HomeMy WebLinkAbout1318 Park AveL
Type of Work: New ❑ Addition ❑ Alteration ❑ Repair ❑
Description of Work: a_R _
Demo ❑ Change of Use ❑ Move ❑
Plan Review Contact Person: 0--) h� Title: I—r-OCN 1 IN
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Phone:-'-tQ`} ,�Q(Q , (�(J.Q� Fax:I J Email: i Q f' IC(ir• LOt1�
Property Owner Information
Name oo-eh L- &waycC Phone:
Street: � � ��� � S it t� Resident of property?: OWV*�
City, State Zip:((
Name Heritage Construction & Roofing
Contractor Information
,
Phone: (407)366-600f0
Street: 1544 Seminola Blvd. Suite 136 Fax: (407)366-6065
City, State Zip: Casselberry, FL 32707 State License No.:� 3L�
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, ��
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: 5th 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 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.
4—
Signature o Owner/Agent Date i ure of Contractor/Agent Date _
Print
1jS%l
LP0
Notary PublicStateofFloridaLesleyG Garza
MyCommissionGG009517
Expires 07107/2020
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
P 61-3 37 -3S-� 6 -0
J Gw.es w
Print Contractor/A2e '
. v"f P9P Notary Public State of Florida
Lesley G Garza
My Commission GG 009517
Expires 07/07/2020
Contractor/Agent is -�C 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 ❑ # of Heads
APPROVALS: ZONINGN ;i- Z,�� -1 g UTILITIES:
Flood Zone:
# of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes ❑ No ❑
WASTE WATER:
ENGINEERING: FIRE: BUILDING:
COMMENTS:
Revised: June 30, 2015 Permit Application
HERITAGE
Consiniclion & Roofing tole.
1544 Seminole Blvd. Suite 136
Cis,wilierry, FL 32707
PH: 407-366-6000
FX:,107-366-6065
Into 0(1,1 leritigecrxilill
C(' rC 150504 5 CCC 1.120650
2 RITAGE
onst ction&Roofing
of, (ATO Fof� coo rfit f,
Contact:
CPolalim ": o7,09:9,i#: 7
MORTGAGE COMPANY INFORMATION
Loan Number:
IrOsvilgr's
Assignment of Insurance Benefla for the Full Roofiteplicemem Only: I hereby assign any and all insurance rights, knefits and proceeds
under any applicable insumnec Policies to I Ictital!" (Au"Irtiction 't hauling, fing. Inc, ("I 1crili9c"), Ole SCOPC of which shall be limited to a Full Roof
(lo'
Replacement I null',c thiStocagarocul and authorization in consideruirsi Or I lcrilagc% agreement to perform services, supply materials and cularwise
perform its obligations under this contract, including not requiring fall Payment u he time orsinsurers} rc as
service. I also hereby direct my insu r(5) 10 Ic c an
tativic. or its ationle) for the dircci purl orobrjarri; actual benefits to he paid by my insurcr(s)
for services tendered. In this regard, I waive 01Y I"i'Icy ,-
and all information requcslcd by I Ictit3t-c, its rvluc-scll If rrlyu is midi directly to the Oltner/Agcrailosared(s), it shall be endorsed over to
Heritage immediately upon receipt. I agfec that any Portion of v%ork, deductibles. kitorment or additional work requested by the undersigned, not
I installation. Dcd-tibic' It is kill OlIncl's lls!""osibiluy to pay all Insurance
covered by insurance, must he paid by tile undelsiglicil on the 0' or
c out -or -pocket e.,p ... e ,it) not exceed tile deductible it'S loss shect. UNLESS replateenunit/repnir of
deteriorated decking is required andlor Ow
DeductibIcs. ovne, le turiount, :is suited an intoc"a � u,
YNOT Pay. j,c, chme. _ pamisc p.,, waive or rebat. .11 of
Owner requests optional apgradc�i . I leritlgc Ci\
any pan of the insurance deductible applicable to the insurance claim for pay merit of work. In the event of a discrepancy, the deductible amount slated on
the insurers l < Sher smat �o erj a c C� ( Initials)
I PLUS ANY APPLIM%t+-:�8 T":
Dart MUST BE PAID IN FULL, mongnzc�To. to speak with
AtORTC:tOEA
HORIZATION: 1. o.ne,J Nitortgagm, grant authorization fOr--
Heritage Construction k- Roofing on millers including, but not limited it), the claim and payment status.
PA"IENT SCHEDULE: Owncr agrees to payr Iferitage based on [Ile rallowing pay sOiedoic: (i) Deposit in the amount of
due upon sinning this contract: (ii) the Contract Priceless the Deposit nod all), applicable deprecillion retained by Owner's inurcr(l), plus Upgrade
Cosa, due and payable to Heritage upon completion Orwork W 119 Performed; and, (iii) the remaining Contract Price (equal to any applicable
I r Odin ' spection no more than
deprnhlr to eciation P" P QTY:-U
re xcti 1, eased. Optional: UPGILl,1A)EI ENl:!Ka1M"(1l "Cel— ork, and
2% ofContract Price may be withheld until inslTOTAL; S— Replacement ork and Price: Pon
— PRICE: S aial�, and provide the labor necessary to perform the
11 terms and conditions -hoer heritage 1grces to furnish it Mat -
insurers 5proval and subject to rile roval appro.xioultely within 30 days, conditions permitting,
full roof replacement which shall take Place (0110oing Owner's insurance COMPWI�'$ aPP - lupany for a J'all roof replacmLiu, Heritage shall
Owners Dectaration,orlmenu Owner acknOW[Odg" and agrees that, upon approval by insurance Cc terminate the services or
perform the roof replaccment upon receipt of funds , from Ownces insurance orap,nv,�CANCEI,I,ATION-: IfOwncr elects to
third business c1,1% after Contract is executed. Owner shall receive a full refund of all deposits. owner
Heritage, Owner may do so before midnight on the Y
ird business (lay after the contract is esccatcd after notification rrom insurer(O that the claim for
may also rescind Contract berate midnight on the th novices ofeancellation, regardless ofreas(114 Shall be Postmarked or delivered
payment on roof contract has been denied, in whole Orin Pall- All rate" ) L1,01ON EXCEPTIONSt The three (3) day right
to Heritages corporate office: 1544 Scminola Blvd, Suit,: 136, Casicli,cm,' Florida 132 W, CANOE c. 1, Owner, have read and understand all statements
of cancellation DOES NOT Al1PI.Y to contracts for emergency horne repairs as little is Of the essence is riber mderstand that this contract
terms and conditions or the *Roof Replacement Contract" and agree dratall &uuls arc acccill3bic 'I'm) lat"racto "I'" t
S to this c ' Onoact must he made in writing and agreed upon
constitutes the entire agreement between the Parties and that any further changes or alteration try to enter into the contract and that it is binding and
by both parties. Each party represents and warrants to ale O,Ilcr that it has the 6111 Power �jnd author
enforce inn at;cOrqcc with its Penns.
Date 77
'liter
Autho' (114criulgellclurcs'ne'livc \Q-
Prior Name
priat'Name agrec 10 retail, "critage for n full mot'rePlaceracm On the tem's arid conditions
TERMS AND CONDITIONS: Acceptance OrTcrins: 1, Owner, hereby nsurcr and rulthorizc and grant full access to tile
'r
slated herein. I further agree to provide I Ictilag . with tile Scope Of 1,055 Report generated by my i licritasc (csc,ves rise right to file a supplemcmal claim
property for purpose or staging and compes
eting all agreed UponSupplemental CluilMolcred after commoncetnera. The supplemental claim
dditional damage is disc' Commencement ofAVork:
with Owner'skins irance in the event that the estimate is incorrect awyor a hatcly due to I tentage upon rcceiPt.
ammunt(s), in addition to any depreciated amounts field back by tile insurer, tire us strikes, fire.
1, ble for delay in, or failure to perform due to: labor con[A)Vcrsies.
-c at I lailage's discretion. Heritage shall not be in Jcr delays caused by andlor,tts, a direct result of Ownces
Work shall Marlene n ijis from usual sourc". histillaurm, it is the soft
weather, Acts OfGOd, war, governmental actions, inability to obtain trial �itagc Noise pollution and Vibratiortu Prior r:
insurer or other circumstances not listed which are beyond the control off let — not limited to. items oil mantles, "vcs or other areas
responsibility of Owner to remove any and off items which are not secured la walls including. but dot 10 the performance of work contracted
susceptible to vibrations, as qune may fall. Heritage shall not be liable for 110 se pollution undlor violations
herein, of damages resulting to person(s) or property.
Scanned by CamScanner
THIS INSTRUMENT PREPARED BY:
Name: Heritage Construction & Roofing
Address: 1544 Seminola Blvd. Suite 136
Casselberrv. FL 32707
NOTICE OF COMMENCEMENT
State of Florida
County of Seminole
Permit Number:
GRANT ►r{rtl_OY: SEh1INOLE_ COUNTY
LERK O C:a.RC;IiT'f C:til.4R:"f '_ Ct�i'►FTR.OL.L.EE;
CL[ftE�' S r 2018025493
RECORDED li:': Ilf','';?It1" •12-36rt3'r
RI..CsORDTIN't_f FEES
Parcel ID Number: 01J 1� :Yl',-tc C :Jl/'-T� J'-) V
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.
of the property and
GENERAL DESCRIPTION OF MPRO MENT:
�- o "
Fee Simple Title Holder (if other than owner) Name:
Persons within the State of Florida Designated by Owner upon whom notice or. other documents may be served
as provided by Section 713.13(i)(b), Florida Statutes.
Name:
In addition to himself, Owner Designates
To receive a copy of the Lienors 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
5'270'7
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
1
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
cc
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, I declare that I have read the foregoing and that the facts stated in it are true
>
a
to the best of my knowledge and belief.17
.
cr_ v
6
Owner's Signature Owner's Printed Name
"' p
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."
i , f+=
L? _� Z
C)wx�0
0
t } a CJ
State of f County of Sew"."10� e
L O O-
-t�
The foregoing instrument was acknowledged before me this-J_ day of G 20
ra
tom/ e, < art
E
by �e- V', !Frr^Se Who is personally kno e ❑
Name of person making statement,-"
OR who has produced identification type of Identification produced: 4v�
i
a" of p4y Notary Public State of Fiutida ry _
Le5l, y G Gaza ~'r
NiV rDMmission itc uuvu l
�FaF�o� boreyu7lu7lZt)tG Nota si
01.
Product Approval Specification Form
Permit #
Project Location Address_ _ f)lb �10 ek, M��Ct (If oe4 (-t 3PMI i
As required by Florida Statute 553.842 and Florida Administrative Code 9N-3, please provide the
information and product approval number(s) on the building components listed below if they are to be
utilized on the construction project for which you are applying for a building permit. We recommend that
you contact your local product supplier should you not know the product approval number for any of the
applicable listed products. Be aware that windows, skylights, and exterior doors must be tested in
accordance with the Florida Building Code, Section 1714.5. More information about Statewide Product
Approval can be obtained at www.floridabuildina.org.
The following information must be available on the jobsite for inspections:
1. This entire product approval form
2. A copy of the manufacturer's installation details and requirements for each product.
Category / Subcategory
Manufacturer
Product
Description
Florida Approval #
(include decimal)
1. Exterior Doors
Swinging
Sliding
Sectional
Roll U
Automatic
Other
2. Windows
Single Hun
Horizontal Slider
Casement
Double Hun
Fixed
Awning
Pass Through
Projected
Mullions
Wind Breaker
Dual Action
Other
June 2014
Category / Subcategory
Manufacturer
Product
Description(including
Florida Approval #
decimal
3. Panel Walls
Siding
Soffits
Storefronts
Curtain Walls
Wall Louver
Glass block
Membrane
Greenhouse
E.P.S Composite
Panels
Other
4. Roofing Products
Asphalt Shingles
YICGC'
—
Underla ments
Z i 3
Roofing Fasteners
Nonstructural
Metal Roofing
Wood Shakes and
Shingles
Roofing tiles
Roofing
Insulation
Waterproofing
Built up roofing
System
Modified Bitumen
Single Ply Roof
Systems
Roofing slate
Cements/
Adhesives /
Coating
Liquid Applied
Roofing Systems
Roof Tile
adhesive
Spray Applied
Polyurethane
Roofing
E.P.S. Roof
Panels
Roof Vents
Other
June 2014
Category / Subcategory
Manufacturer
Product
Description
Florida Approval #
include decimal
5. Shutters
Accordion
Bahama
Colonial
Roll u
Equipment
Other
6. Skylights
Skylights
Other
7. Structural
Components
Wood Connectors /
Anchors
Truss Plates
Engineered Lumber
Railing
Coolers/Freezers
Concrete Admixtures
Precast Lintels
Insulation Forms
Plastics
Deck/ Roof
Wall
Prefab Sheds
Other
8. New Exterior
Envelope Products
Applicant's Signature
Applicant's Name ')GYYVC�) 1 (.
(Please Print)
June 2014
CITY OF
�.y &kNFORD
Building &Fire Prevention Division
RESIDENTIAL RE -ROOF POLICY & PROCEDURES
FIRE DEPARTtAENT
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 OWNERIBUILDER) SIGNATURE: DATE: 171 [ k
CITY OF
SjkNFORD
FIRE DEPARTNIENT
JOB ADDRESS:
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 INSTALLED OVER EXISTING ROOF) �!
DECK TYPE (PLEASE SPECIFY): 00A 5�(�� ( MC4
**PLEASE NOTE. ONL Y I UAUARE FEET OF THE EXISTING DECK I RdIITTED TO BE REPLACED
ROOF VENTILATION: OFF -RIDGE O RIDGE OSOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: O YES O NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 2:12 -4:12 O 4:12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
SHINGLE
S
I
FL# l 3 V S` l�
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
O INSULATED
FL#
TILE
FL#
OTHER: U d �U m
QI
i
FL#
I
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#
O INSULATED
FL#
O TILE
FL#
0 OTHER:
FL#
CITY OF
m; yS.•NFORD
FLORIDA-
CERTIFICATE OF APPROPRIATENESS
HISTORIC PRESERVATION BOARD
CITY OF SANFORD
300 S. Park Avenue
Sanford, Florida 32771
407.688.5145 • www.sanfordfl.gov/HP
THIS DOCUMENT MUST BE POSTED AT ALL TIMES UNTIL
PROJECT IS COMPLETED.
ISSUED TO: DATE ISSUED:
Michael and Helen Fraser March 28, 2018
for
1318 Park Avenue DATE EXPIRES:
Sanford, FL 32771 BP#18-1548 September 29, 2018
Approved to reroof house with Atlas Pinnacle Pristine Asphalt Shingles
(architectural shingles only) and underlayment as needed. Any wood
replacement other than underlayment will require a separate Certificate of
Appropriateness and possible site visit for approval. All pitched roof surfaces
(including porches and additions) must match in design, dimension, profile,
texture, materials, and other v'Lsi al qualities.
Christine Dalton, AICP
Historic Preservation Officer/Community Planner
Please be advised it is the owner and/or agent's responsibility to notify staff of any potential changes from
the approved COA that arise and obtain approval prior to commencing the changes. This Certificate of
Appropriateness does not constitute final development approval. The applicant is responsible for obtaining
all necessary permits and approvals from applicable departments before initiating deve opment.
IS A BUILDING PERMIT REQUIRED F FIE A IVITY LISTED ABOVE? YES ❑ NO
Building Department Representative
y��For�p
CITY OF
SXKFOM
C
t `lit
Fsr•�s�� `FLORIDA
----- --- APPL-ICA-T-ION-#-�-� - FOR A CERTIFICATE Ol APPOPRIATENESS
Answer all the questions on this form and submit all required attachments. Incomplete applications will not
be reviewed. If you have.questions about application requirements contact the Historic Preservation Officer
at 407.688.6146 to ensure your application is complete.
General Information
Downtown Commercial Historic District[] Residential Historic District 12 /Isthisaretro I activrequest? Yes ❑ No
Is this application filed in response to a Notice of Violation from the Code Enforcement Department? Yes❑ No
Proposed. improvements will affect the following elevations: North ❑ South ❑ East ❑ West ❑
Property Address:
Property Owner Information
Print Name: nn1G�nc nP.t. Re kE.v-\ >r
Mailing Address: I 3J K PC-%r K-- l/
Phonex IL/�) 3z� � (� Email: Signature:
Applicant/Agent Information
Print Name: i'(GC' �-� ri�c.P. C [,-nC--
Mailing Address: S —"5 v.^ V . •c„ A (6—�,� '7
Phone: (-t?)364-bad Email: c-\fo Signature:
BY SIGNING BELOW YOU ACKNOWLEDGE THAT A BUILDING PERMIT MAY BE REQUIRED FOR THE S OPE
OF WORK LISTED BELOW. YOU MUST CONTACT THE BUILDING DEPARTMENT TO DETERMINE IF
A BUILDING PERMIT IS REQUIRED. FAILURE TO OBTAIN A BUILDING PERMIT WILL RESULT IN A STOP
WORK ORDER, DOUBLE PERMIT FEES, AND POTENTIAL FINES. BY SIGNING BELOW, YOU ALSO
ACKNOWLEDGE THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND ACCURATE TO
THE BEST OF YOUR KNOWLEDGE.
I hereby understand and agree to the above statements and will pay all city fees related to this application as
required by the city's adopted Fee Resolution.
Signature: �� . g CS/1 T ,E>.,1�� Date: � oZ
❑ Would you like to receive emails regarding Historic Preservation and Community Planning within your community?
Description of proposed work
Completely describe the entire scope of work, including changes in material and color, and methods that will be used to
accomplish the proposed work: For large projects an itemized list is required. Use the reverse side if necessary.
HISTORIC PRESERVATION BOARD • 300 N. Park Avenue • Sanford, Florida 32771 •407.688.5145 • www.sanfordfl.gov/HP
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: r�� ADDRESS: `J � U ec^-(— )am^ Ave.
lq- 1252
I TC'/\VVNQ,_S --� e'� V%C' , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, ENGINEER, ARCHITECT, If 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#: Ccc 1 -2-6- /7 5In
COMPANY / CONTRACTOR: C"%'
CONTRACTOR SIGNATTURE: J I DATE: 61(
(MUST BE SIGNED BY LICENSE HOLDtR 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, 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 C11 day of S Nve 20 JK by:
G�W'Qs W i , v� Who is aersonatly Known to me or has.❑ Produced (type of
identificatio as identification.
I e o otary Public@�Y �u� Notary public State of Florida a
S ate o orI a i t.:;, r° �; LesieY G rze
', CZ; W Comm1ssion Gii 00951'1
" qF �OV Expires 0710712020
Print/Type/Stamp Name
of Notary Public