HomeMy WebLinkAbout134 Brushcreek DrCITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: J J pp
n Documented Construction Value: $ 10,200
Job Address: 134 BRUSHCREEK DR SANDFROD FL 32771 Historic District: Yes No
Parcel ID: 33-19-30-516-0000-1460 Zoning: 32 SQ FT
Description of Work: SHINGLE RE -ROOF, 7/12 PITCH, RHINO UNDERLAYMENT
Plan Review Contact Person: Titia Buncome Title: Office Admin
Phone: 407-278-7788 Fax: E-mail: permit@jasperinc.com
Property Owner Information
Name JOCELYN WEBSTER Phone: 407-547-7623
Street: 134 BRUSHCREEK DR Resident of property?
City, State Zip: SANDFORD FL 32771
Contractor Information
Name JASPER CONTRACTORS Phone: 407-278-7788
Street: 5380 E COLONIAL DR Fax:
City, State Zip: ORLANDO FL 32807 State License No.: CCC1329651
Architect/Engineer Information
Name: Phone:
Street: Fax:
City, St, Zip: E-mail:
Bonding Company: Mortgage Lender:
Address: Address:
Building Permit 13
Square Footage: 32
No. of Dwelling Units:
Electrical
New Service — No. of AMPS:
PERMIT INFORMATION
Construction Type: RE -ROOF No. of Stories: 1
Flood Zone:
Mechanical (Duct layout required for new systems)
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 Fl3C) 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 permitr
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.
CO I Zs6 , ,_
Signature 60mmer/Agent Date
JOCELYN WEBSTER
Print
Owner/Agent'
s Name
Signature of Notary -State of Florida Date
b lzgl-
Signatu fContractor/Agent Date
MICHAEL STEPHEN
Print C;onntractor/Agent's Name
IAA.I.t V -2,6— <
0
Signature of Notary -Slate of Florida Date
TITIA N BUNCOME ., TITIA N BUNCOME
CommissionCiB FF 224168 : o°''; Commission
N FF 224168 My
Commission Expires April
23. 2019 °,r
My Commission Expires April
23, 2019 Owner/
Agent is Personally Known to Me or Contractor/Agentis ersona y Cnown to Me or Produced
ID X Type of ID DL Produced ID X Type of ID DL APPROVALS:
ZONING: ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
WASTE
WATER: BUILDING:
Shall
be inscribed with the date ofapplication and the code in effect as of that date (Code 2010 FBC) 731.135(5)(6) Florida Statutes. REV
07.14
T"13 'WrRYAPENT PREPARED BY:
Addmnu b3B0 E C`dai a r Ortendo 132ti0T"' '
i Efii(' i Q ?%i r17791;' V
NOTICE OF COMMENCEMENT
p KNSAWr:
ParCeIIDNumber..-1°t-30_,119-pCc
The widerailprod hereby gi 111000e that Improvement MAN be made to oartati tee{ fdlowing Informatlon is Provided in this Nodos of Commeeb ProDexiY. rand N1 aooaderica vriMi Chapter 713, Florida Statutes, the
I.DESCRIPTION OF PrtOPERIY: (l egsi rleaWpllon Of the property and street aftM If Salable)
2. GENERAL DESCRIPTION OF talPRtyyglENr: Re-Roofin
3. OVMER INFORiIATFON OR LESSEE INFORMI}TION IF THE LESSEE CONTRACTEDNameandaddress: FOR THE tMIPROYEIIEIJT: %_ tCr tIP ^i ! 13ti4 \iCvy cCee1L heInterestInproperty.-)0nQ,(-A -1 2 r'Irl l
Fero Simple Title Holder (if other than owner ksted above) Neme: Address:
4. CONTRACTOR: Name: J- aSp9rCpnb3Ct=
Address: 5380 E Colonial Dr Orlando Fl 32807Phone Number, 407-278-7788
S. SURETY (If applicable, a copy of trio Paym - bond
Address Is attached): Name'
6. LENDER: Neme: Amount of Bond:
Address: Phone Number:
7. Persona withi(alln till State
to FkrrWa Dssignatad by Owner upon "M notice of other doclmants713.13(1)(a)7., Florida SlahMa. may be prvad as paov{dad by Sol
Name:
Address: Phone Number:
8. In addition, Owner designates
to receJve a copy of the Lierwr a Notice as
of
provided In Section 713.13(1)(b), Florida Statutes. Phone number.
9. Expiration Date of Notice of Crxnmerloement (The expiration Is 1 y?ar from date of record'utg unfeas o dlrterer t date to apecilfed)
pyffiNlNG 7n oINJyER ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARECONSIDEREDIMPROPERPAYMENTSUNDERCHAPTER713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOURPAYINGTWICEFORIMPROVEMENTSTOYOURPROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THEJOBSITEBEFORETHEFIRSTINSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEYBEFORECOMMENCINGWORKORRECORDINGYOURNOTICEOFCOMMENCEMENT.
ISI or Owror or Leases, or Owni or ova (pi ern. and RDA" aipnatoryaTHNORilVAom E`ttt LL9roterr
State of " County of GexnnovC'_
The foregoing instrument was acknowledped before me this % day of Jv
by . Who Is personalty known to me OR
Name of parson mi sWemeM
who has produced Identification E type of identification produced:
omz
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TITIA N BUNCOME M,-Cyr_O
Commission M FF 224168 o
NotrySrpua..
a My Commission Expires
April 23, 2019 1
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Jasper Contractors, Inc. Account Manager fQ / S
5380 E. Colonial Dr. a'*•r ,, Contact N
Orlando. I:L 32807 Insurance Company Informal o
407) 278-7788 Company._LLS ill: T_
800) 337-3361 Fax
JasperRoof.cotn JASPE,R Policy#
Claim >t T]+ /9
Sl Lam.._--=1- -
info tt , mrinc. ,r • 1 tt t_
Contractor's License a CC'C1329651 Nlartgage Company llpfoirnatlon
VISA L "`-
Company _ /l/ -
Loan Numbcr
ROOF REPLACEMENT CONTRACT
Owner(s): `
6C eL t t
Phone: Yo ? _sfl7 76Z
Address:
l 3 '/ J C
Alt Phone:
City: + /
J
St e: Zip code:
3 L- 1 l
Shingle Color:
Email: Roof RCV amount: Drip Edge Color:
If Owner's Insurance Company does not agree to pay for a full roof replacement this contract shall be voidable.
Assignment of Insurance Benefits for the Full Roof Replacement Only: I hereby assign any and all insurance rights, benefits and proceeds
under any applicable insurance policies to Jasper Contractors, Inc. ("Jasper"), the scope of which shall be limited to a Full Roof Replacement. I
make this assignment and authorization in consideration of Jasper's agreement to perform services, supply materials and otherwise perform its
obligations under this contract, including not requiring full payment at the time of service. I also hereby direct my insurer(s) to release any and
all information requested by Jasper, its representative, or its attorney for the direct purpose of obtaining actual benefits to be paid by my
insurer(s) for services rendered. In this regard, I waive my privacy rights. If payment is made directly to the Owner/AgenUlnsured(s), it shall be
endorsed over to Jasper immediately upon receipt. 1 agree that any portion of work, deductibles, betterment or additional work requested by the
undersigned, not covered by insurance, must be paid by the undersigned on the day of installation.
Deductible: It is the Owner's responsibility to Day all Insurance Deductibles. Owner's out-of-pocket expense will not exceed the deductible
amount, as stated on insurer's loss sheet, UNLESS replacement/repair of deteriorated decking is required and/or Owner requests optional
upgrades. Jasper CANNOT pay, waive, rebate, or promise to pay, waive or rebate all or any part of the insurance deductible applicable
to the insurance claim for payment of work. In the event of a discrepancy, the deductible amount stated on the insurer's Loss Sheet shall
overrule Deductible listed above.
Deductible: $ MUST BE PAID IN FULL, PLUS APPLICABLE S LES TAX 1 (initial)
MORTGAGE AUTHORIZATION: 1, Owner/Mortgagor, grant authorization for / Mortgage o. t speak with
Jasper on matters including, but not limited to, the claim and draw status.
Mortgage
initial)
PAYMENT SCHEDULE: Owner agrees to pay Jasper based on the following pay schedule: (i) Deposit in the amount of $ due
upon signing this contract; (ii) the Contract Price, less the Deposit and any applicable depreciation retained by Owner's insurer(s), plus
Upgrade Costs, due and payable to Jasper upon completion of work being performed; and, (iii) the remaining Contract Price (equal to any
applicable depreciation and/or change orders) due and payable to Jasper upon completion of work performed. In the event of a pending
inspection, no more than 2% of Contract Price ma be withheld until inspection has passed.
Optional: UPGRADE ITEM: QTY: _5 e' PRICE: $_ TOTAL: $
Replacement Work and Price: Upon insurer's approval and subject to the terns and conditions herein, Jasper agrees to furnish all materials
and provide the labor necessary to perform the full roof replacement which shall take place following Owner's insurance company's approval,
approximately within 30 days, conditions permitting.
Owner's Declaration of Intent: Owner acknowledges and agrees that, upon approval by insurance company for a full roof replacement, Jasper
shall perform the roof replacement upon receipt of funds from Owner's insurance company.
CANCELLATION: If Owner elects to terminate the services of Jasper, Owner may do so before midnight on the third business day
after Contract is executed. Owner shall receive a full refund of all deposits. Owner may also rescind Contract before midnight on the
third business day after the contract is executed after notification from insurer(s) that the claim for payment on roof contract has been
denied, in whole or in part. All written notices of cancellation, regardless of reason, shall be postmarked or delivered to Jasper's
corporate office: 1955 Vaughn Road, Suite 209, Kennesaw, GA 30144. CANCELLATION EXCEPTIONS: The three (3) day right of
cancellation DOES NOT APPLY to contracts for emergency house repairs as time is of the essence.
I, Owner, hay ad and understand all statements, terms and conditions of the "Roof Replacement Contract" and agree that all
details are a cepta a and satisfactory. ) further understand that this contract constitutes the entire agreement between the parties and
that any f rther c anges o alterations to this contract trust be made in writing and agreed upon by both parties. Each part,
represent nd warrants t' the other that it his the full power and authority to enter into the contract and that it is binding ant
enfnrcea Win ace dance ith its terms.
Authorize er Rep"resen alive Date Owner Date
TERMS AND CONDITIONS: Acceptance of Terms: 1. Owner, hereby agree to retain Jasper for a full roof replacement on the terms at
conditions stated herein. I further agree to provide Jasper with the Scope of Loss Report generated by my insurer and authorize and grant ft
access to the property for the purpose of staging and completing all agreed upon work. Supplemental Claims: Jasper reserves the right to file
supplemental claim with Owner's insurance in the event that the estimate is incorrect and/or additional damage is discovered aft
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City of Sanford
Building & Fire Prevention Division
Re -Roof Permit Card
PERMIT NO. ISSUE DATE: Q
CONTRACTOR:
JOB ADDRESS:
TYPE OF WORK:
cfar
Post this Permit in a 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 REQ UIRED * * *
For Inspection procedures, please refer to the re -roof inspection guidelines provided to you when the permit is issued.
The Mitigation Affidavit will not suffice as an alternative to receivinjZ 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 . . . . . 15-00002383 Date 7/21/15
Property Address . . . . . . 134 BRUSHCREEK DR
Parcel Number . . . . . . . . 33.19.30.516-0000-1460
Application description . . . ROOFING APPLICATION
Subdivision Name . . . . . .
Property Zoning . . . . . . . PUD
Permit . . . . . . RESIDENTIAL ROOFING PERMIT
Additional desc .
Phone Access Code 905919
Permit pin number 905919
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
10-1000 129 BL29 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#:
I; + S 2 S hereby acknowledge that I personally inspected
Roof deck nailing and/or 0" Secondary water barrier work
J, by-. _ S 41 % and have determined that the work
Job Site ddress)
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
Sectio 837.
Sig//nature of Contractor Date
CCC 1-69 .010C:5- 1
Printed Name of Contractor ` License #
License Type: General 0 Building Residential S-Roofing Contractor
0 or any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF
Sworn to (or affirmed) and subscribed before me this day of , 20 IS , by
who is Personally Known to me dr has Produced (type of
idntification) as identification. s.
L' (
SEAL) Signature
of Notary Pub is State
of Florida Print/
Type/Stamp Name TITIA N BUNC ofNotaryPublicCommission # FF 22241s8 a;"
oF
MY Commission Expires Aprll
23, 2019 Revised.'
February 2015
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
12/1/2015
I hereby name and appoint: Luis Rios
an agent of: Jasper Contractors
Name of Company)
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:
134 Brushcreek Dr
Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name: Michael Stephen
State License Number:
Signature of License B
STATE OF FLORIDA
COUNTY OF
rrrrri 120o9=1i
12/31/2015
The foregoing instrument was acknowledged before me this day of ,
200 , by who is personally known
to me or who has produced
identification and who did (did not) take an oath.
Signature
Notary Seal) l L ' ` be S-ey C C Print
or type name Amda
Dew* NOTARY
PUBLIC STATE
OF FLORIDA rA=
vA FF907M 1
E*rsa 8/5/2019 Rev.
08.12) Notary
Public - State of FL Commission
No. F 90 33 My
Commission Expires: as