HomeMy WebLinkAbout138 Fairfield Dr�°'_ CITY OF SANFORD
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BUILDING & FIRE PREVENTION
JAB PERMIT APPLICATION
Application No: g S
Documented Construction Value: $
Job Address: / 0 Pe iye Sm &.,-�Historic District: Yes ❑ No n
Parcel ID: 32 . / 1 - 31- 5'7,f -0000- C�/ q 0 Residential 0 Commercial ❑
Type of Work: New ❑ Addition ❑ AlterationN Repair ❑ Demo ❑ Change of Use ❑ Move ❑
Description of Work: 6?6 F
Plan Review Contact Person: �o �„ (�?gip _ '�/' Title: �Ew tc_ /1 m o ('
Phone: �Fax: Cd
Email: ✓1 (@ Vl to i wt cdn S l�r U l' 4, 0
Property Owner Information
Name
iV\
�' V i yl
Phone:
Street:
Resident of property? : (7'W kt e-t%
C � _�
City, State Zip: x�l o,,�,: , �e rFL ,:.32�•7
on hnformation
Name -_S l Ma o Co W1 tJ �4'� e�,� Phone: \1 L 7 _ 6 �S�i12
Street: e4M�tcdy Fax:
City, State Zip: a a, Jib & 3 Z k) State License No.: ((. L):315�633
Name:
Street: I A
City, St, Zip:
Bonding Company:
Address:
Arch itectlEng ineer 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 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 of application and the code in effect as of that date: 51h Edition (2014) Florida Building Code .
Revised: June 30, 2015 Permit Application
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 with all applicable laws regulating construction and zoning.
Signature of Owner/Agent Date Si re ofContrac ni Date,'
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
Print C tractor/Agent's Name
!/I &//o
Si
Rn
; ANNETTE BLANDNotary Public - State of FloridaCommission # GG 060623 My Comm. Expires Jan 16, 2018Cgen is ersona y own to Me or
Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing❑ Gas ❑ Roof ❑
Construction Type:
Total Sq Ft of Bldg:
Occupancy Use:
Min. Occupancy Load:
New Construction: Electric - # of Amps
Flood Zone:
# of Stories:
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: June 30, 2015 Permit Application
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
I hereby name and appoint: Jo WA B ;4
an agent of: pf' S � On G
(Name of 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):
The specific permit and p lication for work located at:
38 i✓1��;t �'I�n�t- bc11 14 al 32�771
(Street Address)
Expiration Date for This Limited Power of Attorney: y
License Holder Name:
C
State License Number: �,(,� (-- I ,� 2,256 33
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF SE.r►riVV'
The foregoing instrument s acknowledged before me this J5 day of 3Q
200i\t, bywho is `'personally known
to me or ❑ who has produced
identification and who did (did not) take an oath.
Nolery Pr�lie $t81e of Florida
Beef E FW:1
nAycweionGG1s3o47 Signature
era ExpiNK 1011&2021
(Notary Sea
ary Public State of Florida
e' .h E Fishel
: ommission GG 153047
res 1001812021
01 812021
(Rev. 08.12)
Print or type name
Notary Public - State of'7\ r I
Commission No. G (; \I.-Y5a -1
My Commission Expires: lo. ; F" • Vic.I
as
1111111 Hill 1111111111111111111111111111
Permit Number. {_:'t;`+;dl' I°h+L_3?'r i;ENI1110H COUNTY1
Folio/Parcel Identffication Number. a:UTT + UUFJ f. r_VIPTF:�ILLE R
Prepared by John BvmePO J. �+_+ r
LERK'S u 201$004'9?,1
ILLI.! 1' .4 _ . �.J i') I
Return to: 3715 Pembrook Drive Orlando FL 32810 R.Ek�0i�H1--1G F.H' i.10.01'1
RE-'Of,'L E-1, L'.,Y tiilt=_vor e
NOTICE OF COMMENCEMENT
State of Florida, County of _
The undersigned hereby gives notice that Improvement will be made to certain real property,
with Chapter 713, Florida Statutes, the followinginformation is P party, and in accordance
1. Description of pro pegal des provided in this Notice of Commencement.
p 'on of the Property, an j stre address if �iable�
2. General description of ImD vement R �.
.. 76
3. Owner Infop0 or L slae #ftffnation tf the Lessee contracted for the Improvement
Name `CX V, l V
Address
Interest In Prope r
Name and address of fee simple titleholder (if different from Owner listed above)
Name
Address ,
4. Contractor
NameMasimo Construction Inc.
Addres! 3i 1 13er11 Drive Orlando, FL 32810 Telephone Number4079220500
5. Surety (if applicable, a copy Of the payment bond Is attached
Name )
Address Telephone Number
6. Lender Amount of Bond $
Name
Address Telephone Number
7. Persons within�theSta�tsofiodes deal nestedbe served y§ 9 by Owner upon whom notices or other documents may
Provided b 713. 3(1)(a)7, Florida Statutes,
Name
Address �Owner Telephone Number
8. In addition to himself or hates the following to receive a copy of the Lienor's
Notice as provided in §713.13(1)(b), FWda Statutes.
Name
Address Telephone Number
9. Expiration date of notice of commencement (the expiration date may not be before the completion of
construction and final Payment to the contractor, but wi0 be 1
different date is specified) year from the date of recording unless a
WARNING TO OWNER ANY PAYMENTS MADE ARE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT
CONSIDERED gMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN
RESULT IN YOUR PAYING TWICE FOR IINPROVEMVXM 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 COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
fuact,%,n,9c.jarepenalty � Pthat I have read the foregoing notice of commencement and that the
!:of my knowledge and belief.
erarLessee,orOwneror Lessee's Aulhorfaed Offber/DlrectodPartrteNAAanege
r Signatorys TffJnJotFice
The foregoing instrument was acknowledged before me this day of 1 fi by C (��V;n Vy t
as fOr - name of personype Fr ,
e..,
M1fx
.trustee. attorney In fact Name of PAY on behalfom instrument was executed
�
`
"'-
Signeture
of Notary Pubi(C
—State of Fbrida Prin�type, or stamp commissioned
Personally Known OR
name of Notary Public
Produced ID
C
I
Type of ID Produced
�=
t cvrfi e
Ohl Notary Pudic State oFlEtdrl R : September 26, 2011
`',
Beth E Fishel
�- •-
My Commieelon GG 153047
'
a � Expires 10/1812021
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Masimo Construction, Inc. Roofing Contract/Proposal
Address: 3715 Pembrook Drive
Orlando, FL 32810
Phone: (407) 922-0500
State -Certified Roofing Contractor - CCC1328033
State -Certified General Contractor - CGC1509548
Brad Pollack, Contractor I
Customer Name:
Address:
Home Phone:
Irl vir
Cell: t �-r
Insurance Co.:
Adjuster:
Claim #:
.Phone:
Date:
City/State/Zip:
Work Phone:
SPECIFICATIONS
OTHER PROPERTY CONDITIONS
Remove roof to existing deck layers:
❑ Ice/Water Shield, Yes No
❑ Each additional layer $ /Sq. (100 Sq. FL)
❑ Existing Water Damage Yes No
❑ Re-??? exis ' g ieck to meet uplift codes.
❑ Existing Driveway Damage Yes No
if nstall metal drip edge around perimeter of roof.
❑ Skylights:
stall ??? boots to pipes 1 %" 2" 3"
❑Leaks:
Vinstall Gooseneck vents 4" 10•
❑Interior Damage:
❑ Hurricane Mitigation Retrofit.
❑ Emergency Repair Yes No
❑ Apply ASTM 30# Felt Paper to plywood deck.
❑ Tapered Insulation Yes No
❑ Apply �—Sq. Ft. of MET HINGLE LE/SHAKES/FLAT
WORK INCLUDES:
✓ Remove trash from roof, gutters and yard.
❑ Style of roof to be installed:
✓ Protect landscaping where applicable.
Color. F
✓ Roll yard with magnetic roller.
❑ Manufacturer of roofing system:-7GT
✓ Furnish permit
❑ Install ridge vent along peak of roof: Addt'I.
✓ 2-Year warranty
Additional charges of $70 per sheet if decking replacement is needed which is only visible upon tear -off existing roofing materials.
WE PROPOSE
To furnish material and labor complete in accordance with specifications above for the sum of $
PAYMENT SCHEDULE
SPECIAL INSTRUCTIONS:
50% DOWN PAYMENT PRIOR TO ORDERING MATERIALS
PAYMENT IN FULL UPON COMPLETION
EARNEST DEPOSIT: ❑ $ 0.00 ❑ $1000.00 ❑ $
DOWN PAYMENT S�'
FINAL PAYMENT $ �' G
TOTAL $
ACCEPTANCE OF AGREEMENT
This agreement is subject to insurance company approval and does not obligate the homeowner or Masimo Construction, Inc., in any way unless it is approved
by the insurance company and accepted by Masimo Construction, Inc. By signing this agreement you authorize us to negotiate the repairs at a price agreeable to
the insurance company and Masimo Construction, Inc. at NO ADDITIONAL COST TO YOU EXCEPT FOR THE INSURANCE DEDUCTIBLE AND AS PROVIDED
ELSEWHERE IN THIS AGREEMENT. The final price agreed on between the insurance companyand Masimo Construction, Inc. shall become the final contract price.
It is also agreed that any and all insurance rights, benefits, and proceeds pertaining to services provided by Masimo Construction, Inc. under any applicable insurance
policies shall be assigned to Masimo Construction, Inc_ to the extent of the contract amount as stated herein. Further, the owner authorizes_ direct payment by check
of any benefits or proceeds from the insurance company to Masimo Construction, Inc., as consideration for any work performed by Masimo Construction, Inc.
THREE DAY RIGHT OF RESCISSION
THIS WRITTEN AGREEMENT HEREBY SERVES AS NOTICE THAT I MAY CANCEL THIS
AGREEMENT RIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE
OF THIS AGREEMENT -
Owner Signal Date 200— Sales Rep.
Accepted by Masimo Construction, IncJRepresentafive X
Insurance Carrier Claim No.
Events beyond the control of Masimo Construction, Inc. may cause delays to the projected start date or estimated time of completion. Such delays do not constitute
abandonment and are not included in calculating time frames for payment or performance. THE TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGE
ARE A PART OF THIS AGREEMENT.
WHITE - HOMEOWNERS COPY YELLOW - SALESMAN'S COPY PINK - OFFICE COPY
PERMT #
Residential Re -Roof Scope of Work
Jot; ADDRESS:
STRUCTURE TYPE: O SINGLE FAMILY RESIDENCEITOWNHOUSE O MOBILE HOME O APARTMENTICONDOMINIUM
RE -ROOF TYPE: O REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
ORE -COVER (NEW ROOF INSTALLED OVER EXISJTI fNG ROOF)
DECK TYPE (PLEASE SPECIFY):
"PLEASENOTE:ONLYIOOSQUAREFEETOFTHEEXISTINGDECKISPERMI EDTOBEREPLACED""
ROOF VENTILATION: (XOFF-RIDGE O RIDGE OSOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: O YES ' QNO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 — 4:12 4:12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
SHINGLE
FL# Z�I
O METAL
FL#
O MODIFIED BI UMEN
FL#
O TORCH DOWN
FL#
OINSULATED
FL#
OTILE
FL#
O OTHER:
FL#
ROOF 1;XTENSIONS (PORCHES, PATIOS, ETC.) ""IFAPPLICABLE"
ROOF SLOPE: O LESS THAN 2:12 O 2:12-4:12 O 4:12 OR GREATER
TYPE OFRooF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
O SHINGLE
FL#
OMETAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
OINSULATED
FL#
O TILE
FL#
0 OTHER:
FL#
RESIDENTIAL RE ROOFMICY & .PROCEDURES
PERMITTING REQUIREMENTS-NO•PLAN REVIEW REQUIRED
ACCURATE AND COMPTTED RESIDENTIAL RE
IS DOCUMENT (SIGNED) ALONG WITH AN ROOF SCOPE OF WORK ARE
QUIRED TO BE SUBMITTED AS PART OF YOUR PERMIT APPLICATION.
[E SCOPE OF WORK MUST INCLUDE ALL APPLICABLE FLORIDA PRODUCT APPROVAL NUMBERS FOR ALL ROOF
WPONENTS THAT WILL BE INSTALLED ON THE PROJECT.
PERMIT WILL NOT BE ISSUED WITHOUT THESE DOCUMENTS. COPIES WILL BE MADE TO POST ON THE JOB SITE.
'PROJECTS LOCATED IN THE SANFORD HISTORIC DISTRICT WILL REQUIRE PLAN REVIEW AND APPROVAL BY THE
�NFORD HISTORIC PRESERVATION BOARD
INSPECTION POLICY & PROCEDURES
,FINAL ROOF INSPECTION IS THE ONLY INSPECTION REQUIRED
DRESIDENTIAL (SINGLE FAMILY, TOWNHOUSE,
IOBILE HOME, APARTMENT AND/OR CONDOMINIUM) RE RoP'FOR
PERMITS-
.HE
FOLLOWING IS REQUIRED TO BE PROVIDE ON THE JOB SITE:
• PERMIT CARD, POSTEDI N A CONSPICUOUS AND WEATHERPROOF LOCATION
• COMPLETED RESIDENTIAL RE ROOF SCOPE OF WORK
• COMPLETED AND NOTARIZED INSPECTION AFFIDAVIT
• ALL FLORIDA PRODUCT APPROVAL AND CORRESPONDING INSTALLATION INSTRUCTIONS
(PRODUCT APPROVAL SHALL MATCH WHAT IS ON THE SCOPE OF WORK)
• DIGITAL PHOTOGRAPHS (MUST INCLUDE THE PERMIT NUMBER OR ADDRESS IN EACH PICTURE)
PLANE OF THE ROOF, SHOWING THE UNDF-RLAYMENT INSTALLED
o EACH
o ROOF E & SPACING (INCLUDING A MEASURING DEVICE ORRULER)
o ROOF DECKNAILS USED (INCLUDING A MEASURING DEVICE OR RULER SHOWING SIZE OF NAILS)
o UNDERLAYMENT PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
o DRIP EDGE & VALLEY ATTACHMENT (INCLUDING A MEASURING DEVICE OR RULER)
D CKkiAILINGPATTERN
o SHINGLES INSTALLED, NAIL PATTERN AND LOCATION OF NAILS
SKYLIGHTS (IF APPLICABLE)
o DIGITAL PHOTOGRAPHS SHOWING ALL INSTALLATION COMPONENTS, PEP, FL PRODUCT APPROVAL
o DIGITAL PHOTOGRAPHS SHOWING ALL REQUIRED FLASHING, PER FL PRODUCT
FAILURE TO FOLLOW THESE SPECIFIC GUIDELINES WILL RESULT INE C AFFIDAVIT B OPER PERSONAL INSPECTION-
PROFESSIONALIDF-D BY A FLORIDA SIGN
(ARCHITECT OR ENGINEER), CERTIFYING F C OD - -- —
CONTRACTOR (OR OWNER/BUILDBR) SIGNATURE: