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HomeMy WebLinkAbout227 Clydesdale Cir - BR18-002588 - REROOFCITY OF 1W SkNF0RD FIRE DEPARTMENT Building & Fire Prevention Division PERMIT APPLICATION Application No: Documented Construction Value: $ I (D1 -7 (.D Z Job Address: 1-71 CNv6YAC Historic District: Yes[]No© Parcel ID: 3\+ ResidentialD Commercial Type of Work: New[] AdditionQ Alteration Repairer Demob Change of Use Move Description of Work: RE - Plan Review Contact Person: 'f\W\ t\ arle-k Title: CC,C.C— Phone: 8'ZGCI-kA2& Fax: " 45( SF I Email: Ut1 Property Owner Information Name & a Ma\-k\r)E; Phone: (4m Street: 7, 1 (iF f\c'\ rC16 __ Resident of property?:h City, State Zip:S-c)I C'k6 , Contractor Information Name Wn('N Mgr\ECJI Phone: ? sbIZGG-1 f J Street: i 6j k aA WJ Fax: ta c- aSl City, State Zip: cxrl tcr1' C State License No.: (" S -7 Za Name: Street: City, St, Zip: Bonding Company: Address: 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, beaters, tanks, and air conditioners, etc. FBC 1053 Sball be inscribed with the date of application and the code in effect as of that date: 6th Edition (2017) Florida Building Code 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 ofpermit is verification that I will notify the owner of the property ofthe requirements ofFlorida Lien Law, FS 713. The City of Sanford requires payment ofa 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. Sigtuurc 0TYwYONgapt Date Signature o Congiaor/ gent Date Print Owner/Agent's Name Juc ZOf IV Sigoaw to 0 orido Date p':+ CORTNEYDNEiSON Ui • Notary hblk - State ofnodr: F% Commission tGG 133984 r :;r°fComm.6p' A1320213,2091021 6:rui[h'auShNzuoealNoWy.- Owner/Agent is personally L o tractor/Agent is Persona Produced ID Type of ID Produced ID Type of ID BELOW IS FOR OFFICE USE ONLY Print Contrxtor/AAent's Nerve COMNEYDNEWN Notary Pub&-Stateof11t1 * CommissionaGG 1339P My CommAym:es Aug 13, 2021 L-MWIhm4l6--orzi%w" 06 Known to Me or 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 APPROVALS: ZONING: UTILITIES: ENGINEERING: COMMENTS: FIRE: Fire Alarm Permit: Yes No WASTE WATER: BUILDING: wf1: N. rcv %ct*r.; W 2031 SO4 L/&V661 -b WMEOFCOWADCOM agfaof noddy cox" ofvokmb of bustw*—f =Gd elrosai-abo= lfaumbnl Napm =Offs ordaamonCbpla7O, Ole4endopYilmaadae boiorldt0 b4d IlaOelof Conseaarset 4 2- 1 Oetp{pslolldRopallr tW10 Mdrsxn ae tara7tsioa!mYl owftton awnruit FOR OFFICEU9a0U1.Y OlrakrO et11 1otLas et lemrdlealHMlnaMoya ltr lidfe IfrboyrornlaR i IL am amadees; 14% CAA manamo>iarLZ7fl jertd tic Wa aandaddoe»otMabaDbr 0ladwrfianoamM a. Npmartdeoeres NSA 04W loft us Ond EBCti,F, aa-Io4QAra. cmtrsemtsptaaaamb r 9.$on rOtaypY tb[awpyatorvem eond6a11sOMk Ipaaas/addnraa b. PlmRonxatict -- c. Amoimidbardi f1 a 1/ndoa NgrPand addoma t Fbr&=wWn ftftdFlortft - - eaMdyOierrl oaarbopaodcSiota xdmoB IrImbe turtOMVe dbysefto}1s1l Roddy Z Naaeaadsdarap b. Plmrraauadahsolddasaooec a a, to addX mllnaa K 0iaMa=py aldm ihb Haldo as araAAdedb7f7.1af11RA. iio bbQ6M ila EmemondMofuoftdcoc= pmmw Fampow dab' You*mftd*CN wr ply ad3WWdmb is " IthIbm apaxpilow- sta. d F-Torid.a-L _COMW t W )I-S6co nm etsemamlem. bronaau'`'y Mat LaY fe TVl2 ef ap® w l aflidlc iLLle6lFm _%- t°f a F+ tioO Mrmao_. 09_ _V—/ Woft dlD Tlpd IDvroacroed. 4AI4 voCubcmqpcmxcp rfaa3vAD4W ONE WAY REMODELING LLC 2665 North Atlantic Avenue, Suite 331 Daytona Beach, FL 32118 386)643-0579 License# CCC1327237 • LicenseN CBC 1254997 ROOFING - SIDING - GUTTERS - DECKSn To: n Q doCounty: P'01 fDate: Z! X Address: . C/ IX/ e 6' Daytime Phone: I' /' / City: ^ State: /- f zip: g?33 Evening Phone. `i 4/6 Email: ,D azY &ozi Cell Phone: ADDENDUM TO THE INSURANCE ALLOWANCE AGREEMENT DATED One Way Remodeling, LLC: SHALL FURNISI I ALL MATERIALS AND ALL WORK DONE: SI IALL l3 : ERt RMED IN A WORKMANLIKE MANNIER FOR WORK SPECIFIED ON PREMISES LOCATEDABOVE. DESCRIPTION OF WORK AGREED ON: One Way Remodeling, LLC hereinafter (THE COMPANY) will complete all of the insurance prescribed repairs in the insurance lass statement 1'or thefull price of the insurance proceeds plus any ad iti plements that could be incurred. The Company will install a new roof to the home r/ol[P /d dr 6npp1 super the insurance loss state ent. ' rhe Inan acturer ol'the shingles is ` and the color of the roof will be The style of the Shingles will be style. The color of the Drip Edge will be . The manufacturer's warranties will apply. We will install the roof to code. We will protect any landscaping as needed. We will clean around the bushes and shrubs. We will clean out the gutters of any roofing trash and complete a magnetic sweep of the yard. The company is entitled to all taxes, depreciation, permit and tarping reimbursements, supplement,, staged payments, and the full amount of the General Contractor's Overhead and Profit plus any additional insurance payments. All insurance payments will be paid to The Company or to On Time Construction of SW Florida upon request and receipt. Homeowner will continue to agree to display a job sign for the company until 30 days after the work has been completed. Public Liability Insurance is carried by The Componv and is perfnnned under contract. Work to A: perrurmed according to Company specifications. Debris from job will be removed and hauled away. Customer is responsible for all painting wad staining. All installations toe to he at The Company % discretion. All windows to be installed in existing headers. jams and sills. CommcnWOrnissions: Customer to allmv'I he Company to display job sign for 30 days after t.ompletion. All Decayed Non Strocwrnl WoodWill Re Replaced At An Additional S6.00/ fl. Any had plywood will he replaced at S60 a sheet on a I story and $70 a sheet on u 2 story for V., osb. To replace %- plywood it will he SRO a sheet on a I %fury and $90 a sheet on a 2 story. If it is over W12 pitch it will he an extra $I0 a sheer on top of the priorprice. Any Md rouf hoardsgetreplaced at S6 a lord rivet. All work is to he as spceili d. Allwork is to be completed in a workmanlike manner according to standard pructices.'I his contract i% solid only with proper signature. 7 be Sellershall not be held responsible ror time and moteTial delays, strikes, acts orritd or any other muncrs beyond its control. Owner ugnxs that the equity in this property is security for this contract. Since this contract calls for made to order gotdw it is not wtilmi to cancellation. evcept as stated as above. All installations arc to be at the tickler's discretion. Vcftd promius can cause misundcrstardings, therefore this contract constitutes the entire understanding of the parties. and no understanding. collateral, eerhol. or otherwise. 511311 be bind' unless signed by both partics.'ntc Seller is to remove and haul away oil job related dchris. All soles and %counts allruted See rcvcrsc for nddWonal terms nod comet. Thnnl you Go your emicr — - Buyer Signature X Seller Representative X Buyer Signature X ONE WAY REMODELING LLC 2665 North Atlantic Avenue. Suite 331 Daytona Beach, FL 32118 386)643-0579 License# CCC 1327237 • License# CBC 1254997 Owner / Buyer: V I(M6& /- L"T' to Date: Address: 9 .— Ph (1.1): City/State/zip: 3 Ph (W): Email: Cell:' PECIFICATIONS FOR LABOR AND MATERIAL TERMS AND CONDITIONS One Way Remodeling, LLC hereinallcr (TI IL COMPANY) The following are items we think may be covered by your insurance company. Our contract is to complete the repairs approved by your insurance company. Ifony ofthe items that we torte as damaged are not approved, it does NO I' void our contract to complete the rut of the approved rc trs.) Tear Off_ layers Recover Roof with _ Color of Shingles Install lb. Felt Plumbing/RoofJacks Writs Ridge orTurtle Ycar(s) Manufacturer's Limited War nmty Color of Drip Edgc r! /_ EXTRA WORK / Protect landscaping where needed V Clean around bushes and shrubs Clean out gutters and roofing trash only Z Magnetic sweep of yard after job is complete Siding: Gutters: Windows: Additional Information: INSURANCE ALLOWANC9 AGREEMENT THE COMPANY will invest its time and expertise in assisting the homeowner with insurance claim. Terms for insurance work ifapplicablc: This agreement is for the fill scope of insurance replacement cost proceeds and does not obligate the homeowner or TI IE COMPANY unless repairs are approved by the homeowner's insurance company. By signing this agreement, the homctn%ner authorizes THE COMPANY to pursue all repairs at a price agreeable to the insurance company and THE COMPANY at no cost to the homeowner, except for the insurance deductible. The final price agreed upon between the insurance company and THE COMPANY shall become the final contract price ofthe full scope ofinsurance proceeds and is subject to the most current Xactimate pricelist for when the work is performed including General Contractor's overhead and profit. THE. COMPANY. One WaY Remodeling. LLC. or On Time Construction ofSW FL is autbor¢ed to work with my insurance conymaty and mortgage connpanv trganiong all malterc pertaining to rho insurance chtim. including nntyfinancial infn•mation or escrow accounts an(1payment disbursements on the claim apon ntv hebal/ro ger this claim set!!edpmnrptlr. ACCEPTANCE OF CONTRACT THE COMPANY is hereby authorized to perl'onn at their discretion all insurance prescribed repairs for the price ofthe full scope ofthe insurance proceeds. We will complete only the work approved by the insurance company. The terms and specifications stated, I hereby, authorize my insurance company and/or mortgage company to make payment li)r complete repairs directly to THE COMPANY. TIIF, COMPANY is entitled to all taxes, depreciation, permit and tarping reimbursements, billable supplements or staged payments and the lull amount of General Contractor's Overhead and Profit and any additional payments from the insurance company. Insurance Company: (,!-PC Policy# r 1 H V 3 T7057' o Insurance Company PH: ($'$' - ZS(P- .3%ii Claims: 0019 rl-Q9OZS% Insurance Agent: Insurance Agent Address: Agents Ph: Mortgage Company/Address: dl ) aCJ P Q llpx. D Q Z I Mortgage Company Ph: (1/00 Loan#: /C)Qq& 33 /N S Z[p Customer agrees to display THE COMPANY's job sign on their property until at least 30 days alter all insurance repairs are complete: Customer agrees to hold TI IE COMPANY harmless for any of the following: Manage ofany kind, caused by any third party service provider. such as dumpsicr companies or,(tcrialysuppliers. Any damages caused by vibrations, ic. falling pictures, or light fixtures, small cracks or nail pops in drywall. Initial(s) n T THE COMPANY will clean up and remavc all job related debris including anylsalvage -material (siding, guttcrs and / or downspouts and awnings). All salvage material becomes the property ofTIIL= COMPANY. Initials) The Customer agrees that all work will be performed at the Company's discretion. Initial(s) The Customer agrees to pay the Company or On Time Construction ol'SW FL their initial check for the Actual Cash Value amount as a good faith deposit for the work to be performed and any additional payments from this insurance company on this claim are to be paid upon receipt. Initial(S) aIZ41V- The Customer grans permission to THE M n HE COMPANY or On Time Construction ofSW FL to negotiate settlement oni:rs and supplements with the insurance carrier. h)ilial(s) A The Customer authorizes Customer's insurance and mortgage company to make checks payable to 77IL COMPANY or On Time Construct: ofapplicahi and mail them directly to One Way Remodeling, LLC, 2665 N. Atlantic Avenue it 331. Lbylona Beach, FL 32118. Initials) You may cancel this contract at any time before midnight on the third business day. See the attached notice ofcancellation form for an explanation of this right. SUILIECTTO OTHER TERMS ON TIIF, REVERSE SIDE. ACCEPTANCE BY OWNER/BUYER:(J e,& p4 i " n DATE: q ZtY ACCEPTANCE BY OWNER/BUYER; DATE: This Contract agreement respectfully submitted by DATE: City of Sanford Building and Fire Prevention Product Approval Specification Form Permit # Project Location Address 229 C\ N6 s CAa \ e Qvrj SWArr^ IF L ,3Z-77 ) As required by Florida Statute 553.842 and Florida Administrative Code 9M-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.floridabuilding.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 Gt n V- Underla ments 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 / Coatinci Liquid Applied Roofing Systems Roof Tile adhesive Spray Applied Polyurethane Roofing E.P.S. Roof Panels Roof Vents Other hme 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 B. New Exterior Envelope Products Applicant's Signature Applicant's Name RA z'c-\ Q-1sY 1 Please Print) June 2014 LINUTED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: (o - S —1 Ice I hereby name and appoint: ''y*nP t I I'GIS an agent of: {' 0 o \M 4' l e rloC1.1 t nu LC_ 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 perTit and application for work located at: Address) Expiration Date for This Limited Power of Attorney-. License Holder Name: A NaxY tiX?w 2l: State License Number: Signature of License H STATE OF FLORIDA COUNTY OF Ile - The foregoing instrument was acknowledged before me this 5tnay of , 200LR_, by Tt1 Ma irtp'A who isXpersonally known to me or o who has produced identification and who did (did not) tal% an oath. Sign tore Notary Seal) Ny c lt'\Scn Print or type4wne o;;iY '"• CORTNEvDNELSONNotaryPublic -State ofFloridallotary Public - State of V\pC r%\ CO-Misilon. GG 13399e Commission No. F? I QSl MycoT as es %413.2021 NIY Commission Expires: e:rd:: tFr ,F H otai Rev. 08.12) CITY OF MEW 1W SkNFORD Building & Fire Prevention Division FIRE DEPARTMENT Re -Roof Permit Card PERMIT NO. 8 QJ%T ISSUE DATE: CONTRACTOR: n Qr W C, e JOB ADDRESS: a Al C Noiesda-lc- Cve TYPE OF WORK: Loa ap 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 L I 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 PUBLICRECORDSOFTHISCOUNTY, 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 111 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 SXRFORD Building &Fire Prevention Division RESIDENTIAL RE -ROOF POLICY& PROCEDURES r'•IRE DEPARTMENT 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 CONDomngR M) 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 (OROWNER/BUILDER) SIGNATURE: a Q r Y DATE: June Sr 20t4{ CIITYYOFF S,ki4FORD PERMIT # Building & Fire Prevention Division FIRE DEPARTMENT RESIDENTL4L RE -ROOF SCOPE OF WORK JOB ADDRESS: 22`1 0-1 6 e-ez Gr a7 11 STRUCTURE TYPE: (!j'*SINGLE FANIII.Y RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENTICONDOMINIUM RE -ROOF TYPE: 'REPLACEMENT (TEAR OFF EXMWG ROOF AND REPLACE WITH NEW COMPONENTS) O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF) DECK TYPE (PLEASE SPECIFY): PLEASE Nom ONLYI00 SQUARE FEET OF THE EXISnNGDECKIsPERM=D TO BE REPLACED** ROOF VENTILATION: J OFF -RIDGE 0 RIDGE OSOFFrr OPOWERED VENT OTURBOMS SKYLIGHTS: O YES 0NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL M MAIN ROOF AREA ROOF SLOPE: O LESS THAN 2:12 0 2:12 - 4:12 12 OR GREATER TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT 1 SHINGLE cAPPROVAL FL# O MET,u, FL# O MODIFIED BITUMEN FL# O TORCH DOWN FL# INSULATED FL# Tnz FL# O OTHER: FL# ROOF EXTENSIONS (PORCHES. PATIOS. ETC.) **IPAPPLICABLE** ROOF SLOPE: O LESS THAN 2:12 0 2:12 - 4:12 0 4:12 ORGREATER TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL O SHINGLE FL# O METAL FL# O MODIFIED BITUMEN FL# OTORCH DOWN FL# OINSULATED FL# O TILE FL# 0OTC: FL# CITY OF JIS e OBuilding & Fire Prevention Division 1 jj D RESIDENTIAL RE ROOFAFFIDA VIT FIRE DEPARTMENT RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT NAILING, SHEATHING, DRY-jN, FLASHING, AND ALL FINAL ROOF COVERINGS PERMIT M ADDRESS: 'I S \ L Z11 I R DMA N- Y `H—k . AS A(N) GENERAL, BUD -DING, RESIDENTIAL, OR ROOFING CONTRACTOR, ENGINEEIt;'ARCHrrwr, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE FOREGOING INFORMATION IS TRUE AND ACCURATE AND THATALL ROOFING COMPONENTS LISTED ON THE SCOPE OF WORK ATTHE ABOVE REFERENCED ADDRESS HAVE BEEN INSTALLED IN ACCORDANCE WITH THEIR PRODUCT APPROVALS AND ALL APPLICABLE CODE REQUIREMENTS — SPECIFICALLY FLORIDA BUILDING CODE, EXISTING BUILDING. IN ADDrrION I CERTIFY THE INSTALLATION MEETS ALL REQUIREMENTS FOR SECONDARY WATER BARRIER AND NAILING OFTHE ROOF DECK, IN ACCORDANCE WITH THE HURRICANERETROFIT MANUAL REQUIREMENTS (BASED ON F.S. CHAPTER 553.944). LICENSE #: V P COMPANY / CONTRACTOR. ' Y\C VVAL\I CONTRACTOR SIGNATURE: DATE: (p' C15 O MUST BE SIGNED BY LICENSE HOLDER OR O "D ) A FINAL ROOF INSPECTION IS REOUIRED: 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, FLASMG, DRIP EDGE ATTACHMENT) WITH THE PERMITNUMBER 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 <tel \ kr)CA C Sworn to and Subscribed before me this ;" day of ,-\UA C. 20 _]'j6y: Who is' QTersonally Known to me or has D Produced (type of identifica) 4n) as identification. gnat u a of Notary blie -t State o Florida ,••:;:• . CORMI) NELSON Noterywic-% teofRorida 1 Commision/ GG133984 MyCpnm. LVizAug 13,2021 , ant/Type/ St p Name - e':rdthr ughllDUo Notiaryi\ssn of Notary Public