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HomeMy WebLinkAbout455 S Summerlin Ave (2)CITY OF X Building & Fire Nevention Division NFORD PERMIT APPLICATION 'IRE 00AA,T1k'AT,NT No� Application Documented Construction Value -.'$__I���� Job Address: .455 S. Summerlih Ave Sanford, FL 32771 Historic District,: YesF]No 1-1 Parcel ID: 30-19-31-525-0000-0880 Residential FV]CoibmerciaIR Type of Work: NewE] AdditionF] AlterationF] Repair F6/]Demo 1-1 Change of UseEl Move[] Description of Work: REROOF Plan Review Contact Person: Title -- Phone: Fax: Emaik Property "Owner Information. Name Thomas Land1ress' Phone: 407-323-5312 Street: 455 S. Surnmerlin Ave Yes Resident'61' property'. City, State" zip: Sanford, FL 32771 Name Elite Roofing & Gwttelrs, Inc;. 2,. � Street: 25 East 13.th St. Suite, 12, City, State Zip: St. Cloud, FL 34769 Contractor Information Phone,. . 407-87,6-7663 Fax. - State License No.: CCC1327656 Architect/Engineer Information Name: Phone: Street: Fax: City , Y, St9 zip: E-mail: Bonding Company: Mortgage Lendet: 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. I certify that no work or installation has commenced prior to the issuance' of a perntit,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 elvetrical 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 1h Edition (2617) Florida Building Code- 7 Revised.- January 1, 2018 CPermit Applica6onl ) . � 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 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 actualconstruction value, credit will be applied to your permit fees when the permit is issued. OWNER'S AFFIDAVIT: l,certify that all of the foregoing informatipn is accurate and that all work will be done incompliance with all applicable laws regulati g construction and zoning. U . � U, 25 4a �LMhm _ l r L6.NR 5 6J�c z r u, 'Signature of Owner/Agent Date Sionatu of Contrgctor7AQent Date t co;V>o1+ O Nyl w Print Contractor/Agept7 arne E u "a E t t 17 nature of Notary- S e f Florida ry Date BRANDY WERNICKE p State of Florida -Notary Public Commission # GG 122775 ';RaFFtoa°, My C6M,111SSIOR EXpff85 Owner/Agent is Personally Known to Me or Contractor/Agent-is Personally Known to ivle or Produced, ID ✓ Type of ID i_Produced ID Type of ID BELOW IS FOR OFFICE USE ONLY Permits Required: Building 0 Electrical ❑ Mechan cal ] Plum Bing❑ Gas Roof Construction Type: Occupancy Use: Flood Zone: Total Sq Ft of Bldg: Min. Occupancy Load: # of Stories: New Construction: Electric - # of Amps Plumbing e # of Fixtures Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads Fire Al rm Permit: Yes ❑ No ❑ APPROVALS: ZONING: ENGINEERING. COMMENTS`: UTILITIES: FIRE;: WASTE WATER: BUILDING: Revised: January 1, 2018 Permit Application 3/28/2018 IMG_1697.jpg Roof Proposal k i House 15 IF • Otu feu. 1C 2832 32,2.Or . 1 15 tp- obtfdt, IC 861 9.9 �'Ut7EINU' Sc GUTTERS ltC. ACCC1327656 151' Kelley Ave 1 KiWmmee, FL 34744 (407) 876-7663 (ROOF) Total 3693 = 41 1/3 SQ. r„ . Thomas Landress w +t �e •,. 455 S. Summerlin Ave .orae cdV.stem z,p Sanford, F1, 32771 ceae- 407-323-5312 nome•. Erred Exlim to, Drew T... -a,., - .ova - ulretrtrtar.Ciraed �vtxrtsrw The undersigned Contractor agrees to furnish all materials and labor necessary for the work (specified below). I / We the Owner(s) agree to pay the sum of $ i(% i Ta rin>I pr{cc or the wo:41t ,uCieC, to In:nates,rpon caner andler uuunr...:nmpury apyrogl. Se SPECIFICATIONS FOR LABOR AND MATERIAL TruDefinition® DurationO Shingles Recover Roof with Owens Cornin Limited Lifetime Warranty with 10-Year Tru PROtectionO Color: *So ' Tear off all roofing material down to deck surface ' Renail complete deck per state code. JOB ADDRESS _ January 24, 2018 JOB Add- 455 S. Surnmerlin Ave lou eiry,stnte,yp Sanford, FL 32771 countyarlab Seminole .corn ' Flat: NA fib" f • Install Felt: Synthetic Felt •Low: ' install Preformed Starter: Eaves 195', Rakes 99', Overhang 24" • We furnish all material and labor ' install 294' ODE White Metal Edge Eaves & Rakes ' 5 Year Printed Workmanship Warranty ' New Valley 50' Half race Closed Cut • Clean up and haul all trash from roof Daily ' Install Preformed Ridge 140' Standard Hip & Ridge 23' Ridge Vent ' Gutters cleaned of all roofing debris upon completion r Fasteners : Galvanized nails - 6 nails per shingle ' Permit furnished by Company, billed on final invoice • Install cement around all eaves, rakes, valleys, vents and flashings • Roll yard with magnetic roller to best of ability i • Install Double 15# felt on selected low pitch. • Instal( New: 23' Cut In RV Roll, 2 Lead (2"), 2 Lead (3'), 1- Small Broan, 1 - Large Broan, Gutter fasteners must be removed and reinstalled in order to replace drip edge, * Special Instructions' tr 7 i Bad Decking Is An Additional $60.00 Per 4/81/2 inch CDX Plywood j% Jul lvo - ' k sfteflashing Chimney Might Be Needed Once Shingles Are Removed It Is Not Included As Of Nowl It Is Unforseen Protect Surrounding FL Rooms To Best Of Ability. Not Included Delivery Instructions: Try And Roof Load W%da-rri payment required, balance due upon completion or receipt of insurance proceeds, not final in ion. Additional provisions listed on back side of proposal sheet and AG,`.end:tms #1 & N2, ACCEPTANCE OF PROP05AL: By Signing below, customer ace pts th proposal as I agrees to lit s an cond' �a�gA a ding cofuratt, (/' F cC1e Roof& Gutters, Inc / �y Owner Tho—s Uridrs% tt t _•.[_ ae https://ma iI.90091e.com/mail/u/O/?tab=wm#search/landress/1622ab4e225c000e?projector=l &messagePartld=0.1 1 i 1 ACC?R a® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 03/28/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain .policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Doug Jones c/o Artex Risk Solutions, Inc. 8840 E. Chaparral Rd.; Suite 275 CONTACT NAME: PHONE FAX A/c xt No E: (480) 951-4177 A/C No): (480) 951-4266 ADDRESS: SDL.BSD.Certificates@artexrisk.com INSURER(S)AFFORDING COVERAGE NAIC# Scottsdale, AZ 85250 INSURERA : American Zurich Insurance Company 40142- INSURED Oasis Acquisition, Inc Alt. Emp: COMPUTER POWER SYSTEMS, INC 2054 Vista Parkway Suite 300 INSURER B : INSURER C INSURER D : West Palm Beach, FL 33411 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER- 1 7FLO75859354 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRPOLICY LTR TYPE OF INSURANCE INSD WVD SUER POLICYNUMBER EFF MMIDDIYYYY) POLICY EXP JMM/DDIYYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE1:1 OCCUR DAMAGE TO RETED PREMISES(Ea occu ante $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑PRO ❑ LOC JECT PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY - CEa OMBINED SINGLE LIMIT accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) NIA WC 29-38-687-15 06/01/2017 06/01/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT _ $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 Location Coverage Period: 06/01/2017 06/01/2018 Client# 12227-CORP DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) COMPUTER POWER SYSTEMS, INC Coverage is provided for 3421 STATE ROAD 419 only those co -employees of, but not subcontractors WINTER SPRINGS, FL 32708 to: GtK I IFIGA I t HULUtK GANGtLLA I IUN City of -Sanford SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box.1788 ACCORDANCE WITH THE POLICY PROVISIONS. Sanford , FL 32772-1788 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD THIS.INSTRUMENT PREPAREDBY; Name- Jason Beyille /'Elite• Roofing & Gutters, Inc Address: 25 Eastl3th Street; Suite 12 St., Cloud, FL 34769 1111(i (! 1ii�6 i(I i Q1111 Will 1111111 GRANT MALOYY SEMINOLECOUNTY CLERK OF 'CIRCUIT COURT h COtIPTROLLER K 9099' ;;-fig 242 (APgS) CLERKS 2018033583 RECORDED 03/27I20118 Il" .34-_16 P11' RECORDING FEES $10.00 RECORDED 'BY hdevore Permit Number Parcel ID' Number:; 30-19=31-525-0000-0880 The -undersigned herebygives notice that improvement will be made to certain real property, -and in accordance with Chapter 71,3; Florida Statutes, the following information is provided in this Notice of Commencement. 1, DESCRIPTION OF PROPERTY: property and'street address'if. available) 2. GENERAL DESCRIPTION OF IMPROVEMENT: Re roof 3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT Name and address: Thomas Candress 455 S. Summerlin Ave :Sanford FL 32771 Interest in property; _ Fee Simple Title Holder (if other than owner listed above) Name: Address: 4. CONTRACTOR: Name: Elite Roofing & Gutters, Inc Phone Number. 4078767663 Address- 25 East 13th Street, Suite 12, St. Cloud, FL 34769 5? SURETY (If applicable, acopy 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 Nuniber 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 DF THE 'NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER '713, PART 1, SECTION 71`3,13, 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 NOTICEOF COMMENCEMENT. i (signature of Owner or Less e, or Ownerspr Lessee's Authorized OfficerlDirectodPartnerfManager) (State of T— L County of The foregoing Instrument was -acknowledged before me this 4 by,'l �Y'1G l 1 GAS Name of,person making statement Who has produced identification type of Identification produced: SHAHON KERN' :0 • °S Notary Public - State of Florida Commission # GG 061605 7. 2021 My conim. Expires Feb 1 (Print Name and Provide Signatory's Title/Office) day of 1 1i , 20 t Pl- Who is, personally known to me 0 OR CITY OF yD SkNFORD Building & Fire Prevention Division FIRE DEPARTMENT Re -Roof Permit Card PERMIT NO. *9bU3 `00'*6' F) 0ISSUE DATE:cow to s 0 CONTRACTOR: j l Ma 4Q..GvW9rS e JOB ADDRESS: 4AA aft-ft - TYPE OF WORK: . (MeA; 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 � E , PERMIT # 1 O I t) Building & Fire Prevention Division RESIDENTIAL RE -ROOF SCOPE OF WORK JOB ADDRESS: j. s uhi m e v I i n Ave SQ11� v_d ?, z-11 I STRUCTURE TYPE: 4b SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE How O APARTMENTICONDOMINIUM RE -ROOF TYPE: REPLACEMENT (TEAR OPP BXISTING ROOF AND REPLACE WITH NEW COMPONENTS) O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF) DECK TYPE (PLEASE SPECIFY: Z )(7 *'PLEASE NOTE. ONLY 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE,REPI.ACF.D ROOF VENTILATION: D OFF -RIDGE ORIDGE OSOFFfT OPOWERED VENT OTURBINES SKYLIGHTS: O YES a NO IF YES, PLEASE PROVIDE FLORIDA. PRODUCT APPROVAL #: MAN ROOF AREA ROOF SLOPE: O LESS THAN2:12 0 2:12 - 412 O 4:12 OR GREATER TYPE OF ROOF' MANUFACTURER f LORIDA PRODUCT APPROVAL SHINGLE Mtkv- ie- O METAL FL# O MODIFIED BITUMEN FL# O TORCH DOWN FL# OINSULATED FL# O TU_E FL# O OTHER: FL# ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IF APPLICABLE** ROOF`SLOPE: O LESS THAN 2:12 O 2:12 --4:12 O 4:1.2 OR GREATER TYPE OF ROOF MANUFACTURER ]FLORIDA PRODUCT APPROVAL O SHINGLE FL# O METAL FL# O MODIFIED BITUMEN FL# _Q TORCH DO WN F)-# 0INSULATED FL# O TILE FL# O OTHER: FL,# m cly OF RR TA Ruildinn &Fire Prevention Division kNFORD RE,S'IDENTML RE ROOF POLICY& PROCEDURES PERMITTING REQuiREMENTS - NO PLAN REvjEw REQUIRED THIS DOCUMENT (SIGNED) ALONG WITH AN ACCURATE AND COMPLETED RHSIDFNTL9.L 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 BF INSTALLED ON THE PROJECT. A PERMIT WILL NOT BE ISSUED WITHOUT THESE DOCUMENTS. COPIES WILL BE MADE TO POST ON THE JOB SITE. **PROJECTS I,OCA'TED IN THE SANFORD HISTORIC DISTRICT WILL REQUITE PLAN REVIEW AND APPROVAL BY 1'HE SANIORD HISTORIC I'RFSERVATIONBOARD INSPECTION. POLICY & PROCEDIURES 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 REQUIPE.D TO BE PROVIDE ON THE JOB SITE: m PERW CARD, POSTED IN A CONSPICUOUS AND WEATHERPROOF.LOCATION COMPLETED RESIDENTIAL RE -ROOF SCOPE, OF WORK o COMPLETED AND NOTARIZED INSPECTION AFFIDAVIT ALL FLORIDA PRODUCT APPROVAL AND CORRESPONDING INSTALLATTONT INSTRUCTIONS (PRODUCT APPROVAL SHALL MATCH WHAT IS ON THE SCOPE OF WORK) o DIGITAL PHOTOGRAPHS (MUST INCLIME THE PERMIT NUMBER OR ADDRESS IN. EACH PICTURE) r o EACH PLANE OF THE ROOF, SHOWING THE UNDERLAYMENT INSTALLED J( 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 UNDERLAYIYIENT 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 APPROVALC. 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 (ARCHITLCT OR ENGINEER), CERTIFYING FBC CODE COMPLIANCE BY PERSONAL INSIECTION. CONTRACTOR (OR OWM.RBUILDER) SIGNATURE: }9 AA DATE: CITY OF S_________0RD FIRE DEPARTMENT ��. Building & Fire Prevention Division RESIDENTIAL RE -ROOF AFFIDA VIT RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS PERMIT#: " �JGi $ ADDRESS: y55 S. Ste,m►yit-v I i v% Avt- ��q n a rd , FL 32�1-1 1 I V Q Son Be.V 111-e , 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 #: CCC i 3-L:1 �0 5('0 COMPANY / CONTRACTOR: h CONTRACTOR SIGNATURE: DATE: (MUST BE SIGNED BY LICENSE HO ~ R O WNER/BUILDER) A FINAL ROOF INSPECTION IS REQUIRED: THIS SIGNED AND NOTARIZED AFFIDAVIT MUST BE PROVIDED AT THE JOB SITE AT TIIF 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 QR.ADDRESS CLEARLY MARKED ON THE DECK FOR EACH INSPECTION. THE PHOTOGRAPHS MUST INCLUDE A RULER OR MEASURINCx 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 06 (tpa(Ll Sworn to and Subscribed before me this day of 20 1kby: J�50 VI / e— Who isAq'ersonally Known to me or has 11 Produced (type of as identification. ;nature of I9tary Public a le14 IMBERLY M FROST `' 1`� `= MY COMMISSION # GG040235 Building & Fire Prevention Division RESIDENTIAL RE ROOF AFFIDA VIT r RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL VINAL ROOF COVERINGS PERMIT #: / U / �y ADDRESS: 7 �i J I ��/%�/ �%?� !iLlt AS A(N) (.,II NERAL, BUILDING, RESIDENTIAL, OR ROOFING CONTRACTOR, ENGINEER, ARCHITECT, OF F.S. CHAPTER 468 BUILDING INSPECT pR, 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 t� \lls'� -1 W ":� (D COMPANY / CONTRACTOR: \ \ ; ``-�F MOCA- 1 )a k CONTRACTOR SIGNATURE: _ (MUST BE SIGNED BY LICENSE A FINAL ROOF INSPECTION IS REQUIREII: DATE: THIS SIGNED AND NOTARIZED AFFIDAVIT MUST BE PROVIDED AT THE JOB SITE AT THE TIME OF THE FINAL ROOF INSPECTION, ALONG WITH DIGTrAL 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- OF 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 ENGINEE'u) TO CERTIFY, BASED ON PERSONAL INSPECTION, THE INSTALLATION OF ALL ROOFING COMPONENTS. STATE OF FLORIDA COUNTY OF 0tAZ&6_­, Sworn to and Subscribed before me this 0—? day of 20 J4, by: Who i Personally Known to me or h 0 Produced (type of as identification. ; a"'''• KIMBERLYf I FROST y. ` MY COMMISSION # GG040235 EXPIRES October 19, 2020 of Notary Public