HomeMy WebLinkAbout341 Fairfield Dr; 17-2771; ROOF427899
b CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
J 7 7 rApplicationNo
Documented Construction Value: $ 11,200
Job Address: 341 FAIRFIELD DR SANFORD, FL 32771 Historic District: Yes No
Parcel ID: 32-19-31-516-0000-0210 Residential Q CommercialEl
Type of Work: New Addition Alteration [A Repair Demo Change of Use Move
Description of Work: re -roof owens corning fl 10674 techwrap fl 17194 21 SQS 7/12pitch Oakridge Antique Silver Lifetime Warranty
Plan Review Contact Person: Rachel Holcomb Title: Office Manager
Phone: 407-278-7788 Fax: 800-337-3361, Email: permit@jasperinc.com
Property Owner Information
Name SINCLAIR MONIQUE Phone:
Street: 341 FAIRFIELD DR Resident of property?,
City, State Zip: SANFORD, FL 32771
Contractor Information
Name Donald Bouchard Phone: 407-278-7788
Street: 3203 S Conway Rd Ste 201 Fax: 800-337-3361
City, State Zip: Orlando, FL 32812 State License No.: CCC1331153
Architect/Engineer 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 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 (2014) Florida Building Code
Revised: June 30, 2015 Permit Application
5 1
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 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 1CC 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 aird\zoning.
OQ'iuk ( I
Signature of Owner/Agent Date Signature of:Contractor/Agent Date
Karla Almodovar
Print .Owner/Agent's Name Print Contractor/Agents Name
Signature of Notary -State of Florida Date
SignFE, KARLA M ALMODOVAR
Stateof Florida -Notary Public
Commission # GG 111330
My Commission Expires
June 04, 2021
Owner/Agent is Personally Known to Me or Co n i -re,rsona y nown 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: IFlood 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 June30, 2015 Permit Application
9/19/2017 SCPA Parcel View: 32-19-31-516-0000-0210
Property Record Card
AMOPIWYaviaJohnson.CFAParcel; 32<19-31-516-0000-0210
PY' Owner: SINCLAIR MONIQUE
S?nrrq cccxavry x:pczton. !.
Property Address: 341 :FAIRFIELD DR SANFORD, FL 32771.
Parcel information
Parcel 32-19-31-516-0000-0210
Owner SINCLAIR-MONIQUE
Property Address 341 FAIRFIELD DR SANFORD, FL 32771
Mailing 341 FAIRFIELD DR SANFORD, FL 32771
Subdivision Name CELERY LAKES PHASE 2
Tax District Si-SANFORD
DOR Use Code 01 SINGLE FAMILY
Exemptions 00-HOMESTEAD(2013)
County GIS
Value Summary
2017 Working 2016 Certified
I Values Values
Valuation Method Cost/Market
Number of Buildings 1
Cost/Market
1
Depreciated Bldg Value $147 131 127,090
Depreciated EXFT Value $350 363
Land Value $ Market) 32,500 23,100
Land Value Ag
Just/Market Value ^ $179,981 150,553
Portability Adj t
Save Our Homes Adj I $57,588 30,677
Amendment 1 Adj I
P&G Adj i $0 0
Assessed Value $122,393 119,876
Tax Amount without SOH: $2,204,00
2016 Tax Bill Amount. $1,589.00
Tax Estimator
Save Our Homes Savings: $615.00
TRIM Notice Hein
Does NOT INCLUDE Non Ad Valorem Assessments
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ItCV Amouut/ Contract Price: v `\
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r....i,u rnbnr..thti ec Assirr
rnent of lusuranee Deneftts for the Full Roof Replacement Only. I herchy assign any and all Insttrtntec place
beheld;
anu this•-w any
appheablc tnsttrance,policies w Jitcpa Contractors, Inc. (' J•tspe"), the scot-Of.Abich shn11 be limited to a Full rtdx,r keplaccmcnr. 1 nuke this -, Corimmt and
aillhoriration in constduainrt of Jasper'+ agreement to palmrm.services- 'supply materials,and.otherwisc perfrrrnt t[z ohhgattons undo flits C: of L including
riotrequiring full paytncnt at the time or service. I also hereby direct -my insurer tsl In teleaw any and all inforrtution requested by )UP"r, ravaey
repre5critanve(
s), for the direct purpcnc. (if obtaining actual tic' be paid by my insurer(s) for services rendered. In flits regard, tat an. m'rirtion
at in
the day Of rFjtts. if pbyrncnt is mailer directly to flier Dunes/Agaullnsural(s); it shall be endorsed over. to jasper immediately upon receipt. I ap cc: that any p wroak,
dedtiaibles. bcnernatt or additional work requested by the undersigned, riot covered .by i4suraricc. must be paid by the undesutnal the deductible installation. Deductible: It is; the Y)wnci's rcmoncibility 1n par• all m%urance dedit lib ov. Owner's ix,t-of-pocket expense .will not' exceed ingisrequiredamount,
as stated on insurer's loss sheet (the "I oss ShecC'), UNIL SS teplaccm wWmve rebair of
te
or acd lkoCtheinsurancedeductheapplicablcbycode
an(Lior ()%ncr e au the Optional
upgrades, Jaxper CANNOT pay wel e, rebate, far' promise to pay,. , insuranceclaimfarpaymentofwork, In the event of a,dtsecpancy. dtc deductible amount stated on the insutrer's.lAss S cet,sjtVoverrule deductible MUSTBEPAIDINFULL, PLUS APPLICABLE SAMS TA. N/t C>dt)an amount
disclosed. Deductible: S il s Ftongage Co. to speak will RtORTGAGE
AUTHORIZATION: 1, Own-fMprigagor. grant authaiaation f jaebn
matters tndiuiing but not limited to,.thctlarm.andilraw status}( (In[tdat) PAYMEty. r SCHEDULE: owner agrees to sp
due upon signing this contract, (ii) c Conttau Price pay
Jasper based on the follouing'schaludc: (i) Deposit in flier amount of S lids
ode crisis, due and payable to Jasper upon completitxt of less .the Deposit and any applicable depreciation retained by Oune's mstQi71S), .p upgrade vork
being performed; and; (iii) the remaining Contract Price (equal to anyapplicable depreciation and/or change:order due and payable to Jasper upon compdction ,of work performed. In the event of :a pending inspection. no mac than 2%. of Conti act Price may br•withheld until inspection has passed: Re
lacement WorkandPnec. Upon insurer's approval and subject to the Teirits and Conditions er'ns Pt? age'to furnish all matcrinls and P ps
oral. ox nratd provide the-
labor necessary to per(orm'thc full roof replacement winch, shall takii plate foliowing . Patty aPPr Y within 30
days, conditions permitting Owner's Declaration of Intent: Owner acknowledges and agrees that, upon approval by insurance company for a full roof
replacement. Jasper shall perform the roof replacement upon receipt o! fiiads from Owner's,in"starance company. FLORIDA HOMEOWNERS' CONSTUCTION RECOVERY FUND PAYMENT, UP
TO A LIMITED AMOUNT, MAY BE AVAILABLE FROM THE FLORIDA HOMEOWNERS' CONSTRUCTION RECO]'
ERl' FUND IF YOU LOSE. MO'v'EY ON A PROJECT PERFORMED'UNDER CONTRACT, WHERE THE
LOSS RESULTSYROM SPECIFIED VIOLATIONS OF-FLORIDA LAW BY.A LICENSED CO:"TRACTOR. FOR INFORMATIONABOUT`THE RECOVERY FUND AND' FILING A CLAIM, CONTACT THE FLORIDA• CONSTRUCTION INDUSTRY
LICENSING. BOARD AT THE FALLOWING TELEPHONE-NU!vIBER AND ADDRESS: Construction, industry
Licensing Board; 2601 Blairstone Road, Tallahassee, FL 32399-1,039t (950) 4874395 CANCELLATION: If
Owner elects to terminate the Services, of Jasper; Owner may "do so before midnight on the third business dayaIter Contract
is executed. Owner shall receive a, full refund of, all deposits. Owner may also rescind Contract before midnight on the third
business ;day after the contract is executed after notification from ittsure[(s) th'at:the claim for payment on roof 'contract has been denied,
In whole or in part. All written noticesof cancellation, regardless of:reason, shall be postmarked or delivered to Jasper's corporate office-
1690 Roberts Boulevard, Suite 112, Kennesaw, GA 30144. CANCELLATION EXCEPTIONS:. The three (3) dily right of
cancellation DOES NOT APPLY to contracts for emergency- home, repairs as time is of the essence. 1, Owner,,
have read and understand all statements, Terms and. Conditions ofthe "Roof Replacement Contract" and agree that all details
are aceeptahler and satisfactory. IL further understand that this Contract constitutes, the.endire agreement between #tie parties.and that
any further changes.or allerations to this Contract must be made inwriting and agreed upon by both. parties. Each party represents.
and warrants_ to, the other that it has the fall power rind authority to enter into the contrail and that it is' binding and enforceable
in accordance with its terms. Authorized JayieTReprese,tative
Date Date Scanned by CarnScanner
THIS INSTRUMENT PREPARED BY:
Name: Jasper Contractors
o F Cnlonoal
n.c :s
NOTICE OF COMMENCEMENT
f f f f f f flf ff f {ll f f ff f{{ {fl
GRANT MALOYr SEMI NOLE GUNTCLERKOFCIRCOITCOURT9COMYPTROLLERSt; 8991 Pq 117b (1Pgs )
CLERK Is T 201709,230
RECORDED 1.19/19,/2017 02:09:39 PM
RECORDING FEES $10.00
RECORDED ey JP+_lti. o
Permit Number. //))^^
Parcel ID Number: ' t ._ S b 04900 — 0
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, thefollowinginformationisprovidedinthisNoticeofCommencement.
1.
2., GEN DE;RIPTI OF IMPROVEMENT:
iLpOT
3. OWNER INFORMATION OR L SEE INFOPMATION IF THE LESSEE -CONTRACTED FT, HE I P 2,VEMENT:
Name and address: S 'I n C tG I ! / t C /1 { IJe ?L1 FG 1 1'L i- i L I t 3Ji- p f-d
Interest improperly: Owner
Fee Simple Title Holder (if other than owner listed above) Name:
4. CONTRACTOR:'Namer Jasper Contractors
Phone Number. 407-278-7788
Address:, 5380 E' Colonial Drive Orlando, FL 32807
5. SURETY (if applicable, a copy of the payment,bond Is attached): Name:
Address:
Amountof 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:
Address: _
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 ATTORNEYBEFORECOMMENCINGWORKORRECORDINGYOURNOTICEOFCOMMENCEMENT..
nn/*) .,lI
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St;
by
wh
9
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 0, -1 c -1 _i`
1 hereby name and appoint: Rachel Holcomb, Skylar Amkraut, Karla Almodovar Ana Chavez
an anent of: YasperCon>raaos
uoe orc—P-y)
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 work Iocated at:
Expiration Date for This Limited'Power of Attorney:
License Holder Name: Donald Bouchard
State License Number. 'COC1331153
Sign ature of License Holder.
STATE OF.FLQRIDA
COUNTY OF sew
The foregoing instrument was acknowledged before me this _UCday of p V'
200_9r, by Dwaw e—hard who is o personally known
tome or 12 who has produced oL as
identification and who did (did not) take an oath.
pl)
J.
Signature
Notary Sea]) Sky ar Amkraut
Print or type name
SI<YLAR' B AMKR— A— i
Commission H FF 127890 i
My Commission Expires 11
P June 01, 2018 1
Rev...08.12)
Notary Public -:State of FL
Commission No. 127890
My Commission Expires: 6/1/2018
Scanned by C;amScannPr
Building & Fire Prevention Division
Re -Roof Permit Card
PERMIT NO. /7,0* 177/ ISSUE DATE: ® • 4 ®• 7
CONTRACTOR: %JAS
JOB ADDRESS: 341
i
Faip-h*e Id 44#*0-
TYPE OF WORK:
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
427899
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:
L
Yrf, 427899
PERMIT #
City of Sanford Building Division
Residential Re -Roof Scope of Work
JOB ADDRESS: 341 FAIRFIELD DR SANFORD, FL 32771
STRUCTURE TYPE: Q SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: Q 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 PERMITTED TO BE REPLACED * *
ROOF VENTILATION: DOFF -RIDGE O RIDGE OSOFF T 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 Q 4:.12 OR GREATER
OTURBINES
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
Q SHINGLE Owens Corning FL# 10674
O METAL FL#
O MODIFIED BITUMEN FL#
O TORCH DOWN FL#
10 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 04:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
O SHINGLE FL#
O METAL FL#
O MODIFIED BITUMEN FL#
O TORCH DOWN FL#
OINSULATED FL#
O TILE FL#
0 OTHER: FL#
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 . . . . 17-00002771 Date 9/20/17
Property Address . . . . . 341 FAIRFIELD DR
Parcel Number . . . . . . . 32.19.31.516-0000-0210
Application description . . ROOFING APPLICATION
Subdivision Name . . . . .
Property Zoning . . . . . . PUD
Permit . . . . . . RESIDENTIAL ROOFING PERMIT
Additional desc . .
Phone Access Code 1002914
Permit pin number 1002914
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
1000 111 BL03 FINAL ROOF / /
Altamonte Spnings, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs,
Date: q - Dil - 0
I hereby name and, appoint: Scott Mcixsell, James Allen, Michael Watts, Jacob Horst, Ricardo Prito, Paul Padgett
an agent of Jasp- cmof=
Name of Ckimpmy)
to be my la'%ful 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):
NQ The specific permit and application, for work located:at:,
Smea Addr=)
Expiration Date for This Limited Power of Attorney: \ - k- 18-
License Holder Name: k ACU d 'RUU Urljl
State License Number-.' COC1331153
Signature of License Holder.
STATE OF FLORIDA
COUNTY OF, S-r-cie
The foregoinginstrumentwas acknowledged before me this nday of DA 200_\
j . by D- B- who is pers6nah ' Iy known to
me or is who has produced (31- as
identification
and who did (did not) take an Signature
Amlaaut
Notary
Sea]) IN
T
SKYLARBA KRA ul FF127890CommissionMY
Commission Expire June
01 2018 7
Rev.
08.12) Print
or type name Notary
Public - State of, Commission
No. R-1 111-z") 0 My
Commission Expires: D l 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 #: 1 ADDRESS: t 1 `` 1 Af i d C
0
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 #:
COMPANY
CONTRACT
MUST BE S
S_ C C I 11
CONTRACTOR:
OR SIGNATURE: /' DATE:
IGNED BY;LICEN S4!!q',"Jwrzfl
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 a_) day of 20 Q by:
9C _6 Who is Personally Known to me or haProduced (type of
identification),--, as identification.
91'9natW,6'oANotary Public
State o Flor da °" SKXLAaR B AMKRAUT
commission # FF 127890
filar Amkraut '
s My Commission Expires
June 01, 2018
Print/Type/Stamp Name =- ., ;•
of Notary Public