HomeMy WebLinkAboutROOF CERTIFICATION CERTIFICATION FORMCIT
I'1101'OIIY IN
APPLICANT/INS
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ADDRESS INSP
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DATE OF INSPE
This Roof Conditi I
appI opriately lice
complete this for
Is A general, residential, building, or roofing contractor
g code inspector
bred architect
ssional engineer
ig code official who is authorized by the State of Florida to verify building code compliance
a -licensed home inspector
• A build
• A regis
• A profE
• A build
• A Florii
NOTE: This forrrj
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EENSIF
&MCD=MMON Future Roof Condition Certification Form (CANN ED
RED NAME: Brown, Sandra APPLICATION/POLICY #:40EHII -g1�, ()%_ Pfmin0Ai
:,TED: 8 Peru, Fort Pierce FL 34951 Bsandra574@aol.com
ION: August 7, 2018
Certification Form must be inspected and completed by a verifiable Florida -licensed professional. Without an
ed inspector's dated signature, the form will not be accepted. The following FLORIDA-LICENSED individuals may
for Citizens:
does not verify loss mitigation features. Use Uniform Mitigation Verification Inspection Form OIR-61-1802.
ROOF TWO' PHOTOS OF THE ROOF'S CONDITION ARE REQUIRED TO BE SUBMITTED WITH THIS FORM
1 1:1 Predominant Roof
Secondary Roof
Covering Matee'rial: Shingle
Covering Material:
Roof Age (years): 6 months
Roof Age (years):
Remaining Useful Life: 20 rs
Remaining Useful Life:
Date of Last f oofing Permit:
['
Date of Last Roofing Permit:
Date of Last pdate Aril 1 2018
Date of Last Update:
If updated (check one):
Full Replacer ent ✓❑
If updated (check one):
Full Replacement ❑
Partial Repla ement ❑
Partial Replacement ❑
o of Replac Iment
% of Replacement
Overall Condition of Roof:
Overall Condition of Roof:
Excellent ❑
Excellent ❑
✓❑
Good
,Good
Fair
Fair
Poor (explai) H
I
Poor (explain)
Any visible signs of damage/deterioration? (describe)
(e.g. curling, lifted/loose/missing shingles or tiles, sagging or uneven
roof deck) Ji
Predominant Roof
Secondary Roof
Yes: ❑ No: ✓❑
Yes: ❑ No ❑
Any visible ;signs of leaks?
Yes: 1 No: R1
Yes: No: El
Additional Comments:
ALL ROOFI'CONDITION CERTIFICATION INSPECTIONS MUST BE INSPECTED, SIGNED AND COMPLETED BYA VERIFIABLE
FLORIDA- 'ICENSED INSPECTOR. l CERTIFY THAT THE ABOVE STATEMENTS ARE TRUE AND CORRECT.
IDONALD STILLER
772-201-7679 August 7, 2018
Inspector Name (printed)
Telephone Number Date
�/ 41-
Certified Bldg Contractor CBC#1256081
1 Signature of Inspector
License Type License Number
CIT RCF-1109 12
'�CITI IVS Ftarida's
MOMMI� ro �no�� Fukm oof Condition Certification Form
APPLICANT/INSRED NAME: Brown, Sandra APPLICATION/POLICY #:407-951-1103
ADDRESS INSP CTED: 8 Peru, Fort Pierce, FL 34951 Bsandra574@aol.com
DATjE OF INSPOOTION: August 7, 2018
C
T RCF-109 12
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