HomeMy WebLinkAbout301-308 N Lake St (2)Permit # : D, ` -s (., �qC
Job Address: '91f:S Q, Lfty-E
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION
3 \ ) _ 3 � Date:
L4 S �j a¢ e*h 44L s
Zoning: Value of Work: $ /J ted ""
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS Addition/AIteration 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:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: r �(Attach Proof of Ownership & Legal Description)
�o.,
Owners Name & Address: �`4-- ! r e -
Z -n3 » - L 4tDe- Phone:
Contractor Name & Address: �
Y State License Number: CCe J5S +7 C ,�
Phone & Fax: Orlando; Ft 32810 Contact Person: J YMDA LcA Gr) Phone: LJD4g Lt 3- 60G
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. 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, 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 ofFlorida ien Law, FS 713.
Signature of Owner A/ gent Date Signature o ontractor/Agent Date
1 J41 we �±Oh nSt&
Print Own r/ ame Print ontractor/Age is Name
68I'
otary-State o FI i Date S gnature o tary-State of Florida BETWE LOWMAN
NOTARY PUBLIC - STATE OF FLORIDA
COMMISSION # DD388731
EXPIRES 4/28/2009
Own gent is _Personally Known to Me or Contractor/Agent is _Personally KnowtitiMNMgFIRu I-eea NOTARvt
Produced ID - Produced ID
APPLICATI N APPROVED BY: BI Zoning:.
••^•(Initial &, 'dt.)............
LYNDA LEACH ""x
Special Conditions: °��uri C nwA
P c.2�.f GOOie7s9�
moM V1U M
(Initial & Date)
Utilities:
(Initial & Date)
M41
FD:
(Initial & uate)
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company: License #:
One Source Roofing Inc.
894 W. Kennedy Blvd.
Orlando, FL 32810
Project Information
Owner: Permit #:
name
Subdivision:
address
Lot #:
phone
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 the applicable codes and standards.
Contractor:
signature
)qu-t-r-JoaN5D►4
printed name
STATE OF FLORIDA
COUNTY OF V
This instrument was acknowledgq
above referenced individual,
duly licensed contractor with
he/she was authorized to execute th
produced
day of , 200S , by the
who acknowleg
ged that he/she is a
=.-J..�-._..--; and-who-acknowled2ed that
document. Wsh$eA�eitheer personally known to me
WITNESS my hand and seal this day of '200-5.
BETTY L. LOWMAN Notary P c
NOTARY PUBLIC - STATE OF FLORIDA
COMMISSION # DD388731
EXPIRES 4/28/2009
BONDED THRU 1-888-NOTARYI
ONE SOURCE ROOFING, INC.
995 West Kennedy Blvd., Suite 32
Orlando, FL 32810
(407)660-8010
(407)660-1359 Fax
2 -139 -
State License #CCC055607
AGREEMENT
Name: V/-,
Address: L'1l G'r__--
r
City: �G�rj C'✓ L/ ZIP:_ Dater -
Home Phone: 1'f a —�-7*" &-"yWSSork Phone:
..SPECIFICATIONS
(Grade of Shingle: !3 ,
r,
��yle of Shingle:
E,1 :01or of Shingle: Li -.-1
E?A,idge Material:
Galley:
2Vents:
E;'Plumbing Stacks:
ER-lear off EZ -,Yes ❑ No layers
C-1-relt:
, tch: 2 -story i.-- '
L�emove trash from roof, gutters and yard
C�J�/,.RProtect landscaping where needed-
oil
eeded-
oll yard with magnetic roller
F�Furnish permit
SPECIAL ATTENTION AREAS
E1 Existing Driveway Damage a- Yes ❑ No
�kylights:
at eaks:
[Anterior Damage: .40
aAII sheathing lobe replacedQr „L; �er sheet L.F
1660 Old Dixie Highway
Vero Beach, FL 32960
(772)567-4300
(772)567-4650 Fax
SPECIAL INSTRUCTIONS
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 Customer. $ Z <
Additional Work Requested By Customer $
TOTAL AGREEMENT AMOUNT $
CK# DATE
Down Payment
Materials Check $
Final Payment $
ACKNOWLEDGEMENT
UPON SIGNING THIS AGREEMENT, CUSTOMER AGREES TO PAY ONE SOURCE ROOFING, INC. TEN (10) PERCENT OF THE TOTAL AGREED
AMOUNT. UPON DELIVERY OF MATERIALS, CUSTOMER AGREES TO PAY ONE SOURCE ROOFING, INC. HALF THE TOTAL AGREED AMOUNT FOR
THE PROJECT. UPON COMPLETION OF THE PROJECT, CUSTOMER AGREES TO PAY ONE SOURCE ROOFING, INC. THE BALANCE DUE FOR THE
PROJECT. CUSTOMER'S INITIALS
TERMS: This is a binding agreement. Any additional work requested by the General Contractor/Customer will become part of this agreement and General
Contractor/Customer agrees to be financially responsible for all amounts due herein. By signing, this agreement, General Contractor/Customer authorizes One
Source Roofing, Inc. to undertake the construction of project through to completion, and General Contractor/Customer agrees to pay One Source Roofing, Inc. all
amounts due herein.
PERSONAL GUARANTEE: I have reviewed this agreement and by executing below, agree to be personally responsible for all sums due and owing to One Source
Roofing, Inc., agreeing to do work for and on behalf of my company or other entity. One Source Roofing, Inc. shall not be responsible for any incidental and/or
consequential damage including, but not limited to, driveway cracks, loose wall or ceiling hangings, etc., and shall not be liable for any fungus, mold and/or indoor
air quality issues related to this work. This proposat/contract is valid for fifteen (15) days
Accepted by General Contractor/Customer on: Date: _k1 �% By: 1 , t-4-L.L_
By:
Field Supervisor: p Management Approval:
WHITE - COMPANY YELLOW - FIELD SUPERVISOR PINK - CUSTOMER
POWER OF ATTORNEY
Date_
I hereby name and appoint L%t.I 1)a too C(4
Of OKIC-- -6;0U4CF- 'V----;`0 6 aJG
In fact to act for me and apply to the 5 (+M(,GM
Building Department for a�
For work to be performed at a location described as:
Section Township Range
Subdivision
Lot
to qe my lawful attorney
lock
permit
(Owner of Property and Address)
and to sign my name and do all things necessary to this appointment_
dice op)--ptj Ecco s!5,io
Type or Print Name of Register or CeAifted Contractor and Contractor'l License Number
The fi
By_
was acknowledged before me this LT� day of
Who is personallyknown to me/wh produced
As identification and who did not take oath.
NOTBEPUBLIC L. - LOWM AO
State of Florida - COMMISSION # DD388'
EXPIRES 4/28/2009
County of A— BONDED THRU "888 -NOTARY
UCS/ i/'/u^"' Seal
otary Publi , range County, Florida
of 20
Division of Corporations
Florida Deparbnent of State, Division of Corporations
ij7�rl�iP, trrr ra.nr Public y
Florida Non Profit
Pagel of 2
NORTHLAKE VILLAGE V CONDOMINIUM ASSOCIATION, INC.
PRINCIPAL ADDRESS
C/O OFFICE SUPPORT SYSTEMS
753 S. RANGER BLVD.
WINTER PARK FL 32792-4527 US
Changed 05/01/1995
MAILING ADDRESS
PO BOX 5717
WINTER PARK FL 32793-5717 US
Changed 05/03/2004
Document Number
FEI Number
Date Filed
N12733
592615643
12/23/1985
State
Status
Effective Date
FL
ACTIVE
NONE
Registered Agent
Name & Address
FERRARA, WILLIAM G
C/O OFFICE SUPPORT SYSTEMS
753 SOUTH RANGER BLVD.
WINTER PARK FL 32792
Name Changed: 05/01/1995
Address Changed: 05/01/1995
Officer/Director Detail
Name & Address Title
WILSON, KERRY
708 NORTHLAKE DR VD
SANFORD FL 32773-6191
WECHTER, MS. PATRICIA
808 NORTHLAKE DRIVE PD
SANFORD FL 32773-6100
... /cordet.exe?a1=DETFIL&n1=N12733&n2=NAMFWD&n3 0000&n4=N&r1=&r2=&r3=&r,8/10/2005