HomeMy WebLinkAbout705 E Airport Blvd (3)CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No:
Documented Construction Value: $
RV73)00-
Job Address: 06 t #'11fBAV , ' Historic District: Yes ❑ No ❑
Parcel ID: Q 0 Residential Commercial ❑
Type of `York: New ❑ Addition ❑ Alteration ❑ Repair Demo ❑ Change of Use ❑ Move ❑
Description of Work: rccoc�P 4-mr e is_" Al 4-- Qop Ql
Plan Review Contact Person: Gd sE'-err1S Title: -tom 0 m
Phone:,B •OM — 0-1(oZFax: 3�0' L{ Q — Email: on Sos.I
Property Owner Information
Name
Phone: Hog —(al 7~ t 141K
�r►
Street: US, ... AZ
Resident of property?
Mll-
VL 3D7?3
�(
City, State Zip:
m
Contractor Information
Name
Phone: 3& " `' l
Street: Ta)Fax:
City, State Zip: Je Lsbu
, _-�L anqv State License No.:
rchitect/Engineer Information
Name:
Phone:
r
Street:
Fax:
City, St, Zip:
E-mail:
Bonding Company:
Mortgage Lender:
Address:
Address:
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT NIAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COiVINIENCENIENT 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" Edition (2014) Florida Building Code
Revised: Rine 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 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 constntction value of the job at the time of submittal.
The actual construction value will be figured based on the current [CC 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.
SignatttreofOwner/went Date Signatu of ontractor./Agent ate
Print Ow-nerr'Agent's Name
Signature of Notary -State of Florida
Date
Owner/Agent is Personally Known to YIe or
Produced ID Type of ID
01
Sig athire ot'Nota -S ate of Florida Date' I
7i,
iI
"a t77 ;7— `L-Cra A'�'jv��7s<
omilis cn 1I210
N1y coin11 i xpir>s
October 28,
2018
Contractor/Agent is Personally Known to Nte or
Produced [D Type of ID
act-'�PJ
Pin ontractor/Agent's Name
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:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
# of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes ❑ No ❑
WASTE WATER:
BUILDING:
Revised: June 30, 20t5 Permit Application
a
After recording, return to: L-LNf1,5A-y L)vcL-t(/D vn
Covenant Roofinq
1410 Emerson St. Leesburq, FL 34748
Permit No.:
Tax Folio No.: -'Q , 3a -b� Ob(�(� - (% b late of londa f
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 the Property: (legal description of the property and street address if
LegalD cription:
3
Street Address:
2. General Description of Improvement
3. Owner's Information or Lessee information if the lessee contacted for the improvement:
Name: / IGt -1
Address: A CID
Interest in Property:
Name & Address of fee simple titleholder (if different than owner):
4. Contractor Information
1�II
GIAN hIALU'f 9 SEh1Ih10L_E C:OUhal" r'
C:LEI�Ei. OF (:l' 'CIj1T C:OV & r:Uh1f'TfiOL.LEF:
8K 9091 Pa '3b. (1('ss)
CLERK'S T 2rJ18ri2E153
RECORDED 03/14/21.11 a 11.1j1.1:21 il`i
RECORDING FEES slo.i?rl
`oi'c{od�rnmencement
S F
Name: Covenant Roofinq & Construction, Inc. Phone No.:
Address: 1410 Emerson St. Leesbura. FL 34748
5. Surety (if applicable, a copy of the payment bond must be attached):
Name:
Address:
6. Lender Information:
Name:
Address:
52-314-3625
Phone No.:
Amount of Bond: $
Phone No.:
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by
713.13(1)(a)7., Florida Statutes:
Name:
Address:
Phone No.:
8. In addition to himself or herself, Owner designates of
to receive a copy of the following Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes: Phone No.:
9. Expiration date of notice of commencement (the expiration date will be 1 year from the date of recording unless a different date is specified).
u u. ;a
u "v Cs
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 INS TION. IF YOU INTEND TO
OBTAIN FINANCING, CONSULT YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RE N CO ENCEMENT.
S' atu�ner essee, or Owner's or Lessee's Authorized OfficerMirectorrPartnei/Managar
Signatory's Title/Otfice �j�
The regoing i trumentwas acknowledged before me this day of GpiiL 20�, by��*#nASg!5M J/(c�� as
for who
Type of authority (i.e. olficer, trustee, attorney in fact) Name of party on behalf of whom instrument was executed
is personally known or produced VOU
as type of identification.
;.•.�f.%, DANIEL W COUSE JR
_•° ^= Commission # FF 953094
My Commission E x p! r e s Sig a tary ubl, o ri nt, type stamp commissioned name of Notary Public)
January 24, 2020
Notice of Commencement- BF29 (Updated 8.19.16) Astatula, Clermont, Eustis, Fruitland Park, Howey in the Hills, Groveland, Lady Lake,
Lake County, Leesburg, Mascotte, Minneola, Montverde, Mount Dora, Tavares, Umatilla
Limited Power of Attorney
Date
I hereby name and appoint Robert Horne of Covenant Roofing and Construction, Inc. to be my
lawful attorney in fact to ac for me and apply to 6AAr- ),z D
for a rP permit for the address below:
ns � NtXbl-7- 01-vD
Joseph E. Rayl, Contractor Licen�1329936
Acknowledged:
Sworn to and subscribed before me this N day of P-NAPcc-1 , 20
By Joseph E. Rayl who is _✓personally known to me or _ produced as
identification.
Notary Public, State of Florida
My Commission expires:
"Per i"�•
`B�,_ CoLAUsRs oWEGGMAN
oosso
-11", 6*e;p MV Commission
o,orFt�,; Expires
"" May 02, 2021
2/16/2018
SCPA Parcel View: 12-20-30-505-0000-0070
NA
."..
. . . , ' �'
Property Record Card
Parcel: 12-20-30-505-0000-0070
Property Address: 705 E AIRPORT BLVD SANFORD. FL 32773-5417
Parcel Information
Parcel 12-20-30-505-0000-0070
Owner SANTIAGO, THOMAS
Property Address 705 E AIRPORT BLVD SANFORD, FL 32773-5417 I
Mailing 705 E AIRPORT BLVD SANFORD, FL 32773
Subdivision Name SOUTH PINECREST 2ND ADD REPLAT
Tax District SISANFORD
I
DOR Use Code t 01SINGLE FAMILY
Exemptions 00-HOMESTEAD(1994)
Value Summary
I
€ 2018 Working
2017 Certified
Values
Values
Valuation Method
= Cost/Market
Cost/Market
I Number of Buildings
Depreciated Bldg Value
$55,578
$52,412
Depreciated
i
EXFT Value
1 Land Value (Market)
$15,000
' $15,000
j Land Value Ag
I Just/Market Value—
$70,578
$67,412
Portability Adj
Save Our Homes Adj
$11,686
a $9,731
Amendment 1 Adj
$0
P&G Adj
$0
$0
Assessed Value
$58,892
! $57,681m1
Tax Amount without SOH: $590.42
2017 Tax Bill Amount $526.50
Tax
Estimator
Save Our Homes Savings: $63.92
" Does NOT INCLUDE Non Ad Valorem Assessments
Legal Description
LOT 7
SOUTH PINECREST 2ND ADD
REPLAT
PB 11 PG 30
Taxes
wv �'
Nw N
�
_
Taxing Authority
Assessment Value
�' Exempt Values
;Taxable Value
County General Fund
$58,892
$33,892
$25,000
Schools
$58,892
$25,000
$33,892
City Sanford
$58,892
$33,892
$25,000
SJWM(Saint Johns Water Management)
$58,892
$33,892
$25,000
County Bonds
_._
$58,892
$33 892
$25,000v
Sales
i Description
µ Date
Book
Page
Amount
Qualified
Vac/Imp
1
QUIT CLAIM DEED
11/1/2007
06864
1867
$100
No
Improved
SPECIAL WARRANTY DEED
4/1/1992
02423
,.,_
180
---- -------------------- _..___„__
$58,800
No
Improved
CERTIFICATE OF TITLE
11/1/1991
02360
0803
$43,600
No
Improved
i WARRANTY DEED
6/1/1987
01858
A96
$50,500
Yes
Improved
Find Ceonparable SalesW
Land
Method Frontage
Depth
Units
i Units Price
Land Value
LOT
0.00
0.00 ;
1
$15,000.00 ;
$15,000
Building Information
Is Bed/Bath count incorrect? Click Here,
http://parceldeta I I.scpafLorg/ParceIDetaI I Info.aspx?
PI D=12203050500000070
1 /2
Rapt
Description Year Built Fixtures Bed Bath Base Area Total SF Living SF Ext Wall Adj Value Value Appendages
Description Area
FAMILY BLOCK
swuLoaso
Permits
Permit # Description
Agency
Amount CO Date
Permit Date
10/26/2004
00494 PUTTING A WOODEN FENCE BEHIND HOUSE AROUND THE YARD
$900
1/1/2002
Extra Features
Description Year Built Units
Value
New Cost
No Extra Features
mtp:8parceldetai|.sopaO.org/"aum|ootai|mfouupx?P|D~1zoo30oOoOOOOOOrO 2/2
1410 Emerson Street, Leesburg, FL 34748 • State Roofing License: CCC1329936 • License: CGC037504
Phone: 352-314-3625 o Toll Free: 855-314-3625 • Fax: 352-240-3439 C www.covenantrnc.com
SALES CONTRACT
Covenant Roofing & Construction, Inc.. agrees to furnish all materials and labor necessary to do the modernization work at the following address:
Name M (M S c I-) T�4 G,� Phone[`()N 1-7— /I-f 0Phone (w)
Address /vJ li /!ti ',►.,47( T Y'sWrl
City T State _Zip
_Date
Email
In accordance with specifications given below:
REPI
A. SHINGLE ROOF
1. REMOVE OLD ROOF TO WORKABLE SURFACE. iir7�Q7
2. RENAIL ROOF DECK WITH RING SHANK NAILS.
3. REPLACE ANY TTED OD TH STANDARD SHEATHING @ $ PER FOOT AND $ PER SHEET OF PLYWOOD, IF ANY. _(Initial)
4. INSTALL �I�/I - UNDERLAYMENT OVER ENTIRE ROOF. a j�e� �
5. INSTALL FHA/ EA ES DRIP. COLOR
6. INSTALL NEW VALLEY METAL AND FLASHING§ AS NECESSARY.
7. INSTALL NE AD BOOTS OVER VENT PIPES AND RESEAL VENTS.
8. INSTALL YEAR FIBERGLASS SHINGLES. COLOR KI AA
9. INSTALL T EET OF RIDGE VENT AT-@BfER FOOT. COLORAi Ift:
10. CLEAN-UP JOB SITE OF ALL WORK DEBRIS AND HAUL AWAY ALL RELATED DEB AND LEAVE JOB SITE CLEAN.
' 11. CONTRACTOR WILL COORDINATE REMOVAL AND REINSTALLATION OF ROOF RELATED PERIPHERALS SUCH AS (BUT NOT LIMITED TO) SOLAR UNITS, SKYLIGHTS, TV. DISH
AND AIR CONDITIONERS, ETC. REMOVE AND REINSTALL EXISTING SOFFIT AND FACIA @ $4.25 PER 0 TIN TION TO CONTRACT PRICE, IF REQUIRED. THE COST FOR
SUCH WORK WILL BE IN ADDITION TO CONTRACT PRICE AND HEREIN APPROVED BY HOMEOWNER (Initial)
12. ALL WORK COVERED BY A 5 YEAR WORKMANSHIP WARRANTY.
1. Contract Documents. This contract consists of this document, extra work/wood authorizations, if any, and if payments
hereunder are to be financed, all financing documents. No promises other than those specifically set forth in the contract
documents shall be recognized by either party. The entire understanding and agreement of the parties is contained in the
contract documents.
2. It is understood and agreed that this contract shall not become binding upon Covenant Roofing & Construction, Inc. until it is duly
approved, accepted, signed and witnessed by an officer or officers of the Seller,
3. Work on the job described in the ntracdoqpents will commence on approximately - and be
completed on approximately The recited dates are approximations and are subject to scheduling
difficulties of Seller, labor and m rial shortages, acts of God and other events not foreseen by Seller Seller reserves
the right to employ any sub -contractor for the completion of the work described in the contract documents.
4. Covenant Roofing & Construction, Inc. reserves the right to substitute materials of equal or greater value and kind. Any required
materials such as fire retardant plywood, tongue and groove board, etc. will be billed on a time and material basis. All other
changes required by New Jurisdictional Code Enforcement Laws may result in additional charges.
5. Interest at the rate of eighteen (18%) per cent per annum will be charged on all balances not paid as per the terms specified
above. Reasonable attorney's fees will be charged to the Purchaser if it is necessary to place this contract in the hands of an
attorney for collection, and this charge becomes a part of the contract and obligation of the Purchaser to pay.
6. Parties agree that this agreement shall be construed according to the laws of the State of Florida and any action brought
Contract Price
zoe
thereon may be brought in the State of Florida. Venue is hereby agreed to be in Lake County Florida. r'
7. BUYERS RIGHT TO CANCEL (SOLICITED SALES ONLY) If you do not want the goods or services, you may cancel �(e Y C?
this agreement by providing written notice to the seller in person, by telegram, or by mail. This notice must Indicate that you l "
do not want the goods or services and must be delivered or postmarked before midnight of the third business day after you Homeowner Portion $
sign this agreement. (Plus Total from Item No. 3 above)
8. Both worker's compensation and public liability insurance are carried by the Seller and they are applicable to the work to be
performed. UPON COMPLETION
9. It is understood and agreed that the buyer hold harmless, Covenant Roofing & Construction, Inc., for any damages that may
occur to the buyer's driveway(s) during delivery of materials and/or removal of the work related debris that may be required
to perform this home improvement contract. Furthermore, the buyer herein gives permission for typical delivery vehicles and
typical waste removal vehicles to enter said driveway(s) for the purpose of expediting this sales contract.
10. Contractor will coordinate removal and reinstallation of roof related peripherals such as (but not limited to) solar units, skylights,
T.V. dishes and air conditioners, etc. The cost for such work will be in addition to contract price and approved by homeowner.
11. Covenant Roofing & Construction, Inc. shall not be held responsible for damage to electrical lines, water lines, refrigerant lines
Pr other mechanical components that have been improperly installed near roof decking and may be damaged while performing
installation of roofing materials. Villages Roofing & Construction, Inc. shall not be responsible for any additional costs due to
roof decking that may have old materials adhered in such a way that requires redecking of structure.
12. Construction Industries Recovery Fund payment may be available from the CIRF if you lose money on a project performed
under contract, where the loss results from specified violations 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: 7960 Arlington Expressway, Suite 300, Jacksonville, FL 32211-7467 or call (904)
727-6530.
13. Chapter 558, Florida Statutes contains important requirements you must follow before you may bring any legal
action for an alleged construction defect in your home. Sixty days before you bring any legal action, you must
deliver to the other party to this contract a written notice referring to chapter 558 of any alleged construction defects
and to consider making an offer to repair or pay for the alleged construction defects. You are not obligated to accept
any offer which may be made. There are strict deadlines under this Florida Law which must be met and followed to
protect your interests.
Executed in triplicate, one copy of which was delivered to, and receipt is hereby acknowledged by Buyer,
this day of v , 20�.
Approved and Accepted: NOTICE TO OWNER
a. Do not sign this home improvement contract in blank. _
b. You are entitled to a copy of the contract at the time you sign. Keep it to pro eei rig
(Seal) ()) (Seal)
(Dealer Seller) (Purchaser Sign Here)
BY (X)
( itle)
0
SALESMAN—
--
(Seal)
(Purchaser Sign Here)
FORD PRESS, INC. 352-787-4650 (mike)
CITY OF
SkNFORD Building & Fire Prevention Division
RESIDENTIALRE-ROOFPOLICY&PROCEDURES
FIRE DEr ARTPvIENT
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: 6 U
PERMIT # 13 &Z
City of Sanford Building Division
Residential Re -Roof Scope of Work
JOB ADDRESS: loc
STRUCTURE TYPE: ,SINGLE FAiVI[LY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDO:�[INIU,14
RE -ROOF TYPE: 0 Q1EPLACEMENT (TEAR OFF EXISTING ROOF ACE WITH NEW COiVIPONENTS)
RE- OVER NEW ROOF INSTALLED OVER EXISTING ROOF
DECK TYPE (PLEASE SPECIFY):
"PLEASE !VOTE: ONLY 100 SQUARE FEET OF THE EXISTING DECK IS PERzWTTED TO BE REPLACED"
ROOF VENTILATION: DOFF -RIDGE O RIDGE OSOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: O YES O NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #
MAIN ROOF AREA
ROOF SLOPE: QkLESS H.�N 2:12 O 2:12 —4:12
O 4: l2 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
O SHINGLE
FL#
O NVIETAL
FL#
O NIODIF[ED BITUMEN
FL#
OTORCH DOWN
FL#
O INSULATED
FL#
O TILE
FL#
(DTHER:
C"41- 1
FL# 5a�3 P 1
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) ""IFAPPLIC43LE""
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#
0TORCH DOw-r
FL#
O INSULATED
FL#
OTILE
FL#
0 OTHER:
FL#
5j�V1qcQ,
ity of Sanford
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -EN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT /#: I ' . ADDRESS: kj
I X , AS AM GENERAL, BUR DING, RESIDENTIAL, OR
ROOFING CONTRACTOR, XiGINEER, ARCHITEC , F.S. CHAPTER 463 BUILDING INSPECTOR, I HEREBY" AFFIRM, THAT ALL OF THE
FOREGOING INFORMATION IS TRUE A -ND ACCURATE .AND THAT ALL ROOFING COMPONENTS LISTED ON THE SCOPE OF �YORK AT THE
.ABOVE REFERENCED ADDRESS HAVE BEEN INSTALLED Iti ACCORDANCE WITH THEIR PRODUCT APPROVALS AND ALL APPLIC.ABLE CODE
REQUIREMENTS — SPECIFICALLY" FLORIDA BUILDING CODE, EXISTING BUILDING. IN ADDITION I CERTIFY THE INSTALLATION YIEETS ALL
REQUIREMENTS FOR SECONDARYWA FER BARRIER AND NAILING OF THE ROOF DECK, IN ACCORDANCE �\,ITH THE HURRICANE RETROFIT
NL�NUAL REQUIREMENTS (BASED ON F.S. CHAPTER 553.844).
LICENSE 4:
COtb[P.A_NY / CONTR.�CTOR:
CONTRACTOR SIGNATURE:
(:MUST BE SIGNED BY LICENSE HOLD
I
ER)
A FINAL ROOF INSPECTION IS REQUIRED:
DATE:
THIS SIGNED A.ND SOTAR AFFIDAVIT :MLST BE PROVIDED AT THE JOB SITE AT THE TIME OF THE FINAL ROOF INSPECTION,
ALONG WITH DIGITALJK TOGR.APHS OF EACH PLANE OF THE ROOF SHOVVING IN DETAIL ALL COMPONENTS (DECKING,
U.NDERLAYMENT, FLASHING, DRIP EDGE ATTACH'OENT) WITH THE PERMIT NUMBER OR ADDRESS CLEARLY N[ARCED ON THE DECK
FOR EACH INSPECTION. THE PHOTOCR.APHS MUST INCLUDE A RULER OR -MEASURING DEVICE TO CONFIRM .ALL NAIL SPACING, .A.VD
OVERLAPS, INCLLDING DRIP EDGE AND VALLEY FLASHING. PLEASE REFER TO THE RE -ROOF POLICY A_ND INSPECTION PROCEDURE
PAPERYVORK FOR FURTHER EXPLANATION OF ALL REQUIREMENTS.
"FAILURE TO FOLLMN ALL REQUIREMENTS WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION FEE AS
"'ELL 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 LaC-e-
1
Sworn to and Subscribed before me thisday of 20 by:
n I
Who is KP
Known to me or has Produced (type of
fication) as identification.
Sia ature of .''otar/� Qublic
ate of FloIII Ilk"
rida lJ
•°: IINDSAY DUCKRAM
Commission # FF 172210
Print/Type/Stamp 'ame ;; ai My Commission Expires
of Notary Publ October 28. 2018