HomeMy WebLinkAbout208 Laurel Dra
Job Address:
Parcel ID:
Type of Work: New Addition
Description of Work:
mad` x" CITY OF SANFORD
JUL 201y BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: 1 5 - 7_ L( f
Documented Construction Value: $
60
Tr • , Historic District: Yes No ]
Residential Commercial
Alteration Repair Demo Change of Use Move
V"A(' &'
Plan Review Contact Person: Title:
Phone: Fax: Email:
L
Property Owner InformationName q' -i' Phone:
Street: ! SSG to tL 'Dr • Resident of property?
City, State Zip: ary C14 'af, (I () 3
Contractor Information _
Name Phone:
Street:
City, State Zip: _
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Fax:
State License No.:
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender: (2y 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: 51h Edition (2014) Florida Building Code Revised:
June 30, 2015 Permit 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. 6,
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.
t oo,,&,i I.
Signature fOwner/Agent Date Signature of Contractor/Agent Date
P t O er/Agent's Name Print Contractor/Agent's Name
of
IIIIIII MI`11.L ••.
O pNY Notary Public -State of Florida
My Comm. Expires Jan 16. 2018
Commission # FF 071760
F .111..1Flq
Bonded TMoU0 National Notary Assn. 1 Owner/
Agent is ersona ly Known to Me or Produced
ID Type of ID FL JI)L Signature
of Notary -State of Florida 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 APPROVALS:
ZONING: ENGINEERING:
COMMENTS:
of
Heads UTILITIES:
FIRE:
Flood
Zone: of
Stories: Plumbing - #
of Fixtures Fire
Alarm Permit: Yes No WASTE
WATER: 91
1_0111eR] Revised:
June 30, 2015 Permit Application
SCPA Parcel View: 01-20-30-518-0000-0040 Page 1 of 2
v
CJavWJohnnon,CFA Property Record Card
PROPERTY Parcel: 01-20-30-518-0000-0040
f P"HER Owner: ALEXANDER CYNTHIA F
MAINOLECOUNT"Y,FLORIDA Property Address: 208 LAUREL DR SANFORD, FL 32771-5426
Parcel: 01-20-30-518-0000-0040
Property Address: 208 LAUREL DR
Owner: ALEXANDER CYNTHIA F
Mailing: 3665 S ORLANDO DR OFC
SANFORD, FL 32773-5692
Subdivision Name: SOUTH PIN ECREST 1ST ADD
Tax District: Sl-SANFORD
Exemptions:
DOR Use Code: 01-SINGLE FAMILY
Value Summary
2015 Working
Values
2014 Certil
Values
Valuation Method Cost/Market Cost/Marke
Number of Buildings 1 1
Depreciated Bldg Value 32,172 31,213
Depreciated EXFT Value
Land Value (Market) 12,000 12,206
Land Value Ag
Just/Market Value
44,172 43,419
Portability Adj
Save Our Homes Adj 0 0
Amendment 1 Adj 0 0
Assessed Value 44,172 43,419
Tax Amount without SOH: $
2014 Tax Bill Amount $
Tax Estimator
Save Our Homes Savings:
Does NOT INCLUDE Non Ad Valorem Assessments
Legal Description
LOT 4
SOUTH PINECREST 1ST ADD
PB 10 PG 42
Taxes
Taxing Authority Assessment Value Exempt Values Taxable Value
County General Fund 44,172 0 1
Schools 44,172 0 4
City Sanford 44,172 0 V
SJWM(Saint Johns Water Management) 44,172 0 9
County Bonds 44,172 0 V
Sales
Description Date Book Page Amount Qualified Vac/Imp
WARRANTY DEED 3/1/1997 03217 0558 52,000 Yes Improved
ADMINISTRATIVE DEED 8/1/1996 03121 0593
1845
100 No Improved
PROBATE RECORDS 3/1/1996 03039 100 No Improved
Find Comparable Sales within this Subdivision
http://www.scpafl.org/ParcelDetaiUnfo.aspx?PID=01203051800000040 7/30/2015
I;agree that, as the party legally and financially responsible for this proposed construction activity, I will
A
abide by all' applicable laws and requirements that govern owner -builders as well as employers. I also
understand that the construction must comply with all applicable laws, ordinances, building codes, and
zoning'regulations.
C
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 provided on this disclosure or in the 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
I, 'Y
and capable of performing
conditions specified above.
SignatLIFe of Owner -Builder
i5c , do hereby state that I am qualified
construction involved with the permit application filed and agree to the
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
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 a
license.
I understand that building permits are not required to be signed by a property owner unless he or she is
n ,
X
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 name. I 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 1 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.
J
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
l n for the employee. I understand that my failure to follow these laws may subject me to serious financial
risk.
Rev. 9.14.2009
City of Sanford
Roof Permit Application Checklist
All permit application packages must be complete prior to acceptance. You must check each box to the
left or indicate n/a on this submittal. A complete application package shall include the following:
Building Permit Application completed, signed and notarized. Application must include correct address
and complete parcel I.D. number.
q&/ Copy of applicable contractor's license issued by the State of Florida (if the contractor is the
applicant).
A A site specific notarized power of attorney shall be required from the licensed contractor if
he/she appoints an employee of his/her company to sign the permit application as the contractor.
OA Certificate of insurance indicating worker's compensation insurance coverage and naming the City of
Sanford as certificate holder, or a copy of a worker's compensation exemption issued by the State of
Florida (must be submitted with each application if contractor is the applicant).
nl- &mpleted and signed Owner Builder Statement / Affidavit (if the owner is the applicant).
These guidelines were compiled to assist the applicant in preparing a roof permit application and may not be
complete. • The applicant is required to meet all City of Sanford, state, and federal code requirements.
THIS INS iftUMENT PREPAR q BY:
Name( l
Address:vic f ' '
3 1`13 MARYANNE HORSEY SEMINOLE C:OUHTY
CLERK OF CIRCUIT COURT 1, COMPTROLLER
NOTICE OF COMMENCEMENT CLERK'SRK'S r' 117 c3313- C:LERY.'S Y 2111;CI$3313
RECORDED 07l30/2015 12:19 W PH
State of Florida RECORDING FEES $10.00
County of Seminole RECTO ' I-D BY te. i th - zL'
Permit Number: .
t l
Parcel ID Number:y
y' /a
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.
DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available) 461-s
OWNER INP RMAT N:. Z ? Q
CC Name: g
Address: (:. J
v o
Fee Simple Title Holder (if other than owner) Name: z
Address: w W o)
4CONTRACTOR:
L F '` Name: 2
Address:
Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served
as provided by Section 713.13(1)(b), Florida Statutes.
Name:
Address:
In addition to himself, Owner Designates of
To receive a copy of the Lienor's Notice as Provided in
Section 713.13(1)(b), Florida Statutes.
Expiration Date of Notice of Commencement (The expiration date 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.
Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true
talthe best of my knowledge and beli
t
r 'lt
Owne gna re Owners Printed Name
FI da Statute 713.13(1)(g): "The owner must sign the notice of commencement and no one else may be permitted to sign In his or her stead:
State of -ElCounty of `e-Se-' . N 0
The foregoing instrument was acknowledged before me this, day of u l U . 20
byCn )t Ct T .lam1 JA_1 Who is personally known to me
Name of person making statement
OR who has produced identification type of identification produced: L
h
ANNETTE SCOTT
Notary Public - State of Florida
J • : : •_ My Comm. Expires Jan 16, 2018
Notary Signature
ommission # FF 071760
OF Bonded No* National Notary Assn.
Page 1 of 2
RECORD COPY
ry 1
FbrW rlcr»MWtof BCIS Home Log In User Registration Hot Topics I submit Surcharge Stats & Facts Publications FBC Staff I BCIS Site Map I Links I Search
Busines
Professi -al a USER: PubicProdUseral
Regulation (
Q
PjfflV
Product Approval Menu > Product or Application Search > Application List > Application Detail'® FL #
FL15822-R1 Application
Type Revision Code
Version 2014 Application
Status Approved Comments
Archived
J Product
Manufacturer G.M.C. Roofing & Building Paper Products Inc. Address/
Phone/Email 6400 Zerker Avenue Shafter,
CA 93263 661)
339-4324 dave.
swaroopgap@gmall.com Authorized
Signature Technical
Representative Address/
Phone/Email Quality
Assurance Representative Address/
Phone/Email Category
Subcategory
Compliance
Method Florida
Engineer or Architect Name who developed the
Evaluation Report Florida
License Quality
Assurance Entity Quality
Assurance Contract Expiration Date Validated
By Certificate
of Independence Dave
Swaroop dave.
swaroopgap@gmail.com Roofing
Underlayments
ALoINc
SANFORD
15-
2471 Evaluation
Report from a Florida Registered Architect or a Licensed Florida
Professional Engineer Evaluation
Report - Hardcopy Received Zachary
R. Priest PE-
74021 Keystone
Certifications, Inc. 12/
31/2022 Locke
Bowden Validation
Checklist - Hardcopy Received FL15822
RI COI GMC12001.1 2014 FBC Evaluation Report ASTM D 4869 -
Finai.odf Referenced
Standard and Year (of Standard) Standard ASTM
D 226 ASTM
D 4869 ASTM
D 6380 TAS
110 Equivalence
of Product Standards Certified
By Sections
from the Code Year
2006
2005
2003
2000
9/
17/2015
Page 2 of 2
Product Approval Method Method 1 Option D
Date Submitted 04/26/2015
Date Validated 04/27/2015
Date Pending FBC Approval 05/03/2015
Date Approved 06/22/2015
Summary of Products
FL # Model, Number or Name Description
15822.1 30 ASTM D 4869 ASTM D 4869 Type II
Limits of Use Installation Instructions
Approved for use in HVHZ: No FL15822 R1 II GMC12001.1 2014 FBC Evaluation Report
ASTM D 4869 - Final.pdfApprovedforuseoutsideHVHZ: Yes
Impact Resistant: N/A Verified By: Zachary R. Priest 74021
Design Pressure: N/A Created by Independent Third Party: Yes
Other: See evaluation report for limits of use Evaluation Reports
FL15822 R1 AE GMC12001.1 2014 FBC Evaluation Report
ASTM D 4869 - Final.Ddf
Created by Independent Third Party: Yes
15822.2 15 & #30 ASTM D 226 ASTM D 226 Type I and Type II
Limits of Use Installation Instructions
Approved for use in HVHZ: Yes FL15822 RI II GMC12002.1 2014 FBC Evaluation Report
ASTM D 226 - Final.odfApprovedforuseoutsideHVHZ: Yes
Impact Resistant: N/A Verified By: Zachary R. Priest PE-74021
Design Pressure: N/A Created by Independent Third Party: Yes
Other: See evaluation report for limits of use Evaluation Reports
FL15822 R1 AE GMC12002.1 2014 FBC Evaluation Report
ASTM D 226 - Final.pdf
Created by Independent Third Party: Yes
15822.3 Tile Underlayment ASTM D 6380 Class M Type II
Limits of Use Installation Instructions
Approved for use in HVHZ: Yes FL15822 R1 II GMC13001.1 2014 FBC Product Evaluation
Report - Final.pdfApprovedforuseoutsideHVHZ: Yes
Impact Resistant: N/A Verified By: Zachary R. Priest PE-74021
Design Pressure: N/A Created by Independent Third Party: Yes
Other: See evaluation report for limits of use. Evaluation Reports
FL15822 R1 AE GMC13001.1 2014 FBC Product Evaluation
Report - Final.pdf
Created by Independent Third Party: Yes
Back Next
Contact Us :: 1940 North Monroe Street. Tallahassee FL 32399 Phone: 850-487-1824
The State of Florida is an AA/EEO employer. Coovrioht 2007-2013 State of Florida.:: Privacy Statement :: Accessibility Statement :: Refund Statement
Under Florida law, email addresses are public records. If you do not want your e-mail address released In response to a public -records request, do not send
electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions, please contact 850.487.1395. -Pursuant to
Section 455.275(1), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must provide the Department with an email address If
they have one. The emails provided may be used for official communication with the licensee. However email addresses are public record. If you do not wish to
supply a personal address, please provide the Department with an email address which can be made available to the public. To determine if you are a licensee under
Chapter 455, F.S., please click here .
Product Approval Accepts:
echck
C S ArFE
9/17/2015
CREEK Certificate of Authorization No. 29824
17520 Edinburgh Drive
i
Tampa, FL 33647
TECHNICAL SERVICES, LLC (813) 480-3421
EVALUATION REPORT 2014 FLORIDA BUILDING CODE
Manufacturer: G.M.C.ROOFING & BUILDING PAPER PRODUCTS, INC. Issued April 26, 2015
6400 Zerker Avenue
Shafter, CA 93263
661) 399-4324
http://Qmcpaper.com
Manufacturing Plants: Jasper, FL
Pryor, OK
Quality Assurance: Keystone Certifications Inc. (QUA1824)
SCOPE
Category: Roofing
Subcategory: Underlayments
Code Sections: 1507.2.3, 1507.2.8, 1507.4.5.1, 1507.4.5.2, 1507.5.3, 1507.5.3.2 1507.7.3, 1507.7.3.2
1507.8.3, 1507.8.3.2 1507.9.3, 1507.9.3.2
Properties: Physical properties
PRODUCT DESCRIPTION AND APPLICATION
30 ASTM D 4869 Type II ASTM D 4869 Type II asphalt -saturated organic felt underlayment used in steep slope
roofing.
Deck: In accordance with the FBC
Slope: Min. 2:12 and in accordance with the FBC;
Attachment: Mechanically fasten in accordance with the
FBC with minimum 19" headlap and 6"
endlaps.
Allowable roof coverings: Asphalt shingles, metal roofing, wood shakes
and shingles, and slate shingles
LIMITATIONS
1) This evaluation report is not use in the HVHZ.
2) Fire Classification is not within the scope of this evaluation.
3) Wind uplift resistance in not within scope of this evaluation.
4) Roofing felts shall be installed in strict compliance with this evaluation report, the applicable building code,
and the manufacturer's published installation instructions.
5) Deck substrates shall be clean, dry, and free from any irregularities and debris. All fasteners in the deck
shall be checked for protrusion and corrected prior to underlayment application.
6) All underlayments shall be installed with the roll length parallel to the eave, starting at the eave, and lapped
in success courses installed up the deck in a manner that effectively sheds water from the deck. End laps
shall be staggered between courses in accordance with the manufacturer's application instructions.
7) Roofing felts shall not be used with tile roof coverings nor installed over existing roof coverings.
8) Roofing felts may be used as described in other current FBC product approval documents.
9) Installation of the primary roof covering is recommended immediately following installation of roofing felt and
in no case shall the underlayment be exposed for greater than 30 days.
10) All products listed in this report shall be manufactured under a quality assurance program in compliance with
Rule 61G20-3.
GMC12001.1 FL15822.1-R1 Page 1 of 2
This evaluation report is provided for State of Florida product approval under Rule 61G20-3. The manufacturer shall notify CREEK
Technical Services, LLC of any product changes or quality assurance changes throughout the duration for which this report is valid.
This evaluation report does not express nor imply warranty, installation, recommended use, or other product attributes that are not
specifically addressed herein.
CREEK G.M.C.ROOFING & BUILDING PAPER PRODUCTS, INC.
ASTM D 4869 Underlayments1TECHNICALSERVICES, LLC
REFERENCE$
En& Report No. Standard Year
PRI Construction Materials Technologies (TST5878) GAPF-005-02-02 ASTM D 4869 2005e1
PRI Construction Materials Technologies (TST5878) GAPF-004-02-03 ASTM D 4869 2005e1
COMPLIANCE STATEMENT
The products evaluated herein by Zachary R. Priest, P.E. have demonstrated compliance with the 2014 Florida
Building Code as evidenced in the referenced documents submitted by the named manufacturer.
RY R. p
E IV S FS
No 74021
3 STATE OF :
i
N A%E%t
CERTIFICATION OF INDEPENDENCE
2015.04.2
6 13:30:55
04'00'
Zachary R. Priest, P.E.
Florida Registration No. 74021
Organization No. ANE9641
CREEK Technical Services, LLC does not have, nor will it acquire, a financial interest in any company manufacturing or distributing
products under this evaluation.
CREEK Technical Services, LLC is not owned, operated, or controlled by any company manufacturing or distributing products under
this evaluation.
Zachary R. Priest, P.E. does not have, nor will acquire, a financial interest in any company manufacturing or distributing products
under this evaluation.
Zachary R. Priest, P.E. does not have, nor will acquire, a financial interest in any other entity involved in the approval process of the
product.
END OF REPORT
GMC12001.1 FL15822.1-R1 Page 2 of 2
This evaluation report is provided for State of Florida product approval under Rule 61G20-3. The manufacturer shall notify CREEK
Technical Services, LLC of any product changes or quality assurance changes throughout the duration for which this report is valid.
This evaluation report does not express nor imply warranty, installation, recommended use, or other product attributes that are not
specifically addressed herein.
1 •
I .
CITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #: 1 5 1
I,
Roof deck nailhW and/or
at t20 8
hereby acknowledge that I personally inspected
Secondary water barrier work
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.
k (d"AA N4,__ PI l S l S
Si nat re of Contra c or Date
t
t Print d Name of Contractor License #
k License Type: General Building Residential Roofing Contractor
l or any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OFP,r-, SIP
Sworn,to (or affirmed) and subscribed before me this 30L4z day of v4 , 20 , by
0,t _LqQ M-PiA x Ti+ (- , who is Personally Known to me or as produced (type of entificat*
as identification. SEAL)
ignature
o otary Public State
of Florida N
rJ t_—L—e SG Print/
Type/Stamp Name ofrola,,,.. ,
ub ' -. t- AD-Ark- ANNETTE
SCOTT Nolary
Public -State of Florida My
Comm. Expires Jan 16, 2018 Commission #
FF 071760 Bonded
Wm* National Notary Assn. 3