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105 Pinefield Dr - BR17-003080 - REROOF10-k-l CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT 'APPLICATION Application No: 7 3 0W Documented Construction Value: $ 10,8W Job Address` 105 Pinefield Drive Sanford FL 32771 Historic District: Yes No Q Parcel ID: 32-19-31- i15-0000-ow Residential XQ Commercial Type of Work: New Addition Alteration 0 Repair Demo Change of Use Move Description ofWork: reroof Owens Coming FL 10674-R12 Techwrap FL 17194-R1 31 squares 7112 pitch Supreme Driftwood 25 year warranty Plan Review Contact Person: ' Rachel Holcomb Title: admin manager Phone: 407-278-7788 Fax: 800-337-3361 c Email: peiasperinc com Property Owner Information Name Stenneth Brown Phone: Street. 105 Pinefield Drive Resident of property? : yeS City, State Zip: Sanford FL 32771 Name Jasper Contractors Street: 3203 S Conway Rd City, State Zip: Orlando FL 32812 Contractor Information. Phone: 407-278-7788 Fab- 800-337-3361 State License No.: CCC1331153 Architect/ Engineer Information Name: Phone: Street: City, St, Zip: Fag: E- mail: Bonding Company: Mortgage Lender: Address: Address: WARNING TO.OWNEttt_YOUR.FAILUPX TO-RECORD.A.NO.TTCE_OF COMONCEMEN.T_MAY_RESULTIN_YO.UR--__:_: PAYING TWICE FOR MPROYEMENTS TO YOUR PROPERTY: A NOTICE OF COMMIT MEMENT MM 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 perfotrned to meet standards of all laws regalati ng 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 inscribedwith the date of applicationand thecode in effect as of thatdate- V Edition (2014) Florida Building Code Revised: June A 2015 Permit Application VI q. 36, NO _: In addition to the requirements of this permit, there may be.addltimal 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 ofpermit is verification that I will notify the owner ofthe property ofthe requirements of Florida Lien Law, FS 713. The City of Sanford requires payment ofa plan review fee at the time of permit submittal. A copy ofthe executed .contract is requiredinordertocalculateaplanreviewchargeandwillbeconsideredtheestimatedcoushuctionvalueoftheJobatthetimeofsubmittal. 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 permitfees 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 eonstructioii and zoning. Signature ofOw«edAgmt Pint OwnedAgeut'sName SisnatureofNoWryStateofFlorida Date Owner/Agent is Personally Known to Me or Produced ID Type of ID BELOW IS FOR OFFICE USE ONLY Permits Required: Building Electrical[] Mechanical Plumbing0 GasFj Roof Construction Type: Total Sq Ft of Bldg:. Occupancy Use., Min. Occupancy Load: Flood Zone: of. Stories: New Construction: Electric - # of Amps Plumbing - # of Fixtures Fire Sprinkler Permit: Yes n No # of Heads Fire Alarm Permit: Yes Q No Q APPROVALS ZONING: LTTILX— 8 _WASTEW—AX R __ ENGINEERING: FM: BUILDING: COMMENTS: Revised: June 30,2015 PenntApplicWt City of Sanford Building & Fire Prevention Division Re -Roof Permit Card PERMIT NO. ® ISSUE DATE: 0 • 1q. 19 momCONTRACTOR: r CogjM c.W r JOB ADDRESS: 105 TYPE OF WORK: Dr..7 C CJG;r ® _3lf MW ' GZ I PROTECT FROM W&EATHER 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 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 $55.541.2112 aso 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: Pen -nit 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), ceVfifying FBC ode compliance by personal inspection. CONTRACTOR (OR OwNER/BunDER) SIGNATURE: ' ' ` DATE: k"J PERMIT # I J — 30e City of Sanford Building Division Residential Re -Roof Scope of Work JOB ADDRESS: 105 Pinefield Drive Sanford FL 32771 STRUCTURE TYPE: 0 SINGLE FAMILY RESIDENCE/TOWNHOUSE Q. 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: ONLY 100 SQUARE FEET OF THE EXC4TING DECKLS PERMITTED TO BEREPLACED ** ROOF VENTILATION: D OFF -RIDGE Q RIDGE Q SOFFIT QPOWERED VENT OTURBWES SKYLIGHTS: O YES O NOIF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #: MAIN ROOF AREA ROOF SLOPE: Q LESS THAN 2:12 Q 2:12 — 4:12 © 4:12 OR GREATER TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL Q SHINGLE Owens Corning FL# 10674-R12 O METAL FL# 0 MODIFIED BITUMEN FL# Q TORCH DOWN FL# QINSULATED FL# O TILE FL# Q OTHER: FL# ROOF ROOFEXTENSIONS(PORCHES,PATIOS,ETC.) **IFAPPLICABLE**,PATIOS,ETC.) **IFAPPLICABLE** ROOF SLOPE: O LESS THAN 2:12 Q 2:12 — 4:12 Q 4:12 OR GREATER TYPE OF ROOF MANUFACTURER k'LORIDA PRODUCT APPROVAL O SHINGLE FL# O METAL FL# QMODIFIED BITUMEN FL# Q TORCH DOWN FL# QINSULATED FL# o TILE FL# Q OTHER: FL# 428276 LBMDPOWER ; i Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: 10.17.17 1 hereby name and appoint: Karla Almodovar, Skylar Amkraut, Ana Chavez, Gina McDonald & Rachel Holcomb an agent of COtt°O INamarcomp= y) to be my l"fW 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: 105 Pinefield Drive Sanford FL 32771 Sara Add-ss) Expiration Date for This Limited Power of Attorney 01-01-2019 License Holder Name: Donald Bouchard State License Number. CCC1331153 Signature of LicenseHolder: STATE OF FLORIDA + COUNTY OF Sarno* ' The foregoing instrument was acknowledged before me this 17 day of october , 200 17 , by DwaidSouchwd who is c3 personally known to me or w who has produced n>_ as identification and who did (did trot) take an oath Ignanlie Nagy Seal) Oyfar AmImut KYL AMKRAUT t Commission # FF 127no Q My Commission Expires June 01, 201B wi . Rev_ 08. 12) Print or type name Notary Public - State of FL Commission No. 121890 My Commission Expires: 6/112018 nnnpd by C,mSrannPr 10/17/2017 SCPA Parcel View: 32-19-31-515-0000-0940 0Jotmxon. CIA fPaEMMLE QOMRY,, PLOFMA Parcel information I Property Record Card Parcel: 32-19-31-515-0000-0940 Owner: BROWN STENNETH Property Address: 105 PINEFIELD DR SANFORD, FL 32771 Parcel 32-19-31-515-0000-0940 Owner BROWN STENNETH Property Address 105 PINEFIELD DR SANFORD, FL 32771 Mailing 1680 ELMHURST CIR SE PALM BAY, FL 32909-8834 Subdivision Name CELERY LAKES PHASE 1 Tax District S1-SANFORD DOR Use Code 01-SINGLE FAMILY Exemptions Legal Description LOT 94 CELERY LAKES PHASE 1 PB 62 PGS 75 & 76 i Taxes Value Summary 2018 Working Values 2017 Certified Values Valuation Method Cost/Market Cost/Market Number of Buildings Depreciated Bldg Value i 1 r 114,721 1 i $108,103 Depreciated EXFT Valueee 338 350 Land Value (Market)$30,000 30,0D0 Land Value Ag I Just/Market Value " 145,059 1$138,453 Portability Adj Save Our Homes Adj 0 0 Amendment 1 Adj 1$17,753 22,720 P&G Adj so I $0 Assessed Value 1 $127,306 115,733 Tax Amount without SOH: $2,352.98 2017 Tax Bill Amount $2,352.98 Tax Estimator Save Our Homes Savings; $0.00 Does NOT INCLUDE Non Ad Valorem Assessments Taxing Authority Assessment Value Exempt Values Taxable Value County General Fund 127,306 0 $127,306 Schools 145,059 0 $145,059 City Sanford — - I $127,306 0 $127,306 SJWM(Saint Johns Water Management) j $127,306 0 ( _ $127,306 County Bonds I $127,306 0 ! $127,306 Sales Description Date Book Page Amount Qualified Vaclimp SPECIAL WARRANTY DEED 1 8/1/2005 05851 10933 i $152,900 I Yes —^ Improved Find Comparable Sales Land I Method d Frontage LOT Building Information Depth Units Units Price Land Value i 1 i $30,000.D0 $30,000 is beatgatn count incorrecit WICK here Descri lionp Year Built ActuailEffective Fixtures Bad Bath Base Area Total SF Living SF Ext Wall Adj Value Repl Value Appendages 1 i SINGLEFAMILY 2005 1, 6 2_0 1,617 2,053 1,617 UCCO { $114,721 FINISH 120,127 Description Area GARAGE 415.00 i 1 http://parceldetail.scpafl.org/PareelDetaillnfo.aspx7PID=32193151500000940 112 1111111111111111111111111111111111111111111 Jill THIS INSTRUMENT PREPARED BY: Ira(0 pmodwarName: Jasper Contractors Address: 53110 F CnlnniaLDrivp nrinnrin- FI 39807 NOTICE OF COMMENCEMENT Permit Number: / Parcel ID Number• 3 19 -Of — 6i6- I/ d 094-10 GRANT I'IALOIi , SENINGLE COUNTY CLERK OF CIRCUIT COURT & COMPTROLLER BK 9008 Pg 4S2 (1Pss) CLERK'S 4' 2017104587 RECORDED 10/17/2017 10-33.31 All REC:!,'DING FEES $10.130 RECORDED BY .ieckenro 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. DESCRIPTION OF PROPERTY: egal des Lion of the pro erty and street address if a lab9yCepfailsSE' 'L i C—t :46 2. GENEBAI=jD SCRIPTj,O IMPROVEMFJdT: 3. OWNCER INFORMATION OR L j- ESSEE INFORMATION 1; THE LESSEE CONTRACTED FO T E IMPRONEME1 " j _ Name and address: ' Y) C0W'A S-t FYI r)s 1 U S ` ,? Y}E e f c t Vl"10 C "t 1 Interest in property: 03AMpr Fee Slmple 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 of applicable, a copy ofthe payment bond Is attached): 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. Address: 8. In addition, Ownerdesignates to receive a copy of the Lienors 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 70. OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, 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. 5 A04 )n W Signature of Owner or lessee, or Ownets or Lessee's (Print Nameand Providestgnator STiffe/O 6ce) Authorized 06rced WeetodPartnerAbnagef) t ` Jr \ y nif'la xu State of IC rY i[,4 County of u—J _ C' Gl The foregoing instrument was acknowledged before me this b c 711 j C• T' T ti y -- Y \ Who is personally known to me OR C- Nameofpersonmakingstatementrwho has produced identification e of identification produced: ,J < = 4 p iu C3 7rrrri OC OV a i3 va ..r,, KA R LA `M A L M h No< ary signature x c1 ,StateofFloridaNotaryPublirl. ¢ w a Commission # GG 1 t 1330 UA MyCommissionExpiresi. u v ¢'^ June Oa, 2021 5330 E. Colonial Dr. Orlando, FL 32807 3203 Conway Rd., Ste. 201 Orlando, FL 32812 407) 278-7798 800) 337-3361 Fax info@,ia,ttiiic.org Lgz J At`3 P E AsporRoot.aom FL Contractor's License: CCC1329651 tit CCC1331153 RnnIP RF.Fi.AVPMFNT CONTRACT Acmunt Manager. Uge - - Contact #:% 7 Company: Policy #: Claim #: _ Company: OC Loan Number.1 Oww(s). - - -- Phone, O Address: Alt Phone: Io ' City. Stale: Zip Code: in Color. Email- Roof RCV Amount/ Contract Price: Drip . ge Cgiar: 10,800 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 ofwhicb shall be limited to a Full Roof Replaceuimt. I 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. I also hereby direct my insurer(s) to release any and all infdrmation 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 viatve my privacy rights. 1fpayment 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 coy all insurance dedurrgibles. Owner's out-of-pocket expense will not exceed the deductible amount, .as stated on insurer's loss sheet (the "Loss Sheet'j, 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, waive or rebate any or all of the insurance deductible applicable to the insurance claim for payment of work. In the event of a discrepancy, the deductible amount stated on the insurer's Loss Sh et dwLoverrule deductible amount disclosed. Deductible: $ MUST BE PAID IN FULL, PLUS APPLICABLE SALES TAX (initial) MORTGAGE AU 17HORIZATI : I, Owner/Mortgagor, grant authori on for Mortgage Co. to speak with Jasper on matters including but not limited to, the claim and draw status, (initial) PAYMENT SCHEDULE: Owner agrees to pay Jasper based on the following schedule: (i) Deposit in the amount ofS due upon signing ibis contract; (il) the Contract Price, less the Deposit and any applicable depreciation retained by Owner's insuaer(s), plus upgrade costs, dire and payable to Jasper upon completion of work being performed; and, Chi) 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 20% of Contract Price may be withheld until inspection has passed. Optional: UPGRADE HEM: QTY: PRICE: TOTAL: $ Replacement Work and Price: Upon insurer's approval and subject to the Terms and Conditions 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 30 days, conditions permitting. Owner's Declaration of Intent: Owner acknowledges and agrees that, upon approval by insurance company fix a full roofreplacement, Jasper shall perform the roofreplacement upon receipt offunds from Owner's insurance company. FLORIDA HOMEOWNERS' CONSTUCTION 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 323994039, (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 ofiiee: 1690 Roberts Boulevard, Suite 112, Kennesaw, GA 30144. CANCELLATION EXCEPTIONS: The three (3) day right ofcancellation DOES NOT APPLY to contracts for emergency home repairs as time Is of the essence. I, Owner, have read and understand all statements, Terms and Conditions of the "Roof Replacement Contract" and agree that all details are acceptable and satisfactory. I further understand that this Contract constitutes the entire agreement between the parties and that any further changes or alterations to this Contract must be trade 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. J!S q 12 / Authorized Jasper Representative ate r+:r Owner Date Scanned by CainScanner I07 - 5ogo LIMITED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: \ - 1 ,1 I hereby name and appoint: Scott Meixsell, James Allen, Michael Watts, Jacob Horst, Ricardo Prito, Paul Padgett an agent of: Jasw Contractors rune ofCompamy) to be my lawful attomey-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 t and application r wo located at: A4 1 i IJ'f smY Addnm) Expiration Date for This Limited Power of Attorney: License Holder Name: DO vk!u teal State License Number. ccc1331153 Signature ofLicense Holder. f _ STATE OF FLORIDA i, COUNTY OF sen—oie The foregoing instrument was acknowledged before me this k ay ofrawfiper200_L--f , by °staid B-d who is personally (mown to me or m who has produced tx identification and who did (di, Notary Sea]) SKYLAR B AMKRAUT Commission k FF 127890 My Commission Expires June 01 , 2018 Rev. 08.12) Notary Public State of R Commission No. My Commission xpires: Scanned by CamScanner ti W, n City of Sanford Building and Fire Prevention RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOFjCOVERINGSPERMIT#: / Og ADDRESS: t O I ii" 1 (yl y ' `/ I LMUVl'2U: I , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR ROOFING CONTRACT , 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 U MUST BE SIGNED BY LICENSE HOLDER A FINAL ROOF INSPECTION IS REQUIRED: DATE: 1 ` 4 . ! 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 S Wkyl()I(_l Sworn to and Subscribed jbefore me this \ day of NDyL , 20 J'y by: Who is Personally Known to me or has Produced (type of as identification. x ; — o-. SKYLAR B AMI<RAUT.. Commission tt FF 127;i;1: ; My Commission Expires June 01, 2018 of Notary Public