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Home My WebLink About223 Belgian Way (2)CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION D ' Application No:� 3Ja0 Documented Construction Value: S 9,812.00 ' Job Address: 223 Belgian Way Sanford, FL 32773 Historic District: Yes ❑ No Parcel ID: 18-20-31-505-0000-0920 Residential 0 Commercial ❑ Type of Work: New ❑ Addition ❑ Alteration ❑ Repair ❑ Demo ❑ Change of Use ❑ Move ❑ Description of Work: Re -Roof CertainTeed Landmark Architectural Shingles 31sq. Plan Review Contact Person: Saundra Rosberg Title: Secretary Phone: 407-878-3750 Fax: 407-960-2612 Email: BrianSikesRoofing@,cfl.rr.com Property Owner Information Name Neil & Janice Keppeler Phone: 321-397-3870 Street: 223 Belgian Way Resident of property? : Owner City, State Zip: Sanford, FL 32773 Contractor Information Name Brian Sikes Roofing Phone Street: 1550 S HWY 1792 City, State Zip: Longwood, FL 32750 407-878-3750 Fax: 407-960-2612 State License No.: CCC1325977 Architect/Engineer Information Name: Phone: Street: City, St, Zip: Bonding Company: Address: 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: lune 30, 2015 Permit Application Ulf -9-5 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 executfd contract is required in order to calculate a plan review charge and will be considered the estimated construction value of the job atithe 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 Own r Agent at 19.,-, 1 kr.nn-c,-lzA, /,�/q /(,, Print Owner/Agent's Nhrde Signature Notary Public State of Florida . Steven Campbell_ 59 � g My commission FF 9900 969 + ;i 0. expires 05110=20 i g -n aTu-r&rC n rector Agent r Date 1a>rk-ies 12 131 I !P Print Contractor/Agent's Name A I M A& 0.e -44 tea. .1219114 of Nota -St t r' rNotary Public State of Florlde Steven Campbell My Commleolon FF 990959 WD explrea 05/10/2020 OwnerIA—geni is Personally Known to Me or Contractor/Agent is _1,,' Personally Known to Me or Produced ID tT Type of ID fl— ht— 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: Flood Zone: Min. Occupancy Load: # of Stories: New Construction: Electric - # of Amps Plumbing - # of Fixtures Fire Sprinkler Permit: Yes ❑ No ❑ APPROVALS: ZONING: ENGINEERING: COMMENTS: # of Heads UTILITIES: FIRE: Fire Alarm Permit: Yes ❑ No ❑ WASTE WATER: BUILDING: Revised: June 30, 2015 Permit Applicalion 12/5/2016 SCPA Parcel View: 18-2(1-31-50.5-0000-0920 I Property Record Card ��lo ron CFA Parcel: 18-20-31-505-0000-0920 FL(t Owner: KEPPELER JANICE 8 NEIL mwaouroew�. ,toruM Property Address: 223 BELGIAN WAY SANFORD, FL 32773 , - - - — Parcel Information Value Summary Parcel 18-20-31-005-0000-0920 Owner KEPPELER JANICE & NEIL +� 223 BELGIAN WAY SANFORD, FL 32773 Property Address Mailing 223 BELGIAN.WAY SANFORD. FL 32773 Subdivision Name BAKERS CROSSING PHASE 1 Tax District S1-SANFORD DOR Use Code 01 -SINGLE FAMILY Exemptions 00-HOMESTEAD(2006) Legal Description LOT 92 BAKERS CROSSING PH 1 PB 60 PGS 27 - 29 Taxes -, - i Taxing Authority 2017IWorking 2016 Certified LOT 1 $32,000.00 $32,000 Values Values Valuation Method , Cost/Market Cost/Market Number of Buildings I 1 1 Depreciated Bldg Value $126;469 $120.991 Depredated EXFT Value t 1$32,000 Land Value (Market) $32,000 $50,000 Land Value Ag SJWM(Saint Johns Water Management) Jusl/MarketValue" $158!469 $152,991 Portability Adj r - Save Our Homes Adj i $53,087 $48.342 Amendment 1 Adj PBG Adj $0 ; $0 Assessed Value I $105,382 $104,649 Tax Amount without SOH: $2,253.00 2016 Tax Bill Tax Amount $1,284.00 EstlmaT Save Our Homes Savingj: $969.00 1 ' Does NOT INCLUDE Non Ad Valorbm Assessments Taxes -, - i Taxing Authority Assessment Value Exempt Values Taxable Value LOT 1 $32,000.00 $32,000 County General Fund $105,382 $50,000 $55,382 Schools $105,382 $25,0001 $80,382 City Sanford $105,382 $50,000 $55,382 SJWM(Saint Johns Water Management) $105,382 $50.00d:,$55,382 County Bonds $105,382 $50,000: $55,382 les _ t Description Date Book Page 'Amount Qualified i Vac/lmp WARRANTY DEED 7/1/2005 05909 0545 $175,000 Yes ; Improved CORRECTIVE DEED 12/1/2002 04625 0990 $100 No Vacant WARRANTY DEED 9/1/2002 04560 137 i $149,800 Yes I Improved WARRANTY DEED 5/1/2002 04416 j er, $390,000 No Vacant Lind Comparablo Sales Land A p Method Frontage Depth Units Unils Price Land Value LOT 1 $32,000.00 $32,000 Building Information I Is 16dipj1111 ggl!nj in rr _ ? CliRk Here� I Year Built 1 1 --�— httpJ/pareddetail.sc pafl.org/PareelDeWllnfo.aspx?PID=18203150500000920 1/2 THIS INSTRUMENT PREPARED BY: Name: Saundra Rosbarg Address: 1550 S Hwy 17 92 Longwood, FI 32750 NOTICE OF COMMENCEMENT Permit Number: Parcel ID Number: 18-20-31-505-0000-0920 I I!lI11 illil IIII� IlIII IIl11 IIIII Illi illi MARYANNE MORSE, SEMINOLE COUNTY CLERK OF CIRCUIT COURT & COMPTROLLER BY. 8823 P9 757 (1Pss) CLERK'S : 2016128854 RECORDED 12/13/2016 10:21.-Q AM RECORDING FEES tM00 RECORDED BY Wevore The undersigned hereby gives notice that Improvement will be made to certain real property, and In accordance with Chapter 7,13, Florida Statutes, the following Information is provided in this Notice of Commencement. 1. DESCRIPTION OF PROPERTY: (Legal description of the properly and street address if available) 223 Belgian Way Sanford, FL 32773 - LOT 92 BAKERS CROSSING PH 1 PB 60 PGS 27-29 2. GENERAL DESCRIPTION OF IMPROVEMENT: Re -Roof CertainTeed Landmark Architectural Shingles 31sq. 3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT: Name and address: Neil & Janice Kenpeler - 223 Belgian Way Sanford, FL 32773 Interest in property: Owner Fee Simple Title Holder (if other than owner listed above) Name: Address, V) 4. CONTRACTOR: Name: Brian Sikes Phone Number: 407-878-3750 I Address: 1550 S Hwy 17 92 Longwood, 171 32750 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 maybe 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: S. Expiration Date of Notice of Commencement (The expiration is 1 year from date of recording unless a different date is specirtgd) 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. ��Z' 41cg`A,� Al/ d:!�42'C/-C PA - (signature o/ QWW or lessee, or Owner's or Lessee's (Print Name andFrdyide Stgnatorys TIOeMce) AugWro OMcerAYme o iPeAnerN.OnOPI) State of 1'f Af I A- County of 6� MI d16 V e The foregoing Instrument was acknowledged before me this day of DIT -101M 1 P.{ .20 � by Who is personally known to me O OR Nang or person melting statement 1� who has produced identification O type of Identification produced: L f►r Notary Public State of Florld tj Steven Campbell My Commlon FF V01` Expires 05110/2020 890959 ' �Q BY DEPUTYCUPA Brian Sikes ��10GInc. 1550 S. Hwy 17 92 Ph: (407) 960-2611 Longwood, FL 32750 Fax: (407) 960-2612 Neil & Janice Keppeler 223 Belgian Way Sanford, FL 32773 321-397-3870/407-474-2345 kepp32773@yahoo.com PROPOSAL DATE •'••• ► -]11/11616 7844 CONDITIONS OF PROPOSAL Contractor submits this proposal for work on the property herein described. Upon acceptance, Contractor agrees to furnish Iabbr and materials necessary to improve the above premises in a good, workmlike and substantial manner according to the terms, specifications, prt s and plans (if any). Start and Completion: The approximate start date of and approximate completion date of arc subject to permissible delays as per provision (5) on the reverse side. Submitted by X Approved and Accepted ( on(ractor) Date Remove existing shingle roofing and underlayment to expose decking. 31 45.00 1,395.00 All damaged plywood decking if any will be determined at completion of tear off and can be replaced at a rate of $50.00 per 4x8 sheet. (Price includes labor and materials.) Additional damaged wood if any will be determined at completion of tear off and with your approval can be replaced at a rate of $55.00 per hour and the cost of materials. Install 2 1/2in. 8D Rink Shank coil nails along all trusses every six inches to properly secure decking. 31 10.00 310.00 Install one layer of CertainTeed Flintlastic SA base sheet over low sloped portions of roof to right of front I 75.00 75.00 entrance. Install one layer of Synthetic underlayment over entire 5/12 pitch roof. 31 35.00 1,085.00 Install 2 1/2in. aluminum eave-drip around entire perimeter of roof. 250.00 250.00 Install three 411 off -ridge vents. 3 40.00 120.00 Cut out and install one 4ft off ridge vent. 1 50.00 50.00 Install three 4in. exhaust vents. 3 20.00 60.00 Install two 1 1/2in. lead boots. 2 15.00 30.00 Install one 3in. lead boot. I 20.00 20.00 Properly fasten and seal flashing along all walls, eaves, valleys, vents, and boots. i Install 1701b. CertainTeed Flintlastic SA modified rubber roofing over base sheet. Rubber will be fully 1 250.00 250.00 adhered to base sheet using cold process application Install limited lifetime CertainTeed Swiftstart starter shingles with a wind resistance of up to 130 MPH. 0.66 175.00 115.50 Install limited lifetime CertainTeed Landmark architectural shingles with a wind resistance of up to 130 MPH. 29 200.00 5,800.00 Shingles installed with six nails per shingle. Install limited lifetime CertainTeed Shadowridge hip and ridge shingles with a wind resistance of up to 130 1.34 225.00 301.50 MPH. Ground will be swept with a magnet at the end of each working day. Clean entire work area and haul away all debris. 7 YEAR LEAK WARRANTY (LABOR AND MATERIALS) Price includes labor, materials, taxes and all pen-nitting fees. Contractor shall provide all releases of lien from contractor, subcontractors, and material suppliers. Discount to match insurance adjuster's proposal. -301.00 -301.00 TOTAL $9,561.00 ACCEPTANCE OF PROPOSAL This Proposal is approved and accepted. There are no oral agreements. The written terms, specifications, provisions, prices and plans (if any) are the entire agreement. Changes will be X l / made by written change order only. Credit cards may be subject to a 3% convenience charge. Approved ana Accepted(Owner) Da et� You, the Buyer, may cancel this transaction at any time prior to midnight of the third busines§ day after the date of this transaction. Sec Owner's Right to Cancel on the reverse side for details. Basan Sikes IRG Inc. 1550 S. Hwy 17 92 Ph: (407) 960-2611 Longwood, FL 32750 Fax: (407) 960-2612 Neil & Janice Keppeler 223 Belgian Way Sanford, FL 32773 321-397-3870/407-474-2345 kepp32773@yahoo.com PROPOSAL 'I � DATE PROPOSAL" 11/11016 7844 Contractor submits this proposal for work on the property herein described. Upon acceptance, Contractor agrees to furnish labbr.and materials necessary to improve the above premises in a good, workmarjlike and substantial manner according to the terms, specifications, pries and plans (if any). Start and Completion: The approximate start date of and approximate completion date of arc subject to permissible delays as per provision (5) on the reverse side. Submitted by X Approved and Accepted ( ontractor) Uatc Remove existing shingle roofing and underlayment to expose decking. 31 45.00 1,395.00 All damaged plywood decking if any will be determined at completion of tear off and can be replaced at a rate of $50.00 per 4x8 sheet. (Price includes labor and materials.) Additional damaged wood if any will be determined at completion of tear off and with your approval can be replaced at a rate of $55.00 per hour and the cost of materials. Install 2 1/2in. 8D Rink Shank coil nails along all trusses every six inches to properly secure decking. 31 10.00 310.00 Install one layer of CertainTeed Flintlastic SA base sheet over low sloped portions of roof to right of front 1 75.00 75.00 entrance. Install one layer of Synthetic underlayment over entire 5/12 pitch roof. 31 35.00 1,085.00 Install 2 1/2in. aluminum eave-drip around entire perimeter of roof. 250.00 250.00 Install three 411 oft -ridge vents. 3 40.00 120.00 Cut out and install one 4ft off ridge vent. 1 50.00 50.00 Install three 4in. exhaust vents. 3 20.00 60.00 Install two 1 1/2in. lead boots. 2 15.00 30.00 Install one 3in. lead boot. I 20.00 20.00 Properly fasten and seal flashing along all walls, eaves, valleys, vents, and boots. Install 1701b. CertainTeed Flintlastic SA modified rubber roofing over base sheet. Rubber will be fully 1 250.00 250.00 adhered to base sheet using cold process application Install limited lifetime CertainTeed Swiftstart starter shingles with a wind resistance of up to 130 MPH. 0.66 175.00 115.50 Install limited lifetime CertainTeed Landmark architectural shingles with a wind resistance of up to 130 MPH. 29 200.00 5,800.00 Shingles installed with six nails per shingle. Install limited lifetime CertainTeed Shadowridge hip and ridge shingles with a wind resistance of up to 130 1.34 225.00 301.50 MPH. Ground will be swept with a magnet at the end of each working day. Clean entire work area and haul away all debris. 7 YEAR LEAK WARRANTY (LABOR AND MATERIALS) Price includes labor, materials, taxes and all permitting fees. Contractor shall provide all releases of lien from contractor, subcontractors, and material suppliers. Discount to match insurance adjuster's proposal. -301.00 -301.00 TOTAL $9,561.00 ACCEPTANCE OF PROPOSAL This Proposal is approved and accepted. There are no oral agreements. The written terms, specifications, provisions, prices and plans (if any) are the entire agreement Changes will be X made by written chance order only. Credit cards may be subiect to a 3% convenience charee. Approved and Accepted(Owner) a e You, the Buyer, may cancel this transaction at any time prior to midnight of the third businesi day after the date of this transaction. See Owner's Right to Cancel on the reverse side for details. vA%., vA ""A&AVA u Building & Fire Prevention Division Residential Permit Card PERMIT NO. I �• 10 ISSUE DATE: D C'4 • 1 _ 0"'014% • CONTRACTOR: JOB ADDRESS: TYPE OF WORI • Post this permit in a conspicuous location outside • Approved plans must be posted with permit for inspection heave all work uncovered until inspected and approved • Permit expires 6 months from date of issue or last approved inspection PROTECT FROM WEATHER BUILDING INSTEC71ONTME APPROVPD REJECTED 1AVECTOR IR3PECAONTTPE ELECTRICAL APPROVED REECHO 7N9ECIOR FOOTER INSPECTION ELECTRIC UNDERGROUND STEMWALL FOOTER/SLAB STEP. BOND FORMBOARD SURVEY T.U.G. / PRE POWER SLAB / MONO -SLAB ELECTRIC ROUGH LINTEL / TIE BEAM ELECTRIC FINAL SHEATHING - ROOF IN9E070NTTPE MECHANICAL APPROVED REJECTED HMECTOR SHEATHING - WALLS FRAME MECHANICAL ROUGH INSULATION ROUGH IN MECHANICAL FINAL DRYWALUSHEETROCK 1AVEMOAFIVE PLUMBING APPROVED REJECTED LWECTOR LATH INSPECTION FINAL STUCCO/SIDING UNDERGROUND ROUGH FIREWALL SCREW TUB SET FIREWALL FINAL SEWER INSULATION FINAL PLUMBING FINAL FINAL SFR IRVECAONTME GAS INSPECTIONS APPROVED AVECMD NISMEC:OR ROOF IAVECRONT ME "AROPED REJECJED JNSPEM)t GAS UNDERGROUND PIPE ' ROOF DRY -IN GAS ROUGH -IN FINAL ROOF GAS FINAL MISCELLANEOUS / FINAL INSPECTIONS 1AVECT70NTTPE APPROVED REJECTED 7MVEMR 7NaECAONTTPE APPROVED REJECTED nMECW)t PRE -DEMO FINAL DOOR FINALDEMO FINAL WINDOW FINAL SOLAR PANELS IRRIGATION FINAL FINAL POOL SCREEN FINAL SCREEN ROOM FINAL UTI I TY BUDDING FINAL BUDDING OTHER MOBILE HOME TIE -DOWN MOBILE HOMEFINAL 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. NOTICE: IN ADDITION TO THE REQUIREMENTS OF THIS PERM, THERE MAY BE ADDITIONAL RESTRICTIONS APPLICABLE TO THIS PROPERTY THAT MAY BE FOUND Bd 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 FBC105.3.3 VISED:OCTOBER 2014 Impedes Una ass -W2112 TO SCHEDULE AN INSPECTION: • Dial 855.541.2112 • Provide the items requested during the message • The type of inspection requested must be scheduled under the appropriate permit type • Follow the prompts *** To Schedule Fire Inspections: Please call 407.562.2786 *** PLEASE NOTE: Inspections scheduled by 3:30 p.m. will be conducted the next business day. If you experience difficulty, please call 407.688.5150 Monday - Thursday 7:30 am - 5:30 pm for assistance. AUTOMATED INSPECTION SYSTEM CODES BUILDING ELECTRICAL FOOTER 104 ELECTRIC UNDERGROUND 211 STEMWALL 102 FOOTER / SLAB STEEL BOND 221 FORMBOARD SURVEY 147 T.U.G. 216 SLAB / MONO -SLAB 103 PRE POWER FINAL 218 LINTEL / TIE BEAM 105 ELECTRIC ROUGH 212 SHEATHING - ROOF 106 ELECTRIC FINAL 213 SHEATHING - WALLS 115 MECHANICAL FRAME 109 MECHANICAL ROUGH 409 INSULATION ROUGH -IN 110 MECHANICAL FINAL 410 DRYWALL / SHEETROCK 131 PLUMBING LATH INSPECTION 132 UNDERGROUND ROUGH 322 FINAL STUCCO / SIDING 130 TUB SET 312 FIREWALL SCREW 120 SEWER 311 FIREWALL FINAL 143 PLUMBING FINAL 313 INSULATION FINAL 113 GAS FINAL SFR 138 GAS PIPING UNDERGROUND GAS ROUGH -IN 328 314 ROOF ROOF DRY -IN 116 GAS FINAL 315 FINAL ROOF III MISCELLANEOUS / FINAL INSPECTIONS PRE -DEMO 144 FINAL DOOR 136 FINAL DEMO 126 FINAL WINDOW 137 FINAL SOLAR PANELS 134 IRRIGATION FINAL 321 FINAL POOL SCREEN 139 FINAL SCREEN STRUCTURE 127 FINAL UTILITY BUILDING 124 FINAL BUILDING - OTHER 112 MOBILE HOME TIE -DOWN 145 MOBILE HOME BUILDING FINAL 146 Miscellaneous Notes: REVISED: OCTOBER 2014 Inspection Line: 855.541.2112 FIRE INSPECTIONS CITY OF SANFORD 407.562.2786 BUILDING & FIRE PREVENTION BUILDING INSPECTIONS 300 N PARK AVE 855.541.2112 SANFORD FL 32771 DRIVEWAYS -SIDEWALK 407.688.5080 ---------------------------------------------------•------------------------- Page 2 Application Number . . . . . 16-00003320 Date 12/13/16 Property Address . . . . . . 223 BELGIAN WAY Parcel Number . . . . . . . . 18.20.31.505-000Q-0920 Application description . . . ROOFING APPLICATION Subdivision Name . . . . . . Property Zoning . . . . . . . PUD Permit . . . . . . RESIDENTIAL ROOFING PERMIT Additional desc . . Phone Access Code 965681 Permit pin number 965681 ---------------------------------------------------------------------------- Required Inspections Phone Insp Seq Insp# Code Description Initials Date ---------------------------------------------------------------------------- 10-1000 129 EL29 MITIGATION AFFIDAVIT 10 116 BL15 ROOF DRY -IN 1000 111 BL03 FINAL ROOF / / Permit #: 16-3320 1, Brian Sikes CITY OF SANFORD BUILDING SERVICES Residential Re -Roof Hurricane Mitigation Inspection Affidavit hereby acknowledge that I personally inspected VRoof deck nailin nd/ r CzSecondary water barrier work at 223 Belgian Way Sanford, FL 32773 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. Signature of Contractor Brian Sikes Printed Name of Contractor 1-18-2017 Date CCC 1325977 License # License Type: 0 General 0 Building 0 Residential 0 Roofing Contractor 0 or any individual certified in accordance with F.S. 468 to make such an inspection. STATE OF FLORIDA COUNTY OF Seminole Sworn to (or affirmed) and subscribed befor me this »1h day of January , 20 » , by Brian , who i Personally Known to me or has 0 Produced (type of i Mica ' ) as identification. (SEAL) na ary Public State of Florida Steven Campbell Print/Type/Stamp Name of Notary Public