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HomeMy WebLinkAbout200 W 17th StCITY OF SANFORD 1 � 2016 BUILDING & FIRE PREVENTION �L,,� E.% �_ —� PERMIT APPLICATION Application No: - i'Li 5(y Documented Construction Value: $ W75. 0 Job Address: o?yU w 17""S+i 1126rd) F(, 32771 Historic District: Yes ❑ No C'1 Parcel ID: S1 - % 9-10- 50% - 0=- Da30 Residential Commercial ❑ Type of Work: New ❑ Addition ❑ Alteration ❑ Repair ❑ Demo ❑ Change of Use ErMoveEl Description of Work: x-11, & GI qAS l oc5 Pha o mek,- -t-o ✓' wy V 14 Plan Review Contact Person: DII Veu Title: /uh16a 06-prdwa,ltr Phone: (4624134Gd93 Fax: U-n7•(o L1,147U(o Email:Mr.1iSui.[iNlPa�c`1J['.usizml�cscffC�r+1 Property Owner Information Name er 1 i' ovei7 Phone: J21 -25743V V Street: 9l'i W (I W /c��j`�Lan d , RL 2211 Resident of property? City, State Zip: �Ll f'I t1XU I P(, 3279 1 Contractor Information Name w I l f w CI I�►e t (,egacy �Um�1r1A �Y1IIl�S Phone: (40-0-;-5,A5 Street: Ne U1 110 Fax: �4 0 % ' (Pa y - x-17 q (o City, State Zip: lei V fy- I rL ,10 M State License No.: Name: Street: City, St, Zip: Bonding Company: Address: 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 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. 3Q .00 FBC 1053 Shall be inscribed with the date of application and the code in effect as of that date: 51' Edition (2014) Florida Building Code Revised: June 30, 2015 Permit Application 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 1 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 fec 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 'rabic 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: 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. f-e�., 7 �� Stgn of Owner/Agent Dat Signatu o ontracto Date 00— 0P100, 1 ""Ir r�h��eo'1 W1I116M Chat iae Print O/Agent's Name Print Contractor/Agent's Np SZ AL ate Signature of Notary -State of Florida D t MELISSA A. SHIVERY Notary Public - State of Roil »' p,4 MELISSAZ24P. !lf:F• Commission I FF 242911 Notuy Public Fie My Comm. Expires Jun 22, 2019 Commissio. �nWgrwpllNationalNatary Aten . omm. ExM15 or t�Known to Me or Produced ID Type of ID It/ Se BELOW IS FOR OFFICE USE ONLY Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing[] Gase f Roof ❑ Construction Type: Occupancy Use: Total Sq Ft of Bldg: Min. Occupancy Load: Flood Zone: # of Stories: New Construction: Electric - # of Amps Plumbing - # of Fixtures Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads APPROVALS: ZONING: 511qL& UTILITIES: ENGINEERING: COMMENTS: FIRE: Fire Alarm Permit: Yes ❑ No ❑ WASTE WATER: BUILDING: � S -ZS -1L Revised: June 30, 2015 Permit Application REQUIRED INSPECTION SEQUENCE BP# , 1 Address: Z.%;P %.v. ' B'hi1T ING PERMIT min Marx IIns ection Description Footer / Setback Stemwall Foundation / Form Board Survey Slab / Mono Slab Pre our Lintel / Tie Beam / Fill / Down Cell Sheathing — Walls Sheathing — Roof Roof Dry In Frame Insulation Rough In Firewall Screw Pattern -Drywall / Sheetrock Lath Inspection Final Solar Final Roof Final Stucco / Siding Insulation Final Final Utility Building Final Door Final Window Final Screen Room Final Pool Screen Enclosure Mobile Home Building Final Pre -Demo Final Demo Final Single Family Residence Final Building Other REVISED: June 2014 11 ELECTMAL PERMIT Nun I Max I IInsDection Description Electric Underground Footer / Slab Steel Bond Electric Rough T.U.G. Pre -Power Final Electric Final MECFH tMAN[CdL PERMIT Nun Max Inspection Description Mechanical Rough Mechanical Final ectioun Description min Afax73aGas Underground Q Rou h Final 5/16/2016 SCPA Parcel View: 36-19-30-506-0000-0730 Prone rty Record Card "A Parcel: 36-19-30-506.0000-0230 PR Owner: UITHOVEN ROGER W Property Address: 200 W 17TH ST SANFORD, FL 32771 Parent Information Value Summary — Parcel -19-30-506-0000-0230 Owner THOVEN ROGER W Property Address 200 W 17TH ST SANFORD, FL 32771 Mailing 200 W 17TH ST SANFORD, FL 32771 Subdivision Name SANFORD HEIGHTS Tax District SI-SANFORD DOR Use Code 01 -SINGLE FAMILY Exemptions 00-HOMESTEAD(2012) + F - ME 0 Xj f) 12 4 2V C-4 Q 60 15 45 60 I 60 Seminole County GIS 1 Legal Description Tax Amount without SOH, $1,971.13 2015 Tax Bill Amount $1,807.56 Tax Estimator Save Our Homes Savings: $163.57 Does NOT INCLUDE Non Ad Valorem Assessments LOTS 23 + 24 (LESS W IS FT F2O1.6 Working 201.5 CertifiedV'I Values Values Valuation Method Cosl/Market Cosl/Markel Number of Buildings 2 2 Depreciated Bldg Value $142,348 1 $113,524 Depreciated EXFT Value $975 $988 Land Value (Market) $22,701 I $22,701 Land Value Ag - ' '�ii' jijs�iia tlValue $166,024 i $137.213 Portability Adj Taxes Save Our Homes Adj $35,944 $8,037 Amendment I Adj Taxing Authority P&G Adj so $0 AssessedValue1$129.176 Taxable Value Tax Amount without SOH, $1,971.13 2015 Tax Bill Amount $1,807.56 Tax Estimator Save Our Homes Savings: $163.57 Does NOT INCLUDE Non Ad Valorem Assessments LOTS 23 + 24 (LESS W IS FT OF LOT 24) SANFORD HEIGHTS PB 2 PG 63 Taxes Taxing Authority Assessment Value Exempt Values Taxable Value I County General Fund $130,080 1 $50,000 $80,080 Schools $130,080 $25,000 $105,080 LCity Sanford $130,080$50,000 $80,080 --iSo'.0-00-T— SJWM(Saint Johns Water Management) $130 ,080 $80,080 County Bonds ------ $130.080 $50,000 $80.0i Sales Description Date Book Page Amount Qualified \Iacjlmp WARRANTY DEED 3/1/2011 07543 07 14 $100 No Improved SPECIAL WARRANTY DEED CERTIFICATE OF TITLE y 9/1/2009 07263 1341 -9/1/2008 07067 .0935 1 $148,000 $100 No 0 Improved ImprovedImprovedImprovede WARRANTY DEED 6/1/2006 05318 0125 $375,000 [N Y Improved WARRANTY DEED 4/1/2005 05728 1989 $230,000 Yes Improved WARRANTY DEED 3/1/2003 04763 0806 $175,000 No Improved WARRANTY- DEED 11/1/2000 03958 1 I $100 No improved "SAI -S-1 'Land-- t Method Frontage Depth` -Units Units Price Value FRONT FOOT 8 DEPTH 105.00 1 127.00 0 $230001 $22,701 j Building Information hitp://parceldeWl.scpafl.org/Parce[Dctaillnfo.aspx?PID=361930506000007-30 1/2 LIMITED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: d, % I hereby name and appoint: mells'5'q S I' an agent of: UMb1 rl (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): The specific permit and ppli /-?/)0 w ) l? , n fo wor located at: OM02 f�L 3a?i (Street Address) Expiration Date for This Limited Power of Attorney: License Holder Name: W d i t Q r"` 4(7',e State Licens Signature of STATE OF COUNTY C The fo. 200 ,tome -or o who has produced identification and who did (did not) take an oath. ////7//Ie (Notary Seal) N FlOCsmission 71510 (Rev. 08.12) �y (09 f!09 Signature Imflo(k LI rmt or type name Notary Public - State of 9V It*b, Commission No. My Commission Expires: as 10 A`CMLY CERTIFICATE OF LIABILITY INSURANCE DATE (MWDD/YYYY) 3/31/2016 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(les) 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 Brown 6 Brown of Florida, Inc. 2600 Lake Lucien Drive ,Shite 330 Maitland FL 32751 CONTACT Elizabeth Conroy PH Nom. (407)660-8282 FI�,No):(407)660-2012 EDORIESS:ecoaroy@bborlando.com INSURER(S) AFFORDING COVERAGE NAIC0 INSURERAC01ODY insurance Compaay INSURED Legacy Construction, Inc. 875 Jackson Street Suite 110 winter Park FL 32789 INSURERBA11tO Owners IDS. Co. 18988 INSURER CAmerican Builders IDS. Co. INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBERCLI63805013 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. INSR LTR TYPE OF INSURANCEADDLSUOR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 300 N Park Avenue POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYV _ LIMBS A R COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR P Masi, CIRMS/103718_L�---�,-� I 1030L0007995-01 1/7/2016 I 1/7/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence) $ 100,000 MED EXP (Any one person) $ 51000 PERSONAL d ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 7, JELOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2, 000, 000 Employee Benefits $ 1,000,000 B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED B SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS 50-390755-02 1/7/2016 1/7/2017 COMBINED SINGLE LIMIT $ Ea accident) BODILY INJURY (Per person) S 50,000 BODILY INJURY (Per accident) $ 100,000 PROPERTY DAMAGE $ 50,000 Per accident Uninsured motorist BI split limit $ 50, 000 A X r UMBRELLA LIAO EXCESS LIAR R OCCUR CLAIMS -MADE XS171261-0 12/10/2016 1 1/7/2017 EACH OCCURRENCE $ 2 000 000 AGGREGATE $ DED RETENTIONS $ C WORKERS COMPENSATION AND EMPLOYERS' LIALIABILITYSTATUTE Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NN) 11 yes, describe under DESCRIPTION OF OPERATIONS below N/A xCV016582600 3/5/2016 3/5/2017 g ER E.L. EACH ACCIDENT $ 1,000,000 E.L DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 11000,000 I I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more apace Is required) CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014/01) INS1125 mnl4nn ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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 Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Sanford, FL 32772 AUTHORIZED REPRESENTATIVE r P Masi, CIRMS/103718_L�---�,-� I ACORD 25 (2014/01) INS1125 mnl4nn ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Date: March 11, 2016 Project: Roger "Dutch" Uithoven Address: 200 W 17* St Sanford, FL 32771 LEGACY PLUMBING AND GAS Gas Proposal • Install Gas line under home from meter to (1) Range • Will stub up gas line for Range • Pricing to include all labor & materials needed to complete job as stated above • Price Includes Permit fee • Customer may have rebates available through the gas company FPU Customer Approval: Total Price: $625.00 a.. .. '4v 4•►��r +: f�a. A . - :✓ '-t.��;".�•e•r'w •r-.+--�;----�-'meq--w-': •'---•-----•+—••e•-:'- a:� -! rra.Z,,�}a�y..•'�•1•,4' 71 .�ti�,�,i�t �u - � .i ''y . '''�1 ,.CG•• ;. .1;• .�',.)�.,,,�.''` i' '. COPY r ;i i�1 �• � �^fj�.'�7tra�7'}'" ��:`:• '.'r'{� `:�.• }'F, ,. .' - '�>: j•,' �, r. •. 'ir; 4'�`, •S! •" �-'-'•IWJ�Y;� .- 1 MI/.'r4 �vF.` ,{,11Y,.-,,. i ' `t,;Y, , •'r •• P rf •.• , '' „• ,* •� �,. 1 205 ^'.i.t, '•:19Ctrit.'6 'L.,r . -{ �• ( a ';L?' 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'�"art V'y'. •I�„ 1 - .. •v '1n ; ' 1-.^t "117.. j1. .. �e b. •t: �,�1yti�Je�•}` t •7•, '�-� .,). • .�. ., 1','�, ,: •, .;r i .`, o oN • 1, ,( CdSMP_ ANCA' , , .�.rr.'' ,f�r':�. : ,,.,{ , '; .. •F .�,, ' ' �• , ' 1 '�� ,. ' ,`J _ ./' a t`'' `�, r` � ♦_i. - , ' � 1 �',• V TE � a • .. ^'` � '�I � . r .i 'j ,l, i,': - f H. r p -, ti ►(�t;!jl .} EQ $HALL 8E CONSTRUED TO BEA SANFORD ct ib'P> OCEio W ITMNE WORKAND NOT AS tAV Ftlf? FT'! TO VlOIATEr CE ALTER QR,SET ' AS?C7E RN�t OFTHEPRO` iVONSOFTHETECHNICAL ;, ;,;=•L •� , )"ARTS` L :CIES• �10R h�AL�,SSUANCE OF A PERMIT'PAEVENT rNE RAJlL� Ir, C�P•FICIAL FROM THEREAFTER ?j:Qi 11Ft1 A ORRE + tON O•-ERWRORS IN PLANS,: — 1 Z S 7�Ol'�OV�QU''TtOi�tSOF.THISCODE Tr.1` 6 J :,, .