HomeMy WebLinkAbout100 Kelly Cir 17-1595; ROOF426010
b CITY OF SANFORD
BUILDING & FIRE PREVENTION
t PERMIT APPLICATION
P
Application No: /
1110)
Documented Construction Value: $ 9,800
Job Address: 100 KELLY CIR SANFORD, FL 32773 Historic District: Yes No 0
Parcel ID: 12-20-30-511-0000-0600 Residential 0 Commercial
Type of Work: New Addition Alteration Repair El Demo Change of Use Move
Description of Work: Re -roof Owens Corning FL10674 Techwrap FL17194 22 SQ'S 7/12 PITCR
SUPREME ONYX BLACK 25 YEAR WARRANTY
Plan Review Contact Person: Rachel Holcomb Title: Manager
Phone: 407-278-7788 Fax: 800-337-3361 Email: permit@jasperinc.com
Property Owner Information
Name FRANCHESKA AMBERT Phone:
Street: 100 KELLY CIRCLE Resident of property?: YES
City, State Zip: SANFORD, FL 32773
Contractor Information
Name JASPER CONTRACTORS Phone: 407-278-7788
Street: 3203 S CONWAY ROAD SUITE 201 Fax: 800-337-3361
City, State Zip: ORLANDO, FL 32812 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. 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 than date: 51h Edition (2014) Florida !Building Code
Revised: June 30, 2015 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.
of Owner/Agent
Print Owner/Agent's Name
Date
Signature or Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of 1D
VMJ'& "—Jj_ 5/31/2017
Signature of Contractor/Agent Date
KARLA ALMODOVOAR
Print
A"/31/2017
Votary -State of Florida Date
SI<YLAR B AMiCRAUT
Commission 4 FF 12'1H90
tvlyCorrunission Cxt i89
June O1 , 2013
Contractor/Agent is Personally Known to Me or
Produced ID . X Type of ID DL
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Meclianical Plumbing[]
Construction Type: Occupancy Use:
Total Sq Ft of Bldg: Min. Occupancy Load:
Gas[] Roof
Flood Zone:
of Stories`
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING: UTILITIES:
ENGINEERING: FIRE:
COMMENTS:
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Permit Application
380 E. Colonial Dr. d
Orlando, Fl. 32$07 r J
3203 Co -way Rd., Ste.;201
Orlando, 32512 JAS407) 275-77e8 P ER'(,,
00) 337-3361 Fax Jo perRool:com.
induct ;r. nnc,or >
FL Contractor's License:
VISA
r-2m
CCC1329651 & CCC133.1153
Ox ner(s): ROOF REPLACEMENT CONTRAC_-
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ra
Account ManjageryJ I
Contact H:
Policy #: - P 0 c, ,- , , _1
Claim.#:
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Company: U
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IC
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. 1 make this assignment
and authorization in consideration of Jasper's- agreement ,to perform services; supply materials and otherwiseperform 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 scrvices rendered- 1n this regard. I waive my privacy rights.
If payment is made directly to the Owner%Agent/Imured(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 nay all insurance -deductibles. Owner's out-of-pocket expense" will not exceed the deductible amount,
as stated on,insurer's loss sheet (the"Loss Sheet"), UNLESS replacemendrepair of deteriorated decking is required by code. and/or' Owner requests optional
upgrades. Jasper CANNOT pay, waive, rebate, or promise to pay, waive :or rebate any or all of the insurance deductible applicable to the, insurance
claim for payment of work. In the event of a discrepancy, the deductible amount stated on the insurer's Loss Sheet 114verrule deductible amount
disclosed. Deductible: S 49 D 6 C) C _;MUST BE PAiD IN FULL, PLUS APPLICABLE SALES TAX (initial) MORTGAGE
AUTHORIZATION: 1, Owner/Mortgagor, grant authorizati for, Mortgage -Co. to speak with Jasper
on matters including but not limited to, the claim and draw status. F (initial) PAYMENT SCHEDULE: Owner agrees to pay
Jasper based on the following schedule: (i) Deposit in the amount of S, 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.ITEW, QTY; PRICE: TOTAL: S Replacement
Work and Price: Upon insurer's approval and subject to the Terms and Conditions herein, Jasper agrees to furnish all materials and provide
the labor necessary to perform the frill roof replacement which shall take place following Owner's insurance company's approval„ approximately within
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 funds from Owner's insurance company. FLORIDA
HOMEOWNERS' CONSTUCTION 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, CONTACTTHE 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
officer 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. ihoriz
e seerRepresentative7 'Date er Date Scanned
by CamScanner
U 11 911I I li! lll li IfIII 1 lI1:111111111111
GRANT 11ALOYY SEMINOLE COUNTY
THIS INSTRUMENT. PREPARED BY: :LER9 OF CIRCUIT COURT .tr GOIIF'TROLLER`
iL
V~`-P:. 5923 F's bS5 (1F'ss)'
Name: Jasper Contractors CLERK r.S T f01711S391i5
Address: 3203 S ConwaV Road Suite 201 RECORDED l]O/31/ 017 111•38- tail
Orlando FL 32812 RECORDING FEES $10-00
q 2 u 01 0 RECORDED BY tsmith
NOTICE OF COMMENCEMENT
Permit Number:
2 !1
Parcel ID Number
b w ice thimprovement will b to lccertain
7
The undersigned hereby g' real property, and in accordance with Chapter7i3', Florida Statutes, the
following information is provided in this Notice of Commencement.
1. DESCRIPTION OF
2. GENERAL DESCRIPTION OF IMPROVEMENT:
3. OWNER INFORMATION OR
Name and address:-F (A"
Interest in property: owner' -
Fee Simple Title Holder (if other than owner listed above) Name:
4. CONTRACTOR:
Address: 3203. Suite
Phone
5. SURETY (if applicable, a copy of the payment bond is attached): Name: _
Amount of Bond•.
Address:
S. 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.
Phone Number.
Name:
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 ARECONSIDEREDIMPROPERPAYMENTSUNDERCHAPTER, 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOURPAYINGTWICE' FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THEJOBSITEBEFORETHEFIRSTINSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEYBEFORECOMMENCINGWORKORRECOROI,NG YOUR NOTICE OF COMMENCEMENT:
SignatuFac erorLesse ,crOwnePscrLessees
Aulhodzed Otricet(Oirector,/PamedManager)
Prinl Name and Provide StgnaloVS 'Ve[Otfice)
n 3L./v t/Vw Vl
State of } VA — County of -
day of l : \ n , 20
The foregoing' instrument was; acknowledged before me this i
1
1 1111,nrr ,'. ..e--11vknnwn to me OR
by r ` t/ ., _ rL•.•(/m_e6.nn slatemE/nC
who has produced identification-pe of identification
s.,ov...+i.,,, erv.nn+..nm.nu-+.rec.,..roaswr..rl
SKYLAR-B AMI<RAUT ' yr l'4!
Commission It FF 1.27890
MY W)+`•xiiission Expires
June 01 2018
G:uti f.!nYli-L^YWMJ=NStnifl'MR9'•S.+r•TVi'h'W'G I++CJV+.M`7i
V
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 5/31/2017
I hereby name and appoint: Karla Almodovoar, Ana Chavez, Skylar Amkraut, Rachel Holcomb
an aeent of: Jasper contaao,-s
Na= or company)
to be.my lawfid attomey-in-fact to act for me to apply for, receipt for, sign for and do all things
nece$sary to this appointment for (check only one option):
Ca The specific permit and application for work located at:
176 Clear Lake Circle Sanford, FL
Stray Addrm)
Expiration Date for This Limited Power of Attorney: 1-1-19
License Holder Name: Donald Bouchard
State License Number. CrC1331153
Signature of License Holder. ;
STATE OF FLORIDA -1
COUNTY OF seroic
The foregoing instrument was acknowledged before me this 31 day of May ,
200 17 , by Donaid Boudwdwho is ,o personally known
to me or ® who has produced a as
identification and who did (did not) take an.oath.
L
I/
I ' I I — I -
Signature
S Amkraut
Notary Sea])
SKYLAR B AAAICRAUT0. 4q
o -
Cofmmssiotl 11 FF 127890
My Connission E:xpIres n
Q''
June 01. 2018
n
Rev. 0812 )
Print or type name
Notary Public - State of
Commission No.
My Commission Expires:
Scanned by CamScanner
City of Sanford
Building & Fire Prevention Division
1`-
PERMIT NO. 15915ISSUE DATE: 0&.!, •
CONTRACTOR:
JOB ADDRESS:
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
TO SCHEDULE AN INSPECTION:
Dial 407.792.6069 or 855.541.2112
Provide the items requested during the message
The type of inspection requested must be scheduled under the appropriate permit type
Follow the prompts
PLEASE NOTE: Inspections scheduled by 3:30 p.m. will be conducted the
next business day. If you experience difficulty, please call 407.688.5150
Monday - Thursday 7:30 am - 5:30 pm for assistance.
AUTOMATED INSPECTION SYSTEM CODES
Final Roof Inspection Code III
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
REVISED: 04-17 Inspection Line: 407.792.6069 or 855.541.2112
City of Sanford Building Divisionr•
Residential Re -Roof Ins ection Policy & ProceduresPY
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, Townhouses 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 thesespecificguidelines will result in an affidavit provided by a Florida Design Professional (
architect or engineer), certifying FBC code compliance by personal inspection. 5/
31/2017 CONTRACTOR
OR OWNERUILDER 'SIGNATURE: DATE: B
PERMIT #
City of Sanford Building.Division
Residential Re -Roof Scope of Work
JOB ADDRESS: 100 Kelly Circle Sanford, FL 32773
STRUCTURE TYPE: Q SINGLE FAMILY RESIDENCE/TOWNHOUSE Q MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: xQ REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE' -COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECII Y):
PLEASE NOTE' ONLY 100 SQUARE FEET OF THE EXISTING DECK IS PERiVIITTED TO BE REPLACED
ROOF VENTILATION: Q OFF -RIDGE Q RIDGE QSOFFIT QPOWERED VENT QTURBINES
SKYLIGHTS: OYES QNO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: 0 LESS THAN 212 Q 212.-4:12 0 4:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
Q SHINGLE Owens Corning FL# 10674
Q METAL FL#
O MODIFIED BITUMEN FL#
Q TORCH DOWN FL#
0INSULATED FL#
QTILE FL#
O OTHER: FL#
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IFAPPLICABLE**
ROOF SLOPE: O' LESS THAN 2:12 O 2:12 — 4:12 0 4:12 OR GREATER
TYPE.OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
0 SHINGLE FL#
Q METAL FL#
Q MODIFIED BITUMEN FL#
0 TORCH DOWN FL#
0INSULATED FL#
Q TILE FL#
Q:OTHER.. FL#
FIRE INSPECTIONS CITY OF SANFORD
407.562.2786 BUILDING & FIRE PREVENTION
BUILDING INSPECTIONS 300 N PARK AVE
855.541.2112 SANFORD FL 32771
DRIVEWAYS -SIDEWALK 407.688.5080
Page 2
Application Number . . . . 17-00001595 Date 5/31/17
Property Address . . . . . 100 KELLY CIR
Parcel Number . 12.20.30.511-0000-0600
Application description . . ROOFING APPLICATION
Subdivision Name . . . . .
Property Zoning . . . . . . MULTIPLE FAMILY
Permit . . . . . . RESIDENTIAL ROOFING PERMIT
Additional desc . .
Phone Access Code 987008
Permit pin number 987008
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
1000 111 BL03 FINAL ROOF _/_/
City of Sanford
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: "' ADDRESS: LD UM (A j 'z
ffijud 1 VA_?;TX6
I iA a/ ' g-- , 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 #:
COMPANY/
CONTRACT(
MUST BE SIGNED BY LICENSE HOLDER OR O WNER/BUILDER)
DATE: U
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 . /V t'A/t iyp \
Sworn to and Subscribed before me this day of 20 by:
Sa Who is Personally Known to me or hasJroduced (type of
id ificat' n) D - as identification. ((
Si-91natuie—o
Ear
ary Public
State of or(SEAL)
taut
Print/Type/Stamp Name
of Notary Public SKYLAR g AM PAUT
Commission it FF 127890
MV Commission Expires
June 01, 2018
S
D PERMIT #
3 City of Sanford Building Division
Residential Re -Roof Scope of Work
JOB ADDRESS: 100 Kelly Circle Sanford, FL 32773
STRUCTURE TYPE: O SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: Q REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECII•'Y):
PLEASE NOTE: ONLY 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED"
ROOF VENTILATION: XQ OFF -RIDGE O RIDGE OSOFFFr OPOWERED VENT OTURBm'ES
SKYLIGHTS: O YES ®NO IF 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
SHINGLE Owens Corning FL# 10674
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 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#
0INSULATED FL#
OBILE FL#
0 OTHER: FL#