1812 W 1 St - BR17-003247 - ROOF (2)CITY OF SANFORD
V 0 2017 BUILDING & FIRE PREVENTION
w
PERMIT APPLICATION
Application No: Ll
Documented Construction Value: $ rl 9.50 . Ud
Job Address: _5 ,-60 , IFC_ 3 z77 I Historic District: Yes No 91
Parcel ID: 2, S-i 41' - 3C)-'S 46 O 2z1 00 °rO Residential /Commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of Work: Ae-roo
f c,m c;d I'1`/"• 5 ieS iJL-c.h , 1 S'+cy 25 USC S
Plan Review Contact Person: l 6 c4 Shoe ,lcz( Title: CL-Ulye_r
Phone: L)p'7 1 "4 Fax: yo -7 (aV_ $ 'S S`i Email: M *^Coe- s Q tl,co , Co")
Property Owner Information
Name aru S!S, le_'n .540-c -E c-
Street: 3 f2oo 0r,
City, State Zip: L.,ke_ 11 Lc4 i' 3 2-7-7 L4 (,go
Phone:
Resident of property? :
Contractor Information
Name Phone: k7 230
Street: pO 136X S2-2-[o) 0 Fax: 07 GX L $r5_`,
City, State Zip: Lo.-, L.jooy. FL- 3 2-7 'SZ State License No.: -7 sr3 y
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
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: 5th Edition (2014) Florida Building Code
Revised: June 30, 2015 Permit Application
SCPA Parcel View: 25-19-30-5AG-0221-OOAO Page 1 of 2
sc i+oE oour+rG n,aaw
Parcel Information
Property Record Card
Parcel: 25-19-30-5AG-0221-00A0
Owner: JERUSALEM STONE INC
Property Address: 1812 W 1ST ST SANFORD, FL 32771
Parcel
Owner
Property Address
25-19-30-5AG-0221-OOAO
Y..................... ......
JERUSALEM STONE INC
1812 W 1ST ST SANFORD, FL 32771 E
Mailing 3900 WIMBLEDON DR LAKE MARY, FL 32746-4024
Subdivision Name SANFORD TOWN OF
Tax District S1-SANFORD
DOR Use Code 1701-OFFICE/CONV. RESIDENTIAL
Exemptions
Legal Description
W 1/2 + 1/2 OF VACD STS ON
N + W (LESS RD) BLK 2 TR
21
TOWN OF SANFORD
PB 1 PG 116
Value Summary
2018 Working 2017 Certified [
3 Values Values
Valuation Method Cost/MarketCost/Market
Number of Buildings 1 1
j' Depreciated Bldg Value 47,947 47,947 {
Deprecated EXFT Value 3,303 3,438
Land Value (Market) 166 648 166 648
Land Value Ag
JusUMarket Value 217 898 218 033 I
Portability Adj
Save Our Homes Adj 0 0
i Amendment 1 Atlj 0 0
P&G Adj 0 0
Assessed Value 217,698 218,033
1TaxAmountwithoutSOH: $4,151.67
2017 Tax Bill Amount $4,151.67
Tax Estimator
Save Our Homes Savings: $0.00
Does NOT INCLUDE Non Ad Valorem Assessments
Taxes
Taxing Authority Assessment Value Exempt Values Taxable Value !
County General Fund 9 $217,898 0 217,898
Schools 217,898 0 217,898
City Sanford 217,898 0 217,898 E
SJWM(Saint Johns Water Management) 217,898 0 . 217,898 €
County Bonds 217,898 0 217,898
i........ _--------- ._„_,,,_--"'.._......_-..----"'""........_._._.._._._ W.._.._....,.._..._.................._.....,__.__—._..._.._.____..._.-.._.............._._._....._._._.,....._.,,...E
Sales
Description Date — i Book — Page Amount -7 Qualified Vac/Imp _
No Sales
Find Compararile Sal
Land
Method I Frontage Depth Units Units Price Land Value
SQUARE FEET 0.00 0.00 '' 41662 $4.00 $166,648
Building Information
Year Built
I Description Stories Total SF Ext Wall Adj Value Repl Value Appendages ( jctual/Effective _ _ __.JA mm --- --
1 MASONRY 1949 1 1,625 WOOD OVER CONCRETE $47,947 ! $119,867 ' 1 Description _ Area
PILASTER. BLOCK -MASONRY __
i
http://parceldetail.scpafl.org/ParcelDetailInfo.aspx?PID=2519305AG0221 OOAO 10/25/2017
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: ) G-7
I hereby name and appoint: 9 Qber -' S/< u < a,
an agent of: feoo-p;
Name of Con
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):
C The specific permit and application for work located at:
G( 1 fO) Z L-i + JcT(e,
LJGnToCd F— 3?% Street
Address) Expiration
Date for This Limited Power of Attorney: License
Holder Name: 98e,+ A . SA or v" mice < State
License Number: C. CC- O - -7 $ 3g Signature of
License Holder: STATE OF
FLORIDA COUNTY OF
r,'.ho)e, The foregoing
instrument was acknowledged before me this 29 day of20¢Z_,
by fide,-4- )4- s er K.ke< who is l personally known to o
m; or who has produced as identification and
who did (did not) t oath. Sig r
Notary Seal)
4RY, JOEL
HANCOCK NOTARY PUBLIC
STATE OF
FLORIDA J Comm#
FF224497 I Expires
4/27/2019 Print or
type name Notary Public -
State of Commission No.
My Commission
Expires: Rev. 08.
12)
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.
p
Signature of Owner/Agent Date Signatur ofContractor/Agent Date
VvCte,10 J" 65HDJI
Print Owner/Agent's Name
Owner/Agent s
Produced ID
totZr-
ida dAt$ 8tUL1 '
Contnti8610 I FF 184199
My Contra. Expires Jan S. 2019
thro* Nations! NotaryAssn.
Known to Me or
Type of ID
oty-,- -' 4. ,Sor-kn 44e r Print ]
ntraor/Agent's e Signatu
Notary -St ofFiorida Date y
q JOEL HANCOCK NOTARY
PUBLIC STATE
OF FLORIDA Comm#
FF224497 Contractor/
Ag ntis g1r/E11$ia4dW'1i71D(Vn to Me or Produced
ID Typ—eot ID BELOW
IS FOR OFFICE USE ONLY Permits
Required: Building Electrical Mechanical Plumbing[] Gas Roof Construction
Type: Total
Sq Ft of Bldg: Occupancy
Use: Min.
Occupancy Load: New
Construction: Electric - # of Amps Fire
Sprinkler Permit: Yes No APPROVALS:
ZONING: ENGINEERING:
COMMENTS:
of
Heads UTILITIES:
FIRE:
Flood
Zone: of
Stories: Plumbing - #
of Fixtures Fire
Alarm Permit: Yes No WASTE
WATER: BUILDING:
Revised:
June 30, 2015 Permit Application
Thompson Architectural
Metals
813) 248-3456
900) 248-3454
Pax (813) U7-4616
r womemiroofirng--coin
OFF RIDGE ROOF VENT INSTALLATION
WnIML m 4112 pitch required.
Cut out the oft ridge opening in tine rbQ sheathing
as sh wn ip Figure A. Size the opening in
al:cflrdl rice with the correct cutting data Models.
and loc ite the opening 6" minimum off the peak of
the tocf as shown in Figure B, For single vent
applivajons, install went as close to the center of
the roa length as possible. Install rnuldple, vents in
evenly paced areas of the entire roof length.
Do nol cut into trusses or rafters wham cutting
Role ir the roof. -
M71 I IG
Remove interfering shingle nails around the
perim er of the opening. Slide top and side flanges
of the N ent up and under shingles. Allow the bottom
vent fl, nges to lay on top of shingles.
MOUNTING
Care s riould be taken in keeping the vent PrOPedy
aligne . Nall in place ;.icing 1-114" coating roofing
nails s aced approximately 6`_ , 12" on center and
1.112" from each end. Roofing cemerrt should be
appiie i to all shingle edges and nail heads to
prevet t water leafage, In severe weather coastal
const uction zones, caulking around entire
penm ter, under vent flanges and near outer edges
1.
7xJYli;>i7 bride Building Cade TaM¢ 16 7.3-3!°506.A 3
y ° trr ° m
4t v rid: a D r
w a t]' tP51JA
a
Pa lark ds l tZAL l a
s ANDAW OFF RIDGE Vt%T
T! TlL r OFF RIDGE VENT
tlk
srANOARD OFF RIDGE VIrNT
zaImp.
OFF RIDGE VENT
4'
OFF RIDGE VENT
4' 46.25 : 138 8.5" 4ir x 3'
6' 7t7.25 . 210 8.5"
8' 8JC.25 282 8.5" 94" x 3'
10' 118.26. 354 8.5" 11T x 3"
p '. —.I.. v. —
hi> I-ALS - 50 5 E. HfUsboi Dugh Avenuc " Yampa. F1336in (813)
Installation Method (Continued
Thompson Architectural, Meta Company
Standard Off Ridge "dent with Baffle"
Attached to Wood Deck
Standard, Off Itidge Vent with Baffle
Size Length Height
4' 48,25 ' 80'
S' 7U.Z5 8.5"
14' 118.25 .5"
Moe
J
iypicd 6" 4.C. MAX
a
Q
0 0
y;
kt4
tir y 111N f4 4 °
Y
d'
PY \ +Ys Y •• Y
i OEd it caSl. ..
0
a
O
Q 0
Nags.11 Co. min,1-1t4" COMOS1W i"ni,
Arthur Ring Shenk iRoofinq Negs
pacim, 6" 04. MAX SW 1" ROM otmr Edge PimpLtiCste1in', From Each End
4 Clfiarb
sYaa !;leek: Mipimum 15132"' VVWd
s
W
Plan View
17
Installation Method
Thompson Architectural Metals Company
Standard offf Ridge Vert with a e"
Attached to Wood Deck
T-Vent Throat
a^
No,*W 4' 0, V, or V LWO
NoTF inaWjo&n at rWAred
rMd T 4 gw
Roofer strait «Mete InstallationofventMW
VW am.layed down to edp of #re want
base. The bWe rem upon itr9tW witi m
of ryhir les am is #fitted a Wnd ire r+ #sit
to aEfcrnr far an apprcWma y2-1rZ deal' opeNV-
Installattan is cxxn4 u* upw the bdft b
att d*d wllh'1WO W irdn. won "
aeUrtllmg ww& through each Imp W
tl e fides fir the vent
7WO #10 x min_ 31et" saif-abi ON
e
sass on eath side of the 2=11'
alsfltie Cloir Opening
Wrniraa! 4'. 8', 8% or 10' iano
24°
Stan alyd Off Ridge Veiit with Baffle ,
r~e
ittiatorkt,,
1 .rrr. hPer
U. AA013%
AIM16 CITY Of
PERMIT #Sk, F0
Building & Fire Prevention Division
FIRE t*0,'WMENT RESIDENTIAL RE -ROOF SCOPE OF WORK
JOB ADDRESS: 54r2e+ S ch TOCd ; FL- 32-77
STRUCTURE TYPE: SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: PlREPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF) I f/\ \
DECK TYPE (PLEASE SPECIFY): ,
Z \
hS (9
lr
PLEASE NOTE: ONL Y 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED * *
ROOF VENTILATION: OF`F-RIDGE O RIDGE OSOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: O YES CIO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 412 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
V *SHINGLE I i 0 1..+' J 2 r ` FL# -%V U
O METAL FL#
O MODIFIED BITUMEN FL#
O TORCH DOWN FL#
OINSULATED FL#
O TILE FL#
O OTHER: FL#
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IFAPPLICABLE**
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#
O TORCH DOWN FL#
O INSULATED FL#
O TILE FL#
O OTHER: FL#
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.
DATE: CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: Z
3 (`+
1D FLORIDA ROOFING ES C XMATE/SALES ORDER
768 Ferne Drive STATE LICEiNSE: CCC057834
Longwood, FL 32779
Tel:.(407) 830-8554
Fax: (407) 682-8554
w
1d Date of Estimate: - f Sales Rep Name: G i C 1 6-0,
Customer Name: ! N Z Sales Re Phone #: - 7 p _t i ( C v,Y
Job Address: Z- W e J - , 4--k,Cust. Day Phone
City, State, Zip: 'sN Cust. Eve. Phone #: By/
signing below, Customer and Mid Florida Roofing, Inc. hereby agree to the terms and conditions described in this contract: lXRemove
existing roof from above address. Total number of squares: 0 / L Two
or more layers on roof to be removed at $45 per square. $45/sq. X'-f
squares = $ (
included in total price below) Remove
and replace the following items with like or equivalent materials: G.
Valley Metal .Sy total linear fpet ..- H. Plumbing
vent pipe boots: 1 1/2inch: 2 inch: 3 inch: 4 inch:1- 5 inch: I. Kitchen &
Bathroom ven ose: 6" goose: 10" goose: Color: J. - Off -
set ridge vents (4ft): J` Color: K. Ridge
Vents (1Oft): Color: L. Replace
eave-drip (except behind gutters) with: CT pieces. Color: T Replace all
rotten sheeti (if any) a n additional charge of $60 per sheet including installation. Charge is not included in total contract price below. XReplace IIreplaced
wood (
includin heathin , fascia, siding, trusses, tails, etc.) willbe documented and billed separately. underlayment with
the following: 151b Felt 301b Felt Titanium PolyGlass TU Plus 7 Install new
roof using: Architectural S ingles 3 Tab Shingles Concf ete Tile Clay Tile 5V Crimp Standing Seam DECRA G {/ril ! //
e / e Manufacturer/Style: 0 Color: Install new
4ft off -set ridge vents ($80 each) Total $ Install new 10ft ridge vents ($50 each) Total $ Replace 2'
x 2' skylight: Qty: Replace 2' x 4' skylight: Qty: Total $ (included in price below) Upon completion,
Mid Florida Roofing will remove all job -related debris, garbage and excess materials from job site and will use magnet for nails, staples, simplex,
etc. Customer requests
that Mid Florida Roofing remove and discard existing solar heating panels prior to commencement of installation. If this option is not checked,
customer is responsible for removal of solar heating panels prior to commencement of installation. Customer is also responsible for re -installation
of solar heating panels when roof work has been completed, if this option is not checked. SPECIAL INSTRUCTIONS:
f. J
If
payment
is not made under the terms of this contract, Mid Florida Roofing, Inc. reserves the right to place a lien on the above mentioned property and OR be
necessary,
the person on this contract shall pay all court costs, attorney fees and appeal costs (if any). This contract is valid for one month from the date of
acceptance and approval by Mid Florida Roofing, Inc. Mid Florida Roofing, Inc. reserves the right to cancel all or part of this contract at any time. The State
of Florida has a construction recovery fund. WARRANTY: Includes
manufacturer's material warranties and five year workmanship warranty unless otherwise specified in special instructions above. PAYMENT TERMS:
Full payment is due upon completion of the work described on this contract, unless otherwise agreed upon in writing between customer and
Mid Florida Roofing, Inc. LA Accepted:
Date:
Customer Sig
fure Approval: C&
O/
Z_ Date: TOTAL
PRICE = $ ,` ` ` V kk:
T
1111111111111111111111111111111111111111
THIS INSTRUMENT PREPARED BY:
Name: Robert H. Shoemaker
Address: PO Box 522610
Lonowood. FL 32752
NOTICE OF COMMENCEMENT
State of Florida
County of Seminole
i
Permit Number: I 'I Parcel ID Number:
GRANT NALOi f SEtINGLE. COUNTY
CLERK OF CIRCUIT COURT & COMPTROLLER
gl; 9019 P9 163 (Pgs )
CLERK'S x 2017112047
RECORDED 11/06/2017 09:22-'03 All
RECORDING FEES $10.00
RECORDED BY hdevare
25-19-30-5AG-0221-OOAO
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available)
3`
1R17 tA1 Iof Cfrmaf Cnnfnrri GI 49771 "~ `•R'
W 1/2 + 1/2 OD VACD STS ON N + W (LESS 0) BLK 2 TR 21 TOWN OF
SANFORD PB 1 PG 116
GENERAL DESCRIPTION OF IMPROVEMENT:
Reroof .° f
OWNER INFORMATION: /
Name: Jerusalem Stone Inc <`
Address: 3900 Wimbledon Dr. Lake Mary, FL 32746
Fee Simple Title Holder (if other than owner) Name:
CONTRACTOR:
Name: Mid Florida Roofing
Address: PO Box 522610 Longwood, FL 32752
Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served
as provided by Section 713.13(1)(b), Florida Statutes.
Name:
Address:
In addition to himself, Owner Designates
To receive a copy of the Lienors Notice as Provided in
Section 713.13(1)(b), Florida Statutes.
Expiration Date of Notice of Commencement (The expiration date is 1 year from date of recording unless a
different date is specified) 2110/18
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 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.
Under penalties of p rjury, I declarpolhat I have read the foregoing and that the facts stated in it are true
to the best f my k ledge and tef.
Owners Signat Owner's Printed Name
Florida Statute 713.13(1)(g):'The owner must sign the notice or commencement and no one else may be permitted to sign in his or her stead'
State of !' ) 6171 l r-- Countyof QLY t tiC l j /^''
The
foregoing instrument was acknowledged before me this day of ll 6421.Z '7 _ 20 t by
A10 w„ 1 D , /I/V ' 1 J H v- I Who is personally known to me Name
of person making s terpent OR
who has produced identiflcation,N type of identification produced: Notary
81111100 llMtla Contntfs{
ly;# P 1141li l- -- My
Cornet. Expktes Jae 9, 2019 / Notary Signature BondedthroltpftNaBonillNotiryAssrt. ,/
CITY OF"
Building & Fire Prevention Division
OOF AFFIDA V1TRESIDENTMLRE-R
FIRE1'!DEPART" M-flq*
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
SREATRING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERN11T#: /-7— O 160 3Z_q:Z_ ADDRESS: d2- S+ S*ze_j—
AS A(N) Gf.-,NERAL, 13.0anil4cii, RESIDENTIAL, OR
40NNEER., ARCifITECT, OF F.S. CUAPTER 468 BUILDING (INSPECTOR, I HERE'BY AFFIRM, THAT ALI., OF THE
IS TRUE AND ACCURATE AND THAT ALL ROOFING COMPONENTS'LISTED ONTHE SCOPE OF WORK ATHF ABOVE
REFERENCED ADDRF',SS HAVE BEEN INSTALS. EDIN ACCORDANCE WITH THEIR. PRODICT APPROVALS AND ALL APPLICARLE CODE. RFQUIREMENTS-SPECIFICALLY
FLORIDA BUILDING COOL) EXISTING .BUII1D`1N6L IN.NDL)I-FIONIC.ER'I'IFYTHE INe,-['ALLA'i'[ONNIL--L-"I'SALL REQUIREMENTS FOR SECONDARY
WATER BARR [ER AND NAILING OF I ROOF DECK, IN ACCORDANCE W` ITH -1-14E I IIJR RICA NERETROFIT MANUAL REQUIREMENTS (BASED
ON.F.S. CHAPTER 553.844). LICENSE #: C C
C 0,577!a 3 9 COMPANY i CONTRACTOR:,
CONTRACTOR SIGNATURE: DAT
E: 11-7-1-7 MUSTBE SIGNED BY
LICENSE HoLDL:R OR OkkNFR/BUILDER) A FINAL ROOF
INSPECTION IS RFOUIRED* THIS SIGNED AND
NOTARIZED AFFIDAVIT MUST BE PROVIDED AT THE JOB SITE AT THE TIME OF THE FINAL ROOF INSPEGI-ION, ALONG WITH DIGITAL
PIIOTOGFLAPHS OF EACH PLANE OF THE ROOF SHOWING IN DETAIL ALL COMPONENTS (I)EcKIN( , UNDERLAYMENT, FLASHING, DRIP
EDGE ATTAC"MEN-I-) NN-1-111THE PERMIT NUMBER ORADDRESS CLENRLV MARKED ON THE DECK FOR EACH INSPECTION.
THE PHOTOGRAPHS MUSTINCLUDE A RULER OR MFAS'U RING DEVICE TO CONFIRM ALL NAIL SPACING AND OVERLAPS, INCLUDING DRIP EDGE
AND VNLLEY FLASHING. PLEASE RLFER"TO THE RE -ROOF POLICY AND INSPECTION PROCEDURE PAPERWORK FOR FURTHER EXPLANATION
O.F. ALL REQUIREMENTS. FAILURE TO FOLLOW ALL
REQUIREMENTS WILL RESULT IN A FAILED INSPECTION, A RE --INSPECTION FEE AS WELL AS REQUIRING ADESIGN
PROFESSIONAL (ARCHITECT OR ENGINEER) TO CERTIFV, BASED ON TIERSONAL INSPECTION, THE INSTALLATf ON
OF ALL ROOFIN'b COMPONENTS. STATE OF FLORIDA COUNTY
OF sa" -1 "3 f__ Sworn to and Subscribed
before me this =4k day of /Vqteaj-n i)p- t, 20 7 by Who is r Personally
Known to me or has 0 Produced (type of idr6flitilytion) z as identification.
JOEL HANCOCK NOTARY PUBLIC
Ig, re
of Not
Public: STATE OF FLORIDA e
of Sta eofFloridaComm# FF224497 Expires 4/27/2019
Print/Type/Stamp Name
of Nota6 Public