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Home My WebLink About203 San Fernando CtCi JUL 112011 CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION 7 So Application No: f l — Documented Construction Value: $ 01 80 Job Address: al 03 San fr__map0d0 c. Historic District: Yes No Parcel ID: /0 - oz D- 30 - 5FS- 0000 - 13-)-0 Zoning: Description of Work: / Plan Review Contact Person: Title: Phone: 4 D -2— c 3r A - % 7c13 Fax: E-mail: Property Owner Information Name cSal UGC I'P_ Pi4c/ t)r?Phone: 407 - 022 - 7293 Street: C21)3 c Gl 6_ rp&n610 OL. Resident of property? City, State Zip: s 52L46 f-1. , 5,2-77 ,3 Contractor Information Name - LGm %'I Phone: Street: e • Fax: 3K&- -7%4/- 06Li9 City, State Zip: • a % 3 State License No.: 6F L'0'5 6 Architect/ Engineer Information Name: Street: City, St, Zip: Bonding Company: Address: Phone: Fax: E- mail: Mortgage Lender: Address: PERMIT INFORMATION Building Permit Square Footage: %533 Construction Type: No. of Stories: No. of Dwelling Units: Flood Zone: Electrical New Service - No. of AMPS: Mechanical 0 (Duct layout required for new systems) Plumbing ; d New Construction - No. of Fixtures: Fire Sprinkler/Alarm No. of heads: 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. Signature of Owner/Agent Date Print Owner/Agent's Name Signature of Notary -State of Florida Date Owner/Agent is Personally Known to Me or Produced ID Type of ID APPROVALS: ZONING: UTILITIES: ENGINEERING: COMMENTS: FIRE: 21,1111 Signature of Contractor Date ayV /,A)- yerS Print Contractor/Agent's Name k Ll t k of Floridd 1 Date MY COMMISSION # DO 8B5059 EXPIRES: April 29, 2013 Monded Thru Notary Public Underwriters Contractor/Agent is Personally Known to Me or Produced ID Type of ID WASTE WATER: BUILDING: Rev 11.08 LIMITED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: % // ( /// I hereby name and appoint: 6"r ma'a u an agent of:__-FTrS 101u (FYI.,117 lg of Company) to be my lawful attorney -in -fact to act for me to apply for, receipt for, sign for and do all things necessary to this appointment for: The specific permit and application for work located at: at),J6 Street Address) Expiration Date for This Limited Power of Attorney: License Holder Name: State License Number: CFGC S aS(0( > Signature of License Holder: STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this day of . , 20 J II, , byy szrs who is )personall known to me or who has prod-ticedas identification and who did (did not) take an oath. CYY m2- Signature Notary Seal) p a *)@A6 tPrint ortypenameNotary Public -State of TtorS A, Commission No. ')'D `%S 50.5 My Commission Expires: 41 vk j Rev. 3/27/07) tip" rpg DONNA ANMONE AL 4MY COMMISSION # DD 885059 EXPIRES: April 29, 2013 fiaf"P0, ' dedThruNotaryPublicUnderwriters Technician: Date Scheduled: EAST VOLUSIA (386) 760-2226 WEST VOLUSIA (386) 775-0909 We Pump Septic Tanks" Fax: (386) 774-0048 MELBOURNE (321) 253-3939 BUNNELL (386) 586-7460 SEPTIC a SERVICE Cl WARRANTY INVOICE 62605 ORLANDO & SURROUNDING AREAS 407) 323-1769 NA MI: t:..V ATOIC,F PET21 LONE, DATE -7 5 12011 ADDRESS ,& ELNOO Cr PHONE K(3'7 22 7-79 CITY S}(lTf tiq ZIP JOB LOCATION: QUANTITY DESCRIPTION EACH TOTAL T16LLW 1>1letsatL7ttB- rw6-#J1,r3 skQ-Wi..r1.tiVt'tALt o R.L. i i'tie-,' _—_ ww-1 Oizyb_o,_-iwA-' 0.4VlbK &nC) It1f3 1. r;y_ t5(g, -tsg!r LdMG •tN (Lejer 9 06) 3 n c -Ez TG- G rtsvL ACCEPTED BY: f1l1 o TOTAL: y 10 LICENSED & INSURED fFf;t-c:U*Uaoo 746 N. VOLUSIA AVENUE • ORANGE CITY, FLORIDA 32763 wu w-n .• •.nu win •uuu\ nu s l u!`C n\/cD all nova Rom® CERTIFICATE OF LIABILITY INSURANCE OPID .i DATE (MM/DDlYYYY) 07/11/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Aileen Vega FAX aD Ext: 386-736-6444 (/uC,No): 386-736-677SihleInsuranceGroup /DEL 5 ADDRESS: avega@sihle.com1300SWOODLANDBLVD DELAND FL 32720 Phone:386-736-6444 Fax:386-736-6772 CUSTOMERID#: FIRST44 INSURER(S) AFFORDING COVERAGE NAIC# INSURED First Quality Plumbing & Irrigation, Inc. Gary Wayne Evers License number: CFC050566 INSURERA: state Auto insurance Company 000856 INSURER B: BridgeField Casualty Ins. Co. INSURER C : 746 N Volusia Ave INSURERD: INSURERE: Orange City FL 32763 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDD/YYYY) MM/DDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE 1000000 PREMISES (Ea occurrence)$ 100000AXCOMMERCIALGENERALLIABILITY CLAIMS -MADE X OCCUR PBP2298600 01/01/11 01/01/12 MED EXP (Any one person) 5 0 0 0 PERSONAL BADVINJURY 1000000XcontractualBLNKTADDILINSRDCG2033 GENERAL AGGREGATE 2000000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS -COMP/OPAGG s2000000 POLICY X JE Q LOC A AUTOMOBILE X LIABILITY ANY AUTO BAP2139078 01/01/11 01/01/12 COMBINED SINGLE LIMIT Ea accident) lOOOOOO BODILY INJURY (Per person) ALL OWNED AUTOS BODILY INJURY (Per accident) X SCHEDULED AUTOS HIREDAUTOS PROPERTY DAMAGE Per accident) X NON -OWNED AUTOS A X UMBRELLALIAB X OCCUR PBP2298600 01/01/11 01/01/12 EACH OCCURRENCE 1000000 EXCESS LIAB CLAIMS -MADE AGGREGATE 1000000 DEDUCTIBLE RETENTION $ 0 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIV9 OFFICERlMEMBEREXCLUDED? MIA 083033735 BLNKT WAIVER OF SUBROGATI 03/13/11 03/13/12 X X TORY LIMITS ER E.L. EACH ACCIDENT S 1000000 E.L,DISEASE - EA EMPLOYEE 1000000MandatoryInNH) If yes. be under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 1 $ 1000000 A JEquipment Floater PBP2298600 01/01/11 01/01/12 leased 40,000 or rented DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Plumbing Contractor- residential and commercial CERTIFICATE HOLDER CANCELLATION CITY OF SANFORD 407-330-5677 300 N. PARK AVE P.O.BOX 1788 SANFORD FL 32772 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY SA I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD