HomeMy WebLinkAbout113 Belgain WayJob Address: % 1 3
CITY OF SANFORD
-r- �r-- ` BUILDING & FIRE PREVENTION
. MAY 3 1 2016 PERMIT APPLICATION
i I Application No:
BY:. (%)
Documented Construction Value: $ J o -
Parcel ID: 1 9 -,Q 0- 3 ► - 56s' 1)qao - O 13 0
Type of Work: New ❑ Addition ❑ Alteration ❑ Repair
Description of Work: R _ f-00 �- 15N4 Sh
Historic District: Yes ❑ No ❑
Residential Commercial ❑
Demo ❑ Change of Use ❑ Move ❑
Plan Review Contact Person:
&,+o
Izy), ba4do
Title: &&af 40 w
Phone: ,59( -5919 - R36 --i-
Fax:
3 gC- 6 ;l�6 - 5039
Email: 5L_M 6377 V R>)1.. Gt$1'✓1
Property Owner Information
Name �14 �Yt2 Z(j ) 1-1 aA
Street: 15-7y Sov►( !.Oa ewpO 121
City, State Zip: �,-Gn d
Phone: �&-7 — Y& - h�"
Resident of property? :
Contractor Information
Name m o")i Q,u Pl„- �,O i►'1� �.�
Street: tZ S d r _ F' ,M1115 P✓L
City, State Zip: 4A,0dr'vlly 33s��0
Phone: VD -7- 960' 02
Fax:
State License No.: CC''Gt133a��1
Architect/Engineer Information
Name: Phone
Street: Fax:
City, St, Zip: E-mail:
Bonding Company:
Address:
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. 1 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: 5"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.
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 JCC 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 c ction an zoning.
Signature of Owner/Agent Date ature of ontractor/Agent Date
i
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
''{► CLIFFORD S SNYDER
MY COMMISSION # FF931019
A EXPIRES October 26.2019
CWklo9avlu ron+
Contractor gen is _,�ClPersonally 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: Occupancy Use:
Total Sq Ft of Bldg:
Min. Occupancy Load:
New Construction: Electric - # of Amps,
Flood Zone:
# of Stories:
Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads Fire Alarm Permit: Yes ❑ No ❑
APPROVALS: ZONING: UTILITIES: WASTE WATER:
ENGINEERING:
COMMENTS:
FIRE:
BUILDING:
Revised: June 30, 2015 Permit Application
To be completed as required by State Statute Section 713 and other applicable sections.
Permit Application Information - Page Two
Owner's Name
Owner'sAddress // 3 ae4'-." liV-W .Sa.,I&J . Ft .32%33
Fee Simple TNeholder's Name (If other than owner's)
Fee Simple Titleholder's Address (If other than owner's)
City State
Contractor's Name
Contractor's Address
City
Job Name
Job Address
City
Bonding Company Name _
Bonding Company Address
City
Architect/Engineer's Name
Archnect/Engineer's Address
Mortgage Lender's Name
Mortgage Lender's Address
State
State
State
Zip Code
Zip Code
SUITE/UNIT
Zip Code
Zip Code
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 the standards of all laws regulating construction in
this jurisdiction. I understand that a separate pen -nit must be secured for ELECTRICAL, PLUMBING, GAS, MECHANICAL, ROOFING,
SIGNS, POOLS, ETC.
.# OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate arra[hat 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 II der or an attorney before
recording your Notice of Commencement. / 1 n
r- Owner Signature 2
The forego,,M g instrument 1waA a mowledged before me this
by (e+4/Mrll— who is pers}nallykC� to
and who produced
as identfication and who
did not take an oath
Notary as to Owne � /
Commission No
State of FL. County of
My Commission expires
(SEAL)
Contractor Signature — — — —
The forejWg inwas aeknowiedged before me this � . i11d
by Cif► owho is lly known to
and who produced
did not take an oath.
Notary as to Contractor
Commission No
State of FL County of
My Commission expires
(SEAL)
as identification and who
av • Mi4RSCH �Y '
CLIFFORD S SNYDER
+° rf, �� NOTARY PUBLIC • STATE OF FLORIDA
COMMISSION# FF148880 MY COMMISSION N FF931019
EXPIRES/2018
� EXPIRES October 26, 2019
8/7
:;o ��;••� h1G1i30A-0.53 FiorWaNuu ervW.aoro
BONDED THRU F400•NOTARyl
Para mbs informaciSn on espatiol, por favor Ilame of Departamento de Building Safety at ntimero 407-836-5550.
43-75 (Rev 01/13) Page 2 of 2
�ON6T44�A"WM
Im
RE -ROOF WORK
AGREEMENT
Advanced Home Solntlon
Construction Firm
121 S. Orange Ave. 01526
Orlando, Florida 32801
(Oryke) 407400.1224
(Fax) 407.704-2577
9FA Ctrdiled Romw4*W
Fltrlda Statt Lknnill CRC OSSW
(ICRC OIIOT76
Advanced Home Solutions (the "Contractor') agrees to furnish all materials and subcontract Its labor for the below im-
provemenffi at thefo,_llgwing address:,�\_(,
�Y Ste - " -` F�. 3 2-733
for the Owner(s) cx�r , k,.
Homeowners Phone v - Owners Email /at -290% 711`6 444-1- •lam ar.r
Insurance Company S i Jc�)palm 0 `SST -1 SDUS'-Sto 6
( Re -Roof) Lgea& IRM - li.n..t • R - RW. New w • D- Debts *11111-11140"
2. Number of stories - w..,.�„wy.a-"" r2 aa�r'a"ar rat dnw � arayaal11 "teff t tsar red/ OPM'
_�_ &predominant pitch _� /12. oar 7/!2p)Irh warm elimm typbc
3. provide permits, fees, Notice of Commencement filing,'dunplster fees and all applicable taxes. Do Not Remove Pasted 2e11110e'
4. Provide OSHA requited safety & supervision.
5. Protect the surrounding structure, caw -off & remove old roof to workable surface & re -nail roof dock with eight penny ring
shank nails.
7.Owner required to pay all rotten plywood atIla S 60.00/Sheet, 1x6 at S 6.00/L.F., l x8 or T&G at $8.00/L.F. hdnYq wA T Initial
• If ropes fascia is replaced & existing soffit is to be re -installed additional cost orse.00/L.F will apply -
move underbymrnt_ iS/� and install .RJ,;,.r, /fie iA fi/�
9. Remove „& install new 1 -1/2 -or ;7f3/2" cave drip. Color: %.L,Ve . a+rwwA In l
10. RM & R Chimmey Flashing, Counter Flashing & Caulk L.F.
11. RM & R Valley Metal or Ice & Water Shield Product as rcquircd by Florida Building Code. Ins I - L.F.
12. RM & R pipe jacks & tercel: -1/2" x - 2" x� & 3" x 1 & 4"x -
19. Install 20 yr. / 30 yr. / r. Limited Life Time year fiberglas¢ shingle. upIlrode to_ 130 MP IFiwd codL 2.l
Color Manufacturer: �„L :_1...J Brand Initial
14. RM & R new off -ridge ventilation x _Z or RM & R ridge ventilation L.F. to install.
15. Clean job site of all work debris. lbw ae awn am esol" when an/aa the abd alww eau 407.800.1224/ar or addiliewd ew. W weaird
16. D & R existing nailed = or screwed - gutters i". Total L.F. with -- D.S. gutters will rpt be guaranteed
against leaking or damage. The customer requests install of new drip edge over existing gutters? Yes or No-.
Customer request install of new drip edge at pool super gutters requiring D & R of screen enclosure? Yea or No ✓.
17. RM & R all dead valleys with: Granulated peel & stick.
I8. RM & RS lighting rods L.F. A ryarre ertawaN wiu be proddest
19. RM & R of all kitchen vents & goose necks with 8" _-L or I W'
20. All existing static exhaust flims will be cleaned & resealed. Solar - Electric - Gas - Fire Other.
21 . RM & R solar panels = pool panels - water heater - electric panels
22. Skylights: 2' x 2's or 2' x 4'= Caps: poly_ glass_ Mounts: curb= flush Skylight Package: cap only= cap & curb_
23. L -Flashing will be reused unless it is required to be replacement. Addahwrd rsat widWA*.
24.'The Contractor 311J coordinate by subcontracting the removal and reinstallation of roof related peripherals.
• Yke www r err ad is aeeatpt so eonlred of to"Onitr wtlh any tae sukaw adorro do wah rr/a/ed to this evahw.
25. Owners responsibility to contact their cable or satellite provider to re -install equipment. worioanal* werwrny.owr)Jabmardow-.4
27,.'T_ - Year Workmanship Warranty is in effect upon completion. M.rerld WanvnNarorNaiarM.wahnrrr
28. Enhanced Manufactured Warranty: CertaimTeed 3 -Star ( 20yrs = S20/s.q. 4 -Star ( 50yrs) - $25/Lq. (sec wwrino)
29. Owner will be contacted several days prior to the dumpster delivery. 65770N A-.... ) .e TV tA-.
30. AV Non -Insurance Emergency Work requires advance payment prior to start.
Emergency tarping or board -up. Number - Size Cost After Hours
31. All Upgrades & Other Work to be requested must be In writing and request ONLY through your Account Manager.
32. Pro -Construction Inspection completed on 5 /i4 /2U� iY initial
Exhibit: or also we Xactimate for Scope: Demo, =Drywall, -- Insulation.- Painting, = Carpentry. Elect..
-HVAC, --Plumb, _Restoration, - IEP, =Rem ednlion, --Tree Work _Flooring, =Doors, _Wmdows, _ Screens,
NOTES:
A.) ANS la.da (PmddW at Adlwtavao 12772/139 / r.) Ordlume & Lw b PawwM
N r lwwrad (PW l) f
• Iww an" RCV fAlx�b O&L _ • Iraund wquiwd in pey it rm in coveted. Conoun,; YEs _
a.),,in t Dadwok s 4 tvO / S G.)'Fod asWn no fr a RC V (a. G to E. F) f
low*& rmoired deduelibk to be peld was collected YES
C.) In Irrnaee Ckeek f14-orm o 7
Pled by lower collected YES _
D.) Irarsict Dwetiad"
Pad by tiaum collected YES
E) Irraaee S 10 ab
Paid by loom collected YES -
S
1
UnpW Anawl by karcr f
1.) NON -INSURANCE RO-ROOF EMNATE ( Estimate valid fa 30 da)s)
S 5011 Dclin t f colkcbd YES _
2.) O & 1.. C.O.. Roke Weed & Addkkaal Werk f
Paid By elcm or Imintas and collected YES _
3.) Crrdlb to crtener f 1
Pad by compaay Yes -
NOTICE TO OWNER: ADDITIONAL TERMS ARE ON rHE BACK. You are entitled to a copy of the contract at the time you sign. Keep it tqprotmyDur
rights. Executed in triplicsr on py of which was delivered to, and receipt is hereby acknowledge by Owner(s) on 4r/_
fi (x)
Owner Sighith Owner Signature
Contractors Agent Signature Account Manager nail
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City of Sanford
Building and Fire Prevention
Product Approval Specification Form
Permit #
Project Location Address
As required by Florida Statute 553.842 and Florida Administrative Code 9N-3, please provide the
information and product approval number(s) on the building components listed below if they are to be
utilized on the construction project for which you are applying for a building permit. We recommend that
you contact your local product supplier should you not know the product approval number for any of the
applicable listed products. Be aware that windows, skylights, and exterior doors must be tested in
accordance with the Florida Building Code, Section 1714.5. More information about Statewide Product
Approval can be obtained at www.floridabuilding.orcl.
The following information must be available on the jobsite for inspections:
1. This entire product approval form
2. A copy of the manufacturer's installation details and requirements for each product.
Category / Subcategory Manufacturer Product Florida Approval #
Description include decimal
1. Exterior Doors
Swinging
Sliding
Sectional
Roll U
Automatic
Other
2. Windows
Single Hun
Horizontal Slider
Casement
Double Hun
Fixed
Awning
Pass Through
Projected
Mullions
Wind Breaker
Dual Action
Other
June 2014
Category / Subcategory
Manufacturer
Product
Description(including
Florida Approval #
decimal
3. Panel Walls
Siding
Soffits
Storefronts
Curtain Walls
Wall Louver
Glass block
Membrane
Greenhouse
E.P.S Composite
Panels
Other
4. Roofing Products
Asphalt Shingles
CXwv.r-
Underla ments
V— vw
02
Roofing Fasteners
Nonstructural
Metal Roofing
Wood Shakes and
Shingles
Roofing tiles
Roofing
Insulation
Waterproofing
Built up roofing
System
Modified Bitumen
Single Ply Roof
Systems
Roofinq slate
Cements/
Adhesives /
Coating
Liquid Applied
Roofing Systems
Roof Tile
adhesive
Spray Applied
Polyurethane
Roofing
E.P.S. Roof
Panels
Roof Vents
Other
►
June 2014
Category / Subcategory
Manufacturer
Product
Description
Florida Approval #
include decimal
S. Shutters
Accordion
Bahama
Colonial
Roll u
Equipment
Other
6. Skylights
Skylights
Other
7. Structural
Components
Wood Connectors /
Anchors
Truss Plates
Engineered Lumber
Railing
Coolers/Freezers
Concrete Admixtures
Precast Lintels
Insulation Forms
Plastics
Deck / Roof
Wall
Prefab Sheds
Other
8. New Exterior
Envelope Products
Applicant's Signature
Applicant's Name
(Please Print)
June 2014
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:_T�/L
I hereby name and appoint: cy SP" &-V►,7 ,660 aeo
an agent of:
9
(Namc 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):
C
The specific permit and
Expiration Date for This Limited Power of Attorney:
►� I
License Holder Name:
State License Number:
Signature of License H
STATE OF FLORIDA
COUNTY OF rr'�IC1Ac
The forgoing in try t was acknowledged before me this 0+ day of
2001_6 , by who is personally known
to me or o who has produced as
identification and who did (did not) take an oath.
oe
Sign re
(Notary Seal)
CLIFFORD S SNYDER
MY COMMISSION # FF931019
s
EXPIRES October 26, 2019
14071398-0'53 FlpnOaNpta �rvlce.tgm
(Rev. 08.12)
Print or type name
Notary Public - State of _
Commission No.
My Commission Expires:
r ---
This isbuWAut preps by:
Name: y l Z141 r(�
Address: S jvl r
NOTICE OF COMMENCEMENT
MARYAHNE MORSE, SEMINOLE COUNTY
CLH,% OF CIRCUIT COURT & COMPTROLLER
BK 5697 Pq 619 (1P3s)
CLERK'S A 2016055854
RECORDED 05/31/2016 10.'32:47 H1H
RECORDING FEES $10.00
RECORDED BY .ieckem-ij
STATE OF HARMA Permit #:
• COUNTY OF 1'i'11• A PARCEL ID #: -3 1 — <OC — 000,0) - 000
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property. and In
aecordaum with Chapter 713, Florida Statutes, the foUowhrg Information is prodded in this Notice of Commencetneot.
I Description of Property: (Legal description of the property and street address if available) I 8,-t Giot`,yl 1��+-ti Sfl ►1 �i-,c('
•-31-7-71LDs 1h �H I bo PG s
2 General Description of improvements: v 5, -- k•r�.�.C_
3 Owner Name: _
Address. �L
Interest in property:
Name & Address of fee simple titleholder: (if other than own«)
Pboae: l 0
F'L 37,33
4 Contractor's Name: (,fit!,L L<t Phone: 07- (X) /•fid
Address: 1/-S Jl_ RQAIVi' t. 5J/ O
5 Sarcty Name: 1.Phone:
Address: Amount of Bond: $
6 Lender Name: 4 giPhone:
Address:
7 Persons within the State of Florida designated by Owner upon who notice or other documents maybe served as provided by Section
713.13(lxa) 7. Florida Statues: NamL- Phone:
Address: INI I P-
8 in addition to himself or herself, Owner designates the following persou(s) to receive a copy of the Licaor's Notice as provided In Section
713.13(l)(b), Florida Statutes: Name: Phone:
Address -
9 Expiration Date of Notice of Commencement:
(We expiration data is 1 year hom date of rocording unless a dimmer 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 L 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 FiNANCM CONSULT Wf111 YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORKOR RECORDING YOUR NOTICE OF COMMENCEMENT.
Verification Pursuant to Section 92525. Florida Statutes
Under pgnities ofptajury, I declm that 1 have tad the forcgodng and that the frets stated in it ate we to the bat of my knowledge and belieL
Signature of Owner or Owner's Authorized Signatory's Title/Otlice
Officer / Director / Parma / Manager
The foregoing instrument was acknowledged before me this -21& day of UW20 _V�a, by
(name of person) as (type o uthority, ...mg. officer, busttx, attorney in fact) for
(name of party on behalf of wh>i m ted).
(SEAL)
Sr rc o Publrc S m of Florida
ROBE MARSCH
•;►a� e•.
:r° v !1:t NOTARY PUBLIC - STATE OF FLORIDA-.1���/
COMMISSION1i FF148880 Print. Type or Stamp Commissioned Name of Notary Public
EXPIRES 817/2018 Personally Known O or Produced Identification O
•••• BONDBDTHFWi•OOe•Nt7fARY1
.,r."F1ED COPY— MARYANNE MORSE
Scptanbcr 2014 CLERK OF THE CIRCUIT COURT AND
COMPTROLLER
SEMINOLE COUNTY, FLORIDA
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DEPURK
'�'�� WCLEMAY 3 12016
M
D City of Sanford
Building and Fire Prevention
RFSIDENTIAL R1: -ROOF INSPECTION AFFIDAVIT
NAILING, SHEA,rHING, DRY -IN, FLAMHING, AND ALL FINAL ROOF COVERINGS
PERMIT#: Lp — ���_ Am)m-ss: — ^`
AS A(N) GI NI:R4l., BUILDING. RI-.SIDI-.NIIAL, OR
R(>Ul'ING CONIRA('I OR. I;NGINFI:R. ARCI II I hl r. OF I S CII. , i 1 I; t6& 131!li.l)Ira; INSPL(. I OR, I III_ RI"BY AI -FIRM, II IAT ALL OF ME
FOREGOING INFORMATION ISI RUF AND ACCT IIIA I F AND'I I IA F Al I. ROOI ING COMPONENTS LIST LD ON I IIF SCOPE 01" WORD A"r FIIL
ABOVE R13FERENC'ED ADDRESS HAVE. BEEN INS rAl LFA) IN ACC'ORDAN0. WI I It H 1HR PRODUC I' AlTROVALS AND ALI, APPLICABLE: COL)[
REQUIRFMEN"rS-SPE.CIFICALLN" FLORIDA r31J11.1)m;0)1)I LNISIiN(; BU11 DING. IN ADDIIION I CFRIII'i IIIL INSI'AI LAIION MF.FTSALL
REQUIRLMFNIS FOR SECONDARY WA I FR 13AIZRII:R AND NAILIN6, or "I III: Pool- DLCK. IN •\CCORDANCI: WI I It I III-' HURRICANE RE TROFIT
MANUAL REQUIREMENI"S (BASED ON F.S. Climb I:R 553.814).
LICENSER: �� Lt 0C -A( r,
COMI'ANY % CON"I-RAC TOR: -L�c���—�cl ^� /-- -.--1 c6 .- �-1.�1�1-1) L�----.----
J I
CONI RACTORSIGNALIJRI:: --- ----------------- DA IT: +7119
(MUST"
BE SIGNED BY LICENSE HOLDER`( FRT l .
A FIN\I. R(A)F INSI'1:("III)\ IS RFQUIRF.):
THIS SIGNF,D,\ND NO'I'ARI'l.ED:U'I IU,\\'I l" MUST 131. PltO\ IDP:D,\ f 1111:.IOIS SI I'I: ,\'1' rI1P: I IIF. 01'111E FINAL ROOF INSPECTI(►N,
ALO\(; w•Il'll DICT'rAl. PITO-I"OGILAPHS OF F..\('II PLANE OF HIL ROOF SI10\\ ING IN DE"I'•Ul. .\LL CO�IPONEN'I S (DECKING.
UNDFRLAYMENT, FLASIIING, DRIP 1?1)(;L 1"T 1 •\(:I1,'*11:\-I") \1 I I'll 1"111; I'V101I UNUM BE R OR ADDRESS CLEARLY N1ARKLI) ON •TIRE DECK
FOR EACH INSPECTION. TILE PIIO-I'OGRAPIIS NIIIS'I' IN(:I.Ill)E ,\ RULER OR'MEASURING DEVICE, TO CONFIRM ALL NAIL SPACING AND
OVERLAPS, INCLUDING DRIP EDGE AND A,\LLEV IA, VAIING. PLEASE RF.FF.R I O l III: Rl ROOF POLICY AND INSPECTION PROCEDURE
PAPERWORK FOR FURTHER E\PLANA I -ION OF ALA, REQUIRVAIEN I'S.
;:*FAILURE TO FOLLOW ALL REQU I RL'MENTS WILL. RESULT INA FAILED INSPECTION, A RE -INSPECTION FEE AS
WELL AS REQUIRING A DESIGN PROFESSIONAL. (ARCI-11T Cf OR ENGINEI•:R) TO CERTIFY, BASED ON PERSONAL
INSPECTION, THE INSTALLATION OF ALL ROOFING CONIPONENTS.
STATE OF FLORIDA COUNTY OF __ P
1.
Sworn to and Subscribed before me this lot play of 20 1-_ by:
::: �6__\ . Who is U Personally Knom o to me or has P Produced (type of
identifi_ ) ea identilicatiun.
4
Signature of No ary Publie �.�.
State of Florida DANIEL DENAULT
• COmmIsslon 4 GG 97140
.;,Ya `o`, W CQmmissiOn Expires
Print a ►1— - - "' April 24, 7021
of Notary Public