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Application Type Revision L ,j
Code Version 2017 ST. LUCIE COUNTY BUILDING ,DIV N
Application Status ApprofWVIEWED FOR COMPLIANCES
Comments
Archived
v-q%d
CONCBAL,EE) FA WWWEA` XCHMENTS
ARE THE RESPONSIBILITY OF THE
CONTRACTOR OR RECORD
Authorized Signature
Technical Representative
Address/Phone/Email
Quality Assurance Representative
Address/Phone/Email
&-tegory-
Subca g9ry
Compliance Method
DATE I tV #- 1 61c.1L-1
PLANS AND PERMIT MUST BE KEP)foN JOB
0 SITE OR.NO INSPECTIONS) WI - MADE
-ROWYGL=ASS-USA
1111 W. Newport Center Drive
Deerfield Beach, FL 33442
(954) 233-1378 Ext242
alender@polyglass.com
Ariel Lender
alender@polyglass.com
Maury Alpert
1111 W. Newport Center Drive
Deerfield Beach, FL 33442
(912) 429-8610
MAlpert@polyglass.com
Ariel Lender
1111 W. Newport Center Drive
Deerfield Beach, FL 33442
(954) 233-1230
ALender@polyglass.com
Roobo ingv- ,
-6—nd-er1Ny-ment6--
Evaluation Report from a Florida Registered Architect or a Licensed Florida
Professional Engineer
t � Evaluation Report - Hardcopy Received
Florida Engineer or Architect Name who developed the Robert Nieminen
Evaluation Report
Florida License PE-59166
Quality Assurance Entity UL LLC
Quality Assurance Contract Expiration Date 10/05/2018
Validated By John W. Knezevich, PE
I Validation Checklist - Hardcopy Received
Certificate of Independence
Referenced Standard and Year (of Standard)
_5t IPLANS AND ALL PROPOSED WORK
5U RED PY IELD INSPECTORS THAT
Y BE NECESSARY IN ORDER TO
MPLY WITH ALL APPLICABLE CODES.
FL5259 R28 COI 2018 01 COI NIEMINEN.pdf
Standard
Year
ASTM D1970
2015
ASTM D226
2009
ASTM D4798
2011
ASTM 66164
2011
ASTM D6222
2011
FM 4474
2011
FRSA/TRI April 2012
2012
UL 1897
2012
r� t
'S
Equivalence of Product Standards
Certified By u i
Sections from the Code
Product Approval Method Method 1 Option D
Date Submitted 01/24/2018
. Date Validated 01/29/2018
,I
_ Date Pending FBC Approval i 01/30/2018
Date Approved 04/10/2018
R Summary' of Products
FL #
Model, Number or.Name
Description
5259.1
Polyglass Roof
Roofing underlayments
Underlayments
Limits of Use
Installation Instructions
Approved for use in HVHZ: No
FL5259 R28 II 2018 01 FINAL ER POLYGLASS UNDERLAYMENTS FL5259-
R28.pdf
Approved for use outside HVHZ: Yes
Impact Resistant: N/A
Verified By: Robert Nieminen PE-59166
Design Pressure: +N/A/-622.5
Created by Independent Third Party: Yes
Other: 1.) The design pressure in this
Evaluation Reports
application relates to one particular
FL5259 R28 AE 2018 01 FINAL ER POLYGLASS UNDERLAYMENTS' FL5259-
R28.pdf
underlayment system (over concrete deck) for
use under foam -on tile systems (where the
Created by Independent Third Party: Yes
underlayment forms part of the load -path).
Refer to ER Section 5.6.4 for other systems,
other deck types and associated maximum
design pressures. 2.) Refer to ER Section 5 for
other limits of use.
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