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HomeMy WebLinkAbout326 Placid Lake DrCITY OF SANFORD l BUILDING' & FIRE PREVENTION. PERMIT APPLICATION Appli'c'ation No Documented Construction Value: 1{ V 3'27-7-3 Job Address 30.6 P lac* C ! aKe Thr, jQt1 f . Historic District: Yes No .O Pareel ID: Oatd,Q X30-5-)6- 0667 (1,1140 Residential5d Commercial Type of"Work: New Addition , Alteration Repair Demo- Change of Use move Description of'Work: R; -do {NPiY1St!.Ur1'11 t u F L Ia u. Tiorh VI%d'`(. n, -I` i_. 11 10E4 Df e-1AArPlanRevietivContact'Person: l: Phones HDq -,a Faa: $ 00 -33`7- ?Z 61, Email: e rlm l „ Properly"Dwne,r Information Name M aroaIe` I1 Mona Phone: 4 d IT — 3 q,8- -33 q S. Street: c7C to F 1 a6 d tkVP DT. Resident of property.)., City, State Zip: Scan mord 1: L 3D11 `-3 Contractor Information. Name 30-SD1191- CUYIi-t -a(l+D r -S Phone H 0-4 - alFs 71q g C Street: J5SD F CD10Y71011 Y. Fax: 00-3Sr -3-I0 { City, State Zin:: o Y (M Ab L 3 d' State License No.: t ( q YJ5 ArchitecttEngineer Information Name: Street: Phone - Fax: City,.S"t; Zip: T -t iaili Bonding Company: Mortgage .,ender: Address: Address IN YOUR, MU , ST BE OTAIN TICG Or Applictttion is.hcreby niatle'to obtain a permit to do tltc w"o"rk and, installations as indicated. I oertity that no,wdrk:or installation has commenced.priorto the issuance sofa pe'rinit and that all. work willtra performedao: meet standards of all laws regulating construction in this jurisdiction. 1 understand tliat:a'separate permit must be secured for electrical work, plumbing, signs, wells, pools, furnaces, boilers,, heaters, tanks,and air- conditioners, etc: Tilt, 10.3,Shall.be inscribed with''the (late of application and the code in effect as of that state. S'n E.dition (2014) Florida Building Code Revised: lune 30. 2015 PeenutApplication NOTICE: In addition tothe;requiretneni found in the public'mcords ofthis-eouInt3 manI ag , e rne I nt'dist'ricts,state.ag'et cies',br'I final restrictibils,a0plieabie to this, property that may' b6 required from other governmental -entities such as water Acceptance of perniitisvcrification that] will notify- the owner of'the. p 'perty of the require t f Florida Lien , Law, FS 711propertyicrequiremenso Thc,'City,6f Safif6rd requires payment of a plan, review fee at the time, of perrnit,submi I ttal. A copy'of the executed contract is, reiLfle&, in "order" to',calculate. a Plan revi , ew I charge and will I be onside-red,the, le I s1filvated construction I , 1 , V 1a11. 1-c'61F the jpb'a(,tll'e bine of submittal. Tl construction value Will be figured basM'on the; current ICC Valuation Table in effect -at,,the .iitile,tlie,"pernlit is issuedj,ih accordance with local ordinance. Should 'caleul6f6deh;lrgts figured off the' executed contract exceed the .actual construction value, credit will'be applied,to,y9urpermit fees:when.the -hermit ,is issued. OWNER'S AFFIDAVIT: I certifyify that all of the foregoing information is accurate and AhAt, all work will be,done, in complianco with all applicable laws re,gulilditing'construc,tlioln ana zoning. Sigiiatt.irle;ot'()ikiier/Agent Date Pr in t, 0 vncr/A ge nt ' s'N anic Signature of Notary -State of lorida Date Owner/Agent is _ Personally Known to Me or Produced'[D 17pe 'of ID 9bj- Sig6aturc ofContractor/Asent IJat U,; it a' SAMANTHA MURRAY my CoMMISSfO 11 N # f:F944322 EXPIRIES Decemt,er 16. 26i9 Contmictoy/Agent is-_Pqrsonally Known to Me or Produced ,1[3_ Type,ofll])--J--- BELOW IS I FOR OFFICE USE ONLY Te'rinits'Reouiried. 'BuildingE] Electrical F] MechanicalE] PI'mbingF] Gas n Roof Construction Type.:, Occupancy Use: Flood ,,Zonc: Total Sq Ft of Bldg,: Min..Occupancy,Loald- # ofStories: New Construction: Electric - #'of Amps Plumbing -,# of flitlur6 Vire,,Sprinkler Permit: Yes,P No,F A.ofl-leads Fire, Alarm Permit: Yes El NoEl APPROVALS`: ZONING: — IJTIIJTI ES: WAS`rt WATER: EN6 IN EERJNG: FIRE: BUILDING: COMMENTS: Revised: June 310,20,15, Perin it Application V15A xc vu Contractor's License # CCC 1329651 ROOF RE PLACEMENT CONTRACT Mortgage Cont anv:Informatiot Company,' ( 0, Loan Niittiber. Owner(s): Phone:. Address: " -> - [ Alt Phone-, City: Shingle Color: Email- {Roof f !'t< ? i 6?_/,C) 1• CtOr`t RCV rr) yt t . loll( Drip Edge Color: - x1 . Assignment of Insurance Benefits for'the Full Roof Replaccmer-t Only: I hereby a"s"sign any=d all insurance rigltts, benefits and.procecds, under any applieablc insurance 'policics to JasperContractors, Inc. (`°Jasper"), the.scopc of which shall be limited to a °Full Roof Replacemient. I make ibis assignment and aofhbrizatiotv.in considerationof Jasper's agreement i6perf6rm services', supple materials and otherwise perform its. obligations underthis contract, ineluding.not requiring full,payinent at ti c=time of'serice: 1 also, ereliy,diircct my instirer(s) to,releasc any and all information; requested by Jasper, its representative or, its attorney,fn 'the direct purpose of obtaining actual"bene lis to be paid by my insurer(s) for services rendered, In this regard, l waive my privacy rights., If payment'ismade dircc:tly to the Owtier/Agent/Insured(s), it shall be cndorsed over to Jasper immediately upon reccipt: I agree that any portion of work, deductibles, bettenncnt or,additt,onal work requested by the undcrsigrtcd, not covered by insurance, must -be Raid by the undersigned on the day of installation. - Deductible: -It is the Owner's responsibility to'pay all Insurance Deductibles:. ixvhee's tut -of -pocket expense will not;exceed the deductible antaunt, as started on insurer's loss sheet, UNLESS rep[ acen cnt/rcpair'6 deteriarated decking is required and/or Owner requests optional upgrades-Jasiter CANNOT pay, waive, rebate; or promise to pay, waive or rebate all or any part'of the insurance deductible applicable to the insurance claim for payment of work. Tn the event of a discrepancy; the, deductible, amount stated on the insurer's Loss Sheet. shall overrul. Deductible listed above. Deductible>.S° "r> MUST BEI'AIll II` FULL, PLUS APPLICABLE SALES TAX (initial). 1MORTGAGE_:A THORiZATION: 1, ©.vner/Mortgagor,,grant authorization (iqr t"-. e . Mortgage C cak with Jasper on matters ineludmg, butnot limited to, the claim;and drat status. (initial)" PAYMENT SCHEDULE: Owner agrees to pay Jasper based -ori the followingpay schedule: (i) Deposit in the, amount oC$ _ due upon ,sighing this .contract; (ii) the Contract Ptice, less the Deposit,and any applic' ,, epreciation retained by Ouvner's ins er } plus Upgrade Costs, due and payable to Jaspee upon completion of'work being performed; and, (iii) the rdniaining twontract Price, ,(equaI to any applicable depreciation and/or change orders) due and payable to Jasper upon completion of, work perfarrried. lac the even(' of'a pending a, Jasper acesto iUiflnsh all hiaterials svner's'insurance company's approval. insurance company fora fiill roof replacement, -Jasper shall perf6rm the roof replaccinent upon receipt of funds from Owner's insurance company. LAT 1 If owner elects to terminate the, services of.lasperi OWner May after Contract is executed. Qtvner-sliall receivea full refund of All deposits, Owner m thirdbusiness day after the contract is executed after•notifcation from,insurcr(s)'that, denied, in whole or in part. All written notices of cancellation, regardless of reason corlioratc office: 1955 Vaughn Road, Suite 209, Kennesaw; GA -311144. CANIQELLLA'I cancellation DOES NOT APPLY to .contracts for emergencyhome'repairs as time is; of 1, Owuer, h4vc'rcad and understand 'all.statenients, terms :ancl conditions of, the details are :acceptable and satisfactory. I further understandthat tlis.eontract consfit that any further changes or alterations to this contract must be madeAn writing represents. and' warrants to sthe other that it has the full power' alta/ authority to. ch enfnrceable'in accordance with its terms'. sbtcforc`midnight on the third business: day also rscind Contract before midnight on the claim -for payment,pn roof contract has been hall be -.postmarked or, delivered to .Jasper's tN EXCEPTIONS: The -three (:3) day riglit of Roof Replacement Contract" and agree that all utes the entir6,agrecment bet veen.the'parties and and agreed upon by both parties: Each party, ter Into °the contract and that it is binding and er Representative bate. Owner Date D CONDITIONS: Acceptance of Terms: I, Owner, hereby agree to retain Jasper for a fill roof replacement on the terms and i stated herein. I furtb'er'agrcr,ta provide Jasper with the Seope of Loss Repnrt.generaterl by my insurer and authorize and grant full the property fat the -purpose of staging and contpletiiig,all agreed upon work, Supplemental Cl:iiins: Jasper reserves the right to file -a ntal claim withC)tmer's insurance in the event that die- esthnate is incorrect and/or additional damage is discovered after Iti'IAI1IIL" i'0C7( ;EI1€'t0LL G'0UNT'f 6 t; sll _ C:] Ft 'til { 'G{ll{RT #< Cfl!'iF'i' OLLEEf u'fnr 1 1}3 i `2, ('iF9S EI i.'S u ?U 611600 L•tlSL'E.L' jj l/7 f'1111u I;I;;i:`il):IIa 1-I 11 NOTICE OF COI{ MENCEIUIENT State of Florida, County of Orange; The undersigned hereby gives notice" that improvement will be made, fo certain real property and in. accoedande, with Chapter 713, Florida Statutes, the fo[Iouving, information is'prouitled'iin this Not ceof`'Co rnencement: 1. 'Descri tion of property (legal descri tion of the property and street address if ava'ilabie) I. OI PLf CID )t OnS H 1 PQ 51 ,PQS a2THR'' Q9 2..GeE1 dsr'ption of improvement 3. Owner information or Lessee information if"the Lessee contracted for the improve ent Narine. r N k C ' 1:7 L 31121 Address Interest in Property t'I; blame and address of fee simple titleholder.(if different from Owneriisted above) Name Address 4: Contractor • 11 Name UQQSr1f1'"Y'CtG31r' Telephone Number I Q Address Ofl f `LA Se t?i T L. 5., Surety (if applicable, a copy of the payment bond is attached)' Name Telephone Number Address Amount of Bond 6. Lender Name Telephone Number Address 7. Persons within the State of Florida designated by Owner upon whom notices orot erdocuments may be served as provided by §713:13(1)(x)7, Florida Statutes. Name Telephone Number 8, In additionlo himself or herself, Owner designates the following to receiye.a copy ofthelienor's' Notice as provided in §713.13(1)(4}, -Florida Statutes., Name Telephone Number Address' I 9. Expiration date :of ,notice .of commencement (the expiration,date will.he 1 year from tV e,date of recording unless a different date is specified) WARNING TO OWNER:, ANY PAYMENTS MADE, BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OFCOMMENCEdtIENT ARE, CONSIDERED IMPROPER'PAYMENTS UNER CHAPTER 71.3, PART 1, SECTION 713.13, FLORIDA STATU S, Ah 6 CAN. RESULT IN YOUR, PAYING.TWIcE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENC'EMENMU$T BE RECORDED AND POSTED AN *HE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO'OBTAIN FIN NCING, ,CONSULT WITH YOUR -LENDER OR AN,ATTOR EY BEFORE COMMENCING wORKOR RECORDING YOUR NOTICE OF C mmENCEMENT Signature'of:Owner or Lessee, or Owner's or Lessee's Aulhodidd Officer/Director/Partner/Manager Signato 's'Title/Office Theforegoing instrument was acknowledged before me'this day of by moat year name o p • ., n as T. e.o au fol -. yp homy, e:g;, officer: trustee, attomey in fact Name of party on behalf of•whom instrum nt was• executed SignatGt6of Notary Public := State of Florida rint, type, or stamp commissioned r arrte of Notary Public Personalty Known OR Produced ID x Type Of ID Produced w{ r z(a two;'.lis i i AiRR6l4' 4 y t MY COMMIS 3104.# FF9,44322 i w v;f. + CXf'IFt(;9 p,c mgnr 16 20.19 13 „ IN I ` nm a yscN',wmCa3j — ll »+ Form"Content reviseB: 04723/14 43 LIMITED POWER OF ATTORNEY Altamonte S ring,s, CasselbO`iy Lake Mary, LongwOod, 6v edo Sgnf6ed, Setninclic Cotinty, 'Winter Springs ite- I Beret, pame artq_,,ap'p)iht: DANIELLE,DJAZ an' ag'61t of- .IAS PERCONTRACTORS 16 bo mylawfid attloYncy-lin-Aict,to mn(Drape to apply for. receipt for: signi (6r and do all thimm occelssm. v,to, this appointment for (elie& only olle optj(),)) All permits aid submitted by this c6hti ad6l'. GJ The slier ficl-perni i(aInd application for work located at: Expiration Date For TI is Limited PoNverOf Attorney: Liense Holder N. MICHAEL STEPHEN CCC1329651 Sic',pat,Ure of Licenseflolder: STATE OE PLORIDX COONTY OF 1"he fol-cs-'AtIL, ipstrulliell tw,,is,aqkiiowledge(l,belore,iiietli is day,of t20by Al 10AL. -1 A S , Nvho is personally knoNyn to picc or'tNlio has - as aced and %v'ho,did/dicl not takeffin,oath . Notary Public —State, of Commission Number My Commission Expires: CJ Product ApprovalSMaltdUSER: Public user tion PrgqurtAonrgvitiNeng proAuclnrAogi+c»iion,sl:= r:AgohcalionL- >AppllcctionDetail FL-# FLI7873 Application Type New Code Version 2014 Application Status Approved Approved by DBPR. Approvals by DBPR shall be reviewed and ratified bythePOCand/or the Commission if necessary: Comments Archived Product;Manufpcturer System Components Corporation Address/Phone/Email Po Box 2432 Issaquah, WA 98027 425) 392-5150 csh eph erd@systemeomponenis.net Authorized Signature Christopher Shepherd csheptierd@systemcomponents.netsystemcomponents.net Technical Representative Chris Shepherd Address/Phone/Email Pt) Box 2432 Issaquah, WA 9802.7 425) 392-5150 eshepherd@systemcori ponents.net. Quality Assurance Representative Address/Phone/Email Category Roofing Subcategory Underlayments Compliance Method Evaluation Report from a Product Evaluation Entity Evaluation Entity ICG Evaluation Service, LLC Quality Assurance Entity Quality Auditing Institute Ltd. Quality Assurance Contract Expiration Date 01/31/2018 Validated By Chris Bowness, P.E.. Valldation Checklist -"Hardcopy Received Certificate of Independence FL 17873 RO C01 ICC -ES Certificate of Independence Ddf Referenced. Standard and Year (of Standard) Equivalence of Product Standards Certified By Sections from the Code 1507.2.3 150TI3 180T54 1507 73. 1'507 8.3 ISOT9.3' 1507.9.5 l5i8,,2,,I- 1518.4 Product Approval',Method Method 2 Option,A Dbte Submitted 07/0312015, Date Validated 07/03/2015 Date"Pending FB'C Approval Date Approved '07115/2015 DeisOthea pressure N/A Evaluations Reports_ FL17873-R0 A C" atilctOs- 94 orthMnaroeStieet Tallahassee EL The State o6 Florida is an'AA/EEO employee anvrtoM 2007.9 X13 Stara ssitith is meet :: Retund Siatemcnt; o1Finrrcla .Pr"rvacv'S,itrlrmcnl A Under Florida law, email addresses. are —blic r;Mm.-.a.... ............:..:..._ _ _. , . • - ' M uIVIJIUN 01.0000—THERMAL AND MOISTURE PROTECTION SECTICIN::07,30 05—ROOFING FELT AND IINflER"'LAYNiENT REPORT HOLDER- SYSITEWCOMPONENTS CORPORATION POST OFFICE BOX 2432 ISSAQUAH, WASHINGTON 98027 EVALUATION. SUBJECT. FIEtTEXP`(9VLE )Q PRO 3000 ROOFINGUNE)ERLOM ENTS c PMG LISTED Lookfoithe trusted marks of conformity! 2014 Recipient of Prestigious Western States Seismic Policy Council fWSSPCJ Award in,Excellence" A Subsidia of rERWiGtut_ ry COOECOUHCIL• icc-'E'S Gvaluatioll Repoll.s rrre not to he con itvted its re rz sentin ;rtestheticc "or ani, other-altriheuer, rtat rpeci/ko ly aeldress'ed nor are lhcy? to, be c`7rnslrucrt-us art e efnrtiE nteut of the etriyee of,the report car a t recomwendatiun jdr its ttse: There is ndi %v riiriiiiv hI(G Ealucriinn iServiee. LLC. cxCpresxor intplieclas to riity jincllrtg uc• other. Matter in this• 1VTO t. ,rug ns.tu rnl`pt`rxluct covered by tine retjort. Copyright t7 2015 CITY OF SANFORD BUILDING SERVICES Permit #: !6-245$ I: SCOTT MEI.XSELL Residential Re -Roof Hurricane Mitigation Inspection Affidavit hereby acknowledge that I personally inspected oof deek nailing and/oi e -con& y water barrier work at 326 PLACID LAKE DR Job Site Address) was done according to the I lUrricane Mitigation Retrofit N'tanual and have determined that the work based on 753.844 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 state ents in writing with the intent to mislead a public servant in the performance of his or lie bffi shall constitute. a misdemeanor of the second degree pursuant to Section 837.i?6'T> / 10/26/1.6, e of Contractor Date CCC 1329651tx `_ Printed Name of Contractor License # License "hype: Ci C enelal BUildin=`A_ Odential 0ofing Contractor U or any individual certified in accordance with F.S. 468 to make such an inspection. STATE OF FLORIDA COUNTY OF, S-wo n to (or (firmed) aid subscribed before me t i 27) day of OCTOBER. Zp , by Who is f_ Personally Known to me or has 17 Produced (type of identlific tion), -f7Ca nn as identification. SEAL) Signal re f Notaryl'ublic State of Porifi SAMANTHA MURRAY t MY COMMISSION ff FF9,44322 Print/Type/Stamp Namcr`a* Y,, EXPIRES Decemoer 16.2019 of Notary Public 40r saa a1 Floaa..VservicaWr Revise( f ebr uar), 2015 LIMITED POWER OF ATTORNEY Altamonte Sp ings, Casselberry, Lake Mary, Longwood, Oviedo, Sanford, Seminole County, Winter Sprinigs Date: U u t I hereby name and appoint: ` an agent of: Name of Company) to be my lawful attorn§y-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): r&t All permits and applications submitted by this contractor. o The specific permit and application for work located at: 77 Expiration Date For This Limited Power Of Attorney: License HolderName; 1. 1 State License Number Signature of License Holder: STATE OF FLORIDA COUNTY OF The foregoingl instrument was acknowledged before me this _ 7 day of QcA 2U, by F e`h+' who is personally known to me/ or who has produced as identifica0ri and who did/did-not gpJA MURRAY 4 EXMR s peewraw 1E. 2M9 Notary Public - State of e— Commission Number My Commission Expires: _ j 2-) Lo _ A ` CITY OFSIANIFORDBUILDING SERVICE$ Residential Re -Roof. Hurricane 10?l141gotion tuspecfidfl Affidavit Perm it 9: !,6-2-85,9 SCOTT MEIX'SEIL hereby acknowledge that I personally inspected, L o(if'deck- nai I ing arld/orc;S -.Goiidary water, barrier, work at 326 PLACID LAE DR and hav'e' determined that the work 4ob Site, Address) was done accordingto:tlic Hurricane Mitigation Retrofit ManUal. (based on.5-53,844 F.S.) Icertif I y that my, statements herein are tirbe and accurate to the best "Of my' belief and, that I fullyy understand that making any false statetittritsIn Nyriting with the intent to njisleald.a public: servant,in the performance of,his or Ise ffieia shall const I itute a misdemeanor of the second degree pursuant to Section 837_06' / W_ A/ 10/26/16 0,11',Itt' re of Contractor Date CCC 13296_51 Printed Name,of-Contractor Licciis-e 11 License'l' Lenera - -ac'tovypp: L G I L" 2' gLi,ii.diii K sidentiil 4001-11" Conti U,or any individual certified in accordance with F.S. 468 to makesuch an inspection. STATE, OF FLORIDA COUNTY 0-F. tyCkndl' before Inc. Yis, da of ocTOBEk 20_ to affienied) ajid'subscribed be t 'y by s V fill [1 PtvflloIsFPer, ojlally Kno 1 6 to iie,o'i has -bdtleed {type of iden -f)C( kl .4 — as, identification., LZ ISEAL) Si re-f Nbtar.vlPublic State 01110"i LN t Of SAMANTHA MURRAY MY COMWISMN 9 FV,144322, Whit/1 ''le/Stahlip, N flle - mi EXPIRES Decemoef 16,2019yl of Notar 4010"4'53 Flo#N« ,ySeMw cm I?ei, li,, YetI.7,I,'c,brlil(ii: li 201.5 LIMITED POWER OF ATTORNEY tt Altamonte Sp. Ings, Casselberry, Lake Nary, Longwood, Oviedo, Sanford, Seminole County; Winter Springs Date: _ lo ack I hereby name and appoint:. N "o 3f h ( • Cd ` an agent of: of Company) to be my lawful attorney-in-fact to act for me to applyfor, receipt for, sign for'and do all things necessary to this appointment for (check only one option) - OL All permits and applications submitted' by thiscontractor. o The specific pekmit and application for work located at: L -CW e Street Expiration Date For This Limited Power Of Attorney: License HolderName 1"1is11.h State License Number;: Signature of License Holder: STATE OF FLORIDA COUNTY OF 1 The forego 2p J, by instrument -was acknowledged, before me this L day of Q or who has produced S\ham who is personally known to me/ as identification and who did/did not Ant Print or Type Name Notary Public State of _ , Commission Number `'l a' my Commission Expires: 2~ LQ _ n,