HomeMy WebLinkAbout121 Maplewood Dr (2)CITY OF
S. FORD
FIRE pEPARTM-ENT
MAR 01 2018 'Building & Fire Prevention Division
r PERMIT APPLICATION
Application No:
15- / ,;) 1-7
Documented Construction Value: $ 14T2 U , Lift
Job Address: / Z 1 M o l eyyo by- Historic District: Yes ❑ No
Parcel ID:.33—19 " 3b -,Sc- M ` &BOO ~- 011 0 Residential f Commercials
Type of Work: New--] Addition Alteration Repair Q Demo ❑ Change of Use Move
Description of Work: ^` el —
Plan Review Contact Person: Mb ►7 G1 Title: , _
C- sA"
Phone: 635Z)&30 - 0037 Fax: Email: rr� � Qd
movie
Property Owner Information e I (i ,,jj
Name :n&. I�lovie, 0.o Phone: Oqo .�.14- `- ZIOg`I"
Street: 2_1 . j,N b 11 1� 1' Resident of property?
City, State Zip: _Q�Y&Wj. F-I— �2 7_)1
Contractor Information
Name Skumark eoAna. Z
Street: I
City, State Zip: m! )Dt'A (�.3 7- -v� -�
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Phone: (3<;� U US q,�i�i
Fax:
State License No.: C CC- /.331 4 b 4
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: 61 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 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.
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name Print Contractor/Agent's Name
Signature of Notary -State of Florida Date �tureofN�otyState of Florida Dat
Owner/Agent is Personally Known to Me or Contractor/Agent is Personally Known to Me or
Produced ID Type of ID Produced ID Type of ID
ALICIA FOLAN
MY COMMISSION # GG 051557
BELOW IS FOR OFFICE USE ONL ^'' EXPIRES: November30, 2020
�'", p'�P� Bonded Thru Notary Public Underwriters
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: January 1, 2018 Permit Application
11111111111111111111111111111111 11ll 1111
THIS INSTRUMENT PREPARED BY- _ GRANT MALOYr SEMINOLE COUNTY
Name: Skymark Roofing, LLC ;�'Ir'j� GRANT
CLERK OF CIRCUIT COURT & COMPTROLLER
Address: 2845 Palmetto Rd BK 9076 F'3 60 (1E'ss )
Mount Dora, FL 32757 CLERK'S : 2018017799
RECORDED 02/15/2018 10:50:46 AM
RECORDING FEES $10.00
NOTICE OF COMMENCEMENT RECORDED BY hdevore
Permit Number. 2
Parcel ID Number. � 7' �� �� � J i�'f -09Do- 011 �0
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)
/,01 11 R!_1<_ A
2. GENERAL DESCRIPTION OF IMPROVEMENT:
Re -Roof
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPF
: >Q Name and addresslr/n Harie- CLx(,o 121 %-!Gi/1 �I? W ��ul Df.
Interest in property: Owner(s)
Fee Simple Title Holder (if other than owner listed above) Name:
4. CONTRACTOR: Name: Skymark Roofing, LLC Phone Number: 352-805-8935
Address: 2845 Palmetto Rd Mount Dora, FL 32757
5. SURETY (If applicable, a copy of the payment bond is attached): Name:
6. LENDER:
Address:
Phone Number:
Amount of Bond:
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.
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.
L"!I, ,IV,, akw P. 4/0
(Signature of Owner or Lessee, X owfibrls or Lessee's (Print Name and Provide 5 natory's Title/Office)
Authorized Officer/Director a er/Manager) I,
State of a County of
The foregoing instrument was acknowledged before me this day of _� ►JA a 0.4 20
by -nf1A.Pli I ,/
91 Who is personally known tome 0 OR
Name Zf perso� king statement
who has produced identification EY type of identification produced: i7 L
'YP�` ALICIAFOLAN
MY COMMISSION # GG 051557 I RT3 C eu
EXPIRES: November 30, 2020 ' Notary
° — blicUndenvriters L'e'4or i ER7BondedThruNotaryPu N COMPt
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: i
I hereby name and appoint: 1 e 1 LL � 1- n
an agent of:
(Name of
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:
(Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name:
State License Number:
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF &Ke,
The foregoing instrument was acknowledged before me thisyk/ day of'Rb ,
204 y�, b i d I 'c, who is personally known
to me or ❑ who has produced
identification and who did (did not) take an oath.
(Notary Seal)
CLIFFORD E. FONTECCHIO
MY COMMISSION # GG 184984
rr„po EXPIRES: February 12, 2022
Bonded Thru Notary Public Underwriters
(Rev. 08.12)
Signature
Print or type name
Notary Public -State of Fz-
Commission No.
My Commission Expires:
as
' Skymark Roofing, LLC
' ,Ir'lllll SKYMARK 2845 Palmetto Rd • Mount Dora, FL 32757
-�
ROOFING—
CCC 1331332
352-805-8935
Skymark Roofing, LLC ( Contractor ) agrees to furnish all materials and labor necessary to do the home improvements at the following
address: �1
Name Rmlo C-Lcrp Phone (H) Phone (C) W7. 3(D S.y
Address Q 02 Date 2to
City Florida Zip 3Z7`7� Email QMCu�(I CM co
In Accordance with S eci 'cations given below: Re -roof
A. Type of Roof: � � rQ I Pitch �/12. _V1 story _ 2 Story
1. Permits fees, cost to file Notice of Commencement, dump fees and all applicable taxes.
2. Protect the surrounding structure, tear -off & remove old roof to workable surface.
3. Re -nail roof deck with eight penny ring shank nails. (Law & Ordinance).
4. Replace rotted wood t $ - /per 4x8 sheet OSB or PLYWOOD, and $ /LF (2x4 or 1x6 etc,) if any. itial)
5. Install undedavment over entire roof. Roof pitch < 4/12 double 19" Lap
6. Install FHA/VA eaves drip. Color > Size (initial)
7. Install New Valley mateh I and flashing as necessary.
8. Install New Cn (�` boots over vent pipes and reseal v nts//'� ��nn��,
9. Install 30 year fiberglass shingles. Manufacturer: �pr�p.{gr� ((('I 'iin�et—�MlsColor: C?QVJ G(initial)
10. Install L.F. of Ridge Vent and/or (number) of 4 ft. Off -Ridge Vents. Color �Z��rr� (initial)
11. Clean job site of all work debris.
12. The roofing Contractor will coordinate the removal and reinstallation of roof related peripherals such as (but not limited to) Solar units, skylights,
T.V. Satellite Dish and Air Conditioners, etc. Removal and reinstallation of existing gutters will not be guaranteed against leaking and damage.
13. Removal and reinstall existing soffit and fascia at $ /L.F. in addition to contract price, if required. The cost for such work
will be in addition to contract price and herein approved by homeowner.
Gutters VA PIPEJACKS: 1" _1.5" 1-2" 3" 4"
Satelliteye GOOSENECKS. _L4" 10"
Solar Panels: Pool / WH - Size r x— , # Panels Other:
Other:
Homeowner requested approximate start date (weather permitting): / b 20 4- Pre- Home Inspection: (initial)
Roofing Contract Price $ t^ Z , / to
Deposit $ , 3 lei -a
Depreciation / Supplement ( If apj icable) $ SuDD (�ltieA�F � ; r*
Balance Due $ - ! ,pNA � $
Other Charges Eva Aerrawyd) $ UPON COMPLETION
Executed in duplicate, one copy of which was delivered to, and receipt is hereby acknowledge by Buyer on -X, I (Q 20 it
Approved and Accepted:
NOTICE TO OWNER
a. You are entitled to a copy of the contract at the time you sign. Keep it to protect your rights.
c. Homeowner(s) responsible for any additional scope of work not included in this contract.
d. Homeowner(s) will pay this roof Aco
in full prior to starting or completing additional restoration work with an ubc
(x) (x)
urchaser Sign u Purchaser Si ture
(x) 3,s1 5ftf ��
Account Manager Signature Cell Phone Email
ACCORDING TO FLORIDA'S CONSTRUCTION LIEN LAW (SECTIONS 713.001-713.37, FLORIDA
STATUTES), THOSE WHO WORK ON YOUR PROPERTY OR PROVIDE MATERIALS AND
SERVICES AND ARE NOT PAID IN FULL HAVE A RIGHT TO ENFORCE THEIR CLAIM FOR
PAYMENT AGAINST YOUR PROPERTY. THIS CL AI!:4 !c KNO!^l.NJ AS A CONSTRUCTION LIEN.
IF YOUR CONTRACTOR OR A SUBCONTRACTOR FAILS TO PAY SUBCONTRACTORS, SUB -
SUBCONTRACTORS, OR MATERIAL SUPPLIERS, THOSE PEOPLE WHO ARE OWED MONEY
MAY LOOK TO YOUR PROPERTY FOR PAYMENT, EVEN IF YOU HAVE ALREADY PAID YOUR
CONTRACTOR IN FULL. IF YOU FAIL TO PAY YOUR CONTRACTOR, YOUR CONTRACTOR MAY
ALSO HAVE A LIEN ON YOUR PROPERTY. THIS MEANS IF A LIEN IS FILED YOUR PROPERTY
COULD BE SOLD AGAINST YOUR WILL TO PAY FOR LABOR, MATERIALS, OR OTHER
SERVICES THAT YOUR CONTRACTOR OR A SUBCONTRACTOR MAY HAVE FAILED TO PAY.
TO PROTECT YOURSELF, YOU SHOULD STIPULATE IN THIS CONTRACT THAT BEFORE
ANY PAYMENT IS MADE, YOUR CONTRACTOR IS REQUIRED TO PROVIDE YOU WITH A
WRITTEN RELEASE OF LIEN FROM ANY PERSON OR COMPANY THAT HAS PROVIDED TO
YOU A "NOTICE TO OWNER." FLORIDA'S CONSTRUCTION LIEN LAW IS COMPLEX, AND IT IS
RECOMMENDED THAT YOU CONSULT AN ATTORNEY.
M
1. Contract documents. This contract consists of this document, extra work/wood authorization, if any, and if permits
hereunder are to be financed all financing documents. No promises other than those specifically set forth in the contract
documents shall be recognized by either party. The entire understanding and agreement of the parties is contained in the
contract documents.
2. It is understood and agreed that this contract shall become binding upon Roofing Contractor of Record assigned to
the contract on the front.
3. Work on the job described in the contract documents will commence on approximate start date on the front of the
contract and will be completed in a timely manner. The recited date is an approximation and is subject to scheduling diffi-
culties of Seller, labor and/or material shortages, acts of God and other events not foreseen by Seller. Seller reserves the
right to employ any sub -contractor for the completion of the work described in the contract documents.
4. The Contractor of record reserves the right to substitute materials of equal ar greater value and. kiod.,.Any Required
materials such as fire retardant plywood, tongue and groove board, etc. will be billed on a time and materials basis. All
other changes required by New' Jurisdictional Code Enforcement Laws may result in additional charges.
5. Interest at the rate of eighteen (18%),per cent per annum will be charged on all balances not,paid as per the terms
specified above. Reasonable attorney's fees will be charge to the Purchaser if it is necessary to place this contract in the
hands of an attorney for collection, and this charge becomes a part of the contract and obligation of the Purchaser to pay
6. Parties agree that this agreement shall be constructed according to the laws of the State of Florida and any action
brought thereon may be brought in the State of Florida. Venue is hereby agreed to be in Lake County, Florida.
7. BUYERS RIGHT TO CANCEL (SOLICITED SALES ONLY) IF THE OWNER CANCELS THIS CONTRACT AT
ANY TIME BEFORE STARTING THE WORK, AFTER THE MANDATORY 3 DAY CANCELLATION PERIOD, OWNER
AGREES TO PAY_ THE CONTRACTOR TWENTY PERCENT (20%) OF THE CONTRACT AMOUNT PLUS THE COST
OF MATERIALS PURCHASED FORTHWITH AS LIQUIDATED DAMAGES, WHICH THE PARTIES HERETO -.AGREE IS
A FAIR AND REASONABLE AMOUNT INCIDENT TO THE COST AND EXPENSES EXPENDED BY THE CO'rNTRAC-
TOR IN CONNECTION WITH THIS CONTRACT. Owner and Contractor agree that the terms and conditions on the re-
verse constitute a part of this contract and are specifically incorporated herein by reference. Owner acknowledges receipt
of a duly executed duplicate copy of this contract at the time of its execution.
8. Both worker's compensation and public liability insurance are carried by the Seller and they are applicable to the
work to be performed. It is understood and agreed that the buyer hold harmless, Contractor for any damages that
may occur to the buyer's driveway(s) during delivery of materials and/or removal of the work related debris that
maybe required to perform this home improvement contract. Furthermore, the buyer herein gives permission for typ-
ical delivery vehicles and typical waste removal vehicles to enter said driveway(s) for the purpose of expediting this sales
contract.
9. Contractor will coordinate removal and reinstallation of roof related peripherals such as (but not limited to) solar units,
skylights, T.V. satellite dishes and air conditioners, etc.- The cdst for such work will be in addition to contract price and
approved by homeowner.
10. The Contractor of Record shall not be held responsible for damage to electrical lines, water lines, and refrig-
erant lines or other mechanical components that have been improperly installed near roof decking and may be damaged
while performing installation of roofing materials. The Contractor of Record shall not be responsible for any addition-
al cost due to roof decking that may have old materials adhered in such a way that requires re -decking of structure.
11. Construction Industries Recovery Fund payment may be available from the CIRF if you lose money on a project
performed under contract, where the loss results from specified violations of Florida Law by a state -licensed contractor.
For information about the recovery and filing a claim, contract the Florida Construction Industry Licensing Board at the
following telephone number and address: 7960 Arlington Expressway, Suite 300 Jacksonville FL 32211-7467 or call (904)
727-6530.
12. Chapter 558, Florida Statutes contains important requirements you must follow before you may bring any legal
action for an alleged construction defect in your home. Sixty days before you bring any legal action, you must deliver to
the other party to this contract a written notice referring to chapter 558 of any alleged construction defects and to consider
making an offer to repair or pay for the'alleged construction defects. You are not obligated to accept any offer which may
be made. There are strict deadlines under this Florida Law which must be met and followed to protect your interests.
13. THIS CONTRACT CONSTITUTES THE ENTIRE UNDERSTANDING AND AGREEMENT of the parties, and no
other understanding, warranties, collateral or otherwise, shall be binding unless in writing and signed by both parties, and
further this Contract shall become binding and effective as of its acceptance by the Owner. The Contractor agrees to per-
form the work in a good and workmanlike manner with reasonable dispatch in accordance with the attached specifications
and warranty his workmanship for a period of 5 years from the date of install.
DEPARTMENTCITY OF
,Sk�40RD
FIRE
JOB ADDRESS: 1 Z 1 M a .h) e it )Ood D V
PERMIT #
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
STRUCTURE TYPE: �GLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: O<PLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF
DECK TYPE (PLEASE SPECIFY: Y I
**PLEASE NOTE: ONLY 100 SQUARE FEET 4 THE E"XfSTI14G DECK IS PERMITTED TO BE REPLACED**
ROOF VENTILATION: G6F-RIDGE O RIDGE O SOFFIT OPOWERED VENT
SKYLIGHTS: O YES &NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 — 4:12
412 OR GREATER
O TURBINES
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
�HINGLE
FL# '44erl
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
0INSULATED
FL#
O TILE
FL#
O OTHER:
Q
FL# b — f�
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#
0INSULATED
FL#
O TILE
FL#
O OTHER:
FL#
CITY OF
Building & Fire Prevention Division
ORD RESIDENTIAL RE -ROOF POLICY & PROCEDURES
FIRE DEPARTMENT
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 C CODE COMPLIANCE BY PERSONAL INSPECTION.
CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: DATE: /�
CITY OF
Sk�40RD
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF AFFIDAVIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING9 AND ALL FINAL ROOF COVERINGS
PERMIT #: " / Z 7 ADDRESS: �-1 " OUDIPY000d Ir
Saafzrd , 1 3Zn I
I /I yLdK1, W r , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOF CONTRACTOR, ENG EER, 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:
�� ,
CONTRACTOR SIGNATURE: DATE: %al-
(MUST BE SIGNED BY LICENSE HOLDER OR OWNER/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, ARE -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 L41X—
ifs (}�
Sworn to and Subscribed before me this �_ day of MA.2- r1,J 20 iy by:
Who is'4 Personally Known to me or has ❑ Produced (type of
identificatio as identification.
T ature of No u lic
'a.°yo •; ALICIA:FQLAN
ate of Florida MY COMMISSION # GG 051557
�j i^ =y'� EXPIRES: November 30, 2020
(/l,'' `` ;o'a . q, Bonded 7hru Notary Public Underwriters
Print/Type/Stamp Name
of Notary Public