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Home My WebLink About160 Crown Colony Way 17-431; ROOFJob Addre Parcel ID: Type of W IE C I'*' f . FEB 14 2u1 BY• CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: LA ` 1 Documented Construction Value: $ 1 b I f) -CJ . 41UN . _%(oric District: Yes No Residential Commercial Repair Demo Change of Use Move Description of Work: l Plan Review Contact Person: til t(1[ Phone:3& ,M t9 Fax: ny I Title: Email: 1C(AnCaU 90cl %PI[-BrCcom 1I,,, Property Owner Information Name aY P //t[ 1l a Phone: Street: \Uc) Cx oun l i\1 _ Resident of property? : 'e City, State Zip: Contractor Information Name U)(i(?)0z{- 1 Phone: sf to- -fDH P I 1 I Street: Min _ k Fax: _ 3L -b . 3qX[ City, State Zip: State License No.: Arc hltect/Englneer Information Name: Phone: Street: Fax: City, St, Zip: E-mail: Bonding Company: Mortgage Lender: Address: Address: 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. Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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. Iv FBC 105.3 Shall be inscribed vvitli the date of application and the code in effect as of that date: 5"' Edition (2014) Florida Building Code Revised: June 30, 201 5 Permit Application 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 at the time of permit submittal. A copy of the executed contract is required in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal. The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in accordance with local ordinance. Should calculated charges figured off the executed contract exceed the actual construction value, credit will be applied to your permit fees when the permit is issued. 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. V Signature of Owner/Agent Date / ign4 ture of Contractor/Agent Date Print Owner/Agent's Name Pri t Contractor/Agent's Name Signature of Notary -State of Florida Date Owner/Agent is Personally Known to Me or Produced [D Type of ID 7ro of Nota -S ate of Florida Ra e LINDSAY Di1CKHAM Commission # FF 172210 My Commission Expires October 28, 2018 Contractor/Agent is - Personally Known to Me or Produced ID Type of ID BELOW IS FOR OFFICE USE ONLY Permits Required: Building -E] Electrical Mechanical Plumbing Gas Roof Construction Type: Occupancy Use: Flood Zone: Total Sq Ft of Bldg: Min. Occupancy Load: New Construction: Electric - # of Amps Fire Sprinkler Permit: Yes No # of Heads APPROVALS: ZONING: ENGINEERING: COMMENTS: UTILITIES: FIRE: of Stories: Plumbing - # of Fixtures Fire Alarm Permit: Yes No WASTE WATER: BUILDING: Revised: June 30, 2015 Permit Application i .x-14 a I City of Sanford Building Division Residential Re -Roof Inspection Policy & Procedures PERMITTING REQUIREMENTS — NO PLAIN RENIEw REQUIRED This document (signed) along with an accurate and completed Residential Re -Roof Scope of Work are required to be submitted as part of your permit application. The Scope of Work must include all applicable Florida Product Approval numbers for all roof components that will be installed on the project. A permit will not be issued without these documents. Copies will be made to post on the job site. Projects located in the Sanford Historic District will require plan review and approval by the Sanford Historic Preservation Board INSPECTION POLICY & PROCEDURES A Final Roof Inspection is the only inspection required for Residential (Single Family, Townhouse, Mobile Home, Apartment and/or Condominium) Re -Roof Permits. The Following is required to be provide on the job site: Permit Card, posted in a conspicuous and weatherproof location Completed Residential Re -Roof Scope of Work Completed and Notarized Inspection Affidavit All Florida Product Approval and Corresponding Installation Instructions Product Approval shall match what is on the scope of work) Digital Photographs (must include the permit number or address in each picture) o Each plane of the roof, showing the underlayment installed o Roof Deck Nailing Pattern & Spacing (including a measuring device or ruler) o Roof Deck Nails used (including a measuring device or ruler showing size of nails) o Underlayment Pattern & Spacing (including a measuring device or ruler) o Drip Edge & Valley Attachment (including a measuring device or ruler) o Shingles installed, nail pattern and location of nails Skylights (if applicable) o Digital photographs showing all installation components, per FL Product Approval o Digital photographs showing all required flashing, per FL Product Approval Failure to follow these specific guidelines will result in an affidavit provided by a Florida Design Professional (architect or engineer), certifying BC code compliance by personal inspection. CONTRACTOR (OR OWNEWBUILDER) SIGNATURE: DATE: 1 \ JOB ADDRESS: PERMIT # k_j' li3 1 City of Sanford Building Division Residential Re -Roof Scope of Work STRUCTURE TYPE: ®SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM RE -ROOF TYPE: *REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS) O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF) DECK TYPE (PLEASE SPECIFY): 1 1( PLEASE NOTE: OiNL Y 100 SQUARE FEET OF TRE E)CT TING DECK fS PERA[ITTED TO BE REPLACED ROOF VENTILATION: OFF -RIDGE RIDGE 0SOFFIT OPOWERED VENT OTURBINES SKYLIGHTS: O YES 1 NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #: MAIN ROOF AREA ROOF SLOPE: O LESS THAN 2:12 O 2:12-4:12 4:12 OR GREATER TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL SHINGLE FL# O METAL FL# MODIFIED BITUMEN FL# O TORCH DOWN FL# OINSULATED FL# O TILE FL## O OTHER: FL# ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IF APPLICABLE** ROOF SLOPE: O LESS THAN 2:12 O 2:12-4:12 O 4:12 OR GREATER TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL O SHINGLE FL# O METAL FL# 0MODIFIED BITUMEN FL# 0TORCH DOWN FL# 0INSULATED FLA O TILE FL# 0 OTHER: FL# yr City of Sanford Building and Fire Prevention Product Approval Specification Form Permit # Project Location Address As required by Florida Statute 553.842 and Florida Administrative Code 9N-3, please provide the information and product approval number(s) on the building components listed below if they are to be utilized on the construction project for which you are applying for a building permit. We recommend that you contact your local product supplier should you not know the product approval number for any of the applicable listed products. Be aware that windows, skylights, and exterior doors must be tested in accordance with the Florida Building Code, Section 1714.5. More information about Statewide Product Approval can be obtained at www.floridabuilding.org. The following information must be available on the jobsite for inspections: 1. This entire product approval form 2. A copy of the manufacturer's installation details and requirements for each product. Category / Subcategory Manufacturer Product Florida Approval # Description (include decimal) 1. Exterior Doors Swinging Sliding Sectional Roll Up Automatic Other 2. Windows Single Hun Horizontal Slider Casement Double Hung Fixed Awning Pass Through Projected Mullions Wind Breaker Dual Action Other June 2014 Category / Subcategory Manufacturer Product Description Florida Approval # including decimal) 3. Panel Walls Siding Soffits Storefronts Curtain Walls Wall Louver Glass block Membrane Greenhouse E.P.S Composite Panels Other 4. Roofing Products Asphalt Shingles Cp' Underla ments r\c- Roofing Fasteners Nonstructural Metal Roofing Wood Shakes and Shingles Roofing tiles Roofing Insulation Waterproofing Built up roofing System Modified Bitumen a5 Single Ply Roof Systems Roofing slate Cements/ Adhesives / Coating Liquid Applied Roofing Systems Roof Tile adhesive Spray Applied Polyurethane Roofing E.P.S. Roof Panels Roof Vents Other June 2014 Category / Subcategory Manufacturer Product Description Florida Approval # include decimal) 5. Shutters Accordion Bahama Colonial Roll up Equipment Other 6. Skylights Skylights Other 7. Structural Components Wood Connectors / Anchors Truss Plates Engineered Lumber Railing Coolers/Freezers Concrete Admixtures Precast Lintels Insulation Forms Plastics Deck / Roof Wall Prefab Sheds Other 8. New Exterior Envelope Products Applicant's Signature Applicant's Name Please Print) June 2014 T Date Limited Power of Attorney I hereby name and appoint Laura Westman of Covenant Roofing and Construction, Inc. to be my lawful attorney in fact to act for me and apply to for a permit for work to be performed at a location described as: Address of job: Owner and Ad Joseph E. Acknowledged: License #CCC1329936 KIM,- WEN Sworn to and subscribed before me this JZ day of 7 ee , 20_/7. By Joseph E. Rayl who is personally known to me or _ prod ed J fication. y Public, S at loldatj" V -q My Commission expires: i Z iIa D S rev D ( is A -0t Fc 2 V FOR -4 After recording, return to: villages Roofing and Construction, Inc. 1410 Emerson Sl. Leesburg, FL 34748 Permit No.: Tax Folio No.: 33-101- -30 - 5 QS • 060U Dyd GRANT NALOYr SE1111I0LE COUNTY CLERK OF CIRCUIT COURT & COMPTROLLER Bt( uuo Po10-16(11`0s) CLERK'S At 2017015743 RECORDED I2/14/2i117 11.29-,D; All R1::(:ORD1NG BEES $10.00 R 1' R [ D B'r 1akeof Commencement State of Florida 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. 1. Description of the Property: (legal description of the property and street address If available) Legal Description: %_o- 410 LrQWn Cn l e AV Sri b e Ii; rc t e n P B LA It° &5 7 G Street Address: /job COL.In C Qn-N142&Aj 5c,n 177 1 2. General Description of Improvement Roroof 3. Owner's Information or Lessee Information If the lessee contracted for the Improvement: Name: 4&44 LIze Address: { Interest In Property: Name & Address of fee simple titleholder (if different than owner): 4. Contractor Information Name: Villages Roofing and Construction, Inc. Address: 1410 Emerson SL Leesburg, FL 34748 5, Surety (lf appilcable, a copy of the payment bond must be attached): Name: Address: 6. Lender Information: Phone No.: Phone No.: Amount of Bond: $ Name: Phone No.: Address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes: Name: Phone No.: Address: 8. In addition to himself or herself, Owner designates of to receive a copy of the following Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes: Phone No.: 9. Expiration date of notice of commencement (the expiration date will be 1 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 I, 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 YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECOR OU NOTICE OF COMMENCEMENT. i Signature of Owner or Lessee, or Owner's or Lessee's Aumonzeu u7ncerluirectorirannenmranager 0 hP {— Signatory's Tlife/Office The foregoing Instrument was acknowledged before me this day of , 20, by A10;4 for who Type ofauthotily(Le.officer, trustee,etlomeylnfact) ^ J Name ofparty on behalf of whom Instrument was executed Is personally known or produced ,/'YL ii t2Q 2 % l 0 t as type of identification. p 4 a or stamp commissioned name of Nola PublicMichaelH. ReamedEKNFS: JULY 21, 2017 SlgnafureofNotaryPubli—SlaleolFlorida(prnLiyp ry ) CO;'r. tw;ifli FF 037837 Notice of Commencement — BF29 (Updated 0511312013) THE STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 RAYL, JOSEPH E COVENANT ROOFING & CONSTRUCTION, INC 1410 EMERSON STREET LEESBURG FL 34748 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! RICK SCOTT, GOVERNOR 9 STATE OF FLORIDA DEPARTMENT -OF BUSINESS AND PROFESSIONAL REGULATION CCC1329936 , ISSUED, 01/02/2017 CERTIFIED ROO ING Qj0NTRACTOR RAYL, JOSE PHE; COVENANT ROOFING &CONSTRUCTION, I 18 CERTIFIED tinder th.e provisions of Ch.489 FS. Expir6fiondate AUG 31, 2018 - - L1701020002179 DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD GCC1329936 . $ The ROOFING CONTRACTOR Named below IS CERTIFIED Undo the provisions of Chapter 489 FS. Expiration'date:. AUG 31,2018 RAYL,.JOSEP-H E. COVENANT ROOFING & CONSTRUCTION INC 1410 EMERSON STREET LE ESBURG Fl 3448 SS NR..._ issuED01/02/20'17"`" DISPLAY'AS REQUIRED BY LAW SEQ # L1701020002179 CERTIFICATE OF LIABILITY INSURANCE Date 1/17/2017 Producer: Plymouth Insurance Agency This Certificate is issued as a matter of information only and confers no 2739 U.S. Highway 19 N. Holiday, FL 34691 rights upon the Certificate Holder. This Certificate does not amend, extend or alter the coverage afforded by the policies below. Insurers Affording Coverage NAIC # 727) 938-5562 Insured: South East Personnel Leasing, Inc. & Subsidiaries Insurer A: Lion Insurance Company 11075 Insurer B: 2739 U.S. Highway 19 N. Insurer C: Holiday, FL 34691 Insurer D: Insurer E: Coverages The policies of insurance listed below have been issued to the insured named above for the policy period indicated. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions, and conditions of such policies. Aggregate limits shown may have been reduced by paid claims. INSR LTR ADDL INSRD Type of Insurance Policy Number Policy Effective Date Policy Expiration Date Limits MM/DD/YY) NIM/DD/(Y) GENERAL LIABILITY Each occurrence Commercial General Liability Claims Made 11 Occur Damage to rented premises (EA occurrence) kited Exp General aggregate limit applies per: Personal Adv Injury i General Aggregate 3 Policy 1:1 Project 1:1 LOC Products - Comp/Op Agg AUTOMOBILE LIABILITY Combined Single Limit Any Auto EA Accident) Bodily Injury All Owned Autos Scheduled Autos Per Person) 3 Bodily InjuryHiredAutos Non -Owned Autos Per Accident) 3 Property Damage Per Accident) EXCESS/UMBRELLA LIABILITY Each Occurrence Occur F1 Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2017 01x'01/2018 X I WC Stat.- OTH- Employers' Liability tory Limits ER E.L. Each Accident 1,000,000Anyproprietor/partner/executive officer/member excluded? NO E.L. Disease - Ea Employee 1.000,000 If Yes, describe under special provisions below. E.L. Disease -Policy Limits 1 31,000,000 Other Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 Descriptions of Operations/LocationsfVehicles/Exclusions added by Endorsement/Special Provisions: Client ID: 92-70-277 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company": Covenant Roofing & Construction, Inc. Coverage only applies to injuries incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s), while working in: FL. Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937-2138 or by calling (727) 938-5562. Project Name: ISSUE 01-17-17 (CF) Begin Date 5/1/2016 CERTIFICATE HOLDER CANCELLATION CITY OF SANFORD Should any of the above described policies be cancelled before the expiration date thereof, the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to do so shall impose no obligation or liability of any kind upon the insur=_r, its agents or representatives. 300 N. PARK AVENUE SANFORD, FL 32771 j i7.7T•..-sem 19 TE (W/00, lYYY) AC"RL7 CERTIFICATE OF LIABILITY INSURANCE 71/1912017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. 4 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). coNTACT PRODUCER NAME: Adrienne A. KILBRIDE INSURANCE INC. PHONE Ext)_ 813-931-7 67 _ice No): 813.932_7336 1401 W. Busct, Bind. E-MAIL certificate akilbride.com — Tampa, FI 33612 ADcREss -- _ - ! _ —_-- 313.931.7467 Phone. _. INSURER(S) A FORDING COVERAGE — _ _ NAIC d 813.932,7336 Fax INSURERA United Specialty Insurance Co INSURED - INSURER 8: Covenant Roofing & Construction. Inc INSURER c 1410 Emerson Street INSURER D Leesburg, FL 34749 i INSURER E INSURER F rro-rtnf'nTF MI InAPr-P- 'REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT PTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 4^IHICH'THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY T----- PAID CLAINIS. IN5R iADbL SUER- POLICY EFF I LTR TYPE OF INSURANCE POLICY NUMBER MM;DDIYYYY) POLICY EXP i fMM/DDfYYYY LIMITS i l GENERAL LIABILITYiI I EACH OCCURRENCE ! s 1.000,000 COM1,1ERCIAL GENERAL LIABILITY ' DavTA WRENED --- PREMISES IEa occurrence! 3 T 50,000 DE OCCURCLAIMS-NLAATNATL1610039 12/31/10; EDEx(ycnePerscnt in12J31,/17 F•IAr Excluded A-- I r RSONAL8 ADV INJURY I a 1,000,000 j J GENERAL AGGREGATE is 21000,000 J --- i I PRODUCTS AGG is 2,000,000.1GENTAGGREGATELIMITAPPLIESPER. l j CONIPIOP _ POLICY i PR0- i LCC a i COMBINED SINGLE UNLIT I AUTOMOBILE LIABILITY tEa accderB S I ANY AUTO I ` r i BODILY INiURY (Per person) S I , I ALL OVVNED SCHEDULED , i BODY INJURY (Per acddent) S AUTOS _J AUTOS i1NON-O`A.NED PROPERTY DAMAGE HIRED AUTOS p I AUTOS I I I Personal Injury Protecti s I UMBRELLA LIAR ;OCCUR I EACH OCCURRENCE T..' EXCESS LIABI --~ l I CLAINIS-NLADE 1 - AGGREGATE _ I 3 DED RETENTIONS i WORKERS COMPENSATION Y•iC STATU- l IOTH-1 1ORY-LIMUS ; i AND EMPLOYERS' LIABILITY Y! N, I E.L. EACH ACCIDENT 5IANYPROPRIETORMARTNEB;EXEGU INIAI 1 OFFICERIMEh1EER EXCLUDE6? i DISEASE EALD 1ENSP_0 fE 7 SMandatoryinNH) L`vas, descnbe under DESCRIPTION OF OPERATIONS hekwV i cL DISEASE - POLICY LIMIT S t DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remar'xs Schedule, if more space is required) Joseph E. Rayl - Licensee, License #CCC1329936 Qualifier. Additional qualifier Reynolds Holiman, Lic14r1CGC037504 l i i CERTIFICATE HOLDER CANCELLATION City Of Sanford SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 300 North Park Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN I Sanford, FL 32771 ACCORDANCE WITH THE POLICY PROVISIONS. Fax(407)665-7367 AUTHORIZED REPRESENTATIVE i"JS8 1010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD City of Sanford Building and Fire Prevention RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS PERMIT #: 1 U t ADDRESS: uc) adonl C aogocd - I . x^_)_i rX.4 , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR ROOFING CONTRACTOR, ENGINEER, AACIHITECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE FOREGOING INFORMATION IS TRUE AND ACCURATE AND THAT ALL ROOFING COMPONENTS LISTED ON THE SCOPE OF WORK AT THE ABOVE REFERENCED ADDRESS HAVE BEEN INSTALLED IN ACCORDANCE WITH THEIR PRODUCT APPROVALS AND ALL APPLICABLE CODE REQUIREMENTS - SPECIFICALLY FLORIDA BUILDING CODE, EXISTING BUILDING. IN ADDITION I CERTIFY THE INSTALLATION MEETS ALL REQUIREMENTS FOR SECONDARY WATER BARRIER AND NAILING OF THE ROOF DECK, IN ACCORDANCE WITH THE HURRICANE RETROFIT MANUAL REQUIREMENTS (BASED ON F.S. CHAPTER 553.844). LICENSE #: COMPANY / CONTRACTOR: 1 CONTRACTOR SIGNATURE: DATE: MUST BE SIGNED BY LICENSE WNER/BUILDER) A FINAL ROOF INSPECTION IS REQUIRED: THIS SIGNED AND NOTARIZED AFFIDAVIT MUST BE PROVIDED AT THE JOB SITE AT THE TIME OF THE FINAL ROOF INSPECTION, ALONG WITH DIGITAL PHOTOGRAPHS OF EACH PLANE OF THE ROOF SHOWING IN DETAIL ALL COMPONENTS (DECKING, UNDERLAYMENT, FLASHING, DRIP EDGE ATTACHMENT) WITH THE PERMIT NUMBER OR ADDRESS CLEARLY MARKED ON THE DECK FOR EACH INSPECTION. THE PHOTOGRAPHS MUST INCLUDE A RULER OR MEASURING DEVICE TO CONFIRM ALL NAIL SPACING AND OVERLAPS, INCLUDING DRIP EDGE AND VALLEY FLASHING. PLEASE REFER TO THE RE -ROOF POLICY AND INSPECTION PROCEDURE PAPERWORK FOR FURTHER EXPLANATION OF ALL REQUIREMENTS. FAILURE TO FOLLOW ALL REQUIREMENTS WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION FEE AS WELL AS REQUIRING A DESIGN PROFESSIONAL (ARCHITECT OR ENGINEER) TO CERTIFY, BASED ON PERSONAL INSPECTION, THE INSTALLATION OF ALL ROOFING CONIPONENTS. STATE OF FLORIDA COUNTY OF Sworn to and Subscribed before me this day of 20 Gy: Who is Personally Known to me or has n Produced (type of of Notary Pub as identification. LIP95r3Y C7UCi<IiAfv1 Cp;in ission # FF 172210 q; ivly Carnmission Expires Octeb r 28, 2018