RF-17-687 \ n
Miami Shores Village /f 7
� 10050 N.E.2nd Avenue NW
�+ � tftt7 # #3,
Miami Shores,FL 33138-0000 �
�o Phone: (305)795-2204 P `V
° Issue Date:31221201 . Expiration: 09/13/2017
Project Address Parcel Number Applicant
77 NW 99 Street 1131010180480
Miami Shores, FL 33150- Block: Lot: HERBY PEREIRA
Owner Information Address Phone Cell
HERBY PEREIRA 128 97 Street
BROOKLYN NY 11209-
Contractor(s) Phone Cell Phone Valuation: $ 8,000.00
ISAACS ROOFING&INSULATION COI (305)234-5234 (786)277-9756
Total Sq Feet: 2000
Type of Work:Re Roof Available Inspections:
Additional Info:RE-ROOF TILE Inspection Type:
Classification:Residential
Up Lift Report
Scanning:3 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 $4.80
Invoice# RF-3-17-63307
DBPR Fee $4.13 03/22/2017 Credit Card $255.06 $50.00
DCA Fee $4.13
Education Surcharge $1.60 03/15/2017 Credit Card $50.00 $0.00
Permit Fee-New Roof $275.00
Scanning Fee $9.00
Technology Fee $6.40
Total: $305.06
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 at all the foreggn information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. 1711erm re,I author' he above-named contractor to do the work stated.
March 22,2017
Authorized Signature: / Applicant / Contractor / Agent Date
;at
Building Depart Copy
March 22,2017 1
Miami Shores Village
Building Department
artment -
10050 N.E.2nd Avenue,Miami.Shores,Florida 33138 +.
Tel: (305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER: (305)762.4949
FRC. 201 Lt
BUILDING Permit No. F---1C- '1�
PERMIT APPLICATION Master Permit No.
Permit Type: BUILDING ROOFING
JOB ADDRESS: —1-1 N� v� 9 OL ST.
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): as q--L-) 1Z.,-4.P-A Phone#:
Address: 1 11� -l g i T
City: State: -:FL. Zip; 33/3 PS
Tenant/Ussee Name: Phone#:
Email:
CONTRACTOR:Company Name: Phone#:
Address: ID 22-5 5 .--h$1 Y9;S .1e At 4 At'yob
City: ()Ae A4L C t State: -4--L-. Zip:
Qualifier Name:_—ADA&I t-'N cc�,�, 2.t(n 7-- Phone#:
State Certification or Registration#: C-Cet 3 2.55!5, !�e Certificate of Competency#:
Contact Phone#: Email Address:
DESIGNER:Architect/Engineer: Phone#:
�
�0 �c�
Value of Work for this Permit:$ c G V SquarelLinear Footage of Work: [<
Type of Work: ❑Addition ❑Alteration ❑New ❑Repair/Replace ❑Demolition
Description of Work: --TTLZ
Color thru tile:
Submittal Fee$ Permit Fee$_0j—r=)'C)Z--) CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Eduducatiou Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$����
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
CONIlVIENCEIVIENT 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 b approved and a reinspection fee will be charged
Signature �� Signature
r
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this-la—
day
his4aday o / C : ,20&by A�Z b �P `��C day of 20 fig,,by 3�.LI
who is personally known to me or who has produced_,— who is personally own 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:
ANTJi MORM
No"PWft SWOof F WWB
Si FF 104628 Sign:
Print: My OWA Mar.11,2418
nARNAVAUUL
My Commission Expires: ���ed a My e`'' lifJSPublic-State of Florida
s•: Commission#FF 868141
My Comm.Expires Apr 30,2020
" Bonded through National Notary Assn.
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Florida International Engineering and Testing LLC
6175 NW 167 Street,Miami, FL 33015 , s G
Telephone: (305)378-1991-Fax: (305)378-1997
FLORIDA INTERNATIONAL ENGINEERING&
TESTING LAB,LLC Miami-Dade Lab Certification#07-0612.11-State of Florida Ca#27273`
---------------------------------------------------------------------------------------------------------------------
SITE SPECIFIC INFORMATION
Owner's Name: 1=4-_ _
Job Address: '��_ I�� 1�- tA I 'Pn�zlA_
Roofing Contractor: �I t� _
Permit Number: [� �' Type of Tile:
Approximate Roof Height: eet Slope: Approximate Square Footage: ftz
Type of Access to Roof: /Ladder
Other Required Testing Force: I
35lbbss. Testing Equipment: .G. . 100x Shim o Instrument
Date Installed: —9 '>F2 1 I��' Date of Inspection: �Ti 14
----------------------------------------------------------------------------------------------------------------------
TEST RESULTS
P=PASS,F=FAIL
Test Test Test Test Test
Location P or F Location P or F Location P or F Location P or F Location Por F
1 ✓C 21 41 61 81
2 22 42 t 62 82
3 23 43 63 83
4 24 44 64 84
5 25 45 65 85
6 26 46 66 86
7 27 47 67 87
8 28 48 68 88
9 29 49 69 89
10 30 50 70 90
11 31 51 71 91
12 32 52 72 92
13 33 53 73 93
14 34 54 74 94
15 35 55 75 1 95
16 36 56 76 96
17 37 57 77 97
18 38 58 78 98
19 39 59 79 99
20 40 60 80 100
------------------------------
IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL TAS 106,THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT QUALITY CONTROL TEST.
ADDITIONAL TEST INFORMATION
Perimeter Width: ft RESPECTFULLY SUBMITTED BY:
Area Units or ft2 No.of Tests
Perimeter '"-0 0
Field !0 D \ � � T)-"
Corners V I� J�
Hips&Ridges ^
Vinay:iga►•tib,Balaiirishnat_�'V
State o Fa.,exdj.'ic i.6311
r •
FLORIDA INTERNATIONAL ENGINEERING&TESTING LAB, LLC
Job Address: ' s .a11 5
h� 1J 9
Contractor:
Sketch of Roof (NTS)
AM
1
41
Notes
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