HomeMy WebLinkAbout441 Fairfield Dr - BR18-004332 - REROOFBuilding & Fire Prevention Division
FIRE OEPARTMENT
PERMIT APPLICATION
Application No • I k- V3-5d,
1 Documented Construction Value: $ 1 /®w, d D
ob Address: 7-I !"a r_e/ ®y Stt pr G' 3 2 Jl Historic District: Yes Norp
Parcel ID: 32 —H -- 31 41- 9 _IefGd D --Dz-D Residential Commercial
Type of Work: New[] Addition Alteration Repair Demo Change of Use Move
Description of Work:
RE -ROOF
Plan Review Contact Person:
John Byrne Jr Title:
Permit Manager
Phone:
4079220502
Fax: Email: john@masimoconstruction.com
Property Owner Information
Name kmidL14 4 Phone:
Z G > Cgr Resident ofproperty?: lStreet: ia
City, State Zip: -Io e
Contractor Information
Name
Masimo Construction Phone:
4079220502
Street:
16105 83 Place North Fax:
NIA
City, State Zip:
Loxahatchee FL 33470 State License No.:
CCC1328033
Architect/Engineer Information
Name: Phone: /
Street: Fax: g
City, St, Zip: E-mail:
Bonding Company: I d, Mortgage Lender: _
Address: 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: 61h Edition (2017) Florida Building Code
Revised: January 1, 2018 Pernvt Application
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 Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
Signature of Contractor/Agent Date
Print Contractor/Agent's Name
Signature of Notary -State ofFlorida Date
Contractor/Agent is Personally Known to Me or
Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas[] Roof
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:
1:_
Flood Zone:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
Revised: January 1, 2018 Permit Application
Pro eft. Record Card
Parcel: 32-19-31-519-0000-0020
Property Address: 441 FAIRFIELD DR SANFORD, FL 32771
Parcel Information
Parcel 32-19-31-519-0000-0020
Owner(s) RUMPH, RAMONA C
Property Address 441 FAIRFIELD DR SANFORD, FL 32771
Mailing 2226 FIESTA CT ORLANDO, FL 32811-4920
Subdivision Name CELERY LAKES PHASE 2A
Tax District S1-SANFORD
DOR Use Code 01SINGLE FAMILY
Exemptions
65
O
r - -
C15 a
CID s
Rye
F 3
E
P, 54.58 50 50
Legal Description
LOT 2
CELERY LAKES PHASE 2A
PB 68 PGS 1 & 2
Taxes
211
N
N
Y .F
59.25
Value Summary
2019 Working
Values
2018 Certified
Values
Valuation Method Cost/Market Cost/Market
Number of Buildings 1 1
Depreciated Bldg Value
Depreciated EXFT Value
142,532
338$350
136,477
Land Value (Market) _
Land Value Ag
j $34,000 1 $34,000 —
Just/Market Value **— 1 $176,870 1 $170,827
Portability Adj
Save Our Homes Adj so 0
Amendment 1 Adj 1$5,572 15,102
P&G Adj I $0 0
Assessed Value 171,298 155,795
Tax Amount without SOH: $3,018.19
2018 Tax Bill Amount $3,018.19
Tax Estimator
Save Our Homes Savings: $0.00
Does NOT INCLUDE Non Ad Valorem Assessments
Taxing Authority Assessment Value Exempt Values Taxable Value
County General Fund ' $171,298 0 171,298
Schools ! $176,870 0 176,870
City Sanford $171,298
A
f $0 Z $171,298
SJWM(Saint Johns Water Management) — $171,298 j $0
f
171,298
County Bonds ---_
i--`_-------------- $
171,298 0 t $171,298
Sales
Description Date Book Page Amount Qualified Vac/Imp
SPECIAL WARRANTY DEED 1/1/2007 06568 110A 230,000 Yes Improved
Find compwwo So"_ i
Land
Method Frontage Depth Units Units Price Land Value
LOT i 1 $34,000.00 34,000
Building Information
ac2rrect, cnc
Fixtures Bed Bath Base Area Total SF Living SF Ext Wall Adj Value Rep[ Value AppendagesDescriptionIYearBuilt
Actual/Effective
1 SINGLE 2006 7 4 2,021
t
2,470 2,021 CB/STUCCO f $142,532 149,248 fi Description Area
FAMILY i FINISHtfi GARAGE 1389.00
Roofinq Contract/Proposal
Customer Name(s):_
Address: HA4 1 P.
Home Phone:
Insurance C
Adjuster:
Claim #: c
SPECIFICATIONS
Cell
Phone:
Remove roof to existing deck layers. Each
additional layer 5 /Sq. (100 Sq. Ft.) Re -nail
existing deck to meet uplift codes.
0-,I stallI _Ft. metal drip edge around roof perimeter) Color
stall lead boots to pipes 11/2" 2" j 3" 4 j
stall Gooseneck vents 4" 10" - .. `—
1211 4ply Rhino Guard (Synthetic) to wood deck.
4 Apply Sq. Ft. of METAL/.S H,IfNG`t ES/T LE/SHA S/FLAT
o st le of roof to be installed: 1 LJ(' `C1 i.XT- Color:
pitc G -- Manufacturer
7®of roofing system: < __1r14f__ 1:' t Install ridge
vent along peak of roof:
FOLLOWING EXCLUSIONS APPLY.•
JOB DETAILS:
Address: 1800 Pembrook Dr., Suite 300
Orlando, FL 32810
Office: (407) 286-0067
State -Certified General Contractor - CGC1509548
State -Certified Roofing Contractor - CCC1328033
Marney (YIN) Date:
City/State/Zip: Cjn 2
Email Address:
i • 2caner on Deed=
OTHER PROPERTY CONDITIONS
IcelWaterShield/Valley Yes Total Ft
IZI Existing Water Damage
Existing Outside Damage
Skylights:
Leaks:
Interior Damage:
Emergency Repair
Tapered Insulation
Ridgecap Ft.:
Flat Rcap Ft.:
Off Ridge Vents: _
Stories:
Yes No
Yes No
Yes No
Yes No
WORK INCLUDES:
Estimating
Management/Administration
Apply for and furnish permit
Remove trash I debris from roof
Delivery of new materials
Disposal of old materials
Roll yard with magnetic roller
Manufacturer's Warranty
WE PROPOSE to furnish material, equipment and labor to perform work identified above in exchange for full payment from you based upon theTermsandConditionshereafter.
PAYMENT SCHEDULE
35% DUE AS INITIAL DEPOSIT TO SCHEDULE
S 45% DUE ON COMPLETION OF DRY IN PACAKAGE
S BALANCE DUE ON FINAL INSPECTION AND FURNISHING OF LIEN RELEASE DOCUMENT
BALANCE DUE (IF ANY) ON ADDITIONAL WORK THAT WAS PERFORMED
TOTAL DUE
STATUTORY NOTICE: ACCORDING TO FLORIDA'S CONSTRUCTION LIEN LAW (SECTIONS 713.001-713.37, FLORIDA STATUTES), THOSE WHO WORK ON YOUR PROPERTY OR PROVIDE MATERIALS AND SERVICES AND ARE NOT PAID IN FULL HAVE A RIGHTTOENFORCETHEIRCLAIMFORPAYMENTAGAINSTYOURPROPERTY. THIS CLAIM IS KNOWN AS A CONSTRUCTION LIEN. IFYOURCONTRACTORORASUBCONTRACTORFAILSTOPAYSUBCONTRACTORS, SUB -SUBCONTRACTORS, OR MATERIALSUPPLIERS, THOSE PEOPLE WHO ARE OWED MONEY MAY LOOK TO YOUR PROPERTY FOR PAYMENT, EVEN IF YOU HAVEALREADYPAIDYOURAGREEMENTORINFULL. IF YOU FAIL TO PAY YOUR CONTRACTOR, YOUR CONTRACTOR MAY ALSO HAVEALIENONYOURPROPERTY. THIS MEANS IF A LIEN IS FILED YOUR PROPERTY COULD BE SOLD AGAINST YOUR WILL TO PAYFORLABOR, MATERIALS, OR OTHER SERVICES THAT YOUR CONTRACTOR OR A SUBCONTRACTOR MAY HAVE FAILED TO PAY. TO PROTECT YOURSELF, YOU SHOULD STIPULATE IN THIS AGREEMENT THAT BEFORE ANY PAYMENT IS MADE, YOURCONTRACTORISREQUIREDTOPROVIDEYOUWITHAWRITTENRELEASEOFLIENFROMANYPERSONORCOMPANYTHATHASPROVIDEDTOYOUA "NOTICE TO OWNER." FLORIDA'S CONSTRUCTION LIEN LAW IS COMPLEX, AND IT IS RECOMMENDEDTHATYOUCONSULTANATTORNFY
Remove roof to existing deck layers. Each
additional layer S /Sq. (100 Sq. Ft.) Re -nail
C-"ting deck to meet uplift codes.
y-/I stall 4_Ft. metal drip edge around roof perimeterl Color
Install lead boots to pipes 1%a" 2" 3"
Install Gooseneck vents 4" 10"
rApply Rhino Guard (Synthetic) to wood deck.
U Apply Jy Sq. Ft. of METAL/SyH,ING ES/T LE/SHA S/FLAT
St le of roof to be installed: 0 CJif 'li'l "Y Color:
l S Pitc/, _ ( Manufacturerpofroofingsystem: , < l 1 l Install ridge
Cl vent along peak of roof:
FOLLOWING EXCLUSIONS APPLY.•
JOB DETAILS:
I I— —, I I <+VI'd LlI I I%J IN
Ice/Water Shield/Valley Yes Total Ft.: _
Existing Water Damage Yes No
Existing Outside Damage Yes No
Skylights:
Leaks:
Interior Damage:
Emergency Repair
Tapered Insulation
Ridgecap Ft.:
Flat Rcap Ft.:
Off Ridge Vents: _
Stories:
Yes No
Yes No
WORK INCLUDES:
Estimating
Management / Administration
Apply for and furnish permit
Remove trash / debris from roof
Delivery of new materials
Disposal of old materials
Roll yard with magnetic roller
Manufacturer's Warranty
WE PROPOSE to furnish material, equipment and labor to perform work identified above in exchange for full payment from you based upon theTermsandConditionshereafter.
PAYMENT SCHEDULE
35% DUE AS INITIAL DEPOSIT TO SCHEDULE
C.C> 45% DUE ON COMPLETION OF DRY IN PACAKAGE
S W+ L'3 BALANCE DUE ON FINAL INSPECTION AND FURNISHING OF LIEN RELEASE DOCUMENT
S
qj BALANCE DUE (IF ANY) ON ADDITIONAL WORK THAT WAS PERFORMED
S t i/J • LD TOTAL DUE
STATUTORY NOTICE: ACCORDING TO FLORIDA'S CONSTRUCTION LIEN LAW (SECTIONS 713.001-713.37, FLORIDA STATUTES), THOSE WHO WORK ON YOUR PROPERTY OR PROVIDE MATERIALS AND SERVICES AND ARE NOT PAID IN FULL HAVE A RIGHTTOENFORCETHEIRCLAIMFORPAYMENTAGAINSTYOURPROPERTY. THIS CLAIM IS KNOWN AS A CONSTRUCTION LIEN. IFYOURCONTRACTORORASUBCONTRACTORFAILSTOPAYSUBCONTRACTORS, SUB -SUBCONTRACTORS, OR MATERIALSUPPLIERS, THOSE PEOPLE WHO ARE OWED MONEY MAY LOOK TO YOUR PROPERTY FOR PAYMENT, EVEN IF YOU HAVEALREADYPAIDYOURAGREEMENTORINFULL. IF YOU FAIL TO PAY YOUR CONTRACTOR, YOUR CONTRACTOR MAY ALSO HAVEALIENONYOURPROPERTY. THIS MEANS IF A LIEN IS FILED YOUR PROPERTY COULD BE SOLD AGAINST YOUR WILL TO PAYFORLABOR, MATERIALS, OR OTHER SERVICES THAT YOUR CONTRACTOR OR A SUBCONTRACTOR MAY HAVE FAILED TO PAY. TO PROTECT YOURSELF, YOU SHOULD STIPULATE IN THIS AGREEMENT THAT BEFORE ANY PAYMENT IS MADE, YOURCONTRACTORISREQUIREDTOPROVIDEYOUWITHAWRITTENRELEASEOFLIENFROMANYPERSONORCOMPANYTHATHASPROVIDEDTOYOUA "NOTICE TO OWNER." FLORIDA'S CONSTRUCTION LIEN LAW IS COMPLEX, AND IT IS RECOMMENDEDTHATYOUCONSULTANATTORNEY.
Acceptance of Proposal: 1/WE have read and understand the terms and conditions located on the back of this document, which are incorporated 'herein byreferenceandmadepartofthislegalandbindingagreement. The above specification and conditions are satisfactory and hereby accepted and Contractor isauthorizedtobegintheworkafterpayment(s) clear, or as otherwise specified herein. I, as Owner, hereby assign to Contractor any and all insurance payments orproceedsrelatedtoanyclaimImayhaveinvolvingtheworkinthisAgreement. If I, as Owner, receive any check or other proceeds related to the work in this Agreement, I shall endorse and deliver such proceeds to Contractor within 3 days. Contractor has not agreed to waive, rebate or pay any deductible. Owner shall pay all insurancedeductiblestoContractor. I, as Owner, hereby direct my insurer or mortgagor to release any and all information requested by Contractor for the direct purpose ofobtainingactualbenefitorloaninformationanddocumentationtoshowthemhowmuchfundsareavailablefortheworkinthisAgreement. I, as Owner, hereby assignallinsurancebenefitstoContractortotheextentthosebenefitsapplytotheworkinthisAgreement.
Owner
Signature X
Sales Represent ve (Print name) 2 s
APPROVED: l iliAa79fp. j
in _
Owner
Signature DATE: aG d! —,--Y, g
DATE: o it 1
WHITE - OFFICE COPY YELLOW - HOMEOWNERS COPY PINK - SALESMAN'S COPY
Grant Maio Clerk Of The Circuit Court & Comptroller Seminole County, FLInst #2018122031 Book:9237 Page:652; (1 PAGES) RCD: 10/23/2018 11:03:18 AM
REC FEE $10.00
Permit Number:
Follo/Parcel Identification Number. Prepared by:
Masimo Construction
Return to: 1800 Pembrook Drive
Suite 300
Orlando, FL 32810
CERTI To COPY GRANT MALOY
CLER Of THE iJi C', T COURT
AND+ Div"°its' LE.' { .
SEM11 Ol; f I JI.ID
i
BY
Date
State of Florida, County of Orange NCEMENT
The undersigned hereby gives notice that Improvement will be made to certain real property. and in ace„a.,. with Chapter 713, Florida Stati its.. ti— f ...t__ .__ _
1.
2.
931
Interest in PropertyNameandaddress offee Simple titleholder (if different from Owner listed above) Name ,j
4. Contra
Name
5. Surety (if applicable, a copy
6. Lender
Number IV7lZLD5,? c
Telephone Number
Amount of Bond $
Address Telephone Number
7. Persons within the St
be served ate of Monde designated by Owner upon whom notices or other documents maya, provided by §713.13(1)(a)7, Florida Statutes. Name
Address Telephone Number
8.
vi ttt:rselr, owner designates the following to receive aNoticeasprvidedin §713.13(1)(b), Florida Statutes, COPY of the Lienor's
Name
Address Telephone Number
9. Expiration data of notics of commencement (the expiration date may not be before the completion ofconstructionandfinalpaymenttothecontractor, but will be 1 year from the date of recording unless adifferentdateisspecified)
WARNING TO OWNER ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENTARECONSIDEREDIMPROPER'pAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CANRESULTINYOURPAYINGTWICEFORIMPROVEMENTSTOYOURPROPERTY. A NOTICE OF COMMENCEMENT MUST BERECORDEDANDPOSTEDONTHEJOBSITEBEFORETHEFIRSTINSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULTWITHYOURLENDERORANATTORNEYBEFORECOMMENCINGWORKORRECORDINGYOURNOTICEOFCOMMENCEMENT. Under p natty of perjury, I declar at I have read the foregoing notice of commencement and that thefactsedInitaretruetothebestOrjnYknowledgeandbelief. t A
81&tah 01 Owner or Ifessee, orOwner's or lessee's Authorized Officer/Director/Partner/Mana er
ln! n lc
9 Signatory's Tltle/Office
The foregoing instrument was acknowledged before me this 12 day of-10—b&byeasmonth/year name of person
Ty of auth rity ee-.g o r, trustee, attorney in fact
for
Neme of a5party on behalf of whom(
Yinstrument was executed
Signature of Notary Public— State of Florida Pnnt, pe, orstamp commisstPoned name ot Notary PublicPersonallyKnownORPducedIDTypeofIDProduced ,z L _OoON Notary Public State of FloridaBethEFishel
My commionG I53047 ci,
Expires 1p17Pin evised: Sept ber26, 2011
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: U ZOT )
I hereby name and appoint: n \1 Z D _
an agent of:
Name
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 iat:
Street Address)
Expiration Date for This Limited Power of Attorney: `J C4 p\w,c -,st , 2dy p
License Holder Name: Ol
State License Number: C- cc,. 2
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF -42-
The foregoing instrume t was acknowledged before me this 2Z day of 06(_ ,
200 , by who is personally known
to me or o has produced
identification and who did (did not) take an oath.
Signature
Z(Notary Seal) e• ° Notary Public State of Florida
Print or type nameBeth
E Fishel 5
1 y:y- My Commission GG 153047 Qt
tid Expires 10/1812021Notary Public -Stateof .Cx1 Ack.
Commission No. G G My Commission
Expires: 10, ic6. 2_
q2 Rev. 08.12)
CITYOF S,,
kNFOX%."Building & Fire Prevention Division RESIDENTIAL
RE -ROOF POLICY & PROCEDURES FIRE
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 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
UNDERLAYN ENT 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 PER FL PRODUCT APPROVAL FAILURE
TO FOLLOW THESE SPECIFIC GUIDELINES WILL RESULT IN AN AFFIDAVIT PROVIDED BY A FLORIDA DESIGN PROFESSIONAL (
ARCHTTECT OR ENGINEER), CERTIFYIVryjFBC C P611COMPLIANCE BY PERSONAL INSPECTION. CONTRACTOR (
OR OWNER/BUILDER) SIGNATURE: i:.:,' ,! ' DATE:
fir s;CITY OF
4 SkNFORD PERMIT #
Building & Fire Prevention Division
RESIDENTIAL REROOF SCOPE OF WORK
doBADDREss: Lql C;ricielq .1)WVe `11 1 l 92 71l
STRUCTURE TYPE: jp SINGLE FAMILY RmDENCE/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): _64wpol fAtA A,;Ztj
PLEASENOTE. ONLYI00 SQUARE FEEL OF THE EXISTINGDECK IS IYTED TO BE REPLACED"
ROOF VENTILATION: to OFF -RIDGE O RIDGE O SOFFIT OPOWERED VENT
SKYLIGHTS: O YES p NO IFYES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 4:12 OR GREATER
OTURBINES
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
SHINGLE T L /I YJ "(11D FL# fo lZzo 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# OMODIFIED
BITUMEN FL# O
TORCH DOWN FL# OINSULATED
FL# O
TILE FL# O
OTHER: FL#
CITY OF
Building & Fire Prevention DivisionSk4FORDRESIDENTIALRE-ROOFAFFIDAVIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: 8 - `33 2 ADDRESS: '-A ` -bs-
sania , ' 3n
gg, P l kI %L1-4 , 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 #: 6,6 cv ®
r
COMPANY / CONTRACTOR: / l rt 1.0,01 J V C I U
CONTRACTOR SIGNATURE:
MUST BE SIGNED BY LICENSE HOLDER OR
A FINAL ROOF INSPECTION IS REQUIRED:
DATE: 1613 A 8
IF r
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,
UNDERLAY MENT, 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 Se—M1(YCAe-,
Sworn to and Subscribed before me this 31 day of 0C P_C 20 lS by:
Who is Personally Known to me or has Produced (type of
identification) _,% as identification.
F
Signature of Notary Public
State of Florida a `
00 Notary Public State of Florida
Beth E Fishel
My Commission GG 153047Print/Type/Stamp Name rys rR Expires 10/18/2021
of Notary Public