215 Margaret Rd; 17-2237; ELECTRICALFREEDOM ELECTRIC PAGE 01/02
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CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
application No: /7-
Documented Construction Value: S
Job Address: , ( Historic District: Yes No
Pa reel AD: - — Residential Commercial
Type of Work: Nevg:ErAddition Alteration Repair Demo Change of Use Move
Description of Work:
Flan ..Review Contact .Pelr'son: i VWL Title _
Phone: 4 't Fax.. _ Emai eEka- aL- L M O I
Property Owner Information
Name uc . Phone: - T457: 4"
Resident of ro er ? Street: , Lk 1,&) p p h'
City, State Zip:
Contractor Information
Name
Strcet-.1=1 "
City, State Zip:
Name:
Street:
City, St, Zip:
Bonding Company:
Phone: a%Q & -71/75—
Fax: LS3 State
License No.: 15C/35 Arch
itectlEngineer Information Phone:
Fax:
E-
mail: Mortgage
Lender: Address:
Address: WARNING
TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RES IL'I' 1N YOUR PAYING
TWICE FOR IMPROVKMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUs'r BE RECORDED
AND POSTED ON THE .IOB SITE BEFORE THE FIRST INSPECTION. IF VOU INTEND TO OBTAIN FINANCING,
CONSULT WITI.1 YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOt1R NOTICE OF COMMENCEMENT.
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 constniction in
this .jurisdiction. I understand that a sepnrnte permit must be secured for electrical work, plumbing, signs, wells, pools, furnaces,
boilers, heaters, tanks, and air conditioners, etc. F13C
105.3 Shall he imoeribcd with the date of application and the code in effect na of that date: 5" Editinn (2014) Florida Building; Code. V O
Rcviscd:.
func 30, 2015 Permit Arplicltion
r-•
07/19/2017 15:43 3867851503 FREEDOM ELECTRIC PAGE 02/02
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
managernent districts, state agencies, or federal agencies.
Acceptance of permit is verification that 1 will notify the owner of the property of the requirements of Florida Tien i.aw, PS 713.
The City of Sanford requires payment of a plan review fee at the time ol''permit submittal. A copy of the executed contract is required
in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal.
The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in
accordance with local ordinance. Should, calculated charges figured oI.1"thc executed contract exceed the actual construction value,
credit will be applied to your permit fees when the permit. is issued.
OWNER'S AFF: DAVIT: 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.
SiRnaiurc 00wner/Agent .. gate
Owner/Agent's Nnnic
Signahac of Nntary-State of Florids Date
DnIC`
4-f c
gent's Na
o iorid Date
Ji•y' J FICA DOUGLAS
3,6MY CbMMISSION # FF981270 EXPIRES
June 25, 2020 LA07
im-4,50 FWftN61BrY3er$ft,awn _-- Owner/
Agent is Pos. ona.11y .Known to Me or Contractor/Agent: is Personally Known to Me or Produced
1D Type of I Produced1D 7ype of TD BELOW IS
FOR OFFICE USE ONLY Permits Required:
Building Electrical Mechanical Plumbing[] Gas Roof Construction Type:
Occupancy Use: Flood Zone: Total Sq .
Ft of Bldg: Min. Occupancy Load: of Stories: New Construction:
Electric - # of Amps Plumbing - # of Fixtures Fire Sprinkler .
l'crmit: Yes No # of Heads APPROVALS- ZONING:
COMMENTS: ENGINEERING:
UTiTATIES:
FIRE:
Fire
Alarm
Permit: Yes No WASTE WATER:
BUILDING: Revived;
Ame
30.2015 PermitApplieaMon
Ju1.21.2017 4 : 5 4 P M Professional Insurance Center No,3410 P. 1
CERTIFICATE OF -LIABILITY INSURANCE DATE(
MMIbDD "
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 Oft 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 pollcy(ieB) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions or the pollcy, certain pollcles may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). ,
PRODUCER PhonC; (813)251-4900 NCONYAaAME: Proressional Insurance Center Inc
Fax: (813)253-2676
Professional Insurance Center, Inc. PUVCHONlSExIl Nc Na
EWAIIhDDRE2003WeatKennedyBlvd
INSURERS AFFORDING COVERAGE NAIC RTampa, Florida 33606
INSURERA: Protective Insorance Company 12416
INSURED
INSURER B ;
INSUReRC: ORLANDO TRANSPORTATION &TOURS INC
12738 TOPSPIELD DRIVE
ORLANDO, PL 32837
INSURERD:
INSURER E
INSURER F :
COVFRAGFS CFRTIFIrATF NIIMRFRr LJUO RFVICIr1N NI IMRFR-
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSrnR
TYPE OF INSURANCE
ADDL S 8
POLICY NUMBER
POLI EFF
M D
POLICY EXP
MMIOD LIMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
EACH OCCURRENCE
D RENTED
ES (Ea ottu rence)
MEO EXP (Any one arson 5
PERSONAL & ADV INJURY S
GENIAGGREGATE LIMIT APPLIES PGA; POLICY
JEC7 LOC OTHER:
GENERAL
AGGREGATE PRODUCTS-
COMP/OP AGO S
A
AU1oMDBILELIABILITY
ANYAUTO
OWNED
SCHEDULED AUTOS
ONLY AUTOS HIRED
NON -OWNED AUTOS
ONLY AUTOS ONLY N
501001501-
00 1/25/2017 7/25/2018 COMBINEDSINGLE$ 1,000,000 BODILY INJURY (
Per person) OOMLY INJURY (
Per sccidenl) PROPERTYDAMAGE ant
S
UMBRELLALIAB
EXCESS
LAB
OCCUR CLAIMS -
MADE
EACH OCCURRENCE
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AND EMPLOYERS'
LIABILITY YIN ANYPROPRIETORIPARTNER/EXECUTIVE.
OFFICER/MEMBEREXCLUDED7
ElNIA Mandatory In
NH) If yas
0ascnbe under OESdRIPTION OF
OPERATIONS below P 0 -
E.L.
EACH ACCIDENT S E.L.
018EASE-EA EMPLOYEE S E.L.
DISEASE - POLICY LIMIT DESCRIPTION OF
OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Ic required) _ CERTIFICATE HOLDER
IS NAMED AS ADDITIONAL INSURED - SCHEDULED VEHICLES: 2011 - FORD -
ECONOLINR - 1FBSS313L8BDA9016A 2008 - LINCOLN _
TOWN CAR - 2LNHM84W78X641D0B 2015 - FORD -
TRANSIT - 1FB2X22MSM164B8 rG0TI1:Ir:
ATC writ n1=r? r_ANr'FI I ATION Holder's
Nature of Interest: Additional Insured SHOULD ANY
OF THE ABOVE DESCRIBED POLICIES BE CANC94013EFORE City Of
Sanford THE EXPIRATION DATE THEREOF, NOTICE WILL ELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS. 300 N.
Park AUTHORIjf;DREPRESENTA7
Sanford, FL32771ACORD25 (
2016103) Taee-zDT'
GWKU GVKFUKAI INN. All rights reserved. The ACORD
name and logo are registered marks ofAteAO
ICity of Sanford
igg' Building & Fire Prevention Division
Pole
PERMIT No. ISSUE DATE: "7
t
JOB ADDRESS: its ta
TYPE OF WORK: t e.
Post this permit in a conspicuous location outside Leave all work uncovered until inspected and approved
Approved plans must be posted with permit for inspection Permit expires 6 months from date of issue or last a proved inspection
PROTECT FROM WEATHER
All T-Poles limited to 60 amps MAX (unless authorized by the Building Official)
ELECTRIC
INSPECTION TYPE, APPROVED REJECTED INSPECTOR
T-POLE FINAL
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.
F
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 FBC105.3.3
REVISED: 4-17 Inspection Line: 407.792.6069 or 855.541.2112
j
TO SCHEDULE AN INSPECTION:
Dial 407.792.6069 or 855.541.2112
Provide the items requested during the message
The type of inspection requested must be scheduled under the appropriate permit type
Follow the prompts
PLEASE NOTE: Inspections scheduled by 3:30 p.m. will be conducted the next business day.
If you experience difficulty, please call 407.688.5150 Monday - Thursday 7:30 am - 5:30 pm for
assistance.
AUTOMATED INSPECTION SYSTEM CODES
ELECTRIC
T-POLE FINAL 215
Miscellaneous Notes:
REVISED: 4-17 Inspection Line: 407.792.6069 or 855.541.2112
FIRE INSPECTIONS CITY OF SANFORD
407.562.2786 BUILDING & FIRE PREVENTION
BUILDING INSPECTIONS 300 N PARK AVE
855.541.2112 SANFORD FL 32771
DRIVEWAYS -SIDEWALK 407.688.5080
Page 2
Application Number . . . . 17-00002237 Date 7/24/17
Property Address . . . . . 215 MARGARET RD
Parcel Number . . . . . . . . 36.19.30.534-0700-0010
Application description . . . ELECTRIC PERMIT APPLICATION
Subdivision Name . . . . . .
Property Zoning . . . . . . . SINGLE FAMILY
Permit . . . . . . ELECTRIC PERMIT-ALTER/ADD/FIX
Additional desc . . TEMP POLE
Phone Access Code 994913
Permit pin number . 994913
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
1000 215 EL04 TEMPORARY POLE
a