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HomeMy WebLinkAbout163 Kelly Cirl. Lam.•' ` ' CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION c Application No: Documented Construction Value: $ 7,900 Job Address: 163 KELLY CIR SANFORD, FL 32773 Historic District: Yes No Parcel ID: 12-20-30-511-0000-1050 Zoning: 24SQ FT Description of Work: SHINGLE RE -ROOF, 7/12 PITCH, RHINO UNDERLAYMENT Plan Review Contact Person: TITIA 1 UNCOME Title: OFFICE ADMIN Phone: 407-278-7788 Fax: E-mail: PERM IT(cD_JASPERINC.43ft - Property Owner Information Con - Name SANTIAGO GILBERTO & CYNTHIA Phone: 407-923-8336 Street: 163 KELLY CIR Resident of property? : SANTIAGO GILBERTO & City, State Zip: SANFORD, FL 32773 CYNTHIA Contractor Information Name JASPER CONTRACTORS Phone: 407-278-7788 Street: 5380 E COLONIAL DR Fax: City, State Zip: ORLANDO FL 32807 State License No.: CCC1329651 Architect/Engineer Information Name: Phone: Street: Fax: City, St, Zip: E-mail: Bonding Company: Address: Building Permit Square Footage: 24 No. of Dwelling Units: Electrical New Service — No. of AMPS: Mortgage Lender: Address: PERMIT INFORMATION Construction Type: RE -ROOF No. of Stories: 1 Flood Zone: Mechanical (Duct layout required for new systems) Plumbing New Construction - No. of Fixtures: Fire Sprinkler/Alarm No. of heads: I b Shall be inscribed with the date ofapplication and the code in effect as of that date (Code 2010 FBC) 731.135(5)(6) Florida Statutes. ` REV 07.14 1 W 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. 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. 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 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. A copy of the executed contract is required in order to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the plan review fee based on past permit activity levels. Should calculated charges exceed the documented construction value when the executed contract is submitted, credit will be applied to your permit fees when the permit is released. 1fL(2A'fZZ f2am ITX7V Signature of Owner/Agent Date G, 4in0, 2)aYI) \aa0 Print er/Agent's Name ki Signature of Notary -State of Florida Date TITIA N BUNCOME Commission R FF 224168 P, My Commission Expires April 23, 2019 Own a or Produced ID X Type of ID DL APPROVALS: ZONING: ENGINEERING: COMMENTS: UTILITIES: FIRE: Sign c Agent Date Print Contractor/Agent'sAgent's Name- t.I Am.r.0m¢ o ll -4 11-) Signature of Notary -State of Florida Date TITIA N BUNCOME Commission M FF 224168 Ate; My Commission Expires own to Me or Produced ID X Type of ID DL WASTE WATER: BUILDING: Shall be inscribed with the date of application and the code in effect as of that date (Code 2010 FBC) 731.135(5)(6) Florida Statutes. REV 07.14 M THIS INSTRUMENT PREPARED BY: Name: Ti la Buncome Address: 5 E Co DOrlandoOrlando NOTICE OF COMMENCEMENT Pemrtt Number. MARYANNE MURSEt SEMINOLE COUNTY CLERK OF CIRCUIT COURT & COMPTROLLER 9K 08468 Pq 10121 (l pti ) CLERK'S # 2015051275 RELURDED 05/12/2015 02:36:47•PM RECORDING FEES 10.00 RECUNDEEU BY H DeVare Percol ID Number 2. - _ 6 The undersigned Hereby gives notice that Improvement will be made to tart InfollowinginformationisgoviddedinthisNoticeofCamffW%M rent Mai pro".lard accordance with Chapter 713, Fbrida Statutes, the 1. DESCRIPTION OF PROPERTY: (Legal deWptlon of the property and street address If available) 2. GENERAL DESCRIFI IUN OF MAPROVEMENT. 3. OWNER INFORMATION OR LESSEE FORMATION IF THE Name and address!"+ inherLn k ..:il..,. C-1 _ l CONTRACTED FOR 71 — Interest in o - `'` E.II 'i( CV1 2,,1 property: Fee Simple Tltfo HWdsr (If Otter than owner Asted above) Nam: Address. • 4. CONTRACTOR: Name: Jasper Contractors Address: 5380 E Colonial Dr Orlando F132807 Phone Nranber, 407 278- 8 6. SURETY ((f applicable, a copy of the payawnt bmW Is attaeMdy Name: Address: S. LENDER: Name: Amount of Bond: Address: Phone Number: 7. Persona within the Stags of Ftodde Doslgnstsd by Owner upon rrtgm or other dotranenta713.13(1)(a)7., Florida 8latrrtps• aW be served as provtdod by Section Name. Address: Phone Nurrrber; S. In addition, Owner designates ofl0receiveaCOPYoftheLeerlor's Notice as provIded in Section 71313(t)(b), Florida Stabile. Phone nrrntben S. E)Vraton Date of Notice W COmmerlcoment (The eVkr50n Is 1 year from date of mo dng unless a different date is specitied) WARNING 7n OUVjM' ANY PAYMENTS MADE BY THE OWNER AFTER THE D(PrRATION OF THE NOTICE OF COMMENCEMENT ARECONSIDEREDIMPROPERPAYMENTSUNDERCHAPTER713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOURPAYINGTWICEFORIMPROVEMENTSTOYOURPROPERTY. A NOTICE OF COMMENCEMENT 1A)ST BE RECORDED AND POSTED ON THEJOBSITEBEFORETHEFIRSTINSPECTION, IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEYBEFORECOMMENCINGWORKORRECORDINGYOURNOTICEOFCOMMENCEMENT. Tore, m -111- State of 4-1 County of S -em ("(' V- RVwarrMMMWPmvmesw w"re I The foregoin g _Instrumeennt Wag aeJQrowiedQed before me VVz 1 dsy of . • w N i by 'TiiV1 i L+ r PtJs a+ro ro igwterrera . Who is no lmown to nee o OR who has produced Identification 4 type of ldangf Atfon produoedt o..•.;;,, TITIA N BUNCOME s Commission a FF 224168 C FIEDCopy-•MARYANNEMORSE c 1, `' Q. My Commission Expires C .RKOFTI IR UITCOURTAND ;q'Sy April 23, 20I9 C MPTROL °R +qga owl INOLE CO , FLORID.4 By DEPUTY CLERK MAY 12 2nit015 Jasper Contractors, Inc. 5380 E Colonial Dr. Orlando, FL 32807 407) 278-7788 QJ 800) 337-3361 Fax JasperRoof.com inrbnaiasperin c. ort? K,_,•:.o JASPER JasCPCerRoor.00m Contractor's License # C1329651 D!1l1L• UT. Dr A 11L+a.rT7 lT rn rmn t+.n Account Mana er). P_/tt'Joni Contact # S- ' o - ©D in suranceCompa nvInformation Company Fi{tC/ t34crL F Lc Policy # 8W 501a %6 Claim # nl p( Mortaap.eComaanyl nform atio n Company 19Atil- W A &.tcA- LoanNumber of 3J-f''ltio 94 Owner(s): e& -o -k-- c -r ( s Phone; *tfi you- 4a 3 - k 33 6 Address: Alt Phone: City: State: T-L. Zip code. Shingle Color: Email: TT 11"TXTf,+ Ic i1T[r t1l . Roof RCV amount: Drip Edge Color: as v sr11u1% o u1qoUK%m_1,4%- V.VIYIIAIV I UVGa tVU1 AIUKLL TO PAY VUK A IyULL ROOF REPLACEMENT THIS CONTRACT SHALL BE NULL AND VOED. REPLACEMENT WORK AND PRICE: Subject to the terms and conditions below, Jasper Contractors, Inc. ("Jasper") agrees to furnish all materials listed herein and labor necessary to perform the above listed roof replacement for the Replacement Cost Value ("RCV") of Owner's roof, as determined by Owner'sinsurancecompany ("Contract Price'), up to a maximum contract price of $49,999.00. The roof replacement work shall take place following Owner's insurance company's approval, approximately within 30 days, conditions permitting. ',- MortgageMORTGAGEAUTHORIZATION: I, Owner and Mortgage holder, grant authorization for FAL*- O kyt eA Mortgage Co. to speak with Jasper and/or RoofClaim corn on matters concerning the claim and draw status. INSURANCE AUTHORIZATION: I, Owner and Insured, grant authorization for N04-A. PUK54(.4, Insurance Co. to speak with Jasper and/or RoofClaim.com on matters concerning the claim and release of payments. PAYMENT SCHEDULE: Owner agrees to pay Jasper based on the following pay schedule: (i) Deposit in the amount of $_ e— due upon sighing thiscontract; (ii) the Contract Price, less the Deposit and any applicable depreciation retained by Owner's insurance company, plus Upgrade Costs, due and payable to Jasper upon completion of work being performed; and, (iii) the remaining Contract Price (equal to any applicable depreciation) due and payable to Jasper upon completion of work performed. In the event of a pending city inspection, Own shall not withhold more than 20/6 of Contract Price until inspection has passed. Optional: Deductible: $ 580 (initial) UPGRADE ITEM: QTY: -:&— PRICE: S Z:D TOTAL:'t TERMS AND CONDITIONS 1, THE UNDERSIGNED, HAVE READ AND UNDERSTAND ALL STATEMENTS AND CONDITIONS OF THE ROOF REPLACEMENT CONTRACT AND AGREE THAT ALL DETAILS ARE ACCEPTABLE AND SATISFACTORY. I FURTHER UNDERSTAND THAT THIS CONTRACT CONSTITUTES THE ENTIRE AGREEMENT BETWEEN THE PARTIES AND THAT ANY FURTHER CHANGES OR ALTERATIONS TO TH iS CONTRACT MUST BE MADE IN WRITING AND AGREED TO BY BOTH PARTIES. EACH PARTY REPRESENTS AND WARRANTS TO THE OTHER THAT IT HAS THE FULL POWER AND AUTHORITY TO ENTER INTO THE CONTRACT AND THAT IT IS BINDING AND ENFORCEABLE IN ACCORDANCE WITH ITS TERMS 1. DEDUCTIBLE: It is the Owner's responsibility to pay all Insurance Deductibles. Owner's out-of-pocket expense will not exceed the deductible amount, as stated on insurance company's loss sheet, UNLESS replacement or repair of deteriorated decking is required and/or Owner requests optional upgrades. Jas CANNOT pay, waive, rebate, or promise to pay, waive or rebate all or any part of the insurance deductible applicable to the insurance claim for payo ng work. in menthe event of a discrepancy, the deductible amount stated on the insurance Loss Sheet shall overrule Deductible listed above. ('initial) 2. OWNER'S DECLARATION OF INTENT: Owner acknowledges and agrees that, upon approval by insurance company for a full roof replacement, Jasper shall perform the roof replacement. Owner agrees to commence roof replacement upon receipt of funds from Owners insurance company. 3. ACCEPTANCE OF TERMS: 1, Owner, hereby agree to retain Jasper's services for a full roof replacement on the terms and conditions stated herein. I further agree to provide Jasper with the Scope of Loss Report generated by my insurance company and authorize and grant full access to the property for the purpose of staging and completing all agreed upon work. 4. SUPPLEMENTAL CLAIMS: Jasper reserves the right to file a supplemental claim with Owner's insurance in the event that the insurance company's estimate is incorrect and/or additional damage is discovered after commencement. The supplemental claim amounts, in addition to any depreciated •amounts held back by the insurance company, are immediately due to Jasper upon receipt. 5. COMMENCEMENT OF WORK: Work shall commence at Jasper's discretion. Jasper shall not be liable for delay in, or failure to perform due to: labor controversies, strikes, fire, weather, acts of God, war, governmental actions, inability to obtain materials from usual sources, delays caused by, and/or as a direct result of, Owner's insurance company or other circumstances not listed which are beyond the control oflasper. 6. NOISE POLLUTION AND VIBRATIONS: Prior to installation, it is the sole responsibility of Owner to remove any and all breakable or valuable items which are not permanent fixtures to walls, including but not limited to, items on mantles, shelves or other areas susceptible to vibrations; these may fall. Jasper shall not be liable for n oise or vibrations to premises due to Jasper's performance of work contracted herein, or damages resulting to persons or property. 7. CONSTRUCTION DEBRIS: Upon completion of work, Jasper will make a reasonable effort to remove debris from the property, including but not limited to, a general clean-up of construction-rclatod debris and a magnetic sweep of the eve line and walkways surrounding project area. Jasper cannot guarantee the removal of all nails and/or debris. Jasper shall not be liable for any resulting damages. S. LANDSCAPING: While Jasper shall make reasonable efforts to safeguard the lawn and/or shrubbery, it is the sole responsibility of Owner to remove any and all 17ents, exterior furniture and/or valuables. Jasper cannot guarantee the safekeeping of these items nor shall Jasper assume liability for damages. Au ortzed Jasper Representative Date Owner Date City of Sanford Building & Fire Prevention Division \ Re -Roof Permit Card PERMIT NO. 15'm AU & ISSUE DATE: 06? 30. Isob q v m"-A Post this Permit in a conspicuous place outside PROTECT FROM WEATHER Approved plans must be posted with permit for inspection Leave all work uncovered until inspected Permit expires six (6) months from date of issue or last approved inspection A R OOF DR Y-IN INSPECTION IS RE UIRED * * * For Inspection procedures, please refer to the re -roof inspection guidelines provided to you when the permit is issued. The Mitigation Affidavit will not suffice as an alternative to receiving a dry -in inspection. ROOF INSPECTION TYPE APPROVED REJECTED INSPECTOR MISCELLANEOUS INSPECTION TYPE APPROVED REJECTED INSPECTOR ROOF DRY -IN MITIGATION AFFIDAVIT FINAL ROOF 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 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: October 2014 Inspection Line 855.541.2112 TO SCHEDULE AN INSPECTION: Dial855.541.2112 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 3:30 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 ROOF Roof Dry In 116 Mitigation Affadavit 129 Final Roof 111 Miscellaneous Notes: Miscellaneous Sheathing - Roof 106 Insulation - Roof 119 REVISED: OCTOBER 2014 Inspection Line: 855.541.2112 FIRE INSPECTIONS CITY OF SANFORD 407.562.2786 BUILDING & FIRE PREVENTION BUILDING INSPECTIONS 300 N PARK AVE 855.54L.2112 SANFORD FL 32771 DRIVEWAYS -SIDEWALK 407.688.,5080 Page 2 Application Number . . . . . 15-00002220 Date 6/30/15 Property Address . . . . . . 163 KELLY CIR Parcel Number . . . . . . . . 12.20.30.511-0000-1050 Application description . . . ROOFING APPLICATION Subdivision Name . . . . . . Property Zoning . . . . . . . MULTIPLE FAMILY Permit . . . . . . RESIDENTIAL ROOFING PERMIT Additional desc . Phone Access Code 904029 Permit pin number 904029 Required Inspections Phone Insp Seq Insp# Code Description Initials Date 10-1000 129 BL29 MITIGATION AFFIDAVIT 10 116 BL15 ROOF DRY -IN 1000 Ill BL03 FINAL ROOF / / LIMITED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: 12/1 /2015 I hereby name and appoint: John Hester an agent of: Jasper Contractors 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: 163 Kelly Cir street Address) Expiration Date for This Limited Power of Attorney: License Holder Name: Micheal Stephen State License Number: rrr, Qooa, Signature of License B STATE OF FLORIDA COUNTY OF 12/31 /2015 The foregoing instrument was acknowledged before me this day of , 200 , by who is personally known to me or who has produced as identification and who did (did not) take an oath. Notary Seal) Amda Does* NOTARY PUBLIC STATE OF FLORIDA Cam* FF907336 Exilgres &%=19 Rev. 08.12) a" - - Signature Print or type name Notary Public - State of P L Commission No. F C g O-43 3 (e My Commission Expires: g ( 9 THIS lNSTRUMt NT`PREPAFk8bNstma: A14 NOTICE OF tiics Comm ENCEMENT gw gives fmtfce 'lot wqnvfiffw* b8,6ia* OfsaptIPTION bir PROPERTY. It 08ma ir) propaffy. I -C 7— —14-14ULA1. friw g. C0"ACT0R;,Natn6--:'4S AdtIrSSS::.5M0* E'b 10- 0 rtla Dr Off AddresS, wiihlri th 100" 19FIA 6-,Ej E*fiv tq the Limw do In 36dfofj713,13(1C) Date ofnom* Phownun"K. Y.ear "m &te.,4 how 0*WV date L, sped") I k'A of Thl? fum0'0lQ4 •in ttwmorjt W" &ckn kdo&d baijm. nw. who ham pro, OR ucela of CA17LYN HI)VES. Lm qc= lec- - C--3 Lij Ca MARYANNE MORSE, CLERK OF CIRCUIT COURT SEMINOLE COUNTY FL CLERK'S # 2015132769 BK 8593 Pg 1766; (1 pg) E-RECORDED 12/07/2015 09:14:05 AM 10.00 T141S INSTIUAENT PREPARED BY: Hama: Tilia Buncome Addrosa: 5W I- Golatial Or Orlando F132807 NOTICE OF COMMENCEMENT PwmB Humber. Parcel ID Number. 35-21-31-509-0000-1320 MARYME MORSEL SENIMEXE COUNTY CLERK OF C1RWiT COURT i COMPTROLLER SK 08468 Pp 10121 Upq) CLERK'S # 2015051275 RECORDED 05/12/2015 0213607 PM RECORDINS FEES 10.00 RECORDED BY H DeVare The tgldetaigrted her401M That lnipI01l0aiM VM be made to Certain rest ptopatty, and ki =oMamm w{tlt Chapter 713. Florida SUM". 0* kRominp tnWmatlon a in this Notice cfCwnerwemeg. 1_ pE Rl32 H dF 1Y: (Legal dgptp M or the pmperty.ro SUM address ifRV80 e) LOT i TRACT T A ON 2. GENERAL aftOYMIIDNF: Re- Raofi 3. OWNER WFORNA rgbEE IWOPJAAMON IF -ME LESSEE CONTRACTED FOR THE 111PROYEMt31T. Name and addresa:TO fKNGEL 8ELENA/ 3t363 REC Interost in proporty Fos Simplo Tldo Holder Of sated above) Name; Addreas: l% i I J 4. WMACTM Nome MRf r ctors 5380 E Colonial Dr Orton 32607 8_ SURETY ( H applicably, a copy et the ,r ontl M airaeMd}: H S. LENDER; Address: FL Phone Number. 407-278-7788 f attountotBatd: ! Z 7 7. Persona * 1t in be 8tx& of Plorifla bslpar W by p obom nc8a or Ww doearnwft May bit *WOO VWkfed by Ssatlon 711303i1)(a) 7., Florida E101108. Na • Phone Number: 6. In addlibl, Owner desipnstes to receive a copy of the I WW# Notim as ptovIAW in S6Wo6`M b. Expiration fate of Notim of Comnanoemsra M* OpMw Is 1 WMM Tr7 OWNER: ANY PAYMENTS MADE BY THE OWNER V CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART PAYING TWICE FOR IMPROYEf4IENTS TO YOUR PROPERTY. A NOTI JOB SITE BEFORE TtiE FIRST INSPECTION. IF YOU INTEND TO OE BEFORE COMMENCING WORK OR RECOI ING YOUR f+1O= OF CI tato ot FL Cou* o1 Seminole of RuWa 6tetutss. Phone number. A d raxrdirtg WdM a df mffl date Is spaxlied) EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE 03.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR MENCEMENT MUST BE RECORDED AND POSTED ON THE ter M CONSULT VATH YOUR LENDER OR AN ATTORNEY Q rharias3prm Y TNMOtIotJ M foregoing btebranaritMras eckriowlydtlsd baton me this 11 dspr o Q(Aa) _-- zo 15 toy TORRES ANGEL Who Is known tome[? OR rarer Air dru.ax wio Im prod=ad klSntf kelloo k type of MerMllxatlon pw*xed: LL*".TITIA N BUNCOMECommission N ff 224168My Commission ExptreeApril2S, 9019 S 8 Book8468/ Page1012 CFN#2015051275 CITY OF, SANFORD BUILDING SERVICES Residential Re -Roof Hurricane Mitigation Inspection Affidavit Permit #: I C yl?ZL 0 I, LL_cm bNGk 1 hereby acknowledge that I personally inspected Roof deck nailing and/or Secondary water barrier work at (Q?D kelJg and have determined that the work Job Site Add?ess) was done according to the Hurricane Mitigation Retrofit Manual. (based on 553.844 F.S.) I certify that my statements herein are true and accurate to the best of my belief and that I fully understand that making any false statements in writing with the intent to mislead a public servant in the performance of his or her official hall constitute a misdemeanor of the second degree pursuant to Section 837.06 F.S, Printed Name of Contractor Date License # License Type: General Building Residential Roofing Contractor or any individual certified in accordance with F.S. 468 to make such an inspection. STATE OF FLORIDA COUNTY OF Sworn to (or affirmed) and subscribed before me this day of '>— ctw1 be ' , 20 1 , by S& y e S , who is YPersonally Known to me or has Produced (type of ide tification) as identification. SEAL) Signature of Notary Public State of Florida Amda Deswic vw .1 0t _ ) e-5 eV i C NOTARY PUBLIC Print/ Type/Stamp Name STATE OF FLOMDA of Notary Public CWmm# FROM E* rasgi p g Revised: February 2015 CITY OF SANFORD BUILDING SERVICES Residential Re -Roof Hurricane Mitigation Inspection Affidavit Permit #• I (- Jad_6 I,( : Z%DM /=S7-,F4 hereby acknowledge that I personally inspected f -lRoof deck nailing and/or Secondary water barrier work 101 at I L 3 kz q_y C- I kC L)5_ and have determined that the work Job Site Address) was done according to the Hurricane Mitigation Retrofit Manual. (based on 553.844 F.S.) I certify that my statements herein are true and accurate to the best of my belief and that I fully understand that making any false statements in writing with the intent to mislead a public servant in the performance of his or her official duty shall constitute a misdemeanor of the second degree pursuant to Section 837.06 F.S. n 4L 2 - I - -_)_0 / _- K719-Wature of Contractor Date 1 n i+N rCF S T. L- CCU- t ZC? 69S_ Printed Name of Contractor License # License Type: General 0 Building Residential 9 Roofing Contractor or any individual certified in accordance with F.S. 468 to make such an inspection. STATE OF FLORIDA COUNTY OF r l-2 Sworn to (or affirmed) and subscribed before me this day of o , 20.1 , by J3 who is Personally Known to me has & Produced (type of identification) as identification. SEAL) Signature of Notary Public r -ter S><ate of Florida Print/Type/Stamp ame of Notary Public Revised.• February 2015 TITIA. 4=B7uNC0ME Commission # FF 224168 My Commission Expires April 21, 2019