HomeMy WebLinkAbout155 Pine Isle Dr�a
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v0 Job Address:
Parcel ID: (�•
Type of Work: New ❑
Description of Work:
Plan Review Contact
Phone-Aa C
Name
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: I p
Documented Construction Value: $ca c I
Historic District: Yes ❑ Nog
Residential K Commercial ❑
n ❑ .Alteration fq� Repair ❑ Demo ❑ Change of Use ❑ Move El
eai\ Title: roie4 M0L" IGe.ir
Fax: Email: ARN C L,,,d- M r.Otina
Property Owner Information 56 re'}
)"di Phone: Y07`- l t"6 �
3e C4- Resident of property? Al
City, State Zip:
Contractor Information
T�
(fiW rr� 22
Name d 41)
Phone: — "I ` 5QV
Street:Fax' 321{ - f 7i•
City, State Zip: I State License No.: 000 -
Architect/Engineer information
Name: Phone:
i
Street; Fax:
City, St, Zip: E-mail:
Bonding Company
Address:
Mortgage Lender:
Address:
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING; CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
Application is hereby made to obt :in a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet standards of all laws regulating construction
in this jurisdiction. I understand) that a separate permit must be secured for electrical work, plumbing; signs, wells, pools,
furnaces, boilers, heaters, tanks, and air conditioners, etc.
I
FBC 1.05.3 Shall be inscribed with the date of application and the code in effect as of that date: 5t6 Edition (2014) Florida Building Code
Revised: June 30,_2015 I Permit Application
v
1\
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be
found in the public records of this county, and there may be additional permits required from other governmental entities such as water
mana$ement districts, state agencies, or federal agencies.
Acceptance of permit is
The City of Sanford requires 1
in order to calculate aplan re
The actual construction value
accordance with local ordinal
credit will be applied to your I
OWNER'S AFFIDAVIT:
be done incompliance wit
Signature
Signature
Name
that Iwill notify the owner of the property of the requirements of Florida.Lien Law, FS 713.
ent of a plan review fee at the time. of permit submittal. A copy of the executed contract is -required
charge and will be considered the estimated construction value of the job at the time of submittal.
be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in
Should calculated charges figured off ;the executed, contract exceed the: actual construction value,
t fees when the permit is issued;
certify that all 'of the foregoing information is accurate and that all work will
all applicable laws regulating construction and zoning.
� %i� 61 ..
Z r.,
)Date Signat e of ontrac / gent Date
Date
MY COP1fVUSfil1ld # t
Exp ti.t.S M at'rh 24, `019
CLINT .kL)`ra
MV CCiMMISS9ON rF243269
Exai,cLS via ch 24, 20-19,
Owner/Agent is Personally Known to M or' Contractor/Agent isz7personally Known to Me or
Produced ID Type of 1D 4-uv!!3 vi Produced ID Type of ID
IS FOR OFFICE USE ONLY
Permits Required: Build>ng ❑ 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: Ye' ❑ No ❑ # of Heads Fire Alarm Permit: Yes ❑ No ❑
APPROVALS: ZONING:
COMMENTS:
UTILITIES: WASTE WATER:
G: FIRE:
BUILDING:
Revised: June 30, 2015 Permit Application
a
CUSTOMER AGREEMENT / CONTRACT PROPOSAL
J&M Restoration Services Inc.
Central Florida Office
1970 Corporate Sq. Suite D
Longwood, FL 32750
Phone 407-960-3931 Fax 3D-422-0002
C coma Name n� pp
ANF2An1C� /Yl�'i it��tt •
FL License# CGC1525663
Sales,Rep
.. ,04A.L J40CVILl_-TL
Address !� j
ASS d&1C DrLIJr
Insurance Company
Date _Reported
Date of Loss
ISLE
A.
A S.Z
9 ZS-1�
1:t-10-1`�
City State Zip
SssnN+rntJ'i Ft-r32?7
Claim 0
So- vgS! Jt-Q;
Insurance Company Number
TfC�t�-2 - 6 1
Home Phone
Policy If FS.a 192oS'G
Adjuster Phone t
Cell Phone
H (e,ro-15100.
Mortgage Company A
toMI
Mortgage Company a A
Email -
FaA,.J"ATnOUC)AOLAZ4
Loan t
I
Type Loss
Wind Ha'tl
/ Scope of Work
GY Removal and disposal of existing Restoration system down to,
the wood deck:.Includest shingles, underlaymenb drip edge,
pipe boots, ridge/off ridge vents, valley metal .
CY/Re-nail wood deck with 8d ring shank nails, per city code
0 Install new underlayment
L Y Install new drip edge, roof vents, and replace pipe flashing
B Protect landscaping, driveway, and other household
components not associated with project
Er,/Remove/Install existing satellite dishes '(Note: These may
need to be recalibrated by satellite provider:)"
❑ A solar contractor will remove and reinstall solar panels and
solar water/heating"systems as heeded to perform tear off/reioof
M Additional Wood work 2 sheets will be replaced for free and
$7�er sheet after that. $5 per Linear foot of lumber
Driveway ❑ Cracks ❑ Oil Stairrs
Ceilings ❑ Stains ❑ Mold
Dumpster ❑ Driveway
Shingle [+(" F' tuA }(f tt
LX�
(Brand) (Color)
Upgrade Cost
Drip
(Color)
Total Investment Summary
It is agreed upon the amount -of the contract shall be based on the amount equal to full
Deductible �, I �y.0 0o replacement' cost value as stated on insurance "scope of loss" including deductible and all
In the event of a discrepancy, the deductible -
upgrades, supplements, extra charges unless otherwise noted.
amount stated on the insurer's Scope of Loss' x p
shall overrule Deductible listed. f
Ownor =
Bid Price
Due m the unique nature of repairs related to insurance claims, this contract does not include an explicit price because the final scope has not been:agnced upon withthe insurer,
Reaching agreement on the full scope of repairs involves considerable time on Compa tys part we will not proceed with this phase unless you agree to allow us to do the work
once the scope is agreed upon. By signing this agreement, you authorize I& M Restoration Services, Inc to reach agreement on the price and scope of eepairson,your behalf. (&M
Restoration Services, Inc, agrees to bid the workusing the primary insurance industry pricing database. (Xactimate) based on the scope of work agreed. upon with: your insurer.
including general contractor, markup at customary insurance industry rates,(20% markup on Xactimate line items). Any substantial adduioms or deductions to the scope ofwork
-
will : be handled by written construction change orders. No verbal contracts agreed to. All items agreed upon must be in writing. IF YOUR INSURANCE COMPANY DENIES
YOUR CLAIM. THIS AGREEMENTICONTRACT SHALL,BECOME NULL AND VOID,
NOTICE TO INSURANCE COMPANY .ASSIGNMENT OF CLAIM. COVENANT OF PAYMENT:
Owner hereby assigns any and all insurance rights, bene fits, proceeds and any causes of action under any applicable insurance policies whichcover the damage to the property
that Company a to repair pursuant to this contract. Owner further assigns and authorizes Company to seek reimbursement from Owners insurance carrier for payment owed
to Company for services rendered or to be tendered by Company via the initiation of a civil action in a court of competentjurisdiction or other means of recovery. In this
regard, Owner waives privacy rights. Owner makes this assignment in consideration of Company i agreement to perform services and supply materials and otherwise perform
it's obligations under this contract, including not requiring Full payment at the time of service. Owner also hereby directs owner's insurance ourier(s) to release any and all
information requested by Company, its representative, and/or its Attorney for the direct Purpose of obtaining actual benefits to, be paid by`Owner's Insurance carrier(i) for
services rendered or to be rendered.
Acceptance of Terms The above specifications, scope of work and conditions are satisfactory and are hereby accepted It is agreed upon that the amo tntof contract shall be based
on the amount .equal to full replacement cost value (RCV) as stated on the Insurance'scope of loss" including deductible and all upgrades, supplements, extraslchanges, unless
otherwise note& J&M Restomtion Services;. Inc. is hereby authorizedto: do the work as. specified above, along with Xactimate estimate, scope of work: and mtssing_items from
insurance loss report Owner acknowledges reading• understanding and accepts the additional terms and conditions on the back of this form Buyers Right to Cancel - If the buyer
wishes to no longer receive the goods or services presented, buyer maycatud this agreement by providing written notice to 1&M Restoration Services. Inc. in Person, by Telegraph
or by Mail. This notice must indicate that the buyer does not want the goods or services and must be delivered or post marked before midnight of the third(34) business day after
Owner Approval
J i 'act M Additional Owner Approval
this contract, you agree to atlterms on front and back of this contract..
THIS INSTRUMENT PREPARED I Y: JAND M ROOFING SERVICES IN
Name: G-,i.t{fi1!~ :UUrl;`r
A 5 y_
UNIT
- 7970 CORPORATE SQUARE 'L-FF. OF Cs CUT `.QUI T t 'EJhiF'TR.0LLEF'
Address: � , ��
FL 32750 ei_ [t'�?
CLERKS y: 201Vt_It�! J03,
i l; a t'! P i
C COMM
� `�` ®gyp. f i f G r L i{ 1Ii
NOTICE O O C� ENT ra ..� t Pf i d/Or ,
Permit Number.
Parcel ID Number:10 OjO
The undersigned hereby
9 y gives notice that imp
rovement 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. DESCR;PON OF PRO t�,:SLegal d%c�iption of the owQerty and +.nee
2. GENERAL DESCRIPTION OF IMPROVEMENT:
3. OWNER INFORMF
Name and address;
Interest in property:
IF
dx�L;r
Fee Simple Title Holder (if other than owner listed above) Name: V
Address: _
4. CONTRACTO Nante:
Address: Pho Number.
5. SURETY (if applicable, a copy of the p ent bond Is attached): met
Address: }
6. ,LENDER: Name: Amount of Bond:
:Address:
Phone Number....
7. Parsons wiihinritla Statutes. the State of Florida Designated by
713.13(1Owner upon whom notice or other documents may beserved as provided by Section
)(a)7:, Ffor
Name:
Address: Phone Number. _
In addition, Owner designates
to receive a copy of the Lienoes Notice as provided in Section 713.13 O(b 1 , Florida Statutes. Phone number.
(The expiration is 1
9. Expiration Date of Notice of Commencement )
year from date of recording unless a different date is specified)
WARNING 70 OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE .NOTICE OF COMM
CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713. PARTI, SECTION I13.13, FLORIDA STATUTES , AND CAN RESULT IN YOUR
ENCEMENT ARE
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,
(Stgnalura of owner or Lessee, or Owners or asses e
Authortzed Officer/DimcwrifttneNManager)
(P ' �amaandft�vjcdjaSfgns lOffl
s TI8ece)
State of V _ Gountyof__ a r-1441'
The foregoing instrument was acknowledged before me this by e/-}if.�/r7Qj iC� ��jj�� day of JI) 20yr
Name of person making statement
Who has produced Identification type of identification produced:
CLIMT RoTH
MY COM -MISSION ft FF213269
EXPIRES March 24, 2019
Who Is personalty known tome ❑ OR
BY
}A
CITY OF
° SkNFORDBuilding & Fire Prevention Division
FIRE DEPARTMENT Re -Roof Permit Card
PERMIT NO. / V ?3 ISSUE DATE:
P
CONTRACTOR: 3 +of\ A
JOB ADDRESS: ( S S NA XS ta'v
TYPE OF WORK!1Q4e A40.0?
PROTECT FROM WEATHER
• 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 must be removed from job site at final inspection
• Permit expires six (6) months 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 855.541.2112
TO SCHEDULE AN INSPECTION:
• Dial 407.792.6069 or 855.541.2112
• Provide the items requested during the message
• The type of inspection requested must be scheduled under the appropriate permit type
• Follow the prompts
PLEASE NOTE: Inspections scheduled by 5:00 p.m. will be conducted the
next business day. If you experience difficulty, please call 407.688.5150
Monday - Thursday 7:30 am - 5:30 pm for assistance.
AUTOMATED INSPECTION SYSTEM CODES
Final Roof Inspection Code III
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
REVISED: 04-17 Inspection Line: 407.792.6069 or 855.541.2112
CITY OF
S FORD Building & Fire Prevention Division
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
• C.OMPLETEDRESTDENTIAL 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 (NCLUDNG 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 iV1EASURING 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 (OROWNER/BUILDER) SIGNATURE: DATE: As
CITY OF
SkNFORD
FIRE DEPARTMENT
JOB ADDRESS:
PERMIT #
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
`_t 271-13
STRUCTURE TYPE: 9 SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: O REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
Q RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
1
DECK TYPE (PLEASE SPECIFY): �i
**PLEASE NOTE; ONLY IOOSQUARE FF.F. T OF THE E.KISTz vG DECK S PEAmiTTED TO BE REPLACED"*
ROOF VENTILATION'.' �FF-RIDGE
�i''���JJJ ORIDGE QSOFFIT QPOWEREDVENT QTUR$INES
-
SKYLIGHTS: O YES- O NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
------ -------------------------------------------------- ----- ---------------------------------
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 — 4:12 O 4:12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
HINGLE, GAT�,
.
FL#
IDI
2
O METAL
FL#
Q MODIFIED BITUMEN
FL#
QTORCI-I DOWN
FL#
QINSULATED
FL#
O TILE
FL#
O OTH F IZ .-
FL#
ROOF EXTENSIONS (PORCHES, PATIOS ETC.) WFAPPLICABLE**
ROOF SLOPE: O LESS THAN 2:12 O 2:12 — 4:12 0 4:12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
O SHINGL E
FL#'
O METAL
FL#
0MODIFIED BITUMEN
FL#
QTORcH DOWN
FL#
QINSULATED
FL#
Q TILE
FL#
Q OTHER:
FL#
r
PERMIT #:
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF AFFIDAVIT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
ADDRESS: `1%5 ��t1���\� s r
I eV�t(�Ill�Po—Q�y 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 AND7I,IAT 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
REQUIREMENT'S FOR SECONDARY WATER BARRIER AND NAILING OF THE ROOF DECK N ACCORDANCE 1VITH THE HURRICANE RETROFIT
MANUAL REQUIREMENTS (BASED ON F.S. CHAPTER 553.844).
LICENSE #: C —0' 3? !j5(AB
COMPANY / CONTRACTOR: ` Ir J
e
CONTRACTOR SIGNATURE: DATE: 1 ��
(MUST BE SIGNED BY LICENSE HOLDER OR Q ILD
A FINALROOF INSPECTION IS REOUIRED:
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 RF-IN RPECTIONI 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
Sworn to and Subscribed before me this day of
identification)
Signature of Notary Public
State of Florida
Print/Type/Stamp Name
of Notary Public
20 by:
Who is ❑ Personally Known to me or has [= Produced (type of
as identification.
FIRE INSPECTIONS CITY OF SANFORD
e 407.562.2786 BUILDING & FIRE PREVENTION
BUILDING INSPECTIONS 300 N PARK AVE
855.541.2112 SANFORD FL 32771
DRIVEWAYS -SIDEWALK 407.688.5080
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Page 2
Application Number . . . . . 18-00000683 Date 2/02/18
Property Address . . . . . . 155 PINE ISLE DR
Parcel Number . . . . . . . . 10.20.30.511-0000-1190
Application description . . . ROOFING APPLICATION
Subdivision Name . . . . . .
Property Zoning . . . . . . . PUD
Permit . . . . . . RESIDENTIAL ROOFING PERMIT
Additional desc . .
Phone Access Code 1029362
Permit pin number 1029362
----------------------------------------------------------------------------
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
----------------------------------------------------------------------------
1000 111 BL03 FINAL ROOF _�_/_
r CITY OF
S________0RD
� Building & 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 #: f 8 - �/ 0 ADDRESS:
%of
I AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
FIN NTRA NGINEER, 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 Ir _ VA ! 9k Is (A
COMPANY / CONTRACTOR: i ce- S
CONTRACTOR SIGNATURE: 1?0�DATE:
(MUST BE SIGNED BY LICENSE HOLDER OR,O ILD
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
Sworn to and Subscribed before me this W day of FIEB 20 _by:
. Who is 00ersonally Known to me or has ❑ Produced (type of
identification% as identification.
Signatu e o No y Pu CL15+o10T9
State of Florida = MY COMMISSION # FF2132F9
EXPIRES March 24, 2419
. AGr; ;:,.h. C'a3 FloriAallota••fier`iicr..ctrr.
Print/Type/Stamp Name
of Notary Public