HomeMy WebLinkAbout206 McVay Dr (3)Permit # : C),A`
Job Address:
CITY OF SANFORD PERMIT APPLICATION
Date: -S
Description of Work: "JI rviA,t7 `a 5 4 Ze— `For S, Z.�
Historic District: Zoning: _ Value of Work: $ L4 W
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS 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 ,,,)r Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: 0 1- --U- JI -7t) V
s -- L%"
7\
(Attach Proof of Ownership & Legal Description)
Owners Name & Address: �'t) %
t±�ING-Ne
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Phone: 1.V t" �"3-
Contractor Name & Address--
67
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State License Number: C[ t / �S -
If
,
C1
Phone & Fax:
C
act sI
A
Phone:
Bonding Company:
j
Address:
Mortgage Lender:
-- -MAY
2004
Address:
Architect/Engineer:
u-. _
Phone:
Address: , Fax:
Application is hereby made to obtain a permit to do the workU, LUQ 1 iVi ated� 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 regu ing 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 taws regulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT INT YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER. 0).2 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.
Acceof the requirements of Floridan L FS 713.
Signature f Owner/Agent Date Signature of C tractor/Agent Date
*nwner,Agent's Na e I Prin
-/J L/ N Date Si
COMMISSION # DD 188491 I-
XPIRES: February 25, 2007 FL Notary Discount Assoc. Co. e or Cont
Produced ID h t /i /I n U- ��G�', (p a t
6*VP- 1 /4/O
APPLICATION APPROVED BY: Bid;-- 6 Zoning:
(Initial & Date) (Initial & Date)
Special Conditions:
DEBBIE BLANTON
I&
: I*ebruary 25, 20(
FI, Notary Dtsi bunt a�e_
�'//-0
Date -
actor/Agent is _ Personally Known to Me or
Produced ID
_ Utilities: FD:
(Initial & Date) (Initial & Date)
S C0
Seminole County Property Appraiser Get Information by Parcel Number Page 1 of 1
PARCEL DETAIL
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Sanford VI.Ar'll
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GENERAL
2004 WORKING VALUE SUMMARY
07-20-31-505-OE00
Value Method: Market
Parcel Id: 029A Tax District: S1-SANFORD
Number of Buildings: 1
Owner: COBERLY SUSAN E & Exemptions: 00-
HOMESTEAD
Depreciated Bldg Value: $68,772
Depreciated EXFT Value: $0
Own/Addy: COBERLY MAX W
Land Value (Market): $17,500
Address: 206 MCVAY DR
Land Value Ag: $0
City,State,ZipCode: SANFORD FL 32773
Just/Market Value: $86,272
Property Address: 206 MC VAY DR SANFORD 32771
Assessed Value (SOH): $63,166
Subdivision Name: SANORA UNITS 1 + 2 REPLAT
Exempt Value: $25,000
Dor: 01 -SINGLE FAMILY
Taxable Value: $38,166
SALES
2003 VALUE SUMMARY
Deed Date Book Page Amount Vac/Imp
Tax Value(without SOH): $1,180
WARRANTY DEED 10/1986 01786 1470 $66,700 Improved
2003 Tax Bill Amount: $772
QUIT CLAIM DEED 08/1985 01675 0922 $100 Improved
Savings Due To SOH: $408
WARRANTY DEED 08/1980 01295 0019 $50,000 Improved
2003 Taxable Value: $36,988
WARRANTY DEED 05/1980 01280 0733 $35,800 Vacant
DOES NOT INCLUDE NON -AD VALOREM
Find Comparable Sales within this Subdivision
ASSESSMENTS
LAND
LEGAL DESCRIPTION PLAT
Land Assess Method Frontage Depth Land Units Unit Price Land Value
LEG E 23 FT OF LOT 29 & ALL LOT 30 (LESS ELY
20 FT) BILK E SANORA UNITS 1 & 2 REPLAT
LOT 0 0 1.000 17,500.00 $17,500
PB 17 PG 12
BUILDING INFORMATION
Bid Num Bid Type Year Bit Fixtures Base SF Gross SF Heated SF Ext Wall Bid Value Est. Cost New
1 SINGLE FAMILY 1981 6 1,140 1,900 1,140 CONC BLOCK $68,772 $75,574
Appendage / Sgft GARAGE FINISHED/ 660
Appendage / Sgft OPEN PORCH FINISHED/ 100
NOTE: Assessed values shown are NOT certified values and therefore are subject to change before being finalized for ad valorem tax
purposes.
*** If you recently purchased a homesteaded property your next ear's property tax will be based on Just/Market value.
http://www.scpafl.org/pls/web/re—web.seminole—county title?PARCEL=0720315050EOOO2... 5/6/2004
IN
K
AT-HOME
SERV! :*%
This letter will authorize the following person(s) to act as agent(s) on behalf of
RMA Home Services, Inc., D/B/A The Home Depot Installed Sales, 3200 Cobb Galleria
Parkway, Suite 200, Atlanta, GA 30339 to pull and sign for permits and inspections with
respect to the installation, maintenance and repair of windows and siding under Florida
State Building Contractor license number CR C058500.
Authorized person(s):
Angelo Santiago
Angela Lawson Santiago
ao(c� Or�QC
ualifier-Bill Charles Bertier
RMA Home Services, Inc.
D/B/A The Home Depot Installed Sales
STATE OF FLORIDA
COUNTY OF HILLSBOROUGH
The foregoing instrument was acknowledged before me this 26th day of April,
2004, by Bill Charles Bertier.
Notary Public -State of Florida
Kim DeRose
Printed Name:
3 -a) -0k0
My Commission Expires:
• •�5,C1�)' '°°� •KINt•E.....
M. DE ROS
: o.� ` °'"''-
s �$
Commission # DD0143837
ExPiMs 8/21/2006
W!
Bonded thrw9h
"F�orida
Notary Assn.. Ind•
800-432.4254)
........... .•...•.........
i.....•.•..........
Personally Known_ Or Produced Identification
Type of Identification Produced
THD At -Home Services, Inc.
3200 Cobb Galleria Parkway • Suite 200 • Atlanta, GA 30339
(770) 779-1300 • Fax (770) 984-0709 • Toll Free 1-877-469-0114
_______tIaME IMPROVE ENT INSTALLATION CONTRACT
6 i Branch Name: � Date:
- _W - . Sold, Furnished & Installed. by: "
The Home Depot At -Home Services
Branch Number Job #: __Xc. z Jr' ; / 1212 North 39"' Street, Suite 402 Tampa, FL 33605
(813) 247-1300; Fax: (813) 247-1313
FL Lic # CR C05850
Installation Address:
CityState Zip
Purchaser s): SS#: Driver's Lic. # & Exp: Date: Work Phone: Home Phone:
Home.Address:
(if different from Instalfatton. Address) City State Zip
Proiect Information I/We ("Purchaser"), the owners of the property located at the above installation address, offer to
contract with Home Depot U.S.A. Inc. ("Home of furnish, deliver and arrange for the installation of all materials as
described on the attached Spec Sheet # 9? � � incorporated herein by reference and made a part
hereof.
Home Depot. reserves the right to cancel this contract if, upon re -inspection of the job, Home Depot determines that it
cannot perform its obligations due to a structural problem with .the home or because work required to complete the job
was not included in the contract,
DEPOSIT PAYMENT OPTIONS
(Subject to fund verification and/or credit approval.)
L Check, Cashiers Check or US Postal Service Money Order
CONTRACT AMOUNT $5 y _ (made payable to The Home Depot).
*LESS DEPOSIT $ 2• Credit Card* and/or other payment options - Circle One Below
m
Visa, MasterCard Discover , American Express
BALANCE DUES i
ON COMPLETION $ Home Improvemennt/t Loan Home
Home Depot Credit Card
Available Credit: S ( Ctf CT ( HIL & HDCC ONLY)
*Minimum 25% of Contract Amount due upon Acct#:(OO j 5.J 6al"g Z ��'
xpDate:,
- execution of this contract.
Name as it appears on card:,Lk
�,;,4,(,} Z.,
*By my/our signature below, I/We agree to allow. The Home Depot to charge the
Indicate Payment Method For above referenced credit card rhe deposit indicated.
BALANCE DUE ON COMPLETION BELOW F s
te" 00
!Cffardhol ers Signature ate
.
HIL or HDCC Authorization Codes
Deposit
Final Paymont
Not withstanding the terms set forth in the Payment provision of the agreement, should any action be required on the part of
either party to this Agreement to enforce -is rights under the Agreement, the prevailingparty in. such an action will not be -
entitled to an award of attorneys fees and costs in connection with such action: Purchaser agrees that,immediately upon satisfactory
completion of the work, Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and
severally obligated and liable hereunder.
Entire Aureement: This agreement and its attachments, including any financing agreement, contain the complete agreement between the
parties and can not be amended or modified unless in writing in, a separate agreement signed by both parties.
NOTICE TO PURCHASER
Do not sign this contract before you read it. Do not sign this Agreement if blank. You are entitled to a copy of this Agreement at the'
time You sign it. You should keep it to protect your rights. This agreement may contain a mortgage or otherwise create a lien on
your property that could be foreclosed on if You do not pay. Be sure You understand all provisions of this Agreement before You
sign it. Do not sign any Completion Certificate or agreement stating that you are satisfied with the entire project-.beforethis project
is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner
prior to the actual completion of the work to be performed under the contract.
You may cancel this transaction at any time prior to midnight of the third business day after the date of this contract. See Notice of
Cancellation for an explanation of this "right. There will be a service charge equal to 23% of the contract amount if the job is
cancelled by Purchaser AFTER the third. business day.
BY MY/OUR SIGNATURE BELOW, I/WE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. I/WE ACKNOWLEDGE
RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION.
11 1
BY MY/OUR SIGNATURE BELOW, I/WE UNDERSTAND THAT THE AGREEMENT IS SUBJECT TO REVIEW OF MY/OUR
CREDIT HISTORY AND I/WE AUTHORIZE HOME DEPOT TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN
INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED. FROM
INADVERTENT OMISSIONS OR RORS.
SUBMITTED B A09: 16 1 N
Date: G% .
Const
AA09: 16 CF
,...., Date: �� � Mp
ACCEPTED BY
Homeowner
- ` t,, J Date:
Homeowner
NOTICE: ADDITIONAL TERMS, CONDITIONS AND WARRANTIES ARE STATED ON THE REVERSE SIDE AND ARE, PART OF THIS CONTRACT
01-15-04 C -SC
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.Florida Building Code Online
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C*Mmnity
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Page 1 of 4
The flvrida iiepartment of Commujw
nity Affairs
B�ilaf���► Code. fn�forma�iox� sem
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Overview Product Search OrganizationProduct
arch"',---,APR1!catioh1 Attachments
UZI
User: Public User - Not Associated with Organization -
Need Help ?
Application #: FL143
Date Submitted: 09/19/2003
Product Manufacturer: Simonton Windows
Address/Phone/email: 1 Cochrane Ave
Pennsboro, WV 26415
Technical Representative:
Technical Representative Address/Phone/email:
Quality Assurance Representative:
Quality Assurance Representative
Address/Phone/email:
Category:
Subcategory:
Evaluation Method:
Chuck Anderson
1 Cochran Ave..
Pennsboro, WV 26415
(800)746-6687
chuck—anderson@siinonton.com
AAMA
1827 Walden Office Square
Suite 550
Schaumburg, IL 60173
(847)303-5664
webmaster@aamanet.org
Windows
Double Hung
Certification Mark or Listing
Referenced Standards from the Florida Building Code: Section Standard Year
101/I.S. 2 1997
Certification Agency:
Quality Assurance Entity:
Validation Entity:
Date Validated:
Authorized Signature:
American Architectural
Manufacturers Association
09/19/2003
Chuck Anderson
http ://www. floridabui lding. org/pr/pr_detl. asp?IPT=143 &fin=RO Srch
1/19/2004
' Florida Building Code Online
Performance level of the product and conditions or
limitations of use:
Evaluation/Test Reports Uploaded:
Installation Documents Uploaded:
Product Approval Method:
Application Status:
Page:
Go''
Page 2 of 4
Chuck—Anderson@siinonton.com
07-07 40 X 64 H -R50 07-70 36 X
60 H -R50 07-70 52 X 71 H -R50
07-70 47 X 71 H -R50 07-75 48 X
80 H -R35 07-75 53 X 74 H -R30
07-80 56 X 80 H-LC25 07-80 48
X 80 H -R25 07-80 48 X 80 H -
R30 40-17 36 X 60 H -R45 40-17
44.25 X 60 H -R35 40-17 36 X 74
H -R50 40-17 48 X 80 H -R30 40-
17 44 X 60 H -R30 40-17 52 X 71
H -R35 40-17 89 X 60 H -R30 40-
17 96 X 80 H -R25 40-17 72 X 74
H -R45 40-17 44 X 60 H -R45 40-
17 72 X 60 H -R35 75-75 48 X 80
H -R25 75-75 48 X 96 H -R25 75-
75 36 X 74 H -R50 75-75 36 X 72
H-LA55 75-75 52 X 71 H-LC35
75-75 56 X 84 H-LC25 75-75 36
X 60 H -R50 SP 52 X 50 H -R50
SP 37 X 76 H -R65
Method 1 Option A
Approved
Pagel / 2��
Product Model # or Name
Model Description
Reflections 5500; Prism Platinum; Private
Label Premiere; Sears 9300 - Vinyl - Size:
7-07
40 X 64; Reinforcement: Aluminum
Meeting Rails or Stiles; Raring: H -R50;
/32" Glass
Reflections 5500; Prism Platinum; Private
7-70
Label Premiere; Sears 9300 - Vinyl - Size:
7 X 71; Reinforcement: Aluminum all
Rails; Rating: H -R50; 1/8" Glass
Reflections 5500; Prism Platinum; Private
7-70
Label Premiere; Sears 9300 - Vinyl - Size:
6 X 60; Rating: H -R50; 3/32" Glass
Reflections 5500; Prism Platinum; Private
7-70
abel Premiere; Sears 9300 - Vinyl - Size:
2 X 71; Reinforcement: .036 Steel all Rails
Stiles; Rating: H -R50; 1/8" Glass
Renovations 6500 - Vinyl - Size: 53 X 74;
7-75Reinforcement:
Aluminum Meeting Rails or
Stiles; Rating: H -R30; 1/8" Glass
Renovations 6500 - Vinyl - Size: 48 X 80;
7-75Reinforcement:
Aluminum Meeting Rails or
Stiles; Rating: H -R35; 1/8" Glass
http://www.floridabuilding.org/pr/pr_detl.asp?IPT=143&fin=ROSrch 1/19/2004
Florida Building Code Online
Page 3 of 4
http://www.floridabuilding.org/pr/pr_detl.asp?IPT=143 &fin=ROSrch
1/19/2004
Reflections 5100; Prism Gold; Sears 3000 -
07-86
Vinyl - Size: 48 X 80; Reinforcement:
Aluminum Meeting Rails or Stiles; Rating:
-R30; 1/8" Glass
Reflections 5100; Prism Gold; Sears 3000 -
7-80
vinyl - Size: 56 X 80; Reinforcement:
Aluminum Meeting Rails or Stiles; Raring:
-LC25; 3/32" Glass
Reflections 5100; Prism Gold; Sears 3000 -
07-80
Vinyl - Size: 48 X 80; Rating: H -R25; 3/32"
Glass
uminess 4500 Reflections 5050; Prism
ronze; Basic Private Label; Simonton
0-17
pressions; Renovations 6100; ProFinish
Contractor; Luminess 700 - Vinyl - Size: 89
60; Reinforcement: Aluminum Meeting R
Luminess 4500 Reflections 5050; Prism
Bronze; Basic Private Label; Simonton
0-17Impressions;
Renovations 6100; ProFinish
Contractor; Luminess 700 - Vinyl - Size: 44
-X
60; Rating: H -R30; 3/32" Glass
Luminess 4500 Reflections 5050; Prism
Bronze; Basic Private Label; Simonton
0-17Impressions;
Renovations 6100; ProFinish
Contractor; Luminess 700 - Vinyl - Size: 96
80; Reinforcement: Aluminum All Rai
Luminess 4500 Reflections 5050; Prism
Bronze; Basic Private Label; Simonton
0-17Impressions;
Renovations 6100; ProFinish
Contractor; Luminess 700 - Vinyl - Size: 52
71; Reinforcement: .03 6 Steel all Ra
Luminess 4500 Reflections 5050; Prism
Bronze; Basic Private Label; Simonton
0-17Impressions;
Renovations 6100; ProFinish
Contractor; Luminess 700 - Vinyl - Size: 44
60; Reinforcement: Aluminum All Rail
Luminess 4500 Reflections 5050; Prism
Bronze; Basic Private Label; Simonton
0-17
pressions; Renovations 6100; ProFinish
Contractor; Luminess 700 - Vinyl - Size: 72
60; Rating: H -R35; 3/32" Glass
uminess 4500 Reflections 5050; Prism
Bronze; Basic Private Label; Simonton
0-17Impressions;
Renovations 6100; ProFinish
Contractor; Luminess 700 - Vinyl- Size:
.25 X 60; Reinforcement: Aluminum
eetin
Luminess 4500 Reflections 5050; Prism
Bronze; Basic Private Label; Simonton
0-17
pressions; Renovations 6100; ProFinish,
ontractor; Luminess 700 - Vinyl - Size: 48
80 Reinforcement: Aluminum All Rail
Luminess 4500 Reflections 5050; Prism
Bronze; Basic Private Label; Simonton
0-17Impressions;
Renovations 6100; ProFinish
Contractor; ProFinish Master; Luminess
00; Luminess 800 - Vinyl - Size: 36 X 74;
uminess 4500 Reflections 5050; Prism
http://www.floridabuilding.org/pr/pr_detl.asp?IPT=143 &fin=ROSrch
1/19/2004
Florida Building Code Online
P ,
i
Page 4 of 4
Bronze; Basic Private Label; Simonton
0-17 pression; Renovations 6100; ProFinish
Contractor; Luminess 700 - Vinyl Size: 36
60; Rating: H -R45; 3/32" Glass
Luminess 4500 Reflections 5050; Prism
ronze; Basic Private Label; Simonton
0-17Impressions; Renovations 6100; ProFinish
Contractor; Luminess 700 - Vinyl Size: 72
74; Reinforcement: Aluminum All Rai
N
` Co right and Disclaimer ; 02000 The State of Florida. All rights reserved. zr
M;:a>r�mSis3_..
i
http://www.floridabuilding.org/pr/pr detl.asp?IPT=143&fin=ROSrch 1/19/2004
M00F7p 5S'NATION: Simonton Double Hung Series 75-75/07-75 Vinyl Window
# AAAXiUC'M CVF4AL1 NOMINAL SiZ Single up to 53" x 74'N
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- 1GN PRESSURE RA'SvG: Anchors: Positive 55.0 PSF Negative 55.0 PSF MASGNRY L1Nrcr_ 2.0" MIN.
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1 " x 2" cv
WindawS: Design Pressure Rctings Vary; See N F'!jRRING ui
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Code NOA or. Floridc P.c..Evcluation. - Rr<IN _
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NE'?AL DESC�IPT1C,+l:
:` 3" x 3/16" l`APCC1V
f me head and side jambs aro extruded _ o z TYPE A,\ICHCR a $
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P'/C. The well thickness thrcugh which4 N c , c, a N
SILICONE I --o o`
the anchor screw penetrates is a CAULK OR; HALL f C.. rn
minimum of 0.070": 1, x 6" i
1/4" MAX. SHIM A
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SILICONE CAULK
° 1 ' 6" HEACER JAMB 3 112" x 3/16' T•APCON
TYPE ANCHOR v u'S
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SASH TRACK 1.25'• MiN. EMB. 1/4" MAX. SHIM > N
...1 HEAD JAMB ....:
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SILICONE CAULK 3 m
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a 3 1/2" x 3/16" TAPCON c c CV
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MASONRY O
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EXTERIOR v: • 1 Q:LLJ
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NOTE: 1. This installation has been evaluated for use in locations adhering to the Florida 'Building Code
a
and, where pressure requirements as determined by ASCE 7 Minimum Design Loads for Buildings
1 °teed the design 'pressure ratings listed herein.
2. For installations where the sub �%au,t olNc =
g. � .. and Other Structures do not ex
-buck is less than 1-1/2" (F9C section 1707.4.4 Anchorage Methods CONSULTANTS. INC
9 and sub -sections 1707.4.4.1 and 1707.4.4;2) Tapson type concrete anchors must be used and theBtJ.o59.9i97 L
'length mut be such that` a minimum -1-1/4'" engagement of the Topcon into the masonry wall is obtained. a
All interiors and exterior perimeter e surfaces of >the window must be caulked.
,4 - _ _ c urer's' Installation-tl SCALE: 4N T.
3. z
4. See Monufa tInstructions additional hardware �anchorrrig IF required:
s.
DWG. BY iJH
6. When thepeptional Hecd Expenders are used the installer Must minimum 2.0"he I anchor le
mortar joints. �
5. Adjust To con anchor locations, if necessary, to maintain a
Must Adiust the anchor length to maintain the CHK. a R.
53.0 MAX. OVERALL FRAME WiDTH required minimum embedment into the substrate. D+zawtrvc wa.:
• S—ttSRt
CMCR 1 t
I
•.,._ t loaf I loll to 110 11 0l111 a!i i W-`- • • v
l ole a oat n law a lie n sit ate as at
Name: RMA Home Services of
Delaware, Inc.
Address: 3200 Cobb Galleria Pki-. Ste. MARYANNE MORSE, CLERK OF CIRCUIT COURT
zoo, Atlanta. GA 30339 SEMINOLE COUNTY
BK 05300 PG 0432
This Instrument Prepared By: CLERK'S # 2004072643Name: Peggy Pane RECORDED 05/11/2004 02149158 PM
Address: 3200 Cobb Galleria Pkv. Ste. RECORDING FEES 6.0
200, Atlanta, GA 30339 RECORDED BY $ holden
Property Appraisers Parcel Identification:
NOTICE OF COMMENCEMENT
Permit No %D /—., ju 1/
Folio No.
STATE OF FLORID_
COUNTY OF
The undersigned giN es 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 COMnIENCEMENT.
des �ript Ill I I a opem�(in_ c_ 1�de street address if a� ailable ea,4J � WlU �'e /// zd 7, 3d
General description of improvement: O,�r> /��.ao . , ✓__.. , _ . ��� 1 vK
Owner Information - nameand address: n '�. . a -Z'
(
Interest in Property: `y ./Y L Ej
Name and address of fee simple titleholder (if other than Owner): tc POSE
U AT COURT
Contractor — name and address: The Home De of Installed Sales OE
CO"T" Uft�
207 Kelsey Lane, Suite G, Tamp�FL619Phone Number.13-630-Fai Number: 813-630-4112
Surety - name and address.
Lender - name and address: 1:163�j 16WO4
Phone Fax Number: Amount of
Number:
_ fond: $
Persons within the State of Florida designated by Owner whom notices of other documents may be sen ed as provided by
713.13(1)(a)7., Florida Statues: - / I / . ' Al,ame and address: -,J L/_ S/�i7 ` %ZJ�i� /`�/i� V JA i. ko �.z ,! /)�• /l�/ , i
Phone Number: Fax Number:
In addition to himself Owner designates of
to receive a coPy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statures. (Fill in at Owner's option)
Phone Number: Fax Number:
Expiration date of Notice of Commencement (the expiration date is 1 year from the date of recording unless a different
date is specified).
Sworn to and subscribed before me by who is personally known to me or produced
as identification, and who did take an oath, this f- day of . 20�.
Signature of Notar-,.
State of Florida
PrinlPd Name of Nntarv-
Commission No./Expiration:
.......... ................o.. n.o.......u..n..g
;,nr nu KIM M. DE ROSE
Signature of Owner`' - Si afore of Owner
i
Printed Name of Owner .`j t, c ,j a t3 f; l_
Printed Name of Owner
Sworn to and subscribed before me by who is personally known to me or produced
as identification, and who did take an oath, this f- day of . 20�.
Signature of Notar-,.
State of Florida
PrinlPd Name of Nntarv-
Commission No./Expiration:
.......... ................o.. n.o.......u..n..g
;,nr nu KIM M. DE ROSE
=o`
Commission 0 OD0143837
Expires 8/21/2006
Bonded through
"(804432-4254) Florida Notary Assn., InC.
5...........f .......................................5