HomeMy WebLinkAbout107 Skogen Ctn
CEIVED
MAR 0 9 2011
y: NFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: I I ` IC)[ V
IIDocumented
Construction Value: $ 1 U e13 . GG Job
Address: 3I4GG nn L0
l'7-• Historic District: Yes No E Parcel
ID: ' I ? G Zoning: Description
of Work: Plan
Review Contact Person:uj1v (kc Title: p&j c r
Phone:
L -01- 71 Z —1-7 6 4 _ Fax: '407 -7) -/ 8-( b E-mail: +. Property Owner
Information Name 4&
ytsS Tim ? VXI n Phone: Street: Z
ZS i1 Resident of property? : (l r,s City, State
Zip: &-Arrii Contractor Information
Name Phone:
0- % k 2- (% 47 I U,
Street:
j((
OD S 6(>-ka ,- 0Qyr)r F/Cdj 1;U Fax: U>-7l7_- 1 `6! City, State
Zip: Or I , .3 2 toLe State License No.: 2. EGCX' 117, Name: Street:
City,
St,
Zip: i Bonding
Company:
Address: Building
Permit
Isr Square Footage:
No. of
Dwelling Units: Electrical New
Service -
No. of AMPS: Architect/Engineer
Information Phone: Fax:
E-
mail:
Mortgage Lender:
Address: PERMIT
INFORMATION
Construction Type:
Flood Zone:
Plumbing Mechanical (
Duct
layout required for new systems) No. of
Stories: 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:
ENGINEERING:
COMMENTS:
14a11 i /,q I I 1
Signature co ate
s Name
SAWNTHA L FURBOTER
MY COPJIMISSION # DD865138
EXPIRES March 01, 2013
UTILITIES:
FIRE:
Date
Contractor/Agent is V Personally Known to Me or
Produced ID Type of ID
WASTE WATER:
BUILDING:
Rev 11.08
POWER OF ATTORNEY
Date: 311111
I hereby name and appoint 6)-Y` VI -T v '
V)
of ADT Security Services to drop off and pick up permits at the
G Building Department on my behalf for
a LOW VOLTAGE SECURITY permit for work to be performed at a location described as:
Parcel-3 3 -11 36--56q-6cj()IJ' 61-?6
Subdivision
Address of job L Q-7
Owner IA Cc,,rU fiST n'I L- 1`1"
I I
George Manginelli EF0001121
Type or Print Name of Certified Contractor
ZX
Sijnature/kf>WMd Contractor
The fore 'ng instrument was acknowledged, before pp this day of 20 f1
by
who is personally kno n to me/who prodWed as
identification and who did not take oath. of
Public,
Seminole lffmOty,Z
t IRES March 01, 2Q13
COPY CustNo-17561 1380 JobNo- 01
i
as cT`f 1-7
SMALL BUSINESS CONTRACT
CONTRACT DATE: 3 / .Z/it— TOWN NO:
IUVtlllll'lIVWdINI1Vl
CUSTOMER NO: ATP: NO: — LEAD SOURCE:
Section
q
I v I o 0"Ice Copy @2010 ADT Security Services, Inc. (07/10)
Seminole County Property Appraiser cel Number Page I of I
DAV1D.1cmnro;ri CFA, ASA
MSK PPERTY41POftAISFER
35A 9111p_,.
e S%
INOLM MUNTY-Fl. 46
4-1 sANFono,
FL32771-14C4 407-
7sw 14 4& 4
Ar VALUE
SUMMARY 2011
2010 VALUES
Working
Certified GENERAL
Value Method Cost/Market Cost/Market Parcel
Id: 33-19-30-504-0000-0170 Number of Buildings 1 1 Owner:
HARVEST TIME INTERNATIONAL IN I
Q'
Depreciated Bldg Value $61,055 67,213 Mailing
Address: 225 N KENNEL RD Depreciated EXFT Value $0 0 qIty,
Stqtq,Z!p0ods: SANFORD FL $9771 Zj;dValua'(Markot) $25.900 25.000 Property
Address: 107 6KOGEN CT 5ANFQRP 9,771 T7ad V I L 9- Ag $0 41po Subdivi.
slon Npmo: UPPLAND PARK 86,055 92,213 Tax
District: Sl.SANFORD 4b 09rtablityAOJKgorlIptions.,
34,0HARITAl3I,FJCIVIC 0 Wr'f e' i'kd_ J $0 Dar,
W-SINGLE FAMILY Amendment
is
02,29 lot
4
if
2011.
T U ESTIMATE NG4
Taxing
Authority % Assessm ent Value Exempt Values Taxable Value Cqunt},
Aeit rid 86,055 86,055 0 Amendment
1 adjustment Is not applicable to 0"_" 6h os 86,055 86,055 0 C '
4pford City -S 86,055 86,055 0 SJWM(
Salnt liahns Uffpter Maria - ont), 80,055 86,055 0 661,
T0,0561 0 The
tixpble values and taxes are calculated uskg! t.. P*Ing V 14as end the prior ycqrs approved millago rates. SALES
Dead
Date Book P690 t w ii. SPECIAL
WARRANTY DEED 06/2010 07398 1986. 2010 VALUE SUMMARY CERTIFICATE
OF TITLE 0212010 07329.M7 ul 2010 Tax Bill Amount: 1,852 WARRANTY
DEED 07/2004 05394,`JX(Sp t - 2010 Certified Taxable Value and Taxes QUITCLAIM
DEED 06/1997 03769 0188 $5,600 IMgoVed NO DOES NOT INCLUDE NON -AD VALOREM ASSESSMENTS WARRANTY
DEED. 01/1976 01085 0072 $28,900 Improved,- Yes Find
Comparable Sales within this Subdivision_ LAND-
LEGAL DESCRIPTION Lend
Asiess Methoil. Fronvigo Dqpth Land qnIts Unit Prlqp haqq Vf lu.0 LOT
0 Q 1190p, 25109A Wlogo t,VQ LOT 17 UPRIANP PARK PB 20 PO ORMATION
810
Num. @14 Type qqr Bit pigurgg oil 't Qfq@J1 Pr; E§
t gopt UvinPpf
Xtvlvplf B!O WIMP Now SINP6g
FAM!Ly 1970 q W. 01 Will
Appiondggo!
5.0 , QR4N POR0,1vFINISH5.i Appprdago 1
Sqft ENCLOSED 1 IPP 110 T., NOTE:
Appendage
Codes Included in Living Area: Base, ishad, Apartment, Enclosed Porch Finished, Base Semi Finshed
L ar, ge
before being finalized for ad valorem tax purposes. Assessed areNOTcertifiedvWNS4 NOTE: valuesshownIfyou
recently purchased a homesteaded propert based onJust/Market value. zMN",
1 e
A OR" CERTIFICATE OF LIABILITY INSURANCE
DATE (MWDD/YYYY)
11/9/2010
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 FAX
Marsh, Inc. AIC No Ext : 2 2 - AIC No);
ADDRESS: 1166 Avenue of the Americas
New York, NY 10036 PRODUCER
CUSTOMER D
INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: AGCS Marine Insurance Company (Allianz)
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: NafI Union Fire Ins Co. of Pittsburgh, PA
United States INSURER F: New Hampshire Ins. Co.
GUVCKAbCJ ---,--- ..
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.
INSR
I. TYPE OF INSURANCE
ADDL SUBR
POLICY NUMBER
POLICY EFF
MM/DD
POLICY EXP
MM/DD LIMITS
F GENERAL LIABILITY
X COMMERCIAL GENERAL LtABILITY
GL 4360884 (Primary GL) 10/1/2010 10/1/2011 EACH OCCURRENCE 1,000,000.00
DAMAGE TO RENTED
PREMISES Ea occurrence 1,000,000.00
MED EXP (Any one person) 10-000.00
CLAIMS -MADE FRI OCCUR
PERSONAL & ADV INJURY 1,000.000.00
OWNER'S & CONTRACTOR'S
GENERAL AGGREGATE 2,000,000.00
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG 2,000,000.00
COMBINED SINGLE LIMIT
Each accident
1.000,000.00
E
E
E
F
X POLICY •
PRO
LOC
AUTOMOBILE LIABILITY
X ANY AUTOO
ALL OWNED AUTOS
CA 3976576 (VA)
CA 3976575 (AOS)
CA 3976577 (MA)
CA 3976624 (NH) (Primary AL)
10/1/2010
10/1/2010
10/1/2010
10/1/2010
10/1/2011
10/1/2011
10/1/2011
10/1/2011
BODILY INJURY (Per person)
BODILY INJURY (Per accident
PROPERTY DAMAGESCHEDULEDAUTOS
X HIRED AUTOS
Per accident)
NEW HAMPSHIRE (CSL) 250,000
X NON -OWNED AUTOS
UMBRELLA LIAR OCCUR
EACH OCCURRENCE
AGGREGATEEXCESSLIARCLAIMS -MADE
DEDUCTIBLE
PRODUCTS - COMP/OP AGG
NEW HAMPSHIRE (CSL)
B
C
D
E
F
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
Mandatory in NH)
Ityes, describe under
DESCRIPTION OF OPERATIONS below
N / A
026149517
WC 026149514 (FL)
WC 026149516 (MI)
WC 026149513 (CA)
WC 026149518 (MA, ND, NY, OH,
WA WI WY
10/1/2010
10/1/2010
10/1/2010
10/1/2010
10/1/2010
10/1/2011
10/1/2011
10/1/2011
10/1/2011
10/1/2011
X WC STATU- O
R
E.L. EACH ACCIDENT 2,0,•
E.L. DISEASE - EA EMPLOYE 2,000,000.00
E.L. DISEASE -POLICY LIMIT $2.000.000.00
A
A
Builders Risklinstallation/Contract Works
Rental Equipment/Contractors Equipment
OC & OCW 91128600
OC & OCW 91128600
5/1/2010
5/1/2010
5/1/2011
5/1/2011
USD $1,000,000.00 per jobsite
USD $1,000,000.00 per jobsite
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Please refer to attached ACORD 101 for further remarks.
CERTIFICATE HULUEK
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
United States AUTHORIZED REPRESENTATIVE
MARSH USA INC. BY: Frankrin Haliock, Global Marine
David K Casual Program
W I700-AUU7 NHVIlU vWIA1W -I—- rar..ry..w.a...a.a..
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
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