HomeMy WebLinkAbout104 Walnut Crest Rd_ CITY OF SANFORD
BUILDING & FIRE PREVENTION
i PERMIT APPLICATION
D: JAN 3 1 2018 i
71 �% Application No: 18 - � �
t
Documented Construction Value: $ ) 0 1 U
Job Address: � 4 QaL_- Ca� �C • Historic District: Yes ❑ No
Parcel ID: �Residential commercial ❑
Type of `York: New ❑ Addition ❑ Alteration �Repalr ❑ Demo ❑ Chance of Use ❑ Move ❑
Phone:
Fax:
Email:
Property Owner Information Name Phone: q5d-La 7ap,) mil��yy
.
Street: Resident of property?
City, State Zip:��
Contractor Information
Name C-CA =n�
Street: Mr) �E r -
City, State Zip:
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Phone: �2�, �- -q)35
Fax: 35�L a-3LW•
State License No.: C cjL aQ
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
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 RIND 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. 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.
FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 5" Edition (2014) Florida Building Code
Revised: June 30, 2015 Permit Application
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be
totmd 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 [CC 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 certifv 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.
Signature of Owner/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Nle or
Produced ID Type of ID
Signature of Contractor/Agent Date
V
P nt Contras A,ent's Name
Ayr !,L( r
SiThture of e of Florida
L DSAY DUCK'HAM
Comm isslon # FF 1722'10
My Con-,rnisslon Expires
Octobelr 28_2018
Contractor/Agent isV Personally Known to Me or
Produced MD Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing❑ Gas Roof ❑
Construction Type:
Total Sq Ft of Bldg:
Occupancy Use:
Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes ❑ No ❑
APPROVALS: ZONING:
ENGINEERING:
COININIENTS:
Flood Zone:
# of Stories:
Plumbing - # of Fixtures
# of Heads Fire Alarm Permit: Yes ❑ No ❑
UTILITIES: WASTE WATER:
FIRE:
BUILDING:
Revised: June 30, 20t5 Permit Application
Limited Power of Attorney
Date
I hereby name and appoint Robert Horne 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: /0 W
Joseph E. Rayl, Contractor License #CCC1329936
Sworn to and subscribed bef re me this 3)day of J "'"
Bey Joseph E. Rayl who is ersonally known to me or _ produced
.1
Public,' (ate of Florida
My Commission expires:
20 1?
Fr
j` 28 ri
.S
� 111111 �llf ff�1f ff off 1fl�l Permit Number: 11111111 I111
GRANT MALOY;' SEMINOLE COUNTY
Folio/Parcel ID /q- 30- spa= a)oo - D6-�n CI-ERK OF CIRCUIT COURT & COMPTROLLER
Prepared by: BY, 9066 Ps 1768 (1P3s)
CLERK'S A 2018011414
�AKM*14 -- ,ICIG iM RECORDED 01/31/2018 11:38:28 All
Return to: Covenant Roofinq & Construction Inc. RECORDING FEES $11 .0ci
1410 Emerson St. RECORDED BY hdnvore
Leesburg, FL 34748
NOTICE OF COMMENCEMENT
State of Florida, County of
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. De,s cription of property (legal description of the property, and street address if available)
C a f 3 Presr e u 4- LJ5e M6,7ry -L toe
2. Gen des spoon of improvement
r�rw
3. Owner inf rmation or Lessee information if the Lessee contracted for the improvement
Name f w,mQ_
Address n
Interest in Property mU ,�✓ -
Name and address of fee simple titleholder (if different from Owner listed above)
Name
Address
4. Contractor
Name Covenant Roofing & Construction, Inc. Telephone Number 352-728-8818
Address 1410 Emerson St., Leesburg, FL 34748
5. Surety (if applicable, a copy of the payment bond is attached)
Name Telephone Number
Address Amount of Bond $
6. Lender
Name Telephone Number
Address
7. 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
8. 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
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
VI ITH/OUR,kENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
ignature of er or Lessee, or Owner's or Lessee's Authorized Officer/Director/Partner/Manager Signatory's Title/Office/
The foregoing instrument was acknowledged before me this 1' ay of t khy
k by l�� CK1��r►r•
m o near -namd of person
as Cji,� w �" for 0W e"
Type of authority, e.g., officer, trustee, attorney in fact Name of party on behalf of whom instrument was executed
o No 6.Public — State of Florida
C/-
Personally Known OR Produced ID
Type of ID Producg� , "11. _ li_`,
CIEA Of HE Ct 17 COURT
AN COPlrPr
SE IDA ,
Form content revised: WY23/1 E a
Date
Print, type, or stamp commissioned name of Notary Public
JONATHAN L HOLIDAY
'- MY COMMISSION # FF228443
_% wt�,. EXPIRES May 16, 2019
1�07)JAB-0'S� Floaldallola-ySofvicecar
1 /24/2018
SCPA Parcel View: 22-19-30-502-0000-0030
Property Record Card
Parcel: 22-19-30-502-0000-0030
Property Address: 104 WALNUT CREST RUN SANFORD, FL 32771
Value Summary
__........_..._----------------.____---
—
.. __......_...._.__.._ .,
2018 Working 11 2017 Certified
•; Values Values
Valuation Method
Cost/Market Cost/Market
Number of Buildings
1 1
Depreciated Bldg Value
$171,269 $161,341
Depreciated EXFT Value
-
Land Value (Market)
$34,000 $34,000
Land Value Ag
Just Market Value "`
$205,269 $195,341
Portability Adj
Save Our Homes Adj
..$74,237. ,..._._ $67,004
Amendment 1 Adj
$0
P&G Adj
$0 $0
Assessed Value
$131,032 $128,337
Tax Amount without
SOH: $2,931.73
2017 Tax Bill Amount $1,655.88
Tax Estimator
Save Our Homes
Savings: $1,275.85
Does NOT INCLUDE Non
Ad Valorem Assessments
Legal Description
LOT
PRESERVE AT LAKE MONROE
•,PB62PGS12-15
Taxes
Taxing Authority
Assessment Value
Exempt Values
Taxable Value
I i
l
County General Fund
$131032
$50,000 .
$81,032 i a
Schools
$131,032
$25 000
$106,032
City Sanford
$131,032
$50,000
$81,032 ',
SJWM(Saint Johns Water Management)
$131,032
$50,000
$81,032
County Bonds
$131,032 '
$50,000
$81,032
_„�_
Sales
Description j Date
i
I Book ; Page
Amount
Qualified
Vac/Imp
QUIT CLAIM DEED 4/1/2016
08668 1784
$65,500 No
Improved
WARRANTY DEED 3/1/2010
07350 0455
$175 000 Yes
Improved
WARRANTY DEED 2/1/2006
06155 1587
$291 000 Yes
Improved
I
I
` Find Comparable Sales '•
Ik
Land
Method Frontage
! Depth Units
;Units Price Land Value
i LOT
1
$34,000.00
.. ...
.........----------------------
$34,000
_..
�
Building Information
�
Is Bed/Bath count incorrect? Click Here.
f # Description ;Year Built Fixtures Bed
Bath Base Area Total SF Living SF Ext Wall
j Adj Value ( Repl Value
Appendages
i Actual/Effective
1 SINGLE 2006 9 4
2.5 1,042 3,026 j
2,476 CB/STUCCO $171,269 $178,871
j
http://parceidetail.scpafl.org/Parce[Detai l info.aspx? PI D=22193050200000030
1 /2
1 /24/2018
FAMILY
SCPA Parcel View: 22-19-30-502-0000-0030
FINISH
Description Area
GARAGE 44L00
FINISHEb
OPEN
PORCH 109.00
FINISHED
1 UPPER
i STORY 1434.00
FINISHED
Permits
Permit # Description
Agency Amount CO Date €Permit Date
00169 6' PVC FENCE W/3 GATES
SANFORD $4,787 10/22/2012
..------ --- _.. __
00122 NEW - RESIDENTIAL
SANFORD $110,790 2/13/2006 9/9/2005
Extra Features
Description Year Built
Units Value New Cost
PATIO NO VALUE 12/1/2006
1 $0
http://parceldetail.scpafl.org/ParcelDetailinfo.aspx?PID=22193050200000030 2/2
PERMIT #
City of Sanford Building Division
Residential Re -Roof Scope of Work
JOB ADDRESS:
STRUCTURE TYPE: �GLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: 0-6-LACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (N w ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY): 1 (D N(
n�uk ty-r1ol -
**PLEASE !VOTE: ONLY 100 SQUARE FEET OF TA EXi T .VC DECK IS PER;WTTED TO BE REPLACED * *
ROOF VENTILATION: OFF -RIDGE (D'CGE OSOFFIT OPOWERED VENT OTURBNES
SKYLIGHTS: O YES �F YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12"2 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
OSHNGLE�
FL#
O METAL
FL#
O NIODIFIED BITUMEN
FL#
0TORCH DowN
FL#
O INSULATED
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 SHNGLE
FL#
O METAL
FL#
O MODIFIED BITUMEN
FL#
OTORCH DOWN
FL#
O INSULATED
FL#
O TILE
FL#
0 OTHER:
FL#
CITY OF
SANFORD
FIItE DEPART4IENT
Building & Fire Prevention Division
RESIDENTIAL RE-ROOFPOLICY & PROCEDURES
PERMITTING REQUIREMENTS — NO PLAN REVIEW 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), CERTI IN FB CODE COMPLIANCE BY PERSONAL INSPECTION.
CT R OR OWNER/BUILDER C•NTRA• ( ) SIGNATURE: DATE:
1410 Emerson Street, Leesburg, FL 34748 e State Roofing License: CM 329936 • License: CGC037504
Phone: 352-314-3625 e Toll Free: 855-314-3625 e Fax: 352-240-3439 • www.covenantrnc.com
SALES CONTRACT
Covenant Roofing & Construction, Inc. agrees to furnish all materials and labor necessary to do the modernization work at the following address:
Name ;', >��i� t •— r' fY1 �7 ► '� Phoned'- is� --E-Phone (w)
Address X,w-1 C 7 I ot7 Date
r
City State 4 _ ip -3
Email
In accordance with specifications given below:
REROOF:
A. SHINGLE ROOF
1. REMOVE OLD ROOF TO WORKABLE SURFACE.
2. RENAIL ROOF DECK WITH RING SHANK NAILS.
3. REPLACE ANY ROTTE4 WQtD WITH STANDARD SHEATHING @ $ PER FOOT AND $ � PER SHEET OF PLYWOOD, IF A (Initial)
4. INSTALL ` "11"�'i' UNDERLAYMENT OVER ENTIRE ROOF.
5. INSTALL FHANA EAVES DRIP. COLOR
6. INSTALL NEW VALLEY METAL AND FLASHINGS AS NECESSARY.
7. INSTALL NEW LEAD BOOTS OVER VENT PIPES AND RESEAL VENTS.
8. INSTALL YEAR FIBERGLASS SHINGLES. COLOR %n
9. INSTALL '3 FEET OF RIDGE VENT AT $6 BA PER f@OT COLOR
10. CLEAN-UP JOB SITE OF ALL WORK DEBRIS AND HAUL AWAY ALL RELATED DEBRIS AND LEAVE JOB SITE CLEAN.
11. CONTRACTOR WILL COORDINATE REMOVAL AND REINSTALLATION OF ROOF RELATED PERIPHERALS SUCHAS ( UT NOT LIMITED TO) SOLAR UNITS, SKYLIGHTS, TV. DISH
AND AIR CONDITIONERS, ETC. REMOVE AND REINSTALL EXISTING SOFFIT AND FACIA @ $4.25 PER FO T A I ON TO CONTRACT PRICE, IF REQUIRED. THE COST FOR
SUCH WORK WILL BE IN ADDITION TO CONTRACT PRICE AND HEREIN APPROVED BY HOMEOWNER. (Initial)
12. ALL WORK COVERED BY A 5 YEAR WORKMANSHIP WARRANTY.
1. Contract Documents. This contract consists of this document, extra work/wood authorizations, if any, and if payments
hereunder are to be financed, all financing documents. No promises other than those specifically set forth in the contract
documents shall be recognized by either party. The entire understanding and agreement of the parties is contained in the
contract documents.
2. It is understood and agreed that this contract shall not become binding upon Covenant Roofing & Construction, Inc. until it is duly
approved, accepted, signed and witnessed by an officer or officers of the Seller.
3. Work on the job described in the c tract o ufnents will commence on approximately and be
completed on approximately_. The recited dates are approximations and are subject to scheduling
difficulties of Seller, labor and/or material shortages, acts of God and other events not foreseen by Seller. Seller reserves
the right to employ any sub -contractor for the completion of the work described in the contract documents.
4. Covenant Roofing & Construction, Inc. reserves the right to substitute materials of equal or greater value and kind. Any required
materials such as fire retardant plywood, tongue and groove board, etc. will be billed on a time and material basis. All other
changes required by New Jurisdictional Code Enforcement Laws may result in additional charges.
5. Interest at the rate of eighteen (18%) per cent per annum will be charged on all balances not paid as per the terms specified
above. Reasonable attorney's fees will be charged to the Purchaser if it is necessary to place this contract in the hands of an
attorney for collection, and this charge becomes a part of the contract and obligation of the Purchaser to pay.
6. Parties agree that this agreement shall be construed according to the laws of the State of Florida and any action brought
thereon may be brought in the State of Florida. Venue is hereby agreed to be in Lake County Florida.
7. BUYERS RIGHT TO CANCEL (SOLICITED SALES ONLY) If you do not want the goods or services, you may cancel
this agreement by providing written notice to the seller in person, by telegram, or by mail. This notice must Indicate that you
do not want the goods or services and must be delivered or postmarked before midnight of the third business day after you
sign this agreement.
8. Both worker's compensation and public liability insurance are carried by the Seller and they are applicable to the work to be
performed.
9. It is understood and agreed that the buyer hold harmless, Covenant Roofing & Construction, Inc., for any damages that may
occur to the buyer's driveway(s) during delivery of materials and/or removal of the work related debris that may be required
to perform this home improvement contract. Furthermore, the buyer herein gives permission for typical delivery vehicles and
typical waste removal vehicles to enter said driveway(s) for the purpose of expediting this sales contract.
10. Contractor will coordinate removal and reinstallation of roof related peripherals such as (but not limited to) solar units, skylights,
T.V. dishes and air conditioners, etc. The cost for such work will be in addition to contract price and approved by homeowner.
11. Covenant Roofing & Construction, Inc. shall not be held responsible for damage to electrical lines, water lines, refrigerant lines
or other mechanical components that have been improperly installed near roof decking and may be damaged while performing
installation of roofing materials. Villages Roofing & Construction, Inc. shall not be responsible for any additional costs due to
roof decking that may have old materials adhered in such a way that requires redecking of structure.
12. Construction Industries Recovery Fund payment may be available from the CIRF if you lose money on a project performed
under contract, where the loss results from specified violations of Florida law by a state -licensed contractor. For
information about the recovery fund and filing a claim, contact the Florida Construction Industry Licensing Board at the
following telephone number and address: 7960 Arlington Expressway, Suite 300, Jacksonville, FL 32211-7467 or call (904)
727-6530.
13. Chapter 558, Florida Statutes contains important requirements you must follow before you may bring any legal
action for an alleged construction defect in your home. Sixty days before you bring any legal action, you must
deliver to the other party to this contract a written notice referring to chapter 558 of any alleged construction defects
and to consider making an offer to repair or pay for the alleged construction defects. You are not obligated to accept
any offer which may be made. There are strict deadlines under this Florida Law which must be met and followed to
protect your interests.
Contract Price $ __,10f -J/CD
Homeowner Portion $
(Plus Total from Item No. 3 above)
UPON COMPLETION
Executed in triplicate, one copy of which was delivered to, and receipt is hereby acknowledged by Buyer,
this01 day of 4 c-9-+ , 20 f (�
Approved and Accepted: NOTICE TO OWNER
a. Do not sign this home improvement contract in blank.
b. You are entitled to a copy of the contract at the time you sign. Keep it protect your rights.
(Seal) (Seal)
(Dealer -Seller) (Purchaser Sign Here)
(Seal)
BY
�..., (Title) (Purchaser Sign Here)
SALESMAN FORD PRESS, INC. 352-787-4650 (mike)
�U.ernw-
City of Sanford
Buildinlg and Fire Prevention
RESIDEiNTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY' -IN, FLASHING, AND ALLN-FINAL ROOF COVERINGS
PER,\,[IT #: I� -�Q�2- ADDRESS: ��i F-
I , .AS A(N) GENERAL, BU[LDLNG, RESIDENTIAL, OR
ROOFING CO�iTRA TOR, ENGINEER, ARCHITECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY" AFFIRM, THAT ALL OF THE
FOREGOING I.NFORNIATION IS TRUE AND ACCURATE .AND THAT ALL ROOFING COMPONENTS LISTED ON THE SCOPE OF lkORK AT THE
ABOVE REFERENCED ADDRESS HAVE BEEN INSTALLED I\i ACCORDANCE WITH THEIR PRODUCT APPROVALS ,AND ALL APPLICABLE CODE
REQUIKENIENTS — SPECIFICALLY FLORIDA BUILDING CODE, EXISTING BUILDING. IN ADDITION I CERTIFY" THE MNSTALLATION :!MEETS .ALL
REQUIREMENTS FOR SECONDARY WA ('ER BARRIER AND NAILING OF THE ROOF DECK, IN ACCORDANCE WITH THE HURRICANE RETROFIT
MANUAL REQUIREMENTS (BASED ON F.S. CHATTER 553.844).
LICENSE..#: 0 M 3Q P.
ter'
CON[PANY / CONTR-ACTOR:
CONTRACTOR SIGNATURE: _
(MUST BE SIGNED BY LICENSE
R'BUI
A FINIAL ROOF INSPECTION IS REQUIRED:
DATE:
q1 a lv&
THIS SIGNED AND Yg�r-vRIZED AFFIDAVIT MUST BE PROVIDED AT THE JOB SITE AT THE TIME OF THE FINAL ROOF INSPECTION,
ALONG WITH DIGITAL PHOTOGRAPHS OF EACH ?LANE OF THE ROOF SHOWING IN DETAIL .ALL COMPONENTS (DECKING,
UNDERLA- NIE.NT, FLASHING, DRIP EDGE ATTACHMENT) WITH THE PERNIIT :NU,.NIBER OR ADDRESS CLEARLY MARKED O.N THE DECK
FOR EACH INSPECTION, THE PHOTOGRAPHS :MUST INCLUDE A RULER OR:NIEASURI:NG DEVICE TO CONFIRM ALL :NAIL SPACINGAND
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 REQUIRE`IENTS WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION FEE AS
WELL AS REQUIRING A DESIGN PROFESSIONAL (.ARCHITECT OR ENGINEER) TO CERTIFI•, BASED ON PERSONAL
INSPECTION, THE INSTALLATION OF ALL ROOFLNG COMPONENTS.
STATE OF FLORIDA COUNTY' OF
Sworn to and Subscribed efore e this day of 20�vby:
4
fication)
Sig at5re of Notarublic
S to of Florida
Print/Type/Stan Tame
of Notary Public
-14 ��ho is Personally Known to me or has = Produced (type of
as identification.
LINDSAY DUCKHAM
Commission # FF 172210
• 1
My Commission Expires
October 28, 2018