400 Myrtle Ave 17-192; ROOFCITY OF SANFORD
BUILDING & FIRE PREVENTION
IV FTAPERMIT APPLICATION
JAN 18 2017 Application No:
BY` Documented Construction Value:
Job Address: LO MIY AY l-12. Historic District: Yes No
Parcel ID: c -l j n - 5 A WO(hCJ1O Residential g Commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of Work L P4__)C W
Plan Review Contact Person: ROu _OV_c 1 Title:
Phone: 90y, ..Fax: Email:ri:Ylif1QG,yp..Crf'
Property Owner Information
Name , WG tn(',.h, ()6 Phone: (Q0Q , (Q3 5(0 - -
Street:. LIM- Resident of property? : ES
City, State Zip: N PL a)i_77.`T
Contractor Information
Name 'n`t- j:L.0 Phone: a D f 5l 0333
Street:, l.0 i - . McAk"(_ VV_ i'R)WC4 16;5 Fax
City, State Zip: )C.ACIC tn -0 t l ( `t 'EL -2_4 ( State License No.: Crl: 2- l W39
Architect/Engineer Information
Nanne.
Street: Fax:
City, St, Zip: E-mail:
Bonding Company:
Address:
Mortgage Lender:
Address:
WARNING TO O%7NER: 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 pertnit and that all work will be perfarmed 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 109.3 Shall be (inscribed with the date of application and the code in effect as of that date: 3's Edition (2014) Florida Building Code
Revisal: June 30, 2015 Permit Application
13 q.05
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 comity, and there may be additional permits required from other governmental entities such as water
management districts, state agencies, or federal agencies.
Acceptance of permit is verification that 1 will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
The City of Sanford requires payment of a plan review fee at the time of permit submittal. A copy of the executed contract is required
in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal.
The actual construction value will be figured based on the current 1CC 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 ac a that all work will
be done In compliance with all applicable laws regulad co uction zo t
Sigi ItureorOwncr! •nt late lure of Contract ' Date.
Pri (.Owner/Age't's N ie P nt tractor! s N e
le v Pf Notary Public State of FloridaJenniferKinnebrew
v My Commission GG 036778NOWExpires10/06/2020
01 P4 Notary Public State of Florida
Jennifer Kinnebrew
My Commission GG 036778
Expires 10/06/2020
Owner/Agent is Personally Known to Mc or Contractor/Agent is .Personally Known to Me or
Produced ID Type of iD Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
JPermits I egtmcca: Building - Electricitl ]
T _
11!Icchdnica! Q PlumbingQ GasO-' Roan
Construction Type:
Total Sq Ft of Bldg:
Occupancy Use:
Min. Occupancy Load:
New Construction: Electric - # of Amps,
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING i Ig I UTILrrIES:
ENGINEERING:
COMMENTS:
FIRE:
Flood Zone:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Permit Application
THIS INSTR MENT PREPARED BY:
Name: n v r
Address: z1 yh. /i
NOVICE OF COMMENCEMENT
PermltNumbet: 1 I —) 1
GRAI I IIALOYr SENINOLE COUNTY
CLERK OF CIRCUIT COURT & C:ONPTROLLER
BK 8845 P9 1708 (Wss )
CLERK'S Y 20170OL071
RECORDED 01/18/21i17 10:25:00 All
RECORDING FEES $10.00
RECORDED BY hdevore
Parcel ID Number: 96
The undersigned hereby gives notice that improvement w0I 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} r-I ;_yT-: ;,, .; ° s.:
2. GE RAIL DESCRIPTION OF IMPROVEMENT: BY — - - ` ` _ _ ' t" Y (91,
Ke Q nn!' 2.0 17
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT:
Name and address: N(AVjC Mg P AV , )=(.
Interest In property: _QLk3n-f
Fee Simple Title Holder (If other then owner listed above) Namo:
Address:
4. CONTRACTOR: Name: )&Vw\e CoYns, GA-C- Phone Number:
Address: $l la 1 pear; lmyv;, AA ''G A Soa t t&i V t, 3D 1 p
d. SURETY (If applicable, a copy of the payment bond Is attached): Name:
Address: Amount of Bond:
8. LENDER: Name: Phone Number.
Address: -
7. Persona 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.
Address:
8. In addition, Owner designates
Phone Number.
Of
to receive a copy of the Lienoes 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 OWNF_R: 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.
t(r'dnt Name and Provido Stnnolory'e 111lo/Offlo5l
State of F-L County of u U e,
The foregoing Instrumetlt was acknowledged before me this el-1 V- (d day of
by
who has
Signalive br pumor or 1esSaa, or Ovmnra or Losses s
AudioAta 1.011icogDimcloriparfneUManag er)
NARN of person mating mainlnnnt
0 type of Identification produced:
E-11t
Notary Public State of FloridaJenniferKinnebrewMyCommissionGG036778
n Expires 10/06/2020
Who Is personally known to me eOR
BUILDING AND FIRE INSPECTION DIVISION +
CONTRACTOR REGISTRATION CARD *•.._,
Issued to: VAN DEN BOSCH, ROGER
DBA: KINNECORPS, LLC
Licensed as: REGISTERED ROOFING
CONTRACTOR /I /
re
Expiration Date: 09/30/2017
Card No.: 17-12680
License No.: RC29027575
Jaue Wat6oa
Seminole County Building Official
CERTIFICATE OF APPROPRIATENESS
HISTORIC PRESERVATION BOARD
CITY OF SANFORD
300 S. Park Avenue
Sanford, Florida 32771
407.688.5145 • www.sanfordfl.gov/HP
THIS DOCUMENT MUST BE POSTED AT ALL TIMES UNTIL
PROJECT IS COMPLETED.
ISSUED TO: DATE ISSUED:
Nancy Downs January 18, 2017
400 Myrtle Avenue
Sanford, FL DATE EXPIRES:
July 19, 2017
BP#17-194
Approved to reroof with architectural shingles in "Harbor Grey" color..All roof
surfaces (including porches and additions) must be re -roofed and must match in
dimension, profile, texture and other visual qualities. If repair/replacement`of
features (other than roof decking) is necessary, a separate CofA application; must be
submitted.
Christine Dalton, AICP
Historic Preservation Officer/Community Planner
Please be advised it is the owner and/or agent's responsibility to notify staff of any potential changes from
the approved COA that arise and obtain approval prior to commencing the changes. This Certificate of
Appropriateness does not constitute final development approval. The applicant is responsible •for obtaining
all necessary permits and approvals from applicable departments before initiating development.
IS A BUILDING PERMIT REQUIRE FO E ACTIVITY LISTED ABOVE? ;N YES NO
Building De artme t Re resentative
N00 I
APPLICATION # 14
FOR A CERTIFICATE OF APPROPRIATENESS
Answer all the questions on this form and submit all required attachments. Incomplete applications will not be
reviewed. If you have questions about application requirements contact the Historic Preservation Officer at
407.688.5145 to ensure your application is complete.
General Information
Downtown Commercial Historic District Residential Historic Districtprls this a retroactive request? Yes[] NoE
Is this application filed in response to a Notice of Violation from the Code Enforcement Department? Yes NoH
Proposed improvements will affect the following elevations: North South East West
Property Address:
Property Owner Information
Print Name:
Mailing Addr
Phone: -77?
Applicant/Agent Information
Print Name:
Mailing Aft
Phone: 'A0 , 3:S- L I Email: V f! k-CVL L V Signature:
0333 1 myv---)
BY SIGNING BELOW YOU ACKNOWLEDGE THAT A BUILDING PERMIT MAY BE REQUIRED FOR THE
SCOPE OF WORK LISTED BELOW. YOU MUST CONTACT THE BUILDING DEPARTMENT TO
DETERMINE IF A BUILDING PERMIT IS REQUIRED. FAILURE. TO OBTAIN A BUILDING PERMIT WILL
RESULT IN A STOP WORK ORDER, DOUBLE PERMIT FEES, AND POTENTIAL FINES. BY SIGNING
BELOW, YOU ALSO ACKNQWLEDGE THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS
TRUE AND ACCURAT EST OF YOUR KNOWLEDGE.
Signature: Date:
Would you like to eive emails regarding Historic Preservation and Community Planning within your community?
Description of proposed work
Completely describe the entire scope of work, including changes in material and color, and methods that will be used to
accoplishnthe proposed work. For large/ projects an itemized list is required. Use the reverse side if necessary.
tic,
HISTORIC PRESERVATION BOARD • 300 S. Park Avenue • Sanford, Florida 32771 •407.688.5145 • www.sanfordfl.gov/HP
KY LABSouif0ri!oC-*, CLAIM SOLUTIONS
Tampa Office
P O Box 89239
Tainpa, FL 33689
P: 888.898.RYZE
F: 813.689.5461
IofI
9 boo -
Customer Agreement/Contract Proposal
KINNECORPS, LLC
14250 Falconhead Ct
Jacksonville, FL 32224
Phone 904-351-0333 Fax 904-666-7847
FL License# RG291103914, RC29027575
Customer Name
66C11 DO Lox
I ance Company76
Sales
Address
Si1i1
Claim #
a5510
Date Reported ftDa'Loss
City, State, Zip
r
f ' Policy # _ Insurance Company Number
Home Phone Mortgage Company Adjuster Phone #
Cell Ph
Z? -00
Loan # Mortgage mpany #
E a bO6ON5 eJ ,_
Kinnecorps File # ype o oss
Wind it
Scope of Work
Remove and dispose of existing roofing down to wood deck including shingles, underlayment, drip edge, pipe boots, ridge/off ridge vents, valley
metal
Re -nail wood deck with 8d ring shank nails, per city code
Install new underlayment
Install new drip edge, roof vents, and replace pipe flashing
Protect landscaping, driveway, other household components not associated with project
Remove/install existing satellite dishes (may need recalibration by provider)
Solar contractor will remove and reinstall solar panels and solar water/heating systems as need to perform tear off/reroof
Driveway (cracks, stains, etc.)
Ceilings (stains, mold)
Shingle Brand and Color
Drip Color
Notes
Prooverty Conditions
Dumpster
Total Investment: It is agreed the amount of the contractor shall be based on the amount equal to full replacement cost value as stated on insurance
scope of loss" including deductible and all upgrades, supplements, extra charges unless otherwise noted.
Deductible
Change Orders
Owner S
Bid Price
Due to the unique nature of repairs related to insurance claims, this contract does not include an explicit price because the final scope has not been agreed upon with the
insurer. Reaching agreement on the full scope of repairs involves considerable time on Company's part; we will not proceed with this phase unless you agree to allow
us to do the work once the scope is agreed upon. By signing this agreement, you authorize Kinnecorps to reach agreement on the price and scope of repairs on your
behalf. Kinnecorps agrees to bid the work using primary insurance i a ase (Xactimate) based on the scope of work agree._ up .__ ur insurer
i mary msura ustry-rate-(-09%. r iarkuD-Xactimate-line-items)—Affy 9ubstantiaTadditions or deductions to the a-df -
I
ork will be handled by written construction change dr ers. No verbal contracts agreed to. All items agreed upon must be in writing. If your insurance company
our claim this gger ment contract becomes null and voo
NOTICE T CLAIM -COVENANT OF PAYMENT:
Owner hereby assigns any and all rights, benefits, proceeds and any causes of action under any applicable insurance policies which cover the damage to the property
that Company is to repair pursuant to this contract. PJwner further assigns and authorizes Company to see reimbursement from Owners insurance carrier for payment
owed to Company for services rendered by Company via the initiation of a civil action in a court competent jurisdiction or other means of recovery. In this regard
owner waives privacy rights. Qwner makes this assignment in consideration of Company's agreement to perform services and supply materials and otherwise perform
its obligation under this contract including not requiring full payment at the time of service. Owner also hereby directs owner's insurance carrier to release any and all
information requested by Company, it representatives and or its Attorney for the direct purpose of obtaining actual benefits to be paid by Owners insurance carrier for
services rendered or to be rendered.
Acceptance of Terms — The above specifications, scope of work and conditions are satisfactory and are hereby accepted. It is agreed upon that the amount of contract
shall be based on the amount equal to full replacement cost value as stated on the insurance "scope of loss" including deductible and all upgrades, supplements,
extra/changes, unless otherwise noted. Kinnecorps is hereby authorized to do the work as specified above along with Xactimate estimate, scope of work and missing
items from insurance loss report. Owner acknowledges reading, understanding and accepts the additional terms and conditions on the back of this form Buyers Right to
Cancel — If the buyer wishes to no longer receive the goods or services presented, buy may cancel this agreement by providing written notice to Kinnecorps in Person,
by Telegraph or by certified mail. This notice must indicate that the buyer does not want the goods or services and must be delivered or post marked before midnight of
the third (3 d) business day after the agreement is signed.
Owner Approval K Additional Owner
By signing this Contract you agree to all terms on front and back of this contract. (Owner Initial)
SCPA Parcel View: 25-19-30-5AG-0606-0010 Page 1 of 2
pP
Property Record Card
PAjO
Parcel:
25-19-30-5AG-0606-0010 Owner:
DOWNS NANCY B scaccounv,
r ona Property
Address: 400 MYRTLE AVE SANFORD, FL 32771 Parcel
Information Parcel
25.19-30-5AG-0606-0010 Owner
DOWNS NANCY B Property
Address 400 MYRTLE AVE SANFORD, FL 32771 Mailing
400 MYRTLE AVE SANFORD, FL 32771- Subdivision
Name SANFORD TOWN OF Tax
District S1-SANFORD DOR
Use Code 0102-SINGLE FAMILY - SANFORD HISTORICAL DISTRICT Exemptions
00-HOMESTEAD(2014) Value
Summary 2017
Working Values
2016
Certified Values
Valuation
Method Cost/Market Cost/Market Number
of Buildings 1 1 Depreciated
Bldg Value 71,778 68,893 Depreciated
EXFT Value 680 680 Land
Value (Market) 35,640 35,640 Land
Value Ag Just/
Market Value " 108,098 105,213 Portability
Adj Save
Our Homes Adj 5,986 3,811 Amendment
1 Adj PSG
Adj 0 0 Assessed
Value 102,112 101,402 Tax
Amount without SOH: $1,295.71 2016
Tax Bill Amount $1,219.31 Tax
Estimator Save
Our Homes Savings: $76.40 Does
NOT INCLUDE Non Ad Valorem Assessments http://
parceldetail. scpafl.org/ParcelDetailInfo.aspx?PID=2519305AGO6060010 1 / 18/2017
t-1-- I R°Z
tali
Di
City of Sanford
Roof Permit Application Checklist
All permit application packages must be complete prior to acceptance. You must check each box to the
left or indicate n/a on this submittal. A complete application package shall include the following:
E?''-- Building Permit Application completed, signed and notarized. Application must include correct address
and complete parcel I.D. number.
Copy of applicable contractor's license issued by the State of Florida (if the contractor is the
applicant).
L%A site specific notarized power of attorney shall be required from the licensed contractor if
he/she appoints an employee of his/her company to sign the permit application as the contractor.
ti Certificate of insurance indicating worker's compensation insurance coverage and naming the City of
Sanford as certificate holder, or a copy of a worker's compensation exemption issued by the State of
Florida (must be submitted with each application if contractor is the applicant).
N A Completed and signed Owner Builder Statement / Affidavit (if the owner is the applicant).
These guidelines were compiled to assist the applicant in preparing a roof permit application and may not be
complete. The applicant is required to meet all City of Sanford, state, andfederal code requirements.
F City of Sanford
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NA IILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF ROOF COVERINGS
PERMIT #: ( ! - 0000 Z ADDRESS: OO /'/ e
yaN4r,-"
I /t ! liry y%U `,/wjC`/ , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR ROOFING
ONTRACTOR, 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 N 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 #:
9 L 2, ` OZ r S_ -7 5- COMPANY /
CONTRACTOR: CONTRACTOR
SIGNATURE: DATE: 2- S MUST
BE SIGNED BY .LICENSE HOLDS OWN UILDER) 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 Aa Sworn
to and Subscribed before me this /b. day of 20 %71 by: ho
is 0 Personally Known to me or hasxproduced (type of as
identification. Signatu
a Ile-' ;::•pip;:•.. o`'
DAIRA PAOLA RAMIREZ Statofora. ; vA
MY COMMISSION #.FF046072 x— •'+''
eot
o:' EXPIRES August 15.2017 Print/
Type/Stamp Name (407) 398-0153 FloridallolaryService.com of
Notary Public
R
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 viler 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 t provided by a Florida Design
Professional (architect or engineer), certifying FBC 'ante by personal inspection.
CONTRB ACTOR (OR OWNERUILDER) SIGNATURE: DATE: Z Sh
s
JOB ADDRESS: q 0 O J D V 1 I, 1 Iu f P
PERMIT # / 7-49010019Z
City of Sanford Building Division
Residential Re -Roof Scope of Work
STRUCTURE TYPE: % SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS) KRE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
I
wDECKTYPE (PLEASE SPECIFY): oyw
PLEASE NOTE: ONLY 100 SQUARE FELT OF THE EXISTING DECK IS PERMITTED TO BE REPLACED
ROOF VENTILATION: AOFF-RIDGE O RIDGE OSOFFTT OPOWERED VENT OTURBINES
SKYLIGHTS:.O YES 0No IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 -4:12 to4:12 OR GREATER
TYPE OF ROOF MANUFACTURER/ FLORIDA PRODUCT APPROVAL
XSHINGLE Pji i 1 ( FL# ,C4 o
O METAL FL#
O MODIFIED BITUMEN FL#
O TORCH DOWN FL#
0INSULATED FL#
O TILE FL#
O OTHER: FL#
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IF APPLICABLE"
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#
O TORCH DOWN FL#
OINSULATED FL#
O TILE FL#
O OTHER: FL#
b
F City of Sanford
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: ( ! — p00ood o ADDRESS: OO
I KIN 8/ YN ([ Ill /Xfo,'/ , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING ONTRACTOR, 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 NSTALLATION 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#: 9 C Z [ O2. 7S- 7
COMPANY / CONTRA
CONTRACTOR SIGNA
MUST BE SIGNED BY
CTOR: Jc%vQGor
TURE: DATE: 2-1
LICENSE HOLDE OWN ZIULIDER)
A FINAL ROOF INSPECTION IS REOUIRED:
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
Sworn to and Subscribed before me this f day of 7 a 20 %'?- by:
Who is Personally Known to me or has/,(Produced (type of
as identification.
Sianatu a
Stat o on ;.
DAIRA PAOLA RAMIREZ
P MY COMMISSION#FF046072
EXPIRES August 15. 2017
Print/Type/Stamp Name (407) ;98-0153 floriUalloiaryService.com
of Notary Public