HomeMy WebLinkAbout158 Kelly Cir 17-1339; ROOF425889
CITY OF SANFORD
BUILDING,& FIRE PREVENTION
PERMIT APPLICATION
Application No:
Documented Construction Value: $ 8.300
Job Address: 168 Kelly Circle Sa,niord, FL 32773 Historic District: Yes nNo
Pakeell r1l): 12- , 2040-511-0000-0310 Residential 0 Commercial,F
Type of Work: NewEl Addition,E] Alteration E] Repair El Demo Change of "Use,[-] Moye,F1 Description
of Work: re -roof owiens corning 1`110674 techwrap 0 1
17
1
194
23, sq's Supreme Antique Silver 26 yr warranty Plan
1Review Contact Person: SkylarAmki-aut Title: Phone:
407-278-7788 Fax. 80()-337 3361 Email: perrnitP—jasperinc,corn Prbp6fty
Owner Information Name
MC INROE-RAQUEL M Phone: Street:
158 KELLY CIR Resident of property? yes City,
State Zip: 'SANFORD, FL .32773 Contractor
Information Name
Jasper Contractors Phone: 407-278-7788 Street:
3203 S Canw py Road Suite ,201 Flax: 800-337?8361 City,
State Zip:Orlando, FL 32812, State License'No.: CCC11329651 Name:
Street:
City;
St, Zip:' - Bonding
Company: Address-, —
Arch,
ltectlEngineler Information Phone:
Fax:
E-
mail,: Mortgage
Lender: Address:
WARNING
TO OWNER: YOUR -FAILUREITORECORD A NOTICE OF COMMENCEMENT MAY 'M4 ULT,INy0-UR PAYINGTWICEFORIMPROVEMENTS; TO YOUR PROPERTY, A NOTICE OF COMMENCEMENT MUST BE RECORDED
AND POSTED ON THE JOB SITE BEFORE, THE FIRST INS PECT[ON. IF YOU INT END 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, ivork,
willb do
the work and installations as indicated, I certify that commenced
prior to the issuance of a permit and I
that
all no
work or installation has c
peribrmed to meet standards of all laws f6gulating,construction inthisjurisdiction. I understand'that a separate permit must, be sceured,for, electrical work, plumbing, 1signs,_
wells, pools, furnaces, boilers, heaters, tanks, and.air cionditioners, etc. FBC
10-51!3Sball, be inscribed with the date of application and the code,in,effeetesofthat date: 511 Edition (2014)Florldi'Duilding Code Revised:
June 30,2015 Pemit Application
XO-TICF; In addition to the requirements of this permit, there may be, additional restrictions applicable to this property that may be
infoundinthepublicrecordsofthiscounty, and there maybe additional permits required from othe
I
r,govem mental entities such as watermanagementdistricts,
I
state agencies, or federal agencies.
Acceptance of permit is verifidatiion 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 requiredinordertocalculateaplanreviewchargeandwillbeconsideredtheestimatedconstructionValueofthejob, at the time of su'binittail. Theactual construction' V41ud will be figured based on the current WC Valuation Table in e ffcct at the'time the permit" is issued, in acpbrdance,with local ordinance.. Should calculated charges figured off the executed co credit
will be applied to your permit fees when I
the
permit is issuod. contract exceed the'ablual construction value, OWNER'
S —AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work grill bedoneincompliance, with all applicAble'laws regulating construction, and z1om' 5-
9 l7 SiguatumdfOwnerlAgentDataaturc;fCDEtat,/A— I Date TnAt
uwacriAgmt's Name SiO3tuC
Ot NPWY-Statc Of -Florida Date Chvner/Agentlis,—
PersonallyKn6wirt to Ma or Produced ID.
Type of 1b, Uontractor/Agent
is _'Personally Known to Me or Produced ID '
X I Type
of
ID DL BELOW IS
FOR OFFICE USE ONLY Permits Required:
BuildingF] ElectricalE] Metihahical[] Plurilbing[] Gas,E] Roof F1 Construction Type.-,
OccupaoCY Use: Flood Zone: , Total Sq
Ift of Bldg: Nn. Occupiancy'Load: # of Stories: New Construction:
Electric - W of Amps, Plumbing - # of Fixtures Fire,Sp,
rinkler Permit: Yes El No El # of Heads Fire Alarm" Permit: Yes n NoF1 APPROVALS: ZONING:
UTILITMS: WASTE WATER: ENGINEERING: FIRE:
13UILDING:' COAIMENTS-, Revised:
June
30,2015 Pcnnit Application
Altamonte Springs$ Casselberry, Lake Lary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 5-9-17
I hereby name and appoint: Skylar Amkraut, Karla Almodovar, Rachel Holcomb, Ana Chavez
an agent Of. Jasper Contractors
Nome orCompany)
to be my lawful attorney-in-factto 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: 4V 158 Kelly Circle Sanford, rL
Sln:ct
Expiration Date for This Limited Power of Attorney: 1/1/2018
License Holder Name: Michael" Stephen
State License Number: CCC1329651
Signature of License Holder: a A '
STATE OF FLORIDA
COUNTY OF Seminole
The foregoing instrument was acknowledged before the this_ a day of May ,
20017 , by Michael Stephen who is o personally knowntomeora'who has produced DL as
identification and who did (did not) t ke oath.
Signal
Notary Seal)
SKYLAR B AM:
Expires
AUT
Commission tl FF7890
My Coi+imission
June 01, 28
Rcv. 08.12)
31S
Print dr type name
Notary Public - State'of FL
Commission No. 127890
My Commission Expires: 6-1-18
1 1 .it
e AUtlt' i ianA
rin{acrinc k:e>4i
VJu
re
AceucuatM ager`
Pfilraclor's I-iceacc r CC0329651
Owners) `------------- ROOT I LPL, CENIE.'N'1'CONFRAC F
AILY_C+ t
Email— t
State: Zi code:
T) -7
Roof RCV amount-
iorteace+Companv informati
Company
Loan Number C /Lf p
Phon
Alt Phone
Sn gle Color:
8,300 Drip Edge olor:
l
1ssi."• 'insurance Com anv oes nut a reek) pax for a full roof replacement this contract shall be null and void. hnment of Insurance Benefits for the Tull Roof Replacement Only: I hereby assign any and all insurance rights, benefits and proceedsunderanyapplicableinsurancemakethin , : policies to Jasper Contractors, Inc.. ("Jasper" ), the scope of which shall be limited to a Full Roof Replacement. I1
nder this and authorization in consideration of Jasper's agreement to perform services, supply materials and otherwise perform itsobligationstinderthiscontract, includingnot requiring full payment at the time of service. I also hereby direct my insurers to release an aallinformationrequestedb • p` y )
yve. or Itsinsurers) for services rendered. In this regard, I`wtwaive my privacy rights,
orney er the direct
lf payment is madee of
directly totheOwner1ing actualAe et/Insured( )fits
to be m endorsed
over to Jasper iminediately upon receipt. I agree that any portion of work, deductibles, betterment or additional work reques undersigned, not covered by insurance, must be paid by the undersigned on the day of installation. Deductible: It is the U"ner's resooncibility to pay all lnsuranee Deductibles. Owrier's out-of-pocket expense will not exceed the deductible amount, as stated tin uisureCs loss sheet, UNLESS replacetnenvrepair of deteriorated decking is required and,1or Owner requests opti upgrades. Jasper CANNOT Pico, waive, rebate, or promise to pay, waive or rebate all or an)' part of the insurance deductible appli. totheinsuranceclaimforpaymentofwork. in. the event of a discrepancy, the deductible amount stated on the insurer's Loss Shee overruleDeductilelistedabove. Deductible: $ _ •
J MUST
BE PAID IN, FULL, PLUS APPLICABLE SALES TAX MORTGAGEA L. LITHOATiO\: i, Owner/Mortgagor, grant authorization for init Jasper
on matters including, but not limited to, the claim and draw status. - - - ---- - Mortgage€' .to speak with PAYMENT
SCHEDULE. Chvner agrees to pay Jasper based on the following pay schcdnlc: (a) Deposit ill the cunour, ,I S/ (initial)
de
uponsigningthiscontract; (it) the Contract Price, less the Deposit and any applicable depreciation retained by Owner's nt surer(s), plus UpgradeCosts, due and payable to Jasper upon completion of work being performed and, (iii) the remaining Contract Price (equal to any applicabledepreciationand/or change orders) due and payable to Jasper upon completion of work perfonned_ In the event of,a pending inspection, no more than 2% of Contract Pricemay be withheld until inspection has passed Optional: UPGRADEITEM _ OT PRICE: $ Replacement Work
and Price: Upon insurer's —approval tile TOTAL. $ pproval
and
subject to t is terms anti conditions 1 erein, Jasper apices to furnish all materials and providethelabornee-essary to perform the lull roof replacement vvliich shall take place f6llo«ing Ual- Ileinsurance company'sapptsw it approximately within 30 days, conditions permitting. Owner's Declaration of
Intent: Owner acknowledges and agrees that, upon app oval Iiy instuanee con;iha,y ii)r a full roof re-lilaceu; r,. },, 7. shall perform the roofreplacementuponreceiptoffitndsfromOwner's incur, ri e coniparly, CANCELLATION: If Owner elects
to terminate the services of Jasper, O4Nner may do so before midnight on the third bu incss day after Contract is executed. Owner shall receive a full refund of all deposits, Owner inav also rescind Contract before niidill on the third business day afterthecontractisexecutedafternotificationfrominsurer(s) that the claim for payment on roof contract has been denied, in whole orinpart. All written notices of cancellation, regardless of reason, shall be ;yostniarked ot• delivered to Jasper's corporate office: 1690 RobertsBlvdSuit112Kennesaw, GA 30144. CNNCELLNTION EXCF,P'FIONS: The three (3) day right of cancellation DOES NOT APPLYtocontractsforemergencyhomerepairsitstinieisoftheessence. 1, Owncr, have read
and understand all statemcnts, terms and conditions of the "Roof Replacement. Contract" and agree that r,ll details are acceptable and
satisfactory. I further understand that this contract constitutes the entire agreement be(vtccn the parties and that any further changes
or alterations to this contract must be made in writing; and agreed upon by both parties. Each "part', represents and warrants totheotherthatithasthefullpowerandauthoritytoenterintothecontractandthatitisbindingant; enforceable in aecordupce withitsterms. i.ut leT CpreS(
Rlat15' / ate ~— 1 w71ir l) it — — iRMS CONDITIONS:
Acceptance of
Terms; 1, Owner, hereby agree to retain Jasper for a bill roof replacement on the term and conditions stated erein. I
further agrecao provide Jasper with the Scope of Loss Report generated by my insurer and authorize and gr,int access to t,rc
prraPcrty for the purpose of staging arid completing all agreed tipon work. Supplemental Claims: Jasper reserves the right iv tilt a si.rliplemcntal e1,uiut
with (/toner's insurance in the event that the estimate is incorrect and/or additional damage is discovered a Scanned by CarnScanner
THIS INSTRUMENT PREPARED B
Name: Jasper Contractors 1`1 IUCII'
Address- 3203 o nway Road uite
Orlando Ff. 32819
NOTICE OF COMMENCEMENT
IA15'61M
Permit Number: /
y
Parcel ID Number: ` - NOD - ' D
GRA14T 11ALOYr SEMINOLE COUNTY
CLERK OF CIRCUIT COURT & COMPTROLLER
eK 8907 Pg 474 (legs)
CLERK'S T 2017044673
RECORDED 05/95/-017 03.19:46 P11
RECORDING FEES $10.00
RECORDED BY rdtema
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the
following information is provided in (his Notice of Commencement.
1. DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available)
2.
interest in property. nwnpr
Fee Simple Title Holder (if other than owner listed above) Name:
4. CONTRACTOR:
Address: 321 Road Suite
5. SURETY (If applicable, a copy of the payment bond is attached):
Phone Number. 407-278-7788
Address: Amount of Bond
6. LENDER: Name: Phone Number.
7. Persons within the State of Florida Designated by Owner upon whom notice or other documents maybe sezygq-Rfjp[q&pd bVjy ecfan L Y hw
3.1e 1 a 7.; Florida Statutes.
Phone Number: All
Ph OF T i i E CI ,,-Uti COURNamTOO
Address:
SEINOl UNTO; i tDA f$ r R 8.
Inaddition, Owner designates of v _ ,.PUiY
CLEfRK to
receive a copy of the Liendes Notice as provided in Section 713.13(1)(b), Florida Statutes. Phone number: I 1 9.
Expiralion Date of Notice of Commencement (The expiration, is, 1 year from date of recording unless a different date is specified) MAYI WARNING
70 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. Stgnature
atO mcr orLassco, or owners or les3eo's (Print Namo and Provido Signatorys Tille[Office) Authorized:Otfcer/
Director/Par(ner/Monager) ` p State
ofC1
County of 1 11 The foregoing instrument
was acknowledged' before me this 2 day of DIr t l 20 by X0, l
DD-jnV0 li Who is personally known to me D OR Name of person
making sralement Who has produced
identification type of identification produced: a*%; SKYLAR B
AMKRAUT R._ Czt.rp
mtt ission FF 127890, vMy Commission Expires June
01, 2016 Notary
Signature t.
City of Sanford
Building & Fire Prevention Division
Re -Roof Permit Card
PERMIT NO. 110-0 1.1 ? ISSUE DATE:0—So ® 0 i ® o
M 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 I I I
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
425889
PERMIT #
City of Sanford Building Division
Residential Re -Roof Scope of Work
JOB ADDRESS: 158 Kelly Circle Sanford, FL
STRUCTURE TYPE: Q SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: O REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF
DECK TYPE (PLEASE SPECIFY:
PLEASE NOTE: ONL Y 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED"
ROOF VENTILATION: Q OFF -RIDGE O RIDGE O SOFFIT OPOWERED VENT
SKYLIGHTS: O YES O NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 — 4:12 O 4:12 OR GREATER
O TURBINES
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
SHINGLE Owens Corning FL# 10674
O METAL FL#
O MODIFIED BITUMEN FL#
O TORCH DOWN FL#
O INSULATED 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#
O TORCH DOWN FL#
O INSULATED FL#
O TILE FL#
0 OTHER: FL#
City of Sanford Building Division
Residential Re -Roof Inspection Policy & Procedures
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.
Rome, 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 'Instructioils
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 niter)
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 .FIlorida Design
Professional (architect or engineer), certifying F C code compliance by personal inspection.
CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: DATE: 5-9-17
FIRE INSPECTIONS CITY OF SANFORD
407.562.2786 BUILDING & FIRE PREVENTION
BUILDING INSPECTIONS 3-00 N PARK AVE
855.541.2112 SANFORD FL 32771
DRIVEWAYS -SIDEWALK 407.688.5080
Page 2
Application Number . . . . . 17-00001339 Date 5/09/17
Property Address . . . . . . 158 KELLY CIR
Parcel Number . . . . . . . . 12.20.30.511-0000-0310
Application description . . . ROOFING APPLICATION
Subdivision Name . . . . . .
Property Zoning . . . . . . . MULTIPLE FAMILY
Permit . . . . . . RESIDENTIAL ROOFING PERMIT
Additional desc . .
Phone Access Code 983817
Permit pin number 983817
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
1000 111 BL03 FINAL ROOF / /
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, 'Minter Springs
Date: 51 , 5
I hereby name and appoint: Scott Meixsell, James Allen, Michael Watts & Jacob Horst
an agent of. Jasper Contractors
Name ol• 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:
J (Street Address)
Expiration Date for This Limited Power of Attorney: 1/112018
License Holder Name: Michael Stephen
State. License Number: CCC1329651
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF & ML P,
The foregoing instrument was acknowledged before me this _5day of di -A A,
20017 , by Michael Stephen who is o person own
to me or o who has produced DL as
identification and who did (did not) tatake an oat.
Notary Sea])
SKYLAR MKRAUT
Commission # FF 127890
f pr MY Commission Expires
OF "I" June 01 , 2018
Rcv. 08.12)
Si
Amlaaut
Print or type name
Notary Public - State of
Commission No. % L? cf-
My Commission Expires: C9
F City of Sanford
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: 1 1 o) I ADDRESS: ' j V,— ,
Say -if 0 -6 I E L
I , 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 #: C_ C'C_ \ 32C-kc6
COMPANY / CONTRACTOR: _c xr C U-y-vtYCLC_1 CJ J
CONTRACTOR SIGNATURE:
MUST BE SIGNED BY LICENSE HOLDER OR OWNER/BUILDER)
A FINAL ROOF INSPECTION IS REQUIRED:
DATE: 5115 1
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 t fW A0k-'
Sworn to and Subscribed before me this _ l day of _&M 20 1_ by:
Who is Personally Known to me or has oroduced (type of
identification) as identification.
otary Pu
State of Fl Wda
Skylar Amkraut
Print/Type/Stamp Name
of Notary Public
SKYLAR '$ AMI<RAUT
Commission 0 FF 127890
o: My Commission Expires
f°f.°".•' June 01 , 2018