1119 Locust Ave 17-1279; ROOFCITY OF SANFORD
n F= I V E'n BUILDING & FIRE PREVENTION
PERMIT APPLICATION
D MAY 4 2017r
Application No:
Documented Construction Value: $ a
Job Address: 11 C f 4t-Fr ,1 Histo. 'c District: Yes N'
Parcel ID:
LJ
12es2idential Commercial
Type of Work: New Addition Alteration VI Repair Demo Change of Use Move
Description of Work: 'C (A, a r L re T.7 o A
Plan Review Contact Person: Title:
Phone: Fax: Email:
Property.,Owner Information
Name I Phone:.Lo T' AS,,
Street: I
y (°
V Resident of
City, State Zip:
j-7 i
Contractor Information
Name i A P, L u) 7— Phone: 37-C Street:
We--'v '
75all
Fax: City,
State Zip: oc _ oa State License No.: Cc z 3 Q 6 Architect/
Engineer Information Name:
Street:
City,
St, Zip: Bonding
Company: Address:
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 INTEND 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. 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. FBC
105.3 Shall be inscribed with the date of application and the code in effect as of that date: 51 Edition (2014) Florida Building Code Revised:
June 30, 2015 Permit Application
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 at the time of permit submittal. A copy of the executed contract is required
in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal.
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 with all applicable laws regulating construction and zoning.
A,
Signature of Owner/Agent Date
Print Ovine
WMA. ExWes`Wug 2P2t6i8
Commission tr FF 147278
0
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
Signature of Contractor/Agent Date
YVONNE C. ADAMS
Date
Commission # FF 147278
Contractor/Agent is Personally Known to Me or
Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas Roof
Construction Type: Occupancy Use: Flood Zone: _
Total Sq Ft of Bldg: Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING: UTILITIES:
ENGINEERING: FIRE:
COMMENTS:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Permit Application
PROPOSAL NO.
SHEET NO.
DATE
PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT.
NAM ADDRESS
6 C?D
ADDRESS,-
DAT OF PCANS 40
PHONE NO. ARCHITECT
We hereby propose to furnish the materials and perform the labor necessary for the completion of
Y(
C,7
All material is guaranteed to be as specified, and the above work to be performed in accordance with the _2dr
wings and specifications submitted for above work and
completed in a substantial workmanlike manner for the sum of
Dollars ($ with payments to be made as follows.
70 coo :P0
2whotvow
a-46,L je2-6
Any alteration or deviation from above specifications involving extra costs
will be executed only upon written order, and will become an extra charge Respectfully
over and above the estimate. All agreements contingent upon strikes, submitted
accidents, or delays beyond our control.
Per
Note this proposal may be withdrawn by us if not accepted within days.
ACCEPTANCE OF PROPOSAL
The abo4prices, specifications, and conditions are satisfactory and are hereby accepted. You are authorized to do the work 'asspecified. Payments will be made as
outlined above'.' Signature\
Date Signature
THIS INSTRUMENT PREPARED BY:
Name:
Address: /l
NOTICE OF COMMENCEMENT
Permit Number:
Parcel ID Number: 25-19-30-5AG-1 30E-01 00
GRANT MALOY e SEMINOLE COUNTY
CLERK OF C:IRC:UIT COURT tt COMPTROLLER
nKt 8905 I'3 937 (IP.-;s )
CLERK'S 4 2017i 43524
RECORDED U5 04/2i117 081' 20',:' }2 AM
RECORDING FEES $11:1.0ii
RECORDED BY jec- enrD
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)
LOT 10BILK 13TRE TOWN
OF SANFORD PB
1 PG 56 Address 1119 S. Locust Avenue Sanford FI 32771 2.
GENERAL DESCRIPTION OF IMPROVEMENT: Re
Roof/ Shingles 3.
OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT: Name
and address: Deloda Nelson 1119 S. Locust Avenue Sanford FI Interest
in property: Owner Fee
Simple Title Holder (it other than owner listed above) Name: Address: `
4.
CONTRACTOR: Name: S :t'. /,/2G Lr:yl Tl c,t- 0 f^i_ Phone Number: Address: /
d SeG ( btAle-f Aaz h Pal14 -:.p, .3Z (o . 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:
Stateline Contractors, Inc Phone Number: r3t i- A&iracc-
10 Seaflower Path Palm Coast, FL 32164 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. O N
Signature
of
Owner or Lessee, orlownWs or Lessee's (Print Name nd Prov de Signatory's Titlelotice) Authorized Office
r/ Director/Partner/Manager) State ofI
County of The oing
instrumeent' by OL
before me
this of person
making statement who has
produced identification type of identification produced: uar P&
a•+ffl-
le`-
YVONNE
C. ADAMS Notary Public -
State of Florida o`"os
My Comma Expires Aug 21. 2018 ComVNW1mission # FF147278dayof
Who is
personally known to me OR o `` W aCr. ¢ SLLJ
0
J
oo
LL
Y
U Z Q w
wZLY U lJQLo
m
r _
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
I hereby name and appoint: wyG`Di
an agent of:
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 spPPecific permit and application for work located at:
1 ` C!V J of L
Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name:
State License Number:
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF,1 i ()&AqX,
The foregoing instru ent was acknowledged before me this QL day of ,
200 _ by who is personall known
to me or yvho has produced 5r).. I ` kP2-j U as
identification and who did (did not take an oath.
up', QL,,— a n'/
Signature
Frances M. Rivera -Reyes
Notary e Public
9 9a,
I
1-
04Ppr P
eGo Print or type name
State of Florida
My Commission Expires 11/27/2020
Commission No. GG 50253
Rev. 08.12)
Notary Public - State of OOP
Commission No. =--
My Commission Expires: 1i 12`) 2GZ.6
JOB ADDRESS: I I S + M Jal
PERMIT #
City of Sanford Building Division
Residential Re -Roof Scope of Work
STRUCTURE TYPE: SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: JOI&PLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY: L y fN 6
PLEASE NOTE: ONLY 100 SQUARE PEET-OF THE EXISTING DECK IS PERMITTED TO BE REPLACED'"`
ROOF VENTILATION: O OFF -RIDGE O RIDGE ,5 SOFFIT OPOWERED VENT
SKYLIGHTS: O YES 03Q0IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #: MAIN
ROOF AREA ROOF
SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 0-4."1'2 OR GREATER OTURBINES
TYPE
OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL SHINGLE
iyJ / .' FL# O
METAL FL# O
MODIFIED BITUMEN FL# O
TORCH DowN FL# OINSULATED
FL# O
TILE FL# O
OTHER: /1 Cb Q- cif l! j a
FL# ROOF
EXTENSIONS (PORCHES, PATIOS, ETC.) * IFAPPLICABLE** ROOF
SLOPE: LESS THAN 2:12 2:12 - 4:12 J /
OOO4:12 OR GREATER TYPE
OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL O
SHINGLE FL# O
METAL FL# O
MODIFIED BITUMEN FL# O
TORCH DOWN FL# OINSULATED
FL# O
TILE FL# O
OTHER: FL#
City of Sanford Building Division
Residential Re -Roof Inspection Policy & Procedures
PERMITTING REQUIREMENTS — NO PLAN REVIEW REQUIRED
This document (signed) along with an accurate and completed Residential Re -Roof Scope of Work are required
to be submitted as part of your permit application.
The Scope of Work must include all applicable Florida Product Approval numbers for all roof components that
will be installed on the project.
A permit will not be issued without these documents. Copies will be made to post on the job site.
Projects located in the Sanford Historic District will require plan review and approval by the Sanford
Historic Preservation Board
INSPECTION POLICY & PROCEDURES
A Final Roof Inspection is the only inspection required for Residential (Single Family, Townhouse, Mobile
Home, Apartment and/or Condominium) Re -Roof Permits.
The Following is required to be provide on the job site:
Permit Card, posted in a conspicuous and weatherproof location
Completed Residential Re -Roof Scope of Work
Completed and Notarized Inspection Affidavit
All Florida Product Approval and Corresponding Installation Instructions
Product Approval shall match what is on the scope of work)
Digital Photographs (must include the permit number or address in each picture)
o Each plane of the roof, showing the underlayment installed
o Roof Deck Nailing Pattern & Spacing (including a measuring device or ruler)
o Roof Deck Nails used (including a measuring device or ruler showing size of nails)
o Underlayment Pattern & Spacing (including a measuring device or ruler)
o Drip Edge & Valley Attachment (including a measuring device or ruler)
o Shingles installed, nail pattern and location of nails
Skylights (if applicable)
o Digital photographs showing all installation components, per FL Product Approval
o Digital photographs showing all required flashing, per FL Product Approval
Failure to follow these specific guidelines will result in an affidavit provided by a Florida Design
Professional (architect or engineer), certifying FBC code compliance by personal inspection.
CONTRACTOR (OR OWNERBUILDER) SIGNATURE: qr 4,f + DATE:
b
City of SanfordF D tY
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: 7` 1 Z 7 9" ADDRESS:
AS A(N) GENERAL. BUILDING. RESIDENTIAL_ OR
ROOFING CONTRACTOR, ENGINEER, ARCHITECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE
FOREGOING INFORMATION IS TRUE AND ACCURATE AND THAT ALL ROOFING COMPONENTS LISTED ON THE SCOPE OF WORK AT THE
ABOVE REFERENCED ADDRESS HAVE BEEN INSTALLED IN ACCORDANCE WITH THEIR PRODUCT APPROVALS AND ALL APPLICABLE CODE
REQUIREMENTS - SPECIFICALLY FLORIDA BUILDING CODE, EXISTING BUILDING. IN ADDITION I CERTIFY THE INSTALLATION MEETS ALL
REQUIREMENTS FOR SECONDARY WATER BARRIER AND NAILING OF THE ROOF DECK, IN ACCORDANCE WITH THE HURRICANE RETROFIT
MANUAL REQUIREMENTS (BASED ON F.S. CHAPTER 553.844).
LICENSE #:
COMPANY / CONTRACTOR: q elal-
CONTRACTOR SIGNATURE:
MUST BE SIGNED BY LICK OR OWNER/BUILDER)
A FINAL ROOF INSPECTION IS REQUIRED:
DATE:
THIS SIGNED,AND NOTARIZED AFFIDAVIT MUST BE PROVIDED AT THE JOB SITE AT THE TIME OF THE FINAL ROOF INSPECTION,
ALONG WITH DIGITAL PHOTOGRAPHS OF EACH PLANE OF THE ROOF SHOWING IN DETAIL ALL COMPONENTS (DECKING,
UNDERLAYMENT,. FLASHING, DRIP EDGE ATTACHMENT) WITH THE PERMIT NUMBER OR ADDRESS CLEARLY MARKED ON THE DECK
FOR EACH INSPECTION. THE PHOTOGRAPHS MUST INCLUDE A RULER OR MEASURING DEVICE TO CONFIRM ALL NAIL SPACING AND
OVERLAPS, INCLUDING DRIP EDGE AND VALLEY FLASHING. PLEASE REFER TO THE RE -ROOF POLICY AND INSPECTION PROCEDURE
PAPERWORK FOR FURTHER EXPLANATION OF ALL REQUIREMENTS.
FAILURE TO FOLLOW ALL REQUIREMENTS WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION FEE AS
WELL AS REQUIRING A DESIGN PROFESSIONAL (ARCHITECT OR ENGINEER) TO CERTIFY, BASED ON PERSONAL
INSPECTION, THE INSTALLATION OF; ALL ROOFING COMPONENTS.
STATE OF FLORIDA COUNTY OF
Sworn to and Subscribed before me this O %- day of 20 tj_ by:
Wool 'OAA tOV . W ho is Personally Known to me or hasxproduced (type of
ide tification)7_D(+QU LA C. as identification.
Signature of NotaryPublic State
of Florida , Frances M. Rivera -Reyes IMI
A - YP e Notary Public 04
State of Florida Print/
Type/Stamp Name of
Notary PublicMy Commission Expires 1112112020 Commission No.
GG 50253