HomeMy WebLinkAbout240 Fairfield Dra - 2-t-
+� CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No:
16-1530
Documented Construction Value: $ 15,900
Job Address: 240 FAIRFIELD DR SANFORD, FL 32771 Historic District: Yes ❑ No El
Parcel ID: 32-19-31-515-0000-0740 Residential Q Commercial ❑
Type of Work: New ❑ Addition ❑ AlterationEl Repair ❑ Demo ❑ Change of Use ❑ Move ❑
Description of Work: Re Roof Owens Corning FL 10674-R13 15216-R3 36 SQ 7/12 Pitch
Desert Tan Oakridge LIFETIME
Plan Review Contact Person: Skylar Amkraut Title: Admin
Phone: 407-278-7788
Fax: 800-337-3361 Email: Permit@Jasperinc.com
Property Owner Information
Name Zoraida Ramos
Phone:
Street: 240 Fairfield Dr
Resident of property? : Yes
City, State Zip: Sanford FL 32771
Contractor Information
Name Jasper Contractors
Phone: 407-278-7788
Street: 4185 S Orlando Dr
Fax: 800-337-3361
City, State Zip: Sanford, FL 32773
State License No.: CCC1331153
Architect/Engineer Information
Name:
Phone:
Street:
Fax:
City, St, Zip:
Bonding Company:
Address:
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: 5'h Edition (2014) Florida Building Code
Revised: June 30, 2015 %'I �2,30,GPermit 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.,___.____._ �. ._... .... _._
Signature of Owner/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
03/23/18
Signatur of Contractor7Agerlt bate
Rudith Goico
Name
SKYLAR B AMKRAUT
_ Commission # FF 127890
o,. 'My Commission Expires
; o June 01, 2018
1.:..
Contractor/Agent is Personally Known to Me or
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 ❑
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
# of Heads Fire Alarm Permit: Yes ❑ No ❑
UTILITIES:
FIRE:
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Permit Application
THIS INSTRUMENT PREPARED BY:
Name: as Ct3n- 5
Address: Ai SS S rxrlan o dot"• S2— n�F I327`Pj
u33(ogo
NOTICE OF COMMENCEMENT
Permit Number.
Parcel ID Number: 5/5— bra` 0-7q0
vi (�tJ.j�i!('1 0i1
ER
CLEFX'S s )' 7i Alp9s)
U18t)..1299
:%
Uih)t; r. MUri
C'J Z`iZ;j tl?,Sir 1,7
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: (Legal description of the property and street address if available)
2. GENERAL DESCRIPTION OF IMPROVEMENT -
RE -Roof
3. OWNER INFORMATION OR LESSEEINFORMATIONIF THE LESSEE CONTRACTED FOR pTHE IMPROVEMENT:
��[�
Name and address:? Qy0 f1 Y'- Ad Gir,
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 RD SUITE 201 ORLANDO FL 32812
5. SURETY (If applicable, a copy of the payment bond is attached) : Name.
Amount of Bond:
G. 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.
Phone Number.
8. In addition, Owner designates _ of
to receive a copy of the Lienoes 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 70 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 VQRK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
bZrc6f/,�- 4.e'00
mature of Owner or Lessee, or Owner's or Lessee's (Pdnt Name and Provide Signatory's 71drJOfice)
Authorized Oficer/DirectoNPartnedManager)
State ofa-
The foregoing instrument was
by Z-'3�ca iL6 a -
County of e m ur\cA-
riedged before me this 1 ✓
day of _ l `e bl( Q�. 20 �b
Who is personally known to me ❑ OR
Name of person making statement
who has produced identificatiory4 type of Identification produced:
"W'yPly. ANA CHAVEZ
;_� Statellorida-Notary Public
` Commission # GG 112152 rF
M ER r i41)fG'PY tiR;�i�:?'iyi?�t�Y Notary Signature
OF
111111%k y Commission Expires { EI?K, OF T4; CiP,f Ul t iF~;;R?
rma� June 06, 2021 CERK F TH....... i £:.
rfAffal
2018
5380 E. Colonial Dr.
Orlando, FL 32807
3203 Conwav Rd., Ste. 201
Orlando, FL 32812
(407) 278-7788 22�j(p9U
(800) 337-3301 Fax
infwi;" ta4perinc,Gre
VISA
VASE
m _ Jn2pornool,corn
FL Contractor's License:
CCC1329651 & CCC1331153
onnV 13 DV A r V,L4r7Ki'rrnKvrD A r,i
Account Manager
Colltacl d!:
Company: r '� • r - ti e-C
Policy f1: / _j��
Claim If- —
rr C( ( r
Company: { }• ca
Loan Number:
f\\lVf: f\lJf U/1V1J3•fAit.
Owner(s):
--
J'honcG i 7,1(1
AddSS: U r
of q �.t e
AliPhGnC� 7 el) G
U `� S
Gly: ((
sr, N Ls �J
Stale:
fi code:
!
Shingle Color:
r
Email: (� L"
i� �UD/ CGM
Roof RCAmount/ Contract Price:
15,900
Dri Edgc Color:
IC,r�til
If Owner's insurance Coma —ay does not aeree to nay for a fill roof replacement this contract shall he voidlbl�.
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 Jasper Contractors, Inc. ("Jasper"), the scope of winch shall be limited to a Full Roof Replacement. i make this assignment
and authorization in consideration of Jasper'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 Jasper, or its
representative(s), for the direct purpose of obtaining actual benelits to be paid by my instrer's) for services rendcrel. In this regard, I waive my privacy
rights. if payment is made directly to the Owner/Agentflnsured(s), it shall be endorsed over to Jasper immediately upon receipt. 1 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 pav all Insurance deductibles. Owner's out-of-pocket expense will not exceed the deductible
amount, as stated on insurer's loss sheet (the "Loss Sheet"), UNLESS replacetnent/repair of deteriorated decking is required by code an&or Owncr requests
optional upgrades. Jasper CANNOT pay, waive, rebate, or promise to pay, waive or rebate any or all of the insurance deductible applicable to the
insurance claim for payment of w k_ n the event of a discrepancy, the deductible amount stated out the insurer's Loss Sheet shall overrule deductible
amount disclosed. Deductible: S QQ—MOST ICE PAID) 1N FUL (JS APPLICABLE SALES TAX � %L (initial)
MORTGAGE AUTHORIZATiON: i, Owner/Mortgagor, grant authorization for _Mortgage Co. to speak with
Jasper on matters including but not limited to, the claim and draw status. - X(Y7(initial) PAYMENT SCHEDULE: Owner agTecs to
pay Jasper basal on the following schedule: (i) Deposit in the amount of due upon signing this contract; (i) the Contract Price,
less the Deposit and any applicable depreciation retained by Owner's ins r(s), plus upgrade costs, due and payable to Jasper upon completion of
work being performed; and, (in) the remaining Contract Price (equal to any applicable depreciation and/or change orders) due and payable to Jasper upon
corpletion of work performed. in the event of a pending inspection, no more than 2% of Contract Price may he withheld until inspection has passed.
Optional: UPGRADE ITEM: QTY: PRICE: TOl'AL: S
Replacement Work and Price: Upon insurer's approval and subject to the Teens and Conditions herein, Jasper agrees to furnish all materials and
provide the labor necessary to perform the full roof replacement wduch shall take place following Otttner'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, Jasper shall perform the roof replacement upon receipt of finds from Owner's insurance company.
FLORIDA HOMEOWNERS' CONS"1'uCTION RECOVERY FUND
PAYMENT, UP TO A LIMITED AMOUNT, MAY I3E AVAILABLE FROM TIIE FLORIDA HOMEOWNERS'
CONSTRUCTION RECOVERY FUND IF YOU LOSE MONEY ON A PROJECT PERFORMED UNDER CONTRACT,
WHERE THE LOSS RESULTS FROM SPECIFIED ViOL,ATIONS OF FLORIDA LAW BY A LICENSED CONTRACTOR.
FOR INFORIMATiON ABOUTTHE RECOVERY FUND AND FILING A CLAIM, CONTACT •['ilE FLORIDA
CONSTRUCTION INDUSTRY LICENSING BOARD AT •]'HE FOLLOWING TELEPHONE NUMBER AND ADDRESS:
Construction industry Licensing Board: 2601 Blairstone Road, Tallahassee, FL 32399-1039, (8-50) 487-1395
CANCELLATION: if Owner 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 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 Jasper's
corporate office: 1690 Roberts Boulevard, Suite 112, Kennesaw, GA 30144. CANCrLLA'i'iON EXCEPTIONS: The three (3) day
right of cancellation DOES NOT APPLY to contracts for emergency home repairs as time is of the essence.
1, Owner, have read and understand all statements, Ternts and Conditions of the "Roof Replacement Contract" and agree
that all details are acceptable and satisfactory. l 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 enforceable in accordance with its terms.
Authorized asper Representative Date
Owner Date
Scanned by CamScanner
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 03/23/18
Karla Almodovar, Rudith Goico, Skylar Amkraut Rachel Holcomb
I hereby name and appoint: )`itjf '� d 2 rt�iY2��YVilblli€�l� I0 UfsNIW, Gina McDonald & Rachel Holcomb
an agent of: .tasper c* acfas
(,Namc or Company)
to be my lawful 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):
XThe specific permit and
240 FAIRFIELD DR S.
ion for work located at:
D, FL 32771
Expiration Date for This Limited Power of Attorney: 1 /1 /2019
License Holder Name: Donald Bouchard
State License Number CCC1331153
Signature of License Holder_
STATE OF FLORIDA
COUNTY OF se�
The foregoing instrument was acknowledged before me this 23 day of March
200 18 , by o« w soua>ard who is o personally known
to me or ® who has produced ot_ as
identification and who did (did not) take an oath.
l I h, X
Signature
(Notary Seal) Sky ar Amkraut
yo
SKYLAR B AWRAUT t
Commission N FF 127890 j
My Commission Expires t
air;;.•° June O1 , 201 8 �4
(Rev. 08.12)
Print or type name
Notary Public - State of FL
Commission No. 127890
My Commission Expires: 6/1/2018
Scanned by C;amScanner
3/23/2018 SCPA Parcel View: 32-19-31-515-0000-0740
i
dJoiww CFA Property Record Card
Parcel: 32-19-31-515-0000-0740
RNi £ nRuvoi& rrv,rYDrt u Property Address: 240 FAIRFIELD DR SANFORD, FL 32771
Value Summary
2018 Working
2017 Certified
. Values
Values
Valuation Method
Cost/Market
Cost/Market
Number of Buildings —
1
1
Depreciated Bldg Value
$128,387
$120,946
Depreciated EXFT Value
$325 —
$338 —
Land Value (Market)
$34,000
$30,000
Land Value Ag
$162,712
Just/Market Value °'
$151,284
Portability Adj
Save Our Homes Adj
$66,158
$56,716
Amendment 1 Adj
$0
P&G Adj—_.__._..__
$o_..
$0
Assessed Value-------, $96,554 $94,568
....................... ......... ......._ E........._...... _._-____...... .. _...__..-...... ......... ..._........
Tax Amount without SOH: $2,083.00
2017 Tax Bill Amount $1,003.00
j Tax Estimator
Save Our Homes Savings: $1,080.00
' Does NOT INCLUDE Non Ad Valorem Assessments
Legal Description
LOT 74
CELERY LAKES PHASE 1
PB 62 PGS 75 & 76
Taxes
Taxing Authority
Assessment Value
Exempt Values
Taxable Value
County General Fund
( $96,554
—
$50,500 j— — —
$46,054
Schools
$96,554
$25, 500
$71, 054
City Sanford
$96,554
$50,500
$46,054
SJWM(Saint Johns Water Management)
$96,554
1
$50,500
$46,054
County Bonds
$96,554
$50,500
$46,054
Sales
Description Date
Book Page
Amount
Qualified
Vac/Imp
SPECIAL WARRANTY DEED 2/1/2012
07716 0826
$103,400
Yes
Improved
SPECIAL WARRANTY DEED 11/1/2011
CERTIFICATE OF TITLE 8/1/2010
07661 1379 {ft
07428 0524
$88,000
i $100
No
No ---
Improved
Improved
WARRANTY DEED 6/1/2007
06741 q 0868
$216,000
Improved
Yes
-._.__.
_
WARRANTY DEED ; 12/1/2005
06069 08E
$260,000
Yes
Improved
SPECIAL WARRANTY DEED 12/1/2034
..---_
( 05551 1012
L ...... . __ .___.._
$145,600
__ .—_—__.--____..
Yes
...__
Improved
.-.
r '
.' City of Sanford Building Division
r
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.
03/23/18
CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: DATE:
' D
JOB ADDRESS: 240 FAIRFIELD DR SANFORD, FL 32771
PERMIT #
City of Sanford Building Division
Residential Re -Roof Scope of Work
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: (DOFF -RIDGE O RIDGE OSOFFIT OPOWERED VENT
SKYLIGHTS: O YES ONO 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
Q SHINGLE
Owens Corning
FL# 10674-R12
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
O INSULATED
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#
O INSULATED
FL#
O TILE
FL#
O OTHER:
FL#
CITY OF
SkNFORD
FIRE DEPARTMENT
PERMIT NO. *'
CONTRACTOR:
JOB ADDRESS: a �I
Building & Fire Prevention Division
ISSUE DATE:
Re -Roof Permit Card
TYPE OF WORK: nr — V%LA-Orf L.K1I 11�1&F
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 855.541.2112
3
City of Sanford
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: I -1 ADDRESS: % ` D Ta1 IT 1 c (d orivL
�c
I S Y C"Q VI � � . -� `� , 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
COMPANY / CONTRACTOR: JASPER CONTRA S
CONTRACTOR SIGNATURE: DATE: I V
(MUST BE SIGNED BY LICEN13i' OLDER O OWNER/BUILDER)
,Zbv 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 SEMMOLE
Sworn to and Subscribed before me this � day of 20 � � by:
�("fpJ11sWho is ❑Personally Known to me or has N Produced (type of
identification) DL as identification.
Signa r of Notary Public
Stat of lorida "`SI<YLAR B AMI<RAUT
=O pyv n`Bli�.
_N ? Commission q FF 127890
V` My Commission Expires
Print/ ype/Stamp Name ...° rune 01 , 201 8
„°".y
of Notary Public"