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122 London Fog Way 12-2484 (re-roof); ;, 1 5EP 2 0 2�12 CITY OF SANFORD BIJIILDING_&-:FIRE""PREVENTION a PERMIT APPLICATION Application No: 4 �y Documented Construction Value: $ Job Address: i a a �Ja-a i-dq Historic District: Yes ❑ No R"'- Parcel ID: 33 � e) oozy dzao Zoning: Description of Work: Plan Review Contact Person: ,'l /ft�4 Title: V- 0-a-S. Phone: "/0 � -6 � a�_ ax: 3� ) T Y - ANY E-mail: 501i lleje/d /tic - d ✓r, rd.J � ,Cam, Property Owner Information Name i�aC3e�r,-�� l 14,4C.V i�[�d�2. rJ Phone: U 7-" Street: M2 A,010do-AJa Resident of property? City, State Zip: SAWL- Contractor Information Name ( 0Y►� ) AAQI� �/y Phone: �6 Street: c21b ��lyOJ —) iZ� U ADD Fax: �JO�� �l �l '" exC/7 City, State Zip: �� � C"L 3a �� State License No.: Cdd. l 3A 4 U 3 Architect/Engineer Information Name: Phone: Street: Fax: City, St, Zip: E-mail: Bonding Company: Mortgage Lender: Address: Address: PERMIT INFORMATION Building Permit Square Footage: 9,01 Construction Type: No. of Stories: / No. of Dwelling Units: 1 Flood Zone: jud Electrical ❑ Plumbing ❑ New Service - No. of AMPS: New Construction - No. of Fixtures: Mechanical 0 (Duct layout required for new systems) Fire Sprinkler/Alarm 13 No. of heads: 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 ?OB 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 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 APPROVALS: ZONING: ENGNEERING: COMMENTS: narur �.=WoriAenl Date C eze.� o 9 Print Contractor/Aeenir%--Alame ignature of otar to oF-FMi7tlav Date LORRkINE nODFR1GUEZ �+ ov Lotary Nblic, State of Florida $ ,Ommisslon# DD89810 2013 y comm. expires June UTILITIES: FIRE: Contractor/Agent is ersonally Known to Me or Produced 1D Type of ID WASTE WATER: BUILDING: Rev 11.08 THIS INSTRUMENT PREPARED � �BY' k /r-, �k- 611M Name: 1�JAJnY 7 L Address: ID a'`vL+L ?"st Si SEA/IINOLE COUNITY 1 State Florida MARYANNE MORSE, CLERK OF CIRCUIT COURT INOLE COUNTY @7859 Pg 0315; Qpg) CLERK'S # 2EII21 12050 RECORDED @9/2@/k-IDId 18;43.-Q PM RECORDING FEES 1066 RECORDED BY J Eekent•ath(all) NOTICE OF COMMENCEMENT q 5- bado o�aa Permit Number J Parcel ID Number (PID) The undersigned hereby gives notice that improvement will be made to c2 -in real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement DESCRIPTION OF PROPERTY (LegaAescr<ption of e property and street address if available) v GENERAL DESCRIPTION OF IMPROVEMENT �'P lact'S OWNER INFORMATION r ^ Name and address: )9 t R,CONTRACTOR Name and address: 1 Z? Persons within the State of Floridd Desig by Section 713.13(1)(b), Florida Statutes. Name and address: N `I by Owner upon 2 S aO notice or other documents may be served as provided 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 ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, 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 COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. ST'.T O F O dD - COUNTY OF SEMINOLE WNERS SIGNATURE OWNERS PRINTED NAME �-� "(NOTE: Per Florida Statute 713.13(1) (g), owner must sign...... and no one else may be permitted to sigh in .is or he\ r stead „ The foregoing instrument was acknowledged before me this _ day of 20 - by P)hga 6ia-,G,Gy e A, !C Who is personally known to me Name of pers king statement OR who has produced Identification type of identification produced VERIFICATION PURSUANT TO SECTION 92.525, FLORIDA STATUTES. jf UNDER PE AL IES, OF RJUR 9 LARE THAT I HAVE READ THE FOREGOING AND THAT THE FACTS STATf$d IFS11 I ED COPY �r ARE RU TO HE E 68F,EAND BELIEF_ MARYANNP MORSL CLER =OURTSIGNATURE OF NATURAL PERSON SIGNING ABOVE kw JV 8HERYL.QJ2, ENE MILLER ERa •� %"= MY COMMISSION 0 EE101636 ''- - "Notary Signature "�f.�� �•' EXPIRES Jung 09, 2Q95 4t)7) 398-0151 FloddallotaryServloe.com SEP 2 0 2020 i I LIMITED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood,. Sanford, Seminole County, Winter Springs Date: 5- 1- I �, i hereby name and appoint: �d, an agent of (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): fl''1, All permits and applications submitted by this contractor. ❑ The specific pern�it and application for work located at: (Street Address) Expiration Date for This Limited Power of Attorney: „) '�?/ a fir. License Holder Name: CA State License Number: P � a -G ? Signature of License Holder: STATE OF FLORIDA COUNTY OF � „-, The foregoing instniment was ackno�.�ledged before me this day of�� 1 200N�al_, by C \'� �:;-� :� (� ';�`p who is ❑ persona y known to me or ❑ who has produced v'L,__ \ n \ -CDC . \ "t �. as identification and who did (did no to oath t` Sig lre r� (Notary Seal) Print or type name PANAYOTTI PATRICIA Notary Public -State of MY COMMIs.SIC'N .R 00 931678 EYPIR[S:April 13, 2ol4 Commission No. Bonded by CNA Surety m t�1y Comission Expires: _ F (Rev. 3/27107) i 4" ACCREDITED BUSINESS •L�1tJsi R just makes sense... 210 Crown Point Circle; Suite 200, Longwood, FL 32779 Office: 321-972-4094 Fax: 321-972-4471 Toll Free: 877-294-6678 Fax: 877-294-2620 www.axiomcontracting.com FL License# CCC1329763 Job # FZ---// c2g AGREEMENT THIS AGREEMENT IS SUBJECT TO INSURANCE COMPANY APPROVAL OF PAYMENT STREET f 2 Z L�� CITY 1sj..(Ldjl.� ST ZIP 72 i '7 HOME5607.-,U/00%, WORK CELL ��i 2 �-/r r'�q` FAX E-MAIL ADDRESS /)I .'S 441? L6Q SOURCE (9 ACCOUNT REPRESENTATIVE j 0� -W b PHONE NUMBER S 7;. G — 7 -r9 j SPECIFICATIONS 94YPE OF TILE / SHINGLE -% a2ga—W21L, ❑-LOLOR OF TILE / SHINGLE &VALLEY ❑ -VENTS ❑ STYLE G`rEAR OFF ❑ YES. LAYER (S) ❑'-DITCH 112 STORY EI-PtRMIT FURNISHED ❑ REPLACE ALL BOOT JACKS 9-tb FELT aICE & WATER SHIELD F.REMOVE ROOF TRASH FROM ROOF, GUTTERS & YARD SPECIAL INSTRUCTIONS PAYMENT SCHEDULE FIRST PAYMENT 50% SECOND PAYMENT FINAL PAYMENT DUE AFTER ROOF COMPLETED CUSTOMER AGREES TO PAY AXIOM 15% OF THE INSURANCE APPROVED DOLLAR AMOUNT ❑ ROLL YARD WITH MAGI`IETIC RO E IF CUSTOMER CANCELS AFTER THE INSURANCE D-DRIP EDGE KEEP / REPLACE COLOR cP Lk-0 APPROVES PAYMENT'FOR THE DAMAGE INITIALS �. TERMS: THIS CONTRACT DOES NOT OBLIGATE THE PROPERTY OWNER OR AXIOM CONTRACTING GROUP LLC IN ANY WAY UNLESS IT IS APPROVED BY THE PROPERTY OWNERS INSURANCE COMPANY AND ACCEPTED BY AXIOMCONTRACTINGGROUP LLC. BY SIGNING THIS AGREEMENT THE PROPERTY OWNER AUTHORIZES AXIOM CONTRACTING GROUP LLC TO PURSUE THE PROPERTY OWNERS BEST INTEREST FOR PROPERTY REPLACEMENT OR REPAIR AT A "PRICE AGREEABLE" TO THE PROPERTY OWNERS INSURANCE COMPANY AND AXIOM CONTRACTING GROUP LLC WITH�NO ADDITIONAL COST TO THE PROPERTY OWNER OTHER THAN THE INSURANCE DEDUCTIBLE. WHEN "PRICE AGREEABLE" HAS BEEN DETERMINED IT SHALL BECOME THE FINAL CONTRACT AMOUNT AND THE PROPERTY OWNER AUTHORIZES AXIOM CONTRACTING GROUP LLC .TO OBTAIN LABOR AND MATERIAL IN ACCORDANCE WITH THE "PRICE AGREEABLE" AND SPECIFICATIONS SET OUT HERIN AND ON THE REVERSE SIDE HEREOF TO ACCOMPLISH THE REPLACEMENT OR REPAIR. THEREFORE AXIOM CONTRACTING GROUP LLC ACTING AS YOUR CONTRACTOR WILL BE ENTITLED TO ALL INSURANCE PROCEEDS IN ACCORDANCE WITH THIS AGREEMENT. PROPERTY OWNER RECOGNIZES AXIOM CONTRACTING GROUP LLC AS A GENERAL CONTRACTOR AND AS SUCH WILL BE ENTITLED TO 10% OVERHEAD & 10% PROFIT AS ALLOWED BY INSURANCE INDUSTRY STANDARDS. ALL WORK WILL BE PERFORMED AT INSURANCE COMPANY RATES, FIGURES & MONEY. ALL PRICES ARE SUBJECT TO CHANGE. THE FINAL ROOF PRICE IS :THE RCV AMOUNT On INSURANCE PAPERWORK PLUS THE APPLICABLE CONTRACTORS OVERHEAD AND PROFIT. CUSTOMER INITIALS YOU, THE BUYER, MAY CANCEL THIS PURCHASE AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS AGREEMENT. AXIOM CONTRACTING GROUP LLC CONTRACTING GROUP, INC. DISCLAIMS ALL WARRANTIES, EXPRESSED OR IMPLIED WARRANTY OF MERCVANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE EXCEPT AS SPECIFICALLY EXPRESSED ON THE REVERSE SIDE OF THIS AGREEMENT. A CUSTOMER HAS READ AND AGREES TO ALL TERMS AND CONDITIONS ON OF EEMENT ACCEPTED BY HOMEOWNER(S) ON: DATE l l l 12--)�Y X� CO-OWNER: DATE / / BY ADJUSTER'S NAME. AXIOIv1AEPRESENTATIVE: DATE Y BY X sty INSURANCE CO. CLAIM NO. a y Inspection Affidavit I yM14e C'Z_ ,licensed as a(n) Contractor* [Engineer/Architect, (please print name and circle Lic. Type) FS 468 Building Inspector* License #; CC V /3 a 9,7 l 3 On or about _ 91,2_ y//�� 02 '�'d �/��- , I did personally inspect the roof ��'Date & time) deck nailinz and/or secondary water barrier work at (circle one) (Job Site Address) Based upon that examination I have deteAlned the installation was done according to the Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S.) 'gn e STATE OF FLORIDA COUNTY 0175?�, `hDGQ , Sworn to and subscribed before me thist,,Yd/eday of 20Y/,;2-, By Notary Public, State of Florida C + p°s BONNIE J. MURRO�� Notary Public, State of Florida Commission # EE 224619 �/�% i My Comm. expires Sept.16, 2016 (Print, type or stamp name) Commission No Personally known or Produced Identification [/ Type of identification produced. PL `� Z-/ �. * 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.