HomeMy WebLinkAbout1205 W 14 St/ REC=EIVED
:F D NOV 16 2011 CITY OF SANFORD
BUILDING & FIRE PREVENTION
BY: PERMIT APPLICATION
Application No: / - 3 a� Documented Constru ionz-� Va ue: $ a' U�%
yy �jI
Job Address: (AI �2 /N7-)1_0b50 Historic District: Yes ❑ No
Parcel ID• Zoning:
Description of Work: Gi0L7i c6 1, w. i.4.
Plan Review Contact Person: C G-r-7/ E Title: GlG/�C2
Phone: (a (09 ' U4ax: E-mail:
Property Owner Information n
Name �' eA Phone: q U 1
Street: 12 S SResident of property?: E
City, State Zip:
Contractor Information
Name P2 ft #\I CO- eo'yA6,4.'
Street:
City, State Zip: DcL n- o
Name:
Phone: 3 -C -t q 61 'eb;cO7
Fax:
State License No.: C) Gi G
Architect/Engineer Information
Street:
City, St, Zip:
Bonding Compan
Address:
Building Permit O
Square Footage:
No. of Dwelling Units:
Electrical O
New Service — No. of AMPS:
Address:
PERMIT INFORMATION
Construction Type:
Flood Zone:
No. of Stories:
Plumbing D
New Construction - No. of Fixtures:
Mechanical O (Duct layout required for new systems) Fire Sprinkler/Alarm 0 No. of heads:
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 ur permit fees when the
permit is released. A \
Signature of Owner/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced I D Type of I D
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
Rev 11.08
UTILITIES:
FIRE:
Signature of Qsn(ractor/Agent +� Date
Print ntractor/Agent's Name
/ /• //
Signat a oQ otate of FloOMBIE SLANTONDate
r°� �'<'; Notary Public - State of Florida
' : • i My Comm. Expires Feb 25. 2015
? 4 Commission # EE 60182
�
1..°.. .�.' •, Bonded Through National Notary Assn.
Contractor/Agent is PersonallKnown to Me or
Produced I D Type of I D k.. e - (o 111.1 119
WASTE WATER:
BUILDING:
AIEOLS
!t AfArE[SWork Write Up for Weatherization Program
•w•
To Contactor:
Items listed on the work write up may not pertain to your core business function. These items should be bid under the umbrage of your company through licensed
contractors such as Plumbing, Electrical, HVAC. Roofing Etc. It is your responsibility to pug permits and provide results pertaining to your business function
according to Loral Municipality and Code and or provide the some from licensed contractors pertaining to Plumbing, Electrical. HVAC, Roofing Etc. You are
required to provided Certified Payroll for all work performed on residence, for your company and all subcontractors hired by you. Any house or trailer built pre 1978
will require EPA Lead -Safe Work Practice or Lead Testing to be performed by a EPA Lead -Safe Certified Firm. Photos of EPA Lead -Safe Work Practice or
Documentation Supporting Negative Test Results are required for agency documentation b dient file. If additional items are needed in conjunction with a Work
Write Up Item, you must provide an addendum explaining repair. In order for payment to be processed you must provide the Payment Request Form, Signed Invoice
Release of Lien, Passed Permits, LSW Documentation for pre -1978 homes 8 Davis Bacon Compliance.Additional into may be required. AN Work and Punch List
Items must be 100% complete. Prices d items may be subject to change, to meet budget requirements. If so, price and item changes will be agreed upon verbally.
The bid will then be adjusted, signed by MOW as (Addendum to Bid), and sent bade to you. You are required to sign as (Acceptance of Addendum to Bid) and send
back to MOW MOW will then sign as (Acceptance of Bid) and send bade to you. Work may begin. Ag specifications, terms and conditions shag be as described in the
OWNER/CONTRACTOR AGREEMENT end the FLORIDA WEATHERIZATION HANDBOOK MATERIALS, INSTALLATION and WORKMANSHIP STANDARDS.
Item # Description of Materials/Services Required Priority # Material Labor Total
1 40 gal water heater $ 200.00 $ 150.00 $ 350.00
Cassandra Scott DATE: Is 350.00
JOB #
ADDRESS: 11205 W 14th Street Sanford Florida PHONE:
Notice to Bid
Please inspect the property and submit the work -write up with your cost to me NO LATER THAN If your bid meets the criteria, you will
be contacted with the Notice To Proceed With Work, signed, with a time frame for work to be completed in.
Contractor: Premier Plumbing
Addendum to Bid: Date:
MOW
Notice To Proceed With Work
Your contract and proposal for homeowner repairs and upgrades at the above mentioned address. Owners have been examined and
accepted by the Weatherization Program staff. Items have meet the approval of the client. Items mentioned above are to be completed within the specified