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107 Skogen 12-1898li4z CEIVED D JUN 2 8 201712 CITY OF SANFORD BY: BUILDING & FIRE PREVENTION 7BY- PERMIT APPLICATION Application No: Documented Construction Value:$ /QS6 - 0 0 Job Address:/ 0:2 r4- ParcelID: '�_2,-19-3n 9epj&ce_ & t i,A Description of Work: �as)e 4:_10 Plan Review Contact Person: Historic District: YesEl NoR Zoning: LU �f h S C4V"P_ co-,�-f etv� P_ Title: pecf!�L& Phone: Fax: E-mail: :51,ruA, aL.- Property Owner Information Name gef4jesf WM-9 Phone: Street:.-,,gn A4 hl_-erin P Resident of property? City, State Zip: Contractor Information Name Phone: V67-(��(6-926Q Vin-Iffi!2C &.C�ak) Street: Ave'- Fax: 4,16 ;7 - j!::� City, State Zip: LA ItIler 0brLi State License No.: EEC 000 3326 Architect/Engineer Information Name: Street: City, St, Zip: Bonding Company: Address: Building Permit 0 Square Footage: No. of Dwelling Units: Electrical 0 New Service — No. of AMPS: Phone: Fax: E-mail: Mortgage Lender: Address: PERMIT INFORMATION Construction Type: Flood Zone: No. of Stories: Plumbing 0 New Construction - No. of Fixtures: Mechanical 0 (Duct layout required for new systems) 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 requ ' ires 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. n, 46 6 leez 6 TigAture of Owner?ggifnt Date SIgnature of Co�iractor/Agent Date 7-2�-_�,5;7111 Scc>]� F7ce&43Ec"k= Print Owner/Agent's Name Print Contractor/Agent's Name / - - ' e�:11 F% & S­igz�h S i�a itu re6if �l &ta i�-_S ta t e 6-f F I a? i d a D—ate a e of Notary -State of Florida Date pA�:Ok, MAN S WHEELER MY COMMISSION # EE 125999 EXPIRES: December 29,2015 Boled Thru Budget Notary SeMm Owner/Agent is Personally Known to Me or Produced ID Type of ID APPROVALS: ZONING: ENGINEERING: COMMENTS: ow P Notary Public biale of Honda Jessica Mitchell My Commission DD835877 Expires 11/09/2012 Contracl-oMnent is — Personally Known to Me or Produced ID _ Type of ID UTILITIES: WASTE WATER: FIRE: BUILDING: Rev 11.08 CITY OF SANFORD AUG 0 6 201Z UILDING & FIRE PREVENTION r PERMIT APPLICATION ApplicationNo: 15ocumented Construction Value: $ o cD JobAddress: /Ne::� &oo-d 91AQA= C-T- Historic District: Yes El No;& V Parcel ID: Zoning: Description of Work: jAj 1. M Ad IQ t 1-10^' Plan Review Contact Person: Caj1zj,,_"' Title: Phone:M Z28 0G7& Fax: E-mail: Property Owner Information Name epr�� 0 Street: IM tl City, State Zip: _4�2 �_�6rd (7L 3-Z-77/ Phone: Resident of property?: ye'5 Contractor Information Name (rjkl�� e_�eclnc_ 71&c Phone: ZIO-) 37-1911/1 Stree':'Z2-5 0 Wtkbur P t k(,e Fax: ZIP-2 328 0031�1 City, State Zip: C.--ro 0��r�,j PL -z,-z -I q 6 State License No.: 60?0015�,211A 11 Name: Street: City, St, Zip: Bonding Company: Address: Building Permit 0 Square Footage: — No. of Dwel ling Units: Architect/Engineer Information Phone: Fax: E-mail: Mortgage Lender: Address: PERMIT INFORMATION Construction Type: Flood Zone: Electrical 9 New Service - No. of AMPS: U&Armyw Mechanical 13 (Duct layout required for new systems) No. of Stories: Plumbing 11 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, o it flees when the _Y� permit is released. 'I/, /9' Signature of Owner/Agent Date Si-gVMTrr-e of ConTrbacit-or/Apbt '-' Date Print Owner/Agent's Name Signature of Notary -State of Florida Date Owner/Agent is Personally Known to Me or Produced ID TypeofID APPROVALS: ZONING: ENGINEERING: COMMENTS: UTILITIES: FIRE: Print Contractor/Agent's Name (L ;az LA La(± Signature of Notary -State offlorida Date Contractor/Agent is Personally Known to Me or Produced ID _ Type of ID WASTE WATER: BUILDING: Rev 11.08 Ma 8-2-2012 Walters Electric Inc Commercial and Residential 225 E. Wilbur Ave Lake Mary, FL 32746 407.321.8444 Office 407.321.2729 Fax MS West Const Cameron Residence 106 Quail Ridge Ct. Sanford, FL. 32771 14- 15 amp outlets 1- 15 amp VYT outlet I — std flood with sw 1 - Wall mount fixture prewire 2- P. fan prewires 5- sp toggle sw 3- 3way toggle sw 1 -pool table light outlet I - Cable tv outlet Feed new circuits (2) from existing spa sub panel(currently not used). Devices to be white toggle. Includes City of Sanford electrical permit $1,100.00 Calvin Walters Electric Inc. 4073218444 OP ID: TH '44CC>Jzix CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD1YYYY) 1 04106111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 407-869-0962 SIHLE INSURANCE GROUP, INC. 407-774-0936 P. 0. BOX 160398 ALTAMONTE SPRINGS, FIL 32716 Dave Zeldwig/U rseth Split acct CONTACT NAME: PHONE 1FAX LAIC, No Ext): (A/C, No): -h-MAJL' ADDRESS: PRODUCE R CUITIMER,,,WALTE-9 INSURER(S) AFFORDING COVERAGE NAIC INSURED Walter's Electric Inc 225 Wilbur Avenue Lake Mary, FL 32746 INSURER A: Association Insurance Co. INSURER E: -INSURERC: D: -INSURER E: [INSURER INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 13ELOW 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TY EOFINSURANCE ADDL INSR SUBM WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MWDDNYYY) LIMITS GENERALLIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FlOCCUR EACH OCCURRENCE $ 7-- PREMISES(Ea occurrence)__ MED EXP (Anyone person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ LAGGREGATE LIMIT APPLIES PER: PRO- MPOLICY FIJECT 17 LOC PRODUCTS- COMPICIPAGG $ $ AUTOMOBILE LIABILITY ANYAUTO ALL OVVNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OVVNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA LIAB EXCESS LIAB HOCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ A WO RKERS COMPENSA71ON AND EMPLOYERS'IJABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE —] OFFICER/MEMBER EXCLUC r (Mandatory In NH) Ife nder ,� describe U ID , RIPTION OF OPERATIONS below NIA CVOO1668302 01/01/11 01/01/12 x I WC STATU- I x NTH - TORYLIMITS ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEO $ 500,000 E.L. DISEASE POLICY LIMIT fl $ 600,000 DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION SANFOCI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES� BE CANCELLED BEFORE CITY OF SANFORD BUILDING DEPT. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FAX# 407-246-3420 PO BOX 1788 AUTHORIZED REPRESENTATIVE SANFORD, FIL 32772 1 C��,,A W,64,, @ 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26 (2009109) The ACORD name and logo are registered marks of ACORD RE: Permit# 3-11111"IN"jo Inspection Affidavit kV4q4-FC -5, _,licensed as a(n) Contractor* [Engineer/Architect, (please print name and circle Lic. Type) FS 468 Building Inspector* License#; U-co(0-00)v Onorabout 4v& I -ao I I did personally inspect the roo f (Date & time) deck nailing andlor secondan water barrier work at IM; 90411— F—t>& 67:- 0— (circle one) (Job Site Address) e-' 4 il -,e 32-7-7-'-7 "', �- V Based upon that examination I have determined the installation was done according to the H SignAture (Based on 553.844 F.S.) STATE OF FLOR-EDA COUNTY OF Sworn to and subscribed bef6ie me this4q day of &e 20 By DEBBIE BLANTON Notary Public - State of Florida My Comm. Expires Feb 25, 2015 M Commission # EE 60182 Bonded Through National Notary Assn. otary Public, State of Florida type or stamp name) Commission No.: Personally known or Produced Identification Type of identification produced. r6 L' K * General, Building, Residential, or Roofing Contractor or any individual certified under 468 F.S. to *make such an inspection. Include photographs of each plane of the roof with the pern-dt If or address # clearly shown marked on the deck for each inspection.