161 Sand Pine Cir; 18-4050; RE-ROOFSEP 2 6 2018
CITY OF
Building & Fire Prevention Division
ORD'PERMIT APPLICATION
FIRE DEPARTMENT
Application No: ( 05O Documented
Construction Value: 2.7 S Job
Address: 161 SAND PINE CIR SANFORD, FL 32773 Historic District: Yes No Parcel
ID: 02-20-30-510-0000-0630 Residential Commercial Type
of Work: New[] Addition Alteration Repair Demo Change of Use Move Description
of Work: Remove and replace roof. Plan
Review Contact Person: Robert Wormley Title: Phone:
321-303-0766 Fax: Email: wormleyroofinginc@gmail.com Property
Owner Information Name
DAKO 1511 LLC -Trustee Street:
PO BOX 623062 City,
State Zip: OVIEDO, FL 32762 Phone:
407-949-1249 Resident
of property? : No Contractor
Information Name
Wormley Roofing Phone: 321-303-0766 Street:
2473 N John Young Pkwy Fax: City,
State Zip: Orlando, FL 32804 State License No.: CCC1325558 Architect/
Engineer Information Name:
Phone: Street:
City,
St, Zip: Bonding
Company: Address:
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. l 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 Revised:
January 1, 2018 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.
Signature o Owner/Agent Date Signature of Contractor/Agent DJte
Print Owner/Agent's Name
0 Notary Public State of Florida
Emma Victoria Campbell
My Commission GG 164707iM1 ' Expires 02 11/2022
Print Contractor/Agent's Name
ion Notary Public State of Florida
Emma Victoria Campbell
My Commission GG 184707
aa Expires02/11/2022
b
Owner/Agent is >L Personally Known to Me or Contractor/Agent is ?, Personally Known to Me or
Produced ID Type of ID 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
Fire Sprinkler Permit: Yes No
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
of Heads
UTILITIES:
FIRE:
Flood Zone:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Revised: January 1, 2018 Permit Application
Notar
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: C1/ Q 120 1
I hereby name and appoint: Emma Campbell
an agent of. Wormley Roofi
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):
J The specific permit and application for work located at:
161 Sand Pine Cir., Sandford, FL 32773
Street Address)
Expiration Date for This Limited Power of Attorney: 12/30/2030
License Holder Name: Robert Wormley
State License Number: CCC1325558
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF ''
The foregoing instrument was acknowledged before me this day of (,
2001 -S , by -4 (3 r ,n - who is wn
to me or who has produced U as
identification and who did (did not) take an oath.
eiature
y Seal) r a_
Print or type name
cp :Notary Public State of Florida+
a Victoeia Campbell (,; ,.
vommission GG 164 i 07'
Djm wes 02/11/2022
Rev. 08.12)
Notary Public - State of
Commission No. ak I-7 01
My Commission Expires:
SCPA Parcel View: 02-20-30-510-0000-0630 8/31/18, 12:51 PM
cFa Property Record Card
P Parcel: 02-20-30-510-0000-0630ltOCK,4Tv FIQHSy1 Property Address: 161 SAND PINE CIR SANFORD, FL 32773
Parcel 02-20-30-510-0000-0630
Owner(s) DAKO 1511 LLC - Trustee
Property Address 161 SAND PINE CIR SANFORD, FL 32773
Mailing PO BOX 623062 OVIEDO, FL 32762-3062
Subdivision Name 11 HIDDEN LAKE VILLAS PH 2
Tax District S1-SANFORD
DOR Use Code 0103-TOWNHOME
Exemptions
e
Legal Description
LOT 63
HIDDEN LAKE VILLAS PH 2
PB 27 PGS 1 & 2
Taxes
Taxing Authority Assessment Value Exempt Values Taxable Value
County General Fund I $86,497 ( 0 j 86,497
Schools j $112,694 1 0 j 112,694
City Sanford I $86,497 '1$0 i 86,497
SJWM(Saint Johns Water Management)
i----'--'-
86,497 1 0 ! 86,497
County Bonds"^--- 86,497 I 0 86,497
I Sales
Description Date Book Page Amount Qualified Vac/Imp
CERTIFICATE OF TITLE j 6/1/2018 09159 1660 78,600 No Improved
QUITCLAIM DEED 11/1/2005 1 05580 0124 — 100 No— Improved
QUIT CLAIM DEED 12/1/2004 105557_— i 0186
r
100 No
A—
Improved
SPECIAL WARRANTY DEED F
i 8/1/1998 03480 0056 17,500 i No Improved
WARRANTY DEED 8/1/1983 01483 1890 1 $42,400 No Improved
Find COWaaraDla Satan
http://parceIdetai1.scpaf1.org/ParceIDetaiIInfo.aspx?PID=02203051000000630 Page 1 of 2
INVOICE TO
BRIGHT SKY PROPERTIES
ARMEN
407-949-1249
flproperties1995@gmail.com
NO. DESCRIPTION
1 New Shingle Roof
PROPOSAL
JOB ADDRESS
161 Sandpine circle Sanford
Florida
2 Remove existing shingle roof system to wood deck
3 Inspect decking and re -nail to code.
4 Any wood deck repair is an additional charge per the following;
Plywood deck replacement is $30 per sheet plus cost of materials.
Board/Plank deck replacement is'$3 per linear foot plus cost of materials.
5 Provide and install approved underlayment.
Underlayment Type:
6 Provide and install new 26 gauge drip edge.
COLOR:
7 Provide and install new lead boots, goosenecks and flashing where needed.
Color varies depending on shingle color.
8 Provide and install Starter Strips, and True Hip & Ridge.
9 Provide and install algae resistant architectural shingles.
Brand: Color:
10 Provide and install GAF Cobra 3 shingles over ridge vents.
11 Remove and properly dispose of roofing debris from the job site.
12 50 year limit life time manufactures warranty.
13 Wormley Roofing Inc. will provide a 5 year workmanship warranty.
ESTIMATE NO. 1541
DATE 08/28/2018
Proposal good for 30 days.
PRICING INCLUDES ALL APPLICABLE FEES AND PERMITS. TOTAL
We look forward to working with you!
AMOUNT
8,375.00
8,375.00
All Materials are guaranteed by the manufacturer. All work will be completed according to standard roofing practices and current building
codes. Any alteration or deviation from the above specifications, will be only upon written orders and will become a written change — over
and above this agreement. Although we will exercise all due cautions, we cannot be responsible for existing cracked driveways or
damages due to rain, hail, wind or any acts of God. Any leaks that occur during the agreed workmanship period will be repaired by
Wormley Roofing Inc. Any repairs or alterations by others during the workmanship warranty period will void the warranty and Wormley
Roofing Inc. will not be hold responsible
Acceptance of Proposal: THE ABOVE PRICES, SPECIFICATIONS, TERMS AND CONDITIONS OF THIS PROPOSAL ARE
SATISFACTORY AND ARE HEREBY ACCEPTED AND IS CONSIDERED A BINDING CONTRACT. WORMLEY ROOFING,INC. IS
AUTHORIZED TO DO THE WORK AS SPECIFIED.
A 1/3 DOWN PAYMENT OF PROPOSED AMOUNT IS REQUIRED, TOTAL DUE UPON COMPLETION OF JOB, "PLUS COST OF ANY
ADDITIONAL WOODWORK. OWNER ACKNOWLEDGES THAT HE/SHE HAS READ THE ROOFING PROPOSAL AND HAS
RECEIVED A LEGIBLE COPY OF THIS AGREEMENT SIGNED BY CONTRACTOR, INCLUDING ALL TERMS AND CONDITIONS
HEREIN INCLUDED, BEFORE ANY WORK WAS COMPLETED.
Accepted By:
WRI Approval•
Down Payment
Amount:
Date Accepted:
Date Approved:
Date Received:
ADDITIONAL TERMS AND CONDITIONS
1. This contract shall be construed and the relationship between WORMLEY ROOFING, INC. (Contractor) and Homeowner (Owner)
determined in accordance with the laws of the State of Florida including specificallyChapter 713, Florida Statutes, Mechanics Lien
Law, and in particular, Chapter 713.05, Florida Statutes, which provides that Contractor shall have a lien on the real property improved
by the work for any money that is owed Contractor for labor, services, materials, or other items required by, or furnished in
accordance to this Contract. 2.
Contractor shall not be liable for failure or performances due to labor controversies, strikes, fires, weather, inability to obtain materi- als
from usual sources, --or any other circumstances beyond -the -control -of the Contractor,-whetherof-a-similar-ordissimilarnature.- 3.
Contractor shall have no responsibility for existing damages as specified on the face of this contract nor damages from rain, fire, tornado,
windstorm, or other perils, as is normally contemplated to be covered by Owner's Homeowner's Risk Insurance or Busi- ness
Risk Insurance, or unless a specified written agreement be made therefor prior to commencement of the work. 4.
During the duration of the work, Owner's Homeowner's Insurance will be responsible for any interior damage as long as the Contractor
has taken appropriate action to protect the roof during the contracted work. 5.
Contractor is fully licensed and insured and is covered by Worker's Compensation Insurance. 6.
The contract on the face hereof does not include expenses or charges for bond insurance premiums or cost beyond normal insurance
coverage, and any such additional expenses, premiums or cost shall be added to the amount of the contract. 7.
Unless the contract specifically calls for the removal, disturbance, or transportation of asbestos or other hazardous substances, the
parties acknowledge that such work requires special procedures, precautions, and/or licenses. Therefore, unless the contract specifically
calls for same, if Contractor encounters such substances, Contractor shall immediately stop work and allow the Owner to
obtain a duly qualified asbestos and/or hazardous material contractor to perform the work or do the work himself at Contractor's option.
Said work will be treated as an extra under this contract. 8.
Any alteration or deviation from the specifications on the face of this contract involving extra cost will be executed only upon written orders,
and will become an extra charge over and above the contract. 9.
SHOULD DEFAULT BE MADE IN PAYMENT OF THE CONTRACT CHARGES SHALL BE ADDED FROM THE DATE THEREOF AT A
RATE OF ONE AND ONE HALF (1-1/2 %) PERCENT PER MONTH, (18% PER ANNUM) WITH A MINIMUM CHARGE OF $2 PER MONTH,
AND IF PLACED IN THE HAND OF AN ATTORNEY FOR COLLECTION, ALLATTORNEY'S FEES AND LEGAL AND FILING FEES
SHALL BE PAID BY OWNER ACCEPTING SAID CONTRACT. 10.
IF CONTRACT IS CANCELLED BY THE OWNER LATER THAN 3 DAYS from the execution, Owner shall pay to the Contractor fifteen
percent (15%) of the contract price as liquidated damages, not as a penalty, and the Contractor agrees to accept such as
reasonable and just compensation for said cancellation. YOU HAVE 3 DAYS TO CANCEL THIS CONTRACT FROM DATE OF SIGNATURE.
11.
if material has to be reordered or restocked because of cancellation by the Owner there will be a RESTOCKING FEES. If materials were
specialty order, Owner must pay for those materials, and the specialty order material will then become the property of the Owner.
12.
THIS CONTRACT CAN NOT BE CANCELLED ONCE WORK HAS COMMENCED EXCEPT BY MUTUAL WRITTEN AGREEMENT OF
CONTRACTOR AND OWNER. 13.
This contract will expire as specified on the face of contract unless extended in writing by the Contractor. Contractor reserves the right
to revise price in accordance with costs. 14.
Workmanship Warranty is not guaranteed until contract is paid in full. 15.
Contractor is not responsible for any damage on or below the roof due to leaks by excessive wind driven rain, ice, or hail during the
period of the warranty. EXCESSIVE WIND is 65 OR GREATER M.P.H. The warranty is non-transferrable. 16.
The maximum liability for the Contractor shall be the original cost of labor and materials -for the work which Owner agrees shall be liquidated
sum, under any event of default of Contractor herein. 17.
Contractor is not responsible for construction problems of Owner's home. If pointed out and notified to Contractor, Contractor will try
to assist Owner in correcting any problems on a time and material basis. 18.
You authorize Wormley Roofing to place advertising yard signs on your property for promotion and identification purposes for workers
and material suppliers. You grant us an unlimited license to record images of the Work in any form and to reproduce those images
for advertising and promotional use. 19.
THIS CONTRACT IS COMPRISED OF THIS PAGE AND THE REVERSE SIDE OF THIS PAGE AND SHALL BE CONSIDERED THE ENTIRE
CONTRACT BY THE PARTIES. // 1
wner's Initials://j _
Date:
v :( 4 C/ Wormley
Roofing Agent Initials C 1
Grant Malo , Clerk Of The Circuit Court & Comptroller Seminole County, FL
Inst #20181y10285 Book:9218 Page:1723; (1 PAGES) RCD: 9/26/2018 11:40:58 AM
REC FEE $10.00
THIS INSTRUMENT PREPARED BY:
Name: Emma Cam bell
Address: 2473 0 YOUNG PARKWAY
ORLANDO FL 32804
NOTICE OF COMMENCEMENT
State of Florida
County of Seminole
Permit Number: Parcel ID Number. 02-20-30-510-0000-0630
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.
DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available)
LOT 63 HIDDEN LAKE VILLAS PH 2 HIDDEN LAKE VILLAS PH 2
161 SAND PINE CIR SANFORD FL 32773
GENERAL DESCRIPTION OF IMPROVEMENT:
Remove and replace roof.
OWNER INFORMATION:
Name: DAKO 1511 LLC - Trustee
Address: PO BOX 623062 OVIEDO, FL 32762-3062
Fee Simple Title Holder (if other than owner) Name:
CONTRACTOR:
Name: ROBERT WORMLEY / WORMLEY ROOFING INC
Address: 2473 N JOHN YOUNG PARKWAY, ORLANDO FL 32804
Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served
as provided by Spction 713.13(1)(b), Florida Statutes.
Name:
Address:
In addition to himself, Owner Designates of
To receive a copy of the Uenor's Notice as Provided in
Section 713.13(1)(b), Florida Statutes.
Expiration Date of Notice of Commencement (The expiration date 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.
Under penalties of'pqrjury, I declare that 1 have read the foregoing and that the facts stated in it are true
to the best of my k wied Ie d be ef. ^
r 4S i/
r
Q/all
Florida Statute 713.13(1)(9):' The owner must sign thenotice of commencement and no one else may tie permitted to sign in his or her stead.' State
of FJOr I el/A County of C Y A The
foregoing instrument was acknowledged before me this day of 20 1- OLdj
C', —A Who is personally known to me Name
of person making statement : OR
who has produced identification type of identification produced: Notary
Public State of Florida Emma
VictodaLCampbell A c :
My Commission GG 184707 - otary signature Expires
0211 V2022 J O
Nqq F;
f
CITY OF
f SkNFORD Building &Fire Prevention Division
RESIDENTIAL RE -ROOF POLICY& PROCEDURES
FIRE DEPARTMENT
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: DATE:
CITY OF
SkNFORD
FIRE DEPARTMENT
PERMIT #
Building & Fire Prevention Division
RESIDENTIAL RE ROOF SCOPE OF WORK
JOB ADDRESS: 161 Sand Pine Cir., Sandford., FL 32773
STRUCTURE TYPE: 0 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): 1 /2' Plywood
PLEASE NOTE: ONLY 100 SQUARE FEET OF THE EXISTING DECKIS PERMITTED TO BE REPLACED**
ROOF VENTILATION: D OFF -RIDGE RIDGE OSOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: O YES 0$0 IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 -4:12 Q4:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
LJ SHINGLE Atlas FL# 16305-R6
O METAL FL#
O MODIFIED BITUMEN FL#
OTORCH DOWN FL#
OINSULATED 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#
O OTHER: FL#
CITY OF
9 .CFO Building & Fire Prevention Division
RESIDENTIAL RE -ROOF AFFIDAVIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: Cz—q Gs 0 ADDRESS: 161 Sand Pine Cir., Sandford, FL 32773
I Robert Wormley , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, ENGINEER, ARCHITECT, OF F.S. C14APTER 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#: CCC1325558
COMPANY / CONTRACTOR: Wormley Roofing/ Robert4ormley
CONTRACTOR SIGNATURE: DATE:
MUST BE SIGNED BY LICENSE HOLDER 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 FLORIDA COUNTY OF C) ra-n
Sworn to and Subscribed before me this %1 day of Qf' !J' er 20 ff,__ by:
p K o r M Who is Personally Known to me or has Produced (type of
identification)
Signature of Notary Public '
State of Florida
Print/Type/Stamp --Na 'me,
of Notary Public
as identification.
Ia• Notary Public State of Florida
Emma Victoria Campbell
w My Commission GG 184707NYExpires02111/2022