3912 Sanford Ave - BR17-003003 - ROOFCITY OF SANFORD
BUILDING & FIRE PREVENTION
OCT 12 2017
Documented Construction Value: $ L 64 9 0/ 8' - 3 2
PERMIT APPLICATION
Application No: / y, -3 003
Job Address: 9912 S Sotn f-o rd A-U'-,,- Historic District: Yes No
Parcel ID: /3 -- 2 0 0 / - 0 0 0 0 - /6 19,0 Residential Commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of Work: R f- r o o f c (} I n o u
Plan Review Contact Person: nl A+hm M c A -In U ,(4 Title:
Phone: 9Ciy -J0 3 'J..Sf Z Fax: , 2 / - 24)7, 0 y 7 ] Email: nb iTYI Q , Gt v-r rN c Tr>- r M
Property Owner Information
Name Q i' &,K Phone: q1) -7 - yl 6 - 4 L 71/
Street: S'anf rd & - Resident of property?
City, State Zip: KCan U (d , EL 22 13
Contractor Information
Name hens Roo-h(0 Phone: 1)07 71q -ZOT
Street: ly i t QI? 0%,OIfyGG' Fax: l3 2/ - 2 0 7 - b Y 3 7
City, State Zip: _8V p l(I Ft, 3 2 7 f Z State License No.: CC C 0 it j q,2
Name:
Street:
City, St, Zip:
Bonding Company: /VA
Address:
IVA Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender: IV A
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: 5'h 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 ofthis 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 ofthe 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.
C -, /.6 A4 /a-/i-nignatureofNotary -State of Florida Date
Signa ure ofContractor/Agent Date
Print CaR+r LAeenCs Name
Signature
L40%,'..,
Notar,
oy
Pubi:StateofFbrldallotaryPublicStateoffIda , DavidTml 61cMa
Commission GG 114730 Expirs07/24/202G 114730
of &xplres 07/24/2021
Owne o Me or Contractor/Agent is Personally Known to Me or
Produced ID Qk Lit- Type of ID Produced ID 13R; L., Type of 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
cra
P
sew rxtCovnrry a,paaa,
Parcel information
Property Record Card
Parcel: 13-20-30-501-0000-1690
Owner: MILLER JEFFREY E &KELLY K
Property Address: 3912 S SANFORD AVE SANFORD, FL 32773
Parcel 13-20-30-501-0000-1690
Owner MILLER JEFFREY E & KELLY K
PropertyAddress 3912 S SANFORD AVE SANFORD, FL 32773 Mailing
3912 S SANFORD AVE SANFORD, FL 32773-6006 Subdivision
Name PINE CREST Tax
District S1-SANFORD DOR
Use Code Exemptions
01-
SINGLE FAMILY 00-
HOMESTEAD(2001) 1
n
J -
f
169 .:
170 171
179LJ Seminole
County GIS Value
Summary 2017
Working Values
2016
Certified Values
Valuation
Method I CostlMarket CostlMarket Number
of Buildings 1 1 Depreciated
Bldg Value 1 $124,096 119 039 Depreciated
EXFT Value 17 442 18 109 Land
Value (Market) 33,943 33,943 Land
Value Ag Just/
Market Value 175,481 i $171 091 PortabilityAdl
i Save
Our Homes Adj 16,890 15 762 Amendment
1 Ad1 0 P&
G Adj j $0 0 Assessed
Value 158,591 155,329 Tax
Amountwithout SOH: $2,616.00 2016
Tax Bill Amount $2,300.00 Tax
Estimator Save
Our Homes Savings: $316.00 TRIM
Notice Help Does
NOT INCLUDE Non Ad Valorem Assessments Legal
Description — LOTS
169 & 170 & N 20 FT OF LOTS 171 &
172 & E 1/2 VACD ALLEYADJ ON y W &
S 1/2 VAC ALLEYADJ ON N & ALLEY
BETWEEN LOTS PINE
CREST PB
5 PG 78 J i
Taxes — r---___
Taxing
Authority Assessment Value Exempt Values Taxable Value i County
General Fund 158,691 50 000 108,591 Schools
158,591 25 000 133 591 I
City Sanford 158,591 50000 108,591 SJ
WM(Saint Johns Water Management) 158,591 50 000 , 108 591 County
Bonds 158,591 I 50,000 108,591 i
Sales Description
Date I Book Page Amount Qualified Vac/Imp CORRECTIVE
DEED 11/1/1999 i03761 1616 100 No Improved QUIT
CLAIM DEED j 10/1/1999 03742 0697 12,300 ! No Improved WARRANTYDEED
4/1/1996 03060 0645 100 No j Vacant ADMINISTRATIVE
DEED i 6/1/1994 02786 0987 Ty .....
47,
000 No i Vacant WARRANTYDEED
12/1/1990 02250 1319 39000 No Improved WARRANTYDEED
7/1/1985 01652 1053 35 000 No Improved WARRANTYDEED
10/1/1984 01588 1592 100 No Improved ADMINISTRATIVE
DEED 11/1/1979 01255 0939 100 No Vacant 1
FiomparbleFindCaSalesfit__- - _
11 # 1H1111111111111 Hill 11111111111 fill 11111THISINSTRUMENTPREPAREDBY:
Name: Tabitha McAuley
Address: 145 E Sandpiper St, Apopka, FL 32712
NOTICE OF COMMENCEMENT
State of Florida
County of Seminole
Permit Number:
11 i !! DIi ij
Parcel
ID Number: 13-20-30-501-0000-1690 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. DESCRIPTION
OF PROPERTY: (Legal description of the property and street address if available) LOTS
169 & 170 & N 20 FT OF LOTS 171 & 172 & E_1/2 VACD ALLEY AD.10N W. S
1/2 VACD ALLEY ADJ ON N & ALLEY BETWEEN LOTS PINE CREST PB 5 PG 78
3912 S Sanford Ave GENERAL
DESCRIPTION OF IMPROVEMENT: re -
roof shingle OWNER
INFORMATION: Name:
Kelly & Jeffrey Miller Address:
3912 S Sanford Ave, Sanford, FL 32773 Fee
Simple Title Holder (if other than owner) Name: Address:
n
CONTRACTOR: J
Name: Alan's Roofing Address:
145 E Sandpiper St, Apopka, FL 32712 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 Of To
receive a copy of the Lienor's 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) 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 perjury, I declare that I have read the foregoing and that the facts stated in it are true to
best f my kngwl(?;7 and
belief. Owfle7
FGrzY
llu 2 s
Signature Owner's Printed Name 1-7;0 713.13(1)(g): "The owner must sign the notice of commencement and no one else may be permitted to sign in his or her stead ' 1k,
State
of ` ( &Qj County of S e ti fA), ii
20 ^ TheforegoingInstrumentwasacknowledgedbeforemethis _ day of O L by
Who ispersonally knmemto me x
Name
of person making statement OR
who has produced identification type of identification produced: 0012 rG Notary
Public State of Florida David
t Mura My
Commission GG 114730 w
Expires07124/2021
POWER OF ATTORNEY
Date:
I, Alan Field, do hereby authorize to Tabitha McAuley pull the Roofing permit for
NMI
X , -
Alan Field
Personally known to me or driver's license #
State of Florida, County of S
iD —/ 2 --7 -'-
on day of , 2017
7David ra
Stabs of Fbrida
on GG 114730
v,, a12021
CITY OF
WO Building & Fire Prevention DivisionSkORDRESIDENTIALREROOFPOLICY& PROCEDURES
FIRE DEPARTMENT
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: r1__4Z "" DATE: fa"`/ `1-1
CITY OF
Ski4FORIE
Y ty'
FIRE DEPARTMENT
g:
JoB ADDRESS: (% 2 ) San T 1-61 / l V "e
PERMIT #
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
STRUCTURE TYPE: SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: dREPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY): i/2 t tV R IVW I qx H
PLEASE NOTE: ONLY 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED
ROOF VENTILATION: DOFF -RIDGE QfRIDGE OSOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: O YES (2 NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 O 4:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
SHINGLE D W e- 0 COM I FL# 7 -1/2
OMETAL FL#
O MODIFIED BITUMEN FL#
OTORCH 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#
OINSULATED FL#
O TILE FL#
0 OTHER: FL#
ALAN's ROOFING,Kc.
145 E:SwWpiper Street .
Apopka, FL 32712.
x t• ,
Please Print
CONTRACT
Commercial & Residential
Home o3 the FREE Roof Inspection'
www.alansroofinglnc.com
LICENSE NO. CCC046942
Phone: (407) 774-2159
Told Tree; (800) 309-5667
Fax: (321) 207-0437
Cif I 0- t - P7' NAME i _ H.PHONEm ...-u®.__ ._ .. C.PFidNI . __..
u._. DATE
J]--_.__. ADDRESS I l VI &Vlxl (A r vId—ITY SRtt l 7 P E h4ai1
MAIUNGADD RESS _. CITY ZIP _
SALESMAN @.aI CONTACT PWONEi.f i, f '6tt ...C17FIOR CIAI. I }pg #
BRAND AND DESCRIPTION
OF P'RODUC"L 0C. i1 r aL;%./IG.rt-max -/ It ;-dLdR PITY`ki {' 9..
I. PILL A bf-< CITYOR ZCOUNTY PERMIT SQ. RENAIL WOOD F 2.
TEAR
OFF: $0, OF OLD SHINGLES 2— SQ. OF FLAT ROOF SQ. CE OLD TILE 1 LAYER
21AYERS , a 15c7t? PEEL & SEAL 4. INSTALL- `
2 , GALV, VALLEY IrtTAL LF ` _S0 SELFADHERING VALLEY LINER LF — METAL OVER RIDGE LF a. INSTALL- '
ALLAA DRIP EDGE LF-LE STEEL DRIP EDGE LF _ PAN FLASHING tY L FLASHING LFZ6 000L0R B. INSTALL
REPLACE; LF OF RN, Co PLUG COLORS FT VENT SURE 7, REPLACE;
1 1121N. _ 2IN. 3 IN, LEAD BOOTS 4 IN, GRV: 10 IN GR1i S FLEC. RISE µS.
Ivc. STARTER ROLL i STARTER STRIPS CIRCLE ONE 9. LAY
SQUARE CF ` NEW FIBERGLASS SHINGLES CAP 3 --TAB PERF I HIP -& RIDGE 10. INSTALL:
Ski DEAD VALLEY LG. DEAD VALLEY MOIDIFIE LIBERTY 11, INSTALL.
TPO LAYER OF INSULATION —, TBAR I SEAM TAPE 12 ENSTALL
REPLACE: 2 }(2 2 X 4 4X4 SKYLIGHTS AC14Y IC SFA FINED GLASS L fC1
CLASSIC13. HAUL OFF
ALL TRASH AND RUN IVIAGNET AROUND GROUNDS 14, ALL WOOD
WORK WILL BE EXTRA PER ATTACHED WOOD BILL A TV 6
15ALAtT'S
ROOFING
HAS PAYPERMISSION TO CONTRACT WITH AN ENGINEER OFIT'S CHOICE TO CONDUCTANY OR ALL INSPECTIONS THAT WYBEREQUIREDUNDERLOCALORSTATELAW16. SPECIAL INSTRUCTIONS b :6 TOTAL
CONTRACT AMOUNT Pricey
is goodfor30days
ACCESS: CuslCcliel' ayre+^x m to
lre 7vx access prnpereq aM realba;. tnatIICay9' 0gttptTfirYl isbeing Icett Contractorshallnet Pa ha41" fjr, litho.,it, I.f!pkhlioo, !frJ!no" rfr lkw, P, ,iil"nalks, fawn., s - ntdcr sy.1w8; gardefta tePhC syslerns and anyccbea strwtures themot, as a resunorrooftopor,)obdryrugr es, BALANCE DUE UPON DAMAGE ETC.: Ire tamer elljn berpaceiblearrcmarl, rcinsWlia6an and reealibra3ruo or:ata•%te drsfrrr :, $4oubd cwlamer becmTe asvarE COMPLETION y . of damage to prr/r!7fybyC!7nUyr, fhisStGeftr3 !Y e!Y lu•,rekx dusinB the course din&@Itallyn GtT01001, Said dainagje shall be lagh! attc^ntian of the Contractor PriortothelineofPaymonttarlberoof41yaestLti. IfCr tcmts f i4tonotify Contrtlstor of sold dantdge, w.hhin5 `. ayrr'kstgdays of accmrence, thenshaltwafvcanrbhbagairelcontraotorconcemingsaiddamage. Alan s Rearing U notroSponaibre lotmofing nails P=—.1rn a}g NO Line in the dt{i; CusIamar agrecr. ei secureand Preract lheur asss,01 inducing shelves., ceiling tans,Initsarrj'. voter yartmbb73 10 wovitl danager from vitanfion... lamnk4gC (mftr rfajA&l1 a?IYt C4 ports, ele. Q+EIAY&,, C,: tjarjt;Y{a7C"IClA'Jk'ol?!esliI3tC0ft''JcI3(r:raYbeZL',dtodelaysorca*lonod4}'IhiCiMnC$Itsl/tother. labor LLft^,aS1dmatorioa511p lyDl{(!!{tiy^XofothercmNe'Whicol: are beyond Cootractrr and.hcreW acctpts delays occasioned by oneuratortheseelrcumstaynccsIntriotrtstallerbnotlaeroe'. PAYMENT OF CONTRACT: cu€t mer' hereby agreesthat
all 'nnmumsduefartfiswork Shaii4epaid upGncal-tiplrLtionofinstallation, Any afrimtsurWaid%illbeatiiL'restataritorA1Ire%per monm.Carrtractor:shall beenhtedto allcc= dt caMction Iroontng atlomeys• toes. MFIT TO CANCEL: If thla Isa Hine SolicitationSaid, and if you
do not aim the goods or Services, you may cerrcei this agreementbyQ Ildlag wrillen notice R4 the seller in rrerson, by tclogram. or by mail. TF natfce 4rAt t Indicatethat stou do not want emgoo& or se riceandrn!. t9 doij•orod or posb narl;d before rnidi pht of the third Wslnt , day a^9I, you bw this agreemerIL it cancro this at or part of any Cubdawo Patscent. you agreerneni. the rater maynotkeepIFTHIS15NOT.A HOKE SOLICITATION CORTRdCT_. Croon it c sgnad, you
are boundto itby the rawws of the Static ofFlorbda. If in the CA end you breach or yemplito cancelrh s conbaq, tP!r Contraclnr :halftoen:'P:Itdtoall I= profits from the canUoa, ACOF.PTANCE PROPOSAL' TFeaboveprices, sp-cificabansandcondi6ors are. SaliShloo!y ern!
11eieayamepled. All contracts arc subject to Atari's Roofing. Inc, management Approval. Cti:taner agrees
toall=Atan`% kceting; Inc, I—. . photpa. Iurocrs of recommerkl Ilan, satF;tarysona forms, eu to be used forad'-,mrWrg purposes, to case any one or more of ts»ns contained h= Phil Mqd, Iceyalofunenrorcerable- in any respect,tSn Vylli:lity, logaity arw Rnteroo9USty a here wilt lavis 7h _ linillontoereof shall nhl in "•way
beas IC, ed i:npdtiad. SALESMAN NATVeile CUaT0A1ERSIGNATURt ORATE ' 111441A. 14EITAlll !lr l421-=1Construction IIndustries - * Pa0entmay be available
from Itto CorictrUction irydustrieks re4mverpfund i
you losemoney an a project perforn d urodelf contract, where tjw 14ss results from specif io ationg of Floixdo Low by a Stitt; Licensed Contractor. For infcvmotioa t bout the Recovery Fund and filing a claim, contact the :Florida CtLf3 .tit the €aOowinig telepimne nurnIxer and ;tddrat : 85OA87-1395. Florida ConstructionIndts31fy Liounsing Board, 1940 N. MonroeStreet. Tollafassetx, FL 32399. 16-01
PERMIT #
City of Sanford
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
0-:5O03 ADDRESS: 31 I L- &GCvpor d. 4uy-
1 ,d-I My V_y ej L'k— , 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 PRODUCTAPPROVALS 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 #:
COMPANY / CONTRACTOR:-
llCONTRACTORSIGNATURE: _ A .c % DATE: 1611(a
MUST BE SIGNED BY LICENSE HOLDER OR OWNEWBUILDER)
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
Sworn to and Subscribed before me this —6 day of BG,,l-' 20 jj_ by:
q`e . Who is :1 Personally Known to me or has KProduced (type of
ide icaflon). f Nor, ' as identification.
S'jgnature of Notary Public
State of Florida
Print/Type/Stamp Name
of Notary Public
WofFlorida
114730
1