HomeMy WebLinkAbout115 Wornall DrCSI CITY OF SANFORD
�'- BUILDING & FIRE PREVENTION
D 2016 PERMIT APPLICATION
BY. Application No:
Documented Construction Value: $
Job Address: �� 0 ('Dr �"—` Iii toric District: es ❑ No
Parcel ID: Residential Commercial ❑
Type of Work: New ❑ AdditionAlteration ❑ Repair ❑ Demo ❑ Change of Use ❑ Mover❑
Description of Work: Rk
()Ol C ry)C'� 4 US I Q c r-(
Lc- cAror-c,'e_s
Plan Review Contact Person: dot ►-rrkc l rtQ Titl-e/: L �e n�P L�LIQAO'
Phone: Ux1951 tasD Fax: '67 9511 enzV Email• ` iQ,Y► a (�. pppf:i� Van Y. (-O-M
Property Owner Information L16-7
II� � LQ �1 �
Name �j (e✓I L lgtu)i L
l o Phone: 16-7 O bzO pl
Street: W61,10 [I �� -- (z- - --7 Resident of property?
City, State Zip: 'Yn ��� C �YG� -7
Contractor Information
Name C I'l , LLGPhone: L167J U�
Street:GOLVet Fax: q62 �%
City, State Zip: State License No.: CCC 1 S3 6C�70
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. 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: 51 Edition (2014) Florida Building Code
Revised: June 30, 2015 Permit Application �- I
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 1 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 coggtruction and zoning.
A.,J
lZ l I
Signature of owner/Agent Da
E*res: FEB. 20.2018
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Personally Known to Me or
Type of ID
Owner/Agent is
Produced ID
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Date
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EX ires: FEB. 20, 2018
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Contractor/Agent is k Personally Known to Me or
Produced 1D 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 ❑ # of Heads
APPROVALS: ZONING: UTILITIES:
ENGINEERING:
COMMENTS:
FIRE:
Flood Zone:
# of Stories:
Plumbing - # of Fixtures
_ Fire Alarm Permit: Yes ❑ No ❑
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Permit Application
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 12 S lsz
I hereby name and appoint:
an agent of:
(Jame
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 s ecificPRrmit and
L 'rc'::� 01101(110
at:
r--4 T4 3Z
Expiration Date for This Limited Power of Attorney: n ( 1 -I
License Holder Name: , 1 Cl 1�1(I VA Q P 1(J( rl L X04
State License Number:
Signature of License F
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before me this ('�� day of M
200_1_(g_, by TA YL b pSI C-
a-niq dZro I1 who ispersonally known
to me or o who has produced as
identification and who did (did not)xakg,an oath. ,
(Notary Seal)
,., Chris De'ahoz
EOommision#FF09A299
i ExpiRs:FF9.20�2018
� wwwAazonNorAr�t�m
(Rev. 08.12)
Print or type name
Notary Public - Star of
Commission No. c'f
My Commission Expires: T-� 2br
t V THIS INST ENT P EPARED B
Name: O
n 12
cre�3s: i
r
NOTICE OF COMMENCEMENT
State of Florida
County of Seminole
Permit Number:
MARYANNE 1'IORSE r SEI1I1•IOLE COUNTY
CLERK OF' CIRCUIT COURT & COMPTROLLER
LK 8827 P9 1369 (1Pgs)
CLERK'S v 2016131222
RECORDED 12/19/2N6 12:56:--.P11
RECORDING FEES $10'(10
RECORDED BY hdevor-2
Parcel ID Number.
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.
Le CO
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v�mcr� mry rrrvn.
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Name: O L
Address: C
Fee Simple Title Holder (if other than owner) Name:
Address:
CONTRACTOR: rJ �U
lam, r (yi U�—
Name:
Address: ori-- L L
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:
rp'yoti
Address:
In addition to himself, Owner Designates Ain�--
To receive a co of the Lienor's Notice as Provid,
...�PY••.....: o
r
Section 713.13(1)(b), Florida Statutes.
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Expiration Date of Notice of Commencement The expiration date is 1 year from date of recording unless a
different date is specified)
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Q
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,
z =CO
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
g
N
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
z
BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
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Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true
Q, i j o
to the best of my knowledge and belief.
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oda�n& �JAA lean ' I Now(ir)
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Owner's Signature Owner's Printed Name
v
Florida Statute 713.13(1)(g): ' The owner must sign the notice of commencement and no one else may be permitted to sign in his or her stead.'
State of 412940-6 County of
The foregoinginstrument wasacknowledgedbefore me this day of C�LCJ�-��6 .20
by Sri �.i i E- — 1i CTwL11u Who is personally known to me ❑
Name of person making statement
OR who has produced identification type of identification produced: D rZ1VryLS,, L- c.etLS6—
Chris Delahoz•'
' � ,11r Comrtu�Sion#FF094299
' ;Expires: FEB.20.2018
�jaWN Notary signature
Page IV
0 0 0 F A R M Y
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Roo! Army, LLC. proposes to famish and install labor and material in accordance with the above specifications,
and subject to conditions found in this agreement, for the sum of
Total $9,309.73
TERMS:
Total Order paid with signed contract. Building Permit is included. Job related debris to be removed from job site.
$ 9,309.73
(Total Order)
$ 3,103.25
(Paid with Order)
$-------3,103.24
(Due upon Completion of Project)
$ 3,103.24
(Due upon Completion of Final Inspection)
PrintName: Dahle I NOWllfl
Da
By
CITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #: \ (o��
I'�rr-rA hereby acknowledge that I personally inspected
0 Roof deck nailing and/or 0 Secondary water barrier work
at 11 c`b (�'�f�c,CYl���r c�"ccA VL 327711 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
undernd that making any false statements in writing with the intent to mislead a public servant in the
perfo nce of his oy- her offic#1 duty shall constitute a misdemeanor of the second degree pursuant to
Sectioh 837.06 F
. 77 - : I ,
�,Gr • C r01 a I"IMM bontractor License
�+
License Type: 0 General 0 Building 0 Residential Roofing Contractor
0 or any individual certified in accordance with F. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF <�CI`111C;OIe
Sff o- o (or affix d) a d ubscribed before me this day of 20 7 . by
r� ,who Is D Personally Known to me or has duced (type of
id tilirnl L L as identification.
jawwrya�(o EEAIL)
cn
Signa r otary NOTARY PUSUC
State o Florida MSTATEOFFLORIDA
7/21/2019
of Notary Public