1404 Montezuma Ave - BR18-004584 - REROOFJob Address:
Parcel ID: 31- 0 -3 l -501 r P
Type of Work: New Additic
Description of Work:
Review Contact Person:
t.jov 2' 418 PERMIT APPLICATION
Application No: 18' L,5 9 4
Documented Construction Value: $ V'ObC . &_Z
Historic District: Yes NoM,-
Residential Commercial
Alteration [2 Repair Demo Change of Use Move
Phone: " J
J
Fax:
Ci i/,J'I'gl Title:
Property Owner Information
Name OAI Phone:
Street: ov d VY&
JJ
Yt
City, State Zip: iV,4
Resident ofproperty?:
G j)itj ,3,nn , Contractor Information
ii i^ i{k 9t6tZ i y,b Cis { • ,/(/ 7y . +`"*r`c0..a+,' a.?r2S a:.'n6ilxs.s.''=r
3; yc:11lle,e , al' Phone:
tEaL 91tCjn r,,• t y: :
affi i 5 1)F1 :. AWL stB'L°Vf
a Street..: , i ' 9 1 Fax: Si3t t n 1 `,t t,2? i.,P:r
w ,
City, State Zip: rrI 3 Z % State License No.:
Architect/Engineer Information
Name: AY
Street:
City, St, Zip:
Bonding Company; Com an :
Address:
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: 61h Edition (2017) Florida Building 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 of permit 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 of permit submittal. A copy of the executed contract is required in order to
calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal. The actual construction value
will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in accordance with local ordinance. Should calculated
charges figured off the executed contract exceed the actual construction value, credit will be applied to your permit fees when the permit is issued.
OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be
done in compliance with all applicable laws regulating construction and zoning.
Sib tore o Owner/Agent Date
Print Owner/ gent's Nanie
ii 1'13 /W
gnature of Notary -State of Florida Date
tr o c
S gnatur of Contractor/Agent Date
4,.
rint Contractor/Agent's Name
t/1a/1
Signature of Notary -State of Florida Date
r MATT 1MO BOUGHOKnowntoMeorContractor/Agent is t (1i#}r §ate CUFtorldaT, ELLY FREDRceT Q { T Produced ID Typ $ ` '' Commissron rr FF 982538
ti oltr'y f:i = StaCb {ai o l ., y . omm. xPns Jul S, 2020Commission #t FF 215828 '•MINI''Bonded throu t National ry Assn.
OFF
My Comm. Expires Mar 31, 2019
Bonded through National Notary Assn.
3 BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas Roof
Construction Type Occupancy Use:
Total Sq Ft of Bldg: z s Min. Occupancy Load:
Flood Zone:
of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
Fire Alarm Permit: Yes []No
WASTE WATER:
FIRE: BUILDING:
Grant Maloyy, Clerk Of The Circuit Court & Comptroller Seminole Countyy, FL
Inst #2018131185 Book:9251 Page:542; (1 PAGES) RCD: 11/19/2018 9:49:17 AM
REC FEE $10.00 r
THIS IN UM NT P P` REp BY: P '// G, A-k 1
Name: (N
Addre s•cfe
NOTICE OF COMMENCEMENT
State of Florida
County of Seminole
Permit Number:
CLr ghry iN=
y:
BY
t r
Parcel iD Number: 7 L ( f J — ®,?&') m
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following Information is provided in this Notice of Commencement.
and
GFNERAL,DESCRIPTION OF IMPROVEMENT:
4 1nn
i w vv
Address: vi4, it 41 ti
Fee Simple Title Holder (if other than owner) Name: l
Address:
Persons within the State of Florida Designated by Owner upon whom notice or other documents may De serveo
as provided by Section 713.13(1)(b), Florida Statutes.
Name:
Address:
In addition to himself, Owner Designates of
To receive a copy of the Lienor's Notice as Provided in
Section 713.13(1)(b), Florida Statutes.
Expiration Date of Notice of. Commencement (The expiration date is 1 year from date of recording unless a
different date is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A
NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true
to the be f my know dge and belief.
Owner s Signature OwneFsi'Mted Name
Florida Statute 713.13(1)(g): "Theowner must sign the notice or commencement and no one else may be permitted tosign in his or herstead."
State of \ ` County ofN1L
The foregoing Instrument was acknowledged before me this day of/1%$=SL 20
by 8- \'»SSA- Who is personally known to meV,
Name of person making statement
OR who has produced identification type of identification produced:
KELLYFREDRICKSON
big .Notary Public - State of Florida
3 COmmieeltn IFF 215826 Notarysignature
My Comm. Expires Mar 31, 2019
1111=18d thr" National Notary Assn.
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: iX l 2 / -
I hereby name and appoint: 4 J/ a
an agent of: Vz
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 p
i zoI/ v
for work locat at:
Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name:
State License Number:
Signature of License Holder:
STATE OF FLORIDA`
COUNTY OF .01
The foregoing i strument was acknowledged before me this')l044'day of_,
200, by l 403e—' j ,/ice who is)Kpersonally known
to me or who has produced
identification and who did (did not) take an oath.
Signature
Notary Seal) AOLA'V, 33esn Xg_
Print or type name
as
wz
Notary Public - State f ,.., , MATTHEW WG, BOUGHER
Commission No. -•'?° ''2 Notary Public - state of floc
My Commission Exp
Co"NAasronrFF962538
404M. ExPlaa Ju8, 2020 yasn:SOndfd
Araptt :A° Rev. 08.12)
rwoolymsl
DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES (RER)
BOARD AND CODE ADMINISTRATION DIVISION
NOTICE OF ACCEPTANCE (NOA
CertainTeed Corporation
20 Moores Road
Malvern, PA 19355
SCOPE:
MIAMI-DADS COUNTY
PRODUCT CONTROL SECTION
11805 SW 26 Street, Room 208
Miami, Florida 33175-2474
T (786) 315-2590 F (786) 315-2599
www.miamidade.Lyov/economy
This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The
documentation submitted has been reviewed and accepted by Miami -Dade County RER - Product Control Section to be
used in Miami -Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ).
This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product Control Section
in Miami -Dade County) and/or the AHJ (in areas other than Miami -Dade County) reserve the right to have this
product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted
manner, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify, or
suspend the use of such product or material within their jurisdiction. RER reserves the right to revoke this acceptance,
if it is determined by Miami -Dade County Product Control Section that this product or material fails to meet the
requirements of the applicable building code.
This product is approved as described herein, and has been designed to comply with the Florida Building Code
including the High Velocity Hurricane Zone of the Florida Building Code.
DESCRIPTION: Landmark, Landmark Pro, Landmark Premium, Landmark Impact Resistant, Landmark
Solaris Gold/Platinum and Landmark Pro/Architectural 80
LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following
statement: "Miami -Dade County Product Control Approved", unless otherwise noted herein.
RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change
in the applicable building code negatively affecting the performance of this product.
TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the
materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product,
for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section
of this NOA shall be cause for termination and removal ofNOA.
ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by the
expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done I
in its entirety. i
INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and
shall be available for inspection at the job site at the request of the Building Official. i
This NOA revises NOA # 16-1109.18 and consists of pages 1 through 6.
The submitted documentation was reviewed by Hamley Pacheco, P.E.
NOA No.: 17-1211.08
Expiration Date: 02/28/22 t
Approval Date: 10/11/18
Page 1 of 6
i
i
i
ROOFING ASSEMBLY APPROVAL
Category: Roofing
Sub-CateE!orv: Asphalt Shingles
Materials Dimensional
Deck Tvpe: Wood
SCOPE
This acceptance is for CertainTeed Landmark, Landmark Pro, Landmark Premium, Landmark Impact
Resistant and Landmark Solaris Gold/Platinum Shingles as manufactured by CertainTeed Corporation described
in Section 2 of this Notice of Acceptance.
PRODUCT DESCRIPTION:
Product
Certainteed Landmark
Manufacturing Locations # 1, 2, 3, 4, 5, 6, 7, 8, 9,
10
Certainteed Landmark Pro
Manufacturing Locations #1, 3, 4, 5, 6, 9, 10
Certainteed Landmark Premium
Manufacturing Locations #1, 3, 4, 5, 6, 8, 9
Certainteed Landmark Impact Resistant
Manufacturing Locations # 1, 7
Certainteed Landmark Pro/Architect 80
Manufacturing Locations #8
Certainteed Landmark Solaris Gold/Platinum
Manufacturing Locations # 1, 8
Accessory Shingles
I MANUFACTURING LOCATIONS:
E ; _ 1. Peachtree City, GA
2. Ennis, TX
3. Oxford, NC
4. Shakopee, MN
5. Avery (Milan), OH
6. Norwood, MA
i7. Shreveport, LA i
8. Portland, OR 9.
Wilmington, CA 1
10. Jonesburg, MO IAPP
G3 E i ..: Test
Dimensions
Specifications Product Description 13'/
4" x 38 3/4" TAS 110 A heavy weight, dimensional asphalt
shingle. A
heavy weight, dimensional 13'/
4" x 38 1/4" TAS 110 asphalt shingle. A
heavy weight, dimensional 13'/
4" x 38 3/4" TAS 110 asphalt shingle. A
heavy weight, dimensional 131/
4" x 38 3/4" TAS 110 asphalt shingle. A
heavy weight, dimensional 13'/
4" x 38 1/4" TAS 110 asphalt shingle. A
heavy weight, dimensional 13'/
4" x 38 1/4" TAS 110 asphalt shingle. Accessory
shingles for hip, ridge variousproprietaryandstarterstripapplications. NOA
No.: 17-1211.08 Expiration
Date: 02/28/22 Approval
Date: 10/11/18 Page
2 of 6 y
i
EVIDENCE SUBMITTED:
Test Aeency Test Identifier Test Name/Report Date
PRI Asphalt Technologies, Inc. PCTC-01-02-01 TAS 100 01/12/01
CTC-006-02-01 TAS 100 11/12/02
CTC-092-02-01 TAS 100 02/23/12
CTC-091-02-01 TAS 100 02/21/12
CTC-090-02-01 TAS 100 09/02/11
CTC-087-02-01 TAS 100 07/07/11
CTC-086-02-01 TAS 100 07/07/11
CTC-101-02-01 TAS 100 10/05/11
CTC-102-02-01 TAS 100 10/05/11
CTC-109-02-01 TAS 100 01/18/12
CTC-106-02-01 TAS 100 11/02/11
CTC-105-02-01 TAS 100 10/31/11
CTC-089-02-01 TAS 100 07/18/11
CTC-088-02-01 TAS 100 07/18/11
CTC-213-02-01 TAS 100 05/20/14
CTC-212-02-01 TAS 100 05/21/14
CTC-207-02-01 TAS 100 05/20/14
CTC-206-02-01 TAS 100 05/20/14
CTC-110-02-01 TAS 100 02/13/12
CTC-109-02-0,1 TAS 100 02/13/12
CTC-288-02-01 TAS 100 09/27/16
CTC-333-02-01 TAS 100 11/08/17
Underwriters Laboratories, Inc. 94NK9632 Wind uplift resistance TAS 107 11/30/00
R684 UL 790 04/02/01
02NK42448 Wind uplift resistance TAS 107 11/08/02
09CA28873 Letter 07/23/09
1 ICA59020 TAS 107/ ASTM D3161 01/25/12
1INK07864 TAS 107/ ASTM D3161 09/29/11
07CA26696 TAS 107/ ASTM D3161 09/21/07
11CA38844 TAS 107/ ASTM D3161 01/28/12
11CA38844 TAS 107/ ASTM D3161 01/27/12
06CA28237 TAS 107/ ASTM D3161 09/22/06
IONK17366 TAS 107/ ASTM D3161 01/04/11
4786334383 TAS 107/ ASTM D3161 05/28/14
4786307351 TAS 107/ ASTM D3161/ASTM D 3462 05/13/14
11NK08333 ASTM D3462 05/15/12
1 INK08333 ASTM D3462 04/15/12
1 INK07864 ASTM D3462
ti
09/29/11
11NK08333/Letter ASTM D3462 / UL790 11/05/12
11NK08333/Letter ASTM D3462 / UL790 11/05/12
11NK08333/Letter ASTM D3462 / UL790 11/05/12
NOA No.: 17-1211.08
Expiration Date: 02/28/22
Approval Date: 10/11/18
Page 3 of 6
Test Agency Test Identifier Test Name/Report Date
Underwriters Laboratories, Inc. 12NK13474 ASTM D3462 / UL790 05/27/13
4786325932 ASTM D3462 / UL790 04/04/14
478701.1023 ASTM D 3462 08/01/15
I ICA38844 TAS 107/ ASTM D3161 01/26/12
06CA02648 TAS 107/ ASTM D3161 02/23/06
4787084802 TAS 107/ ASTM D3161 03/14/16
4787852839 ASTM D3462 03/24/17
LIMITATIONS:
1. Fire classification is not part of this acceptance; refer to a current Approved Roofing Materials Directory for
fire ratings of this product.
2. Shall not be installed on roof mean heights in excess of 33 ft.
3. 'All products listed herein shall have a quality assurance audit in accordance with the Florida Building Code
and Rule 61G20-3 of the Florida Administrative Code.
INSTALLATION:
1. Shingles shall be installed in compliance with Roofing Application Standard RAS 115.
2. Flashing shall be in accordance with Roofing Application Standard RAS 115
3. The manufacturer shall provide clearly written application instructions.
4. Exposure and course layout shall be in compliance with Detail 'A', attached.
5. Nailing shall be in compliance with Detail'B', attached.
LABELING:
1. Shingles shall be labeled with the Miami -Dade Product Control approved seal as seen below or the wording
Miami -Dade County Product Control Approved".
I" APPROVSoi- I
BUILDING PERMIT REQUIREMENTS:
1. Application for building permit shall be accompanied by copies of the following:
1.1 This Notice of Acceptance.
1.2 Any other documents required by the Building Official or the applicable code in order to properly
evaluate the installation of this system.
NOA No.: 17-1211.08
Expiration Date: 02/28/22
Approval Date: 10/11/18
Page 4 of 6
DETAIL A
SHINGLE LAYOUT
Eaves
LANDMARK, LANDMARK PRO, LANDMARK PREMIUM, LANDMARK IMPACT RESISTANT,
LANDMARK SOLARIS GOLD/PATINUM AND LANDMARK PRO/ARCHITECT 80
NOA No.: 17-1211.08
Expiration Date: 02/28/22
Approval Date: 16/11/18
Page 5 of 6
r
DETAIL B
LANDMARK, LANDMARK PRO, LANDMARK PREMIUM, LANDMARK IMPACT RESISTANT,
LANDMARK SOLARIS GOLD/PATINUM AND LANDMARK PRO/ARCHITECT 80
12"
5 5/8"
Exposure
LOW AND STANDARD SLOPE
ape
Nailing area for "steep" slopes (greater than 21:12)
Nail between bottom 2 nail lines.
r 14 3/4" so i 12" 13 1/4"
1"
6 1/8"
LANDMARK, LANDMARK PRO, LANDMARK PREMIUM, LANDMARK IMPACT RESISTANT,
LANDMARK SOLARIS GOLD/PATINUM AND LANDMARK PRO/ARCHITECT 80
STEEP SLOPE
END OF THIS ACCEPTANCE
NOA No.: 17-1211.08
Expiration Date: 02/28/22
Approval Date: 10/11/18
Page 6 of 6
F—r2pgAry-Record Card
Parcel: 31-19-31-501-OAOO-019A
Property Address: 1404 MONTEZUMA AVE SANFORD, FL 32771
Parcel 131-19-31-501-OA00-019A
E 63 FT OF LOTS 19 & 20
BLK A
BUENA VISTA ESTATES
PB 3 PG 1
FRONT FOOT & DEPTH
In
N
2019
jj7F-7,—.......... . ..
p" king '46AV09ilifled
10es,,
Valuation Method Cost/Market Cost/Market
Number of Buildings 1
Depreciated Bldg Value $84,092 I $80,275
Depreciated EXFT Value
Land Value (Market) $9,815 9,815
Land Value Ag
Just/Market Value $93,907 90,090
Portability Adj
Save Our Homes Adj $0 0
Amendment 1 Adj $0 3 , 182
P&G Adj $0 0
Assessed Value $93,907 86,908
Tax Amount without SOH: 1,651.30
2018jax Bill Amount 1,651.30
Tax Estimator
Save Our Homes Savings: 0.00
Does NOT INCLUDE Non Ad Valorem Assessments
63.00 100.00 0 $190.00 9,815
http://'pa.rceldetaii.sepafl.org!Parcel Detail Info.aspx?Pl D-- 311931501 OA0001 9A 11,18/18, 8:015 PM
Page 1 of 2
02417 REROOF SANFORD $4 500 1 7/11/2003
Permitdata does not originate from the SeminoleCounty Property Appraiser's office. For details or questions concerning apermit, please contact thebuildingdepartmentof thetax district in which the property is located.
No Extra Features
ftttp:jiparcelrietali.scpafl.org?ParcelDefaillr fo.aspx?PID=311931501QA0001JA 11;8/18, 8:05 PM
Page 2 of 2
CITY OF
Building & Fire Prevention DivisionSANFORDRESIDENTIALRE -ROOF POLICY & PROCEDURES
FI >tT
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:
PERMIT #
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
JOB ADDRESS: C /F Q' "('(i/G %i 6r /,Opj
STRUCTURE TYPE: O4GLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: OREPLACEMENT (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 S ARE FE T OF TIIE EXISTING DECK IS PERMITTED TO BE REPLACED"
ROOF VENTILATION: OFF -RIDGE O RIDGE OSOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: O YES NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 02:12-4:12 162 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
O SHINGLE 1 f
C " ' Ct I,cJ 7C Wl y(iiq/ ..F7lf. FL# s ice{
O METAL FL#
O MODIFIED BITUMEN FL#
O TORCH DOWN FL#
0INSULATED FL#
O TILE FL#
315THER: r
FL# 1 !'2I G
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#
0INSULATED FL#
O TILE FL#
O OTHER: FL#
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: / C' ADDRESS: 1 e)/ &,J J ",t % 1)
i
SAS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
Tag TOR NGINEER, AR HITECT, OF F. . CHAPTER 468 BUILIftNG INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE
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. CFIAPTER 553.844).
LICENSE #:
COMPANY / CONTRACTOR:
CONTRACTOR SIGNATURE:
MUST BE SIGNED BY LICEI
A FINAL ROOF INSPECTION IS REQUIRED:
DATE: i v A
THIS SIGNED AND NOTARIZED AFFIDAVIT MUST BE PROVIDED AT THE JOB SITE AT THE TIME OF THE FINAL ROOF INSPECTION,
ALONG WITH DIGITAL PHOTOGRAPHS OF EACH PLANE OF THE ROOF SHOWING IN DETAIL ALL COMPONENTS (DECKING,
UNDERLAYMENT, FLASHING, DRIP EDGE ATTACHMENT) WITH THE PERMIT NUMBER OR ADDRESS CLEARLY MARKED ON THE DECK
FOR EACH INSPECTION. THE PHOTOGRAPHS MUST INCLUDE A RULER OR MEASURING DEVICE TO CONFIRM ALL NAIL SPACING AND
OVERLAPS, INCLUDING DRIP EDGE AND VALLEY FLASHING. PLEASE REFER TO THE RE -ROOF POLICY AND INSPECTION PROCEDURE
PAPERWORK FOR FURTHER EXPLANATION OF ALL REQUIREMENTS.
FAILURE TO FOLLOW ALL REQUIREMENTS WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION FEE AS
WELL AS REQUIRING A DESIGN PROFESSIONAL (ARCHITECT OR ENGINEER) TO CERTIFY, BASED ON PERSONAL
INSPECTION, THE INSTALLATION OF ALL ROOFING COMPONENTS.
STATE OF FLORIDA COUNTY OF
Sworn to and Subscribed before me this d day of i0o J _ 20 by:
ez& `GJft, Who is C iersonally Known to me or has Produced (type of
identification)
Signature of Notary Public
State of Florida
Print/Type/Stamp Name
of Notary Public
as identification.
i—M'ATTMEW
o`'AY P`- _'
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Notary PuWK i $t=e of FroridaCommissionNFF962536
dd M Comm. Expires Jun 5, 2020yAssn. NBondedthroughNatWna1 _ otary