HomeMy WebLinkAbout343 Fairfield DrQ
CITY OF SANFORD
!- BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: I C� l0
Documented Construction Value: $ 8,400
.lob Address: 343 FAIRFIELD DR SANFORD, FL 32771 Historic District: Yes ❑ No El
Parcel ID: 32-19-31-516-0000-0220 Residential Q Commercial ❑
Type of Work: New ❑ Addition ❑ AlterationEl Repair ❑ Demo ❑ Change of Use ❑ Move ❑
Description of Work: Re Roof Owens Comings FL10674-R12 Rhino 15216-R2 32 SQ 7/12 Pitch
Driftwood Oakridge Lifetime
Plan Review Contact Person: Skylar Amkraut
Phone: 407-278-7788 Fax: 800-337-3361
Name Harikumar Gopalakrishnadas
Street: 343 Fairfield Dr
City, State Zip: Sanford, FL 32771
Name Jasper Contractors
Street: 4185 S Orlando Dr
City, State Zip: Sanford, FL 32773
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Title: Admin
Email: Permit@Jasperinc.com
Property Owner Information
Phone:
Resident of property? : Yes
Contractor Information
Phone: 407-278-7788
Fax: 800-337-3361
State License No.: CCC1331153
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 IMPROVEWENTS ,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. 1 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: 51h Edition (2014) Florida Building Code
Revised: June 30, 2015 Permit Application
f'
NOTICE: In addiiion 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 ofpermit is verification that 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.
01.03.2018
Signature of Owner/Agent Date Signatur of Contractor/Age t Date
Rudith Goico
Print Owier/Agent's'Name Print Conlractor/ Xeent's Name
Signature .of Notary -State ofFlorida Date S gnature of -State of Flo id
SKYLAR B AMKRAUT
Commission Ji FF 127890
'my -Commission Expires
° 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 1D. 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:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
WASTE WATER:
BUILDING:
Revised: June 30,2015 Permit Application
Account Manager. to
5380 E. Colonial Ur.
't f
Contact
Orlando. FL 32807m�
g�"i �
Orla d ontt•av lid, Ste. 201
Orlando, Fl-32S12
JASPER
Insu[nfJtJ C2MzM InfctrmA=
Company: wry'
(407)278-7788
Pulicyl:: DacrnfcL� `r
(800) 337-3361 Fax
1s+ere noor.com
Claim 9: /D/ ;
infn'1i i,i�ltcnnc iyry
Fl. Contractor's License:
M0110,ar Company lnformaii
Company;
�-:-�
VISA L-=CA
CCC1329651 & CCC1331153
Loan Number.
REPLACEN11 NT CONTRACT
Phone:
EAddrc-s-s-
AltROOF
Phone:
�r \
State: Zi Codc:
Shingle Color:
La'f %Yrr rt+ f P �1 ` ` ' Roof RCV Amount/ Contract Price: Drip Edge Color:
^t1'Y1 -Ory) 8,400 (iv), L-f,
IrOwner's lncurari C omnmtg lees not n"roc to Dery lion a fall roof repliceme"t Jibs contract shall be oidablc
Assignment or Insurance Benefits for the Full Roof Replacement Only: I hereby assign any and a!I insurance 60, its, benefits and procccd, urwr
any applicable msuvance policies to Jaspr Contractors, Inc. ("Jasper"), the scope of witch shall be limited to a Full Roof Replacenunt. 1 make this ssagrmert
and audionzauon in mnsidcTahtxt of Jasper's agreement to perform services, supply materials and otherwise perform its obligations under thts Ccatract,
mcltxJmg not rtrlcnnng full payment at the lime of service. I aho hereby direct my instcer(s) to release any and all information requested by Jasper, of its
representatisc(si. For die direct pnipoSe of obtaining actual benefits in be paid by my insurcr(s) for services rendered. In tlus rega'd, I waive my privacy
rights. If payment is made directly to the 0wucr1AganVInsu red(s), it shall be endorsed over to Jasper immediately upon receipt. I altrcc that any pon,:in of
wok, deductibles, lkrcrmesit or additional work requested by the undersigned, not covered by insurance, must be paid by the undmiped en the clay of
installation. Deductible: It k the Owner's responsibility to pay all insurance deductibles, O%ner's out-of-pocket expense utll not exceed the dc-d=ible
amount, as stated on insurer's loss sheet (the "Loss Sheet"), UNLESS rcplaceinctiMpair of detenorared docking is required by cock and'or Omer requests
optional upznSei_ Jasper CANNOT pay, n•aht, rebate, or promise to pay, waive or rebate any or ant of the Insurance deductible applicable to the
iasw—=,Cc clann for payment of work. In the event of a disrclrmcy, the deductible amount stated on die nsurr's Less Sheet shall overrule deductible
amount disclosed. Deductible: S 45 7-p MUST BE PAID 1-4 FLILL, P US APPLiCARI-F SALES TAX g (initial)
MORTGAGE AUTHORIZATION:
ORIZON: I, Ou-nrlMcrtgagor, grant authorization for l��%} Mongare Co. to with
Jasper on matters including but not limited to, the claim and draw status. x (initial) PAYMENT SCHEDULE: Owner age,5 to
pay Jasper txiscd on the following schedule: (i) llclxrsit in the amount af5 due upon sinning this contract. (i) the Contact Price,
less the Deposit and any applicable depreciation reutned by Ouncr's insurr(s , plus upgrade costs, due and payable to Jasper upon completion or
work being performed: and• (rid) die remaining Contract Price (equal to any applicable depreciation and/or change orders) due and payab!e to Jasper upon
completion of work Perra mod. In the event of a ding inspection, no more than 2% of Contract Price may be unhlield unul inspection has passer.
Optional: UPGRADE ITEM-Afain QTY: PRICE:61) TOTAL:S
Replacement Rork and Price: Upon insurer's approval and subject to the Terms and Conditions herein, Jaspr agrees to furnish all materials and
pro%ide the labor neccss`ry to performs the full roof replacement which shall take place following Owner's insurance eanpanys approval, approximately
within 30 days, conditions permuting, Owner's Declaration of Intent: Owner acknowledges and agrees that, upon approval by insurance company fer a
full roof replacement. Jasper shall perform the roof teplacernent upon receipt of funds from Owner's insurance company.
FLORIDA HOMEOWNERS' CON rucTION RECOVERY FUND
PAYMENT, UP TO A LIMITED AMOUNT, MAY BE AVAILABLE, FROM TiIE FLORIDA IIOMEOWNERS'
CONSTRUCTION RECOVERY FUND IF YOU LOSE'MONFY ON A PROJECT PERFORMED UNDER CONTR-kCT,
WHERE THE LOSS RESULTS FRO-M SI'rCiFiED VIOLATIO\S OF FLORIDALAW BY A LICFN*SED CONTRACTOR.
FOR INFORMATION ABOUT'TIIE RECOVERY FUND AND FILINt, A CLAIM, CONTACT THE FLORIDA
CONSTRUCTION INDUSTRY LICENSING BOARD AT THE 17OLLOWiN(:TE[.1 1'1lt1Nf. NUNtBER AND ADDRESS:
Construction Industry Licensing Board: 2601 Blairstone Road, Tallahassee, F1.32399-1039, (850) 487-1395
CAhCELLATiO:\: 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 ail deposits. Owner may also rescind Contract before tttidnight on
the third business day afier 11ie contract is executed after notification from insurer(s) that the claim for payment 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: 1690 Roberts Boulevard, Suite 112, Kenncsuu•, GA 30144. CANCEIAXrION F,XCEPTIONS: The three (3) day
right of cancellation DOES NOT APPLY to contracts for emergency home repairs as lime 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
blinding and enforceable in accordance with its terms. n
Owner
Date
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- 66z 0
THIS INSTRUMENT- PREPARED BY:
Name: JJ2SPer Contractors
Address 011%vay oa ut e 201
NOTICE OF COMMENCEMENT
Permit Number:
GRANT NALOYr SEMINOLE COUNTY
CLERK OF CIRCUIT COURT & COr[
BK 9051 Ps 1321 (1Pgs)
CLEkY.`S v 201$000958
RECORDED 0110314019 01:56:59
RECORDING FEES $10.00
RECORDED UY ,leckenra
Parcel ID Number — } 2 Z(:)
The undersigned hereby gives notice that improvement will bo mndo to certain roar property, and In necordanco v4lh Chopler 713, Florida Blatules, Ilia
roQavdng intormaitan Is provided in this Notice of Commencement.
1. DESCRIPTION OF PROPERTY. (Legal clescrlption at tho proparlyand arract addresn tf avaliablo)
2.
3, OWNER
4.
I
6.
Interest in property. Qwnvr
Fee Simple Title Holder (if olrrer than owner listed above) Name;
Address,
CONTRACTOR: Name: Jasper Contractors Phono Number. 407-278-7788
Address: 3203 S Conway Road Suite 201 Orlando, FL 32812
SURETY Of oppticable, a copy of the payment (rand is attached): Nome:
Address Amount of Bond!
LENDER Name: Phone Number.
Address:
7. Persons within the State of Florida Designated by owner upon whom notice or other documantc may be oorved an provided by Section
7iS.13(7)(a)7., Florida Statutes.
Name Phone Number:
Address:
8. In addition, Owner designates of
to receive a copy of the iienot's Notice as provided In Section 713,13(i)(b), Florida Statutes, Phone number:
9. Expiration !late of Notice of Commencement (The expiration is i year from date of recordfag unless a different date to specified)
WARMING TO OWNER., ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE
CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1. 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 R CORDING YOUR NOTICE OF COMMENCEMENT.
1-iArlk�M�r �tri��l�Lkr�Sh,��das
(uteofaanerottarrto,or Oarlcfe orltsseo's Q%W lame and P(mido 109n11e .Wdol6u,)
Aulhedred0l6eerlairecrerlYartelerfhtrwger) 2
State of—(,�'�{ i County of
The foreggNS Instrument was acknowledged before mre, this J 2 _ � day ofIr
by_ N r i l�c�i,�►�i �V (2QEa J�(rS nA a Who Is personally known to inn 0 OR
NOmcufprrsadr,arfng alras.l c �
who has produced identification type of identification produced: Y
_ G
. .. - rlatsry dlgnuula •
I Pri
cf
c.
Scanned by
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole Countv, Winter Springs
Date: 01.03.2018
Karla Almodovar, Rudith Goico, Skylar Amkraut Rachel Holcomb
I hereby name and appoint: Gina McDonald & Rachel Holcomb
an anent of: Jasp- c-macto, S
(Na,neorCompany)
to be my lawful anomey-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:
343 FAIRFIELD DR SANFORD, FL 32771
(Strew Address)
Expiration Date for This LimitedTower of Attorney: 1 /1 /20111 9
License Holder
State License
Donald Bouchard
CCC1331153
Signature of License Holder
STATE OF FLORIDA
COUNTY OF semi- e
The foregoing instrument was acknowledged before me this 03 day of January
20018 by bore tta,akd who is o personally known
to me or is who has produced a as
identification and who did (did not) take an oath.
Signature
(Notary Seal) Skylar Amlaauf
Print or type name
SKYLAR B AMI<RAUT l
Commission N FF 127890 i
o
My Commission Expires )
June 01, 2018
(Rev. 08.12)
Notary Public - State of FL
Commission No. 127890
My Commission Expires: 6/1/2018
, nnnpd by CamScanner
1 /3/2018
SCPA Parcel View: 32-19-31-516-0000-0220
Property Record Card
tasnn.0FA Parcel: 32-19-31-516-0000-0220
PR Owner: GOPALAKRISHNADAS, HARIKUMAR
scne®aorccxxrrv,Fuocw t_ Property Address: 343 FAIRFIELD DR SANFORD, FL 32771
Parcel Information
Parcel 32-19-31-516-0000-0220u�— ^
Owner
GOPALAKRISHNADAS, HARIKUMAR
Property Address
343 FAIRFIELD DR SANFORD, FL 32771
Mailing
27615 FLEETWOOD BEND LN KATY, TX 77494-7641
Subdivision Name
CELERY LAKES PHASE 2
Tax District
S1-SANFORD�
DOR Use Code
01-SINGLE FAMILY
Exemptions
V a�5
Seminole County GIS
Legal Description
LOT 22
CELERY LAKES PHASE 2
PB 65 PGS 29 & 30
Taxes T
J Value Summary
I
1 2018 Working
1 2017 Certified
Values
Values
Valuation Method
Cost/Market
Cost/Market
Number of Buildings
1
1
........
Depreciated Bldg Value
_
$128,724
$121,263
Depreciated EXFT Value
$338
$350
Land Value (Market)
$32,500
$32,500
Land Value Ag
—
Just/Market Value "'
$161,562
$154,113
Portability Adj
Save Our Homes Adj
$0
$0
Amendment 1 Adj
$5,748
$12,464
P&G Adj
$0
$0
Assessed Value
$155,814
$141,649
Tax Amount without SOH:
$2,779.09
2017 Tax Bill Amount
$2,779.09
Tax Estimator
Save Our Homes Savings:
$0.00
' Does NOT INCLUDE Non Ad Valorem Assessments
Taxing Authority
Assessment Value Exempt Values
Taxable Value
County General Fund
$155,814 $0
$155,814
Schools
$161,562 ( $0
$161,562
City Sanford
$155,814 $0
_.._._ ..... _,.. —.....
$155,814
..
—_---_
---
SJWM(Saint Johns Water Management)
$155,814 $0
$155,814
County Bonds
$155,814 ! _ $0
$155,814
Sales
Description
Date
Book
Page
Amount
Qualified
VaGlmp
SPECIAL WARRANTY DEED
12/1/2005
06054_
6054
$248,,501) I Yes
Improved
Find Comparahie Sofas
Land
Method Frontage Depth
j Units
Units Price
Land Value
LOT
1
$32,500.00 1 $32,500
-------1 --
-- - ... ...---
[ Building Information
Is Bed/Bath
count incorrect? Click Here
11 1.
#
Description Year Built Fixtures Bed Bath Base Area
Actual/Effective
Total SF Living SF
Ext Wall
Adj Value
Rep[ Value
Appendages
1
SINGLE 2005 7 4 2.0 ( 2,021
I
2,470 2,021
CB/STUCCO
$128,724
$134,790
Description
Area
FAMILY ! 1
FINISH
OPEN
I 60.00
I
http://parceidetaii.scpafl.org/PareelDetaiIInfo.aspx?PlD=32193151600000220
1/2
-J
4..
.I
i City of Sanford Building Division
Residential Re -Roof Inspection Policy & Procedures
777
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: 343 FAIRFIELD DR SANFORD, FL 32771
STRUCTURE TYPE: O 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 O NO 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
Q 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#
1;CITY OF
,S.kNF0RD Building & Fire Prevention Division
FIRE DEPARTMENT Re -Roof Permit Card
PERMIT NO. g� A07& ISSUE DATE: 1-4-
CONTRACTOR-
7:Si —_ C0A1iX1CLC*br
JOB ADDRESS: 3 te%
r ,a rA
TYPE OF WORK: &,,S •
PROTECT FROM WEAY14ER
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
City of Sanford
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: ADDRESS: 2�H ')_� c r
I AS A(N) GENERAL_ Bi7iLDiNG_ RF.SIDF.NTIAL_ 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: `C
CONTRACTOR SIGNATURE: DATE:
(MUST BE SIGNED BY LICENSE HOLD OR O N BUI D
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 �'P- V ` t ) �i_
Sworn to and Subscribed before me this 1 day of 20 e by:
Who is ❑ Personally Known to me or haNkDProduced (type of
identification) �� as identification.
" SKYLAR B AMKRAUT
127890
Signatur of otary Public _ Commission
My Commission
Expires
State of on a o,?: 'i June O1 , 2018
S6 A
Print/Ty a/Stamp Name
of Notary Public
f y - a? (.-"
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs.
Date: 01.12.18
l hey name and appoint Scott Meixsell, James Allen, Chris Gardner, Juan Lozano, Joel Vargas, Paul Padgett
an agent of: Jasw Contactors
(sue of cmawy)
to be my lawful 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):
II The specific permit and application for work located at:
343 FAIRFIELD DR SANFORD, FL 32771
(Surd Addrez)
Expiration Date for This Limited Power of Attorney:
License Holder Name: Donald Bouchard
State License Number. ccc1331/53
Signature of License Holder: ,
STATE OF FLORIDA3,
COUNTY OF
The foregoing instrument was acknowledged before me this 12 day of January
200 18 , by in +a Bmxhwd who is o personally (mown
to me or la who has produced oL
identification and who did (did not) tak4 an o
(Notary Seal)
y---
) SKYLAR B AMI<RAUT
Commission k FF 127890
'-
- My Commission Expires
June 01, 2018
(Rev. 08. t 2)
Notary Public - State of�
Commission No.
My Commission Expmi- :SQ - N • l
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