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RF-17-365 (2) 3� Perrrm►t�: l�+ Ir-247-366-1 o � Per t+ TY Rif e>• .>„ y� Miami Shores Village 10050 N.E.2nd Avenue NE Work C/i�WCOVon Miami Shores,FL 33138-0000 y y Phone: (305)795 2204 Permttltus:APPRO, OR Issue Data �11�17 Expiration: /2017 : Project Address Parcel Number Applicant 275 NE 94 Street 1132060133830 JOSE AMADOR Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Coll JOSE AMADOR 275 NE 94 Street (305)484-6527 MIAMI SHORES FL 33138- 275 NE 94 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 19,661.00 AKG INSPECTION SERVICES INC (305)235-5511 Total Sq Feet: 2700 Type of Work:Re Roof Available Inspections: Additional Info:tiles+flat re-roof Inspection Type: Classification:Residential Up Lift Report Scanning:3 Tin Cap Final Roof Tile In Progress Roof in Progress Renailing Affidavit Review Roof Cap Sheet Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Contractors Bond $500.00 Invoice# RF-2-17-62922 CCF $12.00 02/13/2017 Credit Card $50.00 $800.00 DBPR Fee $4.50 DCA Fee $4.50 03/01/2017 Check#:24313 $800.00 $0.00 Education Surcharge $4.00 Bond#:3323 Permit Fee-New Roof $300.00 Scanning Fee $9.00 Technology Fee $16.00 Total: $850.00 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 rtify that all the fore information is accurate and that all work will be done in compliance with all applicable laws regulating construction and z in Futhermore,I thor' e e above-named contractor to do the work stated. March 01, 2017 Authorized Signature:Owner Applicant / Contractor / Agent Date Building Department Copy March 01,2017 1 Miami Shores Village LE 3 2017 �` Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 /�\ C✓- l Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 �U FBc 20 i BUILDING Master Permit NoV F 1-1 -3J.5 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC (ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL PLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP *' �.y,p CONTRACTOR DRAWINGS JOB ADDRESS: 27-6 WL JU 11j 2 p City: Miami Shores County Miami Dade Zip: 3 JO Folio/Parcel#: 3zD(o D 03 .3So Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Typ�e: Flood Zone: BFE:• FFE: OWNER:Name(Fee Simple Titleholder): Jo� �'f�"TyT A- Phone#: 30 2- i " Address: 7 S- )y I oly Sr City:_ 1a M I V'e S State: Zip: Tenant/Lessee Name: Phone#: Email: 11 CONTRACT^O :Company Name: �I K(o �, ®'A'" Sug-Mkc-) Phone#:36 235 ,5511 Address: 9 SK) 131 CDU 8 t® • AAIAMI Ft 33 City:_ F� State: ��- Zip: 331 Qualifier Name:V11 A- �(��/� Phone#: ,32Z 5 56 l State Certification or Registration M C&* Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:S 1 G I Square/Unear Footage of Work: 2� Type of Work: ❑ Ad ttion ❑ Alteration ❑ New Repair/Replace . El Demolition Description of Work:TIE' 4- I l Perao f 7rde . Cr"W„, " ,kava- Le It e. " -Few•=, C®-�F�. Specify color of color thrill tile: 'eta, C v 7 Submittal Fee$�.?o it'd _Permit Fee$ SO rO CCF$ 1 Z CO/CC$ —� Scanning Fee$ l Radon Fee$ DBPR$ Vii'• s� Notary$ Technology Fee$ t(O Training/Education Fee$ y Double Fee$ Structural Reviews$ _ Bond$ TOTAL FEE NOW DUE$ 3C�O (Revised92/2412014) 600 !J 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. 1 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 budding 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 ftlivered to the pe whose property is subject to attachment. Also,a certified copy of the recorded notic of commence nt must a posted at the job ite for the first inspection which occurs seven (7) days after the building permit is i sued. In the a ence of uch posted notice, he inspection will not be approved and a reinspection fee will be charged. Signature I Signature / 0 ER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoin instru ent was acknowledged before me this I�dayof Joh> -Nr4 .20 by Vday� �09(N 20by _S who i ersonally kno to _�Zl 1-I2re►-c�l4'L,who' ersonally known 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: y DAISi':1, :AMETTI c..` — Sign: Sign: „ro• AI„ !" �/aPl[T'il nr FTCpi l lurida ,o –ry nliC �brid3 Print: r,id Print: 2� - .^ I Seai: Jnr. rr ',i IVa Il t`fl IJMZ� x.550. Seal: r u Y - -�-- � � -- --_ y Jrnue.. OuYx1P,d 7�1rJ n.Yh YV rl^ 4 APPROVED BYy Plans Examiner Zoning 1 -94. Structural Review Clerk (Revised02/24/2014) OFFICE OF THE PROPERTY APPRAISER Summary Report Generated On:2/10/2017 Property Information y ` 11-3206.0133830 �w,a Folio: ` n Properly Address: 275 NE 94 ST ` Miami Shores,FL 33138-2829 JOSE MOYA AMADOR 7 Owner TIFFANY N SOSA 275 NE 94 ST Mailing Address MIAMI SHORES,FL 33138 USA Primary Zone 1000 SGL FAMILY-2101-2300 SQ 0101 RESIDENTIAL-SINGLE Primary Land Use FAMILY:1 UNIT ' Beds/Baths l Half 312/0 Floors 1 ° Living Units 1 e Actual Area 2,554 Sq.Ft Living Area 2,027 Sq.Ft Adjusted Area 2,245 S%Ft Taxable Value Information Lot Size 9,675 Sq.Ft 2016 20152014 Year Built 1951 County Exemption Value $50,000 $50,000 $50,000 Assessment Information Taxable Value $95,884 $94,870 $93,721 Year 20162015 2014 School Board Land Value $241,547 $232,460 $202,930 ExempfiDn Valu® $25,000 $25,0D0 $25,000 Building Value $156,252 $156,252 $152,211 Taxable Value L $120,8841 $119,8701 $118,721 XF Value $2,106 $1,848 $1,873 city Market Value $399,905 $39o,560 $357,014 Exemption Value $50,000 $50,000 $50,000 Assessed Value $144,870 $143,721 Taxable Value $95,884 $94,870 $93,721 Regional Benefits Information $50,0WExemption Value $50,00 $50,0W, BenefitType 2016 2015 2014 Taxab�Value $95,884 $94,870 $93,721 Save Our Homes Assessment $254,021 $245,690$213,293 Cap Reduction Sales Information Homestead Exemption $25,000 $25,000 $25,000 Previous Sale Price OR Book-Page Qualification Description Second Homestead Exemption $25.000 $25,000 $25,000 01/3012017 $550,000 30403-3250 Qual by exam of deed Note:Not all benefits are applicable to all Taxable Values(Le.County,Scholl 04/01/1976 $65.000 04600 00000 Sales winch are qualified Board,City,Regional). 06/01/1974 $60,000 00000-00000 Sales which are quad Short Legal Description MIAMI SHORES SEC 1 AMD PB 10-70 LOT 22&W112 LOT 23 BLK 28 LOT SIZE SITE VALUE OR 9302 799 The Office of the Property Appraiser is continually editing and updating the tax roll.This websde may not reflect the most current information on record.The Property Appraiser and Miami-Dade County assurnes no liability,see full dimer and User Agreement at httpJ/www.miamidede.gov&fo/diwahmr.asp version: TE AE`! CERTIFICATE OF LIABILITY INSURANCE °A 1/0420/7 ' 01/04/2017 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 CON NONE: Melissa Iglesias AX E&S INSURANCE GROUP PNC No Ext): 786-899-4399 FIC No): 786-899-4409 13701 SW 88TH ST E-MAIL s: miglesias@esinsurancegroup.com RIE SUITE 303-1 INSURER(S)AFFORDING COVERAGE NAIC 0 MIAMI FL 33186-1309 INSURERA: SENECA SPECIALTY INSURANCE COMPANY INSURED INSURER B: BURLINGTON INSURANCE COMPANY AKG INSPECTION SERVICES INSURER C: 14376 SW 139TH COURT INSURER D: BAY 10 INSURER E: MIAMI FL 33186-5503 INSURERF: COVERAGES CERTIFICATE NUMBER: 2015-2016 REVISION NUMBER:01 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 INSD W VD POLICY NUMBER MMIDD EFF POLICY EXP LIMITS COMMERCIAL GENERAL LL481U TY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ®OCCUR PREMISES Eaoccurrence $ 100,D00 MED EXP(Any one person) $ 5,000 A Y BAG-1042526 12/04/2016 12/04/2017 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑PRO- F—]LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER. DEDUCTIBLE s 2,500 AUTOMOBILE LIABWTYEe ad $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS ON-OWNED PROPERTY DAMAGE $ HIRED AUTOS I AUTOS Per aeddent $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ OED I I RETENTION$ $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'IJABILRY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICEWMEMBER EXCLUDED? El (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ H es,des�e under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ GENERAL LIABILITY GENERAL AGGREGATE:$300,000 B (INSPECTIONS/APPRAISALS) 535BO22662 03/08/2016 03/08/2017 EACH OCCURRENCE: $300,000 DEDUCTIBLE: $0 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more apace Is required) GENERAL LIABILITY FOR ROOFING REPAIRS/ROOF REPLACEMENT COMMERICAL&RESIDENTIAL HOME INSPECTIONS INCLUDING WDO INSPECTIONS&ROOF REPAIRS/ROOF REPLACEMENT/ROOFER-CCC042809/ROOFING CONTRACTOR INSURER(A)GENERAL LIABILITY FOR ROOFING REPAIRS/ROOF REPLACEMENT COMMERCIAL&RESIDENTIAL INSURER(C)GENERAL LIABILITY FOR INSPECTION/APPRAISAL:PRODS&COMP OPS$300,000,PERSONAL&ADVERTISING INJURY:$300,000; FIRE DAMAGE:$100,000;MEDICAL PAYMENTS:$5,000 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES BUILDING&ZONING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES FL 33138 AUTHORIZED REPRESENTATIVE © 8-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD i O � . .iIM if Ei - Qu y ■ ■ ■ ■ 1 is r �1 f\<•ist•trllit•7llfit•�Itfon • I■stinctitYt t•7 astV<111q�t•��At•i<ti�0���a N*.M11F!1 !fr;!RISIN�1• I�NASTI�R-RK/1T•�tlAti�NR!•� ��Ns��/�rls�t•�iiAM/rr /si�11����TtAl�w ■%���r�k�I r,A,a• rf#<iMiililFf■iA//■tllsrf�s�s/tr It�anra�f::IMuK islr�tttyt�tr.•■1•�Irt�lRtt�lY>�i�r•(���J CJ rssss>ssRsssssts■ ■�i<1F!•.:l:iii/1I�AIRotitl�AttAt•lirYltAtlATr�tlrttE•�:/7�f7Ytllt<aP-R Ito, rislst!■ tt1■iust!■■u■irtt<NT•��ll■s�russ/■iURNMi X01:00 `aEs>tr��/ri,S::T•t•i 'i� i ■■■oMANNERISM srrs■ sit■\F�-i��//1w�Tt��t��r13.1iM1s17f�t/GtM 1�s�<•��t�i)•t•�it1iM/st173 � 0AA�k�N��f<t�lffMa.rp�rsrM�#i•%sVilrrl�lMttilf )lliAfM;1As'�MMiI�1it�t•r/\��i�l� _ ■t■ ■�Rfi■su�urirflsMENNENs�u■ uu■■\tfftlt•1r11IM ■0,■ u■ 1TIC11 iusi9�•U571{ _„ •uuR♦�s�Util�tislris�Mr�iir<•�Ttl(itt•Cr/�t•M1t11tt11<1s ��1is����1 f .►/�llili�litA111ra■ rrs�rr�si�ilsilSJ/'l1amuclo 9! 01,00 ■rr�'1MSt/a aVlfltfAAt•l. rft•1�1■�il'itl►7t•ys1,11•t•i'f..,1rITY17J�t<tif<sfi�1�ATIt7111►Mtiri•fAA]�Ifrsoilftfif1111!1M,iit�IL ' •s� ■fFK ■i■tiiZrlili■■!■MV/ �1t•.s■If��sRAEsiIR■lis��'ii�1U•iJ/lYl[t>�//� lr JCf6�� rirlt•MR��NUNN tt•ifs■■■�istllrrutt�AtirMl1�s11'IffMRsi�■C�s■I[A�1��M(RARRi.iAlrlsi■■ui ��a R■ ■/fsAirtf tiff■a,s■ ■u■��/■ s<tr!■!■f�Allt•is�<I'[t���lq�iis�i�r�s1<�L7L7 A.IiS�Ai •Ass■■■ <•ps�=uiirutlrrt..ft•■�r1sa!!I�IrI�r�IRfAKIr!'lTrtR�siriTlcirc;■t1f1�s��YtRs�rt���x�f>t/■ 1111ss■C■:1111�<n�A�11<i�mwas Aii�Grrrrfr�r►�\�<Ntilftl�i�%�iiMrlrlr���MaDix■M1■ 1�:CM111M�111i1111111:w1si111:1111�111111�:'yy1111x:1!:11111:1%lx��iiiA� u mom u u ■■ul1/■s1�1■�Irti111flrAsifr,rllrt•�l/11>M`I�rtli•�1N�Ixiirrlrl�Asu`1n1'ti■ ti■ l11■1111M:R<t<t��R1,ionowsommons itt� ill lL•�y ailtt�ti/�t� MwM�IPf1Y4l� j■r� r■iruMl��rtis■■Illllsl i;'irt�s�ISM11�rt lrt1s�111MU ■srlr(■■■�s■lf/s'/uf r�itt t•�ittttlNt•t<>ttww,gm�ttt•■ l■'1`.;rC ' `2:1MANNin G.�:1111111a"■ 9 ,•,rel: • FS "Delivering Excellence Every Day" flEIIA VH DAIDE COUNTY REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS It is the responsibility of the roofing contractor to provide the owner with the required roofing permit, and to explain to the owner the content of this form. The owner's initials in the designated space indicates that the item has been explained. (T1.Aesthetics-workmanship: The workmanship provisions of Chapter 15 (High Velocity Hurricane Zoe) e forthe purpose of providing that the roofing system meets the wind resistance and water intrusion nce standards. Aesthetics(appearance)are not a consideration with respect to workmanship provisions. Aesthetic issues such as color or architectural appearance,that are not part of a zoning code, should be addressed part of the agreement between the owner and the contractor. 2.Renailing wood decks: When replacing roofing,the existing wood roof deck may have to be ed in accordance with the current provisions of Chapter 16(High Velocity Hurricane Zones)of the Florida Building Code. (The roof deck is usually concealed prior to removing the existing roof system). 3. Common roofs: Common roofs are those which have no visible delineation between neighboring (i.e. townhouses,condominiums,etc.). In buildings with common roofs,the roofing contractor and/or wner should notify the occupants of adjacent units of roofing work to be performed. 4.Exposed ceilings: Exposed, open beam ceilings are where the underside of the roof decking can be �ie ed from below. The owner may wish to maintain the architectural appearance;therefore, roofing nail penetrations of the underside of the decking may not be acceptable. The owner provides the option of maintaining this appearance. 5.Ponding water: The current roof system and/or deck of the building may not drain we]]Afd tray au a water to and accumulate in low-lying areas of the roof. Pondin can be an indicm ' f ••••I 966::6 P (accumulate) � 3'i g g tt� p ��� distress and may require the review of a professional structural engineer. Ponding may sheer the life '0 *000:0 expectancy and performance of the new roofing system. Ponding conditions may not be eMt;dit until the original.... 0000 ofing system is removed. Ponding conditions should be corrected. •••••• 0000 . 0000. 6. Overflow scuppers(wall outlets): It is required that rainwater flow off so that tK roof is not •0••• . .. 00 00 0.00:0 e loaded from a build up of water. Perimeter/edge walls or other roof extensions may bleak this discharge if overflow scuppers (wall outlets)are not provided. It maybe necessary to install overflow Scuppers in#g01dance•9e:9 �ith the requirements of Chapter 15 and 16 herein and the Florida Building Code,Plumbs, •• 0 :-000: 7. Ventilation: Most roof structures should have some ability to vent natural airflow through the" of 'or of the structural assembly(the building itself). The existing amount of attic ventilation shall not be ced. iwner's/Agent's Signature: ontractor's Signature: it Number: roperty Address: Z i Florida Building Code 5th Edition(2014) High-Velocity Hurricane Zone Uniform Permit Application Form S202D C (Love Siad Roof System FM In SpqcMc Roof Assembly C"Aponetrts Fashmw Spacing for And rBase Sheet and tdendiy Mangy Aunt (ifa component Is not used Idetf►as'M") GAF Fier 9'°ate hep°#Ria?g9 °c 13-1022 . 15 Parim6 ma 6 eter -oc@ Lap,#Ron 0 6 -0c ?"No: Corner 6-oc O Lap,#Rwws 6 6 Design Wind Fm m RAS 128 of COWWO11Om: 42.8 71.7 100.$ Nundasr of F Per insulatlon Pmaoc1: Pnrea2: P d [Mex.Design pressure,Frorn the Spacit NOA 5 2 . 5 Fleld Perimeter Comer Dant Wood Illustrate Components Noted and Type: Details as Applicable: na WoodMorddrrg. Gutter Edge Termination, G Stripping, Flashing, ContbttVus Cleat. Cant 0.25 Strip, Base Flashing, Coiter- Flashing, Coping,Etc. �Sheet&Na.Of�S): n.a h0mak: (Mean Roof Height, Parapet 1481ght, Height of Base Flashing, Component Material. Ani Shad Fastened8onding Materisk Material Thidawss, Fastener Type, Fastener Spacing or Submit Manufacktrers Details that kwAadw Base L&W n a Comply with RAS 111 and Chapter 16. Sam Inaulatlon Size anti Tt*d(raws: pl� awe Insulation Fastermfiloncling Matedak Sc7 Top fradstion layer na a�V, Fr. 0 Top RwAsIlon size and Tt Pur�et Top kwia6an Faslenerfilordrig Materlek ( Helsiht ease Sheets)s M.ofply(er GAF #75 F. 13 Bese Sheet Fa tB�dieg MMflat roof n- l e Wood Mean • "'. GAFGlass2ix4� ��• 0.00•• Ply Sheets)8 No.of Piy(s) 'FleigM : . •. Ply Sheet F N • 96 0_tyae A hot asphalt _ ••••• • •i T� Mineral Surfaced capsheet1 9690' : ..:. ���•�' 00.00• . 00.00 Top Ply Fastener!Bonding Mated: • • • • • �ynQ 4 hot a�nhRlt •• •• •• 0000:0•••••• •..•.. • granulars 0 • 0 0 0*00 00 0 040 0 Florida Building Code 5th Edition(2014) High-Velocity Hurricane Zone Uniform Permit Application Form Section D (Steep Sloped Roof Sveteml Roof System Manufacturer: Crown Building Products Notice of Acceptance Numbe 14-0102.04 IMinirnum Design VVind Pressures,IT Applicable(Frorn RAS 127 or Calculations): P1. 39.1 P2, 68.1 PS, 100.7 Maxhnurn Design Presswe rom the NOA§Lnclft Mettlod of Me atlach2 Patty Adhesive set AH-160 Steep Sloped Roof Svstem Q2scr1Rjo Doric Type' wood >►�ung ASTM # 30 Root slope: nsuiation: 3 :12 NA Ire Mer. .... NA • . . .... ...... asbener T s spacing:F-C-@ Ridge Vette ny 1.25' r`�.s.roof nailslaps&aa s@ 12'7J.c*.. ..,.:. NA hsshre TypeASTM Type yp 4 Hot Phlik • • •• • Cap Meet: • ASTM 9011 .•..• '..'. ...... Mean Roof Heloht: 14 coming: Sanibel Cpncrete RootTile. so Type A SFie Drip • dge: IF26 ga Galvinized eavestl Florida Building Code 5th Edition(2014) High-Verity Hurricane Zone Uniform Permit Application Form SwWon E Mla Calculationsl For Moment based tale systema,a umm cow Method 1 or 2.Compared tw vaum forM,whh dievalues$roes Mt►If the Mtvdxn are grew than orequal to the Mr values,for emb area of the r94 thea the the dMament moibod is seesplahic 39.1 M�1"Moment Based M Cdeuldions Per RAS 127' 29.3 TO X) 0.313 s 12.23 l_�s 8.96 .� 3.3 NOA Mt (ps:68.1 z.% 0.313 21.3 )—MW 8.96 —MA 12.3 NOA Dt 29.3 (p';100.7 z i 0.313 31S )-Ms- 8.96 _-N6.22-r— NOA 14 29.3 Method 2"Sb4MM Th CttledatiOn Per Table Below" R"uhvd me mat of Robtence M)From Table Below NOA B* Mr Requlmd Moment Roolstant:s• mom PAN Roof 81opo 1F W 25' M' 4W a1z M4 312 SLY i *Mwt be wed in eoajummon with o not of momwt baled We systems endorfed by the Braword County Beard of Balm and Appeals. For Ups based t&systems an Metlied 3.Compared the values for F'with the vabtea for F..u the r values are gra ti"ar equal to the Fr values,for each arta-of the roof,then the do attveimient mdbod is aca"Ime. Method 3-UpUft Based Mh C019014tlBHa Per RAS 127' (pis _zh_-_: TzeosB: ___= Fr+:- NOAF 0000 0000.• teas—.zk-.--=_s ws=_ j-W:—zees8:—= FFs:— NO —r-•. • Whereto Obtain InformationDesafttlon 000000 • •• so**:* Symbol Where fa And 0.0 0 0• r :see*: •a . • • tkwmPlor arM or . .'. 7 ....L M= d H Job She • • Reo 0000. lob NO 10 • . .. OR .• 0066.. MMvWW NOA alarm m NOA • •• Raeb�a000 Mt NQA • • • • • 0000.• app ••• F NOA • . • •goes.• A b Dhoowdm la NOA ' A 6• w@w nt � MIAMI-DADE COUNTY M1AM PRODUCT CONTROL SECTION AW 11805 SW 26 Sheet,Room 208 DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES(RER) Miami,Florida 33175-2474 BOARD AND CODE ARM NISTRATION DIVISION T(786)315-2590 F(786)315-2599 NOTICE OF ACCEPTANCE (NOA) mww.pdamim Ad -gov/esoW= Crown Building Products of Florida,LLC. 6018 HWY.72 Arcadia,FL 34266 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 material 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 AM 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:Sanibel Concrete Roof Tile 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 has been 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 of change a tv ,+• •+ materials,use,and/or manufacture of the product or process. Misuse of this NOA as an endorsemea l oI any praducj, +• for sales,advertising or any other purposes shall automatically terminate this NOA.Failure to corm*with any:ecZioa� ••••:• 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•fo1lowed by the •••.. expiration date may be displayed in advertising literature. If any portion of the NOA is displayed,•t4p itshall Vd$n l *000* in its entirety. •+ •+ •• •• .•.•i• INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer dr its dNtributp"144 •••••• shall be available for inspection at the job site at the request of the Building Official. : .0. • :.Goo: This NOA consists of pages 1 through 6. The submitted documentation was reviewed by Juan E.Collao,R.A. NOA No.:14-0102.04 htUAA!•oA Co u Expiration Date: 02/13/19 • • Approval Date: 02/13/14 Page 1 of 6 ROOFING ASSEMBLY APPROVAL Category: Roofing Sub-Category: Roofing Tiles Material: Concrete Deck Type: Wood 1. SCOPE This approves a system using Sanibel Concrete Roof Tile, as manufactured by Crown Building Products of Florida, LLC., and described in Section 2 of this Notice of Acceptance. For locations where the pressure requirements,as determined by applicable Building Code does not exceed the design pressure values obtained by calculations in compliance with RAS 127 using the values listed in section 4 herein. The attachment calculations shall be done as a moment based system. 2. PRODUCT DESCRIPTION Manufactured by Test Product Applicant Dimensions Specifications Description Sanibel Concrete Roof L=17" TAS 112 High profile,interlocking,one-piece,'S'shaped Tile W= 13.25" concrete roof tile equipped with two nail holes. For H=3.1" direct deck or battened nail-on,mortar set or Thickness:0.56" adhesive set applications. Trim Pieces L=varies TAS 112 Accessory trim,concrete roof pieces for use at hips, W=varies rakes,ridges and valley terminations. varying thickness Manufactured for each file profile. 2.1. MANUFACTURING LOCATION 2.1.1.Arcadia,FL 2.2. EVIDENCE SUBMITTED Test Agency Test Identifier Test Name/Revort Rate,••• PRI Construction Materials ACTT 002-02-01 TAS-112 • . Sept.AD6..' ...... PRI Construction Materials ACTI-002-02-04 TAS-100 • Sept.2"(IOEi• • ••• • Redland Technologies 7161-03 Static Uplift Testing ....•Vec. 1991• 000000 Appendix III TAS 102&TAS 102(A) .'000o %00%;. ' Redland Technologies 7161-03 Wind Tunnel Testing •0 0 0"Dec. 1991 .: • Appendix Il TAS 108(Nail-On) . . . .. ...... Redland Technologies P0402 Withdrawal Resistance Testing o . .. Sept. 1 M . screw vs.smooth shank nails . Redland Technologies Letter Dated Aug. 1,1994 Wind Tunnel Testing ••Aug. *'"'0 TAS 108(Nail-On) • • •••••• Redland Technologies P0631-01 Wind Tunnel Testing •• :July 1994•G o • TAS 108(Mortar Set) Nutting Engineering 13343.1 Physical Properties June 2006 TAS 112 NOA No.:14-0102.04 M 1=COUN7Y Expiration Date: 02/13/19 Approval Date: 02(13/14 Page 2 of 6 Test Aaency Test Identifier Test Name/Report Date The Center for Applied 25-7688-3 Static Uplift Testing June 1996 Engineering,Inc. 25-7688-10 TAS 101(Adhesive Set) July 1996 TAS 101 (Mortar Set) The Center for Applied 25-7688-5 Static Uplift Testing June 1996 Engineering,Inc. TAS 102 (3"Headlap,Nails,Direct Deck,New Construction)F The Center for Applied 25-7688-4 Static Uplift Testing June 1996 Engineering,Inc. TAS 102 (4"Headlap,Nails,Clips) Celotex Corporation 520111-3 Static Uplift Testing Dec. 1998 Testing Services 520191-2-1 TAS 101 March 1999 Trynity/ERD Calculations Aerodynamic Multiplier&Restoring Sept.2006 Moment Due to Gravity American Test Lab of South RT1028.01-13 TAS 112 11/13/13 Florida American Test Lab of South RT1206.01-13 Aerodynamic Multiplier&Restoring 02/05/14 Florida Moment Due to Gravity 3. LIMITATIONS 3.1 Fire classification is not part of this acceptance. 3.2 For mortar or adhesive set file applications,a static field uplift test shall be performed in accordance with TAS 106. 3.3 Applicant shall retain the services of a Miami-Dade County Certified Laboratory to perform quarterly test in accordance with TAS 112, appendix `A'. Such testing shall be submitted to the Miami-Dade Product Control office for review. 3.4 Minimum underlayment shall be in compliance with the applicable Roofing Applications Standards listed section 4.1 herein. 3.5 30/90 hot mopped underlayment applications may be installed perpendicular to the roof slope unless stated otherwise by the underlayment material manufacturers published literature. 000000 3.6 This acceptance is for wood deck applications. Minimum deck requirements shall bf in cbinplianc$Wlih ••••;• applicable building code. 00 0 00 •. •. Me` .. .. .. 0000 .. 3.7 All products listed herein shall have a quality assurance audit in accordance with Honda Building Code and Rule 61 G20-3 of the Florida Administrative Code. 000000 0 :0000: 0000 . . . . • 0 ...... 0000 . .00.. 4. INSTALLATION 0000•• • • ••0••0 0 000 4.1 Crown Building Products of Florida, LLC.'s Sanibel Concrete Roof Tile and its t8ng5tnents shI11a; ••••;• installed in strict compliance with Roofing Application Standard RAS 118,RAS 119,�N MS 120. 0 00 4.2 Data For Attachment Calculations 0 0 :00 0:0 "0 0 0 • 0 • . 0 0 0.00.. I+10A No.:14-0102.04 ECouNIY Expiration Date: 02/13/19 Approval Date: 02/13/14 Page 3 of 6 Table 1: Average Weight(W)and Dimensions(I x w) rile Profile Weight-W(lbf) Length-1(ft) Width-w(ft) Sanibel Concrete Roof Tile 11.33 j 1.417 1.104 Table 2: dynamic Multipliers-.% ft rile I(ft) (ft) Profile Batten Application Direct Deck Application Sanibel Concrete Roof Tile 0.289 0.313 Table 3: RestoringMoments due to Gravity-M ft-Ib Tile 2":12 3":1 4":12" 5":12" 6":12" 7":12"or Profile greater Sanibel Battens Direct Batten Direct Battens Direct Battens Direct Battens Direct Battens Direct Concrete Roof Deck Deck Deck Deck' Deck Deck Tile 9.05 9.05 8.95 8.96 8.79 1 8.81 8.60 8.62 8.38 8.40 8.13 8.16 Table 4: AttachmehWaistance Expressed as a foment-N4(ft4bf) for Nail-On S stems Tile Fastener Type Direct Deck Direct Deck Battens Profile (min 15132" (min. 19/32" plywood) plywood) Sanibel Concrete 2-10d Ring Shank Nails 28.6 41.2 19.4 Roof Tile 1-10d Smooth or Screw Shank Nail 5.1 6.8 2.8 2-10d Smooth or Screw Shank Nails 6.9 9.2 7.3 1 A8 Screw 20.7 20.7 18.1 2 AQ Screws 43.2 43.2 29.8 1-10d Smooth or Screw Shank Nail 23.1 23.1 19.0 Field Clip) 1-10d Smooth or Screw Shank Nail 29.3 29.3 24.0 Eave Cli • 0000.. 2-10d Smooth or Screw Shank Nails 27.6 27.6. 3§,6 •• Field Clip) 2-10d Smooth or Screw Shank Nails 38.1 41.8 Eave Clip 000000 0000. aCrn 000 0 00000 for Two Patty Adhesive Set Systems ' ' 0000.. Tile Tile Application Mininwm Attachment, Profile Flesistance . . 0000:0 Sanibel Concrete Roof Tile Adhesive ; 2W •; 00 0 000 1 See manufacturer component approval for installation requirements. '• 2 The Dow Chemical Company TileBond Roof Tile Adhesive,average weight per patty 10.7 grams. 3MTm 2-Component Foam Roof Tile Adhesive AH-160,avers a Weight per pally 8 grams. NOA No.:14-0102.04 C Expiration Date: 02/13/19 i Approval Date: 02/13/14 Page 4 of 6 Table 6: Attachment Resistance Expressed as a Moment-Mf(ft4bf) for Single Patty Adhesive Set Systems Tile Tile Application Minimum Attachment Resistance Profile Sanibel Concrete Roof Tile 3M 2-Component Foam Roof Tile Adhesive AH-160 66.5 3M 2-Component Foam Roof Tile Adhesive AH-160 38.74 3 Large paddy placement of 63 grams of 3MTm 2-Component Foam Roof Tile Adhesive AH-160 4 Medium paddy placement of 24 grams of 3M'"'2-Component Foram Roof TIe Adhesive AH-160 Table 7:Attachment Resistance Expressed as a Moment-Mf(ft-lbf) for Mortar Set Systems Tile Tile Attachment Profile Application Resistance Sanibel Concrete Roof Tile Mortar Set 24.5 5 TNe-Tate Roof Tile Mortar. 5. LABELING All tiles shall bear the imprint or identifiable marking of the manufacturer's name or logo as seen below or following statement:"Miami-Dade County Product Control Approved". ZA EY 0000 LABEL FOR SANIBEL CONCRETE ROOF TILE 0• •• (LOCATED UNDERNEATH OF TILE) ••• : • • 6. BUILDING PERMIT REQUIREMENTS: ••• . • ••.• • 6.1 Application for building permit shall be accompanied by copies of the following: •..... :*so** • 6.1.1 This Notice of Acceptance. 0 8 0 0.. 0 0 **:ego 6.1.2 Any other documents required by Building Official or Applicable buikj}gg jVde in orier t oa •0 0 0.0 properly evaluate the installation of this system .0 0.•• . • . . •••.•• 0000.. • . • NOA No.:14-0102.04 ExpirationDate: 02!13!1 � Approval Date: 02!13/144 Page 5 of 6 PROFILE DRAWING FASTENER HOLES ® Q UNOERIM OCIl 17" 13 '114" SANIBEL CONCRETE ROOF TILE • END OF THIS ACCEPTANCE '•"" ...... . . ..... 00 .. .. .. .. ...... . . . . ...... NOA No.:14-0102.04 EGo Expiration Date: 02/13/19 • Approval Date: 02/13/14 Page 6 of 6 MIAMI-DADE COUNTY AM PRODUCT CONTROL SECTION e 11805 SW 26 Strcct,Room 208 DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES(RER) Miami,Florida 33175-2474 BOARD AND CODE ADMINISTRATION DIVISION T(796)315-2590 F(786)315-2599 _NOTICE OF ACCEPTANCE (NOA) www miamidade eav/economy ICP Adhesives and Sealants,Inc. 12505 NW 44" Street Coral Springs,FL.33065 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 {1n Miami Dade County)and/or the AHJ(in areas other than Miami Dade County)reserve the right to have this product or material 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:ICP Adhesives Polyset®AH-160 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 has been 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 produci far• sales,advertising or any other purposes shall automatically terminate this NOA.Failure to complywit%qty seAsw e1 ••••0• this NOA shall be cause for termination and removal of NOA. '• • •• • • 000000 • •• 0000•• ADVERTISEMENT: The NOA number preceded by the words Miami-Dade County,Florida, ffif&toliowed by tlae •••• expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, k shall bfdons. • • 0000 • 0000. in its entirety. • • 0000•• • • 0000• INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer oP 4(Distributor'!find• •••• • shall be available for inspection at the job site at the request of the Building Official. ••;• • '• Geese: 00.00• This NOA revises NOA 14-0805.01 and consists of pages 1 through 11. • • • 0• • • • .000• The submitted documentation was reviewed by Alex Tigera. •• • *60• 0 • • NOA No.:16-0315.01 MlAM4.1, 0 0 UAI7Y Expiration Date: 05/10/17 APPROVEDI Approval Date:04/07/16 Page 1 of 11 ROOFING COMPONENT APPROVAL: Category: Roofing Sub Category: Roof tile adhesive Materials: Polyurethane SCOPE: This approves ICP Adhesives Polyset®AH-160 as manufactured by ICP Adhesives and Sealants,Inc.as described in this Notice of Acceptance.For the locations where the design pressure requirements,as determined by applicable building code,do not exceed the design pressure values obtained by calculations in compliance with Roofing Application Standard RAS 127. For use with approved flat,low,and high profile roof tle systems using ICP Adhesives Polyset's AH-160. PRODUCTS MANUFACTURED BY APPLICANT: Produe Dimensions Test Product Description Speeifleations ICP Adhesives N/A TAS 101 Two component polyurethane foam adhesive Polyset'AH-160 ICP Adhesives Foam N/A Dispensing Equipment Dispenser RTF1000 ICP Adhesives ProPack' N/A Dispensing Equipment 30&100 PRODUCTS MANUFACTURED BY OTHERS: Any Miami-Dade County Product Control Accepted Roof Tile Assembly having a current NOA which list attachment resistance values with the use of ICP Adhesives Polyseta AH-160 roof tile adhesive. MANUFACTURING LOCATION: 1. Tomball,TX. 000000 Soo PHYSICAL PROPERTIES: " ' ;'0 '. '. 0000•• • 00 00.0.0 Property Test Results •*0000 • • • Density ASTM D 1622 1.6 lbs./ti..' 0000 ; 0000 • Compressive Strength ASTM D 1621 18 PSI Parallel to rise ' 0 000• 12 PSI Perpendicular to rise 0.0 0 9 9 . 9 • ; •' Tensile Strength ASTM D 1623 28 PSI Parallel to rise 00 0 •'• 0.0.: 909 9 9. Nater Absorption ASTM D 2127 0.08 Lbs./Ft' .••••. .' Moisture Vapor Transmission ASTM E 96 3.1 Perm/Inch • ••0000 Dimensional Stability ASTM D 2126 +0.07%Volume Change @-40"F.,2 weeks :""' 9 +6A%Volume Change @1580F.,1000 9 :"": weeks •• Closed Cell Content ASTM D 2856 86% Note: The physical properties listed above are presented as typical average values as determined by accepted ASTM test methods and are subject to normal manufacturing variation. NOA No.:16-0315.01 FpppE ply Expiration Date: 05/10/17 Approval Date:04/07/16 Page 2 of 11 EVIDENCE SuBmrrTED: Test Aeenev Test IdentlBer Test Name/Report Date Center for Applied Engineering #94-060 TAS 101 04/08/94 257818-IPA TAS 101 12/16/96 25-7438-3 SSTD 11-93 10/25/95 25-7438-4 25-7438-7 SSTD 11-93 11/02/95 25-7492 SSTD 11-93 12/12/95 Miles Laboratories NB-589-631 ASTM D 1623 02/01/94 Polymers Division Ramtech Laboratories,Inc. 9637-92 ASTM E 108 04/30/93 Southwest Research Institute 01-6743-011 ASTM E 108 11/16/94 01-6739-062b[1] ASTM E 84 01/16/95 Trinity Engineering 7050.02.96-1 TAS 114 03/14/96 P36700.04.12 ASTM D 1623 04/18/12 P39740.02.12 TAS 101 02/21/12 TAS 123 Celotex Corp.Testing Services 528454-2-1 TAS 101 10/23/98 528454-9-1 528454-10-1 520109-1 TAS 101 12/28/98 520109-2 520109-3 520109-6 520109-7 520191-1 TAS 101 03/02/99 520109-2-1 •0000• • •0•• 00.0.0 •• . .• • • LIMTTATIONS: ...... 0 '000 9060% 1. Fire classification is not part of this acceptance.Refer to the Prepared Roof Tile Assembly foci 644wing. 0 9999•. 2. ICP Adhesives PolyseO AH-160 shall solely be used with flat,low,&high tile profiles. .'•••. :606:9 • 9999 • 9999• 3. Minimum underlayment shall be in compliance with the Roofing Application Standard RAS X254• 0 . • 4. Roof Tile manufactures acquiring acceptance for the use of ICP Adhesives Polyset�'AH-160�eoftilc adhcsts Q .: 9999 0• with their tile assemblies shall test in accordance with TAS 101. :00:0: • • 5. All products listed herein shall have a quality assurance audit in accordance with the Florida Buildng Colic" 000000 Rule 61 G20-3 of the Florida Administrative Code. • 00. •••••• 00 NOA No.:16-0315.01 MWM EC Expiration Date: 05/10/17 Approval Date:04/07/16 Page 3 of 11 INSTALLATION: 1. ICP Adhesives Polysee AH-160 may be used with any roof tile assembly having a current NOA that lists attachment resistance values with the use of ICP Adhesives PolysetQe' AH-160. 2. ICP Adhesives Polyset`'AH-160 shall be applied in compliance with the Component Application section and the corresponding Placement Details noted herein. The roof tile assembly's adhesive attachment with the use of ICP Adhesives Polyset®AH-160 shall provide sufficient attachment resistance to meet or exceed the resistance value determined in compliance with Miami Dade County Roofing Application Standards RAS 127. The adhesive attachment data is noted in the roof file assembly NOA. 3. ICP Adhesives Polyse&AH-160 and its components shall be installed in accordance with Roofing Application Standard RAS 120,and ICP Adhesives and Sealants,Inc.'s Operating Instruction and Maintenance Booklet. 4. Installation must be by a Factory Trained'Qualified Applicator'approved and licensed by ICP Adhesives and Sealants,Inc.ICP Adhesives and Sealants,Inc.shall supply a list of approved applicators to the authority having jurisdiction. 5. Calibration of the ICP Adhesives Foam Dispenser RTF 1000 dispensing equipment is required before application of any adhesive. The mix ratio between the"A"component and the"B"component shall be maintained between 1.0-1.15(A): 1.0(B). 6. ICP Adhesives Polyset`'AH-160 shall be applied with ICP Adhesives Foam Dispenser RTF1000 or ICP Adhesives ProPace 30&100 dispensing equipment only. 7. ICP Adhesives Polyse0'AH-160 shall not be exposed permanently to sunlight. 8. Tiles must be adhered in freshly applied adhesive.Tile must be set within 1 to 2 minutes after ICP Adhesives Polyset"AH-160 has been dispensed. 9. ICP Adhesives Polyset'AH-160 placement and minimum patty weight shall be in accordance with the Placement Details'herein. Each generic tile profile requires the specific placement noted herein. . . ..•. ..••.. • • . • ...•.• • .. •••••• • •••••• .... • ...•• •..... • • 00.0• 0••••• • . . . . 00..•. 90 NOA No.:16-0315.01 t+MAht E Expiration Date: 05/10/17 Approval Date:04/07/16 Page 4 of 11 Table 1:Adhesive Placement For Each Generic Tile Profile Tile Profile Placement Detail Minimum Paddy Contact Minimum Paddy Gram Area Weight Eave Course-Flat,Low,High All Eave Course 17-23 sq.inches 45-65 Profiles Flat,Low,High Profiles Ej 17-23 sq.inches 45-65 Flat Profile 10-12 sq. inches 30 Low Profile 12-14 sq. inches 30 ro e 30 Flat,Low,High Profiles #3 Two Paddys: 8-9 sq.inches at 12 grams per paddy head of tile 9-11 sq.inches at overlap Two-Piece Barrel(Cap Tile) w tudinal 17 ti er edge)20-25 sq.inches each bead Two Piece Barrel(Pan Tile) Two Piece 65-70 sq.inches 34 grams under pan LABELING: All approved products listed herein shall he labeled and shall bear the imprint or identifiable marking of the manufacturer's name or logo and following statement:"Miami Dade County Product Control Approved"or the Miami- Dade County Product Control Seal as shown below. MWM CQUN7'X • t BUILDING PERMIT REQUIREMENTS: As required by the Building Official or applicable building code in order to properly evaluate the installation of this....• . . .... ...... system. • • • • •••••• • •• •••••• • •••• • ••••• • •••••• • • ••••• •• •• •• •• •••••• • • • • • •••••• NOA No.:16-0315.01 MIAM EC Expiration Date: 05/10/17 1APPROVED1 Approval Date:04/07/16 Page 5 of 11 ADHESIVE PLACEMENT DETAIL#3 , eco+ i 1. On the cave course only,apply a minimum 2 (50.8 ewa 4 mm)x 10"(254 mm)x 1"(25.4 mm)foam paddy � rsert onto the underlayment positioned as shown,under the strengthening rib for flat tile or under the pan portion of the tile for low or high profile tile closest to the overlock of the the being set.Leave approximately 4"(10 1.6 mm)up from the cave edge free of foam to prevent the expanded adhesive from blocking the weep holes. Insure approximately 17-23 int(109.7-148.4 cm2)of adhesive contact with the underside of the file 2. Apply a 4"(101.6 mm)x 4"(101.6 mm)x 1"(25.4 mm)foam paddy onto the underlayment just below FktRAWPTG eTBe the second course line positioned foam paddy under the strengthening rib for flat tile,or under the fW*Mq*VUMkOMW PaftVftftt& pan portion of the tile,closest to the underlock for ` the second course tile to be installed. Insure 4tiscs! approximately 8-9 int(51.6-58.1 cm2)of adhesive contact with the underside of the tile. ' rk (Instructions continued on next page) < : 0000 � • • 0000•• 0000•• •• • of • • 0000•• •000 ••••i• • 0000•• • • • 0000•• 0000 • • • • • • •000.0 0000 • 0000• • 0000•• • • 0000• •• •• •• •• 0000•• • 0000•• • • • • • • 0000•• 0000•• • • • • • • • 0000•• NOA No.:16-0315.01 Ml141M ECOUAITf Expiration Date: 05/10/17 Approval Date:04/07/16 Page 9 of 11 ADHESIVE PLACEMENT DETAIL#3(CONTINUED) 3. Also apply a 2"(50.8 mm)x 4"(101.6 mm)x3/4" mty, , (19 mm)paddy on top of the eave course file i surface as shown,on top of the strengthening rib for flat tile or on top of the pan portion of the tile, closest to the underlock of the first course of tile. Install second course of tile.Insure approximately 9(58.1 cm2)-11 (71cm2)square inch adhesive 14 ' contact with the underside of the tile at the overlap Shmp zz4kh ^ and 7(45.2 cm2)-9(58.1 cm2)square inch adhesive contact with the underside of the file at the head of the tile.Continue in same manner. EM Oil"dog.. "hpmfftTft . . . . .... ...... . . ...... . .. ...... .... . ..... 0 go . . .. .. .. .. .....• . . . . ...... NOA No.:16-0315.01 INAWMDMEC Expiration Date: 05/10/17 Approval Date:04/07/16 Page 10 of 11 MIAM MIAMI-DADE COUNTY 3 PRODUCT CONTROL SECTION 11805 SW 26 Street,Room 208 DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES(RER) Miami,Florida 33175-2474 BOARD AND CODE ADMINISTRATION DIVISION T(786)315-2590 F(786)31525-99 NOTICE OF ACCEPTANCE (NOA) ym1y miami4ade goeleconomv GAF 1361 Alps Road Wayne,NJ 07470 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 material 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 AHD 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: GAF Conventional Built-Up Roof Systems for Wood 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 has been filed and there has been n4 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 revisidif QCeltange iA •• •••••• the materials,use,and/or manufacture of the product or process.Misuse of this NOA as an endEMIlitrht of any • :0800: product,for sales,advertising or any other purposes shall automatically terminate this NOA.Failb?R%compl:r•..% • • with any section of this NOA shall be cause for termination and removal of NOA. 0000 . 00000 0000.. . . 0000. ADVERTISEMENT:The NOA number preceded by the words Miami-Dade County,Florida•andrfo owed.• by the expiration date may be displayed in advertising literature. if any portion of the NOA is$i%p1pYfd,then a •• it shall be done in its entirety. • • g•**•• 0000.. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or*iJ? ijtributars. . ;••••; and shall be available for inspection at the job site at the request of the Building Official. ••: This NOA renews and revises NOA No. 13-0424.09 and consists of pages 1 through 16. The submitted documentation was reviewed by Jorge L.Acebo. NOA No.:13-1022.15 Expiration Date: 11/04119 Approval Date: 11/06/14 Page I of 16 Membrane Type: BUR Deck Type 1: Wood,Non-insulated Deck Description: 19/32"or greater plywood or wood plank decks System Type E: Base sheet mechanically fastened. All General and System Limitations shall apply. Fire Barrier: FireOut Fire Barrier Coating,VersaShiele Fire Resistant Roof Deck Protection or (optional) SecurockT"Gypsum Fiber Roof Board. Base sheet: GAFGLAS'- 480 Ultima" Base Sheet,Stratavent'Eliminator'Nailable Venting Base Sheet,Ruberoie 20,Ruberoid®SBS Heal Weld Smooth or Ruberoie SBS Heat Weld' 25 base sheet mechanically fastened to deck as described below; Fastening Options: GAFGLAS"'Ply 4,GAFGLAS•'FlexPly 6,GAFGLAS"#75 Base Sheet or any of above base sheets attached to deck with approved annular ring shank nails and tin caps at a fastener spacing of 9"o.c.at the lap staggered and in two rows 12"o.c.in the field. (Maimum Design Pressure-45 psf.See General Limitation#7) GAFGLA5Ply 4,GAFGLAS"FlexPly""6,GAFGLAS"'#75 Base Sheet or any of above base sheets attached to deck with Drill-Tec- #12 Fastener or Drill-Tec"'414 and Drill- TecTa 3"Steel Plate,Drill-Tec-AccuTrac"Flat Plate or Drill-TecT'AccuTracJD Recessed Plate 12"o.c.in 3 rows. One row is in the 2"side lap. The other rows are equally spaced approximately 12"o.c.in the field of the sheet. GAFGLA5Flex Ply-6,GAFGLW 475 Base Sheet or any of above base sheets attached to deck with approved annular ring shank nails and tin caps at a fastener spacing of 9"O.C. at the 4"lap staggered and in two rows 9"o.c. in the field. (Ma)dmum Design Pressure 52.5 psf.See General Limitation#7) GAFGL S' #8 lima Base heel, u of - , u r p attached to deck with approved 1'/"annular ring shank nails and inverted 3"steel pla&aV&• **see* fastener spacing of 9"o.c.at the 4"lap and in two rows staggered with a i>�r spaaRg of• • 9"o.c.in the center of the membrane. 096:•0 • •• •••••• 0000.. (Maximum Design Pressure-60 psf.See General Limitation#7) •0000• 0000 GAFGLAS`o 475 Base Sheet or any of above base sheets attached to dee:with�l--x�0 0 0 ,:06 #12 Fastener or Drill-Tec"tl #14 Fastener and Drill-Tee TM 3"Steel P1atc,9Vs ll.Tec •. o 000..• AccuTracr'Flat Plate or Drill-Tec" AccuTrac"'Recessed Plate 12"o.cAm LrAs. Orfbow%0 0 0 0 0.. is in the 2"side lap. The other rows are equally spaced approximately 9'i e�+in the field of . . . . . the sheet. 0.0.0. 0000.. (Maximum Design Pressure--60 psf.See General Limitation#7) 0 • • • • • 0 0 0 .0..0 Any of above Base sheets attached to deck approved annular ring shank nails and 3" •.: inverted Drill-Tec""insulation plates at a fastener spacing of 9"o.c.at the 4"lap staggered in two rows 9"in the field. (Maximum Design Pressure-60 psf.See General Limitation#7) NOA No.:13-1022.15 NHANBEG�Irt1Y Expiration Date: 11/04/18 Approval Date: 11/06/14 PALO Page 14 of 16 Fastening Options: GAFGLASI 475 Base Sheet or any of above base sheets attached to deck with Drill-Tec' (Continued) 412 Fastener or Drill-Tec' #14 Fastener and Drill-Tec'`3"Steel Plate,Drill-Tec— AccuTrac"Flat Plate or Drill-Tec7 AccuTrac�Recessed.Plate 8"o.c.in 4 rows.One row is in the 2"side lap. The other rows are equally spaced approximately 9"o.c.in the field of e (M�rarnurrr esrgra Pressure— psf. ee General L' 'on ) Ply Sheet: One or more plies of GAFGLAS'*Ply 4 or GAFGLAS�#80 Ultima Base Sheet adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 Cap Sheet: (Optional) One ply of GAFGLAS®Mineral Surfaced Cap Sheet or GAFGLAS EnergyCap"BUR Mineral Surfaced Cap Sheet adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbs./sq. Surfacing: components must be applied according to manufacturer`s application instructions. All coatings must be listed within a current NOA. 1. Gravel or slag applied at 400 lbs./sq.and 300 lbs./sq.respectively in a flood coat of approved asphalt at 60 lbs./sq. 2. Topcoat"Surface Seal SB applied at lto 1.5 gal./sq. Maximum Design Pressure: See Fastening Options ..•.•• • .. ..••.• • 0.0.00 •••• 0 • • • • . 000.0. 000• • •000• 00.0•• 0 . 09.0• .• •. .. .• 0 0 0900 • • • ••99.9 000.0• • . • • 0 NOA No.:13-1022.15 tCin Expiration Date: 11/04/18 „ Approval Date: 11/06/14 Page 15 of 16 WOOD DECK SYSTEM LIMITATIONS: 1 A slip sheet is required with GAFGLASO Ply 4 and GAFGLW1 Flex Plym 6 when used as a mechanically fastened base or anchor sheet. 2. Minimum 1/"DensDeck7 Roof Board or 1/2"Type X gypsum board is acceptable to be installed directly over the wood deck. GENERAL LPIITATIONS: 1. 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 20-40 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 I T in each ribbon to allow cross ventilation. Asphalt application of either system shall be at a minimum rate of 12 lbsisq. 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 Ibf.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 Professional Engineer,Registered 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 comer areas shall comply with the enhanced uplift pressure requirements of thesegtjeas,Fasteipeir • •• densities shall he increased for both insulation and base sheet as calculated in compliance with AWJW Appljali oOVA •••• • Standard RAS 117.Calculations prepared,signed and sealed by a Florida registered Profession#6FQ11ipeer, • . • Registered Architect,or Registered Roof Consultant(When this limitation is specifically�®fawd within • • • this NOA,General Limitation#9 will not be appHeable.) •••• ••••• 8. All attachment and sizing of perimeter milers,metal profile,and/or hashing termination desig 0 0 0 ontbrna:0•. :: : 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:l e.Vld, • •• perimeters,and corners).Neither rational analysis,nor extrapolation shall be permitted for enhanced PestenitL%t•:• •••••• enhanced pressure zones(i.e.perimeters,extended corners and corners).(When this limitatio§is SpWificalty ;•••• referred within this NOA,General Limitation#7 will not be applicable.) •• • •••• : • • 10. All products listed herein shall have a quality assurance audit in accordance with the Florida Building Code and •• Rule 61 G20-3 of the Florida Administrative Code. END OF THIS ACCEPTANCE NOA No.:13-1022.15 Expiration Date: 11/04/18 [> E Approval Date: 11/06/14 Page 16 of 16 of 52 TGFL:R 306 P,0o in1,!SY$tctl s 3h@ LtSO 4nf gypsum tHIaTd Under any Of iti4(Qtfpwlhg Ct@Sx P1.$Or .-SpSt£tt is 4C041or O¢"/@F3�'ftY Qty'@fit t f;;r tN9J.•t 17Q.415i?-Qf'!,-HS..ffldntfittUtTS thlCk: gypsum board is mt scceptabte a ternate forgarlrimum irisUlatiwi aerer C-15 32 iit9de toot:dads; The use of,pgl!,wYrerle:iatssak'AtOn board 4i AVeOP-Minimum*-in,titkk oesiite.t:Qard and.Wk with rosin Pafae-(',�Yiteiamn pa rlpo)gsiYt€ 7t riitet.tS d.suitable ati—ate.itir.pskYf1'Yatectfate inoard tet lite YaSlaii t9 CtASs A-:3 Or t sYSiemS. �F,I rgyGvxd FLA r#r'"t rW E-ne`gyGuard FW Or^Ervr!T-Gttard Cnmposur:RW any be subztltuceii W a;rt.A9fAs pptY yanirrata In ufation ht mry Of the falltwtling c iti�i�ts TfklmbWti"Pelma MW maty,iiiiif2ert�vrth attq rrt Etre feilasvinti"AsRhaR Fein sy tias wtttr Not:ltoiafint#!35A t".. "GAFGt.As'a *so Preniforr,ease Sheet m4y he u%ed des M of the:lat1000g systema:. "CsAFotAS :F;%Ply Pa"anti"'9'wny fr mi-A-Fkxibft Pty-6:wre with a alternates to"G tF1sLAS.e:Pty b'. -GAMEMP iH+..rrttztltE,Retouer:t OMT RSO lye used in IisWU of a:Ty-pe[E:te tnsulatlon ti9 artptst ttteTttfiuwtnc3 NC Cla�'stAfeaitoiss. t Felt 5 4TT*with HOtt i Ttg Asphatt"In"hextutated wah"Fwtsmeld MO at 8a 3-c1a11'I0� UAi 'vtittrkviss fti}tku ateci.attY rk.ttte"ASph?t Y tt' "'RtairarWd.P.Aitlfi Smooth"Trey be used ns:an almmate to'RUIWO'ld*,T9t7p StrK�sttf"or"Rei�s4U`�;:fit} or'RStbe[oatn+tl HT' Ruimsitisi:a;fftop 5rneokh 7.5"rawy he tisett as an aifert?ate.to"Rutseralds.mop Sravooth, t ias�A H and C. roofip4'asfi6laRt,,for use with ort�antc W4 glassfells ar modifit.l trttulml memhre"es. tiot. . , 'CdatUtaolsl'<HE(at 4d 3(f SBS rrzofinV nretmbrarre may fib used in lieu of"f8afaezfttd••"(joV W''Afgdtc s_tn any aPFriiciilife Classifitat on. riaF#s A is 4Yack:C-ISM 8ttsitt)e:w EttsuFaLion.{Op;tottai)t Orie a.mase dyers partite ur a nod xtr orqla5s Rifer at poigls+RYaat;a7ate at ureti ar13 or.. poi'tEt3:/P#Sq{,44YCYdnUrastF,!-:txr711G>Sstt4to[6 llti)grethwwcumpositea,wood flb€opoymmYilnufate UAuCstA�».�Ftbybit o �tc.arty4fiickNnsS- PW sih Thiee tu.mors piles TY Gk or•CArGtns Ply Flg a^or-rst-i�iY. surtactrtg:--Gra�rt: .Dack:C-15132 in<idnen 2 irta+ttation(optional'tt One or mOie ia)e s Ae t®lis v+ooti fiber W�3tass fftw or R°1yanuia eueam OA atic;ainy tistcicness pe0tv/polyls?iYmurate compos to or periftel mtha e composge p mad tl�r/i�Y�Y_ Ply Shoot. ++reC a mara�3ues Type G1 Or"ta f LA5 AtGinersi Su 41%Ply APQ Cop SheeS� -Tri-Ply,°Kj tAtnereA urfeced Ca?Sheet"cr"GAfritA§'=<: Carp Shut;-Otte'piY E rergY "'- ukMlnered Swfai ed Cart Street." *Soso • • 0004 •00000 3.;lpeakn.FFC •• • •• • • V IYii�•0 0 00•• 0•00i• Insuiatla"copttoml):- or more laye[s Pelota tvnoddlher, ttass(IhpC,Ai;))Iw ycpatittsate, rrethane..;te titei0at isacyart r=irr,nuxnrntm. • rt>mposrte,pCrlftelurttt ana cnmit�,:u�ost fit v°rioG ffYattUrato EornRa9Et phen4f c> •••••• • • • Ptv shoat" IF"or ovie Afies TVfre Gi`CiAEC t Af>Y-PE)�."Tri-Ply r:PEy cf'or oAfGlAS? Ply fi", •••0•• 5 "T"-FiYf*tii""Surfaced bap$uew or GAG A 0 4 • • • • capsheat.-one-RlY-TYi-:Cis"C�AFGLAScFt�h4lrtEtt�tSttrfa6�2d.Gv�A. f'to�t •0000• C-ner yt aP"$UR Atinerat SOAKea Cap Sheet." • • ••••• • • 4.Rack:C•:MM? iitGhKa:.y • • • • •• •• •• •• 0000•• • Slipha®t(pprlo{tiaf): - ren fir;ttU1C o ro ifeclt. • -%MWBtitin--(optional):--Any thjcXness parllte Or tvaori iti'rM:ot'41ttT58 feh+:f.tt1'Pit}YiSAC`Yt�tt3![Afi tne�Cft7nhaltq t34'iQr: d-®e._ ;4r-Ec�SIP'L�t. •0 00.0 0• flP3G3t1G."OtY$and t'asteplaq System'or attp VI,Classified ftt�datirat ddhasive- 00000 f#as0 shout:^tkn3,R}Y CYT C "GAft�tRS;a r75 fuse Shit 4Y if iriyp 475 Bast_'Shea"(fnay be tralFsd); • • • • lOiy$tcs -Citxe or more pares:ipR.G 3."GAF+l dk5 ply 4 or"lit Ffya Pty:4 nr Cd)PGLAS?;FEY ti. d}i • •0 0.0• Cap131 e# -tlreQ ply Ty fm G3"GAF>�tAS t'flnefai.bur*ed City Sheer.or"Trk-P1Y:k Flttrefzt Si}rfated CaR Sheet 4r'+AF � i • •• • • • • • eoemyCaP"`Buff mineral Surfaced Cap Sno"t." •4 bMFlatlS fe at)i-"TOPCOAT�a toargvcotel-aptatfpit At agate of a-Waif tU©-f inhtmi:fiI :lLC E rsSRusselllD sl fits lRof3fin <TGFVJ A.1306-Roofing SystemsX111it os� CERTIFICATE OF LIABILITY INSURANCE 01JZ2017 Producer: Plymouth Insurance Agency This Certificate Is issued as a matter of Informathm only and confers no 2739 U.S. Highway 19 N. rights upon the Certificate Holder. This Certificate does not amend,extend Holiday, FL 34691 or alter the coverage afforded by the policies below. (727)938-5562 1 Insurers Affording Coverage NAIC# Insured: South East Personnel Leasing, Inc.&Subsidiaries Insurer A: Lion Insurance Company 11075 2739 U.S. Highway 19 N. Insurer s: Holiday, FL 34691 Insurer c: Insurer D: Insurer E: Coverages 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 carWicate 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.Aggregate limits shown rrey have been reduced by paid claims. INSR ADDL Policy Effective Policy Expiration Limits LTR INSRD Type of Insurance Policy Number Date Date (MM/DD/YY) (MM/DD/YY) GENERAL LIABILITY Each Occurrence S T mmercial General Liability Damage to rented premises(F11 Claims Made 11 Occur occurrence) Med F-V neral aggregate limit applies per: Personal Adv Injury General Aggregate Policy 0 Prefect 1:1Loc Products-Comp/Op Agg TOMOBILE LIABILITY Combined Single Limit Any Auto (EA Accident) Ali Owned Autos Bodily Injury Scheduled Autos (Per Person) Hired Autos Bodily Injury Non-Owned Autos (Per Accident) Property Damage (Per Accident) EXCESSIUMBRELLA LIABILITY Each Occurrence Occur ❑Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2017 01/01/2018 X I WC statu- OTH- Employers'Liability tDryUmfts ER Any proprietor/partner/executive officer/member E.L.Each Accident 511000,000 excluded? NO E.L.Disease-Ea Employee $1,000,000 If Yes,describe under special provisions below. E.L.Disease-Policy Limits $1,000,000 Other I Lion Insurance Company Is A.M.Best Company rated A-(Excellent). AMB#12616 Descriptions of Operations/LocationsNehicles/Exclusions added by Endorsement(Special Provisions: client ID: 24-65-198 Coverage only applies to active employee(s)of South East Personnel Leasing,Inc.&Subsidiaries that are leased to the following"Client Company": A.K.G.Inspection services,Inc. Coverage only applies to injuries incurred by South East Personnel Leasing,Inc.&Subsidiaries active employee(s),while worldng in:FL Coverage does not apply to statutory employee(s)or Independent contractor(s)of the Client Company or any other entity. A list of the active employee(s)leased to the Client Company can be obtained by faxing a request to(727)937-2138 or by calling(727)938-5562. Project Name: ISSUE 01/04/2017(AF) Benin Date 3131/2016 CERTFICATE HOLDER CANCELLATION MIAMI SHORES BUILDING& Should any of the above described policies be cancelled before the expiration date thereof,the Issuing ZONING DEPARTMENT insurer will endeavor to mail 30 days mitten notice to the certificate holder named to the left,but failure to 10050 NE 2ND AVE do so shall Impose no obligation or liability of any kind upon the insurer,its agents or representatives. MIAMI SHORES,FL 33138