HomeMy WebLinkAbout2809 Grove Dr - BR18-004624 - REROOFlu
CITY OF NOV 2 1 "'18
J,
Ez. PERMIT APPLICATIONSkNFORD
BUILDING DIVISION
Application No:
Documented Construction Value: $ 18 1
Job Address: ag OC Historic District: Yes No[&
Parcel ID: Q G-a0.31- SO 5 -?)GOO - 0050 Residential [9 Commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of Work: T2 -
Plan Review Contact Person: M ISS19_ 9u\n 10 TitIe Q)tI'YV I"YAY1A11
Phone: 407-(b0 -_5933 Fax: Email: ly ntj 12 P, )(WL- - CO M
1
Property Owner Information
Name Qt'`'Q I t SOYl Phone: A50 - 4q 1 -808J Street: ,
0 ls('.1J1( Resident of property?: Yeg City,
State Zip: JOdt0ya _ F DT 1 Jla Contractor
Information Name
X C. — Phone: LC) 7- q(DD' 5g33 Street: 40
ICI Y V I Fax: City, State
Zip: bAuya _ 1 o'yi 3` State License No.: 0a Name: Street:
City,
St,
Zip: Bonding Company:
Address: Architect/
Engineer
Information Phone: Fax:
E-
mail: _
Mortgage Lender:
Address: 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT Application is
hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. I understand that a
separate permit must be secured for electrical work, plumbing, signs, wells, pools, furnaces, boilers, heaters, tanks, and air conditioners, etc.
FBC 105.3 Shall be inscribed with the date ofapplication and the code in effect as ofthat date: 6`t' Edition (2017) Florida Building Code
NOTICE: In addition to the requirements of this permit, there maybe additional restrictions applicable to this property that maybe found in the public
records of this county, and there may be additional permits required from other governmental entities such as water management districts, state
agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
The City of Sanford requires payment of a plan review fee at the time of permit submittal. A copy of the executed contract is required in order to
calculate a plan review charge and will be considered the estimated construction value ofthe job at the time of submittal. The actual construction value
will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in accordance with local ordinance. Should calculated
charges figured off the executed contract exceed the actual construction value, credit will be applied to your permit fees when the permit is issued.
OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be
done in compliance with all applicable laws regulating construction and zoning.
Signature ofOwner/Agent ate
y.1 AkX&5brl_
Print Owner/Agent's Name
aw Aj 4/26 /90161
Signature of Notary -State of Florida Date
Signature o ontractor/Agent Date
Pri t Contractor/Agent's NU
irJZLL
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or Contractor/Agent is X Personally Known to Me or
Produced ID X Type of ID Produced ID Type of ID
RUBw
RUTH=CNN RUBIN ZPRvgss
NOTARY PUBLIC oQ NOTARY PUBLIC
o IfiAfiE OF FLORIDA STATE OF FLORIDA
o r o
0®tiitt GG159793 BELOW IS FOR OFFICE USE ONLY 2 Comm# GG159793
Expires 11/13/2021 sN E19 0 Expires 11/13/2021
Permits Required: Building Electrical Mechanical Plumbing Gas [I Roof
Construction Occupancy Use:
Total Sq Ft of Bldg: Min. Occupancy Load:
Flood Zone:
of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: k Qcwpa ra «(o. aT 0\$
I hereby name and appoint:
an agent of: XRC . LC Name
of Company) to
be my lawful attorney -in -fact to act for me to apply for, receipt for, sign for and do all things necessary
to this appointment for (check only one option): 0
The specific permit and application for work located at: Street
Address) Expiration
Date for This Limited Power of Attorney: License
Holder Name: State
License Number: \3_A( Q,r! o Signature
of License Holder: STATE
OF FLORIDA COUNTY
OFSe The
foregoing instrument was acknowledged before me this 9,1,' day of , A
a , by ( jQti) Aaa who is V personally known to
me or who has praducka as identification
and who did (did not) take an oath/.A'
1 .
A / 1 . / 1 A 0- Notary
Seal) RUTH-
ANN RUBIN a
NOTARY PUBLIC STATE
OF FLORIDA eComm#
GG159793 Expires
11/13/2021 Rev.
08.12) Signature
Print
or type name Notary
Public - State of Commission
No. G _ My
Commission Expires:
Grant Malo , Clerk Of The Circuit Court & Comptroller Seminole County, FLInst #20181y12565 Book:9222 Page:269; (1 PAGES) RCD: 10/2/2018 3:12:35 PMRECFEE $10.00
THIS INSTRUMENT PREPAREDrBY:
Name: THARA L. HUDSON
VrAddress:
NOTICE -OF COMMENCEMENT
Permit Number.
Parcel ID Number. 06-20-31-505-OG00-0050
e
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, thefollowinginformationisprovidedinthisNoticeofCommencement
1. REBCltU'ilaN QF pRQP S7Y(L 9at descrisu(a2oj ra t$agdlsire0dddfpss ifavailable)
2. GENERAL DESCRIPTION OF IMPROVEMENT:
OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT:
Name and address: THARA L. HUDSON, 2809 GROVE DRIVE, SANFORD FLORIDA 32771
Interest in property:
Fee Simple Title Holder (if other than owner listed above) Name:
Address:
4. CONTRACTOR: Name:_ XRC, LLC Phone Number. 407-960-5933
Address: 4019 W 1st STREET, SANFORD, FLORIDA 32771
5. SURETY (If applicable, a copy of the payment bond is attached): Name:
Address: Amount of Bond:
6. LENDER: Name: Phone Number.
Address:
7. Persons within the State of Florida Designated by Owner upon whom notice or otherdocuments maybe served as provided by Section713.13(1)(a)7., Florida Statutes.
Name: Phone Number.
Address:
In addition, Owner designates Of
to receive a copy of the Lienor's Notice as provided In Section 713.13(1)(b), Florida Statutes. Phone number.
9. Expiration Date of Notice of Commencement (The expiration is 1 yearfrom date ofrecording unless a different date Is specked)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARECONSIDEREDIMPROPERPAYMENTSUNDERCHAPTER713, PART I, 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 THEJOBSITEBEFORETHEFIRSTINSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEYBEFORECOMMENCINGWORKORRECORDINGYOURNOTICEOFCOMMENCEMENT.
jj'— THARA L. HUDSON
SiOn-aluti or Owner or Lessee, or Owner's or Lessee's (Print Name and Provide signatory's TiderDfiiro) Authorized OfftcedDirectoVartnerAUnager)
State of _Rehl& County of Qu 0-
The foregoing instrument was acknowledged before me this _ day of S ` 1 8
by • t-1 A[9rsn Who Is personallyknownto me OR Name
of parsonmaking etaternent who
has produced identification type of identification produced: R -'-Dh y0`13Ucaz S.e RUTH
ANN RLIC V"v"? NOTARYPUBLIC
qcSTATE
OF FLORIDA ComrrkGG159793
Notary Signature Expires
11/13/2021
Property Record Card
Parcel: 06-20-31-505-OG00-0050
SeEcry f+OFmr Property Address: 2809 GROVE DR SANFORD, FL 32771
Parcel Information
Parcel 06-20-31-505-OG00-0050
Owner(s) HUDSON, THARA L
Property Address 2809 GROVE DR SANFORD, FL 32771
Mailing 2809 GROVE DR SANFORD, FL 32773-5226
Subdivision Name WOODMERE PARK 2ND REPLAT
Tax District S1-SANFORD
DOR Use Code 01-SINGLE FAMILY
Exemptions 00-HOMESTEAD(2018)
t
k F
n
i Y
S-
p
Legal Description
LOT 5 BLK G
WOODMERE PARK 2ND REPLAT
PB 13 PG 73
Taxes
Taxing Authority Assessment Value Exempt Values Taxable Value
County General Fund j 157,962 ! 55,000 ; 102,962
Schools i 157,962 30,000 127,962
City Sanford 157,962 j 55,000 1 102,962
SJWM(Saint Johns Water Management) i 157,962 1 55,000 i 102,962
County Bonds 157,962 55,000 i 102,962
Sales
Description Date Book Page Amount Qualified Vac/Imp
WARRANTY DEED 1/1/2002 04308 1231 109,000 E Yes j Improved
CORRECTIVE DEED 1/1/2002 04308 j 1229 100 j No Improved
CORRECTIVE DEED 1/1/2002
rM_---r--.____-------
04308 i 1228 100 1 No j Improved
QUIT CLAIM DEED s 5/1/2001 04087 2001 100 No j Improved
QUIT CLAIM DEED 4/1/1991 02300 0617 100 i No I Improved
QUIT CLAIM DEED 4/1/1985 01635 1636 100 ! No Improved
WARRANTY DEED 9/1/1983 01488 i 1589 38,000 i No Improved
WARRANTY DEED j 4/1/1981 01329 1467 27,000 1 Yes i Improved
WARRANTY DEED i 2/1/1978 01157 0275 18,000 j Yes Improved
Find Comparable Sales
Land
State Farm
HUDSON, THARA
00. 1 One -Story Roof
90
QUANTITY UNIT PRICE TAX GCO&P
11. Remove Tear off, haul and dispose of comp. shingles - Laminated
22.96 SQ 52.21 0.00 4
12. Laminated - comp. shingle rfg. - w/out felt
26.67 SQ 223.36 169.76 1,225.36
13. Roofing felt - 30 lb. 24.16 232.02
26.67 SQ 42.59
14. Roofing felt - 15 lb. 12.47 186.48
26.67 SQ 34.49
low slope ( roll roofing) additional underlayment to cover
15. R&R Drip edge 7.53 85.74
151.50 LF 2.78
16. R&R Continuous ridge vent - aluminum
20.00 LF 9.58 4.12 39.14
17. R&R Flashing - pipe jack - lead
2.00 EA 77.74 5.05 32.12
19. R&R Flashing - pipe jack - split boot
2.00 EA 82.58 5.17 34.08
19. Asphalt starter - universal starter course
151.00 LF 2.29 6.34 70.42
20. R&R Ridge cap - composition shingles
198.00 LF 7.34 13.86 293.44
21. Apply mastic around perimeter of the drip edge
151.00 EA 0.87 3.81 27.04
22. R&R Counterflashing - Apron flashing
58.00 LF 10.83 5.12 126.66
23. Re -nailing of roof sheathing - complete re -nail
2,296.00 SF 0.27 3.21 124.62
24. Step flashing
57.00 LF 10.34 5.39 118.96
Date: 8/26/2018 10:09 PM
59-2521-F901
RCV AGE/LIFE DEPREC. ACV
CONDITION DEP %
1,438.48 1,438.48
7,352.13 13/30 yrs 3,185.91) 4,166.22
Avg. 43.33%
1,392.06 1,392.06
1,118.80 1,118.80
514.44 13/35 yrs 191.08) 323.36
Avg. 37.14%
234.86 13/35 yrs 87.24) 147.62
Avg. 37.14%
192.65 13/35 yrs 71.57) 121.08
Avg. 37.14%
204.41 13/35 yrs 75.93) 128.48
Avg. 37.14%
422.55 13/20 yrs 274.66) 147.89
Avg. 65.00%
1,760.62 13/25 yrs 915.52) 845.10
Avg. 52.00%
162.22 162.22
759.92 13/35 yrs (282.27) 477.65
Avg. 37.14%
747.75 747.75
713.73 13/35 yrs (265.09) 448.64
Avg. 37.14%
Page: 6
HUDSON,THARA
State Farm
CONTINUED - One -Story Roof
59-2521-F901
QUANTITY UNIT PRICE TAX GCO&P RCV AGE/LIFE
CONDITION
DEPREC. ACV
DEP %
25. R&R Valley metal
171.00 LF 6.24 21.43 217.70 1,306.17 13/35 yrs 485.15) 821.02
Avg. 37.14%
26. R&R Modified bitumen roof
1.14 SQ 427.52 7.67 99.02 594.06 13/20 yrs 386.14) 207.92
Avg. 65.00%
Totals: One -Story Roof 295.09 3,152.54 18,914.85 6,220.56 12,694.29
Area Totals: Exterior Level
2,074.84 Exterior Wall Area
3,273.77 Surface Area 32.74 Number of Squares 484.51 Total Perimeter Length
118.85 Total Ridge Length
Total: Exterior Level 443.60 4,557.70 27,345.64 9,043.18 18,302.46
Front Elevation
0.00 SF Walls
0.00 SF Floor
0.00 SF Long Wall
QUANTITY UNIT PRICE
0.00 SF Ceiling 0.00 SF Walls & Ceiling
0.00 SF Short Wall 0.00 LF Floor Perimeter
0.00 LF Ceil. Perimeter
TAX GCO&P RCV AGEILIFE DEPREC. ACV
CONDITION DEP %
There was no observable Accidental Direct Physical Loss to the siding, windows or garage door on this elevation.
Totals: Front Elevation 0.00 0.00 0.00 0.00 0.00
Right Elevation
0.00 SF Walls 0.00 SF Ceiling 0.00 SF Walls & Ceiling
0.00 SF Floor 0.00 SF Short Wall 0.00 LF Floor Perimeter
0.00 SF Long Wall 0.00 LF Ceil. Perimeter
QUANTITY UNIT PRICE TAX GCO&P RCV AGE/LIFE DEPREC. ACV
CONDITION DEP %
There was no observable Accidental Direct Physical Loss to the siding, or windows on this elevation.
Totals: Right Elevation 0.00 0.00 0.00 0.00 0.00 --
Date: 8/26/2018 10:09 PM Page: 7
CITY 0f'
Building & Fire Prevention DivisionSORDRESIDENTMRE -ROOF POLICY & PROCEDURES
FIRE DEPARTMENT
PERMITTING REQUIREMENTS — NO PLAN REVIEW REQUIRED
THIS DOCUMENT (SIGNED) ALONG WITH AN ACCURATE AND COMPLETED RESIDENTIAL RE -ROOF SCOPE OF WORK ARE
REQUIRED TO BE SUBMITTED AS PART OF YOUR PERMIT APPLICATION.
THE SCOPE OF WORK MUST INCLUDE ALL APPLICABLE FLORIDA PRODUCT APPROVAL NUMBERS FOR ALL ROOF
COMPONENTS THAT WILL BE INSTALLED ON THE PROJECT.
A PERMIT WILL NOT BE ISSUED WITHOUT THESE DOCUMENTS. COPIES WILL BE MADE TO POST ON THE JOB SITE.
PROJECTS LOCATED IN THE SANFORD HISTORIC DISTRICT WILL REQUIRE PLAN REVIEW AND APPROVAL BY THE
SANFORD HISTORIC PRESERVATION BOARD
INSPECTION POLICY & PROCEDURES
A FINAL ROOF INSPECTION IS THE ONLY INSPECTION REQUIRED FOR RESIDENTIAL (SINGLE FAMILY, TOWNHOUSE,
MOBILE HOME, APARTMENT AND/OR CONDOMINIUM) RE -ROOF PERMITS.
THE FOLLOWING IS REQUIRED TO BE PROVIDE ON THE JOB SITE:
PERMIT CARD, POSTED IN A CONSPICUOUS AND WEATHERPROOF LOCATION
COMPLETED RESIDENTIAL RE -ROOF SCOPE OF WORK
COMPLETED AND NOTARIZED INSPECTION AFFIDAVIT
ALL FLORIDA PRODUCT APPROVAL AND CORRESPONDING INSTALLATION INSTRUCTIONS
PRODUCT APPROVAL SHALL MATCH WHAT IS ON THE SCOPE OF WORK)
DIGITAL PHOTOGRAPHS (MUST INCLUDE THE PERMIT NUMBER OR ADDRESS IN EACH PICTURE)
o EACH PLANE OF THE ROOF, SHOWING THE UNDERLAYMENT INSTALLED
o ROOF DECK NAILING PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
o ROOF DECK NAILS USED (INCLUDING A MEASURING DEVICE OR RULER SHOWING SIZE OF NAILS)
o UNDERLAYMENT PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
o DRIP EDGE & VALLEY ATTACHMENT (INCLUDING A MEASURING DEVICE OR RULER)
o SHINGLES INSTALLED, NAIL PATTERN AND LOCATION OF NAILS
SKYLIGHTS (IF APPLICABLE)
o DIGITAL PHOTOGRAPHS SHOWING ALL INSTALLATION COMPONENTS, PER FL PRODUCT APPROVAL
o DIGITAL PHOTOGRAPHS SHOWING ALL REQUIRED FLASHING, PER FL PRODUCT APPROVAL
FAILURE TO FOLLOW THESE SPECIFIC GUIDELINES WILL RESULT IN AN AFFIDAVIT PROVIDED BY A FLORIDA DESIGN
PROFESSIONAL (ARCHITECT OR ENGINEER), CERTIFYING FBC CODE COMPLIANCE BY PERSONAL INSPECTION.
CONTRACTOR (OR OWNER/BUILDER) SIGNATURE' ATE: 4
CITY OF
SORD
FIRE DEPARTMENT
JOB ADDRESS:
PERMIT #
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
STRUCTURE TYPE: KSINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF
DECK TYPE (PLEASE SPECIFY:
PLEASE NOTE: ONLY 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED **
ROOF VENTILATION: O OFF -RIDGE 0 RIDGE O SOFFIT OPOWERED VENT
SKYLIGHTS: O YES O NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 X4:12 OR GREATER
O TURBINES
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
SHINGLE
1
FL# (p `
O METAL FL#
O MODIFIED BITUMEN FL#
O TORCH DOWN FL#
OINSULATED FL#
O TILE FL#
O OTHER: FL#
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IFAPPLICABLE**
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 O 4:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
O SHINGLE FL#
O METAL FL#
O MODIFIED BITUMEN FL#
O TORCH DOWN FL#
O INSULATED FL#
O TILE FL#
O OTHER: FL#
CITY OF ,
S ORD Building & Fire Prevention Division
RESIDENTIAL RE -ROOF AFFIDAVIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT ADDRESS: moo j'fOYe 1 fQ
A-d . Floc aa 3a 1`7
I , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, EN I ER, ARCHITECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE
FOREGOING INFORMATION IS TRUE AND ACCURATE AND THAT ALL ROOFING COMPONENTS LISTED ON THE SCOPE OF WORK AT THE
ABOVE REFERENCED ADDRESS HAVE BEEN INSTALLED IN ACCORDANCE WITH THEIR PRODUCT APPROVALS AND ALL APPLICABLE CODE
REQUIREMENTS - SPECIFICALLY FLORIDA BUILDING CODE, EXISTING BUILDING. IN ADDITION I CERTIFY THE INSTALLATION MEETS ALL
REQUIREMENTS FOR SECONDARY WATER BARRIER AND NAILING OF THE ROOF DECK, IN ACCORDANCE WITH THE HURRICANE RETROFIT
MANUAL REQUIREMENTS (BASED ON F.S. CHAPTER 553.844).
LICENSE #: M (L
COMPANY / CONTRACTOR: u_-
CONTRACTOR SIGNATURE: DATE: I.7(0/ Ig
MUST BE SIGNED BY LICENSE HOLDER OR OWNER/BUILDER)
A FINAL ROOF INSPECTION IS REQUIRED:
THIS SIGNED AND NOTARIZED AFFIDAVIT MUST BE PROVIDED AT THE JOB SITE AT THE TIME OF THE FINAL ROOF INSPECTION,
ALONG WITH DIGITAL PHOTOGRAPHS OF EACH PLANE OF THE ROOF SHOWING IN DETAIL ALL COMPONENTS (DECKING,
UNDERLAYMENT, FLASHING, DRIP EDGE ATTACHMENT) WITH THE PERMIT NUMBER OR ADDRESS CLEARLY MARKED ON THE DECK
FOR EACH INSPECTION. THE PHOTOGRAPHS MUST INCLUDE A RULER OR MEASURING DEVICE TO CONFIRM ALL NAIL SPACING AND
OVERLAPS, INCLUDING DRIP EDGE AND VALLEY FLASHING. PLEASE REFER TO THE RE -ROOF POLICY AND INSPECTION PROCEDURE
PAPERWORK FOR FURTHER EXPLANATION OF ALL REQUIREMENTS.
FAILURE TO FOLLOW ALL REQUIREMENTS WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION FEE AS
WELL AS REQUIRING A DESIGN PROFESSIONAL (ARCHITECT OR ENGINEER) TO CERTIFY, BASED ON PERSONAL
INSPECTION, THE INSTALLATION OF ALL ROOFING COMPONENTS.
STATE OF FLORIDA COUNTY OFi ,
Sworn to and Subscribed before me this o1(o ` day of 20 19 by:
A,Q u, Who is XPersonally Known to me or has Produced (type of
id ntification) _ as identification.
Signature of Notary Public RUTH-ANN,-.RUBINStateofFloridaNOTARYPUBLIC
STATE OF FLORIDAill-bo:11-
Expires
COMM#GG159793
Print/Type/Stamp Name 11/13/2021ofNotaryPublic