RF-09-22-2244 Inspection Affidavit 190 NE 93 StMiami Shores Village - BUILDING DEPARTMENT
1'2� 10050 NE 2 Ave Miami Shores, FL 33138
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305-795-2204 www.msvfl.gov
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Permit # DATE:
INSPECTION AFFIDAVIT
licensed as a(n Contractor , ngineer / Architect,
(Print name and circle License Type)
License #: C''CC 13 3 233 �--
On or about to ot2 I did personally inspect the roof deck nailing
(D to & time)
work atC7 D ti Sly— 33 f j U
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the
Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S)
Signature
State of Florida, Miami Dade County:
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 day of tAOMN
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Notary Public, State of Florida at Large �' SAN?'�o'�•,�
NOTARY
to PUBLIC {{pp
For Forms and Applications click here: �''f.,Q�tj ..oe'�,.�`�
http://bIdg.miamishoresviIlage.com/WebLink/Browse.aspx?id=118080&igbi' ;9c &repo=Mia
miShoresVillage
Testing Agency Name:
Address:
Telephone:
Fax:
Email:
Representative Name:
Title:
TAS 106
TEST RESULTS REPORT
GENERAL INFORMATION
A+ Eneineerine Testine Lab LLC.
7066 SW 44 St Miami FL 33155
305-668-5792
786-513-3754
a pl u setlfa ,y aho o. co m
Eng. ABDIAS H. SAENZ
RE # 69687
SITE SPECIFIC. INFORMATION
Roofing Contractor:
Job Address:
Contact. Name:
Owner Name:
Type of Tile:
Roof Height:
J COBB INVESTMENTS LLC
190 NW 93 ST. MIAMI, FLORIDA
JACOB
JACOBO GAITAN
CONCRETE
12 feet
Job Access: LADDER
Approximate Square Footage of Roof:
Required Testing Force: 35 LBS
Certification No. 21-1028.01
Permit #: RF09222244
Date Installed: -
Roof Pitch 3/12
Gate: NO
18.0 SQ. Date Tested: 01/19/2023
Testing Equipment: M2-100, 53741465
TEST LOCATION
PASS FAIL
CORNER
05
PERIMETER
09
RIDGE
03
FIELD
02
TOTAL:
19
a + o. 69687 f'
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ORI
IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL PA 106. THIS ROOF i f TSTATIC UPLIFT QUALITY CONTROL TEST
THIS TAS 106 TEST HAS BEEN PERFORMED IN FULL ACCORDANCE TO THE I F f \qk r1DE COUNTY, WITH NO DEVIATIONS
THIS REPORT IS NOT GUARANTEED IN CASE OF NATURAL DISASTERS. 111
A+ Engineering Testing Lab
ROOF DIAGRAM
190 NW 93 ST. MIAMI, FLORIDA
(PERMIT # RF09222244)
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7066 SW 44 St Miami FL 33155 PH: 305-668-5792 Fax: 786-513-3754. aplusetl@yahoo.com
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