402 Elliott Ave - BR18-004233 - REROOFPERMIT APPLICATION
BUILDING DIVISION
i
r " 7 ` 33ApplicationNo: / 4ti
Documented Construction Value: $ 71 Ky D
Job Address: l / / f d let p-Le;, 52j 21je_61 rl 3; Historic District: Yes No
Parcel ID: , >9 3/ a5bo o oa b Residential , mmercial
Type of Work: New)Q Addition Alteration Repair Demo Change of Use Move
Description of Work: 10e — VOe
Plan Review Contact Person:
Phone:
Name 'pa- g lel"c
Fax: Email:
Property Owner Information
O PSoit/ Phone:
Street: 44 fi-11/ 0/ ai/t- Resident of property?
City, State Zip:. 27il
J Contractor Information
Name Sl
Street:
City, State Zip: UPI AL2
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Phone:
e 7,2 /,,I e 7
Fax:
State License No.: C— 3 0 F3
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: 6"' Edition (2017) Florida Budding Code
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 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 ofsubmittal. 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
a gAC JvhJ20AJ
Owner/Agent's Name
Si ature of Nota
1:''• JUDITH A MCGIWN
MY COMMISSION # FF 183914
c°e EXPIRES: January 9, 2o19
Bonded Thru Notary Public Underwriters
Owner/Ages or
Produced ID Type of ID
Cw-",
Signature of Contractor/Agent Date
o 44 pv 1 140 k
r t Contractor/Agent's Name
ignature of Notary -State of
a•• Li' JUDITHAMCGIWN
MY COMMISSION # FF183914
EXPIRES: January 9, 2019P, BondedThn Notarypublic nd ' rsContractor/Agent is
Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas Roof
Construction Type: Occupancy Use:
Total Sq Ft of Bldg: Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING: UTILITIES:
ENGINEERING: FIRE:
COMMENTS:
Flood Zone:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Permit #
Project Location
City of Sanford
Building and Fire Prevention
Product Approval Specification Form
10 -4 0tm So,4,-d F / 3a -7 —7/
As required by Florida Statute 553.842 and Florida Administrative Code 9N-3, please provide the
information and product approval number(s) on the building components listed below if they are to be
utilized on the construction project for which you are applying for a building permit. We recommend that
you contact your local product supplier should you not know the product approval number for any of the
applicable listed products. Be aware that windows, skylights, and exterior doors must be tested in
accordance with the Florida Building Code, Section 1714.5. More information about Statewide Product
Approval can be obtained at
The following information must be available on the jobsite for inspections:
1. This entire product approval form
2. A copy of the manufacturer's installation details and requirements for each product.
Category / Subcategory Manufacturer Product
Description
Florida Approval #
include decimal)
1. Exterior Doors
Swinging
Sliding
Sectional
Roll Up
Automatic
Other
2. Windows
Single Hun
Horizontal Slider
Casement
Double Hun
Fixed
Awning
Pass Through
Projected
Mullions
Wind Breaker
Dual Action
Other
June 2014
Category / Subcategory Manufacturer Product
Description(including
Florida Approval #
decimal
3. Panel Walls
Siding
Soffits
Storefronts
Curtain Walls
Wall Louver
Glass block
Membrane
Greenhouse
E.P.S Composite
Panels
Other
4. Roofing Products
Asphalt Shingles R/
Underla ments
Roofing Fasteners
Nonstructural
Metal Roofing
Wood Shakes and
Shingles
Roofing tiles
Roofing
Insulation
Waterproofing
Built up roofing
System A Al
Modified Bitumen
Single Ply Roof
Systems
Roofing slate
Cements/
Adhesives /
Coating
Liquid Applied
Roofing Systems
Roof Tile
adhesive
Spray Applied
Polyurethane
Roofing
E.P.S. Roof
Panels
Roof Vents
Other
June 2014
Category / Subcategory Manufacturer Product
Description
Florida Approval #
include decimal
5. Shutters
Accordion
Bahama
Colonial
Roll up
Equipment
Other
6. Skylights
Skylights
Other
7. Structural
Components
Wood Connectors /
Anchors
Truss Plates
Engineered Lumber
Railing
Coolers/Freezers
Concrete Admixtures
Precast Lintels
Insulation Forms
Plastics
Deck / Roof
Wall
Prefab Sheds
Other
8. New Exterior
Envelope Products
Applicant's Signature
Applicants Name
Please Print)
June 2014
Date of Estimate.
Customer Name:
Job Address:
City, State, Zip:_
Customer Email:
SRA Rodkq, LLC
105 TRAIEE COURT • LAKE MARy, FL 32746
PHONE: 407,212.8799
EMA: SA«ENROO[iNG@yAhOO.COM
AGREEMENT
LICENSED AND INSURED CCC1331033
I ,J Sales Rep Name: —sco I 41 "e,,
7J0Viosw Sales Rep Phone: t-lc%'
JE Cust Phone #:
r Cust Cell #:
GfiA ( k y,-,) Cust Fax #:
Proposal for the Following:
Remove existing Shingle Roof / Flat Roof
Haul off all roofing debris ^
Remove and replace the following items:
A. New 30 ply felt or Synthetic underlayment
OD.,New plumbing boots
C/ New kitchen vents
D. Peel n Stick in valley "
1 New 26 gauge Eaves drip
F. New ridge vents / off ridge vents
Re -nailing decking
Replace any unforeseen rotten wood, plywood $50.00 per sheet - facia - decking board $6.00 per foot.
NOTE: Replacement of rotten wood does not consist of any stained or discolored wood, just rotten.
Replace 2x2 skylights / 2x4 skylights
Re -flash Chimney Build Cricket New Chimney Cap
Install new roof Year Architectural 3 Tab Shingles -9
Color Manufacturer
Will cement all edges and valleys
SRA is not responsible for removal and re -installation of solar panels
5 year labor warranty X Permit included
Flat Roof
A. k lb Base Sheet
B. Smooth Modified Bitumen
C. Granulated Modified Bitumen
D. Aluminum Fiber Coating
E. Modified Awaplan 170 Cold Process
Where there is not a 114" fall per foot to meet code on any flat roofs this wiffneed to be brought up to code otherwise no warranty will be
offered by SRA. A SRA representative has explained this to me and I understand and accept theterms otherwise. Initial:
If payment is not made under the terms and conditions of this contract. SRA reserves the right to place a lien in the above mentioned property
and finance charge of 5% per month will be added to the unpaid` accounts 30 days from the`date of the agreed payment of this contract.
Should collection be necessary, the person on this contract shall pay.all court costs; attorney fees and appeal fees (if any). This contract isvalidfromonemonthfromthedataofacceptanceandapprovedbySRA. The`state of Florida has a construction recovery fund.
We propose to furnish the above complete in accordance with the above termss for the sum of:
I $ 7I 'C
14.
Accepted:
Accepted:
SRA Roofing, LLC Authorized Signature
Date:
Datd:'
I . The law provides that either party to a home improvement contract may cancel the contract. The Buyer can cancel this contract
without penalty of obligation, in writing, by certified or registered mail, by midnight of the third business day following the
execution of the home improvement contract. If the contract is cancelled after the aforementioned period then the Contractor is
entitled to ten percent (10%) of the contract price.
If the contractor is required to institute legal proceedings to collect any amounts due under this contract, owner agrees to pay
Contractor the costs of collection including, but not limited to, attorney's fees and court costs.
2. CHANGE ORDERS: No Alterations or extra work shall be done under the terms of this contract without a written order from the
owner, accepted by contractor, which shall expressively state the cost of such alteration or extra work.
3. UTILITIES: Owner shall provide power and water to or near the construction site for contractor to make those connections
necessary to accomplish the work contemplated by this contract.
4. SURVEY: Prior to the commencement of construction owner shall provide contractor with a boundary survey of the property upon
which contemplated by this agreement is to be constructed, which survey shall define and delineate the boundaries of such
property, and show the location of utility easements and setback lines which may effect the use of the property. Contractor
assumes no responsibilities for the construction of any improvements which may encroach upon easements of setback lines not
disclosed upon such survey or otherwise brought to its attention by owner.
5. PAYMENT TO CONTRACTOR: Upon Substantial completion of the work contemplated by this contract.
6. DEFAULT BY OWNER: All monies not paid when due hereunder shall bear interest at the legal rate in force and effect at the
place of the project. Should contractor employ an attorney to collect any sums due it under this agreement or otherwise enforce
its rights hereunder, contractor shall be entitled to collect its reasonable attorney's fees and costs of court.
7. CONTRACTOR"S WARRANTY: Contractor guarantees that the work completed under this contract and any charge orders
thereto shall be in accordance with the plans and specifications therefore, and shall be free from poor workmanship or materials
and contractor shall repair at its own expense for a period of FIVE YEARS from the date of substantial completion of the project
all of the work covered under the contract.
8. CONSTRUCTION INDUSTRIES RECOVERY FUND: The 1993 legislature created a Construction Industries Recovery Fund for
persons who have been adjudged by a court to have suffered monetary damages caused by a contractor, or to whom a licensee
has been ordered to make restitution, which violation occurs after July 1, 1993. The recovery fund is to be funded out of a one
half cent per square foot surcharge on building permits, and any surplus of monies collected from fines imposed by the board.
The limit of recovery under the fund $25,000 per transaction, regardless of the number of claimants. Payments for claims against
one certification holder shall not exceed $50,000 in agreements. Upon the payment of any amount from the fund, the license of
the certificate holder is auotmatically suspended and shall not be reinstated until the amount paid from the fund is reimbursed
including interest. The statute says that bankruptcy does not discharge the penalties and disabilities of the law.
9. SRA is not responsible for any cracked concrete due to delivery of materials.
10. SRA is not responsible for plumbing in attic that is not to code.
11. Warranty is based upon normal wear not warranted from acts of God such as hurricanes, etc.
12. Owner may transfer the warranty one (1) time during the first two (2) years of the installation date.
13. It is homeowners responsibility to address or point out to SRA of any interior ceiling damage, stains etc. due from existing roof
leaks to start of re -roof job.
ACCORDING TO FLORIDA'S CONSTRUCTION LIEN LAW (SECTION 713.001-713.37, Florida Statutes), THOSE WHO
WORK ON YOUR PROPERTY OR PROVIDE MATERIALS AND ARE NOT PAID IN FULL HAVE A RIGHT TO ENFORCE
THEIR CLAIM FOR PAYMENT AGAINST YOUR PROPERTY. THIS CLAIM IS KNOWN AS A CONSTRUCTION LIEN. IF
YOUR CONTRACTOR OR A SUBCONTRACTOR FAILS TO PAY SUBCONTRACTORS, SUB -SUBCONTRACTOR, OR
MATERIAL SUPPLIERS OR NEGLECTS TO MAKE OTHER LEGALLY REQUIRED PAYMENTS, THE PEOPLE WHO ARE
OWED MONEY MAY LOOK TO YOUR PROPERTY FOR PAYMENT EVEN IF YOU PAID THE CONTRACTOR IN FULL. IF
YOU FAIL TO PAY YOUR CONTRACTOR, YOUR CONTRACTOR MAY ALSO HAVE A LIEN ON YOUR PROPERTY. THIS
MEANS IF A LIEN IS FILED YOUR PROPERTY COULD BE SOLD AGAINST YOUR WILL TO PAY FOR LABOR,
MATERIALS, OR OTHER SERVICES THAT YOUR CONTRACTOR OR SUBCONTRACTOR MAY HAVE FAILED TO PAY.
FLORIDA'S CONSTRUCTION LIEN LAW IS COMPLEX AND IT IS RECOMMENDED THAT WHENEVER A SPECIFIC
PROBLEM ARISES, YOU CONSULTAN ATTORNEY.
Grant Malo, Clerk Of The Circuit Court & Comptroller Seminole County, FL
Inst #20181y13239 Book:9222 Page:1966; (1 PAGES) RCD: 10/4/2018 8:25:15 AM
REC FEE $10.00
THIS INSTRUMENT PREPARED BY: CERTIFIED WPY GRANT MALOYName: Scott Allen
Address CLERK OF 1 K CIRCUII' COURT w
2746 AMDCOMP' SEMI,:
4c C )i1!' F t NOTICE
OF COMMENCEMENT By Date ----- -- °'';
Y
CLERK Permit
Number. i A 2 0 181 ParcelIDNumber: 30-19-31-525-0000-0210 ,1
4 -rftThe
undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, EL48QSt4u as, the following
information is provided in this Notice of Commencement. 1.
13E6J 31P2T1ON S1F PBQP.ERTYL(L6ga10edcgpAV gdhe property and street address if available) 2.
GENERAL DESCRIPTION OF IMPROVEMENT: Re -
Roof 3.
OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT: Name
and address: Patricia Johnson 402 ELLIOTT AVE SANFORD FL 32771 Interest
in property: Owner Fee
Simple Title Holder (if other than owner listed above) 4.
CONTRACTOR: Name: SRA Roofing, LLC Phone Number. 407-212-8799 Address:
105 Tralee Ct, Lake Mary, FI 32746 5.
SURETY (If applicable, a copy of the payment bond Is attached): 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. Address:
S.
In addition, Owner designates of to
receive a copy of the Lienor's 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
of Owner oWessee, or Ownersor Lessee's (Print Nameand Provide Signatory'sTide/Office) Authorized
Otli rector/Partner/Manager) State
of County, of d /C •, The•
R l!IIMg Instrument was acknowledged before- me this / day of by
Name
of personmaking statement who
has produced Identification type of Identification produced: Who
is pprsonaly knowntome OR a°
31 r1yj'a, JUDifHAMCGWN My
COMMISSION i FF I=% Notary Signature EXPIRES:
January 9, 2019 AfBondedThruNotarypublicUndambes
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:0/// q
I hereby name and appoint: ls4l
an agent of:
Name of Company)
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):
0-1, The specfc pepaiitJ and a licati for work ocated t: Stree(
Address) Expiration
Date for This Limited Power of Attorney: License
Holder Name: c> a 6 A/ State
License Number: CS C! / -3 )U 3 3 Signature
of License Holder: STATE
OF FL RIDA COUNTY
O The
foregoing instrument was acknowledged before me this / 9day of 200,
by SOof #1/e-tJ who is personally known to me
or who has produced identification and
who did ( t) take an oath. off,, aJ!-,
t [mac Signature Notary
Sea])
JUDITHAMCGIWN fitMY
COMMISSION #
FF 183914 EXPIRES: January
9, 2019 q, Bonded
Thru Notary public Underwriters Rev. 08.
12) Print or
type name Notary Public -
Sta of F1,0e-le%O , Commission No.
A/ / My Commission
Expires: / as
Building & Fire Prevention DivisionSA'NFORD RESIDE NTIAL RE -ROOF 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:
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: qlslls
F O RD PERMIT #
JOB ADDRESS: 0
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
STRUCTURE TYPE: XSINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: O 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: O OFF -RIDGE O RIDGE OSOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: O YES NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: (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#
MODIFIED BITUMEN 4ca g4e-ca FL# C 453 3
O TORCH DOWN FL#
O INSULATED FL#
O TILE FL#
Q 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 METAL FL#
O MODIFIED BITUMEN FL#
O TORCH DOWN FL#
O INSULATED FL#
O TILE FL#
0 OTHER: FL#
Building & Fire Prevention DivisionD1SAN' RD RE- FAFFIDA . RESIDENTIALROO VIT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT#: / ADDRESS: ViJd 1N1,9 4 a° L
I 5_a / / ,q/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 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 #: 6?C M3/b`33
COMPANY / CONTRACTOR:
r ,4 RM/ /
CONTRACTOR SIGNATURE: DATE: (`
MUST BE SIGNED BY LICENSE HOLDER OR OWNER/BUILDER)
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 (ARCHIT:ECT OR ENGINEER) TO CERTIFY, BASED ON PERSONAL
INSPECTION, THE INSTALLATION OF ALL ROOFING COMPONENTS.
STATE OF FLORIDA COUNTY OF Sr-fr/pe/c,
Sworn to and Subscribed before me this /9 day of i_ 20 u by:
Who is r ersonatIy Known to me or has Produced (type of
tification) } as identification.
gnature of Notary Public
S ate of Florida
Print/Type/Stamp Name
of Notary Public
JUDITH A. MCGIWN
MY COMMISSION # FF 183914
EXPIRES: January 9, 2019
Bonded Thru Notary PubMc Underw t m