105 Skogen Ct - BR18-002870 - REROOFCITY OF
S ORD
FIRE DEPARTMENT
Building & Fire Prevention Division
PERMIT APPLICATION
Application No: 1 S ( M
Documented Construction Value: &
Job Address: 105 Sy-,FL 32-n1 Historic District: Yes[]Noo-
Parcel ID: 33-19 - W - - -CAI $C7 Residential ommercial
Type of Work: Newer Addition Alteration [epair[] Demo[] Change of Use[] Move
Description of Work:-Qr pF nlc Y0. - flaslQ YIPuJ S`nin4 e Inc 1 edlQt
01d \ODDCA 4S needed
Plan Review Contact Person: Y-, fnq ':S etmi -lx ti Title: AiMir)
Phone:', 2VZ•(oDZZ Fax: Email._') -JLC-PRooFCC). CC44
Property Owner Information
Name 'Tne ox\&11 Phone: U S"7
Street: lei 'nk) t1 OF Resident of property?
City, State Zip: %,Nd , Fl- 32771
Contractor Information
Name' 6f rug a- eonIry C4; Ors Phone:' 21- 5,11 - (I l to Street:
12RRD IAt a nmd le 1•(c , le L Fax: 12-1- 5-11- L4 I I ZCity,
State Zip: 0PQfy,,GAec : V:L 3S-70E State License No.: ('CC i32'135 I Arch
itect/EngIneer Information Name:
Ill IA Phone: Street:
Fax: City,
St, Zip: E-mail: Bonding
Company: NA Address:
Mortgage
Lender: Nth 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: 6t° Edition (20M Florida Building Code Revised:
January 1, 20I S Permit Application
APPLICANT INFORMATION CONTINUED
Fee Simple Titleholders' Name (if other than owner) _
Fee Simple Titleholders' Address (if other than owner)
Bonding Company
Bonding Company Address
Architect/Engineers' Name
Archltect/Engineers' Address
Mortgage Lender's Name
Mortgage Lender's Address
Application is hereby made to obtain a permit to do the work and installation 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 the
standards of all laws regulating construction in this jurisdiction. I understand that a permit must be secured for
electrical work, plumbing, signs, bells, pools, furnaces, boilers, heaters, tanks and air conditioners, etc.
OWNER'S AFFIDAVIT: I certify that all foregoing information is accurate and that all work will be done in compliance
with all applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
RECORDING YOUR XTICE O F CEMENT.
YOUR LENDER OR AN ATTORNEY BEFORE
Owner's Signature Contractors' Signature
Must be Notarized - see below
STATE OF FLORIDA INDIVIDUAL ACKNOWLEDGEMENT
COUNTY OF VOLUSIA
The foregoing instrument was acknowledged before me this _ 6 1 y I Zco I (date)
boy . it Q ^ 11 (name), who is pertonally known to me or who has producedILe
LME&O
type of identification) as identification and w o d'd (did not) take an oath.
Notary)
STATE OF FLORIDA
COUNTY OF VOLUSIA
The fore of i stru ei
a ' b r^
M';(name of corporation), a
behalf of the ggrporatioy
MATTHEW WM. RAMMIG
1401MY Public. State of Florids
9JCOmm. EOM Dec. 20, 2021
No. GG 181*54
CORPORATE ACKNOWLEDGEMENT CERTIFICA I JH
I. , Co. 2i- 8
w acknowledged bgfq e me this (date)
J (name and title) of 06(1 .me ,\ 1 Oxi rtruf`{,• c Elmdco` (state or pl nt incorporation) corporation, on He/
she i e9Ch SOallyknowtomeorhasnrnd .. I
as identification and who did (did not) take an oath. Notary)
908
A. HALE Notary
Pdit &Ate ofFlorida My
Cow. Eon Oct 18, 2021 No.
GG 1sme
I
CIA joropeft Record Card
Parcel: 33-19-30-504-0000-0180
seRorrKq Property Address: '105 SKOGEN CT SANFORD, FL 32771-3665
Parcel Information
Parcel 33-19-30-504-0000-0180
Owner(s) KENDALL. JOE H
Property Address 105 SKOGEN CT SANFORD, FL 32771-3665
Mailing 105 SKOGEN CT SANFORD, FL 32771-3665
Subdivision Name UPPLAND PARK
Tax District S1-SANFORD
DOR Use Code 01-SINGLE FAMILY
Exemptions OD-HOMESTEAD(1994)
r 85.38 1 80
V-j 62.85
L6 / • M w
V— N
146.42 80 80
I Seminole County GIS
Legal Description
LOT 18
UPPLAND PARK
PB20PG5
Taxes
Taxing Authority Assessment Value Exempt Values Taxable Value
County General Fund 75,347 55,000 20,347
Schools 75,347 30,000 45,347
City Sanford 75,347 55,000 20,347
SJWM(Samt Johns Water Management) 75,347 55.000 20,347
County Bonds 75,347 55,000 20,347
Sales
Description Date Book Page Amount Qualified Varllmp
QUIT CLAIM DEED 6/1/1980 01283 123$ 100 No Improved
WARRANTY DEED 1/1/1976 01085 0067 28,400 Yes Improved
Find wapa"ilw Silas
Land
Method Frontage Depth Units Units Price Land Value
LOT 0.001 0.001 1 1 $34,500.00 1 $34,500
Building Information
is tseansain count incorrect( UICK Here.
Description Year Built
Actual/EHective Fixtures Bed Bath Base Area Total SF Living SF Ext Wall Adj Value Rapt Value Appendages
1 SINGLE 1976 5 2 1& 1,118 1,814 1,118 CONC 87,069 110,214 Description Area
CCC1329729 CCC13273SI
CRC1329809 '16C CRC016377
PARLIAMENT
Roofing & Construction
ORLAN 2LIARUM urvc uL9
300 International Parkway. Suite 304 12800Automobile Blvd. Suite L 4653Salisbury Road, Suite 275 lake Mary,
FL 32746 Clearwater, FL 33762 acksonvOle. FL 32256 ORlce: (407)
949.9196 Office: (727) 571.43 So • Fax: (727) S71.4312 Office: (904) 999.6612 SALES CONTRACT
Ibrlanlenl ReenngLren"
ruelloo of"es 10 rurLIth allraaltrl Iaand lyp,bor accessarytoPerformthe workof theIlDwingaddrese: Name:ziiO4k,,6, 11 1i 1.f41.0 ' lone, L o C Z. 6 sS7 Ccli: Address: jT
C4 pate; 0 6 I 14 I zo I oo City:_LSq
11 Dr-t:l State: F 1 zip: dill l EmaR• County:
Sr I 1 7111 In accordance
with the specifications given below: A: PITCHED
ROOF P$Qj= . ING / METAL / TILE I. REMOVE
EXISTING ROOF TO WORKABLE SURFACE ardrOne L RENAIL
ROOF DECK TVRH RING. SIIANK NAILS. / 3. REPLACE
ANY ROTTEN "DopTTTTII STANDAFSHCATHING017.00 PER LINEAR FOOT OF BOARD AND190.00 PER SNEFTOF PLYW(H)0.IF 1 4. INSTALL_ t I> S orMST•lk 1rUNDERLAYMENTTOENTIREROOFDECKSURFACE 1/ S. INSTALL NETV
VALLEY METAL IN VALLEYS AND REPLACE FLASHING AS NECESSARY. , J 6, INSTALL NEW
LEAD DOM OVER SOIL STACKS AND REPLACE ALL PURPOSE VENTS. 1177 /1 7. INSTALL 6-FHA/VA EAVES DRIP AROUND THE PERIMETEROF THE ROOF.COLOR: INSTALL-_ L} YFAR_
71-N0 C060A• r-r.iLklnAC rltjr.l 9. INSTALL PIECES
OF fORATTIC VENTILATION ATANADDITIONAL COST OFSSSAOEACH. COLOR: 10.CLEAR-UP ANDHAULAWAY RELATED DEBRIS
AND LEAVE 100SITE CLEAN. 11. CONTRACTOR WILL COORDINATE THE REMOVALAND
REINSTALLATION OF ROOFRELATEDPERIPl1ERALS SUCH AS (BUT NOT UNITEDTO) SAYUGHTS.SOLARUNrMT.V. DISHES, AND /OR
AIR CONDITIONERS. ETCSUCHCOSTISADDITIONAL TOCON TNRPRICEREMOVALAND REINSTALWTIONOF VINYL AND/OR METALSOFFITANWSCIA WILL BE
ADDITIONAL $4.25 A LINEAR FOOT. 3; LOW SXI T NG OR FLAT ROOF O /
TORCH MAI f d
Er REMOVE OOSTIHGROOFTOWORKAB SURF CE rde0ne One \ LRDUUL ROOF
DECK WITH RING SHANK H 3.
REPLACEANY ROTTEN WOOD 1VriH STA EATHING O
S7A0 EAR FOOT AND 190 00 PER SHEET OFPLYWOOD. IF ANY. 4. INSTALL SUM JPNSUNDERLAYMEATfOENTIRE FDECK SUR FACE- S.
INSTALL NEIYBOOTSOVER SOIL STACKS AND REPLAC
LLPURPOS 6.UWALL INdiDOUBLE SIDED FOIL INSULATIO rTPORaof. 7. INSTALLW FHA/
VA EAVES DRIP AROUND THE PERn rNERODECOWk INSTALL
YEAR R: 9.CLEAN-UP AND HAUL AWAY REIATEDD ANOLEAVE109SITE
IQ.INSTALLATIONOFAROOF.OVER
SNUMBER2AND4INSECTION& 1LCONTR/TCT'ORITTLLC0Nt THEREMOVALANDREINSrALIATK/H0 OF RELATEDPERIPHERALTSUCH
AS (BUT Nor LIMITED
TO) SKYLIGHTS. SOLUtUN ..KDISHES.AND/OR AIRCONORIONERS,ETC.SUCH CO SADDITIONALTOCONTRACTPRICLREMOVALANDREINSTAUATIONOFVINYL
AND/OR METAL SOFFITANDFASCIA WILL BEADDITIONALAUNEARFOOT. C. Terms and Coodldow I.0000Omwots7tbaon7mme,
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At1.61100mebry UPONOOYPLEIION-ftebmldess9diseaartsand PraalalRlL
Wwz) WINDYIROA110N AOT.
mot"Monwoatadot Executed In
du
leato, one copy which was
doltvorod to,
and receipt
b horo
acknowl
y
i
doof pl
pt by odpod by B1ya, Nb LY 3yy%t 20 NOTICETO OWNER a. Do not sign thishornslmplovearrdcowedinIdnh. a You am
udRkO to a
copy on the
contract at IRA thna you afgn. Kaop It to potoa yourrbhts.
Approved and Accagad By: u m (a.a Iy11) OfficeesSignature urcbasrSIp like
THIS INSTRUMENT PREPARED BY:
Name: Parlament Roofing & Construction . 07 nf\Q Z
Address: 12880 Automobile Blvd. Suite L
Clearwater. FL 33762
NOTICE OF COMMENCEME
Permit Number:
Parcel ID Number: 3- 1 5W - COOL ' 17 V
The undersigned hereby gives notice that improvement will be made to cer
following information is provided in this Notice of Commencement.
1. DESCRIP OF PROPERTY:(Legal description of the property and
2. AQNERAL DESCRIPTION OF IMPROVEMENT:
3. OWNER INFORMATIONORLESSEE INFORMATION IF THE LESSEE r
Nameandaddress: . e j0 f-OMI I l Interest
in property: O Y4Yl217 Fee
Simple Title Holder (if other than owner listed above) Name., NY t 4.
CONTRACTOR: Name: Partament Roofinq & Construction Address:
12880 Automobile Blvd, Suite L. Clearwater. FL 33, S.
SURETY (If applicable, a copy of the payment bond is attached): S.
LENDER: Address:
GRANT
MALOY SEMINOLE COUNTY TCLERKOFCIRCUITCOURT & COMPTROLLER BY.
9157 P9 1367 QP9s ) CLERK'
S : 2018071262 RECORDED
06/21/2013 11:07:53 AM RECORDING
FEES $10.00 real
property, and in d6MfiQF Dri9tYCd> vrl8, Florida Statutes, the address
ifavailable) FOR
THE IMPROVEMENT: N(
d . Vt_ '32--n I Number: (
727) 571-4110 Number.
of
Bond: 7.
Persons within the State of Florida Designated by Owner upon who notice or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes. 8.
In addition, Owner designates N A to
receive a copy of the Lienor•s Notice as provided in Section 713.13(1 9.
Expiration Date of Notice of Commencement (The expiration is 1 year fi Number.
Florida
Statutes. Phone number date
of recording unless a different date is specified) WARNING
TO OWNER: ANY PAYMENTS MADE BY THE OWNER AF1ER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE 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. v
xcdnd c - YW6h • endq!) moo(
q. nature
of Owner orLessee, or Owhoesor Lesseeb (Print Name and Provitle SipnetoryeIU 0Gjn AuthadzedOMcedDlmoor/Panner/Manager) State
of Florida County
of SEMINOLE The
foregoing Instrument was acknowledged before me this by
Kenact 1 Y'cr h C. k kfntt Norm
pe on'" `"0statement Who
has produced identification >r Type of identtocation produced: rCJf L MATTTp
aHEW WM lA
RgAM
aMIIG N`
MY pp'rSi
No. GG
169954 BY of —
3
VW1 ,20 Who Is
personally known tome OCR, k 5311- 1
3, 63- 7,cl-0
City of Sanford
Building and Fire Prevention
Product Approval Specification Form
Permit #
Project Location Address Q tD- 25 l l CA Sand , FL
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.floridabuild inQ.ora. 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
Sliding
Sectional
Roll
U Automatic
Other
2.
Windows Single
Hun Horizontal
Slider Casement
Double
Hun Fixed
Awning
Pass
Through Projected
Mullions
Wind
Breaker Dual
Action Other
June
2014
Category / Subcategory Manufacturer Product
Description(including
Florida Approval #
decimal
3. Panel Walls
Siding
Soffits
Storefronts
Curtain Walls
Wall Louver
Glass block
Membrane
Greenhouse
E.P.S Composite
Panels
Other
4. Roofing Products
Asphalt Shingles FLI -Z O
Underla ments eUndQ0awcmMI FL 25 A-IS
Roofinq Fasteners
Nonstructural
Metal Roofing
Wood Shakes and
Shinciles
Roofing 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
Accordion
Bahama
Colonial
Roll u
Equipment
Other
6. Skylights
Skylights
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
Envelope Products
Applicant's Signature
Applicant's Name
Please Print)
June 2014
vim
i .
SEA41NOLE COUNTY MULTI%UR/SDICTIONAL
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: cq. 2I. 1 g
I hereby name and appoint:::3Ly,(1G 'S. I f dtfu X
an agent of: Parlament Roofing & Construction
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):
All permits and applications submitted by this contractor.
Or
The specific permit and application for work located at:
Calf -i . Ft_ I
Street Address)
Expiration Date for This Limited Power of Attorney: 1
License Holder Name: Peter E. Wozniak
State License Number: C C C 1 3 2 7 3 5 1
Signature of License Holder:
STATE OF FLQRIDA
COUNTY OF M\f) e
The foregoing instrument wras acknowledged before me this 21 day of 5U,nk-
20 \ , by "C 0- ` N-% o_ who is 91Wsonally known to me or
O who has produced
and w did did not) take an th.
Signature of No
ROB A. HALE
Notary Public. State of Florir_•
my Comm. Egkft Oct. 16. 21"'
NO. GG 151gl c
Notary Seal) ROB A. HALE
Notary Public. State Of6tyComm. EgknNo. GG 1151918
as identification
14) A JJA l-C-
Print or type Notary name
Notary Public -State of r 04 42'Q
Commission No. Gr& lS l `i l 8
My Commission Expires: GCLr /6g - ,;?'0 1
City of Sanford Building Division
Residential Re -Roof Inspection Policy & Procedures
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 ofyour 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 c de co a ce by personal inspection. '
CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: DATE:
PERMIT #
City of Sanford Building Division
Residential Re -Roof Scope of Work
JOB ADDRESS: o
STRUCTURE TYPE: 0 SINGLE FAMILY RESIDENCE/TOWNHOUSE 0 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): %10rd
PLEASE NOTE: ONLY 100 SQUARE FEET OF THE EXISTING DECRIS PERMITTED TO BE REPLACED**
ROOF VENTILATION: ® OFF -RIDGE O RIDGE OSOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: O YES 0 NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 ®2:12 - 4:12 O 4:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
OSHINGLE FL# 10W lQ
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: 0 LESS THAN 2:12 0 2:12 — 4:12 0 4:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
O SHINGLE FL#
O METAL FL#
0 MODIFIED BITUMEN FL#
OTORCH DOWN FL#
OINSULATED FL#
0 TILE FL#
O OTHER: FL#
D City of Sanford
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: la -cm lam- ADDRESS: a S tl /l.
I G/' L 2 i ,- , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, GINEER, ARCHITECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE
FOREGOM 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 TILE ROOF DECK, IN ACCORDANCE WITH THE HURRICANE RETROFIT
MANUAL REQUIREMENTS (BASED ON F.S. CHAPTER 553.844).
LICENSE #: (_ r c / 3 -2 7 ? r/
COMPANY / CONTRACTOR:
CONTRACTOR SIGNATURE: -F 1 'IiI C DATE: ,z7
MUST BE SIGNED BY LICENSE HOrR OR OWNERIBUILDER)
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
FOR EACH INSPECTION. THE PHOTOGRAPHS MUST INCLUDE A RULER OR MEASURING DEVICE TOCONFIRM 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 REQUIREMENT'S. Y
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 %/r'is.verR
Sworn to ubscribejd before me this da 20 )Oby:
Y111"PIL " ~ Who <`iersonally has _ Produced (type of
identification)
Signature
State OW
Print/Type/Stamp
of Notary Public
as identification.
V*-//4/ L
JA oM,,.rE"S MA7THE'14s r + ti„ nPUbIIC. >Slf •:.i'FGI::dMyComm. EVires Jan. 17, Y021No. GG a2047JAMES
MATTHEW RAYL Notary
Pub1r. State of Florida My
Comm. E*k a Jan.17, 2021 No.
GG 62047