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HomeMy WebLinkAbout162 London FogwayCITY OF SANFORD RM-EIVEU BUILDING & FIRE PREVENTION No 2016 PERMIT APPLICATION Application No: Documented Construction Value: Job Address: 116 a loy)Aon 'Pb a 1.J cLL_% 2DHistoric District: Yes No Parcel ID: Residential M Commercial Type of Work: New Addition Alteration Repair Demo Change of Use Move Description of Work: r ey-o ) F 3 a 5A C Q.V+ a I A-t-Q.Q J r VV AAA reqrc s FL54L411- ?-9 Plan Review Contact Person: Title: Phone: Fax: Email: Property Owner Information t' Name 6j544 l..e- A 1 LJ 1 -LQ Phone: Street: 233 E, L>J, IboQ. Fku 6 P4:4 2.1 Resident of property?: C! j City, State Zip: Unte.e ry-\ r(n U16 Contractor Information Name R_SzqL-) RcK)Rng i 1 C Phone: Lfu1' 0 14- (0-133 Street: c -1 14 aloud croF4 D tZ- Fax: qyP ' YLl - OV 3 City, State Zip: f)(2 Q - 321 State License No.: Name: Street: City, St, Zip: Bonding Company: Address: Architect/Engineer 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: 51 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. OUA Rl, r) Signature of Owner/Agent Date Signature of Contractor/,gent Date aAo-h z10 Print Owner/Agent's Name Print Contractor/Agent's Signature of Notary -State of Florida Date a re of No Date cha*_ CLla 26c(c c7 Owner/Agent is Personally Known to Me or Contractor/Agent is l' "" 1lall y Knpi too MqKK Produced ID Type of ID Produced ID '1G ' ' _ Notary Public - state of Florida v e «07` ',iy Comm. Expires Dec 26, 2016 o F q,. Commission # EE 858690 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, Fire Sprinkler Permit: Yes No # of Heads APPROVALS: ZONING: ENGINEERING: COMMENTS: UTILITIES: FIRE: Plumbing - # of Fixtures Fire Alarm Permit: Yes No WASTE WATER: BUILDING: Revised: June 30, 2015 Permit Application City of Sanford Building and Fire Prevention Product Approval Specification Form Permit # Project Location Address v 3 a'1'l l As required by Florida Statute 553.842 and Florida Administrative Code 9N-3, please provide the information and product approval number(s) on the building components listed below if they are to be utilized on the construction project for which you are applying for a building permit. We recommend that you contact your local product supplier should you not know the product approval number for any of the applicable listed products. Be aware that windows, skylights, and exterior doors must be tested in accordance with the Florida Building Code, Section 1714.5. More information about Statewide Product Approval can be obtained at www.floridabuilding.org. The following information must be available on the jobsite for inspections: 1. This entire product approval form 2. A copy of the manufacturer's installation details and requirements for each product. Category / Subcategory Manufacturer Product Description Florida Approval # include decimal) 1. Exterior Doors Swinging Sliding Sectional Roll U Automatic Other 2. Windows Single Hun Horizontal Slider Casement Double Hun Fixed Awning Pass Through Projected Mullions Wind Breaker Dual Action Other June 2014 Category / Subcategory ' Manufacturer Product Description Florida Approval # include decimal) 5. Shutters Accordion Bahama Colonial Roll u Equipment Other 6. Skylights Skylights Other 7. Structural Components Wood Connectors / Anchors Truss Plates Engineered Lumber Railing Coolers/Freezers Concrete Admixtures Precast Lintels Insulation Forms Plastics Deck / Roof Wall Prefab Sheds Other 8. New Exterior Envelope Products Applicant's Signature Applicant's Name Please Print) June 2014 0 Category / Subcategory ' Manufacturer Product Description(including Florida Approval # decimal) 3. Panel Walls Siding Soffits Storefronts Curtain Walls Wall Louver Glass block Membrane Greenhouse E.P.S Composite Panels Other 4. Roofing Products Asphalt Shingles C¢ a;t1 Lo,n w+Ar SC4L+LI —1Z Underla ments W rc7 ISa16- 123. Roofing Fasteners Nonstructural Metal Roofing Wood Shakes and Shingles Roofing tiles Roofing Insulation Waterproofing Built up roofing System Modified Bitumen Single Ply Roof Systems Roofing slate Cements/ Adhesives / Coating Liquid Applied Roofing Systems Roof Tile adhesive Spray Applied Polyurethane Roofing E.P.S. Roof Panels Roof Vents Other June 2014 1M111111111111111111111111111111111 I`If;Fi''t rl lhdl: HOBiE60111,10LE C'OUh1T Y C: LE?;(; OF i 1R'C:U1-f COURT & CWTTROLLER THIS IN TRUIv ENT PREPARED BY: Address: Y' _ R zZ Av C-(_ ERK' S x 2016114194. e RECORDED 1.1/1-1 /?1.i16 i, -41 :t'? F'11 u L RECOUNTYMSN State of F orida FLORIDAs NATURALCHOKCE It;'.rOrFitD)ELt a BFf LLniJie5o.1i-'i rlail NOTICEOF COMMENCEMENT Permit Number Parcel ID Number (PID) 33 — 19 —30 -.S'13 — e000 - /b%b 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. DESCRIPTION OF PROPERTY ( Le description of the prope and street address 'f available Lai Io1 m , rt- or k 13 Sy h G5 ry Et GENERAL DESCRIPTION OF IMPROVEMENT re rao P OWNER INFORMATION Name and a ress: a33 w LA CONTRACTOR Name and address: 1"Z'20 2-7l y o r D2- PpfL 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 and address: In addition to himself, Owner Designates of 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 vear 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 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. STATE PF FLORIDA COUNTY OF SEMINOLE O E S SIGNATURE OWNERS PRINTED AME NOTE: Per Florida Statute 7 t6i ) (g), owner must sign...... and no one else may be perrni ed to sign in his or her st The oregoing instrument was acknowledged before me this day of by Who is personally known to me Name of person m king statement r C=111 CV OR who has produced identification type of identification produce4;- VERIFICATION PURSUANT TO SECTION 92.525, FLORIDA STATUTES.UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING AND THAT THE FACTS STATED IN ITARE TRUE T THE BEST OFMYKNOWLEDGEANDBELIEF.SIGNATURE OF NATU ERS SIGNING ABOVE JESSICA L, PEEBLES MY COMMISSION t FF 142972 LL a or 0 EXPIRES: July 17, 2018 i• . `) J rFOF F P\o! Bonded Thru Budget NotaryServices No rySignature L 00 `^ Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: I— -- Cr— V6 I hereby name and appoint: t-it nY` `- 'ZZ \ an agent of 14A -2-"Zc3 LOB f t 1 \ 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 pnd application for work located 10'02 Yl yo Wgc in c C'`l.- 3"1 ` I Expiration Date for This Limited Power of Attorney: - — — 1 License Holder Name: ArJ-4) m `1 (2- -z:i o State License Number: C(-C l 3 a 6L4 S a Signature of License Holder: STATE OF FLORIDA COUNTY OF M The foregoing instrument was a5knowledged before me this I day of 1 JOVQI*n1 200 V.6, by VA Q0 who is ersonally known to me or a who has producee as identification and who did (did not) take an oath. i Notary Seal) M 1 &a E C LA f X Print or type name dtF" pia' MICHAEL LAROCK Notary Public - State of Florida Notary Public -State of v-A My Comm. Expires Dec 26, 2016 Commission No. Commission # EE 858690 E E $SE36gZ My Commission Expires: 1 a -06- ( Rev. 08.12) Prepared By and Return To: Home Loan Alliance Title 711 E Henderson Ave Suite A Tampa, FI 33602 File No. 2016100083 Property Appraiser's Parcel I.D. (folio) Number(s) 33-19-30-513-0000-1070 SPECIAL WARRANTY DEED THIS SPECIAL WARRANTY DEED made this October 27, 2016 by GTE Financial DBA GTE Federal Credit Union existing under the laws of Florida, and having its principal place of business at 711 E Henderson Ave, Tampa, FL 33602, hereinafter called the grantor and Ashley Twilley Ashley Twilley, a Single Woman 100 whose post office address is 233 E Wilbur Ave Apt 21, Lake Mary, FL 32746, hereinafter called the grantee Wherever used herein the terms "grantor" and "grantee" include all the parties to this instrument and the heirs, legal representative and assigns of individuals, and the successors and assigns of corporations ) WITNESSETH That the grantor, for and in consideration of the sum of $ 10 00 and other valuable consideration, receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens, remises, releases, conveys and confirms unto the grantee, all the certain land situated in Seminole County, Florida, viz As shown on Exhibit A which is attached hereto and incorporated herein by reference Subject to encumbrances, easements and restrictions of record and taxes for December 31, 2016 TOGETHER with all the tenements, hereditaments and appurtenances thereto belonging or in any wise appertaining TO HAVE AND TO HOLD the same in fee simple forever AND the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple, that the grantor has good right and lawful authority to sell and convey said land, and hereby warrants the title to said land and will defend the same against the lawful claims of all persons claiming by, through or under the said grantor Special Warranty Deed (corporation) SPECIAL WARRANTY DEED Continued) IN WITNESS WHEREOF, the grantor has caused these presents to be executed in Its name, and Its corporate seal to be hereunto affixed, by Its proper officers duly authorized, the day and year first above written I d, sealed and delivered in our presence Witness Signature) Iu. Punt Vame of Witne Witness Signature) r I C Print Name of Witness) STATE OF Florida COUNTY OF Hillsborough GTE Finance I BY' Kim Yarnell) P Address I Credit Union of Home Loan Alliance 711 E Henderson Ave Tampa, FL 33602 I,Amalia T Stevens , a Notary Public of the County and State first above written, do hereby certify that personally Kim Yarnelli appeared before me this day and acknowledged the due execution of the foregoing instrument Witn ss my hand and q Ic I s al, this the N ar Public My Commission Expires SEAL) speasl Werra* Dead(corporation) AMALIA T STEVENS MY COMMISSION #FF075438 EXPIRES December 10, 2017 407) 398.0163 fiOntlallolaryServiee com SPECIAL WARRANTY DEED Continued) EXHIBIT A Lot 107, Mayfair Oaks, according to the Plat thereof, recorded in Plat Book 50, Page(s) 38, of the Public Records of Seminole County, Florida SperAel Warr" Deed (Corporation) CM-1320432 ; 3050 Halliday Ave Apopka, L Baas a, Job Scheduling 407-8 e'se Lnfo(fri7zoroofI I xonr g sssua a Orlando's Home Town Roofer DLT 41 o CONTRACTOR AGREES TO PROVIDE LABOR AND MATERIALTO COMPLETE THE WORK DESCRIBED IN THIS AGREEMENT. WOOD REPLACEMENT, IS CALCULATED AT UNSEEN DAMAGE AND IF ROTTEN WOOD EXISTS AFTER TEAR -OFF IT WILL BE PHOTO DOCUMENTED AND REPLACED AT AN ADDITIONAL COST ABOVE THIS ESTIMATE AT THE FOLLOWING SPITULATED PRICING. Fascia wood = (1" by pine t@ $8.00 per ft.), (2" by pine @ $9.00 per ft.). Structural = (2" x 4" @ $8.00 per ft.), (2" x 6"@ $9.00 per ft.), (2" x 8" @ $10.00 per ft.). Decking (1"x 6"pine @ $7.00 per ft.), (1 "x 8" pine @ $8.00 per ft.). (1"x loll@ $9.00per ft.). 4'x 8' Sheet of ptywood or OSB decking $75.00 Contractor is not able to estimate unseen rotten wood damage or second layers of roofing until roof has been removed. COMPLETE ROOF REPLACEMENT includes roofing permit and all inspections, 1.tear off and disposal of € NE layer of existing roofing, 2. re -nail entire deck to wind code, 3, install 301b dry -in felt, replace at[ boots vents and flash valley with peat and stick 4. Include COMPLETE INSTALATION OF ROOFING BELOW. Unit Cost Total Cost Architectural Shingles 35 yr,130 MPH Attachment sq. -!. 3Z6iv ur Per -meter Edna Afetaf Burt Vtfite 0, c,Yr / 352— FT AT 91Iflriztn _ 7-1" ea.nai.rtud i7n"F eystam 4 lol- s Additional Terr-ofF over (0N€) layer q 'c Wood Replacement in considered unseen damage and it an extra expense above this eattimate Malinnd above, ROOF TOTAL PRICE y 467 5 z Skylights 7x2 4 x2 _-___— f Wall Hashing ft_ Z Flashing it. Chimney Flashing It.^_-- 4 _ Peal and Stick High Performance 0nderlayment (UPfi0N) sq '1. 0-1 TOTA , AA4--LENT TO BE' E A—, FOLtDN1 -T.D: At Time of.Contraut -- i At time of Material Deliverf on Completion LEGAL NOT±CE UNLESS OT't IERWiSE AGREED TO IN WRITING PRIOR TO START OF WORK: PAYMENTS RECEIVED LATER THAN TEN (10) DAYS WILL BE LEVIED A $150 00 LATE FEE AND SERVICE CHARGE OF 39%PER MONTH .THE UNDERSIGNED AGREES THAT THEY WILL BE RESPONSI- BLE FOR THE COSTS OF COLLECTION OF ANY UNPAID BALANCE, INCLUDING REASONABLE ATTORNEYS FEES. The custaner vxill be refunded 100% of any deposits if canceling this contract within three days. Cancellations made after third (3) business day, will result in the contractor retaining 30%of the total price as a restocking fee. WARRANTY: (5) Years covering defects in workmanship on complete re roof and 1 year on all repairs. Manufacturer warran- ty extended to Customer upon payment in full for work completed. PRICES ARE GOOD FOR 30 DAYS AND AFTER ARE SUBJECT TO CHANGE. Contractor is NOT responsible for interior damage from water penetration into any structure unfit the finished roof as been completed that is not a direct act of negligence. The contractor is NOT responsible for plumbing lines or damage from plurnbing lines run within 4" from the bottom of the roof decking. Contractor assumes no liability for damages to driveways, walkways, structure cracks to walls or ceilings or landscape that is not a direct act of negligence by the Contractor. 1 vi' Boots off RV / Ridge vents Sclhug, A>socialc 3 Boats Cap End Caps 4" Boots Starter Strip Wall Flashing 4" J Vents Valley flashing Peel B Stick Dole 10" J Vents Edge Metal Existing Skylights Any alterations or deviation from above specified scope of work will be executed only upon written orders and will become an extra charge over and above ;he estim te. Rico Roofing is equipped with all the necessary licenses and insurances required by the State of Rorida to provide contracting services in the roofing industry. This proposal with an owner authorized signature and upon final approval by Rizzo Roofing corporate office will become a contract directly between the signed owner and Rizzo Roofing. rhrs agreement constitutes the entire understanding. The Authorzed signature warrants that he or she is the equitable owner of the premises ar represents the owner math viable documentation. Thank you for your business we look forward to serving you- OxN Sigluizuttrtue_ J 1_•• _ Printedivarnc_ Do The ttatiivri_.:vd si nauvc Al w hoe by ,1} noktledgcs thn liale mad and Barg-ee eniii0v to rheltrnas and scalic s Thai are inu'rportduj in this prapasal _ SCPA Parcel View: 33-19-30-513-0000-1070 Page 1 of 2 Property Record Card UaddJa .CFA Parcel: 33-19-30-513-0000-1070 P Owner: GTE FEDERAL CREDIT UNION Property Address: 162 LONDON FOG WAY SANFORD, FL 32771-7761 VaParcelInformation lue SummaryrY Parcel 33-19-30-513-0000-1070 Owner GTE FEDERAL CREDIT UNION Property Address 162 LONDON FOG WAY SANFORD, FL 32771-7761 Mailing 425 PHILLIPS BLVD EWING , NJ 08618- Subdivision Name MAYFAIR OAKS 331930513 Tax District S1-SANFORD DOR Use Code 01-SINGLE FAMILY Exemptions 50 a 104 50 I yg dl Legal Description LOT 107 MAYFAIR OAKS PB 50 PGS 38 THRU 41 Taxes 2017 Working 2016 Certified Values Values Valuation Method Cost/Market Cost/Market Number of Buildings 1A 1 Depreciated Bldg Value 123,576 118,625 200DepreciatedEXFTValue1 $200 Land Value (Market) i $32,000 32,000 Land Value Ag Just/Market Value " 155,776 155 25 Portability Adj•_..._..________.—.___ v_..__...._. I Save Our Homes Adj 0 I $0 Amendment 1 Adj 0 0 P8G Adj Assessed Value A 155,776 150,825 Tax Amount without SOH: $3,023.37 2016 Tax Bill Amount $3,023.37 Tax Estimator Save Our Homes Savings: $0.00 Does NOT INCLUDE Non Ad Valorem Assessments Seminole County GIS Taxing Authority Assessment Value Exempt Values I Taxable Value City Sanford $155,776 I 0 155,776 l 155,776SJWM(Saint Johns Water Management) 155 776 i 0 County Bonds 155,776 76 County General Fund 155,776 00 155 776 N Schools Y 155,776 i sot 155,776 Sales Description Date Book Page Amount Qualified Vac/Imp CERTIFICATE OF TITLE 11/1/2015 1 08580 0129 i $100 !.No Improved CORRECTIVE DEED 3/1/2015 438 11976 100 1 No Improved WARRANTY DEED i 12/1/2002 64643 0397 100 ! No Improved WARRANTY DEED 112/1/1996 03180 0444 106,700 i Yes Improved Find Comparable Sales Land Method Frontage Depth Units Units Price Land Value LOT ( 1 1 $32,000.00 f $32,000 Building Information Is Bed/Bath count incorrect? Click Here. Description Year Built Fixtures Bed Bath Base Area Total SF Living SF Ext Wall Adj Value Repl Value Appendages ActuallEffective f 1 : 1996 8 "_, 3 2_5 '. 1,592 4 2,240 ? 1,592 . $123,576 $134,322 Description Area http://parceldetail.scpafl.org/ParcelDetailInfo.aspx?PID=33193051300001070 11/2/2016 SCPA Parcel View: 33-19-30-513-0000-1070 SINGLE } ! CB/STUCCO FAMILY pFINISH i Permits Page 2 of 2 SCREEN PORCH 110.00 FINISHED GARAGE 1418.00FINISHEDi OPEN PORCH 120.00 FINISHED E Permit # Description Agency Amount CO Date Permit Date 03034 NEW -RESIDENTIAL ISANFORD 76,226 1 12/11/1996 9/1/1996 - Extra Features iption Year Built Units Value New Cost 1/1/2000 1 $200 http://parceldetail.scpafl.org/ParcelDetailInfo.aspx?PID=33193051300001070 11/2/2016 CITY OF SANFORD PERMIT APPLICATION Application # : Submittal Date: Job Address: /3 bd 1eZA X A114 &7- ..Pp. Value of Work: S Parcel ID: Zoning: Historic District: Description of Work: N/C cd RI/V r"r 6 f " <1yrc /`> a sP Square Footage: Permit Type: Building Electrical Mechanical Plumbing )'Q Fire Sprinkler/Alarm Pool Sign Electrical: New Service - # of AMPS Addition/Alteration Change of Service Temporary Pole Mechanical: Residential Non -Residential ! Replacement Neyv Cl (Duct Layout & Energy Calc. Required) Plumbing/ New Commercial: # of Fixtures eOf# of Water & Sewer Lines it # of Gas Lines ) Plumbing/New Residential: # of Water Closets _ z!9- Plumbing Repair - Residential Commercial Occupancy Type: Residential Commercial ,K Industrial Occupancy Use Group(s): Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required) Property Owner: Contractor. g2AZS .AJ sr Address: Address: 27,el n,-,6 e /on, /"-->fz. J Z7-- Phone: E-mail: Phone: 6&7-LM 23 State License Number. 0,0& Bonding Company: Mortgage Lender. Address: Address: Architect/Engineer: Phone: Address: Fax: Plan Review Contact Person: Phone: Fax: E-mail: 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. 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. 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. Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713. Signature of Owner/Agent Date Print Owner/Agent's Name Signature of Notary -State of Florida Date Owner/Agent is _ Personally Known to Me or Produced ID APPROVALS: ZONING: Special Conditions: Rev 07.07 UTIL: FD: S e Contractor/Agent Date Prin n r/ gent's Name Signa of Notary -State of Florida `Date/ G Y P' JOHNTWULVAPIK MY COMMISSION # RD 663796 EXPIRN s Fiw• 4 E_UPU oddTTrruNotaryublcUnderwritersCly,, -_. Produced ID ENG: BLDG: CITY.OF SANFORD BUILDING SERVICES Residential Re -Roof Hurricane Mitigation Inspection Affidavit 01 3 Permit #: 1(4y___C:;1_ I, ' I N u ' L hereby acknowledge that I personally inspected A Roof deck nailin an rx, Secondary water barrier work at 1 b c?, Lov,Aoy-) Job Site Address) a Ll 4xO YJ 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 or her official duty shall constitute a misdemeanor of the second degree pursuant to Section 837.06 F.S. l( Ll Signature of Contract Date A t,-D k•Jy\ n 2-i ZZb CCC L4 ` c 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 C7 Y 'CA Y1 S rnt (o Taffir d) and subscribed befor . © of N aMbU2 , 20 ( , by 11 1 \??JD , who ' Personall Know a or has Produced (type of identification y as identi ication. gna ure o otary Public State of Florida Print/Type/Stamp Name % MIublic -CHAEL statA. e of 1 ta Nolary Public -State of Florida of Notary Public ,'-Fry Expires Dec 26, 2016 s Commission 4' EE 858690 y`"6:. .._r--•w, -• •mil 3