Loading...
RF-16-3099 Permit No. RF-11-16-3099 `SNORES y, Miami Shores Village Permit Type:Roof 10050 N.E.2nd Avenue ti Work Classification:Flat Miami Shores,FL 33138-0000 Perin Permit Status:APPROVED Phone: (305)795-2204 E'GORIDp' issue Date: 11/28/2016 Expiration: 05/27/2017 Project Address Parcel Number Applicant 1132060132480 Miami Shores, FL Block: Lot: MIAMI SHORES VILLAGE Owner Information Address Phone Cell MIAMI SHORES VILLAGE Contractor(s) Phone Cell Phone Valuation: $ 7,900.00 TOP SEAL SERVICES CORP (305)754-7844 Total Sq Feet: 300 Type of Work:Repair Available Inspections: Additional Info:NEW CONSTRUCTION FLAT ROOF/TPO SYS Inspection Type: Classification:Residential Tin Cap Scanning:3 Final Roof Roof in Progress Renailing Affidavit Review Building Review Building Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $4.80 Invoice# RF-11-16-62046 DBPR Fee $3.75 11/28/2016 Money Order $ 12.30 $50.00 DCA Fee $3.75 Education Surcharge $0.00 11/14/2016 Credit Card $50.00 $0.00 Permit Fee-New Roof $50.00 Scanning Fee $0.00 Technology Fee $0.00 Total: $62.30 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDJVIT: I c rtify t t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction an zonin F therm re, I authorize the above-named contractor to do the work stated. November 28, 2016 Authorized Si at re:Owner / Applicant / Contractor / Agent Date Building Department Copy November 28, 2016 1 Invoice Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Fax: (305)756-8972 For Inspections please call: (305)762-4949 Return to: F Shores Village Permit Number: RF-11-16-3099 N.E. 2nd Avenue InvoiceDate: November14, 2016 Shores, FL 33138-0000 Invoice Number: RF-11-16-62046 Bond Number: Bill To Comments: MIAMI SHORES VILLAGE Permit Type: Roof / Work Classification: Flat Date Fee Name Fee Type Fee Amount 11/14/2016 DCA Fee Calculated $3.75 11/14/2016 Scanning Fee Calculated $9.00 11/14/2016 Education Surcharge Calculated $1.60 11/14/2016 Permit Fee- New Roof Adjustable $300.00 11/14/2016 DBPR Fee Calculated $3.75 11/14/2016 Technology Fee Calculated $6.40 11/14/2016 CCF Calculated $4.80 Total Fees Due: $329.30 Payments Date Pay Type Check Number Amount Paid Change 11/14/2016 Credit Card $50.00 $0.00 Total Paid: $50.00 Total Due: $279.30 Tuesday,January 24,2017 Miami Shores Village 7BY —; 2016 ,e Building Department 1< `� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 V`J V1 `J Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 (�FBC 20 Iq BUILDING Master Permit No. 1 to 3 Z 3 PERMIT APPLICATION Sub Permit No. v -3C9q, ❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL PUBLIC WORKS [:] CHANGE OF CANCELLATION [:] SHOP CONTRACTOR DRAWINGS JOB ADDRESS: f! 3 S /y L 7F/ ,r r/L c&% City: Miami Shorest,, County: Miami Dade zip: 33 ?J Folio/Parcel#: t 1 3 Zd(`o o 1 3 M S� Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name(Fee Simple Titleholder): S C-0 7 T I)A J i Phone#: :7 f Co V0 2 a O 0 w Address: IV lt> /O 3 wP f Tib E7 City: State: L Zip: 3 �) ) Vi Tenant/Lessee Name: I9Ay/f M14/A ) f HoAf, U ),AA- _(D,,, Phone#: Email: CONTRACTOR:Company Name: I OP SFAI s>&-o-O c-C- Phone#: 3011�- qeb 32-7 O Address: QLU <IT City: �`Mp� State: Zip: Qualifier Name: I` �1-��t t� ��( f�-'-a Phone#: -3c),5- Q n 6 -37 Z b State Certification or Registration#: cc C CS3r(I Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: 30 O Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: �u COQ-S-rev�co� �o� j P� s`fJ� Mi! Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ do" oez TOTAL FEE NOW DUE$ (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS, HEATERS,TANKS,AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In nce of such posted notice, the inspection will not be approved and a reinspection fee will be charged. 0 . Signature Signature OWNER or AGENTCONT The foregoing instrument was acknowledged before me this The foregoing instrument ,w�as'acnknowledged before/me this as day of VekJ • 20 �� by _ day of 1�V , 20 1 tD by who is V�t ( ,who is p sons y nowrr me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: �✓�''' /�v�c�YL Print: gPrint: 6bdN� •��r'` YULIANA PICCIONI FF 9 Seal: ,_ Commission M FF 984204 Seal' a co Expires M '* MY Gornm 0 2020 y Commission Expires - � kpa April 2 April 20, 2020 *************************************** *** **************************************************************** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Section C2 �"I I®RADE Miami-Dade County HVHZ Electronic Roof Permit Form • "Delivering Excellence Every Day" Illustrate Components Noted and Details as Applicabi Woodblocking, Gutter, Edge Term inations/Stripping/Flashin t' Bois Iat, Cant Strip, Base Flashing, Counterflashing, Coping, Etc. Indicate: Mean Roof Height, Parapet Height, Height of Bas i , C ponent Material, Material Thickness, Fastener Type, Fastener Spacing Or: Submit Manufacturers Details that Comply with RAS 1 & HVHZ, FBC. a Tom • -5 K3 Parapet Wall Height ft, Mean Roof Height t ft. O c see 0 • 0•0 0 goo ••• • •� % • •Y• • Section A/B MIAMI-DiADE Miami-Dade County HVHZ Electronic Roof Pei m "Delivering Excellence Every Day" Section A(General Information) Master Permit No: Process No: Contractor's Name: Job Address: , Roof Category Low Slope ❑ Mechanically Fastened Tile ❑ Mortar/Adhesive Set Tile ❑ Asphaltic Shingles ❑ Metal Panel/Shingles ❑ Wood Shingles/Shakes ❑ Sprayed Polyurethane Foam ❑ Other: Roof Type LSF New Roof ❑ Re-Roofing ❑ Recovering ❑ Repair ❑ Maintenance /Are there Gas Vent Stacks located on the roof? ❑Yes ❑ No If yes,what type? ❑ Natural ❑ LPGX Roof System Information Low slope roof area (ft.2) '3©o Steep Sloped area(ft.z) �' t` Total (ft.2)1 3© G Section B (Roof Plan) Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include dimensions of sections and levels, clearly identify dimensions of elevated pressure zones and location of parapets. Perimeter Width(a'):� Corner Size(a' x a'): Miami Shores Village APPROVED BY DATE ZONING DEPT ,, p F_ BLDG DEPT (NI?.a n,. 0 SUBJECT TO COMPLIANCE WIT ALL FEDERAL`� S �` STATE AND COUNTY RULES AN P REGULATIONS .. ... . . . . . .. . .. . . . . ... . . ... . ... ... ... .. . . . . . . . . . .. . .. .. .. ... . . . . ... . . . .. .. . . . .. .. ... . . . ... . . �ORILIA SECTION 1524 HIGH VELOCITY HURRICANE ZONES—REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS 1524.1 Scope.As it pertains to the section, it is the responsibility of roofing contractor to provide the owner with the required roofing permit,and to explain to the owner the content of the section.The provisions of Section R4402 govern the minimum requirements and standards of the industry for roofing system installations.Additionally, the following items should be addressed as part of the agreement between the owner ant the contractor.The owner's initial in the designate space indicates that the item has been explained. 2• Renailing wood decks:When replacing roofing,the existing wood roof deck may have to b enailed in accordance with the current provisions of Section R4403. (The roof deck is usually conceale r to removing the existing roof system). 4. Exposed Ceiling: Exposed,open beam ceilings are where the underside of the roof decking a be viewed from below.The owner may wish to maintain the architectural appearance;therefore, roofing nail penetration of the underside of the decking may not be acceptable.This provides the option of maintaini the appearance. s• Overflow scuppers(wall outlets): It is required that rainwater flows off so that the roof is not vedoaded from a buildup of water. Perimeter/edge wall or other roof extension may block this discharge if overflow scuppers(wall outlets)are not provided. I ay neves to install overflow scupper in accordance with the requirements of Sections R4 02, R440 an R44 3. Own ent's Si ature Date Contra ig Date Property Address 1, Permit Number Revised on 7/9/2009 LD;07/01/2015; .. ... . . . . . .. . .. . . . . ... . . ... . .•. ... ... .. . . . . . . . . . .. . .. .. .. ... . . . . ... . . . . . . . . . . . . ••• • • • ••• • • Miami-Dade County HVHZ Electronic Roof Permit Form Section C Page(Single Ply Membrane Roof Systems) PH'l►rthe specific roof assembly components.If a component to not required,insert not applicable{nh)In the text box. Roof System Manufacturer. JOHN MANSVILI,$� Single Ply Membra •T e 1 Thickness: Product Approval(NOA): 140618.03 NOA System Type: q1 JM TPO 010X100 in le P Membrane Fasteni an or Bond ng Material 49.4 psf JM TPO SOLVENT BASED par ADHESIVE FULLYADHERED . 82.9 Ful Sheet Wdth: 10X100 12 1/2 Sheet Wdth: 5X100 4.q psf Mwdmum Design Pressure From NOA pat. pNo.of Single Ply 1/2 sheets: `i (P2)Perimeter(aq Size: 4� tt ® ionai Surfadng: (P3)Comer Size; I a 4 (x)a, 4 N/A Roof SlopwRoof Mean Height [Z ft, -.;, r �W Parapet Walla: pacing forAnchor Shpet Attachment ya• ❑Fastener S No []Yee Parapst watt Height: ft. El Single Ply Membrane Attachment –Structural Concrete– ❑ Single Ply Picture Framed In Pertmetera&Comers LWIC Manufacturer. N/A ❑*Single Ply Finger Row attachment in Perimeters&Camara Compress ve Lap Spacing Membrane Sheet Length or Siren N/A Psi Support Spadng: N/A ft.c/o Anchor Sheet Attachment t3dstin Roof For Recovers On ): Field: N/A in.c/o N/A Row N/A in. N/A Perimeter: N/A in.a/c N/A Rows) N/A in. . a er. Comer. N/A In.c/o N/A Row(s) N/A In. N/A V or Bartter. •flnerer Rows Perimeter Row Length Comer Row Length Attached e"do N/A Raw(s) N N/A parallel to La /A ft. N/A Rows) N/A ft. Anchor Sheet: rm. N/A Maximum Roof Deck Wetdabie Plate Spacing –Plata NIA– Anchor Sheat Fastener/Bondin Material: Support Spaclrr3 24"d N/A For Screws&Weldable Mable Plate Spacing –Plates P/ate Attachment Weldable Plate 8 Insulation Been La r Size&Thidmess: paring –Plates WA–� JM TAPERED POLYI90 1.5:MIN 4X4 Wood Nailer Type and Size: Insulation Bass La er Fastdner/Bondin Material: +� JM URETHANE INSULATION ADHBSIVB.75 VIDE12"O.C.--j JWood Nailer or Type and S padre ; Insu a on To er S &Thidrnesa ��� C. N/A S � Unu-18flon TOE La er Fastener/Bondin Mete al: Wit' NIA Number of Fasteners per Insulation Board-:1 –METAL EDGE:TOOK STRIP NIA– • •. I Edge Metal Ment; Ftetd: N/A Perimeter. N/A I Conier IN A 3 © Q . • . • • c a •• ••• •• 1 O d l C PARAPET COPING METAL N/A– ,go 0 /A– •.• „.. ti _ –COPING METAL SIZE N/A– • . .•• –COPING METAL HOOK STRIP N/A– • Parapet Coping hiatal Attachment .•. • ... . Pr/A Reset'�OfTt1 -nr+: Single Ply Wall Flashing MIAM11- Miami-Dade County HVHZ Electronic Roof Permit Form "Delivering Excellence Every Day° Single Ply Membrane Parapet Wall Flashing Detail CONCRETE INSTALL APPROPRIATE SEALANT v (E.G.,POLYURETHANE)AND TOOL A TO FACILITATE WATER RUNOFF a a_ CONCRETE FASTENERS APPROX.17'O.C. c WITH SEALING WASHERS O �•— SHEET-METAL COUNTERFLASHING— Q OPTIONAL INSTALL COMPRESSIBLE / a ELASTOMERIC SEALANT OR TAPE TO d SPAM IRREGULARITIES TERMINATION BAR FAS "D WITH _ APPROPRIATE FAS RS APPROX. /1047C INSTALL CIBLE SEALANT OR TAPE MEMBRANE (x7 '• r .Y ADHER€ MEMBRANE F NG 1 Z ti;• f _zsnwrr BON ADAESI r ep " . . •--•---HOT-Al WELMO& AN LL .......... :::`:: SEALANT tI E UIRED FOR THE SPECIFIC YSTEM� S LA S AND FASTENERS- a Provi a mponent Information Roof Mean Height: Coping Metal Type and Size: n/a Continuous Cleat: I n/a Wall Flashing Material: n/a ❑ Fully Adhered ❑ Mech.Attached Surfacing: n/a Single Ply Membrane Type: I n/a Top Insulation Layer Type: I n/a Base Insulation Layer Type: I n/a .. so . Wood Nailer Type&Size: n/a .. ... .. . . . . Wood Nailer Attachment: n/a 000 Deck Type: Structural Concrete .. . . 0 ... . . . . ... . . . . . . . . . . . . . .. .. . . . .. .. MIAMF M% MIAMI-DARE COUNTY PRODUCT CONTROL SECTION DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES( R) 11805 SW 26 SftW%Room 208 BOARD AND CODE ADMUGSTRATION DIVISION Miami,Florida 33175-2474 NOTICE OF ACCEPTANCE OA T(786)315-2590 F(786)31525-99 www.mlamidade.t—d-conomv Johns Manville Corporation 717 17`Street Denver,CO 80202 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 miterial 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:JM TPO Single Ply Roofing System over Concrete Decks. 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 hasbeen.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 No. 13-OK8.02iatidbonstit,4 of pll*es 1 through 24. The submitted documentation was reviewed Vi Jorgie t.Aeebo. :•: . .. ... .. . . . . . ... . .. ... ... % .. .. NOA No.: 14-0618.03 Mecounmr Expiration Date: 12/24/18 ••• ••• Approval Date: 11/27/14 Page 1 of 24 ... 0 . . ... . . ROOFING SYSTEM APPROVAL at o : Roofing Sub—=r1: Single Ply Roofing Material: TPO Dec-- k Type' Concrete Maximum Design Pressure: -217.5 psf TRADE NAMES OF PRODUCTS MANUFACTURED OR LABELED BY APPLICANT: TABLE 1 Test Product Product Dimensions S�eci� fication Descp_ tion JM TPO 45 45 mils thick ASTM D6878 Polyester reinforced Thermoplastic TAS 131 Olefin single ply membrane, JM TPO 60 60 mils thick ASTM D6878 Polyester reinforced Thermoplastic TAS 131 Olefin single ply membrane. JM TPO 80 80 mils thick ASTM D6878 Polyester reinforced Thermoplastic TAS 131 Olefin single ply membrane. JM TPO FB 115 60 mils thick ASTM D6878 Polyester reinforced,fleece backed, TAS 131 Thermoplastic Olefin single ply membrane. JM TPO FB 135 80 mils thick ASTM D6878 Polyester reinforced,fleece backed, TAS 131 Thermoplastic Olefin single ply membrane. DynaBase 39-3/8"x 49'2" ASTM D6163, An SBS modified bitumen coated, Type I Grade S fiberglass reinforced base sheet. JM Urethane Insulation 1 gal. Proprietary A one part,cold-applied adhesive. Adhesive JM Two Part Urethane Various Proprietary A two-component,cold-applied Insulation Adhesive adhesive. JM Roofing System Various Proprietary A two-part urethane low-rise foam Urethane Adhesive adhesive: JM MBR RA Membrane 1.5L Cartridge Proprietary Two part,cold process membrane Adhesive adhesive: JM TPO Membrane 5 gal. Proprietary A synthetic rubber-based adhesive used Adhesive(Solvent-Based) on single ply roofing membranes. JM TPO Membrane 5 gal. Proprietary A synthetic rubber-based adhesive used Adhesive(Low VOC) with fully or partially adhered TPO ••• ••; ••• ;rQ81ing membrane systems. JM TPO Membrane 5 gal- •• o• ••%A Polymeric,wet laying(single side • DriL�y: . PD ym , Adhesive(Water-Based) •• 00: •• • • •aDDlication),low-VOC adhesive. JM TPO Membrane Primer 3 gal. . . • Proprietary A sy;hetic polymer-based primer. •• •• • • • • • • • • •• • • • • • NOA No.: 14-0618.03 MIAMF E COUNTY J ,,, , ••• • ••• Expiration Date: 12/24/18 • • Approval Date: 11/27/14 ••• • • • • • • Page 2 of 24 • •• 00 • Y • •• •• JM TPO Membrane Primer 3 gal. Proprietary A low VOC,synthetic polymer-based (Low VOC) primer. Urethane Insulation Omen Two Part 5 gal. Proprietary A two-component,plant based,low Ur Adhesive VOC adhesive. JM TPO Walkpad 5/32"x 30"x 50' Proprietary Textured walkway protection membrane. JM TPO Detail Membrane 24"x 50' TAS 131 Non-reinforced membrane for wrapping pipe flashings and vertical stacks and for waterproofing joints of JM TPO Coated Metal. JM TPO Universal Comers TAS 131 Pre-molded for easy installation of curb flashings or corner flashings on JM TPO-Coated Metal or JM TPO Membrane. JM TPO T-Joint Patch 4" TAS 131 Non-reinforced membrane patch for covering.t joints and/or discs and fasteners. JM TPO Pipe Boots 1"x 6" TAS 131 Cone-shaped stepping boots designed for flashing pipe penetrations. Boots JM TPO Peel&Stick Pipe 1"x 6" TAS 131 Cone-shaped stepping boots designed for flashing pipe penetrations. JM TPO Cover Tape 6"x 100' TAS 131 30 mil membrane with a factory-applied peel and stick adhesive tape used to strip in metal flanges. JM TPO 10"Cover Tape 10"x 100' TAS 131 30 mil membrane with a factory-applied peel and stick adhesive tape used to strip in metal flanges. JM TPO Penetration Pocket 7.5"x 6" TAS 131 Two-piece molded pocket with a rigid vertical wall and preformed flanges. JM TPO Coated Metal 4'x 10' Proprietary JM TPO Membrane laminated onto galvanized steel. JM TPO Peel&Stick RTS 6"x 100' TAS 131 45 mil TPO membrane strip with a 3" tape factory laminated along one edge. JM TPO Peel&Stick 10" 10"x 100' TAS 131 45 mil TPO membrane strip with a 3" RPS tape factory laminated along one edge. JM TPO Curb Flashing 18"x 50' TAS 131 60 mil TPO membrane for flashing curbs and parapet walls. JM TPO Reinforced Cover 8;x W. .TAS 131.. 60 mil TPO membrane strip use as a Strip . . . . . .. . ... . • • •• heat-weldable strip in mechanically . . . 00 000 ' ' ' ' ' ' ' fastened systems. • .. • .. .. .. MIAMIAD ••• N OA No.: 14-0618.03 Expiration Date: 12/24/18 Approval Date: 11/27/14 • • Page 3 of 24 . .. .. . . 0 00 00 APPROVED INSULATIONS: TABLE 2 Manufacturer Product Name Product Description (With Current NOA) ENRGY 3,ENRGY 3 25 PSI, Polyisocyanurate insulation Johns Manville ValuTherm,ValuTherm 25 PSI, R-Panel,R-Panel 25 PSI ENRGY 3 AGF,ENRGY 3 AGF 25 Isocyanurate Insulation with glass Johns Manville PSI,ENRGY 3 CGF,ENRGY 3 reinforced facers CGF 25 PSI,ValuTherm AGF, ValuTherm AGF 25 PST,ValuTherm CGF,ValuTherm CGF 25 PSI ENRGY 3 FR,ENRGY 3 FR 25 PSI Isocyanurate Insulation with inorganic Johns Manville coated glass reinforced facers;bottom face is premium coated for combustible decks. Invinsa Roof Board High density polyisocyanurate board Johns Manville with fiber glass reinforced facers DensDeck Silicone treated gypsum Georgia Pacific Gypsum, LLC JM SECUROCK Gypsum-Fiber Fiber reinforced coverboard Johns Manville Roof Board RetroPlus Roof Board High density,perlite base cover board Johns Manville APPROVED FASTENERS: TABLE 3 Fastener Product Product Manufacturer Number Name Description Dimensions (With Current NOA) 1. U1traFast Fasteners Insulation and membrane #12 x 8"max. Johns Manville fastener Length, #3 Phillips head 2. UltraFast 3"Round Galvalume AZ55 steel 3"diameter Johns Manville Metal Plates Insulation Plate 3. U1traFast Square Galvalume AZ55 steel 3"square Johns Manville Recessed Metal Plates Insulation Plate 4. High Load Fasteners Insulation and membrane #15 x 14"max. Johns Manville fastener #3Phillips hd 5. Extra High Load Insulation and membrane #21 x 8"max. Johns Manville Fasteners fastener #3 Phillips head 6. High Load Plates Seam plate with 2-3/8"round steel Johns Manville reinforcing ribs and plate ."eyft*: . : : ..• 7. Extra.High Load Plate%. Inti ati+dlatPlatt :.: '. 3"round Johns Manville . .. ... .. . . . .. 8. JM TPO..RhinoPlate Insulation Plates 3.15"diameter, Johns Manville . ... . ... ... ... •• NOA No.: 14-0618.03 MLAMMMECOUNTYM Expiration Date: 12/24/18 Date.Approval 11/27/14 ... . . . . ... . . . • ••• Page 4 of 24 . . . . . . . . . . . .. .. . . . .. .. EVIDENCE SUBMITTED: Test--Affencv Test Identifier Desc_ D ate FM Approvals 3032235 FM 4470 06/27/08 3030259 FM 4470 06/02/08 3031917 FM 4470 06/20/08 3030383 FM 4470 05/13/08 3033700 FM 4470 10/10/08 3036842 FM 4470 10/02/09 3036559 FM 4470 10/02/09 3035538 FM 4470 10/02/09 Momentum Technologies RX10A8A TAS 131 03/29/10 RX14C8A TAS 131 03/29/10 RX10A8B TAS 131 03/29/10 PRI Construction Materials JMC-180-02-01 Physical Properties 11/11/13 Technologies LLC JMC-088-02-01 Rev 2 ASTM D1876/TAS 117(B) 09/06/13 JMC-132-02-02 TAS 114(D) 07/01/13 JMC-143-02-01 TAS 114(D) 07/01/13 JMC-186-02-01.1 TAS 131 09/19/14 JMC-186-02-02.1 TAS 131 10/10/14 JMC-180-02-01 Physical Properties 11/11/13 JMC-183-02-01.1 Physical Properties 12/18/13 ADCO-001-02-01 Physical Properties 06/16/13 UL,LLC R10167 UL 790 11/20/13 Testy I ERD J33600.08.13 TAS 131 08/09/13 . .. . . . . ... . *00 ••Y Y •t• ••• ••• Y . ••• . • . •• . •• •• •• NOA No.: 14-0618.03 MiAMF4ADE Court Y Expiration ..., , Date: 12/24/18 • •:° Approval Date: 11/27/14 • • • • V: . Page 5 of 24 .00 • •• • 004 . •• . APPROVED ASSEMBLIES: Membrane Type: TPO -Deck Type 3I: Concrete,Insulated Deck Description: Min.2500 psi structural concrete or concrete plank System Type A(1): One or more layers of insulation adhered with approved adhesive;membrane fully adhered. All General and System Limitations apply.Roof accessories not listed in Table 1 of this NOA are not approved add shall not be installed unless said accessories demonstrate compliance with prescriptive Florida Building Code requirements and are field fabricated utilizing the approved membranes lisfed in Table 1. Insulation Layer Insulation Fasteners Fastener (Table 3) Dnsity/ft2 ENRGY 3,ENRGY 3 25 PSI,ValuTherm,ValuTherm 25 PSI,R-Pa el,R-Panel 25 PSI,ENRGY 3 AGF, ENRGY 3 AGF 25 PSI,ValuTherm AGF,ValuTherm AGF 25 PSI,ENRGY 3 CGF, ENRGY 3 CGF 25 PSI,ValuTherm CGF,ValuTherm CGF 25 PSI Minimum 1.5"thick N/A N/A Note: All insulation shall be adhered in W wide ribbons of JM Urethane Insulation Adhesive spaced 12"o.c. Please refer to Roofing Application Standard RAS 117 for insulation attachment. Membrane: JM TPO adhered to insulation using JM TPO Membrane Adhesive(Solvent- Based),or JM TPO Membrane Adhesive(Low VOC)adhesive applied to both the membrane and substrate for a combined rate of 1.67 gal./sq. Side laps are sealed with a 1.5-inch wide heat weld. Maximum Design Pressures: -217.5 psf.(See General Limitation#9) .. ... . . . . . .. . .. . . . . ... . .. ... .. . . . .. . % . % % .. NOA No.: 14-0618.03 cExpfration Date: 12/24/18 MMO "' "• Approval Date: 11/27/14 . . . . . . . . . . Page 6 of 24 . .. .. . . . .. .. ... . . . ... . . CONCRETE DECK SYSTEM LIMITATIONS: 1. If mechanical attachment to the structural deck through the lightweight insulating concrete is proposed,a field withdrawal resistance testing shall be performed to determine equivalent or enhanced fastener patterns and density. All testing and fastening design shall be in compliance with Testing Application Standard TAS 105 and Roofing Application Standard RAS 117 and/or RAS 137,calculations shall be signed and sealed by a Florida Registered Engineer,Architect,or Registered Roof Consultant. GENERAL LDUTATIONS: I. Fire classification is not part of this acceptance,refer to a current Approved Roofing Materials Directory for fire ratings of this product. 2. Insulation may be installed in multiple layers. The first layer shall be attached in compliance with Product Control Approval guidelines. All other layers shall be adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 2040 lbs./sq.,or mechanically attached using the fastening pattern of the top layer 3. All standard panel sizes are acceptable for mechanical attachment. When applied in approved asphalt, panel size shall be 4'x 4'maximum. 4. An overlay and/or recovery board insulation panel is required on all applications over closed cell foam insulations when the base sheet is fully mopped.If no recovery board is used the base sheet shall be applied using spot mopping with approved asphalt, 12"diameter circles,24"o.c.;or strip mopped 8" ribbons in three rows,one at each sidelap and one down the center of the sheet allowing a continuous area of ventilation. Encircling of the strips is not acceptable. A 6"break shall be placed every 12'in each ribbon to allow cross ventilation. Asphalt application of either system shall be at a minimum rate of 12 lbs./sq. Note: Spot attached systems shall be limited to a maximum design pressure of 45 psf. 5. Fastener spacing for insulation attachment is based on a Minimum Characteristic Force(F")value of 275 lbf.,-as tested in compliance with Testing Application Standard TAS 105. If the fastener value,as field- tested,are below 275 lbf insulation attachment shall not be acceptable. 6. Fastener spacing for mechanical attachment of anchor/base sheet or membrane attachment is based on a minimum fastener resistance value in conjunction with the maximum design value listed within a specific system. Should the fastener resistance be less than that required,as determined by the Building Official, a revised fastener spacing,prepared,signed and sealed by a Florida Registered Engineer,Architect,or Registered Roof Consultant may be submitted. Said revised fastener spacing shall utilize the withdrawal resistance value taken from Testing Application Standards TAS 105 and calculations in compliance with Roofing Application Standard RAS 117. 7. Perimeter and corner areas shall comply with the enhanced uplift pressure requirements of these areas. Fastener densities shall be increased for both insulation and base sheet as calculated in compliance with Roofing Application Standard RAS 117 and/or RAS 137.Calculations prepared,signed and sealed by a Florida registered Professional Engineer,Registered Architect,or Registered Roof Consultant(When this limitation 6 specifically referred within this NOA,General Limitation#9 will not be applicable.) 8. All attachment and sizing of perimeter nailers,metal profile,and/or flashing termination designs shall conform with Roofing Application Standard RAS 111 and applicable wind load requirements. 9. The maximum designed pressure limitation listed shall be applicable to all roof pressure zones(i.e.field, perimeters,and comers).Neither rational analysis,nor extrapolation shall be permitted for enhanced fastening at enhanced pressure zones(Le.perimeters,extended corners and corners). (When this limitation is specifically referred within this WAg(�eig�al:l�imitation#7 will not be applicable.) 10. All products listed herein shall have a gna)It p._asWasge alit iVAcordance with the Florida Building Code and Rule 61G20-3 of the Florida Administrative Code. END QF THIS ACCEPTANCE . . % . . .. . . . . . . . . . % .. .. .. NOA No.: 14-0618.03 e eoutar�r Expiration Date: 12/24/18 ••• ••• Approval Date: 11/27/14 • ••• Page 24 of 24 . . .. .. . . . .. .. TGFU.R10167- Roofing Systems Page 1 of 1 SINGLE PLY MEMBRANE ROOFING SYSTEMS(TPO) "Invinsa@"may be used over"ENRGY 3",or as an acceptable alternate to"ENRGY 3@",in any of the following noncombustible Classifications. 1/2 in.thick"Invinsa®"is an acceptable alternate for 1/4 in.thick board for all non-combustible systems. Unless otherwise indicated,"JM TPO Reflexsa"can be used In lieu of"JM TPO"In any applicable system. Unless otherwise indicated,the term"JM TPO FB"will include: "JM TPO FB 100","JM TPO FB 115"and"JM TPO FB 135". Class A-Fully Adhered(TPO) 1.Deleted. 2.Deleted. 3.Deleted. 4.Deleted. S.Deleted. ]. 6.Deleted. 7.Deck:C-15/32 Incline:3/4 Insulation(Optional):—Any UL Classified,any combination,any thickness. Barrier Board:— 1/4 in,min Georgia-Pacific Gypsum LLC DensDeck@ with all joints staggered min of 6 in.from the plywood joints. Membrane:—'7M TPO"fully adhered with TACC"FA-141"applied to the membrane and substrate at 60 ft2/gal in total, 8.Deck:C-15/32 Incline:3/4 Insulation(Optional):—Any UL Classified,any combination,any thickness. Barrier Board:—1/4 in.min Georgia-Pacific Gypsum LLC DensDeck®with all joints staggered min of 6 In.from the plywood joints. Membrane:—"JM TPO"fully adhered with"JM TPO Membrane Adhesive(Water Based)"at 120 ft2/gal. 9.Deck:C-15/32 Incline:3/4 Insulation(Optional):—Any UL Classified,any combination,any thickness, Barrier Board:—1/4 In,min Georgla-Pacific Gypsum LLC DensDeck®with all joints staggered min of 6 in.from the plywood joints. Membrane:—"JM TPO"fully adhered with"JM TPO Membrane Adhesive(Solvent Based)"applied to the membrane and substrate at 60 ft'/gal in total. 10. Deck:NC Incline: 1/2 Insulation(Optional):—"ENRGY 30",any thickness. Membrane:—"JM TPO"fully adhered with"JM TPO Membrane Adhesive(Water Based)"at 120 ft2/gal. 11. Deck:NC Incline: 1/2 Insulation(Optional):—"Invinsa@", 1/4 in.thick;or"Invinsa@"over"ENRGY 30",any thickness. Membrane:—"JM TPO"fully adhered with"JM TPO Membrane Adhesive(Water Based)"at 120 ft2/gal. 12.Deck:NC Incline: 1/2 Inat/(Optional):—"Invinsa@", 1/4 in.thick; or"Invinsa@"over"ENRGY 30",any thickness. rane:—"JM TPO"fully adhered with"JM TPO Membrane Adhesive(Solvent Based) applied to the membrane and substrate at 60 ft2/gal total. 13.Deck:NC Incline: 1/2 Ins on(Optional):—"ENRGY 30",any thickness. M brns:—"JM TPO"fully adhered with"JM TPO Membrane Adhesive(Solvent Based)"applied to the membrane and substrate at 60 /gal ini total. • •• • • • • ••• • •• ••• •• • • • •• • ••• • ••• ••• ••• •• • • Y • • ••• • • • • ••v • • ••• • • • ••• • • http://database.ul.com/cgi-bin/XYV/template/LISEXT/l FRAME/showpage.html`:�name=T... 7/13/2016 Permit^NO. PLC-1-17-187 �s�!OREs q Miami Shores Village t Permit Type:Plumbing-Commercial 10050 N.E.2nd Avenue NE Per ' Work Classification:Addition/Alteration Miami Shores,FL 33138-0000 Perrnit Status:APPROVED ^'ORI��' Phone: (305)795-2204 FLDA Issue Date: 3/1512017 Expiration: 09/11/2017 Project Address Parcel Number Applicant 135 NE 97 Street 1132060132480 Miami Shores, FL Block: Lot: MIAMI SHORES VILLAGE Owner Information Address Phone Cell MIAMI SHORES VILLAGE Contractor(s) Phone Cell Phone CYPRESS CONSTRUCTION GROUP L (954)533-1199 Valuation: $ 16,034.0000 Total Sq Feet: 7910 Type of Work: INSTALLATION OF FUEL LINES FROM THE Available Inspections: Type of Piping: Inspection Type: Additional Info:INSTALLATION OF FUEL LINES FROM THE Top Out Classification:Commercial Re Pipe Scanning:3 Main Drain Heater Water Service Final Water Main Lavatory Final Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $10.20 DBPR Fee Invoice# PLC-1-17-62708 $7.22 03/15/2017 Money Order $481.66 $50.00 DCA Fee $7.22 Education Surcharge $3.40 01/24/2017 Credit Card $50.00 $0.00 Permit Fee $481.02 Scanning Fee $9.00 Technology Fee $13.60 Total: $531.66 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: Ice ' at all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. ,her re,I authorize the above-named contractor to do the work stated. March 15, 2017 Auth ed Signatur ner / Applicant / Contractor / Agent Date Building Department Copy March 15,2017 1 ` O-LMiami Shores Village � 001f� Building D JAN 242017 I d g epartment LB 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Y'—� Tel:(305)795-2204 Fax:(305)756-8972 S-K INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2Q1q BUILDING Master Permit No.PW-2-16-323 PERMIT APPLICATION Sub Permit No.? ` C I--� - 1 B� BUILDING ❑ ELECTRIC ROOFING REVISION EXTENSION ❑RENEWAL QPLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 135 NE 97th Street City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#: 1132060132480 Is the Building Historically Designated:Yes NO X Occupancy Type: N/A Load: N/A Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder):Village of Miami Shores Phone#:305-795-4857 Address: 10050 NE 2nd Ave City: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Tom Benton (Village Manager) Phone#:305-795-4857 Email: bentont@miamishoresvillage.com CONTRACTOR:Company Name: Cypress Construction Group, LLC. Phone#: 954-533-1199 Address: 120 E. Oakland Park Blvd., Suite 105 City: Ft. Lauderdale State: FL Zip: 33334 Qualifier Name: 421-IN ZZ A159LOPA Phone#: 954-533-1199 State Certification or Registration#: QX=(?��a Certificate of Competency#: DESIGNER:Architect/Engineer: CPH, Inc. Phone#: 305-274-4805 Address: 1992 SW 1 st Street I�n ( � •0� . _ City: Miami State: FL Zip: 33135 Value of Work for this Permit:$ ,)00 31 mill Square/Linear Footage of Work: 7,910 LF Type of Work: ❑ Addition ❑ Alteration ❑ New ■❑ Repair/Replace ❑ Demolition Description of work: Installation ofi on-site 1000 gallon above ground storage tank�to-the- 4ey ten ik 3, tor Specify color of color thru tile: �-� Submittal Fee$ Permit Fee$ � 1 u�I^• O� CCF$ 10 ' ,0 CO/CC$ Scanning Fee$ J-yo Radon Fee$-7 • d� DBPR$ 1 Notary$ Technology Fee$ • Training/Education Fee$ i?7 .40 Double Fee$ Structural Reviews$ Bond$ q) TOTAL FEE NOW DUE$ (Revised02/24/2014) Bonding Company's Name(if applicable) N/A Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature / Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this Ir day of Ghvar 20 1- by ��h dayAAof Q uct 20 ,�" by t1` who is personally known to o l I a V !�he Ledc�t who is personally known to me or who has produced as me or who has produced;[�(lyer IaCP►�SP, as identification and who did take an o identification and who did take an oath. NOTARY P NOTARY PUBLIC: Sign: k .X V Sign: Print: ana V ; Print: Seal: Seal: .`4Y- YANADY PRIETO MY COMMISSION#FF 214031 s } .7 lyl (S/I `jam EXPIRES:March 25 2019 �� s o?: onded Thru No Public underwriters 4�'•'is-. ; u.;r.;: 7 s: r ; ************ *l�uilGr@ APPROVED BY /i --r Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) i gORFS Haig Miami shores Village Building Department �tORIDA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: j A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. arrrrrrraararaarrrrraarrararrrrrrrarrrrrarrarrraraarrrraarrrrrrraarrarrrrraaarrrrrraarrrr■ BUSINESS NAME: Cypress Construction Group, LLC. BUSINESS ADDRESS: 120 E. Oakland Park Blvd #105 CITY Ft. Lauderdale STATE FL Zip 33334 BUSINESS PHONE: 9( 54 533 1199 FAX NUMBER(_254 1 206 0005 CELL PHONE 9( 54 ) 683 2261 QUALIFIER'S NAME: Oliver Abeleda QUALIFIER'S LIC NUMBER: PCC 056770 "Eu STATE OF FLORIDA . DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ` Gg CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 ABELEDA. OLIVER 0 CYPRESS CONSTRUCTION GROUP LLC 5681 CYPRESS ROAD PLANTATION FL 33317 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range ;_ STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque I DEPARTMENT'OF BUSINESS AND restaurants,and they keep Florida's economy strong. PROFESSIONAL REGULATION t 1 PCC056770 ;.�~ { Every day we work to improve the way we do business in order ISSUED:- 0$/10/2016 to serve you better. For information about our services,please log onto www.myfloridalicense.com. There you can find more f CERT POLLUTANT STORAGE.SYS CONTR information about our divisions and the regulations that impact I ABELEDA,OLIVER 0 -' you, subscribe to department newsletters and learn more about the Department's initiatives. r CYPRESS CONSTRUCTION GROUP-LLC Our mission at the Department is: License Efficiently, Regulate ' r Fairly.We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, ` .IS CERTIFIED under the provistons of Ch.489 FS and congratulations on your new license! 4 Explranon date AUG 31 2018- L1608100001929 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION t CONSTRUCTION INDUSTRY LICENSING BOARD yo4 The POLLUTANT-STORAGE SYSTEMS CONTRACTOR- Named below IS CERTIFIED '' %t'✓ con w✓ Unde"r the provisions'of Chapter 489 FS. Expiration date:—AUG 31, 2018 , r' ` »*A6ELE15ArOEIVER O �' <s ,(CYPRESS-CONSTRUCTidN GROUP LLC _ r :120 E OAKLAND`PARK SUITE 105, - .FORT LAUDERDALE FL 33334 Mail ccucn. not°n,nn.r_ mtnni nv -------- AC�® DATE(MM/DD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 1/24/2017 THIS CERTIFICATE IS ISSUED AS A 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(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)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 lieu of such endorsement(s). PRODUCER CONTACT C NAME: OIDmerClal Service Brightway Insurance PHONE (855)841-3135 1 AIC No: (904)322-5928 P.O. Box 5700E-MAIL y' m ADDRESS:comm ercial@brig htwa co INSURERS AFFORDING COVERAGE NAIC# Jacksonville FL 32247 INSURERA:Colony Insurance Company 42846 INSURED INSURER B:PTO ressive Express Ins. CO. 10193 Cypress Construction Group LLC INSURERC:Torus National Insurance Company 120 E. Oakland Park Blvd. ,#105 INSURER DHamllton Specialty Ins Co INSURER E: Oakland Park FL 33334-1106 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1671825967 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. ILTR TYPE OF INSURANCE ADDL B POLICY NUMBER POLICY EFF MM/DDS LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ 103GL000096603 09/23/2016 9/23/2017 MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JE� � F—] LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OS X SCHEDULED 03214011-2 7/15/2016 7/15/2017 BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE X HIRED AUTOS X NON-OWNED $ AUTOS (Per. Per accident PIP-Basic $ 10,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 C EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED RETENTION$ 8150IJ162ALI 7/15/2016 7/15/2017 $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E:C DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Pollution Liability AHSECC10354-00 5/8/2016 5/8/2017 Aggregate $1,000,000 Per Occurrence $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) 1 >i'ng-Gas-Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Bldg Dept THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Pedro Fred/ELALOC ~—� - ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025rgmami ACbREY CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1/23/2017 THIS CERTIFICATE IS ISSUED AS A 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(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or 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 lieu of such endorsement(s). CNTACT PRODUCER SUNZ Insurance Solutions, LLC. ID: (Impact) NAME:.. impact Staff Leasing C/o Impact Staff Leasing, LLC PHONE FAX 1315 W Indiantown Road Second Floor A/C No Ext: 561-743 0065 A/C No): 561-748-3235 E-MAIL Jupiter, FL 33458 ADDRESS: klm si naturestaffin inc.com INSURERS AFFORDING COVERAGE NAIC# INSURERA: SUNZ Insurance Company 34762 INSURED INSURER B: Impact Staff Leasing LLC. 1315 W. Indiantown ltd. Second Floor INSURER C: Jupiter FL 33458 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 33892335 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. INSR I ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMA E T CLAIMS-MADE El OCCUR RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICY PRO- JECT F] LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident) $ AUTOS ONLY AUTOS ( HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident *DED RELLA LIAB OCCUR EACH OCCURRENCE $ ESS LIAB CLAIMS-MADE AGGREGATE $ RETENTION$ $ A WORKERS COMPENSATION WCPE0000004607 8/15/2016 8/15/2017 � STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Coverage provided for all leased employees but not subcontractors of:Cypress Construction Group LLC Client Effective:4/18/2016 Plumbing Gas Contractor CERTIFICATE HOLDER CANCELLATION 1840 Miami Shores Village Bldg. Det SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami h r 2nd Avenue g p THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores FL nue ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE J ,r. Glen J Distefano ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 33892335 1 Master Certificate I Debbie Felton 1 1/23/2017 5:27:51 PM (ADT) I Page 1 of 1 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALIJD OCTOBER 1,2016 THROUGH SEPTEMBER 30,1017 DBA: Receipt#:189-233733 Business Name:CYPRESS CONSTRUCTION GROUP LLC ALL OTHER TYPES CONTRACTOR E [ Business Type: (CERT POLLUTANT STORAGE SY EM CONTRACTOR) Owner Name:OLIVER0 ABELEDA Business Opened:06/02/2010 Business Location: 120 E AKLAND PARK BLVD #105 State1Cbunty1Cert1Reg:PCC056770 PT LA ERDALE Exemption Code: Business Picone: 954-533-1195 I Rooms seats Employees Machines Professionals 1 For Vending eVstrteas Only , Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 3.00 0.00 0.00 0.b0 0.04 30.00 f F } THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS 1 THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations, l i Mailing Address: CYPRESS CONSTRUCTION GROUP LLC Receipt #02C-15-00000171. 5681 CYPRESS RD Paid 09/37/2016 3.00 PLANTATION, FL 33317 f