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Home My WebLink About108 Mayfield DrDEC 1It t CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: / 47 --- 3 c�_ /I 3Y: Documented Construction Value: $ t ( f L(02.31 Job Address: �\'1� l� ( 31`Iist1i District: Yes ❑ No Parcel ID: ,3 I S( visa' C) C) ResidentiaZ Commercial ❑ Type of Work: New ❑ Addition Q Alteratiop 9 Repair ❑ Demo ❑ Change of Use ❑ Move ❑ Description of Work: Plan Review Contact Person: Phone: Fax: j Title: Emailr� Property Owner Information o (C)", Name J 0A_1 Phone: L40-7 (U"l d 03-9 1 Street: V -DY Resident of property? City, State Zip: 3 SMntractor InformationC Ph one:Name bivusd �1 2 Street: Fax: City, State Zip: U State License No.: Name: Street: City, St, Zip: Bonding Company: Address: 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. 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: 51" Edition (2014) Florida Building Code Revised: June 30, 2015 Permit Application Mr 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 1 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. If MIA I,.�il` 410 mss, 01 " , 1, 0�0- Date TT V Date IF IF, COWNO Al 711 STATE OF FLORIDA CMMN • 0 *NOTARYPUBUC r. Expl:�• _ r r , •, or Produced r '� � lig I Producedof BELOW / • OFFICE Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing[-] Gas❑ Roof ❑ Construction Type: Total Sq Ft of Bldg: Occupancy Use: Min. Occupancy Load: Flood Zone: # of Stories: New Construction: Electric - # of Amps Plumbing - # of Fixtures Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads APPROVALS: ZONING: ENGINEERING: COMMENTS: UTILITIES: FIRE: Fire Alarm Permit: Yes ❑ No ❑ WASTE WATER: BUILDING: Revised June 30, 2015 Permit Application 11/21/2016 SCPA Parcel View: 32-19-31-516-0000-0790 Property Record Card ' Parcel: 32-19-31-516-0000-0790 Owner: ROWE JAMES F JR & MAMIE L ec FOOyrtKAoraoa Property Address: 108 MAYFIELD DR SANFORD, FL 32771 Parcel Information Parcel 32-19-31-516-0000-0790 Owner ROWE JAMES F JR & MAMIE L Property Address 108 MAYFIELD DR SANFORD, FL 32771 Mailing 108 MAYFIELD DR SANFORD, FL 32771 Subdivision Name CELERY LAKES PHASE 2 Tax District S1-SANFORD DOR Use Code 01 -SINGLE FAMILY Exemptions 00-HOMESTEAD(2006) Legal Description LOT 79 CELERY LAKES PHASE 2 PB 65 PGS 29 & 30 Taxes Value Summary Tax Amount without SOH: $1,890.07 2016 Tax Bill Amount $1,019.55 Tax Estimator Save Our Homes Savings $870.52 ' Does NOT INCLUDE Non Ad Valorem Assessments Taxing Authority 2017 Working Values 2016 Certified Values Valuation Method Cost/Market Cost/Markel Number of Buildings 1 1 Depreciated Bldg Value $114,487 $109,514 Depreciated EXFT Value $2,167 $2,250 Land Value (Market) $23,100 $23,100 Land Value Ag $42,077 County General Fund Just/Market Value " $139,754 $134,864 Portability Adj Save Our Homes Adj $47,677 $43,427 Amendment 1 Adj P&G Adj $0 $0 Assessed Value 1 $92,077 1$91,437 Tax Amount without SOH: $1,890.07 2016 Tax Bill Amount $1,019.55 Tax Estimator Save Our Homes Savings $870.52 ' Does NOT INCLUDE Non Ad Valorem Assessments Taxing Authority Assessment Value Exempt Values Taxable Value Page Schools $92,077 $25,000 $67,077 City Sanford $92,077 $50,000 $42,077 SJWM(Saint Johns Water Management) $92,077 $50,000 $42,077 County Bonds $92,077 $50,000 $42,077 County General Fund $92,077 $50,000 $42,077 Sales Description Date Book Page Amount Oualified Vac/Imp WARRANTY DEED 12/1/2005 06051 0118 $199,900 I Yes Improved SPECIAL WARRANTY DEED 6/1/2005 05801 0732 $257,000 1 Yes Improved Find Comparable Sales Land Method Frontage Depth Units Units Price Land Value LOT Ext Wall Ad' Value 1 1 1 $23,100.00 1$23,100 Building Information 1� Q-A10MM n nl :nnr. r.enN f I:nL LL�..� #Description Year Built Actual/Effective9 Fixtures Bed Bath Base Area Total SF Livm SF Ext Wall Ad' Value 1 Re I Value p Appendages 1 SINGLE 2005 7 3 20 1,874 2,290 1,874 CB/STUCCOI $114,487 $119,882 Description I Area http://pareeldetaii.scpafl.org/ParcelDetaillnfo.aspx?PID=32193151600000790 1/2 universal Roof & Contracting Page 7 of 13 INVESTMENT: Universal Roofing Group, Inc. proposes to furnish and install labor and material in accordance with the above specifications, and subject to conditions found on both sides of this agreement, for the sum of: 0 •CertainTeed Fungus resistant, 3 -Tab shingles with a 25 -year warranty I /1 • CertainTeed Landmark, fungus resistant, Architectural shingles $1UPGRADE SHINGLE OVER RIDGE VENTILATION SYSTEM A[1AMaIvt3T,ffeat'feet•of-new searaales ewnspoU s Provide and install all new (2-1 %* & 1-2"& 1-3°) Bullet Boots IV CertainTeed SureStart Warranty — 3 Star !i i Perform Wind Mitigation Inspection Discounted inspection that when submitted to your Insurance company, can save you hundreds of dollars a year on your homeowner's Insurance premiums $ 10,472.99 ADD $•898.15 y� ADD $ 300 4DB---X34134 ADD $149.9e ADD $129.32 ADD $100.00 Total l i 1/0 :? . : TERMS: Standard industry cash terms; one-third with the order, one-third due upon delivery of materials, balance due upon completion. Building Permit is included. Job related debris to be removed from job site. Universal Roof & Contracting will submit the price and scope of this contract with the insurance company and agrees to do the roof for scope and final dollar amount submitted to the insurance company. The cost to the homeowner, which will be paid to Universal Roof & Contracting, is the deductible, upgrades, and any potential additional work orders including, but not limited to wood, stucco, siding and we# flashing. Additional work orders must be paid by the homeowner at the time the AWO Is presented, before the work Is done, but will be submitted as supplemental requests to the insurance company by Universal Roof and contracting for the homeowner's reimburseme n additional items submitted to the insurance on behalf of this claim, Including overhead and profit, will be owed upon approve The final payment of e4i item should be paid at the end of that item. (i.e. the final payment of the roof is paid when the roof is completed, gutters, screen, interior etc.) r $ d qv 2. 3 Total Order Le/% Pick exr *7y,.i gam. -77 $ Z_ Contract Signing 77 $ 3. Due on Start Date (Deductible and Upgrades) `t 7 $ 3 Due Upon Completion of Roof" (•Remaining money recei od from Insurance and Hidden Damage not factored Into this payment) fne ayment (Any additional money from Insurance: Depreciation, Supplement/payout) 7 iwr�!'*► �'' By: Print Name:�� `=�2� Print Name: Date: 1111111111111110 $ Date: By: Universal Roof & Contracting �rlr��11►��7��T� NOTICE OF COMMENCEMENT Permit Number: 2 T Parcel ID Number: — 3 1 75 C � CSU Y� M V - O I leein 1111111111111111111111111 11111111 MARYANNE MORSE, SEMINOLE COUNTY CLERK. OF CIRCUIT COURT I COMPTROLLER BK. 8812 Ps 84; (1P9s) CLERK'S 0 2416122888 RECORDED 11/29/2016 14:,:1:33 AM RECORDING FEES 814,);nj RECORDED BY hdevrzrr- 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. 1. DESCRIP T OEYRgPERTYAfegal des�Crigt�lor: of the prppB�y�rtd Stre�l addreys av� ble /�� 51q'. Be:) AIA 2. GENERAL DESCRIPTION OF 3. OWNER INFORMATION Name and address: Interest in property: 4. 9/5. Fee Simple Title Holder (if other than owner listed above) Name: THE Address: Amount of Bond: 6. LENDER: Name: Phone Number: Address: 7. 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)(a)7., Florida Statutes. Name: Phone Number: Address: 8. In addition, Owner designates of 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) 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. n �Z =rY; J Ignature'of.Owner Of L'esseQmetrpr Lessee's(Print NerM and,Provlde Signa ory's Tlde/OHlce) jr Authorized Officegoiree /Partner/Manager) �1 t V State of �.lJlt�� County of The foregoing inu�ment Tan ainknov l�A(ed �efo,,Te this day of by who has produced Thalia Coral Acevedo NOTARY PUBLIC _— 'rC nt: FLORIDA Who is personally known to me O OR 7/152015 Florida Building Code Ondine OLI Business Professional . 1 Honda Dep "ntd eas Home I Log in I user Registration I Hot Togis I Submit surcharge I stat: a Facts I Publications I FOC staff I SOS Site MaP 1 Links I Search I Busines Professi I Product Approval USER: Public User Regulation Product Aooroval Menu > Product or Aoollatlon Search > Aoollatlon List > Application Detail 01 THE FL # FL5444-R8 SECRETARt Application Type Revision Code Version 2014 Application Status Approved Comments Archived Product Manufacturer CertainTeed Corporation -Roofing Address/Phone/Emall 18 Moores Road Malvern, PA 19355 (610) 651-5847 mark.d.harner@saint-gobain.com Authorized Signature Mark Harrier mark.d.harner@saint-gobain.com Technical Representative Mark D. Harrier Address/Phone/Emall 18 Moores Road Malvern, PA 19355 (610) 651-5847 Mark.D.Hamer@saInt-gobaIn.com Quality Assurance Representative Address/Phone/Email Category Roofing Subcategory Asphalt Shingles Compliance Method Evaluation Report from a Florida Registered Architect or a Ucensed Florida Professional Engineer Evaluation Report - Hardcopy Received Florida Engineer or Architect Name who developed Robert Nleminen the Evaluation Report Florida Ucense PE -59166 Quality Assurance Entity UL LLC Quality Assurance Contract Expiration Date 07/03/2017 Validated By John W. Knezevlch, PE 0' Validation Checklist - Hardcopy Received Certificate of Independence FL5444 RB COI 2015 02 COI Nieminen.odf Referenced Standard and Year (of Standard) Standard Year ASTM D3161, Class F 2009 ASTM D3462 2009 ASTM D7158, Class H 2008 Equivalence of Product Standards Certified By Sections from the Code Mtpsl/Roridabtilding.orgfpr/pr app o.aspx?peram=wGMOwtDglahlgO7CSsoy"28CcpCIJxNzsPPRyA%3d 1/2 rlonoa mulmng Code Ordine I, am �i� Honda Der+a�td ass Home I Log In I use, Reglsbation I Mot Topics I Submit Surcharya Stab a Facts I Publlatlons I FBC Staff I BOS Site Map I Links Search Busi�nWes // Professi dal V R: "icuproval �ILSiR: Public Ika Regulation Product Approval Menu > Product or Aoollation Seerdr > Andicatlon List > Application Detaa Ft. rt FUS216-R2 Application Type Revision Code Version 2014 Application Status Approved Comments Archived Product Manufacturer InterWrap, Inc. Address/Phone/Emall 32923 Mission Way Mission, NON -US 00000 (551) 574-2939 mtupas@interwrap.com Authorized Signature Eduardo Lozano eloxano@interwrap.com Technical Representative Eduardo Lozano Address/Phone/Email 32923 Mission Way Mission, NON -US 00000 (778) 945-2891 elozano@interwrap.com Quality Assurance Representative Address/Phone/Email Category Roofing Subcategory Underlayments Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed Florida Professional Engineer Evaluation Report - Hardcopy Received Florida Engineer or Architect Name who developed Robert Nieminen the Evaluation Report Florida License PE -59166 Quality Assurance Entity Intertek Testing Services NA Inc. - ETL/Warnock Hersey Quality Assurance Contract Expiration Date 11/17/2015 Validated By John W. Knezevich, PE 4 Validation Checklist - Hardcopy Received Certificate of Independence FL15216 R2 COI 2015 01 COI Nieminen.odf Referenced Standard and Year (of Standard) Equivalence of Product Standards Certified By Sections from the Code 1507.2.3 1507.5.3 1507.8.3 1507.9.3 1507.9.5 tdtpsllBoridabildirg.orWIpr epp A.asp(?param=wGEVXQwtDav3yVVKJZ1QRAdhyMuSkOGQyfeHhVeiOpVSvxwSdCoQ%3d%3d 112 QOTRINITYIERD EVALUATION REPORT EXTERIOR RESEARCH & DESIGN, LLC. Certif►cate of Authorization #9503 353 CHRISTIAN STREET, UNIT #13 OXFORD, CT 06478 PHONE: (203) 262-9245 FAX: (203) 262-9243 Interwrap, Inc. Evaluation Report 140510.02.12-R2 32923 Mission Way FL15216-R2 Mission, BC V2V-6E4 Date of Issuance: 02/17/2012 Canada Revision 2:04/27/2015 SCOPE: This Evaluation Report is issued under Rule 61G20-3 and the applicable rules and regulations governing the use of construction materials In the State of Florida. The documentation submitted has been reviewed by Robert Nieminen, P.E. for use of the product under the Florida Building Code and Florida Building Code, Residential Volume. The products described herein have been evaluated for compliance with the 5u' Edition (2014) Florida Building Code sections noted herein. DEsuu"loN: RhinoRoof Underlayments LABELING: Labeling shall be in accordance with the requirements the Accredited Quality Assurance Agency noted herein. CONTINUED COMPLIANCE: This Evaluation Report is valid until such time as the named product(s) changes, the referenced Quality Assurance documentation changes, or provisions of the Code that relate to the product change. Acceptance of this Evaluation Report by the named client constitutes agreement to notify Robert Nieminen, P.E. if the product changes or the referenced Quality Assurance documentation changes. Trinity IERD requires a complete review of this Evaluation Report relative to updated Code requirements with each Code Cycle. ADVERTISEMENT: The Evaluation Report number preceded by the words "Trinity IERD Evaluated" may be displayed in advertising literature. If any portion of the Evaluation Report is displayed, then it shall be done in its entirety. INSPECTION: Upon request, a copy of this entire Evaluation Report shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This Evaluation Report consists of pages 1 through 3. Prepared by: Robert J.M. Nieminen, P.E. Florida Registration No. 59166, Florida DCAANE1983 The,Torok seal appearing was authorized by Robert Hi minen, P.E on 04/27/2035. This does not sane as an electronically signed deormem. Signed, sated hardmpies have been transmitted to tha Product Aypronl AdmInbIrstor and to the named client CERTIFICATION OF INDEPENDENCE: 1. Trinity IERD does not have, nor does it intend to acquire or will it acquire, a financial interest in any company manufacturing or distributing products it evaluates. 2. Trinity l ERD is not owned, operated or controlled by any company manufacturing or distributing products it evaluates. 3. Robert Nieminen, P.E. does not have nor will acquire, a financial interest in any company manufacturing or distributing products for which the evaluation reports are being issued. 4. Robert Nleminen, P.E. does not have, nor will acquire, a financial interest in any other entity involved in the approval process of the product. S. This is a building code evaluation. Neither TrinitylERD nor Robert Nieminen, P.E. are, in any way, the Designer of Record for any project on which this Evaluation Report, or previous versions thereof, is/was used for permitting or design guidance unless retained specifically for that purpose. L • ' ROOFING COMPONENT EVAWATION: 1. SCOPE: QOTRINITYIERD Product Category: Roofing Sub -Category: Underlayment Compliance Statement: RhinoRoof Underlayments, as produced by Interwrap, Inc., has demonstrated compliance with the intent of following sections of the Florida Building Code through testing in accordance with applicable sections of the following Standards. Compliance Is subject to the Installation Requirements and Limitations / Conditions of Use set forth herein. 2. STANDARDS: Section Properties Standard Year 1507.2.3,150753, 71507.8, Unrolling, Breaking Strength, Pliability, loss ASTM D226 2006 1507.8.3,1507.93,1507.95 on Heating 1507.2.3,150753, 1507.8.3, Unrolling, Tear Strength, Pliability, Loss on ASTM D4869 2005 1507.93 Heating, liquid Water Transmission, Breaking Strength, Dimensional Stability 3. REFERENCES: Uft Examination Reference ate ITS (TST1.509) Physical Properties 300539395C00" 10/27/2011 ITS (T5T1509) Physical Properties 100539395COQ-002 10/27/2011 ITS (TST3509) Physical Properties 100539395COQ-006 03/14/2014 ITS (QUA1673) Quality Control Inspection Report 11/17/2014 4. PRODUCT DESCRIPttoN: 4.1 RhinoRoof U20 is a multilayered polymer woven coated synthetic roof underlayment intended as an alternate to ASTM D226, Type I or Type II felt or D4869 Type II felt. RhinoRoof Underlayment is available in 42 -inch wide rolls, and can be produced in various other sizes. S. LIMITATIONS: 5.1 This is a building code evaluation. Neither TrinityJERD nor Robert Nieminen, P.E. are, in any way, the Designer of Record for any project on which this Evaluation Report, or previous versions thereof, is/was used for permitting or design guidance unless retained specifically for that purpose. 5.2 This Evaluation Report is not for use in the HVHZ. 5.3 Fire Classification is not part of this Evaluation Report; refer to current Approved Roofing Materials Directory or test report from accredited testing agency for fire ratings of this product. 5.4 RhinoRoof Underlayments may be used with any prepared roof cover where the product is specifically referenced within FBC approval documents. If not listed, a request may be made to the AN) for approval based on this evaluation combined with supporting data for the prepared roof covering. 5.5 Allowable roof covers applied atop RhinoRoof Underlayments are follows: • 'TAe�tEi•.Roor�Cov`et"Ovrtoas Underlayn►ent Asphalt Nail -On The Foam -0n Tik Metal Wood Shakes Slate or Shingles & Shingles Simulated Slate RhinoRoof U20 Yes No No Yes Yes No 5.6 Exposure limitations: 5.6.1 RhinoRoof Underlayment shall not be left exposed for longer than 30 -days after installation. 6. INSTALLATION: 6.1 RhinoRoof Underlayments shall be installed in accordance with Interwrap, Inc. published installation instructions subject to the Limitations set forth in Section 5 herein and the specifics noted below. 6.2 Install RhinoRoof Underlayments in compliance with manufacturer's published installation instructions and the requirements for ASTM D226, Type I or II or D4869, Type II underlayments in FBC Sections 1507 for the type of prepared roof covering to be installed. Exterior Research and Design, I.I.C. Evaluation Report 140510.02.12at2 Cemykate of Authorkation tl9503 F115216 -R2 Revision 2:04/27/2015 Page 2 of 3 TRINITY I ERD 6.3 Re -fasten any loose decking panels, and check for protruding nail heads. Sweep the substrate thoroughly to remove any dust and debris prior to application. 6.4 Rhlnoltoof U20: 6.4.1 Fasteners: For exposure:5 24 hours, corrosion resistant fasteners may be 1 -inch roofing nails with a 3/8 -inch diameter head, or those noted in 6.4.2. The use of staples is prohibited. For exposure > 24 hours up to maximum 30 days, corrosion resistant fasteners shall be minimum 14nch diameter plastic or metal cap nails or FBC HVHZ nails & 1-5/8" diameter tin caps (with the rough edge facing up). The use of staples Is prohibited. 6.4.2 Single Laver: Roof Slope > 4:12: End (vertical) laps shall be minimum 6 -Inches and side (horizontal) laps shall be minimum 4 -Inches. Refer to Interwrap, Inc. recommendations for alternate lap configurations and/or the use of sealant under certain conditions. For exposure < 24 hours, use of every -other fastening location printed on the surface is acceptable. For exposure > 24 hours up to maximum 30 -days, use of every fastening location printed on the surface is required. When batten systems are to be installed atop the underlayment, the undedayment need only be preliminarily attached pending attachment of the battens on the same day. Battens shall not be positioned over cap nails. If this occurs, remove the cap nail and patch the hole In accordance with Interwrap published instructions. 6.4.3 Double Laver: 2:12 < Roof Slope < 4:12: End (vertical) laps shall be minimum 12 -inches and side (horizontal) laps shall be minimum half -sheet -width plus 1 -inch. Double layer application; begin by fastening a half -width plus 1 -inch starter strip along the eaves. Place a full -width sheet over the starter, completely overlapping the starter course. Continue as noted In 6.5, but maintaining minimum half -width plus i -inch side (horizontal) laps, resulting in a double -layer application. 7. BUILDING PERMR REQUIREMENTS: As required by the Building Official or Authority Having Jurisdiction in order to properly evaluate the installation of this product. 8. MANUFACTURING PLANTS: Contact the manufacturer or the named QA entity for information on plants covered under Rule 61G20-3 QA requirements. 9. QUALM ASSURANCE ENTm: Intertek Testing Services NA Inc: ETL/Warnock Hersey — QUA1673; (604) 520-3321 - END OF EVALUATION REPORT - Exterior Research and Design, I.I.C. Evaluation Report 140510.02.1242 Certificate of Authorization 1/9503 FUS216-R2 Revision 2:04/27/2035 Page 3 of 3 POWER OF ATTORNEY I hereby name and appoint Joan Mellick Of Universal Roofing Group, Inc. to be my lawful attorney in fact To act for me and apply to the �/� 5je , Building Department for a Re -Roof permit for work to Be performed at a location described as: Section: 39 Township: / Range:, --Ti Lot: 5-4 Block: eDtD– o'7 W Subdivision: 1 /vl'` L,911& � ) (Owner of property and address) And to sign my name and do all things necessary to this appointment. (Signature of Certified Contractor) The foregoing instrument was acknowledged before me this //– r7 —16 By Ken Mellick Who is personally know to me and who did not take an oath. State of Florida County of Orange My Commission expires: Commission#: tf� Thalia Coral Acevedo NOTARY PUBLIC o WSTATE OF FLORIDA i Comrrg FF901799 INCE �90 Expires 7121!2019 N CITY OF SANFORD BUILDING SERVICES Residential Re -Roof Hurricane Mitigation Inspection Affidavit Permit #: - 3211 I, 411mt(lu—hereby acknowledge that I personally inspected at Roof deck nailing and/or Ux�condary water barrier work r', and have determined that the work (Job Site Address) 1 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'o I his or,r official duty shall constitute a misdemeanor of the second degree pursuant to Section 837 6 F lo�15116 Si re o C ractor Date ye A AIIAilk CCco Printed Name of Contractor License # License Type: 0 General 0 Building 0 Residential k Roofing Contractor 0 or any individual certified in accordance with F.S. 468 to make such an inspection. TE OF FLORIDA COUNTY OF ;k d subscribed befort ine this day of ' r 20 _LL,, by who is°1✓�Personally Known to me or has n Produced (type of as identification. (SEAL) b b-lu, Print/Type/Stamp Name of Notary Public Revised: February 2015 Cam o OFS7 FLORIDA COWO FFM00 E TrZ1�p19