2417 S Lake Ave; 18-3508; ROOFAUG 15 2018
CITY OF
i
PERMIT APPLICATIONANFORD
f
BUILDING DIVISION
Application No: 1
Documented Construction Value: $ -7, 0F. , e'
Job Address: 0c5 'I- e Historic District: Yes [INo Parcel
ID: 3U-16(-36 'f ui-kW ' 000 Residential Ercommercial Type
of Work: New Addition Alteration Repair Demo Change of Use Move Description
of Work: ZG- roo Plan
Review Contact Person: Phone:
Fax: Email: Property
Owner Information Name
C, (65 "u- Phone: Street:
a40 '5-, La kc_ Ayk City,
State Zip: 32 -Y) ' Title:
Resident
of property?: Contractor
G
Inf
oC
at o n_ 1 Name
bbkv'a N51 ^ Phone: / q 0-E)2-4-700 Street: 35LZ _ _
Kue-AyzL LA Fax: City, State
Zip: rM It- 3 22'ZD _ State License No.: CGG l 3 27 49 $ Name: Street:
City,
St,
Zip: Bonding Company:
Address: 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 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: 6' Edition (2017) Florida Building Code
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
ekd as Chkuc-A,
Pr nt Owner/Agent's Name
i
oridaSignatureofNotatalel
OY&q WdWdy Kaye Schaffner
fir!)
aQ NOTARY PUBLIC
STATE OF FLORIDA
Jl
Comm# GG070449
Owner/Agent is Person oEkONaoyzd-/2021
Produced ID ' Type of ID PD t.--
Signature of .tractor/Agent Date
L, 4- 1 b4v;,
rint Contractor/Age is Nam
Signature of Notary -State of Florida Dat
SA
Wendy (aye Schaffner
NOTARY PUBLIC
STATE OF FLORIDA
49, 4nContractor/Agent is° t Tres a 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:
ENGINEERING:
COMMENTS:
UTILITIES:
fdI =
Flood Zone:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes []No
WASTE WATER:
BUILDING:
NOTICE TO BUYER
Please tnmal
Cd _ TEILNITF INSPECTION:
Me. the utndemgned Borrowers. ad:no%ledge that wr have r"tivcJ a copy of the T'ertnitc ln+pccfion
Repim regarding the %u*ct Property. Me. a:n'3rc aware of and understand the finding, remarks.
obsercati(ms, recommendations. conditions and other health consideranom av contained therein. Iflve
arrvare satisfied with the condition of the Ietmtc Inspection Report and arc willing to accept the
property m its 'as is" condition. FWe ftirther agree to hold Public 'Title Setvices, l_l.0 , t.eradrr andror
it. dr.siynsted assignees lutmless from any liability in the event of any future infestation
COMPLIANCE;
The undersigned agree, if requested by Closing Agent. to fully cooperate and adjust for clerical cnmrs,
any or all documentation deemed rsectcsary' or desirable in the reasonable discretion of Closing Agent.
HOLD IIARMIL 1S:
In the event that Puhhc Title Services. LLC engaged the services of outside agcncic s for the .Vn ey
aadror termite or othet inspections, it is huxcbv umderstoad and af;rttiJ that such action was unSettaken
h) Public Title Smices. LLC as a cenvcnicmc to the parties of this trariNxtion and to facilitate the.
closing. Public Title Services, LLC ha no affiliation with nor dots it moeivc campcissation fmar said
agencies; therefore the undersigned hereby holds Pals 'rifle services. LLC harmless from any damgcs
or claims which may result fmni said engagement of smices
C? - _ SURVEY:
Me. the u n dmigned PuM%&%Yvnw nm. have examined the survey attached hereto, dated none.
prepared by none. bring lob.'Chder Number )Userinput uss to 1oh'oader number of Survey), and realize
that the fvllowmg erxroxhmcnl and-(v violations affect the captioned property' al follows:
Notwithstanding the above. V%v desire to complete the closing of this transaction mud di.Axwv the
pnxccds, and we iipcc to hold Public Title Senices. LLC and Alliant Notional Title Insunance
Consp my free and harmless from any and all liability, hiss, cost Of expense that rtiight it w by reason of
the AbctvrnxKitirasni enemachsnent nndror violations being insured by said underwriter.
DatcJ gad accepted August 10. 2018 in reference to the Property (waled at 24171.AKF: AVE. SANFORD.
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PRIMROSE CONSTRUCTION
COMPANY
Direct: Email:
407-721-7690 Construction • Roofing rubydavis222@aol.com
Roofing Construction Contract
1. Parties: This Contract is between Carlos Chauca, hereinafter referred to as the Owner, whose address is 115
N. Pressview Ave, Longwood, Florida 32750, and Primrose Construction Company, hereinafter referred to
as the Contractor, whose business address is 3525 Raeford Road, Orlando, Florida 32806.
2. Job Location: 2417 S. Lake Ave, Sanford, FL 32771, Parcel ID Number: 36-19-30-524-1000-0040
Permits: The Contractor, License No. CCC1328498, will acquire the appropriate construction permits,
coordinate required inspections, ensure all work is done in a workmanlike and professional manner, and
complete the Contract in accordance,with the terms contained herein. The permit acquisition shall be within
ten (10) days of the signing of this Contract and permit application. This Contract contains no completion
date and no penalty or award clauses. This Contract allows the Contractor to place a sign and permit box in
the front yard of the job site for the duration of construction to assist inspectors and subcontractors in
locating the construction site.
3. Payments: This Roofing Construction Contract is in the amount of Seven Thousand Two Hundred Dollars
7,200) with payment to Primrose Construction Company, as follows
A. First payment: 50% $ 3,600.00 at contract signing,
B. Final payment: 50% $ 3,600.00 upon completion and cleanup of job site.
D. Any additional work and Change Orders to this Contract shall be paid upon signing of the Change
Order.
4. Owner Responsibilities: The Owners shall provide access to the area of work. Any damage to driveways,
sidewalks, shrubs, landscaping, vehicle damage of any nature shall be the responsibility of the owner and his
respective insurance.
5.
6. Contractor Responsibilities: The following materials and installation are included by the Contractor in the
contract price.
A. Removal of existing roof materials such as eave drip, vent stack covers, ridge vents, off -ridge vents, and
items that are damaged or hinder or prevent the installation of a new roof system.
B. Number Atlas Summit Synthetic 60 Felt Underlayment, and Weathermaster poly stick on flat roof.
C. New roof description: Dimensional Architectural Atlas Pristine Black, and Torch down on Flat roof.
D. The removal, cleanup, and disposal of all roof materials.
E. Install new 2 '/2" eave drip, lead boots, and roof vents.
F. Other: NA
G. Other: Any decayed wood requiring replacement will be charged at $40 per board.
7. Lien Waivers: N/A
8. Warranty: The Contractor warrants the roof workmanship for a period of one year from the date of
completion. The Owner accepts responsibility for the manufacturers limited warranty of thirty (30) years.
Florida Statutes: In accordance with Florida Statutes 489.1425, the following is included in this Contract.
Construction Industry Recovery Fund payment may be available from the Construction Industry Recovery
Fund if you lose money on a project performed under contract, where the loss results from a specified
violation of Florida law by a state -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, 1940 North Monroe Street, Tallahassee, Florida 32399-
0783 Phone: 1-850-487-1395.
10. Understanding: It is expressly agreed that this Contract constitutes the sole understanding between the
parties hereto and that no oral understandings, representations, promises, or other statement whatsoever
made by anyone whomsoever will be binding upon Owners or Contractor unless the same is contained
herein or in another instrument attached hereto and made a part of this Contract and duly signed by all
parties. This contract shall become null and void if not signed by all parties within 5 days of the effective
date shown below.
11. Dispute: Should any dispute arise out of this Contract, the prevailing party shall be entitled to recover its
attorneys fees and costs incurred with such dispute, arbitration or action, through all appeals, bankruptcy
proceedings and collection efforts.
11. Notices: Any notice given pursuant to the Contract shall be sent certified U.S. Mail, return receipt
requested, as follows:
Owner: Carlos Chauca Contractor: Primrose Construction Company
115 N. Pressview Ave 3525 Raeford Road
Longwood, FL 32750 Orlando, Florida 32806
This Roofing Construction Contract is a legal binding Contract with an effective date of August 14, 2018.
Carlos Chauca, Owner
Roofing Contract/2417 S. Lake Ave
Ruby Dav' resident
Grant Malloy, Of The Circuit Court & erk
nst # 0180933I64 ook:9190 Page 1575; (
C10PAGES)
rRCD Seminole08/15/2018 01 16:52 PM REC
FEE $10.00 THIS
INSTRUMENT PREPARED BY: Name:
illJbin bAULS Address: _
STe,5' (Zaujwd NOTICE
OF COMMENCEMENT Permit
Number. Parcel
ID Number:J o CERTIFIED
COPY GRANT MALOY CLERK
OF THE CIRCUIT COURT '*°'"= AND
COMPTROLLER' "'t SEMINOLE
COUNTY, FLORIDA ,'-;->;'s ;' Qdi
DEPUTY CLERNN AUG
IB 2018 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 description of the property and street address if available) 21 (-
4- . «~aloe A0, S4n:r0X-d -3'0-11 2.
GENERAL DESCRIPTION OF IMPROVEMENT_ 19-
e ,lc- r-- 3.
OWNER INFORMATIIONOR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT: Name
and address: (20 Ir to S G kot U m r Interest
in property: I v- V C -7 t 1, Y V'tLoi LO ' V " Fee
Simple Title Holder (if other than owner listed above) Name: 4.
CONTRACTOR: Address:
35 T
S.
SURETY (if applicable, a copy of the payment bond is attached): Amount
of Bond: 6.
LENDER: Name: Phone Number. Address:
O
7.
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)(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. Signature
of Owner essee, or Owner's or Lessee's Authorized
Officer/Director/Partner/Manager) State
of rtmm- County of 012ANI`6 = CAP -
Los C-1 4 AL16A Print
Name and Provide Signatorys Title/Office) The
foregoing Instrument was acknowledged before me this day of Jl-t Us 20) E by
Caxtal Who is personally known tome OR Name
of person making statement who
has produced identiflcationZr 'type of identification produced: ' Wendy
Kaye Schaffner eotPRy4sSoo
NOTARY PUBLIC SE
STATE OF FLORIDA Comm#
GG070449 Notary signature s
CE 19%0 Expires 5/912021
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: y
I hereby name and appoint: 57Ur(eYl'i6U'ta- T x-"6 S
an agent of:
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):
PS The specific permit and application for work located at:
24I -1 5 . ke . r—L
Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name:
State License Number:
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF OPAt4
3;1'7i
The foregoing instrument was acknowledged before me this Iq day of , V -' ,
C1 2W IQ , by bew,3 who i rs ll no
to me or who has produced as
identification and who did (did not) take an oath.
Notary Seal)
Wendy Kaye Schaff ner
ASo NOTARY PUBLIC
STATE OF FLORIDA
2 Comm# GG070449
s/NCE I Expires 5/9/2021
Rev. 08.12)
Signature
Print or type name
Notary Public - State of
Commission No.
My Commission Expires:
SPA Parcel View: 36-19-30-524-1000-0040 Page 1 of 2
Property Record Card
Parcel: 36-19-30-524-1000-0040
Property Address: 2417 LAKE AVE SANFORD, FL 32771
Parcel Information
Parcel 36-19-30-524-1000-0040
Owner(s) C GILL, SAMUEL
C GILL, MIA O
Property Address
Mailing
2417 LAKE AVE SANFORD, FL 32771
i 2417 S LAKE AVE SANFORD, FL 32771-4101
Subdivision Name DREAMWOLD 3RD SEC — --- —
Tax District S1-SANFORD
DOR Use Code 01-SINGLE FAMILY
Exemptions
Legal Description
LOT 4 BILK 10
3RD SEC DREAMWOLD
PB4PG70
I Taxes
Value Summary
2018 Working 2017 Certified
Values Values
Valuation Method Cost/Market Cost/Market
Number of Buildings
Depreciated Bldg Value 63,870 57,795
Depreciated EXFT Value
F------
Land Value (Market) j $16,440 —
r_.._...__..________
14,945
Land Value Ag
Just/Market Value "' i $80,310 72,740
q...---'-..........._....__............__...'.
Portability Adj
Save Our Homes Adj 0 0
Amendment 1 Adj j $5,772 4,978
P&G Adj 0 i $0
Assessed Value 74,538 67,762
Tax Amount without SOH: $1,323.00
2017 Tax Bill Amount $1,323.00
Tax Estimator
Save Our Homes Savings: $0.00
Does NOT INCLUDE Non Ad Valorem Assessments
Taxing Authority Assessment Value Exempt Values I Taxable Value
County General Fund 74,538 0 ; 74,538
Schools 80,310 0 80,310
City Sanford 74.538 `
i. _._ ..__...._.. ._. ._ ... _
0 ' 74,538
SJWM(Saint Johns Water Management) 74,538 i 0 i 74,538
County Bonds 74,538 0 1 74,538
Sales
Description Date Book Page Amount Qualified Vac/Imp
SPECIAL WARRANTY DEED 7/1/1996 03118 i 1824 $38,000 No I Improved
CERTIFICATE OF TITLE
WARRANTY DEED
11/1/1995 02996
11/1/1992 02504
1870 $46,100
0077 $49,500
No
Yes
Improved
Improved
WARRANTY DEED 6/1/1985 01651 0663 $42500 Yes Improved
WARRANTY DEED 1 1/1/1972 00920 — 0046 $17 400 Yes Improved
L—__. - — - .---- Find Comparable Sales
Land
Method Frontage Depth Units Units Price Land Value
FRONT FOOT &DEPTH 61.00 136.00 j 0 $275.00 $16,440'
Building Information
Is Bed/Bath count incorrect? Click Here.
Description Fixtures Bed Bath Base Area Total SF Living SF Ext Wall Adj Value Repl Value Appendages
http://parceldetail.scpafl.org/ParcelDetailInfo.aspx?PID=36193052410000040 8/14/2018
SLPA Parcel View: 36-19-30-524-1000-0040 Page 2 of 2
Year Built
Actual/Effective
1 SINGLE 1 1971 ' 6 i 3 1 2.0 1,1001 1,476 1,280 1 CONIC $63,870 ! $86,311 Description Area
FAMILY i i BLOCK1
UTILITY 1i 80.001
FINISHED
ENCLOSED
i I PORCH j 180.00i1FINISHED
1OPENPORCH 116.00
1 FINISHED
Permits
Permit # Description Agency Amount CO Date Permit Date
01143 REROOF I SANFORD 2,198 2/1/1996
00041 j ENCLOSE CARPORT i SANFORD 200 j 10/1/1993
not or] g In ate from the Seminole County Property A Apra Iser's office. For deta Its or questions concerning a perm It, please contact the building department of the tax district In which the property Is locatea.
ttures
m Year Built I Units I Value I New Cost
No Extra Features
http://parceldetail.scpafl.org/ParcelDetaillnfo.aspx?PID=36193052410000040 8/14/2018
SY
OF
s.NFORD
JOB ADDRESS:) 4'-7 ' " A?-
PERMIT # f y - 5d8
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
STRUCTURE TYPE: SINGLE 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:
PLEASE NOTE: ONL Y 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED*
ROOF VENTILATION: O OFF -RIDGE O RIDGE OSOFFIT OPOWERED VENT
SKYLIGHTS: O YES O NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12
OTURBINES
O 2:12 - 4:12 0 4:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
I SHINGLE FL# -
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** A
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 D.0& 1 ATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
S N E
O METAL FL#
O MODIFIED BITUMEN FL#
O TORCH DOWN FL#
O INSULATED FL#
O TILE FL#
O OTHER: FL#
CITY O
Building & Fire Prevention DivisionS.NFORD RESIDENTIAL RE -ROOF POLICY & PROCEDURES
f T;:>
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), CERTIFYING FBC CODE COMPLIANCE BY PERSONAL INSPECTION.
CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: /I DATE:
Vy
3 Y OF
Building & Fire Prevention DivisionNFORDRESIDENTIALRE-R 0OF AFFIDA VIT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: ' O v ADDRESS: ;2q' 17 C—
I K o Oli PkWo 'AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, AGINEER, 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#: `X` c 4-oqI t COMPANY /
CONTRACTOR: r
CONTRACTOR
SIGNATURE: DATE: 4 MUST
BE SIGNED BY LICENSE HOLDER UUWNER/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 FLORIDA COUNTY OF Q kAi' I--6 Sworn
to and Subscribed before me this _ day of %W 20 12 by: ROW,,,
6AAVCS Who is ersonally Known to me or has Produced (type of identification)
Signature
o otary Pub is State
of Florida Print/
Type/Stamp Name of
Notary Public as
identification. ORY&
V Wendy Kaye Schaffner a'
NOTARY PUBLIC STATE
OF FLORIDA i
Comm# GG070449 S
yCE19 Expires 5/9/2021