HomeMy WebLinkAbout121 Rabun Ct (2)/%
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CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: 1�--)oi_s:4__
Documented Construction. Value: $ 5", y G O
Job Address: `2l ka-b u n Gt' Historic District: Yes ❑ No ❑
Parcel ID: O l — Zo — 31 - S'01— 0OOO — O 3 "co Residential E Commercial ❑
Type of Work: New ❑ Addition L`_I Alteration ❑ Repair ❑ Demo ❑ Change of Use ❑ Move ❑
Description of Work: V"2 — �"aoj�—
Plan Review Contact Person: C-larz-e` Title: K-) -
Phone: 41. 3(; fP UW 0 Fax: Email:'l� C , car► i
Property Owner Information
Name P) i S Q r) CTA..I l O Phone: 221 26Z 3yLl Z
Street: I Z 1 i0.10 y n f± Resident of property?
City, State Zip: S a rn -�:a f d , r l- 3 9 7 73
Contractor Information
Name Heritage Construction & Roofing Phone: (407)366-6000
Street: 1544 Seminola Blvd. Suite 136 Fax: (407)366-6065
City, State Zip: Casselberry, FL 32707 State License No.: CCC132650
Architect/Engineer Information
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
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, b
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: 5'h Edition (2014) Florida Building Code 1�
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 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/A t Date S gn re of Contractor/Agent Date
Print Owner/Agent's Print Contra e
r��
1 1 27//7 7/f�
ure-of Notary -State a Date ignature of Fletary-S n a Date
pv pu k'"ri�Vir'•
o1a Notary Public State of Florida av a ti
? v *,P , ° . Nota Public §tate of Florida
Lesley G Gana o 41,:
c` My Commission GG 009517' , esl�ar?a
v,�,of�,c Expires07/07/2020 � Y +?1?.jj 0' 009517
s,� F�<v: pi5es 07/07/,2020
Owner/Agent is ersonal y nown to e or Contracto,ii Pei o> Me or
Produced ID Type of ID Produced ID ype of ID
BELOW IS FOR OFFICE USE ONLY
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 ❑
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
HERITAGE
Construction & Roofing Inc.
1544 Serninola Blvd. Suite 136
Casselbervy, FL 32707
PH: 407-366-6000
FX:407-366-6065
Info@,Heritageci-.com
CGCJ505',0-15 CM326650
Uwner(s):
Address!
tam
A.
0
ap
P
WX P
A 'etn
City:
Zip Code:
Manufacture:
Account Manager:
lontact:_4)__.. 0
INSURANCE COMPANY INFORMATION
Company:
�P,!JIILII f-,
Policy#:_5HC2 2012 11
ClaitTl ;-':b'fU10(X)3 I 14
MORTGAGE COMPANY INFORMATION
Cornpany-_.$'6fflK (DV- AlKkn,
Loan Number:_0.5t&)_(2_qa11__
-3. 1 26 Z 3;2.
Email:
Roof CRV�
R_Owner's Insurance CoBpaj!X C.jojt _,.pp_
z,11 YLI-0q all b+ _v_okda ble.
As>; ruix�,q of ]q..,Ui;cbene'M5 f.j; tjf ,n;
any and all insu-ance
under any applicable insurance policies to Heritage
-J"C SCOPC (if b-! 11imiled to a Fullt-,,00f
Replacement. imake tLis aLithorization in zt�Ycern-,J sap-,;k raRte-dails ?nd otherwise
perform its obligations under this contract, inciludiric, not at tjht: :J rvice. f also her0l Y :11Y insurers) to release any
and all irz1brm.;t4on rcqi;ested by Heritage, its rep, escwtativi_,, or Z e�Mev for the direct, pwTo.;e of a
m ,y pri%a,.---; rights. 11'7,."ayrneot is In."t",—'ectly to the i". shall be endorsed aver to
for seices rendered. In this regard, I waive 'tual Lcr`cft:5 Wle P�t:�', bY my hasurer(s)
Heritage immediately upon receipt. I agree that any portioxt 0(' work, dc.ductibies "
covered by insurance, mustbt paid by the widersigf!txlCjj jrLy betterment or additional work rcquestc�`dt�y the und2r,sign.cl not
!t;s tilt, Owne'r,"; respurlsibii,ity to pay all; insurance
Deductibles. Ownur-:i ou',-of-Ijocket Sh-,,!L iip"zic p u air
Of
deteriorated deckin q is requirmil and/or 0%wrtex requcs-,.� C.r rac a. I . L C ANNC-T pay, waive, rcb3te, or to -,vaive or rebate all or
any part of the insurance deductible applicable to thl�� inswa-,11ce cjaim for miyrnw ofiv�)rk. In Vic event of a discr--pamr the deductible amount stated on
the insurer's Loss Sbeci shall over rule (icitictibit "'KI!, * Y_
, O'N.
Deductible: PAJ P I �11 jl'ui_i�. ?IAJ5 10,t44V
M0RTC;A6f',T1J_T'J40 --- R1_Z_Ar_10_N-...... Initials)
1, Owner Cr-,,�rj; atj�t� ri j�ii
A� 7 of^ jor iN.,"ort�ia .0
Heritag,- Coistruction &_ Rooting. cl-, ; .., ge C . to speak With
nam! payrnenistatus,
t 0, 11., 2 C
PAYMENT SCHEDULE: Owner agrees to pav'tIel'it`age bas-d 0111 thr- following pa.-, schedule- (i) Deposit in. the ain,nmt of$
due upon signing this contract (ii) the Contract Price, ks !:h,a-y d-pnt.-oiatiov retained by Owne.-'s irisurer(-.31 njus Upgrade
Costs, due and payable to Heritage upo (-ompjf�tizir) (�f wi)r�
n _ _e,q perO^.Trite,; qrt,j, �ijj ) tLe remaining Contract Pric- ferii!al to arily applicable
depreciation adior change orders) due and payable it-, Hct-,i VjK('.
inZ2% of Contract jjj fri the event of a pending_ inspfc1ion, no more than
ji), W "!I held tit iti-I i h� Z!111',C,a ."0VTE,�*I: Ty:_
Q
------ R.tit '.,1a;%1tnent Wort wii-11 Price: Upon
insurees, approval and wbjcz-,z to he ter.-,-t- ?r, -1 -
lio ", ;v`1;.,o 1*.� *1 ssc V 10 oerform, the
IS, a" M ',W.4 i-,-ovide hic !al)f,,r ntt:c
full roof repi3ccqer.-iwh;,,1i shz,.ip;,.cc jfollowin!u y', ;
ap": al, appromirn8zely wit:,nilt 3V; d'lys, Coliditions permitting.
Owner's 0eel&-;jtjr.).,j c,.f frtorit: 0er acKno-,,�jedqc��
C011)illavy for a fil)-vo`
Tf, t I ezneirt, Heritap shall
perform thn roof r 1 a(. -e
!?.ccin�:nt upon reccipt of 6inds fi-,,n Ciwner,s tc i],
Heritagen-r -ate ti1c services of
z Oiviwr may do so before raidrightorl gic Ihird, bow:`,- cxeclw& Owner S113,1 re-iv�t A01 mfund of al) depolits. Owner
d;�V
may also re.s(In(i Cfntrect before midnhit on ,jjQ al;zer ric-lificat t:1at
11 th din for
payment on roof contract has beat, denied, jn
.1 ;. n �Z:ct:s r'C'Ss 01-NaSM, sbilfl be poz tn)arr- d (.r delivered
to Heritage's co.Tyypte. 1)14 Scmino[-3 13h,', L, .'C I j? , J, ".
4 1j(1F, YX(7
-4, F.,27JONS: e thr" (3) day right
of cancellation 60ES N� APPLY to cnlema o." 0`;flt iin, k 0-Clie et'sim,-e. 0
I �, Mi 16,enaarid all statements,
terms at id conditions oj7 ii.(� ai7 .11 L
;It �tg Nrtilt
constitute., the entire agreement .1, ur ders-tand that this contract
by both part"m F.,ach !N,Vv wa I -arc,, )o beaade i-I wr;:!:�oo and afinx-d upon
hm j hority to �,nftr into tbc f;tu!tro.i:tt)_nd thpz it is binding and
enforceable in with its term .
x
Aulhofrzed 'Plcrjta�e Reples aTi V e ---- --
D.
Print Name
TERPMS AND ilz�`,V 4z 'Zf." re;113r'rien-taV., for a f--.0 011 tii terrn-s and conditions
stated herein. I t`uwter grtT to Frovidc. !Jlzritdlle v4fi) u,c "Iftfit'raied by mY mdalh Im.ax I'utcctss to
the
.0 -
property for tl-e purposc offtaging anci up(M %'V;A-A.. :�;applejxi c�,.vlta? Cj111:.1?V'1: Pl�, -:t,'v file a -uppiernCrital claim
with Ownert.,; :o�-L�Zuict-- iri t1--c event that the : ;, , Et i c1t i of
amourf(s), in addition to any depreeiate"a 11 . -`�"' 'ri` "W"' L `_11-C ".u� �`j K' `� U -eCiv
Work shall coranience at disUt.j!tj�)j7. f,j� "jl;�, L, , cvit -POL I Q WL COMM r",a t of Work:
rc, thc 1;c. i�,v .jj, to dole w: coLurov n si �i,
weather, Aat�: ��cve;,xnental iv Uri )Orfom z C strikes, fire,
%it-cOt-sult of Ow-ner's
insurer cMier circumst=ces not listt;,' ViLich at
vvner-v�. mtnc,�e any .Intl aill iuni,, F)t]L� `01; 1IRd * ibl'alii) 7-)� to it is the sole
responsibility ofO
-a"s In it n, 1 im' tt�d to, Ou, ma- ties, shrives or other areas
susrt,,ilible to vilorlitir 7s ?s
j Fnrjrxn��(- of W*rk Contracted
herein, or diirraes restyking
to
THIS INSTRUMENT PREPARED BY:
Name: Heritage Construction & Roofing •Q h fil^�ny G�2 S
;Address: 1544 Seminola Blvd. Suite 136
Casselberrv. FL 32707
NOTICE OF COMMENCEMENT
State of Florida
County of Seminole
Permit Number:
GRANT 11ALOY r SEMINOLE COUNTY
CLERK OF CIRCUIT C:OUR1' & COi'PITZOLLER
CLERK'S T 2018625495
RECORDED 1137/ i 12013 I.2"36.:39 P11
RE -CORD I N(i i•- EES $1.0. i 0
RECORDED BY .Ier_kepire
Parcel ID Number: _0'7 ZQ -" 1 — S07 —=0 -03110
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following infonnatiop is provided in this Notice of Commencement.
DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available)
GENERAL DESCRIPTION OF IMPROVEMENT:
Rp- - f ooF
OWNER INFORMATION:
Name: I + -S On Cra- I iQ
Address: 1 21 R&Lb u n C -f- Sc-n Ford l= L 3 2 7 7�
Fee Simple Title Holder (if other than owner)
CONTRACTOR:
Name: Her; fa-5e Cc,^S•f-rucf'I'(nr) C,-nci
Address: I ;Sill--i S ern; n o j c. K3l u d Sfe / 3 6 Cass o 1b errV 3 2 70 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)(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 1 year from date of recording unless a
different date is specified)
.r—
Qm�
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
2�
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
y� Ing
BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalties of perjury. I 01jare that I have read the foregoing and that the facts stated in it are true
to a best of my knowle a and elief.
C�—
rt„�
o
cc
cc
Owner's Signatu Owner's Printed Name
Ion a tatute 713.13(1)(g): ' The owner must sign the notice of commencement and no one else maybe permitted to sign in his or her stead.'
v
V' oc
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LC
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tate of t� 1 Countyof SC"'\ 1� G ` C
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The foregoing Instrument was acknowledged before me this 2 7 day of 20
� J
z
by r^l Who is personally known to me ❑
x
w
"� m�
Name of person making statemen " - 4L
OR who has produced identification type of identification produced: A�+�d��'"' 1
=-OiOLYIN* Notary Public State of Florida
Wwy G Garza
;p,c ,, o My Commission GG 009517
FnfflOQ' Explres0%/07/2020
CITY OF
SjkNFORD
FIRE DEPARTMENT
��� IMIIII
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: 3Z79
CITY OF
Ski4FORD
DEPARTMENTFIRE
JOB ADDRESS: ` 1I �'c V U h (+0
PERMIT #
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
STRUCTURE TYPE: SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF
/INSTLALLEDOVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY): ifI-/ G O A L&A-%1,YvQ
**PLEASE NOTE: ONLY IOO SQUARE FEET OF THE EXISTING DECK IS PER10ITTED TO BE REPLACED * *
ROOF VENTILATION: DOFF -RIDGE O RIDGE OSOFFIT OPOWERED VENT
SKYLIGHTS: O YES �No IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #: _
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 �:12 — 4:12 O 4:12 OR GREATER
TURBINES
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
SHINGLE
WG
FL# �O
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
O INSULATED
FL#
OTILE
FL#
rr fI j^
OTHER: v �lA �l I�Y\'L�k
I 1
FL# IV1
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IF 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#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
O INSULATED
FL#
O TILE
F L#
O OTHER:
FL#
City of Sanford
.Building and Fire Prevention
RESIDENTIAL RE -ROOF IN PEGTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: I '" / _2S r ADDRESS: l 1 a ,c _ OA • `Carl e—O �
an,
I 3 C} _ � _ 'A (- _ —' AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, ENGINEER, ARCHITECT, 6F 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 553.944).
LICENSE #: (_ t' - C � 7 Z 6 6 G
COMPANY I CONTRACTOR:
CONTRACTOR.SIGNATURE; ! DATE;
(MUST BE SIGNED BY LICENSE H OR OWNERIBUILDER) v
A FINAL ROOF IN.SPFECTION IS REOUIRED;
THIS SIGNED AND NOTARIZED AFFIDAVIT MUST BE PROVIDED AT THE JOB SITE AT THE TIME OF THE FINAL ROOF INSPECTION,
ALONC WITH DIGITAL PHOTOGRAPHS OF EACH PLANE OF THE ROOF SHOWING IN DETAIL ALL CVMPONENTS (DECKING,
UNDERLAYAIENT, FLASHING, DRIP EDGE AT UACHMENT) 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 JC V%01 e
Sworn to and Subscribed before me this J day of / Z }/ ; 20 by:
Who is weersonally Known to me or has 0 Produced (type of
identificst%df �� _, tts identification,
PrintilType/Stamp Name
of Notary Public
���'�"�: any .
o01 Pu Notary Public State of Florida
? Lesley G Ga2a
r:, o My Commission GG 009517
Expires 07/07/2020