HomeMy WebLinkAbout172 Pinefield Dr (3)?•
DECECEIVE
1 2016
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No- � - -5 A07
Documented Construction Value: $ 12 / Z0t�>
Job Address: 111, OVA-CAd ray aA/4Rd • 6 52; Hi toric District: Yes ❑ No
Parcel ID: 31-19 - Doi)h — 631Q 0 Residentia&Commercial ❑
Type of Work: New ❑ Addition ❑ rAlterationg. Repair ❑ Demo ❑ Change of Use ❑ Move ❑
Description of Work:
Plan Review Contact Person: I r IL
Phone: �U1 �5"Jq6_5 Fax:
Email:
Property Owner Information
Name
Street: ) d Y
City, State Zip:
Phone:
Resident of property? :
LAO
Information
Name I 16491
Street: 5 z 51
City, State Zip: _
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
01
Phone: Qb7 ?,q5- wo3
Fax:
State License No.: C Lel Sqq, u
Arch itect/Eng 1 neer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
(a
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, r .
furnaces, boilers, heaters, tanks, and air conditioners, etc. C,l�
FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 51d Edition (2014) Florida Building Code ►/�
Revised: June 30, 2015 Permit Application 4 �O
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 and zoning.
SiEa of Ow / ent Date Siure of-Contractor/Agent Date
mjvk r)1 kuUtP�I � fil I t � I1<dVl/ f' \ n
7MWEVireS
"tDate %-Date
FLOIDAtWN do
FF901799OTARY FUSLIC 7/21/2019 STATE OF FLORIDA
FfW17"
�� 7/21//��
Owner/Agent i Personally Me or Contractor/Agent is Fersgnally Known to Me or
Produced ID Type of I 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: Flood Zone:
Min. Occupancy Load:
New Construction: Electric - # of Amps,
Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads
APPROVALS: ZONING: UTILITIES:
ENGINEERING:
COMMENTS:
FIRE:
# of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes ❑ No ❑
WASTE WATER:
BUILDING: SF
Revised: June 30, 2015 Permit Application
11/22/2016
paw
arr�+aF oau►rrx raona.
Parcel Information
SCPA Parcel View: 32-19-31-515-0000-0360 3 Sri
Property Record Card "w"� -
Parcel: 32-19-31-515-0000-0360 � J 2 -zoo ,
Owner: HALE ROBERT P & NIRAMON P & HALE STEVEN A I
OT -
Property Address: 172 PINEFIELD DR SANFORD, FL 32771
11 Value Summary
Parcel
32-19-31-515-0000-0360
Owner
HALE ROBERT P & NIRAMON P & HALE STEVEN A
Property Address
172 PINEFIELD DR SANFORD, FL 32771
Mailing
172 PINEFIELD DR SANFORD, FL 32771
Subdivision Name
CELERY LAKES PHASE 1
Tax District
S7-SANFORD
DOR Use Code
01 SINGLE FAMILY
Exemptions
00-HOMESTEAD(2016)
+ 50 50 50 40
1
1 i
i
50 50 50 65 I
Seminole County GIS
Legal Description
LOT 36
CELERY LAKES PHASE 1
PB 62 PGS 75 & 76
Taxes
Tax Amount without SOH: $1,837.00
2016 Tax Bill Amount $1,837.00
Tax Estimator
Save Our Homes Savings: $0.00
Does NOT INCLUDE Non Ad Valorem Assessments
Taxing Authority
2017 Working
Values
2016 Certified
Values
Valuation Method
Cosl/Market
Cost/Market
Number of Buildings
1
1
Depreciated Bldg Value
$114,188
$109,228
Depreciated EXFT Value
$2,417
$42,786
Land Value (Market)
$23,000
$23,000
Land Value Ag
$94,802
County Bonds
Just/Market Value "
$139,605
$132,228
Portability Adj
$101,100
No
Save Our Homes Adj
$2,017
$0
Amendment 1 Adj
$0
$100
P&G Adj
$0
$0
Assessed Value
$137,588
$132,228
Tax Amount without SOH: $1,837.00
2016 Tax Bill Amount $1,837.00
Tax Estimator
Save Our Homes Savings: $0.00
Does NOT INCLUDE Non Ad Valorem Assessments
Taxing Authority
Assessment Value Exempt Values
Taxable Value
Page
County General Fund
$137,588
$42,786
$94,802
Schools
$137,588
$25,000
$112,588
City Sanford
$137,588
$42,786
$94,802
SJWM(Saint Johns Water Management)
$137,588
$42,786
$94,802
County Bonds
$137,588
$42,786
$94,802
Sales
Description
Date
Book
Page
Amount
Qualified
Vac/Imp
QUIT CLAIM DEED
4/1/2016
08662
025
$82,100
No
Improved
WARRANTY DEED
7/1/2015
08532
157?
$156,000
Yes
Improved
SPECIAL WARRANTY DEED
6/1/2015
08489
1613
$101,100
No
Improved
CERTIFICATE OF TITLE
12/1/2014
08388
0343
$100
1 No
Improved
SPECIAL WARRANTY DEED
3/1/2004
1 05251
1313
1 $141,300
1 Yes
Improved
Find Comparable Sales
Land
Method
Frontage
Depth Units
Units Price
Land Value
LOT
1
$23,000.00
1 $23.000
Building Information
httpJ/parceldetaii.scpafl.org/ParcelDetaillnfo.aspx?PID=32193151500000360 1/2
it
universal
Zi Roofc' Contracting
Page 7 of 13
INVESTMENT:
Universal Roofing Group, Inc. proposes to furnish and install labor and material in accordance with the above
speyifications, and subject to conditions found on both sides of this agreement, for the sum of:
Teed Fungus resistant, 3 -Tab shingles with a 25 -year warranty
Teed Landmark, fungus resistant, Architectural shingles
Lc%l�/��tall self -adhering modified bitumen in dead valley area
Imo- 'Does not include flashing/stucco in this area.
ail roof deck
n ! SYSTEM
$11,725.01
ADD `
ADD f $+e***
ADD $ 547.86
�y q9
A Install 11 lineal feet of new seamless gutter and 2 new downspout. ADD $ 286.75
vide and install all new (3-2" & 1-3") Bullet Boots ADD
CertainTeed SureStart Warranty - 3 Star ADD $142.52 v�
=Perform Wind Mitigation Inspection ADD $100.00
Discounted inspection that when submitted to your insurance company, C�� can save you hundreds of dogars a year on your homeowner's insurance premiums I
Total
TERMS:
Standard industry cash terms; one-third with the order, one-third due upon delivery of materials, balance due upon
completion. Building Permit is included. Job related debris to be removed from job site.
Universal Roof 6 Contracting will submit the price and scope of this contract with the insurance company and agrees to do the roof
for scope and final dollar amount submitted to the insurance company. The cost to the homeowner, which will be paid to Universal
Roof 8 Contracting, is the deductible, upgrades, and any potential additional work orders including, but not limited to wood, stucco,
siding and wall flashing. Additional work orders must be paid by the homeowner at the time the A WO is presented, before the work
is done, but will be submitted as supplemental requests to the insurance company by Universal Roof and contracting for the
homeowner's reimbursement. qpx dditional items submitted to the insurance on behalf of this claim, including overhead and profit,
will be owed upon approval.
The final payment of each item should be paid at the end of that item. (i.e. the final payment of the roof is paid
when the roof is completed, gutters, /screen, interior etc
$ / C�0 O � tal Order
W
/ $ "� 0'- - Contract Signirfg�
(�.A
6
$ d • - Due on Start Date (Deductible and Upgrades)
$ ��c Due Upon Completion of Roof
('Remaining money received from Insurance and Hidden Damage not factored into this payment)
Final Payment (Any additional money from Insurance: Depreciation, Supplement/payout)
Owner.
Universale
THIS INSTIM
T PAR Y• 11ARYA14NE MORSEr SEMINOLE COUNTY
Name: CLERK. OF CIRCUIT COURT & COMPTROLLER
Address: Bl: 8814 Pg 334 (if'gs)
CLERK'S v 2016123905
RECORDED 12/01/2016 08:52:33 AM
RECORDING FEES $10.00
NOTICE OF COMMENCEMENT RECORDED BY 11devore
Permit Number: /l
Parcel ID Number: V
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the
following information is provided in this Notice of Commencement.
1. DES¢R P IO 0ROPfR :,(Legal de�c l q0 a gyeq ty�a fr�d �tre� a r P Tlal*"4)-1 4�-4 —71.e
2. GENERAL DESCRIPTION OF
3. OWNER INFORMATI01")
ES EE OR ION IF THE L jEE CO tRAC FART HE I PROVE NT:
Name and addressI Interest in oroDert
4,
5.
Fee Simple Title Holder (if other than owner listed above) Name:
Address: Amount of Bond:
6. LENDER: Name: Phone Number:
Address:
7. Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served as provided by Section
713.13(1)(a)7., Florida Statutes.
Name: Phone Number:
Address:
8. In addition, Owner designates of
to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Phone number:
9. Expiration Date of Notice of Commencement (The expiration is 1 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.
4v�* \�"v_ (Y'j �� C
(Signature of, _ _ er w_L'essee :or Owner's or'L'essee s (PAnI Name`arW PmNOe_Slgnatoly TNeLp")-
AuNPiML'
orIzed Officer/Director/Partner/Manager)
State of County of
The foregoing in t u ent w sack wle g before me this day of UwA&V
20 +
by " Who is personally known to me D OR
Name of pe maki''7
ng statement j�f f L
who has produced identification pe of identification produced:`
VOThalla coralAcevedoNOTARY PUBLIC'STATE OF FLORIDA CERTIFIEDCOPY—M R RC.0111rri1>;<FF901799 CLERK OF THE CIRCUI C U4CMP RE 1�Exp(f S 7/21/2019 SE i LE C PITY, FL O IDA
EL' y' 16 DEPUTY CLERK
POWER OF ATTORNEY
1 hereby name and appoint Joan Mellick
Of Universal Roofing Group, Inc. to be my lawful attorney in fact
To act for me and apply to the 91A�
Building Department for a Roof permit for work to
Be performed at a location described as:
Section: SATownship: 4 Range: 31 Lot: .5/`:Block: I000 -- d 2�6& v
Subdivision:
(Owner of property and address)
And to sign my name and do all things necessary to this appointment.
(Sign
Contractor)
The foregoing instrument was acknowledged before me this
By Ken Mellick
State of Florida
County of Orange
My Commission expires:
Commission#:
and who did not take an oath.
Thalia COW Acevedo
SWCE1NOTAWf PUBLIC
0
STATE OF FLORIDA
Ccmrn � FF901799
Expires 7!21!2019
3115&016
FW& D pact atd
Bus nes
Protessi I
Regulation
Florida Building Code Online
FroTessioncii &equiation
RECORD COPY
ASTM D6163
Fair
BUSS Home I Log In I User Registration I
Hot Topics Submit Surcharge I Stats a Facts I Publications I FaC Staff I SCIS site Map I Unks I Search
Product Approval
2008
usl:R: Public use.
2009
Product Approval Menu > Product or Application
Search > A001cation List > Application Wall
FL s
FUS33-R15 SANFORD BUILDING DIVISION
Application Type
Revision
Code Version
2014 A PERMIT ISSUED SHALL BE CONSTRUED TO BE A
Application Status
Approved LICENSE TO PROCEED WITH THE WORK AND NOT AS
AUTHORITY TO VIOLATE, CANCEL, ALTER OR SET
ASIDE ANY OF THE PROVISIONS OF THE TECHNICAL
Comments
CODES, NOR SHALL ISSUANCE OF A PERMIT PREVENT
Archived
THE BUILDING OFFICIAL FROM THEREAFTER
REQUIRING A CORRECTION OF ERRORS IN PLANS.
CONSTRUCTION OR VIOLATIONS OF THIS CODE
Product Manufacturer
CertalnTeed Corporation -Roofing
Address/Phone/Email
18 Moores Road
Malvern, PA 19355
(610) 651-5847
mark.d.harner@salnt-gobain.com
Authorized Signature Mark Harrier
mark.d.harner@saint-gobain.com
Technical Representative Mark D. Harper REVIEWED POR CO E COMPLIANCE
Address/Phone/Email 18 Moores Road _ Sf
Malvern, PA 19355 PLANS EXAMINER
(610) 651-5847 I'Z-r. – ((.� _—
Mark.D.Harner@salnt-gobain.com DATE
Quality Assurance Representative
Address/Phone/Email
Category
Subcategory
Compliance Method
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
Roofing
Modified Bitumen Roof System
Evaluation Report from a Florida Registered Architect or a Ucensed
Florida Professional Engineer
Evaluation Report - Hardcopy Received
Robert Nieminen – U 7
PE -59166
UL LLC OSANFORD
07/03/2017
Sohn W. Knezevich, PE Validation Checklist - Hardcopy Received
FL2S33 RIS COI 2015 O1 COl Nieminen.odf
Year
ASTM D6162
2000
ASTM D6163
2000
ASTM D6164
2005
ASTM D6222
2008
ASTM D6S09
2009
FM 4470
1992
FM 4474
2004
htipsJ/DoridabLAIdirg.org/pr/pr_ppp o.aspx?param=wGEVXQwtDgvwelwRFXRvHOHSbaIVp/o218EtEmwHMM94B91mwIBWsZJ72w%3da/aid 12
I
3f15/2016
Florida Building Code Online
Certified By
Sections from the Code
Product Approval Method Method 1 Option D
Date
Submitted
10/19/2015
Date
Validated
10/28/2015
Date
Pending FBC Approval
10/28/2015
Date
Approved
12/15/2015
Date
Revised
02/04/2016
Summary of Products
r :
FL #
Model, Number or Name
Description
2533.1
Fllntlastic Modified Bitumen
Modified Bitumen Roof Systems ^�
Roof Systems
Limlts of Use
Installation Instructions
Approved for use in HVHZ: No
FL2533 R15 I1 2015 10 FINAL Al ER CERTAINTEED MODBIT FL2533-
Approved for use outside HVHZ: Yes
RIS,odj
Impact Resistant: N/A
Verified By: Robert Nieminen, PE PE -59166
Design Pressure: +N/A/ -630
Created by Independent Third Party: Yes
Other: 1.) Refer to ER Section 5 for Umits of Use.
Evaluation Reports
2.) The design pressure noted in this application
FL2533 R15 AE 2015 10 FINAL ER CERTAINTEED MODBIT FL2533-
relates to one specific system. Refer to the ER
R15.Ddf
Appendix for all systems and max design
Created by Independent Third Party: Yes
pressures.
b:rc4 Nrtt
Contact Us :: 2940 North Monroe Street Tallahassee FL 32399 phone: 850-487.1824
The State of Florida Is an AA/EEO employer. copyright 2007.2D13 State of Florida.:: privacy Statement :: Accessibility Statement:: Refund Statement
Under Florida law, email addresses are public records. If you do rot want your a -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 mall. If you have env questions, please contact 850.487.1395. `Pursuant to Section
455.275(1), Florida Statutes, effective October 1, 2012, licensees Ilontsed under Chapter 45S, F.S. must 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 are public record. If you do not wish to supply a
personal address, please provide the Department with an email address which can be made available to the public. To determine If you are a licensee under Chapter
455, F.S.. please dick h=.
Product Approval Accepts:
. SCCV rT�
httpsJ/Iloridabuilcing.orgfpr/pr app dtl.aspx?param=wGEVXQwtDgvwelwRFXRvHOHSbalVelo2f8EtEmwHMM94B91mw18WsZJ72wa/o3da/o3d ?l2
QOTRINITYIERD
I APpium l 1: ATu;KmFM
REctufa 1ENiS'FOpjV: JeND UVYFr,RESISTANCE
New or Reroof (Tear -Of) A-1 Bonded Insulation, Bonded Roof Cover 36.37
J�r ;' ;�? j�
w�f' +y1 Y 1
Table
Deck
Application
Type
Description
Page
IA
Wood
New or Reroof (rear -OH)
A-2
Mech. Attached Anchor Sheet, Bonded Insulation, Bonded Roof Cover
5-6
18
Wood
New, Reroof (Tear -Off) or Recover
B
Mech. Attached Base Insulation, Bonded Top Insulation, Bonded Roof Cover
7
IC
Wood
New, Reroof (Tear -Off) or Recover
C
Mech. Attached Insulation, Bonded Roof Cover
8-9
ID
Wood
New, Reroof (rear -Off) or Recover
D
Prelim. Attached Insulation, Mech Attached Base Sheet, Bonded Roof Cover
10.11
1E-1
Wood
New, Reroof (Tear -Oft)_
E-.
Non4nsulated-Mech. Attached Base Sheet, Bonded Roof Cover
12-14
1E-2
Wood
New, Reroof (Tear -Off) or Recover
E
Non -Insulated, Mech. Attached Base Sheet, Bonded Roof Cover
15-16
1F
Wood
New or Reroof (rear -Off)
F
Non -Insulated, Bonded Roof Cover
16
2A Steel or Conc. New. Reroof (rear -Off) or Recover B Mech. Attached Base Insulation. Bonded Too Insulation. Bonded Roof Cover 17-19
2B Steel or Conc. New, Reroof (Tear -Off) or Recover C Mech. Attached Insulation, Bonded Roof Cover 20-24
2C Steel or Conc. New, Reroof (Tear -Off) or Recover D Prelim. Attached Insulation, Mech. Attached Base Sheet, Bonded Roof Cover 25-26
3A Concrete New or Reroof (Tear -Off) A-1 Bonded Insulation, Bonded Roof Cover 27-34
3B Concrete New or Reroof (Tear -Of) A-3 Bonded Temp Roof/Vapor Barrier, Bonded Insulation, Bonded Roof Cover 35
3C Concrete New or Reroof (Tear -Off) F Non -Insulated, Bonded Roof Cover 35
4A
LWIC
New or Reroof (Tear -Of) A-1 Bonded Insulation, Bonded Roof Cover 36.37
4B
LWIC
New or Reroof (Tear -Off) A-2 Mech. Attached Anchor Sheet, Bonded Insulation, Bonded Roof Cover 38
4C
LWIC
New, Reroof (fear -Off) E Non -Insulated, Mech. Attached Base Sheet, Bonded Roof Cover 39-43
SA
CWF
New or Reroof (rear -M A-1 Bonded Insulation. Bonded Roof Cover 44
5B
CWF
New or Reroof (rear -Off) A-2 Mech. Attached Anchor Sheet, Bonded Insulation, Bonded Roof Cover 4S
SC
CWF
New, Reroof (Tear -Off) or Recover C Mech. Attached Insulation, Bonded Roof Cover 45
SD
CWF
New, Reroof (Tear -Off) E Non -Insulated, Mech. Attached Base Sheet, Bonded Roof Cover 46
6A
Gypsum
Reroof (Tear -Oft) A-1 Bonded Insulation, Bonded Roof Cover 47-48
6B
Gypsum
Reroof (Tear -Off) A-2 Mech. Attached Anchor Sheet, Bonded Insulation, Bonded Roof Cover 49
6C
Gypsum
Reroof (Tear -Off) C Mech. Attached Insulation, Bonded Roof Cover 49
6D
Gypsum
Reroof (rear -Off) E Non -Insulated, Mech. Attached Base Sheet, Bonded Roof Cover 50
7A
Various
Recover A-1 Bonded Insulation, Bonded Roof Cover 51-57
7B
Various
Recover F Non -Insulated, Bonded Roof Cover 57
The followine notes apply
to the systems outlined herein:
1.
The roof system evaluation herein pertains to above -deck roof components. Roof decks shall be in accordance with FBC requirements to the satisfaction of the AHI. Load resistance of the
roof deck shall be documented through proper codified and/or FBC Approval documentation.
2.
Unless otherwise noted, fasteners and stress plates for insulation attachment shall be as follows. Fasteners shall be of sufficient length for the following engagements:
D Wood Deck:
OMG 014 Roofgrip with Flat Bottom Plate (Accutrac), OMG HD with OMG 3 In. Galvalume Steel Plate, Dekfast 014 with Max Plate or 3' Round Insulation Plate, Trufast HD with Trufast 3'
Metal Insulation Plates or Ftintfast 814 Fastener with FUntFast 3' Insulation Plates. Minimum 0.75 -Inch plywood penetration or minimum 1 -Inch wood plank embedment.
D Steel Deck:
OMG 012 or 014 Roofgrip with Recessed or Flat Bottom Plate (Accutrac), OMG 012 Standard or HD with OMG 3 In. Galvalume Steel Plate, Dekfast 012 or x114 with Hex Plate or 3' Round
Insulation Plate, Trufast DP or HD with Trufast 3' Metal Insulation Plates or FlintFast 012 or 014 Fastener with FIIntFast 3' Insulation Plates. Minimum 0.754nch steel penetration and
engage the top flute at the steel deck.
D Concrete Deck:
OMG 014 Roofgrip with Recessed or Flat Bottom Plate (Accutrac), OMG HD or CD -10 with OMG 3 in. Galvalume Steel Plate, Dekfast 014 or DekSpi ke with Hex Plate or 3' Round
Insulation Plate, Trufast HD or CF with Trufast 3' Metal Insulation Plates or Fllntfast 014 Fastener with FUntFast 3' Insulation Plates. Minimum 1 -Inch embedment. Fasteners installed
with a pilot hole in accordance with the fastener manufacturer's published installation instructions.
Exterior Research and Design, LLC. d/b/a TdnitylERD Evaluation Report 3520.03.04-R15 for FL2533-Ri4
CeNfIcate of Authorization 09503 Revision 15:08/2S/2015
Prepared by: Robert Nleminen, PE -59166 Appendix 1, Page 1 of 57
QOTRINITYIERD
I
3. Unless otherwise noted, insulation may be any one layer or combination of polyisocyanurate, polystyrene, wood fiberboard, perlite, GlasRoc Roof Board or gypsum-based roof board that
meets the CIA requirements of F.A.C. Rule 61G20-3 and is documented as meeting FBC 1505.1 and, for foam plastic, FBC 2603A.1 or 2603.8, when Installed with the roof rover.
4. Minimum 200 psi, minimum 2-inch lightweight insulating concrete may be substituted for rigid insulation board for System Type D (mechanically attached base sheet, bonded roof cover),
whereby the base sheet fasteners are installed through the LWIC to engage the structural steel or concrete deck. The structural deck shall be of equal or greater configuration to the steel and
concrete deck listings.
5. Unless otherwise noted, insulation adhesive application rates are as follows. Ribbon or bead width Is at the time of application; the ribbons/beads shall expand as noted in the manufacturer's
published instructions.
> Not asphalt (HA): Full coverage at 25-30 lbs/square
> Ashland Pliodeck (A-PD): Continuous 0.75 inch wife ribbons, 12-inch o.c. Ribbons of subsequent layers shall be peWndicular to those In the layer below.
> Dow Insta-Stile (061S): Continuous 0.75 to 1 inch wide ribbons, 12-inch o c.
> Dow Spray-N-Grip (D-SG): Full coverage
D
> Millennium One Step Foamable Adhesive (M-OSFA): Continuous 0.2S to 0.54nch wide ribbons, 12-Inch o.c.
> Millennium PG-1 Pump Grade Adhesive (M-PGI): Continuous OS to 0.754nch wide ribbons, 12-Inch ac.
> OMG OlyBond 500 or OlyBond Green (08500): Continuous 0.75-Inch wide ribbons, 22-inch o c. (PaceCart or SpotShot)
> 3M CR-20: Continuous 2S to 3-inch wide ribbons, 12-Inch o c. (Note: TITESET may be used where CR-20 is referenced
> Note. When multiple layers(s) of insulation ond/or coverboard an; installed in ribbon-applied adhesive, adhesive ribbons shaft be staggered from layer-to-layer a distance of one-haif the ribbon spacing.
> Note: The mmdmum edge distance from the adhesive ribbon to the edge of the insulation board shall be not less than one-holy the spedffed ribbons spadng
6. Unless otherwise noted, all insulations are flat stock or taper board of the minimum thickness noted. Tapered polylsocyanurate at the following thickness limitations maybe substituted with
the following Maximum Design Pressure (MDP) limitations. In no case shall these values be used to !Increase' the MDP listings in the tables; rather if MDP listing below meets or exceeds that
listed for a particular system in the tables, then the thinner board listed below may be used as a drop-in for the equivalent thicker material listed In the table:
> Ashland Pllodedx (A-PD) @ 124nch o.c. MDP -105.0 psf (min. 1.0-inch)
r Ashland Pliodedk (A-PD) @ 6-inch o.c. MDP -277.5 psf (Min. 1.0-Inch)
> Dow Insta-Stlk (D-IS): MDP -120.0 psf (Min. LD-Inch)
> Millennium One Step Foamable Adhesive (M-OSFA): MDP -157.5 psf (Min. 1.0-titch)
Y Millennium PG-1 Pump Grade Adhesive (M-PG1)- MDP -1575 psf (Min. 1.0-Inch)
> OMG OlyBond 500 (08500): MDP 4S.0 psf (Min. 0.5-inch Multi-Max FA3)
> OMG OlyBond 500 (0&500): MDP -187.5 psf (Min. OS-inch ISO 9S+ GL)
> OMG OlyBond 500 (OBSOO): MDP -315.0 psf (Min. 0.5-inch ENRGY 3)
> OMG OlyBond 500 (08500): MDP 4875 psf (Min. 0.S-Inch ACFoam II)
Y 3M CR-20: MDP -1175 psf (Min. 1.0-inch)
7. Bonded polylsocyanurate Insulation boards shall be maximum 4 x 4 ft.
S. For mechanically attached components or partially bonded insulation, the maximum design pressure for the selected assembly shall meet or exceed the Zone 1 design pressure determined in
accordance with FBC Chapter 16, and Zones 2 and 3 shall employ an attachment density designed by a qualified design professional to resist the elevated pressure criteria. Commonly used
methods are RAS 117 and FM LPDS 1-29. Assemblies marked with an asterisk* carry the limitations set forth In Section 2.2.1.5.1(a) of FM LPDS 1-29 for Zone 2/3 enhancements.
9. For fully bonded assemblies, the maximum design pressure for the selected assembly shall meet or exceed critical design pressure determined In accordance with FBC Chapter 16, and no
rational analysis is permitted.
•10. For mechanically attached components over existing decks, fasteners shall be tested in the existing deck for withdrawal resistance. A qualified design professional shall review the data for
comparison to the minimum requirements for the system. Testing and analysis shall be In accordance with TAS 105 or ANSI/SPRI FX -1.
Exterior Research and Design, I.I.C. d/b/a TdnitylERD Evaluation Report 3520D3.04 -RIS for FL2533-R14
Certificate of Authorization 89503 Revision 15: 08/25/2015
Prepared by: Robert Meminen, PE -S9166 Appendix 1, Page 2 of 57
VT___a1*'1N1TYjERD
TABLE 7A: RECOVER APPLICATIONS
SYSTEMTYPEA-1: BONDED INSULATION, BONDED ROOF COVER
System
Base Insulation Layer
Top Insulation layer
Roof Cover
MDP
Substrate (See Notes l & 11)
Type
Attach
Type
Attach
Base
Ply
Cap
No.
(pd)
Existing fully bonded,
Min. 0.254nch Dens Deck primed with
R-13
smooth- or granule -surface
FIIntPrime SA or SECUROCK Gypsum-
OB500
None
N/A
SBS -SA
(Optional) SBS -SA
SBS -SA
-120.0
OUR or modified bitumen
Fiber Roof Board
R-14
Existing fully bonded OUR or
Min. 1.5 -Inch ACFoam 11, FIIntBoard ISO
OBS00
Min. 0.25 -Inch Dens Deck primed
with FlintPrime SA or SECUROCK
OB500
SBS -SA
(Optional) SBS -SA
S8S-SA
-120.0
modified bitumen roof cover
or ENRGY 3
Gypsum -Fiber Roof Board
R -15
Existing fully bonded,
smooth- or granule -surface
Min. 0.25 -Inch SECUROCK Gypsum -Fiber
3M CR-
None
WA
SBS -SA
(Optional) SBS -SA
SBS -SA
-172.5
BUR or modified bitumen
Roof Board
20
R -16
Existing fully bonded,
smooth- or granule -surface
Min. 0.25 -inch Dens Deck primed with
3M CR-
None
WA
SBS -SA
(Optional) SBS -SA
SBS -SA
-192.5
BUR or modified bitumen
FlintPrime SA
20
Min. 1.0•Inch ISO 9S+ GL, H -Shield, H -
Existing fully bonded BUR or
Shield CG, ENRGY 3 or JM ISO 3 min. 1.3-
Min. 0.25 -inch SECUROCK Gypsum -
R -17
modified bitumen roof cover
Inch ACFoam III, Min. S.Sanch Multi -Max
CR -20
Fiber Roof Board
CR -20
SBS -SA
(Optional) SSS -SA
S8S-SA
-172.5
FA3 or URra•Max or min. 2.0 -inch
ACFoam IV
Min. 1.0 -Inch ISO 95+ GL, H -Shield, H -
Existing fully bonded BUR or
Shield CG, ENRGY 3 or JM ISO 3 min. 1.3-
Min. 0.25 -inch Dens Deck primed
R-18
Inch ACFoam III, Min. 2.54nch Multi -Max
CR -20
CR -20
S8S-SA
(Optional) SBS -SA
SBS -SA
-192.5
modified bitumen roof cover
FA3 or Ultra -Max or min. 2.0 -Inch
with FlintPrime SA
ACFoam IV
eN`,r��StrsltMs:
R-19
Existing fully bonded BUR or
Min. 0.2S-1nch SECUROCK Gypsum -Fiber
HA
None
WA
SBS -SA -H
(Optional) SBS -AA,
SBS -AA, SOS-
_105.0
modified bitumen roof cover
Roof Board
SBS -TA, APP -TA
Tq, APP -TA
Existing fully bonded, smooth
Mtn. 0.2S -inch SECUROCK Gypsum•Fiber
A -PD, 6-
(Optional) SBS -AA,
SBS -AA, SBS -
R -20
surface BUR or modified
Roof Board
Inch o.c.
None
WA
SBS -SA -H
SBS•TA, APP TA
TA, APP -TA
-105.0
bitumen
R-21
Existing fully bonded, mineral
Min. 0.25 -Inch SECUROCK Gypsum -Fiber
A -PD, 6•
None
WA
SBS -SAH
(Optional) SBS -AA,
SBS -AA, SBS-
_18D.0
surface modified bitumen
Roof Board
Inch o.c.
SBS -TA, APP -TA
TA, APP -TA
Existing fully bonded,
R-22
smooth- orgranule-surface
Min. 0.25 -Inch SECUROCK Gypsum -Fiber
M-PG3
None
WA
SBSSA-H
S85•AA,TA
-180.0
BUR or modified bitumens
Roof Board
SBS TA, APP -TA
SBS -TA,
TA, APP -TA
Exterior Research and Design. I.I.C. d/b/aTrinitylERD Evaluation Report 3520.03.04-R15 for F12533 -R14
Certificate of Authorization #9503 Revision 1S: 08/25/2015
Prepared by: Robert Nleminen, PE -59166 Appendix 1, Page 52 of 57
7J1YL015• Florida BuIldrlg Code Online
Business & ProfessionAil.,lRegulation RECORD COPY
rA
Honda Npa"ntd Bas Horne I Log In I user RepustrdUon I Hot Topa I submu surdtaMe I stats a Facts I publications I FOC staff I Bas site Map I Links I search I
Busines Product Approval
Professi IUSER: Rdlic User
Regulation
Prod= Approval Menu > Product or Application Search > Application List > Application Detail
FL # F15444-118
Application Type Revision
Code Version 2014
Application Status Approved
Comments
Archived
Product Manufacturer CertainTeed Corporation -Roofing
Address/Phone/Emall 18 Moores Road
Malvern, PA 19355
(610) 651-5847
mark.d.harner@saint-gobain.com
Authorized Signature Mark Harrier
mark.d.harner@saint-gobain.com
Technical Representative Mark D. Harrier
Address/Phone/Emall 18 Moores Road
Malvern, PA 19355
(610) 651-5847
Mark.D.Hamer@saint-gobain.com
Quality Assurance Representative
Address/Phone/Email
Category Roofing
Subcategory Asphalt Shingles
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 Robert Nleminen
the Evaluation Report
Florida Ucense PE -59166
Quality Assurance Entity UL LLC
Quality Assurance Contract Expiration Date 07/03/2017
Validated By John W. Knezevich, PE
Validation Checklist - Hardcopy Received
Certificate of Independence FL5444 R8 COI 2015 01 COI Nieminen.pdf
Referenced Standard and Year (of Standard) Standard Year
ASTM D3161, Class F 2009
ASTM D3462 2009
ASTM D7158, Class H 2008
Equivalence of Product Standards
Certified By
Sections from the Code
httpsllfloridabUldrig.orgfpr/pr app M.aspx?param-wGMQwd)O hlgO7CSSOyCOrl28CcpCIJxN2sPPRyA%3d 1/2
I-ionaa tsuioing Code Ordille
NAa Depal Wjci` SCIS Home I Los In I User Replstretron I Hot Topic I submit surchaMe I stats a Facts I Publlatlons I Fac surf I eas site Map I Links I search I
Busines ( Product Approval
ftfessiOr�al UWR* PubiicUser
Regulation
Product Approval Menu > Product lir Application Search > ADMIcation List > Application Detail
FL #
FL15216-R2
Application Type
Revision
Code Version
2014
Application Status
Approved
Comments
Archived
Product Manufacturer InterWrap, Inc.
Address/Phone/Email 32923 Mission Way
Mission, NON -US 00000
(551) 574-2939
mtupas@lnterwrap.com
Authorized Signature Eduardo Lozano
elozano®Interwrap.com
Technical Representative Eduardo Lozano
Address/Phone/Email 32923 Mission Way
Mission, NON -US 00000
(778) 945-2891
elozano@lnterwrap.com
Quality Assurance Representative
Address/Phone/Email
Category Roofing
Subcategory Underlayments
Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed
Florida Professional Engineer
Evaluation Report - Hardcopy Received
Florida Engineer or Architect Name who developed Robert Nieminen
the Evaluation Report
Florida License PE -59166
Quality Assurance Entity Intertek Testing Services NA Inc. - ETL/Warnock Hersey
Quality Assurance Contract Expiration Date 11/17/2015
Validated By John W. Knezevich, PE
!- Validation Checklist - Hardcopy Received
Certificate of Independence FL15216 R2 COI 2015 01 COI Nieminen.odf
Referenced Standard and Year (of Standard)
Equivalence of Product Standards
Certified By
Sections from the Code
1507.2.3
1507.5.3
1507.8.3
1507.9.3
1507.9.5
NtpsJ/floridabildirg.orgfpr/pr app dfl.aspx?param=wGEVXOvADgv3yVVKJZIORAr?ry12u8kQGQyfeHhVeIOpVSYxwSdCoQ%3d%3d 1/2
QOTP".INITYIERD
EXTERIOR RESEARCH & DESIGN, I.I.C.
Certificate of Authorization #9503
353 CHRISTIAN STREET, UNIT #13
OXFORD, CT 06478
PHONE: (203) 262-9245
FAX: (203) 262-9243
EVALUATION REPORT
Interwrap, Inc. Evaluation Report 140510.02.12-R2
32923 Mission Way FL15216-R2
Mission, BC V2V-6E4 Date of Issuance: 02/17/2012
Canada Revision 2:04/Z7/2015
SCOPE:
This Evaluation Report is issued under Rule 61G20-3 and the applicable rules and regulations governing the use of
construction materials In the State of Florida. The documentation submitted has been reviewed by Robert Nieminen,
P.E. for use of the product under the Florida Building Code and Florida Building Code, Residential Volume. The
products described herein have been evaluated for compliance with the St" Edition (2014) Florida Building Code
sections noted herein.
DESCRIPTION: RhinoRoof Underlayments
LABEUNG: Labeling shall be in accordance with the requirements the Accredited Quality Assurance Agency noted
herein.
CONTINUED COMPLIANCE: This Evaluation Report is valid until such time as the named product(s) changes, the referenced
Quality Assurance documentation changes, or provisions of the Code that relate to the product change. Acceptance of
this Evaluation Report by the named client constitutes agreement to notify Robert Nieminen, P.E. if the product
changes or the referenced Quality Assurance documentation changes. Trinity I ERD requires a complete review of this
Evaluation Report relative to updated Code requirements with each Code Cycle.
ADVERTISEMENT: The Evaluation Report number preceded by the words "TrinitylERD Evaluated" may be displayed in
advertising literature. If any portion of the Evaluation Report is displayed, then it shall be done in its entirety.
INSPECTION: Upon request, a copy of this entire Evaluation Report shall be provided to the user by the manufacturer or
its distributors and shall be available for inspection at the job site at the request of the Building Official.
This Evaluation Report consists of pages 1 through 3.
Prepared by:
Robert J.M. Nieminen, P.E.
Florida Registration No. 59166, Florida DCAANE1983
The faalrale seal appearin/ vm aulhorbed by llobert Nieminen,
4/.L on 04/27/2015. 7hb does not serve as an eleetronlutly slFned
rm
dooem. Slaned, sealed hardooples have been trammirtcd to the
"uct Approval Admintstrator and to the named client
CERTIF",noN OF INDEPENDENCE:
1. TrinitylERD does not have, nor does it intend to acquire or will it acquire, a financial interest in any company manufacturing or
distributing products it evaluates.
2. Trinity l ERD is not owned, operated or controlled by any company manufacturing or distributing products it evaluates.
3. Robert Nieminen, P.E. does not have nor will acquire, a financial interest in any company manufacturing or distributing products for
which the evaluation reports are being issued.
4. Robert Nieminen, P.E. does not have, nor will acquire, a financial interest in any other entity involved in the approval process of the
product.
S. This Is a building code evaluation. Neither Trinity IERD nor Robert Nieminen, P.E. are, in any way, the Designer of Record for any
project on which this Evaluation Report, or previous versions thereof, is/was used for permitting or design guidance unless retained
specifically for that purpose.
ROOFING COMPONENT EVALUATION:
1. SOOPE:
r--\� TRINITY ! ERD
Product Category: Roofing
Sub -Category: Underlayment
Compliance Statement: RhinoRoof Underlayments, as produced by Interwrap, Inc., has demonstrated compliance with the
intent of following sections of the Florida Building Code through testing in accordance with applicable sections of the following
Standards. Compliance is subject to the Installation Requirements and Limitations / Conditions of Use set forth herein.
Z. STANDARDS:
'.,Tne��l:'irRooFCo ERROrn►is,
Undedayment
Section
Properties
Standard
Year
1507.2.3,1507.5.3, 71507.8,
Unrolling, Breaking Strength, Pliability, Loss
ASTM 0226
2006
1507.8.3, 1507.93,1507.95
on Heating
& Shingles
Simulated Slate
1507.2.3,2507.5.3, 1507.8.3,
Unrolling, Year Strength, Pliability, Loss on
ASTM D4869
2005
1507.9.3
Heating, Liquid Water Transmission,
No
Breaking Strength, Dimensional Stability
3. REFERENCES:
Entity
Examination
Reference
Date
ITS (TST1509)
Physical Properties
100539395COQ-006
10/27/2011
ITS (1571509►
Physical Properties
300539395000-002
10/27/2011
ITS (TST1509)
Physical Properties
100539395COQ-006
03/14/2014
ITS (QUA1673)
Quality Control
Inspection Report
11/17/2014
4. PRODUCT DESCRIPTION:
4.1 RhinoRoof U20 is a multilayered polymer woven coated synthetic roof underlayment intended as an alternate to ASTM
D226, Type I or Type II felt or D4869 Type II felt. RhinoRoof Underlayment is available in 42 -inch wide rolls, and can be
produced in various other sizes.
S. LJMITA iow
5.1 This is a building code evaluation. Neither Trinity IERD nor Robert Nieminen, P.E. are, in any way, the Designer of
Record for any project on which this Evaluation Report, or previous versions thereof, is/was used for permitting or
design guidance unless retained specifically for that purpose.
5.2 This Evaluation Report is not for use in the HVHZ.
5.3 Fire Classification is not part of this Evaluation Report; refer to current Approved Roofing Materials Directory or test
report from accredited testing agency for fire ratings of this product.
5.4 RhinoRoof Underlayments may be used with any prepared roof cover where the product is specifically referenced
within FBC approval documents. If not listed, a request may be made to the AN) for approval based on this evaluation
combined with supporting data for the prepared roof covering.
S.5 Allowable roof covers applied atop RhinoRoof Underlayments are follows:
5.6 Exposure Limitations:
5.6.1 RhinoRoof Underlayment shall not be left exposed for longer than 30 -days after installation.
6. INSTALLATION:
6.1 RhinoRoof Underlayments shall be installed in accordance with Interwrap, Inc. published installation Instructions
subject to the Limitations set forth in Section 5 herein and the specifics noted below.
6.2 Install RhinoRoof Underlayments in compliance with manufacturer's published installation instructions and the
requirements for ASTM D226, Type I or II or D4869, Type II underlayments in FBC Sections 1507 for the type of
prepared roof covering to be installed.
Exterior Research and Design, LLC.
Certificate of Authorization !19503
Evaluation Report 140510.02.12-R2
FLIS216-R2
Revision 2:04/27/2015
Page 2 of 3
'.,Tne��l:'irRooFCo ERROrn►is,
Undedayment
Asphalt
Nall -On Tile Foam -On role
Metal
Wood Shakes
Slate or
Shingles
& Shingles
Simulated Slate
RhinoRoof U20
Yes
No No
Yes
Yes
No
5.6 Exposure Limitations:
5.6.1 RhinoRoof Underlayment shall not be left exposed for longer than 30 -days after installation.
6. INSTALLATION:
6.1 RhinoRoof Underlayments shall be installed in accordance with Interwrap, Inc. published installation Instructions
subject to the Limitations set forth in Section 5 herein and the specifics noted below.
6.2 Install RhinoRoof Underlayments in compliance with manufacturer's published installation instructions and the
requirements for ASTM D226, Type I or II or D4869, Type II underlayments in FBC Sections 1507 for the type of
prepared roof covering to be installed.
Exterior Research and Design, LLC.
Certificate of Authorization !19503
Evaluation Report 140510.02.12-R2
FLIS216-R2
Revision 2:04/27/2015
Page 2 of 3
�J�TRINI-rYIERD
6.3 Re -fasten any loose decking panels, and check for protruding nail heads. Sweep the substrate thoroughly to remove
any dust and debris prior to application.
6.4 Rhlnoltoof U20:
6.4.1 Fasteners:
For exposure < 24 hours, corrosion resistant fasteners may be 1 -inch roofing nails with a 3/8 -inch diameter head, or
those noted in 6.4.2. The use of staples is prohibited.
For exposure > 24 hours up to maximum 30 days, corrosion resistant fasteners shall be minimum 14nch diameter
plastic or metal cap nails or FBC HVHZ nails & 1-5/8" diameter tin caps (with the rough edge facing up). The use of
staples Is prohibited.
6.4.2 Single Laver: Roof Slope > 4:12:
End (vertical) laps shall be minimum 6 -Inches and side (horizontal) laps shall be minimum 4 -Inches. Refer to Interwrap,
Inc. recommendations for alternate lap configurations and/or the use of sealant under certain conditions.
For exposure < 24 hours, use of every -other fastening location printed on the surface is acceptable. For exposure > 24
hours up to maximum 30 -days, use of every fastening location printed on the surface is required.
When batten systems are to be installed atop the underlayment, the underlayment need only be preliminarily attached
pending attachment of the battens on the same day. Battens shall not be positioned over cap nails. If this occurs,
remove the cap nail and patch the hole in accordance with Interwrap published instructions.
6.4.3 Double Laver: 2:12 < Roof Slope < 4:12:
End (vertical) laps shall be minimum 12 -inches and side (horizontal) laps shall be minimum half -sheet -width plus 1 -inch.
Double layer application; begin by fastening a half -width plus 1 -inch starter strip along the eaves. Place a full -width
sheet over the starter, completely overlapping the starter course. Continue as noted in 6.5, but maintaining minimum
half -width plus 1 -inch side (horizontal) laps, resulting in a double -layer application.
7. BUILDING PERMIT REQUIREMENTS:
As required by the Building Official or Authority Having Jurisdiction in order to properly evaluate the installation of this product.
S. MANUFACTURING PLANTS:
Contact the manufacturer or the named QA entity for information on plants covered under Rule 61620-3 QA requirements.
9. QUALM ASSURANCE ENTm:
Intertek Testing Services NA Inc: ETL/Warnock Hersey — QUA1673; (604) S20-3321
- END OF EVALUATION REPORT -
Exterior Research and Design, I.I.C. Evaluation Report 140510.02.12-R2
Certificate of Authorization #9503 FL15216-R2
Revision 2: 04/27/2015
Page 3 of 3
r
t
10,
CITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit 1 U , -nO-7
1, hereby acknowledge that I personally inspected
/j -Y Roof deck nailing and/or Secondary water barrier work
at 1--7 2 f) -G- eA 01 r 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 t at making any false statements in writing with the intent to mislead a public servant in the
performan -s or her ficial duty shall constitute a misdemeanor of the second degree pursuant to
Section 8 . 6
Si ature Con ractor Date •�° ' `.
A All ili CJL- (.UC611 cel
Printed Name of Contractor License #
License Type: 0 General 0 Building 0 Residential XZpofing Contractor
0 or any individual certified in accordance with F.S. 468 to make such an inspection.
Cn >14 I AA) D.
201y
7 Produced (type of
Revised: February 2015