HomeMy WebLinkAbout123 Lake Ada CrR�C�I`V�D
MAY 2 4 2016
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: I (D' l SO
Documented Construction Value: $
Job Address: 123 Lake W(f <5011Va4 S� 31113 Historic District: Yes ❑ No e'
Parcel ID: Residential 131 -'Commercial ❑
Type of Work: New ❑ Addition ❑ Alteration ❑ Repair ❑ Demo ❑ Change of Use ❑ Move ❑
Description of Work:
Plan Review Contact Person:
Phone: yG'1' 321" ?6 -�.
Fax:
V1\
Title:
Email: A 0 GrtnJ
Property Owner Information !!/�
Name �1n u Q&vr\ Phone: 7 -321—
Street: 2- c-�P_ Ma\ GF Resident of property?
City, State Zip: 3
Contractor Information
Name Phone:
Street:
Fax:
City, State Zip: State License No.:
Architect/Engineer Information
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
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. 1 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: 51, Edition (2014) Florida Building Code
Revised: lune 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 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 of the 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
ie done in compliance with all applicable laws regulating construction and zoning.
-2.y oDl,6 `�, 1j'- V- 201,4
Signature of Owner/Agent Date Signature of Contrac /Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
Print
Signature of Notary -State of Florida \ Date
Contractor/Agent is Personally Known to Me or
Produced ID Type of ID
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 Lodd:
New Construction: Electric - # of Amps,
Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads
Flood Zone:
# of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes ❑ No ❑
APPROVALS: ZONING: UTILITIES: WASTE WATER:
ENGINEERING:
COMMENTS:
FIRE:
BUILDING:
Revised: lune 30, 2015 Permit Application
rb
Property Address:
cam . �--A �') V �. -�k 3 Z
I, e `r1 do hereby state that I am qualified
and capable of performing the requested construction involved with the permit application filed and agree to the
Form of Identification
(Must be Photo ID)
ate
5- zY- 20/b_
A violation of this exemption is a misdemeanor of the first degree punishable by a term of imprisonment
not exceeding 1 year and a $1,000.00 fine in addition. to any civil penalties. In addition, the local
permitting jurisdiction shall withhold final approval, revoke the permit, or pursue any action or remedy
for unlicensed activity against the owner and any person performing work that requires licensure under
the permit issued.
Rev. 9.14.2009
I agree -that, as 'the party legally and financially responsible for this proposed construction activity, I will
abide by all applicable laws and requirements that govern owner -builders as well as employers. I also
'understand that the construction must comply with all applicable laws, ordinances, building codes, and
zoning regulations.
—►" `
I am of aware of construction practices and I have access to the Florida Building Codes.
I understand that I may obtain more information regarding my obligations as an employer from the Internal
Revenue Service, the United States Small Business Administration, the Florida Department of Financial
Services, and the Florida Department of Revenue. I also understand that I may contact the Florida
Construction Industry Licensing Board at 1-850487-1395 or at www.myflorida.com/dbpr/pro/Cilb/ for
more information about licensed contractors.
I am aware of, and consent to, an owner -builder building permit applied for in my name and understand
that I am the party legally and financially responsible for the proposed construction activity at the address
1
M
listed below.
I agree to notify the building department immediately of any additions, deletions, or changes to any of the
information that I have provided on this disclosure or in the permit application package.
Licensed contractors are regulated by laws designed to protect the public. If you contract with a person
who does not have a license, the Construction Industry Licensing Board, the Department of Business and
Professional Regulation and the building department may be unable to assist you with any financial loss
that you sustain as a result of a complaint. Your only remedy against an unlicensed contractor may be in
civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an
individual or firm is injured while working on your property, you may be held liable for damages. If you
obtain an owner -builder permit and wish to hire a licensed contractor, you will be responsible for verifying
whether the contractor is property licensed and the status of the contractor's workers' compensation
coverage.
Property Address:
cam . �--A �') V �. -�k 3 Z
I, e `r1 do hereby state that I am qualified
and capable of performing the requested construction involved with the permit application filed and agree to the
Form of Identification
(Must be Photo ID)
ate
5- zY- 20/b_
A violation of this exemption is a misdemeanor of the first degree punishable by a term of imprisonment
not exceeding 1 year and a $1,000.00 fine in addition. to any civil penalties. In addition, the local
permitting jurisdiction shall withhold final approval, revoke the permit, or pursue any action or remedy
for unlicensed activity against the owner and any person performing work that requires licensure under
the permit issued.
Rev. 9.14.2009
OWNER BUILDER STATEMENT/AFFIDAVIT
Altamonte Springs, Casselberry, Lake Mary, Longwood, Oviedo, Sanford,
Seminole County, Winter Springs
Florida Statutes are quoted here in part for your information to indicate the authority for exemptions for
homeowners from qualifying as contractors and to express any applicable restrictions and responsibilities.
OWNERS MUST PERSONALLY APPEAR AT THE BUILDING DIVISION TO SIGN THIS DOCUMENT
BY SIGNING THIS STATEMENT, I ATTEST THAT: (Initial to the left of each statement)
Rev. 9.14.2009
I understand that state law requires construction -to be done by a licensed contractor and have applied for
an owner -builder permit under an exemption from the law. The exemption specifies that I, as the owner of
�U�
the property listed, may act as my own contractor with certain restrictions even though I do not have a
license.
I'mresponsible
I understand that building permits are not required to be signed by a property owner unless he or she is
for the construction and is not hiring a licensed contractor to assume responsibility.
I understand that, as an owner -builder, I am the responsible party of record on a permit. I understand that I
may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed
in his or her name instead of my own name. I also understand that a contractor is required by law to be
licensed in Florida and to list his or her license numbers on all permit and contracts.
I understand that I may build or improve a one -family or two-family residence or a farm outbuilding. I
may also build or improve a commercial building if the costs do not exceed $75,000. The building or
residence must be for my own use or occupancy. It may not be built or substantially improved for sale or
lease. If a building or residence that I have built or substantially improved myself is sold or leased within
in 1 year after the construction is complete, the law will presume that I built or substantially improved it
for sale or lease, which violates this exemption.
�n n
' V l
I understand that, as the owner -builder, I must provide direct, onsite supervision of the construction.
I understand that I may not hire an unlicensed individual person to act as my contractor or to supervise
persons working on my building or residence. It is my responsibility to ensure that the persons whom 1
employ have the licenses required by law and by city ordinance.
I understand that it is a frequent practice of unlicensed persons to have the property owner obtain an
owner -builder permit that erroneously implies that the property owner is providing his or her own labor
and materials. I, as an owner -builder, may be held liable and subjected to serious financial risk for any
Minjuries
sustained by an unlicensed person or his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner -
builder and am aware of the limits of my insurance coverage for injuries to workers on my property.
I understand that I may not delegate the responsibility for supervising work to a licensed contractor who is
not licensed to perform the work being done. Any person working on my building who Is not licensed
0�
must work under my direct supervision and must be employed by me, which means that I must
comply with laws requiring the withholding of federal income tax and social security contributions
under the Federal Insurance Contributions Act (FICA) and must provide workers' compensation
for the employee. I understand that my failure to follow these laws may subject me to serious financial
risk.
Rev. 9.14.2009
.Florida Building Code Online Page 1 of 2
Business & Professional Regulation
fIMIdaDeptf7lelllof 00S Moore I lav In 1 user Registration I Mot Topics I submit surcharge I Stats a Facts 1 Publications I Fac Stan I acts site Map I Unks I Search I
Bus ine i lvYproduct Approval
Professf IQI USER. Public User
Regulation
Product Apgoval Menu > Ptedu[t or Aoplicatbn Search > Application List > Application Detail
FL # FL2075-R7
Application Type Affirmation
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
Evaluation Entity
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
Sections from the Code
0
Florida Metal Products Inc.
6940 Stuart Ave
Jacksonville, FL 32254
(904) 783-8400
Clark@flamco.com
Clark Jones
clark@flamco.com
clark Jones
p o box 6310
Jacksonville, FL 32236
(904)783-8400
Clark@flamco.com
Clark Jones
p o box 6310
Jacksonville, FL 32236
(904)783-8400
clark0flamco.com
Ve,4 - A - i?� AV_
Roofing
Roofing Accessories that are an Integral Part of the Roofing
System
Evaluation Report from a Product Evaluation Entity
Miami -Dade BCCO - EVL
Miami -Dade BCCO - QUA
01/31/2018
Miami -Dade BCCO - VAL
5f1111111Ad
TAS 100 (A)
Year
1995
N. I affirm that there are no changes in the new Florida
Building Code which affect my product(s) and my product(s)
are in compliance with the new Florida Building Code.
http://www.floridabuilding.org/pr/pr app_dtl.aspx?param=wGEVXQwtDgvFG1 WOugHV... 1/22/2016
,Florida Building Code Online
Documentation from approved Evaluation or Validation Entity 0Yes ONo QN/A
Product Approval Method Method 1 Option C
Date Submitted 02/27/2015
Date Validated 02/27/2015
Date Pending FBC Approval
Date Approved 03/09/2015
Summary of Products
Page 2 of 2
FL !! I Model, Number or Name
Description
2075.1 RVIO
RVIO ALUMINUM RIDGE VENT
Limits of Use
Installation Instructions
Approved for use in HVHZ: Yes
FL2075 R7 11 rv10 noa 12 -0810 -OB exo 1-31-18.odf
Approved for use outside HVHZ: Yes
Verified By: Miami -Dade BCCO - EVL
Impact Resistant: N/A
Created by Independent Third Party:
Design Pressure: N/A
Evaluation Reports
Other:
FL2075 R7 AE rv10 noa 12-0810-08 exp 1-31-18.01
® Neat
Contact lg :: 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 :: Aa3esslblll& Statement :: Refund Statement
Under Florida law, email addresses are public records. If you do not want your e -mall 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 marl. If you have any questions, please contact 650.497.1395. *Pursuant to
Section 455.275(1), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. rust provide the Department with an email address if
they have one. The emalls provided may be used for official communication with the licensee. However email addresses aro 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 dick ISM.
Product Approval Accepts:
®® IMS ■
creditSAFE
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MIA MIAMI-DADE COUNTY
PRODUCT CONTROL SECTION
DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES (RER) 11805 SW 26 Street, Room 208
BOARD AND CODE ADMINISTRATION DIVISION Miami, Florida 33175-2474
T (786) 315-2590 F (786) 315-2599
NOTICE OF ACCEPTANCE (NOA) www.miamidade.eov/economy
Florida Metal Products Inc.
P.O. Box 6310
Jacksonville, FL 32236-6310
SCOPE:
This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The
documentation submitted has been reviewed and accepted by Miami -Dade County RER - Product Control Section to be
used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ).
This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product Control Section
(in Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) reserve the right to have this
product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted
manner, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify, or
suspend the use of such product or material within their jurisdiction. RER reserves the right to revoke this acceptance,
if it is determined by Miami -Dade County Product Control Section that this product or material fails to meet the
requirements of the applicable building code.
This product is approved as described herein, and has been designed to comply with the Florida Building Code
including the High Velocity Hurricane Zone of the Florida Building Code.
DESCRIPTION: RV10 Aluminum Ridge Vent
LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following
statement: "Miami -Dade County Product Control Approved", unless otherwise noted herein.
RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change
in the applicable building code negatively affecting the performance of this product.
TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the
materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product,
for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section
of this NOA shall be cause for termination and removal of NOA.
ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by the
expiration date may be displayed in advertising literature. if any portion of the NOA is displayed, then it shall be done
in its entirety.
INSPECTION: A copy of this entire NOA 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 renews NOA#t 08-0611. 10 and consists of pages I through 4
The submitted documentation was reviewed by Alex Tigera.
MIAMI DADE COUNTY NOA No.: 12-0810.08
... � � Expiration Date: 01/31/18
Approval Date: 01/17/13
Page 1 of 4
ROOFING COMPONENT APPROVAL
Category:
Roofing
Sub -Category:
Ventilation
Material:
Aluminum
Minimum Slope:
2:12
TV -ADE NAMES OF PRODUCTS MANUFACTURED OR LABELED BY APPLICANT
Product Dimensions Test Product
Specification Description
RV10 Aluminum Ridge 7-5/8" x 10'-0" TAS 100(A) Ridge ventilation system
Vent
MANUFACTURING LOCATION
1. Jacksonville, FL.
EVIDENCE SUBMITTED
Test Aeencv/Identifier Name Report
Center for Applied Engineering, Inc. MTS 257414a TAS 100(A)
PRI Construction Materials Technologies, LLC FMP-003-02-01 TAS 100(A)
Date
September, 1995
02/12/08
NOA No.: 12-0810.08
Expiration Date: 01/31/18
Approval Date: 01/17/13
Page 2 of 4
APPROVED APPLICATIONS
Tradename: RV 10 Aluminum Ridge Vent
System Type: Mechanical attachment of ridge vent system over asphalt composition shingles.
Cutout: Truss Construction: Cut shall be 2" wide, and length shall be 12" (plus overhang length)
shorter on both sides of gable end or hips.
Ridge Pole Construction: Cut shall be 3-'/4" wide, and length shall be 12" (plus overhang
length) shorter on both sides of gable end or hips.
Installation: Install end plug on the end of the vent sealed with 100% silicone sealant. RV 10
Aluminum Ridge Vent shall be 4" longer than ventilation slot as to provide a base for the
end plug.
Apply 'h" wide bead of 100% silicone sealant caulk to the bottom flange of the RV 10
Aluminum Ridge Vent sections close to where roof hole will be after vent is installed.
Align end of first section on the end marks and the bottom of the nailing flange on the
chalk line (4" down on both side of the ridge peak.) Nail the RV 10 Aluminum Ridge
Vent in place using 1'/z" aluminum ring shank roofing nails 6" o.c., with the first nail
1'/z" to 2" form the vent end. All nail heads and vent section joints shall be sealed with
100% silicone sealant.
Install Florida Metal Products, Inc. High Wind Straps over each end of ridge vent, all
connections between sections, and at a maximum of 3 ft. intervals over the remainder of
the vent using four 1-1'/z " aluminum ring shank roofing nails per strap
Ridge Shingle: None
Ventilation Refer to manufacturers published literature.
Calculations:
GENERAL LIMITATIONS:
1. RV 10 Aluminum Ridge Vent shall not be installed on roof mean heights greater than 33 feet.
2. RV 10 Aluminum Ridge Vent shall comply with applicable Building Code.
3. RV 10 Aluminum Ridge Vent shall not be installed in conjunction with Gable vents.
4. Refer to applicable Building Code required ventilation.
5. All approved products listed herein shall be labeled and shall bear the imprint or identifiable marking of the
manufacturer's name or logo and following statement: "Miami -Dade County Product Control Approved" or the
Miami -Dade County Product Control Seal as shown below.
Muu�►ow�e couNrr
. l
NOA No.: 12-0810.08
Expiration Date: 01/31/18
Approval Date: 01/17/13
Page 3 of 4
DETAIL DRAWINGS
5-3/4"
M
7-5/8"
RV10 ALUMINUM RIDGE VENT
END OF THIS ACCEPTANCE
NOA No.: 12-0810.08
Expiration Date: 01/31/18
Approval Date: 01/17/13
Page 4 of 4
Florida Building Code Online
Professional Regulation,
Page 1 of 2
Ngjb(xp#riggd BQS Home I Log In I User Registration I Hot opics i u mit u arge tats acts tons toI Mtb bite Map L
Busines�! Product Approval
Professif al ®USER: Public User
Regulation
Product Approval Menu > Product or Application Search > Apollration List > Application Detail
FL it
FR3
Application Type
Revisionevision
1N
Code Version
2014
Application Status
Approved
Comments
Archived
D
Product Manufacturer
Mid -States Asphalt & Cant Strip, Inc.
Address/Phone/Email
1637 51st Avenue
Tuscaloosa, AL 35401
(205) 345-6634
eric@msaroof.com
Authorized Signature
James Buckner
jimmy@cbuckinc.net
Technical Representative Eric Bailey
Address/Phone/Email 1637 51st Avenue
Tuscaloosa, AL 35401
(205) 345-6634
eric@msaroof.com
Quality Assurance Representative Eric Bailey
Address/Phone/Email 1637 51st Avenue
Tuscaloosa, AL 35401
(205) 345-6634
eric@msaroof.com
Category Roofing
Subcategory Underlayments
Compliance Method Evaluation Report from a Florida Registered Architect or a Ucen
Professional Engineer
® Evaluation Report - Hardcopy Received
Florida Engineer or Architect Name who developed the
Evaluation Report
Florida Ucense
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
James L. Buckner P.E. @ CBUCK Engineering
PE -31242
UL LLC
12/31/2019
Do Yeon Kim, P.E.
p Validation Checklist - Hardcopy Received
Standard
ASTM D1970
UL 1897
Florida Licensed Professional Engineer or Architect
FL17401 R3 Eauiv Test Standard EauivodfR3 Eauiv Test Standard Eauiv.odf
Year
2009
2004
https://www.floridabuilding.org/t)r/pr app_dtl.aspx?param=wGEVXQwtDgt... 2/8/2016
Florida Building Code Online
Sections from the Code
Product Approval Method
Date Submitted
Date Validated
Date Pending FBC Approval
Date Approved
Summary of Products
Method 1 Option D
11/02/2015
11/02/2015
11/04/2015
12/15/2015
Page 2 of 2
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The State of Florida Is an AA/EEO employer. Copyright 2007-2013 State of Florida.:: Privacy Statement :: Accessibility Statement :: $dMp
Under Florida law, email addresses are public records. If you do not want your e-mail address released In response to a public -records reques
electronic mall to this entity. Instead, contact the office by phone or by traditional mall. If you have any questions, please contact 8S0.487.13S
Section 455.275(1), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must provide the Department %
address If they have one. The emails provided may be used for official communication with the licensee. However email addresses are public n
not wish to supply a personal address, please provide the Department with an email address which can be made available to the public. To dt
are a licensee under Chapter 455, F.S., please dick b .
Product Approval Accepts:
=WHEN
CredilSAFIE
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FL #
Model, Number or Name
Description
17401.1
1. QUIK-Stick IW, QUIK-Stick IWS,
Self -Adhered Underlayments
I
QUIK-Stick HT, QUIK-Stick HT -Pro,
QUIK-Stick FS
Limits of Use
Installation Instructions
Approved for use In HVHZ: No
FL17401 R3 11 1 OuikStick EVALREPORT.odf
Approved for use outside HVHZ: Yes
Verified By: James L. Buckner, P.E. PE #31242
Impact Resistant: No
Created by Independent Third Party: Yes
Design Pressure: N/A
Evaluation Reports
Other: Refer to Evaluation Report for Umitatlons and
FL17401 R3 AE 1 OuikStick EVALREPORT.Ddf
Conditions of Use. Refer to manufacturer's Installation
Created by Independent Third Party: Yes
Instructions as a supplemental guide for attachment.
17401.2
12. QUIK-Stick HT (High -Temperature)
Self -Adhered Underlayment (with uplift performance
Limits of Use
Installation Instructions
Approved for use in HVHZ: No
FL17401 R3 II 2 OuIkStickHT EVALREPORT.Ddf
Verified By: James L. Buckner, P.E. P.E. #31242
Approved for use outside HVHZ: Yes
Impact Resistant: N/A
Created by Independent Third Party: Yes
Design Pressure: +N/A/ -52.5
Evaluation Reports
Other: Refer to Evaluation Report for Umitatlons and
FL17401 R3 AE 2 OuikStickHT EVALREPORT.Ddf
Conditions of Use. Refer to manufacturer's Installation
Created by Independent Third Party: Yes
instructions as a supplemental guide for attachment.
Sack Next
The State of Florida Is an AA/EEO employer. Copyright 2007-2013 State of Florida.:: Privacy Statement :: Accessibility Statement :: $dMp
Under Florida law, email addresses are public records. If you do not want your e-mail address released In response to a public -records reques
electronic mall to this entity. Instead, contact the office by phone or by traditional mall. If you have any questions, please contact 8S0.487.13S
Section 455.275(1), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must provide the Department %
address If they have one. The emails provided may be used for official communication with the licensee. However email addresses are public n
not wish to supply a personal address, please provide the Department with an email address which can be made available to the public. To dt
are a licensee under Chapter 455, F.S., please dick b .
Product Approval Accepts:
=WHEN
CredilSAFIE
https://www.floridabuilding.org/pr/pr app_dti.aspx?param=wGEVXQwtDgt... 2/8/2016
CBUCK Engineering
Spv0dlty Structural Englrwe=s ing CeucK, Inc. Certlf)cate of Authorization #8064
Evaluation Report
Mid -States Asphalt
"QUIK-STICK"
Roof Underlayments
Manufacturer:
Mid -States Asphalt & Cant Strip, Inc.
1637 51s' Avenue
Tuscaloosa, AL 35402
(800) 489-2391
for
Florida Product Approval
# FL 17401.1 R3
Florida Building Code 5th Edition (2014)
Method: 1- D
Category: Roofing
Sub - Category: Underlayment
Product(s):
Description:
Prepared by:
James L. Buckner, P.E., SECB
Florida Professional Engineer # 31242
Florida Evaluation ANE ID: 1916
Project Manager: Diana Galloway
Report No. 15 -180 -QS -ER
(Revises 15 -180 -115 -ER)
Date: 10 / 27 / 15
Contents:
Evaluation Report Pages 1— 6
"QUIK-STICK"
Self -Adhered Underlayment
Digitally signed by lames L Buckner, P.E.
Electronically signed and sealed documents
shall comply with the provisions of FAC Rule
61615-23.``tllllllll////
* ' No 31242
' STATE OF
�s''•.FLORIDP. '' (9
�ONAI�a�`�.
�x
2015.11.0213:38:15 -05'00'
CBUCK, Inc. • Palm Beach County, Florida
Phone: (561) 491-9927 • Email: cbuck@cbuckinc.net • Website: www.cbuckinc.net
Mailing Address: 2637 E. Atlantic Blvd, 434069, Pompano, FL 33062
FL #: FL 17401.1 R3
Date: 10/27/15
CBUCK Engineering Page rt No.:1 - 04 -QS -ER
Specldlhy Structural Engineering CeuCK, Inc. Certificate of Authorization #8064
Manufacturer: Mid -States Asphalt & Cant Strip, Inc.
Product Category: Roofing
Product Sub -Category Underlayment
Compliance Method: State Product Approval Rule 61G20-3.005 (1) (d)
PRODUCTS
Product
Standard
Thickness
Roll
Description
(Nominal)
Dimensions
QUIK-STICK IW
ASTM D 1970
50 mils
36" x 66.8'
Self -adhering, SBS modified
(Ice & Water)
(200 sgft) rolls
membrane reinforced with non -woven
fiberglass mat and a skid -resistant,
granular surface
QUIK-STICK IW
ASTM D 1970
50 mils
36" x 66.8'
Self -adhering, SBS modified
Sand
(200 sgft) rolls
membrane reinforced with non -woven
(Ice & Water)
fiberglass mat and a skid resistant,
sand surface
QUIK-STICK HT
ASTM D 1970
60 mils
36" x 66.8' or
Self -adhering, SBS modified
(High Temperature)
39" x 61'
membrane reinforced with non -woven
(200 sgft) rolls
fiberglass mat and a skid -resistant,
polyester surface designed for use in
high temperatures
QUIK-STICK HT Pro
ASTM D 1970
60 mils
36" x 66.8'
Self -adhering, SBS modified
(High Temperature)
(200 sgft) rolls
membrane reinforced with non -woven
fiberglass, mat and a skid -resistant,
plastic film surface designed for use in
high temperatures
QUIK-STICK FS
ASTM D 1970
45 mils
36" x 66.8'
Self -adhering, SBS modified
(Film Surface)
(200 sgft) rolls
membrane reinforced with non -woven
fiberglass mat and a skid -resistant,
plastic film surface designed for use in
high temperatures
FL #: FL 17401.1 R3
Date: 10/27/15
CBUCK Engineering Page rt No.: 3 of 6a -Qs -ER
Speacidi l'y Structural E girwering CBUCK, Inc. Certincote of Authorization #8064
Installation: "QUIK-Stick' shall be installed in compliance with applicable code sections of the
Florida Building Code 5th Edition (2014), and in accordance with the installation
method described herein subject to the Limitations and Conditions of Use listed in
this Evaluation Report.
Refer to manufacturer's installation instructions as a supplemental guide for
attachment.
Quality Assurance: The manufacturer has demonstrated compliance of products in accordance with
the Florida Building Code and Rule 61G20-3.0005 (3) for manufacturing under a
quality assurance program audited by an approved quality assurance entity
through UL, I.I.C. (FBC Organization #: QUA 9625).
Performance Standards: The product described herein has demonstrated compliance with:
• ASTM D 1970-09 — Specification Self -adhering Polymer Modified Bituminous
Sheet Materials Used as Steep Roof Underlayment for Ice Dam Protection
• ASTM D 4798-04 - Standard Practice For Accelerated Weathering Test
Conditions And Procedures For Bituminous Materials (Xenon -Arc Method)
TAS 103 - Test Procedure for Self -Adhered Underloyments for Use in
Discontinuous Roof Systems
Standards Equivalency: The ASTM D 1970-01 standard version used to test the evaluated product
assembly is equivalent to ASTM D 1970-09 standard version adopted by the
Florida Building Code 5th Edition (2014).
Code Compliance: The products described herein have demonstrated compliance with the
performance standards listed above as referenced in the current Florida Building
Code.
Evaluation Report This product has been evaluated in compliance with the building envelope
Scope: requirements of the Florida Building Code, as relater+. ;o the scope section to
Florida Product Approval Rule 61G20-3.001.
FL #: FL 17401.1 R3
Date: 10/27/15
CBUCK Engineering N RepoPage rt No.: 4 - 64 -QS -ER
Specidlty Structural EIiQineacmang CBUCK, Inc. CertlJkote of Authorization #8064
Referenced Data: 1. ASTM D 1970-01 Test
By PRI Construction Materials Technologies, Inc.
(FBC Organization ID# TST 1556)
• Report No. WRMI-011-02-01, Date: 9/04/09 (IW)
• Report No. BWR-514-02-01(rev), Date: 9/04/09 (IWS)
• Report No. BWR-543-02-01, Date: 9/04/09 (FS)
• Report No. BWR-522-02-03, Date: 3/17/10 (HT Pro)
2. ASTM D 1970-01 & ASTM D 4798 Test
• Report No. BWR-534-02-01, Date: 9/07/12 (HT)
3. TAS 103 Test
Report No. BWR-533-02-01, Date: 9/07/12 (HT)
4. Equivalency of Test Standard Certification
By James L. Buckner, P.E. @ CBUCK Engineering
(FBC Organization # ANE 1916)
S. Quality Assurance
UL, LLC (FBC Organization #: QUA 9625)
#TG DY. R22025
6. Certification of Independence
By James L. Buckner, P.E. @ CBUCK Engineering
(FBC Organization # ANE 1916)
Limitations and Scope of "Limitations and Conditions of Use" for this evaluation:
Conditions of Use: . This evaluation report for "Optional Statewide Approval' contains technical
documentation, specifications and installation method(s) which include
"Limitations and Conditions of Use" throughout the report in accordance
with Rule 61G20-3.005. Per Rule 61G20-3.004, the Florida Building
Commission is the authority to approve products under "Optional Statewide
Approval'.
• Option for application outside 'limitations and Conditions of Use"
• Rule 61G20 -3.005(1)(e) allows engineering analysis for "project specific
approval by the local authorities having jurisdiction in accordance with the
alternate methods and materials authorized in the Code". Any modification
of the product as evaluated in this report and approved by the Florida
Building Commission is outside the scope of this evaluation and will be the
responsibility of others.
• This report is a building code product evaluation per FLPE rule (FAC) 61G15-
36 to comply with Florida product approval rule (FAC) 61G20-3. This
evaluation report is part of the Florida Building Commission approval for the
listed code related criteria. This report by James Buckner, P.E. and CBUCK
Engineering is not a design certification of code compliance construction
submittal documentation, per FBC section 107, for any individual structure,
site specific or permit design.
• Deck shall be in compliance with applicable building code.
• Fire Classification is outside the scope of Rule 61G20-3, and is therefore not
included in this evaluation.
• This evaluation report does not evaluate the use of this product for use in
the High Velocity Hurricane Zone code section. (Dade & Broward Counties)
A FL #: FL 17401.1 R3
Date: 10/27/15
CBUCK Engineering Page Report No • 5 - a -QS -ER
Speclalty Structural EnQ1r-wv Ir1Q DUCK, Inc. Certificate of Authorization #8064
Mid -States Asphalt & Cant Strip, Inc.
"QUIK-STICK"
Self -Adhered Roofing Underlayments
Installation Method
Manufacturer's General Installation Instructions:
• Product to be applied directly to a clean dry surface, free from any moisture, ice, dust, loose nails,
protrusions, voids or any other debris.
• Store product in the carton in a dry place until ready to use. Keep product out of direct sunlight. Do not
lay rolls on their sides.
• Prime surface as recommended by manufacturer.
• Adhere membrane only in fair weather when the air, surface and membrane are at a minimum
temperature of 40° F. For installation below 40" F, mechanically fasten membrane to deck with nails
until fully adhered.
• Start at the low point of the deck, align the membrane and press into place onto roof deck.
• Adhesive is pressure -activated, so press firmly into place using uniform pressure with a weighted roller.
• Overlap end laps a minimum of 6". Side laps a minimum of 3". Drip edges a minimum of 3/8".
• For valley and ridge installation, cut product to desired length, apply pressure from the middle working
to the outside edges.
• It is recommended QUIK-STICK end laps be sealed with a 1/8" layer of SBS mastic.
• Allow product to completely relax prior to any fastening.
• Minimum slope shall be 2:12 or greater.
• Do not expose QUIK-STICK IW, IWS or FS to direct sunlight for more than 60 days.
• Do not expose QUIK-STICK HT or HT Pro to direct sunlight for more than 90 days.
"QUIK-Stick" shall be installed in compliance with applicable code sections of the Florida Building Code 5th
Edition (2014), and in accordance with the installation method described herein subject to the Limitations
and Conditions of Use listed in this Evaluation Report.
Refer to manufacturer's installation instructions as a supplemental guide for attachment.
CBUCK EngineerinQ
FL #: FL 17401.1 R3
Date: 10/27/1S
Report No.: 1S -204 -QS -ER
Page 6 of 6
Sppcldlty Structural Engirwvring Cevar, Inc. CerUncote of Authorization #8064
(PSA
1
Mid -States Asphalt & Cant Strip, Inc.
"QUIK-STICK"
Self -Adhered Roofing Underlayments
Product Illustrations
69
YYL'Yfl aR{•••
= t)
■
N j
y�
cr
QUIK-STICK IW QUIK-STICK IWS QUIK-STICK FS QUIK-STICK HT QUIK-STICK HT
Ice & Water Ice & Water Film Surface Smooth PRO
SAND High Temp
U Florida Building Code Online
Eric Bailey
Pagel of 3
1637 51st Avenue
Florida License
Tuscaloosa, AL 35401
Quality Assurance Entity
Business:Professional
Regulation
eric@msaroof.com
Category
Roofing � �T •���
Subcategory
Underlayments J ,
rid
Fbrk4jD4WMW!1
SCIS Home I Log In i User Registration
1 Hot Topics 1 Submit Surcharge I Stats 8 Facts I Publications I Fac Staff ( SCIS Site Map I L
Busines}Cy��
ProfessiV� I
Product Approval
®USER: Public User
Regulation
Product Approval Menu > Product or Application
Search > Application List > Application Detail
R3
1500
Application Type
Revision t
Code Version
2014
Application Status
Approved
Comments
Archived
CI
Product Manufacturer
Mid -States Asphalt & Cant Strip, Inc.
Address/Phone/Email
1637 Slst Avenue
Tuscaloosa, AL 35401
(205) 345-6634
eric@msaroof.com
Authorized Signature
Eric Bailey
eric@msaroof.com
Technical Representative Eric Bailey
Address/Phone/Email 1637 51st Avenue
Tuscaloosa, AL 35401
(205)345-6634
eric@msaroof.com
Quality Assurance Representative
Eric Bailey
Address/Phone/Email
1637 51st Avenue
Florida License
Tuscaloosa, AL 35401
Quality Assurance Entity
(205)345-6634
Quality Assurance Contract Expiration Date
eric@msaroof.com
Category
Roofing � �T •���
Subcategory
Underlayments J ,
Compliance Method
Evaluation Report from a Florida Registered Architect or a Ucen
Professional Engineer
J Evaluation Report - Hardcopy Received
Florida Engineer or Architect Name who developed the
Zachary R. Priest
Evaluation Report
2007
Florida License
PE -74021
Quality Assurance Entity
UL LLC
Quality Assurance Contract Expiration Date
01/28/2018
Validated By
Locke Bowden
I? Validation Checklist - Hardcopy Received
Certificate of Independence
Referenced Standard and Year (of Standard)
FL15067 R3 COI MSA14002.2 2014 FBC Evaluation Report Mf
Underlavments- FINAL.odf
ASTM D 3909
1997
ASTM D 6757
2007
ASTM D226
2006
ASTM D2626
2004
ASTM D3909
2004
https://www.floridabuilding.org/pr/pi_app_dtl.aspx?param=wGEVXQwtD... 11/13/2015
, Florida Building Code Online
ASTM D4869
Equivalence of Product Standards
Certified By
Sections from the Code
Product Approval Method Method 1 Option D
Date Submitted
08/28/2015
Date Validated
08/28/2015
Date Pending FBC Approval
09/07/2015
Date Approved
10/16/2015
Summary of Products
Page 2 of 3
2005
FL # Model, Number or Name
Description
15067.1 Arrow 43# Organic Base Sheet
ASTM D 2626 Organic Base Sheet
Limits of Use
Installation Instructions
Approved for use In HVHZ: No
FL15067 R3 Il MSA14002.2 2014 FBC Evaluation
Underlavments- FINAL.Ddf
Approved for use outside HVHZ: Yes
Impact Resistant: N/A
Verified By: PRI Construction Materials Technologle:
Design Pressure: N/A
Created by Independent Third Party: No
Other: See evaluation report for limits of use.
Evaluation Reports
FL15067 R3 AE MSA14002.2 2014 FBC Evaluation
Underlavments- FINAL.Ddf
Created by Independent Third Party: Yes
15067.2
MSA ASTM D-226 15#
ASTM D 226 Type I Saturated Organic Felt
Limits of Use
Installation Instructions
Approved for use in HVHZ: No
FLI5067 R3 H MSA14002.2 2014 FBC Evaluation I
Approved for use outside HVHZ: Yes
Underlavments- FINAL.Ddf
Impact Resistant: N/A
Verified By: PRI Construction Materials Technologle:
Design Pressure: N/A
Created by Independent Third Party: No
Other: See evaluation report for limits of use.
Evaluation Reports
FL15067 R3 AE MSA14002.2 2014 FBC Evaluation
Underlavments- FINAL.odf
Created by Independent Third Party: Yes
15067.3
MSA ASTM D-226 30#
ASTM D-226 Type II Saturated Organic Felt
Limits of Use
Installation Instructions
Approved for use in HVHZ: No
FL15067 R3 11 MSA14002.2 2014 FBC Evaluation I
Undedavments- FINAL.Ddf
Approved for use outside HVHZ: Yes
Impact Resistant: N/A
Verified By: PRI Construction Materials Technologle.-
Design Pressure: N/A
Created by Independent Third Party: No
Other: See evaluation report for limits of use.
Evaluation Reports
FLIS067 R3 AE MSA14002.2 2014 FBC Evaluation
Underiavments- F1NAL.Ddf
Created by Independent Third Party: Yes
15067.4
MSA MSR
ASTM D 3909 Asphalt Roll Roofing
Limits of Use
Installation Instructions
Approved for use in HVHZ: No
FLIS067 R3 Il MSA14002.2 2014 FBC Evaluation I
Underlavments- FINAL.Ddf
Approved for use outside HVHZ: Yes
Impact Resistant: N/A
Verified By: Zachary R. Priest 74021
Design Pressure: N/A
Created by Independent Third Party: No
Other: See evaluation report for limits of use.
Evaluation Reports
FL15067 R3 AE MSA14002.2 2014 FBC Evaluation
Underlavments- FINAL.Ddf
Created by Independent Third Party: Yes
15067.5
MSA The Grid
ASTM D 6757 Saturated Felt
Limits of Use
Installation Instructions
Approved for use in HVHZ: No
FL15067 R3 11 MSA14002.2 2014 FBC Evaluation I
Approved for use outside HVHZ: Yes
Underlavments- FINAL.odf
Impact Resistant: N/A
Verified By: PRI Construction Materials Technologle!
Created by Independent Third Party: Yes
https://www.floridabuilding.org/pr/pr app_dtl.aspx?param=wGEVXQwtD... 11/13/2015
Florida Building Code Online
Page 3 of 3
Design Pressure: N/A
Evaluation Reports
Other: See evaluation report for limits of use.
FL15067 R3 AE MSA14002.2 2014 FBC Evaluation
FINAL.Ddf
Underlavments-
Created by Independent Third Party: Yes
15067.6 MSA UL 15#
ASTM D 226 Type I Saturated Organic Felt
Limits of Use
Installation Instructions
Approved for use in HVHZ: No
FLIS067 R3 II MSA14002.2 2014 FBC Evaluation I
Undedayments- FINAL.Ddf
Approved for use outside HVHZ: Yes
Impact Resistant: N/A
Verified By: PRI Construction Materials Technologle:
Design Pressure: N/A
Created by Independent Third Party: No
Other: See evaluation report for limits of use.
Evaluation Reports
FL15067 R3 AE MSA14002.2 2014 FBC Evaluation
FINAL.Ddf
Undedavments-
Created by Independent Third Party: Yes
15067.7
MSA UL 30#
ASTM D 226 Type II Saturated Organic Felt
Limits of Use
Installation Instructions
Approved for use in HVHZ: No
FLIS067 R3 II MSA14002.2 2014 FBC Evaluation I
Underlavments- FINAL.odf
Approved for use outside HVHZ: Yes
Impact Resistant: N/A
Verified By: PRI Construction Materials Technologle:
Design Pressure: N/A
Created by Independent Third Party: No
Other: See evaluation report for limits of use.
Evaluation Reports
FLI5067 R3 AE MSA14002.2 2014 FBC Evaluation
Underiavments- FINAL.odf
Created by Independent Third Party: Yes
15067.8
MSA Z30
ASTM D4869 Type II Saturated Organic Felt
Limits of Use
Installation Instructions
Approved for use In HVHZ: No
FL15067 R3 II MSA14002.2 2014 FBC Evaluation I
Underlavments- FINAL.Ddf
Approved for use outside HVHZ: Yes
Impact Resistant: N/A
Verified By: PRI Construction Materials Technologic!
Design Pressure: N/A
Created by Independent Third Party: No
Other: See evaluation report for limits of use.
Evaluation Reports
FL15067 R3 AE MSA14002.2 2014 FBC Evaluation
Underlavments- FINAL.odf
Created by Independent Third Party: Yes
Back Next
The State of Florida is an AA/EEO employer. Copyright 2007-2013 State of Florida.:: Privacy Statement :: Accessibility Statement :: Refun
Under Florida law, email addresses are public records. If you do not want your e-mail address released In response to a public -records reque<-
electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions, please contact 850.487.135
Section 455.275(1), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must provide the Department u
address If they have one. The emalls provided may be used for official communication with the licensee. However email addresses are public n
not wish to supply a personal address, please provide the Department with an email address which can be made available to the public. To dr
are a licensee under Chapter 455, F.S., please dick here .
Product Approval Accepts:
W im Io0
%,.an1tvmsn NcT
https://www.floridabuilding.org/pr/pi_app_dti.aspx?param=wGEVXQwtD... 11/13/2015
.
CREEK
Certificate of Authorization No. 29824
17520 Edinburgh Dr
Tampa, Ft. 33647
TECHNICAL SERVICES, LLC (813) 480-3421
EVALUATION REPORT 2014 FLORIDA BUILDING CODE
Manufacturer. MID -STATES ASPHALT AND CANT STRIP, INC. Issued August 27, 2015
1637 51'" Street
Tuscaloosa, AL 35401
(800) 489-2391
httoWwww.midstatesasphalt.com
Manufacturing Plants: Tuscaloosa, AL
Quality Assurance: UL LLC (QUA9625)
SCOPE
Category: Roofing
Subcategory: Underlayments
Code Sections: 1507.2.3, 1507.2.8, 1507.2.9.2, 1507.3.3, 1507.4.5, 1507.4.5.2, 1507.5.3, 1507.5.3.2,
1507.6.3, 1507.6.3.2, 1507.6.5, 1507.7.3, 1507.7.3.2, 1507.8.3, 1507.8.3.2, T1507.8,
1507.9.3, 1507.9.3.2, 1507.9.5
Properties: Physical properties
REFERENCES
Entity Report No. Standard Year
PRI Construction Materials Technologies (TST6049) SWR -502-02-01 ASTM D 4869 2005e01
PRI Construction Materials Technologies (TST6049) SW RS03-02-01 ASTM D 226 2006
PRI Construction Materials Technologies (TST6049) SWR -504-02-01 ASTM D 226 2006
PRI Construction Materials Technologies (TST6049) BWR-509-02-01 ASTM D 2626 2004
PRI Construction Materials Technologies (TST6049) SWR -539-02-01 ASTM D 3909 1997b (2004)E'
PRI Construction Materials Technologies (TST6049) MSA -009-02-01 ASTM D 6757 2007
PRODUCT DESCRIPTION AND APPLICATION
MSA MSR MSA MSR is an ASTM D 3909 asphalt roll roofing product surfaced with mineral
granules for use as a valley liner in asphalt shingle roof systems.
MSA ASTM D 22615# MSA ASTM D-226 #15 is an ASTM D 226, Type I asphalt saturated organic felt
underlayment.
MSA UL 150 MSA UL #15 is an ASTM D 226, Type I asphalt saturated organic fell underlayment.
MSA ASTM D 226 300 MSA ASTM D-226 930 is an ASTM D 226, Type II asphalt saturated organic felt
underlayment.
MSA UL 30# MSA UL #30 Is an ASTM D 226, Type II asphalt saturated organic felt undertayment
MSA Z-30 MSA Z-30 is an ASTM D 4869, Type II asphalt saturated organic felt underlayment
Arrow 430 Organic Arrow 43# Organic Base Sheet is an ASTM D 2626 asphalt saturated and coated,
Base Sheet non -perforated, organic felt underlayment used in low slop applications.
MSA The Grid MSA The Grid is an ASTM D 6757 saturated felt underlayment with woven glass fiber
reinforcement.
MSA14002.2 FL15067-R3 Page 1 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 whictr this report Is valid.
This evaluation report does not express not Imply warranty, Installation, recommended use, or other product attributes that are not
specifically addressed herein.
• CREEK MID -STATES ASPHALT AND CANT STRIP, INC.
Underlayments
TECHNICAL SERVICES, LLC
Deck Type: The roof deck shall be constructed of closely fitted sheathing for new or
existing construction. The deck shall be installed In accordance with FOC
requirements. Roof decks shall have no more than 11C gap at abutting joints.
Min. slope: In accordance with the applicable FBC section.
Attachment method: In accordance with the requirements of applicable FBC sections and the
current published manufacturing instructions.
Allowable Roof Coverinas:
Notes: 1) Open valley applications per 1507.2.9.2
LIMITATIONS
1) This evaluation report is not use in the HVHZ.
2) Fire Classification is not within the scope of this evaluation.
3) Wind uplift resistance In not within scope of this evaluation.
4) 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.
5) Deck substrates shall be dean, dry, and free from any irregularities and debris. All fasteners in the deck
shall be checked for protrusion and corrected prior to underlayment application.
6) All undedayments 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) Underlayments may be used as described in other current FBC product approval documents.
8) Roof coverings shall not be adhered directly to the undedayment. Roof coverings shall be mechanically
fastened through the underlayment to the roof deck.
9) All products listed In this report shall be manufactured under a quality assurance program in compliance with
Rule 61G20-3.
MSA14002.2 FI -15067-R3 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.
Metal Roof
Mineral-
Wood
Clay and
Asphalt
Panels and
Surfaced
Shingles
Slate
Concrete
Shingles
Shingles
Roll Roofing
and Shakes
Shingle
Tile
MSA MSR
Y'
N
Y
N
N
N
MSA ASTM D
226150
Y
Y
Y
Y
Y
N
MSA UL 150
Y
Y
Y
Y
Y
N
MSA ASTM D
Y
Y
Y
Y
Y
Y
226 300
MSA UL 300
Y
Y
Y
Y
Y
Y
MSA Z-30
Y
Y
Y
Y
Y
N
Arrow 430
Organic Bass
N
N
N
N
N
Y
Sheet
MSA The Grid
Y
Y
Y
N
Y
N
Notes: 1) Open valley applications per 1507.2.9.2
LIMITATIONS
1) This evaluation report is not use in the HVHZ.
2) Fire Classification is not within the scope of this evaluation.
3) Wind uplift resistance In not within scope of this evaluation.
4) 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.
5) Deck substrates shall be dean, dry, and free from any irregularities and debris. All fasteners in the deck
shall be checked for protrusion and corrected prior to underlayment application.
6) All undedayments 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) Underlayments may be used as described in other current FBC product approval documents.
8) Roof coverings shall not be adhered directly to the undedayment. Roof coverings shall be mechanically
fastened through the underlayment to the roof deck.
9) All products listed In this report shall be manufactured under a quality assurance program in compliance with
Rule 61G20-3.
MSA14002.2 FI -15067-R3 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.
• CREEK
TECHNICAL SERVICES, LLC
COMPLIANCE STATEMENT
MID -STATES ASPHALT AND CANT STRIP, INC.
Underlayments
The products evaluated 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.
R. pr,i���
No 74021
jr
O:• STATE OF
/•:��/
'i is .... • • XN
1-6 /ON AI �e 0
CERTIFICATION OF INDEPENDENCE
2015.08.27
16:02:42
-04'00'
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
MSA14002.2 FL15067-R3 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.
R905.2.7 Underlayment application.
Underayment shall be installed using one of the following methods:
1. For roof slopes from two units vertical in 12 units horizontal (17 -percent slope), and less than four
units vertical in 12 units horizontal (33 -percent slope). Underlayment shall comply with ASTM D 226,
Type I or Type II or ASTM D 4869, Type II or Type IV or ASTM D 6757 and shall be two layers
applied in the following manner. Apply a 19 -inch (483 mm) strip of underlayment felt parallel to and
starting at the eaves, fastened sufficiently to hold in place. Starting at the eave, apply 36 -inch -wide
(914 mm) sheets of undedayment, overlapping successive sheets 19 inches (483 mm), and fastened
with a 1 -inch (25 mm) round plastic cap, metal cap nails or nails and tin -tabs attached to a nailable
deck with one row in the field of the sheet with a maximum fastener spacing of 12 inches (305 mm)
o.c.., and one row at the overlaps fastened 6 inches (152 mm) o.c. Synthetic underlayment shall be
fastened in accordance with this section and the manufacturer's recommendations.
2. For roof slopes of four units vertical in 12 units horizontal (33 -percent slope) or greater.
Underlayment shall comply with ASTM D 226, Type II or ASTM D 4869, Type IV or ASTM D 6757
and shall be one layer applied in the following manner. Underlayment shall be applied shingle
fashion, parallel to and starting from the eave and lapped 2 inches (51 mm), fastened with 1 -inch (25
mm) round plastic cap, metal cap nails or nails and tin -tabs attached to a nailable deck with two
staggered rows in the field of the sheet with a maximum fastener spacing of 12 inches (305 mm)
o.c., and one row at the overlaps fastened 6 inches (152 mm) o.c. Synthetic underlayment shall be
fastened in accordance with this section and the manufacturer's recommendations End laps shall be
offset by 6 feet (1829 mm).
3. As an alternative, the entire roof deck shall be covered with an approved self -adhering polymer
modified bitumen sheet meeting ASTM D 1970 or an approved self -adhering synthetic underlayment
installed in accordance with the manufacturer's installation instructions.
Name ?
Address
i it�lll liill �11111111110��1 ����� i�ei i�ei
MARYANNE MORSEr SEMINOLE COUNTY
CLERK OF CIRCUIT COURT 1, COMPTROLLER
NOTICE OF COMMENCEMENT BK 5694 F9 465 (Wgs)
CLERK'S - 2016053997
State of Florida RECORDED 05/24/2016 03:35:1.1 P11
County of Seminole RECORDING FEES $10.00
RECORDED B h �j ,n'a
Permit Number: �D ` Parcel ID Number: ( 1 . 217-! 0 ' 4 `-GCbO, IC90
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
DESCRXTIIION OF PIOPER�Y jLegal description of the property and street address if available)
\I GENERAL DESCRIPTUM OF
�i OWNER INF,OPRMATION:
Address: 1. L 5 1—Cu'�4y- L30\ci, Ltd— --2(lh T 0 -VG't 1 1 -7./—/
!
Fee Simple Title Holder (if other than owner) Name:
Address:
CONTRACTOR:
Name:.� G Y \ Q. Q C C•J n Q�
Address:
Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served
as provided by Section 713.13(1)(b), Florida Statutes.
Name:
Address,
In addition to himself, Owner Designates of
To receive a copy of the Lienors Notice as Provided in
Section 713.13(1)(b), Florida Statutes.
Expiration Date of Notice of Commencement (The expiration date 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 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 stated in it are true
n
best of my knowied a and belief.
- -eco-, L m(v-.
Owners Signature Owners Printed Name
Florida Statute 713.13(1)(8): ' The owner must sign the notice or commencement and no one else may be permitted to sign in his or her stead:
State ofCounty of �('t1► ")6 (Q
The foregoing Instrument was acknowledged before me this O�it%yiay of 20
by 1 )2QLf L .. julaf -f: ti Who Is personally known to me ❑
Name of person melting statement �^
OR who has produced identification 'type of Identification produced: l L -(\I t
ANNETTE SCOTT'
i�o- Notary Public - Slate of Florida
My Comm. Expires Jan 16, 201e
�;•� A Commission # FF 071760
ouph National Notary assn.
V.
W
er
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CITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #: / to / 5 0 —7
I,
hereby acknowledge that I personally inspected
0 Roof deck nailing and/or 0 Secondary water barrier work
at l2 3 La ke Rd e, CY 327 7,3 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 837.06 F.S.
.2017
Signature of Contractor Date
�,oeaV, M coy
Printed Name of Contractor License #
License Type: 0 General 0 Building 0 Residential 0 Roofing Contractor
0 or any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF
Sworn to -(or affirmed) and subscribedbe of re me this day of r 1 20 17 , by
01f4 who is D Personany Known to me or has Jd.Produced (type of
identification) e L !2f m o r L, e as identification.
' (SEAL)
nature of Notary Public jW0=A. S~
ate of FloridaNOTARY PUBLIC
STATE OF FLORIDA
Cp,n* FFW 1625
Print/Type/Stamp Name" Expiros am 112019
of Notary Public
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