HomeMy WebLinkAbout104 Country Pl (3)F:
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FEB2i2018
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CITY OF SANFORD
BUILDING-4 FIRE PREVENTION
PE MIT`APPLICI4TION
Application No: �o _-7
112 ' 3 Documented Construction Value!s.$;
�ob Address: 10 Ca,n-bO4 �\ Histor><c District: Yes ❑ No O
4, Parcel ID: 33 I `1. 30 Sots boon OA L 10 Residential Commercial ❑
Type 'of Work: New Addition � ,
*Alteration' Repair ElDemo El' 'Change .of Use-0 MoveET
Description of Work: �h►i1a�E �{-1200�
Plan Review Contact Person: n�na t-c-u I Title*: P-L M C r- QM An t- r
Phone: A514. S41. 5tI Fax: Email:�rrn,�� �.�isonror�� �an�5„1�'C„A
Property Owner Information
Name 1)^f hAY,A Phone: (4 b1 • gcA3,• c19 b S
Street: ��u �n#c,� �I Resident of.property?
City, State Zlpv- 32 l
'Contractor Information
Name ` � s>� o�� nc Phone: q S,1= S Lt 1- 5 i cA
Street: ` 15b S4"- l Fax:
City, State Zip: OAYkA A �_ L State License No.: C_c_ 1 3 3 0 3S o
Architect/Engineer Information,
Name:
Street:
City, St, Zip:
Bonding Company: _
Phone:
Fax:
E-mail:
Mortgage Lender:
Address: 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 1053 Shall be inscribed with the date of application and the code in effect as of that date: V1 Edition (2014) Florida Building Code
Revised: June 30, 2015 Permit Application
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be
found.idihe public records of this county, and there may be additional permits required from other governmental entities such as waters
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 consid'ered'the'estirriated 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.
si e of Owner gent Date Si a ntractor/Agent Date
Print ent's Name 1 Print Contrac InIlame
atur o otary-State of Florida Date SiW&AA of -State o, f Florida Date
ALEXANDRA EPASSO.
L3M
ALEXANDRA E PASSO
�,.MY COMMISSION # FF9877, v MY COMMISSION # FF9877 6!?' EXPIRES May 01, 202U EXPIRES May 01, 2020(b07)388-0153 Floridallotaryservice.com Iorfdallofa rySenice.com
Owner/Agent is Personally Known to Me or Contractor/Agent is Personally Known to Me or
Produced ID Type of ID 'Ft, -b Produced ID Type of ID
BELLOW IS FOR OFFICE USE OILY
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
P ,
Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads Fire Alarm Permit: Yes ❑ No ❑'
APPROVALS: ZONING: UTILITIES: WASTEWATER:' .
ENGINEERING: FIRE
ILDING:
XG&U-T01"_�.�
Revised: June 30, 2015
SCPA Parcel View: 33-19-30-506-0000-0040
Property Record Card
Parcel: 33-19-30-506-0000-0040
ffp*�
I R Owner: GENTILE BARBARA
# 6E�RpA(yt.C-(",(7(NTY, f3 XN?A11.
j Property Address: 104 COUNTRY PL SANFORD, FL 32771
Parcel Information Value Summary
Parcel
33-19-30-506-0000-0040
Owner
GENTILE BARBARA j
Property Address
104 COUNTRY PL SANFORD, FL 32771 �I
Mailing
Subdivision Name
104 COUNTRY PL SANFORD, FL 32771
COUNTRY PLACE THE
I
Tax District
S1-SANFORD
DOR Use Code
I Ot-SINGLE
Exemptions
00-HOMESTEAD(2017)
52.62
7 + -_ 52 �m s um52 _.
00
^Y d = t Via, CV
s
7 j 52 4 53 'i CO
Semmale County— {S __ _
Legal Description
LOT 4
COUNTRY PLACE THE
PB26PG30
Taxes
Page 1 of 2
2018 Working
i 2017 Certified
Values
Values
Valuation Method
Cost/Market
Cost/Market
_ — _
Number of Buildings
---------
1
1
Depreciated Bldg Value
$128 833
$121 396
Depreciated EXFT Value
$1 000
$1 000
Land Value (Market)
$33 000
$33 000
Land Value Ag
ro
Just/Market Value "
$162,833_;
$155,396
Portability Adj
$38, 746
Save Our Homes Adj
$43 733
Amendment 1 Adj
P&G Ad/
_
z$0
$0
_
$0 _
Assessed Value
$119,100
; $116,650
I
3 Tax Amount without SOH: $2,171.13
2017 Tax Bill Amount $1,433.35
Tax Estimator
Save Our Homes Savings. $737.78
' Does NOT INCLUDE Non Ad Valorem Assessments {
i
Taxing Authority
I Assessment Value Exempt Values
Taxable Value
County General Fund
$119,100
$50 000
$69 100 1
Schools
$119,100
$25,000 i
$94,100
City Sanford
$119 100 ,
�50 000
$69 100
SJWM(Saint Johns Water Management)
$119,100
$60 000
$69 10.j
County Bonds
.
$119,100 1
.
$50,000 ±
$69,100 1
Sales
I Description
Date
Book
Page
Amount Qualified
Vac/Imp
DEED
8/1/2016
08749
1 0483
$195,000 Yes
Improved
!WARRANTY
i WARRANTY DEED
12/1/1998
03565
0321
$104,3001 Yes
Improved
WARRANTY DEED
4/1/1986
01731
-0724
$102,500 No
Improved
_ I
I %�Eirrr!'Cz1m'parabte SalesAi
Land
( i Method Frontage Depth i Units LUnits Price Land Value ----
tl LOT 0.00 0.00� 1 $33,000.00 $33,000 !
Building Information
... ...........
Is BedBath count incorrect? Click Here. (k
( y � 9
! # Description Actual/Effective Fixtures Bed Bath Base Area Total SF ( Living SF EExt Wall Adj Value Repl Value Appendages'
{ ! 1
1 SINGLE 1985 7 3 2.0 1,783 2,416 1,783 'SIDING $128,833 ` $149,806 ` I
FAMILY GRADE 3 Description Area
i 483.00 i
httn://narceldetail.scnafl.ors/ParcelDetaiIInfo.asnx?PID=33193050600000040 12/12/2017
DocuSign Envelope ID: 3A49EC3B-ED8E-4F85-BE34-25IF7D7D736F
BISON ROOFING, LLC*
47SO N' !)ixie HNNY 1,9, Oakland Park, FI, 33134 P: 954.541.5197 F: 754.206.6()77 I-icciise �'CC'C1330350
Roofing Sales & Installation Contract
INFORMATIONCUSTAMER -KRA,
s"4 M, "05,is
First Name
7L7 Name
BARBARA
GENTILE
Cell Phone
Home Phone
Email
407-687-8041
407-687-8041
GRAMMIE314@GMAIL.COM
Address
104 COUNTRY PIL
City
—['77e—
Zip
SANFORD
FL
32771
r ecPla ess i;diffeientthanalie`customer,adiiress listed
Address
city —F
State Zip
REPl*EMENT MATERIALbtf!WILt
Property Type:
q SFR 0 Multi Family 0 Commercial
Replacement Roof Type 1:
C4 Shingle 0 Tile 0 Metal 0 Flat
Occupancy:
q Owned 0 Rented
Replacement Roof Type 2:
OShingle 11 Tile 0 Metal 0 Flat 04 N/A
Existing Roof Type 1:
Ig Shingle 0 Tile 0 Metal 0 Flat
Felt:
0 30 lb 0 1S lb R SYNTHETIC
Existing Roof Type 2:
0 Shingle 0 Tile 0 Metal 0 Flat qN/A
Pipe Collars (type/city):
3-LEAD
Roof Height:
-TR
§4 One story 0 Two story 13 Over two stories
Pipe Collars- paintto match
R Yes 0 No
Decking Type:
Plywood 0 Plank
Vents (type/qty/color):
CONTINUOUS RIDGE
Material Delivery Instructions: ROOF LOAD
Drip Edge:
13 2x3 3x3
Is property part of an HOA? OYes WNo If yes, HOA name & contact info:
Drip Edge Color:
BROWN
Chimney Flash (size/color):
I
Brand
Style Color
GAF
TIMBERLINE HD BARKWOOD
Tear Off Existing Roof:
Notes:
Z Yes El No 0 N/A
MATERIALS'I I V
0 19
OleR
E �:�'T�'
�M�f %16111'
Brand
Style
Color
N
Underlayment (check one):
Eave Closure:
Eave Closure Color:
0 Hot Mop
11 TU
❑ Yes El No
Tear off Existing Roof:
Notes:
0 Yes 0 No
N N/A
Amount
Profile
Guage
Color
Aluminum or Steel
NA
Tear Off Existing Roof:
Notes:
0 Yes 0 No E N/A
Type I ',Plf Arihprpd
Notes:
Tapered Insulation: 0 Yes 0 No
Tear Off Existing Roof: 11 Yes El No Q N/A
Leaks/Interior Damage:
CR Yes 0 No
Driveway Damage: 0 Yes 1)j No
Other:
Other:
Roofing Sales & lnziliatmn Contract, Page 1 of 4
DocuSign Envelope ID: 3A49EC3B-ED8E-4F85-BE34-251F7D7D736F
BISON ROOFTNG, LL,C
475O N' Dixie liwy #.i9, 0ak'land Park, Ft'..33334 P: 954.541.5197 F: 754,206.6077 License #CCC1330350
ADDITIONAL WORK/INSTRUCTIONS
a
Existing Solar Panels:
IX N/A
❑ Remove & Discard ❑ Remove & Reset
Notes:
Satellite Dish:
IX N/A
❑ Remove & Discard ❑ Remove & Reset
Notes: Customer is responsible for re-alignment/calibration if needed
Fascia:
0 N/A
❑ Replace (type/size/If):
Gutters:
N/A
❑ 5" ❑ 6" ❑ Whole House
Color:
Notes:
Downspouts:
N/A
❑ 5" ❑ 6" ❑ Whole House
Color:
Notes:
Skylight, Remove/Replace
IIg N/A
❑ Type- Curve Mount ea
❑ Type- Flush Mount ea
Skylight, Re -Flash:
CR N/A
❑ Type- Curve Mount ea
❑ Type- Flush Mount ea
Other:
Other:
Other:
UPGRADES
AMOUNT TYPE OF UPGRADE
CONTRACTTOTAL
$ 20399 ::t::J
PAYMENTSCHEDULE '
AMOUNT
PAID
DUE
$ 8,159.60
8,159.60
Permit Issued
$ 12,239.40
12,239.40
Roof Completion
$ 0
0
N/A
Terms. The terms of this contract include all four pages of the Roofing Sales & Installation Contract. The terms of this contract are subject to a detailed site analysis
and management approval. By signing below, the undersigned confirm that they have read and understood the entire Contract, that they intend to be bound by the
terms of the Contract and that they have all legal authorization and authority to enter into the Agreement.
Alterations and/or verbal agreements. Any alteration or deviation from the terms and or scope of work specified in this Contract will be executed only upon written
orders. Any verbal agreements, including but not limited to warranty extensions or future upgrades, will not be legally binding and will not be considered part of this
Contract.
Notice of Right to Cancel. You, the buyer, may cancel this transaction at anytime prior to midnight of the third business day after the date of this transaction.
DocuSigned by: n DocuuSSiiygn�e�dd by:
Customer. C C ,�1�1--.C' , 4 DO 4A �J�-s— Contractor�Vu
hwv
AF82138DF93134� .. E054D76B42A�4415..
Print Name: Barbara G t k. Date: ��8 Print Name: AN FEW HUNTER Date: 1/29/2018
Management Approval By: iwl T wMxstw Print Name: Yrying Tomasini Date: 1292018
13D255EAC973E41`5...
Roofing Sales &Installation Contract, Page 2 of 4
THIS INSTRUMENT PEPARED BY: GlirihlT I'IHI_r �E11jp(ULC
Name: rc, ..1 ,Ior� t.* .ERf OF' {. COUNTY
c�= r IRt:UIT COURT 2: C Address; '�;so.._ ,�:� t}= 9U78 Ps l-ll (1(;�si Ohif'T'ROLLER
D� CLERK'S Y 2r11$l_119872
IiEQF,!DED l:(2/21;2018 09a25,ii5 I',N
600A-6 VAYK, FL- 333'-f RECORDING FEES'sin CICi
NOTICE OF COMMENCEMENT I,ECORDEO hdevor"H
Permit Number:
Parcel ID Number. S3, 1`11, 30-. SDto • boo 0 • 00
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the
following information is provided in this Notice of Commencement.
1. DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available)
LO,T y 10-1 i -0UnkrV p%
Cov�---?W-6- T1ryE S�mCor F� 3Z�� l
P(S 2tc IF & 3o
2. GENERAL D �$FRIPTION %F IMPROVEMENT:
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT:
Name and address: 'pArbarA GEYIE 1- - IO'I Cz,i it , pi f Snn(or l r R- 32 i'}
Interest in property: _Qune,/-
Fee Simple Title Holder (if other than owner listed above) Name:
4. CONTRACTOR: Name: Oo Phone Number:
Address:_y-}Sb Q.'NY1E WhaIJ C.E q . O^KkA, A-,(k. Fc,
5. SURETY (If applicable, a copy of the payment bond Is attached): Nam
Address: Amount of Bond:
6. LENDER:
Address:
Phone Number:
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.
Phone Number:
8. In addition, Owner designates of
to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Phone number:
9. Expiration Date of Notice of Commencement (The expiration is 1 year from date of recording unless a different date is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE
CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE
JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
kc
g.. ture of Owner or Less e, es e's or see's (Print Name and Provide Signatory's Title/Office)
Authorized Officer/Direc artner/Manager)
State of ]F:� (n(, A A County of AL-) Al c�
The foregoing Instrument was acknowledged before me this day of ��h , 20 18
by
person making statement
who has produced identificationtype of identification pro
;g��"'•"•'•�;^ ALEXANDRA E PASSO ' ;
MY COMMISSION # FF987786
1ao< EXPIRES May 01, 2020
(e 17) 398.0153 FloddallotaryService.com
Who is personally known to me ❑ OR
Date
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 2- 1 Z- 113
I hereby name and appoint: &, Z,� -Clr & ie /1OC 5
an agent of:
(Name of Company)
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):
The specific permit and application for work located at:
SA An rl , t- c, 3 z-- —11
T (Street A dress)
Expiration Date for This Limited Power of Attorney:
License Holder Name: A�AM oQV ,ILrn
11
State License Number:
Signature of License H
STATE OF FLORIDA
COUNTY OF (- o,3 PK8
The foregoing instrument was acknowledged before me this I Z day of QL j.,,
200 j?), by A A Am -, who is g'personally known
to me or o who has produced as
identification and who did (did not) takKath..
Sign e
(Notary Seal)
:e� ALEXANDRA E PASSO
My COMMISSION # FF987786
r? EXPIRES May 01, 2020
(407) 398-0153 FtoridallotaryServrce.com
(Rev. 08.12)
A6C,AAArA eA5505
Print or type name
Notary Public - State of - (o i
Commission No. V t= q 61 -1$(,
My Commission Expires: 5 Zo
• CITY OF
SkBuilding
-� T�® & Fire Prevention Division
1'®i RESIDENTIAL RE ROOF POLICY & PROCEDURES
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: S
-CITY OF
&kNFORD
PERMIT #
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
JOB ADDRESS: IOLA CA I(jAv-Sa PL
STRUCTURE TYPE: SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: 40REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY): 1/2 " L3 ODC
**PLEASE NOTE: ONLY 100 SQUARE FEET OF THE EXISTING DECKIS PERMITTED TO BE REPLACED"
ROOF VENTILATION: OFF -RIDGE QRIDGE OSOFFIT OPOWERED VENT OTURBINES
N0A; QIo - 0-Lt"k, OZ
SKYLIGHTS: O YES 0 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
SHINGLE
NOA-' )to- 081k.1 t
FL#
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DowN
FL#
OINSULATED
FL#
O TILE
FL#
OTHER: r.
I W
0A: IN- 0(43: 1 b
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#
CITY OF
' S,FORDl Building & Fire Prevention Division
1® RESIDENTIAL RE -ROOF AFFIDA VIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: �7 ADDRESS:
I 'AYy-x CbJe3NA 1 ,'n , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
GOOFING CONTRACTOIIDENGITd$ER, 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#: CCL 33C)3C
COMPANY / CONTRACTOR: I
CONTRACTOR SIGNATURE: DATE:
(MUST BE SIGNED BY LICENSE R OR DER
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 I
Sworn to and Subscribed before me this. day of o' � 20 jj by:
-AM i®ijQ h 1 14 Who is,�!Personally Known to me or has ❑ Produced (type of
identification) as identification.
VU!"O) A
Si"a otai FPU [(407)
State of FloridaALEXANDF2A E PASSO'� MYCOMMISSION # FF98778eI
A\C)W\�(A(�� o�a?�. EXPIRES Ma 01. asa-ois3 Y 2020
rl t/ ype/Stamp Name Florldallotaryservice.com
of Notary Public