HomeMy WebLinkAbout123 Gleason Cove (2)FEB 2018 f CITY OF SANFORD
BUILDING & FIRE PREVENTION
rW"
PERMIT APPLICATION
Application No: � g` q-A
Documented Construction Value: $ l9 `t !
Job Address: C t -e-aJO V1 Historic District: Yes ❑ No ❑
Parcel ID: 01 •a2 0 -bQ . ra,3 . 0 C)p0 Residential N—Commercial ❑
Type of Work: New ❑ Addition ❑ Alteration ❑ Repair ❑ Demo ❑ Change of Use ❑ Mov-eI❑
Description of Work: ��KyQ� 74�'p0.� �P��/
?-� a-c �W_ '> 4 yb�`''X�? `� la
Plan Review Contact Person: Title:
Phone: Z a �'{e3? Fax:
Email:_TtM• 0-tMal(e+{ p �,tP��'�i�P2/Mts•(.�/�+
Property Owner Information
Name �Akx C : a\ c r 40 Phone: Ll A a 1 • (o U 7
Street: I )3 Q �L0_,Sov�- tQ 4"e' Resident of property? : J e)
City, State Zip: SC"'�'A I= (. --t�-7? 1
Contractor Information
Name
Street: 9' At y -c
1.
City, State Zip: �0. �� C-4- 3 1 (4 0
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Phone: '*')- a3;")-J-Y0)
Fax:
State License No.: C C ck 331 1 1 I—
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. 1 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: 51" Edition (2014) Florida Building Code
Revised: June 30, 20t5 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 subnttal.
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
Print Owncr/Agent's Namc
Date
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
'2— y
Signature of Contractor/ eye Date
P-14— 0:1 ozz
n ConLractor/Aucnis Nang
Signature of Notary -State of Florida Date
�µ+r>U'• CHRISTINE O'MALLEI'
MY COMMISSION # FF 087307
W. : EXPIRES: January 29, 2018
qd F?° Bonded Thru Notary Publ c Underwriters
Contractor/Agent is X Personally Known to Me or
Produced ID Type 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
Home Depot Contractor License Numbers:
FL: EC0001440, CGC1514813, CRC046858, CAC1813767, CFC1426021, CFC1427642, 22640, CAC 1818831, CCC1331113,
CCC1331130
Salesperson Name and Registration Number:
John Lund : R-1-128533-13-00252
Home Improvement Agreement
Home Depot U.S.A., Inc. ("Home Depot") or Service Provider named below will furnish, install and/or
service the equipment listed below at the price, terms and conditions as outlined on this form.
Customer Information:
Marcia Barnes Tampa 10528800
First Name Last Name Branch Name Lead #
123 Gleason Cove SANFORD FL 32773
Customer Address City State Zip
(407) 221-6676 (407) 221-6676
11
Home Phone# Work Phone# Cell Phone#
mgbarnes12@gmail.com
NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR
OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT:
9208 Florida Palm Drive Tampa FL 33619
Address City State Zip
or Email CustomerCancellationSouth@homedepot.com
BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE
SUPPLEMENT PROVIDES A different CANCELLATION PERIOD. THE STATE SUPPLEMENT
CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE.
YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME
DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME
DEPOT OR PROFESSIONAL, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME
CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU.
OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT
HOME DEPOT'S EXPENSE.
THE LAW REQUIRES THAT THE CONTRACTOR GIVE YOU A NOTICE EXPLAINING YOUR RIGHT
TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL
AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL.
JI-
X.. .._> 12/21/2017
n��......e.�� c�....�.��.e Date
FL: EC0001440, CGC1514813, CRC046858, CAC1813767, CFC1426021, CFC1427642, 22640, CAC
1818831, CCC1331113, CCC1331130
License numbers are subject to change in accordance with local or state government processes. For the most
current listing of license numbers held by or on behalf of the Home Depot, please visit www.homedepot.com/
licensenumbers.
Scope of Work
Job M (internal Reference) Products: Spec Sheet(s) M Project Amount
Roofing Siding Windows Insulation
10528800
❑ Gutters / Covers ❑ Entry Doors ❑ 0
10528800
$ 9947.60
❑ Roofing ❑ Siding Windows ❑ Insulation
❑ Gutters / Covers ❑ Entry Doors ❑ 0
$
LJ Roofing Siding LJ Windows Insulation
$
❑ Gutters / Covers ❑ Entry Doors ❑ 0
Roofing LJ Siding Windows Insulation
$
❑ Gutters / Covers ❑ Entry Doors ❑ 0
SubTotal
$ 9947.60
Sales Tax
$ 0.00
Total Contract
$ 9947.60
Amount
Warranty:
The warranty on the work identified above is listed in the General Terms and Conditions, or if applicable, specified in
the following documents:
HDE-524 Roofing Warranty Premium
Warranty
Name(s):
3
This Instrument Prepared By:
The Home Depot
9208 Florida Palm Dr.
Tampa, FL 33619
Permit No.
State of A County odaf Iyll
NOTICE OF COMMENCEMENT
Tax Folio No. W -at0 -3SS -,S . d40 V -1 y
THE UNDERSIGNED hereby gives notice that improvernents will be made to Ltriain real property, and in accordance with Chapter 713, Florida
Statutes, the following information is provided in this Notice ofConimencenical
of property. and street address if ava)�ablel l0 `, �� W 6 4S J
2. General description of improvement: _SL.gt4Q -4
3. Owner information (� �+
(a) Name and address: l ' �'� L`�C►•�� Y J a�� n L' �V� ' Y` l� L
_�..
(b) Interest io property:._�V�y�.u,�
(c) Name and address of fee simple titleholder of other than owner):
4. Contractor
(a) Name and address: The Home Depot, 9203 Florida Palm Drive. Tampa FL ."3619
(h) Phone number: 813-626-7548
5. Surety
(a) Name and address:
(b) Amount of bond _
(c) Phone number:
6.Lender —�-- —�—`--
(a) Name and address: _ NIA
(b) Phone number:
'. Persons within the State of Florida designated by Owner upon whore notices or other documents may be served as provided by Section
713.130)OR., Florida Statutes:
(a) Name and address: N/A
(b) Phone number: _
8. hi addition to himself. Owner designates the following persou(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),
Florida Statutes:
(a) Nanic and address: I f/rL
(b) Phone number: _
9. Expiration date of notice of coninieucenient (the. expiration date is t year from the 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 L SECTION 713.13, FLORIDA STATUTES. AND CAN
RESULT IN YOUR PAY1N(, TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMNIENCEMFNT MUST BE
RECORDED AND POSTEDON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR .CORI TN G YOL;R 9 ICI OF COMMENCEMENT.
10.
Signature of Ow»cr Ow ier's Authnri7ed UfliceriUirectot
I?vrtner/11ana�er
Si�gnatory sTitL-/Offire
The futegoitg Inv. umcm was acknawtedgeU t>cfore me thi day of c� V ��,y 1 '" �x,`(L� CC^ �� h•t.•�
_fname oFlxrsoni 3.i (type ofauthority. e.g. officer, trustee., a!uora y in fact) for
waive of ixuiy uu Wulf orwhom Instrument ins executedi.
5ignattve of of Puhlic - $IaIe of florid' T �-
Persowlly k w ;diced Idcntificeniun]'
-AND• AND...
C nddi pc!raltith of penury. i declare that 1 have read.(he torcguiog end that the fads stated in it are uut! to 1.hc bast r idh,a
Rcvixd2rd3/17 JOMN LUNG Signature ofNaaualI)crogm in Lin,410) Move
NOTARY PUBLIC
STATE OF FLORIDA
C-91`1# 00050373
Expires 12/3/2020
GRANT MALOY, CLERK OF CIRCUIT COURT SEMINOLE COUNTY FL
CLERK'S # 2017130913 BK 9048 Pg 1249; (1pg) E-RECORDED 12/28/2017 10:55:56 AM
10.00
This instrument Prepared By:
The Home Depot
9208 Florida Palm Dr.
Tampa, FI, 33619
Permit No.
State of Fior a
County
NOTICE
Tax Folio No. W oZy —3y - � • tlu U - 114 (AL ()
T11F. UNDERSIGNED hereby gives notice that improvements will be made in cerain real property, and in accordance with Chapter 713, Florida
Statutes, the, following information is provided in. this Notice of Commencement
ption of property, and street address if lvaiiabiel. 17 (_ f) oC\O. w a, CL
2. General description of improvement: Q,1
3. Owner information
(a) Name acid address: �No, 'n�4�C�,^t S �e1 ��AJd Y►�O
�+
Vim,, c Ym, l� L
it
(b) Interest in_
property:.. CLV�! t4—
—'
(c) Name and address of fee simple titleholder (if other than owner):
4. Contra( tor
(a) Name and address: The Horne Depot, 9203 Florida Palm Drive, Tampa FL 33619
(h) Phone number: 8 t 3-626-7548
5. Surety
(a) Name and address:
(b) Anouni of bond
(c) Phone number:
6. Lender
(a) Nana and address:. NIA
(b) Phone number.
',. Persons within the State of Florida designated by Owner upon whom notices or other documents
may be served as provided by Section
713.130)(a)7,. Florida Statutes:
(a) Name and address: N/ �
Ib) Phone number:
_
8. In addition to himself. Owner designates the following persou(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),
Florida Statutes:
(a) Name and address:
(b) Phone number:
9. Expiration date of notice of commemcemenl (the expiration date is I year from the date of recording tmless a different date is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE. EXPIRATION OF THE NOTICE OF COMMENCFNIENT
ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART L 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 COMNIENCING WORK OR WORV1U
Signature of Owtlrr (A er's Au[horized Oflicec)pirectar
i ;vttlerlllanngrr
11�S,ig�nmory'sTitW(N(fit��_,___..r.._... ,.____....
The fIxegoing imv,umem was acknowledged before me chi 1 day of
y--� (name of tx; sow as -6_ (type oFauthoritY, e.g. officer, trustee... aetoraey is fact i to:'
�c lnatne of'puty uu behalf nrwhominstrnmeta tons executedi.
Sinatureof of Pniie - M to ofForid,
Pesonaltyk w oduced IdcntifiUA1on_L_gh
Veriike!60n Pursuant to Section 92.525Vlo:9da Sww-
t:ndcr tx::uhics o(per,•ury i dedare that 1 have read.tha foregoing and that the Taus smwd in it ary uue to 6c. N-sv r, rwi -dKc any; he 1'
Revixd2rl+lt7 JOMN LUNG Sign,ntreofNaturalPer. .onSignin fi❑1.inekiQlAhoy
*.)NOTARY PUBLIC
STATE OF FLORIDA
Commit GG060373
Expires 12/3/2020
GRANT MALOY, CLERK OF CIRCUIT COURT SEMINOLE COUNTY FL
CLERK'S # 2017130913 BK 9048 Pg 1249; (1 pg) E-RECORDED 12/28/2017 10:55:56 AM
10.00
CTyO
Building & Fire Prevention Division
4FORD 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: l�
LIMITED POWER OF ATTORNEY
1, Raquel Swanner (Name of Home Depot Qualifier), license # CCC1331113, CGC] 514813 hereinafter referred
to as the "License Holder," the qualifying agent of The Home Depot, hereby appoint the following persons as Attorney -
in -Fact of the License Holder/The Home Depot, who shall- act as my agent with respect to only the following matters
(a) signing and submitting buildjn permit applications, (b) obtaining building permits, and (c) obtaining the certificate
c� of occupancy from a.V�rO � , (pertinent city/county/state) on behalf of the License Holder/The Home Depot:
Brian Kirby Tim O'Malley Erick DeDios
Aaron Hallich David Weed
j
LD Raquel SwannerSo.�'>1"I -7
t h, 1 r
Title: Regional Compliance Manager
Company Name: _ Home Depot USA
Mailing Address: 9208 Florida Palm Dr
Tampa, Fl 33619
Telephone No.: 813-626-7548
Fax No.:
State of: Florida
County of: Lake
WITNESSES (Tw atures required:
Sign:
Print Name: � vkt, v,, • aS
Date: t 131, V
Sig
n: n: __ k_�
Print Name : t t t
Date: n
This Limited Power of Attorney is non -durable, meaning it ceases effectiveness if the principal becomes incapacitated.
If I have designated more than one agent, the agents are permitted to act separately.
( ) This power of attorney and authorization shall expire on
(X) This power of attorney and authorization shall continue in full force and effect until I deliver to you a letter
revoking the power or a new Limited Power of Attorney form replacing any previous authorization.
3 C-4-
The foregoing instrument was acknowledged before me this day of20 1 �,-by
Raquel Swanner, the Qualifier of The Home Depot , a
corporation.
Notary Public
Commission Expires:
corporation, on behalf of the
TifilOTHY R. 0 MALLEY
1Y GOMMISSION # GG 117135
EXPIP,ES: August 7, 2021
bonded Thru Notary Public Undernnters
Updated 31912017
SGR/15641978.1
PERMIT #
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
JOB ADDRESS: to G1cf."Sq� Y\, tsv-A-
STRUCTURE TYPE: �GLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINTUM
RE -ROOF TYPE: REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER NEW ROOF INSTALLED OVER EXTSTING ROOF)
DECK TYPE (PLEASE SPECIFY): 1/,� p t j w vu L
*,-'PLEASE, NOTE: ONL Y 100 SQUARE FEET OF THE E ISTING DEC%IS PERMITTED TO BE REPLACED * *
ROOF VENTILATION: D OFF -RIDGE 0 RIDGE OSOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: O YES <? IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 � 4:12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
xINGLE
\ 0.J
FL# /% CSs•
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DO WN
FL#
OINSULATED
FL#
O TILE
FL#
O OTHER:
FL#
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **1FAPPLICABLE**
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#
0 OTHER:
F L#
PERMIT
Building &Z File Prevention Division
FESLDFNTI4L RE -ROOF SCOPE OF WORK
jOB ADDRESS:
STRUCTURE, TYPE- GLE FAMILY RESIDENCE/T oyAF IAOUSE 0 MOETLE HOME, APART1VtENT/COIQDONT''IUM
RE -ROOF TYPE: �REI L.ACEMENT (TEAR OFF E;;TSTTNG ROOF AND REPLACE WIT NEW COi�ON-E S)
0 RE-COVER (NE`h7 ROOF INSTALLED OVER EXISTING ROOF)
/ 4
DECK TYPE (PLEASE SPECIFY): �( of jr � w J L
-mod
*PLEASE NOTE; ONL P 100 SOUA E FELT OF THE Eh7STING DECK IS PERhIITTED TO BE REPLACED
ROOF VENTILATION: D OFF -RIDGE QD RIDGE OSOFFIT DPOWERED VENT OTURBINES
SKYLIGHTS: O YES O 1F YES, PLEASE PRONE FLORIDA PRODUCT:SPPROVAL IE:
-----------------------------------------------------------------------------------------------------------
1VITlAIN' ROOF AREA
ROOF SLOPE: 0 LESS THAN 2:12 0 2:12 - 4:12 4:1? OR GREATER
d r
TYPE OF ROOF
MANUjFACTLRER
FLORIDA PRODUCT APPROVAL
HTNGLE
\ \
FL# r �Ic, s
O METAL
F L#
0MODIFIED BITUMEN
FL#
0 TORCH DOWN
FL#
0 INSULATED
FL#
0 TILE
FL#,
0 OTHER:
FL#
ROOF EXTENSIONS (PORCHES. PATIOS, ETC.) **lFAPPLIC4BLE**
ROOF SLOPE: 0 LESS THAN 2:12 0 2:12 - 4:12 0 4:12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
0 SHINGLE
FL#
O METAL
FL#
0 MODIFIED BF U-N FN
FL#
0 TORCH DOWN
FL#
OINSULATED
FL#
O TTLE
FL#
0 OTHER:
FLU
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF A FFIDA VIT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING,,/SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: /�� 6�/�/l0 q '. ADDRESS: ' pl I t_NA Q 9\ 0AV_Q_—
9
Y - Fo6ol)
11 en / r
AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRA .TOR, NGTNEER, ARCHITECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE
TON 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
COMPANY / CONTRACTOR ,,' i e s % oo /%I'
CONTRACTOR SIGNATURE:
(MUST BE SIGNED BY LICENSE HOLDER
ILDER)
A FINAL ROOF INSPECTION IS REQUIRED:
DATE: ,3 I 1
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 �,� q
Sworn to and Subscribed before me this ` day of i^'L �' 20 1� by:
ident' ication)
ignature of Notary Public
State of Florida
Print/Type/Stamp Name
of Notary Public
Who isXPersonally Known to me or has - Produced (type of
as identification.
ANTHONY DESSOURCES
, Notary Public — State of Florida
Commission # GG 159881
My Comm. Expires Nov 13. 2021
OFFl Bonded through Nadonai Notary Assn.