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RF-16-1819Miami Shores Village RECEIVED Building De g Department p NOV 151017 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 Q—fQL1 INSPECTION LINE PHONE NUMBER: (30S) 762-4949 FBC 20kA BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. O'BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS 0 CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 104 NW 102 ST City: Miami Shores County: Miami Dade Zip: 3 �3 / 5 6 Folio/Parcel#: i 1 " --�l U - U I2L - Of �3 6 Is the Building Historically Designated: Yes NO Occupancy Type: Load: nC-o�\re nsstruction Type: Flood Zone: BFE:: Q L FFE: A OWNER: Name (Fee Simple Titleholder): �'T �O I', - Phone#: I UC3' 356 b-1 G Address: I64 U W MZw d SA - City: 16A A" � nuj� State: J� _ Zip: 33 IS-0 Tenant/Lessee Name: Phone#: Email: S V200n�T�:�W`� Cc�� CONTRACTOR: Company Name: LAR CONTRUCTION INC Phone#: Address: 5341 LIMEWOOD CT rl3(0 City: BOYNTON BEACH State: FL Zip: 33472 Qualifier Name: LUIS ALEJANDRO RODRIGUEZ Phone#: State Certification or Registration #: CCC1330240 Certificate of Competency M DESIGNER: Architect/Engineer: Address: ��11 City: Value of Work for this Permit: $� -5 0 C) 23400 0 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of Work: Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee Structural Reviews $ Training/Education Fee $ CCF $ DBPR $ Zip: ❑ Demolition CO/CC $ Notary $ Double Fee $ Bond $ S© V (Revised02/24/2014) TOTAL FEE NOW DUE $� 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 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 4,atu3*7 ccurs seven (7) days after the building permit is issued. In the absence of such posted notice, the insp'11 be charged. S SignatureR or AGENT CONTRA OR The foregoing instrument was acknowledged before me this day of Al b 1/• 20 1'7-J by ALfe L= o R -Pa-t1,A#0b is personally known to me or who has produced -identification and who did take an oath. NOTARY PU C: Sign: Print: Seal: APPROVED BY (Revised02/24/2014) The foregoing instrument was acknowledged before me this day off(/co !v• ,20 i by Lu/-57 A r! C J A A-) p /?[Z who is personally known to as me or who has produced identification and who did take an oath. NOTARY as Sign: lil Print: .ice OV& Notary Public State of Fbdda y pubfb Stgte of FWW Maria Soto Seal: Matt Soto My Commbabn GO 085552 My CommisWW GG 0855tR2 QW6, Expires o3n1rzo21 a t 03121/2021 :::::::::::*�e sss:**s*s*sssssss:sss**ssssss******s■:ss+r:::::::::::rr*.:::::..s.:::::::.:..: ,i 1 Plans Examiner Zoning Structural Review Clerk Miami Shores Village RECEIVED Building Department 10050 N.E.2nd Avenue Nov 1:5 2017 Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 75656.89728972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. ��1 q Owner's Name (Fee Simple Title Holder):ALFREDO PATINO Phone #: 786-356-8710 Owner's Address: 104 NW 102 ST City: MIAMI SHORES State : FL Zip Code: 33150 Job Address (Of where work is being done): 104 NW 102 ST City: X Miami Shores State: —Florida Zip Code: 33150 Contractor's Company Name: AG STAR CONSTRUCTION INC Phone #: Address: 1827 NW 1 ST City: MIAMI Qualifier's Name: AXEL GALDAMEZ Architect/ Engineer of Record Name: Address: City: Describe Work: State: FL State: Zip Code: 33125 Lic. Number: CCC1329029 Phone #: Zip Code: hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless of all lega nvoly ment. Signature Signature ner or Agent ctor or Architect The foregoing instrument was aknowledged before me The foregoing instrument was aknowledged b fore me this N day of 0 of 20 by Al f�e�o pAT�N� this day of , 2q <by PlUd 6r " Who is personally known to me or who has produced who is personally known to me or who has produced [� as indentification. as indentification. Notary Pu c: Nota bl' Sign: SignJose A. : _ Se t!1'!!ta A. GiMn Seal: � = Commission # FF9AN Commission # FP990930 ;► =Expires: September 3, 2020 �; Expires: September 3, 2020 Bonded thru Aaron Notary Bonded thru Aaron Notary y�` Miami Shores Village `yµortEs 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 CORioA (Permit Issue Date: 6/27/2017 Permit NO. RF-6-16-1819 Permit Type: Roof Work Classification: Flat Permit Status: APPROVED Expiration: 12/24/2017 Project Address Parcel Number Applicant 104 NW 102 Street 1131010220130 Miami Shores, FL 33138- Block: Lot: ALFREDO R PATINO Owner Information Address Phone Cell ALFREDO R PATINO 104 NW 102 Street MIAMI SHORES FL 33138- 104 NW 102 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone AG STAR ROOFING, INC (305)457-9970 ADVANCED CONSTRUCTION SERVIC (305)457-9970 (786)306-8183 of Work: Re Roof itional Info: RE -ROOFING FLAT ;sification: Residential nning: 3 Fees Due Amount Bond Type - Owners Bond $500.00 CCF $2.40 DBPR Fee $3.75 DCA Fee $3.75 Education Surcharge $0.80 Permit Fee - New Roof $250.00 Scanning Fee $9.00 Technology Fee $3.20 Total: $772.90 Valuation: $ 3,700.00 Total Sq Feet: 600 Pay Date Pay Type Amt Paid Amt Due Invoice # RF-6-16-60399 06/27/2017 Check #: 241 $ 272.90 $ 500.00 06/30/2016 Credit Card $ 500.00 $ 0.00 Bond #: 3129 mvanaoie mspections: Inspection Type: Tin Cap Final Roof Roof in Progress In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PL MBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: ify hat all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. t er ore, I authorize the above -named contractor to do the work stated. June 27. 2017 Authorized SigMttl Int / Applicant / Contractor / Agent Building DepartCopy June 27, 2017 1 x a r BUILDING PERMIT APPLICATION Miami Shores Village RECEIVED Building Department MAY -3 7017 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 201Q Master Permit No.t2 C 1 (D' G Sub Permit No. a p I & F-IBUILDING ❑ ELECTRIC N ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: to Y Al I. l 10 z nd S Trc City: Miami Shores County: Miami Dade Zip: 3 3 / Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load OWNER: Name (Fee Simple Titleholder): Address: ( 0 Y AJ W / 0 Construction Type: Flood Zone: BFE: FIFE: :��'� 3S68�►o 33 City: ^M / Ct (�An, )',Pt O ►''P i State: � / � I2i L� b� Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: AG STAR CONSTRUCTION INC Phone#: 3054579970 Address: 1827 NW 1 ST City: MIAMI State: FL Zip: 33125 Qualifier Name: AXEL GALDAMEZ Phone#: State Certification or Registration #: CCC1329029 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of work: RE ROOF TILE Specify color of color thru tile:, Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ Zip: ❑ Demolition CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ Z- 2 ' o (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address Gity , State 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 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 n t be approv fee will be charged. Signa re Signature —(:: Owner or Agent Contractor The foregoing instrument was acknowledged before me this _ day ofm QT_, 20 11, by ' who is personally known to me or who has produced As identification and who did take an oath. NOTA Y PUB IC: Sign: Print: v > 6 b My gomission Expires: �l /�IIIIIIIIJ J APPROVED BY The foregoing instrument was acknowledged before me this 0 Z day of 20 LPL, by #YA,! & /y o k-.* — who is personally known to me or who has produced �! as identification and who did take an oath. NOTAR UBLIC: Sign: Pri t Jose A. Giron tGllyg ommission Expires: '�`a` a.�; - WWII Commission 4 MOO �► ►nission i FP990930 ices September 3, 2020 m11J� g fiber a 2020 �`. thro Aaron Notary �n Plans Examiner Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Zoning Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 JUN 8 d 2018 BY: INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 2014 l� i• ._ V _ t I_ � Q'1 r� BUILDING Master Permit No.PERMIT APPLICATION Sub Permit No. OBUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 104 NW 102 ST City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-3101-022-0130 Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: ROOF Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): / / rk-a do &T / )7 U Phone#: Address: �l l dQ r do / V 1 114 q C- ]) l City: /" �l''J�r / V #' <<j- State: rL Zip: % Tenant/Lessee Name: Email ne#: CONTRACTOR: Company Name: -�,y J C,y Cd C 010,S 1 0-'7` &?-5Phone#: -W�-L Y S % Clq 76 Address: fiy 2 City: lAA-1 State: f Zip: / �, !�1 Qualifier Name: 1` �'l (�O ri Zn I'e �-- Phone#: ��� '1 Y7 q97v State Certification or Registration #: C Ci C Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $--3 " 911 Square/Linear Footage of Work: �, © 0 Type of Work: ❑Addition ❑ Alteration � ew ❑ Repair/Replace ❑ Demolition Description of Work: in Q k(� i /77' Specify color of color thru tile: A Submittal Fee $ � s Permit Fee $ Zn CCF $ 2.4o CO/CC $ (] Scanning Fee $ -I Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ _i . )o Double Fee $ _ Structural Reviews $ Bond $ 5 00 + TOTAL FEE NOW DUE $ 2.72 .9 O (Revised02/24/2014) -71 2-y 9 o 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 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 ins ection which occurs seven (7) days after the building permit is issued. in the absence of such posted notice, the inspection will n t be approved and a reinspection fee will be charged. Signatu OWNER or AGENT The foregoing instrument was acknowledged before me this day of A�U��- 20 by �l✓� �o6;—� - , who is personally known to me or who has produced �►�(�-���-�� as identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: Seal: APPROVED BY Signature NTRACTOR The foregoing instrument w acknowledged before me this day of J u. n 20 11 by pt 7L11 ho is personally known to me or who has producied as �rP�Jos" o . Giron 83 identification ary NOTARY PUBLIC o'Fov'i4pP¢� ..._ _ES- 2016 Sign: Print: Seal: +►r+►*•wrrsrr**�x*r**»**s�xr*•�rr�rr�w*r***�x****rw*��r*raw»*�rr�r*+rwwr*�* Plans Examiner Structural Review Zoning Clerk (Revised02/24/2014) OWNER'S AFFIDAVIT OF EXEMPTION ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR EXISTING SITE - BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PURSUANT TO SECTION 553.844 F.S. To: Miami -Dade County Building & Neighborhood Compliance Department 11805 Coral Way, Suite 111 Miami, FL 33175 Re: Owner's Name & _ Fifeyo l� - PA Tl A/o Property Address / r y a k% / 0 d S /- Roofing Permit Number Dear Building Official: I ALf e'L)Q i? - 104 fI AIO certify that I am not required to retrofit the roof to wall connections of my building because: LdThe just valuation for the structure for purposes of ad valorem taxation in less than $300,000.00. UThe building was constructed in compliance with the provisions of the Florida Building Code (FBC) or with the provisions of the 1994 edition of the South Florida Building Code (1994 $FBQ. Signatule o Property ' ner ALf-fie.e6 R. rA-two Print Name STATE OF FLORIDA COUNTY OF MIAMI-DADE Sworn to and subscribed before me this <g day of (SEAL) a Personally or Produce When the just valuation of the structure for purposes of ad valorem taxation is equal to or more than $300,000.00, and the building was not constructed in compliance with the FBC nor with 1994 SFBC, and affidavit of Roof to Wall Connection Hurricane Mitigation Retrofit must be provided. When buying real estate property, you should not assume that property taxes will remain the same. Whenever there is a change IMPORTANT in ownership, the assessed value of the property may reset to full market value, which could result in higher property taxes. MESSAGE Please use our Tax Estimator to approximate your new property taxes. The Property Appraiser does not send tax bills and does not set or collect taxes. Please visit the Tax Collector's website directly for additional information. Address SEARCH: �104 nw 102 st Owner Name Folio PROPERTY INFORMATION Folio: 11-3101-022-0130 Sub -Division: GOLD CREST SUB r Property Address 104 NW 102 ST Miami Shores, FL 33150-1232 Owner ALFREDO R PATINO Mailing Address 7900 HARBOR VILLAGE DR 504 NORTH BAY VILLAGE, FL 33141 Primary Zone 0800 SGL FAMILY - 1701 -1900 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY: 1 UNIT Suite Beds / Baths / Half Floors Living Units Actual Area Living Area Adjusted Area Lot Size Year Built 3/2/0 1,630 Sq.Ft 9,209.16 Sq.Ft 1947 Map View - Layers m BENEFITS INFORMATION Benefit Type 2016 2015 2014 m Save Our Homes Cap Assessment Reduction $134,547 m Homestead Exemption $25,000 s Second Homestead Exemption $25,000 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). FULL LEGAL DESCRIPTION GOLD CREST A SUB PB 21-56 E1 /2 OF LOT 5 BLK 2 AND LOT 6 i LOT SIZE 85.270 X 108 1 OR 15259-3293 1191 4 m i SALES INFORMATION Previous Sale Price OR Book -Page Qualification Description Previous Owner 1 Prev 01/29/2016 $305,000 29950-0504 Qual by exam of deed MICHAEL A DELGADO TRS 1041 08/18/2015 $230,300 29772-1383 Financial inst or "In Lieu of Forclosure' stated HSBC BANK USA NA C/o, 02/04/2015 $275,100 29496-0280 Financial inst or "In Lieu of Forclosure' stated MATHIEU DESIR TRS MAT 05/27/2011 $0 27758-3989 Corrective, tax or QCD; min consideration MATHIEU DESIR LAND TRUST 04/24/2010 $0 27466-0256 Affiliated parties MATHIEU L DESIR 11/01/1991 $0 15259-3293 Sales which are disqualified as a result of examination of the deed 12/01 /1987 $62,000 13525-4903 Sales which are qualified 02/01/1983 $55,000 11688-0750 Sales which are qualified m For more information about the Department of Revenue's Sales Qualification Codes. 2016 2015 2014 LAND INFORMATION Land Use Muni Zone PA Zone Unit Type GENERAL R-14.25, R-15 0800 - SGL FAMILY - 1701 -1900 SQ Front Ft. BUILDING INFORMATION Building Number Sub Area Year Built Actual Sq.Ft. Living Sq.Ft. 1 1 1947 Units Calc Value 85.27 $202,827 Adj Sq.Ft. Calc Value 1,630 $113,448 2015 Aerial Photography 60ft Featured Online Tools Comparable Sales Glossary Non -Ad Valorem Assessments PA Additional Online Tools Property Record Cards Property Search Help Property Taxes Report Discrepancies Report Homestead Fraud Tax Comparison Tax Estimator TRIM Notice Value Adjustment Board ASSESSMENT INFORMATION 12016IMPORTANT NOTICE: The assessment and exemption values currently shown are preliminary and are subject to change until they are certified on July Year 2016 2015 20' s Land Value $202,827 $149,815 $124,4( i Building Value $113,448 $113,448 $110,5' Extra Feature Value $924 $749 $7! Market Value $317,199 $264,012 $235,7f s 6 Assessed Valuer" TAXABLE VALUE INFORMATION COUNTY Exemption Value Taxable Value SCHOOLBOARD Exemption Value Taxable Value CITY Exemption Value Taxable Value REGIONAL Exemption Value Taxable Value $317,199 $264,012 $101,11 2016 2015 $0 $0 $317,199 $264,012 $0 $0 $317,199 $264,012 $0 $317,199 $0 $264,012 2014 $50,000 $51,187 $25,000 $76,187 $50,000 $51,187 $0 $0 $50,000 $317,199 $264,012 $51,187 rim - de Building Code 5th Edition t �• ` lah- ocltv Hurricane Zone Uniform Permit (Zinc � -1 y /5 tES AND ROOFTOP STRUCTURES AP ov, Shor�'S dill By DCPT on FQ pATF Section A (General Information)�r�rnn� 1/7 l Master Permit No. Process No., w'�� Fp Contractor's Name 4 Co n S !Cb0/), Se-ijma - c.roa o- Job Address ROOF CATEGORY Cl Low Slope O Mechanically Fastened Tile ❑ Mortar/Adhesive Set Tiles ❑ Asphaltic Shingles ❑ Metal Panel/Shingles ❑ Wood Shingles/Shakes ❑ Prescriptive BUR-RAS 150 ROOF TYPE O New roof ❑ Repair ❑ Maintenance O Reroofing ❑ Recovering G ROOF SYSTEM INFORMATION _ Low Slope Roof Area (SF) Steep Sloped Roof AREA (SSF)'b- Total (sn)y U Section B (Roof Plan) Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include dimen- slons of sections and levels, clearly Identify dimensions of elevated pressure zones and location of parapets. 00 FLORIDA BUILDING CODE — BUILDING, W EDITION (2014) 15.37 Section C 1 11®� Miami -Dade County HVHZ Electronic Roof Permit Form Section C Page (Low Slope Roof Systems) "Delivering Excellence Every Day" Fill in the specific roof assembly components. If a component is not required, insert not applicable (Wa) in the text box. ROOF SYSTEM MANUFACTURER: I GAF Product Approval (NOA): 13-1022.15 System Type: Wind Uplift Pressures, From RAS 128 or Sealed Calculations: (P1) Field: -42.8 psf (P2) Perimeters: -71.1 psf (P3) Comers: -108.0 psi Maximum Design Pressure From NOA -52.5 psf Roof Slope: 0.50 " : 12 Roof Mean Height: 16 R Parapet Walls: 0 No ❑ Yes Parapet wall Height It. Deck Type: —5/8" Plywood — Support Spacing: NA " o/c Alternate Deck Type: I NA Existing Roof. SAME Fire Barrier: NIA Vapor Barrier. WA Anchor Sheet NIA Anchor Sheet Fastener / Bonding Material: NIA Insulation Base Layer Size & Thickness: WA N/A NIA Insulation Top Layer Fastener / Bonding Material: N/A Base Sheet(s) & No. of Ply(s): GAF GLASSBASE 75# (1) PLY Base Sheet Fastener / Bonding Material: 1-1/4" RS NAIL AND TIN CAP 1-518" Ply Sheet(s) & No. of Ply(s): GAF PLY IV (2) PLIES Ply Sheet Fastener 1 Bonding Material: HOT MOP ASPHALT Top Ply: I GAF MINERAL CAP SHEET Top Ply Fastening / Bonding Material: HOT MOP ASPHALP Surfacing: I GRANULES SINGLE PLY MEMBRANE: Single Ply Manufacturer / Type: NA Single Ply Sheet Width: � " 112 Sheet Width: F " No. of Single Ply 112 sheets: NA Single Ply Membrane Fastening I Bonding Material: NA 0 FASTENER SPACING FOR BASESHEET ATTACHMENT ❑ SINGLE PLY MEMBRANE ATTACHMENT 1. Field: F1 " a/c @ Laps & F1 rows F97 " o/c 2. Perimeter. F7 " o/c @ Laps & a rows F67 " Ole 3. Comer. a " o% C Laps & E] rows El " o/c NUMBER OF FASTENERS PER INSULATION BOARD: 1. Field: El 2. Perimeter. F1 3. Comer. FN7A Insulation Fastener Type: NA WOOD NAILER TYPE AND SIZE: 1" X 6" FACIAL BOARD Wood Nailer Fastener Type and Spacing: WOOD NAIL 16D EVERY 16" OC EDGE & COPING METAL SIZES: Edge Metal Material: —Galvanized Metal — Edge Size: —3" face 26 ga.— Hook Strip Size: —SELECT EDGE METAL HOOK STRIP0 — • • • • • • Edge Metal Attachment: • • • • • • • • ...... .. : ....:. 1-14" RS NAIL 4" OC Coping Material: iSELECT PARAPET•m-9OPiNGwEiRtz • • Coping Size: I —SELECT COPING MEyj1, a OR Tt4QIS4ESS— • • ; • • - Hook Strip Size: I —SELECT COPING M ET—M HOOK §TRIP•SIZE— • • • • : • Parapet Coping Metal Attachment • • • • • • • • NA .... . . . "".... Edge NaHable Deck MIMAMIDiADE "Delivering Excellence Every Day" Miami -Dade County HVHZ Electronic Roof Permit Form Illustrate Components Noted and Details as Applicable: Top Ply Interplies Base Sheet Roof Mean Height: KI ft. Drip Metal: 3"X3" GALV 26G Surfacing: --- . GRANULES Drip Metal Top Ply: GAF MINERAL CAP SHEET Interplies: 4 Base Sheet: Roof Deck k �' GAF GLASSBASE 75# Deck Type: '....... a PLYWOOD 5/8" .... .. .. ... ...... .... ... .. .. .... ... . . - - - - - . . . . ...... .. . .... .. I %jr V.1%LOVV - Avvua►r, '2Y otl,u,a The use of gypsum board under any of the following Class A, 8 or C systems does not adversely affect the rating. The use of '/1-in. minimum (hick gypsum board Is an acceptable alternate for minimum insulation over C-15/32 thick roof docks. The use of polystyrene insulation board between minimum 34-In. thick perlite board and deck with rosin paper (perllte/rosm paper/polystyrene/pedite) is a suitable alternate for polylsocyanurate board in the following pass A, B or C systems. -energyGuarde RA" or "Tapered EnergyGuarde RA" or "EnergyGuard(D Composite RA" may be substituted for any Arias polylsocyanurate Insulation to any of the following Classifications. Trumbull "Derma Mop" may be utilized with any of the following "Asphalt Felt Systems with Hot Roofing Asphalt". 'GAFGLASO #80 Premium Base Sheet" may be used In any of the following systems. "GAFGLASO Flex Ply 6" and'7d-Ply® Ultra -Flexible Ply 6" are suitable alternates to "GAFGLASO Ply 6". "GAFTEMP Permallte Recover Board" may be used In lieu of any perlite Insulation in any of the following NC Classifications. Unless otherwise Indicated, any of the Asphalt Felt Systems with Hot Roofing Asphalt' may be surfaced with "Fireshield MB" at 2'A to 3-gaU100- fe. "Ruberoldm Dual Smooth" may be used as an alternate to "Ruberold® Mop Smooth' or "Rubaraid® 20' or "Ruberold® 20 HT" "Ruberold® Mop Smooth 1.5" may be used as an alternate to "Ruberold® Mop Smooth" Class A, 8 and C Hot roofing asphalt, for use with organic and glass felts or modified bitumen membranes. "Ruberoldm Heat Weld" SBS roofing membrane may be used in lieu of "Ruberold® Mop" SBS products In any applicable Classification. 1. Deck: C-IS/32 Gass A Inclines 3 Insulation (optional). - One or more layers perlRe or wood Fiber or glass fiber or polylsocyanurate or urethane or perlite/polylsocyanurate composite or perlite/urethane composite or wood fiber/polylsocyanurate composite or phenolic, any thickness. Ply Sheetr — Three or more plies Type G1 or "GAFGLASO Ply 4" or "Trl-Ply® Ply 4" or'GAFGLASIy Ply 6" hot mopped. Surfacing: — Gravel. 2. Deck: C-15132 Incline: 2 Insulation (optional): — One or more layers perlite or wood fiber or glass fiber or polylsocyanurate or urethane or perlite/polylsocyanurate composite or perlite/urethane composite or wood fiber/polylsocyanurate composite or phenolic, any thickness. Ply Sheet: — Three or more plies Type G1 or "GAFGLASS Ply 4" or "74-Plym Ply 4" or "GAFGLAS® Ply 6". Cap Sheet, — One ply Type G3 "GAFGLASO Mineral Surfaced Cap Sheet" or'Trl-Ply® Mineral Surfaced Cap Sheet " or "GAFGLASO EnergyCap- - BUR Mineral Surfaced Cap Sheet." 3. Decki NC Incline: 2 Insulation (optional): — One or more layers perlite, wood fiber, glass fiber, polylsocyanurate, urethane, perlite/polylsocyanurate composite, perlite/urethane composite, wood fiber/polylsocyanurate composite, phenolic, 2-in, maximum. Ply Sheet: — Two or more plies Type GI "GAFGLAS(y Ply 4, "Tri-Ply@ Ply 4• or "GAFGLASO Ply 6". Cap Sheet. — One ply Type G3'GAFGLASO Mineral Surfaced Cap Sheet" or'Trl-Ply® Mineral Surfaced Cap Sheet" or "GAFGLASO EnergyCep`" BUR Mineral Surfaced Cap Sheet." 00040 • • •••• ••• 4. Deck: C-15/32 Incline: 1 • • • • 000 • • ••••a• •• • ••• Slip Sheet (Optional)t — Red rosin paper, nalled to deck. • Insulation (optional).- — Any thickness perlite or wood fiber or glass fiber or polylsocyanurate mechanically fastened or adhered with 000 OMG Inc. "OlyBond Fastening System' or any UL Classified Insulation adhesive. *Soo • • Base Sheet-. — One ply Type G2 "GAFGLASO M75 Base Sheet" or "Tri-PlyO N75 Base Sheet" (may be nalled).• • • • • • 0.00. 000 Ply Sheet: — One or more plies Type GI "GAFGLAS® Ply 4" or "Tri"PIyO Ply 4" or GAFGLAS® Ply 6". • Cap Sheet: — One ply Type 63 'GAFGLASO Mineral Surfaced Cap Sheet" or "Tri-Ply® Mineral Surfaced Cap SITdErer-.r5AFGLA%0 • • • • • • EnergyCap— BUR Mineral Surfaced Cap Sheet." • • • • • • • • • Surfacing (optional): — "TOPCOAT® EnergyCote-' applied at a rate of 2-gal/100-42. 000000 • 5. Deck- NC Incline, 3 • • • ••• http://database.ul. comlcgi-bin/XYV/templatelLISEXTIIFRAMElshowpage.html? name=T... 2/23/2012 MIAMI-QADE MIAMI-DADE COUNTY baiKmau PRODUCT CONTROL SECTION 11805 SW 26 Street, Room 208 DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES (RER) Miami, Florida 33175-2474 BOARD AND CODE ADMINISTRATION DIVISION T (786)315-2590 F (7W 31525-99 NOTICE OF ACCEPTANCE (NOA) iyiym damidade.eov/economy GAF 1361 Alps Road Wayne, NJ 07470 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed and accepted by Miami -Dade County RER - Product Control Section to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ). This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product Control Section (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) reserve the right to have this product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify, or suspend the use of such product or material within their jurisdiction. RER reserves the right to revoke this acceptance, if it is determined by Miami -Dade County Product Control Section that this product or material fails to meet the requirements of the applicable building code. This product is approved as described herein, and has been designed to comply with the Florida Building Code including the High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION: GAF Conventional Built -Up Roof Systems for Wood Decks. 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 performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ...• ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Flprida,.and follbWa. • by the expiration date may be displayed in advertising literature. If any portion of the NO%ie displayed, Alitioll. it shall be done in its entirety. • INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturrejpjhs 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. 13-0424.09 and consists of pages I through 16. • • ; • • ; 000900 The submitted documentation was reviewed by Jorge L. Acebo. '' •' 0000 MIAMFDADE COUNTY N;WN*ot 13-10Z2.130. Expiratlon Date: 11/04/18 • Approval Date: 11/06/14 Page 1 of 16 Membrane Type: BUR Deck Type 1: Wood, Non -insulated Deck Description: 19/32" or greater plywood or wood plank decks System Type E: Base sheet mechanically fastened. All General and System Limitations shall apply. Fire Barrier: FireOut'" Fire Barrier Coating, VersaShiele Fire Resistant Roof Deck Protection or (optional) Securock'" Gypsum Fiber Roof Board. Base sheet: GAFGLAe #80 Ultima Base Sheet, Stratavene Eliminator". Nailable Venting Base Sheet, Ruberoid® 20, Ruberoid® SBS Heat -Weld'" Smooth or Ruberoid® SBS Heat -Weld T. 25 base sheet mechanically fastened to deck as described below; Fastening Options: GAFGLAS® Ply 4, GAFGLAS® FlexPly 6, GAFGLASO #75 Base Sheet or any of above base sheets attached to deck with approved annular ring shank nails and tin caps at a fastener spacing of 9" o.c. at the lap staggered and in two rows 12" o.c. in the field. (Maximum Design Pressure —45 psf. See General Limitation #7) GAFGLAS'0 Ply 4, GAFGLASO FlexPly`" 6, GAFGLAS® #75 Base Sheet or any of above base sheets attached to deck with Drill-Tec'" #12 Fastener or Drill-Tec'" #14 and Drill- Tec'" 3" Steel Plate, Drill-Tec'" AccuTrade Flat Plate or Drill -Team AccuTrae Recessed Plate 12" o.c. in 3 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 12" o.c. in the field of the sheet. (Maximum Design Pressure —0psf. See General Limitation #7) SGAFGLAS® Flex Ply'" 6, GAFGLAe #75 Base Sheet or any of above base sheets attached to deck with approved annular ring shank nails and tin caps at a fastener spacing of 9" o.c. at the 4" lap staggered and in two rows 9" o.c. in the field. (Maximum Design Pressure —52.5 psf. See General Limitation #7) GAFGLAS® #80 Ulti=7 Base Sheet, Ruberoie 20, Ruberoid® Mop Smooth, base sheet attached to deck with approved 1'/," annular ring shank nails and inverted 3" steel plate at a fastener spacing of 9" o.c. at the 4" lap and in two rows staggered with a fastener spacing of 9" o.c. in the center of the membrane. (Maximum Design Pressure —60 psf. See General Limitation #7) GAFGLAS® #75 Base Sheet or any of above base sheets attached to deck with Drill-Tec" #12 Fastener or Drill-Tee#14 Fastener and Drill-Tec'" 3" Steel Plate, Drill-TecT' • AccuTraco' Flat Plate or Drill-Tec'" AccuTrado Recessed Plate 12.' o.c. Ln 4 rowS.. QXIrow is in the 2" side lap. The other rows are equally spaced approximahly19':o.c. in the field of the sheet. 6614066 • .. • (Maxiutum Desigi: Pressure —60 psf. See General Limitation 97). • .:. • • Any of above Base sheets attached to deck approved annular ring ah�a 0 rails and)"s 00 • inverted Drill-Tec' insulation plates at a fastener spacing of 9" o. 9a" the 4" lap stammered in two rows 9" in the field. • (Maximum Design Pressure —60 psf. See General Limitation #7, .. • .. • CM1AMI-MDA.WEUZNTY Ffljw.I 1jllllllllllllr NOT No i 13-1021.11 • • Expiration Date: 11/04/18 Approval Date: 11/06/14 Page 14 of 16 Fastening Options: GAFGLAS® #75 Base Sheet or any of above base sheets attached to deck with Drill-Tec'" (Continued) #12 Fastener or Drill-Tec� #14 Fastener and Drill -Tee 3" Steel Plate, Drill -Tee'" AccuTrae Flat Plate or Drill -Teem AccuTrac® Recessed Plate 8" o.c. in 4 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 9" o.c. in the field of the sheet. (Maximum Design Pressure —7S psf. See Genera! Limitation #7) Ply Sheet: One or more plies of GAFGLAS® Ply 4 or GAFGLAS® 480 Ultima Base Sheet adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbs./sq. Cap Sheet: (Optional) One ply of GAFGLAS® Mineral Surfaced Cap Shee or GAFGLAS® EnergyCapu' BUR Mineral Surfaced Cap Sheet adhered to a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbs./sq. Surfacing: Optional on granular surfaced membranes; required for smooth membranes. Chosen components must be applied according to manufacturer's application instructions. All coatings must be listed within a current NOA. 1. Gravel or slag applied at 4001bs./sq. and 300 lbs./sq. respectively in a flood coat of approved asphalt at 60 lbs./sq. 2. Topcoae Surface Seal SB applied at Ito 1.5 gal./sq. Maximum Design Pressure: See Fastening Options • I. • • sees • ••e• sees•• • sees•• ram �k 13-1;UA1* Expiration Date: IVW1.18 ; Approval Date: 11/06/14 Page 15 of 16 • • sees•• sees•• sees• sees• sees•• • • • •••••• • sees•• WOOD DECK SYSTEM LIMITATIONS: 1 A slip sheet is required with GAFGLASO Ply 4 and GAFGLAe FIex Ply'" 6 when used as a mechanically fastened base or anchor sheet. 2. Minimum'/4" DensDeck7 Roof Board or''/s" Type X gypsum board is acceptable to be installed directly over the wood deck. GENERAL LIMITATIONS: 1. Fire classification is not part of this acceptance; refer to a current Approved Roofing Materials Directory for fire ratings of this product. 2. Insulation may be installed in multiple layers. The first layer shall be attached in compliance with Product Control Approval guidelines. All other layers shall be adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbs./sq., or mechanically attached using the fastening pattern of the top layer 3. All standard panel sizes are acceptable for mechanical attachment. When applied in approved asphalt, panel size shall be 4' x 4' maximum. 4. An overlay and/or recovery 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 sidelap and one down the center of the sheet allowing a continuous area of ventilation. Encircling of the strips is not acceptable. A 6" break shall be placed every 12' in each ribbon to allow cross ventilation. Asphalt application of either system shall be at a minimum rate of 12 tbs./sq. Note: Spot attached systems shall be limited to a maximum design pressure of -45 psf. 5. Fastener spacing for insulation attachment is based on a Minimum Characteristic Force (F') value of 275 lbf., as tested in compliance with Testing Application Standard TAS 105. If the fastener value, as field-tested, are below 275 Ibf. insulation attachment shall not be acceptable. 6. Fastener spacing for mechanical attachment of anchor/base sheet or membrane attachment is based on a minimum fastener resistance value in conjunction with the maximum design value listed within a specific system. Should the fastener resistance be less than that required, as determined by the Building Official, a revised fastener spacing, prepared, signed and sealed by a Florida Registered Professional Engineer, Registered Architect, or Registered Roof Consultant may be submitted. Said revised fastener spacing shall utilize the withdrawal resistance value taken from Testing Application Standards TAS 105 and calculations in compliance with Roofing Application Standard RAS 117. 7. Perimeter and corner areas shall comply with the enhanced uplift pressure requirements of these areas. Fastener densities shall be increased for both insulation and base sheet as calculated in compliance with Roofing Application Standard RAS 117. Calculations prepared, signed and sealed by a Florida registered Professional Engineer, Registered Architect, or Registered Roof Consultant (When this limitation is specifically referred within this NOA, General Limitation #9 will not be applicable.) 8. All attachment and sizing of perimeter nailers, metal profile, and/or flashing termination designs shall conform to Roofing Application Standard RAS 11 I and applicable wind load requirements. * • • • • • 9. The maximum designed pressure limitation listed shall be applicable to all roof pressure zckei(i q. field, perimeters, and corners). Neither rational analysis, nor extrapolation shall be permitted for cr{lged fasted r g at enhanced pressure zones (i.e. perimeters, extended corners and corners). (When this limitpopp js specifically referred within this NOA, General Limitation #7 will not be applicable.) 0000 10. All products listed herein shall have a quality assurance audit in accordance with the Florida AvAing C84%A44 Rule 61G20-3 of the Florida Administrative Code. * 0 0 0 0 0 0* 0 0 END OF THIS ACCEPTANCE NOATIo.! 13-10?aZ!". • • Expiration Date: 11/040PO • Approval Date: 11/06/14 Page 16 of 16 V4�00: 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. a_Renailing wood decks: When replacing roofing, the existing wood roof deck may have to be renailed in accordance with the current provisions of Section R4403. (The roof deck is usually concealed prior to removing the existing roof system). 4.io _Exposed Ceiling: Exposed, open beam ceilings are where the underside of the roof decking can be 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. A u Overflow scuppers (wall outlets): It is required that rainwater flows off so that the roof is not overloaded from a buildup of water. Perimeter/edge wall or other roof extension may block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scup2ers in accordance with the requirements of Sections R4402-,-K403 and R4413. Own Agent's Signature Date Con actor Signature t7 �l /V t/u, j 0 a- S Property Address Permit Number . . .... ...... Revised on 7/9/2009 LD;07/01/2015; ` ...... .. . ...... .... .. .. ..... .. .. .... ...... . . . . . . ...... . . ...... .. . .... 0.9 Testing Agency Name: Address: Telephone: Fax: Email: Representative Name: Title: TAS 106 TEST RESULTS REPORT GENERAL INFORMATION A+ Engineering Testing Lab, LLC. 7066 SW 44 St Miami Fl 33155 305-668-5792 786-513-3754 a a aylusetl(u,yahoo.com Eng. ABDIAS H. SAENZ :. ' - P.E # 69687 SITE SPECIFIC. INFORMATION Roofing Contractor: Job Address: Contact. Name: Owners Name: Type of Tile: Roof Height: Certification No. 16-0413.03 LAR CONSTRUCTION Permit #: RF16-1819 104 NW 102 ST, MIAMI SHORES, FL 33150 __­1 AL•FREDO R. PATINO CAPISTRANO 12 feet Job Access: LADDER Approximate Square Footage of Roof: Required Testing Force: 35 LB PH: 786-318-7061 Date Installed: Roof Pitch: 4/12 Gate: NO 23.00 SQ. Date Tested: 20 /01/18 Testing Equipment: M2-100, S-3741465 TEST LOCATION PASS FAIL CORNER 11 - PERIMETER 34 - RIDGE 25 - FIELD 33 - TOTAL: 103 - ,i No 87 • 'X_ STATE O .� 00�i 8 FSS/O N IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL PA 100, THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT QUALITY CONTROL TEST. THIS TAS 106 TEST HAS BEEN PERFORMED IN FULL ACCORDANCE TO THE REQUIREMENTS OF DADE COUNTY, WITH NO DEVIATIONS THIS REPORT IS NOT GUARANTEED IN CASE OF NATURAL DISASTERS. A w, r A+ En ink eerin Testing Lab ROOF DIAGRAM 104 NW 102 ST, MIAMI SHORES, FL 33150 (PERMIT #) N Y137 23 24 22 5 25 P 12 6f 72 21 82 64 26 14 6 73 18 19 20 Af 81 63 27 5 45 2 74 75 76 77 lr 79 62 28 101 (" 44 53 54 55 56 57 58 29 1 6 1G_ 43 5 94 413 92 41 0 30 99 42 4 95 35 34 33 32 �� 1 A31 r 41 4 96 3 97 40 46 3 39 38 7066 SW 44 St Miami FL 33155 PH: 305-668-5792 Fax: 786-513-3754. aplusetl@yahoo.com RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CC -1330240 1 The ROOFING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 RODRIGUEZ, L.UIS ALEJANDRO. LAR CONSTRUCTION INC 5341 LiMEWOOD CT BOYNTON BEACH FL 33472 ISSUED: 06/12/2016 DISPLAY AS REQUIRED BY LAW r` STATE OF FLORIDA DEPARTMENT OF BUNESS PROFESSIONAL REGULATION AND CCC1330240 ISSUED: 06/12/2016 CERTIFIED ROOFING CONTRACTOR t RODRIGUEZ, LUISALEJANDRO LAR CONSTRUCTION INC IS CERTIFIED under the provisions of C4.489 FS. Expiivron doe AUG 31, 2018 L16065s'0001181 a SEQ # L1606120001181 0 A,NNE .M, GANNON CONSTITUTIONAL TAX COLLECTOR Sen ing Palm Beach County NMMV Serving you. P.O. Box 3353. West Palm Beach, FL 33402.3353 "LOCATED AT- www.pbctax.com Tel: (561) 355-2264 5341 LIMEWOOD CT BOYNTON BEACH, FL 33472 TYPE OF BUSINESS OWNER CERTIFICATION # RECEIPT #/DATE PAID AWT PAID BILL # 23-0081 ROOFING CONTRACTOR RODRIGUEZ LUIS ALEJANDRO CCC1330240 U17 60e047 • 07/20/17 $27.50 660159484 This document is valid only when receipted by the Tax Collector's Office, STATE OF FLORIDA PALM BEACH COUNTY 2017/2018 LOCAL BUSINESS TAX RECEIPT LAR CONSTRUCTION INC LBTR Number: 201362850 LAR CONSTRUCTION INC EXPIRES: SEPTEMBER 30, 2018 5341 LIMEWOOD CT BOYNTON BEACH, FL 33472 This receipt grants the privilege of engaging in or „ bill managing any business profession or occupation within its jurisdiction and MUST be conspicuously displayed at the place of business and in such a manner as to be open to the view of the public, ACORA. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11 28 2017 PRODUCER Phone: (561)210-8715 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Sena & Whitne LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Y HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 190 Glades Road, Suite C Boca Raton, FL 33432 INSURED LAR Construction, Inc. Luis Alejandro Rodriguez 5341 Limewood Ct Boynton Beach, FL 33472 COVERAGES INSURERS AFFORDING COVERAGE INSURER A: Western World Insura INSURER B: INSURER C: D: NAIC # 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN SR ADD' POLICY EFFECTIVE POLICY EXPIRATIONDATE POLICY NUMBER DATE (MMIDDNY) LIMITS (MM/DDNY) GENERAL LIABILITY N PP8439862 06/04/2017 06/04/2018 EACH OCCURRENCE $ 150 )0,000 A X COMMERCIAL GENERAL LIABILITY I $ 100,000 DAMAGE TO RENTE PREMISES (Ea occurs ce) CLAIMS MADE O OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1_,000�000_ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ Included X POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Per person) $ BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ $ RETENTION $ WC STATUS - WORKERS COMPENSATION AND ORY LIMITS ER_ T —ER-- _ _ EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CCC 1330240 f1C01rICIr1A1rC unl ncQ f`AkIf`FI I ATInW SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION MIAMI SHORES VILLAGE DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN BUILDING DEPARTMENT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 10050 NE 2N D AVE IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR MIAMI SHORES, FL 33138 REPRESENTATIVES. AUT ENTATIVE DEA ACORD 25 (2001/08) V AUUHu L;UHPUF(A I IUN 19t%U Printed by DEA on November 28, 2017 at 11:36AM CERTIFICATE OF LIABILITY INSURANCE 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: N the certificate holder Is an ADDITIONAL INSURED, the policy (tea) 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 endonamantial_ FrankCrum Insurance Agency, Inc. 100 South Missouri Avenue Clearwater. FL 33756 FrankCrum UC/F LAR Construction Inc 100 South Missouri Avenue Clearwater. FL 33756 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. NOR TYPE OF INSURANCE DIM Y�US POLICY NUMBER POLICY EFF MMSWmrY) POLICY tDtP WMDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY CWMSMADE OCCUR EACH OCCURRENCE S DAMAPREMGE TORENTED $ MED EXP (Any one person) $ PERSONAL S ADV INJURY f L AGGREGATE LIMIT APPLIES PER: hGEN'-OTHER: POLICY aPROJECT OLOC GENERAL AGGREGATE E PRODUCTS-COMP/OP AGG S $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMB 18, e $ BODILY INJURY Per arson $ OWNED AUTOS SCHEDULED BODILY INJURY (Per aoeldenQ $ ONLY AUTOS HIREONLY AUTOS UT PROPERTYDAMAGE Per oddeM $ S UMBRELLA LIAR OCCUR EACH OCURRENCE HCLAJMS4AADE EXCESS LAB AGGREGATE S DED RETENTIONS $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/IAl ANY PROPRIETORIPARTNERIEXECUTNE OFFICERIMEMBER EXCLUDED? O (Wndit" In NH) N/A WC201700000 01I0112017 - 01/01/2018 X PER STATUTE OTF4 ER E EACH ACCIDENT I000 OOD E.L. DISEASE -EA EMPLOYEE $I.DDO.ODO If yes, describe under DESCRIPTION OF OPERATIONS bebw E.L. DISEASE -POLICY LHNJT r DOO DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached U more space is required) Effective 07/25/2016, coverage is for 100% of the employees of FrankCrum leased to LAR Construction Inc (Client) for whom the client is reporting hours to FrankCrum. Coverage is not extended to statutory employees. CERTIFICATE HOLDER A- Village of Miami Shores Building Department 10050 NE 2 Ave. Miami Shores, FL 33138 ) ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE rION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE PROVISIONS. AUTHORIZED RE� VE 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD