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128 Magnolia Prk Trl; 17-2980; ROOFCITY OF SANFORD BUILDING & FIRE PREVENTION PERMT APPLICATION 428909 / Application No: Documented Construction Value: $ 13,500 Job Address: 128 Magnolia Paris Trail Sanford FL 32773 Historic District: Yes No E1 Parcel ID: 18-20-31-507!.0000-1630 Residential x Commercial Type of Work New Addition Alteration Repair Demo Change of Use[] Move Description of Work: reroof Owens Coming FL 10674-R12 Techwrap FL17194-Rl 35 squares 7112 pitch Oakridge Driftwooc lifetime warranty Plan Review Contact Person: Rachel Holcomb Tittle: admin manager Phone: 407-278-7788 Fax: 800-337-3361 Email: pennft@jasperinecom Property Owner Information Name Joint Powell and. Katherine Powell Phone: Sit: 128 Magnolia Paris Trail Resident of property? ; yes City, State Zip: Sanford, FL 32773 Contractor Information Name Jasper Contractors Phone: 407 278-7788 Street; 3203 S Conway Rd Fax: 800-337-3361 City, State Zaip: Orlando, FL32812 State License No.: _ccmmiim ArchitectfEngineer Information Name: Phone: Street Fax: city, St, Zip: E-mail: Bonding Company: Address: 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 lWf*FND 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 woric or insta Ration has commenced prior to the issuance of a pmmit and that all work will be performed to meet standards of all laws regulati ng construction in this jurisdiction. I understand that a separate permit must be secured for electrical work, plumbing, signs, welts, pools, farmaces, boners, heaters, tanks, and air conditioners, eta FBC 1053 Shall be inscribed with the date of application and the code is effect as of that date: 51h Edition (M4) Fbrida Building Code Revised: June 30, 2015 Permit Applicatim 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 ofpermit 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 submidaL 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 win be done in compliance with all applicable laws regulating construction and zoning, Signatuie0f0%=dA&MA Date PuntOvmedAgenesNam: Signature oMomy-Stan of Flm ida Date Owner/Agent is Personally Known to Me or Produced ID Type of ID le or BELOW IS FOR OFFICE USE ONLY Permits Required: Building Electrical[] Mechanical[] Plumbing[] Gas[] Roof Construction Type: Occupancy Use: Flood Zone: _ Now Construction: Electric - # of Amps Fire Sprinkler Permit: Yes No [] # of Heads APPROVALS: ZONING: ENGINEERING: COADdENTS: UTILITIES: FIRE: Plumbing - # of Fixtures Fire Alarm Permit: Yes No WASTE WATER: BUILDING: Revised: June 3% 2015 Petmit.Appliwtian 10/9/2017 SCPA Parcel View:18-20-31-507-0000-1630 Property Record Card 0 djD . CIA Parcel: 18-20-31-507-0000 1630 Owner: POWELL JOHN & KATHERINE Rs6*1-8 tMwovca°uvrxfeonleWXn. Property Address: 128 MAGNOLIA PARK TRL SANFORD, FL 32773 Parcel Information Value Summary Parcel 18-20-31-507-0000-1630 Owner POWELL JOHN & KATHERINE R Property Address 128 MAGNOLIA PARK TRL SANFORD, FL 32773 Mailing 128 MAGNOLIA PARK TRL SANFORD, FL 32773 Subdivision Name MAGNOLIA PARK Tax District S1-SANFORD DOR Use Code 01-SINGLE FAMILY Exemptions 00-HOMESTEAD(2009) Legal Description LOT 163 MAGNOLIA PARK PB63PGS54-59 Taxes 2017 Working Values 2016 Certified Values Valuation Method- ^_ Cost/Market I Cow arket Number of Buildings 1 1 Depreciated Bldg Value 145,871 139,673 Depreciated EXFT Value Land Value (Market) 39,000 39,000 Land Value Ag . Just/Market Value 184,871 178,673 Portability Adj Save Our Homes Adj 81,036 1 $76,974 Amendment 1 Adj P&G Adj so 0 Assessed Value j $103,835 101,699 Tax Amount without SOH: $2,768.00 2016 Tax Bill Amount $1,225.00 Tax Estimator Save Our Homes Savings: $1,543.00 TRIM Notice Help Does NOT INCLUDE Non Ad Valorem Assessments Taxing Authority Assessment Value Exempt Values Taxable Vatue County General Fund 103,835 50,000 53,835 Schools 103,835 25,000 1 $78,835 City Sanford — 103,835 50,000 53,835 SJWM(Saint Johns Water Management) 103,835 50,000 53,835 CountyBonds 103,835 50,000 53,835 Sales Description Date Book Page Amount Qualified Vactimp WARRANTY DEED 9/1/2008 v- 07075 0066 205,000 Yes Improved WARRANTY DEED 8/112006 06412 0196 282,000 Yes Improved WARRANTY DEED 4/1/2006 06198 ' 0393 882,000 1 No Vacant Find Comparable Sales Land Method Frontage Depth Units Units Price and Value - LOT I ! 1 $39,000.00 39,000 Building Information 11# Description Year Built Fixtures Bed Bath Base Area Total SF Living SF i ExtWall Adj Value Repl Value Appendages IActual/Effectivee III I I http://paroeldetaii.scpafl.org/PareelDetailinfo.aspx?PID=i 8203150700001630 1/2 53801t.Colonial Ur. f 6Orlando, FL, -340 3203 Conway Rd, Ste. 201 pda_i 10, F 32812 407A78-7788 800).337.33til Fax infci0ir[ rinaore 1 D c.r •l`-y _ J AS 1 R Contractor CC'C1 i29651 & l.---------- gyp- ROOF REPLACEMENT GUNTRACT s 1 Phaise - fir+ Address: C€ty: Stale: Zip Code: fiingie Sir Roof RC V Amount/ Contract Pti=. Drip Ed a.0 -1 w € y o= 13,500 7. try. If O nejPs; insLt ance Comma, does not 11=e to mnY for a run rOnf Rnacement r rs corer -ace Assignment of Insurance Benefits for the Poll Roof Replacement Only: 'I hereby assign any and ail trtacaance rtghb, benefits and proceeds tmstrr' any applicable insurance policies to ],riper Contractors, Inc. (" Jospev'), the scoff of which shank limited too Ft11t Roofwit; € make this assignitietii and authorization in consideration of Jasper's agreement to perform services, supply materials and otherwise perform its obligations .ed1 ;. r t. tots t ootrict, . including not requiring fbl€ Mayen at the time of service. I also hereby diced my insurer(s) to release any and all inforargtiom raq bY lamer* or res rcVesentative(s for the direct purpose of obtaining actual benefits to be paid by my insurr`s) for services reawovdcroa tok d I wad- my privacy rights. If paymtnt is made directly to the Oweer/Agenvbtsured(s), it shall be endorsed over io Jasper immediately upon re-ImL. I s¢a tbat any portico of work, deductibles, bctteirstettt or additional work requested by the undersigned, not covered. by €nstaarrtx mast he paid fiiC tba ed on the day of cite deduuctlb-le, installation. Deductible- It is the Qwner's responsibility to nay all insurance deductibles Orvtter's out-of-pocitet tupeuse;a not tFaCd nmotmt, as stated on insurer's loss sheet (the "Loss Sheet'), UNLESS replacemen*epair of deteriorated deking is required bIr cstde a 0* O0"cr rcquelsts optional « pgrades Jasper CANNOT pay, waive, rebate, or promise to pay, waive or rebate any or all of the rasorspet dedoarble applirabic ur the t of in the event of a discrepancy, the deductible amount: stated on cite 6tsuraes Lots>>46test overrule dedactsblc`. insurance claim for payment tinttial) < amount disclose& Deductible: S OU raUST BE PAID IN FIJI1. 'LIM APPLJCABU SAi.ES TAJ( MORTGAGE AUTHORUATION: 1, Owner/Mortgagor, grant authorization for Co is speak Jasper on matters including but not limited to, the claim and draw status. (inldpl) PAYIGIEI `I` u LQ xsgtctpay Jasper based on the following schedule. (i) Deposit in the amount of $ Zb C.r due upon aping ' less the Deposit and any applicable depreciation retained by Owner's instuer(s), plus upgrade costs due work being performed; and, (iii) the remaining Contract Price (equal to any applicable depreciation and/or completionofworkperformed. In the event of a pending inspection, no more iban 2%.of Contract PMt. tray; a Optional: UPGRADE Ti! M' QT, Y: - PRICE; Replacement Work and Price: Upon insurer's approval and subject to tbz Terms and Condthoris berettf, Ias ser provide the.labor necessary to perform the full roof replacement which sbalt take place 7fbiltiwut$ Ovruer s msmtmte i y §{ , € within $ 0 days, conditions permitting. Owner's Declaration of Intent; t admtnvlei sand agrees th t, gr4n : ry l ftili cooeplttcemwtt; laspts shall perform the roof re phicementupon receipt of funds enaz Owrt3 msu?c5 FLORIDA ROMEOW-MRS' CONS.i7C PAYMENT, UP TO A LIMITED AMOUNT, MAY BE AVAYLA$T.` : T CONSTRI( 1CTIO RECOVERY FUNDIF YOU LOSE MONEY ON R WHERE THB. L0Ss.RE_6ULTS FROM.SPECOM VIOLATION 5 0 W FOR:II iirORMA'I?ON ABOUT THE RECOVERY FUND AAk II l€!L C©NSTRUCTiOItI D TDUSTR3l LiCENSIN.G BOARD AT TI3J,$,.0_ i'XN 3 Constrtictsoin industry IacenAng-Board: 260111 r alis ei C^ AiLLT70N: If O'avuw ls to terminate the serves of atttract is executed. Oliviti i I.* 1 reoelr8 a fnl4 Rde thii' (tut: lt#iess day after the `contract is ei ea.. be la iiett% d, Ij whole or in part Ali written a co ¢il3ce 160' oberts 6omleatd, S, '. tight etn1'k1,. Q ti fee r t A•: at ittlr Scanned by CamScanner THIS INSTRUMENT PREPARED BY: Name: Jasper Contractors Address: 5380 E f'ninnial Drive uti 1 NOTICE OF COMMENCEMENT Permit Number. Parcel ID Number. 10 f1i'iAN HALO i SEMINOLE +- um I CLERK OF CIRCUIT COURT tic COMPTROULER CLERK'S 4 2017101357 RECORDED 10/10/2017 il,_t :I.IS (M'i RECORDING FEES SIA,00 RECORDED 1;Y tsmiiil 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 descriptio of the ro erly, nd st et address if available) I o7' lF_gn 1 iA i ct 3 55 " q 2. GENERAL. DESCRIPTION OF IMPROVEMENT: 3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEM T: Name and address: T0 tA}e'Sohn 'i u i f K e ( J Interest in property: Owner Fee Simple Title Holder (f other than owner listed above) 4. CONTRACTOR: Name: Jasper Contractors Phone Number Address: _ 5380 E Colonial Drive Orlando, FL 32807 5. SURETY (If applicable, a copy of the payment bond is attached): 6. LENDER: Name: Phone Number Address: 407-278-7788 Amount of Bond: 7. Persons within the State of Florida Designated by Owner upon whom notice or other documents maybe served as 713.13(1)(a)7., Florida Statutes. Phone Number. S. In addition, Owner designates 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 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. Signature of Omer or Lessee, or Owners or Lessee's Authorized 06cedDirectorrPartnedManageF) J o + ex 3 `I c v.s , fj Print Name and Provide Signatoys TiUdOfGoe) State of \O Y \ V 1` County of The foregoing instru nme was acknowledged before me this day ofa)C AA& r 20 by r ` Name ofng 5rater,nr eo^ Who is personally known tome OR who has produced identiffcationl ype of identification produced: MARSHALL My ADAM749 pssionE0CommissionMF8sig4hiCommi M- O.y 01, 2 428909 LUMTED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: 10.9.2017 I hereby name and appoint: Karla Almodovar, Skylar Amkraut, Ana Chavez, Gina McDonald & Rachel Holcomb an agent of: Jasper Contractor to be my lawful attomey-in-fact to act for me to apply for, receipt for, sign for and do all things necessary to this appointment for (check only one option): XThe specific permit and application for work located at: 128 Magnolia Park Trail Sanford, FL 32773 Street Address) Expiration Date for This Limited Power of Attorney: 01-01-2019 License Holder Name: Donald Bouchard State License Number. CCC1331153 Signature of License Holder_ STATE OF FLORIDA COUNTY OF sen e The foregoing instrument was acknowledged before me this 9 day of october 209 17 , by Donaid Bouchard who is o personally known to me or ® who has produced ot_ as identification and who did (did not) take an oath. Signature Notary Seal) kylar Atnlffaut SKYAR B AMI<RAUT t Commission N FF 123890 j c My Commission Expires OF June 01, 2018 13 L:nT). reRx J iA Lau ll yastv JVi Rev. 08.12) Print or type name Notary Public - State of FL Commission No. 127890 My Commission Expires: 6/1/2018 I;rnnnecl by CamSc:anner CITY OF SkNFORD Building & Fire Prevention Division FIRE DEPARTMENT Re -Roof Permit Card PERMIT NO. d 9 ISSUE DATE: /0,/0,/7 CONTRACTOR: jawe'e JOB ADDRESS: / mqne —re,P4 f TYPE OF WORK: 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: Dial 407.792.6069 or 855.541.2112 Provide the items requested during the message The type of inspection requested must be scheduled under the appropriate permit type Follow the prompts 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 ter: 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), ce 'ng FBC de connpl' by personal inspection. t CONTRACTOR (OR OWNERBuiLDER) SIGNATURE: DATE: 't y 3 PERMIT # City of Sanford Building Division Residential Re -Roof Scope of Work JOB ADDRESS: 128 Magnolia Park Trail Sanford FL 32773 STRUCTURE TYPE: © SINGLE FAMILY RESIDENCE/TOWNHOUSE Q MOBILE HOME O APARTMENT/CONDOMINIUM RE -ROOF TYPE: D REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS) O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF) DECK TYPE (PLEASE SPECIFY): PLEASE NOTE: ONLY 100 SQUARE FEET OFTBEEXIS77NG DECKISPERMITTED TO BEREPLACED ** ROOF VENTILATION: p OFF -RIDGE p RIDGE Q SOFFIT QPOWERED VENT oTuRBINES SKYLIGHTS: O YES O NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #: MAIN ROOF AREA ROOF SLOPE: 0 LESS THAN 2:12 Q 2:12 —4:12 0 4:12 OR GREATER TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL Q SHINGLE Owens Coming FL# 10674 O METAL FL# Q MODIFIED BITUMEN FL# OTORCH DOWN FL# 0INSULATED FL# QTILE FL# O OTHER: FL# ROOF EXTENSIONS (PORCHES. PATIOS, ETC.) **IFAPPLICABLE** ROOF SLOPE: p LESS THAN 2:12 0 2:12 — 4:12 Q 4:12 OR GREATER TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL O SHINGLE FL# Q METAL FL# O MODIFIED BITUMEN FL# Q TORCH DOWN FL# QINSULATED FL# 0 TILE FL# 0 OTHER: FL# 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 . . . . . 17-00002980 Date 10/10/17 Property Address . . . . . . 128 MAGNOLIA PARK TRL Parcel Number . . . . . . . . 18.20.31.507-0000-1630 Application description . . . ROOFING APPLICATION Subdivision Name . . . . . . Property Zoning . . . . . . . PUD Permit . . . . . . RESIDENTIAL ROOFING PERMIT Additional desc . . Phone Access Code 1006253 Permit pin number 1006253 Required Inspections Phone Insp Seq Insp# Code Description Initials Date 1000 111 BL03 FINAL ROOF _/_/_ LIMITED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: \Li 'I I ,hereby name and appoint: Scott Meixsell, James Allen, Michael Watts, Jacob Horst, Ricardo Prito, Paul Padgett an agent Of Jasw conlractors 2came orc-p-Y) to be my lawfiM attomey-in-fact to act for me to apply for, receipt for, sign for and do all things necessary to this appointment for (checkonlyone option): D The specific, permit and Suw Address) Expiration Date for This Limited Power of Attorney: ` \ License Holder Name: r\ DO(_\C' \ 6 )00Ck&C _ C State License Number. ecc1331153 Signature of License Holder. STATE OF FLORIDA C COUNTY OF The foregoing instrument was acknowledged before me this day of M© 2txi; by o«,a 11who is o personally known to me or all who has produced a identification and who did(didnote take an oath- Notary Seal) ANA CHAVEZ State of Florida -Notary Public Commission # GG 112152 My Commission Expires June 06, 2021 Rev. 08.12) e_ - or type name Notary Public - State of Commission No. (l n 1 a My Commission Expires: M. Scanned by CamScanner City of Sanford Building and Fire Prevention RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS PERMIT #: J' / // . 1_4 I ( / , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR ROANG CONTRACTOR, NGINE CHITECT, 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(— \ J> \ l COMPANY / CONTRACTOR: ` C C9 p } `(J CONTRACTOR SIGNAT DATE: MUST BE SIGNED BY LICENSE R OR O UILDER) ADDRESS: 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 VY\ \ \ 01 t Sworn to and Subscribed before me this \—I day of NCO\% 20 \1 by: Who is Personally Known to me or haslelProduced (type of 8'entification) L— as identification. Signature of Notary Public tateofF1 'd o;YPJB% SF NA C H AV E Z a ,.State 6i rl`oricla-Notary Public Commission # GG 112152CkMyCommissionExpires Print/Type/Stamp Name June 06, 2021 of Notary Public