HomeMy WebLinkAbout11-12390 CITY OF ZEPHYRHILLS
5335 - 8TH STREET
• ' �ai3��so-oozo 12390
BUILDING PERMIT
Permit Number: 12390 Address: 39044 SOUTH AVE
Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL.
Class of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: EASY ACRES
Est. Value: Parcel Number: 13-26-21-0100-00000-0060
Improv. Cost: 2,759.00
Date Issued: Name: ALBRITTON, VERNON CURTIS
Total Fees: 75.00 Address: 39044 SOUTH AVE
Amount Paid: 75.00 ZEPHYRHILLS, FL. 33542
Date Paid: 9/29/2011 Phone: (813)782-8557
Work Desc: REPLACE 4 WINDOWS SIZE/SIZE
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FOOTER BOND DUCTS INSULATED SEWER MISC.
ROUGH ELECTRIC LINTEL MISC MISC.
1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC.
DUCTS INSTALLED WATER MISC DRIVEWAY
PRE-SLAB SHEATHING MISC. MISC.
CONSTRUCTION POLE FRAME MISC. MISC.
REINSPECTION FEES: Reinspection fees will compiy with Florida Statute 553.80 (2)(c) when extra inspection
trips are necessary due to any one of the following reasons: a) wrong address b) condemned work resulting
from faulty wnstruction c) repairs or corrections not made when inspections called d) work not ready for
inspection when called e) permit not posted on job site � plans not at job site g) work not accessible.
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, state agencies or federal agencies.
"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 re�cording your notiae of commencement."
Complete Plans, Specifications Must Accompany Application. All work shall be pertormed in accordance with
Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O.
�
CONTRA TOR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
�d� License * �--�
MECHANICAL COMPANY
SIGNATURE �c�s�r�o Y/ N � cua�n Y/ N
Address License *
OTHER COMPANY �
SIGNATURE �c,�sre�o Y/ N F� curx�n Y/ N
Address License #
1 1 1 1 1 1 I 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 I 1 1 1
RESIDENTIAL Attach (2) Plot Plans; (2) sets M Building Plans; (1) set of Enerpy Fortns; R-O-W Peimit for new consWCtion,
Miramum ten (10) worlcirg days after submittal date. Required onsite, Constructpn Plans, Stortnwater Plans w/ Sitt Fence installed,
Sarotary Facili6es & i d�mpster; Ske Work Pertnil fa subdivisbnsllarge projects
COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Fams. R-0.W Permit for new consWCfion.
Minimum ten (10) working days aRer submittal date. Required onsite, CansWction Plans, Stormwater Plans w/ Sitt Fence installetl,
Sanitary Facili6es & 1 dumpster Si[e Work Permit for all new projeds. All cammertial requirements must meet compliance
SIGN PERMIT Attach (2) sets of Engir�eered Plans.
""PROPERTY SURVEY required for all NEW constniction.
Directions.
Fill out application completety.
Owner 8 Contractor sign badc of applica5on, notarized
If OVB� 52500. a Notice of Cemmnneomanf is ronuiro.l �eic ........d� ....e. e�erv��
613780-0020 City �f Zephyrhilis Permit Application Fax-813-780-0021
Building Department
• � Date Received � Z — phone Contact for Permitting
IT R 7 rrT
Ownefe Name Owner Phone Number ��
Owners Address Owner Phone Number �—�
Fee Simple TitlehoWer Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS LOT # �
SUBDIVISION � PARCEL IDp �� "
(06fAINED FROM OPERiY TAX NO CE)
WORK PROPOSED e NEW CONSTR B ADDlALT 0 SIGN Q Q DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM 0 OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME 0 STEEL Q
DESCRIPTION OF WORK /
BUILDING SIZE SQ FOOTAGE HEIGHT �
��UILDING $ � VALUATION OF TOTAL CONSTRUCTION
QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C. „ ���(� O
`r 1
�PLUMBING $ � /�� ��C�! �I `Y�'/^ „
� V
QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION � CL� l Ca��'�-
QGAS Q ROOfING Q SPECIALTY Q OTHER (�,'� L/�
��
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES NO __� „ t �
. J �"'��_
BUILDER � COMPANY y/V�
SIGNATURE REGIS7eRED Y/ N FEE CURaEn Y/ N
Address _ � ����^ (LLicense �
ELECTRICIAN COMPANY
SIGNATURE r�c,�s�rseo Y/ N F� cua�n Y/ N
Address License # �—�
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREh Y/ N
Address License �
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N F� cuRrtEn Y/ N
Address License i
OTHER COMPANY —�
SIGNATURE REGISTERED Y/ N FEE CURREf. Y/ N
Address License �
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1
RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Fortns; R-O-W Permit for new consVuction,
Minimum ten (10) worfcing days after submittal date. Required onsite, ConsWC[ion Plans, Stortnwater Plans w! SiR Fence installed,
Sanitary Facilities & 1 dumpster; Site Work Pertnit for subdivisrons/large projects
COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Fams. R-O-W Permit for new consWcGan.
Minimum ten (10) waking days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Sitt Fence installed,
Sanitary Faalities & 1 dumps[er Site Wor1c Permit for all new projeds. All commeraal requirements must meet compliance
SIGN PERMIT Attach (2) sets of Engineered Plans.
""PROPERTY SURVEY required for all NEW constnx:tion.
Directions: - - -
Fill out application completely
Owner 8 ConVactor sign back of application, notarized
If over;2500, a Notice of Commencement is required. (A/C upgrades over i7�)
" Agent (for the conlrador) or Power of Attomey (for the owner) would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Onty)
Reroofs 'rf shingles Sewers Service Upgrades A/C Fences (PlotlSurvey/Footage)
Driveways-Not over Counter rf on public road�rays..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions"
. ' which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
UNLICENSED CONTRAC70RS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake woric, they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division--Licensing Section at 727-847-
8009 Furthermore, rf the owner has hired a contractor or corrtractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properiy licensed and is not entitled to permitting privileges in Pasco
County
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identfied at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a"certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County WateNSewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's
Protection Guide" prepared by the Florida Department of Agricutture and Consumer Affairs. If the applicant is someone
other than the "owne�', I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the "owner' prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be pertormed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other govemment agencies may apply to the intended work, and that it is
my responsibility to identiiy what actions I must take to be in compliance. Such agencies include but are not limited to:
- Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment.
- Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Artny Corps of Engineers-Seawalls, Docks, Navigable Watervvays.
- Department of Heatth 8� Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authority-Rurnvays.
I understand that the following restrictions apply to the use of fill:
- Use of fill is not allowed in Flood Zone "V" unless expressly permitted.
- If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
- If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, I certity that fill will be used only to fill the area within the stem wall.
- If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversey affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued under the attached pertnit application, for lots less than one (1)
acre which are elevated by fill, an engineered drainage plan is required.
If 1 am the AGENT FOR THE OYYNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commenang construdion. I understand that a separate permit may be required for electricaf work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically inGuded in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension
may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate
justfiable cause for the extension. If woric ceases for ninety (90) consecutive days, the job is considered abandoned.
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
1MTH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COM ENCEMENT.
FLORIDA JURAT (F.S. 117.03)
OWNER OR AGENT CONTRACTO
Subsaibed and swom to (or affim�ed) before me this Subscribed a swonf"to (o atfirm�d) before me this
by by � i, � �,q r
Who is/are personalty known to me or has/have produced Who is/are person known to me or has/have produced
as identificalion. as identificatlon.
Notary Public i - ry Public
"""'� JACQUELIN
Commission No. Com ' 'o ss
`'`' mber 12, 2014
- x res Dece
Name of Notary ryped, printed or stamped Name of Not � ed�1lMeAipy Fan Insxence
ir
. . �� �
City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
J�'� �-� ,,1 _I� � � 1 -
Contractor/Homeowner: �,, i vt�"6 j/��� �1 �
Date Received: � j- � �- � �
,
Site: _ � �� �� �� •�C�i `E
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Permit Type: ��- ,� � �,c.i�y"2�C� � Sr�� cf )1�
Approved w/no comments: Approved w/the below comments: ❑ Denied w/the below comments: ❑
This comme t heet shall e kept with the permit and/or plans.
�� /�
Kalvi Switz r P s Examiner Date Contractor and/or Homeowner
(Required when comments are present)
T STATE OF FLORIDA
�
__��, � DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
°� � CONSTRUCTI�N INDUSTRY LICENSING BOARD (850) 487-1395
�"� �� TALLAHASSEE STR FL T 32399-0783
NYMAN, ALFRED W JR
SEARS HOME IMPROVEMENT PRODUC'TS INC
P O BOX 522290
LONGWOOD FL 32752
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' Receipf # 1 Z-d00U9460
City of Longwood . -
175 W. Warren Avenue, Longwood, FL 32750� STAkTE # C M C 12 4 9 5 i 0
: Esr. ra7a LOe,4� gUSINESS �'A� �:���, CfTY TAX $ 200 . 00
LOCATION: 1024 FLORIDA CENTRAl. P � ADMINISTiiATJVE FEE $ I0. aQ
For the Occupation: _ ���Q� `" ' �'
O� ••-�"--- •�fi TRANSFER FEE $ . Q 0
CON�FRACTOR/OYER 30 ENP��p�i ��tA�s �� '
�'� � PENALTY 90 $ . p 0
SEARS HQlfE IMPROVENENT PR� ��.f �s��,�: .—= �
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PO BQX 52229Q
l.ONG1N�OC3 FL 32752
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A : °'�°'� CERTIFICATE OF LIAB�LITY iNSURANCE °"'�""'"'�°"'�"'
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THIS CERTIFICATE IS ISSIJED AS q M1qF1'ER pF INFORMATION ONLY AND CONFERS NO WGHTS UPON TNE CER7IFICATE MOLDER TMS
CERTIFICATE OOES NOT AFFIRMATi{IELY OR NEGATTVELY ANEND, EXTENp OR ALTER TFIE COVERqGE AFFORDEd BY iHE POUCIES
BE�OW. 7HiS CERTIFICA7E pF INSURANCE DOES NOT CONSTITUTE q CONTRACT BETIMEEN THE ISSUING INSURER(5), AVTHORIZED
REPRESEP(TATIVE OR PROpUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the cert�cate holder is an ADDfiTONqL fNSURID, the policy(ies) must be endorsed. If SUBROG,4T10N IS WAIVEO suqect to .,
the terrna and conditions of the policy, certsin policies may require an endo►semenG q 8q�e„t on thi$ ceniffcat� does not confer rigMs to the ;�
certifica�e holder in lieu of such endasement(s� m
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ChiC2ga Il OffiCe (866) 783-Ti22 FAX �
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Ch�Cdga IL 60601 USA ���; o
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Sears Holdings forporation +���a Inder.nity Insurance Co of Narth qne�i�� 43575
dba Sears Home Irprovemeat Products, inc ��R� A�E American Insurance Compa�y 22667
nttn: aisk �+ianagewerrt E3-219A ��
3333 ae�erly Road
Hoffnldrt EstdtES IL 60179 USA ryg��p�p
NBURHt E:
COVERAGES ���
CERTIFlCATE NUMBER: 570043199018 REVISION NUMBER
THIS fS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO BELDW HAVE BEEN ISSUED TQ TFiE fNSURED NAAAEC ABOVE FOR THE POLICY PERIOD
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De17 R. Hoyt iicense tfCGC1517994, CRCO27383 Tocated @ 1024 slorida Centra] aarkway, �ongxrood, FL 327i0.
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-- DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395
1940 NORTH MONROE STREET
��.�� TALLAHASSEE FL 32399-0783
NYMAN, ALFRED W JR
SEARS HOME IMPROVEMENT PRODUCTS INC
P O BOX 522290
LONGWOOD FL 32752
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� ' �
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� �;.=:: �_�?w: �,�= u : FL # � FL20230-R1 ,
'"� �° �' "�`� "§ s Application Type Revision
�s.. s .� ,: - ' I
�; F. �' �: ,':� Code Version � 4 �p�
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tt '�,�.�..,,�� - ,��� . Comments 1
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Product Manufacturer Wincore Wind w Company, LLC ��
Address/Phone/Email 2 Staunt Avenue � — � �
(304) 485-74 3 ��z��rW QAT�_ - _ F �___,.
jmiller@wincore�l�r5�� ����'�`�� �j �_��,
Authorized Signature Luis Lomas �'�-AN� �XAfViINFF�
---���----
rllomas@Iriomaspe.com
Technical Representative
Address/Phone/Email
Quality Assurance Representative
Address/Phone/Email pj.,LWORK SHALL COMPLY W�TH AL
cate o pREVAILING COD ELECORID CODE DND
Sub at gory �"�� H� CODE,NATIONA LS ORDINANCES
CITY OF ZEPHYRHIL
Compliance Method Certification Mark or Listing
Certification Agency Keystone Certifications, Inc.
Validated By Keystone Certifications, Inc.
Referenced Standard and Year (of Standard) Standard Year
AAMA/WDMA/CSA 101/IS2/A440 2005
Equivalence of Produd Standards
Certified By
Product Approval Method Method 1 Option A
Date Submitted 02/10/2009
Date Validated 02/13/2009
Date Pending FBC Approval 02/16/2009
Date Approved 04/07/2009
http://www.floridabuilding.org/pr/pr_app_dtl. aspx?param=wGEVXQwtDquGotOkaJvZZy... 9/20/2011
Florida Building Code Online Page 2 of 2
Summary of Products
FL # Model, Number or Name Descri 'ow
a23U.1 5408.PYC D()tl6f.� FIUNG 811C DdCJBLE HUNG iNITlQOW 52x63 �
i
Limits of Use Certification Agency Certificate
Approved for use in HVHZ: No FL10230 Rl C CAC 456-125CAR odf
Approved for use outside HVH2: Yes Quality Assurance Contract Expiration Date
Impact Resistant: No 12/31/2011
Design Pressure: +40/-40 Installation Instructions
Other: FL10230 R1 II 08-00374A �df
Verified By: Luis R. Lomas P.E. 62514
Created by Independent Third Party: Yes
Evaluation Reports
FL10230 R1 AE 510553A �df
FL10230 R1 AE NOA 07-0208.07.pdf
Created by Independent Third Party: Yes
10 PY� DOUBLE MUNG $Q P1�C DQAIBLE HUNG WINDfJW 36x72
Lirri�s�ot'U+s� Certification Agency CerCIR7�ate
Approved for use in HVHZ: No FL10230 Rl C CAC 456-401CAR.odf
Approved for use outside HVHZ: Yes Quality Assurance Contract Expiration Date
Impact Resistant: No 12/31/2011
Design Pressure: +50/-50 Installation Instructions
Other: FL10230 R1 II 08-00375A.odf
Verified By� Luis R. Lomas P.E. 62514
Created by Independent Third Party. Yes
Evaluation Reports
FL10230 R1 AE 510555A odf
FL10230 Ri AE NOA 07-0208.07 odf
Created by Independent Third Party• Yes
10230.3 5400 PVC DOUBLE HUNG 5400 PVC DOUBLE HUNG WINDOW 46x77
Limits of Use Certification Agency Certiflcate
Approved for use in HVHZ: No FL10230 Rl C CAC 456-199CAR Ddf
Approved for use outside HVHZ: Yes Quality Assurance Contract Expiration Date
Impact Resistant: No 12/31/2011
Design Pressure: +35/-35 Installation Instructions
Other: FL10230 R1 II 08-00376A.odf
Verified By: Luis R. Lomas P.E. 62514
Created by Independent Third Party: Yes
Evaluation Reports
FL10230 R1 AE 510557A Ddf
FL10230 Rl AE NOA 07-0208 07 odf
Created by Independent Third Party Yes
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DepaKment of Commun/ty aKairs
Florlda Bui/ding Cade On/Ine
Codes anC Sbndards
2555 Shumard Oak Boulevard
Ta!lahassee, Florida 32399-2100
(850) 487-18Z4, Fdx (850) 414-8436
OO 2000-2030 The State of Florida. All right5 reserved.
Privacv Statement I Coovrioht S[atemen[ � Accessibilitv Statement � Plua-in Software � Customer Service Survev I Contact Us
Produd Approval Accepts;
� u^.M1ecA �
�IY�U['It\".l� li: �
VMltl�� ��
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http://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDquGotOkaJvZZy... 9/20/2011
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« �
This Instrument Prepared by� Rcpt:1390437 Rec: 10.00
Name. DS: 0.00 IT: 0.00
SEARSHOMEIMPROVEMENT PRODUCTS, MC 09/26/11 L. Sagastume, Dpty Clerk
1024 Florida Central Parkway
Longwood, FL 32750 PqULR S 0'NEIL,Ph D PqSCO CLERK & COMPTROLLER
Phone 40 7-551-6000 09/26/11 11:44am 1 of 1
OR BK ���2 p � ���
NOTICE OF COMMENC�MENT
Pennrt No
Tax Folio No
t � •�
THE LJNDERSIGNED hereby gives, informs you that the improvement will be made to certain real property, and in ac
with Section 713.13 of the Florida Statutes, tlie following information is provided in this NOTICE OF COMMENCEMCNT.
cordance
1 Description of property (legal description.) �
.,�,.� - 7
. � /r
a) Stree Address: ' r
2 General description of improvements: u,��; J ., ��
3 Owner Information � --__
a) Name and address.
.3 �
b) Name and address of fee simple titleholder (if ot e than owner) �`f
c) Interest in property• �,j�
4 Contractor Information
a) Name and address• SEARS HOME IMPROVEMENT PRODUCTS INC.
1024 FLORIDA CENTRAL pARI{Wpy LONGWOOD FL 32750
b) Telephone No. 407-551-6000
5 Surety Information. Fax No (Opt.) 407-767-8536
a) Name and address
b) Amount of Bond:
c) Telephone No.:
6 Lender Fax No (Opt.) ---__
a) Name and address -----_
Phone No .
7 Identity of person within the State of Florida designated by owner upon who notices or other documents ma be serve
a) Name and address. y �
b) Te(epllone No .
8 In addition to llimself, owner designates the following person to receive a copy of tlie Lien or's Notice as rovided i
�, Section 713 13 (1) (b), Florida Statutes• —
a) Name and address•
P n
b) Telephone No :
9 Expiration date of Notice of Commencement (the expiration date is one year phe date of recording unless a di
date is specified.)
fferent
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE �XPIRATION OI'
OF COMMENCEMEIVT ARE CONSIDER�D IMPROPER PAYMENTS UNDER CHAPTER 713 Ppk
713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTHE NOTiCE
PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE'JOB S 1� SrCTION
THE FIRST INSP�CTIOIV. IF YOU INTEND TO OBTAIN FINANCING, CONSULT YOUa LE S TO YOUR
ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEME 'TC HGrORE
NDCR OR AN
STATE OF FLORIDA �
COUNTY OF �,� �, �___
� `����.�.��- G���� �?�� ���; _ ,
�=a-"•=r'��� �f ^wr�cr or uwner's Authorized Officer/Director/Parmer/Manager
Y :.� •�� t �}�.j ,,
PRINT NAME
The toregoing instrument was acknowledged before me this
� `'�: r_.L,' . � �l Z day of _�S�.l�"i-�►'t���
c: ��c�, irustee., attorne � f�" as y
y m fact, er � ' Z ��> �
party on behalf of whom instrument was executed) (�Ype of authonty, e g.
-----_ (name of
Personally Known OR Produced Identification �
� Notary Signature �
.
Type of Ident�fication Produced A'f%L�Yt+
Jc�-Si.�t;� Name (print) L � ,
Verification pursuant to Section 42.525, Florida Statutes. Under pealties of er'u I declare t] a� e
the facts stated in it are true to the best of my lcno�v]edge and belief. p � ry '
t I have read the foregou�g and that
NOTARY PUBLIGSTATE OF FLORIDA �_) V`"'•/;,-r -^� � -� �:.- [�� L^���±
F ORMS/NOC/VER2007 � � �nce Hullinger �rgnar,�� f*. _
�i:Commission #DD883738 " "` , �a�U,ai rerson S�gning Above —
-. ;�`..�` Expires: JULY 19 2013
B() �� T��B A7'�NTlE ) Qf), INB.
��LORIDA, COUNTY C�F 4���CC�
� CERTIFY THA'T T�H� i=pR�uUsNG IS A
, a�iD CORRECT COPY t�F THE U.1i�Ui�11ENT
_E OR OF PUBUC REC,�_�F�D If�� �-�oS vFFICE
��} MY HAND C� CIA�. S�H�_ fl-il /
DAY 0 i
,_f; S C 'tVEI , C '= �. �v�fi+'�itOLLER
, , , —' :iEPU i Y CLERK
.