HomeMy WebLinkAbout2102 S Summerline AveD
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: (:D7-_5 73 Documented Construction Value: $ 56a•UO
Job Address: . F%L,S-=_��v,� eACtL,0�6 A-L16Historic District: Yes ❑ No 0'
Parcel ID:
Zoning:
Description of Work: E C gL4Pfc,,c- W) LW% 4 U 6x -c C LtC' atc &L Pr7CX A -CA -76Y
Plan Review Contact Person: �(,07�% �2lZZl� Title: [QA1A-- 2
Phone: !C64%lax: E-mail:
Property Owner Information
Name Pjet'Q A cyiGC4 n-mS
Street: Z( CIZ- S • S �, W) 4 CNE /�'✓�
City, State Zip:
Phone:
Resident of property? :
Contractor Information G
Name �( r x'1104 ,/%(,V�6 - e--(, Phone:
Street: I C 6 (C &Cn1Pt� P L iyt Fax:
City, State Zip: Z 7 20 State License No.: C E%r �9 SQ 01 -7 G
Architect/Engineer Information
Phone:
Fax:
E-mail:
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Building Permit 0
Square Footage:
No. of Dwelling Units:
Electrical O
New Service — No. of AMPS:
Mortgage Lender:
Address:
PERMIT INFORMATION
Construction Type:
Flood Zone:
No. of Stories:
Plumbing 0
New Construction - No. of Fixtures:
Mechanical 0 (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 char es exceed the documented
construction value when the executed contract is submitte4, credit will a applie t our permit fees when the
permit is released.
Signature of owner/Agent
Print Owner/Agent's Name
Date
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
Rev 11.08
Print Contractor/Agent's Name
�1� t
Date
ia.ai.//
"" �' ' VE'RE BLANI ON —
Notary Public - State of Florida
My Comm. Expires Feb 25, 2015
Commission # EE 60182
Bonded Through National Notary Assn.
Contractor/Agent is Personally. Known to Me or
Produced I D Type of I D L • ca • (� - T
UTILITIES: WASTE WATER:
FIRE:
BUILDING:
AIEOLS
WXEE¢ AM6 Work Write Up for Weatherization Program
To Contactor.
Items listed on the work write up may not pertain to your core business function. These items should be bid under the umbrella of your company through licensed
contractors such as Plumbing, Electrical, HVAC, Roofing Etc. It is your responsibility to pull permits and provide results pertaining to your business function
according to Local 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
YAP require EPA Lead -Safe Work Practice or Lead Testing to be performed by a EPA Lead -Safe Certified Finn. Photos of EPA Lead -Safe Work Practice or
Documentation Supporting Negative Test Results are required for agency documentation d client 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 b Davis Baoon Compliance.Additional into may be required. All Work and Punch List
Items must be 100% complete. Prices tt 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 back 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 back to you. Work may begin. All specifications, terms and conditions shall be as described in the
OWNER/CONTRACTOR AGREEMENT and the FLORIDA WEATHERIZATION HANDBOOK, MATERIALS, INSTALLATION and WORKMANSHIP STANDARDS.
Item # Description of Materials/Services Required Priority # Material Labor ' " Total
1 40 gal electric $ 350.00 $ 200.00 $ 550.00
2
3
4
5
6
7
8
9
20
10
11
12
13
14
15
Ponda Williams DATE: $ $50.00
Built 1960 lios ti
ADDRESS: 2102 Summerlin Ave Sanford, Florida 32771 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: [1'h /GSC_ 6?CVM6 I'," Signature: Date:
Addendum to Bid: Date:
MOW
Notice Tol roceed With Work
Your contradarid 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