HomeMy WebLinkAbout362 Fairfield Dr (2)CITY OF
, IS�ORD.
�
RRE DEPARTMENT
.,f
M��� Building &Fire Prevention Division
AI 2PERMIT APPLICATION
Application No • r $ r
Documented Construction Value: $ 1011 00.0 0
Job Address: 3 62 F k+(- - 1 P.I A flIriv e. Historic District: YesF]Nog
Parcel ID: IL ` I q - 31 - �-I CI, - 0 p o 0 - 0 Residential Commercial
Type of Work: New❑ Addition[_] Alteration✓ Repair Demo Change of Use Move
Description of Work: RE -ROOF
John Byrne Jr Permit Manager
Plan Review Contact Person: Title:
Phone:
4079220502 Fax: Email: john@masimoconstruction.com
,I Property Owner Information
Name �yQ-Im, A 5u,1, - Phone:
Street: `L ��C � � qU �� 1y Q., Resident of property? : Y�
City, State Zip: saw �-d irk `�
Contractor Information
Name Masimo Construction
Street:
16105 83 Place North
City, State Zip:
Loxahatchee FL 33470
Phone: 4079220502
Fax: N/A
State License No.: CCC1328033
Architect/Engineer Information
Name: Phone:
Street: Fax:
City, St, Zip: E-mail:
Bonding Company: Ah Mortgage Lender:
/V AJ /]A
Address: Address: TTT
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: 6th 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 constru ion nd nin"
Signature of Owner/Agent Date Sig afore of ontractor/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
.J O L6 2l4 K n� J 1_
Print Contractor/Age is amd� e
puma,
Pie(,, ANNETTE BLAND
Notary Public - State of Florida
Commission # GG 060623
My Comm. Expires Jan 16, 2018
Contractor/Agent isersona y wn to Me or
Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing❑ Gas❑ Roof ❑
Construction Type:
Total Sq Ft of Bldg:
Occupancy Use:
Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes ❑ No ❑
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
# of Heads
UTILITIES:
FIRE:
Flood Zone:
# of Stories;
Plumbing - # of Fixtures
Fire Alarm Permit: Yes ❑ No ❑
WASTE WATER:
1 �1
Revised: January 1, 2018 Permit Application
masimo Construction, Inc.
Masimo Construction, Inc.
Roofing Contract/Proposal
Address: 3715 Pembrook. Dr.
Orlando, FL 32810
Office: (407) 286-0067 Phone: (407) 922-0500
State -Certified Roofing Contractor - CCC1328033
State -Certified General Contractor - CGC1509548
Brad Pollack, Contractor
Insurance Co.:
Adjuster:
Claim #:
Phone:
Customer Name: I--Y_C�11�1d(1) Dnc) Date: '
Address: LG G1 I JI 'T I'd �(' City/State/Zip: 3 17
Home Phone: Cell: �3N 6 3M i4Hb Work Phone:
SPECIFICATIONS
A_`Remove roof to existing deck layers.
❑ ach additional layer $ /Sq. (100 Sq. Ft.)
Re -nail existin�de`ck to meet uplift codes.
❑ Install metal drip edge around perimeter of roof.
O'Install lead boots to pipes 11/2" 2" 3"
�KI stall Gooseneck vents 4" 10°
Apply Rhinq Guard (Synthetic) to wood deck.
X,pply Sq. Ft. of ME uSHIN LE /TILE/S AKES/FLAT
�tyle of roof to be ins led:
Color: n
Manufacturer of roofing system:
❑ Install ridge vent along peak of roof:
Addt'l.
OTHER PROPERTY CONDITIONS
Ice/Water Shield
Existing Water Damage
Existing Driveway Damage
Skylights:
Leaks:
❑ Interior Damage:
❑ Emergency Repair _
❑ Tapered Insulation
WORK INCLUDES:
✓ Remove trash from roof, gutters and yard.
✓ Protect landscaping where applicable.
✓ Roll yard with magnetic roller.
✓ Furnish permit
` 5-year warranty
.Yes No
.Yes No
.Yes No
Yes No
Yes No
Additional charges of $70 per sheet if decking replacement is needed which is only visible upon tear -off existing roofing materials.
WE PROPOSE
To furnish material and labor complete in accordance with specifications above for the sum of $
SPECIALINSTRUCTION
PAYMENT SCHEDULE
50% DOWN PAYMENT PRIOR TO ORDERING MATERIALS
PAYMENT IN FULL UPON COMPLETION
EARNEST DEPOSIT: ❑ $500.00 ❑ $1000.00 ❑ $
DOWN PAYMENT$
-
FINAL PAYM ENT $ S_76 t e h
TOTAL $ 0 a :3i,)6-®Q
ACCEPTANCE OF AGREEMENT
This agreement is subject to insurance company approval and does not obligate the homeowner or Masimo Construction, Inc., in any way unless it is approved
by the insurance company and accepted by Masimo Construction, Inc. By signing this agreement you authorize us to negotiate the repairs at a price agreeable to
the insurance company and Masimo Construction, Inc. at NO ADDITIONAL COST TO YOU EXCEPT FOR THE INSURANCE DEDUCTIBLE AND AS PROVIDED
ELSEWHERE IN THIS AGREEMENT. The final price agreed on between the Insurance company and Masimo Construction, Inc. shall become the final contract price.
THREE DAY RIGHT OF RESCISSION
THIS WRITTEN AGREEMENT HEREBY SERVES AS NOTICE THAT I MAY CANCEL THIS
AGREEMENTATANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAYAFTER THE DATE
OF THIS AGREEMENT.
Owner Signature �t .i�!49�e -
Date -1 2001Z Sales Rep. C
Accepted by Masimo Constf cti , Inc./Representative X
Insurance Carrier
Claim No.
Events beyond the control of Masimo Construction, Inc. may cause delays to the projected start date or estimated time of completion. Such delays do not constitute
abandonment and are not included in calculating time frames for payment or performance. THE TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGE
ARE A PART OF THIS AGREEMENT.
WHITE - HOMEOWNERS COPY YELLOW - SALESMAN'S COPY PINK - OFFICE COPY
Pro edy Record Card
Parcel: 32-19-31-516-0000-0530
Property Address: 362 FAIRFIELD DR SANFORD, FL 32771
Parcel Information
Parcel
32-19-31-516-0000-0530
Owner(s)
SCOTT, EVELYN D
SCOTT, ALFRED L
Property Address
362 FAIRFIELD DR SANFORD, FL 32771
Mailing
362 FAIRFIELS DR SANFORD, FL 32771
Subdivision Name
CELERY LAKES PHASE 2
Tax District
S1-SANFORD
DOR Use Code
01SINGLE FAMILY
Exemptions
00-HOMESTEAD(2007)
50
Legal Description
LOT 53���--._.._____�..
CELERY LAKES PHASE 2
PB 65 PGS 29 & 30
Taxes
50 50 50 1 50
Seminole County GIS
Value Summary
2018 Working
Values
2017 Certified
Values
Valuation Method
Cost/Market
Cost/Market
Number of Buildings
j 1
1
Depreciated Bldg Value
I $146,143
$132,098
Depreciated EXFT Value
$338
$350
Land Value (Market)
1$34,000
1 $30,000
Land Value Ag
Just/MarketValue`"
$180,481
$162,448
Portability Adj
Save Our Homes Adj
$86,581
$ ,603 _
Amendment 1 Adj
} $0
~^
Assessed Value
{ $99,900 1
$97,845
Tax Amount without SOH: $2,305.41
2017 Tax Bill Amount $1,075.26
Tax Estimator
Save Our Homes Savings: $1,230.15
Does NOT INCLUDE Non Ad Valorem Assessments
Taxing Authority
Assessment Value
Exempt Values
Taxable Value
County General Fund
.._......... _____.._ ._.__..__ ____ .. ,__..__
Schools
j $99 900
.._______.,_._,___ _.. _.___ _
$99,900
-
$50 000
_ .. .._..__. _
$25,000 s
$49,900
$74,900
City Sanford
$99,900
$50,000 1
$49,900
SJWM(Saint Johns Water Management)
{ $99,900
$50,000 1
$49,900
County Bonds
F $99,900
$50,000 j
$49,900
Sales
Description
Date
Book Page
Amount Qualified Vac/Imp
WARRANTY DEED
5/1/2006
06250 1718 $245,000 'Yes ! Improved
SPECIAL WARRANTY DEED
10/1/2005� —
ME i 1155_ j $230,900 Yes Improved T
Find CompealeSoles
Land
Method
Frontage — Depth
Units Units Price
Land Value
LOT
a 0.00 f 0.00
1 $34,000.00
$34,000
Building Information
# Description ( Year Built Fixtures Bed I Bath ( Base Area Total SF I Living SF I Ext Wall Adj Value I Repl Value I Appendages
Actual/Effective 1
I 1 1 SINGLE 12005i 71 1,874 1 2,290 1 1,874 1 CB/STUCCO 1 $146,143 1 $153,029���
�7 0 2,1
1111111 [fill 11111111111111111111 fill 1111 're'll
9
GRANT 11r11_11Y P SEITINOLE COUNTY
Permit Number: CLERK. OF CIRCUIT COURT & C�iiFTftl_1 L.1_.LR
Folio/Parcel Identification Number: --'—'— BK 9114 F'q 39"
Prepared by: John Byrne CLERK'S T 2013i i4313L
REC:ORDI�D 1-141/1.9 Q"1=t 01:03,ii_; F'11
i,ECORCIING FEES: $1.0.00 J�
RECORDED BY tst;1 l th
Return to: 3715 Pembrook Drive Orlando, FL 3281014
IIAV-
NOTICE OF COMMENCEMENT
State of Florida, County of
The undersigned hereby gives notice that improvement will be made to certain real propig
with Chapter 713, Florida Statutes, the following information is provided in this Notice of encemecnotrdance
1. Description of property (legal description of fjje property, and street address if available)
2. General description of
3. Owner information or Lessee Information If the Lessee contracted for the Improvement
Names Ik A [.. 11-
Interest in Property�nb�J!,..!
Name and address of fee simple titleholder (if different from Owner
4. Contractor
5. Surety (if applicable, a copy of the payment bond is
6. Lender
7. Persons within the Stat
be served as provided
Name
Telephone Number4079220500
Telephone Number
Amount of Bond $
Telephone Number
of Florida designated by Owner upon whom notices or other documents may
f §713.13(1)(a)7, Florida Statutes.
Telephone Number
8. In addition to himself or herself, Owner designates the following to receive a copy of the Lienor's
Notice as provided in §713.13(1)(b), Florida Statutes.
Telephone Number
9. Expiration date of notice of commencement (the expiration date may not be before the completion of
construction and final payment to the contractor, but will be 1 year from the 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 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.
Under penalty of perjury, I declare that I have read the foregoing notice of commencement and that the
facts stated in It are true to the best of my knowledge and belief.
S nature of or Lessee, or Owner's or Lessee's Authorized Offlcer/Director/Partner/ManagerGuorgj
Signatory's Title/Office
The foregoing instrument was acknowledged before me this day of 4 bla by_ �V�\. I a
as for Sc��y
monedyear nof person
of ority, a.g r, trustee, attorney in fact Name of party on behalf of whom instrument was executed
`.��� l
Signature of Notary Public -State of Florida
/ Print, type, or stem commissioned name of Notary Public
Personally Known OR Produced ID ✓ �pM'" Notary Public State of Florida
Type of ID Produced Beth E Fishei
My Commission GG 153047
MA, Expires 10/18/2021 Form Rev_i :September 26, 2011
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: y /
I hereby name and appoint: Ly �R�--vfV\-0—
an agent of: PA a,S! M a UAS � v'V C i k 0 n
(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 an a plication for work located at:
►� d �c,:J Q. SWA-Pt)c�
(Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name: e
State License Number:
Signature of License Holder:
STATE OF FLOA
COUNTY OF GM tn6�e
The foregoing instrument w acknowledged before me this day of
200 �B , by __P�C,-
who iskpersonally known
to me or ❑ who has produced
identification and who did (did not) take an oath.
Signature
as
(Notary Seal) _BC6'�' S A,
Print or type name„
ip Notary Public State of Florida
Beth E Fishel
v My Commission GG 153047
Notary Public - State of apd8 Expires 10/18/2021
Commission No. GG ��5301A 1
My Commission Expires: to - tip - Z,
(Rev. 08.12)
CITY OF
O� Building &Fire Prevention Division
RESIDENTIAL RE -ROOF POLICY &PROCEDURES
FIRE DEPARTMENT
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), CERTIFYIl�p FBC CODEC(JMPLIANCE BY PERSONAL INSPECTION.
CONTRACTOR (OR OwNER/BUILDER) SIGNATURE:
DATE: ��
PERMIT It `3 J
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
JOB ADDRESS: 3 _Iz�i 6l,-i.1- T L A � � e-,, - C
STRUCTURE TYPE: *SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: ] PLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY): Q�.�,'„lj O � & (J� E-�-Ki V\_ — - —
**PLEASE NOTE: ONLY
XOFF-RIDGE
100 SQUARE FEET okTAE EXISTING DECK IS PERMITTED'qb BE REPLACED**
ROOF VENTILATION: 0 RIDGE O SOFFIT OPOWERED VENT
SKYLIGHTS: O YES XNO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 ) 4:12 OR GREATER
OTURBINES
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
SHINGLE
�� DM V ��( �(
FL# 2 '�
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
OINSULATED
FL#
OTILE
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#
OMETAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
OINSULATED
FL#
O TILE
FL#
0 OTHER:
FL#
CITY OF
ORD
{ + Building & Fire Prevention Division
RESIDENTL4L RE-ROOFAFFIDAVIT
FIRE DEPARTMENT
RESIDENTIAL RE-RoOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT ADDRESS: 36 Z p6Lir i 1DC('✓e
S"Aorgl 31771
1 6 r'_/ ( 4 //1 V_ G k , 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 #: (G ( ,3 7 9 053
COMPANY / CONTRACTOR: M a �iyIw (on SAY %Nc T' h A
CONTRACTOR SIGNATURE:
(MUST BE SIGNED BY LICEI
OWNER/BUILDER)
A FINAL ROOF INSPECTION IS REQUIRED:
DATE: 1_2 1 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 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 this 22 day of 0. 20 17 by:
Who is'x Personally Known to me or has ❑ Produced (type of
identification)
Signature of Notary Public
State of Florida
Print/Type/Stamp Name
of Notary Public
as identification.
sp' Notary Public StatiNte of Florida
Beth E Fishel
yc
My Commission GG 153047
Expires 10/18/2021