1002 Celery Ave - BR17-002728 - ROOFr
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CITY OF SANFORD
BUILDING & FIRE PREVENTION
SEP 2017 PERMIT APPLICATION
y; i -- Application No: 7- o? 7 c Y
00
Documented Construction Value: $ /50D .
Job Address: 10 U z Le I f-h-y! 1L y e cSfQ,h IT 4 _I
Parcel ID:
Historic District: Yes No 0
Residential Pf Commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of Work:
Plan Review Contact Person:
Phone: Fax:
Ca-f
Email:
Prope.rty_O:wfr- m ne.r=l:noation Name Ja
A,,l/ l ra-& Street: l
2 C d (` V P/ City, State
Zip: 51cyt &L F'ICt, 2 221 Title: Phone: '
T
02 `3 2 f— 0 612 Resident of
property? : Contractor Information
Name Phone:
Street: Fax:
City, State
Zip: State License No.: Architect/Engineer
Information Name: Phone:
Street: Fax:
City, St,
Zip: E-mail: Bonding Company:
Address: 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: 5'" Edition (2014) Florida Building Code Revised: June
30, 2015 Permit Application lti CITY
OF
SANFORD BUILDING & FIRE
PREVENTION SEP 2017
PERMIT APPLICATION y; i --
Application No: 7- o? 7 c Y 00 Documented
Construction
Value: $ /50D . Job Address:
10 U z Le I f-h-y! 1L y e cSfQ,h IT 4 _I Parcel ID:
Historic District:
Yes No 0 Residential Pf
Commercial Type of
Work: New Addition Alteration Repair Demo Change of Use Move Description of
Work: Plan Review
Contact Person: Phone: Fax:
Ca-f
Email: Prope.
rty_
O:wfr- m ne.r=l:noationNameJa A,,l/
l ra-& Street: l 2 C
d (` V P/ City, State Zip: 51cyt &
L F'ICt, 2 221 Title: Phone: 'T 02 `
3
2 f— 0 612 Resident of property? : Contractor
Information Name Phone:
Street: Fax:
City, State
Zip: State
License No.: Architect/Engineer Information Name:
Phone: Street: Fax:
City, St,
Zip: E-
mail: Bonding Company: Address: 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: 5'" Edition (2014) Florida Building Code Revised: June 30, 2015
Permit Application
4
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 j
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.
1-4
IV, 1 i/ M91207
Signatu of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name Print Contractor/Agent's Name
Oq
Signature of Notary- n a OEBgIggtANTtLDAte Signature of Notary -State of Florida Date
lMF• b '.. MY COMMISSION # IrF 178648
a€ EXPIRES: February 25,2019
9'.;.... •' F1ji'p„(: Bonded ihru lJotary Publicibllc Un t s
Owner/Agent is Personally Down 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: # of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes No # of Heads Fire Alarm Permit: Yes No
APPROVALS: ZONING: UTILITIES: WASTE WATER:
ENGINEERING:
COMMENTS:
FIRE: BUILDING:
Revised: June 30, 2015 Permit Application
OWNER BUILDER STATEMENT/AFFIDAVIT
Altamonte Springs, Casselberry, Lake Mary, Longwood, Oviedo, Sanford,
Seminole County, Winter Springs
Florida Statutes are quoted here in part for your information to indicate the authority for exemptions for
homeowners from qualifying as contractors and to express any applicable restrictions and responsibilities.
OWNERS MUST PERSONALLY APPEAR AT THE BUILDING DIVISION TO SIGN THIS DOCUMENT
BY SIGNING THIS STATEMENT, I ATTEST THAT: (Initial to the left of each statement)
I understand that state law requires construction to be done by a licensed contractor and have applied for
an owner -builder permit under an exemption from the law. The exemption specifies that 1, as the owner of
the property listed, may act as my own contractor with certain restrictions even though I do not have a
license.
I understand that building permits are not required to be signed by a property owner unless he or she is
responsible for the construction and is not hiring a licensed contractor to assume responsibility.
I understand that, as an owner -builder, I am the responsible party of record on a permit. I understand that I
may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed
in his or her name instead of my own name. I also understand that a contractor is required by law to be
j
7
licensed in Florida and to list his or her license numbers on all permit and contracts.
I understand that I may build or improve a one -family or two-family residence or a farm outbuilding. I
may also build or improve a commercial building if the costs do not exceed $75,000. The building or
residence must be for my own use or occupancy. It may not be built or substantially improved for sale or
lease. If a building or residence that I have built or substantially improved myself is sold or leased within
in I year after the construction is complete, the law will presume that I built or substantially improved it
for sale or lease, which violates this exemption.
qt /) I understand that, as the owner -builder, I must provide direct, onsite supervision of the construction.
I understand that I may not hire an unlicensed individual person to act as my contractor or to supervise
nn
1'+
persons working on my building or residence. It is my responsibility to ensure that the persons whom I
employ have the licenses required by law and by city ordinance.
I understand that it is a frequent practice of unlicensed persons to have the property owner obtain an
owner -builder permit that erroneously implies that the property owner is providing his or her own labor
and materials. 1, as an owner -builder, may be held liable and subjected to serious financial risk for any
injuries sustained by an unlicensed person or his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner -
builder and am aware of the limits of my insurance coverage for injuries to workers on my property.
I understand that I may not delegate the responsibility for supervising work to a licensed contractor who is
not licensed to perform the work being done. Any person working on my building who Is not licensed
must work under my direct supervision and must be employed by me, which means that I must
comply with laws requiring the withholding of federal income tax and social security contributions
under the Federal Insurance Contributions Act (FICA) and must provide workers' compensation
for the employee. I understand that my failure to follow these laws may subject me to serious financial
risk.
Rev. 9.14.2009
I agree that, as the party legally and financially responsible for this proposed construction activity, I will
abide by all applicable laws and requirements that govern owner -builders as well as employers. I also
understand that the construction must comply with all applicable laws, ordinances, building codes, and
zoning regulations.
1
0
I am of aware of construction practices and I have access to the Florida Building Codes.
I understand that I may obtain more information regarding my obligations as an employer from the Internal
Revenue Service, the United States Small Business Administration, the Florida Department of Financial
n Services, and the Florida Department of Revenue. I also understand that I may contact the Florida
jl1P Construction Industry Licensing Board at 1-850-487-1395 or at www.myflorida.com/dbpr/pro/cilb/ for
more information about licensed contractors.
I am aware of, and consent to, an owner -builder building permit applied for in my name and understand
that I am the party legally and financially responsible for the proposed construction activity at the address
q listed below.
I agree to notify the building department immediately of any additions, deletions, or changes to any of the
information that I have provided on this disclosure or in the permit application package.
Licensed contractors are regulated by laws designed to protect the public. If you contract with a person
who does not have a license, the Construction Industry Licensing Board, the Department of Business and
Professional Regulation and the building department may be unable to assist you with any financial loss
n that you sustain as a result of a complaint. Your only remedy against an unlicensed contractor may be in
jr civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an
individual or firm is injured while working on your property, you may be held liable for damages. If you
obtain an owner -builder permit and wish to hire a licensed contractor, you will be responsible for verifying
whether the contractor is property licensed and the status of the contractor's workers' compensation
coverage.
Property Address: 100 C CA tr W A, VC, ,
I<,-;) gr fv I v
and capYbie of performing the
conditions specified above.
SianatGFe of Owner -Builder
an ONL FIB
do hereby state that I am qualified
construction involved with the permit application filed and agree to the
Form of Identification
Must be Photo ID)
7 18 zoo
Date
A violation of this exemption is a misdemeanor of the first degree punishable by a term of imprisonment
not exceeding 1 year and a $1,000.00 fine in addition to any civil penalties. In addition, the local
permitting jurisdiction shall withhold final approval, revoke the permit, or pursue any action or remedy
for unlicensed activity against the owner and any person performing work that requires licensure under
the permit issued.
Rev. 9.14.2009
CITY OF
a Building & Fire Prevention DivisionSkNFORDRESIDENTL4LRE -ROOF POLICY & PROCEDURES
FIRE DEPARTMENT
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: i% 0 - DATE:
CITY OF
f I SkNFORD
F12E DEPARTMENT
11"141u_I_I —1
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
JOB ADDRESS:
STRUCTURE TYPE: SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: O REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY): L l cL I Roo L ZOL 1%pfJLOU e L - cz— r - 6 PLEASE
NOTE: ONL Y 100 SQUARE FEET OF THE EXISTING DECK 1 BPS RMITTEDTO BE R PLACED " ROOF
VENTILATION: OOFF-RIDGE O RIDGE OSOFFIT OPOWERED VENT OTURBINES SKYLIGHTS:
O YES ONO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #: MAIN
ROOF AREA 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# ODIFILD$
1T-t-FMEi1---- O
TORCH DOWN FL# OINSULATED
FL# O
TILE FL# O
OTHER: FL# ROOF
EXTENSIONS (PORCHES, PATIOS, ETC.) "IFAPPLICABLE" ROOF
SLOPE: 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# 0
21)IFIED BITUMEN 2
FL# w , TORCH
DowN FL# O
INSULATED FL# O
TILE FL# O
OTHER: FL#
I
CITY OF
SkNFORD Building & Fire Prevention Division
RESIDENTIAL RE-ROOFAFFIDAVIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILIN GJ, SHEATHI(NNG, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: i( / 70" b ADDRESS: X 10 0.2
I I Cs V..:, > 1 LQ , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTACTOR, ENGINE R, 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 #: JV/ / 'j-
COMPANY / CONTRACTOR: Y /
CONTRACTOR SIGNATURE: _ . _ DATE:%LLLr7
MUST BE SIGNED BY LICENSE I-IOLDftf OR OW>kK7BrrLDE
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 SF,r", PAC -
Sworn to and Subscribed before me this d—y day of S 20 LA by:
7 Lam.., Who is Cersonally Known to or has Produced (type of
identification) as identification.
Slgnature of Notary Public
ate of Florida RONALD W. WATSON
MY COMMISSION M FF173478
EXPIRES: Novena 13,201
Print/Type/Stamp Name
of Notary Public