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Home My WebLink About1503 E 2 StI CITY OF SANFORD PERMIT APPLICATION Permit # :O� Date: _ Job Address:✓ L • 2%!D �l i Description of Work: aal� "- ��►C x-D-�a Historic District: Zoning: IT Value of Work: S /V' P. /o Permit Type: Buildingy Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool Electrical: New Service - # of AMPS Add ition/A Iteration Change of Service Temporary Pole Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required) Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines Plumbing/New Residential: # of Water Closets Plumbing Repair - Residential or Commercial Occupancy Type: Residential Commercial Industrial Total Square Footage: � 1 Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: (Attach Proof of Ownership & Legal Description) Owners Name & Address: Phone: Contractor Name & Address: f U State License Number: Phone & Fax: �/ Contact Person: 1/�Il60 [= Phone: Bonding Company: Address: Mortgage Lender: Address: Architect/Engineer: Phone: Address: Fax: 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. 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. 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 watF agement districts, state agencies, or federal agencies Acceptance of it' verification that I yali no fy the owner of the property of the requirements of Lien Law, FS 713. ........................ Special Conditions: 6yNBRiEA6l t wnn. COWOODD03876Gf °fir °v" � 111YI10N ,® eptdon (800)431AM ......... .....Ti�.A.�iii..�i.• igV re of Ow Agent � Date Signature—ontractor/Agent Date �l S et A 7roA/YS yj Print Owner/Ad e ' Name P:?int Name Signature of ary-State of Florida Date Signature Notary -State of Florida tLst T L. LOWMAN ARYCOMMISSIOSTATE D388731 EXPIRES 4/28/2009 BONDED THRU 1-88&NOTARYt Owner/Agent is Personally Known to Me or Contractor/Agent is = Personally Known to Me or _ Produced ID Produced ID APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD: (Initial ) (Initial & Date) (Initial & Date) (Initial & Date) ........................ Special Conditions: 6yNBRiEA6l t wnn. COWOODD03876Gf °fir °v" � 111YI10N ,® eptdon (800)431AM ......... .....Ti�.A.�iii..�i.• Licensed j-.-Sonded Insured ONE SOURCE ROOFING, INC. 995 West Kennedy Blvd., Suite 32 1660 Old Dixie Highway Orlando, FL 32810 Vero Beach, FL 32960 (407) 660-8010 (772) 567-4300 (407) 660-1259 Fax (772) 567-4650 Fax State License #CCC055607 SUBJECT-2TO-AGREEMENT yn' THIS AGREEMENT SUBJECT TO INSURANCE COMPANY APPROVAL r SPECIAL INSTRUCTIONS yr . Name:ILL 4 Address Cityt- ZIP: Date6/F. -c'1J Lrir), lk r` '� �, ��%r Home Phone I%tl�lnrkPhone: �--- - ��• �-� �,�, // SPECIFICATIONS OS lade of Shingle: -*i"""' '`__� ` —=_ -- l3�le of Shingle: j :. i-. •� � • r I ldColor of Shingle: / i •: '� LTJ Ridge Material: alley: �ts: P�I(unbing Stacks: t�d,LTear off L 'Yes ❑ No layers ,k.�F It: I�d"Pitch: 2 -story E1Remove trash from roof, gutters and yard otect landscaping where needed Xoll yard with magnetic roller Furnish permit SPECIAL ATTENTION AREAS xisting Driveway Damage .0-lYes ❑ No ET1 kyllghts: -1 [-6e,aks: r: 94terior Damage: [J -Replace Plywood: C s 1 L-`�' per sheet if needed. COMPANY'S LIMITED WARRANTY - 2 YEARS, ON ROOF REPLACEMENT AND ONE YEAR ON REPAIRS. PAYMENT SCHEDULE Personal checks must be made payable to One Source Roofing, Inc. Agreed Amount With Insurance Company. $ ! Supplement r } / $ 0&P'� l R Upgrade(s) Additional Work Requested By Customer TOTAL AGREEMENT AMOUNT Any upgrade(s) or additional work requested by customer that is not approved by customer's insurance company will be customer's responsibility and will become part of this agreement. PAYMENTS DUE One Source Roofing, Inc. DATE AMOUNT Deductible First Check Final Payment ACKNOWLEDGEMENT PRIOR TO CONSTRUCTION, I (WE), THE CUSTOMER, AGREES TO PAY ONE SOURCE ROOFING, INC. THE AMOUNT OF THE FIRST CHECK(S) I RECEIVE FROM MY INSURANCE CO. CUSTOMER ALSO AGREES THAT UPON RECEIPT OF THE BALANCE OF.TFiE,,WNDS DUE FROM THE INSURANCE CO., FINAL PAYMENT WILL BE PAID TO ONE SOURCE ROOFING, INC. CUSTOMER'S INITIALS 4, TERMS: This agreement does not obligate the homeowner or One Source Roofing, Inc. in any way unless it is approved by the insurance company and accepted by One Source Roofing, Inc. By signing this agreement the homeowner authorizes One Source Roofing, Inc. to pursue the homeowner's best interests for a restoration service at a "price agreeable" to the insurance company and One Source Roofing, Inc. with no additional costs to the homeowner except the deductible. When "price agreeable" is determined it shall become the final contract price of S Z i Jit rr 1, and homeowner authorizes One Source Roofing, Inc. to obtain labor and material in accordance with the "price agreeable" and the specifications above. Any and all monies received from the insurance company as general contractor overhead and profit, supplements and/or cost increases will be paid to One Source Roofing, Inc. in addition to contract price above. One Source Roofing, Inc. shall not be responsible for any incidental and/or consequential damage iricluding, but not limited to, driveway cracks, loose wall or ceiling hangings, etc., and shall not be liable for any fungus, moll and/ or"air quality issues Felat d to this Work. Accepted by Insured on: Date: By; �fj`' `� f4 s'-,ii,;�- y C Insurance Company: Claim a: I . ( -E 4 j y) l _j Field Supervisor L- I t : \ �> ti p r - � i �� (' � Management Approval: WHIZ L - COMPANY YELDAO - FIELD SUPERVISOR PINK - CUSIi)N11.k 7— V - I I s� K2 CC y�oF r �c , Nay Tj:L-VD. r-1— 3 2810 NOTICE OF C0'r1l%1ENCEIti1EIiNT 9tS�flA..ygR..YtMORSE, 'ORSE, CLERK IF CIRCUIT CWRT QNTY BK 05741 PG 11 E,7 CLERK' S 4 2005087831 RECORDED 05/C7/^M 11106i3fi RM RECORDING FEES 10,00 RECORDED BY t holden CERTIFIED COPY M�RYANNE' MORSE CL A I CIR611T COURT 1 U-4841 _. _ . i-..= -?r3Cv �I`:95 .`.::�C3 5-3::n�rC'i9-dr;(51'N!:; :a .-ada :C ..era!r"aa! �rccary, ar.d ,„OCC..,dance wit -•fi vra. : J. �CriC3 :;rw,ced r.:h,s Nc:lca cf Cc,^;r7,a,n m ca ar;, Cascrip:lan of property (la^,al desc ip:icn :f :.-,a = _�ar:y, arc s:raa: a:d 1 rasa a•:aila:i_) 3 s C 2 yr. S am 3z 2. Gar,eral description of improvements) RE -ROOF JkptpLIC i� 3. Owner inforpmaticn n��ny Na.7 e 1 5*0 3 E. • 2NQ Tale bore Number Acdress � `� ,p^ Fax Number i -O W Interest :n Prepsry: s. Fee Slmp!s Title Holder (if other than owner shown above) Name Taiephona Number Address Fax Number _ i�11� SetaYLmo F I tv T --Q C Na. -a Teiechor,a Number OFFICE(407)660-8552 894 W.KENNEDY BLVD. ORL,FL 32810 Fax Number FAX(407)660-8012 6. Surety (if any)_ Name Telephone Number Address. Fax Number 'sf Amount of bond 5 7. Lender (if any) Na -e Tale --hone NLmCer Address Fax Number 3. Persons W;thin the S:a!e of Flcrtca des!grlaiad by Owner .•:)cn whom nc:toes cr o:her documents may be served as crov:cad by 713,13(1)(a)7, Florida S:atu;es. Nane Taie.hcns Number j Address Fax Number 9. In add::ion :a himself cr herself, Cwr.er desiyra!es ;he fcilcwir.y :o r_ceive a _cpy of the Lter.or's Nonce as provided in 713.13(1;(5), Florida Statutes. Vane Talephcne Number Adcress Fax Numoer 10. Expiration date of notice of commencement (the sxp?ra:tcn date is one year from the date of recording ur1e95 diffar ent da:e Is specified): y7�o �7W re l -Z CasaSS-ec S aa:erectGwn r No .-er7t3.13(t;(.g;, ............................................ m :sign... an no one s;se may a enri:;ed :c sl;n In LYNDA LEACH his ]r bar vdad. �punp {{ l agr r"� Co vi* OW387697 S'.vo , 'C ar„ sucsc,.cec before ma :his ay ?�' E)�irost/192009 Banded thru (800)432-425 h 0 is pers�nd ^ o Florida Notary Assn., In- R-o'.vn :c .Te CA produced ( as id "Cation. ••• ••• ••••••••••••• .•. . Date: I hereby name and appoint Ll�jD4 �cq ofOnoo -1 n L to be my lawful attorney in fact to act for me and apply to for a ^ permit for work to be performed at a location described as: Section Township Range 8 Lot Block Subdivision 2AI�1) Sf: (Address of Job) (Owner of Property and Address) and to sign my name and do all things necessary to this appointment, (Type or Print (S Acknowledged: e In CCC CTS -6 0� nam f Certified Contractor and License N) igaature of Contractor) Swom to And subscribed before me this Da of / ! I Y A.D. Notary Public; State of F orida My Commitc;on Expires: NorBEPrn•. LTOWMAN COMMISSION # DD388731 EXPIRES 4/28/2009 BONDED TNRU 1.88&NOTARYI AFFIDAVIT REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS Company: / Q License #: �G CJ� Project Information Owner: S/f name address phone Permit #:_0 S: — 6) 8 J q Subdivision: Lot #: I, , affiant, hereby affirm that I am the duly licensed contractor of record for the above referenced permit, that all the foregoing information is true and accurate, and that the dry -in, flashings at the above referenced address or lot has been installed in accordance with t4(,--pplicable codes and standards. vZY�' printed name STATE OF FLORIDA COUNTY OF _�Z� This instrument was acknowledged before me this day of 20 �y the above referenced individual, &��`3'�-�Cr/ , who acknowledged that he/she is a duly licensed contractor with 6 50va.-e-C , and who acknowledged that he/she was authorized to execute this document. He/she is either per ��,ne or produced as valid identification. WITNESS my hand and seal this o? -7 day of ,.2005 Notary Public FLORENCE A. DE GRAVE * MY COMMISSION # DD 16428` EXPIRES: November 12, 2001 ��0 Ronded Thru Budget Notary Service:,.