1203 Scott Ave - BR08-001105 (REROOF) DOCUMENTSCITY OF SANFORD PERMIT APPLICATION
Application #: ! + Submittal Date: V • G
Job Address: 120.E .. CM xva Value of Work: S
Parcel ID: Zoning: Historic District:
0-
Description of Work ke kd o F SquareFootage: f ! "2r, 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 Calc. 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 Gi Commercial Industrial Occupancy Use Group(s): Construction
Type: t r # of Stories # of Dwelling Units: Flood Zone: (FEMA form required) 0..................
Property
Owner: L / Oy ZJ Contractor: Auc6 /I /T DD 6"Al C Address: .
T C D _ a,/R.Address: P 0 D fy.t kr'4 '0 Phone:
E-mail: Phonevr-i'TZ2'%XrAtateLicense Number: Bonding Company:
4 Mortgage Lender: Address: Address:
Architect/Engineer:
Address: Plan
Review
Contact Person: 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 maybe 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 v fication that I will notify the owner of the prope the irements of da Lien 713. x Z
Signature of
Owner/Agent Date Signa re C ntra "tor Agent Date arc°@
Expires '
niission
C2
9/
201p616629, Owner/Agent
is, P rsonaliy Known to Me or n Produced IDFlbL :1 1 jzo 160 i Z 4i $ V APPROVALS: ZONING:
UTIL: FD: p . PriC
ntractor/
Agent's Nar Signatureof Notary -state
n2) .atY I6 v Contractor/Agent isP1,(
I*' iiown tti Me,4J 0Produced ID\\ ENG: /®'J!EB1LD\G,\
Special
Conditions: Rev 07.
07
x
Haaress: 0 rttiC06947 Rg 1961; tipgl S-
Af JkoYt( {/, 9L 7 SENNOLE COUNTY LERK' S # c'008028656 State
of Florida FLORIDA'SNATURAL CHOICE I RnEn 03l1112008 11:15i47 Apo WIN)RDIND
FEES 10.00 RECORDED BY
T Smith 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. DESCRIPTION OF
PROPERTY (Legal description of the GENERAL DESCRIPTION
OF IMPROVEMENT OWNER INFORMATION /
Name and
address: .fill V,r f
CONTRACTOR
Name
and
address: rty and
street address if available):_ w4Awa! • • AKIj shry.
z7r 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 Section 713.13(
1)(b), Florida Statutes. of To receive
a
copy of the Lienor's Notice as Provided in 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 CONSIDEREDIMPROPERPAYMENTSUNDERCHAPTER713, PART I, SECTION 713.13, FLORIDA STATUTES, ANDCANRESULTINYOURPAYINGTWICEFORIMPROVMENTSTOYOURPROPERTY. A NOTICE OF COMMENCEMENTMUSTBERECORDEDANDPOSTEDONTHEJOBSITEBEFORETHEFIRSTINSPECTION. IF YOUINTENDTOOBTAINFINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORKORRECORDINGYOURNOTICEOFCOMMENCEMENT. STATE OF FLORIDA
COUNTY OF SEMINOLE
n OWNERS SIGNATURE
OWNERS
PRINTED NAME 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." The foregoing instrument
was acknowledged before me this _ day of V ,. , 2QVe by D L
11 j ' . Who is personally
known to me Name of personmakingstatementLLORwhohasproducedidentificationtypeofidentificationproducedVERIFICATIONPURSUANT TO
SECTION 92.525, FLORIDA STATUTE . UNDER PENALTIES OF
PERJURY, I DECLARE THAT I HAVE READ AREIRUE TO THE
BEST OF,MjY KNOWLEDGE AND BELIEF. i i 0
f SIGNATURE OF NATURAL
I '2d y (
l' s2 • //0
y 4 SEAL)
E FOREGOING
AND
THAT THE FACTS STATED IN IT GNING ABOVE p;
Y il`
v 1`40LIr
yy
Punrc State of Flotitia Paul A Olesen
My Copirnissbrr M516629
o+w° Expires
02/09/2010 Notary Signature
b
LIMITED POWER, OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: --V e
I hereby name and appoint:
an agent of:
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):
m% All permits and applications submitted by this contractor.
The specific permit and application for work located at:
Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name:
State License Number;
Signature of License F
STATE OF FLORIDA
COUNTY OF
The foregoing inst ent as ac owledge before me this day of M .
200 , by d c who is,* personally known
to me or o who has produc d
identification and who did (did not) take an oath.
Notary Seal)
xirurA0
Notary Pc State of Florida
Pau! A biesen
or W Epes 02/09/201ommission 516629
Rev. 3/27/07)
Notary Public - State of lFc
Commission No. blo 10 I
My Commission Expires: IU
as
RE: Permit #
o, , €0b 1i , ! 4
Inspection Affidavit
I ,licensed as a<Contra2ctor Engineer/Architect,(
please print a and circle Lic. Type) lding Inspector*
License #. `92
On or about W , I did personally inspect the roo
Date & time) /
deck nailing and/or secondary water barrier work at i%' ys
circle 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.)
Sign Are
STATE OF FLORIDA
COUNTY OF
Sworn to an subscribed be this day of ,% E+ 200flr
By
Notary Public, State of Florida
a• Notarys': 0 ;c State of Florida
WOP7 ofesen
tvi, t ,in-anission D0516629
O;Expires 02/09/2010 (Prin , type or stamp name)
Commission No.: V> I LL a!
Personally known or
Produced Identific on
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.