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Fort Pierce,Florida 34982 SEP
c 2 79019 9`U,o 9
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OWNERBUILDER AFFIDAVIT DISCLOSURE STATEME ST. Lucie County, Permitting
F.S.489.103(7)EXEMPTIONS
State law requires construction to be done by licensed contractors. You have applied for a permit under an
exemption to that law. The exemption allows you,as the owner of your property,to act as your own contractor even
though you do not have a license. You must provide direct, on-site supervision of the construction yourself. You
may build or improve farm outbuildings, a one-family or two-family residence for your use and occupancy. You
may also build or improve a commercial building at a cost not exceeding $75,000.00 as long as it is for your own
use or occupancy.You may not build or improve said structures for the purposes of selling or leasing that building.
If you sell or lease a building you have built or improved within one year after construction is complete, then a
presumption is created that it was built or improved for sale or lease, which is a violation of this exemption. You
may not hire an unlicensed person to act as your contractor or to supervise people working on your building; it is
your responsibility to make sure that people employed by you have licenses required by state law and by county or
municipal licensing ordinances. You may not delegate the responsibility for supervising work to a-licensed
contractor who is not licensed to perform the work being done. Your construction must comply with all ble
laws,ordinances,building codes,and zoning regulations. Initial .
I understand that the building official and inspectors are not there to design or give advice on ho t eet
the minimum code. Initial _
I understand that as an owner-builder that any contract disputes with sub-contractors and I must be handled
in a civil court with the advice of an attorney. This department will not mitigate any contract disputes.
Initial
I understand that if I compensate any person or company for work performed they are required to be
licensed in this jurisdiction. If for some reason they do not possess a license,I may be responsible and li ble •the
cost of the license. Initial
I understand that if any person that is unlicensed and uninsured gets injured on my construction project-
they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and relateKepal
cost,which could include loss of wages during recovery from their injury. Initial
To qualify for this exemption under this subsection,an owner must personally appear and sign the building
permit application and initial the above.
I hereby acknowledge that I have read and understand the above disclosure statement and that I further
understand that any violation of the terms of the owner/builder exemption shall be reported by the Building and
Zoning Department to the Florida State Department of Professional Regulation. Signed and acknowledged on this
day of of 20
Owne Builder Si a e
STATE OF FLORIDA
COUNTY OF S k. %-3 1—%Q-
The foregoing instrument was acicpowledged before me thisal day of Se ,��' ,20
by �W-. Mo b� 1` yy \ who is personally known to me,or who has
produced 'F 1_ p L. as identification. ,
MpR1E
� G1
a d�'n 4 �V ri 5 ar"P7..�" DFANM SION
Type or Print Name of Not ' a bar i6, i"
Signature ofNo Notary Typ Notary =�' ;r: �p(���'e11Cunaenar'•tia�•
Title:Notary Public Commission Number 49ti a
n•
SLCPDSD Revised 05/15/2014
Florida Building Code Online92 Page Page l of 5
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Business/ '� :.
Professional =:., !P Eoduti t l�pprou it RECEIVED
. c User
ud Ar.nro,al Menu>Product or nrg)hration Searci>>Application List>Application Detail S E r 2 7 (�!�
FL
FL8228 R7 Sys Wdo Qpiin r P-Prrjl
Application Type Affirmation --- ---- -
Code Version 2014
Application Status Approved
Comments
Archived
Product Manufacturer Masonite International
Address/Phone/Email 1955 Powis Road
West.Chicago,IL 60185
(615)441-4258
sschreiber@masonite.com
Authorized Signature Steve Schreiber
sschreiber@masonite.com
Technical Representative
Address/Phone/Email
Quality Assurance Representative
Address/Phone/Email
Category Exterior Doors
Subcategory Swinging Exterior Door Assemblies
Compliance Method Certification Mark or Listing
Certification Agency National Accreditation&Management Institute
Validated By National Accreditation&Management Institute,
Referenced Standard and Year(of Standard) Standard Year
ASTM E1886 2002
Uj ASTM E1996 2002
ASTM E330 2002
TAS 202 1994
LL Equivalence of Product Standards
Certified By
itirm that there.are no rhanaes in the:r., F{a•a=
8u iding Codi; tth+. n affect ms ptoduc.t(sl and n y
tyr ciur t(si are in nrn .
pli;rice.:vtth thio new Flo,,-a
t1u Idina Code.
Documentation from approved Evaluation or Validation Entity Yes No -.NSA
Ilttps://www.floridabui ld ing.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDquftCwaMPtp3T... 5/5/2015
Florida Building Code Online Page 2 of 5
z
Product Approval Method Method 1 Option A
Date Submitted 04/29/2015
Date Validated 04/29/2015
Date Pending FBC Approval
Date Approved 05/04/2015
(Summary of Products
FL# IModel,Number or Name Description
3�
18228.1 Fiberglass Side-Hinged Door Unit 6'-8"Opaque I/S and O/S Single Door
[Lrmits of Use Certification Agency Certificate
Approved for use in HVI.9i::Yes FL8228 R7 C CAC NI006900.01.radf
j Approved for use outside HVHZ:Yes Quality Assurance Contract Expiration Date
Impact Resistant:Yes 12/31/2020
it Design Pressure: +85.0/-85.0 Installation Instructions
Other: Evaluated for use in locations adhering to the FL822.8 R7 II FL0160Dx.pdf
(Florida Building Code including the High Velocity Verified By: National Accreditation&Management
Hurricane Zone,and where pressure requirements as Institute
'Idetermined by ASCE 7,does not exceed the design Created by Independent Third Party:
(pressures listed.3'-0"x 6'-8"max nominal size. Evaluation Reports
[Hurricane protective system required in HVHZ, but not 1`1_822S R7 AE 504A.pdf
required in the Wind Borne Debris Region.See DWG-MA- Created by Independent Third Party:Yes
1FLO160-07 for additional information.
18228.2 I.Fiberaiass Side-Hinged Door Unit 8' 0"Opaque I/S and O/S Single Door
!Limits of Use Certification Agency Certificate
Approved for use in HVHK.Yes FL82;>-8 R7 C CAC NI006900,02.pclf
Approved for use outside HVHZ:Yes Quality Assurance Contract Expiration Date
ii Impact Resistant:Yes 12/31/2020
Design Pressure: +70.0/-70.0 Installation Instructions
Other: Evaluated for use in locations adhering to the 1`1_82.?8 R7 II FL0161Dx.Rdf
Florida Building Code including the High Velocity Verified By: National Accreditation&Management
Hurricane Zone,and where pressure requirements as Institute
;determined by ASCE 7,does not exceed the design Created by Independent Third Party:
;!pressures listed. 3'-0"x 8'-0"max nominal size. Evaluation Reports
;Hurricane protective system required in HVHZ,but not FL82)8 R7 AE 503A.0f
'(required in the Wind Borne Debris Region.See DWG-MA- Created by Independent Third Party:Yes
[FLO161-07 for additional information.
118228.3 Fiberglass Side-Hinged Door Unit 6'-8"Opaque Inswing Single or Double Door w/or w/o
] Sidelites
;iLimits of Use Certification Agency Certificate
j Approved for use in HVHZ.Yes FL822.8 R7 C CAC NI006900.01.1)df
Approved for use outside HVHZ:Yes Quality Assurance Contract Expiration Date
Impact Resistant:Yes 12/31/2020
{'Design Pressure: +50.5/-50.5 Installation Instructions
tI Other: =valuated for use in locations adhering to the FL8228 R7 1I FL0160Dx.pdf
Florida Building Code including the High Velocity Verified By: National Accreditation&Management
;(Hurricane Zone,and where pressure requirements as Institute
Idetermined by ASCE 7,does not exceed the design Created by Independent Third Party:
j!pressures listed. 12'-0"x 6-8"max nominal size. Evaluation Reports
''Hurricane protective system required in HVHZ,but not FL8228 R7 AE 502A.Pdf
[required in the Wind Borne Debris Region. See DWG-MA- Created by Independent Third Party:Yes
[�1`1_0160-07 for additional information.
8228.4Fiberglass Side-Hinged Door Unit 6'-8"Opaque Outswing Single or Double Door w/or w/o
Sidelites
i Limits of Use Certification Agency Certificate
Approved for use in HVHK.Yes FL8228 R7 C CAC N1006900.01.udf
ii Approved for use outside HVHZ:Yes Quality Assurance Contract Expiration Date
Impact Resistant:Yes 12/31/2020
Design Pressure: +55.0,/-50.5 Installation Instructions
[Other: Evaluated for use in locations adhering to the FL82?3 R7 11 FL0160Dx.pdf
!!Florida Building Code includln,l the High Velocity Verified By: National Accreditation&Management
!Hurricane Zone,and where pressure requirements as Institute
determined by ASCE 7,does not exceed the design Created by Independent Third Party:
jlpressures listed. 12'-0"x 6'-8"max nominal size. Evaluation Reports
iHurricane protective system required in HVHZ,but not FI-82?8 R7 AE 502A.ndf
!required in the Wind Borne Debris Region.See DWG-MA- Created by Independent Third Party:Yes
4iFL0160-07 for additional information.
[8228.5 Fiberglass Side-Hinged Door Unit "Opaque Inswing Single or Double Door w/or w/o
8' 0
I _ Sidelites
;Limits of Use Certification Agency Certificate
I Approved for use in HVHT..:Yes -� FL82:18 R7 C CAC N1006900.02.pdf
https://www.floi•idabui I(]ing.org/pr/pr_app_dtl.aspx?paraln=wGE,VXQwtDquftCwaMPtp3T... 5/5/2015
Florida Building Code Online Page 3 of 5
Approved for use outside HVHZ:Yes Quality Assurance Contract Expiration Date
Impact Resistant:Yes 12/31/2020
Design Pressure: +50.5/-50.5 Installation Instructions
i Other: Evaluated for use in locations adhering to the FL8228 R7 II FL0167.Dx.pdf
Florida Building Code including the High Velocity Verified By: National Accreditation&Management
Hurricane Zone,and where pressure requirements as Institute
determined by ASCE 7,does not exceed the design Created by Independent Third Party:
pressures listed. 12'-0"x 8'-0"max nominal size. Evaluation Reports
Hurricane protective system required in HVHZ,but not FI-8238 R7 AE 501A.pdf
I required in the Wind Borne Debris Region.See DWG-MA- Created by Independent Third Party: Yes
I,FL0161-07 for additional information.
18228.6 Fiberglass Side-Hinged Door Unit 8'-0"Opaque Outswing Single or Double Door w/or w/o
li Sidelit.es
(Limits of Use Certification Agency Certificate
Approved for use in HVHZYes FL8228 R7 C CAC NI006900.02.1)df
Approved for use outside HVHZ:Yes Quality Assurance Contract Expiration Date
impact Resistant:Yes 12/31/2020
Design Pressure: +55.0/-50.5 Installation Instructions
i Other:Evaluated for use in locations adhering to the FL32:?8 R7 11 FL0161DX"pdf
Florida Building Code including the High Velocity Verified By: National Accreditation&Management
Hurricane Zone,and where pressure requirements as Institute
determined by ASCE 7,does not exceed the design Created by Independent Third Party:
i1pressures listed. 12'-0"x 8'-0"max nominal size. Evaluation Reports
Hurricane protective system r:quired in HVHZ,but not FL82.?8 R7 AE 501A.pdf
(required in the Wind Borne Debris Region.See DWG-MA- Created by Independent Third Party:Yes
1FL0161-07 for additional information.
!'8228.7 Fiberglass Side-Hinged Door Unit 6'-8"Glazed Inswing Single or Double Door w/or w/o
Sidelit.es
Limits of Use Certification Agency Certificate
Approved for use in HVHi:.Yes FI=8228 R7 C CAC NI006900.03.pdf
!!approved for use outside HVHZ:Yes Quality Assurance Contract Expiration Date
impact Resistant: No 12/31/2020
i;Design Pressure: +52.0/-52.0 Installation Instructions
Other: Evaluated for use in locations adhering to the FL82:?8 R7 II FL0162Dx.pdf
Florida Building Code including the High Velocity Verified By: National Accreditation&Management
Hurricane Zone,and where pressure requirements as Institute
idetermined by ASCE 7,does not exceed the design Created by Independent Third Party:
1pressures listed. 12'-0"x 6'-8"max nominal size. Evaluation Reports
Hurricane protective system required in HVHZ and the FL8228 R7 AE 502A.pdf
;Wind Borne Debris Region.See DWG-MA-FL0162-07 for Created by Independent Third Party:Yes
;!additional information.
18228.8 Fiberglass Side-Hinged Door Unit 6' 8"Glazed Outswing Single or Double Door w/or w/o
i_ Sidelites
Limits of Use Certification Agency Certificate
Approved for use in HVHi:: Yes FL82:t3 R7 C CAC NI006900.03.odf
Ii Approved for use outside HVHZ:Yes Quality Assurance Contract Expiration Date
Impact Resistant: No 12/31/2020
iDesign Pressure: +55.0/-55.0 Installation Instructions
Other: Evaluated for use in locations adhering to the FL82 28 R7 II FL0162Dx.pdf
Florida Building Code including the High Velocity Verified By: National Accreditation&Management
Hurricane Zone,and where pressure requirements as Institute
determined by ASCE 7,does not exceed the design Created by Independent Third Party:
pressures listed. 12'-0"x 6'-B"max nominal size. Evaluation Reports
Hurricane protective system required in HVHZ and the FL82:�8 R7 AE 502A.13df
Wind Borne Debris Region.See DWG-MA-FL0162-07 for Created by Independent Third Party:Yes
!additional information.
( FibercI ass Side-Hinged Door Unit 8'-0"Glazed Inswing Single or Double Door w/or w/o
18228.9
)I Sidelites
jlLimits of Use Certification Agency Certificate
I•Approved for use in HVHT: Yes FL82>8 R7 C CAC NI0�6900_04�df
Approved for use outside HVHZ:Yes Quality Assurance Contract Expiration Date
�!Impact Resistant:No 12/3'./2020
!!Design Pressure: +40.0/-45.0 Installation Instructions
Other: Evaluated for use in locations adhering to the FI-82:.1._8 R7 Ii FLO163Dx.odf
iFlorida Building Code including the High Velocity Verified By: National Accreditation&Management
lHurricane Zone,and where pressure requirements as Institute
;idetermined by ASCE 7,does not exceed the design Created by Independent Third Party:
11pressures listed. 12'-0"x 8'-0"max nominal size. Evaluation Reports
lHurricane protective system required in HVHZ and the Ft-8228 R7 AE 501A.1)df
Wind Borne Debris Region.See DWG-MA-FL0163-07 for Created by Independent Third Party:Yes
jiadditional information. _
8228.10 Fiberc1:ass Side-Hinged Door Unit 8'-0"Glazed Outswing Single or Double Door w/or w/o
Sidelites
Limits of Use Certification Agency Certificate
(l Approved for use in HVHZ'.:Yes FL8228 R7 C CAC NI006900.04.odf
i Approved for use outside HVHZ:Yes Quality Assurance Contract Expiration Date
https://www.floridabui lding.org/pr/pr_app_dti.aspx?param=wGE;VXQwtDquftCwaMPtp3T... 5/5/2015
Florida Building Code Online Page 4 of 5
Impact Resistant:No 12/31/2020
Design Pressure: +43.0/-47.0 Installation Instructions
Other: Evaluated for use in locations adhering to the FL8228 R7 1I FL0163Dx.gdf
Florida Building Code including the High Velocity Verified By: National Accreditation&Management
Hurricane Zone,and where pressure requirements as Institute
determined by ASCE 7,does not exceed the design Created by Independent Third Party:
Pressures listed. 12'-0"x 8'-0"max nominal size. Evaluation Reports
Hurricane protective system required in H'/HZ and the FL8228 R7 AE 501A.pLif
j Wind Borne Debris Region. See DWG-MA-FL0163-07 for Created by Independent Third Party:Yes
additional information.
!8228.11 =Fiberglass Side-Hinged Door Unit 6'-8Impact Glazed Inswing Single or Double Door w/or
i w/o Sidelites
l�
Limits of Use Certification Agency Certificate
Approved for use in HVHZ.: No FL8228_R7 C CAC NI006900.05.0f
Approved for use outside HVHZ:Yes Quality Assurance Contract Expiration Date
Impact Resistant:Yes 12/31/2020
Design Pressure: +52.0/-52.0 Installation Instructions
Other: Evaluated for use in locations adhering to the FL8228 R7 11 F1_0162D2i df
Florida Building Code not including the High Velocity Verified By: National Accreditation&Management
Hurricane Zone,and where pressure requirements as Institute
determined by ASCE 7 do not exceed the design Created by Independent Third Party:
!,pressures listed. 12'-0"x 6'-8"max nominal size.See Evaluation Reports
DWG-MA-FLO162-07 for additional information. FL82;',.3 R7 AE 502A.p.df
Created by Independent Third Party:Yes
18228.12 Fiberglass Side Hinged Door Unit 6'-8"Impact Glazed Outswing Single or Double Door w/
II C or w/o Sidelites
Limits of Use Certification Agency Certificate
Approved for use in HVEIZ: No FI-8278 R7 C CAC NIo06900.05.1pdf
Approved for use outside HVHZ:Yes Quality Assurance Contract Expiration Date
Impact Resistant:Yes 12/31/2020
Design Pressure: +55.0/-55.0 Installation Instructions
Other: Evaluated for use in locations adhering to the FL82')S R7 11 FL0162Dx. cif
Florida Building Code not including the High Velocity Verified By: National Accreditation&Management
Hurricane Zone,and where pressure requirements as Institute
determined by ASCE 7 do not exceed the design Created by Independent Third Party:
!pressures listed. 12'-0"x 6-13"max nominal size.See Evaluation Reports
DWG-MA-FL0162-07 for additional information. FI-82:18 R7 AE 502A.t?df
Created by Independent Third Party:Yes
18228.13 Fiberglass Side-Hinged Door Unit 8'-0"Impact Glazed Inswing Single or Double Door w/or
w/o Sidelites
!Limits of Use Certification Agency Certificate
Approved for use in HVHE", No FL82 28 R7 C CAC NI006900.06.odf
Approved for use outside HVHZ:Yes Quality Assurance Contract Expiration Date
Impact Resistant:Yes 12/31/2020
Design Pressure: +40.0/-45.0 Installation Instructions
Other: Evaluated for use in locations adhering to the FL82 t8 R7 11 FL0163Dx.111
Florida Building Code not including the High Velocity Verified By: National Accreditation&Management
ilHurricane Zone,and where pressure requirements as Institute
Idetermined by ASCE 7 do not exceed the design Created by Independent Third Party:
!pressures listed. 12'-0"x 8'-0"max nominal size.See Evaluation Reports
DWG-MA-FLO163-07 for additional information. FL81:8 R7 AE 501A.udf
i Created by Independent Third Party:Yes
�i8228.14tFiberglass Side-Hinged Door Unit 8'-0' Impact Glazed Outswing Single or Double Door w/
or w/o Sidelites
1 Limits of Use T Certification Agency Certificate
Approved for use in HVIFU': No FL82 28 R7 C CAC NI006900.06.1)df
Approved for use outside HVHZ:Yes Quality Assurance Contract Expiration Date
Impact Resistant:Yes 12/31/2020
Design Pressure: +43.0/-,17.0 Installation Instructions
Other: Evaluated for use in locations adhering to the FL82.23 R7 11 FLO163L?x.pLif
jlFlorida Building Code not including the High Velocity Verified By: National Accreditation&Management
j'Hurricane Zone,and where pressure requirements as Institute
(determined by ASCE 7 do not exceed the design Created by Independent Third Party:
pressures listed. 12'-0"x 8'-0"max nominal size.See Evaluation Reports
DWG-MA-FL0163-07 for additional information. 818228 R7 AE 501A.odf
II Created by Independent Third Party.Yes
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Contact Us::1940 North Monroe Street.Tallahassee FL 32399 Phone:850-487-1824
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Under Florida law,email addresses are public records.If you do not want your e-mail address released in response to a public-records request,do not
send electronic mail to this entity.Instead,contact the office by phone or by traditional mail.If you have any questions,please contact 850.487.1395.
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Florida Building Code Online Page 5 of 5
'Pursuant to Section 455.275(1),Flor.da Statutes,effective October 1,2012,licensees licensed under Chapter 455,F.S.must provide the Department
with an email address if they have one.The emails provided may be used for official communication with the licensee.However email addresses are public
record.If you do not wish to supply a personal address,please provide the Department with an email address which can be made available to the public.
To determine if you are a licensee under Chapter 455,F.S.,please click here.
Product Approval Accepts:
:.n 15-R70 gChe:k M
sccuritvm:tic"
https://www.floridabLii lding,.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDquftCwaMPtp3T... 5/5/2015