PERMIT DOCUMENTS L,' O,.
;trit City of Boynton Beach
Building Division
LICENSED ROOFING CONTRACTOR
AFFIDAVIT
ROOF METAL & ROOF SHEATHING INSTALLATION
(EXISTING DETACHED ONE & TWO FAMILY DWELLINGS ONLY)
The City of Boynton Beach offers progressive inspections— call 742-6355
To: City of Boynton Beach, Florida
Department of Development - Building Division
Field Inspection Section
100 East Boynton Beach Blvd., PO Box 310
Boynton Beach, FL !/33425-031Dj�
Re: Permit No. �7
From: D lie 7-)5, ld d% i (Contractor)
i / -
i Sr % (Contractor's Address)
/'e ' l p e rr'.'' L C _ (Owner/s Name)
0 G i . Sa ,4.(Property Address)
CE FICATION SELECTION: (Please check all that apply
edification of roof metal installation, flashing, underlayment.
C rtificat of re-paili roof ashin and remoyy,�I and ff9 ceme t of damaged or rotted wood.
Othe /f9 9m 17ye n o/j' £/ /4 ee
I, 64.104 11" ` eg , arf certified as a roofing contractor (License No.
ar i3Z 9y 4g ) and do hereby certify that all roof work (as indicated above) has been performed
at the above address in accordance with Chapter 15 of the Florida Building Code, Existing Building, as
amended d Manufacturer's Specifications. I understand that the City of Boynton B ch ffers progressive
re-r ins • I have notified the owner of the property of this affidavit.
• t (s-� /y
Signature of Date
STATE OF FLORIDA, COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me thT 14 /3 moo'N(date)by Pc--dal I $ouxrfWho
is personally known to me or who has produced (type of identification)as identification
and who did (did not)take an oath. (SEAL)
Signature of person taking acknowledgement ‘L-A- /�- Y �o C. ---
Name of officer taking acknowledgement—typed, printed or stamped 1)c `I-L-Ice-,., IAA . l
mum
Title or rank �fl c- THt EeN M.IC
in--43g. Serial number �� b 1�-149 �� NOTARY PUBLIC
k''(.J7R STATE OF FLORIDA
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100 East Boynton Beach Blvd,PO Box 310, Boynton Beach FL 33425-0310 Phone:(561)742-6350 Fax:(561)742.6357
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7/12)
`'?�A City of Boynton Beach
mkt Building Division
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ROOF METAL & ROOF SHEATHING INSTALLATION CERTIFICATION
(EXISTING DETACHED ONE & TWO FAMILY DWELLINGS ONLY)
FOR LICENSED ROOFING CONTRACTORS ONLY
I. PURPOSE
The purpose of this Policy is to provide a method for certifying installation of roof metal, roof
underlayment and re-nailing of roof sheathing on occupied or finished one and two family
dwellings. This policy applies only to licensed roofing contractors.
II. AUTHORIZATION
Section 104.6 of the Boynton Beach Amendments to the Florida Building Code, Existing
Building, as adopted by the City of Boynton Beach, provides that requirements necessary for
the public safety, health and general welfare not specifically covered by the standard or the
Building Official shall determine other technical codes or policies.
III. APPLICATION
Qualified applicants may certify the roof metal installation and re-nailing of roof sheathing by
preparing an affidavit certifying that the installation of the roof metal and re-nailing of roof
sheathing complies with all codes, ordinances, rules and regulations; that the qualifier or
designee personally inspected the specific job; and that the roof was installed according to the
Florida Building Code, and Existing Building Code, as amended, and the manufacturer's
installation instructions.
This affidavit must be presented to the inspector at the next scheduled inspectionion-site.
When the roof metal and roof sheathing are not inspected at either a Sheathing,.Tin Tag/Roof
Metal, or Final Inspection, the Structural Building Inspector will either fail the inspection until
certified by the applicant or pass the inspection if the signed affidavit is present at the job site.
Pictures of the re-nailed and repaired roof sheathing and roof metal are optional.
When a Final is the only scheduled inspection and an affidavit is supplied, the Inspector shall
add the comment, "CERTIFIED," and pass the inspection.
Progressive re-roof inspections may still be requested by calling the inspection clerk 24
hours prior to re-roof at (561) 742-6355.
100 East Boynton Beach Blvd,PO Box 310,Boynton Beach FL 33425-0310 Phone:(561)742.6350 Fax:(561)742-6357
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