HomeMy WebLinkAbout2629 El Capitan AvePP
C-fTY OF
FlIRE DEPARTMENT
Building & Fire Prevention Division
PERMIT APPLICATION
Application No: 149 —Zag8
Documented Construction Value: $ , 3 —7-� , o
Job Address: a (n Q L (lap t-LI:2l dvt' Historic District: Yes❑No�
Parcel ID: 5� �(�, <3o ? Q Residential Commercial[]
Type of Work: New[] Addition❑ Alteration ❑ Repair ❑ Demo ❑ Change of Use❑ Move ❑
Description of Work: F& I / r',"_ - u' 0q),10
Plan Review Contact Person: 'Ick �— 14 Dt� Title:
Phone: Fax: Email:
Property Owner Information
Name < / QS 4 Phone: �� - 416 " c� 9
Street: a� �, a,�:, ,. Cap 14CZVI , r V -e- Resident of property? : I
City, State Zip: .tn �o f - D 7 -7 3
Contractor Information
Name f'11�nirP:i.i., :2 C
Street: 0 CC,-4/c, a A f
City, State Zip: kh'n Y ce- 12o`r-k r- L 3 a -7(
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Phone: 4�) -7 - a 61" 3 ( 79
Fax:
State License No.: c-C C / 3 a -73 r
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 a permit and that all work will be performed to meet standards of all laws regulating construction
in this jurisdiction. 1 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: 61" Edition (2017) Florida Building Code
Revised: January 1, 2018 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 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 construction and zoning.
f ` Q- I6P
Sign a ractor/ g tent Dat
Print Contractor/Agent's Name
ANNETTE Nt BLAND
Notary Public — State of Florida
^' Commission # GG 17090C
t.ly Comm. Expires Jan 16.2022
:_-cad 1.rc.g Naicra Nowy Assn,
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: 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 Fire Alarm Permit: Yes ❑ No ❑
APPROVALS: ZONING: UTILITIES: WASTE WATER:
ENGINEERING: FIRE: BUILDING:
COMMENTS:
Revised: January 1, 2018 Permit Application
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.
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.
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.
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. A copy of the executed contract is required in order
to calculate a plan review charge: If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity ,levels. Should calculated charges exceed the documented
constriction value when the executed contract is submitted, credit will be applied to your permit fees when the
permit is released.
- - lVD,1�
Signature of Owner/Agent Date
506cew GK1*11roro
Print Owner/Agent's Name
Signature of of -State of Florida Date
oteR;!?49,�c JOSHUA DAVID SCHARIO
' Commission # GG 145807
c*` Expires September 25, 2021
�TFOF "'Ie Bonded Thnt Budget Notary Sertnces
�as�g
Signature of Con for/Agent Date
Al
Print Contractor/Agent's Name
Signature of Not
-State of Florida Date
P.4p,
JOSHUA DAVID SCHARIO
ogpRY
_ '
Commission # GG 14 5307
Expires September 25, 2021
�lFOF FL04
Banded Ttw Budget Notary SOMM
Owner/Agent is Personally Known to Contractor/Agent is Personally Known to Me or
Produced ID - LZ Type of ID LUr
s Produced ID Type of ID
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
Rev 11.08
UTILITIES:
FIRE:
WASTE WATER:
BUILDING:
insurance
the damab
ANDREW PEET INC.
1641 Woodland Ave. • Winter Park, FL 32789
Lic # CCC1327383
Licensed • Insured
"A Family Tradition Since 1937"
Orlando
(407) 268-3178
SALES AGREEMENT '1*0Wa5_21
Andrew Peet Inc. agrees to furnish all materials and labor necessary to
do modernization work on the premises located at the following address:
Name fl Phone y
Address � , r � City 'Suh�d'
Job Address, 4a&n City
In accordance with the specifications given below:
RE
�200F WITH SHINGLE ROOF AS FOLLOWS:
Date - 4` 5--1v
Zip _ 3�;?7l
Zip
(,�1. Remove l layers of roofing to a smooth workable surface. Each additional layer at $ per square.
2. Replace any bad wood for $4.00 per Lft for Ix, $6.00 per Lft for 2x. $60.00 per sheet of 4x8 Decking.
(I1' 3. Install Eaves Drip. Circle One: Brown - White iQ - Mill - Beige - Reuse
(41" 4. Install ice and water shield in valleys. Circle: - No
(ty 5. Install TO lb. Base felt.
(1�' 6. Install Valley Metal New Reuse
( ) 7A. Chimney Step Flashing New Reuse 7B. Chimney Counter Flashing New Reuse
(u)"8A. Wall Step Flashing New Reuse 8B. Wall Counter Flashing New Reuse
(V 9. If Flashing cannot be reused additional amount may be added as necessary.
W 10. Soil Stack Bogt New Reuse
(� 11. Install �?1i Tedt
year shingles. Manufacturer C',e�'�Cr< ! h
Color Style_ Lmf zipmark.®fir ly wew
(0/ 12. Install Roof Ventilationn Lft Ridge Vent, Lft Shingle over Vent, or
power vents, 2' x 4' Off -Ridge Vents. Electrical hook up to be an additional charge.
( )/13. Clean up all work -related debris. Haul away, leave job site clean.
Additional information:
L I
INSURANCE CLAIMS
All work specified in this sales contract is subject to the approval of the Insurance
Company. This agreement becomes binding to the undersigned as soon as the
Insuran !Ili Compa prove a scope of the wo Is uranceNA..
proceeds ny deductibles, ba ra work, and supplements. The
final price may be adjusted up or down from the sales agreement. If contractor
cannot replace entire roof for insurance proceeds plus deductible, agreement is
void.
Insurance Company
Executed by the Buyer this
day of
Approved and Accepted
a. Do not sign this home improvement contract in blank.
b. You are entitled to a copy of the contract before performance commences on your home. Keep it to protect your legal rights.
c. I/We have read and understand the terms and conditions located on the back of this document, which are incorporated herein by
reference and made part of this legal and binding Agreement.
i Price $ 16Z37a?..o
Down Payment OR
Upon Delivery of
Materials $
Cash Upon//�oa
Completion of Job $ b
(Plus Total for Wood from Item 2 and Item 9)
DIRECTION OFJOINT PAYMENT
I hereby a thorize and di homeowners insurance
("Assigne and applica�exception
company(s), suc
contract of insurance, with thof amages payal
insurance.
A ,
/v-A
This agreement does not obligate the Customer to Andrew Peet Inc. (hereinafter "Contractor"), in any way unless the
approves the cl ' a court ofcompetent jurisdiction orders the insurance carrier to provide coverage and payment for
ustomer. Unless a Lwnrk Qr_upgrade a reque the Contra agrees p ill be completed
n TI7L' !"7 TCT/'IA.iTT r.Tvi-vr.rm _ __ __
Claim# Policy#
Acceptance of Proposal: The above specification and conditions arc satisfactory and hereby
accepted. Andrew Peet Inc. is authorized to begin the work as specified above after receipt of
intention of full payment from my insurance company. BUYER'S RIGHT TO CANCEL:
You have the right to rescind this contract within 3 business days after the date you sign it by
notifying the contractor in writing that you are rescinding the contract.
("4
npany, t ment joito the ' d also to Andrew Peet Inc.
as may be due an ntly or all damages payable under the subject
under the Contents and Additional Living Expenses applicable lines of
Signature �Wr0:3ia- Date:OK-nwg7, It,
Signature
Date:
Signature
Date:
d ew Peet Inc. Representative
S
THIS INSTRUME T PREPARED BY:
Name: c.yW i
Address: • 6 l W
er c PL
NOTICE OF COMMENCEMENT
Permit Number: �f �r�
Parcel ID Number: Q (" d 3 0- Sd �- �bao — 0flBD
!!it!!! tt!!! tltll 16ti1111i1 III[! Itli Itil
GRANT MALOY9 SEMINOLE COUNTY
CLERK. OF CIRCUIT COURT t, COMPTROLLER
BK 9119 Pf3 1940 (1F9s)
CLERIC'S T 2018047138
RECORDED 05/i-i1J2018 01:07a3,1 PN
RECORDING FEES $1+.00
RECORDED BY tsmith
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 dgscription of the property and street a dre if available)
Ibaq _ E1 � AW. 4tn P2 39723
2. GENERAL DESCRIPTION OF IMPROVEMENT: 1g _ 4 O
3. OWNER INFORMATION OR LESSEE I FORMATIION IIF.THE LESSEE CONTRACTED FOR TH IMP VEME
Name and address: _tn5�U l( N / o` 5 61 q pto 15��� F1 � 77,3
Interest in property:
Fee Simple Title Holder (if other than owner listed above)
4. CONTRACTOR: Name:
Address: j_�( L/f !EV'i
5. SURETY (If applicable, a copy of the payment bond is attached):
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 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
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.
2�� 43� 6vih-Qd'
(Signature of Owner or Lessee, or Owners or Lessee's (Print Name and Provide Signatory's Title/Office)
-VVAuthorizyeed�Officcer/Director/Partner/Manager) `
State of l�t<1 106 A County of emid IQ—
The foregoing Instrument was acknowledged before me this day of 7Y• 1 .2016
by JVIy "u{�0� Who is personally known tome ❑ OR
Name of pers aking statement �� G Gas- )/� y �v
who has produced identification type of Identification produced:T �V( Il//� PJ T U
FANS MA1.0
CER11FiE0 CO",Coil C00IR l
o<►RYpba JOSHUADAVIDSCNARIO CLER,_. ,..,v-,t20L'tl' _.-11MA 1
* , Commission # GG 145807'
m'lFOF II-110 Expires Ba ded Thru Budget Nowt' s
Notary
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: grab L 6
I hereby name and appoint:
an agent of:
r
(Name of Company)
.6.
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):
tY The specific per it aQ�ndqapplicati n
(Street
Expiration Date for This Limited Power of Attorney:
License Holder Name:
State License r
Signature of Li
STATE OF FL
COUNTY OF
6-a4-10
Ft 3-) 773
The foregoing ins a nt was ackno ledg d before me this ;26 day of ,
20# l8 , by_& A V C Q who is ersonally known
to me or ❑ who has produced
identification and who did (did not) take an
Signature
s
(Notary Seal)
d,,�v►�, JOSHUA DAVID DOWARIO
Commfssfon # GG 145807
a o� Expires Septamber25, 2021
9IeOF Fl�P\ Bonded Thru Budget Notary Smim
(Rev.08.12)
Print or type name
'A Notary Public - State of Flat,
Commission No.
My Commission Expires:
WPI
SCPA Parcel View: 01-20-30-504-2600-0080
Page 1 of 2
PAPOIRWER
ser aaoF c apuvrx. rtocemn
Parcel Information
Property Record Card
Parcel: 01-20-30 504-2600-0080
Property Address: 2629 EL CAPITAN DR SANFORD, FL 32771
Parcel
Owner(s)
01-20-30-504-2600-0080
GARRISON, JOSEPH A - Tenancy by Entirety
(GARRISON, MELINDA T - Tenancy by Entirety ~� T
Property Address
2629 EL CAPITAN DR SANFORD, FL 32771
Mailing
2629 EL CAPITAN DR SANFORD, FL 32773-5304
Subdivision Name
Tax District
DREAMWOLD
S1-SANFORD
DOR Use Code
0802-MULTI FAMILY 2 UNITS
Exemptions
00-HOMESTEAD(1996)
6i.
Legal Description
LOT 8 BLK 26
DREAMWOLD
PB4PG99
Taxes
GIS
Taxing Authority Assessment Value
Exempt Values
Taxable Value
County General Fund $76,388
$50,000
1 $26,388
Schools $76,388
- __. ..._-..- — .
$25,000
v
— ....... �- _... ._.. _. .
$51,388
City Sanford $76,388
$50,000
$26,388
SJWM(Saint Johns Water Management) $76,388
�_---�
$50,000
--
$26,388
County Bonds $76,388
$50,000
Sales
Description Date
Book Page
Amount
Qualified Vac/Imp
QUIT CLAIM DEED 4/1/2001
v
04058 1696
$100
No Improved
WARRANTY DEED 12/1/1989
a—
}{ 02145 1104
$80,000
No Improved
WARRANTY DEED 7/1/1984
01564 0476�
$11,000
Yes Vacant
Find Comparable Sales
Land
Method
Frontage
Depth Units
Units Price Land Value
LOT
0.00
1 0.00 I 1
$20,000.00 $20,000
Building Information
# Description Year Built Fixtures Bed Bath Base Area Total SF Living SF Ext Wall Adj Value Rep[ Value Appendages
Actual/Effective
1 11985 6 3' 2.0 9591 2,782 1,922 CB/STUCCO i $81,039 , $94,231
- — FINISH Description Area
� I i
http://pareeldetail.scpafl.org/ParcelDetaillnfo.aspx?PID=01203050426000080 5/2/2018
ra{rxeCITY OF
s SkNFORD
DEPARTMENTFIRE
JOB ADDRESS: 9
PERMIT #
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
400 Ae. Sawm'd FL
STRUCTURE TYPE: GKINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: apLACEMENT (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 EXIST/NG DECK is PERMITTED TO BE REPLACED **
ROOF VENTILATION: D OFF -RIDGE Q'I IDGE OSOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: O YES &Iro IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 V 412 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
GHINGLE
l.G�
FL# J I ` C3
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
0INSULATED
FL#
O TILE
FL#
O OTHER:
FL#
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IFAPPLICABLE**
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 4:12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
O SHINGLE
FL#
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
0INSULATED
FL#
O TILE
FL#
O OTHER:
FL#
CITY OF
' � ; ' � ����® Building & Fire Prevention Division
," 1'V RESIDENTML RE R0OFPOLICY & PROCEDURES
FIRE DEPARTA4ENT
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.
DATE: %
CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: / 'Lj a , �G'
City of Sanford
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
/� r a
PERMIT #:- V� �S ADDRESS: Q� ,b I
� �;f 3 �
AvArw Ped 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 ##: CCC (3 2_? � .19
COMPANY / CONTRACTOR:
CONTRACTOR SIGNATURE: _
(MUST BE SIGNED BY LICENSE
2ew
A FINAL ROOF INSPECTION IS REQUIRED:
DATE:
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
Sworn to and Subscribed before me thi
, m'to1-p
s It day of ' ✓ 1 20 g by:
arj SIN v��iT . Who is ersonally Known to me or has ❑ Produced (type of
identi n)
Si n ure of Notary Public
St t of Florida
Print/Type/Stamp Name
of Notary Public
as identification.
JOSHUA DAVID SCHARIO
. , * Commission # GG 145801
� < Expires September 25, 2021
'� OF rV DW4W DN k*W Notary Services