BP-04-407Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
2 4 2004
Permit No. 62 2CO4 —
Master Permit No.
FBC 2091
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) Adr i ana Rosa Phone # (3 0 5) 895 - 31 Owner'
s Address 10618 N_ E- 11 Court - City
Miami Shores State Tenant/
Lessee Name Florida
Zip Job
Address (where the work is being done) 10618 N.E. 11 Court 33138
Phone #
City
Miami Shores Village County Miami -Dade Zip 33138 Is
Building Historically Designated YES NO X Contractor'
s Company Name Quality Roofing Contractor Phone # (305) 751-0382 Contractor'
s Address 13800 N. W. 1st Avenue City
Miami State Florida Zip 33168 Qualifier
Carlos Arocho Architect/
Engineer's Name (if applicable) S
Value of Work For this Permit $1 1 , 500.00 Type
of Work: Addition El Alteration New Phone #
3a
v /= Square
Footage Of Work: 25sq.Tile 8sq. Flat KI
Repair/Replace Demolition Describe
Work: Tear off old roof to wood deck, tin cap 301b. felt, install cgalvani eave
drip metal, mop 901b. ASTM felt, install tiles with polyfoam adhesive setting.
Flat root o tin cap #75 base, mop ply 4, sur ace to mop cap sheetT C
19 409 -*N,,RA** Submittal
Fee $ Permit Fee $ ,3ot CCF CO/CC Notary
S Training/Education Fee $ Technology Fee $ Scanning $
Radon $ Zoning -"' Bond $ Code
Enforcement $ Structural Plan Review. $ — Total
Fee Now Due $ 3'0 1 1 Continued
on opposite side)
Mortgage Lender's Address
city.q: State Zip
p
q,
Application is hereby .made to obtain a permit to do the work and instaIlations as indicated. I certify that no work or installation has
commenced prior to` & Issuance of a permit and that all work will lie performed to meet the standards of all laws regulating
construction in thls Jurisdiction. } Lunderstand that a separate permit,must be secured for.ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS;TURNACES; 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
C
Signature)( Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this 1'7 The foregoing instrument was acknowledged before me this
day of %lic rc 2601 yby' "/ s, ,,k (- )2o 5g day of ; 20G, by
who is personally known+"to me or who has produced who is personally known to me or who has produced
NOTARY PUBLLC
Sign:
Print:
My`Commission Ex
As identification and ho did take an oath.
NOTARY PUBLIC:
Sign:
Print:
identification and who
MARYLOU HERNANDEZ • _*:
MY COMMISSION a DD 060579 My Commission Expires
EXPIR€ OCf p e U 7 Oy 1
i fG b ary$R11 denvmers
14 Icate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
take an oath.
APPLICATIONµAPPROVED BY:-'` Plans Examiner
Engineer
Zoning
Chc12/15/03
i
MIAMI SHORES VILLAGE
BUMDING DEPARTMENT
305-795-2204
Building Inspection Request
Dat 604- ;5
Type Insp'n Ei Cn)Pgx)-]'
Permit No.
Name
ff
Address 10( 7)
I
Compan \
Phone #
Inspection Date
i
Approved
i
Correction
Re-Insp'n Fee 71
1
U.S. SOUTH
Project , 5409
Engineering & Testing Lab., Inc.
6065 N.W. 167th Street, Suite B-23 • Miami Lakes, Florida 33015
Telephone: (305) 558-2588 • Fax: (305) 362-4669
ON -SITE CONCENTRATED UPLIFT LOAD TESTING OF ROOF TILE IN
FULL ACCORDANCE WITH METRO-DADE BUILDING CODE COMPILANCE
PROTOCOL TAS 106
SITE SPECIFIC INFORMATION
Owner's Name: —
Job Address:
Roofing Contractor:
Type of Tile: 'S
Approximate Roof 1
Type of Access to Roof: Scaffolds
Approximate Square Footage of Roof- 2-1 D o ft2 Ladder
Required Testing Force: 3
Date Tested: -7- 1 3 -
Testing Equipment: Chatillion100
TEST RESULTS
P = PASS. F = FAIL
Other
Test Location Uplift Pull Test(P or F) Test Location Uplift Pull Test(P or F) Test Location Uplift Pull Test(P or F) Test Location Uplift Pull Test(P or F)
1 Gj> 26 51 76
2 27 52 77
3 28 53 78
4 29 54 79
5 30 55 80
6 31 56 81
7 32 57 82
8 33 58 83
9 34 59 84
10 35 60 85
11 36 61 86
12 37 62 87
13 38 63 88
14 39 64 89
15 40 65 90
16 41 66 91
17 42 67 92
18 43 68 93
19 44 69 94
20 45 70 95
21 46 71 96
22 47 72 97
23 48 1 73 98
24 49 74 99
25 50 75 100
IN ACCORDANCE WITH TJiE CRITERIA OF PROTOCOL TAS 106, THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT
QUALITY CONTROL TEST.
THIS REPORT-SU6MITTED BY:
P.E.
Civil Engineer:
Lab Certification # 98-0608.04
N ate of FL Certificate Authorization # 4100
PRINTED BY: UNIQUE GRAPHICS: 954-484-9923 FAX: 954-484-9967
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