1112 Oak Ave; 17-3015; GENERAL REPAIRSYg
E ; i t.,
ly
1`41 OCT 12 2017
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No:
Documented Construction Value: $
7 - 30ob
100
pa
Job Address: 11 12.. S ourH Nk- ""' Historic District: Yes LJ No
1 -- 1- 30 - 5 AC- 130S- 0DParcelID: J 7 ' `} Q Residential Commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of ork: 0 ,i4! r !1 .-r P" ,t I- -o 2 rl L D D 5 2 pv-
1
4) r
M `fib~-I'!n
Plan Review Contact Person:
Phone: Fax: Email:
Title.
i'
Property Owner Information
Name T80MAPhone: 107- 5i %- li'ys Street:
1 r1 u 4 14 N 1 t ' Resident of property? : 0 City,
State Zip: r l.{ 1`J} -r% 1 2499 Contractor
Information Name
Phone: G% Street: <
Fax: City,
State Zip:' ,/ 3,) I State License No.: C>77 O Architect/
Engineer Information Name:
i/v 1 II/cL„n 0 P 1'z J
Phone:
Street:
3 1 4-7 H A 0 6/ 6 M D 5 4 Cl If ( "p- Fax: rr
City,
St, Zip: V 1 5 S 1 M M E £ r L E-mail: t clt d"e_ i, l' dl Q C i1 e r, vr .L"0"1 Bonding
Company: Address:
Mortgage
Lender: Address:
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.
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. FBC
105.3 Shall be inscribed with the date of application and the code in effect as of that date: 5"' Edition (2014) Florida Building Code Revised:
June 30. 2015 Pe.mit Applicaf=
14 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 at the time of 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 off the executed contract exceed the actual construction value,
credit will be applied to your permit fees when the permit is issued.
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 coning.
7
Signature of owner/Agent Date
w
Signature of Contracto t Datie
r 1'.r;^? i,entractor/A< ent's N i/
r
Print Owner/Ancnt's Name
Id. lc./)
Signature of Notary -Stare of Florida Date Sit, latwe of r9 0 " u
Av --_L EBSIEKANTON
My COMUISSlO V # FF 17F648
c { EXPIRES: February 25, 2019
S,ur, r '' Bonded Thru Notary Public Under-Arite
Owner/Agent is Personally Knovoi to Me or Contractor/Agent is Personally Known to Me or
Produced ID Type of ID Produced ID Type of ID
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:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING: UTILITIES:
ENGINEERING: FIRE:
COMMENTS:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING
Revised: Jane 30, 2015
Pc:rrnit Application
0
Architect
RA, 0015039 Florida
Permit #s 96-1804(General repairs), 5-61 5 t frioal) 5- 1 (i hani l)
1, Adifliar ". j)'j-pre4,have personally inspected the property at 1112 Oak Ave,_
rcei 51 30,5AG-1305-W40, Sanford, Florida andcertifyAhewofk1fla f was
completed on the above referenced permits,, w-as constructed to the best of my'
knowledgeand complies wilts the minim applicable Florida Building Codes in effect
t the time !he dark w completed,