HomeMy WebLinkAbout14-14955 CITY OF ZEPHYRHILLS �'�
5335-8TH STREET
, (si3)�so-oo20 1 55
` BUILDING PERMIT
Permit Number: 14955 Address: 5504 5TH 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: 11-26-21-0010-06400-0131
Improv. Cost: 8,992.00
Date Issued: 2/10/2014 Name: HILL JEAN
Total Fees: 120.00 Address: 5504 5TH ST
Amount Paid: 120.00 ZEPHYRHILLS FL 33542
Date Paid: 2/10/2014 Phone: 813-751-4179
Work Desc: REPLACE 2 DOORS SIZE/SIZE
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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 following 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 t) plans not at job sibe 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 properly. 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 acxordance with
Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O.
�
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, CO RA TOR SIGNATURE PERMIT OFFI R
,
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
. •
City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
�,... _.
ontract omeowner: � 5 ����S
Date Received: ,,�-- � — ��
s�te: ���"�'� � ., � �- --��.
Permit Type:
Approved w/no comments: Approved w/the below comments: ❑ Denied w/the below comments: ❑
This comment sheet shall be kept with the permit and/or plans.
��,� � �� a � Yot4
Kalvin Switzer—Plans xaminer Date Contractor and/or Homeowner
(Required when comments are present)
sisaso-oozo City of Zephyrhills Permit Application _ F�-a.t3_�ao-oozi
__.�Building Department... ��� � -
nate Received + _..- �.��.. \
Phone Co tact for Pertnittin -�'"- '�' �
' T-ITf-IT --
Owner's Name e � �(��,,,, Owner Phone Number �' ����
Owners Address �. �n
'e Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Addresa
JOB ADDRESS �Q SI � e LOT# � 3 �1
SUBDIVISION PARCEL ID# I— ��� �� —Q
(OBTAINED FROM PROPER7Y TAX NOTICE)
WORK PROPOSED NEW CONSTR ADD/ALT � SIGN Q � DEMOLISH
INSTALL e REPAIR
PROPOSED USE Q SFR Q COMM � OTHER OO
TYPE OF CONSTRUCTION Q BLOCK Q FRAME 0 STEEL Q
DESCRIPTION OF WORK 1S Q C� /U W �� ` � �
BUILDING SI SQ FOOTAGE�.___._._. HEIGHT ��
BUILDING $ VALUA ION OF TOTAL CONSTRUCTI_ O�N�
�ELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
�PLUMBING $ �� `! ��S � ,/�/
`� ,C J
. �MECHANICAL $ VALUATION OF MECHANICAL INSTALLA ON � J.( ("�
-__- �?�"� I'
QGAS � ROOFING Q SPECIALTY � OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
BUILDER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address
License#
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y!N
Address
License#
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Addreas
License#
MECHANICAL COMPANY
SIGNATURE � REGISTERED Y/ N FEE CURRE� Y/N
Address �
License#
OTHER h COMPANY RFO/(jd/�,C p ��i(,(�Ip c�. ,�(,irj
SIGNATURE _ __ _ REGISTERED Y/ N FEE CURRE� Y/N
Address Q V. � lV License# �S �
1 1 1 1 1 I 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1
RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Fortns;R-O-W Permit for new construction,
Minimum ten(10)working days after submitlal date. Required onsite,Construction Plans,Stortnwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster;Site Work Permit for subdivisionsAarge projects
COMMERCIAL Attach-(3)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new consWction.
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stortnwater 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 57500)
" Agent(for the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application On�y)
Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage) .
Driveways-Not over Counter if on public roadways..needs ROW
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 IMPACTIUTILITIES 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
finai 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, Fiorida 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—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'SIOWNER'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 8 Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
- Fede�al 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. 1 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 O�cial 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 TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURRT_ 117. 3)
OWNER O GENT �o CONTRACTOR
Subscrfbed a before tn is Subscrlbed and swom to(or affirmed)before me this
.�by:_. � bY
Who islar erso ly known G me or ha ave produced Who Is/are personally known to me or has/have produced
as id tion. as idenNfication.
."��-,,, BOBBIE . �` "
� �ommiss #EE 14 7
` ° ��� blic Notary Public
� ,
Co Commission No.
Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped
�``�-�FC-C1020 Ciky of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Received
Phone Contact for Permittin __
Owner's Mame Owner Phone Number
Owner's Address Ovmer Phone Number
Fee Simple Titleholde�Name �- -� Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS LOT# �
SUBDtVISION PARCEL ID#
(OBTAINED FROM PROPERTY TAX NOTICE)
1IVORK PROPOSED e NEW CONSTR 8 ADD/AL7 � SIGN Q � DEMOLISH
INSTALL REPAIR
IPROPOSED USE Q SFR Q COMM �� OTHER
T1fPE OF CONSTRUCTION Q BLOCK Q FRAME 0 STEEI Q
DESCRIPTION OF WORK
BUILDING SIZE SQ FOOTAGE�� HEIGHT C�
OBUILDING S VALUATION OF TOTAL CONSTRUCTION
QELECTRICAL $ AMP SERVICE � PROGRESS ENERGY Q W.R.E.C.
QPLUMBING $
OMECHANICAL �� VALUATION OF MECHANICAL INSTALLATION
QGAS Q ROOFING Q SPECIALTY 0 OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES NO
BUILDER COMPANY
SIGNATURE REGISTERED Y! N FEE CURRE� Y/N
Address License#
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y!N
Address License# �- -�
PLUMBER COMPANY
SIGNATURE REGISTERED Y J N FEE CURRE� Y/N
Address License#
MECHANICAL � COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y I N
Address License#
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,ConsVuction Ptans,Stormwater Plans w/Silt Fence installed,
Sanitary FaciBtles 8 1 dumpster;Site Work Permit for subdivisionsllarge projects
COMMERCIAL Attach(3)comptete 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.
Directlons:
Fill out application completely.
Owner&Contractor sign back of application,notarized
If over E2500,a Notfce of Commencement is required. (AIC upgrades over E7500)
" Agent(for the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
AUTHORIZED AGENT
AFFIDAVIT
I��T��D irt1.�OF/�Kereby grant authorization to G L� s�f�l�i'7�/
(Contractor) (Aut orized Agent)
to act in my behalf with the Hernando County Development Department while conducting activities
related to obtaining permits. These activities specifically include signing all documents requiring
signature of"contractor".
/
�'G Sh'�R : is to be considered an agent of my business and
( uthorized Agent)
therefore the signature of said agent is binding and causes me to assume all responsibilities
connected to or associated with the signature as they may relate to my contracting business.
�
I�(�l�b �.� d1�S0 e�iev� the Hemardo County �ev���pr�ent o{,
(Contractor)
and agree to hold the Hernando County Development Department harmless from, any and all
responsibility, claims or other actions arising from or related to the Department's acceptance of the
above agenYs signature for permit-related activities. I further understand that it is my sole
res i ity to grant and terminate ny such authorization and to ensure that the Department
r eives ti; ely notic f any ant or termination.
.
Signature of ntractor ignature of Agent
�
� "' �p�i ,��
e N t e Certification or Registration Number
= LL ^
N O �
Q V Of
G- m °' O
Q y � � nty Certification Number(if applicable)
LL � 'n c
_ ac o
W a E � "PLEASE NOTE: BOTH SIGNATURES MUST BE NOTARIZED"
� T E E
o � �o ry for Contractor's Signature: Notary for AgenYs Signature:
z ''
� �p �
`�N�u�u� �,�il' i(,?!�r�... ���CU �
,,.��c ro$ta of County of State of� County of
:�° «• '�Ei:
=� f�q foregoing was acknowledged before me this �:'���' The foregoing was acknowledged before me thi
��°h . s�;�y�of _, �l�\� ,by d-•cf�� , p� b� ,
�'•���,,,������i�i.. � r� ,who is personally known who is pe�y known to me
�e,orwhoproduced � ,��..�L� L�c_�;�5� as w opr duced �— � C as
identification. 1 Id ti atiQL�.
��
Notary ,ubli nature Notary blic Signature ' � , ,
` _ _ rr;; �-� � _�` _
J � f `i �
� �'� �b
C /� c
��\V����L.✓ � � \ ��..�� �. . � ,_:� i r�uri�,i. s�
�`
Print,Type,or Stamp Name of Notary Print,Type,or Stamp Name o$Notary , � ��;� r,r ,�; t . ,, i � ;��q &
'The original of this affidavit should be kept in the possession of the above designated"A6thoriz�d 4�c�e�t", ThES affid,�vif�;; �
��.�. , ,.:
need only be produced to Hernando County when signing documents in the presence of a::permit=Fepres�r�t�i�y���ewyo� ,.;�e �,= :y
sign a permit application be prepared to produce this affidavit, it will be copied and placed in the appropriate permit
application.'
�'''The Depnrtment,nt its discretion,nray require a coirtractor or license-ho[der to personally app[y for or obfain n b�rilding per��iit
notwithstanding any nuthorizntion allowing another person to npply for or o6tain any permit on belrn/f of a contrnctor,ryunlifrer,or
[icense-holder.
Revised 08l21/00 contauth.sop
i iiiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiii iiii
2014016432
Rcpt:1579204 Rec: 10.00
DS: 0.00 IT: 0.00
PermitNumber 02/03/14 S. Shultz, Dpty Clerk '
Parcel ID Number /I-a� -�l—�l� -- D� ' o a��l PAULR S.0'NEIL,Ph.D.PRSCO CLERK 8 COMPTROLLER
NOTICE OF COMMENCEMENT 02/03/14 �.��55�a� i of i
State of Florida OR BK p� ���I1�
County of Pinellas �J
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real propPrt� anri in ar,cordance with Section 713.13 of the
Florida Statutes,the foilowing information is provided in thi�NnT�rF nc�n���n���.-������T CITY OF ZEPHYRHILLS PB 1 PG 54
1.Description of property(legal description):
-----�f WEST 1/2 OF LOTS 13 14 15 & 16
� BLOCK 64
a)Street�job)Address S S._�.� S^ ��'��, ���l'L...f?,�T __ __ OR 4937 PG 668 -
2.General description of improvements: � � � � � � `'� ,e � �� � ��Y�,_�j'
____ __ _ ___ ._ _...._ _ _ _..... _ ___ __ _... __._
3.Owner Information or Lessee information if the Lessee contracted for the improvement:
a Name and address: A A/ �, . . �' T/1 " ,L L , FL. 3.�`� �-`
) � �L s�_o y__.5 S/�2�?-Z�p��R�C ' � _ _ _
b)Name and address of fee simple titleholder(if different than Owner listed above)
c)Interest in property:
�g _.. . .V _ . _..� LEI�I�W¢�T�1�fFLa ._��7C�� -- �-{ 3Z.Qj
__..
.._
4.Contractor Information ` 7� � ��r N I
a)Name and address: � ����L� +9 �O l�'- �i �'1e�O W S . � _ �.d � h--5.
b)Telephone No.: _ _ p_Q ( � Fax No.: (optional) �a�— "z�s_ �. �j �j
�_a.2 .__ �_ . .�..._ ._ _. _ _ - .. �
5.Surety(if applicable,a copy of the paymen�bond is attached)
a)Name and address: ���-
_-_ __ _... .... _.. __ . _ _
b)Telephone No.:
__ _. _ _ _. _
_ _. _ _ _ .
c)Amount of Bond: $
_ _ _ _ _ . __
6. Lender ,
a)Name and address ��f�- _ _
_..__ _. _ _._..__ _--_. _.____...
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:
� __ _.. --- _ ___.. _ _ . __ _
b)Telephone No.: Fax No.:(optional)
_...._ _... ___ ._._.._ _..__ _ __ _.. _ ____ _._ _
8.a.ln addition to himself or herself,Owner designates 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 OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE
CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES,AND CAN RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON
THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
__.. _. _ ........---- . . ._- ---- -----._ . .__.._. __.___.. . .._--.. _._.____. .
Under penalty of per�ury, I declare that I have read the foregoing notice of commencement and that the facts stated therein are true to the best of my
knowledge and belief. -
�<� _ _ ._�.���.. _...._. __..__. . _.._.... ___ "�'2 a.�n _�� �--L_ �W V l.��!�L
nature of 0 ner or Lessee,or Owner's o Lessee's(Authonzed Officer/DirectodPartnedManager) (Pnnt Name and�Provide Signatory's Title/Offce)
T e forego-ifn�instr en as acknowledged before me this � (�'� day of n,�(7l/`� I�11�� , 20� �
by ����'�lU �� �� 25 ��J����" (type of authority,e.g.officer,hustee,attorney in fact)
for �,1(,�V'f'('(� ti-�l (;�._ __ ___.. . _.. ____ _ � ,�as. :�.(�_���'�— � _..._ _.__ _.._ �_. �_ _ _. �
.�,,r� . I Name of�'erson) " (type of authority,.. e.g.officer,trustee,attorney in fact)
for �1,��� \ ► �-� '`�� �� (name of party on behalf of whom instrument was executed).
Personally Known ❑ Produced ID d %
Type of ID �(, j�(,� ��- �'j��-�(���(� Notary Signature �' -
� ���(��..Q,F�„� . _ .__ __.. ___ __ ___.._ __
Printname JCiC'(�l-�,L�[l(l.'�. �.L�t°�__ _ _
_ _
,,,,,,
.�lrAY pV6�� JAC�UALINE BUTLER
',r�' '�°' Notary Public-5tate of Florida
_ . _ _
;N�' :�'My Comm.Expires May 17,2014
'��/�FOFF��O� Commission#DD 992490
�i�����
, ! /,�'�
�'�� � . � « c�'QpG �H����F FLORIDA, COUNTY OF Pq�C
� ' S I� fG CE,qT�FY THAT TH�FOR�GOWG�IS�
� '� TRUE AND CORRECT COPY OF THE DOCiJMENT
�F • •,
m yoF1'�}yQ�-n�« , * ON FILE OR OF PUBLIC RECORD IN THIS OFFICE
yf � � - . WITNESS MY HAND ANG O�FICIAL SEAL THIS
�".•=>
� � , * -�__DAY OF
. Ibt3� * �AULA S O'NEI � � ��
,��E K& COMPTROLLER
s� ' � � �
�o��_o�,��,.- aY--- ����
- , ._~��.Ty r
�_rR�
� Affordable Windows & Doors
of Tampa Bay, LLC
, � 2$870 U.S. Highway 19 N, Suite 300
Clearwater, FL 33761
Lic. #CGC1520791 727-437-0017
727-725-2933 (Fax) -��.:� - ��—� � �"1 l�'
I(we)hereby contract with Affordable Windows&Doors of Tampa Bay,LLC the following work and authorize Affordable Windows&Doors of Tampa Bay,LLC to furnish all the necessary
materials,iabor and workmanshi o iri�tall,construc[and place the improvements according to the following specifications,terms and conditions on the premises below described.
"I��his coratract, rnade�. � ��� � �
��� Day of a✓ , 20 /'�
C.)�+�ner's Na►iie �� �"7��� -i��,�� -
--� Ph# ome Work Cell
Aciclress ��.5 e� �j ,� �� - -------
� City --�,��e�,�� // ' State �`7 Lip�'' 3 S"%' z--.
Jub ,�ddress. (ff different than above) ,f�,�-�_.-
C�?h'f'KAC"COh'f0 FUI2NISH&1N57'AI.1_MACLRtALS AS FOLLOWS.
❑ Affordable Windows & Doors of Tampa Bay will remove old windows and install the following new
Affordable Windows & Doors of Tampa Bay replacement windows to existing jambs, headers and sills as follow�:
�� I.ocation l�ype MocJel 1t sore�n cr,d ci,uti a,ior F,.o,i�� VMeasw•emeH �,i, F Measurement �.i. Description!Not
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TERMS OF SALE NOTICE
The Buyer(s) agree(s) to pay �sum as follow. ���.,� ANY HOLDER OF THIS CONSUMER CREDIT I 1IAVl�RI:AD
(Aj Cash Price of Work —�-� CONTRACT IS SUBJECT TO ALL CLAIMS ANDAGREF WtI'H
(B) Downpayment Made by Owner $ U�� � AND DEFENSES WHICH THE DEBTOR "fHE"t'ERMSAND
(C) Unpaid Bala � COULD ASSERT AGAINST THE SELLER OF CO�IUITIONS ON'['t-lF
(To aid Upon Completion of Job) GOODS OR BERVICES OBTAINED PURSU- 1�ROM'&P.EVERS�-
� ash upon delivery p To be Financed $S`�4� ANT HERETO OR WITH THE PROCEEDS SID, ES�
HEREOF, RECOVERY HIEREUNDER BY THE
DEBTOR SHALL NOT EXCEED AMOUNT cusron ,H r ini_
PAID BY THE DEBTOR HEREUNDER. �
FLORIDA HOMEOWNERS' CONSTRUCTtON RECOVERY FUND: PAYMENT MAY 8E AVAILABLE FROM THE FLORIDA HOMEOWNERS'CON-
STRUCTION RECOVERY FUND IF YOU LOSE MONEY ON A PROJECT PERFORMED UNDER CONTRACT,WHERE THE IOSS RESULTS FROM
SPECIFIED VIOLATIONS OF FLORIOA LAW BY A LICENSED CONTRACTOR. FOR fNFORMATION ABOUT THE RECOVERY FUND AND FILING A
CLAIM, CONTACT THE FLORIDA CbNSTRUCTION INDUSTRY LICENSING 80ARD AT THE FOLLOWING TELEPHONE NUM6ER AND ADDRESS:
Construction industry Licensing Board
1940 North Monroe Street
Tallahassee, FI.32399-0783
850.487.1395
----------------------°---------------------------°-------------------
ACCORDING TO FLORIQA'S CONSTRUCTt�N LIEN L4W rSperu�NC��a nn�_�i��� ❑i naine creTi iTFC� runcG wun wnou nr.�vn��o oono
Pasco County B�_iilding Sc]�ematic Page 1 of 1
• Generalized Building Schematic
11-26-21-0010-06400-0131
Card: 001
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Pasco County Property Appraiser
Page Layout Modified: 9/6/2013 8:36:26 AM
The Local Time Is: 12/12/2013 7:10:13 AM
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, ,��orida Building Coc"e Online Page i of 4
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BCIS Home Log In User Reg�stra[lon Hot Topics Submit Surc�arge Stals&Facts Publications FBC S[aff � BCIS Si[e Map Links . Search
Busines f��
Profes�i r�a I Product Approval
��w
� USER:Public User
n'� 1
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F�;,tl�ct Aooreval N�.en�.a>Croduce cr Acoli<atiei�Search>FD�licatlon List>4ppliution Detail
��
,��� � �'�� I�� FL# FL75213-R1
�� q Application Type Revision
t���d� i�� �
, b,„„{ �„,g� ..... . . Code Version 2010
Application Status Approved
Comments
Archived
t'�LLWOR(C 5����I1,l;U��1FC.�'«�IT�I AL,
��,EVAILING CODCS,T�LORIDAFUILL�Ii�G
Address/Phone/Email 5200PW CEN URYnBLVD stics �n��'hV:^rj^�i at,�L�'��'`L\Il,���0���,�`�
t� 1 11 L�JiV 7 p � p
(4�0)969 9773�Ex��6� �}�j`������.�I}����i���_F�T1�7_��)�SJ��:�����.-'J
rickw@rwbldgconsultants.com
Authorized Signa[ure Vivian Wright
rickw@rwbldgconsultants.mm .
�
TechnicalRepresentative ScottJohnson ������ �
Address/Phone/Email 5200 W Century Blvd.
Los Angeles,CA 90045 "-�
(440)969-9773 Ext 18 ClTY pF ZEPHYRHiLLS
scottjohnson @ plastproi nc.com
PLANS EXAtVIIN�������14
Quality Assurance Representative Ron O'Conneli
Address/Phone/Email 5200 W Century Blvd.
Los Angeles,CA 90045
(440)969-9773 Ext 16
ronotonnell@plastpro.tom
Category Exterior poors
Subcategory Swinging Exterior poor Assemblies
Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed Florida
Professional Engineer
� Evaluation Report-Hardcopy Received
Florida Engineer or Architect Name who developed the Lyndon F.Schmidt,P.E.
Evaluation Report
Florida License PE-43409
Quality Assurance En[ity National Accreditation and Management Institu[e
Quali[y Assurance Contract Expiration Date 12/31/2014
Validated By Ryan J.King,P.E.
�� Validation Checklist-Hardcopy Received
Certificate of[ndependence FL.5213 Rl COI Ce ttficate Of Inde endenc_. df
Referenced Standard and Year(of Standard) Standard Yea
r
101/I.5.2 1997
101/I.5.2/NAFS 2002
AAMA/W D MA/CSA 101/I.5.2/A440 2005
ASTM E1886 2002
ASTM E1996 2002
ASTM E330 2002
TAS 201,202,203 1994
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. Fl��rida Building Code Online Page 2 of 4
� Equivalence of Product Standards
Certified By
Sections from the Code
Product Approval Me[hod Method 1 Option D
Date Submitted OS/03/2012
Date Validated OS/03/2012
Date Pending FBC Approval OS/OS/2012
Date Approved 06/11/2012
_ ___ __— ._ _._ ___ _ __— _—. _._ __ —. .-._- �.
�Summary of Products ��� ����� ,.
�Go to Pa9e �� � � � Pa9e 1/2� � ..��,...:
FL# Model,Number or Name Description
15213.1 a.Smooth/Wood Grain/White Wood 6'8"Impact"Opaque Fiberglass Single Door-Inswing/OUtswing(X-
; Grain/RUStic/Mahogany Series Fiberglass Configuration)
Door
I Limits of Use Installation Instructions
Approved for use in MVHZ:No FL15213 R1 Il INST 15213 1 odf
Approved for use outside HVHZ:Yes Verified By:Lyndon F.Schmidt,P.E.43409
Impad Resistant:Yes Created by Independent Third Party:ves
i Design Pressure:N/A Evaluation Reports
Other.See WST 152131 for Design Pressure Ratings,any additional FL15213 R1 AE EVAL 15213.1.odf
use limitations,installa[ion ins[ructions and product particulars. Created by Independen[Third Party:Yes
�15213.2 b.Smooth/WOOd Grain/White Wood 6'8"Impact"Opaque Fiberglass Single Door with Sidelite utilizing
� Grain/Rustic/Mahogany Series Fiberglass "Snap Frame"Glazing-Inswing/Outswing(OX or XO-Configurations) �'�,.
Door
fLimits of Use Installation Instructions
IApproved for use in HVHZ:No FL15213 R1 II [NST 15213 2 odf
Approved for use outside HVH2:Yes Verifed By:Lyndon F.Schmidt,P.E.43409
� Impact Resistant:Yes Created by Independent Third Party:�Yes
j Design Pressure:N/A Evaluation Reports
� Other.See INST 15213.2 for Design Pressure Ratings,any additional FL15213 R1 AE EVAL 15213'odf
`use limitations,installation instructions and product particulars. Crea[ed by Independent Third Party:Yes
I
j 15213.3 c Smooth/WOOd Grain/White Wood 6'8"Impact"Opaque Fiberglass Single Door with Sidelites utilizing
Grain/Rustic/Mahogany Series Fiberglass "Snap Frame"Glazing-[nswing/Outswing(OXO-Gonfiguration)
i
Door
�limits of Use Installation Instruc[ions
= Approved for use in MVHZ:No FL15213 R1 II INST 1521�3 odf
i Approved for use outside NVHZ:Yes Verified By:Lyndon F.Schmidt,P.E.43409
; Impact Resistan[:Yes Created by Independent Third Party:Yes
�� Desiqn Pressure:N/A Evaluation Reports
Other:See INST 15213.3 for Design Pressure Ratings,any additional F�15213 Rl AE EVAL 15213°odF
�use limitations,installation instructions and product particulars. Created by Independent Third Party:Yes
�15213.4 d.Smooth/WOOd Grain/White Wood 6'8"Impact"Opaque Fiberglass Single Door with Sidelite utilizing"Lip
! Grain/Rus[ic/Mahogany Series Fiberglass Lite"Glazing-Inswing/Outswing(OX or XO-Configurations)
Door
�Limits of Use Installation Instructions
Approved for use in HVH2:No FL152].; R1 II INST 15213.4.odf
Approved for use outside HVH2:Ves Verified By:Lyndon F.Schmidt,P.E.43409
Impact Resistant:ves Created by Independent Third Party:Yes
� Design Pressure:N/A Evaluation Reports
� Other:See INST 15213.4 for Design Pressure Ratings,any additional FL15213 Rl AE EVAL 152i3 4 odF
iuse limitations,installation instructions and product particulars. Created by Independent Third Party:Yes
i 15213.5 e.Smooth/Wood Grain/Whi[e Wood 6'8"ImpacY'Opaque Fiberglass Single Door with Sidelites utilizing"Lip ����,'
Grain/RUStic/Mahogany Series Fiberglass Lite"Glazing-Inswing/Outswing(OXO-Configuration)
Door
I Limits of Use Installation Instructions
I Approved for use in HVHZ:No FL15213 P1 II SNST 1521'S ocf
'�- Approved for use outside HVHZ:Yes Verified By:Lyndon F.Schmidt,P.E.43409
i Impact Resistant:Yes Created by Independent Third Party:Yes
� Desiqn Pressure:N/A Evaluation Reports
'�� Other.See INST 152135 for Design Pressure Ratings,any additional FL15213 R1 AE EVAL 15"'13�odf
'use limitations,installa[ion instructions and product particulars. Created by Independent Third Party:Yes
I
�15213.6 f.Smooth/WOOd Grain/White Wood 6'8"Impact"Opaque Fiberglass Double Door-Inswing/Outswing(XX- ''���
i Grain/RUStic/Mahogany Series Fiber9lass Configuration)
Door
�Limits of Use Installation Instructions
Approved for use in HVHZ:No FL15213 P.1 tI INST 1��1'6�df
Approved for use outside HVH2:Yes Verified By:Lyndon F.Schmidt,P.E.43409
Impact Resistant:Yes Created by Independent Third Party:ves
Design Pressure:N/A Evaluation Reports
; Other.See INST 15213.6 for Design Pressure Ratings,any additional FL15213 RI AE EVAL 15"3 6 nd`
iuse limitations,installation instructions and product particulars. Created by Independent Third Party:Yes
i 15213J g.Smooth/WOOd Grain/White Wood 6'8'7mpact"Opaque Fiberglass Double Door with Sidelites utilizing
Grain/Rustic/Mahogany Series Fiberglass "Snap Frame"Glazing-Inswing/Outswing(OXXO-Configuration)
Door
��Limits of Use Installation Instructions
Approved for use in HVHZ:No FL15213 R1 II INST 15213�odF
Approved for use outside HVH2:Yes VeriFed By:Lyndon F.Schmidt,P.E.43409
Impact Resistant:Yes Created by Independent Third Party:Yes
� Design Pressure:N/A Evaluation Reports
http://tloridabuilding.org/pr/pr_app_dtLaspx?param=wGEVXQwtDqv3yV VKJZ 1 QRC3FgPGdq9zl%2fncoV WqBt9JC6bd... 12/12/2013
. Plorida Building Code Online Page 3 of 4
. � Other.See INST 15213J for Deslgn Pressure Ratings,any additional FL15213 El AE EVAL 15213J.ptlf
use limitations,installation instructions and product particulars. Created by Independent Third Party:Yes
15213.8 h.Smooth/WOOd Grain/White Wood 6'8"Impact"Opaque Fiberglass Double Door with Sidelites utilizing
Grain/Rustic/Mahogany Series Fiberglass "Lip Lite"Glazing-Inswinq/Outswing(OXXO-Configuration)
Door
Limits of Use Installation Instructions
Approved for use in HVH2:No FL15213 R1 II INST 152:33.odf
Approved for use outside NVHZ:Yes Verified By:Lyndon F.Schmidt,P.E.43409
� Impact Resistant:Yes Created by Independent Third Party:Yes
� Design Pressure:N/A Evaluation Reports
i Other.See INST 15213.8 for Design Pressure Ratings,any additional FL15213 R1 AE EVAL 15213.S,otlf
Iuse limitations,ins[allation instructions and product particulars. Created by Independent Third Party:Yes
15213.9 i.Smooth/WOOd Grain/White Wood 6'8"NOn-Impact"Glazed Fiberglass Single Door utilizing"Snap Frame" �'
' Grain/RUSti[/Mahogany Series Fiberglass Glazing-Inswing/Outswing(X-Configuration)
� Door
(Limits of Use Installation Instructions
IApproved for use in HVHZ:No FL15213 Rl II INST 1521�.U,od(
Approved for use outside HVHZ:Yes Verified By:Lyndon F.Schmidt,P.E.43409
Impatt RCSiStant:NO Cr2dtEd by IndEp2ndEnt Third Pdrty:Yes
Design Pressure:N/A Evaluation Reports
i Other.See INST 152139 for Design Pressure Ratings,any additional Fu5213 Ri aE EVAL 15213.5.odf
�use limitations,installation ins[ructions and product particulars. Created by Independent Third Party:Yes
i 15213.10 j.Smooth/WOOd Grain/White Wood 6'8"Non-ImpacY'Glazed Fiberglass Single Door with Sidelite utilizing
Grain/Rustic/Mahogany Series Fiberglass "Snap Frame"Glazing-Inswing/Outswing(OX or XO-Configurations) �'��,
Door
�Limits of Use Installation Instructions
� Approved for use in HVH2:No FL15213 R1 II IN>T 1521�.IO.oUf
� Approved for use outside HVH2:Yes Verified By:Lyndon F.Schmidt,P.E.43409
j Impact Resistant:No Created by Independent Third Party:Yes
i Design Pressure:N/A Evaluation Reports
� Other.See INST 15213.10 for Design Pressure Ratings,any FL15213 R1 NE EVP.L 15213.SO.odf
�additional use limitations,installation instruc[ions and product Crea[ed by Independent Third Party:Yes
Eparticulars.
f 15213.11 k.Smooth/WOOd Grain/White Wood 6'8"NOn-Impact"Glazed Fiberglass Single Door with Sidelites utilizing ',
Grain/Rustic/Mahogany Series Fiberglass "Snap Frame"Glazing-Inswing/Outswing(OXO-Configuration)
Door
Limits of Use Installation Instructions
( Approved for use in HVHZ:No FL152L- R1 II :NST 15213.il.odr
: Approved for use outside HVHZ:Yes Verified By:Lyndon F.Schmidt,P.E.43409
� Impact Resistant:No Created by Independent Third Party:Yes
IDesign Pressure:N/A Evaluation Reports
, Other.See INST 15213.11 for Design Pressure Ratings,any FL15213 R1 NE EvAL 15213.11.nd-`
iadditional use limitations,installation instructions and product Created by Independent Third Party:Yes
i particulars.
�15213.12 I.Smooth/WOOd Grain/White Wood 6'8"NOn-Impact"Glazed Fiberglass Double Door utilizing"Snap
Grain/RUStic/Mahogany Series N Frame"Glazing-Inswing/Outswing(XX-Configuration)
� Fiberglass Door
j Limits of Use Installation Instructions
� Approved for use in HVH2:No FL15213 R1 ]I INST 15213.12.udf
Approved for use outride HVH2:Yes Verified By:Lyndon F.Schmidt,P.E.43409
� Impact Resistant:No Crea[ed by Independent Third Party:Yes
� Desiyn Pressure:N/A Evaluation Reports
� Other.See INST 15213.12 for Design Pressure Ra[ings,any R15213 FI AE EVAL 15213.12.odf
i additional use limitations,installation instructions and product Created by Independent Third Party:Yes
particulars.
I 15213.13 m.Smooth/WOOd Grain/White Wood 6'8"Non-Impact"Glazed Fiberglass Double Door with Sidelites utilizing ;
Grain/Rustic/Mahogany Series N "Snap Frame"Giazing-Inswing/Outswing(OXXO-Configuration)
j Fiberglass Door
�Limits of Use Installation Instructions
; Approved for use in HVHZ:No F'�15Z13 Rl II INST 15213.13.odi
I Approved for use outside HVHZ:Yes Verified By:Lyndon F.Schmidt,P.E.43409
� Impact Resistant:No Created by Independent Third Party:Yes
jDesign Pressure:N/A Evaluation Reports
� Otber.See INST 15213.13 for Design Pressure Ratings,any FL15213 RI AE E��FL i5213.13.odr`
additional use limita[ions,installation instructions and product Created by Independent Third Party:Yes
particulars.
,15213.14 n.Smooth/WOOd Grain/White Wood 6'8"Non-Impact"Glazed Fiberglass Single Door utilizing"Lip Lite"
Grein/RustiUMahogany Series N Glazing-Inswing/Outswing(X-Configuretion)
Fiberglass Door
j Limits of Use Installation Instructions
� Approved Por use in HVHZ:No FL15213 Ri lI iNST 152L_l4.odf
j Approved for use outside HVHZ:Ves Verified By:Lyndon F.Schmidt,P.E.43409
� Impact Resistant:No � Created by Independent Third Party:Yes
Design Pressure:N/A Evaluation Reports
Other.See INST 15213.14 for Design Pressure Ratings,any FL1521; R1 AE EVAL 1521:s.14.od?
�additional use limitations,ins[allation instructions and produtt Created by[ndependent Third Party:Yes
'particulars.
i15213.15 0.Smooth/WOOd Grain/White Wood 6'8"Non-ImpacY'Glazed Fiberglass Single Door with Sidelite utilizing
Grain/Rus[ic/Mahogany Series N "Lip Lite"Glazing-Inswing/Outswing(OX or XO-Configurations)
Fiberglass Door
i Limits of Use Installation Instructions
! Approved for use in HVHZ:No FLi5Z13 Rl II IN57 i5Z13.1S.�tl�
I Approved for use outside HVHZ:Yes Verified By: Lyndon F.Schmidt,P.E.43409
� Impact Resistant:No Created by Independent Third Party:Yes j
� Design Pressure:N/A Evaluation Reports
� Other.See W5T 15213.15 for Design Pressure Ratings,any FLY5213 Rl AE EVAL 152?3.15 odr
'additional use limitations,installation instructions and product Created by Independent Third Party:Yes
�particulars.
�15213.16 p.Smooth/WOOd Grain/White Wood 6'8"NOn-Impact"Glazed Fiberglass Single Door with Sidelites utilizing '�����....
' Grain/Rustic/Mahogany Series N "Lip Lite"Glazing-Inswing/Outswing(OXO-Configuration)
� Fiberglass Door
!Limits of Use Installation Instructions
Approved for use in HVH2:No FLI5213 P.i II INST 15213.16.oGf
; Approved for use outside HVNZ:Yes Verified By:Lyndon E Schmidt,P.E.43409
� Impact Resistant No Created by Independent Third Party:ves
Design Pressure:N/A Evaluation Reports
; Other.See INST 15213.16 for Design Pressure Ra[ings,any FL15213 F.1 AE EVAL i52i3.15.odf
. Created by Independent Third Party:Yes
http:Ufloridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDqv3yV V KJZ 1 QRC3FgPGdq9zl%2fncoV WqBt9JC6bd... 12/12/2013
, TI<�rida l3uilding Codc Online Page 4 of 4
. �'��.additional use limitations,installation instructions and product
''���,particulars.
��i 15213.11 q.Smooth/WOOd Grain/White Wood 6'8"Non-ImpacY'Glazed Fiberglass Double Door utilizing"Lip Lite"
Grain/Rustic/Mahogany Series N Glazing-Inswing/Outswing(XX-Confguration)
� Fiberglass Door
Limits of Use Installation Instructions
'���. Approved for use in HVHZ:No FL15213 R7 II INST 15213.17,odf
'��. Approved for use outside HVH2:Yes Verifed By:Lyndon F.Schmidt,P.E.43409
'; Impact Resistant:No Created by Independent Third Party:Yes
'; Design Pressure:N/A Evaluation Reports
'��. Other:See INST 15213.17 for Design Pressure Ratings,any FL15213.Rl AE EVAL 15213.1�.oC�
�.:additional use limitations,installation instructions and product Created by Independent Third Party:Yes
�,partiwlars.
�'�.15213.18 r.Smooth/WOOd Grain/White Wood 6'8"NOn-Impact"Glazed Fiberglass Double Door with Sidelites utilizing �'��....
Grain/RUStic/Mahogany Series N "Lip Lite"Glazing-[nswing/Outswing(OXXO-Configuration)
Fiberglass Door
;Limits of Use Installation Instructions
� Approved ior use in HVH2:No FL15213 R1 II :NST 15213.18.odf
�� Approved for use outside HVHZ:Yes Verifed By:Lyndon F.Schmidt,P.E.43409
'� Impact Resistant:No Created by Independent Third Party:Yes
.: Design Pressure:N/A Evaluation Reports
i Other:INST 15213.18 for Design Pressure Ratings,any additional PL15213 R1 AE EVAL 15213.13.�di
i use limitations,installation ins[ructions and product particulars. Created by Independent Third Party:Ves
i 15213.19 s.Smooth/WOOd Grain/White Wood 8'0"Impact"Opaque Fiberglass Single Door-inswing/Outswinq(X-
� Grain/Rustic/Mahogany Series N Configuration)
i Fiberglass Door
�,Limits of Use Installation Instructions
; Approved for use in HVHZ:No FL15213 R1 I[ INST 15�13.19.odf
I Approved for use outside HVHZ:Yes Verified By:Lyndon F.Schmidt,P.E.43409
: Impact Resistant:Yes Created by Independent Third Party:Yes
; Design Vressure:N/A Evaluation Reports
: Other:INST 1521319 for Design Pressure Ratings,any additional FL15213 R1 AE EvAL 1521;.19.od��
(use limitations,installation�instructions and product partiwlars. Created by Independent Third Party:Yes
i 15213.20 t.Smooth/WOOd Grain/White Wood 8'0"[mpact"Opaque Fiberglass Single Door with Sidelite utilizing
� Grain/Rustic/Mahogany Series N "Snap Frame"Glazing-Inswing/Outswing(OX or XO-Configurations) �''���....
Fiberglass Door
�'Limits of Use Installation Instructions
� Approved for use in HVH2:No FL15213 R1 II INST 15213.20.odf
; Approved for use outside HVHZ:Yes Verifed By:Lyndon F.Schmidt,P.E.43409
I Impact Resistant:Yes Created by Independent Third Party:Yes
� Design Pressure:N/A Evaluation Reports
(, Other:INST 15213.20 for Design Pressure Ratings,any additional FL1521? RL Ae EVAL 15213?��.odi�
�use limitations,installation instructions and product particulars. Created by Independent Third Party:Yes
____..---.. ------ -___._.._----
____ .___--
,'Go to Page �� � � � Page 1/2� !� ...��...
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The State of FloriOa Is an PA/EEO employer.CoovrlaM 200]-2013 Sta[e of Floriea ::Privacv Sta[ement::AccesslblllN Sta[emen[::Re�und SIa(emen[
lJnaer Floritla law,emall adGresses are publlc recortls.If you tlo not wan[your e-mail atlGress releasetl in response to a publicrewrds reques[,do not send electronic mail to[his entiry.Insteae,
on[aR[he office by phone or by[raditional mail.If you have any Ques[ions,please contact 850.481.1395.'PUrsuan[(o Section 455.2]5(1),Floritla Statu[es,effective Oc[ober 1,2012,
I�icensees licensed under Chapter 455,F.S.must provide[he Department with an email aadress�if tM1ey have one.The emails provitled may be usetl Por o/ficial communlcation with[he Ilcensee.
However ema�il addresses are pu0l�ic recorE.If you ao no[wish[o supply a personal atlCress,please provide the Oepartmeni wilh an email atltlress w�ic�can be matle available to the public,Ta
tletermine if you are a licensee untler Chapter 455,F.S.,please qick here.
VroAuctApprovalACCepK:
.:. � ���.. �
5l_"CUE`It�31L."Cie6(�s'
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� � � � � � � PRODUC7: oucun,ena Provond 9y:
1- �p BUILDING CONSULTAN75, INC.
� � PIASTPRO INC. JL�v.o. eo. zao voiNOO FL. 35393
Im y � Phone No.: 813.0.59.9797
N � Z� FlBERGLASS DOOR
PART OR ASSEMBLY: Flo.+aa eoara or v.or...to�ai Enqinwn
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I°o �, N � NO DATE BY BILL OF MATERWLS. GLAZING �'��'L z,��
REYISIONS DEfAIL & COMPONENTS �y„ao� F. Se�miEt, P.E. No. L3�OB 2'
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