104 Sandpebble Pl 17-121 RoofJAN/09/2017/MON 05:28 PM FAX No. P.001/011
CITY OF SANFORD
BUILDING & FIRE PREVENTION
4
PERMIT APPLICATION
Application No:
Documented Construction Value: $ kqqL0•\'A
Job Address: `(``a QL Historic District: Yes No
Parcel ID: Residential19 Commercial []
Type of Work: New N Addition Alteration Repair Demo Change of Use Move
Description of Work: •
Plan Review Contact Person: C''L Title: `(-MNA
Phone: AVYi•!g 4 Fax: E,oaa;a: c c e eS x•C 1V1
Property Owner Information
Name Phone: Phone: A! 1'
Street of C C'%c nQQ Resident of property? : Q%k_T\1QS'
City, State Zip:7,
r,rc9 ( C
Contractor Information
Name l ia 1 I. Phone: A
Street,.— C. Fag:
City, State Zip: N iT_i cJ1 State License No.:CQQ041% `123
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
COMMIENC)EMENT.
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 jurisdictiou. 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 Shan be inscribed with the date of application and the code in effect as of that date: 5411 Edition (2014) Florida Building Code
Revised: June 30, 2015 Permit Application
JAN/10/2017/TUE 04:46 PM FAX No, P.001/001
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 planreview charge amd 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 A.liFEDA.VIT: f 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 zonin Signature
of OwuedAgent Date Signature ot Contractor/Agent bate "sue Print
Ovmer/Agent's Name Signature
of Notary -State of Florida Date V-"
w\c e1 aPContrractor/
A
ame, SiguatureofNotary-
State ofPlorida Date J
Owner/
Agent is Personally Known to Me or Contactor/Agent is /Personally Known to YProduced
ID Type of ID Produced IDType of ID BELOW IS
FOR OFFICE USE ONLY Permits Required:
Building Electrical Mechanical plumtbing Gas Roof Construction Type:
Occupancy Use: Flood Zone: _ Total Sq
Ft of Bldg: Min. Occupancy Load: # of Stories: New Construction:
Electric - # of Amps Plumbing - # of Fixtures Fire Sprinkler
Permit: Yes No # of Heads APPROVALS- ZONING:
ENGINEERING: COMMENTS:
UTILITIES:
FIRE:
Fire
Alarm
Permit: Yes No WASTE WATER:
BUILDING: Revised:
June
30, 2015 Permit Application
JAN/09/2017/MON 05:29 PM FAX No, P. 003/011
Number;Permit
114 1:5 TS 1 to
tlY't,1,
J
NOTICE OF COMMENCEMENT
State of Florida, County of Osceola
The undersigned hereby gives notice that Improvement will be made to certain real property, and in accordancewithChapter713, Florida Statutes, the following Infor matlon is provided in this Notice of Commencement. 1, PaLcription of PrDpajjty.Jegal ptlo of the arjv st taddr e if a I !
2. General description of improvem _
r-rf -
3. Owner mforn fo o s8e@ rofor ation if the Lessee contracted for the ImprovementName—t`C``\ MLi\E„Rgg
Interest In Property -'—`
Name and address of tee simple titleholder (if different from Owner listed above) Name
Address
4, Gqntr ct
Name Q.Ma Telephone Numb GAddresZ
5. Surety Cf applible, a copy of the payment bond is attachedl
Address Telephone Number
6. Lender Amount of Bond S
Name
Address Telephone Number
7.
Persons within the State of Florida designatod by Owner upon Whom notices or other documents maybeserved
t
a Irvided by §713.13(l)(a)7, Florida Statutes.
Address Telephone Number
8. to addition to himself or herself, Owner designates the following to receive a copy of theNoticeitpvldedin §713.13(1)(b), Florida Statutes, Lienor's
Name J
Address Telephone Number
9.
o yr caq,mencement (the expiration date wlit be 1'year from the datea of recordingdifferentdateIsspecified)
WARNING To OWNER; ANY PAYMENrs MADE 13Y THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMIENCEIVIENTARECONSIDEREDIMPROPeRPAYMENTSUNDERCHAPTER718, FART I, SECTION 71&13, FLORIDA STATUTE$, AND CANRESULTINYOURPAYINGTWICEFORIMPROVEMENTSTOYOURPROPERri, A NOTICE OF COMMENCENIENT MUST tat: ' RECORDED AND POSTED ON THE ros SITE BEFORE THE PIRST INSPECTION. IF YOU INTEND TO DETAIN FINANCING. CONSULTWITHYOURLENDERORANATTORNEYBEFORECOMMENCINGWORKORRECORp1P1QYOURNOTICE
IN
COMMENCEMENT.
CONS
Slenalurg nt A,.....,. ---. V Cu r! OWJ3 J r Lessee, r Owners or Lessee's Authorized Ol6cerlDirecforpertnewMana er4 Signatorys Tille/p(fice
The foregoing instrument was acknowledged before me this lot day of ?-( i„by .
a3 rnort ear
for name of pe on
Type of aulhonly, e.g., oRiGer, trustee, attorney In fact Name of party on behalf ofwhom 1na11Ument was d"cuted
Slgnatura of Notary Publre — State of Fforide
Print, type. or stamp commisaloned name of Not>;ry PuWtc
Personally Known C)R Produced ID !
Type of 1D Produced..*
i t7I ;tv_r MARISGL 7ACRi ti
STATE. OF PLORIDA Form
content revised: 01/23/14 4KRI CXa:fB s 1fi' i2G 1( Recorded
In Osceola County, FL ARMANDO RAMIREZ, CLERK OF COURT 12/19/2016 03:27:49 PM RECEIPT # 1899201 Rec
Fees 10.00 EXTRA NAMES CFN#
2016187311 eK 5073 PG 1082 PAGE 1 OF 1
JAN/09/2017/MON 05:30 PM FAX No, P,004/011
11/4/2016 Florida Bullding Code Online
3i.yt:i•:9i$;i:i1,::1 1»+:,1:S t'.?. :+1r;N,,'`.ia`r1: `' i:9'';.•`:i• r`•'c'
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aCbs Home Log to User Registration Hot Taplcs Submit surcharge Slats & Fad$ Publications Fac 5taff aCls Site Map Links Searoi
dbpr(! Product Approval
4 USER: Public user
r : • t• `:. ? > -.. _ s Application Detail
1
r FL FL16305-R4
Application Type Revision
Code Version 2014
Application Status Approved
Comments
Archived
Product Manufacturer
Address/Phone/Email
Authorized Signature
Technlcal Representative
Address/Phone/Email
Quality Assurance Representative
Address/Phone/Email
Category
Subcategory
Compliance Method
Atlas Roofing Corporation
2000 RlverEdge Parkway
Suite 800
Atlanta, GA 30328
770) 946-4571
mcolllns@atiasrooflng.com
Meldr n Collins
mcollinsOatlasroofing.corn
Roofing
Asphalt Shingles
Evaluation Report from a Florida Registered Architect or a Licensed
Florida Professional Engineer
Evaluation Report - Hardcopy Received
Florida Engineer or Architect Name who developed Zachary R. Priest ,
the Evaluation Report
Florida License PE-74021
Quality Assurance Entity UL LLC
Quality Assurance Contract Expiration Date 12/31/2020
Validated By Locke Bowden
Validation Checklist - Hardcopy Received
Certificate of Independence
Referenced Standard and Year (of Standard) Standard Year
ASTM D 3161 2009
ASTM D 3462 2009
ASTM D 7158 2008
TAS 100 1995
TAS 107 1995
Equivalence of Product Standards
Certified By
Sections from the Code
1AN/09/2017/MON 05:30 PM FAX No, P.005/011
CREEK ATLAS ROOFING CORPORATION
Asphalt shingles
INSTALLATION
G1assMaster® 30 & Basic Wind Speed (VW,): Tough"Master® 20 Basic Wind Speed (V„d):
Deck (HVHZ):
Deck (Non-HVHZ):
Undedayment:
Min, slope:
Installation (HVH,Z):
Installation (Non-HVHZ):
Max. 194 mph
Max. 150 mph
In accordance with FBC requirements;
Solidly sheathed min, 19/32 in. plywood or wood plank fornewconstruction; Min. 15/32 In. plywood existingconstruction.
In accordance with FBC requirements;
Solidly sheathed min. 15132 in, plywood or wood plank for
new construction; Min. 7/16 In. OSS existing construction. In accordance with FBC requirements,
2:12 and in accordance with FBC requirements, Contact
the Atias Roofing Corporation when installing at slopegreaterthan21:12.
Installed with 5-inch exposure in accordance with RAS 115
and manufacturer's published Installation Instructions. Shingles shall be attached using "B Nall Pattern" detailedbelow.
Installed with 5-Inch exposure In accordance with FBC
requirements and manufacturer's published installationInstructions. Shingles shall be attached using either"4 NallPattem" or'B Nail Pattem" detailed below.
s r; .
4 r .ern
12
Figure 1. GlassMastar9 30 & Tougtr-Master® 20
4 Nail Pattem (Noo-HVHZ, only)
Mirs
12" M _
4
jam-- 12'----••._. f2.r---+---•12"—...-
Figure 2. GlassMastero 30 & Tough -Master® 20
6 Nail Pattern
ATL13002.4
FL 16305-R4
This evaluation. report is provided for State of Florida product approval under Rula 6tGae-3. Fba cnanrrfacturar shall not —CREEKTechnicalSeMces, LLC of any product changes or qustity assurance, changes throughou4 the duration for which this report is valid. This eveluallon report does not express nor imply warranty, Installation, recommended use, or other product attributes that are notapeclficallyaddressedherein.
JAN/09/2017/MON 05:30 PM FAX No, P, 006/011
CREEK ATLAS ROOFING CORPORATION
Asphalt Shingles
Pro -Cute Starter Strip Basic Wind Speed (V„„): Max. 194 mph
Basic Wind Speed (V99d): Max. 150 mph
Deck (HVHZ): In accordance with FSC requirements;
Solidly sheathed min, 19132 in. plywood or wood plank fornewconstruction; Min. 15/32 in. plywood existingconstruction.
Deck (Non-HVH-7): In accordance with FBC requirements;
Solidly sheathed min. 15/32 In. plywood or wood plank fornewMin. 7/16 in.
Underlayment: In cco dancelwith FBC requiremments sting construction.
Min, slope: 2:12 and In accordance with FBC requirements. Contact
the Atlas Roofing Corporation when installing at slope
Installation (HVHZ):
greater than 21,12.
Installed In accordance with RAS 115 and manufacturer's
published installation instructions. Shingles shall be
attached as shown below.
Installation (Non-HVHZ): Installed in accordance with FBC requirements and
manufacturer's published Installation instructions, Shingles
shall be attached as shown below.
T-1I
777
Figures. Pro-CWID Startar Strip
ATL130QZ4
This evaluaFL
18305-R4 Page
7 of 8 tionreportisprovidedforStateofFloridaproductapprovalunderRule6102D-3. The manufacturer shall notify CREEK TechnicalServices, LLC o{ any product changes or quality, assurance: 0hanges throughout the duration for which this report Is valid, ThisevaluationreportdoesnotexpressnorImplywarranty, installation, recommended use, or other product attributes that are not spaclflcallyaddressedherein.
JAN/09/2017/MON 05:30 PM FAX No. P.007/011
7rz6 20t6 Florida Building Code Online
a !` 1J '7 4 ,:.;
t3iTHAi •Lr,
K{f
Cr'i l'y'S. A° "`
m/+`a4.' { ..j} ,.
hrotC; Iisr9 R' apM tu,aloNs.co macruam
usines';L
Professi6n"-a PEApproval R:
Pubuhiic User USER: fir
w . ,,,-,„
a • _ _ .wd -.0 i_L•_. > L x > AppGcatlon Detail FL #
FL17322-PI Application
Type Revision Code
Version 2014 Application
Status Approved Comments
Archlved
Product
Manufacturer Atlas Roofing Corporation Address/
Phone/Email 2000 RiverEdge Parkway Suite
Boo Atlanta,
GA 30328 770)
946-4571 mc0111ns(
99atlasroofing.com Authorized
Signature Me(drin Collins mcoll
In s®atiasroofi ng,com Technical
Representative Address/
Phone/Emall Quality
Assurance Representative Address/
Phone/Email Category
Roofing Subcategory
Underlayments Compliance
Method Evaluation Report from a Florida Registered Architect or a Licensed Florida
Professional Engineer Evaluation
Report - Hardcopy Received Florida
Engineer or Architect Name who developed Zachary R. Priest the
Evaluation Report Florida
License PE-74021 Quality
Assurance Entity UL LLC Quality
Assurance Contract Expiration Date 1Z/31/2020 Validated
By Locke Bowden Validation
Checklist - Hardcopy Received Certificate
of Independence Referenced
Standard and Year (of Standard) FL17322
R1 COI ATL1dOp1 1 2014 FBC Evaluation Report Atlas Vtlderlavments.
od( Standard
year ASTM
D 1970 2009 ASTM
D 226 2006 ASTM
D 2626 2004 ASTM
D 4869 2005 ASTM
0 6380 2003 TAS
103 199E TAS
110 1995
JAN/09/2017/MON 05:31 PM FAX No, P.008/011
7/262010 Florida Building Code Online
Sections from the Code
Product Approval Method Method 1 Option D
Date Submitted 04/19/2015
Date Validated 04/20/2015
Date Pending FBC Approval 04/23/2015
Date Approved 06/22/2015
199"ary of Products
FL # Model, Number or Name Description
17322.1 Atlas underlayments . For use In steep slope roofing
units of use Installation Instructions
Approved for use in HVHZ: Yes FL17312 1 1 [i AiLl40J11 _L,? ram' F9'- ^+ ' r a._,;, c eat
Approved for use outside MVHZ: Yes Vnderloyments.rdf
Impact Resistant: N/A Verified By: Zachary R. Priest 74021
Design Pressure: N/A Created by Independent Third Party: Yes
Other; See evaluation report for limits of use. ; Evaluation Reports
F11 322 RI AE A7L14001 1 2014 FBC Eyaluanon Report
Atlas Underlavments.odf
Created by Independent Third Party: Yes
Con :: ,2603 Blair Stone Road. 7alhhassee FL 32394 prrone: 850-407.1824
The state of Florida is an AA/EEO eMoloyer. Copyright 2007-2013 5WA of Florida- :: Pdvacv Statement :: A TA1W Statement :: Rkfund Statement
Under Florida law, email addresses arc public racords. if you do not want your e.m20 address released In response to a public -records request, do not send electronicmalltothisentity. lrrAoad, contact the ORita by phone or by tradrtlonal mall. If you have any questions, please contact 850.487.1395. *pursuant to section455.275(3), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must provide the Department with an emell address If they haveone. The ema114 provided may be used for offlcial communication with the licensee. However email addresses ere public record. IF you do not wish to supply e
personal addrem, please provide the Department with an email address FS Can be Mae
please c Ck
avallable to the public. To determine If you are 8 licensee under Chapter
Product Approval Accepts!
Cxedir card
Safe
JAN/09/2017/MON 05:31 PM FAX No. P.009/011
CREEK
TECHNICAL SERVICES, LLC
EVALUATION REPORT
Manufacturer; ATLAS ROOFING CORPORATION
2000 Riveredge Parkway, Suite 800
Atlanta, GA 30328
770)612-6267
www.atta srcofina.Com
Quality Assurance: UL LLC (QUA9625)
SCOPE
Certificate of Authorizat/on No, 29924
17S20 Edinburgh Dr
Tampa, FL 33647
813)480-3421
2014 FLORIDA BUILDING CODE
Issued Apol 19, 2015
Categopy; Rooting
Subcategory. Undarlayments
Code Sections: 1507.2.3. 1507.2.4. 1507.2.8. 1507.2.9.2, 1507.3.3. 1507.4.5.1, 1507.4.5.2,
1507.4.5.3, 1507.5.3, 1507.5.3.2, 1507.6.3, 1507.6.3.2, 1507.6.5, 1507.7.3,
1507.7.3.2, 1507.8.3, 1507.8.3,2, 1507.8.8, T1507.8, 1507.9.3, 1507.9.3.2, 1507.9.5,
1507.9.9. 1518.4, 1523.1.1, 1523.6.5.2.1
PF0per1i93: Physical properties
REFERENCES
Entity
PRI Construction Materials: Technologies (TST6049)
Report No.
ATL-033-02-01
Standard
ASTM D 226
Ygar
PRI Construction Materials Technologies (TST6049) ATL-068-02-01 ASTM D 1970
2006
2009PRIConstructionMaterialsTechnologies (TST6049) ATL-068-02-01 ASTM D 4798 2001PRIConstructionMaterlatsTechnologies (TST6049) ATL-068-02-01 TAS 110 2000PRIConstructionMaterials, Technologies (TST6049) ATL-089-02-01 ASTM D 1970 2009PRIConstructionMaterials. Technologies,(TST6049) ATL-090-02-01 TAS 103 1995PRIConstruction. Materials Technologies (TST6049) ATL-149-02-01 ASTM D 1970 2009PRIConstructionMaterialsTechnologies (TSTe049) ATL-164-02-01 ASTM D 197G 2009PRIConstructionMaterialsTechnologies (TST6049) MSA-004-02-01 ASTM D 1970 2009PRIConstructionMaterialsTechnologies (TST6049) NEI-006-02-01 TAS 103 1995PRIConstructionMaterialsTechnologies (TST6049) NEI-029-02-01 ASTM 0 1970 2009PRIConstructionMaterialsTechnologies (TST6049) NEI-045.02-01 TAS 103 1995PRIConstructionMaterialsTechnologies (TST6049) NEI-045-02-01 ASTM D 4798 2001PRIConstructionMaterialsTechnologies (TST6049) NEI-045-02-01 TAS 110 2000PRIConstructionMaterlalsTechnologies (TST6049) NEI-046-02-01 Tensile Adhesion 2007PRIConstructionMaterialsTechnologies (TST6049) NEI-062-02-01 ASTM D 1970199520092009PRIConstructionMaterialsTechnologies (TST6049) NEI-063-02-01 TAS 103
PRI Construction Materials Technologies (TST6049) NEI-063-02-01 ASTM D 4798 2001PRIConst'ruction Materla aTechnologies OST6049) NEI-063-02-01 TAS 110 2000PRIConstructionMaterialsTechnologies (TST6049) NEI-076-02-01 TAS 103 1995PRIConstructionMaterialsTechnologies (TST6049) NEI-076-02-01 ASTM D 4798 2001PRIConstructionMaterialsTechnologies (TST6049) NEI-076-02-01 TAS 110 2000ULLLC (FST1740)
UL LLC (SST1740)
02-NK40952 ASTM D 1970 2009
UL LLC (11ST1740)
02-NK40952
02-NK40952
ASTM D 226
ASTM D 2626
2006
2004ULLLC (11ST1740)
UL LLC (TST1740)
02-NK40952 ASTM D 4869 2005e01
02-NK40952 ASTM D 6380 2003 (21)09)
ATL14001:1 FL1
Page t of 4
This evaluation report is provided for State of Florida product approval under Ruts BRG2U-3. The manufacturer shall notify CREEKTechnicalServices, LLC of any product changes or quality assurance changes throughout the. duration for which this report is valid. This. evaluation report does. not express nor Imply warranty, installation, recommended use, or other product attributes that are notspecificallyaddressedherein.
JAN/09/2017/MON 05:31 PM FAX No. P.010/011
CREEK ATLAS ROOFING CORPORATION
Rooting Undarlayments
TECMNI/'AL SEpL L•;:Ei Lt..,
APPLICATION METHOD
Installation shall be In accordance with the published manufacturer's installation instructions, the FBC, and the
requirements below.
Deck substrates shall be clean, dry, and free from any Irregularities and debris. All fasteners in the deck shall be
checked for protrusion and corrected prior to underlayment application,
The roof deck shall be constructed of closely fitted plywood sheathing for new or existing construction. Plywood deck
shall be installed In accordance with FBC requirements. Roof decks shall have no more than '/a" gap at abuttingjoints.
Exposure of the underlayments shall be limited to a maximum 30 days except as follows:
a) #15 Speclftcation Felt, #30 Specification Felt, and 940 Base Sheet — exposure for than 24 hours may
adversely affect product performance
b) WeetherMasterG Granular SE or WeatherMaster(sP Granular— maximum 14 days
c) WeatherMaster® POlyseal SE and WeatherMaster® TU Ultra SE — maximum 90 days
d) WeatherMaster® TU Ultra —maximum 180 days
Self -adhering underlayments may be adhered to the following substrates as follows in the non-HVHZ:
e) WeatherMasterO Granular, WeatherMaster® Polyseal, or WsatherMasteriSi TU Ultra — primed
concrete, plywood, primed plywood, OSB, or primed OSS
b) WeatherMaster(D Granular SE, WeatherMasterG Polyseal SE, or WeatherMasterO TU Ultra SE —
plywood or primed plywood
c) WeatherMaster® Granular or WeatherMasterO TU Ultra — t7enSDBck Prime
d) WeatherMaster® Polyseal—ACFoam HS
Roof coverings shall be mechanically fastened through the underlayment to the roof deck except as follows (or as
indicated ir) other current FBC product approval documents):
8) WeatherMaster0 TU Ultra -- Convenience Products Touch n' Sea) StormSond Roof Tile Adhesive or
3M 2-Component Roof Tile Adhesive AH-160
b) WeatherMasterO Polyseal SE or WeatherMasterO TU Ultra SE — 3M 2-Component Roof Tile Adhesive
AH-160
c) Slate/Tile Underlayment or #90 Mineral Surface Roll Roofing — Convenience Products Touch n' Seal
StormSond Roof Tile Adhesive, Dow TileBond, or 3M 2-Component Roof Tile Adhesive AH-160
Allowable Roof Coverings:
Matal Roof Wood,
Asphalt Panels and Compoafte Shingles and slate Clay andUnderlaantShinglesShinlesshlrllesShakesShinalesConcreteniatS
specification Felt Y Y Y Y Y N 30
Organic Saturated Felt Y Y Y Y Y N 430
Specification Felt Y Y Y Y Y Y 43
Mtm Shoot Y Y Y Y Y Y 090
Mineral Surface Roll Roofing YI N N N N Y Carina
Guard® EVERFELT 30 Y Y Y Y Y N 9lateMlaUnderfayrrtent
YI N N N N Y WeatherRiaster®
Granular Y N Y Y Y N WeatherMastot®
Polyseal Y Y Y Y Y N WeatherMeater®
TU Ultra Y Y Y Y Y Y WoatherMasta&
200 SE Y N Y Y Y N WoatherMasterO
Film SE Y Y Y Y Y N WeatherMasterVGranular
SE V N Y Y Y N WeatharMasterO Polysaal
SE Y Y Y Y Y Y W.eatheri0astar®
YU Ultra SE F.1—+
ten. Y Y
Y Y Y Y Open valley
applications per 1507.2.9.2 ATM0011.1
FL17322-RI Page 3 of 4 This evaluadon
report Is provided for State of Florida product approvat under Rule M204. The manufacturer shall notify CREEK Technical, Services,
LW of any product changes or quality. assurance Changes throughout the duration for which this report is valid. This evaluatlon
report does not express nor Imply warranty, Installation, recommended, use, or other product aftrlbutes that are not specifically addressedherein.
JAN/09/2017/MON 05:32 PM FAX No. P.011/011
iWC ROOFING, INCv
Mailing Address: WWW.ANCROOFING.COM720BusinessParkBlvd., Unit #10. ,r 866 Mason Ave. Suite #4
Winter Garden, FL 34787 Dayton Beach, FL 32117
GREATER ORLANDO G"DAXTONAA
Ph: (407)654-4500 PROPOSAL/CONTRACT,."; Ph: (386)316.7443
State Roofing License'No. CCC04817.1
State Building Uceme NO-CRC035325 LICENSED / BONDED / INSURED WIND and HAIL DAMAGE SPECIALIST
PROPOSAL SUBMITTED TO WORK TO BE PERFORMED AT:
NAME i/ I J 44 t +r t'% NAME
STREET ! a e lib le % STREET
CITY 7,X -77 CITY i t
PHONE
CELL YO `l - li r.7 026, 'EMAIL
SCOPE OF WORK:
Replace Roof Svstem as per the agreed Scope of Loss while following the Current Building Code.
Re Nail Deck, replace all accessories such as Boots, Vents and Eave.drip and Provide adequate ventilation as per current building code.
All work in a workmanlike manner and prdfesSlonal conduct.
Clean Roof/Grounds and remove all roofinglconstruction debris from property,
Provide a Sulldln Permit and all re uired Inspection Approvals to Include a Final Inspection.
Notes: n C)+ i' C iltr C lA I A!
Sky Llght Option:
Secondary Water barrier Option:
Cricket Option:
Low Slope Option:
Notes-
f
FOR THE SUM OF: Agreed amount by ANC Roofing Inc. and the Insurance Company.
NOTE: 1. Replacement of any unforeseen bad or rotted wood will be installed at an additional charge and will be billed to the
Insurance company during and after completion of roof.
2. This proposal is subject to the acceptance within N/A days and is void thereafter at the option of the contractor.
3. All proposals subject to approval by A N C Management,
4. SUPERVISION AND QUALITY CONTROL. The Contractor shall supervise and direct the work, using his best skill and aitentlon.
The Contractor shell be solel responsible for all construction means, methods, techniques, sequences, procedures and for
contracting and performing all portions of the work and quality control under the Contract.
5. DELAYS, ETC. Purchaser hereby acknowledges that weather patterns may delay the job equal to the storms length and
duration which is beyond the control of the Contractor and Purchaser hereby accepts the delays occasioned by these
Circumstances. Purchaser further agrees to pay 25% of the total contract price to the Contractor due to premature cancellation
of the contract.
6. PAYMENT. Purchaser'hereby agrees that if the amounts due and owing hereunder are not paid when due, Purchaser
shall be liable to pay all costs of Collection, dispute, including, but not limited to reasonable attorneys fee and costs, which amounts
together with all sums due and owing hereunder, shall bear Interest at the maximum allowed industry rate.
7, ANC Roofing, Inc. Is not responsible for faultylnadequately reinforced driveway or A/C lines or Electrical lines too close to the deck.
8. Any unforeseen/hidden double roofs (double tear off) not noted in this contract wilt be at an additional charge.
9. In no event shall the contractor's obligation over the Ilfe of this warranty exceed the price paid for the roof.
Notes:
WARRANTY TERMS: < C + r`r' L'i+' ^ l'h Aq h"
Date, '' ANC Roofing, Inc. Authorized Signature:
ACCEPTANCE OF AGREEMENT
Terms: This agreement. Is for full Insurance scope of loss proceeds and Is subject to Insurance .company's
approval and does not obligate homeowner or ANC Roofing, Inc. unless homeowner's insurance company
approves repair or replacement of roof and/or other damages. By signing this. agreement the homeowner authorizes
ANC Roofing, Inc. to pursue homeowner's best interest for repair or replacement of roof and/or other damages at a'
price agreeable. to the ins..co, and ANC. Homeowner Is res orisible for deductible and The final price agreed'on
betweenthe insurance company and ANC shall become the final contract price .of: FULL SCOPE OF INSURANCE PROCEEDS,
The'specifications set out. herein to accomplish the repair. or replacement of roof and/or other damages. In
the event of the claim being settled through a Public Adjuster or Legal Assistance referred by ANC, this contract will
still be fully executed and in effect under the terms specified within. ' Insurance
Co 17 ' ''Q ! Accepted by tT,vner/euysr Al)*/2
P
Claim #
ocj I . ?iA t' G i Consultant
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j e"'iazz Wre 5 City of Sanford
Building & Fire Prevention Division
I 02 r Re -Roof Permit Card
PERMIT NO. 1 I a! I I ISSUE DATE: 1.19-13
CONTRACTOR:
ILL' *Wdm
TYPE OF WORK:
Post this Permit in a conspicuous place outside PROTECT FROM WEATHER
Approved plans must be posted with permit for inspection
Leave all work uncovered until inspected
Permit expires six (6) months from date of issue or last approved inspection
A ROOF DR Y-IN INSPECTION IS REQUIRED * * *
For Inspection procedures, please refer to the re -roof inspection guidelines provided to you when the permit is issued.
The Miti atgionAffidavitwillnotsufficeasanalternativetoreceivingadry -in inspection.
ROOF
INSPECTION TYPE APPROVED RLJL•"C7LD INSPECTOR
MISCELLANEOUS
INSPEC7 ON TYPE APPROVED 1tF_JEC7F.D INSPECTOR
ROOF DRY -IN
MITIGATION AFFIDAVIT
FINAL ROOF
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: October 2014 Inspection Line 855.541.2112
TO SCHEDULE AN INSPECTION:
Dial855.541.2112
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 3:30 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
ROOF
Roof Dry In 116
Mitigation Affadavit 129
Final Roof 111
Miscellaneous Notes:
Miscellaneous
Sheathing - Roof 106
Insulation - Roof 119
REVISED: OCTOBER 2014 Inspection Line: 855.541.2112
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
Application Number . . . . . 17-00000121 Date 1/18/17
Application pin number . . . 887692
Property Address . . . . . . 104 SANDPEBBLE PL
Parcel Number . . . . . . . . 33.19.30.514-0000-0570
Application type description ROOFING APPLICATION
Subdivision Name . . . . . .
Property Zoning . . . . . . . PUD
Application valuation . . . . 5457
Application desc
reroof/shingles NOC ON FILE
Owner Contractor
MONTERO DAVID P & SANDRA I ANC ROOFING INC
104 SANDPEBBLE PL 720 BUSINESS PARK BLVD
SANFORD FL 32771 WINTER GARDEN FL 34787
407) 417-0205 (407) 654-4500
Structure Information 000 000 REROOF/SHINGLES
Roof Type . . . . . . . . . FIBERGLASS SHINGLES
Permit . . . . . . RESIDENTIAL ROOFING PERMIT
Additional desc . .
Phone Access Code 968693
Permit pin number 968693
Permit Fee . . . . 82.00
Issue Date . . . . 1/10/17 Valuation . . . . 5457
Expiration Date . . 7/09/17
Qty Unit Charge Per Extension
BASE FEE 40.00
6.00 7.0000 THOU BLDG PERMIT -CC APPRVD 9.27.10 42.00
Special Notes and Comments
All projects within the City shall use
WastePro for debris removal. Please
contact WastePro at 407.774.0800.
Normal hours for inspections are from
7:30 through 4:30 Monday through
Thursday. Please be aware you must
contact the Building Official to
schedule a Friday or after hours
inspection. This is required since not
every inspector is licensed to do every
type inspection. Communication is the
key, so please contact the Building
Official if you have any questions at
407.688.5058 or at
dave.aldrich@sanfordfl.gov
Other Fees . . . . . . . . . 01-APPLCTN FEE -BUILDING 25.00
01-BLDG PLAN REVIEW 18.00
01-BLDG DCA SURCHARGE 2.00
01-BLDG DBPR SURCHARGE 2.00
7------------------------------
Fee summary Charged Paid Credited Due
Permit Fee Total 82.00 .00 .00 82.00
Other Fee Total 47.00 .00 .00 47.00
Grand Total 129.00 .00 .00 129.00
300 N PARK AVE
SANFORD, FL 32771
SALE
MID: 9520 Store: 4616 Term: 2902
REF#: 00000001
Batch #: 192 RRN: 701817415961
01/18/17 12:53:25
Trans ID: 0118MDBXQGR6H
APPR CODE: 693049
MASTERCARD Manual CNP
5676
AMOUNT $129.00
APPRCIVFI
Oper: ANTONINIL Type: OC Drawer: I
Date: I/IB/17 01 Receipt no: 59876
BP
2017 121
BUILDING PERMIT RECEIPTS
1.00 $129.08
CC CREDIT CARD $129.00
Total tendered $129.09
Total payment $129.00
Trans date: 1/18/17 Time: 12:59:09
FAILURE TO COMPLY WITH MECHANIC'S LEIN LAW CAN RESULT IN THE
PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS.
NOTE: ALL FEES MUST BE PAID PRIOR TO C.O. BEING ISSUED.
NOTE: PLEASE BE ADVISED ALL PERMITS MUST BE INSPECTED.
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 . . . . . 17-00000121 Date 1/18/17
Property Address . . . . . . 104 SANDPEBBLE PL
Parcel Number . . . . . . . . 33.19.30.514-0000-0570
Application description . . . ROOFING APPLICATION
Subdivision Name . . . . . .
Property Zoning . . . . . . . PUD
Permit . . . . . . RESIDENTIAL ROOFING PERMIT
Additional desc .
Phone Access Code 968693
Permit pin number 968693
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
10-1000 129 BL29 MITIGATION AFFIDAVIT
10 116 BL15 ROOF DRY -IN
1000 111 BL03 FINAL ROOF / /
CITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #: Io - I a I
I, kc fYY-)n 1 C hereby acknowledge that I personally inspected
Roof deck nailing and/or Secondary water barrier work
at 1--A Q1 and have determined that the work
Job Site AddreNs)
was done according to the Hurricane Mitigation Retrofit Manual. (based on 553.844 F.S.)
I certify that my statements herein are true and accurate to the best of my belief and that I fully
understand that making any false statements in writing with the intent to mislead a public servant in the
performance of his or her official duty shall constitute a misdemeanor of the second degree pursuant to
Sectio .06 F.S.
ontractor
Name of Contractor
Q-L 1177Date
License #
License Type: General 0 Building Residential Z Roofing Contractor
or any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF c S
Wmcornto (or of it ed) and subscribed before me this _ day of , 20 )j , byVSM , who is d Personally Known to me or has Produced (type of
yf 'fication) as identification.
SEAL)
Signature of Notary Public
State of Florida
Print/Type/Stamp Name
of Notary Public
SANDRA E PERE2rAus•
Notary Public - State of Florida
Commission # FF 947269
My Comm. Expires Dec 30, 2019
Bonded through National Notary Assn.