HomeMy WebLinkAbout713-715 Meadow St - BR05-003026 (ROOF) DOCUMENTSPermit #: 30
Job Address:
Description of Work: 1= k-- lc _UU --
Historic District: Zoning:
CITY OF SANFORD PERMIT APPLICATION
Date:
Value of Work: S -
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Permit Type: Building Electrical Mechatucal Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Add ition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines 11 of Gas Lines
Plumbing/New Residential: /I of Water Closets Plumbing Repair—Residential or Commercial
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)'
(Alt::ch Proof of 01nc:•stupl&�-cg::l Dcscriptio�),
Parcel #:
Owners Name & Address: --T�t 0. L JLLL_ e1 G� T �� Q =='- �C�h LA
�2l 3z� s�Phone:p -7- —r s�+
Contractor Name &Address: ti—t �.> t' L� �il�y D t !V L2 Gb —� V �r `i=ry `:) "'� fl ,- L—:-1
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Z� Z' I� I State Licensee Number: rz� Z S ` �/
Phon &Fax �-{
- 1iI?IrznC A yd1 53b!� ��ContactPerson: �0�J 0� l�5"�Phone: (a-7 3zZ f)55 0
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engincer: Phone:
Fax:
Address:
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.
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. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RL'•CORDING YOUR NOTICE OF COMMENCEMENT.
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 w• ter management districts, state agencies, or federal agencies.
Acceptance of per vcri ation that I NvAlvve owner of the prop y of he requirem . of 'I a Li Law • S I
QmN late
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I to Signature of Contractor/Agent
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ire of Notary SWUd of Florida Date
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is Personally Known to Me or
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Owner/Agent _
i�roduced
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APPLICATION APPROVED BY: Bldg:
Zoning:
(Initial & Date)
Special Conditions:
's
WaM1MY COMMISSION # DD 188491
EY.PiRES: February 25, 2007
1.800=3-NOTAFIY FL Notary Discount Assoc. Co.
Contrae gent -is-_ Persoiaadl•�-Kraas+�a-Lo-•A6c.r
Produced ID
(Initial & Date)
Utilities: FD`.
(Initial & Date) (Initial & Date)
POWER OF ATTORNEY
Date: (�
I, rAndrew T(Andy-) Adcock do hereby authorize Ruben Birch
To pull the R e r o o fpermit for (-71
hi S
(type of permit) (address) 1
DAFNEY FAYE ADCOCK
NOTARY PUBLIC, STATE OF FLORIDA
r 'AY Comm. Expires DEC. 2, 2008
COMM. # DD376609
Stamp
ersonally l wn to me or driver license # , of State of Florida, County of
day of V
Zoa S
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company: 402e o0 200;;�
quo
License #: l_ l i 0 b Z _Z ':7-0 l
Project Information
Owner. 'J W44, �. �• -t`14a 1J
Permit #:
—113 11 name
`` Nt�A.4-.>o W i • SAV%9DZ:1> Subdivision:
32';d"lL s�
5 4 -ri Lot #:
phone
I,LO-L,4eA , affiant, hereby affirm that I am the duly licensed
contractor of record or the above referenced permit, that all the foregoing information is true
and accurate, and that the dry -in, flashings at the above referenced address or lot has been
installed in accordance with the applicable codes and standards.
Contractor: ;","/
signature
bdt)
printell name
STATE OF FLORIDA
COUNTY OF c -:D e , l tin. v Le
This instrument was acknowledged before me this �� day of v eL, 20 0 5 by the
above referenced individual, ,A t zD ,,. I A 1>do d. K' , who acknowledged that he/she is a
duly licensed contractor with SMA—tt tz— I a F' P telt tt> A , and who acknowledged that
he/she was authorized to execute this document. He/she is e Prr � �r own to me or
producedas valid identification.
WITNESS my hand and seal this - day of �V r"Q- , 20 D
Notary Public
DAFNEY FAYE ADCOC!'
NOTARY PUBLIC, STATE OF FLOR !;
MY Comm. Expires DEC. 2,,c„
5 COMM. # DD370609
�d
DAFNEY FAYE ADCOCK
NOTARY PUBLIC, STATE OF FLORIDA
MY Comm. Expires DEC. 2, 2008
COMM. # DD376609 Y
tate of Florida
4e'rmit No.
4 — C)
�2%`7
I
101
County of Seminole
Tax Folio No. (PID)
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 (jegal descriptionhe pro rty and street address)
11 3-715 WeP- aw 45% o a1C) --q(. 3,-- t
GENERAL DESCRIPTION OF IMPROVEMENT �'-
OWNER INFORMATIrv1
Name and address I - t t'`- GL \-
-7S o AL�0T Lam, Z>eL.0--n.5 0 G
Interest in property (Fee Simple, Partnership, etc.) & W vLe„r
NAME AND ADDRESS OF FEE SIMPLE TITLE AIOLDER.(IF OTHER "TITAN OWNER)
CONTRACTOR !
Name and address �U 6'k"D-D�(�'
SURETY (Bonding Company)
Name and address
Amount of Bond
r-F-RT{"F[ED ^601Y .
MARYANNE PAOR§E
CLW_OFICIRCUIT CC!'IR!T
LENDER
Name and address
Persons within the State of Florida designated by Owner upon whom notice or other documents may be served as provided
by Section 713.13(lxa)7., Florida Statutes:
Name and address
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.
NOTARY PUBUC'S9O'(#'?'i(t!f of Notice of Commencement
Robe'B eTp�tM ate is 1 Year from date of recording unless a dK
ate is
*Commission # DD393765-L..
Rxpires: FEB. 07, 2009 ge Bonded Thru Atlantic Bonding Co., Inc.'LSworn to and sus tbed be e Day of
My Commission Expires:
Not Public
A"' b
The foregoing instrument was acknowledged before me this �� day of �cJR l C-` _ y
a oAN Laos( (name of person acknowledged), who is personally known to
me or who has produced '::- L (type.of identification) as identification
and who did / did not take an oath>
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