HomeMy WebLinkAbout402 S Summerlin Ave - BR18-004777 - REROOFCITY OF OE I
PERMIT APPLICATION
M
BUILDING DIVISION
Application No: '7 7
Documented Construction Value: $ C)
Job Address: e r) Historic District: YesF] No
Parcel ID: 77 Residential Erc-0-1n--mercial 11
Type of Work: New 2-Addition El AlterationF] Repair El DemoEl Change of Use E] Move El Description
of Work: j 0C roo A , Plan
Review Contact Person: 1+7wrDt Dc' I (f 15 Title:—()"(; V) Phone:
t+62- 3 () L9 q q c Fax: Email: Property
Owner Information Name
Phone: Street:
Aye- Resident of property?: City,
State Zip: ; Z--? 7 1 Contractor
Information Name
I-A-CAV"(W el Street:
Lf6l- ( , Ayt- City,
StateZip:- 1:7 -11 Name:
Street:
City,
St, Zip: Bonding
Company: Address:
Phone:
9 0_7 - 3 () L _"I Ll 11 1 6 Fax:
State
License No.: 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 apermit 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
N(yI' 'G: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public
records of this county, and there may be additional permits required from other governmental entities such as water management districts, state
agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
The City of Sanford requires payment of a plan review fee at the time of permit submittal. A copy of the executed contract is required in order to
calculate a plan review charge and will be considered the estimated construction value of the job at the time ofsubmittal. The actual construction value
will be figured based on the current ICC ValuationTable in effect at the time the permit is issued, in accordance with local ordinance. Should calculated charges
figured off the executed contract exceed the actual construction value, credit will be applied to your permit fees when the permit is issued. OWNER'
S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be done
in compliance with all applicable laws regulating construction and zoning. Signature
of Owner/A gentDate Print .
wjier(Agent sName y Signature
of Contractor/Agent Date Print
Contractor/Agent's Name Signature
of Nota on a RNNETttDtB tRtida Signature of Notary -State of Florida Date Y
P, Pubtic -State of F 060623Commission #
GG n 16, 2018 E • ,Aires Ja aPMYmm. Owner/
Agent i "' , 4l "so e or Contractor/Agent is Personally Known to Me or Produced
ID ype of CommID Produced ID Type of ID BELOW
IS FOR OFFICE USE ONLY Permits
Required: Building Electrical Mechanical Plumbing Gas Roof Construction
Type:_ Occupancy Use: Total
Sq Ft of Bldg: Min. Occupancy Load: New
Construction: Electric - # of Amps Fire
Sprinkler Permit: Yes No # of Heads APPROVALS:
ZONING: ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Flood
Zone: of
Stories: Plumbing - #
of Fixtu Fire
Alarm Permit: Yes [-]No WASTE,
WATER: BUILDING:
CITY OF
Building & Fire Prevention DivisionS.,kN 'FORD RESIDENTIAL RE -ROOF POLICY & PROCEDURES
FIRE DEI'ARTrr1ENT
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)
a SHINGLES INSTALLED, NAIL PATTERN AND LOCATION OF NAILS
SKYLIGHTS (IF APPLICABLE)
o DIGITAL PHOTOGRAPHS SHOWING ALL INSTALLATION COMPONENTS, PER FL PRODUCT APPROVAL
a 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:
PERMIT #
City of Sanford Building Division
Residential Re -Roof Scope of Work
JOB ADDRESS: 0 z- (;, [-kt SCh Y` o -J, 1 L _ L7-7
STRUCTURE TYPE: SINGLE FAMILY RESIDENCE/TOWNHOUSE 0 MOBILE HOME Q APARTMENT/CONDOMINIUM
RE -ROOF TYPE: XREPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
Q RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY):
PLEASE NOTE: ONL Y 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED
ROOF VENTILATION: DOFF -RIDGE 0 RIDGE QSOFFIT QPOWERED VENT
SKYLIGHTS: x YES ONO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: Q LESS THAN 2:12 Q 2:12-4:12 Q 4:12 OR GREATER
QTURBINES
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
10 SHINGLE FL#
Q METAL FL#
p MODIFIED BITUMEN FL#
Q TORCH DOWN FL#
p INSULATED FL#
O TILE FL#
Q OTHER: FL#
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IFAPPLICABLE**
ROOF SLOPE: Q LESS THAN 2:12 O 2:12 - 4:12 Q 4:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
Q SHINGLE FL#
Q METAL FL#
O MODIFIED BITUMEN FL#
0 TORCH DOWN FL#
QINSULATED FL#
Q TILE FL#
Q OTHER: FL#
OWNER BUILDER STATEMENT/AFFIDAVIT
Altamonte Springs, Casselberry, Lake Mary, Longwood, Oviedo, Sanford,
Seminole County, Winter Springs
Florida Statutes are quoted here in part for your information to indicate the authority for exemptions for
homeowners from qualifying as contractors and to express any applicable restrictions and responsibilities.
OWNERS MUST PERSONALLY APPEAR AT THE BUILDING DIVISION TO SIGN THIS DOCUMENT
BY SIGNING THIS STATEMENT, I ATTEST THAT: (Initial to the left of each statement)
I understand that state law requires construction to be done by a licensed contractor and have applied for
an owner -builder permit under an exemption from the law. The exemption specifies that I, as the owner of
the property listed, may act as my own contractor with certain restrictions even though I do not have ari( license.
i
I understand that building permits are not required to be signed by a property owner unless he or she is
responsible for the construction and is not hiring a licensed contractor to assume responsibility.
I understand that, as an owner -builder, I am the responsible party of record on a permit. I understand that I
may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed
in his or her name instead of my own Iname. also understand that a contractor is required by law to be
licensed in Florida and to list his or her license numbers on all permit and contracts.
I understand that I may build or improve a one -family or two-family residence or a farm outbuilding. I
may also build or improve a commercial building if the costs do not exceed $75,000. The building or
residence must be for my own use or occupancy. It may not be built or substantially improved for sale or
lease. If a building or residence that I have built or substantially improved myself is sold or leased within
in I year after the construction is complete, the law will presume that I built or substantially improved it
for sale or lease, which violates this exemption.
1 I understand that, as the owner -builder, I must provide direct, onsite supervision of the construction.
I understand that I may not hire an unlicensed individual person to act as my contractor or to supervise
persons working on my building or residence. It is my responsibility to ensure that the persons whom I
employ have the licenses required by law and by city ordinance.
I understand that it is a frequent practice of unlicensed persons to have the property owner obtain an
owner -builder permit that erroneously implies that the property owner is providing his or her own labor
and materials. I, as an owner -builder, may be held liable and subjected to serious financial risk for any
injuries sustained by an unlicensed person or his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner -
builder and am aware of the limits of my insurance coverage for injuries to workers on my property.
I understand that I may not delegate the responsibility for supervising work to a licensed contractor who is
not licensed to perform the work being done. Any person working on my building who Is not licensed
must work under my direct supervision and must be employed by me, which means that I must
comply with laws requiring the withholding of federal income tax and social security contributions
under the Federal Insurance Contributions Act (FICA) and must provide workers' compensation
for the employee. I understand that my failure to follow these laws may subject me to serious financial
risk.
Rev. 9.14.2009
It
I agree that, as the party legally and financially responsible for this proposed construction activity, I will
d abide by all applicable laws and requirements that govern owner -builders as well as employers. I also
f
understand that the construction must comply with all applicable laws, ordinances, building codes, and
zoning regulations.
I am of aware of construction practices and I have access to the Florida Building Codes.
I understand that I may obtain more information regarding my obligations as an employer from the Internal
Revenue Service, the United States Small Business Administration, the Florida Department of Financial
Services, and the Florida Department of Revenue. I also understand that I may contact the Florida
Construction Industry Licensing Board at 1-850-487-1395 or at www.myflorida.com/dbpr/pro/cilb/ for
more information about licensed contractors.
I am aware of, and consent to, an owner -builder building permit applied for in my name and understand
that I am the party legally and financially responsible for the proposed construction activity at the address
listed below.
I agree to notify the building department immediately of any additions, deletions, or changes to any of the
information that I have this disclosure in the1JIrprovidedonor permit application package.
Licensed contractors are regulated by laws designed to protect the public. If you contract with a person
who does not have a license, the Construction Industry Licensing Board, the Department of Business and
Professional Regulation and the building department may be unable to assist you with any financial loss
that you sustain as a result of a complaint. Your only remedy against an unlicensed contractor may be in
civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an
individual or firm is injured while working on your property, you may be held liable for damages. If you
obtain an owner -builder permit and wish to hire a licensed contractor, you will be responsible for verifying
whether the contractor is property licensed and the status of the contractor's workers' compensation
coverage.
Property Address
Ay"cc" 1I` fc,- S , do hereby state that I am qualified
and capable of performing the requested construction involved with the permit application filed and agree to the
conditions sp iied above.
Signature of Owner -Builder
Form of Identification
Must be Photo ID)
Date
A violation of this exemption is a misdemeanor of the first degree punishable by a term of imprisonment
not exceeding 1 year and a $1,000.00 fine in addition to any civil penalties. In addition, the local
permitting jurisdiction shall withhold final approval, revoke the permit, or pursue any action or remedy
for unlicensed activity against the owner and any person performing work that requires licensure under
the permit issued.
Rev. 9.14.2009
CITY OF
Building & Fire Prevention DivisionSkNFORDRESIDENTIALRE-R 0OF A FFIDA VI T
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS ,
PERMIT #: ADDRESS: ' t f-A VIA 61 ry b tt E `¢
I 1-tC'V (- Ci J C O e-- o j _ , 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 / CONTRACTOR:
CONTRACTOR SIGNATURE:C GPGd DATE: ( { f
MUST BE SIGNED BY LICENSE LDER OR OWNER/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,
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 day of
identification)
Signature of Notary Public
State of Florida
Print/Type/Stamp Name
of Notary Public
20 by:
Who is Personally Known to me or has Produced (type of
as identification.
CITY OF
Budding & Fire Prevention Division
RESIDENTIAL RE -ROOF 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.
Timi 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. PRO,
JECTS 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. Ti-
ir.. FOLLOWING IS REQUIRED TO BE PROVIDE ONTHE JOB SITE: PERMIT
CARD, POSTED IN A CONSPICUOUS AND WEATHERPROOFLOCATION COMPLETED RESIDENTIAL
RE -ROOF SCOPE OF WORK COMPLETED AND
NOTARIZED INSPECTION AFFIDAVIT ALL FLORIDA
PRODUCT APPROVAL AND CORRF.SPONDING INSTALLATION INSTRUCTIONS PRODUCT APPROVAL
SHALL MATCFI WHAT is ON THE. SCOPE OF WORK) 0 DIGITAL
PHOTOGRAPHS (MUST INCLUDE Tt I I- PERMITNUMBER OR ADDRESS IN EACH I PICTURE) EACH PLANE
OF THE, ROOF, SHOWING THE UNDERLAYMENT INSTALLED ROOF DECK
NAILING PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER) ROOF DECK
NAILS USED (INCLUDING A MEASURING Dl,,-.VICI,', OR RULER SHOWING SIZE OF NAILS) UNDERLAYMENT PATTERN &
SPACING (INCLUDING A MEASURING DEVICE OR RULER) DRIP EDGE &
VALLEY ATTACHMENT (INCLUDING A MEASURING DEVICE OR RULER) SHINGLES INSTALLED,
NAIL PATTERN AND LOCATION OF NAILS SKYLIGHTS (IF
APPLICABLE) DIGITAL PHOTOGRAPHS
SHOWING ALL, INSTALLATION COMPONENTS, PER FL PRODUCT APPROVAL DIGITAL PHOTOGRAPHS
SHOWING ALL REQUIRED FLASHING, PER FL PRODUCT APPROVAL FAILURE TO
FOLLOW THESE SPECIFIC GUIDELINES WILL RESULT IN AN AFFIDAVIT PROVIDED BY A FLORIDA DESIGN PROFESSIONAL (ARCHITECT
OR ENGINEER), CERTIFYING FBC ('ODE COMPLIANCE BV PERSONAL INSPECTION. CONTRACTOR (OR
OWNER/BUILDER) SIGNATURE: 044 DATE:J-4—yj
PERMIT #
City of Sanford Building Division
Residential Re -Roof Scope of Work
JOB ADDRESS: t / ci +°'Y1f"C r (kt f l"+S CR t 1 C,;^ F e°'7"7
STRUCTURE TYPE: SINGLE FAMILY RESIDENCE/TOWNHOUSE Q MOBILE HOME 0 APARTMENT/CONDOMINIUM
RE -ROOF TYPE: ,REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE W[TH NEW COMPONENTS)
0 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: 10OFF-RIDGE 0 RIDGE QSOFFIT POWERED VENT OTURBINI"S
SKYLIGH"TS: x YES ONO IF YES, PLEASE PROVIDE FLORIDA PRODUCE APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE:: O LESS THAN 2:12 Q 2:12 —4:12 Q 4:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
SHINGLE FL#
Q METAL FL#
O MODIFIED BITUMEN FL#
0TORCH DOWN FL#
0 INSULATED FL#
Q T[LE FL#
Q OTHER: FL#
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IFAPPLICABLE**
ROOF SLOPE: 0 LESS THAN 2: l2 Q 2:12 —4:12 Q 4:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL.
Q SHINGLE FL#
Q MEFI'AL FL#
Q MODIFIED BITUMEN FL#
Q TORCH DOWN FL#
Q INSULATED FL#
Q TILE
EE1
FL#
Q OTHER: FL#
CITY OF
IF &FORD Building & Fire Prevention Division
RESIDENTIAL RE -ROOF AFFIDA VIT
F1tIl DEPARTMENT
RESIDENTIAL RE OOF INSPECTION AFFIDAVIT
NAILING,HE THING, DRY -IN, LASHING, AND ALL FINAL ROOF COVERINGS
x.,
PERMIT# 1,
M -77 -7 ADDRESS:
i } I AS A(NI CFNFRAI.. RI III.DiN(.. RFSIDFNTIAL_ 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 / CONTRACTOR:]
CONTRACTOR SIGNATURE: * ' Li( DATE: + i
MUST BE SIGNED BY LICENSE HOLDER OR OWNER/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,
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 RF 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 .0`-W- t
Sworn to and Su .. Subscribed before me this "day of -A r .11_ A,4- ,,4 20 by:
AL'rb, I A t Qt Who is Personally Known to me or has Produced (type of
identification) I as identification.
Signature of Notary Public
State of Florida
Print/Type/Stamp Name
of Notary Public
ANNETTE BLAND
Notary Public - State of Florida
Commission # GG 060623
My Comm. Expires Jan 16, 2018