HomeMy WebLinkAbout09-9798 CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780 -0020 9798
BUILDING PERMIT
i �t.n•, r, ;;", k ; § A < p. } .":4 . • 54 n � `� te 1 7 y ; ;_ ' +. :Y : ..: "' .I ,: ,d£ K dry,
Permit Number: 9798 Address: 38415 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: 11- 26 -21- 0010 - 08800 -0110
Improv. Cost: 5,381.00 777:31TIE4 kOoikkn
Date Issued: 11/24/2009 Name: LEPIERRE, NORMA
Total Fees: 60.00 Address: 38415 9TH AVE
Amount Paid: 60.00 ZEPHYRHILLS, FL. 33542
Date Paid: 11/24/2009 Phone: (813)624 -3182
Work Desc: REROOF SHINGLE HOME
YMA R• • IN R R• • - • N IAL 60.00
I '04
41/1'
DRY INR•• IN
TAPE JOINTS ROOF INSP
FINAL 17-
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
impr . vements to your property. If you intend to obtain financing, consult with your lender or an attorney
befo : recording your notice of commencement."
.4 ft,
- 1✓i
CONT '49)•R I NA RE PERMIT OFFI 'R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
u,....) ,r
ASPHALT SHINGLES 2007 FBC PRODUCT APPROVALS
MANUFACTURER PRODUCT
TESTS PASSED MIAMI -DADE FL #
LESS THAN 110 MPH 110 MPH AND HIGHER
ASTM ASTM TAS ASTM ASTM TAS
0'3161 D 7158 107 D 3161 D 7158 107
CLASS 0 CLASS G CLASS•F CLASS G
CERTAINTEED CLASSIC HORIZEN
X • 5444.1
CARRIAGE HOUSE X
CENTENNIAL SLATE 5444.1
GRAND MANOR X 5444.1
LANDMARK X 5444.1
LANDMARK PLUS X 5444.1
LANDMARK PREMIUM X 5444.1
LANDMARK TL X
5444.1
PRESIDENTIAL SHAKE X 5444.1
PRESIDENTIAL SHAKE TL X 5444.1
HATTERAS X 5444.1
PATRIOT X 5444.1
X
5444,1
GAF -ELK ROYAL SOVEREIGN
X 10124.1
CAMELOT X
CAPSTONE 10124.1
COUNTRY MANSION X 10124.1
GRAND CANYON X 10124.1
•
GRAND SEQUOIA X 10124.1
GRAND SLATE X 10124.1
GRAND TIMBERLINE X
10124.1
. TIMBERLINE ARMORSHIELD II X 10124.1
TIMBERLINE PRESTIQUE GRANDE X 10124.1
TIMBERLINE PRESTIQUE 30 X 10124.1
TIMBERLINE 30 X 10124.1
TIMBERLINE PRESTIQUE 40 X 10124.1
TIMBERLINE 40 X 10124.1
TIMBERLINE PRESTIQUE LIFETIME X 10124.1
TIMBERLINE ULTRA X 10124.1
SLATELINE X 10124.1
10124.1
1
OWENS CORNING OAKRIDGE PRO 30
X 10674.1
OAKRIDGE PRO 30 AR X
OAKRIDGE PRO 40 10674,1
OAKRIDGE PRO 40 AR X 10674.1
OAKRIDE PRO 50 X 10674.1
OAKRIDGE PRO 50 AR X 10674.1
DURATION X 10674.1
•
DURATION PREMIUM X 10674.1
CLASSIC X 10674.1
CLASSIC AR X 10674,1
SUPREME X 10874.1
SUPREME AR 10674,1
PROMINENCE X 10674.1
PROMINENCE AR X 10674.1
BERKSHIRE X 10674.1
WEATHER GUARD HP X 10674.1
X 10874.1
TAMKO GLASS SEAL AR
X 1958.2
ELITE GLASS SEAL AR
HERITAGE 30 X 1956.1
HERITAGE XL X 1956.3
HERITAGE 50 X 1956.5
X 1958.4
HERITAGE VINTAGE AR X
7154.1
0, 03 -57 . F
a i Ma a� VISA orl
zst OefP f %KG. U \� ► \�
A Division of Ryman Construction, Inc. Proposal # 02 0 4
INC. 36413 SR 54 • Zephyrhills, Florida 33541 Estimate # Phone: 813-782-6094 • Fax: 813-788-6773 tl
License # CCC 1325505 Job # I �7 q
1 - 800 - 800 - ROOF Also, Serving the Central and East Coast of Florida
(7663)
Customer: /A41 cv..9 Z4/4 ,' 4- e Date: 11/A /
Address: 3 '7 L 41/ City2&k 9 S 5 `�
t� Zip: 33 (X
Home #: Cell #: 3 )8a Business #: ' 4 -ad o G
E-mail Address:
U9 'Complete tear off of existing -SA; Additional Ite •
I Secure all loose roof decking as needed according (9f Putt- oerX r i c. Znci oto S
tp Florida Building Codes -'r,,,_A,,, � 9 ring e
Roof dried in with _41 \A-
U Install new valley metal with galvanized metal
utlistall all new " drip edge color:/., -)'
a- Install all new lead boots
Install all new 2 v year fungus- resistant shinglw
[al- Shingle brand/color: Tc - \ i �j ��,'C_ Csi_XJXa A - yam r- , Warranty Package.
All roof related debris removed from job site
3411 materials, labor and permits furnished
Total bid price $S - 1-3'1 - 0
Extra's
Lilliad plywood replaced at a cost of $ • per sq. ft. in the roof field. All other wood worldadditional labor, such as, but not
limited to, valley rebuilding, rafter replacement, etc. will be a rate of $ - S. 00 per man hour plus the cost of materials.
THIS BECOMES A BINDING CONTRACT UPON ACCEPTANCE OF PROPOSAL. PURCHASER ACKNOWLEDGES RECEIPT OF A COPY OF THIS CONTRACT.
1. All material is guaranteed to be as specified and completed in a substantial workmanlike manner.
2. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, hurricane and other necessary insurance upon above work.
3. Labor warranty does not cover damage to roofs caused by lightning, hurricane, tornado, hailstone, impact of foreign objects or other violent storm or casualty damage to roofs due to
settlement, distortion failure or cracking of roof deck, walls or foundation of a building.
4. Workman's compensation and public liability insurance on above work to be taken out by RYMAN ROOFING, INC., a Division of Ryman Construction, Inc., or its subcontractors.
5. RYMAN ROOFING, INC., a Division of Ryman Construction, Inc. is not responsible to provide any materials or to perform any work other than what is described above. Replacement
of deteriorated decking or fascia boards, is not included and will be charged as an extra unless otherwise stated herein.
6. This contract is subject to final approval by RYMAN ROOFING, INC., a Division of Ryman Construction, Inc. and is the entire agreement of the parties and no other written or other
forms will recognized.
7. A charge of I.5% will be made on all unpaid balances after 30 days, plus charges incurred for non - payment procedures, plus attomey's fees.
8. A 496 processing fee will be added to all credit card orders.
Ryi ran Roofing, Inc., a Division of Ryman Construction, Inc. will not be responsible for any damage to septic tanks, sod, shrubbery, paint, satellite signal loss, sprinklers,
concrete drives or any underground piping.
Payment Schedule: 1/00 Payment Method:
Acceptance of Proposal
STATUTORY NOTICE REGARDING CONSTRUCTION LIENS; ACCORDING TO FLORIDA'S
CONSTRUCTION LIEN LAW (SECTIONS 713.001 - 71337, FLORIDA STATUTES), THOSE WHO WORK
ON YOUR PROPERTY OR PROVIDE MATERIALS AND SERVICES 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 - SUBCONTRACTORS, OR MATERIAL SUPPLIERS, THOSE
PEOPLE WHO ARE OWED MONEY MAY LOOK TO YOUR PROPERTY FOR PAYMENT, EVEN IF YOU
HAVE ALREADY PAID YOUR 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 A SUBCONTRACTOR MAY HAVE FAILED TO
PAY. TO PROTECT YOURSELF, YOU SHOULD STIPULATE IN THIS CONTRACT THAT BEFORE ANY
PAYMENT IS MADE, YOUR CONTRACTOR IS REQUIRED TO PROVIDE YOU WITH A WRITTEN
RELEASE OF LIEN FROM ANY PERSON OR COMPANY THAT HAS PROVIDED TO YOU A "NOTICE
TO OWNER ". FLORIDA'S CONSTRUCTION LIEN LAW IS COMPLEX AND IT IS RECOMMENDED
THAT YOU CONSULT AN ATTORNEY.
I ACCEPT THI R P CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND TH P8 11
Qy1SIONS OF THIS CONTRACT.
Purchaser. Date: 1 `
Purchaser: Estimator.
813- 780 -0020 City of Zephyrhills Permit Application Fax- 813- 780 -0021
Building Department
Date Received Phone Contact for Permitting S t 3 ` l - 6
.
Owner's Name NUr, i t --5-- L- e r Owner Phone Number / J t;.2.- 6 4 31 C -
Owner's Address 3 L b 1 I`" q C/Q,, Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS 3 qvi v /� l ue_ LOT # ((\-( a_
SUBDIVISION PARCEL ID# it --2- - -- 1O -owo0 -- 0/10
(OBTAINE FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR ADD /ALT S
INSTALL REPAIR � I 1 MOVE 1 I DEMOLISH
-rip
PROPOSED USE 1 SFR 1 I COMM I 1 OTHER
TYPE OF CONSTRUCTION ( I BLOCK 1 1 FRAME I 1 STEEL 1 1 OTHER 1
DESCRIPTION OF WORK 2 ] (2--roc 60 O u S Q LA)/ 5'1 t vi c,pa5
BUILDING SIZE SQ FOOTAGEO HEIGHT
BUILDING $ 5 3 ' Q l VALUATION OF TOTAL CONSTRUCTION
I ELECTRICAL $ AMP SERVICE 1 1 PROGRESS ENERGY n W.R.E.0
I PLUMBING $
1 MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
1 GAS M ROOFING 1 1 SPECIALTY I 1 OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA 1 IVES El NO
BUILDER COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/ N I
Address License #
ELECTRICIAN COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y 1 N I
Address
License #
PLUMBER COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y / N I
Address License # T I
MECHANICAL COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/ N I
\ess 1 i 4 11 License #
OTHER ` 1A. COMPANY 1` )(Q & 7
SIGNATURE \ , a � REGISTERED 1 Y / N FEE CURRE I Y / N I
Address • l3 S .4 �� 3 License # 15C (3a.S
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 fetter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs Sewers Service Upgrades NC 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 to "deed ". 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 job is considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWIC Eta IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR E a ER OR AN ATTO r EY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
F DA JURAT F.� 117.03)
OWNER OR �� ` . L�/� CONTRACTOR
Subscribed and sw. to (or affirm- o) b= ore m Subscribed and sworn to (or affirmed) before me this
by by
Who is /are personally known to me or has/have produced Who is /are personally known to me or has /have produced
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
11111111111111111111111111111111101111111111111111111111111
2009168880
Rept:1275050 Rec: 10.00
DS: 0.00 IT:0.00
11/24/09 -- ------ --- -- _. — Dpty Clerk
' PAULA S. O'NEIL, PASCO CLERK & COMPTROLLER
11 OOR 4 BK 9 8 014.g, 1 PG e x'42
NOTICE OF COMMENCEMENT
Permit No.
Property Identification No. I j —7 Z- '0O 10 02200 _ 0 110
THE UNDERSIGNED hereby give informs you that the improvement will be made to certain real property, and in accordance with
Section 713.13 of the Florida S atutes the followinl info nation is provided in this NOTICE OF COMMENCEMENT.
I .Description (1 gal � scrip t i ( f) �i ( � � �,, ; IOC
a) Street Address: ''3 C4 j 5 r I `, 2 ..S S PG- Ie �6
2.General des ption of�impro ements: ��� � S ` � �� S'
n 'Q --TOOT
3.Owner Information
a) Name and address: NOr in Ot ,. —5- ��
, " f_t/' ( /'R - r3-‘3C-1 j �• ;
b) Name and address of fee simple titleholder (if other than owner) a �� t j l S
c) Interest in property 3
ntractor Information
a) Name and address: 14 A. PI A 0 C.---- L�Q ,
b) Telephone No.: "f, ;'i��►� �t ` Fax No. • 1 / 1. t ���
5.Snrety Information (Opt) 3S
a) Name and address:
b) Amount of Bond:
•
c) Telephone No.:
ti.Lender Fax No. (Opt.)
a) Name and address:
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 date 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 COMMEN. . M ENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION IF YOU IN D TO OBTAIN FINANCING, CONSULT YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING, WORrnO : CORDING YOUR NOTICE OF COMMENCEMENT.
STATE OF FL,b1MDA /
COUNTY O Lr PA ,... r r ry public State of Florida C�� `
�� 4 A stian Ryman Signature of Owner or Owner's Authorized Officer/Director /Partner/Manager
t;3 ,t� 7, Y , y�C,ommission 00751610
► �'? xpfr s 01/24/2012 ill) /CAI n
Print Name �� / / ��� �
The foregoing trlstnitnent was dip3owledged.before me thist day of � - 20 b
1 \4f�_ ,,,, as , y�rM(.�
in fact) for (type of authority, e.g.,officer, trustee, attorney
(name of party on behalf of whom ins Is . sent was executed).
//
Personally Known\ OR Produced Identification
Notary Signature ,
Type of Identification Produced Name (print) ` 1 1 T t' � n
yr "`/
r�1 rV1
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I have read the foregoing and that
the facts stated in it are true to the best of my knowledge and belief.
FORMS /NOC,rvsd2007 Signature of Natural Person Signing 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
W HAND AND 0 FICI SEAL THIS, DAY OF
PAULA -. *NEIL, CLERK & CoMPTROLO
Gr, K
BY ..
City of _Zephyrhills
BUILDING DEPARTMENT
RE: Permit # Q79S 9/17/07
Inspection Affidavit
I /& /.rl /7/47t ,licensed as a(n) Contractor * /Engineer/Architect,
(please print name and cir e Lic. Type) FS 468 Building Inspector*
License #; P'L'C /,3,2 SSOS'
On or about /z/ , I did personally inspect the roof
ime)
deck nailing and /or secondary water barrier work at
(circle one) (Job Site Address)
3SW 9M
Based upon that examination I have determined the installation was done according to the
Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S.)
ikt
STATE OF FLORIDA
COUNTY OF /
Sworn to and subscribed before me this 3 day of JeCen/ be' . 200
By
Notary Public, State of Florida
(Print, type or stamp name) /
Commission No.:
Personally known ✓ or
Produced Identification
4 4 ,, ��� ANNA MARIE LYNCH - TERRY
Type of identification produced. t Nolary Put►Nc - State of Florida
,41 My Commission Expires Apr 4, 2012
* General, Building, Residential, or Roofing Contractor, ;?� •.ual camilifilitherfieD6Olikflit to ake such an
inspection. Include photographs of each plane of the rod vin • .. marked on the .
deck for each inspection. „ _