HomeMy WebLinkAbout09-9565 CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780 -0020 9565
BUILDING PERMIT
Permit Number: 9565 Address: 38703 9TH AVE
Permit Type: RE -ROOF ZEPHYRHILLS, FL.
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number:
Improv. Cost: 8,505.00.. € ;a� '�
Date Issued: 9/21/2009 Name: RICHARDSON, WILLI
Total Fees: 75.00 Address: 38703 9TH AVE
Amount Paid: 75.00 ZEPHYRHILLS, FL. 33542
Date Paid: 9/21/2009 Phone:
Work Desc: RE -ROOF 17 SQ WITH SHINGLES
H M IMPROV MENT SERVI ES REROOF RESIDENTIAL 75.00
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TAPE JOINTS gtOOF IN
FINAL 10 -C
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection
trips are necessary due to any one of the following reasons: a) wrong address b) condemned work resulting
from faulty construction c) repairs or corrections not made when inspections called d) work not ready for
inspection when called e) permit not posted on job site f) plans not at job site g) work not accessible.
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, state agencies or federal agencies.
The payment of inspection fees shall be made before any further permits will be issued to the person owning same
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing, consult with your lender or an attorney
before recording your notice of commencement."
->(„,
CONTRACTOR SIG ATURE PERMIT OFFI FR
PERM jT E PIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
LL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813 -780 -0020 City of Zephyrhills Permit Application Fax - 813-780 -0021
Building Department r's
Date Received — elm : --
Phone Contact for Permitting
,IIIIIIIiIf111I
Owner's Name IL) I Lt--( hy'Vt ' C /{ .95 G N r Owner Phone Number 3 o —
Owner's Address 3 F-1 03 7 [J Owner Phone Number
Fee Simple Titleholder Name ,j -4A Owner Phone Number
Fee Simple Titleholder Address Oh
JOB ADDRESS 587 O 3 / 4 t.., /19 ( EH Lc--r' p LOT # // T
!
SUBDIVISION PARCEL ID# /�', 4 x/' ' /0 "" o 3 c 0 l 0 //
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED WI NEW CONSTR ADD /ALT 1 SIGN h MOVE I I DEMOLISH
- I NSTALL REPAIR
PROPOSED USE 1 I SFR I I COMM I I OTHER 1
TYPE OF CONSTRUCTION I I BLOCK I I FRAME I I STEEL En OTHER I
/'
DESCRIPTION OF , ORK KC-4.a Chi 0 S S 3 1 1 a_' y! ' c S
BUILDING = ZE S Q FOOTAGE HEIGHT
I BUILDING $ co VALUATION OF TOTAL CONSTRUCTION
I I ELECTRICAL $ AMP SERVICE I 1 PROGRESS ENEiY h W.R.E.C.
/ /
I I PLUMBING $ p-625
I
MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
GAS ROOFING 1 1 SPECIALTY 1 1 OTHER � FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA I IYES LINO A
!
BUILDER / p ' COMPANY ! (Lo V V. S C e --0 " - S
SIGNATURE '�` E '��' ^C, REGISTERED Y/ N 1 P EE CURRENT I Y/ N 1
Address N377 L ,,) . !(GC/ /Q #' & 2 A. 3 137 4 Y License # CC-( 0 J f.P-D- 7
ELECTRICIAN
COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/ N I
Address License #
PLUMBER COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/ N I
Address License #
MECHANICAL COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y / N I
Address License #
OTHER COMPANY
SIGNATURE REGISTERED I Y/ N 1 FEE CURRENT I Y/ N I
Address License #
RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R -O -W Permit for new construction,
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed,
Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions /large projects
COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R -O -W Permit for new construction.
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed,
Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance
SIGN PERMIT Attach (2) sets of Engineered Plans.
****PROPERTY SURVEY required for all NEW construction.
Directions:
Fill out application completely.
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement is required. (A/C upgrades over $5000)
Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs Sewers Service Upgrades A/C Fences (Plot/Survey /Footage)
Driveways -Not over Counter if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to4 restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division— Licensing Section at 727 -847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89 -07 and
90 -07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water /Sewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law— Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the "owner ", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the "owner" prior to commencement.
CONTRACTOR'S /OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to:
- Department of Environmental Protection- Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment.
- Southwest Florida Water Management District - Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
Army Corps of Engineers - Seawalls, Docks, Navigable Waterways.
Department of Health & Rehabilitative Services /Environmental Health Unit - Wells, Wastewater Treatment,
Septic Tanks.
US Environmental Protection Agency- Asbestos abatement.
Federal Aviation Authority- Runways.
I understand that the following restrictions apply to the use of fill:
Use of fill is not allowed in Flood Zone "V" unless expressly permitted.
If the fill material is to be used in Flood Zone "A ", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
- If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, I certify that fill will be used only to fill the area within the stem wall.
If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued under the attached permit application, for lots less than one (1)
acre which are elevated by fill, an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension
may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the , j ob is considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO BE O ORE RECORDING YOUR NOT CEO COMMENCEMENT.FINANCING, CONSULT PROPERTY. IF YOU INTEND TO OBTAIN
WITH YOUR LENDER OR AN ATTORNEY
FLORIDA JURAT (F.S. 117.03)
OWNER OR AGENT CONTRACTOR
Subscribed and sworn to (or affirmed) before me this
Subscribed and sworn to (or affirmed) before me this by
by Who is /are ersonally known to me or has /have produced
Who is/are personally known to me or has /have produced p as identification.
as identification.
Notary Public
Notary Public
Commission No.
Commission No.
Name of Notary typed, printed or stamped
Name of Notary typed, printed or stamped
NOTICE OF COMMENCEMENT 11111111111111111110111111111111111111111111111111111111111
2009133486
Permit No. Rept :1264508 Ree : 10.00
Tax Folio No. /' /- )4 —)--/ OO /rI otr3oo - U// O
DS: 0.00 IT : 0.00
09/21/09 Dpty Clerk
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Section
713.13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT.
1.Description of property (legal description). c; a "he KAI /C C .0 Z7- S" /1 7/ Z. IC-k 603
a) Street (job) Address: ,,' �idi -- a
2.General description of improvements: m j 7R 3
3.Owner Information
j"--- a) Name and address: , l . V !� l 1 in 1 I ' SO f ) 337 c Aue . 2C 0 11 i, l • 33 s4/0-
b) Name and address of ee simple titleholder (if other than owner) to
c) Interest in property
4.Contractor Information HOME IMPROVEMENT SERVICES
a) Name and address: 14377 US 19 NORTH, CLEARWATER, FL, 33764
b) Telephone No.: 727 -530 -0412 Fax No. (Opt.) 727 - 539 -6912
5.Surety Information
a) Name and address:
b) Amount of Bond:
c) Telephone No.: Fallo.(Opt.)_ PAULA S. O'NEIL, PASCO CLERK E. COMPTROLLER
6.Lender 09/21/09 11: a 1 of
R
a) Name and address: 81 1'T P6 428
Phone No.
7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served:
a) Name and address: ■
b) Telephone No.: Fax No. (Opt)
8.In addition to himself; owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes:
a) Name and address:
b) Telephone No.: Fax No. (Opt.)
9.Expiration date of Notice of Commencement (the expiration dote is one year from the 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 YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF CO CEMENT. .
F L O R I D M , = .t:NDRFW RAYL /� •
COTY OF PINE O
= MN `'
UN MMiSSION # DD867206 1 �/
-t,, XPrRE rvi arch 08, 2013 Signatisre of Owner or Owner's Authorized Officer /Director/Partner/Manager
sa 398 -015:1 , , -oii" ' , ,cLcom 4LLt 6. 'IG/f ra ,(
Print Name
The foregoing instrument was acknowl ed before me this /6 day of 5effruaer , 20 07, by
4-1,/ 6 . / Z , /4l 4.) aas a ( if r&,. ( type of authority, e.g. officer, trustee,
, attorney in fact) for (name of party on . of whom trument was executed).
Personally Known OR Produced Identification X Notary Signature /Alta/ ,/
FLA DfiVCt'S Lice-f15E' A/) ,, G t/ Type of Identification Produced• 21D 3 - 927 - '-(0 - 01 I - 0 Name (print) drew / / a_ u /
J
�.J
Verification p .Y • u , 1 92 25, F1ori to Under penalties of perjury, I declare thati have read the foregoing and that
the facts stated 1. ' , e to the best.t my edge d belief.
fa': ,j
r slOr 7D887206f
FORMS/NOC,rvsd2007 ' ' - t . .._.:> NA'9,. IA, 2013 - (/<<e-ge...-..400t) .. 1
Y ' ' 398 -0159 : „ ... �,� i gnature of Natural Person Signing (in line // 10.) Above
STATE OF FLORIDA, COUNTY OF PASCO
THIS IS TO CERTIFY THAT THE FOREGOING IS A
TRUE AND CORRECT COPY OF THE DOCUMENT
ON FILE OR OF PUBLIC RECORD IN THIS OFFICE
WLiNNSS I,uIY HAND A OFFICIAL SEAL THIS
oL �- DAY OF ,¢ 2 60
PAULA S. O'NEIL, CLE K & COMPTROLLER'
BY 41 CLERK
HOME IMPROVEMENT SERVICES
CLEARWATER • JACKSONVILLE ORLANDO SARASOTA
14377 U.S. Hwy 19 N • Suite 101 5570 Florida Mining Blvd S. • Suite 104 2265 Lee Road • Suite 103 1951 Porter Lake Drive • Suite A
Clearwater, FL 33764 Jacksonville, FL 32257 Winter Park, FL 32789 Sarasota, FL 34240
(727)530-0412 • Fax: (727)539 -6912 (904)272-5906 • Fax: (904)262 -0093 (407)767-7663 - Fax: (407)767 -2956 (941)377-6100 • Fax: (941)377 -6133
Toll Free: (877) 845 -6660 Toll Free: (877) 845 -6660 Toll Free: (877) 845 -6660 Toll Free: (877) 845 -6660
Lic. No. CCCO58227
SALES CONTRACT
Home Improvement Services agrees to furnish all materials and labor necessary to do the modemization work at the following address:
Name i t ;it./ in Via ') ct r I('. i -),4 Phone 8/3 - 73 3 35/ Phone (w) 5/3 -_ 5 .:2 3 / 3 5 - -
Da te 7 / / u2 ,
City m e. - ` ! ) A -)1 s + I :)
State Zip 4 ,5'
3 , ,
In accordance with-The specifications given below:
REROOF:
1
A. SHINGLE ROOF � ' . ? I '_ L a b-. . .. M -C t'{ t e ij ()J i( ,3, / ;
1. REMOVE OLD ROOF TO WORKABLE SURFACE.
2. RENAIL ROOF DECK WITH RING SHANK NAILS.
3. REPLACE ANY ROTTED WOOD WITH STANDARD SHEATHING @ $7.00 PER FOOT AND $90.00 PER SHEET OF PLYWOOD, IF ANY. (Initial)
4. INSTALL S.A. WATERPROOFING UNDERLAYMENT QVE9 ENTIRE ROOF.
5. INSTALL FHANA EAVES DRIP. COLOR ' n i it,
6. INSTALL NEW VALLEY METAL AND FLASHINGS /CS NECESSARY.
7. INSTALL NEW LE,„. e AD BOOTS OVER VENT PIPES AND RESEAL VENT
8. INSTALL , : YEAR FIBERGLASS SHINGLES. COLOR 1 3i tC-t (c;r .
9. INSTALL"-: FEET OF RIDGE VENT AT $F99PER FOOT COLOR ( j(1+
10. CLEAN -UP JOB SITE OF ALL WORK DEBRIS AND HAUL AWAY ALL RELATED DEBRIS AND LEAVE JOB SITE CLEAN.
11. CONTRACTOR WILL COORDINATE REMOVAL AND REINSTALLATION OF ROOF RELATED PERIPHERALS SUCH AS (BUT NOT LIMITED TO) SOLAR UNITS, SKYLIGHTS, T.V. DISH
AND AIR CONDITIONERS, ETC. REMOVE AND REINSTALL EXISTING SOFFIT AND FACIA @ $4.25 PER FOOT IN ADDITION TO CONTRACT PRICE, IF REQUIRED. THE COST FOR
SUCH WORK WILL BE IN ADDITION TO CONTRACT PRICE AND HEREIN APPROVED BY HOMEOWNER.
B: PLYRO.OF SYSTEM
1. REMOVE OLD' RDOFTO.WORKABLE SURFACE.
2. RENAIL ROOF DECK WITH RING SHANK NAILS.
3. REPLACE ANY ROTTED WOOD WITH STANDARD SHEATHING-4 .$7.00 PER FOOT AND $90.00PER- SHEETOF PLYWOOD, IF ANY. (Initial)
4. INSTALL S.A. WATERPROOFING UNDERLAYMENT OVER ENTIRE ROOF. - .. -_. - -
5. INSTALL NEW LEAD BOOTS.
6. INSTALL FHANA EAVES DRIP. COLOR - - -- -
7. INSTALL 1 PLY RQOF- SYSTEM: COLOR
G--
8_ - - EAN-UP JOB SITE OF ALL WORK DEBRIS AND HAUL AWAY ALL RELATED DEBRIS AND LEAVE JOB SITE CLEAN. _ •
1. Contract Documents. This contract consists of this document, extra work/wood authorizations, if any, and, if payments t' ) .
hereunder are to be financed, all financing documents. No promises other than those specifically set forth in the contract Contract Price $
documents shall be recognized by either party. The entire understanding and agreement of the parties is contained in the
contract documents
2. It is understood and agreed that this contract shall not become binding upon Horne Improvement Services until it is duly
approved, accepted, signed and witnessed by an officer or officers of the Seller. $
.� 1/ 99 200.00
3. Work on the job described ttlq documents will commence on approximately ,IA C . and be completed Permit
on approximately TI I� `` . The recited dates are approximations and are subject to scheduling dfficulties of
Seller, labor andior material shortages, acts of God and other events not foreseen by Seller. Seller reserves the right to
employ any sub - contractor for the completion of the work described in the contract documents. `
4. Home Improvement Services reserves the right to substitute materials of equal or greater value and kind. Any required r ,`)
material such as fire retardant plywood, tongue and groove board, etc. will be billed on a time and material basis. All other Total $ •` -'
changes required by New Jurisdictional Code Enforcement Laws may result in additional charges.
5. Interest at the rate of eighteen (18 %) per cent per annum will be charged on all balances not paid as per the temps specified
above. Reasonable attomey's fees will be charged to the Purchaser if it is necessary to place this contract in the hands of an
attorney tor collection, and this charge becomes a part of this contract and obligation of the Purchaser to pay.
6. Parties agree that this agreement shall be construed according to the laws of the State of Florida and any action brought 1/3 Deposit $
thereon may be brought in the State of Florida. Venue is hereby agreed to be in Pinellas County, Florida.
7. BUYERS RIGHT TO CANCEL- If you do not want the goods or services, you may cancel this agreement by providing written
notice to the seller in person, by telegram, or by mail. This notice must Indicate that you do not want the goods or services and
must be delivered or postmarked before midnight of the third business day after you sign this agreement.
8. Both worker's compensation and public liability insurance are carried by the Seller and they are applicable to the work to be Subtotal $
performed.
9. 11 is understood and agreed that the buyer hold harmless, Home Improvement Services, for any damages that may occur to
the buyer's driveway(s) during the delivery of materials and/or the removal of work related debris that may be required to
perform this home improvement contract. Furthermore, the buyer herein gives permission for typical delivery vehicles and BALANCE DUE $
typical waste removal vehicles to enter said driveway(s) for the purpose of expediting this sales contract. (Plus Total from Item N0. 3 above)
10. Contractor will coordinate removal and reinstallation of roof related peripherals such as (but not limited to) solar units, skylights
T.V. dishes, and air conditioners, etc. The cost for such work will be in addition to contract price and approved by homeowner. UPON COMPLETION
11. Home Improvement Services shall not be held responsible for damage to electrical lines, water lines, refrigerant lines or
other mechanical components that have been improperly installed near roof decking and may be damaged while performing , 1
installation of roofing materials. Home Improvement Services shall not be responsible for any additional costs due to roof f , / i _ _ - ') .
decking that may have old materials adhered in such a way that requires redecking of the structure. 111 t l a
12. Construction Industries Recovery Fund payment may be available from the CIRF if you lose money on a project performed
under contract, where the loss results from specified violations of Florida law by a state - licensed contractor. For it/ , "/ /') :" ' 4 r 1 i p ) . , / ) .
information about the recovery fund and filing a daim, contact the Florida Construction Industry Licensing Board at the
following telephone number and address: 7960 Arlington Expressway, Suite 300, Jacksonville, FL 32211 -7467 or call (904)
727 -6530. .2 )
13. Chapter 558, Florida Statutes contains important requirements you must follow before you may bring any legal ,.
action for an alleged construction defect in your home. Sixty days before you bring any legal action, you must
deliver to the other party to this contract a written notice referring to chapter 558 of any alleged construction defects
and to consider making an offer to repair or pay for the alleged construction defects. You are not obligated to accept
any offer which may be made. There are strict deadlines under this Florida Law which must be met and followed to
protect your interests.
Executed in triplicate, one copy of which was delivered to, and receipt is hereby acknowledged by Buyer, this
``# day of ° ? / , -a r ; ! f -'t , 20 a j
Approved and Accepted:
NOTICE TO OWNER
a. Do not sign this home improvement contract in blank.
b. You are entitled to a copy of the contract at the time you sign. Keep it to)protect your rights:-
(Seal} ('�``' -°� k -r w-::
)9} -
(Seal)
(Dealer - Seller) ✓ (Purchaser Sign Here)
•
BY QX) .. x ,.. --E: (...e.___ } _y__ _ � .." eal
(Title) �` `' (Purchaser Si Here) )
i
i (
d
SALESMAN ;'----'
HI 0700053
RS 0701566 HIS 6 - 4/10/09
City Hof Zephyrrh lls
BUILDING DEPARTNENT
RE: Permit # q s c ri l ci-6 PsC N «
9/17/07
Inspection Affidavit
1 � �- �. - W 0 2 -/-/ / 4k as a(n) Contractor* /Engineer /Architect,
(picas p r int name and circle Lie. Type) ,�/ FS 468 Building Inspector*
License #; C (L C o OJ 31 I
On or about i ^ Z Z —.1:77 , I did personally inspect the roof
(Date & time)
deck nailing and /or secondary water barrier work at ,
(circle one) (Job Site Address)
V$ 7A .3 q - E.. a_ii-i u .
Based upon that - amination 1 have determined the installation was done according to the
Hurricane Mitig. ` Retrofi Manual (Bated on 553.844 F.S.)
. i'L,ar ` .1,,LdAl
Signature '
STATE OF FLORIDA
COUNTY OF
Sworn and subscribed before me thisy� day of . 200
€.
By Z JL .Cr 2�V , (00 1
Notary Public, State of Florida
Min Prosy • ' -22 -o L
Notify Public, Moe *Monde . t, type or . • •. p name) •
. My comet. exp. Match 22.2013
Comm. NO. DD872975
Commission No.:
Personally known
Produced Identification
Type of identification produced.
* General. Building, Residential; or Roofing Contractor or any individual certified under 468 F.S. to make such an
inspection. Include photographs of each plane of the roof with the permit # or address * clearly shown marked on the .
deck for each inspection.
•