HomeMy WebLinkAbout156 Crown Colony Way 17-1342; ROOFCITY OF SANFORD
BUILDING & FIRE :PREVENTION
PERMIT APPLICATION
Application No:
Documented Construction Vahte: ,S 10,000
Job Address: 156Crown Colony Way Sanford, FL 32771 Historic District: 'Yes No Q hal'
eCI ID:. 33-19-30-50S-0000•0380 Residential El CommercialEl Type
of Work New Addition AIteration Repair El ,Demo Change of UseO Move 0 Description
of Work: re -rent owens corning tl 10674 }echwrap 0 1719424SQ'ds OC'Oakridge Antique Silver Lifetime' warranty Plan
Review Contact Person: SkylarAmkra'ut Title PIIone:
407-278=7788 Fax: 800-337-336'1 Cmail: Permit@jasperinc.com Property
Owner Information Name
Tim 8 Robin Wood Phone: Street:
156 Crown Colony Way Resident ofproperty? : yes City, State
Zip: Sanford, FL 32771 Contractor Information
Name Jasper
Contractor. Phone: 407-
278-
7788 Street: 3203
S'Conway Rd Suite 20f Fax: 800-337-
3361 City, State
Zip: Orlando, FL 328,12 State license No.: CCC1329651' Arch itect/
En9ineer Information Name: Phone:
Street: Fax:
City, St"
Zip, E-mail: Bonding Company:
Address: Mortgage
Lender.
Address: WARNING
TO
OWNER: YOUR FAILURE TO RECORD A NOTICE OF:COMMENC1 MENT MAY RESULT' IN 'UUIi 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. l understand that a, separate permit must be secured for electrical work, plumbing, ,signs; wells, pools, furnaces, boilers,
heaters, tanks, and .tit• conditioners, ete. FBC 105.
3 Shall be inscribed wilb the date Ofapplication and the cade in effect as of that (site: 5't' Edition (2014) Flurida Building Code ItcviscdrJune`30,
2015 Pennit Application.
NOTICE: In, addition to the requirements of this pennit, there may be additional restrictions applicable to this property that may befoundinthepublicrecordsofthiscounty, and these maybe additional pennits-required from other govemmental entities such as water
management, districts, state agencies, or federal agcitcies.
Acceptance of permit is verification that will "notify the owner of the property of the requirements of Florida Lien Law,' rS 713.
The City of Sanford'requires pnyment,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 pcmitfecs when [lie permit is issued.
OVVNER'S.AFFIDAVIT: I certify that all of the foregoing information is -accurate and'`that all work ivill
be done in compliance with, all applicable iaNvs regulating construction and zoning.
Signature of 0n'ncrlAgcnr Daic
Print xvncr/Agcnt'sNarne,
signature ofNotnryStateofFlodda Date
Owner/Agent is PersonallyKnown to Me or Produced
ID' Type of ID Signature
of(ontinctor/Agent Date Contractor/
Agent is, ProducedlD
T; BELOW
IS FOR OFFICE USE ONLY omrnission
s EF 127890 My
Gommission Expires June
01, 2018 Knoxnl
to Me or 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 - #-oi'Amns Plumbing - # of Fixtures Fire
Sprinkler' Permit: Yes No # of I -leads Ire Alarm Permit,: Yes No APPROVALS:
ZONING:' UTILITIES: WASTE WATER: ENGINEERING:
COMMENTS:
FIRE:
BUILDING: Revised:
June 30.,2015 N n,it Application
LBUTER POWER OF ATTORNEY
Altamonte Springs, Casselberry, , Lake Mary, Longwood, ,Sanford,
Seminole County, winter Springs
Date:
herebynameand appoint: Skylar Arnkraut. Karla Almodovar, Rachel Holcomb, Ana -Chavez an
agent of, JaSW Contractor to
be my lawful attomcy4n-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: yj15&Crown Colony Way Sanford, FL 32771 Sbw
Ad&=) ExPiraiion
Date for This Limited Power of Attorney: 111120 118 LiccnscHolder'
Name: Michael Stephen State
License Number CCC1331153 Si-
ehawre of License Holder_ STATEOF
FLORIDA COUNTY
OF Sealinole the
foregoing instrument was acknowledged before me this AO 200_
j:j, by Donald Botntwd -i—
day of k4 Uj , who
is o personal.ly known to
me,or is who has produced Dt- as
identification
and wbo,did. (did not) k e an oa th C2 Signature
Notary
Sea]) Print
or type name 7I
I R 1 AM K RA U: Co
ji.n1,rF ;27890 M"
C Expires Jun
0120IS Rev.
08.12) Scanned
by CamScanner Notary
Public - State of Commission
No. MY
Commission Expires:- C -,j -
Jasper C untrut xs, luc.
53Su t?. Colonial Dr. Account Manager• o E
Orlando, FL 32907 Contact # 0
Insurance Com Information
4A7) 27C-77S8 R
I .
woj 337-3361 Fax Company_
Jaspci Roof.com JAS F' ER Policy #
11
tnf u1aa nc;comC.,Peraj Claim # Contractor'
s License # CCC1329651 Mort a e Co an Information a ®
Company G
G -Z AitmdLoan'Number Owner(
s): ROOF REPLACEIVIENT'CONTRACT Phon
U )
Address:
Cr`
o Alt
Phone: t City:
o
t^ State: Zi cal Shingle
Color. Email:
IS
r / L U c- /0 % — . J _ _ _. Roof RGV amount: Drip Edge Colors vues
not a tee to a for twt root re acemeu, .., ». • ••__ __ ___ Assignment
of Insttranee.Benefats for the Full Roof Replacement Only: I hereby assign any and all insurance rights, benefits and proceeds underanyapplicableinsurancepoliciestoJasperContractors, Ina ("Jasper"),'the scope of which shall be lirnited.to a Full Roof Replacement. I make
this assignment'. and authorization in consideration of Jasper's agreement to perform services, supply materials and otherwise perform its obligations
under this contract, including notrequiringe full eat at the time of service. I also hereby direct my.insurer(s) to release any and All
information requested by Jasper,, its, e representat , or its attorney for the direct purpose of obtaining actual 'benefits to be paid, by my instirer(
s) for services'rendered_ In this regard, I waive my privacy rights. if payment is made directly to the;Owner/Agent/lnsured(s); it shall he endorsed
overto Jasper immediately upon receipt. I agree that any portion of work;.deductibles, betterment "or additional work requested by the mdersigned,
noLcovered by insurance, must be paid by the undersigned on the day of installation. Deductible:
It_ is the Owner's responsibility to pay all Insurance Deductibles. Owner's -out-of-pocket expense will not exceed the deductible amount,
as stated on insurer's loss sheet, UNLESS -repiacemeuvrepair of deteriorated decking is required and/or Owner requests optional upgrades.
Jasper CANNOT pay, waive, rebate, or promise to pay, waive or rebate all or any part of the insurance deductible applicable in"
the insurance claim for payment of work. In the event of'a disaancy, the. deductible tuaotint stated -on the insurer's Sheet shall o —
ducts
Deducts
e G d abo ve. Deductible
S. MUST BE•PAID IN FULL, PLUS APPLICABLE SALES TAX ' " (initial) RTGAGE
AUTHORIZATION: L Owner/Mortgagor, grant authorizadon:for Mortgage Co. o speak with JJ
sper on matters including, but not limited to,.the claim and draw status. initial) A
YMENT SCHEDULE: Owner agrees to pay Jasper based on'the following pay scheduler (i), Deposit in the amount due pcini
sr, ' this contract; a the Contract. Price; less the Deposit and an applicable depreciation retained Owner's ' surer s lus legOePYPPPbyO> P grade
Costs, .due and payable :to Jasper upon completion of work being performed; and, (iii) the remaining Contract Price (equal to any glicable
depreciation and/or change orders) due. and payable to Jasper" upon completion of work performed In the event of a pending mapreebon, no more than 2% of Contract Price may be withheld until inspection has passed. Up,#
bnal: UPGRADE ITEM:.Q I Y: PRICE: $ TOTAL: S Replrcement
Work and, Price: Upon insurer's approval and subject to the terms and conditions herein, Jasper agrees to furnish all materials and {
F ovide the labor necessary to perform the full roof replacement which;sliall take place following Owner's insurance company's approval, ortmately
within 30 days, conditions permitting. e .%
Declaration of Intent: Owner acknowledges and agrees that, upon approval by insurance company fora full roof replacement, Jasper performtheroofreplacementuponreceiptoffundsfrom,Ownd's insurance company. l'
uNC'ELLATION: If Owner elects to terminate the services of Jasper, Owner may do swbefore midnight on the third business day 1>1fcrGontract is executed. Owner shall receive a full refund of alie:deposits.Owner may also rescind Contract before utidtiightton the 2b6shrimsdayafterthecontractisexecutedafternotificationfrominsurers) thatthe claim for payment on roof contract has been in
whole or in part. All written notices of cancellation, regardless of reason, shall be postmarked or delivered to Jasper's corporateoffice:, 1690 Roberts Blvd Still 112 Kennesaw, CA 30144. CANCELLATION EXCEPTIONS: The three (3) day right of tionDOESNOTAPPI:Y to contracts -for emergency home.repairs as time is of the essence. er,
have read and understand all statements, terms and conditions of the "Roof Replacement Contract" and agree that an ore
acceptable and.satisfactory.. I further understand that this contract'comtitptes the entire.agreement between the parties and ny
her changes or alterations to this contract must be made in writing and agreed upon by both parties. Each party eatsaridrrantstotheotherthatithasthefrillpowerandauthoritytoether}'dto tte contract and th it is binding and bleDUacSlthItsterrms. rD.
CONDITIONS: Acceptance of Terms: I, Owner, hereby agree to retain las for a full roof replacement on the terms and ated
herein. 1 further agree to provide Jasper with the Scope of Loss Report gene led by my insurer and authorize and grant full property
for the purpose.of staging and.completing all agreed upon work. Supplemental Claims: Jasper reserves the right to file a claim
with Owner's insurance in the event that the estimate is incorrect and/or additional damage is discovered aller Scanned
by CaniScanner
THIS INSTRUMENT PREPARED Y:
Name: Jasper Contractors CA YVIodova
Address: 3' O nway oa uitp ZU1
Orinnrin, Fi .12812
NOTICE OF COMMENCEMENT
Permit Number:
Parcel ID Number: ; " i .5 ="" ai)U
III tl ll`11 111f I f1 11111f1GRANTMALOY, "SENINOLE COUNTYC}_FRf, OF ,CIRCUIT COIAT , C-bPIPTROLLERP}," 89/17 F3 475 (1'F`*s;' CLERY'S T 2"017044-03RECORDEDt1-VC15/21117 3:19 4b }=11Rit:ORDI:NG FEES jj171 ClRECORDEDBYrdtemp-
The undersigned hereby gives notice that improvement will be made to certain real properly, and in accordance with Chapter 713, Florida Statutes, the.
following information is provided in this Notice of Commencerent.
1. DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available)
2. GENERAL DESCRIPTION OF IMPROVEMENT:
R >- UDf
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT;
Name -and address: --\, lYY1 VVQQtJ ty',)U (.1(-(,.i/Vr} U 0.1Ill' 1}T(,. AAI( _:Z44111)Y(a L L -)4111
Interest in property: nwnar
Fee Simple Title Holder (if other than owner listed above) Name:
Address:
d: CONTRACTOR:Name: Jasper Contractors Phone Number. 407-278-7788
Address: 3203 $ Conway Road Suite 201 Orlando, FL 32812
5., SURETY (if applicable, a -copy of the payment bond is attached): Name: _
Address: Amount of Bond:
6. LENDER: Names Phone Number.
Address:—
7. Persons within the State of Florida Designated by Owner upon whom notice or other documents may.
713.13(1)(a)7., Florida Statutes.
Name: Phone Numbei:
8. in addition, Owner designates of
to receive a copy of the Lienoft 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 differentdate 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 L 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.
Z ,V
Print oand Provide 5tgnatoysTiUe/OfGeo). State
of County of The
foregoing instrument was acknowledged before me this Z' day of G1 QV 1 I , 20 UUC`
by \ l i/V1 N Who is personally known to me O OR Name
of person making statement who
has produced identification4l,type of identification produced: L- _ S-
aR•" 6 AMKRAUT 0111111,mission
it FF 127890 CommyCommissionExpiresJune
01, 2018 10
City of Sanford
Building & Fire Prevention Division
Re -Roof Permit Card
PERMIT NO. ,3 / VA ISSUE DATE: AAwo I os J%7
CONTRACTOR:
JOB ADDRESS: 'T &'oum D Vim•/
TYPE OF WORK: -Re, 2mr
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
F = Di.
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
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) SIGNATURE: ` DATE:.
PERMIT #
City of Sanford Building Division
Residential Re -Roof Scope of Work
JOB AInDRESS' 156 Crown Colony Way Sanford, FL 32771
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._ ONLY 100 SQUARE FEET OF THE EXISTING DECK IS 1ERd1ITTED TO EE REPLACED *
ROOF VENTILATION: (DOFF -RIDGE O RIDGE OSOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: O YES O NO IF YES PLEASE PROVIDE FLORIDA PRODUCT APPROVAL#:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 02:12 — 4:12 x0 4:12 OR GREATER
TYPE OF.ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
Q SHINGLE Owens Corning FL#
O METAL FL#
0 MODIFIED BITUMEN FL#
0 TORCH DOWN FL#
0 INSULATED FL#
O TILE FL#
O OTHER: FL#
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IFAPPLICABLE**
ROOF SLOPE: O LESS THAN 2:1.2 0 2:12 — 4:12 0 4:1.2 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
0 SHINGLE FL#
0 METAL FL#
O MODIFIED BITUMEN FL#
0 TORCH DOWN FL#
0INSULATED FL#
0 TILE FL#
O OTHER: FL#
FIRE INSPECTIONS CITY OF SANFORD
407.562.2786 BUILDING & FIRE PREVENTION
BUILDING INSPECTIONS 300 N PARI: AVE
855.541.2112 SANFORD FL 32771
DRIVEWAYS -SIDEWALK 407.688.5080
Page 2
Application Number . . . . . 17-00001342 Date 5/10/17
Property Address . . . . . . 156 CROWN COLONY WAY
Parcel Number . . . . . . . . 33.19.30.5QS-0000-0380
Application description . . . ROOFING APPLICATION
Subdivision Name . . . . . .
Property Zoning . . . . . . . SINGLE FAMILY
Permit . . . RESIDENTIAL ROOFING PERMIT
Additional desc . .
Phone Access Code 983916
Permit pin number 983916
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
1000 1.11 BL03 FINAL ROOF / /
City of Sanford
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL
w{
ROOF COVERINGSINGS
p
PERMIT ##: ' I ` I ADDRESS: )'Su t g")UUY I coW, (or ( I V /k'_'l
I \ A j ( N ( 0'--U( .( \J W T_ , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROO ING 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 WrrH THE HURRICANE RETROFIT
MANUAL REQUIREMENTS (BASED ON F.S. CHAPTER 553.844).
LICENSE M (7 C. i ( a:a !a LQ \ 1
COMPANY / CONTRACTOR: CA, /) n r k '
CONTRACTOR SIGNATURE:
1
G'sl/ DATE: ( 1
MUST BE SIGNED BY LICENSE HOLDER OR OWNER/BUILDER)
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 NAZI. 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 P D day of _ 20 n by:
Who is Personally Known to me or has kProduced (type of
identification) - Z-- as identification.
Signature of Notary#ublic
State of FloridaKy Ag/iKRAU7 7890o*
VUBs Commission 1. FF L fires
RIM «_
My Commission E' P Print/
Type =` June 01 , 2018 of
Notary Public
q V 9I C/
I Altamonte
Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole
County, Winter Springs Date:
I
hereby name and appoint: Scott Meixsell, James Allen, Michael Watts & Jacob Horst, Ricardo Prito, Paul Padgett an
agent of: Jasper Contractors 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): 0
The specific permit and application for work located at: ^ _ 8 Street
Address) Expiration
Date for This Limited Power of Attorney: 1/1t2018 License
Holder Name: Michael Stephen State
License Number: CCC1329651 Signature
of License Holder: STATE
OF FLORIDA COUNTY
OF The
foregoing instrument was acknowledged before me this day of I 20017 ,
by Michael Stephen who is o nersonaltv kdown to
me or o who has produced DL as identification
and who did (did not) take an oath. Signature
Notary
Seal) $jV* A>u SKYtAR
3 ANIKR.I,UT ! Con1nliss+
on 1i FF 12-1890 a
My Commissmitjune i':kpirr:s 01
20 I s Rev.
08.12) Print
or type name Notary
Public - State of F --- Commission
No. 1 t'1 g-- ) U My
Commission Expires:( o 1 I - r