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Home My WebLink About139 Brushcreek DrCITY OF SANFORD 1 2 1 BUILDING & FIRE PREVENTION pWG PERMIT APPLICATION ApplicationNo: 1 6 -aS 5(c> Documented Construction Value: $ 9,54 Job Address: Parcel ID: 30 __51b 00,22— X Type of Work: New Addition Alteration Repair DAm Description of Work: Phone: 5cDi—Q4q —iea Ra Fax: City, State Zip: Property Owner Information Historic District: Yes No Residential commercial Change of Use Move Resident of property? : Contractor Information Name LJI S- 0 G I = Phone: 40-7 -5,59- F330- Street: - 1 SO Fax: City, State Zip: 0I?.11IA-3 0, R, 3233a State License No.: Name: Street: City, St, Zip: Bonding Company: Address: Arch itect/Eng1neer Information Phone: Fax: E- mail: Mortgage Lender: Address: 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. 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. FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 5te Edition (2014) Florida Building Code Revised: June 30, 2015 Permit Application r' 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 at the time of permit submittal. A copy of the executed contract is required in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal. The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in accordance with local ordinance. Should calculated charges figured off the executed contract exceed the actual construction value, credit will be applied to your permit fees when the permit is issued. 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. , Signature of 0 er/Agent Date gnature of Contractor/Agent , Print Owner/A nt's Name PryiiNontractor/Agent's Name Signature of Notary -State of Florida Date Owner/Agent is Personally Known to Me or Produced ID Type of ID b.._.... _._ _ _ .- ANNETTE SCOTTiayNotaryPublic - State of Florae, i pMy Comm. Expires Jan 16, 20Commission # FF 071760 Bonded Through National Notary Ass Contractor/ gent is Personally Known to Me or Produced ID Type of ID BELOW IS FOR OFFICE USE ONLY Permits Required: Building Electrical Mechanical Plumbing[] Gas[:] Roof 0 Construction Type: Total Sq Ft of Bldg: Occupancy Use: Min. Occupancy Load: Flood Zone: of Stories: New Construction: Electric - # of Amps Plumbing - # of Fixtures Fire Sprinkler Permit: Yes No of Heads Fire Alarm Permit: Yes No APPROVALS: ZONING: UTILITIES: WASTE WATER: ENGINEERING: COMMENTS: FIRE: BUILDING: Revised: June 30, 2015 Permit Application h SEMINOLE COUNTY MULTI%URISD1CT10NAL LIMITED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: 07/15/2015 I hereby name and appoint: CHRISTINA GRIFFIN an agent of: U.S. ROOFING SERVICES 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): Z All permits and applications submitted by this contractor. Or The specific permit and application for work located at: Street Address) Expiration Date for This Limited Power of Attorney: N/A License Holder Name: TED BRYANT State License Number: CCC1325922 Signature of License Holder: STATE OF FLORIDA COUNTY OF _/1-//Q;-- JlTheforegoinginstrumentwasacknowledgedbeforemethis ! day of L4 k 20_, by CGi f VC who is'%person IIy known to me or who has produced and who did (did not) take an oath. Signature of No ary h S. ARCHARO l MY COMMISSION # EE 146235 EXPIRES: March 11, 2016pkeo-w4F"'. Bonded ThN Notary Public Undervrinrr as identification Print or type Notaryname Notary Public - State of -r— tOY I Commission No. i 4 coa3s— My Commission Expires: 3 — I 1— I W 8/7/2015 SCPA Parcel View:33-19-30-516-0000-1020 A ` 0zavid,Jphnson,CRA Property Record Card , it"pE Parcel:33-19-30-516-0000-1020 APPRAISER O J'7gry 1 Owner: MA CATHY D SEMIM COUNTY, Property Address: 139 BRUSHCREEK DR SANFORD, Fl- 32771 Parcel: 33-19-30-516-0000-1020 Property Address: 139 BRUSHCREEK DR Owner: MA CATHY D Mailing: 139 BRUSHCREEK DR SANFORD, FL 32771 Subdivision Name: COUNTRY CLUB PARK PH 2 Tax District: Sl-SANFORD Exemptions: 00-HOMESTEAD (2005) DOR Use Code: 01-SINGLE FAMILY 1 Legal Description LOT 102 COUNTRY CLUB PARK PH 2 PB 54 PGS 22 THRU 24 Taxes IValue Summary 2015 Working Values 2014 Certified Values Valuation Method Cost/Market Cost/Market Number of Buildings 1 - -- 1 - Depreciated Bldg Value 118,093 112,515 11,253 - Depreciated EXFT Value 10,736 _ - Land Value (Market) - 28,000 28,000 Land Value Ag Just/Market Value 156,829 - 151,768 Portability Adj Save Our Homes Adj- 31,321 - m_ 27,256- Amendment 1 Adj 125,508M_ - 124,512 _ Assessed Value Tax Amount without SOH: 2014 Tax Bill Amount Tax Estimator Save Our Homes Savings: i * Does NOT INCLUDE Non Ad Valorem Assessments 2,223.99 1,681.22 542.77 Taxing Authority Assessment Value Exempt Values Taxable Value County General Fund Schools City Sanford 125,508 50,000 I $75,508 125,508 125,508 25,000 50,000 100,508 75,508 SJWM(Saint Johns Water Management) County Bonds 125 5 50, 75,508 I $75,508125,508 50,000 Sales Description Date Book =Page Amount Qualified Vac/Imp SPECIAL WARRANTY DEED 11/1/2004 105561 1 1513 $181,300 No Improved CERTIFICATE OF TITLE 5/1/2004 0929 $100i36P01 No Improved SPECIAL WARRANTY DEED WARRANTY DEED---_-.____ _ 3/1/1999 12/1/1998---103561 j 0247 $138,000 1670 $23,500 Yes Improved Yes Vacant I Find Comparable Sales within this Subdivision I Land Method Frontage Depth Units Units Price Land Value LOT I 1 28,000.00 28,000 Building Information Description Year Built Fixtures Base Area Total SF I Living SF I Ext Wall Adj Value Repl Value AppendagesActual/Effective http:/Avww.scpafl.org/Parcel Detail Info.aspx?PID=33193051600001020 1/2 900°lo Financing Available {0%Interest for 1-Year) CONTRACTOR PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: U.S. ROOFING SERVICES, LLC Emergency Services & Reconstruction 139 Brushcreek Drive 10524 Moss Park Rd. #204-150 Attn: Ron Norman Sanford, FL 32771 Orlando, FL 32832 2405 W. Princeton St. 407) 536-8332 Orlando, FL 32804 877) 693-5766 Toll -Free tsalati@esrfl.com / rnorman@esrfl.com' ReRoof Proposal 407) 530-0169 Fax 772.801.1994 MrTedBryant@Gmail.com SCOPE OF WORK Supply Permit, Notice of Commencement, Materials, Equipment and Labor as required to perform said work; A. Conduct an on -site project start-up meeting with employees to ensure all safety and job site procedures are followed accordingly. All bushes to be covered and extra care taken for lawn and plants. Clean daily as required throughout. B. Remove all existing roof and flashing membranes to the deck surface and haul away to an approved roofing disposal facility. C. Replacement of any damaged or deteriorated plywood decking at an additional cost of $65 per sheet. New decking shall be APA rated for structural use. Deck fastening will meet or exceed local building code requirements (8d Ring -shank deck nails, 6" spaced, nailed to rafters on center) and H-clips will be used between all rafters, all per FL Hurricane Wind Code. Trusses, studs, rafters, fascia, etc. will be replaced at a cost of $1.89-$4.89 per board foot if required. D. Replacement of following flashing materials: step flashings, collars, pipe jacks, lead plumbing boots, perimeter drip edge material and all edge flashing materials. All materials to meet or exceed manufacturer's requirements and to be installed hidden nail" fashion so that no "shiners" are present. E. Installation of one layer of Premium Gorilla Guard roofing underlayment over the newly prepared decking surface. The premium roof felt will be fastened using 1-inch plastic -capped nails with a 1 inch diameter head. Fasteners shall be at 6 inch centers along the side and end laps and at 12 inch centers in two staggered rows in the center of the roll. Each center row will be approximately 12 inches from the side of the sheet. F. Installation of new 35 year, laminated architectural style, algae -resistant shingles. Shingles will be installed in strict accordance with the manufacturer's specifications and shall be fastened using six (6) nails per shingle. G. Paint all vent flashings, penetrations & lead flashings as needed. H. Installation of a shingle vent with a Net Free Vent Area of 18 square inches per lineal foot. Roofing system currently has a vented soffit underneath the eaves. Install new 4' off -ridge vents. Install new Aluminum Ridge Vents. I. Installation of manufacturer's hip and ridge shingle material. Hip and ridge rows will be run straight and shall be installed according to manufacturer's instructions and sealed with hidden fasteners. J. Clean all related construction debris from job site and run magnet daily. Inspect new roof with owner for project close out final. Note: Roof currently has Solar Pool Panels that need to be removed by others. Installation Warranty: 5 years Lifetime Manufacturer Warranty: 1 35 years TOtal COSt. $7,584.00 All material is guaranteed to be as specified, and the above work to be performed In accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum listed above with payments to be made as outlined above. Terms listed above. Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will become an extra change order over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance on above work. Workmen's Compensation and Public Liability Insurance on above work to be taken out by U.S. ROOFING SERVICES, U.C. NOTE -- This proposal may be withdrawn if not accepted within 7 days. Ted Bryant (407) 536-8332 Respectively submitted by US Roofing Services Representative ACCEPTANCE OFPROPOSAL- The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Date Signed: Igoe rlme U.S. ROOFING SERVICES, LLC,10524 Moss Park Rd. #240-150, Orlando, FL 32832 "'-` Notice: Important Www.MyFLRoof.com FL DBPR Ccc1325922 information on back lom Flnancing Available (4%Interest for 1-Year' z- IT IS MUTUALLY AGREED BY THE PARTIES, that: 1.Only such work as is specifically designated on reverse side is included in this proposal, which supersedes all previous proposals or agreements. (orally or in writing) 2. General. The proposal on the reverse side of this page is for prompt acceptance, is subject to approval by Seller's credit department and is entered into by Seller without liability for delay or cancellation from causes beyond Seller's control, including acts of God, labor or civil disturbances, car shortages, war and acts of the Government. Quotations to change without notice. 3. Buyer shall notify Seller in advance when the premises will be ready for the placing of the material, and shall at all times give free and unobstructed access to the place where the work Is to be done, and shall put and keep all surfaces to which the material Is to be applied in a condition satisfactory to Seller so that work to be done under this proposal can be started promptly and once begun, may be pushed to completion without delay. A water and electrical supply source shall be furnished by the Buyer. 4. Protection of Roofing, Waterproofing or Traffic Deck System. Seller shall not be responsible for damages to his installation resulting from carelessness or mistreatment on the part of anyone not in Seller's employ. When a System is turned over to the Buyer as completed, he shall thereafter assume the duty of protecting and caring for same. Any protection required for Seller's completed installation shall be provided by the Buyer. S. If application of Roofing, Waterproofing or Traffic Deck System is complete and cracks then develop in the substrate of over one -eighth of an inch in width, causing rupture of the System, this rupture shall be deemed due to structural movement and cost of repair shall not be borne by Seller. 6. Seller's liability shall be limited to repair of area receiving waterproofing. Seller shall not be responsible for consequential damage to Interior of building or contents thereof. 7. If Seller is instructed to proceed with Installation of insulation materials prior to the material being properly protected from the elements, Seller accepts no responsibility for damaged or displaced material. Replacement will be made by written change order to Seller's contract. 8. Working Hours and Conditions. All work performed under this contract is to be done during normal working hours unless otherwise provided for herein. Buyer shall provide normal job site facilities for health and safety of men in compliance with all applicable governing regulations. 9. Back Charges. Any charge against Seller for labor, service or materials supplied by Buyer will not be paid by Seller unless same have been ordered in writing by Seller and the amount of charges for same approved by Seller's foreman on the job at the time such materials, service or labor were supplied. 20. No credit or allowance will be made by Seller for alterations except such alterations as shall have been consented to, In writing, by Seller. 11. If the work is interrupted or its completion delayed by Buyer for a period of thirty days, payment to cover all labor furnished, all material furnished and placed and all material furnished but not placed shall become due and payable to Seller forthwith.12. Where work under this contract is for Municipality, School District, Board of Commissioners, etc., whether under surety bond or not, Seller reserves the right to notify proper authorities in said Municipality or Bonding Company within thirty days after completion of work, under contract and presentation of bill, If payment is not made in accordance with terms specified above. 13. Any omission, deletion, or additions by contractor, subcontractor, owner, engineer, architect or their authorized representative other than described in this contract may be adjusted upon completion of the job by actual measurement and the corrected billing at the basic price as established herein. No alterations to this proposal or contract shall be made unless agreed to in writing by Seller.14. If any proceedings are commenced such as filing of lien to secure or enforce the payment or any portion of the agreed price, Buyer agrees to pay Seller without special demand, reasonable attorney's fees and legal costs in such proceedings, plus 1.5% interest each month on balance owed. 15. Occupancy or approval by lending or governmental agency shall constitute acceptance of work.16. There are no promises, agreements or understandings not expressed in this proposal or those attachments originated by Seller. FLORIDA HOMEOWNERS' CONSTRUCTION RECOVERY FUND: PAYMENT MAY BE AVAILABLE FROM THE FLORIDA HOMEOWNERS' CONSTRUCTION RECOVERY FUND IF YOU LOSE MONEY ON A PROJECT PERFORMED UNDER CONTRACT, WHERE THE LOSS RESULTS FROM SPECIFIED VIOLATIONS OF FLORIDA LAW BY A LICENSED CONTRACTOR. FOR INFORMATION ABOUT THE RECOVERY FUND AND FILING A CLAIM, CONTACT THE FLORIDA CONSTRUCTION INDUSTRY LICENSING BOARD AT THE FOLLOWING TELEPHONE NUMBER AND ADDRESS: DIVISION OF PROFESSIONS, CONSTRUCTION INDUSTRY LICENSING BOARD,1940 NORTH MONROE STREET, TALLAHASSEE, FL 32399, PHONE: 850.487.1395, EMAIL: CALL.CENTER@DBPR.STATE.FLUS CHAPTER 558, FLORIDA STATUTES, CONTAINS IMPORTANT REQUIREMENTS YOU MUST FOLLOW BEFORE YOU MAY BRING A LEGAL ACTION FOR AN ALLEGED CONSTRUCTION DEFECT SIXTY DAYS BEFORE YOU BRING ANY LEGAL ACTION, YOU MUST DELIVER TO THE OTHER PARTY TO THIS CONTRACT A WRITTEN NOTICE, REFERRING TO CHAPTER 558, OF ANY CONSTRUCTION CONDITIONS YOU ALLEGE ARE DEFECTIVE AND PROVIDE SUCH PERSON THE OPPORTUNITY TO INSPECT THE ALLEGED CONSTRUCTION DEFECTS AND TO CONSIDER MAKING AN OFFER TO REPAIR OR PAY FOR THE ALLEGED CONSTRUCTION DEFECTS. YOU ARE NOT OBLIGATED TO ACCEPT ANY OFFER, WHICH MAYBE MADE. THERE DEADLINES AND ARE STRICT PROCEDURES UNDER THIS FLORIDA LAW WHICH MUST BE MET AND FOLLOWED TO PROTECT YOUR INTERESTS. BUYER'S RIGHT TO CANCEL. This is a home solicitation sale, and if you do not want the goods or services, you may cancel this agreement by providing written notice to the seller in person, by telegram, or by mail. This notice must indicate that you do not want the goods or services and must be delivered or postmarked before midnight of the third business day after you sign this agreement. If you cancel this agreement, the seller may not keep all or part of any cash down payment. NOTICE OF FLORIDA'S CONSTRUCTION LIEN LAW: ACCORDING TO FLORIDA'S CONSTRUCTION LIEN LAW SECTIONS 713.001-713.37, FLORIDA STATUTES), THOSE WHO WORK ON YOUR PROPERTY OR PROVIDE MATERIALS AND SERVICES AND ARE NOT PAID IN FULL HAVE A RIGHT TO ENFORCE THEIR CLAIM FOR PAYMENT AGAINST YOUR PROPERTY. THIS CLAIM IS KNOWN AS A CONSTRUCTION LIEN. IF YOUR CONTRACTOR OR A SUBCONTRACTOR FAILS TO PAY SUBCONTRACTORS, SUB -SUBCONTRACTORS, OR MATERIAL SUPPLIERS, THOSE PEOPLE WHO ARE OWED MONEY MAY LOOK TO YOUR PROPERTY FOR PAYMENT, EVEN IF YOU HAVE ALREADY PAID YOUR CONTRACTOR IN FULL. IF YOU FAIL TO PAY YOUR CONTRACTOR, YOUR CONTRACTOR MAY ALSO HAVE A LIEN ON YOUR PROPERTY. THIS MEANS IF A LIEN IS FILED YOUR PROPERTY COULD BE SOLD AGAINST YOUR WILL TO PAY FOR LABOR, MATERIALS, OR OTHER SERVICES THAT YOUR CONTRACTOR OR A SUBCONTRACTOR MAY HAVE FAILED TO PAY. TO PROTECT YOURSELF, YOU SHOULD STIPULATE IN THIS CONTRACT THAT BEFORE ANY PAYMENT IS MADE, YOUR CONTRACTOR IS REQUIRED TO PROVIDE YOU WITH A WRITTEN RELEASE OF LIEN FROM ANY PERSON OR COMPANY THAT HAS PROVIDED TO YOU A NOTICE TO OWNER. FLORIDA'S CONSTRUCTION LIEN LAW IS COMPLEX, AND IT IS RECOMMENDED THAT YOU CONSULT AN ATTORNEY. Labor Warranty: U.S. Roofing Services, LLC agrees to repair any and all defects on any repairs and/or materials applied for a period of the years stated in this proposal from the date of completion. These repairs or replacements shall be at no cost to the owner for the length of this warranty. This warranty shall be in effect for only the area(s) where work was completed as stated below. This warranty shall not exceed to acts of God, abuse or negligence by the purchaser or causes other than defects in the material and workmanship. Acts of God shall include but is not limited to: Lightning, hail, gale force winds, floods, hurricanes, tornadoes, etc., damage caused by other phases of construction to existing structure and damages to contents of the building. Any defects must be reported to U.S. Roofing Services, LLC in writing within 48 hours. Proper annual maintenance needs to be performed to maintain entire roofing system, gutters, scuppers, etc., free of foreign debris. Notice to Owner: Do not sign this home improvement contract in blank. You are entitled to a copy of the contract at the time you sign. Keep it to protect your legal rights. This home improvement contract may contain a mortgage or otherwise create a lien on your property that could be foreclosed on if you do not pay. Be sure you understand all provisions of the contract before you sign. Printed Name: Signed Name: Dated: U.S. ROOFING SERVICES, LLC, 10524 Moss Park Rd. #240-150, Orlando, FL 32832 Notice: important Www.MYFLRoof.com FL DBPR Ccc1325922 . `,_ , 100°!4•Financing Available (0Y° interest for 1-Ysar}` Left Blank U.S. ROOFING SERVICES, LLC,10524 Moss Park Rd. #240-150, Orlando, FL 32832 — N-Otice: Im— portant Www.MyFLRoof.com FL DBPR Ccc1325922 , THIS INSTRUMENT PREPARED BY: Name: U.S. Roofing Services, LLC Address: r I Ililll illil IIIII IIIII Illll 1111 Jill NOTICE OF COMMENCEMENT State of Florida County of Seminole Permit Number: Parcel ID Number: NARYANNE NORSE, SEM INOLE. C:OUNI CLERK OF CIRCUIT CO>)(T -'_t r' tllf''tl .9L.s-ENBK3'_ CLERK'S Ps 357 (1f'as) ERK'S g 2iii.Ci187881_I RECORDED uv,/ 11!''1.11 10 ';jr'. t ;; RECORDING FEES f it"I,tlt 33-19-30=516-00 0=10 0 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. DLOGI;ffejOUniry UTb ,,Le CaLdes ;iift th p pp er v arld4treet address if available) tt II UU139rLLuscreerive, an Fo'fr'1 ----- 4 I IiJ LL L E NERAL ESCRIPTION OF IMPROVEMENT: R- OWNER INFORMATION: Name: Cathy Ma Address: 139 Brushcreek Drive, Sanford, FL 32771 Fee Simple Title Holder (if other than owner) Name: CONTRACTOR: Name: Ted Bryant/U.S. Roofing'Services, LLC Address: 10524 Moss Park Rd. #204-150,Orlando, FL 32832 Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served as provided by Section 713.13(1)(b), Florida Statutes. Name: In addition to himself, Owner Designates To receive a copy of the Lienor's Notice as Provided in Section 713.13(1)(b), Florida Statutes. Expiration Date of Notice of Commencement (The expiration date is 1 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 1, 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. Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true to the best o my nowledge elief. eamv ov s Signature Y Owner's Printed Name 'r' Florida Statute 713.1 1)(g): "The owner must sign the notice of commencement and no one else may be permitted to sign in his or her stead." rr State of (o 61c Countyof MI. °1 I I ' • 61 P The fof'rapin 1 stru ent was acknowledged before me this A day o , 20 by . 1J Who Is,personally known to me Name o)person making tatem rir '' (A OR who has produced) entification ype of identification produced: u m. GRIFFIN r CF- RIB MY COMMISSION 1 FF 124105 Notary Signature EXPIRES: June 12, 2018 141FF44"\' Bo MThtlliuloNarySwiw W O0 2z 1= m 1c; tSS,q Business Name: U S CITY OF SANFORD Contractor Registration Application P. O. Box 1788, Sanford, FL 32772-1788 Phone: 407.688.5150 Fax 407.688.5152 Email: building@sanfordfl.gov Date: e b /g'C/S- Business Mailing Address: / UJ `oZ F MLi$ P`' %S( City: OKI(mdo State: Business Phone: Fax: Name of Qualifier on S State License Classificz State License Number: Email: mr-kM t ednvia i ' an?11 A $ 10.00 annual registration fee is required for all contractors. State Certified Contractors: State license from Department of Business and Professional Regulation. Certificate of workers compensation insurance AND general liability with the City of Sanford listed as the certificate holder. If faxed or emailed it MUST come from the insurance agent/company. Certificates from contractor' s offices are not accepted. Copy of valid business tax receipt State Registered Contractors: State license from Department of Business and Professional Regulation. Current Seminole County Comp Card Certificate of workers compensation insurance AND general liability with the City of Sanford listed as the certificate holder. If faxed or emailed it MUST come from the insurance agent/company. Certificates from contractor' s offices are not accepted. Copy of valid business tax receipt Specialty Contractors Certificate of workers compensation insurance AND general liability with the City of Sanford listed as the certificate holder. If faxed or emailed it MUST come from the insurance agent/company. Certificates from contractor' s offices are not accepted. Copy of valid business tax receipt Control # City Registration # 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: Building Permit Application completed, signed and notarized. Application must include correct address and complete parcel I.D. number. Cad' Copy of applicable contractor's license issued by the State of Florida (if the contractor is the applicant). C9/ 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. 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). WA 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, andfederal code requirements. CITY OF SANFORD BUILDING SERVICES Residential Re -Roof Hurricane Mitigation' Inspection Affidavit Permit #: 15 - aaoDc S.s I, IC U/ hereby acknowledge that I personally inspected LR-d'of deck nailin an or condary water barrier work at 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 understand that making any i performance of his or h r f Section 837.06 FA,/ S Printed Name of Con actor herein are true and accurate to the best of my belief and that I fully dse statements in writing with the intent to mislead a public servant in the i*luty shall constitute a misdemeanor of the second degree pursuant to Date ao U, 139S q aa. License # License Type: General Building Residential O'Roofing Contractor or any individual certified in accordance with F.S. 468 to make such an inspection. STATE OF FLORIDA COUNTY OF5_M(1_ Sworn to (or affirmed) and subscribed before me is 12,-PN- day of , 20 by who is elfersonally Known to me 4 has Produced (type of i titicat on-L i I as identification. of Notary Public A 11 l M) I I VI A V l, , jj )-,I l -if MOW M. GRIFFIN Print/ Type/Stamp Name ' MY COMMISSION # FF 124905 of Notary Public * * EXPIRES: June 12, 2018 114, VV,4ee BondedThrvBudgetNotuyServka