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362 Placid Lake Dr; 17-3205; ROOFCITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: 1 17 Documented Construction Value: $ 9,100 Job Address: 362 PLACID LAKE DR SANFORD, FL 32773 Historic District: Yes No Parcel ID: 02-20-30-520-0000-0370 Residential 0 Commercial Type of Work: New Addition AlterationEl Repair Demo Change of Use Move Description of Work: re -roof Owens Coming FL10674-R12 Techwrap FL17194-RI 20 SQ'S 7/12 PITCH SUPREME DRIFTWOOD 25 YEAR WARRANTY Plan Review Contact Person: SKYLAR AMKRAUT Title: ADMIN Phone: 407-278-7788 Fax: 800-337-3361 Email: PERMIT@JASPERINC.COM Property Owner Information Name GLEN COFFIELD Phone: Street: 362 PLACID LAKE DR City, State Zip: Name SANFORD, FL 32773 Resident of property? : Contractor Information JASPER CONTRACTORS -DON BOUCHARD Phone: 407-278-7788 Street: 3203 S CONWAY RD STE 201 City, State Zip: ORLANDO FL 32812 Name: Street: City, St, Zip: Bonding Company: Address: Fax: 800-337-3361 YES State License No.: CCC1331153 Architect/ Engineer Information Phone: Fax: E- mail: Mortgage Lender: Address: WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet standards of all laws regulating constriction 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 10.5.3 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 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 pen -nits 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 payinent 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 pennit 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. 1,()J lX 5-- JCJ 'L W.W. 71 Signature of Owner/Agent Date Signature of Contractor/Agent / Date V L A,v Y Print Owner/Agent's Name Print Co tractor/ •gbnt's Name 10.A8J 0 17 1 Signature of Notary -State of Florida Date Signature of Not -State of Florida Date 5(YLAR B AMKRAUT Commission N FF 127©90 y1F.iz,1; My Commission Expires Owner/Agent is Personally Known to Me or Contraeto , , I a Me or Produced ID Type of ID Produced T" Type of D BELOW IS FOR 'OFFICE USE ONLY Permits Required: Building Electrical Mechanical Plumbing[] Gas Roof Construction Type: Occupancy Use: Flood Zone: Total Sq Ft of Bldg: Min. Occupancy Load: New Construction: Electric - # of Amps Fire Sprinkler Permit: Yes No APPROVALS: ZONING: ENGINEERING: COMMENTS: of Heads UTILITIES: FIRE: of Stories: Plumbing - # of Fixtures Fire Alarm Permit: Yes No WASTE WATER: BUILDING: Reviaerl• hme 10. 7015 Permit Application 5380 E. Colonial Dr. Orlando, FL 32807 3203 Conway Rd., Ste. 201 Orlando, FL 32812 407) 278-7788 800) 337-3361 Fax infoCjasperinc.ort Ei ma iA S P R JesperRool.com FL Contractor's License: CCC1329651 & CCC1331153 ROOF REPLACEMENT CONTRACT Account Manager: RG L Contact #: L0 j 01- Insurance CoN Company: Fe"w'! Policy #: Ff) Qf)n no 3 933 <-- D Claim#: DG - 65/ ?,2 2 B0 S7 Mortgage Company Information Company: Loan Number: Owner(s): c6e ( Phone: yob- J Address: Alt Phone: City: State: Zip Code: ShingleAC aft, RI%><o Email: ina S mow Roof RCV Amount/ Contract rice: 9,100 Drip Edge Cppto Wh k G If OKrner's Insuraneg G6mpanvccdoes not agree to nav for a full roof replacement, this contract snau be, Assignment of Insurance Benefits for the Full Roof Replacement Only: I hereby assign any and all insurance rights, benefits and proceeds under any applicable insurance policies to Jasper Contractors, Inc. ("Jasper"), the scope of which shall be limited to a Full Roof Replacement. I make this assignment and authorization in consideration of Jasper's agreement to perform services, supply materials and otherwise perform its obligations under this Contract, including not requiring full payment at the time of service. I also hereby direct my insurer(s) to release any and all information requested by Jasper, or its representative(s), for the direct purpose of obtaining actual benefits to be paid by my insurer(s) for services rendered In this regard, I waive my privacy rights. If payment is made directly to the Owner/AgentMsured(s), it shall be endorsed over to Jasper immediately upon receipt. I agree that any portion of work, deductibles, betterment or additional work requested by the undersigned, not covered by insurance, must be paid by the undersigned on the day of installation. Deductible: It is the Owner's responsibility to pay all insurance deductibles. Owner's out-of-pocket expense will not exceed the deductible amount, as stated on insurer's loss sheet (the "Loss Sheet"), UNLESS replacement/repair of deteriorated decking is required by code and/or Owner requests optional upgrades. Jasper CANNOT pay, waive, rebate, or promise to pay, waive or rebate any or all of the insurance deductible applicable to the insurance claim for payment of work. In the event of a discrepancy, the deductible amount stated on the insurer's Loss Sheet phV1,AVbgule deductible amount disclosed. Deductible: $ 3 1RO MUST BE PAID IN FULL, PLUS APPLICABLE SALES TAX (initial) MORTGAGE AUTHORIZATION: 1, Owner/Mortgagor, grant authorization for' Mortgage Co. to speak with Jasper on matters including but not limited to, the claim and draw status. (initial) PAYMENT SCHEDULE: Owner agrees to pay Jasper based on the following schedule: (i) Deposit in the amount of $ due upon signing this contract; (ii) the Contract Price, less the Deposit and any applicable depreciation retained by Owner's insurer(s), plus upgrade costs, due and payable to Jasper upon completion of work being performed; and, (iii) the remaining Contract Price (equal to any applicable depreciation and/or change orders) due and payable to Jasper upon completion of work performed. In "vent a pending inspection, no more than 2% of Contract Price may be withheld until inspection has passed. Optional: UPGRADE ITEM: C_ QTY: —:U A_ PRICE: . . —Z3_ TOTAL: $ 7:M Replacement Work and Price: Upon insurer's approval and subject to the Terms and Conditions herein, Jasper agrees to furnish all materials and provide the labor necessary to perform the full roof replacement which shall take place following Owner's insurance company's approval, approximately within 30 days, conditions permitting. Owner's Declaration of Intent: Owner acknowledges and agrees that, upon approval by insurance company for a full roof replacement, Jasper shall perform the roof replacement upon receipt of funds from Owner's insurance company. FLORIDA HOMEOWNERS' CONSTUCTION RECOVERY FUND PAYMENT, UP TO A LIMITED AMOUNT, MAY BE AVAILABLE FROM THE FLORIDA HOMEOWNERS' CONSTRUCTION RECOVERY FUND IF YOU LOSE MONEY ON A PROJECT PERFORMED UNDER CONTRACT, WHERE THE LOSS RESULTS FROM SPECIFIED VIOLATIONS OF FLORIDA LAW BY A LICENSED CONTRACTOR. FOR INFORMATION ABOUT THE RECOVERY FUND AND FILING A CLAIM, CONTACT THE FLORIDA CONSTRUCTION INDUSTRY LICENSING BOARD AT THE FOLLOWING TELEPHONE NUMBER AND ADDRESS: Construction Industry Licensing Board: 2601 Blairstone Road, Tallahassee, FL 32399-1039, (850) 487-1395 CANCELLATION: If Owner elects to terminate the services of Jasper, Owner may do so before midnight on the third business day after Contract is executed. Owner shall receive a full refund of all deposits. Owner may also rescind Contract before midnight on the third business day after the contract is executed after notification from insurer(s) that the claim for payment on roof contract has been denied, in whole or in part. All written notices of cancellation, regardless of reason, shall be postmarked or delivered to Jasper's corporate office: 1690 Roberts Boulevard, Suite 112, Kennesaw, GA 30144. CANCELLATION EXCEPTIONS: The three (3) day right of cancellation DOES NOT APPLY to contracts for emergency home repairs as time is of the essence. I, Owner, have read and understand all statements, Terms and Conditions of the "Roof Replacement Contract" and agree that all details are acceptable and satisfactory. I further understand that this Contract constitutes the entire agreement between the parties and that any further changes or alterations to this Contract must be made in writing and agreed upon by both parties. Each party represents and warrants to the other that it has the full power and avtlliority to enter into the contract and that it is binding and enforceable in accordance with its terms. // \ d Au Jasper Represen tive DateDaeOwnerf Mtamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole, County, Winter Springs Date: 10.31.17 Karla Aimodovar, Skylar Amkraut Rachel Holcomb 1 hereby name and appoint: , r66q ILL jjW, Gina McDonald & Rachel Holcomb an agent of: Jasper eontractus 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): XThe specific permit and application for work located at: 362 PLACID LAKE DR SANFORD FL Sara Addrm) Expiration Date for This Limited Power of Attorney: 1 /1 /2019 License Holder Name: Donald Bouchard State License Number.: C C1331153 Signature of License Holder. STATE OF FLORIDA — COUNTY OF sew. The foregoing instrument was acknowledged before me this 31 day of October 200=, by D--dd 8-d-d who is o personally known to me or ® who has produced oL identification and who did (did not) take an oath Signature Notary Seal) Sky ar Amkraut Print or type name SKYLAR B AMKRAUT i Commission ,y FF 127890 d My Commission Expires I. June 01, 2018 Rev. 08.12) Notary Public - State of FL Commission No. 127890 My Commission Expires: 6/1/2018 Scanned by C Amq(-annPr 10/31/2017 SCPA Parcel View: 02-20-30-520-0000-0370 Property Record Card Parcel: 02-20-30-520-0000-0370f(PNV k Owner: COFFIELD GLEN E & CYNTHIA R Property Address: 362 PLACID LAKE DR SANFORD, FL 32773 Parcel Information Parcel 02-20-30-520-0000-0370 Owner COFFIELD GLEN E & CYNTHIA R Property Address 362 PLACID LAKE DR SANFORD, FL 32773 Mailing 1743 CEDAR STONE CT LAKE MARY, FL 32746- Subdivision Name PLACID WOODS PH 1 Tax District S1-SANFORD DOR Use Code 01-SINGLE FAMILY Exemptions Seminole County Gig Value Summary 2018 Working 2017 Certified Values Values Valuation Method Cost/Market Cost/Market Number of Buildings 1 1 Depreciated Bldg Value 8981693,236 Depreciated EXFT Value Land Value (Market) 25,000 25,000 Land Value Ag Just/Market Value 123,816 118.236 Portability Adj Save Our Homes Adj i $0 0 Amendment 1 Adj 5,519 10,693 P&G Adj 0 0 Assessed Value 118,297 107,543 Tax Amount without SOH: $2,118.01 2017 Tax Bill Amount $2,118.01 Tax Estimator Save Our Homes Savings: $0.00 Does NOT INCLUDE Non Ad Valorem Assessments Legal Description LOT 37 PLACID WOODS PH 1 PB 51 PGS 23 THRU 29 Taxes I Taxing Authority Assessment Value Exempt Values Taxable Value County General Fund 118,297 0 118.297 Schools City Sanford i SJWM(Saint Johns Water Management) 123,816 118,297 118,297 0 0 " 0 123.816 118,297 118,297 County Bonds 118,297 0 118,297 Sales Description Date I Book Page I Amount Qualified Vac/Imp WARRANTY DEED 8/1/2015 08536 0740 70,000 1 No Improved WARRANTY DEED- 6/1/2000 03878 0137 82,000 Yes Improved WARRANTY DEED 4/1/1999 03631 0581 80,000 Yes Improved SPECIAL WARRANTY DEED 5/1/1998 03426 0533 73,700 Yes Improved WARRANTY DEED 10/1/1997 t 03322 36,200 No _ Vacant Find Comparable Sales Land Method Frontage Depth Units Units Price f Land Value LOT 1 $25,000.00 25,000 Building Information Is Bed/Bath count incorrect? Click Here. r'----r. ................ 7 ............ . ........_.... 7-..-...... .....-...... .......- ...._.... T 1 _..._ ..... .... ............. ... .._......._. http://parceidetail.scpafl.org/ParcelDetailinfo.aspx?PID=02203052000000370 1/2 l loll# 11111 1111iffil11!11111111 gill 1111 THIS INSTRUMENT PREPARED BY: Name: JASPER CONTRACTORS Address: 3203 S CONWAY ROAD SUITE 201 ORLANDO, FL 32812 NOVICE OF COMMENCEMENT Permit Number. 0 Parcel ID Number. _ oU )--,( 6)-- 590-0/ 000—p37JD c. in Ik1131, E111HOLE COUi)TY C EERY O€ 'CIRCUIT COU.T f. COMPTROLLER CLERK'S v 2017109800 RECORDED 10/ 31/201-7 11= : €45 AM ECORDING FE RECORDED E° ;: Lt= t,ilit The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following informationisprovidedinthisNoticeofCommencement. 1. DESCRIP ION OF PROPE TY; (Le al desc iptlon of the prope antl stree ddress if available) 3 ICA(, (A)OOCfs ?P )l ) s) 0-,5 ZS -fhry q 2. GENERAL DESCRIPTION OF IMPROVEMENT: RE -ROOF 3. OWNER INFORMATION OR LESSEE IN ORRMATION IF THE LESSEE CO TRACT /FO_RjTHE IMPROVEEMEN • ,% Name and address:_ l "I i' j i 1-1' e ]i lfC t i 1 V(It i r c Ce.A t Interest In property: OWNER Fee Simple Title Holder (if other than owner listed above) 4. CONTRACTOR: Address: 3203 S CONWAY ROAD SUITE 201 ORLANDO S. SURETY ( If applicable, a copy of the payment bond is attached): FL 32812 Phone Number. 407-278-7788 Amount of Bond: 6. LENDER: Name: Phone Number.. Address: 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. Phone Number. 8. In addition, Owner designates to receive a copy of the Llenor'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 IMPROPERPAYMENTSUNDERCHAPTER713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICEFORIMPROVEMENTSTOYOURPROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITEBEFORETHEFIRSTINSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCINGWORKORRECORDINGYOURNOTICEOFCOMMENCEMENT. Aulhodzed Off cor/DimclodPa State of \( J \.& Q-- Print Name and Provide Signator7/s Ve(Otfico) of etore me this tday of _ Zp name or Per3rson making statemcml -- - who has produced identification t 3' type of identification produced: SIMAP B AMKRAUT Commission A FF 127890 i My Commission Expires I June 01 , 2018 JJ.,i':.:.:atlRty •:. F.'Y+T..v..'..R_....wu:'s!.cVe N,-.[K...+CI.*,•e. W Who Is personally known to me OR City of Sanford Building & Fire Prevention Division 1=„ Re -Roof Permit Card PERMIT NO. ' ISSUE DATE: 1111101 CONTRACTOR: JOB ADDRESS: TYPE OF WORK: f- Re'. MQV I •t t4q Its PROTECT FROM WEAT R 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 REOUIRED 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 PERMIT # 05 City of Sanford Building Division Residential Re -Roof Scope of Work Jos ADDRESS: 362 PLACID LAKE DRIVE SANFORD FL STRUCTURE TYPE: Q SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM RE -ROOF TYPE: 0 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 OF THE EXISTING DECK IS PERMITTED TO BE REPLACED' ROOF VENTILATION: O OFF -RIDGE Q RIDGE OSOFFIT OPOWERED VENT SKYLIGHTS: O YES Q NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #: MAIN ROOF AREA ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 Q 4:12 OR GREATER O TURBINES TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL SHINGLE OWENS CORNING FL# 10674-R12 O METAL FL# O MODIFIED BITUMEN FL# O TORCH DOWN FL# O INSULATED FL# O TILE FL# O OTHER: FL# ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) "IFAPPLICABLE" ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 O 4:12 OR GREATER TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL O SHINGLE FL# O METAL FL# O MODIFIED BITUMEN FL# O TORCH DOWN FL# OINSULATED FL# O TILE FL# 0 OTHER: FL# 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 pen -nit application. The Scope of Work must include all applicable Florida Product Approval numbers for all roof components that will be installed on the project. A permit will not be issued without these documents. Copies will be made to post on the job site. Projects located in the Sanford Historic District will require plan review and approval by the Sanford Historic Preservation Board INSPECTION POLICY & PROCEDURES A Final Roof:Inspection is the only inspection required for Residential (Single Family, Townhouse, Mobile Home, Apartment and/or Condominium) Re -Roof Permits. The Following is required to be provide on the job site: Permit Card, posted in a conspicuous and weatherproof location Completed Residential Re -Roof Scope of Work Completed and Notarized Inspection Affidavit All Florida Product Approval and Corresponding Installation Instructions Product Approval shall match what is on the scope of work) Digital Photographs (must include the permit number or address in each picture) o Each. plane of the roof, showing the underlayment installed o Roof Deck Nailing Pattern & Spacing (including a measuring device or ruler) o Roof Deck Nails used (including a measuring device or ruler showing size of nails) o Underlayment Pattern & Spacing (including a measuring device or ruler) o Drip Edge & Valley Attachment (including a measuring device or ruler) o Shingles installed, nail pattern and location of nails Skylights (if applicable) o Digital photographs showing all installation components, per FL Product Approval o Digital photographs showing all required flashing, per FL Product Approval Failure to follow these specific guidelines will result in an affidavit provided by a Florida Design Professional (architect or engineer), certifying FBC code compliance by personal inspection. CONTRACTOR OR OWNER/BUILDER SIGNATURE: DATE: 10.31.17 l -7 3-zos LEMTED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs -- Dace: _ 11 I hereby name and appoint: Scott Meixsell, James Allen, Michael Watts, Jacob Horst, Ricardo Prito, Paul Padgett an agent of 'der Conlradas Game orCompany) 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): G Expiration Date for This Limited Power of Attorney: l - I _ 1 - I License Holder Name: State License Number. CCC1331153 Signature of License Holder. : STATE OF FLORIDA COUNTY OF sew The foregoing instttmient was acknowledged before me this 23day of 200 - . by °orwd BO d-d who is o personally (mown to me or is who has produced of as identification and who did (did not) take,an oath. Notary Seal) KRAUT R SI<YLAR B AM p `pPY VUg i 2%HeCommssion7IFF I zI EXp res My Commis o. I off`: 18juneU.t_, 218 Rev. 08.12) Print orWyne name Notary Public - State of Commission No. Zie1- My Commission Expires:Q . ¢ Scanned by CarnScanner City of Sanford Building and Fire Prevention RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT NAILING, SH(EAATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS PERMIT#: l' ADDRESS: -AV( I 5—C, ,, l )I1 % 1) s , If , 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 #: C LC ( . COMPANY / CONTRACTOR: CONTRACTOR SIGNATURE: _ MUST BE SIGNED BY LICENSE A FINAL ROOF INSPECTION IS REQUIRED: DATE: l • 2- 4 - 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 PERMH 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 day of 20 Lly: t> Who is Personally -Known to me or ha Produced (type of - identification) as identification. r „r.-___ SI<YLAR B AMI(RAUT 1, Ignature 001,atary Public P0. Ug Commission N FF 1278 n State on a* ? *__ My Commission ExP1: June 01 , 2018 I +, Print/Typ / tamp Name of Notary blic