HomeMy WebLinkAbout148 Rockhill DrECEIVE
CITY OF SANFORD
NOV 3 0 20% BUILDING & FIRE PREVENTION
PERMIT APPLICATION
' BY• ,
{ Application No: I�P• 320Z
Documented Construction Value: S 100 -DO
Job Address: qfi a. Historic District: Yes ❑ No ❑
Parcel ID: 33-1C_ 3(2- "5\ lo- DQM- iIUJO Residential �p Commercial ❑
Type of Work: New 9 Addition ❑ Alteration ❑ Repair ❑ Demo ❑ Change of Use ❑ Move ❑
Description of Work: Re— gout, oyy-pmC cl)(Y- ►%nq 'F- 1 I ou �+q
Plan Review Contact Person: UA_Title:_ td" I /►)
Phone: 407t q� 7i Fi Fax: 4UD _ ,�� ' ,� Email:
PLr 1rn
Property Owner Information V
Namer_1_D'Lt 'Cr_ b DSe. Phone:
Street: 1(4 � 2DC.kh 1 I pr Resident of property?:
ey
City, State Zip: :5a YJD r d El .�a 9 41
Contractor Information
Name JQc,-be.( Col'1 QCf'U (S Phone: �� �� ZGoo
Street: 15 :� Mc CDi o n i cu � � �x Fax: 3
City, State Zip: 0'n Q nol 0 E— I 300' 6 2 State License No.: r-60 30-10y
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. 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: 5t° 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,therc 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 Licn 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 baud 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: 1 certify that all of the foregoing information is accurate and that all work will
be done in compliance with all applicable laws regulating ci nstruction and zoning.
��N k K
Signature of( hater/Agcn1 Dole tit • laic of Contractor/Agmt I a1c
SAMANTHA MURRAY
Print Avner/Agcin's Namc
Signature of Notary -Suite of Finrida Date Signature
DAMELCIEN DIAZ
MY COMMISSION 41 GG038827
EXPIRES October 16. 2020
Owner/Agent is Personally Known to Me or Contractor/A it is Personally Known to Me or
Produced ID Type of ID Produced ID 'Type of ID TAI
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:
Flood Zone:
# of Stories:
New Construction: Electric - # of Amps 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. 20 1 S 11crmil Application
'Cimcnctt" Inc.
110 d Colonial IN,
t> 1• I. 32907
000) 337•1361 Fa.
lJnsperRonf.canu
Ig1�,,.,,j.aj!!c ny to
•Ata �� 1.>,u�tcs.,.�":�eas..tat �.
w
Iafoi�tla■i. ' •
Pol1:y a• '1�1�5`i 1'3 � .
to ntmom's Limn -v v CCCI 3240! Mortrset Ctunp■ % lsfurvathm_
Lam.4-
ROOF REPLACENiE\'T CONTRACT
Owner(s): pie: +
Address: , Alt Phone: +
_ Iii Jt_oLti.►t �L _Z:ItL Zta '%V I %
City: s
14State: Zip code: Shingle Color.
..E Fu's' F` "jZ•t14 i
Email: Roof RCV amount: Drip Edge Color.
*bLea.oc0(E_:> Aot_ t,o.•. 11100.00
Assignment of Insurunce Ilene -rots for file Full Roof Replacement Only: 1 haehy assign any molt all ntsomcc nphtA Int SU atoll 1%rcr rsts•
under any applicable insui:►nce lxtlicica: to Jasper c4mtracwrt Inc. ("JaspQ'►, the sailte of wiucb shall be limned to it Vup Roof Rejacatt =L 1.
nt:tkc this :usign►nent and authnrimmin in cmuidcrntitm of Jasper's agreement to patcem servicm su*y Utatatals =4 ot`acmv* perkm ib'
obligations under this rontruci, including not requiring full payment at the time of sevice. I also heret+y dimer uLv inttrer(y to rt�JaweaV.v and' -
all intintnttion rcqucsttxl by Jasper, its representative, or its otuvncy for the dual purpose of tabtaining s.-toal benefits to W gold l*}: CAN
insurcr(sl far scnicta rendered. In this regard, I wai%v my privacy riglits. If paytoew is randc directly to the Oaaa%AgdavUwreiilsl. astrain to '
endrtrscd mvr to Jasper immediately ulx)n recaipi. 1 agree that any portico of ►vtuk, dgductnLMt� toterme t er bdditir,nml tib ftgpo d bs the.
undcrsikned, not r+ncrctl by in, trance. must be paid by the umdcrsigpcd on the day ofiristalLation.
Ilednctlble: It is tine restxms►hility fuLciy all In..'a lcc Daiiij u; ei . Owner's out-0f►ockel emxms qi71 not ex(ted ii dbdxh�*�
amou►nL as Ailed on insurer's hm. sheet. LNLESS replxcmenvicixtir of daeriwated decking is required eattllar rima� ttiptkaa)'
upgrudes. Jasper CANNOT pay, webm, rebate, or promise in pay, wait or rebate all or an) prat of the imvraamdg4vn W ti -p '-Wc-
tut the insurance claim hir payment of work. In the c%vaf of a disacpancy. the deductible ataouatt shod on t]it+ ittwatfs's to= Sheet•"
override Deducohle listed above.
Dedur!ihle: S MUST BE PAiD IN FULL, PLUS APPLICABLE SALES TAY - i�4 trIaRA11 , ,
VIORTGA(:E AU7'NOItIGATION:1,Owtia/hltirtlagar.grant.autburiratioatfur ylA JSerg�rcleo mI a•'a�t'
J:uper tm mataas nicluding. but nrn-limital to, the claim anti deers states. __ �la _{Wdalll: '•
PAYMENT SCiIEDULE: Owmr agrees to pay Jasper based on the folltvaiog pay module: (i/ Dry Wt in the saxamt'oi S dere .
Upon signing this contract: (ii) the t'ontrbct Rice, less the Deponit and any oppGable deivcdzdon'nee *k: y or -o s`v iavurizis), If
Upgrade Costs, due and payable to Jasper uptut cmnplcdm of work being p eribimed. and. (•iii) the rmiabiJag Ci a6d Pride (ftfxd ti► tatty, ' i
applicable depreeiatitm nntl'or change orders) dux and pay -able to Jtispv spun tuttal+ktltia of vork ptrtartoed ba t!i>r"M olj ■ pmitt
inspection, no marc than 2% of Contract Price may be %ithbeld uotil inspection bas passed: -. '`C i
Optional: UPGRADE ITtM: _ QTY: PRICE: S TOTAL S_,,
Replacement Work and. Price. Upon iuiurcr's approval and subjoct to the tater% and cao►ditions h rem)ttslietr �nee>i•to:®tai�fd • ' • '+`;'.�
:and provide the labor necessary to perfmn the full tswf reploicement wfiidl 111111111 take place follovtiag tht'ocr'■ arsusaoca Foi�pig3rS.�gj1� ;
app: t+ximatcly within 10 days, coaditfcsns purntittins. • -' •'' ,�,.+ �_y,;
Owner's Declaration of intent: Owner acknowledges and agroo that, ti(><itt appmral-by intatiatce conlliaoY fw o IW1 tuopl
ehall perform Clic roof replacement Upon of funds from Owner's iusurmcc ctanpsn .
CA;VCELI.AT70Y: 1f Otrnv dens to tertalnate the tie>rvlcett of Japer, �Iwtiei copy, ib:dbut6sirt teM�Q��t•.lit_e''`•• i
after Contract U eiteeuted. Qwner shallra:tilttt a full relbnd of au"depodts. Owtiiv Crag ttlq i Qiott�s: "
�
o
the cntract (s caecated after "Ificadan G'ae
third i►tnlaess day aRcisuttausf{�1'liat titrcli -Ibrj io ""' -
denled, In whole -or to part. AD written notices of eaucellatlot, regardletis'olt
corporate offlec 1955 Vtiugbn Road. Suite 209. Kennesaw,, CA *30144. C_4KCtUATil4ft1 'i ,
ciancellativn DOES NOT APPLY to cootrecta torr stttKrQeaFy tia■�e ttpdri tri am is fuf t ie; � ��, ' ��'i' � � +�• f� � , ���'
1, Owner, baye read and understand.au-gawmantst•t■t7As osd etadlN■ri■.d !'�i+p�; �� `„ "
detalb ire .ceepisble. and sattsfaetory:'f fartht► aaudenaanit tilt fills coeaaet iaifllMte�li' ,iii�> Atte# s ' r
that any further chaogri or ikiterations to ibb c"tract lits( lie bady. isft!trlllst�yt> t ;
represent% and warmnts;to the usher flus It.ltuts 1be,fttD pewet'atoly'atiWath�;l`s,
enforceable in -accordance W terms.�'Lit
• �7•L �.+`i .. •meq \M1t ��.. 't. .7• •y, •1 tri C'• s jw�. � a
Authorized Java Repreamistive Date + •. : t :; - '` ,, u'4s'' � i P� • " 1L
TERMS AND CONDITi.ONS: Aeebptlraiet W'.Tart+dss 1;'(ltrria. buoy a8vJleitd . :'
{-OODl�ltlliLR SffitCd 11CretG: 1 tltitbCt aOm 10'pJ■tivto.lfapor,wuthlbe W7 t+� " •� �� v v- r41 ♦' ' c l • D
'actxas to the j►Tapeity for the piapon of sial and all ti(fuii tt7147'rslc:. ' '" '_' ". •',
1 ' alaln� >b •t3v►uts`s tUstJ[fuDCetiip : -�dA - '':,` , _ . .; . • ,�a�.
sujq>lem�tt!I. � ., 0s.;�aoaTe 1s;:ia:derttd' • " _ , , �'a'
ti _ ; •• < ►
t. � _ .c ''. •.`• ,� ��{••�,�+�` 'i.' ''-=i"'3
(•v`itr'%t ''tf} .'.J`f+rf•Ilt...i.i:'i,. .
Scanned by CamScanner
AAAL Prouerty Record Card
FS.CFA Parcel: 33-19-30-516-0000-1160
pp���yy Owner: DEBOSE DEXTER A& LATONYAM �V
PRAISER
sc�sxxecarrn norm, %�.� \ l
Property Address: 148.ROCKHILL DR SANFORD. FL 32771 J J
Parcel Information Value Summary
Parcel 33-19-30-516-0000-1160
Owner DEBOSE DEXTER A& LATONYA M
Property Address 148 ROCKHILL DR SANFORD, FL 32771
Mailing 148 ROCKHILL DR SANFORD, FL 32771-7747
Subdivision Name COUNTRY CLUB PARK PH 2
Tax District S1-SANFORD
DOR Use Code 01 -SINGLE FAMILY
Exemptions 00-HOMESTEAD(2001)
+
14
30
50
5
50
50
116
50
50
50
50
50
seminole county uizS
Legal Description—
LOT 116
COUNTRY CLUB PARK PH 2
PB 54 PGS 22 THRU 24
Taxes
Tax Amount without SOH: $2,772.88
2016 Tax Bill Amount $1,857.06
Tax Eslimalor
Save Our Homes Savings: $915.82
Does NOT INCLUDE Non Ad valorem Assessments
Taxing Authority
Depth
2017 Working
Exempl Values
2016 Certified
Taxable Value
Total SF
Values
$134,150
values
Valuation Method
SJWM(SaintJohns Water Management)
Cost/Market
Cost/Market
Number of Buildings
j 1
1
Depreciated Bldg Value
t
$152,178
+
$146,003
Depreciated EXFT Value
+ $851
$901
Land Value (Market)
$32,000
$32,000
Land value Aq
Just/Market\blue "
$185,029
$178,904
PortabilityAdj
Save Our Homes Adj
$50,879 '
$45,687
Amendment 1 Adj
P&G Adj
; $0
Iso
Assessed value
j $134,150
; $133,217
Tax Amount without SOH: $2,772.88
2016 Tax Bill Amount $1,857.06
Tax Eslimalor
Save Our Homes Savings: $915.82
Does NOT INCLUDE Non Ad valorem Assessments
Taxing Authority
Depth
Assessment Value
Exempl Values
LOT
Taxable Value
Total SF
City Sanford
$134,150
$50,000
$84,150
SJWM(SaintJohns Water Management)
$134,150
$50,000
$84,150
County Bonds
$134,150
$50,000
$84,150
County General Fund
$134,150
$50,000 ,
$84,150
Schools
$134,150
125,000
$109,150
Sales
Description Date Book Page Amount Qualified vadlmp
SPECIAL WARRANTY DEED 6/1/2000 03872 1736 $121,900 Yes Improved
WARRANTYDEED 2/1/2000 ~ 03802 0277 $23,500 Yes Vacant
Fnd Comparablo Sales
Land ----------
Method Frontage
Depth
Units Units Price
Land value
LOT
1 $32,000.00 $32.000
Building Information
Ile Ruri/RmIh eminl inenrrorl7 (aie4 Noro - -- -- ---- --_--- - --_-- -- --- ---- +------- -- - - - I
# Description
Year Built
Actual/Effective
Fixtures
Bed
Bath
Base Area
Total SF
Living SF
I
Ext Wall
Adj value
Repl Value
Appendages
I
1 SINGLE 2000 8I 31 2.5
FAMILY
I I �
i
Permits
1,891 2,348 1,891 CB/STUCCO $152,178 i $161,891 Description Area
' I i FINISH OPEN
! PORCH 40.00
iFINISHED
i GARAGE
i I I i FINISHED 417.00
Permit#
Description
Agency
Amount
CO Date Perm it Date
02961 ADDITION - RESIDENTIAL SANFORD ( $5,300 I ; 8/24/2004
- 4 --
01222 NEW -RESIDENTIAL SANFORD 1 $121,828 , 5/10/2000 1/1/2000
Extra Features
Description
Year Built
Units
Value
New Cost
SCREEN PATIO 1
, 2/12004 i 1 $851 $1,500
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Oviedo, Sanford,
Seminole County, Winter Springs
Date: (gyp
hereby name and appoint:
MARI PEREZ- ARIAS
an agent of. JASPER CONTRACTORS
(\umc of Compam• )
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):
u All permits and applications submitted by this contractor.
u The specific permit and application for work located at:
147 9z(X -hi I l DA
(Sheer AJJrc<s)
Expiration Date For This Limited Power Of Attorney:
License 1 lolder Name: MICHAEL STEPHEN
State Liccnsc Number. CCC1329651
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before me this X36 day of N ��
200. by MN W(k P ,\ who is personally known to me/
or who has produced pL
as identification and who did/did not take an6th.
Signal re
Print or Type Name
(Notary Seal)
Notary Public — State of 1
SAMANNA NJUPPAY Commission Number !rq: 941_(Aaa
•: My COMMISSION 0 Fr*A&"??
'y EXPIRES December +6. V19 My Commission Expires: IZ"
140:. �3"1 ' �z FyyVaNM'yS6MW V)m
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: \� 2-AkID--
I hereby name and appoint: SAMANTHA MURRAY
an agent of: JASPER CONTRACTORS
(Name of Company)
to be my lawful attorney-in-fact to act for me to apply for, receipt for, sign for and do all things
necessary to this appointment for (check only one option):
D The specific permit and application for work located at:
' fir_ (sig Adam)
Expiration Date for This Limited Power of Attorney:
License Holder Name: MICHAEL STEPHEN
State License Number
Signature of License I
STATE OF FLORIDA
COUNTY OF SEMINOLE
The foregoing instrument was acknowledged before me this ` day of N b q
2091_Lr, by fVlt (',116( e t S i t_,p h Cn who is o personally known
to me or o who has produced YOL-
identification and who did (did -"e an oath.
Signature ! I p
(Notary Seal)
'Pri)ntWor type name
;e✓ LWjt, DANIELLE N DIAZ
?a�9ltiY�`' MY COMMISSION 0 GG038827
EXPIRES October 16. 2020
(Rev. 08.12)
Notary Public - State of
Commission No.,, y�
My Commission Expires:
as
.� .. }..: - `:' r• tet`" - :ij'' .;��
+ �aaanA r>rdwrti+rcM w,.-J.•�•r _ .,• ..�.. '-:�'.' ,rr..
�rBusiness't& �P•roiessional;�Regulation.
' ,Dsttt^aarrlanrslorrs",,
:rN,,a: G�•r•n: 11 ►•rJ .11MCtf nr a'.:.carOn bm[rf � ►ra4lte+1 nr • apWKalr•e Dpai
rL7 FL17873
t:V • t .w, a, . Application Type wevv
Code Version 2014
Application Slates APprov&.
'Approved by DRPR Approvals by DOPR shall be reviewed and ratified by
the POC and/or the Commission it necessary.
Cornmerurt
Atehived
Product ManulouUter System Compunvnls Corporation
Address/Phone/Email o0 Dna 2432
Issaquah. WA 98027
(425) 302.5150
cshepherd[dsystcmccmDoncntS net
Authorized Signature Ctaistepher Shepherd
cshcolicrdOsyst emeomp onents.net
reehnieal Reprr•>r smuvp Chris Shepherd
Address!Phorfe/Email PO Bos 2432
Issaoual% SVA 98027
(425)392.5150
eshepherd@syslcmcomponuns net
Ouality Assurance Replcscntahve
Address/Ohone/Email
Calegoryl
R001e10
Suhcatetjory
Undcrlaymenls
Compliance M011100
Evaluation Report from a Product Evaluation Entity
tCC Evalvabon Scnncc. LLC
Evatuatien Entity
Ouality Auditing4estitute Ltd
Quality Assurance Enlity
Quality AsswanccContract EvpuationDale
01/31/2018
validated Oy
Chris Rawness. P E
Validation Checklist • IlardcoPY Received
rcrhbrit rte toc^deniel !
renihcateotIndryxndence
Referenced Standard and year (of S13110101)
r
Equivalence of Product Standards
eeftined By
Sections from the Code 1507.23
1507.3.3
t SO).S 3
1507,7.3
1507.0.3
1507,9.3
1507.9.5
1518.21
1518.4
Product Approval Method
Method Option n
Dale Submitted 07/03/2015
Date Validated 07/03/2015
IWte Pending FUC Approval
ODIC Approved 07/15/7.015
Summary of Product.
FLM Model, Irumber or Name Description
378731 Covcrpto 3000 Synthetic Rooling Pcdurnrance Feil Replacement
_ Undetlayment
s of 'Use'
Approved
in Instructions
Approved for use HVHZ- Yes FL178)3 RO (1 cov¢roro3000 in t+0�tton rill
Approved ter site ad HYNZ: Yes verified By: ICC Evaluation Service. LLC
Impact Resistant: 141A Created by Independent Thud Pony:
Design Pressure: N/A Evaluation Kopans
Other: Evaluation
RO AE ESR 1293 • Ceov odf
17873 Z Covcrpro Synthetic Roofing -- Performance Felt Replacement
Underlaymanl
Limits of use
Installation Instructions
Approved lot use in HvHZ: ves
Approved for use outside MVMZ: Yes
Fu_B]± rtes enw.ns +n.rnuapeyy�
verified Oy: ICC Evaluation Service. LLC
Impxl Resistant: N/A
Design Pressure. N/A
Crealed by Independent Third Party.
Other:
Evaluation Reports
Design Pressure: N/A
FL 178%3 RD All ESR 17.93 • Copy ndf
17873.3 Felter SA300
Synthetic Self -Adhered Root Und¢rtayment
Limits of Use
Installation Instructions
Approved for use in HVHZ: Yes
1L17073 RO It feliex5a300 tnslallalrni. not
Approved for use outside HVHZ: Yes
Verified By: ICC Evaluation Service. LLC
Impact Resistant: NAt
Created by InCependent Third Party:
Design Pressure: N/A
Evaluation Reports
Other:
FL 17073 RO AE ESR 1293 • Colly.odl
17873.4 FelICA Style RXI High Perlormance Synthetic Roof Undcruuynicrd
Limits of Use
Installation Instructions
Approved for use in HVHZ: Yes
FL] 7873 RO II leltex installation odf
Approved for use outside HVHZ: ves
Verilrcd By. ICC Evaluation Service, LLC
Impact Resistant N/A
Create[$ by IndelKndent Thud Pally:
Design Pressure: N/A
Evaluation Reports
Other:
FL17873 RO AF ESR 1293 . Comr tilt
17873.5 Feltex Style RX2 High Perforrttance
Synthetic Roof Underlayment
Limits of use
Installation Instructions
Approved fat use in HVHZ: Yes
FL17473 RO 1t leiter I ... WI lletion.rnlf
Approyed for use outside HVHZ: Yes
verified By., ICC Evaluation Service. LLC
Impact Resistant N/A
Createu by Independent Thud Pony:
Design Pressure: N/A
Evaluation Reports
Other.
FIr7973 R0 AF FSR 1297 • Cppv pill
179736 Prater Contracts Grade
Synthetic Roof Und¢rlaymenl
Limits of Use
lnslolatlen Instructions
Approved for use in HVMZ: ves
Ej_17873 RO II Pro Tex Inclallallon.odf
Approved for use outside HVHZ: Yes
Verilled By. ICC Evaluation Service, LLC
Impact Redstart: NIA
Crralcd by Indclxodent third Pany:
Declgn.Prossuro: rt/n Evaluation Reports
Other: F1 1711711 DO AF FCR 1 9'1 . .9=mU
rm,anl it /5tewrurrbvn.cl•.ri IaUlai:•.trlYt3.9� eSnOez•IIIZO
111e suit Ol eterraar:a•1A:'Iftlt•npbYtr CesrwtM :(d:4n1?S•a1rNtleM*yrrnry Sla;•m.rl tur•.vDMr SlartllvnlyIuM Satnmtnr
UftN flOrrQa yw, tlnid ifCtlsla be DV!'K rKMW "you ores nan;Ym•'1•mia aabtss lNravantrivanst toa mbht+reeeras mwnal, to rot sera ekal•n—Z
Nui to" rn1KY•Inattaa.clAwl the CORK* of Frere a or Imaho'almaa nYwna»ar•Y 91IeWMt plea ie coMx1039 N7,1393 •PVr:uanl lO Seehan i'aS 27311 ).
flarWOStillftltlltelwt OR:aol+ I, 2012,1antet. 144ft ILWAi Chaiier434FS MAT NmaCOthe OeWMtM loth On trnTlatWtaa rl lMy NM art Iner Q,
A.0.41" mal 0e ...4 Ip elfa q rorri+wr�K.uan wA IN rKmilt IbwNN Neil a'1JR.sr1 arr MTrrt rK0'a II rtV !O rot wrap l0 :uDS1 a vee:Onal aq'tll.Ckai!
f!ra•iQtIM lMjgrirlll•'rt wrh.yr NriaJ ttlbtatnN�lran o*maat a*aiiD't ROIM fuy!lYOtlterimme r1Charter 45%. F S O'rlsnt6.4%, r
/YKua APP—al A*ce01/;
E,® ~rry1
Cred
DIVISION: 07 00 00—THERMAL AND MOISTURE PROTECTION
SECTION: 07 30 05—ROOFING FELT AND UNDERLAYMENT
REPORT HOLDER:
SYSTEM COMPONENTS CORPORATION
POST OFFICE BOX 2432
ISSAQUAH, WASHINGTON 98027
EVALUATION SUBJECT:
FELTEX° (STYLE RX1) HIGH PERFORMANCE, FELTEX-' (STYLE RX2) HIGH
PERFORMANCE, FELTEX SA3000 SELF -ADHERING, PROTEX40 CONTRACTOR GRADE,
COVERPRO AND COVERPRO 3000 ROOFING UNDERLAYMENTS
ICCICCF� ICC
C `� PMG Q"-:1 D
Look for the trusted marks of Conformityl "vvv
n�
•7014 Recipient o/ Prestigious Western States Seismic Policy Council
(wSSPQ Aword in Excellence"' A Subsidiary of ipoE�ttioit(iC
AV -ES F.vnhunrun Reponx are not /u he c•uravrucrl as rePrOcti inA «csilltrrics nr trrrr whcr- ourihrrrva 1101
.pre iliru//r fiddressert nnr fire r/rcr it, Ac• consrnrcrl rr., tin t ndurwrreut if/ rhr subject n/ rhe rtpru'r nr it r
rrr.nuuravubfiinn /irr- irs ase. Thcrc• is nn u•trrrrmm M /l 't larrinurirur .R•r•ric'e. /,/.( : tw/was or implicv/. as
n) unr /inrJiu} ,w r,t/wr ruottcr• irr Mi., r rIntri. twin fir run'/uuthrc t t'orrrcrl hr rhe rc/rurr .a+t+tanws ,,,,,�,a�
Copyright 0 2025
Report
Reissued February 2015
This report is subjec( to renewal February 2016.
www.icc-es.ofa I (800) 423-6587 1 (562) 699-0543 A Subsidiary of the lnrerne oval Code Council"
DIVISION: 07 00 00 -THERMAL AND MOISTURE
PROTECTION
Section. 07 30 05 -Roofing Fell and Underlayment
REPORT HOLDER:
SYSTEM COMPONENTS CORPORATION
POST OFFICE BOX 2432
ISSAQUAH, WASHINGTON 98027
(425) 395.5160
vnvw.systomcomoonents.net
EVALUATION SUBJECT:
FELTEX" (STYLE RX7) HIGH PERFORMANCE, FELTEX'
(STYLE RX2) HIGH PERFORMANCE, FELTEX SA300;'
SELF -ADHERING, PROTEXO CONTRACTOR GRADE,
COVERPRO AND COVERPRO 3000 ROOFING
UNDERLAYMENTS
1.0 EVALUATION SCO'IPE
Compliance with the following codes:
0 2012. 2004 and 2006 Inramationa/ SwId nil Coder UBC)
a 2012. 2009 and 2006 Inlernotfonal Residential CodeL
(IRC)
Properties evaluated:
o Physical properties
o Ice harrier
o Fire classification
2.0 USES
FelTex" (Style RX1) High Performance. FelTex° (Style
RX2) High Performance and ProTex` Contractor Grade.
CoverPro and CoverPro 3000 roofing underlayments are
used as alternatives tolthe ASTM D226. type I and Type
11, roofing undeilaymenl6 specified in Chapter 15 o1 the
IBC and Chapter 9 o1 the IRC. The undenaymcnis may be
used as cumponentsl of classified assemblies when
Installed iii accordance with Section 4 3
FelTex SA30e Self -adhering Roofing Underlayment
complies with ASTM 01970 and is used as an alternate to
the ASTM D226, Type I and 11, roofing underlayments
specified in IBC Chapter 15 and IRC Chapter 9. The
undOilayrnenl may also be used where an ice barrier i3
required by IBC Chapter 15 or IRC Chapter 9.
3.0 DESCRIPTION
3.1 Fe1Teit ' (Style RX1) High Performance Roofing
Underlayment and FefTez (Style RX2) High
Performance Roofing Underlayment:
FelTex' (Style RX 1) High Performance and FelTex" (Style
RX2) High Performance roofing underlayments are cross•
woven polypropylene roofing underlayments with a two-ply
proprietary coating on one side. Total weight of the
FelTex') (Style RX1) High Performance underlayment is
3 2 pounds per 100 square feet (4.6 oz iyd2 (154 glm2))
Total weight o1 the FelTex° (Style RX2) High Performance
undeilayment is 2.9 pounds per 100 square feet
14.1 oz Iyd' (140 9lm7)). Standard size for the
underlayment rolls is 4 feel wide by 250 feet long (1.2 m
by 76.2 m). Other roil sizes are available. FelTex`
(Style RX1) High Performance Underlayment and FelTex'
(Style RX2) High Performance Underlayment may also
feature full-color custom -printing adv/od; as specified by
the end user.
3.2 PrOTeli Contractor Grade Roofing Underlayment:
ProTex'' Contractor Grade roofing underlayment is a
eross-woven polypropylene roofing underlayment with
proprietary coatings on both sides. Total weight of the
underlayment is 2.6 pounds per 100 square feet
13.7 oz/yd1(128 glm)). Standard size for the underlayment
rolls is 4 foci wide by 250 [cot long 51.2 m by 76.2 m►.
Other roll sizes are available. ProTex' Contractor Grade
roofing underlayment may also feature full-color custom
printing artwork as specified by the end user.
3.3 FelTex SA3000 Sell -adhering Roofing Underlaymont:
FelTex SA300n Self -adhering Roofing Underlayment
is a cross -woven polypropylene synthetic roofing
underlayment with a proprietary, thermally stable, adhesive
membrane backed with a release film. Total weight of
the underlayment is 9.4 pounds per 100 square feel
03.7 ozlydl (459 g/m2)). Standard size tot the
undedaymenl rolls is 4 feet wide by 53.3 (eel long
(1.2 m by 16.2 m). Other roll sizes are available
3.4 CoverPro and CoverPro 3000 Roofing
Underlayment:
CoverPro and CoverPro 3000 Roofing Underlayment arc
woven polypropylene labncs coaled on ono side and
laminated to polyp/opylene spun bond fabric. Total
weight of the CoverPro underlayment 1• pounds
per
100 square feel 12.6 Oz/yd ( 9 )) T0
of the CoverPro 3000 underlayment is 2.2 pounds per
100 square feet 13.2 ozlyd2 (108 gime)). The standard size
for the underlayment rolls is 40 inches wide by 300 feel
long (1.0 m by 91.4 m) Other roll sizes are available.
4.0 INSTALLATION
4.1 Feffex� (Style RX1) High Porformance. FelTex
t
(Style RX2) High Performance. ProTex'o Contractor
'Revised March lots
ll'r '• l..� J:..dwww..•. per--, ".P. /:..wmw../ a...l.:...+u.e w:.d.....r .nn .NMI UpIIwM.ry MY .rYS!l.,LYl ..ib: ..:.l, a.r ,u: d�_� w. A• f. uorr.•d
vwA.. J.•r/:v wlk.n.f l4r.r/o1..1 .1 ..1.•••�•-..�•�•��M JW IL D..• IJw'LO.�.Mb1aLM/f('I:
n;.u.l. nww Vnu.: /.Lr :: N`J:• •✓.wlJn•.L ... Mme, --
,...un�Y..vA..c••LJ/Yr...14I,.r..1....n L..wn /+../w•J.:n.•nJM dv r.y.+. --
Pago 7 or 3
CoOrf.Cht '.)2015
ESR -1293 1 Most Wtdefy Accepted and 7r(rsted Page 2 of 3
Grade, CoverPro and CovorPro 3000 Roofing
Underlaymonts:
Minimum root slope is 2:12 (17% slope). For root slopes
from 2:12 (17%i) up to1but not including 4 12 (33%). where
the roof is Covered with asphalt shingles, two layers of
underlayment must be; applied in accordance with Section
1507 2.8 of the IBC or Section 8905.2.7 of the IRC. -For
roof slopes from 2117:12 (21%) up to but not including 4.12
(33%). where the root is covered with clay or concrete tiles.
two layers of underlayment must be applied to accordance
with Section 1507.3.3.1 of the IBC or Section R905.3.3.1 of
the IRC. For slopes of 4:12 (33%) or greater, undedayment
must be a minimum of one layer applied shingle fashion.
The deck surface must be dry and tree of dust, din, loose
nails and other piol(u§ions. Damaged sheathing must be
replaced. The underlayment is laid horizontally (parallel to
the cave) with the print side up, and with 3 -inch (7G nim)
horizontal and 64rich (152 mm) vertical laps Overlaps
must run with the now of water in a shingling fashion. The
underlayment must be attached to the roof deck with a
minimum of No. 12 gage 10.109 inch shank diameter
(2.77 mm corrosion -resistant steel roofing nails having
minimum Via -inch -diameter (9.5 mm) heads, or minimum
1•incfr•diamoter (25.4 mm) plastic caps. or No. 16 gage
10.065 inch leg diameter (1.65 mm)) corrosion -resistant
staples having minimum 71%6 -inch crowns (11.1 mm). The
underlayment must be fastened in accordance with the
underlayment application and high wind attachment
requirements specified in IBC Section 1507 or IRC Section
R905. as applicable.
For roots required to have an ice barner, two layers of
Felfex' (Style RX1) High Performance. FCITexr (Style
RX2) High Performance. ProTex` Contractor Grade.
CoverPro or CoverPro 3000 roofing underlayment
cemented together wilh a roofing cement complying with
ASTM 04586: or one layer of self -adhering polymer
modified bitumen sheet complying with ASTM D1970. such
as FolTex SA3D0F sell -adhering roofing underlayment, or
one layer of an ice barner complying with the IMES
Acceptance Criteria for Sell -adhered Roof Underloymenls
for Use as ice Barriers (AC48). must be applied. The
underlayment must bel applied over the solid substrate in
sufficient courses that the underlayment extends from the
cave's edge to a pointiat least 24 Inches (610 mm) inside
the exterior wall line of the building. The underlayment
applied to the field of the roof must overlap the ice barrier.
installation of the root covering can proceed immediately
following the underlayment application. The underlayment
is not intended to be left indefinitely exposed and must be
covered by a roof covering in accordance with the report
holders published installation instructions. For reroofing
applications, after removal of the old roof covering and
roofing felts to expose the roof deck. the same procedures
apply as for new construction.
4.2 FelTex SA300n Sell -adhering Roofing
Underlayment:
Prior to application of the underlayment, the deck surface
must be free of frost. dust and din. loose fasteners. and
other protrusions. Damaged sheathing must be replaced.
The undcriayment rnuit be applied to Plywood or oriented
strand board (OSB) substrates only when the ambient air
and substrate temperatures are above Ireezing.
Starting with a full roil of trio membrane. a portion of the
membrane approximately 3 to 6 feel long (0.9 to 1.83 m) is
uncoiled with the release liner left in place. while unrolling.
lire upper release liner is removed Ind the roll Is aligned
parallel to the cave of the root and placed firmly in place
with heavy hand pressure. The subsequent courses of
membrane are applied parallel to the cave from the lower
edgu of the roof upward in a shingle -lap manner. Side
(horizonlal) laps must be a minimum of 3 inches (78 mm)
and end (vertical) seams must be overlapped a minimum
of 6 inches (152 mm)
In areas of the roof required to have an ice barrier under
Chapter 15 of the IBC or Chapter 9 of the IRC. starting at
the lower edge of the roof eave. the roofing underlayment
is applied over the solid substrate so that the underlayment
extends up from the caves edge to a point at least
24 inches (610 mm) inside the exterior wall fine of the
building. Following placement along the lower edge. the
membrane may be installed either vertically or horizontally.
If the membrane becomes misaligned. the roll mirsl be cut
and restarted Damage and frshmouths mtisl be slit.
pressed Oat and covered with a round patch of membrane
that extends beyond the damaged area by a minimum of
6 inches (152 mm) in all directions. Flashing around
protrusions is installed over the membrane to prevent
water backup. Other flashing must be installed in
accordance with the applicable code.
Installation of the final root covering can proceed
immediately biter inslailafion of the underlayment is
completed. The underlayment is not intended to be left
indefinitely exposed and must be covered by the final roof
covering as soon as possible in accordance with the report
holder's published installation instructions
4.3 Classified Roofs:
Under the 2012 and 2009 IBC and IRC. the FalTcxs (Style
RX1) High Performance. FelTexv (Style RX2) High
Pcdrm
oance. ProTex1 Contractor Grade. CovorPro and
CoverVio 3000 roofing underlayments may be used as
components of classified root assemblies consisting of
Class A glass fiber mat asphalt shingles or Class C organic
fell asphalt shingles complying with the applicable code.
when installed In accordance with this report over a
minimum X10 -inch -thick (9.5 mm) plywood deck for FcITexs'
F
(Style RXt) High Performance and minimum `°I»•inch-
thick (11.9 mm) plywood deck for clTexJ' (Style RX2)
High Performance. ProTexz Contractor Grade. CoverPro
and CoverPro 3000.
Under the 2006 18C. the FelTey� (Style RX1) High
Performance. FelTexI (Style RX2) High Performance,
ProTex Contractor Grade. CoverPro and CoverPro 3000
underlaymenls $'toy be used in Class A or Class B roof
assemblies that utilize the root coverings specified in the
exception 10 Sections 1505.2 and 1505.3. Under the 2006
IRC, the FclTex' (Style RX1) High Performance. FolTox1:
(Style RX2) High Performance. ProTe)P Contractor Grade.
CoverPro and CoverPro 3000 underlayments may be
used with root Coverings o1 brick. masonry, slate, clay or
concrete roof tile. concrete roof deck. ferrous or copper
shingles or sheets. and metal sheets and shingles where
such roof coverings :fro permitted to be used in lieu of a
Class A assembly under Section R902.1.
S.0 CONDITIONS OF USE
The FelTW (Style RXI) High Performance. FelTex'.
(Style RX2) High Performance. ProTee Contractor Grade,
CoverPro. CoverPro 3000 Roofing Underloyments and
Fe1Tex SA300' Self-adliering Roofing Underlayment
described in this report comply with, or are suitable
alternatives to what is specified in. those codes listed in
Section 1.0 or this report. subject to the following
conditions:
ESR -1293 ( Most Widely Accepted and Trusted Page 3 of 3
5.1 Installation must comply With this report, the report
holder's published installation instructions and the
applicable code. A ropy of the report holder's
published installation instructions must be available to
the Code official at the jobsito. In the event of conflict
between this report and the report holder's installation
instructions, this report governs
5.2 Installation is limited le use with approved roof
coverings that are mechanically fastened through the
undertayment to ,thc sheathing or rafters. or to use
with approved roof coverings that are mechanically
fastened to battens or counterbaltens that are
mechanically fastened through the underlaymenl to
the sheathing or rafters
5.3 Installation is limited to roofing systems that do not
involve hot asphalt or coal -lar pitch
5.4 Installation is limited to roofs with a slope of 2:12
(174%) or greater.
5.5 Installation is limned to roofs with ventilated attic
spaces.
5.6 FelTex SAW Sell-adhenng Roofing Underlayment
is limited to structures located in areas where
nonclassded roof coverings are permitted.
5.7 FelTex SA3W* Self -adhering Roofing Underlayment
must not be instalied when frost is present on the root
cock.
5.8 FelTex SA30e Self -adhering Roofing Underlayment
installation is limited to plywood and oriented strand
board (OSB) substrates.
5.9 FelTex" (Style RX1) High Performance. FelT64
(Style RX2) High Pedormance. FelTex SA30e Self.
adherin!). ProTexRConlroclor Grado. CoverPro and
CoverPro 3000 roorrng underloyments are
manufactured under a quality control program with
inspections by ICC Evaluation Service, I.I.C.
6.0 EVIDENCE SUBMITTED
6.1 Data in accordance with the IMES Acceptance
Criteria for Root Underlayments (AC188), dated
February 2012. (ediloriaey revised February 2014), for
PFOTex" Contractor Grade. FelTex 'D (Style RXt) High
Performance. FetTexa (Style RX2) High Performance,
CoverPro and CoverPro 3000 Rooting Underlayments
and FelTex SA300a Self -adhering roofing
underlayment.
6.2 Data in accordance with the ICC -ES Acceptance
Criteria for Self -adhered Roof Underlayments for Use
as lee Barriers (AC48), dated February 2012
(editorially revised May 2014), for FelTex SA30e
Self -adhering roofing underlayment: including liquid
water transmission testing in accordance with ASTM
04869. Section 8.3.5.
6.3 Reports of testing in accordance with ASTM E108 for
FelTex` (Style RXt) High Performance. FelTex`
(Style RX2) High Performance. ProTex° Contractor
Grade. CoverPro and CoverPro 3000 roofing
underlayments.
7.0 IDENTIFICATION
The FelTex` (Style RX I) High Performance. FelTex`
(Style RX2) High Performance. ProTexo Contractor Grade.
CoverPro and CoverPro 3000 Roofing Undedayments and
Fol'fex SA300" Self -adhering Roofing Underlayment are
marked at 48•inch (1.22 m) Intervals with the product
name. Each roll of the product must be labeled with the
System Components Corporation name, the product name.
the manufacturing dale code, and the evaluation report
number (ESR -1293)
Reissued February 2015
This report is subject to rer►evval Febniary 2016.
rwvw.ice-es.ora 1 (800) 423.6587 1 (562) 699-0543 A Subsidiary of the International Code Council
DIVISION: 07 00 00—THERMAL AND MOISTURE PROTECTION
Section: 07 30 05—Roofing Felt and Underlayment
REPORT HOLDER:
SYSTEM COMPONENTS CORPORATION
POST OFFICE BOX 2432
ISSAQUAH. WASHINGTON 98027
(425) 395.5150
www.systemeomoonents.net
EVALUATION SUBJECT:
FELTEX'' (STYLE RX1)IHIGH PERFORMANCE, FELTE)e (STYLE RX2) HIGH PERFORMANCE, FELTEX SA30e SELF -
ADHERING. COVERPRO. COVERPRO 3000 AND PROTEX° CONTRACTOR GRADE ROOFING UNDERLAYMENTS
1.0 REPORT PURPOSE AND SCOPE
Purpose:
The purpose of this evaluation report supplement is to indicate that FelTetio (Style RX1) High Performance. FelText' (Style
RX2) High Perfomtant?e. FelTex SA300' Reif -Adhering, CoverPro. COvciPr03000 and ProTex� Contractor Grade hoofing
UlWerlayments, recognized ,n ICC -ES master report ESR -1293. have also been evaluated for compliance with the codes
noted OO!Ow.
Applicable code editions:
0 2014 Florida Building Code—Building
0 2010 Florida Building COdo--Budding
0 2014 Florida Building Code—Residential
0 2010 Florida Building Code—Residenlial
2.0 CONCLUSIONS
Tate roofing undedayments, described in Sections 2.0 through 7.0 of the master evaluation report ESR -1293. comply with the
2014 and 2010 Florida Building Code—Building and the 2014 and 2010 Florida Building Code—Rosidenfiol, provided the
design and installation are in accordance with the Inrornalia,al Building Codon provisions noted in the master report and
Section 1507 of the Florida Building Code - Building.
use of the roofing undellayments has also been found to be to Compliance with the High -Velocity Hurricane Zone
provisions of the 2014 and 2010 Florida Building Codo—Building and the 2014 and 2010 Florida Building Code—Residential
under the condition that the undertayment is installed to the master report, the manufacturer's installation instructions and the
minimum requirements of Section ISIS of the Florida Building Code—Burldinp
For products falling under Florida Rule 9N•3, verification that the report holder's quality assurance program 1s audited by a
ion for the type of
nducted is the
responsibilityquality Of On approved validation enurance entity approved by the tity (of tlorida he�lcode ding Oficial when the report holder does not posions sess ng oan approve, by
the Commission).
This supplement expires concunentty will, the master report. reissued February 2093, revised March 2015.
'Revised March 2015 �p
:f'I'.lSl"•.•r.rgn..rQ.y.••r.nh•n•:L,/: :.m.IIIw./.,. q/„«ryn.y ,n •!/,.!«, r,mMLt innSnl: vhr y:YHi,dO„hib,•.•,Ir. q.•,Y: Irh'PMM,rvIJ/Ir,'✓ \L�
„rlrnr.rr.Vnr.:: LrA' : q•I: •, ry nrrA:.l. ,/. �xfp�i��
,•,.r.../+.,,:•J•.II/�'•,i%•YI•�rl�.,�.rl.r..I•�.•�-I•vnr•wlhlll. n.. IMl,n.n.n/IIN, /�1'/11'J. ,mow• � ��
...r.,. h.,A.y;.....d......u..•ILIrd...�...r..................r..,r.,«,•r.:li://.•„r.«! .----
Page t or t
cea/1'9h:.? 2015
� J iI11111illlllllldlll11II1111111111111111
1" THIS INSTRUMENT PREPARED BY: MARYANNE MORSE, SEMINOLE COUNTY
Name: JASPER CONTRAQTORS CLERK OF CIRCUIT COURT & COMPTROLLER
Address: 5380 E COLONIAL DR ORLANDO FL 32807 + BK 8812 Ps 1303 (1Pss )
CLERK'S : 2016123105
22 RECORDED 11/29/2016 I)1 *131.1 PI1
RECORDING FEES $10.00
.(,✓ NOTICE OF COMMENCEMENT RECORDED BY hd�,/care
Permit Number:
Parcel ID Number:
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. DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available)
2. GENERAL DESCRIPTION OF IMPROVEMENT:
RE -ROOF
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT:
Name and address:DeKM )eboc. /4Luk- lLh Or. �Gr&M _ t 301--11
Interest in property: OWNER
Fee Simple Title Holder (if other than owner listed above) Name:
Address:
4. CONTRACTOR: Name: JASPER CONTRACTORS Phone Number: 407-278-7788
Address: 5380 E COLONIAL DR ORLANDO FL 32807
5. SURETY (If applicable, a copy of the payment bond is attached): Name:
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.
sC Ng!2 &(�� , Dey-er DPBUSe—
(Signature of (Tuner or Lessee. or Owner's or Lessee's (Print Name and Provide Signatory's Title/Office)
Authorized Otricer/Director/PaMer/Manager)
State of F� County of Ma -9L
The foregoing Instrument was acknowledged before me this .2f' day of NOV
V 20
by C/ lam/*, -1 VI 1J%-4-JWd'\
Name of person making statement
who has produced identification [type of identification produced:
Who is personally known to me 0 OR
*AQAAIdi HURRAY
'E My COMMISSION 0 FF944322 : �MFfM
1 EXPIRES December 16, 2019 ERK HEI COURT
i
NO/t�.o'03 MP
fond isfy3e�vko oom SE NTV prem&
6
Nov a 9 2016 EPUTY CLERK D
CITY OF SANFORD BUILDING SERVICES
. Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #:1 W " J Ca`
I, -1 j ( L,-- G j 1,/,A+ hereby acknowledge that I personally inspected
Goof deck nailing and/orNecondary water barrier work
at ) V (?,0CK ;U Dr. 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.
l ` -n�
Signature of Contractor
_M i c � �-el li✓ �--}�-S
Printed Name of Contractor
1.2,— Y-16
Date
ecc,a;?,rsc0 T I
License #
License Type: 0 General 0 Building 0 Residential Roofing Contractor
0 or any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF 61(%,Y`U
Sworn to (or affirmed) and subscribed before met is 5;6 day of 20 1-6—, by
who is 0 Personally Known to me or has 0 Produced (type of
=of
n) as identification.
(SEAL)
Notary Public
State ofFI r**da
�� � MANTRA HURRAY
Print/Type/Stamp Name"':
of Notary Public W COMMISSO" 0 FF944322
EXPIRES NOW td. 2019 ;
Revised: February 2015