HomeMy WebLinkAbout106 Coleman Cir; 18-3528; RE-ROOF4
PERMIT APPLICATION
Application No:
Documented Construction Value:
Job Address: 10(o E Co `fTO' Ct, d l `.j6" t1-A Historic District: Yes No[]
Parcel ID: 12 - 20 - 3l7 - 5O 2 -pO0 ,n c R d Residential 2--commercial
Type of Work: New Addition
rAlteration
Repair Demo Change of Use Move
Description of Work: Re_— roo
Plan Review Contact Person:
Phone: Fax: Email:
Property Owner Information
Name O ajaj ) 6o lnG t Phone:
Street: 3 /-30 100"
City, State Zip: NY kyr"i- NU ! 13(4
Resident of property?:
Contractor Information
Name 'Pt)b(1 DQ, b
Street: 35Z5- f2a_e4oet ?, ea -A,
City, State Zip: OyIa k t d FC- 3Z80(o
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Phone: 40-7 -7,a I -1 bit 0
Fax:
State License No.: CGe- ( 3 2_ W q9 ?
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: 6"' Edition (2017) Florida Building Code
NOTICE: In addition to the requirements of this permit, there maybe 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 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.
74 J4 Zxd
SignagVe of Owner/Age t Date
R16 -e j) Qykrd:e 2 -iq-Iq
Print Owner/Agent's Name
Signature of Nota"tate'af Flor"*SP"' ssS NOTWq PUBLIC
OF FLORIDA
y 0_STATE
Comm# GG070449
sZ E 9 0 Expires 5/9/2021
Owner/Agent is Personally Known to Me or
Produced ID Type of ID Fy Dt-
yw
Signature Contractor/Agent Date
Print Contractor/Agent's Name
Wendy Kaye Schaffner
oc, TARY PUBLIC
Signature of No State of Florist STAATE OF FLORIDA
2 Comm* GG070449
7 CE 19 0 Expires 519/2021
Contractor/Agent is Personally Known to Me or
Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas Roof El
Construction Occupancy Use:
Total Sq Ft of Bldg: Min. Occupancy Load:
New Construction: Electric - # of Amp
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Flood Zone:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: q-16-1 f
I hereby name and appoint: 0 rAPnt LrVA-
an agent of:
Name of
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:
log C<>lrvna Cw-A1t S ,AA 3a-1
Stree Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name:
State License Number: CGL 1 3 Lg 4`1 2
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF OW66C
The foregoing instrument was acknowledged before me this Iq day of % St' ,
20PA_, by bkzk who is--a-p rsonally known
to me or o who h sawhoas
identification and who did (did not) take an oath.
Notary Seal)
Wendy Kaye Schaffner
ao1pRY Assoc NOTARY PUBLICESTATEOFFLORIDA
Comm# GG070449
SINCE 19 Expires 5/912021
Rev. 08.12)
A Y--,-
Signature
Print or type name
Notary Public - State of _
Commission No.
My Commission Expires:
City of Sanford
Building and Fire Prevention
Product Approval Specification Form
Permit #
Project Location Address 10(. E 6,1 e na.n CtI cl7 e , 5"kr
As required by Florida Statute 553.842 and Florida Administrative Code 9N-3, please provide the
information and product approval number(s) on the building components listed below if they are to be
utilized on the construction project for which you are applying for a building permit. We recommend that
you contact your local product supplier should you not know the product approval number for any of the
applicable listed products. Be aware that windows, skylights, and exterior doors must be tested in
accordance with the Florida Building Code, Section 1714.5. More information about Statewide Product
Approval can be obtained at www.floridabuildhg.org.
The following information must be available on the jobsite for inspections:
1. This entire product approval form
2. A copy of the manufacturer's installation details and requirements for each product.
Category / Subcategory Manufacturer Product
Description
Florida Approval #
include decimal)
1. Exterior Doors
Swinging
Sliding
Sectional
Roll U
Automatic
Other
2. Windows
Single Hun
Horizontal Slider
Casement
Double Hun
Fixed
Awning
Pass Through
Projected
Mullions
Wind Breaker
Dual Action
Other
June 2014
Category / Subcategory Manufacturer Product
Description
Florida Approval #
including decimal)
3. Panel Walls
Siding
Soffits
Storefronts
Curtain Walls
Wall Louver
Glass block
Membrane
Greenhouse
E.P.S Composite
Panels
Other
4. Roofing Products
Asphalt Shingles lei A6 RA 30 5
Underla ments Waj 5Y h if (- (moo 22-
Roofing Fasteners
Nonstructural
Metal Roofing
Wood Shakes and
Shingles
Roofing tiles
Roofing
Insulation
Waterproofing
Built up roofing
System
Modified Bitumen
Single Ply Roof
Systems
Roofing slate
Cements/
Adhesives /
Coating
Liquid Applied
Roofing Systems
Roof Tile
adhesive
Spray Applied
Polyurethane
Roofing
E.P.S. Roof
Panels
Roof Vents
Other
June 2014
Category / Subcategory Manufacturer Product
Description
Florida Approval #
include decimal)
5. Shutters
Accordion
Bahama
Colonial
Roll u
Equipment
Other
6. Skylights
Skylights
Other
7. Structural
Components
Wood Connectors /
Anchors
Truss Plates
Engineered Lumber
Railing
Coolers/Freezers
Concrete Admixtures
Precast Lintels
Insulation Forms
Plastics
Deck / Roof
Wall
Prefab Sheds
Other
8. New Exterior
Envelope Products
Applicant's Signature
Applicant's Name b"43
Please Print)
June 2014
4-
f"
PRIMROSE CONSTRUCTION
COMPANY
Direct: Email:
407-721-7690 Construction • Roofing rubydavis222@aol.com
Roofing Construction Contract
1. Parties: This Contract is between Filadelfo Quinde, hereinafter referred to as the Owner, whose address is
31-30 1001 St, Elmhurst, NY 11369, and Primrose Construction Company, hereinafter referred to as the
Contractor, whose business address is 3525 Raeford Road, Orlando, Florida 32806.
2. Job Location: 106 E. Coleman Circle, Sanford, FL 32712, Parcel ID Number: 12-20-30-502-000-0490
Permits: The Contractor, License No. CCC1328498, will acquire the appropriate construction permits,
coordinate required inspections, ensure all work is done in a workmanlike and professional manner, and
complete the Contract in accordance with the terms contained herein. The permit acquisition shall be within
ten (10) days of the signing of this Contract and permit application. This Contract contains no completion
date and no penalty or award clauses. This Contract allows the Contractor to place a sign and permit box in
the front yard of the job site for the duration of construction to assist inspectors and subcontractors in
locating the construction site.
3. Pam: This Roofmg Construction Contract is in the amount of Seven Thousand Eight Hundred Dollars
7,800) with payment to Primrose Construction Company, as follows
A. First payment: 50% $ 3,900.00 at contract signing,
B. Final payment: 50% $ 3,900.00 upon completion and cleanup of job site.
D. Any additional work and Change Orders to this Contract shall be paid upon signing of the Change
Order.
4. Owner Responsibilities: The Owners shall provide access to the area of work. Any damage to driveways,
sidewalks, shrubs, landscaping, vehicle damage of any nature shall be the responsibility of the owner and his
respective insurance.
5.
6. Contractor Responsibilities: The following materials and installation are included by the Contractor in the
contract price.
A. Removal of existing roof materials such as eave drip, vent stack covers, ridge vents, off -ridge vents, and
items that are damaged or hinder or prevent the installation of a new roof system.
B. Number Atlas Summit Synthetic 60 Felt Underlayment.
C. New roof description: Dimensional Architectural Atlas Pristine Black.
D. The removal, cleanup, and disposal of all roof materials.
E. Install new 2 ''/2" eave drip, lead boots, and roof vents.
F. Other: NA
G. Other: Any decayed wood requiring replacement will be charged at $40 per board.
7. Lien Waivers: N/A
8. Warran : The Contractor warrants the roof workmanship for a period of one year from the date of
completion. The Owner accepts responsibility for the manufacturers limited warranty of thirty (30) years.
4-
Florida Statutes: In accordance with Florida Statutes 489.1425, the following is included in this Contract.
Construction Industry Recovery Fund payment may be available from the Construction Industry Recovery
Fund if you lose money on a project performed under contract, where the loss results from a specified
violation of Florida law by a state -licensed contractor. For information about the recovery fund and filing a
claim, contact the Florida Construction Industry Licensing Board at the following telephone number and
address: Construction Industry Licensing Board, 1940 North Monroe Street, Tallahassee, Florida 32399-
0783 Phone: 1-850-487-1395.
10. Understanding: It is expressly agreed that this Contract constitutes the sole understanding between the
parties hereto and that no oral understandings, representations, promises, or other statement whatsoever
made by anyone whomsoever will be binding upon Owners or Contractor unless the same is contained
herein or in another instrument attached hereto and made a part of this Contract and duly signed by all
parties. This contract shall become null and void if not signed by all parties within 5 days of the effective
date shown below.
11. Dispute: Should any dispute arise out of this Contract, the prevailing party shall be entitled to recover its
attorneys fees and costs incurred with such dispute, arbitration or action, through all appeals, bankruptcy
proceedings and collection efforts.
11. Notices: Any notice given pursuant to the Contract shall be sent certified U.S. Mail, return receipt
requested, as follows:
Owner: Filadelfo Quinde Contractor: Primrose Construction Company
31-30 1041 Street 3525 Raeford Road
Elmhurst, NY 11369 Orlando, Florida 32806
This Roofing Construction Contract is a legal binding Contract with an effective date of August 14, 2018.
Fila Ifo ind , Owner
Roofing Contract/106 E. Coleman
Ruby Davis resident
Grant Maloy, Clerk Of The Circuit Court & Compti'oller Seminole County, FL
Inst #2018093942 Book:9191 Page:1711-
1 (
1 PAGES) RCD: 08/16/2018 01:40:05 PM
REC FEE $10.00
THIS INSTRUMENT PREPARED BY:
Name: Ruby Davis
Address: 3525 Raeford Road
Orlando. FL 32806
NOTICE OF COMMENCEMENT
State of Florida
County of Seminole
Permit Number:
CERTIFIED COPY GRANT MALOY
CLERK OF THE CIRCUIT COURT F/
AND COMPTROLLER
SEMINOLE COUNTY, FLORIDA`
BY, R DEPUTYVCLERK
oat p O 1 e
Parcel ID Number: 12-20-30-502-000-0490
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.
DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available)
106E Coleman Circle Sanford 32712 - Lot 49 South Pinecrest 3rd Add
GENERAL DESCRIPTION OF IMPROVEMENT:
Re -roof
OWNER INFORMATION:
Name: Filadelfo Quinde
Address: 3130-104th Street, Elmhurst, NY 11369
Fee Simple Title Holder (if other than owner)
CONTRACTOR:
Name: Ruby Davis
Address: 3525 Raeford Road, Orlando, FL 32806
Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served
as provided by Section 713.13(1)(b), Florida Statutes.
Name:
In addition to himself, Owner Designates
To receive a copy of the Lienor's Notice as Provided in
Section 713.13(1)(b), Florida Statutes.
Expiration Date of Notice of Commencement (The expiration date is 1 year from date of recording unless
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.
Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true
to the be f kno dge an a ief.
2 Filadelfo Quinde
n r gnatur Owners Printed Name
Florida Statute 713.13(1)(g): "The owner must sign the notice of commencement and no one else may be permitted to sign in his or her stead'
State of 1'i71eWA- County of OR —A- &E
The foregoing instrument was acknowledged before me this _ day of /'>,/ %1U0viy .2011
I g
by riktLI(c, out4e. Who is personally known to me
Name of person making statement
OROR who has produced identification L7 type of identification produced: Ny pLI
SAR 40 Wendy Kaye Schaffner
soNOTARY PUBLIC STATE
OF FLORIDA i
F2 Comm# GG070449 ary signature yN
a 19 0 Expires 5/9/2021
SCPA Parcel View: 12-20-30-502-0000-0490 Page 1 of 2
CM
errwou:ooun rtaFia+
Parcel Information
PropertV Record Card
Parcel: 12-20-30-502-0000-0490
Property Address: 106E COLEMAN CIR SANFORD. FL 32772
Value Summary
Parcel 12-20-30-502-0000.0490
Owners) OUTH REALTY INC
Property Address 106 E COLEMAN CIR SANFORD, FL 32772
Mailing 1327 LAVANHAM CT APOPKA, FL 32712-3069
Subdivision Name SOUTH PINECREST 3RD ADD
Tax District St-SANFORD
DOR Use Code 01-SINGLE FAMILY
Exemptions 00-HOMESTEAD(1997)
J
2018 Working 2017 Certified
Values Values
Valuation Method Cost/Market Cost/Market
Number of Buildings 1 1
Depreciated Bldg Value $66,326 59,392
Depreciated EXFT Value
Land Value (Market) $22,000 15,000
Land Value Ag
Just/Market Value " $88,326 74,392
Portability Adj
Save Our Homes Adj $23,087 10,495
Amendment 1 Adj $0
P&G Adj $0 0
Assessed Value $65,239 63,897
Tax Amount without SOH: $514.40
2017 Tax Bill Amount $445.45
Tax Estimator
Save Our Homes Savings: $68.95
Does NOT INCLUDE Non Ad Valorem Assessments
Legal Description
LOT 49
SOUTH PINECREST 3RD ADD
PB 11 PG 63
Taxes
Taxing Authority Assessment Value Exempt Values Taxable Value
County General Fund 65,239 65,239 0
Schools 65,239 25,000 40,239
City Sanford 65,239 40,239 I 25,000
SJWM(Saint Johns Water Management) 65,239 40,239 25,000
County Bonds 65,239 40.239 25,000
Sales
Description Date Book Page Amount Qualified VaGlmp
CERTIFICATE OF TITLE 6/1/2018 09161 1016 104,000 No Improved
WARRANTY DEED 5/1/1996 03080 0619 69,900 Yes Improved
Find Comparable Sales
Land
Method Frontage Depth Units Units Price Land Value
LOT 0.00 0.00 1 $22,000.00 $22,000
Building Information
Description
Year Built ve Fixtures I Bed I Bath I Base Area I Total SF Living SF Ext Wall Adj Value I Repl Value I AppendagesI
1 SINGLE 1958 6 3 2.0 1,311 2,049 1,511 CONC $66,326 $112,895
Description Area
FAMILY BLOCK
UTILITY 112.00
UNFINISHED
http://parceldetall.scpail.org/ParcelDetailInfo.aspx?PID=12203050200000490 8/16/2018
ACKNOWLEDGEMENT AND RECEIPT OF CLOSING
DISCLOSURE/SETTLEMENT STATEMENT
Buyer/Bormwcr: Seller:
Long Island Spring, LLC, a Florida Limited South Realty, Inc., a Florida Corporation
Liability Compare
Property Address
106*Coleman Circle, Sanford, FI.3277:3
I have carefully reviewed the Closing Disc losurelSettlement Statement and to the hest of my knowledge
and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by
me in this transaction. I further certify that i have received a copy of the Closing Disclosure. Southeast
P xifessional Title. 11C may n ccive interest on funds received in escrow until those funds have been
dishursed and paid, pursuant to Rule 4 21.010(3) uftlte Florida Administrative Code.
TAX PRORATION AGREEMENT
The real estate taxes have been Imitated Can an estimate in the amount of S445A5 and it is hereby agreed
that the actual proration if ditTerent, will be adjusted solely between the buyer and seller.
CORRECTION AND COMPLIANCE AGREEMENT
The undersigned Purchaser/Borrower and Seller. for and in consideration of' the lender funding the
closing ol'the loan, and the Settlement Agent closing the loan, agree that if requested by the lender or
Southeast Professional Title, I.I.C. all parties will fluffy cooperate and adjust all typographical or clerical
errors discovered in anv or all of the closing documentation presented at settlement.
Dated Effective this t day of August, 2018. i
Long Island Spring, i..LC, a Florida Limited
Liability Cgmpany Y
U, rG; * ,r _ South Realty, Inc., a Florida CorporationX,J.. .ver/Borrowe . (ruin a `l iladelfo, Manager
Seller. rues G. Thayer, President
To the hest of my knowledge. the Closing DiselosurelSettlemeni Statement is a true and accurate account
of this transaction. 1 have will cause the funds to be disbursed in accordance with this
statement. l
Settlement Date: 08106/18
A. Settlement Statement U.S. Department of Housing
and Urban Development
B. Type of Loan
OMB Approval No. 2502-0205 1 r
t. FHA 2. 0 RHS 3. Conv. Urdns. 1 6- File Number 7. Loan Number 8. Mortgage Insurance Case Number
4. f_! VA 5. 0 Conv. Ins. 18.0799
C. Note; This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items
marked V.o.c.)' were paid outside the dosing; they are shown here for information purposes and are not included in the totals.
D. Name and Address of Borrower E. Name and Address of Seller F. Name and Address of Lender
Long Island Spring, LLC South Realty, Inc. j
31.30104(h Street 1327 Lavanham Court
E. Elmhurst, NY 11369 Apopka, FL 32712
G. Property Location H. Settlement Agent
tOfi E.Caleman Circle Southeast Professional Idle, LLC
Sanford. FL 32773 151 Southhal) Ln, 4230. Maiflan_d, F_L_ 32761
Lot 49. South Pinetxesl. 3rd Addition Place of Settlement 11. Settlement Date
PS 11162-63 151 Soulhhall Lane, Ste 230
08fOBn8 tSEMINOLEMaitland, FL 32751
i OD' 08106/16
J. SUMMARY OF BORROWERS TRANSACTION:
100.^GROSS AMOUNT DUE FROM BORROWER
K_ SUMMARY OF SELLER'S TRANSACTION:
j 400_GROSSAMOUNT DUE TO SELLER11Contractsalesce _
401 .Centred sates price - - 129.000.00t02Personal
402 Personal property
103 Selllement dtar as to borrower Gne t4003-_ _ O--T 1 403
104.
404
405.
i Adjustments for items paid by seller in advance Adjustments for items paid by seller In advance
t l)E Non-AdValorem Assessments to I i 406. Nat-Ac Va rem Assessmentsmto 107
Countytsxes_f9_ 1013
Assessments to i 408. Assessments entsto 409.
110. 410.
412
120.
GROSS
AMOUNT DUE FROM BORROWER Z00 AMOUNTS
PAID BY OR IN BEHALF OF I 129
fi44
00 1420 GROSS AMOUNT DUE TO SELLER i, 129,
000.
00 ' BORROWER t _ _ .,, _
SM. REDUCTIONS IN AMOUNT TO SELLER 201Deposit or
earnest money 7 000 00 + »5D1 Excess Deposit (sea instructions) 202 Principal amount
of new loan(s) i S02 Settlement charges
la seder (line 1400} - 6,228 00 203,Existing Ioan(s) taken subject to 503 Ex,sfing loans taken subject to i 504. Payoff
of first mortgage loan 205. 505 Payoff
of
second mortgage _.__. gaga loan i506. 207-
507.
209
Adjustments
for
items
ward by seller i Adjustments for items unpaid by seller 21D Non-AdVabrem
Assessments to 11-_to 21
I
510Non - -
Valorem Assessments to 1 Co_untytaxas
0110vt8 OBM18 1 26805 511
Cou taxes 01/01/18 to 08/08118 Y . _ — ... 1_8M._._. Zg6.05'
12212 _
Assessrents 512Assessmentsto513. f. 514
217
Stl La.
rV _ _ _.
i
220TOTALPAID
BY!
FOR BORROWER _ 1_ 2,26805 `520 TOTAL REDUCTION AMOUNT DUE SELLER 6,494.05, 300. CASH A7 SETTLEMENTFROMORTOBORROWER301. Gross 600 CASH
AT SETTLEMENT TO QR FROM SELLER amount due from bon
veer t ne t20 729,64a 00 601. Gross amount duo to seUar fllne 420 129 000 00 302.LLess amounts paidbytforborrowerIlne2202,28605 602 LessredudtonamountduetOseUerGtine520}-__..,_._ ___,_,__.= 0 6,494.05,
303
CASH FROM BORROWER
127,377 95 803 CASH TO SELLER 122.505.95 form HUD-1 (3/
86) ref Handbook 4305.2
A. Settlement Statement A-e
U.S. Department of Housing
and Urban Development OMB Approval No. 2502-0265 cir
B. Type of Loan
1. 1 - FHA 2. t ', RHS 3. X Cores. Units. 6. File Number 7. Loan Number 8 Mortgage Insurance Case Number
4. 1 VA 5. Coriv. Ins. 18-OM
C.Note: This form is furnished to give you a statement Of actual settlement costs. Amounts paid to and by the settlement agent are shown itemsmarked "(P-0-c.)" were paid outside the closing; they are shown here for information purposes and are not included in the totals,
D. Name and Address of Borrower E. Name and Address of Seller
Long Island Spring, LLC South Really, Inc.
F. Name and Address of Lender
31.30 104th Street
1327 Lavanharn Court
E. Elmhurst, NY 11369
Apopka, FL 32712
G. Property Location
106 Coleman Circle M. Settlement Agee
Sanford, FL 32773 Southeast professional Title, LLC
151 Southhall Ln, #230. Maitland, FL 32751
Lot 49. South Pinecrest. art! Addition
PS 11162-63 Place of Settlemetit
I. SOMOmend Date
SEMINOLE
151 Southhall Lane, Ste 230
Maitland, FL 32751 o"S/le
4M_tAAqnVOF 8QRI Q-_ELR2§ TRANSACTION:
DO: 08/mia
100 GROSSt_11M_MMYAMOUNTFROMBORROWERAkD
K. S OF SELL TRANSACTION: I K§,TRAP kA C
Contract Sol es 0 400. PFqSSAfd!?UNT DUE TO SELLER
I— .
2. ' - 2Pedy,
i29.000.004 - : ___1 Pl. _
Cc5racts.ales.pnce 129.000ZO nq
fCf otoprooerty t
Omani chares 644.
W 403. 04.
4Adjustments0
16 far _
pW#by,"1Ie_in&d rkca N-
AdVatorem, 405.
Adjustme
for items by "Ile In advance V107.
A&
tessments Count
taxes y.--- NQrt?d to 1081
to
Assessments
to 4- C"
taxes -to IC1, Assessments
to109. 409. 120.
GROSS
AMOUNT DUE FROM BORROWER 206 AMOUNTS
PAID BY OR IN BEHALF OF BORROWER 201. Depositor
earnest i62, _Principal
amount of new toan(s) - 2t)3.
Existing loan(s) taken sub Ito 20.4.
205. 206,
267'
208,
A49hustaqrlp
for
items unpaid by seller. to 211.
C
taxes 212. Assessments
A0.- 214.
1216.
217.
218.
219.
220-
TOTAL ,
PAID BY I.FOR BORROWER i0i). CASH
AT SETTLEMENT FROM OR TO BORROWER 301- Gross
amount due from borrower (1 120 302... LOSS
Bmoullls paid by/for borrower ine, 220) 3031.---CASH
BORROWER FROM BORR0 . _ - - .. 412._ 129.
S4400420_
GROSS AMOUNT DUE TO SELLER REDUCTIONS IN
AMOUNT TO SELLER' 2,000.
00 501. Excess Deposit (see instructions 502 Settlement
charges to seller (line 1400) 503- Existing
loans taken subject to Payoff ofrust
mortgage loan 505. Payoffof
second mortgage loan 506' 507.
Adjustments
for
items a pnp_!qbyseller 129.000,
00 A 510.
Non-AdVa Assessments 1 ____ _. - II . __ __ _ - ,
to 266.05 '
511Couytaxes 0. i4-.4 t8o081061182151512.
Assessments
514 t2.
266.
05
520. TOTAL REDUCTION AMOUNT DUE SELLER 09- CASH AT
SETTLEMENT TO OR FROM SELLER 129,644.00,
601. Gross amoum due to seller 602, Less reduction
amount due - 10 seller (line 520) 11.27.377.
95: 603. CASH TO SELLER 6,49-4..
05 129,000.00
6,494.05
122.505.95
form HUD- 1 (
3186) ref Handbook 4305.2
U.S, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENTL
70D.
SETTLEMENT CHARGES: —
TOTAL
SETTLEMENT STATEMENT
Fde :18-0799Per-
PAGE 2
ESIBROKERS-COMMISS1 based onjprLc j;
Division of commission (lire 700) as fq! 3 670
PAID FROM
BORROWER'S
FUNDS AT
PAID FROM
SELLER*$
FUNDSAT701. to SETTLEM T- T SETTLEMENT
702 3 LaRq-s.@-Re81tyLLC
703. Comm ssion paid a!Settiament
704.
800
Fee.__ --- ----
La Rom Really LLC
ITEMS PAYABLE
7 p70.0.0
IN CONNECTION MTN LOAN 250,00
801, Loan ,Nh>afionFee ryy- P.O.C.
to
Repo,
05- Lender's Inspection Fee
606.
10
807. AqM!2isyajio n Fee
410.---L",Cerlificafion Fee
812.
913.
814.
815,
wo. ITEMS RBY LENDER TO BE PAID IN ADVANCE @$
902
modernurttl 903.
Hazard Insurance Premium X.
1000,.
RESERVES DEPOSITED WITH UkNDkR_ FOR @
ig,
e M
ma.
1003, Gaunto
fly. tax. Mo.1OP4. 1005-
A AsmsmentS 1OD6.
mo.
mo.
Reserve
for Hazard/Flood In, City/Count 11WL.
TITLE CHARGES 1101.
Settlement a clo.sing I". to Southeast ProesS onel Title, LLC 1103.-
Title to 01 ePuW9rS0t0Mt Professional Title 260.00 495-00; i examInationOI
1104.
Tdleinsurance Binder 1105.
DOcunte- n. preparation to 11,
06- 1107
ffy
le" Pr
to
So
utheasthides
above aem No: 1109
Lendefs coved Owner'
s coverage ra129. 000.00, c?LsIfNrOfOs
jitte, LL /Old R L 1200.
GOVERNMENT
RECORDING n fees
Clerk qCircuit Court 1202, 120--— 929? 3. -
State tayis " tamps Deed $ 903,00 MO e $ 1204, Inlang We
1205. . Tax, Deed $
1300.
AD PMPNALSETTLEMIENT
IM"Ft:GES- to 1302, Pest
inspection
to L ienItQA Search
1305, 13M, 1307,
I '
308.
1400.,
TOTAL SETTLEMENT
CHARGES enter on !tees 103 and 502, SeCti.00s. J and K)- 12200 2200 140
001
6.
228.00
form HUD-1 (
3/86) ref Handbook 4305.2
PURSUANT TO THE ISSUANCE OF TITLE INSURANCE
THIS INSTRUMENT PREPARED BY AND RETURN TO:
Janet M. Mitchell
Southeast Professional Title. LLC
151 Southhall Lane, Ste 230
Maitland, FL 32751
Property Appraisers Parcel Identification (Folio) Numbers:
12-20-30-502-0000-0490
File No. 18-0799
Space Atxn,c This Line For Rmording Data
THIS SPECIAL WARRANTY DEED, made and executed the day of August. 2018
by South Realty, Inc., a Florida Corporation, having its principal place of business at 1327 Lavanham Court,
Apopka, FL 32712. herein tailed the grantor, to Long Island Spring, LLC, a Florida Limited LiabilityCompany, whose post office address is: 31-30 104th Street, E. Elmhurst, NY 11369, hereinafter called theGrantee:
Ilt'herever rrsed herein the tet-s "grcarlor" uric! "grantee" include all the purlies to this nrsimpn w uctd the heir:c. leYal mudassitncgl'indiridaulc, (slid thr .ctrccis.cnrc and ussigus 0(cor7N.)ratinnrl
W I T N E S S E T H: That the grantor, for and in consideration of the sum of TEN AND 00/100'S
10.00) Dollars and other valuable considerations, receipt whereof is hereby acknowledged, hereby grants. bargains, sells. aliens, remises, releases, conveys and confirms unto the grantee all that certain land situate inSEMINOLECounty, State of Florida.
viz:
Lot 49, SOUTH PINECREST THIRD ADDITION, according to the plat thereof, as recorded in Plat
Book 11, Pages 62 and 63, of the Public Records of Seminole County, Florida.
Subject to easements, restrictions and reservations of record and to taxes for the year 2018 andthereafter.
TOGETHER. with all the tenements, hereditament.~ and appurtenances thereto belonging or in anywiseappertaining.
TO HAVE AND TO HOLD, the same in fee simple forever.
AND, the grantor hereby covenants with said grantee that except as above noted, at the time of delivery of thisSpecialWarrantyDeedthepremiseswerefreeofallencumbrancesmadebythem, and they will warrant and defend
the same against the lawful claims of all persons claiming by, through or under grantor.
IN WITNESS WHEREOF, the said grantor has signed and seated these presents the day and year firstabovewritten.
Signed, sealed and delivered in the presence of:
Witness i#1 Signature
STATE OF FLQRIDA COUNTY
OF A )e,"i IC-Q South
Realty, Inc., a Florida Corporation Ja
G. Thayer, President The
foregoing instrument was acknowledged before me this 1_6ay of August, 2018. by James G. Thayer, President of South Realty, Inc., a Florida Corporation, ana`'
behalfof the corporation. He/she is pers .
Hall wn to me Qr as produced , dentifieation. STEAL
Nota
isIfe My
Commission Epµrti 1. •'=_<+ Printed
Notary Signature
CGt`ViPLIANCE AGREEMENT, NON -COERCION STATEMENT AND CLOSING
AGREEMENT
Buyer: Long Island Spring, LLC, it Florida limited Liability Company
Seller_ South Realty, Inc., a Florida Corporation
Property Address: 106 Coleman Circle, Sanford. Fl. 32773
Date: August 6th, 2018
The undersigned huyer and/or seller for and in consideration of closin0itle agent (the "Closing Agent"*) this day dishursutg the fundsfur the closing of the transaction (the "('loving') agree, if required by Closing Agenttolollycooperateandadiustforclericalerror, on any or all closing documentation. Said adjustments to he made ifdeentednecessaryOrdesirableinthereasonablediscretionofclosing'title agent.
The undersigned buyer and seller rurther agree to cooperate fully with Closing Ascent in all efforts to assure
that required suns for closing are collected front the appropriate parties* further. the undersigned agree that should
and oversight or error occur in the collection of said required sums they will immediately upon written ar verhal
notification make any required corrections or pay additional monies required.
In the event that Closing Agent in its efforts to correct documents or collect additional sums required to
complete ibis purchase transaction should incur legal, attorneys and%or court costs. the responsible parry shall heresponsibletoreimburseClosingAgentfursaidcosts.
Buyer further acknowledges that neither seller or any other party to the closing directly or indirectiv. required" the buyer to use the services or any particular or spccitic title cornpam or settlement agent as such termsaredefinedin12U.S.C. 2601 and Rcgulation X Promulgated in connection hcre'vith.
Sometimes recording fees, courier/express mail fees and wire transler Ices may vary due to the unknown
amounts at the time of closing. Therefore, the parties acknowledge hereto, that monies collectex) for recording andcourier/express mail tires may be more or less than the amount collected on the closing statement. Any shorithils oroveragesshallheconsideredthecostofdoingbusiness. Closing Agent will neither refund or collect saiddiflerences.
hat they are aware that title insurance does not protect the buyer against ttte below listed items. The seller
herein acknowledges responsibility for any sums aecriting under said items prior to the date of closing and buyeracknowledgesresponsibilityforsaiditemsaccruingfromIlsedateofelosingonward. Any suns due not shown ontheclosingstatementwillheresolvedbetweenfilehuyerandsellerherein:
A) Any unpaid utility hills
B) Any unpaid trash pickup or trash removal fees
C) Any unpaid personal property tax
U) Any unpaid special assessnent liens. pending code enforcement liens. open permit Pecs or liens
or any other fines due the stale, city or (lie courtly which arc not recorded under Official RecordsfioitkandPageandClerk-',., File Number in the county records
E) Any special assessments or maintenance liens due an assoeialion not recorded in the countyrecords
The parties acknowledge that during the course of the settlement of funds interest may by earned in favorofSoutheastProfessionalTitle, 11C, and buyer and seller hereby waive any rights to such interest.
The undersigned buyer and seller further agree and understand that jn the event said parties are executingdocumentsattwodifferentlocationsanchorontwodilki-c t dates or times, said closing and transaction is clasctl inescrow (no( final) until all required parties to the transaction (given to include, but not limited to, the buyer, seller, lender, realtor(s), title cOmpany(s) and brokers) have fully signed, delivered and complied with all requireddccuntentation, conditions and funds to finalize the transaction.
A.?i_Rtn.PRORA'!'[C)Tv AGREEMENT: It' llac property tar bill Ibr the year of closing has not been issuedbytheTaxCollectoratthetimeofclosing. then the tax promtions set forth on the closing Statement are based uponanestimate. The basis of proration as set forth on the closing statement is hereby accepted by the parties to thistransaction. It is hereby understood and ag.recd that the actual taxes, if different, will he adjusted between theparties, Closing Agent is not m%ponsible for adjustment or re-proral ion of taxes.
ICC)ME:QN'Nt R'S/C`f)Ni MiNiUM "ASS Q A'1]QNt5)_ Ifs AE'1'LICABLE1 The Buyar acknowledgesthe. existence of any homeowners and/()r condominium associalion(s) and is aware that monthly, quarterly or annualmaintenanceassessmentsmaybeduetosaidassocimion(s). Said association(s) may also have the authority toregulateandenforcecommunitycovenantsandrestrictions.
f?RQl1FRTYY C(aNl)l"[`IU I: Closing Agent does not make any representations or warranties nor assume anyliabilitywithrespecttothephysicalconditionofthepropertyortinyrepairstotheproperty. SURVFI)
RI_.:QQJilt11), UR ()l31'A1N[ D); T'hc [3cayer hereby acknowledges receipt of a copy of any surveypreparedforthesuhiecttransaction. The Buyer has reviewed said sun•cy and accepts title: subject to the natterssetforthonsaidsun-cy. C'
LUSINC;!SlsThl.lMC7vT S`TA`I'1:h1[:N`I:_ Closing Agent canes not adjust and/or assume liability leg charge~ for Neater, rents, security deposits. gas. electricity. taxes on personal property, garbage taxes or lees. license taxes, association assessments or dues, or estoppel intonnmion furnished by mortgagees or others. The closing'/settlement slalcment has been reviewed and approved, and the Closing Agent is irrevocably authorized to makecfishursementsinaccordancetherewith. C
URR[:N'f M()R'I'iiAC;[ S, T'he Seller acknowledges that the payoff statement received by the Closing AgentfrontthecurrentmortgageesmayhesubjecttofinalauditalterreceiptofthepayofflundsresultinginademandbysaidmortgageeforadditionalfundsandSelleragreestoholdSoutheastProfessional 'Title, L1,C hanttlesslirrthelossordamageincurredduetoallyinaccuratepayoffbalancewhetherinwritingorgivenverballyandagreestopaytheshortageimmediatelytoSoutheastProficssionalTitle, The
undersigned buyer and seller further agree to indemntfy and hold Southeast Professional 'Title, [.LC andOldRepublicNational "Title Insurance Company harmless of and from all loss, cast, damage and expense of even- kind, including attontevs' Ices, "hick Southeast Professional "Title. LLC and Old Republic National 'Title insuranceCompanyshaltsustainorbecameliableforunderits )xalicies of title insurance now to he issued on account ('for in reliance upon any statements made herein, including but oat limited to, any matters that may he recordedbetweentheeffectivedateoftheCommitmentissuedpursuanttothesettlementandthetimeoftherecordedoftheinstrumentsdescribedinsaidCollunilntenl. The
undersigned buyer and seller are familiar with the nature of an oath and with penalties as provided by thetawsoftheStateofFloridaForfalselyswearingtostmenienlsinaninstrument (f this nature. The undersigned buyerandsellerofrriltheyhavereadtheliregoingaffidavitandfullyunderstandthefuelscontainedherein.
Buyers:
Long Island Spring, LLC, a Florida Limited
Liability Company
Qutnde Filadelfo, Manager
7t2
s-rnTE ®F - N ,/ :1 V
COUNTY OF v i
The lbregoing irimmme nt was acknowledged before: me this 6l day ol'August. 2018 by Quinde Filadelfo, Manager of tong Island Spring LI,C,, a Florida Limited Liability Company. .11eishe is personally known tontcOrleasproduced to t:e , L as identihc t'on a id id (di not) take all Oath.
ary[ u c
My Commission l:xpire s: '71Z No `
70
Prime
I No vy Name Joseph
A. Rodrilgue , Notary
Pub ic, State of .New York No.
01ROU26220 Quaff
in Neseau County Commission
Expires Aug. 02,Y)Q-D,-')-
v
Sellers:
South Realty, Inc., a Florida Corporation
Jame. ¢ Thayer, President
STATE OF FIGPJDA
COUNTY O
f qq(.LTheforegoinginstrumentwasacknowledgedbeforemethisf_!j31ay of August. 2018 by James G. Thayer, Pr eeA..derm, f-•, outh Realty, Inc., a Florida Corporation—.0. behalf of the corporation. He/She is
per5cipai `known candor has producedts ideriti fc,ticm.
Notary
Printed Notary Name
My Commission Expires r. "
Ft•
P•r' :. :: 2tg r,: rl r:b
Y
CJ ..•tom '1. ,:,:+;i ty•!1
HOA DU RIECTW E
Re: Our File No.: 18-0799
Property Address: 106 Coleman Circle, Sanford, FL 32773
We, the undersigned hereby DIRECT Southeast Professional 'Title, LLC as to
the following:
The undersigned Seller hereby certify that there are no mandatory homeowners
association dues on the above referenced -property. If there are said dues, then
they will be handled outside of the closing between the buyer and seller and not
through Southeast Professional Title, LLC.
WE FURTHER CERTIFY that Southeast .Professional 'Title, LLC will
forever be held harmless as to any recourse to the above, including all costs,
including fees paid to any attorney.
Dated. _t P-Iv
Buyer
Long Island Spring, LLC, a Florida Limited
Liabillty Company
By
uinde Fila elfo, Manager
Seller
South Realty, Inc., a Florida
Corporation
By: _ fe4mj.Thayer, President
CITY OF
Building & Fire Prevention DivisionS,NFORD RESIDENTIAL RE -ROOF POLICY & PROCED URES
FIRE DEPART;l4ENT
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-MUSTINCLUDE-ALL-APPLICABLE FLORjEYVPRODUCT'APPROVAlNUMBERSFORALlROOF --
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.
h 6CONTRACTOROROWNER/BUILDER) SIGNATURE''" eakvc y DATE: v
PERMIT #
City of Sanford Building Division
Residential Re -Roof Scope of Work
JOB ADDRESS:
STRUCTURE TYPE: SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS
O RE-COVER( (NEW ROOF INSTA,LLLED OVER EXISTING ROOF
DECK TYPE (PLEASE SPECIFY): y L Uj Oy PLEASE
NOTE. ONL Y 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED ROOF
VENTILATION: D OFF -RIDGE RIDGE OSOFFIT OPOWERED VENT OTURBINES SKYLIGHTS:
O YES ENO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #: MAIN
ROOF AREA ROOF
SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 O 4:12 OR GREATER TYPE
OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL SHINGLE
FL# 3 O
METAL FL# O
MODIFIED BITUMEN FL# O
TORCH DOWN FL# O
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 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# OINSULATED
FL# O
TILE FL# 0
OTHER: FL#
I
1
1
1
i
11
CITY OF
Building & Fire Prevention Division
RESIDENTIAL RE-ROOFAFFIDAVIT
FIRE IPA i ,IINT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: g— -jS _7 ADDRESS: •
F-
I b ij bAv tS , AS AM GENERAL, BUILDING, RESIDENTIAL, OR
GOOFING CONTRAC R, ENGINEER, ARCHITECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE
FORECOnl0tNtOTMATION 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 FLOP IDA 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 4: GC(- 13 Z
COMPANY / CONTRACTOR: ICI m n9y&1 A QfFil (J
CONTRACTOR SIGNATURE: DATE: g Z' 3 / v
MUST BE SIGNED BY LICENSE HOLDER ORDER/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,
UNDERLAYNiENT, 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 02A061e
Sworn to and Subscribed before me this 3 day of v 20 & by:
61/} ppU S Who is LA"e-rsonally Known to me or has Produced (type of
identification) as identification.
Signature of No y P c
State of Florida
Print/Type/Stamp Name
of Notary Public
o`pR Aso
Wendy Kaye Schaffner
aQ
NOTARY PUBLIC
STATE OF FLORIDA
Y Comm# GG070449
ONCE 1 Expires 5/9/2021