notary -State of Florida Date Signature of Contractor/Agent Date Print Contractor/Agent's Name Signature of Notary -State of Florida Date Owner/A— ogenContractorAgentlsPersonayKnowntoer -- risPersonallyKriowritoMeorProduced ID Type of ID . Produced ID Type of ID BELOW IS FOR OFFICE USE ONLY Permits Required: Building Construction Type: Total Sq Ft of Bldg: Electrical Mechanical Plumbing Gas Roof Occupancy Use: Flood Zone: _ Min. Occupancy Load: New Construction: Electric - # of Amps Fire Sprinkler Permit: Yes No # of Heads APPROVALS: ZONING: ENGINEERING: COMMENTS: of Stories: Plumbing - # of Fixtures Fire Alarm Permit: Yes No UTILITIES: 01011011C WASTEWATER: FIRE: BUILDING: Revised: June 30, 2015 Permit Application CITY OF SANFORD U BUILDING & FIRE PREVENTION PERMIT APPLICATION O Application No: o Documented Construction Value: $ 69,500.00 Job Address: 3601 S Orlando Drive Historic District: Yes No M Parcel ID: 11-20-30-300-036B-0000 Residential Commercial© Type of Work: New Addition Alteration Repair Demo Change of Use Move El Description of Work: Interior Wand Exterior Upfit of existing KFC Restaurant. Signage to be submitted separately. No work in kitchen or restrooms. Plan Review Contact Person: Victoria Benham, Lendlease Title: Assistant Zoning Phone:312.396.5578 Fax: Email: Manager victoria.benham@lendlease.com Property Owner Information KFC US Properties, Inc. Name Phone: Street: 9229 Delegates Row, Ste 375 City, State Zip: Indianapolis, IN 46240 Name TBD Street: City, State Zip: Resider Contractor Information Fax: State License No.: Arch itectlEngineer Information Name: CESO 8534 Yankee Street Street: City, St, Zip: Dayton, OH 45458 Phone: 937.435.8584 Fax: E-mail: Bonding Company: Mortgage Lender: Address: 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 theworkand 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 aseparate 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: 51h Edition (2014) Florida Building Code Revised: June 30, 2015 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/Agent Print Owner/Agent's Name Date Signature of Notary -State of Florida Date TBD Signature of Contractor/Agent Print Contractor/Agent's Name Date Signature of Notary -State of Florida I Date Owner/Agent-is ----Personally Known to Meor — -Contractor/Agent is - -- Personally Known to Meor -- - Produced ID Type of ID Produced ID Type of ID Permits Required: Construction Type: Total Sq Ft of Bldg: BELOW IS FOR OFFICE USE ONLY Building Electrical Mechanical Occupancy Use: _ Min. Occupancy Load: New Construction: Electric - # of Amps Fire Sprinkler Permit: Yes No rr # of Heads l APPROVALS: ZONING:-{ 1(o t UTILITIES: ENGINEERING: COMMENTS: kin Zn., i SS.r c O FIRE: Plumbing[] Gas[] Roof Flood Zone: of Stories: Plumbing - # of Fixtures Fire Alarm Permit: Yes No WASTE WATER: BUILDING: 11 Revised: June 30, 2015 Permit Application Lendlease regional Map Based upon where the site is located, please send to the following portal North (Red) KFCnPayApps(a.portal.lend lease. com South (White) KFCsPayApps(q portal.lend lease.com West (Blue) KFCwPayApps(a portal. lend lease. corn Regional Program Map 0 a Lendlease Required Forms — General Information'` Sales Tax Affirmation - This form is only required to be submitted once and should be done in conjunction with the submission of your first pay app. Lendlease trade contract/PO application for payment — This form is required to be submitted each time you are requesting payment. The form should be completed in its entirety and only approved change orders should be included on the pay app. If any sales tax is being invoiced, an invoice with a breakout of sales tax is also required. Partial Lien Waiver — This form is required to be submitted with all pay apps prior to requesting 100% payment. If site location is in Arizona, California, Nevada, Texas or Utah, you MUST use the state specific lien waiver. The required waivers can be found in the Pay App and Waivers Excel file. Each partial waiver tab includes both the Lendlease waiver as well as the waiver required by KFC. Both waivers must be submitted. Lendlease Final Lien Waiver — This form is required to be submitted along with the final pay app when 100% of the total contract value. If site location is in Arizona, California, Nevada, Texas or Utah, you MUST use the state specific lien waiver. The required waivers can be found in the Pay App and Waivers Excel file. Each final waiver tab includes both the Lendlease waiver as well as the waiver required by KFC. Both waivers must be submitted. All forms that require a notary should be signed and notarized on the same day. Trade Cw,tracUSUb—dract AppauUon for Payment To. '.Lend lease (US) Construction; Inc: ..' : j Is Sales Tax Charged? Fran:. 'ABC Construction Co. Ii..Ana d.*gL.ML.—: W..naandreeamtaitt.d.:+.veil Address:. 1 Subcontractor St . '.".. ' i Yes, attach Invoices with tax separately stated New York NY 12345 "- `.'`( and enter Tax Registration p Project: E763709 C12456123 KFC. Way - . .. No CMW franchisee Name Payment Request Number. 2 °i z `. jv,at; Perrod. ;' 36Nw:', 2015 µto °30-Mw ?. 2075 ,-a'q Statement of Trade Contract I Subcontract Account 1. Original trade contracttsubantrac amount S t66'00006"t 2: Approved change order nu rber(s 1 as per attached breakdown) Net) 3. Adjusted trade mntractisubcmGact amount 4. Value of work completed to date (as per attached breakdown) 50,1x70.00.°- 5. Value of approved change orders completed (as per attached breakdown) . 6. (as per attached breakdown) 7. Total to date S. Less amount retained: 9. Total less retainage r 50 00U 001 10. Less previously Candied (deduct line 99 tram previous request) It. Amountduethis,,W W $ Cer60cate of Trade Contractor f Subcontractor For Lent Lease Use henry YendaAl - Pm1erYCast Cerder 3 Cost Twoe _ Cost Code Total b p y ITae*turJr ar.T. axk pckmxJ ar4H maxd4s rrPGd edee,a xea aboa. r.prr.Rr.,m,d,di:e m,r hma.,een. or nr z.-.ee caw.ns errroxp. ian4 ai auCnv¢e4 mangos >Fere6 nfadng m Crt aMns?ekxud Pmnx: r lab. cauh Aat p}rnnt au.XPObW rc2M"lava btei made th.0 M. P.dal<o'rer br xenusp ---ir».% 111 as cry sstnwacon J.W suaamctr—J.4 iA brm ramYaY ar.d tiwr ame e x e wnrr.:an Wt6 tl epefuvwu aria iraA Usmac'sW,wcx i tAa <a<dhs xr. wc.2gnEo-na: o ePr a: a. .at sr» ars x m u.,.w+a.s S.dd Sewirylext rid tMertpiryxrenlf .pnuux. mrs i Wulmwta CxnPanu6.n6n. n,re.rPra y,P,g>a<a. s b aast,n aaan a,tz re. Invoice Total 50,00D.00 sgr.,na. - ttxrtrna A .z AttachedAppirivaf - Manhours Worked on this Project this month: Number of Lost Tim Injuries on this Project this month: s ABC Construction Co."'- J Date: _.. '.: f Trade ContractortSutxontractor Subscribed and swom bebre me this day of - Y-) BY Notary Public. - . _ V Authorized Signature My Commission Fxp res- Tipe. , t+en"dtease Example Lendlease pay app/trade subcontractor application for payment — First 50% Your Lendlease job number, site name, and site address is located within your contract documentation. First 50% pay app must include your sales tax affirmation and the partial waivers found in the pay app and waivers excel file. Complete all highlighted yellow areas Trade CanradlSubcontract Applcadon for Payment To: leM Lease (US) Constration Inc LL+_ Is Sales Tax Charged? From ABC Constnchon Co= _ It..are rw cn+rarer aa:.,a. aa.a r aarm r.raasaoumu+..antn Address:. 1 SUbCOritraGiOr St. _ ,`` - Yes,. attach Invoices With tax separately stated New York; NY 12345" - and enter Tax Registration x . Project 76375.# C124501231ffC Way _ ! No Qvmer, Franchises Name Payment Request Number °:• ! ...„ ;x` -4 period 30-Nov, "2015 to •: 30-Nov - . '2075 Statement of Trade Contract I Subcontract Account 1. Origlrel trade canbxVsldxoNraU amount 2. a- Approved change order as per attached breakdown) Net) " 20.000.00? 3. Adjusted trade contractlsubcontract amount 120,000.00 $ 4. Value of work completed to date (as per attached breakdown) 100.000.00., 5. Value of approved change orders completed (as per attached breakdown) 20:000:00 S. (as per attached breakdown) - 7. Total to date •- .120.000.00 0. Less amount retahned: J-66- + 0 DO,,) 9.' Total less reminage 120,000 00 10. Less prevkusty ceNrcetl (deduct line *9 from previous request) 50.1700.00") 11. Amourd due this request $ : 70,000.00j Certificate of Trade Contractorlaubeontraetof Inere7r arty Cxim vxtr F<hnre9 ardta makide s pFl d ficua, xi alwnalrw, repasertea arae3raiue darmmtAiehnux-:mien as small he iwde Conaatl'sueavcatl ardai eaaaaaa Na gec kgeraof n4bngb Te aDngrehee ProiaS... IasoaNy Lhatpa}saecs, Ass arplrab@ raiecfir, wow bees .aic Eravyn iae gg'oe torso Mpaiaa w!me+n roan1roftJ.ersfuwaro-m-SntardaNiee •-wTaraCm,J l?!raas ruadaq ar4lr5utsMnancxrmfiasiSparbtsacr 's Mr Cmervac:3akY.K. Ix&.-utt sort lbm[asigmE toe mmpf d ; Frdnat stre dlcW Wh+y worm)laax aML M;b)—. 0M%.vinabn aM wtt. W, CDm.: a,uvna.c h-..pm wptiAbbMepefirr,.nacrtivsToce CtrArazl4ficar xr Flretly,icaNdyhi an ir— seperaet) rIA7gareemis&. dW-.P*&(.. Lend Lease Use only Vendor a t invoke Total f-70.000D0 rov.t edA i W o J Atto p,, paw SigracueTrialtrax Approv.2 Sao shad Approval sg— Riv mau htanhours Worked on this Project this month: - p °+ = :'! Number of Lost Tlme Injuries on this Project this month: ABC Cenitruabon:Co. Date: - Trade. Contractor/ Subcontractor Subscribed and swan before me this day of year) By Notary Punk: .: Aufllodzed Warta My Commission Expires: r Title:= M Example Lendlease pay app/ trade subcontractor application for payment — Final 50% Your Lendlease job number, site name, and site address is located within your contract documentation. Final 50% pay app should be submitted once work is complete and should include your final lien waiver(s) found in the pay app and waivers excel file. Complete all yellow highlighted areas. II Pamal Waver and Lim Release by D o Tract Cm,tracmr l Subcantracro, I Supplier Lend Lease Job Number. 6aner Nad aN Ranchnee ?.- -. ..:.;"' _ .... "--Fi 'z ttlre "Onmar) P P_J, For and! ad'm consideration f be aysoent _:; log I}]g 00 jwbdh 4 rep ertetl as bang ty du ,dialed ExamplebytheAppicaooenaForPaymentorIne(s)fmImnac belom e andnsthiss Menem in hall at thean s presently due mom Lend Leaser ( USI C mniioon Loc. lend Leaser, or preseray due 5—the Owner h—gh he "or, Lend Lease, to the undrsigned for site kmishim of labor mdlu muvasie, by the undersigned, the suffaimcy oL dish is hereby mknoeleigad. the udengned does hereby waive. release, and n laquidn any and al rights. drama, d—rd. lies, dean for re"er•:a,norof..1.,.0ftHa,whe°as°dOg.1la.,rndarercontract ,nsomine°",°r°Vh "1w"""hft If the site is located in Arizona, California, Nevada, tad gin d has n may Mrs Pact mg t of ate parimm hue of work tie h mnshug of Io na'anal by Irk dersgrxd gh: tazrrpls [(tarea der 17neetrea am df N W ,AmI.—R p nttoT dC.I.Ind Texas or Utah, you MUST use the state specific h Na -.. (orPuhGnOrdvNow7mm,r w,„ a: _ - waver. be Pmjsal. Use of 0e renn led Lea,i &half be deserted W mean and reef b Lod Dace (US) Constucmn loc. and its agents, hipreseml:iva. employees, &ad—. and al terse acing n chair behalf. This Wai—ad Lim Referee ""I".b of faces, ads, arenas, uirmnnvncas, changes. mnsbuctive or ecu:al delays, acaleraDms, ed&a work, disruptions, intaftenees 0 Complete the waiverswiththefirst50 /o and tw Air whkh have —,ad, ca my be deimed to he. b—d, prior trr the a feadin.c dharmf, —pinqmly my dnns—rely unnsohed for which nilsen partial pay Wke has been provide! ro Lend Lease pursuant m the nguirehrents of the Trade Cbnlract5ubconhntatic ch.,. O,dee n expressly.. forth in Sere dhde A ehacnm he-, app. Y Y Ecapl asapxiFabdh15 lly described eye, and cium p. dany, held under the Theda Camr.V%bconb VPurchasa Order,. '.hessl he chchnipird nPtay w•m., at claimsagainstLedLeese, the Owner and the Property as herainst—desa5ed. Thus War,,. end Lim Release is also inteded a wpoy at and protect Lend Lee.. nm ,tadprdown abond surely. 4my. .1walfa,anygaedaktrirhgbyata- ghLend Lease, se°weer,orthe —It inconnect. will, any clan, d d.ln. The Lendlease job number and project location claim for helief, ai.Kw of ac&chs and the flee waived, rOnsed ad m4nSuished by the lerns of this Waiver and Lien Release. are located within the contract documentation. This Warren and Lien Release is freely and vok ranly gben andtheurdedgnadatnpWd;n. wan diner ter: it has bhlly nyiewad the V.—. ad arz'rto A On Waver and Lien Release. that d is fully 6hfcrned with n,pect ro the ra;a idea of this Waiver and Len Release ad,lhar it his woWa•,ily ctmrm to scorn, 0. terns and condcirts of the Wainer and lien Release in nfam for the paymoni rested at The udersfgned harder represent and oertifes (1) t n all mg,lo wes.labomn, maio.+.'hhnen, vendors and srkmntrachm of any tie, empaywd by the udersgned in Complete all yellow fields on the form. oon mar. w,t, the Protect and a1 bib aarmdy due for tabs, materel; supplies, and rases Furnished by oilers ho the undersigned in ooanan orh *11I canecuciah d unprnveroerts upon the Prapea have been Nty pail less a?plka le ntedce,; (2) the work pe lonned set the maleriah , Ppted so data, as shmvn in t'a AUPfaton for Pay— ce I nfermod berlow, represent rise acbal,aba of ecomphshroenhrodw; be nesters efthe Trade Cmbaa5obc-lracr,Pa:dha&a ohdr(Id of Complete Exhibit A with information of dxbad d led theralo) rbiuy ro th Proy,ci: (gyro obNya:hshs fmJ chip cwn:kansca whLh all Fsdarat. State red Ieal taz.5oaal Secrnty L'ne ploymenr Canlpen,Atp, set W.1—: Ccmp nsaton lay.,). IW, agitasi. a, olhamsa are owed by the undersigned in cnneCuon w,1h n work on the Prq G(4)t signatory subcontractors/suppliers you used to complete the of this Waiver and Lien Release re m aurborc,ed WT f theudenlpmd ms U powered andhonhy to axe to MWew and Lren R lease; ed (5) al` r",ett liarsadice. 111—caa, made by the Wersigg ed in the Trade CwnbacLS. abdo.b WP—t.. Order " I— and to With ..pact to the foregoing work. nsem'stons ad -tin, the uda fined does heresy agree to tat—dy, end hole t loss Led Lease, in payneent and Ped rrarce bond story, t ray, the Cssner and any or whalet wham a claim is asseried by Nnane a involem ern or r0W s hip with 3arr, Ion ray and all Jahn, daragos, bases, eapeme; ad the Irks irewred by nuson of any daim ial In. udarsgxd her rot Wy poi: for elf 1 mate wls and exxnse, hound b mnectm wth irk work on the Protect, bcluding reasonable Arto ray[ fees, coati or a baratn cosh, and nrleh witness ad mnshdesnt fees n mrhid in omnecton with the d:ecser el any svd ohm. The udanigrad Worie, declares that by sgnbg and waling this ing.remt. the uhderegnea shall be co p1 hey ntoppad torn filing or mairdaindng any and of We, dance and cap r don against be Pr4sor and the Pr*;y for or with respect W the work dersodoed n ile Appicabon (chi Paymeoi s rh sc*,I, nfereded harem: and Me,er tier evmr the, airy such fib, claim «slop notice is Ned, dr md— igned shelf imnedimily, take steps to cairn s ch lien, Claim or shop mice to be discharged and atsbid a. its sole atad eapmse. The u Aa rlphed further g,en that the making and receipt of pays. tat and naoricn of this Wfi and Lim R,%s &half in m way release the udenignW ban he mnhmmhg wbt mmt. edh respect to I,e cpmptefas of any work ramainbg undone, winch ist work, wnantY ad guaranty work, and any odher obigat"sner of the nde,sige.d to Led Wse cad o, the 0hmer. IN WITNESS WHEREOF on behrff cf llo ndengned ch MI aulhorbl 11" emcuted th &anent under veal: afsom Ibis day of pay Noah Year Trod,C nRaNertSubcontracmd5uppter agvi aeon for Payment No i . ARC Chadior 'MEAL) a Inudce No.(ci Cmtpany Nam Sirvhahrre STATE OF Tile:t COWRY OF ' Y Sworn bads bsc&.d her— the day of h, Dayu monin Year Nonry Pubic rav ..h...«e ... . n ....._ _.. .. I_— AFFIDAVIT OF SUBCONTRACTOR OR VENDOR FOR PARTIAL RELEASE OF LIEN FOR PROGRESSPAYMENT The undersigned Is under Subcontract with Lend Lease (US) Construction, Inc. [Nam of contractor] ('Contractor'}, of which Contractor's under Contract With to furnish labor andla Materials for the KFC remodel locatedin The undersigned acluitivikidges receipt of the previous Progress Payment Number 4, in the month off' for the amount of which brings the total payment received to date The undersigned is submitting herewitha request for the Progress Payment m the a wWt T S 50 Wo -Iii for the month of to Contractor for payment. The undersigned, as consideration and inducement to Contractor to make future progress payments, hereby waives, releases, and discharges the ONner, Ken" Had Chicken Corporation rKFCCJ, and each of then insurers, parents, subsidianes, related entities, affiliates, members, past and present officers, directors, heirs, and administrators, and Contractor from any and all sub, debts, demands, Wits, charges, interest, penalties, fees, causes of action and claims. whether known or unknown, including, but not limited W. clanis for Dayment chanoe orders. extra work, delay, disruption, acceleration, stack[nQ of trades, disruptions, interferences, Impact claims, claims wider statutes, municipal, state, or federal gaierinnerl, and claims relating to payment bonds, and prompt payment statutes through r mrAnis ,finswrt date) I , for payments received totaling 50.000.00'I Printed Nam of sole proprietorship, corporation or partnership) Signature of Authorized Representative) Title: STATFJCOWAONWEALTH OF Ss COUNTY OF The foregdrg Instrument was subscribed, swoon ro and aciaroWedged before me M day of by My Commission expires: NOTARY PUBLIC, State at Large 0 Example The Lendlease job number and project location are located within the contract documentation. Complete all yellow fields on the form. Final Release by Subcontr-tor I Supplier - Final Waiver at Claims and Lams and Rate. of Rights Lend Lease (US) Catsfixion Inc. _ Dote: - 5uDWntraa a. Purarase Order Dam: Project No: Subcontract a Purchase. Order Price: h$ ':i100.000.00s Amress: Pat Extras and Deducto rs City: Adjusad SuLoontred or P.O. Price: , $ 100,000 00 County: _ Amount Previously Pala: b S MOD0.00 f State: 3 Balance D. Final Payment $ '=.50,000.00? Owner, Name of Franchises The undersigned tereby aclua wkdges that the above Balance Due when paid represents payment to AA for aA labor, matenats, equipment and services. etc., kunish"d by the undersigned Trade Connector. 9ubwntracmr or Supplier, in romunecdon oft Its work performed on the above Protect in accordance a th the above Trade Contract, Subcontract a Purchase Order made by d wilt Lend Lease (US) Cansaaalion. Inc. a with Owner through its agent WO lease.. In consideraton of theamounts and sums previously received, and the payment of $. 50,0001W berg the hell and Final Payment amount due, the unaemimed does hereby waive and release the Owner and Lend lease (US) C—b-bon Inc., Its alnliat. and subsidiaries, horn any and 9 claims, d" clause, Gans and rights of Bern tow the premises desmbed above, and upon imgorrmmary m, ts nahereafterthiuanduponRio monas or other oariderabors due a to become due hwmu horn Oandla Lend Lease (US) Construction Inc. a from any other person. Non a oorpaalim, old damns, liens and fights d Bens being on account of labor, services, materials, fixtures a apparatus heretalas, fumichd byVm undersigned to the Project. The premrsea as ID whldh sa§ d dims and Bens are hereby relmasd are Iden45d as folWws Name and Address of Protect)- _ The undmaigned further represents and warmts thin (1) latrine is duty authorized and emp—of to sign and execute this waiver and release an nWher behalf end on behalf of the conroarn or business lot which hetshe Is Sharma: f21 the undersimed has arapertv perfonnd all wofx and hantshed ll materials of tier r.. if.1 rpwity rrvrterin<c nr aw a-Mdn 1',.Illy per Tenn= aM:.a(re firaFkxt¢ and in a dad Huai unr4mudl4a roamer. n6Fj won nmrnleMly r,.Yj inc urdersigind has paidfor all the lab", materials, equrpnea ad services that t has usd a supplied: (4)the undersigned has m other outstanding and unpaii applico5au. enders, retentiorn. holdbacks or expenses employed -inthe poseDLion of work, dtaryebacks a orbited work a mateards against Ovaner ardlor Lend Lease: as of the data of the afaemenEmed last and final payment mpficatiar (5) any maN:ils which have been supplied a Incorporatedintro the above premises were em,er taken from its fully paid aspen stock s were fully paid for and supplied pasu tnt to the iastand final payment appicaton of Invoice: (6) all raorosentatwra. actor ocr flocks madc by the undcmiaeod to the Trod. Contract. Subcontract or ft d.. Ovder'rcmain in. and a totnaWper p1m; and spr] Bwbats and in a god and wmkmar ike manner, fuly and canpletdy: (3) the undersigned has paid for all the labor. rtaterials. equipment and services that it has used a supplied; (4) the undersigned has no other outstanding and unpaid applications, invoices. retentions. holdbacks or expenses employed in the pmsea3at of work chargebacks or unbSd wok or materials against Owner ardfa Lend Lease, as of the dare of the alorcmenborred last and final payment applimahm; (SP any maerrals which have been supplied a incorporated into Otte above premases were ember taken from its M1ray geld aopm stock w were tufty paid for and wppfied pur'sumt to the last and nnal payment appliwdan or Invoice; S0j allrepreaentati.no,. rather candidates made by the undersigned Jr. the Trade Contract. Subco r as a Purchase Order remain true and accurate. The undersigned futaer agrees to defend, indemr* and hold hamdess the Owner andror Lend Lease, is suety, it any, atRiales and subardianes foram Ions or expenses, (ndrdirg without Imitation mosonable attorneys fees) should any such claim. delay claim, ben a right of lian be asserted bythe undersigned or by my of its m back Nbaers, material— or subcomractors of my tier. in addition' for and in consideration of the emourts and suns received, the alders god hereby waives. releases adrelmotaushes tee Owrter ad+a Lend Lease and its suety. it my, from my and all claims. delay clams. rights. Berl a causes of action in equity a lawwhalscerer arising out at. dimugh a under the above mentioned Trade Contract Subcontract or Purchase Order and the performance of work pursa rd therata. The undersigned Nrlherguarantees that all p mans of the, work hudshed and Installed we in accordance with the Trade Contract, Subcontract a Punch m Order. and that the ferns of ft Trade Comrad. Submanad a Puchase Order with nmpea to this guarantee wit remain in effect for the period speclied vh said Trade Contras, Suhcatrac a Purcase Order. Sworn to before me this _ day d T ear Notary Pt"" MY— .ssxanexpires: Ghhrmkar:trvlSi'(% wa A8(: Gon(rada` - company Nara Sigrsaane Tvpe None and T,& . 0 Example If the site is located in Arizona, California, Nevada, Texas or Utah, you MUST use the state specific waiver. Complete the final waivers with your final application for payment. The Lendlease job number and project location are located within the contract documentation. Complete all yellow fields on the form. AFFIDAVIT OF 51.13CONTRACTOR OF FINAL RELEASE AND WAIVER DF LIENS AgD CLAIMS The undersigned is under Subcontract with Lend Lease W Sl Construction: Inc. (Name of Caitradurl CCtractor"). dwhi h C,anfra laf is under Ca trad With 0 : COww+er'J.'u hmah labr andya Llatnials far the KFC remodel burled in Project"). The undersigned. In croskenrlim d the sum of S , C.-anal Paymertl the receig dwhkh is hereby acknoMedged, does hereby: 1. AdawMWge such sun m feral payment and hereby waiver, releases, aid discharges Pe Owner. K nAlky Fr W Chkken CzryaaCon CKFCC), and each of their insmm parents, subsidiaries. related entlies, d@i abn. members, post and preserd olFcers, diectars, heirs and ad naustrators, and Contractor fmrn any and be silts; debts. derhsnnds, tcrts, charges. Merest, peneides, fees. muses of acdm'a id "ma, whether krewn a unk—,including, but not finned b: claims forpa}merd. dhange onus, exra vook delay, disrupdcrn acceleration, sta_ckig of trades, Ssruptiau, nterkrences: aged eatra clams lvn v seN— mairi I seta -6xlnd mve— ant s r f rd m my 1 haals ant —1--!. d eda M' 1. Waive all dairns, liepilltla, danuges, muses of a6m' and'or fights of any kind, nUuding the right la file n—hanicsiiens aganst the prem"ses andtr Poj-d asMs related n the nmishng of andlor supplying of Work Alatenals. mxhinery. Nei, Wv nba k ttie same: and 2_ Guarantee and xwant Pat all its Submnbpdam matedalmein, and taba ens hmdvedn this Prtgec: have been paid in full. n.- iPrnted Name of sole proprietorship, cmpara0on or partnership) Signature ofAuaronzed Representative) Tek: i Example The Lendlease job number and project location are located within the contract documentation. Complete all yellow fields on the form. Saks Tax Affimlalion T. form muse be camplekd before irubui payment can be released. Sutcontm= I Supplier Nacre LeM Lease assigrod Job # Plem answer the following questions. t. Will you be odleclirg sales tax tram Lend Lease and rerreUinci d lo the govermerr. Yes No NOTE: ym shoWd answer Yes if dre sales tax you mll will be remitted lothe govvnment. llyou havepaid safes tar fo suppliers or paid use tax. on puMuses you made and are merely billirig Lend Lease $or mimbutsemenl, you shoWd arswer No. If you seceded Yes. pl --` prwlde your Tax Regismilion Nurtder. 2 Ahch of Me 1011mui g best desalbes your oxVract? Desor"on required in the bon below 5+VPV ordy aF. _ Desvgt4on required In the tax below RX "" ft, fir- - Description required in the box below. 3. Nas a Resale Cer ilicate been provided to you? ras no 4. Has an ExemiRdon Cemliirate been provided to you? Yes no M Example Sales Tax Affirmation This form is only required to be submitted once in conjunction with the submission of the first pay app. If you answer yes to Question.I you must attach an invoice to your pay app file showing the breakout of tax being charged to Lendlease. 2. 3. 4. What happens once we receive your Pay App? The Lendlease accountant will review for accuracy within 2 business days. a) If approved, pay app will move to step 2. b), If rejected, you will receive notification via email regarding rejection reason(s) and pay app will be required to be resubmitted. Lendlease finance routes pay app to appropriate PM approvers. a) If approved pay app will move to step 3. b) If rejected you will receive notification via email regarding rejection reason(s) and pay app will be required to be resubmitted. Once fully approved the pay app will be entered into our finance system within 3 business days. The pay app will be sent to corporate to be paid. Payment will be issued for franchisee self -financed sites once owner funding is received. Payment will be issued for sites that are not self -financed by the franchisee on the following days. a) All payments will be issued Tuesday or Thursday. b) Payments can be made via ACH or check. i. To sign up to be paid via ACH please contact your Lendlease accountant. ii. If paid by check, the check will be sent via regular mail. INSPECTION SEQUENCE BP# 16-2700 ADDRESS: 3601 S. Orlando Drive BUILDING PERMIT. Min Max Inspection Descri tion Footer / Setback Stemwall Slab / Mono Slab Lintel / Tie Beam / Fill / Down Cell Sheathing — Walls Sheathing — Roof Roof Dry In 10 Frame Insulation Rough Firewall Screw Pattern Drywall / Sheetrock Lath Inspection Building Ceiling Air Barrier Insulation Roof (Com'1) 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 - 1000 Final Commercial — Addition / Alteration Final Commercial — Change of Use Final Building (Other) ELECTRICAL PERMIT x p 01, x 3 Min Max Inspection Description Electric Underground Footer / Slab Steel Bond Electric Ceiling Rough Electric Wall Rough 10 Electric Rough Pre -Power Final Temporary Pole 1000 Electric Final P=L'UMBINGPERMIT' Min Max Inspection Description Rough Plumb Plumbing Underground Plumbing 2nd Rough Plumbing Tubset Plumbing Sewer Plumbing Grease Trap Rough Plumbing Steam / Chill Water Rough Plumbing Final MECHANICAL F7P ERMIT w _ — "'' e . ` r ia • a = Min Max Inspection Descri tion 10 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 1000 Mechanical Final REVISED: June 2014 Rev ' ision)4 Response to Comments 0 Permit # 77 VAL", City of Sanford Building & Fire. Prevention, Division Ph: 407.688.5150 Fax: 407.688.5152 Ernail: building@sanfordfl.gov Submittal .Date ProjectAddress! a-)k U( VCjOO(D Contact: Ph: Fax: ' )gls 1. &S-3 65MI—Q Email: wALao nt+ Trades encompassed in revision: 4 Building 13 Plumbing 11 Electrical 0 Mechanical 0 Life Safety 11 Waste Water General description, of revision: CO Y (svFc J-) C rlGn , [3) CA ROUTING INFORMATION Department Approvals 0 Utilities El Waste Wat -- No zoning issues,o'k to amend permit to lanning remove 8 foot drive thru window canopy with vinyl copy from scope of work. Removal of 4.8 El Engineering square feet. Fire Prevention CP uilding Label QTY. Cummings Part # Description v 1 300-AS-CL24-WH-SC KFC Channel Letters 14 24" O 1 300-AS-CL30-WH-SC KFC Channel Letters 22 1 300-AS-ORDER-PT-CNP B4 DT Order Point Canopy 0 1 300-AS-OCU-AB-CK Anchor BoIVRebar Cage Kit 0 1 300-AS-DTCBAR-NEW 67B DT Clearance Bar (new) 0 1 300-AS-DTCBAR-AB-CK Anchor BoIVRebar Cage Kit 0 1 300-AS-TMPL-121N-WFC WORLD FAMOUS 16 CHICKEN" Letters 12" Paint Template Horizontal 2 S8A Hard Way Paint Template 461300-AS-TMPL-57[N-HW 57"Round No zoning issues, ok to amend permit to remove 8 foot drive thru window canopy with vinyl copy from scope of work. Removal of 4.8 square feet. a ovation: W750279 - 3601 SOUTH ORLANDO DRIVE, SANFORD - FL. 3601 S. ORLANDO DRIVE, SANFORD, F( L tltldl@85e Date: 911212016 PAGE I FIRE INSPECTIONS CITY OF SANFORD 407.562.2786 BUILDING &FIRE PREVENTION y - BUILDING INSPECTIONS 300 N PARK AVE I 855.541.2112 SANFORD FL 32771 DRIVEWAYS -SIDEWALK 407.688.5080 j•------=--------------------------------------------------------------------- I Application Number . . . . . 17-00000078 Date 4/20/17 Application pin number . . . 226034 Revision number . . . . . . . 1 Property Address . . . . . . 3601 ORLANDO DR Parcel Number . . . . . . . . 11.20.30.300-036B-0000 1305 Application type description SIGN PERMIT APPLICATION Subdivision Name . . . . . . Property Zoning . . . . . . GENERAL COMMERCIAL Application valuation . . . . 2440 Application desc logo signage (1) & 1 drive true Owner Contractor KFC US PROPERTIES INC D & R SIGNS C/O DUCHARME MCMILLEN & ASSOC DARRELL L. KING 9229 DELEGATES ROW STE 275 133 THOMASSON AVE INDIANAPOLIS IN 46240 HOLLY HILL FL 32117 904) 252-2777 Structure Information 000 000 ---------------------- Sign Type . . . . . . . . . WALL Other struct info . . . . . SQUARE FOOTAGE 103.00 Permit . . . . . . ELECTRIC PERMIT-ALTER/ADD/FIX Additional desc . . Phone Access Code 972372 Permit pin number 972372 Permit Fee . . . . 35.00 Issue Date . . . . 2/14/17 Valuation . . . . 0 Expiration Date . . 8/13/17 Qty Unit Charge Per Extension BASE FEE 30.00 1.00 5.0000 THOU ELEC PERMIT-ORD 4137 11.24.08 5.00 Special Notes and Comments All projects within the City shall use WastePro for debris removal. Please, contact WastePro at 407.774.0800. Normal hours for inspections are from 1:30 through 4:30 Monday through Thursday. Please be aware you must contact the Building Official to schedule a Friday or after hours inspection. This is required since not every inspector is licensed to do every type inspection. Communication is the key, so please contact the Building Official if you have any questions at 407.688.5058 or at dave.aldrich@sanfordfl.gov CITY OF SANFORD eea CUSTOMER RECEIPT aea Other Fees . . . . . . . . 01-APPLCTN FEE -ELECTRIC 25.00 0 T. BLANDA T CCPeype Drawer: 1 01-APPLCTN FEE -BUILDING 25.00 Date: 4/24/17 01 Receipt no: 11156701-BLDG PLAN REVIEW 12.00 01-PLAN ALTERATIONS 50.00 Year Number Amount 01-BLDG DCA SURCHARGE 237 2817 7801=BLDG DBPR-SURCHARGE 2..37 3601 ORLANDO DR SANFORD, FL 32773 Fee summary Charged Paid Credited Due BP BUILDING PERMIT RECEIPTS 58.08PermitFeeTotal35.00 35.00 .00 00 Other Fee Total 116.74 66.74 .00 50.00 I AC 09136P Tender detail CC CREDIT CARD 658.89 Total tendered 58.08 Total payment 56.66 FAILURE TO COMPLY WITH MECHANIC'S LEIN LAW CAN RESULT IN THE Trans date: 4/21/17 Time:, 8:32:41PROPERTYOWNERPAYINGTWICEFORBUILDINGIMPROVEMENTS. NOTE: ALL FEES MUST BE PAID PRIOR TO C.O. BEING ISSUED. NOTE: PLEASE BE ADVISED ALL PERMITS MUST BE INSPECTED. FIRE INSPECTIONS CITY OF SANFORD 407.562.2786 BUILDING & FIRE PREVENTION BUILDING INSPECTIONS 300 N PARK AVE 855.541.2112 SANFORD FL 32771 DRIVEWAYS -SIDEWALK 407.688.5080 Page 2 Application Number . . . . . 17-00000078 Date 4/20/17 Application pin number . . . 226034 Revision number . . . . . . . 1 Grand Total 151.74 101.74 .00 50.00 FAILURE TO COMPLY WITH MECHANIC'S LEIN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS. NOTE: ALL FEES MUST BE PAID PRIOR TO C.O. BEING ISSUED. NOTE: PLEASE BE ADVISED ALL PERMITS MUST BE INSPECTED. FIRE INSPECTIONS CITY OF SANFORD 407.562.2786 BUILDING & FIRE PREVENTION BUILDING INSPECTIONS 300 N PARK AVE 855.541.2112 SANFORD FL 32771 DRIVEWAYS -SIDEWALK 407.688.5080 Page 3 Application Number . . . . . 17-00000078 Date 4/20/17 Revision number . . . . . . . 1 Property Address . . . . . . 3601 ORLANDO DR Parcel Number . . . . . . 11.20.30.300-036B-0000 1305 Application description . . . SIGN PERMIT APPLICATION Subdivision Name . . . . . . Property Zoning . . . . . . . GENERAL COMMERCIAL Permit . . . . . . ELECTRIC PERMIT-ALTER/ADD/FIX Additional desc . Phone Access Code 972372 Permit pin number 972372 Required Inspections Phone Insp Seq Insp# Code Description Initials, Date 1000 210 ELSF ELEC-SIGN FINAL 9 1 City of Sanford Building & Fire Prevention Division J Ph: 407.688.5150 Fax: 407.688.5152 Email: building@sanfordfl.gov Pen -nit # 1 '- Submittal Date Project Addres t QDLi Contact: Ph: Fax:J`- ` Email: L OCA— D y l nl—? D Trades encompassed in revision: General description of revision: Building Plumbing A V U C• Electrical~`— Mechanical J h 0 Life Safety, L Y +r Cam` Waste Water 111 C 1 f1 ROUTING INFORMATION Department Utilities Waste Water Planning Engineering Fire Prevention 0 Building Approvals io y v v j v n. q wrXA1V F=ry I I I I O 1 300-AS-CL24-WH-SC KFC Channel Letters 14 24" 1 300-AS-CL30-WH-SC KFC Channel Letters 22 1 300-AS-ORDER-PT-CNPY B4 DT Order Point Canopy 0 1 300-AS-OCU-AB-CK Anchor Bolt/Rebar Cage Kit 0 1 300-AS-DTCBAR-RETR0 87A DT Clearance Bar (Retrofit) 0 1 300-AS-TMPL-121N-WFC WORLD FAMOUS 16 CHICKEN" Letters 12" PaintTem late Horizontal 2 300-ASTMPL-571N-HW S8A Hard Way Paint Template 46 57"Round GENERAL NOTES CUMMINGS AS BUILT DT ORDER POINT CANOPY DTC CLEARANCE BAR NEW I - FRONT ELEVATION 2 - REAR ELEVATION Z) FINISH NOTES L_J FAINT SCHEDULE mlAu" pmw W-ALI KFC IMAGE COMPONENTS SCHEDULE CUMMINGS AS BUILT DT ORDER POINT CANOPY DTC CLEARANCE BAR NEW 3 - DINVE-THIM ELEVATION 4 - MITKV ELEVATION PRELIMINARY 7-0 KFC TOFl1EIBCAN SHOWMAN' INCENTIVE SCOPE seal S DR -DO DR WIFORD, I UM_ W75Q79 EXTERIOR ELEVATIONS A-2.1 5'-5' C 1/4-20 SCREWS 4PLCS f 6 112' I 3 1/4' -- DETAIL A SCALE; 3X 6' 10-32X3/4'L ST. SCREWS W/KEX WASHER PAINT TO MATCH BM DETAIL B EXOTIC RED 2086-10 SCALE 3X SPECIFICATIONS COLOR NOTES: ALUMINUM PANEL PRE PAINTED BENJAMIN MOORE EXOTIC RED 2086-10 KYNAR SATIN 631. EXISTING STEEL POWDER COATED RAL 7015 SATIN FINISH REAL"MEALS TO GO' POWDER COATED TO MATCH BENJAMIN MOORE WEDDING VEIL 2125-70 SATIN STRIPES &"CLEARANCE'- WHITE THIS 15 AN UItiGINAL UNPURUSHED DRAWING CRUTED CUSTD?J&FAPPROVAL FOR YOUR PERSONAL USE IN CONNECTION WITH A h .YI Rev. ea DRAWING NO: PROTECT PUNNED FOR YOU BY CIIMMINGS SIGNS, IT IS ns ` G1 u1M® NOT TO RE SHOWN OUTSIDE YOUR ORGANVI.TION NOR 82374C G./ USFO, REPRODUCED. COPIES. OR E%HIOITE.D IN ANY Nev. E2 Rw.15 KFCFA9EIDNLESSAUTHOMZMINWAKINGRYMOFFICERDATE. , I --- DATE: 3-1-2016 OFCUMKNGSSIGNS. R—R3 Rt /6 5. Hawke SITE PLAN mPi a a F =lJ H BSouthr f rf lido Drive1. ti r sr Signage Recomm el QTY. Cummings Item Description Part # # EXISTING STREETVIEW r1 F Job Location: W750279 - 3601 SOUTH ORLANDO DRIVE, SANFORD - FL. 3601.S. ORLANDO DRIVE, rQUSARFORDFL: r . Ut C . lendleaser. F ' Date' 9/12/2016 PAGE t 4-10- 10' REAL EALS T,0 0 IIIIII 1 1--- 2' T Y P PC RAL 7015 SATIN FINISH A PA PC RAL 7015 SATIN FINISH 8'-7' M m THIS IS AN ORIGINAL UNPUBLISHED DRAWING CREATED CUSTOMERAPPROYA: FOR YOUR PERSONAL USE IN CONNECTION WffH A PROJECT PLANNED FOR YOU BY CUNNINGS SKNS. R 6 fir LD l6V10Ui Ga' BE SHOWN O RSIDEs YOUR OR ,HerAT A NRRG, FASHION UNLESS AUMORM IN WRITING BY AN OFFICER DATE OFCUMMMGSSIC06 DI C 1/4-20 SCREWS 4PLCS 6 1/2' 3 1/4- -- DETAIL A SCALE, 3X 6' 1' 6' 10-32X3/4'L ST. SCREWS i W/KEX WASHER PAINT TO MATCH BM DETAIL B EXOTIC RED 2086-10 SCALE, 3X SPECIFICATIONS COLOR NOTES: ALUMINUM PANEL PRE PAINTED BENJAMIN MOORE EXOTIC RED 2086-10 KYNAR SATIN 631. EXISTING STEEL POWDER COATED RAL 7015 SATIN FINISH REAL"MEALS TO GO"POWDERCOATEDTO MATCH BENJAMIN MOORE WEDDING VEIL 2125-70 SATIN STRIPES &"CLEARANCE" -WHITE R-11 Re ---::: - AFCRev.R -e:: Re".13 Rev. 16 DRAWING NO: 82374C DATE 3-1-2016 S. Hawke QTY. I Cummingsmmngs. Ilteeml Description Part# P rr YS ~ {- 3 110- r"r '' asp es•,yc ate•* J i- 5'-5' 1 C 1/4-20 SCREWS 4PLCS I 6 1/2' 3 1/4' -I-- DETAIL A SCALE, 3X 6' 10-32X3/4'L ST, SCREWS W/KEX WASHER PAINT TO MATCH BM DETAIL B EXOTIC RED 2086-10 SCALE, 3X SPECIFICATIONS COLOR NOTES: ALUMINUM PANEL PRE PAINTED BENJAMIN MOORE EXOTIC RED 2086-10 KYNAR SATIN 631. EXISTING STEEL POWDER COATED RAL 7015 SATIN FINISH REAL'MEALS TO GO'POWDER COATED TO MATCH BENJAMIN MOORE WEDDING VEIL 2125-70 SATIN STRIPES &'CLEARANCE' -WHITE THIS IS AN OFXINAL UNPUBLISHED DRA= OtFATED CLIS11D.APPROVAL• FOR 1DUR PERSONAL USE IN CUMlA ION H71I A Cr FOR PLANNED AL YOU BY CUNNINGS SIGlS R 5 L1 3L72bJallai' NOT Eo1DRFvnoo" IQa cOPIESORR DUBITEDININ' AANRY Rev.13 Rev.15 fA5lEON UMFS.S AURK)R DINH17fYJG BYAN OFFICER DATE OKUWAINCSSIC-N& Mc13 Rert16 DRAWING NO: DATE S06 / wando A, - OFFICE 0 1 300-AS-CL24-WH-SC KFC Channel Letters 14 24" 0 1 300-AS-CL30-WH-SC KFC Channel Letters 301, 22 1 300-AS-ORDER-PT-CNP B4 DT Order Point Canopy 0 1 300-ASCU-AB-CK Anchor Bolt/Rebar Cage Kit 0 dp i 300-AS-DTCBAR-RETRO 87A DT Clearance Bar (Retrofit) 0 O 1 300-AS TMPL-121N-WFC WORLD FAMOUS 16 CHICKEN" Letters 12" PaintTem IateHorizontal 2 300-ASTMPL-571N-HW S8A Hard Way PaintTemplate 46 57'Round Ztendlea:seL PAGE 1 CUMMINGS AS BUILT DT ORDER POINT CANOPY DTC CLEARANCE BAR NEW I -FAONT ELEVATION 2 • REAR ELEVATION FINISH NOTES O PAINT SCHEDULE e vlxvNunNln61WM SPECIALITY PAINT (METAL) MIn.aT 14WNNkiMasn ltrnlN aYlTNt•u.WM YLu. WIVE. vArtl'.I r rt:rl. rrr... an , rYir:l u Ka KFC IMAGE COMPONENTS SCHEDULE 9Atnnw ll.mnlr . . n9n r+nanmlwwu•w •Ic• n.W I.IJYNNw Wrl.w I. `INNNn InN FTa r'wu:tn Al NllnYNn AtA Sp:NWNtAivNIW YIII.nIu44Nw aauNrn v4t'.I Unn.. _ :: IILW lox 4'ol v'vA9x 14I.AranA I N:II:A n)eF Nbml I W n]IUY.,Fn1 aINSY'f.5 @ - 14r nYFTU I ruAMnex A.I. 114vWI1Tn eN _Y WAI WCYAAx I . nFPs l Vrt lalhAlF 11 In r. FO.M'Il.91Ip t - AApSFIESY16Ku110 roAMewcAn attxrwar A lAN.3516 INCENTIVE SCOPE w SFINUNDDm SANFM Ix331nW750279 EXTERIOR ELEVATIONS N A-2.0 CUMMINGS AS BUILT DT ORDER POINT CANOPY DTC CLEARANCE BAR NEW r5Imo 3 - DRR/E-TNRU ELEVATION 4-ENTRY ELEVATION PRELIMINARY NO,iOPiplBERiMil N N{p8EPE9 vflNJN 10 roAUEwaN vawu N NELE4SE tD AN. A18 INCENTNE SCOPE NBtSOglA100M SBA60M FL JIII9 EXTERIOR ELEVATIONS K„ A-2.1 I- -- 5-5- -- { C 1/4-20 SCREWS 4PLCS f 6 1l/ 2' 1 3 1/4' - DETAIL A SCALE: 3X 6' 10-32X3/4'L ST. SCREWS W/KEX WASHER PAINT TO MATCH BM DETAIL B EXOTIC RED 2066-10 SCALE: 3X SPECIFICATIONS COLOR NOTES: ALUMINUM PANEL PRE PAINTED BENJAMIN MOORE EXOTIC RED 2086-10 KYNAR SATIN 631. EXISTING STEEL POWDER COATED RAL 7015 SATIN FINISH REAL"MEALS TO GO'POWDER COATED TO MATCH BENJAMIN MOORE WEDDING VEIL 2125-70 SATIN STRIPES &"CLEARANCE" -WHITE THIS IS AN ORIGINAL UNPUBLISHED DRWANG CRE k CUSTOMERAPPROVAI KA YOUR PERSONAL USE IN CONNECTION WTTH A R[rv.E1 P4Vt9 DRAWING NO: PROTECT PLANNED FOR YOU BY CUMMMCS SGNS If IS CNIr1AA INISa USER flEPROO ED. ISIOESEYOUR RGANIZD INN ANY R-2 F-45KFC 82374C FASMN UNLESS AUMORRED IN WRTTWTG BY AN OFFICER DATE DATT: $-1-2016 OECUM11AWSSGNS Rev. P3 _ Rev.rt 4. Flawke