135 Wornall Dr - BR18-002949 - REROOFa
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
j Application No: / 40)g45 Documented
Construction Value: S 9,600 Job
Address: 135 WORNALL DR SANFORD, FL 32771 Historic District: Yes No 0 Parcel
ID: 33-19-30-514-0000-0180 Residential x Commercial Type
of Work: New Addition AlterationEl Repair Demo Change of Use Move Description of
Work: Re Roof Owens Coming FL 10674-R13 15216-R3 Techwrap 17194-112 28 SQ 7/12 Pitch Driftwood Oakridge
LIFETIME Plan Review
Contact Person: Phone: 407-
278-7788 Name ETCHISON,
CYNTHIA L Street: 135
WORNALL DR Skylar Amkraut
Title: Admin Fax: 800-
337-3361 Email: Permit@Jasperinc.com City, State
Zip: SANFORD, FL 32771 Name Jasper
Contractors Street: 4185
S Orlando Dr City, State
Zip: Sanford, FL 32773 Name: Street:
City,
St,
Zip: Bonding Company:
Address: Property
Owner
Information 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. 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. 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 be
found in the public records of this county, and there may be additional permits required from other governmental entities such as water
management districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
The City of Sanford requires payment of a plan review fee at the time of permit submittal. A copy of the executed contract is required
in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal.
The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in
accordance with local ordinance. Should calculated charges figured off the executed contract exceed the actual construction value,
credit will be applied to your permit fees when the permit is issued.
OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will
be-done in compliance -with all- applicable -laws regulating -construction and -zoning: -- - •— — --- -- — -
Signature of Owncr/Agent
Print Owner/Agent's Name
Date
Signature ofNotary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced 1D Type of ID
07/03/18
Signs m ofCont c or Agent Date
Rudith Goico
State of Florida -Notary Public
Commission # GG 112152
v My Commission Expires
June 06.2021 11
Contractor/Agent is/ Personally Known to Me or
Produced 1D • Type of 1D ` >_
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: June 30, 2015 Permit Application
7/3/2018 SCPA Parcel View. 33-19-30-514-0000-0180
fI
O o Johnson, CIA
ZPTPURR
nr aaa oouertr. A.ocwn
Parcel Information
Property Record Card
Parcel: 33-19-30-514-0000-0180
Property Address: 135 WORNALL DR SANFORD, FL 32771
Parcel 33-19-30-514-0000-0180
Owner(s) ETCHISON, CYNTHIA L
Property Address 135 WORNALL DR SANFORD, FL 32771
Mailing 135 WORNALL DR SANFORD, FL 32771-7759
Subdivision Name COUNTRY CLUB PARK
Tax District S1-SANFORD
DOR Use Code 01-SINGLE FAMILY
Exemptions 00-HOMESTEAD(2000)
50 50 48.83
I51.
31
20= 10 1: 17§' 16
50 50 50 55.03 71.05
Seminole County GIS
Legal Description
LOT 18
COUNTRY CLUB PARK
PB 50 PGS 63 THRU 66
Taxes
Value Summary
2018 Working
Values
2017 Certified
Values
Valuation Method Cost/Market Cost/Market
Number of Buildings 1 1
Depreciated Bldg Value 130,992 118,911
Depreciated EXFT Value
Land Value (Market) 38,000 38,000
Land Value Ag
Just/Market Value " 168,992 156.911
Portability Adj
Save Our Homes Adj 63,201 53,296
Amendment 1 Adj 0
PBG Adj 0 0
Assessed Value 105,791 103,615
Tax Amount without SOH: $2,199.00
2017 Tax Bill Amount $1,185.00
Tax Estimator
Save Our Homes Savings: $1,014.00
Does NOT INCLUDE Non Ad Valorem Assessments
http://parceidetaii.scpafl.org/ParcelDetaillnfo.aspx?PID=33193051400000180 1 /3
DocuSign Envelope ID: 7778D7B3-604F4D3D-B66E-OB1E87700E01
JASPER
Jospor 100f.com
800) 337-3361 Fax
info(@jasperinc.com FL Contractor's License:
CCC 1329651 &CCC 1331153
i- VISA
ROOF REPLACEMENT CONTRACT
Account Manager: Joseph Palladino
Contact #: (407) 335-6239
Company:
Policy #:0000534253
Claim #: Cp6000000481
Company: Wells Fargo Bank
Loan Number:
Owner(s): Cynthia Etchison Phone:
Address: 135 Wornall Drive All Phone: 407-314-1042
City:
Sanford
S E Zip Code: 32771 Shingle Color:
OC Oakrid e - Driftwood
Email: cetch2004@gmail.com Roof RCV Amount/ Contract Price:
EEO
Drip Edge Color:
1*Drip Edge - White 6"
If Owner's Insurance Comnany does not agree to nay fora full roof replacement_ this contract shall he yoidahle_
Assignment of Insurance Benefits for the Full Roof Replacement Only: I 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 pay 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 ' pjr 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 stated on the insurer's Loss Sheet shall overrule deductible amount disclosed. Deductible: $3600.00 MUST BE PAID
1N FUL itial).
PAYME LE: Owner agrees to pay Jasper based on the following schedule: (i) Deposit in the amount of $- 00 due upon signing this
contract; (ii) the Contract Price, less the Deposit and any applicable depreciation retained by Owner's insurer(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% ofContract 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 roofreplacement, Jasper shall perform the roofreplacement 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.
DocuSlpmd by: 1pned by:
6/21/2018 I 5:30 PM EDT rz f 6/21/2018 I 5:29 pM ED'
rQ l
ItaetuA per Representative Date P252e04F4... Date
THIS INSTRUMENT PREPARED BY:
Name: JASPER CONTRACTORS Rudilh Golco
Addresa- 4185 ORLANDO DR
SMFORD. FL 32773
M13No3
NOTICE OF COMMENCEMENT
Permit Number.
ParcelIDNumber. 3 19-30524-0MV—D/Cb
The u dorslgned hereby gives nedoa that Improvemerd Nil be mado to cortaln real props y, and In 0000rdanoo with Chepler 713. Florida Stslulr s. the
following Informadon Is provded In N3 Nonce of Commencement
1. DESCRIPTION OF PROPERTY: (Legal description of the Property and $treat addreu 11 avaiab:e)
2. GENERAL DESCRIPTION OF IMPROVEMENT:
Re -Roof
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEM T:
Name and address: 6LIP'Wii d G. t // ,
Interest In property: OWNER
Foe Simplo Tldo Holder Of other than owner (bled above) Name:
Addresa:_
4. CONTRACTOR: Name: JASPER CONTRACTORS phone Nmbor 407-278-7788
Address: 4185 S Orlando Dr, Sanford, FL 32773
a SURETY Of apPllcsbte, a espy of the paymord bond Is atlachod: Name:_
Address AmOM ofBong
S. LENDER Name Phase Mnprj
Address:
7. Persons within the Stab ofnorlda Designated byOwner upon whom notico or other doeumords may be served as provided bySection713.1311(a)7. Florida Statutes
Name Phono Number.
Address'
t1 oddroot Owner dtntgnales of
to reoelvo a copy of the Uenoes Notice oa provided In Section 713.13(1)(b), Florida S1aMng. Phone number.
9. Expiration Date of Notke of Commmrxment (The errpiretlon Ls 1 year from date of recordng uNess a dRererd date Is specified)
WARNING TO OWNER• ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE
CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT LV YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE
JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE COMMENCING WOW OR RECORDING YOUR NOTICE OF COMMENCEMENT.
a ems. Oj4 tip. E;kluso/i
d0 sU r10rWY eReside$ Ooyr TllsOnefi wrrrmrrprr) States
of i County of/-iy /1
The
fongolnp Instrument was ackn&Modged before me this I I day of I-='
NMrcrewrrnrrwleembArr cvl
Who Is personally known to me D OR who
has produced kfordHlcallof type of IdentinaWon produced: _ l 8f113
ANY JONES StateofFlorida-Nolely Pubflc e
Commission s GG 213025 t.......... MY Commission Expire$ April
30.2022 GRANT
MALOY, CLERK OF CIRCUIT COURT SEMINOLE COUNTY FL CLERK'
S # 2018074463 BK 9162 Pg 1810; (1pg) E-RECORDED 06/28/2018 09:31:43 AM 10.
00 L
Scanned
by CamScanner
BUILDING DIVISION
r•1 7'. 18i'1
Building & Fire Prevention Division
Re -Roof Permit Card
PERMIT NO. /r-w dq*4 ISSUE DATE: O J• O C', ' k
CONTRACTOR: SA /r'a . 'J
JOB ADDRESS: ' 3 S • tiD I i /
TYPE OF WORK: I
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 REOUIRED 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: - DATE: 07/03/18
PERMIT #
City of Sanford Building Division
Residential Re -Roof Scope of Work
JOB ADDRESS: 135 WORNALL DR SANFORD, FL 32771
STRUCTURE TYPE: Q SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: Q 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 O 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
O METAL FL#
O MODIFIED BITUMEN FL#
OTORCH DOWN FL#
O INSULATED FL#
OTILE FL#
0OTHER: 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#
OMETAL FL#
0MODIFIED BITUMEN FL#
OTORCH DOWN FL#
O INSULATED FL#
OTILE FL#
0OTHER: 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 . . . . . 18-00002949 Date 7/05/18
Property Address . . . . . . 135 WORNALL DR
Parcel Number . . 33.19.30.514-0000-0180
Application description . . . ROOFING APPLICATION
Subdivision Name . . . . . .
Property Zoning . . . . . . . PUD
Permit . . . . . . RESIDENTIAL ROOFING PERMIT
Additional desc . .
Phone Access Code 1062348
Permit pin number 1062348
Required Inspections
Phone Insp
Seq insp# Code Description initials Date
1000 Ill BL03 FINAL ROOF _/_/_
City of Sanford
Building and Fire Prevention
RESIDENTIAL RE —ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY —IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: I &-- ag q 9 ADDRESS: 5 `j )UA.I (it,!' / f/fl
I L V A a ,,.r : 15PAe_e rp , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, ENGINEER, 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 CONTRATORS
CONTRACTOR SIGNATURE:
MUST BE SIGNED BY LICENSE HoeOR OR ONR/BU DER) A
FINAL ROOF INSPECTION IS REQUIRED: DATE:
J I THIS
SIGNED AND NOTARIZED AFFIDAVIT MUST BE PROVIDED AT THE JOB SITE AT THE TIME OF THE FINAL ROOF INSPECTION, ALONG
WITH DIGITAL PHOTOGRAPHS OF EACH PLANE OF THE ROOF SHOWING IN DETAIL ALL COMPONENTS (DECKING, UNDERLAYMENT,
FLASHING, DRIP EDGE ATTACHMENT) WITH THE PERMIT NUMBER OR ADDRESS CLEARLY MARKED ON THE DECK FOR
EACH INSPECTION. THE PHOTOGRAPHS MUST INCLUDE A RULER OR MEASURING DEVICE TO CONFIRM ALL NAIL SPACING AND OVERLAPS,
INCLUDING DRIP EDGE AND VALLEY FLASHING. PLEASE REFER TO THE RE -ROOF POLICY AND INSPECTION PROCEDURE PAPERWORK
FOR FURTHER EXPLANATION OF ALL REQUIREMENTS. FAILURE
TO FOLLOW ALL REQUIREMENTS WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION FEE AS WELL
ASREQUIRING 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 before me this day of 4k by: fd
Va,",..: UrAeex6 . Who is 0 Personally Known to me or has % Produced (type of tific
iezEk7 as
identification. Si
nature of Notary Public St
to of Flori V (
ANA
CHAVEZ State
of Florida -Notary Public Print/
Type/Stamp Name y Commission a GG 112152 M
Commission Expires of
Notary Public °'?,°.11 1' June 06. 2021