2450 S Palmetto Ave - BR08-001645 - REROOFV, . .. +r
C/
Application
CITY OF SANFORD PERMIT APPLICATION
PP / • Submittal Date:
1 4JobAddress: 1 CL /mP. L /`1 Lie Value of Work: $ Y4 8 0
Parcel ID J- ' 1-- 06CO rok 9 A- Zoning: •storir,-District:
Description of Work: B quare otge:
A ..........................................................
Permit Type: Building GI Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool Sign
Electrical: New Service - # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial Industrial
of Gas Lines
Plumbing Repair- Residential Commercial
Occupancy Use Group(s):
Construction Type: # of Stories: # ofDwelling Units: Flood Zone: (FEMA form required )
PropertyOwner: -'-) .•••!<.1•r I I Contractor: •••••••
Address: N%Dd Address:
Phone: E-mail: Pho" he: `'4 7 5N.W3State License Number: IffJ,1 .3 ;? %d/
Bonding Company:
Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
Mortgage Lender:
Address:
Phone:
Fax:
Phone: Fax: E-mail:
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 pr the requirem ntSUf'f'?Ier' a Lien Law, FS 713.
Signature of Owner/Agent Date Signat a of ontracto gent Date
Print wner/Agent's Name Print C ntractor/A ent's Name
Si t e f o e i Date Sign to" x Notary ublic State of Florida
L11,
J" P``
s Notary Public State of Flor]ds
Geraldine Y Beck Geraldine Y Beck
My Commission DD751818 u My Commission DD75181
CFO, ExpireS Ol/2412012 or Ise" Expires 01/24/2012
0 1_Pefbfiiatf j ma ContAgent is ersona y
t/Produced ID tf L j L$ (ob O Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
UTIL: FD: ENG: BLDG:
bl)/
e34
Ifill 11111II11111111111111111111of11111W111It111111111fill Permit
Number: Folio/
Parcel Identification Number: 36-19-30-541-0000-063A, Prepared
by: Jeremiah Dice . Return
to: Martin Roofing Services 6760
Muskogee St Orlando, FL 32807 MARYANNE
MORSE, CLERK Ua CIRCUIT COURT SEMINOLE
COUNTY BK
0699E Pg 14801 (1py) CLERK'
S # 200605&428 RE1
OUbfD 0: /14/,?O008 11'a;'_y:;SO AM REC
RI01INO FEES 10.00 RECORDED
BY L McKinley NOTICE
OF COMMENCEMENT State
of Florida, County of Orange The
undersigned hereby gives notice that improvement(s) 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 property (legal description of the property, and street address if available) Leq
Lot 63 Less S 3 Ft Pine Heiqhts PB 3 PG 51 2450 Palmetto Ave Sanford FL CERTIFIED CDPY 2.
General description of improvement(s) NfARYANNE ' MORSE Reroofhousewith30vearArchitecturalShingles@OURT3.
Owner information Name
John W & Ann C Hill Telephone Number Address
1220 Turner RD Winter Park FL Interest in Property_ 4.
Fee Simple Title Holder (if other than owner shown above) Name
Telephone Number IYs _
LORIDR 5Contractor
5% N e
Martin Roofinq Services Inc Telephone Number407-679-4553 Address 6760MuskoqeeStOrlando, FL 332807 6. Surety (
if any) Name Telephone
Number Address Amount
of bond $ 7. Lender (
if any) Name Telephone
Number Address 8.
Persons
within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by §
713.13(1)(a)7, Florida Statutes. Name Telephone
Number Address 9.
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 10.
Expiration
date of notice of commencement (the expiration date is one 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 YOUR LENDER OR AN ATTORNEY BEFORE COMMEN ING
WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. 11( %'1i
t % 11. e • - ems_- C= Signature of
Owner Signatory's Printed Name/Title/Office or Owner'
s Authorized Officer/Director/Partner/Manager §713.13[l ][d]) The foregoing
instrument was acknowledged before me this_day of byY, ar) (name of
person) as Ot.it )
A E. /. for Type of authority,
e.g., officer, trustee, attorney in fact) Signature of Notary
115lic — State of Florida Name of party
on behalf of whom instrument was executed) Print, type, or
stamp con6issioned name of Notary Public) Personally Known OR
Produced ID H 46o 4,5 L ' 0 Type of ID
Produced l VA, I J Lr Verificationpursuant to Section
92.625, Florida Statutes: Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true
to the best of my knowledge and belief. Signature of Natural Person
Signing on Line 11-Above Form Revised: 11/20/
07 for r(641 Notary
Public State
of Florida Geraldine Y Beck c .
My Commission DD751818
Expires 01/24/2012
or no
RE: Permit # (p
I
Inspection Affidavit
I.tj Dle' ,licensed as a(n) Contractor* /Engineer/Architect,
please print name and circle Lic. Type) FS 468 Building Inspector*
License #; 6 u— 13 Q 7=) 1 c)
On or about . l, :'-y7,n , I did personally inspect the roo
Date & time)
deck nailing and/or secondary water barrier work at ^` q sd
circle one) (Job Site Address)
AALif F=(of,L41.
Based upon that examination I have determined the installation was done according to the
Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S.)
tea.:
ure
STATE OF FLORIDA
COUNTY OF
Sworn to and subscribed before me this / day of M A2001 A
l,
Ay ^ Notary Public State of Florida Geraldine
Y Beck My
Commission DD751818 4pf,
o Expires 01 /24/2012 Personally
known l/ or Produced
Identification Type
of identification produced. Notary
Public, State of Florida Print,
type or stamp name) Commission
No.: 2)'D 7 i/,Y / — General,
Building, Residential, or Roofing Contractor or an,, ;ertified under 468 F.S. to make such an inspection.
Include photographs of each plane of the roof with ih( =t # or address # clearly shown marked on the deck
for each inspection.