HomeMy WebLinkAbout121 Laurel Dr (5)dPermit #:
Job Address:
Description of Work:
Historic District: Zoning:
CITY OF SANFORD PERMIT APPLICATION '
Date:
e, JcO Ut -F
Value of Work: $
I\ ufr1G'r
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair— Residential or Commercial
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type: # of Stories: k # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: a S ` lei ro a d- 5 -A (Attach Proof of Ownership & Legal Description)
Own/errs Name & Address: wCs.ttiE Q . _G t `t,C
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Contractor Name & Address:Y1- X,r1i'T-C' , _ f7 9 oMi1 sn Cl*Pf4 1XjN0t; < c &^-% SY. Phone &
Fax: V I I I t nLct Pilr$dn: t 5 "'L ' S Phone: %Ao ' 1 +
1 +-+
Bonding
Company: Address: %
nnfi '" • Mortgage
Lender: " ° .:t Address:
Architect/
Engineer: " Phone: r
Address:
I - Fax: Application
is hereby made to obtain a permit to do tiie,work and installations as indicated. I certify that no work or installation has commenced prior to the issuance
of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. I understand that a separate permit
must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and AIR
CONDITIONERS, etc. OWNER'
S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction
and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE
FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. NOTICE:
In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this
county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. Acceptance
of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, F 713. Signature
of Owner/Agent Date Oig5lture of Contractor/Agent Print
Owner/Agent's Name Signature
of Notary -State of Florida Date Owner/
Agent is _ Personally Known to Me or Produced
ID APPLICATION
APPROVED BY: Bld(--I I D 6 Zoning: Initial &
Date) Special
Conditions: a
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5' Date
Sig'
rfa ` fNdWy-giife-df :lorida — Date FLORENCE
A. DE GRAVE cMY
COMMISSION # DD 164280 on *
t iEXPIRE$' to Me or try
DBond_ _ - Utilities:
FD: Initial &
Date) (Initial & Date) (initial & Date)
CITY OF SANFORD, FLORIDA 0
APPLICATION FOR BUILDING F'h:RMIT
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PERMIT ADDRESS Lj1 "kAfe -f)6. af\&'A 3(•71-1 L PERMIT NUMBER
Total Contrac Price of Job ` U Total Sq. Ft.
Describe Work',:a e. ham oss r r ( >_ 1 4
Type of. Construction Re pq',r Prone— Flood (YES) (NO)
Number of Stories
T
Number of Dwellings j Zoning
Occupancy: Residential / Commercial Industrial
LEGAL DESCRIPTION (please attach printout from Seminole County)
TAX I.D. NUMBER - I) r-` r-N~
OWNER
ADDRES
CITY
C,- L a Q n `1 Qi PHONE NUMBER I, ><`1_JI • 1 3 NO
TITLE HOLDER (IF OTHER THAN OWNER)
ADDRESS N \pr
CITY N CA
BONDING COMPANY
ADDRESS
CITY 1 11 W
ARCHI
ADDRE
CITY
MORTGAGE LENDER 1A
ADDRESS ao
STATE
STATE
ZIP
ZIP
CITY 1V,1+ STATE ZIP 1-'L
CONTRACTOR
fir mar ll IIJNE NUMBER 0-Iq
ADDRESS 12 ST. LICENSE NUMBER
CITY STATE ZIP I-.L2)
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, PLUMBING, MECHANICAL, SIGNS, POOLS, ETC.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that
all work will be done in compliance with all applicable laws regulating Construction
and zoning. A COPY OF THE RECORDED COPY OF THE NOTICE OF COMMENCEMENT WILL BE POSTED
ON THE JOB SITE WITH PERMITS NO LATER THAN SEVEN (7) DAYS AFTER THE PERMIT HAS BEEN
ISSUED. FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
THE IMPROVEMENTS TO YOUR PROPERTY. 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, FS713.
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COMMISSION # DD286157 EXPIRES January
29, 2008 MyCOmm'
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BONDED THRU TROY FAIN INSURANCE INC E)OFO$ DeCemt., 10, 2006 ro I
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a 'r Application
Approved BY: FEES:
Building Open
Space Date:
Radon
Police Fire Road
Impact Application PERMIT
VALIDATION: CHECK CASH DATE BY ORIGINAL (
BUILDING) YELLOW (CUSTOMER) PINK (COUNTY TAX OFFICE) GOLD (CO. ADMIN) THIS
APPLICATION USED FOR WORK VALUED $2500.00 OR MORE PY
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r CITY OF SANFORD, FLORIDA
t - ll APPLICATION FOR BUILDING PFPMT'P Y S
PERMIT ADDRESS l . PERMIT NUMBER
Total Contrac Price of Job e , 1--o oo Total Sq. Ft.
Describe Work
Type of Construction
Number of Stories
Occupancy: Residential
Number of Dwellings
Commercial _
loo Prone - (YES
Zoning _
Industrial
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LEGAL DESCRIPTION (please attach printout from Seminole County)
TAX I.D. NUMBER DI 0 H
OWNER PHONE NUMBER
ADDRESS
CITY 1(\n STATE. 1771 ZTP .-A VIA ri ri a
TITLE HOLDER (IF OTHER THAN OWNER)
ADDRESS
CITY
BONDING COMPANY
ADDRESS
CITY
STATE V\I IA- ZIP
STATE hl I q- ZIP
ARCHITECT ME
ADDRESS
CITY • STATE ZIP
MORTGAGE LENDER N
ADDRESS Vr,%%Ka
CITY N a STATE Q i-- ZIP Ill I H
CONTRACTOR
Ffli- (
Cf;HON1 NUMBER
ADDRESS ST. LICENSE NUMBER
CITY STATE ZIP
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, PLUMBING, MECHANICAL, SIGNS, POOLS, ETC.
OWNER'S AFFIDAVIT: I certify that all' the foregoing information is accurate and that
all work will be done in compliance with all applicable laws regulating construction
and zoning. A COPY OF THE RECORDED COPY OF THE NOTICE OF COMMENCEMENT WILL BE POSTED
ON THE JOB SITE WITH PERMITS NO LATER THAN SEVEN (7) DAYS AFTER THE PERMIT HAS BEEN
ISSUED. FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
THE IMPROVEMENTS TO YOUR PROPERTY. 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.-VERI#ICATION THAT I WILL NOTIFY THE OWNER OF THE PROPERTY OF
THE REQUIREMENTS OF FLORIDA LIEN LAW, FS713.
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Si ature &V Ow r/Agent & Date Signature of Contra r &LD9te o
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T pe or IlYint Owner/Agent Name Type or Print Contractor's Na e d 5
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Application Approved BY:
FEES: Building
Open Space
PERMIT VALIDATION: CHECK
Radon
Road Impact
pJ0@N Jane Feuat Cuddy
My Commiaaim: DD077573anE)irea December 10, 2005
Date:
Police Fire
Application
CASH DATE BY
ORIGINAL (BUILDING) YELLOW (CUSTOMER) PINK (COUNTY TAX OFFICE) GOLD (CO. ADMIN)
THIS APPLICATION USED FOR WORK VALUED $2500.00 OR MORE
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CITY OF SANFORD, FLORIDA 1V
sks• ( APPLICATION FOR BUILDING PERMIT
PERMIT ADDRESS 1t t, (tr )%1 a 3. , PERMIT NUMBER
Total Contrac. Price of Job Total Sq. Ft.
Describe Work L 1
Type of Construction
Number of Stories
Occupancy: Residential
LEGAL DESCRIPTION
TAX I.D. NUMBER
Number of Dwellings
Commercial
Flooa Prone (YES) (NO)
Zoning
Industrial
lease attach Drintout from Seminole Count
OWNER 1 \ \ (' PHONE NUMBER ` U
ADDRESS
CITY \ STATE ZIP
TITLE HOLDER (IF OTHER THAN OWNER)
ADDRESS
CITY h'Ti `STATE ' ZIP
BONDING COMPANY \4 _
ADDRESS
CITY STATE ZIP n
ADDRESS tA"
CITY 1-A STATE } ZIP
MORTGAGE LENDER IV
ADDRESS r,,l \ 0
CITY STATE t\11 ( ZIP 1'"l
f1I 11nF V
CONTRACTORL 4 i(7;HAN NUMBER
ADDRESS ) ST. LICENSE NUMBER
CITY U13n i A STATE ZIP
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, PLUMBING, MECHANICAL, SIGNS, POOLS, ETC.
OWNER'S AFFIDAVIT: I certify that all' the foregoing information -is accurate and that
all work will be done in compliance with all applicable laws regulating construction
and zoning. A COPY OF THE RECORDED COPY OF THE NOTICE OF COMMENCEMENT WILL BE POSTED
ON THE JOB SITE WITH PERMITS NO LATER THAN SEVEN (7) DAYS AFTER THE PERMIT HAS BEEN
ISSUED. FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
THE IMPROVEMENTS TO YOUR PROPERTY. 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, FS713.
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Signature of Owner/Agent & Date Signature of Contrac6j6r & Date 0 n 1<
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Application Approved BY:
FEES: Building
Open Space
PERMIT VALIDATION: CHECK
Radon
Road Impact
pAYaQ gene Faust Cuddy
W;W E"r mission D0077573Decemberto, 2005
Date:
Police Fire
Application
CASH DATE BY
ORIGINAL (BUILDING) YELLOW (CUSTOMER) PINK (COUNTY TAX OFFICE) GOLD (CO. ADMIN)
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THIS APPLICATION USED FOR WORK VALUED $2500.00 OR MORE
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CITY OF SANFORD, FLORIDA
APPLICATION FOR BUILDING PERMIT
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PERMIT ADDRESS -fit it' C. i. \1 1 PERMIT NUMBER
Total Contract Price of
Describe Work
Type of Construction
Number of Stories
Occupancy: Residentia
LEGAL DESCRIPTION
TAX I.D. NUMBER
Job Total Sq. Ft.
Flood Prone (YES) (NO)
Number of Dwellings Zoning
f Commercial Industriali
please attach printout from Seminole County)
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OWNER Jr -,1••Y"i '5om—.;
VN
k ADDRESS
C !t
PHONE
NUMBER "', ! j 1' I CITY
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ZIP TITLE
HOLDER (IF OTHER THAN OWNER) t...51';-4 ADDRESS
CITY : ,
STATE 1= ZIP BONDING
COMPANY a i4 _ ADDRESS -•)
CITY
r, r STATE 1 ZIP ARCHITECT
ADDRESS _
1 CITY
MORTGAGE
LENDER ADDRESS
CITY
STATE
T t ZIP STATE
ZIP CONTRACTOR
I i P d f \f ` 4 L:: 1 ' , a , i PHONE NUMBER ADDRESS . ` ,
1 ST. LICENSE NUMBER CITY , ,^
STATE ZIP 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, PLUMBING, MECHANICAL, SIGNS, POOLS, ETC. OWNER'
S AFFIDAVIT: I certify that all the foregoing information 'is accurat'e.,and that all
work will be done in compliance with all applicable laws regulating construction and
zoning. A COPY OF THE RECORDED COPY OF THE NOTICE OF COMMENCEMENT WILL BE POSTED ON
THE JOB SITE WITH PERMITS NO LATER THAN SEVEN (7) DAYS AFTER THE PERMIT HAS BEEN ISSUED.
FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR THE
IMPROVEMENTS TO YOUR PROPERTY. 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, FS713. H
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Type
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My COMMIS ;on p o
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Application
Approved BY: Date: FEES:
Building Radon Police Fire Open
Space Road Impact Application PERMIT
VALIDATION: CHECK CASH DATE BY ORIGINAL (
BUILDING) YELLOW (CUSTOMER) PINK (COUNTY TAX OFFICE) GOLD (CO. ADMIN) 0
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APPLICATION USED FOR WORK VALUED $2500.00 OR MORE
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Premiere Restoration
January 12, 2005
City of Sanford- Building & Permitting Division
300 N. Park Ave.
Sanford, FL 32771
407-330-S600
RE: Application for Building Permit: NO STRUCTURAL DAMAGES Repairs
only due to hurricane damages.
To Whom It May Concern:
Enclosed please find the following:
Our blank check # , representing payment for the permit
A fully executed copy of N.O.C.
Building Permit Application (1 page)
Power of Attorney
Three Sets (3) of the Scope of Work
vEISv c'- C oP(- o
If you have any questions please feel free to contact us.
Sincerely,
Jessica Liles
Office Manager
Premiere Restoration Orlando
Formerly: Morgan Services, Inc.
www.restoreteam.com
5107 Andrus Ave. - Orlando, FL 32804 • Tel (407)292-9744 • Fax (407)292.8425
Lic. Number CBC056687 • Lic. Number CCC057594
Project Location
Owner's Name
Owner's Address
AM
Premiere Restoration
U1I rdo=
POWER OF ATTORNEY
To: 1 + - A Date: _
I hereby name and appoint Janet Wolfe, Corrine (.Lisa) Whaley, Rick Charron car
Qscar Weeks of Silver Streak Deliverx to be my lawful attorney in fact to act for me
and apply for work to be performed at a location described as:
Section Township —Range —Lot —Block —Subdivision
Parcel ID O ` '
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And sign my name and do all things necessary to this appointment.
Signature of Contractor
Michael A. Morgan CB 6687
Acknowledge:
Sworn and subscribed before me this i -'d y of JU 2006.
Notary Public, State of Florida
My commission expires I_ `CC))' b seal
4 ON Jane Faust Cuddy
Commission DD077573
or it Expires December 10, 2005
www.restoreteam.com
5107 Andrus Ave. • Orlando, FL 32804 • Tel (407)292-9744 • Fax (407)292-8425
Lic. Number CBC056687 9 Lic. Number CCC057594
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Seminole County Property Appraiser Get Information by Parcel Number Page 1 of 2
PARCEL DETAIL
DAavtD JOFMOOK CFA, ASA
PROPERTY
APPRAISER
SEMINOLE COUNTY FL.
1101 E.FIRSTSr
BANFORO, FL32771-1468 407 - 66
a - 7SO6 GENERAL Parcel
Id:
01-20-30-517-OD00-0090 Tax District: S1-SANFORD Owner: APPLING
WAYNE L & RITA R Exemptions: 00-HOMESTEAD Address: 121
LAUREL DR City,State,
ZipCode: SANFORD FL 32773 Property Address:
121 LAUREL DR SANFORD 32773 Subdivision Name:
SOUTH PINECREST Dor: 01-
SINGLE FAMILY SALES Deed
Date
Book Page Amount Vaclimp WARRANTY DEED
09/1982 02783 1486 $19,300 Improved Find Comparable
Sales within this Subdivision LAND Land
Assess
Method Frontage Depth Land Units Unit Price Land Value FRONT FOOT &
DEPTH 75 120 .000 170.00 $11,603 f < BaeK >
A 2006 WORKING
VALUE SUMMARY Value Method:
Market Number of
Buildings: 1 Depreciated Bldg
Value: 61,812 Depreciated EXFT
Value: 0 Land Value (
Market): 11,603 Land Value
Ag: 0 Just/Market
Value: 73,415 Assessed Value (
SOH): 54,661 Exempt Value:
25,000 Taxable Value:
29,661 Tax Estimator
2004 VALUE
SUMMARY Tax Value(
without SOH): $1,010 2004 Tax
Bill Amount: $587 Save Our
Homes (SOH) Savings: $423 2004 Taxable
Value: $28,642 DOES NOT
INCLUDE NON -AD VALOREM ASSESSMENTS LEGAL
DESCRIPTION
PLAT LEG LOT
9 BLK D SOUTH PINECREST PS 10 PG 10 BUILDING INFORMATION
Bid Num
Bid Type Year Bit Fixtures Base SF Gross SF Heated SF Ext Wall Bid Value Est. Cost New 1 SINGLE
FAMILY 1956 3 1,246 1,918 1,246 CONC BLOCK $61,812 $87,059 Appendage / Sgft
ENCLOSED PORCH FINISHED 1300 http://www.
scpafl. org/pls/web/re_web.seminole_county_title?parcel=0120305170D000090&cpad=Laurel&cpad_num=121 &cctr=... I /6/05
Seminole County Property Appraiser Get Information by Parcel Number Page 2 of 2
I
Appendage / Sgft UTILITY UNFINISHED / 60
Appendage / Sgft SCREEN PORCH UNFINISHED / 312
NOTE: Assessed values shown are NOT certifted values and therefore are subject to change before being finalized for ad valorem tax purposes.
Ifyou recently purchased a homesteaded property your next yeaes property tax will be based on Just/Market value.
a -
h4://www.scpafl.org/pls/web/re—web.seminole—county—title?parcel=O120305170D000090&cpad=Laurel&cpad num=121&cctr=... 1/6/05
I
f This ins u' ment Prep r. e By:
Name l L i- J `Ur C11 OICQI
Address 1r.L
C)6-dr)Oo Fv &?)OL{
e it No. Tax Folio No.
NOTICE OF COMMENCEMENT
STATE OF F 1' _
COUNTY OF (L' f__ Q.
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and in accordance
with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Description of prop rty: (legal desc iption,of pro erty, and street address if available)
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40.f 1? bl 19i,u Clams f 06 /0 /Dcl CD
2. General description of improvement:
esvP,_e- me *) pre -loss n fra s glue d Lu rr!a
3. Owner information I 1 C OJLLQ Tr'L 3,( a. Name and address: oaq n F_ NC(,'R 16- b.
Interest in property: 0-Y'In`C his c.
Name and address of fee simple titleholder (if other than owner): j I lq 4.
Contractor:,PfryY ,ce ' 1`e;Staro`ta O a c1 - F rrn r I M Sef 0\CI- 1 nc ' a. Name
and address: lbrl anC\U , J() 6 j b. Phone
number: h-`D-I-ac a - (A-I L c. Fax
number (optional, if service by fax is acceptable): VAC-1 - a(,-1t rurl ®M1111-091OW-H®1181110flam 5. Surety
a. Name
and address: l b. Amountofbond $ c: Phone
number: d. Fax
number (optional, if service by fax is acceptable): 6. Lender ,
n a. Name
and address: 1 b. Phone
number: c. Fax
number (optional, if service by fax is acceptable): t4ARYANW X]
RSIr, LIEW W CIRWI.T UWT MINME CUM
BK 05580
FPS 1289 CLERK'' S # ;
r 01011504'07304RMUNDED 01/
13/; M4205- PM RELORDIN8 FL_
S 1&6% REUINLEU BY
t holden 7. Persons
within the State of Florida designated by Owner upon whom notices or othe provided in
section 713.13(1)(a)7., Florida Statutes: a. Name
and address: j +yam b. Phone
number: 1 I ` c. Fax
number (optional, if service by fax is acceptable): CTRTITIED COPY.
M RYANNE`
HORSE 8. In
addition to himself, Owner designates the following person(s) to receive a copy of the LienoFs Notice,as,provided in Section
713.13(1)(b), Florida Statutes: a. Name
and address': b. Phone
number: l ` c. Fax
number (optional, if service by fax is acceptable): 9. Expiration
date of notice of commencement (the expiration date is 1 year from the date of recording unless a different date
is specified) S3Qn. )_M, Q Sworn to
and subscribed before me by j,)A iC/ /A% Signature of Owner//?I-c,- wh is
personally known to me or produced X7 asidentification, and who did take Owner's Name 1:)Ayti`iZ /l/1D an oath,
this ,t? day of `' Ai .1 LOUwners ddress: I1fOIre- Signature of Notar '
Printed name of
Notary / J 4 4 6,qy —! (% Commission No./Expiration:
f — afta V Lisa Gattie MYCOMMISSION# DD286157 EXPIRES
Seal: a January
29, 2008 BONDED THRU TROY
FAIN INSURANCE, INC ALL INFORMATION MUST
BE TYPED OR PRINTED LEGIBLY TO COMPLY WITH RECORDING REQUIREMENTS.
INSURED :. Wayne -Appling
LOCATION : 121 Laurel DR
Sanford, FL 32773
COMPANY : Florida Farm Bureau
P RJ1 I
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MATE OF REP I4RT
DATE OF LOSS
08/29/2004
08/13/2004
POLICY NUMBER HO 8400388
CLAIM NUMBER 259526
OUR FILE NUMBER 259526
ADJUSTER NAME Brandon McLeliand
1.0 MC Minimum Charge Exterior Jamb for Prehung S/CExteriorDoor
1.0 MC Minimum Charge Electrical Service Call
1.0 MC Minimum Charge Heating & A/C Service Call
1.0 MC Minimum Charge Emergency Repairs to Cover &
Protect
1.0 SQ Remove Roofing -Dump Fee
24.6 SQ R/R 3-Ply w/o Gravel Built-up Residential Roofing1.0 MC Minimum Charge Fireplace Chimney1.0 MC Minimum Charge Debris Removal
26.1 SY R/R Vinyl Sheet Flooring
220.0 SF Add Floor Prep for Vinyl Flooring
490.0 SF R/R Wall Sheetrock
490.0 SF Texture for Wall Sheetrock
490.0 SF Clean, Seal & Paint Walls',
220.0 SF R/R Ceiling Sheetrock
220.0 SF Popcorn Texture
220.0 SF Clean, Seal & Paint Ceiling
62.0 LF R/R Base Moulding J
62.0 LF Paint / Finish Base Moulding
220.0 SF Mlldecide Ceiling
496.0 SF Mlldecide Walls
220.0 SF Mildecide Floor
77 ls /s an estimate of recorded damages and is subject tosiMao
Form CESTAM"P2
final
P
r
i1 trf
PLANS REVIEWEDC"y OF O)•
INSURED' ; Wayne ApplingLOCATION : 121 Laurel DR
Sanford, FL 32773
COMPANY : Florida Farm Bureau
1.0 MC Minimum Charge Suspension SyStem AcousticalTileCeiling
200:0 SF R/R Wail. Sheetrock
200.0 SF Texture for Wall Sheetrock
100.0 $1-- R/R Wallpaper-1/2 Wall
200.0 SF Clean, Seal & Paint Walls
34.0 SF R/R Ceiling Sheetrock
34.0 SF Popcom Texture
34.0 SF Clean, Seal & Paint CeilingEA10EA :> :<R/R H--- /C Door (Dr. Only) .r... SIM60LO
Form
CUST-If1"P2 DATE
OF REPORT 08/20/2004 DATEOFLOSSPOLICY
NUMBER 08/13/2004 CLAIM
NUMBER HO 8400388 250526
OUR
FILE NUMBER 259526 ADJUSTER
NAME Brandon McLelland t
INSURED, Wayne A piingLOCATION : 121 laurel DR
Sanford FL 32773
COMPANY : Florida Farm Bureau
45.0 SF Cover/Protect Floors
288.0 SF Cover/Protect Walls
45.0 SF Clean, Seal $ Paint Ceiling
SIMBDLA
Form CE6T-112.E-0P2
DATE OF REPORT 08/29/2004DATEOFLOSS08/13/2004
POLICY NUMBER
CLAIM NUMBER HO 8400388
OUR FILE NUMBER
259526
259528
ADJUSTER NAME Brandon McLelland
nv urctu :, WAYNE APPLING
LOCATION : 121 LAUREL LN
SANFORD, F3277,31
COMPANY[/
DATE OF REPORT 09/09/2004 I
DATE OF LOSS
POLICY NUMBER HO ,8400388
CLAIM NUMBER 270322
OUR FILE NUMBER 270322
ADJUSTER NAME JASON RINEWALT
ywuanuw Description Unit Cost
816.0 SF Mildicide Wall Treatment
620.0 SF Mildicide Floor Treatment
6.20.0 SF R/R Premium Grade Glazed Ceramic Floor Tile in
Mortar l -"
816.0 SF R/R Premium Grade PINnvood Sheet Wall Paneling
816.0 SF Paint / Finish Premium Grade Plywood Sheet Wall
Paneling -- tAc, 4- nlecoZO
620.0 SF R/R Ceiling Insulation
1436.0 SF R/R Sheetrock Walls & Ceiling
102.0 LF R/R Base Moulding
102.0 LF Paint / Finish Base Moulding
RCV I DEP
Thls is
SIMSOL® an estimate of recorded damages and is subject to review and final approval by the Insurance carrier.
Form CEST-112.5-SP2
ACV