308 NE 99 St (2)CITIZENS PROPERTY INSURANCE CORPORATION
FLORIDA BUILDING CODE SHUTTER MITIGATION VERIFICATION AFFIDAVIT
Applicant(s):
Property Address:
Date Installed:
CIT-26 (07/200
'is 3wrOIALS
38 EVE S/.
Main; ,5 ores 33/3e
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Policy No: 54 a E 751
A. Specify the type of protection installed:
Class A (Hurricane Protection)
All exterior wall and roof openings m buildings mpa resistant coverings t(e 9 shutters roof ridge,
impact and plumbing v nts)
ust
impaa resistant resistant doorsore, , and/or /or impact resistant glazing that meet the requirements of one of the following:
Check One:
❑ SSTD 12
❑ ASTM E 1886 and ASTM E 1996 (Missile Level C — 9 Ib)
[[sMiami-Dade PA 201, 202, and 203
❑ Florida Building Code TAS 201, 202, and 203
L Class B (Basic Impact)
All exterior wall and roof openings in buildings (doors, windows, skylights and vents, other than roof u e,
impact resistant and plumbing vents) must be fully protected with impact resistant coverings (e.g.
'm act resistant doors, and /or impact resistant glazing that meet the requirements of ASTM 1886 and ASTM
i p
E 1996 (Missile Level B — 4.5 Ib).
E Class C (Ordinary Non - Impact)
A glazed lazed openings (windows, skylights, sliding glass doo oors, d oors character sties etc.) must be protected
with shutter devices or wood structural panels that
a. Corrugated storm panels made of Steel, Aluminum, or Polycarbonate in which individual panels are no wider than
14" and have a nominal profile of 2" or greater.
b. Roll -Up shutters with aluminum slats.
c . Accordion shutters with aluminum slats.
d. Colonial or Bahama shutters with all the following features: late in place
i. Heavy gauge metal frames,
ii. Extruded aluminum slats that are anchored to both sides of the frame, or solid metal backing p
behind slats,
iii. Structural hinges, and
iv. A mechanism to lock shutters closed during a storm.
Structural Panels — Plywood or OSB (oriented ecut strand cover glazed minimum thickness of 7 /1 6 inch and
e. m S Code Table 160 with
a for locations hardware maximum panel span must 8 feet. Panels must be precut greater than 130 mph, attachments
provided.
design wind Pa must 0e fastened less. F locati nsewithrdesignllwind speed g
design wind speed is 130 mph
be designed to resist component feet cladding loads
may o the FBCed with polycarbonate flat panels used or
Up to two small windows (each 4 square
as a cover.
1 of 2 pages
CITIZENS PROPERTY INSURANCE CORPORATION
FLORIDA BUILDING CODE SHUTTER MITIGATION VERIFICATION AFFIDAVIT
B. Certify the type of protection installed:
I hereby certify that I am (CHECK ON : ❑ a State of Florida registered Architect, or El an Engineer,
proficient in structural design, or a Building Code Official (who is duly authorized by the State of
Florida or its county's municipalities, to verify building code compliance); and that shutters, on the building or
unit at the address indicated above comply with:
X Class A
(Hurricane Im • act)
OR ❑ Class B
(Basic Impact)
OR ❑ Class C
(Ordinary — Non - Impact)
I hereby certify that I am a State of Florida registered Building Inspector and that shutters on the building
or unit at the address indicated above comply with:
❑ Class C (Ordinary — Non - Impact)
Name of Company
Signature
Phone License No
Date
This Affidavit and the information set forth in it are provided solely for the purpose of verifying that certain structural or
physical characteristics exist at the Location Address listed above and for the purpose of permitting the Named
Insured to receive a property insurance premium discount on insurance provided by Citizens Property Insurance
Corporation and for no other purpose. The undersigned does not make a health or safety certification or warranty,
express or implied, of any kind, and nothing in this Affidavit shall be construed to impose on the undersigned or on
any entity to which the undersigned is affiliated any liability or obligation of any nature to the named insured or to any
other person or entity.
NOTICE TO APPLICANTS: If unable to obtain the appropriate signature(s) above, you must attach documentation
indicating compliance with the Specified Type or Protection indicated in Section A of this form.
C. All Applicants: To receive the premium credit being applied for, please read and sign the
certification below.
CERTIFICATION OF APPLICANT
I hereby certify and agree to the following: (1) The property listed above has been fitted with Windstorm
Protective Devices which protect all openings in accordance with the requirements stated in Section A of this
affidavit. (2) I agree to close and secure the devices in the event of a tropical storm or hurricane warning.
(3) In the event that I cannot install or secure such devices myself, I have or will arrange for someone else to
assume that duty.
Signature of Applicant(s): Date:
Citizens reserves the right to confirm all information contained in this form via a survey of the risk.
"Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of
claim or an application containing any false, incomplete, or misleading information is guilty of a felony of
the third degree."
CIT -26 (07/2004) 2 of 2 pages
BP2004 -1228
Project: <NONE>
Owner: KRISTINA BURROWS
Phone: 305/758 -9868
Job Address: 308 99 Street NE Parcel: 1132060135590
Miami Shores Village, FL 33138-
Block: Lot:
Scheduled Insp # Inspection Type
Inspection History
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Status
Imported Permit
Inspector Date Completed
11/05/2004 INSP2004 -4466 WINDOWS DENIED None None 11/5/2004
SL GL. DOOR FIXED PANELS ARE MISSING CLIPS TOP & BOTTOM SEE SHEET 3 OF 9 IN NOA
12/03/2004 INSP2004 -4808 WINDOWS DENIED None None 12/3/2004
NO NOAS FAR INSPECTION
02/02/2006 INSP -8577 WINDOWS DENIED George 2/2/2006
flat 1......:e.
THERE WAS NO ACCESS TO HOUSE TO INSPECT WINDOWS PLEASE CALL BACK IN
02/08/2006 INSP -9126 WINDOWS AND DOORS APPROVED Claudio Grande 2/8/2006
PLEASE DO INSPECTION BETWEEN 10:00 AND 10:30 AM
Thursday, May 25, 2006 Page 1 of 1