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RF-16-499 (2) V Inspection Worksheet Miami Shores Village oj�' 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax:(305)756-8972 Inspection Number: INSP-260908 Permit Number: RF-2-16-499 Scheduled Inspection Date:June 24,2016 Permit Type: Roof Inspector: Mesa,Michel Inspection Type: Final Roof Owner: ARENAS,JORGE Work Classification: Tile Job Address:286 NE 99 Street Miami Shores,FL 33138-2435 Phone Number Parcel Number 1132060134310 Project <NONE> Contractor. ENVIROTECH ROOFING GROUP INC Phone:(305)207-4993 Building Department Comments NEW TILE ROOF WITH ENTEGRA ROOF TILE BELHA In mctlo Passed Commenits HIGHS TILES INSPECTOR COMMENTS False Inspector Comments -n Ane. Passed CREATED AS REINSPECTION FOR INSP-260837. CREATED AS REINSPECTION FOR INSP-259170, CREATED AS REINSPECTION FOR INSP-259088.CREATED AS REINSPECTION FOR INSP-253468. 5/18/16 CANCELLED INSP. BECAUSE OF RAIN. Failed 05/19/2016 CANCELLED BY DARWIN Correction Needed cancel by darwin(qualifier)786-317-1046 Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid 3 June 23,2016 For Inspections please call:(305)762-4949 Page 113 of 28 TAS 106 TEST RESULTS REPORT GENERAL INFORMATION Testing Agency Name: A+ Engineering Testing Lab, LLC. Certification No: 16-041303 Address: 7066 SW 44 St Miami F133155 Telephone: 305-668-5792 Fax: 786-513-3754 Email: aplusetl'a-yahoo.com Representative Name: Eng. JAIME REYES Title: P.E# 71460 SITE SPECIFIC. INFORMATION Roofing Contractor: ENVIROTECH ROOFING,INC. Permit#: RF-2-16-499 Job Address: 286 NE 99 ST MIAMI SHORES, FL. Contact. Name: DARWIN PH: 786-317-1046 Owners Name: JORGE ARENAS Type of Tile: EAGLE CAPISTRANO Date Installed: Roof Height: 12' feet Roof Pitch 3/12 Job Access: LADDER Gate: No Approximate Square Footage of Roof: 15.0 ft 2 Date Tested: 05/11/16 Required Testing Force: 35 LBS Testing Equipment: M2-100,S-3741465 TEST LOCATION PASS FAIL CORNER 5 - PERIMETER 12 - RIDGE 7 - FIELD 15 - TOTAL: 39 - p%!P OF- RE o®®�ee m No 714 40 ®o T TE .° 610 o°( Ode I ° nfdTR� IA OF PROTOCOL PA 106,THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT QUALITY CONTROL TEST. THI 5� ��Iq(>S I ERFORMED IN FULL ACCORDANCE TO THE REQUIREMENTS OF DADE COUNTY,WITH NO DEVIATIONS THIS R °� G . TEED IN CASE OF NATURAL DISASTERS. w A+Engineerin Testing esting Lab ROOF DIAGRAM ENVIROTECH ROOFING,INC. 286 NE 99 ST MIAMI SHORES,FL. T T T T T T T T T T V" T 7066 SW 44 St Miami F133155 PH:305-668-5792 Fax:786-513-3754.aplusetl@yahoo.com AC " DATE(MMIDDn'YYY) CERTIFICATE OF LIABILITY INSURANCE 06,09/2016 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poky_(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In fieu of such endorsement(s). PRODUCER CONTACT NAME: -_" -- — -- First Class Insurance Market PHONE (305j 441-2997 __{a h)o}: ._(305)441-6443 4101 NW 9th Street ' L fcimc@aol.com Miami,FL 33126 INSURERS AFFORDING COVERAGE MAIC a Phone (305)441-2997 Fax (305).44.1-64.43 . ...... INSURERA: JAMES RIVER INSURANCE COMPANY INSURED IN.$URik!.B.-,-.PROGRESSIVE EXPRESS INSURANCE COMP ENVIROTECH ROOFING GROUP,INC. INSURERC: _._.__..._.._._........ _ _ 745 SW 98TH CIRCLE INSURER D: MIAMI,FLORIDA 33174 INSURER E.g._..,..._...._.. _ INSURER F COVERAGES _CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRADD'SUBR POLICYEFF POLICYEXP LTR TYPE OF INSURANCE INSR POLICYNUM13ER MMfDD MMIODIYYYY LIMITS - —- © COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000.00 6Ab1AGE TO RENTED ❑ CLAIMS4AADE ❑� OCCUR PREMISES Ea_oxurrence) _ $ 50,000.00 ❑ MED EXP(Any oneperson) S 1,000,000.00 A _. __... .............. 00066733-1 05(11/2016 05/11/2017 ❑ PERSONAL&ADV INJURY $ 1,000.000.00 GEMLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 POLICY ❑ jp&T ❑ LOC PRODUCTS-COMPIOPAGO $ 2,000,000.00 El OTHER $ _...._. AUTOMOBILE LIABILITYCOMBINEOISINGLE LIMIT S 50 ,000.00 ❑ ANY AUTO BODILY INJURY(Per person) $ B ❑ AUTOWNED Q SCHEDULED 01412520-0 03/0912016 03/09/2017 BODILY INJURY(Per accfdem) $ - _.._. El HIREO AUTOS ❑ ANUTOSWNED { OPER�Y DAMAGE $ ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE El DED ..11 RETENTIONS _._._._._...._-...-- WORKERS COMPENSATION [:]PPERR. E ❑0TH' AND EMPLOYERS'LIABILITY YIN _ __....._ ANY PROPRIETORIPARTNERIEXECUTIV E.L.EACH ACCIDEN7OFFICERIEMBER _..-- (Mand tory In NH) EXCLUDED? N I A E.L DISEASE-EA EMPLOYEE: If yes,describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT g DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 161,Additional Remarks Schedule,if more space Is required) LICENSE#CCC1328704 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPT. 10050 NE 2 AVENUE AUTHO REPRESENTATIVE MIAMI SHORES,FLORIDA 33138 F ©1988-rAORPORATION. Ailrights reserved. ACORD 26(2014101)QF The 0ogo are registered marks of ACORD 123 9 `�q7