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HomeMy WebLinkAbout145 Hazel BlvdCITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: 14D - % 9 Documented Construction Value: S q-1Z 1 o Job Address: y 5 N azd i3 ly a Historic District: Yes [INo [ Parcel ID: Residential Commercial Type of Work: New Addition Alteration Repair Demo Change of Use Move Description of Work: — DOI' I1 C I n (1 Flint 14 D LT S I I o S Pi Intiti_ni-tx i I_t,..--- _ - .t Plan Review Contact Person: JDArtinWravu, Title:__ Ad M I n Phone: - 913•blb•3SS- Fax: 911-LF52•y4,tn Email: 1 D[1nnPhoMLO V(11d-S Ch01cc Property Owner Information "c onst-rLkQ ton. c0m Name __ E e,6ere nnold, Phone: 201 • IsSi. O L44b Street: 14 S P G 7 e.1 F51 y d Resident of property?: y e S City, State Zip: QhOr , FL 32 Contractor Information Name 401U4f QLVni r S L'ilonSi7 L-1-, nnPhone: R_7'1 L S •.SS Street: SZ30WK(- Ahe RIVda(aDu Fax: -A1-1•223•yL1n City, State Zip :j , t FL 3 3 p9 State License No.: COG 13 2g52iS Architect/Engineer Information Name: N 10- Phone: Street: City, St, Zip: Bonding Company: _ DI d eet hl r( -I _ Address: p gDyL I1e35 Mi1WdMK1[,\1VI S3201 Fax: E- mail: Mortgage Lender: Nid, Address: WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICEFORIMPROVEMENTSTOYOURPROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED ANDPOSTEDONTHEJOBSITEBEFORETHEFIRSTINSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULTWITHYOURLENDERORANATTORNEYBEFORERECORDINGYOURNOTICEOFCOMMENCEMENT. Applicationis 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 thisjurisdiction. 1 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: 5" Edition (2014) Florida Building Code Revised. June 30, 2015 Permit Application NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may befoundinthepublicrecordsofthiscounty, 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. C' Signature of Owner/Agent Date ge,bec04- Coppola, Pnn 'ner/Agent's Name Si ure of Notary -State of Florida date M"v'' •. JO RV WEAVER e.r .: MY COMMISSION A FF 173982 EXPIRES: November 4, 2018 a ? ` Bonded Thru Wary Public Undewnters owner/Agent is -Personally Known to Me or Produced ID Type of ID 2 )Z Signature ntra Date c9O644 kJaKmclI PIon tractor/Agent's Name JV&44-*> %% Sign a of Notary -State of Florida Date 0 r. ,1,, JO ANN WEAVER MY COMMISSION A FF 173582 EXPIRES: November 4.2018 Bonded TMu Notary Public Urderwrdert Co c r gen Is erson3l ly Known to Me or Produced ID Type of ID BELOW IS FOR OFFICE USE ONLY Permits Required: Building Electrical Mechanical Plumbing[] Gas Roof 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 APPROVALS: ZONING: UTILITIES: ENGINEERING: COMMENTS: Revised: June 30.2015 FIRE: Fire Alarm Permit: Yes No WASTE WATER: BUILDING: Permit Application THIS IN TRUMENT PREPARE BY: Name: 1 L ( 0 S Addless+1 It pi1D SEN!lNOLE COUNTY Sate f Florida rroarws r"TURu arorcr NOTICE OF COMMENCEMENT Permit Number Parcel 10Number (PID) JO • Z0.30 • g Q q • D o u) • 0 21 L) und ersigned dersignedhereby gives nobce Mat improvement wfl be made to certain real property. and in accordance with Chapter 713. Florida Statutes, the 10/ow09 EffoMMW is provided in this Notice of Commtxlcemem. t vailable) o f Z i 10I7-tI Glcr ( R7A P&LE3 GENERAL DESCRIPTION OF IMPROVEMENT G Y OD I OWNERINFORMA Name and address: CONTRACTOR Persons within tM State of Florida Desgnabd by Owner upon whom notice or other documents by Section 713.1300L Florida Statutes. may a nerved as provided Name and address: In addition to himself. Owner Dssignatea of Section 773.13(1Nb). Florida SbhRes. To receive a Copy of the Lrerfof s Nobce as Provided to ExpiraOw Date of Notice of Commencement: The expiration data N 1 year both data of racordino unlns a differat t dabs Is sceeWad 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 IMPROVMENTS 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 BEF ENCING WORK,ECORDING YOUR NOTICE OF COMMENCEMENT. STA IDA (/ COUNTY OF SEMINOLE d C r' TORE SPRINTED NAME NOTE Par fTorida 9tatub 71313(1) ( runt Won— and no one ebe maybe Pe to sign In his or her steed." The foregoing instrument was acknowledged before me this l L day of Name of person making s Who is personally known to me OR who has produced Identification type of Identification produced VERIFICATION PURSUANTA SECTION 112523. FLORIDA STATUTES. UN TIES OF PERJUM. I DECLARE THAT 1 HAVE READ THE FOREGOING AND THAT THE FACTS STATED Qt IT THEOF/,MAY KNOWLE AND BELIEF. GNA F NATURAL PERSON SIGNING Vfi MAT10#WCATON MYODWAS" tt FF226166 EI( pIRES: May 3. 2019 i r • . `I r a0edla care t'btalrIIatC IAdseAts 5r , f'!./ ff l MARYANNE MORSE, CLERK OF CIRCUIT COURT SEMINOLE COUNTY FL CLERK' S # 2016012716 EIK 8628 Pg 0371; (1p9) E-RECORDED 02/05/2016 09:54:24 AM 10. 00 INSTALLATION AGREEMENT EIN# 38-3927480 ' Phone: (877) 652-3555 k` Date : -+ Insured N , } N ww horiteownetschoiceconstruction.tom i TeHt c/ / `.: Job'Addreis: c j i r' '' Rri Exterior Work: ROOF •-'ws +r, /t a r . t _N ' } - s r r - , ` Shingle Types: t t Composition Shi le- 3 TAB Ar - „ , . 7_ r g chitectural / Laminated/ Dirriensionil Shingle / Flat Roof: YES NO Shlnile Color: CL` orip Edee Color 'l R - ". ., F ! kiRe 1%ertt: Ailetal Shingle Over Ctff Ridge 4' /Color Underlaymen 'Synthetic_ 30LB Felt_ 151-8 Felt_ Peel N Stick "` Roof pitch can affect what is allowed 'per Florida Building Code•'• DISH: DISPOSE cis' KEE_ P'•' If you goose t`o'keep thedisci, we will not re-iristall Iton your roof. You 511661d c ll yoi , network provider to relocate the Gish"' Interior/Other Payment Details: Insurance: I Depreciation: , -L&O Upgrade(s): y Deductible: Payees on toss Draft: exp: , Circle One: Monitored or Non Monitored Mail Away. Local Bank Endorsement, .1 or, Homeowners Choice __(VVVVVC onnst on will handle the Bank Endorsement If you have solar, panels, please select one 4 the following options: I/tMe will handle the solar panel portion of this project ourselves. 1/we will have the panels removed prior to our In date. The allowance from the binsurancecompanyisiobereturnedtormeuponcompletionoftheprojectbyHomeownersChoiceConstruction, after Homeowner Choice Construction has beenpaidinfull. This indtidespayment for depreciation: - '' *• 7 -,s - . f T . - .. 1/1Ne wisA for Flometiwners t9iolce Con"striation to remove the Panels, but I/We will have itstalled. Hom" Y n f eowners Choice Constnxtion will removethesolarpanels"at Np CHARGE; but Horneowers Choice Construction is Nt7T i"Ie for anyydamaae'tliat may occur as a result of handliiti tine solar pariefs. The r• ,., . allowance from the itisjirince company'ls to be retumed to me upon completion of ttie pioject by Hom'eoin 4n Choice C6ni truftion, after Homeowners ChoiceConstructionhasbeenpaidinfull: VIE 1/We wish for Homeowners Choice Construction to supervise the removal and re -Installation of the solar panels: Homeowners Choke Construction will haveourlaborersremovethepanelsandwillhirealicensedplumbertore -install them_ Homeowners Choice Construction does'not acc*'any liability for handling solarPanels'and there Is no warranty Irnplied'or expressed.' If the funds provided by your insurance company are not suffident;'we r6y supplement them For additionalmoney: 'r - •- , ` , .%. • .. _. > r s s , t • r Notes: ANY DEVIATIONS FIR IS CONTRACT MUST BEAPPRO ALL' AND SUBM 71 IN WRfTIN THROU H A M1 GE ORDER FORM Customer Srgnature: Date h a 4 Construction: Sign Dief ;, rr • Customer Signature: s . Da _ C 1 CERTIFICATE OF LIABILITY INSURANCE' DATEIMMIDD/YYYY) 7/17/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVEORPRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jon Rock The Contractors i't301Ce Agency NAME: PHONE (800) 918-3564 FAX (B77)684-9951A/C No: PO Box 13645 XoDRSS:Jon@nginsuranceonline.com INSURERS AFFORDING COVERAGE NAIL 0ChandlerAZ85248 INSURERA:Preferred Contractors Insurance 12497INSURED Homeowners Choice Construction LLC INSURER B : 4830 W. Kennedy Blvd Ste N600 INSURER C : INSURER INSURER E Tampa FL 33609 INSURER F : KtVIbIVN NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATEMAYBEISSUEDORMAYPERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN8RLTR TYPE OF INSURANCE Oa' S POLICY NUMBER MPMO/LICYPPIYYYYI MM%ICDD/YYW LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR PC2506243-01 5/12/2015 5/12/2016 EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED PREMISE Ea occurrence S 50,000 MED EXP (Any one person) S 5,000 PERSONAL 3ADVINJURY S 1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER POLICY PRO-E T LOC OTHER GENERAL AGGREGATE S 1,000,000 PRODUCTS - COMP/OP AGG S 1,000,000 S AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS AUTOS NON -OWNED IN SINGLE LIMIT Ea aaident BODILY INJURY (Per person) 5 BODILY INJURY (Per accident) S PROPERTY DAMAGE Per accident) S S UMBRELLA LIAR EXCESS LIAR HCLAIMS-MADE OCCUR N I A EACH OCCURRENCE S AGGREGATE DID RETENTIONS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNERtFXECUTIVE OFFICERIMEMBER EXCLUDED7 IMandatory, In NH) I1 Yes, desmbe under DESCRIPTION OF OPERATIONS below EO H- SPTARTUTEERSE. L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE S E L. DISEASE - POUCY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) r G TICl/a TL' 11I11 nrn City of Sanford 300 N., Park Ave. Sanford, FL 32771 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Robert Rock1JON 00,4 v lyoa- cU 14 AI-VKU L UKI-VKA I IUN. All rights reserved. ACORD 25 ( 2014/01) The ACORD'name and logo are registered marks of ACORD INS026 (201401) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING'BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MAXWELL, SCOTT D HOMEOWNERS CHOICE CONSTRUCTION L.L.C. 4830 W KENNEDY BLVD, #600. TAMPA FL 33609 Congratulations! With this -license -you -become one of the nearly -- one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurant: and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log ontc www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly We constantly strive to'serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! 850) 487-1395 DETACH HERE RfCK SCOTT,_GOVERNOB „ - _ KEN-L-AWSON-SECRETARY ISSUED: 07/09/2015 DISPLAY AS REQUIRED BY LAW SEQ # L1507090000451 CERTIFICATE OF LIABILITY INSURANCE Date 7/23/2015 producer. Plymouth Insurance Agency This Ce tifiolte is Issued as a matter of Information only and confers no 2739 U.S. Highway 19 N. lights upon the Certificate Holder. This certificate does not amend, extend Holiday, FL 34691 or alter the coverage afforded by the policies below. Insurers Affording Coverage NAIL # 727) 938-5562 Insured: South East Personnel Leasing, Inc. & Subsidiaries Insurer A" Lion Insurance Company 11075 Insurer B: 2739 U.S. Highway 19 N. Insurer C: Holiday, FL 34691 Insurer D: Insurer E: Coverages The policies or insurance listed below have been issued to the insured named above for the policy period indicated. Notwithstanding any requirement, lens or condition of arty contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions, and conditions or such limits shown may have been reduced by paid claims. polices. Aggregate INSR LTR ADDL INSRD Type of Insurance Policy Number Policy Effective Date Policy Expiration Date Limits MM/DD/YY) MM/DD/YY) GENERAL LIABILITY Each Occurrence Commercial General Liability Claims Made 0 Occur Damage to rented premises (EA occurrence) Mad Exp Personal Adv InjuryGeneralaggregatelimitappliesper. General Aggregate Policy Protect LOC Products - Comp/Op Agg AUTOMOBILE LIABILITY combined Single Limit Any Auto EA Accident) Bodily InjuryAllOwnedAutos Scheduled Autos Per Person) Bodily InjuryHiredAutos Non -Owned Autos Per Accident) Property Damage Per Accident) EXCESS/UMBRELLA LIABILITY Each Occurrence Occur Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2015 01/01/2016 x wC stattl OTH- Employers' Liability to Limits ER E.L. Each Accident 1.000.000Anyproprietor/partner/executtve officer/member excluded? NO E.L. Disease - Ea Employee S1,000,000 If Yes, describe under special provisions below. E.L. Disease - Policy Limits 1,000,000 Other I Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 Descriptions of Operations/Locations/Vehicles/Exclusions added by EndorsementfSpecial Provisions: Client ID: 81-67- i82 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company": Homeowners Choice Construction L.L.C. Coverage only applies to injuries incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s), while worldng in: FL. Coverage does not apply to statutory employee(s) or independent contracWr(s) of the Client Company or any other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937-2138 or by calling (727) 938-5562. Project Name: ISSUE 07-23-15 (AF) Begin Date 11 12 2014 CERTIFICATE HOLDER CANCELLATION CITY OF SANFORD Should any of the above described policies be cancelled before the expiration dale (hereof, the issuing insurer will endeavor to maul 30 days written notice to the certificate holder named to the left, but failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. 300 N. PARK AVE. SANFORD, FL 32771 LIMITED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: 3 1 z 1 1 b I hereby name and appoint: John 1) W A Lr an agent of: Name 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): 311"" The specific permit and application for work located at: 14!5 Hazej Blvd . ord I (3treet Ad ess) Expiration Date for This Limited Powei• of Attorney: 3 1 Z `11 License Holder Name: Scoff MeLkwell State License Number: Signature of License H STATE OF FLORIDA COUNTY OF +j I IS The foregoing instrument was acknowledged before me this 2 day of Mn r Lk 20,W LI* by cS C Q+ M" WLL I who is wfersonally known to me or o who has produced identification and who did (did not) take an oath. Sig#ature Notary Seal) To An ji Wz a w-f Print or type name Notary Public - State of Elm d rt" s+ '10 Commission No. A MY CO MMON I FF 1rM EMFIES:Nww*er4,201e My Commission Expires: s fky. • Bonded Thu Nfty Putfe Urdnrto Rev. 08.12) as 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: J' 0 Building Permit Application completed, signed and notarized. Application must include correct address and complete parcel I.D. number. 19 Copy of applicable contractor's license issued by the State of Florida (if the contractor is the applicant). 0 rt .0 j i e El 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. r 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). Ir.Cilti O 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, slate, and federal code requirements. CITY OF SANFORD BUILDING SERVICES Residential Re -Roof Hurricane Mitigation Inspection Affidavit Permit #: / b — 6 7 11 M &yw t-0 hereby acknowledge that I personall y inspected X Roof deck nailing and/or 0 Secondary water barrier work at 145 H G Ze i BIV Q ycd L 3277 3 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 3l3Iic0 Signat6r of Contractor Date ACL44t- AXwe.iI C0CI 52$53 Printed Name of Contractor License # License Type: General 0 Building Residential L Roofing Contractor or any individual certified in accordance with F.S. 468 to make such an inspection. STATE OF FLORIDA COUNTY OF 4 . I Sworn to (or affirmed) and subscribed before me this r day of (V\ A. rch 20 byACO-+ IAA AkkmLI f , who is LFPersonally Known to me or has 0 Produced (type of I ation) as identification. SEAL) Si ature of Notary Public State of Florida ZT0 4nr,fe- e JO ANN WEAVERPrint/Type/Stamp Name' 4 :+e MY COMMISSION # FF 173882 of Notary Public EXPIRES: November 4, 2018 q y,.• Bonded Thru No:2ry Publk Un&nwbrs