HomeMy WebLinkAbout173 Brushcreek Dr5— c t/3-D
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CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Documented Construction Value: $ 10248.82
Job Address: 173 BnishcrePk Dr historic District: Yes No
Parcel ID: 33-19-30-514-0000-0320 Zoning:
Description of Work: RE -Roof
Plan Review Contact Person: _ Debra Dean Title: Qualifier
Phone: Fax: E-mail: ddPa apragnardres.toration com
Property Owner Information
Name Mel Conrad
Street: 173 erushcreek Dr.
City, State Zip: _Sanford Ft 49771
Phone:
Resident of property?:
Contractor Information
Name pig ,airdReStnrat;nn Phone: 4n7-3nnaer,
Street: 1220 Central Park Dr Fax:--407-330-7661
City, State Zip: Sanford,-W 32771 State License No.: CCC1330234
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Building Permit E3"'
Square Footage:
No. of Dwelling Units:
Electrical
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
PERMIT INFORMATION
Construction Type:' No. of Stories
Flood Zone:
New Service —Wo. of AMPS:
Mechanical (Duct layout required for new systems)
1
Plumbing
New Construction - No. of Fixtures:
Fire Sprinkler/Alarm No. of heads:
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 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. 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 the
permit is released.
fit^ c—ice
Signature of Owner/Agent Date Signature of Contractor/Agent 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 1D
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
Print Cond2unr/Aien—el Name
UTILITIES:
FIRE:
CINDYA. DUNN
Notary Public - State of FloridaMyCOMM. Expires Apr 22. 2018Commission # FF 1 f 52Pg
Contractor/Agent is > Personally Known to Me or
Produced ID Type of ID
WASTE WATER:
BUILDING:
Shall be inscribed with the date of application and the code in effect as of that date (Code 2010 FBC) 73I.I35(5)(6) Florida Statutes.
REV 07.14
Permit Number:
Folio/Parcel ID 1
Prepared by: Pi
Return to:
1 IIV NOTICE OF COMMENCEMENT
State of Florida, County
The undersigned hereby glVes notice that improvement will: be
with Chapter 713, Florida Statutes, the following information is
1. DpAgriptipn of pp6,orty Qeg>al descibtion of,the Drtlerty.
t1ARY411'1E 110RSEr SEMINOLE CQUNTY
s,'LERK fit" GIRC:UIT COURT & !::0rif'TR0LLEi; 6K 8,52 P3 166'r (1pas )
CLERK'S T 2015086605
RECORDED 07t2 4'"2i1.15 10:13:07 AN
R;.:WRUAhtG r"EES; $lii,Ci(r
RUOR00 Er hdevor,s_
made to certain real property, and, in accordance
provided in this Notice of Commencement.
and,9wLi ddress,if available)
2. General descj I' o We e u
RE -ROOF / f • " ' ; j .
3. Ownertnfpyna tgcq o5 _ ssee nfor ikon Jf ,xtte Lessee contracted for
Interest in Proper y '
Name and address of fee simple titleholder (if different from Owner fisted
Name
Address_
4. Contractor
Name Proquard Restoration, Inc. Telephone Number407-330-7663
Address 1220 Central Park Dr. Sanford, FL. 32771
5. Surety (if applicable, a copy of the payment bond Is attached)
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 may
be served as provided by §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 Lienor's
Notice as provided in §713.13(4)(b), Florida Statutes.
Name Telephone Number
Address
g. Expiration date of notice of commencement (the expiration date may not be before the completion of
construction and final payment to the,contractor, but 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 19-'
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, CONSUL'. WJITTHH YOUR LENDER OR AN QRNEY BEFQFtE COMMENCING WORK OR RECORDING YQUR NOTICE OF COMMENCEMENT.
ry
Cat
Owner or Lessee, or Owner's or Lessee's Authorized
The foregoin instrument was acknowledged before me this o& day
al
r
for
Type of a t§rIty .g., offlcer ust e, attorney In fact
Signature of Notary Public — State of Florida
Personally Known _ OR Produced ID
Type of ID Produced
Form content revised: 10117/12
7//5"
Signatory's TitleMftice ==k
name of person
Name of party on behalf of whom Instrument was executed
Print, type, or stamp commissioned name of Notary Public
t:PAwl" "N LLOYD CHANDLER FORTSON
MY COMMISSION *FF179M7 c .
EXPIRES November 30, 2018 t ? t
407) 39"Js3 ftrIftNotMServIce.com
Ia • _ W) in
PROGUARD RESTORATIONnw,-L y CTt TION
1220
Central Park Drive, Sanford FL. 3277i qPh: 407-330-7663 Fax: 407-330.7661 State Certified #
CCCX330234 PROPOSAL t
CONTRACT "NWP oguardrestoration.com Date Submitted
To
Address l7
Pvcr l.r ,r.r to _ City PH#
PH#
State Zip
3Z 7 71 Email Job
Address
WO Eby
Submit Speciticado And Estli 2C20 ayer
roof. Eachadd aonal layer at S Install valinerinallvasethmwhouttlaymeMfDaseply. Install new
soil where needed.. stack Aasttings (bouts). Insmll newroofvonroofdeck, colorroot S install t - Replace any
rotten or de 1 { Per =
heel
d wood on the roof deck for Plywood (ifneeded),/} mat work
scope or information: l( G . ,. L „ All work *
cops and/or 'boats sPOCIMW in this contract agreement la subjecttoorcontingentupontheapprovalofthe4UatOmQr,* Insurance campers. The undersigned further appoints PROGUARD rGre ATFON (
hereMMUr referred -to as `PROGUARD") as its rePreaentstive andpermitsPROGUARDtonegotiatewiththeInsurancecomprayfor "Moment of the insurance claim, M there la a d e scope and/or Coate,, PROGUARD may nsgotl*b a reasonable n o!
wo rePlacoment
and/
or replacement coat mutually agreed between PROGUAF and theInsurancecompany, PROD WARD will not start until work Is and bytheInsurancecofpany, INSURANCE C01APANr
werL' For. Per
square.
Per foot,
or- 1. ( n
Cwt!WAmount:
U.S.
Dollars ($ Payment to
be made upon completion or as follows: Aflpaymwb b
r WYs b PRpGUWiNZAR,p RFSiiQRAT10N wtljr The above
prices s ACCEPTANCE OF PRppO bons located
es andconditions of this contract are OF and
are
hereby accepted. I / We Have read and understand the termsandconditionslocatedonthebackofthisdocument / contract agreement. PROQUARD RESTORATION hereafter referredtoas "PROGUARD"} is authorized to do the work as specified stipulations ofthiscontractagreement. Payment wit a made as stated ace in accordance `
S with the
terms and conditions and Au#horizbd
gr tl re Print Namel`
l . Sales Ct Title
PERMIT NO. -1 0
City of Sanford
Building & Fire Prevention Division
Re -Roof Permit Card
ISSUE DATE: o 7 a 02 /Z
CONTRACTOR: f W r V
JOB ADDRESS: 7. it ea S h e
TYPE OF
Post this Permit irfa conspicuous place outside PROTECT FROM WEATHER
Approved plans must be posted with permit for inspection
Leave all work uncovered until inspected
Permit expires six (6) months from date of issue or last approved inspection
A R OOF DR Y-IN INSPECTION IS RE UIRED * * *
For Inspection procedures, please refer to the re -roof inspection guidelines provided to you when the permit is issued.
The Miti ation A idavit will not su fce as an alternative to receivinQ a dry -in inspection.
ROOF
INSPECTION TYPE APPROVED REJECTED INSPECTOR
MISCELLANEOUS
INSPECTION TYPE APPROVED REJECTED INSPECTOR
ROOF DRY -IN
MITIGATION AFFIDAVIT
FINAL ROOF
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.
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. FBC 105.3.3
REVISED: October 2014 Inspection Line 855.541.2112
TO SCHEDULE AN INSPECTION:
Dial855.541.2112
Provide the items requested during the message
The type of inspection requested must be scheduled under the appropriate permit type
Follow the prompts
PLEASE NOTE: Inspections scheduled by 3:30 p.m. will be conducted the
next business day. If you experience difficulty, please call 407.688.5150
Monday - Thursday 7:30 am - 5:30 pm for assistance.
AUTOMATED INSPECTION SYSTEM CODES
ROOF
Roof Dry In 116
Mitigation Affadavit 129
Final Roof III
Miscellaneous Notes:
Miscellaneous
Sheathing - Roof 106
Insulation - Roof 119
REVISED: OCTOBER 2014 Inspection Line: 855.541.2112
FIRE INSPECTIONS CITY OF SANFORD
407.562.2786 BUILDING & FIRE PREVENTION
BUILDING INSPECTIONS 300 N PARK AVE
855.541.2112 SANFORD FL 32771
DRIVEWAYS -SIDEWALK 407.688.5080
Page 2
Application Number . . . . . 15-00002430 Date 7/27/15
Property Address . . . . . . 173 BRUSHCREEK DR
Parcel Number . . 33.19.30.514-0000-0320
Application description . . . ROOFING APPLICATION
Subdivision Name . . . . . .
Property Zoning . . . . . . . PUD
Permit . . . . . . RESIDENTIAL ROOFING PERMIT
Additional desc . .
Phone Access Code 906602
Permit.pin number 906602
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
10-1000 129 EL29 MITIGATION AFFIDAVIT
10 116 BL15 ROOF DRY -IN
1000 111 BL03 FINAL ROOF / /
CITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #: 15 — 24 3 V
4%.- DeOlf1 hereby acknowledge that I personally inspected
oof deck nailing and/or Lf'Secondary water barrier work
at 1"l3,ruS.C c lL Vy-, 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 toSection837.06 F.S.
Signatulr e of Contractor
31(E yn_ 4
Printed Name of Contractor
Date
0_00_) 3j,3 6 A 3
License #
License Type: General J Building Residential Roofing Contractor
or any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF's,j
jSworn to (o r ffirmed) and subscribed before me this day of 20 I s bZe-&,Y1tole Y
who is rsonally Known or as Produced (type ofide 'fication) as identification.
SEAL)
Signature of Notary Public
Sta/te of Florida
Print/Type/Stamp Name l l/,.Steve Pate
of Notary Public ^* = COMMUN # FMn52
EMRM oa. 29. 2MO
WWW.AAMNOTARY.COY
Revise& February 201