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HomeMy WebLinkAbout20-22569 CITY OF ZEPHYRHILLS 5335-8TH STREET (813)780-0020 22569 BUILDING PERMIT PERMIT INFORMATION LOCATION INFORMATION Permit Number: 22569 Address: 38834 5TH AVE Permit Type: RE-ROOF ZEPHYRHILLS, FL. Class of Work: ROOF REPLACEMENT Township: Range: Book: Proposed Use: SINGLE FAMILY RESIDENTIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 11-26-21-0010-17300-0050 Improv. Cost: 11,360.00 OWNER INFORMATION Date Issued: 3/03/2020 Name: CHRISTIANSON RUSSELL ANTHONY&A Total Fees: 150.00 Address: 130 RAVEN CLIFF LN Amount Paid: 150.00 BROUSSARD LA 70518-5340 Date Paid: 3/03/2020 Phone: 813-363-6936 Work Desc: REROOF SHINGLE/ BACK PORCH MODIFIED CONTRACTORS APPLICATION FEES IRON CITY CONSTRUCTION LLC REROOF RESIDENTIAL 150.00 G DRY IN ROOF INSP 1- Ins ections Required TAPE JOINTS ROOF INSP FINAL REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or first reinspection,whichever is greater,for each such subsequent reinspection. NOTICE: In addition to the requirements of this permit, there maybe 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, state agencies or federal agencies. "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your property. If you intend to obtain financing,consult with your lender or an attorney before recording your notice of commencement." Complete Plans,Specifications Must Accompany Application.All work shall be performed in accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O. NO OCCUPANCY BEFORE C.O. TRACTOR SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 813aeo=0020 City ofZephyrhillS'Permit:Application_ FaX-e13a80-0021' :.Building:Department• � •. fate R®calved R. cto erimtttin ,;tG ;:' s•: ;;i" :Pho"ne,Co taCE rP _0its:: wner�#:Nam. .. � .�.�' • GiNnor�alott�T�iunb :_:; ��...3.:�. .I�;,��: o..� w- . ,OilrneCs�Address - . - OVvner Pkon���lamtie't��:� s•Z - r:3 _ -- tl-AD AlEft" Y SUBDIVISIONS=.. >r-. - - .. ::(bB,TA1NEDr•�,`RO' P,13O,Pt5ltTlf Y'AXJ'1Qf1C;El...r. ;,r: ,:: ti P.OSEb- idEWCON3T(t Ab0/AkrT•��� ••SfGN`'• - :+'.:` •tj>tHty�isr�- NSrALL'r: v<'. OS M RO P -D�US -E ?0: !t - - ..J•' �.F:,:,.,-fir A- 'DESt"IlIp.TION 01= ORK,.. e(`o �►. /: ;B 1 '1 u LDINGSIZE =F- T Q. 00 AGE ..HMI•• ••fez +S S .:Y 'r B•��LDIN• ON.O TO ALr'CONSTFf U'CTI�N'� 0 ELECTRICAL' $ AMP..,SERVICE. DUKERENER QMECHANICAL $: VALUATION OF.MECHM. ibAL'.INS'TAL AT,fON OGAS ROOFING; � _ SPECIALTY.,, OTHER-- ' '' I 1 _ ,`n'E!"'T FINISHED FL1OOR;ELEVAT.ON S.. `�' tBLOOp1ZONE:�JIREA t:. ;. ���YS ' :'`•NO , . .BUILDER COMPAt1JY. ::r ilddrAs�"• �'l`�r-:. - .P /� .:: _ :,�- ..I:ic,®nse#,. {� ;:t.. ELECTRI,CIAN:. COMPANY:. SIt;NAURE `:aEGistgRD , »::Y`/:N::,�r: : .. EP. . :.:.:: _ t(RR Address' PLUMBi:R' „ COMpdNY. SIGNATURE: :`R€GtiSi�f2tki Y-%Ni,:s :`a'-EEE%.Ci1RRF.1y:%'1 ':Y%Jf�i :.. , Address-� ::l�defis9'#-. - MECHANICAL-- . .. -• •�;: ,;CbMPAFIY':. ' •: - ��' a r. a� ! Y/?N - FEE; URRE ^... t Y!�!V•. �S1Gi�A�TUF�E^'i' 'i.. Poio f OTHER,,,; �, SIG�IAYUItE''. Rtc'$IEIiEDr rY/a?I�k s:r,:, FEE:C4IRRE. "_r ,:. .. ..- .�-. ?:f• :�f: s'.'.=•«•^f: j t.:.,+�.: N. ...i g s t Y O ` isx-`'f: 'I di .'P�r�• 1 's'e of �orFhs. "(�- a f••n b,r,.- - RIb>rN1'iA1` _`Attaoh' tt#aen :'(.� e...o, �,( g�(..), y� (.,).�;� .,�a}��°�.;. -o .,v•s.l�l �?u mN'r a �+o�t�e:�7�'-J•'•�1,; ..;�'�?-+Yi'^ ,.•�,Y e•�:4'",""'.'i'.`�`;:;,.,A ,� Ri,t•'1•"1 •:"'�'c::- ..".f. xMlnffortuter►: OIork+i�g�dayseRrsfii-date: R onsire:,Conti`ctlorf,lleoik)`stet?rAFi ;v�/ �IFerlcb.rpstdllet!t": .Sanitary Fbdlitles:8�,dumpster;'s,ite Wdt7cAeiiY Yt'-,ftirsrtbdieilsl�i§A .iig Fprojeits'. COMMERCIAL, Attach:2 co►riplete sots'.ofl;BuffdfpgPlans�pldsa;af.;LS `Ppge (1j?SeY�of Erte(gy:Forms:RO=W Pdrin7t:for`ndwcq±s(n%ction?:; Mlnlrrium t8jrk(1 ;workin , a'Ufa'er•'Sbttalr` t `"" ,' ��R. ., "ew;R 4 'sue.-consffu brrsP;l�ils�.storri, ater��a>n wf< i�t, a ir- l: i -aued; _: Sanitary:dalitffes.`8.;1 cJu 160, Sl a iflork' rmit tlor'a1l AeaitproJebts All 66ihiheed',Kro�ul......ts,rtiU t Wiest mp118n :.:, ... SIGN PERMIT:— Atr-W.12')eetst9f�Engir�t}eere� •'•`pRbt��R1YY;$,iJ`IfVEY`r?equlted fdr•.aIINf:W cbfi3tnicKfon - Directions: FIII out applibation compfetoly. CtwriAf B C ontr�ctoc. ign pacic;otepRlicadon;notarized. If ov+�r'32500,^a Notlfce 6 VOmmerice n®n!'is required: :(A/C upgrad®s:oyec:S7500) Agont;(farAhwoontractot):or.;Power..ofAttomey,((or•th own er)!.wbd1d`'be'someotte Witlt`hots'Htdd4etterf M:bwner.7autltdriiir�g same: OVER:T"E'COUN`rERP,ERMITsTING-- ,,:{oopv,-of iahtrPi�required) Reroofs ifs Sewers Se Nib rvir.9 Upgrades;A}/C':"'' Fe iiCbolot/Survey/Footage) Driveways-Not over'Counter if on.public roadways..needs ROW NOTICE OF DEED RESTRICTIONS: The uiidersigrred-*,und6rstands that'this permit-may be subject to°deed°restrictions° which-may-be.-mo.re.-testdctive.than„County.�eguiations. The undersignediassumes-,respansibiiityfb'r°complianeeacvith any a�plicable_deed:restrictions.: ' iUNi 1:BENS'ED 3 7RrAC OR ANC CON R% (70R RES OFFBiB'IL jE l 'tl o ci vn; Iiii; ire contfactor or contractors to"undertake"v+rork s,:tfil y<,may4beArtequire6 to be licensed in arc or�iaf�c�with.:s#ata:,and�;.lpca�regt�fatibnt-P t -the Eontractor�i&mot licensee as required by law, both thwewner*'•and`4b6#i}acti�r tt lay~tie°sited fot -tnisttemeanor violation under state law: .if.tire own eryor,intonded,cctn#ractorr:are uncertain;as;to.wtlat licensing,ragisucerr�onts.may�applj�for,the Mitended:work;-they-arwadvised to contact the Pasco'-County`Building-tn peCtit�n'°Di�riaio6Llcensing Section at 727-847- 8009: Furthermore, if the owrier;4ti,s; tirel�:�a,contractor or,contractors, .he`.is adKised.;,to have the contractor(s) sign .portions:of.,the'*°contra'ctor:Block"..,of,thin appllcation•for.which.they_:wilt:be responsible,. ;if you, as the owner sign as the -contractor,.that may be an•indication that'he is not,properly licensed-and Is not entitled.4o-permitting-privileges in Pasco County,;.: . TRA ISPOR'EATiON IMPACT1UTILl* SfM•P. AND:.RESOURCE RECOVERY-FEES: The undersigngdzund(ends that T'ranspportsitidn�!lmpact::Ee-es-and--ReeeurserRecover.y F.ees.,mayapply<to:themonstructionmoPnew buildings;"change of •use in existing-"buildings,ar`expansion`:of'eit�sting buildings,.as specifed':in Pasco County Ordinance•number:.0"7.and .90-07•, as.amended.:.,.:Thetunderslgned..also:. ,r^derstai4% ,.that)stich feos,-as:.may,.b:ekdue,wwillLbe<'rdentified`at`tt a f+rii`e of permitting. Ott isi_fUiithsrirderstotrttltatah'portatian:Impact Fees-and.Resource Recove.,ry Fees must be paid„prior to " receiving ao.','eertific� Hof.occuperio?,br-fitialxpowpr:r0lease���tttfhe'projact;dtre r►r3t�invcjave a cent cate-af c�ccijpatncy"or final:power release;,the-fees.:must-be paid-.prior to permit issuaiibe. ,'Further-io *Pas¢ County Water/Sewer Impact fees_are 3due,theywmustspe_pa datir or tocp-it issuanco in accordance:�i the applicable Pasmo;County ordinances z ' C'ONSTFUCTIONsi:�IN'LAW- it(Chsipte�' ;;ilorltlaStatutee;:es ame�fied):Y�ilt;�dluation3`ofsinroork�isr��;:��gt):OO or;more, i certify:that�1::the YappiCeant� :halevha'ee�t p*resided-.with:a::copy'<of�theme FioridauConsttrciction triers Law-�Womeowner's Protection-GuideA..prepared by the,.Fdorida.:Cepariment of Agdculture•and.-Consumer.'Affairs.i:if-therappiicant+istsiDMp-eo3e other than the"o finer" f #i{t t f la aEftaifie`it a-capy b.3 di,64e descrity 'ooui ei t'sancb-promise in good faith to deliver it to-the°owndrl:-prior-•to:comrrreggp aQnt. :C:Q.NTMtI�►CTOR'SlOi1lf" iD�A 1! c�rti ,that:a ttae fof at�oa�jr; h sE p Ili ax4op t.*q i�ait -arid tF�at:.alX�ui+ock w111"be done.in coirripllance wit is at!'" pplio le:laws_:regulating,,constructionw-zonin'g and i i�'d�;developmerll.: /i,8plication is hereby made to obtain a permit tad•o iaiiorfic ar iissfalt �id i'sf rikdtcated. i.,certify-that rno work or.installation has commenced.prior to Issuance,of:a.perrn t and,.that all work will;be•,.performedJ6-..nier+t;sta idards of„all.-laws..,r..eguiating cen"s trctlon;� rity"andr,051t� , zoiiing rt`i#;mgulations, � la3 3' levetopment-regulatloris in the•`jur lstlictioh: .I also certify that I understand:that the--regulations of other government'agenciesaf.nay„applyatn-th�e4tntended work,•and;that•it is my responsibility to identify:what actionsal:nmust take•to`be:•in compliance. Such agencies include but areinotAltri ite.d to: - Department of Environm.eritat:Protection-Cypress Bayheads,Wetland_WAreas yard.-Environmentally Sensitive Lands;WaterMasted' , $1fE;: ;"-a Southwest Florida tlyatei! tlitanagement DistrictMelis, Cypress."•.$pyheads, > Wetland Area% -Altering Watercourses.. - Army Corps,of Engineers»s':edralfs;:Docks::NavigablerWaterways: Department oVvHealth:� fl habtilitative;�Servi .s/1=nirironmental Health Unit Weils,r:Wastewater� reatrn`ent, Septic-Tanks. USrEnrtitonrrientaiiP itdotlor oney.Asi estos-abatement:"-. _ Federai'AVwTi`h-::Auitho I understand.that::the-f ollOwlltg rest t iOn4 of fill: Use!t f hil ts.notealt e l iri liito i ne°V"urilose'teaipr.essl permitted: . -if"thd�#lF Material ls,to:...be-used in flood done "1", it is ririiterstooa`that a drainage. plan addressing a "compensating;uojmr' ifli b�g4surrlifled'at'4tlme4of��perrxiittrt ,rtvhpl „,pGoparec#fiy;a°pr.,a#.e_ssionsi'engineer licensed'liy the State of-Plodda. w f*_then Ili -ter aF is ttr;be user;irr�F.leod Z 11Jfie �i`" tri connection with a permitted building using's 6 consfructian..1" rtifji°'ttiat gll.0 i i Bused only„Q - if fill:"material isu?ed An..any area, Is:certtfy that use.of such:flit wilt not adversely affect.„gdjacent wpcoper#ies:- If use:of. itLy fo.4inctstp- dvelrsely effect�adjac ei�� rop+'s'iti'es,#Ells wraer,�maytcclted for violating the conditions-of the building'permit iss red:unclep,ffie-attached permit application;for lots•less than�n..ev{1;).. acre;r�ti►ifich are e[eyaxe�laby411 niongineered itt�aj age plan iequired. It!am3#hQ'/kG?NT iR="7l iia QWt ER,°'I'pfbhiise.in good.�faitlti#a_inform::the owneroi#h'e p'eimitting:corrditiiinsset forth in ti is.,affidayit: rlor-to_commencjng.Hcbnstruction. I understand:that a.separate.permit,may,be.required for electrical:=work, P . gas plumbing,.,::signs;.weils;�pools ,air• .coiaditioriing,•r ►.or other instaitafronswnotwspecift ally,anclurTea irt�tMe applii ation. A permit issued.•shall be.'construed to be•a.license to•proceediwith,,the.work.and not-as authority to-violate,canceiF;aiter or;;.. set�asldelanypiroyieions of?tlrer# ayhnicai codes;-tor shaltisswaiac of~a permit°prevent:the Buiidictg Offciatf om tfieraafter requ!ring* -correctldn of*.errcir-s lri plans,.construction or violations:0 any-codes ••,Eiery-permit-issued`°sti21Hbecome.invalid unless.-the work•.:authoi-ized.bysuch--permit is commenced,within stx.month-0 cif;. .0rmitAssuenc000r...if.work;autho i ed by the~permif,is-suspended'or`abandoned'for-,period'of,sIx(6)months aft0f1he:time the work'!s commenced An extension maybe.requested sin writing,,.from.thwore Building Ofhcial'fdMa��irriod not to exceed ninety'(90)days and will demonstrate l justifiable.cause,for ttie;exterisiorir14k:te asas far•ninet�fzt"�g consecutiue:.days;:the.job�is corisidered.:abandoried - WiA►Rai NG„ "4:QWN.ER: 'YOUR'`fA1RURE..TCI:RE00RD A;NOTI,CE JF C oE MMENGEME-N.T MA iX;-RESULT IN;•YQUR l.__.i., ,� _ -.�.. „�... ,'.k-f.,h� {... .`;. _ aein'y, ..�. tR. •..:f'- :.p1,- .tn:Y: ..tn.�^, ., - _ PAYiNGV1'WkVFO -1MPROVE'W&�°S 'O,,.bu)M rl�Ot?Iwlt :•.i 1�bl. PtTit1, �O.C?ll�`ALN PIN li C1N �:C?t 7 S4tt:T; WITH:.YO.URktSENDI: ORwAfi1�A 1!OR14 Y"hCt=O'iI�E�91t id 3 DING'YOC11St AtO itC' ifJP°` i3iGilNEI C.E1111iE=NT._ - - - Ci7ittDA t712A S:-1"iy:03)s._ •, _w.-_.,.-: 4W1EWO1VAGEN7;: "sCONTRAirTOR' "^ Sub Gibed �sin=td. R �(or4aifinneitjr 9fioire�mediit§<=`"<, Sufxseri60-aridlswa'Atb orti fitied�bafore`•Tne'Uiis : d wo ti t` ). . .bye:. - . ... ,.,-.. ., :,tiy<� • .. . ; .: .._.. ,: . ... Who istare personally known to me or has/have-produced Who lstare:personally;knownvto mero`r`aFiasMOO'e-pre clue asidentlficaUon; :=i- dstiiieiitltCctiort t: Notary Public, :;NotaryPi�tilic:: Commission No. Commisslort,No. Name of Notary typed.Printed or stamped Name, 4'4iGiityped,p#nte* t@iriped>=..•: INSTR4 2020037201 OR BK 10063 PG 1 087 Page 1 of 2 03/03/2020 02:11 PM Rcpt:2141128 Rao:18.50 DS:0.00 IT:0.00 Nikki AlvarezSowles,Esq.,Pasco County Clerk&Comptroller Permit No. Parcel ID No 1 1-26-21-001 0-1 7 30 0-00 5 0 NOTICE OF COMMENCEMENT State of Florida County of Pasco 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. Description of Property: Parcel Identification No. 11-26-21-0010.17300-0050 Street Address: 38834 5TH AVENUE,ZEPHYRHILLS,FL 33542 2. General Description of Improvement Reroof 3. Owner Informations or Lessee information if the Lessee contracted for the Improvement: CHRISTIANSON RUSSELL ANTHONY Name 38834 5TH AVENUE ZEPHYRHILLS FIL Address City State Interest In Property: Owner Name of Fee Simple Titleholder. (If different from Owner fisted above) Address 4. Contractor Iron City Construction LLC City State Name 5D42 Silver Charm Terrace Wesley Chapel FL Address City State Contractor's Telephone No.: 813-909-3778 S. Surety. Name Address City State Amount of Bond: $ Telephone No.: 6. Lender. Name Address City State Lender's Telephone No.: 7. Persons within the State of Florida designated by the owner upon wham notices or other documents may be served as provided by Section 713.13(1)(a)(7),Florida Statutes: Name Address City State Telephone Number of Designated Person: 8. In addition to himself,the owner designates --of— to receive a copy of the Llenor's Notice as provided in Section 713.13(1)(b),Florida Statutes. Telephone Number of Person or Entity Designated by Owner. 9. Expiration date of Notice of Commencement(the expiration date may not be before the completion of construction and final payment to the contractor,but wail be one year from the date of recording unless a different date Is specified): WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Under penalty of perjury,I declare that I have read the foregoing notice of commencement and that the facts stated therein are true to the best of my knowledge and belief. STATE OF Pt'BRrUA &ge.AD7ta COUNTY OPPASM'Wac." 4eo 4t" ti, Signature of Owner or Less ,or Owner's or Lessee's Authorized Officer/Director/Partner/Manager Signatory's Title/Office The foregoing Instrument was acknowledged before me this e_5 day of }7 .20—by as 4O aJ �u .; (type of auth ity,e.g.,ofV%r,trustee,attorney In fact)for OVA V��/tah e. .,rv� (name of party on behalf of whom Instrument was executed). Personally Known V.R Produced Identlfication Notary Signature Type of Identificatlon Prodyced Name(Print) lie MARGEDAY ■ Notary Public•California l Placer County Commission r 2260733 My Comm.Expires Oct 28,2022 wpdata/b cs/noticecommencement_pc053048 OR BK 10063 PG 1 088 Page 2 of 2 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California ) County of '%?& �.AA ) On -o?_S" --2 0 before me, �a; Date Here Inse Name and Tie of the Officer personally appeared - Na e(s)of Signers) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capac'ity(ies),and that by his/her/their signature(s)on the instrument the person(s), or the entity upon behalf of which the person(s)acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph oAY is true and correct. MARGE Notary Public-Callfornfa WITNESS my hand and official seal. Placer County Commission N 2260733 *MY Comm.Expires Oct 28,2022 Signature Xm ,lignatureloNotaryPublk Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signers) Other,Than Narned'-Above: Capacity(ies)Claimed by Signers),. Signer's Name: Signer's Name: ❑Corporate Officer — Title(s): ❑Corporate Officer— Title(s): Partner — ❑:Limited p General..;.,,.:.; ❑Partner — ❑Limited ❑General ❑ Individual ❑Attomey in Fact.., ; ❑Individual ❑Attorney in Fact ❑Trustee ;❑,Guardian or Conservator L Trustee ❑Guardian or Conservator ❑Other: ❑ Other: Signer Is Representing: Signer Is Representing: ©2014 National Notary Association -www.NationalNotary.org - 1-800-US NOTARY(1-800-876-6827) Item#5907 f Y f State Of Florida,County Of Pasco This is to certify that the foregoing is a �LLLP €f, K true and.correct copy of the document on file or of public record in this Office, Witness my hand and offic al seal this S �' day of 1� ri Y Nikki Alvarq' wles, Esq.,Clerk&Comptroller had A,v3�e Pasco�C� Korlds B U v�y , Deputy Clerk lit Business & Professional Regulation BCIS Home ( Log In User Registration Hot Topics Submit Surcharge Slats&Facts Publications Contact Us BCIS Site Map I Links Search Florida Product Approval USER:Public User «.vWt� ra aopr , t rc�,_:s�kr�aim Product Approval Menu>Product or Application Search>Application List>Application History>Application Detail FL# FL5680-R24 Application Type Revision Code Version 2017 Application Status Approved HAa,!)-0r, P 0jjfH pRE:V ILIR)t Comments I Archived ❑ _ ' � . SIG CODE, j'r OFZEPHYRHILLS Product Manufacturer GAF Address/Phone/Email 1 Campus Drive Parisppany,NJ 07054 (800)766-3411 rristieh@gaf.com Authorized Signature Robert Nieminen Ireith@nemoetc.corrr EOF DA7' AfqR 0 3?® Technical Representative William Broussard P LAi ne PAt ZEPHy�L�! I �0 Address/Phone/Email 1 Campus Drive EMINE r I�L Parsippany,NJ 07054 R S (800)766-3411 , Technica]QuestionsGAF@gaf.com Quality Assurance Representative Address/Phone/Email Category Roofing Subcategory Modified Bitumen Roof System 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 J.M. Nieminen the Evaluation Report Florida License PE-59166 Quality Assurance Entity UL LLC Quality Assurance Contract Expiration Date 12/17/2021 Validated By John W.Knezevich,PE Validation Checklist-Hardcopy Received Certificate of Independence FL5680 R24 COI 2019 01 COI NIEMINEN.odf Referenced Standard and Year(of Standard) Standard Year ASTM D6162 2008 ASTM D6163 2008 ASTM D6164 2011 ASTM D6222 2011 FM 4470 2012 FM 4474 2011 TAS 114 2011 Equivalence of Product Standards Certified By Sections from the Code Product Approval Method Method 1 Option D Date Submitted 02/19/2019 Date Validated 02/19/2019 Date Pending FBC Approval 03/02/2019 Date Approved 04/16/2019 Date Revised 06/12/2019 Summary of Products FL#., Model,Number or Name Description 5680.1 GAF Modified Bitumen Roof Systems SBS and APP Modified Bitumen Roof Systems. . Limits of Use Installation Instructions Approved for use in HVHZ:No FL5680 R24 II 2019 02 FINAL Al ER GAF MB FL5680- Approved for use outside HVHZ:Yes R24.odf Impact Resistant:N/A Verified By: Robert Nieminen PE-59166 Design Pressure:+N/A/-465 Created by Independent Third Party:Yes Other: 1.)The DP noted herein pertains to one specific Evaluation Reports system. Refer to the ER Appendix for all systems and max. FL5680 R24 AE 2019 02 FINAL ER GAF MB FL5680- design pressures.2.)Refer to ER Section 5 for Limits of Use. R24.Ddf Created by Independent Third.Party:Yes Back Next Contact Us::2601 Blair Stone Road,Tallahassee FL 32399 Phone:850-487-1824 The State of Florida is an AA/EEO employer.Copyright 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 mall.If you have any questions,please contact 850.487.1395.-Pursuant to Section 455.275(1), 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.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 click here. Product Approval Accepts: ®� ® eChec Credit Card -Safe City of Zephyrhills 5335 r St . Zephyrhills FL 33542 (813)78d=0d20 ROOFING INSPECTION AFFIDAVIT Perrnit No.: � ClUO)" licensed under Chapter.468,Florida Statutes as a(n): Contractor y Engineer_ =Architect Building Inspector_ License No: 1 31 �l/ ECG On or about. did personally inspect the: Check: Roof Deck Nailing Y�L -Dry in Flashing and-Drip edge Checkwhich was used: 30#felt- Peel and Stick Other(List) K.1'x llo tiny-he xPL At the followin address: Way, ^c'- Based Upon that examination, i have determined the installation was done.according to.the Hurricane Mitigation Retrofit Manual(Based on Section 553:844, Florida Statutes). Signature: f�- -_ STATE OF FLORIDA COUNTY OF PASCO Swo n to and subscribed before this day BY: Notary Public State of Florida �•�.rti. ,,,,","; '.'TfRESA`A'PIEPER `�: Wtary..ftbiic-State of Florida + = Commission rr GG 021659 + f+�,;�,• My.Comm!-Expires Sep 30,2020 ���s 9onded.through'NationaLNotarypssn,