HomeMy WebLinkAbout116 Belgian WayJob Address:
Parcel ID:
CITY OF SANFORD
3
BUILDING & FIRE PREVENTION
4
Ito
PERMIT APPLICATION
Application No: 6-010`7
Documented Construction Value: $, 2q,. 101,
Historic District: YesF1 No n
0 q U Residential R 17Commereml
Type of Work: New ild AdditionEl Alte ti R —'% Description
of Work: 1p
1011111 RepairEl Demo [I Change of Use El move [I I
jqn (e- < Plan
Review Contact Person: 15CQJN j iy Title: 46)
q Ig 3oo Phone: Fax: 40764 Email: 12- tr n 14± Property
Owner Information Name -
3Dffi -K- P- ---- Phone:
4M Yap- 1 575-( Street:
a Al-co —, - - — — Resident of property? City,
State Zip- p Contractor
Information Name
Phone:
Street:
Fax:
City,
State Zip: State License No.: Architect/
Engineer Information Name:
Street:
City,
St, Zip: Bonding
Company: Address:
Phone-
Fi
E-
Mortgagi
Address:
WARNING
TO OWNER. YOUR FAILURE TO RECORD A NOTICE OF COINIMENCEMENT MAY RESULT IN YOUR PAYINGTWICEFORIMPROVEMENTSTOYOURPROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDEDANDPOSTEDONTHEJOBSITEBEFORETHEFIRSTINSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. A,
PPlication is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commencedpriortotheissuanceofapermitandthatallworkNOEbeperformedtomeetstandardsofalllawsregulatingconstructioninthisjurisdiction. 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
1053 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 watermanagementdistricts, 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, inaccordancewithlocalordinance. 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: Z 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 Signature of No
Y
State of Florida Date
ZoctonNYDIrR
Ml'
FF931019
roaggg53 E2g, 20'19
pjyOwner/Agent is Personally Known to Me or Contractor/Agent is Py nown to Me orProducedIDTypeofIDProducedIDTypeofID
BELOW IS FOIE OFFICE USE ONLY
Permits Required: Building Electrical
Construction Type:
Total Sq Ft of Bldg:
Mechanical Plumbing Gas Roof
Occupancy Use:
Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes No
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
Flood Zone:
of Stories:
Plumbing - # of Fixtures
of Heads Fire Alarm Permit: Yes No
UTILITIES:
FIRE:
WASTE WATER:
BUILDING:
Revised: June 30, 2015
Permit Application
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: V q P fl V
I hereby name and appoint:
an agent of: 4J V 0 0a fhoftu S OI L41 do
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 ap lication for work located at:
I t tC a u aq faii&d iij
Street Addre )
Expiration Date for This Limited Power of Attorney:
License Holder Name:
State License Number:
Signature of License F
STATE OF FLORIDA
COUNTY OF
jc6huG toGrGogh
The foregoing ins nrut was acknowledged before me this (0 day of OWil.
20/i by OJnVA /( 1 1(,1 L)i i'GfG C?'who is sonally known
to me or o who has produced
identification and who did (did not) take an oath.
Notary Seal)
My COMMISSION # FF931019
EXPIRES October 26, 2019
447)398-0'53 F1origa14o;ary8ervke.c0m
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Signature
Print or type name
Notary Public - State of
Commission No.
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ROBS MARSCN NOTARY
PUBLIC - STATE OFFLORIDA Pfjat, T'jr4Ifidl)"1 COMMISSION# FF148M
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ROBB MARSCH
NOTARY PUBLIC - STATE OF FLORIDA
COMMISSION# FF146M
EXPIRES 8f7/2018
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CLIFFORD S SNYDER
MY COMMISSION# FF931019
EXPIRES October 26, 2019
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MARYANNE MORSE, CLERK OF CIRCUIT COURT SEMINOLE COUNTY FL
CLERK'S # 2016104153 BK 8780 Pg 1387, (lpg) E-RECORDED 10105/2016 09:04:14 AM
1U00
City of Sanford
Building & Fire Prevention Division
PERMIT NO. ® U #3
e ' ISSUE DATE: ' `:! !
CONTRACTOR:
JOB ADDRESS: !••••S Lo_16 UW1q'
TYPE OF WORK: I IV--,r
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 ROOF DR Y-IN INSPECTION IS REQUIRED * * *
For Inspection procedures, please refer to the re -roof inspection guidelines provided to you when the permit is issued.
The Miti ate ion Affidavit will not suffice as an alternative to receiving 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
r4 .,
ACCt7fOrT$tT
t3USIN$5S
0010 YTro4t payment; tany, Is due within 30
reiniburHmerit;for costs of cokedon iinciuding.rea
torts for the breach, or enforcement, of any tetras a
WO'I K A010MENT
Advanced Mottle Sdiul:lims
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txt tttbrn j°hm„jtterelnatter referred to of'(0nPa(W) to enter my, hope tyr
pioperty,.furnish materla s,, supilf ail equp"mant and perform titl,tat5rir micas
1.5%monthly are charged toainy-and all unpaid Weikel, Compap0had.Da'entitle'd to
is and costs] of ,unpaid amounts,by Owner/Agent orid for reawnabh aitorney%f feel and
A4Tf I`OMIAL AGi WTSt I understand that in the best judgment of Company; materials may W treated'with a Commercial andmitrobiat:agent to,
inhiCit the; gra?wth of microfirgantsms during'"ttae dtying,{ protest, I har'a teceived advanced notice of the use of antimitro iai and/or antunk:rptiial "praductas parr of
khe restoration prpEes;, i understand it Is Deyond'the esptrttse of Company to,datxrmtne tt somaone Is sensidye to ffs'apphcadttn-. t agr+N.to'IIWd Compa»yt arnt.
less aa'ttw van Mtn1t*oWal'ttgar t
STOA WORK'MOLD HARMt$SS: Wthe'tIvent Company is not ato perornt allowedfittrecommended procedures and/or drying equipment is removed prematurity, tagree:
ro.retease.aind,hold t Coer+
panyhaTniksY, and Inder ntiy-company against all aiatiris, or actions that may retuhh. oinsuch-praudurts. ADDITIONAL
TERMS'AAE ON THE SACK. ,'BY -SIGNING BELOW 1 AGREE .TO AND HAVE UNDERSTOOD -THE TERMS Of THIS AGREEMENT. You are entitled"to a COPY, hiref the contract at the time you sign, 001) it ta'protett your dghts: Executediip triplicate, one copy of which was delivered to,, andratiiPtisherebyacknowlejdggeebyOwnerjvsfjon', / 20. r ant'
Signatyre
Print
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Contractor D iE t.:IT Srgnatore at Contractor. '.,.Attount;Manager `f F—F+++klVtlil+.W'.Fia t. Dedi*
tcable S r, j Date of Lost, prlor'Root Claims: Yei A CNq:) prior Restoration Claims: Yei at Stormoamar.No Storm Date (. i . Tarp Yea aQW IEP required Yes ot Interior Yes of ERS.Yes ar Mameowner
Cell a Adjuster
Name ,_ InSurarsto
Adjuster Atortgsge=
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bytr¢ariO4,cor n ptsuvante "
lisokrntnes a Ael)u vnIthts hereinatEer
referred to as'Campany"); for afsignmerit
in tonsfderatton:af Company's I contract,
Including the inspectlan an estim carrfer(
s} to telltale any and all 0ormatftin beneffW,
p be paid by my lrtsurance,W(Aer( DIRECT
PAYMENT AMORtiATION I hereby 4 Company:.
The paym6nrof any benefits, or:prac derstandthatd
ath responsible, for payment (dr piny,
utclt diing any applicable deductible, DATED
THIS _Jr DAY Of _ Print
Owrser/Agent #1 L prim
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S R#GNT TO CA)VCE1: You have the right controett
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hereby oWflit any and all lnsaranto rights, benefits, proceeds artd any causes of t011ele%.
trt, 1LCCH1 C9 I4Lir.i j i Advanced Hortie'MI rtiona C-nttttti n Firm, W:
O! to berondierod t}y'Campany> in thin ragatd t waive my privacy rights. I make this rform,servic'
m and sugpiy maleriats and othertvise'per(tirm its-aa0gations-undtSrthis and not
regdiring fuii;payment at the time of service: I also hereby direct.my:insurartce ampany, Its
reprosenlatfve, and/or its Attorneyfbrthe.purpose Of obtaining actual rider d
or to bexandered. f belierrithe appropriate insurance carrierto be u"quivocally,
instruct direct Pi gment of, -a y Insurance benefits ur proceeds to any inust-
be sent directly to Company,find payment made solely to"Company, i un- Itovided by
Company for which payment°is not recoverable from trig insrirai ce'com- 3ignaWre owner/
Agtn2:R1__y cstlrad,this
coIratract`in w4hir ,I bustnasa tiGfys after the.dote you sign it by no6fihtg the r „. NowBid ()
wear/AYertt Cw tact Cotil atry i
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CITY OF SANF®RI) BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #:
1> hereby acknowledge that I personally inspected
Y Roof deck nailing and/or eSecondary water barrier work
at IV1
Job Site
and have determined that the work
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 o r official duty shall constitute a misdemeanor of the second degree pursuant toSecti3 . 6 F.
O I J2120
Si re f on actor Date
V461 _
Printed Name of Contractor License#
License Type: General 1 Building Residential VRoofing Contractor
or any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF F ,ORIDA COUNTY OF anq
Sworn to (or affirmed) an subscribed before me this __A7 day of Dmb , 20 _1,0_, by t7ShUQ /ln aUq19 who is Personally Known to me or has Produced (type of identi
cation as identification. State
of Yrida qY•
p ROBB MARSCH Print/
Type/Stamp Name ao` uB'NOTARY PUBLIC• STATE OFFLORIDA of Notary
Public COMMISSION# FF148880 EXPIRES 8f712018
fuf EJai'
BON0EDTHW*&9&NOTARYI