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HomeMy WebLinkAbout178 Clear Lake Cir; 17-2427; ROOF427395 CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: c-) Documented Construction Value: $ 12,300 Job Address: 178 CLEAR LAKE CIR SANFORD, FL 32773-5694 Historic District: Yes No 0 Parcel ID: 02-20-30-5GJ-0000-0020 Residential X Commercial Type of Work: New Addition Alteration Repair Demo Change of Use Move Description of Work: RE -ROOF OWENS CORNING FL10674 TECHWRAP FL17194 30 SQ'S 7112 PITCH SUPREME ANTIQUE SILVER 25 YEAR WARRANTY SKYLIGHT FL1978-1 Plan Review Contact Person: Phone: 407-278-7788 SKYLAR AMKRAUT Title: ADMIN Fax:800-337-3361 Email: PERMIT@JASPERINC.COM Property Owner Information Name KAUFMAN MITCHELL & KAUFMAN ROBERT & FARESE BET#hone: Street: 178 CLEAR LAKE CIR Resident of property? : yes City, State Zip: SANFORD, FL 32773-5694 Contractor Information Name DONALD BOUCHARD Phone: 407-278-7788 Street: 3203 S CONWAY RD STE 201 Fax: 800-337-3361 City, State Zip: Name: Street: City, St, Zip: _ ORLANDO FL 32812 Bonding Company: Address: State License No.: CCC1331153 Architect/Engineer Information 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: Ste 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 requiredinordertocalculateaplanreviewchargeandwillbeconsideredtheestimatedconstructionvalueofthejobatthetimeofsubmittal. 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. Signature of Owner/Agent Owner/Agent's Name Date Signature of Notary -State of Florida Date Via- k wAv Signature of Contractor/Agent Date V C1 t, I n-I in n / r\.-t M It'I Y Print Co tractor/ gent's Name 5-"&" 17 Signature of Not -State of Florida Date SKYLAR B pMKRAUT ock n = M C o Commission N FF 127890 y mmission Expires Owner/Agent is Personally Known to Me or Contracto A"Z'r& 'L,s Me or Produced ID Type of ID Produced I `-)9Type of ID h l BELOW IS FOR OFFICE USE ONLY 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 - # of Amps Plumbing # of Fixtures Fire Sprinkler Permit: Yes No # of Heads Fire Alarm Permit: Yes No APPROVALS: ZONING: ENGINEERING: COMMENTS: UTILITIES: FIRE: WASTE WATER: BUILDING: Rrvicerl• Tune. 30. 7015 Permit Application 7 5380 E. Colonial Dr. Orlando, Fl, 3i907 3203 Conway Rd, Ste. 201 Orlando, Fl. 32812 407) 27$.7788 600) 337-3361 Fax Cn FVISA IM JASPER, I'L Contractor's License' CCC1329651 &.CCC133,1153 Account hlanjgcr Contact company Policy #- Clain) 5"LA n Montracc Comnlilly. In - Company. Loan Number-. Owncits). Photv. Address: All P hon City; 511111g. Colm Emaal- Roof RCY Aniounte Contract Met, 12,300 Dnp WaFg;r Cv0f k.-. h it 4 If OA-nrr's I n3Uj;ancgCojrnnanv dges not arrerin, nay for p fulrOOLrenijacenwpi- 11LU LUM"XI. A M proceeds under Ass for the Full Replacement Only: I licurby assiP an rights, benefits VA ignment of Insurance y and 3111 Insurance J'aC any applicable tnsw=cc N, I licics; to Jisper Contractors, Inc, C.119=1 the scope Or which shall be limited 10 a Full R6of Rep cn-cnt, I make this assignment form scnicej its obligations under this Con"Wt. and auttionzatim in, consideration of Ja5pas 2611 emieW to Per, supply materials and othcr*isc perform inclvd mi; not requiring full payment at , the l ime or wince. I 1 '666 herct I ! y-diroct I i ny jnsurc'*I to telcasc any -and all, inkwffution requested by Jlqxx, of Its rcprcscntativc(s). for the direct purp(he of obtaining actual I benefits In be p ) -*icforsaes rcndcred. In this rcgxd. I waive My Pn-.-ACY 1. paid by my n1suict(s, tiolls. 1j'payment is nude directly 10 the 01ARcr1Ai;cnt7nsurckW, it shAl be cndo6W 0-1ver 10 Jasper 11"ImcdatclY upon receipt I agree that any portion of v% cm-mcid by iniuwcc, must bc.paid by the undcrstgned on tht d3y-ofark, dcdU ' ctiNcs, betterment ct additional uvirk requested by the undersigned, liefS.oulor.p&kct L expense, I Al not exceed die deductible installation. Pcdijctibtc,: it is oulcr*3 rcstionsibilily to nay all insurance Muglibl 0 to -1" SbectI, UNI -SS rcplaccrncn0cp2ir oftleterioniod docking is rcki4wrd by code and'or Owner requestsmount, mount, as stated on in.=er"s st sheet (the - optional upgades. Jasper CAN\OT pay, %%ahv, ftbitle, or I protnise Ilk pay, waj%v or irttiale any or allo[Ahe insurvnit"doduclible applicatite to the 121m,fo I r payment of vwk cy, the deductible amount stated on the insurer's Less 5hccl %lcrr'Wc deductible insurancc C in the event of, a disqej= deductible j e ;; amount disclosed.,11eductible: S kckc) MUST BF FAJQMEW, PLUS AP OLE SALFIS, TAX %c flult at) 3th MORTGAGE AU-nIORIZATION-_ 1, 0%mcrAllortgagori grant audionzation for Pb_%f'Or1C Co to speak jisper on m3tters thc1tWing but not limited to, the claim and draw status, _(Initial) PAYSIrWir SCIIEDULF 0,%ncr agrees to con pay Jasper baso on tile following schedule. (i) Deposit in the -amount of ...... due ,upon s3 tngth bit ,taut kt4iW upontompict Otill the Contract Price. f less the Deposit and any applicable dqw&ialion wainod by (Julicr's tnsurcr(e'. plus upgrade costs, due arid p3yi ion work, being Mfrinncd, and. ( iji) the tcrnainmg Contract 11ticc.1equal to any applicable depreciation znd'or charige ocirlas) due and p;y3b1c to Jasm upon completion or work perrormcd In the event f a padding inspection, no motc,than 21,'. of Contract Pricc y be %ithheld uriul inuK"icn has pissed. Optional: UPGRADE.ADE ITIEN, QT'NPR[41F— TOTAL Replacement Work and Price: Upon msureVs AWO'al and, sublect to the I-Mirts and Conditions bereln, aspa agrees to humish all nutenals and provide the labor necessary 10 Pcrf(wm the N11 roof replacement %%Ihich &ball, lake puci follouing Owner's insurwricccompiny's apprml-al, a:pproxiflutelly within I 30 dais, conditions permitung Owner's Declaration or Intent: Owner 3cknoWedges and 'agrees that, upon apptmal by insurance company for a full roof replacement, J& 4pa shall perform the roof replacci-ricrit upon receipt of funds from 0%incr'% insurance company. FLORIDA 1 110 1 N1 EOWNERS' CONSTUCTION RFCOVERVI FU\11) PAYNISEN-l', UP TO A LIMITED AMOUNT, MAY BE AVAILABLE FROM THE FLORIDA HOMEO.WNERS' ME CONSTRUCTION RECOVERY FUND IFYOU ,LOSE .NIONEVON A PROJECr PERFOR..1 D UN DER CONTRACT,. WHFRETIIFI,OSSRF,gU'LTS'FR0 ISI CIFIE VI0I.4'tTiO%'$,OF1'I.ORtDALAIIYBVA,LICLN FOR INFORMATION ABOUT THE RECOVERY FUND AND FILING A CIkINJCONTAC`I_THE FLORIDA CONSTRUCTION INDUSTRY LICENSING BOARD AT TIM FOLLOWING TELEPHONE NuMliER AND ADDRESS; Construction Industry Licensing O.oArds'2601'Dlmitttbne Read, Tallahassee, 1:L32399409,050487.1395 CANCELLATION: If OAncr elects to terminate llic stnicts of Jasper, Owner may do so before midnight on the third business w day after Contract is ejecuted. 0rier' shollreceiveafullrefundorall deposits. Owner may also rescind Contract before midnight on the third business.day after the contractIsexecutedafternotificationfrominsurers) that the claim (dirpsymen't on,ro'of contract has been denied, in whole or In part. All -ATiticn notices of cancellation,- regardlesSLor reason, shall be postaurked or delivered to Jasper's corpora I tic office: 169.0 Roberts, 13oulevard, Suite 112, Kennesaw. GIA 30144. CANCELI.ATION EXCEPTIONS,: The three (3) day kght of cancellation DOE$ NOT AMIL I V to c6nirmcls,for emergency home. repairs airs as time Is of the essence. Owner. have read and understand all statements, - terms and Conditions ofthe"Root Rcplsccnwnt Contract- and agree It all details are acceptable, slid satisfactory. 1 further understand that this Contract constitutes the entire agreement between the es and . that, any further changes or alterations to this Contract ' must be made in writing, and agreed upon by both parties. party represents, and warrants to the other that It has the full power and authority to enter Into the contract and that it Is esand enforceable In accordance with I Ititterms, Jasper Rcprtxntativc Date Owncr Date LBUTED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: 8/8/2017 1 hereby name and appoint: Rachel Holcomb, Skylar Amkraut, Karla Almodovar Ana Chavez an aeent of: .lasp"con"Cto,5 e orc«nwnr) 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: 178 Clear Lake Circle Sanford FL 32773 tsvtet addrcssl Expiration Date for This Limited Power of Attorney: 1-1-2018 License Holder Name: Donald Bouchard State License Number. ccct331153 Signature of License Holder. STATE OF FLORIDA — COUNTY OF sei The foregoing insonrment was acknowledged before me this 8 day of August , 200 17 , by oonoia B-d-d who is o personally known to me or is who has produced ot_ as identification and who did (did not) take an oath Signature j Notary Sea]) is-ylar Amkraut Print or type name SKYLAR B AMKRAUT 1£ Commission i FF 127890 j My Commission Expires June 01, 2018 3 Rev. 08.12) Notary Public - State of FL Commission No. 127890 My Commission Expires: 6/1/2018 Srannt-d by CnmScanner 8/9/2017 SCPA Parcel View: 02-20-30-5GJ-0000-0020 Property Record Card CfA Parcel: 02-20-30-5GJ-0000-0020 P Owner: KAUFMAN MITCHELL & KAUFMAN ROBERT & FARESE BETH scuxxx ocxRrrvPnrx Property Address: 178 CLEAR LAKE CIR SANFORD, FL 32773-5694 Parcel Information Value Summary Parcel 02-20-30-5GJ-0000-0020 Owner KAUFMAN MITCHELL & KAUFMAN ROBERT & FARESE BETH Property Address 178 CLEAR LAKE CIR SANFORD, FL 32773-5694 Mailing PO BOX 471 BALDWIN, NY 11510 Subdivision Name HIDDEN LAKE VILLAS PH 3 Tax District S1-SANFORD DOR Use Code 01-SINGLE FAMILY Exemptions 00-HOMESTEAD(2014) Legal Description LOT 2 (LESS BEG SW COR RUN N - 26 DEG 52 MIN 21 SEC E 14.98 FT S 63 DEG 7 MIN 39 SEC E 146.77 FT N 63 DEG 32 MIN E 19.17 FT S 6 DEG 8 MIN 54 SEC E 10 FT S 63 DEG 32 SEC E 27.41 FT N 63 DEG 7 MIN 39 SEC W 147.32 FT TO BEG) & SLY 26.66 FT OF LOT 3 HIDDEN LAKE VILLAS PH 3 PB 28 PGS 3 TO 6 Taxes 2017 Working 2016 Certified Values Values Valuation Method Cost/Market Cost/Market Number of Buildings 1 1 Depreciated Bldg Value 88,907 75,970 Depreciated EXFT Value 1,200 1,200 Land Value (Market) 25,000 21,000 Land Value Ag Just/MarketValue" 115,107 98,170 Portability Adj Save Our Homes Adj 13,586 8,499 Amendment 1 Adj 11,446 6,069 P&G Adj 0 0 Assessed Value 90,075 83,602 Tax Amount without SOH: $1,324.00 2016 Tax Bill Amount $1,153.00 Tax Estimator Save Our Homes Savings: $171.00 Does NOT INCLUDE Non Ad Valorem Assessments Taxing Authority Assessment Value Exempt Values i Taxable Value County General Fund 90,075 24,399 $65,676 Schools 101,521 24,399 $77,122 City Sanford p 90,075 24,399 $65,676 SJWM(Saint Johns Water Management) 90,075 24,399 $65,676 County Bonds 90,075 24,399 $65,676 Sales Description Date Book Page Amount Qualified Vacllmp PROBATE RECORDS 11/1/2014 08372 0856 100 No Improved WARRANTY DEED 9/1/1988 02005 1467 88,200 Yes Improved WARRANTY DEED 2/1/1988 0 193 1 269,100 No Vacant Find Comparable Sates Land 1 Method Frontage Depth Units Units Price Land Value LOT 0.00 0.00 1 $25,000.00 $25,000 http://parceldetaii.scpafl.org/Parcel Detail Info.aspx?PID=0220305GJ00000020 1/2 City of Sanford Buildingdg Preventiono Division SI rI 18 Re -Roof d PERMIT NO. 1 P7— 94#1 ISSUE DATE: kolcop 0 9's 19 CONTRACTOR: M%A JOB ADDRESS: ' 1 _ l LaK f. (2,1 C TYPE OF WORK: epse.® r Is IL 0 les PROTECT FROM WEA' 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 PERMIT # ' !] r City of Sanford Building Division Residential Re -Roof Scope of Work JOB ADDRESS: 178 Clear Lake Circle Sanford, FL 32773 STRUCTURE TYPE: O 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 I00 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED" ROOF VENTILATION: O OFF -RIDGE O RIDGE O SOFFIT OPOWERED VENT SKYLIGHTS: ® YES O NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #: 1978-1 MAIN ROOF AREA ROOF SLOPE: O LESS THAN 2:12 O 2:12 —4:12 4:12 OR GREATER O TURBINES TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL QSHINGLE Owens Corning FL# 10674 O METAL FL# O MODIFIED BITUMEN FL# O TORCH DOWN FL# 01NSULATED 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# 0INSULATED FL# O TILE FL# O OTHER: FL# D 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 mustincludeall 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: a 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: - 8/8/2017 i i lfi f iliii 1iii [i llii ii iii GRANT 11ALOYP SENINGLE COUNTY THIS INSTRUMENT PREPARED BY: CLErZK,OF CIRCUIT COURT & COMPTROLLER Name: - Jasper Contractors (?4' i\w\%-Cko BK 3963 Ps 162 (Apgs) Address: 3203 S Conway Road Suite 201 CLERK `S T2017080039 Orlando, FL 32812 RECORDED 09/09/2017 02.42-28 P11 ya131115 RECORDING FEES !10.00 NOTI CE OF COMMENCEMENT RECORDED BY jedr-1*enrfj lermil Number- 2rcel ID Number: 0 he undersIgned hereby gives notice that improvemenE will be made'(0 certain real property, and In accordance With Chapter713j Florida Slatules, the 31lowinp Information is provided in this Notice of Commencement. DESCRIPTION street LIM Se C- DESCRIPTION OF OWNER INFoRmAT(bN OFZ Name and address, vj % tA IF THE Vo. U LV -r-i 0 Interestin property. L)wner 37 -1-1 Fee Simple Tiffe, Holder (if other than owner listed above) Name: Address., CONTRACTOR: Name: Jasper Contractors' Phone Numbec- 407-278-7788 Address: 3203 S Conway Road Suite 201,00ando, FL 32812 SURETY (If applicable, a copy of The payment bond is 2ffached): Name-, Address: Amount afBond: LENDER: Name: Phone Number_ Address Persons Within the State of Florida Deeigna(ed by Ownerupon whom notice orother'documents may be served,as provided by Section 713.13(1)(a)7., Florida Statutes. Name: Phone Number Address: n addition, Owner designates of. a receive a copy of the Lienor's Notice as provided in Section 713A3(1)(b), Florida Statutes.,Phone number. xpiration, Dale of Notice of Commencement (The expiration is 1 yearfrom date of recording unless a different date is speciffed)- NIArG TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF 7142 NOTICE OF COMMENCEMENT ARE SIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES; AND CAN RESULT IN YOUR NGTWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND To OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY RE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. V of County of—su faal a juu regoinginstrumentwasacknowledgedbeforemethisday.of j V- 0 oA ylL- -T \ Who is personally known tome 0 OR is produced identificatiortJ type of identification produced: SKYLAR B AMKRAUT commission # FF 127890 or mycommission Expires June 011, 2018 f86 • 4 LIMITED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: 2-X 1—+ I hereby name and appoint; Scott Meixsell, James Allen, Michael Watts, Jacob Horst, Ricardo Prito, Paul Padgett an anent of Jasw Contractors tame or 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): Theificpermit and application for work;located:at: i Ct f' © (- r f-&T5Yd . P Stroet Address) Expiration Date for This Limited Power of Attorney: License Holder Name: Vd State License Number. CCC1331153 Signature of License Holder. STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this '2 \ day ofU, 2001-----, by ooaa eo„atara who is o personally known to me or to who has produced DL as identification and who did (did not) take an oath. kw Aw - 0, h Signature Notary Seal) 6"a Mom\ odovaV Print or type name KARLA M ALMODOVAR o State of Florida -Notary Pub is Commission # GG 111330 P My Commission Expires a dune 0a, 2021 Rev. 08.12) Notary Public - State of V A M&G Commission No. kk k i? b My Commission Expires: Scanned by CamScanner City of Sanford Building and Fire Prevention RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS PERMIT#: \q -2_ ` ADDRESS: , " \ '8 C\ACV L U,V C V I m ; Lb a) -/ , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR ROOFIN6 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 ,_(yJ ` 1S ( COMPANY / CONTRACTOR: A QQcy AYQL%f V r CONTRACTOR SIGNATURE: MUST BE SIGNED BY LICENSE HOLDER OR OWNER/BUILDER) A FINAL ROOF INSPECTION IS REQUIRED: DATE: - ' . l - 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 OFF Sw n to and Subscribed before is day of 20 by: 1 ( ° Who i11 Personally Known to me or has Produced (type of identification) as identification. UAA U, C1 UAW - Signature of Notary Public State of Florida (S'FAL) Nv n Print/Type/Stamp Name '?j lilt/,, KARLA M ALM DOVAR of Notary Public .`` B<' State of Florida -Notary Publica€ Commission # GG 111330 s My Commission Expiresea0"`0` June 04, 2021Omn