HomeMy WebLinkAbout120 Borada Rd; 17-2122; ROOFCITY OF SANFORD
BUILDING & FIRE PREVENTION
fa y i JUL 1 d17 PERMIT APPLICATION
ApVlication No: 2-1 2Z
BY. .
Documented Construction Value: $ ` 13.60
Job Address: 120 Zo2A DA 12). SA&FO(Lp 1=L 32-4-43 Historic District: Yes No D
Parcel ID: IV' 3G> - 5 F%2 — oow ._ \\yy Residential011"Commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of Work: 'OF - 2aoe A iAAL r Sh-aQ G La 3'Z Vi
o Plan Review Contact Person:
Phone: Fax: Email:
Property Owner Information
Title:
Namey AN 1 T (L3A , } Phone: 10l -7 6 3 ' » LA 2 Street:
Qu E o-R A,tJA `120A.0 Resident of property? : o . . City,
State Zip: FL 3 z-:3 -3 Contractor
Information Name
GQE LG -(Sc)yTc" Phone: LAU-i - Zck - iS Street: <
036 D4. ? t-iii.l TPS 6Ly1 Fax: Li0'-t - Z4i3 - 1-1i- 2"L City,
State Zip: _GQLAN DC) _ 1 328111 State License No.: _PC C 13 2 $ 3 S $ Architect/
Engineer Information Name:
Street:
City,
St, Zip: Bonding
Company: Address:
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. 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: 5a' 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 befoundinthepublicrecordsofthiscounty, and there may be additional permits required from other governmental entities such as watermanagementdistricts, 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 requiredinordertocalculateaplanreviewchargeandwillbeconsideredtheestimatedconstructionvalueofthejobatthetimeofsubmittal.
The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, inaccordancewithlocalordinance. 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 willbedoneincompliawithallapplicablelawsregulatingconstructionandzoning.
0--U, q (-a
si tureofOwner/Agent
L +
Date
OCRt 'A
Wnt Owner/Agent's Name
Agnat.re of Not te oof INflidgna
a
Date _ iture of Notary -State of Florida A.- epRr
oue Notary Public Stets of Florida Helen
M Williams State
of Flo My
Commmion GG 008278 NExpiresove/2020 Ow
nal y nown to Me or Produced
ID Type of ID 'G If) L_ BELOW
IS FOR OFFICE USE ONLY Permits
Required: Building Electrical Mechanical Plumbing Gas Roof Construction
Type: iv
7.,1-Z -)7' o
t fr Signatureactor/Agent Date Total
Sq Ft of Bldg: 2Er-
ls GOV I c4i Print
Contractor/Agent's Name rida
Helen
M Williams Con
v
Notary Public My
Commrasion GG 0p8278 ExpirosOtiM6/
2020 Personally
Known to Me or Produced
ID Type of ID Occupancy
Use: Flood Zone: Min.
Occupancy ]Load: # of Stories: New
Construction: Electric - # of Amps Fire
Sprinkler Permit: Yes No APPROVALS:
ZONING: ENGINEERING:
COMMENTS:
Plumbing - #
of Fixtures of
Heads Fire Alarm Permit: Yes No UTILITIES:
WASTE WATER: FIRE:
BUILDING: Revised:
June 30, 2015 Permit
Application
SCPA Parcel View: 10-20-30-5FR-0000-1100 Page 1 of 2
C AdJotm3m,CFA
Parcel Information
Property Record Card
Parcel: 10-20-30-5FR-0000-1100
Owner: PUTERBAUGH JAN D & PUTERBAUGH KELLY
Property Address: 120 BORADA RD SANFORD, FL 32773
Parcel 10-20-30-5FR-0000-1100
Owner PUTERBAUGH JAN D & PUTERBAUGH KELLY
Property Address 120 BORADA RD SANFORD, FL 32773
Mailing 120 BORADA RD SANFORD, FL 32773-5543
Subdivision Name HIDDEN LAKE PH 2 UNIT 2
Tax District S1-SANFORD
DOR Use Code 01-SINGLE FAMILY
Exemptions 00-HOMESTEAD(2000)
i
AAj A467W
1 -
t L LP
CP
vQ 0 2blvi
e.
CIO, CQ Wr ,0 r
Value Summary
2017 Working 2016 Certified
Values Values
Valuation Method Cost/Market Cost/Market
Number of Buildings
m
1 1 1
Depreciated Bldg Value 123,437 107,975
Depreciated EXFT Value 600 600
Land Value (Market) 25,000 21,000
Land Value Ag
Just/Market Value" 149,037 129,575
Portability Adj
Save Our Homes Adj 51,793 34,331
Amendment 1 Ad/ s
P&G Adj 0 0
Assessed Value 97,244
Tax Amount without SOH: $1,684.00
2016 Tax Bill Amount $996.00
Tax Estimator
Save Our Homes Savings: $688.00
Does NOT INCLUDE Non Ad Valorem Assessments
Legal Description
LOT 110
HIDDEN LAKE PH 2 UNIT 2
PB 25 PGS 62 & 63
Taxes
Taxing Authority Assessment Value Exempt Values Taxable Value
County Bonds, 97,244 55 000 [ $42,244
SJWM(Saint Johns Water Management) 97,244 i 55,000 [ $42,244
Schools
W_.. .
97,244 30,000 $67 244
City Sanford 97,244 55,000 $42,244
County General Fund 97,244 55,000 3 $42,244
Sales
Description Date Book Page Amount Qualified Vac/Imp
WARRANTY DEED 10/1/2001 04247 i 0050 100 No Improved
WARRANTY DEED
WARRANTY DEED
1/1/1999
3/1/1991
03584
02276
0658
0756
1 89 900 Yes Improved
69 500 . No Improved
CERTIFICATE OF TITLE 02216 1 0886 53 700 No Improved
WARRANTY DEED--- - 11/1/1982
W -
01425 0036 52,400 i Yes Improved
Find Comparable Sales)
Land
Depth Un s Unds Price and Value
Method Frontage
0.00 0 1 i 25,000 00 $25,000
e Building Information
Is Bed/Bath count incorrect? Click Here. _
s-
Year Built. -- nFiturDescriptionxesBedBathBaseAreaTotalSFLivingSFExtWallAdjValueReplVae
Actual/Effective
http://parceldetail.scpafl.org/ParcelDetailInfo.aspx?PID=102O3O5FROOOO11OO 7/13/2017
SCPA Parcel View: 10-20-30-5FR-0000-1100 Page 2 of 2
1 J SINGLE 1982 6 4 , 2.0 1,742 i 2,270 jv 2,255 i CONC 123,437 147,388 Description Area
j FAMILY E a j BLOCK
I OPEN
PORCH [ 15.00
FINISHED
BASE SEMI_
i 513.00FINISHED
Permits
Permit # _ Description Agency Amount CO Date Permit Datenv
02956 E ADDITION -RESIDENTIAL SANFORD 200 9/25/2003
Extra Features
Description Year Built Units Value New Cost
HOME -SOLAR HEATER 11/1/2005 1 0
SCREEN PATIO 1 11/1/1988 1 600 i $1,500
http://parceldetail.scpafl.org/ParcelDetaillnfo.aspx?PID=1020305FROOOO110O 7/13/2017
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
e Completed and Notarized Inspection Affidavit
All Florida Product Approval and Corresponding Installation Instructions
e (Product Approval shall match what is on the scope of work)
o 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: - ` '1 L
DATE: 1 Z I
X
THIS INSTRUMENT PREPARED BY:
Name: Over the To Roofers, LLC
Address: 296
01!dFido, Ft:14n 1 a ('). - • (a avl'
1
Permit Number:
t I Ill{ t111111f 1111 Ill
GRr-'04T 11t C?'r'r Et9Ih OLE GC3(lh1TYC.!_!:_Eit: OF C:TRCii}:T COURT ; C:OrlPTROLLER
CLERK'S r 20/7071050
RECORDED L17/1.]3/21_i17
RECORDED P't lid'ev,,'We
Parcel ID Number.
The undersigned hereby gives notice that Improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, thefollowinginformationisprovidedinthisNoticeofCommencement.
1. DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available)
2. GENERAL DESCRIPTION OF IMPROVEMENT:
ft'SA3 6 t F- 2,2 J r
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT:
Name and address: FdC3AuCi-k 1?C a ZAOA Z(J l4J utZL
Interest in property: Cti a'l_=a C=-t2 `' C)--f -
Fee Simple Title Holder (if other than owner listed above) Name:
Address:
4. CONTRACTOR: Name: Gregg Bovich Phone Number: 407.293.4715
Address: 5036 Dr. Phillips Blvd, Ste 296, Orlando, FL 32819
5. SURETY (If applicable, a copy of the payment bond is attached): Name:
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 Section713.13(1)(a)7., Florida Statutes.
Name:
Phone Number:
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 ARECONSIDEREDIMPROPERPAYMENTSUNDERCHAPTER713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOURPAYINGTWICEFORIMPROVEMENTSTOYOURPROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THEJOBSITEBEFORETHEFIRSTINSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEYBEFORECOMMENCINGWORKORRECOINGYOURNOTICEOFCOMMENCEMENT.
dCm (
Print
eX! C r1
Print Name and Prbwrda Signatory's 1'itle/Office)
The foregoing Instrument was acknowledged before me this - day of —y c
by r
20
t
Who is personally known to me ORNemeofpersonmakingstaement
who has produced identification IR type of identification produced:
SFvvT T at 5_: '`'t,l'
v b'`
ia,<<_ py_
Pa, Notary PubliC State of FWkia
t,® Helm M 011111sms
c % My Commijilon GG 008278 ` 0
Of EXpiret os/1e/2020 Notary Signe
JV
Altamonte Springs, Casselberry, Lake Mary, ]Longwood, Sanford,
Seminole County, Winter Springs
Date: L- 1 13 Z v 1-4-
I hereby name and appoint: 'SAL -
an agent of
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:
1-20 {3G(2Ai>, kZUNQ F 3 Z -4q 3
Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name: G Q c G-& moo- I e N
State License Number:_ Ccc { 1) Z g35 8
Signature of License Holder: C I ),`,
STATE OF FLORIDA
COUNTY OFF
The foregoing instrument was acknowledged before me this day of y L 20 , by 6 2_ C, {} who is)p personally knowntomeorowhohasproduced
identification and who did (did not) take an oath.
as
Signature
Notary Seal)
Ow ram Notary Public State of Florida
Helen M Wiltiatns
My Commission GG 008278
Expires 08/16/2020
APrit or type name
Notary Public - State of 1 (- !R- mpP-
Commission No.
My Commission Expires:
Rev. 08.12)
PERMIT #
City of Sanford Building Division
Residential Re -Roof Scope of Work
JOBADDRESS: I'ZO _5O1LADA ROAiD sAnlfog g,FL 327-+3 STRUCTURE
TYPE;REPLACEMENT
ZNGLE
FAMILY RESIDENCE/TOWNHOUSE MOBILE HOME OO APARTMENT/CONDOMINIUM RE -
ROOF TYPE: (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 PERMITTED TO BE REPLACED * * ROOF
VENTILATION: DOFF -RIDGE RIDGE OSOFFIT OPOWERED VENT SKYLIGHTS:
O YES NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #: MAIN
ROOF AREA ROOF
SLOPE: O LESS THAN 2:12 12 — 4:12 O 4:12 OR GREATER O
TURBINES TYPE
OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL SHINGLE
L F Tim,36uloE "o FL# \ O VZ LI . (Z k ) 0
METAL FL# O
MODIFIED BITUMEN FL# O
TORCH DOWN FL# O
INSULATED FL# TILE
FL#
O
OTHER: FL# ROOF
EXTENSIONS PORCHES PATIOS ETC. **IFAPPLICABLE** ROOF
SLOPE: QLESS THAN 2:12 O 2:12-4:12 O 4:12 OR GREATER TYPE
OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL O
SHINGLE FL# O
ME L FL# ODIFIEDBITUMEN
i NCII/aS JT( FL# 2`i (<< TORCH
DOWN t
FL#
O
INSULATED FL# O
TILE FL# O
OTHER: FL#
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h
BCtS Home Log In User Registration Hot Topic 5 Business/
Professional
ct Approval USER: blicUser Surcharge
Stats & Facts Pubkations FBC Staff BCIS Site Map Links Search Regulation
PrQQyct
Approval Menu > Product or Aoolkation Seu1Gh > Application List > Application Detall i
E
r $ FL # FL10124-R11 Application
Type Revision Code
version 2010 Application
Status Approved Comments
Archived
Product
Manufacturer Address/
Phone/Email Authorized
Signature Technical
Representative Address/
Phone/Email Quality
Assurance Representative Address/
Phone/Email Category
Subcategory
Compliance
Method Florida
Engineer or Architect Name who developed the Evaluation
Report Florida
License Quality
Assurance Entity Quality
Assurance Contract Expiration Date validated
By Certificate
of Independence GAF
1361
Alps Road Wayne,
NJ 07470 973)
872-4421 lindarelth@trinityerd.
com Beth
McSoriey lindarelth@trinityerd.
com Beth
McSorley 1361
Alps Road - Bldg 11-1 Wayne,
NJ 07470 973)
872-4421 BMcSorley@gaf.
com Roofing
Asphalt
Shingles Evaluation
Report from a Florida Registered Architect or a Licensed Florida Professional
Engineer Evaluation
Report - Hardcopy Received Robert
Nieminen PE-
59166 UL
LLC 05/
03/2015 John
W. Knezevich, PE Validation
Checklist - Hardcopy Received FL
10124 R11 COI Trinity ERD CI Nieminen 2013.pdr Referenced
Standard and Year (of Standard) Standard ASTM
D3161 (Class F) ASTM
D3462 ASTM
D7158 (Class H) TAS
107 Equivalence
of Product Standards Certified
By Sections
from the Code i Year
2006
2007
2007
1995
1
of 2 3/26/2014 8:49 AM
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Product Approval'Method
Date Submitted
Date Validated
Date Pending FBC Approval
Date Approved
Method 1 Option D
08/29/2013
08/29/2013
09/08/2013
10/18/2013
FL # Model, Number or Name
t—_
Description
10124.1 GAF Asphalt Roof Shingles Fiberglass reinforced 3-tab, laminated, 5-tab and hip/ridge asphalt
shingles
jLimits of Use Installation Instructions
Approved for use in HVHZ: No F_LIO-1-24 R11 II er08 .9-1. INAL GAF As hpaltSh0_91es FL10124-
Approved for use outside HVHZ: Yes I RI I.o fd
Impact Resistant: N/A Verified By: Robert Nieminen PE-59166
I Design Pressure: N/A Created by Independent Third Party: Yes
II Other: Refer to ER, Section 5. Evaluation Reports
LI 4 Ri1 E_eLQ62913FINAL GAF phalt Shinole I,1.R.12-9=
R11-Rdf
Created by Independent Third Party: Yes
Facto next
Contact Us :: 1940. North t4onfoe 51te%. Tallahassee FL 32399 Phone' 850-487-1824
The State of Florida Is an AA/EEO employer, Copyright 2007-2013 State of Florida.:: Privacy Statement :: Acrosibili[v Statemg91 7: Refund Statement
Under Florida law, email addresses are public records. If you do not want your e-mail address released in response to a pubbc-records request, do not send electronic
mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions, please contact 850.487.1395. 'Pursuant to Section 455.275(1),
Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must provide the Department with an email address if they have one. The emails
provided may be used for E ffiCial Communication with the licensee. However emal addresses are public record. If you do not wish to supply a personal address, please
provide the Department with an email address which can be made available to the public. To determine if you are a licensee under Chapter 455, F.S., please click hgro-.
Product Approval Accepts:
cGtx_V.
Credit
2 of 2 3/26/2014 8:49 AM
Florida Wiilding Code Online Page 1 of 2
W2 IT! T r..
s
P
SCIS Home Log In User Registration Hot Topics Submit Surcharge Stats A Facts Publications FBC Staff BCIS Site Map ( Links { Search
hda
Aus-:--cus.,
Product Approval
Pr
Product Aonroval Menu > Product or Application Search > Application List > Application Detail
FL #
Application Type
Code Version
Application Status
Comments
Archived
Product Manufacturer
Address/Phone/Email
Authorized Signature
Technical Representative
Address/Phone/Email
Quality Assurance Representative
Address/Phone/Email
Category
Subcategory
Compliance Method
Florida Engineer or Architect Name who developed
the Evaluation Report
Florida License
Quality Assurance Entity
Quality Assurance Contract Expiration Date
Validated By
Certificate of Independence
FL10124-R19
Revision
2014
Approved
0
GAF
1 Campus Drive
Parisppany, NJ 07054
800) 766-3411
mstieh@gaf.com
Robert Nieminen
lindareith@trinityerd.com
Beth McSorley (current)
1 Campus Drive
Parsippany, NJ 07054
973) 872-4421
bmcsorley@gaf.com
Roofing
Asphalt Shingles
Evaluation Report from a Florida Registered Architect or a Licensed
Florida Professional Engineer
Evaluation Report - Hardcopy Received
Robert Nieminen
PE-59166
UL LLC
03/03/2018
John W. Knezevich, PE
0 Validation Checklist - Hardcopy Received
FL10124 R19 COI 2016 01 COI Nieminen.pdf
Referenced Standard and Year (of Standard) Standard
ASTM D1970
ASTM D3161
ASTM D3462
ASTM D7158
TAS 107
Equivalence of Product Standards
Certified By
Sections from the Code
Year
2009
2009
2009
2008
1995
http://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDquracBeVCbdM... 1 /19/2017
Florida Building Code Online Page 2 of 2
Product Approval Method
Date Submitted
Date Validated
Date Pending FBC Approval
Date Approved
Summary of Products
Method 1 Option D
08/26/2016
08/26/2016
08/30/2016
10/13/2016
FL # Model, Number or Name Description
10124.1 GAF Asphalt Roof Shingles Fiberglass reinforced 3-tab, laminated, 5-tab and hip/ridge
asphalt shingles
Limits of Use Installation Instructions
Approved for use in HVHZ: No FL10124 R19 II 2016 08 FINAL ER GAF Asphalt
Shingles FL10124-R19.pdfApprovedforuseoutsideHVHZ: Yes
Impact Resistant: N/A Verified By: Robert Nieminen PE-59166
Design Pressure: N/A Created by Independent Third Party: Yes
Other: Refer to ER, Section 5. Evaluation Reports
FL10124 R19 AE 2016 08 FINAL ER GAF Asphalt
Shingles FL10124-R19.pdf
Created by Independent Third Party: Yes
Back Next
Contact Us :: 2601 Blair Stone Road, Tallahassee FL 32399 Phone: 850-487-1824
The State of Florida is an AA/EEO employer. Copyright 2007-2013 State of Florida.:: Privacy Statement :: Accessibility Statement :: Refund Statement
Under Florida law, email addresses are public records. If you do not want your e-mail address released in response to a public -records request, do not send
electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions, please contact 850.487.1395. *Pursuant to
Section 455.275(1), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must provide the Department with an email address if
they have one. The emails provided may be used for official communication with the licensee. However email addresses are public record. If you do not wish to
supply a personal address, please provide the Department with an email address which can be made available to the public. To determine if you are a licensee under
Chapter 455, F.S., please click here .
Product Approval Accepts:
11 ctkK4 10
Credit Card
Safe
http://www.floridabuilding.org/pr/pi_app_dtl.aspx?param=wGEVXQwtDquracBeVCbdM... 1 /19/2017
CITY OF SA NFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #: 11- * 12, 1
I,i Ll-}
hereby acknowledge that I personally inspected
4/ oof deck nailing and/or econdary water barrier work
at i -0 il 0 t and have determined that the work
Job Site Address)
was done according to the Hurricane Mitigation Retrofit Manual. (based on 553.844 F.S.)
I certify that my statements herein are true and accurate to the best of my belief and that I fully
understand that making any false statements in writing with the intent to mislead a public servant in the
performance of his or her official duty shall constitute a misdemeanor of the second degree pursuant toSection837.06 F.S.
G
Signatur Contractor
Qgti (4)
Printed Name of Contractor
7-tz i 7
Date
CcC
License #
License Type: General Building 0 Residential V iing Contractor
or any individual certified in accordance with F. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF Psx C r
Sworn to (or affirmed) and subscribed before me this 17 X_ day of - l 20 _, by6a-?- C, r r G , who is;l Personally Known to me or has 0Produced (type of
identification) as identification.
SEAL)
Signature of Notary Public
t to of Florida
C -;E-
Print/Type/Stamp Name
Nan Pustate of FWida ofNotaryPublicNmew, M Wiuiams My commiseWGG008278p F
pP Ms 08116 020