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Home My WebLink About165 Pincerest DrCITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: • I to - 3 13s Documented Construction Value: S 100,00 Job Address: (5 t �r Cr•� s�- '�� _ Historic District: Yes ❑ No 0 Parcel ID: 1)1-Zp _30- S17 -OAdO- 034 O Residential Er Commercial ❑ i Type of Work: New ❑ Addition ❑ Alteration. Repair ❑ Demo ❑ Change of Use ❑ Move ❑ Description of Work: ��e c( (1-4- - wvr-� Plan Review Contact Person: —C1o,nn (2&_%.or Title: Street: 3 \ D •.S, Via.\'n�:�f%o Phone: NuI-416-2S3`I Fax: I-TLL-An- ggpS Email: anti 1 1<A:) JovLlo'-Adr(A Com Property Owner Information Name 44- Phone: Street: 3 \ D •.S, Via.\'n�:�f%o v.� ResidedYf of ' r "` "' �' i` ►; �'d "' -"-;: '. t . City, Statq�ZiP a c:.'. • t . s •.. .:-S-' • •••, - Yy L it. •i.:,.: :`a e - ' — ^• t •",� :."Y 1 . C.�' .. .'/ p :' J •.� •:., �.y. t11. `'-W+Yr1.N'.�.1V 'Contractor — rri �r'I •�•'• •I 1.iMv' _ Information -�-•� YJ. Name-i>6,.I J Phone: Ig -,a5 Street: 1 O % l", -k" t -'It ^r;. r ! lr _ Fax: ��rL�-!S X`1 • q 4 US City, State Zip: „terra r -al 3x.1 17, State License No.: ci5Co4 tX7 3 Architect/Engineer Information Name: l.. A Phone: _ Street: - Fax: City, St, Zip: E-mail: Bonding Company: tri I A, Mortgage Lender: Address: - 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. 1 understand that a separate permit must be secured for electrical work, plumbing, signs, wells, pools, furnaces, boilers, heaters, tanks, and air conditioners, etc. FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 5" 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 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: 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 61 he±211 A4 Signature of Contractor/Agent Date 174om A s 2 GASo n� Print Contractor/Agent's Name Lo Signatu Date Signatur of NMI. IL KtHf3Hf APFq�M.ltitn3} 1' *. W OOMMISM f FF 9151139 ; Mr IMWISS m, : FF 915639 EXPIRES: December 21, EXPIRES- December 21, 2019 BoMW Thou Now vino u Bmdw TMu wm Pu* 1111110"t" Owner/Agent is Personally Known to Me or Contractor/Agent is ✓ Personally Known to Me or Produced ID Type of ID Produced 1D Type of 1D BELOW IS FOR OFFICE USE ONLY Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing❑ Gas[-] Roof ❑ Construction Type: Occupancy Use: Flood Zone: Total Sq Ft of Bldg: Min. Occupancy Load: # of Stories: New Construction: Electric - # of Amps Plumbing - # of Fixtures Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads Fire Alarm Permit: Yes ❑ No ❑ APPROVALS: ZONING: UTILITIES: WASTE WATER: ENGINEERING: FIRE: BUILDING: COMMENTS: Revised: June 30, 2015 Permit Application STATE OF FLORIDA Ct DE9;%RTMENT-OF FINA1N L—,!�ERVICES �II I DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY EXEMPTION Ij ;I ��^"f 10 CERT67CATE OF ELECTION TO BE EXEMPT FROM FLORIDA iL I WORKERS' COMPENSATION LAW :D DATE: ;7 IV3112014 ' f EImWATK»LDATE; 12r0"16 Ii IEFFECTIVE PERSON: CA61W TIy�NAS R vI� } it i E FEIN: 593S276B0 I BUSINESS NAM -E AND ADDRESS: - i E I DOVE BUILDERS,OF CENTRAL FLORIDA INC I' 1108 LAKE MMNIE DR. r I ,1 SANFORD FL 32773 ±1. T' SCOPES OF BUSINESS OR TRA LICENSED BUILDING 109 LAKE MNWE OR SANFORD FL 37773 SCOPES OF BUSINESS OR TRA JCENSED BUILDING Ptrnu.nlb CMpw.v f•} c S. a ol•nr of eorpr•tlm vele.lsob arr�Ptim tram T4} f!1•Pitr by S61p. n1ilre•Eb a •betion une.rMe s.tlbn may m.Ab f noov.r b..of oarpen nf.oliner Tb d%aptr. Pumusm to chww =2), F a, CerAcsm of owcwn 10 boll==* .IKben eo M o�xMnapt» bulb m «malt Purw.nl ro Cb.ptr.•a. 113} F,.b. NA , *I WtJbn tob. su0�l.a �noa It d any we aro tt�i. eNp orvr beak. r tfr rw. wo of MD artlbn. Me poram more m Me nobse r crtoom m trlp.r mow me rpuMmrrb d Mb secbm tr burroe of a mrblob. TM e.p•r.rrm shN,•wtr • oMSe•b • .r� 1b o Ir barn a on p.non mrt1W m the arbllab b m..l Or rpulr.nrnb a ar webon STATE OF FLORIDA i DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION ` s F CONSTRUCTION INDUSTRY EXEMPTION ��^"f 10 iL uw orE,.r amr cLoao. :D wcamptwua"p4laaia1°oo ou:,+a, ttrRer.so►tc 12"A70N avbu,lmG.tE: 177301=4 iI PEN" c*Am rmow's it i E par: aarQrato i E BUSINESS NAME AND ADDRESS: DOVE BURDERS OF CENTRAL FLORIDA. INC 109 LAKE MNWE OR SANFORD FL 37773 SCOPES OF BUSINESS OR TRA JCENSED BUILDING Ptrnu.nlb CMpw.v f•} c S. a ol•nr of eorpr•tlm vele.lsob arr�Ptim tram T4} f!1•Pitr by S61p. n1ilre•Eb a •betion une.rMe s.tlbn may m.Ab f noov.r b..of oarpen nf.oliner Tb d%aptr. Pumusm to chww =2), F a, CerAcsm of owcwn 10 boll==* .IKben eo M o�xMnapt» bulb m «malt Purw.nl ro Cb.ptr.•a. 113} F,.b. NA , *I WtJbn tob. su0�l.a �noa It d any we aro tt�i. eNp orvr beak. r tfr rw. wo of MD artlbn. Me poram more m Me nobse r crtoom m trlp.r mow me rpuMmrrb d Mb secbm tr burroe of a mrblob. TM e.p•r.rrm shN,•wtr • oMSe•b • .r� 1b o Ir barn a on p.non mrt1W m the arbllab b m..l Or rpulr.nrnb a ar webon STATE. OF FLORIDA 'DEPART;MEN wOF,BUSINI =MP PROFESSIONAL GULP tBQ040673 07 CERTIFIED. -B -I' CON.CRACT R CASON,*,T,'HO N G, DOVE, BUIPE.,St E 5WOR1.1 Yr AND 119/2016 jyf48 I'S.dEkTIFIJED ihe,Orovisl'ns of Ch. Expimtuindeto 20,10, I S: : 4 GROWTH AND RESOURCE MANAGEMENT Building and Zoning 123 West Indiana Avenue Volusia Co" Deland, FL 32720 FLORIDA (386) 736-5929 Fax (386) 943-7096 To: County of Volusia Building Activity Re: Permit # A CHITECTIENGINEERAFFIDAVIT Florida Registered Before me, the undersigned authority, personally appeared,,, ---AA � !Z AtPA S (Architect or Engineer) License Number %ill , who being first duly sworn, deposes and says: I did personally inspect and examine the constructed at P4— Based upon my examination, I have determined that the construction was do according to the plans, specifications and design and meets the requirements of the curift'ff* 81t'1s0 Florida Building Code and amendments thereto, specifically, the Wind Loacs,J e- In Sections R301.2 or 1609. �.`�Q�; •�a� ''•.• *�'•� w rT Further affiant saith not. y t-�S'i� 's w V • • 2 � r i Affiant – Signed and Seal%o ••S`" •�'Q •. • Fp A�: •�� STATE OF FLORIDA ��FSS I ONP� COUNTY OF Volu)4,,'��'111I�+►!'', Sworn to and subscribed before me this _ day of —,20/G , by rj rft1-U 0.X.--" TMOMAB A. WALBM Npply puptlo • state of (156 Notary f Florida signature Conunlselon FF 981068 + My COMM. E�Iree Mu 2, 2020 8on0e0tAtOu� II INd Nonny A$In. (Print, type or stamp name) Personally known or Commission No.: F '7ciT,6 Produced Identification >� Type of identification produced fL DC A 3Q1 5937)wo e P !o f jt,1/ y