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RF-17-2096 EECEIVEC Miami Shores Village OCT 27 2017 Building Department O"Q� 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 S,� FBC 20(q BUILDING Master Permit No. I2- 20 W PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL �I [:]PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I �� i�/" r-- /0 z S�l�Qfi City: Miami Shores Countv: Miami Dade Zio• Folio/Parcel#: Is the Building Historically Designated:Yes NO !/r i Occupancy Type: - Load: Construction Type: G 13S Flood Zone: Xe BFE: FFE: _ ��lcc�sal Fg mAl OWNER: Name(Fee Simple Titleholder): Iia C-1G a, Q e�1; S.4?— J vA Phone#: it'6- 2 Z- 3-f--) Address: !-0P-0 N 0 102— Cit ,S)-10 re-5 State: Zip: 53)38' Tenant/Lessee Name: )) Phone#: Email: gj:7 Z b-c- ver GL[7l, c r7.H CONTRACTOR:Company Name: Ano c-' Phone#: Address: City: State: Zip: Qualifier Name: Phone#:, State Certification or Registration#: Certificate of Competency#:. DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Co •:�-1.t'kM to'1�9M ''�fYLWiKA�MR'1!11�4eir`12�S LA`:rr.✓ A1", 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$ 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..... I OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO~OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT- IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged beforemethis The foregoing instrument was acknowledged before me this `T�ay of �� 20 t l�by day of 20 ,by h' isM1 ers no al to who is personally known to me or who has produced -fl t t me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: 1 Sign: , Sign: Print: L Print: Seal: •�;�� '"•. MAHARAI K.GONZALEZ Seal: MY COMMISSION#GG 044602 " a= EXPIRES:November 2,2020 •.;;01���.• Bonded Thru Notary Public Underwriters ********** *************************************************************** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ©G"Td�er 2-7 2d 1 fA'-1 .lZo a T'�chi 10 r-ellc Vle, ham a ��-"�, 4L 7'l0-4 /�0 /4 vrr'i pze- 710)W t-volf) X9 0 f-,CA k,�s f o. .wse-- 110 tee. 12,r,,d� , 740 I'e,,->IGL ce 7L49 4" e� /1GZvG ,S•GJ�'JG � �- �►e 4✓ ��ir1-rte '�'� �,� /���7'��d� (i✓ / v1l492 r SS ved- kD /2o v'� TecA /VP r 7,7V C9 U arA Se C6 r Permit No. RF-8-17-2096 `yHOR;;s Miami Shores Village Permit Type:ROOF F 10050 N.E.2nd Avenue NE ' s ' Work Classification:Fiat Miami Shores,FL 33138-0000 Permit Status:APPROVED Phone: (305)795-2204 F+<ORtDA Issue Date:8/22/2017 Expiration: 02/18/2018 Project Address Parcel Number Applicant 1280 NE 102 Street 1132050220030 Miami Shores, FL 33138-2618 Block: Lot: MARK&DENISE JUANICO Owner Information Address Phone Cell MARK&DENISE JUANICO 1280 NE 102 Street MIAMI SHORES FL 33138-2618 1280 NE 102 Street MIAMI SHORES FL 33138-2618 Contractor(s) Phone Cell Phone Valuation: $ 5,600.00 FLORIDA ROOF-TECH CORP ROOFIN (305)557-9685 Total Sq Feet: 444 i Type of Work:Re Roof Available Inspections: Additional Info:RE-RROF FLAT ROOF Inspection Type: Classification:Residential Tin Cap Scanning:3 Final Roof Roof in Progress Renailing Affidavit Review Roof Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Contractors Bond $500.00 Invoice# RF-8-17-64925 DBPR Fee I $3.75 CCF $3.60 08/18/2017 Check#:005348 $50.00 $726.10 DCA Fee $3.75 08/22/2017 Check#:005371 $726.10 $0.00 Education Surcharge $1.20 Bond#:3494 Permit Fee-New Roof $250.00 Scanning Fee $9.00 Technology Fee $4.80 Total: $776.10 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 AIDAVI str conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting s um responsibility f all work done by either myself, my agent, servants, or employes. I understand that separate permits are required foPLU BING, A ICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS certi t all the regoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructiout I au orize the above-named contractor to do the work stated. August 22, 2017 ut ori re:O er / Applicant / Contractor / Agent Date Buil a ment Copy August 22, 2017 1 a Miami Shores Village RECEIVED �eyf' Building Department AUG 18 2017 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 5 FBC 20 BUILDING Master Permit No. Q-..� 1� —Z�1 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISIONS ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL PUBLIC WORiKRS� ,1',.�CHANGE'OF [—] CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 10B ADDRESS: 4-2&P A-E 10-2 :4 City: Miami Shores County' Miami Dade Zip: 13d Folio/Parcel#: /300,�I ,2 QD30 FIs thelBidirding Historically Designated:Yes 3 NO--3 \�V ` Occupancy Type:` Load: Constru,ti\r,fype:� v V V Flood Zone: rY BFC- (' 1'3 FF�FF '.� IAN . OWNER:Name g(��Fee Simple 1Titleholder : �/ ��!�- Qn (� Phone#: Address: -)sQ /02 p City: State: FL Zip: 33�3Q Tenant/Lessee.Name: Phone#: Email: CONTRACTOR:Company Name: T {��t e4- P Phone#:d�JfJr7-�e(.15 Address: ;)-7.30 Gel O �n City: '!(� State: 1" Zip1� : �0� Qualifier Name: k(O-(6 Qdl 1�Ct(1✓Z (� \\�V��`� Phone#: 3 DS j(,e f J a State Certification or Re istration#: � , Uv Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: _ City: _State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: k4 4- Type of Work: ❑ Addition ` 0N'Alteration ❑ New 0 Repair/Replace ❑ Demolition Description of Work: t�\+\� Doc ( I Fv Specify color of color thru tile: �h Submittal Fee$ Permit Fee$ .-%0 •W _ CCF$_ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ _ Double Fee$ Structural Reviews$ _ Bond$ ���•r03 (Revised02/24/2014) TOTAL FEE NOW DUE$ 2/_IBJ. �D 42G, Io Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address s City State Zip r 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. 1 e absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. /i Signature e-7> _ Signature OWNER or AGENT CTO R The foregoing instrument �a/s acknowledged before me this The foregoing instrument as acknowledged before me this ao day of20 �� by day V/ 0311'I'CM4Z 3V 20 , by � C who is per onally known to K 3u-! ��1 rl�� t4 who is persori`ally known to me or who has produced PL-Df i 01'64L as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: ', n Sign: Print: Seal: Seal: oar?Y!�a� PAOLA M LOP o!!"Y'` PAOLA M LO A I/ I/ � MY COMMISSION#FF076 74 MY COMMISSION#FF076574 'wr►• EXPIRES:DEC 15,2017 � � IXPIRES:DEC 15,2017 , APPROVED BV�FY Plans Examiner Zoning r Structural Review Clerk (Revised02/24/2014) e AC'n CERTIFICATE t f L 111% - ' LIABILITY INSURANCE tlATE,M���,��IYYYY) THIS CERTIFICATE I5 ISSUED AS A MATTER OF INFORMATION.ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NE8118/2017 GATIVELY AMEND,,EXTEND OR.ALTER THE COVERAGE AFFORDED BY THE POLIGII»5 BELOW, THIS CERTIFICATE OF INSURANCE DOES, CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORi2Eb REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. tM terms an c the certificate holder is an AbbIT1ONAL INSURED,the POlicy(iea)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conn l i u s the endpolor,certain polities may require an endorsement. A statement on this certificate does not Confer rights to the certificate holder in lieu of such endorsamentfs). ' PRoovcER - FNA TACT Melissa V Cruz Pan American. insurance Group LLC NE;,_, _NE ."". .. _— 1S0 Alhambra Circle 'L4.ExU TaaFA:xIL - 7_�,.PI9 5uit8 92 _. mcruz 8namins _�—..•.._.., yidRE$�� �P _ graup,com Coral Gables FL 33134 —........ _INSURERi9iAFFORDiWGCOVERAGE INSUREaA I{insale Insurance Co €NSURwO — _ ._.._ ,__..__._.__ 389X! Florida Roof-Tech Carp Roofing Done Right INSURERS Guaranteed dba Florida Roof-Tech INSURERc 2730 West 78 Street )wsUREi : HialeahFI 33010" €IVSURERE 1... _......._.__. _ € COVERAGES €NSURER F� I CERTIFICATE fdUMBER:CL1691603597 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCCD BY PAID CLAIMS. €tdfr R` ._._—.._.. .........._LADOLSUgR LTR TYPE OF INSURANCE 3 �........`".. . POLICYfiFF I POU€YEXP"T ' ._........,..„,_... ...___ J X COMM GENERAL LIABILITY POLICY NUMBER ! M DPIV IMM/ ... LIMITS A 1 EACH.OCCURRENCE i g 1 flOC 40C� 'CLAIMS-MADE x I oCCUR IEA i)APAIAGE TO kEwtb ._ Q1tl0€542786�U 191161202`0 9(x5.;2017 PREIaISESiEa �are� 1100,00 MED EXP EXP tar€y ��ce scn} 5,000 g 1 GeN F;F�AiCLIMITAPPLIESPER: ;. i ... _ ^' !I i,PERSCNAk$AL+V€N t)KY 1 OS30 Otl0_. €.._ JJ I vElvERAs AGCR«A?'E _ 2,000,000 I PH X .tEe x LOC - 5 .. I 07hFR PRDD ryRUL Tb-.CQ �OP AGG 2,000,000 _ , AUTOMOBILE LABILITY € ,8 I I ANY A610 I 1 Ls a_,Bfi�t�1L f� OWNFO a _. . ..._ 'L NFO SI,NHLSUi,ED 1 i �}yC'DiLYIN,#E,'T71f'at a€5[hi b AUTOS AUTOS _..... NEONON-OYHIRED AUTOS UOS AOnILY IN1tI€�iY tI'er c itl �i) PRQPERTY ).J�LMAGE ... I UMBRELLA LIAR DGCUK t I EXCESSEAC LIAB .._...,, _CLAIMS-kt 1)E. 1 ... .. . AGGREGATE EN E _ DEC) _ __...... i$ REreNTruN� � � � iWDIM ERS t{JMPENSA7ION II -AND EMPLOYERS LIABILITY } ,ANY FKOR€E`Dft PnR'rNEREXE:;UT€VE YI NI t . ._ �TUrir, j EII rManda Scy In N ) XCL€0E D?,: i .�N t AOFFICERt � _... ... ..... ... _ C e j( {MnndataryinNH) � �6 I EACH A£,4InENT n:5 R7PTIOIJ[3�'OPERATIONS ba�cra, J ... _..... L UISI^Aat: FA FMP OYt W.. I E E..OISEASaE-POLiCY L€MI'€ 5 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES(ACCORD 101,Additional Reiner SCIIadula,may be attached If mora spaca is required} State License No. CCCO52460 Roofing Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department THE EXPIRATION DATE, THEREOF, NOTICE- WILL BE DELIVERED IN 10050 14E 2nd Avenue ACCORDANCE WITH THE.POLICY PROVISIONS. Miami Shores,, FL 33138 AUTHORIZED REPRESENTA'DVE - - Melissa _... y ACORb 25 ZQ1AfQf @3988-2014ACORD d.CORPORATION. Ati rights reserve W_) The ACORD name find logo are registered marks Of.ACORD INS025 t2c;ap 1 1 004683 Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT A BILL—DO NOT PAY '165822 LBT BUSINESS NAME/LOCATION RECEIPT NO. FLORIDA ROOF—TECH CORP ROOFING DONE EXPIRES LvI�HR6dtH�fV�F[EEp 2730 W 78 ST 7444232 SEPTEMBER 30, 2017 HIALEAH FL 33016 Must be displayed at place of business Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS FL ROOF—TECH CORP ROOFING DONE RI®61f,10EQ?KTlr5 BUILDING CONTRACTOR PAYMENT RECEIVED C/O RODRIGUEZ MARCIAL CCCO52460 BY TAX COLLECTOR Worker(s) 1 $45.00 08/17/2016 ECHECK-16-173487 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, Permit,or a certification of the holder's qualifications,to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles-,Miami'=Dade Code Sec Ba-216. For more information,visit www miamidade aov/tuxcollector RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION . CONSTRUCTION INDUSTRY LICENSING BOARD iq 1-1:40M 111101116 1;1 4;V CCC052460 1, . The ROOFING CONTRACTOR `n Named below IS CERTIFIED Under the provisions of Chapter 489 FS. . ���;m , ;� �'. �►�-° Expiration date: AUG 31, 2018 ,�r r RODRIGUEZ, MARCIAL Lft„ UE, FLORIDA ROOF-TECH CO�Ft00FING DONE RIGHT GUARANTEED 27308TH STREET. eHIAEAH � O16 RE- ISSUED: 08/17/2016 DISPLAY AS REQUIRED BY LAW SEO# L1608170002407 �c o` CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDnYYY) 07/20/2017 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 have ADDITIONAL INSURED provisions or 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 CONTACT NAME: PHONE A/C,No,Ext): 800 277.1620 X4800 FAX A/C,No): 727 797-0704 FrankCrum Insurance Agency, Inc. E-MAIL ADDRESS: 100 South Missouri Avenue INSURERS AFFORDING COVERAGE NAIC# Clearwater,FL 33756 INSURER A: Frank Winston Crum Insurance Company 11600 INSURED INSURER B: FrankCrum L/C/F Florida Roof-Tech Corp Roofing Done Right INSURER C: Guaranteed INSURER D: 100 South Missouri Avenue INSURER E: Clearwater FL 33756 INSURER F: COVERAGES CERTIFICATE NUMBER: 434697 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AD IR) SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSRD WVD (MMIDDrYYYY) (MMIDDIYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one penton) $ PERSONAL B ADV INJURY $ P L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY F__]PROJECT [---]LOG PRODUCTS-COMP/OP AGO $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO OWNEDAUTOS SCHEDULED BODILY INJURY Perper—) $ ONLY AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ PER STATUTE OTH- WORKERS COMPENSATION AND WC201700000 01/01/2017 01/01/2018 X ER A EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $1,00G,000 (Mandatory in NH) If yes,describe under, E.L.DISEASE-EA EMPLOYEE $1.000.000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $i.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Effective 02/03/2014,coverage is for 100%of the employees of FrankCrum leased to Florida Roof-Tech Corp Roofing Done Right Guaranteed(Client)for whom the client is reporting hours to FrankCrum.Coverage is not extended to statutory employees. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shoes Village Building Department AUTHORIZED REPRESENTATIVE 2nd Avenue Miami Miami Shores,FL 33138 ©1988-2016 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACCOR"® P ATE(MM/DDIYYYY) L� CERTIFICATE OF LIABILITY INSURANCE 7/20/2017 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 CONTACT Melissa V. Cruz NAME: Pan American Insurance Group LLC PHONE (305)445-6441 FAC No: (305)445-6469 150 Alhambra Circle E-MAIL ADDRESS:mcruz@panaminsgroup.com Suite 925 INSURERS AFFORDING COVERAGE NAIC# Coral Gables FL 33134 INSURERA:Kinsale Insurance Co. 38920 INSURED INSURER B Florida Roof-Tech Corp Roofing Done Right INSURERC: Guaranteed dba Florida Roof-Tech INSURER 2730 West 78 Street INSURERE: Hialeah FL 33016 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1691603697 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE J=WVD POLICY NUMBER MMIDDIYYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X❑OCCUR DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ 0100042786-0 9/16/2016 9/16/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO JECT ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident I $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ t If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ l DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) It c.QJ)Se - or Or CON4Gc*0Y i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN S 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Melissa Cruz/MVCy-��- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) a t i t i SHORES T f 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 govern 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• Renailing wood decks: When replacing roofing,the existing wood roof deck may have to be re ed in accordance with the current provisions of Section 84403. (The roof deck is usually concealed prior to removing the existing roof system). 4. '` Exposed Ceiling: Exposed, open beam ceilings are where the underside of the roof decking c e viewed from below. The owner may wish to maintain the architectural appearance;therefore, roofing nail penetration of the underside of the decking may not be acceptable. This provides the option of maintaining the appearance. 6. Overflow scuppers(wall outlets): it is required that rainwater flows Qff so Ihat the roofis. not overloaded from a buildup of water. Perimeter/edge wall or other roof extensiort g4 11lock th4••• 0000:• discharge if overflow scuppers(wall outlets)are not proms v d d. It may ecessa •to ircAall overflcW•.• *• scuppers in accordance with the requirements of Sections 03 nd R449 3. • .... ...... IDate ,raiOwner/A ent's Si ure 9 9Contractor ignature ate D /0 54 Property Address Permit Number Revised on 7/9/2009 LD;07/01/2015; 1 ,SNoRESG,tt Miami Shores Village — 'inn logo J� gm r" Building Department �,�- .•o�� 10050 N.E.2nd Avenue iDp` Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 7,56.8972 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 Date: 7120 1-7 10050 NE 2nd Ave Miami Shores, FI 33138 Re: Owner's Name: G��1� , -yl 142 0 Property Address: JD8Z) N9 IO2 64. Roofing Permit Number: Dear Building Official: 1H(,K r"&v certify that I am not required to retrofit the roof to wall connections of my r 0000 bu7he g because: 0000 0000.. justvaluation for the structure for purpose of ad valorem taxation is less than $300,000.00.12.66; attac�lee"6*6�of ad •. 0000.. valorem taxation. •••••• 0000 � :0000: o The building was constructed in compliance with the provisions of the Florida Building Code (FB )*C-with the provisions 0000. 00.00. 00 0 • of 1994 edition of the South Florida Building Code (1994 SFBC) • 0000.. 0000.. Signature 00 . 000 • 000000 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 day of IULLY 02017 p41RY,PV6 _,:• � PAOLA M LORA Notary Public, Sate of Florida at Large MY COMMISSION#FF076574 C EXPIRES:DEC 15,2017 • 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 wi 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 5/2112009 i r Property Search Application - Miarn. T de County Page 1 of 2 "mo HE PRO'Er"T" "PPRAISER OFFMUE Ow I P H YA Summary Report Generated On: 7/19/2017 Property Information " a Folio: 11-3205-022-0030 ' 1280 NE 102 ST •. �'� # ` �` - Property Address: r Miami Shores,FL 33138-2618 Owner DENISE JUANICO MARK T JUANICO � Y Mailing Address 1280 NE 102 ST MIAMI SHORES,FL 33138 USA PA Primary Zone 1100 SGL FAMILY-2301-2500 SQ Primary Land Use �- 0101 RESIDENTIAL-SINGLE ` # _ FAMILY: 1 UNIT Beds/Baths/Half 3/3/1 3, K Floors 1 Living Units 1 Actual Area 3,314 Sq.Ft Living Area 2,326 Sq.Ft Adjusted Area 2,881 Sq.Ft Taxable Value Information Lot Size 12,862.6 Sq.Ft 2017 2016 2015 Year Built 1961 County Exemption Value $50,500 $50,500 $50,500 Assessment Information Taxable Value 1 $253,245 $246,998 $244,930 0000 Year 2017 2016 2015 School Board , 0 • Land Value $462,829 $430,486 $392,085 Exemption Value $25,580 : $25,50 $25 50 Building Value $200,518 $200,518 $200,518 Taxable Value $278,24!; $271,998 $269,9 XF Value $17,922 $17,946 $12,643 City 0000 0 0 i.••• Market Value $681,269 $648,950 $605,246 Exemption Value $5CM" $6 W �54 Assessed Value $303,745 $297,498 $295,430 Taxable Value $234, • $24%0% wiK680 • Regional 900060 ••• Benefits Information Exemption Value $50,500 0 NO. Benefit Type 2017 2016 2015 Taxable Value $2 3,.245; $.46,998 %J4.JJ0 00 Save Our Homes Assessment • Cap Reduction $377,524 $351,452 $309,816 Sales Information Homestead Exemption $25,000 $25,000 $25,000 Previous OR Book- Second Sale Price Page Qualification Description Homestead Exemption $25,000 $25,000 $25,000 12/28/2011 $100 27946- Corrective,tax or QCD;min Civilian Disability Exemption $500 $500 $500 3431 consideration Note:Not all benefits are applicable to all Taxable Values(i.e.County, 07/01/1999 $0 18677- Sales which are disqualified as a result School Board,City, Regional). 2009 of examination of the deed 04/01/1999 $0 18653- Sales which are disqualified as'a result Short Legal Description 0317 of examination of the deed 5 53 42 11/01/1993 $225,000 16128- Sales which are qualified AMD PL OF PORT OF REV PL OF MIAMI 2178 SHORES SEC 8 PB 41-64 W1/2 LOT 2 LESS S4.2FT OF W51 AFT &LESS S12.8FT OF E48.6FT BLK 185 http://www.miamidade.gov/propertysearch/ 7/19/2017 _....... ... . ...... _ _. ROOF ASSEMBLIES AND ROOFTOP STRUCTURES ' r►. `t e SECTION 1525 � . 1 HIGH-VELOCITY HURRICANE ZONES UNIFORM PERMIT APPLICATION 1 1 Florida Building Code 5th Edition(2014) i High-Velocity Hurricane Zone Uniform Permit Application Form 1 1 INSTRUCTION PAGE 1 1 1 COMPLETE THE NECESSARY SECTIONS OF THE UNIFORM ROOFING PERMIT APPLICATION FORM AND ATTACH THE REQUIRED DOCUMENTS AS NOTED BELOW: 1 1 Roof System Required Sections of the Attachments Required 1 Permit Application Form See List Below 1 Low Slope Application A,B,C 1,2,3,4,5,6,7 1 Prescriptive BUR-RAS 150 A,B,C 4,5,6,7 1 Asphaltic Shingles A,B,D 1,2,4,5,6,7 1 Concrete or Clay Tile A,B,D,E 1,2,3,4,5,6,7 1 Metal Roofs A,B,D 1,2,3,4,5,6,7 1 Wood Shingles and Shakes A,B,D 1,2,4,5,6,7 1 -- i Other As Applicable 1,2,3,4,5,6,7 1 1 ATTACHMENTS REQUIRED: I 1 1. Fire Directory Listing Page 1 1 2. From Product Approval: 1 Front Page Specific System Description • .""• 1 Specific System Limitations G ••• • "" •••••• 1 • .eneral Limitations �•��•• .• . . ' 1 Applicable9 Detail Drawings • •' ' *090:0 • ..•0 • 3. Design Calculations per Chapter 16,or if applicable,RAS 127 or RAS 128 ••• . ::00**: 1 _4_ Other Component of Product Approval • '•• 00000. 1 5. Municipal Permit Application . '..' • ••• 00000 1 6. Owners Notification for Roofing Considerations(Reroofing Only) : ';'; 0 ,• 1 7. Any Required Roof Testing/Calculation Documentation • •• :•.::. 000090 • r ROOF ASSEMBLIES AND "T Florida Building Code 5th Edition(2014) High-Velocity Hurricane Zone Uniform Permit Application Form. f Section A(General Information) Py 3 Master Permit No. Process No. 1 1 Contractor's Name_ �cO r 0j 1 1� 1 Job Address C'Z8 1`F b 2 S ( 1 1 ROOF CATEGORY ZL"Slope ❑ Mechanically Fastened Tile ❑ Mortar/Adhesive Set Tiles ❑ Asphaltic Shingles ❑ Metal Panel/Shingles ❑ Wood Shingles/Shakes ❑ Prescriptive BUR-RAS 150 ROOF TYPE Reroofing 1 11 New roof ❑ Repair 13 Maintenance Reroofing ❑ Recovering,< ROOF SYSTEM INFORMATION '1 Low Slope Roof Area(SF)� Steep Sloped Roof AREA(SSF) Total(SF) 444 I Section B(Roof Plan) 1 Sketch Roof Plan: illustrate all levels and sections,roof drains,scuppers,overflow scuppers and overflow drains. Include dimen- 1 sions of sections and levels,clearly identify dimensions of elevated pressure zones and location of parapets. 1 r:; i 0000 1 1 0909V • .. . '� .. 001 0000.. - 0000. _ 0000. W rA •PA • ••�•• 1 99999 I 999999 � QQ � 999999 � • 0 0..- ----- ._.�.—. ---0000-----_ 0000 0000.. W 1 0000.. •Do 0 • •• 1 Cn _ 1 U) cn ') !z I } .. E 1 z -W �QLI y A, < ° m m Cn ' DEWED s -- 1 ROOF ASSEMBLIES AND ROOFTOP STRUCTURES Florida Building Code Sth Edition(2014) " 1 High-Velocity Hurricane Zone Uniform Permit Application Form. 1 I 1 Section C'(Low Slope Application) Top Ply Fastteeneer/BQndin Matg. erial:_ ' 1 Fill in specific roof assembly components and identify /I�dlnj, �� 1 manufacturer N k i (If a component is not sed,Identify as"NA") Surfacing: 1 Fastener Spacing for Anchor/Base Sheet Attachment: 1 System Manufacturer: 11s Q L $ 1 1 Field: "oc @Lep,#Rows @_'oc 1 1 Product Approval No.: '� �Zi 1 Perimeter. "oc @ Lap,#Rows 4-@ "oc 1 1 1 1 " " i Design Wind Pressures, From RAS 128 or Calculations: Comer: oc @ Lap,#Rows 4 @ oc 1 1 P1—A'7,^ P2: "7 P3: Number of Fasteners Per Insulation Board: n� 1 1 Field�LI Perimeter Comer /� 1 Max. Design Pressure,from the specific pro�uct 1 1 approval system: 2• �S Illustrate Components Noted and Details as Applicable: 1 Woodbloddng,Gutter, Edge Termination,Stripping, Flashing, 1 1 Deck: Continuous Cleat,Cant Strip,Base Flashing,Counterflashing, 1 1 Type: P y wOUD Coping,Etc. � j Indicate: Mean Roof Height, Parapet Height, Height of Base 1 1 Gauge/Thickness: /- Flashing, Component Material, Material Thickness, Fastener 1 1 1 Type,Fastener Spacing or Submit Manufacturers Details that 1 1 Slope: ! . Comply with RAS 111 and Chapter 16. 1 01 1 Anchor/Base Sheet&No.of Ply(s):�A 5 `o " I An hpr/Base Sheet Fastener/Bonding Material: .sic h h :j FT. •; •' 1 Insulation Base Layer: 'A H 4- Joe#41* . x/'4, 00:, 1 Base Insulation Size and Thickness: x is 0 eight 94•0 • 3� 0 0 eoo*:o 1 Base Insulation Ffastener/Bondin Material: 000000 ' 0 NIf�' • 000 , 0 0 :0000•• 1 •.E� 0001<00 FT. 1 i Top insulation Layer: µ�b 0.00 .•+• 00000 000000 Top Insulation Size and Thickness: . ••Mean •••••• 1 -------- -- ----- •Roof • 1 Top Insu�ption Fasten er/BondIng Material: Freight ; 1. 0 :**go:••. • • 00 • 000 1 . 00.00• 1 Base Sheet(s)&No.of Ply(s):I Q('1 C-L,5�.f54� •`• • 0 1 i Base Sheet Fastener/Bonding Material: � 1 I l� �� A 1 Ply Sheet(s)&No.of Ply(s): IN rdmz yie* y 1 ► , 1 Ply Sheet Fastener/Bonding Material: 1 1 50Ezf�Q 1 Top Ply: l 1 1 , TGFU.R]4571 - Roofing SYMMIS Page 5 of 13 baa Sheet(hot mopped or mechonlafly taacansd). ply sheat(Optsenal)t-One or mon IWers'DUKW,"Xb"sx APP S"or"POLYP"(heat fuod),'EL ASFOMSE',"XtraFlaX llidS GLASS Bass","ELASTOFLEX V","Xbskx SBS Glop Interply",*ELASTOFIIX V-C'(hot mopped or heat fufa!)or Type f32 teas tlhaet(hot mopped or mechanically fa itensd). Membranes-"DUPLEX G PR","XtreFlex APP Dual","POLYFRESKO G FR","XtraAex APP G FR","XtreFlex APP G HP"or"POLYFLEX G FR"(modified bitumen),hoot fused. 18.Deck:C-15/32 IndMns 1/2 Insuladont-Polyisocynnurate(2 In.min),glass fiber(15/16 In.min),perllte/polylsocyanurate composite,perAte/urathans aomposlte(2 In.min). MM Shoats-One or more layers*DUPLEEX",•Xtreflax APP S"or"POLYFLEX"(heat food or mechanically fastened),"ELASTOBASE", "XtreFlex SBS GLASS Bao',"ELASTOFLEX V',"Xtrafisx SM Glen Interply"or r ps G2 bass @hoot(hot mopped or mod arskoft fastened). ply Skeet(Optloeal)s-one or mon layers'DUPLEX','Xtreflex APP S"or"POLYFLEX"(haat Need),'ELASTOBASE','Xtril"N SBS GLASS Bao","ELASTOFLEX V","Xtnfiex SBS Glass IntM**,"ELASTOFUX V-C'or Type G2 bass sheet(hot mopped or mechanically fastened). Membranes-"ELASTOPLEX S6 G",'ELASTOFLEX S6 G-C"or"POLYMESKO G SBS"(modified bitumen),hot mopped. 19.Deck:C-15/32 )Irsdlrses 1 Insukidons- 1/4 In.thick G-P Gypsum DensDeckm,partite,wood fiber or plea fiber,1 In.,mechanically lastsned. Ply sheat:-Type G2,mechanically fastened. Membranes-"POLYFLEX"or"Xbvftx APP S"heat welded. surfacing:-Monsey Products"Endure Aluminum Roof Coating","Weather Mick"or'Pro-Graft Aluminum Roof Coating",1.5 gal/sq; or Brewer"Fortress 5001 Asphalt Emulsion',applied at 4 gal./@q.,followed by"PoyPlus 600,applied at M-1 gal./sq. 20.Deeks C-15/32 Inallnes 2-1/2 warrior Maids- 1/4 in.(min)G-P Gypsum DensDecktl with all joints staggered 6 In.from the Plywood joints. Sam shoots-Type G2,mlichanlally fastened. Membrane:- "POLYFLEX G FR","XtraFlex APP G HP',-Xtreflex APP G PRO or"POLYFRESKO G PR",heat fused in place. 21.Dodk:C-15/32 Indhimm 2 Inaulatlon(Optlonal)t-Polylsocyanumte,per(lte,wood fiber or polylsocyanurste/perllte board,any thickness. Barrier Board:-1/4 In.(min)G-P Gypsum DemDsdt*,mechanically fastened with all joints staggered 6 In.from the plywood joints. sane sheets-"ELA�/S�TOBASE "Xtr@Mox SBS GLASS Base'(poly/send),mechanically fastened or"ELASTOFLEx SA v NAT", "ELASTOFLEX SA V FR"or"ELASTOFLEX SA V FR BASE VERT "(self adhered). Ply sheet(Optlenal)i-'ELASTOBASE",'Mil"Iex SBS GLASS Beae'(poly/sand),heat fused or mechanlaYy{estened,IN•ELASTORA*•••. SA V PLUS FR", '-EL/STOFL EX SA V FR"or"ELAST�OFLEX SA V FR BASE VENT",(each adhered). •' • •• • •• Membranes-"POLYFLEX SA P PR",'POLYFRESKO G APP SA P PR","ELASTOFLEX SA P FR",'POLYPRESKGC.SBS SA P Fg""RASTOFLEX • SA v FR HT",(self adhered)or*POLYFLEX G PR",'XtraFNx APP G HP',"Xtrafiex APP G PR","POLYFREWP t FIJI,'DU GI'R",-XtrAF11dls... RES APP Dual% "ELASTOFLEX S6 G FR","POLYFKO G SBS PR',"ELASTOFLEX VG PR","XtraFlex SBS POLY ,,@ traFlex SBS9pLY G T",• "XtreFlex SBS GLASS G "XtraMex SBS GLASS GT"or•ELASTOSHIELD TS G PR",heat fused. •'••• • • •'•••• •• •• • r22.Dock:C-15/32---,/ Irsdkwi Y/2 • 0 **,:*0* •• •• •• (Insuletlon(Optlenal)s-Polylsocyanumin 1.5 in:(min.)with all joints staggered 6-In.(min.)from WhIftod joints. - Baas Sheets'=Type G2;mechanically fastened followed by"ELASTOBASE","XtraFlex SBS GLASS Bale",maehanlcalky fsatened. • ••••• Z—Ply sheat(Optlersal)e-"ELASroFLEx SA V PLUS PW-,"EUISTOFLEX SA V FR'or'ELASTOFLEX SAW FR 4ASE VEN1'`,JltAhadher+ed). `- �Membrassas-"POLYFLEX SA P FR";"POLYMMSKO G APP SAP PR";'ELASTnFLEX SA P FR","POLYFREEFKD G"SBS SA P FR",or*DU F C= • FR";"XtraFlax APP Dual"-,."POLYFLFX G'PR","XtraFNx APP G HP","Xtrefiex APP G fR",'ELASTOPLEX g6 G FRe,'POL"" KOG SBS • • "ELASTOFLEX VG FR', "XtraFlex SBS POLY G','XtraFlex SBS POLY G T","ILtraFlax 5BS GLASS G","XtraFlex SBS GLASS GT;•pr "ELASTOSHIELD TS G FR",heat flsssd. 23.Ducks NC Indksat 2 Insulation(Optllmol)s-Atlas Roofing'ACFoam III"or"ACFosm 11"or Hunter Panels"H-Shield",any thickness. Sana Shoat-"ELASTOBASE",'XtraFlox SBS GLASS Base"(poly/sand),haat fused or mechanically fastened or"ELASTOFLEX SA V FR", "ELASTOFLEX SA v PLUS PR"or'ELASTOFLEX SA v PR MSE VENT",(self adhered). Membranes-"POLYFLEX SA P PR "POLYFRESKO G APP SA P PR',-ELASTOFLEX SA P FR","POLYFRESKO G SBS SA P PR',"ELASTOFLEX SA V FR HT",(self adhered)or"POLYFLEX G FR",-AmFlax APP G HP","Xtreflex APP G FR","POLYFRESKO G PR","XtraFlex APP Dual", "DUPLEX G PR","ELASTOFLEX S6 G FR","POLYFRESKO G SBS PR","ELASTOFLEX VG FR","XtraFlex SBS POLY G","XtreFlex SBS POLY G T","XtraFlex SBS GLASS G",'XtreFlex SBS GLASS GT"or"ELASTOSHIELD T5 G FR",heat fused. 24.Deck:C-15/32 toclk+es 3 Insuletlon(Optlonal)s-Polylsocyanumts,p@rllte,wood fiber or polylsocyanurate/perllte board,any thickness. Barrier Steeds- 1/4 In.(min)G-P Gypsum DensDockf,mechanically fastened with all joints staggered 6 in.from the plywood joints. SIM!theft-'ELASTOBASE","XtreFlex SBS GLASS�Base"(poly/send),mechanically fastened. ph skeet ptl keet(Oonal)s-'ELASTOFLEX SA V PLUS PR","ELASTOFLEX SA V PR"or"ELASTOFLEX SA V FR BASE VENTT",(self adhered). Membraste:-"ELASTOFLEX S6 G PR","XtreFlex SBS POLY G","XtraFlex SBS POLY G T"or"POLYFRESKO G SBS FR",heat fused. hq://database-ul.comlegi-bin/XYV/template/LISEXT/IFRAME/showpage.html?mmde.T,,, 8/29/2014 i MIAMI-DADC COUNTY PRODUCT CONTROL SECTION 11805 SW 26 Street.Room 208 DEPARTMENT OF REGULATOR AND ECONOMIC RESOURCES(RER) Miami,Florida 33175-2474 BOARD AND CODE ADMINISTRATI N DIVISION T(786)315-2590 F(786)315-2599 NOTICE OF ACCEPT NCE OA Polyglass USA,Inc. 15o Lyon Drive Fernley,NV 89408 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use Rof product Control used to be documentation submitted has b n reviewed and accepted by Miami-Dade CountyIJurisdiction(AHJ). used in Miami Dade County an other areas where allowed b the Authority g This NOA shall not be valid aft r 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 q ality assurance purposes. If this product or material fails to perform in the accepted manner,the manufacturer will i cur 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-Dae County Product Control Section that this product or material fails to meet the requirements of the applicable tuilding code. This product is approved as described herein,and has been designed to comply with the Florida Building Code including the High Velocity Hu icane Zone of the Florida Building Code. DESCRIPTION:`Polvglass Ii Adhered Roof 8yetem`over Woo&DeekO 4,900 LABELING: Each unit shall tear a permanent label with the manufacturer's name or logo,pity, stat>`.aQ,followLna.•• statement: "Miami-Dade Counre Product Control Approved" unless otherwise noted hererifl. • •• • • 94,94,9• .. . • . . RENEWAL of this NOA shall be considered atter a renewal application has been filed SAO Ltere has been no chgpg`.: in the applicable building code negatively affecting the performance ofthis product. 00000' 0 • 94,4,99 4,.4,• 00.00. 00 , 9 . � 4,4, TERMINATION of this NOA will occur after the expiration date or if there has been 1lre0hsion or*otlange in ths..... materials, use, and/or manufacirtre of the product or process. Misuse of this NOA as an end0oriement of any product,•* for sales,advertising or any other purposes shall automatically terminate this NOA. Failure to comply auilh any stt'.11t1n• of this NOA shat l be cause for t rmination and removal of NOA. 0000 ; •• 0•: • 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# 13-05 4.10 and consists of pages I through 33. The submitted documentation reviewed by Alex Tigera. I NOA N 13-121,7.01-0 —f � Expiration Date: 10/11/17 Approval Date: 11/06/14 Page 1 of 33 i it Membrane Type: SBS/AP� Deck Type 1: L)ood,.P4(on-Insulated Deck Description: 19/32" or�reater plywood or wood plank. System Type E(1): Base sh�et is mechanically attached to roof deck. stem Liml Nona apply. Roel accessories not listed In Table 1 of this NOA are not approved All General and Sy and shall not be installed unit mid accemr%s demonstrate complian )s ce with proscriptive Florida uildhg Code requirements and are fi fabricated umving the approved membranes 1Mtsd is Table 1. I Base Sheet: One plyl of Elastobase, XtraFiex SBS Glass Base, Elastobase P or Polyanchor fastened to the deck as(described below: Fastening#1: Attach ase sheet using 11 ga annular ring shank nails and 1=5/8"diameter tin caps sp ed 8" o.c`in, 4"-lap-and 8'�o.c.•in three equally.spaced_staggerod rows in the center ofthe.sheet,. Fastening 02: Attach ase sheet using OMG#14 Roofgrip fasteners and Flat Bottom Metal Plates,Dekfast #14 wit Dekfast Galvalume Steel Hex Plates,Polygrip Fasteners#14 with Polygrip Hex Plates r Trufast#14 HD Fasteners with Trufast 3"Metal Insulation Plates spaced 12"o.c. in a 4" lap d 12"o.c. in two equally spaced staggered rows in the center of the sheet. Ply-Sheer. One or ore plies of Elastoflex•SA V (1.5-mm),Elastoflex SA V PLUS, XtraFiex SBS Base SA, EI toflex SA V FR(1.5-mm)or Elastoflex SA V PLUS FR,self-adhered. Membrane: One ply of Polyfresko G SBS SA,Polyfresko G SBS SA FR,Polyfresko G APP SA, _ E -y Polyf a ko G APP SA FR,Elastoflex SA P,Elastoflex SA P FR,XtraFiex SBS.P,§A, P.oiyfle-X-7 LA P,_olyKool, XtraFlex Kool APP S SA, Polyflex SA P FR or:XtraFlex AF?A�$4, self-•9 0�� adhere. •••0•e Or 00..60 One pl of Polyflex G,torch-applied. 000400 0 • 6666 060600 • 0000.. 6166 Surfacing: (Optional)Install one of the approved surfacing products listed " pple 4 to obtain desire!(';••. coating or required fire classification. 66'.66 6 0-000' .. . 666666 0000.. Maximum Design �_ 6 6�66�6 0000.. Pressure: 52:5 p f;.(See_Generni limitation X17.). 0 6.6 6 •• • 666 6 :0000. 0 • i I i I i I i NOA No.: 13-1217.01 + Expiration Date: 10/11/17 Approval Date: 11/06/14 + Page 26 of 33 WOOD DECK SYSTEM LIMITATIONS: I. A slip sheet is required.withiPly 4 and Ply 6 when used as a mechanically fastened base or anchor sheet. GENERAL LIMITATIONS: I. Fire classification is not pirt of this acceptance; refer to a current Approved Roofing Materials Directory for fire ratings of this product. 2. Insulation may be installs 1 in multiple layers. The first layer shall be attached incompliance with Product Control Approval guidelin s. All other layers shall be adhered in a full mopping of approved asphalt applied within the EVT range and t a rate of 20-40 lbs./sq.,or mechanically attached using the fastening pattern of the top layerI sire 3. All standard panel sizes a e acceptable for mechanical attachment. When applied in approved asphalt, pane shall be 4' x 4' maximum. { 4. An overlay and/or recoery 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 side lap and one down the center of the sheet allowing a continuous area of ventilation. Encircling of the strips is not acceptable. 6" break shall be placed every 12' in each ribbon to allow cross ventilation. Asphalt application of either systet shall be at a minimum rate of 12 lbs./sq. Note: Spot attached sy0ems shah be 11s11ted to a mazimnm d"n premare of-+S pef. 5. Fastener spacing for insul ion attachment is based on a Minimum Characteristic Force(F')value of 275 Ibf.,as tested in compliance with eating Application Standard TAS 105. If the fastener value, as field-tested,are below 275 Ibf. insulation attach ent shall not be acceptable. 6. Fastener spacing for mec ical attachment of anchor/base sheet or membrane attachment is based on a minimum fastener resistance value i i conjunction with the maximum design value listed within a specific system. Should the fastener resistance be ess than that required,as determined by the Building Official,a revilad•fastener spacing, prepared, signed and scaled by a Florida registered Professional Engineer;Raestered Anti ect, or••eeee Registered Roof Consulta it may be submitted. Said revised fastener spacing shall utilizi the vgilfidt'�,wal • resistance value taken froi n Testing Application Standards TAS 105 and calculatigq%:n,compliM a with RAAfing. Application Standard RA 117. ...... 7. Perimeter and corner area , shall comply with the enhanced uplift pressure requirtaior 1 of ttpewteas. Fastener* densities shall be incre ed for both insulation and base sheet as calculated*in.00mpliarpe,,with see Application Standard RA 117. Calculations prepared, signed and sealed by a•floriaa regilatefadProfeag" Engineer, Registered Arc iitect, or Registered Roof Consultant (When this 111W806l Is specifically refersld within this NOA,Geo I Limitation 09 will not be applicable.) .. • ..0 *Got% 8. All attachment and sizing f perimeter nailers,metal profile,and/or flashing terAnaliopt desi(ins shall con#Vpl(q 00 0 Roofing Application Stani lard RAS 1 I 1 and applicable wind load requirements. �'. : • 9. The maximum designed p essure limitation listed shall be applicable to all roof pressure zones(Le Meld, perimeters, and corners).I leither rational analysis, nor extrapolation shall be permitted for enhanced fastening at enhanced pressure zones( .e. perimeters,extended corners and corners).(When this limitation Is specifically referred within this NOA,General LimiteNon N7 will not be applicable.) 10. All products listed herein hall have a quality assurance audit in accordance with the Florida Building Code and Rule 61 G20-3 of the Flori fa Administrative Code. END OF THIS-ACCEPTANCE NOA No.: 13-1217.01 Expiration Date: 10/11/17 Approval Date. 11/06!11 Page 33 of 33