105 E Coleman Cir - BR18-004566 - FENCEr
XSRF0 R
FIRE 0GPAl$"iMENT
Building & Fire Prevention Division
NOV 9Qr RESIDENTIAL FENCE PERMIT APPLICATION
Application No: T
Documented Construction Value: $ 2 , q
Job Address:' -C-N)b" 1. l St CDCAKCA t Parcel
ID•1.1 -2D- 13D "naw- Owo -OC 40 mil
Title•1.(i, `I : Email: -
Plan
Review Contact Person: Phone:
40 QCrs Historic District:
Yes No Residential Fence
Information Type of
Fence: Wood Metal PVC/Vinyl Rron Other Fence Height:
Feet Additional Information:
0--7 l Gates: 1-)
I Pr- Total Linear Feet: ) o-- i Of VC,
Fences with
a height of over 6 feet will require signed & sealed structural engineering" Cry Property
Owner
Information f Name ,
Wo
j e6L Phone: `'l b - I I Street:S1 (
Tlcp o-n CA cA-q Resident of property? : S City, State
Zip )1 J p'Fnence
Contractor
Information NameM- U
RnOl Csl ( Phone: Street: o '
I Y1UU0 ®y • Fax: City, State
Zip: -T(y)0 Please Note:
The Building Department does not perform site inspections on Residential Fence permits. A
signed and notarized Fence Affidavit is required to be submitted along with this permit application.
Please see the attached Fence Permit Submittal Guidelines. 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. Effective: August
1, 2017
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: 511 Edition (2014) Florida Building Code
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.
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
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
I(D
Signature ofContractor/Agent Date
ram i
Print Contractor/Agent's Name.
I
Signature of Notary -State ofFlorida Date
a
1 ) I t-P I )-
Contractor/Agent is Personally Known to Me or
Produced ID Type of ID
otPR Rebecca M. Liquori
NOTARY PUBLIC
STATE OF FLORIDA
Comm# GG237628
E I Expires 7/11/2022
BELOW IS FOR OFFICE USE ONLY
c
PLAN REVIEWAPPROVAL: PLANNING: 19 —14 HISTORIC:
COMMENTS:
ok to install approx.107 linear feet of 6 foot high
privacy fence and O gate(s) as shcvnn on pian. Fence
shall be constructed with finished side facing outward.
Effective: August 1, 2017
MnRROAK-01 TIFFANY
a Co CERTIFICATE OF LIABILITY INSURANCEi
DATEIMMIDDIYYIY)
04/04/2018
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 OR 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(les) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsements .
PRODUCER
Merrill Insurance
1520 S Bay Street
Eustis, FL 32726-5555
C NTACT
PHONE Ext): (352) 589-5200 FAX No):(352) 589-5222
IEALo, AD Rs,,askme@merrillinsurance.com
INSURERS AFFORDING COVERAGE NAIC #
INSURERA:Allied Depositors 42587
INSURED
Mossy Oak Fence LLC
271 Southridge'Industrial Dr
Tavares, FL 32778
INSURERB:Auto-Owners Insurance 18988
INSURER C: Southern Owners Insurance Co 10190
INSURERD:Associated Industries 23140
INSURER E :
INSURER F :
COVEHLAGtS U mm I Ir'K.A I C NUMDCrR:
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 THISCERTIFICATEMAYBEISSUEDORMAYPERTAIN, 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.
INSR TYPE OF INSURANCE
ADDL SUBR POLICY NUMBER
POLICY EFF LICY EXPPO LIMITS
A
B
X COMMERCIAL GENERAL LIABILITY
FoccuRCLAIMS -MADE X CP3046546
5170293400 04/04/2018 04/04/2019
EACH OCCURRENCE 1,000,000
DAMAGEPREMISES !2ccrr
g0p,ppp
MED EXP (Anyoneperson) 5,000
PERSONAL& ADV INJURY 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY j&- LOC
OTHER:
AUTOMOBILE LIABILITY
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
FILTOS ONLY AOTl7S ONLY
GENERAL AGGREGATE 2,000,000
PRODUCTS - COMP/OPAGG 2,000,000
COMBINED
aeSINGLE
LIMIT 1,000,000 BODILY
INJURY Perperson) BODILY
INJURY Peraccident PROPERTY
AMAGE Per
accident C
D
X
UMBRELLA LIAB EXCESS
LIAR X
OCCUR CLAIMS -
MADE NIA
5170293401
AWC1104530
04/
04/2018 04/
04/2018 04/
04/2019 04/
04/2019 EACH
OCCURRENCE 3,000,000 AGGREGATE
PER
I OTH- 3,
000,000 DIEDX
RETENTION $ 0 WORKERS
COMPENSATION AND
EMPLOYERS' LIABILITY YIN ANY
PROPRIETOR/PARTNER/EXECUTIVE FFICER/MINI ER EXCLUDE( Mandatory
In NH) yes,
describe under DESCRIPTION
OF OPERATIONS below E.
L. EACH ACCIDENT 1,000,000 EL.
DISEASE - EA EMPLOYEE 1,000,000 E:
L. DISEASE - POLICY LIMIT 1,000,000 DESCRIPTION
OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) SHOULD
ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City
of Sanford ACCORDANCE WITH THE POLICY PROVISIONS. 300
N Park Ave S-
anford, FL 32771 AIJTHOFtIZEI) REPRESENTATIVE nee
nr1dG ArnDn rr1RPr1PATInN All rinhfq rPBP.rvP.dACORD
25 (2016/03) The
ACORD name and logo are registered marks of ACORD
2018 2019
A iNO,. 137538.
RECEIPT NO 8760042515
LAK AUNTY lr4 CpLLECTOR LAKECOUNTY B.U$INESS TAX RECEIPT %; STIR OF:FI QRIDA
16
ExPIRE5; S2PTEMBER 30
EMPl,9YEE5;
2019
TYPE qF PUBLIC SERVICE 41 1
BUSINESS:k#i 0I1NAL X 600
BU$1NLSS MOSSY OAK FENCE LLC271`S0UTHRIDGE INDUSTRIAL DR' r PEI"l' b U4
t;we .pAMSFERE b.q-a
AM.1 NT,RAIp Ii0.4(1'
MOSSY,OAK FENCE LLC271SOUTHRIDGE' INDU$TRIAL DR
TAVARESj FL 32778
Receipt #201$
201,
0026020
Pald 07/27/Q 6P Db
I
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: ) I WP ' (—
I hereby name and appoint:
an agent of:
Name of Company)
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):
a-- The s ecific e and ap lication for work located at: N11
Street Address)
Expiration Date for This Limited Power of Attorney: r
License Holder Name: G-(i
State License Number: 1 5 1
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF i 1
The fQregoing instrument was acknowledged before me this lLyday of j--- 200Y6 ,
by who is m-p>=rsonally known to
me or who has produced as identification
and who did (did no take an oath. Signature
Notary
Seal) Print
or type name SpRy
Rebecca M. Liquori NOTARY
PUBLIC Notary Public -State of STATE
OF FLORIDA Commission N0. Z
2 Comm# GG237628 My Commission Expires: 1 t X 1 S/
Nc0T%'bExpires 7/11/2022 Rev.
08.12)
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PPROV EL
BOUNDARYSURVEY
LEGAL DESCRIP770N.• LOT 4, SOU7H PINECREST THIRD ADD1710M, ACCORDING TO 7HE PLAT 774EREOF, AS RECORDED IN PLAT BOOR H,
PAGE 63 OF ;HE PUBLIC RECORDS OF SEMINOLE COUNTY, FLORIDA,
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Ok to install approx. _l0%linear feet of 6 foot high
privacy fence and Q_ gate(s) as shown on plan. Fence
shall be constructed with finished side facing outward. XEWAN CIRCLE E
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SS•RFORD
ORE DOARTMENT
Building & Fire Prevention Division
FENCE PERMIT SUBMITTAL CHECKLIST
RESIDENTIAL ONLY)
All permit application packages must be complete prior to acceptance. You must check each box to the
left or indicate n/a on this submittal. A complete application package shall include the following:
Fences must be compliant with the City Land Development Regulations, Schedule F
Fence Permit Application completed and signed. Application must include correct address and complete
parcel I.D. number.
Copy of a contract, signed by the contractor and the property owner, indicating the documented
construction value (if the contractor is the applicant)
Copy of the Business Tax Receipt (if the contractor is the applicant).
Nl Owner/Builder Statement/Affidavit
CY Certificate of insurance indicating worker's compensation insurance coverage and naming the City of
Sanford as certificate holder, or a copy of a worker's compensation exemption issued by the State of
Florida (must be submitted with each application if contractor is the applicant).
Indicate the number of linear feet, height, number of gates, and type of material on application.
Two (2) copies of site plan indicating where the fence will be located on the property.
Fence Affidavit, signed and notarized
Repairs
No Permit is requiredfor Fence Repairs. A Fence Repair is qualified by one or more ofthefollowing: Replacing
individual slats; no more than 10% of the entire fence Replacing
a section; no more than 3 sections of the entire fence. A section is defined by the fencing material
between 2 posts. Replacing
a post; no more than 4 posts total. Posts must be placed in or directly around the removed post without
encroaching on neighbor's property. Replacing
a gate Please
contact the Building Division if you have any questions on Fence Repairs" These
guidelines were compiled to assist the applicant in preparing a fence permit application and may not be complete.
The applicant is required to meet all City of Sanfordcodes and requirements. Effective:
August 1, 2017
tiTY OF
SANFORD
FIRE DEPAfITMENT
Building & Fire Prevention Division
RESIDENTIAL FENCE AFFIDAVIT
6 FEET OR LESS IN HEIGHT)
PERMIT #: 'J ADDRESS: 1 o 5. ` a p y,
J1 i " ay-okip
I i )1 af `1' 1 f t ( i e r HFRFRV AFFTRM THAT ALL. OF THR FORFMTNC:
INFORMATION IS TRUE AND ACCURATE. THE FENCE WILL BE INSTALLED IN THE APPROVED LOCATION AS SHOWN ON THE APPROVED SITE
PLAN. THE FENCE WILL BE NO HIGHER THAN C FEET, MEASURED FROM GRADE. THE FINISHED SIDE OF THE FENCE IS REQUIRED TO FACE
OUT. IT IS THE HOMEOWNER'S RESPONSIBILITY TO VERIFY THE FENCE IS PLACED WITHIN THE PROPERTY LINES AND ANY DISPUTES
BETWEEN ADJACENT HOMEOWNERS WILL BE A CIVIL MATTER. I UNDERSTAND THAT FAILURE TO PROPERLY FOLLOW THESE GUIDELINES
AND ADHERE TO ALL CITY CODES (SANFORD LAND DEVELOPMENT REGULATIONS, SCHEDULE F) COULD RESULT IN THE FENCE HAVING
TO BE REPLACED, RELOCATED OR REMOVED AT THE OWNER'S EXPENSE.
ENCE CONTRACTOR
BY SIGNING THIS AFFIDAVIT, YOU ARE ACKNOWLEDGING YOU HAVE MADE THE HOMEOWNER AWARE OF THE FENCE AFFIDAVIT
STIPULATIONS AS STATED ON THIS DOCUMENT.
j
COMPANY / CONTRACTOR:
CONTRACTOR SIGNATURE: Q Jam. DATE:
1-1 HOMEOWNER (OWNER/BUILDER)
OWNER/BUILDER NAME:
OWNER / BUILDER SIGNATURE:
PLEASE NOTE"
DATE:
THE BUILDING DEPARTMENT WILL NOT CONDUCT ANY INSPECTIONS ON RESIDENTIAL FENCES. THIS
AFFIDAVIT MUST BE PROVIDED, SIGNED AND NOTARIZED, AT THE TIME OF PERMIT SUBMITTAL AND WILL
SUFFICE AS THE FINAL INSPECTION APPROVAL FOR THE FENCE.
STATE OF FLORIDA COUNTY OF S6T0\V-)y 1
Sworn to and Subscribed before me this day ofl 20)Kby: IfR
k "-e Y— . Who is P-fe-rsonally Knownto me or has 0 Produced (type of n ' ication)
as identification. 0, M
h 0 Tgnatureof
Notary Pu lic State of
Florida Priu./Type/
Stsa.mi;.Na we of Notary
Public otney Rebecca
M. Liquorl o o
NOTARY PUBLIC STATE OF
FLORIDA z Comm#
GG237628 SYNC` E19
0Expires 7/11/2022 Effective: August
1, 2017