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RF-17-2120Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Pe mit Issue Date: 812212017 Permit NO. RF -8-17-2120 Permit Type: Roof Work Classification: Fiat Permit Status: APPROVED Expiration: 02/18/2018 Parcel Number Applicant 1100 NE 108 Street Miami Shores, FL 33161- 1122320280290 Block: Lot: WILLIAM HODGES Owner Information Address 1100 NE 108 Street MIAMI SHORES FL 33161-7300 Phone Cell Contractor(s) HOME CARE ENTERISES INC Phone (305)758-8899 Cell Phone Valuation: Total Sq Feet: $ 16,000.00 3500 Type of Work: Re Roof Additional Info: RE -ROOF FLAT ROOF CAPSHEET NO INSUL Classification: Residential Scanning: 4 Fees Due Bond Type - Contractors Bond CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - New Roof Scanning Fee Technology Fee Total: Amount $500.00 $9.60 $4.88 $4.88 $3.20 $325.00 $12.00 $12.80 $872.36 Pay Date Invoice # 08/22/2017 08/22/2017 Pay Type RF -8-17-64953 Check #: 4039 $ 822.36 $ 50.00 Check #: 4038 $ 50.00 $ 0.00 Amt Paid Amt Due Bond #: 3492, Available Inspections: Inspection Type: Tin Cap Final Roof Roof in Progress Renailing Affidavit Review Roof 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 AFFID construction and : I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating ing. Futhermore, I authorize the above-named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy August 22, 2017 Date August 22, 2017 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 RECEIVED AUG 22 2017 FBC 2014 BUILDING Master Permit No. iF X="1-1 -212 0 PERMIT APPLICATION Sub Permit No. ElBUILDING ❑ ELECTRIC I. ROOFING ❑ REVISION ❑ EXTENSION RENEWAL PLUMBING MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: (10 0 Ng /QS ah-ee4 City: Miami Shores County: Miami Dade Zip: 331(0 1 Folio/Parcel#: 11- 22.32 -02,s- - 029 0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): W '\\V rn 3r-cc�AcS Phone#(t) C1s7 - Z Li 9 y Address: 1 1 00 N E 10S - J S•IYee4 City: a rn i ShioYes State: FU Zip: 3 3 I (-0 Tenant/Lessee Name: Phone#: Email: b i 11 k oci eSre � yr1c 1 J .corn / co- ►-o q,5 -y P 401. corn CONTRACTOR: Company Name: 1-10 m e r e -krp r t5(S Phone#: (P 75.& b'Sii Address: (472- NAA/ 11 ff 5ke t -F City: Rlct MI State: Ft-• Zip: 'J` 31(0(9 Qualifier Name: 1. C1 U ICI Pip 0 r)4 -e Phone#:(30Z 75dr S ?9 State Certification or Registration #: Certificate of Competency #: CCC- 13a54.07/ DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ / in 00 0 Square/Linear Footage�of Work: 350 0 Type of Work: El Addition El Alteration ❑ New E Repair/Replace ❑ Demolition Description of Work: -roo•F 14cc+ root' ce?pshrcf no ir)Sulcl-hor) i r, Specify color of color thru tile: . , a u�.....: Submittal Fee $ ,CD. -(').7"- 4-D Permit Fee $ CCF $ CO/CC $ 7 Scanning Fee $ Radon Fee $ DBPR $ . Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) ,..0.0031/4., rock 2ponie. �i&cei 5b4 -72o3 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signatu /_ _ OW E'o GENT The foregoing instrument was . knowledged before me this The foregoing instrument was acknowledged before me this 01 day of P" = 20 l"1 , by Oq day of Au nusk , 20 f , by W1\\lcim ocktjeS , who is(fersonally known TciV LCI - j Orl-i-e , who isersonally knowri to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: Notary Public State of Florida Sandra L. Aponte My Commission GG 114594 Expires 06/15/2021 APPROVED BY (Revised02/24/2014) as me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: Plans Examiner Notary Public State of Florida Sandra L. Aponte �� Expires Commission GG 114594 oR„o Exres 0605/2021 Zoning Structural Review Clerk RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA - DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION - _CONSTRUCTION'INDUSTRY LICENSING BOARD LICENSE NUMBER -_ ". ` 4' 0001328671 _,.+; r - ` ' - i .` _ '* W ti . ti The.ROOFING CONTRACTOR:- -Narfied belo i IS`CERTIEIED ,Under•,the:proVisions of:Chapter 48 --E2piration date -AUG 31;,2018 -� 0;7 - T ,� W ,HOME•CARE ENT.ERPRI -4255513ISCAYNE:BLVD NORTH-MIAMf BEACT •2:FL.33181 - - N,, �`•'--''` J"� ,Aye -. ^:.. fitt �, �• - '� -•' i 1� ISSUED: 07/31/2016 DISPLAY AS REQUIRED BY LAW SEQ # L1607310002869 Local Busi ness Tax Recei pt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 4051918 BUSINESS NAM E/LOCATION HOME CARE ENTERPRISES 672 NW 118 ST MIAMI, FL 33150 OWNER HOME CARE ENTERPRISES CIO DAVID APONTE QUALIFIER Worker(s) 1 RECEIPT NO. RENEWAL 4858321 EXPIRES SEPTEMBER 30, 2018 Must be displayed at place of business Pursuant to County Code Chapter BA - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 SPECIALTY BUILDING CONTRACTOR CCC1328671 PAYM ENT RECEIVED BY TAX COLLECTOR 75.00 08/21/2017 0237-17-005391 This local Business Tax Racal pt only con"rrm payment cf the Local Business Tax. The Racal pt is not a license, pernit, ora certi "cation of the holder's quaff i "cations. to do busi cess Folder muff conply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NQ above !rust be displayed on all commercial vehicles - Miarri-Dade Code Sec 8a-276. 8,012 For more information, visit www.rrianidade.gpv/taxcdlector .eco d CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 08/21/2017 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(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CanbeanBay Insurance Inc. 20454 S Dixie Hwy Cutler Bay, FL 33189 Phone (305) 2542969 Fax (305) 254-2984 CONTACT Daisy Espinoza NAME: PHONE . EMI: (305) 254-2969 /c, Noy (305) 2542984 AADDDDRESS: carribeanbayins®bellsouth.net INSURERS) AFFORDING COVERAGE NAIC # INSURER A: Rockingham Casualty Company ,EACH OCCURRENCE INSURED Home Care Enterprises Inc. 672 NW 118 St Miami FL 33168- INSURER 8 : J COMMERCIAL GENERAL LIABILITY .CLAIMS MADE J OCCUR INSURER C : DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER D : y ■ INSURER E : S 5,000.00 INSURER F : PERSONAL & ADV INJURY COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS INDICATED. I CERTIFICATE 1 EXCLUSIONS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INR LTR'NSR TYPE OF INSURANCE ADDLISUBR wVD POLICY NUMBERLIMITS 17184 Binder POLICY EFF (MM/DD/YYYY) 08/21/2017 POLICY EXP (MM/DDIYYYY) 08/21/2018 ,EACH OCCURRENCE S 1,000,000.00 A J COMMERCIAL GENERAL LIABILITY .CLAIMS MADE J OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100'000.00 ■ MED EXP (Any one person S 5,000.00 El PERSONAL & ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPUES PER: • POUCY • JECaT • LOC GENERAL AGGREGATE 5 2,000,000.00 PRODUCTS • COMP/OP AGG $ 2,000,000.00 0 OTHER S AUTOMOBILE LIABILITY jj♦ ANY AUTO II ALL OWNED SCHEDULED AUTOS ' IIAUTOS NON -OWNED II HIRED AUTOS NI AUTOS ■ ❑ COMBINED SINGLE LIMIT (Ea accident) S BODILY INJURY (Per person) 5 BODILY INJURY (Per accident) 5 PROPER DAMAGE (Per acci nt) $ $ r ❑ UMBRELLA LIAB MI OCCUR • EXCESS LIAR 0 CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ i U DEO 0 RETENTION S I S WORKERS COMPENSATION 4 AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTNC N / A ❑ PEAR UTE ■ OeRTH - E L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? i (Mandatory In NH) H yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYE $ E L. DISEASE - POUCY LIMIT S ( DESCRIPTION OF OPERATIONS I LOCATIONS l VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) GC Lic#CCC 1328671 CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014/01) QF CORD CORPORATION. 1 rights reserved. The ACORD name and logo are registered marks of ACORD Miami Shores Village 10050 N.E. 2nd Ave• Miami, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTH --, - - ACORD 25 (2014/01) QF CORD CORPORATION. 1 rights reserved. The ACORD name and logo are registered marks of ACORD • Report Viewer /1 100% Page 1 of 2 JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW** CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 3/2/2016 EXPIRATION DATE: 3/2/2018 PERSON: APONTE DAVID FEIN: 861121573 BUSINESS NAME AND ADDRESS: HOME CARE ENTERPRISES 12555 BISCAYNE BLVD #790 NORTH MIAMI BEACH FL 33181 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL LICENSED ROOFING CONTRACTOR CONTRACTOR Phrsuar4 to Chapter 410.05(14), F.S., an officer of a corporation who dads exempton from this chapter by filing a certificate of election Wer this section may not recover benefits or compensation Wer tis chapter. Pursuant to Chapter 440.05(12), F.S., Certiflcales of dection to be exempt... apply cnly within the scope of the business or trade listed co the notice of election to be exempt. Phrsuara to Chapter 440.06(13), F.S., Notices of decgcn to be exempt and certificates of election to be exempt shall be subject to revocation It at any time after the filing of the notice or to issuance of the certificate, the person named on the notice or certificate no larger meets the requirements dais section for isawnceof a certificate. The dcpanmert shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 .. 1) IV R LICENSE CLASS F A153-160-65-346-0 DAVID APONTE 12555 BISCAYNE BLVD APT 790 NORTH MIAMI BEACH, FL 3319.1 006 09-26.1965 SEx: ueD: 11.28-2010 H11-226, 2018 14417 et) Miami Shores Vutage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNERS'S AFFIDAVIT OF EXEMPTION ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR EXISTING SITE- BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PERSUANT TO SECTION 553.844 F.S. To: Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, FI 33138 Re: Owner's Name: W \ \c y ' 081e5 Property Address: 1 e NG I f S- 3-\c"es, -171-5,31 I Roofing Permit Number: Dear Building Official: I �ti \\vc�cc\o c\t e S certify that I am not required to retrofit the roof to wall connections of my building because: The just valuation for the structure for purpose of ad valorem taxation is less than $300,000.00. Please attach proof of ad valorem taxation. ❑ The building was constructed in compliance with the provisions of the Florida Building Code (FBC) or with the provisions of 1994 edition of the South Florida Building Code (1994 SFBC) Date: 44h Signature � /:Z/&/6 Print Name State of Florida County of Dade The undersigned, being the first duly sworn, deposes and says that he/she is the owner for the above property mentioned. Sworn to and subscribed before me this oy day of (1u• uS-\- 20 r-7 Notary Public, Sate of Florida at Large "II: "�s� Notary Public State of Florida Sandra L. Aponte c. o` My Commission GG 114594 Corti" Expires 06t13/2021 • When the just valuation of the structure for purpose of ad valorem taxation is equal to or more than $300,000.00, and the building was not constructed with FBC nor a 1994 SFBC. Then you must provide a building application from a General Contractor for the Roof to Wall connection Hurricane Mitigation. Revised on 5/21/2009 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Horida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ROOF PERMIT REQUIREMENTS 1. PERMIT APPLICATION. (SIGNED AND NOTIREZED BY BOTH OWNER AND CONTRACTOR) 2. OWNERS AFFIDAVIT OF EXEMPTION, F.S. 553.844 3. AFFIDAVIT OF COMPLIANCE WITH ROOF TO WALL CONNECTION FOR HURRICANE MITIGATION. 4. PRODUCT APPROVAL. (2 SETS) o Front page. o Specific system description. o Specific system limitation. o General system limitations. o Fire Directory Listing Page. 5. DESIGN CALCULATIONS PER CHAPTER 16. OR IF APPLICABLE RAS 127 OR RAS 128. (2 SETS) 6. ROOF PERMIT PACKAGE (2 SETS) 7. OWNERS ROOFING CONSIDERATION (REROOFING ONLY) 8. $50 SUBMITTAL FEE. REVISED ON 7/9/09;07/01/2015; Property Search Application - Miami -Dade County OFFICE OF THE PROPERTY APPRAISER Summary Report Property Information Folio: 11-2232-028-0290 Property Address: 1100 NE 108 ST Miami Shores, FL 33161-7300 Owner WILLIAM HODGES Mailing Address 1100 NE 108 ST MIAMI, FL 33161 PA Primary Zone 1000 SGL FAMILY - 2101-2300 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY : 1 UNIT Beds/Baths/Half 3/2/0 Floors 1 Living Units 1 Actual Area Sq.Ft Living Area Sq.Ft Adjusted Area 1,697 Sq.Ft Lot Size 11,124.1 Sq.Ft Year Built 1949 Assessment Information Year 2017 2016 2015 Land Value $272,780 $202,637 $161,070 Building Value $99,784 $99,784 $99,784 XF Value $0 $0 $0 Market Value $372,564 $302,421 $260,854 Assessed Value $195,567 $191,545 $190,214 Benefits Information Benefit Type 2017 2016 2015 Save Our Homes Cap Assessment Reduction $176,997 $110,876 $70,640 Homestead Exemption $25,000 $25,000 $25,000 Second Homestead Exemption $25,000 $25,000 $25,000 Note: Not all benefits are applicable to all Taxable Values (i e. County School Board, City, Regional). Short Legal Description MIAMI SHORES ESTATES PB 47-58 LOT 1 BLK 3 LOT SIZE 85.570 X 130 Page1of1 Generated On : 8/4/2017 Taxable Value Information Previous Sale 2017 2016 2015 County Exemption Value $50,000 $50,000 $50,000 Taxable Value $145,567 $141,545 $140,214 School Board Exemption Value $25,000 $25,000 $25,000 Taxable Value $170,567 $166,545 $165,214 City Exemption Value $50,000 $50,000 $50,000 Taxable Value $145,567 $141,545 $140,214 Regional Exemption Value $50,000 $50,000 $50,000 Taxable Value $145,567 $141,545 $140,214 Sales Information Previous Sale Price OR Pa Boe ok 9 Qual�cation Description 08/14/2009 $0 26980-3171 Corrective, tax or QCD; min consideration 05/15/2009 $225,000 26980-3161 Trustees in bankruptcy, executors or guardians The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp Version: HOME CARE ENTERPRISES INC. 12555 BISCAYNE BLVD #790 NORTH MIAMI FL, 33181 Tel : (305) 758-8899 FAX : (305) 758-0809 Date: SI /(cl—I State of Florida County of Dade Before me this day personally appeared ' Qu l d -14 e who, being duly sworn deposes and says: Th she will be the only person working on the project located at: 1100 N E )QE- S+ eco - 1(--1(01-11- res J Sworn to or affirmed and subscribed before me this (v day of Pu i, 20 17 Personally know Or produced identification Type of Identification produced jodRv �% Notary Public State of Florida Sandra L. Aponte "S c ' My Commission GG 114594 v vt Expires 06/13/2021 Print or Stamp Name of Notary Notice to Owner — Workers' Com p Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signatu State of Florida County of Miami -Dade The foregoing was acknowledge before me this 1(.0 day of , 20 \'7 . who i s ersonally know to me or has produced as identification. ner By WVC,rr,y5 Notary: SEAL: 0010 Pig, el". Notary Pub±v.'State of Florida • 1 Sandra L. Aponte "•",i : v •,•. Any Cnrnn :ssion GO 114694 RECEIVED ROOF ASSEMBLIES AND RAOFTUP STROUC„TURES �,o,�L s for/alb' '►e 5t dition (2014) GO�^Q�PNG� s P..„09, ligh=Velocity Hurricane Zone Uniform Permit Application Form. v 'i3 C'� -\O G0\ Section A (General Information) A�� N`Master Permit No. 1 Process No. Contractors Name I kr \ Cc»- e c rev Y Ls-c.s Job Address 6/Low Slope O Asphaltic Shingles 1 J o 0 NJ E 10 F- 5 r 4- H tel• m i 51^p -es ft. 3 31(01 O New roof 0 Repair ROOF CATEGORY ❑ Mechanically Fastened Tile ❑ Metal Panel/Shingles ❑ Prescriptive BUR -RAS 150 ROOF TYPE 0 Maintenance ❑ Mortar/Adhesive Set Tiles ❑ Wood Shingles/Shakes is Reroofing 0 Recovering ROOF SYSTEM INFORMATION Low Slope Roof Area (SF) 3S0 0 Steep Sloped Roof AREA (SSF) $- Total (SF) 35 Oa ..• .• •...1�• Section B (Roof Plan) • • • • Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers andpyorflcw drains.•Inclede dime?! • sions of sections and levels, clearly identify dimensions of elevated pressure zones and location of nrpQgts. 1 1 11 1 1 1 1 1 1 1 1 1 1 1 1 1 1 11 1 0000 • • 4000• 1 -Ic 1- T cL °w S e p C� a •.• • •0• • • • • ••. • OP W ••• • • • .• • • • • 0 •• .•I • • •• • • •.110. • • • ..! • ••d.•• •..1••• • 1• • ••I.•• ••1..• ••• •• 1 • • FLORIDA BUILDING CODE — BUILDING, 5th EDITION (2014) 15.37 Copyright to, or licensed by. ICC (ALL RIGHTS RESERVED); accessed by Elmer Palacio on Jun 8, 2015 10:32:12 AM pursuant to license Agreement. No further reproductions authorized. INTERNATIONAL CODECOUNCIL 1 1 1 1 11 1 1 111 1 1 1 1 1 1 1 1 1 1 1 1 ROOF ASSEMBLIES AND ROOFTOP STRUCTURES Florida Building Code 5th Edition (2014) High -Velocity Hurricane Zone Uniform Permit Application Form. Section C (Low Slope Application) Fill in specific roof assembly components and identify manufacturer (If a component is not used, identify as "NA") System Manufacturer: 1 Product Approval No.: l-lolo.d1 1 Design Wind Pressures, From RAS 128 or Calculations: 1 1 1 1 1 .1 1 1 1 1 1 1 1 1 1 P1: t'`a.+� P2: � k •� P3: 1 0%• O Max. Design Pressure, from the specific product approval system: Deck: Type: Sk T Cr Gauge/Thickness: NIA Slope: b .� O Anchor/Base Sheet & No. of Ply(s): 1 s j ell Anchor/Base Sheet Fastener/Bondin Material: (.S N a.15 o -►s l c L Insulation Base Layer. N Base Insulation Size and Thickness: Base Insulation Fastener/Bonding Material: 1 Top Insulation Layer: NI 1> 1 1 Top Insulation Size and Thickness: 1.4 f).- 1 . 1 Top Insulation Fastener/Bonding Material: 1 1 1 Base Sheet(s) & No. of Ply(s): # `I 5 r�I Top Ply Fastener/Bonding Material: Pro k- r�o e ASohgt-V Surfacing: ►.J,A Fastener Spacing for Anchor/Base Sheet Attachment: Field: c\ " oc @ Lap, # Rows . @ 9 " oc Perimeter:. " oc @ Lap, # Rows ''1. @ __( • oc Comer. 6 " oc @ Lap, # Rows 4 @ " oc Number of Fasteners Per Insulation Board: Field Vick Perimeter NIa Comer V\ ft. 1 1 1 1 1 1 1 1 Illustrate Components Noted and Details as Applicable: 1 Woodblocking, Gutter, Edge Termination, Stripping, Flashing, 1 Continuous Cleat, Cant Strip, Base Flashing, Counterflashing, 1 Coping, Etc. 1 Indicate: Mean Roof Height, Parapet Height, Height of Base Flashing, Component Material, Material Thicknem,.FFStener 1 Type, Fastener Spacing or Submit Manufacturerngtpr that 1 Comply with RAS 111 and Chapter:16.. • . 1 * • .. • 1• H A„• • 1 3 v.$ 'D2'? tAc e 9I'sti? 4- Phil -4- M of pip 5hcci - •. • • •.•• • • •••• ••WT..• . . • IBASe *7 1 Base Sheet Fastener/Bonding Material: oZ vc..) `, ' i 1 l- p,r)' L. A. N 041� pp t- r/ Ply Sheet(s) & No. of Ply(s): C -7'A. 't Q \ (,,)--)e1"1 1 1 Ply Sheet Fastener/Bonding Material: 1 lam/ t rti o y A S `p not \ k• J- Top Ply: �r•Ar� 1Nktuerot.„ Gnp S�ieJ1' 15.38 INTERNATIONAL CODE COUNCIL! • . •• •• • • . • • • • • • • •• • FT. • .. . 0\•00 • •• • Parapet I-teighb • • . • • 1 •• 1 1• • .•. •• •• •. 12 Mean Roof Height 1 1 1 1 1 1 1 1 1 1 FLORIDA BUILDING CODE — BUILDING, 5th EDITION (2014) Copyright to, or licensed by, ICC (ALL RIGHTS RESERVED); accessed by Eliezer Palacio on Jun 8, 2015 1032:12 AM pursuant to License Agreement. No further reproductions authorized. • • .' • ROOF ASSEMBLIES AND ROOFTOP STRUCTURES Florida Building Code 5th Edition (2014) High -Velocity Hurricane Zone Uniform Permit Application Form Section D (Steep Sloped Roof System) Roof System Manufacturer: Notice of Acceptance Number. Minimum Design Wind Pressures, If Applicable (From RAS 127 or Calculations): P1: P1: P1: Roof Slope: : 12 Deck Type: Type Underlayment: Insulation: . ftielgp Ventilation? ••• . . .. • .. . . • • .. • • • • • • •• •.•. • . • • • • •• •• ••.. •• • • , • . • • • Fire Barrier: Type & Spacing: Adhesive Type: Type Cap Sheet: Roof Covering: Type & Size Drip Edge: •• • •• •• Mean Rppt Wight: • -.• • • • • • • • • • • • • • . • • • • • • •. 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 11 1 1 1 1 1 FLORIDA BUILDING CODE — BUILDING, 5th EDITION (2014) 15.39 Copyright to, or licensed by, ICC (ALL RIGHTS RESERVED); accessed by Eliezer Palacio on Jun 8, 2015 10:32:12 AM pursuant to License Agreement. No further reproductions authorized. INTERNATIONAL CODE COUNCIL SECTION 1524 HIGH VELOCITY HURRICANE ZONES — REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS 1524.1 Scope. As it pertains to the section, it is the responsibility of roofing contractor to provide the owner with the required roofing permit, and to explain to the owner the content of the section. The provisions of Section R4402 govem the minimum requirements and standards of the industry for roofing system installations. Additionally, the following items should be addressed as part of the agreement between the owner ant the contractor. The owner's initial in the designated space indicates that the item has been explained. 2. 4. 6. Overflow scuppers (wall outlets): It is required that rainwater flows OM that the roof is nt1 loaded from a buildup of water. Perimeter/edge wall or other roof extensibii flay block thi% , • di /I harge if overflow scuppers (wall outlets) are not provided. It may be necessai t n.stall overflow ppers in : ccordance with the requirements of Sections R4402, R4403 and Rp4I . • • .. • Renailing wood decks: When replacing roofing, the existing wood roof deck may have to be re'n ed in accordance with the current provisions of Section R4403. (The roof deck is usually cone ed prior to removing the existing roof system). Exposed Ceiling: Exposed, open beam ceilings are where the underside of the roof decking ca - iewed from below. The owner may wish to maintain the architectural appearance; therefore, roo ng nail penetration of the underside of the decking may not be acceptable. This provides t itoption of ma' taining the appearance. • • • • •• • •• • • • • ••• • wner/Agent's . T*'ure Date 1100 INLe 1 e. 54 - M tctrn1SAD' QS Property Add !ss n•331(,) Revised on 7/9/2009 LD;07/01/2015; Permit Number • . • • • • • • • • • • MIAMIDADE COUNTY DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES (RER) BOARD AND CODE ADMINISTRATION DIVISION NOTICE OF ACCEPTANCE (NOA} GAF t Campus Drive Parsippany, NJ 07054 MIAMI-DADE COUNTY PRODUCT CONTROL SECTION 11805 SW 26 Straw, Room 2.08 Miami, Florida 33175-2474 T (786)315-2590 F (786) 31525-99 www.minmickuda.eovieconomv 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 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 Fldtida $uildingnode. including the High Velocity Hurricane Zone of the Florida Building Code. • • DESCRIPTION: GAF Conventional Built -Up Roof Systems for Wood.Decks.•• • • •• • •••• • •• LABELING: Each unit shall bear a permanent label with the manufacturer's name or logid,2lt';state an$. :• following statement: "Miami -Dade County Product Control Approved", unless otherwise notefherein. • RENEWAL of this NOA shall be considered after a renewal application has been filed aid there has brAntj . change in the applicable building code negatively affecting the performance of this produgt. • • . ••• • ••• • • TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in • the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed In advertising literature_ if any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA revises NOA No. 13-1022.15 and consists of pages 1 through 31. The submitted documentation was reviewed by Jorge L. Acebo. MIAM .DAD: COU APPROVED NOA No.: 14-1030.01 Expiration Date: 11/04118 Approval Date: 05/04/17 Page 1 of 31 Membrane Type: Deck Type 1: Deck Description: System Type Lr(1): All General and System Fire Barrier: (optional) Base sheet Fastening Option #I: Fastening Option #2: Ply Sheet: Cap Sheet: Surfacing: BUR Wood, Non -insulated 19/32" or greater plywood or wood plank decks secured 6 in. o.c. at panel end and intermediate supports with 8d ring shank nails to supports spaced 24 in. o.c. at max. Anchor sheet mechanically attached to roof deck Limitations shall apply. Topcoat° FireOue" Fire Barrier Coating, VersaShield®Fire Resistant Roof Deck Protection, VersaShielde Solo' Fire -Resistant Slip Sheet installed per manufacturer's installation instructions. GAFGLAS° #80 Ultima' Base Sheet, Stratavent°Nailable Venting Base Sheet, Ruberoid° 20 Smooth, Ruberoid° SBS Heat -Weld' Smooth or Ruberoid° SBS Heat -Weld' 25 base sheet mechanically fastened to deck as described below; GAFGLAS° Flex Ply"' 6, GAFGLAS° #7S Base Sheet, Tri -Ply° #75 Base Sheet or any of the above anchor 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. (Maximum Design Pressure S2.S psi: See General Limiralion #7) GAFGLAS° 480 Ultima' Base Sheet, Ruberoid°20 Smooth or Ruberoid®Mop jnpgth attached to deck with approved 1'A" annular ring shank nails and Invertgd 3" std ploleat a fastener spacing of 9" o.c. at the 4" lap and in two rows staggered'with a astener Spading of 9" o.c. in the center of the membrane. • • • (Maximum Design Pressure —60 psi See General Lirnilation #7j • One or more plies of GAFGLAS° Ply 4, Tri-Ply°D Ply 4 or GAFGan.#€0 Ultrcnar isa Sheet adhered in a full mopping of approved asphalt applied within i :EVT rang an[ at a rate of 20-40 lbs./sq. installed per manufacturer's installation inst; ;ctig#s ; • • . • (Optional) One ply of GAFGLAS° Mineral Surfaced Cap Sheet, p1y° BUR Gra?ule Cap Sheet or GAFGLAS° EaergyCap"' Mineral Surfaced Cap Sheet adhered in MAI: mopping of approved asphalt applied within the EVT range and ata rate of 20-40 lbs./sq. installed per manufacturer's installation instructions. • • • • Optional on granular surfaced membranes; required for smooth membranes. Chosen 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° Membrane or Topcoat° Surface Seal SB applied at 1 to 1.5 gal./sq. OR Topcoat° MB Plus applied at 0.5 to 0.75 galjsq.(to be used as a primer) followed by Topcoat° Membrane applied at 0.5 to 0.75 gal/sq. 3. Fiber Aluminum Roof Coating. Maximum Design Pressure: See Fastening Options M!AM4DADE COUNTY APPROVED NOA No.: 14-1030.01 Expiration Date: 11/04/18 Approval Date: 05/04/17 Page 25 of 31 WOOD DECK SYSTEM LIMITATIONS: t A stip sheet is required with GAFGLAS°° Ply 4 and GAFGLAr Flex Ply' 6 when used as a mechanically fastened base or anchor sheet. 2. Minimum V" DensDeck' Roof Board or V2" Type X gypsum board is acceptable to be installed directly over the wood deck. GENERAL LIMITATIONS: I. Fire classification is not part of this acceptance; refer to a current Approved Roofing Materials Directory for fire ratings of this product. 2. Insulation may be installed in multiple layers. The first layer shall be attached in compliance with Product Control Approval guidelines. All other layers shall be adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 16s/sq., or mechanically attached using the fastening pattern of the top layer 3. All standard panel sizes are acceptable for mechanical attachment. When applied in approved asphalt, panel size shall be 4' x 4' maximum. 4. An overlay and/or recovery board insulation panel is required on all applications over closed cell foam insulations when the base sheet is fully mopped. if no recovery board is used the base sheet shall be applied using spot mopping with approved asphalt, 12" diameter circles, 24" o.c.; or strip mopped 8" ribbons in three rows, one at each sidelap and one down the center of the sheet allowing a continuous area of ventilation. Encircling of the strips is not acceptable. A 6" break shall be placed every 12' in each ribbon to allow cross ventilation. Asphalt application of either system shall be at a minimum rate of 12 lbs./sq. Note: Spot attached systems shall be limited to a maximum design pressure of -45 psf. •••• 5. Fastener spacing for insulation attachment is based on a Minimum Characteristic Force (f) vallte of 2751bt:,.tlb tested in compliance with Testing Application Standard TAS 105. If the fastener value, ds„fjeld3ested, ata 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 spacifio system : 6hoald 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 ApoE»teatt or Registered, Roof Consultant may be submitted. Said revised fastener spacing shall utilize the withdrawat'tesistance vette taken from Testing Application Standards TAS 105 and calculations in compliance with Roel% Applicatidh Standard RAS 117. • • • • 7. Perimeter and corner areas shall comply with the enhanced uplift pressure requirements o'thgse,press. Fastener densities shall be increased for both insulation and base sheet as calculated in compliance with Roofing'RiVic" tion • Standard RAS 117. Calculations prepared, signed and sealed by a Florida registered Professional Engineer, •• Registered Architect, or Registered Roof Consultant (When this limitation is specifically referred within this NOA, General Limitation #9 will not be applicable.) 8. All attachment and sizing of perimeter nailers, metal profile, and/or flashing termination designs shall conform to Roofing Application Standard RAS 111 and applicable wind load requirements. 9. The maximum designed pressure limitation listed shall be applicable to all roof pressure zones (i.e. field, perimeters, and corners). Neither rational analysis, nor extrapolation shall be permitted for enhanced fastening at enhanced pressure zones (Le. perimeters, extended comers and corners). (When this limitation is specifically 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 61G20-3 of the Florida Administrative Code. END OF THIS ACCEPTANCE • • • • • • NOA No.: 14-1030.01 Expiration Date: 11/04/18 Approval Date; 05/04/17 Page 31 of 31 INA Wood Nailer Fastener Type and Spacing: • • • • •'• .. • NA Section C Page (Low Slope Roof Systems) FIN M the specific roof assembly components. if a component Is not required, Insert not applicable (n/a) In the text box. Top Pty: ROOF SYSTEM MANUFACTURER: Product Approval (NOA): GAF 14-1030.01 System Type: ign Wind Uplift Pressures. From RAS 128 or Sealed Calculations: (P1) Field: -42.8 psf (P2) Perimeters: 71.7 psf (P3) Comers: -108.0 psf Maximum Design Pressure From NOA: 52.5 Roof Stope: 0.50 " :12 Roof Mean Height psf 16 Parapet Walls No ° Yes Parapet wall Height Deck Type: 1-5/8" Plywood— Support Spacing:1 NA Alternate Deck Type: I NA Existing Roof. " o/c ft. !SAME Fire Barrier. NA Vapor Barter. Anchor Sheet Anchor Sheet Fastener! Bonding Material: INA Insulation Base i.ayer Size & Thickness: NA tnsulation Base Layer Fastener l Bonding material: INA Insulation Top Layer Size & Thickness: INA !GAF MiNERAL CAP SHEET Top Ply Fastening !Bonding Material: 1 HOT MOP ASPHALT Surfacing: INA SINGLE PLY MEMBRANE: Single Ply Manufacturer 1 Type: NA Single Ply Sheet Width: " 112 Sheet Width: Fin t " No. of Single Ply 1/2 sheets: FiTi ft Single Ply Membrane Fastening /Bonding Material: Insulation Top Layer Fastener 1 Bonding Material: INA Base Sheet(s) & No. of Ply(s): f GAF GLASSBASE 75# (1) Base Sheet Fastener! Bonding Material: 1-1/4" RS NAIL & TIN CAP 1-518' Pty Sheet(s) & No. of Ply(s): 'GAF PLY IV (2) Ply Sheet Fastener! Bonding Material: 1 HOT MOP ASPAHLT INA El FASTENER SPACING FOR BASESHEETATTACHMENT 0 SINGLE PLY MEMBRANE ATTACHMENT 1. Field E "olc@ Laps & f ! rows F7 "o/c 2. Perimeter. D "olo Q Laps & El rows ED " o/c 3. Comer. E:=1" o!o 01 Laps & a rows " 010 NUMBER OF FASTENERS PER INSULATION BOARD: 1. Field: r--1 2. Perimetec r l 3. Comer. ED Insulation Fastener Type : INA WOOD NAILER TYPE AND SIZE •••• • • • ..•• • • • •. . ••l• •• •• . • ...... •• • • .. • Ma • EDGE & COPING METAL SiZES: • • • • • •• • Edge Metal Materiak —Galvanized . Metal-- • - - :.•. . Edge Size: —3"face 26 9a — • • • • Hook Strip S --SELECT EDGE MEbel71019K STRIP SjZ - Edge Metal Attachment 1-1/4" RS NAIL4 OC 1 Coping Material: Coping Size: Hook ship Size: —SELECT COPING METAL HOOK STRiP SIZE— Parapet Coping Metal Attachment: 1 --SELECT PARAPET WALL COPING MATERIAL. —SELECT COPING METAL SIZE OR THICKNESS— NA Illustrate Components Noted and Details as Applicable: Top Pty hnterplies \ Base Sheet Roof Deck ti S 4 4 N 5•1 -..- Drip Metal - Roof Mean Height Drip Metal: LZ • . • . 3"X3" GALV 26 G ft. • • • • • • ••• • •..4 • • •••1 • Top Ply: !GAF MINERAL CAr glIET Interplies: ••• • • GAF PLY IV (2) • •t• •• • •1 •..i • • Base Sheet: 'GAF GLASSBASE 75# Deck Type: PLYWOOD 518" •• • •• • •• • •• • •• • •• • •• • TGFU.R14153 - Roofing Systems Page 2 of 48 Trumbull "Perma Mop' may be utilized with any of the following "Asphalt Felt Systems with Hot Roofing Asphalt". "GAFGLAS® 480 Premium Base Sheet" may be used In any of the following systems. "GAFGLAS® Flex Ply 6" and'Trf-Ply® Ultra -Flexible Ply 6" are suitable alternates to "GAFGLAS® Ply 6". "GAFTEMP Perrnalite Recover Board' may be used in lieu of any perlite insulation in any of the following NC Classlficattons. Unless otherwise indicated, any of the "Asphalt Felt Systems with Hot Roofing Asphalt" may be surfaced with "TOPCOAT® Flreshleld MB" at 21/2 to 3-gal/100-ft2. "Ruberold® Dual Smooth" may be used as an alternate to 'Ruberold® Mop Smooth" or "Ruberold® 20" or "Ruberold® 20 HT". "Ruberold® Mop Smooth 1.5" may be used as an alternate to "Ruberold® Mop Smooth°. Class A, B and C Hot roofing asphalt, for use with organic and glass felts or modified bitumen membranes. "Ruberold® Heat Weld" 585 roofing membrane may be used in lieu of 'Ruberoid® Mop" SBS products in any applicable Classification. Gass A 1. Decks C-15/32 Incline: 3 insulation (Optional): — One or more layers perilte or wood fiber or glass fiber or polyisocyanurate or urethane or periite/polylsocyanurate composite or perilte/urethane composite or wood fiber/polyisocyanurate composite or phenolic, any thickness. Ply Sheet — Three or mom piles Type G1 or "GAFGIAS® Pty 4" or "Tri -Pty® Ply 4" or "GAFGLAS® Ply 6' hot mopped. Surfacing: — Gravel. 2. Deck: C-15/32 Incline:2 Insulation (Optional): — One or more layers petite or wood fiber or glass fiber or polyisocyanurate or urethane or perllte/polylsocyanurate composite or perilte/urethane composite or wood Aber/polyisocyanurate composite or phenolic, any thickness. Ply Sheet — Three or more piles Type 61 or "GAFGiAS® Ply 4" or "Tri -Ply® Ply 4" or "GAFGLAS® Ply 6". Cap Sheets — One ply Type G3 "GAFGLAS® Mineral Surfaced Cap Sheet" or "TN -Ply® Mineral Surfaced Cap Sheet " or "GAFGLAS® EnergyCap" BUR Mineral Surfaced Cap Sheet". 3. Deck: NC Inline: 2 •••• • Insulation (Optional): — One or more layers peritte, wood fiber, glass fiber, polyisocyanurate, urethanes perilt%olylsocyaaer8ft • composite, perete/urethane composite, wood flberfpolytsocyanurate composite, phenolic, 2 -in. maxdmum.• • • • Ply Sheet: — Two or more piles Type GI. ""GAFGAS® Ply 4", "Tri -Ply® Ply 4" or "GAFGLAS® Ply 6". • • • • • • • • • Cap Sheet — One ply Type G3 "GAFGLAS® Mineral Surfaced Cap Sheet" or "Tri -Ply® Mineral Surfaced Gap lick!!' or "GAFEILAS6 EnergyCap'" BUR Mineral Surfaced Cap Sheet. • • • 4. Deck: C-15/32 Incline: 1 •••• • •• • •• • •••• • •• ••• Slip Sheet (Optional): — Red rosin paper, nailed to deck. • •• ' Insulation (Optional): — Any thickness petite or wood fiber orglass fiber or polyisocyanurate • D po Y cyanurete mechank5}11jf�sRaned or rid�ierecititrlth OMG Inc. "OlyBond Fastening System" or any UL. Classified insulation adhesive. • • • • • • • • •••• • Base Sheat — One ply Type G2 "GAFGLAS® 475 Base Sheer or "Til -Py® 475 Base Sheet" (may be na»tggy . . • • Ply Sheets — One or more plies type GI "GAFGLAS® Ply 4" or "Tri -Ply® Py 4" or GAFGIAS® Ply 6". • • • • • Cap Sheet — One plyType G3 "GAFGLAS® Mineral Surfaced Cap Sheet" or "Tri -Ply® Mineral Surfaced O6p Sheer or *GAN j15. •' • • • EnergyCapm BUR Mineral Surfaced Cap Sheet". • • • • • Surfacing (Optional): — "TOPCOAT® Ertergycnbe'"' Elastomeric Coating" applied at a rate of 2-ga1/100-Ii=i • • : • • • • • • 5. Deck: NC Inclines 3 • • Base Sheet, — One ply Type G2 "GAFGLAS® 475 Base Sheet" or "iii -Ply® 475 Base Sheet". Ply Sheet: — One or more piles Type GI "GAEGLAS® Ply 4" or "Tri -Ply® My 4" or "GAFGLAS® Ply 6". Cap Sheet: — One ply Type G3 "GAFGLAS® Mineral Surfaced Cap Sheet" or'Tri-Ply® Mineral Surfaced Cap Sheet" or''GAFGLAS® EnergyCap'" BUR Mineral Surfaced Cap Sheet." 6. Deck C-15/32 Incline: 2 Insulations — One or more layers periite, glass fiber, polyisocyanurate, urethane, perltte/polyisocyanurate composite, perllte/urethane composite, phenolic, 1 in. minimum (offset a minimum of 6 -in. from plywood deck points). Base Sheet — One or more plies Type 61 or Type G2 or Type G3. Membrane: — One or more piles "Ruberoid® Torch Smooth" or "Ruberold® Torch Granule" or'Roberotd® Torch Granule Plus" or "Ruberoid® Mop Smooth" or "Ruberolda Mop Smooth 1.5" or "Ruberold® Mop Smooth Plus" or "Ruberold® Mop Granule' or "Ruberoid® Mop Plus Granule" or "ROOFMatchm SBS Modified Granular" or "Tri -Ply® 585 Modified Bitumen Membrane" or "ROOFMatchm APP Modified Granular" or "Fri -Ply® TP -4G" or "Fri -Ply® TP -4" or "Ruberold® Dual Smooth'. Cap Sheet — Type G3 "GAFGLAS® Mineral Surfaced Cap Sheet" or "Tri -Ply® Mineral Surfaced Cap Sheerer "GAFGLAS® EnergyCap"" BUR Mineral Surfaced Cap Sheet" fully adhered with hot rooting asphalt. 7. Deck: C-15/32 Inclines 2 Insulation (Optional): — One or more layers perfte or wood fiber or glass fiber or polyfsocyanurate or urethane or pertite/potylsocyanurate composite or pulite/urethane composite or wood fiber/poylsocyanurate composite or phenolic, any thickness. Base Sheet — Two or more•pies Type G2 or Type G3. Ply Sheet (Optional): — One or more plies Type 61. Membranes — One or more piles "Ruberoid® Torch Smooth" or "Ruberold® Torch Granule" or "Ruberoide Torch Granule Plus" or "Ruberoid® Mop Smooth" or "Ruberold® Mop Smooth 1.5" or "Ruberoid® Mop Smooth Pius' or "Ruberolde Mop Granule" or "Ruberold® httpd/database.ul.com/cgi-bin/XYV/template/LISEXT/1FRAME/showpage.htmi?name=T... 5/22/2017 Miami Shores Viiiage Building Department RE: Permit # RF -B- - l act INSPECTION AFFIDAVIT - c'\i `d Pott ke (Print name and circle License Type) License #: C' CC v a.s-(1 \ On or about a/31 ji7 (Date & time) work at 1 I OO N F 10S- SA -cc e l- t-ckcimk S -c r-. R.33 L21 (Complete Job Site Address) Based upon that examination I have determined the installation was done according to the Hurricane Mitigation Retrofit 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 DATE: aJ3O1fl licensed as a (ff�Contractor Engineer / Architect, FS 468 Building Inspector , I did personally inspect the roof deck nailing Manual Bas- • .f 53.844 F.S) Signature State of Florida County of Dade: The undersigned, being the first duly sworn, deposes and says that he/she is the contractor for the above property mentioned. Sworn to and subscribed before me this 31 day of Pw Notary Public, Sate of Florida at Large us Notary Public State of Florida Sandra L Aponte noMy Commission GO 114584 Expires 08/13/2021 'General, Building, Residential, or Roofing Contractors or any individual certified under 468 F.S. to make such an inspection. Include photographs of each plane of the roof with permit # and address # clearly shown marked on the deck for each inspection vondee.l ,,,, nrinnniAlgn1 nmo