HomeMy WebLinkAbout2802 S French Ave (3)CITY i
ORD
FIRE EXPARTMENIN
Building & Fire Prevention Division
PERMIT APPLICATION
Application No:
Documented Construction Value: $
Job Address:�2- S• Sa Historic District: Yes❑No❑
Parcel ID: - 3 0 ' !I'L _00DD - (D07 Residential Commercial❑
Type of Work: New❑ Addition❑ Alteration ❑ Repair ❑ Demo ❑ Change of Use❑ Move ❑
Description of Work: 4�_0_p
Plan Review Contact Person: a uwso, IVQv,, Title: Loke4t�
Phone: `! 2A-2-61-"OD Fax: Y f V Email:
Property Owner Information
Name 0-l OA"J D SIVOA, Phone:
Street: C� 3 - 16YLCL Ie pa-14 Resident of property?
City, State Zip: N&sd '-- 3 2-n3
�^ r- �I_, _, Contractor Information
Name Q�11 Wn-S'64cz)rl C— Phone: 3
Street: b Fax: A )A -
City, State Zip: State License No.: 8C L l 32--c13 78
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
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
FI.NANCING, 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
Signature of Owner/Agent Date
5�2�-<--,, 3-y? - / -�3
Name
Signature o o dW _ Date
y
:+ 0 SHARON KERN
E • . Notary Public - State of Florida
Commission # GG 061605
My Comm. Expires Feb 17
Owner/Agen is Fi�sea2 alk n to ATe
Produced ID Type of ID
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. ¢moo y
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Signature of Contractor/Agent Date
�ll�son �Q.s�
Pr Con ctor/Agent's Name
Signature of Notary -State of Florida Date
Contractor/Agent i Personally 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: January 1, 2018 Permit Application
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: � A"� 111
I hereby name and appoint: n`�
an agent of: �O-gk �� ,
(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):
0,
The specific permit and application fR r work located at:
2 $02 f--V t r.!-. Svc
(Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name: kt-'LA-S U 1"1 tQ oud
State License Number: Or-&l3-q3-1 g
Signature of License Holder: o_ U'� N)-L - IV a
STATE OF FLORIDA
COUNTY OF ""
The foregoing instrument was acknowledged before me this�I�t.Cday of L" ,
200S , bht "t n r, G06 K who is ❑ personally known
to me or y o has produced
identification and who
r-� 32-1113
(Notary Seal)
DANA DENISE PICONE
��1PRY lyB ,,
Notary Public • State of Florida
Commission # GG 1278'1
M Comm. Expires Jul 18, 2020
°;`,�� Bonded through National Notary Assn. `
(Rev.08.12)
V AT -)A— P !- U N -e—
Print or type name
Notary Public - State of
Commission No.
My Commission Expires:
El
LEI)
Nash Construction, Inc.
20241 Oberly Pkwy Orlando, FL 32833
CONSTRUCTION, INC.
Ken Barber: 407-310-8856
PROPOSAL/CONTRACT
Date: 3/27/18
Submitted to: Ken Barber/Orlando Stop Leak
Email:
Phone: 1-407-310-8856
Job Location: 2808 sS.French Ave. Sanford. FL
Stein le Roof Replacement:
1.Tear Off down to decking .
2.Apply Bitumen 3ply Roof Covering.
3.install New Drip Edge New Lead Boots and Ridge Vents.
4. Replace rotten wood up to 2 sheets of plywood included in price. (Any
additionai wood wifi be an extra charge.)
Grand Total: $1 1.500a ®®
by the above proposed
scope of work. Walk perimeter with a roll magnet.
* Nash Construction, Inc will make every effort to avoid damage,
but cannot be held responsible for minor peripheral damage to
grass, plants, driveways, sprinklers, items inside home, pictures,
falling items, etc.
* Nash Construction, Inc will provide a five (5) year warranty on
workmanship from completion
date. Roofing materials will be covered by applicable
manufacturer's warranties.
*License, insurance, and obtaining necessary permits are
included in price. Any deviation from the above specifications
may incur additional charges above the original estimate.
CONTRACT AMOUNT: We hereby propose to furnish material,
equipment and labor in accordance with above specification for
the sum of.- $ 91 500.00
**We propose 12 deposit to be paid at signing of contract which
Totals to: $55, 750.00, The remaining balance of. $5 750.00 is
due upon the completion of the work and satisfactory final
inspection with the Building and Safety Division municipality thG
issues the building permit per building.
WASH CONSTRUCTION, INC OWNS ALL MATERIAL UNTIL
BALANCE IS PAID IN FULL.
*This proposal will expire 30 days from date. After 30 days,
Nash Construction, Inc. reserves the right to revise our price in
accordance with costs in effect at that time.
W
*All material is guaranteed to be as specified. All work to be
completed in a workmanlike
manner according to standard practices. Workman's
Compensation and General Liability
Insurance Certificates are to be provided upon request. We
appreciate the opportunity to offer our services to you.
ACCEPTANCE OF PROPOSAL / CONTRACT: The above
SERVICES THAT YOUR CONTRACTOR OR A
SUBCONTRACTOR MAY HAVE FAILED TO PAY. TO
PROTECT YOURSELF, YOU SHOULD STIPULATE IN THIS
CONTRACT THAT BEFORE ANY PAYMENT IS MADE, YOUR
CONTRACTOR IS REQUIRED TO PROVIDE YOU WITH A
WRITTEN RELEASE OF LIEN FROM ANY PERSON OR
0�t.!P=� NY �
s+AT HAS PROVIDED TO YOU A "NOTICE TO
OWNER.'' _FLORIDA'S CONSTRUCTION LIEN LAW IS
THAT
\/P1' n A \"l1"l lU T'
Initia
THIS INSTRUMENT PREPARED BY: `
Name: Nash Construction, Inc A ji I j u -,
Address: 20241 Oberly Pkwy, Orlando, FI 32833
NOTICE OF COMMENCEMENT
Permit Number:
Parcel ID Number: 01-20-30-512-0000-00713
GRAwr MALOYf SEMINOLE COUNTY
CLERK OF CIRCUIT COURT & COrIPTROLLER
BK 9099 F'9 18 (iP9s)
CLERK'S 2018033517
RECORDED 03/27/2018 12:47:52 P11
RECORDING FEES $10.00
RECORDED BY tsmith
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)
S 22 FT OF E 150 FT OF LOT 7 + N 56 FT OF E 150 FT OF LOT 8 AMENDED PLAT DRUID PARK PB 7 PG 5
2802 S FRENCH AVE SANFORD, FL 32773
2. GENERAL DESCRIPTION OF IMPROVEMENT:
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT:
Name and address: ORLANDO STOP LEAK LLC 237 BRIDLE PATH CASSELBERRY, FL 32707-3145
Interest in property:
Owner
Fee Simple Title Holder (if other than owner listed above) Name: N/A
Address:
4. CONTRACTOR: Name: Nash Construction, Inc Phone Number: 321-201-4300
Address: 20241 Oberly Pkwy Orlando, FI 32833
5. SURETY (If applicable, a copy of the payment bond is attached): Name: n/a
Address: Amount of Bond:
6. LENDER: Name: n/a 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: n/a Phone Number:
Address:
8. In addition, Owner designates
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.
a::." 4-1— 0
(Signature of Owner or Lessee, or Owner's or Lessee's (Print Name and Provide Signatory's Title/Office)
Authorized Officer/Director/Partner/Manager)
State of 'Bo( i . County of 5. lO 0 l Q— �M �,`�1r i
The foregoing instrument was acknowledged before me this L.� day of 9 � l 1 20
by �(1�Abi Who is personally known to me ❑ OR
Name of p n making statement
who has produced identification CA type of identification produced:
rP`'A�'• SHARON KERN
• +� : Notary Public • State of Florida
_•.
.or Commission # GG 061605
y ; My Comm. Ex lr
P is
Feb 77. 2021
SCPA Parcel View: 0 1 -20-30-512-0000-007B
http://parceldetail.scpafl.org/ParcelDetaillnfo.aspx?PID=O 120305120...
f
CFA Property Record Card
pfiftParcel: 01-20-30-512-0000-007B NO 6
SEM24MCCOUN", FLORIDA I Property Address: 2802 S FRENCH AVE SANFORD, FL 32773
Parcel Information Value Summary
Parcel 01-20-30-512-0000-007B
Owner ORLANDO STOP LEAK LLC
Property Address H02 S FRENCH AVE SANFORD, FL 32773
Mailing 1237 BRIDLE PATH CASSELBERRY, FL 32707-3145
Subdivision Name I DRUID PARK AMENDED PLAT
Tax District _S1-SANFORD
DOR Use Code FAMILY
Exemptions 00-HOMESTEAD(2006)
2018 Working
2017 Certified
Values
Values
Valuation Method
Cost/Market
Cost/Market
Number of Buildings
1
1
Depreciated Bldg Value
$57,253
$49,977
Depreciated EXFT Value
$325
$338
Land Value (Market)
$20,000
$14,000
Land Value Ag
Just/Market Value
$77,578
$64,315
Portability Adj
Save Our Homes Adj
$17,899
$5,863
Amendment 1 Adj
$0
P&G Adj
$0
$0
Assessed Value
$59,679
$58,452
Tax Amount without SOH: $570.08
2017 Tax Bill Amount $531.57
Tax Estimator
Save Our Homes Savings: $38.51
Does NOT INCLUDE Non Ad Valorem Assessments
Legal Description
S22FT OFE15OFT OF LOT
7 + N 56 FT OF E 150 FT OF
LOT 8
AMENDED PLAT DRUID PARK
P11 7 PG
Taxes
Taxing Authority
Value Exempt Values
Taxable Value
County General Fund
-assessment
$59,679
$34,679
$25,000
Schools
$59,679
$25,000
$34,679
City Sanford
$59,679
$34,679
$25,000
SJWM(Saint Johns Water Management)
$59,679
$34,679
$25,000
County Bonds
$59,679
$34,679
$25,000
Sales
f -
Description
Date
Book
Page
Amount
I Qualified
Vac/Imp
WARRANTY DEED
3/1/2018
09089
1724
$80,000
Yes
Improved
WARRANTY DEED
2/1/2005
05608
1945
$124,000
Yes
Improved
WARRANTY DEED
10/1/2004
05485
0706
$98, 0 00
Yes
Improved
QUITCLAIM DEED
12/1/2001
04313
0180
$100
No
Improved
WARRANTY DEED
8/1/1997
03286
1081
$64,500
Yes
Improved
WARRANTY DEED
8/1/1996
03121
0481
$19,000
No
Improved
QUIT CLAIM DEED
4/1/1996
03068
0590
$16,300
No
Improved
WARRANTY DEED
10/1/1995
02983
0133
$100
No
Improved
QUITCLAIM DEED
8/1/1994
02807
1620
$100
No
Improved
QUIT CLAIM DEED
2/1/1994
02807
1614
$24,000
No
Improved
Page I of 2 (12 items) (11 2
Find Comparable Sales
Land
Method Frontaae -----F-D;-.th i Units Units Price I Land Value
CITY OF
YYS7✓Es i'°
RD
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DEPARTMENTFIRE
PERMIT #
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
JOB ADDRESS: ago 2 S. fin, c h -y & Sm4 -o(- f R
STRUCTURE TYPE: SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: 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 100 SQUARE FEET OF TTIE EXISTING DECK IS PERMITTED TO BE REPLACED"
ROOF VENTILATION: O OFF —RIDGE O RIDGE �OFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: O YES i" NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
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 M ETAL
FL#
.MODIFIED BITUMEN
FL#
TORCHDOWN
Q
�II' j e-
FL#
'�%�
` V
OINSULATED
FL#
O TILE
FL#
O OTHER:
FL#
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) "IFAPPLICABLE* / A
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#
0 OTHER:
FL#
CITY OF
S ORD
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF POLICY & PROCEDURES
I ip
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
MI COMPLETED RESIDENTIAL RE -ROOF SCOPE OF WORK
MI COMPLETED AND NOTARIZED INSPECTION AFFIDAVIT
MI 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 A"1`FACHMENT (INCLUDING A MEASURING DEVICE OR RULER)
o SHINGLES INSTALLED, NAIL PATTERN AND LOCATION OF NAILS
MI 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 (ARCHTTECT OR ENGINEER), CERTIFYING FBC CODE COMPLIANCE BY PERSONAL INSPECTION.
CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: OA-X ` �' � V ' DATE: 5)�-52_ ) U
wl
"=a:.wr
AWM Vb.09
EON
State of Rod tp
Y of Seminole
Pam* Number: PactxliD Ilamhets 11 �0 30-516�D-0490
ty •t The eprdersegrted om ttmt t+l De aft-toa►n PY� end to amArde wNh
CtapW M RoMasf .wetta*�tB��i provicead;tsrrfas,pta a can�nanoa enr
DE CRUnM OF PROPERTY:.(Legal.do=tt= 91.tt<e froPBrtY:sndsLreet Ba abta)
„SOT49 HIDDEN t.AK PH 3 umTRW-38.00 %] '
124 MGEWAWR etR SANFORDI FL 32773
GWEIM DESCR MIM OF lMPROVOIE]NT:
Re -roof of PdmW MOM
Fee stmpte Thie folder (tF other than owner) u,a
Peraeas witfdn the State of Florida Dasd by Oaaer upoa wltomuott� oratrser rroanrtar� may oa se[vea
as pmvlded bysee0att y1D.t3(1H6)r Fiorfdh .
Narr�
aderesx
tR addtion OD himset� Owner of
To mate a copyaf ft Uww% Notm as Prodded In
SoWan 719.1S(1)(b), Florida Sales.
Exp how Data of Noom of C*wmww.amvdt(m is 1 pw dram dab of ra�sg unloas a
dWa Md date Is apaoflted) h J ' r_a OI ct -
WARNM TO OiNNEfi ANY PAymms MADE BY Tie OwN R AmER THE t7tPIRam OF THE NOTICE OF
COMMENCE& ENT ARE CONSIDERED IMPROPER PAYMEM UNDER CKAPM 713. PART 6 SECTION 713.13.
RMWA STATVna% AND CAN RESULT IN YOUR PAYING y.WIM FOR MgWvEMF3�ITS TO YOUR PROPMY. A
EJ NoTicE OF OOMMENCEIT misrr BE RECOROt� AND POSTED ON THE".Ws WE Btu THE F RST
INSPECTION. IF YOU WEND TO OBTAIN FINANCING WMM' WITH YOUR -LENDER OR AN ATTORNEY
BEFORE COMMENCNG WORK OR RECORDING YOUR"NOTICE OF COh MUMENIMT
{ Uttdar pen w" of perjury. I dodm @tdt I Nava read the fmadh s a w that tho facts stated to ft Inca
loth a atsd belle!.
•s�Ttl<1�(ij(g1:•nraew�armuae�rtl,ana9maoaaaa ewmieal�am�rOePasa�d W r�r(ar�ara�rabed:
ste0aal Cocurtyof Ora Inat
ThataregolgihutrunaeMw+asadawwladgeaheQaamethis�_dayot` %i%li'yY_I •��e
b , Who is persmu* ta:own to rr:e
►am.orvw�a�e
OR who has pmduaed tea of Dart p o&ma : -Fax-
let"
iG'lSTf IF ! ANT _ %/(J J�
rrgri.Commissionl GG 23892, MYCemmISSIon Expiresa
,, AU�,Uj'-.23, 202e i
••T. RfT��. y �.�.+r+...� - i
GRANT MALOY, CLERK OF CIRCUIT COURT SEMINOLE COUNTY FL
CLERK'S # 2018032561 BK 9097 Pg 1567; (1pg) E-RECORDED 03/26/2018 10:22:16 AM
10.00
F D ; , City of Sanford
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT#: 12�5 ADDRESS:
I G�, 0 "J 4 _' . 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 #: CLc' J_'_3 q' "L -) Q
COMPANY / CONTRACTOR: (V ( 0 ✓�' ^' (,
CONTRACTOR SIGNATURE:
(MUST BE SIGNED BY LICENSE
OR OWNER/BUILDER)
A FINAL ROOF INSPECTION IS REQUIRED:
DATE:)/
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
rnrr.n TV Unr, r vn r un i rar,n yr r+i i. nrvutnr irmiq i o.
"PAILUKL' IUl'VLLVW ALLXhVU1K1MN1L1NIJ WILUR1,3UL111-4AtAlLLi111V,YL1IIUIN,AXL-11VJrV,UIIU1N1'L'L' AJ
STATE OF FLORIDA
COUNTY OF S-dMt r,
The foregoing instrument was
Acknowledgge-d before me this�
Day of PTNCLr M L
Who is personally known to me or
Who has produced
(Type of Identification
As Identification and who (dkQ
- - - - (d'id..- - o
(Sign re ofM
1=21)
Typed, Printed, or Stamped Nme
--- - ----- ---------- of Notary Official
��1p0.V p�i
SHARON KERN
►� Notary Public - State of Florida
COMMiSSlon # GG 061605
My Comm. Expires Feb 17, 2021