HomeMy WebLinkAbout2515 Yale AveSXK�ORD
z=iBf DEPARTMfiN'1
Building & Fire Prevention Division
PGRAHT APPLIC.A TION
,Application No: / R-6a
Documented Construction Value: S 10906
_. 2515 YALE AVE SANFORD, FLORIDA 32723 Historic District: Yes❑Noa
emu :..,. ..,�. -
1'arcel ID: 06-20-31-502-0900-0100 _ }3esidential� Commercial
Type of Work: Nell] Addition❑ AlterationFI Repair Demo Change of Use❑ Move❑
Description of Work: ROOF REPLACEMENT
Plan Review Contact Person: MEGHAN MILLER Title:
Phone: Fax:
4074019599 3214455593 ):'mail: MEGHAN.M)LLER@RESTORSURANCE.COM
_
Name
TRINH LYNA L & KHAN
Street: 2515 YALE AVE
Property Owner information
H Phone: 407 9278070 _
Resident of property?
City State Zip: SANFORD, FLORIDA _
Contractor Information
Name 11 ���19_�� Phone: L{Ol . !A) I - l Ci
Street: �%� i�L?� 2 Fax: —3a - uw5 ' 55013
City, State Zip: Y 1 �j h C t� it z� R— State License No.: CC" J_ 92=2—a
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Architect/Engineer Information
Phone:
Fax: E-mail:
Mortgage Lender:
Address: _
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF 4C'OMMFNCF1t1 NT MAN' RESULT IN YOUR
PAYING '11110E FOR IMPROVEMENTS TO YOUR PROPERTY A NOTICE OF C0MMENCENIENT NIUST BE
RECORDED AND POSTED ON 'TFIE JOB SITE: BEFORE; THE FIRST INSPECTION, IF YOU INTEND TO OBTAIN
FINANCINGCONSULT WIT14 YOUR LENDER OR AN ATTORNEY BEFORE: RECORDING YOUR NOTICE, OF
C011MENCE,MENT.
Application is hereby made to obtain a permit to clo the work and installations as indicated. I cxrtif} that no work o: installation I.ias
conm':enced prior to the issuance of a permit and that ali work will be performed to meet standards ofall jaws regulating, constru do
wells, pools,
n this .iurisdictioit. I understand that a separate permit must be secured for electrical work, plumbing, signs,
furnaces, boilers, heaters, tanks, and air conditioners, etc.
F'BC 105.3 Shall be inscribed pith the (late of application and the code in effect as of 'that irate: fill, F;dujun (2017) f1orida Building Code
Pcrma Application
itcvised: Janutm,1.201$
N01'1CF,: In addition to the requirements of thi, pci mit, there= may be additional restrictions applicable to this, property diku may be
found in the public records of this county, and there may be additional permits required from othei governinentil entities such as water
management districts, state agencies, or federal agencies.
Acceptance offierunit is verification that I will nofifv the Owner ofthc PlOpeNlty Ofthe reqUiNlnentS of Flodda Lien Law, fS 713.
The City of Sanford acquires piwillont of a Plan review fee at dic time of*pe! mit sub-Mit%fl. A copy ofthe execated contra ct is required
in order to calculate a plan review charge and %vill be ('ousidered the estimatcd consIrUC600 \aAle of 111C,jOb, at the finle Of-subillittal,
Tice actual construction value =vill be figured based on the cuirent ICC, Valuation Table in effect at Ilic time the permit is issued, in
accordance with local ordinallCe. Should CalCkllklled char�s fil"gured off the executed Contract exceed the actual construction value.
crettit,vili be applied to your permit FeCS When the VC1-olit is iSSUCCI.
OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will
be clone in compliance with all applicable la4Ns regulating construction and zoning.
H 112- 11 U
- --- ------- --
era C)FR
I 1v :.` luau 0", L , ,, i", /A
n -%rcl!4 S Narne Print Conumt,,/Ay;lt Name
A-
aA1Y1LLU-.
1IOTARY PUBLIC
STATE OF FLORIDA
Cayvv# GGO=25
ivevim30*112020
0wner,1A,-,ejij is -Wrsonal ly Known to Me Or
PrOKILICed ID \-" Ty pe of I b D—VAVA—V—!1AACkr\5C
- - I-H JELL 12
meoFlond. w muff
NOTARYPUMJC
STATE OF FLORIDA
COMO em
E) 7/2=
contr".1,clor/Azent Is USOMIJIN, Known to Me or
ProdUced ID — Type of ID
.BELOW IS FOR OFFICE TSE ONLY
Permits Required. BuildingE] FlectricallF.] Nleclianieal[] Plumbifig[j 'GasL] Roof
Construction Type-_ 0'ecupancy Ulse: Flood Zone-.
Total Sq Ft of Bidg- Min. Occupancy Load: 9 of Stories
New, Construction; Ele4,tric - 9 of Amps_-------- Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes 1 NoF1 Fire Alarm Permit: Yes[] No [j-
APPROVALS: ZONING:--. U'l[ITHES: . ..... WAS IE WNYER:
ENG IN I,,E RING: I'lRE: - BUILDING:--,
COMM,ENTS:
Rmscdl: 3aLmy" I, �XJIR
THIS INSTRUMENT PREPARED BY: 11111111111111111111111111111111Jill Jill
Name: Tom Reeves (} GRAt1T MALOYr SEHINOLE COUNTY
Address: 630 N Hart Blvd (� _ V �t CLERK OF CiRC:UIT COURT 3 COMPTROLLER
Orlando, FI3281tiOK 90?2 P? 151 (1F9s)
CLERK'S : 2018028662
s.��'w� �� COMMENCEMENT
� ���� �� RECORDED 0371S/2t11S :Ui Ill:,? A11
NOTICE REt RDING FEES kellroJ
.� � �� � RECORDED BY ,iar_i;nnre
Permit Number.
Parcel ID Number. 06-20-31-502-6900-0100
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the
following mfohnation is provided in this Notice of Commencement
1. DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available)
LOT 10 BLK 9 PALM TERRACE PB 4 PG 82
2. GENERAL DESCRIPTION OF IMPROVEMENT:
ROOF REPLACEMENT
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR. THE IMPROVEMENT:
Name and address Lyna L Sr Khanh Trinh 538 ManderleY Run Lake Mary F132746
Interest in property: Simple
Fee Simple Title Holder (if other than owner listed above) Name:_ 5 A mF
Address:
4. CONTRACTOR: Name RestorSurance Services Phone Number. 407 401 9599
Address: 630 N'Hart Blvd Orlando, FI 32818
5. 'SURETY (If applicable, a copy of thepayment bond is attached): Name
Amount of
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 its :provided .by Section
713.13(1)(a)7., Florida Statutes,
Phone Number.
8.. In addition, Owner designates
to receive a copy of the-Lienor's Notice as provided:. in Section 713.130)(b), Florida -:Statutes. Phone numbers
9.. Expiration Date of Notice of Commencement (The expiration is 1 year from date of recording :unless a: different date isspecified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE
CONSIDERED IMPROPERPAYMENTS 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 INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
96AA l,` 0- V IA)N L yiU fl i p I Al N
(Signature M:Ownar w lasnee, o Owrrefs br �ess99'a {Pnnt Name and Roma signatory's 1,1wom a)
Auttronzed OfGccrtpiroclorlPaMeriManagcr)
State of -lor I County Coun of
r ��
The foregoing instrument was acknowled acknowledged before me this �t"� '''
9 1 dayofmAp�H 22tla
by��ii�h Who is personally known to me ❑ OR >
Name of person m9 stalemenl C
who has produced identificatiora
n fD e of identification produced: { J �/ IV P V 1 ����,SQ � ca
McBhett Rrl�tar � v w �'
NOTARYI�IJBIIC t (� , cc �
Nolary Signature � s
W
U V
R 0 S 0 r
"'�` a t J �� lr'
Roofing Services
ReConstruction Insurance Specialist
CCC 1329220 CBC1255480
630 N. Hart Blvd,
Orlando, FL 32818
Office 407-401-9599 Date: /�
Fax 321-445-5593
www.Rest rSurance.com
Rep
Customer ,��tta
��
Address
City, St, Zip_ yam,
County �J Subdivision
Home Work
Cell- Or 9 OW Gate Code
Email
SPECIFICATIONS
<FVER ROOF WITH , _
�T LE OF SHINGLES �
2fOLOR OF SHINGLES �� L
IrfEAR OFF
91EAR MANUFACTURER WA ANTY
21INSTALL APPROVED STARTER COURSE 4'e
NSTALL APPROVED VALLEY
(INSTALL RIDGE
Q4IPE FLASHINGS COLOR.L�_
Lk,AETAL EDGING COLOR -
T COLOR J j •�- -7p 6 VLL MATERIALS 41 GRADE —�
❑L V S OPE SYSTEM
GC N UP AND HAUL OFF ALL DEBRIS
R�ORSURANCE SERVICES, LLCTO FURNISH OWN INSURANCE
uYFAR(S) WARRANTY ON WORKMANSHIP ��CIFI'IATIONS
_
CJSEE ATTACHED ADDENDUM FOR ADDITIONAL S
CIA ZONAL GUTTER WORK MAY BE NEEDED
ROTECT LANDSCAPING AS NECESSARY
❑S ELLIITE DISH REMOVE REINSTALL ONLY
Li
❑SPECIAL INSTRUCTIONS 0V_
WE HEREBY CONTRACT to furnish all permits, labor and material
complete in accordance with the ,abboovse specifications, for
t�h�e,�m
of
JAW
DEPOSIT $
PAYMENT :(Check One)
BALANCES
Payment is to be made upon substantial completion
(to b determined by Contractor and not dependant on the
issuance of the Certificate of Occupancy or Final Inspection.
Payment is to be made according to a payment
schedule which is attached hereto and made a part herein.
Job # la'-607
Cell
TERMS AND CONDITIONS
1) The Company shall have no responsibility for damages from fire,
windstorm, or other hazard, as is normally contemplated to be covered
by Builders Risk Insurance, unless a specific written agreement be made
therefore Priorto commencement of the work.
2) The Contract on the face hereof does not include expenses or charges
for additional bond or insurance premiums or costs beyond normal
bond and insurance coverage, and any such additional expenses,
premiums or costs that have been added to the amount of the contract.
3) Replacement of deteriorated decking, facia boards, S roof jacks,
ventilators, flashing or other materials, unless otherwise stated in this
contract, are not included and will be charged on a time and material
basis if needed at $65.00 per sheet BC plywood installed or $4 per linear
foot for plank board decking.
4) The Company shall not be liable forfailure of performance ordelays in
the completion of work due to labor controversies, strikes, fires,
weather, inability to obtain materials from usual sources, or other
circumstances beyond the control of the Company whether of a similar
ordissimilarnature.
5) If roofing and sheet metal work is involved, it is understood and
agreed to that our standard roof guarantee shall be acceptable and that
all terms and provisions therein • shall prevail, unless otherwise
specifically agreed to in writing priortothe commencement ofthe work.
6) The Company is not responsible for any damages below the roof, due
to leaks by excessive wind, ice or hail during the period of the warranty.
7) The Homeowner is responsible for satellite realignment fees. The
Company is responsible for satellite dish remove and reinstall only, with
calibration to be performed by others.
8) If material hasto be reordered or restocked because of cancellation or
other default by the customer, there will be a restocking fee equal to
fifteen percent(IS%) of the contract price.
9) This contract and warranty shall not be assigned and is
nontransferable.
10) If this contract is cancelled by the customer later than three (3)
working days from execution, Customer shall pay to the Company
twenty percent (20%) of the contract price as liquidated damages, notas
a'penalty, and the Company agrees to accept such as reasonable and
just compensation forsaid cancellation.
11) This contract cannot be cancelled once work has commenced except
by mutual written agreement of both parties.
12) If any provision of this agreement should be held to be invalid or
unenforceable, the validity and enforceability of the remaining
provisions of this agreement shall not be affected thereby.
13) Any representatives, statements, or other communications, not
written in this contract are agreed to be immaterial, and not relied on by
either party, and do not survivethe execution of this contract.
14) The Company is not responsible for any damage to driveways,
sidewalks, landscaping or sod byvendors, suppliers, ordumpsters.
15) The laws of the State of Florida shall govern the validity,
SCPA Parcel View: 06-20-31-502-0900-0100
Page 1 of 2
cartdAannmon.cra Property Record Card
(�yUr rR Parcel: 06-20-31-502-0900-0100
sensu�7usca�nrrv,a:�acxnw Property Address: 2515 YALE AVE SANFORD, FL 32771
Parcel Information
Parcel
06-20-31-502-0900-0100
Owner(s)
R_I_NH, LYNA L
RINH, KHANH----�'-_- -_- _ — -
Property Address
Mailing
2515 YALE AVE SANFORD, FL 32771
538 MANDERLEY RUN LAKE MARY, FL 32746
Subdivision Name
PALM TERRACE
Tax District
S1-SANFORD
DOR Use Code
01-SINGLE FAMILY
Exemptions
VI
C)
Seminole County GIS
2018 Working 2017 Certified
Values
Values
Valuation Method
Cost/Market
( Cost/Market
Number of Buildings
1
1
Depreciated Bldg Value --
$99,167
$80,718
Depreciated EXFT Value
Land Value (Market)
$12,513
$9,555
Land Value Ag
Just/Market Value "
$111,680
$90,273
Portability Adj
Save Our Homes Adj
Amendment 1 Adj
$0
$12,380
- $0
$0
P&G Adj
$0
$0
Assessed Value
$99,300
$90,273
Tax Amount without SOH: $1,718.00
2017 Tax Bill Amount $1,718.00
Tax Estimator
Save Our Homes Savings: $0.00
Does NOT INCLUDE Non Ad Valorem Assessments
http://parceldetail.scpafl.org/ParcelDetaillnfo.aspx?PID=06203150209000100 5/2/2018
�rORD
PTI4E DEPAP MENT
PERMIT # l ?— ZoBS
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
Jt»t()nxl ss:7$ Y'e tsVe 32 23
STRUCTU,RPI TY'.PL': (SINOLG (AM.ILY Rki-SIDF.NCIiCI'OWNHOUSE O MOBILE 110,Ni}.•_ O Al':1RT\4E7.NT,'CONDO\47NI11M
RF.-ROOK TYPk:: 42�RE4PI.,AC'1:MTa'I-(TI3AR OFF EXiS'17N(; ROC)T- AND RrPE.AC13 WITH N6W COA4I'ONHN9`S)
ORL (OVF-R (NFW ROO)' Iv�'IALLUD OVER EXISTING ROOF.)
D (.'K'CYPE; (PLEASE T'CCIFY):
_ — ----- ........ ......... -...... - - ----- --- __ --
* *PLP:ASF NOTE: ONLT' 100 Sf)u..AR6 FEET OF TIIL LX1STING I)LCK IS PL RAli77:L D TO.BE REPLACLI) * *
ROOF' VENTIIATIO\: O(-)FP-RID(;r. �RIUCiki OSOFFIT OPOWERIA) VENT OTURDINES
sim'Ictu': 0 )"ES 4NU II Y IiS, PTa ASr- PROVIDL FLORIDA PRODuci AT'PROVA 1. 4:
MAIN ROOF Alt EA
ROOF Sl.oPk;: O L6SS 1'I-IAN 2:12 O 2:12-4:1.2 ('Y4:12 OR GREA n-R
' TYPE OF ROOF
j I11NGLE
MANUFACTURER
QnS��rn_i -_-
FLORIDA PRmucr APPROVAL:
/T� p I�1 ----
11?! �115/_7IL-8 2
(0`META1,
O MODIFIED BITUMEN
p
FL#
:FIA4
i
O-TORCH DOWN
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1=I4
I O INSUI-ATED
t-
O TILE
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o-OTHER: _ _ _
n>�rr�m_er_r��t ino
FLP.
�-R 3
ROOT-EXTENSIONS-(POR IIES, PATIOS, ET(.':) "*'IFAPPLIC4BLr,"'`
Rom' SLOPE: O LESS'rIh,N 2:12 O 2:12 - 4:12 O 4:12 OR GREATER
i TYPE O ROOF --
1�';':\'�UFe\CPQRk:R
FI WDA PRODuCl- APPROVAL.
two-11tI�INGLE
( G,1
PLir'
O MODIFIED B ITUMEN
F L#
OTORCFI DOWN
O INSULATED
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Building & Fire Prevention Division
' RE.SIIIENTIALRE-ROOF POLICY & PROCEDURES
PF>i2i1Du 1\t RF:Qu1RrmL:\ tS-NO PI A\ 121;1'i}..1V Ru.Q TR7;D
1 US DOCUMENT (W(MED) ALONG WI-111 AN .ACCIJRA'FEAND CO' f LI'1I3D RESIDI..N It A], Rr-Roor Swop.' or WORK ARE
RE UI I D T010 SI IMI'll1 [ _ AS PARI OF YOUR 1' MMI I' APPLICATION.
TIE Scorn w Won Ml!41 INC'IXD3. ALL APPIKA131.-(' 3'Lf'mWA PRODUI T A `I%OVAL.NUMBERS FOR All ROOF
COR7PO k \ t STIIAT 4Yil.,l BE 1NS�IPAI,111) UN I HF' PROJEC'i ,
APFRV711 WILL 'JtJ' Hl_ ISSUr"D wtFHOU`F IIII.SI:I?OC(.jMEN'IS. COPIES WILL !3E MADF To Poor ON THE JOB ATE.
**t R.O,FAC: T,S LOCATED IN THE S NFORD HISTORIC 1i1STRICT WILL: REQUIRE PLAN REVIF:AV AND APPR0v.AL BY -1 HE
SANFORD H wroRFC PR} SF RVA"1'ION WMRD
1NSPISCFION, POLICI^ & PROt hDt RF;S
A-€'INAL Rt)OP I "" ' %-Clt)V A TFU? MY i,NSP1.C'"IR)Twlil'.t,)L; M Il RJR RE',mDENTIAL (SINGI-r, E ANIII:.Y, TOWNHOUSE.
molml.I. IIOMt3. APARE MEN FA'ND/OR COh'D0,,A4lN UM) RE -ROOF PERMITS,
I III ,R WWh'G 0 R:FQUIRIT) 1`0 BF PROVIDE ON'II:IL JOB SITE:
v PERNITI CARD, POS 1 ED:IN A C �JNSNCl OUS A`NI) WFA 111LRPROOF I OCA11ON
a COMPI.1 1 t O RESIDENTI iL. RI Rt lOI SCOFF Or WORK
o Cti:)MPE_L I`FI3 ARI) tiva,/Atilrl'.D IiVSi?l.,C;"PION ArITD.A4`I:1`
s A LFi.,MMAPmmucI":APPROVALANDC)RRESPONDITNGINS"IALLA'LU)NINSTRUCrIONFS
(PRODUCT APPROVAI,SI tAl.1, •1A I'(:l I II`EIAi IS E:}N I f IL St:(;7PI=' {)F' al ORK)
o OIGI`i�Al z 1>1101,06RAI'.IIS-(MUD [ I:NCLUOF. THE PI:R,NIFLNI NABER..OR ADDRESS IN FACM PIC`Frj12E).
o EACH PIAANEOTOP, ROOF. SIIC)WItiCi1HI;.UN!I)(:RI.riIMI,, I'INS'E'AlIiLt,I).
O Root-' Dr,,cK NAILING PAT'FE:RN $ S;PA'cING {IN(:3.L. DI\{, ,l MI;ASI;IRING.DIi\'tC'I:OR RULIsIt}
G ROOF DECK 14MI i USED (INCLUDING \ MIJ9)RWG DEVICE OR I2[ 3LF.R SHOWING SI%I, OI NAILS)
r UND RLAYt1ENINPAF1rAN&SPA'ING(INC1:CDItiC AM1-ASURIN(iDE'VICLOR, RUI:1,A)
c; DRIP FIX�I` S VALLEY A"F A( HNIHN'l UNC6UDI'NG A MEASURING DI;.VICki OR RULER)
c- SIt1NGl1 5 1 S"I`AE.,L.t?:D, N lI[ PA'CI'E'f{P A 'I) L,C1C AilCaw Oi NA LS
0 ShA`LIC H S (W APPI.0 ARIT)
0 D161 I:At, P HO'i'OGR APIIS A IOWi1,`G iiLL INSTALLATIC1:` C,C}liPONPN 1 S, PI RF'L f Roru, r APPRQVrAL
a DIGITAL PE for IOGR.APIJS A MW NCL.i Y REY"RED FLAY IiNti PLR FL FTODUCT APPROVAL
C:i ILLR(7:`i'O FOI:LOW t l VSE SPF UFIC GI IDEUNEfi Si ns RI_SiAT IN AN AFF1DAN IT PROVIDED BY A FIARMA DEMGN
PROTI.SSION.AL (ARCMTECT O12 ENCINEERY CEWHI'YING FBC CODE CONIPLIANCE. BY PLRSON.AL INSPFC"i ION.
(:0N`I I AC: f0R (OR OLE SLIT. IiC'1€.laitR] SIC=NAIUR.F.' DA'cE ;
__ -----
ll
Ma
s � i i ;, i ,p f d� j,a t • ,q p�
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
I hereby name and appoint:
an agent of: z2SAbY5uwa(,Ce. S%( V l u s
(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 specific permit and application for work located at:
(Street Address)
Expiration Date for This Limited Power of Attorney: 05107 � 7 OP
License Holder Name: Mi Ma I �Aamm
State License Number: l�C
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before me this
20(f JSZ, by M 1C-VNC I VACLM Y1
to me or ❑ who has produced
identification and who did (did not) take an oath.
IvExplres
ly Mft
NOTARY PUBLIC
STATE OF FLORIDA
cmvn# G
&2712020
(Rev. 08.12)
Sig a re
'MQghan Mti��.>,
Print or type name
2—day of M Q ,
who is ersonally known
Notary Public - State of FIOY 00,
Commission No. bbbo —5
My Commission Expires:(P l 2112 01
as
CITY OF
S ------- Building & Fire Prevention Division
ORD
RESIDENTL4L RE-R OOF A FFIDA VIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: 16— IOU) ADDRESS: 2515 Yale Ave `)QYig{71/(`�. - .3
Lyna ri- h
I All J `Cjl� 1 1 ► AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
fZ'OFING CONTRACTORENGINEER, ARCHITECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE
r FORMATION 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 AIA.
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 #: 323 Z21�
COMPANY /CON"FRACTOR: � MVI
CONTRACTOR SIGNATURE: DATE:ol
(MUST BE SIGNED BY LICENSE HOLDER O O NER/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,
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 f
Sworn to and Subscribed before me this I day of 20 t� by:
KA( ch &L I Haw rn. Who is �rsonally Known to me or has ❑ Produced (type of
identification) of U n
M-0 (flno n M
-
Signa of Notary Public
State lorida
Mpmmn M ► I Iev
Print/Tpe/Stamp Name
of Notary Public
as identification.
MaghenMiller
NOTARY PUBLIC
STATE OF FLORIDA
C4nma GGW6025
E*res 612MOM