HomeMy WebLinkAbout1702 W 3 Stcdratwpwupw.w4p CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
F D RECEIVED
F
JUN 13 2016 Application No: (D43
BY: '6 Dcum nted Construction Value: $ aWa%
Job Address: 1-7601 �'`� �v ra `S'r Historic District: Yes ❑ No ❑
Parcel 1D: oL5- \q - 3 D- S NG - OtAX0 •OO 6 C� Residential ❑ Commercial ❑
Type of Work: New ❑ Addition ❑ Alteration ❑ Repair ❑ Demo ❑ Change of Use ❑ Move ❑
Description of Work: 2kp\ Ck t, S W, VAZI-1,A S t -P- �C_ S -Z-9—
Plan Review Contact Person: 7� fv\ NQV,&,\1u Title:
Phone: _o174nu7- R466 Fax: Email: -► &elCfk1.k-
n Property Owner Information �'`cM`+ m
Name Phone: 4 0 7- 33 V • ����
Street: l"70*, W 3 r;l- (5'r Resident of property?
City, State Zip: SCkV%_"")L- F(_ 3,4771
Contractor Information
Name
Servim
Street: 040® n°� Palmna„e
City, State Zip: Tompo. FL 33010
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Phone:
Fax:
-7a-�- (*a 9-Y O
State License No.: C1` 6_0q& 69 rZ
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
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.
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 it 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. q
0
FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 5m Edition (2014) Florida Building Co
Revised: June 30. 2015 Permit Applicilion ��
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 at the time of permit submittal. A copy of the executed contract is required
in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal.
The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in
accordance with local ordinance. Should calculated charges figured off the executed contract exceed the actual construction value,
credit will be applied to your permit fees when the permit is issued.
OWNER'S AFFIDAVIT: 1 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 coning.
Signature of Owncr/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced I D Type of I D
BELOW 1S FOR OFFICE USE ONLY
Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing[] Gas❑ Roof ❑
Construction Type:
Total Sq Ft of Bldg:
Occupancy Use:
Min. Occupancy Load:
Flood Zone:
# of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures.
Fire Sprinkler Permit: Yes[] No ❑ # of Heads
APPROVALS: ZONING: -1 -16 SrqTILITIES:
Fire Alarm Permit: Yes ❑ No ❑
WASTE WATER:
ENGINEERING: FIRE: BUILDING: 5� 4•Zo•l�
Revised. June 30. 2015 Permit Application
Signature of Contractor/Agent
Date
Print Contractor/Agent's Name
—:0t&'LA-
G- ;k
Signature of Notary -State of Florida
Date
_,',.....°! ; MARYLOU SESAK
f MYCOMMISSION #FF146073
•`'�?orn?�Af EXPIRES July 29. 2018
(407) 798A157 Floridallota Se .cont
ally Known to Me or
on rac or
Produced ID Type of ID
BELOW 1S FOR OFFICE USE ONLY
Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing[] Gas❑ Roof ❑
Construction Type:
Total Sq Ft of Bldg:
Occupancy Use:
Min. Occupancy Load:
Flood Zone:
# of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures.
Fire Sprinkler Permit: Yes[] No ❑ # of Heads
APPROVALS: ZONING: -1 -16 SrqTILITIES:
Fire Alarm Permit: Yes ❑ No ❑
WASTE WATER:
ENGINEERING: FIRE: BUILDING: 5� 4•Zo•l�
Revised. June 30. 2015 Permit Application
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SUPPLI•:sltt•Wl' ,VI*I',%CIIFD IIFKIiR) CONLUNS A
1•'URNI TO USE Il ('),NF L� SP --C'MCALI1' PRESOURM
111' 1171' m ('l�ti I�IJAII:N'S ti I i1'll�.
,VUTICIi: AUUI.1 IONAI. TERA1S AND CONnrl
AND ANF PANT(
'IONS ARE STATED CAN TI IF REVERSE SIDE'
IN IMIS C'ONdI'NA(T
(71.08•t5 wane WurlCli-FJo Yellow-Cuscomm
f!a: hi-arument Ilitraicd f)y
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OF CONI•NIENt ENIENT
tfa:C of �In' J
( t,unry o; �Mvnt1��-
'fill: l;\IIf:RSII'iN! i1 l:crcby ,^.lets nnuec fn:tt n:y:ni, rn•mc n:!: b: n>,tde if, tx>:Am real pw el:cay, atnl in aaoudan;c t<dt i? Ci!np:el -F!,u o'
Stolotcs, the f llvxa:g intprtn.u!nn is ptoe tdcd In the% Notice of Conimewc uent
u1 pro cr,;: 11a) ai dese: t, tion t•i pnipartc. and etreet addlcss it acatla 1; I
(icncrtldewmiton Tol ,, cinent:
! f )sena :nlirtnrtion p .. . A_ -- --•• -•-- •- --
la) Na Inc atrJ x'aires..
lhi Imtrc.I nt Prnper):. p 4?`LN, k— _.--•-- ........_ _.......-----..
t.) Manx• and adJrc» of f6c stlnptc ullrheldo (if other than v.Ancr)
4. Cfrotmrlor
(,:) N•s+nc and addres.: Ilcmc ncpm lit-ine Scnv,cs. 9201 Florida Palm Dn:c, I'xcpa• Fl. 51:119
tb) Phune nunlbe:. 1 13-626.7548
i Surety
la) Name alit! uddress.
(b) .amour.! of bund
tc)Phonenuxnba:,--
4, LetJcl
YL -
(a) i`amc and a+Idrcu•--._—...------ ntl'i ---------•— - - ------
Ib) Phtmc nuji*w:
7. Persons uithin the State of Florida desipmed by Owva upon whom Ixnice__s or ntFer d :un:ent, mry lc acn e.: us :>m•:dc.! to S%,;ct::::
3.13(l Ila)?.. Florida Statures.
(a) Nante And address:
Ih) Phone number, _
S. In ad,litioa to h!mstlf. Otonet tkxlgnatcc die follouing person(s) to reeeiee a oup) of the Litn.t% n N itic.: ec pm•.id<d in 5cchel: 71; Qf 1;t.hi.
Rill ida Smtutcs:
(a) Nam and addrm'. _ — N.A
Ib) Phone number
9. Expiration date of noiieo of commencement (the expiration date is I year from the dare of recording unias a different Jate k >pvctl-:edl
A'AILNING TO OWNER: ANY PAYMENTS MADE BY THE OV^ItR ArTLR T111- EXPIRATION OF THE NOTICE OF COMMENC-I'ME`:T
ARF. CONSIDERED IMPROPER PAYMENTS UNDL'R CHAIrr1:R'13. PART I. SLCfIO,N 713.13. FLORIDA S'f ATUTES, AND CAN
RESULT IN YOUR PAYING TWICEFOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MLIST HF.
RECORDED AND POSTED ON THE JOB SITE BEFORE TILE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANC:IN6, ('()\S1:1'I
WITH YOLRi LMI ER AR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDI`G YOUR NOTICE OF COtStAif IXr-NIT:NT
igomtuc of (hoer or Ouna's Atahonud OltieevDutator
Pa111WO llaager
1 Siugtory's Tld/d0frux
7bc fore6wing itstrvtnent was acknowledged before me this a day of �uVe W 07 M\�
���� (name of penoo) asrj W VAft-- (type of autbarity, e.g. armor. trustee, +trimer in Ifo
(mole of paiy on bdulf of wbom inurvntrnt was executed)
MATT 138141"
NdTAR�
YX c STATE rAF OR FL1��A enwally known or Produced klertlGcatlun ZZ
• C mill F1108M yairjc&j) Purmat to��9'L525. Florida Starnes
l'ndcr ptranhies of perjury, l dtxlue dta I bave read the fam oing aid flat the bets anted in it ore true to the beat or my knowkdge and belief.
X y r- Ra, -4
15*411A o atura�ersun Signing (in nw)101 Abtwa
MARYANNE MORSE, CLERK OF CIRCUIT COURT SEMINOLE COUNTY FL
CLERK'S # 2016059261 BK 8703 Pg 1139: (1 pg) E -RECORDED 06/08/2016 03:19:47 PM
10.00
To Whom It May Concern:
This letter will authorize the following person(s) to act as agent(s) on behalf of THD At -Home
Services, INC, D/B/A The Home Depot At -Home Services, 2690 Cumberland Pkwy SE, Suite 300,
Atlanta, GA 30339 to sign and pull for permits, inspections, and licensing with respect to the installation,
maintenance and repair of windows, doors, siding, and storm protection under Florida State Residential
Contractor license number CRC046858.
Authorized person(s):
Brian Kirby
Don Kirby
Katrina Kirby
Tim O'Malley
Christine O'Malley
Elizabeth Hutchinson
John Hutchinson
Erick DeDios
Aaron Hallich
Larry Hall
Qualifier— Boysie Ramdial
THD At -Home Services, INC
The Home Depot At -Home Services
STATE OF FLORIDA
COUNTY OF HILLSBOROUGH
Owner: Alice Ross
Address: 1702 W 3`d St
Sanford, FL 32771
The foregoing instrument was acknowledged before me this aJ_ of 0 I by Boysie
Ramdial. j n
Notary Vblic — State of Florida
Nytol— i' IPq kcr
PrintedName
a V%X
My Commission Expires
Personally known _x_ or Produced Identification
Amber Fla ter
NOTARY PUBLIC
STATE OF FLORIDA
CmvW FF970934
EWNS 7111PM
THD At -Home Services, Inc.
207 Kelsey Lane - Suite K - Tampa, FL 33619
Phone: 813-402-3700 - Fax: 813-6304112 - Toll Free: 855-729-6002
RECORD COPY RECEIVED
JUN 13 2016
F o City of Sanford
Building and Fire Prevention
Product AppM:'O ecification FFIRS ISE! DFORCODECOMPLIANCE
PLANS EXAMINER
Permit # 6 - 1 6 4 3 DATE
-71
Project Location Address 1-76;1 W 3 �. S } ��� 1,- 'r 3, .'
As required by Florida Statute 553.842 and Florida Administrative Code 9N-3, please provide the
information and product approval number(s) on the building components listed below if they are to be
utilized on the construction project for which you are applying for a building permit. We recommend that
you contact your local product supplier should you not know the product approval number for any of the
applicable listed products. Be aware that windows, skylights, and exterior doors must be tested in
accordance with the Florida Building Code, Section 1714.5. More information about Statewide Product
Approval can be obtained at www.floridabuildinQ.org.
The following information must be available on the jobsite for inspections:
1. This entire product approval form
2. A copy of the manufacturer's installation details and requirements for each product.
Category / Subcategory I Manufacturer I Product I Florida Approval #
1. Exterior Doors •• -• __ __ _ _ _
SE9 TO 86 A
winging WITH THE WORK AND NOT AS
Sliding AUTHORITY TO IOLATE, CANCEL, ALTEM UR 5h]
Sectional CODES NOR SIHAL ISSUANCE OF A PERMIT PREVENT
ROTI U THE BUIL I REQUIRING )RRrC1iom QF FARCIRS IN NS
Automatic CONSTRUCTION OR VIOLATIONS OF THIS CODE
Other
2. Windows
Single Hung I"'t JI V7 S,� �� �`1`l►►• a l
Horizontal Slider
Casement
Double Hun
Fixed
Pass Through
Projected
Mullions v ilsyN
Wind Breaker
Dual Action
Other
June 2014
Category / Subcategory
Manufacturer
Product
Description
Florida Approval #
include decimal
5. Shutters
Accordion
Bahama
Colonial
Roll u
Equipment
Other
6. Skylights
Skylights
Other
7. Structural
Components
Wood Connectors /
Anchors
Truss Plates
Engineered Lumber
Railing
Coolers/Freezers
Concrete Admixtures
Precast Lintels
Insulation Forms
Plastics
Deck / Roof
Wall
Prefab Sheds
Other
8. New Exterior
Envelope Products
Applicant's Signature ,� `�
Applicant's Name
(Please Print)
June 2014
�SS
i
WECIAI CONAOERAT(01i$.
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