Loading...
HomeMy WebLinkAboutSUBMITTED PAPERS2014-01-13 17:09 j.e.taylo7 -oofing 772 468 8397 >> P 6/7 DATE: FEES DUE: RECEIPT #: Permit o, J / Planning & Development Services Department p d Building & Code Regulation Division o 7300 Virginia Avenue Ft. Pierce, FL 34982-5652 Tel. 772-462-15.53 ',t APPLICATION FOR �ROOF PERMIT Cie Couh6' 1. Location/Site Address: _ 51 n1'5 A(Y� n F- 2. Parcel ID Number: 4 0 ?."(��3 • N(n j - cnm -1 Office Use Section TownshiP Range Map Pate Zonin Land Use I Initials Only 3. Description of Project or Work Activity: 4. Total Roof Area (square feet): _ QaCC 5. Roof Pitch: 6. Type of Roof: [fiberglass Shingle [ ] Concrete Roof Tile [ ] Wood Shake / Shingle [ ] Tar & Gravel [ ] Modified Bitumen [ ] Other [ Product Approval required for all types of Roofing 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 I 8. Contractor Informattion Namo: �11�3E1 iti�l11 I\PR Ayn)LS. IC � rt��Y1L8y9 Jr FL Reg/Cert #: (2(i�a, � 3 9 _5 % 5� Address: cif of j11(',�Wni1Y� �Y, County Cert#: ''?_,' (1 I9 City: . _Pi ?,YC F_, State: [ l Business Name: Zip: Phone: *Phone. 9. Value of Construction: $Qa� "Note Dry -in and Final Inspection Required. Additional inspection maty be required per Product Approval, CONTRACTOR/OWNER'S AFFIDAVIT: I certify that all of` c in1' ranation eontuined in this application is correct and that all work will be done in compliantwi ll applicable laws regulating construction and zoning, 4�f_ V PRINT UALIFIERS/OWNERS NAME SIGNATIJP.00F QUALIFIER/OWNER STATE OF FLORIDA, COUNTY OF ACKNOWLEDGED BEFORE ME Tills DAY OIt 20_a, BY ` :S�IGNATURE LL K OWN r TV O ME OR HAS PRODUCED AS IDENTIFICATION NOTARY PUBLIC•STATE OF FI ORIOA • •"" Karen $. Nielsen OTARY L' TYPE OR PRINT NAME OF NOTARY (�e9i011-Expires: Commission #DD1000358 COMMISSION NUMBER wv I JUNE 12, 2014 BUNDW TIptU ATLANCIC DONDINO Ca, INC. NOTICE TO OWNEF_ FAILURE TO RECORD A NOTICE, OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT YOUR LENDER OR ATTORNEY BEFORE RECORDING YOUR NOTICE Or COMMENCEMENT. Revlsed 4/26/2010 2014-01-13 17:09 j.a.tayle goofing 772 468 8397 >> , P 7/7 muptenymppralsur- ot, Luau county, t-L I nupwWWW.p831c,01 sic/prc.asp'fprC1IQ=34uLbU3uuu7uuw PROPERTY RECORD CARD %h,mn I1r1,'711j1i% lzeeutd: 1 of { =<I'rcv �cl ISpI.C.Is'rurll 'f14 es FA vulphom I'fr rrlll., Ilnuu• I'r mI 1'roperry Irlenlit'icnliou ,�,11C1f �0 SSilt!Addrees: 5615 Buchanan Dr YarceliD: 3402-603.0001.000.1 L G Sec/7'own/Run};e: 11 :36S ;40E Account #: 36609 Map ID; 34/11N Usc Typt: SF Rcs Zoning; RS•3 City/Cnty: Saint Lucic County `., OwnwNlnp and Nbilrng Legal Uescriplioll Owncr, Shawn Wands Lisha Lindcnbcrgcr 1NDIAN RIVER ESTA'l'ES-UNIT-M- BLK 6 LOTS 26 AND 27 (MAP 3411IN) Addmm; 5615 Buchanan Dr (OR 3234-2276) Fort Pit= FL 34982.3211 Kola Inl'uuurdrou Ahm"mm:n1:013 '1 mal baud and 6uildin:; Dote Price Code Deed Book/Page 2013 final; 71600 Land Value; ercr'; 0.91 9/28/2010 89900 0001 WD 3234 / 2276 ��� Assessed; 71600 Building Vu16r) 7/25/2006 100 01 QC 2619 / 2783 Ag,Credil; 0 Finished Area; 1440 SgFt 9/16/3996 90000 00 WD 1036 / 234I Excmpt; 46600 5/17/1990 100 01 QC 0691 / 2035 'Taxable: 25000 8/I/1986 18300 00 CV 0512 / 2916 'Taxes: 663.06 10/1/1978 7500 00 CV 0320 12548 1111/1973 2500 00 CV 0221 / 0620 ttl'11„ItItiG Ltih<)R1L1'I'I Exterinr l salon. Vit%v; - Rooleovcr: Ext'rypcl HC - HC YctnBlt: Grade: C - C E11Yr1311: Storyl•Ighl; 0020 - 2 Story No,Units: Inu•rior hrarufl'ti BcdRooms: 2 FIccttic: FullButh: 2 licatType: 1/213tdlt: 0 }IwtFuel: "�.A/C: 100 %1.11mcd; 5pccial Ivadures:uul Y:1rcl 11C1r1'r '1.ypc Y/S Qty, Units Qual. Cond. DWC — Oriv-Concrct Y 1 2100 AV AV Shingle RoolStrucl: GA - Gable 1917 I.,rume: - 1987 PrimeWall: VS - Vinyl Siding 1 SCUWaI I; MX - MAXIMUM YnnlntWull: DW - Drywall FHA - FrcdHotAir Avg1•IU1,1: SLIM - Electric Inn, Flocs: CU - Carpet 100 WSprinklcd: 0 Land [11foruatlion YrBlt. No, Usc'I'ypc .11ype Mcmure Depth 1987 1 0100-SF Res 01 -Front Ft 132 300 THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED, Page 9 of 1 Page 1 of 2 Florida Building Code Online S s C x£. ° A 9 t 9 C{p�d F'ri iii BCIS Home ; Login User Registration ; Hot Topics ; Submit Surcharge } Stats &Facts : Pubiieations i FBC Stall ;BCIS Site Map ;Links :Search Businesc(/ f f _�'�� Product Approval Professional 1\-1 USER: Public User Regulation ZEMg-gProduct Approval Menu > Product or Application Sgardl > Eppli ati List /y�pJl On it ��� _. � FL # , _ FL10674-RB Application Type _ --Revl$jOn �—" 2010 Code Version Application Status Approved Comments Archived ❑ Product Manufacturer Owens Corning Address/Phone/Email One Owens Corning Parkway Toledo, OH 43659 (740) 404-7829 g reg. kee ler@owenscorning. com t Authorized Signature Greg Keeler g reg . keeler@owenscorni ng.com Technical Representative Mel Sancrant Address/Phone/Email 1 Owens Corning PKWY Toledo, OH 43659 (419)376-8360 met.sancrant@owenscornig.com Quality Assurance Representative Address/Phone/Email Category '% Roofing ; Subcategory Asphalt Shin I s lv► 9� Compliance Method Evaluation Report from: a Florida Registered Architect or a Licensed Florida Professional Engineer 21 Evaluation Report -¢ Hardcopy Received Florida Engineer or Architect Name who Robert J.M. Nieminen developed the Evaluation Report Florida License PE-59166 Quality Assurance Entity UL LLC Quality Assurance Contract Expiration Date 09/26/2014 Validated By John W. Knezevich, PEA Validation Checklist - Hardcopy Received Certificate of Independence FL10674 IRS COI Trinity ERD CI - Nieminen.pdf Referenced Standard and Year (of Standard) Standard Year ASTM D3161, Class F 2006 ASTM D3462 2007 ASTM D7158, Class H 2007 Equivalence of Product Standards Certified By hqp://floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDgtBNbEY5 V%2boQT... 6/ 19/2013 Florida Building Code Online, Page 2 of 2 Sections from the Code Product Approval Method Method 1 Option D Date Submitted 12/19/2012 Date Validated 12/20/2012 Date Pending FBC Approval 12/25/2012 Date Approved 02/04/2013 of D-ndueYa FL # IlModel, Number or Name IlDescription 10674.1 Owens Corning Asphalt Roofing 3-tab, laminated, starter, and hip & ridge Shingles and Starters Limits of Use Approved for use in HVHZ: No Installation instructions FL10674 R8 II er121912FINAL OC Asphalt Approved for use outside HVHZ: Yes Shingles FL10574-R8.Ddf Impact Resistant: N/A Verified By: Robert 3. M. Nieminen PE - 59166 Design Pressure: N/A Created by Independent Third Party: Yes Other: Refer to ER, Section 5. Evaluation Reports FL10674 R8 AE er121912_FINAL OC ASDhait Shingles FL10674-RB.Ddf Created by Independent Third Party: Yes Back Next Contact Us :: 1940 North Monroe Street Tallahassee FL 32399 Phone: 850-487-1824 The State of Flonda 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 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 arq 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: ® f sLLUritv3ii Tat ic,' http://floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDgtBNbEY5 VD/`2boQT... 6/ 19/2013 EXTERIOR RESEARCH & DESIGN, LLC. Certificate of Authorization #9503 Q0TFuN1WJERD 353 CHRISTIAN STREET, UNIT #13 OXFORD, CT 06478 PHONE: (203) 262-9245 FAX: (203) 262-9243 EVALUATION REPORT Owens Corning Evaluation Report 037940.02.12-112 One Owens Corning Parkway FL10674-118 Toledo, OH 43659 Date of Issuance: 02/06/2012 Revision 2: 12/19/2012 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 designed to comply with the 2010 FBC and 2010 FBC Residential Volume sections noted herein. DESCRIPTION: Owens Corning 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 6. Prepared by: Robert J.M. Nieminen, P.E. Florida Registration No. 59166, Florida DCA ANE1983 The facsimile seal appearing was authorized by Robert Nieminen, P.E. on 12/19/2012 This does not serve as an electronically signed document. Signed, sealed hardcopies have been transmitted to the Product Approval Administrator and to the named client CERTIFICATION OF INDEPENDENCE: 1. TrinityiERD 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. Trinity IERD 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, P.E. does not have, nor will acquire, a financial interest in any other entity involved in the approval process of the product. '\,JTRINITf IERD ROOFING SYSTEMS EVALUATION: 1. SCOPE: Product Category: Roofing Sub -Category: Asphalt Shingles Compliance Statement: Owens.Corning Asphalt Roof Shingles, as produced by Owens Corning, 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 Pr Standard Year 1507.2.5, R905.2.4 Physical Properties ASTM D3462 1507.2.7.1, R905.2.6.1 Wind Resistance ASTM D3161, Class F 2007 2006 1507.2.7.1, R905.2.6.1 Wind Resistance ASTM D7158, Class H 2O07 3. REFERENCES: Entity Examination Reference Date UL LLC (CER9626) Physicals & Wind Resistance File R2453, Vol;. 3 UL LLC (CER9626) Physicals & Wind Resistance 20120516-R2453 02/15/2007 05/16/2012 UL LLC (TST9628) Physical Properties 06CA20263 11CA34308 04/18/2006 02/18/2012 UL LLC (TST9628) Wind Resistance Miami -Dade (CER1592) FBC HVHZ Compliance 07-1116.12 02/14/2008 Miami -Dade (CER1592) FBC HVHZ Compliance 09-0915.12 10-0817.09 12/16/2009 10/27/2010 Miami -Dade (CER1592) FBC HVHZ Compliance Miami -Dade (CER1592) FBC HVHZ Compliance 10-0817.10 10/27/2010 Miami -Dade (CER1592) FBC HVHZ Compliance 10-0817.08 10/27/2010 10/27/2010 Miami -Dade (CER1592) FBC HVHZ Compliance 10-0817.07 Miami -Dade (CER1592) FBC HVHZ Compliance 11-0411.03 06/16/2011 Miami -Dade (CER1592) FBC HVHZ Compliance 12-0309.01 UL LLC (QUA9625) Quality Control Service Confirmation R2453 07/19/2012 Exp. 09/26/2014 4. PRODUCT DESCRIPTION: 4.1 Asphalt Shingles: 4.1.1 Classic® and Supreme° are fiberglass reinforced, 3-tab asphalt roof shingles. 4.1.2 Berkshire@ are fiberglass reinforced, 4-tab asphalt roof shingles. 4.1.3 Duration, TruDefinition® Durations, Durations, Premium Cool, TruDefinition Duration Designer Color Collection, TruDefinition® Oakridge°, Oakridge° and WeatherGuard`g� HP are fiberglass reinforced, laminated asphalt roof shingles. 4.2 Berkshires' Hip & Ridge Shingles, High Ridge, Hip & Ridge with Sealant, WeatherGuardo HP Hip & Ridge Shingles and ProEdge Hip & Ridge Shingles are fiberglass reinforced,. hip and ridge asphalt roof shingles. 4.3 Starter Strip Plus and Starter Shingle Roil are starter strips for asphalt roof shingles. 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 Directoy for fire ratings of this product. 5.3 Wind Classification: Exterior Research and Design, LLC. Evaluation Report 037940.02.12-112 certificate of Authorization #9503 FL10674-RS Revision 2: 12/19/2012 Page 2 of 6 ��J TRINITY J ERD 5.3.1 All Owens Corning 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 Vasd = 150 mph (V,,,t = 194 mph). 'Refer to Section 6 for installation requirements to meet this wind rating. 5.3.2 All Owens Corning hip & ridge shingles and Starter Strip Plus 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 Vaed =150 mph (V,,,t = 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. 5.3.4 Refer to Owens Corning published information on wind resistance and installation limitations. 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 Owens Corning 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 R9b5.2.3. 6.2 Asphalt Shingles: 6.2.1 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: r Berkshire° shingles require minimum five (5) nails per shingle. > WeatherGuard'�' HP shingles require minimum six (6) nails per shingle. Starter Strip Plus requires minimum five (5) nails per strip. Refer to Owens Corning published information on wind resistance and installation limitations. 6.2.2 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.; 6.2.4 Where the roof slope exceeds 21 units vertical in 12 units horizontal, special methods of fastening are required. Contact the shingle manufacturer for details. 6.2.5 Minimum Nailing - Classic® & Supreme: Msniew or Arse pan nnNlf am W High nd dowwwa Vh hisRsi Ants W►s visntoa narinslart rIt. EsposkIdn Exterior Research and Design, LLC. Certificate of Authorization #9503 Norms$ Man*" or Anse pas VAnd Anas NipA Wind dssysnss Y A. pan visatoa -1--hs Areas visstos hwrtss i 5 6ff Exposure Exposk " Evaluation Report 037940.02.12-112 FL10674-RS Revision 2: 12/19/2012 Page 3 of 6 6.2.6 Minimum Nailing - Berkshire®: SeaYaa ship G tia & 1tgaJa 8lY rj ri i 9 i 9ti r �TRINITY I ERD S"Im sttp G 6� & kW t' a a 7' AsTlter rootingcosBlent CwwM & *hod$ attado 6.2.7 Minimum Nailing - Duration& TruDefinition® Duration, Duration® Premium Cool & TruDefinition�D DurationO Designer Color Collection: 4 Nall Pattem Esgoama do 4 davos Su r tn%miag ana width AnadaclamSuntbF 1' t' tY � 59," EYP � Nab 5�" Exposure 64p*.daa'osidbo Cteros 6Kpnlg•daasyosaeidn Mir as avaaro anro sop taLntMmnBunMai Patten anassatwawuu. bdevao � • • a't`�"i u5 r�tu�rajve Q-0!'ta•MlagtH FYnp17° � � yy� pip r r,tom f�nafN 1r sv�P LIE1r 5X'Ecposute Naas s?a Exposm 5%ptdg•do etpod dift Caws si9 pufg. doaximddw 6.2.8 Minimum Nailing - TruDefinitions Oakridge0, Oakridgep: d Nall Pattwn Espwm con I dams r t' 657Er'Expowre Nab 66P8"Expoww EaPasfdd1da661Cptdg Clam Egv4ddndo6Vgpadg. Exterior Research and Design, I.I.C. Certificate of Authorization #9303 6 Nail Mum EsVena tan 6 dams t. r Nab PO Cum 65J8'Expoww S posiSW es M S6/B pdg. Eaposfdda dt 66/8Ptdg. Evaluation Report 037940.02.12-R2 FL10674-R8 Revision 2: 12/19/2012 Page 4 of 6 C:1t" 6.3 6.3.1 6.3.2 6.3.3 6.3.4 JTRINIIY,ERD Minimum Nailing - WeatherGuard@ HP: :?• •:'� '% d �'iyr+fib, Hip & Ridge Shingles: Installation of Berkshire@ Hip and Ridge Shingles, High Ridge, Hip & Ridge with Sealant, WeatherGuarde HP Hip and Ridge Shingles and ProEdge Hip & Ridge Shingles shall comply with the manufacturer's current published instructions, using four (4) nails per shingle. Refer to Owens Corning published information on wind resistance and installation limitations, including the use of hand -sealing for wind warranties. 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. Minimum Nailing - Berkshire® Hip & Ridge and High Ridge: Fip.1 �• p,W�IkgWna OkeQfoo A Nasser----- )4 A i t EIC q 1 1 j Minimum Nailing - Hip & Ridge with Sealant: Rig. 2 -Nigh Whd Fastagng Nimm (4 Nails) rim Shingle---+ nd Discard 2.. 2" Ex SStc�T 12.. P ' Fastening SISl S-Exposure Distance 12 '• Fig. 2 YQpMftV sieew�. Naffs Naps l- r� lop Lartsnafal T a a- I weas r r i i E� i ' i 1 �t� Exterior Research and Design, LLC. Evaluation Report 037940.02.12-R2 certificate of Authorization #9503 FL10674-RS Revision 2: 12/19/2012 Page 5 of 6 6.3.5 Minimum Nailing - WeatherGuard@ HP Hip and Ridge: Fig. A q T pinlli�trlp YfYW A Notts o q \ i I 4 i i I i t i EIpO5U1� i TRINITY ERD Fig. C Hip & Ridge Shingle Fastening TopVlaw NaIIN Nall@ r 7' V 7' 1 i 1 etpow o Ir 6.3.6 Minimum Nailing - ProEdge Hip & Ridge Shingles: Prevailing Wind Direction SWW strip A/ 6• E<p-- — Faun7W F�rurs� Hoof cfnwnt 7. LABELING: Standard-11•—� Fastening Pattam i I ~I -I {-r u• t suhm 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. S. 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 ; (414) 248-6409; karen.buchmann@ul.com - END OF EVALUATION REPORT - Exterior Research and Design, LLC. Evaluation Report 037940.02.12-R2 Certificate of Authorization #9503 FL10674-RS Revision 2: 12/19/2012 Page 6 of 6 Florida Building Code Online Page 1 of 2 -yndaapaft-,,em! Busines " Professign!I Regulation BCIS Home Log In , User Registration ; Hot Topics Submit Surcharge Stats & Facts Publications FBC Staff BCIS Site Map Links Search Product Approval irFILE Copy O Product Approval Menu > Product or Application Search > Application List > Applitation Detail FL # FL2418-R4 Application Type, Code Version _Revision__ r- 'i — 2010 Application Status Approved *Approved by DCA. Approvals by DCA shall be reviewed and ratified by the POC and/or the Commission if necessary. Comments Archived F Product Manufacturer Address/Phone/Email Authorized Signature Technical Representative Address/Phone/Email Maxim Industries, Inc. 1630 Terre Colony Court Dallas, TX 75212-6221 (214) 905-2021 info@maximskylights.com David Thornton info@maximskylights.com Quality Assurance Representative Address/Phone/Email Category Sky Lights Subcategory Skylight Compliance Method Certification Agency Validated By Referenced Standard and Year (of Standard) Equivalence of Product Standards Certified By Certification Mark or Listing National Accreditation & Management Institute, National Accreditation & Management Institute, Standard TAS 201 Florida Building Code TAS 202 Florida Building Code TAS 203 Florida Building Code Year 1994 1994 1994 http://floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDgs 1 UBZYvQ3nuIYZKWMdraMgzb3... 3/23/2012 Florida Building Code Online Page 2 of 2 Product Approval Method Date Submitted Date Validated Date Pending FBC Approval Date Approved Method 1 Option A 02/21/2012 02/23/2012 02/29/2012 ummary of Products FL # IlModel, Number or Name Description 2418.1 jDade Curb Mount Skylight Curb Mount Skylight Limits of Use Certification Agency Certificate Approved for use in HVHZ: Yes FL2418 R4 C CAC NI0109198A-R1.Ddf Approved for use outside HVHZ: Yes Quality Assurance Contract Expiration Date Impact Resistant: Yes 12/31/2012 Design Pressure: +60/-60 Installation Instructions Other: FL2418 R4 II MAX0002 RevA. Ddf Verified By: Robert 3. Amoruso, PE FL No. 49752 Created by Independent Third Party: Yes Evaluation Reports FL2418 R4 AE PER 2000 RevO 411-1209 MAX0001- MAX0002. Ddf Created by Independent Third Party: Yes 2418.2 Dade Self Flashing Skylight ISelf Flashing Skylight f Limits of Use Certification Agency Certificate Approved for use in HVHZ: Yes FL2418 R4 C CAC NI009198-R1.Ddf i Approved for use outside HVHZ: Yes Quality Assurance Contract Expiration Date Impact Resistant: Yes 12/31/2012 Design Pressure: +60/-60 Installation Instructions Other: FL2418 R4 II MAX0001 RevA.Ddf Verified By: Robert J. Amoruso, PE FL No. 49752 Created by Independent Third Party: Yes Evaluation Reports j FL2418 R4 AE PER 2000 RevO 411-1209 MAX0001- MAX0002. Ddf Created by Independent Third Party: Yes Back Next Contact Us :: 1940 North Monroe Street, Tallahassee FL 32399 Phone: $50.487-1824 The State of Florida is an AA/EEO employer. Copyright 2007-2010 State of Florida.:: Privacy Statement :: Accessibility Statement :: Refund Statement Under Florida law, e-mail 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 mall to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions regarding DBPR's ADA web accessibility, please contact our Web Master at webmasterOdbor.state.fl.us. Product Approval Accepts: sx.` ® eCnsct M CredItSCAr http://floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDgsI UBZYvQ3nuIYZKWMdraMgzb3... 3/23/2012 MAXIM INDUSTRIES, INC. SELF FLASHING SKYLIGHT INSTALLATIONANCHORAGEDETAILS GENERAL NOTES: INSTALLAWON NOTES: 3' MAX. FROM 12' MAX. - 1. THIS PRODUCT IS DESIGNED TO COMPLY WITH THE HIGH CORNERS TYP. f O.C. TYP. VELOCITY HURRICANE ZONE (HVHZ) OF THE 2010 FLORIDA 1. ONE (1) INSTALLATION ANCHOR IS REQUIRED AT EACH o g N BUILDING CODE (FBC). THE PRODUCT DETAILS CONTAINED ANCHOR LOCATION SHOWN. I HEREIN ARE BASED UPON SIGNED AND SEALED TEST REPORT A"01-43381.01 AND ASSOCIATED LABORATORY 2. THE NUMBER OF INSTALLATION ANCHORS DEPICTED ARE o DRAWINGS. THE MINIMUM NUMBER OF ANCHORS TO BE USED FOR , 7 ~- =O a,o PRODUCT INSTALLATION. 3- MAX. FROM z 2. ADEQUACY OF THE EXISTING STRUCTURAL FRAMING AS A CORNERS TYP. Ir S MAIN WIND FORCE RESISTING SYSTEM CAPABLE OF 3. FOR INSTALLATION INTO WOOD ROOF OEM USE #12 WITHSTANDING AND TRANSFERRING APPLIED PRODUCT WOOD SCREWS OF SUFFICIENT LENGTH 10 ACHIEVE 1 318 �= LOADS TO THE STRUCTURE IS THE RESPONSIBILITY OF INCH MINIMUM EMBEDMENT, MINIMUM EDGE DISTANCE IS y r) u q a THE ENGINEER OR ARCHITECT OF RECORD. 1 INCH. N Y N 2 • • lz 0 N 3. IN AREAS WHERE WIND-BORNE DEBRIS PROTECTION 4. MINIMUM EMBEDMENT AND EDGE DISTANCE EXCLUDE I I C) Zoo z REQUIREMENTS EXIST USE OF AN APPROVED IMPACT WALL FINISHES, INCLUDING BUT NOT LIMITED TO p U 05 aJ 2 PROTECTIVE SYSTEM IS NOT REQUIRED. STUCCO, FOAM, BRICK VENEER AND SIDING, • 96' ? U, yo ?s 4. SKYLIGHT MATERIAL: 6063-T6 EXTRUDED ALUMINUM. 5. INSTALLATION ANCHORS SHALL BE INSTALLED IN 12' MAX. O.C. TYP. I 92.50' MAX. gM 102' w a IL SKYLIGHT INNER AND OUTER DOME MATERIAL: ACCORDANCE WITH ANCHOR MANUFACTURER'S MAX. MAX. O.A. O.A. // POLYCARBONATE (NOA 10-0329.03) INSTALLATION INSTRUCTIONS AND ANCHORS SHALL I O.A. INT,O.A. rn NOT BE USED IN SUBSTRATES WITH STRENGTHS LESS D.L.O. SKYLIGHT DOME FLANGE THAN THE MINIMUM STRENGTH SPECIFIED BY THE ANCHOR MANUFACTURER. I LENGTH FRAME FRAME LENGTH z , LENGTH LENGTH e 6. INSTALLATION ANCHOR CAPACITIES FOR PRODUCTS 8g � HEREIN ARE BASED ON SUBSTRATE MATERIALS WITH I Q';dg P THE FOLLOWING PROPERTIES: , I A. WOOD- MINIMUM SPECIFIC GRAVITY OF 0.42. 6 ~ 44.50' MAX. OA, D.L.O. WIDTH Robeh.l.Anw wP.L. 48' MAX. O.A. INT. Fkddl P.E. W. 49752 SKYLIGHT FRAME WIDTH ��4�eauattt�t 491/4' MAX. O.A. ' ' DOME FRAME WIDTH ± •a`,p$r• V ti Ma 49752 54' MAX. O.A. TABLE OF CONTENTS FLANGE WIDTH Z 13! SHEET REV. SHEET DESCRIPTION DESIGN PRESSURE RATING(PSF) IMPACT RATING ELEVATION &ANCHOR ! io-..,STAiTE OF 1 — NOTES, ELEVATION 8 ANCHOR LAYOUT t60 0 LARGE MISSILE _- IMPACT ''%ssi'°R'•°�'c� 2 — SECTION VIEWS LAYOUT 1. Minimum #12 fastener by others. Pre -punched installtion holes 3" from each corner, maximum 12" on center. Minimum penetration = 1-318". 2. .050" X 1.5" X 1.75" 6063-T6 extruded aluminum retaining angle. Aluminum angle mitered and welded @ four comers, 3. 47.5' X 95.5" LIV Enhanced outer polycarhonate dome (NOA: #10-0329.03) @ 8" height on test sample (dome height varies per skylight size but not less than the larger of 10%, of the dome's span or 4"). 4. 7.5" X 95.5" UV Enhanced inner polycarbonate dome (NOA: #10-0329.03) @ 4" height on test sample (dome height varies per skylight size but not less than the larger of 10% of the dome's span or 4"). 5. OSI PR256 urethane sealant. Located between aluminum retaining angle and outer dame & between Inner dome and aluminum frame. 6. Sealant tape. 1" X .125" located between outer and inner domes. 7. 6063-T6 extruded aluminum frame. Aluminum frame mitered and welded @ four comers. 8. #12 X 1.75" fastener. One fastener located equidistant from each comer. Four fasteners per skylight. 9. #10 X .375 18-8 stainless steel fastener. Located 4" from each corner, maximum 11" on center. 10. All units equal to or less than the total square footage or the test specimen, 36 square feet, will be accepted under this approval. Width and/or height of tested unit cannot be exceeded. 11. The tight -transmitting plastic shall be mounted a minimum of 4 inches above the plane of the roof on a self -flashing 0.060" Aluminum Frame meeting the requirements of types of construction in accordance with the 2010 FBC, Sections 2610.2 and 2612.4.5.1.1 and the 2010 FRC, Section R4412.1.4.5.1. Outer Polycarbonate Dome O Imter Polycarbonate Dome O.060" Extruded Aluminum Retaining Angle Design Pressure: 60psf +/- 3" Installation Flange Roof deck, covering and training by others. All roordetails shall comply with Chapter 15 of the 2010 FBC and Chapter 9 "f the 2010 FRC. # 12 Stainless Steel Fastener with neoprene gasket. One fastcncr located equidustant from each comer. (Four fusteners per 7Tape skylight) / —Condensation Gutter Self Flashing Model 1110 X .375" stainless steel fastener (? 4" 1'mm each corner, maximum I I" on center. 0.060" Aluminum Frame Minimum #12 wood screw with O min. 1-3/8" embedment into substrate receiving point. Installation holes 3" from each comer, maximum 12" on center. 1-3/8" Min. O 0 ZO A 7 W_ X O> 0 F- z z U to = O to Of to a LL vWi ~U. o W to Ruben.). "'--, P.E. RAM P.E. No. 49152 - AMES A GEAf No 49752 S?'ATE OF 2I ~I al �1 MAIM INDUSTRIES, INC. CURB MOUNT SKYLIGHT INSTALLATIONANCHORWE DETAILS GENERAL NOTES: INSTALLATION NOTES: 1. THIS PRODUCT IS DESIGNED TO COMPLY WITH THE HIGH VELOCITY HURRICANE LONE (HVHZ) OF THE 2010 FLORIDA I. ONE (1) INSTALLATION ANCHOR IS REQUIRED AT EACH BUILDING CODE (FBC). THE PRODUCT DETAILS CONTAINED ANCHOR LOCATION SHOWN. HEREIN ARE BASED UPON SIGNED AND SEALED TEST REPORT NO. ATI D143301.01 AND ASSOCIATED 2. THE NUMBER OF INSTALLATION ANCHORS DEPICTED ARE LABORATORY DRAWINGS. THE MINIMUM NUMBER OF ANCHORS TO BE USED FOR PRODUCT INSTALLATION. 2. ADEQUACY OF THE EXISTING STRUCTURAL FRAMING AS A MAIN WIND FORCE RESISTING SYSTEM CAPABLE OF 1 FOR INSTALIA'TION INTO WOOD ROOF DECK. USE 012 WITHSTANDING AND TRANSFERRING APPLIED PRODUCT WOOD SCREWS OF SUFFICIENT LENGTH TO ACHIEVE 1 3!B LOADS TO THE STRUCTURE IS THE RESPONSIBILITY OF INCH MINIMUM EMBEDMENT. MINIMUM EDGE DISTANCE IS THE ENGINEER OR ARCHITECT OF RECORD. 1 INCH. 3. IN AREAS WHERE WIND-BORNE DEBRIS PROTECTION 4. MINIMUM EMBEDMENT AND EDGE DISTANCE EXCLUDE REQUIREMENTS EXIST USE OF AN APPROVED IMPACT WALL FINISHES. INCLUDING BUT NOT LIMITED TO PROTECTIVE SYSTEM IS NOT REQUIRED. STUCCO, FOAM. BRICK VENEER AND SIDING. 4. SKYLIGHT MATERIAL: 6063-T6 EXTRUDED ALUMINUM. 5. INSTALLATION ANCHORS SHALL BE INSTALLED IN SKYLIGHT INNER AND OUTER DOME MATERIAL: ACCORDANCE WITH ANCHOR MANUFACTURER'S POLYCARBONATE (NOA 10-0329.03) INSTALLATION INSTRUCTIONS AND ANCHORS SHALL NOT BE USED IN SUBSTRATES WITH STRENGTHS LESS THAN THE MINIMUM STRENGTH SPECIFIED BY THE ANCHOR MANUFACTURER. B. INSTALLATION ANCHOR CAPACITIES FOR PRODUCTS HEREIN ARE BASED ON SUBSTRATE MATERIALS WITH THE FOLLOWING PROPERTIES: A. WOOD• MINIMUM SPECIFIC GRAVITY OF 0.42, TABLE OF CONTENTS SHEEF REV. SHEET DESCRIPTION 1 NOTES, ELEVATION & ANCHOR LAYOUT 2 SECTION VIEWS 4" MAX. FROM 10.50" MAX. CORNERS TYP. ~I^� O.C. TYP. 4' MAX. FROM CORNERS TYP. DESIGN PRESSURE RATING (PSF1 IMPACT RATING �� D LARGE MISSTEP. IMPACT 10.50" MAX. r O.C. TYP. .- 1 1 1 1 1 48" MAX. O.A. FIXED D.L.O. WIDTH 518" MAX. O.A. CURB WIDTH 5216" MAX. O.A. WIDTH Uu- 3 MAX. 994. OA. MAX. FIXED OA. D.L.O. CURB icunru LENGTH ELEVATION & ANCHOR T.AVni1T 1008" MAX. O.A. LENGTH 0 O Y �5 xa 0' coo �V Oxy O r F a6 U 6 zzz �g 0a a m> OW W O z Robert J. A,-. P.E. Fb4di P.E. Nw 49152 z l c' fig 1. Minimum #12 fastener by others. Pre -punched installtion holes 4" from each corner, maximum 10.5" on center. Minimum penetration = 1-3/8" 2. .060" X 1.5" X 1.75" 6063-T6 extruded aluminum retaining angle. Aluminum angle mitered and welded @ four corners. 3. 52.5" X 100.375" UV Enhanced outer polycarbonate dome (NOA: #10 0329.03) @ 8" height on test sample (dome height varies per skylight size but not N LL p o g x less than the larger of 10% of the dome's span or 4') 4. 52.5" X 100.375" UV Enhanced inner polycarbonate dome (NOA: #10-0329.03) @ 4" height on test sample ( dome height varies per skylight size but not less than the larger of 10% of the dome's span or 4y 5. OSI PR256 urethane sealant. Located between aluminum retaining angle and outer dome & between inner dome and aluminum frame. 6. Sealant tape. 1" X .125" located between outer and inner domes. 7. 6063-T6 extruded aluminum frame. Aluminum frame mitered and welded @ four corners. F w a a 8. #12 X 1.75" fastener. One fastener located equidistant from each corner. Four fasteners per skylight. 9. #10 X .375 18-8 stainless steel fastener. Located 4" from each corner, maximum 11" on center. 10. All units equal to or less than the total square footage or the test specimen, 36 square feet, will be accepted under this approval. Width and/or height of tested unit cannot be exceeded. 11. The light -transmitting plastic shall be mounted a minimum of 4 inches above the plane of the roof on a curb constructed in accordance with requirements of types of construction in accordance with the 2010 FBC, Sections 2610.2 and 2612.4.5.1.1 and the 2010 FRC, Section R4412.1.4.5.1, o O N �' 2 Q .060" Extruded Aluminum Retaining Angle OMinimum #12 wood screw with min. 1-3/8" embedment into substrate receiving point. Installation holes 4"- from each corner, maximum 10.5" on center. Design Pressure: 60psf +/- Roof deck and training by others. All roof details shall comply with Chapter 15 of the 2010 FBC and Chapter 9 of the 2010 FRC. Outer Polycarbonate Dome O Inner Polycarbonate Dome r Sealant t'_J Sealant Tape O - Sealant t:'.l — Condensation Gutter Sealant 0 Curb Mount Model # 12 Stainless Steel Fastener with neoprene gasket. One fastener located equidustant from each comer. (Four fasteners per skylight) # 10 X .375" stainless steel fastener @ 4" from each corner, maximum I I" 9 on center. 0.060" Aluminum Frame 1-3/8" Min. Embedment 0 0 U Z 0 J 0 tt w 0 Rohn J. Ammuso, P.E. Mod. P.E. Na 49752 NO 49752 Q STATE OF srV�t?A10P Property Appraiser - St.Lucie County, FL Sbawn DeSantis Record: I of I Property Identification Site Address: 5615 Buchanan Dr Sec/Town/Range: 11 :36S :40E Map ID: 34/11N Zoning: RS-3 http://www.paslr-,o-rpltpaslc/prc.asp?prclid=340260300010001 PROPERTY RECORD CARD <cPrev 'tiext» Spec.Assmut Taxes Exemptions Permits Home Print Ownership and Mailing Owner: Shawn DeSantis Lisha Lindenberger Address: 5615 Buchanan Dr Fort Pierce FL 34982-3211 CO ParcelID: 3402-603-0001-000-1 G,y Account #: 36609 y�o,+JCIE _. Use Type: City/Cnty: SF Res j ��'".',._ .° . •� Saint Lucie County Legal Description 1NDIAN RIVER ESTATES-UNIT-02- BLK 6 LOTS 26 AND 27 (MAP 34/11N) (OR 3234-2276) ,dales Information Assessment 2013 Date Price Code Deed Book/Page 2013 Final: 71600 9/28/2010 89900 0001 WD 3234 / 2276 Assessed: 71600 7/25/2006 100 01 QC 2619 / 2783 Ag.Credit: 0 9/16/1996 90000 00 WD 1036 / 2341 Exempt: 46600 5/17/1990 100 01 QC 0691 / 2035 Taxable: 25000 8/1/1986 18300 00 CV 0512 / 2916 Taxes: 663.06 10/1/1978 7500 00 CV 0320 / 2548 11/1/1973 2500 00 CV 0221 / 0620 BUILDING LNFOR 'L4TIO,N Total Laud and Building Land Value: _-2cres: 0.91 Building Valli . 20 Finished Area: 1440 SgFt Exterior Fealures View: RoolCover: S im Shingle RooiStruct: GA - Gable ExtType: HC - HC YearBit: 1987 Frame: - Grade: C - C EIIYrBIt: 1987 PrimeWall: VS - Vinyl Siding Storyl-Ight: 0020 - 2 Story No. Units: 1 Sccwall: - Interior Features BedRooms: 2 Electric: MX - MAXIMUM PrmintW all: DW - Drywall FullBath: 2 HeatType: FHA - FrcdHotAir AvgHt/Fl: 1/2Bath: 0 HeatFuel: ELEC - Electric Prm.Flors: CU - Carpet %A/C: 100 %Heated: 100 %Sprinkled: 0 Special Features and bard Iterns Land Information Type Y/S Qty. Units Qual. Cond. YrBlt. No. Use Type Type Measure Depth DWC - Driv-Concret Y 1 2100 AV AV 1987 1 0100-SF Res BI -Front Ft 132 300 THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED Page 1 of 1 2014-01-20 13:20 j.a.tay �� ��,fing 772 468 83977724626443 P 2/2 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 # I, VL4 It licensed as �C�ontractor/Engineer/Architect (Please rint name &, clrcle license type) "Fpector "'General, Building, Residential or Roofing Contractor or any individual cerdfled under 468 F,S, to make Such an Inspection, On or about I did personally inspect the roof deck nailing (Date) work at: �('Q [ R �fA YI1c1Y L L� Yt }Lt•O. (Job site address) Based upon that examination 1 have determined the installation was done according to the Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S.) s� Signature and Seal (2L22.529E- license # STATE OF FLORI COUNTY OF Sworn to a d subIberd efore me this d,f 20 by !� a Oki M . Who is pcuabGow n own to me U who has produced as ldentif cation, Notary Publi of F �. Signature of Nota rityr gdyPuttG5TAiivOP Fl1m>� B ry' �Wrl"f, Kareu S, Nielsen Commission Number: Commission#1)D1000356 (Mor000En 01/19/2011Expires: J1J1�+� 7Z, 201�# IioNOCDTIU UILTLANrICDONDIXCCa,mdC. RECEIVED .!"! 21 MA JOSEPH E. SMITH, "'';LK OF THE CIRCUIT COURT - SAID LUCIE COUNTY FILE ## 3915161 Qi, '�)OK 3595 PAGE 1098, Recorded/14/2014 at 10:24 NOTICE OF COMMENCEMENT TO BE COMPLETED WHEN CONSTRUCTION VALUE EXCEEDS $2,500.00 OR WHEN HEATING OR AIR CONDITIONING REPAIR OR REPLACEMENT EXCEEDS $7,500.00 PERMIT #: TAX FOLIO #: 340 Z Coo 3 . QW I . 000 - I State of Florida, County of S�%Yt} LUCK , the undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with chapter 713, Florida slatutes, the following information is provided in this notice of Commencement. 1. LEGAL DESC IPTION OF P OP RTY (AND TREET ADDRESS IF AVAILABLE): 5(D I S IO,I,3Qhat M-b Tind��N �vev �sis-unij o2-fi1 K U Lb�s 2. GENERAL DESCRIPTION OF IMPROVEMENT:,_ IER INFORMATION or ❑LESSEE INFORMATION Name:rjLlgj — �' Lessee contracted for the Improvement) -N E-51F1Y\ lS Address: Str b. Interest in property: erty.- �n11t1AYl DX) V4• 1PIeV(�,, L' Sggia- - OLUT.L>✓F- c. Name and address of fee simple title holder (if other than owner): N/A 4. CONTRACTOR: a. Name: J. A. TAYLOR ROOFING, INC. Address: 302 MELTON DRIVE, FORT PIERCE, FL. 34982 b. Phone number: 772-466.4040 S. SURETY COMPANY (IF Applicable, a copy of the payment bond Is attached): a. Name & Address: _N/A b. Phone number: Bond amount: 6. LENDER/MORTGAGE COMPANY: a. Name & Address: _N/A b. 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 713.13 (1) (a) 7., FLORIDA STATUTES: a. Name & Address: _N/A b. Phone number: fax number: 8. IN ADDITION TO HIMSELF OR HERSELF, a. Owner designates _N/A of to receive a copy of the lienor's notice as provided in section 713.13(1) (b), Florida statues. b. Phone number: 9. EXPIRATION DATE OF NOTICE OF COMMENCEMENT: (THE EXPIRATION DATE IS ONE (1) YEAR FROM THE DATE OF RECORDING UNLESS A DIFFERENT DATE IS SPECIFIED). WARNING TO OWNER, ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13. FLORIDA STATUTES AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING AND THAT THE FACTS IN IT ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF (SECTION 92.525, FLORIDA STATUTES SIGNATURE OF OWNER or LESSEE or OWNER'S AUTHORRED OFFICER/DIRECTOR/PARTNER/MANAGER - SIGNAORY'S TITLE / OFFICE TFiF. fb^R,FC3Qt�IG I>� MENT WAS ACKNOWLEDGED BEFORE ME THIS _DAY OF�P, 20� BY: NAME OF PERSON TYPE OF AUTHORITY NAME OF PARTY ON BEHALF OF WHOM INSSTTRUM/ ENT WAS EXECUTED ❑PERSONALLY KNOWN OR 26ODUCED IDENTIFICATION TYPE OF IDENTIFICATION PRODUCED 1 ). L' NOTARY SIGNATURE / NOTARY PRINTED NAME / NOTARY SEAL NOTARY PURI.TC-STATE, OF FLORIDA Karen S. Nielsen fir;,;:: __„ c IDD1000358 '.• Expir�a: iUNE 12, 2014 BONDED THRU A'r1.,1NTIC RONDLNG CO., INC. STATE OF ST. LU IE THIS TRUE A ORIGIN _I Date- -- DATE: FEES DUr RECEIPT #: Permit #: - Planning & Development Services Department 0 Building & Code Regulation Division r. 2300 Virginia Avenue Ft. Pierce, FL 34982-5652 Tel. 772-462-1553 APPLICATION FOR ROOF PERMIT SEE EVERSE SIDE FOR TRUCTIONS 1. Location/Site Address: ( CAmgnan Or- V 2. Parcel ID Number: �34 6 L. ( "t) con I • (hLL • i Office Use Only Section Township Range Map Page Zoning Land Use Initials 3. Description of Project or Work Activity. 4. Total Roof Area (square feet): � 1 5. Roof Pitch: 6. Type of Roof: [ fiberglass Shingle [ ] Concrete Roof Tile ] Tar & Gravel ] Modified Bitumen ] Wood Shake / Shingle 1 Other [ v�Product Approval required for all types of Roofing 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 1 I 8. Name:��1�wn�P.\1=1Y1tiS, �S 1=1 inn .Y)L8y9er Address: City:. �I�Y�.E, State: Zip: Phone: 9. Value of Construction: $ Contractor Information FL Reg/Cert #: County Cert #: Business Name: " 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 t�e inf: rmation contained in this application is correct and that all work will be done in complianc wi II applicable laws regulating construction and zoning. PRINT UALIFIERS/OWNERS NAME SIGNATUIILP OF QUALIFIER/OWNER STATE OF FLORIDA, COUNTY OF 1I 1 ACKNOWLEDGED BEFORE ME 7T. DAY OF 20_, BY V 1 WHO IS P RS ALL OWN ME OR HAS PRODUCED AS IDENTIFICATION �p I �'1 p E NOTARY PUBLIC -STATE OF FLORIDA "1�+ ` is��'""' Karen S. Nielsen SIGNATURE F NOTARY /TYPE OR PRINT NAME OF NOTARY WCommission#DD1000358 Mi COMMISSION NUMBER 1O©©�b ••„,,. Expires: JUNE 12, 2014 BONDED MU ATLANTIC BONDING CO., INC. NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE 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