1500 Summerlin Ave; 17-1826; ROOFCITY OF SANFORD
EN BUILDING & FIRE PREVENTION
PERMIT APPLICATION
emu. D JUN 19 2017
Application No:
Y.
00
Documented Construction Value: $ 3, So d -
Job Address: /5o d S- t u r1r\ - Historic District: s No
Parcel ID: Residential Commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
4 ic /4cys eDescriptionofWork: o - dlh2j,
Plan Review Contact Person: Title:
Phone: Fax: Email:
Pr perty Owner Information
N eZ. e Phone: D
i-
Street: S.
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z 'xx3. ,.4x ,y., a a r'4 _ •kt + -ih +` a.;`r,
esident of plopertyT,
79City, State Zip: t' , V
tiA.tContractorInformation. it} i+} . al4.4
Name C vas e_ Phone: 6(0%_ ( 5- s33
Street: O Of< 20 g-7-o Fax:
City, State Zip: t.AJoo
e State License No.:
Architect/Engineer Information
Name: Phone:
Street: Fax:
City, St, Zip: E-mail:
Bonding Company: Mortgage Lender:
Address: 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: 51n Edition (2014) Florida Building ode
Revised: June 30, 2015 Permit Application `0
NOTICE: In addition to the requirements of this permit, there may be';additional, estrictionst applicable to this property that may lie'
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
be done in compliance with all applicable laws regulating c
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e of weer/Agent ate
lwner/Agent's
M
Date
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is accurate and that all work will
nd zoning.
for/Agent Date
t'!6caVy-State oft1gRidgNTONINI D
Notary Public - State of Florida
r= My Comm. Expires May 21, 2018
Commission # FF 125242
Owner/Agent is Personally wn to a or Contractor/Agent is Personally,Y to Me or
Produced ID Type of I % .2'rProduced ID Type of ID Q)/ -
673 - d BELOW
IS FOR OFFICE USE ONLY Permits
Required: Building Electrical Mechanical Plumbing Gas Roof Construction
Type: Total
Sq Ft of Bldg: Occupancy
Use: Min.
Occupancy Load: New
Construction: Electric - # of Amps_ Fire
Sprinkler Permit: Yes No # of Heads APPROVALS:
ZONING: UTILITIES: ENGINEERING:
COMMENTS:
FIRE:
Flood
Zone: of
Stories: Plumbing - #
of Fixtures Fire
Alarm Permit: Yes No WASTE
WATER: BUILDING:
Revised:
June 30, 2015 Permit Application
a_
CONTRACT AGREEMENT
This agreement is made on this day of CJt n 20 17between
kn V %^s of 3I q `? qV,,4 ST—
Name Address City
f /S 53 R (Contractor)
State Zip Phone
and i of
me Address City
Client)
State Zip Phone
The above contractor will perform the following work as described in this agreement for $ 3, Soo, o
in compensation from the client..
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Job Description:_ R)I)OS4
Work to commence on w (,tV-(,?6l-)and is estimated to be completed ono! I e 1
Date Date
Contractor:
Signature
j -
Print
Client: Loa-,
Signature
L,
Print
i
Datej G e 1
Date:
1 .%
THIS INST U ENT P jETARED
Name r'
Address:
NOTICE OF COMMENCEMENT
State of Florida
County of Seminole
Permit Number: Parcel ID Number:
GRANT 11ALOY t SENINOLE COUNTY
CLERK Cif` CIRCUIT COJJR1 & COMPTROLLER
CLERK'S 4 2017060820
RECORDED 061115!21"r17 1_12.02 24 P11
RECORDING FEES $10.00
RECORDED BY Jeckenro
31 lq - 31501 D67015 012- 0 a
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.
DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available)
r.
GENERAL -
i(:f of I ROVEMj -sC Fee
Simple Title Holder (if other than owner) Name: Address:
CONTRACTOR:
p J L)
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t
Name:
P/( _ J Address:
0 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)(b), Florida Statutes. Name:
Address:
In
addition to himself, Owner Designates of To
receive a copy of the Lienor's Notice as Provided in Section
713.13(1)(b), Florida Statutes. Expiration
Date of Notice of Commencement (The expiration date 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 of perjury, I declare that I have read the foregoing and that the facts stated in it are true to
the besJ of my knowledge and belief. t
11CL L 4 l is Owners'
Signature Owners Printed Name Florida
Statute 713.13(1)(g):' The owner must sign the noti mmen ment and no one else may be permitted to sign in his or her stead." State
oun of tt
f fegoipg instr rent 14r \I r}6w)Idged before me this it ' `day of 20 by
X 1171W /I U/7 V I a111JV / Who is e4onally//known to me a
e of pe(sonNuaft statem 2 t _ ! / J,/ A —_fay has
typetbf identification y
MARCU8 FREOERlCK MALAVE NO"
POW • SM of FlofW Caynls"
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Comm. Expim Jan 26, 2019 gnua
110M 111f01p1 N1tl011i1 KOtn Ann. Notary
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SEA41NOLE COUNTY MULTI -JURISDICTIONAL
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: s9_ ? ft /,110 / 7 `
ll
1 hereby name and appoint: I r j 1 u K i
an agent of: _ G. ! U" 5 C /,e. / , r
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):
D All permits and applications submitted by this contractor.
Or
The specific permit and application for work located at:
Street Address)
Expiration Date for This Limited Power of Attorney-.
License Holder Name: C vie-PN C,
State License Number:..
Signature of License Holder:
STATE OF FLORIDA,,' {
COUNTY OF
The foregoing instrument was acknowledged before me this
2011 , by QA-V1%kC` W% U
who. has produced
a d who did (did not) take an oath.
Y\. kvp
Signature of Notary Print or type Notary name
irRY PU6 , DAVID J MITRO Notary Public - State of
Notary Public State of Florida Y r O ` R
ro,` My Comm. Expires Jan 31, 2018 Commission No. 1"C (
p iikr Co(nmissfon # FF 081976 My Commission Expires: 'Shr'-. .3 Z0 1 U
4./
2LI day of M A\4 ,
who is XpersJally known to me or
as identification
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JOB ADDRESS: / Soo Lm P" i /
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: 0 REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOFINSTALLED OVER EXISTING ROOF
DECK TYPE (PLEASE SPECIFY): P ` /c j 64% 000
PLEASE NOTE: ONLY 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED * *
ROOF VENTILATION: OOFF-RIDGE ® RIDGE OSOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: OYES ONO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 02:12 - 4:12 O 4:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
SHINGLE 1 /`e FL# ., , Old i P-pO
O METAL FL#
O MODIFIED BITUMEN FL#
O TORCH DOWN FL#
O INSULATED FL#
O TILE FL#
O OTHER: 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#
O TORCH DOWN FL#
OINSULATED FL#
O TILE FL#
0 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), certifyin B ode compliance by personal inspection.
CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: DATE: ` (/
Y
City of Sanford
t
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: '
r, '"
I (J ADDRESS: / f;0 . v r + +''y J
Y1C , 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 WITkI 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 #: C Cc, 13 Z_9-;l
COMPANY / CONTRACTOR' a
CONTRACTOR SIGNATURE: LPk_. L
MUST BE SIGNED BY LICENSE HOLDER 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 .Seen jcLe
Sworn to and Subscribed before me this 21 day of _ 20 by:
Who isPersonally Known to me or has Produced (type of
identification) as identification.
T t
Signature of Notary Public
State of Florida
CA V' d r ,-' r o
Print/Type/Stamp Name
of Notary Public
1
111 1
0 °'`; DAVID J MITRO
Notary Public - State of Florida
yA auz My Comm. Expires Jan 31, 2018
Commission FF. 081076