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Home My WebLink About146 Clear Lake CirJob Address: Parcel ID: (, ) J, " AUG Z 3 2U 13 Jffmllr= Type of Work: New Addition Description of Work: Plan Review Contact Person: - 1 Phone:0 0 14 j - t S__Fax• Na,4 n V\1 Street: 11410 City, State Zip: CZ c03 O(A CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: / d3 7S Documented Construction Value: $ , j Historic District: Yes No Residential ZJ-Oommercial eration Repair Demo Change of Use Move 3 1( bliSL Gil t Si Title: Email: 0_ Property Owner Information oA4 Phone: Resident of property? : r Information Name f Phone: 4(D 0 `Y -o Street: iV LP- 'e_ Fax: City, State Zip: State License No.: 001'a(07)4 Architect/Engineer Information Name: Street: City, St, Zip: Bonding Company: Address: 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: 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 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 Print Owner/Agent's Name Date Signature of Notary -State of Florida Date Owner/Agent is Personally Known to Me or Produced ID Type of ID Signature of Contractor/Agent Date Print Contractor/Agent's Name Signature of Notary -State of Florida Date Contractor/Agent 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 Construction Type: Total Sq Ft of Bldg: Occupancy Use: Min. Occupancy Load: New Construction: Electric - # of Amps Fire Sprinkler Permit: Yes No APPROVALS: ZONING: ENGINEERING: COMMENTS: of Heads UTILITIES: FIRE: Flood Zone: of Stories: Plumbing - # of Fixtures Fire Alarm Permit: Yes No WASTE WATER: BUILDING: Revised: June 30, 2015 Permit Application 8/23/2016 SCPA Parcel View: 02-20-30-5GJ-0000-0190 Property Record Card IWCIA Parcel: 02-20-30 5GJ-0000-0190 Owner: ZZ-MAK PROP LLC C'MORDA Property Address: 146 CLEAR LAKE CIR SANFORD, FL 32773 Parcel Information 0-0190GJ-0002-20-30-50 Owner, MC LL PropertyAddress 146 CLEAR LAKE CIR SANFORD, FL 32773 Mailing 116 SPRINGHURST CIR LAKE MARY, FL 32746 Subdivision Name i HIDDEN LAKE VILLAS PH 3 Tax District j S1-SANFORD DOR Use Code 0103-TOWNHOME Exemptions fLO C I. 0 7 Seminole County GIS r r s Value Summary 2016 Working 2015 Certified Values Values Valuation Method ; Cost/Market ; Cost/Market Number of Buildings 1 t 1 Depreciated Bldg Value $59 113 $51 371 Depreciated EXFT Value $1,200 ; $1,200 i-_---------- ----- Land Value ( Market) $ $16,000 = $12,000 Land Value Ag Just/Market Value ** ; $76 313 i $64 571 PortabilityAdt Save Our Homes Ad1 $0 i $p _ Amendment 1 Ad/ $5 285 r $0 P&G Ad/ $0 i $0 s.. . . . ......... ...._.. Assessed Value ; $ 71,028 i $64,571 Tax Amount without SOH: $1,314.11 r 2015 Tax Bill Amount $1,314.11 Tax Estimator Save Our Homes Savings: $0.00 TRIM Notice Help Does NOT INCLUDE Non Ad Valorem Assessments Legal Description LOT19 _._........ ..._.._ ._ ......... .. _ _..........,.. HIDDEN LAKE VILLAS PH 3 PB 28 PGS 3 TO 6 Taxes Taxing Authority Assessment Value Exempt Values Taxable Value— County General Fund j $71 028 $0 ; $71,028 Schools $76, 313 ; 0 . City Sanford I $71,028 f $0 $71,028 r SJWM( Saint Johns Water Management) $71,028 $0 . $71028 County Bonds 71 028 , $0 ° $71,028 i Sales Description -- — _ — Date — -- Book I Page Amount — Qualified _ Vac/Imp— QUITCLAIMDEED 2/ 1/2014 08206 0860 $100 { No { Improved r.._. _ ._,. WARRANTY DEED , 12/1/2009 07301 0140 $61,500 i No Improved w ....._ -.. _.. ------ _ .._ _.._.._.._ ... _._._._ --------------_------ --- .----------_._. WARRANTY DEED 2/1/2006 06139 1 1710 $187,000 s Yes ; Improved y.. WARRANTY DEED 2/1/2005 05625 0426 $115 000 s Yes Improved SPECIAL WARRANTY DEED 2/1/1999 03616 ; 1917 $52,700 No Improved CERTIFICATE OF TITLE ; 4/1/1998 03410 s 0226 $100 ; No i Improved 4.: ......... .. : .... ... ,. ., ,. ......:....,. ;.,...... . .. .... .... SPECIAL WARRANTY DEED 3/1/1998 403533 ; 1827 $100 s No ;Improved g._ ._._ _ _ _ _ _ _. _._ _._ _..__. WARRANTY DEED i 4/1/1993 02567 1397 _ _._ .__._ 61,200 ,Yes (Improved WARRANTYDEED 3/ 1 /1985 -- 01628 — 0474 64,000 4 Yes i Improved Find Comparable Safes i Land http://parceldetai l.scpafl.org/Parcel Detai I info.aspx?PID=0220305GJ00000190 1/2 8/23/2016 SCPA Parcel View: 02-20-30-5GJ-0000-0190 Method } Frontage I Depth Units ; Units Price Land Value (1 LOT 0.00 j 0.00 1 $16,000.00 f $16,000 Building Information m -._ _ _ _ Is Rar1/Rath rns snt inrnrrart9 rlir4 Wom Year Built i I I i 1DescriptionFixturesSBedBath ; Base Area Total SF LivingSF Ext Wall Ad' Value Re I Value A ends esActual/Effective ; p PP g 1 SINGLE 1985 ! 6 ' 2 i 2.0 - 1,020 i 1,333 i 1,020 CB/STUCCO $59,113 + $68,142' s Description AreaFAMILY ; FINISH GARAGE 297`00 i f FINISHED 1 OPEN t ; PORCH 16.00 FINISHED Permits Permit # Description Agency Amount I CO Date Permit Date 01242 ADDITION - RESIDENTIAL i SANFORD j $2,000 ' 1/25/2005 Extra Features Description A Year Built Units T-- Value 77 New Cost SCREEN PATIO 1 i 12/1/1985 ( 1 `s $600 : $1,500 i FIREPLACE 1 j 12/1/1985 _ 1 ; $600 $1,500i http://parceldetaii.scpafl.org/Parcel Detai I Info.aspx?PID=0220305GJ00000190 2/2 Archway CONTRACT TInternational Inc I Contract Date: Certified General Contractor-CGC1504809 480 Lake Bennett Ct, Suite B Phone: 407-636-8851 Certified Roofing Contractor-CCC1326774 Longwood, Florida 32750 Fax: 888-340-6538 Email: info@arcwinc.com Client Name: "' 14 A 0— ,- fir ,% . Client Address: / - (3 1 ,- 7+ Phone: Email: Insurance Co.: Phone: Adjuster's Name: Phone: Email: Claim No.:l Policy #: Scope of Work: 1. Remove existing roof to decking. Renail deck to meet uplift code 2. Install dry in with Z 0 underlayment 3. Install new lead flashing on all plumbing projections 4. Install new galvanized valley metal or Peel & Stick membrane per code 5. Install new drip edge(color to be selected by owner) 6. Install new shingles (color to be selected by owner) 7. Removal and insta lation of any solar panels is the owner's responsibility. 8. we can remove the satellite dish, but the owner is responsible for re -installation or adjustment 9. Any unforeseen condition, like rotted wood and deck replacement cost is extra. 10. Workmanship guaranteed for years) and manufacturers warranty is years FINAL CONTRACT PRICE: $ 4 1 ej , ()(A This agreement is subject to the insurance company approval and does not obligate the owner or Archway International, Inc. in any way unless it is accepted by the insurance company and accepted by Archway International, Inc. By signing this agreement owner authorize Archway International, Inc. to negotiate at a price agreeable to the insurance company and Archway International, Inc. for roof replacement at no additional cost to owner except for the insurance deductible. The final price agreed on between the insurance company and Archway International, Inc. shall become the final contract price and Archway International, Inc. will receive all the proceeds for the work completed by Archway International, Inc. THREE DAY RIGHT OF RESCISSION THIS WRITTEN AGREEMENT HEREBY SERVE AS NOTICE THAT I MAY CANCEL THIS AGREEMENT AT ANY TIME PRIOR TO MIDNIGHT OF THIRD BUSINESS DAY AFTER THE DATE OF THIS AGREEMENT CLIENT'S SIGNATURE/ APPROVAL PRINT DATE YO CONTRACTOR'S SIGNATURE/ APPROVAL PRINT DATE CHAPTER 558 STATUTORY NOTICE: FLORIDA LAW CONTAINS IMPORTANT REQUIREMENTS YOU MUST FOLLOW BEFORE YOU MAY FILE LAWSUIT FOR DEFECTIVE CONSTRUCTION AGAINST A CONTRACTOR, SUBCONTRACTOR, SUPPLIER, OR DESIGN PROFESSIONAL.. FOR. AN ALLEGED CONSTRUCTION DEFECT' IN YOUR BUILDING. SIXTY DAYS BEFORE: YOU FILE YOUR LAWSUIT, YOU MUST DELIVER I'0 THE CONTRACTOR, SUBCONTRACTOR, SUPPLIER, OR DESIGN PROFESSIONAL AWRITTEN NOTICE OFANY CONSTRUCTION CONDITIONS YOUALLEGEARE DEFECTTVE AND PROVLDE YOUR CONTRACTOR AND ANY SUBCONTRACTORS. SUPPLIERS. OR DESIGN PROFESSIONALS THE OPPORTUNITY TO INSPECT THE ALLEGED CONSTRUCTION DEFECTS AND MAKE AN OFFER TO REPAIR OR PAY FOR THE ALLEGED CONSTRUCTION DEFECTS. YOU ARE: NOT OBLIGATED TO ACCEPT ANY OFFER MADE BY THE CONTRACTOR OR ANY SUBCONTRACTORS, SUPPLIERS,, OR DESIGN PROFESSIONALS. THERE ARE STRICT DEADLINES AND PROCEDURES UNDER FLORIDALAW. CONTRACT TERMS AND CONDITIONS The following provisions form part of the contract between the parties hereto. Archway International, Inc. will be referred to Archway„ GUARANTEE: For new roof sold and installed by Archway, the Customer will receive the manufacturer's warranty offered for the shingles and a five years labor warranty by Archway. The extent of this guarantee shall not exceed the contract amount paid to Archway and shall not extend to consequential damages. CLAIMS: All claims for nonfulfillment of the contract shall be made within 30 days from completion of the work. Archway reserves the right to correct any condition For which it is responsible including damage to other property. In the event others repair or attempt to repair any problem with the work done by Archway, unless authorized by Archway in writing, all guarantees and warranties associated with Phis project shall be void and of no other further force and effect. Archway shall not be liable for any cost of work or repairs to its work done by others unless previously authorized by Archway in writing. PAYMENT: Owner has represented to Archway that it has the funds available to make payment and has further agreed to supply financial records satisfactory to Archway, prior to commencement of construction. If Archway in its sole discretion is not satisfied with Owner's current or future ability to pay it may terminate this contract. Final payment is due oil the completion of the job and is a condition precedent to any warranty or guarantee obligation ofArchway. Any release, lien waiver or warranty issued pursuant to this project is delivered in escrow subject to payment and may be cancelled for nonpayment. Archway right to payment is not contingent upon the acceptance of work done by others and over which Archway has no control. The prevailing party in any litigation, arbitration or mediation relating to this agreement shall be entitled to recover its reasonable attorneys' Pees from the other party for all [natters, including, but not limited to appeals. Orange County, Florida, shall be proper venue for any litigation involving this agreement. Interest shall be clue on all amounts not paid within 30 days of the date due at eighteen percent per annum. Owner agrees to execute any documents necessary for the contractor to recover payment for all rebates or credits available associated with this project. UNFORESEEN CONDITIONS: In the event that unforeseen conditions arise that couldnot be determined by visual inspection, such additional work shall be performed on it time and material basis over the price stated in this contract. Examples of conditions which will be considered an unforeseen condition giving rise to an increase in the cost of the job would be the discovery of additional roofs during tear -off; or that the original roof was solidly mopped to the deck; deck conditions requiring repair, or any other condition that Archway should not reasonably have anticipated and included in the price provided for in the contract. PRE -CONSTRUCTION INSPECTION/LEAKS: Roofs ready for replacement are generally leaky and holding water which may, through no fault ofArchway, leak into the building during the course of the re -rooting process. Archway shall use best roofing practices to minimize the risk of leaks but owner agrees not to hold it liable for leaks not directly caused as a result of negligent practices. Additionally, interior damage generally pre-exists commencement of the re -roofing project. Owner agrees to provide access to all interior areas and top floor units in order for the parties to document pre-existing damage. The risk is upon Owner, who agrees to indemnify and hold Archway harmless, against any claim by Owner or any other party seeking to holdArehway liable for damages where Archway was not provided access during its pre - construction inspections to the areas in question. Owner also shall have the responsibility to notify its residents of the steps that must be taken to protect tbeir property, which will be contained in the Start -Up letter provided by Archway. Owner shall also provide the staging area and cooperate to inform and assist in preventing residents or others front entering that area or any area under construction. PRICES QUOTED ARE FOR GALVANIZED flashing, eves drip and gravel stop unless otherwise specified. SIGNS AND LIGHTING: Unless otherwise specified in this contract. Archway shall not be liable for damage to signs and lighting about the premises. Any expenses necessary to remove or install signs and lighting shall be paid by Owner. RISK OF DAMAGE: It can be expected that the work will cause vibration, which could cause damage to the building or its contents. The Owner is in the best position To secure said property or, in the case of tenants, to advise them of the need to do so. Archway does not assume any risk and shall not be held liable for damage to stained, cracked or damaged ceilings or ceiling components, cracked or damaged plaster, insulation, acoustical tile or personal property or fixtures within or about the building(s), cracks in driveways, curbs and sidewalks or soffit repair or replacement. Additionally, Archway shall not be liable for damage to parked vehicles or property located in or about the staging area assigned for its use, or for any damage or injury for respiratory problems which may result from the odors associated with its work. The Owner shall advise its tenants and employees of these risks and concerns and take such action as it deems reasonable. DELAYS: Archway shall not be liable in any respect for any delays caused by strikes, labor disputes, court injunctions, and actions by the Owner or by third parties. Acts of God, or other conditions outside of its control. In the event Archway must remobilize as a result of any action for which the Owner is responsible, or clue to weather or other conditions not the responsibility ofArchway, Archway shall be entitled to an increase of the contract price attributed thereto. BREACH: In the event Owner terminates or breaches this contract, or if a condition attributable to Owner or Owner's property arises that prevents Archway from fulfilling the contract, Archway shall be entitled to be paid that percentage of the contract price as the percentage of work performed; plus for work not performed, all expenses incurred in preparing to per same, mobilization expenses and profit which would have been realized had the work been completed. If the contract is canceled as a result of strike, labor dispute or conditions not the fault of or attributable to either party hereto, Archway shall be entitled to recover from Owner that percentage of due contract price as the percentage of work performed; plus for work not performed, all expenses incurred in preparing to perform same, mobilization expenses or other expenses incurred related to the project but not profit for work not performed. NO ORAL'PROMISES: There are no promises, representations or understandings outside of this instrument which instrument represents the complete agreement Between the parties. No modification of this contract shall be valid unless in writing, signed by the party against whom the change is asserted. Any notification required by this contract shall be made in writing. LIMITATION OF LIABILITY: (a) materials supplied or installed by others; (b) exposure to clamaging substances such as oil, solvents etc.; (c) failure of the substrate, surface or materials under the roof; (d) improper drainage; (e) lack of recommended maintenance; (f) damage resulting from water entry from any portion of the building structure which is not a part of the roofing system, or (g) any claim related in any way to damage or injuries from mold, spores, fungus, any organic pathogen or exposure to toxic or noxious substances :fumes or vapors. Archway shall have no obligation under this Contract until all bills for installation, service, and materials have been paid for in full. f THIS INSTRUMENT PREPARED BY: Name: `! o f,c.a_ Address: 1EN11401..l::. i,. M.R4 Fy,' 0f f:ItI:aIT ( :(1!lf;T 3 t-1E'1'f;'4:)L_L_E f' CLERK IS Y 20i60 f 148 RI ('.0Rlal'D I;h f E_f:0RG'ING FEE:", t.i.l;l„Illl REC0R1'A,_D C'Y tftaa /far f Permit Number: Parcel ID Number: _an: __3_% The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, thefollowinginformationisprovidedinthisNoticeofCommencement. 2. GENERAL DESCRIPTION OF IMPROVEMENT: Full roof replacement 3. OWNER INFORMATION OR LESSEE INFO MATION THE LESSEE CONTRACTED FOR THE IMPROVEMENT: Name and address: 'fi Gqk t dl (('• a r >. _ t li 11G Ya el Interest in property: 1N4E K' (II_r j f_ ifk[4 Fee Simple Title Holder (if other than owner listed above) Name: Address: 4. CONTRACTOR: Name: Archway International Inc Phone Number: Address: 480 Lake Bennett Ct Longwood fl 32750 5. SURETY (If applicable, a copy of the payment bond is attached): Name: Address: 6. LENDER: Name: n/a Address: Phone Number: Amount of Bond: 7. 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)(a)7., Florida Statutes. Name: Phone Number: 8. In addition, Owner designates m to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Phone number: 9. Expiration Date of Notice of Commencement (The expiration 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 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 BEFORECOMMENCINGWORKORRECORDINGYOURNOTICEOFCOMMMENCEMENT. 4/ 1 0 { ' ( Signature of OGmer or-, essreet o 0is or Lessee's Y/ ~ r/ ( Print Name and F ovide Signatory s T e/Office) AuthorizedOfficer/Director/P,a(ner/Manager] 1,, t i 21 State of (A s _ County of _` CT") ti r-0 - The foregoing instrument was acknowledged before me this 1"`; _ day of _,i C; 201 a by ` Name of person making statement Who is personally known to me(O—OR who has produced identification type of identification produced: AT J COUCH ti My COMMISSION # FF984753 EXPIRES April 21, 2020 0>' 1 9e of s F"I Not rySery ;e.00rr; AUG 2Q1 u, tit!I lcty f l JolarySignature;: CLERKOF i hi i:Cl It t [ (i R t AIv 7 Sc • e EC '3N 1 f FtIDAPa tp`i ib.. By _CEPUTf CLERK Sanford Hidden Lake Villa Homeowners Association, Inc Approval Form Architectural Control Committee (ACC) approval for improvements to exterior of Hidden Lake Villas and Carlton Homes. (SHEDS WILL REQUIRE A SIGNED SHED REQUIREMENT FORM ATTACHED) Instructions: Please complete the following information and mail or fax form to the address below. Upon approval, a signed copy will be forward to you. Visual inspection by ACC member or Managing Agent may be necessary. Some improvements may require a permit from the City of Sanford and application would be made after receipt of approval. All approvals will be made at the monthly board meeting held the second Tuesday of each month. if you need approval sooner put date needed by and reason Please Print) Name: f bpi ri 121c; k'11;?Address of improvement c 7 Cl X. Sr,'> Telephone:^=iG-r 2 - _`_cDate: Description of Improvements: (If you need more space attach a 8x I I sheet of paper.) 49 For Fences and additions: Applicant must submit drawing on a plat or survey showing that fence or addition is not blocking the required 10 (Ten) foot casement behind all villas. For painting: Villas -- Applicant must provide color selection number from color palette or color samples. Homes — ppliraj t-musj( rovide paint color samples(s). Roofs - Villas -f 0nly Deset-t'Tarttor Copper -wood are allowed. Homes- ro-lor mus bapproved by ACC committ c. Signature of Applicant: Mail to: Sanford Hidden Lake Villas HOA, Inc PO box 1706 Sorrento, FI. 32776-1706 Fax: 866-346-6016 Any questions call the managing agent on 407-340-0006. Approved by representative of ACC or Association Board Member. r Signature I - __- _ Dater _.-- Signature 2 Signature 3` Date: c' Date: FINAL BOARD APPROVAL, and verification that enhancement was completed as stated above. Verified by ACC or board member Signature This approval will expire 60 days from the approval date Date: 8/23/2016 Florida Building Code Online BCIS Home ; Log In r User Registration Hot Topics ; Submit Surcharge ! Stats & Facts I Publications , FBC Staff i BCIS Site Map Links 1 +Search flda Product Approval USER: Public User Product Approval Menu > Product or Application Search > Application List Search Criteria Refine Search Code Version 2014 FL# 5444 Application Type ALL Product Manufacturer ALL Category ALL Subcategory ALL Application Status ALL Compliance Method ALL Quality Assurance Entity ALL Quality Assurance Entity Contract Expired ALL Product Model, Number or Name ALL Product Description ALL Approved for use in HVHZ ALL Approved for use outside HVHZ ALL Impact Resistant ALL Design Pressure ALL Other ALL Saarrh Raeulte - Annli—tinne FL# Tvoe Manufacturer Validated By Status FL5444-R9 Revision CertainTeed Corporation -Roofing John W. Knezevich, PE Approved History Category: Roofing 954) 772-6224 Subcategory: Asphalt Shingles rr •-- -r ^rr•'-...r —, — -. any iau . uy .,e — anwm ' i wrn.r"s"Vn n necessary. Contact Us :: 2601 Blair Stone Road. Tallahassee FL 32399 Phone: 850-487-1824 The State of Florida is an AA/EEO employer. Copvrioht 2007-2013 State of Florida :: Privacy Statement :: Accessibility Statement :: Refund Statement Under Florida law, email addresses are public records. If you do not want your e-mail address released in response to a public -records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions, please contact 850.487.1395. *Pursuant to Section 455.275(1), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must provide the Department with an email address if they have one. The emails provided may be used for official communication with the licensee. However email addresses are public record. If you do not wish to supply a personal address, please provide the Department with an email address which can be made available to the public. To determine if you are a licensee under Chapter 455, F.S., please click here . Product Approval Accepts: Credit Card Safe https://www.floridabuilding.org/pr/pr—appjst.aspx III CITY OF SANFORD BUILDING SERVICES Residential Re -Roof Hurricane Mitigation Inspection Affidavit Permit #: d - S I, 1k r Q Z2opg hereby acknowledge that I personally inspected 0,R-6of deck nailing and/or -1- ondary water barrier work at q6 0 &2 21 a k`e, Ot- &'e 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 to Section 837.06 F.S. 44_ i ature of Cdntractor L. Date 3a(q -7 Printed Name of Contractor License # License Type: General Building Residential Roofing Contractor or any individual certified in accordance with F.S. 468 to make such an inspection. STATE OF FLORIDA COUNTY OF S e ram/--y Sworn to (or affirmed) and subscribed before me this '30 day of 4V q , 20 by who is Personally Known to me oVhas Produced (type of identification) SEAL) Signature of Notary Public State of Florida Print/Type/Stamp Name as identification. of Notary Public rh COUCH F934753 e 2020Fipr Servl porn j ROBERT J COUCH z MY COMMISSION M FF9$4753 OF EXPIRES April 21, 2020 e o,a1 FWWNWISOM0,60M 3