HomeMy WebLinkAbout121 E Jinkins Cir (2)CITY Ofq�
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FIRE ()EP 14TMiT'
Building & Fire Prevention Division
PERMIT APPLICATION
Application No:
00
Documented Construction Value: $
Job Address: V21 C• C.ir, spm6T 21--3 Historic District: Yes❑No❑
Parcel ID: \2-2o •'3o- Sod Residents l rcommercial❑
Type of Work: New❑ Addition❑ Alteration ❑ Repair ❑ Demo ❑ Change of Use[] Move ❑
Description of Work: Inc it �f -Igo 0�
Plan Review Contact Person: &&etj Title: Pf�f m\:k Nr
Phone: Fax: Email:_Y m i� f7is ail goo �'no Prrc►
---.-.-Property Owner Information S0 ►�{�cpnx
Name Phone: y 01 L\te l lz9 O
Street: 121 -. • C,i r Resident of property?
City, State Zip: 3Z1 3
,Contractor Information
Name '\?) 15po "Qnoj�' M Phone: C(sL1. 5 Lt I. S t 41}
Street: 1�}50 AAJ.. bi,tiE 11►�v S+,c q Fax:
City, State Zip: VAk1An c\- PA'K , P L State License No.: C CC 1'-� 3 n 3 5
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
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 1.05.3 Shall be inscribed with the date of application and the code in effect as of that date: 6`h Edition (2017) Florida Building Code
Revised: January 1, 2018 Permit 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 ICC( Valuation. Table -in effect rat 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.pernmit 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.
- 2- 12 • l 8
i nature Owner/ gent Date Signature of Contractor/Agent Date
De- 0 -WA A ANM AS 11\ri1 I h
Print Owner/Agent's Name Print Contractor/AgentWName
of Florida Date
.Y� CARLCAMPANELLI
`fir+ MY COMMISSION #GG158326
EXPIRES: NOV 07, 2021
Bonded through 1st State Insurance
Owner/Agent is Personally Known to Me or
Produced ID _ Type of ID fL TDC,
' /
e of
Nota -State of Florida Date
CARL CAMPANELLI
MY COMMISSION #GG1 58326
EXPIRES: NOV 07, 2021
OF1 Bonded through 1st State Insurance
Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
to Me or
Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing[] Gas ❑ Roof ❑
Construction Type:
Total Sq Ft of Bldg:
Occupancy Use:
Min. Occupancy Load:
New Construction: Electric - # of Amps,
Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILIT.IES:
FIRE:
Flood Zone:
# of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes ❑ No ❑
WASTE WATER:
BUILDING:
Revised: January 1, 2018 Permit Application
1'-'5/20�R
1PAS0wWJoN=vkCFA
OINIZaR
.. ........ 0-1 Inf-0—
SCRA Parcel View: 12-20-30-504-0000-0140
Property Record Card
Parcel: 12-20-30-504-0000-0140
Property Address: 121 E JINKINS CIR SANFORD, FL 32771
SummaryValue
i 2018 Worlang
2017 Certified
Values
Values
Valuation Method Cost/Market
Cost/Market
--------- ------ - ------------- ----- ------
Number of Buildings 1
-- -- -------- - -------------------------- -----
- -----
1
----------------------- -
---
Depreciated Bldg Value $7Z452
$68 261
Depreciated EXFT Value $13,516
$14,016
----------
Land Value (Market) $15,000
---------- ---- ---------
$15,000
Land Value Ag
.... ......
Just/Market Value $100,968
11
$97,277
- -------------------
Portability Adj
- - ---------- . . .......
.. .......................
---------- - ---------------- ------------------- -
Save Our Homes Adj $10,774
$8,938
------------------
Amendment I Adj $0
---------- - ---
P&G Adj $0
$0
-----------
Assessed Value $90,194
............
$88,339
Tax Amount without SOH: $1,064.45
2017 Tax Bill. Amount $894.25
Tax Estimator
Save Our Homes Savings: $170.20
Does NOT INCLUDE Non Ad Valorem Assessments
..... .........
Legal Description
LOT 14
SOUTH PINECREST 4TH ADD
PI3 12 PG 43
Taxes
Taxing Authority
Assessment Value Exempt Values_--J,
Taxable Value
County General Fund
$90,194 i
$50,000, $40,194
-- ---------------
Schools
------- — - ---- -- --
$90,194
... .. .....
$25,000 = $65,194
City Sanford
$90,194
$50,000 $40 , 194
.......... ........ .. . .. .......
SJWM(Saint Johns Water Management)
. .............. ---------------- ---------
$90,194
...... ........... ---------------------- ----------
$50,000 $40,194
County Bonds
$90,194
------------
---------------- -
$50,000 $40,194
I
Method Frontage Depth Y Units JUn�ds Land Value
LOT 0J)o 0.00 $15,000.00 $�15,000
. .. .......... . . . .. ......... ---- ....... . .. .......
Building Information
#
De. Fixtures Bed Bath 1 Base Area
Total SF]
Living SF i Ext Wall
T)�j Value Repil Value
Appendages
IffEfffetiv
jjj
SINGLE 1 1959 6 2.0 1,554 2,832 1,554 CONC $72,452 i $120,754
Description
j' Area
http://parceidetaii.scpafl.org/ParcelDetaillnfo-aspx?PID=12203050400000140 1/2
DocuSign Envelope ID: 75520BF8-8FOB-4878-9C3D-768FE38F7CO1
BISON ROOFING. LLC
4750 N &xic Hwy —9, Oakland Park, Fl- 333134 P:954.541.5197 17:754.206.6077 1Jccnse4CCCI330350
Roofing Sales & Installation Contract
CUSTOMEkANFORMATIbN
First Name Debra Fast Name Seda
Cell Phone Email
4074637290 Home Phone 4074637290 Championpar@aol.com
Address
121 E Jinkins Cir
City Sanford State FL 2ip 32773
PROJECT INFORMATION:,.' �,' -'
� 1. 1-,--":1 11
Projectaddress is same,as above. 0 Oro 6ctaddress is different than the customer address
llstid'abovC project address is'as below'.
Address
City
State
Zip
PROPERTY DETAILS,
�,;!��EPLACE MATERIAL TAILS,
Property Type:
SFR 0 Multi Family 0 Commercial
Replacement Roof Type 1:
M Shingle 0 Tile 0 Metal 0 Flat
Occupancy:
Owned 0 Rented
Replacement Roof Type 2:
OShingle 11 Tile 0 Metal U Flat 0 N/A
Existing Roof Type 1:
R Shingle 13 Tile 0 Metal 13 Flat
Felt:
0 30 lb 0 15 lb §? SYNTHETIC
Existing Roof Type 2:
05hingle 0 Tile 0 Metal 0 Flat qN/A
Pipe Collars (type/qty):
4-LEAD
Roof Height:
q One story 0 Two story 0 Over two stories
Pipe Collars- paintto match
C4 Yes 13 No
Decking Type:
q Plywood 0 Plank
Vents (type/qty/color):
CONTINUOUS -CHARCOAL
Material Delivery Instructions: ROOF LOAD
Drip Edge:
0 2x3 14 3x3
Is property part of an HOA? OYes Ig No If yes, HOA name & contact info:
Drip Edge Color:
BLACK
Chimney Flash (size/col or):
I N/A
REPLACEMENTMATERIALS Shingle ,Rdofing&?,
Brand
Style
Color
GAF
TIMBRLINE HD
CHARCOAL
Tear Off Existing Roof:
Notes:
M Yes 0 No El N/A
REPLACEMENTWATERIALS., iTilo Roofing
Brand
Style
Color
NA
Underlayment (check one):
Eave Closure:
Eave Closure Color:
0 Hot Mop El TU
0 Yes 0 No
Tear Off Existing Roof:
Notes:
0 Yes 0 No W N/A
REPLACEMENT MATERIALS::Metal Roofing
Amount
Profile
Guage
Color
Aluminum or Steel
NA
Tear Off Existing Roof:
Notes:
0 Yes 0 No KI N/A
S.--, 66, Slope A66firl&',
Type I
ZIfAdh,-r,-d
Notes:
Tapered Insulation: 13 Yes 0 No
Tear Off Existing Roof: 0 Yes 0 No 19 N/A
PRE-EXISTING DAMAGES,
Leaks/interior Damage: 0 Yes M No Driveway Damage: 0 Yes [A No
Other:
Other:
Roofing Sales & Installation Contract, Page 1 of 4
DocuSign Envelope ID: 7552OBF8-8FOB-4B78-9C3D-768FE38F7CO1
BISON ROOFING, LLC
4750 N Dixie Hwy 49, Oakland Park, FL 33334 P: 954.541.5197 1'7: 754.206,6077 License #CCC1330350
ADDITIONAL WORK/INSTRUCTIONS.,
..
Existing Solar Panels:
CR N/A
❑Remove & Discard ❑ Remove & Reset
Notes:
Satellite Dish:
❑ N/A
❑ Remove & Discard Remove & Reset
Notes: Customer is responsible forlre-alignment/calibration if needed
Fascia:
(4 N/A
❑ Replace (type/size/If):
Gutters:
9 N/A
❑ 5" ❑ 6" ❑ Whole House
Color:
Notes:
Downspouts:
W N/A
(3 5" ❑ 6" ❑ Whole House
Color:
Notes:
Skylight, Remove/Replace
❑ N/A
1O Type- Curve Mount 2 ea
❑ Type- Flush Mount ea
Skylight, Re -Flash:
❑ N/A
lj4 Type- Curve Mount 2 ea
❑ Type- Flush Mount ea
Other:
Other:
Other:
UPGRADES-
AMOUNT TYPE OF UPGRADE
S
CONTRACTTOTAL
$ 21,401.00
PAYMENT SCHEDULE
AMOUNT
PAID
DUE
$ 6000.00
6000.00
Permit Issued
$ 10,901.00
10,901.00
Roof Completion
$ 4500.00
4500.00
Roof Completion
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 any time prior to midnight of the third business day after the date of this transaction.
DocuSigned by: CE054D76B42A4415
Docuu JSiign�e�d�by:Customer: 0)""'U ed� �"'y""'tl& Contracto ° `WAJ�"'ElEAA70F8654472... ...
Print Name: Debra Sed1 —Signed by.V_5EAC973E4F5..
n,, _Date: �6i ?niR Print Name: ANDREW HUNTER Date: 2/6/2018
Management Approval By: Print Name: Yrying Tomasini Date: 2/6 2018
Roofing Sales & Installation Contract, Page 2. of 4
THIS INSTRUMENT PREPARED BY:
Name: FAOC�[C-ui '4�nor-Aaq
Address: 'Ppl I& r,, r-, GRANT NALOY7 SENINOLE COUNTY
CLERK OF CIRCUIT COURT 1, CONF'TROLLER
4a'2�b h4 - lb i x 115 V41 Z4 S.+6 5 SK 9078 P9*1608 (I )
: Pss
0Ak<AAAe- 'FA-ft-LI 'Ft. 33-531-1 CLERK'S 4 201801987S '
NOTICE OF COMMENCEMENT RECORDED'r02/21, f2018 09:26:037 AN
RECORDING FEES $-J.Cj.(jCj
State of Florida RECORDED 13Y Ildevore
County of Seminole
Permit Number: Parcel 10 Number: 12-- ZQ - S0 - '56LA - 0000 - 0140
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.
DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available)
P (25 143
GENERAL DESCRIPTION OF IMPROVEMENT:
191Y4 Z 14 :41 R I;[*) zi ", TA 1 Col: A
Address: VL% V- \ r\ i.
I
Fee Simple Title Holder (if other than owner)
CONTRACTOR: - Name: ' �) 150r-\ " QOO �1(\Jq
Address: i'4%,6 "W V St*- S OA K, I AM PAM 'PL 33 ?)
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)(b), Florida Statutes.
Name:
Address:
In addition to himself, Owner Designates
of
To receive a copy of the Lienor's Notice as Provided in
Section 713.13(1)(b), Florida Statutes.
Expiration Date of Notice of Commencement (The expiration date is I 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 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 RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalties of perjury,) declare that I have read the foregoing and that the facts stated in it are true
to the ,�bof my knowledge an belief.
L !�aa
Owner's gn t re Owner's Printed Name
Florida Statute 713.13(1)(g): " The owner must sign the notice of commencement and no one else may be permitted to sign in his or her stead."
State of — County of "R(-8.-3Af-8
The foregoing instrument was acknowledged before me this day oft 20 1A
by DC\0(-A SCc�-a Who is personally known to me ❑
Name of person making statement
ela-
OR who has produced Identification type of Identification produced: 17t— 1�!L
CERTIFIED COPY 'Z GIR)h1l' WMt LY,,
ALEXANDRA E PASSOF CLERK OF THC C11 1 0
ANh rommTkni
My COMMISSION # FF987786
4 " A a RMINOLL COUNTY, 7
W EXPIRES M
Rf." 11 ay 01, 2020
-(407) 398-0153 FloddnNolaryService,com
Date—_
zril- - r--v IN
.L%
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 2- 12 - \ "
I hereby name and appoint:
an agent of:
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:
iZk F•_1;n �n< Cir C�A frA. mac_ `2,2.
(Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name:
State License Number:
Signature of License H
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before me this 17- day of ,
200 1 a , by (\ckAyy\ �awa�l „� who is gfersonally known
to me or ❑ who has produced as
identification and who did (did not) take an oath.
(Notary Seal)
=ALEXANDRA
DRA E PASSOSSION # FF987786S May 01, 2020NotaryService.com
(Rev.08.12)
Signature
0 6An6 o (IS505
Print or type name
Notary Public - State of
Commission No.
My Commission Expires: S • 1 • Zo
y.
CITY OF
p SkNF'uRD
Building & Fire Prevention Division
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:
CITY OF
PERMIT #
SkNVORD
Building & Fire Prevention Division
FIRE DI.I'A R r'"I `" s RESIDENTIAL RE ROOF SCOPE OF WORK
JOB ADDRESS: 121 C C i S" L-A
STRUCTURE TYPE: &SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: 0 REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY): Vz W , no a
**PLEASE NOTE: ONLYI00 SQUARE FEET OF THE EXISTING DECKIS PERMITTED TO BE REPLACED**
ROOF VENTILATION: D OFF -RIDGE RIDGE OSOFFrr OPOWERED VENT OTURBINES
NoA' - 02►-4-.0'2-
SKYLIGHTS: O YES el O IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 V 4-12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
SHINGLE
GA—
tJOF�'-
FL# C)e I i. I I
METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
OINSULATED
FL#
O T'ILE
FL#
OTHER:
NoA'
FL# 1 Ll - o c o 3, l
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) *W APPLICABLE**
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#
QMODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
OINSULATED
FL#
O TILE
FL#
O OTHER:
I FL#
CITY OFr
&��ORD Building & Fire Prevention Division
RESIDENTIAL RE -ROOF AFFIDAVIT
NNE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: /) ADDRESS: �?-k G r
Sain�r> t �� 3Z -43
TA ' An--\ (-P)J C1M 11 r , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR,�ENGIFIEER, ARCHITECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE
FOREGOING INFORMATION IS TRUE AND ACCURATE AND THAT ALL ROOFING COMPONENTS LISTED ON THE SCOPE OF WORK AT THE
ABOVE REFERENCED ADDRESS HAVE BEEN INSTALLED IN ACCORDANCE WITH THEIR PRODUCT APPROVALS AND ALL APPLICABLE CODE
REQUIREMENTS — SPECIFICALLY FLORIDA BUILDING CODE, EXISTING BUILDING. IN ADDITION I CERTIFY THE INSTALLATION MEETS ALL
REQUIREMENTS FOR SECONDARY WATER BARRIER AND NAILING OF THE ROOF DECK, IN ACCORDANCE WITH THE HURRICANE RETROFIT
MANUAL REQUIREMENTS (BASED ON F.S. CHAPTER 553.844).
LICENSE #: C.CC— S 0
COMPANY /CONTRACTOR:
CONTRACTOR SIGNATURE: Q ' DATE:q -Z--/
(MUST BE SIGNED BY LICENSE 6 LDER O 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 -d— by:
(-�6Aff-N . Who is,Personally Known to me or has ❑ Produced (type of
Qj
identification) as identification.
r►r !''
Signa ure of Notary Public ALEXANDRA E PASSOS
State of Florida '_ MY COMMISSION # FF987786
I.�.}1'', 14%. EXPIRES May 01, 2020
V ` x Pr��fA P`' l�jlj (�S (407)39843153 RodCallotaryService.com
Print/Type/Stamp Name
of Notary Public