1512 Mellonville Ave - BR18-004298 - REROOFCITY OF
S'k 41`4 U` RD PERMIT APPLICATION
BUILDING Qivlsialy
Application No: t
A
Documented Construction Value: $'7f.
Job Address: 1-5 0- "le,nV L Ae r Historic District: Yes [I No
Parcel ID: Residential Q Commercial
Type of Work: New Addition ] Alteration Repair Demo Change of Use Move
Description of Work: Ae, - Uor
Plan Review Contact Person:
Phone: Fax:
Ti
Property Owner Information
Name Gil(Phone: 3"et " 7P RW5
Street: / 51 _ /41C_161L . 11 C4uc Resident of property?: 3'SV rSCity,
State Zip: _ W 71 Name
Street:
City,
State Zip: Name:
Street:
City,
St, Zip: Bonding
Company: Address:
Contractor
Information Phone:
Fax:
State
License No.: Architect/
Engineer Information Phone:
Fax:
E-
mail: Mortgage
Lender: Address:
WARNING
TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE
FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED
ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT Application
is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to
the issuance of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. I understand that
a separate permit must be secured for electrical work, plumbing, signs, wells, pools, furnaces, boilers, heaters, tanks, and air conditioners, etc.
FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 6`h Edition (2017) Florida Building Code F
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
willbe figured based on the current ICC Valuation Table in effect at the time the permit is issued, in accordance with local ordinance. Should calculated
charges figured off the executed contract exceed the actual construction value, credit will be applied to your permit fees when the permit is issued.
OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be
done in compliance with all applicable laws regulating construction and zoning.
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name Print Contractor/Agent's Name
Signature ofNotary -State of Florida Date Signature of Notary -State of Florida Date
Owner/Agent;., ..x. Personally Known to Me or Contractor/Agent is Personally Known to Me or
Produced ID Type of ID Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas Roof
Construction Type: Occupancy Use: Flood Zone:
Total Sq Ft of Bldg: Min. Occupancy Load: of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
Fire Alarm Permit: Yes No
WASTE WATER:
FIRE: BUILDING:
r
t I . Year Built
AGIL
IFixturesBed Bath Base Area Total SF Living SF I Wall Adj Value 11 Repf V.Iue,4AppendagesDescription
I SINGLE 1970
FAMILY
5 3 1.5 950 1,528 1,110 BRICK+WOOD $66,084 $91.783 Description AreaCOMBO
I BASE SEMI 160.00FINISHED
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)
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
the property listed, may act as my own contractor with certain restrictions even though I do not have a
license.
I understand that building permits are not required to be signed by a property owner unless he or she is
responsible 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.
I understand that, as the owner -builder, I must provide direct, onsite supervision ofthe 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 I
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
I and materials. I, as an owner -builder, may be held liable and subjected to serious financial risk for any
injuries 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 ofthe 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
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
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 1-850-487-1395 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 addresslistedbelow.
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 L
1, -- 5 r`1'-- _S -7' 1( , do hereby state that I am qualified
and capable of performing the requested construction involved with the permit application filed and agree to the
conditions specified above.
Signature of/Owner-Builder
Form of Identification
Must be Photo ID)
Date
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
Quote Date
10/15/2018
SANFORD CASH SALES
Sunniland Sanford
4011735St. Rd. 419
Longwood, FL 32750
Office: (407) 322-2421
Fax: (407) 324-4421
Email: Sanford@SunnilandCorp.com
Sale
SANFORD
NET 30 DAYS
Sales Person
SALE CDA
48 BD HERITAGE 30 RUSTIC CEDAR FRS 51975616SQ
2 RO MSA QUICKFELT SYN UNDRLAY 10SQ 521446
1 BX RH SIMPLEX 1 IN PLAS HD 744298
1 BX COIL NAIL GENERIC 1-1/4 INCH 750017
1 EA FLASHING CEMENT 533800
3 RO BITEC APM 4 T TAN TORCH GRAN 523189
3 BD TAMKO ELITE FRS RUSTIC CEDAR 519788
2 BD TAMKO STARTER 512479
1 RO G2 ARROW Z GLASS BASE 3 SQ 522363
2 EA STACK 2 IN LEAD 544713
1 EA STACK 3 IN LEAD 544714
1 EA FREIGHT 999998
lYhKb prud cP- v o ruYa,i
LI $ 355.1
JAMES GILL 3,86-747-2745'
1512 MELLONVILLE AVE.
SMILEY CUSTOMER
SANFORD, ,FL
SHIP: 10/15/2018
Contact Number
EK
2
1
1
1
3
3
2
1
2
1
1
Sub Total
2, 034.85
28.00
68.50
22.00
30.00
32.00
60.50
25.25,
39.00
39.00
9.80
14.00
35.00
Tax
139.99
1,344.00
137.00
22.00
30.00
32.00
208.50
75.75
78.00
39.00
19.60
14.00
35.00
Grand Total
2,174.84
Quote is valid for 30 days. Ifdelivery is included in price quote, every attempt will be made to deliver and roof load the materials. Ifroof load is too
difficult or too dangerous, materials will be delivered curbside. If more than one delivery is required, additional charges may apply. All deliveries
are made at the customers risk including, but not limited to, damages to sidewalks, driveways, buildings, trees, shrubbery, lawns, and septic tanks.
All items are sold as is and without express or implied warranty by Sunniland, including but not limited to warranties forfitness or merchantability.
Returns must be approved by Sunniland and are subject to a 20% Restocking fee. In the event ofdispute, venue shall be in Seminole County, FL.
Grant Maloyy, Clerk Of The Circuit Court & Comptroller Seminole County, FL
Inst #2018120217 Book:9234 Page:1099; (1 PAGES) RCD: 10/18/2018 10:56:56 AM CERTIFIED COPY GRANT MALOYRECFEE $10.00
1-1-M-Uil LUURT-' AND 1OMPTROr ER ;
E ! SEMINO,
THIS INSTRUMENT PREPARED) BY: ¢I
U Tad FLORIDA
Z Name: :J -VLNCS C-7t/! BYAddress: LERKclrFL. Oates
NOTICE OF COMMENCEMENT
State of Florida
County of Seminole
Permit Number. Parcel ID Number: ` ( — yS O 0 3 $
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.
DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available)
I'SC + r
I1n I Gcr1 L• a" 2r S CC
GENERAL DESCRIP,] ION OF IMPROVEMENT:
OWNER INFORMATION:
Name:/
Address:
Fee Simple Title Holder (if other than owner) Name:
Address:
CONTRACTOR:
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 Lienoes 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)
WABWNG 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 penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true
to the best of my knowledge and belief.
60nws &;1- X
I Ownefs Signature Owner's Printed Name
Florida Statute 713.13(1)(g):'The owner must sign the notice ofcommencement and no one else may be permitted to sign In his or her stead.'
State of rz:—,C County of AiZ, ' -
The foregoing instrument was acknowledged before me this day of OCiTb Y 20 k
by /`.}t'' . Who is personally known to me
V_ Name of person making statement
k,, Q
OR who has produced identificationwtype of identification produced: 1-- — "_
1— •
D
DEBBIEBLANTON
s kiy COMMIssION OFF 178649
EXPIRES: February 25,2019
c, •' BondedThruNolarypubliicUndetarilerst; •' Notary Signature
CITY OF
Building &Fire Prevention DivisionS,,kNFORDRESIDENTIAL RE -ROOF POLICY & PROCEDURES
LIRE DEPAI2TsiMENT
PERMITTING REQUIREMENTS — NO PLAN REVIEW REQUIRED
THIS DOCUMENT (SIGNED) ALONG WITH AN ACCURATE AND COMPLETED RESIDENTIAL RE —ROOF SCOPE OF WORK ARE
REQUIRED TO BE SUBMITTED AS PART OF YOUR PERMIT APPLICATION.
THE SCOPE OF WORK MUST INCLUDE ALL APPLICABLE FLORIDA PRODUCT APPROVAL NUMBERS FOR ALL ROOF
COMPONENTS THAT WILL BE INSTALLED ON THE PROJECT.
A PERMIT WILL NOT BE ISSUED WITHOUT THESE DOCUMENTS. COPIES WILL BE MADE TO POST ON THE JOB SITE.
PROJECTS LOCATED IN THE SANFORD HISTORIC DISTRICT WILL REQUIRE PLAN REVIEW AND APPROVAL BY THE
SANFORD HISTORIC PRESERVATION BOARD
INSPECTION POLICY & PROCEDURES
A FINAL ROOF INSPECTION IS THE ONLY INSPECTION REQUIRED FOR RESIDENTIAL (SINGLE FAMILY, TOWNHOUSE,
MOBILE HOME, APARTMENT AND/OR CONDOMINIUM) RE —ROOF PERMITS.
THE FOLLOWING IS REQUIRED TO BE PROVIDE ON THE JOB SITE:
PERMIT CARD, POSTED IN A CONSPICUOUS AND WEATHERPROOF LOCATION
COMPLETED RESIDENTIAL RE —ROOF SCOPE OF WORK
COMPLETED AND NOTARIZED INSPECTION AFFIDAVIT
ALL FLORIDA PRODUCT APPROVAL AND CORRESPONDING INSTALLATION INSTRUCTIONS
PRODUCT APPROVAL SHALL MATCH WHAT IS ON THE SCOPE OF WORK)
DIGITAL PHOTOGRAPHS (MUST INCLUDE THE PERMIT NUMBER OR ADDRESS IN EACH PICTURE)
o EACH PLANE OF THE ROOF, SHOWING THE UNDERLAYMENT INSTALLED
o ROOF DECK NAILING PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
o ROOF DECK NAILS USED (INCLUDING A MEASURING DEVICE OR RULER SHOWING SIZE OF NAILS)
o UNDERLAYMENT PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
o DRIP EDGE & VALLEY ATTACHMENT (INCLUDING A MEASURING DEVICE OR RULER)
o SHINGLES INSTALLED, NAIL PATTERN AND LOCATION OF NAILS
SKYLIGHTS (IF APPLICABLE)
O DIGITAL PHOTOGRAPHS SHOWING ALL INSTALLATION COMPONENTS, PER FL PRODUCT APPROVAL
o DIGITAL PHOTOGRAPHS SHOWING ALL REQUIRED FLASHING, PER FL PRODUCT APPROVAL
FAILURE TO FOLLOW THESE SPECIFIC GUIDELINES WILL RESULT IN AN AFFIDAVIT PROVIDED BY A FLORIDA DESIGN
PROFESSIONAL (ARCHITECT OR ENGINEER), CERTIFYING FBC CODE COMPLIANCE BY PERSONAL INSPECTION.
CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: DATE:
PERMIT #
City of Sanford Building Division
Residential Re -Roof Scope of Work
JOB ADDRESS:
STRUCTURE TYPE: O® SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: ® REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY):
PLEASE NOTE: ONLY 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED'"
ROOF VENTILATION_ DOFF -RIDGE RIDGE OSOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: O YES ® NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: (A) LESS THAN 2:12 O 2:12 - 4:12 O 4:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
SHINGLE i'1 j p-
tl P(0(;•CL FL# 1 b
OMETAL FL#
O MODIFIED BITUMEN FL#
O TORCH DOWN FL#
OINSULATED FL#
O TILE FL#
0 OTHER: FL#
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IFAPPL/CABLE**
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 O 4:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
O SHINGLE FL#
O METAL FL#
O MODIFIED BITUMEN FL#
Q TORCHDOwN FL#_
OINSULATED FL#
O TILE FL#
0 OTHER: FL#
6/6/2018 Florida Building Code Online
1
E ;
SCIS Home Log In i User Registration Hot Topics ` Submit Surcharge Stats ® Facts Publications 1 FBC Staff ` RCIS Site Map ; links Search
b
mH
V. Product Approval
USER: Public Useror
rod=Approval Menu > Product or Application Searrh > pgRlication List > Application Mail
FL # FL16270-R4
Application Type Revision
Code Version 2017
Application Status Approved
Approved by DBPR. Approvals by DBPR shall be reviewed and ratified by
the POC and/or the Commission if necessary.
Comments
Archived
Product Manufacturer
Address/Phone/Email
Authorized Signature
Technical Representative
Address/Phone/Email
Quality Assurance Representative
Address/Phone/Email
Category
Subcategory
Compliance Method
Certification Agency
Validated By
Referenced Standard and Year (of Standard)
Equivalence of Product Standards
Certified By
BITEC, INC.
2 Industrial Park Drive
P.O. Box 497
Morrlton, AR 72110
501) 354-8585
dga@bi-tec.com
James Buckner
jimmy@cbuckinc.net
David G. Allen
2 Industrial Park
PO Box 497
Morrilton, AR 72110
dga@bi-tec.com
Roofing
Modified Bitumen Roof System
Certification Mark or Listing
UL LLC
James L. Buckner, P.E. @ CBUCK Engineering
Validation Checklist - Hardcopy Received
Standard
UL 1897
UL 580
Year
2012
2006
Product Approval Method Method 1 Option A
Date Submitted 12/05/2017
hftps://www.floridabuild ing. org/pr/pr_app_dfl.aspx?param=wGEVXQwtDgsNc735fObMiuc46QD18%2b97q Ps48mP3nlASg4sLwCRosQ%3d %3d im
6/6/2018
1
Florida Building Code Online
Date Validated 12/29/2017
136te Pending FBC Approval
Date Approved 01/04/2018
Summaryof Products FL #
Model, Number or Name Description 16270.
1 01 "APM 4T", APM 4.ST", SPM Bitec APP/SBS Modified Bitumen Roof Systems, adhered over I 4.
5T", "ISA-4T' or "Mineral Design mechanically -fastened, Non -insulated Wood Deck, Heat fused MDA"
per System #1 Limits
of Use Certification Agency Certificate Approved
for use in HVHZ: No FL16270 R4 C CAC UL Cert TGIK.R13231.pdf Approved
for use outside HVHZ: Yes Quality Assurance Contract Expiration Date Impact
Resistant: No 12/31/2021 Design
Pressure: +N/A/-60 Installation Instructions Other:
Refer to Certification & current edition of FBC for FL16270 R4 II UL Cert TGIK.1113231.Qf Limitations
and Conditions of use. Refer to Manufacturer's Verified By: UL LLC Installation
Instructions as Supplemental Guide. Created by Independent Third Party: Evaluation
Reports Created
by Independent Third Party: 16270.
2 — 02 - "SFM-3.51-l", SFM-3.51-1-FR", Bitec APP/SBS Modified Bitumen Roof Systems , adhered over SFM-
4H-FR", "SPM-3.5H" or "Mineral i mechanically -fastened, Non -Insulated Wood Deck, Hot Mopped Design
MDS" per System #1 Limits
of Use Certification Agency Certificate Approved
for use in HVHZ: No FL16270 R4 C CAC UL Cert TGIK.R132:31.p_ Approved
for use outside HVHZ: Yes Quality Assurance Contract Expiration Date Impact
Resistant: N/A 12/31/2021 Design
Pressure: +N/A/-60 Installation Instructions Other:
Refer to Certification & current edition of FBC for FL16270 R4 II UL Cert TGIK.R13231.pd j Limitations
and Conditions of use. Refer to Manufacturer's Verified By: UL LLC f Installation
Instructions as Supplemental Guide. Created by Independent Third Party: i Evaluation
Reports I Created
by Independent Third Party: 16270.
3 03 - "APM-4T", APM-4.57', SPM- Bitec APP/SBS Modified Bitumen Roof Systems adhered over 4.
5T", "ISA-4T" or "Mineral Design mechanically -fastened, Insulated Wood Deck, Heat fused per MDA
System #2 Limits
of Use g Certification Agency Certificate Approved
for use In HVHZ: No d FL16270 R4 C CAC UL Cert TGIK.R13231.pdf i ApprovedforuseoutsideHVHZ: Yes Quality Assurance Contract Expiration Date Impact
Resistant: No 12/31/2021 Design
Pressure: +N/A/-52.5 Installation Instructions Other:
Refer to Certification & current edition of FBC for FL16270 R4 II UL Cert TGIK.R13231.pdf Limitations
and Conditions of use. Refer to Manufacturer's Verified By: UL LLC Installation
Instructions as Supplemental Guide. Created by Independent Third Party: Evaluation
Reports i Created
by Independent Third Party: 16270.
4 ; 04 - "SFM-3.5H", SFM 3.SH-FR", Bitec APP/SBS Modified Bitumen Roof Systems, adhered over SFM-
4H-FR% "SPM-3.5H" or "Mineral mechanically -fastened, Insulated Wood Deck, Hot Mopped per Design
MDS" System #2 Limits
of Use Certification Agency Certificate Approved
for use in HVHZ: No FL16270 R4 C CAC UL Cert TGIK.R13231.pd Approved
for use outside HVHZ: Yes Quality Assurance Contract Expiration Date Impact
Resistant: No 12/31/2021 E
Design Pressure: +N/A/-52.5 Installation Instructions Other:
Refer to Certification ¤t edition of FBC for FL16270 R4 II UL Cert TGIK.Ri3231.pdf !! Limitations
and Conditions of use. Refer to Manufacturer's Verified By: UL LLC Installation
Instructions as Supplemental Guide. Created by Independent Third Party: Evaluation
Reports Created
by Independent Third Party: J 16270.
5 05 - "APM-4T", APM-4.5T', SPM- Bitec APP/SBS Modified Bitumen Roof Systems, adhered over i
4.5T', "ISA-4T" or "Mineral Design mechanically -fastened, Insulated Wood Deck with Barrier MDA"
board, Heat fused adhesive per System #3 F
Limits of Use Certification Agency Certificate Approved
for use In HVHZ: No f FL16270 R4 C CAC UL Cert TGiK.R13231.odf Approved
for use outside HVHZ: Yes i Quality Assurance Contract Expiration Date Impact
Resistant: No 12/31/2021 Design
Pressure: +N/A/-67.5 for
Installation
Instructions FL16270
R4 II UL Cert TGIK.R13231.p-dfOther: Refer to Certification & current edition of FBC Limitations
and Conditions of use. Refer to Manufacturer's Verified By: UL LLC Installation
Instructions as Supplemental Guide. Created by Independent Third Party: Evaluation
Reports Created
by Independent Third Party: s hftps://
www.floridabudding.org/pr/pr app dU.aspx?param=wGEVXQwtDgsNc735fObMiuc46OD18%2bg7gPs48mP3niASg4sLwCRosQ%3d%3d 2A
6/6/2018 Florida Building Code Online
16270.6
106 - "SFM-3.5H", SFM-3.5H-FR% Bitec APP/SBS Modified Bitumen Roof Systems, adhered over
SFM-4H-FR", "SPM-3.5H" or "Mineral mechanlcally-fastened, Insulated Wood Deck with Barrier
Design MDS" ( board, Hot Mopped or Cold Applied Adhesive per System #3
Limits of Use
Approved for use in HVHZ: No
Approved for use outside HVHZ: Yes
Impact Resistant: No
Design Pressure: +N/A/-67.5
Other: Refer to Certification & current edition of FBC for
Limitations and Conditions of use. Refer to Manufacturer's
Installation Instructions as Supplemental Guide.
Certification Agency Certificate
FL16270 R4 C CAC UL Cert TGIK.R13231.pdf
Quality Assurance Contract Expiration Date
12/31/2021
Installation Instructions
FL162.70 R4 II UL Cert TGIK.R1323i.pdf
Verified By: UL LLC
Created by Independent Third Party:
Evaluation Reports
Created by Independent Third Party:
16270.7 j 07 - "APM-4T", APM-4.5T", SPM- Bitec APP/SBS Modified Bitumen Roof Systems, adhered over
4.5T", "ISA-4T" or "Mineral Design mechanically -fastened, Insulated Steel Deck with Barrier
MDA" board, Heat fused adhesive per System #4
Limits of Use
Approved for use in HVHZ: No
Approved for use outside HVHZ: Yes
Impact Resistant. No
Design Pressure: +N/A/-60
Other: Refer to Certification & current edition of FBC for
Limitations and Conditions of use. Refer to Manufacturer's
Installation Instructions as Supplemental Guide.
Certification Agency Certificate
FL16270 R4 C CAC UL Cert TGIK.R13231.pdf
Quality Assurance Contract Expiration Date
12/31/2021
Installation Instructions
FL16270 R4 TI UL Cert TGTK.R13231.Qff
Verified By: UL LLC
Created by Independent Third Party:
Evaluation Reports
Created by Independent Third Party:
16270.8 108 - "SFM-3.5H", SFM-3.5H-FR", Bitec APP/SBS Modified Bitumen Roof Systems, adhered over
SFM-4H-FR", "SPM-3.5H" or "Mineral mechanically -fastened, Insulated Steel Deck with Barrier
Design MDS" board, Hot Mopped or Cold Applied Adhesive per System #4
Limits of Use
Approved for use In HVHZ: No
Approved for use outside HVHZ: Yes
Impact Resistant: No
Design Pressure: +N/A/-60
Other: Refer to Certification & current edition of FBC for
Limitations and Conditions of use. Refer to Manufacturer's
Installation Instructions as Supplemental Guide.
Certification Agency Certificate
FL16270 R4 C CAC UL Cert TGIK.R13231.12df
Quality Assurance Contract Expiration Date
12/31/2021
Installation Instructions
FL16270 R4 II UL Ced TGIK.R13'231.W
Verified By: UL LLC
Created by Independent Third Party:
Evaluation Reports
Created by Independent Third Party:
16270.9 09 - 11APM-4T11, APM-4.5T", SPM- t Bitec APP/SBS Modified Bitumen Roof Systems, adhered over
4.5T", "ISA-4T" or "Mineral Design mechanically -fastened, Insulated Concrete Deck (Cellular,
MDA" Gypsum, Vemiculite, Perlite or Structural) with Barrier board,
Heat Fused per System #5
Limits of Use
Approved for use in HVHZ: No
Approved for use outside HVHZ: Yes
Impact Resistant: No
Design Pressure: +N/A/-112.5
Other: Refer to Certification & current edition of FBC for
Limitations and Conditions of use. Refer to Manufacturer's
Installation Instructions as Supplemental Guide.
Certification Agency Certificate
FL16270 R4 C CAC UL Cert TGIK.R13231.pdf
Quality Assurance Contract Expiration Date
12/31/2021
Installation Instructions
FL16270 R4 II UL Cert TGIK R13231 pd
Verified By: UL LLC
Created by Independent Third Party:
Evaluation Reports
Created by Independent Third Party:
16270.10 110 - "SFM-3.5H", SFM-3.5H-FR", = Bitec APP/SBS Modified Bitumen Roof Systems, adhered over
I SFM-4H-FR", "SPM-3.5H" or "Mineral i mechanically -fastened, Insulated Concrete Deck (Cellular,
Design MDS" Gypsum, Vemiculite, Perlite or Structural) with Barrier board,
Hot Mopped or Cold Applied Adhesive per System #5
Limits of Use
Approved for use In HVHZ: No
Approved for use outside HVHZ: Yes
Impact Resistant: No
Design Pressure: +N/A/-112.5
Other: Refer to Certification & current edition of FBC for
Limitations and Conditions of use. Refer to Manufacturer's
Installation Instructions as Supplemental Guide.
Certification Agency Certificate
FL16270 R4 C CAC UL Cert TGIK.R33231.pdf
Quality Assurance Contract Expiration Date
12/31/2021
Installation Instructions
FL16270 R4 II UL Cert TGIK.R13231.12d
Verified By: UL LLC
Created by Independent Third Party:
Evaluation Reports
Created by Independent Third Party:
hftps://www.floridabuilding.org/prlpr app_dtl.aspx?param=wGEVXQwtDgsNc735fObMiuc46QD18%2b97gPs48mP3nlASg4sLwCRosQ%3d%3d 3/, 'w
6/6/2018 Florida Building Code Online
The State of Florida Is an AA/EEO employer. 2007-2013 State of Florida.:: Privacy Statement :: Accessibility Statement :: Refund Statement
Under Florida law, email addresses are public records. If you do not want your e-mail address released in response to a public -records request, do not send electronic
mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions, please contact 850.487.1395. *Pursuant to Section
455.275(i), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must provide the Department with an email address if they have
one. The emails provided may be used for official communication with the licensee. However email addresses are public record. Ifyou 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 area licensee under Chapter 455, F.S.,
please dick he er
Product Approval Accepts:
29 *j 0 99
https://www.floridabuilding.org/pr/pr_app_dg.aspx?param=wGEVXQwtDgsNc735fObMiuc46QD18%2b97(lPs48mP3nlA5g4sLwCRosQe/a3d%3d 411
CITY OF
Building & Fire Prevention DivisionSkNFORDRESIDENTIALRE-ROOFAFFIDAVIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: ' L / ADDRESS:
a FL 3-,-773
G,' l ` AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, ENGINEER, ARCHITECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE
FOREGOING INFORMATION IS TRUE AND ACCURATE AND THAT ALL ROOFING COMPONENTS LISTED ON THE SCOPE OF WORK AT THE
ABOVE REFERENCED ADDRESS HAVE BEEN INSTALLED IN ACCORDANCE WITH THEIR PRODUCT APPROVALS AND ALL APPLICABLE CODE
REQUIREMENTS — SPECIFICALLY FLORIDA BUILDING CODE, EXISTING BUILDING. IN ADDITION I CERTIFY THE INSTALLATION MEETS ALL
REQUIREMENTS FOR SECONDARY WATER BARRIER AND NAILING OF THE ROOF DECK, IN ACCORDANCE WITH THE HURRICANE RETROFIT
MANUAL REQUIREMENTS (BASED ON F.S. CHAPTER 553.844).
LICENSE #:
COMPANY / CONTRACTOR:
CONTRACTOR SIGNATURE: DATE:
MUST BE SIGNED BY LICENSE HOLDER O)( OWNER/BUILDER)
A FINAL ROOF INSPECTION IS REQUIRED:
THIS SIGNED AND NOTARIZED AFFIDAVIT MUST BE PROVIDED AT THE JOB SITE AT THE TIME OF THE FINAL ROOF INSPECTION,
ALONG WITH DIGITAL PHOTOGRAPHS OF EACH PLANE OF THE ROOF SHOWING IN DETAIL ALL COMPONENTS (DECKING,
UNDERLAYMENT, FLASHING, DRIP EDGE ATTACHMENT) WITH THE PERMIT NUMBER OR ADDRESS CLEARLY MARKED ON THE DECK
FOR EACH INSPECTION. THE PHOTOGRAPHS MUST INCLUDE A RULER OR MEASURING DEVICE TO CONFIRM ALL NAIL SPACING AND
OVERLAPS, INCLUDING DRIP EDGE AND VALLEY FLASHING. PLEASE REFER TO THE RE -ROOF POLICY AND INSPECTION PROCEDURE
PAPERWORK FOR FURTHER EXPLANATION OF ALL REQUIREMENTS.
FAILURE TO FOLLOW ALL REQUIREMENTS WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION FEE AS
WELL AS REQUIRING A DESIGN PROFESSIONAL (ARCHITECT OR ENGINEER) TO CERTIFY, BASED ON PERSONAL
INSPECTION, THE INSTALLATION OF ALL ROOFING COMPONENTS.
STATE OF FLORIDA COUNTY OF
Sworn to and Subscribed before me this lWV 1day of_v__ \O r-- w 20 f % by:
Who is Personally Known to me or has Produced (type of
identification) 1_ L. ) } — as identification.
ctj nj
ignature of Notary Public --
State of Florida'-
Print/Type/Stamp Name
of Notary Public
ANNETTE BLAND
Notary Public - State of Florida
Commission # GG 060623
My Comm. Expires Jan 16, 2018