HomeMy WebLinkAbout1906 William Clark AveCITY OF
S,,kNFURD
i 2018,Building & Fire Prevention Division
APRPERMIT APPLICATION
BY Application No:
Documented Construction Value: S 8,500
Job Address: 1906 William Clark Ave, Sanford 32771 Historic District: Yes❑NoFv—/]
Parcel ID: 36-19-30-520-0000-0580 Residential Commercial❑
Type of Work: New❑ Addition❑ Alteration[] Repair[] Demo❑ Change of Use❑ Move❑
Description of Work: Re -roof
Plan Review Contact Person:
Phone:
Name Gloria Chauca
Street: 11 Tappan Zee Land
City, State Zip:
32771
Name Ruby Davis
Street: 3525 Raeford Road
City, State Zip.
Name:
Street:
City, St, Zip: _
Fax:
Title:
Email:
Property Owner Information
Orlando, FL 32806
Bonding Company:
Address:
Phone:
Resident of property? :
Contractor Information
Phone: 407-721-7690
Fax:
State License No.: CCC1328498
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. 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: 6"' Edition (2017) Florida Building Code
Revised: January 1, 2018 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.
.,
WnWA7�'71061L— Date
Print Owner/Agent's Name
:.A
Signature of Notaryt to of ic]J Date
Signature �mw.,.�I.rlAgenl�� Date
1-9—U64 t)J)l �
P'riny/t� CCooDnttraa or/Agent's Name r / �
Signature of *Jary-lWte orFlorida Date
�otk ygsso Wendy Kaye Schaffner �pSARygsso Wendy Kaye Schaffner
n NOTARY PUBLIC o� n NOTARY PUBLIC
7
' STATE OF FLORIDA o STATE OF FLORIDA
i Comm# GG070449 1�a Comm# GG070449
Owner/Agent is sI' biiali f— {A PPWlor Contractor/Agent is Ems§ V Known to Me or
Produced ID Type of ID T--DL Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
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 ❑ # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Flood Zone:
# of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes ❑ No ❑
WASTE WATER:
BUILDING:
Revised: January 1, 2018 Permit Application
SCPA Parcel View: 36-19-30-520-0000-0580
Page 1 of 2
M
Legal Description
�S26FTOFLOT 58&N36FT
OF LOT 59 & 1/2 OF VACD
ALLEY ON W
PINEHURST
PB3PG71
j Taxes
Property Record Card
Parcel: 36-19-30-520-0000-0580
Property Address: 1906 WILLIAM CLARK AVE SANFORD, FL 32771-3352
Value Summary
Seminole County GIS
2018 Working
Values
2017 Certified
Values
Valuation Method
Cost/Market
Cost/Market
Number of Buildings
1
1
Depreciated Bldg Value
$34,217
j $35,964
Depreciated EXFT Value
Land Value (Market)
_....._....__.._._..._.....-----_.._.._............
1 $16,709
.._._....._.—.._...___.-.._.._
; $15,190
_._._.__...-----__...._......_.
Land Value Ag
,
j
Just/Market Value"
$50,926
$51,154
Portability Adj-----�-----.._.-l.--------------
Save Our Homes Adj
.------------
I $0
i $0
--
Amendment 1 Adj
---'
$0
- -
$1,789
P&G Adj
--------i
$0---------
Assessed Value—�I
t�$0
$50,926
$49,365
Tax Amount without SOH: $951.00
2017 Tax Bill Amount $951.00
Tax Estimator
Save Our Homes Savings: $0.00
Does NOT INCLUDE Non Ad Valorem Assessments
Taxing Authority
Assessment Value Exempt Values
Taxable Value
County General Fund
$50,926 j
$0 j
-
$50,926
Schools
j-- $50,926 ;
— —
$0
City Sanford
- ---- ------- ..._.-- - -- - ---- ---- - -- ----
SJWM(Saint Johns Water Management)
$50,926
----- - t- -- -------- --- - ---- --- ------
$50,926 j
$0 i
$0 1
$50,926
$50,926
County Bonds ----------
---- -- -- - $50,926 j
$0
$50,926
Sales
Description Date Book Page Amount Qualified Vac/Imp
SPECIAL WARRANTY DEED 2/1/2018 09083 0859 $65,000 1 Yes Improved
WARRANTY DEED 1/1/2018 - 09063 - -! 1240 - ! $40,000 No I Improved
SPECIAL WARRANTY DEED — 1/1/2018 _ 09064 1419 - $54,000 No - F_ - Improved
_ ..._ .... .- ....-...... ..... ........ .... ... ..... :...__ ............. _ _. _.L...._ ......_...
WARRANTY DEED 5/1/1991 02301 1892 $36 900 1 Yes Improved
Find Comparable Sales
Land
Method Frontage
Depth
Units Units Price
Land Value
FRONT FOOT & DEPTH ( 62.00
( 136.00
l 0 $275.00
I $16,709
Building Information
> Bed/Bath count incorrect? Click Here.
# Description Year Built Fixtures Bed Bath Base Area Total SF Living SF Et Wall I Adj Value Repl Value Appendages
Actual/Effective
http://parceldetail.sepafl.org/ParcelDetaillnfo.aspx?PID=36193052000000580 3/31/2018
Detail by Entity Name
Page 2 of 2
Detail by Entity Name
Florida Limited Liability Company
GOLDEN KEYS HOMES LLC
Filing Information
Document Number L17000164687
FEI/EIN Number NONE
Date Filed 08/02/2017
Effective Date 07/28/2017
State FL
Status ACTIVE
Principal Address
11 TAPPAN ZEE LN
LONGWOOD, FL 32750
Mailing Address
11 TAPPAN ZEE LN
LONGWOOD, FL 32750
Registered Agent Name &Address
QUINDE, LUIS
11 TAPPAN ZEE LN
LONGWOOD, FL 32750
Authorized Person(s) Detail
Name & Address
Title MGRM
QUINDE, LUIS
11 TAPPAN ZEE LN
LONGWOOD, FL 32750
Title MGRM
CHAUCA, GLORIA
110 SHEPHERD CT
LONGWOOD. FL 32750
Annual Reports
No Annual Reports Filed
Document Images
08/02/2017 — Florida Limited Liability View image in PDF format
Florida Department of State, Division of Corporations
http://search. sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 4/2/2018
PRIMROSE CONSTRUCTION
COMPANY
Direct:
407-721-7690 Construction • Roofing Email:
g rubydavis222@aol.com
Roofing Construction Contract
1. Parties: This Contract is between Golden Key Homes, LLCca hereinafter. referred to as the Owner, whose
address is 1 l Tappan Zee Lane, Longwood, Florida 32750, and Primrose Construction Company,
hereinafter referred to as the Contractor, whose business address is 3525 Raeford Road, Orlando, Florida
32806.
2. Job Location: 1906 William Clark Avenue, Sanford, FL 32771, Parcel ID Number:
39-19-30-520-0000-0580
3. Permits: The Contractor, License No. CCC1328498, will acquire the appropriate construction permits,
coordinate required inspections, ensure all work is done in a workmanlike and professional manner, and
complete the Contract in accordance with the terms contained herein. The permit acquisition shall be within
ten (10) days of the signing of this Contract and permit application. This Contract contains no completion
date and no penalty or award clauses. This Contract allows the Contractor to place a sign and permit box in
the front yard of the job site for the duration of construction to assist inspectors and subcontractors in
locating the construction site.
3. Payments` This Roofing Construction Contract is in the amount of Eight Thousand Five Hundred Dollars
($8,500) with payment to Primrose Construction Company, as follows
A. First payment: 50% $ 4,250 at contract signing,
B. Final payment: 50% $ 4,250 upon completion and cleanup of job site.
D. Any additional work and Change Orders to this Contract shall be paid upon signing of the Change
Order.
4. Owner Responsibilities: The Owners shall provide access to the area of work. Any damage to driveways,
sidewalks, shrubs, landscaping, vehicle damage of any nature shall be the responsibility of the owner and his
respective insurance.
5.
6. Contractor Responsibilities: The following materials and installation are included by the Contractor in the
contract price.
A. Removal of existing roof materials such as eave drip, vent stack covers, ridge vents, off --ridge vents, and
items that are damaged or hinder or prevent the installation of a new roof system.
B. Number Atlas Summit Synthetic 60 Felt Underlayment.
C. New roof description: Dimensional Architectural Atlas Pristine: Color: Owner to choose.
D. The removal, cleanup, and disposal of all roof materials.
E. Install new 2 %" eave drip, lead boots, and roof vents.
F. Other: Any decayed wood requiring replacement will be charged at $40 per board.
7. Lien Waivers: N/A
8. Warranty: The Contractor warrants the roof workmanship for a period of one year from the date of
completion. The Owner accepts responsibility for the manufacturers limited warranty of thirty (30) years.
Florida Statutes: In accordance with Florida Statutes 489.1425, the following is included in this Contract.
Construction Industry Recovery Fund payment may be available from the Construction Industry Recovery
Fund if you lose money on a project performed under contract, where the loss results from a specified
violation of Florida law by a state -licensed contractor. For information about the recovery fund and filing a
claim, contact the Florida Construction Industry Licensing Board at the following telephone number and
address: Construction Industry Licensing Board, 1940 North Monroe Street, Tallahassee, Florida 32399-
0783 Phone: 1-850-487-1395.
10. Understanding: It is expressly agreed that this Contract constitutes the sole understanding between the
parties hereto and that no oral understandings, representations, promises, or other statement whatsoever
made by anyone whomsoever will be binding upon Owners or Contractor unless the same is contained
herein or in another instrument attached hereto and made a part of this Contract and duly signed by all
parties. This contract shall become null and void if not signed by all parties within 5 days of the effective
date shown below.
i.1. Dispute: Should any dispute arise out of this Contract, the prevailing party shall be entitled to recover its
attorneys fees and costs incurred with such dispute, arbitration or action, through all appeals, bankruptcy
proceedings and collection efforts.
11. Notices: Any notice given pursuant to the Contract shall be sent certified U.S. Mail, return receipt
requested, as follows:
Owner: Golden Key Homes, LLC Contractor: Primrose Construction Company
11 Tappan Zee Lane 3525 Raeford Road
Longwood, Florida 32150 Orlando, Florida 32806
This Roofing Construction Contract is a legal binding Contract with an effective date of April 18, 2017.
Gloria Chauca, Managing Member
Roofing Contract/1906 William Clark
gRuy APre=ident
1 v THIS INSTRUM NT PREPARED BY:
Name: k.,U b4hdAM
Address: 51s'2s' aL6)gA R OAa
Ul'u-ly M 329ag
Permit Number:
Parcel ID Number: %-I47- 30-5a •19000 05 To
191f1f ��i�� I11�1 �11�� 11111 l��l! 11�1 I��1
GRANT I°IALOYr SEM INOL.E COUNTY
CLERK OF CIRCUIT COURT & COMPTROLLER
Btt ' 102 P--i 2-'� ClPss)
CLERIC'S g 20i8O35372
RECORDED +34/0312018 i i ::L7: ° ;% rill
RECORDING FEES $10.00
RECORDED BY lidevore
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. DESCRIPTION OF PROPERTY: (Legaldes ription of the
M Gto e It . - -L_
2. GENERA DESCRIPTION OF IMPROVEMENT:
3. OWNER INFORMATION OR LESSEE INFO
e �P`,
Name and address: /)V')
Interest in property: OW a `�
Fee Simple Title Holder (if other than owner listed above) Nam
and street address if available)
CONTRACTED FOR THE IMPROVEMENT:
4. CONTRACTOR: Name: Iey 0 h 0A-Y 0, Phone Number:
Address: 352-S R4444A IZof D/`lf olr) T2. 3 ik,
5. SURETY (If applicable, a copy of the payment bond is attached): Name:
Address: Amount of Bond:
6. LENDER: N
Address:
Phone Number:
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.
8. In addition, Owner designates
Phone Number:
of
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 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.
State of Ela dO County of I hi d if
The foregoing instrument/wads acknowledged before me this _
by
Name of p rso making statement
who has produced identification
of identification produce
JENNIFER M. MORALES
_ Notary Riiblic, State of Florida
Commissional GG 117441
My Comm. expires Aug. 31.2021
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: cF 2_-l8
I hereby name and appoint: -�71
0
#-AM4M 'I_Tojd_C46S
an agent of: ?amt 0--k CAriS4yv L1gd)' 4rwl�
(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):
[' The specific permit and application for work located at:
fib(, . Wi lh/iYn OAavk At-f_ . S(A&_i r/j
(Street
Expiration Date for This Limited Power of Attorney:
License Holder Name: h/,i bAA) JS
State License Number: 132.E 41 V
Signature of License Holder: (2VAZ4,'"
STATE OF FLORIDA
COUNTY OF OC4
The foregoing instrument was acknowledged before me this
20J 2 , by eUb�) Dwi&
to me or ❑ who has produced
identification and who did (did not) take an oath.
(Notary Seal)
Ot0, Ygss Wendy Kaye Schaffner
o. NOTARY PUBLIC
STATE OF FLORIDA
Comm# GG070449
ONCE 19�� Expires 5/9/2021
(Rev. 08.12)
Signature
Print or type name
Notary Public - State of
Commission No.
My Commission Expires:
2 day of ATr:, ) ,
who is RTersonally known
as
CITY III
}`1RE °)I PAIti 3 MEWE
PERMIT #
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
JOB ADDRESS: l D� t0d 1� Q/ n 0,Lrt(c. A P, 7 A 4 n 3XTW
STRUCTURE TYPE: 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: (& OFF -RIDGE O RIDGE OSOFFIT 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
OTURBINES
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
(DSHINGLE
6L& r4A_t.
FL# 1 (305'
O METAL
FL#
O MODIFIED BITUMEN
FL#
OTORCH DOWN
FL#
O INSULATED
FL#
QTILE
FL#
OOTHER: U11 4! !i►&4
e�umM4 5� yr icbc
FL# u�
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#
OTORCH DOWN
FL#
O INSULATED
FL#
QTILE
FL#
0 OTHER:
FL#
CITY Or
Building & Fire Prevention Division
S,,kNFORD RESIDENTIAL RE -ROOF POLICY & PROCEDURES
rIRF 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 (1F 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 TI4ESE 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: �lY�'" '' DATE: �6
CITY OF
SANFORD
Building & Fire Prevention Division
RESIDENTIAL RE-ROOFAFFIDAVIT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
iNAILING, S/H'EATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT##: iADDRESS: ,)90(o WIbia-,nCIaA-/fit
bL, D013 , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRAC FOR, 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 GG 1 3 2_2` Y`1 g
COMPANY / CONTRACTOR: 1--TrIm ro (.fSYV, M j z a2l7�j
CONTRACTOR SIGNATURE: DATE:
(MUST BE SIGNED BY LICENSE HOLDER O WNER/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 O"C Z
Sworn to and Subscribed before me this _ day of r ( 2017 by:
TNb h ba,I) o Who is,2-Nrsonally Known to me or has ❑ Produced (type of
identification)
Signature of io ary bl c
State of Florida
Print/Type/Stamp Name
of Notary Public
as identification.
e otARYgsWendy Kaye s�e; NOTARY PUBLIC
g
o L o STATE OF FLORIDA
Comm# GG070449
��Nce Ie�O Expires 5/9/2021