31 5TH ST - DECONSTRUCTIVE FORM FOR ROOF SZ 4 - g(Z t o-c-Gc e., -5s Z -06 zfs -•S oi-el t e,
591 -7338 s'(6
f, City of Jacksonville PERMIT NO. 1J8 t9 b
Planning and Development
4411/1@- -7-71:131t 1
, 04. 4 i Building Inspection Division
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I / P l {�jCJii� OFFICE USE ONLY
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Application for: pt y 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. pyo
Before me thisdayof in the County of Duval,State of Florida,
has personally appeared �, L M! C J herein by
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( CD(� himself/herself and affirms all statements and declarations herein are true and
Signed: F, 1` p�� accu e. 6 a"f „....,
Property Owner Notary Public at Large, tate of F3 1 d4.. ,County of DLtvK-I
Personally known ,or Produced Identification
ID Type:
*Pot. Notary Public State of Florit$
Contractor Affirmation l My Commission
Dutton
/ / )c My Commission FF 926298
awr Expires 11,1ef2t11!
Company: '.5/76- a �n Z.Z C
Address of Project: 3/ 5— A-L' Ji-. j A„ h c /77..-, 2-
Requested By: .5 /1+.CL,.d
Reason for Request: Art."- 0. v y p L Sie:(:-.1-.c.,„ C.,(-)c,;Z,-.2 ,---c45-4. .6,-.ac,, cir
I, S ifs` 6:_,A.' 9 , 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.
efe'j'.-----N--- --
Signed: Date: 7 /l
An Approved Copy of this Application Must be On-Site at Time of Destructive Roofing-In-Progress Inspection