HomeMy WebLinkAbout14-14879 CITY OF ZEPHYRHILLS
° 5335-8TH STREET
(si3)�so-oo20 14879
BUILDING PERMIT '
Permit Number: 14879 Address: 5754 12TH ST
Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL.
Class of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11-26-21-0010-05200-0110
Improv. Cost: 2,622.00
Date Issued: 1/15/2014 Name: FORCE, SHIRLEY
Total Fees: 75.00 Address: 5754 12TH ST
Amount Paid: 75.00 ZEPHYRHILLS, FL. 33542
Date Paid: 1/15/2014 Phone: (407)892-4978
Work Desc: REPLACE 1 DOOR & 5 WINDOWS SIZE/SIZE
FOOTER BOND DUCTS INSULATED SEWER MISC.
ROUGH ELECTRIC LINTEL MISC MISC.
1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC.
DUCTS INSTALLED WATER MISC DRIVEWAY
PRE-SLAB SHEATHING MISC. MISC.
CONSTRUCTION POLE FRAME MISC. MISC.
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80(2)(c)when extra inspection
trips are necessary due to any one of the foilowing reasons: a)wrong address b) condemned work resulting
from faulty construction c) repairs or corrections not made when inspections called d) work not ready for
inspection when called e) permit not posted on job site� plans not at job site g)work not accessible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, 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
Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O.
_ � -
CONTRACTOR SIGNA PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
..... ..... ........ v�.� ..� ._..r...��....... . �.....-• •rr••-�-'-"
Building Department
Date RecNved �� Phone Gontact for Permittin 2�
Owners Name s,�'R�� Owner Phone Number � ?- - �7
Ownera Address 5Z S I � S% Ovmer Phone Number _
Fee 8imple Titleholdsr Name � � Owner Phons Number
Fee Simple 7itleholder Address
JOB A�DRESS S ^T 5 �.- SI 2-2PI�R r�i I 5 (... 3 S � LOT# + ! +- �t
3UBQNISION C`fir e 2 ��+2vini I.�� PARCEL ID# - � _ „ "�
(OBTAINED FROM PROPERTY TAX N0TI6E)
WORK PROAOSfD e NEW CONSTR 8 ADD/ALT �� SIGN CJ Q DEMOUSH
INSTALL REPAIR
PROR0.8ED.USE_ Q SFR Q COMM � OTHER
TYPE OF CON8tRUCT10N Q BLOCK Q FRAME � STEEL Q (-- �1
DESCRIP�ION OF WORK K l� � 2 � -'�- .$�2+c- S.z � f L`i`t 0
l�l. //tr� b
BUIL�IN(i SIZE SQ FOOTA(3EC� HEI(iH7 �–�
QBUILDING $ Z��2r QG VALUATION OF TOTAL CONSTRUCTION
QELECTRICAL ($ —� AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
�—_
QPLUMBING S ��� 1 7
QMECHANICAL S
VALUATION OF MECHANICAL INSTALLATION �
[�GAS Q ROOFING Q SPECIALTY [_] OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
G ��-� 1`'�
�
� -
BUILDER COMPANY �ow-�S NoMt �eaT�2s �n!�
SIGNATURE REGISTERED Y I N FEE CURRE� Y/N
Address O �O� O �� a�'`��d`� ��"$�� License# C.�o�. � ..s d �3 t7�`!�
ELECTRIC WN COMPANY
316NATURE REGISTERED Y/ N FEE CURRE� Y/N
Address Llcense# � �
PLUMBER COMPANY
31(iNA?URE REGISTERED Y/ N FEE CURRE� Y/N
Addross License# r
MECHANICAL COMPANY
SIQ�NATURE REGISTERED Y/ N FEE CURRE� Y/N
Addross License# I
OTHER COMPANY
SIONATURE REOISTEREp Y/ N FEE CURRE� Y/N
Address Lfcense#
RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new constructlon,
MlNmum ten(10)working days after submittal date. Required onsite,Constructlon Plans,Stormwater Plans wl Silt Fence insblled,
Sanitary FadllUes 8 1 dumpster,Site Work Permit for subdivislons/large projects
COMMERCIAL A!tach(3)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms. R-O-Vd Pemrit for new constructlon.
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stonnwater Plans w/Silt Fence installed,
Sanitary FadllUes 8 1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance
SICiN PERMIT Attach(2)sets of Engineered Plans.
"""PROPERTY SURVEY requlred for all NEW construcUon.
Directions:
Fill out application completely.
Ovmer 8 Contractor sign back of application,notarized
If over�500,a Notice of Commencement is required. (AIC upgrades over 57500)
'• Agent(for the contractor)or Power of Attomey(for the owner)would be someone with nota�ized tetter from owner authorizing same
OVER THE COUNTER PHRMITTIN(i (Front of Application Only}
Reroofs if shingles Sewers Serv(ce Upgrades A/C Fences(Plot/Survey/Footage)
Drivevrays-Not over Counter if on public roadways..needs ROW
NOTICE OF DEED R�$TRICTIONS: The undersigned understands that this permit may be subjecf to"deed"restrictions"
which rnay:be mors rea�ictive than County:regulations. The undersigned assumes cesponsibi�ity for compliance with'any
appiicable deed restrictfons.
UNLIC�ED C�N'F'�tii4�TOR3 AND COW'fiRACTOR RESPONSIBILITtES: if the owner has hired a contractor or
contractors to undertake work, they may be required to be licensed fn accordance with state and local regulations. If the
contfactor is not Ifcen$pd as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law. If the;owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, tMeyarE�,advised to contact the Paseo County Building Inspection Division—Licensing �e�tion at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the °contractor Block° of thfs application for which they will be responsible. If you, as the owner sign as the
contraetor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges In Pasco'
County.
TRd1�SPORTATION IMP�►CTIUTIUTIES IMPACT AND RESOURCE R�COVERY FEE3: The undersigned unde�stands
that Transportation Imp�ct Fees and Recourse Recovery Fees may apply to the construction of new buildings, chan e of
use in existing building�,°oc�xpansion of exiating buildings, as specifled in Pasco County Ordinance n��nber 89-0�ar►� ""`
�-07, as ameMded. The ur�dersigned also understands, that such fees, as may be due, will be identi�ed at the time of
permitting. It is further understood that Transportatfon Impact Fees and Resource Recovery Fees must be paid prltirtd `
reeeiving a "certifi�ate bf occupancy" or flnal power release. If the project does not involve a cer#ificate of occupancy or
final power relea$e, the-fees must be paid prfor to permit issuance. Furthermore, ff Pasco County Water/Sewer Impacf'
fees are due,:they-must be pald prfor to permit issuance in accvrdance with applicable Pasco County ordinanEes.
CON3TRUCTION LIEN l.�'►W(Chapter 713, Florida 3t�tutes, as amended): If valuation of work is $2,500.00 or more, i
ce�tify that I, the appllcant, have been provided with a copy of the "Florida Construction Lien Law—Homeowr�er�s
Protection Guide" prepared by the Florida Department of Agricalture and Consumer Affairs. If the applicant is someone
other than the"owner", I eertify that I have obtained a copy of the above described document and promfse in good faith•to
deliver it to the"owner"privr to commencement.
CONTRACTOR'SIOWNER'S AFFIDAVIT: i certify that ail the information in this application is accurate and that alk w�rk
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application i§
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or InstaAation has
commenced prior to issuance of a permit and that all work will be pertormed to meet standards of all laws regulating
constcuction, 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 inteFlded work, at�d tMaf it is
my responsibility to identify what actions I must take to be in comptiance. Such ageneies inelude but are not limited to:
- Department of Environmental Protection=Cypress Ba�rheads, Wetland Areas and EnvironmentaAy Sensi�ive
Lands, Water/Wastewater Treatment.
- SouthwesE Florida Water Management Disteict-Wells, Cypress Ba�heads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalis, Docks, Navigable Watervvays.
- Depm�trnent of Health 8 Rehabliit�ative Services/Environmental Health Unit-Welis, Wastewater Tre.atment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
Feder�l'Aviatlon Awtho�ity-Runwa.ys.
I undetst�nd that tMe following restrictions apply to the use of fill:
Use of fill is not allAwed in Flood Zone"V" unless expressly permitted.
If the flll material is to be used in Flood Zone "A", it is understood that a drainags p.lan 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 th� fill material is to be used in Flood Zone "A" in connection with a perrnitted building using stem wai!`
� construction, I c�rtify that`fill wiil be used only to fill the area within the stem wall.
If fill materiai is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fiil is found to adversely affect adjacent properties, the owner may be cited for viola�in�
the cQnditions of the buflding permit issued under tMe attached permit application, for lots less than o�re (4)
acre which are elevated by fill,an engineered drainage plan is required.
If I am the AGENT F`OR TWE'OWNER, I promise in good faith to inform the owner of the permikting conditions set fo�th ir�
this affidavit prior to commencing construction. I understand ihat a separate permit may be required for electrical work,
plumbing, signs, w�lls, pools, air conditioni�rg, g
as, or other installations not specificaliy included in the applica�ion� A :
perrriit issusd s ha l l be cons tr�e d t o be a license to proceed'with the work and not as authorlty to.vlolate, cancel, alt�r, or `
set aslde any provisions of the teehnical codes, nor shall issuance of a permit prevent the BuOding Official from thereafter
requirfng a correction vf errors fn plans, construction or violations of any codes. Every permit issued shall become'invatid
unt�ss the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit (s suspertded or ab��doned for a period of six(8) months after the time the work is commenced. An extensioa`
may be requested, in writing, from the Building Official for a period not to exeeed ninety (90) days and will demon§trate
just�iable cause for the e�ctension, Ifwork ceases for ninety(90)consecutive days,
th�job is considered abandoned.
yyq��,��G �p p�AINEx�;:; YCIUR FAtLURE TO RECORD A NOTICE OF COMMENEEI�AENT MAY F�ESULT IM Y�1WR-
PAYING TWICE FOR I1ri�P-ROVEMENTS Ta YDUR PR�CE��D• �FY�� INT TM ETOF O���e��T�' CONSULT
WITH 1�Ql�J��4E"��D �� �N ATTQRN�Y a�F�RE �
FLORt[3A JURAT'(F.S.117:b3)
OWNER OR A(3ENT CONTRACTOR
Subscribed and swom to(or aiflrmed)before me this Subscribed and swom to(or aiflrmed)before me this
�--bY by
Who Is/are personalty known'Eo me or haslhave pro8uced Who fs/are personally knovm to rne 6r haslhaue:pro�itl�ed
as IdentlticaBon. as idendfication.
Notary Public
Notary Public
Commisslon No.
Commission Na
Name of Notary typed�Prfnted or stamped Name of Notary typed,prfnted or stamped
�, � �
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City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: �_(JZ,(�_�
Date Received: � � �^� `�
site: � / S� � 2 � �(
Permit Type: ���(*,� �J�Gt�r ✓ZL%(�_S � �G'l 0��'
Approved w/no comments:y(J J Approved w/the below comments: ❑ Denied w/the below comments: ❑
��.
This comment sheet shall be kept with the permit and/or plans.
. ���r _ r.- y-� .
y
Kalvin Switzer—P Examiner Date Contractor and/or Homeowner
(Required when comments are present)
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� Customer Name FORCE, SHlRLEY
Customer Address
5754 12TH ST,
c•�y
ZEPHYRHILLS
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FRONT ENTRY
5-r� �z.e., 18 s`-t
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Flc�rida Building Code Online r Q�� 1 �l �
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Product Approva! `
:USFR:Publlc USGr
Prvduc[Aovroval Menu>Product or Anallcatlon Search>Anaf/catlon Lis!>Appll�atlon Detal/
FL# FL4904-RS
Application Type Revision
Code Version 2010
Application Status Approved
*Approved by OBPR.Approvals by DBPR shall be revlewed and ratified by the
POC and/or the Commisslon if necessary.
Comments
Archived
P�oduct Manufacturer Masonite International
Add�ess/Phone/Email '�
1955 Powis Road
West Chicago,IL 60185
(615)441-4258
sschreiber@masonite.com
Authorized Signature Steve Schreiber
sschreiber@masonite.com
Technica/Rep�esentative
Address/Phone/Email
Quality Assurance Representative
Address/Phone/E�-narl
Category Exterror poors
Subcategory Swinging Exterior poor Assemblies
Compliance Method Certification Ma�k or List/ng
Certification Agency Nationa/Accredltation&Management Instltute,
Validated By National Accreditation&Management Institute,
��V��w Dp1�� /�-�—=�
���1�1'OF ZEPHYRHI� c
Referenced Standard and Year(ofStanda�d) Standard P�WNS EXA��INEF��
TAS 201
TAS 202 1994 -^.
TAS 203 1994
Equiva/ence of Product Standards
Certified 8y
,�;i�i� , ,` :il � ,., ti . .. .__.
r ,S �
�'f:1.YS7.�'i.lA�lli �il�t; 5. � �_'�.i<iL��1i:�l.x� Z .T,_
��i��E I...i j�1�i:i�,l 1 i,���i\!l. �.�l���f l��vJ
i ;;�, S} ;"� i \,fJ�-(�i.1.�1)��}��;��l �.`�
Product Approval Method Method 1 Option A
Date Submitted i0/12/2011
Date Valldated 03/18/2012
Date Pending FBC Approval
Date Approved 03/26/2012
�Summary of Products � ��__..____..._________._.._._._._.____.__.__.__._______.__.___-._-_----_____._�._..__._�----
�
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Page 2 of 3
Florida Building Code Online ,
� r'
FL# Model,Num6er or Name Descri tion
4904.1 Wood-edge Stee/Side-Hinged Door 6'-8"Opaque I/S and O/5 Single Door
Units
Limfts of Use CertiRcatfon Agency Certiffcate
Approved for use in HVHZ: Yes FL4904 RS C CAC NI006110.Di.vdf
Approved for use outside HVHZ: Yes Quality Assurance Contract Exp�ration Date
12/31/2014
impact Resistant:Yes Installation Instructions
Deslgn Pressure: +76.0/-76.0
Other:Evaluated for use in locations adhering to the Florida FL4904 RS II FL0128.odf
Buifding Code including the High Velocity Hurricane Zone,and Verified By: Nationa/Accredltation&Management Institute,
where pressure requirements as determined by ASCE 7, Minimum Created by Independent Third Party:
Deslgn Loads for Buildings and Other Structures, does not exceed Evaluation Reports
the design pressures llsted. 3'-0"x 6'-8"max nominal size. When FL4904 R5 AE 504A.odf
large missile impact resistance!s required, hurricane protective Created by Independent Third Party: Yes
s stem is NOT required. See OWG-MA-FLOi28-OS for details.
4904.2 Wood-edge Steel Side-Hinged Door 8'-0"Opaque I/S and O/S Single Door
Units
Limits of Use Certi�catlon Agency Certfflcate
Approved for use in HVHZ: Yes FL4904 RS C CAC N10061 i 0.02.ndf
Approved for use outside HVHZ: Yes Qua/ity Assurance Contract Exp�ration Date
Impact Resistant:Yes 12/31/2014
Design Pressure: +70.0/-70.0 Installation Instructlons
Other:Evaluated for use in locations adhering to the Florida FL4904 R5 II FL0129.vdf
Building Code ircluding the H/gh Velocity Nurricane Zone, and Verified By: Nationa/Accreditation&Management Institute,
where pressure requirements as determined by ASCE 7, Minlmum Created by Independent Third Party:
Des(gn Loads for Buildings and Other Structures, does not exceed Evaluation Reports
the design pressures listed. 3'-0"x 8'-0"max nominal size. When FL4904 RS AF 503A.Ddf
large missiJe impact resistance is required, hurricane protective Created by Independent Third Party: Yes
s stem is NOT re uired. See DWG-MA-FL0129-OS for details.
4904.3 Wood-edge Steel Side-Hinged Door 6'-8"Opaque I/5 and O/5 Door w/or w/o Sidelites
Units
Limits of Use Certiflcation Agency Certificate
Approved for use in HVHZ: Yes FL4904 R5 C CAC NI006110.Oi.odf
qpproved for use outside HVHZ: Yes Quality Assurance Contrac!Exp�ration Date
impact Resistanf: Yes 12/31/2014
Design Pressure: +55.0/-55.0 Installation Instructions
Other:Evaluated for use in locations adhering to the Florida FL4904 RS II FL0128.odf
Building Code ircluding the High Velocity Hurricane Zone,and Verlfied By: National Accreditation&Management Instltute,
where pressure requirements as determined by ASCE 7, Minimum Created by Independent Third Party:
Design Loads for Buildings and Other Structures, does not exceed Eva/uation Reports
the design pressures listed. 12'-0"x 6'-8"max nominal size. When FL4904 R5 AE 502A.odf
large missile impact resistance is requlred, hurricane protective Created by Independent Thrrd Party: Yes
system is NOT requlred on opaque panels, but is required on glazed
panels. See DWG-MA-FL0128-OS for details.
4904.4 Wood-edge Steel Side-Hinged Door 8'-0"Opaque I/5 Door w/or w/o Sidel![es
Units
Llmifs oi Use Certlfitation Agency Certificate
Approved for use in HVHZ: Yes FL4904 RS C CAC N1006i10.02.odf
Approved for use outside HVHZ: Yes Quality Assurance Contract Expiration Date
Impact Resistant: Yes 12/31/2014
Design Pressure: +45.0/-50.0 Installation Instructions
Other:Evaluated for use in locations adhering to the Florida FL4904 RS II FL0129.ndf
Buiiding Code ircluding the High Velocity Hurricane Zone, and Verified 8y:Nationa/Accreditation&Management Institute,
where pressure requirements as determined by ASCE 7, Mlnimum Created by Independent Third Party:
Design Loads for Buildings and Other Structures, does not exceed Evaluation Reports
the design pressures listed. 12'-0"x 8'-0"max nominal slze. When FL4904 RS AE SOIA.Ddf
large missile impact resistance is required, hurricane protective Created by Independent Third Party: Yes
system is NOT required on opaque panels, but is required on glazed
panels.See DWG-MA-FL0129-OS for details.
4904.5 Wood-edge Steel Side-Hinged Door 8'-0"Opaque O/S w/or w/o Sidelites
Units
Limits of Use CertfFcatlon Agency Certifcate
Approved for use in HVHZ: Yes FL4904 RS C CAC NI006i10.02.odf
Approved for use outside HVHZ: Yes Qualily Assurance Contraet Expiralfon Date
Impact Resistant: Yes 12/31/2014
Design Pressure: +50.0/-45.0 Installation Instruetlons
Other:Evaluatad for use rn locations adhering to the Florida FL4904 RS II FL0129.Ddf
Building Code including the High Velocity Hurricane Zone, and Verified By: National Accreditation&Management Institute,
where pressure�equirements as determined by ASCE 7, Minimum Created by Independent Third Party:
Design Loads for Buildings and Other Structures, does not exceed Evaluation Reports
the design pressures listed. 12'-0"x 8'-0"max nominal size. When FL4904 R5 AE 501A.odf
large missile Jmpact resistance is required, hurricane protective Cr�ated by Independent Third Party: Yes
system!s NOT requlred on opaque panels, but is required on glazed
anels. See DWG-MA-FL0129-OS for details.
http://www.floridabuilding.org/pr/pr_ app dtl.aspx?param=wGEVXQwtDqteluIwHNbblSc... 6/26/2013
Florida Building Code Online Yage .s or .�
4904.6 Wood-edge Steel Side-Hrnged Door 6'-8"G/azed I/S and O/S Door w/or w/o Sidelites
Units
timits of Use Certifitation Agency Certificate
Approved for use in HVHZ: Yes FL4904 RS C CAC N1006110.03.odf
Approved for use outside HVHZ: Yes Quality Assuranee Conlrac!Expiratfon Date
Impact Resistant:No 12/31/2014
Deslgn Pressure: +50.5/-50.5 Installation Instruetfons
Other:Evaluated for use in locations adhering to the Florida FL4904 RS II FL0130.Ddf
Building Code including the High Ve/ocity Hurricane Zone, and Verified By:Nationa!Accreditation&Management Institute,
where pressure requirements as determined by ASCE 7, Minimum Created by Independent Third Party:
Design Loads for Buildings and Other Structures, does not exceed Evaluation Reports
the design pressures listed. 12'-0"x 6'-8"max nominal size. When FL4904 RS AE 502A.odf
large missile impact resistance is required, hurricane protective Created by Independent Third Party: Yes
system!s required. See DWG-MA-FL0130-05 for details.
4904.7 Wood-edge Stee/Side-Hrnged Door 8'-0"Glazed I/S Door w/or w/o S/delltes
Un/ts
Limfts of Use Cerd�catfon Agency Certi�cate
ApprovedforuseinHVHZ: Yes fL4904 RS C CAC NIU061i0.04.vdf
Approved for use outside HVHZ: Yes Quality Assu�ance Contract Expiration Dafe
Impact Resistanf:No 12/31/2014
Design Pressure: +40.0/-45.0 Instal/ation Instrucfions
Other:Evaluated for use in locations adhering to the Florida fL4904 RS 7I FL0131.Odf
Buildinq Code including the High Velocity Hurricane Zone, and Verified By: Nationa/Accreditation&Management Institute,
where pressure requlrements as determined by ASCE 7, Minimum Created by Independent Third Party:
Design Loads for Buildings and Othe�Structures, does not exceed Eva/uation Reports
the design pressures/isted, 12'-0"x 8'-0"max nominal size. When fL4904 RS AE 501A.Ddf
large missile impact resistance is required, hurrrcane protective Created by Independent Third Party: Yes
s stem is re uired. See OWG-MA-FL0131-OS for details.
4904.8 Wood-edge Steel Side-Hinged Door 8'-0"Glazed O/5 Door w/or w/o Sidelites
lJnits
Limlts of Use CertiFcation Agency Certl�cate
Approved for use in HVHZ: Yes FL4904 R5 C CAC N10061i0.04.vdf
Approved for use outside HVHZ: Yes Quality Assurance Contract Expiration Date
Impact Resistant:No 12/31/2014
Design Pressure: +45.0/-40.0 Installatfon Inst�uctions
Other:Evaluated for use in locations adhering to the Florida f14904 RS 11 fL0i31.vdf
Building Code inc/uding the High Ve/ocity Hurricane Zone, and Verlfied By:Natfona/Accreditation&Management Institute,
where pressure requirements as determined by ASCE 7, Minimum Created by Independent Third Party:
Design Loads for Buildings and Other Structures, does not exceed Evalualfon Reports
the design pressures listed. 12'-0"x 8'-0"max nominal size. When FL4904 RS AE SOIA.Odf
large missile impact resistance is required, hurricane protective Created by lndependent Third Party: Yes
s stem is re uired. See OWG-MA-FL0131-OS for detalls.
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`" ° `� "' N0. DATE BY M'CHORING LOGITIONS
� REVISIONS � DEfAILS
Florida Building Code Online Yage 1 ot 4
. + -
. .
roduct Approval
USER:Pub!!t User
Product Anvroval Menu>Produc[or Annflcatlon Searrh>Anollcatlon Ust>Appl/caGon D�tsll
FL# FL11206-R8
Application Type Revision
Code Version 2010
Application Status Approved
*Approved by OBPR.Approva/s by DBPR shall be revlewed and ratlfled by the
POC and/or the Commission if necessary.
Comments
Archived •-�
Product Manufacturer Pella Corporation
Address/Phone/Email 102 Main St.
Pella,IA 50219
(641)621-6096
pellaproductapproval@pella,com
Authorized Signature TROY FARR
tbfarr@pella.com
Technical Representative TROY FARR
Address/Phone/Email i8600 NE WILKES ROAD
PORTLAND, OR 97230
(503)405-9176
tbfarr@pella.com
Quality Assurance Representative TROY FARR
Address/Phone/Email 18600 NE WILKES ROAD
PORTLAND, OR 97230
(503)405-9176
tbfarr@pella.com
Category Windows
Subcategory Sing/e Nung
Compliance Method Certification Mark or Usting
Certification Agency Window and Door Manufacturers Association
Validated By lames L. Buckner, P.E. at CBUCK EngineeNng
��; Validation Checklist-Hardcopy Rece/ved
Referenced Standard and Year(of Standard) t nd r Year
AAMA 101/I.5.2-97 1997
AAMA/WDMA/CSA 101/I.5.2/A440-08 2008
Fquiva/ence of Product Standa�ds
Certified By
Product Approval Method Method 1 Option A
Date Submitted 09/27/2013
Date Valldated 10/09/2013
http://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDqs6WGOndIU... 11/19/2013
Florida Building Code Online rage � or 4
Date Pendinq FBC Approval
Date Approved 10/16/2013
Summary of Products � �
FL# Model,Number or Name Descrl t/on
11206.1 Series 10/20 High Performance Sing/e Viny/H1gh Performance Single Hung Window(42"x 72)
Hun
Limlts of Use Certifieatfon Apency Certificate
Approved for use in HVHZ:No FL11206 R8 C CAC 41i-H-1046.00.ndf
Approved for use outside HVHZ: Yes Quality Assurance Contract Expiratlon Date
Impact Resistant:No 08/07/2017
Design Pressure: +50/-50 Instsllatlon Inslrudlons
Other:Conflgurations of g/ass shall conform to the current ASTM FL11206 R8 11 Orewina 1572 vdf
EI300 standard. Verlfled By: Warren W.Schaefer, P.E. 44135
Created by Independent Third Party: Yes
Evaluatlon Reports
F�1��06 R8 AE Drawina 1572 vdf
Created b Inde endent Third Pa : Yes
11206.2 Series 10/20 High Performance Sing/e Vinyl High Performance Single Hung Twin Compos(te(72"x 65-
Hung 1/2"
Limits of Use Certificatlon Agency CertificaM
Approved for use in HVHI:No FL11106 R8 C CAC 411-H-1043.40.vdf
Approved fo�use outslde HVHZ: Yes F�1»06 RS C CAC 411-H-1043.46.ndf
Impact Resistant:No Quallty Assurance Contract Expiration Date
Design Pressure: +50/-50 11/17/2017
Other:Configurations of g/ass shall conform to the current ASTM Insta!lstfon instructions
E1300 standard. FL11206 R8 1I D2wlno 1571.ndf
Verif/ed 8y: Warren W. Schaefer, P.E. 44I35
Created by Independent Third Party: Yes
Evaluation Reports
FL11206 R8 AE Drawino i572.vdf
Created b Inde endent Th/rd Pa : Yes
11206.3 Series 10/20 Sin /e Hung Vln /Sin le Hun Tri le Com oslte(108"x 72')
Limits of Use Cert)ficatJon Agency Cert/ffcate
Approved fo�use!n HVHt:No FL11206 R8 C CAC 41 i-H-1043.31.vdf
Approved for use outside HVHZ: Yes FL11206 R8 C CAC 411-H-3043.63.ndf
Impact Reslstant:No Quali[y Assurance Contract Expiratfon Date
Desfgn Pressure: +35/-35 03/31/2018
Olher:Configurations of g/ass shall conform to the current ASTM Installatfon Instructlons
E1300 standard. FLI1206 RS 77 Orawlna 1572.odf
Verlfied By: Warren W. Schaefer, P.E. 44135
Created by Independent Third Party: Yes
Evaluation Reports
FL11206 RS AE Drawlno i572.pdf
Created 6 Independent Third Party: Yes
11206.4 Series 10/20 Sin /e Hung Vin I Sing/e Hun Trl le Com oslte i08"x 53.5)
Limits of Use Certificatfon Agency CertlFeate
Approved for use in HVHZ:No FL11206 R8 C G4C 411-H-1043.SS.vdf
Approved for use outside NVNZ: Yes Quality Assurance Contract Expiration Date
Impaet Reslstant:No 11/19/2017
Design Pressuro: +35/-35 Insta/lation instructfons
Other:Configurations of glass shall conform to the current ASTM FL11206 RS 11 Drawina 1572.Ddf
E1300 standard. Verlfled By: Warren W. Schaefer, P.E. 44135
Created by Independent Third Party: Yes
Evaluation Reports
FL11206 R8 AE Drawinq 1572.Ddf
Created by Inde endent Thlyd Pa : Yes
11206.5 Series 10/20 Sing/e Hung Vin /Fixed Over Sin le Hung Composite 30"x 76"
Limits of Use Certffication Agency Certificate
Approved for use in HVHZ:No FL11206 R8 C CAC 411-H-1043.34.ndf
Approved for use outside HVHZ: Yes Quality Assurance Contract Expiration Dale
Impact Resistanf:No 11/10/2017
Design Pressure: +35/-35 installation Instructions
Other:Conflgurations of g/ass shall conform to the current ASTM FLi1206 R8 II D�awina 1572.odf
E1300 standard. Verified By: Warren W.Schaefer, P.E. 44135
Created by Independent Third Party: Yes
Evaluation Reports
FLI1206 R8 AE Drawino 1572.vdf
Created by Inde endent Thlyd Pa : Yes
11206.6 Series 10/20 Sin le Hun V!n /Fixed Over 5/n /e Hung Composite(46"x 76°
Limits of Use Certif/catfon Ageney Certificate
Approved for use in HVHZ:No FL21206 R8 C CAC 411-H-1043.28.odf
http://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDqs6WGOndIU... l 1/19/2013
Florida Building Code Online rage s or 4
� Approved for use outside HVHZ: Yes Quallty Assurance Conlract Expiration Dste
.impact Reslsiant:No 11/11/2017
Design Pressuro: +30/-30 installatlon Inslructions
Other:Configurations of g/ass shall conform to the current ASTM FL11206 R8 II Drawina 1572.Ddf
E2300 standard. Verlfied By: Warren W. Schaefer, P.E. 44i35
Created by Independent Third Party: Yes
Evaluatfon Reports
FL21206 RS AE Drawina 1572.ndf
Created b Independent Thlyd Pa : Yes
11206.7 Series 10/20 Sing/e Hun Vin I Sin le Hun W/ndow 48"x 72"
Llmlts of Use CertfFcatlon A�ency Certlficate
Approved for use in HVHZ:No FLi1206 R8 C G1C 411-H-1043.04.vdf
Approved for use oufslde HVHZ:Yes Quality Assurance Contract Expiratfon Date
impact Resistant:No 08/04/2017
Design Pressure: +35/-35 installation Instruetfons
Other.Con�gurations of g/ass shall conform to the current ASTM FL11206 R8 11 Orawlna 1572.vdf
E1300 standard. Verlfled By: Warren W. Schaefer, P.E. 44135
Created by Independent Th/rd Party: Yes
Evaluatfon Reports
FL11206 R8 AE Drawina 1572.ndf
Created 6 Inde endent Third Pa : Yes
11106.8 Series 10/20 Sing/e Hung Vin /Sin /e Hun Wlndow 48"x 59-i/2"
Limits of use Certl�cation Apency Certlflcate
Approved for use in HVHZ:No F�11206 R8 C CAC 411-H-1043 08 vdf
Approved for use outside HVHZ: Yes Qus/!ty Assurance Contract Expiration Date
impact Resistant No 08/04/2017
Deslgn Pressure: +35/-35 Insta/lation Inst�ucHons
Other:Con�guretions of glass shall conform to the current ASTM FLi1206 R8 11 Drawina 1572.vdf
E1300 sWndard. VerlRed By: Warren W.Schaefer, P.E. 44135
Created by Independent Third Party: Yes
Evaluation Reports
FL11206 RS AE Drewina 1572.vdf
Created 6 Inde endent Third Pa : Yes
11206.9 Series 10/20 Sing/e Hung Vin 1 Sin le Hun Window 36"x 59-1/2"
Limits of Use Certi�cation Ageney Certifeale
Approved for use fn HVHZ:No FL11206 R8 C CAC 411-H-1043 16 odf
Approved for use outside HVHZ:Yes Qua/J!y Assurance Conlract Expiration Date
Impact Resistant:No 08/03/2017
Design Pressuro: +35/-35 Installstfon Instructions
Other. Configurations of g/ass shaN conform[o the current ASTM FL11206 R8 II Drawlna 1572 vdf
E1300 standard. Verified By: Warren. W. Schaefer, P.E.44135
Created by Independent Thlyd Party: Yes
Evaluatfon Reports
FLi1206 R8 AE Drewina 1572.odf
Created b Inde endent Third Party: Yes
11206.10 Serles 10/20 Sing/e Hung Vln 1 Sin /e Hun Wlndow 48"x 84)
Limits of Use Certiflcatlon Apency Certiflcate
Approved for use in HVHZ:No FL11206 R8 C CAC 411-H-1043.20.odf
Approved for use outside HVHZ: Yes FL11206 RS C CAC 411-H-1043.24.vdf
Impact Res/stant:No Quality Assurance Contract Explration Date
Design Pressur�e: +35/-35 08/07/20i7
Other:Conflgurations of g/ass shall conform to the current ASTM Instapatlon Instruct/ons
E1300 standard. FLi1206 R8 II DrawJna 1572.ndf
Verified By: Warren W. Schaefer, P.E. 44i35
Created by Independent Third Party: Yes
Evaluation Reports
FL11206 RS AE Drawina 1572.vdf
Created 6 Inde endent ThJrd Pa : Yes
21206.11 Serles 10/20 Sing/e Hung VIn I SJn /e Hun Wlndow 36"x 72"
Lfmits of Use Certlflcation Ayency Certificate
Approved for use in HVHZ:No FL21206 R8 C CAC 411-H-1043.12.vdf
Approved for use outside HVHZ: Yes Qua!!fy Assuranee Conlract Expiration Date
Impact Resistant:No 08/03/2017
Deslgn Pressure: +35/-35 Installation Instructfons
Other:Configurations of g/ass shall confo�m to the current ASTM FL11206 R8 11 Orawino 1571.odf
E1300 standard. Verffled By: Warren W. Schaefer, P.E. 44135
Created by Independent Third Party: Yes
Evaluatfon Reports
FL21206 R8 AE Drawlna 1572.vdf
Created b Inde endent Th1rd Pa : Yes
11206.12 Series 10/20 Sin /e Hun V/n I 5!n /e Hun Twln Com osite 72"x 53.5"
Limits of Use Certlflcatlon Agency Certifcate
Approved for use in HVHZ:No FL11206 R8 C CAC 411-H-1043.43.odf
http://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDqs6WGOndIU... 11/19/2013
Florida Building Code Online rage s or 4
Approved for use outside HVHZ: Ves Qua/I!y Assurance Conlract Expiration Date
Smpact Resistant:No 11/11/2017
Design Prossuro: +30%30 Instal/atlon Ins[ructfons
Olher:ConFguratlons of g/ass shall confo�m to the cu�rent ASTM FL11206 R8 II Draw/no 1572 Ddf
E1300 standard. Ver/f/ed By: Warren W. Schaefer, P.E. 44135
Created by Independent Th/rd Party: Yes
Evaluation Reports
FL11206 R8 AE I)rawinn 1572 Odf
Created b Inde endent Third Pa : Yes
11206.7 Series 10/20 Sing/e Hun Vin l S/n le Hun W/ndow 48"x 72"
�its of Use Certlfcat/on Ayency Ceit/flcale
pproved for use in HVHZ:No FC11206 R8 C G4C 411-H-104��4 vdf
Approved for use outside NVHZ: Yes Qual/ty Assurance Contract Expiratfon Date
Impact Resistant:No 08/04/20i7
Deslgn Pressure; +35/-35 Insla//sHon Instruetlons
Other:Configurations of g/ass shall conform to[he current ASTM FL11206 RS 1I Drawina �s��.,�p
E1300 standard. Verif/ed By: Warren W. Schaefer, P.E. 44135
Created by Independent Third Party: Yes
Eva/uatfon Reports
FL11206 R8 AE D�aw/na �S72 odf
Created b Inde endent Th/rd Pa : Yes
1 i206.8 Series 10/20 Sing/e Hung Vin /S/n !e Hun Window 48"x 59-1/2"
Limits of Use Certlflcation Apency Cert/ffcate
Approved for use in HVHZ:No FL1�206 RS CAC 411-H-1043 08 adf
Approved for use outside HVHZ: Yes Qua/ffy Assurance Contract Ex Iralion Date
Impact Resfstant:No 08/04/2017 p
Desfgn Pressure: +35/-35 Inslal/alion Instructlons
Other:Conf/gurat/ons of g/ass shal!conform to the current ASTM fL11206 R8 II D2w/no i57Z��f
E1300 standard. Verlfred By: Warren W. Schaefer, P.E. 44135
Created by Independent Thlyd Party: Yes
Evalua!/on Reports
FL11206 RS AE Drawina 1572 adf
Created 6 Inde endent Third Pa : Yes
11206.9 Series 10/20 Sing/e Hung VIn f Sin /e Hun Wlndow 36"x 59-1/1"
�mits of Use CertiFcalfon Agency Certifcate
pproved for use in HVHZ:No FL11206 RS C CAC 4i1-H-1043 16 odf
Approved for use outs/de HVHZ: Yes Qua/fty Assurance Cont�ad Expl�ation Date
Impact Resistant:No 08/03/2017
Deslgn Prcssure; +35/-35 Insta//sllon Instructfons
Other:ConfJguratfons of g/ass shall conform to the current ASTM FL11206 R8 II Draw/na 1572 odf
E2300 standard. Ver/f/ed By: Warren. W. Schaefer, P.E.44135
Created by Independent Thlyd Party: Yes
Eva/uatfon Reports
FL11206 R8 AE Dr wlna 2572 ndf
Created 6 Inde endent Third Party: Yes
11206.10 Series 10/20 Sin !e Hun V!n I 51n le Hun W/ndow 48"x 84)
Limits of Use
Approved for use in HVHZ:No Ce����a�1on Ayency Certificate
Approved for use outsfde HVHZ: Yes fL11206 RR r' i' C 411-H-Ia43 20 vdf
Impact Resistant:No _FL11206 RS C CAC 411-H-1043.24.pdf
Des/gn Pressur�e: +35/-35 Qua/Tty Assurance Contract Explration Date
Other:Conf/guretions of glass sha!!conform to the current ASTM Inslallation Instructlons
E1300 standard.
FL21206 R8 I! Draw/no 1572 vdf
Ver�ffed By: Warren W. Schaefer, P.E. 44i35
Created by Independent Third Party: Yes
Eva/uatfon Reports
fL11206 R8 AE Drawino 1572 ndf
Created b Inde endent Thlyd Pa : Yes
11206.11 Series i0/20 S/n /e Hung V/n /5/n le Nun W/ndow 36"x 72"
Limits of Use
Approved for use in HVHZ:No Ce���catfon AQency Cert/ficate
APPro�ed for use outside HVHZ: Yes FL11206 RB [" �'qC qf t y 1043�2 Ddf
Impact Resfstant:No Q�s�jtY�surance Contrad Explration Date
Desfgn Pressure: +35/-35 �8/03/2017
Olher:Confrgurations of g/ass sha!l conform to the current ASTM FL11206,R8 IISD awrjna 1572 ndf
E1300 standard. Verlf/ed By: Warren W. Schaefer, P.E. 44135
Created by Independent Thlyd Party: Yes
Eva/uaffon Reports
FL11206 R8 AE Draw/no 1572 ndf
Created 6 Inde endent Th/rd Pa : Yes
11206.12 Series 10/20 Sin /e Hun
Vin /S/n le Hun Tw/n Com osite 72"x 53.5"
Limits of Use
Approved for use in HVHZ;No Certifica!!on Agency Certiffcate
FL11206 R8 �C 411 y 1043 43 vdf
http://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDqs6WGOndIU... 11/19/2013
Florida Building Code Online Yage 4 ot 4
Approved for use outside HVHZ: Yes QualJly Assurance Contract Expfration Date
Impact Resistant:No 11/17/20i7
Design Prossuro: +35/-35 Ins[a/lat/on Instructlons
Other:Configurations of g/ass shall conform to the current ASTM FLI1206 R8 II Drawina 1572.ndf
E1300 standard. Verlfled By: Warren W.Schaefer, P.F. 44135
Created by Independent Th/rd Party: Yes
Evaluatfon Reports
fL11206 R8 AE Draw/no 1572.ndf
Creafed by Inde endent Third Parly: Yes
11206.13 Serles 10/20 Sin /e Hung Vln I S/n /e Hun Twln Compos/te 96"x 53.5"
Limlts of Use Cert/ficatfon Agency Certifleste
Approved for use in HVHZ:No FL11206 R8 C CAC 411-H-1043.57.odf
Approved for use outside HVHZ: Yes Quallty Assurance Contract Expiratfon Date
Impact Reslstant:No 11/19/2017
Design Pressure: +35/-35 Installation Inslrud/ons
Ofher:Con�gurations of g/ass shalf conform to the current ASTM FL11206 R8 II Draw/Ra 1572.ndf
E2300 standard. Veri�ed By: Warren W. Schaefer, P.E. 44135
Created by Independent Thlyd Party: Yes
Evaluatlon Reports
FLI1206 R8 AE Draw/na 1572.vdf
Created b Inde endent Third Pa : Yes
11206.14 Ser/es 10/20 Single Hung Vinyl Sln /e Hun Twin Com oslte 96"x 72"
Limits of Use Certifeation Ageney Ceitlfieate
Approved for use in HVHZ:No FL11206 R8 C CAC 411-H-1043.49.�df
Approved for use outslde HVH2: Yes FL11206 R8 C CAC 41i-H-1043.60.odf
Impacf ResislanC:No Qua//ty Assurance Contract Expiratfon Date
Des/gn Pressure: +30/-30 1 i/18/2017
Other:Configurations of g/ass shall conform to the current ASTM Installation Iastrucllons
E1300 standard. FL1i206 R8 11 Drewina 1572.odf
Verified By: Warren W. Schaefer, P.E. 44135
Created by Independent Third Party: Yes
Evalualfon Reports
FLII206 R8 AE Orawina 1572.ndf
Created by Independent Third Pa : Yes
11206.15 Serles 10/20 Sin /e Hung Vin /S/n /e Hun TwJn Com osite 72"x 72"
Limits of Use Certificatfon Apency Certi�cate
Approved for use in HVHZ:No fL1i206 R8 C CAC 411-H-1043.37.vdf
Approved for use outside HVHZ: Yes Qua/ity Assurance Contract Expiratfon Date
Impact Resistant:No 11/17/2017
Desfgn Pressure: +35/-35 insta!/atTon instructions
Other:Conflgurations of g/ass shall confo�m to the current ASTM FL11206 R8 II D�awina 1572.ndf
E1300 standard. Verifled By: Warren W. Schaefer, P.E. 44135
Created by Independent Thlyd Party: Yes
Evaluation Reports
FL11206 R8 AE Drawina 1571.vdf
Created 6 Independent Third Pa : Yes
11206.16 Series 10/20 Sing/e Hun Vin !Fixed With Sin /e Hun Flankers(108"x 72')
Limits of Use CertfRcation Agency Certffieate
Approved for use in HVHZ:No FLI1206 R8 C CAC CCL for Pella 411-H-950-02 vdf
Approved for use outside HVHZ: Yes Quality Assurance Contrad Expiration Date
Impact Resislant:No 10/03/2015
Design Pressure: +30/-30 Installation Instructions
Other:Configuratlons of g/ass shall conform to the current ASTM FL21206 RS 11 Orawing 1572.ndf
Ei300 standard. Verifled By: Warren W. Schaefer,P.E. 44135
Created by Independent Th/rd Party: Yes
Evaluation Reports
FL11206 R8 AE Drawina 1571 vdf
Created by Independent Third Pa : Yes
http://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDqs6WGOndIU... 11/19/2013
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2014001605
',Permit Number . Rec: 10.00
Parcel ID Number t j_-Z(, -2 i _ v 6 ��j - p S'�p� - d i�e Rcpt:1573325
DS: 0.00 IT: 0.00 ,
N O T I C E O F C O M M E N C E M E N T 0 1/0 6/1 4 K. Kraengel , Dpty Clerk
State of Fiorida ,. ,..,::.:. ;. :. ;... ,� ;
County of . . ... . . , .. .
THE UNDERSIGNED hereny gives notice that improvements will be made to certain real property, and in accortlance with Section 713.13 of the
Florida Statutes,the foilowing information is provided in this NOTfCE OF COMMENCEMEtJT.
1.Description of property(legal description):C;rY v� Zep�RYl+.1!s_�� f ,pg 5� �.n;s i � f �Z 3 ik s_z__q rz
_ �Y..���°,�_2 S"C,
a)Street(job)Address: S`7_S..`._'f...... .....I.'lTh..... S_=-.._..._Z_e�_tiQ_y_�,_;►�_..s...._......�= � 3� S+�2 ....._...._.....__. .
_...................... ...................._........._....................................._....................
2.General description of improvements:
--..............................................................._..............................._Q..--,.,......,...,.................._..._..............._................_..._.............._........_... - ........._..............._................................................................
----.�-a���fi�nJ�r��?4�_.t.�"��G3,.✓ie.r�T .___
3.Owner Information or Lessee information if the Lessee contracted for the improvement:
a)Name and address: S ^ -
�:..i..�2�2.�._...fL�.C�.C..�...._....-�'r....._7�..._�...___�_�T�,.._s�f........._Ze.Phrty..�'.'...I.fS...._..!` C 33._5...`f_z..................................
................................
b) Name and address of fee simple titleholder(if different than Owner listed above) --
__.�.____ ---_.._�...__--........._..---.._._..__.._.-
c) interest in property: �.�..�t�(_z....................................................-
_..........-............................-........................._............_..................... ..............._.............-........................._............................................................................
4. ntractor Information
� a)Name and address: ! ' `7c����q�_����(c�_�L
-__�v.tb�� 1-�crn�_ L'�r��Z.C`� 1 v�[_. �o '3ox
b)Telephone No.: �-
.....�ii G�7..)_._`�,?c}_-.�t1��._.....__..._......_..---....__._.._...... Fax No.:(optional) .._.._..._....---....._:................................._..._.._...... -........_.�.a$'.-I...�...........
5.S u r e t y(i f a p p li c a b le,a copy o f t he paymen t bon d is attached)
a)Name and address: ���
b)Telephone No.: Pau�a s.o'NEIL,Ph.D.PRSCO CLERK & COMPTROLLER`
....................._.......... -....._...................._........_............._.............._....._......._..._..___.........................................._.... 01/06/14 11:30am 1 of 1
c Amount of Bond: OR BK ���� PG 'Z���
_�.._..................._....... ................................._..._......................_.................._........._._..._.._.....__._..........................._.
6.Lender
a)Name and address:
_.............._�._�5....---..._....._.........._.........._......._............_.._ ...._. ......._................._..........._..._....._...__................._.__._......_......_....__....
..._...................___.........................................................................._...._.........
b)Telephone No.:
...._.........................._....._....._...._.........._..._.._......................_........_............._._......._.........._........_.._.. -...._........_....._............._.............._............................ .............._...
7.Persons within the State of Florida�designated by Owner upon whom notices or other documents may be served as provided by Section
713.13(1)(a)7., Florida Statutes: -
a)Name and address: _. �f-f-�
_........ ..........._._.._......._.._.............................................._....._..._...._.........._............_..._.._._........._........._.._..__........_................._......_....._.._._......_.................__.........._...................................................................
b)Telephone No.: Fax No.:(optional) _
..............--........_........--- _.._....................................................................
8.a.in addition to himself or herself,Owner desi nates � �� of
� ...._ _�-_...__....----
to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes.
b)Phone 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 will be 1 year from the date of recording unless a different date is specified): ,20
.__-
WARNING TO OWIVER: ANY PAYMEIJTS MADE BY THE OWNER AFfER THE EXPIRATION OF THE NOTICE OF COMMENCEMEIVT ARE
CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART I,SECTION 713.13,FLORIDA STATUTES,AND CAN RESULT IN YOUR i
PAYING TWICE FOR IMPROVEMENTS TO Y'OUR PROPERTY. A NOTICE OF COMMENCEMEI�ff MUST BE RECORDED AND POSTED ON �
11-IE 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.
......._.............................-�-...._..-- -.........._._....._._.._._.._._.--�-�—•--.._..-�------�----�----��—�-_...-�------�_...-�--�----..._.__._...._......_._..-------- ...._......._..._..�--�--...:._.. -�-.......................J
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
k�wledqe and belief. .
� O ' , � / e
_ _� -��-_ _ .. •,.�- ��^l7 i I'`/C �Q._,�.��,_---__.....
{Signature of Owner or L ee,or Owners or Lessee's(Authorized Officer/DirectodP�rtner/Manager) (P'nt Name and Provide ' atory's Title/Office)
The fo oin�instr� nt w acknowledged before me this Z�"�l� day of � G`�h2� ,20 1�J
by -:����---__ -���.,. __.._.. �__..........._�_____
fOf � --�--f�'�3�� (�yPe of authority,e.g.officer,Wstee,attorney in fact)
_.._._.____..._._._ as �. /�1� .�
_-_,.__.__.,
--_—4_
(tVame of Person) ""�'°°�""'��"�'"`�--�"'
- (type of aufhority,...e.g.officer,truste ,ariomey in fact)
for (name of pa`tty ehalf of hdm instrument was executed).
-.............--............ .
--......_- --......_.................._._................- .........__.__.
........_......_....._.....�----..._
Personally Known Produced ID
Type of ID ��� � Notary Signature
' ._ .._ 10�►'l ___............._._.
Print name - ��_
s-r�C G�k ���y _.._...___
NATASHA A.BUCIIANAII
� MYCOMMIS6IQ�I�701�
D�IRES:JAN 30,20t7
°1� Bonded thcaiql►t st Sbh Imuraie�
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