RF-01-21-40 AFFMiami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
W: (305) 795.2204
Fax: (305) 756.8972
RE: Permit # V= u�
INSPECTION AFFIDAVIT
DATE: 11 U�3 I
I Love I S Tb) u licensed as a (n) Contractor / Engineer / Architect,
(Print name and circle License Type) FS 468 Building Inspector
License #: tr h C. = 1515 C0 (C� 1-1K
On or about ��� 1'a� a I , I did personally inspect the roof deck nailing
(Date & time)
work at ID9140-L
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the Hurricane Mitigation Retrofit
Manual (Based on 553.844 F.S
Signature
State of Florida
County of Dade:
The undersigned, being the first duly sworn, deposes and says that he/she is the contractor for the above property
mentioned.
Sworn to and subscribed before me this — libVILAWY day of 16-11
Notary Public, Sate of Florida at Large MAYELIS PEREZ
MY COMMISSION # HH 069221
EXPIRES: February 4, 2025
Bonded Thru liotargPr�LNc Underwriters
"General, Building, Residential, or Roofing Contractors or any individual certified under 468 F.S. to make such an inspection. Include photographs of each plane of the Fool mn
permit # and address # clearly shown marked on the deck for each inspection
aa„-1— 17tn1')n1n1Gn1ionno
DocuSign Envelope ID: BF1D7C31-B993-4CO3-A972-4CA26B9F4425
FLORIDA TEC
PROVIDING SOLUTIONS TO THE ROOFING INDUSTRY
CONCENTRATED UPLIFT LOAD TESTING ON ROOF TILE
TO COMPLY WITH FBC PROTOCOL TAS-106
Lab Report No. 132406
C.A. # 30448
Lab Certificate # 18-1114.01
PROPERTY ADDRESS: 10940 NW 2na Ave., Miami PERMITNo: RF-01-21-40
PROPERTY OWNER: Terrance B Washington ROOFING SQUARES: 17
CONTRACTOR: T&S Roofing Systems. Inc. ROOF PITCH: 4:12
TILE TYPE: Spanish "S" INSPECTOR INITIALS: AA
ATTACHMENTMETHOD: Foam Adhesive TESTDATE: 04/05/2021
Testinq Equipment: Uplift Gauge FGE-100X Test Tabulation Required Testing Force: 35 Ibs
No.
RESULT
No.
RESULT
No.
RESULT
No.
RESULT
No.
RESULT
I-9
Passed
10-19
Passed
20-27
Passed
THIS ROOF HAS PASSED THE STATIC UPLIFT IN ACCORDANCE WITH FBC PROTOCOL TAS-106.
"ROOF SKETCH"
38'
Sincerely,
Yan L. Solis, P.E.
Lic. No. 75423
OamSigned by:
Yam. " Sala
93B2 nNW2C411...
4/5/2021
53'
2
3
7
5
L-
-
-
- - -
1
4
6
?6
24
i
The method and software that have
been utilized to sign and seal the
report, comply with the intent of the
Board Rules. Specifically, with
reference to Florida Statutes 471 and
the Florida Administrative Code Rule
61 G15-23.003 for Engineers.
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.�� L • S o
C E•N
*'• No. 75423 '*
�•,. STATE OF
�....
�RL O R I d ��
10735 SW 216" St. Unit 404 Tel: 305-256-4550
Miami FL 33170 Page 1 of 1
www.FloridaTEC.net Fax: 305-256-6833
DocuSign Envelope ID: BF1D7C31-B993-4CO3-A972-4CA26B9F4425
Lab Report No.
FLORIDA TE0
5
PROVIDING SOLUTIONS TO THE ROOFING INDUSTRY
C.A. # 30448
Lab Certificate # 18-1114.01
CONCENTRATED UPLIFT LOAD TESTING ON ROOF TILE
TO COMPLY WITH FBC PROTOCOL TAS-106
PROPERTY ADDRESS.
10940 NW 2nd Ave.. Miami
PERMITNo:
RF-01-21-40
PROPERTY OWNER:
Terrance B Washington
ROOFING SOUARES:
17
CONTRACTOR:
T&S Roofing Systems. Inc.
ROOF PITCH-
4:12
TILE TYPE:
Spanish "S"
INSPECTOR INITIALS.
AA
ATTACHMENT METHOD:
Foam Adhesive
_ TEST DATE:
04/05/2021
Testina Eauioment: Uplift Gauge FGE-100X Test Tabulation Required Testing Force: 35 Ibs
No.
RES ULT
No.
RESULT
No.
RESULT
No.
RESULT
No.
RESULT
1-9
Passed
10-19
Passed
20-27
Passed
THIS ROOF HAS PASSED THE STATIC UPLIFT IN ACCORDANCE WITH FBC PROTOCOL TAS-106.
"ROOF SKETCH"
Sincerely,
Yan L. Solis, P.E.
Lic. No. 75423
EA
OaaoBipn� bY:
t."SA4
93829769992C4II..
4/5/2021
2 3
F -- --
-
J _.
1 4
6 24
38'
5
53'
7
The method and software that have
been utilized to sign and seal the
report, comply with the intent of the
Board Rules. Specifically, with
reference to Florida Statutes 471 and
the Florida Administrative Code Rule
61 GI5-23.003 for Engineers.
8
J
J
9 N
10
� C'E'jlj
Nn. T5a23
STATE ❑F
.�;• F�OR1D
10735 SW 2161h St. Unit 404 Tel: 305-256-4550
Miami FL 33170 Page 1 of 1
www.FloridaTEC.net Fax: 305-256-6833