HomeMy WebLinkAbout124 Islamorada Way (2)CITY OF
rl E DEPARTMENT
y,-- I q- f
BUAWng 4 Fire PFeven#ion Division
PERWTAPPLICATION
APPllcation No: _L 9 / 9 FS
Documented Construction valu • $ 12012 53 ~
Job Address: 12416AMORADA WAY,SANFORD FL 32771
Parcel • 291931501000028410 Historic District: Yes❑No
Type of Work: Ne Residentiaio Commercial[]
Addition❑ Alteration Repair giemo
Description of Work; REMOVE AND REPLACE OLD ROOF DUE❑ TO Hof Use Move
DAMAGE.HURRICANE
Plan Review Contact Person: JENNIFER CHAVARRIA
Phone: 407-816-1155 Title: ADMINISTRATOR
: 4�7-483- Fag --- Lmail:JCHAVARRIA@REROOFAMERICA,COM
Name TIFFANI N WILLIAMS Property Owner Information
Street:
124 ISLAMORADA WAY Phone: 407-988-9569
City, state Zip: SANFORD FL. 32771
Resident of property?.. OWNER
Contractor Information
Name REROOF AMERICA CONTRACTORS
Phone: 4'07-816.1155
Street: 1523 KELLEY AVE
City, State Zip.: KISSlMFVlEE FL 34744
Fag: 407-483-5899,
State License No.: CCC1326253
Name: N/A Architect/Engineer Information
Street. -
City, St, Zip:
Bonding Company: N/A
Address: -
Phone: -
Fax- -
E-mail:
Mortgage Lender: -
Address:
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF CO
PAYING TWIG FOR IAiPROVEMENTS To YOUR PROPERTY. A NOTICE OF C®NiIVIEIVf E
RECORDED AND IPOS'I�IA ON THE JOB SITE BEFORE 'IRE COMMENCEMENT MAY RESULT IN YOUR
T MUST BE
FINANCING, CONSULT FIRST INSPEC1 ON. IF YOU INTEND D O OBTAIN
COMMENCEMENT. WTIH YOUR LENDER OR AN ATTORNEY $EFFoR RECORDING YOUR NOTICE OF
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify
commenced prior to the issuance of a Permit and that all work will be performed to meet standards of all Zap o�`regulating mstonstruc has
in this jurisdiction. I understand that a separate permit crust be secured for electrical worEr, plumbi construction
furnaces, boilers, heaters, tanks, and air conditioners, etc. n& signs, wel
ls, pools,
1'RC 1053 Slap be Inscribed with the date of application and the code in effect as of that date; 61 Edition (2017) Florida $oRg
Code
Revised; Jamimy 1, 2018
Permit Application
NOTICE: In addition to the requirements of this permit, there may be add'€bona[ restricctions applicable to #his
found in the public records of thin county, and there may be additional permits required from outer govemmenhal entities such as water
management districts, state agencies, or ProPen3' that may be
federal agencies.
Accepran,ce of permit is verification that I w171 no
tify 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
in order to calculate a plan review ebarge and wil! be considered the estimated gubmi copy of the executed contract is required
The actual cens#ructi°n value will be figured based on the current ICC Valuation Table at
at the value of the job
thth e � of submittal.
in accordance with local ordinance. Should calculated .barges t3gured off the executed exceed the
..edit will be applied to our permit is issued, e,
y perTnit fees when the permit is issued. actual conch uctian value,
— .. ,.8 K% -a M Ir. LOA V11'; I certify that all of the
bed ne i o foregoing information is accurate and that all work will
( spliance with ail applicable 1pws regulating Construction and xotumig.
4 Siganttut of Wn went { i
Dale , i nne of Contractor/ � ,
Printot�nt„ ..._.��_. �•`i i ��.'.'_..}%�f�`: ��/ �.a.-..`r.: f _C __ C_ -.�.1
JENNIFER E. CHAVARRA
* * MY COMMISSION # FF 122359
p^
EXPIRES: September 9, 268
'fort+ /�Mdihtu hdOf Notaroervices
Owner/Agent is Personalty Kn wn to M
enr
Produced. ID Type of ID
�gh!Lt-CHAVARRM
* MY COMMISSION # FF 122359
EXPIRES: September9, 2018
Bonded 7hru 9ud5#Notary 9mVas
Contractor/Agent is/ Personally own to a or
Produced ID +,/ Type of ID / , .
Permits Required: Building ❑ Electrical
❑ Mcchanical ❑ Plumbing[] Gas ❑ Roof[]
Construction Type: Occupancy iTse:
Flood Zone:
Total Sq Ft of Bldg: Mm- Occupancy Load:
# of Stories:__.
New Construction: Electric - # of Amps
Plumbing - # of FUfirres
Fire Sprinkler Permit; Yes[] NO[] # of Heads
Fire Alarlm>! Permit: Yes [l No []
APPROVALS: ZONING: UTILffms:
WASTE WATER:
COUNTS;
ENGINEERING: FIRE:
13LUL;DING:
R-iced. January 1, 2018
Permit Application
Package Summary Recording Report
Report generated: Wed, 11 Apr 2018 01:01 PM EDT
Package: 78043 - FINNEY - 38E48718-4141-117C-09F9-42941 ED96E2B
Status: Recorded
Submitter: Reroof America Contractors (FLT87E)
Recipient: Seminole County, FL
Documents
Document Name Document Type # of Pages Status Recording Number Recording Date Fees
Notice of Commencement NOTICE COMM 1 Recorded E 2018038939 B 9107 P 1745 Wed 04/11/2018 08:06 AM EDT 10.00
Fees
Fee Type Payment Account Name Fee Amount
Recording Fees Invoice 10.00
Submission Fees Invoice 3.50
............................................................................._._._._._._._._._._._._._._._.-..-..-..-.._.._.._..-.._.._..-•------..-..-..-..-..-..-..-.--..-.---.-.-..-..-..
Total Fees: 13.50
Questions Contact:
Simplifile Support 800.460.5657, option 3
5072 North 300 West
Provo, UT 84604
THIS INSTRUMENT PREPARED BY.
Name: YAZMIN RIVERA
Address:
NOTICE OF COMMENCEMENT
Permit Number:
Parcel ID Number: 29193150100002840
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.
I. DLEpllI '40N OF PROPERTY: (Legal description of the property and street address if available)CELERY KEY
2. GENERAL DESCRIPTION OF IMPROVEMENT:
REMOVE AND REPLACE ROOF, HURR{CANE DAMAGE
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT:
Name and address: TIFFANI N WILLIAMS, 124 ISLAMORAIDA WAY, SANFORD FL 32771
Interest in property: OWNER
Fee Simple Title Holder (if other than owner listed above) Name: N/A
4. CONTRACTOR: Name: REROOF AMERICA CONTRACTORS
Address: 1523 KELLEY AVE KISSIMMEE FL 34744
5, SURETY (if applicable, a copy of the payment bond is attached): Name: NIA
6. LENDER: Name: NIA
Address:
Phone Number: 407-816-1155
Phone Number;
Amount of Bond:
7. Persons within the State of Florida Designated by Owner upon whom notice or other documents maybe served as provided by Section
713.13(1)(a)7., Florida Statutes.
8. In addition, Owner designates
Phone Number:
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
QQ�BINE 4EFORE THE FIRST INSPECTION.
B�F�Sf ff VTMMENCNG WORK OR RECORDINIG YOUR NOTICE OF YOU CONSULT WITH YOUR LENDER OR AN ATTORNEY
mature of Owner or Lessee, or er's or
Authorized Mar.'Direcior7P er/Manac
State Of Tpl i County
(Print Name and Provide Signatory's roe/Office)
The foregoing instrument was acknowledged before me this w- day of
by &r 17.1t 7 11 Who is personally known to me 11 OR
Name of pars g slalement
who has produced identification ype of identification produced'
Wow
JENNIFER E. CHAVARRIA
* W COMMISSION # FF 12MS9
EXPIRES: September 9, 2018
B0nded1hru8u*tNo"Servirxs
GRANT MALOY, CLERK OF CIRCUIT COURT SEMINOLE COUNTY FL
CLERK'S # 2018038939 BK 9107 Pg 1745; (1pg) E-RECORDED 04/11/2018 08:06:43 AM
10.00
AMERICA
CONTRACTORE!
Reroof America Contractors FL, ILLC
1M Kelley Ave.
V.e. Kissimmde"FL34744
FL License #CCC1326253
www.reroofamerica.com
04�p
Service Agreement
Name of Property Owner(s): -4 1 NAAGIC-7 Date: 13
W/8,
Property Address: 12-1415 1A ni cP-A-6 City: S7%1rQ)C/J State: R-Zip:3Zice/
Owner's Mobile Phone: 6` Home Phone:
Third Party Company: rurq Contact Name:
Third Party Phone: Third Party Fax.,
6-2-2- -26q
Claim Number.b
. 9 Claim Type:,
By.sigging this agreemeft the Property OWner(s).authorize(s) Reroof America Contractors FL, LLCto
provide services in the form of property inspections, ladders, safety equipment, photos, scope of -Work, satellita
imagery, weather and/or manufacturer warranty related history. Reroof Am6rica Contracfors,� FL, LLC will provide
necessary reports, or fin'dings, on any`,deficiencies to your property, structures,
ures, materials,,OfWbrkmanship,'related to,
warranties,, weather or workmanship. If, Re'roof America, Contractors, FL, LLC services result in your property being
recovered, awarded,, approved or paid for, by third -party, [manufacturer's warranty, disaster,recoverV. insurance;
lawsuit, or any other pairty] the `Property OWner(s) agrees, to enter into,a formal building contract to proceed with
repairs for the precise scope --of work and value, of recovery approved by the third pLarty within 30 days of recovery
I
payment being issued to the customer. The Property Owner(s) agrees .that all monies allocated for the approved scope
of work will be paid to the company for completing the work. The Property Owner(s) also acknowledges:
• The Property Owner(s) authorizes, any 3rd patty payer to make any payments jointly or
directly to the companyforcompleting the scope of work.
• The Property Owner(s) accept the, terms and conditions set forth on the back of this
agreement for the appointment of the company.
• You, the Property Owher(s), may cancel this agreement at any time prior to midnight of
the third business day after the.date the agreement Was signed.,
Scope of Work:
&)g d2s
Pro Owners) America Co actor FL, LL Representative
Ftt
X—M Prino n t Name) !79 1 1 t-
(Print Name
Signature.� Signature�
Date: Z, Date:
CITY OF
A:- S.&FORD'
FIRE DEPARTMENT
Building & Fire Prevention Division
Re -Roof Permit Card
PERMIT NO. 119-1 � ISSUE DATE: 4 t9. 18
CONTRACTOR:
JOB ADDRESS:
TYPE OF WORK:
6%44
'Re'-
0
R]
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
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
----------------------------------------------------------------------------
Application Number . . . . . 18-00001885 Date
4/19/18
Application pin number . . . 257695
Property Address . . . . . . 124 ISLAMORADA WAY
Parcel Number . . . . . . . . 29.19.31.501-0000-2840
Application type description ROOFING APPLICATION
Subdivision Name . . . . . .
Property Zoning . . . . . . . SINGLE FAMILY
Application valuation . . . . 12013
----------------------------------------------------------------------------
Application desc
reroof/shingles noc on file
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
WILLIAMS TIFFANI N REROOF AMERICA CONTRACTORS
124 ISLAMORADA WAY 1523 KELLEY AVE
SANFORD FL 32771 KISSIMMEE
FL 34744
(407) 816-1155
--------------------- Structure Information 000 000 ----------------------
Roof Type . . . . . . . . . FIBERGLASS SHINGLES
----------------------------------------------------------------------------
Permit . . . . . . RESIDENTIAL ROOFING PERMIT
Additional desc . .
Phone Access Code 1045525
Permit pin number 1045525
Permit Fee . . . . 131.00
Issue Date . . . . 4/19/18 Valuation . . . .
12013
Expiration Date . . 10/16/18
Qty Unit Charge Per
Extension
BASE FEE
40.00
13.00 7.0000 THOU BLDG PERMIT -CC APPRVD 9.27.10
91.00
----------------------------------------------------------------------------
Special Notes and Comments
All projects within the City shall use
WastePro for debris removal. Please
contact WastePro at 407.774.0800.
Normal hours for inspections are from
7:30 through 4:30 Monday through
Thursday. Please be aware you must
contact the Building Official to
schedule a Friday or after hours
inspection. This is required since not
every inspector is licensed to do every
type inspection. Communication is the
key, so please contact the Building
Official if you have any questions at
407.688.5058 or at
dave_aldrich@sanfordfl.gov
Other Fees . . . . . . . . . 01-APPLCTN FEE -BUILDING
25.00
01-BLDG PLAN REVIEW
39.00
-------------------------------------------------------------------------=
Fee summary Charged Paid Credited
Due
Permit Fee Total 131.00 .00 .00
131.00
Other Fee Total 64.00 .00 .00
64.00
Grand Total 195.00 .00 .00
195.00
CITY OF SANFORD
# +� CUSTOMER RECEIPT **
Oper: BLANDA Type: OC Drawer: 1
Date: 4/19/18 01 Receipt no: 109668
Year Number Amount
2018 1885
124 ISLAMORADA WAY
SANFORD, FL 32771
BP BUILDING PERMIT RECEIPTS
$199.93
AC 20126B
Tender detail
CC CREDIT CARD $199.93
Total tendered $199.93
Total payment $199.93
1 Trans date: 4/19/18 Time: 11:46:03
--------------------------------------------------------------
FAILURE TO COMPLY WITH MECHANIC'S LEIN LAW CAN RESULT IN THE
PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS.
NOTE: ALL FEES MUST BE PAID PRIOR TO C.O. BEING ISSUED.
NOTE: PLEASE BE ADVISED ALL PERMITS MUST BE INSPECTED.
CITY OF
SANFORD
Bxiilding & 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' & PROCEDDRES
A FINAL ROOF INSPECTION IS; THE ONLY INSPECTION REQUIRED FOR RESIDENTIAL (SINGLE FAMILY; TOWNHOUSE,
MOBILE HOMES APARTMENT AND/OR CONDOMINIUM) RE -ROOF PERMITS.
THE FOLLOWING IS REQUIRED TO BE PROVIDE ON THE JOB SITE:
• PERMIT CARD, POSTED. [NA 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)
i 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, TER 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:9 DATE: 4/
Y OF ,
S:CITRFO
FIRE DEPARTMENT
JOB ADDRESS:
PERMIT #
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
STRUCTURE TYPE: O SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: O REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY):
""PLEASE NOTE: ONLYI00 SQUARE FEET OF THE EXISTING DECKIS PERMITTED TO BE REPLACED"
ROOF VENTILATION: O OFF -RIDGE O RIDGE Q SOFFIT QPOWERED VENT QTURBINES
SKYLIGHTS: Q YES O NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: Q LESS THAN 2:12 Q 2:12 - 4:12 O 4:12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
Q SHINGLE
FL#
Q METAL
FL#
0 MODIFIED BITUMEN
FL#
0 TORCH DOWN
FL#
QINSULATED
FL#
Q TILE
FL#
Q OTHER:
FL#
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) ""IFAPPLICABLE""
ROOF SLOPE: Q LESS THAN 2:12 0 2:12-4:12 Q 4:12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
Q SHINGLE
FL#
Q METAL
FL#
Q MODIFIED BITUMEN
FL#
Q TORCH DOWN
FL#
QINSULATED
FL#
Q TILE
FL#
O OTHER:
FL#
CITY OF
S,i bNFORD
riplE DEPARTWEN'r
Jos ADDRESS:
PERMIT # i�--60tviEwl,
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
VI/
STRUCTURE TYPE: SINGLE FAMILY RESIDENCE/TOWNHOUSE 0 MOBILE HOME 0 APARTMENT/CONDOMINIUM
,RF-ROOFTYPF: O/REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
0 RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY):
*'I'll'i.EAsENoTE. ONLY 100 SQUARE FEET 01"THE EXISTING DECK IS PERMITTED TOBEREPLACED **
ROOF VENTILATION: DOFF -RIDGE ORIDGE OSOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: 0 YES ONO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL,#:
--------------------------------------------- ------------------------------------------------------------------------
MAIN ROOF AREA
ROOF SLOPE: 0 LESS THAN 2:12 0 2-.12-4:12 0 4:12 OR GREATER
TYPE or, ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
(9SHINGLE
FL#'/P
0 METAL,
FL#
0 MODIFIED BITUMEN
FL#
OTORCHDOWN
FL#
0 INSULATED
FL#
OTILE,
FL#
OOTHER:
FL#
ROOF EXTENSIONS (PORCHES, PATIOS, FTC.) **IFAPPiICABI;E**
ROOF SLOPE: 0 LESS THAN 1: 12 02:12-4:12 0 412 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
0 SHINGLE
FL#
OMETAL
FL#
OMODIFIED BITUMEN
FL#
O,ToRcH DOWN
FL#
0 INSULATED
FL#
OTILE
FL#
0 OTHER:
FL#
CITY OF
.►. ORD
FIRE DEPARTMENT
Building & Fire Prevention Division
RESIDENTIAL RE ROOF AFFIDAVIT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND
ALL FINAL ROOF COVERINGS
PERMIT #: / I u ADDRESS: :>:J( Tsama-ra Na%&
v
Iy u 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 #: Ced, /(
1
COMPANY/CONTRACTOR: Jam,
CONTRACTOR SIGNATURE:f����ka
DATE:
(MUST BE SIGNED BY LICENSE H OR OWN UILDE
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 FLORtDA COUNTY OF
Sworn to and Subscribed before me this 3�day of 20 / 1 by:
'elk. . Who is ❑ Personally Known to me or has Vfroduced (type of
n
as identification.
L
turW Notary Public - +°':�0.'Pt",� JENNIFER E. CHAVARRIA
of F16rjda * * MY COMMISSION # FF 122359
A
n EXPIRES: September 9, 2018
9'FOFr�o�Bonded ThruBudget Notary 3ervkes
'TVDe/StamD Name V
of Notary Public