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HomeMy WebLinkAbout1213 W 6 StNOV 14 2011 CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: ,4 ` 1 Documented Construction Value: $ 31 � • � � Job Address: tat 3 W Ci� _ZA. SUtlf%w6 . FL ��'Historic District: Yes ❑ No ❑ Parcel ID: cab- 19 - 30 - 5 A I - o%% S - 0030 Zoning: Description of Work: Plan Review Contact Person: Phone: Fax: Title: E-mail: Property Owner Information Name J1 _ Street: I a . (� S City, State Zip: SGnior C� ia� 1 Phone: Resident of property? : Contractor Information Name A Phone: I'�' O-1 - 8 a 6- 3a3 3 Street: G�G�,c�►U.Jt �� _ �(. Sl,a�e d11 Fax: `��� S City, State Zip: DC lc,.r'&3 . FC State License No.: F 0013 x1 Architect/Engineer Information Name: Street: City, St, Zip: Bonding Company: Address: Phone: Fax: E-mail: Mortgage Lender: Address: PERMIT INFORMATION Building Permit ❑ Square Footage: Construction Type: No. of Dwelling Units: Flood Zone: Electrical New Service - No. of AMPS: Mechanical ❑ (Duct layout required for new systems) Plumbing ❑ No. of Stories: New Construction - No. of Fixtures: Fire Sprinkler/Alarm ❑ No. of heads: 5(DZ.pa Application is hereby made to obtain a permit to do the work and installations as indicated. l 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 l 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 to your permit fees when the permit is released. Signature of Owner/Agent Date Owner/Agent's Name Signature of Notary -State of Florida Date Owner/Agent is Personally Known to Me or Produced ID Type of ID APPROVALS: ZONING: UTILITIES: ENGINEERING: FIRE: COMMENTS: Rev 11.08 X' Signatureof tractor/Agent Date ck 11► Print Contrec Agent's 4*ne kL3 - Jt__ 1 In Moll signature of Notary -S to of Florida t+' t EE 11 MY COMMISSION _AIRES: Au sA2.20ears � i h B01aee im "owl Contractor/Agent is Personally Known to Me or Produced ID Type of ID WASTE WATER: BUILDING: POWER OF ATTORNEY Date: 11 /0101 I hereby name and appoint Samuzi la -L of ADT Security Services to drop off and pick up permits at the S C Building Departonent on my behalf for a LOW VOLTAGE SECURITY permit for work to be performed at a lo. ation described as: Parcel 61L 5 - \9 - 30 - 5 A ' d hs - oo3O Subdivision Address of job a 3 6 �1�. - bG, c% Owner Q_CA George ManF�neili EF0001L2I Type or Print Name of Certified Contractor Sign o CcrtWtd Contractor The foregoing instrument was acknawledged. b by .i who is personally wn to a/who produdck as identification and who did not take oath. State of Florida County of 0((ACN,-# Notary Public, Seminol®County, Florida me this j) 11 day of 20IL n n LAUREN RAJNAUTH ►: r MY COMMISSION t EE 118072 ?= EXPIRES: August 2, 2015 fig; , Bonded Thm Notary POW Underwrites DCPA HyperLiteWeb Parcel View: 25-19-30-5AI-0815-0030 f r 00vk1 Jcift iaon. CFA Parcel: 25-19-30-5AI-0815-0030 T ROPERTY Owner: ONEAL ULESEY C &REGINA R APPRAISER Property Address: 1213 W 6TH ST SANFORD, FL 32771 SEMMACLE COUN rY. FLORIDA < Back Save layout Reset Layout New Search Parcel: 25.19.30.5AI.0815.0030 Value Summary Property Address: 1213 W 6TH ST CT _ ­4 R I 0 10 11 7r% Map Aerial Both Footprint + E) Extents Center Dual Map View - External Tax Owner: ONEAL ULESEY C b REGINA R 2011 Certified Mailing: 1213 W 6TH ST Values SANFORD, FL 32771 Valuation Subdivision Name: SEMINOLE PARK Cost/Market Tax District: Sl-SANFORD Deed Date Book Page Amount Vac/Imp Qualified CORRECTIVE DEED 08/2007 06797 1621 S 100 Improved No CORRECTIVE DEED 07/2007 06749 0547 $100 Vacant No WARRANTY DEED 07/2007 06752 lag $150.200 Improved Yes Exemptions: 00 -HOMESTEAD (2008) Number of DOR Use Code: 0103-TOWNHOME Buildings I 1 Depredated W 6TH ST 61 FA7!& 01 -Ft I CT _ ­4 R I 0 10 11 7r% Map Aerial Both Footprint + E) Extents Center Dual Map View - External Tax 2012 Working 2011 Certified Values Values Valuation Cost/Market Cost/Market Method Deed Date Book Page Amount Vac/Imp Qualified CORRECTIVE DEED 08/2007 06797 1621 S 100 Improved No CORRECTIVE DEED 07/2007 06749 0547 $100 Vacant No WARRANTY DEED 07/2007 06752 lag $150.200 Improved Yes Number of Land Buildings I 1 Depredated 566.466 S66,807 Bldg Value Depreciated EXFT Value Land Value $%.560 $7,560 (Market) Land Value Ag Just/Market 574,026 574,367 Value Portability Adj Save Our Homes SO SO Adj Amendment 1 Adj Assessed Value 74,026 S74.026+-- Tax Amount without SOH, S686 2011 Tax Bill Amount 1686 Tax Estimator Save Our Homes Savings- SO Does NOT INCLUDE Non Ad Valorem Assessments Legal Description LOT 3 BLK 8 TR 1 S SEMINOLE PARK PB 2 PG 75 Tax Details Taxing Authority Assessment Value Exempt Values Taxable Value County General Fund 174.026 549.026 S2S.000 Schools 574,026 525.000 149.026 City Sanford S74.026 549.026 525.000 SJWM(Saint Johns Water Management) 574,026 549.026 $25,000 County Bonds $74,026 549.026 $25,000 Sales Deed Date Book Page Amount Vac/Imp Qualified CORRECTIVE DEED 08/2007 06797 1621 S 100 Improved No CORRECTIVE DEED 07/2007 06749 0547 $100 Vacant No WARRANTY DEED 07/2007 06752 lag $150.200 Improved Yes Find Comparable Sales within this_Subdivision Land Method Frontage Depth Units Unit Price Land Value FRONT FOOT & DEPTH so 81 210.00 57,560 Building Information p Description Year Built Fixtures Base Area Total SF Heated SF Ext Wall Adj Value Repl Value 1 SINGLE FAMILY 2007 6 752.00 1,779.00 1,432.00 CB/STUCCO FINISH 566,466 568,170 Pagel of 2 http://www.scpafl.org/ParcelDetails.aspx?PID=25-19-30-5AI-0815-0030 11/11/2011 RESIDENTIAL SERVICES CONTRACT ins IIH�RIIIIIIIIII� CONTRACTDATE ' ' ( I ACCOUNT NO 0 a 4 NO [11 SOURCE Section• • ADT Security Services, Inc. ("ADT") Customer Name S L Office Address wo Jr'�ahoolle —3li, ('Customer" or '1" or 'me' or 'my') TOTAL OF PAYMENTS FOR THE INITIAL TERM IS ( (TOTAL MONTHLY SERVICE CHARGE FROM BELOW) (A. TIMES B.) (EXCLUSIVE OF ANY APPLICABLE TAXES, FEES, FINES AND RATE INCREASES) LATE CHARGE - PAYMENT IS DUE PURSUANT TO MY SELECTED BILLING PREPAYMENT — IF I PREPAY THE SEE SECTIONS 2, 7, 15 AND FREQUENCY, PRIOR TO THE START OF SERVICE. MY FIRST BILUCHARGE WILL TOTAL OF PAYMENTS PRIOR TO 19 OF THIS CONTRACT FOR BE SENT/MADE SHORTLY AFTER MY SERVICE BEGINS. ADT MAY IMPOSE A THE END OF THE INITIAL TERM ADDITIONAL INFORMATION ONE-TIME LATE CHARGE ON EACH PAYMENT THAT IS MORE THAN TEN (10) OF THIS CONTRACT, THERE IS NO ABOUT NONPAYMENT, DEFAULT DAYS PAST DUE, UP TO THE MAXIMUM AMOUNT PERMITTED BY LAW, BUT IN PENALTY OR REFUND. AND ACCELERATION. NO EVENT WILL THIS AMOUNT EXCEED $5.00. 1 of 6 Administrative Copy 02011 ADT. All rights reserved. (04/11) N 01 0, f a.W^^ `` d 13 V N I 5 P Address . Doc -t City L I �1 • 0 � � � State FRZIP Tax Exempt No. 401 Protected Premises' 1 J Telephone Tax Expire Date 19> Traditional Phone O Other (Qualified) O Other (Non -Qualified) www.MyADT.com 1.800.ADT.ASAP• Alternate l Q I , . " $ 1 0 ' (1.800.238.2727) Telephone 1 O Home Cell O Work Alternatep Telephone 2 O Home O Cell O work IF FAMILIARIZATION PERIOD IS REJECTED INITIAL HERE (see Paragraph 14 of the Terms and Conditions for explanation) EMAIL r Q 111 ( d- D P I ~' 1!5'1/ / U U 11 IC - 10 M Communications Authorization: I authorize ADT to provide me with information and updates about the security system and new ADT and third -party products and services to the'contact information provided by me. I may unsubscribe or opt out by emailing donotcontact®ADT.com or by calling 888.DNC4ADT (888.362.4238). Initial here - »•• Confirmation of Appointments: I authorize ADT to call me using an automated calling device to deliver a pre-recorded message to set/confirml It `/ appointments and provide other information and notices about the alarm system at the telephone number(s) provided by me. Initial here Alarm System Ownership: O Customer -Owned S ADT -Owned I ACKNOWLEDGE AND AGREE TO EACH OF THE FOLLOWING: (A) THIS CONTRACT CONSISTS OF SIX (6) PAGES. BEFORE SIGNING THIS CONTRACT, I HAVE READ, UNDERSTAND AND AGREE TO EACH AND EVERY TERM OF THIS CONTRACT, INCLUDING BUT NOT LIMITED TO PARAGRAPHS 5 AND 18 OF THE TERMS AND CONDITIONS. (B) THE INITIAL TERM OF THIS CONTRACT IS THREE (3) YEARS. (C) ADT IS NOT A SECURITY CONSULTANT AND CANNOT ADDRESS ALL OF MY POTENTIAL SECURITY NEEDS. ADT HAS EXPLAINED TO ME THE FULL RANGE OF EQUIPMENT AND SERVICES THAT ADT CAN PROVIDE ME. ADDITIONAL EQUIPMENT AND*SERVICES OVER THOSE IDENTIFIED IN THIS -CONTRACT ARE AVAILABLE AND MAY BE PURCHASED FROM ADT AT AN ADDITIONAL COST TO ME. 1 HAVE SELECTED AND PURCHASED ONLY THE EQUIPMENT_AND SERVICES IDENTIFIED IN THIS CONTRACT. (D) NO ALARM SYSTEM CAN PROVIDE COMPLETE PROTECTION OR GUARANTEE PREVENTION OF LOSS OR INJURY. FIRES, FLOODS, BURGLARIES, ROBBERIES, MEDICAL PROBLEMS AND OTHER INCIDENTS ARE UNPREDICTABLE AND CANNOT ALWAYS BE DETECTED OR PREVENTED BY AN ALARM SYSTEM. HUMAN ERROR IS ALWAYS POSSIBLE, AND THE RESPONSE TIME OF POLICE, FIRE AND MEDICAL EMERGENCY PERSONNEL IS OUTSIDE THE CONTROL OF ADT. ADT MAY NOT RECEIVE ALARM SIGNALS IF COMMUNICATIONS OR POWER IS INTERRUPTED FOR ANY REASON. (E) ADT RECOMMENDS THAT f MANUALLY TEST THE ALARM SYSTEM MONTHLY AND ANY TIME I CHANGE TELEPHONE SERVICE, BY CALLING 1.800.ADT.ASAP OR BY LOGGING IN TO WWW.MYADT.COM. (F) THIS CONTRACT REQUIRES FINAL APPROVAL BY AN ADT AUTHORIZED MANAGER BEFORE ADT MAY PROVIDE ANY EQUIPMENT OR SERVICES, AND IF APPROVAL IS DENIED, THEN THIS CONTRACT WILL BE TERMINATED, AND ADT'S ONLY OBLIGATION WILL BE TO NOTIFY ME OF SUCH TERMINATION AND REFUND ANY AMOUNTS I PAID IN ADVANCE. ADT R present tive a e {►- � Rep. Rep. License No. , j (lf Required) ID No. Customer's Approval: Original Signature Required (Must match Customer Name in Section 1 above) _ X e/ C���Cj oz � NOTICE OF CANCELLATION I, THE CUSTOMER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. I ACKNOWLEDGE BEING VERBALLY INFORMED OF MY RIGHT TO CANCEL AT THE TIME OF EXECUTION OF THIS CONTRACT AND RECEIPT OF THIS NOTICE. ' FINANCIAL DISCLOSURE STATEMENT THERE IS NO FINANCE CHARGE OR COST OF CREDIT (0% APR) ASSOCIATED WITH THIS CONTRACT. A. NUMBER OF' Lf $ PAYMENTS OR THE B. AMOUNT OF EACH PAYMENT IS $ TOTAL OF PAYMENTS FOR THE INITIAL TERM IS INITIAL TERM IS 36: (TOTAL MONTHLY SERVICE CHARGE FROM BELOW) (A. TIMES B.) (EXCLUSIVE OF ANY APPLICABLE TAXES, FEES, FINES AND RATE INCREASES) LATE CHARGE - PAYMENT IS DUE PURSUANT TO MY SELECTED BILLING PREPAYMENT — IF I PREPAY THE SEE SECTIONS 2, 7, 15 AND FREQUENCY, PRIOR TO THE START OF SERVICE. MY FIRST BILUCHARGE WILL TOTAL OF PAYMENTS PRIOR TO 19 OF THIS CONTRACT FOR BE SENT/MADE SHORTLY AFTER MY SERVICE BEGINS. ADT MAY IMPOSE A THE END OF THE INITIAL TERM ADDITIONAL INFORMATION ONE-TIME LATE CHARGE ON EACH PAYMENT THAT IS MORE THAN TEN (10) OF THIS CONTRACT, THERE IS NO ABOUT NONPAYMENT, DEFAULT DAYS PAST DUE, UP TO THE MAXIMUM AMOUNT PERMITTED BY LAW, BUT IN PENALTY OR REFUND. AND ACCELERATION. NO EVENT WILL THIS AMOUNT EXCEED $5.00. 1 of 6 Administrative Copy 02011 ADT. All rights reserved. (04/11) nRESIDENTIAL SERVICES CONTRACT imaunuuumo CONTRACT ' I I/ ACCOUNT NO CUSTOMER5 b013 o 1 S ,NO m SOU CE LEAD DATE Section 2. Services to be Provided (continued) Monthly Service Charge O Initial/Annual Recurring Municipal Fee billed separately, Initial/Annual Fee ® Standard Monthly Service, Burglary (Subject to change based on local law) Service includes: Customer Monitoring Center Signal O Customer to obtain and pay for initial/annual municipal Receiving and Notification Service for Burglary, Manual Fire and Manual Police Emergency �• $ / alarm use permit. Failure -to obtain and provide ADT with the municipal -alarm use permit registration number could' y result in no municipal fire/police response to an alarm from the premises and/or a fine. O Standard Monthly Service, Fire/Smoke Detection Service includes: Customer Monitoring Center SignalMunicipal $ Electrical Permit Fee $ lIL e7 Receiving and Notification Service for Fire, Manual -Fire O Customer to obtain electrical permit and Manual Police Emergency O Carbon Monoxide O Flood O Low Temp$ Installation Price $ 3 O Medical Alert $ . Taxable Amount ® Safewatch Cellguard• $ A ( Non -Taxable Amount $ O SecurityLink• $ Connection Fee $ 4D Extended Limited Warranty/Quality Service Plan (QSP) $ / Admin Fee' $ / J O Guard Response Service $ Sales Tax on Installation* i $ �B O Other $ Deposit Received $ �� Total Monthly Service Charge y 1 • Balance Due upon Installati n* *If applicable sales tax not shown, it will be added to the first invoice. Section• • to be Installed COntfgl� /t J n nC C • i P nejIi 1 c ori �.oa° o��O� S`'� a`� fi \oa¢\. Q ����. �Q ¢�d�Qo��a�Q !rl Ile C to O°° �` G�aOe �¢ Oe (,a 0¢ Sa �` {, V PO ��` POP 1c'} Q� Comments Package Name: Includes: Foyer Living Room IrY 1 Family Room Office Dining Room Kitchen Laundry Room Hallway Master Bedroom Master Bath Bedroom 2 T" Bedroom 3 Bath 2 Basement Garage Totals 1� I E = Existing Equipment Estimated Installation Start Date U_LLJ INSTALLER NOTES. 2 Of 6 02011 ADT. All rights reserved. (04/11) RESIDENTIAL SERVICES CONTRACT numui�ia CLEAD DATECT CUSTOMER EDUIVE ACCOUNT NO 4 5 s' JOB M SOURCE SectionBilling O Check received for. O Installation: Check # Amount $11 11 11 O Annual Service Charges Collected:. Check # Amount FTM I authorize ADT: O To withdraw all Service'Charges from my bank account: ® To charge my credit/debit card for: O Annually O Semi -Annually O Quarterly O Monthly tD Installation O 3 monthly credit/debit card payments of equal amounts Choose one: • O Checking O Savings (available only for telephone orders with an installation price Name of Bank/Credit Union over $400 or field sales with an installation price over 51,500) ®All/Recurring Service Charges O Annually O Semi -Annually O Quarterly m Monthly ABA Routing Number Bank Account Number m VISA O MasterCard O Discover O AMEX Credit/Debit Card Number Expiration Date EWE Recurring Service Charge Amount $ 11 1. 11 M M Y Y Name as it appears on bank account Recurring Service Charge Amount $1 1 WHE Cardholder's. Name I authorize ADT to debit my bank account -for the amount of all Recurring Service Charges If I am using a debit card, I authorize ADT to debit my bank account for the amount of indicated above. I may revoke this authorization only by notifying ADT and my bank in all Recurring Service Charges indicated above. I may revoke this authorization only by writing at least 10 business days before the scheduled debit notifying ADT and my bank in writing at least 10 business days before the scheduled debhG If no oval is filled above, service charges will be withdrawn monthly. If no oval is filled above, my credit/debit card will be charged monthly. I authorize ADT to withdraw the amounts in this section from my bank account or credit card through an Automated Clearing House ('ACH'). These payments are for the equipment and services described in this Contract This authorization will remain in effect until the termination date of this Contract or until I cancel it in writing, whichever occurs first I also agree to notify ADT in writing of any changes in my account information at least 15 days prior to the next billing date. If a payment date falls on a weekend or holiday, payment may be executed on the next business day. Because this is an electronic transaction, these funds may be withdrawn from my account each month as early as the transaction date. If the date or amount of the ,:-- withdrawal changes, ADT will notify me at least 10 days prior to the payment being collected. If an ACH transaction is rejected for non -sufficient funds (NSF), ADT may attempt to process the charge again within 30 days, and an NSF charge may apply. The origination of ACH transactions to my account must comply with the provisions of U.S. law. I am an authorized user of this credit card or bank account, and I will not dispute the payment with my credit card company or bank, so long as the amount corresponds to the terms indicated in this Contract. O To send me a bill: O Annual) O Semi -Annually O Quarterly O Other DOA Approval If no oval is filled, ADT will send bill quarterly. Authorized Account Signature: C C Section• and System Data i ICS#0 MT1Lb.VFFP Name VISME V1 /.I Address �- P I 16fI r lfR_ ® City State ZIP Cross St.. 0 / Premises' Phone #1 Phone #2 O Cell Only MunicipalityrioI� �/} I S'., f� Municipality t () I` Police Name r Fire Name' Municipality. Patrol Name Medical Number & Number Job Type 4b New Sale O Change Over O Upgrade Control Type O HW a RF Permit ' Affiliation Member # Number Burglar Alarm:qD Yes O No Fire / Smoke: O Yes O No Two -Way Voice: O Yes O No Cellulai O Parallel O Standard Model: Profile Preferred Monitoring ® Communication Account Management Ft Codes: Ownership System Service Services Method Services y GuardMarket Resale -Former ERIService ® ELW/QSP Group U_LJ Acct # Former CS # Section• Password This password must be issued to all users of the alarm system, including all people listed in Section 7. An optional, secondary password for service individuals, housekeepers, tenants, etc. is available upon request. A password must'be no less than three (3) and no more than five (5) characters in length and may not contain any punctuation or spaces, offensive language or non-standard spelling. Customer may change passwords and contacts by going to www.MyADT.com or by calling ADT toll-free at 1.800.ADT.ASAP. , Section•'Contact These are the individuals who may be called in the event'of an alarm. Because they may need to meet the authorities in response to an alarm, I will provide them access to my premises, the password, and the keypad code. Jy selecting the 'Yes' designation on the right I am identifying which of these individuals may be called prior to notification of the authorities. Customer/Emergency Contact #1t 4 4 6 O m -•O 00 0;1G Print FirsULast Name Phone.I Home Cell Work Yes • No O O O O O S J / Phone Home Cell Work Yes No Customer/EmergencyContact #2 ( I / /� �j /� P y Aft �' y � � r � � )Gell or O Print First/Last Nae Phone 7 ` r r Home O O O 0 0 h ' Phone Home Cell Work Yes No r Alternate/Emergency Only Contact1 16 � C �'f ) p ( kA to l� q .,, q . ' d (.- ' �� y /j O 4D O OO 1f r' ! ' Print First/Last Name ( Phone 1 Home Cell Work Yes No G�' S V. ( � iV .,� V7 C� O .10O O 10 I l'� Phone ' Home Cell Work Yes No 3 Of 6 02011 ADT. All rights reserved. (04/11)