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HomeMy WebLinkAbout1615 E 8NOV 2 g 2016 CITY OF SANFORD BUILDING & FIRE PREVENTION A /-:� PERMIT APPLICATION I Application No: (12 - 3 1 FJ Documented Cbnstruction Value: S 41r,5 -6r. D -Z) Job Address: �jS / Historic District: Yes ❑ No ❑ Parcel ID: 36�/ �Z % —a Or Od —A347 0 Residential [Commercial ❑ Type of Work: New ❑ Addi&. tion ❑ Alteration ❑ Repair Demo ❑ Change of Use ❑ Move❑ 'Description of Work: _ G .P t -,2R (,ao Plan Review Contact Person: CC[ y/ Title: �Y Phone: '5_ffJV17J Fax: 007 YfZ Email: g4zf /i� Prop/erty Owner Information Name` �`< >'�/ Phone: Street: Resident of property'": City, State Zip: �'� 27 Contractor Information Name 71�� Street: City, State Zip: Name: Street: City, St, Zip: _ j('0iD 7 Phone: 707 F,57 IF67% 'Fax: `t dl�,c/,// State License No.: (?I *COT,7 M_ Architect/Engineer Information Phone: Fax: E-mail: Bonding Company: 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 ?HE 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, beaters, tanks, and. air conditioners,, etc. F13C 105.3 Shall be inscribed with'the date of appli'catibir and" the code Erreffect as of.that•date: 5Yhi Edition (2014) Flbrid'a Bm1ding Code Revised: lune 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 req#cs payrmcat of awplan review fee at the time of Qertait submittal: A copy of the execetea contFact-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 irr 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. &/I d, A-�, Signature of OwnekAAg/eenntt►/ Datc (KY'r ( IQII Print Owner/Agent's `\ •• 1j,� ///�/,// signature of Notaty-State of Florida, Date FF 988740 y :y .er: �-ftd, d• Q Owner/Agent is Personally 'gt}jjT6���or Produced 1D Type of ID Signature of Contractor/Agent /Date �i Print ntr etor/ gent's Sivacade of -Nota iG 00 ' 7T Contractor/Agenrj; y Int q*n to Me or Produced 1D �'��� ON BELOW IS FOR OFFICE USE ONLY Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing[] Gas ❑ Roof ❑ Construction Type: Occupancy Use: Total Sq Ft of Bldg: Min. Occupancy Load: New Construction. Electr=ic - # of Amps Flood Zone: # of Stories: Plumbing - # of Fixtures Fire Sprinkler Permit: YesE]- Nb ❑ # of H'ead's Fire Alarm Permit: Yes ❑ NoE]- APPROVALS: ZONING: UTILITIES: WASTE WATER: ENGINEERING: COMMENTS: FIRE: BUILDING: Revised: June 30, 2015 Permit Application. LIMITED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: % / 0 f I hereby name and appoint: an agent of. 1,9. � rte, �� (Name 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 fbr•(check •only ene,op'tion): O The for work located at: (Street Address) Expiration Date for This Limited Power of Attorney: 'f A License Holder Name: 61- J C� qc`4v `li State License Number: (914 ? Signature of License Holder: STATE OF FL TDA COUNTY OF The foregoing instrumen was a o d ed before me this u2! da of V 204 � by Q p(� �� y who isrsonally known to me or o who has produced as identification and who did (did not) take an oath. 2b ip (NArytea) � � ?Po611e0�d F'♦` (Rev. 08.12) Signa e Print or type name Notary Public - State ofG Commission No. My Commission•Expires: THIS INSTRUMENT PREPARED BY: Name: K Adams Address: NOTICE OF COMMENCEMENT State of. Florida County -of Seminole. Permit Number: I lo -3 (,7 5 Parcel ID Number: I 11111111111111111111111111111111111 II11 MARYANNE MORSEP SEMINOLE COUNTY CLERK. OF CIRCUIT COURT & COMPTROLLER BK, 8812 P9 613 (1P9s) CLERK'S : 2016122828 RECORDED 11/29/2016 09�35:17 All RECORDING FEES $10.00 RECORDED BY hd*vore 30-19-31-527-0000-0360 The undersigned hereby gives notice that Improvement will be made to certain real property, and in accordance with gChhagpter 771(3, FFlloriiddapStaatutes, the following information is provided in this Notice of Commencement. W Pi I ?6 �t Pf M4fAi lgec"1 Sin pf iiye�rgp� atl9 get address if available) an or AOU l S F' GENERAL DESCRIPTION OF IMPROVEMENT: House re -pipe OWNER INFORMATION: Name:_ Harry & Holly Philpott Address: 1615 E 8 St Sanford 32771 Fee Simple! Title- Holder (if other than owner) Name: Address: CONTRACTOR: Name: Roto Rooter Address: 1404 Gemini Blvd Orlando 32837 Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served as provided by Section 713.13(t)(b), Florida Statutes. Name: Address: In addition to himself, Owner Designates of To receive a copy of the Lienors Notice as Provided in Section 713.13(1)(b), Florida Statutes. Expiration Date of Notice of Commencement (The expiration date 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: 7.13: PART I; SECTION 7.13.13, 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 COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Under penalties of perjury, I declare that 1 have read the foregoing and that the facts stated in it are true to the best of my knowledge aUbejle�f., Harry Philpott Owners Ignanure-Owne/s'PrinledWame Florida'SlaWle 713.13(1)(gx - Thavomer mustign the notice•of-oommencemenl.and no -one -else maybe permitted Cosign in his -or her stead.' State of / — County of M /h �- The foregoing instrument was acknowledged before me this2, day of , 20r A -- - . . by NaMe of person OR who has produced Ldentll WORCURTAND RSE of 1, CLER�� q COM�4 • 4PYT-' SEM�rlyrQ�E:�:I:y0 �e eonded�'e:! BY' "' E phi/ �/L C V 1 V/�Z��p public V�� Who, is peosortally kmwmto me El produced: (> IgOTV— 77� PROPOSAL ' �OQTE� Roto -Rooter $errtCws ComPO" 5 3 – .r •ieleetwa s Fa. 4,,.Vk1v Pl-"" ,.o 1-000-01rt 000r"1410 rrss• ewAtw sxw��cx t3w+wrs:(40 ) SSA-9SS7 • illx (401) Of 1,4tltf 1404 Gw"" @tya . 0r/at-do it. "My l -800-6ET-ROYV crc 0047 -Me ;ate �eesl P'976"), SubmjttPd T Work To Be Prnrfortyv4w At ro es > Roto -11,+.11.•. he.eby to turnlsh all the matow,al• and to od~r" oil ttm lot—' rw w&ary Mr thw compl/lNsn art JJd`�fi�•��C rc�J' t 1'!',tt!7Car Q lit'ik)r (., 9C Days 1 r ; W Days t T riE_ TE RMS AND CONDITIONS ON THE- HE VE H E SIDE OF THIS PPOPOSAL Y, Tl, (1r()(1t,1E}i m,}y tie *1',dra'4Vr, by R()r(1 :x CPpteo W1tRlr1 i�`ratln'K� ,'-wtween the partws ark' ISJ n, ,ta dfx)rtti w0i be vr31Ki uMCSs in rttrlt{rg anc P"nfr,! tiA'r11c+T tit trber ACCEPTANCE Of P OPOSAL - .. 3t•3�t: 't.. a e �,�� yT.tf'a "',a! .v -e `qn�A� t(? Etta 4v. //-Z7_�, A� 0® CERTIFICATE OF LIABILITY INSURANCE °o3n2r0 6°""�"' 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 Ileu of such endorsement(s). PRODUCER MARSH USA INC. 525 VINE STREET, SUITE 1600 CONTACT NAME: PHONE FAX Alc No): E�r1 R ADDRESS: CINCINNATI, OH 45202 Attn: Cindnnati.Cer1Request@rne sh.com I F: 212-948-0785 INSURERS AFFORDING COVERAGE NAIC fl INSURER A: Old Republic Insurance Company 24147 00053 INSURED 53 - ROTO -ROOTER SERVICES COMPANY 1404 GEMINI BOULEVARD INSURER 8: NIA NIA INSURER C : Midwest Employers Casually Company 23612 INSURER D: ORLANDO, FL 32837-9423 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: CLE.M857317.30 REVISION NUMBER:4 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 INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MMIDD POLICY EXP NMIDD UNITS A X COMMERCIAL GENERAL LIABILITY MWZY6013216 04101/2016 04/01/2017 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE a OCCUR GE ToRENTED PREM/ ES Ea occuffencel $ 750,000 MED EXP (Any one person $ 5,000 PERSONAL d ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 6,000,000 X POLICY JECT F-] LOC PRODUCTS - COMPIOP AGG $ 6,000,000 $ OTHER: A AUTOMOBILE LIABILITY MWTB2195716 04101/2016 04/01/2017 COMBINED SINGLE LIMITa ccident y 5,000,000 Ea BODILY INJURY (Per person) S X ANY AUTO X ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per awdent) S PROPERTY DAMAGE $ Per accident) X HIRED AUTOS X NON -OWNED AUTOS S UMBRELLA UAB OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAR CLAIMS -MADE DED I I RETENTIONS $ l A c C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORlPARTNER/EXECUTIVE D OFFICERIMEMBER EXCLUDED? (Mandatory In NH) NIA A MWC11826416 (AOS) MWC3o1934 02 � EWC0063808 (XS OH) 04/01/2016 04101/2016 0410112016 0410112017 04/01/2017 04101/2017 X STARTUTE ETH - E L. EACH ACCIDENT $ 1.000,000 E.L. DISEASE • EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If mom space Is required) CERTIFICATE HOLDER CANCELLATION CITY OF SANFORD, FL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 300 N PARK AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SANFORD, FL 32771 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORMED REPRESENTATIVE of Manch USA Inc. Manashi Mukhedee _>LMuao►.► ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD