HomeMy WebLinkAbout132 Brushcreek DrJob Address: 3 d
Parcel ID: � l
/( H Y —
CITY OF SANFORD
`r" BUILDING & FIRE PREVENTION
PERMIT APPLICATION
l.:
JAN 1 1 20%
Application No:
BY:
Documented Construct' n Value: $
Type of Work: New ❑ Addition ❑ Al
Description of Work:
Plan Review Contact Person: J1 cY
��
Phone: `107-6 �Cl 'q /l�'ax:
Name
Street:
City, S
Name Va V
Street:
City, State Zip:
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
3d7n l
Historic District: Yes ❑ No ❑
/ 16 Residential Commercial ❑
❑ Repair ❑ Demo ❑ Changetof UseO Move ❑
e
nformation V
('� q
Phone:
Resident of property?
intormation -7 6 I
Phone: qO �6 78
Fax: L State License No.: —O 11
�
Arch itecVEngineer 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 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 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 constriction 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.
Signature of Ow / gent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name Print Contractor/Agent's Name
l l• a� l l (� 2� 117
Signature
04 PqV P�e�',
ROSE A SMITH
Notary Public - State of Florida
=, Commission # GG 54688
°'f,OFF ;P' My Comm. Expires Mar 24, 2021
Owner/Agent i
Produced ID J,-' Type of ID -D - 6
SFnf - tod LoriROSE A SMITH
Notary Public - State of FloridaCommission # GG 54688
��My Comm. Expir Mar 24, 2021
C wn 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:
# of Heads
UTILITIES:
FIRE:
Flood Zone:
# of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes ❑ No ❑
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Permit Application
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: I n, 1%
I hereby nai
an agent of:
to be my lawfiil 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):
CtY The sp.ecific,pprmit and application for,ork loc ed at:
1.3
1!-\
Address)
Expiration Date for This Limited Power of Attorney: 1 ' 62
License Holder Name:
State License Number;
Signature of License F
STATE OF FLORIDA
COUNTY O
The foregoing instrument was ackDowledged before me this a"i day of_,
200�, by V\ ►(L 2,� who is ❑ personally known
to me or ❑ who has produced as
identification and who did did not) take an oath.
J
Signature
(Notary Seal)
" ROSE A SMITH
State of Florida
Mar 24,
2021
(Rev. 08.12)
Print or type name
Notary Public - State of
Commission No.
My Commission Expires:
1111111 H11111111111111111111111 fill 1111
{.:litt�i!`d: l�li;L.�' it .• .1.)P•1 �'1;
r t I
Permit Number: �� ! 1
Parcel ID Number: -�� .1J 5�t0 "UoQo L16o
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 PROPERTY: (Legal description of the property and street address if available)
2. GENERAL IESCRIPTIO %PF IMPR7MENT:
FOR THE IMPROVEII&ENT-
3. Name aOWNERnd add INFOResls:� t� O RJi�U�-E` e A t-i - ld ' i LESSEE E CC N 1 TED5h CY��'S /✓/�Jr' /l/1 j ► 1.� �
Interest in property:
Fee Simple Title Holder (if other than owner listed above)
4. CONTRACTOR: Name: / t"t G Y! V LAA L/ V-\OC' % % /'la y ri PtWe Number:
Address: Y V J r 1A f I f iV Y—w L./
5. SURETY (If applicable, a copy of the ayment bond is attached):
Amount of Bond:
6. LENDER: Name: Phone Number:
Address:
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:
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:
9. Expiration Date of Notice of Commencement (The expiration 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.
&12M a"'i" '�! —
( ignatur f er or Lessee, or er's or Lessee's
Authorized Officer/Director/Partner/Manager)
pcffl�m IC,-6 &4AO-0,W44
(Print Name and Provide Signatory's Title/Office)
State of County of
The foregoing Instrument was acknowledged before me this ,��I_ day of , 20 )
wl
Advantage Roofing Inc
6903 Partridge Lane
Orlando, FL 32807
407-678-9721
advantageroofinginc@yahoo.com
www.roofingadvantage.com
State Lic# CCC052477
Lee Alfredson
132 Brushcreek Dr
Sanford, FI 32771
4076160399
Items
Shingle Roof Replacement
Estimate ID: 3NDQND
Date: Nov 15, 2017
Advantage Roofing Inc is dedicated in combining its resources to ensure the highest quality of workmanship and commitment.
We have familiarized all personnel with project conditions and are familiar with all local building codes. Thank you for the
opportunity, time and attention in your process of choosing a qualified contractor.
RE-ROOFPREPARATION
• Coverall plants and shrubbery with tarps to eliminate damage and catchall loose trash and nails.
• Obtain and post all necessary permits in accordance with all local codes.
• Remove existing roof: Shingle roof to wood decking (Roof type).
• Removal of extra roof layers will be charged at an additional cost of $25.00 Per SQ.
ROOFINGSYSTEM
• Re -nail decking per FL Hurricane Litigation Reguirements.(8D RING SHANK NAILS PER FL BUILDING CODES)
• Install new: GAFArchitectural Timberline HD Shingles in accordance with manufacturers specifications and all
local codes. (Lifetime 50 Yrs / 130 MPH Wind Rating)
WOOD WORK
• Replace defected/rotten wood at an Additional cost: $60.00 per sheet plywood.
• Replace defected/rotten wall, chimney flashing, plank and fascia boards at an Additional cost: $5.50 per. Lin. Ft.
• ($150.00 Wood Credit)
UNDERLAYMENT/DRY-IN
• Install Synthetic (Shingle Underlayment) throughout entire roof deck.
• Install Peel & Stick Leak Barrier in the following vulnerable areas that apply ( valleys, Penetrations, Skylights, and
Chimneys).
EAVEDRIP FLASHING& SKYLIGHTS
• New eave drip 32 #pieces. Color: White
• Install new lead plumbing boots: 3 inch. 1 2 inch. 3
• Furnish and install new valley metal over peel and stick membrane:
Remove and install new glass curb mount skylights. (2x4)
1.5 inch. _ Boot covers 4 Black
75 Lin. Ft.
(2x2)
Advantage Roofing Inc page 1 of 3
• Remove and install new 4 ft. off ridge vents: Qty.
• Install new gooseneck vents: 10 inch. 4 inch. 2
• Install hip and ridge cap shingles. 175 Lin. Ft.
• Install required starter shingles at eave. 150 Lin. Ft.
JOB COMPLETION
• Clean job site thoroughly each day and rernove all job related debris from premises. Magnetically drag job site for any
loose nails.
• Request all necessary permit inspections(Please do not remove any county permits until final inspections have been
completed).
WORKMANSHIP WARRANTY
• Workmanship warranted against ALL LEAKS AND DEFECTS for Five (5) Years from date of completion.
• Manufacturers warranty applies to materials only. Warranties are transferable onetime.
ADVANTAGE ROOFING INC. hereby propose to furnish labor, materials, insurance, permit fees, dump fees,
supervision, equipment, qualified installers, and taxes: complete in accordance with the above specifications.
NOTES/COMMENTS
*FL Wind Mitigation Inspection Included.
* Weatherwood shingle color.
Summary
Subtotal $10,236.58
Tax $0.00
Total $10,236.58
Advantage Roofing Inc page 2 of 3
Terms and Conditions
This contract and any agreement pursuant thereto is between Advantage Roofing Inc, hereinafter referred to as the "Co"or
`Company"and the customer(s)named herein on the will be subject to all appropriate laws. regulations and ordin antes of the
state of Florida and the terms and conditions. The above proposal, specifications and conditions are satisfactory. and
Advantage Roofing is hereby authorized to do the work as specified. This proposal is subject to acceptance within 30 days and is
void thereafter at the option of the Licensed Contractor. Should default be made in payment of this contract, charges should be
added from the date their of completion at a rate of (1 %) percent per month. 18%per year with a minimum charge of $ 2.00 per
month, and if placed in the hands of an attorney for collection, all attorney fees, legal, and filing fees shall be paid by customer
acceptingsaid contract.
1. According to Florida's Constitution L ien Law (sections 713.001-713.37, Florida Statues), those who work on your property
or provide materials and are not paid in full have the right to enforce their claim for payment against your property. This claim is
known as a construction lien. If your contractor or subcontractor fails to pay subcontractors. sub -subcontractors, or materials
supply or neglect to make other legally required payments, the people who are owed money may look to your property for
payment. even if you have paid your contractor in full. If you fail to pay your contractor, your contractor may also have alien on
your property. This means if alien is filed on your property it could be sold against your will to pay for labor, materials, or other
services that your contractor or subcontractor may have failed to pay. Florida construction lien law is complex and is
recommended that whenever a specific problem arises, you should consult an attorney.
2. All Contracts are subject to approval of our credit department and office without exception. The person executing this
contract must obtain the approval of the officer of the company for this contract to be effective under any conditions.
3. The company shall have no responsibility from damages from fire, tornado, windstorm, or other perils, as is normally
contemplated to be covered by homeowners insurance or unless a specified written agreement be made therefore prior to
commencement of the work. Company shall not be reliable for failure of performances due to labor controversies, strikes, fires,
whether, in ability to obtain materials from usual sources, ofany other circumstances beyond the control of the company,
weather of similar or dissimilar nature. Acts of extreme nature voids all warranties. 'Co. "cannot be held responsible for any
form of mold damage. Manufacturer's warranty applies to materials. Advantage will not be responsible for previous
structural issues, plumbing line damage due to improper installation, driveway damage, gutters, soffits, nor solar panels.
4. If material has to be reordered or restocked because of cancellation by the customer there will be a restocking fee equal to
twenty five percent (25%) of the contract price. /f this contract is cancelled later than three days from execution, the customer
shall pay to the Company twenty five percent (25%) of the contract price as liquidated damages, not a-,;,? penalty, and the
company agrees to accept such as reasonable and just compensation for said cancellation,
5. THIS CONTRACT CAN NOT BE CANCELLED ONCE WORK 15 COMMENCED ACCEPT BY MUTUAL WRITTEN
AGREEMENT OF THE PARTIES.
6. Any representations, statements or other communication not written on this contract or agree to be in material, and not
relied on by either party, and do not survive the execution of this contract. The company is not responsible for construction
problems of your home.
7.FLORIDAHOMEOWNERS'CONSTRUCTIONRECOVERYFUND. PAYMENT,. UP TOALIMITEDAMOUNT,MAYBE
A VA ILA BL E FROM THE FLORIDA HOMEOWNERS' CONSTRUCTION RECOVERY FUND IF YOU LOSE MONEYONA
PROJECT PERFORMED UNDER CONTRACT, WHERE THE LOSS RESUL TS FROM SPECIFIED VIOLATIONS OF FtORIDA
LAW BYA LICENSED CONTRACTOR. FOR INFORMA TION A BO U T THE RECO VER Y FUND A ND FILINGA CLAIM,
CONTACT THEFLORIDA CONSTRUCTION INDUSTRYLICENSING BOARD AT THE FOLLOWING TELEPHONE NUMBER
ANDADDRE55.• 1940 North Monroe Street. Tallahassee, FL 32399-0783 Telephone: 850-487-1395
Website.• www.myfloridalicense.com
Lee Alf redson Nov 28, 201.7
Advantage Roofing Inc page 3 of 3
CITY OF Building & Fire Prevention Division
r u RESIDENTIAL RE ROOFPOLICY & PROCEDURES
SASFOR_-
FIRE DEPARTMEt`T
PERMITTING REQUIREMENTS - NO PLAN REVIEW REQUIRED
THIS DOCUMENT (SIGNED) ALONG WITH AN ACCURATE AND CO TION.ED RESIDENTIAL RE ROOF SCOPE OF WORK ARE
REQUIRED TO BE SUBMITTED AS PART OF YOUR PERMIT APPLICA
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
REQUIoOD PERMITS.
ENTIAL (SINGLE FAMILY, TOWNHOUSE,
A FINAL ROOF INSPECTION IS THE ONLY INSPECTION
MOBILE HOME, APARTMENT AND/OR CONDOMINIUM) RE -ROOF
THE FOLLOWING IS REQUIRED TO BE PROVIDE ON THE JOB SITE:
• IT CARD, POSTED.IN A CONSPICUOUS AND WEATHERPROOF LOCATION
PERM
• 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
SPACING (INCLUDING A MEASURING DEVICE OR E OF NAILS)
o ROOF DECKNAILING PATTERN &
o ROOF DECKNAILS USED (INCLUDING A MEASURING DEVICE OR RULER SHOWING
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
FAILURE TO FOLLOW THESE SPECIFIC GUIDELINES WILL RESULT I C MPLi ,N E ByN AFFIDAVIT PERSONALINSPECTION VIDED BY A FLORIDA DESIGN
PROFESSIONAL (ARCHITECT OR ENGINEER), CERTIFYING FBC CODE - -- - _
-- --- •----------- ��• DATE: ,
CONTRACTOR (OR OVMER/BUILDER) SIGNATURE:
PERWHT #
City of Sanford Building Division
Residential Re -Roof Scope of Work
J'013 ADDRESS: ,J c S h
STRUCTURE TYPE: �INGLE FAMILY RESIDENCFITOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: PLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY):
"PLEASENOTE: ONLY100SQUARE FEET OFTHEEXISTINCDECKISPERMITTED TO BEREPLACED""
ROOF VENTILATION: OOFF-RIDGE iDGE OSOFFIT OPOWEREDVENT OTURBINES
SKYLIGHTS: O YES adlqo IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 412 OR GREATER
TYPE OF, ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
SHINGLE
G k�
FL# ;L4 - \-2,\CA
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
OINSULATED
FL#
OTILE •
FL#
O OTHER:
FL#
ROOF EXTENSIONS (PORCHES, PATIOS, no "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 Thm
FL#
O OTHER:
FL#
SCPA Parcel View: 33-19-30-516-0000-1450
Page 1 of 2
P sat,
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sc�.sexxccntsvrY Fa;nrrxin
Property Record Card
Parcel: 33-19-30-516-0000-1450
Property Address: 132 BRUSHCREEK DR SANFORD, FL 32771
Parcel Information
Parcel
33-19-30-516-0000-1450
Owner
ALFREDSON, RICHARD D
ALFREDSON, DEBRA L
Property Address
Mailing
132 BRUSHCREEK DR SANFORD, FL 32771
132 BRUSHCREEK DR SANFORD, FL 32771-7748
Subdivision Name
Tax District
COUNTRY CLUB PARK PH 2
S1-SANFORD
DOR Use Code
Exemptions
01-SINGLE FAMILY
00-HOMESTEAD(2016)
0 +
50
� a
50
50
50
50
50
50
7
50
Seminole County GIS
Legal Description
LOT 145
COUNTRY CLUB PARK PH 2
PB 54 PGS 22 THRU 24
Taxes
Value Summary
2018 Working
2017 Certified
Values
Values
Valuation Method
Cost/Market
Cost/Market
Number of Buildings
1
1
Depreciated Bldg Value $126,511
$119,376
Depreciated EXFT Value $550 _
$575
Land Value (Market)
$38,000
$38,000
Land Value Ag
JusUMarket Value'*
$165,061
$157,951
Portability Adj
Save Our Homes Adj
i $16,350
$12,299
Amendment 1 Adj
$0
_.
P&G Adj �._
I $0.�
$0
Assessed Value
1$148,711
$145,652
Tax Amount without SOH: $2,219.78
2017 Tax Bill Amount $1,985.58
Tax Estimator
Save Our Homes Savings: $234.20
' Does NOT INCLUDE Non Ad Valorem Assessments
Taxing Authority
Assessment Value
Exempt Values
Taxable Value
County General Fund
$148,711
.—
........
� ��$25,000
$50,000
$98,711
Schools —�
$123,711
City Sanford
$148,711
$50,000
$98,711
SJWM(Saint Johns Water Management)
$148,711
$50,000
Y
$98,711
County Bonds
�— $148,711
$50,000
$98,711
Sales
Description
Date
Book
Page
Amount
Qualified
Vac/Imp
QUIT CLAIM DEED
7/1/2017
108955
( 0585
$100
j No
Improved
WARRANTY DEED
6/1/2015
08488
1766
$168,100
Yes
Improved
WARRANTY DEED
9/1/2010
07458
1173
$119,900
No�
Improved
WARRANTY DEED
10/1/2003
05100
1274
$138,900
Yes
Improved
SPECIAL WARRANTY DEED
4/1/2000
03851
0293
$107,700
Yes
Improved
WARRANTY DEED
12/1/1999
03791 1137
$23,500
Yes
Vacant
I±Ind Comparable Sales
Land
Method Frontage Depth Units Units Price Land Value
LOT ? 1 $38,000.00 $38,000
Building Information
Is Bed/Bath count incorrect? Click Here.
# Description Fixtures Bed Bath Base Area Total SF Living SF Ext Wall Adj Value Rapt Value Appendages
http://parceldetail. scpafl.org/ParcelDetailInfo.aspx?PID=3 3193051600001450 1 / 11 /2018
SCPA Parcel View: 33-19-30-516-0000-1450
Page 2 of 2
http://parceldetail. scpafl.org/ParcelDetailInfo.aspx?PID=3 3193051600001450 1 / 11 /2018
CITY OF .
p S.,k�FORD
FIRE DEPARTMENT
Building & Fire Prevention Division
RESIDENTIAL RE-ROOFAFFIDAVIT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: ADDRESS: 1"> zy rU S h Cre,'iK V r ..
Snn4l d . 32--1 -1 1
I S K\ t-e—l— , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, ENGINEER, ARChIfECT, 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 ##: G O 5 Z 4-1-1
COMPANY / CONTRACTOR: T `U V n n 1 nQ e__� 1 \DC_TF_1\ nQ
CONTRACTOR SIGNATURE: _
(MUST BE SIGNED BY LICENSE
OWNER/BUILDER)
A FINAL ROOF INSPECTION IS REQUIRED:
DATE: 0
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 Qz
n,
Sworn to and Subsc 'bed before me this da of � �20 j Q by:
r
. Who is ersonally Known to me or has ❑ Produced (type of
Tloft'),1 V
ident. cation) A as ident'f'cation.
Signature of Notary Public
State of F orida
sa P 0
Print/Type/Stamp Name
of Notary Public
SASHARAMSAY
r� �`� = Notary Public - State of Florida
r`.' \i'
• ' � Commission # GG 162247
;r�,� W,-- My Comm. Expires Nov 21. 2021
c` ;`•° Bonded Voigh Naiona No,,arvAssn.