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JAN 2 61011
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: I — Documented Construction Value: $j 333 . O�o
JobAddress: 13 I-er71 Pen T'06— kzLj Historic District: Yes ❑ No ❑
Parcel ID: 33l Q — 1,0- S)3- 0000 — D I SV Zoning:
Description of Work: PC —`'QCL"G o CC- SF�1A:�LrE�
Plan Review Contact Person: 1.JO;�JE- I'-10 9 Title:
Phone: %-Albq r_774 ZZIST Fax: "-i 0 72 E-mail:
Property Owner Information
Name OSI Cq�T�Y1
Street: (2✓ 4� 'F'O (r
City, State Zip: 3
Phone:
Resident of property? :
Contractor Information
Name lint � >7 t�1�t�61 - Phone: 9--v25Le';t r��
Street: 446-Vot,1 WK Au. S`TF •2205 Fax: q67 -7 2 s .2 M
City, State Zip: �1r1'la's��.��'FCJ `f' State License No.:
Architect/Engineer Information
Name:
Phone:
Street: Fax:
City, St, Zip:
Bonding Company:
Address:
E-mail:
Mortgage Lender:
Address:
PERMIT INFORMATION
Building Permit D
Square Footage: $-7 �b /� -SqOACons/t�JStruction Type:
No. of Dwelling Units: I Flood Zone:
Electrical O
New Service — No. of AMPS:
Mechanical O (Duct layout required for new systems)
No. of Stories:
Plumbing O
New Construction - No. of Fixtures:
Fire Sprinkler/Alarm D No. of heads:
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.
The City of Sanford requires payment of a plan review fee. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges ex eed the documented
construction value when the executed contract is submitted, credit will be appliedto ur,�ermit fees when the
permit is released. �-,
61
ll4
Signature
Print Owner/Arsdt•ilmlaiAe� / , Print G6mractcr/AP�ditY•s Name
r ' ry RUDY F KEL5IGK-rte r //
l/ _�"f§�: RUDY F KELSICK-PETERSEN
•c MY COMMISSION q EE093T98 •: MY COMMISSION q EE093T96
EXPIRES May 21, 2016
• EXPIRES May 21. M16
407F
Owner/Agent is 3�e oral y newn_to-Me-o Cont 1 totr>3 Pe—rsonally Known to Me or
Produced 1D Type of ID Produced ID Type
APPROVALS: ZONING: UTILITIES: WASTE WATER:
ENGINEERING: FIRE: BUILDING:
COMMENTS:
Rev 11.08
Permit No.
Tax Folio, No. 33' 1 - 30- 0/5-0
NOTICE OF COMMENCEMENT
State of Florida
County of Seminole
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.
1. f?escription of property: (legal description of the property, and strect addmss if
NMNUK MRSE, CM OF CIRCUIT CAT
SENINOLE DANrY
BK 0770: Pg 0634; 11pg)
CLERK'S 0 2022008983
RECORDED 01/24/2012 04231226 PH
AMMINS FEES 10.00 Coo
QED BY J ENteuroth tal l )C>iRZPNN� MOcO�
N,
ca-- _.,,.F_ cAy
i K 01U -ICS
2. General description of improvement: F v sit i
3. Owner information: Name:
Address: 1
b. Interest in property: M r0n Bbl—
c. Name and address of fee simple titleholder (if other than Owner): Name:
Address:
4. Contractor Name: I Phone number: 40 i7Sj a!S'
c. Address: 1�. 4� nn U 6 -LA -c 'Tx • 2 205-P-- _ AGTi�►ylO�-re- >I=' -S, Pt. -Z92/ -V=
S. Surety Name
Address:
b. Amount of bond: S
6. Lender: Name:
Address:
b. Lenders phone number:
7.a. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 71 .13(1)(a)7., Florida Statutes: Name:
Address:
8.a. In addition to himself or herself, Owner designates of to receive a copy of the
Licnor's Notice as provided in Section 7I3.13(1)(b), Florida Statutes.
b. Phone number of person or entity designated by owner:
9. Expiration date of notice of commencement (the expiration date is I year from the 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 71 .13, 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 INSPECTION. IF YOU INTEND TO OBTAI N FINANCING, CONSULT WITH YOUR
kb"RDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF
Public
A
Signatory's Title/Office
was acknowledged before me this day of . (year) , by (name of person) as (type of
irusteerattomey-in-fact) for (name of party on behalf of whom instrument was executed) .
(SEAL)
Known_ OR Produced Identification Type of Identification Produced
rsua t to Section 92.525. Florida Statutes: Under penalties of perjury, I declare that I have read the foregoing and that
in igar¢ Lrue tghe best of my/ kno%yledge and belief.
ral erso Signi`lrlg A �v t;i �,
i ! J1�tiM't ib.• ['>�' RUDY F KELSII',K-pETERSt?N
,1.15 _-��` �/ .e •c MY COMMISSION# EE093796'
EXPIRES May 21, 2015
�u �[/` X07 9tlbotb3 iwdesrtas servieeAM
SDR.
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: \ —11nl/
I hereby name and appoint: Ls 0A A �'Ud r
n ♦ n A _ /)
an agent of LZ)Ci 02�,AN
orcompmy)
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:
The specific permit and application for work located at:
(Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name: -
State License Number:
Signature of License H
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before me this V/ day of
200 i , by A /4•., F.'t.k who is a'personally known
to me or o who has produced br i Lk as
identification and who did (did not) take an oath.
(Notary Seal)
. ' DAVID T MORA
MEXPIRES April 12 201
Y COMMISSION # DD879454
, 3
a
(407 398-0153 Flaidol�oWN3crvbo.eom
(Rev. 3/27/07)
Signature
Print or type name
Notary Public - State of _
Commission No.
My Commission Expires:
1
WLAN'S
ROOF ING.INC.
445 Douglas Ave, Ste 2205E
Adamonte Sptinps, FL 32714
Plaaua Print
CONTRACT
Commercial & Residential
"Home of the FREE Roof Inspection"lo
www.alansroofinginc.com
LICENSE NO.CCC046942
Orlando: (407) 774-2158
Toll Free: (800) 309-5667
Fax: (407) 774-2891
NAME &;2r�IPHONEL'O?
0 2aJO JDATE
ADDRESS % CITY ZIP & 9271
M. HOME
OTHER COMMERCIAL
1.1080
� e
PRODUCTS60O
COLOR f
PITCH (7
15'1.
PULLA CITY_ I A&,YdO6&R COUNTY PERMIT SO. RENAIL WOOD
2. TEAR OFF r SO. OF OLD SHINGLES —SO. OF
SO.OF FLAT ROOF SO. OF OLD TILE
3. DRY IN WI F L 1 YER ' y 2 RS FT. / SO. TILE
4. INSTALL 2fm GALV. VALLEY METAL—FT. 550 SELF ADHERING UNDERLAYMENT FT. METAL OVER RIDGE
5, INSTALL FT. ALUM) FT. STEEL DRIP EDGE - r / FT. L. FLASHING COLOR
6 INSTALUREPLACE_ JQ..FT. OF R.V. _1_OTYI FT. OFF RIDGE VENT_ LUGS91!&L—COLOR
Zr'7.
REPLACE 1% IN. 2 IN.—J_3 IN. LEAD BOOTS.341 Icdt 101N. GRV'S LEC. RISER
-< STARTER STRIPS /
9. LAY SO.OF NEW FIBERGLASS SHINGLES / • CAP FT. H.R.
10. INSTALL SMJ LG. DEAD VALLEY
11, INSTALL TORCH OR TPO LAYER OF INSULATION
12. STALL/REPLACE 2 X 2 2 X 4 4 X 4 SKYLIGHTS ACRYLIC SFA LOW E SELF FLASHING
DOMES CM GLASS
13. AUL OFF ALL TRASH AND RUN MAGNET AROUND GROUNDS
ALL WOOD WORK WILL BE EXTRA PER ATTACHED WOOD BILL
14
01
15. SPECIAL INSTRUCTIONS
��,,,s
(/) /� •• L
t Jf�-,� ' Nc
F333,
o(.
ALAN'S ROOFING INC. HAS PERMISSION TO CONTRACT WITH ENGINEER OF ITS CHOICE TO
6 MY
CONDUCT ANY Oh ALL INSPECTIONS THAT MAY BE REQUIRED UtdDER LOCAL OR STATE LAW.
TOTAL DUE UPON
COMPLETION
01
-,7,73
11
C�t7
ACCESS. Customn apses to allow urns tothapropentrand re0zeSthat heavy aauwPwnW It bolnp used.
ConhaetN lr'JO rot boaaero Ion, wrMoul IkNadon, d+^+Oa todruewaya. alderatlo.lawna. fpnnaln ayslfr111. Qa�dant. fptk systems andany olhot smuctures morM. asa wesultolrooapporlobdeRvenN.
DAMAGE. ETC.: Snodd tautomer become alone of dar ago to Property by Contio0w. two agents. or emptoyao3 dump aro course of Installation of the root. sad damage Mal be brought to We anonaon of the
Contractor pdor tothe time of psyrnertl lot are roolln buealdal. it Customer lolls tonoWy Corbaclor of said damage. within S wowlung days of otawonce, then shatiwalvo W #.tines agatral Cordractet conbon*vi sold
damage. Alan's Roorrnp.ft. Is nor roapoadde for roohrq nabs Ponetralup A/C lines NM acK.
DELAYS. ETC.: 14reby arAnowledpa IMI Conhaaer may be etAlen to delays oaasloned by Inst~ weather• labor disputes, and mslodat suopty ~ago%whKh we beyond the Control of Ms Contractor ane
hereby awPrs delays oetasenod trr one a ON ol Mesa creumolonca N No snaalgbon of his root. Fuller agrovs to pay Corsrodor an amoum at 10', of Ma Comrad prks should Out cordracs be
cancelled ha any roamn onrulolhe NAiaron blworli on root. M Mnm dnIght ol ea rned butbaasday filar ergr nor,
PAYMENT CONTRACT. Cuet by aprons alai It int amounts due and o-mUQ heteunder we not paid Men due. also Wti W Nene b ay rot arnbod ro. rfaf-0Mpe
aaomoysloesendoosb, /k�'6 , together rah all turns and owing hereunder• sallbsre interest w I%% pow month.
ACCEPTANCE PROPOSA Thea . spealcadons aMcononloo ne sadaloctory end
nowobvaaeptoo.A3owd, �tl 1 tomuagomemsoprw 94ESMANSIGNATURE
CUSTOMER SIGNATURE 4' OATELL_LL4L1_ MANAGEMENT APPR
Construction Industries RocoYdry Fund: Payment may be available from the construction Industries recovery fund if you lose money on a project performed undor contrast where the 1033
results from swrlisd violations of Flonde Law by a State Licensed Contractor. For information about the Recovery Fund and filing a claim. Contact the Florida CILB at the following tolephone
number and address: 850487.1395. Fbnda Construction Industry Licensing Bosrd.1940 N. Monroe Street. Tallahassee. FL 32789.
City of Sanford
BUILDING DIVISION
RE: Permit # )
Inspection Affidavit
,licensed as a(n) Contractor* /Engineer/Architect,
(please print name and circle Lic. Type) FS 468 Building Inspector*
License #; (f --,U
On or
�'• S Pte- , I did personally inspect the roo
deck nailing and/or secondad water barrier work at j , (- (.tmt>6-., Ter:
(circle one (Job Site Address)
Based upon tha xamination I have determined the installation was done according to the
Huai e Mi 'ga 'on Retr fit Manual (Based on 553.844 F.S.)
�11
gwo to a u scribed before me this ,'Lday of ��i►? .200
a r1 i)
Not P t of Florida
RUDY F KEI.SICK'PETERSEN
'c MY COMMISSION 0 EEOQ3T98
EXPIRES May 21, 2015
,. .,PIKo stamp name)
407 39"43 FIDMONO
Commission No.:
Personally known or
ro uce entification
Type of identification produced.
* General, Building, Residential, or Roofing Contractor or any individual certified under 468 F.S. to make such an
inspection. Include photographs of each plane of the roof with the permit # or address # clearly shown marked on the
deck for each inspection.