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HomeMy WebLinkAbout153 Pine Isle Dr (2)CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: 1 d - / Documented Construction Value: $ 14,200 Job Address: 153 PINE ISLE DR SANFORD, FL 32773 Historic District: Yes ❑ No 0 Parcel ID: 10-20-30-511-0000-1180 Residential Q Commercial ❑ Type of Work: New ❑ Addition ❑ Alteration El Repair ❑ Demo ❑ Change of Use ❑ Move ❑ Description of Work: Re Roof Owens Corning FL 10674-R13 15216-R3 36 SQ 7/12 Pitch Driftwood Supreme 25 Years Plan Review Contact Person: Skylar Amkraut Title: Admin Phone: 407-278-7788 Fax: 800-337-3361 Email: Permit@Jasperinc.com RAMIREZ, RAMON Property Owner Information Name RAMIRFz, ANGELA Phone: Street: 153 PINE ISLE DR Resident of property? : Yes City, State Zip: SANFORD, FL 32773 Name Jasper Contractors Street: 4185 S Orlando Dr City, State Zip: Sanford, FL 32773 Contractor Information Phone: 407-278-7788 Fax: 800-337-3361 State License No.: CCC1331153 Architect/Engineer Information Name: Phone: Street: City, St, Zip: Bonding Company: Address: 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: 51h 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 will notify fhe owner of the property of the requirements of Florida Lien Law, FS 711 13, 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 pennit.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_zonng. _ 04/04/18 Signature of owner/Agent Date Signatur of Contractor/Agerit Date Print OwnedAgent's Name Signature of Notary -State Date Owner/Agent is Personally Known to Me or Produced ID Type of ID Rudith Goico Name - SKYLAR B AMKRAUT Commission ti FF 127890 _. o; MY Commission;Expires ° June 01, 2018 Personally Known to Me or Contractor/Agent is Produced ID ype of ID BELOW IS FOR OFFICE USE ONLY Permits Required': Building ❑ Electrical ❑ Mechanical ❑ Plumbing❑ Gas[_ Roof Construction Type: Occupancy Use: Flood Zone: Total Sq Ft of Bldg: Min. Occupancy Load: # of Stories: New Construction: Electric - # of Amps Plumbing - # of Fixtures Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads APPROVALS: ZONING: ENGINEERING: COMMENTS: UTILITIES: FIRE: Fire Alarm Permit: Yes ❑ No ❑ WASTE WATER: BUILDING: Revised: June 30, 2015 Permit Application 4/4/2018 SCPA Parcel View: 10-20-30-511-0000-1180 oavia;Wlmao,,, I:�n Parcel Information Property Record Card Parcel: 10-20-30-511-0000-1180 Property Address: 153 PINE ISLE DR SANFORD, FL 32773 Parcel Owner 10-20-30-511-0000-1180 RAMIREZ, RAMON — RAMIREZ, ANGELA Property Address 153 PINE ISLE DR SANFORD, FL 32773 Mailing 153 PINE ISLE DR SANFORD, FL 32773- Subdivision Name STERLING WOODS Tax District S1-SANFORD DOR Use Code 01-SINGLE FAMILY — Exemptions 00-HOMESTEAD(2016) 50 t 50 Legal Description LOT 118 STERLING WOODS PB 54 PGS 93 THRU 95 Taxes 50 1 50 1 50 r �. 50 50 50 Seminole County GIS Taxing Authority Assessment Value Exempt Values Taxable Value County General Fund $161,350 $50,000 $111.350 Schools $161,350 $25, 000 $136, 350 City Sanford $161,350 $50,000 $111,350 SJWM(Saint Johns Water Management) $161,350 $50,000 $111,350 ..... ........ ........... ...... County Bonds .......... $161,350 _._..... ......... .. .......... ....... ........ $50,000 1 $111,350 Sales Description Date Book Page Amount Qualified Vac/Imp WARRANTY DEED SPECIAL WARRANTY DEED 6/1/2014 5/1/2000 1 08282 038631 ; 0128 0953 $179,000 Yes $115,800 I Yes Improved Improved WARRANTY DEED 3/1/2000 03828 0476 $315,000 No Vacant Find Cotparahk Salmi Land Method Frontage Depth ;Units 'Units Price Land Value LOT I 1 $25,000.00 $25,000 Building Information Year Built # Description Fixtures :Bed Bath Base Area Total SF 'Living SF Ext Wall Adj Value Repl Value Appendages Actual/Effective http://parceidetail.scpafl.org/ParcelDetailInfo.aspx?PI D=10203051100001180 1 /2 4'S9 E. Colonial Dr. OTr ando, FL 32IN07 320-3, Conway Rd., Ste 201 (Mando. FI i2)sI (40 tt t 7.:rf, F r I r, r 10 lK i r JA S ffF ---'o ',"E " R "'n"""""wyJaaparRool,coin FL Contractor's License: CM329651 & CCC1331153 ROOF REPLACI.NIE_NT CONTRACT ACCQRnt tManager �•� � 1 � 6' ('17•"r, 0 _ Contact 4: 1/ 6 7 13 - (ram In uranr-e Cnmoanv Inforntatinn Company: A", Policy tf: A � /L ] r, l :3�� Claim, N1-lorloan Coinpany Ibformntion Company -- Loan Number: Phone: y -v, on co } $talc: %I Code: ic CQ ,C ��u _t-.� era 77 �21 Email- _ Roof RCV Amount/ Contract P rice: Ed °t Coloc -_;— �.; 01 , r` � c -� f r�r � �' _ (� t, .: , r cr l 14,200 t {- r 11 On ner's insrtritn a Comolifi-y df cs not t to wiv for it full roof rtmlacement this contract Shall he voidable Assignment of Insurance Denciits for the Full Roof Replacement Only: I hETehy assign any and all insurance ri_Oils, benefits and proceeds under an,., a}. s,hcab:e insurance policies to Pa -.HT Conmctota. Inc. ("Jasper'•), the scope of v.hich shall be limited to a Full Roof i eplacernem. I make this assignment and ;ter}cnz:tttcn In ct3nsidrttcrt of Jasper's aueement to pnlrtnn sort°ices, supply matey als and othervise perform its obligations under this Contract, olc!udrig not rNuiring, cull pa,tmeru at the ante of seriicc, I ako hereby direct my msurcr(s) to release any and all information requested by Jasper, or its represeniatvc(s), for the diret:t purpoa,e of ol-iainmg actual benefits to be paid by my msurcr(s) for services rendered. In this regard, I waive my privacy rift. If pa) -lent is n i. directly to die t)t�n•ar 1\gcnt'insared(sl. it shall he endorsed over to Jasper immediately upon receipt. I agree that any portion of Wofl daluctibies, b_tt_rmcni or aWitional trorh rcqucsicd by the undcrsicncd, not covered by insurance, must be paid by the undersigned on the day of ins allztton Deductible: It is the Quai is responsibiins to pav all insurance deductibles. OkweT's out-of-pocket expense will not exceed die deductible arnztmt, as :ratc-d on inairer's loss sheet (the "'Loss Sheet"). L�%'LL•SS replaceinenVrcpair of deteriorated decking is required by code andor Owner requests 0P1ic1•1al upgades. Jasper CANNOT pay, naive, rehate, or promise to pay, waive or rebate any or all of the insurance deductible applicable to the utst_ance claim for paynient .,f )vork. in t i, event of a dut-rep.utcy. the deductible amount stated on the insurer's Loss Sheet stiAlP'trrule deductible arrrunt discloscd. Dcductihte: S 1 - . �. -` � � r) ,�+ �11.57 BE P,111J IN' FULL, PLUS APPLICABLE SALES TAB f� � (initial) MORTGAGE AUTHOR17 kTION 1, Onncrlhlcmeeagor. Brant authorization for NkNq� � tf- to speak with Jasper on matters including but net limited to. the claim and draw status. - n (initial) PAYMENT SCHEDULE: Owner agrees to Ply Ja_sper based on the following schedule: 0) Dcposit in die amount if S _ - �<-��- due upon signing this contract-, (it) the Contract Price, less the D.T�osrt and any applicable &-predation rerained by Owner's irys>!ucr(s)pl� ride costs, due and payable to Jasper upon completion of work hoeing p^rfcrmed; and, gilt) the remain rig Contract Price (equal to any applicable d(Tircciauon and/or change orders) due and pa}able to Jasper upon completion of .tork perfermcd. In the event of a pending inspection, no more than 21,0 of Contract Price may be withheld umtil msPectioti has passed. Optional: U11GIU-kDE ITEM: QTY: PRICE: TOTAL: S Replacement Work and Price: Upon insurer's appro%al and subject to the Terms and Conditions herein, Jasper agrees to furnish all materials and pro%id, the labor necessary to pt-rform the full roof replacement winch shall take place following ON%ncr's insurance company's approval. approximately within 30 tiays, conditions pertmttinL�. Owner's Declaration of Intent. Owner acknowledges and agrees that. upon approval by insurance company for a full ro?frcplacemenL Jasper shall perform the roof replacement upon receipt of funds from Ottncr's insurance company. FLORIDA IIO:A1EO,%VNERS' CONSTUCTION RECOVERY FUND PAYMENT, UP TO A LnIITED AMOUNT, MAY BE AVAILABLE FROAT THE FLORIDA IiO.MEO\VNERS' CONSTRUCTION RECOVERY FUND IF YOU LOSE MONEY ON A PROJECT PERFORATED UNDER CONTRACT, WHERE THE LOSS RESULTS FROM SPECIFIED VIOLATIONS OF FLORIDA LA\\' BY A LICENSED CONTRACTOR. FOR INFOR:IIATION ABOUT THE RECOVERY FUND AND FILING A CLAIM, CONTACT THE FLORIDA CONSTRUCTION INDUSTRY LICENSING BOARD ,%,r'I'iIE FOLLOWING TELEPHONE NUMBER AND ADDRESS: Construction Industr%' Licensing Board: 2601 Blairstone Road, Tallaha4sce, FL 32399-1039, (850) 457-1395 CANCELLATION: If Oivner elects to terminate the services of .Jasper. 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 frnm 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 he postmarked or delivered to Jasper's corporate office: 1690 Roberts Boulevard, Suite 112, Kennesaw, GA 30144. CANCELLATION E\CI•>PTIONS: The three (3) da- right of cancellation DOES NOT APPLY to cataracts for emergency home repairs us time is of the essence. J, Owner. have read and understand all statements, Terris and Condilions of the "Roof Replacement Contract" and agree that all details are acceptable and satisfactory. 1 further 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 enforceahl0n accordance with its terms. —f1cpresent1UNe Date ! Owner .1` Date M Scanned by CamScanner 11111111111111 lull 111111111111 hill 1111111111 THIS INSTRUMENT PREPARED BY: Name: _ JASPER CONTRACTORS Address: 3203 S CONWAY ROAD SUITE 201 ORLANDO. FL 32812 �3Zz�3 NOTICE OF COMMENCEMENT Permit Number. Parcel ID Number: K0 i]tiiifi i H 'J A Ch111-4ISL"E COUN I Y CLERK OF CIRCUIT COLIRT & COrIPTROLLER Ev 910*"' F's 1103 (ip9s) CLERK'S 8 20181713190"'t 'RECORDED _1r/03r2-01f Ilr: 2'1-10 F11 RECORDING FEES $10.00 REC:ORDEE: BY hde",i i, = 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 Nonce of Commencement. 1. DEISCRIPTION OF PROPERTY: (Legal description of the property and street address iravailable) 2. GENERAL DESCRIPTION OF IMPROVEMENT: RE -ROOF 3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT: Name and address: /CL2�yj/Y1 IWmn (,53 P/j ej I-5(c Jr r S- . > -/ 3? 3 Interest in property: OWNER Fee Simple Title Holder (if other than owner listed above) 4. CONTRACTOR: Name: JASPER CONTRACTORS Phone Number: 407-278-7788 Address:. 3203 S CONWAY ROAD SUITE 201 ORLANDO FL 32812 - 5. 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 maybe served as provided by Section 713.13(1)(a)7., Florida Statutes. Phone Number. Address: 8. In addition, Owner designates to receive a copy 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 1, 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. . y (signature of Owner or Lessee, or Owners or Le Authorized 01ficad0itector/PartnedManager)ss State of kf County of (Print Name and provide signatorys Tiner019ce) The foregoing instrument was acknowledged before me this l ` day of llta2 ; Lei .20)1 by Name or person making statement who has produced identification type of identification produced: �KARLA M ALMODOVAR : Pia moo` State of; Florida -Notary Public e Commission#GG111330 My Commission Expires June 04, 2021 Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County; Winter Springs Date: 04/04/18 Karla Almodovar, Rudith Goico, Skylar Amkraut, Rachel Holcomb I hereby name and appoint: Ana Chavez and/or Michelle Monsalve An a -dent of Jasw Conracto,s' 0\— or camP.-yi to be my lauful attomey-in-factto act for me to apply for, receipt for, sign for and do all things necessary to this_appointmew for (check only one option): XThe specific permit and application for work located at: 153 PINE ISLE DR SANFORD, FL 32773 (Strew Address) Expiration Date for This Limited Power of Attorney: 1 /1 /2019 License Holder Name`. DonaldBouchard State -License Dumber. °cc'331153 Signature of License Holder ` STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this 04 day of April 200 18 ;, by Donald Bouchard who is o personally known to me or ® who has produced ot_ identification and who did (did not) take an oath. Signature (Notary Seal) Sky ar Amlaauf "'- sKYLAR B AMI(RAUT l '•- i Commission N FF 127690 ac Mq Commission Expires June 01, 201 8 '.:Mln�IC'ManFFJ��.YPw�P�+ Rxi.�+1W/ir%�+[+rtYJ (Rev. 08.12) Print or type name Notary Public - State of FL Commission No. 127890 My Commission. Expires: 6/1/2018 as ScannPti by C,amScannPr CITY OF `0 ! &A,NTro 1FIRE DEPARTMEN Building & Fire Prevention Division Re -Roof Permit Card PERMIT NO. �8 + ISSUE DATE: CONTRACTOR: JOB ADDRESS: I . P— a ,J=ZAe Ajv� TYPE OF WORK" PROTECT FROM WEATHER • Post this Permit and all required documents in a conspicuous place outside • Digital Photographs are required - please follow re -roof policy and procedures guide • All trash, debris and dumpsters must be removed from job site at final inspection • Permit expires six (6) months from date of issue ROOF INSPECTION TYPE APPROVED REJECTED INSPECTOR FINAL ROOF FAILURE TO FOLLOW THE RESIDENTIAL RE -ROOF POLICY & PROCEDURES WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION FEE AND MAY REQUIRE AN AFFIDAVIT, SIGNED AND SEALED, FROM A REGISTERED FLORIDA DESIGN PROFESSIONAL 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. 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. FBC 105.3.3 REVISED: 4-17 Inspection Line 407.792.6069 or 8SS.S41.2112 h ` F� DCity of Sanford Building Division " Residential Re -Roof Inspection 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: 04/04/18 F D' PERMIT # City of Sanford Building Division Residential Re -Roof Scope of Work JOB ADDRESS: 153 PINE ISLE DR SANFORD, FL 32773 STRUCTURE TYPE: O SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM RE -ROOF TYPE: O REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS) O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF) DECK TYPE (PLEASE SPECIFY): **PLEASE NOTE: ONL Y 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED" * ROOF VENTILATION: O OFF -RIDGE O RIDGE O SOFFIT OPOWERED VENT SKYLIGHTS: O YES O NO 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 O TURBINES TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL OX SHINGLE Owens Corning FL# 10674-R12 O METAL FL# O MODIFIED BITUMEN FL# O TORCH DOWN FL# OINSULATED FL# O TILE 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# O MODIFIED BITUMEN FL# O TORCH DOWN FL# OINSULATED FL# O TILE FL# O OTH ER: FL# FIRE INSPECTIONS CITY OF SANFORD 407.562.2786 BUILDING & FIRE PREVENTION BUILDING;INSPECTIONS 300 N PARK AVE 855.541.2112 SANFORD FL 32771 DRIVEWAYS -SIDEWALK 407.688.5080 ---------------------------------------------------------------------------- Page 2 Application Number . . . . . 18-00001670 Date 4/04/18 Property Address . . . . . . 153 PINE ISLE DR Parcel Number . . . . . . . . 10.20.30.511-0000-1180 Application description . . . ROOFING APPLICATION Subdivision Name . . . . . . Property Zoning . . . . . . . PUD Permit . . . . . . RESIDENTIAL ROOFING PERMIT Additional desc . . Phone Access Code 1042506 Permit pin number 1042506 ---------------------------------------------------------------------------- Required Inspections Phone Insp Seq Insp# Code Description Initials Date ---------------------------------------------------------------------------- 1000 111 BL03 FINAL ROOF _/_/ zP;C1� r City of Sanford Building and Fire Prevention RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS PERMIT #: ► �- Ulu ADDRESS: l � 1 � 1 I lk� \V \7 �'i�5 , 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 #: CCC1331153 JASPER CONTRAT' RSA, COMPANY/CONTRACTOR: , CONTRACTOR SIGNATURE: DATE: q V - t Q/ (MUST BE SIGNED BY LICENSFyk1 DEIR O E UILDER) A FINAL ROOF INSPECTION IS REQUIRED: THIS SIGNED AND NOTARIZED AFFIDAVIT MUST BE PROVIDED AT THE JOB SITE AT THE TIMEOF 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 SEMINOLE Sworn to and Subscribed before me this May of , ` 20 �by: Who is ❑ Personally Known to me or has N Produced (type of ideent�ific io D as identification. V _ Sign atur Notary Public SKYLAI2 B AMICRAU�� State or f da� ^ /a g �:�., S ` ComDussion # FF 127890 I NAY Commission Expire,,; IK. June CI Print/T pc/Stamp Name "f5° 70I 8 of Notary Public 1ju111117 Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: 4 ` W 1 0 I hereby name and appoint: Scott Meixsell, James Allen, Chris Gardner, Juan Lozano, Paul Padgett an agent of fie` Contractors or Company) to be my law1b] attomey-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): The specific permit and application for work located at; (SUW Addrm) p� Expiration Date for This Limited Power of Attorney. License Holder Name: State License Number CCC1331153 Signature of License Holder - STATE OF FLORIDA COUNTY OF sew The foregoing instrument was acknowledged before me this day of 2001!�_. by oonaw eoua>ard who is o personally known to me or a who has produced a as identification and who did (did not) toe a,Qoath. (Now' Seal) SLA IB AMKRAUT 1 27890 mI. 3o Comission 4t FF -- MY Commission Expires June 01 201 8 (Rev. 08.12) v 1'� Print or Notary Public - State of Commission No. Xqa 'p� D My Commission Expires: L,' 1 [ g" Scanned by CamScanner