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113 Belgian Way; 17-1801; ROOFJob Addre Historic District: Yes No Parcel ID: IV5 -ao • 31 - S - O©On - d 130 Residential M Commercial Type of Work: New Addition Alteration Repair Demo Change of Use Move Description of W Plan Review Contact Person: Title• \c %Ctin Phone: Fax: Email: PL o r`. Property Owner Information Name JC S f__< Phone: 4M - \\lD' kb5(-Q Street: 3 'elQlan 1/.0 _ Resident of property? : tit Wit' City, State Zip: 2sQCNRC*2 , L Contractor Information Name Phone: 4"01, 9080116R5 Street: 2.1 —b`1 oc Xye -* a -7 Pt Fax: 40i1 - -7CA - 261-1 — City, State Zip: CKNQ Fr L S28DLp State License No.: =2 LUPAlD Architect/ Engineer Information Name: Street: \ \ Q City, St, Zip: Phone: Fax: E- mail: Bonding Company: Ja_ Mortgage Lender: Address: Address: WARNING TO OWNER: YOUR FAILURE. TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENT'S 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 (late: 5"' Edition (2014) Florida Building Code Revised: June 30, 2015 Pcnnit Application A ^1 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 ol'Owner/Agent Date Signature of Contractor/Agent Date Print Owner/Agent's Name Signature of Notary -State of Florida Dale Owner/Agent is Personally Known to Me or Produced ID Type of 1D Print Contractor/Agent's Name L,/) I A b 191t7 Signature of tary- ate to Date Contractor/Agent is _>(_ Personally Known to 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 Fire Sprinkler Permit: Yes No APPROVALS: ZONING: ENGINEERING: COMMENTS: Flood Zone: of Stories: Plumbing - # of Fixtures of Fleads Fire Alarm Permit: Yes No UTHATIES: WASTE WATER: FIRE: BUILDING: O y Q m . W 0 NQx 0 0 W 0 Z0oN ap ._ 0 Q o ._ N N mE— uJ E Z o ? QU L` Revised: June 30, 2015 Permit Application Ibis iruuvmmt Name: Nam _ Admssa NOTICE OF COMMENCE STATE CW Permit #: a COANTY 0FtCD]qCi1=PARM iD #: J t73E UNDIMICNED taeby d m aaft that imprawnc amtrdsaee WI& Cbapar713, FMrNa Sraiubm dw Wowl t Dgsr[ptian o! Propetyt (L ePyl tksrsiptim of the 2 Ga mal Dmripdoa of lmproeeaoents: i r 3 Owner Nattae: Address:; inrerssiin property: Name &',AdArea of fee detpte 4 Cotmador's Nava: ; Address: 5 Surety Names Addrew 6 Ltxda Naow: Addreu 7 Parsons within the Sbte,ofFlorida deugo"ed 713.13(i)(s) 7. Florida Starnes: Name: Address: 8 :n addition to bivaelt or herself, Owner defy 7LUXI)(b16 Floida Sbttote: Name: Address: 9 gzpiertton Date of Notice of Commeneevuat: WARRING TO OSM'FR ANY'PAYMOM MADE 1 CON MEM WROPER PAYMENTSSUR PROPERTY. UNDER OMPT TWICE S 76 , FMBAPROVENEI gi3ORE ntE'FatST INSPOCIlON. ff YOU INTEND CONMEXCM WORK ORREC!TINO YOUR NOTICI del t! Sigaaane ofOwrxr or tavnct Authorized Offim I Dirgdor t Parma I Manages The mgimat®mt WO =kFWWICd3WbCfvec name orpmost) ac Y DANIEL BRYAN DENAU TJP,P I F Commission # GG 9714 e ` My Commission Expire PA ril 24.., 2021 SWwmbcr2014 Scanned by CamSfanner Scanned by CamScanner 1 NT OkW rtnda m artala red "am. and Ir dfea Va'P !r tblr Notloa of CaemneaM- stt tufdrar if awailabk) , if other dart owner) PYeoc AmouatofBoad: S war. upon who uedoe or. ether docotaetrts may be served as Provided by Seditaa Phone: T ptsnon( s) eo rxdve a copy of like L,fetaor"s Notice as provided in Secibll Pboar. no" dote is I yes" fmtn dare of tscveding uak" a dtrermt dmo It mccitwo OWNER AFTER nM EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE ART L SECTION 713.13, FLORIDA STATUTES AND CAN RESULT W YOUR PAYING CH OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE XG SITE AW FWANCINO, CONSULT wmi YOUR LENuu OR AN ATTORNEY a3EPORE that the Gas stated in it am uw u, dw bot of my knowledge and belief. IIF Signatory' s TitWOtTm r( day of__,20j _Lby type of authority, ...eg. officer, in fart) for pstry on behalf of wha { ' meat at ' Signatu P 7aneff lint Print, Type of SWT roved Name of Notary Public Personally Known Ur or Produced )dandocadon o CERTIFIED COPY -GRANT MALOY CLERK OF THE CIRCUIT COURT`, AND COMPTROLLER s'rf5")' e:., -' SEMINOLE COUNTY, FLORIDA a4. BY — 64 4-AL DEPUTY CLERK GRANT MALOY, CLERK OF CIRCUIT COURT SEMINOLE COUNTY FL J UN 15 2017 CLERK' S # 2017058377 BK 8930 Pg 0786; (1 pg) E-RECORDED 06/13/2017 09:21:13 AM 10. 00 Advanced Home Solution Construction Firm 121 S. Orange Ave. 01526 RE -ROOF WORK Orlando, Florida 32801 CON S fli ULMON PIFIM AGREEMENT omce) 407-800-1224 Fax) 407-704-2S77 EPA Certified Rtnovstor Florida State Lkmn# CRC 058297 IICRC #110776 Advanced Home Solutions (the "Contractor") agrees to furnish all materials and subcontract its labor for the below im- provements at the f_ olling address: I 1 City for the Owner(s) j lcf'cr 7„ \fit k1 & Homeowners Phone TZ) y/G — 1 C Owners Email /{'l' A 71; 6 4 s o.-• Insurance Company— S 1Jv),r,Y Claim # .S'T=1-s D0 o 1n A_an with sneriecations given below to subcontract ( Re -Roof) Lrstd: -Rm - dem, ve • R - s eplecs ne. or • D- Dd-h ' Rs' Rye' I. Remove,4 layers of. 3-7cL4&underlayment.lfaddklonalroofJngrgeraanfoandaddidanetrnuwlBeppty. 2. Number of stories a— & predominant pitch _ig_ /12. Orr, Tin pitch steep ckorges apply. 3. Provide permits, fees, Notice of Commencement filing, dumpster fees and all applicable taxes. pa Not Remove Posted Permits' 4. Provide OSHA required safety & supervision. 5. Protect the surrounding structure, tear -off & remove old roof to workable surface & re -nail roof deck with eight penny ring shank nails. ,Law A Ordinance nW covered by its prance is the rgWeialbulri of list homeownrr. 7. Owner required to pay all rotten plywood at S 60.00/Sheet, I x6 at S 6.00/L.F., 1 x8 or T&G at S8.00/L.F. pdaday sm J initial If rotten fascia is replaced & existing soffit is to be re -installed additional cost of S8.00/L.F will apply. Remove existing underlayment iS/ and install 3a 9, Remove ,1 Ja " & install new 1-1/2" or /2" cave drip. Color: ,- e- rannnsna initial10. RM & R Chimney Flashing, Counter Flashing & Caulk L.F. I I. RM & R Valley Metal or Ice & Water Shield Product as required by Florida Building Code. ins 11 -- - L.F. 12. RM & R pipe jacks & reseal; 1/2" x - 2" xz? & 3" x L & 4" x - 13. Install 2/0 'yr. /I 30 yr. I 50 n Limited Life Time year fiberglass shingle. upieradeto_ 130MPH W1ndCode. S Color 1&1^ C aloes Manufacturer: . 1,,;,,4,, t j Brand Ca..t,.•c initial 14. RM & R new off -ridge ventilation x or RM & R ridge ventilation L.F. to install. I S. Clean job site of all work debris. Please be atinre use condors when on Job she and ahyaN call 407-800-1224 for any additional Mean ap needed 16. D.& R existing nailed = or screwed _ gutters _. ". Total - L.F. with --- D.S. gutters will rat be guaranteed against leaking or damage, The customer requests install of new drip edge over existing gutters? Yes _or No--. Customer request install of new drip edge at pool super gutters requiring D & R of screen enclosure? Yes _ or No _. 17. RM & R all dead valleys with: Granulated peel & stick. 18. RM & RS lighting rods -- L. F. A separate estimate will be provided 19. RM & R of all kitchen vents & goose necks with 8" ' L or 10" 20, All existing static exhaust fans will be cleaned & resealed. Solar ^ Electric - Gas = Fire Other: - 21. RM & R solar panels - pool panels - water heater - electric panels 22. Skylights: 2' x 2'_ or 2' x 4'- Caps: poly_ glass_ Mounts: curb_ flush_ Skylight Package: cap only_ cap & curb_ 23. L- Flashing will be reused unless it is required to be replacement. Addidonal rosy. will apply. 24. The Contractor will coordinate by subcontracting the removal and reinstallation of roof related peripherals. The owner is upe to adttempt io contractor coordinate with any the subcontractor to do work. related io this contract 25. Owners responsibility to contact their cable or satellite provider to re -install equipment. Workmanship Warren& voided lfhnstalledon roof. 27.z- Year Workmanship Warranty is in effect upon completion. Material Warranty PrevidedbyManatedunr. 28. Enhanced Manufactured Warranty: CertainTeed 3-Star (20yrs) _ $20/s.q. 4-Star (soyrs) --- S25/s.q. (see wsrraaty) 29. Owner will be contacted several days prior to the dumpster delivery. LOCATION ,Q , - -c 1"6'r 30. All Non -Insurance Emergency Work requires advance payment prior to start. Emergency tarping or board -up. Number Size - - _ Cost After Hours 31. All Upgrades & Other Work to be requested must be in writing and request ONLY through your Account Manager, 32. Pre - Construction Inspection completed on S r lA /20 Z f Initial Addendum Exhibit: "-" or also see Xacdmate for Scope: - , Demo, Drywall,-- Insulation,-- Painting, = Carpentry, =.Elect., HVAC, -Plumb. = Restoration, =1EP,=Remediation, _Tree Work, , Flooring, iDoors, —Windows, _Screens, _ NOTES: A.) AFiS Invoke (Provided at Adjmtmenq S F°' -_i /F.)Ordieaucek Low is Paid when lurred(PWq S Insurance RCV Sq . ,01 o Iywlth O&L ! lr d required to pay if not in covered. Collected YES _ B.) Imorauce Deductible S%. 0100 / S_ .. G.)Totni Balance One from RCV ( R. C, D, E, F) S lrooreds required deductible to be paid ." collected YES _ Unpaid Amount by Insurer S C.) luironnoce Check S_o47, o `j 1.) NON -INSURANCE R&ROOF ESTIMATE ( Estimate valid for 30 days) Paid by Insurer collected YES _ S _ 50% Deposit S collected YES _. D.) Insurance Depreciation $_ 2.) O & 4 C.O„ Rotten Wood At Additional Work $ Paid by Imurer collected YES —,: Paid By Client or Imured.S _ and collected YES _ E.) Iroarance Supplements S,____.,_ 3.) Credits to ttntomer S S Paid by I.— collected YES . Paid by Company Yes LVOTICE TO OWNER: ADDITIONAL TERMS ARE ON THE BACK. You are entitled to a copy ofthe contract at the time you sign. Keep it tq protect your rights. Executed in triplic!Mpy of which was delivered to, and receipt ishereby acknowledge by Owners) on -if, (x) (x)-- Owner Sighare Owner Signature Contractors Agent Signature Account Manager mail Scanned by CamScanner - f Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: I hereby name and appoint: _72 an agent of:—R-Cl3HC-i4 IOL _iQ S : allIC Or UOmO811y to be my lawful attorney -in -fact to act for nie to apply for, receipt for, sign for and do all things necessary to this appointment for (check only one option): l The Wecific permit and application for work located at: 1j (Titreet Add] Ss) Expiration Date for This Limited Power of Attorney:___ 1 1 License Holder Name: T _ 0'. State License Number: Signature of License H..... STATE OF FL A COUNTY OF sl^ O The foregoing instrument was a •laio vledged before 111e this _eday of JI Y 20'j by . (' , -4- , who is ) personally known to me or Ej who has produced identification and who did (did not) take an oath. Stgnatur . Notary Seal) rn`• e';. DANIEL BRYAN DENAULT Commission # GG 97140 MY Commission Expires AprII 24, 2021 Rev. 08.12) Print or type name. Notary Public - State of Commission No. My Commission Expires: as City of Sanford Building and Fire Prevention Product Approval Specification Form Permit # Project Location Address As required by Florida Statute 553.842 and Florida Administrative Code 9N-3, please provide the information and product approval number(s) on the building components listed below if they are to be utilized on the construction project for which you are applying for a building permit. We recommend that you contact your local product supplier should you not know the product approval number for any of the applicable listed products. Be aware that windows, skylights, and exterior doors must be tested in accordance with the Florida Building Code, Section 1714.5. More information about Statewide Product Approval can be obtained at www.floridabuilding.org. The following information must be available on the jobsite for inspections: 1. This entire product approval form 2. A copy of the manufacturer's installation details and requirements for each product. Category / Subcategory Manufacturer Product Description Florida Approval # include decimal 1. Exterior Doors Swinging Sliding Sectional Roll Up Automatic Other 2. Windows Single Hun Horizontal Slider Casement Double Hun Fixed Awning_ Pass Through Projected Mullions Wind Breaker Dual Action Other June 2014 Category / Subcategory Manufacturer Product Description Florida Approval # lincluding decimal 3. Panel Walls Siding Soffits Storefronts Curtain Walls Wall Louver Glass block Membrane Greenhouse E.P.S Composite Panels Other 4. Roofing Products Asphalt Shingles Underlayments P ki c1 t 6521 Roofing Fasteners Nonstructural Metal Roofing Wood Shakes and Shingles I. Roofing tiles Roofing Insulation Waterproofing Built up roofing System Modified Bitumen Single Ply Roof Systems Roofing slate Cements/ Adhesives / Coating Liquid Applied Roofing Systems Roof Tile adhesive Spray Applied Polyurethane Roofing E.P.S. Roof Panels Roof Vents Other June 2014 Category / Subcategory Manufacturer Product Description Florida Approval # include decimal 5. Shutters Accordion Bahama Colonial Roll u Equipment Other 6. Skylights Skylights Other 7. Structural Components Wood Connectors / Anchors Truss Plates Engineered Lumber Railing_ Coolers/Freezers 1 Concrete Admixtures Precast Lintels Insulation Forms Plastics Deck / Roof Wall Prefab Sheds Other 8. New Exterior Envelope Products i Applicant's Signature Applicant's Name Please Print) June 2014 City of Sanford Building Divisiont Residential Re -Roof Inspection 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), certifyin F C co compliance by personal inspection. CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: DATE: G 1 9 l l 1 PERMIT # I City of Sanford Building Division Residential Re -Roof Scope of Work JOB ADDRI:SS:I STRUCTURE TYPE: *SINGLE FAMILY RESIDENCE/TOWNHOUSE. O MOBILE HOME O APARTMENT/CONDOMINIUM RE -ROOF TYPE: (6 REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WrrH NEW COMPONENTS) O RE-COVER (NEw ROOF INSTAI.i.[:D OVER EXISTING ROOF) DECK TYPE (PLEASE SPECIFY): PLEASE NOTE: ONLY 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED * * ROOF VENTILATION: OOPF-RIDGE O RIDGE OSOFFIT OPOWERED VENT OTURBINES SKYLIGHTS: O YES 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 SHINGLE FL# O METAL FL# O MODIFIED BITUMEN FL# OTORCH DOWN FL# O INSULATED 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 GREA"TER TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL O SHINGLE FL# O METAL, FL# O MODIFIED BITUMEN FL# OTORCH DOWN FL# O INSULATED FL# O TILE FL# 0 OTHER: FL#