RF-19-2023Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 09/05/2019
Location Address Parcel Number
154 NW 97TH ST, Miami Shores, FL 33150 1131010250040
Contacts
Permit NO.: RF-08-19-2023
Permit Type: Roof
Work Classification: Tile
Permit Status: Approved
Expiration: 02/25/2020
LINTON HUGH DAWKINS Owner QUALITY PLUS CONSTRUCTION Contractor
154 NW 97 ST, MIAMI SHORES, FL 331501735 PAUL ANTHONY SCOTT
1021 NW 200 TER, MIAMI, FL 33169
Business: 7862674252
Description: RE -ROOF Valuation: $ 15,550.00 Inspection Requests:
REPLACING PERMIT#1-19-13 305-762-4949
Total Sq Feet: 0.00
Fees Amount
50% Renewal Fee $137.50
Total: $137.50
Payments
Date Paid Amt Paid
Total Fees
$137.50
Check # 5118
08/29/2019 $50.00
Cash
09/05/2019 $87.50
Amount Due:
$0.00
Applicant Copy
For Inspections, Call (305) 762-4949 or Log on at https://bidg.miamishoresvillage.com/cap/.
Requests must be received by 3pm for following day inspections.
NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
additional restrictions applicable to this property that maybe found in the GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS,
public records of this county. STATE AGENCIES, OR FEDERAL AGENCIES.
05, 2019 Page 1 of 2
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
RECEIVED
MUG 209
d31AI333 l
FBC 20 I-1
BUILDING Master Permit No.r�0%/9�l?✓
PERMIT APPLICATION Sub Permit No.'- — 00'1 q-,9093
❑BUILDING ❑ ELECTRIC �OOFING ❑ REVISION ❑ EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 6 /N W 97 _/ t-
City: Miami
Shores /� County: Miami Dade Zip:
Folio/Parcel#:� %_E/1*0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): IrrC- p4.Jk//yf Phone#: We 4,p /8'(A4
Address: �4" f &) / 's
City: m >a f 4o 2�' State: 'Ez o i A Zip: _s 3 / d
Tenant/Lessee Name: /yI>9 Phone#:
Email:
CONTRACTOR: Company Name:
Address: /Oy NV► 2100
Phone#:
City: MM—/ State: rti Zip:
Qualifier Name: POW/ 7//;07r Phone#:
State Certification or Registration #: Gr/r/ �Yli���% Certificate of Competency #:
DESIGNER: Architect/Engineer: IVIAf + Phone#:
Address:
City:
State: Zip:
Value of Work for this Permit: $ �/� �✓�� Square/LinearF,000ttage of Work:
❑ ElrF
l L/3
Type of Work: ❑ Addition Alteration New � Repair/Replace ❑ Demolition
Description of Work: 0gr__/N00/
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ 1 ,3-1• -fO CCF $ CO/CC $
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $
Notary $.
Double Fee $
Bond $ on pzp%
TOTAL FEE NOW DUE $
(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
M/
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 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.
)4ak�
Signature Signature
OWNER or AGENT
CONTRACTOR
The foregoing instrument was acknowledged before me this
The forego' g instru ent was ackpowledged before me this
23 day of A cog
, 20 _i f ] by
23� day of ,20 (` l by
GIWIV %���/��� who is personally known to
PAIZI 4 , who is personally known to
me or who has produced as
me or who has produced as
identification and who did take an oath.
identification and who did take an oath.
NOTARY PUBLIC:
NOTARY PUBLIC:
Sign:
Sign:
tt
LLAA,c��P yb�t�
`�
�t�\t1- k-4-4�
Print:
Print: fie o,��1cl`�-
Seal: LUDLOW BRAWN
Seal : iP' ^! ,`t� lUOLOW BRONM
ro'N`_
co ► t eG uzA"
_
�'�Qf
car o�, GG �aai
Cr� Fey 2022
N �"�1�w Febrwry/� LYfL
'O� 00111/d ��11��Y�Yy��i
�h�Oe R11�TMI1 �+,
################################## ## ##########Plans###########################################################
APPROVED BY t � Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LICENCES
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE*
D. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
D. COPY OF LIABILITY INSURACE*
E. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
*YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
Certificate must specify the description of operations or contractor license number.
........................................................... ■ ............................. ■ ■
BUSINESS NAME: 61WA&Y rbZ
BUSINESS ADDRESS: CITY / '/ oOW STATE �i ZIP
BUSINESS PHONE: FAX NUMBER ( )
CELL PHONE ( ) QUALIFIER'S NAME: / ft 7;qr
QUALIFIER'S LIC NUMBER: Tit/ 7i7ZZ?,
15�, rv� q� ST
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner - Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees, including the owner, must obtain workers' compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if:
l . The officer owns at least 10 percent of the stock of the corporation, or in the case of
an LLC, a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
3. The corporation is registered and listed as active with the Florida Department of
State, Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use
day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of
workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CnNTFNTR
Signature:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this 9�—t day of N 3" , 20 11
By LiNpcij je j__s who is ersonally know me or has produced
�'�
Notary: zVia'
�`'•
SEAL:
f •.a
020t `�p�
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 01/14/2019
Location Address Parcel Number
154 NW 97TH ST, Miami Shores, FL 33150 1131010250040
Contacts
Permit No.: RF-01-19-13
Permit Type: Roof
Work Classification: Tile
Permit Status: Approved
Expiration: 0 7/02/ 2019
LINTON HUGH DAWKINS Owner QUALITY PLUS CONSTRUCTION Contractor
154 NW 97 ST, MIAMI SHORES, FL 331501735 PAUL ANTHONY SCOTT
1021 NW 200 TER, MIAMI, FL 33169
Business: 7862674252
Description: RE -ROOF Valuation: $ 15,550.00 Inspection Requests:
305-762-4949
Total Sq Feet: 1,893.00 _j I
Fees
Amount
Application Fee - Other
$50.00
CCF
$9.60
Copies Fee (Manual)
$4.65
DBPR Fee
$4.13
DCA Fee
$2.75
Education Surcharge
$3.20
Roofing Fee
$225.00
Scanning Fee
$12.00
Technology Fee
$6.88
Total:
$318.21
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$318.21
Check # 4570
01/14/2019 $318.21
Amount Due:
$0.00
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, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore Lautherize-the above named contractor to do the work stated.
Signature: Owner / Applicant / Contractor / Agent
January 14, 2019 Page 2 of 2
� ��311G1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC 2111(00FING
JAN 0 S 2(�Or
� M
FBC 20 l�
Master Permit No. Vy A
Sub Permit No
❑ REVISION ❑ EXTENSION DRENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: _ tV54 CR7T m~ 6-r
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 7�0 — 025y0 `-0 Is the Building Historically Designated: Yes NO
Occupancy Typo — Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): L1V11pV1 �C�y�<K��� Phone#'lbCo'Ca(Zj90�
Address:
City: -kc'v-tz 5t&c2w---� State: L— Zip:
Tenant/Lessee Name: IA- Phone#:
.Email:A,�IN :q
CONTRACTOR: Company Name: VlC��1 ` � �S �V�� 0�1 ` Phone#: ✓o5—Ct?92202,
Address: (53 1
City: C-A0�rcke--"� State: �0V-k J\G Zip:
Qualifier Name: PcILA cc-- Phone#:5V5f2t78 —22-02—
State Certification or Registration #: Lc—I3 Z' 5 ?3 Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address:
hone#:
City: State: Zip:
Value of Work for this Permit: $ Footage of Work:
Type of Work: El Addition ❑ Alteration ❑ New Repair/Replace ❑Demolition
Description of Work: ,e-C�n 4
Specify color of color thru the:Y,
Submittal Fee $ Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
C csPTE-� . e4 . ASE5 .
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
CCF $
DBPR $
CO/CC $ —`
Notary $ —'
Double Fee $
Bond $b ` Cz
TOTAL FEE NOW DUE $ 3 (9 2 1
cg) 9 •ZI
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
M
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien low brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved cnd a reinspection fee will be charged.
X Signature Signature
_ =,�k
OWNER or AGENT
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
21 day of K�. 2016 by �1 day of f . 20 l n by
who is personally known to c.�W S-1-0-t who is personally known to
S>ZS2-5Zb-S2 is$
me or who has produced ye1-s L^t C- • as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
identification and who did take an oath.
NOTARY PUBLIC:
Sign: - Sign: 1
Print:Print: Aow �!
Seal: �`!"» LUDLOW BROWN
Seal: o.►�; �G� LUDLOWBROWN
Ant Commission / GG 182468 ? Commission / GG 18240
row Expku February 4.2022 a '
BaWWThuI `cl o� EVIF February4,1e2M
*°*#*a***s,nL
�j
APPROVED BY "� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
RICK SCOTT, GOVERNOR
JONATHAN ZACHEM, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
THE ROOFING CONTRACTOR HE
,REIN IS`CERTIFIED UNDER THE
PROVISIONS OF:CHAPTE'R 489, FLORIDA STATUTES
SCOTT, PAU L ANTHONY
QUALITY PLUSCONSTRUCTION INC
1021 NW 200 TERR
" MIAMI FL 33169
LICENSE NUM6tR: CCC1327373
EXPIRATION DATE: AUGUST 31, 2020
Always verify licenses online at MyFloridaLicense.com
Do not alter this document in any form.
QThis is your license. It is unlawful for anyone other than the licensee to use this document.
■
I �OI'10 )
pr
Local Business Tax Fbcei Pt
M iami-Dade County, State of Florida
-THIS IS NOT A BILL - DO NOT PAY
5870127
BUSINESS NAM E/LOCATION RECEIPT NO,
QUALITY PLUS CONSTRUCTION RENEWAL
INC 6122469
2521-NW 131 ST ST
MIAMI, FL 331.67
EXPIRES --
SE.PTEMBER 30, 2019
Must be displayed at place of business
Pursuant to County Code
Chapter 8A — Art. 9 & 10
CV: iv ER SEC TYPE OF BUSINESS
PAYMT
QUALITY PLUS CONSTRUCTION INC 196 SPECIALTY BUILDING BYTAXrCORLLECTOR
CONTRACTOR 75.00 08/29/2018
Worker(s) 1 CCC1327373 0226-18-000615
This Local Busi ness Tax Recei pt only con ^rrrs payrnent of the Local Business Tax. The Reoei pt i s not a I icense,
perm t, or a certi "cab on of the holder's qual i "cations, to do busi ness. Holder rrut corm y w i th any governmental
orraVovernmental regulatory laws and requirernentswhich apply to the business.
The REM PT NO above must be displayed on al I comnerci al vehicles - Miarni -Dade Oode Sec Ba-276.
nIMM � For more infornetion,v sit wwwrriarridadagov/taxcollector
CE�� t �"Y ICE °��`"'
a�13t2Fs1a
T?m t CAFE IS ISSIl AS A UkTMR OF i fATJM CtLY AND CONo Rd6:ttM UPON TiM CEUMATE HOt Wit. TICS
ATE 06M NOT AfFSOATAMLY OR NEGATAOELY A OR ALTER THE COVERAGE AFFORDED BY THE PO
uctes
BELOW. TM. C CATE OF *JSUP.4XCE DOES fief Cok*Tf t= A-COIITRACT SETWE94 THE Aim
RlEPRESEWAV,FE OR PROMMM AND rrfE ATE HOLDER.
IMPORTANT- Ii fe cer hoider is an ADDIITI NAL 04SUM. foe pofiqoeo mLzt be W410960d, 9 T=—lSWAM subsea lothe
tesrres acid Of fbe poSey, pofio9es may reqft as axbr A sfaltaerd On tjs4ertWjc3te does ncd ee du rigir�t -to lice
mtficaw hoiden in am of such,
_
PRODEJCEi2 , asFrscr
MAPLES fNSL#RAN(',c A09%CY, AM ACt0 FCY -06A
1061 EAS i SAMPLE ROAD
POMPANO BEAC:-i, r-L 33064
QUALITY PLUS C01�Si . J07 I0s F W-.
2521 N W 13lst S?F=
MAK FL 33,67.
OOVEPAGES CERTar"TE
REVISION kviNSER.
I TtitS M TO CSrT-Y 7MAT TrM POD OF MUPANCZE LISTED B: LOW -AVE BEEN ISSUED ; O 'm E 8 'ABOVE FOR �c POLICY PEF= INDICAT-J. NO r IAND64- ANY FEQUi i't. -ERM. OR CONDPIKN
CSZrF CA.T VAY BE tSSLsp OR MAY PERTAIN, :: vE
OF ANY CCi�: C- OR 07-E2 DOCt%@iF WTrH RE SPSC7 TO Ye-40H TFljs ,
MPA%CE AFFORDED 3Y THE PMJCES DES'RBED FE—RaN iS SiSJECT TO ALL THE Tt
D CLUVONIS AND COtNDf—i 10NS OF SilCti POUM. LDS
_RmS,
SHOWN MAY HAVE BEEN REXCED 3Y ?Aa3 CAS
Tm TYPE OF 21SURAMM
Policy Nmiam POLICY8F i PvtrcYr?P f
LamI
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the OF OPEPA7JONS/ LUCATXX4 / VE HICL,ES (A�CO ACOi� i8t, Ad�ocae 1�Gs.Sd1e0� :f iOxe sjac 6 �iee� .
y
LIC #: CCC 1327373
t�RTt�e� arse rs�ez�
_ -
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
10050 N.E. 2ND AVENUE
MIAMI SHORES FL.33138
s ANY OF THE ABOVE 06SCROM POLKMS BE CANCELLED 80:0RE
THE 09VtATM DATE THEREOF, DIOaM W.&L BE DEUVERED IN
ACCORDANCE VM THE POLICY PROVIStom
A f---
JIMMY PATRONIS
CHIEF FINANICAL OFFICER
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW *
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 8/6/2018
PERSON: PAUL A SCOTT
FEIN: 593778455
BUSINESS NAME AND ADDRESS:
QUALITY PLUS CONSTRUCTION INC
1531 NW 168 TERRACE
MIAMI, FL 33169
SCOPE OF BUSINESS OR TRADE:
Licensed General Contractor Licensed Roofing Contractor
EXPIRATION DATE: 8/5/2020
EMAIL: SIMSCOT27@YAHOO.COM
IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under
this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply
only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be
exempt and certificates of election to be exempt shall be subject to revocation 'rf, at any time after the filing of the notice or the issuance of the certificate, the
person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a
certificate at any time for failure of the person named on the certificate to meet the requirements of this section.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13
QUESTIONS? (850)413-1609
Quality Plus Construction Inc.
Phone: 305 978 2202 Email: simscot27@yahoo.com
2521 NW 131 St. Miami FL 33167
Lic: CCC 1327373
Date:
State of. �G01�1 D
Before me this day personally appeared
1,20Gl(, :57W)7-
who, being
duly sworn, deposes and says, that he will be the only person working on the project
located at: A� AJA V Si /'//MI 5hVA S
_1a::
Contractor Signature
Sworn to (or affirmed) and subscribed before me this 2- day of S 2019
By '� ", t. Sc..c -c-c
Personally known
Or produced Identification
Type of identification produced
N otaryINMIte
GENE E PEREZVOODE
Commission M GO 13M
Expires August 18, 2M
qWW nw 1v0gMNWWY" * .
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner — Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees, including the owner, must obtain workers' compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if:
I . The officer owns at least 10 percent of the stock of the corporation, or in the case of
an LLC, a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
3. The corporation is registered and listed as active with the Florida Department of
State, Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use
day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of
workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
Owner
State of Florida
County of Miami -Dade
Slit -
The foregoing was acknowledge before me this ay of , l Jam. 20 0, .
By�j 1/\�pv� �c.��l`�\y�� who is personally known to me or has produced
as identification.
Notary:%�— oti►�'; !G LUDLOW BROWN
r Commission I GG 182468
SEAL: p1 �. EVkw FeNuary 4.2022
scow Thu Mot?"" Somm
Property Search Application - Miami -Dade County Page 1 of 1
4 'm == F I "' E 0% F T I a ` P R 0 P E R Tay" A P-," P R A I SO` tr R
U F G U H L
Summary Report
Property Information
Folio:
11-3101-025-0040
Property Address:
154 NW 97 ST
Miami Shores, FL 33150-1735
Owner
LINTON HUGH DAWKINS
Mailing Address
154 NW 97 ST
MIAMI SHORES, FL 33150-1735
PA Primary Zone
0800 SGL FAMILY - 1701-1900 SQ
Primary Land Use
0101 RESIDENTIAL - SINGLE
FAMILY: 1 UNIT
Beds / Baths / Half
3/2/0
Floors
1
Living Units
1
Actual Area
1,616 Sq.Ft
Living Area
1,351 Sq.Ft
Adjusted Area
1,479 Sq.Ft
Lot Size
8,625 Sq.Ft
Year Built
1948
Assessment Information
Year
2018
2017
2016
Land Value
$18
$189,543
$189,543
Building Value
$110,925
$102,938
$102,938
XF Value
$0
$0
$0
Market Value
$300,468
$292,481
$292,481
Assessed Value
1 $94,593
$92,648
$90,743
Benefits Information
Benefit
Type
2018
2017
2016
Save Our Homes
Assessment
$205,875
$199,833
$201,738
Cap
Reduction
Homestead
Exemption
$25,000
$25,000
$25,000
Second
Exemption
$25,000
$25,000
$25,000
Homestead
Note: Not all benefits are applicable to all Taxable Values (i.e. County,
School Board, City, Regional).
Short Legal Description
1 53 41 PB 42-60
RESUB OF BLK 3 OF BONMAR PARK
LOT 4 BLK 3
LOT SIZE 75.000 X 115
OR 15082-3948 0691 1
Generated On : 1/3/2019
Taxable Value Information
2018
2017
2016
County
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
$44,593
$42,648
$40,743
School Board
Exemption Value
__........ _®-. _ _ .e.__._
Taxable Value
$25,000
._...... �.........._..._
$69,593
$25,000
.._-._
$67,648
$25,000
- .._...... -- .........
$65,743
City
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
$44,593
$42,648
$40,743
Regional
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
$44,593
$42,648
$40,743
Sales Information
Previous Sale
Price
OR Book -Page
Qualification Description
06/01/1991
$63,000
15082-3948
Sales which are qualified
The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser
and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at hftp://www.miamidade.gov/info/disclaimer.asp
Version:
https://www.miamidade.gov/propertysearch/
1/3/2019
b
ROOF ASSEMBLIES AND ROOFTOP STRUCTURES
Florida Building Code 6th Edition (2017) 1
High -Velocity Hurricane Zone Uniform Permit Application Form 1
I
Section A (General Information) �j 1
Master Permit No. Process No. l 3 i
Contractor's Name T.) \ �e-O ►1 1
Job Address 1
1
ROOF CATEGORY
❑ Low Slope ❑ Mechanically Fastened Tile Mortar/Adhesive Set Tiles 1
❑ Asphaltic Shingles ❑ Metal Panel/Shingles ❑ Wood Shingles/Shakes j
❑ Prescriptive BUR-RAS 150 1
ROOF TYPE 1
❑ New roof O Repair ❑ Maintenance Reroofing ❑ Recovering 1
1
ROOF SYSTEM INFORMATION 1
Low Slope Roof Area (SF) 0 Steep Sloped Roof AREA (SSF) 1858 Total (SF)/J9 1
1
Section B (Roof Plan) 1
Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include dimen-
sions of sections and levels, clearly identify dimensions of elevated pressure zones and location of parapets. 1
Florida Building Code Edition 2010
High Velocity Hurricane Zone Uniform Permit Application Form
Section D (Steep Sloped Roof System)
-
Roof System Manufacturer:
Product Approval Number: 6?
Minimum Design Wind Pressures, If Applicable (From RAS 127 or Calculations):
Pi : � P2.12 �" P3: �i�
Maximum Design Pressure
Product Approval Specific System:
-
Method of Tile Attachment:
Steep Sloped System Description
Deck Type:
Roof Slope: \Type Under4yment:
12 \Insulation:
Fire Barrier:
F ,&
Fastener Type & Spacing:
Ridge Ventilation? ,q /4_
Adhesive Type:
Type Cap Sheet:
Mean Roof Height:
Roof Covering:
'-' S
Type & Size Drips —�
Edge: 22 4 I
s`�
Florida Building Code Edition 2010
High velocity Hurricane Zone Uniform Permit Application Form
Section E (Tile Calculations)
For Moment based tile systems, choose either Method 1 or 2. Compare the values
for M,witn the values from Mr. If the Mrvalues are greater than or equal to the M,
values, for each area of the roof, then the tile attachment method is acceptable.
M iod 1 "M oment iSsecd le Calculations Per RAS 127"
(P,: / : x A = /3f - M�l=MProduct Approval M, sT2x`,_ M9.% = Mrz/L Product Approval M S b
(P3;� Mri4 Product Approval ,--_
Method 2 "Simplified Tile Calculation Per Table Below"
Required Moment of Resistance (M,) From Table Below Product Approval Mr
M Re uired Moment Resistance*
Mean Roof Height -i►
Roof Slope
15'
20'
25'
30'
40'
2:12
34.4
36.5
38.2
39.7
42.2
3:12
32.2
34.4
36.0
37.4
39.8
4:12
30.4
32.2
33.8
35.1
37.3
5:12
28.4
30.1
31.6
32.8
34.9
6:12
26.4
28.0
29.4
30.5
32.4
7:12
24.4
25.9
27.1
28.2
30.0
'Must be used in conjunction with a list of moment based the systems endorsed by the
Broward County Board of Rules and Appeals.
For Uplift based the systems use Method 3. Compare the values for F' with the values for
Fr. If Vie F' values are greater than or equal to the Fr values, for each area of the roof, then
the life attachment method is acceptable.
Method 3 "Uplift Based Tile Calculations Per RAS 127"
x 1: _x w:= �) - W: _x cos 0: _= Fr, _ Product Approval F'
(P=: _ x 1: _____ _x w:= _) - W: _x cos o. = Frr _ Product Approval F'
(P3: ^ x 1: _ _x w:= _ ) - W: �x cos 0: F,, _ Product Approval F'
Where to Obtain information
Description
Symbol
Where to find I
Design Pressure
P1 or P2 or P3
RAS 127 Table 1 or by an engineering analysis preparad by PE based on ASCE 7
Mean'RoofHeight
H
jobS-te
Roof Slope
9
,lob Site
Aerodynamic Mul'rpiier
1
Prcduct Approval
Restoring Mcmen, due to Gravity
Mt
I Produci Approval
Attachment Resistance
W4
Product Approval
Required Momert Resistants
M,
Calculated
Minimurn Attachment Resistance
P
Produc' Approval
Required lrplif: Resistance
F,
Calculated
Average Tile Weight
W
Product A7proval
Tile Dimensions
I =length wvrd;h
.
f Pro�cl Apprcvai
I
All caiculvions rmist be submilied to the 8uiiding Official at the time of permit acprrcation.
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
AFFIDAVIT OF COMPLIANCE WITH ROOF TO WALL CONNECTION HURRICANE MITIGATION
RETROFIT FOR EXISTING SITE -BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PURSUANT
TO SECTION 553.844 F.S.
To: Miami Shores Village Building Department Date:
10050 NE 2nd Ave
Miami Shores, FI 33138
Re: Owner's Name:
Property Address:IQ 4NW c17�'ZZk5o
Roofing Permit Number:
Dear Building Official:
certify that I have improved the roof to wall connections of the referenced
property as required by the Manual of Hurricane Mitigation Retrofits for Existing Site -Built Single Family Residential
Structures s adopted by the Florida Building Commission by Rule 9B-3.047 F.A.C.
Signature
State of Florida
County of Dade
Print Name
The undersigned, being the first duly sworn, deposes and says that he/she is the owner for the above property mentioned,
Sworn to and subscribed before me this _ ?45t day of 20 1$
Notary Public, Sate of Florida at Large
D252-529—h2-3be:,—o
(SEAL)
E OF ♦R�f
Revised on 5/21/2009
UN)LOW BR"
COW*" i GG 1824U
FeWiwr+.20n
8-dWnweAWNM.ym -
FINAL COMPLIANCE
Miami shores Village
Building Department
10050 N.E,2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756,8972
OWNERS'S AFFIDAVIT OF EXEMPTION
ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR EXISTING SITE -
BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES
PERSUANT TO SECTION 553.844 F.S.
To: Miami Shores Village Building Department Date: _LL 21 2-0kb
10050 NE 2nd Ave
Miami Shores, Fl 33138
Re: Owner's Name: Li Ao v\ y,,S
Property Address: P-94 KW 9 7"- 6t K-,-, 51,o rc-'-� fL a3150
Roofing Permit Number:
Dear Building Official:
j.Sr_',',ns certify that I am not required to retrofit the roof to wall connections of my
build/in� because:
�Che just valuation for the structure for purpose of ad valorem taxation is less than $300,000.00, Please attach proof of ad
valorem taxation.
o The building was constructed in compliance with the provisions of the Florida Building Code (FBC) or with the provisions
of 1994 edition of the South Florida Building Code (1994 SFBC)
I
Signature
State of Florida
County of Dade
Print Name
The undersigned, being the first duly sworn, deposes and says that he/she is the owner for the above property mentioned,
Sworn to and subscribed before me this � day of 20 \16
LUDLOW BROWN
. * Commission 8 GG 18240
Notary Public, Sate of Florida at Large _.� _ _ N,l,a� F.xpirsaFaOruery4,2022
o� no saaW nw &*oltromgr arse.
Dv Uc- D Z52 •- 52 b — 52 - 38s — 0
C when the just valuation of the structure for purpose of ad valorem taxation is equal to or more than $300,000.00, and the building was not constructed with FBC nor a 1994
SFBC. Then you must provide a building application from a General Contractor for the Roof to wal' connection Hurricane Mitigation,
Revised on 5.12112009
RE: Permit #
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
INSPECTION AFFIDAVIT
DATE: / 0
I �c��� S c-c licensed as a (n) Contractor / Engineer / Architect,
(Print name and circle License Type) FS 468 Building Inspector
License #: C-�A32 71.7'3
On or about ��� \LL SCaS- I did personally inspect the roof deck nailing
(Date & time)
work at 7-�" v-s' H c�x 55 xave$ -Y-L 33150
(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)
9/,,�
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 2l At
day of P� 20/e
Notary Public, Sate of Florida at Large
CWLUDLOWBROWN
WPJNIOn # GG 1 92468
l�rFor
E*hs Fskuwy 4. 2W
��`ot
BawN il�u apilMNolry Surbw
'General, Building, Residential, or Roofing Contractors or any individual ce tJied under 468 F.S. to make such an inspection. Include photographs
of each plane of the roof with
permit # and address # clearly shown marked on the deck for each inspection
0—i—A — 171i n/9n I A %A P) 19MO
CHAPTER 15, SECTION 1524
HIGH VELOCITY HURRICANE ZONE5
REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS
1524.1 Scope. As it pertains to this section, it is the responsibility of the roofing contractor to provide
the owner with the required roofing permit, and to explain to the owner the content of this section. The
provisions of Chapter 15 of the Florida Building Code, Building 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 and the contractor. The owner's initial in the
designated space indicates that the item has been explained.
��-1-"-Renailmg Wood`Dedl�When-replacing roofing, he exng wood roo"7F&" may have to he
renailed in accordance with current provisions of Chapter 16 (high -Velocity Hurricane Zones) of the
Florida Building Code, Building. (The roof deck is usually concealed prior to removing the existing roof
system.)
Y a 2. Exposed ceilings: 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 penetrations of the underside of the decking may not be acceptable. The owner provides
the option of maintaining this appearance.
Xk 3. Overflow Scuppers (wall outlets): It is required that rainwater flow off so that the roof is not
overloaded from a buildup of water. Perimeter/edge walls or other roof extensions may block this
discharge if overflow scuppers wall outlets) are not provided. It may be necessary to install overflow
scuppers in accordance with the requirements of: Chapter 15 and 16 herein and the Florida Building
Code, Plumbing.
5 2 2-i 2a 1 �3
xowner's/Agent's Signature Date Contractor's Signature
Form AB-326 (Page 2 of 7) New 6/30/2015
MIAMI•QADE �'-'
MIAM1-DADE COUNTY
PRODUCT CONTROL SECTION
DEPAIZTMFN'1' O1- RF,CULA"1'ORV AND ECONOMIC RESOURCES (RER)
11805 SW 26 Street, Room 208
130ARD AND CODE ADMINISTRATION DIVISION
Miami, Florida 33175-2474
T (786) 315-2590 F (786) 315-2599
NOTICE OF ACCEPTANCE (NOA)
�ti'w�s.miamidade.�ov/economy
Polyglass USA Inc.
I III W. Newport Center Drive
Deerfield Beach, FL 33442
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-Dadc 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-Dadc County Product Control Section
(in Miami -Dade County) and/or the AHD (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: Polyglass Polystick Underlayments
LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following
statement: "Miami-Dadc 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, Florida, and followed
by the expiration date may be displayed in advertising literature. if any portion of the NOA is displayed, then
it shall be done in its entirety.
INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and
shall be available for inspection at the job site at the request of the Building Official.
This NOA renews and revises NOA No.15-0410.04 and consists of pages I through 8.
The submitted documentation was reviewed by Freddy Semino.
NOA No.: 17-0614.22
Expiration Date: 09/13/21
Approval Date: 07/06/17
Page 1 of 8
ROOFING COMPONENT APPROVAL
Category: Roofing
Sub -Category: Underlaymcnt
Material: SBS , APP Self -Adhering Modified Bitumen
PRODUCTS DESCRIPTION:
Test Product
Product
Dimensions
Specification Description
Polystick IR-Xe
65' x 3'3-'/s"
ASTM D 1970 A fine granular/sand top surface self -adhering, APP
Or 65' x 3'
polymer modified, fiberglass reinforced, bituminous
Martufacturing
60 mils thick
sheet material for use as an underlayment in sloped roof
Location #1 & #2
assemblies. Designed as an ice & rain shield.
Polystick Dual Pro
61' x 3'3-'/8"
TAS 103 and A rubberized asphalt self -adhering, glass-fiber/polyester
60 mils thick
ASTM D 1970 reinforced waterproofing membrane. Designed as a
Manufacturing
metal rooting and roof tile underlayment.
Location #2
Polystick ,rile Pro
61' x 3'3-3/s"
TAS 103 and A rubberized asphalt self -adhering, glass-fiber/polyester
60 mils thick
ASTM D 1970 reinforced waterproofing membrane. Designed as a metal
Manufacturing
roofing and roof tilc underlayment.
Location #2
Polystick TU Max
65'8" x 3'3-3/8"
TAS 103 and A rubberized asphalt self -adhering, polyester reinforced
60 mils thick
ASTM D 1970 waterproofing membrane. Designed as a a roof tile
Manufacturing
underlayment.
Location #1 & 42
Polystick. TU P
32' 10" x 3'3-1/s"
TAS 103 and A rubberized asphalt waterproofing membrane, glass-
130 mils thick
ASTM D 1970 fiber/polyester reinforced, with a granular surface
Alanufacturing
designed for use as a tile roof underlayment.
Location #t2
Polystick TU Plus
65' x 3'3-3
TAS 103 and A rubberized asphalt self -adhering, glass-fiber/polyester
(Surface Printing)
80 mils thick
ASTM D 1970 reinforced waterproofing membrane. Designed as a metal
roofing and roof tile underlayment.
N/anu/acturing
Location # I & #2
Polystick MTS
65'8" x 3'3-'/K"
TAS 103 A homogeneous, rubberized asphalt waterproofing
60 mils thick
membrane, glass fiber reinforced with polyolefinic film
"Ifanufacttfring
on the upper surface for use as an underlayment for metal
Location #2
roofing, roof tile, slate tiles and shingle underlaymcnt.
Polystick NITS Plus
65'8" x 3'3-'/8"
TAS 103 A homogeneous, rubberized asphalt waterproofing
60 mils thick
membrane, glass fiber reinforced with polyolefinic film
Manufacturing
on the upper surface for use as an underlayment for metal
Location #2
roofing, roof tile, slate tiles and shingle underlayment.
Elastotlex S6 G
32' 10" x 3'3-%"
TAS 103 and Polyester reinforced, SBS modified bitumen membrane
ASTM D 6164 with a sanded back face and a granule top surface. For
Manufacturing
use in roof tile underlayment systems.
Location 42
NOA No.: 17-0614.22
MIAMI-DADE COUNTY= Expiration Date: 09/13/21
Approval Date: 07/06/17
Page 2 of 8
MANUFACTURING PLANTS:
1. Hazelton, PA
2. Winter Haven, FL
EVIDENCE SUBMITTED
Test Agency
Test Identifier
Test Name/Report
Date
Trinity I ERD
PI0870.09.08-R1
TAS 103
12/04/08
P 10870.04.09
TAS 103/ASTM D4798 & G 155
04/ 13/09
P33360.06.10
ASTM D1970
07/01/10
P33370.03.1 I
TAS 103
03/02/11
P33370.04.1 I
ASTM D 1623
04/26/11
P36900.09.1 1
TAS 103/ASTM D4798 & G155
09/01/1 1
P37300.10.11
TAS I10/ASTM D4798 & D1970
10/119/1 1
P40390.08.12-2
ASTM D 1623
08/07/12
P37590.07.13-1
ASTM D6164
07/02/13
P45270.05.14
TAS 103, TAS 110 & ASTM D1623
05/12/14
P46520.10.14
ASTM. D 1623
10/03/ 14
P44360.10.14
TAS 103 & TAS 110
10/07/14
P43290.10.14
ASTM D 1970 & TAS 110
10/17/14
PLYG-SC10130.06.16-3
TAS 103&TAS 110
06/27/16
PLYG-10130.06.16-1
ASTM D1970 & TAS 110
06/27/16
PRI Asphalt Technologies
PUSA-035-02-01
TAS 103
09/29/06
PUSA-055-02-02
TAS 103
12/10/07
PUSA-089-02-01
TAS 103/ASTM D4798 & G155
07/06/09
Momentum Technologies, Inc.
JX20H7A
TAS 103/ASTM D4798 & G155
04/01/08
RX 14E8A
TAS 103/ASTM D4798 & G 155
11 /09/09
DX23DSB
TAS 103/ASTM D4798 & G155
02/18/10
DX23D8A
TAS 103/ASTM D4798 & G155
02/18/10
LABELING:
1. All membranes or packaging shall bear the imprint or identifiable marking of the manufacturer's name or logo, city
and state of manufacturing facility and the following statement: "Miami -Dade County Product Control Approved"
or the Miami -Dade County Product Control Seal as shown below.
MIAM4DADE COUNTY
BUILDING PERMIT REQUIREMENTS:
Application for building permit shall be accompanied by copies of the following:
L This Notice of Acceptance.
2. Any other documents required by the Building Official or applicable building code in order to properly evaluate the
installation of this materials.
NOA No.: 17-0614.22
QI•DADECOUNTY Expiration Date: 09/13/21
► ► Approval Date: 07/06/17
Page 3 of 8
INSTALLATION PROCEDURES:
Deck Type 1: Wood, non -insulated
Deck Description: Min. 19/32" plywood or wood plank
System Type E(1): Anchor sheet mechanically fastened to deck, membrane adhered
Anchor/Base Sheet: One or more plies of ASTM D 226 Type Il or ASTM D 2626.
Fastening: Per FBC 1518.2 & 1518.4 Nails and tin caps 12" grid, 6" o.c. at a minimum 4" head lap. (for
base sheet only)
Membrane: Polystick 1R-Xe, Polystick Dual Pro, Polystick Tile Pro, Polystick TU Max, Polystick
TU P, Polystick TU Plus, Polystick MTS or Polystick MTS Plus, self -adhered.
Surfacing: See General Limitations Below.
Deck Type I : Wood. non -insulated
Deck Description: Min. 19/32" plywood or wood plank
System Type E(2): Anchor sheet mechanically fastened to deck, membrane adhered
Anchor/Base Sheet: One or more plies of ASTM D 226 Type II or ASTM D 2626.
Fastening: Per FBC 1518.2 & 1518.4 Nails and tin caps 12" grid, 6" o.c. at a minimum 4" head lap. (for
base sheet only)
Membrane: Elastoflex S6 G, hot asphalt applied
Surfacing: See General Limitations Below.
Deck Type 1:
Wood, non -insulated
Deck Description:
Min. 19/32" plywood or wood plank
System Type E(3):
Base sheet mechanically fastened to deck, subsequent cap membrane self- adhered.
Anchor/Base Sheet:
One or more plies of ASTM D 226 Type II or ASTM D 2626.
Fastening:
Per FBC 1518.2 & 1518.4 Nails and tin caps 12" grid, 6" o.c. at a minimum 4"head lap. (for
lease sheet only)
Ply Sheet:
Polystick MTS Plus, self -adhered with minimum 3" horizontal laps and minimum 6"
vertical laps.
Membrane:
Polystick TU Plus, self -adhered.
Surfacing:
See General Limitations Below.
NOA No.: 17-0614.22
MIAMI•DADE C UNTYM Expiration Date: 09/13/21
+ Approval Date: 07/06/17
Page 4 of 8
INSTALLATION REQUIREMENTS:
1. All nails in the deck shall be carefully checked for protruding heads. Re -fasten any loose deck panels, and
sweep the deck thoroughly to re move any dust and debris prior to application.
2. Place the underlayment over metal drip edge in accordance with RAS l 1.1.
3. Place the first course of membrane parallel to the cave, rolling the membrane to obtain maximum contact.
Remove the release film as the membrane is applied. All side laps shall be a minimum of 3" and end laps shall
be a minimum of 6". Roll the membrane into place after removing the release strip. Vertical strapping of the
roofwith Polystick is acceptable. Nlembrane shall be back nailed in accordance with applicable building code.
4. When applying the membrane in the valley, start at the low point and work to the high point, rolling the
mcmbrane from the center outward in both directions.
5. For ridge applications, center the membrane and roll from the center outward in both directions.
6. Roll or broom the entire membrane surface so as to have full contact with the surface, giving special attention
to lap areas.
7. Flash vent pipes, stacks, chimneys and penetrations in compliance with .Roof Assembly current Product Control
Notice of Acceptance.
8. All protrusions or drains shall be initially taped with a 6" piece of underlayment. The flashing tape shall be
pressed in place and formed around the protrusion to ensure a tight fit. F, second layer of Polystick shall be
applied over the underlayment.
GENERAL LIMiTA1IONS:
Fire classification is not part of this acceptance.
Polystick Dual Pro, Polystick Tile Pro, Polystick TU Plus, Polystick MTS and Polystick MTS Plus may be
used in asphaltic shingles, wood shakes and shingles, non-structural metal roofing, roof tile systems and quarry
slate roof assemblies.
Polystick TU P may be used in all the previous assemblies listed except metal roofing.
Polystick IR-Xe may be used in all the previous assemblies listed except metal roofing and roof tile systems.
Polystick TU Max may be used in non-structural metal rooting and roof tile systems.
Elastoflex S6 G may be used in roof tile systems only.
3. Deck requirements shall be in compliance with applicable building code.
4. Polystick IR-Xe, Polystick Dual Pro, Polystick Tile Pro, Polystick TU Max, Polystick TU P, Polystick TU
Plus, Polystick MTS and Polystick MTS Plus shall be applied to a smooth, clean and dry surface. The deck
shall be free of irregularities.
5. Polystick IR-Xe, Polystick Dual Pro, Polystick Tile Pro, Polystick TU Max, Polystick TU P, Polystick TU
Plus, Polystick MTS and Polystick MTS Plus shall not be adhered directly over a pre-existing roof membrane
as a recover system.
6. Polystick IR-Xe, Polystick Dual Pro, Polystick Tile Pro, Polystick TU Max, Polystick TU P, Polystick TU
Plus, Polystick MTS and Polystick MTS Plus shall not be left exposed as a temporary roof for longer than the
amount of days listed in the table below after application. Polyglass reserves the right to revise or alter product
exposure times; not to exceed the preceeding maximum time limitations.
Ex osure Limitations (Days)
MTS
IR-Xe
If lastoflex
S6 G
TU
Plus
TU P
Tile Pro
Dual Pro
TU Max
MTS Plus
Winter Haven, FL
180
90
180
180
180
180
180
180
180
Hazelton, PA
N/A
90
N/A
180
N/A
N/A
N/A
180
N/A
7. All products listed herein shall have a quality assurance audit in accordance with the Florida Building Code and
NOA No.: 17-0614.22
MIAMMADE COUNTY Expiration Date: 09/13/21
Approval Date: 07/06/17
Page 5 of 8
Rule 61 G20-3 of the Florida Administrative Code.
8. In roof the application, data for the attachment resistance of roof tiles shall be as set forth in the roof tile
manufacturer's Notice of Acceptance.
Polvstick 'file Pro, Polystick TU Max, Polystick TU Plus or Elastonex S6 G may be used in both adhesive
set and mechanically fastened roof the applications.
Polystick Dual Pro is limited to mechanically fastened roof tile applications.
Polystick MTS and Polystick MTS Plus are limited to mechanically fastened with the limitations outlined in
Section 9.
Polystick TU P may be used in mechanically fastened roof tile applications with the exception of mortar set tile
applications.
9. When loading roof tiles on roof tile underlayment for (direct -to -deck) tile assemblies, the maximum roof slope
shall be as follows: (See Table Below)
Tile
Polystick
Elastoflex
Polystick TU Plus,
Polystick
Polystick
System (E3)
Profile
MTS
S6 G
TU P, Tile Pro,
TU Max
MTS Plus
MTS Plus with
Dual Pro
TU Plus
Flat Tile
Prohibited
4:12
6:12
6:12
5:12
6:12
without battens
Profiled
Prohibited
4:12
6:12
6:12
4:12
6:12
Tile
without battens
The above slope limitations can be exceeded only by using battens in accordance with the Approved Tile System
Notice of Acceptance and applicable Florida Building Code requirements. When battens are required, they shall
be utilized during loading and installation of tiles.
10. Care should be taken during the loading procedure to keep foot traffic to a minimum and to avoid dropping of
tile directly on the underlayment. Refer to Polyglass' Tile loading detail below for loading procedure — two tiles
laid perpendicular to slope followed by a maximum four tile stack parallel to the slope, for a total of 6 tiles — for
all underlayments except Polystick MTS which shall be loaded onto battens.
LO
Ll Ii "Itiall
oil imij
iij
POL`rSnCK fU Pus
NOA No.: 17-0614.22
Expiration Date: 09/13/21
Approval Date: 07/06/17
Page 6 of 8
11. Refer to prepared roofing system Product Control Notice of Acceptance for listed approval of this product with
specific prepared roofing products. Polystick IR-Xe, Polystick Dual Pro, Polystick Tile Pro, Polystick TU
Max, Polystick TU P, Polystick TU Plus, Polystick NITS, Polystick MTS Plus or Elastoflex S6 G may be
used with any approved roof covering Notice of Acceptance listing Polystick IR-Xe, Polystick Dual Pro,
Polystick Tile Pro, Polystick TU Max, Polystick TU P, Polystick TU Plus, Polystick MTS, Polystick MTS
Plus or Elastoflex S6 G as a component part of an assembly in the Notice of Acceptance.
If Polystick IR-Xe, Polystick Dual Pro, Polystick Tile Pro, Polystick TU Max, Polystick TU P, Polystick
TU Plus, Polystick NITS, Polystick MTS Plus or Elastoflex S6 G are not listed, a request may be made to the
Authority Having Jurisdiction (AHJ) or the Miami -Dade County Product Control Section for approval provided
that appropriate documentation is provided to detail compatibility of the products, wind uplift resistance, and fire
testing results.
POLYGLASS GENERAI. APPLICATION GUIDELINES FOR POLYSTICK MEMBRANES
PLEASE CHECK WITH LOCAL BUILDING CODES REGARDING LIMITATIONS OF SPECIFIC APPLICATIONS.
LOCAL, CODES MAY SUPF,RSEDF POLYGLASS RF,QUIREMENTS AND RECOMMENDATIONS.
1. Polyglass does accept the direct application of Polystick underlayment membranes to wood decks. Installers are
cautioned to refer to applicable local building codes prior to direct deck installation to ensure this is acceptable.
Please also refer to applicable Product Data Sheets of the corresponding products.
2. All rolls, with the exception of Polystick TU Plus should be back -nailed in selvage edge seam as per Polyglass
Back Nailing Guide. Nails shall be, I 1 gauge ring shank type, applied with a minimum 1 V metal disk as
required in Miami -Dade County or simplex type nail as otherwise allowable in other regions, at a minimum rate
of 12" o.c. Polystick TU Plus should be back nailed in designated area marked "nail area, area para clavar" on
the face of membrane, with the above stated nails and/or disks. The head lap membrane is to cover the area being
back -nailed. (Please refer to applicable local building codes prior to installation.)
3. All seal lap seams (selvage laps) must be rolled with a hand roller to ensure full contact.
4. All fabric over fabric; and granule over granule end laps, shall have a 6" wide, uniform layer of Polyglass
Polyplus 55 Premium Modified Flashing Cement, Polyglass Polyplus 50 Premium MB Flashing Cement,
XtraFlex 50 Premium Modified Wet/Dry Cement, Polyglass PG500 MB Flashing Cement, applied in between
the application of the lap. The use of mastic between the laps does not apply to Polystick MTS.
S. A maximum of 6 tiles per stack are allowed when loading tile on the underlayments. Refer to the Polyglass Tile
Loading Guidelines. See General Limitations #9 and #10.
6. Battens and/or Counter -battens, as required by the tile manufacturers NOA, must be used on all projects for
pitch/slopes of TV12" or greater. It is suggested that on pitch/slopes in excess of 6'/4"/12", precautions should be
taken, such as the use of battens to prevent tile sliding during the loading process.
7. Minimum cure time after membrane installation & before loading of roofing tiles is Forty -Eight (48) Flours.
8. Polystick membranes may not be used in any exposed application such as crickets, exposed valleys, or exposed
roof to wall details.
9. Repair of Polystick membranes is to be accomplished by applying Polyglass Polyplus 55 Premium Modified
Flashing Cement, Polyglass Polyplus 50 Premium MB Flashing Cement, XtraFlex 50 Premium Modified
Wct/Dry Cement, Polyglass PG500 MB Flashing Cement to the area in need of repair, followed by a patch of the
Polystick material of Like kind should be set and hand rolled in place over the area needing such repair. Patching
membrane shall be a minimum of 6 inches in either direction. The repair should be installed in such a way so
that water will run parallel to or over the top of all laps of the patch.
NOA No.: 17-0614.22
Expiration Date: 09/13/21
Approval Date: 07/06/17
Page 7 of 8
10. All self -adhered membranes must be rolled to ensure full contact with approved substrates. Polyglass requires a
minimum of 40 lbs for a weighted roller for the rolling of the field membrane. Hand rollers are acceptable for
rolling of patches or small areas of the roof. Brooming may be used where slope prohibits rolling.
11. All approved substrates should be dry, clean and properly prepared, before any application of Polystick
membranes commences. An approved substrate technical bulletin can be furnished upon request. It is
recommended to refer to applicable building codes prior to installation to verify acceptable substrates.
12. The Polyglass Miami -Dade Notice of Acceptance (NOA) approval for Polystick membranes can be furnished
upon request by our Technical Services Department by calling 1 (800) 894-4563.
13. Questions in regards to the application of Polyglass products should be directed to our Technical Services
Department at 1 (800) 894-4563.
14. Polyglass recommends that applicators follow good roofing practices and applicable procedures as outlined by
the National Roofing Contractors Association (NRCA).
PLEASE CHECK WITH LOCAL BUILDING CODES REGARDING LIMITATIONS OF SPECIFIC APPLICATIONS.
LOCAL CODES MAY SUPERSEDE POLYGLASS REQUIREMENTS AND RECOMMENDATIONS.
END OF THIS ACCEPTANCE
NOA No.: 17-0614.22
MIAMI•DADECOUNTY Expiration Date: 09/13/21
1 Approval Date: 07/06/17
Page 8 of 8
MIAMI-DADE COUNTY
MIAM PRODUCT CONTROL SECTION
iis 1 1805 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 (786) 315-2599
NOTICE OF ACCEPTANCE (NOA) www.miamidade.t'ov/eeonomv
ICP Adhesives and Sealants, Inc.
12505 NW 44th Street
Coral Springs, FL. 33065
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: ICP Adhesives Polyset' AH-160
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, Florida, and followed by the
expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done
in its entirety.
INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and
shall be available for inspection at the job site at the request of the Building Official.
This NOA renews NOA 16-0315.01 and consists of pages 1 through 11.
The submitted documentation was reviewed by Alex Tigera.
�01 MA i
APPROVED
NOA No.: 17-0322.03
Expiration Date: 05/10/22
Approval Date: 04/27/17
Page 1 of 11
ROOFING COMPONENT APPROVAL:
Category: Roofing
Sub Category: Roof tile adhesive
Materials: Polyurethane
SCOPE:
This approves ICP Adhesives Polyset® AH-160 as manufactured by ICP Adhesives and Sealants, Inc. as described
in this Notice of Acceptance. For the locations where the design pressure requirements, as determined by applicable
building code, do not exceed the design pressure values obtained by calculations in compliance with Roofing
Application Standard RAS 127. For use with approved flat, low, and high profile roof tile systems using 1CP
Adhesives Polyset AH-160.
PRODUCTS MANUFACTURED BY APPLICANT:
Product Dimensions Test Product Description
Specifications
ICP Adhesives N/A
Polyset'AH-160
ICP Adhesives Foam N/A
Dispenser RTF1000
1CP Adhesives ProPack® N/A
30 & 100
TAS 101 Two component polyurethane foam adhesive
Dispensing Equipment
Dispensing Equipment
PRODUCTS MANUFACTURED BY OTHERS:
Any Miami -Dade County Product Control Accepted Roof Tile Assembly having a current NOA which list attachment
resistance values with the use of ICP Adhesives Polyset' AH-160 roof tile adhesive.
MANUFACTURING LOCATION:
Tomball, TX.
PHYSICAL, PROPERTIES:
Property
Test
Density
ASTM D 1622
Compressive Strength
ASTM D 1621
Tensile Strength
ASTM D 1623
Water Absorption
ASTM D 2127
Moisture Vapor Transmission
ASTM E 96
Dimensional Stability
ASTM D 2126
Closed Cell Content ASTM D 2856
Results
1.6 lbs./ft.'
18 PST Parallel to rise
12 PSI Perpendicular to rise
28 PSI Parallel to rise
0.08 Lbs./Ft
3.1 Perm / Inch
+0.07% Volume Change @ -400 F., 2 weeks
+6.0% Volume Change @1580F., 100% Humidity, 2
weeks
86%
Note: The physical properties listed above are presented as typical average values as determined by
accepted ASTM test methods and are subject to normal manufacturing variation.
NOA No.: 17-0322.03
MiAMI.DADEcouNTl' Expiration Date: 05/10/22
• Approval Date: 04/27/17
Page 2 of 11
EVIDENCE SUBMITTED:
Test Agency
Center for Applied Engineering
Miles Laboratories
Polymers Division
Ramtech Laboratories, Inc.
Southwest Research Institute
Trinity Engineering
Celotex Corp. Testing Services
Test identifier
Test Name/Report
Date
494-060
TAS 101
04/08/94
257818-IPA
TAS 101
12/16/96
25-7438-3
SSTD 11-93
10/25/95
25-7438-4
25-7438-7
SSTD 1 1-93
11 /02/95
25-7492
SSTD 11-93
12/12/95
NB-589-631
ASTM D 1623
02/01/94
9637-92
ASTM E 108
04/30/93
01-6743-011
ASTM E 108
1 1 /16/94
01-6739-062b[1]
ASTM E 84
01/16/95
7050.02.96-1
TAS 114
03/14/96
P36700.04.12
ASTM D 1623
04/18/12
P39740.02.12
TAS 101
02/21/12
TAS 123
528454-2-1
TAS 101
10/23/98
528454-9-1
528454-10-1
520109-1
TAS 101
12/28/98
520109-2
520109-3
520109-6
520109-7
520191-1
TAS 101
03/02/99
520109-2-1
LIMITATIONS:
1. Fire classification is not part of this acceptance. Refer to the Prepared Roof Tile Assembly for fire rating.
2. iCP Adhesives Polyset'' AH-160 shall solely be used with flat, low, & high tile profiles.
3. Minimum underlayment shall be in compliance with the Roofing Application Standard RAS 120.
4. Roof Tile manufactures acquiring acceptance for the use of ICP Adhesives PolyseO' AH-160 roof tile adhesive
with their tile assemblies shall test in accordance with TAS 101.
5. All products listed herein shall have a quality assurance audit in accordance with the Florida Building Code and
Rule 61 G20-3 of the Florida Administrative Code.
MIAMI•DADE COUNTY
NOA No.: 17-0322.03
Expiration Date: 05/10/22
Approval Date: 04/27/17
Page 3 of 11
INSTALLATION:
1.
2.
4.
5.
6.
ICP Adhesives Polyset' AH-160 may be used with any roof tile assembly having a current NOA that lists
attachment resistance values with the use of ICP Adhesives PolyseO' AH-160.
ICP Adhesives Polyse0" AH-160 shall be applied in compliance with the Component Application section and the
corresponding Placement Details noted herein. The roof the assembly's adhesive attachment with the use of ICP
Adhesives Polyset`' AH-160 shall provide sufficient attachment resistance to meet or exceed the resistance value
determined in compliance with Miami -Dade County Roofing Application Standards RAS 127. The adhesive
attachment data is noted in the roof tile assembly NOA.
ICP Adhesives Polyset'' AH-160 and its components shall be installed in accordance with Roofing Application
Standard RAS 12G, and ICP Adhesives and Sealants, Ine.'s Operating Instruction and Maintenance Booklet.
Installation must be by a Factory Trained 'Qualified Applicator' approved and licensed by ICP Adhesives and
Sealants, Inc. ICP Adhesives and Sealants, Inc. shall supply a list of approved applicators to the authority having
jurisdiction.
Calibration of the TCP Adhesives Foam Dispenser RTFI 000 dispensing equipment is required before application
of any adhesive. The mix ratio between the "A" component and the "B" component shall be maintained between
1.0-1.15 (A): 1.0 (B).
ICP Adhesives Polyset'R AH-160 shall be applied with ICP Adhesives Foam Dispenser RTF1000 or 1CP
Adhesives ProPack`•' 30 & 100 dispensing equipment only.
7. ICP Adhesives Polyset' AH-160 shall not be exposed permanently to sunlight.
8. Tiles must be adhered in freshly applied adhesive. Tile must be set within 1 to 2 minutes after ICP Adhesives
Polyset' AH-160 has been dispensed.
9. ICP Adhesives Polysef' AH-160 placement and minimum patty weight shall be in accordance with the
'Placement Details' herein. Each generic tile profile requires the specific placement noted herein.
NOA No.: 17-0322.03
MIAMI•DADECOUNTY Expiration Date: 05/10/22
• Approval Date: 04/27/17
Page 4 of I l
Table 1: Adhesive Placement For Each Generic Tile Profile
Tile Profile
Placement Detail
Minimum Paddy Contact
Area
Minimum Paddy Gram
Weight
Eave Course - Flat, Low, High
Profiles
All Eave Course
17-23 sq. inches
45-65
Flat, Low, High Profiles
#1
17-23 sq. inches
45-65
Flat Profile
#2
10-12 sq. inches
30
Low Profile
42
12-14 sq. inches
30
High Profile
#2
17-19 sq. inches
30
Flat, Low, High Profiles
#3
Two Paddys: 8-9 sq. inches at
head of tile 9-11 sq. inches at
overlap
12 grams per paddy
Two -Piece Barrel (Cap Tile)
Two Piece
2 Beads (1 each longitudinal
edge)20-25 sq. inches each
bead
17 grams per bead
Two Piece Barrel (Pan Tile)
Two Piece
65-70 sq. inches
34 grams under pan
LABELING:
All approved products listed herein shall be labeled and shall bear the imprint or identifiable marking of the
manufacturer's name or logo and following statement: "Miami -Dade County Product Control Approved" or the Miami -
Dade County Product Control Seal as shown below. _
BUILDING PERMIT REQUIREMENTS:
As required by the Building Official or applicable building code in order to properly evaluate the installation of this
system.
NOA No.: 17-0322.03
MIAMI•DADECOUNTY Expiration Date: 05/10/22
"' • ' Approval Date: 04/27/17
Page 5 of 11
ADHESIVE PLACEMENT DETAIL # 1
%a t%m"h plascic caanwiM Paddy itanaatfsTila-�
tlndrttaymant .�� ° 1°i �•ti. '.,�1 '�,'�
Law room,
g:atunsogtransl ° `•�- '-' w _ r..
�'
Nail?hmugh piostk cxment
iwhem rewiradi
Paddy M.Meath.rdal
vind-fayn.wn-t 4,ti�. •,, �'..= •,.14 '.!
Qatiesss optional
k r,
10{n ]m
k J
��' Eav�ei:losura
F�raCosrse-" k''` Fasc►r
N4gh+ough0,10101ccaeAanF--y.,,. P.eldylsa-AlsTil-I
(*#mnra i'red4 3'`
4
"+. to to s
2 in' wide
Rattans f •�°'
apaonal
EavaC,sursaa Fascia
W"_ P"lNe
yt I.V d0suse
0ir� l'' w., �J in ,Dri a e r ` P d9
APPROYED
Flat/Low Profile Tile
1. Starting at the eave course, apply a minimum 2"
(50.8 mm) x 10" (254 mm) x 1" (25.4 mm) foam
paddy onto the underlayment positioned as shown,
under the strengthening rib closest to the overlock
of the tile being set.
2. Continue in same manner. Insure approximately 17
(109.7 cm2) — 23 (148.4 cm2) square inch adhesive
contact will: the underside of the tile.
Medium Profile / Double Pan Tile
1. Starting at the eave course, apply a minimum 2"
(50.8 mm) x 10" (254 mm) x 1" (25.4 mm) foam
paddy onto the underlayment positioned as shown
under the pan portion of the tile closest to the
overlock of the tile being set.
2. Continue in same manner. Insure approximately 17
(109.7 cm'-) — 23 (148.4 cm2) square inch adhesive
contact with the underside of the tile.
High Profile / Single Pan Tile
l . Starting at the eave course, apply a minimum 2"
(50.8 mm) x 10" (254 mm) x 1" (25.4 mm) foam
paddy onto the underlayment positioned as shown
under the pan portion of the the closest to the
overlock of the tile being set.
2. Continue in same manner. Insure approximately 17
(109.7 cm') — 23 (148A cm') square inch adhesive
contact with the underside of the tile.
NOA No.: 17-0322.03
Expiration Date: 05/10/22
Approval Date: 04/27/17
Page 6 of 11
ADHESIVE PLACEMENT DETAIL # 2
toil
_h—,Jl. pk."k c,rmrna Paddy 4rrrrarh Ta-1
B sttt�ws cars nal
Eaw4aursa.
Faklai
Eavollwurr
Nall through plastic cean.nt
;weer. regalrrdl
/ ._.-paddy iBantath Tile)
—^
k
swenseptnvnal t .•4 ^r 1}y
x`
Eavr CnurW
MIAMI-DADE COUNTY
. .MW
Flat/Low Profile Tile
Starting at the eave course, apply a minimum 2" (50.8
mm) x 10" (254 mm) x 1" (25.4 mm) foam paddy
onto the underlayment positioned as shown under the
strengthening rib of the tile closest to the overlock of
the tile being set. Insure approximately 17 (109.7 cm'-)
— 23 (148.4 cm') square inch adhesive contact with the
underside of the tile.
2. At the second course, apply a minimum 2" (50.8mm)
x 7" 077.8 mm) x 1" (25.4 mm) foam paddy onto the
underlayment positioned as shown under the
strengthening rib closest to the overlock of the tile
being set.
3. Continue in same manner. Insure approximately 10"
(64.5 cmz) - 12(77.4 cmz) square inch adhesive
contact with the underside of the tile.
Medium Profile / Double Pan Tile
Starting at the cave course, apply a minimum 2" (50.8
Trim) x 10" (254 nun) x 1" (25.4 mm) foam paddy
onto the underlayment positioned as shown under the
pan portion of the tile closest to the overlock of the
tile being set. Insure approximately 17 (109.7 cmz) —
23 (148.4 cmz) square inch adhesive contact with the
underside of the tile.
2. At the second course, apply a minimum 2" (50.8mm)
x 7" 0 77.8 n m) x 1" (25.4 mm) foam paddy onto the
underlayment positioned as shown under the pan
portion of the tile closest to the overlock of the tile
being set.
3. Continue in same manner. Insure approximately 12"
(77.4 cm2) - 14 (90.3 cmz) square inch adhesive
contact with the underside of the tile.
(instructions continued on next page)
NOA No.: 17-0322.03
Expiration Date: 05/10/22
Approval Date: 04/27/17
Page 7 of 11
ADHESIVE PLACEMENT DETAIL # 2 (CONTINUED)
Prddrr 150r r06 rY.)
;� YY�.pfiai�
trip eke
APPROVED
High Profile / Single Pan Tile
1. Starting at the eave course, apply a minimum 2" (50.8
mm) x 10" (254 mm) x 1" (25.4 mm) foam paddy
onto the underlayment positioned as shown under the
pan portion of the tile closest to the overlock of the
tile being set. Insure approximately 17 (109.7 cmz) —
23 (148.4 cmz) square inch adhesive contact with the
underside of the tile.
2. At the second course, apply a minimum 2" (50.8mm)
x 7" 077.8 mm) x 1" (25.4 mm) foam paddy onto the
underlayment positioned as shown under the pan
portion of the tile closest to the overlock of the tile
being set.
3. Continue in same manner. Insure approximately 17"
(109.7 cm') - 19 (122.6 cmz) square inch adhesive
contact with the underside of the tile.
NOA No.: 17-0322.03
Expiration Date: 05/10/22
Approval Date: 04/27/17
Page 8 of 11
ADHESIVE PLACEMENT DETAIL # 3
Mail through Plastic --I Paddy (between tiles)
)when requisedl., 1
battens optional a �\ (J Pa ddy tunder We)
ddy
aftile
singleIpad60gle paddy
�y
on andedarm" L e 2 x s in.
xl�LL
2 in.
i
�� �7 v �---r3reC3asnne
FWLow Profile Tile
Mal through plastic cement Single paddy under tile
Isrhen required) paddy Ibetween Wes)
Battens t � ` fPaddy (under Cite}
gopaddy �.
Jt tile
4 x 4 in.
Skxfi@ paddy
underlayrmeM
tin(
/- - Eave Closure
EareCourse /•' y' yasda
Medium Profile TilK
.•.
APPROVED J
I . On the cave course only, apply a minimum 2" (50.8
mm) x 10" (254 mm) x 1" (25.4 mm) foam paddy
onto the underlayment positioned as shown, under
the strengthening rib for flat tile or under the pan
portion of the tile for low or high profile tile closest
to the overlock of the tile being set. Leave
approximately 4" (101.6 mm) up from the cave
edge free of foam to prevent the expanded adhesive
from blocking the weep holes. Insure
approximately 17-23 in (109.7-148.4 cm2) of
adhesive contact with the underside of the tile
2. Apply a 4" (101.6 mm) x 4" (101.6 mm) x 1 " (25.4
mm) foam paddy onto the underlayment just below
the second course line positioned foam paddy
under the strengthening rib for flat tile, or under the
pan portion of the tile, closest to the underlock for
the second course tile to be installed. Insure
approximately 8-9 in'- (51.6-58.1 cm2) of adhesive
contact with the underside of the tile.
(instructions continued on next page)
NOA No.: 17-0322.03
Expiration Date: 05/10/22
Approval Date: 04/27/17
Page 9 of 11
ADHESIVE PLACEMENT DETAIL # 3 (CONTINUED)
Nail ttwough plastic slr4e paddy WYdN tile
}when requuiredl
Paddy tbetweenfiles]
Battens`
paiW (under tile)
opoonalSk.; ✓;
* P=.*an �_
--0'4xain.
�
'�` � �
*•��,
sin* 2 x 4 in. �
,�
ddy on
tile -
Eare Course —
y riascia
Weephoie
\
� Eaw closure
loin... 2in. ,s'��
i Drip edge
High ProflieTiie
APPROVED
Also apply a 2" (50.8 mm) x 4" (101.6 mm) x 3/<"
(19 mm) paddy on top of the eave course tile
surface as shown, on top of the strengthening rib
for flat tile or on top of the pan portion of the tile,
closest to the underlock of the first course of tile.
Install second course of tile. Insure approximately
9 (58.1 cm'-) - 11 (71cm2) square inch adhesive
contact with the underside of the the at the overlap
and 7 (45.2 cm') - 9 (58.1 cm') square inch
adhesive contact with the underside of the tile at
the head of the tile. Continue in same manner.
NOA No.: 17-0322.03
Expiration Date: 05/10/22
Approval Date: 04/27/17
Page 10 of 11
ADHESIVE, PLACEMENT DETAIL
TWO PIECE BARREL
1) Place enough adhesive to achieve 65 to 70 sq. in. Steep pitch applications
in contact with the pan tile. t (when required)
2) Turn covers upside down. Place adhesive In
to 1 1n. from outside edge of cover tile.
Then install the tile. Ensure 20 to
25 sq. in.contact area.
^�J�s
Underlayment
Sheathing
Eave closure
(motar shorn)
weephole fascia Board
Remove top portion of the eave course cover tile. Abut to second course of
pan tiles. Ensure eave end of pan and cover tiles are flush at eave line.
Two Piece Barrel - High Profile Tile
APPROVED J
Two Piece Barrel (Cap and Pan) Tile
l . Starting at the eave course, apply a minimum 2"
(50.8 mm) x 10" (254 mm) x l" (25.4 mm) foam
paddy onto the underlayment positioned as
shown under two adjacent pan tiles. Support eave
tiles from rocking until adhesive has a chance to
cure.
2. Continue in same manner bringing two pan
courses up toward the ridge. Insure
approximately 65 (419.4 cm2) — 70 (451.6 cm2)
square inch adhesive contact with the underside
of the pan tile.
Turn covers upside down exposing the underside
of the tile. Apply a minimum 1" (25.4 mm) x 10"
(254 mm) bead of adhesive directly on the inner
edge of each side of the cover tile. Leave
approximately 3/4" (19 mm) to 1" (25.4 mm)
from the outside edge of the tile, inward, free of
foam to allow for expansion.
4. Turn cover tile over after foam is applied and
place onto pan tile course. Insure a minimum of
20 (129 cm2) - 25 (161.3 cm2) square inch
contact area on each side of the cover tile to the
pan tile. Continue in same manner. Trim away
any cured exposed foam adhesive. Pointing of
longitudinal edges of the cover tiles are
considered optional.
5. When additional nailing is required, 2" (50.8
mm) x 4" (101.6 nun) nailers or the tie wire
system using galvanized, stainless steel, or
copper wire and compatible nails may be used.
END OF THIS ACCEPTANCE
NOA No.: 17-0322.03
Expiration Date: 05/10/22
Approval Date: 04/27/17
Page 11 of 11
ur MIAMI-DADE COUNTY
MIAMI•C14M PRODUCT CONTROL SECTION
Ma - 11805 SW 26 Street, Room 208
DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES (RER) Miami, Florida 33175-2474
130ARD AND CODE ADMINI5TRATION DIVISION 'r (786) 315-2590 F (786) 315-2599
NOTICE OF ACCEPTANCE (NOA) iv�sw.n,iar»idadc.�ov;ecoaorm
Entegra Roof Tile, LLC
1289 NE 9"' Ave
Okeechobee, FL 34972
SCOPE:
This NOA N 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: Bella "High S" Tile
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, Florida, and followed by the
expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done
in its entirety.
INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall
be available for inspection at the job site at the request of the Building Official.
This NOA renews NOA No. 14-1 120.05 and consists of pages 1 through 5.
The submitted documentation was reviewed by Gaspar J Rodriguez.
MIAMI•DADE COUNTY
�F_3=10YANJ
NOA No.: 16-0112.06
Expiration Date: 07/13/21
Approval Date: 02/25/16
Page 1 of 5
ROOFING ASSEMBLY APPROVAL
Category:
Roofing
Sub -Category:
Roofing Tiles
Material:
Concrete
Deck Type:
Wood
1. SCOPF,
This approves a roofing system using Entegra Bella "High S" concrete roof tile as manufactured in Okeechobee,
FL and described in Section 2 of this Notice of Acceptance. For use in locations where the pressure requirements,
as determined by applicable Building Code, do not exceed the design pressure values obtained by calculations in
compliance with PAS 127 using the values listed in section 4 herein. The attachment calculations shall be
prepared as a moment based system.
2. PRODUCT DESCRIPTION
Manufactured bl'
Test
Product
Applicant Dimensions
Specifications
Description
Bella "High S" Length = 16 !/z"
TAS 112
High profile, interlocking, extruded concrete roof tile
Width = 13-'/4"
Type 2
equipped with two nail holes. For mechanical, mortar
Thickness ='/"
Class 11
or adhesive set applications.
Trim Pieces I = varies
TAS 112
Accessory trim, concrete roof pieces for use at hips,
w = varies
rakes, ridges and valley terminations.
varying thickness
2.1 MANUFACTURING LOCATION
1. Okeechobee, FL
2.2 EVIDENCE SUBMITTED
Test Agency
Test Identifier
Test Name/Report Date
The Center for Applied Engineering, 25-7094-(3,
6 & 9)
Static Uplift Testing Oct. 1994
Inc.
TAS 102
']'lie Center for Applied Engineering,
25-7120-(1 & 2)
Static Uplift Testing Nov. 1994
Inc
TAS 102
The Center for Applied Fngineering,
25-7183-(3 & 4)
Static Uplift Testing Feb. 1995
Inc.
TAS 102
The Center for Applied Engineering. 25-7214-(3, 4, &7)
Static Uplift Testing March, 1995
Inc
TAS t02
The Center for Applied Engineering,
25-7804-4
Static Uplift Testing Sep. 1996
Inc
TAS 102
Celotex Corporation
5201 l l-3
Static Uplift Testing Dec. 1998
Testing Services
TAS 101
Celotex Corporation
520191-2-1
Static Uplift Testing March 1999
Testing Services
TAS 101
Walker Engineering, Inc.
Calculations
Aerodynamic Multiplier March 1999
NOA No.: 16-0112.06
MIAMI-DADE COUNTY
Expiration Date: 07/13/21
�FJJ''
Approval Date: 02/25/16
Page 2 of 5
2.2 EVIDENCE SUBMITTED
Test A2encV Test Identifier Test Name/Report Date
Walker Engineering, Inc. Calculations Restoring Moment June 2007
IBA Consultants, Inc. 2421-94 ASTM C 1167 June 2006
American Test Lab of South Florida RT1210.03-15 TAS 112-95 Dec 2015
3. LIMITATIONS:
3.1 Fire classification is not part of this acceptance.
3.2 For mortar or adhesive set tile applications, a static field uplift test in accordance with TAS 106 may be
required, refer to applicable building code.
3.3 Applicant shall retain the services of a Miami -Dade County Certified Laboratory to perform quarterly test in
accordance with TAS 112, appendix `A'. Such testing shall be submitted to the Miami -Dade Product
Control Section for review.
3.4 Minimum underlayment shall be in compliance with the applicable Rooting Applications Standards listed
section 4.1 herein.
3.5 30/90 hot mopped underlayment applications may be installed perpendicular to the roof slope unless stated
otherwise by the underlayment material manufacturers published literature.
3.6 This acceptance is for wood deck applications. Minimum deck requirements shall be in compliance with
applicable building code.
4. INSTALLATION
4.1 Entegra Sales, Inc.'s Bella "high S" concrete roof the and its components shall be installed in strict
compliance with Roofing Application Standard RAS 118, RAS 1 19 and RAS 120.
4.2 Data For Attachment Calculations
Table 1: Average Weight (W) and Dimensions (I x w )
Tile Profile
Weight-W (Ibf)
Length -I (ft)
Width-w (ft)
Bella "High S" Tile
10.5
1.375
1.08
Tile
Profile
Bella "High S" Tile
Table 2: Aerodynamic Multipliers - A
A (ft')
Batten Application
0.349
(ft')
Direct Deck Application
0.378
Table 3: Restoring Moments due to Gravity - M9 (ft-Ibf)
Tile
212"
3":12"
4":12"
5":12"
6":12"
Greater than
7":12"
Profile
Bella -"High
Battens
Direct
Battens
Direct
Battens
Direct
Battens
Direct
Battens
Direct
Battens
Direct
S" Tile
Deck
Deck
Deck
Deck
Deck
Deck
6.19
6.89
6.11
6.80
5.99
6.67
5.85
1 6.51
5.68
6.33
5.50
6.13
MIAMI DADE COUNTY
NOA No.: 16-0112.06
Expiration Date: 07/13/21
Approval Date: 02/25/16
Page 3 of 5
Table 4: Attachment Resistance Expressed as a Moment - Mf (ft-Ibf)
for Nail -On Systems
Tile
Profile
Fastener Type
Direct Deck
(min 15/32" plywood)
Direct Deck
(min. 19/32" plywood)
Battens
Bella "High
_T_10dRiing Shank Nails
28.6
41.2
19.4
S" Tile
1-10d Smooth or Screw
Shank Nail
5.1
6.8
2.8
2-10d Smooth or Screw
Shank Nails
6.9
9.2
7.3
1 #8 Screw
20.7
20.7
18.1
2 #8 Screw
43.2
43.2
29.8
1-10d Smooth or Screw
Shank Nail Field Clip)
23.1
23.1
19.0
1-10d Smooth or Screw
Shank Nail Eave Clip)
29.3
29.3
24.0
2-10d Smooth or Screw
Shank Nails Field Clip)
27.6
27.6
38.6
2-10d Smooth or Screw
Shank Nails Eave Clip)
38.1
38.1
41.8
2-10d Ring Shank Nails' 33.1 48.1 F 50.9
1. Installation with a 4" the headlap and fasterners are located a min. of 2'/z' from head of tile.
Table 5: Attachment Resistance Expressed as a Moment Mf (ft-Ibf)
for Two Patty Adhesive Set Systems
Tile
Profile
Tile Application
Minimum Attachment
Resistance
Bella "High S" Tile
Adhesive
29.32
11 See manufactures component approval for installation requirements.
12 Flexible Products Company TileBond Average weight per patty 10.7 grams.
3W 2-Component Foam Roof Tile Adhesive AH-160 Average weight per patty 8 grams.
Table 6: Attachment Resistance Expressed as a Moment - Mf (ft-Ibf)
for Single Patty Adhesive Set Systems
Tile
Profile
Tile Application
Minimum Attachment
Resistance
Bella "High S" Tile
3MT" 2-Component Foam Roof Tile Adhesive AH-160
66.53
3M' 2-Component Foam Roof Tile Adhesive AH-160
38.74
3 Large patty placement of 63grams of 3M" 2-Component Foam Roof Tile Adhesive AH-160.
4 Medium patty placement of 24 rams of 3M'" 2-Component Foam Roof Tile Adhesive AH-160.
Table 7: Attachment Resistance Expressed as a Moment - Mf (ft-Ibf)
for Mortar Set Systems
Tile Profile
Tile Application
Attachment Resistance
Bella "High S" Tile
Mortar Sets
24.5
5 Tile-Tite Roof Tile Mortar.
NOA No.: 16-0112.06
Expiration Date: 07/13/21
Approval Date: 02/25/16
Page 4 of 5
5. LABELING
5.1 All tiles shall bear the imprint or identifiable marking of the manufacturer's name or logo as seen in detail
below, or following statement: "Miami -Dade County Product Control Approved".
OR
�l �J
ENTEGRA SALES BELLA "HIGH S" CONCRETE TILE LABEL
(LOCATED UNDERNEATH TILE)
BUILDING PERMIT REQUIREMENTS:
As required by the Building Official or the applicable Building Code in order to properly evaluate the
installation of this system. This Notice of Acceptance on its own cannot be used to obtain a building permit.
PROFILE DRAWING
END OF THIS ACCEPTANCE
NOA No.: 16-0112.06
MIAMI•DADE COUNTY Expiration Date: 07/13/21
Approval Date: 02/25/16
Page 5 of 5
r.wAC62 Engineering Inc.
Testing & Engineering Service
Certificate of Authorization # 8131
Tel: 954.245.8976; Fax: 954.301.7776
5230 NE 18 Avenue, Fort Lauderdale, FI 33334
Roof Tile Uplift Test Report
Attention: Miami Shores Village, Building Department
10050 NE 2nd Ave, Miami Shores, FL 33138
Client: Quality Plus Construction
Test Date: 02/26/2020
Permit # RF-08-19-2023
Property Address: 154 NE 97t" Street, Miami Shores, FI
Roof Pitch: Type of Tile: Roof Area:
3 in 12 Entegra Roof Tile 18.93 squares
Tile Attachment Method: Two Component Polyurethane Foam Adhesive -Poly Pro AH 160
Field Instrument : IMADA Force Gauge 0-100 Serial number: 243454
Test Location
Total Number of Tests
Field Uplift Pull Test
Test results
Perimeter Area: 8.93(Ti-T9)
9
As per FBC 2017
Passed
Field Area: 10.00(T10-T19)
10
As per FBC 2017
Passed
No. of Corner: 10.00(T20-T29)
10
As per FBC 2017
Passed
Ridge Areas: 96 pcs. (T30-T39)
10
As per FBC 2017
Passed
Important:
These laboratory results can change due to future weather impacts and/or unavoidable roof
traffic. Therefore, this report represents the TAS 106 results at the time of the test.
Please see attached a Roof Sketch for this project.
Cordially,
AC132 Engineering Inc. (NOA 09-1005.01)
n orno Acevedo, PE
Fla. Reg. No: 36466
ACB2 Engineering Inc.
Engineering and Laboratory Services
5230 NE 18" Avenue
Fort Lauderdale, Florida 33334
Phone: (954) 245-8976 Fax: (954) 301-7776
-'1