137 Pinefield Dr 17-3204 RoofCITY OF SANFORD
BUILDING & FIRE PREVENTION
1 PERMIT APPLICATION
x x
D
Application No: r -3a09
Documented Construction Value: $ 9,100
Job Address: 137 PINEFIELD DR SANFORD, FL 32771 Historic District: Yes NoFA
Parcel ID: 32-19-31-515-0000-1210 Residential ® Commercial
Type of Work: New Addition Alteration X Repair Demo Change of Use Move
Description of Work: RE -ROOF OWENS CORNING FL10674-R12 TECHWRAP FL17194-RI 7/12 PITCH
20 SO'S SUPREME DESERT TAN 25 YEAR WARRANTY
Plan Review Contact Person: SKYLAR AMKRAUT
Phone: 407-278-7788 Fax: 800-337-3361
Name CLYNNIE WYNN
Title: ADMIN
Email: PERMIT@JASPERINC.COM
Property Owner Information
Phone:
Street: 137 PINEFIELD DR Resident of property? : YES
City, State Zip: SANFORD, FL 32771
Contractor Information
Name JASPER CONTRACTORS -DON BOUCHARD Phone: 407-278-7788
Street: 3203 S CONWAY ROAD SUITE 201
City, State Zip: ORLANDO FL 32812
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
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. 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" Edition (2014) Florida Building Code
Revised: June 30, 2015 Permit Application 4 1 (A' 3
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 ofpermit 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 ofpermit submittal. A copy of the executed contact is requiredinordertocalculateaplanreviewchargeandwillbeconsideredtheestimatedconstructionvalueofthejobatthetimeofsubmittal. 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 ofOwner/Agent Date
Owner/Agents Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
VW I,m A ' 10.31.17
Signature of Contracto r/Agent ,
pa
Date
l
v ('C,' "CcLujy"' P
rinnttContractor/ tjge}it's Name 10.31.
l_7 Produced Florida
Date
S1<YLAR
B KRAUT Commission 4
FF 127ti90 My Commission
Expires Me or
T vne
fIDNI) '_ BELOW IS
FOR OFFICE USE ONLY Permits Required:
Building Electrical Mechanical Plumbing Construction Type:
Occupancy Use: Total Sq
Ft of Bldg: New Construction:
Electric - # of Amp Min. Occupancy
Load: Fire Sprinkler
Permit: Yes No # of Heads APPROVALS: ZONING:
ENGINEERING: COMMENTS:
UTILITIES:
FIRE:
Gas[]
Roof
Flood Zone:
of Stories:
Plumbing - # of
Fixtures Fire Alarm
Permit: Yes No WASTE WATER:
BUILDING: Rvvicrrl•
lone
10. 7015 Permit Application
n Account 61anager lj
5380 F. Colonial Dr. Contact tf: t'' S 1
Orlando, Fl- 32807 Insurance Comagm In
3203 Conway Rd., Ste. 201 JASPER Company: r - !
Orlando, FL 32812 Policy N, *o o d 0 3 SC- Da
407) 278-7788 Jefparnoof corn. Claim g: v7 7 Y/ f
ti00) 337-3361 fax Mortg
mlu•.r act<peruu.nr>; I I Contractor's License: Company:
VISA IIt - f
C:CiC1329051 A CCC1331153 Loan N6mbcr:"
ROOF REPLACEMENT CONTRACT
licsncr(s): Phone'.
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City, pp
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10, r' f ' t Ca CJO t i, rr l
Roof RCS' Amount/ Contract Price.
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Assignment of Insurance Benefits for the Full Roof Replacement Only: 1 hereby assign any and all insurance rights. benetics and proceeds under
any applicable insurance policies to Jasper Contriclors. Inc. ("Jasper"). the scope of which shall be limited to a Full Roof Replacement I make this assignment
and authorization in consideratim of Jasper's agreement to perform services, supply materials and otherwise perform its obligations under this ContracL
including not requiring full payment at the time of service. I also hereby direct my insurer(s) to release any and all information requested by Jasper, er"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 aunt 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 agee that any portion of
work, deductibles, betterment or additional work requested by the undersigned, not covered by insurance, must be pain by the undersigned on the day of
installation, Deductible: It is the Owner's responsibility to nay all insurance deductibles. Owner's out-of-pocket expense will not exceed the dedumble
amount, as Stated on nis'urer's loss sheet (the "Loss Sheet"), UNLESS replaccinendrepair of deteriorated decking is required by code andor Owner requests
optional upgrades. Jasper CANNOT pay, waive, rebate, or promise to pay, waive or rebate any or all of the insurance deductible applicAble to the
insurance claim Ibr payment of worW n the event f a discrepancy, the deductible amount stated on the insurer's Loss Sheet shall overrule de&-tcuble
amount disclosed. Deductible: S 4-20 i MUST BE PAID IN F111.1, PLUS APPLICABLE: SAILS TAX / Cnitial)
MORTGAGE A11THORIZATION: 1, O%kner!!viortgagor, grantauthorvanon for Mortgage Co. to speak with
Jasper on matters including but not limited to, the claim and draw status (initial) PAYMENT "SCHEDULE' Owner a-grees to
pay „Jasper based on the following,schedule: (i) Deposit in the ainount of S _,(;el due upon signing this contract. (ii) the Contract Price_
less the Deposit and any applicable depreciation retained by Owner's insure(%), plus upgrade costs, due and payable to Jasper up.G contpletim of
work being performed; and, (in) the retraining Contract Price (equal to any applicable depreciation and'or change orders) due and payvMe to Jasper up m
completion of work performed In the event of a pending inspection, no more than 2% of Contract Price may be withheld until inspection h.ic passed.
Optional: UPGRADE ITEM: QTY: PRiCE TOTAL 5
Replacement Workand' Ill -ice: Upon instrer's approval and subject to die 'ferns and Conditions herein, Jaspei- agrees "to furnish all raterials and provide
the labor necessary to perform the full roof replacement wfiich shall take place following Owner's insurance company's approval, approximately within
30 days, conditions permitting, Owner's Declaration of intent: Owner acknowledges and agrees that, upon approval by instaznec company for a full
roof replacement, Jaslnr shall perform the roof replacement upon receipt of funds from Owner's insurance company FLORIDA
HOcMEOWNE'RS' CONSTUCTION RECOVERY FUND PAYMENT,
UP TO A LIMITED AMOUNT, MAY BE AVAILABLE FROM THE FLORIDA HOMEOWNERS' CONSTRUCTION
RECOVERY FUND IF YOU LOST. MONEY"ON A PROJECT PERFORMED UNDER C0ITRACI', WHERE
THE LOSS RFSULTS 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 NIUNIBER AND ADDRESS: Construction
Industry Licensing Board: 2601 Blairstoue Road, Tallahassee, FL32399-1039, (850) 487-1395 CANCELLATION:
if Owner elects to terminate the services of .riper, Owner may do so before midnight on the third business day
after Contract is executed. Owner shall receive a fall 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(%) 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 1,12, Kennesaw, GA 30144. CANCELLATION F.XCEPrio;NS: 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, 'teems and Conditions of the "Roof Replacement Contract" anti agree that
all details are acceptable and satisfactory. 1 further understand that this Contract constitutes the entire agreemEnt betsseen the parties
and that any further ,changes or alterations to this Contract must he made in writing; and agreed upola h foth; Each
party represents and warrants to the other that it has the full power and authority to enter into the•, binding;
and enforceable in accordance with its terms. Authorize
asper Representative Date once Scanned
by CamScanner
LU TTED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 10.31.17
Karla Almodovar, Skylar Amkraut, Rachel Holcomb
I hereby name and appoint: Ana Chavez and/or Michelle Monsalve
an aeent of: Jasw contacto, S
orc«opany)
to be my lawftil 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 application for work located at:
137 PINEFIELD DRIVE SANFORD FL
Strw Addras)
Expiration Date for This Limited Power of Attorney:
1 /1 /2019
License Holder Name: Donald Bouchard
State License Numbecccttts3 r. Signature
of License Holder. STATE
OF FLORIDA COUNTY
OF sew The
foregoing instrument was acknowledged before me this j1 day of October 200__
i2, by t1add t —h-d who is o personally known to
me or ® who has produced ot_ as identification
and who did (did not) take an oath. wx
Signature
Nosy
Sea]) ley ar Amkraut SKY*
AR B AMKRAUT Commission
N FF 127890 S My
Commission Expires or.•°
June 01, 2018 1 Rev.
08.12) Print
or type name Notary
Public State of FL Commission
No. 127890 My
Commission Expires: 6/1/2018 Srannt-
d by CamScanner
THIS INSTRUMENT PREPARED BY:.
Name: _ Jasper,Contactors
Address: 5380 F r ortial nriya
nrinnrin, FI 398n7
iVOTICE OF COMMENCEMENT
k o
Permit Number:
Parcel ID Number: 19
IM111JIM1111111111H1111111111111111
R';il - 11ALOYP SEt1INOLE COUNTY
LERK UI. CIRCUIT C lOUR T ? COMPTROLLER
Q Ii 1719 lF
CLERK'S x 20171 t9801
lE:Oh`Lsi_f 1 i l.ii'1'1' ii o 1•s:45 AN
RECORDING FEE. K.10. 00
REC:ORDLD B tt avore
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the
followinginformation Is provided in this Notice of Commencement. 1.
DESCRIPTION OF PROPERTY: (Legal de cription of theproperty and street address if available) tomI21. Ce cc Kcs i(iaSe 3 Gz i GS S sib 2.
GENERAL DESCRIPTION OF IMPROVEMENT: 3.
OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT- ,--{-- Name
and address: l,V >7 01 u nn 1 E L 3 . 'ne'I'. IGr ")( ,5r'' t(: ; =L interest
In property: C1wnPr Fee
Simple Title Holder (if other than 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 documentsmay be served as provided by Section 713.13(l)(a)7., Florida Statutes. Name:
Phone Number. Address:
B.
In addition, Owner designates of to
receive a copy of theLienors Notice as provided in Section 713.13(1)(b), Florida Statutes. Phone number. 9.
Expiration Date of Notice of Commencement (The expiration 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. Signature
ofOwner orLessee, or Ownersor Lessee's (Prtgt ame and Provide Signator/aTfg ffice) Authorized
Oi lcerlDirectorlPertner/Manager) State
of 1 i'1. Countyof v—\, The foregoinginstrumentwas
acknowledged before me this t day of l .t 6 .20 l by. Who is
personally known tame OR Name of person
making statent who has produced
identification [e of fdenttflcatlon produced: J,& ANA CHAVEZ
d State a1:'
Ftririda-Notary Public Commission # GG 112152
ofai ,? My Commission
Expires June 06, 2021
0A
10/31/2017 SCPA Parcel View: 32-19-31-515-0000-1210
Property Record Card
P '
CFA Parcel: 32-19-31-515-0000-1210
Owner: WYNN CLYNNIE L
sswo ccour, Aon Property Address: 137 PINEFIELD DR SANFORD, FL 32771
Parcel Information
Parcel 32-19-31-515-0000-1210
Owner WYNN CLYNNIE L
Property Address 137 PINEFIELD DR SANFORD, FL 32771
Mailing 137 PINEFIELD DR SANFORD, FL 32771-
Subdivision Name CELERY LAKES PHASE 1
Tax District S1-SANFORD
DOR Use Code 01SINGLE FAMILY
Exemptions
0
Legal Description
LOT 121
CELERY LAKES PHASE 1
PB 62 PGS 75 & 76
Taxes
Value Summary
2018 Working 2017 Certified
Values Values
Valuation Method CostlMarket Cost/Market
Number of Buildings 1 1
Depreciated Bldg Value 114,121 107,537 —
Depreciated EXFT Value 3,402 3,568 ;
Land Value (Market) 32,500 32500
Land Value Ag
Just/Market Value " 150,023 143,605
Portability Adj
Save Our Homes Adj 0 0
Amendment 1 Adj 0 _ 0
P&G Adj 0 0
Assessed Value 150,023 143,605
01 Tax Amount without SOH: $2,734.46
2017 Tax Bill Amount $2,734.46
Tax Estimator
Save Our Homes Savings: $0.00
Does NOT INCLUDE Non Ad Valorem Assessments
Seminole County GIS
Taxing Authority Assessment Value Exempt Values Taxable Value
County General Fund 150,023 [ $0 150,023
Schools - 150,023 — $0 150,023
City Sanford 150,023 $0 150,023
SJWM(Saint Johns Water Management) 150,023 $0 150,023
County Bonds 150,023 $0 150,023
Sales
Description Date Book Page Amount Qualified Vac/Imp
WARRANTY DEED
SPECIAL WARRANTY DEED
1/1/2017
12/1/2003
08840
05145
1568
110
1 $191,000
121,300
Yes
Yes
Improved
Improved
Find Comparable Sales
Description Year Built Fixtures Bed Bath Base Area Total SF Living SF Ext Wall Adj Value Repl Value AppendagesActual/Effective
1 SINGLE 2003 } 6 3 20 1,617 { 2,053 1,617 CB/STUCCO $114,121 $120,127 Description Area
FAMILY I i FINISH
http://parceidetail.scpafl.org/ParceiDetailinfo.aspx?PID=32193151500001210 1/2
City of Sanford
r R #D Building & Fire Prevention Division
Re -Roof Permit Card
PERMIT NO. 177- 3a0LJ ISSUE DATE: ' /
CONTRACTOR: 'Jaste r- CnAb-artnro,
JOB ADDRESS: 131 "Pi ue;J AA776r -
4
TYPE OF WORK:
I PROTECT FROM WEATHER I
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
1200E
NSPECTION TYPE APPROVED REJECTED INSPECTOR
INAL 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: INADDITION TO THE REQUIREMENTS OF THIS PERMIT, THERE MAY BE ADDITIONAL RESTRICTIONSAPPLICABLE TOTHIS PROPERTYTHAT 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
PERMIT # l r7 - Li
City of Sanford Building Division
Residential Re -Roof Scope of Work
JOB ADDRESS: 137 PINEFIELD DR SANFORD, FL 32771
STRUCTURE TYPE: Q SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: (3 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 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED
ROOF VENTILATION: ® OFF -RIDGE ® RIDGE O SOFFIT OPOWERED VENT
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 4:12 OR GREATER
OTURBINES
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
SHINGLE OWENS CORNING FL# 10674-R12
O METAL FL#
O MODIFIED BITUMEN FL#
O TORCH DOWN FL#
O INSULATED 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#
O OTHER: FL#
3a D 14
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 ofyour permit application.
The Scope ofWork 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: 10.31.17
A + •
LEMTED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
l
Seminole Countv, Winter Springs
Date: V
I hereby name and appoint: Scott Meixsell, James Allen, Michael Watts, Jacob Horst, Ricardo Prito, Paul Padgett
an agent of Jasw cOftactQ
lame oremopany)
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 application for work located at:
mxt A dress)
Expiration Date for This Limited Power of Attorney: 1 `
License Holder Name: Qp\DAd 'bVOGV lard,,
State License Number. ccC»t is3
Signature ofLicense Holder.
STATE OF FLORMA
COUNTY OF sew
The foregoing insmrment was acknowledged before me this2vda of 1Vy
200 . by Dorwd 6«,atiand y '
whois o personally known to
me or ® who has produced DL as
identification
and who did (did not_take 4n oath, \ Notary
Seal) S
K Y L ARom......., BAMI<RAUT l /I\ ConlnliSsIM, N FF 127890 MYCarnn);ssion Expires June
01, 2018 iRev.
08.12) rrmt
or type name Notary
Public - State of IF Commission
No. 1 My
Commission Expires: (n r t l vScanned
by CamScanner
City of Sanford
Building and Fire Prevention
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
rf PERMIT #: r 1 ( ADDRESS: 1 J t I Y`tfi l /'G V V
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 #: `\
COMPANY / CONTRACTOR:
CONTRACTOR SIGNATURE:
MUST BE SIGNED BY LICEN
A FINAL ROOF INSPECTION IS REQUIRED:
DATE: 1 l - 11 - n
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 PERNUT NUMBER ORADDRESS 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 CERTWY, BASED ON PERSONAL
INSPECTION, THE INSTALLATION OF ALL ROOFING COMPONENTS.
STATE OF FLORIDA COUNTY OF Q A A in (,````
Sworn to and Subscribed before me this day of YV OU.by:
o.is Personally.I{nown to me or has. Produced (type of _
Signature of fary Public
State of Flo a
SKYLAR B AMi<RAUTk' no j``oppY V Bf '
Print ype mp Name _ Commission # FF 127890 t.
of Notary Public ='= My Commission Expires a,
2015June01 , —
U.-F-