HomeMy WebLinkAbout178 Brushcreek DrApplication No: d 3
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Documented Construction Value: $ 9167.13
Job Address: 178 Brushcreek Dr. Historic District: Yes No
Parcel ID: 33-19-30-518-0000-1590 Zoning:
Description of Work: RE -ROOF
Plan Review Contact Person: nehra nean Title: Qiialifier
Phone: Fax: E-mail:
Property Owner Information
Name Marr.PvNqV Inr Street:
178 Brushcreek Dr. City,
State Zip: Sanford, FI. 32771 s
Phone:
Resident
of property? : Contractor
Information Name
Proguard Restoration Phone: 407-330-7663 Street:
1220 Central Park Dr. Fax: 407-330-7661 City,
State Zip: Name:
Street:
City,
St, Zip: _ Sanford,
FL. 32771 Bonding
Company: Address:
Building
Permit Square
Footage: No.
of Dwelling Units: Electrical
New
Service — No. of AMPS: State
License No.: CCC1330234 Architect/
Engineer Information Phone:
Fax:
E-
mail: Mortgage
Lender: Address:
PERMIT
INFORMATION Construction
Type: Aspht. Shing No. of Stories: 1 Flood
Zone: Plumbing
New
Construction - No. of Fixtures: Mechanical (
Duct layout required for new systems) Fire Sprinkler/Alarm No. of heads: ov
0
4 Shall
be inscribed with the date of application and the code in effect as of that date (Code 2010 FBC) 731.135(5)(6) Florida Statutes. REV
07.14
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that noworkorinstallationhascommencedpriortotheissuanceofapermitandthatallworkwillbeperformedto
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 RUPROVEMENTS 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.
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. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges exceed the documented
construction value when the executed contract is submitted, credit will be applied to your permit fees when thepermitisreleased.
Signature ofOwner/Agent Dam
Print Owner/Agent's Name
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
a-Jt- OL. ; 7/13/15
Signature ofContractor/Agent Date
Print
Daze
Notary Public . state of Florida
My Comm. Expires Apr 22, 2018
commission # FF 115280
15-1S
Contractor/Agent is _X Personally Known to Me or
Produced IDType of ID APPROVALS:
ZONING: UTILITIES: WASTE WATER: ENGINEERING:
FIRE: BUILDING: COMMENTS:
Shall
be inscribed with the date of application and the code in effect as of that date (Code 2010 FBC) 731.135(5)(6) Florida Statutes. REV
07.14
PROGUARD RESTORATION
t
2 "W&re Q-Wcfty Comes Terse
P"i-eerr 1220 Central Park Drive, Sanford FL. 32771
BBB 6 er' `f Ph: -407-330-7663 * Fax: 407-330-7661
T
State Certified # CCC1330234
www.proguardrestoration.corm
PROPOSAL / CONTRACT
Date „T=3 .
Submitted ToSu _
l
Zi
Address C+IS tie City s' State - p
PH# PH# Email
Job Address
We Hereby Submit Specifications And Estimates For:
Remove existing
1 layer roof. Each additional layer at $ per square.
Install .SV'a'a T7 G- undedayment / base ply.
y Install valley liner in all valleys throughout where needed..
Install new soil stack flashings (boots).
Install new roo vents on the roof deck, color
Install Cie /`+ +d roof, -rw:::n . / '
Replace any rotten or damaged wood on the roof deck for $ per foot, or, $
per sheet of plywood (if needed).
Additional work scope or information: LS ; - G . % ra r
tJ i 3 rA—LIr a 1 G h
INSURANCE CLAIMS ONLY Contract Amount:
All work scope and/or costs specified in this contract agreement
is subject to or contingent upon the approval of the customer's ( op
insurance company. The undersigned further appoints PROGUARD U.S. Dollars ($ / 1 (D )
RESTORATION (hereinafter referred to as "PROGUARD") as its
representative and permits PROGUARD to negotiate with the Insurance Payment to be made upon completion or as follows:
compnay for settlement of the insurance claim. If there is a ,difference of y
work scope and/or costs, PROGUARD may negotiate a reasonable
replacement and/or replacement cost mutually agreed between PROGUARD
and the insurance company. PROGUARD will not start until work is
approved by the insurance company.. •--
INSURANCE COMPANY fll):E. tit
Al! payments to be made payable to PROGUARD RESTORATION only
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions of this contract are satisfactory and are hereby accepted. I / We have read and understand
the terms and conditions located on the back of this document / contract agreement. PROGUARD RESTORATIONS
hereafter referred to as "PROGUARD") is authorized to do the work as specified and in accordance with the terms and conditions and
stipulations of this contract agreement. Payment will be made as stated above.
Authorized Signature Sales i1
Print Name Rc 1
Title
The
with
1. 1
A
f Permit Number.
Fotio/Parcel ID M. . ,
Prepared by: Proquard Restoration
1220 Central Park. Dr.
Sanford FL. 32771
Return to: Procivard Restoration
1220 Central Park Dr.
Sanford, FL. 32271
ID IT NOT CE OF COMMENCEMENT
State of Florida, County'0
undersigned hereby gives notice that improvement will be
Chapter 713, Florida Statutes, the following Information is
illii! Ifni iffii flffl ifil Iflf I Ilfl Iffy
LERY, OF CIRCUIT COURT_ h COMPTROLLER
VK 3504 P bi! :1i'ss:
CLERK'S 4 20150748 71
RECORDED 07/10,12015 12.10:20 PM
RECORDING FEES $10.0rl
RECORDED 'SY .ieckenro
made to certain real property, and in accordance
provided in this Notice of Commencement.
Name and address of fee simple titleholder (if different from Owner listed above)
Name
Address .
4. Contractor
Telephone Number 407-330-7663
5. Surety (if
Name Telephone Number
Address Amount of Bond $
6. Lender
Name Telephone Number
Address
7. Persons within the State of Florida designated by Owner upon whom notices or other documents maybeservedasprovidedby §713.13(1)(a)7, Florida Statutes.
Name Telephone Number
Address
8. In addition to himself or herself, Owner designates the following to receive a copy of the LienoesNoticeas_ provided in §713.13(1)(b), Florida Statutes.
Name Telephone Number
A,JA---
9. Expiration date of notice of commencement (the expiration date will be 1 year from the date of
unless a different date is specked)
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 ?1&13, FLORIDA STATUTES, AND CANRESULTINYOURPAYINGTWICEFORIMPROVEMENTSTOYOURPROPERTY. A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONS#'"
WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMlAENCEME Nf.' -f
ignature of 6wnetIK , Owner's or Lessee's Authorized Offimr/Director/Partner/Manager _ Signatory's Tide/Office k
The foregoing instrument was acknowledged before me this day of by _
mo r nam f person !;
as for - :.i
Type of auth , e.g., officer, lruste , attorney in fad Name of party on half of whom b4trument was executed r
l:
Signature of Notary Public — State of Florida Print, type, or stamp commissioned name of Notary Publ'
Personally Known-. OR ProducedID Type
of ID Produced pt'"''w LLOYD CHANDLER FORTSON t ,•
MY COMMISSION #FF170587 EXPIRES
November 30, 2618. ii is 'U 107)
3sFs o153 FloridaNataryServlee.com G
V
0
zr3
T
J'
w Form
coritent revised: 01/23/14
i
CITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #: /j__ 9
I, , d . L a -,r) hereby acknowledge that I personally inspected
Goof deck nailing and/or EPS'e-condary water barrier work
at % 7 8 Ai",h A(%Q., /1 , JA and have determined that the work
Job Site Address)
was done according to the Hurricane Mitigation Retrofit Manual. (based on 553.844 F.S.)
I certify that my statements herein are true and accurate to the best of my belief ,and that I fully
understand that making any false statements in writing with the intent to mislead a public servant in the
performance of his or her official duty shall constitute a misdemeanor of the second degree pursuant to
Section 837.06 F.S.
Signature of Contractor
eo_rn
Printed Name of Contractor
Date
0_0 c 133043
License #
License Type: General Building Residential N fCoofing Contractor
or any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF
vor to (orAffirmed) and subscribed before me is day of , 20 N , by rn_ ,
who is LWPersonally Known to me or s Produced (type of identification)
as identification. SEAL)
Signature
of Notary Public State
of Florida Print/
Type/Stamp Name of
Notary Public Revised.•
February 2015 LLOYD
CHANDLER FORTSON MY
COMMISSION #FF179587 oF'
F'` EXPIRES November30, 2018 407)
398-0153 FloridallotaryServicexom