105 Laguna Ct - BR18-002974 - REROOFCITY OF
Sk ORD
FIRE DEPARTMENT
Building 8 Fire Prevention Division
PERMIT APPLICATION
Application No: N T J tl!
Documented Construction Value: S
Job Address: l0 S LA -GU a/A- CT . 3"f=Q1Zb Historic District1: Yes No®
Parcel ID: Residential (Commercial
Type of Work: New Addition Alteration 9 Repair Demo Change of Use Move
Description of Work: R 6 !Qo F:
Plan Review Contact Persova5y$/6 Ztc i_"A-G19 Title: ` Phone:
C(0J-2,'>Z:'2(g V1 Fax:32/—VY5— (//%( Email: cr a ivereo aos.oecinll s f Property
Owner Informationt4i%w Name
11e.}e N 3)MINOn Phone: O .
Street: S LAckulla e..T Resident of property?: s City,
State Zip: S6D_T:!2KC1 Contractor
Information Name
f eci)1A a ^,-4 TS Phone: qol- Z5Z_ 96 41 Street:
JO I p6fer-A f(6( iV d Fax: ei1 -
C4y,-State Zip: '%ry\o4e., Pn m 3z'+14 -Siaie-Li-ce-nai3o:: O—CC 13Z9'(00 Architect/
Engineer Information Name:
Street:
City,
St, Zip: Bonding
Company: Address:
Phone:
Fax:
E-
mail: Mortgage
Lender: lq 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 XECURZ150D
AND_)?US'1T DUIV 7ffJUJ3 b I'1-14YFOW fffE 1T161-11491EC Y_ 1OR -1-F_YUU 1N1'E11TO_T U U131'191N 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. FBI. •iv.
i:Etiaii('iC Sit 3:.filiw,'.6itIS iltC 3oi'v of application all ilty CvuC in (20%i1) iv.... uuii i. - 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 ofthe property ofthe 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 -cone uction -and -zoning.
Ae--7
7 d /8
Signs of /Agent D gnaturc of Contrac gent Date
r vS
Print Dwner/Agent' ame Print Contract r/ gent' Name
0 A 10 _."fl "V:710 '/"`7d /P L
i awro of Notary -State of Fi 'da Date Si ature of Notary -State of F 'da
a+ " •. NATHALIE JARAMILLO
i° NATHALIE JARAMILLO Notary Public State of Florida
Notary Public - State of Florida y • Commission p GG 215712
y®`= Commission # GG 215712 ~?ov n My Comm. Expires May 8, 2022
My Comm. Expires May 8, 2022 Bonded through National Notary Assn.
Bonded through National Notary Assn.
Owner/Agent is P Contractor/Agent is ? Personally Known to Me or
Produced ID _ Type of ID i L LAC - V$4— Produced ID Type of ID
BELOW IS FOR -OFFI-CE USE -ONLY
Permits Required: Building Electrical Mechanical Plumbing[] Gas Roof
Construction Type:
Total Sq Ft of Bldg:
Occupancy Use:
Min. Occupancy Load:
Flood Zone:
of Stories:
New Construction: Electric- # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes[] No
APPROVALS: ZONING:
NCi1N l;KI1VCi:
COMMENTS:
of Heads
UTILITIES:
5tk
Fire Alarm Permit: Yes No
WASTE WATER:
3OE 171NG:
Revised: January 1, 2018 Permit Application
5/15/2018 SCPA Parcel View: 1D-20-30-503-0400-0560
PM eft, Record Card
Parcel: 10.20-30.503-0400-0560
tzwuaourodstrv,tonox Property Address: 105 LAGUNA CT SANFORD. FL 32773
Parcel Information Value Summary i
Parcel 10-20-30-503-0400-0560
Owner(S) LANE, JACLYN A - Tenants in Common
LANE, JONATHAN R - Tenants .in Common
Property Address 105 LAGUNA CT SANFORD. FL 32773
Mailing 105 LAGUNA CT SANFORD, FL 32773-5545
Subdivision Name HIDDEN LAKE PH 2 UNIT 1
Tax•Dislrict S1=SANFORD`
DOR Use Code 01-SINGLE FAMILY
Exemptions 00-HOMESTEAD(2005)
G•
7
6 •
Seminole Count GIS,
Legal Description - -
LOT 56 BLK 4
HIDDEN LAKE PHASE If UNIT I
PB 24 PGS 15 TO 17
V201U8Working 2017 CertifiedsValues
Valuation Method Cost/Market Cost/Market
Number of Buildings 1 1
Depredated Bldg Value 101,823 83,193
Depreciated EXFT Value S851
T
901
Land Value (Market) 30,000 25.000
Land Value Ag
Just/Market Value " 132,674 109,094
Portability Adj - -
Save Our Homes Adj 62,233 40,102
Amendment 1 Adj 0 -
P&G Adj 0 0
Assessed Value 70,441 68,992
Tax Amount without SOH: $1,289.46
2017 Tax Bill Amount $600.80
Tax Estimator
Save Our Homes Savings: $688.66
Does NOT INCLUDE Non Ad Valorem Assessments
Taxes I
Taxing Authority Assessment Value Exempt Values Taxable Value
County General Fund 70."1 45,441 25,000
Schools 70,441 25.000 45,441
City Sanford 70.441 - - 45.441 - 25,000
SJWM(Saint Johns Water Management) 70.441 45,441 25,000
County Bonds - 70,"1 45,441 25,000
Sales
Description Date Book Page Amount Qualified Vadlmp
WARRANTY DEED 7/1/2004 05404 12,53 132,500 Yes Improved
WARRANTY DEED 7/1/2001 04162 1 QD4 101,500 Yes Improved
WARRANTY DEED 11/1/1998 03543 192] 70,100 Yes Improved
QUIT CLAIM DEED 2/1/1992 54,900 No Improved
WARRANTY DEED 11/1/1980 jJ1307 rzg5 45,600 Yes Improved
N1 d Cormparaole stws l
Land
Method Frontage Depth Units Units Price Land Value
LOT 0.00 0.00 - 1 $30,000.00 $30,000
Building Information
http://pareeldetail.scpafl.org/ParceiDetaillnfo.aspx?PID=10203050304000560 1 /2
This Instrumeot Prepared by and Return to:
tohn Taylor
Fassett, Anthony & Taylor. P.A.
1325 W. Colonial Or.
Orlando, FL 32804
Our File No.: 1178.19 (Toni Suveney)
Property Appraisers Pared Identification (Folio) rumbas:
10.20.30-503-0400-0560
SPA CEASOVE THIS UVF. FOR RECORDbvG DATA
COU86 copy OIoriginal rAlidr hit beer sent
to reco "
ITHS WARRAIN DEED, made the 21st day of June, 2018 by Jonathan R. Lane and Jaclyn A. Lane, husband and
wife, whose post office address is 105 Laguna Court, Sanford, FL 32773, herein called the grantor, to Jeffrey R. SheltonandColetteN. Shelton, husband and wife, whose post office address is: 105 Laguna Court, Sanford, FL 32773s,
hereinafter called the grantees:
Wherever used herelr the terra Vantor" and gran.ce" tnc.nudc all the parlor to this i stn4ment and the hein., legal
representatives and assigns ofindividuals, and the .successors and assigns ofcotporadons)
W l T N E S S E "1' If: That the grantor, for and in consideration ofthe sum ofTEN AND 0011WS (SI0.00) Dollars and
other valuable considerations. receipt whereof is hereby aclatowledged, hereby grants, bargains, sells, aliens, remises,
releases, conveys and confirms unto the grantee all that certain land situate in SEMINOLF County, State of Florida, described as follows:
Lot 56, Block 4, Hidden Lake Phase 11, Unit 1, according to the map or plat thereof, as recorded in Plat Book
24, Page(s) 15 through 17, inclusive, of the Public Records ofSeminole County, Florida.
Property Address: 105 Laguna Court, Sanford, FL 32773
Subject to covenants, conditions, restrictions, reservations, limitations, easements and agreements ofrecord, ifany, taxes
and assessments for the year 2018 and subsequent years, and to all applicable zoning ordinances and/or restrictions and
prohibitions imposed by govtsnmenial authorities, ifany.
TOGETHER, with all the tenements, hercditaments and appurtenances thereto belonging or in anywise appertaining.
TO HAVE AND TO HOLD, the same in fee simple forever.
AND, the grantor hereby covenants with said grantee that the grantor is lawfully seized ofsaid land in fee simple; that the
grantor has good right and lawful authority to sell and convey said land, and hereby fully warrants the title to said land
and will defend the same against the lawful claims of all persons whomsoever.
SIGNATURE PACE TO FOLLOW
SIGNATURE PAGE OF WARRANTY DEED
Lot 56, Block 4, Hiddcn Lake Pbase 11, Unit D
Di %*7TNESS WHEREOF, the said grantor has signed and scaled these presents the day and ycar first above written.
Signed, scaled and delivered in the presence of
Warms 01 signatwe
Ah" A.
61Wnstb tXLanewitnessMtPrinted\mne
Wtttas
MSWEENEY
Witness Ir_ Printed Name I )'n AILane
STATr:Or• FLORIDA
COUNTY OF ORANGE
Ile foregoing instrument was acknowledged before me this 21st day of June, 2018 by Jonathan R. Lane and Jaclyn A.
Lane who have produced VqrSas identification,
votary signature
My Commission Expires:
aWV tutx S" d rbtaoy1yfDCbenN+I,sM.Maen.
asR EAOa27 O
Mr
Exhibit "A"
Legal Description for File No.: 1178-19
Lot 56, Block 4, Hidden Lake Phase 11, Unit 1, according to the map or plat thereof, as recorded
Plat Book 24, Page(s)15 through 17, inclusive, of the Public Records of Seminole County, Florida.
CREATIVE ROOFING SPECIALISTS
IW- - I - - fth
Cell 407-399-2233 Email Creativeroofingsuecialists(a)-g_mail.com
501 Green Briar Blvd, Altamonte Springs FL 32714
Jeffrey and Colette Shelton
105 Laguna Ct.
Sanford FL, 32773
Proposal
06/03/2018
Work To Be Done At Your Premises:
1. Pull Permit with Seminole County.
2. Remove existing three top shingles and underlying materials, and replace it with
architectural shingles, including nails, -down to the deck:(33 .squares including
starters) (2 square ridge cap)
3. Nail all decking with 8D spiral ring shank nails, installed according to the code.
4. Install with 30 lb. Summit Sixty Synthetic underlayment.
5. Remove and install all existing ridge vents with new on roof (qt. 1).
6. Remove and install gooseneck vents (qt 210 in) on roof.
7. Remove and install all new boot (qt. 3) lead pipe flashing and all roof vents.
8. Apply polystick to all valley flashings on roof.
9. Remove and replace one damaged section (16ft) of facia in front (Ix6 cedar).
10. Remove existing drip edge and install all newgalvanized, factory. painted drip edge
2 ''/z" (color to be determined by customer), nailed according to code.
11. Remove and replace all plywood with visible damage.
12. Install 30 year (limited manufacturers guarantee) Type of shingle: architectural,
color determined by customer. (Shingles resistance: up to 110 mph wind coverage)
T3. Clean work cites thorouglli'ly and sweep magnetically -for-loose nails.
14. Remove petition wall dividing garage and remove all electrical wires in wall.
15. No structural repair is required.
License CCC 1327601
1
CREATIVE ROOFING SPECIALISTS
10.0-
Cell 407-399-2233 Email Creativeroofingsnecialists@,gmail.com
501 Green Briar Blvd, Altamonte Springs FL 32714
Any additional damage found to the plywood will result in additional charge ($50 per sheet)-
All waste management will be removed by CRS, waste removal will be added to total-
All debris as a result of construction was removed by Creative Roofing Specialist.-
If not satisfied with work performed, Creative Roofing Specialist will supply a full Guarantee-
For further. information feel free to contact contractor with the numbers provided above -
RoofTotal..................................................................................$12,250.00
Wallremoval Total...........................................................................$750.00
CedarFacia Total ............................................................................$125.00
Waste Management Total .......................... .......................................... $500.00
AGrand Total............................................................................................$13,625.00
Down Payment Total ................................................. ...... .... .... ......$6,812.50
Proposal VALID 30 DAYS FROM PROPOSAL DATE.
PAYMENTS TO BE MADE AS FOLLOWS: NET 10 DAYS AFTER COMPLETION OF JOB. A
FINANCE CHARGE OF 2.0% PER MONTH WILL BE CHARGED ON ALL INVOICES OVER 30
DAYS OLD.
Acceptance of the Proposal- The above prices, specifications and
accepted. You are authori4Fd to do the worns specified. Payment
Authorized Signature
Customer Signature
ins are satisfactory and are hereby
made as shown above. -'I
License CCC 1327601
Illiillllllllllllllllllltlllillllllllll THIS IN UMENT PREP D
Name: cs Si+G u ItCt - GRANT MALOY, SEMINOLE COUNTYAddress: Srfl/ rrPe/lbriar $C/ CLERK OF GIRGUIT COURT i'. NOjee- 3BMFTROLLER l lf-arnon +-e sv 27 5 Y, 9166 P9 16]S (1P9s) State ofFloridaCLERY.'S 0 201807725E NOTICE OFCOMMENCEIIISMED07/05/2018 12:33:39 PM R —8RECOR
DIpN,GFEES $10.00 Permit Number
Parcel ID Number (PID) l 46 3 - 01/0 0 -Os-6 0 THEUNDERSIGNED
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 (legai description of the property, and streetaddress tf available) ,j 0 T S(e (f LK If 4'11J erl LaKe Anse It
t1.&r ( Ae24 O,4S is mri /OS-t-AGtiA-JA -r ca"=ns?h.Cr z-7-7-) 2. GENERAL DESCRIPTION
OF IMPROVEMENT: R &RoOF 3. OWNER INFORMATION:
Name and address:
TeAFrey d- Co fe Interest in property:
I Name and address
of fee simple titleholder (if other than Owner): 4. CONTRACTOR: (name.
address 5. SURETY: / Name,
address and
phone number: Amount of bond $
6. LENDER: (name,
address and phone number): A Cr - S#
9fog D.fL 7. Persons within the
State of Florida designated by Owner upon whom notices or other documents may be served as provided by section 713.13(
1)(a)7., Florida Statutes: (name, address and phone number): 8. In addition to
him/herself, Owner designates of Lienor's Notice as
provided in Section 713.13(1)(b), Florida Statutes. to receive a copy
of the 9. Expiration date of
notice of commencement (theexpiration date is 1 year from the 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 COMMENCEMENTARE CONSIDERED IMPROPER PAYMENTS UNDER
CHAPTER 713, PART 1, 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. STA F FL DA
COUNTY OF SEMINOLE M a e'MeVShePdqri . AVER9 SIGNATURE OWNERS PRINTED
NAME The foreaoinn instnsnent_was
acknowledoed before me this daA y of l / 20by Identification pe Who is -personally me
OR who
has produced rmdon produced — VERIFICATION VERIFICATION PURSUANT TO
SECTION 92.
525, FLORIDA STATUTES. UNDER PENALTIES OF PERJURY, I DECLARE
THAT I HAVE READTHE FOREGOING AND THAT THE FACTS STATED IN RARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF. Grant ThtliR®
g 6jjjgUg#;j NOTARY pd§EjLS SIGNATURE OF NATURALPERSONSIGNINGABOVE
STATE- 0# 148019k rTrrr Print, Type or Stamp jwah
t
041-# FF9SPGs
City of Sanford
Building and Fire Prevention
Product Approval Specification Form
Permit #
Project Location Address ioS' LPFIau NA CT" S 'Fore-o f l 3a4a3
As required by Florida Statute 553.842 and Florida Administrative Code 9N-3, please provide the
information and product approval number(s) on the building components listed below if they are to be
utilized on the construction project for which you are applying for a building permit. We recommend that
you contact your local product supplier should you not know the product approval number for any of the
applicable listed products. Be aware that windows, skylights, and exterior doors must be tested in
accordance with the Florida Building Code, Section 1714.5. More information about Statewide Product
Approval can be obtained at www.floridabuilding.org.
The following information must be available on the jobsite for inspections:
1. This entire product approval form
2. A copy of the manufacturer's installation details and requirements for each product.
Category / Subcategory Manufacturer Product
Description
Florida Approval #
include decimal
1. Exterior Doors
Swinging
Slidina
Sectional
Roll U
Automatic
Other
2. Windows
Single Hun
Horizontal Cli igr
Casement
Double Hun
Fixed
Awning
Pass Through
Projected
DAI Illinne1 •IM 111VI IV
Wind Breaker
Dual Action
Other
June 2014
Category /Subcategory Manufacturer Product
Description(including
Florida Approval #
decimal
3. Panel Walls
Siding
jO'Ns
Storefronts
Curtain Walls
Wall Louver
Glass block
Membrane
Greenhouse
E.P.S Composite
Panels
Other
4. Roofing Products
Asphalt Shingles Ce tttof
Underla ments g 0O 1 ZI - RI
Roofing Fasteners
Nonstructural
Metal Roofing
Wood Shakes and
Shingles
Ro ing tiles
Roofing
Insulation
Waterproofing
Built up roofing
System
Modified Bitumen
Single Ply Roof
Systems
Roofing slate
Cements/
Adhesives /
Coating
Liquid Applied
Roofing Systems
Roof Tile
adhesive
Spray Applied
Polyurethane
Roofing
E.P.S. Roof
Panels
Roof Vents
Other
June 2014
Category / Subcategory Manufacturer Product
Description
Florida Approval #
include decimal
5. Shutters
Aecordion
i3anama
Colonial
Roll u
Equipment
Other
6. Skylights
Sk li hts
Other
7. Structural
Components
Wood Connectors /
Anchors
Truss Plates
Engineered Lumber
Railing
Coolers/Freezers
Concrete Admixtures
Precast Lintels
Insulation Forms
Plastics
Deck / Roof
Wall
Prefab Sheds
Other
8. New Exterior
Envelo a Products
Applicant's Signature
Applicant's Name
Please Print)
June 2014
2r . SXi-
OF
FORD Building& FirePrevention Division
RESIDENTL4L RE-ROOFPOLICY &PROCEDURES
FIRE DEPARTMENT
PERMITTING REQUIREMENTS —NO PLAN REVIEW REQUIRED
THISDOCUMENT (SIGNED) ALONG WITH AN ACCURATE AND COMPLETED RESIDENTIAL RE -ROOF SCOPE OF WORK AREREQUIREDTOBESUBMITTEDASPARTOFYOURPERMITAPPLICATION.
THE SCOPE OF WORK MUST INCLUDE ALL APPLICABLE FLORIDA PRODUCT APPROVAL NUMBERS FOR ALL ROOFCOMPONENTSTHATWILLBEINSTALLEDONTHEPROJECT.
A PERMIT WILL NOT BE ISSUED WITHOUT THESE DOCUMENTS. COPIES WILL BE MADE TO POST ON THE JOB SITE.
PROJECTS LOCATED IN THE SANFORD HISTORICDISTRICTWILLREQUIRE PLAN REVIEW AND APPROVAL BY THESANFORDHISTORICPRESERVATIONBOARD
INSPECTIONPOLICY & PROCEDURES
A FINAL ROOF INSPECTION IS THE ONLY INSPECTION REQUIRED FOR RESIDENTIAL (SINGLE FAMILY, TOWNHOUSE, MOBILE HOME, APARTMENT AND/OR CONDOMINIUM) REROOF PERMITS.
THE FOLLOWING IS REQUIRED TO BE PROVIDE ON THE JOB SITE. -
PERMIT CARD, POSTED INA CONSPICUOUS AND WEATHERPROOF LOCATION
COMPLETED RFBIDHNTIAI, RFrROOFSCOPEOFWORK
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 ORRULER)
o ROOF DECK NAILS USED (INCLUDING A MEASURING DEVICE OR RULER SHOWING SIZE OFNAILS)
o UNDERLAYMENT PATTERN & SPACING (INCLUDING A MEASURING DEVICE ORRULER)
o DRIP EDGE & VALLEY ATTACHMENT (INCLUDING A MEASURING DEVICE OR RULER)
o SHINGLES INSTALLED, NAIL PATTERN AND LOCATION OFNAILS
SKYLIGHTS (IFAPPLICABLE)
o DIGITAL PHOTOGRAPHS SHOWING ALL INSTALLATION COMPONENTS, PER FL PRODUCT APPROVAL
o DIGITAL PHOTOGRAPHS SHOWING ALLREQUIRED FLASHING, PER FLPRODUCT APPROVAL
FAILURE TO FOLLOW THESE SPECIFIC GUIDELINES
PROFESSIONAL (ARCHITECT OR ENGINEER), CERTj'
CONTRACTOR (OR OWNER/BUILDER)
L RESULT IN AN AFFIDAVIT PROVIDED BY A FLORIDA DESIGN
fG FBC CODE COMPLIA B PERSONAL INSPECTION.
DATE-
CITY OF
9 S,ki4FORD PERMIT#
Building & Fire Prevention Division
FIRE DEPARTMENT RESIDENTIAL RE -ROOF SCOPE OF WORK
JOBADDRESS:I0,5- _ LA-GUju a eT. Sl4A.) FOjeb. K 32-7%/
STRUCTURE TYPE: WGLE FAMII,Y RESIDENCEfrOWNHOUSE Q MOBILE HOME Q APARTMENT/CONDOMINIUM
RE -ROOF TYPE: OREPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
RE-COVER (NEW ROOF INSTALLED OVER EWTIJG ROOF)
DECK TYPE (PLEASE SPECIFY):
PLEASE NOTE: ONLY 100 SQUARE FEET O TIE EXISTING DECK IS PERMITTED TO BE REPLACED
ROOF VENTILATION: QOFF-RIDGE IS EDGE 0SOFFIT QPOWERED VENT
SKYLIGHTS: Q YES PO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL !1:
MAIN ROOF AREA
ROOF SLOPE: Q LESS THAN 2: 12 (8r2:12 - 4:12 Q 4:12 OR GREATER
QTURBWES
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
SHINGLE E FL9 5 ICl
Q METAL FLN
Q MODIFIED BITUMEN FLN
QTORCH DOWN FL#
QINSULATED FLN
Q T I,E FLU
OTHER:UrtJi Ct t4 FL# / SO - R
v
Fl1AFFaTF,N,SIf)NC.(PfIA!'ARS,.P4TTAS..RTr,) R!IFAPPr.fr4Rr.F**
ROOF SLOPE: Q LESS THAN 2:12 p 2:12 - 4:12 Q 4:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
Q SHINGLE FLN
Q METAL FL#
Q MODIFIED BITUMEN FL#
QTORCH DOWN FL#
QINSULATED FL#
Q TI,E FL#
r>lYrurv,• FL.N. .
CITY OF
SkNFORD Building & Fire Prevention Division
RESIDENTIAL REROOF AFFIDA VIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: % 2 / 7 l ADDRESS: /O C 46 d N r4 tfT- -
5A u - o2 FL 32773
271SSI 4,6 a— 1 AR A(M) (iFUFRAI_ Rim-nimr. RFCMFNT1A1. OR
ROOFING CONTRACTOR, ENGINEER, ARCHITECT, OF F"9-I HAPTER 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
ABOVEI(E'Fb'RT:Nt,'EU ATA) ESS RAVElbl'ENINS'7'A'Ll,E'UT9 ACCUkUANC WITHMTR'PRU Oi I, AWROVALS ANu ALL AW-LICA13LE 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 Il: C G / — 2-
COMPANY / CONTRACTOR: t4 _ K t7r-df-T/[/ 1—i KOOF-1
CONTRACTOR SIGNATURE: \ DATE: O
MUST BE SIGNED BY LICENSE ER OR OWNER/BUIL )
A FINAL ROOF INSPECTION IS REOUIRED:
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
X3{t £1lC{{ {13P£CT{a\. T{{£ {'{{L3'{'-.•t.L{'f{S'l.:i:ST. {NC'.A.'3£ ,l ^:.4.1.:L:: :£J..,:,?L.;l'G •3£'•,'CE :C3X{': i.:.,{, t'.'.:{.. S{'.tC:1C .L.'V{i
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 8 C V'VI - Vt C:> ( -9--
Sworn to and Subscribed before me this day of J c.t- l 201 by:
Who is E*ersonally Known to me or has It roduced (type of
iden ' ca ion) as identification.
o* '••''. NATHALIE JARAMILLO
W." Notary Public - State of FloridaSatureofNotaryblic Commission 0 GG 215712
a c°'' M Comm. itfateofFloridaYExpes May 8, 2022
r (, 1 Bonded through National Notary Assn.
12 0.J" ti l'>
Print/Type/Stamp Name
of Notary Public