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Home My WebLink AboutORFR PERMITermit #: ORFR T2 ssue Date: � ��T �� arcel #: 1121303AG126C0000 ite Address: 566 DIINMAR : _� : , ' CITY OF WINTER SPRINGS Building Division • � - �� ca��pgtiE C�PY 1126 East SR 434 Winter Springs, FL 32708 Office: 407-327-5963 Inspection Line: 407-327-7596 ORPHAN ROOF RESIDENTIAL wn �r : Lot #d 000 ontractor: (CC) MID FLORIDA ROOFING INC 768 FERNE RD, LONGWOOD, FL 32779 icense #: CCCO57834 ork: ROOFING escription: RE ROOF 50SQ HOUSE & 28 SQ GARAGE WITH 6/12 PITCH SHINGLES alue of Work: $0.00 quare Footage: Floor Footage Total: onstruction Type and Occupancy.: Code prinklers: ees: Code Account Description ROOF_SHC pg�ygC, ROOF Description Amount Paid Due S2sz.oa So.00 Szsz.00 Total : $zsz. oo $o. oo Sz52. o0 Notice This permit becomes null and void if work or construction is not begun within six (6) months after its issuance, or if the work authorized by this permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. Certification I hereby certify that I have read and examined this document and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. Granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law re ulating construction or the performance of construction. � -- . �--��G � a ,. . Signature Contractor or Authorized �,gent_ Date �Z��i;� �9�� `�� 2 . �� , �� r� �� pQ�/_ �,J AF�IAA� �'�'- c� � � . COPYRIGHT KIVA 1997 - 2008 Phone: Phone: 407-830-8554 �� SET_17_CPI City of Winter Springs MiSC NfISCELLANf0U5 CASH �ECEIFTS D�3te I Ti7e : 05/14/OB 1Za45 Parnier�t e S 25�000 Receipt # �., : 16�48�9 Ch��_k/C; e�jit Car��.,�c 11379 Glerk �':. �j�ii�t�ois D- ' -I "1 ��*. .. i ,..-.. ,. - , . + � � . . CITY OF WINTER SPRINGS PERMIT APPLICATION Permit ��0/l ��o Date :� y G� Time Type of Permit: (Check all that apply) Building Electrical Plumbing Mechanical � �! � 6 � Fence Pool Shed � Roofing C'�ntract � al��e: Orphan R.O.W. Pods Sign Arbor Permit # Septic Permit # r (Fee Simple) Owner's Name v iin ( tM�� Phone # Mailing Address S(n(9 �,�v,,,,�1' L�; r• Consh•uction Address .$�`� �v�rns� C_i�'• Lot # Living sq.ft. l floor 1 Living sc�. ft. 2" floor Living Other sq. ft. Sq. ft. Of: Garage Entry Rear Porch Other non-conditioned Subdivision Zoning Section Township Range, Contractor �;� �aa�:�� Address 7G� �erne 1.�i_ �,.u�./ r� 3z77� Phone # y �3a �rSS`�License # eCCaS7�r3�{ Expires K �* Workman's Comp Expires Z D Bonding Company Address Architect/Engineer Address Mortgage Lender Address (p�/� Q/T�.� Work Description /"G�--raa � 5�55. �� .Z8 55. Gcr�rt. L✓i��+ Ot�e SCo%;.w �dr��:a� J�j�Ph� , Electrical: Contractor Address License # Expires Phone # Amperage Work Description Amperage Voltage Phase T-Pole: Yes No �� 1:1R�cl�.e«ical: Contractor Address �� '�i License # Expires __ Phone # Contrac�Amo�r�$.._ � Work Description System Type EER SEER Plumbin�: Contractor Address License # Expires Phone # Contract amount $ Work Description # of: Fixtures to be added Sewer Water Heaters Vacuum Breakers UG Water Drains Commercial Fixtures: As defined by 1994 Standard Plumbing Code Fixture Unit-Table 713.1 OTHER: Type Contractor Address License# Expires Phone Contract Amount: Work Description Swi�nn:i�:g I.ot C;radin�-.T;,.pe: _ ..�1 _ F3, � _ C', � - - O- ther - - Will Existing Drainage Be Altered? Yes, No. Distance from edge of pool to: Rea1 Yard, Side Yard 1, Side Yard 2. Engineering Division may require a survey for final inspection. �' J v V if't'�t �_�..w �. �.:' c:' �. .. . . • �'• .,�:c:'Ji� 1�'. "fr:tu �b' } J=� yt".:�i� >Y� Yg, l ;. �' n�•dn�: ti •i �t,v�t?,. ri �ti� ,�; ��, i ;t, `.+f.:. i C:1.:1�'.i?!::115ifff..J'�i.1 �,. .S �S �� . e • �, 4 r 1'r t:.7fy?7(:: • j� �, ;ti� ._ • . q � . _ 0 . • . :! _ .. '� . r. � Y • ► ' . Fe►rce � � Type of Material for Fence Fence Height Linear Feet of Fence to be Installed Contract Amount $ � Sign: Name of Business, Phone # Owner/Manager Phone # Installer/Sign Co. Phone # E�isting Sign (Y/N) Description Proposed Sign Description Size of Sign X Contract Amount $ Type of Sign Outdoor Advertisement (on-site) Construction Real Estate Outdoor Advertisement (off-site) ldentification Other OFFICE iJSE ONLI' CALCULATED VALUE PERMIT FEES Building Permit Plan Review Electrical Permit Mechanical Permit Plumbing Pernut Right-of-Way Permit Arbor Permit Other PERNIIT TOTAL: IMPACT FEES Transportation Impact Police Impact Fire Impact Other IMPACT FEE TOTAL � u Commun�ty Dev: Reviewed By e � Engineering; � Reviewed By_ r. , Fire Marshall: Reviewed By_ Building: Reviewed By_ Date: Approved Date: Approved Date: Approved Date: Approved YES YES YES YES NO NO NO NO WARNING TO OWNER YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU 1NTEND TO OBTAIN FINANCING, CONSULT YOUR LENDER OR ATTORNEY BEFORE RECORDING A NOTICE OF COMMENCEMENT. APPLICANT: I CERTIFY THAT ALL THE FOREGOING INFORMATION IS ACCURATE AND THAT ALL WORK WILL BE DONE IN COMPLIANCE WITH ALL APPLICABLE LAWS REGULATING CONSTRUCTION AND ZONING. I FURTHER UNDERSTAND THAT WORK MUST COMMENCE WITHIN 60 DAYS AND BE COMPLETED WITHIN ONE YEAR FROM DATE OF ISSUANCE OR THE PERMIT WILL EXPIRE. COMPLIANCE CERTIFICATION I CERTIFY THAT THE POOL CONSTRUCTION WILL COMPLY WITH ALL APPLICABLE N.S.P.I. DESIGN REQUIREMENTS AND THE POOL COMPLIES WITH SECTION 1803.1.3 OF THE 1997 STANDARD BUILDING CODE. OWNER MUST SIGN ALL PERMIT APPLICATIONS. EXCEPTION: CONTRACTOR PROVIDE AN "OWNER SIGNED" CONTRACT OR A NOTARIZED POWER OF ATTORNEY, FROM THE OWNER, GRANTING AUTHORITY TO THE CONTRACTOR. _ , � � S.IG ]ii A % (Owner/Agent) The foregoing instrument was acknowl Before me this day of 20 By who is perso known to me and/or has produced �who is personally as identification and who did (did not) take an oath. as identi Notary Notary � (seal) (seal) � - S�GNATL�RE � (Contractor) The foregoing instrument was acknowledged Before me this ly� of �� i produced icl�(did hotl take an oath. �� ry Publ Stete'Olflorida r gylyig P • � Aqy Cqn DD710341 � or A� �pres 11 11 - - - - � ,. � . , c . . ,y�.� �.� DL'�► .. ` 768 �eme Drive � , Longwood, FL 32779 , Tel: (407) 830-8554 Fax: (407) 682-8554 Date of Estimate: Customer Name: Job Address: � City, State, Zip: _ �wnumn9 - by1V1B ROOFYIVG ESTIMATE/SALES.ORDER STATE LICENSE: CCCO57834 4575 N. US 1' Suite 11- Vero Beach, FL 32967 Tel: (772).713-0317 Fax:(772)567-0037 ,;.. �~ �� _ �._-. 0' d�_ Sales Rep Name: L� 4� � f ��Q,I� C}� l Sales Rep Phone #:77a, I -Sdy5 • Cust. Day Phone #: �10?� [�Q54,�y ! 0 3 7 d k Cust. Eve. Phone #: By signing below, Customer and Mid Florida Roofing, Inc. hereby agree to the terms and conditions described in thls contract. � 13f Remove existing roof from above address. Total number of squares: � Roof Pitch: �� r A� ❑ Two or more layers on roof to be removed:at $45 per square. $45lsq. X squares =$ c ��(jnUluded �� al price� �Remove and replace the following items with like or equivatent mat�rials: . , A ��'yT 31 �� , . , � � f�� A. Valley Metal total linear feet , @ �iy��i,�. . � B. � Plumbing vent pipe boots: 1 Y: inch: 2 inch: 3 inch: 4 inch: 5 inch: �: C. Kitchen 8 Bathroom vents: 4" goose: 6° goose: 10" goose: Color: . D. Off-set ridge vents.(4ft): Color: E. Ridge Vents (10ft): Color: �� I � �� • _I /� � F. Replace eave=drip (except behind gutters) with: pieces. Color: �0. Ql� Bra Wn � Woa o� �� n � Replace all rotten sheeting (if any) at an additional charge of $60 per sheet including installation. Charge is not included in total contract price below. . All replaced wood (including sheathing, fascia, siding, trusses, tails, etc.) will be documented and billed separately. " �Replace underlayment with the following: ❑ 151b Felt �301b Felt ❑ Titanium ❑ PolyGlass TH-Pk1s y�'a�r v 4� �� m.S r � Install new roof using::lJ Architectural Shingles ❑ 3 Tab Shingles ❑ Concrete Tile ❑ CIay�Tile ❑ 5V Crimp ❑ Standing Seam ❑ DECRA ManufacturedSryle: O / O V 1• �� Color: �("b �(� w 8 �� ❑ Install, new 4ft off-set ridge vents ($80 each) Total $ ❑ Install new 10ft ridge vents ($50 each) Total $ ❑ Replace 2' x 2' skylight: Qty: 0 Replace 2' x 4' skylight: Qty: Total $ (included in price below) �Upon completion, Mid Florida Roofing will'remove all job-related debris, garbage and excess materials from joti'site and will use magnet for nails, staples, simplex; etc.' � � � • -. :. . • � ,. . ... :.,_ ..... ... - . , . . ❑ Customer requests ttiat Mid�Florida Roofing �remove and�discard existingrsolarheating;panels:prior,�to commencement of installation. If this option is not checked, customer is responsible for of.solar,heating panels.prior of installaGon. Customer is aI§o responsible for re-installation oi sola� heating panels when roof work has been.completed, if th'is : option �is not checked. SPECIAL INSTRUCTIONS: • /-/om e. o�.�Jn e r �► aT �An. d�V �►-� an f a o I,�J o o� w ml' lS . � I,J000lwar. � n�e,eo�s f� b e �o.��. w� rl�e ..`� ;�I l�/o��' al �; . Gre w,�1'S A n j o b a.n: o�� ; n f i�/�C�/ �A�i o;n n� r, Cf.� n o�� 0% u�D G l"C �,�J� If payment is not made under the.terms.of this contract, Mid Florida Roofing, Inc. reserves the right to place a lien on the above mentioned property. and a finance charge of 5% per month will be added to the unpaid accounts 30 days from date of agreed payment of this contract. Should collection action be necessary, the person on this contract shall pay all court costs, attomey fees and appeal costs (if any). This cont�act is valid for one month from the date of acceptance and approval by Mid Florida Roofing, Inc. Mid Florida Roofing, Inc. reserves the right to cancel all or part of this conVact at any Gme. The State of Florida has a construction'recovery fund. . WARRANTY: Includes manufacturers material warranties and fiv.e year workmanship warranty unless othervvise specified in special instructions above. PAYMENT TERMS: Full payment is due upon compl Gon of the work described on this cont act, nless otherwise agre upon in writing b ee customer and Mid Florida Roofing, Inc. �� j( i b� � pm p/e �eQ� rUfe V f rp/� s�� Q � /- a. P �� L �� -- Acce ted. � L!/� '%- �ate: Customer Signature . ApprovaL• �'I� ��[/ v ' � " �" " ' Date: � �� t�0 bQoo.�'. J TOTAL P-RICE = S 's :�a �;,, � � � , :�� ~�'�'�= .` ,, � [�,IQ� �t:�DEtI6�A'6a00FItVG ESTII�ATE/S�4LES ORDEFt 768 Feme Drive STATE LICENSE: CCC.057834 ' 4575 N.� 1• Suite 11-N Longwood, FL 32779 Vero Beach, FL 32967 Tel:, (407) 830-8554 Tel: (772) 713-0317 Fax:(407)682-8554 , Fax:(772)567-0037 Date of Estimate: 0►r'G{� I a� Sales Rep Name: �G, � ,D� l�P-�� Customer Name: � r,� a •: Sales Rep Phone #: a- /- 6 Job Address: u�n mar Ce r� q, Cust. Day Phone #: �/D 7- g.5' y�o - City, State, Zip: ` r rrn s 3� a Cust Eve: Phone #: � � By signing below, Customer and Mid Florida Roofing, Inc. hereby agree to the terms and conditions described in thls contract: c a s G Remove existing roof from above address. Total number of squares: � Roof Pitch: � I Z, �� [ � nQ.Q,�� ❑ Two or more layers on roof to be removed at $45 per square. $45/sq. X squares =$ (included in tofal:,price below) �Remove and replace the following items with like or equivalent materi�ls: A. Valley. Metal /� total linear fe � � � . � • � . B. Plumbing vent pipe boots: 1'/: inch: 2 inch: � 3 inch: J_ 4 inch: ' 5 inch: C. Kitchen 8 Bathroom vents: 4" goose: 6 goose: 10 goose: . Color: D. Off-set ridge vents (4ft): Color: E. Ridge Vents (10ft): 7� Color: / � � J'�� f� F. Replace eave-drip (except behind gutters) wi . � pieces. Color: fed e I'Q I f 0(I�I1 ��A �� . er.� �Replace all rotten sheeting (if any)�t an additional_charge of $60 aer heelincluding installation. Charge is not included in total contract price below. All replaced wood (including sheathing, fascia, siding, trusses, tails tc. will be documen e and billed separately. `, ii. s ` � Replace underlayment with the following: It L� 301b Felt ❑ Titanium �PolyGlass Tii�ius y��+ ��' ,1�� f l`U Install new roof using: �1 Architectural Shingles ❑ 3 Tab Shingles 0 Concrete Tile ❑ Clay Tile ❑ SV.Crimp 0 Standing Seam O DECRA '. ManufacturedStyle: O/� � O �/ � � Color. c'0 h W�!0 VI ` ❑ Install new 4ft off-set ridge vents ($80 each) Total $ ❑ Install new 10ft ridge vents ($50 each) Total $ °�.. D Replace 2' x 2' skylight: Qry: �Replace 2' x 4' skylight: Qry: � Total $ S� Q� {included in price below) �Upon completion, Mid Florida Roofing will remove all job-related debris, gart�age'and excess materials�from job site and will use magnet for n ils, staples, simplex, etc. � � � - �� sibm�r �e.q�cs�s f�r.ln,: :4-�, : rd��c�- or .,rt�/aee ar mew S�ree�, ❑ Customer requests that Mii1 Florida Roofing remove and�discard�existing solar h�ating=p�nels.prior to commencement of installation. If this option is not checked; customer is responsible for removal of solar heating panels prior to commencement of installaGon. Customer is also responsible for re-installation of solar Fiea� V�ng papels when roof ork has been co�1pleted, i this opti9h i� not checked. I{ nMp o� .►r,e� � Ua,na1J n,an � d10 ��J ood 1.)nr� en 1 t�mkv rn,wnn�Cr � SPECIAL INSTRUCTI �GmOv� � g P�. 3 x T'Q nc 0 v�-�- ��. i �,C� P t'o� �C mo� � .s��/%9�fJ� J a 0� �u�bb�r In 0�2a01 a n ch�im �ol 2 � C�i►�6 n�ou.��f � �2n1e1 U � (-l� �lA s� �� o,��ne�" i0"Xl If payment is not made under the terms of this contract, Mid Florida Roofing, Inc. reserves the right to place a lien on the above mentioned property and a finance charge of 5% per month will be added to the unpaid accounts 30 days from date of agreed payment of this contract. Should collection action be necessary, the person on this contract shall pay all court costs, attomey fees and appeal costs (if any): This convacCis valid for one month trom the date of acceptance and approval by Mid Florida Roofing, Inc. Mid Florida Roofing; Inc. reserves the right to cancel all or part of lhis contract at any time. � The State of Florida has a construction recovery fund. _ WARRANTY: Includes manufacturer's material warranties and five year workmanship warranty unless otherwise specified in special instructions above. PAYMENT TERMS: Full payment is due upon completion of the work described on this contract, unless otherwise agreed pon wn ng between customer and Mid Floric�a f�b� g, ln �� I/ )�. C pM P � e �Q J w �] Z�,� TW� W Le 1`S p sr�r /�0.'�Q., �!�/ /� l � 0 �� T Accepted: �ti �� Date:� l� d Customer Signatur Approval: �W Q/N/ �� Date: � � y � �� s Oo�. �' W � J TOTAL PRICE = S � ' . . .. .� ._ `+� . , , ~. I:• _��t�Ofl L .M1'� � • 1 . ;' :i: :::• ' K THIS INSTRUM�[�1�:'�'RE6�'AF�ED BY: Name: Ro�r1- 5�0.�',�►�.�<er Address: 7�� t� �' • L F�-- 32�`1 State of Florida ��VE� b9�Y �.:4 2fl�3 CI11: 'RING3 MARYpNN6 MURS�, CLEkK U� CTRCUTT LYtURY SEMIN(ILE� CtlUNTY � �K o�yy� �� oiiy; c�uUf CLERk' S . # �C>l">8�:)55547 RECUiill�U 0y/ 13l:'t108 QI a 11::3� F't� . RECfI�bING F�ES �1t►.0(t RECORUED BY L McKinley � NOTICE OF COMMENCEMENT Permit Number Parcel ID Number (PID) 1 � a �� 3�� '� �O � C° d� The undersigned .hereby gives nottce that improvement will be made to certain real property, and in accordance with Chapter T13, Flo�ida Statutes, the following infortnation is provided in this Notice of Commencement. F PROPERTY (Legal desc (� r n n 'rr, L�f' � i GENERAL DESCRIP710N OF IMPROVEMENT OWNER INFORMA' Name and address: Y CONTRACTOR Name and address: of the property and street address if available) � � , •;-� ,� , � � �.�,.-� '1 t��.1/l.l� �) . �� . .�.s�e.�..es�,�s� . "� ��'p'(Ji'Y��C�CERI�:� / �.f � o b� �un /r1 Rr �' ('f' (, ry ��J S/` {�� J �"l � 2 �o `��.��,� q�� "�` �' � � � �A1D IF0.�R1�� v�� tJ.0 � /L0111pA ROO�iN�I LC,� ns�s aEe�n�D ROOFING �- ---• ---- -------- .. Wi\{iOwri� rr w• .� . � � iI S! I� Persons within the State of Florida Designated by.Owner upon whom nottce or other documents may be served as provlded. by Section 713.13�1)(b), Florida Statutes. � Name and address: In addition to'hlmself, Owner Designates of � To receive a copy of the Lienors Notice as Provided in Sectlon 713.13(1)(b); Plorida Statutes. Explration Date of Notice of Commencement: The expiratlon date Is 1 year from date of recording unless a different date is specified. WARN/NG TO OWNER:�ANY PAYMENTS MADE BY THE OWNER AFT�R THE EXPIRATION OF THE NOTICE OF CqMMENCEMEN7 ARE CONSIDERED IMRROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13� FLORIDA 3TATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVMENTS TO YOUR PROPERTY. A. NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SIT� BEFORE THE FIRST INSPECTION. IF YOU INTEND TO 0B7AIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. �' /' , � STATE OF FLORIDA � COUNTY OF SEMINqLE � ��f ` J 7 ��1 � S � u L �� ,, /�F" �'i7�1 � ij L� � O ERS SIGNATURE � OWNERS PRINTED NAAAE "( OTE: Per Florida Statute 713.13(1) (g), owner must s1gn...... and no one else may be pemtitted to sign tn his or her stead." The foregoing tnstrument was acknowledged before me thts /� day of _�/�C'.�-l/I . 20 b '1 �/n � S �IC� � 1� (�/1� P��L . Who Is personally known to me Y �,� . Name of person making �tatement OR who has p�oduced [dentlfication F�� type of identiflcation produced �� ;. __ - VERIFICATION PURSUANT TO SECTION 82.525, FLORIDA STA7UTE3. UNDER PENALTIES OF PERJURY, I DECLARE tHAT I HAVE READ THE FOREOOING AND THAT THE FACT3 STA'iED IN IT ARE TRUE TO THE BEST OF MY KNOWLEQGE AND BELIEF. . _ ,�1 . ,� /'.i n o /l /,' ." � SIGNA 8. WN80t11! . IN � ^ �e - � �f Flal� , . . wOw�Mo�E�M�M�MV►t�,lOt c.�.w� r oo raa�: �nMa�n�rMa�►�n. � . PERSON . ..,. .. .. . ... ; .. . ... • - - • .. , } � ��-INSPECTIO�N - a NOTICE � CITY OF WINTER SPRINGS BUILDING DIVISION Customer Service Office: (407) 327-1800 Ext. 305, 307, 326 Schedule Inspection Line (407) 327-7596 Contractor: ��/ ►,�J �L dC �U H n �, Permit Number: � Lot Number: Address: ��' � �- � '� � Inspection PerFormed: — �� Date: � ,�� RE- INSPECTION FEE: $ 1,�� 1�� NOTE: RE-INSPECTION FEES MUST BE PAID PRIOR TO RE-INSPECTION. THIS NOTICE AND ALL APPROVED PLANS MUST BE ON SITE FOR ALL I CTIONS AND RE-INSPECTIONS. PLEASE NOTE ADDITION �'F��.---� Y N BUILDING INSPECTOR Inspector Contact Available 7:30 a.m. - 8:30 a.m. •(407) 327-5973, 5974, 8988 , Page 1 t � � � � . ._ _ ,�. , . ; ,.:•=. ' . . . ' • i!;'., y t. r � . � �it uf Winter Sprin�s . � . �UI�,DING DI�SIOI� � xE: Perrnit # aoOR a I � S(� � Inspec�ion Affidavit Date �' p I__ /Cc��t l�- ��/�I�.'ei ,licensed as a(n) Contractor* fEngineer/A.rchitect, lplease priat name and circle Lic Type) , , FS 468 Buii�ing�Inspector* License #;_ On or about _ �lJy�t�� Y� an/'yr� , I did personally inspect the roo . (Date & time) deck nailine and/or secondarv water barrier work at .�(,�, �v S /� �i /'' � (crrcle one) (Job Site Address) � Based upon that examination I have determined the installation was done according to the � Hurrican�Mitigation Retrofit Manual (Based on SS3.844 F.S.) Please see attached � photographs. . � � .�..._.._ .. - �, ' . � � Signature ' � ' � {� � � STATE OF �'LORIDA � ' � �OUNTY OF � Swom to and subscribed before me this �f�`'day of ��,, . 200,� BY__�.��-�• �S�,e��►�c1G�,- . ' Notary Fgblic, S��te-6�'lorida . � �� y, Enk Jason Kantarjian � a �• My�Commission DD318891 ' � �d� Expires May 12, 2008 Personally�known �or Produced Identification Type of identification produced. � '(�rint, ty��'or stamp name) Commission No.: � .��0 0 �� * Genera], Bu�lding, Resid�tial, ar Roo$ng Conhactor or any individual certified under 468 F.S. to make�such an inspection. Include phowgraphs of each plane of the roof with the perrnit # or address # clearly shown marked on the � deck for each inspection. � %' � � z � a�' � � �. �� W, �.� a � �€ . �. ° a � U � � �!� . .. .. .. d. , ..' , .� . -� ' �. .. .. . � City of Winter S�rings � Building Division ROOF DRY-TN A1vD �LASHING INSPECTIONS 'AFFIDAVIT �� . � �y �� 4 TY �� _ _ A ��' g Ch �� Syi '� R 'Nc 8 ' Company Name: /�1;�—��;�c ��;;, License Number: �,(� pS7�3`� W . ,.. . Company Addressc . . .. �,�, r� 2�� 9 PROJECT INFORMATION Subdivision: Address: 5(Q� ��.�,,,.� �/' � � Permit Number: I ' ��`�� sti�e��'r �, affiant, here-by affirm that I am the dul ualifier of, and duly licensed Contractor of Record for the above referenced permit, that all of the foregoing information is true and accurate, AND that the dry-in and flashing at the above referenced location has been installed in accordance with all applicable Codes, Standards and Manufacturers Specifications. Contractor: _��,��, .,�j � ae�r�e� (Print Name) (Signature) State of Florida County of: _ ��; . �. : 4'i. ' . This instrument was acknowledged before me this � of ,--� 20 � by the above referenced individual, llcle�l�. y,QemcKe,. wh acknowledged � (Print Name) that he/she is the qualifier of, and duly licensed Contractor . with 1 /�l i�- i /�-F � hS , and who acknowledged that he/she was authorized (Name of Company) to execute this document. He/she is either personally known to me _ produced �� as valid identification. Witness my hand and official seal this 2,3 day of 4 � , 20 G� : CJI� ��t�I�vt {��q �it S9t,2e 04 ��+? (Notary Public) � �� 's �awGt "r,� a � c�y Cu�i;s� f�i�.`.a'1Ta�T � `�'c�cs°�� En�:T�0 - _ Printed Name: �� e i,,� i�7' ' My commission Expires: , �� r .. ~ ` � '� _ ..Q � `�/' � . , � I��. . / . . ` ' , t`, � . . r � . . � �-` '- .. v - � 3 ` , J ` t J � � ` \ ,\ � � � ,:t{ � . - °,1;, ,. 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