HomeMy WebLinkAbout114 Monterey Oaks DrCITY OF SANFORPL
BUILDING & FIRE PREVENTION-
PERMITAPPLICATION
Application No.•
Documented Construction Value: $ (1 t
Joh Address: W4 M O N T E i2 r,- Y 0 / K-S PQ V E Historic District: Yes No
Parcel ID: '7Jr3 19 36 51-1 6000 00 3'b Residential R Commercial
Type of Wort:: New Addition Alteration 5d Repair Demo Change of Use Move
Description of Work:
Plan Review Contact Person: Jh t)CA-+1'.1^,1,.n (r D'1sS Title: cow' -ctC-t 012,
Email: SU2pOy-- " 0C,116( itnyyik r00fir . (A Phone: ll V1 113 1323 Fax:
L/-C2(0
Property Owner Information
t LNanceINNAM ) I MR SSA FS l i Phone: y q( I
Street: i N H0 -1\11-l 1zC y b14 KS 912 Resident of property?:
City, State Zip: sanib rd E f_ 3 2 -n -
Contractor Information
Name J yAoA+u.A n ptjY )--h Phone: m -1-1-3 l3
Street: 5 5 15 S 6RA N EI t-= A V F Fax:
City, State Zip; (LPL LA NIl1 p Et- State License No.: CCe 155 Architect/
Engineer Information Name:
Street:
City,
St, Zip: Bonding
Company: Address:
Phone:
Fax:
E-
mail: Mortgage
Lender: Address:
WARNING
TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COA11MENCEMENT 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 ineet 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: 5"' Edition (2014) Florida Building Code Revised:
June 30, 2015 Pennit 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 pennit is verification that Iwill 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.
flue 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.
7 7*-7
Signature of OwnerlAgent Date -ature
Owner/Agent's Name PrKnt Contractor/Agent's Name
Signature of Na Signature of Notary State of Flo_ 4da ....T..,_ .,, Daces,
KRISTINE LANT iii ISTINE LA 31F
Commission G(3 23$92 At * Commissiun 4 i G 3892
1j
4 my Commission My Commission Expires
August 23, 2t?zQ ;N, AugustAuyusi 23, 2t}20
Owner/Agent is Personally Known to Me or Contractor/Agent is V Personally Known to Me or
Produced ID , of Type of ID TJD Produced ID Type of TD
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas Roof
Construction Type: Occupancy Use: Flood Zone:
Total Sq Ft of Bldg: Min. Occupancy Load: # 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: FIRE: BUILDING:
COMMENTS:
Revised: June 30, 2015 Permit Application
Nationwide General Contracting
5515 S Orange Avenue
Orlando, FL 32809
Phone:407-773-1323
Fax: 888-473-2030
Date: 1 112,5 //7
LLC to perform
Certified Roofing Contractor:
CCC1331155
M
property owner/agent), authorize Nationwide General Contracting,
services at my property located at
2. Assignment of Benefits: I hereby assign any and all insurance rights, benefits, proceeds, and any causes of
action under any applicable insurance policies to Nationwide General Contracting LLC, for services rendered or
to be rendered by Nationwide General Contracting LLC. By executing this document, I intend for all rights, bene-
fits, and proceeds for services rendered by Nationwide General Contracting LLC to be irrevocably assigned solely
and exclusively to Nationwide General Contracting LLC. In this regard, I waive my privacy rights. I make this as-
signment in consideration for Nationwide General Contracting LLC's agreement to perform labor, services,
supply materials, and perform its obligations under this contract,, including not requiring full payment at the time
of service. I hereby unequivocally direct my insurance carrier(s) to release any and all information requested by
Nationwide General Contracting LLC, its representative, and/or its attorney for the purpose of obtaining actual
benefits to be paid by my insurance carrier(s) for services rendered or to be rendered.
3. Authorization to Communicate: Owner hereby gives Owner's written consent to representatives from Con-
tractor to speak with. Owner's insurance carrier and Mortgage Company. Owner also hereby directs Owner's in-
surance carrier(s) & Mortgage Company to release any and all information requested by Contractor or its repre-
sentative for the direct purpose of obtaining actual benefits to be paid by Owner's insurance carrier(s) and/or
Mortgage Company .for Services. In this regards Owner, waives Owner's privacy rights.
Mortgage Company:
Loan Number:
4. Direct Payment Authorization. I hereby authorize and unequivocally direct payment of any benefits for
services rendered by Nationwide Genereal Contracting, LLC to be made payable solely to Nationwide General
Contracting, LLC and shall be delivered directly and exclusively to Nationwide General Contracting, LLC.
5. Property Owner's Expense. Owner's out of pocket expenses will be the deductible (S and
any upgrades requested by owner or otherwise not covered by owner's insurance.
Date of Loss: Q1 I
Manufacturer:
PROPERTY OWNER:
PROPERTY AGENT:
ADDRESS: IN
Type of Damage:
Product Line:
Printed
Printed
I f) , <nA rir lr---) 77
PHONE NUMBER: (HM) (WK),
EMAIL: f- 't A A rAM 4%1 QkrjI - (Otn
INSURANCE COMPANY:
3.5 3 5
INSURANCE CLAIM NUMBER: N
Color:
Signature
Signature
TEAM MEMBER:
ature
This contract and any agreement made pursuant hereto is between Nationwide General Contracting, LLC hereinafter
referred to as "Co." or "Company," and the customer(s) named herein on the reverse side, will be subject to all appro-
priate laws, regulations and ordinances of the applicable state of job performced ant to the following terms and condi-
tions
1. All contracts are subject to approval of our credit department and office, without exception. The person executing
this contract must obtain approval of an office of the Co. for this contract of be effective under any conditions.
2. SHOULD DEFAULT BE MADE IN PAYMENT OF THIS CONTRACT, CHARGES SHALL BE ADDED FROM
DATE THEREOF AT RATE OF ONE AND ONE HALF (1-1/2%) PERCENT PER MONTH (18% PER ANNUM)
WTIH A MINIMUM CHARGE OF $200 PER MONTH AND, IF PLACED IN THE HAND OF AN ATTORNEY
FOR COLLECTIONS, ALL ATTORNEY'S FEES, AND LEGAL AND FILING FEES SHALL BE PAID BY THE
CUSTOMER ACCEPTING SAID CONTRACT.
3. The Company shall have no responsibility for damages from rain, fire, windstorm, or other perils, as it is normally
contemplated to be covered by homeowner's insurance or business risk insurance, or unless a specified written agree-
ment be made, therefore prior to commencement of the work.
4. The quotation on the face thereof does not include expenses or charges for bond or insurance premiums or costs
beyond normal insurance coverage, and any such additional expenses, premiums or costs shall be added to the
amount of the contract.
5. Replacement of deteriorated decking, fascia boards, roof jacks, ventilators, flashing or other materials, unless oth-
erwise STATED IN THIS CONTRACT, are NOT INCLUDED and will be charged as an extra on a time and material
basis of $87.50 per hour plus materials.
6. The Company shall not be liable for failure of performance, i.e. delay to meet completion date, due to labor contro-
versies, strikes, fires, weather, inability to obtain materials from usual sources, or any other circumstances beyond the
control of the Company, whether of a similar or dissimilar nature.
7. If roofing and sheet metal work is involved, it is understood and agreed that our standard roof guarantee, a copy of
which is available in our office, shall be acceptable and that all terms and provisions therein shall prevail, unless oth-
8. The company is not responsive for any damages on or below the roof due to leaks by excessive wind driven rain, ice,
or hail, during the period of warranty. EXCESSIVE WIND IS 50 OR GREATER MPH. THE WARRANTY IS
NON-TRANSFERRABLE.
9. If material has to be reordered or restocked because of cancellation by the customer, there will be a RESTOCKING
FEE equal to fifteen percent (15%) of the contract price.
10. If the contract or warranty shall not be assigned except by or with written permission of the Company
11. IF THIS CONTRACT IS CANCELLED BY THE CUSTOMER, customer shall pay to the Company $2,000 or fif-
teen percent (15%) of the contract price,whichever is less, as liquidated damages, not as a penalty, and the Company
agrees to accept such as a reasonable and just compensation for said cancellation.
12. THIS CONTRACT CANNOT BE CANCELLED ONCE WORK IS COMMENCED EXCEPT BY MUTUAL
WRITTEN AGREEMENT OF BOTH PARTIES.
13. PAYMENTS are to be made: 1 st draft & deductible upon insurance approval; and a balance upon completion of
work. Other arrangements must be discussed with Credit Manager
14. If any provision provison of this contract should be held to be invalid or unenforceable, the validity and enforce-
ability of the remaining provisions of this contract shall not be affected thereby. ANY REPRESENTATIONS, STATE-
MENTS, OR OTHER COMMUNICATIONS NOT WRITTEN ON THIS CONTRACT ARE AGREED TO BE IM-
MATERIAL, and not relied on by either party, and do not survive the execution of this contract.
15. ANY REPRESENTATIONS, STATEMENTS, OR OTHER COMMUNICATIONS NOT WRITTEN ON THIS
CONTRACT ARE AGREED_ TO BE IMMATERIAL, and not relied on by either party, and do not survive the execu-
tion of this contract.
16. The maximum liability for the Co. shall be the original cost of labor and materials for the repair which customer
agrees shall be a liquidated sum, under any event of default of Co. herein.
17. During the duration of the work, the customers homeowner's insurance will be responsible for any interior damage
as long as the Company has taken appropriate action to protect hte roof during the repair of the roof.
18. If there are any solar panels on the roof, the Co. will not be responsible for damage during repair, so homeowner
agrees to have a solar panel company take the appropriate action to protect the roof during the repair of the roof.
19. The Co. is not responsible for construction problems of your home. If pointed out and notified to our Co., we will
try to assist you on correcting them on a time and material basis.
20. If applicable, it is the customer's responsibility to inform the Company of any homeowner's association require-
ments imposed upon their property.
21. This contract is composed of this page and reverse side of this page and shall be considered the entire contract by the
parties.
22. For all issues of warranties on product and/labor, contact Nationwide General Contracting, LLC at 5515 S Orange
Ave, Orlando, FL 32809.
THIS INSITU MENT PREPARED BY:
Name: KNSTIOf',-_LNT
Address: 5724 Mort Concorde Ln
Orlando FL 32829
NOTICE OF COMMENCEMENT
Permit Number.
ParcellD Number. n 13 30 511 0000 Ono
The tmderstgned hereby gives notice that Improvement will be made to certain real property, and In accordance with Chapter 713. Florida Statutes, the
fouowing infortna8on is provided In this Notice of Commencement.
1. DESCRIPTION OF PROPPJZTY: (Legal description the property and street address It evekable)
UT Sk Mt fiEQ y AkC rt A.
r
A REpLAT" VB 56 MIS 3;,,& 4,14
IN ftv URIVE
2. GENERAL DESCRIPTION OF IMPROVEMENT:
Re -roof of primary dwelling.
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTF2 FOR THE IMPROVEMENT:
Name and address:
Interest In property:
Fes Simple Title Holder (if other than owner listed above) Name:
4. CONTRACTOR: Name: QM
Address: 5724 Port Concorde
Phone Number:407-773-1323
32829
S. SURETY (It applicable, a copy of the payment bond is attached): Name:
Address: Amount of Bond:
S. 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)(917., Florida Standess.
Name: Phone Number.
Address:
8. In addition. Owner designates of
to receive a copy of the Ueners 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 recordng unless a different date is specified)
WARMG 70 QWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE
CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713. PART 1, 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.
I C4, h i in nr M 1-- owyL r
SO%SWM or Owes or tome. orowure of Lesue's ' and prwde Sgnews Tkubi ")
State of_ Firma cc"of Qf (.111clo
The foregoing Instrument was acknowledged before me this ZQ day of NOVZPAk.ti .20 ) by
0 & t't %* ( nrtc,.NN 1 Who is personally known to me Q OR N&
I 01 twang sreNnew who
has produced ldendficatien H' typo of WorMication produced: -4= f -
KINSTINE
e .:e (.I1aT Oil.
Commicsron a GO 23M ) MV
COT -mission Ea p:req / AUoust
23, 2020 e GRANT
MALOY, CLERK OF CIRCUIT COURT SEMINOLE COUNTY FL CLERK'
S # 2017122123 BK 9034 Pg 0158; (1 pg) E-RECORDED 12/04/2017 02:53:47 PM 10.
00
CITY OF
ORD, Building & Fire Prevention Division
FIRE DEPARTMENT Re -Roof Permit Card
PERMIT NO. 7&4* ISSUE DATE: O`
CONTRACTOR: 4;oiah0Iac &o
JOB ADDRESS:11q Aaeffcerey
TYPE OF WORK: joyo IP -
PROTECT FROM WEATHER
Post this Permit and all required documents in a conspicuous place outside
Digital Photographs are required - please follow re -roof policy and procedures guide
All trash, debris and dumpsters must be removed from job site at final inspection
Permit expires six (6) months from date of issue
ROOF
INSPECTION TYPE APPROVED REJECTED INSPECTOR
FINAL ROOF
FAILURE TO FOLLOW THE RESIDENTIAL RE -ROOF POLICY & PROCEDURES WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION
FEE AND MAY REQUIRE AN AFFIDAVIT, SIGNED AND SEALED, FROM A REGISTERED FLORIDA DESIGN PROFESSIONAL
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 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. FBC 105.3.3
REVISED: 4-17 Inspection Line 407.792.6069 or 855.541.2112
TO SCHEDULE AN INSPECTION:
0 Dial 407.792.6069 or 855.541.2112
Provide the items4requested during the message
The type of inspection requested must be scheduled under the appropriate permit type
Follow the prompts,
PLEASE NOTE: Inspections scheduled by 5:00 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
Final Roof Inspection Code III
Inspection Policy & Procedures
A Final Roof Inspection is the only inspection required for Residential
Single Family, Townhouse, Mobile Home, Apartment and/or Condominium) Re -Roof Permits.
The Following is required to be provide on the job site:
Permit Card, posted in a conspicuous and weatherproof location
Completed Residential Re -Roof Scope of Work
Completed and Notarized Inspection Affidavit
All Florida Product Approval and Corresponding Installation Instructions
Product Approval shall match what is on the scope of work)
Digital Photographs (must include the permit number or address in each picture)
o Each plane of the roof, showing the underlayment installed
o Roof Deck Nailing Pattern & Spacing (including a measuring device or ruler)
o Roof Deck Nails used (including a measuring device or ruler showing size of nails)
o Underlayment Pattern & Spacing (including a measuring device or ruler)
o Drip Edge & Valley Attachment (including a measuring device or ruler)
o Shingles installed, nail pattern and location of nails
Skylights (if applicable)
o Digital photographs showing all installation components, per FL Product Approval
o Digital photographs showing all required flashing, per FL Product Approval
Failure to follow these specific guidelines will result in an affidavit provided by a Florida
Design Professional (Architect or Engineer), certifying FBC code compliance by personal inspection
REVISED: 04-17 Inspection Line: 407.792.6069 or 855.541.2112
PER UT #
City of Sanford Building Division
Residential Re -Roof Scope of Work
JOB ADDRESS: 11q
STRUCTURE TYPE: SINGLE FAMILY RESIDENICEfrOWNHOUSE 0 MOBILE HOME 0 APARTMENT/CONDOMINIUM
RF,,,-ROOFTYPE: 9REPLACEMFN-1- (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
ORE -COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY): Cpy
Pi.EAsE NOTE : ONLY.100 SQUARE FEET OP' THE EX DECK IS PERA117-TED TO BE REPLAUD"
ROOr VENTILATION: 00FF-RIDGE 0 RIDGE OSOFFIT OPOWEREDVENT OTURBINES
SKYLIGHTS: AYES Po IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL#:
MAIN Row, AREA
ROOF SLOPE: 0 LESS THAN 2:12 02:12-4:12 -04:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
0 SHINGLE c t r4mTted Fut 599Li-
0 METAL FL9
0 MODIFIED BITUME' FL#
TORCH DOWN FL# 0
0 INSULATED FL#
OTILE FL#
0 OTHER: FLIA
110OF EXTENSIONS (PORCHES, PATIOS, ETC.) "IPAPILICABLE"
ROOF SLOPE: 0 LESS THAN 2:12 02:12-4:12 12 Olt GREATER
TYPE OF ROOF MANUFAC'rURFR FLORIDA PRODUCT APPROVAL
TINGLE FL#
0 METAL FL#
0 MODIFIED BITUMEN FL#
0 TORCH DOXV1,1 FLIT
0 INSULATED F Lit'
OTILE FL#
0 OTHER: FU/
City of Sanford Building Division
Residential Re -Roof Inspection Policy & Procedures
PERMITTING REQUIREMENTS — NO PLAN REVIEW REQUIRED
This document (signed) along with an accurate and completed Residential Re -Roof Scope of Work are required
to be submitted as part of your permit application.
The Scope of Work must include all applicable Florida Product Approval numbers for all roof components that
will be installed on the project.
A permit will not be issued without these documents. Copies will be made to post on the job site.
Projects located in the Sanford Historic District will require plan review and approval by the Sanford
Historic Preservation Board
INSPECTION POLICY & PROCEDURES
A Final Roof Inspection is the only inspection required for Residential (Single Family, Townhouse, Mobile
Home, Apartment and/or Condominium) Re -Roof Permits.
The Following is required to be provide on the job site:
Permit Card, posted in a conspicuous and weatherproof location
Completed Residential Re -Roof Scope of Work
Completed and Notarized Inspection Affidavit
All Florida Product Approval and Corresponding Installation Instructions
Product Approval shall match what is on the scope of work)
Digital Photographs (must include the permit number or address in each picture)
o Each plane of the roof, showing the underlayment installed
o Roof Deck Nailing Pattern & Spacing (including a measuring device or ruler)
o Roof Deck Nails used (including a measuring device or ruler showing size of nails)
o Underlayment Pattern & Spacing (including a measuring device or ruler)
o Drip Edge & Valley Attachment (including a measuring device or ruler)
o Shingles installed, nail pattern and location of nails
Skylights (if applicable)
o Digital photographs showing all installation components, per FL Product Approval
o Digital photographs showing all required flashing, per FL Product Approval
Failure to follow these specific guidelines will result in an affidavit provided by a Florida Design
Professional (architect or engineer), certifying FBC code compliance by personal inspection.
CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: DATE:
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 . . . . . 17-00003765 Date 12/22/17
Property Address . . . . . . 114 MONTEREY OAKS DR
Parcel Number . . . . . . . . 33.19.30.517-0000-0080
Application description . . . ROOFING APPLICATION
Subdivision Name . . . . . .
Property Zoning . . . . . . . PUD
Permit . . . . . . RESIDENTIAL ROOFING PERMIT
Additional desc . .
Phone Access Code 1021385
Permit pin number 1021385
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
1000 111 BL03 FINAL ROOF _/_/
G
City of Sanford
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: ` — ADDRESS: ( LI My NT t — OAK P St1NFVRP
FL 31113 I
V d via r An Portr7 k 'AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR cQQF11VCi
CONTRACT ENGINEER, ARCHITECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE FOREGOING
INFORMATION IS TRUE AND ACCURATE AND THAT ALL ROOFING COMPONENTS LISTED ON THE SCOPE OF WORK AT THE ABOVE
REFERENCED ADDRESS HAVE BEEN INSTALLED IN ACCORDANCE WITH THEIR PRODUCT APPROVALS AND ALL APPLICABLE CODE REQUIREMENTS-
SPECIFICALLY FLORIDA BUILDING CODE; EXISTING BUILDING. IN ADDITION I CERTIFY THE INSTALLATION MEETS ALL REQUIREMENTS
FOR SECONDARY WATER BARRIER AND NAILING OF THE ROOF DECK, IN ACCORDANCE WITH THE HURRICANE RETROFIT MANUAL
REQUIREMENTS (BASED ON F.S. CHAPTER 553.844). LICENSE #:
c C G 13 31' 1 5 COMPANY /
CONTRACTOR: J V , C(,ALa 1 0w)-j h CONTRACTOR
SIGNATURE: _ „ "ter r% DATE: ( p MUST
BE SIGNED BY LICENSOHOLDER OR O WNER%BUILDE ' A
FINAL ROOF INSPECTION IS REQUIRED: THIS
SIGNED AND NOTARIZED AFFIDAVIT MUST BE PROVIDED AT THE JOB SITE AT THE TIME OF THE FINAL ROOF INSPECTION, ALONG
WITH DIGITAL PHOTOGRAPHS OF EACH PLANE OF THE ROOF SHOWING IN DETAIL ALL COMPONENTS (DECKING, UNDERLAYMENT,
FLASHING, DRIP EDGE ATTACHMENT) WITH THE PERMIT NUMBER OR ADDRESS CLEARLY MARKED ON THE DECK FOR
EACH INSPECTION. THE PHOTOGRAPHS' MUST INCLUDE A RULER OR MEASURING DEVICE TO CONFIRM ALL NAIL SPACING AND OVERLAPS,
INCLUDING DRIP EDGE AND VALLEY FLASHING. PLEASE REFER TO THE RE -ROOF POLICY AND INSPECTION PROCEDURE PAPERWORK
FOR FURTHER EXPLANATION OF ALL REQUIREMENTS.,' FAILURE
TO FOLLOW ALL REQUIREMENTS WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION FEE AS, WELL
AS REQUIRING A'DESIGN PROFESSIONAL (ARCHITECT OR ENGINEER) TO CERTIFY, BASED ON PERSONAL INSPECTION,
THE INSTALLATION OF ALL ROOFING COMPONENTS. STATE
OF FLORIDA COUNTY OF iaf1 QA P Sworn
to and Subscribed before me this / & hday of 20 by: J}
0 jfflat f A-oWho is `Personally Known to me or has Produced (type of identification)._
as identification. Signature
of Notary Public «r«w:.y,.: • State
of Florida or'f i .
KRISTIMF.
Lre S A04T
Commission #
GC' 23892 qtj
My
Commission res Print/
Type/Stamp Name of
Notary Public