1811 W 15 St - E18-004483 - TEMP POLErotrb• •
v ' ~off ; •, I.i .) , tlo`j 0 6 2.0 PERMIT APPLICATION
Application No:
Documented Construction Value: $ Tj
Job Address: i [J Y` - Historic District: Yes D No
Parcel ID: Residential kCommercial
Type of Work: Newj Addition Alteration Repair Demo Change of Use Move
Description of Work:
Plan Review Contact Person: Title:
Phone: Fax: Email:
r r
Property Owner Information
Name 1,-, Phone:
Street: 22- _4WVResident ofproperty?
City, State Zip: J&iA K,
ntra Information
zNam - Phone: _ ,. ,. •
Street:- .. Y l _ yJIAFAE-Fax: ..
City, State Zip: ` t2 State License No.: -2i
Architect/Engineer Information
Name:
Street:
City, St, Zip:
Phone:
Fax:
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.
FBC 105.3 Shall be inscribed with the date ofapplication and the code in effect as of that date: 6`s Edition (2017) Florida Building Code
NOTICE: In addition to the requirements ofthis permit, there may be 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 manar/meneiNstricts, state
agencies, or federal agencies.
Acceptance ofpermit is verification that I will notify the owner of the propertyof 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 ValuationTablein effect at the time the permit is issued, in accordance withlocal 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 in compliance with all applicable laws regulating construction and zoning.
Signature of Owner/Agent
Print Owner/Agent's Name
Date Signature ofContractor/Agent Date
I*vI I, (I'T7--
Name
Signature ofNotary -State ofFlorida Date Sign eof,Vr ;State ofFl%r TTE BLAND Date
Notary Public - State of Florida
Commission # GG 060623
My Comm. Expires Jan 16, 2018
Owner/Agent is Personally Known to Me or Co 33 5An to Me or
Produced ID Type of ID Produced ID Type ofID
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 Sprinlder Permit: Yes No # of Heads Fire Alarm Permit: Yes No
APPROVALS: ZONING: UTILITIES: WASTEWATER:
ENGINEERING: FIRE: BUILDING:
COMMENTS:
R ._ r-f Lt
REQUEST FOR PRE -POWER
COMMERCIAL PROPERTIES
Altamonte Springs, Casselberry, Lake Mary, Longwood, Oviedo, Sanford, Seminole
County, Winter Springs
Date: r
Project Name:, Project Address: f
Building Permit #: , f 2 Electrical Permit # ?) f 2
In consideration for authorizing the appropriate utility company to energize the facility, we agree with and
understand the following:
1. The facility will not be occupied until a certificate of occupancy has been issued.
2. If the jurisdiction hereafter finds that the facility has been occupied before a certificate of occupancy has
been issued, the jurisdiction will have the unilateral right to direct the utility to terminate electrical service
without notice. Furthermore, we understand and agree that should the jurisdiction exercise such right, the
jurisdiction will not be responsible for any damages or costs which may result from the exercise of such
right. Also, in the event any third party claims damages from the exercise of such right, we agree to jointly
and individually indemnify and hold harmless the jurisdiction from all such damages and costs, including
attorney's fees.
3. The building or structure shall be weather tight and secure. The electrical wiring in the area designated for
pre -power shall be complete and in safe order. All electrical services associated with the area will be 100%
complete unless specifically approved by the electrical inspector.
4. Interior electrical rooms shall be lockable, if electrical panels are in an area 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.
5. If provided, the fire sprinkler system -must be operational, per the local AHJ requirements, with water on
the system prior to pre -power.
6. This pre -power approval is valid for a maximum of 180 days from date ofapproval.
7. Check with the local jurisdiction for fees associated with pre -power.
Print Name of Owner/Tenant Print Name of Gen. Contractor Print Name of El. Contractor
Signature of Owner/Tenant Signa ture en.da®r
Gen. Contractor License #
Q
Signature of El. Contractor
SODZCQS El.
Contractor License # JURISDICTION
EMPLOYEE NAME: JURISDICTION:
CALLED
INTO: Progress Energy XFlorida Power and Light on Rev.
02.10.15)