HomeMy WebLinkAbout116 Carmel Bay DrCITY OF
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FIRE NPARTIMEN1
Building & Fire Prevention Division
PERMIT APPLICATION
Application No: � d " I weo (
Documented Construction Value:-$ 01 _—,)CXD
Job Address: "U c(urM'e'f p'�,�u [�f Historic District: YesalloF]
Parcel ID: 3 3 -1q - 30 - 51q - C)L-00 - h .)00 Residential�CommercialF1
Type of Work: Newts Addition❑ Alteration Repair❑ Demo❑ Change of Use❑ Move❑
Description of Work: "�h2
Plan Review Contact Person: r-� Title: 1?exyy*1Ain4
Phone: 'x�.� -3�1- �ty'10 Fax:tiy-i t Email: QpY`� 1 _ C 1 YOo� �nq . Cc�Y►-1
Property Owner Information
Name -T% M 0.N2t-NS Phone: L10r)- qQo! - (0(0d`1
Street: ,VV C_CArnneA b14 p.r. Resident of property?: MeS
City, State Zip: �Gn pr FI • 3 a'1-11
Contractor Information
Name 9,t»6 C0nSAV"Lt+1Or\ Zinc-. Isasi nD6 S '-4-1) Phone: 3a1- 30t- yy'7O
Street: y ?t10 G-t s W, D p Fax: 30 (4411
City, State Zip: oc k-e6cte _ t . 3aA 55 State License No.: CCe t 5A'6aCo
Architect/Engineer Information
Name: Phone:
Street: Fax:
City, St, Zip: E-mail:
Bonding Company: Mortgage Lender:
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 Or
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 perfornied to meet standards of all laws regulating construction I
in this jurisdiction. l understand that a separate permit must be secured for electrical work, plumbing, signs, wells, pools,
furnaces, boilers, heaters, tanks, and air conditioners, etc. n
FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 6t1 Edition (2017) Florida Building Code
Revised.: January t, 2018 Permit Application IN �q
NOTICE: In a'ddittoti 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 maybe additional permits requited from other governniental.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_requi'retnerrts of Florida Lien Law, FS 713.
The City of Sanford requires payment of a plan review fee at the tine of permit sibi titial'. 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, 1CC 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 Owner7Agerit Date
Print Owner/Agent's Name
Signature;ol'Notary-State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
0
Date'
Print Contractor/Agent's Name
SigLxpires,04i2712021
�[§�'ARerNAte of Florida to
pril Leigh Elrod
y Commission GG 098736
Contract ' gent is Personally Known to Me or.
roduced ID Type: 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 ❑ # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
Fire Alarm Permit: Yes ❑ No ❑
WASTE WATER:
FIRE: BUILDING:
Revised: January 1, 2018 Permit Application
AV
t
Customer Name: a YA owQ'65
Street,. A C:cvr Vlel 6001 o {`
City / State / Zip:tbc�
Phonek-1' l) qb; Aa`7 Email: G) OUAgT'r'n -tl .cCM
71at
108 1
P
w
Scope of work includes;
• Obtaining all required permitting,and,scheduled inspections
Removal and disposal of all existing roofing materials Peel-N-Stick
Inspecting and re -nailing the'd,ecking 6" on center with:8d ring shanks In the
perimeter and field for local code compliance $
• Installing Self Adhering (peel-n-stick, SWR) underlayment on entire home
Replacing all exposed flashing, drip edge, lead boots, ridge vents, and gooseneck Felt Underlayment
vents $
• Installing CertainTeed Landmark 130MPH Limited Lifetime Warranty Dimensional
Shingles with CertainTeed starter shingles and CertainTeed hip/ridge caps Shingle Color:
• Saving existing soffit, fascia, and gutters with best effort when removal is needed
11- 2 Sheets of plywood replacement and 8' of fascia board
• Maintaining a clean and safe work environment through the day along with Drip Edge Color:
magnetically sweeping the yard and landscaping for nails'
• A Wind Mitigation Inspection Form will be completed (if applicable)
Any additional wood damage must be replaced to be in compliance with current building codes at 'I q o b
$48 per sheet of plywood and $8 per linear foot of fascia. Additional wood replacement prices
include all material and labor. Price does not include any painting nor stucco/siding repairs where
deteriorated flashing had to be removed and replaced. �Z COUl�t1
ALL WORK COMES WITH A: a
—)0 YEAR WORKMANSHIP WARRANTY
SO YEAR MATERIALS WARRANTY C7007 4 040c7
ADDITIONAL NOTES:
�C %vOO�1HB Cdnsemetion —One. 7)4u CkSID1kQY �RIQ
By signing above, you are agreeing to the following'. terms and conditions:
• Both parties; signing above are In mutual agreement to commence with the work stated above which is fimited to what is stated in this proposal.
All final payments are due upon ,100%completion of the roof unless prev ously discussed and nnted In the contract. Any funds owed,greater than 30 days beyond the completion date are
subject to a late fee charge of 2% compounded every thirty (30) days.
• If Included in the contract, the wind mitigation form will be completed but is considered a service free of charge with the reroof and shallaot be held, as a reason to vAthhold final payment.
\ p. -, 3 3 - I'l - 3o - 5)9 - 00,0 0 - OSOO
NOTICE OF COkM?41FNCEN1FNT
sTATEor. Flor COUNg
THE UNDERS[GNED hereby gives notice that improvement willbe made to certain real properly, e�d in accordance with Chapter 713, Florida Statutes,
the following Womation is provided in this Notice of Cninmencernent.
1. Description
3. Owner information:
a. Name and address: rill
b. Phone -number: LiR
c. Name and address of fee simple
I of property, afid street address if av,
-yl,b,l IRS , ., Dr
7-71
4. Conhactor:
a. Name and address: G&GRoofing Construction Inc. 456,OusH'Ipi),BM-RoCkledq(FL32955
b. Pho rie number: 321w3014470
5. Surety:
a. Name and address: WA,
b. Amouintof bond S c. Phone numb(,•
6. Lender:
A Name and address: 08
b. Phone numbec be wasProvided
11 video by Section 713-13(t)(3)7,,
7. Persons with the State of Florida designated by owner upon whom notices or other documents gar yed Pro
Florida Statutes:
a. Name and address: N/A
b. 'Phone number! copy of th I eLic Moticeas provided in Section 713.13(l)(b).
B. In addition to himself, Owner designates the fbilov 9 116=11(8) to receive a On rids
se
Florida Statutes:
a. Nameandaddress: NIA
b. Phone nomberl- 9. Expiration date of notice of commencement (the expiration date is one'(1) year
fr oni,ft date Orworag unless a different date, is illccified)
WARNING TO OWNER: ANY PAYMUS,UAD I E I BY THE EOWNER AFTER THE WiRk ff014 QFTHE NOTICEPF COMIMENO�,
' R'CHA TER 713, — I I IN73.13, FLORIDA STATUTES,'AND CAN RESULT
ARE CONSIDERED IVROpEp PART- Ii SECITO
,pAyMSM UNDE P I AND
PROPERTY. A NOTICE OF CoNiIENC8411NT MUST BE RECORDED
IN YOUR PAYING TWICE FOR DO I ROVEMENTS TO YOUR P1
'
POSTED ON THE JOB SITE. F INSPECTION..IF YOU FINANCING, CONSULT V�O YOUR
INTEND
LENDER OR AN ATTORNEY I BEFORE COMMENCING OR I C, 6F 60%IMENCEMENT.
"I
Signature of Owner or.O,wner's Autlidmil OffIcerlDirector/yartriernmanager
signatory's Title/office
e foregomig instrument was achoWledged before mothis J CO day of �)0_101"t- by
__(type of authority, ..-e-9,
(name of person) as (name oflarty ou behalf o whom instrumentre outed),
officer, trustee, attorney in fact) for t
Signature of Notary Public — State of i1crida
Print, type,,.or,stamp 'comml 6d rk'neof Notary Public
ry k
= 7 OR Produced Identification
APHI Leigh Etmd
i Leigh
Personally I Known
my 1�—Mlssfbn Go OW36
Aly C �ZZ-313 0= illi Expl— 04/2712021 Type of i4ellikation produced
E.
Veritication ursuan(tb Section 92.52.5, Florida S,hrtes
Under penalties of perjury, I declare that I have read theforegoiAg that c1act st e t o -bestof m knowledge and belief.
Signature of natural pe 9 kre
GRANT MALOY, CLERK OF CIRCUIT COURT SEMINOLE COUNTY FL
CLERK'S # 2018041015 BK 9111 Pg 0375: (1 pg) E-RECORDED 04113/2018 0228:48 PM
10.00
? r.
City of Sanford
4r .• . �s Buildingand Fire. Prevention
Project Location Address 1110 ('Qrme,( EVRA►' �9-7-71
As required by Florida Statute 553.842 and Florida Administrative, Code, 9N-3, please provide the
information and product approval number(s) on the building components listed below if they are to be
utilized on the construction project for which you are applying fora ,building permit. We recommend that
you contact your local product supplier should you not know`the product approval number for any of the
applicable listed products. Be aware that windows, skylights; and exterior doors must be tested in
accordance with the Florida Building Code, Section 1714.5.More information about Statewide Product
Approval can be obtained atwww.floridabuilding.org.
The following information -must be available on the jobsite for inspections:
1. This entire product approval form
2. A copy of the manufacturer's installation details and requirements for each product.
Category/ Subcategory
Manufacturer
Product
Description
Florida Approval #i
include decimal
1. Exterior Doors
Swinging
Sliding
Sectional
Roll U
Automatic
Other
2. Windows.
Single Hun
Horizontal Slider
Casement
Double Hun
Fixed
Awning
Pass Through
Projected
Mullions
Wind Breaker
Dual Action
Other
Jule 2014
Category / Subcategory
Manufacturer
Product
Description
Florida Approval #
_including
3. Panel Walls
,Siding
---Soffit& --- .. ... ...... . . ................ ..
Storefronts
Curtain Walls
Wall Louver
Glass block
Membrane
Greenhouse
E.P.S Composite
Panels
Other
4. Roofing Products
Asphalt Shingles
-e- ck
La rf,\av, Ic-
Underlaymeats
I
Roofing Fasteners
Nonstructural
Metal Roofing
Wood Shakes and
Shingle's
Roofing tiles
Roofing
Insulation
Waterproofing
Built up roofing
System
Modified Bitumen
Single Ply Roof
Systems
Roofing slate
Cements/
Adhesives
Coating
Liquid Applied
Roofing Systems
Roof Tile
adhesive
Spray Applied
Polyurethane
Roofing
E.P.S. Roof
Panels
Roof Vents
Other
June 2014 2
Category Subcategory
Manufacturer
Product
Description
Florida Approval #
(include decimal)
5. Shutters
Accordion
Bahama
Colonial
Roll up
Equipment
Other
6. Skylights
Skylights
Other
7. Structural
Components
Wood Connectors
Anchors
Truss Plates
Engineered Lumber
Railing
Coolers/Freezers
Concrete Admixtures
Precast Lintels
Insulation Forms
Plastics
Deck / Roof
Wall
Prefab Sheds
Other
8. New Exterior
Envelope Products,
Applic
Applicant's Name 7:j�'6-&A
(Please Print)
June 2014 3
•
Sk�O'RD
FIRE DEPARTME�NT
Building & Fire Prevention Division
Re -Roof Permit Card
PERMIT NO. V I VLy I ISSUE DATE: %of r,
CONTRACTOR: QM 61
JOB ADDRESS: ®®� Caipm C I A , 47001"
TYPE OF WORK:
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
TO SCHEDULE AN INSPECTION:
• Dial 407.792.6069 or 855.541.2112
• Provide the items "requested during the message
• The type of inspection requested must be scheduled under the appropriate permit type
• Follow the prompts
PLEASE NOTE: Inspections scheduled by 5:00 p.m. will be conducted the
next business day. If you experience difficulty, please call 407.688.5150
Monday - Thursday 7:30 am - 5:30 pm for assistance.
AUTOMATED INSPECTION SYSTEM CODES
Final Roof Inspection Code III
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
REVISED: 04-17 - Inspection Line: 407.792.6069 or 855.541.2112
CITY Of
Building & Fire Prevention Division,
NFORD RESIDEAWAL RE -ROOF POLICY& PROCEDURES
F111E DEPARTMENT \Vp cavn�N it eau br�
PFRN,ItTTtNG RrQUIRFNIENTS— No PLAN REVIEW REQUIRED
'I'HtS 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,
Ti IE SCOPE' OF WORK MUST INCLUDE ALL, APPLICABLE FLORIDA PRODUCT APPROVAL NUMBERS FOR ALL ROOF
A PERMIT WILL NOT BE issurD WITHOUT THESE DOCUMENTS. COPIES WILL BE NIADE TO POST ON THE JOB SITE.
"PROJECTS LOCATED IN THE SANFORP HISTORIC DISTRICT WILL REQUIRE PLAN REVIEW AND APPROVAL BYTHE
SANFORD HISTORIC PRESERVATION BOARD
INSPECTION POL ICY & PROCEDURES
A FINAL ROOF INSPECTION IS THE ONLY INSPECTION REQUIREDFORRESIDENTIAL (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 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 FACH PICTURE)
o EACH PLANE OF THE ROOF, SHOWING THE UNDERLAYMENT INSTALLED
• ROOF DECK NAILING PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
• ROOF DECK NAILS USED (INCLUDING AMEASURING DEVICE OR RULER SHOWING SIZE OF NAILS)
• UNDEkLAYMENT PATTERN & SPACING -(INCLUDING A MEASURING DEVICE OR RULER)
• DRIP EDGE.& VALLEY ATTACHMENT (INCLUDING A MEASURING DEVICE OR RULER)
• SHINGLES INSTALLED, NAIL PATTERN AND LOCATION OF NAILS
e 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 PIZOVIDE D BY A FLORIDA DESIGN
PROFESSIONAL (ARCHITECT OR ENGINEER), CERTIFYING FBC CODE COMPLIANCE BY PERSONAL INSPECTION.
CONTRACTOR (OR OWNEi/,BwL-DrilISI—IGNiAl-l��UIR�L:.:� DATE:_,/_t9
PERMIT #
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF {WORK
i
I
__... _...... _JOB"ADDRESS 1 \� 00'1r meal it)aS4 V
STRUCTURE TN PE: /TOWNMOBILE F/CONDOMINIUMC �hLC\
—�RE-ROOF TY'PF. —-- •REPL-ACEMENT (TEAR OFF EXISTING ROOF AND REPLACE -WITH NEW COMPONENTS)..- -•-- - - _
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
a
DECK TYPE (PLEASE SPECIFY): P\\AWOO(�
*PLEASE NOTE. O:VLY 100 SQVARE rEET OF TI r I YISTLVG DECK /S PERMITTED TO BE REPLACED**
ROOF VENTILATION: QOFF-RIDGE RIDGE QSOFFIT QPOWERED VENT QTURUINES
SKYLIGHTS: O YES G "`I IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
------------------------------------------------------------------------------------------------------------------------------------------------------------------
MAIN ROOF AREA
ROOF SLOPE: Q LESS THAN 2:12 Q 2:12 - 4: l2 er4.12 OR GREATER
TYPE OF: ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
IIINGLF..
►^ , L:
FL# L•I
O METAL
FL#
O MODIFIED'BITUMEN
FL#
QTORCI-I DOWN
FL#
Q INSULATED
FIX
QTILE
FL#
Q(OTIIER: k
FUt 'Fl.l da-f�4
ROOF EXTENSIONS (PORCIIFS PATIOS, ETC.) *"IFAPPLICABLE"
Rom, SLOPE: Q LESS THAN 2:12 Q 2:12 - 4:12 Q 4:12 OR GREATER
TYPE OF ROOF
MANUFAC-111RF.R
FLORIDA PRODUCT APPROVAL
Q SHINGLE
FL#
Q M ETA L
FL#
O MODIFIED BITUNIEN
FL#
QTORCII DOWN
FL#
Q INSUL.ATED
FL#
QTILE
FL#
O OTHER:
FL#
FIRE INSPECTIONS
CITY
OF SANFORD
407.562.2786
BUILDING
& FIRE
PREVENTION
BUILDING INSPECTIONS
300
N PARK AVE
855.541.2112
SANFORD FL 32771
DRIVEWAYS -SIDEWALK 407.688.5080
----------------------------------------------------------------------------
Page 2
Application Number . . . .
. 18-00001861
Date 4/18/18
Property Address . . . . .
. 116 CARMEL BAY
DR
Parcel Number . . . . . . .
. 33.19.30.519-0000-0300
Application description . .
. ROOFING APPLICATION
Subdivision Name . . . . .
.
Property Zoning . . . . . .
. PUD
Permit . . . . . . RESIDENTIAL ROOFING PERMIT
Additional desc . .
Phone Access Code 1045079
Permit pin number 1045079
----------------------------------------------------------------------------
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
----------------------------------------------------------------------------
1000 111 BL03 FINAL ROOF / /
CITY OF
i;.S_______0RD Building & Fire Prevention Division
RESIDENTIAL RE -ROOF AFFIDAVIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT#: I I ADDRESS: kW caYme.k 1D.y xDy-
I R" YYwV-1G` SYYxI +V1 , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
RO FING CON F�� 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',�)aq - aGU
COMPANY / CONTRACTOR:
(MUST BE SIGNED BY LICENSE HOLDER
A FINAL ROOF INSPECTION IS REQUIRED:
DATE: 7`_Yy / a if -
THIS 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 g„r�►
Sworn to and Subscribed before me this 31 day of Sul 20 1 O by:
rva.4Li suwA-" Who is Cry -Personally Known to me or has ❑ Produced (type of
identification)
as identification.
Sig l u of Nq a Public
ate of lorid
ADW�1 r (
Pri t/Type/Stamp Name
of Notary Public
P` Notary Public State of Florida
y� 'Pnl Leigh Elrod
y co corn, GG 098736
a �. My
�12712021