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4. City of Bartow P.O. Box 1069 Bartow, FL 33831-1069 (863) 534-0100
6. Building Department Re-Roof Affidavit

   In-Progress: Contractors – A complete affidavit must be on the job site in case the inspector does not arrive before completion of work. If the re-roof work is completed prior to inspector arrival, the inspector will accept a properly completed affidavit and may do the final inspection.

8. Permit Number
9. Job Site Contact Phone #
11. Site Address
13. City
14. State
15. Zip Code
17. Contractor/Owner/Builder First Name
18. Contractor/Owner/Builder Last Name
20. Contractor ID
22. Nail schedule of purling and/or re-nailing of decking
24. Amount of Framing/Sheathing Repair
26. Specifications & type of underlayment overlap and roof pitch
28. Sealed edges, objects, and valleys, valley material type with a minimum of four-inch (4”) flashing cement
30. Nail schedule for eve drip, metal, roof shingles
32. Roof Vent Types and Qualities

    1. Gas
    2. Plumbing
    3. Dryer
    4. Range
    5. Bath
33. Attic Ventilation

    1. On Ridge
    2. Off Ridge
35. Date Work Preformed
    Date Work Preformed
37. First Name
38. Last Name
40. Signature
42. State of Florida
44. Sworn or affirmed to me on this __________ day of ______________________________ 20____
46. By: _______________________________________________________________________________
48. Who is _________ or is not ________ known to me.
50. Identified By: _____________________________________________________________
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