HomeMy WebLinkAbout2320 Cordova Dr (2)=BY:
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: 1 I Documented Construction Value: $ /f 00 —
Job Address: rr 07� C.n Q Qce,_ Historic District: Yes ❑ No ❑
Parcel ID: x'00 - Oy 0 U Zoning:
Description of Work: Ale uJ Pr`✓'► ` u r\+ 1-M S'
Plan Review Contact Person: Title:
Phone: Fax: E-mail:
Property Owner Information
NameuJ!,.k- I Phone: W7 - 704 - 0' ('D3
�o
Street: o:s�C Cr d o jCy ' rN-%� R_ Resident of property?
City, State Zip:
Contractor Information
Name S GqeyAxCqA Phone: yU� - -71 t - Alt
Street: 1238" abc4m.w,t e&,o. ,.l 4y-9, Fax: " M
City, State Zip: GAcwAu I El= ? ag aG State License No.: -rS00003ok_31
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Building Permit 0
Square Footage:
No. of Dwelling Units:
Electrical O
New Service - No. of AMPS:
ArchitectlEngineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
PERMIT INFORMATION
Construction Type: I -on Sti� 0 -No. of Stories:
Flood Zone:
Mechanical 13 (Duct layout required for new systems)
Plumbing O
New Construction - No. of Fixtures: (0
Fire Sprinkler/Alarm O 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
most be secured for electrical work, plumbing, signs, wells, pools, furnaces, boilers, beaters, 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 1 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 our permit fees when the
permit is released.
Signalum 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 1D Type of ID
M§Mure oMontractor/Agent Date
-S C v Pr Mcn �✓
Print Contractor/Agent's Name
9i1dPY "Puolic . State o1'Plbrida
My Comm. Expires Feb 25, 2015
Commission 0 EE 60182
Bonded Through National Notary Assn.
Contractor/Agent is Personal) Known to Me or
Produced ID Type of ID Eis tr e • 'I i1)) /
APPROVALS: ZONING: UTILITIES: WASTE WATER:
ENGINEERING: FIRE: BUILDING:
COMMENTS:
Rev 11.08
Ucense lS0000382 Bonded 8 Insured
3584 Avalon Park Blvd Ste. 1
0182
Orlando, FI 32828
Phone it 407.718.7878
Kevin Jansen
407-704-0923
mkevinjansen®gmail.com
Install (4) zone residential Irrigation system
Water source: reclaimed
Design; manifold, (2) rotor sones and (2) pop-up zones
rimer' Rainblyd, Exterior Esp modular
Rain sensor: Ralnblyd INR2 wireless
I•fixtures and materials commercial grade
I PVC will be schedule 40
T80 -Irrigation warranties all workmanship and materials for 1 full year
• Permit fees can very city to city and are only estimated and not X arl of the
Service Invoice
Estimate
DATE: November 28, 2011
FOR:
2320 Cordova Or
Sanford, FL 3277.1
Mell" 401R1L
tiervlce InV
Labor fee -
Permit 75.00
Signature TOTAL 0,600.00
LMakeia`II the s+�iDe_gl le t`o�TtB�rOtSe Ides
Total due in 15 days. Overdue accounts subject to a service charge of 1% per month.
'THANK YOU FOR YOUR BUSINESS!
E
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
CONSTRUCTION INDUSTRY
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA
WORKERS' COMPENSATION LAW 0
EFFECTIVE: 06/26/2011 EXPIRATION DATE: 06/25/2013
PERSON: THOMAS S OVERMAN
FEIN: 743202858
BUSINESS NAME AND ADDRESS:
T & O SERVICES LTD CO
1338 RICHMOND GRAND AVE
ORLANDO. FL 32820
SCOPE OF BUSINESS OR TRADE:
1- REPAIR SERVICE 2- MAINTENANCE
3- IRRIGATION
IMPORTANT
I' Pursuant to Chapter 440.05114►, F.S., an officer of a corporation who
0 elects exemption from this chapter by filing a certificate of election
L under this section may not recover benefits or compensation under this
D chapter.
H Pursuant to Chapter 440.051111, F.S., Certificates of election to be
exempt.. apply only within the scope of the business or trade listed on
E the notice of election to be exempt
R
E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt
and certificates of election to be exempt shall be subject to revocation
if, at any time after the filing of the notice or the issuance of the
certificate, the person named on the notice or certificate no longer meets
the requirements of this section for issuance of a certificate. The
department shall revoke a certificate at any time for failure of the
person named on the certificate to meet the requirements of this
section.
CUT HERE
QUESTIONS? (850) 413-1609
* Carry bottom portion on the job, keep upper portion for your records.
OWC-151 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11