RF-19-97Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit No.: RF-01-19-97
Permit Type: Roof
Work Classification: Tile
Permit Status, Approved
Issue Date:01/15/2019 Expiration: 07/15/2019
Location Address Parcel Number
74 NE 97TH ST, Miami Shores, FL 33138 1132060130750
Contacts
JOLYON & BERNICE MORRIS Owner GROUP II INC Contractor
74 NE 97 ST, MIAMI SHORES, FL 33138 CARLOS VALDERRAMA
6465 SW 8 ST, MIAMI, 33144
Mobile: 7862518190
Home: 7866215576
Description: RE ROOF TILE Valuation: $ 13,000.00 Inspection Requests:
TotalSq Feet: 2,550.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$7.80
DBPR Fee
$4.50
DCA Fee
$3.00
Education Surcharge
$2.60
Roofing Fee
$250.00
Scanning Fee
$9.00
Technology Fee
$7.50
Total:
$334.40
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$334.40
Credit Card
01/15/2019 $334.40
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, 1 authorize the above named contractoE_U2,do the work stated.
Authorized Signature: Owner
/ Applicant / Contractor
Date
January 15, 2019 Page 2 of 2
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax. (305) 156-8-71
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑N ROOFING
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
JOB ADDRESS: 74 NE 97 St
RECEIVED
JAN 15 f201"9
��I
FBC 20 R-
Master Permit Nou. T- � 9 — 01
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade zip: 33138
Folio/Parcel#: 11 -3206-013-0750 Is the Building Historically Designated: Yes NO X
Occupancy Type: SF Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): JOlyon W Morris Phone#: 305-775-7686
Address: 74 NE 97 St
City: Miami Shores State: FL Zip: 33138
Tenant/Lessee Name: n/a Phone#:
Email:
CONTRACTOR: Company Name: Group II, Inc Phone#: 786-621-5576
nr��rPcc 6465 SW 8 St
City: Miami State: FL zip: 33144
Qualifier Name: Carlos A Valderrama Phone#: 786-621-5576
State Certification or Registration #: CCCO57129 Certificate of Competency #: n/a
DESIGNER: Architect/Engineer: n/a Phone#:
Value of Work for this Permit:
Type of Work: ❑ Addition
Description of Work: Reroof
City: State: Zip::
Square/Linear Footage of Work: zs—M N
❑ Alteration ❑ New 0 Repair/Replace ❑ Demolition
Specify color of color thru the:
Submittal Fee $
Scanning Fee $
Permit Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE S
Bonding Company's Name (if applicable)
Bonding Company's Address
City
n/a
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
unknown
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. 1 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 andf reinspection fee will be charged.
Signature �/l -' Signature
( pp NE*D ENT COT CTOR
The foregoing instrument was acknowledged before me this
1Oth day of January
Jolyon W Morris
me or who has produced n/a
20 19 , by
who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
as
The foregoing instrument was acknowledged before me this
1 Oth day of January
Carlos A Valderrama
me or who has produced n/a
20 19 , by
who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
Print: Day a Aar D° IJ IU Print: day aQffAW FIN LA PU
Seal: hPkW 3 iQ= Seal: 4&�*
6 kftK 3�lmt2
BWM ftu Anal Mt>V� Boa" #=Atoll IIIO "
as
ssssss*sssss*sssss*ss*sssssrs* sssss.ssssssrssssssss*ssssss*s*ssssssssss*sssss*sss*ss*s*s*sssss*sss*ssssssss
APPROVED BY �S t Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
1/15/2019 Property Search Application - Miami -Dade County
OFFICE THE PRO
Summary Report
Property Information
Folio:
11-3206-013-0750
Property Address:
74 NE 97 ST
Miami Shores, FL 33138-2331
Owner
JOLYON W MORRIS
BERNICE F MORRIS
Mailing Address
74 NE 97 ST
MIAMI SHORES, FL 33138 USA
PA Primary Zone
1100 SGL FAMILY - 2301-2500 SQ
Primary Land Use
0101 RESIDENTIAL - SINGLE
FAMILY: 1 UNIT
Beds / Baths / Half
3/3/0
Floors
2
Living Units
1
Actual Area
Sq.Ft
Living Area
Sq.Ft
Adjusted Area
2,700 Sq.Ft
Lot Size
8,625 Sq.Ft
Year Built
1939
Assessment Information
Year
2018
2017
2016
Land Value
$215,711
$215,711
$215,711
Building Value
$220,794
$220,984
$221,175
XF Value
$2,132
$2,150
$2,168
Market Value
$438,637
$438,845
$439,054
Assessed Value
$438,637
$438,8451
$439,054
Benefits Information
Benefit
Type
2018
2017
2016
Homestead
Exemption
$25,000
$25,000
$25,000
Second Homestead
Exemption
1 $25,000
$25,000
$25,000
Note: Not all benefits are applicable to all Taxable Values (i.e. County, School
Board, City, Regional).
(Short Legal Description I
MIAMI SHORES SEC 1 AMD PB 10-70
LOT 3 & W1/2 LOT 2 BLK 6
LOT SIZE 75.000 X 115
OR 19035-3770 03 2000 1
COC 24361-4246 03 2006 1
Generated On : 1/15/2019
2017 Aerial Photography 200ft
Taxable Value Information
2018
2017
2016
County
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
1 $388,637
$388,845
$389,054
School Board
Exemption Value
1 $25,000
$25,000
$25,000
Taxable Value
$413,637
$413,845
$414,054
City
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
1 $388,637
$388,845
$389,054
Regional
Exemption Value
1 $50,000
$50,000
$50,000
Taxable Value
1 $388,637
$388,845
$389,054
Sales Information
Previous
OR Book-
Price
Qualification Description
Sale
Page
07/23/2015
$100
29710-2635
Corrective, tax or QCD; min
consideration
10/10/2014
$555,000
29367-4939
Qual by exam of deed
12/05/2011
$292,300
28080-3766
Financial inst or "In Lieu of Forclosure"
stated
03/01/2006
$808,000
24361-4246
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 http://www.miamidade.gov/info/disciaimer.asp
Version
To
Re:
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 ExiSTINGiITli=
BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES ...... ; • • •' •
PERSUANT TO SECTION 553.844 F.S.
Miami Shores Village Building Department
10050 NE 2nd Ave
Miami Shores, A 33138
...... .....
Aate:• 1/10 ChU ......
. . . . ......
Owner's Name: Jolyon W Morris .000
...
Property Address: 74 NE 97 St, Miami Shores, FL 33138
Roofing Permit Number:
Dear Building Official:
I Jolyon W Morris certify that I am not required to retrofit the roof to wall connections of my
building because:
X The 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 olthe South Florida Building Code (1994 SFBC)
Jolyon W Morris
Signatufe Print Name
State of Florida
County of Dade
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 loth day of January, 2019
Dann De V Pit
� rr�oo�nbaion;iflQ?AG1iT
Notary Public, Sate of Florida at Large S/Z
Bwftlft Axonft"
• 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 Wall connection Hurricane Mitigation.
Revised on 5/21/2009
OWNER'S AFFIDAVIT OF EXEMPTION
ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR EXISTING SITE -
BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES
PURSUANT TO SECTION 553.844 F.S.
1/10/2019
To: Miami -Dade County Building & Neighborhood Compliance Department
11805 Coral Way, Suite 1 I 1 0000
Miami, FL 33175
. . .... ......
Re: Owner's Name Iolyon W Morns
......
......
Property Address 74 NE 97 St, Miami Shores, FL 33138 ' .... • 660066 . ...
...... .. .... .
. . . . .
.. .. .. . ......
Roofing Permit Number
. . ...... . . ......
Dear Building Official: .
Jolyon W Morris 00.0 "' • •'
I certify that I am not required to retrofit the reef•to wall
connections of my building because:
HThe just valuation for the structure for purposes of ad valorem taxation in less than $300,000.00.
UThe building was constructed in compliance with the provisions of the Florida Building Code
(FBC) or with the provisions of the 1994 edition of the South Florida Building Code (1994
Print Name
STATE OF FLORIDA COUNTY OF MIAMI-DADE
Sworn to and subscribed before me this loth
day of January , 2019 ,
(SEAL) QP
�Ds laPit
E�x 3/
X Personally known BORE Ar01y
or Produced Identification
When the just valuation of the structure for purposes of ad valorem taxation is equal to or more than
$300,000.00, and the building was not constructed in compliance with the FBC nor with 1994 SFBC,
and affidavit of Roof to Wall Connection Hurricane Mitigation Retrofit must be provided.
5
it
SECTION 1524
HIGH VELOCITY HURRICANE ZONES — REQUIRED OWNERS NOTIFICATION FOR ROOFING
CONSIDERATIONS
1524.1 Scope. As it pertains to the section, it is the responsibility of roofing contractor to provide the owner with
the required roofing permit, and to explain to the owner the content of the section. Thg provjsions 0jjtion R4402 •
govern the minimum requirements and standards of the industry for roofing system ingWIAti4ns. Additionally, the , •
following items should be addressed as part of the agreement between the owner ant tbecoatractot'M6wner's...;.
initial in the designated space indicates that the item has been explained. • • •. •. .
.... . .....
2. Renailing wood decks: When replacing roofing, the existing wood goof deckfni�llave to"''
.. .. .. . ......
be r ail in accordance with the current provisions of Section R4403. (Thg * * jigck is usually
conceale prior to removing the existing roof system). • • •
. .
4. Exposed Ceiling: Exposed, open beam ceilings are where the underside of the;eddecking
ca be viewed from below. The owner may wish to maintain the architectural appearance; therefore,
ropfing nail penetration of the underside of the decking may not be acceptable. This provides the option of
irlta g the appearance.
i
6. Overflow scuppers (wall outlets): It is required that rainwater flows off so that the roof is
not overloaded from a buildup of water. Perimeter/edge wall or other roof extension may block this
discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow
ajerift
scuppers in accordance with the requirements of Sections R4402, R4403 and R4413.
Signature Date Contractor Signature Date
7 0E 97 St, Miami Shores, FL 33138
'Property Address
Revised on 7/9/2009 LD;07/01/2015;
Permit Number
OA
ROOF ASSEMBLIES AND ROOFTOP STRUCTURES
b fiF/orlda'Bullding Code Sih Edition (2014)
r` High -Velocity Hurricane Zone Uniform Permit Application Form.
- _ Section A (General Information)
Mans r it No. _ Process No.
4 w rs Name Group II, Inc
ob A f ss 74 NE 97 St, Miami Shores, FL 33138 ' • • , 1
ROOF CATEGORY
❑ Low Slope ❑ Mechanically Fastened Tile IX Mort%f"Wsive SiPTAt. . • •
❑ Asphaltic Shingles ❑ Metal Panel/Shingles ❑ Wodtf 4"AQles/Shaltesr •; • • • • 1
RECEIVED ❑ Prescriptive BUR-RAS 150 • • • • • • • • • • : S
ROOF TYk • •
JAN 15- Z919 §[ New roof ❑ Repair ❑ Maintenance ❑ Reroofing : . • • ❑ Recovering ;... •;
' Q ROOF SYSTEM INFORMATION 41 •
.... 1
Low Slope Roof Area (SF) 1 Steep Sloped Roof AREA, (SSF)= Total (SF)!Zr� A9rV
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
I
1
1
1
1
1
I
1
1
1
1
1
1
1
1
1
1 1
1
1
' 1
a
FLORIDA BUILDING CODE — BUILDING, 5th EDITION (2014) 15.37
Capynalu to. a ik..d by. ICC (ALL RIGHTS RESERVED); accessed by Mora Palado on Jan $. 2015 10'•3202 AM pursuant to Umse
Agwemano,►hvtuwhe� t�e�nfMfndwtyxlltMKlSdti-
ROOF ASSEMBLIES AND ROOFTOP STRUCTURES
Florida Building Code Sth Edition (2014)
High -Velocity Hurricane Zone Uniform Permit Application Form
Section D (Steep Sloped Roof System)
Roof System Manufacturer:
1
Notice of Acceptance Number.
1
Minimum Design Wind Pressures, If Applicable (From RAS 127 or Calculations):
;
P1:
P1: P1:
• • •
•����•
.
•.i...
Deck Type: 5/8" CDX Plywood
""
0......
1
0000
Type Undedayment: ASTM #30 Felt
....
• • • • • • • •
•
• x • •
Roof Slope:
1 0 •
3 12
•
Insulation: n/a
�.....
• 00
•• ...
Fire Barrier: n/a
0000
1
1
Ridge Ventilation?
Fastener Type & Spacing:
1-1/4" RS Coil Nails
1
1
Adhesive Type: Hot Asphalt
1
1
Type Cap Sheet:
Tile Underlayment
1
1
1
Mean Roof Height:
12' Roof Covering:
lat Concrete Tile w/ Med Pad
y 1
1
Type & Size Drip 3"x3" Galv
1
Edge:
1
1
1
FLORIDA BUILDING CODE — BUILDING, 5th EDITION (2014) 15.39
Copyright to, or liccnscd by. ICC (ALL RIGHTS RESERVED): accessed by Mieur Pslaoio on Jun 8, 2013 10:32;12 AM pursuant to Ucensc
A4namewt, No fwther repreMietionr aud+ee�d.
1
1
1
1
t
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
t
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
ROOF ASSEMBLIES AND ROOFTOP STRUCTURES
Florida Building Code 5th Edition (2014)
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, with the values from K. If the M, values
are greater than or equal to the M, values, for each area of the roof, then the the attachment method is acceptable.
Method 1 "Moment Based Tile Calculations Per RAS 127" e e e •
(P1: 39.1 x 7, .313 =-12.24) - Mg:8.03 = Mrt -4.21 Product Approval M, -40.4 .0. e e a e
(P2. 68.1 xX .313 =-21.32) - Mg: 8.03 = M(2-13.29 Product Approval Mf -40.400 :0 e 0: s
(P3:100.7x?..313 = 31.52 ) - Mg: 8.03 = M� -23.49 product Approval M, _
Method 2 "Simplified Tile Calculations Per Table Below" • • :.. a :.
ease
Required Moment of Resistance (Mr) From Table Below Product ADDroval M.
M, required Moment Resistance' .. ..
Mean Roof Height
Roof Slope
15'
20'
25'
30' .
:40'
e
2:12
34.4
36.5
38.2
39.7 ;
`¢2.2 •
3:12
32.2
34.4
36.0
37.4
S9.8
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
e
`Must be used in conjunction with a list of moment based tile systems endorsed by the Broward County Board of Rules and
Appeals.
For Uplift based tile systems use Method 3_ Compared the values for F' with the values for Fr. If the F' values are greater than or
equal to the Fr values, for each area of the roof, then the the attachment method is acceptable.
Method 3 "Uplift Based Tile Calculations Per RAS 127"
(P1:_ x L = x w: _ ) - W: x cos 0 _ = F„ Product Approval F'
(P2:_ x L = x w: = ) - W: x cos A _ = Fn Product Approval F
(P3:_ x L = x w: = _) - W: x cos 0 = F� _ Product Approval F'
Where to Obtain Information
Description
Symbol
Where to find
Design Pressure
P1 or P2 or P3
RAS 127 Table 1 or by an engineering analysis pre-
pared by PE based on ASCE 7
Mean Roof Height
H
Job Site
Roof Slope
0
Job Site
Aerodynamic Multiplier
x
Product Approval
Restoring Moment due to Gravity
M9
Product Approval
Attachment Resistance
M,
Product Approval
Required Moment Resistance
M9
Calculated
Minimum Attachment Resistance
F'
Product Approval
Required Uplift Resistance
Fr
Calculated
Average Tile Weight
W
Product Approval
Tile Dimensions
L = length W = width
Product Approval
All calculations must be submitted to the building official at the time of permit application.
.see so
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a
a
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15.40 FLORIDA BUILDING CODE - BUILDING, 5th EDITION (2014)
Copyright to, or licensed by, [CC (ALL RIGHTS RESERVED); accessed by Eliezer Palacio on Jun 8, 2015 10:32:12 AM pursuant to License
Agreement. No hurter repFoduetions. aethewcea.
M IAMI-DIACfE
® PRODUCT
COUNTY
CT CONTROL SECTION
DEPARTMENT OF PERMITTING, ENVIRONMENT, AND REGULATORY AFFAIRS (PERA) 11805 SW 26 Street, Room 208
BOARD AND CODE ADMINISTRATION DIVISION Miami, Florida 33175-2474
T (786) 315-2590 F (786) 315-2599
NOTICE OF ACCEPTANCE (NOA) www.miamidade.eov/sera
Boral Roofing, LLC
7575 Irvine Center Drive, Suite 100
Irvine, CA 92618 ....
. . .... ......
SCOPE:
This NOA is being issued under the applicable rules and regulations governing the use of c8AAMction materials. The • • • •
documentation submitted has been reviewed and accepted by Miami -Dade County PERA - go * Control Section....
to be used in Miami Dade County and other areas where allowed by the Authority Having1psetction f ri AMJ3 . • • • • •
.
This NOA shall not be valid after the expiration date stated below. The Miami -Dade Couloy1wduct fttrotSection • • •
......
(In Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) reserva tha siPt to have this • •
product or material tested for quality assurance purposes. If this product or material fails to perform inothe accepted...:.
manner, the manufacturer will incur the expense of such testing and the AHJ may immediJte1y'rpvoke:modi1?y, or •
suspend the use of such product or material within their jurisdiction. PERA reserves the riOt to revo* 09. •
acceptance, if it is determined by Miami -Dade County Product Control Section that this product or matenaCfails 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: Saxony 900 Concrete Roof 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 renews and revises NOA407-0711.03 and consists of pages 1 through 8.
The submitted documentation was reviewed by Alex Tigera.
NOA No.: 12-0222.03
MIAMW3ADECOUNTYM Expiration Date: 04/26/17
Approval Date: 04/19/12
Page 1 of 8
ROOFING ASSEMBLY APPROVAL
Category
Roofing
Sub -Category:
Roofing Tiles
Material:
Concrete
Deck Type:
Wood
1. SCOPE
This NOA approves a system using Saxony 900 (Shake, Slate & Split Shake) Concrete -Roof
Tile, as manufactured Boral Roofing LLC in Lake Wales, FL. and described. this NotiM-bf
Acceptance. For locations where the pressure requirements, as determined by aVelicable Bbi"Og
Code does not exceed the design pressure values obtained by calculations in c0ig1l4qce with RAS
127 using the values listed in the installation section herein. The attachment calculations $half pe
done as a moment based system.. ****so •
2. PRODUCT DESCRIPTION
Manufactured by
Applicant
Saxony 900
Trim Pieces
Dimensions
1=17"
w = 13"
1-5/32" thick Slate
1-9/32" thick Shake &
Split Shake
Test Pro;uct ; •, •: •
Specifications Desc&i I
TAS 112 Flat profile, interlocking, high-*.:..*
pressure extruded concrete roof tile
equipped with two nail holes. For
direct deck or battened nail -on, mortar
set or adhesive set applications.
Length: varies TAS-112 Accessory trim, boosted Barcelona,
Width: varies concrete roof pieces for use at hips,
varying thickness rakes, ridges and valley terminations
manufactured for each tile profile.
2.1 MANUFACTURING LOCATION
2.1.1. Lake Wales, FL.
2.2 SUBMITTED EVIDENCE:
Test Agency
Test Identifier
Test Name/Report
Date
Redland Technologies
7161-03
Static Uplift Testing
Dec. 1991
Appendix III
TAS 102 & TAS 102(A)
The Center for Applied
94-084
Static Uplift Testing
May 1994
Engineering, Inc.
TAS 101 (Mortar Set)
The Center for Applied
94-060A
Static Uplift Testing
March, 1994
Engineering, Inc.
TAS 101 (Adhesive Set)
NOA No.: 12-0222.03
MIAMMADECOUNTY Expiration Date: 04/26/17
C
Approval Date: 04/19/12
Page 2 of 8
The Center for Applied
25-7183-6
Static Uplift Testing
Feb. 1995
Engineering, Inc.
TAS 102
(2 Quik-Drive Screws,
Direct Deck)
The Center for Applied
25-7183-5
Static Uplift Testing
Feb. 1995
Engineering, Inc.
TAS 102
(2 Quik-Drive Screws,
Battens)
The Center for Applied
25-7214-1
Static Uplift Testing
March, 10.%%
Engineering, Inc.
TAS 102'000
"•'
(1 Quik-Drive Screw, Direct • • • �; •
Deck)
""" '
The Center for Applied
25-7214-5
Static Uplift Testing
. ...March,1991
Engineering, Inc.
TAS 102
•
• • • • •
(I Quik-Drive Screw,
••;••; .• ;•;
Battens)
.. •• of •
Redland Technologies
7161-03
Wind Tunnel Testing
: * bec. L991.
Appendix II
TAS 108 (Nail -On)
; . • • •
Redland Technologies
Letter Dated Aug. 1,
Wind Tunnel Testing
0 • Aug. $q� •
1994
TAS 108 (Nail -On)
Redland Technologies
P0631-01
Wind Tunnel Testing
July 1994
TAS 108 (Mortar Set)
Redland Technologies
P0402
Withdrawal Resistance
Sept. 1993
Testing of screw vs. smooth
shank nails
The Center for Applied
Project No. 307025
Wind Driven Rain
Oct. 1994
Engineering, Inc.
Test #MDC-77
TAS 100
Atlanta Testing & Engineering,
R1.894
Physical Properties
Aug. 1994
Inc.
R2.894
TAS 112
R3.894
Celotex Corporation Testing
520109-1
Static Uplift Testing
Dec. 1998
Service
520111-4
TAS 101
Celotex Corporation Testing
520191-1
Static Uplift Testing
March 1999
Service
TAS 101
Walker Engineering, Inc.
Evaluation
25-7094
February 1996
Calculations
Walker Engineering, Inc.
Evaluation
25-7496
April 1996
Calculations
Walker Engineering, Inc.
Evaluation
25-7584
December 1996
Calculations
25-7804b-8
25-78044 & 5
25-7848-6
NOA No.: 12-0222.03
M"MADECOUNTY Expiration Date: 04/26/17
Approval Date: 04/19/12
Page 3 of 8
Walker Engineering, Inc. Evaluation 25-7183 March 1995
Calculations
Walker Engineering, Inc. Evaluation Aerodynamic Multipliers January 2007
Calculations
Walker Engineering, Inc. Calculations Two Patty Adhesive Set April 1999
System
Walker Engineering, Inc. Evaluation Restoring Moments Due to February 2007
Calculations Gravity
Nutting Engineers 130 TAS 112 January 2007
3. LINIITATIONS '
3.1 Fire classification is not part of this acceptance.
3.2 For mortar or adhesive set the applications, a static field uplift test sUalf 6e performed in
accordance with TAS 106. """
3.3 Applicant shall retain the services of a Miami -Dade County Certified Lahwtory to pe*vn
quarterly test in accordance with TAS 112, appendix `A'. Such testing- all.6e subi»idb&to
the Building Code Compliance Office for review. • • • •' • •
3.4 Minimum underlayments shall be in compliance with the applicable Roofrrf+g Ap0gX1gns
Standards listed section 4.1 herein. •
3.5 30/90 hot mopped underlayment applications may be installed perpendicular to the roof ;lope
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 the applicable Building Code.
4. INSTALLATION
4.1 Saxony 900 (Slate, Shake & Split Shake) Concrete Roof Tile and its components shall be
installed in strict compliance with Roofing Application Standard RAS 118, RAS 119, and
RAS 120.
4.2 Data For Attachment Calculations
Table 1: Average Weight (W) and Dimensions (I x w )
Tile Profile
Weight-W (lbf)
Length-1 (ft)
Width-w (ft)
Saxony 900
Slate, Shake & Split Shake
11.5
1.417
1.08
Table 2: Aerodynamic Multipliers - X (ft)
Tile
X (ft)
(fts)
Profile
Batten Application
Direct Deck Application
Monieri-ifetile Saxony 900
0.289
0.313
Slate, Shake & Split Shake
NOA No.: 12-0222.03
rxL MMADe couwrir Expiration Date: 04/26/17
' Approval Date: 04/19/12
Page 4 of 8
Table 3: Restoring Moments due to Gravity - Mg (ft-Ibf)
Tile
2":12"
3":12"
4":12"
5":12"
6":12"
7":12" or
Profile
greater
Saxony
900
Battens
Direct
Deck
Battens
Direct
Deck
Battens
Direct
Deck
Battens
Direct
Deck
Battens
Direct
Deck
Battens
Direct
Deck
7.16
8.12
7.08
8.03
6.97
7.91
6.82
7.74
6.65
7.55
6.46
7.34
Slate,
Shake &
Split
Shake
•••
Table 4: Attachment Resistance Expressed as a Moment - Mf (ftlbf)
for Nail -On Systems : • 0 •
Tile
Fastener Type
Direct Deck
Direct {beak
Battens
Profile
(min 15132"
(min. a9132:'
:...:*
plywood)
plywoR.�
• • •
Saxony 900
Slate, Shake &
2-10d Ring Shank Nails
30.9
36A • •
4 .2 •
1-10d Smooth or Screw Shank Nail
7.3
98 • • • •
4.0
2-10d Smooth or Screw Shank Nails
14.0
18.8 e
7.4•
Split Shake
1 48 Screw
30.8
30.8
• 18.2
2 48 Screws
51.7
51.7 •
4'4
1-10d Smooth or Screw Shank Nail
24.3
24.3
2ti'2
Field Clip)
1-10d Smooth or Screw Shank Nail
19.0
19.0
22.1
Eave Clip)
2-10d Smooth or Screw Shank Nails
35.5
35.5
34.8
Field Clip)
2-10d Smooth or Screw Shank Nails
31.9
31.9
32.2
Eave Clip)
Table 5: Attachment Resistance Expressed as a Moment Mf (ft-Ibf)
for Two Patty Adhesive Set Systems
Tile
Tile Application
Minimum Attachment
Profile
Resistance
MonierLifetile Saxony 900
Adhesive
31.3
Slate, Shake & Split Shake
1 See manufactures component approval for installation requirements.
2 Dow Chemical TileBond Average weight per patty 13.9 grams.
Polyfoam Product, Inc. Average weight per patty 8 grams.
APPROVED J
NOA No.: 12-0222.03
Expiration Date: 04/26/.17
Approval Date: 04/19/12
Page 5 of 8
Table 6: Attachment Resistance Expressed as a Moment - Mf (ft-lbf)
for Single Patty Adhesive Set Systems
Tile
Profile
Tile Application
Minimum Attachment
Resistance
Monierl-ifetile Saxony 900
Slate, Shake & Split Shake
Polyfoam Pol ProTm
Polyfoam Pol ProTm
40.4
3 Large paddy placement of 45 grams of Pol ProTm.
4 Medium paddy placement of 24 grams of Pol ProTm.
Table 7: Attachment Resistance Expressed as a Moment - Mf(ft-lbf) ."".
•
for Mortar Set Systems
Tile
Tile
AttswAgient ; • • • • •
Profile
Application
Resistance
Monierl-ifetile Saxony 900
Mortar Set
• •48,9 ; • •; •
Slate, Shake & Split Shake
5. Tile-Tite Roof Tile Mortar
'
5. LABELING : • • • : •
5.1 All tiles shall bear the imprint or identifiable marking of the manufacttira?s name or logo as
detailed below, or following statement: "Miami -Dade County Product Control Appro+u 111
LABEL FOR SAXONY 900 TILE (LAKE WALES FL PLANT
LOCATED UNDERNEATH TILE
6. BUILDING PERMIT REQUIREMENTS
6.1 Application for building permit shall be accompanied by copies of the following:
6.1.1 This Notice of Acceptance.
6.1.2 Any other documents required by the Building Official or applicable building code
in order to properly evaluate the installation of this system.
NOA No.: 12-0222.03
MIAMMOME COUNTY11111 Expiration Date: 04/26/17
�LWA•
Approval Date: 04/19/12
Page 6 of 8
NAIL F
u
PROFILE DRAWING
WATERLOCK
SAXONY 900 CONCRETE ROOF TILE (SLATE MODEL)
5/32 " (slate)
9/32 " 4s4ake)
ERLAY
MONIERLIFETILE SAXONY 900 CONCRETE ROOF TILE (SPLIT SHAKE MODEL)
NOA No.: 12-0222.03
MIAMI GR1DE COUNTY Expiration Date: 04/26/17
Approval Date: 04/19/12
Page 7 of 8
• •••• • • ••••••
•••••
•••••• • ••• •••••
••
•• •••••• ••• •• • •••••
•
• • • •
MONIERLIFETILE SAXONY 900 CONCRETE ROOF TILE (SHAKEIVIOQEL) ; ... • • • • • • • •
• • ••••••
• . . . .1100
END OF THIS ACCEPTANCE • 0000
NOA No.: 12-0222.03
MIAMMADECOUNTY Expiration Date: 04/26/17
Approval Date: 04/19/12
Page 8 of 8
MIAMI-DADE COUNTY
PRODUCT CONTROL SECTION
BUILDING AND NEIGHBORHOOD COMPLIANCE DEPARTMENT (BNC) 11805 SW 26 Street, Room 208
BOARD AND CODE ADMINISTRATION DIVISION Miami, Florida 33175-2474
T (786) 315-2590 F (796) 315-2599
NOTICE OF ACCEPTANCE (NOA) www.mismidade.gov/buildina/
Polyfoam Products, Inc.
11715 Boudreaux Road
Tomball, TX 77375
SCOPE: ....
This NOA is being issued under the applicable rules and regulations governing the use -of construction tnaterialso.. •
The documentation submitted has been reviewed and accepted by Miami -Dade County ONC- Prodypt Control -
Section to be used in Miami Dade County and other areas where allowed by the AuthdMtighving Jurisdiction • • • • • •
(AHJ)- ......
This NOA shall not be valid after the expiration date stated below. The Miami -Dade C+oun Product Control
Section (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade CocU 5 Teserve tlitiht to:::::.
......
have this product or material tested for quality assurance purposes. If this product or warrUl fails to perform . •
in the accepted manner, the manufacturer will incur the expense of such testMg 'arid the. AHJ may.... %
immediately revoke, modify, or suspend the use of such product or material within theig jurisdic�ton. )3NC; . . . .;
reserves the right to revoke this acceptance, if it is determined by Miami -Dade Cddnty 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: PoIypro® AU160
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 renews NOA# 06-0201.02 and consists of pages 1 through 7.
The submitted documentation was reviewed by Alex Tigera.
NOA No.: 11-0124.04
MUW414 ADE COUMV Expiration Date: 05110tI2
... , Zj Approval Date: 04/14/11
Page 1 of 7
ROOFING COMPONENT APPROVAL:
Category: Roofing
Sub Category: Roof the adhesive
Materials: Polyurethane
SCOPE:
This approves Polypro® AH160 as manufactured by Polyfoam Products, Inc. as described in Section 2
of this Notice of Acceptance. For the locations where the design pressure requirements, as determined by
applicable building code, does 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 tiles system using Polypro® AH 160. Where the attachment calculations arc done is. a.. • .... • .
moment based system for single patty placement, and as an uplift based system for dedebre pattx� �r� ms
•••••• • ••••••
PRODUCTS MANUFACTURED BY APPLICANT: "" 0 ' :....:
Product Dimensions Test Product'Dest4otioa00000 :.*So
��+00000
• •
SWCi$cations • • : • • : • • : • : • • • • •
PolyproO AH160 N/A TAS 101 Two component DblYufiethane Mant
adhesive •
. . . . ......
Foampro® RTFI000 N/A Dispensing Equipment- :""'
•• • • •• • •
ProPack® 30 & 100 N/A Dispensing Equipment '.%.'
PRODUCTS MANUFACTURED BY OTHERS:
Any Miami -Dade County Product Control Accepted Roof Tile Assembly having a current NOA which
list moment resistance values with the use of Polypro AH160 roof file adhesive.
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 lbsJft.'
18 PSI Parallel to rise
12 PSI Perpendicular to rise
28 PSI Parallel to rise
0.08 LbsJFe
3.1 Perm / Inch
+0.07% Volume Change @ -40° F., 2 weeks
+6.0% Volume Change @I58'F., 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.: 11-0124.04
Expiration Date: 05/10/12
Approval Date: 04/14/11
Page 2 of 7
EVIDENCE SUBMITTED:
Test eney
Center for Applied Engineering
Miles Laboratories
Polymers Division
Ramtech Laboratories, Inc.
Southwest Research Institute
Trinity Engineering
Celotex Corp. Testing Services
LINWATIONS:
Test Identifier
#94-060
257818-1 PA
25-7438-3
25-7438-4
25-7438-7
25-7492
NB-589-631
9637-92
01-6743-011
01-6739-062b[l]
7050.02.96-1
528454-2-1
528454-9-1
528454-10-1
520109-1
520109-2
520109-3
520109-6
520109-7
520191-1
520109-2-1
Test Name/Report
TAS 101
TAS 101
SSTD 11-93
SSTD 11-93
SSTD 11-93
ASTM D 1623
ASTM E 108
ASTM E 108
ASTM E 84
TAS 114
TAS 101
TAS 101
TAS 101
.....
.....
Date
04/08/94
12/16/96
10/25/95
11/02/95
12/12/95
02/01/94
04/30/93.
......
11/16/94
O1AWS%
03/14J90�.
. .
10/23/98
12/"l8/98' .
....
03/02/99
1. Fire classification is not part of this acceptance. Refer to the Prepared Roof Tile Assembly for fire
rating.
2. Polypro® AH160 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 Polypro® AH160 roof tile adhesive with
their tile assemblies shall test in accordance with TAS 101.
5. Roof Tile manufactures acquiring acceptance for the use of HANDI-STICK roof tile adhesive with
their the assemblies shall test in accordance with TAS 101 with section 10.4 as modified herein.
F _W
2
F'=
MS
NOA No.: 11-0124.04
MuuHFo�oa Expiration Date: 05/10/12
Approval Date: 04/14/11
Page 3 of 7
INSTALLATION:
1. Polypro® AH 160 may be used with any roof tile assembly having a current NOA that lists uplift
resistance values with the use of Polypro® AH160.
2. Polypro® AH160 shall be applied in compliance with the Component Application section and the
corresponding Placement Details noted herein. The roof tle assembly's adhesive attachment with
the use of Polypro® AH160 shall provide sufficient attachment resistance, expressed as an uplift
based system, to meet or exceed the uplift resistance determined in compliance with Miami -Dade
County Roofing Application Standards RAS 127. The adhesive attachment data is noted in the roof
tile assembly NOA
3. Polypro® AH 160 roof tile adhesive and its components shall be installed in accordance with
Roofing Application Standard RAS 120, and Polyfoam Products, Inc. Polypro® AH160 Operating
Instruction and Maintenance Booklet. • • • •
4. Installation must be by a Factory Trained 'Qualified Applicator' approved and Keensed by;>r9V9am
Products, Inc. Polyfoam Products Inc, shall supply a list of approved applicatbN (d the authority
having jurisdiction. • • • • • • •
5. Calibration of the Foampro® dispensing equipment is required before appliAgQ pf any idlheAve.
The mix ratio between the "A" component and the "B" component shall be meiatWued betwepp.1.0-
1.15 (A): 1.0 (B). The dispense timer shall be set to deliver 0.0175 to 0.15 poands per tit€ fc'
determined at calibration. No other settings shall be approved. • • • • • • •
6. Polypro® AH160 shall be applied with Foampro RTF1000 or ProPack® 30 dt 100 tlisperWpg; •
equipment only. •
7. Polypro® AH 160 shall not be exposed permanently to sunlight. •
8. Tiles must be adhered in freshly applied adhesive. Tile must be set within 2 to 3 minutes after
Polypro® AH160 has been dispensed.
9. Polypro® AH160 placement and minimum patty weight shall be in accordance with the'Placement
Details' herein. Each generic tile profile requires the specific placement noted herein.
Table 1: Adhesive Placement For Each Generic Tile Profile
Tile Profile
Placement
Detail
Single Paddy
Weight Min.
rams
Two Paddy Weight
per paddy Min.
rams
Flat, Low, High Profiles
#1
35
N/A
High Profile (2 Piece
Barrel)
#1
I
17/side on cap and
34/ an
N/A
Flat, Low, High Profiles
#2
24
N/A
Flat, Low, HighProfiles4
#3
8
LABELING:
All Polypro® AH160 containers shall comply with the Standard Conditions listed herein.
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.: 11-0124.04
MtaMFo�aoe cotmrY Expiration Date: 05/10/12
Approval Date: 04/14/11
Page 4 of 7
ADHESIVE PLACEMENT DETAIL 2
SINGLE PATTY
P&O (Benuth Tb)
Ud srkywl
m
1
In. in.
EmC4ffm •
Fetch
Undedapeent
I
71n. Vw, 12 In.
Asbh�
qft EA" Coarse
Peddy(BentATle)
0
0
a
Goo
Fate;
0
waqws:
0 48 dosum
NOA No.: 11-0124.04
Expiration Date: 05/10/12
MIAM,ft .RECOUNTY Approval Date: 04/14/11
•Page 6 of 7
ADHESIVE PLACEMENT DETAIL 1
SINGLE PATTY
IN through Pluft comot
Urmspeent •
1
EmCw" •
Fasch
course oxv:
Keep edhosks sppm
Em Cotime
4 [a up from W"Ies
Ti—,m=
21"
EmCmm •
Keep adhal" mmm
upfmmweeplaNs
Paddy (BVM% Tr*)
0 0 0
e fol4
Piece mottoOPIA1 W
o sdhnln to Umm v to 23 d"Poftape 9 0 0*
piesibris
squors kda In cooled wOh the pan t1b 91 P
2)Tutu ,, upside down. PINCOMR101 to la
To I In. Frm birlsids adp of omT Me!e
Then WW the 119.
Underkyrnont
lop"Am
oftbeem
Comemile,
Abut buaW course of DO"
pin Ike. Emm em awl d Pa" Nmbr
pensodcoverMossre on IN
Rush it OM Iles.
Emelosure w"Upbole Fadal
NOA No.: 11-0124.04
WMAMMADE COUNTY
Expiration Date: 05/10112
Approval Date: 04/14/11
mj� Page 5 of 7
ADHESIVE PLACEMENT DETAIL 3
DOUBLE PATTY
Nall through plastic cement Paddy Nall through plastic cement Single paddy under file
(between 919) UrderiRyment Single paddy between tile
Paddy 2 In. x 7 In. medium
• (under 019) site paddy am
course only
•
Single Paddy n.x 3 In. see
under file•
------
x3i 4 In. 2 In.
Single
Pat 4 In. Single
ngle paddy on 2 in. under • paddy on
layment under -
*Soo*@
Single paddy•Fascla
courts an top of file Weep"
alkh'. Em
Single paddy 11. X 7 In. medium qaffifth� cour" va closure
on top of the min paddy am Dflp edge
Fmla course only A
Nall through plastic cement Single paddy
under the Single paddy
between the
AM-
171 In.x 3 In. 4 In.
Single paddy
on underlsyment 2 n.
Single paddy Eave Cluum
on top of the In. x 7 In. medium
sin paddy em course only
Eve CourseFascia
I -
END OF THIS ACCEPTANCE
NOA No.: 11-0124.04
Expiration Date: 05/10/12
Approval Date: 04/14/11
Page 7 of 7
AFFIDAVIT OF COMPLIANCE WITH ROOF DECKING ATTACHMENT AND SECONDARY
WATER BARRIER HURRICANE MITIGATION RETROFIT FOR EXISTING SITE -BUILT
SINGLE FAMILY RESIDENTIAL STRUCTURES
PURSUANT TO SECTION 553.844 F.S.
11/04/2019
To: Miami -Dade County Building Official
11805 Coral Way, Suite 111
Miami, FL 33175
Re: Owner's Name Iolyon W Morris
Property Address 74 NE 97 St
Roofing Permit Number RF-01-19-97
Dear Building Official:
I Carlos A Valderrama certify that the roof decking attachment and fasteners have been
strengthened and corrected and a secondary water barrier has been provided as required by the "Manual
of Hurricane Mitigation Retrofits for Existing Site -Built Single Family Structures" adopted by the
Florida Building Commission by Rule 9B-3.047 F.A.C.
Qualifying
Signature f Qualifying ent
Carlos A Valderram
Print Name
L . I
STATE OF FLORIDA CO OF MIAMI-DADS
Sworn to and subscribed before me this 4th
day of November , 2019
(SEAL) Wpd Do LA Pa
cowoa+eoion #coo»r
bon: 3 rA=
Bonded tlw Arai Nohry
X Personally known
or Produced Identification