HomeMy WebLinkAbout145 Oakview PlCITY OF SANFORD
w; BUILDING & FIRE PREVENTION
MAR 4 201a k PERMIT APPLICATION
Application No:
Documented Construction Value: $ l Zt 100
L c,
Job Address: 1 H ,.I T) a Ky i e w PL Historic District: Yes ❑ No ❑
Parcel ID: 1 D- Z O -3 D - S ( I - D OU Q - D 1 _7 O Residential Commercial ❑
Type of Work: New ❑ Additioon ❑ Alteration ❑ Repair ❑ Demo ❑ Change of Use ❑ Move ❑
Description of Work: R e- I` C�[�
Plan Review Contact Person: Title:
Phone:
Fax:
Email:
Property Owner Information
Name -2 (.t 1 Phone: LtD-7 - 97 ' S 6R 3
Street: 1 L-f Al Ky I P uj PI Resident of property?
City, State Zip: sO � � , �L- 321`77 2—
Name
Street
City, 4
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
nation
Phone: -32-1- 3 ( lv ` q 77 y
Fax: _� Z I" 31(n - Li 7 7 S
State License No.: CM 3 3 Q 7 77
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. 1 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: 511 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 wil l 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.
Signat of Owner/Agent Date
- T�rrq Cr v s-e-
Print Oyvnee/Agent's Name
ignature of N
TAMARA J. SUMNER
•
My COMMISSION 9 GG 073562
••'Ti
EXPIRES:J,unee 1,5�, 220.2�1y
�F FLAP`;
Boa* Ttw Notsy N& NNgIw b*
Owner/Agent is Personally Known to Me or
Produced ID : Type of ID
//J 11' ?Z f10
Si of Contractor/Agent Date
� Q,( A1, '�t.W,, ' sum,
P ontractor/A ent's le
I �
Signa tary-State of Florida
71 vP. RUSSELL
MY CCPoIMISSION # GG 09%32
EXPIRES: August 28, 2021
P&ICUnderxdtere
Bonded Thhlu Notary
Contractor/Agent is / Personally Known to Me or
Produced ID Type of ID
Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing[] Gas❑ Roof ❑
Construction Type: Occupancy Use:
Total Sq Ft of Bldg:
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
i�tMx.�;&8<Svnlr
Parcel Information
Property Record Card
Parcel: 10-20-30-511-0000-0170
Owner: CRUISE TERRY L JR
Property Address: 145 OAK VIEW PL SANFORD, FL 32773
Parcel
10-20-30-511-0000-0170
Owner
CRUISE TERRY JR
Property Address
145 OAK VIEW PL SANFORD, FL 32773
Mailing
145 OAK VIEW PL SANFORD, FL 32773
Subdivision Name
STERLING WOODS
Tax District
S1-SANFORD
DOR Use Code
01-SINGLE FAMILY
Exemptions
00-HOMESTEAD(2001)
00
lb
149.4'1
Seminole County GIS
Legal Description
LOT 17
STERLING WOODS
PB 54 PGS 93 THRU 95
Taxes
Value Summary
2018 Working
Certified
Values
12017
Values
Valuation Method
Cost/Market
Cost/Market
Number of Buildings
11
.._._....__...__,__._..._._....... _..
1
Depreciated Bldg Value
$176,566
$166,368
Depreciated EXFT Value
$11,839
; $12,322
Land Value (Market)
I $25,000
$25,000
Land Value Ag
i
Just/Market Value **
i $213,405
1 $203,690
Portability Adj
I
Save Our Homes Adj
$58,236
$51,713
Amendment 1 Adj
i $0
P&G Adj
{ $0
$0
Assessed Value
! $155,169
$151,977
Tax Amount without SOH: $3,090.71
2017 Tax Bill Amount $2,106.02
Tax Estimator
Save Our Homes Savings: $984.69
* Does NOT INCLUDE Non Ad Valorem Assessments
Taxing Authority Assessment Value
Exempt Values
Taxable Value
County General Fund
$155,169
$50,000 1
$105,169
Schools 1
$155,169
$25,000 i
$130,169
City Sanford
$155,169 !
$50,000 j
$105,169
SJWM(Saint Johns Water Management)
$155,169 !
-_..-----
$50,000
_._..__..._------._
$105,169
County Bonds
$155,169 1
$50,000
$105,169
Sales
Description
Date
I Book
Page
Amount Qualified
Vac/Imp
QUIT CLAIM DEED
j 9/1/2012
i07868
i 1249
$100 ! No
Improved
_.—._--------
SPECIAL WARRANTY DEED
7/1/2000
03902
0028
$145,900 j Yes
I Improved
... ..... _..__.__..__.__.._.____.__---------
WARRANTY DEED
7/1/1999
03687
.—
1507
":, $315,000 No
.....
I Vacant
Find Comparable Sales
Land-^._.____ _
Method Frontage Depth Units
Units Price Land Value
LOT
$25,000.00 $25,000
Building Information
# j Description I Year Built ive p Fixtures Bed I
Bath I Base Area I Total SF Living SF Ext Wall ( Adj Value j Repl Value I Appendages
go
DATE:
WINTER SPRINGS ROOFING AND REPAIR, LLC. CCC1330777
Reconditioning 4- Repairs + ExtendingRoofLife
2100 N Ronald Reagan Blvd, Suite 1072, Longwood, Florida 32750
Office: 321-316-4774 * Phone 407-832-3330 * Fax 321-316-4775
E-Mail: billtheroofer130aol.com * www.winterspringsroofingandrepair.com
FOR: RE -ROOF
PROPOSAL 2017-
'ACCREDITED
�x pUSINE55''+
CUSTOMER: Terry Cruise
PRODUCT COLOR
ADDRESS: 145 Oak View Place
Shingles: 30vr/130 mph
Tile:
Sanford, FL 32773
PHONE: 407-687-5693 OTHER:
Metal:
Low Slope:
E-MAIL:
Eave:
Vents:
DESCRIPTION
AMOUNT
All labor, materials, permitting, dumpsters and expenses for job completion.
i Remove existing roof coverings on the pitched and low sloped decks to bare plywood. This includes the multiple layers of underlayment from
previous roof jobs. Inspect, repair, replace the decking as necessary and refasten to meet 2016 standards and codes. Wood replacement allotted
into the pricing.
Will cover the decking with a combination of 30 lb. felt and high temp U.V. self -stick underlayment. Synthetic option available at no extra cost.
i The low pitched areas will be modified with a 3 ply rubber membrane system to account for the low slope, in color matching the new roof. This
sometimes requires a re -decking system to create necessary drainage pitch.
i The roof perimeters and eaves will have new, powder coat painted flashings in matching color.
Install new valley and wall flashings in appropriate areas. New metals will be installed over a waterproof membrane. Galvanized counter
flashing will be installed where applicable,
i Install new attic ventilation system. We will add supplemental vents to help extend roof life as necessary. Will replace with either off ridge
vents or continuous ridge vents according to the individual roof design.
i Will replace all miscellaneous roof vents with new ones in matching color.
Replace all PVC flashing covers with new ones and double wrap with a rigid outer shell in matching color.
i Install new shingle which will be a 30 year architectural, fungus resistant, with 130 mph wind rating of owner's choice. There is literature that
claims them to be lifetime, but we do not wish to endorse this. Install high definition heavyweight style hip n ridge trim shingles to match.
Remove dumpster, clean property, run magnets and pass inspections.
i Warranty: Standard company policy is 7 year workmanship along with the product manufacturer's limited 30 yr. warranty.
i Price is an all-inclusive Grand Total.
JOB SPECIFIC DETAILS:
PLEASE READ THE FOLLOWING AND INITIAL:
Homeowner is responsible for allowing access to the property along with exterior power source. Homeowner understands that there is an inherent risk involved when -
having an invasive service as a roof replacement although all proper precautions and care will be provided. There is always a small chance of inconsequential damages
to occur for which we cannot be held liable. We recommend that customer do not park near the work areas or dumpsters. We cannot be held liable for accidental damage
resulting from parking issues or nails in tires, as well as damaged driveways since access to and from the structure is essential for re -roofing. Roof work often
necessitates that we have to work around TV dishes and gutters. While we do our best to detatch and refasten it will sometimes be necessary for the owner to call these
services for follow up. Customer is responsible for notifying WSRR of re -piping or disclosure of any pre-existing problem concerning the attic or roof.
Acceptance of Proposal: the above prices and specifications and conditions are satisfactory and are hereby accepted. WSRR is authorized to do the work as stated.
Cancellation by homeowner is subject to 25% default fee for Liquidation damages as allowed by law. Disputes arising out of terms or conditions of this contract are
subject to Mediation and Binding Arbitration by both parties and administered by the Better Business Bureau Care Program. Customers are responsible for their attorney
Customer
feeds. Payments not rendered in acco nce with contract agreement shall be subject to finance charges of 18%.
initial
TOTAL
C,PQ-q Vey
��
Signature of cceptance Date DEPOSIT DUE AT ACCEPTENCE
$1 6c
BALANCE DUE ON COMPLETION
I UNDERSTAND THAT BALANCE IS DUE ON COMPLETION. Cust. Initial CREDIT CARDS SUBJECT TO 3% SERVICE FEE Cost. Initial -�
Florida Homeowners' Construction Recovery Fund
According to Florida's construction lien law (Section 713.001.713.37. Florida Statues) those who work on the property or provide materials and are not
Payment may, be available from the Florida Homcoumers' Construction
paid in full have a right. to enforce their claim for payment against your property. If your contractor or a subcontractor fails to pay subcontractors, sub -
Recovery Fund if you lose money on a project performed under contract
subcontractors or material suppliers, the people who are owed money may look to your property for payment even if you have already paid your
where the loss. results from specified violations of the Florida law by a
contractor in full. If you fail to pay yourcontractor, your contractor may also have a lien on your property. This means if a lien is filed your property
licensed contractor. For information about the recovery fund and filing a
could be sold against your will to pay for labor, materials, or other services that your contractor or a subcontractor ay have failed to pay. To protect
claim contact the Florida Construction industry licensing board at the
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
following telephone number and address:
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
Construction Industry Licensing Board; 1940 North Monroe Street
consult an attorney. -
Tallahassee, FL 32399-1395; 800-487-I395
THIS INSTRUMENT PREPARED BY:
Name: Tammy Sumnergnter Springs Roofing and Repai
Address: 2100,N Ronald -Reagan Blvd #1072
Longwood. FL 32750
NOTICE OF COMMENCEMENT
State of Florida
County of Seminole
! 111111 I111111111,1 1# #1 [rifff-111 # �#
ia1-,'AH P1AL13111 .J7l_%:
CLERK OF i_ 4:f:i:(.41:7 ; OUR CCOPli ` T ROLLER
CLERK'S Y 201802i,.1E3
h�(;{:I1j�;iE11 il.fil',f,7f11» 11=°'_,1, o jFr ril'1
l E l'- R. �11 1'i i7 FEES BY lidevore
Permit Number: Parcel ID Number: 10-20-30-51-0000-0170
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)
145 Oak View Place. Sanford. FL 32773: LOT 17: STERLING WOODS: PB 54:
PGS 93 THRU 95
GENERAL DESCRIPTION OF IMPROVEMENT:
RE ROOF
OWNER INFORMATION:
Name -.-Terry Cruise
Address: 145 Oak View Place; Sanford, FL 32773
Fee Simple Title Holder (if other than owner)
CONTRACTOR:
Name: Winter Springs Roofing and Repair, LLC
Address: 2100 N Ronald Reagan Blvd #1072; Longwood, FL 32750
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: Winter Springs Roofing and Repair, LLC
Address: 2100 N Ronald Reagan Blvd $1072; Longwood, FL 32750
In addition to himself, Owner Designates
Section 713.13(1)(b), Florida Statutes.
of
To receive a copy of the Lienor's Notice as Provided in
Expiration Date of Notice of Commencement (The expiration date 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.
Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true
to the bes H�geaief.
Owner's Signature Owner's Printed Name
Florida Sta to 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 i I or County of 'e vy\ thC,t
The foregoing instrument was acknowledged before me this Zit day ofyy C' .v. I; �� 201 %
b r'V i s-�. .Who is personally known to n
Name of person making statement:
OR who has produced identification ❑ type of identification produced: +— o
TAMARA I SUMNER
MY COMMISSION # GG 073582
c¢ EXPIRES: June 15 2021
•"'';�os �tq•'� BW1ded T11fu hiotarlr Pi1�C Utldet'M11eB
7
h-
No Signature l
W CI
irC,=�
W.wiL,
SE'MINOLE COUNTY MULT/%URISDICTIONAL
f � I e j i I E I,' i �'•I `r . i �.�� {.I i-- ,�. Y � �,•1 ��` � � r,..._
E I
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 1.3-1 1 �
I hereby name and appoint: TAMARA J SUMNER
an agent of: WINTER SPRINGS ROOFING AND REPAIR, LLC
(Name 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):
Q✓ All permits and applications submitted by this contractor.
Or
❑✓ The specific permit and application for work located at:
IN6- CutI4 \,/� PI - Sar .�wa(, 3-D '7-3
(Street Address)
Expiration Date for This Limited Power of Attorney: 316 I )�
License Holder Name: WILLIAM R SUMNER JR
State License Number:
Signature of License He
rrr1 '1'1m77
STATE OF FLO DA
COUNTY OF �C-minlsl C
The foregoing instrument was acknowledged before me this .5 day of I�'(9 •�
20 by 5�"yw"4-✓ who is� personally known to me or
❑ who has produced as identification
and who did (did not) take an oath.
Sign re of Notary Print or type Notary name
TINARUSSELL
MY COMMISSION # GO 099632
I
EXPIBES August 28, 2021
TINARuSSELL
MY COMMISSION # GG 099632
EXPIRES'
Nu0us120,2021
gondudThruNO PuWlcUndern�ltete
Notary Public - State of FLe>�- ( 0R
Commission No. gi `' 4 3
My Commission Expires: q1-2
r CITY OF
Building & Fire Prevention Division
ORD,
SANRESIDENTIAL 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.
**PRO.IECTS 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:
tr �` CITror
k
FIRE DEPARTMENT
PERMIT #
Building & Fire Prevention Division
RESIDENTL4L RE -ROOF SCOPE OF WORK
JOR ADDRESS: 195 O7l K V i p o P I ck e-
STRUCTURE TYPE: )6 SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: 6REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
/) II
npcw TVPF. /PI .FACF CPF.C1FV)' // 7 P/Vtk i
**PLEASE NOTE: ONLY I00 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED"
ROOF VENTILATION: OFF -RIDGE O RIDGE OSOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: O YES '(56NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
------------------------
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 & 12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
HINGLE
C &kGt� L"14m4.I` - 3u
FL# J Ljq 1
O METAL
FL#
O MODIFIED BITUMEN
FL#
OTORCH DOWN
FL#
0INSULATED
FL#
OTILE
FL#
O OTHER:
FL#
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#
OMODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
0INSULATED
FL#
O TILE
FL#
0 OTHER:
FL#
f� CIT1 O,F
Building & Fire Prevention Division
,. RESIDENTIAL RE-ROOFAFFIDAVIT
FIRE .DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT#: t? - 1 3(o3 ADDRESS: f LA S Oct K V i'e-w R
So r�fbrd I FL 3277 3
I I/Mt I' 1,o rl I )- 1_�"Vnn �� - , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, ENGINEER, 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 C a l 3 3 C)
COMPANY / CONTRACTOR:
CONTRACTOR SIGNATURE:
(MUST BE SIGNED BY LICENSE R OR
A FINAL ROOF INSPECTION IS REQUIRED:
N
l r, C
DATE: 3A l (!
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,
UNDERLAVMENT, 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 O I rl^'` C_
Sworn to and Subscribed before me this ;0 54 day of /WCH 20IS by:
(��ICi wiwy�r, Who i Personally Known to me or has ❑ Produced (type of
identificatio) as identification.
.�
ure of No u lic
State of Florida ,,.:.�, TINARUN c OW2
`i MY COMMISSIO 2t
p, t�� EMPIRES: August 28, 20
Al 7 I �UC+:J 5 °�— t, I "i J' ' ,�• Not Pubik Undetw�t�
Print/Type/Stamp Name
of Notary Public