HomeMy WebLinkAbout413 Bella Rosa Cir (2)e
LVED
JAN 17 2012
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: Io'l' Documented Construction Value:
Job Address: / d� X0 &2 CA (', tr Historic District: Yes ❑ No ❑
Parcel ID:
Description of Work: ri '
Plan Review vContact Person:
Phone: 1167' 5,3 A - 7/53' Fax:
Zoning:
E-mail:
Property Owner Information
Name A Goch t: 5
Street: L�[,3 /kl/o Ros" e;e—
City, State Zip: _5a'„ AgM r(, 0'7 7'j
Title: =L^A s
Phone: 65-&13
3
Resident of property? :
Contractor Information
Name o C Phone: -3
Street: -S t9V-< Fax: (�5�/ - / VL 7
City, State Zip: "'jo State License No.:' �f 46
Architect/Engineer Information
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Building Permit ❑
Square Footage: _
Phone:
Fax:
E-mail: _
Mortgage Lender:
Address:
PERMIT INFORMATION
Construction Type:
No. of Dwelling Units: Flood Zone:
Electrical ❑
New Service - No. of AMPS:
Mechanical ❑ (Duct layout required for new systems)
No. of Stories:
Plumbing 0-111,
New Construction - No. of Fixtures:
Fire Sprinkler/Alarm ❑ No. of heads:
00
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.
I AA Cf� &�-X N / /3-/7-*�
-Signature of Owncr/Agent Date
Print 0%%mer/Agent's Name
15. PH 1&.),.
Signature of to -State of FI i a Datc
Ewa
s GEORGE F. AY
LSWOi'K J L
?.. r. MY COMMISSION / EE 044323
'-', • 8 EXPIRES: March 22, 2015
'�I..I BoMed Thti Notary Publr Undervniten11
Owner/Agent is Personally Known to Me or
Produced I D Type of I D brill Yr ► (,
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
Rev 11.08
/ loi- c,, - 1-13 ;L
Signature of Contractor/Agent Date
_/:�p1��
Print Contractor/Agent's Name
OF
_y -
of Not -State of Flo da D• e��/
",, GEORGE F. AYISWORTK JR.
r. MY COMMISSION I EE 040.923
EXPIRES: Match 22, 2015
Bonded Thtu Notary Publk Undawrlin
Contractor/Agent is personally Known to Me or
Produced ID Type of ID
UTILITIES: WASTE WATER:
FIRE:
BUILDING: / l Z
Fax (407) 851-1297
SAMSAGAS'
P.O. Box 593641 8222 S. Orange Ave.
Orlando, Florida 328593641
W W W.SAMSOAS.COM
POWER OF ATTORNEY
Date: ;aJ 5,x a jS
OFFICE (407) 855.1903
I, Randal Sams of Sams LP Gas Co., do hereby give my permission for
'D AJ to pull permits in the CrAL, 4 San; For 4a
at anytime until further notice. f 3 !3%a >PcsQL-
License Holder Name: Randal Sams
State License Number: 0
Signature of Licen o er:
STATE OF FLORIDA
COUNTY OF ORANGE
The forgoing instrument was acknowledged before me this day of
a S b *�R"A(- who is rsonally
�identi
ho has produced
and who did/did not take an oath.
A�,
mr—d
& Z-
gignature f
ole
Print or type name
(Notary Seal)
Notary Public -State of Florida
fly,. GEORGE F. AYMORTH. JR. �l
r MY COMMISSION N EE 044323 I w Commission No. C LS v 2�
3 EXPIRES: March 22,= I4 M Commission Expires .3 2Z- JojT
Banded lrru Notary Pub k Underwriters y
• Commercial • Indut t ial
Since 1964
L CUSTOMER COPY
79500
I'
SAM 5 O UAS
P.O. BOX 593641 8222 S. Orange Ave.
Orlando, Florida 32859-3641 Orlando, Florida 32809-6733
�--
(407) 855-1903 • (407) 855-1906 - (407) 855-6506
www.samsgas.com
O SERVICE ORDER O INSTALLATION ORDER
ACCOUNT NUMBER
CALL DATE
PROMISE DATE
NAME JCJ I I'A!5 A C�� � � Q 739
MAILING ,i
ADDRESS/
CITY „t I•otfcl STATE rl. ZIP �%
`
CITY
COUNTY
• - • • -
HOME PHONE WORK PHONE
CELL
PHONE
�COOKT ANG TYPE GRILL TYPE
•- •
PERCENT SIZE TANK GALLONS IN TANK
. • •.
MATERIALS 22
•
DRYING
POOUSPA
FORKLIFT
GENERATOR
LABOR�lCIV
CHARGE 23
S v `�
GOND. SERIAL NUMBER
FIREPLACE
FIRE PIT
TRAVEL CNG 74
HEATING
WATER HEATER
START PR END PR TIME LOCK UP
GAS CHECK 25
// �tN�
GAS LIGHTS
SUMMER KITCHEN
PERMIT 47
/ ��v OJ)
PART •
QTY
DESCRIPTIONIMATERIALS
PRICE
AMOUNT•
START PR END PR I. TIME LOCK UP
CUSTOMER/PRESSURE TEST ON
X
GAS
lQ•
vef ! 6w (�
�
I-'--1w
/ ®/
�) 1w
`�
SALES TAX 60
ZJ
TECHNICIANIPRESSURE TEST'
X
UTILITY TAX
TANK RENTAL
KEEP FILL: Y or N
RATE CODE ZONE
TAXES
T7(t 7%2 T%3 1X• -TX-5
DEPOSIT 46
101.
,
•
Sri ♦ W
V �
CUST. TYP
DEL FRE O
TOTAL RECEIVED
r'
TANK LOCATION
N
W E
S
THE LP. GAS INSTALLATION DESCRIBED HEREON HAS BEEN RECEIVED AND INSTALLED TO MY COMPLETE SATISFACTION AND 1 HAVE
BEEN INSTRUCTED IN ITS USE. I HAVE BEEN INSTRUCTED AS TO ODOR OF L.P. GAS AND HOW TO TURN THE GAS SERVICE VALVE OFF IN
THE EVENT OF AN EMERGENCY. 1 HAVE ALSO READ THE GAS SERVICE AGREEMENT AND THE INSTALLATION ORDER AND AGREE TO
ALL REOUIREMENTS, RESTRICTIONS AND POLICIES OF THE GAS COMPANY.
NOTICE TO PURCHASER
(A) DO NOT SIGN THIS BEFORE YOU READ IT, OR IF IT CONTAINS ANY BLANK SPACES. (B) OU ARE ENTITLED TO AN EXACT COPY OF THE PAPER YOU SIGN. (C) YOU HAVE THE RIGHT TO PAY
IN ADVANCE THE FULL AMOUNT DUE, AND UNDER CERTAIN CONDITIONS TO OBTAIN A P IAL REFUND OF THE TIME PRICE DIFFERENTIAL. (D) WE WILL HONOR ESTIMATES FOR 30 DAYS ONLY.
CUSTOMER'S SIGNATURE X �C j' - '�_�.�'�' ,�� ,� DATE r I
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MAP OF SURVEY
"BOUNDARY WITH IMPROVEMENTS"
LOT 49, CELERY ESTATES NORTH, ACCORDING TO THE PLAT
THEREOF,AS RECORDED IN PLAT BOOK 7>, PACES 38-45 OF
THE PUBLIC RECORDS OF SEAfINOLE COUNTY, FLORIDA.
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a I LOT 48 gee
wl _ tu jl..�
�i N89'50'10'E 125.00'
I / EL -J3.7-, D
-- =-a--
— 25.5•
�CMALATM COVERED
: 01rVEM�
C/L - CENTERLINE
CONC -CONCRETE
EMT - EASDENT
150.2'—yp
PADS
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RESIDES
FF -14.88
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41.5
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S.C.M. . !ET CD,MUETE MDIAPEMT
F.C.M. . FEUD Comom M&APENT
F. I.M.C. - TARO JRb/ MOD AND CAP
I. J.R. - FOUR JM VV ROD
l.I.R.C. - STT IRM RDD AND CAP
• FMD HADD - FOW MAIL AND DISC
v°C.P. : Fv rrt Wma POra
mh
S89'50'10IN 125.00'
CITY OFr&O+T+.6A.J • BUILDW '-• nN R 4W I
I
PLANNIOG A"I? DRIELf1P►+SF T ScRVICES I
I I
APPROVE31� ---
OAT.AY 0 9 2011
N CERTIFIED TO AND FOR THE EXCLUSIVE
BENEFIT OF:
SCALE 1- - 30' MApCEA CONES
UNIVERSAL AMERICAN MORTGAGE COMPANY
NORTH AMERICAN TITLE INSURANCE COMPANY
NORTH AMERICAN TITLE COMPANY
PROPERTY ADDRESS:
413 BELLA ROSH CIR.
SURVEY NOTES:
• - :.I.R.C. 5/0 Le 16605 LKESS NOTED
1 HEREBY CERTIFY THAT THE MAP OF SURVEY SHOMN
HEREON IS IN ACCORDANCE WITH THE TECHNICAL
STANDARDS AS SET FORTH BY THE BOARD OF
PROFESSIONAL LAND SURVEYORS IN CHAPTER 8J-17.
FLORIDA ADMINISTRATIVE CODE PURSUANT TO SECTION
472.027. FLORIDA STATUTES.
ACCORDING TO THE FEDERAL EMERGENCY MANAGEMENT
AGENCY FIRM MAP NO. 1210C 0090 F. EFFECTIVE,
09/26/07. THE PROPERTY DESCRIBED HEREON IS IN 46.10-,
ROC E. LS NO. 6306
ZONE •AE' FLORIDA EGISTEREO LAND SURVEYOR AND MAPPER. NOT
A LETTER MAP REPROVED PORTIO HAS BEEN ISSUED VALID M DUT THE SIGNATURE G THE ORIGINAL RAISED
ZONRECE 'X ' (CASE 09-04-SS40A1. ERiIFTNG THE IMPROVED PORTION OF THIS LOT AS SEAL OF A FLORIDA LICENSED SURVEYOR AND NAPPER.
DTE
P.O.C. - POINT OF CO DIENCE1OR
P.0.0. - POINT OF PEGIMMIND
P.O. T. - POINT OF TpMINB
P.C. - POINT OF MYAnW
P.I. - POINT OF JMTETHCTJOM
P. T. - POINT OF TANGENCY
UTILITY EASEMENT
O.E. - DRAINAGE E$-,Xmw
nATF nF FTFI_n SIIGVFY
PLOT PLAN 01/20/11
BOUNDARY 2/19/11
FORMBOARD 2/23/11
FOUNDATION 3/3/JJ
SINAL 3/D/11
- LHEASLADENT
- POFED 0 0llCRJPTiON
- DELTA OR CENTRAL AMU
- RADIUS
A - AFC LENGM
RA - ARC "mc eT6tMEss
t ACONDIIDB Mfr
E�ATION
i : P rIN� 9E0 TLo01 EIEYArra
O.U.E. - DRAINAGE AND UTILITY EASE1pN
LLs - LICENSED SIRY M
P.R.N. : MIRAEIIENT AEFERWE MDMMIT
�CMALATM COVERED
: 01rVEM�
C/L - CENTERLINE
CONC -CONCRETE
EMT - EASDENT
FRANKLIN, HART & REID JOB RCT NO.E 120038 RMATION
CIVIL ENGINEERS - LAND SURVEYORS DRAWN BY: TOF
1368 EAST VINE STREET, KISSIMMEE. FL 34744 REVIEWED BY: GRR
PHONE 846-1216 FAX 846-0037
CERTIFICATE NO. LB 6605