103 Sandpebble Pl`i �2\ �1 A
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CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: / j — a / g a Documented Construction Value: $ JobAddress: 103 Ealxdp-. el PL Historic District: Yes ❑ No ❑
Parcel ID: 3.3 - I R 30 - 5' 1 Ll - 0000 -0 616 Zoning:
/, Description of Work: �QCQ 4f r- kca_4'er'
Plan Review Contact Person:
Phone:
Fax:
E-mail:
Title:
Property Owner Information
Name 6ea )a W (',I 00re Phone: '10-7 �f 30- 6M-6-
Street: - _10 a, d� 2 �0�� l �L Resident of property? : es
City, State Zip: SCC•� '�OrGft >r,!� 3Z7-7
G(0-
/�r"Con/tractor InformationG�Name " 0 e6 00 treL �1fl 1�Gr1t O'' Cery (MS6 Phone: 4 0'7". F-5-9 - y' �� 7
Street: I `lOt 6E r d°{ Fax: 'Y67-6'5_7 -01(1 9'
City, State Zip: 0 -_ a 'tA' FL '3;�IF,37 State License No.: ! C O 573 �9
Name:
Street:
City, St, Zip:
Bonding Company:
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address: Address:
PERMIT INFORMATION
Building Permit ❑
Square Footage: Construction Type: No. of Stories:
No. of Dwelling Units: Flood Zone:
Electrical ❑
New Service - No. of AMPS:
Mechanical ❑ (Duct layout required for new systems)
Plumbing
New Construction - No. of Fixtures:
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 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.
Signature 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 ID Type of ID
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
fll.A.
/Z
Signa of Contractor/Agent ate
Z� I dr4
Print Contractor/Agent's Name
G,?•/3. /2
DEBBIE BLANTON
=otira'v'a�6
�.•�?
Notary Public - State of Florida
_. *
•
My Comm. Expires Feb 25, 2015
'= P�:'
Commission # EE 60182
II ���
Bonded Through National Notary Assn.
Contractor/Agent is/✓ Personally Known to Me or
Produced ID Type of ID
WASTE WATER:
BUILDING:
Rev 11.08
ROT®_
�'��i-1
Date �i INVOICE NO. M 16T(& 2 L t4
Customer , _ a h/ linnatom„ Technician�,k
PLUMBING &
Roto-Rooter Services Company
DRAIN SERVICE
Remittance Address: 5672 Collections Center Drive, Chicago IL 60693
1-800- GET -CBOT®
Service: 1-800-GET-R
#CFC057359 General (407) 859-9557
uc.
Commercial Site Inspection & Estimate (See Binding Terms On Reverse) Customer
Qtv/Location/Description Labor Parts Discount Total Accept Decline
Main Sewer Line
ws= - .r-
. ,,;
Outside Clean Out Covers
Outside "Vent Covers -
❑' _ .- - t .- _ :. =" < _ ❑ .. ,❑ `.
_ Exterior Water Faucets
Men's Room Urinal(s)
❑
❑ ❑
Men's Room Urinal(s)
❑
❑ ❑
Men's Room Toilet(s)
❑
❑ ❑ .
Men's Room Toilet(s)
❑
❑ ❑
Ladies' Room Toilet(s)
❑
❑ ❑
Ladies' Room Toilet(s)
❑
❑ ❑
Men's'Room Sink(s)
❑
❑ ❑
Men's Room Sink(s)
❑
❑ ❑
Ladies' Room Sink(s)
❑
❑ ❑
Ladies' Room Sink(s)
❑
❑ ❑
Triple'BayStrainers
❑
::° �: _ §. ❑:, 0"
Indirect Drains(Air.Gaps) :N`l
JS.....4L6 b S :.
—��`%'. "
Floor Drain Cover, -
0 =:�i� � ?� ❑ - _ � -"
Misc. Floor Drain'
Elp = ❑ -A� ❑ ;4
Had $ink Re -Washer-- -
n
❑
,1-
as•`
tvk
'Ya
- - -- - - - ❑-- ❑
Mop Sink Faucet " " -
0`- -
Tti. -y, _.: - ❑ 0
Inlet Line (to Grease Trap)
❑
❑ ❑
Outlet Line (from Grease Trap)
❑
❑ ❑
Outgoing Line (from Building)
❑
❑ ❑
3-Bay Indirect Line
❑
❑ ❑
3-Bay Faucet
❑
❑ ❑
Ice Machine Indirect Drain
❑
❑ ❑
.e->x•,t'._,.s.-....,T• _- yi•,,..�y,:....-. •. y.,-. , vsx -.: •''�-;::- -"`-v;-T-t+,-,n a�,:;4'r..- ,Y, , .h-v - .7- ..-,.�... ,..�..�...:. _.�r.�y.
�..
- Ft ❑ _ ❑
Grease Trap: ❑
Water Heater
�.
- zf _ 4
❑ r :; _ _ � - `� ❑ ;O $
Backflow Prevention �Dev'ice
d
= '° ❑ 0 a
. -
High" Pressure Water Jettitig=
❑
R' ❑ D
Other _ - 0=
- - - ;<.�.<..��.�.�', '.��� <:T :-p- -p
Maintenance Products
❑
❑ ❑
Quantity Discount Package
❑
❑ ❑
WORK ORDER AUTHORIZATION I authorize the services indicated and agree to pay the amounts specified. I have read and agree to the terms on the
reverse side, including the limits
on Roto-R er's responsibility specified in those terms.-
G✓/aa
(Signatur
(Print Name) -• � ���
ESTIMATE AND TION OF WORK TO BE PERFORMED (The approximate starting date is - - and the
Total estimate reflects customer
approximate completion date is
Neither date is guaranteed. Unexpected conditions or problems could cause delays.)
authorization of work as indicated above.
Labor $4S-0, y..,
_ y
Parts $ b5ce,SS
Discount $
Product $
1.�-. 024,
COMMENTS/ADJUSTMENTS/CHANGES IN WORK:
Other $
TOTAL $ I;3 10 _
Tax not included in estimate.
COMPLETION I acknowledge completi of the above described work which has been done to my complete satisfa tion.
Store Stamp/P.O.#:
(Signature)
r (Print Name)a<r-. «.
.p
LIMITED POWER OF ATTORNEY
Date: 6e - OCR - ( I—
I hereby name and appoint: 3-C-t,rn fs(-Xk
an agent of:
)`_,(r S2-rU lep
(Name of Company)
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):
0 All permits and applications submitted by this contractor.
The specific permit and application for work located at:
/D 3 J"'O"U ('L
Expiration Date for This Limited Power of Attorney:
License Holder Name: 901,ZA4 b rj C c e-r0,
State License Number: C r C- O S'7 3 S-
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF FL
The foregoing ' t-n}ment was acknowledged before me this day o �f
20- 7�, by (�4 ( 2A who is personally known
to me or o who has produced as
identification and who did (did not) take an oath.
ignature
(Notary Seal) L
Print or type name
DANIEL BURGOS
NOTARY PUBLIC Notary Public - State of F� '
STATE OF FLORIDA Commission No. 6E 113,9 L�
Comm# EE173240 My Commission Expires:- - J Io
Expires 2/26/201.6
(Rev. 3/27/07)
'P00A ld Johnson, CFA Parcel: 33-19-30-S14-0000-061Q
ROPERTY Owner: MOORE BEN7AMIN R
"PIWSM Property Address: 103 SANDPEBBLE PLSANFORD, FL 32771
SEM&NOLE COUNl Y, FLORIDA
< Back Sale La out Reset La out New Search
Parcel:33-19-30-514-0000-0610
Property Address: 103 SANDPEBBLE PL
Owner: MOORE BENJAMIN R
Mailing: 103 SANDPEBBLE PL
SANFORD, FL 32771
Subdivision Name: COUNTRY cl IIR PARK
Tax District: Sl-SANFORD
Exemptions:
DOR Use Code: 01-SINGLE FAMILY
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Value Summary
2012 Working
2011 Certified
Values
Values
Valuation
Cost/Market
Cost/Market
Method
Number of 1
1
Buildings
Depreciated
$86 062
$91,340
Bldg Value
Depreciated
DCFT Value
Land Value $21,000
$23,000
(Market)
Land Value Agi
Jsst/Market $107,062
vaillp .*
$114,340
Portability Ad'
Save Our Homes SO
$0
Ad'
Amendment 11 SO
SO
Ad'
Assessed valuel S107,062
S114,340
Tax Amount without SOH: $2,278
2011 Tax Rill Amnnnt $2,278
Tax Fctimator
Save Our Homes Savings: $0
* Does NOT INCLUDE Non Ad Valorem
Assessments
Deed
Date Book Page
Amount
Vac/Imp
Qualified
WARRANTY DEED
04/2012
flZZfi2
Q7S7
S131,OWI
ImprovedImprovedi
Yes
SPECIAL WARRANTY DEED
07/1998
aa4ikl
Da56
$114,6001
Improved[
Yes
WARRANTY DEED
04/1998
n3h6l
$22,000
Vacant
No
Land
I Methodl Frontage Deothl Unitsl Unit Price[ Land Value
Building Information
Year Base