2526 Poinsetta Ave 17-73; ROOFCITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: ( — 9 ? —
Documented Construction Value: $ 'K60' ego
or, .0
17011
e VO 1 0,4,j 3 1z ) 'Z: YeSEI No>< Job Address: '12, Historic District:
Parcel ID: 0&naO o3LI2 qgR2 Residentialo CommercialEl Type of
Work: NewEl Addition El AlterationEl RepairEl Demo El Change of Use 0 Move El Description of Work: Plan Review
Contact Person: Dkq
bVI, Title: Phone: 44 - 0_-00 Fax:
Email: o 2- Property Owner InformationNamePhone:
Street: 6C>0
S 0SCf_'
0)D L)(_ und , (X Resident of property? City, State Zip: ate Contractor
Information r) C'1`
I Name
Fc- -2 0) Phone:
Street: Fax: City, State3Zip: '
3 e_
W State LicenseNo.: Architect/EngineerInformationName: Street: City,
St, Zip: Bonding
Company:
Address:
I K K
Phone: Fax:
AtZ 4
E-mail:
I
Mortgage Lender: Address:
WARNING TO
OWNER:
YOUR FAILURE
TO
RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAVING 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: 5" Edition (2014) Florida Building Code Revised: June 30,2015 Permit Application
NOTICE: In addition to the requirements of this permit, there may be adi:litiional restrictions applicA7* to this property that may be
found in the public records of this county, and there may be additiona{ Oermlts required from other go eenmental 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.
Signature ofOwner/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is — Personally Known to Me or
Produced ID Type of ID
Signature of Notary -State of Florida Date
Contractor/Agent is Personally Known to Me or
Produced ID _ Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical [] Mechanical F] Plumbingn Gas[] Roof []
Construction Type:
Total Sq Ft of Bldg:
Occupancy Use:
Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes n No F]
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
W00
135 W. Pineview Street, Altamonte Springs, FI, 32714-2006
407) 682-3355 * Fax (407) 682-1956
PROPERTY L4ANAgEMENT AGREEMENT
THE UNDERSIGNED OWNER HEREBY EMPLOYS THE UNDERSIGNED Broker exclusively to
rent, lease, operate and manage the real property situated in the:
City of -3—arl,kr-d zip 17 1 3 County of &m /no t _State of Florida.
Property Address c? 56? Lp - , R) ln3tttp- Av-p- for a period of one year,
date beginning 3-110 —/Ito and automatically renewed after the expiration date of each term upon the
following TERMS AND CONDITIONS, Contract maybe cancelled with 60 days' notice provided all
fees are paid to Presidential Group South, LLC. This cancellation only applies to units where Presidential
Group South, LLC is currently collecting management fees,
BROKERS OBLIGATIONS
The Owner grants to the Broker the following duties, authority and powers:
a. Full management and control of said Property with authority to collect all rents and other monies
and securities from tenants in the Property and issue receipts thereof.
b. To negotiate new leases and renewals of existing teases in accordance with the rent schedule and
terms as approved by the Owner and the Broker jointly. Broker shall handle all tenant requests
and negotiations that may arise.
C. To have repairs made, to purchase necessary supplies and to pay bills and charge same to Owner.
The Owners approval shall first be obtained on improvements and repairs that exceed $ 100,00 in
cost (except emergency repairs). At the termination of this agreement the Owner assumes the
obligation of any contract entered into by the Broker on the Owner's behalf.
In the event an emergency repair is necessary under situations which would either render the
premises untenable to the tenant or under such circumstances as repairs may be necessary to
prevent damage to the premises, Broker is authorized to take whatever action an owner of
reasonable prudence and concern would be expected to undertake for the protection of his
Property and or the fulfillment of his legal obligation to the tenant. With regard to such
emergency repairs, Broker is authorized to expend whatever sums of money as may be required
and may reimburse itself for said repairs out of rents collected in the event Owner does not
reimburse Broker for same within thirty (30) days frorki the date Broker places said notice in the
mail.
e. The Broker hereby accepts the Agency and agrees to perfon-n faithfully and diligently the duties
of a real estate managing agent. The Broker does not guarantee the payment of rentals by the
tenants, but will make every reasonable effort to collect same.
f. Broker shall maintain accurate records of all monies received and disbursed in connection with
the management of the Property. Such records shall he opened for inspection by Owner at all
reasonable times. Broker shall render itemized statements of receipts, expense charges and
accruals and to remit to Owner receipts less disbursements and accruals for future expenses. In
the event disbursements shall exceed receipts, Owner shall promptly reimburse the Broker upon
demand. Owner assumes full responsibility for the payment of any expenses and obligation
incurred in connection with the exercise of Broker's duties set forth herein.
9.
Authentisign 10: 26ASC807-OfAE-4CA4.9865-600F5C72E$AB
OWNER'S OBLIGATION
Owner agrees:
a. Indemnify and save the Broker completely harmless front any and all costs, expenses, attorney's fees, suits, liabilities, darnages
or claims for damages, including but not limited to those arising out of any injury or death to any person or persons or damage to
any property of any kind whatsoever and to whomsoever belonging, including Owner, in any way relating to the management of
the premises by the Broker or the performance or exercise of any of the duties, obligations, powers or authorities herein or
hereafter granted to the Broker.
b.To pay mortgage indebtedness, property and employee taxes, special assessments and to place insurance as follows:
I Insurance for the perils of fire, lightning, wind, hail, explosion, smoke, riot, aircraft, vehicles, vandalism and burglary
on the contents.
2. "All Risk" protection on the building and rental income.
3. Insurance for liability for personal injury and property damage in the amount of S300,000.00
4. Any insurance obtained shall be with a carrier approved by the Owner and in the amount and in the fiann approved by
the Owner.
S. The policies shall name the Broker as well as the Owner as the party insured and shall specifically include coverage of
the indemnity and hold harmless provision set forth in this paragraph except in cases in which the loss is caused by the
Broker's own willful misconduct or gross negligencc.
The Broker is hereby directed to accrue and pay for the following from the Owner's funds:
a.Owncr agrees to pay Broker a fee or fees for services rendered at the rates hereinafter set forth. Owner rccogni7cs Broker as
agent in any negotiations relative to the property or any part thereof, which may have been initiated during the term hereof and if
consummated shall compensate Broker in accordance with the rates hereinafter set forth. Such compensation is due and payable
on demand and may be deducted by the Broker from receipts. *If agreement is canceled due to sale of home or before contract
expires, owner will pay $100, 00 cancellation fee and all advertising costs.
MANAGEMENT: §IJ OF COLLECTIONS UP TO A MAXIMUM OF $100.00 A MONTH
Collections to include Rent, Forfeited Security Deposits applied to rent (not for damages)
Forfeited Purchase Options]
ATTORNEYS FEES/LEASE DRAFTING: In the state of Florida a Broker is not allowed to, by law, draft
a lease. Therefore, there will be an administrative fee of $50.04 for preparation of the lease. The charges to
cover these attorneys fees and administrative charge will be collected from the first monies received If Broker
does not currently have the funds from landlord to pay this.
LEASING: 6n OF ONE MONTHS RENT
ADVERTISING: BROKER PAYS ALL ADVERTISING COSTS.
LEASE RENEWAL: 1150.00 ADMINISTRATIVE AND NEGOTIATING FEE
ELECTRONIC TRANSFER OF FUNDS: L3.00 PER MONTH UNLIMITED TRANSFERS (ONLY MONTHS
TRANSFERRED) )( YES NO (if yes, please provide a copy of voided check)
LATE CHARGES: BROKER RETAINS.100% OF LATE CHARGES AND NSF FEES
The Broker accepts this exclusive employment and agrees to use due diligence in the exercise of the duties, authority and powers
conferred upon him under the terms hereof This contract may also be canceled for cause, on sale of said Property in condemnation
or the bankruptcy or insolvency of either party.
OWNERS NAME: MH Land Holdings. LLC E-MAIL ADDRESS: M11oyl2E1g@qMa1i&qM
BEST PHONE NUMBER TO REACH YOU AT ALL TIMES: 407-484-1539
MAILING ADDRESS: 260 S. Osceola Ave., #706
OWNERS SOCIAL SECURITY NUMBER:
3130/2016Lw6kii.6"ATURE DATE
47-4470626
Orlando FL
0" state
BROKETI N LURE DT4ATE
i Authonfisign 10. 26ASCO07-OFAE-4CA4,SB65400FSC72EBA8
LIMITED POWER OF ATTORNEY
Date:
I hereby name and appoint A-0 &,g to be my lawful attorney in
fact to act for me and apply for a ke, t7 permit for work to be
performed at the location described as:
Address of Jot))
And to sign my, narne, and do all things necessary to this appointment.
signature of Certified Contuctor)
it r-AZr7A,4:
Printed Nante of C oniiii&Waiialiccnsc Number) STATE
OF FLORIDA COUNTYOF W Z—e The
foregoing instrunzc t was acknowledged before me this day of 2. who
is)<pci-sonally known to me or has 0 produced type
of identification) as identification and who did SEAL)
JOHN
R. BYRNE Commission #
FF "24 4 Expires
May 15, 2020 Bonded
Pn troy Fain Mmno $W385-7019
Folio/Parcel ID t __ - — .' —1 — 111111111111 H111 1111111111111111111 RE
Prepared by. Bradley S Pollack
0 -
y- '
H[HfLi, "OUH1,Y0371TP-e-m6_r k Drive Hf ' )RS 'Ei .0-DE 1 '1 C:
A_EkT OV CIRCUIT COURT COUTROLLEROrlandoFlorida32810
Return to: masimo Construction. Inc. CLF RK 6u 21:II613CI623
3715 Pembrook All
Orlandorn Florida 3-281 f1f
NOTICE OF COMMENCEMENT
State of Florida, County of
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordancewithChapter713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Description o;f4groperqty (le d,scription of -the prope _qy,.pnd street address if vailable) 160 > rnoe,, 4 jO& 42. General description of i proveme t
42
3. Owner information or Lessee In& n if th - atioe Lessee contracted for the improvement Ki--- ^A , " # , T , j Interest
in Prope - --- - — -- _F 1 — ,- Name
and address of fee simple title older (if different from Owner listed above-) Name
Address
4.
Contractor Name
Masimo Construction, Inc. Telephone Number 407.922.0500 Address3715PembmokDriveOrlandoflorida328105.
Surety (if applicable, a cagy of the payment bond is attached) Name
Telephone Number Address
Amount of Bond S 6.
Lender 1
N C311 It; - I Telephone Number Address-
7.
Persons within the State of Florida designated by Owner upon whom notices or other documents may beservedasprovidedby §713.13(1)(a)7, orlda Statutes. Name
A / 7 A Telephone Number Address
III Z /Z 8.
In addition to himself or herself, Ownet designates the fallowing to receive a copy of the Lienor's Notice
as provided in §713.13(i)(b), Florida Statutes. 9.
Expiration date of notice of d6imencement (the expiration date unless
a different date is specified) Telephone
Number be
1 year from the date of recording WARNING
TO OWNED 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 YOtAR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDE1101
ED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT VfITH '/Y90 ALPOOR AN_5rTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. of
Owner or The
foregoing or
Owners or Lessm's Authorized Officer0rector/PannedNianager Signatory's TitWOffice was
acknowledged before me this 0- day of by .0 rnontWyear
name of person-'- as
for Type
of authority, e.g. officer, trustee, attorney in fact Name of party on behalf of whore instrument was executed Known
OR NEU
M-6Form
corl'w John
BjEne of
Florida Print. type. or stamp commissioned name of Notary Publiciced VI/ IDJOHN
R. BYRNE Commission #
FF 992414 Expires
May 15, 2020 Bonded
TNU Troy I* InVAra $00-385-70 19
12112x2016 . Detail by Entity Name
K~U W xv v m U" ~= "".= Name
FloridaCompany
MH LAND HOLDINGS LLC
Document Number L15000114586
PEKE|NNwmbar N/A ' ~
Date Filed 8702%2015
State FL
Status ACTIVE
Last Event REINSTATEMENT
Event Date Filed 10/17/2010
2SU3.08CEOLAAVE,
UN\T#70G
ORLANDO, FL32801 UN
260 S. DSCEDLAAVE.
UNIT #708
ORLANDO.FL32O01 UN
Registered Agent NaMe Address
HC)YLER,.MATT D `
260 S. OGCEOLAAVE. UNIT 706
ORLANDO.FL32OO1
Name Changed: 1O/17/2O1G
Name & Address
Title MGR
HOYLER.MATT O
2G08.OSCEOLAAVE. UNIT 7O0 ORLANDO.
FL328O1 UN AnnWal
Reports Report
Year Filed Date 2016
1017/2016 inquirytype=
BntityNwne&dinwmonType=lnioal&msm^ mneOnder=MHLAwDHO0w 212
P.O.
Masimo Construction, inc.
Masirno Construction, Inc.
Roofing Contract/Proposal
Address: 1049 Blackwood Street
Altamonte Springs, FL 32701
Phone: (407) 922-0500
State -Certified Roofing Contractor - CCCI 328033
State-CoTtIfied General Contractor - CGC1509548
Brad Pollack, Contractor,, . I
Customer Name,
Home Pho Cell:
SPECIFICATIONS
1;401110VO roof to existing deck — layers.
Each additional layer s /Sq. (100 Sq. Ff.)
ellR"all oxIstIng deck to moot uplift codes.
nstall — Inotall drip edge around orlmeter of roof.
td'lnstnll load boots to pipes 1%" 3,,
dinstall Gooseneck vents 4"
ti urricano Mitigation Retrofit
1 Apply ASTM 30# Felt Paper to pJywpo&d9ck.
6APply — Sq. Ft. of METXLJSHINGLESITILEISHAKESIFLAT
El Style of roof to be Installed.
Color. Pjtch-.
keturor of roofing system;
ridge vent along peak of roof:
Insurance Co.
Adjustor:
Claim #:
Phone,
Date:
Work Phone:
OTHER PROPERTY CONDITIONS
Q Ico/Wator Shield —Yes No
El Existing Water Damage —Yes No
El Existing Driveway Damago —Yes No
13 Skylights:
El Looks,
0 Interior Damage*.
0 Emergency Repair — yes No
El Tapered Insulation — Yes No
WORK INCLUDES:
v",Removo trash from roof, gutters and yard.
Protect landscaping whore applicable.
Roll yard with magnetic rollor.
Furnish permit
2 year warranty
Additional charges of$70 per shoot If docking, replacement is needed which Is only visible upon tear -off existing roofing materials.
WE PROPOSE
To furnish material and labor complete in accordance with raJ2A9lfi,@tI9n§ c vofor the sum of $
SPECIAL INSTRUCTIONS: M MENT SCHEDUIX
50% DOWN PAYME NTPRIOR TO ORDERING MATERIALS
PAYMENTY ,$FULL UPON COMPLETION
EARNEST DEPOSIT:, $500.00 0 $1000.00 0 $
DOWN PAYMENT Z
MALPAYMENT %-'_' i
4- TOIJAL
ACCEPTANCE
OF AGREEMENT This
agreement is subject to insurance company approval and does not obligate the homeowner or Masimo Construction, Inc. in anyway unless It
is hpproved by the insurance company and accepted by Masimo Construction, Inc, By signing this agreement you authorize us to negotiate the
repairs at a price agreeable to the Insurance company. and Masimo Construction, Inc. at N_Q AD9ITI!2NAL_QOSJ'TQ . __yQ_VEXGFPT OR THE INSURANCE DE
UCTIBLE AND AS '_O ED EL§gyyHE I EE — The final price agreed on between the Insurance company Eg VMJ3&1KJ_KMAG_BMENJ. and Masimo
Construction, Inc. shall become the final contract price and Masimo Construction, Inc. will receive all insurance proceeds for the work completed
by Masimo Construction, Inc. THREE DAY
RIGHT OF RESCISSION THIS WIRITJIEI
IGREEMENT HEREBY SERVES AS NOTICE THAT I MAY CANCEL THIS A'OREEMENTAT. E PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE O*P
THIS AGREEMENT. Owner Signatur
My 'y I J Data. 15 1 \ t —
I —
200 1 G Sales Rep., Accepted by
Masimo ConstructioW.-Int-14/Representative X insurance Carrier
Claim No Events beyond
the control of Masimo Construction, Inc. may cause delays to the projected start date or estimated time of completion, Such delays do not
constitute abandonment and are not included in,calculating time frames for payment or performance. THE TERMS AND CONDITIONS ON THE REVERSE
SIDE OF THIS PAGE ARE A PART OF THIS AGREEMENT. WHITE - HOMEOWNERS
COPY YELLOW - SALESMANS COPY PINK - OFFICE COPY
City of Sanford
Roof Permit Application Checklist
All permit application packages must be complete prior to acceptance. You must check each box to the
left or indicate n/a on this submittal. A complete application package shall include the following:
Building Permit Application completed, signed and notarized. Application must include correct address
and complete parcel I.D. number.
Copy of applicable contractor's license issued by the State of Florida (if the contractor is the
applicant).
A site specific notarized power of attorney shall be required from the licensed contractor if
he/she appoints an employee of his/her company to sign the permit application as the contractor.
Certificate of insurance indicating worker's compensation insurance coverage and naming the City of
Sanford as certificate holder, or a copy of a worker's compensation exemption issued by the State of
Florida (must be submitted with each application if contractor is the applicant).
Completed and signed Owner Builder Statement / Affidavit (if the owner is the applicant).
These guidelines were compiled to assist the applicant in preparing a roof permit application and may not be
complete. The applicant is required to meet all City qf,Sanford, state, and federal code requirements.
CITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #: f7 -- 73
I, &&,1 /0,
6 f /< hereby acknowledge that I personally inspected
toof deck nailing and/or Secondary water barrier work
7-3
at " r J Fl - 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 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 $37.06 F.S.
Signature of Contractor Date
d /-10 mr C e, Z319&-53
Printed Name of Contractor License #
License Type: F1 General 7 Building Residential Roofing Contractor
or any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF
Sworn to (or affirmed) and subscribed before me this day of , 20 , by
who is'ersonally Known to me or has Produced (type of
idea ati ) as identification.
SEAL)
PrintlT tam NamiYpp
of Notary Public
JONN R. BYRNE
Catnrniaa O 0 FR 992414
AMY 15, 2020
F* 0WW470,q
CITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #: V7 - 73
1, , (-2 (
N,
6 c( . hereby acknowledge that I personally inspected
Y/Roof deck nailing and/or 71 Secondary water barrier work
at AQe, 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 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
Secti"837.06 F.S.
9)17'
Signature of Contractor Date
CC ce[A
Printed Name of Contractor License #
License Type: F1 General 7 Building F1 Residential KRoofing Contractor
U or any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF _:5,-eL /do 1 2
Sworn to",,. dl and subscribed before m 2pthis47dayof :74-?k1 0 12by
who isXPersonally Known to me or has FtProduced (type of identifl
do as identification. SEAL)
Sigfi;(*
re of Notary-P filic 0 *
A0 Sta"-"' f Flan 7, T-V, 1 ,4 Printfri"
Pe/Stamp Name of
Notary Public COMM4"
W99204 EOM
May iS, 2020 OW4W
71n Tmy F* Www" 4*3WI019 3