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Home My WebLink About1043 Upsala Rd (2)Permit # Job Address: CITY OFSANFORD PERMIT APPLICATION Date: ® 91 A;i Description of Work: 45,!A /20 - Zsj am& Total Square Footage %%%: Historic District. "Zoning: Value of Work: S Permit Type: Building Electrical f�Mechanical Plumbing Fire Sprinkler/Alarm Pool _ Electrical: New Service I# of AMPS !W Addition/Alteration Change of Service Temporary Pole _ Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required) Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial Occupancy Type: Residential Commercial Industrial Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required Owners Name & A dress: _ %i�� GUG I Phone: S/v% 2/P"///lg Contractor Name & Address: J7.�1/G7fiyLrC�/ /3/jp��[� S gd . 161 Fj dUlzWx 4Q.- State License Number: f 4c 13Vv2_7y-0 Phone & Fax: �d7 �� 7/� Contact Person: 6�—�`-��Siv�.'T Ls Phone: A0277 Bonding Company: Address: Mortgage Leader. Address: Architect/Engincer: Address: Phone: Fax: Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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: 1 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. 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 1 will notify the owner of the property of the requirements of F rida i w. FS 713 4'4c Signature ofOwner/Agent Dale Sign re,FJonlract-A . L ent D c /� Print Owner/Agent's Name Alontractor/Agcrit' Name -/�-vSignature of Notary -State of Florida Date of Notary -S c of Florida Date BARBMA J FRANKS a W1 C4101111111DD0399573 awwas 211 &2=9 Owner/Agent is _ Personally Known to Me or Contractor/Agent is _ o feRir W0H32-4254` Produced ID Produced ID i Irlort0a Notary Assn., trio • ..............i APPROVALS: ZONING: Special Conditions: Rev 03/2006 UTIL: FD: ENG: BLDG:fjah V U C►t hk (IHUA 1 t VI'I LIAbIL1 I Y91N5UuKAN�t;t 3:02:45 PM PRODUCER (407)628-3441 FAX (407)539-0619 04/11/2006 Lassiter -Ware Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE of Orange/Seminole, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO Box 940159 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Maitland, FL 32794-0159 INSURERS AFFORDING COVERAGE INSURED Structured Broadband Services, LLC INSURERA NAIC,# United States Fidelity & Guar 25887 308 Aul in Avenue INSURERS Auto Owners Oviedo, FL 32765 IN'SURERc Everest National 18988 A WKr_R D INSURER E COVERAGES THE POLICIES OF INSURANCE I I4TFn ACI nru uw. ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WIIQQ-Vtu IV THE INSURED TH R SPECTT TO WHICHD ABOVE FOR THEITHIS ''I 11)111J1)ICATE CERTIFICATE MAY BE IS8UEp A DING MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIO S OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR ADD'rGENERAL PE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE I POLICY EXPIRATION ABILITY 1 -680 -3256C292 -TIL -06 04/13/2006 04/13/2007 EACHOCCURRENCELIMITs RCIAL GENERAL UABILTTY AIMS MADE M OCCUR DAMAO TO RENTED S 300, 000 A WED EAP (Arty one person) T 10 nnn DESCRIPTION PERSONAL 6 ADV YJ.ARY $ 1 000 GENT AGGREGATE L APPAPPLIES PER GENERAL AGGREGATE S 21000 ,000 X POLICY LOC PRODUCTS • COMPIOP AGG f 2,000 AUTOMOBILE LIABILITY ANY AUTO ALL 46-303-853-00 03/23/2006 03/23/2007C 0"'BINEDswGLELItiuT (Ee acadent) S owrvED Auros11000 A X SCHEDULED AUTOS BODLYN,AIRY X HIRED AUTOS (Per Person) f X I`OKOVVNEDAUTOS BODLYINJURY (Per accident) f PROPERTY DAMAGE GARAGE LIABILITY (Per accident) _ ANY AUTO NO COVERAGE AUTO ONLY. EA ACCIDENT S OTHER THAN EA ACC S EXCESSIUMBRELLA LIABILITY AUTO ONLY. AGO _ X OCCUR CLAIMS MADE EACH OCCURRENCE $ S 000 A -680-3256C292-TIL-06 04/13/2006 04/13/2007 AGGREGATE s 5,000, DEDUCTIBLE s RETENTION $WORKE S SCOMPENSATIONAND EMPLOY EMPLOYERS' LIABILITY 2700007587-061 04/1 3/2006 04/13/2007 )( OR f B ANY PROPRIETORIPARTNERIEXECUTIVE T OFFICERIMEMBER EXCLUDED? E.L. EACH ACCIDENT $ 1,000, II s. descM)e odorWSIO S�EGAL PROvISKNJS tYNow E.L dSEASE . EA EMPLOYEE S 1 1 000 OTHER E.L. DISEASE • POLICY LMT S 1.000- .000_ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISION IS City of Sanford 300 N Park Avenue P.O. Box 1788 Sanford, FL 32772 ACORD 25 (2001/08) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _IQ— DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. 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