HomeMy WebLinkAbout810 S Palmetto Ave (2)CITY OF SANFORD PERMIT APPLICATION RECEIVED
Application #: Imo' 1 Submittal Date: �' - A P R — 9 2007
Job Address: ��O S • •4 cM� t 1� "� Value of Work: $
Parcel ID: Zoning: Hist051c DistSict:
`` -- -- _ .� c_ . S G �C C.
Description of Work:_:S % e- D!'i;�t � Fri : �; Lt.� v�J� Square Footage:
................. 0.....................................................................................................
Permit Type: Building Electrical ❑ Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
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
Occupancy Type: Residential ❑ Commercial ❑
Industrial ❑
Construction Type: # of Stories: # of Dwelling Units:
Plumbing Repair —Residential ❑ Commercial ❑
Occupancy Use Group(s):
Flood Zone: (FEMA form required)
........................................................................................................................
Property Owner: J�CT -U _=7i/ Contractor:
Address: �� P%l t/ CJ Address:
if; its E-mail !�L-�ur.'Yy ✓-f c .`C ��
Phone:
Bonding - 1V7 STZ-3 yl3
g Company:
Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
ea`J Phone:
Mortgage Lender:
Address:
Phone: Fax:
State License Number:
Phone:
Fax:
0.
E-mail-
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. 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.
;i
Acceptance of permit is ve ' tcatio will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
.�--
ignature of Owner/Agent` J~ Date Signature of Contractor/Agent Date
Print k er/Agent' ame
Signature of Notary- tate o lorida Date
t tj ���!
Ow is MY Ct'RY�K41�4f1M 6 . e or
'Ip EXPIRES: F
1.8MMorcer FLN.-gDis0p„mtA�Co.
APPROVALS: ZONING:
Special Conditions:
Rev 02/2007
Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
Contractor/Agent is _ Personally Known to Me or
Produced ID
FD: ENG: BLDG:
a
Code violations found during inspection
are required to be corrected.
Plan/permit issuance does not grant
proval of a code violation. 2004
C109.1
L��cs� 1�4f1�
Structural plan review is limited to a
general survey for code compliance. No
review is implied nor was taken to
verify structural adequacy
�Mtiv
«� OFFIC
l�:yc.ic Lei
Ad'
�se,wt
PLANS`RE�IEWED
CITY OF SA,NFORQ
L, -,j 'n't 6 /(.a.1,4
e"A f 4F, -u fs
wp s W114
PERMIT ��' IldZ
Install electricai outlets spaced no more
that 12' apart and with no point on the
wall more than 6' from an outlet.
5 NEC 210.52 (A) (1)
,Ld I -LA/ LQa
WX YZ"
Install a new exterior receptacle outlet
if the existing exterior receptacle outlet
is enclosed within the new enclosed
Space per 2005 NEC 210.52(E).
t
Exterior receptacle required on the front
and rear of the dwelling unit.
NEC 210.52 (e)
SarAC-i ,Fo
AA" Fly., s e.
N
/� w/e- IM .
0011— _
-'O�)
When the existing exterior lighting
outlet is within a new enclosed space,
provide a new exterior lighting outlet at
the new entrance or exit door. 2005
NEC Article 210.70(2)(b)
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R.O. 72"
4 1..2" STILES
4 t/2 TOP RAILS
i 1t2 BOTTOM RAIL
118 DOUBLE STRENGTH GLASS
I
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R.O M"
DOUBLE INSWING CASEMENT WINDOW
8
'121_ _
DRAWN: CCS, INC. BARRY D. PORTNOY
�1H LICENSED PROFESSIONAL ENGINEER
ADAM P�iRTNOY ii' 200 N4. LAUREL AVE. ,(;
309 LAKE FAIR LANE j' jf 576 MAJOR BOULEVARD
,i: SANFORD, FL 32771 �, ORLANDO, FL 32819
WINTER PARK FL, 32789 ? !I PE 0018258
APPENDIX 13-D
FLORIDA ENERGY EFFICIENCY CODE FOR BUILDING CONSTRUCTION
FORM 60OC-04 Residential Limited Applications Prescriptive Method C CENTRAL 4 5 6
Small Additions, Renovations & Building Systems
..1i :,ti ne,.
- -- „gyp - � t c ; ua c,yy cmuerrcy uoue may De demonstrated by the use of Form 60OC-04 for additions of 600
square feet or less, site -installed components of manufactured homes, and renovations to single- and multiple -family residences. Alternative methods are
provided for additions by use of Form 600B-04 or 600A-04. a /
PROJECT NAME: A/L ,L t° BUILDER:
AND ADDRESS: IS. .Ll2 Q PERMITTING CLIMATE
.5 R„! �, _37 J- / OFFICE: ZONE: 4 11 5 11 60
OWNER: Ailt-" r';.J w PERMIT NO.: JURISDICTION NO.:
SMALL ADDITIONS TO EXISTING RESIDENCES (600 square feet or less of conditioned area). Prescriptive requirements in Tables 6C-1, 6C-2, and 6C-3
apply only to the components of the addition, not to the existing building. Space heating, cooling, and water heating equipment efficiency levels must be met
only when equipment is installed specifically to serve the addition or is being installed in conjunction with the addition construction. Components separating
unconditioned spaces from conditioned spaces must meet the prescribed minimum insulation levels. RENOVATIONS (Residential buildings undergoing ren-
ovations costing more than 30% of the assessed value of the building). Prescriptive requirements in Tables 6C-1 and 6C-2 apply only to the components
and equipment being renovated or replaced. MANUFACTURED HOMES AND BUILDINGS. Only site -installed components and features are covered by
this form. BUILDING SYSTEMS. Comply when complete new system is installed.
1. Renovation, Addition, New System or Manufactured Home
2. Single-family detached or Multiple -family attached
3. If Multiple -family -No. of units covered by this submission
4. Conditioned floor area (sq. ft)
S. Predominant eave overhang (ft.)
6. Glass type and area: 4- /ev,s;AA,
a. Clear glass AP/,.ts " A= ARZ rf& Akx4
b. Tint, film or solar screen y�
7. Percentage of glass to floor area�//�``_% �'JT'=
8. Floor type and insulation: r7e_ -t- ST K &7' T!� ie
a. Slab -on -grade (R-value)Se
b. Wood, raised (R -value) -
c. Wood, common (R -value)
d. Concrete, raised (R -value)
e. Concrete, common (R -value)
9. Wall type and insulation:
a. Exterior: 1. Masonry (Insulation R -value)
2. Wood frame (Insulation R -value)
b. Adjacent: 1. Masonry (Insulation R -value)
2. Wood frame (insulation R -value)
c. Marriage Walls of Multiple Units` (Yes/No)
10. Ceiling type and insulation:
a. Under attic (Insulation R -value)
b. Single assembly (Insulation R -value)
11. Cooling system*
(Types: central, room unit, package terminal A.C., gas, existing, none)
12. Heating system*
(Types: heat pump, elec_ strip, natural gas, LP -gas, gas h.p., room or PTAC,
existing, none)
13. Air distribution system*
a. Backflow damper or single package systems* (Yes/No)
b. Ducts on marriage walls adequately sealed* (Yes/No)
14. Hot water system:
(Types: elec., natural gas, other, existing, none)
Pertains to manufactured homes with site -installed components.
Please Print CK
1. Ke-NflclA4i-e 4A cll9sv.!
2. .S�tEr%.duc i
3. "-
4. / 5tL sa
I. Single Pane Double Pane
Paid, j9 sq. ft. sq. ft.
6b. sq. ft sq. ft.
7. %
8a.
R =
lin. ft.
8b.
R = //
/4<2 sq. ft -
8c.
R =
sq. ft.
8d.
R =
sq. ft.
Be.
R =
sq. ft.
9a-1
R =
sq. ft.
9a-2
R=
it US sq. ft -
9b -1
R =
sq. ft.
9b-2
R =
! /.i sq. ft.
9c.
10a.
R =
!�? / .1Z sq. ft.
10b.
R =
sq. ft.
/
�r
11.
Type:
12.
SEER/EER�/: ^a
Type: A
HSPF/COP/AF_ vm ff '
13a.
�%Q S ,
13b.
14.
Type:
AIC -
e -EF:
I hereby certify that the plans ands 'f' o covered by the calculation are in compliance with Review of plans and specifications covered by this calculation indicates compliance with the Florida
the Florida de. K ,/`AT_E.J / Energy Code. Before construction is completed, this building will be inspected for compliance in
fN �-® accordance with Section 553.908, F.S.
DATE:
BUILDING OFFICIAL:
I hereby ce his di in com a with the Florida Energy Code: fl
OWN AGENT: = DATE: 6/ DATE:
FLORIDA BUILDING CODE - BUILDING
13-D.35R
APPENDIX 13-D
Climate Zones 4, 5, 6
TABLE 6C-1: PRESCRIPTIVE REQUIREMENTS FOR SMALL ADDITIONS (600 Sq- Ft. and Less), RENOVATIONS TO EXISTNG BUILDINGS AND SITEANSTALLED COMPONENTS OF MANUFACTURED HOMES
COMPONENT
MINIMUM
INSULATION
INSULATION
INSTALLED
J
3
Concrete Block
Frame, 2'x 4'
Frame, 2'x 4'
Common, Frame
Common, Masonry
R-5
R-'11
R-19
R-11
R-3
z_
Central A/C - Split
SEER= 10.0
SEER =
0
c�7
_Z
J
tWj
Under Attic
Single Assembly; Enclosed
Frame
Metal Pans
Single Assembly; Open
Common, Frame
R.yp
R-19
R-13
R-10
R -it
2'-.87 P-.78 &-.87 T-.78 4'-.87 3'.-.78
T-.75 U-.61 -- 2'-.75 V-.61 X-.75 2-.61
U-.57 V-.57 0'-.44 2'-.57 V-.44
• U-.39 V-.39 U-.35
0'-.30
Room unit or PTAC
EER = 8.5'
EER =
U
SECTION
Cr
O
OJ
u
Slab -on -grade
Raised Wood
Raised Concrete
Common, Frame
No Minimum
R-11 .
R-5
8-11
Electric Resistance
ANY
O
U
0
In unconditioned space
In conditioned space
R-6
No minimum
F
- Single Pkg.
TABLE 6C-2: PRESCRIPTIVE REQUIREMENTS FOR GLASS AREAS IN ADDITIONS ONLY See Table 13 607.1.ABC.3.2 and 13 608.1.ABC.3.2
Maximum percentage glass to floor area allowed is selected by type, overhang length, and solar heat gain coefficient. Maximum % _ Installed % _
MINIMUM
INSTALLED
EQUIPMENT
EFFICIENCY
EFFICIENCY
z_
Central A/C - Split
SEER= 10.0
SEER =
0
Single Pkg.
SEER = 9.7
SEER =
2'-.87 P-.78 &-.87 T-.78 4'-.87 3'.-.78
T-.75 U-.61 -- 2'-.75 V-.61 X-.75 2-.61
U-.57 V-.57 0'-.44 2'-.57 V-.44
• U-.39 V-.39 U-.35
0'-.30
Room unit or PTAC
EER = 8.5'
EER =
U
SECTION
REQUIREMENTS
CHECK
Exterior Joints & Cracks
Electric Resistance
ANY
O
Heat pump - Split
HSPF = 6.8
HSPF =
F
- Single Pkg.
HSPF = 6.6
HSPF =
a
Room unit or PTHP
COP = 2.7-
HSPF7COP =
Multistory Houses
606.1
Air barrier on perimeter of floor cavity between floors.
0
Gas, natural or propane
AFUE =.78
AFUE =
Combustion Heating
Fuel Oil
AFUE = .78
AFUE =
rn
612.1
Comply with efficiency requirements in Table 612.1.ABC.3.2. Switch or clearly marked circuit breaker electric or cutoff
(gas) must be provided. External or built-in heat trap required for vertical pipe risers.
F w
Electric Resistance
EF =.92
F =
EF -
O= a
T
Gas; natural or LPyas
EF =.59I
EF =
3
Fuel Oil
EF = .54
EF =
TABLE 6C-2: PRESCRIPTIVE REQUIREMENTS FOR GLASS AREAS IN ADDITIONS ONLY See Table 13 607.1.ABC.3.2 and 13 608.1.ABC.3.2
Maximum percentage glass to floor area allowed is selected by type, overhang length, and solar heat gain coefficient. Maximum % _ Installed % _
GLASS TYPE, OVERHANG, AND SOLAR HEAT GAIN COEFFICIENT REQUIRED FOR GLASS PERCENTAGE ALLOWED
UP TO 20%
UP TO 30% UP TO 40% UP TO 50%
Single Double
Single Double Single Double Single Double
OH-SHGC OH-SHGC
OH-SHGC OH-SHGC OH-SHGC OH-SHGC OH-SHGC OH-SHGC
V-.87 0'-.78
0'-.75
2'-.87 P-.78 &-.87 T-.78 4'-.87 3'.-.78
T-.75 U-.61 -- 2'-.75 V-.61 X-.75 2-.61
U-.57 V-.57 0'-.44 2'-.57 V-.44
• U-.39 V-.39 U-.35
0'-.30
Get certified SHGC from the manufacturer or use defaults: Single clear SHGC =.75, double Gear SHGC =.66, and single tint SHGC = .64
TABLE 6C-3 MINIMUM REQUIREMENTS FOR ALL PACKAGES
COMPONENTS
SECTION
REQUIREMENTS
CHECK
Exterior Joints & Cracks
606.1
To be caulked, gasketed, weather-stripped or otherwise sealed.
Exterior Windows & Doors
606.1
Max. 0.3 cfm/sq.ff_ window area; .5 cfm/sq.ft, door area.
Sole &. Top Plates
606.1
Sole plates and penetrations through top plates of exterior walls must be sealed. -
Recessed Lighting
606.1
Type IC rated with no penetrations (two alternatives allowed).
Multistory Houses
606.1
Air barrier on perimeter of floor cavity between floors.
Exhaust Fans
606.1
Exhaust fans vented to unconditioned space shall have dampers, except for combustion devices with integral exhaust
ductwork.
Combustion Heating
606-1
Combustion space and water heating systems must be provided with outside combustion air, except for direct vent
appliances.
Water Heaters
612.1
Comply with efficiency requirements in Table 612.1.ABC.3.2. Switch or clearly marked circuit breaker electric or cutoff
(gas) must be provided. External or built-in heat trap required for vertical pipe risers.
Swimming Pools & Spas
612.1
Spas & heated pools must have covers (except solar heated). Noncommercial pools must have a pump timer- Gas spa &
pool heaters must have minimum thermal efficiency of 78%.
Hot Water Pipes
612.1
Insulation is required for hot water circulating systems (including heat recovery units).
Shower Heads
612.1
Water flow must be restricted to no more than 2.5 gallons per minute at 80 psig.
HVAC.Duct Construction,
Insulation & installation
610.1
All ducts, fittings, mechanical equipment and plenum chambers shall be mechanically attached, sealed, insulated and
installed in accordance with the criteria of Section 610.1. Ducts in attics must be insulated to a minimum of R-6.
HVAC Controls
607.1
Separate readily accessible manual or automatic thermostat for each system.
GENERAL DIRECTIONS:
1. On Table 6C-1 indicate the R -value of the insulation being added to each component and the efficiency levels of the equipment being installed. All R -values and efficiencies installed must meet or exceed
the minimum values Fisted. Components and equipment neither being added nor renovated may be left blank.
2. ADDITIONS ONLY. Determine the percentage of new glass to conditioned floor area in the addition as follows. Total the areas of all glass windows, sliding glass doors and glass door panels. Double the
area of all nonver ical roof glass and add it to the previous total. When glass in existing exterior walls is being removed or enclosed by the addition, an amount equal to the total area of this glass may be
subtracted from the total glass area. Divide the adjusted glass area total by the conditioned floor area of the addition. Multiply by 100 to get the percent. find the largest glass percentage under which your
calculated percentage falls on Table 6C-2. Prescriptives are given by the type of glass (single or double pane) and the overhang (OH) paired with a solar heat gain coefficient (SHGC). For a given glass type
and overhang, the minimum solar heat gain coefficient allowed is specified. Actual glass windows and doors previously in the exterior walls of the house nd being reinstalled in the addition do not have to
comply with the overhang and solar heal gain coefficient requirements on Table 6C-2. All new glass in the addition must meet the requirement for one of the options in the glass percentage category you
indicated. The overhang (OH) distance is measured perpendicularly from the face of the glass to a point directly under the outermost edge of the overhang.
3. RENOVATIONS ONLY. Replacement glass needs to meet the following requirements. Any glass type and solar heat gain coefficient may be used for glass areas which are under at least a 2 -foot overhang
and whose lowest edge does not extend further than 8 feet from the overhang. Glass areas being renovated that do not meet this criteria must be either single -pane tinted, double -pane clear or double -pane
tinted.
4. BUILDING SYSTEMS. Comply when new system is installed for system installed. -
5. Complete the information requested on the top half of page t.
6 Read 'Minimum Requirements for Small Additions and Renovations; Table 6C-3, and check all applicable items.
7. Read, sign and date the'Owner/Agent' certification statement on page 1.
13-D.36R
FLORIDA BUILDING CODE - BUILDING
PLN 7' OF SURVEY
OESCRIPTION_ LOT 3• BLUCK 1-FIER L. -IOW OF-QNFORO
RS Rf_ COROE IN PL B T BOOL(__ 1 PfiCE131 59 ___OF
THE PUBLIC RECOROS OF E411NOL E COUNT Y, FL ORIOIq
SOUTH R/W OF 8TH
..
+a 64-I7.5 117.0 0
O 32.20
O I STY WOOD FRAhf
O os 0810
O O N a
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12.00
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20.60 40.40 �y ' 26. ]
rr
GARAGE �o of CARPORT
h 8.501. f.
N 90=00'00" E
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NS RE WED
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vrvOF0 FORD
M. EDWARD GORDON SURVEYING
rYrF swwr 60UWARY o(>- 11173,2006
REGISTERED LAND SURVEYOR 02259 SCALE I" - JO'
PO Box 1557 SAt FORD . FLORDA 32772 PHONE 324 5720
509 WEST 9 TH STREET SANFORD . FLORIDA
�AV.: xEEr,• oY:
THE SURVEY DEPICTED HERE IS NOT COVERED BY PROFESSIONAL LRbErTY 11JSURAI\I
117.00
I
LOT 4
I
LEGEND:
ELEV - ELEVATION
N&D - NAIL AND DISK BLK -BLOCK
FD - FOUND
POB • POINT OF BEGINNING ESMT • EASEMENT
ESMT - EASEMENT
POC • POINT OF COMMENCMENT IP =IRON PIPE CERTIFIED TO:
STY -STORY
(E • CENTERLINE
CB • CHORD BEARING R • RADIUS KURT EWEN AND JAC:KIE EWEN
RAW - RIGHT OF WAY e = DELTA
X -X -X • FENCE
PL • PROPERTY LINE C • CHORD HARRY G. REID III
RES - RESIDENCE
PC - POINT OF CURVE L • LENGHT FIDELITY NATIONAL TITLE INSURANCE CO.
BLDG - BUILDING
CONC • CONCRETE P =PLAT MARKS. SAUM
WD FRM • WOOD FRAME
MON - MONUMENT 0 • NUMBER
UTIL - UTILITY
RD -ROAD ■ -FD CONC MON 0
Qi • FD REBAR r
O - SET REBAR 02258 El - SET CONC MON 02259
TOM - TEMPORY BENCH
MARK INV • INVERT
N.O.- NATURAL GROUND
FF - FINISH FLOOR BM • BENCH MARK
NOTES:
I NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL
OF A FLORIDA LICENSED SURVEYOR AND MAPPER
2 THIS SURVEY WAS PREPARED FROM TITLE IIJFORMATION FURNISHED TO
THE SURVEYOR, THERE MAY BE OTHER RESTRICTIONS OR UNRECORDED
EASEMENTS THAT EFFECT THIS PROPERTY.
3 NO UNDER GROUND IMPROVEMENTS HAVE BEEN LOCATED UNLESS OTHER WISE
SHOWN
4 DIMENSIONS SHOWN FOR THE LOCATION OF IMPROVEMENTS HEREON SHOULD
NOT BE USED TO RECONSTRUCT BOUNDARY LINES.
5 BEARINGS ARE BASED ON ASSUMED DATUM AND ON THE LINE SHOWN AS
BASE BEARING (B.B.).
6 VERTICAL CONTROL (NATIONAL GEODETIC VERTICAL DATUM 1929)
M. EDWARD GORDON SURVEYING
rYrF swwr 60UWARY o(>- 11173,2006
REGISTERED LAND SURVEYOR 02259 SCALE I" - JO'
PO Box 1557 SAt FORD . FLORDA 32772 PHONE 324 5720
509 WEST 9 TH STREET SANFORD . FLORIDA
�AV.: xEEr,• oY:
THE SURVEY DEPICTED HERE IS NOT COVERED BY PROFESSIONAL LRbErTY 11JSURAI\I
Sanford Historic District
Application for a Certificate of Appropriateness
810 Palmetto Ave.
1. Seal off side door on the North side of the house. Stairs and railing would be removed. Removing this
entrance to the house will allow for the space inside the doorway to become a laundry room. Eventual fencing
and landscaping will eliminate the usefulness of this entrance and conceal its view from the street
2. Enclose back porch and make the current space into a sun room. Enclose the space with salvaged historic
windows.
Proposed) windows
2 — 9 light casement windows for the north exposure (window on left above)
2 — Frames consisting of 2 — 6 light casement sashes for west exposure — one on each side of
the door (See below)
The look of the proposed windows is consistent with windows on the north exposure on each side of the
fireplace.
Proposed Door — See Attachment
3. Change bathroom window. The current configuration of the guest bath does not allow for the possibility of a
shower without exposing the windows to water.
We are proposing the replacement of the current window with a 6 light window (2 high and 3 across —
30 inches wide by 12 inches high). The new window would be placed at the top of the current window
opening — the window would open out from the bottom to allow for venting.
CCS Restoration will construct the proposed window (the window below is not to scale). The six light
windows on the north side of the house measure 30 inches wide by 18 inches across.
L__—j
1
Attachment — Proposed door for the rear entrance to the house (salvaged wood
door)
CITY OF SANFORD HISTORIC PRESERVA'iION BOARD
APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS
P.O. Box 1788, Sanford, FL 32772-1788
Phone: 407.302.5805 Fax: 407.330.5679
TO: THE HISTORIC PRESERVATION BOARD OF THE CITY OF SANFORD, FLORIDA
❑ Downtown Commercial Historic District P-ife'sidential Historic District
❑ This application is filed in response to a notice from the Code Enforcement Department
ADDRESS OF PROPERTY: _ t'
Propegy Owner
Signature:
Mailing Address: P(4,\n
Phone: �-� I . '? , L4 3CiO -Fax
Applicant/Agent
Signature:
Mailing Address:
Print Name: 1` uc4 Cw cr,
Print Name: ��o� Cj,J•t�'�
Phone: fx--:.)
I certify that all information gentaipd4in th' application is true and accurate to the best of my knowledge.
Applicant/Owner: Date: _ / Z Z - -7
0-1 - 11_�o
Please use the attached criteria checklist as a guide to completing the application. Incomplete applications cannot be
reviewed and will be returned to you for more information. You are encouraged to contact the preservation planner at
407-330-5672 to make sure your application is. complete.
Description of Proposed Work/Application Category: (Check all that apply)
❑ Site Improvements/driveway/walkway ❑ Storage shed ❑ Moving structures
replacement windows or doors ❑ Underskirting ❑ Awnings
❑ New construction/additions ❑ Signs ❑ Demolition
❑ Roofs/gutters/downspouts ❑ AC/Mechanical ❑ Fences/Gates/Pergolas
❑ Replacement siding/flooring/porch ❑ Paint ❑ Other
Completely describe the entire scope of work: all changes in material, color or location to the exterior of the building,
where on the property the work will occur and how the work will be accomplished. For large projects, an itemized list is
recommended. Attach additional pages if necessary.
A Certificate of Appropriateness is valid for six months unless otherwise noted
Historic Preservation Board Meeting Date:
Application is Approved
Conditions:
Signed
OFFICIAL USE ONLY
//�,d Staff Review Date:
Approved with Conditions
Date
/• Z.,
Denied
***This Certificate must be prominently displayed on the building when work is in progress***
Requirements for Certificate of Appropriateness Application