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HomeMy WebLinkAbout116 N Bristol CirCITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: Documented Construction Value: $ 1'3, 71 J. ; & Job Address: i 1 b I J G i S`� I Cr �C / a Historic District: Yes ❑ No ❑ Parcel ID: 000c? . 06- 30 Residential ❑ Commercial ❑ Type of Work: New ❑ Addition ❑ Alteration ❑. RepairEl. Demo ❑ Change of Use ❑ Move ❑ Description of Work: (Z9_ rvtov\e, e)051,74 S k N1a l!a U n Ao-r1g v 1 iqn J re- 421E. Plan Review Contact Person: Phone: - 07-- �°J& - l 517 Fax: N'e ; I5 0 Title: PC 6t 1 ec—% /p4 rJsf-v Email: ga iyi YN O -t2 o dlq t) JO C252 V-0 . Property Owner Information Name in"rA e56i r Phone: q7T- C;J93 Street: �J 9 E Resident of property? City, State Zip: S �.' oCJ . EL 7i�7T ,hh r &CIMA Contractor Information V Name akhdo Street: W o qL f4o' vw City, state zip: Qc kvijo Phone: q07 - -�75 - Fax: State License No.: <<C 1325 D T-'5'-O Architect/Engineer Information Name: Phone: Street: Fax: City, St, Zip: Bonding Company: Address: 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 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. 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: 5t° Edition (2014) Florida Buildingf ode [ Revised: June 30, 2015 Permit Application g l 0 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. ,t c 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 ac rate and that all work will be done in compliance with all applicable laws regulating construction and o ing. ca)rta>e �c�,,►le�u,r �� �j1 7 Signature of Owner/Agent Date IIVL: 14(3m1=s0 Print Owner/Agent's Name Signatu Notary- of Florid Date STACY L. PAPKE NOTARY PUBLIC -F rATL OF FLORIDA ires ��//30/2019 Owner/Agent is Ye sonAy Known to Me or Produced ID Type of ID EL -g> fat!-1oNco-59 -sa 3 _v //,L3 f $(a Signa`fiife-J'F-e6n1factor/Agent — Date Print Contractor/Agent's Name LSign of Notary a of Flo 4 a Date STACY L. PAPKE NOTARY PUBLIC STATE OF FLORIDA Comm# FF Contract /� gerff)lr 31� 11ally Known to Me or Produced ID 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: COMMENTS: Flood Zone: # of Stories: Plumbing - # of Fixtures #, of Heads Fire Alarm Permit: Yes ❑ No ❑ UTILITIES: WASTE WATER: FIRE: BUILDING: Revised: June 30, 2015 Permit Application LIMITED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: 1 ) $ a01 I hereby name and appoint: �4 y ece) n M0,1, 's 6h an agent of. of to be my lawful attorney -in -fact to act for me to apply for, receipt for, sign for and do all things neces ry to this appointment for (check only one option): The specific permit and application for work located at: 11� 1J• sC�"Q Crr (Street Address) Expiration Date for This Limited Power of Attorney: 0 1 / 031 2Oab License Holder Name: �('a�nk 1 V C; l w State License Number: Signature of License Holder: STATE OF FLORIDA COUNTY OF Q(Zg (A-1 The foregoing instrument was acknowledged before me this'3-4 day of , ona 20C_, by rrc�nl� tAii lScv� who is erslly own to me or o who has produced identification and who did (did not) take an oath. STACY L. PAPM Si e NOTARY PUBLIC jTATE OF FLORIDA� Oorrurt FF215383 sA� Expires 3/30/2019 Print or a name Notary Public - State of ' w.t D Commission No. ' d 1 ,c�3 3 My Commission Expires: 34gaicl (Rev. 08.12) as my Date: Proposa�Io.: Phone: (407) 275-9444 Fax. (407) 282-4416 6682 Hoffner Avenue, Orlando, FL 32822 PROPOSAL SUBMITTED TO: ES.+M � NAME: 64/!�� / AA & JOB NAME: tt& liT -SA 1.51QC Clif STREET: N- O - t CITY: d STATE: FL ZIPJ,, 77,3 PHON We hereby submit specifications and estimate for: 1. Remove existing Pitch Roof , L Flat Deck Roof 2. Remove and replace damaged wood at an additi al cost of $ 2.25 /SQ.FT (sheathing) or $4.25 LF(1x )* 3. Furnish and install Synthetic Underlayment , #30 Felt or Peel & Stick 4. Remove and replace all lineal feet of drip edge. COLOR _ 7� 5. Remove and replace 4" . 6" �, 10" J-vent.Color 6. Remove and replace 4" _�, 3" �, 2" 11/21'_,L_ Lead boot flashings 7. Furnish and install 3-TAB Architectural Torch Down Ila= 8. Manufacturer A4F �'dyj9Aa 14"% COLOR 9. Furnish and install lineal feet of aluminum ridge -vents. COL9V 10. Furnish and install 4' off ridge -vents COLOR HA0&-' 11. Six nails per shingle 12. Seal all roof edges and penetrations 13. Install new -peel & stick membrane in valley(s) roll(s) 14. Remove all roofing related debris from premises. 15. Guarantee workmanship for 5 (five) years. TBD= To be determined 'Total amount of wood is unknown until after removal of the existing roof, therefor all charges for wood are additional to the below stated price. We hereby propose to furnish labor and materials -complete in accordance with Jh e above specifications, for the sum of -" ;C14n -I' 1t10SaV1J SeY�nl�uvld N aft'plu e, � W� an t(-// oo Dollars ($13, 713. /�) with payments to be made as Follows: 50% up front and balance! upon All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alterations or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accident or delays beyond our control. This proposal subject to acceptance within 14 days and it is void thereafter at the -.option of the undersigned. 1--�e Authorized Signature: �&L_�e ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. I agree to all the Terms and Conditions on the back side of this proposal. ACCEPTED: Signature Signature IATE 11-7 DATE www.theoriandoroofingco.com o email: admin@theoriandoroofingco.com State Certified Building Contractor CBC 060546 ♦ State Certified Roofing Contractor CCC 1330550 � THIS INSTRU :NT REPA ED BY•�.Ci ►� ���'n SSG/► Name: o.,n.�o kemo-G'wa tlzvinany Address: e r4- A d L -eg NOTICE OF COMMENCEMENT State of Florida County of Seminole Permit Number: GRANT 1'1N_0 i '.3EC' 11%1011 i 011h, i CLERK. OF CIRCUIT f O41R1 C:ONF'TROE..E_ER BI< 90 1 F'-us 1'270-4271. (2f-'::aa) CLERK'S T 2018i 01719a7 RECORDED 1)1/ t /2?ii1 1 12.`5,j ,.zr r'1°I RECORDING FEES; RECORDED BY 1--st:91 th Parcel ID Number: (')7 - 90 - "� I ��G - 0000 - C530 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 property and street address if available) Lo4- 53 C I5�t GENERAL DESCRIPTION OF IMPROVEMENT:. Name: b I1`y,,f_ yo r4 e5,�5t>( .,0tl` .10, Address: 1 l� ► �-v Ci a n .., p-'7 7 3 Fee Simple Title Holder (if other than owner) Name: PC1G C4� '" Oil Address: c CONTRACTOR: g� ,,•-^��`� `" Name: o d od o i2,r<JV A" C'(J ry) 44 n Y pata.�•'' Address: % �P t'1 v s^ .��- 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: 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 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 COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Under penalties of perjury, I declare that 1 have read the foregoing and that the facts stated in it are true to the best of my knowledge and belief. 0 rZ cLA�� O I. I VAe- IfY#1105-49 Owner's Signature Owner's Printed Name Florida Statute 713.13(1)(g): "The owner must sign the notice of commencement and no one else may be permitted to sign in his or her stead." ate of AA-ai& n/a County of CP—AA6L to foregoing instrument was acknowledged before me this ,1L day of Za- urn& , 20 by 0L 1 ✓C 1,a✓Y1I_-sA<P— Name of person making statement E;d,- OR who has produced identification �pe of Id, STACY L. PAPKE NOTARY PUBLIC STATE OF FLORIDA Cann# FF215383 Expires 3/30/2019 Who is personally known to me ❑ CITY OF r Building & Fire Prevention Division S ORD RESIDENTIAL RE ROOF POLICY & PROCED URES FIRE DEPARTMENT 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), CERTIFYING FBC COD MPLIANCE BY PERSONAL INSPECTION. CONTRACTOR (OR OWNER/BuiLDER) SIGNATURE: L DATE: PERMIT # /<a U Building & Fire Prevention Division RESIDENTIAL RE -ROOF SCOPE OF WORK JOB ADDRESS: 114 N& i .s4o � C- c STRUCTURE TYPE: SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM RE -ROOF TYPE: 0 REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS) O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF) DECK TYPE (PLEASE SPECIFY: * *PLEASE NOTE: ONLY 100 sou. ROOF VENTILATION: 0 OFF -RIDGE OF THE EXISTING DECK IS PERMITTED TO BE RLPLACBD ° ° O RIDGE OSOFFIT OPOWERED VENT OTURBINES SKYLIGHTS: O YES `RNO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #: MAIN ROOF AREA ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 (Z 4:12 OR GREATER TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL © SHINGLE -CAW O FL# O METAL FL# O MODIFIED BITUMEN FL# O TORCH DOWN FL# OINSULATED FL# O TILE FL# O OTHER: FL# ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IFAPPLICABLE** 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# O MODIFIED BITUMEN FL# O TORCH DOWN FL# OINSULATED FL# O TILE FL# O OTHER: FL# -111/20/2017 �OWd Jatu=, CIA PPE JAN, Parcel Information SCPA Parcel View: 07-20-31-506-0000-0530 Property Record Card Parcel: 07-20-31-506-0000-0530 Owner: RAMESAR, OLIVE Property Address: 116 BRISTOL CIR SANFORD, FL 32773-7324 Value Summary Parcel 07-20-31-506-0000-0530 Owner RAMESAR, OLIVE Property Address 116 BRISTOL CIR SANFORD, FL 32773-7324 Mailing 116 N BRISTOL CIR SANFORD, FL. 32773-7324 Subdivision Name BRYNHAVEN 1ST REPLAT Tax District Sl-SANFORD DOR Use Code 01-SINGLE FAMILY Exemptions 00-HOMESTEAD(1994) Seminole County GIS Legal Description LOT 53 BRYNHAVEN 1ST REPLAT PB 39 PGS 20 & 21 Taxes 2018 Working Values 2017 Certified I Values Valuation Method I Cost/Market 1 Cost/Market Number of Buildings 1 Depreciated Bldg Value 1 $102,562 1 $96,768 Depreciated EXFT Value i $1,200 1 $1,200 Land Value (Market) $20,000 $20,000 Land Value Ag Just/Market Value Portability Adj $123,762 j $117,968 Save Our Homes Adj $46,075 1; $41,879 Amendment I Adj J $0 P&G Adj $o 1 $0 Assessed Value $77,687 $76,089 Tax Amount without SOH: $0.00 2017 Tax Bill Amount $0.00 Tax Estimator Save Our Homes Savings: $0.00 Does NOT INCLUDE Non Ad Valorem Assessments Taxing Authority Assessment Value Exempt Values Taxable Value County General Fund $77,687 $77,687 $0 Schools City Sanford $77,687 $77,687 $77,687 $77,687 $0 $0 SJWM(Saint Johns Water Management) $77,687 $77,687 $0 County Bonds $77,687 $77,687 $0 Sales Description Date Book Page Amount Qualified Vac/Imp WARRANTY D 2/1/1989 02042 1662 $85.800 1 Yes Improved Find Comparable Sales Land Method Frontage Depth Units Units Price Land Value LOT 0.00 0.00 $20,000.00 $20,000 Building Information Is Bed/Bath count incorrect? Click Here. Description Year Built Fixtures Bed Bath Base Area Total SF Living SF Ext Wall Adj Value Rep[ Value Appendages Actual/Effective I SINGLE 1989 8 3 2.0 1,480 1,968 1,480 CB/STUCCO $102562 $115,889 Description Area e FINISH a GARAGE :420 090 http://parceldetaii.scpafl.org/ParceiDetailinfo.aspx?PID=07203150600000530 1/2 CITY OF Building & Fire Prevention Division lSki4FORD RESIDENTIAL RE ROOF POLICY & PROCEDURES FIRE DEPARTMENT 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), CERTIFYING FBC COD MPLIANCE BY PERSONAL INSPECTION. CONTRACTOR (OR OWNER/BumDER) SIGNATURE: DATE: t r; CITY OF Sk�4FORD f a: DEPARTMENTFIRE JOB ADDRESS: A ' `I 5f t Soo 1 Cif. PERMIT # Building & Fire Prevention Division RESIDENTIAL RE -ROOF SCOPE OF WORK STRUCTURE TYPE: 06SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM RE -ROOF TYPE: O REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS) O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF DECK TYPE (PLEASE SPECIFY): U1I)QU **PLEASE NOTE: ONLY 100 SQUA FAT OF THE EXISTING DECKIS PERMITTED TO BE REPLACED ' ROOF VENTILATION: (5) OFF -RIDGE O RIDGE O SOFFIT OPOWERED VENT SKYLIGHTS: O YES (�NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #: MAIN ROOF AREA ROOF SLOPE: O LESS THAN 2:12 Q 2:12 - 4:12 4:12 OR GREATER O TURBINES TYPE OF ROOF MANUFACTURER FLORIDA APPROVAL SHINGLE - AN'0 PRODUCT FL# O METAL FL# O MODIFIED BITUMEN FL# O TORCH DOWN FL# OINSULATED FL# O TELE FL# O OTHER: FL# ROOF EXTENSIONS (PORCHES, PATIOS, ETC.)**IFAPPLICABLE** 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# O TORCH DOWN FL# OINSULATED FL# O TILE FL# 0 OTHER: FL# r- -- CITY OF S 0 �..�' .. fling & Fire Prevention Division RESIDENTIAL RE ROOF AFFIDA VIT FIRE DEPARTMENT RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS PERMIT #: .,1 -7d ADDRESS: 1 `� � �j � -i-p I � i � 3 I ,_ Ca4a 11l el Is On , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR ROOFING CONTRACTOR, ENGINEER, ARCHITECT, 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 #: C C. C I JV s JLJ COMPANY / CONTRACTOR: CONTRACTOR SIGNATURE: (MUST BE SIGNED BY LICENSE HOLDER OR OWNER/BUILDER) DATE: 6 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 COMPONENTS. STATE OF FLORIDA COUNTY OF C)g&t�kCNL Sworn to and Subscribed before me this day of _lL�A-2u 20 by: 16Ls3.,) Who is*Personally Known to me or has ❑ Produced (type of identification) as identification. STACY L. PAPKE i " re of N P0151fe NOTARY PUBLIC State of Florid�vy STATE OF FLORIGA' Comm* FF215383 Expires 3/30/2019 Print/Type/St mp Name of Notary Public