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HomeMy WebLinkAbout21-1441 Q City Of Z@phyrhlllS PERMIT NUMBER 5335 Eighth Street Zephyrhills, FL 33542 BGR-001441-2021 Phone: (813)780-0020 Issue Date: 02/01/2021 Fax: (813)780-0021 Permit Type: Building General (Residential) Property Number Street Address . 02 26 210080 00100 0130 6005 11Th Street Owner Information Permit Information Contractor Information Name: MARGO MCNAMARA Permit Type:Building General(Residential) Contractor: GREENTEK PROPERTY Class of Work:Reroof SOLUTIONS LLC Address: 6005 11Th St Total Valuation:$8,103.00 ZEPHYRHILLS,FL 33542 Total Fees:$80.52 1 Phone: (813)393-7336 Amount Paid:$80.52 Date Paid:2/1/2021 11:56:5 Project Description REROOF SHINGLE Application Fees Building Permit Fee $80.52 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 subsequent reinspection. 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 permit 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 add fee 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. CONTRACTOR SIGNATURE PE IT OFFICE PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 )y� ` Building Department Date Received ��✓ S D Phone Contact for Permitting - -rrn-row. M r Q Owner's Name J"U1�6�-ANC Me Q Owner Phone Number Owners Address 600 IIh. T. ) t 5 Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address T 1 LOT#JOB ADDRESS 6005 IkA-, )TREEZ l3 SUBDMSION �ysGN SUB, PARCELID# oz.-'z6'2�-00�o-001Go-�ol30 - (OSTAINED FROM PROPERTYTA7t NOTICE) WORK PROPOSED ® NW CONSTRALL 8 REPAIR SIGN = = DEMOLISH PROPOSED USE SFR 0 COMM•i = OTHER TYPE OF CONSTRUCTION BLOCK 0 FRAME = STEEL = aESo�>= e e 1 T1 G lt1GL )RE VLACF. o'eCEO w O DESCRIPTION OF WORK BUILDING SIZE —� SQ FOOTAGE 21�0 HEIGHT =BUILDING S C� 1 IDS VALUATION OF TOTAL CONSTRUCTION =ELECTRICAL $ v AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C. =PLUMBING g =MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION =GAS ® ROOFING Q SPECIALTY = OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO BUILDER �1I1� COMPANY. SIGNATURE 1`1 J"'� REGISTERED I Y/ N FEE CURREN t,�Y/N Address License#(1 1v ELECTRICIAN N (A COMPANY SIGNATURE 1 t��` REGISTERED Y/ N FEE CURREN Y/N Address ►v IQ. License# I PLUMBER J n COMPANY' SIGNATURE t�1 REGISTERED Y/ N FEE CURREN wY,/N Address 1 !-1 License# `y MECHANICAL NJ A COMPANY I . N A SIGNATURE 1'1\ REGISTERED I Y/ N FEE CURREN �Y1/N Address A License# IV OTHER . COMPANY 6{�N�CEK PRA $ 1 VT 1.LG SIGNATURE. REGISTERED I Y/ N FEE CURREN Y/N Address loz2o H Nay RD, oT License# IC-CC 332D2� RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction, Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stornwater Plans w/Silt Fence installed, Sanitary Facilities&1 dumpster,Site Work Permit for subdivisions/large projects COMMERCIAL Attach(2)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Fortes.R-O-W Permit for new construction. Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, Sanitary Facilities&1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance SIGN PERMIT Attach(2)sets of Engineered Plans. —PROPERTY SURVEY required for all NEW construction. Directions: Fill out application completely. Owner&Contractor sign back of application,notarized If over$2500,a Notice of Commencement Is required. (AIC upgrades over$7500) Agent(for the contractor)or Power of Aftomey(for the owner)would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (copy of contract required) Reroofs if shingles Sewers Service Upgrades A/C Fences(PloUSurvey/Footage) Driveways-Not over Counter if on public madways..needs ROW 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 ` Building Department a NOTICE OF DEED RESTRICTIONS:The undersigned understands that this permit may be subject to"deed"restrictions"which may be more restrictive than County regulations.The undersigned assumes responsibility for compliance with any applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES:If the owner has hired a contractor or contractors to undertake work,they may be required to be licensed in accordance with state and local regulations.If the contractor is not licensed as required by law,both the owner and contractor may be cited for a misdemeanor violation under state law.If the owner or intended contractor are uncertain as to what licensing requirements may apply for the Intended work,they are advised to contact the Pasco County Building inspection Division—Licensing Section at 727-847-8009. Furthermore,if the owner has hired a contractor or contractors,he is advised to have the contractor(s)sign portions of the"contractor Block"of this application for which they will 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 to permitting privileges in Pasco County. TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES:The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings,change of use in existing buildings,or expansion of existing buildings,as specified in Pasco County Ordinance number 89-07 and 90-07,as amended.The undersigned also understands,that such fees,as may be due,will be identified at the time of permitting.It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a"certificate of occupancy'or final power release.If the project does not involve a certificate of occupancy or final power release,the fees must be paid prior to permit issuance.Furthermore,0 Pasco County Water/Sewer Impact fees are due,they must be paid prior to permit Issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW(Chapter 713,Florida Statutes,as amended):If valuation of work is$2,500.00 or more,I certify that I,the applicant, have been provided with a copy of the"Florida Construction Lien Law—Homeowners Protection Guide"prepared by the Florida Department of Agriculture and Consumer Affairs.If the applicant is someone other than the"owner",1 certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the"owner prior to commencement CONTRACTOR'S/OWNER'S AFFIDAVIT:I certify that all the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construction,zoning and land development.Application is hereby made to obtain a permit to do work and installation as indicated.I certify that no work or installation has commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating construction,County and City codes,zoning regulations,and land development regulations in the jurisdiction.I also certify that I understand that the regulations of other government agencies may apply to the intended work,and that it is my responsibility to identify what actions I must take to be in compliance.Such agencies include but are not limited to: - Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands,Water/Wastewater Treatment. - Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. - Army Corps of Engineers-Seawalls,Docks,Navigable Waterways. - Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment, Septic Tanks. - US Environmental Protection Agency-Asbestos abatement. - Federal Aviation Authority-Runways. I understand that the following restrictions apply to the use of fill: - Use of fill is not allowed in Flood Zone"V"unless expressly permitted. - If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a "compensating volume"will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. - If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall construction,I certify that fill will be used only to fill the area within the stem wall. - If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties.If use of fill is found to adversely affect adjacent properties,the owner may be cited for violating the conditions of the building permit issued under the attached permit application,for lots less than one (1) acre which are elevated by fill,an engineered drainage plan is required. If I am the AGENT FOR THE OWNER,I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing 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 application.A permit issued shall be construed to be a license to proceed with the work and not as authority to violate,cancel,alter,or set aside any provisions of the technical codes,nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors In plans,construction or violations of any codes.Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance,or if work authorized by the permit is suspended or abandoned for a period of six(6)months after the time the work is commenced.An extension may be requested,in writing,from the Building Official for a period not to exceed ninety(90)days and will demonstrate justifiable cause for the extension.If work ceases for ninety(90)consecutive days,the job is considered abandoned. 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 BTAIN FINANCING,CONSULT WITH YOUR LENDER ORAN ATTORNEY BEFORE RECORDIN link FLORIDA JURAT(F.S.117.03) OWNER OR AGENT CONTRACTO Subscribed and swom to(or affirmed)before me this Subscribed and om o or affi ed)before a this by 02-0 - t o E J Who is/are personally known to me or has/have produced Who is/are pe nally known to rr a or has/have produced as identification. ..�. as id nti tion. Notary Public uI , Notary Public Commission No. Commission NO._CTCT 3-12.L1 Io Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped A DAVID HILL �. Notary Public,State of Fluids .1 Commission No.GG342410 aw.7 Commission Expires 06/06/2023 INsTR#2021013058ORBK10262PG1379 Page if, 01/21/2021 12:08 PM Rcpt:2251388 Rec:10.00 DS:0.00 IT:0.00 Nikki Alvarez-Sowles,Esq.,Pasco County Clerk&Comptroller AM RECORDING—PM P,To, 10220 Harney Road Thonotosassa,FL 33592 MU ME OF 0 The undersigned hereby gives notice that iinprovement mill be made to certain real property.and in accordance with Chapter 713. Florida Statutes,the following infitratation is provided in this Notice of Commencement. t. DLWRIMO;N oFPROPEItTY(Legal description of the property&street address,ifasidlable)TAXFoUo NO.: SUBDIVISION Bt OCIC__i TRACr L07 __BLDGL L-IrX 'N3o% go%, pit !J. PG 1o!3 BL.O*,IL o IL %7.0 ?G 0110 01R.5 536 4k-0-122 2.GENTMAL DESCRIPTION OF nWR0'WTXM"r. fg4m& 3. OWNERMURNLATION ORLYMIX LNFQ10LAMo'.VlF THE LLSSEE CONMCTEDFORTHE rAPROAVMNr-. Cq Q — A bi tO rin-'5 "ante"doddress: M - * --104 b.interest in Property: Owner-'j Ime and address offee simple titleholder(iftfiffaeor fiom omm fisted obove)�c.IN 4. a.CONTRACTOR'S NAM GrGSITM PrOPO4 SOIUUOnS Counclof saddress: 10220 Homey Road,Thonolosassa,FIL 33592 b.Phone amber 813-333-1963 5. St'�jtMQfqVVjicabje,a copy ofthepmrsuent bond isaftsched); a.\,'=e and address: NIA b.Phone amber c.Amount ofbm&-$ 6.a.LENDER'S NAME: N/A Lender's address: _b.Phone n=ber_ 7. persons within the State of Florida designated by Owner upon nbom notices or other documents may be served as provided by Seeton 713.13(1)(a)7..Florida Statutes: a ;=e and aftgw, NIA b.Phone ambers of desipmed perww. B.a.In addition to himself or herself Owner designates of to receive a copy of the Lievor's Notice as provided in Section 713.13(1)(b).Florida Statutes. 9. Expiration date of notice of commencement(the expiration date will be I year from the date of recording unless a different date is specified): - 20�-- NVARNUM IQ OWNIM:ANY PAY'IENTS MADE BY THE AFTER THE EP-E&&1M0T THE NOTICE OF ON%—'M- ARE CONSIDERED LMPROPER PAYMQa$UNDER CHAPTER 713 PART-L SECTION 713.13,FLORIDA STATUM,AN-V CW RESULT D;yQU _TO)VOLT ,PROPERTY A NOTICE CQ.Q9RCXh9=IRMT BE g P-A-Y—MQ TWICE FOR M9XQW-NMMS RECORDED ANM PQ$M ON'UM X0B SEEM BEFORE IM EMn WSREMON,W YOU RUEtMTO OBTAIN FIKAKM(h CONSULT AXT(W YOUP,LEX N -MNCING WORKM RECD -0 YOUR 140TICE OF C0M=N-MN-M�M MERDRA MORNEY BEFORE coXm RDD-4 (Signature ip.t ..9TOwnir or Lessee.of Owner's or Lessees Authorized 011icerMirector/Parluet:02 Unager) State ofTLOF-km T co-Myof WkU-S%6Pm36kN The foregoing instrument was acknowledged before me s0 day odwa, 202.1 by KN94C)—jk G L tj 6"M (*Pe of authority...P—#.ctfficsr�.trust,;Mornay in fact).. for A' k-61 , , . (name of party on behalf ofwhom instrument I%,%as executed) VL Personally ou Pro duced Identificatim-Z Type of1dentificatiou Produced.has-'SLAI-600-lill-o DAVID HILL Notary Public,State of Florida Is Comm"on No.GG3424110 '(Signature of Notan.-Public) -*or Cwnm1s5im Expires 0$10M3 (Rkk Type,or Stamp Commissioned Name ofl4otary Public) $tato Of Florida,County Of PaS00 This Is to certify that the foregoing is a true and correct copy of the document on file or of public record in this office. Wltne s my hand. pnd official seal this day of D" )aru 2mj-- Nikki Alvaro l-Sowle-q.'Esq.,Cjer�)&Comptroller 87 Pasco IWdasco Ugv® BY Deputy Clerk U qy8 _ +.. li SE C148�OZ8"da.±+C1_iC�&k7 42' :. ©I7' ■ . S'!- R'i - jPH�NE;877-�8Z 832 PRQPEFUYSCLURK :5.-LtC INSTALL, 1"AGREE�IP_E�1T - - --- hR1 (�wi1Cr; city.`St,zip: t' L t -1; - county: Subsfivisidn: i _ . 1l0igC:_ 3Vfld:: __ - Cell: .r t insurtu►ce Cvtllpany;_ v : ;_ Claim,#: �' BOA,Yes or (Circle)___ Grater ode: :tUaiNc' CIFICATIONS. !: NIANUPACT'Uit61t(Sp � .--- _ _ _ ---_ C 2`Y.EA[L`WOAI:IiANSNCPWARRANTY�t;O.NV,'SLUPF 0 S fv i.rjauiI}E -- r e 'ADDITIONAL WAARRANTY b11TIMS.-.-- ` G fG r,]T-F - G7 COLt)lt'_Q ANII'IALS .NEMShRY a TE'u'i<orF � RUAYMENT _.�' i tl ;jaitOTE4"I' t.r1NDSCr1PiNGrPOCiL,1)l;Ci�'AS`�.- '' ��PAINTALi, 00FiiAR 1VARCTONSAT,C11; 13 fACi URER'.WAR ;1 3NTCRI 'R--WOR.t: ___ 5►('�,.. ,t7 0 nt:CK1NG r. . G VALLEY � - - .,���. - - - C7 SPECGtL=INSiI'RUG'i'IONS- d P&E PI:AS1lING5_ a AMETAL"GOGiNG:_- _ __'' boa E FF . re 0 d ' _ _ - GlsNEf�AL-CON'Pit�C'Iff G SPEC�):ICA7'1Q;ya' 0 ADDITiONAL'ROSF - ' Sl'S1'EAtI .... __ __,�C�ct�►lC'--_Str.�'.� .� _ ___. _���-_. - € [i7J R>~PLA6E STEP-FLASHING i " 1VRgp ALLPENEitkTIONS'NITH,tICFA-VATE'ft,SiIIELfi W C' LEA'NUP'ANU"HAUL OFF ALL DEBRIS,ROLL,FORNAILS - [3 S 1'CAR 1VORICI IANSHiPP'VARRr1NTY STEEP SLOPC Proptiity;Owno�.Natters �Paymririt-'Tzrms You,may pay_u"s as,you,.aro,pald:by,tiaiie c inptetii;r?, artdiar,'a'i�ffi ur, 1l kdn y6u .cohWdl work .done `on .your, •property, 'Cor!tir�Ctora, enortgagn company Eteleases. .yoirr 'turtd�, an8; :a ii?Eft tIOB. Subcontracto_""rs and`Matnelai'.aiitl`Equtpment Suppliers'ell:ttaye a COMPLETED MSi&Vi Wil fiol racers ttir;; a _.nr+oitt required!s Right to'Llonyouur•proRnrty. A you_pay,ue,we will prtiVlde you lho' P you P. p_tom.. _•bq, UElf WAIVERS aa.ragatred that-releasaa theso righta,'Ps"a:pait of yourinsor ace and rnortgege companies. ,this,rrontfact,you§Ws 4iAhe spedfic'RIGHTTQ=CURElany,.mafejial or Otfdr-8'Firiariciat`Summarv, workmAnstifpde(ectyouctainnreger+d(ilg,tfiiscantraciby,givingusaccess - - - - -- W ln3p€ct;docuiiient,and'CUEtE the defect. A, { boat - inrE HEREBY'RRQPOSE 'to'furnish oil rnaterials,labor,suod,onttrictors, equipment and other s oea and items iequii`ed to cornAtet®;tfii5 Ro Roof: 1V1 __ F1:st Check .v ��, g-��-- agieement to meat of ezceed`211 state b local building codes:Atl:contracts+Upgiades: --_-- Ded►ri ,tile:— . started ivithih 3Q Day-s of Nnding o completed t Ihln 90 days of staring; Itltaitor. - U-�a� — Rcprecialion1031 ExiCfIOC- __ FlnaT Pay; ,Depredatlon,,Otdlnanca&4w,any approved change Work Not boing: :IRsurance Total; _ orders and supptements`iiointhe tnfueance company are due�peneetelpt., `' rAi:deddedbiepaviiient-,,5(e4ueuponslg'eiiigoftoittiact; - - `but no later than irrate�lal drop srthe aticue refere_tioed-jobs • addi6s. rat io Aca�ptetl bySOvi►ntlr8y == y " s = -- - -- - - -- Date:_b�f � �' c0 4� ��' �-_`_�-O:�' As .property ownei,:I;hereby authorize LLC.tis my.:Contractor•and diiec►trny insurance company to.aPprove:th- reconstruction partron oFmy clarmtbttsed on this agcemcnc�tllien el+celitcd.pcior to tlre.satisfactory adjustiiieiit of rny,;claim;.it•is executed'CONTliVG1 T'[lPO+I�APPRt7VAL�'�of mY claun .No wor{:�yill procEed}u>itil.iriy.clalmr<is adju5terirfa my sdiisCnction;ale mate_rfal scle666ii5aiid oti "`sitictiudfi&)FlNALIZFDArid?fiiritis:arc avmilalile'to pa -4tit the iJobs as ilicy,are satisfactoril cOropletdd. fit Business & Professional Fegulation BCIS Home I Log In I User Registration I Hot Topics I Submit Surcharge I Stats&Facts I Publications Contact Us I BCIS Site Map I Links I •Search I FI rida r10m, Product Approval USER:Public User Product AMMUygil Menu>Product or Application Search>gp_plication List>Application Detall FL# FL10124-1128 Application Type Revision Code Version 2020 Application Status Approved Comments Archived Q Product Manufacturer GAF Address/Phone/Email 1 Campus Drive Parisppany,NJ 07054 (800)766-3411 mstieh@gaf.com Authorized Signature Robert Nieminen Ireith@nemoetc.com Technical Representative William Broussard Address/Phone/Email 1 Campus Drive Parsippany,NJ 07054 (800)766-3411 TechnicalQuestionsGAF@gaf.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 0 Evaluation Report-Hardcopy Received Florida Engineer or Architect Name who developed the Robert Nieminen Evaluation Report Florida License PE-59166 Quality Assurance Entity UL LLC Quality Assurance Contract Expiration Date 12/16/2022 Validated By John W.Knezevich,PE 0 Validation Checklist-Hardcopy Received Certificate of Independence FL10124 R28 COI 2020 01 COI NIEMINEN.odf Referenced Standard and Year(of Standard) Standard Year ASTM D1970 2015 ASTM D3161 2016 ASTM D3462 2010 ASTM D7158 2019 TAS 107 2020 Equivalence of Product Standards Certified By Sections from the Code Product Approval Method Method 1 Option D Date Submitted 09/21/2020 Date Validated 09/26/2020 Date Pending FBC Approval 10/02/2020 Date Approved 12/15/2020 Date Revised 12/21/2020 Summary of Products FL# Model,Number or Name Description 10124.1 GAF Asphalt Roof Shingles Fiberglass reinforced 3-tab,laminated,5-tab and hip/ridge asphalt shingles Limits of Use Installation Instructions Approved for use In HVHZ:No FL10124 R28 11 2020 09 21 FINAL ER GAF ASPHALT Approved for use outside HVHZ:Yes SHINGLES FL10124-R28.pAf- Impact Resistant:N/A Verified By:Robert Nieminen PE-59166 Design Pressure:N/A Created by Independent Third Party:Yes Other:Refer to ER,Section S. Evaluation Reports FL10124 R28 AE 2020 09 21 FINAL ER GAF ASPHALT SHINGLES EL12124-1128.pd 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 AAJEEO 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 mail.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 ernalls provided may be used forofficlal 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 hem. Product Approval Accepts: Credit Card Safe U ° e Professional Regulation BCIS Home I Log In I User Registration I Hot Topics I Submit Surcharge I Stats&Facts Publications Contact Us I BCIS Site Map Links I •Search I , Florida rw Product Approval USER:Public User EN.t1ruWFi',+�.� Product Approval Menu>Product or Aonlica[lon Search>eppiication Lis[>Application Detail FL# FL22259-R3 Application Type Revision Code Version 2020 Application Status Approved Comments Archived G Product Manufacturer Beacon Sales Acquisitions,Inc.c/o Owens Coming Roofing and Asphalt LLC Address/Phone/Email 1 Owens Coming Parkway Toledo,OH 43657 (740)587-3562 greg.keeler@owenscoming.com Authorized Signature Greg Keeler greg.keeler@owenscoming.com Technical Representative Address/Phone/Email 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 0 Evaluation Report-Hardcopy Received Florida Engineer or Architect Name who developed the Zachary R.Priest Evaluation Report Florida License PE-74021 Quality Assurance Entity Intertek Testing Services NA,Inc.-QA Entity Quality Assurance Contract Expiration Date 12/31/2024 Validated By Steven M.Urich,PE Validation Checklist-Hardcopy Received Certificate of Independence FL22259 R3 COI OCR17002.3 2020 FBC Eval Beacon Tri-Built Syn Underlaym n final.p_df Referenced Standard and Year(of Standard) Standard Year ASTM D 1970 2015 ASTM D 226 2009 ASTM D 4533 2015 Equivalence of Product Standards Certified By Sections from the Code Product Approval Method Method 1 Option D Date Submitted 10/21/2020 Date Validated 10/23/2020 Date Pending FBC Approval 10/28/2020 Date Approved 12/16/2020 Summary of Products FL# Model,Number or Name Description 22259.1 Beacon Tri-Built A mechanically attached,synthetic underlayment for use in steep slope roofing applications as an alternative to ASTM D 226,Type I or Type II felt. Limits of Use Installation Instructions Approved for use in HVHZ:Yes FL22259 R3 II OCR17002.3 2020 FBC Eval Beacon Tri-Built Syn Approved for use outside HVHZ:Yes Underlayment final.pdf Impact Resistant:N/A Verified By:Zachary R.Priest PE-74021 Design Pressure:N/A Created by Independent Third Party:Yes Other:See evaluation report for limits of use. Evaluation Reports FL22259 R3 AE OCR17002.3 2020 FBC Eva[Beacon Tri-Built Syn Underlayment final.pd 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.CODVrioht 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 mall 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(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 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 click here. Product Approval Accepts: ®® © ecr�I Credit Card Safe G re e noi TT E: KK PROPERTY SOLUTIONS , LLC 10220 HARNEY RD.THONOTOSASSA FL 33592 PHONE NUMBER-(813)-333-1963 Business Name : Greentek Property Solutions LLC Business Address : 10220 Harney Road Thonotosassa FL 33592 .Office Phone : 813-333-1963 E-FAX Number : 813-441-8106 e-mail Address : dhill@&Yreentekps.com Ron DeSantis,Governor Halsey Beshears,Secretary • . - FloridMAW STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION IN0JSTRY1 LICENSING BOARD , THE ROOFING CONTR IED UNDER THE PROVISIONS_`, GHAJ•PTERyy S4'89;yFL0R`[ A C. TUTES EF GR,E�NT6KI p�R�r;PE RTY'SOL.UTIONS-LLC .`102 NEY=- b'A,D T ; Ofi�OTOSAS[y=rpSAL335�92 sue_ i/P LICENS 6KRCCG133�2028 EXPIRATION DATE: AUGUST 31, 2022 Always verify licenses online at MyFloridaLicense.com Ell ' Do not alter this document in.any form. 0�� This is your license. It is unlawful for anyone other than the licensee to use this document. AL/+ �j ® DATE(120/20 YYYY} �4.I/�lsl.� CERTIFICATE OF LIABILITY INSURANCE 05/20/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER co TACT Certificates Department NAME: Single Source Insurance PHONE (727)29$-0302 FAX (727)29$-0029 A/C No.Ex! A/C No: 2189 Cleveland Street E-MAIL S: certificates@singlesourceins.com ADDRE Unit 235 INSURER(S)AFFORDING COVERAGE NAIC 0 Clearwater FL 33765 INSURERA: United Specialty Ins Cc 12537 INSURED INSURER B: AmGUARD Insurance Company 42390 Greentek Property Solutions,LLC INSURERC. American Interstate Insurance Company 31895 10220 Hamey Rd INSURER D: INSURER E: 7honotosassa FL 33592 INSURERF: COVERAGES CERTIFICATE NUMBER: CL2052010891 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCEAOOLBUBK POLICY EFF POLICY EXP LIMITS LTR I SD WVD POUCYNUMBER MMIDp MM1DD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE ®OCCUR PREMISES Ea occurDrenoe $ 100,0 DANIAGE TO 00 MED EXP(Any one person) S 5.000 A Y Y VGGPOO4156 05/22/2020 05112212021 PERSONAL&ADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 PiPOLICY❑JEG Q LOC PRODUCTS-COMPIOPAGG S 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s 1,000,000 Ea accident ANYAUT4 BODILY INJURY(Per person) $ B OWNED x SCHEDULED GRAU146756 05/22/2020 05/22/2021 BODILY INJURY(Per accident) s AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S X AUTOS ONLY M — $ AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE S DEC) I I RETENTION$ s WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 0 -... - C OFFICERIMEMBEREXCLUDED? NIA AVWCFL2868$62020 02/13/2020 02/13/2021 1,000, 0 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 00 It yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMITS DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached tf more space Is required) Certificate Holder is listed as Additional Insured with regards to General Liability.Primary&Non-Contributory Wording included.Certificate Holder listed in favor of Waiver of Subrogation with regards to General Liability.30 day written notice in the event of cancellation. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN CITY OF ZEPHYRHILLS ACCORDANCE WITH THE POLICY PROVISIONS. 5335 8TH ST AUTHORIZED REPRESENTATIVE ZEPHYRHILLS FL 33542 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 2020 2021 HILLSBOROUGH COUNTY BUSINESS TAX RECEIPT EXPIRES SEPTEMBER 30,2021 154799 OCC.CODE IRENEWAL '260.025004 OFFICE Receipt Fee 30.00 Hazardous Waste Surcharge 40.00 Law Library Fee 0.00 BUSINESS GREENTEK PROPERTY.SOLUTIONS LLC 10220 HARVEY RD THONOTOSASSA, FL 33592 202 Off"' 2021 GREENTEK PROPERTY SOLUTIONS LLC NAME 10220 HARVEY RD MAILING THONOTOSASSA, FL 33592 ADDRESS Paid 19-648-053468 07/21/2020 70.00 BUSINESS TAX RECEIPT DOUG BELDEN,TAX COLLECTOR HAS HEREBY PAID A PRIVILEGE TAX TO ENGAGE 813-636-5200 IN BUSINESS.PROFESSION.OR OCCUPATION SPECIFIED HEREON THIS BECOMES A TAX RECEIPT WHEN VALIDATED. 9 GreenTE-K PROPERTY SOLUTIONS , LLC 10220 HARNEY RD.THONOTOSASSA FL 33592 PHONE NUMBER-(813)-333-1963 Business Name : Greentek Property Solutions LLC Business Address : 10220 Harney Road Thonotosassa FL33592 Office Phone : 813-333-1963 * E-FAX Number : 813-441-8106 -e-mail Address : dhill@greentekps.com I J c\,-- V��uo_, License Holder For Greentek Property Solutions LLC, State Certified Roofing License Number, CCC1332028, Designate The Following Personel, As Authorized To Sign , Make Application For Permits,And Pick Up Permits, From The City Of Zephyrhills, �PNjt> LA.P," "ILL R FL bQ4 W4o0_jj2_61_02S_0 SMMR"ThA IELVZAS� Mtjg FL bi-# Ygoo T-P�E mck FL bLtc CD The foregoing instrument was acknowledged before me this 2 ND. day of Mftak .201ZO By 3WA v_r T-Pqc►kAC6 0-, as license holder,for Greentek Property Solutions LLC Personally Known elo- or Produced Identification Type Of Identification Produced (Signature of Notary Public) AMMDADAVIS (Print,Type,or Stamp Commisloned Name of Notary Public) COMMISSION#GO 081028 EMPIRES:March 6,2020 Bonded ru Notary Public UrderydOm