HomeMy WebLinkAbout800 E 4 St 17-106 ROOFCITY OF SANFORD
BUILDING i FIRE PREVENTION
PERMIT APPLICATION
Application No: l I (D (0
Documented Construction Value: S r"
Job Address: Sri Arn-a'(er--- sn- q FnT1 F 1 Historic District: Yes No
Parcel ID: OnC) - IQ - 31- S\ L — (YX-)C)— C)'_ 00 Residentis I Commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of Work: ) (
Plan Review Contact Person:
Phone:
Title:
Fax: Email:
Property Owner Information
Name M ('1tY 1(1 J N CIIgS
City, state Zip: s\11`
Phone:
Resident of property?:
Contractor Information
Name(CPC.1 EpoC ' cf- 4' Phone:4(n— VD21— Q Ez
Street: -)024 C (-' Q \C h f 1 ' \l'11 n Fax:
City, State Zip: 11i 1\_ iTl i C State License No.. 1.1, C 153
Architect/Engineer Information
Name: Phone:
Street: Fax:
City, St, Zip: 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. 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. 1 understand that a separate permit must be secured for electrical work, plumbing, signs, wells, pools,
furDaoes, hollers, heaters, tanks, and air conditioners, etc.
FBC l(K.3 Shall be inscribed with the date of application and the code in effect as of that date: SO Edition (2014) Florida Ba
Revised: June 30, 2015 Permit Applicmion
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 Florida 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 wit all applicable laws regulating construction and zoning.
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Print O%nedARent's
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Name
0(011,19
t;Ar:'ey' DEBBIE BLANTON
MY COMMISSION # F'F 178648
a€ EXPIRES: February 25, 2019
F od' °e' Bonded Thru IJotary Pubk Underwriters
Owner/Agent is Personally Known to Me or Contractor/Agent is _ Personally Known to Me 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
APPROVALS: ZONING: UTILITIES: WASTE WATER:
ENGINEERING: FIRE: BUILDING:
COMMENTS:
Revised: rune 30, 2013 Permit Application
V
NGTs
of
Lake Mary LLC. WORK
AUTHORIZATION This
Work Authorization Agreement (the "Authorization") is made on the date stated below by and between Building EMT's of Lake Mary,
LLC (the "Company's and the "Customer" (as defined below). This Authorization (with all terms and conditions within) is approval
to the Company by the Customer to proceed with the Company's "Work" (as defined below) to clean, preserve, protect, repair
and secure the property ("Property") as described below. Customer
Name: (10 K. V 6 Property Name: The
real property located at 90 L% city_sjay 6? _State VL Zip County:
SeMjr,.Ji,4Z, Date of Occurrence: Term of Agreement: as necessary The
Work: Company's Work - (1) Emergency remediation and mitigation services, temporary and permanent repairs to roof(s), window(
s), door(s), exterior(s) and elevator(s), as required. Additional services as required The
Company and the Customer agree to the following terms and conditions within: 1.
The Customer fully understands that the Company is not, does not make any claims to be, nor represents itself to be in any way, a public adjuster 2.
The Company agrees to charge the Customer orily for the Insurance Proceeds recovered and/or collected from the insurance policy(s), as it pertains to the Company'
s Work (in whole and in part), including overhead and profit. The Company agrees to collect compensation from the Customer after the Insurance Proceeds
have been received by the Customer. 3.
The Customer agrees to provide the Company with a complete copy of their current insurance policy(s), including but not limited to, the page of declarations, forms
and endorsements, limits of coverage and deductible(s), within 5 days of the commencement of the Work. 4.
The Customer agrees to pay the Company the deductible liability in full, as outlined in their insuran licy(s) within :r5a days of the commencement
of the Work. If all Work has been performed and completed by the Company before the day grace period ends, the Customer agrees
to pay the Company the deductible liability upon completion of the Work. 5.
The Company agrees to provide to the Customer and the insurance carder(s) with a complete estimate of the Work, including all supporting documentation, as
it pertains to the Work, and in accordance with national insurance standards and pricing. 6.
The Customer agrees to pay the Company all Insurance Proceeds recovered and/or collected from the insurance policy(s), detailed on the payment remittance,
as it pertains to the Company's Work (in whole and in part), including overhead and profit. 7.
The Customer agrees to provide the Company with a complete copy of all communications, drafts, payment remittance, Insurance Proceeds, or any other documents
and/or forms of payment when received, as it pertains to the Company's Work. The Customer agrees to remit payment in full to the Company for the
Insurance Proceeds recovered and/or collected from the insurance policy(s), including overhead and profit, as detailed on the payment remittance, as it pertains
to the Company's Work, within 10 business days. 8.
In the event further damage occurs, additional damage is discovered that was not submitted on the original estimate or items on the original estimate were not
paid in full by the insurance carrier(s), the Customer agrees to file a supplement(s) within 30 days of written notice given to the Customer by the Company. If
the Customer doesn't engage in meaningful participation within 30 days of written notice by the Company, the Customer accepts full liability of the entire disputed
cost and will remit payment in full to the Company within 10 business days. 9.
The Company shall provide all the materials, services, and labor to fully perform the Work in a professional and workmanlike manner. The Company shall be responsible
for obtaining all necessary building permits and paying all related and necessary fees for the Work. The Company shall have sole control over the means
and methods by which the Work is performed. 10.
The Customer and the Company agree that any changes and/or modification(s) to this Authorization must be accompanied by a signed and fully executed Change
Order or separate written agreement with all terms and conditions that may apply within. The
Customer and Company hereby agree to be bound by all the terms and conditions in this Authorization as set forth on the front and
reverse side of this agreement. THE
CUST THE COMPANY: Signature:
Signature: Print
Name: Print Name: Date:
Date: , Florida:
7025 CR 46A • STE 1071 #433 • Lake Mary, FL 32746 Phone 800-BLDG-EMT Fax 800-532-9597 www.
buildingemts.com CM-CO57129 • CC-CO58158 • CG-0058633
LIMITED POWER OF ATTORNEY
Date: IMP
I hereby name and appoint: J C 1 V ,1
an agent of: Lcnru'v oofflary
Namejof 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):
All permits and applications submitted by this contractor.
Or
The specific permit and application for work located at:
Street Address)
Expiration Date for This Limited Power of Attorney -
License Holder Name: C
State License Number:
Signature of License
l
STA- OF FLORIDA
COUNTY OF S 4--m .tno\ C
The foregoing instrument was acknowledged before me this day of )
201, by G c zj a 6 G n cNP r- who is personally known to me or who -
has produced \ c; r: A 0 t t : e s \, c e S e as identification and
who did (did not) take an oath. Signatur4
of N I011litlallLdlal
Pu1
0 iN=
ta vA=
Print
or type Notary name Notary
Public - State of Ac<< Commission
No. Ca My
Commission Expires: og 1 o
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SEMI
9Y
THI$ INSTRUMENT PREPARED BY:
Address' —lL / ( Jj `•'tr x_ •.,Zrz_
NOTICE OF COMMENCEMENT
1111111111111111111111111111111111111111
GRANT I1ALOYP SEMINOLE COUNTY
CLERK OF CIRCUIT COURT is C:OPIPTROLLER
BK void P3 159 (11"3s)
CLERK'S Y 2017002962
RECORDED 01/10/2017 11:11:4-8 Ail
RECORDING FEES `I.1171.01
RECORDED BY hdevore
State of Florida
County of Seminole
G
Permit Number. Parcel ID Number.
The undersigned hereby gives notice that Improvement will be made to certain real property, and In accordance withChapter713, Florida Statutes, the following information is provided in this Notice of Comrnenoement.
DESCRIPTION OF PROPERTY: (Legal description of the property and street address H available)
O (5 t \A10 0 + Sno F .l
GENERAL DESCRIPTION OF IMPROVEMENT:
1P V- irr
OWNER
Address:
Fee Simple Title Holder (H other than owner) Name:
Address: 1
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)(b), Florida Statutes.
Name:
In addition to himself, Owner Designates
of
To receive a copy of the Lienoes Notice as Provided in
Section 713.13(1)(b), Florida Statutes.
Expiration Date of Notice of Commencement (The expiration date Is 1 year from data 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 FIRSTINSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalties of perjury, 1 declare that I have read the foregoing and that the facts stated In It are true
to the beat of my knowle(i a an belief.
Owners S,gnan+re Owners Printed
Fl Stetute 713.13(1)(g):' The owner must sign the notice of commencement and no one else may be permitted to sign in Ns or her stead.'
State of r— iaV 6 Countyof J C' /1 The
foregoing Instrument was acknowledged before me this day of a n Zo 47 by
Ci j'( c; /C . / L2 L _Cl Y Who is personally known to me l Nam
of person making qa OR
who has produced Identification type of Identification produced: ANNAM.
CAB AN E'
r
MY COMMISSION N FF 045123 23EXPIRES:
August 2ii, Bonded
Thin Notary Publ'w Underwrilats GRANT
MALOY •.,, RCUIT
COURT DEPuTv0
1,02017 Notary
gn
City of Sanford.
Building and Fire Prevention
RESIDENTIAL. RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #_ l r ADDRESS:
I lC::I\ C Q o r - . AS A(N) GENERAL, BUB.DING, RESIDENTIAL, OR
ROOFING CO CTO GINEER, ARCHITECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE
FOREGOING INFORMATION 6S TRUE AND ACCURATE AND THAT ALL ROOFING COMPONENTS LISTED ON THE SCOPE OF WORK AT THE
ABOVE REFERENCED ADDRESS HAVE BEEN INSTALLED IN ACCORDANCE WITH THEIR PRODUCT APPROVALS AND ALL APPLICABLE CODE
REQUIREMENTS -SPECIFICALLY FLORIDA BUILDING CODE, EXISTING BUILDING. IN ADDITION] CERTIFY THE INSTALLATION MEETS ALL
REQUIREMENTS FOR SECONDARY WATER BARRIER AND NAU34G OF THE ROOF DECK, IN ACCORDANCE WITH THE HURRICANE RETROFIT
MANUAL REQUIREMENTS (BASED ONNF.S.CHAPTER 55533.944). '^
G}
y ^^
LICENSE #: _ (' ` ,1 , V , W U V
COMPANY/CONTRACTOR:
CONTRACTOR SI DATE:
MUST BE SI BY LICENSE HOLD
THIS SIGNED AND NOTARI?M AFFIDAVIT MUST BE PROVIDED AT THE JOB SITE AT THE TIME OF THE FINAL ROOF INSPECTION,
ALONG WITH DIGITAL PHOTOGRAPHS OF EACH PLANE OF THE ROOF SHOWING IN DETAIL ALL COMPONENTS (DECKING,
UNDERLAYMENT, FLASHING, DRIP EDGE ATTAC DIET ) WITH THE PERMIT NUMBER OR ADDRESS CLEARLY MARKED ON THE DECK
FOR EACH INSPECTION. THE PHOTOGRAPHS MUST INCLUDE A RULER OR MEASURING DEVICE TO CONFIRM ALL NAIL SPACING AND
OVERLAPS, INCLUDING DRIP EDGE AND VALLEY FLASHING. PLEASE REFER TO THIN RE -ROOF POLICY AND INSPECTION PROCEDURE
PAPERWORK FOR FURTHER EXPLANATION OF ALL REQUIREMENTS.
FAILURE TO FOLLOW ALL REQUIREMENTS WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION FEE AS
WELL AS REQUIRING A DESIGN PROFESSIONAL (ARCHITECT OR ENGINEER) TO CERTIFY, BASED ON PERSONAL
INSPECTION, THE INSTALLATION OF ALL ROOFING COMPONENTS.
STATE OF FLORIDA COUNTY OF
Seminole
Sworn to and Subscribed before me this 1 St day of February 20 17 by:
Gregory F. Bonner Who is Mftnonally Known to we or has (produced (type of
identification)
Cc.
Signature of Notary Public
State of Florida
Constance P Lima
PrizH/Type/Stamp Name
of Notary Public
as identification.
CMIANCE P LIMA
PpLlk • Slril d Emma