210 San Fernando Ct; 17-2203; ROOFCITY OF SANFORD
fi :
s ` ±IJ 1 BUILDING & FIRE PREVENTION
4 PERMIT APPLICATION
Application No: 40
Documented Construction Value: $
Job Address: c%d fAAI % d C?, Historic District: Yes No [-
Parcel ID: Residential Commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of Work: , E- _ GLCCI L%N`L — —5 Gl''S
Plan Review Contact Person: — 14-Title:
Phone: (/ 4 Fax: Email:
Property Owner Information
Name
Street: d
City, State Zip: 1—'z-
l. ?, _271
Phone:
Resident of property? :
Contractor Information
Name 1,
Street: 6 OmE 01 C
City, State Zip: t7,zay,1V Oef 3 i
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Fax:
State License No.: Gce 13Z=
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 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: 51h Edition (2014) Florida Building Code /—/
Revised: June 30, 2015 Permit Application l (, q l-
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 doSv,4 comUIfance with all applicable laws regulating construction and zoning.
Agent
Print Owner/Agent's Name
Date Signature of Contractor/Agent Date
Print Contractor/Agent's Name
71
Signature 1Votary-State of Florida Date Signat/e of Notary -State of Florida ,Date
BASSEM HAIDAR WAHAB I ' "• ° BASSEM HAIDAR WAHABMYCOMMISSION # FF 942044 = MY COMMISSION # FF 942044
o EXPIRES: April B, 2020 = +` EXPIRES: April 8 2020
R6 t a ` Bonded Thru Notary Pubric Underwriters Rt ,t\ bonded Thru Notary public Underwriters
Owner/Agent is Personally Known to Me or Contractor/Agent is Personally Known to Me or
Produced ID Type of ID 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:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Permit Application
9111 Or:!tt I90I1 Ilglll Itll#i [fill 11111 91
Folio/Parcel ID #: !0- Zy- 5E4j- (10610
Prepared by: ;S',nt4 6,FI//.4s
Return to: P. ,s1. A G rC
GR041- I` ALLCY> 9r=rIIIgFl_.1= i 0U,41
L L{h Of
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1:{t(:U ii COURT `
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C:LERK'S r 2ij.71:172917
RECORI1l_C? 0'1Sr„r:, -'
NEC
RECOR!)ECl r .,,:; i •.I;
NOTICE OF COMMENCEMENT
State of Florida, County of Orange
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 propertrty (legalAde/s i 'on of the pr rty, and street address if available
2. G-endraldescription'ofimprovemenf _
3. Owner informationQLLessee information if the Lessee contracted for the improvement Name //`% /
Addre .
E LtJ DGL J Interest
in Property Name
and address of fee simple titleholder (if different from Owner listed above) Name
Address
4.
Contractor ,-- / Name
U r t
I / 01 /b elephone Numberwg,1/9- r6 r: Address
0 D 5.
Surety (i applica le, a copy of the payment bond is attached) Name
Telephone Number Address
Amount of Bond $ a, ,_ 6.
Lender Cr Name
Telephone Number Address
4 7.
Persons within the State of Florida designated by Owner upon whom notices or other documents ntB 8.
In addition to himself or herself, Owner designates the following to receive a. copy of the Lienor's Notice
as provided in §713:13(1)(b), Florida Statutes. Name
Telephone Number Address
9.
Expiration date of notice of commencement (the expiration date may not be before the completion of construction
and final payment to the contractor, but will -be 1 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YqklR-tE-NDEB OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature
9POoer or Lessee, or Owner's or Lessee's Authorized Officer/Director/Partner/Manager J
AN6A__ Signatory'
s Title/Office The
fooing instrument was acknowledged before me this day of by 1/,1/ month/
year name of person as
for Type
of authority, e. ., fficer, rustee, attorney in fact Sign
re ol Notary Public — State of Florida Personally
Known -/—/OR Produced ID Type
of ID Produced Name
of party on behalf of whom instrument was executed Print,
type, or stamp commissioned name of Notary Public r''•
BASSEM HAIDAR WAHAB MY
COMMISSION t FF 942044 Of
EXPIRES: April 8, 2020 Rf
Itr Bonded Thru Notary Pubric t)nderrrtkea Y
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Form
content revised: 10/17/12
PERMIT #d— F D. ,
City of Sanford Building Division
Residential Re -Roof Scope of Work
JOB ADDRESS:r/D/
STRUCTURE TYPE: NGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY): lo'Q
PLEASE NOTE: ONLY 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED * *
ROOF VENTILATION: OOFF'RIDGE DGE OSOFFIT OPOWERED VENT
SKYLIGHTS: O YES No IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 4:12 OR GREATER
OTURBINES
TYPE 'ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
DISHINGLE FL#
O METAL FL#
O MODIFIED BITUMEN FL#
O TORCH DOWN FL#
O INSULATED FL#
O TILE FL#
O OTH ER: FL#
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IFAPPLICABLE**
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 O 4:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
O SHINGLE FL#
O METAL FL#
O MODIFIED BITUMEN FL#
OTORCH DOWN FL#
0INSULATED FL#
O TILE FL#
O OTHER: FL#
f
Cityof Sanford Building Divisiong
k 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 OWNER/BUILDER) SIGNATURE: DATE: i
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: Z f -_ i 2::
I hereby name and appoint: _;q rf-C- 1
an agent of Tt rn ? O /.It i ^yj
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 work located at:
Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name:w
State License Number: (UGC /9 ') /? [
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before me this day off
200Z_, by C- EJ who is4olpersonally known to
me or who has produced as identification
and who did (did not) take an oath. gn
ure Notary
Seal) ,v t Print
or type name Notary
Public - State of 11111AI
11HASSAN AHMAD MSO]2019
Commission
No. Notary
Public - State of F Commission #
FF 220My Commission Expires: My Comm.
Expires Jul 25,Bonded through
National Nota Rev. 08.
12)
BRACKERT CONSTRUCTION INC.
CONTRACT
Representatives "// Date
Brackert construction Inc. agrees to furnish all materials and labor necessary for the work specified below on the
premises at:,//
Name Phone#
Address d YA16) f-d Work#
City jA6i ! .State Zip Code,Cetl# Z9 ; r
ns for La
0' insurance Claim
Cash Job
Recr an
Roof
with MFG: Q:
Q Years Manufacturer Warrty Style
oif Shingles Color
of Shingles_ 4— Ud''
TT ear off I Layers & roof over existing decking d
decking Replaced (§ $_ per sheet eplace
Felt 930 ,/ N 1 i_ ew
Valleys with Ice & water p'
Replace Stacks 1 '/2 "-— 2"_L3"__Z 4"_ Paint Stacks
with anti -rust paint to match Terms
a V
urtrineRidge Vent If. Off Ridge Vent_ Install
new metal drip edge Color G- /i FM '
Ican up and haul away all Roof debris D
Roll Magnet around yard/ blow driveway Qr
Prackert construction Inc. will furnish Permit CZ-'
Year- of Labor Warranty Q/-
AII supplemental fillings to be paid directly to rackert
construction Inc. The
owner/insured authorizes and request the name of Brackert
construction Inc. to be included on all drafts
or checks pertaining to this claim. Ali
Proposals and Contracts are subject to Approval by Management Contract
Price $ g //Q Deposit
due at signing, $ Balance
Due at Completion $ eq llm P.
O. Box 61W2 Orlando, Rarkla 32a61 Co -
Purchaser) Tel.
407-617-5567 Fax. 407-362-1962 EmaH: bassemwahabl@hourtml.com Brackert
construction Inc.License # CCC1327178
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT ##: 12, ;/ 2(1Y 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 #: If —
1, /
ezi ? 12 9
COMPANY/CONTRACTOR:
CONTRACTOR SIGNATURE: DATE: —,,./34
MUST BE SIGNED BY LICENSE HOLDER OR OWNER/BUILDER) —
A FINAL ROOF INSPECTION IS REQUIRED:
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 ! day of 20 _? by:
Who is & ersonally Known to me or has Produced (type of
identification) as identification.
n a
Sig tore of Notary Public
State of Florida
Print/Type/Stamp Name
WAHABofNotaryPublic ; GrS`—- FM 14AIDAR
r)N # FF 942044
r
ru Notary public Undewhen
SEJA HAIDA:AHAB
4ISSION F 942D44ES: Apr20PDPuunde°n7, i
fbru Notary