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RF-14-1175Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-230336 Permit Number: RF-6-14-1175 Scheduled Inspection Date: May 13, 2015 Permit Type: Roof Inspector: Rodriguez, Jorge Inspection Type: Final Roof Owner: LUND, KENNETH AND ALEXANDRA Work Classification: Repair Roof Job Address: 1001 NE 96 Street Miami Shores, FL 33138- Phone Number (714)721-2270 Parcel Number 1132060143740 Project: <NONE> Contractor: ARCON ROOFING Phone: 954-753-3100 Building Department Comments REPAIR 800 SQ FT AND CONCRETE DECK 03-11-15 Construction project is active. see inspections related under 14-744 INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-213672. Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. May 12, 2015 For Inspections please call: (305)762-4949 Page 8 of 30 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 .I JUN o 5 2014 BY: FBC 20 L0 BUILDING Permit No. P, C) PERMIT APPLICATION Master Permit No. Vv-- Permit Type: BUILDING ROOFING JOB ADDRESS: / 06 / f 4 1 /— City: Miami Shores County: Miami Dade Zip: 3 313 1- Folio/Parcel#: // - 3 o C - o 1Z • A 3 7 lely Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): I <e•V N' e?-Phone#: Address: 166/ A-1 1 G S c - -floe ? f1 City: � /��n State: 41L_ Zip: `33 13 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: A2e0A) 1 oyr,, .S Phone#: 9j-'V q 79 i YCA Address: ,2%U / ;%44j /,6 -� City: D,�., a ;fj G� State: �� Zip: 33 d I Qualifier Name: Phone#: State Certification o Registration #: 77 Certificate of Competency #: Contact Phone#: Email Address:/3/L fie,,, Al;�ii 9 DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Addition ❑Alteration ❑New .Wepair/Replace ❑Demolition Description of Work: Cfi" S y%- Color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ i Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF 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 ap r6ed and aereinspecti a ill be charged. Signature t9L Signature acLl \ / F-A`u Owner or Agent Contractor The fore oing instrume��nntt,,((was acknowledged before me, this, The foregoi instrument was acknowledged before me this day o�> 201�, by �`'' 4� day of , 20, by who is personally known to me or who has produced C-t1 who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY P IC: Sign: Print: My Commission Expires: APPROVED BY : Plm) A Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Print: My Commission Expires: I NOTARY PUBLIC: Sign.t� o WO NAN, 6 k****** Zoning Clerk AU-B 2-193 3 STATE OF F `DEP . ARTMEXTOF BUSINESS AN] Q T N qNS: RUCTIO 1 US 7 7 § 3 CD 7'6" !,J; G6/-20'J2di2,.li200 '4:` th4:k66F'1'; NG,,`:dbNv,kA6T6R: en - Under the' -provisions of,-:Chaptpk-149-8 kty - ---Named"*�,�belowIS CERTIFIED�z R �lj Expiration date: AUG -:3 1,,.. 2014tt,6� ERLG IOAN �,LUCIAN '-VXRCON,.-.ROOFINQ:. 2280 NW 16 ST ,::. POMPANO BEACH. FL33 0 �V- V is RICK COTTI:,.-'�.l GOVERNOR::"--i ON SEQ# L12 0 8 2 0 0 18 7 6 KEN LAWSON SECRETARY �04, Cit v Pompano ano Beach REGISTRATION NO. pompano y f p Abe , Business Tax Receipt 3.4 ,_00028922 Florida's Warmest Welcome 2013- 2014 NEW RENEWAL X OWNER ARC clN 'ROOF ;jN'' f ;r., ,. DATE ISSUED ,,cy,f,OFY�e 1^•t ACCOUNT'NO. 441221o, REGISTRATION FEE 1, 7 6 S BUSINESS NAME A1ti60N 1'dOO 1,NC." DELINQUENT CHG. ' C-0 LOCATION ' r 80" Nw 16 S T TRANSFER FEE , 00 CLASSIFICATION TOTAL AMOUNT PAID•, coar Ar TIO ;-13c tOt' tat:, (R ) EFFECTIVE DATE EXPIRATION DATE diR �:L11 { F2 r t,a�t OCTOBER,4, 1a SEPTEMBER 30 { �, lw, i e atyi lr t I f^ ;�(j s i BUSINESSES MUST CONSPICUOUSLY DISPLAY THIS . , ,I"1 1, BUSINESS TAX RECEIPT TO PUBLIC VIEW AT - BUSINESS LOCATION CONTRACTORS MUST MAINTAIN ON FILE CURRENT LICENSING AND INSURANCE NOTICE: A NEW APPLICATION MUST BE FILED IF THE BUSINESS NAME, OWNERSHIP OR ADDRESS IS CHANGED, THE ISSUANCE OF A BUSINESS TAX RECEIPT SHALL NOT BE DEEMED A WAIVER OF ANY PROVISION OF THE CITY CODE NOR SHALL THE ISSUANCE OF A BUSINESS TAX RECEIPT BE CONSTRUED TO BE A JUDGEMENT OF THE CITY AS TO THE COMPETENCE OF THE APPLICANT TO TRANSACT BUSINESS. 6 CERTIFICATE OF LIABILITY.IN5URANCE DATE /YYYY) 06/05/1/05/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: Fed USA Retail, Inc. 1164 North State Road 7 PHONE (954) 404-612 Ac SaNo): (954) 589-0488 -MAIL brett.lickteig(dlfedusa.com INSURER AFFORDING COVERAGE NAIC # Lauderhill, FL 33313 Phone (954) 306-6626 Fax (954) 769-1086 INSURER A: Canal Indemnity Ins Co 27790 INSURED INSURER B: Progressive Express 10193 Arcon Industries Inc / Emanuel Cazacu Enterprises Inc dba Arcon Roofing INSURER C : INSURER 0: 2280 NW 16th St INSURER E : Pompano Beach, FL 33020 (954) 753-3100 INSURER F : %'Vvcr%AU=0 GtKUFiCAit NUMBER: 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 LTR TYPE OF INSURANCE ADD UB POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A GENERAL LIABILITY COMMEROAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE © OCCUR ❑ NN GL105156 09/23/2013 09/23/2014 EACH OCCURRENCE $ 1,000,000.00 DAMA TO RENTEDPREMISES Ea occurrence $ 50,000.00 MED EXP (Any one person $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE s 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: 0 POLICY ❑ JECTPRO ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ B AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED SCHEDULED AUTOS © AUTOS ❑ HIREDAUiOS ❑ NON -OWNED AUTOS 13 N N 04369366-4 09/23/2013 09/23/2014 OMBINED SINGLE LIMIT a accdent 100,000.00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident $ PROPERTY DAMAGE Per accident $ a ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAR ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DIED 0 RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUrIVE OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS bel: N / A M WC STATU OTI+ RY U ITS El ER E.L. EACH ACCIDENT s E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Arcon Roofing license * CCCO57677 VGR a ar•IVN I C rIVLUCR CANCELLATION Miami Shores Village Attn:Joanna 10050 NE 2nd Ave. Miami Shores, FL 33138 ACORD 25 (2010105) OF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 06/05/2014 14:20 FAX 7277970704 CRUM a 001/001 gATS MwDomYTf AC.'CMcf CERTIFICATE OF LIABILITY -INSURANCE W&7014 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 AFFQROED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, ANO THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy (les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms end corMidons of the policy, certain policies may roquft an endorsement A staternerrt on this cerdticate does not confer rights to the cerdllcate holder in lieu of such endorselneltt con cr PRODUCER PNOIIE 1-800-'.77.1920 x4900 727.797-07 1.. Ra (M SMAIL AOMC FRANKCRUM INSURANCE AGENCY. INC. 100 S. MISSOURI AVE. INSUREWSI AFFORDING GOY GE t INSURER n: FRANK WINSTON CRUM INSURANCE CO. 11500 CLEARWATER FL 33750 LNsur:FD INSURER e INSURER C NSURER LT. FrankCrum 1-800.277-1620 NSURER E too S MISSOURI AVENUE 1N8UR4R F. CLEARWATER FL 33766 GCIVtWLU tNlw6 I$ TO CERTIt'Y THAT THE POLICIES OF INSURANCE &jSTW 111LOw NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAMDING ANY ARWREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTWR DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAK THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERMS, EXCLUSKIN3 AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAWS. �Iyll TYPE OF NBURANCE AODL SUER OOUCY NUMBER POLKY CFV fM ( � wry LTR W aR wW oaNCRALUAeAITY EACH OCC e E f DAMAGE YO RE TED PREAIIBEB EeaauraNs f IAMIACLWAk GCNERAL LIABILITY °PWIT0S �4 =OCGuR CLAIMB.IMOE 1 PER90NALe ADV tNAJRY T GENERAL AOORFAATE f GENT AOOREOATE UM!'APPUE9 PER: PRODUCTS• wOP AQG S qi .T f . AU--. UAre.!TY c9mb1N6D2vjm.EuFAiT (Ea i S 8C00.Y fNJVR'r d'fr p.r.v,l ""-- i A(+r AV'O BODILY INJURY (PFr ndow q f A L c TIEL SCHEDULED AUTty AuTOC I NON 4mmw PROPER 4REG AUTO!, AUTOS (Po ,AL;a.,q S f UfdBREUA LK9 W" EACH OCCURRENCE f AOOREGATE _ EKCESSUAB CLAIM94 UE OED j RETENTIONS f WC2101400000 1112014 ii1r2015 vNIT TDRY YL ld,11T8 Eli A YYORKERR COfaPU4ATNYN "aX FACHACCIDENT _ S1 OOO 000 EMPLOYERS' LIABILITY ANT PRCPRRTOWPARTNERWECUMIE t I[I OFFICE"ENBER EMCUd1E117 N!A INLAMIh" I E: OISEA -EA EfAPfOYEE Sl If EL pSEA -POLICY LIMIT 31 00000E OE,',CRVTION OF OPERATICNS LWow I ! I EeGRIPnON OF wewims 1 LOCATIONS I VENICLEA jAwal AOORO lei, AdMOOIW RemaTAi ichMUAr.IT,,,n. Ap o b I�i„N) EFI=ECTIVE 0711212006, COVERAGE IS FOR 100% OF THE EMPLOYEES OF FRANKCRUM LEASED TO ARGON INDUSTRIES, INC DBA ARCON ROOFING 013A EMANUEL CAZACU ENTERPRISES (CLIENT) FOR WHOM THE CLIENT IS REPORTING HOURS TO FRANKCRUM COVERAGE IS NOT EXTENDED TO STATUTORY EMPLOYEES. (CLIENT REF.: QUALIFIER: LICENSE: CCC05767T) I;CK I IriGR I C nwwmR - - - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES VILLAGE ACCORDANCE WITH THE POLICY PROVIMONS. ATTEN:JOANNA AUTHORJ=REPRESCHTATNE 10060 ME 2ND AVENUE MIAMI SHORES. FL 33138 O IN&2010 ACORD CORPORATION. AD rlghis r"tr+ed. ACORD 25 (2010105) TM ACORD name and logo eve reWovered rmrA* or ACORO /ICON ROOFON6 2280 N.W. 16th Street Pompano Beach, FL 33069-1517 (954) 753-3100 - Broward (561) 368-1800 - Palm Beach (954) 977-4442 - Fax David Magen Re: Kenneth Lund Res. 1001 NE 96 St N. Miami Shores, FL. 33138 Licensed and Insured Roofing Contractors 1. Arcon will clean the concrete deck. June 5, 2014 2. Arcon will Slope the deck for positive drainage. 3. Arcon will prime the deck with Sealoflex primer as per current SFBC. 4. Arcon will Waterproof the deck using Sealoflex products. 5. Arcon will install new aluminum drip edge and new flashing membrane per SFBC. 6. Arcon will leave the area clean of all roofing debris generated by this scope of work. Total Cost. $8,800.00 Terms: 50% upon start 50% upon completion Price includes a five (5) year maintenance warrant 'nst defects in workmanship.-P��R�r,° F\01 -14 No�ac 1tg1 a. Arcon Re m � Accepted by Date vIr- 1\-t k k'i S . .... . . .... . . . . . . . . . . DECK LAYOUT FOR: •�• ' ' ' "' 5 2014 WATERPROOFING, ,.. B�JUNO LUND'S RESIDENCL:• ' "• ' •� �•� . . . . . . . . . . Miami Shores Village APPROVED BY DATE 'DNING DEPT BLDG DEPT SUE3JECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND RFOULATIONS EXISTING 6" Dlf Sa PPER ROOF ASSEMBLIES AND ROOFTOP STRUCTURES Florida Building Code Edition 2004 High -Velocity Hurricane Zone.Uniform Permit Application Form. • rf ` j �A��GcIC C7' S� I�ST�'`/ Low Slope Applica Fill in specific roof assembly components and identify manufacturer (If a component is not used, identify as "NA") System Manufacturer: -5"r"�LC Product Approval No.: Design Wind Pressures, �RASr Calculations: Pmax1 • "- yS6,LPmax2:-47,Pmax3• Max. Design Pressure, from the specific Product Approval system: +-,d.G 7 J9 Deck: Type. �a�v c�GTc fJ �I Gauge/Thickness: `�/ Slope: Anchor/Base Sheet & No. of Ply(s): Anchor/Base Sheet Fastener/Bonding Material: Insulation Base Layer: Base insulation Size and Thickness: Base Insulation Fastener/Bonding Material: Top Insulation Layer: Top Insulation Size and Thickness: Top Insulation Fastener/Bonding Material: Base Sheet(s) & No. of Ply(s): Base Sheet Fastener/Bonding Material: Ply Sheet(s) & No. of Ply(s): Ply Sheet Fastener/Bonding Material: Top Ply: Top Ply, Fastener/Bonding Material: Su acing. -Fastener Spacing for Anchor/Base Sheet Attachment: Field: " oc @ Lap, # Ro}+s " oc Perimeter: " oc , # Rows —. ® oc Corner: Lap, #Rows " oc Nu Fasteners Per Insulation Board: Field Perimeter Corner Illustrate Components Noted and Details as Applicable: Woodblocking, Gutter, Edge Termination, Stripping, Flashing, Continuous Cleat, Cant Strip, Base Flashing, Counter - Flashing, Coping, Etc. Indicate: Mean Roof Height, Parapet Height, Height of Base Flashing, Component Material, Material Thickness, Fastener Type, Fastener Spacing or Submit rCAS.yi-`, W Heigh J .. ••.••• • • 0 Mean • • • • • . • Roof • Heig'hZ• • M I A M I -MADE BUILDING CODE COMPLIANCE OFFICE (BCCO) PRODUCT CONTROL DIVISION NOTICE OF ACCEPTANCE (NOA) Sealoflex Waterproofing Systems, Inc. 2516 Oscar Johnson Dr. Charleston, SC 29405 MIAMI-DADE COUNTY, FLORIDA METRO-DADE FLAGLER BUILDING 140 WEST FLAGLER STREET, SUITE 1603 MIAMI, FLORIDA 33130-1563 (305) 375-2901 FAX (305) 375-2908 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed by Miami -Dade County Product Control Division and accepted by the Board of Rules and Appeals (BORA) 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 Division (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. BORA reserves the right to revoke this acceptance, if it is determined by Miami -Dade County Product Control Division that this product or material fails to meet the requirements of the applicable building code. This product is approved as described herein, and has been designed to comply with the Florida Building Code and the High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION: Sealoflex Waterproofing Systems for Concrete Deck LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami -Dade County Product Control Approved", unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the of this "". performance product.. . . .... ...... TERMINATION of this NOA will occur after the expiration date or if there has been a rtoisidn or ":' ' • . . change in the materials, use, and/or manufacture of the product or process. Misuse of thig MWas an endorsement of any product, for sales, advertising or any other purposes shall automatical Fferminate ; • • • • ; this NOA. Failure to comply with any section of this NOA shall be cause for termination d�reinoval o • an'of ..�..� NOA. .... ...... . ... ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County,' Florida, arid* ..... • • • •; • followed by the expiration date may be displayed in advertising literature. If any portiorref ttR 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 manufactw orits ; • • • ' distributors and shall be available for inspection at the job site at the request of the Building Official. ' • " This NOA renews and revises NOA No. 08-1007.04 and consists of pages 1 through 14. The submitted documentation was reviewed by Jorge L. Acebo MIAM WADE COUNTY NOA No.: 10-0608.04 Expiration Date: 10/13/15 Approval Date: 11/04/10 Page 1 of 14 ROOFING ASSEMBLY APPROVAL Cateeorv: Roofing Sub-Cate¢orv: Waterproofing Systems Materials: Elastomeric Maximum Pressure -267.5 psf TRADE NAMES OF PRODUCTS MANUFACTURED OR LABELED BY APPLICANT: Test Product Product Dimensions Specification DescrlptiOn Cemflex Concentrate 1 or 5 gal. TAS 114 Additive used to produce Cemflex Slurry, a base liquid coat for use over concrete substrates. Sealoflex Pink® 1 or 5 gal. TAS 143 Base and saturation liquid coat. Metal Etch PrimerTM 1 or 5 gal. Proprietary Primer for all unprotected metal surfaces. Sealobond Primer WBTM I or 5 gal Proprietary Primer for use over painted concrete, wood or steel, or unpainted masonry substrates. Sealoflex FabricTM Proprietary Non -woven polyester reinforcing fabric for use in the Sealoflex roof system. Sealoflex Finish CoatTM I or 5 gal. TAS 143 Top waterproofing coating. Sealoment P1usTM 50# bags Proprietary Primer for concrete or lightweight concrete. Sealoflex CT PinkTM 1 or 5 gal. Proprietary Solvent borne, base and saturation coat. Sealoflex CT TopTM 1 or 5 gal. Proprietary Solvent borne, single components roof • • • • coating. .... • • • • • • CorabaseTM 50 lb. bags Proprietary Polymer modified portlant*gethent "• powder used as a tile adheAt8 • WearcoatTM 1 or 5 gal. Proprietary .... .... Liquid applied emulsion doatmg . . * *' o o • .. . ... (available in smooth or nonskid versit)p • ..... ...... containing aggregate) for Pedgsjrian .' traffic surfaces. ' CoraflexTM 1 or 5 gal. Proprietary Liquid applied, water dis •' • • • purs�ed • • � based coating for pedestrian traffic • • • • surfaces. aMLAMI ME COUNTY ..• NOA No.: 10-0608.04 Expiration Date: 10/13/15 Approval Date: 11/04/10 Page 2 of 14 L1 TRADE NAMES OF PRODUCTS MANUFACTURED OR LABELED BY APPLICANT: Test Product Product Dimensions Specification Description Dampseal 10ITM 1 gal. or 1 qt. Proprietary Two component epoxy primer for use kits over concrete. Sealoflex ButtergradeTM 1 or 5 gal. SealopatchTM 50 lb. bags Sealodrain 650TM 4' x 50' 46 lbs Proprietary Trowellable waterborne paste for surfacing irregular substrates. Proprietary Portland cement based single component thixotropic patching and repair mortar. .ASTM D4716 A two-part fabricated soil sheet, drain, and board. TRADE NAMES OF PRODUCTS MANfJI' ACTURED BY OTHERS: Test Product Product Dimensions Specification Description Manufacturer Concrete Pavers Min. 24" x 24" x 1-%" ASTM C902 4000 psi Min. Compressive Generic strength, 5% water absorption max. Ceramic Tiles Min. 12" x 12" x'/z" ASTM C902 Ceramic plaza deck walking Generic tiles, 5% water absorption max. EVIDENCE SUBMITTED: Test Aeencv Test Identifier Test Specification Date • ... Celotex Testing Center, Inc. MTS Job No. 258211 Physical Properties `' ` "``: • TAS 143 .'05/20/9$ " "" • Exterior Research & Design, #4213.07.97-1 TAS 114 ` * * * *r0/20/00.... :'''': LLC. 4210.06.02 TAS 114-C/D/J • • • • ,06/17/0!2....' ..... #4213.09.00-1 R. TAS 114-D & J / TAS 117-13 1.0/25/05. ... . • : • • • #4234.05.05 TAS 114-J / TAS 117-B ..' . 05/041n.. ` • • • • • • • #4234.10.05 TAS 114-J / TAS 117-13 .... +1,0/20/05 • • Trinity I ERD S30750.03.10 ASTM D 6083 . . . . . . ...... .03/24/1V..... .. . .... 0000 NOA No.: 10-0608.04 Expiration Date: 10/13/15 Approval Date: 11/04/10 Page 3 of 14 APPROVED APPLICATIONS: Deck Type 3 Concrete Decks, Roof Plaza Decks Deck Description: Min. 2500 psi, dual slab construction (roof plaza) System Type (1): Sealoflex CT Substrate: Structural concrete shall be water cured a minimum of 14 days. The curing method must be a water cure, wet coverings, paper sheets, plastic sheets or approved liquid curing compound such as sodium silicate. Substrate All surfaces must be dry, smooth, free of depressions, voids, and protrusions, and Preparation: clean and free of any non -compatible curing compounds, foam release agents and other surface contaminants. Poured in place concrete must be monolithic, smooth, free of voids, spalled areas, laitance, honeycombs, and sharp protrusions. Precast concrete decks shall be mechanically secured to minimize differential movement and all joints between units shall be grouted. The substrate must be cleaned to remove loose debris, and a test patch of Sealoflex- CT Pink shall be applied to the surface to check adhesion. Apply 6" wide strips of Sealoflex Fabric at the junction of all vertical and horizontal surfaces, changes in plane and expansion joints. Concrete around drain shall be depressed to promote positive water drainage. Membrane All cracks, expansion joints, base flashings, penetrations and junctures at Flashing: horizontal/vertical changes in plane shall be flashed with Sealoflex Fabric and Sealoflex CT Pink in accordance with Sealoflex published details. All cracks greater than'/16" wide shall be routed and filled with Cgrabase or ' .... • • • • • • Sealopatch and lined with a Sealoflex CT Pink and Sealoflex Fabfic.'Crecks • • • • , • • smaller than'/16" wide shall be filled with Sealoflex Buttergrade. 9 •, .. • • • • • • • • • For vertical surfaces the Sealoflex Fabric shall extend at least 6" intpA.; horizontal .. surface. At field and wall expansion joints, install Sealoflex Fabric §"Joboth sides.. • • • • • of the joint. ...... . ... ..... All drains areas shall be Sealoflex 0 • • • pre -detailed with CT Pink and S'ealollex Fabric , extending 6 inches beyond the drain flange on all sides and secured ty'Q clamping .' ....:. . ring to the drain. Drain must be maintained free to weep at membrane level. :""' • .. . .... Primer: Prime Concrete decks with ONE of the following: 0000 • Sealoment Plus at 250 ft2 / 50 lb. bag. Allow for 24 hour cure. • Dampseal 101 at 100-150 ft2 / gal. apply two coats. • Sealobond Primer WB at 250 ft2 /gal. NOA No.: 10-0608.04 MIAMI.OADE COUNTY Expiration Date: 10/13/15 • Approval Date: 11/04/10 Page 4 of 14 Base Coat: Apply a moderate base coat of Sealoflex CT Pink to the prepared area and embed Sealoflex Fabric directly into the wet base coat. Use a clean, dry brush to fully embed the fabric, removing any wrinkles or bubbles. Allow to dry until the fabric is firmly adhered (minimum 30 minutes). Apply a saturation coat of Sealoflex CT Pink to fully saturate the fabric from above. Fabric joints shall be overlapped a minimum of 3". Top Coat: Apply two (2) coats of Sealoflex CT Top at a total rate of 70 ftz/gal. Integrity Test: Required, and shall be performed in accordance with ASTM D 5957. Water maybe maintained for a period longer than 24 hours if required. Inspection: Contractor and a representative of the membrane manufacturer shall inspect the waterproofing assembly and notify the contractor of any defects. All defects shall be corrected. Drainage Install drainage mat/board or Sealodrain 650 over topcoat of Sealoflex CT Top. Mat/Board: Surfacing: Structural Concrete Slab, minimum 2500 psi, in compliance with applicable Building Code. Minimum 5 inch thick for continuous pour. If less than 5 inches thick, topping slab shall be broken into maximum 10 ft x 10 ft panels with control joints. (See General Limitation # 10) Maximum Design N/A (Topping concrete slab shall comply with applicable Building Code Pressure: requirement.) . . .... ...... •••• •••• • • •••• •••• ••••• •••••• • ••• ••••• •• •• •• • •••••• • • • • • •••••• • NOA No.: 10-0608.04 Expiration Date: 10/13/15 Approval Date: 11/04/10 Page 5 of 14 Deck Type 3 Concrete Decks, Roof Plaza Decks Deck Description: Min. 2500 psi, dual slab construction with the finish (roof plaza decks) System Type (2): Sealoflex CT (1.3.1.3) Substrate: Structural concrete shall be cured a minimum of 14 days. The curing method must be water cure, wet coverings, paper sheets, pastic sheets or approved liquid curing compound such as sodium silicate. Substrate All surfaces must be dry, smooth, free of depressions, voids and protrusions and Preparation: clean and free of any non -compatible curing compounds, foam release agents and other surface contaminants. Poured in place concrete must be monolithic, smooth, free of voids, spalled areas, laitance, honeycombs, and sharp protrusions. Precast concrete decks shall be mechanically secured to minimize differential movement and all joints between units shall be grouted. The substrate must be cleaned to remove loose debris, and a test patch of Sealoflex-CT Pink shall be applied to the surface to check adhesion. Apply 6" wide strips of Sealoflex Fabric at the junction of all vertical and horizontal surfaces, changes in plane and expansion joints. Concrete around drain shall be depressed to promote positive water drainage Membrane All cracks, expansion joints, base flashings, penetrations and junctures at Flashing: horizontal/vertical changes in plane shaII be flashed with Sealoflex Fabric and Sealoflex CT Pink in accordance with Sealoflex published details. All cracks greater than 1/16" wide shall be routed and filled with Corabase or Sealopatch and lined with a Sealoflex CT Pink and Sealoflex Fabric. Cracks smaller than'/16" wide shall be filled with Sealoflex Buttergrade. For vertical surfaces the Sealoflex Fabric shall extend at least 6" into the horizontal surface. At field and wall expansion joints, install Sealoflex Fabric 6" to both sides of the joint. • • • • All drains areas shall be pre -detailed with Sealoflex CT Pink an!l.SI(Mex .... • • Fabric extending 6 inches beyond the drain flange on all sides andsacased by •the 0 • • • • • • clamping ring to the drain. Drain must be maintained free to weep a; membrane • ; ; • ... level. ...• •••• • . •.•• ••.• ..... Primer: ...... . ... Prime Concrete decks with ONE of the following: ' ..' : ..... • • • • • • • Sealoment Plus at 250 ft' / 50 lb. bag. Allow for 24 hour etiaa • • • 00 • Dampseal 101 at 100-150 ftz /gal. apply two coats. • • ,..... • Sealobond Primer WB 250 ftz / gal. .. 0 : • • • • 0000 NOA No.: 10-0608.04 Expiration Date: 10/13/15 Approval Date: 11/04/10 Page 6 of 14 Base Coat: Apply a moderate base coat of Sealoflex CT Pink to the prepared area and embed Sealoflex Fabric directly into the wet base coat. Use a clean, dry brush to fully embed the fabric, removing any wrinkles or bubbles. Allow to dry until the fabric is firmly adhered (minimum 30 minutes). Apply a saturation coat of Sealoflex CT Pink to fully saturate the fabric from above. Fabric joints shall be overlapped a minimum of 3". Top Coat: Apply two (2) coats of Sealoflex CT Top at a total rate of 70 ftl/gal. Integrity Test: Required, and shall be performed in accordance with ASTM D 5957. Water maybe maintained for a period longer than 24 hours if required. Inspection: Contractor and a representative of the membrane manufacturer shall inspect the waterproofing assembly and notify the contractor of any defects. All defects shall be corrected. Drainage Install drainage mat/board or Sealodrain 650 over topcoat of Sealoflex CT Top. Mat/Board: Topping Slab: Structural Concrete Slab, minimum 2500 psi, in compliance with applicable Building Code. Minimum 3 inch thick for continuous pour. If less than 3 inches thick, topping slab shall be broken into maximum 10 ft x 10 ft panels with control joints. Surfacing: Concrete pavers (24" x 24" x 1-%") 4000 psi minimum or ceramic plaza deck tiles (12"xl2"x %") embedded into Sealoflex Corabase applied to the top Sealoflex-CT coating with a'/4" trowel. (See General Limitation # 10) Maximum Design -267 psf (See General Limitation #9) Pressure: . ...... ...... .. .... ..... .... ...... . ... ..... NOA No.: 10-0608.04 Expiration Date: 10/13/15 Approval Date: 11/04/10 Page 7 of 14 Deck Type 3 Concrete Decks, Non -Insulated Deck Description: Min. 2500 psi System Type (3): Tile Finish over Sealoflex CT (1.3.1.2 or 1.3.1.4) Substrate: Structural concrete shall be water cured a.minimum of 14 days. The curing method must be a water cure, wet coverings, paper sheets, plastic sheets or approved liquid curing compound such as sodium silicate. Substrate All surfaces must be dry, smooth, free of depressions, voids, and protrusions, and Preparation: clean and free of any non -compatible curing compounds, foam release agents and other surface contaminants. Poured in place concrete must be monolithic, smooth, free of voids, spalled areas, laitance, honeycombs, and sharp protrusions. Precast concrete decks shall be mechanically secured to minimize differential movement and all joints between units shall be grouted. The substrate must be cleaned to remove loose debris, and a test patch of Sealoflex-CT Pink shall be applied to the surface to check adhesion. Apply 6" wide strips of Sealoflex Fabric at the junction of all vertical and horizontal surfaces, changes in plane and expansion joints. Concrete around drain shall be depressed to promote positive water drainage Membrane All cracks, expansion joints, base flashings, penetrations and junctures at Flashing: horizontal/vertical changes in plane shall be flashed with Sealoflex Fabric and Sealoflex CT Pink in accordance with Sealoflex published details. All cracks greater than'/16" wide shall be routed and filled with Corabase or Sealopatch and lined with a Sealoflex CT Pink and Sealoflex Fabric. Cracks smaller than'/16" wide shall be filled with Sealoflex Buttergrade. For vertical surfaces the Sealoflex Fabric shall extend at least 6" into the horizontal surface. At field and wall expansion joints, install Sealoflex Fabric 6" to both sides of the joint. All drains areas shall be pre -detailed with Sealoflex CT Pink and Sealoflex . • • • • . Fabric extending 6 inches beyond the drain flange on all sides a>Zd sGa red by Aeo e 00 clamping ring to the drain. Drain must be maintained free to wee t* t membrane • • level. • Primer: Prime Concrete decks with ONE of the following: .... • • • • • • •••• • • • • • • • Sealoment Plus at 250 ft2 / 50 lb. bag. Allow for 24 hour cuse! ee • Dampseal 101 at 100-150 ft2 / apply two • • gal. coats. • Sealobond Primer WB 250 ft2 / gal. • • • • • • • • • .. . NOA No.: 10-0608.04 MIAM WiADE COUNTY Expiration Date: 10/13/15 JAPPROVEDI_Approval Date: 11/04/10 Page 8 of 14 Base Coat: Apply a moderate base coat of Sealoflex CT Pink to the prepared area and embed Sealoflex Fabric directly into the wet base coat. Use a clean, dry brush to fully embed the fabric, removing any wrinkles or bubbles. Allow to dry until the fabric is firmly adhered (minimum 30 minutes). Apply a saturation coat of Sealoflex CT Pink to fully saturate the fabric from above. Fabric joints shall be overlapped a minimum of 3". Integrity Test: Required, and shall be performed in accordance with ASTM D 5957. Water maybe maintained for a period longer than 24 hours if required. Top Coat: Apply two (2) coats of Sealoflex CT Top at a total rate of 70 ft2/gal. Inspection: Contractor and a representative of the membrane manufacturer shall inspect the waterproofing assembly and notify the contractor of any defects. All defects shall be corrected. Surfacing: Concrete pavers (24" x 24" x 1-%") 4000 psi minimum or ceramic plaza deck tiles (12"x12"x'/z") embedded into Sealoflex Corabase applied to the top Sealoflex-CT Top coating with a''/4" trowel (See General Limitation # 10) Maximum Design -267.5 psf (See General Limitation #9) Pressure: ...... .. . ...... .... .... . . .... ..... .... ...... . ... ..... NOA No.: 10-0608.04 Expiration Date: 10/13/15 Approval Date: 11/04/10 Page 9 of 14 Deck Type 3 Concrete Decks, Non -Insulated Deck Description: Min. 2500 psi System Type (4): Sealoflex CT or Sealoflex (1.3.1.1 or 1.3.1.5) Substrate: Structural concrete shall be water cured a minimum of 14 days. The curing method must be a water cure, wet coverings, paper sheets, plastic sheets or approved liquid curing compound such as sodium silicate. Substrate All surfaces must be dry, smooth, free of depressions, voids, and protrusions, and Preparation: clean and free of any non -compatible curing compounds, foam release agents and other surface contaminants. Poured in place concrete must: be monolithic, smooth, free of voids, spalled areas, laitance, honeycombs, and sharp protrusions. Precast concrete decks shall be mechanically secured to minimize differential movement and all joints between units shall be grouted. The substrate must be cleaned to remove loose debris, and a test patch of Sealoflex Pink or Sealoflex CT Pink shall be applied to the surface to check adhesion. Apply 6" wide strips of Sealoflex Fabric at the junction of all vertical and horizontal surfaces, changes in plane and expansion joints. Concrete around drain shall be depressed to promote positive water drainage. Membrane All cracks, expansion joints, base flashings, penetrations and junctures at Flashing: horizontal/vertical changes in plane shall be flashed with Sealoflex Fabric and Sealoflex Pink or Sealoflex CT Pink in accordance with Sealoflex published details. All cracks greater than 1/16" wide shall be routed and filled with Corabase or Sealopatch and lined with a Sealoflex Pink or Sealoflex CT Pink and Sealoflex Fabric. Cracks smaller than 1/16" wide shall be filled with Sealoflex Buttergrade. For vertical surfaces the Sealoflex Fabric shall extend at least 6" into the horizontal surface. At field and wall expansion joints, install Sealoflex Fabr p-0 • • to both sides of the joint. • • • • All drains areas shall be preAetailed with Sealoflex Pink or See.ItffWCT Pink' and Sealoflex Fabric extending 6 inches beyond the drain flange bb"rsides and secured by the clamping ring to the drain. Drain must be maintaihl a%ee to weed • at membrane level. ...... . ... Do not mix Sealoflex Pink or Sealoflex Finish Coat materiaba{1tL.Sealoflex. • CT Pink or Sealoflex CT Ton ' Primer: Prime Concrete decks with ONE of the following: ' ..' • • • • • Sealoment Plus at 250 ft2 / 50 lb. bag. Allow for 24 hour cure. • • • • • Dampseal 101 at 100-150 ft2 / gal. apply two coats. • Sealobond Primer WB 250 ft2 / gal. NOA No.: 10-0608.04 Expiration Date: 10/13/15 MIAMJ APPRO ED! Approval Date: 11/04/10 Page 10 of 14 Base Coat: Apply a moderate base coat of Sealoflex Pink or Sealoflex CT Pink to the prepared area and embed Sealoflex Fabric directly into the wet base coat. Use a clean, dry brush to fully embed the fabric, removing any wrinkles or bubbles. Allow to dry until the fabric is firmly adhered (minimum 30 minutes). Apply a saturation coat of Sealoflex Pink or Sealoflex CT Pink to fully saturate the fabric from above. Fabric joints shall be overlapped a minimum of 3". Integrity Test: Required, and shall be performed in accordance with ASTM D 5957. Water maybe maintained for a period longer than 24 hours if required. Top Coat: A. Apply two (2) coats of Sealoflex Finish Coat at a total rate of 70 W/gall. (Choose A OR B) OR B. Apply two (2) coats of Sealoflex CT Top at a total rate of 70 ft2/ga. Inspection: Contractor and a representative of the membrane manufacturer shall inspect the waterproofing assembly and notify the contractor of any defects. All defects shall be corrected. Surfacing: Apply Wearcoat at a rate of 90 W/gal. or Coraflex at a rate of 20 ftz/gal. (See General Limitation # 10) Maximum Design -230 psf (See General Limitation #9) Pressure: • • .•.. •••. . . •• •• •• • •••••• to ...•• NOA No.: 10-0608.04 Expiration Date: 10/13/15 Approval Date: 11/04/10 Page 11 of 14 Substrate Type 3: Concrete Decks Substrate Description: Min. 2500 psi, dual slab construction (roof plaza) System Type (5): Membranes applied directly to substrate (1.3.1.3 or 1.3.1.6). All General and System Limitations apply. Substrate All surfaces must be dry, smooth, free of depressions, voids and protrusions and Preparation: clean and free of any non -compatible curing compounds, foam release agents and other surface contaminants. Poured in place concrete must be monolithic, smooth, free of voids, spalled areas, laitance, honeycombs, and sharp protrusions. Precast concrete decks shall be mechanically secured to minimize differential movement and all joints between units shall be grouted. The substrate must be cleaned to remove loose debris, and a test patch of Sealoflex-CT Pink shall be applied to the surface to check adhesion. Apply 6" wide strips of Sealoflex. Fabric at the junction of all vertical and horizontal surfaces, changes in plane and expansion joints. Concrete around drain shall be depressed to promote positive water drainage Membrane All cracks, expansion joints, base flashings, penetrations and junctures at Flashing: horizontal/vertical changes in plane shall be flashed with Sealoflex Fabric and Sealoflex CT Pink in accordance with Sealoflex published details. All cracks greater than'/16" wide shall be routed and filled with Corabase or Sealopatch and lined with a Sealoflex CT Pink and Sealoflex Fabric. Cracks smaller than 1/16" wide shall be filled with Sealoflex Buttergrade. For vertical surfaces the Sealoflex Fabric shall extend at least 6" into the horizontal surface. At field and wall expansion joints, install Sealoflex Fabric 6" to both sides of the joint. All drains areas shall be pre -detailed with Sealoflex CT Pink and Sealoflex Fabric extending 6 inches beyond the drain flange on all sides and secured by the clamping ring to the drain. Drain must be maintained free to weep at membrane...@ level. sees . sees Primer: Prime Concrete decks with ONE of the following: "' ;" see a • Sealoment Plus at 250 ft2 / 50 lb. bag. Allow for 24 hour cure. sees sees • Dampseal 101 at 100-150 ft2 / gal. apply two coats. • . • e ... • Sealobond Primer WB 250 ft2 / gal. s e e . e . e Base Coat: Apply a moderate base coat of Sealoflex CT Pink to the prepared aneapo embed Sealoflex Fabric directly into the wet base coat. Use a clean, dry brash to fully ;.. e: embed the fabric, removing any wrinkles or bubbles. Allow to dry Qntil ft fabrit is firmly adhered (minimum 30 minutes). Apply a saturation coat of S2ald lex CT :*so Pink to fully saturate the fabric from above. Fabric joints shall be overlapped a e * 0 minimum of3". NOA No.: 10-0608.04 MIAMI•Du4DE Expiration Date: 10/13/15 • � •. COUNTY Approval Date: 11/04/10 Page 12 of 14 sees.. sees.. sees.* sees. sees. sees.. e e e eeee e • •geese • s v NA v,c. itz1 M Miami Shores Village Y Building Department O050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 NSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 201e BUILDING Master Permit No. J— Sub Permit o. �f' �`7 / �.� 9REVISION ❑ EXTENSI RENEWAL PERMIT APPLICATION ❑ BUILDING ❑ ELECTRIC RqROOFING AUG 07 2014 PLUMBING ❑ MECHANICAL PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP j CONTRACTOR DRAWINGS JOB ADDRESS: Imo`' �£ T City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Constr ction Ty e: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): ' `f�''/ Phone#: Address: /00! ^)' - <`" 5�/ City: State: f Zip: 3!�,/ 3 K Tenant/Lessee Name: Phone#: Email CONTRACTOR: Company Name: IV 3,,, //./—_ Phone#: Address: A OO / /-F 4?;�nl City: Qualifier Name: 7/Arpt Ps: State: --/( hone#: p: S-- State Certification or Registration #:: Certificate of Competency #: DESIGNER: A chitecctt/Engineer: / r pw,�1eS q(ti0 Phone#: ��� O/ Address: 4?&? j/ '<,-� City: N• /f't A.— State: EL Zip: /G2 Value of Work for this Permit: $ r� Square/Linear Footage of Work: Type of Work: ❑ Addition D7cription of Work: Owe- ] Alteration ❑ New roe✓ d yo &f -We ❑ Repair/Replace ❑ Demol °tea' 17 S�/JG�✓/'a / S�✓D�l� mil` / h ., Cil•�'�"'U'� � c9 r� 'rPr/sr- C-v c CA_ Wcc S a( 1PA4 Specify color of color thru tile: r��� fl ,oN' ° Submittal Fee $_ Scanning Fee $ _ Technology Fee $ Permit Fee $ Radon Fee $ Training/Education Fee $ CCF $ CO/CC $ DBPR $ . Notary $ Double Fee $ Structural Reviews $ Bond $ TOTALTEE NOW DUE $ , ,, • _ _ `c) (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State r Zip , 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. In the absence of such posted notice, the inspection will n2,7ro d a d a reinspec ' fee will be charged. _ Signature r Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this _ day of W 1 /!%l1r7L 20 by lL /d who is personally known to me or who has produced G identification and who did take an oath. NOTARY PUBLIC: The foregoing instrument was acknowledged before me this day of me or who has produced 20 by , who is personally known to identification and who did take an oath. NOTARY PUBLIC: as Sign: Sign: Print: Print: Sea Seal: F,.Wf po% Notary Public State of Florida Joanna M FelicianoMy Commission FF 082753OiMs�k** 011124018 f*#*&*A********************************************************************* APPROVED BY>/�—// `r� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)