PERMIT DOCUMENTS OWNER/BUILDER AFFIDAVIT (CONTINUED)
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10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the
United States Small Business Administration, the Florida Department of Financial Services, and the Florida Department of
Revenue.I also understand that I may contact the Construction Industry Licensing Board by calling 561-233-5525 or visiting their
website,htto://www.pbcaov.com/pzb/Contractors for more information about licensed contractors.
I I. I am aware of, and consent to, an owner-builder permit applied for in my name and understand that I am the party legally and
financially responsible for the proposed construction activity at the property address stated below.
12. I agree to notify the City of Boynton Beach Building Division immediately of any additions, deletions, or changes to any of the
information that I have provided on this disclosure.
Licensed contractors are regulated by laws designed to protect the public. If you contract with a
person who does not have a license, the Construction Industry Licensing Board and Department of
Business and Professional Regulation may be unable to assist you with any financial loss that you
sustain as a result of a complaint. Your only remedy against an unlicensed contractor may be in civil
court. It is also important for you to understand that, if an unlicensed contractor or employee of an
individual or firm is injured while working on your property, you may be held liable for damages. If you
obtain an owner-builder permit and wish to hire a licensed contractor, you will be responsible for
verifying whether the contractor is properly licensed and the status of the contractor's workers'
compensation coverage.
To apply for an owner-builder permit, this form must be completed and submitted with the building
permit application package.
Property Address
Property Owner L--,
)7,22.,:a
(Signature
STATE OF FLORIDA
COUNTY OF PALM BEACH
r.
The f regoing instrument was/acknowledged before me this O day of zeiev (month)02-10 (year),
by U-AL6V , !T ti I C (printed name of signer).
Notary's signature �t.cg.� C " ^" /4 &- , (SEAL)
"``"""" 7777 �. Notary Public State of Florida
Notary's name, punted, typ or stamped g �N oynthie Henriksen
My Commlasion GG 149339
Personally known OR produced identification Expires tofoenort
a
Type of identification produced
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MIAMFf]ADE MIAMI-DADE COUNTY
COUNTY PRODUCT CONTROL SECTION
11805 SW 26 Street,Room 206
DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES(RER) Miami,Florida 33175-2474
BOARD AND CODE ADMINISTRATION DIVISION T(786)315-2590 F(786)315-2599
NOTICE OF ACCEPTANCE (NOA) www.miamidade.eov/economy
GAF
1 Campus Drive
Parsippany, NJ 07054
SCOPE:
This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The
documentation submitted has been reviewed and accepted by Miami-Dade County RER- Product Control Section to be
used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction(AHJ).
This NOA shall not be valid after the expiration date stated below. The Miami-Dade County Product Control Section
(In Miami Dade County)and/or the AHJ(in areas other than Miami Dade County)reserve the right to have this
product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted
manner,the manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify,or
suspend the use of such product or material within their jurisdiction. RER reserves the right to revoke this acceptance,
if it is determined by Miami-Dade County Product Control Section that this product or material fails to meet the
requirements of the applicable building code.
This product is approved as described herein, and has been designed to comply with the Florida Building Code
including the High Velocity Hurricane Zone of the Florida Building Code.
DESCRIPTION: GAF Royal Sovereign® Shingle
LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo,city, state and following
statement: "Miami-Dade County Product Control Approved",unless otherwise noted herein.
RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change
in the applicable building code negatively affecting the performance of this product.
TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the
materials,use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product,
for sales,advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section
of this NOA shall be cause for termination and removal of NOA.
ADVERTISEMENT: The NOA number preceded by the words Miami-Dade County, Florida, and followed by the
expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done
in its entirety.
INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and
shall be available for inspection at the job site at the request of the Building Official.
This NOA renews and revises NOA 14-1022.16 and consists of pages 1 through 4.
The submitted documentation was reviewed by Freddy Semino
dor
MIAMIOADE COUNTY NOA No.: 18-0123.06
APPROVED Expiration Date: 04/22/23
Approval Date:03/01/18
Page 1 of 4
ROOFING ASSEMBLY APPROVAL
Category: Roofing
Sub-Category: Asphalt Shingles
Materials 3-Tab
Deck Type: Wood
SCOPE
This approves GAF Royal Sovereign®Shingle as manufactured by GAF as described in this Notice of Acceptance,
designed to comply with the Florida Building Code and the High Velocity Hurricane Zone of the Florida Building
Code.
PRODUCT DESCRIPTION
Product Dimensions Test Product Description
Specifications
GAF Royal Sovereign®Shingle 12" x 36" TAS 110 Fiberglas reinforced heavy weight asphalt roof
shingle,with a 3-Tab profile
MANUFACTURING LOCATIONS
1. Savannah,GA.
2. Tampa,FL.
3. Mt. Vernon, IN.
4. Mobile,AL.
5. Dallas,TX.
6. Myerstown, PA.
7. Fontana,CA.
EVIDENCE SUBMITTED
Test Agency Test Identifier Test Name/Report Date
PRI Construction Materials Technologies, Inc. TAS 100 GAF-332-02-01 01/17/12
TAS 100 GAF-376-02-01 10/15/12
Underwriters Laboratories, Inc. TAS 107 08NK02337 03/12/08
TAS 107 08NK12906 10/10/08
TAS 107 11 CA47919 12/03/11
ASTM D 3161 /TAS 107 09CA41642 09/28/10
ASTM D 3161 /TAS 107 09CA38549 10/30/09
ASTM D 3462 08NK02337 03/12/08
ASTM D 3462 09CA21715 05/20/09
ASTM D 3462 08CA61515 07/15/09
ASTM D 3462 1 ICA47919 12/03/11
ASTM D 3462 4788199685 12/20/17
ASTM D 3462 4788199685 01/03/18
NOA No.: 18-0123.06
nIAn►owoE COUNTY Expiration Date: 04/22/23
APPROVED
Approval Date: 03/01/18
Page 2 of 4
LIMITATIONS
1. Fire classification is not part of this acceptance; refer to a current Approved Roofing Materials Directory for
fire ratings of this product.
2. Shall not be installed on roof mean heights in excess of 33 ft.
3. All products listed herein shall have a quality assurance audit in accordance with the Florida Building Code
and Rule 61620-3 of the Florida Administrative Code.
INSTALLATION
1. Shingles shall be installed in compliance with Roofmg Applications Standard RAS 115.
2. Flashing shall be in accordance with Roofing Applications Standard RAS 115.
3. The manufacturer shall provide clearly written application instruction.
4. Exposure and course layout shall be in compliance with Detail "A", attached.
5. Nailing shall be in compliance with Detail"B", attached.
LABELING
Shingles shall bear the imprint or identifiable marking of the manufacturer's name or logo, city and state of
manufacturing facility, and following statement: "Miami-Dade County Product Control Approved" or the Miami-Dade
County Product Control Seal as shown below.
MIAMIDADE COUNTY
APPROVED
BUILDING PERMIT REQUIREMENTS
1. Application for building permit shall be accompanied by copies of the following:
1.1 This Notice of Acceptance.
1.2 Any other documents required by the Building Official or the applicable code in order to properly
evaluate the installation of this system.
MWMFDaDE COUNTY NOA No.: 18-0123.06
APPROVED Expiration Date: 04/22/23
Approval Date: 03/01/18
Page 3 of 4
DETAIL A
COURSE LAYOUT
1st Course of Shingles
2nd Course of Shingles •
3rd Course of Shingles
IF I EMII I1111. 5•
,;. _
Drip Edge
DETAIL B
OVERALL DIMENSIONS AND NAILING PATTERN
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—36"
1--
IIIMME1011111111M
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50
• an 14"1
END OF THIS ACCEPTANCE
NOA No.: 18-0123.06
MIAMFDADE COUNTY Expiration Date: 04/22/23
APPROVED
Approval Date: 03/01/18
Page 4 of 4
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