HomeMy WebLinkAbout135 Andrews RdI
S
" fti 'o' CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: ! $— ��1a
Documented Construction Value: $ 9,500
Job Address: 135 ANDREWS RD SANFORD, FL 32773 Historic District: Yes ❑ No 0
Parcel ID: 18-20-31-503-0000-0510 Residential ❑x Commercial ❑
Type of Work: New ❑ Addition ❑ Alteration x❑ Repair ❑ Demo ❑ Change of Use ❑ Move ❑
Description of Work: Re Roof Owens Corning FL 10674-R13 15216-R3 Techwrap 17194-R2 30 SQ 7/12 Pitch
Driftwood Oakridge LIFETIME
Plan Review Contact Person: Skylar Amkraut Title: Admin
Phone: 407-278-7788 Fax: 800-337-3361 Email: Permit@Jasperinc.com
Property Owner Information
Name Nancy Massino Phone:
Street: 135 Andrews RD Resident of property? : Yes
City, State Zip: SANFORD, FL 32773
Contractor Information
Name Jasper Contractors Phone: 407-278-7788
Street: 4185 S Orlando Dr Fax: 800-337-3361
City, State Zip: Sanford, FL 32773 State License No.: CCC1331153
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 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: June 30, 2015 :2Li 8 /Z 0 6 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 oftbis 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 isWrificatiori,that I will notify the owner of the property of the requirements of Florida Lien Law, FS 1 71 3.
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 peitlit 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 la s regulating con$trqgfiQR d, z
an, onmg._
147
05/15/18
signature of0vpiq/Agent Date SignaturqlofContractor/Age tlt Date
Rudith Goico
Print 0%vner/Agent's Name
Signature oll'Notary-State, of Florida Date
m l�F 1278,9P
Commission #
'My Co tmmisslon Expires
June 01. 2018
Owner/Agent is Personally Known "to Me or Contractor/Agent is Personally Known to Me or
Produced ID Type of ID Produced ID - type of ID
BELOW IS FOR OFFICE USE ONLY,
Permits Required: Buildingn Electrical[] MechanicalE] PlumbingF] GasE] RoofF]
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: YesF1 No n # of Heads Fire Alarm Permit: YesF1 NoEl
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
WASTE WATER:
BUILDING;
Revised: Jund 30, 2015 Permit Applicatim
DocuSign Envelope ID: FA9010CA-66A8-47A9-A1C3-2FE7605B626C
Account Manager: Joseph Palladino
Contact #: (407) 335-6239
Insurance ; Information
Company: Citizens
Policy #:01719600
Claim #: 00100146991
Mortgage Company information
Company:
Loan Number:
Owner(s):
Nancy Massimo
Phone:
Address: 135 Andrews Road
Alt Phone: 4074512722
City:
Sanford
SVE.
Zip Code: 32773
Shingle Color:
*OC Supreme - Driftwood
Email:
nancymassino@gmail.com
Roof RCV Amount/ Contract Price:
9,500
Drip Edge Color:
1 *Drip Edge - White 6"
If Owner's Insurance Company does not agree to nay for a full roof replacement, this contract shall he voidable.
Assignment of Insurance Benefits for the Full Roof Replacement Only: I hereby assign any and all insurance rights, benefits and proceeds under any
applicable insurance policies to Jasper Contractors, Inc. ("Jasper"), the scope of which shall be limited to a Full Roof Replacement. I make this assignment
and authorization in consideration of Jasper's agreement to perform services, supply materials and otherwise perform its obligations under this Contract,
including not requiring full payment at the time of service. I also hereby direct my insurer(s) to release any and all information requested by Jasper, or its
representative(s), for the direct purpose of obtaining actual benefits to be paid by my insurer(s) for services rendered. In this regard, I waive my privacy
rights. If payment is made directly to the Owner/Agent/Insured(s), it shall be endorsed over to Jasper immediately upon receipt. I agree that any portion of
work, deductibles, betterment or additional work requested by the undersigned, not covered by insurance, must be paid by the undersigned on the day of
installation. Deductible: It is the Owner's responsibility to pay all insurance deductibles. Owner's out-of-pocket expense will not exceed the deductible
amount, as stated on insurer's loss sheet ("Loss Sheet"), which is hereby incorporated by reference as the Scope of Work ("SOW"), UNLESS
replacement/repair of deteriorated decking is required by code and/or Owner requests optional upgrades. Jasper CANNOT pay, waive, rebate, or promise
to pay, waiveD rebate any or all of the insurance deductible applicable to the insurance claim for payment of work. In the event of a discrepancy, the
deductibl a^mo/untt stated on the insurer's Loss Sheet shall overrule deductible amount disclosed. Deductible: $3900.00 MUST BE PAID
IN FUL / V 4ni
PAYMEOwner agrees to pay Jasper based on the following schedule: (i) Deposit in the amount of $ • 00 due upon signing this
contract; (ii) the Contract Price, less the Deposit and any applicable depreciation retained by Owner's insurer(s), plus upgrade costs, due and payable
to Jasper upon completion of work being performed; and, (iii) the remaining Contract Price (equal to any applicable depreciation and/or change orders)
due and payable to Jasper upon completion of work performed. in the event of a pending inspection, no more than 2% of Contract Price may be withheld until
inspection has passed.
Optional: UPGRADE ITEM: RATE: UPGRADE ITEM: RATE:
Replacement Work and Price: Upon insurer's approval and subject to the Terms and Conditions stated herein, Jasper agrees to furnish all materials and
provide the labor necessary to perform the full roof replacement which shall take place following Owner's insurance company's approval, approximately
within thirty (30) days, conditions permitting. Owner's Declaration of Intent: Owner acknowledges and agrees that, upon approval by insurance company
for a full roof replacement, Jasper shall perform the roof replacement upon receipt of Loss Sheet from Owner's insurance company.
FLORIDA HOMEOWNERS' CONSTRUCTION RECOVERY FUND
PAYMENT, UP TO A LIMITED AMOUNT, 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 VIOLATIONS OF FLORIDA LAW BY A 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:
Construction Industry Licensing Board: 2601 Blairstone Road, Tallahassee, FL 32399-1039, (850) 487-1395
CANCELLATION: If Owner elects to terminate the services of Jasper, Owner may do so before midnight on the third business
day after Contract is executed. Owner shall receive a full refund of all deposits. Owner may also rescind Contract before midnight
on the third business day after the contract is executed after notification from insurer(s) that the claim for payment on roof
contract has been denied, in whole or in part. All written notices of cancellation, regardless of reason, shall be postmarked or
delivered to Jasper's corporate office: 1690 Roberts Boulevard, Suite 112, Kennesaw, GA 30144. CANCELLATION
EXCEPTIONS: The three (3) day right of cancellation DOES NOT APPLY to contracts for emergency home repairs as time is of
the essence.
1, Owner, have read and understand all statements, Terms and Conditions of the "Roof Replacement Contract" and agree that all details
are acceptable and satisfactory. I further understand that this Contract constitutes the entire agreement between the parties and that any further
changes or alterations to this Contract must be made in writing and agreed upon by both parties. Each party represents and warrants to
the other that it has the full power and authority to enter into the contract and that it is binding and enforceable in accordance with its
terms. Docusigned by:
DocuSigned by:
3/26/2018 1 9:09 AM EDT ��fcenAsaaD... Date
� a�`� 3/26/2018 1 9:08 AM
� iza p.er Representative Date
iN
THIiANISTRUMENT PREPARED 13Y:
- Name: JASPER CONTRACTORS
Address: 3203 S CONWAY ROAD SUM201
ORLANDO, FL 32812
NOTICE OF COMMENCEMENT
f 11111111111 1111 11111111 11111111i111111
GRANT MALOYr SEMINOLE COUNTY
CLERK OF CIRCUIT COURT 6 COMPTROLLER
CY, 9133 Ps Sd (1Pas)
CLERK'S A 2018054998
RECORDED 05/15/2018 11:12:08 AN
RECORDING FEES $10.00
RECORDED BY hdevore
Permit Number.
Parcel ID Number: '-COW— as/p
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 PROPERTY: (Legal description of the property and street address it available)
2. GENERAL DESCRIPTION OF IMPROVEMENT:
R13-ROOF
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT. -
Name and address:
Interest in property: OViNRk
Fee Simple Title Holder (f other than owner listed above) Name:
Address:
4. CONTRACTOR: Name: JASPER CONTRACTORS Phone Number. 407 278-7788
Address: 3203 S CONWAY ROAD SUM 201 ORLANDO FL 32812
5. SURETY (if applicable, a copy 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 Number.
Address:
8. In addition, Owner designates of
to receive a copy of the Lienoes 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
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 NOTICE OF COMMENCEMENT.
t5t%9-- of Owner ssce ar Owner s ar see's (Pdnt Name pl Pmdde Signatmys Titterorfee)
AulhodudOfTi ir0iieeladpartnedManagar)
State of County of
The foregoing instrument was acknowledged before me this 2 tf day of. 20
by rs �t�
Wp
Name of person Who is personally known to me ❑ OR
ar rtakrng statement
who has produced identfficationV type of identification produced:
:? :State of Florida -Notary Public
y .- Commission # GG 178413
' My Commission Expires
January 24. 2022
.Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 05/15/18
Karla Almodovar, Rudith Goico, Skylar Amkraut, Rachel Holcomb
I. hereby name and appoint: Ana Chavez and/or Michelle Monsalve
an agent of: Jasperconeacxom
•. C~� of Campanyl
to be my lav&d attomey-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 specific permit and application for work located at:
135 ANDREWS RD SANFORD, FL 32773
(strxt Address)
Expiration Date for This Limited Power of Attorney: 1 /1 /2019
License Holder Name: Donald Bouchard"
State License.Number. CCCM1153
Signature of License Holder
STATE OF FLORIDA --�
COUNTY OF s
The foregoing instrument was acknowledged before me this 15 day of May
20918 , by o«dd souchmd who is o personally known
to me or ® who he
identification and
(Notary Seal)
> }o;.' SKYLAR B AMI T �+ � s• db
n Com4mission FF 127890 ►
o' My Commission Expires
''';Fo��•�; June 01, 20T8
(Rey`. 08.12)
Print or type name
Notary Public - State of FL
Commission No. 127890
My Commission Expires'. 6/1/2018
Scanned by CamScanner
5/15/2018
SCPA Parcel View: 18-20-31-503-0000-0510
r(P
Property Record Card
Parcel: 18-20-31-503-0000-0510
rc,x.ev, Property Address: 135 ANDREWS RD SANFORD, FL 32773
Parcel Information
Parcel
Owner(s)
18-20-31-503-0000-0510
MASSINO, NANCY—
Property Address
135 ANDREWS RD SANFORD, FL 32773
Mailing
1729 TRAVERTINE TER SANFORD, FL 32771-7733
Subdivision Name
ROSE HILL
Tax District
S1-SANFORD
DOR Use Code
Exemptions
01-SINGLE FAMILY
Seminole County GIS
Value Summary
2018 Working 2017 Certified
Values Values
Valuation Method cost/Market Cost/Market
Number of Buildings 1 1
Depreciated Bldg Value $133,867 $116,136
Depreciated EXFT Value m _
Land Value (Market) $30,000 — $30,000
Land Value Ag
Just/Market Value" $163,867 $146,136
Portability Adj
Save Our Homes Adj $0 $0
Amendment 1 Adt,--___---
P&G Adj $0� $0
Assessed Value $149,112 $135 556
I
_ -—.-....— ......... ........ ... _....._ ....
Tax Amount without SOH. $2,650.00
2017 Tax Bill Amount $2,650.00
Tax Estimator
Save Our Homes Savings: $0.00
" Does NOT INCLUDE Non Ad Valorem Assessments
Legal Description
LOT 51
ROSE HILL
PB54PGS41 &42
Taxes
Taxing Authority
Assessment Value
Exempt Values
Taxable Value
County General Fund
$149,112
$0
$149,112
Schools
$163,867
$0
$163,867
City Sanford
$149,112
$0
$149,112
SJWM(Saint Johns Water Management)
$149,112
$0
$149,112
County Bonds
$149,112
$0
$149,112
RalPs
---- ------ ------_ _... --- ----_
Description
------ — ._...._. _..... ._ _ _.----- ...----...------ -
Date Book Page Amount Qualified
...-...-- -- -
Vac/Imp
QUIT CLAIM DEED
1/1/2006
06109
0686
$100 No
Improved
CERTIFICATE OF TITLE
_ --
11/1/2004
-----------
05518
j
_
0882
_- _ __.
$139,900 No
§ ..
Improved _
WARRANTY DEED
7/1/2001
04134
0657
$121,600 Yes
Improved
SPECIAL WARRANTY DEED
9/1/1998
03496
1719�
$1,456,500 No
Vacant
Fired Compambla Sates
Land
Method
Frontage
Depth Units Units Price
Land Value
LOT
1 $30,000.00
$30,000
_... -. _. ._..._ — _ ..
Building Information
Iss Bed/Bath cp ount incorrect? Click_ Here.
_
# Descri tion Year Built Fixtures Bed T Bath Base Area Total SF Living SF T Ext Wall Adj Value
II—Repl Value Appendages
I �-
http://parceidetaii.scpafl.org/ParcelDetailInfo.aspx?PID=1 8203150300000510 112
CITY OF
SkNFORD Building & Fire Prevention Division
FIRE DEPARTMENT Re -Roof Permit Card
-IlaPERMIT NO. I 4XIQ ISSUE DATE: �� �/
CONTRACTOR: MAnee
JOB ADDRESS:
TYPE OF WORK:
PROTECT FROM WEATHER I
• 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
PERMIT # t - 1 of
City of Sanford Building Division
Residential Re -Roof Scope of Work
JOB ADDRESS: 135 ANDREWS RD SANFORD, FL 32773
STRUCTURE TYPE: Q 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: ONLY 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED
ROOF VENTILATION: 0 OFF -RIDGE O RIDGE OSOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: O YES O NO 1F YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 — 4:12 Q 4:12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
Q SHINGLE
Owens Corning
FL# 10674-R12
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
OINSULATED
FL#
OBILE
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#
O MODIFIED BITUMEN
FL#
OTORCH DOWN
FL#
O INSULATED
FL#
O TILE
FL#
0 OTHER:
FL#
D City of Sanford Building Division
Residential Re -Roof Inspection 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: 05/15/18
n yD
City of Sanford
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILINGG, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: O� ( ADDRESS: 4A <,
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 #: CCC1331153
COMPANY/CONTRACTOR: JASPER CONTRATORS
CONTRACTOR SIGNATURE: DATE:
(MUST BE SIGNED BY LICENSE R OR OWNER/BUILDER)
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,
ALOi G WITH DIGITAL PHOTOGRAPHS OF EACH PLANE OF THE ROOF SHOWING IN DETAIL ALL COMPONENTS (DECKING,
UND)AYMENT, FLASHING, DRIP EDGE ATTACHMENT) WITH THE PERMIT NUMBER OR ADDRESS CLEARLY MARKED ON THE DECK
FOR iACH INSPECTION. THE PHOTOGRAPHS MUST INCLUDE A RULER OR MEASURING DEVICE TO CONFIRM ALL NAIL SPACING AND
OVE�*tAPS, INCLUDING DRIP EDGE AND VALLEY FLASHING. PLEASE REFER TO THE RE -ROOF POLICY AND INSPECTION PROCEDURE
PAPI&WORK 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 SEMINOLE
Sworn to and Subscribed before me this day of �V+ `� 20 4 by:
Who is ❑ Personally Known to me or has X Produced (type of
de �ificationL as identification.
Si nature of Notary Public ANA CHAVEZ
St of Florida ,=�`P Ue< ,State,9fi Fl,or da-Notary Public
12152
avc'Z _* Commission # Expires
;�•FOFF�ac, My Commissionon Expires
„, June 06, 2021
Print/Type/Stamp Name
of Notary Public
SEMINOLE COUNTY MULT! JURISDICTIONAL
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: "t a"
I_hereb_y_name_and_appoint; Scott Meixsell, Chris Gardner, Paul Padgett, James Allen
_.-._....... -- — ----- ----------- - ----- --- ----
an agent of: JASPER CONTRACTORS
(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):
.
❑All permits and applications submitted by this contractor.
x
Or
❑ The specific permit and application for work located at:
(Street Address)
Expiration Date for This Limited Power of Attorney: 1
License Holder.Name: Donald Bouchard
State License 'Number: CCC1331153
Signature of License Holder:
STATE OF FLOR&VIA/
COUNTY OF y,C'
The foregoing instrument was ack owledged before mq this day of
20�, by �c9(1�t; who is ❑ personally known to me or
O who has produced as identification
, AN CHAVEZ
ji�o State of Florida -Notary Public
o Commission n CG 112152
� �, y'Commission Expires
June1)6, 202-1
Print or type Notary name
Notary Public - State of l_c� t,
Commission No. L .lv�
My Commission Expires: ? (0 �-