HomeMy WebLinkAbout151 Andrews RdMAR- 1
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No:
Documented Construction Value: $
Job Address: �J1 M�Kd. '?)"23Historic District: Yes ❑ NoK
Parcel ID: L�� ��ji — Residential Commercial ❑
Type of Work: New ❑ Addition ❑ Alteration ❑ Repair L✓� Demo ❑ Change of Use ❑ Move ❑
Description of Work: LQ — j _op7 _-
Plan Review Contact Person: -ft* bVNV C-nr�'Ta'
Phone:AO 1O -'35U� .(-e.CMFax: Email:
Property Owner Information
Name E6.-vch a onA No+l1G)/ K%l+S_
Street: Ill A\^&ew_s �Ze�•
City, State Zip: Sc-n f6('8 �1 • 32773
Title: AarjA t k)
Phone: (yG7) `1Z7- 5a2_6
Resident of property? :
Contractor Information
Name G+v.6 9-oc*iv�5 Phone: (� 7 14146-6000
Street: I SyL{ C 'I vio I 9IVcA • SL- •4-e 136 Fax: '-ICI) 36, ^_So4S'
City, State Zip: CG,55+21be1rN FI- 3Z-X-, State License No.: CCCf 3�66'�
Architect/Engineer Information
Name:
Street:
City, St, Zip:
Bonding Company:
Phone:
Fax:
E-mail:
Mortgage Lender:
Address: 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: 5" Edition (2014) Florida Building Code
Revised: June 30, 2015 � ( 3Q .613 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 1CC 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 Owtter/Agent's Name
Date
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
-Uv—,eo,�
ature of Contractor/Agent Datc
Gt�^e5 t�
Print Contractor/ ' a
S ature of Notary -St —ate —of F one a Date
tir'1r"5!
ro1pRY PL@4• Notary Public State of Florida
Lesley G Garza
!i Aa My Commission GG 009517
Expires 07/07/2020
o t at`tr'/��gbls'�'�P`�'roii�al y 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:
Flood Zone:
# of Stories:
Plumbing - # of Fixtures,
# of Heads Fire Alarm Permit: Yes ❑ No ❑
UTILITIES: WASTE WATER:
FIRE:
BUILDING:
Revised: June 30, 2015 Permit Application
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 3/2p A 8'
I hereby name and appoint: no\ R �r_ e
an agent of: Re ( i tc;t e, 2 cc v\s+ . cw-, go p_ -iF,�nc.,
(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/ The specific permit and application for work located at:
l'91 Aid c'ews 9-85c"r^-r'r1ar6 �= I. 3z,-n3
(Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name:
State License Number: C. CCI
,S :tgnatuL-re-of-i•c ens•e-Ho 1 dp:
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before me this day of ^ C, r' ,
200_q,_, by vti252l d c who is ersonally known
to me or ❑ who has produced
identification and who did (did not) take an o
(Notary Seal) L gs i e )e� 6G rZ gi
Print or type name
FIF
Notary Public State of Florida Notary Public -State of
Lesley G Garza &C-Pe-I51
MyCommissi0nGG009`� COmmlSSlonNO.�Expires07I0712020a_�r�^ My Commission Expires: 7/1/20
_ ex
Flrid
(Rev. 08.12) " ouNotGGarza of o?
Lesley mission GG 0095
u �"i EKP�res 0710712020
as
HERITAGE
Construction & Roofing Inc.
1544 Seminola Blvd. Suite 136
Casselberry, FL 32707
PH: 407-366-6000
FX:407-366-6065
Info@Heritagecr.com
CGC 1505045 CCC 1326650
:�A"
onstruction�Roofing
ROOF REPLACEMENT CONTRACT
Account Manager: 1$24RK
Contact: 40O 4130 "TI 3
INSURANCE COMPANY INFORMATION
Company:
Policy #:I
Claim #: I
MORTGAGE COMPANY INFORMATION
Company:
Loan Number:
Owner(s): _►
tvNARo KILT-S �►�G� }� i �`S
Phone:
Address:
1.�� 1 �Ir4o2Ellis
Cell:
4o? 92- So2v
City: State: Zip Code:
E741: If ` / 5 �/ p A )
1 J G /w
�S N F Q L 32 3
n`
Manufacture: Style: Color:
Roof CRV:
if Owner's Insurance Company does not agree to pay for a full roof replacement this contract shall be voidable.
Assignment of Insurance Benefits for the Full Roof Replacement Only: I hereby assign any and all insurance rights, benefits and proceeds
under any applicable insurance policies to Heritage Construction & Roofing, inc. ("Heritage"), the scope of which shall be limited to a Full Roof
Replacement. I make this assignment and authorization in consideration of Heritage's agreement to perform services, supply materials and otherwise
perform its obligations under this contract, including not requiring full payment at the time of service. i also hereby direct my insurer(s) to release any
and all information requested by Heritage, its representative, or its attorney for the direct purpose of obtaining actual benefits to be paid by my insurer(s)
for services rendered. In this regard, I waive my privacy rights. If payment is made directly to the Owner/Agent/Insured(s), it shall be endorsed over to
Heritage immediately upon receipt. I agree that any portion of work, deductibles, betterment or additional work requested by the undersigned, not
covered by insurance, must be paid by the undersigned on the day of installation. Deductible: It is the Owner's responsibility to pay all Insurance
Deductibles. Owner's out-of-pocket expense will not exceed the deductible amount, as stated on insurer's loss sheet, UNLESS replacement/repair of
deteriorated decking is required and/or Owner requests optional upgrades. Heritage CANNOT pay, waive, rebate, or promise to pay, waive or rebate all or
any part of the insurance deductible applicable to the insurance claim for payment of work. in the event of a discrepancy, the deductible amount stated on
the insurer's Loss Shot shall over rule deductible listed below.
Deductible: It, 0 MUST BE PAID IN FULL, PLUS ANY APPLICABLE SALES TAX ( Initials)
MORTGAGE AUTHORIZATION: I. Owner / Mortgagor, grant authorization for Mortgage Co. to speak with
Heritage Construction & Roofing, on matters including , but not limited to, the claim and payment status.
PAYMENT SCHEDULE: Owner agrees to pay Heritage based on the following pay schedule: (i) Deposit in the amount of $
due upon signing this contract; (ii) the Contract Price, less the Deposit and any applicable depreciation retained by Owner's insurer(s), plus Upgrade
Costs, due and payable to Heritage upon completion of work being performed; and, (iii) the remaining Contract Price (equal to any applicable
depreciation and/or change orders) due and payable to Heritage upon completion of work performed in the event of a pending inspection, no more than
2%of Contract Price may be withheld until inspection has pa•.ed. Optional: UPGRADE ITEM: i �V Q"1 Y.
_ PRICE: $ TOTAL: $ Replacement orktiand Price: Upon
insurer's approval and subject to the terms and conditions herein, Heritage agrees to fumish all materials and provide the labor necessary to perform the
full roof replacement which shall take place following Owner's insurance company's approval, approximately within 30 days, conditions permitting.
Owner's Declaration of Intent: Owner acknowledges and agrees that, upon approval by insurance company for a full roof replacement, Heritage shall
perform the roof replacement upon receipt of funds from Owner's insurance company. CANCELLATION: If Owner elects to terminate the services of
Heritage, Owner may do so before midnight on the third business day after Contract is executed. Owner shall receive a full refund of all deposits. Owner
may also rescind Contract before midnight on the third business day after the contract is executed after notification from insurer(s) that the claim for
payment on roof contract has been denied, in whole or in part. All written notices of cancellation, regardless of reason, shall be postmarked or delivered
to Heritage's corporate office: 1544 Seminola Blvd., Suite136, Casselberry, Florida 32707. CANCELLATION EXCEPTIONS: The three (3) day right
of cancellation DOES NOT APPLY to contracts for emergency home repairs as time is of the essence. I, Owner, have read and understand all statements,
terms and conditions of the "Roof Replacement Contract" and agree that all details are acceptable and satisfactory. I fiirther understand that this contract
constitutes the entire agreement between the parties and that any further changes or alterations to this contract must be made in writing and agreed upon
by both parties. Each party represents and warrants to the other that it has the full power and authority to enter into the contract and that it is binding and
enforceable in ac ordance with its terms. �y
Gv WIT
Authorized Heritage Representative Elate Owner Date
Print Name Print Name
TERMS AND CONDITIONS: Acceptance of Terms: 1, Owner, hereby agree to retain Heritage for a full roof replacement on the terms and conditions
stated herein. I further agree to provide Heritage with the Scope of Loss Report generated by my insurer and authorize and grant full access to the
property for the purpose of staging and completing all agreed upon work. Supplemental Claims: Heritage reserves the right to file a supplemental claim
with Owner's insurance in the event that the estimate is incorrect and/or additional damage is discovered after commencement. The supplemental claim
amolmt(s), in nddition to any depreciated amounts held back by the insurer. are immediately due to iioi Pc upon receipt. Commencement of Work:
Work shall commence at Heritage's discretion. Heritage shall not be liable for delay in, or failure to perform due to: labor controversies, strikes, fire,
weather, Acts of God, war, governmental actions, inability to obtain materials from usual sources, delays caused by and/or as a direct result of Owner's
insurer or other circumstances not listed which are beyond the control of Heritage. Noise Pollution and Vibrations: Prior to installation, it is the sole
responsibility of Owner to remove any and all items which are not secured to walls including, but not limited to, items on mantles, shelves or other areas
susceptible to vibrations, as these may fall. Heritage shall not be liable for noise pollution and/or vibrations due to the performance of work contracted
herein, or damages resulting to person(s) or property.
11191111111111111f 11#1111111111111111f111
THIS INSTRUMENT PREPARED BY:
Name: Heritage Construction & Roofing Av\A-- ivy
Address: 1544 Seminola Blvd. Suite 136
Casselberry, FL 32707
NOTICE OF COMMENCEMENT
Permit Number:
Parcel ID Number:
i. I l�l)i,11 i — 4l-.I..i�_ 1
CLERK v w?iii.��i;ay�c`;.
-
;:L' .f; f is i t2 _,,iiii
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. DESCRIPTIO 0 PROPERTY: (Legal d scription of the ope and street add ess Y ailable)
Lo-4- H3 Pose 4-► c c P _ 5-4 LPG S �� ownd 4
2. GENERAL DESCRIPTION OF IMPROVEMENT:
P-e -- raa'F
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT:
Name and address: FA —'cn-c'd 6-In ► %/o+nC y
Interest in property: 0Wh2 Y-
Fee Simple Title Holder (if other than owner listed above) Name:
4. CONTRACTOR: Name: e 6+C11 gP C,C.Y+Sk • 9C GOfihhone Number: Ct-lo-713 6-6 —6 oG 0
Address: IS�f�-( _Sew��v�Gle A(y-'. stnif36 CcsSettbeyi` r=(. RrZ70-7
S. SURETY (If applicable, a copy of the payment bond is attached): Name:
Address: Amount of Bond:
6. LENDER: Name: Phone Number:
Address:
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 ccpy 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.
(Signature of Owner or Lessee, or Owner's or Lessee's
Authorized Officer/Director/Partner/Manager).
State of Countyof s� t hGi e
(Pant Name and Provide Signatory's Title/Office)
The foregoing Instrument was acknowledged before me this 2_0 day of 11A G1 20
by - �c `N�► �'�+ r t ��5 Who is personally known to me*16R
Name of person king statement _'�, u � r,� /^�
who has produced Identification s of identification produced: -77 ' —� `'� S — 63 —00l3 —y
�xrrr,BG yataryPublic. State ofFlorida
LesleyGGarza
My Comnvssion GG 009517
y�oESLQ Expires07i0712020
ISERTIFIED0 :' '
Yaignan
CLERK OF f r'3
1,11D
R
CITY OF
°' j•� SkNFORDBuilding &Fire Prevention Division
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 FBC CODE COMPLIANCE BY PERSONAL INSPECTION.
CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: ` DATE: 3 r 20 / f y
/CITY OF (� p
l� O PERMIT #
FIRE DEPARTMENT Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
JOB ADDRESS: t4Y1 6 CCtn/S &: • SGIv., 'FoccI - 1: i • 327?3
STRUCTURE TYPE: GLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: a PLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF
DECK TYPE (PLEASE SPECIFY:
**PLEASE NOTE: ONLY �ZFF
RE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED * *
ROOF VENTILATION:
IDGE O RIDGE OSOFFIT OPOWERED VENT
SKYLIGHTS: O YES1F 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
OTURBINES
TYPE F ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
SHINGLE
AM Gls
FL#
O METAL
FL#
O MODIFIED BITUMEN
FL#
OTORCH DOWN
FL#
O INSULATED
FL#
OTILE
FL#
'� i
OTHER: Uv�er' e h�
,��-� GtS
FL#
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#
OTORCH DOWN
FL#
O INSULATED
FL#
O TILE
FL#
0 OTHER:
FL#
CITY OF
.Sk�4FORD Building & Fire Prevention Division
RESIDENTIAL RE -ROOF AFFIDA VIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, S��H--))EATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: S�ZV ADDRESS: 191 /"lr6ce, ✓S M4-
Sc F-1. 32773
I ��W�P.S t/�%Q`� 1V1G� 'AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, ENGINEER, ARCHITE'ff, 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 #: CCC S32 465—C /
COMPANY / CONTRACTOR: 4e_c %A-cnce CGvS-�' - 0M A F—COPt 115
CONTRACTOR SIGNATURE:
(MUST BE SIGNED BY LICENS H DER OR OWNER/BUILDER)
A FINAL ROOF INSPECTION IS REQUIRED:
DATE: 3 /2o l fp
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 y of,/1^pl i- 20 by:
Who is ❑ ersonally Known to me or has ❑ Produced (type of
identific ' n) tion.
�c
State of Florida
Print/Type/Stamp Name
of Notary Public
eY aue Notary Public State of Florida
Lesley G Garza
My Commission GG o09517
� 0r Expires 071071207.0
City of Sanford
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFF11AVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: [� —1 i Zzo ADDRESS: t s 1 AT-j&Qw & A6.
I � 6 % to G� , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, ENGINEER, ARtAITECT, 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 CORE, 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 i 32_ 6 5-Q
COMPANY / CONTRACTOR: C V1
CONTRACTOR SIGNATURE: DATE:?/g/ig
(MUST BE SIGNED BY LICENSE H D �OROWNER/BUILDER)
A FINAL ROOF INSPECTION IS REOUIRED:
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 .Sew Ihp 1 £
Sworn to and Subscribed before me this !;__ % day of \Tc., l y 20 _a by:
Who is ii ersonally Known to me or has ❑ Produced (type of
as identification.
— State of Florida
Print/Type/Stamp Name
of Notary Public
far voe Not
Public State of Florida
�° Lesley G Garza
• < My Commission GG 009517
Expires 0710712020