168 MAGNOLIA ST - DESTRUCTIVE INSPECTION In City of Jacksonville PERMIT NO.
j Planning and Development
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/ l Building Inspection Division
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OFFICE USE ONLY
Application for: Approved by:
Destructive Roofing-In-Progress Inspection Date Approved:
ROOFING-IN-PROGRESS INSPECTIONS
A Roofing-In-Progress Inspection is a required inspection per the Florida Building Code—Existing Building (FBC-EB).
The purpose of the inspection is to confirm any required deck nailing has been completed and proper installation of a
secondary water barrier as required by Rule 9B-0475. This required inspection was not requested by the contractor
prior to completing the shingle installation for the above referenced permit, and now a Destructive Roofing-In-
Progress inspection must be performed by removing certain portions of shingles and/or underlayment to insure
compliance with state law. Not complying with this requirement could affect your insurance coverage for storm
damage.
Owner Affirmation
I understand that the contractor, for the reason listed below, was unable to acquire a Passed Roofing-in-progress
Inspection. I also understand the Destructive Roof in Progress Inspection will require the Contractor to remove and
replace shingles and/or underlayment as required by the City of Jacksonville Building Inspection Division to verify
work is in compliance with all state and local codes.
Before me this CA day ofM,..11-I%in the County of Duval,State of Florida,
has personally appeared 50,1 k.\VQc herein by
// r ,...,. himself/herself and affirms all statements and declarations herein are true and
Signed: a( j •
TORRES acc`�(ate_
i • :,,^4` ;ISSiON ���e� ner cJSl. u.Not- \1. �a�lu'Z
aV:i: +''-c•SepteaWHr 13 2019 Notary Public at Large,State of ck ,County of 0VJ1 c,�,
0071 o+aa Fkm.4�Na01,60'rire mwr Personally known ,or Produced Identification ✓
ID Type: V-Z)�
Contractor Affirmation
Company: C—c)vn ' Sc \))tx Q5-q.c.5 0vai-cs-S
Address of Project: ((0 c.s. /lAcr.`i,\r'101/4 : t if\k`aA\1.C.
Requested By: C•:. CtA (okC.4 — BOJ-k-s �A.D
Reason for Request:-"T'1S(-)Qr--k rA ,CJ ft-0 F SckuUQd (rx--F R—
I, l),--C:x 1 `"Qp- - , understand City of Jacksonville Building Inspection Division procedures
as outlined in Bulletin G-04-08. I also understand the Destructive Roofing-in-progress inspection is not part of those
procedures and is an exception to the procedure. In addition, I understand that any non-code compliant work identified during
this inspection may result in the assessment of additional re-inspection fees.
Signed: 11,i) c> a- - �A_,
?..f _ Date: \ 1 0 - ` $
An Approved Copy of this Application Must be On-Site at Time of Destructive Roofing-In-progress Inspection