167 Twin Coach Ct - BR18-004605 - MOBILE HOME DEMOCITY OF t 2018
PERMIT APPLICATIONSkNFORD- w
BUILDING DIVISION
Application No:
Documented Construction Value: $_s=`
Job Address: 0 C. rl C Co n kX!J1 • Historic District: Yes NoM'-'
Parcel ID: E -' . '1 " Residential EKCommercial
Type of Work: New Addition AlterationEl Repair Demo Change of Use Move Description
of Work: Mob tobI k Q. vb Y 9 tie , X 0Phone
96 9-LA'a')_ (D S Fax: Property
Owner Information y
Q(D :_QS® NamePhone: " Street:
Q^Yh-1 W Z r( 1I n !Ema- 0c) Resident of property?: " City,
State Zip8n ILt'Ad r M1 . k t7 Contractor
Information Name
MAR E I :Se". Phone: a(-o ^,ETI «- N - o Street: (
D O tlid co k % n Fax: 1 M 0 ^
1
City,
State Zip: .1 ' 3ar State License No.: Architect/
Engineer Information Name:
Phone: Street:
City,
St, Zip: Bonding
Company: Address:
Fax
E-
mail: 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'b Edition (2017) Florida Building Code
NOTICE: In addition to the requirements ofthis permit, there maybe additional restrictions applicable to this property that maybe 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 ofFlorida 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
Lk
Signature of Owner/
Print Owner/Agent's Name ..
Signature of
Al" tiA
WCOMMISSIfJ 0
L
020884
o EXPIRES. -)Ng a114, 2020
i 8o>" TM~ PuedolJn wwke 1;
Signature of Contractor/Agent Date
otary-St 9'ldddda Date N, Ci-1QMYCOMMISSION # GG D20864 v
EXPIRES: August 14, 2020
Bonded firu Notary Qubik Undmwriten
Owner/Agent is Tennllfffll 1765rr—actor/Agent i ersonally Known to Me or
Produced ID. Type of ID Produced ID ype of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas Roof
Construction Type: Occupancy Use:
Total Sq Ft of Bldg: Min. Occupancy Load:
Flood Zone:
of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes No # of Heads . Fire Alarm Permit: Yes No
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES: ' , J WASTE WATER:
FIRE: BUILDING:
Grant Malo , Clerk Of The Circuit Court & Comptroller Seminole County, FL
InSt#2018132563 Book:9253 Page:274; (1 PAGES) RCD: 11/21/2018 2:56:07 PM
REC FEE $10.00
CERTIFIED COPY GRANT MALOY
CLERK OF THE CIRCUIT COURT
THIS INSTR ENT P ARED Y: AND COMPTgOLLER ? ? 3
j A } } IRW D Y Li r
Name:II'C
SEA'ii =;rjli I vTY FLORIDA
Address.
BY pEP41`IICLERK
Date L U 1®1
NOTICE OF COMMENCEMENT
Permit Number.
Parcel ID Number. 12-20-30-300-0130-0000
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the
following information is provided in this Notice of Commencement.
1. DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available)
2. GENERAL DESCRIPTION OF IMPROVEMENT:
MOBILE HOME DEMOLITION
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT:
Name and address: CARRIAGE COVE LLC 27777 FRANKLIN RD. STE 200 SOUTHFILED Mi. 48034
Interest in property: OWNER
Fee Simple Title Holder (if other than owner listed above) Name: NA
4. CONTRACTOR: Name: M&R BOBCAT SERVICE AND CONST. Phone Number. 386-427-6355
Address: 680 NAPOLI LANE NEW.SMYRNA BEACH FL. 32168
S. SURETY (If applicable, a copy of the payment bond is attached): Name. NA
Address: Amount of Bond:
6. LENDER: Name: NA Phone Number.
Address:
7. Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served as provided by Section
713.13(1)(a)7., Florida Statutes.
Name: NA Phone Number.
Address:
8. In addition, Owner designates of
to receive a copy of the Lienor's Notice as provided in Section 713.13(1xb), Florida Statutes. Phone number.
9. Expiration Date of Notice of Commencement (The expiration is 1 year from date of recording unless a different date is specified)
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 I, 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.
wwo.:-...
State of 0Y? %p roy County of F1ul t AiL7 L
TIFFANY NAJERA
Pft Name and Provide SWnatoiye nde/Olfke)
The foregoing instrument was acknowledged before me this Or 1 day of NMnM=e 20
by ___ 1 r (nw 1 1 S'Who Is personally known to metjQVR
Nam of person making statement ,
who has produced Identification type of Identification produced:
IOr AMY NAU.
s W COMMISSION M GO 02M
of EXPIRES:Attgust14,2020
DmWlbrgNataryPypG(ltidt (
111• ,''
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
I hereby nai
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):
The specific ermit and application for work located at:
V-) CSS-tiK-i - -iin)&& . -V(- -
Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name:
State License N
Signature of Lic
STATE OF FLORIDA
COUNTY O
The foregoing instrument was acknowledged before me this ay ofumNgm
2001L, by Mj[h(AC r-KS who is sonally known
to me or who has produced as
identification and who did (did not) take an oath..,
E'!
5 co0MlSswus 14,22°y,s
Print or typAname
Notary Public - State of _
Commission No.
My Commission Expires:
Rev. 08.12)
NM01K
V .
fl.ORIDA\
March 2013
NOTICE OF
DEMOLITION
RENOVATION
Florida Department of
Environmental Protection
Division of Air Resource Management
TYPE OF NOTICE (CHECK ONE ONLY): L t'OICIGINAL
TYPE OF PROJECT (CHECK ONE ONLY): DEMOLITION
IF DEMOLITION, IS IT AN ORDERED DEMOLITION?
IF RENOVATION:
IS IT AN EMERGENCY RENOVATION OPERATION?
IS IT A P N NEID RENOVATION OPERATION?
n
I. Facility Name f i C 1(Q" ` nvQ_
REVISED CANCELLATION
RENOVATIONS
OYES i
YE NO
Qy NO
DEP Form 62-257.900(1)
Effective 10-12-08
Page 1 of 2
OR ASBESTOS
COURTESY
City- State-rIOUDI`TZip 5a-I JCA, County Q 1'.[1`3L Site
Consultant Inspecting Site Building
Size a' (Square Feet) # of Floors Building Age in Years Prior
Use: School/College/University esidence Small Business Other Present
Use: School/College/University DRfridence Small Business Other II.
Facility Owner i Phone ( ) Address "
City
State M r Zip 4 Ill.
Contractor's Name i . Phone Cak) Address
City
State Zip ` Is
the contractor exe4t from licensure 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. Procedures
to be Used (Check All That Apply): Strip
and Removal Glove Bag ulldozer Wrecking Ball 041
Wet Method Dry Method Explode I Bum Down OTHER:
VI.
Procedures for Unexpected RACM: _ VII.
Asbestos Waste Transporter: Name Address
City
Vill.
Waste Disposal Site: Name Address
Phone )
State
Zip Class
City
State Zip IX.
RACM or ACM: Procedure, including analytical methods, employed to detect the presence of RACM and Category I and It nonfriable ACM. 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 renovation and evidence that the required training has been accomplished by this person will be available for inspection during
normal business hours.
M%, W rfikcys I I.I -Ik
Print Name of Owner/Operator) (Date)
Signature of Owner/Operator) (Date)
DEP USE ONLY Postmark/Date_Received ID#,
DEP Form 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."
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.
Vill 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.
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