HomeMy WebLinkAbout110 Royalty CirJob Address:
Parcel ID:
Type of Work: New 19 Addition
Description of Work:
Plan RevLipw Contact Person: 1 r L V
Phone: 't -' 16 --(OVI Fax:
CITY OF SANFORD
j
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
SEP 14 2016
pplication No:
a
Documented Construction Value: $
1 (! V, 1(&rd Historic District: Yes No
Alteration
io,
Residential commercial
Repair Demo Change of Use Move
1, 4-e. P (d, rcear 0-F SFR.
7 n Email:
Title: v-1 S
L,eeol IZct eAo(:
Property Owner Information
Name i S 1. I Ili Phone: 1-6 to
Street: I 10 iro Resident of property?
r
City, State Zip: Q :
r
Name
I
Contractor Information
I'
K-S 11,( 1 1j(1 1 • ` Phone:
Street: 6711 S TV t 0.
City, State Zip:
IName: (c U.1
Street:
City, St, Zip: Or I
Lf -I-3qq y'7R7Fax:
Cl. l r L_ 3 X7 50, State License No.: xS e C 0 S 17 0 Y
Bonding Company: 11 k-
Address:
Architect/Engineer Information
Phoney:
Fax: b
E-mail:
33
kit-)n .'-'/2 t9l'1'1
Mortgage Lender: A -
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: 5t° Edition (2014) Florida Building Code
coRevised: June 30, 2015 Permit Application
I JCOftAl)
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
be done in compliance with all applicable laws regulating construction nd zoning.
Signatur of I er/ gent Date Sign of Con r/Agent Date
t- veaM1L5, E-6'tp
Prin Owner/Agent's ame PrAit Contractor/Agent's Name
Signature
Owner/Agee
Produced ID
J-\
Date
VICKY METTS
Notary Public - State of Florida
Commission # FF 929278
s- My Comm. Expires Dec 7, 2019
Signature of F-Sta rida D tc
Oly PUe( VICKY METTS
Notary Public -State of Florida
Commission # FF 929278
My Comm. Expires Dec 7, 2019
i 'FOF F Bon ad through at Notary Assn.
or C
Type of Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
to Me or
Permits Required: Building Electrical Mechanical Plumbing Gas Roof
Construction Type: Occupancy Use:
Total Sq Ft of Bldg: Min. Occupancy Load:
Flood Zone:
of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes No # of Heads
rr
APPROVALS: ZONING: UTILITIES:
ENGINEERING:
COMMENTS:
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Ok to install 40' x 10' (400 square foot) screen room as shown on plan. Structure shall not be installed
within the 20 foot drainage easement.
Revised: June 30, 2015 Permit Application
REQUIRED INSPECTION SEQUENCE
BP# 1 (. - ZS%Av4
BUILDING -PERMIT
Min Max Ins ection Description
Footer / Setback
Stemwall
Foundation / Form Board Survey
Slab / Mono Slab Prepour
Lintel / Tie Beam / Fill / Down Cell
Sheathing — Walls
Sheathing — Roof
Roof Dry In
Frame
Insulation Rough In
Firewall Screw Pattern
Drywall / Sheetrock
Lath Inspection
Final Solar
Final Firewall
Final Roof
Final Stucco / Siding
Insulation Final
Final Utility Building
Final Door
Final Window
Final Screen Room
Final Pool Screen Enclosure
Final Single Family Residence
Final Building (Other)
Address: 1
ELECTRICAL 1P-MMTT
Min I Max I Inspection Descrintion
Electric Underground
Footer / Slab Steel Bond
Electric Rough
T.U.G.
Pre -Power Final
Electric Final
MECHAN ICAtL !PERMIT
Min I Max I Insnection Descrintiogn
Mechanical Roug
Mechanical Final
I Min I Max I Inspection Description
Gas Unde
Gas Roug
Gas Final
REVISED: June 2014
V__..__ .
THIS INS-Tft MENT PREPARED BY:
Name: _ e l I ,1 LQV ,
Address: J iy '•T CL!2 24_'_y
NOTICE: OF COMMENCEMENT
State of Florida
County of Seminole
iI...,:_RK ;.;I ;_ t(.r.:il rx F ii rr "i L f
LFi i,.'S x ?I:}).6?!93237r
1 ,t '.` •
I'i
k::E:_
Permit Number. Parcel ID Number: _-5 - Irff 3o-S7Q5 ` 0c,CIO __-oI C:)
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.
ULNURIPTION QF PROPERTY (Legal description of the property and street address if available) , L ,rio c?u-r I/ f.I f r,S' v r)I i,{j %' P iB h ,S 7 to -7
e'r-
Address: I I C) KLWI til C4 r-- i,V(
Fee Simple Title Holder (if other than owner)
Lat'1 Ili / f W; /J. --1Lr-
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:
In addition to himself, Owner Designates
To receive a copy of the Lienor's 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 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.
Under penalti s of perjury, I declare t a 1 bave read the foregoing and that the facts stated in it are true
to the best any knowledg and bet f
Own s Si ature Owner Printed Name
Florida to a 713.13(t (g): ' The owner must sign the ce of commencement and no one else may' permitted to sign In his or her stead'
State of i' 1 D C C(2-Q— County of 0
The foregoing instrument was acknowledged before me this `J day of zo t
by Yam' 1'cAS- eA 'titi Ci<Q ` Who is personally known to me
Name rson makingstatemen
OR who has produced Identificatlo type of identification produced:
VICKY METTS
4PpY FHB,, State of Fio:ida
M
Notary PubIIC - - -
n
S
fF 929278Gommissio =
2019 NolaMyComm. Expires Dec 7 c . '
L"fi 1 iCl! RT ANDOFfo;" L' ivIPTRU' LERBondedthroughNationalNotaryAssnd;AFA
a
SENAINOLL OUNTY, LORI lrfasc _ v `e
t t 4\mow
By DEPUTY CLERK
M RECORD COPY
Plan :Types:
F1 Screen Room
Pool Screen/Cage (Removable Screen - Remove screen when wind speed exceeds 75 MPH)
Pool Screen/Cage (Non -Removable Screen - Designed to withstand actual Wind Speed.)
Car Port
Patio Cover
F _TkOtrer: cN
A .Jtj 3xq, Project, Address:
I 16 K City: New
JVJ
Revision 0J 1z
dQ Contractor Name:
Mark's Lawn Maintenance & Screens, Inc. Address: 575
Justamere Road REVIEWED POR CODE COMPLIANCE City: Geneva
PLANS EXAMINER Zip Code:
32732 Iq. ((eDATE Phone/Fax:
407-748-2667 407-349-9787 Email: leemka@aol.
com C hoose
One: Mail nv' Pick Up r] Fed Ex*[] -3—No of Copies esign ForF.
edExoptiongottowyoAt-alunlil)(111-1,scre-_nr -com and provide FedEx account #) Payment; CheckF]
Credit Card For Credit
Card option go to vvww. i1glTlin irnscreeLl-d—esiffil--c2ni to pay bY§A*dffb)BUILDING DIVISION Engineering prepared
by: A PERMIT ISSUED SHALL BE CONSTRUED TO BE A LICENSE TO
PROCEED WITH THE WORK AND NOT AS AUTHORITY TO
VIOLATE, CANCEL, ALTER OR SET ASIDE ANY
OF THE PROVISIONS OF THE TECHNICAL al "A "U',
CODES, NOR SHALL ISSUANCE OF A PERMIT PREVENT S VI'
THE BUILDING OFFICIAL FROM THEREAFTER O CONSTRUCTION
OR VIOLATIONS OF THIS CODE ig, p,NFORD
0 4
REQUIRINGA CORRECTION OF ERRORS IN PLANS, PA 6
2
5 4 4 Engineer: Michael Thompson, MSc, P.E. (P.E. #47509) 4401 Vineland
Road — Suite A6, Orlando, FL 32811 Office: 407-
734-1470 Cell: 407-721-2292 Project Manager:
Paul Thomas 386-479-9509 Fax: 888-923-8181- Email: altii-
ninL.Imscreendesigri@yahoo.coti-% Website: www.
@lunIinurnscreen CA#30930
Ultimate, Wind Speed(mph);E(posed Category: G Risk CiAegbry'
creort Room:
Insulated Pan Roof
Fascia F1 Wall: Block F] conventionalF]
Uprights — --x Top Plate x Kick Plate
Po Fee n/Cage
Dome[] Gablef-I Mansard
Guttero Wall: Block[] conventional
Beams x Uprights x Purlin X—
Car Port:
InsulatedF] PanF]
Fascia El Wall: Block 0 Conventional
Beams x Post -x_______
PatioCover:
Insulated PanF1
Fascia Wall: BlocICj Conv ntiona
Beams Post x.
1
6cr6t)
xistingNew: 4" Slabn PieroRibbon Foote x Pavers Note:
In the event that there is a conflict with the design plans and general notes and design standard, the contractor shall
utilize the more stringent dimensions and member sizes prior to ordering rnaterials, fabrication and/or construction between
the plans and the general notes and design standard.
General Notes & Design Standards
Unscreened Patio Roorn Enc osure)
The following are general design standards. More stringent design standards may be noted on the plans. In the event
of a conflict in plans and/or design standard dimensions and/or member sizes, the contractor must utilize the more
stringent dimensions and/or member sizes prior to ordering materials, fabrication and/or construction.
Design Codes:
Florida Building Code 2014 (5" Edi(ion)
Aluminum Design Manual 2010
ASCE 7-10
Design Loads:
Pursuant to FBC Chapters 16 & 20
Ultimate Wind: -130 MPH (FBC %'able 2002.4) (35 psj)
Risk Category: -See attach site specific plan sheet (IFBC 7hble 1604.5)
Exposure Category: -See attach site specific plan sheet (T'BC 1609.4.3)
Additional Load requirements
Structural members supporting screened enclosures are designed for wind in both of two orthogonal directions using
the pressures given in Table 2002.4. Each primary member is also designed for a 300 pound load applied vertically
downward along any 1 foot of any member, not occurring simultaneously with wind load. In addition to wind
pressures, purlins is also be designed for a 200 pound load applied vertically downward along any I foot of any
member, not occurring simultaneously with wind load.
Design Basis:
Allowable Stress Design (ASD) =Allowable Strength Design (ASD) divide by safety factor
General Requirements:
Reproductions of contract drawings by contractor in lieu of preparation of shop drawings signifies acceptance of
information shown as correct and obligates himself to any expense, real or implied, arising from their use.
A change to the structural drawings due to the acceptance of alternates and/or substitutes is the responsibility of the
contractor and must be submitted to the engineer for approval.
The general contractor and each subcontractor shall review the approve construction plans in its entirety and verify
all existing conditions prior to the start of any work. All inconsistencies shall be reported to the designer and/or
structural engineer, if needed. Should contractor construct the premises in a fashion not consistent with the plans
prepared by the designer and/or structural engineer, or in any fashion, change the plans and drawing without the
review and approval from the designer and/or structural engineer. Then designer and/or structural engineer shall
bear no responsibility or liability for the construction of premises and accuracy of the drawings.
Foundation and Earthwork:
Applicable only when unsuitable soils are encountered.
When unsuitable soils are encountered as specified bearing -strata, notify owner's representative/engineer.
Soil bearing capacity — 2,000 psf Minimum
Provide neat excavation for footing and place concrete immediately after excavation and inspection.
Pump water from footing excavation if greater than one inch.
Compact all fill to 95% ASTM D698 density.
Unit soil weight = 105 pcf
Internal angle of friction = 30 degrees
Coeff. Of friction between footing and soil = 0.5
4401 Vineland Road., Suite A6, Orlando, FL 32811. (P) 407-734-1470 (F) 407-734-1790
www.aluminumscreendesign.com
DANNIII \
Structural Aluminum:
Conform to latest edition of Florida Building Code and Aluminum Design Manual standard practice for aluminum
design.
All aluminum shall be 6005-T5 (E= 10,000 ksi; Fy = 35 ksi) with a minimum wall thickness of 0.046"
Splicing prohibited without prior approval as to location and type.
Burning of holes in aluminum members is prohibited. Any member with burned holes must be replaced.
Aluminum Protection:
Shall be pursuant FBC 2003.8.4. Aluminum surfaces in contact with dissimilar materials, lime -mortar, concrete, or
other masonry materials, shall be protected with powder coated or ESP paint or alkali -resistant coatings, such as
heavy -bodied bituminous paint or water -white methacrylate lacquer.
Screws:
Aluminum self -tapping screws shall conform to ASME B 18.6.4 specification.
Self —tapping screws shall meet the requirements of ADM J.5
Maximum fastener spacing shall not exceed (31-20t) where "t" is the member thickness in inches.
For roofing and siding connection, use minimum 412 screws for end and side laps spaced at 12" max for side lap
and end lap fasteners shall be no more than 2" from the end of overlapping sheets.
Bolts:
Bolts and other fasteners shall be aluminum, stainless steel, hot -dip or electro-galvanized steel. Double cadmium
plated steel bolts may also be used. Bolt holes diameter shall not exceed 1/16" larger than the bolt diameter and shall
be spaced at a minimum of 2.5 times the bolt diameter with minimum edge distance of 1.5 times the bolt diameter.
Bolts shall meet the requirements of ADM J.3
Concrete
Conform to ACI 318, latest edition and ACI 301
Compressive Ultimate Strength (Minimum at 28 days) shall be 3000 psi
Exposed chamfer edges shall be'/4"
Reinforcine Steel:
Conform to ACI 318 and 315, Latest edition
All reinforcement steel shall be ASTM A615 Grade 60.
Smooth dowels & ties shall be ASTM A 185
Welded Wire Fabric shall be ASTM A185 or A82 (Flat sheet).
Deformed bar anchors shall be ASTM A496, Grade 70
Cover: Footing 3"
Washer:
Washers shall be used under bolt heads and under nuts.
Hole Alignment:
Poor matching holes must be rejected. Contractor shall prevent holes from drilling and distort the metal. All chips
and foreign matter between contacting surfaces shall be removed before assembly.
4401 Vineland Road., Suite A6, Orlando, FL 32811. (P) 407-734-1470 (F) 407-734-1790
www.aiuminumscreendesign.com
Beams & Uprights:
In the event of a conflict with the values in this table and the site specific plan, the contractor must utilize the more
stringent dimensions and/or member sizes between the site specific plan and the below applicable span limitations
prior to ordering materials, fabrication and/or construction.
130 MPH
PRIMARY HEADER BEAM MEMBERS -OPEN COVERED PATIO -(No Screen Insert)
SIZE
3" Pan Roof Span
Maximum Roof Span
6'4"
3" Pan Roof Span
Maximum Roof Span
W_0
3" Pan Roof Span
Maximum Roof Span =10'
0"
3" Pan Roof Span
Maximum Roof
Span = 12'_0"
3" Pan Roof Span
Maximum Roof Span =
1.5'-0"
2 X 4 10'-01' 9'-0" 9'-0" 0" W_0"
2 X 5 13"-0" 12'-0" 11'-0" 10'-o" 9'-0"
2 X 6 15'-0" 14'-0" 13'-0" 12'-0" 11'-0"
2 X 7 17'-0" 16'-0" 14'-0" 14'-0" 13"-0"
2 X B 21'-0" 20'-0" I8'-0" 17'-0" 16"-0"
2 X 9 21'-0" - 20'-0" * 20'-0" 2.0'-0" 1.9"-0"
2 X 10 21'-0" * 20'-0" " 20'-0" ' 20'-0" * 19'-0" x
column size is 3 x 3 x D.125" I1jg" j unless noted otherwise with a max height of 9` O"-'ICSR) control E 1.4.. Larger span req larger column size.
Knee Bracine:
Contractor shall provide knee bracing on 45 degree angle pursuant the attach detail sheet that specified size and
length requirements. Knee bracing on upright above super gutter intersection shall be connected to upright no more
than 6" above the super gutter. Knee brace size shall be a minimum of 2 x 2 for beam span of 15' max; 2 x 3 for 30'
max; 2 x 4 for beam span greater than 30'.
Intermediate/1-leader Beam:
Contractor is required to install a minimum 2 x 7 intermediate header beam supported with 3 x 3 column spaced at
10 feet (max) when insulated roof span exceeds 15 feet.
Patio Cover:
Contractor is required to install insulated root' covering pursuant to the Florida product approval specification.
Overhang shall be a maximum of IA" along the side, 3'-0" along the front and 1/2" along the front interface
between the super gutter and the attached pool cage knee riser wall.
Edue Distance:
Contractor is required to install uprights to provide a 2" minimum clearance from edge of slab and/or tooter.
4401 Vineland Road., Suite A6, Orlando, FL 32811. (P) 407-734-1470 (F) 407-734-1790
www.aluminumscreendesign.com
46
x3 Z
In the event of a codict in member sizes shown On
the plans and the general notes, the contractor must
Utilize the more stringent member size requirements•
a , a e• 3
o
x
ROLL FORM GUTTER IS ATTACHED TO
3" PAN ROOF WITH 410 6" FROM ENDS 24" O.0
ROOF IS ATTACHED TO FRONT WALL
SUPP iRT BEAM WITH (4) 4 1. 0 1"
PER PA—i
BRACKET FROM 3X3 IS ATTACHED
TO CONCRETE WITH 2 1/4" X 2"
TAPCONS TYP.
ALUl`d'iINUMSCREENDE S I LAN. COM
ALUNIINU Iv1SCREENDESIC>:N
C YAHOO.COM
PHONTE: 407-747-1470
FAX: 407-7 4-17 90
3" C CHANNEL IS ATTACHED TO FASCIA WITH 410 2" INTO RAFTER TAILS
6" FROM ENDS 24" O.C. & TO 3" PAN ROOF WITH (3) 410 1" PER PANNEL _—
ROLL FORM FASCIA IS
ATTACHED TO PAN ROOF
WITH 910 1 " 6" FROM
ENDS 24" O.C.
3X3 POSTS ARE ATTACHED
TO 2X7 BEAM WITH 2 1/4" X 3 1/2"
3X3 POST IS ATTACHED TO
BRACKET WITH 1 1/4" X 3
1 /7 n r A n n T A r U n llT T C
DESIGN STATEMENT
METAL IS .046 THICKNESS OR GREATER ALLOY IS 6005-T5
ALL TAPCONS SHALL PROVIDE MINIMUM OF 1 1/8" EMBEDMENT DEPTH
MICFruU.L T HUN PSON
4401 VlNELAND ROAD
SUITE A6
THIS STRUCTURE HAS BEEN DESIGNED IN ACCORDANCE TO MEET THE REQUIREMENTS OF THE 2014 (5TH EDITION)
OF THE FLORIDA BUILDING CODE FOR OPEN AND SEMI -OPEN STRUCTURES AND SHALL WITH STAND ULTIMATE WIND
SPEEDS OF 130 NCH (FOR 3 SECOND GUSTS) NOMINAL SPEED 101.4 MPH UP TO A 15FT ROOF HEIGHT, FACTOR OF 1.0, AND EXPOSURE C, RISK CATEGORY i
CONTRACTOR SHALL FIELD VERIFY ALL PLANS DIMENSIONS PRIOR TO MATERIAL PURCHASE, FABRICATION AND CONSTRUCTION
CONTRACTOR SHALL NOTIFY THE ENGINEER IMMEDIATELY SHOULD SITE CONDITIONS DIFFER FROM CONSTRUCTION PLANS
ORLANDO, FT 32811
47509
30 '930,
PLAT OF BOUNDARY SURVEY for: MARONDA MOME5, INC,
DESCRIPTION: LOT 10, CROWN COLONY 5UBDIV1510N
3EMINOLLRECORDEDINPLAT900K !al PAX(S) I W I A ILU ID PUBLIC RECORDS or. _ COUNTY, r C]ri'IDA
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CERTIFIED TO:
Christopher D. 6 Margaret S. Clevenger o
America's wholesale Lender EPLy l•5 Kampf
Title & Guaranty Corp. Adnoram
Title Company, Inc. LOT
J- a Chicago
Title Insurance Co. -- s E
FLOOD
CERTIFICATION wa,
BASED
ON :THE FEDERAL EMERGENCY - pet J ; o V ,OY g MANACEMENTACENCY
FLOOD INSURANCE Lo.t. i I Ll S b Ok to install 40 x 10 (400 square foot),scree n RATE"
MAP, THE STRUCTURE SHOW
HEREON.00ES NOT LIE WTHIN room as shown on plan. Structure shall not be THE
100 YEAR FLOOD'HAZARD AREw U3e 1 R' THIS `
STRVCTURE LIES IN ZONE ' X " installed within the 20 foot drainage easement. cOuuum
Y-PANEL ND:/Loze9.00AC;C=CFFrCTIVE
DATE: AP MAP
REWS16M OATEN R1L
17, 1899 ilea]
NO I QICI 1*34 D SUBXCT
TO CHANCE) •• ba
i yS6 NOTES: = _ t, '
BEARINCS'ARE BASED- ON THE EASTERLY Ip w
r,
W Te
LINE
OF LOT,10 BErNc SI2'2J'4IT. ' ^^b"1 .0? •1 p x 2.
UNOCRCROUNO IMPROVEMENTS,, ROOF 'OVERHANGS '• ANO-
FOOTERS HAVE NOT BEEN LocAxor LA VC AELEVATIONS:: ARE, -BASEDI ON NATIONAL. GEODE Cr VERTICAL
DATUM OF 1929: t>J {, , A 4..
BUILDING TIES ARE. TO FOUNOAPON. Vo 5
6VILDING TIES ARE /VDT TO BE USED TO V;
kulaCONSTRUCTDEEoORPLATTEDLINES,B,
BEARINGS AND DISTANCES spioym #,imoN AREMEASURED` ANDPERRECORDEDPLAT;UNLESS OTHER
NSE NOTED. d' Ttic"'-
UNDCR T.7VED4l' `!D` • ":, LM!0 rn .7» R' OO 0OI V• D :UE: S and MAPPERS
MAKE` NO'RMRVA710N5 OR .GUARANTEES AS ,TO THEAKFORMATION
REFLECTED HEREON PERTAINING : M EASEMENM , RICHTS
OF WAY, SETBACK LINES, AGREEMENTS AND OTHER -MATTERS, ARC6.041 0 ` AND, rVRrHCR,
THIS INSTRUMENT NINTENDED FORTH ALL SVCH
MATTETVSSUCH N ORFORMATION SHOULO CH' m 20'C'11 y 0 '1(o
Z G 1 A : /(::
2
BE OBTAINED
AND CONFIRMED
BY -OTHERS THROUGH APPROPRIATE CH.BRG.=. ROYALTY CIRCLE nnE- I,ERII,oAnoN, g S54"46' 1 `•.• '
IGI1T= OF=WAY A86REV1A T10NS/LEGEND: T.•roam 01 "a. 3 Q.'FOUNO 11/4-
IRON PIPE (LS 2006)-0 FOUND IRON ROD` 0 FOUND' " *DN'N IQIK . FOLWO4'X4'CONCR£IE MQNUMENTAIO, 314 NO. -NUMBER At -POINT
OF TANGENCY CONC-CONCRETE W.E. - WALL EASEMENT FE.;Feo4cE L AIHrF t ITT ADIUS
P.
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INTERSECTION' L S-LD SURVEYOR PR•G-POINT ,OFFREVERSE. CURVATURE D.E.-DRAINAGE' EASEMENT 2N,-CHORD; PC.-PONT.OFCURVATURE
O R-OfFIQAL` RECORDS P C C,-PAINT .0F • COMPQUND. CURVA TURC U.E. -UnUTY EASEMENT ARC -ARC LEHCMt.B-LICENSED
BUSINESS. f?L TC= ORD BEARnVC SBU.E-9DEWALK A,•UnL!TY'EASEMENT. QU.QSE HAINAZE, Uitr,ITY d CENIFRLINf A/C -AIR CONDITIONER'PAD &
DELTA CEKMAL_;MIOLEY, D,&V.G-ORAINACE &.'Unt;trY,EASEgENT. SIDEWALK EASEMENT IHIS SURVEY NOT°VALID UNLESS EMBOSSED
REV19UFll DATE N1TH> SIOYATVRE• 4N0 13AISED SEAL •OF.
i' .0 :®y, INC. o AFL
DA UCxW= VE MAPPER - 'RECERnnED
ttALAND SURVEYORS AND"MAPPERS nN LDCATIONCOUNTYROAD.--427 S9VTH rOUNOATtON-LOCATION...
2-11.21, LONGINOW, FLORIDA 32750-5499 DOWCj(f
CAVONP - 'PRENT FORMBOARO LOCATION H-1 TELEPHONE (407) 830-'9060 FLORID- NLQDCR"ZOOj STAKE HOUSE 1-(
e•(pp FAX No. (407) 339-J639 LMNSED BU9NESS NUMBER 507J STAKELOTI-l.•IOG? w0 STAKC LOT_7m2•14l.I1 W.Li STAKE HO -(
T LW - 141.5AI WO, FORW CHECK Z.003.7SO _.. W (I HXWC A TT( _Q13 _ I C t•'1
IK Q i7 V 'L7' - •" LOT by i cr__-G nca:R£cE r. Gwo r4X:0RQIWcoL)a,
tr=sfi:Building and Fire Prevention
Product Approval Specification Fora
Permit #
Project Location Address 17L 007,,1
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.orq.
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 U
Automatic
Other
2. Windows
Single Hun
Horizontal Slider
Casement
Double Hun
Fixed
Awning
Pass Through
Projected
Mullions
Wind Breaker
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Other
June 2014
Category / Subcategory Manufacturer Product
Description(including
Florida Approval #,
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
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Nonstructural
Metal Roofing
Wood Shakes and
Shingles
Roofing tiles
Roofing
Insulation
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System
Modified Bitumen
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Systems
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Adhesives /
Coating
Liquid Applied
Roofing Systems
Roof Tile
adhesive
Spray Applied
Polyurethane
Roofing
E.P.S. Roof
Panels r's,
jjIi
a n C, 0 r/
Roof Vents 0
10,
l
Other
June 2014
Category/ Subcategory Manufacturer Product
Description
Florida Approval #
include decimal
5. Shutters
Accordion
Bahama
Colonial
Roll u
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
Applicants Name
Please Print)
June 2014
r'''i
k 5
BCIS Home Lag In User Registration Hot Topics submit Surcharge Stats & Fads
Business-,,,-,. `—
I Product ApprovalProfessional ''',. ' USER: Public user
Q +
k > Application Detail
tom,
FL FL5Ei1 R3
f>s`psr;,
M Application Type Revision
Code Version 2014
Application Status Approved
Comments
Archived
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Product Manufacturer Elite Aluminum Corporation
Address/Phone/Email 4650 Lyons Technology Parkway
Coconut Creek, FL 33073
954)949-3200
dk@dokimengineering.net
Authorized Signature Do Kim
dk@dokimengineering.net
Technical Representative Dan Cooke
Address/Phone/Email 1801 NW 64th Street
Ft. Lauderdale, FL 33309
954)491-3700
eiitealum@aol.com
Quality Assurance Representative
Address/Phone/Email
Category Roofing
Subcategory Products Introduced as a Result of New Technology
Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed Florida
Professional Engineer
Evaluation Report - Hardcopy Received
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
Do Kimr P.E.
PE-49497
Quality Auditing -Institute Ltd.
11/30/2020
James L. Buckner, P.E. at CBUCK Engineering
Validation Checklist - Hardcopy Received
t,75n13CI__erof ndpen n 2Qe. f Sections from
the Code 709.2
Product Approval Method Method 2 Option B
Date Submitted 04/30/2015
Date Validated 05/01/2015
Date Pending FBC Approval 05/10/2015
Date Approved 06/23/2015
Summary of Products
FL # Model, Number or Name Description
7561.1 j Aluminum/Aluminum Composite 3'/4'/6"x0.024"x1lb EPS Composite Panel, 3"/4"/6"x0.032x1lb
Panels EPS Composite Panel, 3"/4 /6"x0.024"x21b EPS Composite
Panel, 3"/4"/6"x0.030'x2lb EPS Composite Panel,
Limits of Use ; Installation Instructions
Approved for use in HVHZ: Yes fL756i_R3_.11_Elite FL7S61 R3 2Q 3 ._ s?_st llation Qv.g_pdf
Approved for use outside HVHZ: Yes Verified By: Do Kim, P.E. PE 49497
Impact Resistant, No Created by Independent Third Part;/- Yes
I Design Pressure: 180/-80 Evaluation Reports
i Other: 1n HVHZ, not to be used in structures considered i FL75 1_R _AE.lite AI lm FL,JS( l,_ R_ = —:.FBC
livino areas per H BC Section 1616 unless impact protection is I _E 3,I I- i n)df
provided. See installation drawing for nominal alletvarle design i Created by Independent Third Party: Yes
pressures and spans.
ContaQ VS_Nor h f•tcnrL_._Stream. Tallahassee L. 's2 Q Phone: gS0-487-1 F??
the State of Flc:ida is an AAJEEO employer.yright 2J;:7-Oi3t e4f r70rida.:: Privarr Statement Acc?;_ihil,t>• 4ry!:=me,it Rgfund Statement
Under Florda la,-, e:naii addresses are public records. If you tlo riot,,ant your e-mail address released in response to a pub;ir records request. do not rend elecnnmc
P ad to this ennty. Instead, contact the office by phone or by traditional mail. 1f you have any questions, please contact 6°•6.4g7J 95. 'Pursuant to Section
455.27HO), nerida Statutes, effective October 1, 2012, iicensee5 licensed under Chapter 455, F.S. must provide the Departrr•ent '.':ithan email address it they have one.
The emails provided may be used for official communication r:itt; the Ilcensee. Ho:rever email addresses are public record if you do net cash to supply a Personal address,
p'.easc piov,o< the Department wah an email address which car: be nada available to the public To determine if .eau e.,e a licensee under Chapter 455. F.S., alese
click hp,e . Product
Approval Accepts: ao
We
IVE
Do Kim & AssoCIATESy t_L..0
CONSUL.TIN13 STRUCTURAL ENGINEERS
FloiidaBoaid of Engineers Certificate of Authorization No 26887
Certificate of InAeendenc'e
Do Kim and Associates, LLC. and Do Kim, P.E do not have nor will acquire financial interest in the
company manufacturing of distributing the product of in any other entity involved in the approval process
of the product named in the accompanying Florida Product Approval
Do Klm,
r-L #49497
nn n- 1r%AIn
01I I')A nl'71
ELITE PANEL SPAN TABLES
3 0024 x 1 - LB EPS PANELS
rnl.l..fiwr;ol_ C1.CAR SPAN C!-IARTS)
I{ I f MAX. r 1 I DwnBLf PAW (rT
i lLLnV n
n (Psi 11 t I /Fla i / 1?I /IpT
iifTI "_I
4' r. 0.024 x I - 1_B EPS PANELS
ALLOWABLE CLCAP^ SPAN CHARTS)
NET MAX. ALLOWABLE SPAN (FT)
ALLOWABLE
LOAD (PSV)' L/80 L/li VI80 L/240
Inj-'-. IY.M15n1 I'IAJ
Is% Ill? ly of I a1J9J
q lz DJ IC.- 1 `Ai9i'- n ]nUWto,, 1091
b• >, J.U_:_' 1 - LB LPS PANELS
I)WADL1, C1_EAR_ ,(till CHAII;:>
IIL I I HA. nLLOJnOt L ,Par: a NAI_i It IILC
i L.- HO
1. , Inq?. III C/ 14i
133, 12.Ip 1]a{
Ia.Jr lay.
rJ IL tq 1LIO la.9r
GJ 7U5 4A_ JI1..] J.II
Net allowable loads are permitted to be multiplied by 1,67 to derive ultimate foods (psf).
3' x 0.032 x 1 - I_B EPS PANELS
r1, L.r1WtiRI.E CI C R SPIN C'HARTS>
LLU JAI LL
I. •: I'di "f v I i L till L •I20 L/:Dn i L/?a0
4- .c 0,03r x i - LE EPS PANELS i
ALLOWABLE CLEAR SPAN CHARTS)
NET MAX ALLOVABLE SPAN (FT)
AI-t.(}VABLE
LOAD (PSF)I I t./__ L112D /I80 L/2<0
coalinaiU i'a:,o
196r
1911
cU 1 f9_ti '"•"i%iti 11./i'
qsn
I6 2 111 I C•' U.>..
4U
IS. n n , ti• _
IJAI 1i.2 7fu
1 10, 1.1n
6' 11 U iE ac t I c ` f tlLl S
ALLOWABLE CLEAR `I rIN IO f,)
ALLOWABLE f
3' x 0.024 n 2 - Lb EPS PANCLS
ALLOWABLE Ct,[AR SPArl COl"PTS)
NET I are, t!, LWA._,. 'c,, -r ,
LLCWFL L
17/180.1 L/, •SO
UUJ L-t "P` PAi,l LJ!
t)i LJW u,l !` Lt_. i :>f AM LFHahT;i j
I;E- -I-t I t DWA tLL >PA- F• I
GENERAL NUTFS
1. Composite panels shill be construcad using type )003.11154 aluminum facings, I or 2 PU ASTA1 C-578 .anxnu. brand LI'S
gdhcrc us alundnum fining% with Asldard (lhcmicul 211200 IS0 grip. fabrication to tse by Elite panel PWducls only in
accordance with approved fabrication nxdlods.
1;'tile mn(p3.wI, nannI.in a Ul. 1715 (int) elass'll' (ext) mling And are NER•501 upp,uvc0
rh8 specilicntinn has hcen designed =it shall be fshricaad in acennLJnce with the reyuircmunls of the Florida Ouil(ling Code
5" Edition (FOE). conlprssitc tancis comply with Clalpto 7 kalipn 720. CN ptar 8 &action 03. Clas.+ A interior finish. and
Clclpler 26 Section 2603. All local huilding code amendments shall he adhcled to :a required.
4. 'rise designer shall determine by Accepted cngirlcering practice the allowable load.%for site stxcitic load conditions (including
load eunlhirwlimls) mint. the:• data foot Use ullowablu Iuads lables and span, in Ili:. approval.
IkOectinn limits end afloeahie spans lave been listed to noel FOC including the IIVHZ- In FIVHZ. Ibis Prod uct'hall he used
in,lNcoao. ,.,I Ill be Consider Tl living am.s- per Sce)im, 1616 Ludes impact resillance in accordance to lieu I IVHY.
rcgaiirmcnl: are met.
b S dery I Luna of 2.0 Ices i-a n- I" Jcvs iup nlln u i I d "I p 1 r re T ....... hr the Glad -line: tar
Alununum Strunme, Pan l Jnd runlPrnu to the HIC Cann •r it n l .t)
7 loving ism Nc ..ducted in accordance s) ASI hit 77115. SIR rah rc I of t mcie for 13.0din ('onaruea
b Itct,ra t s. tetraIIFTI.0519Nh.IILI'hD6210110. 11.66 06( I lta'60G 2105111:fiJ IIG. { IF 11051002, I IE I
Ixr 2W7, Ill:11.05-1987, II7'160t1-2069.III I -fife 7(17U I11i'1 I-116 7071 IIF1 i•05-19vJ.1Il ll OS. Pr/l IO ri (11: 1)72,
Illi rl-Uh2(Mj IFI1.06.2071, 1-IIJI-05-1996, ill •f10 •1989.111. 1'105•Iw3jil1l05•I9k S.Ill:fl-us I1)S Ill: Il-05.
19nt1. ITI I t•IIS- I'/'77, hO'1'I.11.521137. ilia"1.11$-2029, li El'1-11520}0. IIL'f b(15 2030. rill f I AS.' W I. I I I•. i'i •1152(ts &, i llf ll •
05.203A. I IL I'I.n'••2031, I IGTI-iJ5-2113X. lifl'I-U5-2065. I1FTI-05-2040. I ILI 1-05-2042.
9. Linear inlcrpnlation shall be allowed for IigurL. within the Inhlc: shown.
IU. I'ancls with (an beams sls:llttx+consalcm-dc4uwalcm to Similarpaticls vilhout fan beams. Dusigrt PrullSsiunnls may include
me.orc .th Prose Iran bean, to exceed sisa(vn figures es ptl ol'sitc- pccifie gaping •rind
P. PANELS,
6LLJWn13LL ::.'I L 4,1• .i IAN t.HAR T'S) i
n'(:I srzX ALLOWAULL 1
l l 0 JALLF
I.IIA 1 rf J )I I 1.'I 111 0 1 lIt1P 1./24n
n
NI
n` {an 30R
SEAL JUNI VI/H
CO>1 rillorrrs CA RING
I
0000 00000( ;
0000000000( n'
f
N M <CIN6S
n11 F pCKlliO_CBGSYSL.CLB1 OPTIO NALCL
ORll> can
t SLDP[
a (
In'7FI HIN SLOPE)
MAX VIIIIH INIERLOC11110:
j{
vARF.L
ZL
o
00nDOOCDObO )
or-
00 + EPS LCRC ILO DR a 00000n000060
lu
ALu"ItIVw PnTIo: p00 .f
i rAf.l,."
00t I`
CI CAR .iP.+v n f 1N:)LC TO It.cirC-____.-- 00---nH--
00 +
I o0
1DD INI[YN . ; (If' 00 35' MA.% 11+ rRLlli 4 Y'/.{
To. Rl r4 I. J.IdHS ! 00 Gr PnJ:,I. vi nTl'. P SIDES
u•,<nR Ilf SIP.[ runt AftI.L IIY VA!. 1. nR tar Al. U O
IIJI1 lJ. AJIY [JrIU.e% Cnr,,Jll.r+ - I
PAI:G, 1. sPAIJ Unc (li." NA% Ai SInr.5>
l._._«...__.-_.____.__.__ J
EPS ROOF PANEU SPAN DESCRIPTION
00 KIM
A ASSOCIATCE• LLC
CONSULTING
STRUCTURAL
ENGINEERS
PO sox IDW.
r mr•, rt.usrn
iul: (xn7 051.%55
q-Y.Jp.!. Des Uqn
r+ ntUlefd, M,eeYeTaAMgeYK
i.weargooucrArrnw7,t
ris isnn.Nlan-rqc rnooU0ucs
uMso+u TAW-.,
FL No. -
FL-1001 ET
1 OF 1
DO KIM & AS50CIATES, LLC
CONSULTING STRUCTURAL ENGINEERS
Florida Board of Engineers Certificate of Authorization No. 26887
Product Evaluation Deport
Date: April 10, 2015
Report No.: {=L ` 7561-R3
Product Category: Roofing
Product sub -category: Products introduced as a Result of New Technology
Product Name: EPS Foam Core w/ Aluminum Skin Composite Panels
Manufacturer: Elite Aluminum Corporation
4650 Lyons Technology Parkway
Coconut Creek, FL 33073
Phone: 800-421-0682
Scope:
This product evaluation report issued by Do Kim and Associates, LLC and Do Kim, P.E. for Elite
Aluminum Corporation is based on Florida Department of Business and Professional Regulation Rule
61 G20-3, Method (2) (b) of the State of Florida Product Approval. Re-evaluation of this product sliall be
required following pertinent Florida Building, Code modifications or updates.
Do Kim and Associates. LLC and Do Kim, P.E. do not have nor will acquire financial interest in the
company manufacturing or distributing the product or in any other entity involved in the approval process
of the product named herein.
This product has been evaluated for use in locations adhering to the Florida Building Code, _5"' Edition
FBC) and where pressure and deflection requirements, as determined by Chapter 16 of the Florida
Building Code, do not exceed the design pressures as shown on the approval.
Y
tMfl
Off,
4'-:Ft ORIOP a(1\
ONAL
4-25-15
Do Kim, P.E.
FL 449497
P.O. Box 10039 813.857-9955
Tampa. F). l i679 dkOdokimenaineerins* net
DO KIM & ASSDCIATESy LLC
CONSULTING STRUCTURAL ENGINEERS
Supporting Documents
i . Code Compliance
a. The product assembly described herein has demonstrated compliance with the Florida
I31.111din<g Code 5°i Edition (FBC), Section 1709.2.
2. Drawings:
a. Drawing No. FL-1001 titled" F_PS Foam Care Composite Panels", sheet 1-1, prepared by
Do Kim and Associates, LLC., signed and sealed by Do Kim, A.E.
3. Testinu
a. Testing per ASTM E72-05 as performed by Hurricane Engineering & Testin`, Inc.
HI Ti). and reported in test report numbers HETI-05-1988, HETI-06-2104, HETI-06-
066. HETI-06-? 105, HETI-06-2067, HETI-05-1002, HETI-06-2107 HETI-OS-1987,
HP'TI.-06-2069. HETI-06-2070, HETI-06-2071, HETI-05-1994, HETI-05-1991, HETI-
06-2072. HETI-06-2073. HETI-06-2074, HETI-05-1996, HETI-05-1989: HETI-05-1993,
HETI-05-1985, HETI-05-1995, HETI-05-1990. HETI-05-1997, HETI-05-2037, HETT-
05-2029, HETI-05-2039, HETI-05-2030, HETI-05-2041, HETI-05-2048, HETI-05-2036,
HEI 1-05-203 1. HETI-05-2038. HETI-05-2065, HETI-05-2040, HETI-05-2042.
4, Calculations
a. Panel performance engineering analysis for tested loading conditions have been prepared
based on comparative and/or rational analysis, prepared, and submitted by Do Kim; P.E.
5. Other
a, Quality Assurance Agreement verified with Quality Auditing Institute, LTD. (QAI
Laboratories, LTD.) (FBC Oroanization 4QUA7628).
P.O. Box 10039
813.U7-9955
Tamna Ff. . 11679
dkra dokimenf7ineerinu.net
DO KiM & ASSOCIATES, LLC
CONSULTING STRUCTURAL ENGINEER;
Limitations and Condition of Use
1. Code Compliance
a. The product assembly described herein has demonstrated compliance with the Florida
Building Code 5"' Edition (FBC), Section 1709.2.
Lar-e and small missile impact resistance has NOT been tested to or evaluated for in this
approval. In HVHZ, this product shall be used in structures "not to be considered living areas'
per Section 1616 unless impact resistance in accordance to the HVHZ requirements are met.
3. Each product listed above shall be installed in strict compliance with its respective Product
Evaluation Document and site specific engineerin` along with all components noted herein.
4. Use of each product shall be in strict accordance with its Product Approval Evaluation and
Limitations of Use.
5. Composite panels shall be constructed using type 3003-H 154 aluminum facings, i or 2 PCf
ASTM C-578 carpenter brand EPS adliere to aluminum facings with Ashland Chemical 2020D
ISO grip, Fabrication to be by Elite panel products only in accordance with approved fabrication
methods.
6. Elite roof panels maintain a UL 1715 (int) class 'B' (ext) rating and are NER-501 approved.
7. This specification has been designed and shall be fabricated in accordance with the requirements
of the FBC, composite panels comply with Chapter 7 Section 720, Chapter 8 Section 803_ Class
A interior finish, and Chapter 26 Section 2603. All local building code amendments shall be
adhered to as required,
8. The designer shall determine by accepted engineering practice the allowable loads for site
speelilc load conditions (including load combinations) using the data ti'Oln the allowable loadsmb
tables and spans in this approval.
9. Deflection limits and allowable spans have been listed to meet F13C including the HVHZ._ (L./80
for spans < IT-0" and 1./180 for spans > 12'4').
10. All suppOrtinu ]lost structures shall be designed to resist all superimposed loads.
1 1. All coif ponents.which are permanently installed shall be protected against corrosion.
contamination, and other such damage.
12. Size and Span Limitations:
a. Composite panels shall be limited to those specific panels listed in the DWG. FL- 1001,
b. Allowable panel spans shall not exceed those listed in the tables of DWG. FL-1001.
P.O. Box 10039
813.857-99i5
Tamna FT. 111679
dl rn rinkimens ineerinu.net
LIMITED POWER OF ATTORNEY
Date: ( 7bce
I herebyd appointnameanppto be my lawful attorney in fact
to 'act for me and apply for aJAff/ permit for work to be performed
at the location de cribed as: AO
G Address
of Job) 01a
Owner of
Property) And to
sig* mtAamVland c ash things necessary to this appointment. Signature of
Contractor
and License Number) STATE OF
FLORIDA COUNTY OF The fore
i g in trument was acknowledged before me is Tl day of , 20 by Y —
J ,who is personally known to me or has produced take 4
o V W
w•
r+we cs o9ac o r Si atureofrotaryPublic, State Of Florida s oZ '90 saes 93Wdx3 IfA, 11
SCh AlHUVi3sn1Nos "jim y ' Pr t/
Type/Stamp Name of Notary Public tyye of
identification) as identification and who did October 2009
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #:
I, hereby acknowledge that I personally inspected
NI Roof deck nailing and/or M Secondary water barrier work
at Atl W I 1 `W) NE. W d _5i 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 837.06 F.S.
Sig ur f Contracto
Ufni',(_ M , _)61 7-D 'Pipj I P
Printed Name of Contractor
q -2U _,ac)I to
Date
r a 3
License #
License Type: General Building Residential V<oofing Contractor
171 or any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF {'}q I yj Q [e-
Swore to or aff,><rmed) and . ubscribed before me this day of , 20 ) (.0 by
who is G Personally Known to me or has Produced (type of
i entifi ation) as identification.
y (SEAL)
Sign ture of Notary Public
Stat tiFlo ida
cX Q
Print/Type/Stamp Name
of Notary Public ti
ALFREDOJAEN
W COW SION 0 FF 914924
yEo nQr Bonded OW LWK*SI,'IY