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RF-19-2843Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 P 9 raltki• Issue Date: 01/09/2020 Location Address Parcel Number 353 NE 91ST ST, Miami Shores, FL 33138 1132060136520 Contacts Permit NO.: RF-1 1 -19-2843 Permit Type: Roof Work Classification: Flat Permit Status: Approved Expiration: 07/07/2020 MEHRDAD FARID Owner ALPERO GENERAL CONTRACTOR Contractor 726 92 11L ALFREDO PEREZ 8900 SW 126 TER, MIAMI, FL 33176 Business: 7863577414 LETIMANRI@YAHOO.COM Description: RE ROOF FLAT Valuation: $ 4,500.00 Inspection Requests: TotalSq Feet: 550.00 _j Fees Amount Application Fee - Other $50.00 CCF $3.00 DBPR Fee $3.75 DCA Fee $2.50 Education Surcharge $1.00 Roofing Fee $200.00 Scanning Fee $9.00 Technology Fee $6.25 Total: $275.50 Payments Date Paid Amt Paid Total Fees $275.50 Check # 120 01/09/2020 $225.50 Cash 11/27/2019 $50.00 Amount Due: $0.00 Building Department Copy In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. ct Authorize Signature: Owner / Applicant / Contractor / Agent //i,� Date of— Na x O January 09, 2020 �// Page 2 of 2 ENTERED c2- k?)`kj v&I'll 121 ,v BUILDING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING ❑ ELECTRIC ZOOFING ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS 2 �. JOB ADDRESS: r7 ) � 'G NOV 2 7 2019 BY: Lt�k FBC 20' 1 : Master Permit NoRE 11' 19 - 2 43 Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Miami Shores County: Miami Dade Zip: 33 l 3 S Folio/Parcel#: " �2 0%"� ©�� 5� Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type:.00F Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): �— A lam` ('J Phone#: S 2 4 O 1 �� Address: -$ r7 3 N S ( S� City: HI A-K % State: zip: Tenant/Lessee Name: Email Phone#: CONTRACTOR: Company Name: 1 "JV k Phone#: 146 3s-7 4 ql Address: i _!d Q City: State: Zip: 3 3 I Qualifier Name: #4 Il�r_p W — 0 Phone#: CNO 0 /OD State Certification or Registration #: (1 d" DESIGNER: Architect/Engineer: Certificate of Competency #: hone#: Address: City: State: Zi Value of Work for this Permit: $ Square/Linear Footage of Work: J� Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 1) % F Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee.$ Radon Fee $ DBPR $ Notary $ Technology Fee $_ Structural Reviews $ (Revised02/24/2014) Training/Education Fee $ Double Fee $ Bond $ S-Ob ' TOTAL FEE NOW DUE $ 22 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. /1') , _ n Signature / OWNER or AGE . T The foregoing instrument �was acknowledged before me this day of ► �/ V 20 I , by d Avt who is personally known to me or who s prod identifica ion d w N TARY UBLI Sign: Print: vt�l V1 as did tal an oath. �\\ will1wl//// �Y PRIFPN11Vii Z • � ��GH2S,?o��A��.• *: 6�.• =* "( rXtr(ufment 'CONTRACTOR The fore ing /w1as acknowledged before me this day of 0V . 20J by kFrIO& V= o is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Z OGG 267Ma : �•��a_ a _ _, ,A- ADZ Print: Seal:U j/9'P/ ''�blic undo ��\�$ Seal UO� �Gr � o. M ///ZZNIC �fl1 1 XT j ,\\\\\ ° G � c ' Z. t` . qa Wi9 �" egthruAa, �C :*: rr**::********ss***:*s****** ::::****s*******s***r**********r*s***:rs•*****s*s***k*#fat***:sssaisss*sss APPROVED BY Plans Examiner Zoning / Structural Review Clerk I (Revised02/24/2014) PropcoN Search Application - Miami-111& C'uuntN hops: Al)l)s'I'A'I)i-ol)crt\sral'rh it report (Its .. 1 r -1 ►}� i 'tom U Detailed Report Property Information Folio: 11-3206-013-6520 353 NE 91 ST Property Address: Miami Shores, FL 33138-3129 MEHRDAD MAC FARID Owner NASRIN TALEB HAGHIGHAT 353 NF 91 S1 Mailing Address BOCA RATON, FI.- 33487 USA PA Primary Zone 1000 SGL FAMILY - 2101-2300 SQ 0101 RESIDENTIAL - SINGLE Primary Land Use FAMILY. 1 UNIT Beds I Baths / Half 3/3/0 Floors 2 Living Units 1 Actual Area Sq Ft Living Area Sq Ft Adjusted Area 3.410 Sq Ft Lot Size 16,000 Sq Ft Year Built 1928 Assessment Information Year 2019 2018 2017 Land Value $479,679 $479.679 $479,679 Building Value $505,709 $462.680 $261,070 XF Value $15.660 $15,660 $15,660 Market Value $1,001,048 $958.019 $756409 Assessed Value $1,001.048 $958 019 $565,832 Benefits Information Benefit Type 2019 2018 2017 Save Our Homes Cap Assessment Reduction $190,577 Homestead Exemption $25,000 Second Homestead Exemption $25,000 Note Not all benefits are applicable to all Taxable Values (i e County School Board City Regional) Generated On 11/26/ Taxable Value Information 2019 2.018 % County Exemption Value $0 $0 $50 Taxable Value $1 001 048 $958,019 $51 School Board Exemption Value $0 $0 $ 25 Taxable Value $1,001,048 $958,019 $540 City Exemption Value $0 $0 $50 Taxable Value $1,001,048 $958.019 $515 Regional Exemption Value $0 $0 $50 Taxable Value $1,001,048 $958,019 $515 The Office of the Property Appraiser is continually editing and updating the tax roll This website n•,ay not reflect the most current information on record The Property Appraiser s Miamr. Dade County assumes no liability, see full disclaimer and User Agreement at http //www miamidade gov/info/disclaimer asp Version. PropertN Scarch Application - Miami -Dade C'uunt\ Imp": Apps'PAihropertysem-ch ;i report do A P P R 4 A �i S E' F F C EV I _� `Y 4 � I } Generated On 11/26, Property Information Folio: 11-3206-013-6520 Property Address: 353 NE 91 ST Roll Year 2019 Land, Building and Extra -Feature Details Land Information Land Use Muni Zone PA Zone Unit Type Units Calc V GENERAL R-17 5, R-18 5 1000 Front Ft. 12500 $479 Building Information Building Number Sub Area Year Built Actual Sq Ft. Living Sq Ft Adl Sq Ft Calc V 1 1 1928 2,732 $441 2 1 1928 678 $64 Extra Features Description Year Built Units Ca,c V Pool 6' res AVG 3-8' dpth. plain feat 250-649 sf 1955 1 $15 Wall - CBS unreinforced 1928 300 5 The Office of the Property Appraiser is continually editing and updating the tax roll This website may not reflect the most current information Miami -Dade County assumes no liability. see full disclaimer and User Agreement at http //www miamidade.gov/info/disclaimer asp on record The Property Appraiser C Version ACC)RV CERTIFICATE OF LIABILITY INSURANCE DATDIYYYY) 11/22/22212019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER TACT ALL CITY INSURANCE INC. NAME: INGRID HERRERA 1400 NW 107th AVE PHONE . (305)463-9431 FAC N, ;(305)436-6797 SUITE 210 ADOREE-MAIL GM_AIL ALLCITYINS.COM DORAL FL 33172- INSURERS) A FORDING COVERAGE NAIC II _ INSURER A :EVANSTON INSURANCE COMPAN 35378 INSURED INSURER B ;INFINITY AUTO INSURANCE 11738 ALPERO GENERAL CONTRACTOR, INC. INSURER C: 8900 SW 126 TERR INSURER D : MIAMI FL 33176- r`nL/FRAr:FS r'FRTIFICATF NIIMRFR• REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE 'ADDL' SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS A GENERAL LIABILITY 3AA370287 11/18/201911/18/2020 1 EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED S 1 OO,000 x COMMERCIAL GENERAL LIABILITY MED EXP (Any one person, S 5,000 CLAIMS -MADE I -- OCCUR PERSONAL BADV INJURY $ 1,000,000 L_ GENERAL AGGREGATE S 2,000,000 GE T AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S 2,000,000 X POLICY PRO- LOC S B AUTOMOBILE LIABILITY 509820036138001-2 10/18/2019 110/18/2020 Ea accident) INGLE LIMIT S 1,000,000 X ANY AUTO I BODILY INJURY (Per person) S BODILY INJURY (Per accident) S ~— ALL OWNED SCHEDULED x I AUTOS AUTOS PROPERTY DAMAGE S NON -OWNED HIREDAUTOS AUTOS S A UMBRELLA LIAB is OCCUR 'I 11/18/2019 11/18/2020 EACH OCCURRENCE S 1,000,000 LAGGREGATE S $ 1,002,000 is EXCESS LIAB CLAIMS -MADE �EZXS3016670 I DE RETENTION I WORKERS COMPENSATION I WC STATU- OTH- AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT S OFFICER.!MEMBER EXCLUDED? N / A ❑ (Mandatory In NH) E.L. D:SEASE - EA EMPLOYEE S If yes, unFdeOrP ESCRIPTIONeE RATIONS below E.L. DISEASE - POLICY LIMIT S i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ALFREDO PEREZ ROJAS CGC1510221 CCC132818 IS COVERED UNDER THIS INSURANCE POLICY. MEGL 0009-01 0918 Blanket Additional Insured CG 20 01 0413 Primary And Noncontributory - Other Insurance Condition MEGL 0241-01 0516 Blanket Waiver of Transfer of Rights Against Others To Us MEGL 0313 0217 Construction Project(s) - General Aggregate Limit GtK I IFIL:A I t HULUtK L ANGtLLA I IUN M1 VVVVVV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES VILLAGE ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVENUE MIAMI SHORES FL 33138- AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD M 1 1 I Florida Building Code (nth E dition (201.7) • High -Velocity Hurricane Zone Uniform Permit Application Form Section A General Information Master Permit No. ^ _ Process Contractor's Name Job Address ROOF CATEGORY •""' U'Low Slope ❑ Mechanically Fastened Tile ❑ Mortar/A:dfljslve SQt TV;- ❑ Asphaltic ❑ Metal PaneUShingles ❑ Wood Shirtiglos/Shakos • Shingles 60 00 0.: ❑ Prescriptive BUR-RAS 150 Ai;T.trpre • Gas 1rnt•Sjacks; Ye!%U rlo ...... ROOF TYPE Type: Natoura4lAD LP 4XI_j . .. . . . Ckw Roof Ik Re -Roofing ❑ Recovoring C) Repair ❑ Maintenance ROOF SYSTEM INFORMATION Slope Roof Area (SF) Steep Sloped Roof Aroa (SF) Total (SF) --- _ Section B (Roof Plan) Sketch Roof Plan: Illustrate all levels and sectlons, roof drains, scuppers, overflow scuppers and overflow drains. Include dimensions of sections and levels, clearly Identify dimensions of elevated pressure zoneH and location of parapets. _ ..� I It�?1; i 1 Iif11 I ICI II I. � I 11 I L Al ti.. e� mm ano Rif v.. f A l ! 1. I• I I I I I I I '_ IIILIIIiI-- I L.1�1� I IIII. L I I ! I I � I III ...1.• . I . Florida Building Code 6th Edition (2017) High -Velocity Hurricane Zone Uniform Permit Application Form Section C (Low Slope Application) Fill in specific: roof assembly components and identify manufacturer (if a component is not used, identify as "NA") System Manufacturer: GAF Product Approval No.:18-0919.07 Design Wind Pressures, From RAS 128 or Calculations: P1: -42.8 p2: -71.7 P3: -108.0 Max. Design Pressure, from the specific product approval system: -52.5 _ Deck: Type: CDX PLYWOOD Gauged-hickness:_5/8 = 19/32" Slope: 1 ":12" Anchor/Base Sheet & No. of Ply(s). _ N/A Anchor/Base Sheet Fastener/Bonding Material: N/A Insulation Base Layer Base Insulation Size: and Thickness: N/A N/A Base Insulation Fastener/Bonding Material: N/A Top Insulation Layer: N/A Top Insulation Size and Thickness: N/A Top Insulation Fastener/Bonding Material: NIA Base Sheet(s) & No. of Ply(s): 1-Base Sheet #75 Base Sheet Fastener/Bonding Material: 1-1/4" R/S NAILS & 1-5/8 TIN CAPS Ply Sheet(s) & No. of Ply(s): Plies Ply IV Fiberglass Ply Sheet Fastener/Bonding Material: STEEP ASPHALT TYPE IV Top Ply: MINERAL SURFACE CAP SHEET 123 01-48 4119 PAGE 3 Top Ply Fastener/Bonding Material: STEEP ASPHALT TYPE IV Surfacing: N/A Fastener Spacing for Anchor/Base Sheet Attachment: Field: 6 " oc @ Lap, # Rows 2 @ 6 " oc Perimeter: 6 " oc @ Lap, # Rows 4 @ 6 " oc Corner. 6 " or, @ Lap, # Rows 4 @ 6_" oc Number of Fasteners Per Insulation Board: Field N/A Perimeter N/A Corner N/A Illustrate Components Noted and Details as Applicable: Woodblocking, Gutter, Edge Termination, Stripping, Flashing, Continuous Cleat, Cant Strip, Base Flashing, Counterflashing. Coping, Etc. Indicate: Mean Roof Height, Parapet Height, Height of Base Flashing, Component Material, Material Thickness, Fastener Type, Fastener Spacing or Submit Manufacturers Details that Cot riply with RAS 111 and Chapter 16. oN V G` __._�T-•_._.__.i....__18" in. Parapet Height i 12' _._ j!---...... Mean Roof Height Vq N ,T • ` 17 " • • w • Y • • • • . In • • • • • • 0 0 0 • Florida Building Code 6th Edition (2017) �i High -Velocity Hurricane tone Uniform Permit Applicatiowoorm Section C (Low Siooed Roof -System) FM In 80eclft Roa�fWwrnblY Components and'W" Mar unr (If a Component Is not wed. klw* as •NAI SYSIOM G A F WM No.• I S -- o 9 (R V o Design wind Pressures From PM 128 or Calculsdw : Prnexic 42• Prnenc2�• p+r :i• • O(� MwL Design Prsg ors. Fran 1frp;S F _ NOA G System: Dsdr: l •yunod Typs: GsuBObidoross:- S �- An&,odSase Sheet & Na of Piy(s): Andw filase Sheet Fadww/Bonding Mane): Sese Insidedon Size and Thidmew Base Insulation Faatensr/BondbV Material: Top hwdatison Layer. Top Insulation Size and Thk uww Top Insfindon Fastener/Bonding Material: Base Sheets) & No. of Ply($). S S Fasbner 8pecMq for AnchorlBass Sheri Fiekt . b _ oc a Lap. # Roars 2- OP _ oC ParkneW.. - oc a Lap, d Rows . ' oc Comer: _�. - oc a Lap. 8 Rows - oc Ply Shest(s).8 No. of Ply(s)• Plyradirtg Matadi: Toppy: / ��»Pig/ C�-P Top Ply Fssbener/ Bondrp.Material: Surfacing; 6ranc. /a�B Numbs• of Fasbners Per Insulation Board . Field Perimeter per •. Ilhtsh aio Components li;w and • •••• Details as Applicable: ' • • • •' ' • • • • Woodblocidng, Gutter Edga • • Tenn*,#ion, Shipping, Flashing, Coethawus • Cleat. • �;t. Strip, Base Flashing, Couder, Rmh�ng, • Mean Roof Heli Parapet yei8h�,• �r Height of Base Flashing, Comp•onent M".1. Material Thidmess, Fastener Type, Rapp Li Spacing or Submit Deteils thattilt . Comply var" 111 and Chapter 18. ,A. Pa � IL'MAetl t" v+t rwa&at �O a *00 - M Florida Building Code 6th Edition (2017) High -Velocity Hurricane lone Uniform Permit Application Form Section Q Low SlopQd Roof stem Fill In Sptwtfic Roof Assembly Components Fastener Spacing for Anchor/Base Sheet and Identify Manufacturer Attachment (if a componont Is not used, identity as'NA� / � r�Fleld:..tr:. _' w �J �P, # Rovre ,� ._ @ .�.••-� 0° . . sysiom Marndar�uror:l��f �..!_ 1«T�I (l� l �'C1il . • • • • • I� h �j ) f'orimatar. ,�.;,,�' or. _, l.a p Rows � � • • • • • � • Comor. .. _ oo (ci) l.ap, N Rrnvo .... �• • •°$ • • • • • • • t)asign Wlnd Pressures, From RAS 129 of Cairuialions: • Number of Fasteners Per Insuralreff' ••.••. > Pmax2:...:_1.�:.. Board • • • - Max, cosign Posr+uroy From lhn Spoclflc NQA Carrfbf • • _.• •.... . • • • • • • • • • Field ....._..�. Panmator ..._....... r..• a 00 lanck: �1 Illustrate Components Noted aqd... Type...-._�._` ....��.. '.(%. ......_._ Details as Applicable; . . . . ....:. I I Woodblocking, Gutter, Edyo Tprminption, ; • • • • GaugolThickness: _ )..% ..._.._ ..--.... -• ••-•• Stripping, Flashing, Gontinuous G1fl�t! Gant • • • • • • Strip, Qasn Flashing, Counter- Flaaing, : . • • • • Slupo.,4... �__ ....__.. _ _......_ ................. ... ... _ Coping, Etc. tiRoof tgoogAl Anc.horlHnto51nnt R No. n1 l'ly(%):._ olyht of ones {lashl , cmponunt MHeight, Typo, Fuatonor An.hgrl�ase Shoot Fastonort6andin fy)ulWini: Material Thickness, Faatanef TYP t l I '��' .!`_ �.�L.�`_� 1_._._��-T!}__I._ )f-_.!.,t10 . :P• Spacing or Submit Manufacturers Details that I R t T l Camply with RAF) 111 and Chapter 16- r -•--- � (� -c i . Insulation BnStl fiese Insuletlon Size and Thickness:_.-.__.....-.�-. Base insulation Fnstonor/Honding Matoriul Top Insulation ►.aynr ., ._ .� ..�-- Parapet [Zao ( 1 Top Insutatlnn Size and ThlcJcnosg:. _................._ . --. - Holnhi Tv !;, m �1 i., Top Insulation F°ast+murlHonding Matorfal: r T Be.. Shoot(s) & No. of f'ly(n):..,._..._._.._......._..._....__...... ____ _�- •' .— _ FT, Qasa Shoat Fastonudlianding Matoriei: Moan Roof _._ �'_ 1 �� f�"7 >�!►�f I .—�. _. fi �� Height 8 No•ofPl Ply Shaet(s). Y(Si � -•--�-"• {y Shoot Fastonarl on i g M to ' I: T op F I i �\ t N S'.l:la�—.....�•-ii'1-.-._ .?.�-..� l..l0, _...._ y.iJF�.F......-....... � T t to C- ��y,¢,�� No� , � � f oppP"�5—Tie o w, 0 0s ,a In .� r fi +- z lo MIAMH DE' DEPANTMF:NT OF REC71i1,ATt)RY AND VCONOMIC RESCIUM FS (REIR) BOAR1) AND C)1)E ADN9INIS FRAT1ON1)1VIS10N NOTICE OF ACCEPTAN(_E,NOA) _ --- _-_- GAF' I Campus Drive Parsippany, NJ 07054 MIAMI-DARE COUN"fY PRODUCT C ON"ruoi svc rjw, 11805 SW 26 SUcct. Room 208 Mruni. I lori(h 3317S-2474 'I (796)315-25oo F (786)31525-99 wwvv.miamidadc.euv/ecunom) .••••• SCOPE: •••••• This NUA is being issued under the applicahle rules and ret!,ulations governing the use o W1*1St ruction • materials. The documentation submitted has been reviewed and accepted by Miami-Dmi:_,,,flinty jiF*R•-•- Product Control Section to he used in Miami Dadc County and other areas where allowt d V.the AvYlloritw Having Jurisdiction (AI IJ). ••�••� �•� This NOA shall not be valid after the expiration date stated below. The Miami -Dade (;ounty:Produ-ct Control Section (In Miami Dade County) and/or the AFIJ (in areas other than Miami I;ad q.Fpunty)• reserve the right to have this product or material tested for quality assurance purposes. P'*1)rodt� tort•• material fails to perform in the accepted manner, the n-iantrfacturcr will incur the expense of such tesZ111'f;• and the Al 1.1 moy immediately revoke, nrodily, or suspend the use of Stich prodtict or material within their jurisdiction. M-'R reserves the righl to revoke this acccptancc, if it is determined by Mianli-Dade County Product Control Section that this product or material fails to ntect the rcquircnlcnts 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: t:ach 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 marnrfacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales, advcrtisiilf, or any otlrcr purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be calls(, for tcrimimtion and removal of NOA. ADVERTISEMENT: The NOA numhcr preceded by the words Miarni-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 riser by the manufacturer or its distributors and shall be available for inspection at the joh site at the request of'the Mlildinp, Official. This NOA renews and revises NOA No. H.-1010.0land consists of'pages I through 27. The submitted documentation was reviewed by Jorge I,. Acebo. MIAMI-DADE COUNTY .... NOA No.: 18-0919.07 Expiration Date: 11/04/23 Approval Date: 11/08/18 Page I of 27 Membrane Type: BUR neck Typc 1 I: Wood, Non insulated Deck Description: Mir) 1 5/32" thick or greater plywood or wood plank secured 6 in. o.c. at panel end and intern]ediate, stlj)j)orls with 8d ring shank nails to supports spaced 24 in o.c. at nlax. Systern 'I'vpe E(3): Anchor sheet 111-harlically attached to roof deck. • • All General and System Limitations shall apply. : •`. ` "":' Fire harrier: TOPCOAT FircOtt[ "' Fire Barrier Coating, VersaShield' FIre1<QIiIStant Slip Sheet of (optional) VersaShieldQO Solo"' Fire -Resistant Slip Sheet installed per nlafluracttlre.r's I stallatiotl �••••� Instrilctions. • • • • • Anchor sheet: •• •• •• ••••• (iAFGI_AS"-''t/75 li:l,,e Sheet, Fri-Ply'k 1175 Base Sheet, Ruhei1;; ;; SmodRl'cy ; ""'` (;AI-GL,AS'I Slr,ll,l\,crltR' Venting Nailable Base Sheet is secuttd'aS described OM)w Fastening; M',"Ili-Dade County Approved nlin. 12 ga. annular ring shank nailsiolnd nlwl. I-S/8 in. ....:. )ptioll NI: •••••• dialnetcr tin caps :Ire spaced 8 in, o.c. in the min. 4 in. wide anchoiesheet side laps and 8e••••0 In. o.c. in the field of the sheet in two staggered rows. •• • • •• • - , - (Maximum lksit n Pressure: —45 psj See General Limitation #7) 'Utill'rllll ;! Optloll b.! Mlanll-Dade C011lll\' ;�i)I)I' - fill. I .'. ;;2L �.Ifl ll ll III! Shilllk rlall5 find Illlll. I-'? dlallleter till Caps ale ';I)al, (i"�(I'll' Illl I ,t I 1\I(l' anchol• sheet side dpti arld 0 l _...._._._ Ill U.0 In the field Ol, 11Ir ti III 11 o :,1;I 4', C'I'v r.1 I'll\1',\. (Maxi mu1n 1)C.1JhJ7 Ness -e: —52.5 p,Pf See General L.imitalion #7) Fastening Drill-Tec`"' # 14 Fauenel:s and Drill -Tec"' 3 in. Standard Steel Plates, Drlll-Tec'"' Option 43: Accu Frac"" Flat Plates or Drill-Tec" 3 in. Ribbed Galvalume Plate (Flat) are spaced 16 ino c, in the Irvin 4 in. wide anchor sheet side laps and 16 in. ox. in the field of the she'cl ill two atagl;cred rows. (Maximum lk.si,;;n Pressure: 52.5 pvf See General Limitation #7) Fastening Drill• I-ec", 1114 F:I Il`It.'r5'ind Drill-Tec"' 3 in. Standard Steel Plates, Drill-Tec'" Option H4: Accu'(rac'Flat P1,Ites or Drill-Tec " 3 in. Ribbed Galvalume Plate (Flat) are spaced 12 in. o.c. in the min I in. wide anchor sheet side laps and 12 in. o.c. in the field of the sheet in two staggered rows. (Me,Lvimum Desi n Pressure: —60 psf See General Limitation #7) Fastening DI'lll-Tec" 814 F;r,wne°r.s and Drill-Tec " 3 in. Standard Steel Plates, Drill -'FLU Option #F: AccuTrac` I'lat 111oit,-, or Drill-Tec", 3 in. Ribbed Galvalunle Plate (flat) are spaced 8 ill. o) c 111 the Illlll 4 III. veldt: aildlor sheet side laps and 8 in. ox. in the field of the sheet Ill three staggered ruvv,. (Maximum Design Pres:vure: --97.5 psf. See General Limitation #7) Shet•r n optional cap sheet Is I)rlsrnl: - f Two or n)orl plic,, ol'GAFGI.ASx PI) •I '1 ri-Ply° Ply 4, GAFCILAS"' Flex Ply 6 adhered in a full nloppinp 11l hot a>phalt applied at 20-40 lbs./sq. installed per manufacttu-er's inslAlation instru( 60111, When optional Cap .sheet is not present, Three or more ph(-, of GAFG1,AS`` Ply 4, Tri-Ply"' Ply 4, GAFGLAS' Flex Ply 6 adhered in a Bill mopping of hot asphalt applied at 20-40 lbs./sq. installed per n)anufactorer•s In':lollation instructions. NOA No.: 18-0919.U7 CUAU, COUNTY Expiration Date: 11/04/23 .07 Approval Date: 11/08/18 Page 23 of 27 . IV' BUR Granule Cap Sheet o,CA—_' �,-' cotadhered mufull moppiognfho| ' asphalt applied at 20 — 40 lbs./sq. installed per manufacturer's installation instrucliol'is Hu,@doX: Optional ongrnnu|urSur|xcnlmembranes; required for smooth membranes. Chosen components njust be applied according to manufacturer's application inm,vohnxv. All coatings ,just »* listed within ucurrent NOA. |Grovc|ordngyapplied m40O|hx/xq.and ]OO|hy/xq. respectively ioaUou6l cn^jo( nvpmveuasphalt ut 60|bx./sq. ° 2 Topcoat' u4cmhmu*o To ��S ,�v Seal ° , Topcoat, u u cx S8opy|ioda/ |otoo \ ��|/;�°°�° 0K °°°°�° '0r Topo010' MHP/uoupp|i*dxtO.5mO.76jo|./oq.(mhcused o°°°°°�°e*k`U� �'�h! |upcoo[°K4nmhmnrapp|icdn(0.5NO.75 gal./sq. °°°°° l Fiber A|mmnmoRoof Coating, MuximumDesign °° °° °° °°°°�° Pressure: 8C,Fastening Above. °°°°°° ° ° NOmNu' 18-09/9.07 Expiration Date: 11m4/23 Approval Date: ||xN/|8 Page z*orz7 WOOD DECK SYSTEM LIMITATIONS: A 011; Sheet is required Willi GAFGI.ASQ'` fly 4 and (JAFGLAS`" Flex My" 6 when used as a mechanic;llly fastened ha„' o anchor sheel. fv11111nn,m 'A" DcilsDcck' Roof Board or %" 'I'ype X f;ypstlm board is acceptable to be installed directic over the \N ood deck GF.NFRM, 1AMITA'r1ONS:; I I'n, Classification is not parr of this acceptance; refer to a current Approved Roofin ' ••••� rilklws of this product. I l 6 Matrfiars I�irc�tory�or fire: .' In,nlJlion Ina\ he installed in multiple layers. The first layer shall be attached in com �••�•� � -P f�i,�iccawith Pre,illk( Conlrcl • ApI'rcr�'<d guidelines. All other layer's shall be adhered in a full mopping ofapproved asp644apphc4.\itI4n tllc • • I \ I rrin_Qe and at a r:rtc cil 20-40 Ih.e./sq., car mechanically rjltached using the. fusteninf F urw0of (li<:aoj)•lRyca ••••� 3 11 .uuufard panel sues ar ,rcecptuhle fnr nlr.chanicctl auachntc'nt• Whco applied in af�xkv(Pdasphaft!%njl sire ••'••' ,Ir.ill be �I' ,� d' ntaxmium. so 00 4 An urcrlay and/or recovery board insulation panel is required on all applications over c:&%P4ell foam ins;.Ilation.•••0.• Wllc it the base sheet is fully mopped. If no recovery board is used the base sheet shall A appl ed usir:�aatit. mopping with approved asphalt, 12" diameter circles, 24" o.c.; or strip mopped 8,, ribbcinsiri three ro\\s,0ojx' at �••••� each sidelap and one down the center of the sheet allowing a continuous area of'ventilation. Encirclfly gf,t1le sti ;> is not acceptable A 6" break shall be placed ev70 ery 12' in each ribbon to allow cross ventilation. Asphalt appl cmion ol•eilher r;ystent shall be al a minimum vale ol' 12. It's Aq Note: Spot attached systems ,hall be linr,ted to It maximum design pressure of-45) psf'. I ;i,r,uc r spacing for instllaliori attachmenl is based tin a Minimum Characteristic I'orce (F') value of' 7-; Ihf, as 27� I ur comlarlMM C with 1 e,ting Application Slanctard 1 AS 105. Ville fastener value, as field-tested, are below 27ti Ib1 insulation attachment shall not be acceptable. 6 Faseller spacing for mechanical attachment of anchor/base sheet or membrane attachment is based on a mrnimuin fst>Icncr resistance value in conjunction with the maximum design value listed within a specific system. Should thct t;lslcner resistance be less than that required, m determined by the Building Official, a revised fastener sp;icing, Plc'imlcd. signed and sealed by a Florida Registered Professional I-:ngineer, Registered Architect, or Rcr istcrcd Rc1 Co.Isulllilt may he,uhinilted Said revised fastcncr.,pac;ink;shall uUlizc the withdrawal re,i,uurcr vah,c �� iinui fcslinr; Applic,Iti0n 5ta11daids I•Ati Ms and calculation.; in compliance with Rooling Application Jt.nnl,trd RAS 1 17 7 Pe, mete, and corner areas shall comply with the enhanced uplift pressure requirements of these areas. Fastencr denvlic, .,hall be increased for both insulation and base sheet as calculated in compliance with Rooting Application Slandard RAS 1 17. Calculations prepared, signed and sealed by a Florida registered Professional Engineer, Rew,tcred Architect, or Registered Roof Consultant (When this limitation is specifically referred within this 'VOA, General ►,itwitation #9 will not be applicable.) 8. AI'. ,tlriehineni and sirilig ol'perinieter nailers, metal profile, anti/or flashing termination designs shall conform to l6ol 1 ,. Application Standtud RAS I I I and applicable wind Ic,ad req,iireincnis, 9 1 h, ,n<i, munr de,ie,neel prc,surc 1lnniation listed ,hall he applicable• to all roof pressure zones (i.c. field pe rri tern. and corners). Neither rational analysis, nor estrapofation shall be permitted for enhanced Iastening at enh,utced pressure /one, (i.c perimeters, extended corners and corners). (When this limitation is specifically referred within this NOA, General Limitation #7 will not be applicable,) 10. All products listed herein shall have a quality assurance audit in accordance with the Florida Building lode and Rule: 61Ci20-3 of the Florida Administrative Code. FIND OF THIS ACCEPTANCE, MIAMI•DADECOUNTY NOA No.: 18-0919,07 ■I� r Expiration Date: 11/04/2.3 Approval Date: 1 I/08/18 Page 27 of 27 GAf, "rGr'U-R 1306 - lll, Product 5pcc IIItIY81Woductspcc.ul,com/documenI.php'?id= I,(I U,Il I Surfacing: — Gravel. 2. Deck:,C-15/32 Incline: 2 Barrier Board (Optional): -- One or more layers minimum 1/4-in. thick Georgia-Pacific Gypsum LLC "DensDeck@ Roofboard" or "DensDeck@ Prime Roofboard" or "DensDeck@ DuraGuardTm Roofboard" or minimum 1/4-in. thick United States Gypsum Co. "SECUROCKO Roof Board" (Type FRX-G) or "SECUROCKO Glass -Mat Roof Board" (Type SGMRX). Insulation: --- One or more layers perlite or wood fiber or glass fiber or polyisocyanu rate or urethane or perlite/polyisocyanurate composite or perlite/.urethane composite or wood fiber/polyisocyanurate composite or phenolic, a+� !kickness ••• •••••• p p •Y• • Ply Sheet: — Three or more plies Type G1 "GAFGLASO Ply 4" or "TTi-PIyO F244-or '. GAFGLAS@ Flex Ply 6" or "Tri-Ply@ Ultra -Flexible Ply 6", fully adhVrjT*[yvith hotroofing;••••; asphalt. ••••.. Cap Sheet: — Type G3 "GAFGLAS® Mineral Surfaced Cap Sheet" tV'Tri-PI?@ 13UR ••:••. Granule Cap Sheet" or "GAFGLASO EnergyCap"m Mineral-Surface.iKepp Sheet%,•�ully ;;;;;• adhered with hot roofing asphalt. •••••• •• 3. Deck: NC Incline: 2 . . . . ...... .... % Barrier Board (Optional): -- One or more layers minimum 1/4-in. thick Georgia-Pacific Gypsum LLC "DensDeck@) Roofboard" or "DensDeckO Prime Roofboard" or "DensDeck@ DuraGuard rm Roofboard" or minimum 1/4-in. thick United States Gypsum Co. "SECUROCKO Roof Board" (Type FRX-G) or "SECUROCKO Glass -Mat Roof Board" (Type SGMRX). Insulation (Optional): -- One or more layers perlite or wood fiber or glass fiber or polyisocyanu rate or urethane or perlite/polyisocyanurate composite or perlite/urethane composite or wood fiber/polyisocyanurate composite or phenolic, 2-in. maximum. Ply Sheet: — Two or more plies Type G1 "GAFGLASO Ply 4" or "Tri-Ply@ Ply 4" or "GAFGLASO Flex Ply 6" or "Tri-Ply® Ultra -Flexible Ply 6", fully adhered with hot roofing asphalt. Cap Sheet: — Type G3 "GAFGLASO Mineral Surfaced Cap Sheet" or "Tri-Ply@ BUR Granule Cap Sheet" or "GAFGLASO EnergyCapTM Mineral -Surfaced Cap Sheet", fully adhered with hot roofing asphalt. 4. Deck: C-15/32 Incline: 1 Slip Sheet (Optional): — Red rosin paper, nailed to deck. Insulation (Optional): — Any thickness perlite or wood fiber or glass fiber or polyisocyanurate mechanically fastened or adhered with OMG Inc. "OlyBond Fastening System" or any UL Classified insulation adhesive. Base Sheet: ---- One ply Type G2 "GAFGLASO #75 Base Sheet" or "Tri-Plye #75 Base Sheet" or "GAFGLASO #80 Ultimalm Base Sheet" or "GAFGLASO Stratavent0 Nailable Venting Base Sheet", mechanically fastened. Ply Sheet: — One or more plies Type G1 "GAFGI..ASO Ply 4" or "Tri-Ply@ Ply 4" or GAFGLAS@ Flex Ply 6" or "Tri-Ply@ Ultra -Flexible Ply 6", fully adhered with hot roofing asphalt. Unl`, TGFU.R 1306 - uL Product spec http://productspcc.ul.com/docurrient.php?id—'I'GI'U.iZ I > Cap Sheet: — Type G3 "GAFGLASO Mineral Surfaced Cap Sheet" or "Tri-Ply® BUR Granule Cap Sheet" or "GAFGLASO EnergyCapTM Mineral -Surfaced Cap Sheet", fully adhered with hot roofing asphalt. Coating (Optional): --- "United Coatings1m TOPCOAT® EnergyCoteTm Roof Coating" or TOPCOAT® MB Plus Coating" or "United Coatings TM Roof Mate MB Plus Coating" applied at a rate of 2-gal./100-ft.2. 5. Deck: NC Incline: 3 Base Sheet: — One ply Type G2 "GAFGLASO #75 Base Sheet" or "Tri-Plye #75 Base Sheet" or "GAFGLASO #80 Ultimalm Base Sheet" or "GAFGLASO Stratavemt0 Mailable Venting Base Sheet" or "GAFGLASO Stratavent0 Perforated VentingQase Sheet" or ••••;• "GAFGLASO Stratavent0 Nailable Venting Base Sheet" or "GAFGE,g§p Strgt&A-,nt0 '• Perforated Venting Base Sheet", mechanically fastened or fully adhated with hot roofir•••. asphalt. •1Q•••• Ply Sheet: — One or more plies Type G1 "GAFGLASO Ply 4" or "T'ri-'PI O F'I •d" or "GAFGLAS® Flex Ply 6" or "Tri-Ply® Ultra -Flexible Ply 6", fully adbarac with hct.Lfin,g..... asphalt. ..•... Cap Sheet: -- Type G3 "GAFGLASO Mineral Surfaced Cap Sheel" or "Tri-FZIy,&BUR Granule Cap Sheet" or "GAFGLAS® EnergyCap1m Mineral-SurfaCWd :ip Shea:, fully:••••; adhered with hot roofing asphalt. • safe 6. Deck: C-15/32 Incline: 2 Barrier Board (Optional): — One or more layers minimum 1/4-in, thick Georgia-Pacific Gypsum LLC "DensDeck® Roofboard" or "DensDeck® Prime Roofboard" or "DensDeck® DuraGuard rm Roofboard" or minimum 1/4-in. thick United States Gypsum Co. "SECUROCKO Roof Board" (Type FRX-G) or "SECUROCKO Glass -Mat Roof Board" (Type SGMRX). Insulation: — One or more layers perlite or glass fiber or polyisocyanurate or urethane; or perlite/polyisocyanurate composite or perlite/urethane composite or phenolic, 1-in. thick minimum (offset a minimum of 6-in. from plywood deck joints). Base Sheet: — One or more plies Type G1 "GAFGI-.AS® Ply 4" or "Tri-Ply® Ply 4" or "GAFGLASO Ply Flex 6" or "Tri-Ply® Ultra -Flexible Ply 6" or Type G2 "GAFGLAS® #75 Base Sheet" or "Tri-Ply@ #75 Base Sheet" or "GAFGLASO #80 UltimaTm Base Sheet" or Type G3 "GAFGLASO Mineral Surfaced Cap Sheet" or "Tri-Ply@ BUR Granule Cap Sheet", mechanically fastened or fully adhered with hot roofing asphalt. Membrane: — One or more plies "RUBEROIDO Torch Smooth" or "Tri-Ply® APP Smooth" or "RUBEROID® Torch Granule" or "RUBEROIDO Torch 180" or "Tri-Ply(R) APP Granule", torch applied or "RUBEROIDO Mop Smooth" or "RUBEROIDO Mop Smooth 1.5" or "RUBEROIDO Mop Plus Smooth" or "RUBEROIDO Mop Granule" or "Intec Flex PRF" or "Tri-Ply@ SBS Granule" fully adhered with hot roofing asphalt. Cap Sheet: — Type G3 "GAFGLASO Mineral Surfaced Cap Sheet" or "Tri-Ply® BUR Granule Cap Sheet" or "GAFGLAS® EnergyCapTM Mineral -Surfaced Cap Sheet", fully adhered with hot roofing asphalt. 7. Deck: C-15/32 Incline: 2 HIGH VELOCITY HURRICANE ZONES SREQUIIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS :...:e 1524A Scope. As it pertains to the section, it is the responsibility of roofing contractEr, t�'prrvvrde the owner with • • • •' • the required roofing permit, and to explain to the owner the content of the section. The•previeions o4 Section R44ti2 • • • govern the minimum requirements and standards of the industry for roofing system it icIlHtiens. Additiftally, the following items should be addressed as part of the agreement between the owner ant,!M•c. wtracto:*T.he'awner's initial in the designated space indicates that the item has been explained • • • • • • • • • • • ...... ... . ..... ione; 2• 'll Renailing wood decks: Mien replacing roofing, the existin •• --- ---_.^.__. g rc��f deck rnay.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. J_W_ ---Exposed Ceiling: Exposed, open bearn ceilings are where the underside of We roof dookin can be viewed from below 1'he owner may wish to maintain the architectural appearance, therefore q roofing nail penetration of fhe underside of the decking may not be acceptable This provides the option of maintaining the appearance. 6• _.__Overflow scuppers (wall outlets): It is required that rainwater flows off so that the roof is no 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 necessar to install overflow scuppers in accordance with the requirements of Sections R4402, 613 4 13 Owner/Agent's Signature pate ---- 1. - -��//%� Contra i e Date Property Address Permit Number Revised on 7/9/2009 1.f.),07/0112015, Miamishores village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 331,38 Tel: (305) 795.220d Fax: (305) 756,8fW OWNERS'S AFFIDAVIT OF EXEMPT16-N : •••.•• ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FORtRrSTINC SITE.. ;••••; BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES••• 0.:'. PERSUANT TO SECTION 553.844 F.S. •••••• ••• ••�••• To: Miami Shores Village Building Department • • •: • • • date: • _. ...... 10050 NE 2nd Ave . _ _ Miami Shores, FI 33138 00 ' 0 0 0090 Re: Owner's Name, AE- _ 91 /`�1 jy j(� . `F . �� Property Add ress:._'3.. 23- �L___ Roofing Permit Number:-__ Dear Building Official: certify that I am not required to retrofit the roof to wall connections of my building because: P-Tree jusf valuation for the structure for purpose of ad valorern taxation is less than $300,000.00, Please attach proof of ad valorem taxation. r-1 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 ;,FBC) Signature State of Florida County of Dade Print Name �,Y"PCB �_'4) JOCELYN OSORIO MY COMMISSION #GG0$666$ e a EXPIRES MAR 22, 2021 Bonded thr,,ngh 1st State Insurance 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 1 1PV *N JOCELYN OSORIO zo. B`n� MY COMMISSION #GGOB�' Notary Public, Sate of Florida at Large __ —�"�'.. EXPIRES' MAR 22, ?r Bonder/ through 1st State • When thn, lust valuation o1 the Structure for purpose of ad valorem taxation is equal to or more than 5300,Qoo oo, and If,(! building was o0l constructed with FBC or a 104' ' SFBC. Then you must provide a building nppliration from a General contractor !of Iht: Rot)[ lu thrall Connect'On Hurricane Mitigation Revised on 512112009 / 1 ® DATE (MM/DDIYYYY) AC" o CERTIFICATE OF LIABILITY INSURANCE 01 /01 /2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTNAMEACT Plymouth Insurance Agency Plymouth Insurance Agency PHONE 727-938-5567 FAX 727-938-5500 1AIC No Ext�_ (A/C No): 2739 U.S Highway 19 N. AIL ADDRESS: PIAP@plymouth.net Holiday FL 34691 INSURER(S) AFFORDING COVERAGE _NAIC_k 727-938-5500 _ INSURER A, Lion insurance Company 11075 INSURED I INSURER B Alpero General Contractor 8900 SW 126 Terrace Miami FI- 33176 INSURER C : INSURER D : INSURER E : INSURER F : rnv=DAnGc rrPRTIFIrATI= NIIIMRFR- REVISInN Nt1MBER- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POI.ICY 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. LICY EXP IN RI ADDLSUBR�TYPE OF INSURANCE INSR WVD POLICY NUMBER MM DPOLIDIYYYY MCY EFF MIDD/YYYY LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY AMA PREMISES Ea occurrence $ MED EXP (Any one person) $ _ CLAIMS -MADE L] OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGO GEN'L AGGREGATE LIMIT APPLIES PER: $ POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ _ ANY AUTO BODILY INJURY (Per person) $ S ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE JPer accident — $ S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ I— EXCESS LIAB CLAIMS -MADE DIEDRETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑NIA (Mandatory in NH) WC71950 01/01/2020 01/01/2021 �/ WC STATU- OTH- X TQRY—LI . T E3 _ E.L. EACH ACCIDENT ------- E.L. DISEASE - EA EMPLOYEE $ 1, 000.000 --- S 1�� E.L.. DISEASE - POLICY LIMIT If yes describe under DESCRIPTION OF OPERATIONS below $ 1,000.000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CCC1328188 r-amf_F[ 1 a IIf Im SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department 10050 NE 2 Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores FL 33138 AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) V 1ttlou_zV I A%. UMU VVMr-UMA I IV14. All llyl na IC,UI VVU. The ACORD name and logo are registered marks of ACORD