404 W 20 St - BR18-004230 - METAL ROOFCITY OF
S,kNFORD
BUILDING DIVISION
PERMIT APPLICATION
Application No: Ik— 7" ) 36
Documented Construction Value: $ IR loo _ a-)
h n
Job Address: i 0L o?O— 1 (,ln"/, A , 2 Historic District: Yes No
Parcel ID: 3G - -Sao- ODW -157W Residential Commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of Work:
Plan Review Contact Person: , PR 11. 1 Title:
Phonec?-2L 2 36 -lam o96& Fax:gO- Xy - 011o Email:1,( J?I/1JUL q"u'L6C) Property Owner Informati/
o/n ,/ NameA// i /
1 Phone: 7U %- yCo3 - Z 2.S Street: ('7 (o
D lJ(D1191d 1 '(/. Resident of property?: N6 City, State Zip:
M-170 Contractor Information / nn
Nam C
Phone:
16 7 - 52 - 2 Street:" l, l
Yl d 0 CIIQ n C f W u Fax: 7 U%- o25y) City, State Zip: l
Ql7G? 7 , %Y ?,?Al(,) State License No.:(("/) 09370 9 Architect/Engineer Information Name:
Phone: Street: City,
St, Zip:
Bonding
Company: '0 Address:
Fax: E-mail:
Mortgage
Lender:
1 //7
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 1053 Shall be inscribed with the date of application and the cod
V
e in effect as of that date: 61 Edition (2017) Florida Building Code
NQ110E: In addition to the requirernents, oftbis pernift, there inay he additional restrictions applicable to this property that. inay he 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 ageillclo.
Acceptance ref permit is verification that I will notify the owner of the property of the requirenicias of 11orida Lien Law, FS 71,3.
I'he City of Sanford requires payment of a plan review fee at the Lillie ot'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 ofthe job at the time of'submittal. 'I'he actual construction value
will be figured based oil the current ICC Valuatioq 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 o(Ownerl Agent Date
A V 0,,-, ?0&,/1
1) rint Ole
1", —
more
Sig otarv-State of Florida DaVYIN1,
111
tc
Notary Public State of Florida
William Penuel
My Commipjon FF 923404Owner/Agent is Per rXifniftir'b0offl000
Produced ID Tyr7o., -
SignKmcof C.ntac,,1Agc.4t Date
RM
10-164:a
Signature cif Notary-Shireofflorid-,k ov%. f)Oary Public State of Florida
W*
0
t William Penuoi
7 MY Commission FF 923404OfIVdr-Expires lo/olmig
Contractor/Agent is —'Personally known to Meor Produced
ID — T)Te of ID Permits
Required: Building M Electrical n Mechanical n PlumbingEl Gas 0 Roof El Construction Type:
Occupancy Use: Flood Zone: Total Sq
Ft of .Bldg: Min. Occupancy .load: of Stories: New Construction:
Electric - # of Amps Plumbing - # of Fixtures Fire Sprinkler
Permit: Yes n No F] # of Heads APPROVALS: ZONING:
ENGINEERING: COMMENTS:
UTILITIES:
FIRE:
Fire
Alarm
Permit: Yes []No [] WASH WATER:
BUILDING;
3
Parcel: '•
Property address: 404 YV 20TH ST SANFORp, FL 32r, 1-3637,
j intonrt"on Value SummwY
Pal 136/930S064wDa isw 208 vt4idnq > 201T Cettfied
values Values fOwner(s) BOWLIN, ALLAN D - Joint Tenants with tight of
BOWLIN KRISTINA Joint Tenants wAh not Ot SurvfvOrsh c> Valuation ve'.hxl COsi00wA ,e€ COst Martr,et
P-Patty A kk— 404 W 20TH ST SANFORD. FL 327T1?831f &ild;srgs 1 1
Mailing 16468 COPELAND RD MILTON, FL 325-1"603 .. eFrecia3zd Bide, Value $87,163 $73.4'.6
NameSubdision cq*?FOR4 HEIGHTS D ! '=Vr ed EXFT-iffi:/aPx 31..899bdivSt.899 L.__ - -- Tax
DiStf t d Sl=SANFORD " '_anC'va,a (Marxet) $.;.a,9w $28,325 DOR
Use Code j Ot-SINGLE FAMILY Land Value Ap Exerrrotims
i Portability
Ad] Save
Our Homes Adj $0 3O Arnenoment
1 Ad7. W,8 SO P&
G Adj so SO Assessed
Value St 19.5C4 $108,6AO Tax
AmountWMW SOH: $2,OW.67 Amxµ
1 $2,068.67 Tax
Est nz€cr Save
Our Homes Savings: $0.00 Does
NOT INCLUDE Non Ad Valorem Assessments Legal
Description LOTS
150+ 151 SANFORD
HEIGHTS PS2PG63
Taxes
T-
kV Attittartty, Assessment Value Exempt Values Taxable Value County
General Fund 119,504 0 119.504 Schaots
119,962 s0 11%962 City
San,`ord I19,504 SO 1t9,504 SJV4
A(Saitrt Johns Wader Management) 119,504 0 119,504 County
Bands 119,504 0 119.50 Sates
Description
I Date Book Page Arrtatrnt Quamw VaCAmp WARRANTS'
DEED 7/112004 Q;ti95 127,WO Yes Improved WARRANTY
DEED &112003 sib 63,800 No Improved hhtd
Cormp b* Salt Land
teod
Fmntage DepthUnits Units Price Land Value FRONT
T & DEPTH 100,00 154.00 0 530p.00 3p g0p Soitding
Information Frw: :
h t Fn.., .. ';?cjs Here; ill
Descriptiond yewACiUAcklffectives F1cd Bath Base Area ? T Lid SF EzF VtaEi T
Fui;
V Rom(V Valuepf a9eS SINGLE
@ 3 G 1,260 2,102 1,754 GONC i7J63 $126,78 FA1lQid. v ResCriPtion Area
lCity of Sanford
Building and Fire Prevention
Product Approval Specification Form
Permit #
Project Location Address. D L/ (! D
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 www.floridabuilding.org.
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
Florida Approval #
including 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
Underla ments 77C 125',-2. 5Z
Roofing Fasteners
Nonstructural
Metal Roofing
rj Ccx,,n+ L1140,
dq !2, o<< yS
Wood Shakes and
Shingles
Roofing tiles
Roofing
Insulation
Waterproofing
Built up roofing
System
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
Applicant's Name C/G•yv
Please Print)
June 2014
rant Maloy, Of The Ccuit Court SminolelerInt # 01811 8I58 Book:9229 Page:60 (1 PAGES)IRCDe OM 1/ 018 1t2:14:27 PM
Arl PIt I0A'ORDIR0-RIi TLRN'rU
Preslioe Metal Roofing Inc.
6061 Gindenana Pkvry 0 100
Orlando FL 32810
I.N.,,1NI 1 liF • _
nS0 D' ookI ICE O CO.-N'IA-IENCEIiENT
CERTIFIED ROCYGRANTMALOYCLERKOFTHECIRCUITCOUpT
SE(Awo
BY `
f
nu.n!
Date DEPUTY CLERK
0 C T 1 2---
the undersigned hcrcbd given imticc that improvement will be, made to certain real property. and in accordance with Chapter 713 13
Florida Statu". the fullo+ring mfunnaliun is provided in the NOTICE OF COMMENCEMENT
I DESCRIPTION OF FROPERTY I Legal description X sneer address. it available) .T'• .x POLIO SU.:r(p' % ' r'd 0[D' QQoV ' oO
Sl'atil\ISIU. 16/ 1 DhOCFi TR\(T LUT DLUG 1\IT
gongsT sAN Fo Fk SA 9 r -&53 %
2. GENERAI, VENCRIrTION UE IMPRUVEME.\T:/tlE72 J 4 ,,,, 00F
3 O\\ NElt INFORMATION , N—_ AAel_Jm & W J'/N
b Addr— Y_/ 6d Fl•- — c inirresi in nrulem•I•_,_
d .oi,A•.nw ,dse>}.•rree:,nips.• uneniaa,i or,nl nh.a o..noq v r 1v i rr - o [r vo
CON?RACTUR'S NAME. ADDRESS AND PRONE %UXIDAR:
Gen. McFGnneYI Presligo Metal Roofm Ingo. 407-290.6203
6061 Cindenane Pkvry ? 10D Orlando FL 32810
i -it 'RETI'S NAME. ADDRESS ANDPHONE NI-118FR AND aUSDA\IOI'NT:
LENDER'S NAME. ADDRESS AND I'l1USE NL JIBt;it; //I
J1/ T
7 Identity ul'parsnns within the State ofl:lurida designated by owner upon whinn notices or other documents mad' be sewed a,
provided by Section 713 1 j (1) (a) 7.. Florida Statutes
NA?IE,ADDRESSAND PIIUNF.NUMDER: . /
In addition tit himsell or herself: Owner dc5ignates the k4low'ing to rcccroc a copy of the Lienor's Notice as provided in Section
713 131 I) (b). Florida Situates
NAME ADDRE.." ANT) PHONE NCDIDER:
9 E'xpu:nlun 1 o nyucc v cum Ic'Mcnt the expuauun date is I (car ITum the date of recording unless a different (late is
spcctticd) . V
art(ca:n n ptirsumt toSection e_ 525. Flatida Stntuica
I u lu, irm.luea ofpcqun. I deeiarc that I hve read the iuinung arxi that the Cacti m n .tic true Io the Let ofme kiwwiedge and bcherlscclion F] 321. Flood Staituca
Allan, > / /4 _
Sisull a or Owhir or eirtt lame and pruvide Si„natoq>s'I'itic/Offrc
Olvner•+authuiied Ofrreer/Directur/1'arinernl:mnger
State of Florida
Count% of
The I'orceomg Instrument was acknowledged hctorc me this day of . 20
na c I cram) itypc of authunty. e g officer. truster, attorney in 1cictI
For
mole ol'party on hchalf ol'whom instrument was e.Nccuh: )
1'ersonal1v kno+vn or _roduecd the lidlowing type of identif ication
1
M 11 (Sion ure of Nolan Public)
Notary Public State of FloridaFWilliamPenuel
MY Commitslori FF 923404
ofn EXPlre31010112019
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
I hereby name and appoint:('I
an agent o£
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):
The specific /permit and application for wor cated at:
Oil1L /A/ W -C 2
Street Address)
Expiration Date for This Limited Power of Attorney: /o - 16 - 1,9
License Holder Name: ` -? 0 1- (l 1 A M L 11)17 6
State License Number: Ce C o-12 ?0 g
1.0
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF OjMip n "
The foregoing i strument as acknowledged before me this _ o—day ol .N ,
200, by of who is personally known
to me or who has produced as
identification and who did (did no n oat
Si re
Notary Seal)
Print or type name
11 Not®V pubUc stat® of Florida otary Public - State of
WAM"atn Penuc! ommission No.
gF (
b0was 92
y Commission Expires:
Rev. 08.12)
CITY OF
Building & Fire Prevention DivisionSkNFORDRESIDENTIALRE -ROOF POLICY & 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: DATE: Sy
CITY OF
SkNFORDw.fs
FIRE DEPARTMENT
JOB ADDRESS:
PERMIT #
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
i
STRUCTURE TYPE: (ZrSINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: O REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
ICE -COVER (NEW ROOF INSTALLED OVER/EXISTING ROOF
DECK TYPE (PLEASE SPECIFY): Z)/2(4f'SI6.K/4G 4,U&SEe 5) \ E
PLEASE NOTE: ONLY 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED
ROOF VENTILATION: D OFF -RIDGE (3 R )GE OSOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: O YES CJ'10 IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 (J 2:12 - 4:12 O 4:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
O SHINGLE FL#
c TAL I FL#
O MODIFIED BITUMEN FL#
O TORCH DOWN FL#
OINSULATED FL#
O TILE FL#
O OTHER: FL#
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IF APPLICABLE**
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#
0MODIFIED BITUMEN FL#
O TORCH DOWN FL#
OINSULATED FL#
OTILE FL#
O OTHER: FL#
Oct 11 18, 12:47p Bill Penuel 3527896690 p.1
PRESTIGE
METAL ROOFING
6061 Cindedane Parkway, Suite 100
Orlando, FL 32810
Florida Contractors License
CCC 033709! CGC058169
Contract Amount
Down Payment $
Total Balance
Toll Free (888) 807 6511 • ' Fax (407)290-6316
We the owners) of the premises mentioned below, hereby engage and hire you as the contractor, to furnish and install all necessary materials and lat
o install, construct and place the improvements according to the following specifications, terms and conditions, on and in the premises below descritNhchwewarrantandrepresentthatwehavegoodrecord -title as to owners in our name.
Dwner's Np e(s) t f.t • %+'.. ..11.{,(. ;;'r :%f'. C e-U ;C J Gi' 'j' , 3 0 Phone -
d- l : Y- Cit i ' F .C.. y ' State. Zip
esgription of work to be done and materials to be uscd ! G%' % 3 L'S 1kla ICU l • ' t`•7
y l ' t J
Remove existing eave drip from perimeterof home and replace rotten wood where deemed necessary by contractor. to r_ sheets of plywood and/or -L
5 per linear foot). linear feet of lumber, (Additional plywood @ $100 per sheet, lumber @5
Install synthetic vapor/water barrier on entire sloped surface of roof.
Remove and replace/discard existing skylights.
Remove exl tang off ridge vents, turbine vents from roof surfaces and sheet holes.
Install %Z:' :.', _gauge metal roof system on entire sloped surface of roof including flash- ings, eave drip, square vents, and ridge caps. Color to be. r .,'',,f 1 t• ..' Obtain all necessary building permits.
fRemove construction debris from job site.
Furnish lifetime labor warranty and deliver manufacturers' year material warranty. 0own payment of $ ' received _/ /_ and balance of $6vj / C :"' due upon completion of
described work.
N Flhenrequiredorrequested:
l;Remove existing roofing material from surface of roof and renail decking.
Install Radiant Bubble on entire sloped surface of roof.
Install 20 gauge metal purlins; 1" EPS insulation with Radiant Barrier and taped seams on entire sloped surface of roof
Vent ridge of home after installation at home owner's request for up to 1 year after completion date.
Vent ridge of home at time of roof installation.
Owner shall be responsible fob rem3yal and re -installation of any solar heating nels and satellite dish receivers. Additional work to be done. ' il>U k4k :-i*71 (7 f 11 !V)A y .j. A/ , ? l:." .,/ t!)r) W
Work not to be done
All of the above check boxes and the'work not to be done" section have been reviewed and explained to me. P
ortractor has public Iiabirity insurance. All sub -contractors have certificate of insurance or exemption. at the time services are rendered,
he undersigned contractor agrees to sell and the undersigned buyer(s) (Jointly and severally, If more than one) agrees to purchase the above described goods and services which are to be fumishrusedinthemodemiration, rehabilitation, repair, alteration, or improvement of the real property located at buyer's address given above, Prestige Metal Roofing reserves the right to assign tlontracttoanotherLicensedContractoratit's discretion.
Npproximate Start Date _Approximate Completion Date r-'-f%fit - ,. iCC 7
r
NO WORK WILL BE CONSIDERED UNLESS HEREIN SPECIFIED, NO VERBAL AGREEMENT RECOGNIZED
Notice to Owner
Do not sign this home improvement contract if blank.
You are entitled to a copy of this contract at the time you sign. Keep it to protect your legal rights.
This home improvement contract may contain a mortgage or otherwise create lien on your property that could be foreclosed on if you fail to pay. Be sure you understarIlprovisionsofthecontractbeforeyousign.
This contract is subject to review -and approval by management of Prestige Metal Roofing and is not valid until approved.
Construction Industries Recovery Fund
ayment may be available from the Construction Industries Recovery Fund if you lose money on a project performed under contract, where the loss results from specifie
olations of Florida Law by a State -Licensed Contractor For information about the recovery fund and filing a claim, contact:
lorida Construction Industry Licensing Board Go 1940 North Monroe 5t. Tallahassee, FL 32399-0783 (904) 727 6530
rrentinre . Tho ndrnr rnnnifirnthnn and nnnrlilinnn ArR naiini.aia lb i .. d ..,. I., I I I if 11 1 1
CITY OF
S_______F0RD Building & Fire Prevention Division
RESIDENTIAL RE -ROOF AFFIDA VIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #:. ADDRESS:
f,e
I y C: Al , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
O ING CONTRACTOR GINEER, ARCH ECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE
FORE ATION 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 #: e .J 70 9
COMPANY / CONTRACTOR: a57746 41W4
CONTRACTOR SIGNATURE: - DATE: A0_'?9- AR
MUST BE SIGNED BY LICENSE HOLD OR GWNER/BUTL-6ER)
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
to and Subscribed before me this AS day of C&Q/ 20 (S' by:
Who is B'Personally Known to me or has Produced (type of
as identification.
SligiYature bf Notary P—ublic
State of Florida
t Notary Public State of Florida
Print/Type/StampName q William Penuel
y OF RP toy Commission FF 923404ofNotaryPublicPires10/01/2019