HomeMy WebLinkAbout111 Clear Lake Cir (2)CITY OF SANFORD
BUILDING & FIRE PREVENTION
,tl DEB PERMIT APPLICATION
Application No:
Documented Construction Value: S
L,,'J!o'b Address: 1. ��G�'e �`�( e— Historic District: Yes ❑ No E
Parcel ID: �,�� �FrT �000-- 000 y Residential commercial
Type of Work: New ❑ Addition ❑ Alteration ❑ Repair ❑ ' Demo ❑ Change of Use ❑ Move ❑
Description of Work: (�G t..
Plan Review Contact Person: Title:
Phone: Fax: Email:
Property Owner Information
Name 1yi ,'L'. S Phone: a- 3 Z 3- 2 3
street: ��/ (7,�,� Lo
; ; Resident of property?
City, State Zip: .5: f t- - 2 1.73 ry
/ Contractor Information
Name N�1 Phone. �n"%'=ll S 533
Street: ( L( 3 9 O �. Fax:
City, State Zip: 1900 iq,3 State License No.:
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Architect/Engineer 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: 5"' Edition (2014) Florida Building Code
Revised: June 30, 2015 Permit Application
� e
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. Y'
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. -
of Owner/Agent
Date
/gnature
V A', ` e/
o
Print Owner/Agent's Name
A ef
It. .. 19- . All
1SijFt7ur,T,ofVW9tate of Florida Date
�, 1}�+'� ;' •
°0.
DEBRY A. CASON
MY COMMISSION N FF 127826
EXPIRES: September 22, 2014
Bonded Thru Notary Public Undenrrhors
Owner/Age
a or
Produced ID
Type of ID
Signature of Contractor/Agent Date
Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
Contractor/Agent is Personally Known to Me or
Produced IDType 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:
Flood Zone:
# of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Fire Alarm Permit: Yes ❑ No ❑
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Permit Application
CONTRACT AGREEMENT
This agreement is made on this j q day of 20JS�'between
Name Address City
(Contractor)
State Z'p - p Phone
and i( G� Fi S S of
am r� Address City
5;! �& �JW (Client)
State Zip Phone
The above contractor will perform the following work as described in this agreement for $ 4 000. co
in compensation from the client.
Job Description: Pee- po
4 "1-( t Via;
1 6C
� 0 e
Work to commence -in,:9-y 20/and is estimated to be completed on
Date Date
Contractor: Date:
Signature
Prin
-ent:
Signature
I s
Print
Date: �� cz J ��
1�
THIS INST"ENT PREP?RED ICf:
Name: L!�' ✓rYY�l/ r
Address: 6 G1-1( t- GRANT tit"DLO';',• OENINOLE COUNTY
—o-�r I - CLERK Of- CIRCUIT COURT 1, CONPTROLLER
k W t—(-, !S �z' J �zBK 91J79 Pi 417 (Pos)
NOTICE OF COMMENCEMENT CLERK'SRECORDED g{{2018020111iiy:ih.oS' Ph1
State of Florida I:EC0RDTING FEES $10.130
County of Seminole
RECORDED BY iidevore
Permit Number: Parcel ID Number: U,;�—)-a 3 a SGT- (fOoU ._o-7oo
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available)
/ f I C I e o-e- o-C e c e—
GENERAL DESCRIPTION OF IMPROVEMENT:
�Oj1me: INFO
Name:�, �
Address: 1(
Fee Simple Title Holder (if other than owner) Name:
Address:
CONTRACTOR:
Name:
Address: - u
3 Z9{[
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 Lienor's Notice as Provided in
Section 713.13(1)(b), Florida Statutes.
Expiration Date of Notice of Commencement (The expiration date is 1 year from date 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 FIRST
INSPECTION. 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, I declare that I have read the foregoing and that the facts stated in it are true
to the t o y n wled a and belief.
Owners Signature U Owners Prints Name
Florida Statute 713.13(1)(g): "The owner must sign the notice of commencement and no one else may be permitted to sign in his or her stead
State of h County of 44
The foregoin Instrument was acknowledged before me this_ day of 20
by Who is personally known to me
111 Name of person ma ng sidiecifent
0
OR who has produced identification ❑ type of identification produced, z '
. tips* ^y DEBRY A. CASON
., MY COMMISSION Y FF 127826 _
a EXPIRES: September 22, 2018
Bonded Thru Notary Public Underwriters
0
t
DEPARTMENTCITY OF
Sjki4F' J �D
FIRE
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF POLICY & PROCED URES
PERMITTING REQUIREMENTS — NO PLAN REVIEW REQUIRED
THIS DOCUMENT (SIGNED) ALONG WITH AN ACCURATE AND COMPLETED RESIDENTIAL RE -ROOF SCOPE OF WORK ARE
REQUIRED TO BE SUBMITTED AS PART OF YOUR PERMIT APPLICATION.
THE SCOPE OF WORK MUST INCLUDE ALL APPLICABLE FLORIDA PRODUCT APPROVAL NUMBERS FOR ALL ROOF
COMPONENTS THAT WILL BE INSTALLED ON THE PROJECT.
A 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
SANFORD HISTORIC PRESERVATION BOARD
INSPECTION POLICY & PROCEDURES
A FINAL ROOF INSPECTION IS THE ONLY INSPECTION REQUIRED FOR RESIDENTIAL (SINGLE FAMILY, TOWNHOUSE,
MOBILE HOME, APARTMENT AND/OR CONDOMINIUM) RE -ROOF PERMITS.
THE FOLLOWING IS REQUIRED TO BE PROVIDE ON THE JOB SITE:
• PERMIT CARD, POSTED IN 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)
o EACH PLANE OF THE ROOF, SHOWING THE UNDERLAYMENT INSTALLED
o ROOF DECK NAILING PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
o ROOF DECK NAILS 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)
o SHINGLES INSTALLED, NAIL PATTERN AND LOCATION OF NAILS
• SKYLIGHTS (IF APPLICABLE)
o DIGITAL PHOTOGRAPHS SHOWING ALL INSTALLATION COMPONENTS, PER FL PRODUCT APPROVAL
o DIGITAL PHOTOGRAPHS SHOWING ALL REQUIRED FLASHING, PER FL PRODUCT APPROVAL
FAILURE TO FOLLOW THESE SPECIFIC GUIDELINES WILL RESULT IN AN AFFIDAVIT PROVIDED BY A FLORIDA DESIGN
PROFESSIONAL (ARCHITECT OR ENGINEER), CERTIFYING FBC CODE COMPLIANCE BY PERSONAL INSPECTION.
CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: DATE:' , !
SkNFOCITY OF
JOB ADDRESS:
PERMIT #
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
STRUCTURE TYPE: 0 SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: (6 REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF
DECK TYPE (PLEASE SPECIFY): p 1 '1'o- Op
* *PLEASE NOTE: ONL Y 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED
ROOF VENTILATION: (0 OFF -RIDGE O RIDGE O SOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: OYES ONO 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
(16 SHINGLE
/+YY,
FL#✓��
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
OINSULATED
FL#
O TILE
FL#
O OTHER:
FL#
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IFAPPLICABLE**
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 O 4:12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
O SHINGLE
FL#
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
O INSULATED
FL#
O TILE
FL#
0 OTHER:
FL#
SEMINOLE COUNTY MU!_TI IUR15D1CTIONAL
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs.
Date:
I hereby name and appoint:y J t^t S
an agent of: (?(10 . —[,"\c -
(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):
❑ 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:
State License Number: GCC (�
0 ' \�
Signature of License Holder: i` J
STATE OF FLORIDA t�(a
COUNTY OF
a
The foregoing instrument was acknowll�edged before me this who is ❑personally known tome or
_ as identification
D who has produced
d who did (did not) take an oath. �e
��l ode
a Pri t or type Notary name
nat a of Notary
t N t r Public - State of FL
El
MELODY D. LEENotary Public - Slate of Floridacommission# FF902089• My Comm. Expires Jul 21, 2019
oay _ D
Commission No.
My Commission Expires: % o
FI
I CITY OF
SANFORD
FIRE .DEPARTMENT
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF A FFIDA VIT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FIINN°A/L ROOF COVERINGS
PERMIT #: ( D of cc.] ADDRESS: I / / C/(2!r / Z,aZe 6�..
(�,Y I-I.I �_ w 119 e -e ' 1 'AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, ENGINEER, ARCHITECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE
FOREGOING INFORMATION ISTRUE 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 I CERTIFY THE INSTALLATION MEETS ALL
REQUIREMENTS FOR SECONDARY WATER BARRIER AND NAILING OF THE ROOF DECK, IN ACCORDANCE WITH THE HURRICANE RETROFIT
MANUAL REQUIREMENTS (BASED ON F.S. CHAPTER 553.844).
LICENSE #: C C C-
COMPANY / CONTRACTOR: f Pn O
CONTRACTOR SIGNATURE:
(MUST BE SIGNED BY LICENSE HOLDER OR OWNER/BUILD
A FINAL ROOF INSPECTION IS REQUIRED:
THIS SIGNED AND NOTARIZED 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 ATTACHMENT) 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 REFF,R TO THE 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 V r
Sworn to and Subscribed before me this a— day of �'� 20 / Q by:
Who is ❑ Personally Known to me or has ❑ Produced (type of
L
ident' >cation)as identification.
a.
Si6atu're-oy5WaryPu i
State of Flor yMELODY O.ILEE
Print/Type/Stamp Name
of Notary Public
Notary Public - State of Florida
* ' Commission # FF 902089
* ; Oe:
'%'Fove�o;`` My Comm. Expires Jul 21, 20jO
��