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HomeMy WebLinkAbout146 Wornall DrCITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: /6e7— file—/ Documented Construction Value: A4" &LCf C.f Job Address: Q vt.U- u y 1 — Parcel ID: 3 3-1 q 30 -s1Q -o&-o -Dggc) . Type of Work: New Addition Alteration Repair Description of Work: W,A', V\n Historic District: Yes No 1 0 Residential Commercial Demo Change of Use Move slf\A" q- rQ -f)1e(c- Plan Review Contact Person: Title: Phone: (-\10-AQ5 iq._C3QL Fax: J Email: t ( 1 (' Property Owner Information Name Phone: Street: (Vc Resident of property? : f City, State Zip: Y1 cXC i f:1 , i Contractor Information (( f I,,, Name r 1/a Phone: j-(0S([_ i 1 SW Street: 7---'0 rK / f Fax: City, State Zip: 3 7 State License No.: Architect/Engineer Information Name: Phone: Street: Fax: City P- E - ail: Bonding Company - Address: 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 of application and the code in effect as of that date: 5" Edition (2014) Florida Building Code Revised: June 30, 2015 Permit Application NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management dish-icts,:state agencies, or federal agencies. Acceptance of permit is verificatiop that I will notify the owner of the property of the requ irements• 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 of the job at the time of submittal. The actual construction value will be figured based on the current [CC 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 i all applicable laws regulating cons uction and zoning. ad Signature of Owner. Agent Dale Si aontrao or/Agent , - Date Print 70-v,;Vdl nt's Name , Si narive ary-state o Florida Date MARISOL ZAERI NOTARY PUBLIC STATE OF FLORIDA Comm# EE859569 ire 1/13/2017 Owner/Agent is Personally Known to M1 or Produced ID Type of ID I,1'YJ Le t C s Namer Signahirc o&Wtary-State of FOA1- SOL ZAERIDate t1SW___ NOTARY PUBLIC STATE OF FLORIDA Comm# EE859569 ceTres 1/13/2017 Contractor/ Agent is yPersonall Known to Me o Produced lD pe of ID v C. 14 j iINL41 BELOW IS FOR OFFICE USE ONLY Permits Required: Building. Electrical Mechanical Plumbing Gas Roof Construction Type: Total Sq Ft of Bldg: Occupancy Use: Min. Occupancy Load: Flood Zone: of Stories: New Construction: Electric - # of Amps Plumbing - # of Fixtures Fire Sprinkler Permit: Yes No # of Heads Fire Alarm Permit: Yes No APPROVALS: ZONING: UTILITIES: ENGINEERING: FIRE: COMMENTS: WASTE WATER: BUILDING: Revised: June 30, 2015 Pennil Application LIMITED POWER OF ,ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs IDate: I hereby name and appoint:Mm cac6J'6'* an agent of: 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): 1 The specific permit and a p ication for w rk to ted at: a C 1 c n bcna (l Qf' cur - aMo d, ft-j 3 Street Address) Expiration Date for This Limited Power of Attorney: License Holder Name: State License Number; Signature of License F STATE OF FLO DA COUNTY OF The foregoing i trument wq& acknowl 206T, by N Li Q. to me or who has produced identification and who did (did no ) take Notary Seal) pm MARISOL ZAERI NOTARY PUBLIC STATE OF FLORIDA Comm# EE859569ExpirSS 1/1312017 before me this day , who is ersonally known t InO AA 4 as 3th 4, .-- /l 4 j Print or type name Notary Public - State of Ar C/&_ Commission No. My Commission Expires: [&?/,20/7 Rev. 08.12) A_City of Sanford Building and Fire Prevention Product Approval Specification Form Permit # Project Location Address As required by Florida Statute 553.842 and Florida Administrative Code 9N-3, please provide the information and product approval number(s) on the building components listed below if they are to be utilized on the construction project for which you are applying for a building permit. We recommend that you contact your local product supplier should you not know the product approval number for any of the applicable listed products. Be aware that windows, skylights, and exterior doors must be tested in accordance with the Florida Building Code, Section 1714.5. More information about Statewide Product Approval can be obtained at www.floridabuilding.org. The following information must be available on the jobsite for inspections: 1. This entire product approval form 2. A copy of the manufacturer's installation details and requirements for each product. Category / Subcategory Manufacturer Product Description Florida Approval # include decimal) 1. Exterior Doors Swinging Sliding Sectional Roll Up Automatic Other 2. Windows Single Hun Horizontal Slider Casement Double Hung Fixed Awning Pass Through Projected Mullions Wind Breaker Dual Action Other June 2014 Category / Subcategory Manufacturer Product Description Florida Approval # including decimal 3. Panel Walls Siding Soffits Storefronts Curtain Walls Wall Louver Glass block Membrane Greenhouse E.P.S Composite Panels Other 4. Roofing Products Asphalt Shingles nja Underla ments S —1 hQQ -T Roofing Fasteners Nonstructural Metal Roofing Wood Shakes and Shingles Roofing tiles Roofing Insulation Waterproofing Built up roofing System Modified Bitumen Single Ply Roof Systems Roofing slate Cements/ Adhesives / Coating Liquid Applied Roofing Systems Roof Tile adhesive Spray Applied Polyurethane Roofing E.P.S. Roof Panels Roof Vents Other June 2014 Category / Subcategory Manufacturer Product Description Florida Approval # include decimal 5. Shutters Accordion Bahama Colonial Roll up Equipment Other 6. Skylights Skylights Other 7. Structural Components Wood Connectors / Anchors Truss Plates Engineered Lumber Railing Coolers/Freezers Concrete Admixtures Precast Lintels Insulation Forms Plastics Deck / Roof Wall Prefab Sheds Other 8. New Exterior Envelope Products Applicant's Signature Applicant's Name Please Print) June 2014 ANCROOFING INC. 720 Business Park Blvd., Unit #10CENTRALFLORIDAWinterGarden; FL 34787Ph: (407)654 d500 SOUTHFLORIDFax: (407)654-4527 Ph: (561) 202-6901 PRO1 OSt9.1t I t;o Il CT Fax: (561) 202-6902 11-o0I--J . Y 5 (s lr nail+IlnR 1 i. r.in N,,( itt'u• • s+ 1 I[ Ii:v4it11 / 1,1 r"two i uNsulml) lYitviY u-l lini. i7.4.11 i{'1: tirr-t:i li.tl fPROPOSALSUBMITTEDTOWORKTOBEPERFORMEDAT: NAME l 'J L (_ NAMESTREETlt—L STREETCITY E> PHONE — T zs--. CITY CELL tf}C— -- i> O EMAIL SCOPE OF WORKy FOR THE SUM OF: -1 ki Su /' NOTE: 1. Replacement of any unforeseen bad or rotted wood will be installed at an additional charge and writ be billed to theinsurancecompanyduringandaftercompletionofroof. 2. This proposal is subject to the acceptance within N/A days and is void thereafter at the option of the contractor. 3. All proposals subject to approval by A N C Management. 4. SUPERVISION AND QUALITY CONTROL. The Contractor shall supervise and direct the work, using his best skill and attention. The Contractor shall be solely responsible for all construction means, methods, techniques, sequences, procedures and forcontractingandperformingallpotionsoftheworkandqualitycontrolundertheContract. 5. DELAYS, ETC. Purchaser hereby acknowledges that weather patterns may delay the job equal to the storms length anddurationwhichisbeyondthecontroloftheContractorandPurchaserherebyacceptsthedelaysoccasionedbythesecircumstances. Purchaser further agrees to pay 20% of the totat contract price to the Contractor due to premature cancellationofthecontract 6. PAYMENT. Purchaser hereby agrees that if the amounts due and owing hereunder are not paid when due, Purchaser shall be liable to pay all costs of collection, dispute, Including, but not ,limited to reasonableattorney's fee and costs, which amountstogetherwithallsumsdueandowinghereunder, shall bear interest at the maximum allowed industry rate. 7. ANC Roofing, Inc, is notresponsible for faulty or inadequately reinforced driveway. 8. Any unforeseen double roofs (double tear oft) not noted in this contract will be at an additional charge. 9. In no event shall the contractor's obligation over the life of this warranty exceed theprice paid for the roof. Notes: O I / h 19 r W r !( G A 06 S(o l1 p< G l// ze5et/ 400rC) /li© U1,4 /1n4Z on fGar`? WARRANTYTERMS; 5-- 1*cfr tUffrkMAI ," / !, fe Vm ,L 5 h ray% Date: d 2 V ! 6 ANC Roofing, Inc. Authorized Signature: VV 'Yx A /O Z 0 ( ACCEPTANCE OF AGREEMENT Terms: This agreement is for full Insurance scope of loss proceeds and Is subject to insurance company's approvalanddoesnotobligatehomeownerorANCRoofing, Inc. unless homeowner's insurance company approvesrepairorreplacementofroofandforotherdamages. By signing this agreement the homeowner authorizes ANCRoofing, Inc. to pursue homeowners best interest for repair or replacement of roof andfor other damages at a priceagreeabletotheEns. co, and ANC. Homeowner is responsible for deductible and The final price agreed on betweentheinsurancecompanyandANCshallbecomethefinalcontractpriceof: FULL SCOPE OF INSURANCE PROCEEDS. The specifications set out herein to accomplish the repair or replacement of roof and/or other damages. IntheeventoftheclaimbeingsettledthroughaPublicAdjusterorLegalAssistancereferredbyANC, this contract willstillbefullyexecutedandIneffectunderthetermsspecifiedwithin. Insurance Co.( !' r r .4 / t Accepted by Owner/Buyer Claim 0 "y L/3 -7-79 -7 Consultant / THIS INSTRUMENT PREPARED BY: Name: ANC Roofing, Inc. - Crystal Sharp Address: -WirrWr-G'ardun_Ft34787 I IlEfll Bili! IIIII ilIII IIIlI IIIII IIII18il ilrii `rt°t,fi!!. f`I+I? I r `;Ei'IThdtJl_.f:: C+)Ut-4,—r LEfi;iC2016li109-.A: r: i+., L. r rr; :, ., t L-L _r,i._r:-ail f'r) Permit Number: Parcel ID Number: 33-19-30-514-0000-0490 The undersigned hereby gives notice that improvement will be made to certain real property; and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. DES RIPTIONIQ) PROPERTY: (L gal SJGliption of the property and street address if available) 1144 WWornall UDnve Sanford, t-L 3 /-I LUtV3- COuM rY—Cta trP-rk-P B-50-PGS-63-ttTr 2. GENERAL DESCRIPTION OF IMPROVEMENT: Reroof 3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT: Name and address: Carol Lee Interest in property: 146 Wornail Drive Sanford, FL 32771-7758 Fee Simple Title Holder (if other than owner listed above) Name: Address: 4. CONTRACTOR: Name: ANC Roofing, Inc. - Arman Hedayat Phone Number: 407-654-4500 Address: 720 Business Park Blvd Unit 10 Winter Garden, FL 34787 5. SURETY (If applicable, a copy of the payment bond is attached): Name: Address: 6, LENDER: Name: Phone Number. Address: Amount of Bond: 7. Persons within the State of Florida Designated by Owner upon whom notice or other documents maybe served as provided by Section 713. 13(1)(a)7., Florida Statutes. 8. In addition, Owner designates Phone Number: 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 year from 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 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 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. l f o L L---C-cSignature of Owner or Lessee, or Owner's or Lessee's (Print Name and Provide Signatory's Title`Ofrice) Authorized OffirarfDireclndPartner!Manager) 1 Stateofi C County of c`, C_(j: V 1 ( The forego•ng instrument was acknowledged before me this , . day of i i f -LA' 20 by \ ) i _ Who is personally known to me yty^OR Nam-) of +po/r'`'n makingsta!ement who has produced identificatio4.( hype of identification produced: MARISOL 7.AERIa NOTARY PUBLIC d ?N STATE OF FLORIDACERTIFIED COPY- MARYANNE Camm# EE859569 CLERK OF THE CIRCUIT COURT AND` srKGE 1 Expires 1/13/2017 COMPTROLLER SEMINOLECOUNTY, FLORIDA V By Duo _ _ DEPLjWCLERtL 161201t Florida Building Code Online lit Fionda Departmentof BCIS Home Log In User Registration Hot Topics ( Submit Surcharge I Stats & Fads Publications FBC Staff BCIS Site Map I Links I Search Busines Professi 61 QOUSER: Approval Puubb lic User Regulation 1 ..EMMEProduct ADproyal Menu > Product or Application Search > Application List > Application Detai DOUE20M FL # FL10124-R17 Application Type Revision Code Version 2014 Application Status Approved Comments Archived Product Manufacturer Address/ Phone/Email Authorized Signature Technical Representative Address/ Phone/Email Quality Assurance Representative Address/ Phone/Email Category Subcategory Compliance Method Florida Engineer or Architect Name who developed the Evaluation Report Florida License Quality Assurance Entity Quality Assurance Contract Expiration Date Validated By Certificate of Independence Referenced Standard and Year (of Standard) Equivalence of Product Standards Certified By GAF 1 Campus Drive Parisppany, NJ 07054 973) 872-4421 lindareith@trinityerd. com Beth McSorley lindareith@trinityerd. com Beth McSorley (current) 1 Campus Drive Parsippany, NJ 07054 973) 872-4421 bmcsorley@gaf. com Roofing Asphalt Shingles Evaluation Report from a Florida Registered Architect or a Licensed Florida Professional Engineer Evaluation Report - Hardcopy Received Robert Nieminen PE- 59166 U L LLC 05/ 14/2016 John W. Knezevich, PE r Validation Checklist - Hardcopy Received FL10124 R17 COI 2015 01 COI Nieminen.odf Standard Year ASTM D1970 2009 ASTM D3161 2009 ASTM D3462 2009 ASTM D7158 2008 TAS 107 1995 https:// floridabui lding.orglprlpr_app_dtl.aspx?param=wGEVXQwtDquracBeVCbdM QNZD6Zesy3BpT6YGGOoRax64Ksl%2bsxAOQ%3d%3d 1/2 N;V16/2016 Sections from the Code Florida Building Code Online Product Approval Method Date Submitted Date Validated Date Pending FBC Approval Date Approved Summary of Products Method 1 Option D 12/16/2015 12/16/2015 12/19/2015 02/10/2016 FL # Model, Number or Name Description 10124.1 GAF Asphalt Roof Shingles Fiberglass reinforced 3-tab, laminated, 5-tab and hip/ridge asphalt shingles Limits of Use Installation Instructions Approved for use in HVHZ: No FL10124 R17 II 2015 12 FINAL ER GAF Asphalt Approved for use outside HVHZ: Yes Shingles FL10124-R17.pdf 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 5. Evaluation Reports FL10124 R17 AE 2015 12 FINAL ER GAF Asphalt Shingles FL10124-R17.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 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: INER go EI:hK{: E ICredi91 EC https://floridabuilding.orglpr/pr app dtl.aspx?param=wGEVXQwtDquracBeVCbdMQNZD6Zesy3BpT6YGGOoRax64Ksl%2bsxAOQ%3d%g3d 2/2 ITRINIIY ERD EVALUATION REPORT GAF 1 Campus Drive Parsippany, N1 07054 EXTERIOR RESEARCH & DESIGN, LLC. Certificate of Authorization #9503 353 CHRISTIAN STREET, UNIT #13 OXFORD, CT 06478 PHONE: (203) 262-9245 FAX: (203) 262-9243 Evaluation Report 01506.01.08-1118 FL10124-1116 Date of Issuance: 01/03/2008 Revision 18: 08/24/2015 SCOPE: This Evaluation Report is issued under Rule 61G20-3 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 evaluated for compliance with the S1h Edition (2014) Florida Building Code sections noted herein. DESCRIPTION: GAF Asphalt Roof Shingles LABELING: Labeling shall be 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. Trinity) ERD 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 "Trinity IERD 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: i Robert J.M. Nieminen, P.E. Florida Registration No. 59166, Florida DCAANE1983 The facsimile seal appearing was authorized by Robert Nieminen, P.E. on 08/24/2015. This does not serve asan electronically signed document. Signed, sealed hardcopies have been transmitted to the Product Approval Administrator and to the named client CERTIFICATION OF INDEPENDENCE: 1. TrinitylERD 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. Trinityl ERD 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. 5. This is a building code evaluation. Neither TrinityI ERD nor Robert Nieminen, P.E. are, in any way, the Designer of Record for any project on which this Evaluation Report, or previous versions thereof, is/was used for permitting or design guidance unless retained specifically for that purpose. PTRINITYIERD 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 Property Standard Year 1507.2.5, R905.2.4 Physical Properties ASTM D3462 2009 1507.2.7.1, R905.2.6.1 Wind Resistance ASTM D3161 2009 1507.2.7.1, R905.2.6.1 Wind Resistance ASTM D7158 2008 1507.2.7.1, R905.2.6.1 Wind Resistance TA5107 1995 3. REFERENCES: Kniitt 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 PRI (TST 5878) Wind Driven Rain GAF-407-02-01 01/21/2013 UL (TST 1740) ASTM D3462 93NK6295 11/29/1993 UL (TST 1740) ASTM D3462 99NK43835 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 OINK9226 05/21/2001 UL (TST 1740) ASTM D3161 01NK37122 12/18/2001 UL (TST 1740) ASTM D3462 01NK37122 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 03CA5367 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 1740) ASTM D3462 04NK22009 05/06/2005 UL (TST 1740) ASTM D3161 04NK22009 05/09/2005 UL (TST 1740) ASTM D3462 05NK27924 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 Exterior Research and Design, LLC. Evaluation Report 01506.01.08-1178 Certificate of Authorization #9503 FL10124-R16 Revision 18: 08/24/2015 Page 2 of 6 4. QOTRINITYIERD iniitt Examination Reference Date 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) ASTM D3161,D7158,D3462 10CA13686 05/15/2010 UL (TST 1740) ASTM D3462 IOCA07264 05/27/2010 UL (TST 1740) ASTM D3462 IOCA11953 10/29/2010 UL (TST 1740) ASTM D3161,D7158,D3462 IONK11951 10/30/2010 UL (TST 1740) ASTM D3161,D7158,D3462 IONK12070 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 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. (TST 9628) ASTM D3462 12CA34891 10/12/2012 UL, LLC. (TST 9628) ASTM D3161,D7158,D3462 12CA58151 02/15/2013 UL, I.I.C. (TST 9628) ASTM D3161 12CA38083 02/26/2013 UL, LLC. (TST 9628) ASTM D3161 13CA32332 06/18/2013 UL, LLC. (TST 9628) ASTM D3161 13CA37934 08/02/2013 UL, LLC. (TST 9628) ASTM D3161,D7158,D3462 4786875675 07/17/2015 UL, LLC. (QUA 9625) Quality Control Inspection Report, R21, Mobile, AL 06/19/2015 UL, LLC. (QUA 9625) Quality Control Inspection Report, R21,'Myerstown, PA 07/21/2015 UL, LLC. (QUA 9625) Quality Control Inspection Report, R21, Tuscaloosa, AL 06/26/2015 UL, LLC. (QUA 9625) Quality Control Inspection Report, R21, Michigan Cty, IN 05/14/2015 UL, LLC. (QUA 9625) Quality Control Inspection Report, R21, Shafter, CA 07/16/2015. UL, LLC. (QUA 9625) Quality Control Inspection Report, R21, Savannah, GA 06/24/2015 UL, LLC. (QUA 9625) Quality Control Inspection Report, R21, Minneapolis, MN 07/14/2015 UL, LLC. (QUA 9625) Quality Control Inspection Report, R21, Mt. Vernon, IN 07/10/2015 UL, LLC. (QUA 9625) Quality Control Inspection Report, R21, Baltimore, MD 07/21/2015 UL, LLC. (QUA 9625) Quality Control Inspection. Report, R21, Tampa, FL 06/26/2015 UL, LLC. (QUA 9625) Quality Control Inspection Report, R21, Dallas, TX 07/15/2015 UL, LLC. (QUA 9625) Quality Control Inspection Report, R21, Ennis, TX 07/09/2015 UL, LLC. (QUA 9625) Quality Control Inspection Report, R21, Fontana, CA 07/16/2015 PRODUCT DESCRIPTION: 4.1 Asphalt Shingles: 4.1.1 Marquis® WeatherMax®, Royal Sovereign® and Sentinel® are a fiberglass reinforced 3-tab asphalt roof shingles. 4.1.2 Camelot®, Camelot® 11, Country Mansion® 11, Glenwood'"', Grand Canyon®, Grand Sequoia®, Grand Sequoia® IR, Monaco®, Sienna®, Timberline American Harvest®, Timberline® ArmorShieldTM 11, Timberline® Natural Shadow®, Timberline HD®, Timberline® Cool Series, Timberline Ultra HD® and Woodland® are fiberglass reinforced, laminated asphalt roof shingles. 4.1.3 Slateline® is a fiberglass reinforced 5-tab asphalt roof shingle. 4.2 Hip & Ridge Shingles: 4.2.1 Seal -A -Ridge® Ridge Cap Shingles, Seal -A -Ridge® IR Impact -Resistant Ridge Cap Shingles and Timbertexo Premium Ridge Cap Shingles are fiberglass reinforced, hip and ridge asphalt roof shingles. 4.3 Starter Strips: 4.3.1 Pro -Start® Starter Strip Shingles and WeatherBlocker"A Premium Eave/Rake Starter Strip are starter strips for asphalt roof shingles. Exterior Research and Design, LLC. Evaluation Report 01506.01.08-R18 Certificate of Authorization #9503 FL10124-1116 Revision 18: 08/24/2015 Page 3 of 6 5. LIMITATIONS: 5.1 This is a building code evaluation. Neither TrinityJERD nor Robert Nieminen, P.E. are, in any way, the Designer of Record for any project on which this Evaluation Report, or previous versions thereof, is/was used for permitting or design guidance unless retained specifically for that purpose. 5.2 This Evaluation Report is not for use in the HVHZ. 5.3 Fire Classification is not part of this Evaluation Report; refer to current Approved Roofing Materials Directory for fire ratings of this product. 5.4 Wind Classification: 5.4.1 The GAF asphalt shingles noted in Section 4.1 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 use in all wind zones up to Vasd = 150 mph (V„ n = 194 mph). Refer to Section 6 for installation requirements to meet this wind rating. S.4.2 The GAF hip & ridge shingles noted in Section 4.2 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 use in all wind zones up to Vwd = 150 mph (V ii = 194 mph). Refer to Section 6 for installation requirements to meet this wind rating. 5.4.3 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. 5.5 All products in the roof assembly shall have quality assurance audit in accordance with the Florida Building Code and F.A.C. Rule 61G20-3. 6. INSTALLATION: 6.1 Undedayment: 6.1.1 Underlayment shall be acceptable to GAF and shall hold current Florida Statewide Product Approval, or be Locally Approved per Rule 61G20-3, per FBC Sections 1507.2.3, 1507.2.4 or R905.2.3. 6.2 Starter Shingles: 6.2.1 Installation of Pro -Start Starter Strip Shingles and WeatherBlocker Premium Eave/Rake Starter Strip 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, Grand Canyon, Grand Sequoia, Grand Sequoia IR, and Woodland require minimum five (5) nails per shingle. Slateline requires minimum six (6) nails per shingle. 6.3.2 Fasteners shall be in accordance with manufacturer's published requirements, but not less than FBC 1507.2.6 or R905.2.5. 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. Exterior Research and Design, I.I.C. Evaluation Report 01506.01.08-1118 Certificate of Authorization #9503 FL10124-R16 Revision 18: 08/24/2015 Page 4 of 6 TRINITY I ERD 6.4 Hip & Ridge Shingles: 6.4.1 Installation of Seal -A -Ridge Ridge Cap Shingles and Seal -A -Ridge IR Impact -Resistant Ridge Cap Shingles shall comply with the manufacturer's current published instructions with a minimum two (2) nails, minimum 3/8- inch head diameter, per shingle and nominal 0.25-inch diameter beads of Henkel "Loctite PL S30 Roof & Flashing Sealant". 11.51 Sealant 292mm) 1" Sellante 2L-_m) (25m) Enduit d'etancheite 12' 305 mm) I Nail Clavo 6 5/8' - 7 5/8' Clouer 168 - 194 mm) I 12' 305 mm) 6.4.2 Installation of Timbertex Premium Ridge Cap Shingles shall comply with the manufacturer's current published instructions with a minimum two (2) nails, minimum 3/8-inch head diameter, per shingle and beads of Sonneborn NIP1 Gun Grade Polyurethane Sealant or Henkel PL Roofing and Flashing Sealant. 1'4a'id!&m 1:R92 iiiai} t" 6 SQilant025rrtiri) 29 mn} 1=neii tdi drmnchi-W 4a v0{fCf (45 LT.rIt mm.) 1.. gas =0 6.4.3 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. Exterior Research and Design, I.I.C. Evaluation Report 01506.01.08-1118 Certificate of Authorization R9503 FL10124-1116 Revision 18: 08/24/2015 Page 5 of 6 7. 8. 9. 10. LABELING: 7.1 Labeling shall be in accordance with the requirements 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. BUILDING PERMIT REQUIREMENTS: As required by the Building Official or Authority Having Jurisdiction in order to properly evaluate the installation of this product. MANUFACTURING PLANTS: Contact the named QA entity for information on which plants produce products covered by Florida Rule 61G20-3 QA requirements. QUALITY ASSURANCE ENTITY: UL LLC — QUA9625; (847) 664-3281 Exterior Research and Design, I.I.C. Certificate of Authorization #9503 END OF EVALUATION REPORT - Evaluation Report 01506.01.08-1118 FL10124-1116 Revision 18: 08/24/2015 Page 6 of 6 2M 9/2016 Florida Building Code Online FlondaDepaitfneni BCIS Home Log In User Registration ( Hot Topics ( Submit Surcharge Stats & Facts I Publications i FBC Staff BCIS Site Map I Lin f Search i Bus4ines Professi nal Product Approval USER: Public User Regulation lR!!!!!'flslf!IIR!!lIB Product Approval Menu > Product or Application Search > Application List > Application Detail D FL # FL16226-R2 Application Type Revision Code Version 2014 Application Status Approved Comments Archived Product Manufacturer Atlas Roofing Corporation Address/Phone/Email 2000 RiverEdge Parkway Suite 800 Atlanta, GA 30328 770) 946-4571 mcollins@atlasroofing.com Authorized Signature Meldrin Collins mcollins@atlasroofing.com Technical Representative Address/Phone/Email Quality Assurance Representative Address/Phone/Email Category Roofing Subcategory Underlayments Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed Florida Professional Engineer o Evaluation Report - Hardcopy Received Florida Engineer or Architect Name who developed Zachary R. Priest the Evaluation Report Florida License PE-74021 Quality Assurance Entity UL LLC Quality Assurance Contract Expiration Date 12/31/2020 Validated By Locke Bowden Validation Checklist - Hardcopy Received Certificate of Independence FL16226 R2 COI ATL13001.2 2014 FBC Product Evaluation Report - FINAL.Ddf Referenced Standard and Year (of Standard) , Equivalence of Product Standards Certified By Sections from the Code 1507.2.3 1507.2.8 1507.3.3 1507.4.5.1 1507.4.5.2 1507.5.3 https://floridabui lding.orglprlpr_app_dti.aspx?param=wGEVXQwtDgsNc735fObM i pAugi8W N %2bisLJj 1 KUJfxwIjOtsCsfibDQ%3d%3d 1/2 2/19/2016 Florida Building Code Online 1507.5.3.2 1507.7.3 1507.7.3.2 1507.8.3 1507.8.3.2 1507.9.3 1507.9.3.2 1507.9.5 1518.4 Product Approval Method Method 2 Option B Date Submitted 04/19/2015 Date Validated 04/20/2015 Date Pending FBC Approval 04/23/2015 Date Approved 06/22/2015 Summary of Products FL # Model, Number or Name Description 16226.1 Gorilla Guard EverFelt Spec 30 ASTM D 6757 & ASTM D 226, Type II underlayment Limits of Use Installation Instructions Approved for use in (HVHZ: Yes FL16226 R2 II ATL13001.2 2014 FBC Product Evaluation Report - FINAL.DdfApprovedforuseoutsideHVHZ: Yes Impact Resistant: N/A Verified By: Zachary R. Priest 74021 Design Pressure: N/A Created by Independent Third Party: Yes Other: See evaluation report for limits of use Evaluation Reports FL16226 R2 AE ATL13001.2 2014 FBC Product Evaluation Report - FINAL.pdf Created by Independent Third Party: Yes 16226.2 SUMMIT & SUMMIT 60 Synthetic underlyaments for steep slope roofing Limits of Use Installation Instructions Approved for use in HVHZ: Yes FL16226 R2 II ATL13001.2 2014 FBC Product Evaluation Report - FINAL.pdfApprovedforuseoutsideHVHZ: Yes Impact Resistant: N/A Verified By: Zachary R. Priest 74021 Design Pressure: N/A Created by Independent Third Party: Yes Other: See evaluation report for limits of use. Evaluation Reports FL16226 R2 AE ATL13001.2 2014 FBC Product Evaluation Report - FINAL.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 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: CA No ECEEck wommCrediAr,:1, 1ttCC https://floridabui lding.orglprlpr_app_dti.aspx?param=wGEVXQwtDgsN c735fObM ipAugi8W N %2bisUj 1 KUJfxw IjOtsCsfi bDQ%3d%3d 2/2 ti CREEK Ys; d" TECHNICAL SERVICES, LLC Certificate of Authorization No. 29824 17520 Edinburgh Dr Tampa, FL 33647 813) 480-3421 EVALUATION REPORT 2014 FLORIDA BUILDING CODE Manufacturer: Atlas Roofing Corporation Issued March 30, 2015 2000 Riveredge Parkway, Suite 800 Atlanta, GA 30328 770) 612-6267 http://www.atlasroofing.com / Manufacturing Plants: Meridian, MS -- Calgary, Alberta Canada Gujarat, India Quality Assurance: UL LLC (QUA9625) SCOPE Category: Roofing Subcategory: Underlayments Code Sections: 1507.2.3, 1507.2.8, 1507.3.3, 1507.4.5.1, 1507.4.5.2, 1507.5.3, 1507.5.3.2, 1507.7.3, 1507.3.2, 1507.8.3, 1507.8.3.2, 1507.9.3, 1507.9.3.2, 1507.9.5, 1518.4 Properties: Physical properties REFERENCES Entity PRI Construction Materials Technologies (TST5878) PRI Construction Materials Technologies (TST5878) PRI Construction Materials Technologies (TST5878) PRODUCT DESCRIPTION AND APPLICATION Report No. Standard Year ATL-033-02-01 ASTM D 226 2006 ATL-101-02-01 ASTM D 6757 2007 ASTM D 226 2006 TAS 117(B) 1995 ASTM D 1781 1998(2012) ATL-134-02-01 ASTM D 6757 2007 ASTM D 226 2006 ASTM D 4869 2005e1 Gorilla Guard® EverFelt ASTM D 6757 and ASTM D 226, Type II mechanically fastened underlayment made Spec 30 from asphalt -saturated organic felt reinforced with glass fiber for steep slope roof applications. Rolls are a nominal 36-inch wide by 72-ft long. Unless otherwise noted, the following application details shall be followed for New and Existing construction. Deck: In accordance with FBC requirements; New construction in the HVHZ shall be in. 19/32 in. plywood Min. slope: 2:12 and in accordance with FBC requirements Attachment for 2:12 to 4:12: Mechanically fasten to deck in accordance with Manufacturer's published application instructions and FBC requirements; Min. 19 in. head lap and 6 in. end lap. Attachment (HVHZ) for > 4:12: Mechanically fasten to deck in accordance with Manufacturer's published application instructions and FBC (HVHZ) requirements; Min. 4 in. head lap and 6 in. end lap. Attachment (Non-HVHZ) > 4:12: Mechanically fasten to deck in accordance with Manufacturer's published application instructions and FBC requirements; Min. 2 in. head lap and 4 in. end lap ATL13001.2 FL16226-R2 Page 1 of 3 This evaluation report is provided for State of Florida product approval under Rule 61 G20-3. The manufacturer shall notify CREEK Technical Services, LLC of any product changes or quality assurance changes throughout the duration for which this report is valid. This evaluation report does not express nor imply warranty, installation, recommended use, or other product attributes that are not specifically addressed herein. CREEK TECHNICAL SERVICIES, LLC ATLAS ROOFING CORPORATION Underlayments Gorilla GuardO EverFelt Allowable roof coverings: Asphalt shingles, metal roof panels and shingles, Spec 30 - Continued wood shakes and shingles, and slate shingles. Clay and concrete tiles are allowable when installed with ASTM D 6830, ASTM D 249 organic cap sheet, or other approved underlayments in accordance with FBC requirements. Summit@ ASTM D 226, Type II alternative underlayment made from inorganic, woven polypropylene fabric dual -coated with resin for steep slope roof applications. Rolls are a nominal 48-inch wide by 250-ft long. Unless otherwise noted, the following application details shall be followed for New and Existing construction. Deck: In accordance with FBC requirements; New construction in the HVHZ shall be in. 19/32 in. plywood Min. slope: 2:12 and in accordance with FBC requirements Attachment for 2:12 to 4:12: Mechanically fasten to deck in accordance with Manufacturer's published application instructions and FBC requirements; Min. 24 in. head lap and 12 in. end lap. Attachment > 4:12: Mechanically fasten to deck in accordance with Manufacturer's published application instructions and FBC requirements; Min. 4 in. head lap and 12 in. end lap Allowable roof coverings: Asphalt shingles, metal roof panels and shingles, wood shakes and shingles, and slate shingles. Summit@ 60 ASTM D 6757, ASTM D 4869, Type II and ASTM D 226, Type II alternative underlayment made from inorganic polypropylene fabric with woven polymeric scrim for steep slope roof applications. Rolls are a nominal 48-inch wide by 250-ft long. Unless otherwise noted, the following application details shall be followed for New and Existing construction. Deck: In accordance with FBC requirements; New construction in the HVHZ shall be in. 19/32 in. plywood Min. slope: 2:12 and in accordance with FBC requirements Attachment for 2:12 to 4:12: Mechanically fasten to deck in accordance with Manufacturer's published application instructions and FBC requirements; Min. 24 in. head lap and 12 in. end lap. Attachment > 4:12: Mechanically fasten to deck in accordance with Manufacturer's published application instructions and FBC requirements; Min. 4 in. head lap and 12 in. end lap Allowable roof coverings: Asphalt shingles, metal roof panels and shingles, wood shakes and shingles, and slate shingles. ATL13001.2 FL16226-R2 Page 2 of 3 This evaluation report is provided for State of Florida product approval under Rule 61G20-3. The manufacturer shall notify CREEK Technical Services, LLC of any product changes or quality assurance changes throughout the duration for which this report is valid. This evaluation report does not express nor imply warranty, installation, recommended use, or other product attributes that are not specifically addressed herein. p EEK_ ATLAS ROOFING CORPORATION j't Underlayments TECHNICAL SERVICES, LLC LIMITATIONS 1) Fire Classification is not within the scope of this evaluation. 2) Wind uplift resistance in not within scope of this evaluation. 3) Installation of the evaluated product shall comply with this report, the FBC, and the manufacturer's published application instructions. Where discrepancies exist between these sources, the more restrictive and FBC compliant installation detail shall prevail. 4) Deck substrates shall be clean, dry, and free from any irregularities and debris. All fasteners in the deck shall be checked for protrusion and corrected prior to underlayment application. 5) The roof deck shall be constructed of closely fitted sheathing for new or existing construction. Roof deck shall be installed in accordance with FBC requirements. 6) All underlayments shall be installed with the roll length parallel to the eave, starting at the eave, and lapped in success courses installed up the deck in a manner that effectively sheds water from the deck. End laps shall be staggered between courses in accordance with the manufacturer's application instructions. 7) Roof coverings shall not be adhered directly to the underlayment. 8) The underlayment may be used as described in other current FBC product approval documents. 9) The underlayment shall be exposed on the roof deck for a maximum 30 days unless otherwise stated. 10) All products listed in this report shall be manufactured under a quality assurance program in compliance with Rule 61 G20-3. COMPLIANCE STATEMENT The products evaluated herein by Zachary R. Priest, P.E. have demonstrated compliance with the 2014 Florida Building Code as evidenced in the referenced documents submitted by the named manufacturer. No 74021 STATE OF O S C O RS,0N A E% %. CERTIFICATION OF INDEPENDENCE 2015.03.3 2-0 0 9:12:02 Zachary R. Priest, P.E. Florida Registration No. 74021 Organization No. ANE9641 CREEK Technical Services, LLC does not have, nor will it acquire, a financial interest in any company manufacturing or distributing products under this evaluation. CREEK Technical Services, LLC is not owned, operated, or controlled by any company manufacturing or distributing products under this evaluation. Zachary R. Priest, P.E. does not have, nor will acquire, a financial interest in any company manufacturing or distributing products under this evaluation. Zachary R. Priest, P.E. does not have, nor will acquire, a financial interest in any other entity involved in the approval process of the product. END OF REPORT ATL13001. 2 FL16226-R2 Page 3 of 3 This evaluation report is provided for State of Florida product approval under Rule 61G20-3. The manufacturer shall notify CREEK Technical Services, LLC of any product changes or quality assurance changes throughout the duration for which this report is valid. This evaluation report does not express nor imply warranty, installation, recommended use, or other product attributes that are not specifically addressed herein. CITY OF SANFORD BUILDING SERVICES Residential Re -Roof Hurricane Mitigation Inspection Affidavit Permit #: I, hereby acknowledge that I personally inspected oof deck nailing and/or Secondary water barrier work at `L,`Q (` j , X 1 and have determined that the work Job Site Address) was done according to the Hurricane Mitigation Retrofit Manual. (based on 553.844 F.S.) I certify that my statements herein are true and accurate to the best of my belief and that I fully understand that making any false statements in writing with the intent to mislead a public servant in the performance of his or her official duty shall constitute a misdemeanor of the second degree pursuant to Section 83 .06 F.S. 05)oil I Signature of Contractor Date nm 0 UffS- V76 Printed Name of Contractor U License # License Type: General El Building Resident ial oofing Contractor or any individual certified in accordance with F.S. 68 to make such an inspection. STATE OF FLORIDA COUNTY OF no V S rn to (or a firmtd) and ubscribed before this I day of W_"H , 20 , by x u- , who isPersonally Known to me or has Produced (type of identi is tion) L4A as identification. SEAL) Sign ture f Notary P blic State of lijovid C j r Sol _ $;,yew NIARISOL ?AERI Print/Ty a/Stamp Name TARy PUBLIC of Notary Public STATE OF FLORIDA Comm# EESS9569 Expires 1/13/2017 3