HomeMy WebLinkAbout2605 Park Dr (2)tP
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1bMAY
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No. Documented Construction Value: $
Job Address: 7 (000 i,I`A (+ N • Historic District: Yes No 2
ParcelID:D1—C)D-'
Description of Work:
Plan Review Contact Person: c'Y,l.M (jT- n -t4. --t
cQ
Phone: "C Zv Fax: "WTOU (z 4 l [
Zoning:
Property Owner Information
Name obj La I;y k.6/W,' ' Phone:
Street: () (i ey%bf n U1116 AU Resident of property?
City, State Zipw 3E:-7 G a
Contractor Information
Name r1 j Phone: G t-{
Street: Fax: 4 G7- 7 1 Z
City, State Zip: ()r• r- rj o . 3z ,e State License No.:
Architect/Engineer Information
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Building Permit IJ
Square Footage:
No. of Dwelling Units:
Electrical
New Service – No. of AMPS:
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
PERMIT INFORMATION
Construction Type
Flood Zone:
Mechanical (Duct layout required for new systems)
No. of Stories:
Plumbing
New Construction - No. of Fixtures:
Fire Sprinkler/Alarm No. of heads:
C_yVI
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.
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.
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.
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. A copy of the executed contract is, required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve'the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges . exceed the documented
construction value when the executed contract is submitted, credit will be applied to your permit fees when the
permit is released.
Z 11
Signature of Owner/Agent Date Sig natu of 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
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
Rev -1 1.08
UTILITIES:
FIRE:
ature ofNotary-State oFZWa ..- 6at
t.
31
p ANTHA L FURBOTg
commI1(SSit PJ # D131"
t PIRES hflarch 01, 2013
G a0169
Ce gen is Personally Known to Me or
Produced ID Type of ID
WASTE WATER:
BUILDING
POWER OF ATTORNEY
Date: 7/
I hereby name and appoint 6(f k5_f .
of ADT Security Services to dgop off and pick up permits at the
Building Department on my behalf for
a LOW VOLTAGE SECURITY permit for work to be performed at a location described as:
Parcel
Subdivision
Address of job (t` U•
Owner .iU i 1 f l (ivy'
The fd
by
who is
Georze Manonelli EF0001121
Typp or
4coifi dCoritrlactor
rtified Contractor
ig
instrument was acknowledge d+before me this 2 day of 20-4
yk okvn tome/who)produced
and who did not take oath.
State of Floyiqa
ou ty of /L
Not y Public, Seminole o Florida
qq pp pp pp''py pp r, fpm Tpp811AiANiT- A L FUR60 1 OR .
t".-r.PiRES march 01, 2013
g8.Ot93 FlottdetJot 1Y8
COPY CustNo-175611583 JobNo- 01
IIII IIIII Illlu IIII4IIIIIIII IIII II IISMALLBUSINESSCONTRACT
23523?/b 3081UE04
CONTRACT DATE: -LJ AQn "" TOWN NO: _ 5a CUSTOMER NO: JOB NO. LEAD SOURCE:
1 Of b Central Storage Copy 02011 ADT Security Services, Inc. (01/11)
i
t `tx.r r:,.
F "' r, y. lyyt 4 61, •.'q,t:;%f¢2:; 1 ". 4q. #;s;'
on9F ,.
ADT Security Services, Inc. ("ADT") Business Name ("Customer") qw c DQ, l3osn ,
Office Ad ress
3/6Osortff)57
Address Z 6 0 5eCitySgM./h d State/ Zip /Q. 32773 Responsible Party
V Yr V 7 32Q Protected Premises' Telephone Y177,V'78- 9-17,
V
L!'iraditional Phone Other (Qualified) Other (Non -Qualified)
Tel: 1 -800 -ADT -ASAP1-800-238-2727 Alternate Telephone 1 (Circle one) Home / Cell / Work w/ ext.
Alternate Telephone 2 (Circle one) Home / Cell / Work w/ ext. IF FAMILIARIZATION PERIOD IS
ACCEPTED INITIAL, HERE EMAIL
Communications Authorization: You hereby authorize ADT to furnish information and/or updates regardingg your securi system and new ADT and/or. third pa products and services t
ADT customers to the contact information rovided b ou You may unsub i or o tout b emaili donotcontactadt corn orb calling888 DNC4ADT 888 362 4238. Initial herY
Confirmation of Appointments: You hereby expressty authorize AD I y u ' g an automated calling device to deliver a prerecorded message to seticonfirm a servicefinsta la ' n
appointment at the telgp one number s s ow abo e. Initial her
Ownership of System and Equipment: Customer- caned pA6T-Owned
Verticals Retail: Business Services: Personal Services: AutomotivefTransportation:
G oce ood• Health Services; Rest urants: I sa{le: Other: •
yµtp T :. F • l VF 'Yk S'" - F iF sT t €. i.'4.'
f1t" ty — InitialFeeAlarmMonitoringandNotificationServices
Monrge Wur lary (BA) ADT to obtain construction
permit - Holdup (HUA) OMunid al Construction Permit
Fee -- -- Customer to obtain and pay for initial/annual municipal
alarm Your failure to
ADT
Duress Two-way voice use permit obtain and provide with
your municipal alarm user permit registration number could resultinOCriticalConditionMonitoring (
CCM) F1DDdI3-TemperaturP no municipal fire/police response to an alarm from your
premises and/or a
fine.
Other. Parallel
Protection 11 Annual UL Certificate
fee- ADT Select* DataSource - Installation Price __ _ _— -_ -
0•- Taxable Amount (Leave blank if ADT -
Owned) Non -Taxable Amount (Leave blank if ADT -
Owned) - — S
r% ` §' Open/Close
Login _ u- wised Scheduled Open/
Close IDT Select Entry ------- -- — iQ 7 ConnectionFeeOtherServicesSalesTaxon
Installation`
T- ---^-------_ Quali Service PlanSP^ ------------- QSP)' t TaxNo.
h ------ ----- ---- --- If Quali Service Plan (QSP) is Declined Customer must Initial here —_ * Tax E nation Date%t
a. Preventative Maintenance/lnspections Per Year Total Installation Charge` l91 -2--3--4— 6- -12 circle
on
Trainin Dire_ctConne_dion Services Deposit Received: 100% deposit required < $
500 Monthly Recurring Municipal Fee (Subject to change based on local law) Minimum SD% deposit required $
500t Customer to obtain and ay for municipal alarm use permit _ D Money Order L7 Check O Credit/Debit
Card On Site
Services Response-Olnterior_OExterior__
Guard
Other. Balance
Due* If applicable sales tax is not shown, it will be added to the firstinvoice. Total Monthly Service Charge'
73 / Estimated Installation Start Date Estimated Installation Completion
Date YOU ACKNOWLEDGE AND ADMIT THAT BEFORE SIGNING YOU HAVE READ THE FRONT AND BACK OF THIS PAGE IN ADDITION TO THE ATTACHED
PAGES WHICH CONTAIN IMPORTANT TERMS AND CONDITIONS FOR THIS CONTRACT. YOU STATE THAT YOU UNDERSTAND ALL THE TERMS AND
CONDITIONS OF THIS CONTRACT. YOU ARE AWARE OF THE FOLLOWING: NO ALARM SYSTEM CAN GUARANTEE PREVENTION OF LOSS; HUMAN ERROR IS
ALWAYS POSSIBLE; WE MAY NOT RECEIVE ALARM SIGNALS IF THE TELEPHONE UNE OR OTHER ALARM TRANSMISSION SYSTEM IS CUT, INTERFERED WITH,
OR OTHERWISE DAMAGED OR IF TELEPHONE OR ELECTRICAL SERVICE IS UNAVAILABLE FOR ANY
REASON. THIS CONTRACT REQUIRES FINAL APPROVAL OF AN ADT AUTHORIZED MANAGER BEFORE ANY EQUIPMENT/SERVICES MAY BE PROVIDED. IF
APPROV- AL IS DENIED, THIS CONTRACT WILL BE TERMINATED AND ADT'S ONLY OBLIGATION TO YOU WILL BE TO NOTIFY YOU OF SUCH TERMINATION
AND REFUND ANY AMOUNTS PAID IN
ADVANCE. SECOND AND THIRD PAGES ACCOMPANY THIS PAGE WITH ADDITIONAL TERMS AND CONDITIONS SET FORTH ON PAGES 4 THROUGH 6, INCLUSIVE,
OF THIS AGREEMENT AND YOU UNDERSTAND AND AGREE TO ALL SUC S AND
CONDJTICLNS. DT Rep.: Rep. ID No.: R'S
V
f Rep. License No.: r1ginal Signature
quired 1 Of b Central Storage Copy 02011 ADT Security Services, Inc. (01/
11)
Seminole County Property Appraiser Get Information by Parcel Number
Personal Property I Please Select Account -71
Page 1 of 1
http://www.scpafl.org/web/re_web.seminole_county_title?parcel=01203050600005150&c... 4/29/2011
ii r
S
JAYID .IOHAE'DW CFA,IASA
PROPERTY
APPRAISERk I
GE INOLE iGOUNTY-FL. @k ''. •' - z
1101 E. F7asT;si
i 9A,KFORDr.FL3277t-146H 4.:
407-665-7608
VALUE SUMMARY
2011 2010
VALUES
Working Certified
GENERAL Value Method Cost/Market Cost/Market
Parcel Id: 01-20-30-506-0000-5150 Number of Buildings 1 1
Owner: THOMAS DAVID F & KATHLEEN M Depreciated Bldg Value $63,636 $63,636
Mailing Address: 705 TIMBERWILDE AVE Depreciated EXFT Value $2;7111 $2,711
City,State,ZipCode: WINTER SPRINGS FL 32708 Land Value (Market) $68,488 $68,488
Property Address: 2605 PARK DR SANFORD 32771 Land Value Ag $0 $0
Facility Name: Just)Market Value $134,8 $134,8
Tax District: S4-SANFORD- 17-92 REDVDST
Portablity$0 $0Adj $0 $0
Exemptions:
Save Our Homes Adj $0 $0
Dor: 33 -NIGHT CLUB
Amendment 1 Adj $0 $0
Assessed Value (SOH) $134,835 $134,835
Tax Estimator
2011 TAXABLE VALUE WORKING ESTIMATE
Taxing Authority Assessment Value Exempt Values Taxable Value
County General Fund $134,835 $0 $134,835
Amendment 1 adjustment is not applicable to school assessment) Schools $134,835 $0 $134,835
City Sanford $134,835 $0 $134,835
SJWM(Saint Johns Water Management) $134,835 $0 $134,835
County Bonds $134,835 $01$134,835
The taxable values and taxes are calculated using the current years working values and the prior years approved millage rates.
SALES
Deed Date Book Page Amount Vac/Imp Qualified
WARRANTY DEED 04/2011 07556 1897 $180,000 Improved Yes 2010 VALUE SUMMARY
WARRANTY DEED 10/2002 046.86 1,786 $200,000 Improved No 20.10 Tax Bill Amount: $2,708
WARRANTY DEED 10/1990 02232 1262 $350,800 Improved No 2010 Certified Taxable Value and Taxes
DOES NOT INCLUDE NON -AD VALOREM ASSESSMENTSWARRANTYDEED10/1980 01303 1129 $68,000 Improved No
WARRANTY DEED 04/1980 01274 0290 $65,000 Improved No
Find Sales within this DOR Code
LEGAL DESCRIPTION
LAND
PLATS Pick... Land Assess Method Frontage Depth Land Units Unit Price Land Value
SQUARE FEET 0 0 9,784 7.00 $68,488 LEG LOTS 515 517 & W 1/2 VACD ALLEY ADJ ON E OF LOT
515 (LESS RD) FRANK L WOODRUFFS SUBD PB 3 PG 44
BUILDING INFORMATION
Bid Num Bid Class Year Bit Fixtures Gross SF Stories Ext Wall Bid Value Est. Cost New
Building 1 MASONRY PILAS 1942 4 2,390 1 CONCRETE BLOCK -STUCCO - MASONRY $63,636 $159,091
Sketch
Permits
EXTRA FEATURE
Description Year Bit Units EXFT Value Est. Cost New
COMMERCIAL ASPHALT DR 2 IN 1979 4,068 $1,481 $3,702
COMMERCIAL CONCRETE DR 4 IN 1982 1,444 $1,230 $3,076
NOTE: Assessed values shown are NOT certified values and therefore are subject to change before being finalized for ad valorem tax purposes.
If you recently purchased a homesteaded property your next ear's property tax will be based on JustlMarket value.
http://www.scpafl.org/web/re_web.seminole_county_title?parcel=01203050600005150&c... 4/29/2011
8
AC®R® CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YYYY)
1119/2010
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 lieu of such endorsement(s).
NUMBER MM/DD/YYYYEFFPOLPOLICY
PRODUCER
Marsh, Inc.
NAME:
FAX
AICNNo Ext: 212 345-5000 AIC No:
ADDRESS:
1166 Avenue of the AmericasE-MAIL
New York, NY 10036 PRODUCER
CUSTOMER ID #•
INSURERS AFFORDING COVERAGE NAIC #
10/1/2011
INSURED INSURER A: AGCS Marine Insurance Company (Allianz)
MED EXP (Any one person) $10,000.00
ADT Security Services, Inc. INSURER B: CHARTIS CASUALTY COMPANY
T.
3160 Southgate Commerce Blvd INSURER C: Commerce & Industry Ins Co.
Ste 38 INSURER D: Illinois National Insurance Co.
Orlando , FL 32806 INSURER E: Nat'l Union Fire Ins Co. of Pittsburgh, PA
United States INSURER F: New Hampshire Ins. Co.
I+CI'fTICIf ATC \il lilO CD. Qi 7pnl _ A Wl ul\II Im NI lmmYwl
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.
NSR
LTRWVDTYPEOFINSURANCE
ADDL SUBR
NUMBER MM/DD/YYYYEFF POLPOLICYMNOIIIDDYEXP
LIMITS
F GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
United States
GL 4360884 (Primary GL) 10/1/2010 10/1/2011 EACH OCCURRENCE $1,000,000.00
DAMAGE To
PREMISES (Ea
occuE
ence) $1,000,000.00
MED EXP (Any one person) $10,000.00
CLAIMS -MADE IJ OCCUR
T.
PERSONAL & ADV INJURY $1,000,000.00
OWNER'S & CONTRACTOR'S
GENERAL AGGREGATE $2;000,000.00
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000.00
X I POLICY PRO
LOC
E
E
E
AUTOMOBILE
X
LIABILITY
ANY AUTO
CA 3976576 (VA)
CA 3976575 (AOS)
CA 3976577 (MA)
10/1/2010
10/1/2010
10/1/2010
10/1/2011
10/1/2011
10/1/2011
COMBINED SINGLE LIMIT $1,000,000.00
Each accident
BODILY INJURY (Per person)
F ALL OWNED AUTOS CA 3976624 (NH) (Primary AL) 10/1/2010 10/1/2011 BODILY INJURY (Per accident)
SCHEDULED AUTOS PROPERTY DAMAGE
X HIRED AUTOS Per accident)
NEW HAMPSHIRE (CSL) $250,000XNON -OWNED AUTOS
UMBRELLALIAB OCCUR EACH OCCURRENCE
AGGREGATEEXCESSLIARCLAIMS -MADE
DEDUCTIBLE PRODUCTS - COMP/OP AGG
NEW HAMPSHIRE (CSL)
RETENTION $
B
C
D
F
WORKERS COMPENSATION
AND EMPLOYERTLIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? El
DNH)
Mandatory in
andunderyes, describe er
DESCRIPTION OF OPERATIONS below
NIA
WC 026149517, A,
WC 026149514 (FL)
WC 026149516 (MI)
WC 026149513 (CA)
WC 026149518 (MA, ND, NY, OH,
WA, WI, WY)
10/1/2010
10/1/2010
10/1/2010
10/1/2010
10/1/2010
10/1/2011X
10/1/2011
10/1/2011
10/1/2011
10/1/2011
WCSTATU- OTH-
T /MIT R
E.L. EACH ACCIDENT $2,000,000.00
E.L. DISEASE - EMPLOYE $2,000,000.00EAE
E.L. DISEASE - POLICY LIMIT $2,000,000.00
A Builders Risk/installation/Contract Works OC & OCW 91128600 5/1/2010 5/1/2011 USD $1,000,000.00 per jobsite
A Rental Equipment/Contractors Equipment OC & OCW 91128600 5/1/2010 5/1/2011 USD $1,000,000.00 per jobsite
Blanket Transit W 91128600 5/1/20105/1/2011 r conveyance
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Please refer to attached ACORD 101 for further remarks.
corlca,ATc unl r%CD CANCFI I ATInN
U 1Ut$t5-ZUUV AL:UKLJ I.VKYUKAI IUM.. All ngnis reserveo.
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
Generated by EXIGIS LLC. For more information visit www.exigis.com.
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 Ave
ACCORDANCE WITH THE POLICY PROVISIONS.
Sanford, FL 32771
AUTHORIZED REPRESENTATIVEUnitedStates
MARSH USA INC, BY: Franklin HaOock, Global Marine
David Kon Casualt Program T.
U 1Ut$t5-ZUUV AL:UKLJ I.VKYUKAI IUM.. All ngnis reserveo.
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
Generated by EXIGIS LLC. For more information visit www.exigis.com.