2804 S Palmetto Ave - BR08-001690 (REROOF) DOCUMENTSCITY OF SANFORD PERMIT APPLICATION
Application # : a // Submittal Date:
Job Address: t PN Value of Work: $
Parcel ID: `t/Jr Zoning: Historic District:
Description of Work: Square Footage: J6
Permit Type: Building 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 Cale. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair —Residential Commercial
Occupancy Type: Residential Commercial Industrial Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood
Zone: (
FEn1A form required )
PropertyOwnr: .d 1a••. ..............................
Contractor _I 1%iD•,r•• ............
Phone: U 0+ 56
Bonding Company:
Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
Phone: .
Mortgage Lender:
Address:
Phone: Fax:
State License Number:
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 re uired from other governmental entities such as water management districts, state agencies, or federal agencies.
ceptance of en . i veri a on t will ti the owner of the /
gnature
bf the require en of Florida Lien Law, FS 713.
Q
bate of Contractor/.Agent Date
Print wner eni'vame t`sName
Signature of otary-State of Florida Date atet to
RISTOPHER E MICHALSKIiftCHRISTOPHEREMICHALSKICOMMISSION # DD776366
MY COMMISSION # DD776366 EXPIRES April 07, 2012
R,VI EXPIRES A ril 07, 2012 ,, p FloridallotaryService.com
F emftTX6ffiMe or Contractor gent is _Personally Known to Me or
Produced ID Produced ID
APPROVALS: ZONING: UTIL: F D: ENG: BLDG:
Special Conditions:
Rev 07.07
THIS INSI UMENT PR ED BY: Italliallulfalltllgmlll11111111111111111111111111111111111111
Name:
Addres r s1. 1' M€1RYANNE. MORSEL CLERK UF CIRCUIT CUURTSEMINOLECOLINTY
SEMINULE COUNTY
State of F on a Ftowo.>5N)ITMRALc}jo,10E
8K 0699b P7q O58s (1 )
CLERK'S # L)08058055
RECORDED 05/19/,008 0:3:43:26 PM
NOTICE OF COMMENCEM INS FEES 10.00
MnPermitNumberParcelIDNumber (PI6)1
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 PROPER7(t(LegaMe$crip ion oAe prop yj nd)Stre T ress i a i ble -
GENERAL DESCRIPTION OF -IMPROVEMENT,
OWNER INFORMA
Name and address:
OATJR ROOFING, INC.
CONTRACTOR 384, "EMORAN COMMERCE PL.
Name and address:
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 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 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.
STATE OF FLORIDA / COUNT OF SE INOLE
OWNERS SIGNATURE7 ' '~
C•" /
OWNERS PRINTED NAME
J
NOTE: Per Florida Statute 713.13(1) (g), owner must sign...... and no one else may be permitted to sign in his or her stead."
41- The fore ing insJt ument wa ackt-71ee^d ge before me this day of W. _., 20
CZ l 17,11 . A l j e Who Is personally known to me
type of identification produced
VERIFICATION PURSUANT TO SECTION 92.525, FLORIDA STATUTES.
UNDER PENALTIES OF PERJURY, I DECLARE THAT i HAVE READ THE FOREGOINGA T T&W8pVgFLPA&ALSKl
ARE T . E TO E BEST OF Y NOW E GE AN BELIEF. t
i =•{ MY COMMISSION # DD776386
EXPIRES April 07, 2012
SIGNAT OF NATURAL PERSON SIGNING ABOVE 409 a oS`'
MAPYANNE
MORSE tas
FlvrltleNolar Service.com CLEWOF.
CIR('I_IIT, 60URT SEWN01E
COUNTY,.,'FLORIDR- cLEr":-,
nn Notary
Signature
1
is
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: '67& /Os'
I hereby name and appoint:
an agent of: DX&
of Company)
to be my lawful attorney -in -fact to act WT-fne to apply for, receipt for, sign for and do all things
necessary to this appointment for (check only one option):
X* All permits and applications submitted by this contractor.
The specific permit and application for work located at:
Expiration Date for This
License Holder Name:
State License Number:
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF
Street Address)
of Attorney
The fore oing instrument was acknowledged before me this day
200 , by who is r perso lly known
to me or who has produ&id
identification and who did (did not) take an oath. -
Signature
Notary Seal)
CHRISTOPHER E MICHALSKI
MY COMMISSION # DD776366
EXPIRES April 07, 2012
407) 398 0153 FioridallotaryService.com
Rev. 3/27/07)
Print or type name
Notary Public - State of &1114State -
Commission No. .v
My Commission Expires: Qoia
as
P. I
RE: Permit #
p_ -
O - 'w °
Inspection Affidavit
4 ILn,licensed as a(n) Contractor* /Engineer/Architect,
please print name and circle 'c. Type) FS 468 Building Inspector*
License #; Ca- I Z T'5q LE
On or about , I did personally inspect the roo
Date & time)
deck nailing and/or secondary water barrier work at )I? (IM
circle one) i—I _ (Job Site Address)
Based upon that examination I have determined the installation was done according to the
Hurric Mi ' ti Re ofit Manual (Based -.on 553.844 F.S.)
Signature
STATE OF FLORIDA
COUNTY OF
Sworn to and subscribed before me this day of 24
y oh _ 1
Notary Public, State of Florida
p•!µ ".od•,; CHRISTOPHER E MICHALSKI
0r MY COMMISSION # DD776366 (Print, type or stamp name) v EXPIRES April 07, 2012
407) 398-0153 FloridallotaryService.com
Commission No.: 22 6 3
Personally known or
Produced Identification r
Type of identification produced
s General, Building, Residential, or Roofing Contractor or any individual certified under 469 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.
1*