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HomeMy WebLinkAbout1209 4 St Ezz CEIVFe FEB 0 8 2011 F;EqkROF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: J — 11 Documented Construction Value: $3443.6%) Job Address: ILCA q44% 'T' • Historic District: Yes No Parcel ID: 130 - 5 • 3 1 ' S) La 'UZ 60— 61(.10.1 Zoning: Description of Work: Lr, VG (C gr o.4i r: c I Plan Review Contact Person: `'Cyyl Fr %U f Tnnitle: Phone: -' Cn - IZ - i"1 Uy Fax: 4- ID -71 Z' E-mail: `11 i rbPIA- r(1 • &, l I Property Owner Information Name (,L) ( i-4zvvi L_G riz, 3 r,, Phone: 4M- 33G ~ 3 1 4 2. Street: 17— nq 4`n('t le— Resident of property? : (10 City, State Zip: Gi.ng2r6G , 1'L 3%iI r Contractor Information Name f JPhone: Street: G ax:U7 City, State Zip: nr I t2 3 z 11-0u State License No.: Name: Street: City, St, Zip: Bonding Company: Address: Architect/ Engineer Information Phone: Fax: E- mail: _ Mortgage Lender: Address: PERMIT INFORMATION Building Permit Square Footage n 4 ;' S "' 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 New Construction - No. of Fixtures: Fire Sprinkler/ Alarm No. of heads: I Application is'"hereby made' to obta'ina 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 HOUR 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 7,13. 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 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: COIUlMENTS: UTILITIES: FIRE: Signature ofContrac A (Date a r It Q' Contractor/ ent s4AAA Name OV44-JAI re of Notary -State of FloriM v Date SAMANTHA L FURBOTER MY COMMISSION # OM5138 EXPIRES March 01, 2013ov ,.• 308-0163 Floridallota ervice. Contractor/Agen n to Me or Produced ID Type of ID WASTE WATER: BUILDING: Rev 11.08 L_ ._J T LIMITED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: 111 I hereby name and appoint: fc J ( (1 tr C n an agent of. y F f U> 0—C'r-s 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 necessary to this appointment for (check only one option): iY All permits and applications submitted by this contractor. The specific permit and application for work located at: Street Address) Expiration Date for This Limited Power of Attorney: License Holder Name:Cry rA E. Y V l Cv(1L( (0 F11 State License Number: L(77,l Signature of License Holder: STATE OF FL RIDA COUNTY OF ,,rn v nDl The foregoing instrument was acknowledged before me this day of, 20QI, by ,^,60ln EJ who is rdpersonally known to me or o who has pro ced Vas identification and who did (did n take an oath. ( ' ature p r l-_ Seal y 'r-"&P• C'—l.• Icy SAIIANTHA L EUR80TER Print or type name My COMMISSION # DD86593$ EXPIRES March 01, 2ot3 Notary Public - State of 407F Commission No. Dl& l3 _ My Commission Expires: S2 I ZG Rev. 3/27/07) 11W. Z02 Cus -- mgF, i nADTSCcurityServices -Inc (AQ7 ('Yu' fr) oor ou Us © " Our") Of# ce Address — We -or Address - f Ci f!'j - ,_ _ Affinity Name 43 In. ty .. '-, ' 7 E - ZipF Tax Exempt No, State-/ n Prate Prern+ses= eiephone : Tax Expire: Pate redraditional Mhone Other (Qualified)-• L7 Other'-(Non Quahfied) 1 8pp°38 2727 '~ lternate Telephone 1 ' . (Cirele'one) Home 1 ;e /Work w1 ext. IF14IICTA 41#?atg T2iepl one 2 (Cyie{e one) home / CeIU NQrJc v r/ eict.' Zs'A'TI©I%RD=1? 0_ 1.._. REJ= C7I= 3I 1T4L'HE3E - Ef17AhL - — Co rnt nfcat s rasAu.horaza_ rorl #2rebyaapthtiri e; PT tp furnish inforrlaation!.and/0T updatgs regarding your security°system.and;meuv A DTra d/pr lo!t tf 9i i party rodcn s nri seev cgsf available; o CDT cdstaprruers to°the contacttin-forTnation provided by_ypu '"u rnay-nsubscrlbe or-opt=nut by, rna Jm dpnotconta a t iri3 a la : alJira • $d p 1;C AD7 $8J3= 62423$ JnWtrbere_ z =:. Cii f+rriaa xior 38 p o ra#i en.- 0'sou-d er by xpressly at ihr rize ADT: o'ca f =.yc>u using an automated caJlrng.device-:to_deliver.'a prerec©rded rtie"ssage o r. sWcorn`frcm4iXb- arateia6§t,5libfi6,a oriatrneri#tea# e;# Ameera'urnbers shown-a#ove..Jnafaalyher -; __ ::,._- IN. ,: SysennwCalraersfiip isx s rrer Ouur ed " kDT±vried tarac3a on#ilj/SeTt[e Biirg la i tolonfiJlly$ eruaceCharge` Nlumcipal Cons#ruct onPeranitFee "I Customer" ra Seivc"earadudesAtloniitonrag Center igr al e eivanyand j Cvsto er to;obtam coijstruction' permit _ Notification 5eru ce fio urglary Manual fir anfl Tara alPoJice nergeracy, s `.: ' ©then: _ # .- : g irdard fot ly er rue tie sv oke a#e[tion instal.lai on Pn e ! - :' Service includes Custorrie Monrto'nng'CenterSlgnal Receiving}and- NdrFcatlon Sgrvicetfpr Fqe MarivalTire :and ManualohceTrrigrgetin! Taxable Amount" Eh Carbon;Monox de _p.Flood . D.Low_Inmp b _._liar TaxabJa ArrLo rtt- ::' .: z MeKAI Alert - ' 'Connection;fee 5afewaLc h L=ellguartJ®; _, , - ` Secur Lmk® Tpio stallatici Charge' Ictended lirni#ed' Ifarraniy/Quahiy Sent ce J'Jan QSP)°_ j f I . DeposiTAeceived . p ar espouse eryice ;, Y `. s rBatanc-*if-©--A--tact-fi Nloiitlilyecurring'Muniapal Fee {SubjectAs tochange'based onocal haw) `J Liustome o Airtaiiand pay#or municipal aiarm_use }iermit ' , itfaPphrable sales tax notaown itwviil t eadded to your first invoice K© tiler .. _ , s _ _ . Y_- ::_ 1, _-,. , j ' e w Total 111;cinthly JrarttaUi rarivalitect r r gM mic palFee`balledseparateJyI t injtlall SubJectxo c}iange#ased on local lawj -a Annual Fee L 3'./ fs# tca#ed#artAate pCustomertoobtainandPayfiornnitialYannualmumdpa! alarnaysi ; :- rzF r permatYijrfailure #o obtain and prowde ADT wath your mun clpal U h , alarm. use:permitiegistration number cotild result in.rao,munrtlpalfire/ j .: 3 ponce response to ara alarm Jrom you wprem ses and/ora,fine ,,, EStfrna#ed Completion Date; YOU ACKNOWLEDGE AND AADMITTf AT-'0) 41V1'EiHAVE XPLAINED•TO YDL1 THETULUiRANGE OF-1QUiPMENT AND S£RVICES tAVAIIABLE TO'YAl3;' 2) ADDtTIflNA1 EQ17iPME1VI \ND=fiER.14LfS4U [E4+ TH49T E5C IBEp tEREWAftE•AVA41f SL Aiilp MAY=13E DBTWiNED FROMUS'-AT AN"ADDITI.ONAUCOST TD' YOU x3+)`',Y,OU,fHAVE?C44SEMI AAID?Fi;'/EiCONTRtl4 iED?F.C3#t 0Ii1La T IE£'Q f1PMi 1 1T;.A1 lIU ,H. ISERVIC ES°DESCRIBE04 jZ F31S4 fRA,Lf . 4)7 4talTl"AL TERM OF411S CNTRACT`ISTORTfREE (3)YEAfi5,'iAi IDr)'OYJSf4D141D 7VIANIJALYifESfi'Y{IUR;SYS7El1Y1'MO1tiTiL' 11Y1TI=l'ADTh4S WELL='AS i1PC3N AN5'.C' IANGE TO TI'fE'7E-'tPHONEj5'ERV4CE IN YOU PREMISESyTO'LONF RiVI:PRDPER TELEPf ONE>Li111E 51`tZURE,ANID #{A7 1GT lAL,7i2AIJS1VIiSSION'?IS Fl3NCT10NING PRDPERL1r Y LALI9NG aDTrA 1 8DD' 1DT ASA?! AND=FOLL01111 T+,JE PROMPTS): WE ARE NDT A'SEtliRl fY CONSULT INT YOU ACKNOWLEDGE AaND` ADMIT"THAT BEFORE SIGNING ?ygU.MAVE;READ TF E iDNT AND 43AC4C DF,Ti fS RAGE IN-ADDI11tJN :TO HE ATTACHED, AGES WHICH CONTAIN aMPORTA AND CDND17,113N5;FOR F115 CPNT1 TACT _YOU. STATE THAT YOU.UNDERSTAND ALL tHE TERIVJS ANp:, CONDRJDNS<t3F T,TERMSTHISCONTRAACT INCLUDING'41U N1DT IiMITED,T13,ARAGRAPHS,S, 8, 9;,yD 7 ND 72 'DU,LIRE AV1fARE 7©F.TNE;£OLLOWING:YO 74L#tfUlS!5TEI191 l fFN GU 'RANTEE4' RE NTION OF'LOSS` 11M7 N fRRDR'15+9LWAY5 POSSIBLE alYEJ1 1J YfiiOTftECEIVf`A1ARMSIGNALS4F'THET LEPHONEIUNE-ORZTHER-ALARM TRANSMISSION SYSTEM' IS,*l1T 1NTERF,-ERED;WITH OR;OTHERWISE DANIAGEQ QR1FTELEPMONE,DR LECTRICACSERI/ICE IS UNAVAILABL'E FOR ANYREASON. THIS :CONTRACT #iEQUIRfS fINALAPPROVA1.i-fOF AN ADT QUTJ ORIZED; IIJANA.GER'$EECBM, ANC' EQUIPN1ENTlSERVIGES;IVIAY SE PROVIDED. IF APPROVAL iS DENIED, TWIS CONTRACT. WILUBE TFRMINATfp AND ADTS•ONLY.OBLIGAT4ON`-O YOU:WlL",L BE Ted'MOTIF'1,XOW OF UEM R(IIINATION;AND RfFUND:ANY AMOUNTS PAIDaN-ADVANCE t r.:... _ .. SECOND ANDTHIRD PAGES ACCOMPANY THIS PAGE WITH ADDITIONAL TERIVIS=AND CCiNDIT,IONS . ADTRep Rep. 6' No Ci45; ER S.APPROVAL:. ATE Rep. LicensezNo. (If; Regwred). i110TICE ,0F .CAINCELL , TI:ON YOU, THE CUSTOMER, - MAY CANCEL THIS TRANSACTION _ ANY TIME -,PRIOR TO .MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE 'DATE OF THIS TRANSACTION. SEE ATTACHE'Di NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. of CUStOmer COpV © 2010 ADT Securitv Services, Inc. (08110) Seminole County Property Appraiser Get Information by Parcel Number Page 1 of 1 74 29 2I DAVID JOHNSON. CFA: ASA 3 3 1 W O PIMTV E 4TH ST a w. t111—Q—L6Ml C".. SE MINGLE COUNTY FL: 19 A' 1..A.11 0 14 .. 0 91T01"E. FiR5T,ST SANFOHD, FL3277t-1468. ifi Wt V^' '.a. id g 4D7-665-75015 A 1>3 t, to VALUE SUMMARY 2011 2010 VALUES Working Certified GENERAL Value Method Cost/Market CosUMarket Parcel Id: 30-19-31-516-0200-016A Number of Buildings 1 1 Owner: LONG WILLIAM D JR Depreciated Bldg Value 38,107 42,116 Mailing Address: 1209 4TH ST E Depreciated EXFT Value 624 624 City,State,ZipCode: SANFORD FL 32771 Land Value (Market) 10,395 10,395 Property Address: 1209 4TH ST E SANFORD 32771 Land Value Ag 0 0 Subdivision Name: FAIRVIEW Just/Market Value 49,126 53,135 Tax District: S1-SANFORD Portablity Adj 0 0 Exemptions: Save Our Homes Adj 0 0 Dor: 01-SINGLE FAMILY Amendment 1 Adj 1 $0 0 Assessed Value (SOH) 1 $49,126 53,135 Tax Estimator 2011 TAXABLE VALUE WORKING ESTIMATE Taxing Authority Assessment Value Exempt Values Taxable Value County General Fund 49,126 0 49,126 Amendment) adjustment is not applicable to school assessment) Schools 49,126 0 49,126 City Sanford 49,126 0 49,126 SJWM(Saint Johns Water Management) 49,126 0 49,126 County Bonds 1 $49,126 0 49,126 The taxable values and taxes are calculated using the current years working values and the prior years approved millage rates. SALES Deed Date Book Page Amount Vac/Imp Qualified WARRANTY DEED 09/2006 06429 1111 $121,000 Improved Yes WARRANTY DEED 07/2000 03893 0539 $3.8,500 Improved Yes 2010 VALUE SUMMARY QUIT CLAIM DEED 07/1999 03701 0777 $100 Improved No 20axa.x. Amount: 1,067 QUIT CLAIM DEED 03/1998 03385 0017 $100 Improved No Value FINAL JUDGEMENT 0211998 03366 0530 $100 Improved No 201Certified Taxable Vand Taxes N DOES NOTINCLUDENON -AD VALOREM ASSESSMENTS WARRANTY DEED 11/1994 02847 1296 $26,000 Improved Yes WARRANTY DEED 01/1983 0.14.33 12.06 $100 Improved No WARRANTY DEED 01/1974 01014 0234 $13,000 Improved Yes Find Comparable Sales within this Subdivision LAND LEGAL DESCRIPTION Land Assess Method Frontage Depth Land Units Unit Price Land Value PLATS: Pick .. FRONT FOOT & DEPTH 55 105 .000 225.00 $10,395 LEG E 1/2 OF LOTS 16 + 17 BLK 2 FAIRVIEW PB 4 PG 71 BUILDING INFORMATION Bid Num Bid Type Year Bit Fixtures Base SF Gross SF Living SF Ext Wall Bid Value Est. Cost New Building, Sketch 1 SINGLE FAMILY 1953 3 700 999 916 CONC BLOCK $38,107 48,237 Appendage / Scift OPEN PORCH FINISHED / 20 Appendage/Sgft BASE /216 Appendage / Sgft UTILITY UNFINISHED / 63 NOTE: Appendage Codes included in Living Area: Base, Upper Story Base, Upper Story Finished, Apartment, Enclosed Porch Finished,Base Semi Finshed EXTRA FEATURE Description Year Bit Units EXFT Value Est. Cost New ALUM CARPORT W/SLAB 1980 240 624 $1,560 NOTE: Assessed values shown are NOT certified values and therefore are subject to change before being finalized for ad valorem tax purposes. Ifyou recently purchased a homesteaded property your next ear's property tax will be based on Just/Market value. http://www.scpafl. org/web/re_web.seminole_county_title?parcel=3019315160200016A&cp... 2/3/2011 acoR© CERTIFICATE OF LIABILITY INSURANCE FDATE DDM(YY) 11l9/2010 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 endorsements . PRODUCER NAME: PHONE I AMAICNoExt: 212) 345FAX500CA/C No: Marsh, Inc. L ADDRESS: 1166 Avenue of the Americas New York, NY 10036 PRODUCER CUSTOMER ID 4: i INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: AGCS Marine Insurance Company (Allianz) i ADT Security Services, Inc. INSURER B: CHARTIS CASUALTY COMPANY 3160 Southgate Commerce Blvd INSURER C: Commerce & Industry Ins Co. Ste 38 INSURER D: Illinois National Insurance Co. Orlando , FL 32806 INSURER E: Nat'l Union Fire Ins Co. of Pittsburgh, PA United States INSURER F: New Hampshire Ins. Co. i I ewrcc reoTr rrnre kil1"0e0• R97A0S - e DFVISIi7N NI IMRFD• 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. INSRLTR TYPE OF INSURANCE IADDLISUBR I POLICY EFF POLICY NUMBER. MMIDD/Y POLICY EXPMM/DD/YYYY) I LIMITS F GENERAL LIABILITY jX COMMERCIAL GENERAL LIABILITY 1 GL 4360884 (Primary GL) 110/1/2010 1 110/1/2011 EACH OCCURRENCE S1.000,000.00 DAMAGE TO RENTED PREMISES (Ea occurrence) 1,000,000.00 j MED EXP (Any one person) 10,000.00CLAIMS -MADE j, OCCUR I I PERSONAL & ADV INJURY j $1,000,000.00OWNER'S &CONTRACTOR'S I' I GENERAL AGGREGATE 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG 2,000,000.00 I PR I X , POLICY I r LOC E E E F I AUTOMOBILE x j X1 IX LIABILITY II ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS 1 NON -OWNED AUTOS I j I CA 3976576 (VA) 1D/1/2U1D CA 3976575 (AIDS) ! 10/1/2010 CA 3976577 (MA) i011/2010 I CA 3976624 (NH) (Primary AL) i 10/1/2010 10/1i2011 10/1/2011 10/112Oi l 110/1/2011 i COMBINED SINGLE LIMIT Each accident) i,000,00U.00 BODILY INJURY (Per person) BODILY INJURY (Per accdent), PROPERTY DAMAGE Per accident) NEW HAMPSHIRE (CSL) 250,000 I I I i i I j UMBRELLA LIAB OCCUR j EACH OCCURRENCE j AGGREGATEEXCESSLIABCLAIMS -MADE] H jj DEDUCTIBLE RETENTION $ PRODUCTS - COMP/OP AGG j NEW HAMPSHIRE (CSL) B C D E F WORKERS COMPENSATIONIANDEMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? El Mandatoryin NH) If yes, describe under DESCRIPTION OF OPERATIONS below I j N / A I WL, 02614 31 ( I , A, A, ) 1 10/1/2010 WC 026149514 (FL) 10/1/2010 WC 026149516 (MI) 10/,1/2010 I WC 026149513 (CA) ! 10/1 /2010 WC 026149518 (MA, ND, NY, OH, 10/1/2010 110/1/2011 WA. WI, WY) 10/ 1/2011 1 10/1/2011 10/ 1/2011 1 10/1;2011 1 X WC STATUS 1 OTH-1 T RY LIMIT R I 1 E.L. EACH ACCIDENT 2,000,00&00 I I E. L. DISEASE EMPLOYEE 2,000,000.01) E. L. DISEASE - POLICY LIMIT 2,000,000.00 A I A Builders Risk/installation/Contract Works Rental Equipment/Contractors Equipment Blanket Transit IOC OC & OCW 91128600 15/l/2010 OCW 9112:600 15/1/2010 Vll 11 51112010 5/ 1/2011 5/ 1/2011 I 1 2 11Conveyance USD $ 1,000,000.00 per jobsite USD $ 1.000,000.00 per jobsite DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Please refer to attached ACORD 101 for further remarks. r= VTIPIreTF Wr)l r1FD rANCFI 1 ATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Sanford THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 300 N Park Ave ACCORDANCE WITH THE POLICY PROVISIONS. Sanford, FL 32771 AUTHORIZED REPRESENTATIVE UnitedStatesMARSH" INC, BV: rranklin Ha1,:,I, Global AAanne j David K- . Casually Program U 19Ub-1UUy At;UKU t;UKI'UKA I IUN. All rlgnts reserves. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD Generated by EXTGIS LI C. For more information v-sit www.ex-g-s.com.