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Home My WebLink AboutSUBMITTED PAPERSI DATE: I ► i—i ► 1 FEES DUE: I RECEIPT #: I Permit #: ►i ► `( 1 ► -4 � Planning & Development Services Department Building & Code Regulation Division SC o p 2300 Virginia Avenue ;I Ft. Pierce, FL 34982-5652 &y Fo Tel.772-462-1553 rf "Cie APPLICATION FREVERSESOR E FOR tROOF PERMIT Coco% NSTRUCTIONS 1. Location/Site Address: / ®� G �' .vim. (�L1, 2. Parcel ID Number: / 3o f 61 3 " 63 Lr co C� 3. 4. 6. I Office Us e I Only Description of Project or Work Activity: Total Roof Area (square feet): ,�Kl^ 5. Roof Pitch: Type of Roof: [ kPberglass Shingle [ ] Concrete Roof Tile [ ] Wood Shake / Shingle [ ] Tar & Gravel [ ] Modified Bitumen [ ] Other [ ] Product Approval required for all types of Roolmg Material (2 Sets) ] All Commercial Roofing requires design by an Engineer or Architect (2 Sets) with Product Approval attached ** Roof Mitigation per F.S. 553.844 will be required. 7. Owner Information 8. Contractor Information Name: 11g/hG '<"G �T Address: l i&? W (o cL, 6-laffC-k City: ) State: FG Zip: '3 1? Phone: rog Z�� rle 9. Value of Construction: $ 1 reGeG FL Reg/Cert #: 6Lc %3 7 J County Cert #: Business Name: Cell Phone: **Note Dry -in and Final Inspection Required. Additional inspection may be required per Product Approval. CONTRACTOR/OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is correct and that all work will be done in compliance wi 411 applicable laws regulating cons and zoning. PRINT QUALIFIERS OWNERS NA L SIGNAOTCURIE OF QUALIF WNER STATE OF FLORIDA, COUNTY OF � � ACKNOWLEDGED BEFORE ME THIS DAY OF'. 20 BY l MPERSONALLY I OWN TOM HAS 6.\4 SIGNAT OF T Y TYPE COMMISSION NU BER pp, 1A JTl %E&E (�i lilyOF NOTARY c)t f d "H P pE3530. Ap�rl 12 2015 �yUnUe�riters NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TR FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT YOUR LENDER OR ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. Revised 4/26/2010 Florida Building Code Online Page 1 of 1 Florida Deparnent�- Business Professi � a'l Regulation rch Criteria Refine Search o Version 2010 FL# 10124 ication Type ALL Product Manufacturer ALL !gory ALL Subcategory ALL ication Status ALL Compliance Method ALL Iity Assurance Entity ALL Quality Assurance Entity Contract Expired ALL luct Model, Number or NameALL Product Description ALL roved for use in HVHZ ALL Approved for use outside HVHZ ALL act Resistant ALL Design Pressure ALL �r ALL Search Results - Applications FL# Tvge Manufacturer Validated By Status FL10124-R11 Revision GAF 15ohn Category: Roofing (954)�1ch, PE 72-6224 Approved History Subcategory: Asphalt Shingles *Approved by DBPR. Approvals by DBPR shall be reviewed and ratified by the POC and/or the Commission if necessary. ` Contact Us :: 1940 North Monroe Street. Tallahassee FL 32399 Phone: 850-487-1824 The State of Florida is an AA/EEO employer. Copyright 2007-2013 State of Florida.:: Privacy Statement :: Accessibility 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 850.487.1395. 'Pursuant to Section 455.275(1), Florida 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: ,... eCGeck -®a ra®a�t �r � •mot http://www.floridabuilding.org/pr/Pf_app_lst.aspx 1/13/2014 Florida Building Code Online 1 Page 2 of 2 Certified By Sections Prom the Code Product Approval Method Date Submitted Date Validated Date Pending. FBC Approval Date Approved Summary of Products Method 1 Option D 04/04/2012 04/25/2012 04/29/2012 06/11/2012 FL # Model, Number or Name Description 10124.1 GAF Asphalt Roof Shingles Rberglass reinforced 3-tab, laminated, 5-tab and hip/ridge asphalt shingles Limits of Use Installation Instructions Approved for use in-HVHZ: No rI-10124 R7i ei0 x317. PJ i.. �� r1s,nFjt Approved for use outside HVHZ: Yes Sh;n(?!er i i_10 'K_ R7..7JE Impact Resistant: N/A Verified By: Robert Nieminen PE-59166 Design Pressure: N/A Created by Independent Third Party: Yes Other. Refer to ER, Section S. Evaluation Reports Created by Independent Third Party: Yes Contact Us :: 1940 North Monroe Street_ Tallahassee FL 32399 Phone: 850-487-1824 The.State of Florida Is an AA/EEO employer. Copyright 2007-2010 State of Florida.:: Privacy Statement`.: Accessibility 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 sendelectronicmail to this entity. Instead, contact the office by phone or by traditional mall. If you have any questions, please contact 850.487.1395. 'Pursuant to Section 455.275(I), Florida 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 emaits provided may be used for official communication with the licensee. However email addresses are public record. If you do not wish to supplya-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: 'tt url t' 9'T� http://floridabuilding.org/pr/pr app_dtl.aspx?param=wCTEVXQwtDquracBeVCbdMQNZ... 10/4/2012 Ty.. EVALUATION REPORT GAF 1361 Alps Road, Building 7-3 Wayne, N) 07470 EXTERIOR RESEARCH & DESIGN, LLC. Certificate ofAuthorization #9503 353 CHRISTIAN STREET, UNIT #13 OXFORD, CT 06478 PHONE: (203) 262-9245 FAX: (203) 262-9243 Evaluation Report 01506.01.08-119 FL10124-R7 Date of Issuance: 01/03/2008 Revision 9: 04/19/2012 SCOPE: This Evaluation Report is issued under Rule 9N-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; and Florida Building Code, Residential Volume. The products described herein have been designod to comply with the 2010 Florida Building Code sections noted herein. DESCRIPTION: GAF Asphalt Roof Shingles LABELING: Each unit shall bear labeling in accordance with the requirements 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. if the product changes or the referenced Quality Assurance documentation changes. TrinitylERD 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 "TrinitylERD 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 4. Prepared by: Robert J.M. Nieminen, P.E. Florida Registration No. 59166, Florida DCA ANE1983 _ The facsimile sea! appearing was authorized =-•-.o�_�+i = by Robert Nieminen, P.E. on 04/19/2012 ;• :^ 7hls does not serve as an electronically signed .,,+.; `?'�E '• c ;�,.; ;. •�,.' document. Signed, sealed'hardcoples have been _�� . �-„',.•'`, transmitted to the Produd Approval Administrator and �.�� to the named client CERTIFICATION OF INDEPENDENCE: 1. TrinitylERD does not have, nor does it Intend to acquire or will It a'culre, a financial Interest In any company manufacturing or distributing products It evaluates. 2. TrinitylERD is not owned, operated or controlled by any company manufacturing or distributing product§Ittevaluates. 3. Robert Nleminen, P.E. does not have nor will acquire, a financial Interest -in any company manufacturlrig::or distributing products for which the evaluation reports are being Issued. 4. Robert Nieminen, P.E. does not have, nor will acquire, a financial interest in any other entity involved in the approval process of the product. ROOFING SYSTEMS EVALUATION: 1. SCOPE: Product Category: Roofing Sub -Category: Asphalt Shingles Compliance Statement: GAF Asphalt Roof Shingles, as produced by GAF, have demonstrated compliance with the following sections of the Florida Building Code and Florida Building Code, Residential Volume through testing in accordance with the following Standards. Compliance is subject to the Installation Requirements and Limitations / Conditions of Use set forth herein. 2. STANDARDS: Section Proioerty Standard Year 1507.2.5, R905.2.4 Physical Properties ASTM D3462 2007 1507.2.7.1, R905.2.6.1 Wind Resistance ASTM D3161, Gass F 2006 1507.2.7.1, R905.2.6.1 Wind Resistance ASTM 07158, Class H 2O07 1507.2.7.1, R905.2.6.1 Wind Resistance TAS 107 1995 3. REFERENCES: Entity Examination Reference Date GAF (PDM 1915) Letter of Equivalency Seal -A -Ridge Impact Resistant IR 01/13/2012 PRI(TST 5878) ASTM D3462 GAF-059-02-01 09/02/2004 PRI (TST 5878) ASTM D3462 GAF-080-02-01 05/25/2005 UL (TST 1740) ASTM D3462 93NK6295 11/29/1993 UL (TST 1740) ASTM D3462 991\11<43835 01/12/2000 UL (TST 1740) TAS, 107 94NK9632 03/29/2000 UL (TST 1740) ASTM D3462 01NK06632 02/02/2001 UL (TST 1740) ASTM D3161, TAS 107 01NK9226 05/21/2001 UL (TST 1740) ASTM D3161 01NK37122 12/18/2001 UL (TST 1740) ASTM D3462 01NK3712.2. 12/19/2001 UL (TST 1740) ASTM D3161, TAS 107 02NK12980 04/10/2002 UL (TST 1740) ASTM D3161, TAS 107 02NK30871 09/09/2002 UL (TST 1740) ASTM D3161 03CAS367 03/11/2003 UL (TST 1740) ASTM D3462 03NK26444 10/17/2003 UL (TST 1740) ASTM D3462 04NK13850 06/07/2004 UL (TST 1740) ASTM D3161 04NK13850 06/23/2004 UL(TST 1740) ASTM D3161 04NK30546 03/10/2005 UL (TST 1.740) ASTM D3462 04NK22009 05/06/2005 UL(TST 1740) ASTM D3161 04NK22009 05/09/2005 UL (TST 1740) ASTM D3462 OSNK27924 02/10/2006 UL (TST 1740) ASTM D3161 OSNK27924 02/11/2006 UL (TST 1740) ASTM D3161, D3462 06CA18077 06/05/2006 UL (TST 1740) ASTM D3161, D3462 06CA18074 06/16/2006 UL (TST 1740) ASTM D3161, D3462 06CA35251 10/18/2006 UL(TST 1740) ASTM D3462 06CA31603 12/01/2006 UL (TST 1740) ASTM D3161, D3462 06CA41095 12/27/2006 UL.(TST 1740) ASTM.D3161 07NK05228 03/13/2007 UL (TST 1740) ASTM D3161 06CA31611 04/04/2007 UL(TST 1740) ASTM D3161 06CA61148 04/09/2007 UL (TST 1740) ASTM D3161, D3462 07CA31742 11/08/2007 UL (TST 1740) ASTM D3161, D7158, D3462 08CA06100 03/13/2008 UL (TST 1740) ASTM D3161, D3462 07CA55908 04/01/2008 UL (TST 1740) ASTM D3161, D3462 09CA10592 03/26/2009 UL.(TST 1740) ASTM D3161, D3462 09CA06856 05/15/2009 UL (TST 1740) ASTM D3161, D7158, D3462 09NK06647 08/01/2009 UL (TST 1740) ASTM D3161, D7158, D3462 .09CA27281 08/27/2009 UL (TST 1740) ASTM D3161, D7158, D3462 10CA35554 03/05/2010 UL (TST 1740) ASTNI D3161, D7158, D3462 10CA13686 05/15/2010 UL (TST 1740) ASTM D3462 10CA07264 05/27/2010 UL (TST 1740) ASTM D3462 IOCA11953 10/29/2010 UL (TST 1740) ASTM D3161, D7158, D3462 1ONK11951 10/30/2010 UL (TST 1740) ASTM D3161, D7158, D3462 1ONK12070 11/04/2010 UL(TST 1740) ASTM D3161, D7158, D3462 08CA06100 01/30/2010 UL (TST 1740) ASTM D3161, D7158, D3462 10CA53934 03/31/2011 UL(TST 1740) ASTM D3161, D7158, D3462 11CA48924 10/22/2011 Exterior Research. and Design, LLC. Evaluation Report 01506.01.06-R7 Certificate of Authorization #9503 FL10124-R7 Revision 9: 04/19/2012 Page 2 of 4 `III ERa UL (TST 1740) ASTM D3161, D7158, D3462 11CA47919 12/03/2011 UL (TST 1740) ASTM D3161, D7158, D3462 11CA48408 12/08/2011 UL (TST 1740) ASTM D3161, D7158, D3462 11CA48725 12/09/2011 UL, LLC. (QUA 9625) Quality Control Inspection Report, File No. R21 02/06/2012 UL, LLC. (QUA 9625) Quality Control R3915 Current 4. PRODUCT DESCRIPTION: 4.1 Marquis WeatherMax, Royal Sovereign and Sentinel are a fiberglass reinforced,. 3-tab asphalt roof shingles. 4.2 Camelot, Camelot II / Camelot 30, Capstone, Country Mansion, Country Mansion II, Grand Canyon, Grand Sequoia, Grand Slate, Grand Slate II, Monaco, Timberline American Harvest, I Timberline ArmorShield II, Timberline Natural Shadow, Timberline Natural Shadow Arctic White, I Timberline HD / Timberline Prestique 30, Timberline Prestique 40 / Timberline Cool Series, Timberline Ultra HD / Timberline Prestique Lifetime, Timberline Majestic / Timberline Majestic 30 and Woodland are fiberglass reinforced, laminated asphalt roof shingles. 4.3 Slateline is a fiberglass reinforced, 5-tab asphalt roof shingle. 4.4 Seal -A -Ridge, Seal -A -Ridge Armorshield, Seal -A -Ridge Impact Resistant IR, Ridglass.8, Ridlglass; 10, Ridglass 12 and Timbertex Hip and Ridge are fiberglass reinforced, hip and ridge asphalt roof shingles. 4.5 ProStart Starter Strip Shingles and WeatherBlocker Starter Strip Shingles are a starter strips for asphalt roof shingles. i i S. LIMITATIONS: 5.1 This Evaluation Report is not for use in the HVHZ. 5.2 Fire Classification is not part of this Evaluation Report; refer to current Approved Roofing Materials Directory for fire ratings of this product. 5.3 Wind Classification: 5.3.1 All GAF shingles noted herein are Classified in accordance with FBC Tables 1507.2.7.1 and R905.2.6.1 to ASTM D3161, Class F and/or ASTM D7158, Class H, indicating the shingles are acceptable for us in all wind zones up to Vasa = 150 mph (V„it = 194 mph). Refer to Section 6 for installation requirements to meet this wind rating. 5.3.2 All GAF hip & ridge shingles noted herein are Classified in accordance with FBC Tables 1507.2.7.1 and R905.2.6.1 to ASTM D3161, Class F, indicating the shingles are, acceptable for us in all wind zones up to Vasd = 150 mph (Vint = 194 mph). Refer to Section 6 for installation requirements to meet this wind rating. 5.3.3 Classification by ASTM D7158 applies to exposure category B or C and a building height of 60 feet or less. Calculations by a qualified design professional are required for conditions outside these limitations. Contact the shingle manufacturer for data specific to each shingle. 5.4 All products in the roof assembly shall have quality assurance audit in accordance with the Florida Building Code and F.A.C. Rule 9N-3. 6. INSTALLATION: 6.1 Underlayment: 6.1.1 Underlayment shall be acceptable to GAF and shall hold current Florida Statewide Product Approval, or be Locally Approved per Rule 9N-3, per FBC Sections 1507.2.3, 1507.2.4 or R905.2.3. 6.2 Starter Shingles: i Exterior Research and Design, LLC. Evaluation Report 01506.01.08-1117 Certificate ofAothmization #9503 FL10124-R7 Revision 9. 04/19/2012 Page 3 of 4 6.2.1 Installation of ProStart Starter Strip Shingles and WeatherBlocker Starter Strip Shingles shall comply with the manufacturer's current published instructions. 6.3 Asphalt Shingles: 6.3.1 Installation of asphalt shingles shall comply with the manufacturer's current published instructions, using minimum four (4) nails per shingle in accordance with FBC Sections 1507.2 or R905.2, with the following exceptions: ➢ Camelot, Camelot --II / Camelot 30, Grand Slate II, Country Mansion II, Monaco and Woodland require minimum five (5) fasteners per shingle 6.3.2 Fasteners shall be in accordance with manufacturer's published requirements, but not less than FBC 1507.2.6 or R9.05.2.5. Staples are not permitted. 6.3.3 Where the roof slope exceeds 21 units vertical in 12 units horizontal, special methods of fastening are required. Contact the shingle manufacturer for details. 6.4 Hip & Ridge Shingles: I 6.4.1 Installation of Ridglass 8, Ridglass 10 and Ridglass 12 asphalt shingles shall comply with the manufacturer's current published instructions with a minimum two (2) nails per side [t kal of four (4) nails per shingle] and asphalt roofing cement. 6.4.2 Installation of Seal-A-Rldge, Seal -A -Ridge Armorshield and Seal -A -Ridge Impact Resistant IR asphalt shingles shall comply with the manufacturer's current published instructions with a minimum two (2) nails per shingle. 6.4.3 Installation of Timbertex Hip and Ridge asphalt shingles shall comply with the manufacturer's current published instructions with a minimum two (2) nails per shingle and beads of Sonneborn NP1 Gun Grade Polyurethane Sealant or Henkel PL Roofing and Flashing Sealant. 6.4.4 Fasteners shall be in accordance with the manufacturer's published requirements, but not less than FBC 1507.2.6 or R905,2.5. Staples are not permitted. 7. LABELING: 7.1 Each unit shall bear a permanent label with the manufacturer's name, logo, city, state and logo of the Accredited Quality Assurance Agency noted herein. 7.2 Asphalt shingle wrappers shall indicate compliance with one of the required classifications detailed in FBC Table 1507.2.7.1 / R905.2.6.1. B. BUILDING PERMIT REQUIREMENTS: As required by the Building Official or Authority Having Jurisdiction in order to properly evaluate the Installation of this product. 9. MANUFACTURING PLANTS: Contact the named QA entity for information on which plants produce products covered .by Florida Rule 9N-3 QA requirements. 10. QUALITY ASSURANCE ENTITY: UL LLC — QUA9625; (847) 664-3281 - END OF EVALUATION REPORT - Exterlor Research and Design, I.I.C. Certificate of Authorization #9503 Evaluation Report 01506.01.08-117 FL10124-R7 Revision 9: 04/19/2012 Page 4 of 4 JF 0 O . •1t �TF '; ry4k � • J f-: f 1• 13 4 �,�i-. ,� -•�•^�. .y.-1 ^"r , �- .. ..r- ,� f. ,�,+ - - }?�i+ ,�,;„x i F�,.; `S:L `- 1'. -'i `"` +._�:"`-rm- 7 - - � - ".l l+`' �Y !'•-.h }?�*„� a . „� c •�y�! � i a Y'I'`, c '{T ` •r h i , P� S.O r{�p� a 4 `f•. r + +'�'R"�p�re ii �,�i ��`� ` - r ,. �i J.��•i >•�.}��T�,}�",�yiN,� v 'u .''llft�,� t��`�a� �•.� .;e'}r�r�'.Sf��W �, �'r ::�" tt ..'.r`�{Aiw:46k' `w.` a^� �. „•,�►` R ,. 1� �,'�►y; �,`' 1 {'{'r4' ►�.. r�'� . .:�?� I�.f;�i� s', �bij ,1,{. .�` ' m•• .t � �' y .�,.� ,b,a�,`�':r '� b ® �, .r. F i .. � _ Ff � � � "� � • • , r, r ri r �' X c� '�? � �,(� . � M.N•�irr}� r y% �.._ stiy 1 • Slit w � }..!p � �'"~�y91, h•fr Av.��y*�r��'r �� 'wn� �*�''' }. ��..-. ,. •`k�i '��j• y"�' A �� . �t�r:.�Y` ,�.., -- _- •a _.i� Yf ♦ i'' M 1 1 Fi .Fiti lii�,D"i<"'Sil�+, v ' I `f.y "+ ' , _ •K ��' ,�.�r'^'1 rtr' ,.. ram-- — — - •- ;�� l b.t• ' • �'� , ♦ 4 Z; 9``f.\� y;j+ 'A.� � 'Gr1a- �t`A �. � o Y A \ �r t •�}y � Nit ;� AA ,�'• � ,.� \ .. `� ';; , 4 ��i� ♦'�� rt � a IV �• '�'�'�"� . v<':k .n 4' �� . 5 �� •. ..r x ` �r, 41 n `�+ - S .fir. rl��•.76�,.� !, h� � h' „�Ft�i;+ ,y,�S.�i�,y.'i}.. ,,i ` •r c w 1 I r � (1 ii N. Mft mll� woo At P � .j✓p�� /r }.S yyr� �S n h I I I I 1 1 , 41 a! i 0 r Y' a 10 9 Planning & Development Services Building & Code Regulation Division 2300 Virginia Avenue Fort Pierce, FL 34982 772-462-2165 or 772-462-2172 Fax: 772-462-6443 ROOF INSPECTION AFFIDAVIT Re: Permit # 1 _ 0 1 —6 1 as fr�- /20%,F S , licensed as a(n)Contractor*/Engineer/Architect (Please print name & circle license type) *FS468 Building Inspector * Gene 1, Building, esidential r Roofing tractor or any individual certified under 468 F.S. to make such an inspection. On or about 1 J G% , I did personally inspect the roof deck nailing (Date) work at: � Cj 6� C ��`-�(' L f---- (Job site address) Based upon that examination I have determined the installation was done according to the current edition of the Florida Existing Building Code Section 611 or the product approval submitted (whichever is most strigent). Signatu d Seal License # r. STATE OF FLORIDA COUNTY OF its- k3 day of 20_, -dVho is personally k wn to me or who has produced as identification. Swo Notary Public, State of Florid Signature of Notary-__' Commission Number: En 01/19/2011 me (Seal) DAWN MILONE Notary Public - State of Florida •= My Comm. Expires Mar 22, 2017 Commission # EE B77571 Bonded Through National Notary Assn. JOSEPH E. SMITH, OF THE CIRCUIT COURT - SA34 ',LUCIE COUNTY 'FILE # 3914829 0- -OOK 3595 PAGE 193, Recorded '13/2014 at 01:06 ) 7� NOTICE OF COMMENCEMENT Permit No. C7 0' W Tax Folio No. _- State of Florida Cour ty of St. Lucie The undersigned hereby f Ives notice that improvement will be made to certain �re�al property, and in accordance with Chapter 713, Florida Statutes, j the following Information Is provided In this Notice of Commencement. i--r�C W "d 6jJr` Ic U 0' L 1 — L IC ),ra 16 (- f G yin 4 F I* OF 1Of )� Legal Description of Prop rty: (and street address if available):: 1 ? b % / /�1�,/� /�— General description of i rovement: %� J�GC7 t" J rP V Owner information or see infor ion B the Lessee contracted for the Improvement: Name Address a Interest In property: G Name and address of fee Imple titleholder (ii'llifferent from Owner listed above): Contractor's Name: : evj 7i/-5 Contractor Address: SG VL, 1,60hone Number: 2CrY 6,64 /1 Surety (if applicable, a copy of the payment bond is attached): Amount of bond: $ Name and address: Phone number: Lender Name: Phone Number: Lender's address: Persons within the State DfFlarlda designated by Owner upon whom notices or other documents may be served as provided by Sectlon 713,13(1) (a)7., Florida Sil atutes: Name: Phone Number: Address: In addition to himself or f erself, Owner designates of to receive a copy of the Lienor's Notice as providE d in Section 713.13(1) (b), Florida Statutes. Phone number of person r entity designated by owner: Expiration date of notice f commencement: (the expiration date may not be before the completion of construction and final payment to the contractor, but will be 1 N 2ar from the date of recording unless a different date is specified) WARNING TO OWNER: All IY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UP DER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOU k PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTE VDTO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT, Under penalty of perjury, I declar hat I have read the foregoing notice of commencement and that the facts stated therein are true to the best of my knowledge and belief r //� aA &=A (Si re of Owner or essee, or Own s or Lessee's Authorized Officer/Director/Partner/Manager (Signatory's The forpgofn, (Signature of (Print, Type, acknowledged before me this daisy o , 201 as� 5- 1 1 for J�Kority (e.g. officer, trustee) (e.g. officer, trustee) Party on behalf of whom instrument was execute Personally known or produced Identificatl State of Florida) iissioned Name of Notary Public) Type of Identification produced STATE OF FLORIDA ST. LUCIE C NTY TH IORTIFYTHAT S A CE )CORRECT dOPIF THE ORGI 1r.W t. MW 2't