HomeMy WebLinkAbout1001 W 8 StCITY OF APR 2 6 21
Building & Fire Prevention Division
S01ka PERMIT APPLICATION
._
FIRE DEPARTMENT pp
- A lication No:
Documented Construction Value: $ 8,000.00
Job Address: 1001 W 8TH ST SANFORD, FL 32771 Historic District: Yes❑NoF—1
Parcel ID: 25-19-30-5AI-1013-0060 Residential Commercial
Type of Work: New❑ Addition❑ Alteration 0 Repair ✓7 Demo ❑ Change of Use❑ Move
Description of Work: Re -roof
Plan Review Contact Person: Darryl Culbreth Title: Contractor
Phone: 407-692-0765 Fag: 407-442-0756 Email: crewcontractors@yahoo.com
'O�; ���Pil / 'roperty Owner Information
Name C edrick Phone:
Street:I 001 W 8TH ST SANFORD, FL 32771 Resident of property? :
City, State Zip:
SANFORD, FL 32771
Name Crewpro,lnc.
Street: 6439 John Alden Way
City, State zip: Orlando FI 32818
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Contractor Information
Phone: 407-692-0765
Fag: 407-442-0756
State License No.: CCC-1327169
Architect/Engineer Information
Phone:
Fag:
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: 61 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 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.
ffLd_Ae�� �Z� L4 -ZL4. 18 (::�_ Of -47 ry
Signature of Owner/Agent Date ' ignature of Contractor/Agent Date
MOdfec_i U yx�,n
Print Owner/Agent's Name
4PpY vy ,, HEq j R LEE BURKHART
i�• .
MY COMMISSION # GG014762
EXPIRES July 24. 2020
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
Name
�S�n ture No _ -State of FI rida Date
t1p.
MELODY D. LEE
:" c Notary Public - State of Florida
+ar Commission # FF 902089
%FOF ' O 1My Comm. ExpI Jul 21, 2019
_Persona Known to Me or
Produced ID Type o I _,•.�f ftd`
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.
Flood Zone:
# of Stories:
Plumbing - # of Fixtures,
Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads Fire Alarm Permit: Yes ❑ No ❑
APPROVALS: ZONING: UTILITIES: WASTE WATER:
ENGINEERING:
COMMENTS:
FIRE:
BUILDING:
Revised: January 1, 2018 Permit Application
1111111111111111111111111111111111111111
THIS INSTRUMENT PREPARED BY:
Name: Crewpro,lnc. LO a,j-r1 -I-& *
1 Address: 6439 John Alden way -Orlando FI 32818
NOTICE OF COMMENCEMENT
State of Florida
County of Seminole
Permit Number:
GRANT MALOYf SEMINOLE COUNTY
CLERK OF CIRCUIT COURT & COMPTROLLER.
eK 9117 Pq 938 (IP93 )
CLERK'S T 201804 3OZ
RECORDED 04 /25/2018 ►]3 a g r ;; . 3 PM
RECORDING FEES $1.0.00
RECORDED BY hdevore
Parcel ID Number: 25-19-30-5AI-1013-0060
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.
DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available)
LOT 6 BLK 10 TR 13 SEMINOLE PARK PB 2 PG 75
1001 W 8TH ST SANFORD FL 32771
GENERAL DESCRIPTION OF IMPROVEMENT:
Re -roof house
OWNER 1
Address: 1209 CAROLINA AVE'CLEWISTON, FL 33440-5624
Fee Simple Title Holder (if other than owner) Name:
CONTRACTOR:
Name: Crewpro,lnc.
Address: 6439 John Alden way Orlando Florida 32818
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)(b), Florida Statutes.
Name:
Address:
In addition to himself, Owner Designates
of
To receive a copy of the Lienor's Notice as Provided in
Section 713.13(1)(b), Florida Statutes.
Expiration Date of Notice of Commencement (The expiration date 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 ATTORNE
BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. , 7t
Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it
to the best of my knowledge and belief.
M��WA--, l - /0-�I --(e2— /1/1, / I �-c - , /X Oil
Owner's Signature Owner's Printed Name
Florida Statute 713.13(1)(g):' The owner must sign the notice of commencement and no one else may be permitted to si
"G.
State of FL0121 oA County of SEMIWOI.E
The foregoing instrument was acknowledged before me this _Z_Lj_ day of
by M t I Cl red h 1 Y nn Who is personally known to me LrJ
Name of person making statement
OR who has produced Identification ❑ type of identification produced:
•'arvy HEATHER LEE BURKHART
MYCOMMISSION # GG014762
:g• EXPIRES July 24. 2020 Notary Sign re
r
20
PERMIT #:
CITY 4F
Ski4FORD Building & Fire Prevention Division
RESIDENTIAL RE-ROOFAFFIDAVIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
ADDRESS: ,l DO 1 0• %Str-e
snr"� p0a 4, n
I V t:�rr (w �— (iv 10 f if� ) , 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 #: C- c L — ( 3-Z--j ( U q
COMPANY / CONTRACTOR:
CONTRACTOR SIGNATURE: ` DATE:
(MUST BE SIGNED BY LICENSE HOLDER M OWNEOBUILDER
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 ATTACHNI ENT) 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
Sworn to and Subscribed before me this day of
20 by:
DK l Vl.� I ` °}'�� Who is ❑ Personally Known to me or has roduced (type of
iden fication)as identification.
gna ure otary Public
St a orida � 6IOZ'IZ InP sa►idx3 �wwo0 6yy �.��edo�;�.,
► 69OZ06 JJ # uolsslwwo0
N-d'yD
BPIJoIJ !o alelS - o!IQnd ARION
PrintJT a/Stamp Name331 '0 A0013W an of Notary Public
CREW PRO, INC.
CONTRACT
This Agreement this 19th day of April 2018 by and between CREW PRO,INC., hereafter called the contractor, and
Charlotte Fredrick hereafter called the Owner, WITNESSSETH that the Contractor and the Owner for the conditions
name agree as follows. .
The Contractor shall furnish labor material and perform the work on the property listed Below:
1001 W. 8th Street Sanford Florida 3283S
Crewpro Inc. is licensed in Roofing, General Construction and will dedicate it resources to ensure the highest level
of workmanship. Crewpro and its staff are very familiar with your project and local building codes and law.
Scope of work
Obtain permit from Building Department
Re -Roofing House
Remove all roofing material and underlayment down to the wood deck
Remove fleshings and drip edge
Clean and re nail complete roof deck to meet new building codes
Replace all damaged wood deck at a charge of $60.00 per sheet
Seal oll joints and flashing with roof cement
Seal all walls to deck inside corners with roofing cement
Install all new metal roof edge trim around complete roof
Install New drip edge flashing, Vent pipe flashing, L flashing and valley flashing throughout.
Install new synthetic underlayment in compliance with local building code requirements manufacturer's requirements.
Install new GAF Shingles Timberline HD
Install new Peel n Stick underlayment
Install torch down Modified Bitumen to low slope area
Notice:
" 2 year Workmanship Warranty from date of completion.
Existing roof parts will be loaded in dump trailer or trash containers for disposal by Crewpro.
Crewpro will not be responsible for Sprinkler system, Sprinkler heads, gutters or any gutter claims or damage unless gutter
replacement is part of contract.
New Roof System Price $8,000.00
The Contractor shall maintain Worker's Compensation and General liability insurance policies throughout the duration of this work. Payment may be
available from the Florida Homeowners' Construction Recovery Fund if you lose money on a project performed under contract where the loss results from
specified violation of Florida law by a licensed contractor. More info about this fund can be obtained by calling 850-921-6593.
If concealed or unknown physical conditions are encountered at the site that differ materially from those indicated in the Contract Documents or from those
conditions ordinarily found to exist, the Contract Sum and Contract time shall be equitably adjusted and signed, by owner and contractors.
Conditions: All material is guaranteed to be as specified. All work is to be completed in a workman like manner according to standard practices. Any alteration
or deviations from specifications involving extra cost will be executed only upon written orders and will become on extra charge over and above the estimate. If
this contract is cancelled after the permit is issued there will be a $500.00 Concelation fee. All agreement contingent upon strikes, accidents or delays beyond
our control. Owner to carryfire, tornado and other necessary insurance. Contractor reserves the right to charge 1 112% per month on past due balances, this
represent an annual rate of 18%. Owner agrees to pay contractor's attorney fees and court cost if owner is place in the hands of an attorney for collection.
Total Investment: $ 8,000.00
Payments shall be made as follows: 50% after permitted, and 40% at 50% stage of job. The remaining balance will be paid
after final inspection and customer walk thru.
Signed day of 20 and 19th day of April 2018
Owner .(�1'0(.�.f� � � contracton Darryl Culbreth
Phone: 407.692.0765 1 Fax: 407.442.0756 1 6617 JOHN ALDEN WAY, ORLANDO, FL 328181 LIC#CFC1428328
CREWCONTRACTORS@YAHOO.COM LIC#CBC-059056 LIC#CCC-1327169
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: '�' 23 ' `�
I hereby name and appoint:DvZ(yu
an agent of- pu , --T4 r— r
(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 Csppeecificpe it application nffor wffk loc ed at:
11 l '�
(street Address)
Expiration Date for This �imited Power of Attorney:
License Holder Name:
State License Number:
Signature of License H
STATE OF FLORIDA
COUNTY OF��
The foregoing instrument was ac owlet
200 I , by jbi^
to me or ❑ who has produced tX--
identification and who did (did not) take
before me this day of
who is ❑ personally known
Signature
(Notary Seal) del 6 djy
Print or fype name
osPaJP�a� MELODY D. LEE Notary Public - State of F Lo ✓\
Notary Public - State of Florida Qa
Commission No. F
Commission # FF 902089
M Commission Expires: ZI 10
My Comm. Expires Jul 21, 2019 Y P
�II11111�
(Rev. 08.12)
as
SXi4ORD
FIRE DEPARTMENT
PERMIT # / 19 ` q
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
JOB ADDRESS: I d
STRUCTURE TYPE: ( SINGLE FAMILY RESIDENCE/TOWNHOUSE Q MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WTI'H NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
V " DECK TYPE (PLEASE SPECIFY): OVp
* *PLEASE NOTE. ONLY 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED
ROOF VENTILATION: O OFF -RIDGE O RIDGE OSOFFIT OPOWERED VENT OTURBINES
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 0 4:12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
SHINGLE
FL#
Q
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
OINSULATED
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#
MODIFIED BITUMEN
FL# �O
O TORCH DOWN
FL#
O INSULATED
FL#
O TILE
FL#
0 OTHER:
FL#
CITY OF
S,ki4FORD
FIRE DEPARTMENT
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF 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.
CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: DATE:
SCPA Parcel View: 25-19-30-5AI-1013-0060
Page 1 of 2
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POP SG64NY'A.l°. G�N,A:IY, V'i;.B:M.
92
Parcel Information _
M
Property Record Card
Parcel: 25-19-30-5AI-1013-0060
Property Address: 1001 W 8TH ST SANFORD, FL 32771
Value Summary
2018 Working 2017 Cel
j Values
Values
Valuation Method Cost/Market
Cost/Market
Number of Buildings 1
1
Depreciated Bldg Value $23,366
$21,997
Depreciated EXFT Value
--r-i7
Land Value (Market) 600
$7,600
Land Value Ag
Just/Market Value i $30,966
$29,597
---.._._.�....._._.—
_... ...-.. _..._.._..__._c.__....-__.
Portability Adj
r
Save Our Homes Adj $0
$0
Amendment 1 Adj $0
i
$0
P&G Adj $0
$0
Assessed Value $30,966
$29,597
Tax Amount without SOH: $563.57
2017 Tax Bill Amount $563.57
Tax Estimator
Save Our Homes Savings: $0.00
' Does NOT INCLUDE Non Ad Valorem Assessments
Legal Description
LOT 6 BLK 10 TR 13
SEMINOLE PARK
PB2PG75
Taxes
Taxing Authority ___7 Assessment Value Exempt Values Taxable Value
County General Fund $30,966 1 $0 $30,966
Schools $30,966 , $0 , $30,966
City Sanford $30,966 [ $0 i $30,966
SJWM(Saint Johns Water Management) $30,966 : $0 1 $30,966
County Bonds J $30,966 i $0 [ $30,966
Sales
Description Date Book Page Amount Qualified Vac/Imp
� _.mmee�
PROBATE RECORDS 3/1/2018 l 09094 1974 $100 i No j Improved
F1ndt Comparable Sales
._.....
Land
Method Frontage � Depth Unit�-Units Price � Land Value
FRONT FOOT & DEPTH 48.00 120.00� 0 1 $174.00 $7,600
Building Information
Is Bed/Bath count incorrect? Click Here. ��
Year Built
# Description _ Fixtures Bed Bath Base Area Total SF Living SF Exit Wall Adj Value Rep Value VV lue Appendages
Actual/Effective ��������___
1 SINGLE 1935 3 ' _ 3 1 5 ; 1,056 1 2,486 1,450 ' WD/STUCCO $23,366 $58,414 Description Area
FAMILY FINISH
UTILITY
t UNFINISHED 588.00
210.00
http://parceldetail.scpafl.org/ParcelDetailInfo.aspx?PID=25193O5AI10130060 4/26/2018
CITY OF '
S ------- FORD Building & Fire Prevention Division
RESIDENTIAL RE ROOFAFFIDAVIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND
ALL
rFINAL ROOF COVERRI-N�GS
PERMIT#: / R••, ADDRESS: if ��if tilt 5 �.1
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 #: C C ( — � 7) �l t 4 -i
COMPANY / CONTRACTOR: O lr 00
CONTRACTOR SIGNATURE: — DATE: �r
l`
(MUST BE SIGNED BY LICENSE HOLDER OR OWNER/BUILD )
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 L�
worn to and Subscribed before me this day of . 20 J6 by:
"L42'
I M(Vto is ❑ Personally Known IJme or has ❑ Produced (type of
as identification.
t
ignature of Notary Public
tatee of 1Florida /1�
f j J ' \ '
Arint/Type/Stamp Name
of Notary Public
1 � Y
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