297 Clydesdale Cir - BR17-002707 - ROOF427645
b ( CITY OF SANFORD
BUILDING 8( FIRE PREVENTION
J` 1 PERMIT APPLICATION
Application No
Documented Construction Value: S tJ
Job Address: 297 CLYDESDALE CIR SANFORD, FL 32773 Historic District: Yes No
Parcel ID 18-20-31-506-0000-0470 Residential Commercial .
Type of Work: New Addition Alteration El Repair Demo Change of Use Move
Description of Work: Re -roof Owens Corning FL 10674 Techwrap FL 17194 31 SQS 7/12pitch Supreme Brownwood 25yr Warranty
Plan Review Contact Person: Rachel Holcomb Title: Office Manager
Phone: 407-278-7788 Fax: 800-337-3361 Email- permit@jasperinc.com
Property Owner Information
Name CARTY JO ANN Phone:
Street: 297 CLYDESDALE CIR Resident of property?
City, State Zip: SANFORD, FL 32773
Contractor Information
Name Donald Bouchard Phone: 407-278-7788
Street: 3203 S Conway Rd ste 201 _ Fax: 800-337-3361
City, State Zip: Orlando, FL 32812 State License No.:
Architect/Engineer Information
Name: Phone:
Street:
City, St, Zip:
Bonding Company:
Address:
Fax:
E-mail:
Mortgage Lender:
Address:
CCC1331153
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. -1F YOU INTEND -TO OBTAIN -
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY 13EFORE 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 (late of application and the code in effect as of that date: fill' Edition (2014) Florida Building Code
Revised: June 30, 2015 Permit Application
NOT:ICE'.- 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 Owner/Agent Date Signatu -o c gent Date
Karla Almodovar
Print Owner/Agent's Name Print Contractor/Agent's Name
Signature of Notary-State.of Florida Date
1 pYP je KAR'LA M. ALMODOVAR- State of Florida -Notary Public
Commission # GG 111330yarcMy,Commission Expires
June 04, 2021
Owner/Agent is Personally Known to Me or Co In to Me or
Produced ID Type of ID Produced ID Type of ID
BELOW ISFOR OFFICE -USE ONLY Permits
Required: Building Electrical 0 Mechanical Plumbing[] Gas Roof[] Construction
Type: Occupancy Use: Flood Zone: Total
Sq Ft of Bldg: Min. Occupancy Load: # of StoriesNew
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
5380'E. Colonic! Dr.
Orlando, hl" 32807
3203 Conway Rd., Ste, 201
Orlando, FL 32812
407) 278-77S&
800) 337=3361 Fax
to tii(rt Jhnc•ri ticair
VISA
Account Maualcr _ - -
Contact :l'
policy 1t:
Claim tk
Loran Number.
TJvmcr(s): phnric
oL` . 3 _f ` %i zr G 4r
Addres An Pitone'
St i t'odc: Slim Ic Color -
Email; Roof RCV mount/ Contract Pncc: Drip,' gel Color,
yl
11 Qwn Ls I nsura nee 'otnnanY does not agree to pHy for a [till roof replacement SILj I omrait_nnn
Assignment of Insurance Benefits for the Full Roof Replacement Only: I hereby assign, any and all insurance rtghis, benefit, and procuxts'under
any applicable tnsuraneo politics, to Jasper Crnitraciors, htc. ("Jasper'•), the scope t,i' whtcli shall be )tmitexl to u Full' kixYt l2cpluccmrnt'. I rnuke this asst tmatt
and authon atton inconsu)cmtion of Jasper's agreement to perform services; supply materials and oiltcmwise perform its obtr);ationz under this Contract,
including not requmng full payment at the time.of'scrvicc. f also hereby direct my insurers) to rt eatic any and all information rcque+tcYl by lasper. of tls.
rcprescruatiye(s), for the direct purpgsc of ohtauting actual benefits to be, paid by my nsurcr(s) for services, rendered- In thi; regard, I u-aive my, privacy
rights If payment is made directly to tl c Owng!Agatt/Insured(s), it %hall be endorsed over to Jasper immediately upon receipt, i agree that any portal ofwork, dMucti;bles, bettcrtnent or addillot al NvorIk requested by the undersigned, not covered by insurance, must be paid by the ttndi rsipncd on tlic day of
installation. Deductible: It is the (yµher's responsibility to pity all insurance'deducubles Owner's ourofpocket expa x will not exceed the deductible
amount, as stated on insurer's toga shect (the "Liss Sheet-), UNILLSS repiaceincnVrcp4ir of detcnurated,t] ing is rcc)uired by code arxfor (Mncr requ Nis
optional upgrades. Jasper° CA.NNOl pay, waive, 'rebate, or promise: to pay, waive or`rebale, any or all of the insurance deduclble• applicable n) the
insurance claim for i3itypieni of work. In dte•'ceer t of a discrepancy, the dMuctible amount stated on'the• tnsurcr':s Loss 5licet t,all overrule deductible
amount disclosed. Deductible `S, jf)00,iOd MUST BE PAID IN FULI,,,PLUS APPLICABLE SALES TA (fmitial)
MORTGAGE AUTHORIZATION I Ouner/Mortgagor, grant audnO17Or Mo a c Co. to speak with
Jasper on nrtatters.tncludmg, but not limited to, Ilic claim and draw stau(Initial) PAYMENT SCHEDULE: Owner agrees to
pay Jasper bated on the following schedule. (i)`Dcposit in the amour due upon signing this contract, (n) the Contract Price,
less the Deposit and) any applicable depreciation retainer by Uwrter's msurer(s), plus upgrade costs, due and ,payable to Jasper upon completion of
work hang lierfonned; and. ,(tit) the remaining Contract Price (equal to any applicable deprectai on andlor change orders) due and payable to Jasper uponcompletionofworkperfurmeti. In the event of a pending inspection,, no, more than 2% of Contract Pncc may be withheld until, m unction has pascal.
Replacement ''V'ork, and Price -Upon- insurer-'s-a roval avid subject to -the
PRIG Jasper, age.
SOptional: U GRADI' ITEM. Q
P
c -Terms and Conditions, hrscin, Jasper agrees .to.furntsh- all.matenals_and__
rgvide the labor necessaryy to tiro Owner's Declaration of Innttenth(ywncreacknou
lace allo%v rid wreastinnnsurance company s approval. approximately
within 0 days, condi i , permitting. approval. by insurance company for a
full roofreplacement: Jasper shall Per the roof: replacement upon receipt of funds front Owner's'msinancc company.
FLORIDA IIOM ONVNI RS' CONSTUCTiON RECOVERY FUNS)
PAYMENT, UP TO A LIMITED AMOUNT, MAYBE AVAILABLE FROM -THE FLORIDA HOMEOWWERS'° CONSTRUCTION RECOVERY FUND iF YOU DOSE MONEY ON ;A PROJECT PERFORMED UNDER CONTRACT, WHERE THE LOSS RESULT'S FROh•I SPEt'iF1ED VIOLATIONS OF FLORIDA LA14' B1' A LICENSED CONTRACTORFOR1N'FORMATION ABOUT TII RECOVERY FUND AND Fll i\G, A CLAINI,,CONl`TACT THE FLORIDA
CONSTkUC"I'.1ON INDUSTRY I.ICENS1N(;.BOriRD AT 7'NE FOLLOW ING;TELE PHONE NUMBER AND ADDRESS:
Construction Industry Licensing Board: 2601 'BlairAmie Road.'1'allahassec, FL 32399-I,039, (850) 4$7-1395
CANCELLATION If Owner elects to terminate the services of ,jasper,. Owner may do so before midnight "tin the third busines'sdayafterContractisexecuted. Owner %hall receive a full refund or all deposits. Owner may also rescind Contract before midnight onthettirdbusiness .day after the contract is executed after notification from insurer(s) that the claim for payment on roof contract hasbeendenied, in whole -ur n part. All written notices of cancellation, re ardless of reason, shall he postmarked or delivered to.Jasper'scorporate ,office: 1fi90, Roberts Boulevard,,Suite 112, Kennesaw, GA 30144 CANCELLATION E\CEPTIOtiS: The three (3j dayrightofcancellationDOESNOTAPPLYtocontriteforemergencyhomerepairsastimeIsoffheessence. 1 Owner;: have read and .understand all statements, Terms and Conditions of thc_"Roof. R:eplucemcnt Contrad7 and agreethatalldetailsareacceptableandsatisfactory, 1 further understand that this Contract constitutes the entire agreement between theatanyfurtherchangesoralterationstothisContractmustbemadeinwritingandagreeduponbybothparties. parties and thEachpartyrepresents and warrants to the other that It has the full power and authority to enter into the contract and that It isBindingandenforceableInaccordancewithitsterms.
dlutonaticr.Rc rescntativc Ddtc zc ` , p
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THIS INSTRUMENT PREPARED BY:
Name: Jaspe'rContractors JY1W t(C
Address: 53iin F Cninnial Drivp
nrlanrin, FI 32R07
NOTICE OF COMMENCEMENT
Permit Number:
Parcel ID Number: _ n- —3 (/ 7 // 6 OWC)'C
tf ,LJ', r uEtlIttt7LE (UIJI rylIF1, ) HT COURT & "Orl!"Ti;JLLER' K -5_3 (lFa_)
CLERK'S 4 *?0 727;y. 08
PHiC.1HG tF ELl e110.01l1
1
RECORDED BY hd,_. -111-3
The undersigned hereby gives notice that improvement will be made to certain real property; and in accordance with Chapter 713, Florida Statutes, the
following information is provided in this Notice of Commencement.
1. DESCRIP IO OF P OPERTY: (Legal description ofthe grope street address if av 'able)
1'07 7 k6ks C' oss'r a Vc (- J, h2. S
2. GENEIW DESCRIPTION OF IMPROVEMENT:
3. OWNER INFORMATIOnIN OR LESSEE INFOR ATION IF THE LESSEE CON , CT FO T EIMP OVEM T: / -
7
Name and address: l ar1 . q l l/(lE5(CI E 1 C(Y!1 df/ t .j 2 T 73
Interest in property: Ownar
Fee Simple Title Holder (if other then owner listed above) Name:
Address:
4. CONTRACTOR: Name-, Jasper Contractors Phone Number. 407-278-7788
Address: 5380 E Colonial Drive Orlando, FL 32807`
5. SURETY (if applicable,a copy of the 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 maybe served as provided by Section
713.13(1)(a)7., .Florida Statutes.
Name: Phone Number.
8. In addition, Owner designates of
to receive a copy of the Lienoes Notice as provided in Section 713.13(1)(b), Florida Statutes -Phone number..
Expiration Date of NoticeofCommencement' he a - (T xpi ation is-1year from dateof recording: unless a;different dateisspecified)
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 ATTORNEYBEF9REVONMENCINGWORKORRECORDINGYOUR'NOTICE OF COMMENCEMENT.
Job h
Print Name andProvide.Sfgnatorys Tj OMce)
State of`
j `, , aa'County of
The foregoing instrument was acknowledged before me this 2 ` day of J C k kA 20
who has produced identification k type of identification produced:
T'RAVIS LIPP
State of Florida -Notary Public
Commission # GG 118086
My Commission Expires
June 22,. 2021
Altamonte Springs, Casselberry,, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: "J 1
I hereby name and appoint: Rachel Holcomb, Skylar Arnkraut, Karla Almodovar Ana Chavez
an aoznt of: ca,raaa-s
Na,rrcofCOMP- J
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 permit and a ;plication for work located at: 2:C c r1 } r^ P ran le (I ,-. < r -4i1-r;^1, F L
Expiration Date for This Limited Power ofAttorney:
License Holder Name: Donald Bouchard
State License Number. CCC1331153
Signature ofLicense Holder
COUNTY OF
The foregoing instrument was:acknowledged before me this aday of U;
200_nL: by 9oudwd who is personally known
to me or is who has produced oL as
identification and who did (did not) take an oath:
Signature
Nosy Sea]) Sley ar Amkraut
Print or,type name
Notary Public State of Ft_
SI<YLAR B AMI(RAUT ti
Ct! FF 1278rJ0 y CotIlnlrssionNo. 127890 ommissiony
6/112018_ mod'
c My Commission ExP res, j_ _ .M--OIL1II11SSIOn EXp1IeS: 0
June
01, 2018 Retie.
08.12) Srannpd
by CamScannpr
sCITY OF
bRSki4FO
dAFIRE OEPARTMEN
Building & Fire Prevention Division
Re -Roof Permit Card
PERMIT NO. /7oo A707 ISSUE DATE: 09s, /3,/7
CONTRACTOR: D
JOB ADDRESS: 42 7 01q_01eftTCt41'G ' TYPE
OF WORK: 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
WSPECTION
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 855.541.2112
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 DOTE: 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 III
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
F D City of Sanford Building Division
l j2A"Residential Re -Roof Inspection Policy & Procedures
u-
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 t e-soope of work)--
Digital Photographs (must include the permit number or address in each picture)
o Each plane ofthe 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) ...m _ .._ ._ . _... _ ___ ..... _....
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: t 'l A ii \ o OX A VQ_ DATE:
PERMIT # FAD;
City of Sanford Building Division
Residential Re -Roof Scope of Work
JOB ADDRESS: 2 - 1 eS c IP (` V I
C r.), Vnhrrl . L
STRUCTURE TYPE: SINGLE FAMILYRESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM RE -
ROOF TYPE: Z& 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: ONLY IOO SQUARE FEET OF THE EXISTING DECK IS PERDILTTED TO BE REPLACED' * ROOF
VENTILATION: OOFF-RIDGE ORIDGE OSOFFIT OPOWERED VENT OTURBINES 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 TYPE
OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL O
SHINGLE FL# O
METAL FL# O
MODIFIED BITUMEN FL# OTORCH
DOWN FL# 0INSULATED
FL# O
TILEFL# 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#
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 . . . . . 17-00002707 Date 9/13/17
Property Address . . . . . . 297 CLYDESDALE CIR
Parcel Number . . . . . . . . 18.20.31.506-0000-0470
Application description . . . ROOFING APPLICATION
Subdivision Name . . . . . .
Property Zoning . . . . . . . PUD
Permit . . . . . . RESIDENTIAL ROOFING PERMIT
Additional desc . .
Phone Access Code 1002310
Permit pin number 1002310
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, AND ALL FINAL ROOF COVERINGS
PERMIT #: 1 - ADDRESS:
I G 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 #: 1 55 )
COMPANY /CONY
CONTRACTOR SIGN
MUST BE SIGNED
RA CTOR: )o 1am a S
ATURE: DATE: ' / 1
BY LICE HO OR OWNER/ LDER)
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 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 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 Se M`>(''
Sworn to and Subscribed before me this day of \v 20 _)Aby:
Who is Personally Known to me or has Produced (type of
identification) IDLI as identification.
kl ) A - P1 L"AL&x_ -
Signature of Notary Public
State of Florida
i Vla Wa-lwca Print/
Type/Stamp Name of
Notary Public p
b KARLA M ALMODOVAR 4 '
State of Florida -Notary Public r
Commission p G.G 111330 MyCommissionExpiresOFJune04, 2021
LUMTED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 1 O - u - (`)
1 hereby name and appoint. Scott Meixsell, James Allen, Michael Watts, Jacob Horst, Ricardo Prito, Paul Padgett
an agent of 'asw O"
Dame of
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 sp4fie permit and application for off located at: _
SwDa Address) — —
Expiration Date for This Limited Power of Attorney: i
License Holder Name: C V6
State License Dumber. CCC1331153
Signature of License Holder: .
STATE OF FLORIDA t
COUNTY OF S— e
The f_regoing instrument was acknowledged before me this day of
200 t t, by °ara'd d who is o personally known
to me or o who has produced tx as
identification and who did (did not) take an oath.
CU,a u'N"%WSL
Signature
Notary Seal)
Print or type name
KARLA M ALMODOVAR
srPOB4 State of Florida Notary Public
Commission # GG 111330
My Commission Expirestune04, 2021
Rev. 08.12)
Notary Public - State of loyavck
Commission No.
My Commission Expires:
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