HomeMy WebLinkAbout152 Bedford Ct; 17-3020; MOBILE HOM DEMOC" OF SANFORD
BUILDING & FIRE PREVENTION
P_ C E n V E PERMIT APPLICATION
OCT 12 2011 Application No:/ "2 _Zo JV
B1' ocumented Construction Value: $ ^T 1 p *
00
Job Address: 5 eeQKord C1 - Historic District: Yes No D/
Parcel ID: 1 -?— Z-C; _?_50 7?_->C-Q 01 *' >r:;> ad CU R idential [CommercialEl
Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of Work:S`
Plan Review Contact Person:
cc
Title:
Phone: 4'1—(j.1 Fax: In Email: CZjVt C4e C W( (as. yy(cp
Property Owner Information ` C(:)rn
Name KV Phone:
l r
Street: 1-r(I t 1
11i'Cry
Resident of property?: N 0
City, State Zip:ta '4-k'(.C al 041 43- L!
Name QA I L 1 IV 64'1' SLY&h one: / - 10
Street: `` '00 ' + G) Fax:
City, State Zip: (. _2>7_f (pq / State License No.: c 6C151
Architect/Engineer Information
Name: Phone:
Street: Fax:
City, St, Zip: E-mail:
Bonding Company:
Address:
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 th e date of application and the code in effect as of that date: 5`h Edition (2014) Florida Building Code
Revised: June 30, 2015 *— Fm6 ke Ar, 6P -OF-* Permit
Applicationi 2'L `
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.
1 O6J V tcho l Signature
UAu Date Signature of Contractor/Agent Date MI Chap. (
100 rLs Pr in
weer/Agent's game Print Contractor/Agent's Name qN Q,
Y aA:::a a , IC f Signature of
Notary -State of FI =Sioaate 7'.1io
A1KFIAIl
Y HALL I. MY
pM rlls$tON GG 020864 ION # GG 020864EXPIRES:I1 ,202 ,t ta, zo2o y p
llc Nobry Owner/Agent
is Personally Known to Me or Contractor/Agentis Personally Known to Me or Produced ID Type
of ID 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: # 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: COMMENTS: FIRE:
BUILDING:
Revised:
June 30,
2015 Permit Application
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
I hereby name and appoint: 1( `' t 1( `z.C`
an agent of:
Ir
v '` rV t C` `" g
Name of Company)
to be my lawful attorney -in -fact to act for me to apply for, receipt for, sign for and do all things
nec sary to this appointment for (check only one option):
The specific permit apd application for.work located at:
Street Address)
Expiration Date for This Limited Power of Attorney: 10 '
License Holder Name: K k Q \ a P,'
State License Number:
Signature of License U
STATE OF FI„q)RJDA
COUNTY OF
The foregoing i s ment was acknow edge before me this9-bay of
20 , by k C p Car(L_:5 who is personally known
to me or o who has produced
identification and who did (did not) take an oath.
rt Q 9
Signature
Notary Seal) A-Tq 4odl
Print or type name
y AW MALL
M
zs MY COMMISSION # GG 02 m
E)pRE&Augua14,2Mo Notary Public - State of
Bon WTWuNWYPUWWMWW* Commission No. a
My Commission Expires:
Rev. 08.12)
as
i
FLORIDA
March 2013
NOTICE OF
DEMOLITION
Florida Department of
Environmental Protection
Division of Air Resource Management
RENOVATION
y
TYPE OF NOTICE CHECK ONE ONLY): CJ IGINAL
TYPE OF PROJECT (CHECK ONE ONLY): WIDEMOLITIO N
IF DEMOLITION, IS IT AN ORDERED DEMOLITION?
IF RENOVATION:
IS IT AN EMERGENCY RENOVATION OPERATION?
IS IT A PLANNED RENOVATION OPERATION? `
I. Facility Name cA c r L CL 0,-e Cov *- V
REVISED CANCELLATION
RENOVATION
YES10
YES 2
DEP Forth 62-257.900(1)
Effective 10-12-08
Page 1 of 2
OR ASBESTOS
COURTESY
City State Zip County A V1. I WV VC
Site Consultant Inspecting Site
Building Size (Square Feet) # Floors Building Age in Years
Prior Use: School/ ollege/University idence ElSmall Business Other
Present Use: ElSchool/College/Univ esidence [ISmall Business Other
it. Facility Owner
rsity
Phone ( )
Addr ss
City State m (
111. Contractor's Name ' Phone
Address Ce
City ` State Zip w rs—
Is the contractor exempt fro 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.
Procedvd/s to be Used (Check All That Apply):
Yl Strip and Removal 0 Glove Bag Bulldozer Wrecking Bail
Wet Method Dry Method Explode Bum Down
OTHER:
VI. Procedures for Unexpected RACK
VII. Asbestos Waste Transporter: Name
Address
Citv
Vill. Waste Disposal Site: Name
Address
City State Zip
IX. RACM or ACM: Procedure, including analytical methods, employed to detect the presence of RACM and Category I and II nonfriabie ACM.
Phone (
State Zip
Class
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 required training has been accomplish d by thi person will be available for inspection during
normal business hours n /' ( , `-
7
Print f Owne Operat ) [[[
6 (
Date)
to
Signature of Owner/Operator) (Date)
DEP USE ONLY Postmark/Date Received ID#
DEP Forth 62-257.900(1)
Effective 10-12-08
Page 2 of 2
Instructions
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.
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."
11. Complete the facility owner information.
111. 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.
VIII. Complete the waste disposal site information
IX. List the amount of RACM or ACM of each type of asbestos to be removed. (Note: A volume measurement of RACM
off facility components is only permissible if the length or area could not be measured previously.) Identify and
describe the listed surfacing material and other listed materials as applicable.
X. Provide the address where the Department is to send the invoice for any fee due. Do not send a fee with the
notification. The fee will be calculated by the Department pursuant to Rule 62-257.400, F.A.C.
Sign the form and mail the original to the district or local air program having jurisdiction in the county where the project is
scheduled (DO NOT FAX). The correct address can be obtained by contacting the State Asbestos Coordinator at:
Department of Environmental Protection, Division of Air Resources Management, 2600 Blair Stone Road, Tallahassee, FL
32399-2400.