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HomeMy WebLinkAboutProduct Approval4/2d/2020 Florida Building Code Online Professional' Regulation BCIS Home y Log In User Registration i. Hot Topics i Submit Surcharge Stats & Facts ! PubLcations '. Contact Us I, SCIS Site Map Links search ba Product Approval " K �I USER: Public User Product Approval Menu Product or Application Search Application List Search Criteria Refine Search Code Version 2017 FLA 1654 Application Type ALL Product Manufacturer ALL Category ALL Subcategory ALL Application Status ALL Compliance Method ALL Quality Assurance Entlty ALL Quality Assurance Entity Contract Expired ALL Product Model, Number or Name ALL Product Description ALL Approved for use in HVHZ ALL Approved for use outside HVHZ ALL Impact Resistant ALL Design Pressure ALL Other ALL 5taarrh Racuita � Annlieafil nc u,nu..... a ucwrasar N.. Contact Us :: 2601 Blair Stone Road, Tallahassee FL 32399 Pte: ?50-487-1824 The State of Florida is an AA/EEO employer. _�gpyright 2047-2013 Skate cf Florida.:: Pri Statement :: A sibifi Statement :: Refund Statement - 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 850.4$7.1395. *Pursuant to Section 455.275ti), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, E.S. must provide the Department with an email address if they have one. The emails provided may he 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, FS., please click here . Product Approval Accepts: -eCheck Credit Card Safe 1")� k' CW https://fioridabuilding.org/pr/pr app_Ist.aspx 11l Type Manufacturer V lidated By Status FL1654-R26 Revision POLYGLASS LISA John W. Knezevich, PE Approved History_ Category: Roofing (954) 772-6224 Subcategory: Modified Bitumen Roof System u,nu..... a ucwrasar N.. Contact Us :: 2601 Blair Stone Road, Tallahassee FL 32399 Pte: ?50-487-1824 The State of Florida is an AA/EEO employer. _�gpyright 2047-2013 Skate cf Florida.:: Pri Statement :: A sibifi Statement :: Refund Statement - 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 850.4$7.1395. *Pursuant to Section 455.275ti), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, E.S. must provide the Department with an email address if they have one. The emails provided may he 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, FS., please click here . Product Approval Accepts: -eCheck Credit Card Safe 1")� k' CW https://fioridabuilding.org/pr/pr app_Ist.aspx 11l ENGINEER EVALUATE Polyglass USA, Inc. 1111 West Newport Center Drive Deerfield Beach, FL 33442 (954)233-1230 NEMO I etc. Certificate of Authorization #32455 353 Christian Street, Unit #13 Oxford, CT 06478 (203) 262-9245 TEST CONSULT CERTIFY Evaluation Report P9290.02-08-1124 FL1654-R26 Date of Issuance: 02/11/2008 Revision 24: 10/14/2019 SCOPE: This Evaluation Report is issued under Rule 61G20-3 and the applicable rules and regulations governing the use of construction materials in the State of Florida. The documentation submitted has been reviewed by Robert Nieminen, P.E. for use of the product under the Florida Building Code. The product described herein has been evaluated for compliance with the 6th Edition (2017) Florida Building Code sections noted herein. DESCRIPTION: Polyglass SBS and APP Modified Bitumen Roof Systems LABELING: Labeling shall be in accordance with the requirements of the Accredited Quality Assurance Agency noted herein. CONTINUED COMPLIANCE: This Evaluation Report is valid until such time as the named product(s) changes, the referenced Quality Assurance documentation changes, or provisions of the Code that relate to the product change. Acceptance of this Evaluation Report by the named client constitutes agreement to notify Robert Nieminen, P.E. of any changes to the product(s), the Quality Assurance or the production facility location(s), NEMO I etc. requires a complete review of this Evaluation Report relative to updated Code requirements with each Code Cycle. ADVERTISEMENT: The Evaluation Report number preceded by the words "NEMO Ietc. Evaluated" may be displayed in advertising literature. If any portion of the Evaluation Report is displayed, then it shall be done in its entirety. INSPECTION: Upon request, a copy of this entire Evaluation Report shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This Evaluation Report consists of pages 1 through 5, plus an 81 -page Appendix. Prepared by: -- ;.;rrrrF,, I_ t - Robert J.M. Nieminen, P.E. ' �¢ . Florida Registration No. 59156, Florida DCA ANE1983 The facsimile seal appearing was authorized by Robert ° ;°�,, v !Nieminen, P -E. on 10/14/2019. This does not serve as an I e e=onically signed document, CERTIFICATION OF INDEPENDENCE: I. NEMO ETC, LLC does not have, nor does it intend to acquire or will it acquire, a financial interest in any company manufacturing or distributing products it evaluates. 2. NEW ETC, LLC is not owned, operated or controlled by any company manufacturing or distributing products it evaluates. 3. Robert Nieminen, P.E. does not have nor will acquire, a financial interest in any company manufacturing or distributing products for which the evaluation reports are being issued. 4. Robert Nieminen, F.E. does not have, nor will acquire, a financial interest in any other entity involved in the approval process of the product. 5. This is a building code evaluation. Neither NEMC) ETC, LLC nor Robert Nieminen, P.E. are, in any way, the designer of Record for any project on which this Evaluation Report, or previous versions thereof, is/was used for permitting or design guidance unless retained specifically for that purpose. :)2018, NEW ETC, LLC ROOFING SYSTEMS EVALUATION: SCOPE'1. Product Category: Roofing Sub -Category: Modified Bitumen Roof Systems NNEMOIetc. Compliance Statement: Polyglass SBS and APP Modified Bitumen Roof Systems, as produced by Polyglass LISA, Inc., have demonstrated compliance with the following sections of the 6th Edition (2017) Florida Building Code through testing in accordance with the following Standards. Compliance is subject to the Installation Requirements and Limitations J Conditions of Use set forth herein. 2. STANDARDS: Section Property Standard Year 1504.3.1 Wind FM 4474 2011 1504.3.1 Wind UL 1897 2012 1504.7 Impact FM 4470 2012 1507.10.2 Physicals ASTM D4997 2001 1507.11.2 Physicals ASTM D6162 2008 1507.11.2 Physicals ASTM D6163 2008 1507.11.2 Physicals ASTM D6164 2011 1507.11.2 Physicals ASTM D6222 2011 1507.11.2 Physicals ASTM D6509 2009 3. REFERENCES: Entity Exam Reference Date Enti Exam Reference Date ERD (TST6049) Physicals P10490.10.08-2 10/30/2008 FM (TST1867) FM 4470 3006115 05/02/2001 ERD(TST5049) FM 4470/4474 P13760.09.09 09/10/2009 FM ITST1867) FM 4470 3012321 07/29/2002 ERD (TST6049) FM 4470/4474 P13770.09.09 09/10/2009 FM (TST1867) FM 4470 3014692 08/05/2003 ERD(TST60491 FM 4470/4474 P30540.11.09-131 11/30/2009 FM (TST1867) FM 4470 3014751 08/27/2003 ERD(TST6049) FM 4470/4474 P30550,12.09 12/02/2009 FM (TST1867) FM 4470 3007170 OV13/2004 ERD(TSTG049) Physicals P33960.12.10 12/30/2010 FM (TST1867) FM 4470 3019317 06/30/2004 ERD (TST6049) FM 4470/4474 P33970.03.11 03/15/2011 FM (TST1867) FM 4470 3020703 07/30/2004 ERD (TST6049) Physica}s P37590.03.13 -3A 03/06/2013 FM (TST1867) FM 4470/4474 3018332 01/31/2006 ERD(TST6049) FM 4470/4474 P39680.03.13 03/04/2013 FM (TST1857) FM 4470/4474 3023368 03/20/2006 ERD(TST6049) Physicals P37590.03.13 -1-R1 06/26/2013 FM (TST1867) FM 4470/4474 3024594 05/23/2006 ERD (TST6049) Physicals P37590,03.13 -2-R1 07/01/2013 FM (TST1867) FM 4470/4474 3023458 07/18/2006 ERD(TST6049) Physicals P37590.07.13.2 07/01/2013 FM (TST1867) FM 4470/4474 3030668 09/12/2007 FRO(TST6049) Physicals P37590.03.13 -5-R1 07/01/2013 FM (TST1867) FM 4470/4474 3032172 06/12/2009 ERD (TST6049) Physicals P37590.07.13-1 07/02/2013 FM (TST1867) FM 4470/4474 3049631 04/21/2014 ERD (TST6049) FM 4470/4474 P41630.08.13 08/06/2013 FM (TST1867) FM 4470/4474 3057029 02/02/2017 ERD (TST6049) Physicals P45940.09.13 09/04/2013 MEMO (TST6049) Criticality 45-PLYG-18-001.05.18 36/23/2012 ERD (TST6049) Physicals P44370,10.13 10/04/2013 NEMO (TST6049) FM 4474 4L-PLYG-18-003.08.18 08/21/2018 ERD (TST6049) Physicals P39520.09.14-2 09/11/2014 NEMO (TST6049) Criticality 45-PLYG-18-001.10.18 10/03/2018 ERD (TST6049) FM 4470/4474 SC6160.11.14 11/10/2014 NEMO (TST6049) ASTM D4897 45-PLYG-18-00211.18-2 11/16/2018 ERD (TST6049) Physicals P45440SC.03.15-1 03/31/2015 NEMO (TST6049) ASTM D6164 45-PLYG-18-002.11.28-3 11/28/2018 ERD (TST6049) Physicals SC5170.05.15 05/08/2015 NEMO (TST6049) FM 4474 4L-PLYG-18-003.11.18 11/28/2018 ERD 17576049) FM 4474 SC8085.05.15 05/19/2015 NEMO (75TG049) FM 4474 4141LYG-18-003.01.19 01/1112019 ERD (TST5049) Physicals SC5170.12.15 12/29/2015 NEMO (TST6049) ASTM D6163 45-PLYG-18-002.01.19-A 01/24/2019 ERD (TST6049) FM 4470/4474 SC9455.15 04/01/2016 NEMO (TST6049) ASTM D6162 4S-PLYG-13-002.01.79-B 01/25/2019 ERD (TST6049) FM 4470/4474 PLYG-SC8905.05.16-1 05/17/2016 NEMO (TST6049) FM 4474 4L-PLYG-18-003.04.19-A 04/08/2019 ERD (TST6049) FM 4470/4474 PLYG-SC8905.05.16-2 05/17/2016 MEMO (TST6049) ASTM D6222 4S-PLYG-18-002.05.19-C 05/20/2019 ERD (TST6049) FM 4470/4474 PLYG-SC10815.07.19-R1 09/23/2016 NEMO (TST6049) ASTM 06222 4S-PLYG-18-002.05.19-D 05/20/2019 ERD (TST6049) UL 1897 PLYG-SC12025.10.15 10/12/2016 NEMO (7576049) ASTM D6163 4S-PLYG-18-00205-19-H 05/20/2019 ERD JST6049) FM 4470/4474 PLYG-5[11475.16 11/17/2016 NEMO (TST6049) ASTM D6164 45-PLYG-18-002.05.19-N 05/31/2019 FRO (TST6049) FM 4470/4474 PLYG-SC13235.01.17 01/17/2017 NEMO MT6C49) Criticality 45-PLYG-18-001.06.19.A 07/17/2019 ERD (TST6049) FM 4470/4474 PLYG-SC13920.05.17 05/30/2017 NEMO (TST6049) ASTM D6164 45-PLYG-18-002.09.19-1 09/06/2019 ERD (TST11294) FM 4470/4474 PLYG-CTL13945.M.17-1 05/30/2017 NEMO (TST6049) ASTM D6164 4S-PLYG-18-002.09.19-J 091D6/2019 EAB fT5T11294) FM 447014474 PLYG-CrL13945.05.17-3 05130/2027 PRJ(TST5878) Physicals Pi.) )SA-062-02-02 2210412007 ERD(TST6049) FM 4470/4474 PLYG-SC13945.05.17 05/30/2017 PRI(TSTS878) Physicals PUSA-061-02-02 01/28/2008 ERD (TST6049) FM 4470/4474 PLYG-SC15760.09,17 09/11/2017 PRI(TST5878) Physicals PUSA-064-02-02 02/27/2008 FM (TST1867) FM 4470 2W7A7,AM 08/04/1994 PRI(TST5878) Physicals PUSA-062-02-02 12/04/2008 FM (TST1867) FM 4470 OD3A3.AM 04/04/1997 PRI (TST5878) TAS 114 PUSA-188-02-01 02/08/2017 FM (TST1867) FM 4470 2DOAO.AM 12/23/1998 PRI (TST5878) TAS 114 PUSA-188-02-02 02/08/2017 FM (TST1867) FM 4470 2D5A9.AM 06/22/1999 PM (TST5878) TA5 114 PUSA-188-02-03 02/0812017 FM (TST1867) FM 4470 3006646 01/04/2000 PRI (TST5878) TAS 114 PUSA-202-02-01 05/17/2017 FM (TST1867) FM 4470 3001334 01/25/2000 PRI (TST5878) TAS 114 PUSA-21)2-02-02 05/17/2017 NEMO ETC, LLC Evaluation Report P9290.02.08-1324 Certificate ofAuthorizotion #32455 6" EDITION (2017) FBC NON-HVHZ EVALUATION FL1654-R26 Polyglass Modified Bitumen Roof Systems; (954) 233-1330 Revision 24: 1.0/14/2019 Page 2 of 5 ONEMO I etc. EntitV Exam Reference Date En_..#ice Exam Reference Date FM (TST1867) FM 4470 3001334 02/15120DO M-13(CER1592) HVHZ Various NOAs Various FM (TST1867) rM 4470 3000857 01/12/2000 M-D(CER1592) Prop. for Rev. 10-0823 10/12/2010 FM (TST1867) FM 4470 3004091 01/12/2000 UL (QUA9625) Quality Control Service Confirm 09/13/2018 4. PRODUCT DESCRIPTION: — This Evaluation Report covers Polyglass Modified Bitumen Roof Systems installed in accordance with Polyglass USA, Inc. Published installation instructions and the Limitations / Conditions of Use herein. The following Polvglass ABU A: KULL-t2DODS FOR POLYGLASS MODIFIED BITUMEN ROOF SYSTEMS Product Specification Reference Grade Type Elastovent ASTM D4897 N/A N/A Polyglass G2 Base ASTM D4601 N/A II Polyflex SA Base ASTM D4601 N/A 11 Elastobase SA ASTM D4601 N/A it ASTM D6163, Table 2 S I Polyglass Base ASTM D6509 N/A N/A Elastoshield HT ASTM D6162 5 111 Elastoshield HT G ASTM D6162 G III Elastoshield HT G FR ASTM D6162 G III Elastobase ASTM D6163 S I Elastoflex V ASTM D6163 S I Elastoflex SA V ASTM D6163 5 I Elastoflex SA V FR ASTM D6163 5 1 Elastoflex SA V Plus ASTM D6163 S i Elastoflex SA V Plus FR ASTM D6163 S I Elastobase P ASTM D6164 S l Elastoflex SA Base HD ASTM D6164 S Elastoflex 56 ASTM D6164 S I Elastoflex S6 HP ASTM D6164 S II Elastoflex V G ASTM D6163 G Elastoflex V G FR ASTM D6163 G I Elastoflex S6 G ASTM D6164 G I Elastoflex S6 G FR ASTM D6164 G I Polyfresko G SBS ASTM D6164 G I Polyfresko G 5BS FR ASTM D6164 G 1 Elastoshield TS G ASTM D6164 G Elastoshield TS G FR ASTM D6164 G I Elastoflex SA P ASTM D6164 G I Elastoflex SA P FR ASTM D6164 G Polyreflect ASTM D6164 S I NEMO ETC, LLC Evaluation Report P9290.02.08 -R24 Certificate ofAuthorization #32455 6"EDITION (2017) FBG NDN-HVHZ EVALUATION FL1654-R26 Polyglass Modified Bitumen Roof Systems, (954) 233-1330 Revision 24:10/14/2019 Page 3 of 5 TABLE 1 Type _ NEMO 1 etc. ROLL -GOODS FOR POLYGLASS MODIFIED BITUMEN ROOF SYSTEMS Product Specification Reference Grade Type Polyflex ASTM 06222 S I Polyflex G ASTM D6222 G I Polyflex G FR ASTM D6222 G I Polyfresko G ASTM D6222 G I Polyfresko G FR ASTM D6222 G 1 APR Membranes Polybond ASTM D6222 S I Polybond G ASTM D6222 G I Polyflex 5A P ASTM 06222 G I Polyflex SA P FR ASTM D6222 G f Polyfresko G SA ASTM 06222 G I Polyfresko G SA FR ASTM 06222 G 1 Polykool ASTM D6222 S I 5.1 This is a building code evaluation. Neither NEW ETC, LLC nor Robert Nieminen, P.E. are, in any way, the Designer of Record for any project on which this Evaluation Report, or previous versions thereof, is/was used for permitting or design guidance unless retained specifically for that purpose. 5.2 This Evaluation Report is not for use in FBC HVHZ jurisdictions. 5.3 Refer to a current Approved Roofing Materials Directory for fire ratings of this product. 5.4 For steel deck installations, foam plastic insulation shall be separated from the building interior in accordance with FBC 2603.4 unless the exceptions stated in FBC 2603.4.1 and 2603.6 apply, 5.5 The roof system evaluation herein pertains to above -deck roof components. Roof decks and structural members shall be in accordance with FBC requirements to the satisfaction of the Authority Having Jurisdiction. Load resistance of the roof deck shall be documented through proper codified and/or FBC Approval documentation. 5.6 For recover installations, the existing roof shall be examined in accordance with FSC 1511. 5.7 For mechanically attached insulation or membrane or strip -bonded insulation, the maximum design pressure for the selected assembly shall meet or exceed the Zone 1 design pressure determined in accordance with FBC Chapter 16. Zones 2 and 3 shall employ an attachment density designed by a qualified design professional to resist the elevated pressure criteria. Commonly used methods are ANS!/SPRI WD1, FM Loss Prevention Data Sheet 1-29, Roofing Application Standard RAS 117 and Roofing Application Standard RAS 137. Assemblies marked with an asterisk* carry the limitations set forth in Section 2.2.10.1 of FM Loss Prevention Data Sheet 1-29 (January 2016) for Zone 2/3 enhancements. 5.8 For assemblies with all components fully bonded in place, the maximum design pressure for the selected assembly shall meet or exceed critical design pressure determined in accordance with FBC Chapter 16, No rational analysis is permitted for these systems. 5.9 For mechanically attached insulation or membrane over existing roof decks, fasteners shall be tested in the existing deck for withdrawal resistance. A qualified design professional shall review the data for comparison to the minimum requirements for the system. Testing and analysis shall be in accordance with ANSI/SPRI FX -1 or Testing Application Standard TAS 105. 5.10 For bonded insulation or membrane over existing substrates in a re -roof (tear off) or recover installation, the existing deck or existing roof surface shall be examined for compatibility with the adhesive to be installed. If any surface conditions exist that bring system performance into question, field uplift testing in accordance with ANSI/SPRI IA -1, ASTM E907, FM Loss Prevention Data Sheet 1-52 or Testing Application Standard TAS 124 shall be conducted on mock-ups of the proposed new roof assembly. NEMO FTC, LLC certificate of Authorization #32455 Evaluation Report P9290.02,08 -R24 6T" EDITION (2017) FBC IUON•HVHZ EVALUATION FL1654-R26 Polyglass Modified Bitumen Roof Systems; (954) 233-1330 Revision 24: 10/14/2019 Page 4 of 5 NMEMO I etc. 5.11 For bonded insulation or membrane over existing substrates in a recover installation, the existing roof system shall be capable of resisting project design pressures on its own merit to the satisfaction of the Authority Having Jurisdiction, as documented through field uplift testing in accordance with ASTM E907, FM Loss Prevention Data Sheet 1-52 or Testing Application Standard TAS 124. 5.12 Metal edge attachment (except gutters), shall be designed and installed for wind loads in accordance with FBC Chapter 16 and tested for resistance in accordance with ANSI/SPRI ES -1 or Roofing Application Standard RAS 111, except the basic wind speed shall be determined from FBC Figure 1609.3(1), 1609.3(2) or 1609.3(3). 5.13 All products in the roof assembly shall have quality assurance in accordance with FAC Rule 61G20-3. For non- Polyglass components listed within wind uplift rated assemblies in Appendix 1, refer to the Product Approval of the component manufacturer. 6.1 Polyglass Modified Bitumen Roof Systems shall be installed in accordance with Polyglass USA, Inc. published installation instructions, subject to the Limitations / Conditions of Use noted herein. 6.2 System attachment requirements for wind load resistance are set forth in Appendix 1. "MDP" - Maximum Design Pressure is the result of testing for wind load resistance based on allowable wind loads, and reflects the ultimate passing pressure divided by 2 (the 2 to 1 margin of safety per FBC 1504.9 has already been applied). Refer to FBC 1609 for determination of design wind loads. As required by the Building official or Authority Having Jurisdiction in order to properly evaluate the installation of this product. Contact the noted QA agency for information on product locations covered for F.A.C. Rule 61G20-3 QA requirements UL LLC -QUA9625; (314) 578-3406, k.chancellor@us.ul.com - THE 81 -PAGES THAT FOLLOW FORM PART OF THIS EVALUATION REPORT - NEMO ETC, LLC Evaluation Report P9290.02.08 -R24 Certificate OfAuthorization 1132455 6"' EDITION (201.7) FBC NON-HVHZ EVALUATION Polyglass Modified Bitumen Roof Systems; (954) 233-1330 FL1 Revision 24: 10/114/20194/2019 Page 5 of 5 mn O ry m LD 0 m rqw m mn n pp mb ry m mb m rn ct mn mll man n mb Op 00 LLI m r` v uai C3 ^ n n as o0 rn a n 4 LU z w` } 0 � U > o } v u x0 u U w u0 o °}' v o > a p m` v U O u c rr O cr o 4 fl w ° -° U u II U O O II O m '3 O' a OCA N O `y n' cC c mr c O > O II > p > II II O W 0 cc O ¢ c 0 mr O a s cc a v m v II u cs 0 u p u 'p] b > i7 > 61 a a I C C 0 C 4. 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SMITH, CLERK OF THE CIRCUIT COURT -- SAINT LUCIE COUNTY FILE # 4697032 OR BOOK 4407 PAGE 29, Recorded 04/08/2020 02:7.3:20 PM NOTICE OF COMMENCEMENT TO K COMPLETED WNEN CONSTRUCHON VALUE EXCEEDS W eo il6 OR WHEN 14 EAYIN6 OR AIR CONDMONMG REPAIR OR ItEPtACCMENT EXCMDE: $7.sao.60 stateaf Florida, County of Indian 1i€iver- The undersi ned here by gives notice that 713, Florida Stetutes, the following 10farImatiOn is provided in this Notic of COM,Mememenatvemerrc wilt be made to Certain real property, and in etwrtlance with Chapter I. Legal description of the property (ond camplete street address if avaifob(ej. 2. t~e end Ti tion of improtremen#: .. 'ZSlra `tk S . a 3. (DQwnerinformatiOnor 0Lessee information (,ftheLesseecontrartedforthe a. Pia me:. improvement): - 'i N2.1fn I�. Add rens: "' Ir t t, `%l, n -A (streetaddress) c. Interest in property: (campfete cityrlame) (state) (zip rode) d. blame & complete address Of fee simple titleholder (if different from Owner listed above): 4. Contractor: a. Name: b. Address:- 1Z_1 (sireetaddress) --•. �- �' �• -::rc- C. Phone number_ (complete city name) (stare) (zip code) S. Surety Company (if applicable a cope of the peryrrrent bond is attached): 4. Warne & Complete street address: b. Phone number. 6. Lender/Mortgage Company: Bond amount: a. Name & COmplete street address: b. Lender's phone number: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 71.3.13(1.)(a)7., Florida Statutes: a. rName & complete street address: b. Phone number: 8. In addition to himself or herself, Fax number; a. Owner designates of to receive a cagy Of the Lienor's Notice as provided in Section 713,13j1)(b), Florida Statutes. b. Phone number: �- Expiration date of notice of commencement: (the expiration date WWI be 1 year from the date of recordinp anless a different date rsspecifrred). ANY PAYMENTS MADE D THE ESUL'rI17t'rERl p ING T CE O IM RHE OTICE OF WARNING To awNER-, VEMEN COMMENCEMENT ARE CONSIPERE€7 LMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713_,_33 SEFDFLORIDA HE FIR T I SPE CAN . IF YOU IN YOUR PA71NG 1'kAr1iE FOR [IYFPROVEMlIV'TS TO YOUR PROPERTY. A NOTICE OF CONIMMCEMENT MUST BE RECORDED AND POSTED DN T}{ES{76 SITE BEF(7RE THE FIRST IlVSFECTION. IF YOU IPITEND TO D6TAIR FN(Ai LING, CONSULT W ITN YgUR LENDER OR AN ATTORNEY BEFORE COMMEPNOWU WORN OR RECORDING YOUR NOTICE OF C4MME!�9DrIENT. v r.�r ��t� �1 ignahtre o r3rvneror essee, r i7wnels or Lessee'sAathDrked OBimrIDirector/partnerlmanaoer 9 ) (SI F41 The foregoing irtstrumerlt was=knowledged before Rae this day of l 2C �"? Ery; Wrizee- a dna-,me of person sIgningabove} ��'-#r As;°f�Q For lit '; { f�Y1 _ Jeri (type of auahorrty e,g_ officer, truste4 at[nmey iRfact) {name of parry oR behoif of v;hom lnstmmenr wtedl ersona€ly lcrrnwn OR 0Produced Identification Type of ldentffication produced Notary signature F1 ori -7-1 Notary Printed Name ihlatary $cal =EDERORMMNotf FteridaCo41576MY C24. 2820