142 Sterling Pine St 17-167; roof0
CITY OF SANFORD
Q l BUILDING &FIRE PREVENTION
PERMIT APPLICATION
r
BY.,
t 1
Applicationlication No: 1 (D ri
Documented Construction Value: $ 1 , 31(D . 023
Job Addre,,
Parcel ID:
Historic District: Yes No
Residential Commercial
Type of Work: New Addition Alteration® Repair Demo Change of Use U Move U
Description of Work:
Plan Review Contact Person: l'Ylefifd4-h 5rn*0+1 Title:( ud on ft'Uno=
Phone: 4n]-i0-7-7-7(0(p3 Fax: L/07- t0-7-7--JW4 Email: 1ri P. l r 1 C4•JJcor
Property Owner Information
Name erIC I(wr-i-
Street: ( ne St
City, State Zip: ?d FL 3 cQ
Phone: 3 l -1- 3n 4 Oq k 5
Resident of property? :
Contractor Information / /
Name S( Cr ux rds o n'1erlCl, InC• Phone: C)7'L07-7--1 &(o3 Strcet:
n6B 1 1a c- Fax: 7>'i 1-i0 City,
State Zip: inn er r FL 35 State License No.: ,C J 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 LN'TEND 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. I understand that a separate permit must be secured for electrical work, plumbing, signs, wells, pools, furnaces,
boilers, heaters, tanks, and air conditioners, etc. FBC
105.3 Shall be inscribed with the date of application and the code in effect as of that date: 5t6 Edition (2014) Florida Building Code Revised:
June 30, 2015 Permit Application
T T1. 5t
1 f this ermitthererria be additional restrictions applicable to this property that may beNOTICE: In addition to the requiIements o p ,, .1 Y „ II
founain the public records ot=rr county, and there may, betadditional 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 at the time of permit submittal. A copy of the executed contract is requiredinordertocalculateaplanreviewchargeandwillbeconsideredtheestimatedconstructionvalueofthejobatthetimeofsubmittal.
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 wit all applicable laws regulating const ti zo ing.
i-5 -7 1"5-/7
Signature of O%vner/Agent Date Signanire' of Contractor/Agent Date
Print 0«rer/
Signature'$4+a i,-State of Florida
MEREDITH SMITH
MY COMMISSION #FF137903
0 1, 20113
pi EXPIRES July
vF Of f•
sarvlcaoom
1
Print Contractor/Ag is Nat
I
Signature of N tate of Florida Date
Z.: MEREDITH SMITH
MY COMMISSION #FF137903
Eo,,ua; EXPIRES July 1, 2018
07 398.0153 Flnrld"101ary --
Owner/A n ersona ly [Cnown to Me or Contractor/Agent.is Personally Known to Me or
Produced ID _Q Type of ID D O 138 33?d Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building
Construction Type:
Total Sq Ft of Bldg:
Electrical Mechanical Plumbing Gas[] Roof
Occupancy Use:
Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes No
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
of Heads
UTILITIES:
FIRE:
Flood Zone:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Revised: June 30, 2015
Permit Application
1 lastlt until allot dell tlele slide lilt loaf
THIS INSTRUMENT PREPARED BY:
Name: Meredith Smith
Address:
NOTICE OF COMMENCEMENT
Permit Number: ` I
GRANT 11ALOYY SEMINOLE COUNTY
CLERK OF CIRCUIT COURT & COMPTROLLER
BK O°37 F'9 1543 (1P:gs)
CLERK'S A 2017001263
RECORDED 1-11/05/2017 02:59:13 PM
RECORDING FEES 1CI,Ctii
RECORDED BY hdevore
Parcel ID Number: JL2- 3d
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 PROPERTY: (Legal description of the propg and streddresss if 2.
GENERAL DESCRIPTION OF IMPROVEMENT:"Rffnop 3.
OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR HE IMPROVEMENT: Name
and address: E 'r r Interest
in property: OL nt° r Fee
Simple Title Holder (if other than owner listed above) Name 4.
CONTRACTOR: Name: JA Edwards of America, Inc. Phone Number: 407.677.7663 Address:
7058 Sta oint Ct. Winter Park, FL 32792 5.
SURETY (If applicable, a copy of the payment bond is attached): Addre
6.
LENDER: Address:
Phone
Number: Amount
of Bond: 7.
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)(a)7., Florida Statutes. In
addition, Owner designates Phone
Number: of
to
receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Phone number: 9.
Expiration Date of Notice of Commencement (The expiration is 1 year from 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 CONSIDEREDIMPROPERPAYMENTSUNDERCHAPTER713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYINGTWICEFORIMPROVEMENTSTOYOURPROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITEBEFORETHEFIRSTINSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature
of Owner or Lessee, or Owner's or Lessee's (Print
Name and Provide Signatory's T itle/Offico) Authorized
Officer/Director/Partner/Manager) State
of hi (C1 County of Srm( 11pl fP. The
foregoing instrument was acknowledged before me this I rr I day of l 20 ILO by
x tC 1(tb&1- Who Is personally known.to me OR Name
of person making statement O who
has produced identification LQQtype of identification produced: /V/J J/L/(X/ VX 1 MEREDITH
SMITH My
COMMISSION ##FF137903 EXPIRES
July 1, 2018 4
7).398.0153 FloridnNot Ft ry AarvloP,aam JAN0 52017
E C
PY GRP.NT AALUY ;, • ,, LER C
t)F ft c .IPCUIT i1UIiT SEND O
CU SIY, FWRiDA BY DEPU
1
CLCRK
IMA
JA Edll•Ivartds of America, /nr-
Your Ffoaflng 5pertaltat/
AGREEMENT SUBJECT TO INSURANCE COMPANY APPROVAL
Customer: 6/^/'c kehr Date: 1/ l o l ol
Property Location: /y Sf/t,g p:S Day: 3( !7) 37q _
City: S*a'yJ'Cfd FL
ROOF SPECIFICATIONS Brand:
Ridge Materi /VaRey: Open lose
Ice & Water Shie Pitch:
Roof Accessories 1
Drop Instructions:
SIDING SPECIFICATIONS Brand:
Zip: % 7 el. Evening: (_) -
E-Mail: M W-4 6 gr-,Q1 . co
i k,4ed% Style: Color:
Tear-OI Veno(B-oDZ S hingle Over / Aluminum Fe.5
Story: 1 lJ 3 Walkoutt`Yes)/ No
Straight Lap / Dutch Lap Exposure: 4" 4.5"
Eleva 'on being side ool at house from stree
Drop nstruc ' s:
GU R SPECIFICA O Color:
Special Instructions:
1 f-1 r o. 1,Y1 ' VV-0
other:
t` Left
Style:
Back
Color:
Homeowner Initials:
TERMS
1. By signing this Agreement, you authorize JA Edwards of America Inc. to be present during the insurance adjustment and negotiate the settlement with your insurance company.
2. Unless otherwise agreed in writing, your out -of --pocket costs will be limited to your insurance deductible amount However, you must promptly pay JA Edwards of America Inc.
all amounts you receive from your insurance company. if you desire material upgrades or other work done on your property, you will incur additional out-of-pocket expenses.
3. This Agreement is not valid or binding on any party unless and until it is signed by both you and JA Edwards of America Inc. Once signed by you and JA Edwards of America Inc.
JA Edwards of America Inc. will be awarded with the job described above and the scope and price of the work will be set forth in the insurance adjuster's summary.
4. Your signature below provides your agreement to all the terms and conditions set forth on the front and back of this Agreement. Please carefully read the entire front
and back of this Agreement.
5. Homeowner agrees to assignment of benefits to Contractor (JA Edwards of America) for payments from in=ance company to
facilitate timely payments to contractor for all works approved in insurance scope.
ASSIGNMENT OF INSURANCE BENEFITS: I, the policyholder, named insured or authorized representative, hereby assign any and all insurance
benefits, rights, proceeds and any causes of action under any applicable insurance policies to JA Edwards of America for services rendered or toberenderedbyJAEdwardsofAmericaand, in the regard, waive my privacy rights. This assignment is given in consideration of JA Edwards of
America's agreement to perform services as described above, including not requiring full payment at time of service. I also hereby direct my
insurance carrier(s) to release any and all information requested by JA Edwards of America, its representative(s) and/or its attorney for the
purpose of obtaining benefits to be paid by my insurance carrier(s) for servicesAendero or to be rendered and authorize JA Edwards and my
carrier(s) to communicate as needed with each other in this regard. Gt, 11M ' l o ors16 / k 1f(,i
Believe the appropriate insu nce ier is:
r
11 First Check- S J 'S Z'131L/
C1 l Q 6 Check # Date
Signature Custom Date
Balance Due: $
ZU / c'. 6) -6 Check # Date
JEards ojAmerica Inc. Rep) Date ce: / v
1407-67E7-7.
pplements dt permit
rance company
7058 Stapoint Court • Winter Park, F132792 •Ounce: 407-677-7663 • Fax7521
City of Sanford
Building & Fire Prevention Division
PERMIT NO. I # 0 I (01 ISSUE DATE:
CONTRACTOR: SA EbulAbs + r
JOB ADDRESS:
TYPE OF WORK: t..:p
Re -Roof Permit Card
Post this Permit in a conspicuous place outside PROTECT FROM WEATHER
Approved plans must be posted with permit for inspection
Leave all work uncovered until inspected
Permit expires six (6) months from date of issue or last approved inspection
A ROOF DR Y-IN INSPECTION IS REQUIRED * * *
For Inspection procedures, please refer to the re -roof inspection guidelines provided to you when the permit is issued.
The Mitigation Affidavit will not suffice as an alternative to receiving a dry -in inspection.
ROOF
INSPECTIONTYPE APPROVED REJEC'7'1--D INSPECTOR MISCELLANEOUS
INSPECTION
TYPE APPROVED REJF.C76D INSPECTOR ROOF
DRY -IN MITIGATION
AFFIDAVIT FINAL
ROOF 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. FBC 105.3.3 REVISED:
October 2014 Inspection Line 855.541.2112
TO SCHEDULE AN INSPECTION:'
Dial855.541.2112
Provide the items requested during the message
The type of inspection requested must be scheduled under the appropriate permit type
Follow the prompts
PLEASE NOTE: Inspections scheduled by 3:30 p.m. will be conducted the
next business day. If you experience difficulty, please call 407.688.5150
Monday - Thursday 7:30 am - 5:30 pm for assistance.
AUTOMATED INSPECTION SYSTEM CODES
ROOF
Roof Dry In 116
Mitigation Affadavit 129
Final Roof III
Miscellaneous Notes:
Miscellaneous
Sheathing - Roof 106
Insulation - Roof 119
REVISED: OCTOBER 2014 Inspection Line: 855.541.2112
CITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #: 1-7 - KV `7
1, Ct rW c OLr hereby acknowledge that 1 personally inspected
6Roof deck nailing and/or Secondary water barrier work
at and have determined that the work
Job Site Addresk)
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
understand that making any false statements in writing with the intent to mislead a public servant in the
performance of his or her official duty shall constitute a misdemeanor of the second degree pursuant to
Section 837.0 in 1-a4-0
Signature of Contractor Date
GPrai 11 schr)Lcr alc0 5a I
Printed Name of Contractor License #
License Type: General Building Residential woofing Contractor
or any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF I rJQJC
T
Sworn to (or a firmed) and subscribed before me this g day of , 20 1-7 , by
Gr ralc a i' hOi , who is Personally Known to me or has Produced (type of
identifica on as identification.
SEAL)
Signa re of Notary Public
State of Florida MEREDITH SMITH
Print/Type/Stamp Name
of Notary Public
MY COMMISSION #FF137903
FOFnd?:' EXPIRES July 1, 2018
407) 398.0153 Flo rldANot a ry Service. com