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2640 Vineyard Cir 07-290132-gig--3 -5-2 _0000 Does 11'Y OF SAN1OVD Nr:f,ali I';,i'I'LCt: \'I ION Job Address. o msie aeCL Cam— — --— Dcscripiion of Work: New Cnnstructiojl_ — SFR -Polar Squat Fuuta;;c IIistnric District Zoning- R 'Value of Work: S —7 to t [TFD— Permit Type: Building —X ElectlIC31 -- MCcI1;%;:1Ca1 __ Plumbing _-- Fire Sprinkler/Alarm _ 1%,ol RECEIVED Electrical. New Service — # of AMPS Addition,Ahm!ttun Cl,Jngc of SciNice 'Temporary Pole—_ AUG 0 % 2UU7 Mechanical Residmial X Non -Residential Replacement —._ New _ ,(Duc; Layout & FxxigY Calc. Regtmer,) 1"mmbing/ New Commercial- $1 of Fixtures 11 of `N,,tCr << Sr,scr i_unss _ of ails Lines 11iumbing/New Residential: A of Water Closets _—_ Plimibin^ Repair - `Zr,id;nual or C oinaic,ci;J —_— Occupancy Ti pe: Residen ial _ Cornmetciel __ Inuustrial t ) Construction Type. LA # of Stories: p of DMclling knits- _ Flood Zone: X _ t,F:IA Girni retl„ireJ) O snet s Name & Address. , tec i 775HarleyStaaand K . , Ste. 1 1 0, orange try__ - 940 Contractor Name & Address _ 775 Harley Strickand F3 d,,S e- ,Orasn c teiCl _CGCL5J_0_1_4_S PtiuneRrsa3 — 4C •7940rax— ,_7anj.'nnt.ctre„on nPhhi.Clay_ton--mm.,386-851-7977 Bonding Company N Address Mortgage ]. ender' NZ Address' ___ __ _ _ _ Architc iEnginecr: Steve Kastner —_ _--_ i'hn nr2— Sg _ Address' 6905 Wickham Rd.Melbourne,FL --_--_ — :.,s __?21-751-4496 Arplii aeon is hciehy made to obtain a permit to do the work :,nd mltallarwnc its u•J,ca:cd ! cc,uf;• !i,m nv „, r of n,si;illJUOn has co'nir.encc,l r•-inr io the uruancc of a pernii! and that all work will he perfonnca to nicC. stai:dci ]s of ail law s rri;ulaunt; consiniclnm m ti:r:: In,r:(t'•-b•'n I mnietsiant: d1J1 a scl;,aali piton om,l he secured I'x CLI:C'TRIC\L WORK, PLUMBING, SIGN.'), \': LLLS, i'OUi.S• I I:It.'J.'•.0 L`,, It( 'iLl;l:, Iir,A:T:.R:i,'i A'J!;;,. anJ A: R CONDITIONERS, ctc. Q212 ICS AI 1_IDAVIT. I cciufy that all of the foregoing information is accuiate and that all wgrl: ss-,t1 be,line in crnni,hancc with all algih;ahle :aw-s regoiat,ny construction and Zoning; WARNfN(; 10 OWNER YOUR FAI! IJRV TO RI —CORDA NOTH. i_ 0F.0049,1r.NCl .!FN I MAY RCStil.. i IN YOUR PA) IN6 I" A ICE FOR IMPR( VEMI.N 1'S TO YOUR PROPER.] Y IF )r 01) INTEND 1 O OflTA;N FINANCING, CONSULT waii TOOK LI:NDLK UK AN ArrORNL' Y BC1'GRE RECORVNG YOUR NOl ICE OF CUMMi;M( E1,1 i.Nr NOTICE: In addn••,n to the requirements of this liennit, there :nay lrt addinoral resit it wins appbr;hle to this piui rly at may be found in the public rccoru'% of This county, and lima: may be 4dditional permits requited fen: other guvci • menial ea:utc.-, such as w.ner m oar• t nt ,tr, , sialC •,Sri ics al Acceplance of , cm m is venficanon that I will notify the owner ul the prc;••-ri, ul the i; ga;:aacnis t f Fluu a , 1' 7! i. Signawic of Ownci;AgL,u DJ!e S:grJt,n of C ra.W /lt.ni '-- Wtc l 1 1 - l A .--- Sys S-%/•e / Print owner/Agent's Name Signature of Nutary•Staic of Fiurida !)at-, S'g-miu,t. i f ,:oiJt i •`lu:r o! . ••an'•i Da:c Debra M. Clayton My Commission DD248439 a V Expires December 12.2007 owner!,\ grit i, _ I'eisnnaily Known to i0e ur (,m::a, h•i. ^.;u.i ,c 1'c;or•J::, Kinw.c to Me :r Pi, rduc ed ID Ili ,., .;,I iD -- - APPROVALS. S. ZONING. $ 1.11 !L j&Lfk> Special Conditions Kc+ oN-006 a0- q#t I VG UTILITY IMPACT FEES SW-$ y8 a(P4p Ui(0e a,,r e;m(e-, City of Sanford Building Division Submittal Requirements for Residential Building Permit Two (2) recent boundary and building- location surveys showing setbacks frorn all structures to property lines for permit for structures (not fences). Two (2) complete sets of construction design drawings drawn to scale. Complete sets to include: a. Foundation plan indicating Tooter sizes for ,ail bearing walls. Provide side view details of these footers with reinforcement bar replacement. b. Floor plan indicating interior wall partitions and room identification, room dimensions, door; window, and/or opening sizes, smoke detector location(s), landings, decks; stairs, bathroom fixtures, and distances from walls. *`Thu State of Florida rc:luires bathroom compliance with Florida Accessibility Code. C. An elevation of all exterior walls - east, west, north, and south. 1=finish fluor elevation height as per Engineering Depanument or subdivision plat. d. Cross sections of all wall sections to be used in the su'ucture, bearing and nutrbearing interior and exterior walls, show all components of wall sections. C. Framing plan for floor joists where cotiventionaiiv framed. flan is to indicate span, size and species of materials to be used. f. Engineered truss plan with details of bracing. engineered beams for spacing openings to cant' and support trusses. g. Stair details with tread and riser dimensions, stringer size, methods of attachment, placement of handrails and guardrails. I-t. Square footage table showing fuota-::s: 1. Garages/Carports _ $ _ sq. ft. 2. Porches/Entries g O sq. ft. 3. Patio(s) _ sq. ft. 4. Conditioned Structure J q Z ? stl. li. 5. Total Gross Area a_ sq. ft. Three (3) sets of completed Florida Energy Code Dorms. Soil analysis and/or soil compaction report. Ifsoils appear to be unstable or if' structure is to be built on fill, a report may be requested by the Building Ofliciai or his representative. Other submittal documents: a. Utility letter or approval when public water supply and/or sewer system connection to be made. b. Septic tank permit issu: d by Seminole County Health Dept. C. Arbor permit when trees to be removed from property. Contact the Engineering Dept. for details regarding the arbor ordinance and perrnit. d. Seminole County Road linpact fee statenici t. e. Property ownership verification. f. Driveway permit issued by Ci!y Engineering Department. Application to be completed thorOL[ghly and signaturc;s provided by a licensed and insured contractor and property owner. If electrical, rnechanical, or plumbing permits have not been issued, inspections will not be scheduled ur made and subcontractors will be subject to prnalty under city ordinances. Date tO [7A Owner/Agent Signature ` _ COUNTY OF SEMINOLE IMPACT FEE STATEMENT ISSUED BY CITY OF SANFORD STATEMENT NUMBER 107-75094 DATE: 1 BUILDING PERMIT NUMBER: ;'"(CITY) COUNTY NUMBER: UNIT ADDRESS: - , ".'o- TRAFFIC ZONE: JURISDICTION: 06 CITY OF SANFORD SEC: TWP: RNG: PARCEL: SUBDIVISION: TRACT: PLAT BOOK: PLAT BOOK PAGE: BLOCK: LOT: OWNER NAME: MIr ADDRESS: t /. / C ,n n776 3 APPLICANT NAME: / 1 c .a v o ADDRESS: LAND USE CATEGORY: 001 - Single Family Detached House TYPE USE: Residential WORK DESCRIPTION: Single Family House: Detached - Construction FEE BENEFIT RATE FEE UNIT RATE PER # 6 TYPE TYPE DIST SCHEDULE DESC. UNIT OF UNITS ROADS ARTERIALS CO -WIDE 0 dal unit 8 705.00 ROADS COLLECTORS NORTH 0 dwl unit $ 000.00 LIBRARY CO -WIDE 0 dwl unit 6 54.00 SCHOOLS CO -WIDE 0 dwl unit $1,384.00 AMOUNT DUE r" STATEMENT 1 RECEIVED BY: 7O1 SIGNATURE: PLEASE PRINT NAME) l DATE: TOTAL DUE 1 4 705.00 1 3 000.00 1 4 54.00 1 $ 1,384.00 NOTE TO RECEIVING SIGNATORY/APPLICANT: FAILURE TO NOTIFY OWNER AND ENSURE TIMELY PAYMENT MAY RESULT IN YOUR LIABILITY FOR THE FEE. **** DISTRIBUTION: 1-COUNTY 3-CITY 2-APPLICANT 4-COUNTY NOTE** PERSONS ARE ADVISED THAT THIS IS A STATEMENT OF FEES WHICH ARE DUE AND PAYABLE PRIOR TO ISSUANCE OF A BUILDING PERMIT. PERSONS ARE ALSO ADVISED THAT ANY RIGHTS OF THE APPLICANT, OR OWNER, TO APPEAL THE CALCULATIONS OF THE ROAD, LIBRARY SYSTEM AND/OR EDUCATIONAL (SCHOOL) IMPACT FEES MUST BE EXERCISED BY FILING A WRITTEN REQUEST WITHIN 45 CALENDAR DAYS OF THE RECEIVING SIGNATURE DATE ABOVE, BUT NOT LATER THAN CERTIFICATE OF OCCUPANCY OR OCCUPANCY. THE REQUEST FOR REVIEW MUST MEET THE REQUIREMENTS OF THE COUNTY LAND DEVELOPMENT CODE. COPIES OF THE RULES GOVERNING APPEALS MAY BE PICKED UP, OR REQUESTED, FROM THE PLAN IMPLEMENTATION OFFICE: 1101 EAST FIRST STREET, SANFORD, FLORIDA 32771; (407) 665-7474. PAYMENT SHOULD BE MADE TO: CITY OF SANFORD BUILDING DEPARTMENT 300 NORTH PARK AVENUE SANFORD. FL 32771 PAYMENT SHOULD BE BY CHECK OR MONEY ORDER, AND SHOULD REFERENCE THE STATEMENT NUMBER AND CITY BUILDING PERMIT NUMBER AT THE TOP LEFT OF THE NOTICE. THIS STATEMENT IS VALID ONLY IN CONJUNCTION WITH ISSUANCE OF A*** SINGLE FAMILY BUILDING PERMIT******************** 2,143.00 Building Permit#: 0-7" 2clo I MARYANNE MI)R5E9 CLERK OF CIRCUIT COURT Tax I.D.#32-19-31-300-013A- 0 310 SEMINOLE COUNTY BK 06789 Pg 0623t tlpg) NOTICE OF COMMENCEMENT CLERK'S # 20071 l 8276 STATE OF Florida RECORDED 08/ 14/2007 M:28:00 AM COUNTY OF VOLUSIA RECORDING FEES 10.00 The undersigned hereby informs all concerned that the improve>it6AmmilliYbp 00eto certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is stated in this Notice of Commencement: Description of Property: Street Address: 2640 Vineyard Circle, Sanford, FI. Legal: Lot 31, TUSCA PLACE — SOUTH, ACCORDING TO THE MAP OR PLAT THEREOF, RECORDED IN Plat Book 6753, Pages 0001 and 0002, Public Records of Seminole County, Florida. Owner Information: Mercedes Homes, Inc. 775 Harley Strickland Blvd., Suite 110, Orange City, FI. 32763 Owners interest in site of the bnprovements: FEE SIMPLE Fee simple title holder if other than owner: N/A k Contractor: Mercedes Homes, Inc. Address: 775 Harley Strickland Blvd., Suite 110, Orange City, Fl. 32763 Phone Number: 386-851-7940 Fax Number: 386-851-7941 Lender: Bank of America, N.A. Address: 250 S. Park Ave., #400, Winter Park, FL 32789-4316 Attn Phone Number: Fax Number: Surety (if any): (name and address) N/A Phone Number: N/A Fax Number: N/A Amount of Payment (Surety) Bond: $ N/A Person within the State of Florida designated by owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7, Florida Statutes: Name & Address: Bank of America, 250 S. Park Ave., Suite 400 Winter Park, FL. 32789 Attn: Melinda Plakiotis Phone Number: Fax Number: In addition to himself, owner designates: N/A Name & Address: N/A Phone Number: N/A Fax Number: N/A to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(B), Florida Statues. Expiration date of Notice of Commencement (the expiration date is 1 year from the date of recording unless a different date is specified) Io erceaes ri lnc. THIS INSTRUPAENT P RED BY: NAME 1 ( l ADDR. 7—di I Xplc° /la G Volusia/FlaglerDivisi Sworn to and subscribed before me this day of - 204by Timothy F. Durkin who is personally known to me. 51 Aotary Public, oiV. My commission Expires: yi Debra M. Cjayton My Commission 00248439 an Expires December 12. 2007 N.Ir,,:;*` 7,Iso ICITY OF SANFORD PERMIT APPLICATION r 1Application #:— - _ Submittal Date: 7 60JobAddress: C;104O 1 oc N ax-b Ct-e t ¢.. Value of Work: S S5 fin D , Parcel ID: Zoning: Historic District: 1 Description of Work: ( It" .7 Lr_ Prhl '-Ca t t Square Footage: 1:2- G 11 Permit Type: Building 0 Electrical 0 Mechanical O Plumbing)6 Fire Sprinkler/Alarm 0 Pool 0 Sign 0 Electrical: New Service - # of AMPS Addition/Alteration 0 Change of Service 0 Temporary Pole 0 Mechanical: Residential 0 Non -Residential 0 Replacement 0 New 0 (Duct Layout & Energy Calc. Required) Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # ofGas Lines Plumbing/New Residential: # of Water Closets ,_ Plumbing Repair- Residential 0 Commercial 0 Occupancy Type: Residenti&IX Commercial 0 Industrial 0 Construction Type: # of Stories: # of Dwelling Units: Occupancy Use Group(s): Flood Zone: (FEMA form required ) 0......., ............... 1.. Property Owner: Contractor i^-f - Address: Address: & D o S. Vb l",rc 11 e- G4-. 3a7 43 Phone: E-mail: Pbone r°84, State License Number: CJ-"C- 0SS-68 2- Bonding Company: Address Architect/Engineer: Address: Plan Review Contact Person: Mortgage Lender: Address: Phone: Fax: Phone: Fax: E-mail: Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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 aU 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 ofthis 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 ofthe prop!theemen fFlorida Lie w,.FS I13... y Signature ofOwner/Agent Date a ofContricteshtfent Date f7A rrJ - 4t4S,A-moo Print Owner/Agent's Name Signature ofNotary -State of Florida Date Owner/Agent is _ Personally Known to Me or Produced ID APPROVALS: ZONING: Special Conditions: Rev 07.07 UTIL: FD: Print Cyd Actor/Agent's il'-V- ",7 Signature of a o Pia., ura A: Engstrom Commission # DD597801 Expires September 21, 2010 W 86n000 Troy Fain - In9mnmee. Inc. e00.3W70/9 Contractor/Agent is _Z— Personally Known to Me or Produced ID ENO: BLDG: LIMITED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: / /, >$— 07 I hereby name and appoint: S vi 1 4-4 an agent of. i`T" I k r^&-k— , 516 -y1 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 specific permits and application for Expiration Date for This Limited Power of Attorney: License Holder Name: b A 16 State License Number. QsS Signature of License Holder: STATE OF FL RIDA COUNTY OF UOLLUSI A. The foregoing instrpmeat was acknowledged before me thisay of 200 by 1q'VlD K 80re:S+4C> who is ? ly o to me or ? who has produced as identification and who did (did not) take ry oath. Signature - " U Notary Seal) &PIUZ,4 A PV Print or type name o Laura A: Engstrom , M%)'&AdW 5-7019 Commission # DDS97801 Notary public - State of gorte( -- Expires September 21, 2010ExTroys • Septembereft.r E0p,7E010 Commission No. W 517 01 My Commission Expires: 10-cAt- to Rev. 3/27/07) Permit # : Date: CITY OF SANFORD PERMIT APPLICA ON f L.::z -7 /v Job Address: 2 (p 4o %n eyard ' /r eI - Description of Work: 14' AA.) Pl l I-or AVYV P— Total Square Footage Historic District: Zoning: Value of Work: S 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 Wat losets Plumbing Repair — Residential or Commercial Occupancy Type: Residential Commercial Industrial Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required) Owners Name & Address: Ml;IrG 77S NatrLey 14rIi Contractor Name & Address: J e I 531 Omodis ca ckL Phone & Fax: q0?- .333- 2 Bonding Company: Address: Mortgage Lender: Address: Architect/Engineer: Address: Contact Person: CA - Phone: State License 1 . . EC 13,00 371 S- Phone: Fax: 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. 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 ofpermit is verification that I will notify the owner of the property of the requirements on 713. Signature of Owner/Agent Date Signs of Contmc r/Agent Date Print Owner/Agent's Name Signature of Notary -State of Florida Date Owner/Agent is _ Personally Known to Me or Produced ID APPROVALS: ZONING: Special Conditions: Rev 03/2006 UTIL: FD: r Wis me/ i a ` tate of Florida Date Contractor/Agent is _Personally Known to Mc or Produced ID ENG: BLDG: JACQUELYN HOBACK s' MY COMMISSION I DD 528159 EXPIRES: Mardi 14, 2010 a CERTIFICATE OF LIABILITY INSURANCE OroUtLORDDELAELE06 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE r Rolfe Davis Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. O. Box 945255 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. tland FL 32794-5255 ne : 407-691-9600 INSURERS AFFORDING COVERAGE NAIC 0 INSURED INSURER A: Amerisure Mutual Ins. Co. 23396 Del -Air Electrical Services, Inc INSURER B: . Great American Insurance Co. 16691 INSURER C: INSURERD: 531 Codisco Wav Sanford FL 32752-0522 INSURER E: COVERAGES 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 AGGREGATE LIMITS SHOWN MAY HAVE BEENREDUCED BY PAID CLAIMS. LTR NS TYPE OF INSURANCE POLICY NUMBER DATE MM/D DATE 1111MIDD POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE 1000000 A X X COMMERCIAL GENERAL LIABILITY CLAIMS MADE F_Xj OCCUR GL2037417 06/01/07 06/01/08 PREMISES Eao xenoe 300000 MED EXP (Any one person) 10000 PERSONAL & ADV INJURY i 1000000XContractualLiab X Per Project Aggre GENERAL AGGREGATE s 2000000 GEN'LAGGREGATE LIMIT APPLIESPER., PRODUCTS - COMP/OP AGG s2000000 POLICY X PRO-JECTLOC A AUTOMOBILE LIABILITY X ANY AUTO CA2037415 06/01/07 06/02/08 COMBINED SINGLE LIMIT Ee de'd) 1000000 . BODILY INJURY Per person) X ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY Per accident) X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per soaderd) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT i OTHER THAN EA ACCAUTO ONLY: AGG ANY AUTOi EXCESS/ UMBRELLA LIABILITY EACH OCCURRENCE i 5000000 B X OCCUR CLAIMSMADE SBU5965778 06/01/07 06/01/08 AGGREGATE s 5000000 S i DEDUCTIBLEX RETENTION $10000 A WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? WC2037419 06/01/07 06/01/08 X TORY LIMBS I I ER E. L. EACH ACCIDENT 500000 E. L. DISEASE - EA EMPLOYEE s 500000 M yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT s 500000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS The General Liability policy includes a blanket additional insured endorsement for the Certificate Holder if required by written contract. Liability is limited to loss or damage arising out of negligent acts of the insured. *Except as required by Florida Statute. CERTIFICATE HOLDER CANCELLATION CITYSAN SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 * DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DOSO SHALL City of Sanford IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR 300 N Park Avenue REPRESENTATIVES. REPRESENTATNE SanfordFL32771ACORD 25 (2001/08) © ACORD CORPORATION 1988 0 CITY OF SANFORD P.O. BOX 2847 SANFORD, FL 32772-2847 407)330-5640 FAX: (407) 330-5646 APPLICATION FOR WATER AND/OR SEWER AVAILABILITY 1. APPLICANT NAME: I " I I'rU Y ( Applicant) erg_ (, 'f'' 1 _ Z.—7J/ ADDRESS r f 'j (Y 1CA. 111 r 7ErLE HONE f^,f' 3 (c; _ r `- d S/ • 7 9 ' 2. PROPERTY -- STREET ADDRESS:'1/IY L O V ( n is r c[ e • d Parcel ID *: 3 : - i q - 31 _ Db -013 A - 0 3 i o) Has the site plan been approved by the Planning Board? If yes, when? 3. PROPOSED DEVELOPMENT What is the property to be used for? Type of Use) If commercial use, please give information on water and sewer flow requirements: FLOW/G.P.D.) 4. CERTIFICATION I certify that to the best of my knowledge that all information supplied Ms awlication is true. Print Name) (Signature) FOR CITY USE ONLY: AVAILABILE• SUBTOTALS WATER: YES / NO ROAD BORES STREET CUT $ LINE EXTENSION $ $ SEWER YES / NO ROAD BORE _ STREET CUT $ LINE EXTENSIONS S RECLAIM: YES / NO ROAD BORES STREET CUT $. LINE EXTENSION $ $ WATER RECLAIM SEWER LINE DEPTH FT LINE DEPTH FT LINE DEPTH FT SEWER IMPACT FEE: $ WATER IMPACT FEE: i SEWER TAP FEE: S WATER METER SET FEE: S TAP $ RECLAIM METER SET FEE $ TAPS. ADDITIONAL INFORMATION: PROPERTY STATUS: NEW STRUCTURE ( ) EXISTING STRUCTURE ( ) STRUCTURE DEMOLISHED ( ) iPPROVED BY: L!TILITIES ENGINEER OR OPERATIONS COORDINATOR) (DATE) till FEE MUST BE PAID BEFORE SERVICES CAN BE PROVIDED Revised ADril 2007 7- 2 q01 U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE I OMB No. 1660-0008 Feoeral Emergency Management Agency=xDires rebruary 28. 2009 National Flood Insurance Prooram Important' Read the instructions on pages 1-8. SECTION A - PROPERTY INFORMATION For Insurance Company Use - Al Buildino Owner's Name Policy Number A2. Building Street Adoress (including Aot.. Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number Vc> t1i n C V 40-,PC ! e pCity54KState 1d4- ZIP Cooe J i A3. Property Description (Lot and Block Numgers, Tax Parcel NUMDef. Legal Description. etc.) , LoT,t 77i444 0944C -sevAA Pe47Rppok 7?^TJ•,1-5 y X-hei/7z A4. Buildino Use (e.g.. Residential, Non -Residential, Addition, Accessory, etc.)- A5. Latitude/Longitude, Lai IS ° 5l7 SS Long 81 - Y 2 O Horizontal Datum: LJ NAD 1927 NAD 1983 A6. Attach at least 2 Dnotograpns of the building if the Certificate is oeing used to obtain flood Insurance A7. Building Diagram Number_L A8. For a building with a crawl space or enclosure(s), provide: A9. For a Duilding with an attached gPage,provide: 1 a) Square footage of crawl space or enclosure s) sq fl a) Square footage of attached garage_(kf— sq ti b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage enclosure(s) walls within 1.0 toot aoove adjacent grade walls within 1.0 foot above adjacent grade f / A c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.D sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Numoer B2 County Name B3. State CI of 4060--D /202 I em.,,.vle G B4. Ma /Panel Numoer B5. Suffix B6. FIRM Inoex B7. FIRM Panel B8. Flood B9. Base Flood Elevations (Zone Date=Hective/Revised Date Zone(s) AO. use base flood deoth) P O L( 17G GVC16 Zg' Z40'7 Gj 2 Zip% S6E 3 `/ o B10. Indicate the source of the Base Flood Elevation (BFE) oata or base flood depth entered in Item B9. _ / FIS Profile FIRM Community Determined Other (Describe) y04#54E r1da 2)1-Ad/6x 611. Indicate elevation datum used for BFE in Item B9• NGVD 1929 25NAVD 1988 Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBP,S) area or Otherwise Protected Area (OPA)? Yes RT NoDesignationDatejQ`) 4 CBRS OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: Construction Drawings- Building Under Construction' unsned Construction A new Elevation Certificate will be required wnen construction of the building is complete C2. Elevations - Zones Al-A30, A=_, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, AR/A. AR/A=. AR/A1-A30, AR/AH. AR/AO. Complete Items C2 a-g oelow according to the building diagram specified in Item A7, Benchmark Utilized /L-(04 Vertical Datum yA-v G 64 Q 8 Conversion/Comments 4 Check the measurement used a) TOD of bottom floor (including basement, crawl space, or enclosure floor) 7-1 4— Z feet meters (Puerto Rico only) b) Top of the next higher floor ._ r -1 feet Elmeters (Pueno Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) IV ._!J feet meters (Pueno Rico only) d) Attached garage (top of slab) 24 -ft-® feet meters (Puerto Rico only) e) Lowest elevation of machinery or equipmen! servicing the ouilding feet meters (Puerto Rico only) Describe type of equipment in Comments) f) Lowest adjacent (finisned) graoe (LAG) ?rl!_z© feet meters (Puerto Rico only) g) Highest adjacent (finished) grade (HAG) 7-(a. 8 feet meters (Pueno Rico only) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. FLOR104 44NiP 5urc C y f R MaPP&QUo.2gps U Check here if comments are provided on back of form r , Certifier's Name Y- License NUmDerWlf:fl k,, C,rvoNL moo. ZDOs Title 'Company Name r 6 •_ n.T_ C.QVd /`%G //V C. 170+ *'c.k t riVONC Address City N State L ZIP Cooe cry -% K4rr 'a{ ¢h AwC Lo 9 - Signature jy Date Telephone -+ r FEMA Form 81-31, Feoruary 2006- See reverse side for continuation. Replaces, all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use• 3uildinc Street Aooress nnciudmg Apt.. Unn. Suite. andror Bloc No.) or P.O. Route and Box No. Policy Numoer ZG o E: y2 c t City d FO State r r , ` _ eA ZIP Code Comoany NAIC Numoer SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy botn sioes of tnis Elevation Certificate for (1) community official. (2) insurance agenUcomoany, and (3) building owner. Comments 1 ' e y _CCii C .>t 1 c Dil's Signature I Date 3 3- Check here if attacnments SECTIO - BUILpING SL.EVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and k'(without BFE). complete Items Ell-E5. If the Certificate is inienoed to suppon a LOMA or LOMR-F reouest, complete Sections A, B, and C. For Items E1-E4, use natural grade, if available. Check the measurement used In Pueno Rico only, enter meters. E 1. Provide elevation information for the followino and check the aoprooriaie boxes to show whether the elevation is aoove or below the highest adjacent grade (HAG) and the lowest adiacent orade (LAG) -t II l a) Top of bottom floor (including casement, crawl space, or enclosure) is J feet a meters !J aoove or !_I below the HAG. b) Too of bottom floor (including casement, crawl space, or enclosure) is _ feet 0 meters 1:3 aoove or IJ below ine LAG E2 For Building Diagrams 6-8 with permanent flood openings provioed in Sectignn A Items 8 and/or 9 (see cage 8 of Instructions), the next higher floor elevation C2.b in the diagrams) of the ouilding is _ feet J meters aoove or 0oelow the HAG. E3. Attached garage (top of slab) is l feet meters a above or below the HAG E4 70D of platform of macninery and/or eouioment servicing the building is _ Q feet 1] meters E)aoove or ] Delow the HAG E5. Zone AO only: II no flood oepth number is available, is the too of the Dottom floor elevated in accordance with the community's fl000plain management ordinance? Yes No Unknown. Tne local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (witnout a FEMA-issued or community -issued BFE) or Zone AO must sign nere. Tne statements in Sections A. B, and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Adoress City State ZIP Code Signature Date Telephone Comments Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official wno is autnorzed oy law or ordinance to administer the community's floodplain management ordinance can complete Sections A., B, C for E), and G of tnis Elevation Certificate Complete the applicable item(s) and sign below. Check, the measurement used in Items G8. and G9. G i. 1-7 The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect wno is authorized by law to certify elevation information. (Indicate the source and oate of the elevation data in the Comments area below.) G2 A community official completed Section E for a building located in Zone A (witnoui a FEMA-issued or community -issued BFE) or Zone AO. G3. J The following information (Items G4.-G9.) is provided for community floodDlain management purposes. G4. Permit Numoer I G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This Dernin has Deen issued for: New Construction Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: feet meters (PR) Datum G9. BFE or (in Zone AO) oeptn of flooding at the building site- LED feet meters (PR) Datum Local Official's Name Title Community Name ^ ' Telepnone Sionature Date Comments _ 4 :neck here if attachments FEMA, Form 81-31, February 2006 Replaces all previous editions Permit Il : __ Feb Address: CITY OF SANFORD PERMIT APPLICATION 1 n t Date: I )— I I t Description of Work T[\5-0.\ New i" \IAC Total Square Footage Historic District: Zoning: Value of Work: S 500 Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool Electrical: New Service — N of AMPS Addition/Alteration Change of Service Temporary• Pole lechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required) Plumbing/ New Commercial: q of Fixtures N of Water & Sewer Lines H of Gas Lines Plumbing/New Residential: N of Water Closets Dccupaney Type: Residential —4/— Commercial Industrial Construction Type: N of Stories: q of Dwelling Units: Jwoers Name & Address: Plumbing Repair — Residential or Commercial Flood Zone: (FEMA form required) Phone: oatractor Name &Address: Py / 1 ' S O I TWig:( Suit LlcenskNumber: ,...nn 7449 hone & Fat: _ 3ouding Compaoy: ddress: ilortgage Leader. lddress: rcbRect/Eagiaeer: Lddress: Contact Person: Phone. Fax: pptication is hereby made to obtain a permit to do the work and installations as indicated 1 caiify that no work or installation has commenced prior to the ssuanee of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. 1 understand drat a separate wamit roust be sawedfor ELECTRICAL WORD PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS. HEATERS. TANKS, and o0.; D. i;014a.-'S' u,;. WHER' 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 onstruction and zoning, WARNQNG TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING WICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN kTTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. 40TICE: 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 his county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. axptance of permitis verification that 1 will notify the owner of the property of the requiremen lorida ' Law, 3. 7 — Signature of Owner/Agent Date c of Contractor/Agent Date ROBERT G. DELLO RUSSO Print Owner/Agent's Name Pr1rA Contractor/Agent's Name I I Signature of Notary -State of Florida Date Signature of Notary -State of Florida Date „ MIRINDA C. TURNER MY COMMISSION 8 DD, 7857 y. EXPIRES: June ter, 201 I OwnedAgent is _ Personally Known to Me or Contractor/Agent isY Personally B0" d TM"'NOM PubUoUndawAun Produced ID Produced ID PPROVALS: ZONING: UTIL: FD: ENG: BLDG: pecial Conditions: ev 03MO