HomeMy WebLinkAbout15-15997 ' � CIT�( OF ZEPHYRHILLS '�
5335-8TH STR.FET �
�siypso-oozo 159
B ILDING PERMIT
I
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 15997 Address: 6744 ERIN CIRCLE
Perr�it Type: RE-ROOF ZEPHYRHILLS, FL.
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: VALLEYDALE RO ASSOCIATION
Est. Value: Parcel Number: 03-26-21-0170-00000-1310
Improv. Cost: 4,500.00 OWNER INFORMATION
Date Issued: 2/09/2015 Name: STEPHANS JANE & KACZKOWSKI VICT
Total Fees: 90.00 Address: 4802 LOBELIA CT
Amount Paid: 90.00 PLAINFIELD IL 60586-8652
Date Paid: 2/09/2015 Phone: � 813-783-9293
Work Desc: REROOF RUBBER
CONTRACTOR S APPLICATION FEES
L FL RIDA WEATHERPR FING&CO RERO F RESID NTIAL 90.00
.� � I n ^- � �r--�
L
�r
�`-
Ins ections Re uired
DRY IN ROOF INSP
TAPE JOINTS ROOF INSP �
FINAL Z ' �Z, - � ,5
REINSPECTION FEES: Reinspection fees will omply with Florida Statute 553.80 (2)(c) when extra inspection
trips are necessary due to any one of the fol owing reasons: a) wrong address b) condemned work resulting
from faulty construction c) repairs or corre ions not made when inspections called d)work not ready for
inspection when called e) permit not pos ed on job site f) plans not at job site g)work not accessible.
NOTICE: In addition to the requirements of this p rmit, 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 m nagement, state agencies or federal agencies.
"Warning to owner: Your failure to record notice of commencement may result in your paying twice for
im ovements to your property. If you int nd to obtain financing, consult with your lender or an attorney
before recordi g your notice of commencement."
Co lete Plans, Spe �cations Must Accom any Application.All work shall be pertormed in accordance with
City Codes and Or inances. NO OCCUPANCY BEFO C.O. �
,
C TRACTOR SIGNA URE PERMIT OFFI R
PERMIT EXPIRES IN 6 M NTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPE ION - 8 HOUR NOTICE REQUIRED
PROTE T CARD FROM WEATHER
s�saao-oozo City of Zephyrhills Permit Application Fax-813-780-0021
' Building Department
Date Received phone ontact for Permitting ��I �z- _ �� r`"�
Owner's Name � ���(.J�- `n-� C��1/�Y��� Owner Phone Number 8��J ?�3— "f'Z-/'3
�
Owner's Address L'J � �� �t 7C�N �,�� ZE��` � ��Owner Phone Number
� '
Fee'Simple Titleholder Name Owner Phone Numbe�
Fee Simple Titleholder Address I �
�
JOB ADDRESS ��� � ��� �I '�-I �������� �`C �� �L LOT# r 3 /
SUBDIVISION �����T �'7 L £_ ._ PARCEL ID#_��_-'��'--"���k!�7�-���Q O •- .�3f v_ -- - -' —
- �- (OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR ADD/P,LT � SIGN � C] DEMOLISH
e INSTALL 8 REPAIR
PROPOSED USE � SFR Q COMM 0 OTHER / ,
TYPE OF CONSTRUCTION � BLOCK Q FRAME' 0 STEEL Q
DESCRIPTIONOFWORK ��C���� ��'u�� �1/� �� ��`V ��/" ��� �'�� I'�����'���
BUILDING SIZE SQ FOOTAG �O O'�✓ HEIGHT ��
OBUILDING $ �j_n�, V LUATION OF TOTAL CONSTRUCTION
F�
�ELECTRICAL $ A P SERVICE � PROGRESS ENERGY Q W.R.E.C.
p�
OPLUMBING $ , �`�a'`
' 'y�,V
OMECHANICAL $ V LUATION OF MECHANICAL INSTALLATION . A J�l/ �
+v�nJ���1'
�GAS � ROOFING Q SPECIALTY 0 OTHER � `� l� -
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA DYES NO
BUILDER - �f—wt�✓' �e��0� I � � COMPANY '�ILL '��,�Rle�1� �i��IEi�fE'��(1�1i7'!/�1,�.
SIGNATURE REGISTERED Y/ N FEE CURRE� Y�/-N� ' -
Address �'L-3� r��'�� �l!'E�, �E �' �;� License# �� � /�a� ��(�/� �
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ 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/N
Address License#
RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building PI ns;(1)set of Energy Forms;R-O-W Permit for new construction,
Minimum ten(10)working days after submi tal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster;Site Work Permit for subdivisions/large projects
COMMERCIAL Attach(3)complete sets of Building Plans lus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction.
Minimum ten(10)working days after subm ttal date. Required onsite,Construction Plans,Stormwater Plans w%Sill Fence installed,
� Sanitary Facilities&'I dumpster.5ite 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 EW 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 Attomey(for the o ner)would be someone with notarized letter from owner aufhorizing same
OVER THE COUN7'ER PERMITTING � .(Front of Applicati n Only)
Reroofs if shingles Sewers < � SeFvice Upgrades A!C Fehces(PIot/Survey/Footage)
Driveways-Not over�Counfer if on public roadways..need ROW , '
,
NO"CICE OF DEED RESTRICTIONS: The undersigned understands that this permik may be subject to °deed" tes��ictioris''
which may be more restrictive than Gounty regulatians. The iandersigned assumes respons9bil9t}+fo�compllarice�iviEti aiiy
applicable deed resfric#ions. .
UNL.ICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITI�S: !f the owner has hired a conlracto� o�
contracfors to undertake work, fhey may be required ta be licensed in accordance rivith sfate and fiocal regiatations. If the
contractor is not licensed as �equired by law; both the owner and con#ractar may be cited for a misdemeano� 'violation
under state law. If#he awner or Intended contractor are uncertain as to irvhat licensing Cequ9rements rmay apply�o� �he
intended work, #hey are advised to contact the Pasca County �uilding Inspection Division—Licensing Section at 727-8�7=
8409. Fu�thermore, if the owne'r has hired a contractor or contrac�ars, he.is advised to have the coiitractor(s) sig�i
por#ions of fhe "contracfor Biock" of fhis applicafion for rivhich fifi�ey wili �ie responsib(e. If yot1; as �he bwne"r sigri a's {iie
contractor, that may be an indica#ion that he is not properly licensed and is not entitled ta permitting privileges iri Pascii
Gounty. �
TRANSPORTATION IMPACT/UTILITI�S IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Tsansportation tmpac� Fees and Recourse Recovery Fess may appty to the canstruction of new buildings, change of
use in existing buitdings, or expansion af existing buildings, as specified in Pasca Counfy Ordinance number 89-07 and
90-07, as amended. The undersigned also understands, that such fee's; as may be due; will be identified at tlie time of
permitting. It is further understood that Transpor�ation lmpac� Fees and Resource Recovery Fees rrtust be pai� p�io� to
' receiving a "certificate of occupancy" or�nal power release. If the praject daes not involve a ce�ti�icate of occupancy o�
fnal power re{ease, fhe fees must be paid prior to perfia:�it iss�ance. Furthei-rnore, i� Pasco Coiinty VltateflSewer Impact
fees are due, they must be paid prior to permit issuance in accardance virith applicable Pasco County ordinances.
CONSTRUCTlC?N LIEN LAW(Chapter?13, Florida Statutes, as amended): !f valuation of v+rork fs$2,500.00 or more, !
certify that I, the applicanf, have 6een provided with a copy of the "Fiorida Construction Lien Law—Homeawner's
Pratection Guide" prepared by the Florida Department of Agriculture and Cansumer Affairs. If the applicant is sameone
other fhan the"owner°, t certify that 1 have obtained a copy of the above described doc�tment and protnise in goad faifh ta
deliver it ko the"owner" prior to commencement.
CQNTRAGTOR°S/OWNER'S AFFIQAVIT: 1 certify that ai) ths RnformaEion in thRs application is accurate arid that a�l inrork
wili be done in compliance with all applicable laws �egulatirig cohstruction, zoning and land devetopment.. Applica�iori is
� hereby made to abtain a permit to do work and installation as indicated. I ce�tify that no work o� 9nsta!la�toii li�'s'
cammenced prior to.issuance of a permit and that all wor�C wili be perfar►nec� to meet stan�a'rds af all faws �egu�a�ing
constructian, County ia�d�•�City cades, zaning regulations, and land development regulations in the jurisdiction. I also
cerfify tha# E understand fFtat'fhe regulations af othe'r govetnment agencies rrtay apply�o the inten�ed iivork, ant� �Fiat iE is �
my responsibility to identify wliat actions I must take to be in compliance; Such agencies include 6ut are not limited to:
- Department of Environmental Protectian-Cypress Bayheads; Wetland Area's and Environinentat!}� Sensiti've
Lands, WateriWasfewate�Treatment. '
- Southwest Florida Water Management District-Weils; Cypress Bayheads, 'INetland A�eas; Altering
Watercourses.
- Army Corps of Engineers-Seawalls, Docks, Navigable V1laterway's.
- Department of Hea4th & RehabllRtative Serv�ceslEnvironmental Hsalth Unit-1Ne}Es, 1Nastewate� Ti�eatment,
Septic Tanks.
- US Environmenta{ ProEectiori Agency-Asbestos abatement: •
- Federal Aviation Aufhority-Runways. - '
1 underskand that the following�estrictions apply to the use of fill:�
- Use o€fiil is nat ailowecf in Flood Zone"V�unless expressly permitted.
- If the fill material is to be used in Flood Zone "A", it is understoad �hat .a drainage Plan addressing a
"cotn�ensating voltime" will be 'submitted at time of permitting whic�i �s prepared by a professional engineer
licensed by the State of Fiorida.
- if the fill material is to be !used in Flood Zane "A" in connection with a permitted building using stem wal!
cansfruction, I certify that fifl wiil be used aniy to fiil the area within the sEem waii.
- If fill material is to be used in any area, I certify that use of such fill will not adversely affec� adjacent
, properties. If use of�II is found to adversely a�Fect adjacent properkies, the owner may be cited foC 'vlolatii�g
, the conditions of the building permit issued under the aktached permit application, for lots less lhan.one ('I)
acre whlch are elevated by fiii, an engineered clrainage plan is required. , i
If I am the AGENT FOR THE OWNER, t promise in good faifh to info�m the awne`r of 1he permitting condifions `se��o'r�h in
� this a�fidavit prior to commencing construction. I ianders�and that a separate pe�mit tnay be 'required fot electrical work;
plumbing, signs, wells, pools, air conditionirig, gas, br other ins#aliations na� specifca4ly ii�cluc�ec� in �he applicatioii: A
permit issued shall be construed to be a license to proceed with the work and nof as aukho�ity to,violate, cancel; a��e�; ar
set aside any provisiorts of the�echnical codes, nor shali issuance of a permit prevent�he Suilding C?fficial from 4he�ea��eC
requiring a correction of errors in plans, constructian or violations of any codes. Every permit issued shall become invalid
unless the work aufharized by such permit is cominenced within six months of pe'rmit issuance, o� if wofk autliotized by
the permi#is suspended or abandoned for a period of six(6} manths after fhe time the wa�k is comrrienced. An ex�ension
may be requested, in writing, from the Building Officiai far a period na� to exceed iiinety (90) days and "will dei�noH'strate
jus#ifiable cause for the exfension. if worlc ceases for nirtety. �90}consecufive days,Etie jab is consic�e'red 'abaridoiied,
WARNING TC1 OWNER: Y4UR FAIE.URE TO RECQRD A NQTIGE Q� C4N{MENCEMENT MAY REStl�'C !N YOt1R
, PAYING 7WICE FOR IMPROVEMEN7'S TO YOUR PROPERTY. IF YOU INTEND TO OBTAMN FiNANCING, CONSULT
W1TH YC►UR�ENDER OR AN ATTORNEY BEFQRE RECORDING YOUR NOTICE OF COMMENCEMENT.
� FLQRiDA JURAT(F:S.'117.d3}
QWNER OR AGEPIT C4NTRACTQR"'���✓ ��-�'�/./1� �
5ubscribed and sworn to(or a�nned)before me thfs u c ib d and swom ta or affittrted)bef re e fh'ss
by �(,� /I'— by—.____�'l_��J�' �G[L-r�'"0,�,�.�
Who lslsre persanally knawn to me or haslhave produced W a islare persanaliy kno_ wn to m�.o�haslhave produced
as identificativn. as idenGficatlan.
. , , .
Notary Public f�otary 1'iiblic
Commission No. missio a. •����+�°y'`•= � �`
_'.i ':+= MY COMMISSION N FF 126167 ' ' ` �
; ;;, ra; EXPIRES:Ju! 4,2018. �
Name of Notary typed,printed or skamped N of Not type ,printed o� " "' °t�y "rau°as""�ters� „1
, �!� ,.
. f
ALL FLO A WEATHERPROOFING °F
AND ONSTRUCTION, INC. �
-. -- 4231 112th enace N'•Cleazwater,FL 33762 ��
--�;�,:�:;; (87� 72-1019•Fax(72�572-5670 �j ��3r�re�e
- ;;-, = .AllFloridaRoofs.com g�3 76 j r
a" � �"' � State Certified L cense#CCC132740 #CBC125900� � I�•��
� l ws�� N��.,h ,
' Owner(s)/Purchaser(s): v �,L j0� CZ �Phone:(H) (W) (C)
[/ r /�
MailingAddress: � 7 �f City: � �ounty /`AT CG State:,�7rp:
[Circle:SB•MHP J Community Name: `Q-- Lot#:
Alternate Address: ity: State:_Zip: Phone: _
E-mail:
VWe,the Otimer(suPurchaser(s)of the premises described below, reinafter reterred to as"Purchase�'offer to com2ct with ALL FLORIDA WFATHERPROOFING AND
CONS7RUCTION,INC.,hereinafter reterred to as"Contracto�'to tu ish,to deliver and artange tor inslallation of ail materials necessary to improve the premises located at
Jobsite Address: Ciry: State:_TJp:
acxorcling to the following written specifiqtions:
- SOLID WHITE MEMBRAN •E.BRAND" � ❑ HINGLE-LOOK MEMBRANE:BRAND&COLOR
❑ OTHER:
1.PROVIDE ENERGY-SAVING INSU TED WAT PROOFING SYSTEM FOR THE FOLLOWING AREA(S):
�
2.INCLUDE ENERGY-SAVING DOUBLE-FOIL FA ED INSULATION AS INDICATED:
O BRONZE:45 MIL NO INSULATION O S VER 45 MIL 1-1/4"INSULATION �GOLQ 45 MIL 1-5/8"INSULATION
3.ALL CUSTOM ROUNDED PRESSURETREA FRAMING INC UDED.
4.INCLUDE NEW SPUN ALUMINUM VENTS: SMALL ,�LARGE US MER
INITIALS FOR
5.INCLUDE UP TO 100 S�.FT.OF NECESSAA ECK REPLACEMENT.ADOITIONAL DECK SYSTEM
REPLACEMENT TO BE INVOICED SEPARATE AT$3.00 PER S�UARE FOOT.
6.INCLUDE ALL RE�UIRED PERMITS.
7.CLEAN UP AND REMOVE ALLJOB-RELATED DEBRIS FROM JOB SITE.
8.MAIL OUT[LIMITED LIFETlME j NO-LEAK,T ANSFERABLE WARRANTY FULLY COVERING ALL LABOR AND
MATERIAL.($50 TRIP FEE MAY APPLY)
9.ADDITIONAL INFORMATION:
- - - .� - � - -- -
10.IT IS UN RSTOODTHATTHE FOLLOWING�REAS WILLyQT s�ctvar.�Ax�soF�76�.�rnwn�r�xaHSas
BE INCLUDED IN THE COVERAGE PROVIDED BY THIS �rs�.�'�°arata�ASZOSSCt�-
AGREEMENT(Also See Drawing at Right): �°�"���'����,
� �Q�
OTHER NOTES: ���� ��
�� c� nv� CUSTOME
INRIALS
�'f�,.t?2� ,�'I/l c?�7'� Y
�� G"t-v s S�,�t,rT'� 3� � �
N07E:RETi4lL SALES TAX MU SE CHARGED UNLESS TNE CUSTOMER SlGNS THE FOLLON/1NG:
I certify that I own the land on which the stru ure I am improving is permanently affixed.Furthermore,1 have filed a declaration
with the Property Appraiser requ tin sV ure q@ as as r ry and k bears�n°RP°decal.
SIGNATURE: l�
c!�'�YZ�Z ,
The CASH CONTRACT PRICE for all Labor Materials(including any applicable discounts)is$ y����
Terms:O Cash O Credit(Subject to ihe approval of the redit Sales Department) Sales Tax S �`
If this is a cash transaction,the purchase pric�shall be ai as follows: .,r. ,.,1
. Cash down Payment(Nlinimum 33%}S i Balance Payable$ �J �.r�/u Total Price S V��
If this is a aedit Uansaction,the agreement f r credit is co ined in a separete document which is incorporated herin by reference a made a part thereof.
UWe undersigned are hereby authorizing ALL FLORIDA WEA HERPROOFING AND CONSTRUCTION,INC.to verify and review my/our credit record with an inde-
pendent credit reporting agency and release them from all liabi incurring from inadvertent omissions or errors.
Verbal understandings and agreements with represenWU s shall nat be binding.All understandings and agreements must be set forfh in wrfting in this
i Contrad.ADDITIONAL PROVISIONS ARE STATED ON R ERSE SIDE AND ARE PART OF THIS CONTRACT.
UNLESS OTHERWISE SPECIFIED,IT IS UNDERSTOOD THAT THE OWNER(S}IS/ARE READY FOR THIS WORK TO BEGIN.THE PURCHASE PRICE
QUOTED ABOVE WILL BE HONORED ONLY UNTIL .Purchaser(s)understands and agrees that if this agreement is cancelled afrer the
rescission period, the Purchaser is fiable tur twenry five percent of the total sales price as damages to the Contractor.In theeventtl�isoffertoCOntractis
not aaepted by Contractor,any payment made hereunde shall be re(unded to tl�e Purchaser(s)and this proposal Shall be nu�and void and of no efrect
Contractor is not responsible for epsting shucturai defects,dry rol or other fadors beyond our control.No repairing,plastering,painting,prpentry,or decorat-
ing is included unless specifiplty charged for and specifie in vrriting herein.Purchaser agreas to pay the Total Price in fuil upon installation unless othefwise
agreed to in writing.If installation is started but not complet fhe same day and the pa�ies agree ihat the installation is not completed,Purchaser may withhold
10%of the Total Price until installation is completed. � � ��^��
INWITNESSWHEREOFPurchaser(s)havehereuntosign theirname(s)thfs�dayof � ��
and aeknowled�e�reeei�t of a e of this Con act
�--- --- ---------�------------z—�
I � — — � � /,� �� K�t1��� /- � r�
�SUBMITT D BY:Repres ative Date a D Y:Purch sedOwner� Date I
I ACCEPTED BYAuthorized Signature for Contractor � Date ACCEPTE�BY_PurchasedOwner Date _J
L—————�——————— —————— ———————
_- I
� _c�fj o
o�V I
rt>ui�iun
,•.+G�yv�.-=�«- I
..,�. a`'..� , i
ity of Zephyrhills
BUILDING LAN REVIEW COMMENTS
�
Contractor/Homeowner: /��,..�.. L o R� D A �� -- E R P�ao r i N�
Date Received: 2. " 3 — / .s
site: 6 7 YY ER/N C I .
Permit Type: ER00 V 8F Q
Approved w/no comments: Approved w/t e below comments: ❑ Denied w/the below comments: ❑
This comment sheet shal be kept with the pe it and/or plans.
�
/
Kalvin Sw ze ans Examiner D te Contractor and/or Homeowner
(Required when comments are present)
• �
Permit Number: . � IIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIII��I�III
. IIIIIIIII
. Folio/Parcel Identificatior� Number; O3���� f � 2015016102
Prepared by:•George Vaezi nI�n` O n n��_ /� Q
/ Rept:1657934 Ree: 10.00
� All Florida Weatherpro.oflng Cs C/onst�4cNo ,Ine: DS: 0.00 IT: 0.00
Return to:4231 113th Terrace N , 02/03/2015 D, B., Dpty Clerk
Clearwater FI. 33762 .�' • �+ . . ,' • '
�`D p1'IC� :.� �(�MlN�����I��T �
State of Florida, County of T�f �� ' ~ - •
The undersigned herebY gives notic�that ImR[o �mQnt will bQ ma�Q to���rtain re�l property, and in accordance
with Chapter 713, Florid�Statutes, th�foll4wit19��fafm�tiQ�i� prevl��d It1 thi� Notice of Commencement.
1. Descy'ption of Co :g�ty(le al �e� ri_�ip�o e �r � � nd s�Fe@t dd.r- ss if available
6 7�f�t p-��e�,l�� (�i/�t P ". �i��l��laC�f, �� ��5"4.� �/'i9LC�'f�.�,9L�' N�.!�1�.
_._.___._..._.___..._..._______._._ . _ � .,. .
. .... .
2. Gene a d�s r' ion of improyemen_ �A,�,.. /3�
'�
.. ................_.__�_._._..;—... . � _._.^_�-----�- �---- ... .
3 Owner inf matio q �es5ee info.r-m�tlQn �'I�re/�e ���Q�ItPa�Cted fQ�the �mprovement '�
Name �.. V+����/ ,
. . .... .- � � -� -- .._ .�_ _ . . _ _..._ .. .. ....-_ . -
_.. _ ., .- •
� Address "
r�e �..r_f__� z
.,_..__. . _. --.. _--._____
Interest in Property = � ��
� - ---: ..._......... ._
- - - ---�-- ---- ..._�.—----- — � � ------ -_ . ,_.._......_.... _. D
, Name and address of fee simple�i��@hold_�(iF�jff@���t�fotTt QWrler�i�t�d abovP) m�
Name N/A o N� i
.. __ ....- -�---......_.__�._.. - -
Address _ _.------._.---._...__.. . _._........_�... ..._
_. - - :ama
. ........ ....._..._..-•----- - -�_.._ .--�-_�.-- -- - - --- W vr
4. Contractor , � ' - m��
me Travls Fulford /Josh Fi�(ford /A(1 Floridp W.n�hgrp�oQftlr¢�Gonstruc�jon- ���'5'�'���9 �a z
Te�e,�Mo►?e Nymber_ :
dress 4231 i 7 2th Terraee N: ClearWa�ters F�337f�2 '��� ;
rety(if applicabl�, �copy of tjie p�yment �zn�i�atta��ied) '��� '
�ame N�A `feleghpne Number �,;,�
... . . ......� -- --..� ..__ ._._-�-.-,.,_----.-....� �
... .. ;w�
Address A!rlou�tt of Bo�d $ d • �■�+b D
..._......._. _ _... _..___.__-- --------
6. Lender - -.- -- -� . ....—,— � �
0
Name "�" � Telephone�IVumber c,..
_ .. .. .
_ ...__, .__. - .
- , ..._,._--,-- m
Address , . �
. .... ... ........_.. _....._...••--._�.....---.-�.s-`_. .._..--�---�- • ---_. __ ,-r-T.�.._.
7. Persons within the State of Florida c�esjg ;pteei gy Ow.�tet�u�j�n whom notices pr other d.ocuments tnay �°�� i
be served as proyided 6y§'T13,13(1)(a)7� =14�Ida S4aEut�s�, � ��.3
Name N�A T T__� _ ST�alephone Number - � �
_ ._.._.._ . __ -
.. ... - -
Address .....:_..__. ........ . o
-
_-___��.--- -
, ..._..._..-- - --- ---�---- -. ------ -..___.----��------ -
8. In addition to himself or herself,QH±�er . Ig11dEe�ftj�follQWl11�to rQ�Qqve a�Copy of the Lienor's �
Notice as provided in§713.13(1)(b), �lo�l tt�Xat`ItQs,
Name "'" ' . . ' _ . TQI4phone Number �
--. __ . . -- - ---
Address . ��
.. . ...._......---_.- - - - �. . _---...._--,-r�-.,r�... - .-, .,�. ._.� _ +
9 Expiration date of notice of comm���em [�t(th��xpi��tion ��te•may not be before the cumpletion of ± I
construction and�nal payment to the epnt[a tQr, bl�t Wil) k�a 1 y��r f1'om the date of recording unless a �
different date is specified) N/A • �
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WARNING TO OWNER:ANY PAYMENTS MADQ BY�'HE Qyy�1�R�1.�T�Fi�Mp QKRIRATIQN 4�F THE l�OTIC�OE COMMENP�MENT
ARE CONSIDERED IMQROPE�FAYMENTS UNq�R esl'I..FT�R 71��PART I,SEGT�9N 713.��,F�,QRIRA STATUTE9,,AN�CAN
RESULT IN YOUR RAYING TINICE FQR IMPROVEM�NT �`p Y�Uf��.�O�fRTY,A NOTIC�QF COMM�tdCEMENT MU$T BE
RECORDED AND POSTED ON TI-IE JOB.$�TE BEfQRE H,��IRST IHSP�CTION.Ir•YQU INT4MD fi0 QBTaN FINAf.VCING,CONSUl7 ' I
WITH YOUR LENDER OR AN ATT0t2N�Y BEFOR��4?M..�::N��NQ WO�2K qR RF.-Q/�RDINQ YOUR.NOTIG�OF CQIL7IV(E.NCEMENT. i
Under penalty of perjury, I declare that I haY �t�ad.th�f�t'�9ojr�g I�ptiGe pf pommer�cement a�nd that the �
facts sta d in it are true ta the best of�ny k. Qwte�d�i�a!�s1_bellef, I
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Signature ot Owner or Lessee,or Qv�n ',or Le�s@@'s,��Nth .f(�ecj Uf�4�r(Rlfecto�{R��tnQrfN�anager Slgna2ory Title/piflce
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����.1���� STAT��� FLORl�A, �OUNTY OF�,����
THIS IS T0�CERTIFY THAT THE FOREGOING IS A
�c o � ''��'� TORN�AND CORRECT COPY OF THE DOClJM�NI'
o FILE OR OF PUBLIC RECORD IN THIS OFFlCE
� � ��, �' � � 1NITNESS MY HAND AND�OFFICIAL SEAL
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PRODUCT APPROV L �P�CIFICATION SHEET
As required by Florida Statute 553.842 arrd Florida Admin strative Code 96-72, please provide the information and approval
numbers on the building components listed below if they ill be utilized on the construction project for which you are appiying
for a building pennit. We recommend you contact your lo I product supplier should you not know the product approval
number for an of the a licable listed roducts. Statewi e a roved roducts are listed o�line www.floridabuildin .or
Cate o Subcate o Manufacture� Product Descri tion A roval Number s
1. EXTERIOR DOORS
A. SWINGING ' -
. B. SLIDING
C. SECTIONAUROLL UP ' I
D. OTHER ',
2. WINDOWS '
A. SINGLE/DOUBLE HUNG
B. HORIZONTAL SLIDER
C. CASEMENT
D. FIXED
E. MULLION
F. SKYLIGHTS
G. OTHER
3. PANEL WALL
A. SIDING
B. SOFFITS
C. STOREFRONTS
D. GLASS BLOCK
E. OTHER
4. ROOFING PRODUCTS
A. ASPHALT SHINGLES
B. NON-STRUCT METAL
C. ROOFING TILES
D. SINGLE PLY ROOF Mule-Hlde Produds Co.,Isf ThertnoplasUc pofyolefln single ply roof systems FL12772,1
E. OTHER
5. STRUCT COMPONENTS
A. WOOD CONNECTORS
B. WOOD ANCHORS
C. TRUSS PLATES
D. INSULATION FORMS
E. LINTELS
F. OTHERS
6. NEW EXTERIOR
ENVELOPE PR�DUCTS
A.
. The products listed below did not demonstrate product a proval at plan review. I understand that at the time of inspection of these
products,the following informatlon must,be available to e inspector on the jobsite; 1)copy of the product approval,2)perFormance
characteristics which the product was tested and certifie to comply with,3)copy of the applicable manufacturers installation
requirements. Further, I understand these products may have to be removed if approval cannot be demonstrated during inspection.
' �( i �
AP L ANT SIGNATURE DATE
R-1305 01-04
Plorida Building Code Online http://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEV...
�:� Product Approval .
�9 USER:Publk User
p,BQ u�,�t Aooroval Menu>Product or Aoelicati >AppliGdt(pII1.'LSt>ADD�UOn DEtail
FL# FL12772-R2
Application Type Revision
Code Version 2010
Appiication Status Approved
Comments '
Archived �7���
�3UiL:t��i�I:��,_'.u?J�L��i�'bPLi'
���a ���.j�'r.S�i''L����1..���C3,
Product Manufacturer Mule-Hide Products GTo:,'Iri p �G ANI9
BLEC"�'R[CA�,. �,LJ3v�
Address/Ph�ne/Email ge o tPWIc53511-D548j1,�"C;��I-��-"������
(608)365-3111 Ext809
li nda reith @tri nityerd.com
Authorized Signature Timothy McFarland
lindareith@trinityerd.com
�,F_�Jlf�'JV I�ATE����S
Technical Representative Tim McFarland ��7Y ��.'�y��yF�y��l�` �
Address/Phone/Email 1195 Prince Hali Dr �
SuiteA PLAP�IS EXAlinIP�1�R l—
Beloit,WI 535115481
(608)365-3111
tim.mcfarland@mulehide.com
Quality Assurance Representative
Address/Phone/Email
Category Roofing
Subcategory Single Ply Roof Systems
Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed
Florida Professional Engineer
� Evaluation Report-Hardcopy Received
Florida Engineer or Architect Name wh developed Robert Nieminen
the Evaluation Report
Florida License PE-59166
Quality Assurance Entity FM Approvals-QA
Quality Assurence Contract Expiration ate 06/14/2015
Validated By John W.Knezevich,PE
� Validation Checklist-Hardcopy Received
Certificate of Independence FL12772 R2 COI Trinit�ERD CI-Nieminen-2013�df
Referenced Standard and Year(of Sta dard) Standard Year
ASTM D6878 2006
FM 4470 1992
FM 4474 2004
TAS 114 2011
Equivalence of Product Standards
Certified By
Sections from the Code
Product Approval Method Method 1 Option D
Date Submitted SO/10/2013
Date Validated 10/14/2013
I of? Date Pending FBC Approval �o/zo/zo�3 6/26/2014 2:35 PM
floricla Building Codg Online http://www.floridabuilding.org/pr/pr app_dtl.aspx?param=wGEV...
Date Submitted � 10/SO/2013
Date Validated SO/14/2013
Date Pending FBC Approval SO/20/2013
Date Approved 12/13/2013
Summa of Products
FL# Model,Num r or Name Description � I'
127' 72,1 �` �Mule-Hide TP -c Single Ply Roof Thermoplastic polyolefin single ply roof systems �
� I Systems �� _.
Limits of Use Instaliation Instructions
Approved for use in HVHZ:No FL12772 R2 II A1 er092713FINAL MULE-HIDE TPO-
Approved for use outside HVHZ:Ye c FL12772-R2.pdf
Impact Resistant:N/A Verified By: Robert Nieminen PE-59166
Design Pressure:+N/A/-525 Created by Independent Third Party:Yes
Other: 1.)The DP noted in this applic tion pertains to one Evaluation Reports
particular assembly.Refer to the ER ap endix for all FL12772 R2 AE er092713FINAL MULE-HIDE TPO-
assemblies and DP's.2.)Refer to ER s tion 5 for Limits of c FL12772-R2.odf
�Use. Created by Independent Third Party:Yes
i __....._ ----- ---
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?of 3 6/26/2014 235 PM
Mobile/Manufactured Home Roof Covering Details
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