HomeMy WebLinkAboutProduct Approval T reasure Harvey E. Koehnen
C oast Professional Engineer#32831 40w_1 01/f79(44_
B uilding Architect#AR0009471
E nigineers, Certified General Contractor#CGCO24776
Inc.
These tables Are For RqofCoyer1DAs
Roof coverings Installed on Buildings with a
Mean Roof k_ielght of 30'or Less Located In Exposures B, C or D
.Table R3 01.2[2]_P F,- �F t 610 574 A5c 9 7-1 dD
COMPONENTS AND CLAL)DIMG WOP
,,ST CASE DE3I(3N PRESSURE TPSF].
160 Exp S 160 Eyp C,"160 Exp C 160 Exp D 160 Exp D
(One story! - (Two story*) (One story") (Two story)
Roof 5 0 to 7 degrees Zone 1 -27.6 ---33-A -38.7 -40.6 -45.9
1
I/ I Z 6
Roof
=:1 1/2/12 pitch Zone 2 -46.4 -56,2 -65.0 -68.3
Zone3 _69.8
Zone 3 -69.8 . -84.5 -97.7 -102.7 -115.9
Roof,7 to 27 degrees Zane 1 -25.3 -30,7 -35.5 --37.2 -42
V degrees=6/12 pitch Zone 2 -44,1 -5314 -61.8 -64.9 -73,3
Zone 3 -66A -78.8 -91.2 -95.7 - 108:;1
Rool'5 27 to 45 degrees Zone 1 -27.8 -33Y -40.0 -40.1 -46:2
46 degrees= 12112 Pitch Zone 2 -32A 39.3 -45A -47.7 -53.8
Zone 3 -32.4 -39.3 -45A -473 -53.8
.160 Exp B 150 Exp C 150 Exp C 150 Exp D 150 Ezp D
(one story*) (two story*) (one story=) (tWO StOFVF)
Roof>0 to 7 degrees Zone 1 -24.3 -29.5 -34.1 -35.8 -40.4
7degrees=1112112 pitch Zone 2 -40.8 -49A -57.2 -60.0 -67.8
Zone 3 -61.4 -74.3 -86.0 -90.3 -102,0
Roof>7 to 27 degrees Zone 1 -22,2 -26.9 -31.1 -32.7 -36.9
27 degrees=6/12 pitch Zone 2 -38.7 .-46.0 -54.2 -56.9 -e4.3
Zone 3 . -67,3 -69.4 -80.3 -84.3 -95.2
Roof>27 to 45 degrees Zone 1 -24.3 L29.5 -34.1 -35.8 -40.4
45 degrees=12112 pitch Zone 2 -28.4 -34,4 -39.8 -41,8 -47.2
Zone 3 -28A -34A -39.8 -41.8 -47.2
One story*-one story building with a maximum mean roof height of 16 feet
Two story*=two story building with a maximum mean roof height of 30 feet
-if-allowed by the Miami Dade N.O.A or Florida Product Approval ,any systern.that does-.not meet the
milliMum components and cladding pressures for the area that the building Is located per this forrr
may require a Florida licensed engineer to revise the fastener spacing
Elyse Circle PHONE (772)466-5509
T C B E,Inc.
7205 ElyI
Port Saint Lucie FAx (772)489-3035
Florida 34952-8212 EMAIL hkoehnen@tcbeweb.com
WEB SUE http://www,tcbew-eb.com
0 0 4 4 • � • 6 Q,�
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Product Approval Menu>Product or Application Search>Application List>Application Detail
FL# FL1654-1116
Application Type Revision
Code Version 2014
Application Status Approved
Comments
Archived
Product Manufacturer POLYGLASS USA
Address/Phone/Email 150 Lyon Drive
Fernley,NV 89408
(570)384-1230 Ext 242
jakins@polyglass.com
Authorized Signature James Akins
jakins@polyglass.com
Technical Representative Steve Wadding
Address/Phone/Email 150 Lyon Drive
Fernley,NV 98408
(602)363-7139 i
stevew@polyglass.com -
Quality Assurance Representative James Akins _
Address/Phone/Email 555 Oakridge Road ``pp
Humboldt Industrial Pkwy
Hazleton,PA 18201 -
(800) 894-4563
jakins@polyglass.com
Category Roofing
Subcategory Modified Bitumen Roof System
Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed Florida
Professional Engineer
�6 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 06/27/2016
Validated By John W.Knezevich, PE
V. Validation Checklist-Hardcopy Received
Certificate of Independence FL1654 R16 COI 2015 01 COI Nieminen.odf
Referenced Standard and Yeai (of Standard) Standard Year
ASTM D6162 2000
ASTM D6163 2000
ASTM D6164 2005
ASTM D6222 2008
ASTM D6509 2009
FM 4470 1992
FM 4474 2004
Equivalence of Product Standards
Certified By
Sections from the Code
Product Approval Method Method 1 Option D
Date Submitted 06/17/2015
Date Validated 06/23/2015
Date Pending FBG Approval 06/28/2015
Date Approved 08/18/2015
Date Revised 12/16/2015
Summary of Products
FL# Model,Number or Name Description
1654.1 Polyglass SBS and APP Modified SBS and APP modified bitumen roof systems
Bitumen Roof Systems
Limits of Use Installation Instructions
Approved for use in HVHZ:No FL1654 R16 II 2015 06 FINAL Al ER POLYGLASS MODBIT FL1654-
Approved for use outside HVHZ:Yes R16.Ddf
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 application Evaluation Reports
relates to one particular assembly over concrete FL1654 R16 AE 2015 06 FINAL ER POLYGLASS MODBIT FL1654-
deck. Refer to the ER Appendix for other systems and R16.Ddf
deck types.2.) Refer to ER,Section 5 for other Limits Created by Independent Third Party:Yes
of Use.
Contact Us::1940 North Monroe Street,Tallahassee FL 32399 Phone:850-487-1824
The Slate 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(l),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:
WA ® -- M
security%n:Tiucs
� ,[ RINITY ERD
APPENDIX 1:ATTACHMENT REQUIREMENTS FOR WIND UPLIFT RESISTANCE
Table Deck Application Type Description Page
1A-1 Wood New or Reroof(Tear-Off) A-2 Mech.Attached Anchor Sheet,Bonded Insulation,Bonded Roof Cover 4
IA-2 Wood New,Reroof(Tear-Off)or Recover A-2 Mech.Attached Anchor Sheet,Bonded Insulation,Bonded Roof Cover 5
18 Wood New,Reroof(Tear-Off)or Recover B Mech.Attached Base Insulation,Bonded Top Insulation,Bonded Roof Cover 5
1C Wood New,Reroof(Tear-Off)or Recover C Mech.Attached Insulation,Bonded Roof Cover 6
1D Wood New,Reroof(Tear-Off)or Recover D Prelim.Attached Insulation,Mech.Attached Base Sheet,Bonded Roof Cover 6
1E-1 Wood New or Reroof(Tear-Off) E Non-Insulated,Mech.Attached Base Sheet(nails),Bonded Roof Cover 7-8
IE-2 Wood New,Reroof(Tear-Off)or Recover E Non-Insulated,Mech.Attached Base Sheet(screws&plates),Bonded Roof Cover 8-9
iF Wood New or Reroof(Tear-Off) F Non-Insulated,Bonded Roof Cover 9
2A Steel or Conc. New,Reroof(Tear-Off)or Recover B Mech.Attached Base Insulation,Bonded Top Insulation,Bonded Roof Cover 10
213 Steel or Conc. New,Reroof(Tear-Off)or Recover C Mech.Attached Insulation,Bonded Roof Cover 11-12
2C Steel or Conc. New,Reroof(Tear-Off)or Recover D Prelim.Attached Insulation,Mech.Attached Base Sheet,Bonded Roof Cover 13-14
3A-1 Concrete New or Reroof(Tear-Off) A-1 Bonded Insulation,Bonded Roof Cover 15-18
3A-2 Concrete New or Reroof(Tear-Off) A-1 Bonded Temporary Roof,Bonded Insulation,Bonded Roof Cover 19-20
3B Concrete New or Reroof(Tear-Off) F Non-Insulated,Bonded Roof Cover 21
4A LWIC New or Reroof(Tear-Off) A-1 Bonded Insulation,Bonded Roof Cover 22-23
413 LWIC New or Reroof(Tear-Off) A-2 Mech.Attached Anchor Sheet,Bonded insulation,Bonded Roof Cover 24
4C LWIC New or Reroof(Tear-Off) E Non-Insulated,Mech.Attached Base Sheet,Bonded Roof Cover 25-27
5A CWF New or Reroof(Tear-Off) A-1 Bonded Insulation,Bonded Roof Cover 28
513 CWF New,Reroof(Tear-Off)or Recover A-2 Mech.Attached Anchor Sheet,Bonded Insulation,Bonded Roof Cover 29
5C CWF New,Reroof(Tear-Off)or Recover B Mech.Attached Base Insulation,Bonded Top Insulation,Bonded Roof Cover 30
51) CWF New,Reroof(Tear-Off)or Recover C Mech.Attached insulation,Bonded Roof Cover 30
5E CWF New,Reroof(Tear-Off)or Recover E Nan-Insulated,Mech.Attached Base Sheet,Bonded Roof Cover 30
6A Gypsum New or Reroof(Tear-Off) A-1 Bonded Insulation,Bonded Roof Cover 31-32
68 Gypsum New,Reroof(Tear-Off)or Recover A-2 Mech.Attached Anchor Sheet,Bonded Insulation,Bonded Roof Cover 33
6C Gypsum New,Reroof(Tear-Off)or Recover C Mech.Attached Insulation,Bonded Roof Cover 33
61) Gypsum New,Reroof(Tear-Off)or Recover E Non-Insulated,Mech.Attached Base Sheet,Bonded Roof Cover 33
7A Various Recover A-1 Bonded Insulation,Bonded Roof Cover 34-36
7B Various Recover F Non-Insulated,Bonded Base Sheet,Bonded Roof Cover 36
The following notes apply tothe systems outlined herein:
1. 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 AHJ. Load resistance of the
roof deck shall be documented through proper codified and/or FBC Approval documentation.
2. Insulation/base sheet fasteners shall be of sufficient length for the following deck engagement:
➢Wood: Minimum 0.75-inch penetration.
➢Steel: Minimum 0.75-inch penetration and engage the top flute of the steel deck.
➢Concrete: Minimum 1-Inch embedment Into pilot hole in accordance with fastener manufacturer's published installation Instructions.
3. Unless otherwise noted, insulation may be any one layer or combination of polyisocyanurate, polystyrene, wood fiberboard,perlite, gypsum-based roof board or mineral-wool roof board that meets the OA
requirements of F.A.C.Rule 61G20-3 and is documented as meeting FBC 1505.1 and,for foam plastic,FBC Chapter 26,when installed with the roof cover.
Exterior Research and Design,LLC.d/b/a Trinity]ERD Evaluation Report P9290.02.08-1114 for FL1654-R36
Certificate of Authorization#9503 Revision 14:06/17/2015
Prepared by: Robert Nieminen,PE-59166 Appendix 1,Page 1 of 36
TRINITY I ERD
14. Unless otherwise noted,refer to the following references for bonded base,ply or cap sheet applications.
TABLE 1:POLYGLASS ROOF COVERS
Reference Layer Material Application
BP-AA Base Polyglass G2 Base,FBC Approved ASTM D4601,Type 11
HA at 20-40 lbs/square
(Base and Ply sheets,Asphalt-Applied) Ply Polyglass Ply IV,Polyglass Ply VI,FBC Approved ASTM D2178,Type IV or VI
SBS-AA Base or Ply Elastobase,Elastobase Poly,Elastoflex V,Elastoflex 56,Polyglass HT Base 650
(SBS,Asphalt-Applied) Cap
Elastoflex S6, Elastoflex S6 G, Elastoflex 56 G FR, Elastoshield TS-G, Elastoshield TS-G FR, Polyfresko G SBS (sand-backed), HA at 20-40 lbs/square
Polyfresko G SBS FR(sand-backed)
SBS-TA Base or Ply Elastoflex V,Elastoflex S6
(SBS,Torch-Applied) Cap
Elastoflex V,Elastoflex S6,Elastoflex 56 G,Elastoflex 56 G FR,Elastoshield TS-G,Elastoshield TS-G FR,Polyfresko G SBS(poly- Torch-Applied
film backed),Polyfresko G SBS FR(poly-film backed)
/ SBS-SA Base Elastoflex SA V Base,Elastoflex SA V FR Base,Elastoflex SA V Plus,Elastoflex SA V Plus FR
Self-Adhering
(SBS,Self-Adhering) Cap Elastoflex SA P,Elastoflex SA P FR,Polyreflect
APP-TA Base or Ply Polyglass APP Base,Polyflex,Polybond Torch-Applied
/ (APP,Torch-Applied) Cap Polyflex,Polyflex G,Polyflex G FR,Polybond,Polybond G,Polyfresko G,Polyfresko G FR
/ APP-SA Cap /
vv (APP,Self-Adhering) P Polyflex SA P,Polyflex SA P FR,Polyfresko G SA,Polykool Self-Adhering V/
15. Any of the following FBC Approved coatings may be applied to the top roof membrane without adverse effect on the system wind load performance. Refer to current Roofing Materials Directory for fire ratings
associated with coating usage.
➢ PG200 Non Fibered Roof Coating;
➢ PG300 Fibered Roof Coating;
➢ PG600 Non-Fibered Aluminum Roof Coating;
➢ PG650 Fibered Aluminum Roof Coating;
D PG700 High Quality Elastomeric Roof Coating;
➢ PG800 Asphalt Emulsion Roof Coating;
➢ Polyplus 60 Premium Non-Fibered Aluminum Roof Coating;
➢ Polyplus 65 Premium Fibered Aluminum Roof Coating;
➢ Polybrite 70 Premium Grade Elastomeric Roof Coating;
➢ Polybrite 90 High Solids Silicone Roof Coating or Polybrite 95 Silicone Roof Coating.
16. The following represent priming requirements for gypsum-based coverboards:
➢ Dens Deck and Dens Deck Prime shall be field-primed with PG100 prior to self-adhering or torch-applied membrane application. No priming is required for hot-asphalt membrane applications.
➢ SECUROCK Gypsum-Fiber Roof Board does not require field priming for any membrane application.
17. "MDP"=Maximum Design Pressure is the result of testing for wind load resistance based on allowable wind loads.Refer to FBC 1609 for determination of design wind loads.
Exterior Research and Design,LLC.d/b/a Trinityl ERD Evaluation Report P9290.02.08-R14 for FL1654-1116
Certificate of Authorization#9503 Revision 14:06/17/2015
Prepared by: Robert Nieminen,PE-59166 Appendix 1,Page 3 of 36
r
a
\JTRINITY1 ERD
TABLE 1E-2:WOOD DECKS—NEW CONSTRUCTION,REROOF(TEAR-OFF)ORRECOVER
SYSTEM TYPE E: NON-INSULATED,MECHANICALLY ATTACHED BASE SHEET(SCREWS&PLATES),BONDED ROOF COVER
System Deck(See Base Sheet Roof Cover MDP(psf)
No. Note 1) Base Fasten Attach Ply Cap
OMG#12 Standard Roofgrip or OMG#14 Heavy
W-43 Min.15/32- Pol lass APP Base Duty(min.1-5/8-inch Ion with OMG 3"Round three,eqo. at 4-inch lap and 6-inch o.c.In
Inch plywood yg y( g) three,equally spaced,staggered center rows (Optional)APP-TA APP-TA -90.0
Metal Plates or OMG Flat Bottom Metal Plates
Min.15/32- OMG#12 Standard Roofgrlp or OMG#14 Heavy 6-inch o.c.at 4-inch lap and 6-inch o.c.in (Optional)BP-AA,SBS-AA, SBS-AA,SBS-TA
W-44 Inch plywood Elastobase(with sand top surface) Duty(min.1-5/8-inch long)with OMG 3"Round -90.0
Metal Plates orOMGFlatBottomMetalPlates three,equally spaced,staggered center rows SBS TA or APP-TA or APP-TA
W-45 Min.15/32- Elastobase(with sand top surface) Trufast#12 DP or Trufast#14 HD(min.1-5/8-inch 6-inch o.c.at 4-inch lap and 6-Inch o.c.in (Optional)BP-AA or SBS-AA SBS-AA -90.0
Inch plywood long)with Trufast 3"Metal Insulation Plates three,equally spaced,staggered center rows
OMG 012 Standard Roofgrlp or OMG#14 Heavy
Min.15/32- 6-inch o.c.at 4-inch lap and 6-inch o.c.in five,
W-46 Inch plywood Polyglass APP Base Duty(min.1-5/8-inch long)with OMG 3"Round equally spaced,staggered center rows (Optional)APP-TA APP-TA -120.0
Metal Plates or OMG Fiat Bottom Metal Plates
Min.15/32- OMG#12 Standard Roofgrip or OMG#14 Heavy 6-Inch o.c,at 4-inch lap and 6-Inch o.c.In five, (Optional)BP-AA,SBS-AA, SBS-AA,SBS-TA
W-47 Inch plywood Elastobase(with sand top surface) Duty(min.1-5/8-Inch long)with OMG 3"Round equally spaced,staggered center rows SBS-TA or APP-TA or APP-TA -120.0
Metal Plates or OMG Flat Bottom Metal Plates
W-48 Min.15/32- Elastobase(with sand top )surface Trufast#12 DP or Trufast#14 HD(min.1-5/8-inch 6-inch o.c.at 4-Inch lap and 6-inch o.c.in five,
Inch plywood long)with Trufast 3"Metal Insulation Plates equallyspaced,staggered center rows (Optional)BP-AA or SBS-AA SBS-AA 120.0
TABLE 1F:WOOD DECKS—NEW CONSTRUCTION OR REROOF(TEAR-OFF)
SYSTEM TYPE F:NON-INSULATED,BONDED ROOF COVER
System Deck(See Roof Cover
No. Note 1) Primer MDP(psf)
Joint Treatment Base Ply Cap
W-49 Min.15/32- (Optional)PG100 None SBS-SA (Optional)SBS-SA,SBS- SBS-SA,APP-SA,SBS- -90.0
Inch plywood TA,APP-TA TA,APP-TA
W-50 Min.15/32- (Optional)PG100 None Polyflex SA Base (Optional)One or more APP TA -90.0
Inch plywood APP-TA
W-51 Min IS/32-
(Optional)PG100 place d joints are covered with to create continuous bond.4-Inch wide strips of Elastoflex SA V Plus,rolled into Elastoflex SA V Elastoflex SA V FR e or Base TA,(Optional)
ionalAPP-TASBS-SA,SBS- SBS-SA,
P APP-SA,SBS- -97.5
inchW-52 Min.15/32- (Optional)PG100 Plywood joints are covered with 4-inch wide strips of Elastoflex SA V Plus,rolled into Elastoflex SA V Plus or (Optional)SBS-SA,SBS- SBS-SA,APP-SA,SBS- -135.0
Inch plywood place to create continuous bond. Elastoflex SA V Plus FR TA,APP-TA TA,APP-TA
W-53 Min.15/32- (Optional)PG100 Plywood joints are covered with 4-inch wide strips of Elastoflex SA V Plus,rolled into Polyflex SA Base (Optional)One or more APP-TA -135.0
Inch plywood place to create continuous bond. APP-TA
Exterior Research and Design,LLC.d/b/a Trinity)ERD Evaluation Report P9290.02.08-R14 for FL16S4-R36
Certificate of Authorization#9503 Revision 14:06/17/2015
Prepared by: Robert Nieminen,PE-59166 Appendix 1,Page 9 of 36
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building,Permit:Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential Yes
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION .p
Address: 2-(CO �l-E C [ 1P
Legal Description: \N e�;-k— WOca �A(%V\y1 C5�
Property Tax I D#: 2-41 —1 — -1 dZ` 0 1 C3 Q ^G(10 2 Lot No. Z
Site Plan-Name: N/a Block No. CP
Project Name: N/a
Setbacks Front N/a Back: N/a Right Side: N/a Left Side: N/a
DETAILED DESCRIPTION OE WORK r - ,
We will tear off the existing roofing down to the plywood, Re-nail the deck to the current code and Re-roof.
1112-
UitlfbN LNFORMAT_IQN
Additional work to be nertormedd under this permit—check all appy:
11 HVAC Gas Tank —]Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers 1:1 Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor: N/a
Cost of Construction:$ Litilities:n Sewer Septic Building Height: N/a
OWNER/,.LESSEE CO NTRACTQR:.
Name V,4 HAa C PT Name: Christopher Collins
Address: ;�,74 PoVk( C\Q fair) &)-,Q. Company: Collins Roofing Inc
City: ,s�_ State: Address: PO Box 12867
Zip Code: 3 _I Fax:N/a City: Fort Pierce State:FL
Phone No.N/a Zip Code: 34979 Fax: 772-489-6505
E-Mail:N/a Phone No. 772-201-1352 or 772940-8607
Fill in fee simple Title Holder on,next page(if different E-Mail: CollinsroofingincC@gmaii.com
from the Owner listed above) State or County License: CCC-058011
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRU.,C-ION LIWI AW INFORMATION
DESIGNER/ENGINEER: d N plicable MORTGAGE COMPANY: d No le
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Phone:
FEESIMPLE TITLE HOLDER: d_Not Applicable 7BONDING COMPANY: t Applicable
Name:
Ad d ress: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is.in conflict with an.y..applicable Home Owners Association rules,bylaws or and.covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that 1 will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Xs
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 by this_day of 20 _by
1
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
CO M P LETE
INITIALS
_ 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, Christopher Collins , licensed as a(n)Contractor*/Engineer/Architect
(Please print name&circle license type) *FS468 Building Inspector
*General,Building,Residential or Roofing Contractor or any individual certified under 468 F.S.to make such an inspection.
On or about I IP I did personally inspect the roof deck nailing
(Date)
work at: Z I U0 5- 34-o"
(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).
X CCC-058011
Signature and Seal License#
STATE OF FLORIDA
COUNTY OF
Sworn to and subscribed before me this day of 20_,
by Who is personally known to me or who has produced
as identification.
Notary Public,State of Florida
Signature of Notary:
Commission Number: (Seal)
En 01/19/2011