HomeMy WebLinkAbout162 Pinelsles Dr*�! -Pft.
E, JUN 1 2016 CITY OF SANFORD
Er BUILDING 8 FIRE PREVENTION
PERMIT APPLICATION
Application No:
Documented Construction Value: $.-71)7-2 .36
Job Address: 162 PI n <_ I SI r S lY Historic District: Yes ❑ No [J'
Parcel 1D: 10•2-0.30 •,SI I • 061�D• 0-150 Residential[] Commercial 11
Type of Work: New ❑ Addition ❑ Alteration [9 Repair ❑ Demo ❑ Change of Use ❑ Move ❑
Description of Work: R e' Tlint1
VI IT)1 2JA-aI7� 1 1h--tr,Wrab Gllnt-)�1A rid flr1.ihAIA+(FL IS7_II..I-'J`
Plan Review Contact Person: TO Anr)WLQVLr Title: A Amtin
Phone: 813 'U I to • 3555 Fax: 898. 49 (b • D "1 1 Z Email:, i o ann� nn� L+hem rorty .CON
Property Owner Information
Name jelC1_,+4e Ahc1ra rel r-_ Phone: 904•514D• ML4 7y 1
Street: _j 1 j 2 Pi n L I SkS I X Resident of property? : t S
City, State Zip: -H- 32,27 3
Contractor Information
Name ,qt) Lt+f)fXt) PM RtS+ Df Q+-tO/1 Phone:3�15- 17-09Ckn`
Street: g 2 U 0 9 Ll j P 14 7 Q Blvd #�D I Fax:• 0112
City, State Zip: -52 KAQ it FL 3-51L I 0 State License No.: O Q C 13 Z9 si?14
Architect/Engineer Information
Name: I (L Phone:
Street:
City, St, Zip:
Bonding Company: Ql d E onto h►qu.r&4
Address: ED Bwe Ile 3�5
MUD au kee m I I
Fax:
Mortgage Lender: W I Ol-,
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. 1 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. 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 1053 Shall be inscribed with the date of application and the code in effect as of that date: 5i° Edition (2014) Florida Building Code
Revised: lune 30.2015 Permit Application
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 Owner/Agent
Prim Owner/Agent's Name
Date
Signature of Notary -State of Florida Date
Signature of Contractor/Agee Date
M o 'M A y6
Print Contractor/Agent's Name
41
MARYLOU SESAK
'= MYCOMMISSION #FF146073
EXPIRES July 29. 2018
(407) 398-0159
Owner/Agent is Personally Known to Me or Contractor/Agent is ,,!:!C_ Personally Known to Me or
Produced ID Type of ID Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing[] Gas❑ Roof
Construction Type: Occupancy Use:
Flood Zone:
Total Sq Ft of Bldg: Min. Occupancy Load: # of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads
APPROVALS: ZONING: UTILITIES:
ENGINEERING: FIRE:
COMMENTS:
Fire Alarm Permit: Yes ❑ No ❑
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Permit Application
HOMEOWNERS
CHOICE CONSTRUCTION
Date: -_ Insured Name: s' `
effel hi r^1
Telq�` y 7 Job Address: ` `' ) /
Exterior Work: ROOF
T
INSTALLATION AGREEMENT
EIN: 81.1725414
LIC: CGC1513427
3? --W3
Shingle Type: GAF Royal Sovereign 25 Year 3 -Tab Shingle GAF Timberline HD Lifetime Dimensional Shingle Flat Roof: YESr NO
Shingle Color: U�� Drip Edge Color: � )V Idge Vent:_ Metal _Cobra 3 _4' Off -Ridge Color:
Underlayment;�<Synthetic _301b Felt _251b Felt _Peel & Stick NOTE: Roof pitch can affect what underlayment is allowed per building code.
Dish: DISPOSE or KEEPNOTE: If you choose to keep the dish, please contact your satellite provider upon completion to reinstall It (HCC does not reinstall dishes).
HOA Approval: Homeowner confirms he/she has personally y rifled the type, style, and color of the shingles selected and homeowner accepts full responsibility for
obtaining any necessary HOA approval(s). Initial:
Payment Details Insurance: ACV: ,iJ 7 -Deductible: 'Upgrades: RCV: %%/ l+�l&O:
Installation Payment: Homeowner agrees to release the ACV, Deductible, and Upgrades amounts listed above totaling: - to Homeowners
Choice Construction at completion of the roof. Homeowner agrees not to withhold said payments over minor construction defects/disputes and/or status of the
county's final inspection. NOTE: Payments above marked with an asterisk (•) denote payments that are
the homeowner's responsibility (not the insurance company).
Payees on Loss Draft: L b lKi t 1 r0T 41 •�f �t �t/ HJ r t�C� 1 M 6 r r' AI) 10% Draft Expiration:
Draft Endorsement: (Circle three total, one In each group) Monitored gr Non -Mont red -Mail ayr�r Local Bank Endorsement I/We will handle the Bank
Endorsement gLHomeowners Choice Construction will handle the Bank Endorsement.
Missed Items and/or Supplements/Hidden Damages: I agree to allow Homeowners Choice Construction to request supplemental funds from my insurance
company for mistakes. Items missed, documented price increases, overhead & profit, underlying damage, etc. that may not be reflected on my Insurance Settlement
Statement. I agree to release all supplemental funds (if any) to Homeowners Choice Construction. This will not affect the amount I will have to pay out -o -pocket.
Exclusion: Most insurance companies will not cover rotten wood unless directly damaged by the storm (please see line 3 on back page). Initial: 9-40P 0
Solar Panels: YES Qr NO If Yes, check ONE below:
I/We will handle the solar panel portion of this project. 1/We will have the panels removed prior to the roof Installation date. The allowance from the
insurance company is to be returned to me when all work in this agreement is complete and Homeowners Choice Construction has been paid in full.
I/We wish for Homers Choice Construction to remove and dispose of the panels and I/We will ensure the plumbing Is Inactive prior to install.
ANY D (ATf M T C Cf MUST BE PP OVED BY LLP IES AND BM WRI G THROUGH A HAN ORDER FORM
G 6611
Homeowners Choice Constructl n Signature Date Cu/ or Signature Date
mA5252016
(877) 652-3555
9260 Bay Plaza Blvd, Suite 501 Tampa, FL 33619
www. homeownerschoiceconstruction.com
THIS I TRU ENT PR PAR BY
Name: �0 C ftOn
Address. VII
SEMINOLE COu?�'7Y
tete bf Florida FWRIDA'f UTIRAI CMOu t
NOTICE OF COMMENCEMENT
Permit Number Parcel ID Number (PID) I n •20.3 b • jut • nam. Faso
The undersigned hereby gives notice that Improvement well be made to certain real property, and In accordance with Chapter 713.
Florida Statutes. the following information is provided in this Notice of Commencement.
the prWrty and street address if available) I of 75
GENERAL DESCRIPTION OF IMPROVEMENT E '1 DDL
OWNER INFORMATION
Name and address:
F 1 X2"1 "13
CONTRACTOR
Nnenn nnA nAAroea• . Q I144'11 M P ro R cs +o
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), Florlds Statutes.
Name end adcress:
In addition to himself, Owner Designates of
To receive a Copy of the Lienors Notice as Provided in
Section 713.13(1)(b), Florida Statutes.
Expiration Daft of Notice of Commencement:
The oxpirstlon date Is 1 Year from date of recording unions a different daft 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 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
BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
COUNTY OF SEMINOLE
V
!IG-M—a OWNERS PRINTED NAME
s Ststuto 713.13(1) (g). owner must sign— and no one fee may be permitted to sign In his or her stood."
a`going instrument was acknowledged before ms this day of
J me, �
by Jene-ft&AnJfoLJ& Who Is personally known to me
Name of person malung statel*M /
OR who has aroduced Identification�^ Il type of identification produced
--X Z0
VERIFICATION PURSUANT TOS ON 92326, FLORIDA STATUTES.
OF
WUTIE1MCi1TON
WfOMOR ION1FF226166
EXPIRES May S 2019
9oRdre 11w Na1rp PuCre Wlesnwlos,s
1 HAVE Rq" THE FO DING AND THAT THE FACTS STATED IN R
BELIEF. i�
MARYANNE MORSE, CLERK OF CIRCUIT COURT SEMINOLE COUNTY FL
CLERK'S # 2016060489 BK 8705 Pq 1761: (1Dq) E -RECORDED 06/13/2016 09:06:43 AM
.0 .00000e
SOUTNERN PRO
Authorization Letter / Power of Attorney
Owner / Jobsite: TeA l ► e A n ► r -c-,
162 P,� Ss►e �r
5-,*,,o0F/3.2273
To Whom It May Concern,
I Michael Kos, hereby authorize the following persons to act as agents on behalf of myself and
Southern Pro Restoration LLC to pull and sign for the above referenced Building Permit which
was submitted under my Florida State Contractor License number CCC1329584.
This authorization is valid one year from date of signature.
Authorized Persons:
Brian Kirby
John Christianson
Erick DeDios
Martin Sterling
Aaron Hallich
Joseph Orozco
Tim O'Malley
Elianora Morejon
Frank Jaramillo
Christine O'Malley
Regai
STATE OF FLORIDA
COUNTY OF t ►4 IGr
The forgoing instrument was acknowledged before me this Z � day
of , 20( <- by Michael Kost, who is personally known to me.
otary ofthe P b c
'Printed Name
WE VI MOW 93WdX3
4L8►VCLdd a N04sslnnoo An
(SE 4WHIN avwrn Nosvr ,.;`
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.
D Copy of applicable contractor's license issued by the State of Florida (if the contractor is the
applicant).
(7� 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.
O 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).
D /IVACompleted 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.
CITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #:1(1 -0000 1-7 37
I. _ M 1 rAuk f _ 1 110 5* hereby acknowledge that I personally inspected
E'Roof deck nailing and/or LVSecondary water barrier work
at 42, P I f12. I S IL tD r 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
performs e o ' or her official duty shall constitute a misdemeanor of the second degree pursuant to
Sectio 7.0
S�tlll.
Signature o-Trontractor Date
hAiae-1 kocf CCC 131q 584
Printed Name of Contractor License #
License Type: 0 General 0 Building 0 Residential 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 2 �_ day of u 20 I_, by
�1—� 1 KA sir , who is &Personally Known to me o as 0 Produced (type of
i ' 1c ion) as identification.
(SEAL)
Sig6dture of Notary Public
Statef Florida �,.•..� �o�Nw��R
;�y1lP V [ ,fr MY=OASSION r FF 173%2
_.: .:
Print/T a/Stam Name EXPIRES: November 4. 2018
YP P 7 }�• '` Sousa n.0 rarmy wee ubew.em
of Notary Public
3