HomeMy WebLinkAbout16-17944 li ' �-t'`
� I ' CITY OF ZEPHYRHILLS ;
� 5335-8TH STREEI'
� (813)780-0020 17 44 ;
� BUILDTNG RERMIT � �
' - � PERMIT INFORMATION LOCATION INFORMATION � - `
` Permit I�umber: 17944 Address: 3850 QUAKER RIDGE ST LT 132 I
Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL. �
Ciass �f Work: 434-ADDlALT RESIDENTIA� Township: Range: Boafc: ;
` Propo�ed Use: NOT APPLICABLE Lot(s): Block: Section: �
Square Feet: Subdivision: MAJESTIC OAKS ;
Est'.Value: Parcei Number: 24-26-21-0030-00000-'1210 �
Improv. Cost: 23,000.00 OWNER lNFORMATII'�N
Date�Issued: 1112212016 Name: NHC-FL'{35 �LC
Total Fees: 345.00 Address: 6991 E CAMELBACK RD STE 8310 �
Amount Paid: 345.QQ SCC}TTSDALE AZ 85251-2493 �
Date Paid: 11/22/2016 Phane: 813-783-7518 �
Wo';k Desc: CARPQRT 18 X13, RM ADDITI4N 'k6 X 13, SHED W/CONCRETE 10 X 13 1
1 CONTRACTOR S APPLICATION FEES
SUNSTATE ALUMINUM WC BUILQING FEE 225.Q0 ;
HC}MEC}�IVNER ELECTR(CAL FEE 60.00
BAHR'S�PROPANE GAS &A/C, INC. MECHANICAL FEE 60.00 �
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Ins ectians Re uired i
F ER I 2ND ROU H PL � M I S T! CEI G �
FOOTER�OND DUCTS INSULATED SEWER MiSC.
ROUGH E�.ECTRI LINTEL MISC MISC. �
1ST ROU�',H PLUMB PRE-METER INSUTATiQN WR�L. MISC.
DUCTS itV��TALLED WATER M(SC DRtVEWAY I
PRE-SLAB SHEATHING MISC. MISC.
CC?NSTRl��CTION POLE FRAME M1SG. MISC. '
REINS�ECT'xON FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the
locai jovernment shail impose a fee af four times the amounfi of the fee impased for the initiat inspection or
I first reinspection,whichever is greater,for each such subsequent reinspection.
NOTICE: In addition to the requirements of this permit,there maybe additiona! restrictions applicable to this property that
may b�� found in the public recards of this county, and there may be additianal permits required from other governmental�
� entities such as wafier management, state agencies�or federal agencies. �
"Wa�ining to awner: Your failure to record a natice of cammencement may resutt in yaur paying twice far
impravements to your property. If yau intend ta obtain financing,consult wifih your lender or an attorney
++ before.recording your not�ce of commencement."
Complete Plans,Specifications Must Accompany Application.All work shall be pertormed in accordance with
�� City Codes and Ordinances. NO OCCUPANGY BEPORE C.O. �
� N4 OCCUPANCY BEFt3RE C.O. �
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CONT C O SIGNATURE PERMIT OFFI R i
PERMIT EXPIRE5 IN fi MONTHS WITHCtUT APPROVED INSPECTION i
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED �
�� PRt�TECT CARD FROM WEATHER '
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e�3-7so-oazo City af Zephyrhills Permit Application Fax-813-780-0021
Bullding Department .� . ' J.- ,
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" Date Received /-f�,.,f/�, 3 � �""���
i fi LY Phane Gontact for Permitttn f
7TIT1'�7Tf�' . ,;:. : �
Owner's Name � ' Z�/S�L� ls I'�"t"'fS � Owner Phone Number ` O S ""'�d�`���
r ' ,i / // ffSdQ�C j92 �F'Y�S1 � �
Owner's A Idress �G.Qrhd' �JlsG�- �a� S�'� �"3�� Owner Phone Number �
Fee Simple Titlehalder Name Owner Phone Number
FeeSimpll TitleholderAddress
JQs,aoa I,�SS 85 � �t er� al �,.1,.t`�tS �'�- 3�`1�-- �.oT� .�aZ--
SUBDI1tIS10N ��a�G'���C ��Z�S PARGEI.iD# -�� - �l- C����. � Q I}(.�I��!(a f C�
(dBTAINED FROM PROPERTY TAX NOTICE) �
WORK PRI POSEA , NEW COMSTR ADQIALT � S1GN Q Q DEMQLISH �
� e iNSTALL � REPAIR
PROPOSED USE Q SFR Q CQMM 0 OTHER �
'1'YPE OF II ONSTRUCi'tON Q BLOCK Q FRAME � STEEL �
DESCRtPTION OF WdRK Gl t t� LY l 7`! !L�'� 7`- C�)?tY�.°7�
BUlLQlNG SIZE �� � SQ FOOTAGE �! �I '�" HElGHT �-��
Tf'�1'�rii"'�Te�r�rl�f"1�i1�'e"t'I�IT1Ti"'ITI�s'k�1Ti"'TITiT1Trr!'7�"T1Tl�l�t�"C'11T1"r"l�s�{�i�c'1�iTiTi�i" ,
VALUATION OF TOTAL.CONSTRUCi'ION
f ca����Q.Q
UILDING $
'�;ELECTRICAL $ , AMP SERVICE � PROGRESS ENERGY Q W.R.E.C. i
0��LUMBING $ � ��(� �
l:J
MECHANICAL $ VALUATION dF MECMANICAL INSTALLATION� � �� ;`
� Y ��� i
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QGAS Q ROOFING Q SPECtAL7Y � OTHER !�
FINISt-tEDI F�04R E�EVR7IQNS �-� F�QOD 2L7NE Af2EA QYES NO j
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-�-k-1--1-1-i�a-b-�1-E-F-1�-f-a-1-1-i-1-F-1-f-f-1-N-�1--1-I-i-I--F-i-f-1-�t-b-1-F-�1--E-1--F-1-I--f-I�-1-f-1-1-#-F-3-1-l-1-1-�i-f-�-1-a-f--f-1-�-�-1-
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BUILDERI /�GLi4� i����y���y� � COMPANY L/C!!•f cJ T`l•LTZ' LfGh/Hu��
SIGNATURE � REGISTERED Y/ N FEE CURREN Y/N
Addl�ess /S� j�r-� /�G'�� — 2�i/�l �� 3 a"ui- �icense# �/2G D��'�.5"17
ELECTRIGIAN j 1 _� �`���� �� � COMPANY p_/
SIGNATURE U��J �� REGISTERED Y/ N FEE CURREN Y/N
�
Add ess License# � -�
PltlMBE�� COMPANY
��
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
Add��ss .�� License# �_ �
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MECHAt�tCAt I��� /���.�.� �u GOMP�4[�iY �O�lersr!-�'��sa� ��C
SIGNAT i RE REGISTERED Y I N F6E CURREN .Y I N
Address �J�I �t2`° �t.- ��Cr ls� 3SY � License# �1�C(� El3��(! � �
OTHER�) GOMPANY
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SIGNATURE REGISTERED Y I N FEE CURREN Y/N '
II �Address Llcense� �
I1111111111IlIlIM11111111 '9t1i11I111IlIlII1111AI111111I111I1 [ IItIAII
RESIDE�TIAL Attach(2)Plot Flans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction, � �
� iVIlnEmum ten('10}warking days afEer sabmItta!date. Requfred onsite,Gonstructian Pians,Stormwater Ptans wt Siit Fence instaiied,
Sanitary Facilities&1 dumpster;Site Work Permit for subdivisions/large projects
COMMERGIAL Attach(3)complete sets of Building Plans plus a L.ife Safety Page;(1)set af Energy Forms.R-O-W Permit for new construction.
Minimam fen(1 d}working days afEer submitEat date. Required ottsite,Ganstructian Plans,Stormwatsr Ptans w!SESt Fence instailed,
�� 8anitary Faciiities&1 dumpster.Site Work Permit for all new proJects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Pians.
"'**PRQPERTY SURVEY required far a11 NEW canstruction.
-�4-i•.I{-1.-1-f-#.•1-4.{�f..�-i-1-f-1-f-1-1�--L-i..4.E.�1-I..i..l-�..1-1..1-{-1..�-W�1-I..I..f-f..l-f-i-�.-W-i-�-a-1-f-�-f-b.i-f-i-i-f.a•.le.l..l-h
Directio s: ,
FiII out appliGatlon campletely.
Owiner&Contractor sign back of appiication,nofarized
, If over$2500,a Notice of Commencement is required. (A/C upgrades over$7500)
•" Agent{for the contractor)ar Power of Attomey{for fhe owner}would be someone wifh no#arized tetter from owner authodzing same
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OVER THE COUNTER PERMITTING (Front of Application Only)
Reroafs�ii(shingles Sewers Service Upgrades AtC �ences{PlotiSurveyiFooiage)
Drivoways-Not over Caunter if on public roadways..needs ROW
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NOTICE C�F DEEp RES'TRICTI(JNS: The undersigned understands that fhis permit may be subject to"deed"res#rictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility far compliance with any
appiicable deed restrictians. �: �
UNLICEN:>ED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired .a contractar or
cantractor:�to undertake work,they may be required ta be licensed in accordance with state and local regulations. 1F the
contracfor is nof licensed as required by iaw, both the owner and contractor may be cited for.a misdemeanar vio(ation
under stat�� law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
inte�rded�nrark,they are adUised to contact the Pasco Coctnty Suilding 3nspec#ion Division—C.icensing Sectian at 727-847-
8009. Furthermare, if the owner has hired a contractar or cantractors, he is advised to have the contractar(s) sign
portians of the "cat�tractor B(ack" of this application far which they will be responsible. !f you, as #he owner sign as the
contractor, that may be an indication �hat he is not properly 1ic�nsed and is not enti#led ta permitting privi(eges in Pasco
County.
TE2ANSPCIRTATI4N IMAACTIUI"iL[T[ES]MPACT AND RESOURCE RECOVERY FEES; The urtdersigned urtcierstands
that Transportation Impac# Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of _
use in exi:�fing buildings, ar expansion of existing buildings, as specified_in Pasco County Ordinance number 89-07 and
9a-07,_as camended. The-andersigned also understands, fhat such fees, as may be due, wili be identified at the time of
permitting. It is further understaod tliat Transportation Impact Fees and Resource Recovery Fees must be paid priar to
receiving el"cerEificate afi occupancy" or final power release. If the project does not invalue a certificate of occupancy or
final powe.r release, the fees must be paid prior fa permifi issuance. Furthermore, if Pasco County WaterlSewer impact
fees are diae,they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTI�.LIGTION LtEN L.AW(Chapfier 793,F[orida Statutes,as amended}: If vaivation of work is$2,500.Q0 or more, l
certify that I, the applicant, have been provided with a copy of the "Florida Canstruction Lien Law—Homeowner's
Protection Guide" prepared by the Fiorida Department of Agriculture and Consumer AfFairs. [f the applicant is someane
ofher than fihe uowner", ( certify that i have obtained a copy of the above described document and promise in good faith ta
deliver it tc�the"owner"prior to commencement.
CO�ITl3A{;TOR'SIOWNER'S AFFIDAVIT: I certify that ail the information in this application is accurate and that alI work
will be dor�e in compliance with all applicable laws regulating canstruction, zoning and land development. Applicatian is
� hereby m�de to obtain a permit to do work and installation as indicated. ! cerkify tha# no work or installation has
commence.d prior to issuance of a permit and that ail work wi11 be pertormed to meet standards af ai! laws reguiating
construcficm, County and City codes, zoning regulations, .and land development regulations in the jurisdictian. I also
� certify thaf:3 uriderstand that the regulations.of ather gavernment agencies may apply ta the intended wark, and that it is
, my responsibility to identify what actions I must take to be in compliance. Such agencies include but are nof limifed to:
• Department af Environrnenta! Protecffan-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands,Water/Wastewater Treatment.
- Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
1lttatercourses.
- Army Corps of En�ineers-Seawalls, Docks, Navigable Waterways.
- Department af Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic'fanks.
- US Environmental Rrotection Agency-Asbestas abatement.
- Federal Aviatian Autharity-Runways. - �
I understand that the foliowing restrictions app(y to the use of fii(:
- Use af fill is not allawed in Flood�Zone"V"unless expressly permitted.
- Ef the fi11 material is ta be used in Flaad Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submit#ed at time of permitting which is prepared by a professional engineer
ficensed by the State of Florida.
- if the fi1i materia( is to be used in Fioad Zone "A" in connection with a permitted building using stem waii
construction, I certify that fill will be used only to fill the area within the stem wall.
- If fi1l material is to be used in any area, I certify that use ot such fll wili nat adverseiy affect adjacent
properkies. If use of fill is found to adversely affect adjacent praperties, fhe awner may be cited far violating
the conditions af#he buiiding permit issued under the attached permit application, for lots less than one (1)
acre which are elevated by fi11, an engineered drainage plan is r�quired.
If I am the AGENT FOR THE OWNER, I promise in good faith ta inform the awner of the permitting conditions set forth in
this affda�rit prior to commeneir�g construction. i understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the applicafion. A
permit iss�ed sha!! be cons#rued to be a license to proceed with the work and not as authority to violate, cancel, alter, or
set aside,�ny pravisioris of the technical codes, nar shail issuance af a permit prevent the Building Official from thereaf#er
requiring ��correction of errors in plans, construction or viqlations of any codes. Every permit issued shall became invalid
unless the:work authorized by such permit is commenced within six months of permit [ssuance, or if wark authorized by
� the permit is suspended ar abandoned for a period of six(6} manfhs:after the time the work is commenced. An extension
may be rE:quested, in writing, from the Building Official for a period nat to exceed ninety (90) days and will demonstrate
jusfifiable cause far the e�ensian. If work ceases for ninety t90}consecutive days,the job is cansEdered abandaned.
1NARNIN{x Td 01tVNER: YOUR FAlLURE TO RECORD A NQTlCE OF CCJMMENCEMENT MAY RESULI' !N YOUR
PAYING 1'WICE FOR iMPROVEMENTS Tt7 YOUR PROPERTY. IF YUU INTEND TO'OBTAiN FINANCING,CONSULT
WITH YOIJt2 LENDER dR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.-
FLORIDA JL1FtAl`(F.S.1.97. 8} .,
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OWNER OR AGENT. . �/�O?G� CONTRACTOR ��C6���L�.L.�^�
Subsaribed��n bywom ta(or af6rmed}be€ore me this ' ��c�d�cL��c� om to{ar a �rme before me this
f tT" I
Who is/are personally known ta me or has/have produced Who s/are'— n to me or has/have produced
as identificatfon. as ldentification.
�
Nofaty Public `" ��. hiotary PubSic
, .
Commission No. Com is ' n No.
Name of Notary typed,printed or stamped Name of ary,� , ' ed �_
.��:'� y8;- JACQt1ELJNE 80
- '*. k= Commissin ��S
��;g�;; B xpires D�ember 92,Zp2
�„fs ndpd Thrv 7m},Fain tnsurance 8pp.3g3�18
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DISCLOSIIR$ STA`+'�*�'�' FOR OWNSIt i
CITY OF Z8P8YRHILLS BIIILDING DEPARTMENT
. _, �2Ur c� /'4 i/`�S'tiP �� have read and fully understaad aad !
agree to the provisions c�f this iastzvment. "
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The uadersigned states aad affirme tha.t he or she is deaizous o� constructing, �
renovatiag, addirig to os reroofiag his or her owa domicile, that he or she
actually occupi.es, or will ocaupy by said domicile, and same is not for
sent, lease or sale. That he or ahe ahall comply ovith the following cond9.tioas: ,
I.. Tha� the owaer aad he or she alone shall act as the bni.lder fos a17. phases o£ ,
conatructioa.
2. That the oamer av3.1Z comply m3.th al.l provisions of the C.i.ty of Zephprhills ;
o��**�*+ces and codes pertineat to th� building.
3. That ia tlie eveat variauts phase� vf construction ase subcontracted, he will j
E.'ILgage only psoperly licensed subcoatractors�aad will personally supesvise '
such v�ork:
4. That in the event the Buildiag Inspector shall requ3re �orsections to be made,
the owaer v�rill asaume full respoasibi.2ity to iasnse they, are made, and upon
completioa will call fox a reinspectioa before proceediag with the building.
5. That the ownea sha1Z assnme full responsibility �or the construetioa and wi1l
not expect supesvisioa of his work trom the C3.ty of xephyr3zills Bnildi�o�g �
Department.
6. That prior to final i.nspeation aay additioaal fees, inclnd:i.n.g re.inspection
fees, must be paid ia fu].l. A mrittea, reqnest from this oEfice sha.11 �
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� consti.tute aa o�ficial notice to pay addi.ti.onal fees.
7. That the oo�aer sha�.l comply wi.th a17. C3ty,' State aad 8ederal 1ao�s ia rega=d to �
social security, worI�ta.a's compeasation, Ziea laws, eto., where appli.cable_
8- Z`ha� i-he owaer shal], comply w3th al.l the tsafety aodes issued by �he Florida
Industrial Commissioa.
9. 3tate lao+r requires constructian to be done by licensed coatrac�ors. You have
applied for a permi.t nader aa exemption to �hat law. The exemptioa allows �
you, as the owner o� your property, to act as ponr owa contsactor arith certain �
rest:rictions even though you do not have a Zicens�. You must provide direct �
onsite supervision of the coas�saction yourseli. You may bnild or i.mprove a �
one-family or taro-family reside�nae or a farm outbui], ,
diag. Yon. may also bui.ld
or improve a cwamercial buildi.ng, provided your costs do aot exceed $25,0�0. . i
The building or resideace mnst be fos yous owa use or occupaacy. St tnay aot
be built or substantially improved ior sale or lease_ Sf you se1Z ox� lease a �
b�i.ldiag you have buil.t or substaat3.ally impsoved yousse].f within I year after �
the caastrnctioa. is canaple�e, �� 7.aea c$±11 presume �tlaat you built o�c �
snbatantially improved if £or sale or 7.ease, avhich is a violation of this �
exemption. You map not h�.x�e aa ur�licensed persoa to act as your contractor or i
to superviee people workiag on your bui.ldiag_ It is your rasponsibility to �
make evs'e tisat peop].e employed by you have licenaes required by s�ate law an.d
by cpuaty or mnaicipal licensiag ordinaacas. Yott utay not deZegate tlie ,
reapoasibility for supervisi.ag woric to a liaen.sed cantractor who is not i
licensed to perfoxm the �vork being done. Any pexson wor3c-i.ng on yo� bvi.lcliag
�
who is not licen�ed muat work under yanr direct superv3sioa and ntust be
eaiQloyed by you, which meaas that yon mus� dednct F.I.C.A. and wi�hholdiag tax
and psovide worlcers' compensatioa for that etaployee, all. as prescribed by law_
Yvur constructi.oa must camply 9vi.th al.l applicable lasva, ordiaaaces, bnildi.ag
codes, and zoniag regalationa.
ow�sa.•s s=�,suxs � � ne� ///��l/�U
ADDxsSS " g5 v _ n. , � .s iCL --c� �
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. SUiV STATE"ALUI�i1NUN1, INC. �
� 6154 Fort King Rd. ' ,
ZEPHYRHI�.IS, FL 33542
� (81"3j 788-7�a� '
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EET JOH NAME �
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+,STATE and ZI�CQDE �a���H
:FfITEGT DA?E OF PLANS JOB PHONE �
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We hereby su6mit specittca@ons and estimates far. •�
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iD!� C hereby ia terial a labor—complete in accordance with above specifications,for t e sum of:
! {�
+dauars($_ �_—}.
Pa M ;tre rna t o .
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All unpai�tl balances subject to 1.5°lo mon�hly inter$st fee, I
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All materiall is guarantead to 6e as specified.M worh to be completed En a woikmeniNce . d
mannar aoCotdtng ro sfandard prac�ioes.Asry atteratirn�or devtatlax from atwve�� Si �
involving e�tra costs wiu be executed onry upon written orde►s,and wiil 6ecome an
charga.aver and a6ove tlie�+stimate_A�agcecments contin�ent up�stdlces.accidenfs '
or delays tieyond_our camol.Owner to Carry fire,mmado and other neoessary i�surance. Not9:This propOsal maY� = i
our workers are,fut�y covered 6y wari�annar►'s Compen,atian tnsmanca. wiihyirawn by us if not accepted v�nthin days. �
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7HE UNDERSIGNED hereby glves notice that impmvement will be made to certain real property,and In accordance wilh Chapter�13.Flodda Statules,
the fa{lawing inttjimatian is pravided ia 2his NottCe of Commencement: �.5 h �r,,�� �
i. DesCriptian of Property: Parcei Identificafron No, a�:�� �«�J�t1lJ.3 d'—�C..+C.X1�"'JZ f C�
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lend�r's Te3ephone Na. ���� ,t � � �
7 Pers Ins within the State oi Florida designated by lhe awner upon whom notices or other documeMs may be sarved as provided by � � �� � � � I{
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TelepIIhone Number o(Person or Entity Designaled by Owner. o ��' ��_ �W
9. Expi ti4stion dafe af Nntice of Cammencement(the a�iration date may aat 6e befflre the campiatiar�of canstruction and finai payment io the � � � �} �? �
cont ii dor,bul wi�l be ane year hom Ihe date oi lecordng unless a diHerent data is specifled): �' O O (� � �
WARNING TO pWNER: ANY PAYMENTS MADE'BY THE OWNER AFTEft 7HE EXPIRATION QF THE NOTICE OF COMMENCEMENT � �" 2 � fn i
AR�)C6NStpEf2ED iMPf2�PEF? PAYMETlTS UNDER CHAPTER 7t3, PAt2T 1, SECTION 713.13, FlOR1DA STAI'UTES, AND CAN (,V (/j Q�� Q ,
RESI}LT IN YOUR PAYIAIG TWiCE F£}R IMPi20VEM£NTS TO YOUR PROPEi2TY. A N07ICE OF CL7MMEPtCEMENT MUST 6E � -�^ �_.. �
wIT�YOUR lEN ER OR�N ATT R EY B�EFORe�OMMENCING WORK OR�RECORD NG(YpUR NOTiCE O COMMENCEMENTS��7 g.�.. ��� � � I
LtndBlr penalty of petjury,1 dedare that i have read the faregning nrsifce ot camm+eruement and Rhat the(acts slated therei�are tr�e to the best � � ~ d �� �- p � ;
of my knovAedge and be3�ef. � i
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COUNTYOF �RSCO ��'h-��6`� �" ^^��b"«" �`_p'�� .g � � If
Stgnature of Qvmer or Lessee,w Owners ar Lessee's Authorized Qa�
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Archived ❑
Product Manufacturer • Kinro,Inc
AddressjPhone/Email 2703 College Ave.
• Goshen,IN 46528
(574)535-1125
rmanthey@Icil.com �
Authorized Signature " Rick Wright � •
rickw@rwbidgconsultants.com � I
, Techntcal Representative �
Address/P.hone/Email �
Quality Assurance Representative '
Address/Phone/Email. ,
Category Windows �
Subcategory Single Hung
Compliance Method Certification Mark or Listing
Certification Agency Ame�ican Architectural Manufacturers Association
Validated By, Ryan J.King,P.E. �
µ Q7 Valfdation Checklist-'Hardcopy Received �
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Referenced Standard and Year(of Standard) �tandard Year
AAMA/WDMA/CSA S01/I.S.2/A440 2008
I Equivalerice of Froduct Standards
Certifled By �
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Product Approval Method � Method 1 Optfon A
Date Submitted 02/24/2015 I
_ Date Validated 02/25/2015 �
Date Pending FBC Approval
I Date Approved 03/02/2015 �
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Application Type , Reviston ,
Code Version 2014 I
Applicatfon Status Approved •
. *Approved by DBPR.Approvals by DBPR shall be reviewed and ratified
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Comments
Archived ❑
Product Manufacturer PGT Industries
Address/Phone/Email y 1070 Technology Drive
� . Nokomis,R 34275
(941)486-0100 Ext22318
' druark@pgtindu§tries.com � �
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� Authorized Sfgnature - Jens Rosawski - �
' - jrosowskf@pgttndustrles.com �
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Technical'Representative ]ens Rosowski
Add�ess%Phone/Email 1070 Technology Drive
• Nokomis,FL 34275
(941)486-0100 Ext 21140
- jrosowski@pgtindustrfes.com
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Quality Assurarice Representative
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Address/Phone/Emafl .
Category Windows �
Subcategory Single Hung .
Compliance Method . Certification Mark or Listing �
Certification Agency Keystone Certlflcations,Inc.
Validated By Steven M.Urich,PE
� Validation Checklist-Hardcopy Received I
Referenced Standard and Year(of:Standard) Standard Year ;
AAMA/WDMA/CSA 101/I52/A440 2011 !
AAMA/WDMA/CSA 101/IS2/A440 2005 ��
AAMA/WDMA/CSA!OS/IS2/A440 2008
ANSI/AAMA/WDMA 101/I.S.2/NAFS 2002
ASTM E1886 2005
ASTM E1996 2012
ASTM E283 2004
ASTM E330 • 2002 �
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Equivalence-of Product Standards , �
Certified By ;
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Code Version 2014 , I
Applicatlon Status Approved • , �
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Product Manufacturer Norandex Buildtng Materlals Distributidn
Address/Phone/Emall 300 Executive Parkway West
' Suite 100
Hudson,OH 44236
(740)323-1787 i
' Christine.Watson@norandex.com '
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Authorized Signature � Christine Watson - j
Ctiristlne.Watson@norandex.com �
TechnicaLRepresentative Christine Watson I
Address/Phone/Email 300 Eicecutive Parkway West
Suite 100 � -
Hudson,OH 44236 ;
, .. (740)323-1787 �
Christine.Watson@norandex.com �
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Quality Assurance Representative • ° �
Address/Phone/Email '
Category Panel Walis I
Subcategory � Siding
Complfance Method Evaluation Report from a Florfda Registered Archftect or a Licensed' I
Florida Profess(onal Engineer
' l� Evaluatfon Report-Hardcopy Received
Florfda Engineer or Architect Name who developed Robert Nleminen '
the Evaluation Report
Florfda Ucense PE-59166
Quality Assurance Entity. Architedural Testing,Inc.
Qualtty Assurance Contrad Explration Date 12/31/2015 -
Valldated By John W.Knezevich,PE
C�Z1 Validation Checklist-Hardcopy Received
� Certificate of Independence FL12500 R2 COI 2015 OS COI Nieminen.odf
Referenced Standard and Year(of Standard) Standard Year
• ASTM D3679 2009
Equlvalenee of Product Standards �
Certified By .
Sectlons from the Code
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Archived p ` I
Product Manufacturer Custom Window Systems Inc. II
Address/Phone/Ema(I , .. 1900 SW 44th Avenue ' I
� Ocala,FL 34474
- -� (352)368-6922
- � ekoss@cws.cc I
Authorized Signature Koss Erin i
,.-. � , • ekoss@cws.cc
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- - Technical-Representative' �� Erin Koss � I
Address/Phone/Email 1900 SW 44th Ave.
Ocala,FL 34474
(352)368-6922 Ext291 -
ekoss@cws.cc
Quality Assurance Represenfative ]ay Lathrop
' ` Address%Phone/Email 1900 SW 44th Ave. �
� � Ocala,FL 34474 � �
"' `. - � (352)368-6922 Ext 291 i
. jlathrop@cws.cc , +
Category Exterior poors
Subcategory ' •�Swing(ng Exterior poor Assemblles
Complfance Method Evaluation Report from a Florida Registered Architect or a Lice�sed
Florida Professional Engineer
C� Evaluation Report-Hardcopy Recelved
Florida Engineer or Architect Name who developed Lucas A.Turner
the Evaluation Report
Florida License PE-58201
Qualfty Assurance Entity Keystone Certifications,Inc.
Quality Assurance Contract Expiretion Date 07/21/2020
Validated By Steven M.Urtch,PE
I� Valtdation Checklist-Hardcopy Received
Certificate of Independence FL161 RS COI EvalReo CWS-176E(Guardian Door).odf
Referenced Standard and Year(of Standard) Standard Year
AAMA/301/I.S.2-97 1997
ASTM E1300-04 2004 ,
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Equivalence of Product Standards
Certifted By i
Secdons from the Code �
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