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Home My WebLink About21-3052City of Zephyrhills 5335 Eighth Street Zephyrhills, FIL 33542 Phone: (813) 780-0020 Fax: (813) 780-0021 BGR-0030 -2021 Issue Date: 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, lr4 VAkW 0 jq1 t A It 10-im ='M 070? . . I• " e;—#A?X'M accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O. NO OCCUPANCY BEFORE C.O. CONTRA R SIGNATURE PE IT OFFICEC) PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER i 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Building Department Date Received k C)—\q- - a0l i Phone Contact for Permitting I (,; G � (�3) 41121111114t Owner's Name 'I Owner Phone Number S Owner Phone Number E===Owner's Address Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address -2_1 JOB ADDRESS LOT #9 I ac kLD01'�to SUBDIVISION PARCELID#1 (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR F__1 ADD/ALT SIGN DEMOLISH INSTALL REPAIR PROPOSED USE SFR 000MM OTHER TYPE OF CONSTRUCTION t BLOCK Q FRAME STEEL -,P-- DESCRIPTION OF WORK I S I = BUILDING SIZE I SO FOOTAGE HEIGHT It xx8 x vkxw IE I t W.4LIE At k x 'LIE W x x x CX W k X X X X W_ X XX tit k1t It XXX t AL E Xk'k't W X E I X It k It ttlt 14E =BUILDING =ELECTRICAL VALUATION OF TOTAL CONSTRUCTION AMP SERVICE PROGRESS ENERGY W.R,E.C. =PLUMBING 1$ =MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION =GAS ROOFING X] SPECIALTY = OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES No BUILDER COMPANY E;= ;:= SIGNATURE REGISTERED YL N FEE CURREN Y/N L J Address License # ELECTRICIAN COMPANY I SIGNATURE REGISTERED LLLN _J FEE CURREN Address License # PLUMBER F COMPANY [�Y �F.. SIGNATURE REGISTERED l N CIJRR�E.Y J N�� Address F_ License # MECHANICAL COMPANY [ SIGNATURE REGISTERED L_y2_N _J FEE CURREN YIN Address License # OTHER COMPANY SIGNATURE REGISTERED N FEE CURREN _I/N -A iz-11a LMU__f21___ Vnlsadv,07 7 Address h 0 V-d 1't R-1 License # 11t*SAtI14111i titIlt t110211t t141111*11 I at 1111i 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, Stormwater Plans wl Silt Fence installed, Sanitary Facilities & I clumpster; Site Work Permit for subdivisions/large projects COMMERCIAL Attach (2) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. 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, (A/C upgrades over $7500) - Agent (for the contractor) or Power of Attorney (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 AIC Fences (Plot/Survey/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 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 contracter(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, if 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 1, the applicant, have been provided with a copy of the "Florida Construction Lien Law —Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs, If the applicant is someone other than the "owner", I 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, Welland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment. - Southwest Florida Water Management District -Wells, Cypress Bayheads, Welland 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 W" 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 'W' 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 he construed to be a license to proceed with the work and not as authority to violate, cancel, after, 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. 11**tZ4_ 0,1111111'.4=001MMMIJ41111 U17,111TIMMAIT, 1, WMA Z1.01 U OWNER OR AGENT Subscribed and swom to (or affirmed) before me this Who is/are personally known to me or hasJhave produced as identification. Public Commission Name of Notary typed, printed or stamped CONTRACTO Sub I and swo r aff ad be tM r —!=rsonally known to me or has/have m t 7) -, 4 Who is/are personally s/ha�e produced _ as identification. to 1.�Nmary Public Commission No.-_(-12 01 Name of Notary typed, printed or stamped nIP KAITLIN L, HIOTT My COMMISSION # GG 287172 EXPIWS: December 27, 2022 BondedThru Notary Public Underwrilprmj I F Force 1,"ngineering &Testiuq"�� "33 Phm-"'� -18 11 �K-ro-'6603 FA ""R i � 54q Whab Product Evaluation Report STEELIMMICI SYSTElfS. LL Him 29 Ga. AG Roof Panel over 1x,4 Klood Purihns over 1.5132" Plywood Florida Building Code 2020 Per Rule 61G20-3 Method: 1 —1) Category: Roofing Subcategory: Metal Roofing Cxm;dimce Metk+-9: f 16221,-3.445(1)(s) NON HVHZ Lakeland, Florida 33811 Johnathan Green, P.E, #88223 Valiclator: Brian Jaks P,E, #70159 Contents: Evaluation Report Pages I -- 5 SEALED AND THE SIGNATURE MUST BE VERIFIED ON ANY ELECTRONIC COPIES, '- —' F" Force Enghwerhng &Tesfinig /ueoe��u,n��mw,w uumue�w�wn�X 40��3 '�xX: �1u/�54,9,96,1, Compliance Statement: The product asdescribed inthis report has demonstrated compliance with the Florida Building Cnde2O2O Sections 15043.2, 15047. Product Description: AGRoof Panel, Min. 29Ga. Steel, 36"Wide, through fastened roof panel over 1x4 wood pudins over one layer ofasphalt shingles (optional) over min. 15/32" APA Plywood decking. Non'StructurdApp||ce/ion. Panel Material/Standards: Material: Min. 29Ga. Steel, conforming tnFlorida Building Code ZO2OSection 1507.43. Paint finish optional. Yield Strength: Min. 80.0ksi Corrosion Resistance: Panel Material shall comply with Florida Building Code Panel Dimension(s): Thickness: 8D15^nin. Width: 36^Maximum Coverage Rib Height: %" major rib at9^0-C� Panel Rollformer: A,S,C. Machine Tools Panel Fastener: #10-15x1-1/2"n|0Woodghpwith sealing washing qrapproved equal uyminimum penetration through plywood Corrosion Resistance: Per Florida Building CodeZU20, Sectiun15U7.4.4. Substrate Description: Min. 1x4 No. 2 SYP wood purlins over maximum one layer of asphalt shingles/felt paper (optional) over min. 15/32" thick, APA Rated plywood over supports at maximum 24^O.C. The lx4wood pudinsshall befastened tnthe plywood with (l)8dx2B"Ring Shank Nail et4^DI. Design nf1x4wood pvd|ns'plywood and plywood supports are outside the scope nfthis evaluation, Substrate must be designed inaccordance w/Florida Building Code 2o20. Maximum Total Uplift Design pressure; 78.5 psf 10L0 psf *Design Pressure includes a Safety Factor = 2.0. THIS -ITEM HAS BEEN DIGITALLY SIGNED AND SEALED gvJOHmAT*AN GREEN OwTHE DATE ADJACENT TQTHE SEAL. �_.Mmpw WIN SEALED AND THE SIGNATURE MUST BE VERIFIED ON ANY ELECTRONIC COPIES, _ ' � &Tesfing /*,5'3ummpw uunue.necsrrmw pa*m ' �znus404,60o r�x' 540-4AN0,46 Code Compliance: The product described herenhasdemunstratedcomWiencewith The Florida Building Code 2U2C\Section 1504.32' I5047. Evaluation Report �� The product evaluation is limited tocompliance with the structural wind load requirements ofthe Florida Building Code ZO2O asrelates toRule 61G20-3. Performance Standards: The product described herein has demonstrated compliance with: ° UL5B8-0S-Test for Uplift Resistance ofRoof Assemblies ° VLl897'ZV1Z'Uplift Test for Roof Covering Systems 0 FK0447l Foot Traffic Resistance Test Reference Data: l� VL58U'U6/l897-O4Up|iftTest Force Engineering & Testing, Inc. <p8COrganization #TST-S3l8> Report No. 476-8I6OF12 1 FK*4471-1O'Foot TrafficResistance Test Force Engineering & Testing, Inc. <F8COrganization #T5TS32O> Report No. 476'Ol6OTFl2 l Certificate vfIndependence By]ohnmthanGreen, P.E.(No.88223)@Force Engineering &Tesdng (FB[Organization #ANEID: l29O1) Test Standard Equivalency: The UL1897-Dtest standard bequivalent tothe UL 1897-2012test standard, The FM 4471-10, Foot Traffic Resistance test standard bequivalent to the FM 4471-92, Foot Traffic Resistance test standard Quality Assurance Entity The manufacturer has established compliance ufroof panel products in accordance with the Florida Building Code and Rule 61G20-3.0O5(S)for manufacturing under aquality assurance program audited hvonapproved quality assurance entity. Minimum Slope Range: Minimum Slope shall comply with Florida Building Code 2O2n including Section z5O7.4.2and inaccordance vvithManufmctupeorccnmmendatiomu. For slopes less than 3:12'lap sealant must heused iothe panel side laps. Installation: install per manufacturer's recommended details. PAM SEALED AND THE SIGNATURE MUST BE VERIFIED ON ANY ELECTRONIC COPIES. /95m��w,m�c�w u�m�� Naulv�'xmue4�xummA\:/2m//e440 9966 underlawment Per Florida Building CodelUZO Section 15U71.1and manufacturer's installation guidelines. Roof Panel Fire Classification: Fire classification bnot part of this acceptance. Shear Diaphragm: Shear diaphragm values are outside the scope ufthis report. Design Procedure: Based nnthe dimensions ofthe structure, appropriate wind loads are determined using Chapter 16 ofthe Florida Building Code 2VZVfor roof cladding wind loads. These component wind loads for roof cladding are compared tothe allowable pressure listed above. The design professional shall select the appropriate erection details toreference inhis drawings for proper fastener attachment tohis structure and analyze the panel fasteners for pullout and pullover. Support framing must beincompliance with Florida Building Code 2020 Chapter ZZfor steel, Chapter Z3for wood and Chapter 16for structural loading. SEALED AND THE SIGNATURE MUST BE VERIFIED ON ANY ELECTRONIC COPIES, Testing, $hBAPie: S ,;44dW(,1603 FAX "x} 40,,9;€poi IN it h k #10-15 x 1 1 /2" HiLO WOODGRIP / SEALING WASHER '- ix4 WOOD PURLINS e 24' ILA. ATTACKD TO PLYWOOD Wt (1) 8dx2 11 ' RING SHAW NAILS e 4' O-C ONE LAYER OF ASPHALT SHINGLES/FELT (OPTIONAL) OVER 15/' PLYWOOD M2 #10-15 x 1 1 /2" HILO WOODGRIP / SEALING WASHED ONE LAYER OF ASPHALT SHINGLES (OPTIONAL) OVER 15/32' PLYWOOD ITEM THIS ill° HAS S BEEN !DIGITALLY�iISEALED BY OHNATHAN G ON ADJACENT COPIESOF !DOCUMENT ARE !SEALED AND THE SIGNATURE MUST BE ON ANY DATE (MM1DDNY ACC>1?0 CERTIFICATE OF LIABILITY INSURANCE 10131120 TIFICATE HOLDER. TH THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICI BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZ REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER I . - I N L INSU D provisions or be enclors isit-rar Iffirzigig". 09911-14 aw-as 01M I [lilt a PRODUCER ALL BUSINESS UNDERWRITERS BOX 3075 DUNNELLON INSURED TYER'S ROOFING & SON, INC. KIMBERLY AND JR TYER 11720 BAILEY ROAD ICATWI F-r-M THIS IS TO CERTIFY I HAI I Ht� VVI-1k, INDICATED. NOTWITHSTANDING ANY CERTIFICATE MAY BE ISSUED OR Mi EXCLUSIONS AND CONDITIONS OF SU TIP.OF.NSUPANCE X COMMERCIAL GENERAL LIABILITY , CLAIMS -MADE 'XOCCUR A GEN'L AGGREGATE LIMIT APPLIES PER 'X POLICY PRO- JECT LOC ACT ALL BUSINESS UNDERWRITERS E 40, Ed): _(727) Lq403-9470 Q�, Na}. L FSS:, AkiBI44NDE-RWRITER,S@-BELL-S-OUTHNN,ET.,-.- !NSqRERlS)AFF NG COVERA NAIC 0 HOUSTON SPECIALTY INSURANCE CO B: E: Is RtVIbIUN NUMDIM-PS: TIFICATE NUMBER: , OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD EQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS., AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EXCESS LIAD CLAIMS-MADE� DED RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNERIEXECLITIVE OFFICERIMEMBER EXCLUDED' NIA (Mandat.ly I. NH) If yes, describe under I TEN-25-843 IOUCY EFF IIUUI,y FA LIMITS tMIDDfYYYY YYr y MITS EACH OCCURRENCE_ --DAMAGE RENTEDE_T` S 100,000 EMIS S.(Ea,ocr rren 9) - 10131/20 10/31/21 MED EXP (Any one 5,000 .PERSONAL ADV INJURY S 1,000,000 G ERAL AGGREGATE 2,000,000 PRODUCTS - COMPIOP AGG_ S_ _2,090,000 - S S = w I W-4110 00 1 21a. M10*112HIM-01=101sumn COMBINED SINGLE LIMIT S (Ea accigent) _ __ BODILY INJURY (Per perSOn) S BODILY INJURY (Per accident} S PROPERTY DAMAGE� S (Per accident}... EACH OCCURRENCE S AGGREGATE S PER OTH- STATUTE .ER EL EACH ACCIDENT EL DISEASE, EA EMPLOYEE, S E.L.DISEASE-POLICY LIMIT �S CERTIFICATE HOLDER CANCELLATION CITY OF ZEPHYRHILLS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 5335 EIGHTH STREET ACCORDANCE WITH THE POLICY PROVISIONS, ZEPHYRHILLS, FL, 33542 AUTHORIZED REPRESENTATIVE J BACON@C I ZEPHYRH ILLS. FL. US lmfffla e @ 1988-2015 ACORD CORPORAT The ACORD name and logo are registered marks of ACORD STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Wlim, ON I F-11 11111 W-11 I. r—AVI-1 a a 2 Congratulations! With this license you be o ' me' ne jo 'om ' co the nearly one million Floridians licensed by the Department of Business and Professional Regulation. r and they keep Florida's economy strong. Oreq 51"Tre TTo77MrII,#1ro,re'uI- in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! STATE OF FLORIDA DEPARTMENT dblar OF BUSINESS AND PROFESSIONAL REGULATION CCC058194 ISSUED: 08/18/2020 CERTIFIED ROOFING CONTRACTOR TYER, KIMBERLY CROSS TYER'S ROOFING &SON INC Signatu 'g LICENSED UNDER CHAPTER 489, RIDA STATUTES EXPIRATION DATE: AUGUST 31,2022 Al t" Ron DeSantis, Governor Halsey Beshears, Secretary STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER: CCC058194 EXPIRATION DATE: THE ROOFING CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES TYER, KIMBERLY CROSS TYER'S ROOFING & SON INC 11720 BAILY RD KATHLEEN FL 33849 ISSUED: 08/18/2020 Always verify licenses online at MyFloridaLicense.com Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. JIMMY PATRONIS CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 7/23/2021 PERSON: KIMB111 II ERLY C TYER FEIN: 371r� 479193 EXPIRATION DATE: 7/23/2023 EMAIL: TYERSROOFING@AOL�COM TYER'S ROOFING & SON, INC 14 (11720 BAILEY RD J,T LEEN, Fl-,49-- SCOPE OF BUSINESS OR TRADE: Roofing ® All Kinds and I IMPORTANT: Pursuant to subsection 440.05(14), F,S-, an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter, Pursuant to subsection 440,0511 F,S,, certificates of election to be exempt issued under subsection (3) shall apply only to the corporate officer named on the notice of election to be exempt and apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to subsection 440,05(13), F.S., notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate, The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 E01375075 QUESTION5? (850) 413-1609 Nikki Alvarez-Sowles, Esq., pasco County Clerk & Comptroller state Of Florida I County of Polk itrument was acknowledged before me this -E-)d,.f 20a\ The By (Name of Femn) Personally (nowmn or MY COMMISSION ff GO 287172 ^ _' �� ROOFING INSPECTION AFFIDAVIT Permit No —Z—tc— licensed under Chapter 468, Florida Statutes as a(n): Contractor En ineer Architect Building Inspector_ License No. On or aboutdid personally inspect the: Check: Roof beck Nailing Dry in Flashing and Drip edge Check which was used: 30# felt_ Peel and Stick_ Other (list) CJi At the following address: Based upon that examination, I have determined the installation was done accordine to the Hurricane Mitigation Retrofit Manual (Based on Section 553.844, Florida Statutes). Signature:�� STATE OF FLORIDA Sworn to and subscribed before this day � *� BY:��V� Notary Public State of Florida KAITLIN L. H6 i � C0MMISS10N # GG 2ua-- 1 o�� t (t Bonded ih tttRlot.ryPah(iet.fndei�yntrs �