HomeMy WebLinkAboutROOF AFFU,959
CITY OF WINTER SPRINGS
Re -Roof Inspection Affidavit
This affidavit must be signed and inspected by the licensed individual as stated below. Site workers are
not authorized to do the inspection and fill in the time and date.
Affidavit must be provided at the iob-site prior to final inspection
Permit # Lo 2-j — OVOO 2 Y,53
DATE: 1 Z — Z3
�a5e C ... , licensed as a(n) Contractor* ngineer Architect FS 468 Building Inspector*
(Please print name clearly) (Must circle license type)
License #: (2-C-C
P I personally inspected the Roof deck nailing on:
JS I personally inspected the Flashing & Dry -in on:
(� I personally inspected the Roof Materials on:
work at: 00 S Flt 1 f"-rax A-Ve. u )1 VL
(Job Site Address)
YC
DATE Initial
DATE INITIAL
0q_ /Z 23 J C-- (Per FBC 7" Edition)
DATE INITIAL
Based upon that examination I have determined the installation was done according to the Hurricane Mitigation
Retrofit Manual (Based on 553.844 F.S.)
Underlayment SHALL be in compliance with R905.2.7
CONTRACTOR'S STATEMENT: Under penalty of perjury, I declare that the foregoing information and facts
contained in this document are true and correct. (Florida Statute 92.525)
Signature
ueneray tswlding, Residential, or Roofing Contractor, or any individual certified under 468 F.S. to make such an
STATE OF FLORIDA, COUNTY OF )
Affirmed and subscribed before me this / Z day of G' 20�by '1)5C C- 015—fZN—" whois
Personally known to me or who has produced (type of ID)
identification.
o�*or rLs� Notary Public Stale of Florida
Jennifer Martinez
y ; v My Commission HH 008774
?ofn Expires06/10/2024 r ��.
i>� r tt!�
Signature otary ublie State of Florida Print, Type or Stamp Name of Notary