MARK A. GRENIER MCP, CBO
Development Services
BUILDING OFFICIAL
352-241-7311
mgrenier@clermontfl.org
RESIDENTIAL RE-ROOF AFFIDAVIT
Permit #: ____________________
Date: ______________________
Job Address: _____________________________________________________________________________________
Structure Type: _____ One or Two- Family Residence
_____ Mobile Home
Re-Roof Type: ____ Replacement (Tear off existing & replace) ____ Recover (New over Existing)
Job Description/ Special Notes:_______________________________________________________________________
____________________________________________________________________________________________________
Slope of Roof: ___Less than 2:12*
___2:12-4:12 ___4:12 or Greater
*No shingle application allowed
A FINAL ROOFING INSEPCTION IS REQUIRED
This signed and notarized affidavit must be provided at the jobsite at the time of the final roofing inspection along with
photographs of all components of the roof installation including but not limited to ridge and off ridge ventilation, roof
sheathing, underlayment, drip edge, skylights, and shingles. These photos must include the permit number or address
clearly displayed in each photograph. The photographs must include visual verification that the work was performed at
the above listed address. Please include a measuring device as a reference to confirm all installation requirements per
the Florida product approval and applicable building codes.
I _______________________________, Licensed as a(n) __ Contractor, __ Engineer, __ Architect, __FS 468 Building
information is true and accurate and that the sheathing, nailing, dry-in, flashings at the above referenced address will be
installed in accordance the applicable codes, Florida product approval installation instructions and standards set forth in
the most current edition of the Florida Building Code- Residential and the Florida Building Code- Existing Building.
Inspector, License # _____________________________ or __ Owner Builder hereby affirm that all of the foregoing
Signature: ________________________________________
STATE OF FLORIDA; COUNTY OF LAKE:
Sworn to and subscribed before me, by means of
☐
physical presence or
☐
online notarization, this ______ day of
___________, _________(year), by _____________________________ who is personally known to me or who has
produced __________________ as identification.
____________________________________
Signature of Notary Public – State of Florida
My commission expires:
____________________________________
(Print, type, or stamp commissioned name of Notary Public)
1-15-21
685 W. Montrose Street • Clermont, FL 34711 • www.ClermontFL.gov
