?le sen

TONSIRUCTIONUniform Mitigation Verification

lnspection

lXlffi7'7n*<Q1

Bellair Condo Assn 2727 N Atlantic Ave Daytona Beach, Florida 32118

form and an with theInspection Date: Nov 27 ,2013

Owner InformationOwner Name: Bellair Condo Assn Contact Person: Bobbie Hodges

Address:2z2z N Aflantic Ave HomePhone:

City: Daytona Beach, Florida Zip: gz11g Work Phone: z$e-.677 -sB7 1

county: vohrsia Cell Phonel

Insurance Company: Policy #:

Year of Home: 1965 # of Stories:9 Email:

Uniform Mitigation Yerification Inspection Form

IlIOTft Any doeuwntation ffid in vd&lat@ tk mmfliere or existre deash Mrdfum or nd{igarfon *Jfribufc mrstacx*mpny&foform. At&eastonephotugraphmustaacmpany{hisf,ormtovalfulafcdatlribrytemarkedimqucrlfromr3thfi€h?. Tkfuirermayarkdilional$dionsrcgardirytfumitigat$dfeatuds)verif;iedmtkisformo.

t- &d[dig ffi: Was fu sramre hrilr ia coupliare with tu S[6q{{s BrdXding Co& {FEC 2S01 s laer} OR f,or brres lffird infu IIffiIZ (Miami-k sr Broward corm*ips), Soerth Ftorida EuiXding re (SFEC-94)?

f] a" n*A* in corryliarca ry$.tuPc: Vem-puilt *- kr tourres buitt ilr 200212&CI3 pmvide a pmit rypttuation wi[ha fute attrr 3 I llffiZ: Buitdfutg P€rmsit Appfimtion Date GmdrnErrrty)-E- fu {fp HYIIZ Oryty: Built in coryliarce ryidr &s SFEC-94: Yas Euilt

-

for klm hlrilt in 1994" 1W5, and 1996

previde apmit apptricatiom wi&adarc afur9lLll94:. Buildi{tg Pffitsit ApptfuiCInDafsan'amrrnrvr

C Uskrewn or dse6 wt ffif &rs roq{dren€n{s of Ansrver *A- or "!l-Z napf C-oyerigi Sefuf atl noof oovering f5ryres ia use" Provi& tb trmmit appti*arion "laF OR. FBC/fodDC Frcdwt Approval mnu!fu

OR Year of Origimat nn$talla{iom/RepXacement OR iodicate fftat oo in{orrnafion **nas available to verify compliamce for erch roofcoverimg idemlifid-

2.1 Rmf Coverirg lYper

I-1,. *n"*-egtass Shingrel-t| | z. comevcuyrt

f-1.,o",t-lo ,o,,,o

l---i.. r"*oot-Jlrl1. "*,ru"o{"ol9tl

Pemit AppliqtionDate

-rrry_

trBC or MDCPrcduct ApprcYal #

P*,rr', Nrrrb*0s0200

No hfomitionYtr of Original INtattatim or PmYided for

R€placement CompliuceCompliuce

2AA5

ffl ,C" Atl roof coverings lisfd above rM fu FBC wi& a FEC or illfiami-ffi Prodrs Approval lisring cammt d time of

- in*tallatisn OR bavo a roofiag pormfft applicalioae date sl s afrer 3/1102 OR tIre roof ir origfural and boit{ i$ 2$CI4 sr larer.

l-l n" Ail roof coverimgs Save a lr&ami-Me Pr:oduet ,{pBmoval tistiry culr€r$ af fire of imralla{ioqr OR. €ix lhe til/HZ oEdy) a

E roofng p'rnit apptica{ion eftr;r q{t ll994 arrt before 3/#2mZ OR tb roof is o{igisal and hxilf ful 1997 or larer.

ll C" fu or rwe roof ooverings do sst ffi@ fu of Aoswry *A3 sr o'B-"

[J n- No roof coveriogs mct fu mryireMs of, Aaswer *A- or *E--

Uflha{ i$ ee wea}estfCIrmof rffif dtrkatracltffia(?A. Plywood/Oriented strand board (OSB) roof sheathing attached to the roof truss/rafter (spaced a maximum of 24" inches o.c.)

by staples or 6d nails spaced at 6" along the edge and 12" in the field. -OR- Batten decking supporting wood shakes or wood

shingles. {R- Any system of screws, nails, adhesives, other deck fastening system or truss/rafter spacing that has an equivalent

mean uplift less than that required for Options B or C below.

B. Plywood/OSB roof sheathing with a minimum thickness of Tll$"inchattached to the roof truss/rafter (spaced a maximum of24"inches o.c.) by 8d common nails spaced a maximum of 12" inches in the field.-OR- Any system of screws, nails, adhesives,

other deck fastening system or trusVrafter spacing that is shown to have an equivalent or greater resistance than 8d nails spaced

a maximum of 12 inches in the field or has a mean uplift resistance of at least 103 psf.

C. Plywood/OSB roof sheathing with a minimum thickness of 7ll6-inch attached to the roof truss/rafter (spaced a maximum ofZ4"inches o.c.) by 8d common nails spaced a maximum of 6" inches in the field. -OR- Dimensional lumberlTougue & Groove

decking with a minimum of 2 nails per board (or 1 nail per board if each board is equal to or less than 6 inches in width). -OR-

Any sysGm of screws, nails, adhesives, other deck fastening system or ffuss/rafter spacing that is shown to have an equivalent

Inspectors Initiat$ D9N fropertr

*This verification form is valid for up to five (5) years provided no matcrial changes have been mde to the strueture.

2727 NAtlantic Ave Dayiona Beach, Florida 32118

OIR-81-1802 (Rev. 01112) Adopted by Rute 690-170.0155 Page I of4

or greater resistance than 8d common nails spaced a maximum of 6 inches in the field or has a mean uplift resistance of at least

182 psf.

D. Reinforced Concrete Roof Deck.

E. Other:

F. Unknown or unidentified.

G. No attic access.

4. Roof to Walt Attachment: What is the 1VEAKEST roof to wall connection? (Do not include attachment of hipivalley jacks within

5 fu{of fu furside sorffiide cmprof tkrosf infusrmioa{imCIf WEAKESTtyf}l-l a. Toe NailsI {

il m:irffiTfrfJ*fl::, plate of wall using nails driven at an angle through the truss/rafter and attached to

f] Vfetaf connectors that do not meet the minimal conditions or requirements of B, C, or D

tf *'**

Secured to trusslrafter with a minimum of three (3) nails, and

Attached to the wall top plate of the wall framing, or embedded in the bond beam, with less than aYz" gap fuom

the blocking or ffuss/rafter and blocked no more than 1.5" of the truss/rafter, and free of visible severe

corrosion.

Metal connectors that do not wrap over the top of the truss/raIler, orMetal connectors with a minimum of 1 strap that w,raps over the top of the truss/rafter and does not meet the nail

position requirements of C or D, but is secured with a minimum of 3 nails.

E.

F.

G.

H.

Unknown or unidentified

No attic access

5. Roof Geometry: Whx is the roof shape? (Do not consider roofs of porches or carports that are attached only to the fascia or wall ofthe host structure over unenclosed space in the determination of roof perimeter or roof area for roof geometry classification).

Ieffi"

Hip Roof Hip roof with no other roof shapes greater rhan lOVa of the total roof system perimeter.

Totallmg&ofooa-hip feffirr€c: s f@Tdalroofstrut*mperiffie.c-fMFlat Roof Roof on a building with 5 or more units where at lea*9A%o of the main roof area has a roof slope of

lessthan2l12.Roofareawithslope1essthan2:l2-sqft;Totalroofarea-sqftOther Roof Any roof that does not qualify as eifher (A) or (B) above.

(st*ndud unMaynter*s r hd-ryd felts do m* q$alify as m SW*.)

A SWR (also called Sealed Roof Deck) Self-adhering polymer modi.fied-bitumen roofing underlayment applied directly to the

sheathing or foam adhesive SWR barrier (not foamed-on insulation) applied as a supplemental means to protect the

dwelling from water intrusion in the event of roof covering loss.

B. No SWR.C. Unknown or undetermined.

Inspectors Initials DCN Pmpst,

*This verification form is valid for up to five (5) years provided no material changes have been made to the structure orinaccuracies found on the form.

C.

l--] c. single wraps- Metal connectors consisting of a single strap that llraps over the top of the trusslrafter and is secured with a

minimum of 2 nails on the front side and a minimum of 1 nail on the opposing side.

D- Iloubleltrraos

[--l Oi", Connectors consisting of 2 separate straps that are attached to rhe wall frame, or embedded in the bondt-t ,

Dearn, on either side of the truss/rafter where each strap wraps over the top of the truss/rafter and is secured witha minimum of 2 nails on the front side, and a minimum of 1 nail on the opposing side, or

Metal connectors consisting of a single strap that wraps ovel the top of the truss/rafter, is secured to the wall on

both sides, and is secured to the top plate with a minimum of three nails on each side.

Anchor bolts structurally connected or reinforced concrete roof.

Other:

Structural

2727 N Atlantic Ave Daytona Beach, Florida 32118

OIR-81-1802 (Rev. OU12) Adoptd by Rule 69O-170.0155 Page 2 of4

7. Openine Protection: What ls the g@! form of wind borne debris protection installed on the structure? First, use the table to

determine the weakest form of protection for each category of opening. Second, (a) check one answer below (A, B, C, N' or X)based upon the lowest protection level for ALL Glazedopenings and (b) check the protection level for all Non-Glazed openings (.1,

.2, or .3) as applicable.

Op*ning Protection Leryel ChartPlae an nfl ful d! ilffi to fukrltify d fwm c{ prptert*m foi rse fse*dropmirqtWe" Cfuedrer*y qre aasw betw lA&trlr 10, bsed om tie redredfsrm d prdecriom {bue* rwl for arry d Oe 6ld openftgs and fudlcate

thB n#t fuin oil pq*{on {hu*est rw! fm ilorcnced opwtct8s.

Gked@tuqr fi{rn&edeomirffi

$htutrsGr#yM

Gtr#E&ffi sryl8trc 6h66

ilor*Crrykf

6ffipf,Bffi

il/a 0$mAmffimb&e-tftereare raoopeniregs af rhis tp on ttlrc $ltflffirir€ NA NIS i{A $$A

A V€nt#ied cqrdk pressule &,*xge rm&si[e {9*bforwimilsas doors/a-5 & fsrdcy{igi,ts}

B \r'erified cydk preesure & ilarge rnissfle #l-s $b fstarftdsus fus/2 eforskyl*Chc)

€ yed$ied dyrrcd/S68 inaeecfngTahb tr699-1*2 sf fihe FgC 2{m7

DVertf&ed l\tori-6{aze{, fu*rysGarage doss *rdimeirg co*mpffiamcetpit*a ASffiil f33o" AN$r/EASaaA nG8, or PAy'TAS 2s2 fuu$nd pr*ssxrre rsista{?c€

,t@$ir8Proteft s! pro*fumstfiatappeartB heAorB bl$ are nstvartffid

ffijher prorcafive corrcrir$sthat carrenorhe Cdefitifi€d mA, B, or C

x Atuo \ilfn*&c.n€ Mr'rs Medlik m x x

A. Exterior Openines Cvclic Pressure and 9-Ib Larse Missile (4.5 Ib for skvlishts onlv) All Glazed openings are protected at

a minimum, with impact resistant coverings or products listed as wind bome debris protection devices in the product approval

system of the State of Florida or Miami-Dade County and meet the requirements of one of the following for "Cyclic Pressure

and Large Missile Impact" (Level A in the table above).

o Miami-Dade County PA 2AL 202, anil203. Florida Building Code Testing Application Standard (TAS) 201, 202, qid2o3. American Society for Testing and Materials (ASTM) E 1886 and ASTM E 1996

. Southern Standmds Technical Document (SSTD) 12

o For SMights Only: ASTM E 1886 4! ASTM E 1996

o For Garage Doors Only: ANSVDASMA 115

G, All Non-Glazdqleairgs ciascifiod as A ile {he tahte *bove. orno }fom4lazsd qp€trisgs exist

L_hi,fff"Trm31y*****classifidas{xsrclDillrbraMe &sve,amdaroNoo$azedryemiaguclas*ifiodes{.ec/el &C. N,sr

f--lA.3 Ones More Noa-Glezed @iogs is clasaifidas l-elr€l B, C, N, orX ia&e rabileatuve

I lB. Exterior Openine Protection- Cvclic Pressure and 4 to 8-lb Larse Missile (2-4.5 lb for slslishts onlv) A1l Glazedt-r

operungs are prorected, at a minimum, with impact resistant coverings or products listed as windborne debris protection devices

in the produci approval system of the State of Florida or Miami-Dade County and meet the requirements of one of the followingfor "Cyclic Pressure and Large Missile Impact" (Levet B in the table above):

' ASTM E 1886 4l! ASTM E 1996 (Large Missile - 4-5 1b.)

. SSTD 12 (Laree Missile - 4lb. to 8 1b.)

o For skylights only: ASTM E 1886 and ASTM E 1996 (Large Missile - 2 to 4.5 1b.)

.l All E{on$ladry,imgscXa*si6odau AorB ia&e tahlealrsv€" orm l{oa4lazpdopeiAgsexi66

-2 Ooe or lifure F,Ion Glazed ryiags eksi&ed as {*tel D ia tk fab&e &ocre" ar*rl m hilom$azed opeaaiag,$ a]lassiGed as Levei C, EI. or Xin the table above

OaeorMo{c No{r$tazdopoings isetas,siMas l-svrf,C, l{, orX ia{fue tab{eahove

All Glszd strmiCI96 are aovered wiilfu-plywood/O$B rmimg tfue reqairemears of,Table 16@-1.2 sf ffie FEC 2m7 d{evel C ia &e fahle ahovc}"

l-1., Al[ Nmslazsd ryiogs classifiod as A" E, orC in &e rable &ove, orrmhloq4lased opmfurgs exicf

I b-Z O** More Ncm4lacdopeaiagsalassifid as X.evelD fo {ktabfleabove, andso Nm4scdryimguclamifiad asLevelNor X imU th. tahle above

lJ: O** toioren$en-Cdadoptugs i* etramifiodas {-enelNorXto&e rab$eatuv'e

Inspectors Initials DCN 6on"r1, 466r'**" 2727 N Atlantic Ave Daytona Beach' Florida 32118

*This verification form is valid for up to five (5) years provided no material changes have been made to the structure orinaccuracies found on the forrruOIR-81-1802 (Rev.0UL2) Adopted by Rule 690'170'0155 Page j of4

N. Exterior Ooenins Protection (unverified shutter syst€ms with no documentation) AII Glazed openings are protected with

p."t*t-" ""*""gr not meeting the requirements of Answer "A'0, "8", or C" or systems that appear to meet Answer "A" or "B'

*itir m dmureofafion of cprypliance (Levol N is #r table ahvo)"fllziffi m docureaarion of cprypllance (l-evol nil 1lr fff iable amv€}"

l_h.t A$ Nso4f,ezed opemimgs clasrifid ac l.;evel A" B. C s h{ !o {he tabfte above, s no Nom4lazed opemiog* exisr

[*"ffi*L{ore Nonsiruod opnioge clasuifid as Lcvel D tu {tu rable atuve, d no Nom4lazed cpenimgs *iasuifid m l;eve"l X io *re

Ore ol Mw t'flm4iszd opeuimgs ns cia*siM as L,evel X in fu {&le above

(ckk one)Home inspector licensed under Section 468.8314, Florida Statutes who has completed the statutory number of hours of hurricane mitigation

training approved by the Construction lndustry Licensing Board and completion ofa proficiency exam.

Building code inspector certified under Section 468.6W, Florida Statutes.

General, buildins or residential contractor licensed under Section 489.1 i 1, Florida Statutes.

Professional engineer licensed under Section 47 l.Al5, Florida Statutes.

Professional architect licensed under Section 481.213, Florida Statutes.

Any other individual or entity recognized by the insurer as possessing the necessary qualifications to properly complete a uniform mitigation

verification form pursuant to Section 627.711Q), Florida Statutes.

The definitions on this form are for inspection purposes only and cannot be used to certify any product or construction feature

as offering protection from hurricanes.

Inspectors Initials DCN Pton*4, 2727 NAtlanticAve Daytona Beach, Florida 32118

*This verification form is valid for up to frve (5) years providedinaccuracies found on the forrnOIR-81-1802 (Rev. Olll2) Adoptd by Rule 69O-170.$155

no material changes have been rnade to the structure or

Page 4 of4

X. None or Some Glazed Ooenings One or more Glazed openings classified and Level X in the table above.

MNrcITTOT,I INSPECTIONS MUST BE CERTIFIED BY A SUALIFIED INSPECTOR.

Section 627.711(2), Florida Statutes, provides a listing of individ.uals who rnay sign this fortn.Qmlified Imp@lor Name:

Donald C" Nielsen - State Certified Home lnspectorLnsffiTy{rc:State Certified General Contractor

Limse o(CE{(ii&f#g,1*CGC049839 and H12160

Inspection Company:

Nielsen Construction, LLCPhore:

386-214-8348

I

Individuals other than licensed contractors licensed under Section 489.111. Florida Statutes. or professional ensineer licensed

under Section 471.015. trIorida Statues. must insnect the structures personallv and not through emplovees or other persons.

ffircll*cr* umdcrd?t.015ors"{tr"lllmva$ibrfueallirdem&vewfu rctNre resuioite*i[. krowNeds" ardexperience to conduct a mitigation veffication inspection

r, Donald C Nielsen am a qualified inspector and I personally performed the inspectionor (licensed

(print name)contractors and. professi.onal engineers only)l had my employee ( ) per{orm the inspection

(print name of inspector)and I agree to be responsible

Qualified Inspector Signature: p"r". Nov 27, 2013

.{a idfivi&laitorentitvwklkmwiulvon&ruus& ffi ne*|iffitr oro"ikefslneonfrfidrMmfitialfo]nvrrifu#$rfffilnissubieci io investieation bv the [Iorida Division of Insurance Fraud and may be subiect to administrative action bv the

apnropriate licensine aeency or to criminal nrosecution. (section 627.711(4)-(1. trlorida Statutes) The Oualified Insrrector who

certifies this form shall be direcflv liable for the misconduct of emoloyees as if the authorized mitigation insoector Personallv

Homeowner to comDlete: I certify that the named Qualified Inspector or his or her employee did perform an inspection of the

this form and that of identification was provided to me or my Authorized Representative

Signature: pr6. Nov 27,2013

An individual or entity who knowingly provides or utters a false or fraudulent mitigation verification form with the intent to

obtain or receive a discount on an insurance premium to which the individual or entity is not entitled commits a misdemeanor

of the first (Section 627.7 1-1(7), Florida Statutes)

CITIZENS PROPERTY lNSURANCE CORPORATION

BUILDING TYPE II AND IIIMITIGATION VERIFICATION AFFIDAVIT

This affidavit must be completed to capture mitigation features applicable to a Type ll (4 to 6 story) or Type lll (7 or more story)building. This affidavit is required for either residential condominium unit owners or commercial residential applicantsrequesting mitigation credits in such buildings.

Terrain Exposure Gategory must be provided for each insured location.

I hereby certifo that the building or unit at the address indicated above TERRAIN EXPOSURE CATEGORY as defined under theFhfe8l@gffieb{Orcfk&e}: fl ExposureC or 15 ExposureB

Certification below for purposes of TERRAIN EXPOSURE CATEGORY above does not require personal inspection of thepremises.

Certification of Wind Speed is required to establish the basic wind speed of the location (Complete for Tenain B only if YearBuilt On or After Jan.1, 2002).

I hereby certify that the basic WIND SPEED of the building or unit at tllg address indicated above based upon county wind

speed tines defined underthe Florida Building Code (FBC) is {Check One): fJ 2100 or E }110 or E Z1ZO

Certification of Wind Design is required when the buildings is constructed in a manner to exceed the basic wind speeddesign established for the structure location (Complete for Tenain B only if Year Built On or Afier Jan .1 ,2002).

I hereby certify that the building or unit at the address indicated above is designed and mitigated to the Florida Building Code

(FBc)WNDDESIGNof (Checkone): fi 2100or n >1r0or E :tZO

Certification for the purpose of establishing the basic WIND SPEED or llUlND SPEED DESIGN above does not require personal

inspection of the premises.

Specifv the type of mitiqation device(s) installed:

tr Roof Coverings

g Level A (Non FBG Equivalent) - Type ll or lllAll roof cover types and conflgurations that do not meet Level B below

g Level B (FBC Equivalent) - Type ll or lllE Roof coverings that satisff all of the following cpnditions and are one of the following types:

1. Built-Up

2- Modified Bitumen

3. Sprayed Polyurethane foam

4. Liquid membrane applied over concrete

5. Asphalt roll roofing

6. Wood shakes in good condition, attached with at least two mechanical fasteners

7 . Ballasted mof designed to meet the design wind speed requirements

8- nsph* roof ms&rys ffi ln ro&rre AS'IM D 3{61 {rnodtfied for ,1S ilrryh} or Miami l% Cflrmry PA107-95.

AII mechanical equipment must be adequately tied to the roof deck to resist overtuming and sliding during high winds. Any flatroof covering with flashing or coping must be mechanically attached to the structure with face fasteners (no clip/cleat systems);and roof coverings on flat roofs must be 1 0 years old or less.

s{.,E,Ecr oF *{*JRAN*E- Bellair Condo Assn

Apry?Fss"2727 N Atlantic Ave Daytona Beach, Florida 32118

I story Conncrete Condo Building

BUILDING TYPE: fX lN{+teGsmrios} E lll (Tormorestories)

MrT-BTrr & trI (8/2008)

CITIZENS PROPERry INSURANCE CORPORATION

BUILDING TYPE IIAND III MITIGATION VERIFICATION AFFIDAVIT

Roof Deck Attachment

I Level A - Wood or Other Deck Type tl onlyRoof deck composed of sheets of structural panels (plywood or OSB).OrArchitectural (non-structural) metal panels lhat require a solid dec*ing to support weight and loads.OrOther roof decks that do not meet Levels B or C below.

fl Level B - Metal Deck Type ll or lllMetal roof deck made of structural panels lhat span from joist to joist.

f, Level G - Reinforced Concrete Roof Deck Type, ll or lll,A rnd sffidrse oormrcad d #An*bre ry Sred Srrcfural co&cr]# A*gW b be sdferyporl*W ardintegrally attached to wall/support system.

Secondary Water Resistance

il UnderlaymentA edf-drc*trg Fo&,rffir nmtrffied bt&xtwr rommg rsder&ayrrsd $*r n$fuer sfm# rffi! @ ad s{tce ry&s{&bcded bermffi fl?e rod @w{itqg trd rmrry*d fee uderftpmerf} !il{f, a ilfmirrssn ilidh d 6' rMfu eterwdfeffiffi d AA'rM A ,970 frffied anrer d pryB1ooffiB ffire b precf *sillr ilffi {{#r6tom. AS *ewrdayr@er rcefukse proe* #Gr$l be lrffi perfs nwdfueEia'$ rcmcrur}er#frsrs" Rffi€ fuS oraitrk papebased products are not acceptable for secondary water resistance-

Foamed AdhesiveD emr*Opdylsgraesfremr&qdxesreryptudomdi:lr#*rtfiercofslffirtrrybpa#clirtHturfr@!!maler

intrusion.

il Opening Protection

I Glass A (Hurricane lmpact) -Ag q@ed €pen*rE€ ftnirer6" shftrc" dideq gMs d@s, dotrs n{trr !il&ld{nl|,s,etc) less than 30 fuet above grade must be protected with inw mdMrdm6*rq6 {e"g- sfxMs}, &rryd mesui$addoors, and/or impact resistant glazing that meet the Large Missile ( I lb.) impact requirements of:

Gssrorz;Desrr,l E 1886 and ASTM E 1996;

fiMiami-Dade PA 201, Z0?,arld203;

ffiFlorida Building Code TAS m1,202and 203.

A0 gfued Wrdrrys bm $an 30 f;eef, aMa grde slu6 rreed dE lsge MEs66e Tesfi #.dtrd reM M. A&ghzed epalirryr befiffir 30 dd 60 tud eoqfe gre ns,M nEe{ $e &nd hM Td otrSe reepdee Md-For btderryp loc#d *r &e FlVl{Z (l'iqttr Vdo@ f*sricdre Tsre} d gked ryerefu66 gr@flari @ 6d absuegrade must also meet the Small Missile Test of the respective slandard.

I Class B (Basic lmpact] - All glazed openings (windows, skylights, sliding glass doors, doors with windows, etc)less than 30 feet above grade must be protected with impact resistant coverings (e.9. shutters), impact resistantdoors, and/or impact resistant glazing that meet the Large Missile ( 4.5 lb.) impact requirements of

LIASTM E 1886 and ASTM E 1996

All glazed openings less than 30 feet above grade shall meet the Large Missile Test standard referenced above. Allglazed openings between 30 and 60 feet above grade must meet the Small Missile Test of the respective standard.For buildings located in the I{VHZ (High Velocity Hunicane Zone) all glazed openings greater than 60 feet abovegrade must also meet the Small Missile Test of the respective standard.

Mrr-BTII & IIr (8/2008)

CITIZENS PROPERTY INSURANCE CORPORATION

BUILDING TYPE IIAND III MITIGATION VERIFICATION AFF1DAVIT

GERTIFICATIONI certify that I am {CHECK ONE OF THE FOLLOWNGI:

E a resident licensed General, or Building Contractor, il a Licensed Building lnspector, I a RegisteredArchihc( fl an Er4gineer ln &e SHeof FtorUa, ffi a Building Code Official (who is duly authorized by the Stateof Florida or its county's municipalities to verify building code compliance).

I also certifo that I personally inspec{ed the premises al lhe Location Address listed above on the inspection date provided on thisAffidavit. ln my professional opinion, based on my knowledge, information and belief, I certiry that the above statements are trueand conect.

This Affidavit and the information set forth in it are provided solely for the purpose of veriffing that certain structural or physical

characteristics exist at the Location Address listed above and for the purpose of permifting the Named lnsured to receive a property

insurance premium discount on insurance provided by Citizens Property lnsurance Corporation and for no other purpose. The

undersigned does not make a health or safety certification or waranty, express or implied, of any kind, and nothing in this Affidavitshall be construed to impose on the undersigned or on any entity to which the undersigned is affliated any liability or obligation ofany naiure to the named insured or to any other person or entity"

Nielsen Construction, LLC Phone: 386-214-8348Name of Company:

Name of lnspector

lnspection Date:

Signaturer

Applicanfs Signature:

Donald C Nielsen License Type Cert Gen License # CGC04gffig

11-27-2013

11-27-2413

"Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or anapplication containing any false, incomplete, or rnisleading inforrnation is guilty of a felorry of the third degree"'

MIT-BT II & III (8/2008)