HomeMy WebLinkAbout2308 W Lisa Ct; 18-3908; ROOFt,13FORb . 5 f
PERMIT APPLICATION
Application No: / c) --510')' Documented
Construction Value: $ 90 400 Job
Address: Historic District: Yes No In ParcelID:
Residential [ Commercial Type
of Work: New Addition yAlteration Repair Demo Change of Use El Move MoveDescription
of Work: eDO-1 Plan
Review Contact Person: I I 5,9 l Phone:
W - W-5933 Fax: Email: M %SS 12 @ X RCf L • COCO Property
Owner Information Name (
1 1 •IPe Phone: Street: =03
yJ tiso. Lot Resident of property?: "ICEs City, State
Zip- .."`, Contractor Information
Name %.. ,. L ....,,... _ ; ..:.,
r Phone: 11A, Street:
3AT0_&
Fax: 1 City,
State
Zip: CJ.1 L
3a
State License No.: W( 29116 6 Architect/Engineer
Information Name: Phone:
Street: Fax:
City, St,
Zip: Bonding Company:
Address: 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`s`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 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.
Signature of Owner/Agent
Print Owner/Agent's Name
Date Signature of Contractor/Agent Date
Prin ntractorlAgent's Fam`y .
Signature ofNotary -State of Florida Date Signature ofN
ANNETTE M BLANDC Notary Public - State of FloridaCommissionGG170900MyComm. Expires jan 16, 2022Owner/Agent is Personally Known to Meor ContractocrcecPM6n2H,)b1 iWW to Me or
Produced ID Type of ID Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas Roof
Construction Type: Occupancy Use:
Total Sq Ft of Bldg: Min. Occupancy Load:
Flood Zone:
of Stories•
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
CITY OF
ORD Building & Fire Prevention Division
RESIDENTIAL RE -ROOF AFFIDAVIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT ##: ADDRESS: U-5a Couxt
I 1 1 `f -me1W , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, ENGINEER, CHITECT, 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 #: l' o-t ,-)-C)O-\ \ wD
COMPANY / CONTRACTOR:
t `
CONTRACTOR SIGNATURE: DATE: (("\ ` 1 1 ao o
MUST BE SIGNED BY LICENSE HOLDER OR OWNER/BUII DER)
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 t`o and Subscribed before me this day of 20 by:
Who is' Personally Known to me or has Produced (type of
identification) as identification.
Signature of Notary Public RUTH-ANN ROBINStateofFlorida
11,610- ofNOTARY'
PUBLIC
STATE OF FLORIDA
IXn- Oj1 Comm#GG159793
Print/Type/Stamp Name Expires 11/13/2029
Notary Public
Grant Maloy, Clerk Of The Circuit Court & Comptroller Seminole County, FL
Inst #2018104782 Book:9209 Page:1565; (1 PAGES) RCD: 9/13/2018 11:59:15 AM
REC FEE $10.00
THIS INSTRUMENT PREPARED BY:
Name: ANGELA M. POPE
Address:
NOTICE OF COMMENCEMENT
Permit Number.
Parcel ID Number. 36-19-30-544-0000-0230
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.
1. RES RIPT19N9F_PR9 7Y:1Lslderition of the property and street address if available)
2. GENERAL DESCRIPTION OF IMPROVEMENT:
RE -ROOF
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT:
Name and address: ANGELA M. POPE 2308 W LISA COURT, SANFORD, FLORIDA 32771
Interest in property:
Fee Simple Title Holder (if other than owner listed above)
4. CONTRACTOR: Name: XRC, LLC Phone Number. 407-960-5933
Address: 4019 W 1St STREET, SANFORD, FLORIDA 32771
S. SURETY (If applicable, a copy of the payment bond is attached): Name:
Amount of Bond:
6. LENDER: Name: Phone Number:
Address:
7. Persons within the State of Florida Designated by Owner upon whom notice orother documents maybe served as provided by Section
T13.13(1)(6)7., Florida Statutes.
Name: Phone Number:
8. In addition, Owner designates
to receive a copy of the Lienot's Notice as provided In Section 713.13(1)(b), Florida Statutes. Phone number.
9. Expiration Date of Notice of Commencement (The expiration is 1 year from date of recording unless a different date is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT 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.
ANGELA M. POPE
PrintName and Provide Signatoys n¢e/Ot6ce)
County of 5emind
fledged before me this 7J — day of
who has produced Identification type of Identification produced:
2
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: a 0 8
I hereby name and appoint: m f nAG Rll`>1
an agent of: (ZC L-LC-
Name of Company)
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:
Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name:
State License Number: C'U' 7j q (fl
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF ,&M" 4
The foregoing instrument was acknowledged before me this day of ,
200, by f7 pit) ,(, who is erso ally known
to me or o who has produce
identification and who did (did not) takeanoath. ion
Lup Signature
Notary
Seal) ova
Yes RUTH-ANN RUBIN 0C,
NOTARY PUBLIC a -
STATE OF FLORIDA L
a Comm# GG159793 siN
10 Expires 11/13/2021 Rev.
08.12) QA_
gnn RUB Print
or type name Notary
Public - State of 0l Commission
No. q-i9 My
Commission Expires: l l I Vaoaas
911212018 SCPA Parcel View: 36-19-30-544-0000-0230
J019=1CFA Property Record Card
P4W Parcel: 36-19-30-544-0000-0230
Property Address: 2308W LISA CT SANFORD. FL 32771
Parcel Information Value Summary
Parcel 136-19-30-544-0000-0230 1 i I I 2018 Working 12 Certified 07Owner(
s) POPE, ANGELA M Property
Address j 2308 W LISA CT SANFORD, FL 32771 Mailing
12308 W LISA CT SANFORD, FL 32771 Subdivision
Name I TWENTY WEST Tax
District I Sl-SANFORD DOR
Use Code y 01-SINGLE FAMILY Exemptions
1 T00-HOMESTEAD(2018) 59.
76 4
Cn2
0)Cn
10 06
Cn
cd
a)
CT)
Legal
Description LOT
23 TWENTY
WEST PB
16 PG 36 Taxes
Taxing
Authority County
General Fund Values
Values Valuation
Method Cost/Market Cost/Market Number
of Buildings Depreciated
Bldg Value 76,377 61 085 Depreciated
EXFT Value 4,880 3,745 Land
Value (Market) 15,000 12,000 Land
Value -Ag- Just/
Market Value 96,257 1 76,Ko Portability
Adj Save
Our Homes Adj 0 16,121 Amendment
I Adj 0 P&
G Adj 0 0 Assessed
Value 96,257 60,709 Tax
Amount without SOH: $675.11 2017
Tax Bill Amount $546.39 Tax
Estimator Save
Our Homes Savings: $128.72 TRIM
Notice Help Does
NOT INCLUDE Non Ad Valorem Assessments i
Assessment Value Exempt Values Taxable Value 96,
267 $50.000 $46,257 Schools
96,257 25,000 71,257 City
Sanford 96,257 50,000 46257 SJWM(Saint
Johns Water Management) 96,257 50.00 . 0 46257County Bonds 96,
257 50,000 46,257 Sales Description I
Date
Book 1 Page I Amount Qualified Vactimp WARRANTY DEED 7/
1/2017 08947 1588 123,000 Yes Improved WARRANTY DEED 6/
112010 07403 0170 99,000 Yes Improved 1 WARRANTY DEED
9/11/2008 07076 1350 100 No Improved WARRANTY DEED 8/
1/2008 07076 1352 55300 No Improved WARRANTY DEED 8/11/
2008 07076 1351 100 No Improved PROBATE RECORDS 6/112007
06744 0254 100 No Improved WARRANTY DEED 11/1/
2003 05169 0373 31,000 Yes Improved WARRANTY DEED 8/1/
2003 04970 0328 25,500 No Improved WARRANTY DEED 1/111977
01146 0025 25,500 Yes Improved WARRANTY DEED 1/111973
00990 1906 21,900 Yes Improved Flwd Land hftp://parceldetail.
scpafl.
org/
ParcelDetailInfo.aspx?PlD=36193054400000230
XRC Xtreme Roofing & Construction LLC Sales Representative
CGC1511861 / CCC1329126 Hunter Kitchens
4019 W 1 st Street (SR-46)
Sanford, FL 32771
407)960-5933
Angie Pope
Job #53449 - Angie Pope
2308 W Lisa Court
Sanford, FL 32771
e
i
f.r
ctreme
Roofing & Construction
3p,,/R_SSAw hint
Estimate # 1181352
Date 9/7/2018
Item j Description oty i! Price i` Amount
Services 1.00 $0.00 $0.00
Roofing Permit Roof Permit - Obtain Permit with City / County, Record 1.00 $385.00 $385.00
Notice of Commencement with County. Meet with
inspectors for required inspections.
Item ;1 Description Qty ! rice it Amount
Roofing O/C Oakridge Make it your own. 18.00 $385.12 $6,932.16
When does your house become a home? When the place
you live in begins to reflect the life you're living. When
every change, big or small, makes it more your own.
Choosing a new roof is your opportunity to make a major
impact on the look of your home- and we're here to help.
So you can be confident that your new roof will enhance
and protect your home for year to come.
The Total Protection Roofing System. The Right Choice.
Preparation of Scope of Work: Re -roof
Time to Complete Scope of Work: 7 Days
Roof System over 5% pitch. Shingles are missing in
several locations. Remove damage roofing system.
Remove drip edge flashing. Check decking system and
re -nail per code. Install Owens Coming Architectural
Shingles
Limited Lifetime Warranty.
10-year Algae Resistance Limited Warranty
Wind Resistance Limited Warranty 110/130
130 mph is applicable only with 6 nails application and
Owens coming starters along eaves and rakes.
A. Remove existing roofing system. One Layer
B. Check the decking system, remove damaged materials
and re -nail per code. Install new material as needed.
C. Remove existing drip edge.
D. Install High Performance Synthetic Roof Undedayment
features a durable construction that works with your
shingles to help shield your home from moisture infiltration.
E. WeatherLock® Mat Self -Sealing Water Barrier is
designed to act as an additional line of protection and is
installed in the valleys.
F. Install accessories. Lead Boots, Goose Necks, ect.
G. Install Owens Coming® Starter Strip Shingle
H. Install Oakridge Shingles. Oakridge shingles are The
Right Choice for long lasting performance and striking
beauty.
I. Install hip and ridge.
J. Install vent system.
I. Keep a clean and safe working area
J. Owner to supply a staging area for: Dumpster, electric
and water hook up.
K. Contractor to supply all equipment to install to Owens
Corning specifications
L. All sq ft will be determined at start of job with a
representative from XRC.
M. 10 Year Warranty Labor ** - Manufacture Limited Life
Time Warranty *"
Owens Coming has been a leader in the building
materials industry for over 75 years. So you can be
confident that your new roof will enhance and protect your
home for years to come.
Roofing Roof Coating System Roof Coating System. Pressure wash and clean area. 1.00 $1,971.69 $1,971.69
Prep, seal, prime area. Coat roof. White.
Roofing Wood Replacement Replacement of bad wood with owners approval as 3.00 $0.00 $0.00
follows: Plywood - $85.00 per 4x8xl/2; Board Sheeting
8:00 per linear foot; Rafters $6.00 per linear foot; Fascia
8.00 per linear foot. Additional layers of shingles will be
35.00 per square foot.
Dump fee Dumpster will be on site for construction debris only and 1.00 $350.00 $350.00
will be hauled away.
Item
Note on Estimates
Roofing Payment Terms
Promo
Description
NOTE: Estimate are based upon what could be visually
seen at the time of inspection, any unforeseen damage
will result in a change order and possible additional
charges. XRC LLC will not be held responsible for
damages to any sprinklers, underground pipes, drains,
foundations, or any other unmarked or privately owned
underground systems. XRC LLC will preform locates for
power, telephone and cable lines by calling 811 for
locations on your property.
Payment Terms: 10% Signed Contract / 50% Start of
Project / 20% Dry -in Inspection / 20% Project Completion
Friend of the family. Contract bid for the re -roof will be at
9,500.00 if clients sings today
Sub Total
Total
S P E C I A L I N S T R U C T I O N S
Qty j; Price ;', Amount i
1.00 $0.00 $0.00
1.00 $0.00 $0.00
1.00 638.85) ($638.85)
9,000.00
9,000.00
Thank you for taking the time to meet with us today.
The estimated fee is valid within 7 days from the date of this proposal; therefore, this proposal shall be considered as a legal and binding
document within those 7 days. A review estimate fee will be done after 7 days if the proposal is not signed and returned. All deposits are non-
refundable. All material is guaranteed to be as specked. All work to be completed in a workmanlike manner according to standard practices. Any
alternations for deviation from the agreed upon specifications involving extra costs will be executed only upon written orders, and will become an
extra charge over and above the estimate. All agreements are contingent upon strikes, accidents, or delays beyond our control. Owner is to carry
fire, tomado and other necessary insurance. All materials remain property until payment is received in full. If litigation arises out of this contact, the
prevailing party will be entitled to its attorney fees and costs. The venue of any litigation arising from this contract shall be Seminole County,
Florida.
Authorized Acceptance Signature
Date of Acceptance
Note: This proposal may be withdrawn if not accepted within 7 days.
Digitally signed by Angie
Pope
Date: 2018-09-11
CITY OF
FIRE DEPARTMENT
PERMIT #
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
JOB ADDRESS: --
STRUCTURE TYPE: 0 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: ONLY 100 SQUARE OF THE EXISTING DECKIS PERMITTED TO BE REPLACED"
ROOF VENTILATION: O OFF -RIDGE O RIDGE O SOFFIT OPOWERED VENT
SKYLIGHTS: O YES 0 NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #: _
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 3K4:12 OR GREATER
OTURBINES
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
SHINGLE FL# 10 614 - R'
O METAL FL#
O MODIFIED BITUMEN FL#
O TORCH DOWN FL#
0INSULATED 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 0f '
SORD Building &Fire Prevention Division
RESIDENTL4L REROOF POLICY & PROCED URES
FIRE OEPARTMENT
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 ACONSPICUOUS AND WEATHERPROOF LOCATION
COMPLETED RESIDENTIAL RE -ROOF SCOPE OF WORK
COMPLETED AND NOTARIZED INSPECTION AFFIDAVIT
ALL FLORIDA PRODUCT APPROVAL AND CORRESPONDING INSTALLATION INSTRUCTIONS
PRODUCT APPROVAL SHALL MATCH WHAT IS ON THE SCOPE OF WORK)
DIGITAL PHOTOGRAPHS (MUST INCLUDE THE PERMIT NUMBER OR ADDRESS IN EACH PICTURE)
o EACH PLANE OF THE ROOF, SHOWING THE UNDERLAYMENT INSTALLED
o ROOF DECK NAILING PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
o ROOF DECK NAILS USED (INCLUDING A MEASURING DEVICE OR RULER SHOWING SIZE OF NAILS)
o UNDERLAYMENT PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
o DRIP EDGE & VALLEY ATTACHMENT (INCLUDING A MEASURING DEVICE OR RULER)
o SHINGLES INSTALLED, NAIL PATTERN AND LOCATION OF NAILS
SKYLIGHTS (IF APPLICABLE)
o DIGITAL PHOTOGRAPHS SHOWING ALL INSTALLATION COMPONENTS, PER FL PRODUCT APPROVAL
o DIGITAL PHOTOGRAPHS SHOWING ALL REQUIRED FLASHING, PER FL PRODUCT APPROVAL
FAILURE TO FOLLOW THESE SPECIFIC GUIDELINES WILL RESULT IN AN AFFIDAVIT PROVIDED BY A FLORIDA DESIGN
PROFESSIONAL (ARCHITECT OR ENGINEER), CERTIFYING FBC CODE COMPLIANCE BY PERSONAL INSPECTION.
CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: DATE: 'A aO 18
CITY OF
Ski4FORD' Building & Fire Prevention Division
RESIDENTIAL RE -ROOF AFFIDAVIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: r 8 `" 3q O ADDRESS: d.30P Y V L;ba l_OUIIy"
T=led 3:2-7-71
I IIILLLMO 11-ADDUiLl , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, EN ER, 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 #: , 1 spq i aco 1 COMPANY /
CONTRACTOR:
X I' C LL01 CONTRACTOR SIGNATUR< /
Y MUST BE
SIGNED BY LICENSE HOLDER OR OWNER/BUILDER) A FINAL
ROOF INSPECTION IS REQUIRED: DATE: 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 20 AB by: Who isAersonally
Known to me or has 0 Produced (type of ide ification
as identification. Im- Qy;
Quo Signature of
Notary Public tate of
Florida QU s
RUTH-ANN' RUBIN n gP °
NOTARY PUBLIC N&A- PMR;) 0-\ Print/Type/Stamp
Name z 2 STATE OF FLORIDA COmin# GG159793 NeofNotaryPublicExpires11/13/202,