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RF-16-3456 Permit No. RF-12-16-3456 �sNo"Es r. Miami Shores Village M Permit Type:Roof 10050 N.E.2nd Avenue NE trII� Work Classification:The Miami Shores,FL 33138-0000 tires Permit Status:APPROVED Phone: (305)795-2204 fCORIDA Issue Date: 12/23/2016 Expiration: 06/21/2017 Project Address Parcel Number Applicant 716 NE 92 Street Number: BLDG M 113206044001 Miami Shores, FL 33138-0000 Block: Lot: SHORES PLAZA EAST CONDO Owner Information Address Phone Cell SHORES PLAZA EAST CONDO MIAMI SHORES FL 33138-0000 Contractor(s) Phone Cell Phone Valuation: $ 16,550.00 RODMAN ROOFING INC (305)264-3551 ....... _...__......_........,. .__ ....._ ..._..� Total Sq Feet: 2400 Type of Work:Re Roof Available Inspections: Additional Info:RE ROOF ENTIRE BUILDING COLOR THRU Inspection Type: Classification:Commercial Scanning:4 Up Lift Report Tin Cap Final Roof Tile In Progress Renailing Affidavit Review Roof Cap Sheet Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $10.20 DBPR Fee Invoice# RF-12-16-62454 $4.50 12/23/2016 Check#:3197 $348.20 $0.00 DCA Fee $4.50 Education Surcharge $3.40 Permit Fee-New Roof $300.00 Scanning Fee $12.00 Technology Fee $13.60 Total: $348.20 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and Mini mor ,I authorize the above-named contractor to do the work stated. December 23, 2016 Auth rizeii ign :Owner / Applicant / Contractor / Agent ate Buildi Department Copy December 23,2016 1 Miami Shores Village7EC T ; Building Department os 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 BUILDING Permit No. � I I�13Sg PERMIT APPLICATION Master Permit No.—kr- 1( 3qP54- (^ FBC 20 Permit Type (circle): Building (�Roofin Owner's Name(Fee Simple Titleholder) —TtNt s6vw P 6A�q 4."t Phone# 7 93 "S / 1S Owner's Address_ I gs n F n1 1 A City M 1 D-M 1 Sh-t,c o State Zip �, 1 Tenant/Lessee Name Phone# Email.. F I �!i`e CO— rA Job Address(where the work is being done) `� ,v L 2 S�,rf e+ City Miami Shores Village County Miami-Dade Zip FOLIO/PARCEL# Is Building Historically Designated YES NO Flood Zone Contractor's Company Name. !� A (An r),D f D _phone# Contractor's Address a 1 S 7 [ UJI-J to p City State -- Qualifier Name rn Phone# State Certificate or Registration No. (S'Q7— Certificate of Competency 1 No. f Contact Phone_�O l Z�,_ r E-mail R�xA mall rD6-Ct✓9 e `�d'(ttq Architect/Engineer's Name(if applicable) �JA Phone# �1A1'YIQ � L7�'ty�h��vrn+4 Value of Work For this Permit$_I OSD.DO Square/Linear Footage Of Work: CO Z4 / Type of Work: ❑Addition ❑Alteration []New ❑ Repair/Replace ❑Demolition Describe Work: V- yc bu.i,aInG - 1�3'0 Chanftj `ko byi�.Aj pt-,m A -To 1W10(Q, r )�-� ***************************************Fees******************************************** Submittal Fee$ Permit Fee$ CCF$ CO/CC Notary$ Training/Education Fee$ Technology Fee$ Scanning$ Radon$ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Due$ See Reverse side--> 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 ELECTRICAL WORK,PLUMBING, SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 Z3 The foregoing instrument was acknowledged before me this day of–JU C — 20 h(p,by CA,t day of 20&,by�qpr_ �„ U� who is personally known tome or who has produced P-1.-I/L who is personally known to me or who has produced ' ` As identification and who did take an oath. _ �� as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: r Sign: Print::a��X� Print: rS My Commission Expires: ----- -My Commission �1.PY y�. ��� +�'' JOFIN BOWERS JOHN BOWERS +: MY CO"11 SION M FF 004030 �} = MY COMMISSION li FF 004030 i' B nrgrY;hru+ c M i 2017 +:��i.p�;` FXP'uES:ApRI 1,2017 wary f ublic Underwriters l�p ;;•` Soodcd Thru Notary Pub tic Underwriters APPLICATION APPROVED BY (tLu!1 46- Plans Examiner Zoning Engineer Clerk checked (Revised 07/10/07) Miami Shores Village0 0 Department MAY 1 a 2016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax: (305)756.8972 BY' INSPECTION'S PHONE NUMBER:(305)762.4949 BUILDING Permit No../ PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: BUILDING L ROOMNG � OWNER:Name(Feer Slimple Titleholder):Sf 1 Orre S F'l�Z o, E a S Phone#: Address:_7'U Al p Z-�`'-e Q_T City:M 1 am'1 Shi)re"�) State: F L zip: 3 313 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: City: Miami Shores ' f County: Miami Dade Zip: Folio/Parcel#: 2 O`7 Is the Building Historically Designated:Yes NO Flood Zone: CONTRACTOR:Company Name: 4�odrncui 2oofincA , Inc. Phone#: 305.2� Address: /0 15 I 5Y-) 1 Z a C T: , Itt/0' ji / City: M /a rn State: l-L zip: 331 0 Qualifier Name:L7_6w Ro d m a rg Phone#: State Certification or Registration#: C (2 V,5/J / 0 Certificate of Competency#: Contact Phone#:� � S- A ' 3 S/ Email Address: /'O olIn a aroo '/%7 G,' o va h p .GUn'1 DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$��� V- ()D Square/Linear Foot e of Work: L �C S Type of Work: ❑Addition ❑Alteration DNew l epair/Rep ce ODemolition Description of Work: r—cC( Submittal Fee$ Permit Fee$—,-1()3' CC CCF$ 20 CO/CC$ Scanning Fee$ 2 ' 00 Radon Fee$q• a DBPR$ 9) Bond$SOO Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ 27 Structural Review$ _ TOTAL FEE NOW DUE$ 2�8 U �2-G Bonding Compatiy's Name(if applicable) PM 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 ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 - Y Signature Owner or Agent J Contractor y The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this-1 day of q AM 20.j-,by�Aq� —S tlL day of 20 j�Q,by ►U '-ti.�VMla��, who is ersonally known me or who has produced w is personally kn�own a or who has produced As identification and who did take an oath. as to and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sig Print: Print: BRANDI WARD � My Commission Expires: ?;'1° i '�'' ;: MY COMMISSION#FF 004030 .:_ MY COMMISSION t FF 171733 My Commission Expires: ,: ' . EXPIRES:January 5,2019 EXPIRES:April A? `%''' d•' Bon2017 ded Thru Notary Public Underwriters go Thru Notary Public undembfs 11111 APPROVED BY vt' Plans Examiner Zoning Structural Review Clerk (Revised 07/10/07)(Revised 06110/2009)(Revised 3/15/09) Commercial Reroofing Statement MIAMI-Q E Miami-Dade County HVHZ Electronic Roof Permit Form Commercial Reroofing Statement for Existing Buildings "Delivering Excellence Every Day" Contractor Name: Process Number: Job Address: The following applicable statements, for low slope roof systems only, are required to be completed when applying for commercial reroofing permit applications. Is there insulation in the existing roof system? Yes ❑ No M/ If yes, then I attest that the insulation to be installed in the proposed roofing system shall have the same thickness and R-Value as the existing insulation. Note: Structures built after March 15, 1979 must comply with the Florida En erCode-- Architect ode. ❑ Archit ct ❑ P.E. Contractor License Number:e CCCUS__S_ Signature: (required) L No Change I attest that the proposed roofing system is an exact replacement of the existing roofing system. I also attest that existing overflow drains and/or scuppers are sized so that no more than 5" of water will accumulate on any portion ofnfing should the primary drainage system be blocked. 1616.3 FBC Architect ❑ P.E. Contractor License Number: 1QUC517iqa Signature: (required) ❑ Change to the roofing system Roofing permit applications in other than Group R-3 occupancy, involving a change in the roofing system and recovery applications must include signed and sealed calculations for the supporting structure, and a statement as follows. "I have reviewed the structural and drainage adequacy of the existing roof structure with regard to the proposed roofing system and hereby approve the installation as proposed." ❑ Architect ❑ P.E. License Number: Signature: (required) ,e+A1 , Florida Department of MIAM11­aaoe I FLOR A ' Environmental Protection Miami-Dade DERM Division of Air Resource Management Air Quality Management Division 701 N.W.1 st Court,2nd Floor NOTICE OMOLITION OR ASBESTOS RENOVATION Miami,Florida 33136 TYPE OF NOTICE(CHECK ONE ONLY): ORIGINAL ❑ REVISED ❑CANCELLATION ❑ COURTESY TYPE OF PROJECT(CHECK ONE ONLY): ❑ DEMOLITION ❑ RENOVATION 6 ROOFING IF DEMOLITION,IS IT AN ORDERED DEMOLITION? ❑YES NO IF RENOVATION: IS IT AN EMERGENCY RENOVATION OPERATION? ❑YES !!<CJ NO File# IS ITA PLANNED RENOVATIAC126 OPERATION�/? ElYES VNO Process# I. Facility Names Ore S CQ ST Address Ic S'W4e--e. '— city 1Gt M�1 b 5 State_L- Zip 3-3139 County Site Consultant Inspecting Site Building Size (Square Feet) #of Floors Building Age in Years Prior Use: ❑School/College/University Mesidence ❑Small Business Other Present Use: ❑School/College/University I Residence ❑Small Business Other 11. Facility Owner Phone( ) Address_ City S ` State FL zip -33,138r- _ III. Contractor's Name odma 1 Roc-)lr'i oo . I rl C Phone 65Z(oL1" 35 S ll Address D l� � ilDR City 1 t 1 I 1 Q m) State F_Zip '153)IRIC Is the contractor exempt from licensure under section 469.002(4),F.S.? ❑YES ❑ NO IV. Scheduled Dates: (Notice must be po tm rked 10 worki g d s before the project start date) Asbestos Removal(mm/dd/yy)Start:b 10 Finish: ib Demo/Renovation(mm/dd/yy)Start: Finish: V. Description of planned demolition or renovation work o be e"performed and methods to be employed, including demolition or renovation techniques to be used and description of affected facility components. Procedures to be Used(Check All That Apply): ❑ Strip and Removal I ❑ I Glove Bag I ❑ I Bulldozer ❑ Wrecking Ball E0 I Wet Method ❑ I Dry Method I ❑ I Explode ❑ I Burn Down OTHER: VI. Procedures for Unexpected RACM: VII. Asbestos Waste Transporter:Name Phone(� Address City State Zip Vill.WasQt �- mte Disposal Site: Name e,,t 4 �CI nd Address ��� City m!Q i State L Zip 7 IX. RACM or ACM:Procedure,including analytical methods,employed to detect the presence of RACM and Category I and II nonfriable ACM. Amount of RACM or ACM' square feet surfacing material square feet cementitious material linear feet pipe square feet resilient flooring cubic feet of RACM off facility components �square feet asphalt roofing Identify nd describe surfaci g material and other materials as appli abl AJa stns - 'eNs s !S G� Akishlr?6s onki I certify that the above information is correct and that an individual trained in the provisions of this regulation(40 CFR Part 61,Subpart M)will be on- site during the demolition or renovation and evidence that the required training has been accomplished by this person will be available for inspection during normal business hours. I have read and understood the additional information provided on the back of this form. 4ntName Ow O r or) ►7 - -26(4wne Operator) (Dat (Contact phone#) DERM USE ONLY Postmark/Date Received ID# 161_01-15810/10 DISTRIBUTION: White-DERM Yellow-Applicant Pink-Reserve Gold-Reserve DISCLAIMER ' This "NOTICE OF DEMOLITION OR ASBESTOS RENOVATION" is required pursuant to the provisions of 40 CFR 61 Subpart M and Rule 62-257.301, F.A.C. and must be submitted prior to any demolition or regulated asbestos abatement activity. This document is an Asbestos Notification only and is not a permit. This NOTICE OF DEMOLITION OR ASBESTOS RENOVATION does not constitute a waiver of or approval for any federal, state, county, or local permits that may be required for this facility. INSTRUCTIONS for COMPLETING NOTICE OF DEMOLITION OR ASBESTOS RENOVATION The state asbestos removal program requirements of s. 376.60, F.S., and the renovation or demolition notice requirements of the National Emission Standards for Hazardous Air Pollutants (NESHAP), 40 CFR Part 61, Subpart M, as embodied in Rule 62-257, F.A.C., are included on this form. Check to indicate whether this notice is an original, a revision, a cancellation, or a courtesy notice(i.e., not required by law). If the notice is a revision, please indicate which entries have been changed or added. Check to indicate whether the project is a demolition or a renovation. if you checked demolition, \vas it ordered by the State or a local government agency? If so, in addition to the information required on the form, the owner/operator must provide the name of the agency ordering the demolition, the title of the person acting on behalf of the agency, the authority for the agency to order the demolition, the date of the order, and the date ordered to begin. A copy of the order must also be attached to the notification. if you checked renovation, is it an emergency renovation operation? If so, in addition to the information required on the form, the owner/operator must provide the date and hour the emergency occurred, the description of the sudden, unexpected event, and an explanation of how the event caused unsafe conditions or would cause equipment damage or an unreasonable financial burden. If you checked renovation and it is a planned renovation operation, please note that the notice is effective for a period not to exceed a calendar year of January 1 through December 31. I. Complete the facility information. This section describes the facility where the renovation or demolition is scheduled.This address will be used by the Department inspector to locate the project site. Provide the name of the consultant or firm that conducted the asbestos site survey/inspection. For"prior use" check the appropriate box to indicate whether the prior use of the facility is that of a school, college, or university; residence, as "residential dwelling" is defined in Rule 62-257.200, F.A.C.; small business, as defined in s. 288.703(1), F.S.; or other. If"other" is checked, identify the use. Please follow the same instructions for "present use." 11. Complete the facility owner information. Ill. Complete the contractor information. IV. List separately the scheduled start and finish dates (month/day/year) for both the asbestos removal portion of the project and the renovation or demolition portion of the project. V. Describe and check the methods and procedures to be used for a planned demolition or renovation. Include a description of the affected facility components. (Note: The NESHAP for asbestos, which is adopted and incorporated by reference in Rule 62-204.800, F.A.C., requires obtaining Department approval prior to using a dry removal method in accordance with 40 CFR section 61.145(3)(c)(i).) VI. Describe the procedures to be used in the event unexpected RACM is found or previously nonfriable asbestos material becomes crumbled, pulverized, or reduced to powder after start of the project. VII. Complete the asbestos waste transporter information. Vill. Complete the waste disposal site information. IX. List the amount of RACM or ACM of each type of asbestos to be removed. (Note: A volume measurement of RACM off facility components is only permissible if the length or area could not be measured previously.) Identify and describe the listed surfacing material and other listed materials as applicable. 2015 FLORIDA NOT FOR PROFIT CORPORATION ANNUAL REPORT FILED DOCUMENT#726432 Apr 28, 2015 Entity Name: SHORES PLAZA EAST CONDOMINIUM, INC. Secretary of State CC6665113347 Current Principal Place of Business: 745 N.E.91ST ST MIAMI SHORES, FL 33138 Current Mailing Address: 745 N.E. 91ST ST MIAMI SHORES, FL 33138 FEI Number:59-0597536 Certificate of Status Desired: Yes Name and Address of Current Registered Agent: ZARAGOZA,OSCAR 745 NE 91ST ST MIAMI SHORES,FL 33138 US The above named entity submits this statement for the purpose of changing its registered office or registered agent,or both,in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Date Officer/Director Detail : Title PD Title VD Name GONZALEZ,ROBERT Name TALAVERA,CARLOS Address 9120 NE 8TH AVE,APT 4G Address 726 NE 92ND ST,APT 7L City-State-Zip: MIAMI SHORES FL 33138 City-State-Zip: MIAMI SHORES FL 33138 Title STD Title D Name ZARAGOZA,OSCAR Name DE ROJAS,JORGE Address 726 NE 92ND ST,APT 1 L Address 9140 NE 8TH AVE,APT 4H City-State-Zip: MIAMI SHORES FL 33138 City-State-Zip: MIAMI SHORES FL 33138 Title D Name ACOSTA,CECILIO Address 736 NE 92ND ST,APT 2K City-State-Zip: MIAMI SHORES FL 33138 1 hereby cerory that the information indicated on this report or supplemental reportis true and accurate and that my electronic signature shall have the same legal effect as ifmade under oath;that/am an offer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 617,Ronda Statutes and that my name appears above,or on an attachment with all other Ake empowered. SIGNATURE:OSCAR ZARAGOZA SCTYITREASURER 04/28/2015 Electronic Signature of Signing Officer/Director Detail Date � � f ,44 CONSU W FAMEERS, ZW,, A-1 CONSULTING ENGINEERS, INC ROOF STRUCTURES CONSULTING ----`� ON SITE CONCENTRATED UPLIFT LOAD TESTING ROOF TILE ROOF IN ACCORDANCE WITH METRO-DADE BUILDING CODE COMPLIANCE TAS No. 106 ; UPLIFT TEST EXPERTS SITE SPECIFIC INFORMATION Owner's Name: Permit#: Job Address: 7A,d N C 72 �— Roofing Contractor: /l a_bAl��*/ Type of Tile: 4Q ,770 yQ/✓����a�O Date installed: Approximate Roof Height: feet Roof Pitch: 3 1/Z Type e of Access to Roof: Scaffolds Ladder Other Approximate Square Footage of Roof: 90_ft 2 Required Testing Force:35 lbs. Testing Equipment: F.G.E. 100 Date Tested: 17 ST LOCATION UPLIFT PULL TEST ST LOCATION UPLIFT PULL TEST rFST LOCATIO UPLIFT PULL TEST TEST LOCATIOb UPLIFT PULL TEST rEST LOCATIO UPLIFT PULL TEST rEST LOCATION UPLIFT PULL TEST 1 26 51 76 101 126 2 27 52 77 102'- 127 3 28 53 78 103 128 4 29 54 79 1 104 129 5 30 55 80 1 105 130 6 31 1 '56 81 1 106 131 7 32 57 82 1 107 132 8 33 58 83 108 133 9 34 59 84 109 134 10 35 1 60 85 1 110 135 11 36 61 86 111 136 12 37 62 87 112 137 13 38 63 88 ' 113 138 14 39 1 64 89 114 139 15 40 65 90 115 140 16 41 66 A1 % 116 141 17 42 67 117 142 18 43 68 la118 143 19 44 69 119 144 20 45 70 145 21 46 71 S• 96 121 146 22 47 72 7 122 147 23 48 73LA 123 148 H2524 4 74 99 124 149 50 75 100 125 150 IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL PA 106,THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT QUALITY CON- TROL TEST. THIS TAS 10e AS BEEN PERFORMED IN FULL ACCORDANCE TO THE REQUIREMENTS OF DADE COUNTY, WITH NO DEVIATIONS. THIS REPORT SUBMIT Jose A.Martinez P.E. #031509 A-1 CONSULTI G , INC. Lab. erti' #07-0306.03 Renews:01-1224.05 4383 S.W. 70th Ct, Miami, Florida 33155 • Telephone(305)740-9550 - Fax (305)740-9550 ENGLISH: Cell (305) 609-6388 •SPANISH: Cell (3051 498-9804 A-1 CONSULTING ENT'GEVTEERS INC. ROOF STUCTL'RES CONSULTING LT'LIFT TEST Ems"ERTS L Vii$. CERTIFIC-4iTiOI'r;No.01-1224-5 4383 SW 70 CT, AILA II FL. 33155 TEL.305-74. 0-9550 F_ .305-740-9550 Owner's name: Permit#: RF-2016-3456 Job address: 716 NE 92 ST MIAMI SHORES FL Roofing contractor: RODMAN ROOFING INC T�Tpe of tile: DORAL BARCELONA TILE Date installed: 'kPprox mate roof height: 19 feet Roof Pitch: 3/1.2 Tipe of access to roof: Scaffold: Ladder: Other: _pprodmate square footage of roof: 24,00 ft2 Reqttired testing force: 35 lbs Date tested: 02/08/2017 Number of tests: 50 SKETCH OF ROOF 15 le, 13 12 1.1 1= „ 50 3: 5 3 a 1 ?5 24 c3 33 3 7 31 33, 37 35 35 3i ?E u3 L� 4 33 Reviced: ASH Date: 02/08/2017