HomeMy WebLinkAbout600 E 1 St; 17-2278; ELECTRICALCITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No.
Documented Construction Value: $
Job Address: Historic District: YesEl NoEl Parcel ID:
ResidentialF] CommercialF] Type of
Work: NewEl Addition M AlterationEl Repair El DemoEl Change of UseEl Move El Description of Work: Z:Z a
Plan Review Contact Person: Title: Phone:
Fax: Email: Property Owner Information
Name Phone: Street:
Resident of property?
City, State
Zip: Contractor Information Name
Phone: E'> = -3
6 6 -
7 2- Z- Street: Fax: --5, e 6 - 3
6 4 - City, State Zip: &L L -3
L f a, 7 State License No.: `-4 c100 Z,6> 16- Architect/Engineer Information Name: Phone: Street:
Fax: City,St,
Zip: 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: 511 Editiou (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 befoundinthepublicrecordsof'this county, and there may be additional permits required from other governmental entities such as watermanagementdistricts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Licn Law, FS 713
Tate City of Samford 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 IC,C 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 constriction 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.
OSignaturet' No vncriAgent Date , i.", Convector/Agent Datc
Print O«-ner/Agent's Name
Signature or Notary -State of Florida Date
Owner/Agent is Personally .Known to Me or
Produced ID Type of ID
gent's Name
Q, use No ry Public State of Flora
uac b Marshall
aty Commission FF 076707
at f oF Expires 12it5t207
Contractor/Agent is -X— Personally Known to Me or
Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas Roof
Construction Type:
Total Sq Ft of Bldg:
Occupancy Use:
Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Flood Zone:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Pennit Application
APPENDIX C
APPLICATION AND CERTIFICATE FOR PAYMENT
CUSTOMER: Florida Power and Light
COMPANY: FPL Energy Services, Inc
CONTRACTOR: L & S Enterprises LLC
RELEASE #: 3 PURCHASE ORDER #:
PROJECT: Fort Mellon Park Solar Tree Project
DATE OF THIS INVOICE: REMIT TO:
INVOICE NUMBER:
APPLICATION NO:
PERIOD TO:
This Contractor's Application for Payment is submitted pursuant to the above -mentioned Release issued by the Company
to the Contractor and dated as of , 20 and any partial or full release, as applicable, all Contract
Documents incorporated therein. Initial capitalized words used herein but not defined shall have the meaning ascribed
to such words in the General Conditions attached as General Conditions For Contract Work to the above -mentioned
Release.
CONTRACT CHANGE(S) SUMMARY
Scope Change(s) approved in previous ADDITIONS DEDUCTIONS
months by Company
Net change by Scope Change(s) TOTALS
Application is made for payment as shown below in connection with the Contract Documents.
1. ORIGINAL CONTRACT PRICE 45,900.00
2. NET CHANGE BY CONTRACT CHANGE(S)
3. CONTRACT PRICE TO DATE
Line 1 ± 2)
4. TOTAL COMPLETED & STORED TO DATE*
5. RETAINAGE:
a. % of completed Work
Column D + E)
b. % of stored materials
Column F)
TOTAL RETAINAGE
Line 5a + 5b)
6. TOTAL EARNED LESS RETAINAGE
Appendix C-6