3500 Park Ave; 17-3054; REROOFCITY OF SANFORD
BUILDING +& FIRE PREVENTION
PERMIT APPLICATION
Application No:
Documented Construction Value: $ -7c' "6tom,/
Job Address: i l Historic District: Yes No1D
Parcel ID: i 2 ` 20 -° C - 621 -- 02 7 0 Residential ® Commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of Work: rC "' 00j'; , a /4- 0 w Y. fi
Ian Review Contact Person: tine, >n
r
Title: !'
Phone: q _12 5 Fax: Email: (f1 t`
l • /`i, Lr} i
Property Owner Information
Name
r}
l
r--
Phone:
Street:% t oofrt $ F' t ° Resident of property?
City, State Zip: of o . 1/9 FL C
Contractor Information
Name f 5, I
rm
Phone: qi 5 -2 , 4 ti
Street: 11-PO(, oo Fax: /
City, State Zip: 4 ! ., . i _' r State License No.: {,
Architect/Engineer Information
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
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 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: 5te 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 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.
Jv ri3 / ?
Signature of Owner/Agent Date
Print Owner/Agent's Name
J2
Signature of Notary- tat, of Flotida 6W J
DORENE L PENHALIOON
MY COMMISSION # FF 221832
EXPIRES: June 24, 2019
Bm&d Thru B00 Notary Serykei
Owner/Agent t Personally Known to Me or
Produced ID Type of ID
za4V-W-
4
12
Signature of C) ontractor/Agent/ ate
Print ContractortAgent's Name
V. Mr13-1-7
Signature of Notary -State of Florida date
ROBERTV. MALONEY
MY COMMISSION # FF 917403
EXPIRES: October 12, 2019
widThrauv/tNoaryS11*a
Contractor/Agent is Personally Known to Me or
Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing[] Gas Roof
Construction Type: Occupancy Use:
Total Sq Ft of Bldg: Min. Occupancy Load:
New Construction: Electric # of Amps
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING: UTILITIES:
ENGINEERING: FIRE:
70 It U_lU_a a
Flood Zone:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Permit Application
i Property Record Gar
tYtYtd ,bhlton, CFA
Parcel: 12-20-30-504-0000-0270
Owner: HICKSON MARY G & GORDIE STEPHEN H
xw Cx.ccxaunrrr, r<t.ofx¢tn i
Property Address: 3500 SPARK AVE SANFORD, FL 32771 i
Parcel Information Value Summary
Parcel 12-20 30-504 0000 02702017 Working i 2016 Certified
Owner HICKSON MARY G & GORDIE STEPHEN H i i— Values Values
VatuaGon Method Cost/Market Cost/Market 1PropertyAddress3500SPARKAVESANFOROFL32771j
Number of Buildings 1 1Mailing' 7733 COUNTRY Pl. WINTER PARK, FL 32792-9316
Depreciated Bldg Value $53,914 $47,020SubdivisionNamejSOUTHPINECREST4THADD
i Depreciated EXFT Value
Tax District ; S1 SANFORD i Land Value (Market) $15,000 $14,000 IDORUseCode01SINGLEFAMILY
Land Value Ag
Exemptions :-
Just/Market Value " $68,914 $61,020
elrPortability Adj Save
Our Homes Adj $0 $0 1 3 -
f
6N 7003 94.98 ' 5 Amendment 1 Adj $1,792 $0 P&
G Adj - $0 $0 Assessed
Value $67.122 $61,020 0 '
7
i I d 120
120 Tax
Amount without SOH: $1,223.18 2016
Tax Bill Amount $1,223.18 Tax
Estimator Save
Our Homes Savings: $0.0o 0
28
TRIM Notice Help a
Does NOT INCLUDE Non Ad Valorem Assessments 0
120 i
i r Seminole County GIS Legal
Description LOT
27 SOUTH
PINECREST 4TH ADD PB
12 PG 43 Taxes
j
Tawng Authority Assessment Value I Exempt Values 1 Taxable Value County
General Fund 67.122 0 67,122 Schools
68,914 0 68,914 i
City Sanford 67,122 0 67,122 SJWM(
Saint Johns Water Management) 67,122 0 67,122 County
Bonds 67,122 0 67,122 Sales
Description
Date . Book Page Amount Qualified Vac/Imp WARRANTY
DEED 2/1/2000 03807 100 No, Improved WARRANTY
DEED 2/111985 01615 1206 62,600 Yes Improved WARRANTY
DEED 1/1/1984 01518 1076 60,000 Yes Improved WARRANTY
DEED 7/1/1983 01475 1331 60,000 Yes Improved Land
Method
Frontage Depth Units L Units Price t Land Value Ij O0.00 0.00 1 $15,000 00 $15,000 Building
Information is
BgdlBath count incorrect? Click Here- _ Description
1 Year Built Fixtures Bed Bath i Base Area Total SF Living SF I Ext Wal- 1 rAdj Value I Repl Value Appendages
Mjp WINDOWS & CONSTRUCTION, INC.
LAKE MARY, FL 32746
407)265-2215 / PHONE
JAY FRANK 407-314-6862
mjpwinCwcfl.rr.com
LICENSE # CRC057525& LICENSE 4 CCC057886
PROPERTY ADDRESS:
STEVEN GORDIE
3 500 S. PARK AVE
SANFORD, FL 32771
EMAIL ADDRESS` STEVEN STEfNE omGMAII-COM
A PROPOSAL FOR THE. FOLLOWING:
TO TEAR OFF EXISTING SHINGLE ROOF
HAUL OFF ALL ROOFING DEBRIS & MATERIAL
INSTALL NEW PEEL & STICK tYNDERLAYMENT
INSTALL NEW PLUMBING STACKS
INSTALL NEW VENTS
INSTALL NEW PEEL & STICK IN VALLEYS
INSTALL 26 GUAGE EVE DRIP
RE -NAIL DECKING TO CODE
OCTOBER 10, 2017
REPLACE ANY ROTTEN WOOD AT AN ADDITONAL COST OF $55.00 PER SHEET OR $6.00
PER LINEAR FOOT FOR DECKING BOARD AND FASCIA BOARD ini"tial
REPLACE 2- 2X2 SKYLIGHTS GLASS
INSTALL NEW 30 YEAR ARCHETICTUAL SHINGLES
WILL CEMENT,ALL EDGES OF ROOF AND VALLEYS
MJP IS NOT RESPONSIBLE FOR REMOVAL AND RE -INSTALLATION OF SOLAR PANELS
3 YEAR LABOR WARRANTY
PERMIT INCLUDED
WE PROPOSE TO FURNISH THE ABOVE COMPLETE IN ACCORDANCE WITH THE ABOVE
TERMS FOR THE SUM OF:
TOTALING: $7,850.00
GABLE END ABOVE SHINGLE ROOF NEEDS NEW WALL FLASHING AND NEW CEMENT
BOARD SIDING
800.00 UNCAULKED & UNPAINTED
PRICES ARE GOOD FOR 30 DAYS FROM ABOVE DATE
TERMS: TOTAL PAYMENT DUE UPON COMPLETION
CONTRACTOR'S ACCEPTANCE
COMPANY REPRESENTATIVE:
OWNER'S ACCEPTANCE
THE FOREGOING TERMS, SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY AND
ARE HEREBY AGREED TO. YOU ARE AUTHORIZED TO DO THE WORK SPECIFIED.
PAYMENT WILL BE MADE AS OUTLINED ABOVE. THE OWNER UPON SIGNING THIS
AGREEMENT REPRESENTS A ND WARRANTS THAT HE/SHE HAS READ THIS
AGREEMENT.
OWNER: zv--3iA- zv--lle l DATE:
THIS INSTRUMENT PREPARED BY:
Name: `DOREdN5 ppEENNHHftlJ09 N. rQ
Addresa.
52746
NOTICE OF COMMENCEMENT
State of Florida
County of Seminole
Permit Number: Parcel ID Number:
GRANT 11ALOYP SEI1INOLE COUNTY
CLERK OF CIRCUIT COURT i:, COrIPTROLLER.
BK 911C7 Pg 1380 (iPgs)
CLERK'S 4 20171043491
RECORDED 10/16/2017 04.13O.' it P11
RECORDING FEES $10.00
RECORDED R .ia, l'.?f1Pi7
12-20-30-504-0000-0270
The undersigned hereby gives notice that improvement will be made to certain real property; and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
LtE$ IPIIQNl3F.ERL?PERUf 118fla1 spt{ptiprtpfthepro, rho gttd.sttqjt address if available)
CiFMAFSCRIPTION OF IMPROVEMENT:
OWNER INFORMATION:
Name: MARY HICKSON & STEPHEN GORDIE
Address: 7733 COUNTRY PL WINTER PARK, FL 32792-9316
Fee Simple Title Holder (if other than owner) Name:
Address:
Address: 208 TEAKWOOD COURTLAKE MARY, FL Persons
within the State of Florida Designated by Owner upon whom notice or other documents may be served as
provided by Section 713.13(1)(b), Florida Statutes. Name:
In
addition to himself, Owner Designates Section
713.13(1)(b), Florida Statutes. of
To
receive a copy of the Lienor's Notice as Provided in v, >
i Expiration
Date of Notice of Commencement (The expiration date is 1 year from date of recording unless a`F'
different
date is specified) WARNING
TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF rt COMMENCEMENT
ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13 zz FLORIDA
STATUTES; AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A C 2 NOTICE
OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST Z3 INSPECTION.
IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY c L"? BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. t
m ri Under
penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true 0 cr ° to
the best of my knowledge and belief. 1
aUA e1y
6 Or r'c Ownbes
Signature Owner's Printed Name Florida
Statute 713.13(t)(9): ' The owner must sign the nodes of commencement and no one else may be permitted to sign in his or her stead.' State
of County of i// 1 %% %i /-f / The
foregoing instrument was acknowledged before me this day of 2 by
f 'Q he/1 eke ,!Liz + Who is personally known to me Name
of person making statement OR
who has produced identification1k type of identification produced: DORENE
L PENHWGON MY
COMMISSION t FF 22/832 - EXPIRES:
June 24, 2019 Notary dgnatu Ilk a
BcNedlUNBU*tNObtydtrvkit
CITY OF
SkNFORD
M,.
DEPARTMENTFIRE
Building & Fire Prevention Division
Re -Roof Permit Card
PERMIT NO. /7-m 3or4 ISSUE DATE: /0, 174. 17
CONTRACTOR: th J to
JOB ADDRESS: ast)o Park
TYPE OF WORK!e f JJVo0,F
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 111
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
y or
t Building & Fire Prevention Division
CITY
RESIDENTIAL RE -ROOF POLICY& PROCEDURES
1',IRE DEPARTMEN'r
PERMITTING REQUIREMENTS - No PLAN REVIEW REQUIRED
THIS DOCUMENT (SIGNED) ALONG WITH AN ACCURATE AND COMPLETED RESIDENTIALsIDENTIAL 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 WITHOUTTHESE DOCUMENTS. COPIES WILL BE MADE TO POST ON THE JOB SITE,
PROJECTS LOCATED` IN THE SANFORD HISTORIC DISTRICT WILL REQUIRE PLAIN 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 FOLLOWINGIS REQUIRED TO BE PROVIDE ONTHE JOB SITE:
0 PERM11"CARP, POSTED IN A, CONSPICUOUSAND WEATHERPROOF LOCATION
COMPLETED RESIDENTIAL RE -ROOF SCOPE OF WORK
0 COMPLETED AND NOTARIZED INSPECTION AFFIDAVIT
ALL FLORIDA PRODUCT APPROVAL AND CORRESPONDING INSTALLATION INSTRUCTIONS
PRODUCT APPROVAL SHALL MATCH WHAT IS ON THE SCOPE OF WORK)
0 DIGITAL PHOTOGRAPHS (MUST INCLUDE THE PERMIT NUMBER OR ADDRESS IN EACH PICTURE)
EACH PLANE OF THE ROOF, SHOWING THE UNDERLAYMENT INSTALLED
ROOF DECK NAILING PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
ROOF DECK NAILS USED (INCLUDING A MEASURING DEVICE, OR RULER SHOWING, SIZE OF NAILS)
UNDERLAYMENT PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
DRIP EDGE & VALLEY ATTACHMENT (INCLUDING A MEASURING DEVICE OR RULER)
0 SHINGLES INSTALLED, NAIL PATTERN AND LOCATION OF NAILS
0 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: /0- /6
CITY OF
i
i SkNFORD
FIRE DEPARTMENT
JoB ADDRESS:
PERMIT #
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
STRUCTURE TYPE: )eSINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY): - I`
PLEASE NOTE: ONLY 100 SQVARE.FEE T OF fHE EXISTING DECK IS PERMITTED TO BE REPLACED
ROOF VENTILATION: DOFF -RIDGE ,RIDGE OSOFFIT OPOWERED VENT
SKYLIGHTS: OYES ONO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 -4:12 4:12 OR GREATER
O TURBINES
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
SHINGLE t (tL ! I t !
J
FL# I : `,-' 5-^"
O METAL FL#
OMODIFIED BITUMEN FL#
OTORCH DOWN FL#
01NSULATED 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#
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 . . . . 17-00003054 Date 10/17/17
Property Address . . . . . 3500 PARK AVE
Parcel Number . . . . . . . 12.20.30.504-0000-0270
Application description . . ROOFING APPLICATION
Subdivision Name . . . . . SOUTH PINECREST 1ST ADDITION
Property Zoning . . . . . . SINGLE FAMILY
Permit . . . . . . RESIDENTIAL ROOFING PERMIT
Additional desc . .
Phone Access Code 1007533
Permit pin number 1007533
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date i
1000 111 BL03 FINAL ROOF _/_/_
CITY OF
r Ski!4FORD
FIRE DEPARTMENT
Building & Fire Prevention Division
RESIDENTIAL REROOFAFFIDAVIT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAjI LING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: I 1 ADDRESS: _ 6 -VD " pa jzs
I t / J Per)hatic. V/ , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, ENGINEER, ARCHITECT, OF F.S. Cft4PTER 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 ONF.Fj.
S. CHAPTER553.844).
LICENSE #: 1/ LJ K(
COMPANY / CONTRACTOR: I' / do 6V3
CONTRACTOR SIGNATURE: Y DATE: _
MUST BE SIGNED BY LICENSE HOL ER OR OWNER/BUILDER)
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 FLOREDA COUNTY OF JXM I r0 16
Sworn to and Subscribed before me this 7 day of Na Ver 1-hwV_ 2011 by:
M& r) i n 14 {i h I Leon. Who is ersonally Known to me or has Produced (type of
identification) as identification.
V. -Wc
Signature of Notary Public ,to'!;..fk, ROBERTV.MALONEY
State of Florida *
4e,"Ife-
OA * MY COMMISSION # FF 917403
EXPIRES: October 12, 2019
R V rbe p-T v - M'ft- o ll Bonded Thru Budget Notary Servke4 Print/
Type/Stamp Name of
Notary Public