119 Poplar Ave 17-86; ROOFDocu
Application No:
Construction Value: $
M-LO "*all
kyj 4 z 19 Lei z I
W.1•
Job Address: 1"'L L4 i", -7 1 Historic District: YesEl No El Parcel
ID: Residential EJ Commercial Type
of Work: New[] AdditionEl AlterationEl RepairEl DemoEl Change of UseEl Move[] Description of Work: CIL -is Plan
Review Contact Person: Title: Phone:
Fax: Inc -.? 2 t Email:
e cl c Property Owner Information Name Phone: Street:
City, State Zip:
Resident of
property? :
Contractor Information Name
t- Phone: 6,
z 7
Street: Fax: City, State Zip: '7
State License
No.: Name: Street: City, St, Zip: Bonding
Company:
Address:
ArchitecVEngineer Information Phone:
IM 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: 51 Edition (2014) Florida Building Code Revised: June 30, 2015 Permit Application -
4
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 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.
be do in com
Signat re of Owner.
Print Own'gent'
1/certify that all of the foregoing information is accurate and that all work will
all applicable laws regulating construction and zoning,,
Signature of Notary -State of Florida Date
tsAY No4ary Public St*e Of FtOr'd'aM0
Bobbi But ler
t My Com,t&fAon FF 044726 ff.
0j Expims 0611212 o1 7 QwnCr'
CO Me or Produced
ID _ Type of ID Signature
of Con d-r/Agerit- Date Print
Contractod , Agent's Name' to
Signature
of Notary -State of Florida Date 001
Notary Put* State Of Fiord& Bow
Butler My
Commomlon Ff 044725 J
OF Expires 0411212 17 Con
nown to Me or Produced
ID Type of ID 1
11 1 1,
111
M la • Permits
Required: BuildingE] ElectricalE] Mechanical[] Plumbing[ GasE] Roof [] Construction
Type: Occupancy Use: Flood Zone: - Total
Sq Ft of Bldg: Min. Occupancy Load: New
Construction: Electric - # of Amps, Fire
Sprinkler Permit: YesE] NoE] # of Heads APPROVALS:
ZONING: ENGINEERING:
CWTUFS
1321 UTILITIES:
12110
of
Stories: Plumbing - #
of Fixtures, Fire
Alarm Permit: Yes n No [] WASTE
WATER: BUILDING:
Revised:
June 30, 2015 Permit Application
THIS INSTRer PREPARED BYiIName. cf: {:j ry
Address: cis/
L!2 j t- kri 0 0 7 T i, 1 j 1 J
NOTICE OF COMMENCEMENT
ERK16 A,!,' 26 171`1111J300
State of Florida
County of Seminole
Permit Number. Parcel ID Number: i 1, -3 U 5 A o oacl
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.
DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available)
Al 4-5' 0'-- i -r o E vJ 10 a E -r 12. 3 Tel I :z -/Z &j "j 00 G Sfi.d % o 'C-D
f0 13 / 106
119 19'D LAr V2 A L/ C !:=5 1] 3.2-7-7 1
GENERAL DESCRIPTION OF IMPROVEMENT:
lfe a a t<
OWNER INFORMATION:
Name: J A 50 9 -r(-4 Q- N
Address:
r-h 3 -71
Fee Simple Title Holder (if other than owner) Name:
Address:
CONTRACTOR:
Name:
4fq& ASZi5 LoAI&-vJQt30 -3 S-jAddress:
Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served
as provided by Section 713.13(l)(b), Florida Statutes.
Name:
Address:
In addition to himself, Owner Designates of
To receive a copy of the Lienor's Notice as Provided in
Section 713,13(1)(b), Florida Statutes,
Expiration Date of Notice of Commencement (The expiration date Is 1 year from date of recording unless a
different date Is specified)
WARNING M OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT A DERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 71313, RUTS C
FLORID S k7T TES AND CAN 'ULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A
C"
T
NOTI, O , "
U
OIMMEN(5f-MPKT BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECT[ k IF YOU I ND T 0 AIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE MMENCIN RK OR EC RDING YOUR NOTICE OF COMMENCEMENT.
Under altles of perju ,1 decl re th t I have read the foregoing and that the facts stated In it are true
to the
INSPECT[
my [growled e and eliel
ers Sign Owner's Printed Name
Flori a Statute 713.13 (0):" er ust sign t a notice of commencement and no one else may be permitted to sign in his or her stead."
State of County of M't
r s fTheforegoingInstrumentwasacknowledgedbeforemethisdayofI120 by
aLagr-, Who Is personally known to me Name
of person making statement OR
who has produced IdentificationEl type of Identification produced: Notary Public
State of Florida Bobbi Butler
My Commission
FF 044726 Notary Signature Expires 08/
1212017
LIMITED
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
That 1, ESTEL LEE SPURLIN, hereby name and appoint BILLY JOE COUCH an agent of
ESTEL L. SPURLIN. INC- as my true and lawful attorney and as agent for me to apply for.
receipt for, sign for and do all things necessary to this appointment For all permits and
applications submitted by this contractor.
This Power of Attorney is of limited duration, and shall inure to agent immediately upon my
signature below, and shall remain in force until September 1, 2019.
Be it known by all persons that 1. ESTEL LEE SPURLIN. by m% hand below. hereb,,
acknowledge and affirm the appointment of BILLY JOE COUCH as my agent in fact. to act on
my behalf, as herein set forth above.
In Witness Whereof, we have hereunto set our hands and seals the-, day of August. 2016.
Signed, sealed and delivered in the presence of:
Witness 'Wature
Printed Name
I
Witness Signature
Printed Name
ESTEL LEE SPURl..PN,,-,-ffidividuatty an
President of ESTEL L. SPURLIN. INC.
State License Numbers:
CRC057995 Certified Residential Contractor
CCC056769 Certified Roofing Contractor
STATE OF FLORIDA
COUNTY OF SEMINOLE
Be It Known, That on the Ij day of August, 2016, before me. Pamela S. Walker. a NOTARY
PUBLIC, in and for the STATE OF FLORIDA, duly commissioned and sworn, personally came
and appeared ESTEL L. SPURLIN, N/A to me personally known or by identification. FL. DR.
LIC. #S164-212-38-339-0, and known to me to be the same person described in and who
executed the within power of attorney. and he acknowledged under oath the within power of
attorney to be his act and deed.
In Testimony Whereof, I have hereunto subscribed my name and affixed my seal of office the
day and year last above written.
PAMELA S. WALKER
MY COMMISSION d FF204229 Pamela S. Walker, Notary Public
EXPIRES. Februai} 26, 2019
2
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:
Building Permit Application completed, signed and notarized. Application must include correct address
and complete parcel I.D. number.
Copy of a contract, signed by the contractor and the property owner, indicating the documented
construction value of the project.
L Copy of applicable contractor's license issued by the State of Florida (if the contractor is the
applicant).
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 pen -nit application as the contractor.
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).
I" 1,11L Completed and signed Owner Builder Statement / Affidavit (if the owner is the applicant).
V' For Re -Roof Permits other than asphalt shingle, wood shake or wood shingle, please provide two (2)
copies of Florida Product Approval and Manufacturer Installation Instructions for the roof covering
product and the underlayment.
Contact person information entered in Naviline?
tr
Application forms stamped received and initialed?
These guidelines were compiled to assist the applicant in preparing a roqfpermit application and may not be
complete. The applicant is required to meet all City of Sanford, state, and federal code requirements.
Revised: February 2015
City of Sanford
Residential Re -Roof
Hurricane Mitigation Inspection Process
1 Roofing contractor shall be responsible for the protection of contents and structure at all
times.
2. An in -progress inspection shall be scheduled after the old roof has been removed and
the dry -in is complete. All components of the dry -in must be in place. To schedule an
inspection, call 407.688.5151.
3. For roofs using an entire peel and stick dry -in, a nailing affidavit shall be required to be
posted on jobsite at time of in -progress inspection.
4. A minimum of one hundred (100) square feet of the new roof component shall be installed
at time of inspection. Up to fifty percent (50%) of the new roof may be installed, but all
flashing and valley metal shall remain exposed for inspection.
5. The contractor shall contact the inspector the day of the scheduled inspection between
7:30 a.m. and 8:30 a.m. to coordinate the inspection time. Please call 407.688.5061 or
5063
6. At time of inspection the inspector shall, at his or her discretion, select location(s) for
inspection.
7. A representative of the contractor shall be on job site to facilitate any necessary repairs.
8. After the inspection is conducted, the contractor will make any necessary repairs and
proceed as directed by the inspector.
9. For approved inspections, the inspector shall collect the required affidavit for filing with the
permit application.
The above shall serve as the inspection process to meet requirements per Florida Statute. Any and all
suggestions to better serve the contractor needs will be considered.
Revised: February 2015
f
CITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #:
1, hereby acknowledge that I personally inspected
Roof deck nailing and/or Secondary water barrier work
at 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
Printed Name of Contractor
Date
License #
License Type: General Building I-] Residential Roofing Contractor
11-1 or any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF
Sworn to (or affirmed) and subscribed before me this day of , 20 , by
who is Personally Known to me or has Produced (type of
identification) as identification.
SEAL)
Signature of Notary Public
State of Florida
Print/Type/Stamp Name
of Notary Public
Revised: February 2015
C E,'BILU C K
r=IaIN StrLm=ftxc* &rvQ1r*3w1riq
Evaluation Report
Rib Panel"
Metal Roof Assembly
Manufacturer:
CBUCK, Inc. Certificate of Authorization #8064
Millennium Metals, Inc.
10200 Eastport Road
Jacksonville, FL 32218
877) 358-7663
for
Florida Product Approval
FL 5211.2 R6
Florida Building Code Sth Edition (2014)
Per Rule 61G20-3
Method: 1 - D
Category: Roofing
Sub - Category: Metal Roofing
Product:
Material:
Panel Thickness:
Panel Width:
Support:
Prepared by:
James L. Buckner, P.E., SECS
Florida Professional Engineer # 31242
Florida Evaluation ANE ID: 1916
Project Manager: Youry Demosthenes
Report No. 15-104-Rib-S9W-ER
Revises 12-117-Rib-S9W-ER)
Date: 7/ 1/15
Contents:
Evaluation Report Pages I — 8
Rib Panel"
Steel
29 gauge, Minimum
3601
Wood Deck
Digitally signed by James L. Buckner, P.E.
Electronically signed and sealed documents
shall comply with the provisions of FAC Rule
61GIS-23. %xlllll11J rf
Z_ No 31242
411 Z:
0 STATE OF
CORIOP'
S .....
CSUCK, Inc. 2015.07.01 11:03:27 -04'00'
1399 N. Killian Drive, Suite 4, West Palm each, Florida 33403
Phone: (561) 491-9927 a Email: cbuck@cbuckinc.net a Website: www.cbuckine.net
CBUCK Eminginee-arlinug
FL #: FL 5211.2-116
Date: 7/1/15
Report No.: 15-104-Rib-SM-ER
Page 2 of 8
E4Decia"'w SiTLK:hxcN encorwerInQ CBUCK, Inc. Certificate of Authorization #8064
Manufacturer:
Product Name:
Product Category.
Millennium Metals, Inc.
Rib Panel"
Roofing
Product Sub -Category Metal Roofing
Compliance Method: State Product Approval Rule 61G20-3.005 (1) (d)
Product/System "Rib Panel"
Description: 29 gauge (Minimum Thickness) Steel roof panel mechanically attached to Plywood
Deck with screws.
Product Assembly as Refer to Page 4 of this report for product assembly components/materials &
Evaluated: standards:
1. Roof Panel
2. Fasteners
3. Underlayment
4. Insulation (Optional)
5. Barrier Board (Optional)
Support: Type:
Wood Deck
Design of support and its attachment to support framing is outside the scope of this
evaluation.)
Description:
0 15/32 (min,) or 19/32" (min.) or greater plywood,
or Wood plank (min. specific gravity of 0.42)
Slope: Minimum slope shall be in compliance with FBC Chapter 15 Section 1507.4.2,
applicable code sections and in accordance with manufacturer's
recommendations.
Performance: Wind Uplift Resistance:
Design Uplift Pressure: Refer to Table "A"
Refer to "Table A" attachment details herein)
r J w.0
FL M FL 5211.2-116
Date-, 7/1/15
Report No.:z5-z04-8ih~SM-[n
Page 3 of 8
CBVCK,hnc. Certificate ofAuthorization x8064 Performance
Standards: The product described herein has demonstrated compliance with: UL580-
G—Test for Uplift Resistance o/Roof Assemblies w
UL1D97'U4—Uplift testforroof covering systems Standards Equivalency:
The UL 580-94 standard version used to test the evaluated product assembly isequivalent to
UL580-06stendard version adopted by the Florida Building Code 5th Edition (
2014). The UL1897-98
standard version used totest the evaluated product assembly is equivalent to UL1897-
04standard version adopted by the Florida Building Code 5th Edition (2014).
Code Compliance: The product
described herein has demonstrated compliance with Florida Building Evaluation Report This product
evaluation is limited to compliance with the structural requirements of Scope: the Florida Building
Code, asrelated tothe scope section toFlorida Product Approval Ru|eG1G2O-3.0O1. Limitations and wScoi2e
of "Limitations and Conditions
of Use" for this evaluation: Cmmdidmmm of Use, This evaluation report for "
Optional Statewide Approval" contains technical documentation, specifications and installation method(s) which
include Limitations and Conditions ofUse" throughout the report
in accordance with Rule 61G20-3.005. Per Rule 61G20-
3.004' the Florida Building Commission is the authority tuapprove products under "Optional Statewide Approva|".
Option for application outside "Limitations and Conditions of
Use" Rule 61G20-3.005(1)(e) allows engineering
analysis for "project specific approval by the local authorities having jurisdiction in accordance
with the alternate methodsandn`ater|a|sauthodoedintheCude°.Anymodificadonnfthepnnduct as evaluated in
this report and approved by
the Florida Building Commission is outside the scope of this evaluation and will
be the responsibility of others. Design ofsupport system |uoutside the scope ofthis report.
Fire Classification is outside the scope of Rule 51G20-3, and
is therefore not included inthis evaluation. This evaluation report does not evaluate the use
of this product for
use in the High Velocity Hurricane Zone code section. (Dade &8rovvardCounties) This metal roof system was
tested to transmit the roof loads directly
to the building structural support deck. Quality Assurance: The manufacturer has demonstrated compliance of
roof panel products in
accordance with the Florida Building Code and Rule 61G20-3]}05 (3)for
manufacturing under quality assurance program audited by an approved quality assurance entity through Keystone
Certifications, Inc. (F8[Organization #: QUA1824).
C B U C K E",ii: n qjN I n erAear I n,(,,,l
FL #: FL 5211.2-116
Date: 7/1/15
Report No.: 15-104-Rib-SM-ER
Page 4 of 8
Sp*'aclaIN StTuchiral EnQ1neerinq CBUCK, Inc. Certificote of Authorization #8064
Components/Materials
by Manufacturer):
Roof Panel:
Material:
Thickness:
Panel Width:
Rib Height:
Yield Strength:
Corrosion Resistance
Fastener:
Type:
Size :
Corrosion Resistance
Standard:
Rib Panel
Steel
29 gauge (min.)
36" (max.) Coverage
3/4"
40 ksi min.
In compliance with FBC Section 1507.4,3:
ASTM A792 coated, or
ASTM A653 G90 galvanized steel
Hex -Head Wood Screw with WSW
10 x 1-1/2"
or min, length to penetrate deck, 3/16"
Per FBC Section 1506.6 and 1507.4.4
Per ANSI/ASME B18.6.4
Components/Materials Underlayment:
by Others): Material and application shall be in compliance with FBC Section 1507.4.5.1 and
1507.4.5.2, applicable codes and in accordance with manufacturer's
recommendations.
Insulation (Optional):
Type:
Thickness:
Properties:
Density:
Or Compressive Strength
Rigid Insulation Board
3" (max.)
2.25 pcf (lbs/ft') min.
20 psi min.
Insulation Notes:
Rigid Insulation shall meet minimum density OR compressive strength.
Insulation shall comply with FBC Section 1508. When insulation is
incorporated, fastener length shall conform to penetrate thru bottom of
support a minimum of 3/16".
Barrier (Optional):
Barrier Board: Approved Barrier, up to 1/2" thick
Date: 7/1/15
Page 5 of 8
Installation: Installation Method:
Refer todrawings on Pages 6-8ofthis report.) Fastener
spacing: Refer toTable °A°Below along the
length ofthe panel) Row Spacing: Refer
teTable °A" Below along the row, across
the panel profile) m Rib Interlock: Lapped
m Minimum fastener penetration
thru bottom of support, 3/26". For panel construction at
the end of panels, refer to manufacturer's instructions and any site specific
design. Referenced Data: TDe—ck--]—
Thickness TABLE "
A" ALLOWABLE
LOADS
Fastener RowF
Spacing Spacingi
Refer to
Drawings Design
Pressure PSF)
Allowable
design pressure
for
allowable stress design (ASD) with a margin of safety of 2 to
1. Install the "Millennium Rib"
roof panel assembly in compliance with the installation method listed in this
report and applicable code sections ofF8C 5th Edition (2014). The installation method described
herein is in accordance with the scope of this evaluation report. Refer tomnanufactuve/
sinstallation instructions asasupplemental guide for attachment. 1 UL5QO-
94&UL1Qg7-9DUplift
Test @yHurricane Test Laboratory, LLC(FB[Organization #
TSTID: 1S27) Report #:O23]'O321'03,Report Date: Q/%7/
O3,Specimens #I-2 Report #:O23J~O51D-D3,Report Date: 8/27/
O3,Specimen #2 2. UL58O-940'UL1897-98Uplift Test ByHurricane Test
Laboratory, LL[(FBCOrganization #TSTID: 1527) Report #:O2]
2-O911-OS,Report Date: 9/27/O4,Specimen #1
Engineering Analysis ByC8UCKEngineering 4. Quality Assurance ByKeystone Certifications, Inc. (QUA ID: lQ24)
Millennium Metals
Licensee #
4]3 5.
Equivalency ofTest Standard Certification 8yJames LBuckner, P.
E.@[8U[KEngineering F8[
Organization #ANE1916) 6. Certification ofIndependence 8yJames
L.Buckner, P.E.@C8U[KEngineering F8[Organization #ANE191G)
ks-%,m ff
ytkl (": . . .. . . . .
FL #: FL 5211.2-R6
Date: 7/1/15
Report No.: 15-104-Rib-S9W-ER
Page 6 of 8
aJcNtW !—:)tTLA=turo1 &nQ1rx--4Pr1nQ CBUCK, Inc. Certificate of Authorization #8064
Installation Method
Millennium Metals
Rib Panel" Roof Panel Attached to Wood Deck
91
Profile Drawings
361-
Typical Panel Profile View
J—
F
3/4"
TABLE "A"
ALLOWABLE LOADS
Deck Fastener Row Refer to Design Pressure
Thickness Spacing Spacingi Drawings PSF)
METHOD 1 15/32" 91, 24- A 47.5
METHOD 2 15/32" 9. 12" A 95
METHOD 3 15/32- 5",4",5",4",... Pattern 16" B 113.75
EMETHOD 4 19/32- 91, 16" A 71
METHOD 19/32" 5",4",5",4",-. Pattern 16" B 144.25
Allowable design pressure for allowable stress design (ASD) with a margin of
safety of 2 to 1.
L J1(*""* A
FL #: FL 5211.2-116
Date: 7/1/15
Report No.: 15-104-Rib-S9W-ER
Page 7 of 8
SPeK--1c,!wltw E2,tTL)ctx-wc31 EncairwaerinQ CBUCK, Inc, Certificate of Authorization #8064
Installation Method
Millennium Metals
Rib Panel" Roof Panel Attached to Wood Deck
91 1 go 1 9. 1 91
Fa§jqDqj Rgft
Across Panel VVKJth
10 Hex-Flead Screw with EPDM washer
3116!'min. penetration thru deck
Spaced To oc. across the panel
Detail A - Typical Assembly Profile View
9" o,c. Typical
Detail A - Typical Assembly Isometric View
FL ##: FL 5211,2-R6
Date: 7 / 1 / 15
Lr.-,--EB3,LUJCC.7K E neering
Report No.: 15-104-Rib-59W-Eft
Page 8 of 8
Eg3eclaM4i`. r 1 zn(;)I lnc CQUCK, inc. Certificate of Authorization t#8064
Installation Method
Millennium Metals
Rib Panel" Roof Panel Attached to Wood Deck
511 I 4 1 1 511 ' 4!# I See I 4" I 511
r
Acrossm` \AAdth
Hex -Head Screw with EPDM
penetration thru • •
Spaced
Detail B - Typical Assembly Profile View
Fastener:
61 4" 51. a., 5. 4.. 51.
Thickness per Tape A
Detail B - Typical Assembly Isometric View
City of Sanford
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT#: ADDRI_>SS:
AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, ENGINEER, ARCHITECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I FIERF"BY AFFIRM, T[ IA'r A1.1. OF THE
FOREGOING INFORMATION IS TRUE AND ACCURATE AND THAT ALL ROOFING COMPONENTS LISTED ON THE SCOPE OF WORK ATTHE
ABOVE REFERENCED ADDRESS HAVE BEEN INSTALLED IN ACCORDANCE WITHTI IEIR PRODUCT' APPROVALS AND ALL APPLICABLE CODE.
REQUIREMENTSNTS — SPECIFICALLY FLORIDA BUILDING CODE, Ex ISTING BUILDING. JANG. IN ADDITION I CERTIFY THE INSTALLATION MEETS A[,(,
REQUIREMENTS FOR SECONDARY WATER BARRIER AND NAILING OF 41IF-1 ROOF' DECK, IN ACCORDANCE wri-it'l-BE HURRICANE RETROFIT
MANtJAI,Rl-,-,QtJIRF-,Ml,'N-1"',(BASED ONF,S.CHAPTER 553.844).
LICENSE#:
COMPANY / CONTRACT
CONTRACTOR SIGNATU
MUSTBI, SIGNED BY LI
OR:
R'., % DATE:
CE.NSE Flo, -,'R R Ow E J LDE
A FINAL ROOF INSPEC"FION IS REQUIRED:
THIS SIGNED AND NOTARIZED AFFIDAVIT MUST' BE PROVIDED AT TIDE JOB SITE AT THE TIME OF THE FINAL ROOF INSPECTION,
ALONG WITH DIGrI'A1, PHO'FOGRAPHS OF EACH PLANE OF THE ROOF SHOWING IN DETAIL ALL COMPONENTS (DECKING,
UNDERLAYMEN't', FLASHING, DRIP EDGE Al'I'ACHMENT) WITH'I'HE PERMIT NUMBER OR ADDRESS CLEARLY MARKED ON THE DECK
FOR EACH INSPECTION. THE Ptio'roGRAPIISMUST INCLUDE A RULER OR MEASURING DFVICP,'t'O(,,'ONFIRM ALL NAIL SPACING AND OVERLAPS,
INCLUDING DRIP EDGE AND VALLEY FLASHING. PLEASE REFER ,roTHE RF-ROOF POtAcV AND INSPE(-FION PR(K,'.El)tjRv, 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 14 /- C k_
SworntoandSubscribedbeforemethisC21C) day of 20 1 by: 50U0'
10 '_. Who i Personally Known to me or has 0 Produced (type of isPersonallyas
identification. Signature
of Notary Public State
of Florida i
Print/
Type/Stamp Name of
Notary Public da
P.b"- =-te r"
I NotaryPublicStateofBobbi
Butler My
commission FF 044726 nor
Expires 081121017