1510 Mellonville Ave; 17-2692; ROOFCITY OF SANFORD
SEP 0 BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: I 'i - QLD 9
Documented Construction Value: $ 8,590.00
Job Address: 1510 S. Mellonville Ave, Sanford, FL. 32771 Historic District: Yes No
Parcel ID: 31-19-31-505-0000-0340 Residential Commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of Work: Roof Replacement - IKO Cambridge Asphalt Shingles - 31 Squares
Plan Review Contact Person: Brian Kuehner Title: R/R Manager
Phone: 321-441-2300 Fax: Email:
Property Owner Information
Name Katina Badger Phone: 407-314-8687
Street: 1510 S. Mellonville Ave. Resident of property? : yes
City, State Zip: Sanford, FL. 32771
Contractor Information
Name Collis Roofing, Inc. Phone: 321-441-2300
Street: P.O. Box 520668 Fax: 321-441-2313
City, State Zip: Longwood, FL. 32752 State License No.: CCC058022
Architect/Engineer Information
Name: n./a Phone:
Street: Fax:
City, St, Zip: E-mail:
Bonding Company:
Address:
n./a Mortgage Lender:
Address:
n./a
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: 5`h Edition (2014) Florida Building Code
Revised: June 30, 2015 Permit Application
ermit Number: _
Parcel' ID.Number:'
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida StatufollowinginformationisprovidedinthisNoticeofCommencement.
DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available)
I. GENERAL DESCRIPTION OF IMPROVEMENT:
3.
OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT: Name and address:
Interest in property:
Fee Simple Title Holder (if other than owner listed above) Name: Address:
4. CONTRACTOR: Name:
Address: Phone Number:
5.
SURETY (If applicable, a copy of the payment bond is attached): )Name:
6. LENDER: Name:
Address _ Phone Number:
7_
Amount of Bond:
OtdEe or t-lorida Designated by Owner upon whom notice or other documents may be served as provided b713.13(1)(a)7., Florida Statutes.
Vame: y Sect
Aodress: Phone Number.
8. In addition, Owner designates
otoreceiveacopyoftheLienOr's Notice as provided in Section 713.13(1)(b), Florida StatutesfPhone number: 9.
Expiration Date of Notice of Commencement (The expiration is 1 year from date of recording unless a different dat e is specified) !_
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NCONSIDEREDIMPROPERPAYMENTSUNDERCHAPTER713, PART I, SECTION 713.13, FLORIDA STATUTES, PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE
NOTICE OF COMMEN
TEED
JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUAND CAN RESULT INBEFORECOMMENCINGWORKORRECORDINGYOURNOTICEOFCOMMENCEMENT. RECORDED AND POSTED Q
YOUR LENDER OR AN ATTC
mature of Owner or Lessee, or
Authorized OffirarmGn,+,.,0.,.
hate of
o Laus
r
gQ[(
Print Name and Provide 1
natory's Title/Office)
he foregoing instrument was acknol
y * _: DRIVER LICENSE CLASS E
Name of Person r B326-514-72-680-0
ho has produced identification Elty
KATINA NOCOLE
t3ADGfR
1510 S MELLOWALLE AVE
SANFORD. FL 32771-2979
DOB 05-20-1972
a4, 6SUE13: t1A itEST:
A EN
ORSEGG"
DONORODwauon
M a motor vmWx* coram tes ewnsem to any sob—ty test r-pusd by isn. v
airy a
i eakaarYkang ra
n known
tome OR
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.
OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will
be done in compliance with all applicable laws regulating construction and zoning.
Signature of Owner/Agent Date
l N 11rm k)
Print Owner/Agent's Name `
Signature f =
TAM `
swe a Ftd" o Pav PUA Nalts<y Pub - o
i Commission # FF 937709
s.+ o;? : My Comm. Expires
gWW through NffilonaMar
16, 2020 l
Notary Assn. Owner/
Agentft- er onally nown to Me or Produced
ID Type of ID f? L a--
Q6sIq V 6
on, 4/" - -/1) Signature
01 Contract /Agent Date 3
c ( 30 /u / a Print
Contractor/Age 's ame Signature
f of t r WENDY
STARS le `
2O"PY
PU°fin :
Notary Public - State of Florida Commission #
FF 937709 4
My omm. Expires Mar 16, 2020 P„`
O`' hrough National Notary Assn. Cnntra
Me or Produced
ID Type of ID 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: New
Construction: Electric - # of Amps Flood
Zone: of
Stories: 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
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 8/21 /2017
I hereby name and appoint: Ray Henderson
an agent of: Collis Roofing, Inc.
Name of Company)
to be my lawful attorney -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):
t] The specific permit and application for work located at:
1510 S. Mellonville Ave, Sanford, FL. 32771
Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name: J. Douglas Lanier
State License Number: CCC058022
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF Seminole
The foregoing instrument was acknowledged before me this 21 day of August ,
200-
1-7_, by J. Douglas Lanier who is i personally known
to me or who has produced as
identification and who did (did not) take an oath.
Signature
Notary Seal)
Print or type name
Notary Public - State of df
Commission No.
My Commission Expires.
Rev. 08.12)
THIS INSTRUMENT PREPARED BY: Roofing
Name: St,-ohan 'e P.0. Brix 51GFi
Address:, 19t-F-
NOTICE OF COMMENCEMENT
W e &P Mori da Co u 114y O-F %
Permit Number. ^
t --^^
x( Parcel ID Number: 3 -` 1 =
i-E: (. OF-':•1::i:1
i'6 FIEFSff._j1l
EC
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 PROPER : (Legal des do of the property and t et address if available)
on `S CC rg 13 IF Cz 7 r
2. GENERAL DESCRIPTION OFJMPROVEMENT:
3. OWNER INFORMATION
Name and address:_I
Interest in property: 1,.:
Fee Simple Title Holder (if other than owner listed above) Name:
Address:
4. CONTRACTOR: Name: t1. 1.J:i '.i'rri;'i Phone Number:
Address: i`)tC'C* F!_
5. SURETY (If applicable, a, copy f the payment bond is attached): Name:
AAA—.j //.n . Amount of Bond:
6. LENDER:
Address:
Phone Number.
7. Persons 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.
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.
08F
Signature of owner or Lessee, or Ovbers or Lessee's (Print Name and Provide Ugnatoys Title/Office)
Authorized Offioer/Director/Partner/Manager)
State of —EI DI-1 4 County of S Cog rt kid
The foregoing instrument was acknowledged before me this day of
by . `(+ 1 (.1 A), &I Who is personally known to me OR
Name of person maldrigMinfernent `Cy
who has produced identificatiory a of identification produced: r- I :P, 34,, —ia-
WEHO`1 SjAI TS
C
4
t
aJ'P, State of ftorldae NOtilth public
Commission FF 967109
ys•
Ct> Egwes mar,• pSSn•
tigibry SignatuUP
R
9/6/2017 ' SCPA Parcel View: 31-19-31-505-0000-0340
Propertx Record Card
CaAd
rAS• •
on Parcel: 31-19-31-505-0000-0340
AWR Owner: BADGER, KATINA N
se svcoi
Property Address: 1510 S MELLONVILLE AVE SANFORD, FL 32771-2979
Parcel Information -- -- --- Value Summary - -
Parcel 31-19-31-505-0000-0340
Owner BADGER, KATINA N
Property Address 1510 S MELLONVILLE AVE SANFORD, FL 32771-2979
Mailing 1510 S MELLONVILLE AVE SANFORD, FL 32771-2979
Subdivision Name SAN LANTA 3RD SEC
Tax District S1-SANFORD
DOR Use Code 01-SINGLE FAMILY
Exemptions 00-HOMESTEAD(1998)
Legal Description
LOT 34 -
SAN LANTA 3RD SEC
PB 13 PG 75
Taxes
2017 Working 2016 Certified
Values Values
Valuation Method j Cost/Market Cost/Market
1
85,241
Number of Buildings 1
Depreciated Bldg Value 92,256
Depreciated EXFT Value 388
15,000 -
400
13,500 - Land Value (Market) -
Land Value Ag
Just/Market Value - 107,644 99,141
Portability Adj---
Save Our Homes Adj 18,039 - 11,379 '
Amendment 1 Adj
T
P&G Adj -- 0 0
Assessed Value 89,605 87,762
Tax Amount without SOH: $1,173.00
2016 Tax Bill Amount $945.00
Tax Estimator
Save Our Homes Savings: $228.00
TRIM Notice Help
Does NOT INCLUDE Non Ad Valorem Assessments
Taxing Authority Assessment Value Exempi Values Taxable Value
County General Fund
Schools
89,605 50,000 ( $39,605
89,605 25,000 $64,605
City Sanford -- - -- 89,605
89,605
89,605
50,000 39,605
SJWM(Saint Johns Water Management) 50,000 39,605
County Bonds 50,000 I $39,605
Sales
Description Date Book Page Amount Qualified Vac/Imp
WARRANTY DEED
WARRANTY DEED -
9/1/1997
5/1/1984
03298
j 91554
1144
0504 - -
59,000
35,000
Yes
Yes
Improved
Improved
Find Comparable Sales
Land
Method Frontage Depth Units Units Price Land Value
LOT I 0.00 0.00 1 I $15,000.00 15,000
Building Information
is Ceatbain count Incorrect! LACK here.
Description
Year Built
Fixtures Bed Bath Base Area Total SF Living SF Ext Wall Adj Value Repl Value Appendages
Actual/Effective
1 SINGLE 1970 8 4 1 2.5 950 2,592 2,350 CB/STUCCO i $92,256 126,378 Description Area
FAMILY FINISH
http://parceldetail.scpafl.org/ParcelDetailInfo.aspx?PiD=31193150500000340 1/2
9/6/2017 SCPA Parcel View: 31-19-31-505-0000-0340
i i I BASE SEMI I 200.00
FINISHED
E i OPEN—
i r
I ; PORCH i 152.00
FINISHED
UTILITY —
I FINISHED !
90.00
i
BASE SEMI — -
FINISHED
1200.00
Permits
atures
Description Year Built Units Value New Cost
PATIO 1 5/1/2008 1 $388 $500
http://parceldetai1.scpafl.org/ParcelDetailInfo.aspx?PID=31193150500000340 2/2
PERMIT # _ 7 2
City of Sanford Building Division
Residential Re -Roof Scope of Work
dOBADDRESS: 1510 S. Mellonville Ave, Sanford, FL, 32771
STRUCTURE TYPE: (9) SINGLE FAMILY RESIDENCE/TOWNHOUSE p MOBILE HOME Q APARTMENT/CONDOMINIUM
RE -ROOF TYPE:. (2) 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: Oft YI00 SQUARE FEET OF THE EXISTINGDECKIS PERMITTED TO BE REPLACED**
ROOF VENTILATION: Q OFF -RIDGE (S) RIDGE OSOFFIT QPOWERED VENT QTURBINES
SKYLIGHTS: OYES ONO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
Poor. SLOPE: Q LESS THAN 2.12 Q 2:12-4:12 0 4:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
SHINGLE IKO Cambridge FL# FL7006-R9
O METAL FL#
Q MODIFIED BITUMEN FL#
Q TORCH DOWN FL#
QINSULATED FL#
Q TILE FL#
OTHER: Underlayment Interwrap Rhino U20 FL# FL15216-R2
ROOF EXTENSIONS (PORCHES,_PATIOS, ETC) **jFAPPLIGIBLE**
RbOF SLOPE: Q LESS THAN 2:12 Q 2:12-4:12 O 4:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
0 SHINGLE FL#
Q METAL FL#
Q MODIFIED BITUMEN FL#
Q TORCH DOWN FL#
QINSULATED FL#
QTILE FL-9
Q OTHER: FL#
gyp. City of Sanford
Building and Fire Prevention
RESIDENTIAL RF, -R000F INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -INS FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT#: ADDRESS: 1510 S. Mellonville Ave, Sanford, FL. 32771
I J. Douglas Lanier ASA(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#. CCC058022
COMPANY/CONTRACTOR: Collis Roofing, Inc. / J. Douglas Lanier
CONTRACTOR SIGNATURE: DATE:
MUST BE SIGNED BY LICENSE HOLDER OR OWNER/BUILDER)
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 ROOT 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 REANSPECTION 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 Seminole
Sworn to and Subscribed before me this day of 20 17 by:
J. Douglas Lanier . Who is !X Personally Known to me or has D Produced (type of
identification) as identification.
Signature of Notary Public
State of Florida r
PrintrJ:ype/Stamp Name
of.Notary Public
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)
a 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
SKYLIG14TS (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.
0a,,`40 t;-
o
CONTRACTOR (OR OWNERIBUILDER) SIGNATURE: U DATE: 8/21 /2017
City of Sanford
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: 17-2692 ADDRESS: 1510 S. Mellonville Ave Sanford F1
I J. Douglas Lanier , 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 #: CCC058022
COMPANY/CONTRACTOR: Collis Roofing, Inc. / J. Douglas Lanier
CONTRACTOR SIGNATURE: !L ® DATE:
MUST BE SIGNED BY LICENSE HOLDER OR O R/BUIL R)
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 Seminole
Sworn to and Subscribed before me this <5 day of _ 20 117 by:
J. Douglas Lanier Who is Q Personally Known to me or has Produced (type of
identification) as identification.
Signature of Notary Public
TRISSA S KELLYStateofFlorida
MY COMMISSION # GG135698
Trissa Kelly =%;, ,,= EXPIRES August 17, 2021
Print/Type/Stamp Name
of Notary Public