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HomeMy WebLinkAbout1105 Siginaw DrCITY OF SANFORD PERMIT APPLICATION Permit # : G%� Date: 3/ 14rt 0� Job Address: ' �1�5 IV�CJ-2� �✓ I\1� C�c3tY�_- �� rn�r,,,,.r t �� �5 Description of Work: Q��0.1 ✓ M2i �l �+'�" C�C�r��"moi Historic District: _� Zoning: Value of Work: S Aecl> 'C Permit Type: Building Electrical '>4 Mechanical Plumbing Fire Sprinkler/Alarm Pool Electrical: New Service - # of AMPS Addition/Alteration ( Change of Service Temporary Pole Mechanical: Residential Non -Residential Plumbing/ New Commercial: # of Fixtures Plumbing/New Residential: #of Water Closets Occupancy Type: Residential Replacement New (Duct Layout & Energy Calc. Required) , # of Water & Sewer Lines # of Gas Lines Commercial X_ Industrial Plumbing Repair - Residential or Commercial Total Square Footage: Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: (Attach Proof of Ownership & Legal Description) Owners Name &, Address: _` f� kq Q2t`� 4 �-i rj • U 1 5c -w C -u -� 10-7 /yM by'\ neQ, � "t ` o) Mme o*J. �-r Phone: 4 1 96007_ A �1 Contractor Name & Address: G ,�czkYt� ©State LicenseNumber: F-C CCC) lsb�l Phone & Fax:401 �� �^ O�(� X 12-9/1- )Contact Contact Person: ��1✓IS pv�� V Its Phone: Bonding Company: Address: Mortgage Lender: Address: Architect/Engineer: Phone: Address: Fax: 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. 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 pennits required from othergovernmental 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 ndarLien Law, FS 713. 7 Signature of Owner/Agent Date Signature of Contra\ctor/Agentt to Print Owner/Agent's Name Print Contractor/Agent's Name Signature of Notary -State of Florida Date Signatq�tnf�lary-State p���a,, e� {� NOTARY ? t L - STATE OF F I(IDA CAMMISSION # DD446174 ?, V. EXPI1ES 6/29/2009 Owner/Agent is Personally Known to Mea Conti it is Personal Know r t p� Produced ID Produced ID—)pA}rri'st�i! Si13�8-�1tA�Yt APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD`. (Initial & Date) (Initial & Date) (Initial & Date) (initial & Date) Special Conditions: f� Seminole County Property Appraiser Get Information by Parcel Number Page 1 of 1 Kik http://www.scpafl.org/web/re_web.seminole_county_title?PARCEL=2819305 RZOAOOOOO... 3/16/2007 ^4 OAViD J©MNSom. CPA, ASA PROPERTY a '` 4 APPRAISERSEMINOLE COUNTY FL,1 1701E. F►ersT ST SANF©Rt?, F13277i•7+Q 584G7-665 7506 {*:a 2007 WORKING VALUE SUMMARY GENERAL Value Method: Market Parcel Id: 28-19-30-5RZ-OA00-0000 Number of Buildings: 0 Owner: REGENCY OAKS OF SEM CO Depreciated Bldg Value: $0 Own/Addr: HOMEOWNERS ASSN INC Depreciated EXFT Value: $0 Mailing Address: 107 N LINE DR Land Value (Market): $10 City,State,ZipCode: APOPKA FL 32703 Land Value Ag: $0 Property Address: JustJMarket Value: $10 Facility Name: Assessed Value (SOH): $10 Tax District: S1-SANFORD Exempt Value: $0 Exemptions: Taxable Value: $10 Dor: 94 -RIGHT OF WAY/ROAD/DI Tax Estimator SALES 2006 VALUE SUMMARY Deed Date Book Page Amount Vac/Imp Qualified 2006 Tax Bill Amount: $0 QUIT CLAIM DEED 10/2006 06449 1429 $100 Vacant No 2006 Taxable Value: $10 DOES NOT INCLUDE NON -AD VALOREM Find Sales within this DOR Code ASSESSMENTS LAND LEGAL DESCRIPTION Land Assess Frontage Depth Land Unit Land PLATS: Pick._ Method Units Price Value LOT 0 0 1.00010. 00 $10 TRACT A (LESS RD) REGENCY OAKS UNIT ONE PB 68 PGS 88 - 92 Permits I 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. Kik http://www.scpafl.org/web/re_web.seminole_county_title?PARCEL=2819305 RZOAOOOOO... 3/16/2007 F- - This certificate is cxecuted by Liberty Mutual Insurance Group as resents such insurance w is afforded by those companies. BM0068 Certificate of Insurance This certificate a issued as a matter of information only and confer no rights upon you the certificate holder. This certificate is not an insurance policy and does not amend, extend, or alter the coverage affo ded by rim policies limed W- ow. This is to certify that (Name and address of Insured) Palmer Electric Company, FTAL 875 Jackson Avenue Winter Park, FL 327894610 , at the issue date fthis certificate, insured by the Company under the polloy(ies) listed below. The insurance afforded by the listed policy(ics) is sub) Liberty Mutual,. to all their terms, exclusions and conditions and is nor auereo ov amV r Ex iration Type Eff✓Es . Date(s) Policy Number(s) Limits of Liability Continuous* 10/012006 / 101012007 WC2.151-276128-1 16 Coverage afforded under WC law of Employers Liability Extended the following states: Bodily Injury By Accident rt. X Policy Term $500,000 Each Accident Buddy Injury By Disease $500,000 Policy Limit Bodily Injury By Disease Workers Compensation $500,000 Each Person 10/01/2006/ 10101P007 T132-151-276128.136 General Aggregate -Other than Prod/Completed Operations General Liability $2,000,000 Products/Completed Operations Aggregate $2,000,000 Made Bodily Injury and Property Damage Liability $1,000,000 Per Occurrence HClaims X Occurrence Retro Date Personal and Advertising Injury $1,000,000 Per Person / Organization Other Liability Other Liability $1,000,000 Dama a to Prem Rent $10,000 Med Pa 1 0101 /2006 1 1 0101 12007 AS2-151-276128-146 Each Accident - Single Limit - B. 1. and P. D. Combined. Automobile Liability $1,000,000 Each Person X Owned Each Accident or Occurrence X Non -Owned X Hired Each Accident or Occurrence Umbrella Excess Liability$4,000,OW 10/01/2006/10/0112007 TI -12-651-276128-126 Single 1Jm1I for BI & PI) Liability Over Underlying Limit C Additional Insured (GL) End. N CG 2033 and Desigmted Insured (Auto) End. NCA 2048: City of Sanford 300 No. Park Avenue Samford, Fl. O 32772 M M F, N T S alhhe certificate expiration date is continuous c r extended term, you will be notified if coverege is terminated or reduced before the certificate expiration data However, you will not be notified amually of the continuation ofe--rage. Special Notice - Ohio: Any person who, with intent to defraud or knowing that he / she is facilitating a fraud against an insurer, submits an application or felts a claim containing a false or deceptive stttemem is gnihy of inamance fraud. Important informa6on to Florida policyholders and certificate holders: in the —nlyou have any questions or need information about this certificate for any reason, plcase contact your local sales producer. whose name and telephom number appears in the lower left comer of this certificate. The appropriate local sales office mailing address may also be obtained try calling this number. Notice o cancellation: (not applicable unle. a number of days is entered below) , Before ate stated expiration dale the company will not cancel or reduce the insurance afforded under the above Policies until at (cast 30 days notice of such cancellation has been mailed m'. Office: LAKE MARY, FL Phone: 407-829-7951 t Certificate Holder. MARY BLAND Authorized Representative All, - Ma, -r 14"1 t i n o City of Sanford 300 No. Bark Avenue Sanford, FL 32772-1788 Date Issued: 09/26/2006 Prepared By: CM