HomeMy WebLinkAbout315 Sir Lawrence DrCITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: /0 rp1?6',
ion Value: $ L3 -ID-
Job Address: 3 I S j /L W)"l')C2 ,i" lQ, Historic District: Yes No
Parcel ID: 10 -,PD -30 -'506- 000 O - D % .9- O Residential U Commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of Work: r Q Y'00t—' 2-7 S 4 S i nsle- C Q'r- a 1,111 L arj Im W _
FLSL x4L4 — tZc'i
Plan Review Contact Person:
Phone: Fax: Email:
Property Owner Information
Name 1 01 L4 1 1 N B0(_r0%_,.> G? Phone:
Title:
Street: C%-1-"jO On Wor-e,S TRI DwD n Resident of property?
City, State Zip:
r A
o.\\GS .
Contractor Information
Name \ 1 C -
Street: :L1 l `i 0-o vA C rUF-4 Dre-
City, State Zip: p C)q+ra Ft 3Z1y3
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Phone: q V7 — (I I -Li — 6-7 33
Fax: q U-) - gLq - bUL43
State License No.: CCL 13Z Ly Sol
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet standards of all laws regulating construction
in this jurisdiction. I understand that a separate permit must be secured for electrical work, plumbing, signs, wells, pools,
furnaces, boilers, heaters, tanks, and air conditioners, etc.
FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 51 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 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 Daweo N Signature of Contractor/Age Date
j N
CY
d !i"
Print Owner/Agent's Name LuPrint Contractor/Ag s Name
JLu a.
Signature of Notary -State of Florida Date FE Si n e
of
Z = '
f
ViJIJJl
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5
Owner/Agent is Personally Known to' e4or r Contractor/Agent is Pe Me or
Produced ID Type of ID Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas Roof
Construction Type: Occupancy Use:
Total Sq Ft of Bldg: Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes No
APPROVALS: ZONING:
ENGINEERING:
Flood Zone:
of Stories:
Plumbing - # of Fixtures
of Heads Fire Alarm Permit: Yes No
UTILITIES: WASTE WATER:
FIRE: BUILDING:
Revised: June 30, 2015 Permit Application
11
FireBuildingand 1
Product Approval Specification Form
Permit #
Project Location Address '-30S Si L.re.r, ce 2 +Wc rL-- 32 --?-7
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.org.
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
Florida Approval #
including 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
Underla ments
Roofing Fasteners
Nonstructural
Metal Roofing
Wood Shakes and
Shingles
1
t.W i.o•+• r r r F'LSq'Aq— C2-
Roofin tiles lb X2_
Roofing
Insulation
Waterproofing
Built up roofing
System
Modified Bitumen
Single Ply Roof
Systems
Roofing 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
5. 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
THIS INS MFN PREPARE BY:
Name:, t}tin (L
Address'. L .3'27p3
NOTICE OF COMMENCEMENT
1;90111111111111101111111151111111 H111 loll
I'lr°l °'i'iihdFll i`1ORSE, '3011HOLE C-'Ou 'y
CL-EI:I,. OF' C:11ZC:U):T MUM' U)ITTROI_I_ER
8f- -, ir13K. i.i'1 1•,:iv t•.I-'J'_i1
CIERK'S t- 201b11411%
RECORDED 11.1021201-6 12e.1.1:12 I'11
II_:COf:Li]:haG F-E[::S !:•1.ilufif
l?,';. 17dravore
Parcel ID Number. ' of D -"3o -- S-6-0000— D
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the
fallowing information is provided in this Notice of Commencement.
1. DESCRIPTIONN O PROPS (Legal sc n.of t rop street address if available)
2. GENERAL DESCRIPTION OF IMPROVEMENT: r f oD?
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT:
Name and address:
0 ( 3or r UW cv-
Interest in property:
Li0
v -ic.-1'-t D,n "D Q S TAX \C.i 7 l l 1'1Abn SiSTS 2vcyo p,1.b S jG
0 N '
1Ul
Fee Simple Title Holder ('1f other than owner listed above) Name:_
Address: Phone Number. 407-884-7663
a. CONTRACTOR: Name: Rizzo Roofing. LLC
kb 3 1t7
Address:_ a ( CivL Di- -
5. SURETY (If applicable, a copy of the payment bond is attached): Name:
Amount of Bond:
Address: none
6. LENDER: Name: flOfte
Phone Number
Address:
Owner upon whom notice or other documents may be served as provided by Section7. Persons within the State of Florida Designated by
713.13(1)(a)7., Florida Statutes.
Phone Number.
Name:
Address -
of
8. In addition, Owner designates
to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Phone number.
9. Expiration Date of Notice of Commencement (The expiration is 1 year from date of recording unless a different date is specified)
OF NT A.RE
WARNING TO OWNER: ANY PAYMENT MADECHAPTERH70WNER13, PART
AFTER
SECTION 713!13 FOLOR
DATSTA7UHE
OTEISEAND CAN RESULT EN YOUR
CONSIDERED IMPROPER PAYMENTS UNDERPAYINGTWICEFORIMPROVEMENTSTOYOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THEJOBSITEBEFORETHEFIRSTINSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEYBEFORECOMMENCINGWORKORRECORDINGYOURNOTICEOFCOMMENCEMENT.
co
l =_-
Signature of Owner or Lessee, or Owner's or Lessee'sAa (Print Name and Provide Signatory's TidelOffice)'
P T
FAuthorizedofTcer/Director/Parinermanager) b0l
t ,f!/c
2
State of jC a- County of
o
The foregoing instrument was acknowledged before me this
Z - day of Q -
Who is personally known to m OR o 0byt
Name of person making statement ¢
who has produced identification 0 type of iden ation produced: z
o
Y K. L:
ON#
OF
Notary signature w 1tv ('ii+" I SSI35486 _. r
C S: A017 U1 m
OF FVe
rL ?* 7" wt +Y* 5 i'*, 4"f4'yFr°^', W ::+ry '7.i ' ''. - f • . 7 ro
Selling AssociateLEndCapsSignature^
4' Boats f Starter Strip _ Wall Flashing
q eaa Ram a 3050 Holliday Ave Apopka, R 32703
Job Scheduling 407-884-7663
Date
infoogrizzoroofingllc.com
Orlando's Home Town Roofer
y Any alterations or deviation from above specified scope of work will be Owner Authoriz d
executed only upon wriften orders and will became an extra charge over and
1 01-4no( Nowe wo Z
above the estimate. R"czor Roofing LLC Is equipped with all the necessary
ye . 3 S Si`r GRcvrPs/Ge nit ar d,
5--- ------ y/ ,3 %lit
signature and upon final approval by Rizzo Roofing LLC corporate office
Ta CONTRACTOR AGREES TO PROVIDE ALL LABOR, MATERIAL, AND EQUIPMENT (UNLESS OTHERWISE SPECIFIED) TO COMPLETE THE .\
WORK DESCRIBED IN THIS AGREEMENT. The customer authorizes the contractor to display a sign for the duration of the job and to use photos
1 taken at the job site for display, promotion and advertising without compensation. WOOD REPLACEMENT, IS CALCULATED AT UNSEEN DAM-
AGE AND IF ROTTEN WOOD EXISTS AFTER TEAR -OFF IT WILL BE DOCUMENTED AND REPLACED AT AN ADDITIONAL COST ABOVE
THIS ESTIMATE. Fascia wood = (1" by pine @ $6.50 per ft.), (2" by pine @ $8.00 per ft.). Structural = (2" x 4" @ $10.00 per ft.), (2" x 6"@ i
11.00 per ft.), (2" x 8"@ $12.00 per ft.). Decking (1"x 6"pine @ $6.50 per ft.), (1"x 8" pine @ $8.00 per ft). (1"x 10"@ $8.50 per ft.). 4'x8' I
Sheet of plywood or OSB decking $70.00 COMPLETE ROOF REPLACEMENT Includes roofing permit and all inspections,
4 9,tear off and disposal of ONE layer of existing shingles, 2. re -nail entire deck to wind code, 3, install 30 pound Jett,
ORY-114 4, replace alt boots vents and valley flashing 5_ the COMPLETE INSTALATION OF ROOFING CHOICE BELOW,
unit cut Total Cost
3TC/ANasarEr narty,35year5hinglessq.fit.------------------- Celer----------
I(Ormidwrtara( Bangles 35 year. 130mph attachment,
at__x„.....----------------------
S-h-im le -s ---sq-R- - 7_-___._Cal-cr'--- ------
utM- Ble k rear --------.--- --------- ----- -
Z-LATZ sq It Demo Ruck S35 per sq. Black White Brawn
Lilball repiacement is an ultra expense ABOVE THIS ESTIMATE as stipulated aheve - - - - - - - - - - - - - signature
b-v-T'p- -
Addttian Tear -off air- tL _ —- _ ` .disposal of one layer of existing roofing included aU others at $ 40.00 per
TOTAL ROOF PRICE
1 ' ykmihval: W, i Wutu Riosisiant tlnderlayment (option)., y. .--
Solar Vent 3O wall f 15 watt quantity _ (option)
Sktdiglrts 2'x 7 units 4x 4 units s
4-----s-
tVail flashing ft.-- - ..-7 Hashing [L- - - - Special flashing It- _ _ _ _ 7 - — --------------------------------- .._...
TOT'aL PAVAIKINT TO.B.E KAD9 AS FOLLOWED: At Time of Contract
At time of Material Defivery On Completion X'/399
LEGAL N077CE. UNLESS OTHERWISE AGREED TO IN WRITING PRIOR TO START OF WORK: PAYMENTS RECEIVED LATER THAN TEN (10) DAYS WILL BE
LEVIED A $150.00 LATE FEE AND SERVICE CHARGE OF 3% PER MONTH ,THE UNDERSIGNED AGREES THAT THEY WILL BE RESPONSIBLE FOR THE a
COSTS OF COLLECTION OF ANY UNPAID BALANCE, INCLUDING REASONABLE ATTORNEYS FEES. The customer will be refunded 100°/6 of any deposits if
canceling this contract within three days. Cancellations made after third (3) business day, will result in the contractor retaining 30% of the total price as a restocking fee. rWim: (5) years covering refects in worlananshm on complete re roof and 1 year on all repairs. Manufackaer Mir" extended to Custorm upon payment in pfullforworkcompleted. PRICES ARE GOOD FOR 30 DAYS AND AFTER ARE SUBJECT TO CHANGE. Contractor is NOT responsible for interior damage from water
penetration into any structure until the finished roof as been completed that is not a direct act of negligence . Contractor asstanes no liability for damages to driveways, g
walkways, strucUue cracks to walls or ceilings or landscape that's not a direct act of negligence. by the Contractor. F
f. 3 2"Boats 3 OH RV id'
s
3' Bouts Cap A Selling AssociateLEndCapsSignature^
4' Boats f Starter Strip _ Wall Flashing
6' J Vents Valley flashing _ Peel a Sock Date
17 J Vents Edge Metal _ Existing Skylights
y Any alterations or deviation from above specified scope of work will be Owner Authoriz d
executed only upon wriften orders and will became an extra charge over and Signature___-`
above the estimate. R"czor Roofing LLC Is equipped with all the necessary
licenses and insurances required by the State of Florida to provide contracting Printed Name
services in the roofing industry. This proposal with an owner authorized
5
n
signature and upon final approval by Rizzo Roofing LLC corporate office Date _ v
will become a contract directly between the singed owner and Rizzo
y
l
The authorized drove harc bRoofingLLC . This agreement constitutes the entirere understanding, The Au-
9
siptature
road and as,"entirely to the
temy
actin-Avd es they have
p and semccs that
tnodzed signature warrants that he or she is the equitable owner of the premis-
n ate into orated in this rrPP EmsniesorrepresentstheownerwithviabledocumentationThankyouforyour
business we look forward to serving you, a
101312016 Gmail - Invitation Homes- W0: 1714556- High Priority - KSL Roof-Shinglesfriles Missing- s2fo0370 315 Sir Lawrence Drive, Sanford, FL 37773
MGmail tri
George Dietz <georgesdietz@gmaii.com>
Invitation Homes - WO: 1224556 - High Priority - KSL Roof-Shingles/Tiles Missing -
s2fo0370: 315 Sir Lawrence Drive, Sanford, FL 32773
Kristopher Lopez <kdstopheclopez@invitationhomes.com> Wed, Oct 12, 2016 at 2:32 PM
To: "georgesdietz@gmail.com" <georgesdietz@gmail.com>
Cc: Kim Lucas <klucas@invitationhomes.com>, Orlando Maintenance<OdandoMaintenance@invitationhomes.com>
To Rizzo Roofing LLC,
Please contact Demetrius Smith @ (321) 696-4413 to schedule repairs.
Full description: Kimroof is missing shingles and the garage ceiling is showing signs of water damage from the roof Alt# 321-689-
5546Active Leak 10/12/16 2:30 PM - KSL - Please use GL code 1200700 for invoicing.
High Priority
We have the following additional contact information for them.
Name: Demetrius Smith - Phone: (407) 221-8653; (321) 696-4413; (352) 617-3776 - eMall: lakeesha.harris@yahoo.com;
my23inches@yahoo.com (D. Smith email)
Let us know the date and time you're able to schedule the repairs with the resident
by calling us at (877) 759-7556 or email us at
Initial cost cannot exceed $100 without prior approval from our office.
Kind regards
Invitation Homes
Mtps://mail.google.com/mail/u!0ru=2&ik=db3672BF73&view=pt&search=inbox&msg=157ba2a8c2566a67&simi=157ba2a8c2566-G7 W
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 11— 1 (.b
I hereby name and appoint:
an agent of: 2- z'L d R b o F i nn, j a r
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:
3 Si % I A VJ ?--ENCjE C>fz-- Sc"'y oyez V!,L
Street Address)
Expiration Date for This Limited Power of Attorney: 5 1
License Holder Name:
State License Number:
Signature of License Holder: OL'— U
STATE OF FLORIDA
COUNTY OF Qai1(iQ Z
The foregoing i trument was owledged before me this I day of
200L, by t {-hO" Z?h who is ersonall kno
to me or o who has produced as
identification and who did (did not) take an oath.
Notary Seal) 1M.t a . l l:a.-L
Print or type name
Notary Public - State of Tqw'1CLO
Commission No. M '0961610
My Commission Expires: 12— 7-L --111
MICHAEL LAROCK I
Notary Pubic - State of Florida
Rev. 08.12) wr j n
n
orc_ E Aires Dec 26, 2016
e , Coc mission # EE 853690
SCPA Parcel View: 10-20-30-506-0000-0720
Property Record Card
PAr
Parcel: 10-20-30-506-0000-0720
Owner: 2014-1 IH BORROWER LP
c9O1 r FtioFco+
Property Address: 315 SIR LAWRENCE DR SANFORD, FL 32771
Parcel Information •Value Summary
Page 1 of 2
Parcel 10-20-30-506-0000-0720
I
Save Our Homes Adj-
1 2017 Working
Values
2016 Certified
Values
Owner 2014-1 IH BORROWER LP
Valuation Method Cost/Market
Number of Buildings 1 _
1
Cost/Market
1
Property Address 315 SIR LAWRENCE DR SANFORD, FL 32771
C/O INVITATION HOMES TAX DEPT 1717 MAIN ST STE 2000
Mailing Depreciated Bldg Value 1 $92,782 89,067
0
DALLAS, TX 75201
117,469
Depreciated EXFT Value ---
Land Value (Market) $25,000
Land Value Ag ;
Just/Market Value " } $117,782
1 -
25,000
114,067
Subdivision Name GROVEVIEW VILLAGE 2ND ADD REPLAY
Tax District St-SANFORD
DOR Use Code 01 -SINGLE FAMILY
PB 26 PGS 7&8
Exemptions
Portability Adj I
Save Our Homes Adj- 0 0
Amendment 1 Adj - 313 -- -_-- 7,277 .-- -- -
P&G 0
Assessed Value 117,469 j $106,790
Tax Amount without SOH: $2,195.66
2016 Tax Bill Amount $2,195.66
Tax Estimator
100 #` Save Our Homes Savings: $0.00
O '
Does NOT INCLUDE Non Ad Valorem Assessments
Legal Description
LOT 7272
GROVEVIEW VILLAGE 2ND ADD REPLAT
PB 26 PGS 7&8
Taxes-
Taxing Authority Assessment Value Exempt Values Taxable Value
City Sanford 117,4691 01 117,469
SJWM(Saint Johns Water Management) 117,469 01 117,469
CountyCounty Bonds 117,469 0 117,469
County General Fund 117,469 • 0 i 117,469
Schools I 117,782 0 117,782
Sales
Description Date Book Page Amount Qualified Vac/Imp
SPECIAL WARRANTY DEED 5/1/2014 08274 0006 100 No Improved
WARRANTY DEED 4/1/2013 108031 1241 100 No Improved
WARRANTY DEED 11/1/2012 07904 0096 88,000 Yes Improved
SPECIAL WARRANTY DEED 7/1/2012 07823 0326 67,000 No Improved
SPE lil- WARRANTY DEED 4/1/2012 07762 1653 100 No Improved
CERTIFICATE OF TITLE 9/1/2010 07452 1021 100 ; No Improved
WARRANTY DEED 11/1/2006 06511 1427 210,000 Yes Improved
WARRANTY DEED 7/1/2002 04465 0123 103,000 I Yes
L.
Improved
WARRANTY DEED 4/1/1996 03070 0435 70,500 1 Yes Improved
8/l/1-99O 02221 1232 100 E No Improved
Page 1 of 2 (12 items) [31 2
Find Comparable Sales
I Land
http://parceldetail.scpafl.org/ParcelDetailInfo.aspx?PID=10203050600000720 11/2/2016
SCPA Parcel View: 10-20-30-506-0000-0720
Building Information
Is Bed/Bath count
Page 2 of 2
Description
Year Built
Actual/Effective Fixtures Bed Bath Base Area Total SF Living SF Ext Wall Adj Value Repl Value Appendages
1 SINGLE 1987 6 3 2.0 '; 1,294 ' 1,911 1,294 CONC $92,782 $106,037
t Description 7Area
FAMILY i i BLOCK
GARAGE
420.00
i
FINISHED
OPENW-'-
I j ( PORCH 35.00
j FINISHED
OPEN
I ' ` PORCH i 162.00
I Y FINISHED
Permits
1.
Permit # Description Agency Amount CO Date Permit Date
No Permits
Extra Features
Description Year Built Units Value New Cost
No Extra Features
http://parceldetail. scpafl.org/ParcelDetailInfo.aspx?PID=10203050600000720 11/2/2016
CITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #: A, d
c7 13_?
I,hereby acknowledge that I personally inspected
X Roof deck nailigl /or Ysecondary water barrier work its
at -3« 1—, z_ ch ",, rcn ce 1/ 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.
r
Signature of Contract Date
Nf c n 7 z-z.J .CCC C 3 2blf
Printed Name of Contractor License #
License Type: General Building Residential Roofing Contractor
Elor any individual certified in accordance with F.3 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF C Y -CA Me 1,
Sworn o (or affir ed) and subscribed before met s da of 1 owr)k-4,,20 Ral , by
Z , who is sonally Known me or has Produced (type of
identification) as iden ica on.
SEAL)
Signature of Nota
State of Flo '
rm p ame
of Notary Public VILA ,IL't t'r i,
1
MIC;IAEL LAROCK
Notary Public - State of Florida
1y ` omm. Fxpire3 Dec 26 2016
Commission # EE 858690
CI'T'Y OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #: I to - 09:37
I, iqrj+H o N y R!,--vw hereby acknowledge that I personally inspected
V Roof deck nailing(nsl/or U Secondary water barrier work
at 515- 5
it
2 lXa w PCNC.e, p ,r, o,4 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.
d_ -2t7 VIV_ It - 21- 16
Signature of Contr ctor Date
VA;;no- C(C 13 Z_& WS
Printed Name of ontractor License #
License Type: General Building Residential -
or any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF p rav,,q Q
Sworn to (or affirmed) and subscribed before me this f 0'aM 17CR , 20 1 , by
who is ersonall Known to a or has Produced (type of
identificaYsn- as-ide>trti-ffii
EAL)
Si etsl>tc
State of Florida pR PLF 4rl MtCt{AEL l AROCK
Notary Public - State of Fiortda
Print/Type/Stamp Name r* ' ; pmm,.. Expires Dec 2s, 2046
of Notary
Publicommission #
5E 858690
3