HomeMy WebLinkAbout2519 S Sanford Aver-r8--IS
y,a 211 CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: — (-7 0
nn Documented Construction Value: $ ,
564• q 1
Job Address: 2� "Ij . "7�V� Historic District: Yes ❑ No ❑
Parcel ID:Residential Commercial ❑
Type of Work: New ❑ Addition %te�ra�tion ❑ Repair ❑ Demo ❑ Change of Use ❑ Move ❑
Description of Work: _
Plan Review Contact Person: _\p(a ���t�, Title: k,,��f�}r�Qj'r'
Phone: `�• �T:l� DtO7(a) Fax: 4 Email:
it
Property Owner Information ++,
Name Phone: , 312• iowA
Street: ick 5.'S c %_dl Resident of property? lu>
City, State Zip: 1��7
Contractor Information
Name tVt rZoo Phone: _4bri' 4 • obo8
Street: �� N {�: rCQ�p Fax`
City, State Zip: , �'� State License No.: CCC.tM 4-1 y
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 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 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: Sth Edition (2014) Florida ,Building Code
Revised: June 30, 2015 Permit Application
.... __ - -_ ..
�q ,L13
NOTICE: In addition to the reo_uirements of this permit, there may be additional restrictions applicable to this property.tbat 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 conk' an oning.
Stpnahme oVvzcrfAgcnt Date
Cif
�ff•V
TRICi.AtYNNHENDERSON
Notary PuNic - State of Florida
r } •
CoMr,,lissicrt = GG 125377
_
my co.'nrn. Enires Jul 2C• 2021
....•
...:iC�i`�;s:"h P:2iIC"ak h9i?ry.?.4S'..
to Me or
uced ID __J��Type of ID
BELOW IS FOR. OFFICE USE ONLY
Permits Required: Building ❑ Electrical ❑ Mechanical[] Plumbing0 Gas ❑ Roof
Construction Type: Occupancy Use: Flood Zone: _
Total Sq Ft of Bldg: Min. Occupancy' Load:
New Construction: Electric - # of Amps.
# of Stories`
Plumbing - # of Fixtures.
Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads Fire Alarm Permit: Yes [-J No ❑
APPROVALS: ZONING:
COMMENTS:
UTILITIES:
WASTE WATER:
ENGINEERING: FIRE: BUILDING:
Rnzscd 1anuwy 1, 2018 Pennitfipolicauot:
PERMIT #:
City of Sanford
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAI -iNG, SHEATIUNG, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
ADDRESS: 251- I 3. �r� jbws
(2w i t , Sam J
ROOFING CONTRACTOR, ENGINEER, ARC : AS AN GENERAL, BUILDING, RESIDENTIAL, OR
OF F.S. GRAFTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE
FOREGOING INFORMATiO1�T TS TRUE AND ACCURATE AND THAT ALL ROOFING COMPONENTS LISTED ON THE SCOPE OF WORK AT THE
ABOVE REFEREiVCED ADDRESS HAVE SEEN INSTALLED IN ACCORDANCE WITH THEIR PRODUCT APPROVALS AND ALL APPLICABLE CODE
REQUIREMENTS — SPECIFICALLY FLORIDA BUII DiriG CODE, EXISTING BUILDING_ IN ADDITION I CERTIFY THE INSTALLATION MEETS ALL
REQUIItEMENTS FOR SECONDARY WATER BARRIER AND NAILING OF HAPTER 553.844). THE ROOF DECK, IN ACCORDANCE WITH THE HURRICANE RETROFIT
MANUAL REQUIREMENTS (BASED ONES. C
LICENSE #: CM 192..q` '1
COMPANY / CONTRACTOR:
CONTRACTOR SIGNAT _
(MUST BE SIGNED BY LI O DER OR
A FINAL ROOF INSPECTION IS REQUII2—
DA. E:e�,n..e.).n.a
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 DETAH. ALL COMPONENTS (DECKING,
UNDERLAYMENT, FLASIiING, DRIP EDGE ATTACHJ%IENT) 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
Swop t S s ed before me thijday of 20dby:
-Whoally Known to me or has G Produced (type of
as identification.
VieoTjon a , T ', ". •. MCIA L"NN HENDP50N
`s `�=. No!aryPUblic- Stateoi=Eoiida
&Ay Comm. Expi =s Jei 20. 2021
Print/Type/Stamp Name
SCr�?t14hrC4 21irr?IA en•?iSr.
of Notary Public
'CifA t..
E 7-2774963
R H Y N E
'4k �
RESTORATION REP: -e�
FL LIC# CCC1329471 9 e j ute ONE: 4
OWNER tr
DATE f E.LAODRESS J,
"' t
STREET/ P CELL PHONEi n
CRy tij
STATE 3 t l ZIP `� i HOMEPHONE t !,/�l
We hereby submit scope of work for: m/' CLEAN ALL GUTTER DEBRIS
{ HAUL OFF CONSTRUCTION DEBRIS
o Tear Off i tLi g/r,,ROLLMAGNETS THROUGH YARD
o # of Squares Off A eo,' LIEN WAIVERS PROVIDED 2 to 3 WEEKS AFTER FINAL
o Recover roof with C i s I`T C PAYMENT,
o # of Squares On-1 ';& 1 After tear off, these additional cost may occur:
o Shingle/ Color Ok`sG tts'ot-f�2f�
o Protect Property as Needed Daily *Plywood $SS.00 per sheet - * Roof to Wail flashing $6.00 per LFT
o Decking Type 1k _. 'Shingles $20.00 per SO. for extra layer*Fascia Board $8.00 perLFT
o Underlayment t� *Underlayment $10.00 per SQfor extra layer
O Metal Edge Color ! E 1 [` t - -Terms: The undersigned (Customer) herby agrees to the proposed
o Valley Type N 1pr scope of work and the contract price. The company agrees to furnish all
o Hip and R' a 1�' materials, labor and necessary permits upon, receiving the deposit which
O Nails aA I VFn t i 0 (y0 Is equal to 40% of the contract price and the balance due upon
o Pipe
:,Seal around all vents, f shings and pipes
ca' Furnish all materials, labor and necessaryermits
m-//Delivery Instructions
cap' 2 Year Roofing Workmanship Warranty
Repair Description
1)
2)
3)
4)
completion of roof.lnsurance Claims: Rhyne Restoration to be all
insurance checks
Roof Replacement t -'y,rzd� i tip. S
ElRoof Repair }t trIetiR $
Total $
Acceptedyby Owner:
3�M1DRpA COIISTRU@DN UCH. ACPORDMD TO RtlRIDA'S CONSTRD@OX UCN UW {SECTION I11W1�T13.BT, M1ONIW STATUIES� THOSC WHOWOM ONTOUA leDPEEM1 OR PAOVIDf MATEIFMEf AND A%NOTPAID-It}tULL tNVf A NGHT TD ENFDRRTNExI tlwlM FOR PATMEHT
AG4INATYOU0. PROPFRfY.TH6 GAIM6RYDVIN AtACMrtR4RW1UEK NYOUA CORTAARgR O0. ASUDCONTRAROP tYLS TO P4Y SUACONFRACEORS,SUR3IAlODx[RAROAT�DRMATERW ANPtI[AS OR NEIaFtiSTO MAFE OD1E0.1FOAtlY 11£gUIRED VAYMFN[S,THE IEOPLE
WNO AREOWEDTHEMIXEETMATLOOSFAYOURP1IOFERttE PAYRMEVENUYOU NAVEPAIDYOIM CONtMR051N NLL6TOU TA VHAVYAO MMRAETOR,TOURODNTMCTORMAY WNAVE WI ONTOURPRDPFATT.txIAon IEAUENGfAEO,YOUAPAOPFN(Y
COUID Rf50fOAGADFSf TGup WAL TO PAYfoA 1A800. M0.tERM1A OROMEAAfpYE�A THAT YOUR CONTRACfORORSUrCONTRACTOE MAY NAVEEABED TO PAY.10 PAOfEC[TOUAigF, YOU SNOULOTTWUTE ix 1NIS CDxTAART WlT BEFORE ANC MYMFMGMADE iWR
@MTRIROR ISREgUTAEDTO PAOVWFTOU VATX AwgDT[N AFee..e. Of MEA FROM ANT➢EASON 0A @MPAxYTx TN45 PROVIOEDTO TOUA'NOTICE TOOwNER.' FU)RN4'S @isLRDCnON UfN LAW 6 @MPl£1t AND 6 ftfDOMMFNAEOTMT WNFNFViRATPEOFK PRDBIEM
2)FLO ,YOU zImm-TAN ATTORNEY.
1) FlO0.1DA IgMEOI•MERS CONSTAU'OON RECOVERY FUN]. PAYMENTMAY BE AVAILARIEfROMTNE RORm0. VgMfOVlNFAY EONSERUCIION RECOVERY W IW B YOU IOAE MONEY MA PNOIxTPEgFCAM£D UNDER W 4TRAC1, wXFRETXE LOST AETUMT TIL:M TPFLUICO VIOIATIONTOF
32399.
pOROA UW EYA LCEASEO CONfRA'SOA. CON I:WOAMATIINIAE�Uf THE RECOVERY kMOANOHJNG A [ItJM. C1INfARTNE ROiItACONSiRURKIN UGAISTAY UCFIL'ING ROAROATTHE NSItOWINGTEVF NONE NUMBER ANO AOT&65: CR$19E0 NORTH MONAOEST., f41,TAWNASTEEH,
31 ANY pAIAC Fql OBNSIRU[i10N DEEECEA ARE SUBIFRTOTN[NO .AND.BE PR WLNONS OF ObtPT6t SAP, fEORBM STAMPS.
41 BII'IERARIGNTTOEANGl:TiiN'Na Romt mtltlhDon Mle,mlNYw Ao notwSM Aoodsasmices.tvumaY DN��Mh Alreemurtb OrwidMrAwHoen ev6¢MMerelWMptnoN,byttlq¢m.orby NuiATAN nDUtt vwsLM®o¢Matyw de nol waN tRe Amdsm xrvice sMmwiNe
det�.eredorprR•.marbe! before RddiVSM a du bdN beNrou d0.yaker for s:Ae FkN4.<amee4xYOR wsd ¢N AA•es�ro�+.. Die aeBermayroE keep aYor pn d areTvsk barn WYmeet BTNENnSFNNAAserPenlvw.apee Mx Y°ul+e.e tl¢k¢npwee0 roN¢ef WarVkt¢on¢I
orsAYN eAditiw. ro We erAdnP mmeietd MeF.
1.r. i iA c --/
i• INSTRUMENT•ED RY
•' � P44 a
�'t M' if•� _ -r �ti7
-Permit Number:
Parcel if?.Itumbor. ffi: i- a 1 ` 5M.-
The undersigned hereby gives iwke that Ex pramment will be Made (o cerlain real pmpa dy. and in w=dmwe with Chapter 713, Florida Slatutes. fhe
foitowt V winnation is Fo%wed in this Nwe of Commerventent
1.
2.
3_ OWNER INFORMATION OR LE"EE iNFOR1AATtON WTHE I, MEe CONTRACTED FORTHE itWFROVEMENT: � _ ^
Name and address- i t, 2 i M a
Interest in property: _ _ —
Fee Simple This Holder (7 other than owner listed above) Plante:
Addre� .
4, CONTRACTOR: Name: RHYNE RESTORATION f'horre Number 407 277-4963
Address: 10338 MIDDLEVVICH DR - OR[ ANDO, FL 32832
s. 15UPZff (R applicable, a 04T of the payment bond b aftched); Name:
address Amountof Band:
G. LEWElt Nsm Pt>z�e N°mbar.
Address:
T. Persons vein the Stile of Fbr Desklr>ated by owner apron whom notice or ether docW"pi s. may be served as provided by Section
7 s./a(t)(A)r, Florida SUMA9e.
Nara � Phone Numbs
Address
ti In addition. Ovmw des%pwles of
to remive a copy of the tienor s Notice as provided is Section 718.13(1 )(b). Florida Statudes. Phone Lumber_
S. Expkation Date of Nefice Of Comwmcer t (The e)V"hon is i year it m date of recor* g wdess a different flab is aPCified)
• W/IRNt AlOWAW& ANY PAYMENTS GLADE 13Y THE OWNER AFTER THE EXPIRATION OF THE NOTICE CiF COMMENCEMENT ARE
CONSIDERED aWROPER PAYMENTS UNDER CHAPTER 713, PART L SECTION T13.13, FLORiOA STATUTM AND CAN RESULT IN YOUR
PAYING 'TWICE FOR IMPROVBVIE7= TO YOUR PROPERTY. A NOTICE OFCOUMBiCEMENT MUST BE RECORDED AND POSTED ON THE
JOB SITE BEFORE THE FiR5T jlHWECTION. IF YOU INTEND TO OBTAIN FWANCING, COJSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE COMMENCING WORK OR RF-CORDING YOUR NOTICE OF COMMENCEMENT_
b or
Tub foregafn9 I was 1ec3 o before me this _ _ day of ?a---
WhD fs y tcrsowan to me O Ott
wile has oroWiced ldentlliC¢tfot�(ype of it uMcaf o procbteed
''� ••'' u :
� ; a of pc�dd
'^�,
W-V
�F
4: r
{Yttf lvCr x.
r.•.�' - A6t,�t,
_ ' �.$ \. • :
i� 2[V I'FJC�C 5d Ot:Jfllid _
lCrt'[r{Ss•J'' _ � ^ . c.)n ,.
GRANT MALOY, CLERK OF CIRCUIT COURT SEMINOLE COUNTY FL
CLERK'S # 2018041905 BK 9112 Pg 1059; (1pg) E-RECORDED 04/17/2018 10:18:57 AM
10.00
CITY OF
S,&�40RD
FIRE DEPARTMENT
Building & Fire Prevention Division
Re -Roof Permit Card.
PERMIT NO. 18-t8_70 ISSUE DATE: 14.0 1011911111111"1 a
CONTRACTOR: cbobk
JOB ADDRESS: a.51 SS • S1e.1 �►r ,�
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
Building & Fire Prevention Division
RESIDENTIAL RE ROOF POLICY & PROCED URES
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) SIGNATU DATE: (04, O IX
CITY OF
S,�NFQRD
M °
JOB ADDRESS: oC 5 H J
PERMIT # r %
Building & Fire Prevention Division
RESIDENTIAL RE ROOF SCOPE OF WORK
RE
STRUCTURE TYPE: (SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: 'REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE PLEASE SPECIFY): y i`
* *PLEASE NOTE: ONLY 100 SQUARE FEET
bF THE EXISTING DECK7.4PERMITTED TO BE REPLACED**
ROOF VENTILATION: DOFF-RI.DGE qi(RIDGE OSOFFIT OPOWERED VENT OTURHINES
SKYLIGHTS: O YES NO IF YES, PLEASE .PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 *2:12-4:12 O 4:12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
HINGLE
FL# ,O
O META
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
O INSULATED
FL#
O TILE
FL#
O OTHER: C tiI�
tv i L�K U1J�' N�;UiII S' C
FL#
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IFAPPLICABLE**
ROOF SLOPE: O LESS THAN 2:12 L:1.2 - 4:12 O 4:12 OR GREATER
TYPE OF ROOF MANUFACTURER
SHINGLE
O METAL
FLORIDA PRODUCT APPROVAL
FL#
FL#
O MODIFIED BITUMEN
FL#
0TORCH DOWN
FL#
OINSULATED
FL#
OT1LE
FL#
O OTHER:
FL#
City of Sanford
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAti?NG, SREATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #:I
V I�� O ADDRESS: 251q 3 •5wfuy� t .
I I , AS AN GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, ENGINEER, ARC , 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 ONF.S. CHAPTER 553.844).
LICENSE #: Oro- q41 1
COMPANY / CONTRA
CONTRACTOR SIGN
(MUST BE SIGNED B
CTOR-
DATE:o�n.%w_
1120 ►ER OR OWNEUILD S
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 (DECHING,
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
Swo n t S ed before me this day of 20 by:
Who is(sonally Known to me or has ❑ Produced (type of
O
Public
of
Print/Type/Stamp Name
of Notary Public
as identification.
"
TRICIA LYNN HENDERSON
Notary Public - State of floiida
Commission € GG 126377
+L
,,,,,,
My Comm. Expires Jul 20.2021
BcrdedtFrcu,hNatior=lM1CLryFssr.