1105 E 4 St - E18-004654 - CHANGE OUT EXISTING AMP3
PERMIT APPLICATION
Application No: _ p
Documented Construction Value: $ 1, -7 6C
Job Address: 1 OS 6. 5b4jrc'_ f\ ;-77 1 Historic District: Yes 0No
Parcel ID: Residential 0—Commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of Work:
C)r- <'tr h
Plan Review Contact Person: Title:
Phone: LA 0-7 his ? u% % Fax: Email: G, Cltn e l:r n
Property Owner Information Se in'4zs W01
Name C'\ Phone 3 S '60 f) `7 71-j
Street: 1 (U 5 - Lt 4,n5 Resident of property? : S
City, State Zip: Sc/-Xq,' Z sr \ 3 a-7-71
Contracto `In rmation
Name Z-75_()5 n Phone: LAU,
Street: a rju E . Fax:
City, State Zip: ) _ J --\ 3 aS-u ` State License No.:
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Architect/Engineer Information
Phone:
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 aseparate permit must be secured for electrical work, plumbing, signs, wells, pools, furnaces, boilers, heaters, tanks, and air conditioners,
etc.
FBC 1053 Shall be inscribed with the date ofappl/ution and the code ineffect asof that date: 6t° Edition (2017) Flodda Building Code
NOTICE Inaddition to the requirements of this permit, theremaybe additional restrictionsapplicable to thisproperty thatmaybe found in thepublicrecordsofthiscounty, and there may be additional permits required from other governmental entities such as water management districts, state
agencies, or federal agencies.
Acceptance ofpermit is verification that I will notify the owner of the property ofthe requirements ofFlorida Lien LM FS 713.
The City ofSanford requires payment of a plan review fee at the time ofpermit 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 ofthe job -at the time ofsubmttaL The actual construction value
will be figuredbased on thecurrent ICC valuationTable ineffect at the time thepermit is issued, in accordance with local ordinance. Should calculated
charges figured offthe 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 m compliance with all applicable laws regulating construction and zoning.
rt
Suture of owner/Agent Date
CC
Print Owner/Agent's Name
o Y Notary Public State of Floridar° o Dion —
a mate oItPMd325 DatexptresI
Sign a of Conhactor/Agent Date
3oS1,\ tinne
Print Contractor/Agent's Name
Notary Public State of Florida
is Date 11 a j 1 `yes &"22
Owner/Agent is Personally Known to Me or Contractor/Agent is Personally,Cr3o to 1VIe 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
APPROVAIS: ZONING: t, 1 UTILITIES: WASTE WATER
ENGINEERING: M BUILDING:
i'
REOUEST FOR TUG & PREPO + R AGREEMENT
ALL RESIDENTIAL PROPERTIES
Altamonte Springs, Casselberry, Longwood," Oviedo, Sanford,
Seminole County, Winter Springs
Date• 1_l \ 1 fS '
Project Name:whZl'\ Ub Project Address: i 1 U5 . Sa4val' A:
Building Permit M. Electrical Permit # 1 J - UUUU y CoEH
In consideration for authorizing the appropriate utility companyto energize the facility, we agree with and
understand the following:
1. This Tug/Pre-power application is valid only forone -and two-family dwellings.
2. The facility will not be occupied until acertificate of occupancy has been issued.
3. If the jurisdiction het+eaRer finds that the facility has been.occupied before acertificate of occupancy has
been issued, thejurisdiction will have the unilateral right to direct the utility to terminate electrical -service
without notice. Furthermore, we understand and agree that should thejurisdiction exercise.such right, the
jurisdiction will not be responsible for any damages or costs which may -result from the exercise ofsuch
right Also, in the event any third party claims damages from the ;exercise of such right, we agree to jointly
and individuallyindemnify and hold harmless thejurisdiction from all such damages and costs, including
attorney'-s fees.
4. Prior to..pre-power, the"building or structure shall be weathertight and secure. The electrical wiring.in the
area designated for pre -power shall iz ,complete and in safe order: All electrical -services associated; with the
area will be 100% complete unless specifically approved by the electrical;inspector.
5. Interior electrical rooms shall be lockable, f electrical panels are in awarea that cannot be locked by doors,
the panels shall be equipped with a locking mechanism (approved by the AHJ). The licensed: electrical
contractor or his licensed representative shall hold the keys(s)for such access to electrical panels to prevent
energizing circuits other than.those that are safe.
6. This TUG/Pre-power approval is valid for a maximum of 180 days from date of approval.
7. If provided, the fine sprinkler system must be operational with water on the system prior to pre -power.
TUG approval is for service and outside GFCI outlets only.
9. Check with the local jurisdiction for fees associated with tags.
ZaMmm
fOwnerrrenant
6,A-
Ownarrenant
JURISDICTION EMPLOYEE NAME:
Print Name of Gen Contractor
Signature ofGen. Contractor
Gen. Contractor License #
Print Name of E1..Contractor
s' " tune ofEl. t6ittractor
El. Contractor License 0
JURISDICTION:
CALLED INTO- o Progress Energy o.Florida Power and Light on / i
Rev. OV10115)