109 Madden Ave - RE18-002814 - REROOFCITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
p
Application No: D ' o yn6
Documented Construction Value: $ 6,500
Job Address: 109 MADDEN AVE SANFORD, FL 32773 Historic District: Yes No x
Parcel ID: 12-20-30-511-0000-0670 Residential x Commercial
Type of Work: New Addition AlterationEl Repair Demo Change of Use Move Description
of Work: Re Roof Owens Corning FL 10674-R13 15216-R3 Techwrap 17194-R2 26 SQ 7/12 Pitch Driftwood
Supreme 25 YEARS Plan
Review Contact Person: Phone:
407-278-7788 Name
JEREMY W TILTON Street:
109 MADDEN AVE Skylar
Amkraut Title: Admin Fax:
800-337-3361 Email: Permit@Jasperinc.com Property
Owner Information City,
State Zip: SANFORD, FL 32773 Name
Jasper Contractors Street:
4185 S Orlando Dr City,
State Zip: Sanford, FL 32773 Name:
Street:
City,
St, Zip: Bonding
Company: Address:
Phone:
Resident
of property? : Yes Contractor
Information Phone:
407-278-7788 Fax:
800-337-3361 State
License No.: CCC1331153 Architect/
Engineer Information Phone:
Fax:
E-
mail: Mortgage
Lender: Address:
WARNING
TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED
AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
Application
is hereby made to obtain a permit to do the work and installations as indicated. 1 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. 1 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: 5" Edition (2014) Florida Building Code Revised:
June 30, 2015 Permit Application
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may befoundinthepublicrecordsofthiscounty, 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 pen -nit 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 ofOwner/Agent Date
Print Owner/Agent's Name
Signature ofNotary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
8
Signs m of Cont a or Agent Date
Rudith Goico
AIJA CHAVEZ
State of Florida -Notary Publ
Commission # GG 112152
My Commission Expires
June 06.2021
Contractor/Agent is Personally Known to Me or
Produced 1D Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing[] Gas[] Roof
Construction Type: Occupancy Use:
Total Sq Ft of Bldg: Min. Occupancy Load:
Flood Zone:
of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes No # of Heads Fire Alarm Permit: Yes No
APPROVALS: ZONING: UTILITIES: WASTE WATER:
ENGINEERING: FIRE: BUILDING:
COMMENTS:
Revised: Junc 30, 2015 Permit Application
6/15/2018 SCPA Parcel View. 12-20-30-511-0000-0670
on, cFFArP4A0N0j'Fdwu 16
s wao«oounrrY a,oaioA
Parcel Information
Property Record Card
Parcel: 12-20-30-511-0000-0670
Property Address: 109 MADDEN AVE SANFORD, FL 32773
Parcel 12-20-30-511-0000-0670
Owner(s) TILTON, JEREMY W
Property Address 109 MADDEN AVE SANFORD, FL 32773
Mailing 109 MADDEN AVE SANFORD, FL 32773-7332
Subdivision Name MONROE MEADOWS
Tax District S1-SANFORD
DOR Use Code 01-SINGLE FAMILY
Exemptions 00-HOMESTEAD(2003)
79
Legal Description
LOT 67
MONROE MEADOWS
P13 46 PGS 16 & 17
Taxes
0)
0
V
N
Seminole County GIS
Value Summary
2018 Working
Values
2017 Certified
Values
Valuation Method Cost/Market Cost/Market
Number of Buildings 1 1
Depreciated Bldg Value 105,326 88,106
Depreciated EXFT Value
Land Value (Market) 25,000 20,000
Land Value Ag
Just/Market Value " 130,326 108,106
Portability Adj
Save Our Homes Adj 50,058 29,489
Amendment 1 Adj 0
P&G Adj 0 0
Assessed Value 80,268 78,617
Tax Amount without SOH: $1,270.00
2017 Tax Bill Amount $709.00
Tax Estimator
Save Our Homes Savings: $561.00
Does NOT INCLUDE Non Ad Valorem Assessments
nttp:nparceiaetail.scpan.org/Parceioetaillnfo.aspx?PID=12203051100000670 1/3
DocuSign Envelope ID: 4AE4AC8A-9C46-4B67-939B-FC66BC33DBB4
JASPER
Ja por i0ot.com
800) 337-3361 Fax
info@jasperinc.com FL Contractor's License:
J ®
CCC 1329651 & CCC 1331153
v15A ROOF REPLACEMENT CONTRACT
Account Manager: Joseph Palladino
Contact #: (407) 335-6239
Company: u-If l
Policy #:010439532
Claim #: 010439532/90a
Mortgage C mm anv Information
Company: Everhome Mortgage
Loan Number:9000337662
Owner(s):
Jeremy Tilton Phone:
Address: 109 Madden Avenue Alt Phone: 407-405-6478
City: S Zip Code: 32773 Shingle Color:
Sanford OC Supreme - Driftwood
Email: familytilton@att.net Roof RCV Amount/ Contract Price:
6,500
Drip Edge Color:
1 *Drip Edge - White 6"
If Owner's Insurance Company does not agree to nay for a full roof replacement, this contract shall he vnidahle_
Assignment of Insurance Benefits for the Full Roof Replacement Only: 1 hereby assign any and all insurance rights, benefits and proceeds under any
applicable insurance policies to Jasper Contractors, Inc. ("Jasper'), the scope of which shall be limited to a Full Roof Replacement. 1 make this assignment
and authorization in consideration of Jasper's agreement to perform services, supply materials and otherwise perform its obligations under this Contract,
including not requiring full payment at the time of service. 1 also hereby direct my insurer(s) to release any and all information requested by Jasper, or its
representative(s), for the direct purpose of obtaining actual benefits to be paid by my insurer(s) for services rendered. In this regard, I waive my privacy
rights. If payment is made directly to the Owner/Agent/Insured(s), it shall be endorsed over to Jasper immediately upon receipt. I agree that any portion of
work, deductibles, betterment or additional work requested by the undersigned, not covered by insurance, must be paid by the undersigned on the day of
installation. Deductible: It is the Owner's responsibility to Day all insurance deductibles. Owner's out-of-pocket expense will not exceed the deductible
amount, as stated on insurer's loss sheet ("Loss Sheet"), which is hereby incorporated by reference as the Scope of Work ("SOW"), UNLESS
replacement/repair of deteriorated decking is required by code and/or Owner requests optional upgrades. Jasper CANNOT pay, waive, rebate, or promise
to pay, w ' Dgr rebate any or all of the insurance deductible applicable to the insurance claim for payment of work. In the event of a discrepancy, the
deductibl o ted on the insurer's Loss Sheet shall overrule deductible amount disclosed. Deductible: s3220.00 MUST BE PAID
IN FUL
1
initial).
PAYME 4T 9112ME ULE: Owner agrees to pay Jasper based on the following schedule: (i) Deposit in the amount ofS• 00 due upon signing this
contract: (ii) the Contract Price, less the Deposit and any applicable depreciation retained by Owner's inswer(s), plus upgrade costs, due and payable
to Jasper upon completion of work being performed; and, (iii) the remaining Contract Price (equal to any applicable depreciation and/or change orders)
due and payable to Jasper upon completion of work performed. In the event of a pending inspection, no more than 2% of Contract Price may be withheld until
inspection has passed.
Optional: UPGRADE ITEM: RATE: UPGRADE ITEM: RATE:
Replacement Work and Price: Upon insurer's approval and subject to the Terms and Conditions stated herein, Jasper agrees to furnish all materials and
provide the labor necessary to perform the full roof replacement which shall take place following Owner's insurance company's approval, approximately
within thirty (30) days, conditions permitting. Owner's Declaration of Intent: Owner acknowledges and agrees that, upon approval by insurance company
for a full roof replacement, Jasper shall perform the roof replacement upon receipt of Loss Sheet from Owner's insurance company.
FLORIDA HOMEOWNERS' CONSTRUCTION RECOVERY FUND
PAYMENT, UP TO A LIMITED AMOUNT, MAY BE AVAILABLE FROM THE FLORIDA HOMEOWNERS'
CONSTRUCTION RECOVERY FUND IF YOU LOSE MONEY ON A PROJECT PERFORMED UNDER CONTRACT,
WHERE THE LOSS RESULTS FROM SPECIFIED VIOLATIONS OF FLORIDA LAW BY A LICENSED CONTRACTOR.
FOR INFORMATION ABOUT THE RECOVERY FUND AND FILING A CLAIM, CONTACT THE FLORIDA
CONSTRUCTION INDUSTRY LICENSING BOARD AT THE FOLLOWING TELEPHONE NUMBER AND ADDRESS:
Construction Industry Licensing Board: 2601 Blairstone Road, Tallahassee, FL 32399-1039, (850) 487-1395
CANCELLATION: if Owner elects to terminate the services of Jasper, Owner may do so before midnight on the third business
day after Contract is executed. Owner shall receive a full refund of all deposits. Owner may also rescind Contract before midnight
on the third business day after the contract is executed after notification from insurer(s) that the claim for payment on roof
contract has been denied, in whole or in part. All written notices of cancellation, regardless of reason, shall be postmarked or
delivered to Jasper's corporate office: 1690 Roberts Boulevard, Suite 112, Kennesaw, GA 30144. CANCELLATION
EXCEPTIONS: The three (3) day right of cancellation DOES NOT APPLY to contracts for emergency home repairs as time is of
the essence.
1, Owner, have read and understand all statements, Terms and Conditions of the "Roof Replacement Contract" and agree that all details
are acceptable and satisfactory. 1 further understand that this Contract constitutes the entire agreement between the parties and that any further
changes or alterations to this Contract must be made in writing and agreed upon by both parties. Each party represents and warrants to
the other that it has the full power and authority to enter into the contract and that it is binding and enforceable in accordance with its
terms. Doc si nedbDocuSlpnedby: 0 y:
5/23/2018 1 1:20 PM EDT r—p,-5/23/2018 I 1:19 PM
Represe Give Date '- @Qeossntu'as... Date
l`!
THIS INSTRUMENT PREPARED BY:
r_:w' Name: JASPER CONTRACTORS l4`u1 rAddress: 4185 S ORLANDO DR
SANFORD, FL 32773
c0z2S81
NOTICE OF COMMENCEMENT
Permit Number.
Parcel ID Number. 12' 9-a .30-SI I — OGop '0
1Ii11it t11i11111! tu I11 I III It I
GRANT MALOYr SEMINOLE COUNTY
CLERK OF CIRCUIT COURT & COMPTROLLER
BY, 9149 Ps 1380 (1P9s)
CLERK'S : 2018065898
RECORDED 06/11/2018 11a22:46 AM
RECORDING FEES $10.00
RECORDED BY hdevore
The undersigned hereby gives notice that Improvement will be made to certain real property, and In accordance with Chapter 713, Florida Statutes, thefollowingWormationisprovidedinthisNoticeofCommernmlenL
1. DESCRIPTION OF PROPERTY: (Legal description of the property and street address If available) r _ e _ i_-%
2. GENERAL DESCRIPTION OF IMPROVEMENT:
Re -Roof
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT.
Name and oddness: { ss: 9`r1,MCn /09 LladalP t R e I SailA el, P/ 5277
InWest In property: OWNER
Fee Simple Title Holder (If oftrthan Owner listed atave) Name:
Address:
4. CONTRACTOR: Name: JASPER CONTRACTORS Plane Number: 407-278-7788
Address: 4185 S Orlando Dr Sanford, FL 32773
i. SURETY Of applicable, a Copy ofthe payment bond Is attached) : Name:
Address: Amount of Bond:
6. LENDER Name: Phone Number
Address:
7. Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served as provided by Section713.13(1)(a)7., Florida Statuties.
Name: Plane Nurnber.
Address:
6. In addition, Owner designates of
to receive a copy of the Lienoes Notice as provided In Section 713.13(1)(b), Florida Statutes. Phone munber.
8. Expiration Date of Notice of Commencement (The expiration is 1 year from date of recording unless a different date is spedtied)
WARMt4G TO OWNER• ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARECONSIDEREDIMPROPERPAYMENTSUNDERCHAPTER713. PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOURPAYINGTWICEFORIMPROVEMENTSTOYOURPROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND. POSTED ON THEJOBSITEBEFORETHEFIRSTINSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEYBEFORECOMMENCINGWORKORRECORDINGYOURNOTICEOFCOMMENCEMENT.
0 e I -con ; c r-dA-,)
W VOW or Lagee. orOwners or % (prod No mid Prowl 7WWOOMM) M90dzed
State of F County ofa ind GC.
The foregoing Instrument was aclumwiedged before me this 3 day of
by
Nam or person win" sbftmem
who has produced Identification rtype of Identification produced:
RUDITH GOICO
S pf Florida -Notary Public
ission A GG 178413
My Commission Expires
January24, 2022
Aft"
SEMINOLE COUNTY ML/LTI%LIRISD/CT/ONAL
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 06/15/18
1-hereby-name-and-appoint: Rudith Goico, Adreanna Ocasio, Skylar Amkraut, Amanda Cieplinski
an agent of: JASPER CONTRACTORS
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):
rt
All permits and applications submitted by this contractor.
Or
The specific permit and application for work located at:
109 MADDEN AVE SANFORD, FL 32773
Street Address)
Expiration Date for This Limited Power of Attorney: 01 /01 /19
License Holoer.Name: Donald Bouchard
State License Number: CCC1331153
Signature of License Holder:,
STATE OF FLORIDA
COUNTY OF Seminole
The foregoing instrument was acknowledged before me this 15 day of June
2018 , by Donald Bouchard who is 0 personally known to me or
9) who has produced DL
and wh di `( id not) take an oath.
Signa ure of Notary
gRk-,
ANA CHAVEZ
State of Florida -Notary Public
tCfvlyCornmisslon Epires
June 06, 2021
as identification
Print or type Notary name
Notary Public - Slate of `r `•CTt; t c
Commission No. (--I. L:n aff -_
My Commission Expires: .( l l
Sr l'Ok, . • i
i
BUILDINGDIVISION Building & Fire Prevention Division
Re -Roof Permit Card
PERMIT NO. LL?'o 427 9 / V ISSUE DATE: O • /• /
CONTRACTOR: %,JaQ side r
i
JOB ADDRESS: /O 9 4L d j 4-e 0A"'.0
TYPE OF WORK: ^ e. &Wr
PROTECT FROM WEATHER
Post this Permit and all required documents in a conspicuous place outside
Digital Photographs are required - please follow re -roof policy and procedures guide
All trash, debris and dumpsters must be removed from job site at final inspection
Permit expires six (6) months from date of issue
ROOF
INSPECTION TYPE APPROVED REJECTED INSPECTOR
FINAL ROOF
FAILURE TO FOLLOW THE RESIDENTIAL RE -ROOF POLICY & PROCEDURES WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION FEE
AND MAY REQUIRE AN AFFIDAVIT, SIGNED AND SEALED, FROM A REGISTERED FLORIDA DESIGN PROFESSIONAL
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: 4-17 Inspection Line 407.792.6069 or 855.542.2112
TO SCHEDULE AN INSPECTION:
Dial 407.792.6069 or 855.541.2112
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 5:00 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
Final Roof Inspection Code 111
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
REVISED: 04-17 Inspection Line: 407.792.6069 or 855.541.2112
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 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: -ti- DATE: 06/15/18
f
D, PERMIT #
City of Sanford Building Division
Residential Re -Roof Scope of Work
JOB ADDRESS: 109 MADDEN AVE SANFORD, FL 32773
STRUCTURE TYPE: O SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: O REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY:
PLEASE NOTE: ONL Y 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED*
ROOF VENTILATION: DOFF -RIDGE O RIDGE OSOFFIT OPOWERED VENT
SKYLIGHTS: O YES ( NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 — 4:12 4:12 OR GREATER
OTURBINES
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
Q SHINGLE Owens Corning FL# 10674-R13
OM ETAL FL#
O MODIFIED BITUMEN FL#
O TORCH DOWN FL#
O INSULATED FL#
O TILE FL#
O OTHER: FL#
ROOF EXTENSIONS (PORCHES. PATIOS. ETC.) **1FAPPLICABLE**
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#
OTORCH DOWN FL#
0INSULATED FL#
TILE FL#
0 OTHER: FL#
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 . . . . . 18-00002814 Date 6/21/18
Property Address . . . . . . 109 MADDEN AVE
Parcel Number . . 12.20.30.511-0000-0670
Application description . . . ROOFING APPLICATION
Subdivision Name . . . . . .
Property Zoning . . . . . . . MULTIPLE FAMILY
Permit . . . . . . RESIDENTIAL ROOFING PERMIT
Additional desc . .
Phone Access Code 1059526
Permit pin number 1059526
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
1000 111 BL03 FINAL ROOF / /
I City of Sanford
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, ANDALLFINAL ROOF COVERINGS ,,pp
PERMIT#: I ADDRESS:) rr V
e. n 81± 1 v ,
AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR ROOFING CONTRACTOR,
ONGINEER, ARCHITECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE FOREGOING INFORMATION
IS TRUE AND ACCURATE AND THAT ALL ROOFING COMPONENTS LISTED ON THE SCOPE OF WORK AT THE ABOVE REFERENCED
ADDRESS HAVE BEEN INSTALLED IN ACCORDANCE WITH THEIR PRODUCT APPROVALS AND ALL APPLICABLE CODE REQUIREMENTS — SPECIFICALLY
FLORIDA BUILDING CODE, EXISTING BUILDING. IN ADDITION I CERTIFY THE INSTALLATION MEETS ALL REQUIREMENTS FOR
SECONDARY WATER BARRIER AND NAILING OF THE ROOF DECK, IN ACCORDANCE WITH THE HURRICANE RETROFIT/ MANUAL REQUIREMENTS (
BASED ON F.S. CHAPTER 553.844). LICENSE #: CCC1331153
COMPANY / CONTRACTOR:
JASPER CONTRATO CONTRACTOR SIGNATURE:
zz DATE: MUST BE
SIGNED BY LICE OLD R 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 ROOFSHOWING 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 SEMINOLE Sworn to
and Subscribed befor a this ( day of / 20 by: S_4 '
WWho is D Personally Known to me or has Di! Produced (type of identiticati n)
DL as identification. R6gV AUT
o,, elte01
Flonda Np1e220805 Si natuiaofNtaryPublicg * SCon,r^'ssio qio Expires State ofo ' ? MY C Ju eisso 22 Print/
7'
y tamp Name c ofNotary
Public
LUMTED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 2
I hereby name and appoint: Scott Meixsell, James Allen, Chris Gardner, Juan Lozano, Paul Padgett
an agent of conveMm
Kane of Coa Vwy)
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):
The specific permrt and application f work located at:
f'1r A A rr n I n , ,-a
Sam Aaarea)
Expiration Date for' Limited Power of Attorney: \ —
License Holder Name:
State License Number. COC1331153
Signature of License Holder.
STATE OF FLORMA
COUNTY OF
t ` jTheforegoinginstrumentwasacknowledgedbeforemethisodayof
200_IK, by Dmw 13—hard who is o personally libown
to me or a who has produced tx as
identification and who did (did not) take an o th.
Signature
Notary Seal) &w&d
Print or name
KY'AR 8 ANotsry Pubtc Notary Public - State of
ou, o, of Ftooda. 220t305
sSCommissio^ H;Gn Expires
COIDInISSIOD N0.
MY CJu^eto' • 2022 My Commission Expires: Cs) ZOZZ
Rey. 08.12)
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