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HomeMy WebLinkAbout1819 Paloma Ave (2)Application No: Q. - L0 a 3 RECEIVEIFIR JAN 11 2012 OF SANFORD BY: BUILDING &PREVENTION RMUA APPLICATION Documented Construction Value: $ "I a 11b Job Address: 17-,l Cl ] t� CA_ -A kQ SC#1f0Y-rJ Historic District: Yes ❑ No ❑ Parcel ID: Z)l I q 31 51c) oaocl - Zoning: Description of Work: d e is z=dnc 9 LA_-ja� A4pr,`4,P_ )' -- Plan Review Contact Person: Karen liuphn Title:'Aljn,,� Ek.,O Phone: Ub—f '61,2\,- - 1% as Fax: L WI $1 a —1 I '1► E-mail: Property Owner Information Name eJUe_<< �'Z Phone: 1-i r� 3oi �i - 5-151 Street: I %l q 'Paj ory-OL -,Ave-- Resident of property? City, State Zip: SOX)Erd E_C_ Za1-11 Contractor Information Name Q_ 1'�Sit uQ �' Mille-rf,Ltt aC � Phone:QM D c� - Vgaa Street: &153 ? reXyn l Q � QOtAJ Q Fax: (AM is I a --11-7) I I City, State Zip: Or tando T—L 3=')sState License No.: E C_ Architect/Engineer Information Name: Phone: Street: St, Zip: Bonding Company: Address: Building Permit ❑ Fax: E-mail: _ Mortgage Lender: Address: PERMIT INFORMATION Square Footage: Construction Type: No. of Stories: No. of Dwelling Units: Flood Zone: Electrical New Service - No. of AMPS: Mechanical ❑ (Duct layout required for new systems) Plumbing ❑ New Construction - No. of Fixtures: Fire Sprinkler/Alarm ❑ 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 to your permit fees when the permit is released. Signature of Owner/Agent Date Print Owner/Agent's Name -Z cr� — Signature of Contractor/Agent Date Print Contractor/Agent's Name Signature of Notary -State of Florida Date Signa Date Y CO N DD860602 �a d EXPIP.FS: February 11.2013 IJ06)HOTAAY n Morryth— A— Co. Owner/Agent is Personally Known to Me or Contractor/Agent is Personally Known to Me or Produced ID Type of ID Produced ID Type of lD APPROVALS: ZONING: UTILITIES: ENGINEERING: COMMENTS: Rev 11.08 FIRE: WASTE WATER: BUILDING: LIMITED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: I- la- I a I hereby name and appoint: an agent of: to be my lawful attorney-in-fact to act for me to apply for, receipt for, sign for and do all things necessary to this appointment for (check only one option): All permits and applications submitted by this contractor. The specifjQpermit and application for work located at: (Street Address) Expiration Date for This Limited Power of Attorney: la - License a -License Holder Name: S+� P— V rn ► 1 �� State License Number: E -C' 00co 'E—�R4 Signature of License Holder: A cl,"� STATE OF FLORIDA COUNTY OF o The foregoing instrument was acknowledged before me this day ofnyvo 20Q2, by k y who is ?personwn to me or ? who has produced identification and who did (did not) tae an oath. Signaturkj (Notary Seal) Ebn& a r Print or tylia name Notary Public - State ofFicciAs Commission No. My Commissi S ANDY M. GARpNER COMMISSION M DD860602 (Rev. 3/27/07) XP'R Febrya,y 10 2013�: + '_.ry Di.oam„1qa, Co. cCLLE'Z 2153 Premier Row Orlando, F132809 Phone: 407.812.1822 Fax: 407.812.7171 Lowes's of Sanford Store 1657 3780 Orando Drive Sanford, FL 32773 Customer Contact Rebecca Katz Lowes Invoice 79520 Invoice #7772 • . 1/11/2012 Net 10 Rebecca Katz 1819 Paloma Ave Sanford, FL 32771 Customer Phone Customer Alt. Phone 407-324-5751 Lowes PO Installer # 126228700 95428 Due Date 1/21/2012 Invoice Amount $92.00 A� -0 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYYI 1212 Oil THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Praxiom Risk Management, LLC CONTACT NAME: 123 West Bloomingdale Ave. #300 Brandon, FL 33511 PHONE WC. No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC 0 INSURER A : Amtrust / Technol2gy Insurance Company 4237 PREMI Ea occurrence) $ INSURED Resource Management, Inc. RMI Management II, LLC INSURER 8: INSURERC: INSURER D: 281 Main Street, Suite 5 INSURER E: Fitchburg MA 01420 INSURER F AUTOMOBILE LIABILITYMBCg08m ANY AUTO AALLUTOOSMED e AUTOS NON-0OWN HIREDAUTOS AUTOS COVERAGES CERTIFICATE NUMBER: 12038159 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ITR TYPE OF INSURANCE A00L 31.1811 POLICY NUMBER MMMIDDIYYYY Y EFF MMIDDIYYY LIMITS GENERAL LIABILITY COMENTED MERCIAL GENERAL LIABILITY CLAIMS -MADE D OCCUR EACH OCCURRENCE $ PREMI Ea occurrence) $ MED EXP (An one on) $ PERSONAL 6 ADV INJURY $ GENERAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER: PRO. LOC POLICY D PRODUCTS - COMPIOP AGG $ $ AUTOMOBILE LIABILITYMBCg08m ANY AUTO AALLUTOOSMED e AUTOS NON-0OWN HIREDAUTOS AUTOS LIMIT$ BODILY INJURY (Per person) $ BODILY BODILY INJURY (Per aoridenl) S PR�OBEERdTY AMAGE $ P S $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE $ DED RETENTIONS $ S S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNEWEXECUTIVE r OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA TWC3305715 1/1/2012 1/1/2013 wCSTATu• 0TH TORY LIMITS ER E.L. EACH ACCIDENT S 1,000,000 E L. DISEASE • EA EMPLOYEE S 1 000.00 E L DISEASE - POLICY LIMIT I S 1,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If mon apace Is roqulmd) Proj/Job Info (if any): / Workers' Compensation coverage is provided for only those employee leased to, but not subcontractors of Miller Electrical Services, Inc. PEO Client Name: Miller Electrical Services, Inc. Location: 2153 Premier Row, Orlando, FL 32809 PEO ClientlD#: 750045 CERTIFICATE OLDER CANCELLATION City of Sanford P.O. Box 1788 Sanford FL 32772 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE David E. Carothers ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CERTNO.: 12030159 Dindi DeAngelo 12/29/2011 2:73:52 PM Page 1 or 1 This Certificate cancels and supersedes ALL previously issued certificates.