HomeMy WebLinkAbout2003 Hactwell AveCITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: f YO 7 Documented Construction Value: $
Job Address: I6b3 L r il,'(s ._ _iA V e- Historic District: Yes No
Parcel ID• Zoning:
Description of Work:n
Plan Review Contact Person: Title:
Phone: Fax: E-mail:
16. Prope Owner Information
Name \J
i Phone: o % ' v & _ 3
Street: 2003 r ` Resident of property?
City, State Zip: C 7
Contractor Information
b ow
Name Phone: -
Street: t Fax: -2? "1
City, State Zip: State License No.:
Architect/Engineer Information
Name: Phone:
Street: Fax:
City, St, Zip: E-mail:
Bonding Company:
Address:
Mortgage Lender:
Address:
PERMIT INFORMATION
Building Permit
Square Footage: Construction Type:
No. of Dwelling Units: Flood Zone:
Electrical
New Service — No. of AMPS:
Mechanical 0 (Duct layout required for new systems)
No. of Stories:
Plumbing
New Construction - No. of Fixtures:
Fire Sprinkler/Alarm No. of heads:
Lw
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. e N
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
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Sign u Contracto ent Date
Print Contractor/Agent's Name
l a--0 J
Signature of Notary -State of Florida Date
p DEBB IE-BL lN,10N'.
MY COMMISSION 0 DD629096
EXPIRES: February 25, 2011LOFFLOP800-3-NOrA,4Y Ff. Notary Discount Assoc. Co.
Contractor/Agent is Personal] Known to Me or
Produced ID Type of ID I..- C (oft,
WASTE WATER:
BUILDING:
Rev 11.08
M&S an rt6!/aEEcs Work Write Up for Weatherization Program
To Contactor.
Items listed on the work write up may not pertain to your core business function. These items should be bid under the umbrella of your company through licensed
contractors such as Plumbing, Electrical, HVAC, Roofing Etc. It is your responsibility to pull permits and provide results pertaining to your business function
according to Local Municipality and Code and or provide the same from licensed contractors pertaining to Plumbing, Electrical, HVAC, Roofing Etc. You are
required to provided Certified Payroll for all work performed on residence, for your company and all sub -contractors hired by you. Any house or trailer built pre 1978
will require EPA Lead -Safe Work Practice or Lead Testing to be performed by a EPA Lead -Safe Certified Firm. Photos of EPA Lead -Safe Work Practice or
Documentation Supporting Negative Test Results are required for agency Documentation & client file. If additional items are needed in conjunction with a Work
Write Up Item, you must provide an addendum explaining repair. In order for payment to be processed you must provide the Payment Request Form, Signed Invoice
Release of Lien, Passed Permits, LSW Documentation for pre-1978 homes & Davis Bacon Compliance.Additional info may be required. All Work and Punch List
Items must be 100 % complete. Prices & items may be subject to change, to meet budget requirements. If so, price and item changes will be.agreed upon verbally.
The bid will then be adjusted, signed by MOW as (Addendum to Bid), and sent back to you. You are required to sign as (Acceptance of Addendum to Bid) and send
back to MOW. MOW will then sign as (Acceptance of Bid) and send back to you. Work may begin. All specifications, terms and conditions shall be as described in the
OWNER/CONTRACTOR AGREEMENT and the FLORIDA WEATHERIZATION HANDBOOK, MATERIALS, INSTALLATION and WORKMANSHIP STANDARDS.
Material, "`Labor ,TotalItem #,DescrlptlonoffMaterlalslS,eniiceslRequ(re,d, I_- a. Priority
1 Install 40 gallon electric HWH w R-12 insulation rating, drip pan & relief line to pan.
10 550.00
NAME: Monja Shantell Wright DATE: 111112010 550.00 PO rt 6 ;iS
vs ra it w_,s,k,.r.
w ar ,a..,F-.,Built1972 JOB mwrightl2-10 ADDRESS: 2003 Hartwell Ave.
Sanford FI. 32771 PHONE: 407-402-2389 407-323-1254 r am OEM Please
inspect the property
and submit the work -write up with your cost to me NO LATER THAN 11-17-2010. If your bid meets the criteria, you will be contacted with the
Notice To Proceed With Work, signed, with a time frame for work to be completed in. Contractor: Signature: Date: Addendum
to Bid: Date:
MOW up Your contract
and
proposal
for homeowner repairs and upgrades at the above mentioned address. Owners have been examined and accepted by the Weatherization
Program staff. Items have meet the approval of the client. Items mentioned above are to be completed within the specified time frame. You may
begin work on XX-XX-2010. You shall complete all work on or before XX-XX-2010. Acceptance of Bid: Date:
Jay Curbow / Weatherization Manger MOW (may proceed) Meals
on Wheels Etc. Acceptance of 2801 S.
Financial Ct. Sanford FL, 32773 Addendum to Bid: Date:
Office: 407-333-8877 ext.114 / Fax 407-829-2468 CONTRACTOR (sign & send back)
Cell: 321-388-4829
a.. "a5
ion 3 5 S`i