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HomeMy WebLinkAbout109 Andrews Rd - BR17-002909 -REROOF41(0-A 1 CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: 9 0 r Documented Construction Value: $ 7300 Job Address: 109 Andrews Rd Sanford FL 32773 Historic District: Yes No 0 Parcel ID: 18-20-31-503-0000-0640 Residential 0 Commercial 11 Type of Work: New Addition Alteration ® Repair Demo Change of Use Move Description of Work: reroof Owens Coming FL 10674-R12 Techwrap FL17194-Rl 27 squares 7/12 pitch Supreme Brownwood 25 year warranty Plan Review Contact Person: Rachel Holcomb Title: Admin Manager Phone: 407-278-7788 Name C Robert Jones Jr Street: 109 Andrews Rd City, State Zip. Sanford FL 32773 Name Donald Bouchard Street: 3203 S Conway Rd City, State Zip: Orlando FL 32812 Name: Street: City, St, Zip: Bonding Company: Address: Fax: 800-337-3361 Email: permit@jasperinc.com Property Owner Information Phone: Resident of property? : Contractor Information Phone: 407-278-7788 Fax: 800-337-3361 State License No.: CCC1331153 Arch itect/E ng 1 neer 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: 51 Edition (2014) Florida Building Code Revised: June 30, 2015 Permit Application rq9-('> 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 ofthe property of the 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 co r struction 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. Signature of Owner/Agent Print Owner/Agent's Name Date Signature of Notary -State of Florida Date Owner/Agent is Personally Known to Me or Produced ID Type of ID Q--aQ-1-1 Date ANA CHAVEZ rroState of Florida -Notary Public Commission # GG 112152 My Commission Expires u+ June 06, 2021 Contractor/Agei}t is Personally Known to Me or Produced ID V Type of ID _ BELOW IS FOR OFFICE USE ONLY Permits Required: Building Electrical Mechanical Plumbing Gas Roof Construction Type: Total Sq Ft of Bldg: Occupancy Use: 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 Fixtures, Fire Alarm Permit: Yes No WASTE WATER: BUILDING: Revised: June 30 2015 Permit Application THiS INSTRUMENT PREPARED BY: Name. JASPER CONTRACTORS Address: 3203 S CONWAY ROAD SUITE 201 ORLANDO, FL 32812 NOTICE OF COMMENCEMENT 4\tn"lCb Permit Number. Parcet ID Number. its - L(b -- 51 — 3 - xo i liiill iilli lilll liiil lilil Illil Illlliil GR(IHT MFILOY, SEMINOLE COUNTY CLEi,Y, OF CIRCUIT COURT & COMPTROLLER It ;1,77 h'g 6-51 (1r'gs) CLERK'S 4 2017097888 RECORDED 09/27/2017 12:55:36 PM RE0,11,"iING FEES $10.00 RECORDED NY hdevore The undersigned hereby gives notice that Improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, thefollowinginformationisprovidedInthisNoticeofCommencement. 1. DESCRIPTIONpQ PROPERTY: (Legal description of the property and street address it available) 2. GENERAL DESCRIPTION OF IMPROVEMENT: z RE -ROOF 3, OWNER I addres N O ES`S, SEE,,It t1RMA> t PE LES'E CONCONTRACTEDzED F i l `PeRO SN CNameandaddress• Y ,, ' t (l tit Interest in property: OWNER Fee Simple Title Holder Or other than owner listed above) Name; Address: 4. CONTRACTOR: Name: JASPER CONTRACTORS Phone Number. 407-278-7788 Address: 3203 S CONWAY ROAD SUITE 201 ORLANDO FL 32812 S. SURETY Of applicable, a copyofthe payment bond is attached): Name: Address: Amount ofBand: 8. LENDER. Name: Phone Number. Address: 7. Persons within the State of Florida Designated by Owner upon whom notice or other documents maybe 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(i)(b), Florida Statutes. Phone number. 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 THE JOB SITE BEFORE THE FIRST INSPECTION, IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEYBEFORECOMMENCINGWORKORRECORDINGYOURNOTICEOFCOMMENCEMENT. SlgneturaorOwnerarla e,erOvme/aortessee's(PrWNomeand provide stgnatorysTldelOt6ce) AugwdxedORradRinedet/PaMerftnager) t p Stateof`\ `) N"'N County of, The foregoing instrument was acknowledged before me this day of ,rr C .20 \-I by ` "-' ` Q < Who is personally known to me O OR NameorpersonrmYingstotemantwhohas produced identification l r type of Identification produced: _, -- rN ANA CHAVEZ s Staie of Florida -Notary Public E Commission # GG 112162 My CommissionExpiresMllJune 06, 2021 LtMCitlC r . t 1 L4 i"4 i tS4: t r` pateScanned by CamScanner 5380 F. Colonial Dr. Orlando. 1-1_ 32W 3203 ConAay Rd, Ste, 201 Orlando, FL 32812 407)279-, tC p',W1337-33n1 Fa\ Into t.t;t,ctin( or. MM V15A Cr Addiess: ` 9999M64 JASPER 1=i_ i; antra tot'; i urns: ROOF RL 1'1 1('1'N1l'N court \1 ,•.::•: nlltvl 1 Itti,1ita t' t inyr>;,t'l' Nl, rtil-airzCann'ut 1111kAM111,11a i Lmn \uttit,ct + MI sWILIc y,;twfc F, k t Ft'\ lmr u+t I. „tIttact .Pncc Prip age colot. If ON% '; Insurance CompsinN doci not agrec to 11113 ' d full roof renjaccuient- this contract I Assignment of insurance Benefit. for the Full Rotif Rcplacemcot Onyl: 1 hc,rt- .+.,,kn aft, and all insivance rrliits, t%Mcft:. AM prtrtly- ttewia erne applicable insurance policies to Jasper ('rntractem in( l 'laspa" 1, the : ,,pc of which .hall be Itnutel to., 1-till goof R,pU,,c cn1 1 nukC thta a r ttttrc ,t and authorization in .vnsidemttm of Jaspm c7's agicccnttopal:,rtit se yut;. suppl\ 11"le".1s and oil'er,\t;c perEotm its ohhwsrgas t% M t}tt; t' tr t wN includingnot requiring full payment at the time of serttce. 1 also hcrcb% direct my a cttrcctsl to release art) Al it all inftr'niha1 rcyutextii Jaapsr. represcrttati.e(s). for the direct purpose of obtaining actual benefits to be paid by my instaci-t;l (i,r scr\icea rc-ndcscd IT, tht, trgerl. I Hatt= QUpn&': rights- If payment is made directly to Lite caner ;\cart InaurCvi(.), it shall he endorsed v cr to Jasper Immediately ttpea, rr~e,pt 1 4pec thin ,aw. portion of work. deductibles. betterment tr atiiitit,ttal ,tort requC;ttci by the understgncvi. not tv\cnd by'nstaalIcc, must be paid ty the ttn.Iaa v'tN on the eta. , t installation.r' Deductible: It is theowner's resron;ibtlas to Dery all tneurancr deiucti les (A\te r's cult-of•p cka cspe-tt r will notcaveei the e Mi , ihtt amotmt. as stated on insurer's loses sheet lthe "Loss Sheet"), L \LESS replace%" repau of dttcntruc 1 do l uiR a re}aired M .vets and,v teener tnitx sts optional upgradm JasperCANNOT pa}. rebate. or promise Ili pay-, \saitr or rebate any tit- all of theinsurance dct tittle apt+Ii'-swc to dw msttrsrice claim for payment of \\ ort, jin the cwtit of a dtsacptncy, the dolumbic aitmwrt seitci t„t the o:,urtz > dos, Shot all ot,rrrnle itia he amount disclosed. Deductible: S i l < < MUST BF. PAID IN FULL. I'Ll'S :\Pill 1( _\RI I S,\l US T.\\ MORTGAGE: AFMORIT_•\TION. 1. C1\ ttieT \Itxleigar, cnuu aut}tttrvauon , . C e' ! "L — lo gat to yraA atth Jasper on marten mcludtne but not limited to, the claim and drat, status. • 1 C Cl ' (initial} P:\t \lE'\ 1 St'Il! hl 1 t r.t,tnp at'iCCM ,` pa,Jaspe s,bisedon the fallo\\,ng schedule-(i) Dcposu cat the amount ofS (tiler pvt siHnut} d i te'.' e .c t',rxaa t ycr. y less the Deposit and an% applicable dtpreciation retamel by Owner's insitrats) plus UpErade cer., clue alit pa\abtc to 1LIv^t ulvo "otttpietim of volt" being performed and (nil the rcm.immg Contract Puce (tqual to Inn apl hcable deprctitatuit and or cltangc orders) due and payable to Jaq,n upv completion of aork performed. can tits etcnt of a pending Inspection. no more than :10 of Contract Price m.%\ iv \yitltheld tatti# to lx\Yxt"i hi. puUai PR1Ci 7111AL S Optional: UPGRADE fli\i's pprottl and subitct to the Tcrins and londinexis hcreui, 1asila apvc, to tirmsh all matetals an- d ReplacWork and Price: UponmuirprovidethelabornecessarytoperformthefullrtwCreplacementWitchshalltakeplacefollo\\ing 0vmcr's instaancc ctvupany's appro\tii, arlvvyintti.l\ ithin 30 days, conditions permitting Onner's Declaration of intent. Cluticr achno\yltvil rs and aErccs that, t1'' \ aps,t.,.al M tnatri t,e .vtinp n tux a full chiefreplaccment. Jasper shall perform the rotif replacement IV" rdeipt of ftuui< fn,m O"nays a»tttx"cc contl+^ FLORIDA 11011FOWNERS' CONSTl'('VION R1'.C(lt'E'R1 FI \1) PAY{F:\T, I'll TO A LIMITED :\lOt l , NIA1 RF .\\ :Ul. \l1l 1' FROM 11{F Fl ORID \ 1{O\1FO\\ \"I'v' CONSTRUCTION RECO\"ERY FUND IF YOV LOSE NION V Y ON :\ PROJh_CT l'FRFOI:Nit' D 1 \1IFR C'(1\ It, \( 1, YHERE THE LOSS RESULTS FROM SPECiFIED \ IO1_\1 It)\S 01: 1I.O121D \ I \\\ R1 \ 1 It t \Sl D C (t\ 1!t \( i OR. FOR INFORMATION ABO11'l'HE RECMERi" 1 1 \D A\D Fll.l\(:.\ ('1..\l\1, ( (1\ 1 \C i lilt CONSTRUCTION l 'DUSTRY LICENSING HOARDARD Al' 7111• FOLIA)\\ I\l 11.1 F1'11O\I \i M11FR A\D WIM SS: Construction Industry Licensing hoard: 2601 Blairstonr Road, fallah tssee, 1'1 3231)13-11134, (S50) 487•1345 CANCELLATION: if Owner elects to terminatetheservicesofJasper. Otyner urn} do sit before midnight tilt the third buiine;e day after Contract is executed. Owner shall receive a full refund of all deposits. Otytcr` nuly' aka rrsrind ('oi'tra 1 beritn mithtigbt an ay after the contract is executed after notification front insurers) that the claim f"r paymeol tin r-txtf etytilra(t Itns the third business d been denied, in whole or in part. All written not of cancellation, regardless of reason, shall he po<tntarl.ed or deli, to corporate office: 1690 Roberts Boulevard. Suite 112,`Kennesaty, GA 30144. CANCt LIA11O\ FWFI'IIONS'- The three (3) diiy right of cancellation DOES NOT APPLY to contracts for emergency home repairs as time is "f the essence. I, oth part Owner, have read and understand all statements, Terms and Conditions of the "Roof Replacemrnl t ttittrrct" wid itgive that all details are acceptable and satisfactory. I further understand that this Contract can<titutrs the entire nI tren'ent lictt,a the ny further changes or alterations to this Contract "lust he made in writing and agreed till"'[ h' b parties and that 'ai ec, p p the other that ithas the full power and authority to enter into the contract anti that it 'k arty represents Each and warrants to bindingandenforceableinaccordanceit'ith its terms. 7 cu tic ax rt ed Jaspek• iepresentatiVe Date Scanned by CamScanner LMTED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: 09-29-2017 I hereby name and appoint: Rarla Almodovar, Skylar Amkraut, Ana Chavez, Gina McDonald & Rachel Holcomb an agent o-E Jaqw cDnvacto s Numt orgy) to be my lawful attomey--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): XThe specific permit and application for work located at: 109 Andrews Rd Sanford FL 32773 S— Address) Expiration Date for This Limited Power ofAttorney. 01-01-2018 License Holder Name: Donald Bouchard State License Number. ooct-3"53 Signature of license Holder_ STATE OF FLORIDA L COUNTY OF sei,,;no+e The forep-oing instrument was acknowledged before me this 29 day of September 200 17 by owgid Baud xd who is a personally known to me or at who has produced a- as identification and who did (did not) take an oath. Signature 04otary Seal) QarArnkraut Print or type name liltlh/ 1SKYLARBAMKRAi1T Commission rr FF 1271390 My Commission Expires June 01, 2018 S.w>. Rev. 08.12) Notary Public - State of FL Commission No. 127890 My Commission Expires: s/1/2018 Scann(-ri by CamScanner 9/29/2017 SCPA Parcel View: 18-20-31-503-0000-0640 Property Record Card i4a Parcel: 18-20-31-503-0000-0640 Owner: JONES C ROBERT JR & LUANN S Property Address: 109 ANDREWS RD SANFORD, FL 32773 VITO, 3 Y M E 71ZIR Seminole County GIS Legal Description LOT 64 ROSE HILL PB 54 PGS 41 & 42 Taxes Value Summary 2017 Working Values 2016 Certified Values Valuation Method CostfMarket Cost/Market Number of Buildings 1 1 Depreciated Bldg Value 115,183 104,937 Depreciated EXFT Value 14,776 15,443 Land Value (Market) 30,000 27.000 Land Value Ag Just/Market Value " 159,959 147,380 Portability Adj Save Our Homes Adj 53,728 43,334 Amendment 1 Adj P&G Adj 0 0 Assessed Value 106,231 104,046 Tax Amount without SOH: $2,140.00 2016 Tax Bill Amount $1,272.00 Tax Estimator Save Our Homes Savings: $868.00 TRIM Notice Help Does NOT INCLUDE Non Ad Valorem Assessments Taxing Authority Assessment Value Exempt Values Taxable Value County General Fund 106,231 50,000 56,231 Schools _ _......_._._.-_._ 106,231 25.000 81,231 City Sanford 106,231 50,000 56,231 SJWM(Saint Johns Water Management) 106,231 50,000 56,231 County Bonds ^ -- __..•._ 106,231 50,000 56,231 Sales Description Date Book Page Amount Qualified Vaclimp CORRECTIVE DEED 12/1/2002 04621 1913 100 1No Improved WARRANTY DEED 10/1/2002 04563 0494 149,900 Yes Improved WARRANTY DEED 8/1/2001 04184 0796 166,300 Yes Improved SPECIAL WARRANTY DEED 9/111998 03496 1 9 1,456,500 No Vacant Find Comparable Sales1 Land Method Frontage Depth Units Units Price Land Value LOT 1 30,000.00 30,000 Building Information s Bed/Bath count incorrect? Click Here. Description Year Built Fixtures Bed Bath Base Area Total SF Living SF Ext Wail Adj Value Rep] Value Appendages httpJ/parceldetail.scpafi.org[ParcelDetailinfo.aspx?PID=18203150300000640 112 PERMIT # o ! City of Sanford Building Division Residential Re -Roof Scope of Work JOB ADDRESS: 109 Andrews Rd Sanford FL 32773 STRUCTURE TYPE: Q 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 INSTALLED OVER EXISTING ROOF) DECK TYPE (PLEASE SPECIFY): PLEASE NOTE: ONLYI00 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED ROOF VENTILATION: OOFF -RIDGE O RIDGE O SOFFIT OPOWERED VENT OTURBINES SKYLIGHTS: O YES ONO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #: MAIN ROOF AREA ROOF SLOPE: O LESS THAN 2:12 O 2:12 — 4:12 ® 4:12 OR GREATER TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL Q SHINGLE owens coming FL# 10674 O METAL FL# O MODIFIED BITUMEN FL# O TORCH DOWN FL# OINSULATED 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# O OTHER: FL# 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), certifyin FBC code comp 'an a by personal inspection. CONTRACTOR (OR OWNERBUQ.DER) SIGNATURE: DATE: v r}City of Sanford Building & Fire Prevention Division J C I J 0- Re-Roof Permite , t . PERMIT NO. 1 i e CONTRACTOR: J a JOB ADDRESS: 1-014, ISSUE DATE: I V 01 3 TYPE OF WORK: ®0 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: INADDITION TO THE REQUIREMENTS OF THIS PERMIT, THERE MAY BE ADDITIONAL RESTRICTIONS APPLICABLETO 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 City of Sanford Building and Fire Prevention RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS PERMIT#: ` -171 - 10 —( V 1 ADDRESS: 10 awbra F i L-m j 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 THEIRPRODUCTAPPROVALS 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 #: U-C i b J I I C COMPANY/CONTRACTOR: CONTRACTOR SIGNATURE: / DATE: MUST BE SIGNED BY LICENSE HO R UII 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 a,ww-f_ . Sworn to and Subscribed before me this day of - 20 f by: iJ Co , Who is Personally Known to me or has 'roduced (type of identification) as identification. S SKYLAR B AMKRAUTSignatureotaryPuIcCommission #t FF 127890 State of or da A= M , S ar Amkraut o My June ssion Expires E°F June 01, 2018 Print/Type/Stamp Name of Notary Public