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HomeMy WebLinkAbout2430 Laurel AveCITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: —1 -- 3 7 LIL Documented Construction Value: $ ow 0 Job Address:.2 -0 C 4:24 t,e -A _= Historic District: Yes No El Parcel ID: -?L , % 9 • A7?0 . .53 ,? • ® 00 61 2 D Residential [Commercial Type of Work: New Addition AlterationEl Repair Demo Change of Use Move Description of Work: Plan Review Contact Person: 4,) b/ / 74;o C ae Title: Phone: sS- k Fax: %.- Email: 6eJ1so3))' 47e 4 PropertyOwner Information jj Name fIJ'& aA_ 6'otc(,e,-% Phone: 1-6 7' Street: C2 `/'? y 4 G-L.Ly, e- L— Resident of property? City, State Zip: SoeC-- 3.1.771 Contractor Information Name c O6__ Phone: V0 7 . 3 .L1 1 Street: 96 6 " C/Le h CL Fax: Vy 7 . City, State Zip: /L,:;, State License No.: Cy ArchitectlEngineer Information Name: Phone: Street: City, St, Zip: Bonding Company: / J oq 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. 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: 51h Edition (2014) Florida Building Code Revised: June 30, 2015 Permit Application In L NOTICE: In addition to the requirements of this permit, there may beadditional restrictions applicable to this property that may be found in the public records of this county, and there may be additional its required from other governmental entities such as water management districts, state agencies, or federal agencies. Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713. The City of Sanford requires payment of a plan review fee at the time of permit submittal. A copy of the executed contract is required in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal. The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in accordance with local ordinance. Should calculated charges figured off the executed contract exceed the actual construction value, credit will be applied to your permit fees when the permit is issued. OWNER' S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be. done in compliance with all applicable laws regulating construction andAoning. I 12/?0 ! l 7 Signature nt ` Date r is ^ -5 C p v (-C dC Print Owner/Agent' Name S atur of Notary -State of Florida Date DONAUYAIPSLi Notary Public state at Commission #" a 0;221 06 i QwrY® P gent Qgu S,I nown to Me or ProduceclD' "" Type_0I of Conntractor/Agent Date 4Al AQ,tI Print Contractor/Agent's Name Signature of Notary -State of Florida Date BELOW IS FOR OFFICE USE ONLY Permits Required: Building Electrical Mechanical Plumbing[] Gas Roof Construction Type: Total Sq Ft of Bldg: Occupancy Use: Min. Occupancy Load: Flood Zone: of Stories: 4e or 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 ADCOCK ROOFING 800 French Ave. Sanford, 0• . • adcockroofinglObellsouth.net www.adcockroofing.com CERTIFICATIONSTATE December 14, 2017 CONTRACT Name: Brian Goulet Phone: (407) Address: 2430 Laurel Ave. Cell: (407) City: Sanford, FL 32771 Fax: (407) Email: SCOPE OF WORK: COMPLETE ROOF REPLACEMENT 1. Remove old existing roof on complete house. 2. Re -nail decking as per building code. 3. Dry in with new layer of synthetic underlayment. 4. Install new 30-year architectural shingles. 5. Install new drip edge; 26 gauge, painted galvanized. 6. Install new kitchen and bathroom vents. 7. Install new lead flashings on plumbing pipes. 8. Install new ventilation to match existing. 9. Secure all permits. 10. Clean up & haul away debris. 11. Inspections included. Labor & Materials: $4200.00 Extra — Bad wood & flashings: Time & Materials - $70.00 per sheet plywood; 2 x 4 and fascia - $4.50 ft.; Warranty: 30 Years on Materials from Manufacture 5 Years on Workmanship Andy Adcock, Owner THIS INSTRUMENT PREPARED BY: 4/14 OIGOG+'{ Name: ADCOCK ROOFING Address: 800 S. FRENCH AVE. SANFORD, FL 32771 Permit Number: Parcel ID Number. 36-19-30-538-0000-0360 GI i`)NT Il1A?-L0Y SENINOI_E Ct3tlNT"r C:J::RK ?,. F CIRCUIT COURT & CONIPTRIOLLER CLERK'S 0 2017129010 REC i]RDECj !.:?i?1r'21:117 14'eli.aal)2 F)I'I REC:t:3RDING t FT7ES i-10.00 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) LOT 36 + S 40 FT OF LOT 35 BECKS ADD PB 3 PG 101 2. GENERAL DESCRIPTION OF IMPROVEMENT: Re -Roof 3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT: i 4. Name and address: Brian Gouleto 2430 Laurel Ave. Sanford FL 32771 Interest in property: OWNER Fee Simple Title Holder (if other than owner listed above) CONTRACTOR: Name: Adcock Roofing Phone Number: 407-322-9558 Address: 800 S. French Ave., Sanford, FL 32771 5. SURETY (If applicable, a copy of the payment bond is attached): 6. LENDER: Address: Phone Number: Amount of Bond: 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. 8. In addition, Owner designates Phone Number: 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. The by Print Name and Provide Signatory's Title/Office) County of —e` f instrument was acknowledged befo no this ZC) day of 1',4 La , 20 q1f ' rj i A Al u % a/._k' Who is personally known to me OR who has produced identification type of identification produced: CEPTo I r GiRANT r i A Or CI C, isAN, nisi} y° jv,. . r A. SETTLEMENT STATEMENT Dependable Title Services of Florida, Inc. 4865 N. Wickham Road, Suite 103 Melbourne, Florida 32940 321-610-3999 fax:321-610-7958 B. TYPE OF LOAN 1. FHA 2. L FMHA 3.. CONV. UNINS. 4. VA 5. CONV. INS. 6. File Nwabu: 1. r.om Numlw: 7-6172 8. Mortgage Ins. c-No.: C NOTE: This form is furnished to give you a statement ofactual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked Doc) were paid outside the closin¢ They are shown here for informational Purposes and are not Included in the totals Brian Goulet, a single man D. Buyer: 806 Escambia Drive Sanford, Florida 32771 Wilmington Savings Fund Society, FSB, as Trustee of Stanwich Mortgage Loan Trust A E. Seller: 1600 South Douglass Road, Suite 130A Anaheim. California 92806 F. Lender: 2430 Laurel Ave G. Property: Sanford, Seminole County, Florida 32771 Lot 36-35, Becks Addition,_Book 3, Paee 101, Seminole County. Florida H. Settlement Agent: Dependable Title Services of Florida, Inc. Place of Settlement: 4865 N. Wickham Road, Suite 103, Melbourne, Florida 32940 Brevard County J. Summary of Buyer's Transaction K. Summary of Seller's Transaction 100. Gross Amount Due From Buyer: 400. Gross Amount Due To Seller: 101. Contract Sales Price 86100.00 401. Contract Sales Price 86,100.00 102. Personal Property 402. Personal Pronertv,. 103, Settlement Charges to Buyer line 1400 401.50 403. d PaidSeller In Advance: A u en It id b Seller In dvanc • 106 City / Town Taxes 406. City / Town Taxes 107. County /Parish Taxes Dec 11, 2017 faru Dec 31, 2017 28,55 407. County / Parish Taxes Dec 11, 2017 thru Dec 31, 2017 28.55 108. Assessments 408. Assessments 109. Non- Ad Valorem Tax Assessments 409, Non- Ad Valorem Tax Assessments 120 Gross Amount Due from Buyer: 86,530.05 420. Gross Amount Due to Seller:6128.55 200. Amounts Paid by or in Behalf of Burg::: 500, Reductions in Amount Due toSeller: 201, Deposit / Earnest Money 8,000.00 501. Excess Deposit btLq instructions) _ 202. Principal Amount of N w Loan 502. Settlement Charges to Seller (Line 1400) 7,319.75 203. Existing Loan(s) _ 503. Existin¢ Loans) 204. 504. Payoff of First Morteaee 205. 505. Pgyoff of Second Mort age 206. 506. Purchase Money Mortgage Adjustments for Items Unpaid by Seller: A ju t ncnts for Items Unpaid by,eller: 210 City / Town Taxes 510. City/To nTaxes 211. County / Parish Taxes 511. County/ Parish Taxes 212, Assessments 512. Assessments 213. Non- Ad Valorem Tax Assessments 513. Non- Ad Valorem Tax Assessments 220. Total Paid by / for Buyer: _ 8AOO.QO 520. Total Reductions in Amount Due Seller: 7319.75 300. Cash at Settlement from / to 33sverr, _ 0_Ca h at gl Igment to / from Seller: 301. Gross Amount due from Buyer (line 120) 86,530.05 601. Gross Amount due to Seller (line 420) 86,128.55 302. Less Amount Paid by/for Buyer (line 220) 8,000.00 602. Less Reductions Amount due Seller (line520) 7,319.75 303. Cash From Buyer: 78,53U5 603. Cash To Seller: 78,808.80 May 2007 Settlement Date:December 11, 2017 File Number. 17-6172 L. Settlement Charges 700. Total Sales / Broker's Commission: Based on Price $86,100.00 ® 6.00% = $5,166,00 Division of Commission as followsFunds Paid from Buyer's at Settlement Paid from Seller's Funds at Settlement 701. 2,583.00 to All Flgrida Propeily Group,Inc. 702. 2 583.00 to Sparrow Realty Gr u LLC 703. Commission Paid at Settlement 5.166.00 704. Realtor Transaction Fee 800. lternN Payable In Connection with Loan: 801. Loan Origination Fee 802. Loan Discount 803. Appraisal Fe 804 Credit Report _ 805. Lenders Inspection Fee 806. Mortgage Insurance Application Fee 807. Assumption Fee 0. ItemIternaRegidred by Lender to be Paid inAdvance; 01. Daily interest charge 902. Mortgage Ins-usAnee Premium _ 03. Hazard Insurance Premium 904. Flood Insurance Premium 1000. Reserves Deposited with Lender: 1001 Hazard Insurance 1002. Mortgage Insurance 1003 City Property Taxes 1004 County Property Taxes 1005. Annual Assessments 1100. Title Charges: 1101. Settlement or Clos ng Fee to Dependable Title Services of Florida Inc. 350.00 350.00 1102. Abstract or Title Search to Alliant National Title Insurance Company c $75.00 by Seller 1103. Title Examination 1104 Title Insurance Binder 1105 Document Preparation 1106. Notary Fees 1107. Attorney Fees includesabove item numbers: 1108. Title Insurance to Dependable Title Services of Florida, Inc. includesaboveitemnumbers: _ 495. 08 1109. Lender's Coverage 0.00 1110. Owner's Coverage 86,100.00 Risk Rate $495. 08 Premium: 1111. Document scanning and storage fee to Fla ler Document Imaging and Storage, Inc. 20.00 1200 Government Recording and Transfer Charges; 1201. Recording Fees: Deed 27.00 Mortgagg 0.00 Releases 0.001 27.00 1202 City/County Tax/Stamps: Deed 0.00 Mortgage 0.00 1203 State Tax/Stamps: Deed 602.70 Mortgage 0.00 602.70 1204. Intangible Tax to Clerk of the Circuit Court 1205 E-Recording Fees to Shnplifile for Clerk of the Circuit -Court.- 4.50 4.50 1206. POA Affidavit Recording Fees to Sim lifile for Clerk of the Circuit Court 18.50 1300 Additional Settlement Charges: _ 1301 Survey _ 1302 Pest Inspection 1303. CountyTaxes - 2017 to Seminole Counjy Tax Collector 501.39 1304. Municipal Lien Search to Property Debt Research 125.00 1305. FedEx/Shipping Fee to Dependable Title Services of Florida Inc. 16.50 1306. Utility Bill to City of Sanford 40.08 1307, - 1308. - 1309. 1310 -_ 1312. 1313. _ 1314. . 1315. 1400. Total Settlement Charges (Enter on line 103, Section J and line 502, Section K) 401.50 7,319.75 May 2007 9ettiement'Date:December 11, 2017 File Number: 17-6172 A. SETTLEMENT STATEMENT Dependable Title Services of Florida, Inc. 4865 N. Wickham Road, Suite 103 Melbourne, Florida 32940 321-610-3999 fax:321-610-7958 1 have carefiilly reviewed the Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction, I further certify that I have received a copy of Settlement Statement. Wilmington Savings Fun Society, FSB, as Trustee of Stanwich Buyer: Seller: Mortgage Loan Trust A Brian Goulet By: Carrington Mortgage Services, LLC, Its attorney -in -fact The Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed in accordance with the instr o ies hereto. Settlement4e;nt: Date: December 11, 2017 o Riley Settlement Date:Deoember 11, 2017 File Number: 17.6172 A. SEITLEM ENT STATEMENT Dependable Title Services of Florida, Inc. 4865 N. Wickham Road, Suite 103 Melbourne, Florida 32940 321-610.3999 1Lx 321.610.7958 I Inve carefully reviewed the Settlament Statement and to Ua but of my knowledge and belie[ it is a true and accurate statement of all receipts and disbursements node on my account or by me in this transaction I killer certify that I love received a copy of Setdetnent Statement. Buyer. The Sett with sue Sewell May 2007 Wilmington Savings nurd Society, FSB, as Trustee of Sianwich Seller. Mortgage LoanTrusl A By: Carrington Mortgage Services, LLC, Its atiomeydndaet wu atWis transaction. 1 have caused or will came the rinds to be disbursed in accordance Date: December 11, 2017 CITY OF Building & Fire Prevention DivisionSFORDRESIDENTL4LRE -ROOF POLICY & PROCEDURES FIRE DEPARTMENT 1 7 ^.37 144 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. Id` S CONTRACTOR ( OR OWNER/BUILDER) SIGNATURE: DATE: µCITY OF S f IRE DEPAIRTMENT PERMIT # 3 Building & Fire Prevention Division RESIDENTIAL RE -ROOF SCOPE OF WORK JOB ADDRESS: OL / k La_ u_a e (. J c c<- STRUCTURE TYPE: aSINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM RE -ROOF TYPE: O'f;CEPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS) O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF) DECK TYPE (PLEASE SPECIFY): o PLEASE NOTE: ONLY 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED * * ROOF VENTILATION: DOFF -RIDGE O RIDGE OSOFFIT OPOWERED VENT OTURBINES SKYLIGHTS: O YES ©'NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #: MAIN ROOF AREA ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 (E)T-11 2 OR GREATER TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL Q'SHINGLE FL# O METAL FL# O MODIFIED BITUMEN FL# O TORCH DOWN FL# O INSULATED FL# O TILE FL# O OTHER: FL# ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IFAPPLICABLE** ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 O 4:12 OR GREATER TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL O SHINGLE FL# O METAL FL# O MODIFIED BITUMEN FL# OTORCH DOWN FL# O INSULATED FL# O TILE FL# 0 OTHER: FL# SCPA Parcel View: 36-19-30-538-0000-0360 Page 1 of 2 Property Record Card P h Parcel: 36-19-30-538-0000-0360 R Owner: CITIFINANCIAL SERVICING LLC cote+w, 'Lpren Property Address: 2430 LAUREL AVE SANFORD, FL 32771 Parcel Information Parcel 36-19-30-538-0000-0360 Owner CITIFINANCIAL SERVICING LLC Property Address 2430 LAUREL AVE SANFORD, FL 32771 Mailing 1000 TECHNOLOGY DR O FALLON, MO 63368-2239 Subdivision Name BECKS ADD Tax District S4-SANFORD- 17-92 REDVDST DOR Use Code 01-SINGLE FAMILY Exemptions 00-HOMESTEAD(1995) b i 35 a 361 127 Land Seminole County GIS Value Summary 2018 Working 2017 Certified Values Values Valuation Method Cost/Market Cost/Market Number of Buildings 1 1 Depreciated Bldg Value 43,436 _ 40,937 Depreciated EXFT Value Land Value (Market) 23,265 23,265 Land Value Ag Just/Market Value 66,701 64,202 Portability Adj Save Our Homes Adj 9,301 7,983 Amendment 1 Adj 0 P&G Adj o —._. 0 Assessed Value 57,400 56,219 Tax Amount without SOH: $569.34 2017 Tax Bill Amount $516.90 Tax Estimator Save Our Homes Savings: $52.44 Does NOT INCLUDE Non Ad Valorem Assessments Method Frontage Depth Units Units Price Land Value FRONT FOOT & DEPTH 90.001 127.00 1 0 1 $275.00 1 $23,265 Building Information is bearCain count Incorrect! DICK Here. Description Year Built Actual/Effective Fixtures Bed Bath B ase Area Total SF Living SF Ext Wall Adj Value Repl Value Appendages 1 SINGLE 1954 3 2 10 864 1,285 1,161 SIDING 1 $43,436 $80,811 FAMILY GRADE 3 j Description Area 55.00IIj http://parceIdetai1. scpafl.org/ParcelDetaillnfo.aspx?PID=36193053 800000360 12/21 /2017 AdUMML CITY OF jjS,kNF0P D FIRE DEPARTMENT Building & Fire Prevention Division RESIDENTLAL RE-ROOFAFFIDAVIT RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS PERMIT #: ADDRESS: AV a qr'L 2-17'? / I 7%"j G;yz(:n J A—D C,,=;. e/k , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR ROOFING CONTRACTOR, 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#: < fc 6 C COMPANY / CONTRACTOR: 1-1-L I %I CONTRACTOR SIGNATURE: - DATE: . _ 20/ / MUST BE SIGNED BY LICENSE H LDER WNER/BUILDER) A FINAL ROOF INSPECTION IS REOUH2ED: 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 `l'1 1 //)O L +— Sworn to and Subscribed before me this day of C 20 17 by: fl IYrz-l7( S 1 Who is ersonally Known to me or has Produced (type of ion) as identification. ture of Public Poe%, DONALD RASH State of Florida ?, _ p blic - State of Florida Notaryuc € Commission # FF 221706 Q/ ? fo c My Comm, Expires Apr16,2019 sn Prt/Type/Stamp Name of Notary Public