4451 W 1 St; 18-3563; TENTSUG 21 2018
FIRE DEPARTfAENT
Building & Fire Prevention Division
PERMIT APPLICATION
Application No: '" aD (03
Documented Construction Value: $ ae v co
Job Address: L).7 rni.. 1.4 5 4- Historic District: Yes Noli?
Parcel ID: Q R—IC- M_ OMO --pp20 Residential Commercial
Type of Work: NewZAddition Alteration Repair Demo Change of Use Move[]
Description of Work:
Phone: 0-7-701 _2tLq Fax: Email: )Z1 to
vroperty owner Information
Name DeaMl€lale_ oc&,Cc.))Quo lck-ersz &LL Phone:
Street: i-- a, A 905— Resident of property?
City, State Zip: & Ar,Me-4Pf
Contractor Information
Name JdGeL, -P- -SYme w) I r6"EP, Ac- S Phone: Street: -
Hu 0 CA-MeS ' Fax: City,
State Zip: Of 10 ri R_ 32zg0State License No.: CAL 000,391L Architect/Engineer
Information Name: Phone:
Street: Fax:
City, St,
Zip: E-mail: Bonding Company: _
f4'6 CY1c.,' 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. 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. FBC 105.
3 Shall be inscribed with the date of application and the code in effect as of that date: 6' Edition (2017) Florida Building Code Revised: January
1, 2018 Permit 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 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 ofthe 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 zoning.
Signature of Owner/Agent
Print Owner/Agent's Name
Date hat4ofAlrarctor/Agent ate
Ome
Print Contracto /Agent's Name
ao I
Signature of Notary -State of Florida Date Sig ature of Nota - tate of FloriKi
Pie Nptery Publ'c State of FloridaKimberlyMByrdaMyCommissbnGG0192a2
i a ^ Expires 0810812020
Owner/Agent is Personally Known to Me or Contra r/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: # of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes No # of Heads Fire Alarm Permit: Yes No
APPROVALS: ZONING: E lol- $ 1 FUTILITIES: WASTE WATER:
ENGINEERING: FIRE: BUILDING:
COMMENTS: U:- ,Q_ C ,P 'Z' I t
Revised: January 1, 2018 Permit Application
8/20/2018 SCPA Parcel View: 28-19-30-525-0000-0020
cry
Pm
CouMY F1.ORtose
Parcel Information
Pro e y Record Card
Parcel: 28-19-30-525-0000-0020
Property Address: 4451 W 1 ST (& 4425) ST SANFORD, FL 32771
Parcel 28-19-30-525-0000-0020
Owner(s) SEMINOLE MEDICAL DEVELOPERS LLC
Property Address 4451 W 1ST (& 4425) ST SANFORD, FL 32771
Mailing PO BOX 805 WINDERMERE, FL 34786-0805
Subdivision Name
Tax District
SEMINOLE MEDICAL BUILDING -
S1-SANFORD
DOR Use Code
ExemptionsExemptions
19-PROFESSIONAL SERVICE BLD
21 215.90 196
f e
221 215.90 3
Legal Description
LOT 2
SEMINOLE MEDICAL BUILDING
PB 75 PG 50
Taxes
Value Summary
2018 Working 2017 Certified
Values Values
Valuation Method Cost/Market Cost/Market
Number of Buildings 1 1
Depreciated Bldg Value 561,072 $531,741
Depreciated EXFT Value 27,412 28,047
Land Value (Market) 575,424 575,424
Land Value Ag
Just/Market—Value " 1,163,908 1,135,212
Portability Adj
t........ .......
Save Our Homes Adj 0 0
Amendment 1 Ad/ 0 0
P&G Adj 0i 0
Value 3--81,163,908 1,135,212
Tax Amount without SOH: $21,616.00
2017 Tax Bill Amount $21,616.00
Tax Estimator
Save Our Homes Savings: $0.00
TRIM Notice Help
Does NOT INCLUDE Non Ad Valorem Assessments
Taxing Authority Assessment Value Exempt Values Taxable Value
County General Fund 1,163,908 0 1,163,908
Schools 1,163,908 0 1,163,908
City Sanford 1,163,908 0 1,163,908
SJWM(Saint Johns Water Management) 1,163,908 0 1,163,908
County Bonds 1,163,908 0 ; 1,163,908
Method Frontage Depth Units Units Price Land Value
SQUARE FEET 0.00 0.00 47952 $12.00 $575,424
Building Information
YearDescription Built Stories Total SFActual/Effective Ext Wall Adj Value Repl Value Appendages
1 MASONRY 2009 1 5,208 MASONRY & GLASS PANELS -CURTAIN $561,072 $632,194 I Description Area
PILASTER. ! WALLS i
No Appendages
I j I
http://parceldetail.scpafl.org/ParcelDetail Info.aspx?PI D=28193052500000020 1 /2
8/20/2018 SCPA Parcel View: 28-19-30-525-0000-0020
Permits
Permit # Description Agency Amount CO Date Permit Date
00492 AWNINGS SANFORD 13 130 1 12/22/2009
00344 INSTALL GROUND SIGN SANFORD 11,000 i 11/23/2009
00345 INSTALL 1 WALL SIGN SANFORD 6,000 11/23/2009
00064 INSTALLATION OF NEW FIRE ALARM SYSTEM t SANFORD 4,800 10/8/2009
02462 CMU BLOCK DUMPSTER ENCLOSURE SANFORD 4,500 9/9/2009
01651 CENTRA CARE - INTERIOR BUILDOUT ii SANFORD 504,396
i
12/30/2009 ' 5/11/2009
Permit data does not originate from theSeminole County PropertyAppraiser'soffice. Fordetails orquestions concerning apermit, please contactthe building department of the tax district In which the property Is located.
Extra Features
YearDescription Built Units Value New Cost
WALKS CONC COMM 6/1/2009 2,010 5,156 6,653
STUCCO WALL 6/1/2009 210 651 840
STONE WALL 6/1/2009 114 ( 574 741
POLE LIGHT STEEL 1 ARM 6/1/2009 81 7,712 7 712
IRON GATE 6/1/2009 78I 302 390
COMMERCIAL CONCRETE DR 4 IN 6/1/2009 65 107 1 38
COMMERCIAL ASPHALT DR 2 IN 6/1/2009 18,306 , 12,910 16,658
http://parceidetail.scpafl.org/Parce[Detaillnfo.aspx?PID=28193052500000020 2/2
Applicant / Business Information:
Applicant / Business Name: David Helseth / Centra Care
Authorized Agent: Adeo Media
Applicant Address: 4451 West 15t Street
City: Sanford State: FI Zip: 32771
Business Phone: 407-833-9200 Business Fax: 407-650-2877
Email: David CMadeomedia.com
Property Owner Information:
Owner Name: Seminole Medical Developers, LLC
Owner Address: PO Box 805 _
City: Windermere State:Florida Zip: 34786
Business Phone: Business Fax:
Email:
1, Seminole Medical Developers, LLC , Property Owner of:
Address: 4451 W. 1' Street Sanford, FL 32771
Hereby give permission to the above mentioned Applicant,/ Business and Authorized Agent. Who is
applying for a Special Use /Special Event / Open -Air Permit / Tent Permit to use the above listed
location and will have full use of the restroom facilities located at the above address'. The location of this
business is commercial, therefore, itshall only be used for purposes allowed by city code.
Property Owner Signature
Sworn to (or affirmed) and subscribed before me this .2 day; of 201 , by L0 D d ll T.j-Ac•t S 61r1
name of person making statement).
Notary Signatur
Personally Known OR Produced Identification
Type of Identification Produced:.[.••., OONS
1N RESA`UnNoibryPublicStateof Florida
At CW' Expiress 1Aay6, 2022
BoAdOd... Npt1t1taiipLary Assn.
Letter of Permission
Date:
To Whom It May Concern:
Please be advised that 1
owner/Client)
allows KIRBY RENTALS, LLC permission to erect a tent (s) on our property located at
s-/ ,4- s ,fir. 32 7/
address)
Please be advised,_ bathroom facilities will be provided.
Sincerely,
Signature)
Title)
SHANNON S. SAYREt0.YpV i•
Notary Public - State of Florida
1Comtnlsslon
at fF 182298
My Comm. Expires Jan 24, 2019
uuBondedIt m* National Notary Assn k
State of Florida
6 County
Sworn to and subscribed before me
By tQo,,y, c I5P.1::6
Signer's Name)
This& L day of ALL4.,1 20 /c/
Notary Signature
Z 6 dLJ Notary Printed Name
NOTARY PUBLIC PERSONALLY KNOWN or 1D PRODUCED
Special Power of Attorney
Date: o
I hereby name and appoint Kimberly M. Byrd
of Kirby Rental Service to be my lawful attorney in fact to act for me and apply to the
building department.
Tent permit for work located at location described as:
9 L4s1 (D_ Ise- S-
Owner of property)
and to sign my name and do all things necessary to the appointment.
Jeffrev P. Frame License #: OCL 0003911
Printed name of Certified Contractor & License Number
of Certified Contractor
The foregoing instrument was acknowledge before me this PLY- A
By 10 t r` who is personally known to me.
State of Florida
County of
Witness
Witness
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ISSUED BY
KIRBY RENTAL, LLC
Division of Kirby Rentals LLC
115 Business Center Drive Suite 1 411 Hames Avenue 8051 Bayberry Road
Ormond Beach, FL 32174 Orlando, FL 32805 Jacksonville, FL 32256
MANUFACTURERS OF THE FINISHED TENT PRODUCT DESCRIBED HEREIN
DATE:
This is to certify that the materials used in the construction of the 1p,- *4 —CLk
by the
TE\
19
have been flame retardant treated (or are inherently non-flammable)
Snyder Manufacturing Company
Their registered application concern number F-140-01 is approved and registered by the State Fire Marshal
and the application of said chemicals was done in conformance with the laws of the State of California and the rules and
regulations of the State Fire Marshal.
Flame Retardancy Cannot Be Removed By Washing And
Is Good For The Life Of The Material.
THEIR
Fabric Meets The Requirements Of Specifications
Listed As NFPA-701 (Large Sc
F-140-01 - t7"
REGISTERED Signed:
APPLICATION JOIZIAWDEPARTMENT
CONCERN NO.