HomeMy WebLinkAboutUNIFORM PERMIT APPLICATIONROOF ASSEMBLIES AND ROOFTOP STRUCTURES
SECTION 1525
HIGH -VELOCITY HURRICANE ZONES - UNIFORM PERMIT APPLICATION
Florida Building Code 6th Edition (2017)
High -Velocity Hurricane Zone Uniform Permit Application Form.
INSTRUCTION PAGE SCANNED
BY
St. Lucie County
COMPLETE THE NECESSARY SECTIONS OF
THE UNIFORM ROOFING PERMIT
APPLICATION FORM AND ATTACH THE
REQUIRED DOCUMENTS AS NOTED BELOW:
Roof System
Required Sections of the
Permit Application Form
Attachments Required
See List Below
Low Slope Application
A,B,C
1,2,3,4,5,6,7
rescriptive BUR-RAS 150
A,B,C
4,5,6,7
Asphaaltic5StiIng as'S'
Concrete or Clay Tile
A,B,D,E
1,2,3,4,5,6,7
Metal Roofs
A,B,D
1,2,3,4,5,6,7
Wood Shingles and Shakes
A,B,D
1,2,4,5,6,7
Other
As Applicable
1,2,3,4,5,6,7
ATTACHMENTS REQUIRED:
I.
Fire Directory Listing Page
2.
From Product Approval:
Front Page
Specific System Description
Specific System Limitations
General Limitations
Applicable Detail Drawings
3.
Design Calculations per Chapter 16, or If Applicable, RAS 127 or RAS
4.
Other Component of Product Approval
5.
Municipal Permit Application
6.
Owners Notification for Roofing Considerations (Reroofing Only)
7.
Any Required Roof Testing/Calculation Documentation
FLORIDA BUILDING CODE 6th Edition (2017) — BUILDING
5.31
ROOF ASSEMBLIES AND ROOFTOP STRUCTURES
Master Permit
Florida Building Code 6th Edition (2017)
High -Velocity Hurricane Zone Uniform Permit Application Form.
Section A (General Information)
Process No.
Contractor's Name I U -4 s k e. d 11-n �-•
Job Addresscz�—lg(/''t�(%�i'"i�.,
ROOF CATEGORY
❑ Low Slope ❑ Mechanically Fastened Tile ❑ Mortar/Adhesive Set Tile
Asphaltic Shingles ❑ Metal Panel/Shingles ❑ Wood Shingles/Shakes
❑ Prescriptive BUR-RAS 150
ROOFTYPE
V.New Roof 0 Repair CI Maintenance 0 Reroofing IS Recovering
ROOF SYSTEM
INFORMATION
Low Slope Roof Area (SF) - Steep Sloped Roof Area (SF) L4 i� Total (SF)
Section B (Roof PIS
Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains.
Include dimensions of sections and levels, clearly identify dimensions of elevated pressure zones and location of
parapets.
15.32 FLORIDA BUILDING CODE 6th Edition (2017) — BUILDING
ROOF ASSEMBLIES AND ROOFTOP STRUCTURES
Florida Building Code 6th Edition (2017)
High -Velocity Hurricane Zone Uniform Permit Application Form.
Section C (Low Slone Application)
Fill in specific roof assembly components
and identify manufacturer
(If a component is not used, identify as "NA")
System Manufacturer:
Product Approval No.:
Design Wind Pressures, From RAS 128 or Calculations:
Pmax1: Pmax2: PmaX3:
Max. Design Pressure, from the specific Product
Approval system:
Deck:
Gauge/Thickness:
Anchor/Base Sheet & No. of Ply(s):
AnchorlBase Sheet Fastener/Bonding Material:
Insulation Base Layer.
Base Insulation Size and Thickness:
Base Insulation Fastener/Bonding Material
Top Insulation Layer:
Top Insulation Size and Thickness:
Top Insulation Fastener/Bonding Material:
Base Sheet(s) & No. of Ply(s):
Base Sheet Fastener/Bonding Material:
Ply Sheet(s) & No. of Ply(s):
Ply Sheet Fastener/Bonding Material:
Top Ply:
Top Ply Fastener/Bonding Material:
Surfacing:
Fastener Spacing for Anchor/Base Sheet Attachment:
Field: _" oc @ Lap, # Rows _ @ _" oc
Perimeter: _" oc @ Lap, # Rows _ @ _" oc
Corner: _" oc @ Lap, # Rows _ @ oc
Number of Fasteners Per Insulation Board:
Field_ Perimeter_ Corner
Illustrate Components Noted and Details as
Applicable:
Woodblocking, Gutter, Edge Termination, Stripping, Flashing,
Continuous Cleat, Cant Strip, Base Flashing, Counter -
Flashing, Coping, Etc.
Indicate: Mean Roof Height, Parapet Height, Height of Base
Flashing, Component Material, Material Thickness, Fastener
Type, Fastener Spacing or Submit
FLORIDA BUILDING CODE 6th Edition (2017) — BUILDING 15.33
ROOF ASSEMBLIES AND'ROOFTOP STRUCTURES
Florida Building Code Edition 6th Edition (2017)
High -Velocity Hurricane zone Uniform Permit APPlication Form.
Section D (Steep Sloped Roof System)
Roof System Manufacturer: NZ I A
Notice of Acceptance Number:
Minimum Design Wind Pressures, If Applicable (From RAS 127 or
Calculations
11: 33 P2: P3: 04
Steep Sloped Roof System Description
Deck Type:
Type Underlayment:
Rop� Slope: 5 � '� Q � � 3d (h ,
5�_. 12 Insulation: N
5i,ecl.
Fire Barrier: N r A S"hed
Ridge Ventila'o '.2 Fastener Type & Spacing: i
l�! I4- r'i Shank
Adhesive Type:ET
/I
GG-E �..c?i'll2 ri'f
Mean Roof Height:
Type Cap Sheet: N hh e
Roof Covering: .
\ Type & Size Drip
n Edge:
\ 9aldanized a"xa"
drib edges
15.34
FLORIDA BUILDING CODE 6th Edition (2017) — BUILDING
ROOF ASSEMBLIES AND ROOFTOP STRUCTURES
Florida Building Code 6th Edition (2017)
High -Velocity Hurricane Zone Uniform Permit Application Form.
Section E (Tile Calculations)
For Moment based dle systems, choose either Method.I or 2. Compare the values for Mr with the values from Mp If the Mt values are greater than or
equal to the Mr values, for each area of the roof, then the dle attachment method is acceptable.
Method I `Moment Based Tile Calculations Per RAS 127"
(Pt:-xL-=-)-Mg;-=Met- Product Approval Mf_
(72.-x2.- )-Mg:_=Mr2- Product Approval Mf_
(P3:-x).- )-Mg:_=Mr3_ Product Approval Mf-
Method 2 "Simpli6ed Tde Calculations Per Table Below"
Required Moment of Resistance (Mr) From Table Below Pn A.- a""..,...i ar.
Mr required Moment Resistance`
Mean Roof Height ->
Roof Slope
15,
20'
25'
30'
40'
2:12
34.4
36.5
38.2
39.7
42.2
3:12
32.2
34.4
36.0
37.4
39.8
4:12
30.4
32.2
33.8
36.1
\37.3
5:12
28A
30.1
31.6
32.8
34.9
6:12
26.4
28.0
29.4
30.5
32.4
7:12
24.4
25.9
27.1
28.2
30.0
*Must be used in conjunction with a list of moment based file systems endorsed by the Browsed County Board of Rules and Appeals:
For Uplift based did systems use Method3. Compared the values for with the values for Fr. IftheF values ere greaterthan or equal ro the Fr values,
for each area of the roof, than the the auachmenr method is acceptable.
Method 3 "Moment Based Tile Calculations Per RAS 127-
(PI:
x L_=_xw:=_)-W;_x
cas8
_=Fr1_
Product Approval F_
(P2:x
L_
=Xw:=_�-W;_x
Cos h-_=Fr2_
Product Approval F_
(Pv:
XL_
xwc= 1-w.
.....
Whereto Obtain Information
Description
Symbol
Where to find
Design Pressure
PI or P2 or P3
PAS 127 Table 1 or by an engineering analysis prepared by PE based on ASCE 7
Mean Roof Height
H
lob Site
Roof Slope
B
fob Site
Aerodynamic Multiplier
d
Product Approval
Restoring Moment duem
01.1y
Mg
Product Approval
Attachment Resistance
Mf
Product Approval
Required Momeni Resistance
M,
Calculated
Minimum Attachment
Resistance
F'
Product Approval
Required Uplift Resistance
Fr
Calculated
Average Tile Weight
W
Product Approval
Tile Dimensions
L=length
W = width
Product Approval
AR calculations must be submitted to the building official at the rime of permit appBcadon.
FLORIDA BUILDING CODE 6th Edition (2017) - BUILDING 15.35
SECTION 1524 -HIGH VELOCITY HURRICANE ZONES
REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS
1524.1 Scope. As it pertains to this section, it is the responsibility of the roofing contractor to provide the owner with
the required roofing permit, and to explain to the owner the content of this section. The provisions of Chapter 15 of
the Florida Building Code, Building govern the minimum requirements and standards of the industry for roofing
system installations. Additionally, the following items should be addressed as part of the agreement between the
owner and the contractor. The owner's initial in the designated space indicates -that the item has been explained.
1. Aesthetics -Workmanship: The workmanship provisions of Chapter 15 (High Velocity Hurricane Zone)
are for the purpose of providing that the roofing system meets the wind resistance and water intrusion performance
standards. Aesthetics (appearance) are not a consideration with respect to workmanship provisions. Aesthetic
issues such as color or architectural appearance, that are not part of a zoning code, should be addressed as part of
the agreement between the owner and the contractor.
2. Renafling Wood Decks: When replacing roofing, the existing wood roof deck may have to be renailed
in accordance with the current provisions of Chapter 16 (High Velocity Hurricane Zones) of the Florida Building
Code, Building. (The roof deck is usually concealed prior to removing the existing roof system).
3. Common Roofs: Common roofs are those which have no visible delineation between neighboring units
(i.e., townhouses, condominiums, etc.). In buildings with common roofs, the roofing contractor and/or owner should
notify the occupants of adjacent units of roofing work to be performed.
4. Exposed ceilings: Exposed, open beam ceilings are where the underside of the roof decking can be
viewed from below. The owner may wish to maintain the architectural appearance; therefore, roofing nail
penetrations of the underside of the decking may not be acceptable. The provides the option of maintaining this
appearance.
5. Pending Water: The current roof system and/or deck of the building may not drain well and may cause
water to pond (accumulate) in low-lying areas of the roof. Pending can be an indication of structural distress and
may require the review of a professional structural engineer. Pending may shorten the life expectancy and
performance of the new roofing system. Pending conditions may not be evident until the original roofing system is
removed. Pending conditions should be corrected.
6. Overflow Scuppers (wall outlets): It is required that rainwater flow off so that the roof is not overloaded
from a buildup of water. Perimeter/edge walls or other roof extensions may block this discharge If overflow
scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accordance with the
requirements of Chapter 16 and 16 herein and the Florida Building Code, Plumbing.
7. Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of
the structural assembly (the building itself). The existing amount of attic ventilation shall not be reduced.
Exception: Attic spaces, designed by a Florida licensed engineer or registered architect to eliminate the attic
venting, venting shall not be required.
COMMENTS:
Owner's/Agent's ignature D to ontractk-nature
City of Plantation
Rev. 03/15/12
Owner's/Agent's ignature D to ontractk-nature
City of Plantation
Rev. 03/15/12
UL. Evaluation Report
UL ER2453-02
Issued: April 5, 2017
Visit We On -Line certifications Dlreetorr. Www.ul.com/erdirectorV
for current status of Report
UL Category Code: ULEZ
CSI MasterFormatal
DIVISION:
07 00 00 —THERMAL AND MOISTURE
Sublevel 2:
07 30 00 — Steep Slope Rooting
Sublevel 3:
07 3100 — Shingles and Shakes
Sub4avel 4:
07 3113 — Asphalt Shingles
COMPANY:
OWENS CORNING.
ONE OWENS CORNING PKY
TOLEDO, OH 43659
(419)248-7060
h�.ilww�.6wenscoenlatt.eom/
1. SUBJECT: Asphalt Shingles
CLASSIC®, SUPREME®,
DURATION® PREMIUM, TRUDEFINITIONS DURATION®, TRUDEFINITIONO DURATION® STORMw
TRUDEFINITIONS DURATION® MAXm, TRUDEFINITION® OAKRIDGM, OAKRIDGES,
WOODCRESTS, WOODMOORS, TRUDEFINITIONS WEATHERGUARDS HP, BERKSHIREQ,
DEVONSHIREw,
WOODSTARTS STARTER SHINGLE, STARTER STRIP PLUS, STARTER STRIP SHINGLE, AND TRI
BUILT STARTER STRIP
BERKSHIRE@ HIP & RIDGE SHINGLES, HIGH RIDGE HIP & RIDGE SHINGLES WITH SEALANT,
RIZERIDGES HIP & RIDGE SHINGLES WITH SEALANT, WEATHERGUARDS HP HIP & RIDGE
SHINGLES, PROEDGEA DURARIDGEn" HIP & RIDGE SHINGLES AND PROEDGES STORMS HIP
& RIDGE SHINGLES
2. SCOPE OF EVALUATION
02015, 2012,'2009, and 2006 Intemational Bulding Code S (IBC)
s2015, 2012, 2009, and 2006 Intsmatlonal Res/dential Code (D QRC)
■ [CC ES Acceptance Criteria for Quality Documentation (AC10), Dated December 2012
® [CC ES Acceptance Criteria for Alternative Asphalt Roofing Shingles (AC438), Dated March 2012
The products were evaluated for the following properties:
■ External Fire Exposure (ANSI/UL790, ASTM El08)
■ Wind Resistance (ASTM D3161; ASTM D7158)
® Physical Properties ( iCC-ES AC438)
3. REFERENCED DOCUMENTS
® ANSIIUL790 Eighth Edition, (ASTM E108), Standard Test Methods for Fire Tests, of Roof Coverings
■ ASTM D3161-13, Standard Test Method for Wind -Resistance of Steep Slope Roofing Products
(Fan -Induced Method)
■ ASTM D7158-11, Standard Test Method for Wind Resistance of Asphalt Shingles (Uplift Force/Uplift
Resistance Method)
■ UL Subject 2375, Outline of Investigation for Hip and Ridge Shingles (UL Fire and Wind Tests)
s ICC-ES Acceptance Criteria for Alternative Asphalt Roofing Shingles (AC438), Dated March 2012
4. USES
OWENS CORNING asphalt shingles described in this report are alternatives. to asphalt shingles
complying with Section 1507.2.5 of the 2015, 2012. 2009 and 2006 ISC and Section R905.2.4 of the
2015, 2012, 2009, and 2006 IRC, and are Class A roof coverings for new and existing roofs.
S. PRODUCT DESCRIPTION
OWENS CORNING asphalt shingles are roof covering materials complying with the following properties
when installed as described in this report. The products are three -tab shingles, laminated shingles and
hip & ridge shingles. The products are available in standard and metric sizes.
Fire Classification: OWENS CORNING asphalt shingles covered under this Report have been tested for
fire classification Class A in accordance with UL790 (ASTM E108). Shingles tested In accordance with
UL790 (ASTM E108) qualify for use under Section 1505.1 of the 2015, 201E, 2009 and 2006 IBC and
Section R902.1 of the 2015, 2012, 2009 and 2006 IRC.
Wind Resistance: OWENS CORNING asphalt shingles covered under this Report have been tested for
wind resistance in accordance with ASTM D3161 or ASTM D7158.
Shingles tested in accordance with ASTM D3161 are classified as Class F or Class A and qualify for use
under the exception to Section 1507.2.8.1 of the 2015 IBC, Section 15072.7.1 of the 2012, 2009 and
20D6 IBC, or the exception to Section R905.2.4.1 of the 2015, 2012, 2009 and 2006 IRC.
Shingles tested in accordance with ASTM D7158 are classified as Class. H and qualify for use in locations
as shown in Table 1504.1.1 of the 2015 IBC, Table 1507.2.7.1 of the 2012 and 2009 IBC or Table
R905.2.4.1 of the 2015, 2012 and 2009 iRC, where the maximum basic wind speed is 150 mph (67 m/s)
or less with exposure category of B or C (ASCE 7) and a maximum building height of 60 feet (18.3 m).
Installation must be in accordance with Section 1507.2.7 of the 2015, 2012, 2009 and 2006 IBC or
Section R905.2.6 of the 2015, 2012, 2009 and 2006 IRC, as applicable.
Physical Properties: OWENS CORNING asphalt shingles covered under this Report have been tested
for physical properties in accordance with AC 438. Shingles tested In accordance with AC438 qualify as
an alternative roof covering for use under Section 1507.2.5 of the 2015, 2012, 2009 and 2006 IBC or
Section R905.2.4 of the 2015, 2012. 2009 and 2006 IRC. When installed in new construction in
accordance with this report and the OWENS CORNING installation instructions, the shingles are a Class
A fire classification roof covering. When the shingles are installed over existing roof coverings, the fire
classification is maintained.
Page 2 of 30
MIAMI-DADS COUNTY
Ml
.'' Q REGULATORY AND ECONOMIC RESOURCES (RER) PRODUCT CONTROL SECTION
11805 SW 26 Street, Room 208
llE %MINISTRATION DIVISION Marat Florida 331752474
T (786) 315 2590 F (786) 315.2599
NOTICE OF ACCEPTANCE (NOA) RM �MMff /kCGHGMV
Owens Corning Roofing and Asphalt, LLC
One Owens Corning Parkway
Toledo, OR 43659
SCOPE:
This NOA is being issued under the applicable rules, and regulations governing the use of construction materials. The
documentation submitted has been reviewed and accepted by Miami -Dade County RER - Product Control Section to be
used in Miami -Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ).
This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product Control Section
(in Miami -Dade County) and/or the AHJ (in areas other than Miami -Dade County) reserve the right to have this
product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted
manner, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke; modify, or
suspend the use of such product or material within their jurisdiction. RER reserves the right to revoke this acceptance,
if it is determined by Miami -Dade County Product Control Section that this product or material fails to meet the
requirements of the applicable building code.
This product is approved as described herein, and has been designed to comply with the Florida Building Code
including the High Velocity Hurricane Zone of the Florida Building Code.
DESCRIPTION: Oakridge®, TruDefrnition Oakridge@, and TruDefinition Oakridge® Artisan Colors
Shingles
LABELING: Each unit shall bear a permanent label with the manufacturer s name or logo, city, state and following
statement: "Miami -Dade County Product Control Approved", unless otherwise noted herein.
RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change
in the applicable building code negatively affecting the performance of this product.
TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the
materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product,
for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section
of this NOA shall be cause for termination and removal of NOA.
ADVERTISEKENT: The NOA number preceded by the words Miami -Dade County, Florida,'and followed by the
expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done
in its entirety.
INSPECTION: A copy of this entire NOA 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 NOA renews NOA No. 12-0430.01 and consists of pages 1 through 4.
The submitted documentation was reviewed by Gaspar J Rodriguez.
APPROVED 11
NOA No.: 15-1102.03
Expiration Date: 02/03/21
Approval Date: 01/21/16
Page 1 of 4
ROOFING ASSEMBLY APPROVAL
Category:
Roofing
Sub -Category:
Asphalt Shingles
Materials:
Laminate
Deck Type:
Wood
SCOPE
This approves a roofing system using Oakridge®, TruDefrnition Onkridge®, and TruDefinition Oakridge®
Artisan Colors asphalt shingles manufactured by Owens Corning as described in Section 2 of his Notice of
Acceptance.
PRODUCT DESCRIPTION
Product Dimensions
Test Product Description
Specifications
Oakridgeg, 13 %4" x 39 3/s"
TruDefmition Oakridge@, and
TAS 110 A heavy weight, fiberglass reinforced laminate
TruDetinition Oakridge®
asphalt shingle with continuous bead of
Artisan Colors
sealant.
Manufacturing
Locations #1, 2, 3, 4
Oakridge®, 13 '/4" x 39 3/s"
TruDefinition Oakridge®, and
TAS 110 A heavyweight, fiberglass reinforced laminate
TruDefinition Oakridge®
asphalt shingle with dashed bead of sealant.
Artisan Colors
Manufacturing
Location #1, 2, 3, 4, 5
MANUFACTURING LOCATION
1. Memphis, TN
2. Irving, TX
3. Savannah, GA
4. Jacksonville, FL
S. Atlanta, GA
EVIDENCE SUBMITTED
TestAgencv TestIdentitier
TestName/Reyort Date
PRI Construction OCF-153-02-01
TAS 100
Materials Technologies OCF-152-02-01
TAS 100 09/22/10
OCF-158-02-01
TAS 100 09/21/10/10
OCF-151-02-01
/10
TAS 100 1111/10/10
OCF-150-02-01
TAS 100
OCF-165-02-01
09/21/10
TAS 100
OCF-170-02-01
Ol/07/11
TAS 100
OCF-177-02-01
06/06/11
TAS 100
OCF-178-02-01
12/05/11
TAS 100
02/02/12
M�AMWXDECOUMY
NOA No.: 15-1102.03
Expiration Date: 02/03/21
Approval Date: 01/21/16
Page 2 of 4
Underwriters 09NK14530
ASTM D 3462
12/31/09
Laboratories R2453
ASTM D 3462
10/11/10
R2453
ASTM D 3462
11/03/10
R2453
ASTM D 3462
10/11/10
R2453
ASTM D 3462
10/11/10
R2453
ASTM E 108
01/13/11
R2453
ASTM E 108
10/11/10
R2453
ASTME 108
11/03/10
R2453
ASTME 108
10/I1/10
R2453
ASTM E 108
10/11/10
09NK14530
TAS 107 (ASTM D 3161)
12/31/09
R2453
TAS 107 (ASTM D 3161)
10/27/15
IONK13947
TAS 107 (ASTM D 3161)
11/12/10
R2453
TAS 107 (ASTM'D 3161)
10/11/10
R2453
TAS 107 (ASTM D 3161)
10/27/15
1ONK13947
TAS 107 (ASTM D 3161)
01/28/11
I ICA15662
TAS 107 (ASTM D 3161)
05/27/11
I ICA65092
ASTM D 3462 / TAS 107 (ASTM D 3161) / ASTM E 108
02/14/12
11 CA40912
ASTM D 3462 / TAS 107 (ASTMD 3161) / ASTM E log
11/30/11
LINIITATIONS
1. Fire classification is not part of this acceptance; refer to a current Approved Roofing Materials Directory for
fire ratings of this product.
2. Shall not be installed on roof mean heights in excess of 33 ft.
3. All products listed herein shall have a quality assurance audit in accordance with the Florida Building Code
and Rule 61 G20-3 of the Florida Administrative Code.
INSTALLATION
I. Shingles shall be installed in compliance with Roofing Application Standard RAS 115.
2. Flashing shall be in accordance with Roofing Application Standard RAS 115
3. The manufacturer shall provide clearly written application instructions.
4. Exposure and course layout shall be in compliance with Detail'A', attached.
5. Nailing shall be in compliance with Detail 'B', attached.
LABELING
Shingles shall be labeled with the Miami -Dade Seal as seen below, or the wording "Miami -Dade County
Product Control Approved".
ruantuoaDSCOUNrrn
BUILDING PERMIT REQUIREMENTS
Application for building permit shall be accompanied by copies of the following:
I.I This Notice of Acceptance.
1.2 Any other documents required by the Building Official or the applicable code in order to properly
evaluate the installation of this system.
APP0.0VEDI
NOA No.: 15-1102.03
Expiration Date: 02/03/21
Approval Date: 01/21/16
Page 3 of 4
DETAIL A
DETAIL B
2"
1%
END OF THIS ACCEPTANCE
APPROVED
EXPOSURE
NOA No.: 15-1102.03
Expiration Date: 02/03/21
Approval Date: 01/21/16
Page 4 of 4