256 Wagon Wheel Ct - BR17-003021 - MOBILE HOME DEMOJob Addre
Parcel ID:
uu OCT 12 209
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No:
Documented Construction Value: $
r) -,30A /
At
Historic Dis;'
Commercial
Yes No
Res' ential
Type of Work: New Addition Alteration Re air Demo L Chan a of Use El Move
A
Description of Work: l `
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Plan Review Contact Person: k-A Ir
Phone: Q t 2,1 US55 Fax:
Property Owner Informationr `
Name M i'V1.1.U4't'1 Phone:
Street:` 71-1 : f'r-+'1, l
U Resident of property? : W C)
City, State Zip: e( d t4 i `l b at Contractor
Inf rmation 1
Name ._
ate[ P ILS W 4, C hone: L Street: _
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L11
S VG) Fax: City,
State Zip: 0. ( (1 s / State License No.:` Architect/
Engineer Information Name:
Phone: Street:
Fax: City,
St, Zip: E-mail: 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 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. 0
FBC
105.3 Shall be inscribed with the date of application and the code in effect as Doff that date: 51 Edition (2014) Florida Building Code Revised:
June 30, 2015 " % LS ' t 4 Pennit Application
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 ofthis 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 ofpermit submittal. A copy ofthe 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 zoning.
to I to
Signature of A Date
S C N 1P-K-C(—
rr Owner/Agent's Name _
Signature of Contractor/Agent Date
M t CkO!.I PCA k s
no --.,,otractr/Agent's Name 4-1 _
D) 1 kD1 11 Signature
of No / u
11 ei
q
7
f1r .N My
COMMISSION # GG 02W 1 ' s AMY HA s
s"sMY COMMISSION EXPIRES:
August 14,2020EXPIRES: AuguBonded TIMuNotaryPublfeUldetWtitlRs; o, c Pi Bonded Thru NotatY Owner/
Agent is Personally Known to Me or Contractor/Agent isn to Me or Produced
ID Type of ID Produced ID Type of I.DBELOW
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 Permit: Yes No # of Heads Fire Alarm Permit: Yes No APPROVALS:
ZONING: UTILITIES: WASTE WATER: ENGINEERING:
FIRE: BUILDING: COMMENTS:
ro
iUll? Revised:
June 30, 2015 Permit Application
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: to - — 11
I hereby name and appoint: A
an agent of "y' R Q?c
1 tkcl' - V
vv l
Name of Company)
V3
Ct,cec-e
Vol. l Vic -
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):
V/ The_pecific permit and application for work located at:
Street Address)
Expiration Date for This Limited Power of Attorney: 1 o — (I I jS
License Holder Name:
State License Number:
Signature of License H
STATE OF FI CJWA
COUNTY OF
The foregoing i tt e t was ackno edge before me this`r(' ' tiay zo,,20 -7 , by t' 1 \ f Ct / IL.S who issonally known
to me or who has produced as
identification and who did (did nQt) t4ke an oath. ,n
Signature
Notary Seal
Ay HALL Print or type name
s W COMMISSION # GG 020864
hiEXPIRES: August 14, 2020
Bonded Thru Notary Public Underwritersw,oi,.•
Rev. 08.12)
Notary Public - State of _
Commission No.
My Commission Expires:
r
FLoli16A
March 2013
Florida Department of
NOTICE OF Environmental Protection
DEMOLITION Division of Air Resource Management
RENOVATION
TYPE OF NOTICE (CHECK ONE ONLY): /bRIGINAL REVISED CANCELLATION
TYPE OF PROJECT (CHECK ONE ONLY): (ai DEMOLITION RENOVAT N
IF DEMOLITION, IS IT AN ORDERED DEMOLITION? DYES ONO
IF RENOVATION:
IS IT AN EMERGENCY RENOVATION OPERATION? YES OO
IS IT A PLANNED RENOVATION OPERATION?
I, ,
YE(S
f V O
1. Facility Name %i-0 Q a CA->J Q _ b4 o6 t ` Q 94n
City -_-Xi V l lrQr CA_ State J ffL- Zip County =C' fY I ( (I(
Site Consultant Inspecting Site
Building Size q , (Square Feet) # Floors Building Age in Years
Prior Use: School/College/University L'y Residence Small Business Other
Present Use: School/College/University Vesidence Small Business Other
II. Facility Owner Phone ( )
Address 2
City - State KA I Zip
III. Contractor's Name L- Phone( t
DEP Form 62-257.900(1)
Effective 10-12-08
Page 1 of 2
OR ASBESTOS
COURTESY
City fr_ IA 2 ?A State Zip -_7" l e-
Is the contractor exempt from li ensure under section 469.002(4), F.S.? YES NO
IV. Scheduled Dates: (Notice must be postmarked 10 working days before the project start date)
Asbestos Removal (mm/dd/yy) Start: Finish: Demo/Renovation (mm/dd/yy) Start: Finish:
V. Description of planned demolition or renovation work to be performed and methods to be employed, including demolition or renovation techniques
to be used and description of affected facility components.
Procedurprto be Used (Check All That Apply):
ITI Strip and Removal 1 Glove Bag F Bulldozer Wrecking Ball
I Wet Method I Dry Method I Explode LJ Bum Down
OTHER:
VI. Procedures for Unexpected RACK -
VII. Asbestos Waste Transporter: Name
Address
City
Vill. Waste Disposal Site: Name
Address
City State Zip
IX. RACM or ACM: Procedure, including analytical methods, employed to detect the presence of RACM and Category I and II nonfriable ACM.
Phone )
State Zip
Class
Amount of RACM or ACM* X. Fee Invoice Will Be Sent to Address in Block 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
square feet asphalt roofing
Name:
Address:
City:
State/Zip:
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 r qoton
an evidence
thaMOW
the r ired trai in has been accompli hed by thi person will be available for inspection during
normal business hours.+ C .— -5 Ito 10 11777
P ' e of r/O erat
1 L {. (
Dat )
Signature of Owner/Operator) (Date)
DEP USE ONLY Postmark/Date Received ID#
DEP Forth 62-257.900(1)
Effective 10-12-08
Page 2 of 2
Instructions
The state asbestos removal program requirements of s. 376.60, F.S., and the renovation or demolition notice
requirements of the National Emission Standards for Hazardous Air Pollutants (NESHAP), 40 CFR Part 61, Subpart M, as
embodied in Rule 62-257, F.A.C., are included on this form.
Check to indicate whether this notice is an original, a revision, a cancellation, or a courtesy notice (i.e., not required by
law). If the notice is a revision, please indicate which entries have been changed or added.
Check to indicate whether the project is a demolition or a renovation.
If you checked demolition, was it ordered by the State or a local government agency? If so, in addition to the
information required on the form, the owner/operator must provide the name of the agency ordering the demolition, the
title of the person acting on behalf of the agency, the authority for the agency to order the demolition, the date of the
order, and the date ordered to begin. A copy of the order must also be attached to the notification.
If you checked renovation, is it an emergency renovation operation? If so, in addition to the information
required on the form, the owner/operator must provide the date and hour the emergency occurred, the description of the
sudden, unexpected event, and an explanation of how the event caused unsafe conditions or would cause equipment
damage or an unreasonable financial burden. If you checked renovation and it is a planned renovation operation,
please note that the notice is effective for a period not to exceed a calendar year of January 1 through December 31.
Complete the facility information. This section describes the facility where the renovation or demolition is scheduled.
This address will be used by the Department inspector to locate the project site. Provide the name of the consultant
or firm that conducted the asbestos site survey/inspection. For "prior use" check the appropriate box to indicate
whether the prior use of the facility is that of a school, college, or university; residence, as "residential dwelling" is
defined in Rule 62-257.200, F.A.C.; small business, as defined in s. 288.703(1), F.S.; or other. If "other" is checked,
identify the use. Please follow the same instructions for "present use."
II. Complete the facility owner information.
III. Complete the contractor information.
IV. List separately the scheduled start and finish dates (month/day/year) for both the asbestos removal portion of the
project and the renovation or demolition portion of the project.
V. Describe and check the methods and procedures to be used for a planned demolition or renovation. Include a
description of the affected facility components. (Note: The NESHAP for asbestos, which is adopted and incorporated
by reference in Rule 62-204.800, F.A.C., requires obtaining Department approval prior to using a dry removal method
in accordance with 40 CFR section 61.145(3)(c)(i).)
VI. Describe the procedures to be used in the event unexpected RACM is found or previously nonfriable asbestos
material becomes crumbled, pulverized, or reduced to powder after start of the project.
VII. Complete the asbestos waste transporter information.
VIII. Complete the waste disposal site information.
IX. List the amount of RACM or ACM of each type of asbestos to be removed. (Note: A volume measurement of RACM
off facility components is only permissible if the length or area could not be measured previously.) Identify and
describe the listed surfacing material and other listed materials as applicable.
X. Provide the address where the Department is to send the invoice for any fee due. Do not send a fee with the
notification. The fee will be calculated by the Department pursuant to Rule 62-257.400, F.A.C.
Sign the form and mail the original to the district or local air program having jurisdiction in the county where the project is
scheduled (DO NOT FAX). The correct address can be obtained by contacting the State Asbestos Coordinator at:
Department of Environmental Protection, Division of Air Resources Management, 2600 Blair Stone Road, Tallahassee, FL
32399-2400.