HomeMy WebLinkAbout116 Crooked Pine DrCITY OF SANFORD
BUILDING & FIRE PREVENTION
\/y///►�\ PERMIT APPLICATION L,I
Application No: I r3 a
Documented Construction Value: $ / 1 7 ®® �
Job Address: l (o C.rz. 4o p1mE D12•
Parcel ID: I � - 3 6. 5 v(o - OOM - 06 00
Type of Work: New ❑ Addition ❑ Alteration ❑ Repair
Description of Work: h E —
Historic District: Yes ❑ No ❑
Residential Commercial ❑
❑ Change of Use ❑ Move ❑
Plan Review Contact Person:
kC mi 1). SSA Title: Du-)0 %e
Phone:
/ %3�
Fax: Email: rL) tk 6 U to 3 3�
Property Owner Information
Name �Raa_o
DE, Ak,
Phone: LID - 7 S1
Street: IN, O
"�
n
pllu Z)P- Resident of property?
City, State Zip:
5,4Al'
u ,
C 3oZ
Contractor Information
Name SS
�`f� e��1}S
LLC., Phone: % 6 73T
Street: 2 %
S
ycCS
Rd Fax: N I4-
City, State Zip:
''nn
�t na
�
D
State License No.: Cop 196; ?aO
Name: v
Street:
City, St, Zip:
Bonding Company
Address:
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender: r•�
Address:
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT INYOUR
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: 5th Edition (2014) Florida Building Code
RrvkM- hmr.'40 9015
Pr it Annli—tirm
r
a
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.
4JZZU-9L 3 - T hr
Signature of Owner/Agent Date Signature of Contractor/A nt 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 (14tractor/Aacnts Name
of Notary -State of
Contractor/Agei4 is
Produced ID
9Ss:�u
1'�?e
or Date SHANA BALAY
(U ��� NOTARY PUBLIC
STATE OF FLORIDA
tee.. `` Comm# FF12711S
Expires 9/22/2018
_ Persona11 Known to Me or
Type of ID
9--,-Yyv--7(k)-
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:
Rr is ,+ tnne In In] S Permit Annliratinn
426 Suggs Rd
Apopka, FL. 32703
FL. License # CCC1326929
Serving the Orlando Metro Area
Proposal Submitted To:
Work To Be Performed At: ❑ Same Address
Name: � ??icA V
Address:
Address: 116 G
City & State:
rd i
City & State; ,
Date:
Phone #: �, 7 J —`/6�
Quoted by: Ke1th D. Russell
//WE, the Owner(s) or Owner's Agent of thepremises described above authorize Russell Brothers hereinafter fe►red to as
reanlike
°Contractor", to furnish allmaterials and labor necessary to roof and/orimprove these premises in a good, workmand
substantial manneraccorrling to the following terms, specifications and provisions:
✓ Tearing off old shingles
✓ Installing synthetic polymer underlay over entire roof
✓ REplacing flashing at walls and ventpipes as needed
✓ Rgnlacing drip edge and vents as needed
�—
✓ Cleaning up and removing all debris Drip Edge Color: X 1 l
Installing new shingles Shingle Color:
GAF Dimensional Shingle
Re -Roof Flat Section: ❑ N/A ❑ YES
✓ All permit and inspection fees included
*"Wooddecking will be Installed atan additional charge of .00persheet ofplywood or
$50.00 per 10 linear feet ofsheathing boards up to 1 "x 8", as needed
Additional Notes and Instructions:
Contractor proposes to perform this above work, (subjectto any additions and/or deductions pursuant to authorized change orders) for a
Total Sum of $ 7,76 C) _ ® n Down Payment of $ d7n
Remainder due upon day of completion.
This contractis approved and accepted. l(we) understand there are no oral agreements or understandings between the parties
of this agreement. The MHP9117 terms,. provisions, plans (if any) and specifications in this contract is the entire agreement between
b)e parties. Changes in t s a reement s4all be ritten change order only and with the express approval ofboth parties.
17 Qpangesm incur additional char es.
Date :X )
Apr ved and Accepted-omeowner orent
2�t(t D. Wjuseff
Date
Approved and Accepted: Contractor
'This proposal may be retracted, by Russell Brothers, if not accepted within 30 days.
CITY OF
4w SANFORD
FIRE DEPARTMENT
Building & Fire Prevention Division
RESIDENTM4L RE -ROOF POLICY & PROCEDURES
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: tNA Qzxl�� DATE: 7�
CIT� OF
SANFORD
FIRE DEPARTI%4ENT
PERNIIT #
Building & Fire Prevention Division
RESIDENTIAL RE ROOF SCOPE OF WORK
JOB ADDRESS: ) 1 6 e K-ff)KE p1'1W'__
STRUCTURE TYPE: SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
I,
DECK TYPE (PLEASE SPECIFY): VV L)a O {�LFdl11 1 f� C,
""PLEASE NOTE: ONLY 100 SQUARE FEET OF THE EXISTING DECKIS PERMITTED TO BEREPLACED"
ROOF VENTILATION: SCOFF -RIDGE O RIDGE Osomr OPOWERED VENT OTURBINES
SKYLIGHTS: O YES Wo IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 Q 2:12 - 4:12 60 4:12 OR GREATER
TYPE OF ROOF
MANUFACT
FLORIDA P/RODucr APPROVAL
SHINGLE
�RER p
-U;
A t ,"iIL11 N E D
FL# ICJ - D 9 o
O METAL
FL#
O MODIFIED BTTUMEN
FL#
O TORCH DOWN
FL#
OINSULATED
FL#
O TILE
FL#
O OTHER:
1FL#
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) x"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#
OINSULATED
FL#
O TILE
FL#
0 OTHER:
FL#
Permit Number.
FolioJParbel ID k I 1 - l o - 3U - 5o(o - 0oc>G - o(p8
Prepared by. Ruth A. Russell
Russell Brothers LLC
420 Suggs Rd., Apopka, FL 32703
Return to: Russea Brothers LLC
426 Suggs Rd.
Apopka, FL 32703
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l.l..C_RK � S It 201302504
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_
NOTICE OF CMMENCEMENT
State of Florida, County of, 5 1 Af 0 Le -
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.
1. Description of property (legal description of the property, and street address if available)
�-o-i (or7 ffip0€N I-AgE PN•3 'l),v,f Z 111' CR60K�n Pima Q/Z,�Z�z3
2. General description of improvement
Re -Roof Asohan Shkmles
3. Owner
0
contracted for the improvement
Address 11 (a lQ h;y e - 40rr A2n�j 5 2- 7 7-3
Interest In Property owner
Name and address of fee simple titleholder (if different from Owner listed above)
Name N/A
Address
4. Contractor
Name Russell Brothers LLC Telephone Number407-625'1738
Address 426 Sugp Rd., Apopka, FL 32703
5. Surety (W applicable, a copy of the payment bond is attached)
Name N/A Telephone Number
Address Amount of Bond $
6. Lender
Name NIA Telephone Number
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may
be served as provided by §713.13(1)(a)7, Florida Statutes.
Name N/A Telephone Number
Address
8. In addition to himself or herself, Owner designates the following to receive a copy of the Lienor's
Notice as provided in §713.13(1)(b), Florida Statutes,
Name rlrA Telephone Number
Address
9. Expiration date of notice of commencement (the expiration date will be 1 year from the 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 1, 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 YOU NDEft OR Atj ATWRNIj BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
aaJA1&P
Signabire of Owner or or OwnePs or Lessee's Authorized OfficedDirectoriParbwAbneW Signatory's Titie/Offioe
The foregoing instrument was acknowledged before me this _�L day of by k f c "-a r d Q er. ko
as O Lt>/N r name of person
for 1�n�.�s�—t9 I3R0T+{5P.s 4-021
Type of authority, a g.. ofaoer, trustee, attorney in fact Name of party on behalf of whom ktstrrmtent was executed
of Notary Public - State of Florida Print, type, or stamp commissioned name of Notary Public
P Wally Known OR Produced ID "�
Type of ID Produced L L Cf92 1 f a d
CERTIFIED COPY GRANT r�.4AUDY ?�'"Y ��s JUAN C VIAMONTES
CLi R F TN C1!$CmT rMuR f 4t Notary Public State of f lilm
AND E�tvt C;; i Ffi -'"� ?� Commission • *44ad0i
St Nfl `ice r"ir 9�r sg My comm. Expires Abr S; 2941
Form content revised: 01r2X14
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 3 - 7-
I hereby name and appoint: L / 774 S
`
anagent of T lO S SIF-i.L IZJ j }4 E E5
(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):
Cd' The specific permit and application for work located at:
l % C _00 k'c o P,'n/C `D�► yZ , 4,4NPr,o
(Street Address)
Expiration Date for This Limited Power of Attorney: - (n - 2 0 / 9
License Holder Name: UTk? N/J qzSSq-Uk-
State License Number: a a0
'�A�Signature of License Holder:
STATE OF FLORIDA
COUNTY OF ' Y\ Ot,Q
The foregoing i strument was ackn�
200 , by'l(16 IN
to me or m4ho has produced
Tix—
identification and who did (' not)
(Notary Seal)
SHANA BALAY
NOTARY PUBLIC
` v
STATE OF FLORIDA
CortnrO FF127115
Expires 9/22/2018
(Rev. 08.12)
d before me this day of fyYX
SSQ_ l l who is o personally known
as
oath.
____j clWoQ &�j v
Print or type name �+`
Notary Public - State of v l' l i/��-1
Commission No.
My Commission Expires: a-�
CITY OF
S��FORD Building & Fire Prevention Division
RESIDENTIAL RE -ROOF AFFIDA VIT
f I R E DE �AA M,EI'T
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: 0 ! r U ADDRESS: I lQ 940 AJE L 9
SAP0IZ4),
I - ss&k > 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 IS 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 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 #:
COMPANY/CONTRACTOR
:SS
LL-c'-
CONTRACTOR SIGNATURE: DATE:
(MUST BE SIGNED BY LICENSE H LDER OR OWNER/BUILDER
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 REFER 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
Sworn to and Subscribed before me this day of ► k�-o/, 20 V by:
Who is 0 Personally Known to me or has�roduced (type of
identification) L 1 L( — ^� ( -O as identification.
igna re ary Public
f F Franciscus Tunnissen
NOT P C
.A F IDA
Print/Tye I res 2/26/2020
of Notary Pu Ic