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ITD7BY: U G 17 0015
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: Documented Construction Value: $ a i j@bQ
Job Address: I q A I (in6 f, 9 _321-1 1 Historic District: Yes No
Parcel ID: ` _q • •51 R • (' • !7 bO Zoning:
Description of Work: R e D
Plan Review Contact Person:Q D A71 n \8.(,p Ll I/ e Y Title: I r1
Phon4211)(QS2'L355S —Fa.:' "1 1)%Z1 ipl b E-mail: COnsfirU 4-1OnwCom C OIC
Property Owner Information
Name of r 1 S Phone: N 32.2 AASI
Street: C an Or. Resident of property? : y C S'
City, State Zip: sS ClN-b(d . EL 327 7 1
Contractor Information
Name NOMe vdnt(Sch ICC C0jsf(U(•-(0fj Phone:( -71>IJs2-3SSS
Street: t•( 3D VY K C nAe d v B1 Y d #(f U) Fax: (RI-7) 223 - L[ U I t7
City, State Zip: ?G M
n
G t h 3 3 U 0 9 State License No.: ( I ,3 5 33
Architect/Engineer Information
Name: (),, Phone:
Street:
City, St, Zip:
Fax:
E-mail:
Bonding Company: 01 d R Q DLt b I I G Su f e-f -/ Mortgage Lender: S Uh Tr U 4
Address: Pb R6u t Ln35 Address:Pb 136x 2_iD 10
WIINN ft AV_eP. WI 532a1 'Ri(hM0a0V6 232-UD PERMIT
INFORMATION Building
Permit C9, Square
Footage: Construction Type: r b DI I h a No. of Stories: No.
of Dwelling Units: 1 Flood Zone: Electrical
New
Service - No. of AMPS: Mechanical (
Duct layout required for new systems) Plumbing
New
Construction - No. of Fixtures: Fire
Sprinkler/Alarm 13 No. of heads:
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.
Si re 05wn&AKgent Date Signature of Contractor/Agent Date
Al
Print Owner/Agent's Name
Sig re o Notary -State of Florida Date
C-1, MY COMMISSION # FFR7VQ• f EXPIRES: November 4, 2018
1fQ y,,• Bonded Thru Notary Public lJndervrtiters
Owner/Agent is Personally Known to Me or
Produced ID _ Type of ID FL OL
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
Rev 11.08
UTILITIES:
FIRE:
Print Contractor/Agent's Name
Sig e o Notary -State SfFlorida Dat
JO ANN WEAVER
MY COMMISSION 9 FF 173862
a. EXPIRES: November 4, 2018
i Bonded Thru Notary Public llndamiters
Contractor/Agent is V Personally Known to Me or
Produced ID Type of ID
WASTE WATER:
BUILDING:
CONSCCDNS VSIfTRUCTION ,IVALInstallation Agree Lie#
CGC 1513427 Eie#
CCC 1328533 Exterior
Work: ROOF 2Z7 7/ ShingleTypes: /
GAF Royal Sovereign 25 Year Shingle;- 3 TAB GAF Timberlil shingle Color:
j'G Drip Edge Color Loa I Underiaymert syntlie
ti%%c 30L 8 Felt 15LB Felt Peel N Stick "' DISH: DIV—
M vs, KEEPA#/A choose to keep the dish, we will not re -instal it on Payrnertt Detags:
Payees on
Loss Draft s.1)(MCode One:
Monitored or on Monitor / Mail Away ff you
have solar panels, please select onte,of the following options:' I/We
will handle the solar panel portion of this project ourselves. I/We vAll insurance company
is to be returned to me upon completion of the project by Di includes payment
for depreciation. I/We
wish for Dirnensiowl Construction to remove the panels, but i/We vAl t NO CHARGE,
but Dimensional Construction Is NOT Iiable for arty damage that may c company is
to be returned to me upon completion of the project by Dimensional Con I/We
wish for Dimensional Construction to supervise the removal and re-&str remove the
panelsand.will hire a licensed plumber to re -install them. Dimensional C no warranty
implied or e)Wressed. if the funds provided by your irsu%nce company ANY DEVIATIONS
FROM THIS CONTRACT MUST BE APPROVED BY ALL PARTI Dimensional Construction
Authorized Agent; sign Date Custom , EIN# 38-
3927480 Phom (888)
742-6163 k.D
Lifetime Dimensional Shingle / Flat Roof: YES /NO $ Ige Vent
Metal Cobra Off Ridge 4' / Cob_ oof pitchn
affect what is allowed per Florida Building Code*** should call
your network provider to relocate the dsh'** Upgrade(s):
Deductible:x1 Jr Dimensional
Construction
will handle the Bank Endorsement I e
panels
removed prior to our install date. The allowance from the ial Construction,
after Dimensional Construction has been paid in ful. This r them
re-
intstaled. Dimensional Construction will remove the solar panels at r as
ai result of handing the sow panels. The allowance from the insurance cation after
Dimensional Construction has been paid in full. 1 - ion
of
the solar panels. Dimensional Construction will have our laborers trudion does
not accept any IiablTrty for handling solar panels and there is not sufficient,
we may supplement them for additional money. AND SUBMITTED
IN WRITING THROUGH A CHANGE ORDER FORM T Date
Date
I 11H 111H 11113i lilli HIM Hill 1I f Il l This
instrument prepared by: MARY'Af<NE HORSEY SEMINOLE COUNTY Name:
o i tA t q s l() ri q- ( COn S+ ru C+-IO n CLERK OF CIRCUIT COURT & COVIPTROLLER Address:
D BK
r8`.r504P9 1.576 (1C'sis) L
D±i,f E, PO-1 M Ofol, FL 34221 CLERK'S V4 2015075151 RECORDED
07/13/2015 09;46:25' tall NOTICE
OF COMMENCEMENT RECORDING FEES $10-00 RECORDED
BY hdevvre STATE
OF FLORIDA Permit #: COUNTY
OF SEMINOLE PARCEL ID #: 3 i • I9.30 • S $ ' CEO • IOD T14E
UNDERSIGNED hereby gives notice that improvements 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) Lot I o /3 t' KC I of V I I W I t d e D.F Loch
Arbor Set? Ll e 119 A,Idea.nDr, 4&n^pord, FL' 32-7-11 2
General Description of Improvements: Re -roof 3
Owner Name: O 1fMF-r7:5' Phone: 4 - y5% Address:
Interest
in property: () W n L r Name &
Address of fee simple titleholder: (if other than owner) 4
Contractor's Name: DIMenStonaj.Cnnetruc+lon Phone: (aswiLa-Latus Address:
13 0 3 10+6 S+ F. PQL I N t+40, FL 34 22.1 5
Surety Name: Phone: Address:
Amount of Bond: $ 6
Lender Name: Sunrrus+ Phone: (800) 63L4' -7929 Address:
p0 3ox R602U, Rl ehr,40nd A/A 73 R K 7
Persons within the State of Florida designated by Owner upon who notice or other documents may be served as provided by Section 713.
13(1)(a) 7. Florida Statues: Name: Phone: Address:
8
In addition to himself or herself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.
13(1)(b), Florida Statutes: Name: Phone: Address:
9
Expiration Date of Notice of Commencement: the
expiration date is I year from 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 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, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING
WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Verification
Pursuant to Section 92.525, Florida Statutes Under
penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true to the best of my knowledge and belief. t
Sig
re wner or Owner's Authorized Signatory's Title/Office Of
tc r / ctor / Partner / Manager S"
rThe
foregoing instrument was acknowledged before me this day of Zt20 /'__, by n-s name of
person) as n-%,/- (type of au(hority, ...e.g. officer, trustee, attorney in fact) for 1 j
a a 7 (natne of party on behalf of whom instrument was xecute j. SEAL) Signature
of
No ic, State o 1 id_aQ JAMEB
WALFORD ,
t•LJ•
C l-C Print, Type
or Stamp Commissioned Name of Notary Public MY COMMISSION # FF 154770 a• EXPIRES:
August 26 2018 Personally Known vgC tt Produced Identification,R_ September 2014
ty?t
Bonded Thru Notary Public Underwriters r Y-
A
NNE MORSE aP t»;;
4ti ttt s 4,
nFIED LERKOFECIR
TCO RTAND 6• MPTR
J. 11, N
FLORID
tr;e DEPUTY CLERK
City of Sanford
Roof Permit Application Checklist
All permit application packages must be complete prior to acceptance. You must check each box to the
left or indicate n/a on this submittal. A complete application package shall include the following:
M'/ Building Permit Application completed, signed and notarized. Application must include correct address
and complete parcel I.D. number.
CK Copy of applicable contractor's license issued by the State of Florida (if the contractor is the
applicant).
M/ A site specific notarized power of attorney shall be required from the licensed contractor if
he/she appoints an employee of his/her company to sign the permit application as the contractor.
Gd Certificate of insurance indicating worker's compensation insurance coverage and naming the City of
Sanford as certificate holder, or a copy of a worker's compensation exemption issued by the State of
Florida (must be submitted with each application if contractor is the applicant).
I pl 161 0 Completed and signed Owner Builder Statement / Affidavit (if the owner is the applicant).
These guidelines were compiled to assist the applicant in preparing a roof permit application and may not be
complete. The applicant is required to meet all City of Sanford, state, and federal code requirements.
Cl
F City of Sanford
Building and Fire Prevention
Product Approval Specification Form
Permit #
Project Location Address 11! I Acid f . g nCC( , EL 321"1 1
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 U
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
Descri tion
Florida Approval #
including 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 GAE - - L I
Underla ments IL - p
Roofing Fasteners
Nonstructural
Metal Roofing
Wood Shakes and
Shingles
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
S. 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
Concrete Admixtures
Precast Lintels
Insulation Forms
Plastics
Deck / Roof
Wall
Prefab Sheds
Other
8. New Exterior
Envelope Products
Applicant's Signature
Applicant's Name _ 5C' 1M j(v/ t l I
Please Print)
June 2014
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 1 1? 01 ISr
I hereby name and appoint:170 n Ny S1 P r
an agent of:
Name
U
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):
The specific permit and application for work located at:
Street Address)
Expiration Date for This Limited Power of Attorney: `j I U i 11.
License Holder Name:—&aii AdW(tlI
State License Number: 0SCC,132 &533
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF M an Q- -e e
The foregoing instrument was acknowledged before me this 20 day of,
20Q, by ' (.0 M 0)LWC 11 who is personally known
to me or who has produced
identification and who did (did not) take an oath.
Sighature
Notary Seal) J-0 Po' l n\^ 1 a Ve-r
Print or type name
aaNivWEAVER Notary Public - State of Florid ar
MY COMMISSION 8 FF 173882 Commission No. 11 g
eEXPIRES: oyPm neUnd zoie
M Commission Expires: 11m;,t • an Underwriters y p 0
Rev. 08.12)
as