HomeMy WebLinkAbout211 Belgian Wayi
'AN 3 0
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No:
?- (per
Documented Construction Value: S � 10;
Job Address: Historic Districts Yes ❑ No ❑
Parcel ID: Residential a, Commercial ❑
Type of Work: New ❑ Addition ❑ Alteration ❑ Repair ❑ Demo ❑ Change of Use ❑ Move ❑
Description of Work: 9,e e-yoS,r13
S�;vw ► e_
Plan Review Contact Person: Title:
Phone:
Fax:
Email:
Property Owner Information 7
Name Phone:`��-
Street: \ \z_ _ Resident of property?
City, State Zip:
Contractor Information
n
Name � �G U n � w (� do �A nj, Phone: 0 q
Street: Q C5 g o y y �-o d (42f Fax:
City, State Zip: oc My n Co f - � F G , State License No.: CCC 13 313 3 3--
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
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 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: 5th Edition (2014) Florida Building 6(7.
C�odd�e
if 0
Revised: June 30, 2015 Permit Application l 6 ``tc)
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 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 all applicable laws regulating construction and zoning.
0
Signature of Owner/Agent Date
/ - 30 -/r
atu of ntractor/Agent Date
-� V 0 7 l�l�n.�► H [✓I PS
Pr!Owner/ ent's N �"e Prin ont ctor/Agent's Name
��� � I LSO
1.
Signature of Notary -State of Florida Date Signature of Notary -State of Florida Date
<> ;�,., ANNETTE M BLAND
Notary Public -State of Fondal
Commission GG 1709CC
My Corrm. Expires Jar 6.2C22
Owner/Agent is Personally Known to Me or Cont occ2C:hr cc �aacra Jc:ary A55'
own to Me or
Produced ID Type of ID Produced ID Type 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: June 30, 2015 Permit Application
SCPA Parcel View: 18-20-31-505-0000-0980
Page 1 of 2
��
i7auid9oison crA Property Record Card
�P Parcel: 18-20-31-505-0000-0980
s�rsu�x.a<c.,cn,��w R II Property Address: 211 BELGIAN WAY SANFORD, FL 32773
Building Information
Values
Values
Valuation Method CosUMarket Cost/MarketNumber of Buildings 1 ) 1
Depreciated Bldg Value $146,794 $138,355
Depreciated EXFT Value $767 I $814
Land Value (Market) $34,000 I $34,000
Land Value Ag
Just/Market Value'* $181,561 $173,169
Portability Adj
Save Our Homes Adj $65,178 $59,180
Amendment 1 Adj $0 ...... ...... ...._.........
P&G Adj $0 1 $0
Assessed Value ' $116,383 $113,989
Tax Amount without SOH: $2,509.54
2017 Tax Bill Amount $1,382.67
Tax Estimator
Save Our Homes Savings: $1,126.87
" Does NOT INCLUDE Non Ad Valorem Assessments
# Description Year Built Fixtures Bed Bath Base Area Total SF Living SF Ext Wall Adj Value Repl Value Appendages
Actual/Effective E �
1 SINGLE 12002 8� 4 i 2.0 1 1,955 1 2,390, 1,9551 CB/STUCCO r $146,794 $154,928
FAMILY j FINISH 1 DescnpUon Area
�) 425.00
http://parceldetail.scpafl.org/ParcelDetaillnfo.aspx?PID=l 8203150500000980 1 /30/2018
# Description Year Built Fixtures Bed Bath Base Area Total SF Living SF Ext Wall Adj Value Repl Value Appendages
Actual/Effective E �
1 SINGLE 12002 8� 4 i 2.0 1 1,955 1 2,390, 1,9551 CB/STUCCO r $146,794 $154,928
FAMILY j FINISH 1 DescnpUon Area
�) 425.00
http://parceldetail.scpafl.org/ParcelDetaillnfo.aspx?PID=l 8203150500000980 1 /30/2018
SCPA Parcel View: 18-20-31-505-0000-0980
Page 2 of 2
I
GARAGE �
FINISHED {
OPEN
PORCH 10.00
� FINISHED �
Permits
Permit # Description
Agency
Amount CO Date
Permit Date
01108 INSTALL 171' X 6 PVC FENCE W/WALK GATE
SANFORD
$3 283 1
3/29/2010
00420 PAD PER PERMIT 211 BELGIAN WAY
SANFORD
$87,784 4/29/2002
12/1/2001
Extra Features
__� ..
�_�_.
Description Year Built
Units
Value
New Cost
SCREEN ENCL 1 5/1/2002
1 $467
$2,000
._._... �__ . ..,...._._..._._,. }..-- -.._. _.
PATIO 1 5/1/2002
_......_ , . __
..,,, .,_.m_....._....w..,_.. .._.._._
1 $300 t
.._._..................... ..._
$500
t
http://parceldetail.scpafl.org/ParcelDetailInfo.aspx?PID=l8203150500000980 1/30/2018
THIS INSTRUMENT PREPARED BY: I
Name: lam, Ln� +e,� Q::;- NY\L,� 01 A& A
Address: _, o too q- u Tyayu
k Mdn rot-. FL 3.1 �
o •
Permit Number: ^�-
Parcel ID Number:
GRANT MALOYr SEMINOLE COUNTY
CLERK OF' CIRCUIT COURT & CON!"TROLLER
BK 9066 Ps r'a (1F3s )
CLERK'S T 20180111806
RECORDED 01/•30/'21013 1021"48 AN
RECORDING FEES $10.00
RECORDED BY tsmith
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)
all 60 wad4 5r,n 1xZ IF"<-
2. GENERAL DESCRIPTION OF
3. OWNER INFORli OR LESSIEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT:
Name and address:
Interest in property: ('i` Vim Y S
Fee Simple Title Holder (if other than owner listed above) Name:
4. CONTRACTOR: Name: U�, k� rY�od Ss �vlc� Phone Number:
Address: `moo r? 04- 4_+C3 1�LA R L
5. SURETY (If applicable, a copy of the payment bond is attached): Name:
Address: 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:
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:
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.
(Signature o ner or Lessee, or Owner's or Lessee's
Authorized Officer/Director/Partner/Manager)
State of ` ` nc , cl County of
(Print Name and Provide Signatory's Title/Office)
The foregoing instrument was acknowledged before me this `' day of
by C L 'S� `vC-C�j Who is personally known to me\ OR
Name of person making statement
who has produced identification ❑ type of identification produced
e ,xt /! NEE ,y Public State of Florida
r
' : Ue61"El A B;aokover-Blais
Mv Commission FF 155256
v:"oFe,O E::pira,09/15/2018
p
A&G UNITED ROOFING
PO BOX 4704248
LAKE MONROE FL, 32747-0248 t
(407) 982-0757
LTHT`E� I�[�I0111W
Contractor's License #.
ROOF REPLACEMENT MUTUAL (GREEMENT
Sales Rep 6R2, `A
Contact # (4 U , 5d ' U '' )
Insurance Company Information
Company 57-vrw' EY71
Policy # A,) A
Claim # A) I 'A
Mortgage Company Information
Company A/ I A
Loan # /i 1 A
Owner(s)
i{ v1'! � �V2 I sort
Phone:
Address:
Alt Phone:
City: C '
..Jt% LX a
State:
F t
Zip code:
jc�313
Shingle Color'-
tJr��C vJoo�
Email:
Roof RCV amount:
Drip Edge Color:
IF THE HOMEOWNER'S INSURANCE COMPANY DOES NOT AGREE TO PAY FOR A FULL ROOF REPLACEMENT, THIS AGREEMENT SHALL BE VOIDABLE
-'Assignment of Insurance Benefits for Full Roof Replacement or Repairs Only:l hereby assign and all insurance rights, benefits and proceeds under any ,
applicable insurance policies to A&G UNITED ROOFING LLC. (A&G), the scope.of which shah be limited to a Full Roof Replacement or Roof repair. I make
this assignment and authorization in consideration of A&G's agreement to perform services, supply materials and otherwise perform its obligations under
this agreement, including not requiring full payment at the time of service. I also hereby direct my insurer(s) to release any and all information requested
by A&G, its representative, or its attorney 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 A&G immediately upon receipt.
I agree that any portion -of work, deductibles, betterment or additional work requested by the undersigned, not covered by insurance, must be paid by the
r
undersigned on theday of installation. �—Q�i'
Deductible: $ O • MUST,,,BE PAID IN FULL, PLUS APPLICABLE SALES TAX /{ .) (-\ (initial)
t.,
MORTGAGE AUTHORIZATION: I, Owner/Mortgagor, grant authorization for ,4% { Mortgage Co. to speak with A&G on matters including
but not limited to, the claim and draw status. In
PAYMENT SCHEDULE: Owner agrees to pay A&G based on the following pay schedule: (i) Deposit in the amount of $ due upon signing
this agreement:(ii) the agreement price, less,the Deposit and;any applicable depreciation retained by Owner's insurer(s), plus Upgrade Cost, due and payable
i
to A&G upon completion of work being -performed; and ,(iii) the remaining Agreement Price (equal to any applicable depreciation and/or change orders) due
and payable to A&G upon completion of work performed. In the event of a pending inspection, no more than 2% of Agreement Price may be withheld until
inspection has passed. b,# ff��11 }
j Optional: UPGRADE ITEM"r N 1 !� Qty: r2) Price $ - fC/ t TOTAL
Replacement Work'and Price: Upon insurer's approval and subject to theterms and conditions herein, A&G agrees to furnish all materials and provide the
labor necessary to -perform the full roof replacement or repair 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 or repair, A&G shall
perform the -roof replacement or repair upon receipt of funds from Owner's insurance company.
CANCELLATION: if Owner elects to terminate the services of A&G, Owner may do so before midnight on the third business day after Agreement is
executed. Owner shall receive a full refund of all deposits. Owner may also rescind Agreement before midnight onthe third business day after the
C?. . o,
contract is executed after notification from insurers) that the claim for paymentkn roof contract has been denied, in whole. All written notices of
cancellation, regardless of reason, shall bef `postmarked or delivered to A&G's corporate office: 565 Merry Brooke Circle, Sanford FL, 32746.
CANCELLATION EXCEPTIONS: The Three (3l day right of cancellation DOES NOT APPLY to contracts for emergency home repairs as time is of the essence.
I, Owner have read and understand all statements, terms and conditions of the" Roof Replacement or Repair Agreement" and agree that all details are
acceptable and satisfactory. I further understand that this agreement 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 bothSparties. Each party represents and warrants to the other that it has the full
power of authority to enter into the agreement and that it is binding and enforceable in accordance with its terms.
Authorized A&G Representative Date Ow er Date f�f
TERMS AND CONDITIONS: Acceptance of Terms: 1, Owner, hereby agree to retain A&G for a full roo replacement on the terms and conditions stated herein. I
I further agree to provide A&G with the Scope of Loss Report generated by my insurer and authorize and grant full acdess to the property for the purpose of i
staging and completing all agreed upon work. Supplemental Claims: A&G reserve the right to file a supplemental claim with Owner's insurance in the event
the.:estimate_is_inco.rr_ect.and/or additional damage is discovered after.
- T
Commencement. The supplemental claim amount(s), in addition to any depreciated amounts held back by the insurer, are immediately due to
A&G United Roofing upon receipt. Commencement of Work: Work shall commence at A&G United Roofing's discretion. A&G United ,
Roofing shall not be liable for delay in, or failure to perform due to: labor controversies, strikes, fire, weather, Acts of God, war,go'vernmental
actions, inability to obtain materials from usual sources, delays caused by and/or as direct result of Owner's insurer or other circdnsfances'not
listed which are beyond the control of A&G United roofing. Noise Pollution and Vibrations: Prior to installation, it is the sole responsibility of
Owner to remove any and all items, which are not secured to walls including, but limited to, items on mantles, shelves or other areas susceptible
i to vibrations, as these may fall. A&G United Roofing shall not be liable for noise pollution and/ or vibrations due to the performance of work
contracted herein, or damages resulting to person(s) or property. Construction Debris: Upon completion of work, A&G United Roofing will
make reasonable efforts to remove debris from the property, including but not limited to, a generalclean-upof construction -related debris and a
magnetic sweep of the eve line and walkways surrounding the project area. As A&G United Roofing cannot guarantee the removal of all nails
and/or debris, it shall not be liable for resulting damages. Landscaping: While A&G United Roofing will make reasonable efforts to cover the
lawn and/or shrubbery, it is the sole responsibility of the Owner to remove and/or safeguard any and all plants, shrubbery, lawn ornaments,
furniture and/or valuables. A&G United Roofing cannot guarantee the safekeeping of these items nor shall it assume liability for damages.
Timely Payment: It is Owner's responsibility to ensure prompt payment from Mortgagee and/or insurer. A&G United Roofing must be paid
immediately upon receipt of funds or, in the alternative, not exceed 30 days from date of install. If A&G United Roofing is not paid -within the
requisite time period, all promotions, advertising specials, and/or discounts shall be voided. Owner shall also be responsible for any collection
fee(s) incurred. Force Majeure: A&G United Roofing shall not be liable for any natural and/or unavoidable catastrophes that interrupt the
expected course of events and restricts A&G United Roofing from fulfilling its obligations herein, such as, but limited to excessive wind, hail,
ice, rain, extreme weather conditions, fire, war, governmental actions or other Acts of God. Labor Warranty: A&G United Roofing shall
provide the Owner a two (2) year, non -transferable warranty on labor once the contract is paid in full. A&G United Roofing is not responsible for
any damage below the roof due to, but not limited to: leaks, cracks, fissures, etc. caused by excessive wind, ice hail, snow or any Act of God
during the warranty period. In the event of an extreme weather condition or Act of God, which warrants an insurance claim, Labor Warranty
shall be voided. A&G United Roofing shall not be liable for damages from fires, windstorms or other hazards as is normally covered by
Homeowner's Insurance or Builder's Risk Insurance unless a specific, written agreement is made prior to commencement. This contract, and any
warranty provided herein, shall not be assigned or transferred by either party, except by written instrument and signed by both parties.
Manufacturer's Warranty: All materials used are subject to Manufacturer's Limited Shingle Warranty. Any defect of materials is covered, and
subject to, the manufacturer's warranty specifications-, this shall void A&G United Roofing Warranty. Pre -Existing Materials: Repair of
deteriorated decking, "waves" in decking, fascia board, roof jacks, ventilators, flashing, chimneys, gutters or other such materials (unless I
otherwise expressly stated in the Contract) are not included. Should Owner elect to repair any and/or all of these pre-existing materials, Owner
shall be charged for both materials and labor. A&G United Roofing shall be liable neither for the replacement of, nor for ny damages arising
from, Owner's election to retain these pre-existing materials. Pre -Existing Conditions: A&G United Roofing shall not be responsible or liable
for issues due to improper ventilation, deteriorated decking "waves" in decking, appearance of roof due to irregularities in underlying roofing
system or other pre-existing, structural defects. Shingle Color Change: Should a shingle color change be requested within 48 hours of mutually
agreed upon installation date, a $200.00 express shipping fee shall be charged by A&G United Roofing to Owner. This fee MUST be paid on
date of installation. Minimum Contract: A&G United Roofing reserves the right to terminate any Contract if Contract Price does not exceed
$4,999.99. The invalidity or unenforceability of any provisions of this Agreement shall not affect the validity or enforceability of any other
provision of this Agreement, which shall remain in full force and effect. BINDING ARBITRATION: If a dispute arises from or.relates to this
contract or the breach thereof, and if the dispute cannot be settled through direct discussions, the parties agree to endeavor first to settle the
dispute by mediation administered by the American Arbitration Association under its Construction Industry Mediation Procedures before
resorting to arbitration. The parties further agree that any unresolved controversy or claim arising out of or relating to this contract, or breach
thereof, shall be settled by arbitration administered by the American Arbitration Association in accordance with its Construction. Industry
Arbitration Rules and judgment on the award rendered by the arbitrators may be entered in any court having jurisdiction thereof. The statue of
limitations on all disputes, which arise from or relate to this contract or a breach thereof, shall be one (1) year from the date of signing Roof
Replacement Contract. Claims shall be heard by a panel of three (3) arbitrators. The mediator shall not be empanelled as an arbitrator. The place
of arbitration shall be Orlando, Florida. The arbitration shall be governed by the laws of the State of Florida. All deposits, fees and expenses of
the mediation and/or arbitration, including required traveling and other expenses or charges of the mediator and/or arbitrator, shall be borne by
the initiating party. Depositions shall be limited to a maximum of 25 per party and shall be held within 180 days of the making of a request.
Additional deposition may be scheduled only with the permission of the arbitrators, and for good cause shown. Each deposition shall be limited
to maximum of 8 hours duration. Any dispute regarding discovery, or the relevance of scope thereof, shall be determined by the arbitrators,
which determination shall be conclusive. The arbitrators will have no authority to award punitive, consequential or other damages not measured
by the prevailing party's actual damages not measured by the prevailing party's actual damages, except as may be required by statute. In no event
shall an award in arbitration exceed the amount of the Roof Replacement Contract. Any award in an arbitration initiated under this clause shall be
limited to monetary damages and shall include no injunction or direction to any party other than the direction to pay a monetary amount. The
award shall not include pre or post -judgment interest. The award of the arbitrators shall be accompanied by a reasoned opinion. Notwithstanding
any language to the contrary in the contract documents, the parties hereby agree: that the Underlying Award may be appealed pursuant to the
AAA's Optional Appellate Arbitration Rules ("Appellate Rules"); that the Underlying Award rendered by the arbitrator(s) shall, at a minimum,
jbe a reasoned award; and that the Underlying Award shall not be considered final until after the time for filing the notice of appeal pursuant to
the Appellate Rules has expired. Appeals must be initiated within thirty (30) days of receipt of an Underlying Award as defined by Rule A-3 of
i the Appellate Rules, by filing a Notice of Appeal with an AAA office. Following the appeal process the decision rendered by the appeal tribunal
may be entered in any court having jurisdiction thereof. Except as required by law, neither party nor an arbitrator may disclose the existence,
content or results of any arbitration hereunder without the written consent of both parties. Should either party disclose the existence, content or re
results of any arbitration hereunder, that party shall forfeit any and all damages awarded as a result of arbitration. Damages: To the extent
i permitted by law, in no event shall A&G United Roofing, its officers, directors, shareholders, representatives, employees, attorneys, affiliated
entities or insurers be liable to Owner for any incidental, indirect, punitive, special or consequential damages arising out of or related to the
performance, nonperformance or termination of Contract. Cancellation Fees: Should owner elect to cancel the Contract outside of the statutory
three (3) day time frame, a cancellation fee shall apply to compensate A&G United Roofing for its time, expense and professional services which
were rendered to Owner. The fee shall be 25% (twenty-five oercent) of Contract. but shall not exceed $2.500.00.
JOB ADDRESS:
0
PERMIT #
City of Sanford Building Division
Residential Re -Roof Scope of Work.
STRUCTURE TYPE: C/SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: &REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF
DECK TYPE (PLEASE SPECIFY): \ y Wes &
* *PLEASE NOTE: ONL Y 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED
ROOF VENTILATION: (OFF -RIDGE O RIDGE O SOFFIT OPOWERED VENT
SKYLIGHTS: O YES dNO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 d4:12 OR GREATER
O TURBINES
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
OSHINGLE
Owens i�uMlYl
FL# k3 S 1 +9 s�� SEsla
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#
-z�
CITY OF
Building & Fire Prevention Division
S �o
-- — -- - ------ � � ��-�RESIDEIVTIAL RE=ROOFPOLICY &PROCEDURES------
FIRE DEPARTA4ENT
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: 30 Sgn a 0 12(
CITY OF
": A Building &Fire Prevention Division
RESIDENTIAL RE-ROOFAFFIDAVIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: �j C Q ,� ( ADDRESS: J 11 6e to
EC 3��3
I (a A n. A �A � n e5 , 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 #: CC-0- 13 3 133 f
COMPANY / CONTRACTOR: A * J-, 20o�r' h�
CONTRACTOR SIGNA'
(MUST BE SIGNED BY
A FINAL ROOF INSPECTION IS REQUIRED:
DATE: 7Qr1
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 S(IrIPIKd
Sworn to and Subscribed before me this Qj�j_ day of 20 I g by:
C-avq 1�I--s Who isA.Personally Known to me or has ❑ Produced (type of
ident►cation) as identification.
Sig ure of Notary lic
EN
St of Florida �a ,
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I�,rSI�I''.
MV Cam StFi
Print/Type/Stamp Name �'' ���'''1'`` '
of Notary Public