HomeMy WebLinkAbout2001 S Magnolia Avey i'•.ECEI
NOV 17 2011
D CITY OF SANFORD
Y: NG & FIRE PREVENTION
PERMIT APPLICATION
Application No: 1a- 3 LA u Documented Construction Value: $ L - � 3
Job Address: tQ 00/ SiA- (2!�F. 4Se:ar.01Ln Historic District: Yes ❑ No ❑
Parcel ID: .3L — M -7n f)0Z 00/a Zoning:
Description of Work: L - &6a,- 4f- a;X Ae�s
Plan Review Contact Person:
Title:
Phone: A 15' Fax: LIP 77!Z -.2�!/ E-mail: M -c.
Property Owner Information 49 5.a
Name Phone: LQ -'J 2�
T
Street: Zoo fv Resident of property?
City, State Zip:
Contractor Information
NametjVI; AdRA< W4-< Phone: Cfa_)- 7V 2/ 9- F'
Street: Fax: U d) i 2$j • S 1
City, State Zip: State License No.: GCC_d 469 (2—
/�-t,TRrner►r� qh s 3 a
rc i ec�/Engineeer nformation
Name: Phone:
Street: Fax:
City, St, Zip: E-mail:
Bonding Company: Mortgage Lender:
Address: Address:
PERMIT INFORMATION
Building Permit G1
Square Footage: S Construction Type: No. of Stories:
No. of Dwelling Units: Flood Zone:
Electrical O
New Service - No. of AMPS:
Plumbing O
New Construction - No. of Fixtures:
Mechanical 13 (Duct layout required for new systems) Fire Sprinkler/Alarm 0 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 exceed the documented
construction value when the executed contract is submitted, credit will be applied o your permit fees when the
permit is released.
.
voctzIoc
A Signature or er/Agent Date
-lit \0
ISiC.K-PETERSEN
MY COMMISSIOM " EE093796
EXPIRES lk•1ay',11, 2015
F WdaNntai /SP'r;P com
Produced ID Type of
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
Rev 11.08
(/ &4 1\ \1—
Z — l \
` Signaturef nt or/Agcnt Date
Print Contractor/A 111's Name
i
si urc of or ate or Florida to
RUDY F KEI.SiCK-PETERSEN
MY COMMISSION # EE093796
'JWp' EXPIRES May 21, 2015J
(407) 386-0163 Rwidallotaryservice.mm
or Contractor/Agent Is Personally own to Me or
_ Produced ID Type of ID
UTILITIES:
WASTE WATER:
FIRE: BUILDING:
2
Permit No. 3 �� G
Tax Folio No. -1 q-3 o 5a.9 uoo0-0010
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. Description of
—ASIM11.111111 MN llNIN11lglNluaIN1111G
MR161PN E MORSE, CLERK OF CIRCUIT COURT
SEMINOLE COUNTY
BK 07663 Pg I0L71 Upg)
CLERK'S #21033222309
RECORDED 11114/:011 OLWStE2 RN
RECi1RDIN6 FEES IN OO
RECORDED BY T Smith
of the property, and street address if available) �[.,=Z' I j- -I- j5u&71 S
2. General description of improvement: — ILQ 113
3. Owner information: Name:
Address: AC01 '3 -"�7 7/
b. Interest in property:
c. Name and address of fee simple titleholder (if other than Owner): Name:
Address:
4. Contractor Name: : Phone number: ! x 7 ? a rbcs/
c. Address: d r S
5. Surety Name
Address: S
b. Amount of bond: $ t®r,1 �E Opv �Op
6. Lender: Name:
Address: 0 N
b. Lender's phone number: C� ��p�.�
7.a. Persons within the State of Florida designated by Owner upon whom notices or other docume&*nay be s e
provided by Section 713.13(1)(a)7., Florida Statutes: Name: �Qv 1
Address: •
8.a. In addition to himself or herself, Owner designates of to receivMWpy of the
Lienoes Notice as provided in Section 713.13(I)(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 1,
SECTION 713.13. 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 10B
SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF
Y COMMENCEMENT.
".. d u
/ Signature of Owner or Owners Au rized Oft icer/Director/Partner/Manager ,� /O gnat ry's Title/Office
The foregoing ins ent was acknowledged before me this 1S day of � V , (year�t, by (name of person) as (type of
author�'ry, .. e. cer, trustee, attorney m fact) for (name of parry on behalf of whom instrument was executed) .
!r D..
/
(SEAL)", -0 O�S � 94,. v
4'r
ajoNot Public �.115)- fully Known OR Produced Identification�7ype of Identification Produced
Verification pursuant to Section 92.525, Florida Statutes: Under penalties of perjury, I declare that I have read the foregoing and that
Vthe fa s stated in it are true to the best of my knowledge and belief:nat
Sigure o Nan
Rev. date 3/2008
Person Signing Above
RUDY F KELSICK-PETERSEN
MY COMMISSION H EE093796
21, 2015
WLAN'Sm
ROOF ING.INC.
445 Douglas Ave, Ste 2205E
Altamonte Springs, FL 32714
Please Print
CONTRACT
Commercial & Residential
"Home of the FREE Roof Inspection"e
www.alansroofinginc.com
LICENSE NO.000046942
Orlando: (407) 774-2158
Toll Free: (800) 309-5667
Fax: (407) 774.2891
NAME 7' , r '
PHONE
TE f
ADDRESS CITY r 1W ZIP
M. HOME
OTHER COMMERCIAL
JOB#
BRAND OF ~ 1/
LOR n
PRODUCT .S l� � i' %dI4
�'►
PITCH Syj]
1. PULL A CITY OR COUNTY Z&L,�= PERMIT SO. RENAIL WOOD r14 O6—P
2. TEAR OFF SO. OF OLD SHINGLES SO. OF FLAT ROOF SO. OF OLD TILE
3. DRY IN WITH 30# 1 YER 2 LA ERS FT. / SO. TILE
4. INSTALL�iaFT. GALV. VALLEY METAL— FT. 55# SELF ADHERING UNDERLAYMENT FT. METAL OVER RIDGE
5. INSTALL FT. ALUM./46aFT. STEEL DRIP EDGE "37TNA / FT. L. FLASHING COLOR
6 ZLYU
INSTALUREPLACE FT OF R.V. OTYJ FT. OFF RIDGE VENT PLUGS COLOR
7. REPLACE nth IN. 2IN.--L-3IN. LEAD BOOTS -4 IN.10 IN. GRV'S ELEC. RISER
STARTER STRIPS_4,Lt-_e_-
9. LAY SO. OF NEW FIBERGLASS SHINGLES / S l s CAP FT. H.R.
]
10. INSTALL SM./ LG. DEAD VALLEY
]
11. INSTALL TORCH OR TPO LAYER OF INSULATION
]
1 INSTALUREPLACE 2 X 2 2 X 4 4 X 4 SKYLIGHTS DOMES CM Law E GLASS�NING
13. HAUL OFF ALL TRASH AND RUN MAGNET AROUND GROUNDS
14. ALL WOOD WORK WILL BE EXTRA PER ATTACHED WOOD BILL
15. SPECIAL INSTRUCTIONS
A/
]
16 ALAN'S ROOFING , INC. HAS MY PER I SION TO CONT CT WITH AN ENGINEER OF IT'S CHOICE TO
CONDUCT ANY OR ALL INSPECTIONS THAT MAY BE F3EOI IlRED UNDER LOCAL OR STATE LAW.
TOTAL DUE UPON
COMPLETION
ACCESS. Customor agrees tD agow access to the property and realizes that heavy Cpuipment Is being used.
Contractor shell not be liable for, without limilatio . damngo to driveways. sidewsats, lawns, sprinkler systems, gardens. septic systems and any other structures thereof, as a result of rooftop orjob deliveries.
DAMAGE, ETC.: Should customer become aware of damage to property by Contractor, his agents, or employees during the course of Installation of the cool. said damage shag be brought to the attention of ate
Ceniraclo; priet to The time of payment for the roof In cusstion. If Customer fails to "Ily Contractor of Said damage. -thin 5 working days of occurrence, then shag waive all rights against Contractor Concerning said
damage. Alan's Rooirng,Inc. isnal responsible lot roofing nags penetrating A;Clines Inthe nbk.
DELAYS. ETC.: hereby acknowledges that Contractor may as subject to delays occosloned by Inclement weather, labor disputes. and material supply shortages which are beyond the control of the Contractor and
heroby accepts del ye occasioned by one or all of those circumstances In the Installation of his roof. Further agrees to pay Contractor an amou*v7aj1 total contract Price shm)ld Inis contract be
cancc lad for any reason piorto IM Inglatlon of work on tool, but after mldnight of the third business day alter signing.PAYMENT CONTRACT: Customer hereby agrees that a the amounts due and ow" hereunder are not pold when due, alsolineabe galea to udtng. but nol lurilled to reasonable
olloney's lots and costs, which rummints. together with all SUMS and owing hereunder, shag bare merest at l t9 1per motlh.
ACCEPTANCE PROPOSAL: The above prices, spealicaurins and conditions are satisfactory, and
herebyaccopled All contracts are syttlecl to management approval SALESMAN SIGNATURE
CUSTOMER
�� MANAGEMENT APPROVAL
Construction Industries Recovery Fund Payment may be available from the construction industries recovery fund it you lose money on a project performed under contract, where the loss
results from specified violations of Florida Lawby a Slate Licensed Contractor. Forinformatlon about the Recovery Fund and filing a claim, contact the Florida CILB st the following telephone
It mberand addrass:850-487.1395. Florida Construction Industry Licensing Board, 1940 N. Monroe Street, Tallahassee. FL 32399.
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: �� Nv� 1�
I hereby name and appoint:
an agent of:
(Name
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:
S ct" q0'.r-1
Expiration Date for This Limited Power of Attorney:,
License Holder Name:
State License Number: LC,C-'- 0'-6 91 y- y
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before me this -Lr -day of I.✓a ✓ ,
200 , by r, /,r- „ Q cel d who is sonally known
to me or o who has produced as
identification and who did (did not) take an oath.
c -
Signature
(Notary Sea]) Z)A,-, 2��G�d
Print or type name
E�:y DAVID T MAUFRA Notary Public - State of
LN
Commission No.
COb�111SS10N # D0879464
EXPIRES April 12, 2013 My Commission Expires:
FiorldallolorySarvfx.com
(Rev. 3/27/07)
M1
Issue Date: 12/21/2010
FLORIDA ROOFING. SHEET METAL & AIR CONDITIONING CONTRACTORS ASSOCIATION, INC
RSA INSURERS
ISSUED TO:
City Of Sanford
Building Dept.
Po Box 1788
Sanford, FL 32772
Attention:
1-800-767-3772 - FAX (407) 671-2520
CERTIFICATE OF INSURANCE
COPY PROVIDED TO:
Alan's Roofing & Alan's Roofing, Inc. and Adco
14498 Ponce De Leon Blvd.
Brooksville. FL 34601
Alan's Roofing &Alan's Roofing, Inc. and Adco et al
This is to Certify that: 14498 Ponce De Leon Blvd.
Brooksville, FL 34601
being subject to the provisions of the Florida Workers' Compensation Act, has secured the payment of compensation
by insuring their risk with the FLORIDA ROOFING, SHEET METAL & AIR CONDITIONING CONTRACTORS
ASSOCIATION SELF INSURERS FUND, P.O. Box 4907, Winter Park, FL 32793.
COVERAGE NUMBER: 870-033049
EFFECTIVE DATE: 1/1/2011
EXPIRATION DATE: 1/1/2012
LIMIJS
Workers' Compensation: Statutory - State of Florida
Employers' Liability: $1,000,000.00 Each Accident
$1,000,000.00 Disease, Each Employee
$1,000,000.00 Disease, Policy Limit
REMARKS: Non -cancelable. without 30 days prior written notice, except for non-payment of premium which will be
a 10 day written notice.
Complete named insured to read: Alan's Roofing & Alan's Roofing, Inc. and Adco Construction, Inc. and BHD
Construction LLC and Spring Hill Construction, Inc.
Alan Field as Oualifier, License OCCCO46942
This certificate is issued as a matter of information only, is not a policy and of itself does not afford any insurance.
Nothing contained in this certificate shall be constructed as extending coverage not afforded by the policy(ies) shown
above or as affording insurance to any insured not named above. This provides coverage for Florida pollcyholders
and Florida domiciled employees only.
s
By: By
Brett Stiegel, Administrator Debra Guidry, CPCU, Un erwriting Manager
FRSA-SIF FRSA-SIF
890-3 S00/600d 6SZ-1 Z068KLZSET pTaT3 ueTV-W083 TS:60 TT. -ST -TT
From:Eileen Corsini FaxiC:Momow Insurance Page I of 2 Date:1111502011 09:35 AM PWA of 2
ALANS-1 OP ID: EN
ACORO'
CERTIFICATE OF LIABILITY INSURANCE
DATE (MrrDMMI
11115111
THIS CERTIFICATE 16 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CER71FICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(a), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: It the eergneate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certaln policies may require an endorsement. A statement on this certificate does not confer rights to the
cerdi cote holder In Iron of such endorsement(s).
pomp PER 813-M-1669
IWRE:
MORROW INSURANCE GROUP
LENORA C. OLNEYlAI96064 813-M1-37
18936 NORTH DALE MABRY HIGHWAY
TAMPA, FL 33549
Lenora C. Olney
IAIC, no):
AWMAUL
DOREOS:
INSUSERIBI AFFORDING COVERAGE MAIC e
INSURER A ; MONTPELISR US NS COMPANY
EACH OCCURRENCE f 1,000 000
INfVREO ALAN'S ROOFING, INC
16498 PONCE DE LEON BLVD
:cmERa.INS. Co. Or. AMERICA 24732
PERSONAL s ADV INJURY S 1,000,000
BROOKSVILLE, FL 34801
RNSURM C
INSURIER D:
s
INSURER 6:
AUTOMOBRE UABRIJTV
X ANY AUTO
ALL
AOWNED SCHEDULED
OM
X MIREDAUTOS X /N►IOl►N r.
INSU
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICM THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
LIAR
TYPE OF NSURAIICE
SHOULD ANY OF INE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
mum
POLICY NUMBER
lopwomwMI
LIMITS
A
GENERAL UA91LITY
PXcou.M1EQC1ALGEWEmtuwuTY
OCCUR
TRACTUAL Lae
MP000S007000QS
07M1111
07/11112
EACH OCCURRENCE f 1,000 000
PREMIBE6. �.nr e S 50.wqCLAIMS-MADEXX
MEDEXP W*ft00 eal S 5.
PERSONAL s ADV INJURY S 1,000,000
GENERALAGGREOATE S 2,000,000
GEN,L AGGREGATE LIMIT APPLIES PER
A71 POLICY PRm Loc
PRODUCTS . COMPIOP AGG S 2.000.00
s
8
AUTOMOBRE UABRIJTV
X ANY AUTO
ALL
AOWNED SCHEDULED
OM
X MIREDAUTOS X /N►IOl►N r.
4CC29309410
461W11
06104112
E. ; S 1.000.00
BODILY INJURY Me/ pawn) I
BODILY INJURY (Par Otti0Pn1) t
pas ' n GE f
S
UMBRILLA LIAROCCUp
excess LAMB
CLAIMS -MADE
EACH OCCURRENCE f
AGGREGATE 1
D I I q r10N e
f
WORKERS COMPINIA71010
AND EMPLOYERS' LAAGN PIVr
AMY PAOPRoETORNMTNEP EAErAMvE YD
OFFICER MEMBER EXCLUDED?
IM6040 1v In NMI
If�IT11*0 goo�r
OESCRIPTONOFOPERATIONS00oav
NPM
W C 8rAT1�
MI e
EA. EACH ACGOENT f
E.L. 018EAGE -CA EMPLOYEE S
.LOISEASE.P000YLIMIT I
OEltlbP110N OR OPERAnONS / wc.TloMe / vEHICLEf 1Aea11 ACOIa tOt, ArAMewr R�nwA� ScIINvN, l/ nleN vpvra n nwb�111
CERTIFICATE HOLDER CANCELLATION
- - CITYSAN
SHOULD ANY OF INE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITY OF SANFORD
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEWERED IN
ACCORDANCE WITH THE POLICY PROVISION&
BUILDING DEPT
300 N PARK AVE
SANFORD, FL 32771
AUTMORIZEDREPRESENTAIIVE
,n
C.
®1888,2010 ACORD CORPORATION. AO rights resewed.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
890-3 S00/S00d 6SZ-1 Z068VSLZSET pT2T3 URTV-W083 ZS:60 LZ, -ST -TT
THANK YOU FOR SUPPORTING ECONOMIC DEVELOPMENT
Where Innovation Drives Economic Growths
Local county business taxes are used by the Polk County Board of County Commissioners
to support Central Florida Development Council of Polk County (CFDC) initiatives,
activities and programs.
For more on economic development in Polk county visit: www.CFiDC.org
Centro/ Roirido `
D�'v prnent Coundl
of POLK COUNTY; FLORIDA♦
POND COUNTY LOCAL 6UMNESS TAX RECEIPT
ACCOUNTM ISM CI .A ; 9
IGVVIGNINIAME
FTf" ALAN JMES
9UMNESS MME AND MAIUNG ADDRESS Coors
ALMIS ROOl911D
14MPONE Se LEON OLVO
a 11 RPM" PLUM -"IN
OFFICE OF JOE O.
EXPIRES: 91=012
N" -�
AC1IYfl1► Type
CONOU10M ROOFING
PROFi:MNAL LICENSE IIF APPUCABLE)
d
CFC *TAX COLLECTOR 7Oe o� '"tea Teuspenior�* �
_ --
PAia-4098b%S•0001-0001 10fOb/2011 09/30/2031 JMM 428 57.75 ALAN'S ROOFING
919-A 100/188d LSO -1 Z0686SLZS£L PTarA U1eTK-W0H3 SV OT III -90 -OT
11/28/2011 NON 9:13 FAX
RE: Permit # /,Z 3
City of Sanford
BUILDING DIVISION
Inspection Affidavit
x ,licensed as a(n) Contractor* /Engineer/Architect,
(please print name and circle t.ic. Type) FS 468 Building Inspector*
License #;
On or about \ - SSI; '�" I did personally inspect the roof
(Date & time)
_deck nailinz andWsecondary water barrier work at a,001
(c' c one) (Job Site Address)
Based upon that ei!i ltion I have determined the installation was done according to the
Hurrjne Mitygl{{ion Retrofit Manual (Based on 553.844 F.S.)
STATE OF FLORIDA
COUNTY OF
Sworn end ed b ore -me -this day of /4 0 v .200//
RUBY F KEISICK-PETERSEN
MY COMMISSION AP EE09 M
EXPIRES May 21, 2015
Personally known or
Produced Identification
Type of identification produced.
Notary Public, State of Florida
(Print, type or stamp name)
Commission No.:
* 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 H or address # clearly shown marked on the
deck for each inspection.
®001/001