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INDIAN RIVER COUNTY BUILDING DEPARTMENT <br />aZ <br />ORI <br />ROOFING Product Approval Affidavit Form <br />As required by Florida Statute 553.842 and Florida Administrative Code 96-72, please provide the information and the Product <br />approval number(s) on the Roofing components listed below. In the event that any of the listed products in this form change during <br />construction, this form must be revised and re -stamped. <br />The following information must be available on the jobsite for inspections: <br />1. This entire product approval form, stamped as "Reviewed" by the Building Department Plans Examiner. <br />2. Miami -Dade NOA or Florida Product Approval referenced in the product approval form. <br />3. A copy of the manufacture's installation instructions, details and requirements for each product. <br />Permit Number: <br />Address: <br />Contractor/Applicant: <br />Category/Subcategory Approval Manufacturer Product / Model Number <br />Number(s) <br />1. Roof Sheathing Fasteners <br />2. Underla ment <br />3. Asphalt Shingles <br />4. Roofinq Tiles <br />5. Tile Adhesive <br />6. Tile Fasteners <br />7. Non -Structural Metal Roofing <br />8. Wood Shingles/Shakes <br />9. Wood Shingle/Shake Nails <br />10. Roofing Slate <br />Built u roofing <br />11. Modified bitumen <br />12. Single -Ply roofing system <br />13. Roofing insulation <br />Liquid Applied Roof System <br />14. Cements-adhesives- <br />coatin s <br />15. Sprayed -on Polyurethane System <br />Other <br />16. Skylight <br />17. Other <br />1 have reviewed the above components or cladding and these products provide adequate resistance to the wind <br />loads and forces specified by current code provisions. <br />Name: Signature: <br />Date: Contractor License: <br />Page 5 of 9 <br />