100 London Fog Way 12-2445 (re-roof)FB
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a 3 2012 �
CITY OF SANFORD
f BUILDING &FIRE PREVENTION
PERMIT APPLICATION
Application No: C+' 7 Documented Construction Value: $
Job Address: / O O 4_ 6",00Iv zf!T-O Lu !¢ V Historic District: Yes El No LAY
T
Parcel ID:
Zoning:
Description of Work: _ /Zor- Y7i00F Ski
Plan Review Contact Person: Title:
Phone: L14 '! G e2r1—-,�„Z� Fax: ,39Z Y7/ E-mail: C/j7144C2 4S:�",Om �QryllZ��`��vG-
Property Owner Information Go
Name %t'.dam .�' Phone: yG 7f---
Street: jAe) ,pp f=Q(o1e�� Resident of property?
City, State Zip: 19664yvt ZfG- %%/ <
Contractor Information
Name fiXlDI'r- 00Iv7/21�%//I,& 4! L"a"a Phone:
Street: Q2/d 02oCV1yA/"V7 G//1 Cl ' o1-00 Fax: 9 %aZ L/'�' 7/
City, State Zip: ,:�� U- 7 2�F State License No.: G CC 3 f �
Name:
Street:
City, St, Zip:
Bonding Company: _
Address:
Building Permit
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
PERMIT INFORMATION
Square Footage: _�?60 O Construction Type: 12t /Zoo c No. of Stories: l
No. of Dwelling Units: / Flood Zone:
Electrical ❑
New Service — No. of AMPS:
Mechanical ❑ (Duct layout required for new systems)
Plumbing ❑
New Construction - No. of Fixtures:
Fire Sprinkler/Alarm ❑ No. of heads:
1�
I
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.
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.
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.
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. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges exceed the documented
construction value when the executed contract is submitted, credit will be applied to your permit fees when the
permit is released.
Signature of Owner/Agent
Print Owner/Agent's Name
bignature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
Rev 11.08
UTILITIES:
FIRE:
/4�,1001
1 ! Jr F,Fd24
Pnnt Contractor/Agent's Name
Signature of Notary -State of Florida Date
BRENDALACHAPELLE
$� Notary Public, State of Florida
Commission k EE 213514
My comm. expires July 23, 2016
Contractor/Agent is Personally Known to Me or
Produced ID X Type of ID -Fr! f_
WASTE WATER:
BUILDING:
I
Customer
i
axiom
cantracting graup. I
/tjustmakessense
210 Crown Point Circle, Suite 200, Longwood, FL 32779
Off ice: 321-972-4094 Fax:321-972-4471
Toll Free: 877-298-6678 Fax: 877-294-2620
FL License# CCC1329763
www.axiomcontracting.com
CONTRACT CONFIRMATION
SS
Street /O'j
City/ST/Zip _S�9-jlq)"-p �(
Home Ph.
W
Cell CX07 et= -,I- j - O r ?,r
Email C. � D C I /? 4_qS iW4, r,c , 6, --
Date of Original Contract
Specifications 9011
Work
Fax
PREFERRED
fONTRACfOR
Job # /Z_
V_2441L�Q UJO
C., n er
WJAMWAWA�
Total Charge for above listed work is:
PAYMENT SCHEDULE IS AS FOLLOWS:
50 % upon material delivery:
Balance to Depreciation Upon Roof Completion:
Remaining Balance Upon Receipt of Depreciation:
— 0-
-0—
�AR_W�_4Mffl
(if applicable)
(if applicable)
Axiom has the right to supplement the insurance company for any and all additional damages
or missed items. if supplements are approved, customer agrees to pay that -money to Axiom.
The work listed above to be performed under the same conditions as specified in original
contract unless oth ise specified.
AUTH ZED BY
HOMEO N 11 AT HOMEOWNER DATE
We hereby agree to furnish labor and materials - complete in accordance with the above
specification, at above stated price.
. 5, / 2
XI07 CONTRACTING GROUP ATE
NOTE: THIS REVISION BECOMES PART OF, AND IN CONFORMANCE WITH THE EXISTING CONTRACT
THIS INSTRUMENT PREPARED BY:
Name: �.iist4r
Address: c?00
�79 SFI,/I11\10L.E COZrnITY
State of lorida
MARYANNE MORSE9 CLERK OF CIRCUIT COURT
SE14INGLE COUNTY
AK 07854 Pg N38; (1pg)
CLERK'S # 2012109094
RECORDED 09/13/20112 01:37:48 PM
RECORDING FEES 10.04
RECORDED BY J Eckenroth(all)
NOTICE OF COMMENCEMENT
Permit Number Parcel ID Number (PID)
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
-,�rMlWnnu nc DPnr)s=RTV 11 anal riascrintinn of the oroDerty and street address if available)
GENERAL DESCRIPTION OF IMPROVEMENT
OWNER INFORMATION
Name and address:el� X4
CONTRACTOR '
Name and address:
bp 0 r 79
11
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 and address:
In addition to himself, Owner Designates of
To receive a copy of the Lienors 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 RE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.1
A3,
FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVMENTS 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 COMM_�NCING'WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
STAT OF. FLPRIDA / COUNTY OF SEMINOLE
».
OWNERSV IG RE OWNERS PRINTED AME
"(NOTE: Per Florida Statute 713A3(1) (g), owner must sign....., and no one else may be permitted to sign in his or her stead."
The foregoing in was acknowledged before me this �_ day of __ . , 2U a
by h y� r Lo�,p (n� W o is personally known to me_
Name of pers aking statement
OR who has produced identification type of identification produced
CERTIFIED COPY
VERIFICATION PURSPANT TO SECTION 92.525, FLORIDA STATUTES_ MARYANNE MORSE
UNDER PENALTIES O ERJURY, I DECLARE THAT I HAVE READ THE FOREGOING AND THAT THE FACTS STATED 1
gVRK OF CIRCUIT COURT
ARE TRU O THE, OF MY KNOWLEDGE AND BELIEF. SEMINOLE COUNTY, FLORIDA
i
r e SIGNATURE OF NATURAL PERSON SIGNING ABOVE DEPUTY CLERK
- - - ISEp 1 3 2012
8H1RYL QR9,N MILLIER
k�l
MY COMMISSION. � ��1a1636
� `r 001"116 Jwflq QD, 2015 Notary Signatu e
A09 a9.61@3 �h5ti�dND1� 8anri�e,oarA
'ity of at S `t
RE: Permit # 12 — 02 `d`7'S—
Inspection Affidavit
,licensed as a(n) Contractor* /Engineer/Architect,
(please print name and circle Lic. Type) FS 468 Building Inspector*
License#; e-t✓C, /3dq�7G3
On or about 9 - Ir-C2 c/o?, 5—�t qo ,�yj�- , I did personally inspect the roof
Date & time)
de nailing and/or secondga water bars r work at Q U 40&'0a lie /CO C' CQ%!�Y
(circ e one (Job Site Address)
Based upon that examination I have determined the installation was done according to the
Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S.)
STATE OF FLORIDA
COUNTY OF
Sworn to and subscribed before me this day of � .2047
By,
Notary Public, State of Florida
REM
PELLE
e of Florida
E 213514uly 23, 2ots (Print, type or stamp nam
Commission No.:
Personally known or
Produced Identification �;-/,
Type of identification produced.—�
* General, Building, Residential, or Roofing Contractor or any individual certified under 468 F.S. to make such an
inspection. Include photographs of each plane of the roof with the permit # or address # clearly shown marked on the
deck for each inspection.