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RF-17-2244AFFIDAVIT OF COMPLIANCE WITH ROOF DECKING ATTACHMENT AND SECONDARY WATER BARRIER HURRICANE MITIGATION RETROFIT FOR EXISTING SITE—BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PURSUANT TO SECTION 553.844 F.S. To: Miami -Dade County Building Department 11805 Coral Way, Suite 111 Miami, FL 33175 Re: Owner's Name . (nctr j Property Address 12 0) NE q g ��-�- Roofing Permit Number 12F- q —11-22.44 Dear Building Official: I Lc'-. l certify that the roof decking attachment and fasteners have been strengthened and corrected and a secondary water barrier has been provided as required by the "Manual of Hurricane Mitigation Retrofits for Existing Site -Built Single Family Structures" adopted by the Florida Building Commission by Rule 9B-3.047 F.A.C. Qualify. g Agent Si'3, ature of Qualifying Agent Print Name STATE OF FLORIDA COUNTY OF MIAMI-DADE Sworn to and subscribed before me this 5 day of (SEAL) SGT , 20 I , )(Personally known or Produced Identification ,;eY►1y JANETTE DIAZ � `'' •': MY COMMISSION # GG035634 EXPIRES • a a = OA, 2020 C:\Documen s and Seuings' tcl`My Documenb'SlatisticsGtaph _2\Roofng Affidavit Compliance -9 26 O7Fillable.doc s(i)",c7 NOTICE.OF COMMENCEMENT A RECORDED COPY MUST DE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO, TAX FOLIO Nail -3ZQ$'0I 0 - OO /a STATE OF FLORIDA: COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property. and In accordance with Chapter 713. Ftorlda Statutes, the foEowing tnformatton is provided In this Notice of Commencement. CFN: 20170466471 BOOK 30651 PAGE 2877 DATE:08/11/2017 02:54:57 PM HARVEY RUVIN, CLERK OF COURT, MIA-DADE CTY space above rssomod for use of rscording ottico 1. legal description of property and street/address: I0/01 9 .S+, h-4 t ekr r I t U re S 1 1 33 (3� 2. Description of improvement: ocrF 3.Owner(s) name anddress: !_ • ' . . Interest In property: f1iLa 21� Name and address of fee simple titleholder: :2. 'do a s leo r-es,1l ;11 , 4. Contractor's name, address and phone number: K OWA cleiel DA 1142.. 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number: Amount of bond S 6. Lender's name and address' 7. Persons within the State of Ronda designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(47., Florida Statutes, Name, address end phone number: S. In addition to himself, Owners designates the following person(s) to recelve a copy of the Uenor a Notice es provided In Section 713.13(1Xb), Florida Statutes. Name, address and phone number. �• a .9. ExpkaUon date of this Notice of Commencement: (the expiration data la 1 year from the date al rsoor6ng unless a dxlaent dela Is epeci WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF. COMMENCEMEEYTARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13. FLORIDA STATUTES. AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SIRE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WfTH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. • Slgr>}►tyr • of or Owner(s). d • fficer/Directorrtner/Manager By ,X Print Name g rtjr Cl l e -P . Print Name Title/Office Title/Office STATE OF FLORIDA COUNTY OF MIAMI-DADEr �"t':'ti a0 1 - The foreooing Instrument was pcknowledged before me This s_=. day of Pru 9 l�I S fi By I7`erY\Lue (,`Q 0 individually, or 0 as for 0 Personally known, or4produced the following type of IdenU a1), Signature of Notary Public: � •orrINP r— 00 Print Name: _ • - `. (SEAL) VF,RtFIOATION PURSUANT TO SECTION 92.626. FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts stated In It are true, to the best of my knowledge and belief. • Signet .. YnV! r marts) or Owner(sp ut orized Offcer/DIrector/Pertner/M _BY Ati AA "•,",,, • MELANIE MUAIZ • +,• 41: NotaryPubNC-StateofFioridn - • �'= CornlfLlsion#FF93261r • 9 r ; : • li $OAMerl 3. . National N• "v'r;;•,,, MELANIEMUAIZ• , iy ��°` NotaryPubilc-Stateotr• • •- Commbsbn#FFS+..•:.5 ■• ;I: My Comm. Expires Nov '1.2019 >i %As 2 N LL €0 h Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 1201 NE 94 Street Miami Shores, FL 33138- Owner Information Permit Issue Date: 9/21/2017 Permit NO. RF -9-17-2244 Permit Type: Roof Work Classification: Tile Permit Status: APPROVED Expiration: 03/20/2018 BERNARD & DEMETRIO LORIS LEE Address Parcel Number 1132050100010 Block: Lot: 1201 NE 94 Street MIAMI SHORES FL 33138- 1201 NE 94 Street MIAMI SHORES FL 33138- Applicant BERNARD & DEMETRIO LORIS I Contractor(s) T&S ROOFING SYSTEMS INC. Phone 305/265-2654 CeII Phone Phone (954)673-6513 CeII Valuation: $ 29,400.00 Total Sq Feet: 4200 Type of Work: Re Roof Additional Info: RE -ROOF TILE Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - New Roof Scanning Fee Technology Fee Total: Amount $18.00 $5.25 $5.25 $6.00 $350.00 $9.00 $24.00 $417.50 Pay Date Pay Type Amt Paid Amt Due Invoice # RF -9-17-65092 09/21/2017 Credit Card $ 417.50 $ 0.00 Available Inspections: Inspection Type: Up Lift Report Tin Cap Final Roof Tile In Progress Renailing Affidavit Review Roof Cap Sheet 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 ass me responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for - ' CAL, " UMBING, MECHANICAL WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OW RS AFFIDAVIT 1 ce th- th for:.oing information is accurate and that all work will be done in compliance with all applicable laws regulating co struction and zone- q. Futh:rmor. : u 6 • ze the above-named contractor to do the work stated. \ Aut �e• S : Own r Applicant / Contractor / Agent Building De September 21, 2017 opy September 21, 2017 Date 1 1 BUILDING PERMIT APPLICATION ❑ BUILDING ❑ ELECTRIC 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 ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: r20 I j J 9 City: Miami Shores RECEIVED SEP��1,p91p1) LX-=- S+11' ;�FBC 201'4 Master Permit No. Z 1 1 Da -IL( Sub Permit No. ❑ REVISION ❑EXTENSION ❑ CHANGE OF ❑ CANCELLATION CONTRACTOR ' ❑ RENEWAL ❑ SHOP DRAWINGS County: Miami Dade Zip: Folio/Parcel#: 1 \ �� - GI or I 0 Occupancy Type: Load: Construction Type: Is the Building Historically Designated: Yes NO Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): P) --e fir\ y 61 L'e-e Phone#: Address:17.0\ ki ¶ LI ` J- City: J'\t 0\I/1(' I WV'e-S State: i -'L Zip: -) I ) D Tenant/Lessee Name: Phone#: Email: CONTRACT UR: ompany Najme: Address: \ �M_ \b NVJ City: \ Qualifier Name: \ 06\ State Certification or Registration #: Phone#: Zip: Phone#: Certificate of Competency #: Phone#: DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ Type of Work: ❑ Addition Description of Work: iktoo ❑ Alteration VC". 1 I e. City: State: Zip: Square/Linear Footage of Work: 1 l ❑ New ❑ Repair/Replace ❑ Demolition Specify color of color thru tile: *1 (ii/VP Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ Lill- .S0 (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature / Signature OWNER or AGENT The foregoing instrument was acknowledged before me this CONTRACTOR ( The foregoing instrument was acknowledged before me this 1 (, d y of �� 20 r) , by l 6 day of, 20 , by yt (ley \ who is personally known to jA/ /V1 v /�ho is personally known to me or who has produced as me or who has produced as identification and who did take an oath. NOTARY P Sign: Print: Seal: 1 - i * i till Notary P :tic - State of Florida Commis ion # GG 044769 My Comm. Expires Nov 3, 2020 "%;`,)r, ......... ************************************** *********** APPROVED BY (Revised02/24/2014) CDA * identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: 41/1 AA A 1 NIEL PERE) Not ry Public - Stat: Florida • C mission # GG 044769 My Comm. Expires Nov 3, 2020 ************************ Plans Examiner Structural Review *** **************** Zoning Clerk Property Search Application - Miami -Dade County Page 1 of 1 HCE OF THE PROPERTV APPRAISER Summary Report Property Information Folio: 11-3205-010-0010 Property Address: 1201 NE 94 ST Miami Shores, FL 33138-2946 Owner BERNARD LEE JTRS DEMETRIO T LORIS JTRS Mailing Address 1201 NE 94 ST MIAMI SHORES, FL 33138 USA PA Primary Zone 1400 SGL FAMILY - 3001-3250 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY : 1 UNIT Beds / Baths / Half 3/2/0 Floors 1 Living Units 1 Actual Area 3,250 Sq.Ft Living Area 2,720 Sq.Ft Adjusted Area 2,897 Sq.Ft Lot Size 14,295 Sq.Ft Year Built 1959 Assessment Information Year 2017 2016 2015 Land Value $514,620 $479,168 $435,712 Building Value $242,479 $244,434 $246,390 XF Value $20,707 $20,724 $13,715 Market Value $777,806 $744,326 $695,817 Assessed Value $715,401 $700,687 $695,817 Benefits Information Benefit Type 2017 2016 2015 Save Our Homes Cap Assessment Reduction $62,405 $43,639 $645,817 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 BAY VIEW PB 40-16 LOT 1 LOT SIZE IRREGULAR OR 19890-0504 08 2001 1 COC 22016-0443 01 2004 1 Generated On : 9/19/2017 Taxable Value Information 2017 20161 2015 County Exemption Value $50,000 $50,000 $50,000 f Taxable Value 1 $665,401 $650,687 $645,817 School Board Exemption Value $25,000 $25,000 $25,000 Taxable Value $690,401 $675,687 $670,817 City Exemption Value $50,000 $50,000 $50,000 Taxable Value $665,401 $650,687 $645,817 Regional Exemption Value $50,000 $50,000 $50,000 Taxable Value $665,401 $650,687 $645,817 Sales Information Previous Sale Price OR Book -Page Qualification Description 07/31/2014 $1,022,500 29260-1300 Qual by exam of deed 01/01/2004 $667,400 22016-0443 Sales which are qualified 08/01/2001 $432,500 19890-0504 Sales which are qualified 12/01/1993 $290,000 16197-1048 Sales which are qualified 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: http://www.miamidade.gov/propertysearch/ 9/19/2017 Section AB "Delivering Excellence Every Day" Master Permit No: Contractor's Name: Job Address: RECEIVED SEP 19201 Miami -Dade County HVHZ Electronic Roof Pe Section A (General Information) Process No: (T AND S ROOFING 11201 NE 94 ST ❑ Low Slope ❑ Asphaltic Shingles O Sprayed Polyurethane Foam Roof Category ❑ Mechanically Fastened Tile O Metal Panel/Shingles O Other: ❑✓ Mortar/Adhesive Set Tile O Wood Shingles/Shakes Roof Type ❑ New Roof ❑✓ Re -Roofing 0 Recovering 0 Repair 0 Maintenance •••, . ••••. a•r••• Are there Gas Vent Stacks located on the roof? 0 Yes 0 No • _ • 1;1 Natural . _ Roof System Information Low slope roof area (ft.2) 0 Steep Sloped area (ft.2) 14200 Section B (Roof Plan) Total (ft.2) • • . • ••.• j4200- ..•• • • • • • • • • •.• •• Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drams. Include .• dimensions of sections and levels, clearly identify dimensions of elevated pressure zones and ipcafio, of poppets. • Perimeter Width (a'): Corner Size (a' x a'): • • .• • •.• • • • �vE� 3�DG �tfrtcti`N1TN U� S S C ; 0 s�,t�1P LaS STI" F OANJ ` c•,Jn`1 (A� °/ x-99 SiAiwa/ dio,e-V--( Bag ops- S ' 12- 2 .. • •. ..• • •••• • • •••• •••• ••• • • •••• .. •••• .. .. • •••• 90 • .. • ••• •• . • ..• • ••• : • • • • • • • • • Tile Roof System "Delivering Excellence Every Day" Roof System Manufacturer: Miami -Dade County HVHZ Electronic Roof Permit Form Section D Tile Roof System BORAL ROOFING LLC Notice of Acceptance Number (NOA): 116-0711.05 Minimum Design Wind Pressures, If Applicable (from RAS 127 or Calculations): P 1: F9.1 P2: 8.1 P 3: 100.7 Maximum Design Wind Pressures, (From the NOA Specific system): '31 .3 psf Fill in the specific roof assembly components. If a component is not required, insert not applicable (n/a) in the text box. Roof Slope: Roof Mean Height: "/12" SIM Method of Tile Attachment: ft. ;--Adhesive, 2 Small Paddy Polyfoam Polypro- Alternate Method of Tile Attachment per NOA: Drip Edge Size & Gauge: Drip Edge Material Type: Drip Edge Fastener Type: --3" face 24 ga.-- --Galvinized Metal -- 1 1/4 RS NAILS Hook Strip/Cleat gauge or weight: -- Select Hook Strip -- Deck Type: 1*--6/8"'PlyWood-- Optional Insulation: • • • • • • • • • • • Optional Nailable Substratt! • • • • • • • • • • • • • • . • • Optional Nailable SubstratiitAtiachmel: • • • • . . . .. • • •••• i•••• Basesheet Type: • . . • • • • • • • • • • • • #30 ASTM TYPE II • • • • • • . • • . Fastener Type for Basesheet Attachment: 1 1/4 RS NAILS 6" OC AND 12" FIELD Tile Underlayment (Cap Sheet ) Type: 1TILE SEAL Tile Underlayment Attachment Method: SELF ADHERED Tile Profile: SAXONY 900 - - — • Section E r iM IAM I•DADE) 6...J "Delivering Excellence Every Day" Miarni-Dade County FIV{ -HZ Electronic Roof Permit Form Section E (Tile Calculations) Method 1 "Moment Based Tile Calculations Per RAS 127" For Moment based tile systems, use Method 1. Compare the values for Mr with the values from Mf. If the Mf values are greater than or equal to the Mr values, for each area of the roof, then the tile attachment method is acceptable. P 1: P2: P 3: :39.1 68.1 1100.3 xX x�. x .315 .315 12.31 21.45 31.59 - Mg: - Mg: - Mg: 7.62 7.62 7.62 = Mr1: = Mr2: = Mr3: 14.69 {13.83 23.97 31.3 31.3 31.3 Method 3 "Uplift Based Tile Calculations Per RAS 127" NOA Mf NOA Mf NOA Mf For Uplift based tile systems use Method 3. Compare the values for F' with the values for Fr. If the F' values are greater than or equal to the Fr values, for each area of the roof, then the tile attachment method is acceptable. .... P1: P2: P3: xl: xl: xl: 111111 NM =1 Ixw: MN x w: x w: - W: - W: - W: NM Mil x cos A:17 = Fr1: x cos 8: = Fr2: cos A: = Fr3: . . . • Where to Obtain Information to complete tile calculations, . . . Description Symbol Where to Find .. . • . . • ... . • • Design Pressure P1 or P2 or P3 Table 1 RAS 127, or by an engineer analysis prepared, signed and sealed by a professional engineer based on ASCE 7. — Mean Roof Height H Job Site Roof Slope Aerodynamic Multiplier A ! X Job Site Product Approval (NOA) Restoring Moment due to Gravity Mg Product Approval (NOA) Attachment Resistance Mf Product Approval (NOA) Required Moment Resistance Mr Calculated Minimum Attachment Resistance I F' Required Uplift Resistance Fr Product Approval (NOA) Calculated Average Tile Weight W Tile Dimensions I = length w = width Product Approval (NOA) Product Approval (NOA) hi1,4MIDADE DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES (RER) BOARD AND CODE ADMINISTRATION DIVISION NOTICE OF ACCEPTANCE (NOA) Boral Roofing, LLC 7575 Irvine Center Drive, Suite 100 Irvine, CA 92618 MIAMI-DADE COUNTY PRODUCT CONTROL SECTION 11805 SW 26 Street, Room 208 Miami, Florida 33175-2474 T (786) 315-2590 F (786) 315-2599 www.miamidade.gov/economv 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, moiltr, or suspend the use of such product or material within their jurisdiction. RER reserves the rightto revoke this a !c' ptance, if it is determined by Miami -Dade County Product Control Section that this product or mate�i4g fails to meg: �i1e requirements of the applicable building code. This product is approved as described herein, and has been designed to comply with the Floc: da e..ilding.Coda including the High Velocity Hurricane Zone of the Florida Building Code. • • • • • DESCRIPTION: Saxony 900 Concrete Roof Tile . . • .. . • .... LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo,, ity, slate 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 product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA renews NOA No.13-0723.05 and consists of pages 1 through 8. The submitted documentation was reviewed by Alex Tigera. MIAMI•DADE COUNTY APPROVED \ v' NOA No.: 16-0711.05 Expiration Date: 04/26/22 Approval Date: 09/29/16 Page 1 of 8 ROOFING ASSEMBLY APPROVAL Category: Roofing Sub -Category: Roofing Tiles Material: Concrete Deck Type: Wood 1. SCOPE This NOA approves a system using Saxony 900 (Slate, Shake & Split Shake) Concrete Roof Tile, as manufactured Boral Roofing LLC in Lake Wales, FL and described this Notice of Acceptance. For locations where the pressure requirements, as determined by applicable Building Code, do not exceed the design pressure values obtained by calculations in compliance with RAS 127 using the values listed in the installation section herein. The attachment calculations shall be done as a moment based system. 2. PRODUCT DESCRIPTION Manufactured by Test Product Applicant Dimensions Specifications Description Saxony 900 -Slate Length = 17" TAS 112 Flat profile, interlocking, high-pressure extruded Width = 13" concrete roof tile with twq nail jioles. Fpr gl ttct deck,.. • • thickness = 1-5/32" batten, mortar set or adhes"tyg %ei; appliQaticias. .' Saxony 900 Split Shake Saxony 900 -Shake Trim Pieces MIAMI•DADE COUNTY Length = 17" Width = 13" thickness = 1-9/32" Length = 17" Width = 13" thickness = 1-9/32" Length: varies Width: varies varying thickness TAS 112 . . . Flat profile, interlocking, $ig1 . essure extruded • concrete roof tile with two n�ii1oles. For 1 rest deity, • • batten, mortar set or adhesiygt'appl42tttt?s' Top • surface produced with 4 difainetnit configurations: ' 1. Complete tile brushed. • • 2. Right half brushed f livIn in drawing) • • 3. Left half brushed • 4. No brush • • • • • • •• • ••. • TAS 112 Flat profile, interlocking, high-pressure extrttc�ed concrete roof tile with two nail holes. For direct deck, batten, mortar set or adhesive set applications. TAS -112 Accessory trim, boosted Barcelona, concrete roof pieces for use at hips, ridges and rakes. NOA No.: 16-0711.05 Expiration Date: 04/26/22 Approval Date: 09/29/16 Page 2 of 8 • 2.1 MANUFACTURING LOCATION 2.1.1 Lake Wales, FL 2.2 EVIDENCE SUBMITTED: Test Agency The Center for Applied Engineering, Inc. The Center for Applied Engineering, Inc. The Center for Applied Engineering, Inc. The Center for Applied Engineering, Inc. The Center for Applied Engineering, Inc. The Center for Applied Engineering, Inc. The Center for Applied Engineering, Inc. Redland Technologies Redland Technologies Redland Technologies Redland Technologies Atlanta Testing & Engineering, Inc. Celotex Corporation Testing Service Celotex Corporation Testing Service Walker Engineering, Inc. Walker Engineering, Inc. Walker Engineering, Inc. Walker Engineering, Inc. Walker Engineering, Inc. Walker Engineering, Inc. Walker Engineering, Inc. American Test Lab of South Florida Test Identifier 94-084 94-060A 25-7183-6 25-7183-5 25-7214-1 25-7214-5 Project No. 307025 Test #MDC -77 7161-03 Appendix II & III Letter Dated Aug. 1, 1994 P0631-01 P0402 R1.894/R2.894/R3.894 520109-1 520111-4 520191-1 Evaluation Calculations Evaluation Calculations Evaluation Calculations Evaluation Calculations Evaluation Calculations Calculations Evaluation Calculations RT0617.04-16 Test Name/Report Static Uplift Testing TAS 101 (Mortar Set) Static Uplift Testing TAS 101 (Adhesive Set) Static Uplift Testing TAS 102 (2 Quik -Drive Screws, Direct Deck) Static Uplift Testing TAS 102 (2 Quik -Drive Screws, Battens) Static Uplift Testing TAS 102 (1 Quik -Drive Screw, Direct Deck) Static Uplift Testing TAS 102 (1 Quik -Drive Screw, Battens) Wind Driven Rain TAS 100 • • • • • •• • Wind Tunnel Testing • TAS 108 (Nail -On) Wind Tunnel Testing TAS 108 (Nail -On) Wind Tunnel Testing • • • • TAS 108 (Mortar Set) . Withdrawal Resistance Testing of screw vs. smooth shank naiL. • 4000 • • •.•4 Physical Properties TAS 112 Static Uplift Testing TAS 101 Static Uplift Testing TAS 101 25-7094 25-7496 25-7584/25-7804b-8/25-7804-4 & 5 25-7848-6 25-7183 Aerodynamic Multipliers Two Patty Adhesive Set System Restoring Moments Due to Gravity TAS 112 Date May 1994 March, 1994 Feb. 1995 Feb. 1995 March, 1995 March, 1995 •bc� .••1.994 •. • • •• • • • . • 15ec.' 1991 • • • • • Wirt994 • .. .3ulyf994 Sapt:1993 ••• . • Aug.' 1994 • • • • • • • Dec. 1998 March 1999 February 1996 April 1996 December 1996 March 1995 09/01/16 April 1999 09/01/16 06/29/16 NOA No.: 16-0711.05 Expiration Date: 04/26/22 Approval Date: 09/29/16 Page 3 of 8 3. LIMITATIONS 3.1 Fire classification is not part of this acceptance. 3.2 For mortar or adhesive set tile 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 Building Code Compliance Office for review. 3.4 Minimum underlayments 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. 3.6 This acceptance is for wood deck applications. Minimum deck requirements shall be in compliance with the applicable Building Code. 4. INSTALLATION 4.1 Saxony 900 (Slate, Shake & Split Shake) Concrete Roof Tile and its components shall be installed in strict compliance with Roofing Application Standard RAS 118, RAS 119, and RAS 120. 4.2 Data For Attachment Calculations • • • • .. • .••• • •• • • • Table 1: Average Weight (W) and Dimensions (I x w)• • �•lb••. • ••• Tile Profile Weight -W (Ibf) Length -I (ft) . • ..• • Width -w (ft) ...fl.. ;•• Saxony 900 10.9 1.417 • .• •• ••• '1.08 . .. ••. ... Slate, Shake & Split Shake Slate, Shake & Split Shake 7.70 .. ..• •.• ; Table 4: Attachment Resistance Expressed as a Moment - Mf (ft-Ibf) for Mechanically Fastened Systems Tile Profile Fastener Type Direct Deck (min 15/32" plywood) Direct Deck (min. 19/32" plywood) Battens Saxony 900 Slate, Shake & Split Shake 2-10d Ring Shank Nails 30.9 38.1 17.2 1-10d Smooth or Screw Shank Nail 7.3 9.8 4.9 2-10d Smooth or Screw Shank Nails 14.0 18.8 7.4 1 .#8 Screw 30.8 30.8 18.2 2 .#8 Screws 51.7 51.7 24.4 1-10d Smooth or Screw Shank Nail (Field Clip) 24.3 24.3 24.2 1-10d Smooth or Screw Shank Nail (Eave Clip) 19.0 19.0 22.1 2-10d Smooth or Screw Shank Nails (Field Clip) 35.5 35.5 34.8 2-10d Smooth or Screw Shank Nails (Eave Clip) 31.9 31.9 32.2 Table 5: Attachment Resistance Expressed as a Moment Mf (ft-Ibf) for Two Paddy Adhesive Set Systems Tile Profile Tile Profile Tile Application Minimum AttaChment : ••R•esistance ••• Saxony 900 Slate, Shake & Split Shake Adhesive' 31.3•- ••• 1 See foam adhesive manufacturer's component approval for installation requirements. • • • • •• • ••-•-- • 2 The Dow Chemical Company TileBondi' one -component foam minimum weight per paddy 13.9 grdMS.• • 3. ICP Adhesives Polyset® AH -160 two -component foam, minimum weight per paddy 8 grams.• •: • •• •• • • • • • •• • Table 6: Attachment Resistance Expressed as a Moment -MiZ{t:fi) for Single Paddy Adhesive Set Systems • • • • Tile Profile Tile Application •INinimum•Atta hmertt Resistance Saxony 900 Slate, Shake & Split Shake ICP Adhesives Polyset® AH -160 Two -component foam 118.94 40.45 3 Large paddy placement of 45 grams of Polyset® AH -160. 4 Medium paddy placement of 24 grams of Polyset® AH -160. Table 7: Attachment Resistance Expressed as a Moment - Mf(ft-Ibf) for Mortar Set Systems Tile Profile Tile Application Minimum Attachment Resistance Saxony 900 Slate, Shake & Split Shake Mortar Set6 43.96 5 Tile-Tite Roof Tile Mortar MIAMIDADE COUNTY APPROVED NOA No.: 16-0711.05 Expiration Date: 04/26/22 Approval Date: 09/29/16 Page 5 of 8 •.• • • • .• . • ... • .. • .. . • . • • • ••• ••• • 5. LABELING 5.1 All tiles shall bear the imprint or identifiable marking of the manufacturer's naive or logo as detailed below, or following statement: "Miami -Dade County Product Control Approved". LABEL FOR BORAL SAXONY 900 TILES (LAKE WALES FL PLANT) LOCATED UNDERNEATH TILE 6. BUILDING PERMIT REQUIREMENTS 6.1 Application for building permit shall be accompanied by copies of the following: 6.1.1 This Notice of Acceptance. 6.1.2 Any other documents required by the Building Official or applicable building code in order to properly evaluate the installation of this system. NAIL HOLES PROFILE DRAWINGS • . • • . ... . .. • . .... • .. •. . ... • .... . . .... • . . .. .. .. . . • .... • • • . • . • • • • • • •. . • . •• . • • . .. . ... . • • 1-5/32" (Slate) 17" r IAMIDADE COUNTY, APPROVED UNDERLOCK SAXONY 900 - SLATE 13" COVERLOCK NOA No.: 16-0711.05 Expiration Date: 04/26/22 Approval Date: 09/29/16 Page 6 of 8 NAIL HOLES P PROFILE DRAWINGS - "V•.,.`�ti��'�` .'mac"a -. �� 17" Note: Available Top Surface Finishes 5. Complete tile brushed 6. Right half brushed (shown in drawing) 7. Left half brushed 8. No brush SAXONY 900 - SPLIT SHAKE MIAMI•DADE COUNTY APPROVED 13" • . • . • .. . . .... . . .... . . .. .. . . . •• • . . .. . . . .... • .. • . • ... • . . • • • .. • . . ... • . . . . ••• . • • • • . . . • . • • • • • • NOA No.: 16-0711.05 Expiration Date: 04/26/22 Approval Date: 09/29/16 Page 7 of 8 • PROFILE DRAWINGS SAXONY 900- SHAKE END OF THIS ACCEPTANCE • .... • . . . . .. . . . . . ..• .. .... • . . • • • • • • • • • • • • • .. NOA No.: 16-0711.05 Expiration Date: 04/26/22 Approval Date: 09/29/16 Page 8 of 8 DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES (RER) BOARD AND CODE ADMINISTRATION DIVISION NOTICE OF ACCEPTANCE (NOA) Boral Roofing LLC. 7575 Irvine Center Drive, Suite 100 Irvine, CA 92618 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.. MIAMI-DADE COUNTY PRODUCT CONTROL SECTION 11805 SW 26 Street, Room 208 Miami, Florida 33175-2474 T (786) 315-2590 F (786) 315-2599 www.miamidade.gov/economv • requirements of the applicable building code.• • •••• •• This product is approved as described herein, and has been designed to comply with the Florida Btiilddng Cole. • • • including the High Velocity Hurricane Zone of the Florida Building Code. • •••• • DESCRIPTION: BORAL TileSeal LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, cite st 4e and Miaowing 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 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 renewes NOA#13-1113.05 and consists of pages 1 through 4. The submitted documentation was reviewed by Freddy Semino MANMADE COUNTY APPROVED NOA No.: 17-0530.10 Expiration Date: 07/31/18 Approval Date: 07/27/17 Page 1 of 4 • •• • • • • • • • • • • • ROOFING COMPONENT APPROVAL Category: Sub -Category: Material: Roofing Underlayment SBS PRODUCTS DESCRIPTION: Product BORAL TileSeal Dimensions 36" x 36' rolls 36" x 72' rolls MANUFACTURING LOCATION: 1. Brentwood, NH EVIDENCE SUBMITTED: .-Test Agency i Tnhegl—iters Laboratories, Inc. IRT-Arcon, Inc. PRI Asphalt Technologies, Inc. PRI Asphalt Technologies, Inc. PRI Construction Materials Technologies, LLC. MIAM•DADE COUNTY _APPROVED Test Specification TAS 103 ASTM D 1970 Test Identifier R14610 02-012 NEI -006-02-01 NEI -008-02-01 NEI -045-02-01 NEI -053-02-01 NEI -076-02-01 NEI -034-02-02 Product Description SBS self -adhering asphalt sheet material with a white glass re -enforced polyester surfacing fabric; for use as an underlayment in sloped roof assemblies. Test Name/Report• •,per • Follow up Service •' • ; , V3'! O2 TAS 103 • 02/2£/02' TAS 103 ••••'• :ONO: 402 • • • • TAS 114 (H:) A7/30/02 • • ASTM D 4798 & ASTM G 1 SS • . (1g/a8/07 ASTM D 4798 & ASTM G 115 • ; ,05/04/08 TAS 103 / ASTM D4798 . V2/1.4t11 ASTM D 1970• • A1✓29L13 • NOA No.: 17-0530.10 Expiration Date: 07/31/18 Approval Date: 07/27/17 Page 2 of 4 APPROVED ASSEMBLIES: Deck Type 1: Deck Description: System E(1): Base Sheet: Membrane: .,S Surfacing: Wood, non -insulated 15/32" or greater plywood or wood plank Anchor sheet mechanically fastened deck, membrane adhered. One or more plies of ASTM D 226 Type II or ASTM D 2626 with a minimum 4" head lap and a 6" end lap mechanically fastened to deck with approved nails and tin caps 6" o.c. at the laps and two staggered rows 12" o.c. the field of the roll. One or more plies of BORAL TileSeal Underlayment with a minimum 3" head lap and minimum 6" end lap. Place the first course of membrane parallel to the eave, rolling the membrane to obtain maximum contact. Remove the release membrane as the membrane is applied. Vertical strapping of the roof with BORAL TileSeal Underlayment is acceptable. All end laps and laps without black selvage area shall be sealed under lap using an SBS modified mastic. Note: When used in Tile roof systems BORAL TileSeal Underlayment shall be back nailed to deck with approved annular ring shank nails and tin caps at a maximum 6" o.c. at the side laps. No nails or tin caps shall be exposed.• • • •• • 40 •••• • • . Approved for Approved Adhesive Set Roof Tile Systems, Mechanically�as t erred Roof 1i%, Metal Roofing, Wood Shake & Shingles, and Asphaltic Shingle assemb1 s4: • •• ...• • • • •••• • . • .• •• • •. • . • • •• • • . •. • • . •• • ••• • NOA No.: 17-0530.10 Expiration Date: 07/31/18 Approval Date: 07/27/17 Page 3 of 4 LIMITATIONS: 1. Fire classification is not part of this acceptance. 2. This acceptance is for prepared roofing applications. Minimum deck requirements shall be in compliance with applicable building code. BORAL TileSeal underlayment shall be installed in strict compliance with applicable Building Code. 3. BORAL TileSeal underlayment shall be applied to a smooth, clean and dry surface with deck free of irregularities. 4. BORAL TileSeal underlayment shall not be applied over an existing roof membrane as a recover, but may be applied over a roofing Base/Anchor sheet underlayment. 5. BORAL TileSeal underlayment shall not be left exposed as a temporary roof for longer than 180 days of application. 6. The standard maximum roof pitch for BORAL TileSeal underlayment shall be 6:12 when tiles are loaded directly to the BORAL TileSeal underlayment; loading boards or battens are required on roof pitches greater than 6:12". 7. Refer to Prepared Roofing system Product Control Notice of Acceptance for listed approval of this product with specific prepared roofing products. 8. Tiles shall be stored on battens on roof pitches greater than 6:12". 9. BORAL TileSeal underlayment may be used with any approved roof covering Notice of Acceptance listing BORAL TileSeal underlayment as a component part of an assembly in the Notice of Acceptance. If BORAL TileSeal underlayment is not listed, a request may be made to the Authority Having Jurisdiction (AHJ) or the Miami -Dade County Product Control Department for approval provided that appropriate • documeni St7on is provided to detail compatibility of the products, wind uplift resistance, and fire testing resui't§y •; • • . •• • 10. All nails in the deck shall be carefully checked for protruding heads. Re -fasten any loose•dooic4n panelei.fi veep the deck thoroughly to remove any dust and debris prior to application. • • • 11. When applying the membrane in the valley, start at the low point and work to the high point:do ing thinvaili,rane from the center outward in both directions. For ridge applications, center the membranetcl.r ll fron the enter • • • • • • • outward in both directions. • . . • .... 12. Roll or broom the entire membrane surface so as to have 100% contact with the surface, gtVing Special attention to •, •• overlap areas. ' ' 13. Flash vent pipes, stacks, chimneys and penetrations in compliance with Roof Assembly tpgitn2 Product Cgntrol • • Notice of Acceptance and applicable Building Code. ••. 14. All protrusions or drains shall be initially taped with a 6" piece of underlayment. This target piece shall be pressed in place and formed around the protrusion to ensure a tight fit. A second layer of BORAL TileSeal underlayment shall be applied over the underlayment, and sealed using an SBS modified mastic. 15. 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. 16. All membranes or packaging shall bear the imprint or identifiable marking of the manufacturer's name or logo, city and state of manufacturing facility, and the following statement: "Miami -Dade County Product Control Approved" or the Miami -Dade County Product Control Seal as shown below MIAMI•DADE COUNTY APPROVED END OF THIS ACCEPTANCE MIAMI•DADE COUNTY APPROVED NOA No.: 17-0530.10 Expiration Date: 07/31/18 Approval Date: 07/27/17 Page 4 of 4 MIAM I-DA11 1 DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES (RER) BOARD AND CODE ADMINISTRATION DIVISION NOTICE OF ACCEPTANCE (NOA) ICP Adhesives and Sealants, Inc. 12505 NW 44th Street Coral Springs, FL. 33065 MIAMI-DADE COUNTY PRODUCT CONTROL SECTION 11805 SW 26 Street, Room 208 Miami, Florida 33175-2474 T (786)315-2590 F (786) 315-2599 Ivww.miamidade.gov/economy 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 Florida ggiliiing 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 loge,•eity, 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 all Wit .•.• • .• • . • •.•• • • • • • • • state► an Iollowilrag... . •• • . • •... • has beer! 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 chede in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA renews NOA 16-0315.01 and consists of pages 1 through 11. The submitted documentation was reviewed by Alex Tigera. .. J MIAMI•DADE COUNTY NOA No.: 17-0322.03 Expiration Date: 05/10/22 Approval Date: 04/27/17 Page 1 of 11 • ROOFING COMPONENT APPROVAL: Category: Sub Category: Materials: Roofing Roof tile adhesive 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 tile systems using ICP Adhesives Polyset® AH -160. PRODUCTS MANUFACTURED BY APPLICANT: Product ICP Adhesives Polyset®AH-160 ICP Adhesives Foam Dispenser RTF1000 ICP Adhesives ProPack® 30 & 100 Dimensions Test Product Description Specifications N/A TAS 101 Two component polyurethane foam adhesive N/A N/A PRODUCTS MANUFACTURED BY OTHERS: Dispensing Equipment Dispensing Equipment • .... • .... .... • .. • . • .•. • . .. • . • . .. .. •... Any Miami -Dade County Product Control Accepted Roof Tile Assembly having a current Nr which list attachment resistance values with the use of ICP Adhesives Polyset® AH -160 roof tile adhesive. • MANUFACTURING LOCATION: 1. Tomball, TX. PHYSICAL PROPERTIES: Property Density Compressive Strength Tensile Strength Water Absorption Moisture Vapor Transmission Dimensional Stability Closed Cell Content Test ASTM D 1622 ASTM D 1621 ASTM D 1623 ASTM D 2127 ASTM E 96 ASTM D 2126 ASTM D 2856 • • . . .. . Results ... • .. 1.6 lbs./ft.3 18 PSI Parallel to rise 12 PSI Perpendicular to rise 28 PSI Parallel to rise 0.08 Lbs./Ft2 3.1 Perm / Inch +0.07% Volume Change @ -40° F., 2 weeks +6.0% Volume Change @158°F., 100% Humidity, 2 weeks 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. MIAMWADE COUNTY APPROVED . • • NOA No.: 17-0322.03 Expiration Date: 05/10/22 Approval Date: 04/27/17 Page 2 of 11 EVIDENCE SUBMITTED: Test Agency Center for Applied Engineering Miles Laboratories Polymers Division Ramtech Laboratories, Inc. Southwest Research Institute Trinity Engineering Celotex Corp. Testing Services Test Identifier #94-060 257818-1PA 25-7438-3 25-7438-4 25-7438-7 25-7492 NB -589-631 9637-92 01-6743-011 01-6739-062b[1] 7050.02.96-1 P36700.04.12 P39740.02.12 528454-2-1 528454-9-1 528454-10-1 520109-1 520109-2 520109-3 520109-6 520109-7 520191-1 520109-2-1 Test Name/Report TAS 101 TAS 101 SSTD 11-93 SSTD 11-93 SSTD 11-93 ASTM D 1623 ASTM E 108 ASTM E 108 ASTM E 84 TAS 114 ASTM D 1623 TAS 101 TAS 123 TAS 101 TAS 101 TAS 101 • • • • • ..• . .... . . .. .. • . . • • • . . .. . Date 04/08/94 12/16/96 10/25/95 11/02/95 12/12/95 02/01/94 04/30/93 11/16/94 01/16/95 03/14/96 0d/Igri (v2/21%12 •••• • 1-0/234)8 . .. • 12/28198 • .'• . . • . • • • . • ... • '.. 03/02/99 • LIMITATIONS: 1. Fire classification is not part of this acceptance. Refer to the Prepared Roof Tile Assembly for fire rating. 2. ICP Adhesives Polyset® AH -160 shall solely be used with flat, low, & high tile profiles. 3. Minimum underlayment shall be in compliance with the Roofing Application Standard RAS 120. 4. Roof Tile manufactures acquiring acceptance for the use of ICP Adhesives Polyset® AH -160 roof tile adhesive with their tile assemblies shall test in accordance with TAS 101. 5. 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. MIAMIDDADE COUNTY NOA No.: 17-0322.03 Expiration Date: 05/10/22 Approval Date: 04/27/17 Page 3 of 11 • INSTALLATION: 1. ICP Adhesives Polyset® 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 Polyset® 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 tile assembly NOA. 3. ICP Adhesives Polyset® 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 RTF1000 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••I P. • Adhesives ProPack® 30 & 100 dispensing equipment only.• • • • • • • 7. ICP Adhesives Polyset® 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 minuticisokter ICP Adhesives • Polyset® AH -160 has been dispensed. • • • • • • • .•••• . 9. ICP Adhesives Polyset® AH -160 placement and minimum patty weight shall be in acc,44410.pge with the.. • • Placement Details' herein. Each generic tile profile requires the specific placement note$.herein. •.:..' MIAMI•DADE COUNTY APPROVED •. • • • • . • •. • • • • • .•. • • • • • • • • NOA No.: 17-0322.03 Expiration Date: 05/10/22 Approval Date: 04/27/17 Page 4 of 11 Table 1: Adhesive Placement For Each Generic Tile Profile Tile Profile Placement Detail Minimum Paddy Contact Area Minimum Paddy Gram Weight Eave Course - Flat, Low, High Profiles All Eave Course 17-23 sq. inches 45-65 Flat, Low, High Profiles #1 17-23 sq. inches 45-65 Flat Profile #2 10-12 sq. inches 30 Low Profile #2 12-14 sq. inches 30 High Profile #2 17-19 sq. inches 30 Flat, Low, High Profiles #3 Two Paddys: 8-9 sq. inches at head of tile 9-11 sq. inches at overlap 12 grams per paddy Two -Piece Barrel (Cap Tile) Two Piece 2 Beads (1 each longitudinal edge) 20-25 sq. inches each bead 17 grams per bead Two Piece Barrel (Pan Tile) Two Piece 65-70 sq. inches •• 34 grana: Hiller pan... LABELING: •• • • • .• • • • •••• ••• • • • • • All approved products listed herein shall be labeled and shall bear the imprint or identifiable arj�jtig of tj�e • • • • • manufacturer's name or logo and following statement: "Miami -Dade County Product Control Appt'oved" ar t114 Miami. Dade County Product Control Seal as shown below. • f9AMl RADE COUNTY rjuk BUILDING PERMIT REQUIREMENTS: •. •• .•.• • • • • • • • • • • • • • • • •• • • • • ••• • • • • • As required by the Building Official or applicable building code in order to properly evaluate the installation of this system. MIAMI•DADE COUNTY APPROVED NOA No.: 17-0322.03 Expiration Date: 05/10/22 Approval Date: 04/27/17 Page 5 of 11 ADHESIVE PLACEMENT DETAIL # 1 4asF t icuyli plastic ti•w rt 'dndei?ipmiult Paddy. l4rticaac 7. _'i U i?onbi laailthrough pia=_ -ice cement Iwhtnreciiircdy Undrrlaymant rel-•:.�:i•;�. --•: I L atttl ns optiona' 1i�ail :E uyrt ce7vii {tvriemrrgarrrJ'; Undrrlayrrenl�.- Paddy laenfa.i.Til..1 Pascia Voeepiete [.3:" d'asurt pulp cd. Flat/Low Profile Tile 1. Starting at the eave course, apply a minimum 2" (50.8 mm) x 10" (254 mm) x 1" (25.4 mm) foam paddy onto the underlayment positioned as shown, under the strengthening rib closest to the overlock of the tile being set. 2. Continue in same manner. Insure approximately 17 (109.7 cm2) — 23 (148.4 cm2) square inch adhesive contact with the underside of the tile. Medium Profile / Double Pan Tile 1. Starting at the eave course, apply a nlitrtrhtrin 2" (50.8 mm) x 10" (254 nam) x 1." (25.4M foam paddy onto the underlayment jositio retl as shown • under the pan portion ot e; t1e closest tQ the overlock of the tile being,y .• •. 2. Continue in same manner.diii re approximately 1W.: .. • (109.7 cm2) — 23 (148.4•c square inelr adhesive • contact with the undersiV2•dPtjre tile. • . • • . • .. • ... • • . High Profile / Single Pan Tile 1. Starting at the eave course, apply a minimum 2" (50.8 mm) x 10" (254 min) x 1" (25.4 mm) foam paddy onto the underlayment positioned as shown under the pan portion of the tile closest to the overlock of the tile being set. 2. Continue in same manner. Insure approximately 17 (109.7 cm2) — 23 (148.4 cm2) square inch adhesive contact with the underside of the tile. NOA No.: 17-0322.03 Expiration Date: 05/10/22 Approval Date: 04/27/17 Page 6 of 11 ADHESIVE PLACEMENT DETAIL # 2 &il Ii,rauGh 1,i.n c[r111Htf% {?�I•-a�:-� r tnuire dl Ft.}c'.dy' �L4t:ryrklhi:lsl Basins opt.nal El Caudat -�Fa:tla Esvetlaaare Nail ihrau*h plastic cement ;when required; Urd•rl4pr,sn!"•Y�. Pon_ C- liens opik,n4FJ r? - -Paddem:a lltilile;i EAVM Cc: 4 ' MIAMI•DADE COUNTY APPROVED Flat/Low Profile Tile 1. Starting at the eave course, apply a minimum 2" (50.8 mm) x 10" (254 mm) x 1" (25.4 mm) foam paddy onto the underlayment positioned as shown under the strengthening rib of the tile closest to the overlock of the tile being set. Insure approximately 17 (109.7 cm2) — 23 (148.4 cm2) square inch adhesive contact with the underside of the tile. 2. At the second course, apply a minimum 2" (50.8mm) x 7" (177.8 mm) x 1" (25.4 mm) foam paddy onto the underlayment positioned as shown under the strengthening rib closest to the overlock of the tile being set. 3. Continue in same manner. Insure approximately 10" (64.5 cm2) - 12 (77.4 cm2) square inch acl•l es ve contact with the undersidepf the tile. •••••• • • • • •• • • •• • • • • Medium Profile / Double Pan rfileee • ••• • •••• • • • • • • • 1. Starting at the eave course, g13151�' a minimum 2" (50.$': • mm) x 10" (254 mm) x 1"•(:;Xx m) foarxpaddy onto the underlayment positjgiAl as shownu nder the • pan portion of the tile closest tb tele overlockpf the tile being set. Insure approximately 17 (elU9'7 tm2) • 23 (148.4 cm2) square inch'ad1 essve cox6aet v+ith the. • underside of the tile. • • • •• 2. At the second course, apply a minimum 2" (50.8mm) x 7" (177.8 mm) x 1" (25.4 mm) foam paddy onto the underlayment positioned as shown under the pan portion of the tile closest to the overlock of the tile being set. 3. Continue in same manner. Insure approximately 12" (77.4 cm2) - 14 (90.3 cm2) square inch adhesive contact with the underside of the tile. (Instructions continued on next page) NOA No.: 17-0322.03 Expiration Date: 05/10/22 Approval Date: 04/27/17 Page 7 of 11 ADHESIVE PLACEMENT DETAIL # 2 (CONTINUED) 2Jsiltltrauyh iwIucieraquiredI �nI lit}i-n+nt P.i-J 13«rr.l1hTjl«.) - I fascia -s 4` lV«.pTi i - 'Dili: cage MIAMI•DADE COUNTY APPROVED High Profile / Single Pan Tile 1. Starting at the eave course, apply a minimum 2" (50.8 mm) x 10" (254 mm) x 1" (25.4 mm) foam paddy onto the underlayment positioned as shown under the pan portion of the tile closest to the overlock of the tile being set. Insure approximately 17 (109.7 cm2) — 23 (148.4 cm2) square inch adhesive contact with the underside of the tile. 2. At the second course, apply a minimum 2" (50.8mm) x 7" (177.8 mm) x 1" (25.4 mm) foam paddy onto the underlayment positioned as shown under the pan portion of the tile closest to the overlock of the tile being set. 3. Continue in same manner. Insure approximately 17" (109.7 cm2) - 19 (122.6 cm2) square incli•V,sive contact with the underside:of theitile. • • • • • 4.• • • • •• • • • • •••• •••• • • • • •••• • • •• • • • • • •• •• •••• • • • • • • • • • • • • • • •• • ••• • • • •• NOA No.: 17-0322.03 Expiration Date: 05/10/22 Approval Date: 04/27/17 Page 8 of 11 ADHESIVE PLACEMENT DETAIL # 3 Nail through pl este ceme.nt Paddy Clew eentifes) lwhenrequired) \i `z Battens optionaly1 Nerdy 'under tile) • `''• Singlepaddy i� 1 ontopottile •' 4x4in �� ••._ Srng[epadd� �, - � under the Smglepaddy onundedayme5„r- 2x4in, 'f Flat/Low Profile Tile Nail through plastic cement 'when required) Battens optional 5inglepaddy under tile ;s ._:"6,- on ntopgle paddy�' }} onto of Erle / l 4xain. 2x4in.'= Singgle paddy on underlaymentf� Paddy 'between tiles) paddy [under tile' Eave Course Eave osure • Fascia Medium ProfileTile 1. On the eave course only, apply a minimum 2" (50.8 mm) x 10" (254 mm) x 1" (25.4 mm) foam paddy 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 overlook of the tile being set. Leave approximately 4" (101.6 mm) up from the eave edge free of foam to prevent the expanded adhesive from blocking the weep holes. Insure approximately 17-23 in2 (109.7-148.4 cm2) of adhesive contact with the underside of the tile 2. Apply a 4" (101.6 mm) x 4" (101.6 mm) x 1" (25.4 mm) foam paddy onto the underlayment just below the second course line positioned foam paddy under the strengthening rib for flat tile, or under the pan portion of the tile, closest to tharidelilock for the second course tile to bairlstalled.•fnsure • approximately 8-9 in' cni ::adhesive • • contact with the under dg pf jhe tile. • •••• • • • • •••• • (Instructions continued on ne.ipgge) • • •• •• •••• • • • • • • • • • • • • • •• • • ••• • • • •• • • • •• NOA No.: 17-0322.03 Expiration Date: 05/10/22 Approval Date: 04/27/17 Page 9of11 ADHESIVE PLACEMENT DETAIL # 3 (CONTINUED) Nail through plasticceinent•- Sinolepaddy under tie (when required) ?' Battens optional { r~` ,single ddy\ i oaundedaymen c __; -,e'4x41n. f "� Single 2x4in, j'�.., / paddy on .�` `jam Paddy {between tires) Paddy {under tile} 1 �S /737 �, 7 Yf Ewa Course — y< }} Fascia Weephole Eave closure '=;}� 2 Drip edge High ProflleTile MIAMI•DADE COUNTY APPROVED 3. Also apply a 2" (50.8 mm)x4"(101.6mm) x3/4" (19 mm) paddy on top of the eave course tile 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 contact with the underside of the tile at the overlap and 7 (45.2 cm2) - 9 (58.1 cm2) square inch adhesive contact with the underside of the tile at the head of the tile. Continue in same manner. •••• • • • • •••• • • • •• • • •• • • • ••. • • •••• • • • •••• • • •• • • • • • •• •• •••• • • • • • • • • • • • • • • •• • ••• • •• • • •• NOA No.: 17-0322.03 Expiration Date: 05/10/22 Approval Date: 04/27/17 Page 10 of 11 ADHESIVE PLACEMENT DETAIL TWO PIECE BARREL 1) Place enough adhesive to achieve 65 to 70 sq. in. in contact with the pan tile. 2) Turn covers upside down. Place adhesive in to 1 in.from outside edge of cover tile. Then install the tile. Ensure 20 to 25 sq.in.contact area. Underlayment Steep pitch applications (when required) Sheathing Eave closure (motar shown) Weephole fascia Board Remove top portion of the eave course cover tile. Abut to second course of pan tiles. Ensure eave end of pan and cover tiles are flush at eave line. Two Piece Barrel - High Profile Tile MIAMI•DADE COUNTY APPROVED Two Piece Barrel (Cap and Pan) Tile 1. Starting at the eave course, apply a minimum 2" (50.8 mm) x 10" (254 mm) x 1" (25.4 mm) foam paddy onto the underlayment positioned as shown under two adjacent pan tiles. Support eave tiles from rocking until adhesive has a chance to cure. 2. Continue in same manner bringing two pan courses up toward the ridge. Insure approximately 65 (419.4 cm2) — 70 (451.6 cm2) square inch adhesive contact with the underside of the pan tile. 3. Turn covers upside down exposing the underside of the tile. Apply a minimum 1" (29.el•th n) x 10" (254 mm) bead of adfiesivedirectly'd$ the innel• edge of each side of the.ove r tile:Lw ova approximately 3/4" (12) to 1" (25;1 mm) • from the outside edge pf the tile, inward, free of foam to allow for expansion. . • • . . .. . . • . 4. Turn cover tile over aitei•foam is applied and • place onto pan tile cd..iild.•]hsure a mitimum of • • 20 (129 cm2) - 25 (161.3 cm2) squarairkh contact area on each s.de.ofithe cover ti • le to tho pan tile. Continue in same manner. Tr away any cured exposed foam adhesive. Pointing of longitudinal edges of the cover tiles are considered optional. 5. When additional nailing is required, 2" (50.8 mm) x 4" (101.6 mm) nailers or the tie wire system using galvanized, stainless steel, or copper wire and compatible nails may be used. END OF THIS ACCEPTANCE NOA No.: 17-0322.03 Expiration Date: 05/10/22 Approval Date: 04/27/17 Page 11 of 11 • . • OWNER'S AFFIDAVIT OF EXEMPTION ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR EXISTING SITE - BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PURSUANT TO SECTION 553.844 F.S. Re: Owner's Name Property Address Roofing Permit Number Dear Building Official: I ( � ,\ae, indl connections of my building because: •• • • •••• certify that I am not required to ret/Olt:the rpof•lo wall • • • • •••• • •• • • • V. •••• • • • • !�J The just valuation for the structure for purposes of ad valorem taxation in 18Ss'than $300,000.00. • • • •• • • • •• •• •••• LJ The building was constructed in compliance with the provisions of the: lorida Building Codes •• • (FBC) or with the provisions of the 1994 edition of the South Florida Building rode •(1994 SFBC). ••••••• •• •• Print Name STATE OF FLORIDA COUNTY OF MIAMI-DADE Sworn to and subscribed before me this day of (SEAL) Personally known or Produced Identification ,20 ,(, DAN1 L PEREZ . ; ,•U * , S. Notary Pubi . - State of Commiss' 7 # GG 0 %;Foot•' P;ly Comm. Expires Nov 3, When the just valuation of the structure for purposes of ad valorem taxation is equal to or more than $300,000.00, and the building was not constructed in compliance with the FBC nor with 1994 SFBC, and affidavit of Roof to Wall Connection Hurricane Mitigation Retrofit must be provided. 8/10/2017 , Property Search Application - Miami -Dade County OFFICE OF THE PROPERTY APPRAISER Summary Report Property Information Folio: 11-3205-010-0010 Property Address: 1201 NE 94 ST Miami Shores, FL 33138-2946 Owner BERNARD LEE JTRS DEMETRIO T LORIS JTRS Mailing Address 1201 NE 94 ST MIAMI SHORES, FL 33138 USA PA Primary Zone 1400 SGL FAMILY - 3001-3250 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY : 1 UNIT Beds / Baths / Half 3/2/0 Floors 1 Living Units 1 Actual Area 3,250 Sq.Ft Living Area 2,720 Sq.Ft Adjusted Area 2,897 Sq.Ft Lot Size 14,295 Sq.Ft Year Built 1959 Assessment Information Year 2017 2016 2015 Land Value $514,620 $479,168 $435,712 Building Value $242,479 $244,434 $246,390 XF Value $20,707 $20,724 $13,715 Market Value $777,806 $744,326 $695,817 Assessed Value $715,401 $700,687 $695,817 Benefits Information Benefit Type 2017 2016 2015 Save Our Homes Cap Assessment Reduction $62,405 $43,639 • •$T3 ,E17 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 ('.e. County, School Board, City, Regional). Short Legal Description MIAMI SHORES BAY VIEW PB 40-16 LOT 1 LOT SIZE IRREGULAR OR 19890-0504 08 2001 1 COC 22016-0443 01 2004 1 Generated On : 8/10/2017 • . • • : Taxable Value Information • • • • Previous Sale ••`LOT) .••• • • •••! •$6Q,000 2016 • • • • $5Q,000 :•••a15 • • •. t50,000 County Exemption Value Taxable Value $8t5,881 $36,087 • •$T3 ,E17 School Board • ' • • • • • . Exemption Value .$25,000 M5,t80 • $25,00 Taxable Value $695,401 '$'695,6:7 • $670,817 •a City Exemption Value $50,000 $50,000 $50,000 Taxable Value $665,401 $650,687 $645,817 Regional Exemption Value $50,000 $50,000 $50,000 Taxable Value $665,401 $650,687 $645,817 Sales Information Previous Sale Price OR Book -Page Qualification Description 07/31/2014 $1,022,500 29260-1300 Qual by exam of deed 01/01/2004 $667,400 22016-0443 Sales which are qualified 08/01/2001 $432,500 19890-0504 Sales which are qualified 12/01/1993 $290,000 16197-1048 Sales which are qualified 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: "Delivering Excellence Every Day" MIAMI-DADE 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. 1. Aesthetics -workmanship: The workmanship provisions of Chapter 15 (High Velocity Hurricane Zone) are for the purpose of providing that the roofing system meets the wind resistance and water intrusion performance 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 as 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 renailed 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.betweti.xetghboring.. units (i.e. townhouses, condominiums, etc.). In buildings with common roofs, the roonngc ontrhFtbtand/or '• owner should notify the occupants of adjacent units of roofing work to be performed..:.. 4. Exposed ceilings: Exposed, open beam ceilings are where the underside af•Lire roo:'d&king ran.11e viewed from below. The owner may wish to maintain the architectural appearance;thEt&lore, loofing nait•'• •• penetrations of the underside of the decking may not be acceptable. The owner provides the optiorj of • • •• • maintaining this appearance. • • • • . • 5. Ponding water: The current roof system and/or deck of the building may'hordrairtwgll:and may • cause water to pond (accumulate) in low-lying areas of the roof. Ponding can be an indication of structural distress and may require the review of a professional structural engineer. Ponding may shorten the life expectancy and performance of the new roofing system. Ponding conditions may not be evident until the original roofing system is removed. Ponding conditions should be corrected. 6. Overflow scuppers (wall outlets): It is required that rainwater flow off so that the roof is not overloaded from a build up of water. Perimeter/edge walls or other roof extensions may block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accordance with the requirements of: Chapter 15 and 16 herein and the Florida Building Code, Plumbing. 7. Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of the structural assembly (the building itself). The existing amount of attic ventilation shall not be reduced. Owner's/Agent's Signature: Contractor's Signature: Property Address: Date: Permit Number: V .4 BUILDING PERMIT APPLICATION ❑ BUILDING ❑PLUMBING 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 Master Permit No. Sub Permit No. ❑ ELECTRIC XROOFING ❑ REVISION RECEIVED JUN 2 21011 S�� FBC Zo ty a�F -1(0 16i ❑ EXTENSION RENEWAL ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR "'JOB ADDRESS: (Z 0 1 4 4 11-(- S DRAWINGS City: Miami Shores County: Miami Dade Zip: 3 3 (3 (1 Folio/Parcel: /f• -3z Qs-- o/Q-rjptO Is the Building Histo LLT Designated: Yes NO L. -- Construction Type: 4. FJpod 'on WO BFE: VD FFE: NO v 0 r 1 Lc( Phone#: `7,P6 - S 12- - ?7? I Occupancy Type: Load: /OWNER: Name (Fee Simple Titleholder): PA:0 l'vi • Address: /20 ( A '74 r1? .57 City: A 1 v.M S---00 S State: Zip: 7 ? ' 3 ? Phone#: c72 Tenant/Lessee Name: Email: DT LC 62 G G(M iC.. • co CONTRACTOR:Company Name: 1.4 d & � ,►. i CCS Coy/ Phone 67(V5ge 8 33 Address: J (e 0 w C/ City: 1 k le Statee� 'T L Zip: 336 l7 Qualifier Name: t (i� e/Ir �.. '� VC ( K Phone#: 319(97il{3-10b State Certification or Registration #: eCL— (32 DESIGNER: Architect/Engineer: IUA} Address: Ay / Value of Work for this Permit: $ / fOOo' Type of Work: ❑ Addition ❑ Alteration Description of Work: Certificate of Competency #: Phone#: City: State: Zip: if7--''(Q/ Square/Linear Footage of Work: ❑ New Repair/Replace ❑ Demolition ?e•- Awl= / i /e. 2& /Vet' P/a. f /2000 Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ P--( TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) -Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. /Signature NER or AGENT Signature L/ / r�NTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this �Y 00 day of Toil e--- , 20 �� , by Z�a day of Mu Ay ,20 l,by o -I who is personally known to 1-{4ittcf &4110Yr , who is personally known to me or who has produced as me or who has produced identification and who did NOTARY PUBLIC: identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: MARIA CRUZ :' MY COMMISSION # FF997102 '•I,,,:;,;• 'f� EXPIRES July 09, 2020 (407) 398-0153 floridallotaryService.com ****Isli********************************************************************** 11 **************************** APPROVED BY (Revised02/24/2014) as `_afke,pp oath. MARIA CRUZ At MY COMMISSION # FF997102 ,, - EXPIRES July 09, 2020 (407) 398.0153 FloridallotaryService.com Sign: Print: M ri i- cv z - Seal: Plans Examiner Structural Review Zoning Clerk