HomeMy WebLinkAbout125 Wornall DrCITY OF SANFORD
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BUILDING & FIRE PREVENTION
OCT 2 ti y PERMIT APPLICATION
Application No:
Documented Construction Value: $
Job Address: i 1T Utz d lIV c& p//! ; 3,272Z Historic District: Yes No z_
Parcel ID: Residential t& Commercial
Type of Work: New Addition Alteration RepairM Demo Change of Use Move
of Work:
of
1.e4'-/I
1-2
Plan Review Contact Person: Z22I(_42L _ Title:
Phone: Fax: C1?2— Email: ;V c `iaQ , Gr"
z—
i.
Property Owner Information
Name Phone: 02
Street: D N Resident of property? :S
City, State Zip:
Contractor Information
Name V- 1%2' C d Phone: %— %% % V5 r9
Street: 626 2 Fax: W7 )-?2
City, State Zip: '3 292-2— State License No.: 0CC
Architect/Engineer Information
Name: Phone:
Street: Fax:
City, St, Zip:
Bonding Company:
Address:
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, poolsfurnaces, boilers, heaters, tanks, and air conditioners, etc.
t n
V
FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 511 Edition (2014) Florida Building Code ^
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 pen -nit 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.
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
l
Signatu r6000fContractor/Agent // D Prin[
C ra r/Agent's Name Signature
of Notary -State of Florida Date STEPHEN
PATRICK DOLAN MY
COMMISSION 0 FF 071532 EXPIRES:
December 27, 2017 Nf,
TEOF
F`0e Bonded Thru Budget Note rvIces Contractor/
Agent is Personally Known to Me or Produced
ID Type of ID BELOW
IS 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: ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Fire
Alarm Permit: Yes No WASTE
WATER: BUILDING:
Profaer Record Card
Parcel. 3319-30-514-0000-0130
Owner: KLENK BRIAN J
Property Address: 125 WORNALL DR SANFORD, FL 32771
Parcel Information Value Summary
Parcel 133 19 30 514 0000 0130 l Owner :
KLENK BRIAN J i Property
Address i 125 WORNALL DR SANFORD, FL 32771 I
Mailing !
125 WORNALL DR SANFORD FL 32771 7759 Subdivision
Name ? COUN7RYC UB PAF,'K Tax
District S1 SANFORD DOR
Use Code, 01SINGLE FAMILY Exemptions , 00-
HOMESTEAD(2008) i 1 2017
Working E 2016 Certified I Values
Values Valuation Method
i Cost/Market Cost/Market Number of
Buildings 1 1 Depreciated Bldg
Value 124,213 $119 219 j Depreciated EXFT
Value Land Value (
Market) 32,000 ' $32,000 Land Value
Ag JUst/Market
Value '° 156,213 $151,219 E Portability Adj
Save Our
Homes Adj 43 988 $39,774 Amendment 1
Adj E P&G
Adj 0 € $0 Assessed Value
112,225 $111,445 I Tax
Amount
without SOH: $2,217.92 2016 Tax
Bill Amount $1,420.62 Tax Estimator
Save Our
Homes Savings: $797.30 Does NOT
INCLUDE Non Ad Valorem Assessments a Seminole County
GIS Legal Description
LOT 13
COUNTRY CLUB
PARK PB 50
PGS 63 THRU 66 Taxes Taxing
Authority
Assessment Value Exempt Values Taxable Value Schools 112,
225 r 25,000 87,225 City Sanford
112,225 50 000 62,225 k `. SJWM(Saint
Johns Water Management) 112,225 50,000 62,225 County Bonds
112,225 . 50 000 62,225 1 County
General Fund 112,225 , 50 000E 62,225 Sales f
E
Description i
Date Book Page Amount Qualified Vac/Imp E WARRANTY
DEED 7/1/2006 0G.398 0608 252,900 Yes Improved SPECIAL WARRANTY
DEED 8/1/1998 03495 0278 102,000 ' Yes Improved i ( WARRANTY
DEED 9/1/1997 103309 0429 22,000 Yes Vacant j r Land
j
Method
Frontage E Depth Units Units Price Land Value LOT 32,
000.00 32,000 Building Information
Is PedlBath
count Incorrect? Click I Mere. r YaarRuili
x
Ins. Co-.
Licensed & Insured
First in Quality Tel.#
First in Service
First in Satisfaction
l
Claim # ST 6 / Q 7 0'7
800-411-0920
LIC # CCC1330939 6767 Hoffner Avenue
LIC # CRC1331435
Orlando, Florida32822
IbklenL,
Adj. Name
Tel. #
PROPOSAL SUBMITTED TO t'1 _ K- *,-!, lcz' DATE
STREET L JO Cv1"-0 61, JOB #
CITY, STATE, ZIPS6,tn!&,4 -. 3 71SUBDIVISION
HOME PHONE l 'q O7)- Y Z '' 750 BUSINESS PHONE
SPECIFICATIONS FOR LABOR AND MATERIAL
041 Off. Shingles: _L Layers
j
ssionall Install: Brand r Cr r iy Type Color
Zll:
Valleys Ft
i"d 30 ib. f elt 0 Peel & Stick Synthetic Undedayment
R al, sidewalls, counter and wall flashings O Re -Use Drip Edge al5rilp Edge -
1-1/2" 2" 3" 4" or Plumbing Vents
a4l ation:. Goose Necks Off Ridge Vents Ridge Vents Color to ra
Renail Plywood Sheathing to Code
S ght 2 x 2 4x4
Z PPi "`.0od replaced at $60 - per sheet (if needed). Clean-up and haul off all job related trash oil yard W h mE
Atlantic Roofing is not responsible for pre-existing structural conditions.
Buyers agree they have seen, read & understand all terms & conditions of this contract & agree to be bound by same.
ALL ROOF$ HAVE A 5 YR LABOR WARRANTY
CONTINGENT
This proposal W contingent upon the Insurance company paying for damages. This proposal will be VOID only if claim is disallowed by Insurance company.
Property owner's our -of -pocket expense is not to exbeed the deductible amount. The insurance company will determine and set the price of the claim.
YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE IF
THIS TRANSACTION. BY SIGNING ABOVE, PROPERTY OWNER AGREES TO PROCEED. WITH THE WORK AS PER PROPERTY -LOSS
WORKSHEET WHEN RECEIVED.
We propose to hereby furnish materials and labor, complete in accordance with above speciftations for the sum of the insurance as per the insurance
company loss scope shpet,.ir which is incprpo herein and ereof by reference, to include customary profit and overhead when multiple
trade Incurred $ '-'XW% "
t// 0O\X0 Paymen earn io e_ac e.
11 4/U / (•
ryJ _
Authorized Signature'
Must be approved by c ompany owner. No other word ekpnessed orimptied verbally. All ch es to be in writing and accepted before commencement of
changes. NOTE: This proposal may be wtthdrawn by us. If not accepted within 30 days.
ACCEPTANCE OF PROPOSAL- The above , sp lions and conditions are satisfactory and are hereby accepted. You are authorized to do the
work as specified. D(C
Payment will be made as outline above
Date,,,
I N11111111111111 iil i IIIII I I I ! I " THIS INSTRUMENT PREPARED BY:
Name: /vt
Address:
Permit Number:
t 2
Parcel lD Number:
I`Ir ia'(ilil'IE NOR- Er SEI°III'IULE i:0UPITY
i1F C:IRCUZI COURT t•: C0NFTl` WLI_Efi
CLERK'S u 201611i 1737
I:a:a)Fa'.I:(.i ii,..,,r':if i1" ,.iis-•- t
F.IECORDED, i:,'i iitll:lvOi",_
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the
following information is provided in this Notice of Commencement.
1. DESCRIPTION OF PROPERTY: (Legal description of the p pert and street address if available) (
AI1. 7
Lo Co U 0 lbL,4 > —
2. GENERAL DESCRIPTION OF IMPROVEMENT:
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT:
Name and address:_ ! I ++ t'• . C ( W f N . j 1
Interest in property: m ir
Fee Simple Title Holder (if other than owner listed above) Name:
4. CONTRACTOR:
Address: (O / (0 / A9 2nU 11111 f 5.
SURETY (If applicable, a copy of the payment bond is attached) Phone
Number: Amount
of Bond: 6.
LENDER: Name: Phone Number: Address:
7.
Persons within the State of Florida Designated by Owner upon whom notice or other documents maybe served as provided by Section 713.
13(1)(a)7., Florida Statutes. Name:
Address:
8.
In addition, Owner designates Phone
Number: of
to
receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Phone number: 9.
Expiration Date of Notice of Commencement (The expiration is 1 year from date of recording unless a different date is specified) WARNING
TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN 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
CO7)
jG
WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. r
14 ir,,t .Pn e
o er or Lessee, or Owner's or Lessee's (Print Name and Provide Signatory's Title/Office) Authorized
Officer/Director/Partner/Manager) GG°
State
ofE116-V1 County of v 14 )v I
The
foregoing instrument was acknowledged before me this day of ` , 20 by
I, / ft I-W K jell Who is personally known to me OR Name
of person making statement (' who
has produced identificationdtype of identification produced: F L ' `( _ G76 GRACIELA
GAGNE MY
COMMISSION # FF985949 EXPIRES
April 25, COPY-
MARYANNEMORSE ;0.
001- :'' ',,.Ij
Notary igq ure 407)
398.0153 FlorldeN r
t
LE F7HHC OURTAND A'' ; T (
201OMpTR LER SEMINOLE 0 .
FLO
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
I hereby name and appoint:
an agent of:
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 application for work loca ed a
ti'
Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name: rl(liC'-
State License Number: CC'C 3 !% 3 2
Signature of License Holder:
3,-77
STATE OF FLORIDA
COUNTY OF _L'
The foregoing instrum nt was acknowledged before me this W ay of 06 a
200, by ill C e-r2 who is personally known
to me or who has produced as
identification and who did (did not) take an oath.
Signature
Notary Seal)
AN
1532STEPHENPATRICKDOL
MY COMMISSION # FF 07
EXPIRES'. Decembet 27,201
mf1 epfv`o
e BoM,dTbruBudget""YServices
Rev. 08.12)
P,4,4rc t 6aI o
Print or type name
Notary Public - State of'
Commission No. v7 /
My Commission Expires: la-L!k7-1'1
Product Approval Specification Form
Permit #
Project Location Address S 3)72-7
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.floridabuilding.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 Manufacturer Product
Description
Florida Approval #
include decimal)
1. Exterior Doors
Swinging
Sliding
Sectional
Roll U
Automatic
Other
2. Windows
Single Hun
Horizontal Slider
Casement
Double Hun
Fixed
Awning
Pass Through
Projected
Mullions
Wind Breaker
Dual Action
Other
June 2014
Category / Subcategory Manufacturer Product
Description
Florida Approval #
including decimal)
3. Panel Walls
Siding
Soffits
Storefronts
Curtain Walls
Wall Louver
Glass block
Membrane
Greenhouse
E.P.S Composite
Panels
Other
4. Roofing Products
Asphalt Shingles
Underla ments S e f
Roofing Fasteners
Nonstructural
Metal Roofing
Wood Shakes and
Shingles
Roofing tiles
Roofing
Insulation
Waterproofing
Built up roofing
System
Modified Bitumen
Single Ply Roof
Systems
Roofing slate
Cements/
Adhesives /
Coating
Liquid Applied
Roofing Systems
Roof Tile
adhesive
Spray Applied
Polyurethane
Roofing
E.P.S. Roof
Panels
Roof Vents e+,t SGU
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
CITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit
I, e— hereby acknowledge that I personally inspected
CK.$oof deck nailing and/ovx-secondary water barrier work
at i a-T 1AJZ91eA,,1 // and have determined that the work
Job Site Address)
was done according to the Hurricane Mitigation Retrofit Manual. (based on 553.844 F.S.)
I certify that my statements herein are true and accurate to the best of my belief and that I fully
understand that making any false statements in writing with the intent to mislead a public servant in the
performance of his or her official duty shall constitute a misdemeanor of the second degree pursuant to
Section 837.06 F.S.
Signat re of Contractor
e
Printed Name of Contractor
l &
Date
re(f l3 o 39
License #
License Type: General Building ResidentialRoofing Contractor
or any individual certified in accordance with F.S.468 to make such an inspection.
STATE OF FLORIDA COUNTY OF lq" -7tiv-
Sworn to (or affirmed) and subscribed before me this ? day of 20 /6 , by
who iersonally Known to me or has Produced (type of
idention) as identification. SEAL)
Signature'
of Notary Public Stat
Florida I. ,
PY.
P STEPHENPATRICKDOIAN j
t /C' s 2 ' ' o * MY COMMISSION # FF 071532 Print/
Type/Stamp Name * EXPIRES: December 27, 2017 BondedThru
BudgetNOWY se"'ces of
Notary Public r°
rFOFFl°p