150 Lakeside Cir; 14-269; RE-ROOFNOV 0 7 2013 CITY OF SANFORD
s BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: ` Documented Construction Value: $ SL
Job Address: Historic District: Yes No>'
Parcel ID: ZZ-Z ( - C
C7 13 - n C - 022 6 Zoning:
ll
Description of Work: v. \ G
Plan Review Contact Person: ja,6, _`T_1A-C-j(AA__ Title
Phone: i 0 7 -7 (07 - 6 I (ZFax: 1/09 -,_)6% -7/ 10 '_E-mail: LD e5 A . ' rn O P l
Property Owner Information
2 _ '^ 03 Z
Name- a Y (l e C- ", 1 o vi-P. Phone: J
V
Street: Resident of property?
City, State Zip: Z
Contractor Information
C /
Name Q!- Phone: 7 V`i ly7 - lJ I Z.
Street: YD o I7-e-I /1n, i}9•cL Fax: ! Q % -7( 7
J %
City, State Zip: Z% Z)) State License No.: CG0 (. Z S LC
Architect/Engineer Information
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
PERMIT INFORMATION
Building Permit 'r
Square Footage: Construction Type:FW_14r
No. of Dwelling Units: Flood Zone:
Electrical
New Service - No. of AMPS:
Mechanical (Duct layout required for new systems)
Plumbing
No. of Stories: 1
New Construction - No. of Fixtures:
Fire Sprinkler/Alarm 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 b a our permit fees when the
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Ilk L
Agent's Name
LORRAINE GAETA
Notary Pobl c - State of Florida
My comet Expires Jar 25. 2015
Contractor/Agent is Personally Known to Me or
Produced ID Type of ID
WASTE WATER:
BUILDING:
Rev 11.08
d2JT1 RooFtrvs
3194
JTI Roofing Contract
Address: 406 Hermitage Drive Insurance Co.
Altamonte Springs, FL 32701 Adjuster:
Phone/Email: (407) 767-6912/ljones@jtiroofmg.com Claim #:
State -Certified Roofing Contractor - CCC1325756 Phone:
State -Certified General Contractor -- CGC036067
Jan Tukker, Contractor (f i I <
Customer Name: rl. C,2cl_l l i 7. E' _ Date: 3
Address: [ Sr i, (/l City/State/ZIP: Q a
Home Phone: Cell: 221S b 00_r
Work Phone:
Email:
SPECIFICATIONS/PRICE BREAKDOWN
ITEM TYPE QTY AMOUNT TOTAL
Tear -off shingle
Replace Shingle
Replace Felt
Hurricane Retrofit
Steep
2od Story Charge
Valley Material
Drip Edge
Vents/Goose Neck
Flat Roof
Interi r/Exterior
Skylights
Solar Panels Detach/Replace
Remove Trash from Roof, Gutters and Yard 6A 1 r"
ITEM TYPE QTY AMOUNT TOTAL
Ridge Vent
Off -Ridge Vents
Decking
Lead Boots
Debris Removal
Insurance Co.
Initial/Estimated Date:
Amount
Insurance Co. Agreed
Amount
Date:
Upgrades ae u
Insurance Supplement
TOTAL Date:
Shingles — Type: Color
fA C— PAYMENT SCHEDULE
Roll Yard with Magnetic Roller - V S"
PAYMENT IN FULL UPON COMPLETION
Protect Landscaping Where Applicable lii/o 39(2 j4-
Delivery/Special Instructions: /(43 EARNEST
DEPOSIT: $500.00 $1000.00 $ 61f
h10 L` > DOWN AYMENT $ FINAL PAYMENT $ 7f
JAN TUKKER, PRESIDENT TERMS:
THIS AGREEMENT4S "SUBJECT TO" INSURANCE COMPANY APPROVAL. JTI ROOFING IS AUTHORIZED
TO PERFORM WORK AND RECEIVE FULL AMOUNT OF INSURANCE PROCEEDS, INCLUDING OVERHEAD
AND PROFIT, ONLY UPON APPROVAL BY INSURANCE COMPANY. ACCEPTANCE
OF AGREEMENT The
above prices, specifications and conditions of this agreement are satisfactory and are hereby accepted. I/We have read and understand the terms and conditions located
on the back of this document/agreement. JTI Roofing is authorized to do the work as specified and in accordance with the terms, conditions and stipulations of
this agreement. Homeowner hereby authorizes Insurance Company and/or Mortgage Company to make payment for completed repairs directly to Contractor and mail
insurance proceeds to Contractor. Homeowner hereby assigns to Contractor their rights to any insurance proceeds from Insurance Company for goods and services
as described in the specifications. THREE
DAY RIGHT OF RESCISSION THIS
WRITTEN AGREEMENT HEREBY ES S NOTICE THAT I MAY CANCEL THIS AGREEMENT AT ANY TIME
PRIOR TO MIDNIG OF T B ESS AFTER THE DATE OF THIS AGREEMENT. Homeowner
Approval: r-- Date: ,®3 a/3 Contractor
Approval: Date:
THIS INSTRUMENT PREPARED BY:
Name: Lorraine Gaeta
Address: 406 Hermitage Drive
Altamonte Springs, Florida 32701
NOTICE OF COMMENCEMENT
MHRYANNE NORSf+, SEMINOLE DAINTY
CLERK OF CIRCIJIT MAT r1 U114PTROLLER
8K 08158 PR 13921 Upg)
CLERK'S # 2013141971
RECQRDPO 11 /0'//2013 120004 PN
Rf'~(.;[INOING FEES 10.00
REUIRDI:I) BY T Smith
Permit Number:
Parcel ID Number: 11-20-30-5KB-0000-0220
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 property and street address if available) Cf SME ttt
Leg Lot 22 Hidden Lake Ph 3 Unit 7 pb 36 pqs 79 & 80 a •"'"'"'',r
150 Lake Side Cir Sanford 32773
2. GENERAL DESCRIPTION OF IMPROVEMENT: CLERK of VEORCU 41j ' CG N a
re roof with asphalt shingles nnPTRQLLER „nA
EO 0lytr
OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMP Q(,ItAA t 9 fipVt6APA3. OWNER INFORMATION
Name and address: John Cecilione 150 Lakeside Cir. Sanford FI 32773 a1a
Interest in Fee Simple 8Y Nft a ? property:
Fee Simple Title Holder (if other than owner listed above) Name:
Address:
4. CONTRACTOR: Name: Jan TUkker, Inc. Phone Number: 407-767-6912
Address: 406 Hermitage Drive Altamonte Springs, FI 32773
5. SURETY (If applicable, a copy of the payment bond is attached): Name:
Address:
Amount of Bond:
6. LENDER: Name: Phone Number:
Address:
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.
Name: Phone Number:
Address:
8. In addition, Owner designates 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
CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, 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
JOB 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 COMMENCEMENT.
Under penalties perjury, ec re that a rea foregoing and that the facts stated in it are true to the best of my knowledge and
belief. z
Sign luro, or Owner's or Lessee's (Print Name and Provide Signatory's efOwnerorLesseeTitle/
Office) Ithr
razed Officer/Director/Partner/Manager) State
of The
IL`.
CIf. County' tz=— u instrument
was acknowled ed before me this LP day of rir/
C T
tif wQ,t 20 6%
l 0JY 1L--- - -- Name
of person making statement _. who
has produced identification a of identification produc( LORRAINE
GAETASEAL_N(
Aary Public - Siate , Lofida_ ctPii,.tNy
niii;onvn Expires Jan 2s. 2(t5 Conran
scion El 58561
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
n SIherebynameandappoint: `, i % Y '
an agent of: 1 cr, ___1_-xV
Name of Company)
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 (check only one option):
The specific permit and application for on located at:
D U e 2
Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name:
State License Number:
Signature of License Holder:
STATE OF FLO IDA /
w
COUNTY OF WL—
The fo egomg instrument wad 20q,
by to
me _ identification
and who did (did Notary
Seal) I-
MRAINE GAETA Notary
Public - State of Florida vs
t,4y Comm. Expires Jan 25. 2015 Commission #
EE 58561 Rev.
08.12) before
me this day of who
i"pf Print
or type name ^ / Notary
Public - State of G-C Commission
No. f
SZQ
My
Commission Expires: LEI Q
vvk,4 .
CITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #: l `4 — Z 0
I, -1 a, 1l .C- hereby acknowledge that I personally inspected
Roof deck nailing and/or) Secondary water barrier work
at I SZ L,,4 k e St d Lho+. and have determined that the work
Job Site Address)
was done according to the Hurricane Mitigation Retrofit Manual. (based on 553.844 F.S.)
I certify that my stateme7falstatementsetrue and accurate to the best of my belief and that I fully
understand that making ain writing with the intent to mislead a public servant in the performance
of his or her shall constitute a misdemeanor of the second degree pursuant to Section
837.06 F.S. Signature
f Con ctor Date Printed
Name of Contras or License # License
Type: General Building Residential 0 Roofing Contractor or
any individual certified in accordance with F.S. 468 to make such an inspection. STATE
OF FLORIDA COUNTY OF` _ Swop
to (or affirmed) pnd subscribed before me day of , 20 by who
i ersonally Known to me or has Produced (type of e
tion) as identification. SEAL)
S
gnature of Notary Public 2S
ate of Florida M412!
9:!±.t 6—'mPrint/
Type/Stamp Name LorrnlNE cnErn of
NotaryPublic ° °• \•` '. Notary Public -State of Florida J .
My
Comm. [xpires Jan 25. 20i5 EE
55561 commissionf1
CITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #: L L Z
1, 1a '1 C (C.2 hereby acknowledge that I personally inspected
deck nailing and/or Secondary water barrier work
at and have determined that the work
Job Site Address)
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 falsq statements in writing with the intent to mislead a public servant in the
performance of his or cia1 duty shall constitute a misdemeanor of the second degree pursuant to
Section 837.06 F.S.
Printed Name of
Da
o_d'
License #
License Type: El General Building L_j Residential Roofing Contractor
or any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF FLORIDA COUNTY O
Sw n to (or, aff med) and subscribed before me day of 120 , by
I v`-L who is Personally Known to me or has f
ent' tion) as identification.
SEAL)
Signature of Notary Public
tate of Florida
Print/Type/Stamp Name o`: 1'" '° a''. L.ORRAINE GAETA
of Notary Public '
c' *
Notary Public - State of Florida
My Comm Expires Jan 25. 2015
Commission fEE 58561