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Home My WebLink About1270 Upsala Rd 04-130 House DemoO 1 CITY OF SANFORD PERMIT APPLICATION rt Permit # l Date: Job Address: U l J t`l Yl F c 1 _ -a) of -19 Description of Work: Historic District: Zoning: Value of Work: $ 1000 _. Permit Type: Building 4_ Electrical Electrical: New Service — # of AMPS Mechanical: Residential Non -Residential Plumbing/ New Commercial: # of Fixtures Plumbing/ New Residential: # of Water Closets _ Occupancy Type: Residential Commercial Mechanical Plumbing Fire Sprinkler/Alarm Pool Addition/ Alteration Change of Service Temporary Pole _ Replacement New (Duct Layout & Energy Calc. Required) of Water & Sewer Lines # of Gas Lines Plumbing Repair — Residential or Commercial Industrial Total Square Footage: Construction Type: #//oa f Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: `'' ( Attach Proof of Ownership & Legal Description) T Owners Name & Address.- V\Y'\ 1 it l C\'PA7i — V ]C I Jt%i E X P Ja sJ. C \ Ve_ Contractor Name & Address: Phone & Fax:.1d 3 Bonding Company: Address: Mortgage Lender: mpir-I Address: ' r-'u_(i \ \ Architect/ Engineer: Address: L 6_S4 ate License Number: 1 Person: Q,5'C Phone: Fax: 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. 0 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 YOUl3. PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. 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. Acceptatri, erific ion t I II notify the owner of t e property of the require nth of Flor' I ien F 713. N sj caner/ Agent j ate ign re of Co9tsa for/Agent ate gent' s Name Print Contra,&/Agent's Name s a,c' 1 03 . /) f tc no 1aI r61 atur03 Signe of Notary -State o FI da Dated Signature of Notary -State of orida Date sy'P Sandra Jones a.AMY COMMISSION # DD108880 EXPIRES July 5, 200 Boil WddPPA F I§ I AN6 finally Known to Me or Produced ID rLAPPLICATION APPROVED BY: Bldg: Zoning: Initial & te) Special Conditions: P I Sandra Jones ylY COMMISSION A DD108880 EXPIRES Contractor/AgentisealcnowntoM9% % 2006 Produced ID BgtypFptuniiROYFAN INSURANCE INC SF` Initial & Date) Utilities: FD: Initial & Date) (Initial & Date) 9 I Building Division Acknowledgement A. Permit Application B. State Forms C. State Statutes/Contractor Licensing Public Works Acknowledgement A. Sidewalk Closing B. Street Use/Closing l . Walkways — Protection — Width 2. Barricades — Protection — Width 3. Fencing — Protection — Width - Height 4. Curb Protection/Sidewalk Protection/Street 5. Storm Sewer Protection C.. Dust Control Police Department Acknowledgement A. Traffic Control B. Crowd-Control/Security Utility Department Acknowledgement A. Water, Sewer — Capped off, Sealed B. Water for Dust Control (Meter) Engineering& Planning Acknowledgement A. Historic District B. Zoning Issues Address of Job: Additional Comments: G.b"neck O yb2 0 33 5677 r I l DEMOLITION Building Division Acknowledgement A. Permit Application B. State Forms C. State Statutes/Contractor Licensing a Pu6licaWorks Acknowledgement A. Sidewalk Closing B. Street Use/Closing 1. Walkways — Protection — Width 2. Barricades — Protection — Width 3. Fencing — Protection — Width - Height 4. Curb Protection/Sidewalk Protection/Street 5. Storm Sewer Protection C,. Dust,Control.. Police Department. Acknowledgement A. Traffic Control R ' Crowd ConfroUSecurity Utility Department Acknowledgement A. Water, Sewer — Capped off, Sealed B. Water for Dust Control (Meter) Engineering & Planning Acknowledgement A. Historic District B. Zoning Issues Address of Job: Additional Comments: Gib"neo7 4 yb-e__ 1J r'1m on S I7 l s. 03 0/11/2003 10:19 4073022540 SANFORD PD PAGE 02 R . 1 12Ar.1 FKtG ti Building Dlviaion Acknowledgement -- ---- — A. Permit Application B. State Forms C; State statutes/Contractor Licensing Public Works Acknowledgement A Sidewalk Closing B. Street Use/Closing 1. Walkways - Protection - Width 2. Barricades — Protection -- Width 3 Fencing — Protection — Width - Height 4. Curb Protection/Sidewalk Protmlion/Street 5. Storm Sewer Protection C, ,Dust Cpatrol Police Department Acknowledgement A. Traffic Corttro! 14. ' Crowwd.0 orwrol/Security Util" Departrrteat Acknowledgement A. Water. Sewer -- Capped off, Sealed B. Water for Dust Control (Meter) Engineering & Planning Acknowledgement A. Historic District B. "Zoning issues address of -Job. Imo? . . vl i4n S Additional Commentsfi Las JILMOLITION Building Division Acknowledgement A. Permit Application B. State Forms C. State Statutes/Contractor Licensing Public Works Acknowledgement A. Sidewalk Closing B. Street Use/Closing 1. Walkways — Protection — Width 2. Barricades — Protection — Width 3. Fencing — Protection — Width - Height 4. Curb Protection/Sidewalk Protection/Street 5. Storm Sewer Protection C Dust Control Police Department, Acknowledgement A. Traffic Control R. ' Crowd Control/S6ct rity M1 Utility Deparf nent_Ackn wledgement : 57, A. Water, Sewer — Capped off, Sealed B. Water for Dust Control (Meter) Engineering & Planning Acknowledgement A. Historic District B. Zoning Issues Address of Job: Additional Comments: nej V ayb No t 7 7/frS i,r°• 6_ 3SOf 5677 r DEMOLITION Building Division Acknowledgement A. Permit Application B. State Forms C. State Statutes/Contractor Licensing Public Works Acknowledgement A. Sidewalk Closing B. Street Use/Closing I. Walkways — Protection — Width 2. Barricades — Protection — Width 3. Fencing — Protection — Width - Height 4. Curb Protection/Sidewalk Protection/Street 5. Storm Sewer Protection C:. DusLControl.. Police Department Acknowledgement A. Traffic Control B: Crowd.ControUSecurity Utility Department Acknowledgement A. Water, Sewer — Capped off, Seated B. Water for Dust Control (Meter) r Engineer"ing`& Planning Acknowledgement,=' A. Historic Distract B. Zoning Issues Address of Job: / 2_-7 0 -,A /, S Additional Comments: G.b ne Q yb2- Pt405 7 77 r