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HomeMy WebLinkAbout101 Bristol Forest Tel'9-_ 9a —18 CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION F - a Li Application No: Documented Construction Value: $- Job Address: �%, rl -ol Historic District: Yes ❑ No U Parcel ID: ;QD-'!`-I '-w 2= " oqt;):o Residential [Commercial ❑ Type of `'York: New ❑ Addition ❑ Alteration ❑ RRepair ❑ Demo ❑ Change of Use ❑ Move ❑ Description of Work: t- P Ce-4 91c�'1et� (?9t v-s I 1290)%4J Plan Review Contact Person: Phone: Fax: 'Title: Email: I.'001 �^ {�A Property Owner Information Name _ t__.1 tr� Phone:% Street: C� 1 8 cti �'To-r Iz�e� �r Resident of property? : _V�E'a, f City, State zip: &?—t4.re3 Contractor InformationName t't G1 Phone: Street: d. �l /Q .- � �� Fax: City, State Zip: Win r state License No.: C'CC/.3d�% /� Architect/Engineer Information Name: Street: City, St, Zip: Bonding Company: Address: Phone: Fax: E-mail: Mortgagelender: 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 COINTMENCEMENT 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. l certify that no work or installation has cornmenced 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 codee in effect as of that date: 516 Edition (2014) Florida Building Code Revised: June 30. 2015 1permit 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 construction value of the job at the time of submittal. The actual construction value will be figured based on the current 1CC 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 ompliance with all applicable laws regulating construction and zoning. Date Signature ofContractirIggent Date �Print Owner/Agent's N fire Print Contractor/Age is Name Signatu w Nor I - aUuv rl—ullui,—, , 1:�-. -f MARK SKINNER' ��U Ass MARK SKINNER r Notary PublicState of Florida'���� {PgrPU4' c Natary Public State of flodda Commission # FF 899949 # FF 899949 - * 20t9 YCommission am_ Comm. E; pins Jui l4, 2i119 FOFFL,* My Comm. Expires Jul 14, My through National Notary Assn. `Owner/Ag Ln INotaryAssn. Bode rough NationaBonded Contras or men i, ersona y nown to. Me or r, xa e Produced Ill Type of ID Produced ID Type of ID BELOW IS FOR OFFICE USE ONLY Permits Required Construction Type: Total Sq Ft of Bldg: Building ❑ Electrical ❑ Mechanical ❑ Plumbing❑ Gas❑ Roof ❑ Occupancy Use: Main. 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 Permit Number: 22-19-30-502-0600-0920 Mill 111131111111111,1111.111111111 !1111411 Folio/Parcel ID #: iV i - T.v ,Lfi€jrli ! r c,0UNT Prepared by: Mark Skinner i _LERK' S V 201801E9r 1a- Ci � i 7I ?l b ii 1 : U -3:1 I'i:+ Return to: Crewpro; Roofing > .0 5703 Red Bug Lake Rd #234 Winter Springs, Fl 32708 NOTICE OF COMMENCEMENT State of Florida, County of Orange 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) Lot92 Preserve at Lake Monroe 2. General description of improvement Reroof sloped roof with asphalt shingles 3, Owner information or Lessee information if the Lessee contracted for the improvement< Name Cindy Pakphanh Address 101 Bristol Forest.Trl, Sanford, FL 32771 Interest in "Property owner Name and address of fee simple titleholder (if different from Owner listed above) Name _ Address 4. Contractor Name Crewpro Inc Telephone Number407-797-7130 Address 5703 Red Bug Lake Rd #234 Winter Springs, F1.32708 5. Surety (if applicable, a copy of the payment bond is attached) Name Telephone Number Address Amount of Bond $ 6. Lender Narhe Telephone Number' Address 7. Persons within the State of Florida designated by Owner upon whom notices or other documents, may be served as provided by §713.13(1)(07, Florida Statutes. Name Telephone !Number Address 8. In addition to himself or herself, Owner designates the following to receive _a copy of the Lienor's !Notice as. provided in §713.13(1)(b), Florida Statutes. Name Telephone Number Address 9. Expiration date of notice of commencement (the expiration date may not,be before the completion of construction and final payment to the contractor, but will be 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER,AFTER T,HE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT INYOUR 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 tENDERDR AN A,-rbRNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT, Slrn.tur Own essee, or Ownees or Lessee's Authorized Officer/Director/Pariner,/Manager Signatory's I ittervmce e , The foregoing instrument was acknowledged before me thisay of by monthtyear nam Zloc f perso_ ;o as 0adelt for Type o utho 'ty, e.g., G r, trustee, attorney in fact nature of Notary Public — State of Florida Personally Known OR Produced ID Type of ID Produced/ Form content Name of party on behalf of whom instrument was execute v a a o w Print, type, stamp commissioned: name of Notary Public v A H' CCn �Koa� 9. 'Ussv AnioN iEttatiEN 96nOJ41 POPUOE �;`� 6lOZ'b t tat' saildq -urulo0 AIN ,: � , sv � -n � z 666669 dd +# WISSIt 11110J r r r co C,rn R> w T 7° EPttald;o a1Ei5 ollgad 63tt}oN tl3NNIxS N8VW w Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: I hereby name and appoint: O � " / an agent of. /U ,-_%2L. C oPCompany) 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): ei The specific permit and application for work located at: /Uto ;,r-- rc-t (Street Expiration Date for This Limited Power of Attorney: License Holder Name: !-�! State License Numbe Signature of License STATE; OF FLORIDA. COUNTY OF s¢''1: h d The foregoing insuument was acknowledge before)ne this —/,-/Zy of 20V � , by e who is gWrsonally known to me or o who has produ ed as identification and who did (did not) take an oath. � � • (Notary Seal) S19 .fture Print 0 type name Q�Y .... MARKSKINNER Notary Public - State of Notary Public -State of Florida rt G Commission No. �� . s Commission # FF 899949 My Comm EAPires Jul 14, 2019 � My Commission Expires: 117 x1 Bonded through National Notary Assn. , (Rev. 08.12) -12/13/201.7 SCPA Parcel View: 22-19-30-502-0000-0920 6 *_rraperl gcord Card s Parcel: 22 19 30- 32-0000-0920 Owner. POKP14 A 1;H NOUYKAY & CINDY a:;r x, cewmrY, ra a Property Addrusw, 1,01 t" RJ~ ,;"t;?'s Parcel Information Value Summary Parcel • 22-19-30-502-0000-0920 2018 Working 2017 Certified Values I Values Owner . POKPHANH NOUYKAY & CIND Valuation Method Cost/Market Cost/Market Property Address 101 BRISTOL FOREST TRL SANFORD. FL'32771 __._ ... Number of Buildings 1 1 Mailing 101 BRISTOL FOREST TRL SANFORD, FL 32771- Depreciated Bldg Value $170,822 $160,919 Subdivision Name t rd1?;'E iDepreciated EXFT Value Tax District S3-SANFOR FRONT REDVDST Land Value (Market) $34,000 $34,000 DOR Use Cade 01-SINGLE FALand Value Ag Exemptions uiz ,Q(a" $204.822 $194,919 T _ -- -- Portability Adj CD` Save Our Homes Adj $0 $0 001 + 50.0,0 50.00 74.27 i Amendment 1 Adj $Q$0 �= OP&G Adj $0. $0 ( t Assessed Value $204,822 $194,919 _ v CD Lo 1 Tax Amount without SOH: $3,711.55 J] $3,711.55 j _ Tax Estimator O Sava Our Homes Savings: $0.00 L%- Does NOT INCLUDE Non Ad Valorem Assessments © 50.00 50.00 60.00 y - -- - I aer- nole County Ca1S ` Legal Description LOT 92 PRESERVE AT LAKE MONROE PB 62 PGS 12 - 15 Taxes Taxing Authority Assessment Value I Exempt Values Taxable Value _ ,_.. __ .... �. _ • i..._. . __.,�. •. •... ,,.....$204.822 $0 $204,8 County General Fund 22 Schools S204,822 $0 $204.822 City Sanford $204,822 $0 $204,822 SJWM(Saint Johns Water Management) $204.822 $0 $204,822 , County Bonds $204.822 $0 $204,822 Sales Description Date Book Page Amount Qualified Vacllm p WARRANTY DEED 811/20168750 0156 S223,000 Yes Improved WARRANTY DEED 811/2005 J3#17;a ) i $319,000 Yes Improved WARRANTY DEED 3/1/2005 Gv Ei1 ) 5 $220,300 Yes Improved Land Method Frontage Depth Units Units Price Land Value _. _ ..... LOT 1 $34,000.00 S34,000 Building Information t ed p�cumd ullcouerr a G u ; ,�,, — i Year Built # Description Fixtures Bed Bath Base Area Total SF Living SF Ext Wall .Adj Value Rep] Value Appendages r p Actual/Effective 1 SINGLE 2005 9 4 2,� 1,042 3,026 2,476 CB/STUCCO $170.822 $178,871 Description Area FAMILY FINISH - OPEN 109.00 htip://parceldetail.scpafl.org/ParceiDetaillnfo.aspx?PID=22193050200000920 1/2 &� , d REW RO NY! CCC1327169 5703 Red ;Bug lake Rd 4234 Winter Springs, FL 32708' 407-797-7130*866-214-3181 fax * crewpro.roofiing@gmail.com Roofing Contract Name Gndy POKPHANH U Address 101ro8ristolForestTrlr City Zip Sanford FL 32771= Phone 703 599 6656 General Scope pf Work Remove existing roof system to deck Dispose of torn off roof debris Replace any damaged Wood on roof Install Complete New Roof System Date 12/13/2017 Crewpro Rep Mark Skinner Phone 321-332-8980 Remove existing roof system down to the deck Old Roof parts loaded into dumpster/dump trailer for disposal Sweep yard 3 times for nails and other metallic debris Cover A/C and sensitive plants where possible to protect from falling debris No old parts of former roof will be reused in new roof system unless otherwise noted Roof Deft Preparations Roof deck should be in 100% sound condition before new roof system is installed inspect all roof deck and support, replacing all wood unsatisfactory for new roof Renail deck to bring up to current codes. Wood Allowances 4x8 plywood ea 3 ea or 1x10 lumber F 100' Additional 4x8 plywood installed at $60.00 per sheet including labor. Additional 1x10 lumber installed at $40.00 per including labor. Page 1 S703 Red Bug Lake Rd #234 Winter Springs, FL 32708' 407-797-7130'866-214-3181 fax "trewpro.roofing@gmail:com Certainteed Roofers Select Underlayment for Steep Slope Mulehide SA Basesheet for Low Slope Peel and Stick additional water barrier for Valleys X Certainteed Flintlastic Black,Diamond Underlayment for low slope Certainteed Roof Runner Synthetic Underlayment X IRX Granulated Peel and Stick Underlayment Roof Vents and Accessories Replace all boots and Goosenecks X Install all new Lamanco ridge vent Install all new off ridge vents X Install new Kennedy Glass skylights Install new Galvanized Drip Edge X Install all new Solar Attic Vents Roof Coverings Certainteed XT25 3 Tab shingles GAF Natural Shadow Architectural Shingles Certainteed Landmark Architectural Shingles Certainteed Landmark Pro Architectural Shingles X Owen Corning Designer Color Architectural Shingles Mulehide SA Modified Bitumen Certainteed Flintlastic Modified Bitumen Mulehide TPO Eagle Concrete Tile Warranty Information Material Warranty Wind Warranty Non Pro Rated Period Installation/Labor Warranty Transferrable Page 2 Limited Lifetime I GREW z �m CCC1327169 5703 Red Bug lake Rd #234 Winter Springs, FL 32708 - 407-797-7130•866-214.3181 fax * crewpr6.roofing@gmaii.com GAF Natural Shadow Architecural Shingle Roof system Certainteed Landmark Architectural Roof System Certainteed Landmark Pro Architectural Roof System Mulehide SA Modified Bitumen Roof System Certainteed Flintlastic Modified Roof System Payment Options Intial Deposit in the amount of 50% payment due upon material delivery to roof Balance of roof invoice due upon roof completion 194 due upon roof,completion Plus any wood equal payments of L I Customer to pay by Credit Card 0 All materials applied to manufacturer specifications. Crewpro not responsible for any water damage inside of house until roof has been completed Acts of nature while roof is in progress is not the responsibility of Crewpro Inc Payment may be available from the Homeowners Construction Recovery Fund if you lose money on a project performed under contract, where the loss results from specified violations of Florida law by a licensced contractor. More info available by calling 950-921-6593. This contract includes all necessary permits, sales taxes, workers comp insurance and all other misc charges Crewpro will not be responsible for any damages to Solar panels. Panels should be removed and installed by solar professionals Crewpro will not be responsible for gutters or any gutter claims unless gutter install is specified in contract. Crewpro agrees to commence work within days and complete within days unless affected by weather Crewpro will not be responsible for falling objects inside of the home including the inside frames of skylights. All litigation involving homeowner and Crewpro will be conducted before a single judge or arbitrator. Payment due upon completion of roof unless otherwise specified. There are no finance charges of any kind. late payments will accessed a delinquent charge at maximum.permissable rates Buyer may cancel this agreement within 3 business days with no penalty. Later cancellations will incur a $soo.00 fee for permitting and planning services. No other agreements or understandings, verbal or written expressed or implied are part of this agreement unless specified herein. Page 3 CREW"FR-0 ' 10 a 5703 Red Bug Lake Rd #234 Winter Springs, FL 3270$ * 407-747-7130*866-2i43181 fax"' crewp"ro:roofirig@gmail.com Roof dimensions Ridge Dimensions Shingle Manufacturer Shingle Type Shingle Color Drip Edge Color Projected Start Date 1972 r-- 200 Certainteed� landmark 2/8/2017 Homeowner understands.that this agreement shall not bind the contractor until approved and fully executed by an officer of Crewpro Roofing. Acceptance of this proposal shall constitute a contract between the parties for the above described work and according to the terms and conditions as set forth by this agreement and subject to the governing laws and regulations. Owner or Agent Date Crewpro Officer Date Z %3 Page 4 CITY OF SXNFORD pqv, r —T PERMIT# ) �q Building &Tire Prevention Division RESIDENTIAL RE -ROOF SCOPE OF WORK JoB ADDRF.SS: Tt) ces � I'p-ocace- STRU,CTURF,Tvpr- (�? �MNGLE FAMILY RESIDENCE/TOWNHOUSE, 0 M013ILL 110ME 0 APAWrMLNT/CONDOMIN�ItjM ' RL-ROOF TYPE: Q<FPl.ACFMEN'l (TEAR Ol.-FEXISTING ROOF AND REPL.'�CF Wi-I'li NE W COMPONENI*S) 0 RE-COVER (NEW ROOT- INSTALLED OVER rkl',TING ROOF) DECK TYPE (PLEASE SPECIFY).* ;T E IE;',! 'PERAfinFD TO BEREPLACEI)** **PLE.,tSl,.'NoTE.* ONLY.100SQUAREP� �-ETOVISTIAIG DECK 1.5 6-- -RED Vt-,NT 0-1-URBINE'S Roor'VENTILATION: &-Or-�I-RIDGI� R 11) G, F, 0SOFI'IT OPOWE SKYLI,GII'FS- 0 YES (D>(�,F YES, PLEASE.pROvwE FLORIDA PIROII)ulc-r APPROVAL -------------------------------- 7 --------------------- ----------- I ---------------- -1 ---------- ----------------- I - -------------------- MAIN Rom, AREA ROOF SLOPE: 0 LESS TI [AN 2:12 0 2:12 - 4:12 e-4.12 OR GREATER OF ROOF MANUFACTURER FLOtdbA PRODUCTAPPROVAL &S1�1INGLr FL# OMETAL FL# C) MODIFIFD BITUMEN FLU;' 0 TORCH FL-4 �DONXINI C) INSULATED 11A 0TfLE Fl,# 0 O-UiER: ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IF A Pl'l.lCABLE,*,* ROOFSLOPL' OLESSTHAN2:12 02:12- 4:12 0 4:12 OR (JREATER '['YPL OF Roo . MANUFACTURER FLORIDA PRODUCT APPROVAL . . ... ........... C)SHINGLE FLA METAL FL# 0 MODIFiFI) BrruMLN FLU' 0 1 1 POWN FL# ORC11 0 1 NSULATFD FLJ'! TILE I nOTRER: F I-V CITY OF FIRE DEPARTMIENT Building & Fire Prevention Division --RESIDENTIAL RE ROOFPOLICY & PROCEDURES" -- PERMITTING RE QUIREMENTS —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: PERMIT NO. CONTRACTOR: 1 JOB ADDRESS: Building & Fire Prevention Division ISSUE DATE: • Re -Roof Permit Card 1(Stome- TYPE OF WORK_;� : .OD04 PROTECT PROM 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 rI 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 Skr4FORD 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 0 PER.MiT #: I _y % ADDRESS: `d f (S r e-- " ' , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR ROOFING CONTRAC OR, 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 #: w G /.'> --�p / COMPANY / CONTRACTOR: G t^ C )0q' �% C CONTRACTOR SIGNATURE: DATE: (� -7 (MUST BE SIGNED BY LICENSE HOL WNER/BUILDER) 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 day of � 20 L& by: Cl F �1-Who is 4?V'e-rsonally Known to me or has ❑ Produced (type of iden ' cation) as identification. nature of Notary Public tate of Florida • �,���o„` JOSEPH 0. PATITUCCI Notary Public - State of Florida Print/Type/Stamp Name of Notary Public Commission # FF 219782 F My Comm. Expires Apr 12. 200119 ,��:'�� �t .• National Notary m•