HomeMy WebLinkAbout1406 Cypress Ave 17-3079 roofCITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No:
Documented Construction Value: S lr
Job Address: I L10 '_v SS Ave, Historic District: Yes No 9" Parcel
ID: 9(-(q- ((- St 2 - DS` 6 -Q6r7Q Residential Commercial LJ
TypeofWork: New Additio_"` n El Alteration Repair Demo E Change of Use move El Description
of Work: e6Lr t Camd---(yo( : ( od,o AeJPlan Review
Contact Person: ,Gi I Title: l r4_Ce AAte rP Phone: "
t C am}-t ~ %
Fax:
t)f?- r
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Email: 1 v
Property
Owner Information n ,Q
Name
10 a i 4i(i n c)A Phone: 40i- IV Street: r
q & C re_<s }4 e, Resident ofproperty? City, State Zip:
r Contractor Information
S (-
Name fPd0
C+±lu- Phone:C)'i= Street: (S / f
Fax: 401
City,
State Zip:
C1((i 1t<C.t1` - State License No.:. Architect/Engineer Information
Name: Phone: Street:
Fax: City,
St, Zip:
E-mail: Bonding Company: Mortgage
Lender: Add ress: 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: 51h Edition (20.14) Florida Building Code Revised: June 30,
2015 Penn it 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 ol'permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
The City of Sanford requires payment of a plan review fee at the time of permit submittal. A copy of the executed contract is required
in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal.
The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in
accordance with local ordinance. Should calculated charges figured Off the executed contract exceed the actual construction value,
credit will be applied to your permit fees when the permit is issued.
OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will
be done in compliance with all applicable laws regulating construction and zoning.
AA
m6flA.,- IDlmh9
Signature of Owner/Agent Date Signature SfContractor nt Date
Z rrrrZ
Print Owner/Agent's Name Print ntractor/Agent's 'amen
Signature of Notary -State of Florida Date Signatu [
14
fskmeot'Bddil4aJA M R6 ITS
MY COMMISSION # PF970513
EXPIRES March 10, 2020
711'1 4133 r1wtd vW vSwA,* t;m
Owner/Agent is Personally Known to Me or Contractor/Agent is ,Personally Known to Me or
Produced ID Type of ID Produced ID Type of ID
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: UTILITIES: WASTE WATER:
ENGINEERING: FIRE: BUILDING:
COMMENTS:
Revised: June 30, 2015 Permit Application
TAG , General Contractors Inc.
1517 N Orange Blossom Trail
Orlando, Fl. 32804
Orlando 407420-7900 Fa.\ 407 -601-7997 b
FL License MC-061644 Roofing CCC-1 328779
General Contractors Inc. ATLAS
AGREEMENT
TH IS AG REEM ENT IS SUBJECT TO INSURANCE COMPANYAPPROVAL OF PAYM ENT YES I NO INITIAL
CUSTOMER (J) I 1-:LA- , I-
dalk), 0A-1
STRE'll"T PrQ c4pe-%
crry SIJ- zip 377
JAOmF A,,11
EMAIL ADDRESS /--C A.. _44
Project
SPECIFICATIONS
14ANUFACTURER OF SHINGLE
0 STYLE OF SHINGLE
0 COLOR OF SHINIGI-E
0 VALLEYS._
D V17NTS — L-3 STYLE
TEAR OFF A ZNES LAYER(J)
STORY J5 vAq
lrERMIT kRNISHED JaREPLACE ALL BOOTJACKS SYNT'FIlr'
riCUNDE-R[,AYMEN"l' E3ICE & WATER SHIELD 11 PROTECT' LANDSCAPE
WHERE NEEDED I SPECIAL INSTRUZTJQNS,
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YNI wr SECOND FINAL PAYMENT
DUT
AFTER ROOF COMPLETED 11 01-1-
YAR AGNET ROLLER DRIPEDGE KEEP/ C.
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tnc is C,CC— Tlw—COC,661WX)ITRA ,0 CT DPFS N91-0131.16AIT. 1 E PROP ' MTY0110NEROR 'Tag XAA C%nAcir- iNAv,`Y WAS' LINT ft is kPpko,1h) fiy,Tj#i V'R H)WN E OJ1E4TY',p NIrRs,fNSVRANQV
CONIPA Ny and w I fit M NFRANDWCHAf6' 6 R6 WNT OR
REPAIR AT
A 'PRI L' AGOIFAAIW'rO -1-11 IE Ow''NERS ipst ARA' NCF IN-WkEST FORIPROPERT)'REPI.ACL WTST W! Ovimsui, PROPER-
fy OVINERSICONIFIANYAND "TAWWIT11 NIQADDITJOIIALCOI
TTOTIIL PROPERTY DEDUUMUL WHIN 'PRIC'E AGREEABLE' HAS MIEN DETERIAINED ITVALL
SECOME THE MIN AL CONTRACT A.11IOUN`1'ANDTjIE PROPERTYOWNLR AIJ11'IIORIZL,S "TAG" TO Otrl'AIN I-AI30R AND MATERIAL IN' ACCORDANICE WITH
THE "PRICE AGREEABLE' AND SPECIFICATIONS scr ourr HERIN AND ON THE REVERSE SIDE 1113RE01; TO ACC(, ,k.jPLIS[rnfI;
REPLACEMUrr ORREPAIR. THEREFORE `TAG" ACTING AS YOUR CONTRACTOR WILL rfli MWITLEDTO ALI. INSURANCE PROCEEDS IN ACCORDANCE KITH THIS A(
j6EE\4FXT. ALL PRICES ARE SUBJECI-M CHANGE. YOU, THE BUYE MAY CANCEL 1-1-11S PURCHASE Al ANY TIME PRIOR l'O',,ilL)NIGIII,
O:,THE TIIIRDBUSINESS DAY AI, I'L'RTIIFF.)A]'EOI;'I'IlIS,%(',RFI--NiF-\9'. ENPRESSED OR 1.1"'UrO
FITNESS iibRtl PARricu"R OV r11f, RSE SIDE OF T116AGRCEAMYT, IFFORANYREASON TH),CROOF tVNOT('UVERED B), INSURANCFAX0 THE HOMEOW.MIR WOULD LIKE us 7*0 PROCFE'D JjjTH THEMORKITHOULD8ETfIrRFSP0A7,V180.IT31 OF THE HOMEOWNkR TO PA YINr(lIt FOR THE ROOF SIGNBELOWIF I'OU 11101ILDSTILL LIKE US
710 PROCEED 07T11 THE WORKAND 1*OUU7LL &WFOR 100% OFT11E11ORK QUOTED. B, UNDERSTAND ROOF IS NOT CO VERE'D
B)'IVVUR.4iVCEA.,VDIl(;Ri..'F To AIVINFULL FOR ROOF CUSTOMER HAS READ AND AGREFS TO AUTERAIS AND
CONDITIONS ON FRONT & BACK OF THIS AGREEMENT. ACCEPTED BY HOMEOWNERS) ON: DATE....2 5-1
M CO-OWNM DATE . ... ...t BY x TA76-REPRESENTATIVC-.-
DATE- BY' X .l tip Insurance (:'. (
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THIS INSTRUMENT PREPARED BY: SLI
J. Co 61243-
Name: TAG General Contractors, Inc.
Address: 1517 N Orange Blossom Tr
Orlando, FL 32804
NOTICE OF COMMENCEMENT
Permit Number:
2 r , ,'
Parcel ID Number: 5t Ci 'J t 'U US UD "- (N—)C)
GRANT CIALOYr SEIIINOLE COUNTY
CLERK OF CIRCUIT COURT & CONPTROLLER
BK 41M F's 69` (1F'9S)
CLERK'S T 2017104683
RECORDED l.! /17/22017 12 =5 -04 I'ii
RECORDED BY hdevore
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 this Notice of Commencement.
1. DESCRIPTION OF PROP TY: (Legal descnptio of the property and street address if available)
cA—t.4w• B
i ,()y roc
2. GENERAL DESCRIPTION OF IMPROVEMENT.
Re -roof
3. OWNER INFORMATION OR LESSEE INFORMATION 1F THE LESSEE CONTRACTED FOR THE IMPROVEMENT:
Name and address: Wit.-.t _ ,L, `,,_->
Interest in property: 011t9A_Iele_
Fee Simple Title Holder (if other than owner listed above) Nam
4. CONTRACTOR: Name: TAG General Contractors, Inc. Phone Number: 407-420-7900
Address: 1517 N Orange Blossom Tr Orlando, FL 32804
5. SURETY (If applicable, a copy of the payment bond is attached): Name:
Address: Amount of Bond:
6. LENDER: Name: Phone Number:
Address: rprITI r
7. Persons within the State of Florida Designated by Owner upon whom notice or other documents rr ii
713.13(1)(a)7., Florida Statutes. SEWN
Name: _ _ Phone Number,'
8. In addition, Owner designates
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 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.
Signature of Owner or Lessee. or Owner's or Lessee's (Print Name and Provide Signatory's Title/Office)
Authorized Officer/Director/Partner/Manager)
State of J t County of QCq'24e_
The foregoing instrument was acknowledged before me this day of ) G4v L 20 ( 1
by fJ, ' t '-l11 n Who is personally known tom OR
Name of person making statement
who has produced identification type of Identification produced:
0
LARaY'.iONESPEARSON Notary Signature
MY CC7MtN1SSION 0 00005628
EXPIRES June 26, 2020
1407)39"153 F*ddaNtxa can
City of Sanford
Roof Permit Application Checklist
All permit application packages must be complete prior to acceptance. You must check each box to the
leftor indicate n/a on this submittal. A complete application package shall include the following;
VlfBuilding Permit Application completed, signed and notarized. Application must include correct address and
complete parcel I.D. number. 0
Copy of applicable contractor's license issued by the State of Florida (if the contractor is the applicant).
A
site specific notarized power of attorney shall be required from the licensed contractor if he/
she appoints an employee of his/her company to sign the permit application as the contractor. Ed
Certificate of insurance indicating worker's compensation insurance coverage and naming the City of Sanford
as certificate holder, or a copy of a worker's compensation exemption issued by the State of Florida (
must be submitted with each application if contractor is the applicant). 0
Completed and signed Owner Builder Statement / Affidavit (if the owner is the applicant). These
guidelines were compiled to assist the applicant in preparing a roof permit application and may not be complete.
The applicant is required to meet all City of Sanford, state, and federal code requirements.
rCITY OF
S FO
ti
FIRE ADEPARTMEN Building & Fire Prevention Division
Re -Roof Permit Card
PERMIT NO. I l •w 3067 9 ISSUE DATE: / D , / 9, I "7
CONTRACTOR:
JOB ADDRESS: N 04 C V 19 re 3 S
TYPE OF WORK: AC109 P M 00L A / o+
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 5:00 p.m. will be conducted the
next business day. If you experience difficulty, please call 407.688.5150
Monday'- Thursday 7:30 am - 5:30 pm for assistance.
AUTOMATED INSPECTION SYSTEM CODES
Final Roof Inspection Code III
Inspection Policy & Procedures
A Final Roof Inspection is the only inspection required for Residential
Single Family, Townhouse, Mobile Home, Apartment and/or Condominium) Re -Roof Permits.
The Following is required to be provide on the job site:
Permit Card, posted in a conspicuous and weatherproof location
Completed Residential Re -Roof Scope of Work
Completed and Notarized Inspection Affidavit
All Florida Product Approval and Corresponding Installation Instructions
Product Approval shall match what is on the scope of work)
Digital Photographs (must include the permit number or address in each picture)
o Each plane of the roof, showing the underlayment installed
o Roof Deck Nailing Pattern & Spacing (including a measuring device or ruler)
o Roof Deck Nails used (including a measuring device or ruler showing size of nails)
o Underlayment Pattern & Spacing (including a measuring device or ruler)
o Drip Edge & Valley Attachment (including a measuring device or ruler)
o Shingles installed, nail pattern and location of nails
Skylights (if applicable)
o Digital photographs showing all installation components, per FL Product Approval
o Digital photographs showing all required flashing, per FL Product Approval
Failure to follow these specific guidelines will result in an affidavit provided by a Florida
Design Professional (Architect or Engineer), certifying FBC code compliance by personal inspection
REVISED: 04-17 Inspection Line: 407.792.6069 or 855.541.2112
CITY OF
NFQ
F 'I R f 0 "fRA R T M E N
Jos ADDRESS:
PERMIT 4
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
STRLCTIJRF TYPE: (2 SINGLE FAMILY RESIDENCE/TOWNHOUSE 0 MOBILE HOME 0 APARTMENT/CONDOMINIUM
RE-ROOFTYPE: (2(REPLACEMENT ('FEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS) 0
RE-COVER (NEW ROOF INSTALLED OVER Fxis*riNG ROOF) DECK
TYPE (PLFASE SPECIFY): P1 vwj& PLEAsENoTE.
0,'VLY 100 SQUARE FEkTOF THE EXISTLIVC, DECK IS PERMITTED TO BE REPLACED" ROOF
VENTILATION: 0 OFF -RIDGE 0 RIDGE OSOFFIT (OPOWERED VENT OTURBINES SKYLIGHTS:
0 YES e"N'O IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL 4: MAP,
ROOF AREA ROOF
SLOPE: 0 LESS THAN 2:12 02:12-4:12 0 4:12 OR GREATER TYPE
OF ROOF MANUFACTURER FLORIDA PRODLIC'I'APPROVAL O
SHINGLE 0
MVTAL IODIFIED
BITUMEN 4— FL;-, 0-
1-ORCIIDOWN FL# OINSULATED
FL# OTILE
FL# OOTHER:
I f'11# ROOF
EXTENSIONS (PORCIIFS, PATIOS, ETC.) "MAPPLICABLE" ROOF
SLOPE: 0 LESS THAN 2:12 0 2:12-4:12 0 4:12 OR GREATER TYPE
OF ROOF MANUFACTURER FLORIDA PRODLTcr APPROVAL OSHINGLE
FL4 0
N11 ETA L FL4 0
MODIFIED BITUMEN FL# 0
TORCH DOWN FL# 0
INSULATED FL# 0'
r[LE 00THER:
FL#
ITY OF
Building & Fire Prevention DivisionSkNFORDRESIDENTIALRE -ROOF POLICY& PROCEDURES
FIRE DEPARTMENT
PERMITTING REQt1rIRFMENTS - 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.
TI IE SCOPE OF WORK MUST INCLUDE ALL APPLICABLE FLORIDA PRODUCT APPROVAL NUMBERS FOR ALL. ROOF
COMPONENTS THAT WILL BE INSTALLED ON THE PROJECT.
A PERM[TWILL, NOT BE ISSUED WITHOUT THESE DOCUMENTS. COPIES WILL BE MADE TO POST ON THE JOB SITE.
PROJECTS LOCATED IN THE SANFORD HISTORIC DISTRICT WILL REouIRE, 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)
0 DIGITAL PHOTOGRAPHS (MUST INCLUDE THE PERMIT NUMBER OR ADDRESS IN EACH PICTURE)
EACH PLANE OF THE ROOF, SHOWING THE, UN DERLAYMENT INSTALLED
ROOF DECK NAILING PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
ROOF DECK NAILS USED (INCLUDING A MEASURING DEVICE OR RULER SHOWING SIZE OF NAILS)
UNDERLAYMENT PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
DRIP EDGE & VALLEY ATTACHMENT (INCLUDING A MEASURING DEVICE OR RULER)
SHINGLES INSTALLED, NAIL PATTERN AND LOCATION OF NAILS
0 SKYLIGHTS (IF APPLICABLE)
DIGITAL PHOTOGRAPHS SHOWING ALL INSTALLATION COMPONENTS, PER FL PRODUCT APPROVAL
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: awl., DATE: to
U 17w
FIRE INSPECTIONS CITY OF SANFORD
407.562.2786 BUILDING & FIRE PREVENTION
BUILDING INSPECTIONS 300 N PARK AVE
855.541.2112 SANFORD FL 32771
DRIVEWAYS -SIDEWALK 407.688.5080
Page 2
Application Number . . . . 17-00003079 Date 10/19/17
Property Address . . . . 1406 CYPRESS AVE
Parcel Number 31.19.31.507-0500-0070
Application description . . ROOFING APPLICATION
Subdivision Name . . . . . SAN LANTA 1ST SECTION
Property Zoning . . . . . SINGLE FAMILY
Permit . . . . . . RESIDENTIAL ROOFING PERMIT
Additional desc . .
Phone Access Code 1007947
Permit pin number 1007947
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
1000 111 BL03 FINAL ROOF / /
CITY OF
kNFORD Building & Fire Prevention Division
RESIDENTIAL RE-R 0 OF A FFIDA VIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: C ADDRESS: 1 q0 6 ( QrP SS A)
r 3z--)
IlE ( '1 (c , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR ROOFING
CONTRACT , 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 OsN7
F.
S. CHAPTER 553.844). LICENSE #: (
1
COMPANY /
CONTRACTOR:P/PIG CONTRACTOR
SIGNATURE: DATE:o/ 1, S MUST
BE SIGNED BY LICENSE HOLDER O WNER/BU DER) A
FINAL ROOF INSPECTION IS REQUIRED: THIS
SIGNED AND NOTARIZED AFFIDAVIT MUST BE PROVIDED AT THE JOB SITE AT THE TIME OF THE FINAL ROOF INSPECTION, ALONG
WITH DIGITAL PHOTOGRAPHS OF EACH PLANE OF THE ROOF SHOWING IN DETAIL ALL COMPONENTS (DECKING, UNDERLAYMENT,
FLASHING, DRIP EDGE ATTACHMENT) WITH THE PERMIT NUMBER OR ADDRESS CLEARLY MARKED ON THE DECK FOR
EACH INSPECTION. THE PHOTOGRAPHS MUST INCLUDE A RULER OR MEASURING DEVICE TO CONFIRM ALL NAIL SPACING AND OVERLAPS,
INCLUDING DRIP EDGE AND VALLEY FLASHING. PLEASE REFER TO THE RE -ROOF POLICY AND INSPECTION PROCEDURE PAPERWORK
FOR FURTHER EXPLANATION OF ALL REQUIREMENTS. FAILURE
TO FOLLOW ALL REQUIREMENTS WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION FEE AS WELL
AS REQUIRING A DESIGN PROFESSIONAL (ARCHITECT OR ENGINEER) TO CERTIFY, BASED ON PERSONAL INSPECTION,
THE INSTALLATION OF ALL ROOFING COMPONENTS. STATE
OF FLORIDA COUNTY OF- Sworn
to and Subscribed before me this 2-5- day of 06V GEI 20 11 by: Who is
C'Personally Known to me or has Produced (type of ide •tication_))
as identification. j&66t
l SignatuU of
Notary Public SOiVJA N1 ROBERTS State ofFloridaMYCOMMISSION #
A Print/Ty /
Stamp Name 2020 EXPIRES
March10, 2020 398.0133
rWnUoNvtn sv,vU;- wn• of Notary
Public