HomeMy WebLinkAbout131 Gleason Cove+lp
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No:
Documented Construction Value: S 7,900
Job Address: 131 GLEASON CV SANFORD, FL 32773 Historic District: Yes ❑ No 0
Parcel ID: 02-20-30-523-0000-1500 Residential ❑x Commercial ❑
Type of Work: New ❑ Addition ❑ Alteration El Repair ❑ Demo ❑ Change of Use ❑ Move ❑
Description of Work: Re Roof Owens Corning FL10674-R12 Rhino 15216-R2 21 SQ 7/12 Pitch
Desert Tan Oakridge Lifetime
Plan Review Contact Person: Skylar Amkraut
Phone: 407-278-7788 Fax: 800-337-3361
Name Janice Zaidi
Title: Admin
Email: Permit@Jasperinc.com
Property Owner Information
Phone:
Street: 131 GLEASON CV Resident of property? : Yes
City, State Zip: SANFORD, FL 32773
Contractor Information
Name Jasper Contractors Phone: 407-278-7788
Street: 4185 S Orlando Dr Fax: 800-337-3361
City, State Zip: Sanford, FL 32773 State License No.: CCC1331153
Arch itectlEnginee r Information
Name: Phone:
Street: Fax:
City, St, Zip: E-mail:
Bonding Company:
Address:
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: 5'h 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
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 thati 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 Aapplicable_laws regulating construction and, ezoning.___ __ ------
Signature of Owner/Agent
Print Owner/Agent's'Name
Date
Signature of Notary -State of Florida Date
- 01.02.18
Signatnr of Contractor/Age t Date
Rudith Goico
Name
SKYLAR B AMKRAUT
Commission q FF 127890
_ 'My Commission Expires
a_
June 01 , 2018
Owner/Agent is Personally Known to Me or Contractor/Agent is Personally Known to Me or
Produced ID Type of ID Produced ID ype of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing❑ Gas❑ Roof ❑
Construction Type:
Occupancy Use:
Flood Zone:
Total Sq Ft of Bldg: Min. Occupancy Load: # of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads Fire Alarm Permit: Yes ❑ No ❑
APPROVALS: ZONING: UTILITIES: WASTE WATER:
ENGINEERING: FIRE: BUILDING:
COMMENTS:
Revised: Jime30, 20'15 Permit Application
5380 E. Colonial Dr.
Orlando, FL 32807
3203 Conway Rd., Ste. 201
Orlando, FL 32812
(407) 278-7788
(800) 337-3361 Fax
int�itn'.inni:rinc.nrc
VISA
JASPER
Je�pernocf.com
FL Contractor's License:
CCC1329651 & CCC1331153
ROOF REPLACEMENT CONTRACT
Account Manager:
Contact N; t,& Y 615
insttranee l Omnanv iiniormagon
Company: I z u
Policy #:QI . 3
Claim 4: .D Z ?°>
ge Cop)Ijany Information
Company: 7.f 7 cfpp N
Loan Number: / J�YZ--7
Owner's):
-7
Phone:
0 7 -- 7 S-2 56 '?
Address- n
Alt Phone.
City:
S
Zp C
Shingle Color:�a�'
a-7 .
Email:
1 E Qr
j 1QAI(.
; J'
Roof RCVO Amount/ Contract Price:
O
Drip Edge Color: «/tr -7,r�
11_ywneRs Jtrsurance t'mmijanv i'Iot"ot agree to nay for full roof replacement this contract shall be voidable
Assignment of insurance Benefits for the Full Roof Replacement Only: 1 hereby assign any and all insurance rights, benefits and proceeds under
any applicable insurance policies to Jasper Contractors, Inc. ("Jasper"), the scope of which shall be limited to a Full Roof Replacement. J make this assignment
and authorization in consideration of Jasper's agreement to perform services; supply materials and otherwise perform its obligations under this Contract,
including not requiring full payment at the time of service, 1 also hereby direct my insurer(s)to release any and all information requested by Jasper, or its
rcpresentative(s),, for the direct purpose of obtaining actual benefits to be paid by my insurer(s) for services rendered In this regard, i waive my privacy
rights. if payment is made directly to the Owner/Agent/insured(s), it shall be endorsed over to. Jasper immediately upon receipt. i agree that any portion of
work, deductibles, betterment or additional wvrk requested 'by the undersigned, not covered by insurance, must'be paid by the undersigned on the day of
installation. Deductible: it is the Owner's responsibility to uav all insurance deductibles. Owner's out-of-pocket expense will not exceed the deductible
amount, as stated on insurer's loss sheet (the "Loss Sheet'j, UNLESS. replacement/repair of deteriorated decking is required, by code and/or Owner requests
optional upgrades Jasper CANNOT pay, waive, rebate, or promise to pay, waive or .rebate any or all of the insurance deductible applicable to the
insurance claim for payment of work. In the event of a discrepancy, the deductible amount stated on the insurer's Loss Sheet sh'all.overrule deductible
amount disclosed Deductible: S_ 02.7o D C> MUST BE PAID iN FU PLUS APPLICABLE SALES TAX K, Z (initial)
MORTGAGE AUTHORIZATION: 1, Owper/Mortgagor, grant authorization. for ! COL"i7 N. A1 Mortgage Co. to speak with
Jasper on matters including but not limited to, the'claim and draw status., (initial) PAYMENT SCHEDULE: Owner agrees to
pay Jasper based on the following schedule: (i) Deposit in the amount of S: due upon signing this contract; (ii) the Contract Price,
less the Deposit and any applicable depreciation retained by Owner's insurer(s), plus upgrade costs; due and payable to Jasper upon completion of
work being performed; and, (iii) the remaining ;Contract Price (equal to any applicable depreciation and/or change orders) due and payable to Jasper upon
completion of work performed In the event of a pending inspection, no more than 2% of Contract Price may be withheld until inspection has passed.
Optional: UPGRADE ITEM: QTY: PRICE: TOTAL: S
Replacement Work and Price: Upon insurer's approval and subject to the Terms and Conditions herein, Jasper agrees to furnish all materials and
Provide the labor necessary to perform the full roof replacement which shall take place following Owner's insurance company's approval, approximately
within 30 days, conditions permitting, Owner's Declaration of Intent: Owner acknowledges and agrees that, upon approval by insurance company for a
full roof replacement, Jasper shall perform the roof replacement upon receipt of funds from Owner's insurance company.
FLORIDA HOMEOWNERS' CONSTUCTION RECOVERY FUND
PAYMENT, UP TO A LIMITED AMOUNT, MAY BE AVAILABLE FROM THE FLORIDA HOMEOWNERS'
CONSTRUCTION RECOVERY FUND IF YOU LOSE MONEY ON A PROJECT PERFORMED UNDER CONTRACT,
WHERE THE LOSS RESULTS FROM SPECIFIED VIOLATIONS OF FLORIDA LAW BY A LICENSED CONTRACTOR.
FOR INFORMATION ABOUT THE RECOVERY FUND AND FILING A CLAIM, CONTACT THE FLORIDA
CONSTRUCTION INDUSTRY LICENSING BOARD AT THE FOLLOWINGTELEPHONE NUMBER AND ADDRESS:
Construction Industry Licensing Board: 2601 Blairstone Road, Tallahassee, FL 32399-1039i (950) 487-1395
CANCELLATION: If Owner elects to terminate the services of Jasper; Owner may do so before midnight on the third business
day after Contract Is executed. Owner shall receive a full refund of all deposits. Owner may also rescind Contract before midnfghton
the third business day after the contract is executed after notification from Insurer(s) that the claim forpayment on roof contract has
been denied, In whole or in part. All written notices of cancellation, regardless of reason, shall be postmarked or delivered to Jasper's
corporate office: 16" Roberts Boulevard, Suite 112, Kennesaw, GA 30144. CANCELLATION EXCEPTIONS: The three (3) day
right of cancellation DOES NOT APPLY to contracts for emergency home repairs as time is of the essence.
1, Owner, have read and understand all statements, Terms and Conditions of the "Roof Replacement Contract" and agree
that all details are acceptable and satisfactory. I further understand that this Contract constitutes the entire agreement between the
parties and that any further changes or alterations to this Contract must be made in writing and agreed upon by both parties.
Each party represents and warrants to the other that it has the full power and authority to enter Into the contract and that it is
binding and enforceable in accordance with its terms.
Authorized Jasper -Representative Date
/ (� It=,% - .-
LA /
Owner D' e
Scanned by CamScanner
THIS INSTRUMENT PREPARED BY: GRANT MALOY, SEMINOLE COUNTY
Name: JASPER CONTRACTORS CLERK OF CIRCUIT COURT 1, COit
TRO
Address: 3203 S CONWAY ROAD SUIT$ 201 BK 9051 Ps 1322 (1Pss )
ORLAM0 FL 32812 CLERK'S Y 2018000959
RECORDED 01/117 '01g 01:5559
PH
RECORDING FEES 10.00
NOTICE OF COMMENCEMENT RECORDED BY .1F,_kenro
Permit Number
Parcel ID Number: a� (000— 1500
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes,
following information is provided in this Notice of commencement.
the
f
1. DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available)
Lv.
{'SO
2. GENERAL DESCRIPTION OF IMPROVEMENT:
RE -ROOF
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT.
Name and address: _ n Z ZiCV- , 13 l F,jpit�Qn CQ
Interest In property: OWNER
f
Fee Simple Title Holder (if other than owner listed above) Name:
Address:
4. CONTRACTOR: Name: JASPER CONTRACTORS Phone Number. 407-278-7788
Address: 3203 S CONWAY ROAD SUITE 201 ORLANDO FL 328I2
5. SURETY (If applicable, a copy of the payment bond Is attached): Name:
Address: Amount of Bond:
6. LENDER: Name: Phone Number. ,
Address:
I
7. 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)(a)7„ Florida Statutes.
Name: Phone Number.
Address:
8. In addition, Owner designates Of
to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes, Phone number: j
9. Expiration Date of Notice of Commencement (rhe expiration is 1 year from date of recording unless a different date is specified)
I
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT
CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES,
ARE
AND CAN RESULT IN Y
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON
JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
UR
THE
LENDER OR AN ATTO
BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
__q
ure or Owner of Less e, o Owneys or lessee s (Print Name and Provide Signatorys TitlelOffice)
Aul.4 dzed OlfieedDimc rIP rtnedManager) —
U
State of U e ..
County of
�
The foregoing instrument was acknowledged before me this / day of D ece j')/) W,(-
by—..- at a. (c' e a �'"� Who is personally known to me b�' OR
Name of person making statement
who has produced identification El type of identification produced:
_..
°''tic - State of Fitt-
":s ;ion#FF9236st
rI';o r:; E! ire
roan• P i Oct 1, 2C
ELIZABETTH HOROUIST
Nay P(111Hc - State of Florida
COMMI981011 # FF 923694
My COMM- Expires Oct 1, 2019
LLER
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 01-02-18
Karla Almodovar, Rudith Goico, Skylar Amkraut Rachel Holcomb
I hereby name and appoint: M't WWjW, Gina Mc5onald & Rachel Holcomb
an agent of: Jasw Conraaom
Nzinc or company)
to be my lawful attomey-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):
The specific permit and application for work located at:
131 GLEASON CV SANFORD, FL 32773
(Sum Addrm)
Expiration Date for This Limited Power of Attorney: 1 /1 /2019
License Holder Name: Ronald Bouchard
State License Number. CCCt33t153
Signature of License Holder
STATE OF FLORIDA �1
COUNTY OF
The foregoing instrument was acknowledged before me this 02 day of January
20918 , by °oruid d who is o personally known
to me or ® who has produced of as
identification and who did (did not)takean oath.
Signature
(Notary Sea]) S'kylar Amlaaut
wF
SKYLAR 8 AWRAUT It
Commission N FF 127890
�d
- f-
My Commission Expires
June 01, 2018
(Rev. 08.12)
Print or type name
Notary Public - State of FL
Commission No. 127890
My Commission Expires: 6/1/2018
Scanned by CamScannPr
1 /2/2018
*Mm, CFA
Parcel Information
SCPA Parcel View: 02-20-30-523-0000-1500
Property Record Card
Parcel: 02-20- 30-523-0000-1500
Owner: ZAIDI JANICE P LIFE EST (JOHNSON ALYSIA S)
Property Address: 131 GLEASON CV SANFORD, FL 32773
Parcel
02-20-30 523-0000-1500
Owner
ZAIDI JANICE P LIFE EST (JOHNSON ALYSIA S)
Property Address
131 GLEASON CV SANFORD, FL 32773
Mailing
131 GLEASON CV SANFORD, FL 32773
Subdivision Name
PLACID WOODS PH 2
Tax District
DOR Use Code
S1-SANFORD
01-SINGLE FAMILY
Exemptions
00-HOMESTEAD(2002)
Legal Description
LOT 150
PLACID WOODS PH 2
PB 58 PGS 4-6
Taxes
Value Summary
1 2018 Working 2017 Certified
Values Values
Valuation Method
Cost/Market Cost/Market
Number of Buildings
1
III
Depreciated Bldg Value
�
$98,651 $93,092
Depreciated EXFT Value
Land Value (Market)
$25,000 $25,000
Land Value Ag
---
Just/Market Value "
$123,651 $118,092
Portability Adj
Save Our Homes Adj
$55,075 $50,926
Amendment 1 Adj
P&G Adj
$0
$0 $0
Assessed Value
$68,576 $67,166
Tax Amount without SOH: $1,460.80
2017 Tax Bill Amount $588.81
Tax Estimator
Save Our Homes Savings: $871.99
' Does NOT INCLUDE Non Ad Valorem Assessments
Taxing Authority
Assessment Value
Exempt Values
Taxable Value
County General Fund
$68,576
$43,576
$25,000
Schools
$68,576
_
... — -
$25,000
$43,576
City Sanford
$68,576
1
$43,576 ,
$25,000
SJWM(Saint Johns Water Management)
$43 576
$25,000
........ .........
County Bonds
j $68,576
$43,576
$25,000
Sales
Description
1 Date
Book
Page
Amount
Qualified
Vac/Imp
QUIT CLAIM DEED
SPECIAL WARRANTY DEED
6/1/2015
8/1/2001
08493
04154
1 0464
0112
$100
$86,700
No
Yes
Improved
Improved
--
Find Compara bile Sam
Land
Method
Frontage
Depth Units Units Price
Land Value
LOT
1 $25 000.00
$25,000
Building Information
Year Built
# Description ,Actual/Effective Fixtures Bed Bath Base Area Total SF Living SF Ext Wall Adj Value Repl Value Appendages
1 SINGLE 2001 6 3 2.0 1,204 1,466 1,204 CB/STUCCO $98,651 $104,393
i
Description ;Area
FAMILY FINISH
http://parceldetaii.scpafl.org/PareelDetailinfo.aspx?PID=02203052300001500 1/2
CITY OF
SkNFORD Building & Fire Prevention Division
FIRE DEPARTMENT Re -Roof Permit Card
PERMIT NO. &w �.� ISSUE DATE:
CONTRACTOR: Zms,ye.r CPatr=i&rs,
Is
JOB ADDRESS:I—q G a►
TYPE OF WORK: • rocx CL
PROTECT FROM WEA HER
• Post this Permit and all required documents in a conspicuous place outside
• Digital Photographs are required - please follow re -roof policy and procedures guide
• All trash, debris and dumpsters mW. be removed from job site at final inspection
• Permit expires six (6) month. from date of issue
ROOF
INSPECTION TYPE APPROVED REJECTED INSPECTOR
FINAL ROOF
FAILURE TO FOLLOW THE RESIDENTIAL RE -ROOF POLICY & PROCEDURES WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION
FEE AND MAY REQUIRE AN AFFIDAVIT, SIGNED AND SEALED, FROM A REGISTERED FLORIDA DESIGN PROFESSIONAL
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 REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS,
STATE AGENCIES, OR FEDERAL AGENCIES. FBC 105.3.3
REVISED: 4-17 Inspection Line 407.792.6069 or 8SS.541.2112
,1
City of Sanford Building Division
Residential Re -Roof Inspection Policy & 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), certifying FBC code compliance by personal inspection.
CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: DATE: 01.03.2018
PERMIT #
City of Sanford Building Division
Residential Re -Roof Scope of Work
JOB ADDRESS: 356 FAIRFIELD DR SANFORD, FL 32771
STRUCTURE TYPE: Q SINGLE 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):
* *PLEASE NOTE: ONL Y 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED
ROOF VENTILATION: DOFF -RIDGE ORIDGE 0SOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: O YES ONO 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
O SHINGLE
Owens Corning
FL# 10674-R12
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
O INSULATED
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#
O INSULATED
FL#
O TILE
FL#
0 OTHER:
FL#
4.City of Sanford
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHE�A"THING, DRY -IN, FLASHING, AND ALL FINAL( ROOF COVERINGS
PERMIT #: 1 (�/y ADDRESS:
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
COMPANY / CONTRACTOR: nViNaS
CONTRACTOR SIGNATURE: DATE: \ ✓ , { .
(MUST BE SIGNED BY LICENSE HOLDER OR O _ ER/ U DER
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 � �L
Sworn to and Subscribed before me this day of 20 __Ub :
Who is ❑ Personally Known to me or has roduced (type of
as identification.
Co"'* EXP es
Con�m�ss�on � n
FF
My Coln'JS on
June