2615 Palmetto Ave - BR17-000260 - DEMOC
IV
2
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No:
L I Documented Construction Value- $
Job Address: 204-&qfffiwd-A-ye Sanford Fl, 32773 Historic Di ice: Yes 0 No
0 cial00 ()(D .- 0 Residential D Commer
Type of Work: New M AdditionEl AlterationEl RepairEl DemoEl Change of UseE] Move D
c A
Description of Work:
Plan Review Contact Person: Tom Hunt Title: VP Construction
Phone: 407-361-5505 Fax: Email: 1om@edcsqom...
Property Owner Information
Name Phone: 407-323-0711
Street: 2612 S Sanford Ave, Sanford FL 32773 Resident of property? :
City, State Zip:
Name Excelsior Develonment Co. Phone: 407-771-4442
Street: 755 Rinehart Road, Suite 200 Fax: 407-771-4452
City, State Zip: Lake Mary, FL 32746 State License No.: CGC038661
Architect/Engineer Information
Name: Gerald Gross Phone: 407-256-7118
Street: 205T North Ibis Drive Fax:
City, St, Zip: Eriny Breeze, Fl, 33453 E-mail: _Clod e.whd ail.com
Bonding Company: Mortgage Lender:
Address: 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 pennit to do the work and installations as indicated. I certify that no work or installation has
Dflafix 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: 56 Edition (2014) Florida Building Code
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el
Revised: June 30,2015 PermitApplication
j_ i i a4ditiji to thi it jWents j j tb jjWjj, thjW jjj AR illiij
management districts, state agencies, or federal agencies.
MINORII = EMIMMMMMOREM
Ilk 's, C? 1 -7r4rntijln,11' sipa 0 C Date si atu of nt ov-) n k it4ic;on;o -r Date
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Print 0 neraWF*+,1a— (-VAkfCCkx--
Si e o xi iI6 e -State ofFl rj Date
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a of Florida
9
LORRIJONES
Pyu ,we of FloridaNotaryPublw. Notary Public -State of Florida Commission # GG 005295Commission # GG 005295 sJ 2020Comm. Expires Jun 23, 2020 My cninv Expires Jun 23, 2020My
n 11V nowlOwner/Agent is Fe a I own to e or Contractor/Agent is ersonally Known to Me or
Produced ID Type of ID Produced ID _ Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required- Building[] Electrical[j Mechanical[:] PlumbingEl GasD RoofEl
Construction Type: Occupancy Use- Flood Zone: —1
Total Sq Ft of Bldg: Mo. Occupancy Load: # of Stories®
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: YesEl NoEl # of Heads Fire Alarm Permit: Yes [] NoEl
APPROVALS: ZONING: UTILITIES: 'WASTE WATER:
ENGINEERING: FIRE: BUILDING:
COMAWNTS:
Revised: June 30,2015 Permit Application
Floirida Department of DEP Form 62-257,900(1)
Effective 10-12
NOTICE Page t of 2
DEMOLITION Division of Air Resource Management OR ASBESTOS
RENOVATION
PE OF NOTICE (CHECK ONE ONLY): ORIGINAL REVISED [I CANCELLATION COURTESY
PE OF PROJECT (CHECK ONE ONLY): DEMOLITION El RENOVATION
IF DEMOLITION, IS IT AN ORDERED DEMOLITION? DYES NO
IF RENOVATION:
IS IT AN EMERGENCY RENOVATION OPERATION? [:YES NO
IS IT A PLANNED RENOVATION OPERATION? E]YES 0 NO
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N i.:i . i.. `« it • • •:..: . . i « « i . '. •, . !': «..
VIL Asbestos Waste Transporter: Name Phone )
Address
city State Zip
Vill. Waste Disposal Site; Name Class
Address
city State Zip
IX. RACM or ACM- Procedure, including analytical methods, employed to detect the presence of RACM and Category I and It nonfria le ACM.
Amount of RACM or ACM* X. Fee Invoice Will Be Sent to Address in dock Below; (Print or Type)
square feet surfacing material
linear feet pipe
cubic feet of RACM off facility components
square feet cementitious material
square feet resilient flooring
s care feet as halt roofin
7s-- P -'i - -zooddess wi, ?Ay?-r
City:
State/Zip: Z? LI 7
Identify and describe surfacing material and other materials as applicable:
I certify that the above information is correct and that an individual trained in the provisions of this regulation (40 CFR Part 61, Subpart M) will be on -site
during the demolition or ran tionLand evidence that the requireftraining has been accomplished by this person wrrill be available for inspection during
normal business hours. Ei'
Print f r/Op r or) Name a r/Oper or) (Date)
DEP Form 62-257,900(l)
Effective 10-12-08
Page 2 of 2MM:1
I
THIS INSTRUMENT PREPARED
Address:
Name: Lord Panzironi
Permit Number:
Parcel ID Number: 01 -20-30-506-0000-0830
GRlff 11ft1...Oyy SE11INOLEC COUNTY CLERK
OF CgriC:Uj1j C:OORI' to C:[lrIN-RULER 8K8,13!5f, Pj 67,3 : CLERK'
S 2017s:E.;°;E:2 RECORDED
02,=`E:E6/2017 0 :0kvl-33 1::`11 RECORDED
13,'t lidevt-re following
information is provided . of 1.
I do th t and street address if available) ingle * . •
w y e.. crikVion
t •
2.
GENERAL DESCRIPTION OF • Demo
house and detached 3.
OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT: Edwin
Nameandaddress: ` Interest!
I property: Owner Holderr1ITAMple
Title4.
CONTRACTOR: NameExcelsior Develonment CO Phone Number: 407-771-4452 Address: 755
Rinehart Road Suite 200 Lake Mary FL 32746 Address: Amount
of Bond: a Name:
Phone
Number: ZI Noticeto
receive
acopyoftheLienor's 9. Expiration
Date of Notice of Commencement (The expiration is I year from date of recording unless a different date is specified) LLi WARNING TO
OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER
PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713,13, FLORIDA STATUTES, AND CAN 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 COMMENCING
WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature f
o nor r Lessee, or Qwner`s or lessee's (Print Nama and Provide Signatory's iiktett?iYce} Authorized Offic
rector/Partnerl eager) State of
C 5f > County ofY la The foregoing
instrument was acknowledged before me this day of 20 In by
tf ,
f Who is personally known to ma R Name of
person making statement