170 W Lake Mary Blvd - BC06-000267 (INTERIOR REMODEL) DOCUMENTSPERMIT ADDRESS
I
ADDRESS N'C )co
PHONE NUMBER
r
PROPERTY OWNER C Q.yC ` .
PHONE NUMBER d ' \ es aoO
ELECTRICAL CONTRACTOR
MECHANICAL CONTRACTO
PLUMBING CONTRACTOR
MISCELLANEOUS CONTRACTOR
PERMIT NUMBER FEE
MISCELLANEOUS CONTRACTOR
PERMIT NUMBER FEE
SUBDIVISION
PERMIT #O o - a U) DATE \ d
PERMIT DESCRIPTIONN a .C1- _1Z`QA%-_@_O J
PERMIT VALUATION
SQUARE FOOTAGE
n
O
a
CITY OF SANFORD PERMIT APPLICATION
Permit # : 0 —?4'l
Job Address: 17c W Lc M,
Description of Work:
Historic District:
Date: II
Zoning: Value of Work: S Q m0
Permit Type: Building Electrical Mechanical __. Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration —.I— Change of Service Temporary Pole
Mechanical: Residential Non -Residential + Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address:
Attach Proof of Ownership & Legal Description)
Phone:
Contractor Name & Address: Aumied C. AI C t., G". 0, akfa- *_ it rJ 5 { Nr f - "rL
State License Number: CAC 1913101 3 37 oz
Phone & Fax: Contact Person: /3Cat A-e T Phone:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address: Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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.
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. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
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 1 will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
Signature of Owner/Agent Date SfV61ure of Contractor/Agent Date
Print Owner/Agent's Name
Signature of Notary -Stale of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg:
Initial & Date)
Special Conditions:
Zoning:
Prin6,Cw for is Name
N \-I\u\cam
Signature of Notary -State of Floridu- Date
My COMMISSION # DO 164280
r
i
EXPIRES: November12,2006
Cont, : gepS bptg t1 %wi n to Me
Produced ID b ^ `( `% n /
2[
1 " \ I,_
Initial & Date)
Utilities: FD:
Initial & Date) (Initial & Date)
Permit # .
Nm.o
Job Address:
Description of Work:
Historic District
CITY OF SANFORD PERMIT APPLICATION
arurug: • aluc v1 TV us co I. I r h v% Li —
Permit Type: Building Electrical A— Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing(New Residential: # of Water Closets, Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Pored M
Owners Nacre & Address:
Bonding Company:
Address:
Mortgage Lender:
Address:
Attach Proof of Ownenhip & Legal Description)
AmbiteLWEngiamr. Phone:
Address: Fax: _
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.
OWNER'S AFFIDAVIT: 1 certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
consinrction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTItiE OF COMMENCEMENT.
190I1CB: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public recordsef
this county, and there may be additional permits required from other govemmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of nail is ve 'fio ion that 1 w notjfyhe or o eprop ofthe rrquireme /FQlorida Lien w^713. ) /Iflo Si
of /Agent Signature of Contractor/Agent Date uraemanrasyq rwn
y Flolary
Pt11)
i:C., Slate of FloridaFl JV4 comm.
eK aes June 30, 2008 A No.
DD
334127 con to
Me or ucedlD L—
APPLICATION APPROVED
BY: Bldg. Initial & Date)
Special Conditions:
Print Contractor/
Agent's Name V. 9
os' Date Signature
of Notary -Stale of Florida Date Zoning: Contractor/
Agent
is _ Personally Known to Me or, Produced ID
Initial & Date)
Utilities: FD:
Initial & Datc) (
Initial & Datc)
CITY OF SANFORD PERMIT APPLICATION
Permit #: Q6 2a
Job Address:
Description of Work:
Historic District:
Date: / ,40 / ey '200
Value of Work: $ 0
Permit Type: Building Electrical Mechanical Plumbing _,%,_ Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential` Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures CJ # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial —_X_ Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name& Address:
Contractor Name &
Phone &'Fax:
Bonding Company:
Address:
Mortgage Lender: .
Address:
Architect/Engineer:
Address:
Attach Proof of Ownership & Legal Description)
wC I '/ <<,i c ka ir^e . Labe Nt,dT^/. /=L . 3y7
ei.s w A:-5'
St to Lic/e c N her:75% /
Contact Person: L/ S /"{1/01 Phone: S/.3 yb
Phone:
Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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.
OWNER'S AFFIDAVIT: 1 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. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
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 FS 713.
Signature of Owner/Agent Date Signature of Contractor/Agent Date
t `N \,_ —
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg: Zoning:
Initial & Date)
Special Conditions:
Print CoNfac1or-/1ARen1:5 Name
l -0s
hfureetary-State3TFlorida Date
r r Fi OREINCE A. is GRAY:
t * MY COMMISSION # OD 164281
EXPIRE N igq rlOgrn !m 1 erg Fcto Me or P ,
uced ID - - u et rvu"'VS S { Initial &
Date) Utilities:
FD: Initial &
Date) (Initial & Date)
THIS INSTRUMENT .PREPARED BY:..
Name: Stanley H. Sandefur
Address: c/o Sandefur & Associates -Inc.
Permit No.
181 Timacuan Blvd, Lake Mary FL 32746
STATE OF Florida
COUNTY OF Seminole
VARYMW WWI MEW OF CIRCUIT CUURT
Sl;YiUKA-E LUNTY
BK 05972 F#G 0161
CLERK'S 4 2(*5187353
RECORDED 10/281M Q A R PH
RECORDING FEES 10.00
RECORDED BY t holden
NOTICE OF COMMENCEMENT
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and inaccordancewith. Chapter 713, Florida Statues, the following information is provided in this Notice ofCommencement.
1: Description of property: Lot 5 Boulevard Plaza Subdivision Plat Book 58 Page 47
Public Records of Seminole County FloridaStreetAddress: 180 West Lake Mary Blvd. Sanford FL 32773 CERTIFIED COPY
2. General description of improvement: Retail tenant improvements MA Y N E MOR;
CLE F C RCU T C
3. Owner information SEM UNT . Q
ra. Name and address: Sandefur & Associates, Inc.
181 Timacuan Blvd., Lake Mary, FL 32746 DEPUTY OLE
b. Interest in property: Fee Simple T 2 8 2005
1 C. Name and address of fee simple titleholder (if other than owner); N/A
Q 4. Contractor: (name and address) Jerald L. Lenik, General Contractor CGC#025953
1800 S. Riveiside Drive, Edgewater, FL 32132
5. Phone: (386) 428-1662, Fax: (386) 428-1231Surety
a. Name and address:
b. Amount of bond $ N/A
6. Lender: (name and address) N/A
7. Persons within the State of Florida designated by Owner upon whom notices or other documents maybeservedasprovidedbySection713.13 (1) (a) 7, Florida Statutes: (name and address) None
8. In addition to himself, Owner designates the following person (s) to receive a copy of the Lienor'sNoticeasprovidedinSection713.13 (1) (b), Florida Statutes: None
9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recordingunlessadifferentdateisspecified): March 1.2006
SANDEFUR & IATES INC.
BY:
Stanley H. Sandefur PresidentSignatureofOwner) Print Owner's Name)
STATE OF FLORIDA
COUNTY OF SEMINQLE
I HEREBY CERTIFY that on this day, before me, an'officer duly authorized to administer oaths and
take acknowledgments, personally appeared STANLEY H. SANDEFUR as President of SANDEFURASSOCIATES. INC a Florida corporation, known to me to be the person described in and whoexecutedtheforegoingNoticeofCommencement, and acknowledged before me that he executed the same. Said person is (check one) X personally known to me or produced asidentification.
WITNESS my hand and official seal in the County and State last aforesaid this l97 day ofSePC,r , 2005.
SEAL) ;STAN)EY
x N NO IARY PUBLIC, STATE OFF ORIDAv
@ DtES: F
aoosHaouy a Holy D'umme A oe Cw
7
10/28/05 SEMINOLE CO Y GOVERNMENT - PERMIT FEES REi]EBPT 16:22:20
APPL # 05-10001395 PERMIT # RECEIPT # 0345395
OWER:
JOB ADDRESS-. *CIT-Y UNASSIGNED NORTH LOT #:
SCI ROAD ARTERIALS 1399.27 1399.27 .00
SCI ROAD COLLECTORS NORTH 263.49 283.49 .00
TOTAL FEES DUE ............. 1682.76 P A 1
AMOUNT RECIIVED............: 1682.76 t4OV 7005
DEPOSITS NON-REFUNDABLE CITY pF ANFORD
THERE IS A PROCESSING FEE RETAINAGE FOR ALL REFUNDS ++
COLLECTED BY: BDSB02
CHECK NUMBER.........:
CASH/CHECK AMOUNTS...:
COLLECTED FROM:
DISTRIBUTION.........:
BALANCE DUE..........:
000000001624
1682.76
CHINA WOK
1 - COUNTY 2 - CUSTOMER -3 -
00
4 - FINANCE
i
COUNTY OF SEMINOLE
IMPACT FEE STATEMENT
STATEMENT NUMBER: 05100013
I
DATE: October 28, 2005BUILDINGAPPLICATION #: 05-10001395
BUILDING PERMIT NUMBER: 05-10001395
UNIT ADDRESS: LAKE MARY BLVD W 170 11-20-30-300-023A-0000
TRAFFIC ZONE:022 JURISDICTION:
SEC: TWP: RNG: SUF: PARCEL:
SUBDIVISION: TRACT:
PLAT BOOK: PLAT BOOK PAGE: BLOCK: LOT:
OWNER NAME:
ADDRESS:
APPLICANT NAME: SANDEFUR & ASSOCIATES, INC.
ADDRESS: 181 TIMACUAN BLVD LAKE MARY FL 32746
LAND USE: RESTAURANT EXPANSION
TYPE USE:
WORK DESCRIPTION: CITY-SANFORD
SPECIAL NOTES: BOULEVARD PLAZA. CHINA WOK.
I----------------------------------
FEE BENEFIT RATE UNIT CALL UNIT TOTAL DUETYPEDISTSCHEDRATEUNITSTYPE
ROADS-ARTERIALS 'CO -WIDE ORD
Restaurant - Sit Down* 4,340.00 758 1000nsft 3,289.72
ROADS -COLLECTORS NORTH ORD
Restaurant - Sit Down* 878.00 758 1000nsft 665.52FIRERESCUEN/A
LIBRARY N/A
00
SCHOOLS N/A
00
PARKS N/A
00
LAW ENFORCE N/A
00
DRAINAGE N/A
00
CREDIT FEES: 00
SCI ROAD ARTERIALS
Retail 50-99999 Square Feet 2,494.00 758 1000gsft 1,890.45- SCI ROAD COLLECTORS NORTH
Retail 50-99999 Square Feet 504.00 758 382.03-
AMOUNT DUE 1,682.76
STATEMENT , _?
RECEIVED BY: SIGNATURE:
PLEASE PRINT NAME)
DATE:
NOTE TO RECEIVING SIGNATORY APPLICANT: FAILURE TO NOTIFY OWNER AND
ENSURE TIMELY PAYMENT MAY RESULT IN YOUR LIABILITY FOR THE FEE. ***
DISTRIBUTION: 1-BLDG DEPT 3-APPLICANT
2-FINANCE 4-LAND MANAGEMENT
NOTE**
PERSONS ARE ADVISED THAT THIS IS A STATEMENT OF FEES DUE UNDER THE
SEMINOLE COUNTY ROAD, FIRE/RESCUE, LIBRARY AND/OR,EDUCATIONAL
ISSUANCE OF A BUILDING PERMIT.
PERSONS ARE ALSO ADVISED THAT ANY RIGHTS OF THE APPLICANT, OR OWNER,
TO APPEAL THE CALCULATION OF ANY OF THE ABOVE MENTIONED IMPACT FEES
MUST BE EXERCISED BY FILING A WRITTEN REQUEST WITHIN 45 CALENDAR
DAYS OF THE RECEIVING SIGNATURE DATE ABOVE, BUT NOT LATER THAN
CERTIFICATE OF OCCUPANCY OR OCCUPANCY. THE REQUEST FOR REVIEW
MUST MEET THE REQUIREMENTS OF THE COUNTY LAND DEVELOPMENT CODE.
COPIES OF RULES GOVERNING APPEALS MAY BE PICKED UP, -OR REQUESTED,
FROM THE PLAN IMPLEMENTATION OFFICE: 1101 EAST FIRST STREET,
SANFORD FL, 32771; 407-665-7356.
PAYMENT SHOULD BE MADE TO: SEMINOLE COUNTY OR CITY OF SANFORD
BUILDING DEPARTMENT
1101 EAST FIRST STREET
SANFORD, FL 32771
PAYMENT SHOULD BE BY CHECK OR MONEY ORDER, AND SHOULD REFERENCE
THE COUNTY BUILDING PERMIT NUMBER AT THE TOP LEFT OF THIS STATEMENT.
THIS STATEMENT IS NO LONGER VALID IF A BUILDING PERMIT IS NOT***
ISSUED WITHIN 60 CALENDAR DAYS OF THE RECEIVING SIGNATURE DATE ABOVE
DETAIL OF CALCULATION AVAILABLE UPON REQUEST. CALL 407-665-7356.
CITY OF SANFORD FIRE DEPARTMENT
FEES FOR SERVICES
rr
PHONE # 407-302-1091 * FAX #: 407-330-5677
DATE: Ot3 / PERMIT I `9
BUSINESS NAME / PROJECT:y —S I I l CAQ ±= "---slq Ki d Z' j r—
CONST. INSP. [ l C / O INSP.:[ l REINSPECTION [ l PLANS REVIEW
F. A. [ J F.S. [ J HOOD [ ] PAINT BOOTH [ BURN P IT [
TENT PERMIT f ] TANK PERMIT [ ] OTHER [ S
TOTAL FEES: S ((PE-R UNIT SEE BELOW)
COMMENTS:
Address / Blde. # / Unit # Square Footage Fees per Bldg. / Unit
2.
3.
4.
5.
6,
7.
8.
9.
10.
11.
12.
13,
14.
15.
16.
17.
18.
19.
20,
Fees must be paid to Sanford Building Department, 300 N. Park Ave., Sanford, FI. 32771 Phone # -407-
330-5656. Proof of Payment must be made to Fire Prevention division bef re any further services can take
place. I certify that the abo a is true and correct and that I
will comply with all pplicable codes d ord' ances
of the City of Sanfori 1, Flori
Sanford Fire evention Division Ap i nt's tignature
AFcFIVZpoS
CITY OF SANFORD PERMIT APPLICATI 20 ?00
Permit # : O Ulf 1 te. ZI
Job Address: O vi Z L V L. Z
escription of Work:
Historic District: Zoning: Value of-OOf7
Permit Type. Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial Industrial Total Square Footage: --/
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: Attach Proof of Ownership & Legal Description)
Owners Name & Address: Sandefur & A-moc ates, Inc'
181 Timac uan Blvd., Lake Derry, FL 32746 407 321-&2Phone:
Contractor Name & Address: Jerald L. L nik, General O:RtraCtOr
1800 S. Riversi Drive, algaatex, FL
State License Numbe : 0M q 3
Phone & Fax: (386) 428-1662 Contact Person: Jerald L:.'Leni$ hone:Lf
Bonding Company:
I
Address:
Mortgage Leader:
Address:
Architect/Engineer:
Address:
Phone:
Fax:
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. 1 understand that a separate
permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
AIR CONDITIONERS, etc.
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. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
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 o notiSUhe owner of the property of the requirem of Florida , S 13.
9 t 7— 0
Signature nt
2
Date gnature of Contractor/Agent Da e
Stanley H. Sandefur, Pres. JWAQ-'* L, `CNI1<
Print wner/Agent's Name Print ntractor/Agent's Name
e. 2
Signature of Nota _ __ _ _ _— -- • Signature of Notary -State of Florida
MY COWSSION S DDM208 MY COMMISSWNtM tfB
O IItES: February 08. 2110E •* ptPQtES: February 08, M
Owner/Agent is KnoRrNt0dvQ oW Awn Co. C tractor/Agent is Personally Known to + fl. NoegDiamurrAaiw Co.
Produced ID f Produced
APPLICATION APPROVED BY: Bldg: n Pit ties: D:
Initial & Date) Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions:
UrffZff IMPACT FEES
w49- $l? a? 60 -
J
POWER OF ATTORNEY
Date: 9 - l•Z d S
1, .E L. LE1V I k
pull the A Mo`!YG L. permit for
Type of permit
0119A) fflAJA
do herby authoriz V -I ) Z tr l q to
l76 W • LA KE nA,R % t1 1)
job address
V n `wf.!u04,, JO ANN M. JOHNSON
Notary t . *
MY COMMISSION i DD 285822
EXPIRES: March 23, 2008
Bonded Thro Budget N pr Services
Personally known to me or drivers license # P4-D 7' 3 Z.Z
State of Florida, County of on Selp 12 day of
20 D '
K
DEVELOPMENT M WORKSHEET
Utility Department
Project Name:
Date
Owner/Contact.Person:
Phone:
Address: / %o
1) TYPE OF DEVELOPMENT: Residential El Non -Residential
2 TYPE OF UNTT(s)i Single Family ' Multi -Family Commercial; Industrial
j
3 TOTAL NUMBER OF UNITS or.BUILDINGS:
4) TYPE QF UTILITY CONNECTION:
a) Meter: Individual Master b
b) Sewer Tap: Individual . Common
Tap Required Tap Existing
Tap Required Tap Existing
5) WATER METER SIZE: %-inch 1-inch 1 '/.-inch 2-inch Supplied by
Contractor
6) AWS METER:' None Individual Master Supplied by El(
Alternative water supply) Meter Meter Contractor
a) Meter Size: %-inch 1-inch 1 %Z-inch 2-inch SConlied by
trac or El
SUMMARY OF IMPACT FEES METER SET and TAP CHARGES
Water impact fees........ $1Z-
5 COMMENTS:
Sewer impact fees........ $ i%3 Z
Water Meter set .......... $
Water Meter set and tap $
Meter deposit and S/C.. $
Sewer tap ................ $
AWS Meter Set ..., ....$
AWS Meter Tap & Set..$
TOTAL DUE .......... $
Signature - Utility Director or Engineer Date:
b 2p O6 6
1
of 2 City of Sanford Utility Department Page
Updated: July, 2005 P.O. Box 1788, Sanford, Fl. 32772 Phone (
407) 330-5641
City Of Sanford Utility Department
DEVELOPMENT FEE WORKSHEET (cont.)
Water System Impact Fees . Equivalent Residential Connection (ERC) = 300' Gallons Per Day (GPD)
Residential
1193/Unit -Single family structure, or multi -family unit containing three (3) bedrooms or more.
894.50/Unit - Multi -family unit or Mobile Home unit containing less than three (3) bedrooms. (This category is based on
judgment/assumption, estimation that such family units on average require 75% - 225 GPD single family unit.)
Commercial — Industrial— Institutional
1193 /ERU - Fixture unit schedule from Southern Plumbing Code will be used. One ERU will be charged for connection and uptotwenty (2) fixture units. For projects having more than twenty (20) fixture units, the Impact Fee will be
determined by increments.,of.25% based on multiples of five (5) fixture units above the twenty (20) fixture unit
base for the first ERU. (Example: twenty-five (25) fixture units will be rated as 1.25 ERU; twenty-six (26) fixture
units will be rated as 1.5ERU.)
Sewer System Impact Fees Equivalent Residential Connections = 300 Gallons Per Day (GPD)
Residential
2688/Unit - Single family structure or multi -family unit containing three (3) bedrooms more.
2016/Unit - Multi -family unit or Mobile Home unit containing less than three. (3) bedrooms. (This category is based on
judgment/assumption/estimation that• such family units on.average require ?5% of water and sewer service of an
average single family unit.)
Commercial — Industrial — Institutional
2688/ERU - Fixture unit schedule from Southern Plumbing Code will be used. 'One ERU'will be charged for connection and up
to twenty (20) fixture units. For projects having more than twenty (20) ..fixture Units the Impact Fee will be
increments of 25% based on multiples of five (5) fixture units.above the.tw"ty (20) fixture unit -base for the first
ERU. (Example: twenty-five (25) fixture units will be rated as 1.25 ERU; twenty -sic (26) fixture units will be rated as 1.5 ERU.)
A — A l.n 1VT%rM"M + 7TWTrrC WID FiYTITRF_C AND GROUPS
1ADLZ /VY.1 La(I"lii1qlfVGraga%J v----
FDKTURE TYPE DRAINAGE FIXTURE UNIT . MINMUM SIZE
VALUE AS LOAD FACTORS; OF TRAP inches
Automatic clothes washers, commercial' 3 2
Automatic clothes washers residential 2 2
Bathroom group consisting of water closet, lavatory, bidet and 6
bathtub or shower
Bathtub (with or without overhead shower or whirlpool 2 1 y:
attachments
2 1 '/.
Bidet
2 1
Combination sink and tray
Dental Lavatory1 1 '/.
Dental unit of cuspidor 1 I %.
Dishwashing machinec2 domestic 2 1 '/'
Drinking fountain Yi 1 /4
Emerizency floor drain 0
2
2
2 Footnote'
Standard Floor drains
Kitchen sink, domestic 2 1
Kitchen sink, domestic with food waste grinder and/or. dishwasher: 2 • 4'/s'
Laundry tray 1 or 2 compartments) 2 1 Y2
Lavatory1 1 '/+ .
Shower com artmen domestic 2 2
Sink 11 2 1 y'
Urinal 4 Footnote
Urinal 1 gallon per flush or less 2e Footnote
Wash sink circular or multiple) each'set of faucets 2 1 '/s
Water closet, flush-o=meter tank, public or private 4c Footnote
Water closet private installation 4 Footnote
Water closet, public installation 6 1 6 Footnote
For SI: 1 inch'— 25.4 mm. 1 gallon 3.785 L.
For traps larger than 2 iriches, trench type drains and floor sinks use Table 709.2.
A showerhead over a bathtub or whirlpool bathtub attachments does not increase the drainage fixture unit value:
See section 709.2 through 709.4 for methods of computing unit value of fixtures not listed in Table 709.1 or for rating of devices intermittent
flows.
Trap size will be consistent with the fixture outlet size. IFor the purpose of computing loads on building drains and sewers, water closets or
urinals shall not be rated at a lower drainage fixture unit unless the lower values are confirmed by testing.
For the purpose of computing loads on building drains and sewers, water closets or urinals shall not be rated at a lower drainage fixture unit
unless the lower values are confirmed by testing.
TAR1.F. 709.2 DRAINAGE FIXTURE UNITS FOR FIXTURE DRAINS OR TRAPS
FIXTURE DRAIN OR
TRAP SIZE (inches)
DRAINAGE FIXTURE
UNIT VALUE
1A 1
lh 2
2 3
2 y, 4
3 5
4 6
COMMERCIAL — INDUSTRIAL — INSTITUTIONAL FEE CALCULATION: Total Fixture Units (F.U.): Z 3 F.U.
Total ERU(s) : Total F.U. _ divide by 20 = /. 5- ERU(s) (F.U. / 20 = ERU )
Water Impact Fee: $1193 x ERU(s) = $ l7 g? go
Sewer Impact Fee: $2688 x /, ERU(s) = $ IV d 3 Z
Upddted: July, 2005 Page 2 or 2 Standard Plumbing Code 1997
CITY O, SANF04313 PERMIT APPLICATION
Permit # : Date: I I l es / c j -RECEIVED
Job Address: kQ /Awf IA 507
Description of Work:
v
0 2U 9
Historic District: Zoning: Value of Work: $ ) D t7
Permit Type: Building Electrical
Electrical: New Service - # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial
Construction Type: # of Stories:
Parcel #:
Owners Name & Address:
Mechanical 5 Plumbing Fire Sprinkler/Alarm Pool
Addition/Alteration Change of Service Temporary Pole
Replacement New (Duct Layout & Energy Ca1c. Required)
of Water & Sewer Lines # of Gas Lines
Plumbing Repair - Residential or Commercial
Industrial Total Square Footage:
of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Attach Proof of Ownership & Legal Description)
Phone:
Contractor Name & Address: AS S 'ro—A Al r Inc O !A— C,r_t44lIsk i- -4drT_c4_ W**4V
State License Number: 'TL(/.33Toz
Phone &Fax: i,2 l — a/ D Contact Person: Phone:
Bondine Comoanv:
Address:
Mor page Lender:
Address:
Architect/Engineer: Phone:
Address: Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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.
OWNER'S AFFIDAV IT: 1 cenify 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. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
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 properly of the requirements of Florida Lien Law, FS 713.
Signature of Owner/Agent Date Signature of Contractor/Agent Date
cf,446Id n&A*7 .
Print Owner/Agent's Name P onlors Name
A4.
Signature of Notary -State of Florida Date Signature of Notary -Stale of Florida Date
FLORENCE k GE GRA-ra
MY COMMISSION # DO 164280
EXPIRES: November 12.2006
Owner/Agent is _ Personally Known to Me or C ntractor/Agent isg3 Rers rt 1 tXgwRlo Me o rl
Produced ID Produced ID MS GL% =
3 3' v
APPLICATION APPROVED BY: Bldg: MF Zoning: Utilities: FD'--/%
Inr ial & Date) (initial & Date)
Special Conditions:
Initial & Date)
x
CITY OF SANFORD FIRE DEPARTMENT
FEES FOR SERVICES
PHONE # 407-302-1091 * FAX #: 407-330-5677
DATE: `' bS PERMIT #:
BUSINESS NAME / PROJECT:
ADDRESS:
PHONE 16- , . CM-8 jCXQ FAX NO.:
CONST. INSP. [ J C / O INSP.:[ j REINSPECTION [ j
F. A. [ 1 F.S. [ J HOOD PAINT BOOTH
TENT PERMIT ] TANK PERMIT] OTHER [ ]
TOTAL FEES: $ 5z21 ' ..,
e-) (
PER UNIT SEE BELOW)
PLANS REVIEW [ ]
j BURN PERMIT [ J
Address / Bldg. # / Unit # Square Footage Fees per Bldg. / Unit
1.
2. jQ13.us
4.
5.
6.
7.
8.
9.
10.
12.
13,
14.
15.
16.
17.
18.
19.
20.
Fees must be paid to Sanford Building Department, 300 N. Park Ave., Sanford, FI. 32771 Phone a -407-
330-5656. Proof of Payment must be made to Fire Prevention division before any further services can take
place. I certify that the above is true and correct and that I
will comply with all applicable codes and ordinances
M ///
111
of the City of Sanford, Florida.
Sanford Fire Prevention Division Applicant's Signature