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RF-08-19-1821, 360 NW 112th TerMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 360 NW 112TH TER, Miami Shores, FL 33168 1121360010220 Contacts Description: RE -ROOF Valuation: $ 12,200.00 Inspection Requests: t �E� Total Sq Feet: 2,200.00€ wN` 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 $12.00 Technology Fee $7.50 Total: $337.40 Payments Date Paid Amt Paid Total Fees $337.40 Check # 0005 11/08/2019 $287.40 Credit Card 08/07/2019 $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. Aut4ized Signature Owner / Applicant / Contractor / Agent Date November 08, 2019 Page 2 of 2 9�(!� `1� RECEIVELl Miami Shores Village Al 0 7 mg �Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 'WL Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC 0 ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 360 NW 112 TER City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11 -2136-001 -0220 Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): JO ANNE M CASH Phone#: Address: 360 NW 112 TER City: MIMAI SHORE State: FL Zip: 33168 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: BURCORP LLC Phone#: 7866635900 Address: PO BOX 540031 City: OPA-LOCKA State: FLA Zip: 33054 Qualifier Name: RAY BURKE Phone#: 7866635900 State Certification or Registration #: CCC1328436 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: ova S/� Type of Work: ❑ Addition ❑ Alteration ❑ New Q Repair/Replace ❑ Demolition Description of Work: REROOF Specify color of color thru tile: Y/ Le.r9- VC)d Submittal Fee $ M. ID Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Bond $ Soo' Io TOTAL FEE NOW DUE $ ��'J 9 --� - 4b 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. Signature) 14,kb""L / OWNER or AGENT The foregoing instrument was acknowledged before me this c�� day of /W , 20 l � by ,7r7 tAffi fb _, who is personall wn to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Signature e�L-f e CONTRACTOR The foregoing instrumentwasacknowledged before me this 2y /day of 20 lei by 9QU who is p ser ono nown to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: < Sign: 75 Print (k �� Print:bnarun WWI V'�R�c�ys Pr�GC c>, Seal: aQP p Commission ;t GG043525 Seal: ;11-4-Af - Sharon 1ar�rl Expires: October 31, 2020 - _ Commission t GG043525 ": "- Expires: October at, 20H Bonded thru Aaron Notary Bonded, Awn Notary APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Property Search Application - Miami -Dade County Page 1 of 1 OFFICE OF THE PROPERTY Arr"PRAISER %;.,:. , Summary Report Property Information Folio: 11-2136-001-0220 Property Address: 360 NW 112 TER Miami Shores, FL 33168-3300 Owner JO ANNE M CASH Mailing Address 360 NW 112 TERR MIAMI, FL 33168-3300 PA Primary Zone 0700 SGL FAMILY - 1551-1700 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY: 1 UNIT Beds / Baths / Half 2/2/0 Floors 1 Living Units 1 Actual Area 1,451 Sq.Ft Living Area 1,376 Sq.Ft Adjusted Area 1,401 Sq.Ft Lot Size 7,500 Sq.Ft Year Built 1955 Assessment Information Year 2019 2018 2017 Land Value $169,335 $161,028 $161,028 Building Value $97,510 $97,510 $97,510 XF Value $3,432 $3,467 $3,502 Market Value $270,277 $262,005 $262,040 Assessed Value $87,593 $85,960 $84,192 Benefits Information Benefit Type 2019 2018 2017 Save Our Homes Assessment $182,684 $176,045 $177,848 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 NEW MIAMI SHORES ESTS PB 51-80 LOT 6 BLK 2 LOT SIZE 75.000 X 100 OR 13904-2566 1188 5 Generated On : 8/7/2019 Taxable Value Information 2019 2018 2017 County Exemption Value $50,000 $50,000 $50,000 Taxable Value $37,593 $35,960 $34,192 School Board Exemption Value $25,000 $25,000 $25,000 Taxable Value $62,593 $60,960 $59,192 City Exemption Value $50,000 $50,000 $50,000 Taxable Value $37,593 $35,960 $34,192 Regional Exemption Value $50,000 $50,000 $50,000 Taxable Value $37,593 $35,960 $34,192 Sales Information Previous OR Book - Price Qualification Description Sale Page 13904- Sales which are disqualified as a result of 11/01/1988 $0 2566 examination of the deed 11807- 06/01/1983 $58,000 Sales which are qualified 1720 10780- 06/01/1980 $60,000 Sales which are qualified 1793 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/disclaimer.asp Version: https://www8.miamidade.gov/Apps/PA/propertysearch/ 8/7/2019 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. V COPY OF QUALIFIER'S STATE LICENCES B. ✓// COPY OF LOCAL BUSINESS TAX RECEIPT C. V COPY OF LIABILITY INSURANCE* D. V 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: BUSINESS ADDRESS: PO Bo_,� 6 YOU 5 i CITY=I r� STATE ZIP�4 BUSINESS PHONE: (:ZU ) 66 3 — S qOO FAX NUMBER ( CELL PHONE CJ. 4) %It3S �'5i0 QUALIFIER'S NAME: R ( 1 QUALIFIER'S LIC NUMBER: GG 0 2 EY 3 �, 0 Ron DeSantis, Governor STATE OF FLORIDA Halsey Beshears, secretary DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE ROOFING CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES BURKE, RAY ANTHONY BURCORP LLC 2320 NW 182 ST MIAMI GARDENS FL 33056 LICENSE NUMBER: CCC1328436 EXPIRATION DATE: AUGUST 31, 2020 Always verify licenses online at MyFloridaLicense.com Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. Local Business Tax Fbcei pt Miami -Dade County, State of Florida THIS IS NOT F+ 61LL DO NOT PAY 7165183 BUSINESS NAM M E/LOCATION RECEIPT NO. E X P I R E S BURCORP LLC RENEWAL SEPTEMBER 30, 2019 18800 NW 2ND AVE 218 7443529 MIAMI GARDENS, FL 33169 Must be displayed at place of business Pursuant to County Code Chapter 8A Art, 0 & 10 r-)� f�� N C-:; F� S�:C T� PE OF F3t1SIN ESS YM BURCORP LLC 196 SPECIALTY BUILDING D'`'Y Tf�. ENT RECEIVED i3X C,�� LL E-C r�7R C/O BURKE RAY CONTRACTOR 49.50 10/11 I2018 Worker(s) 1 CCC 1328436 CREDITCARD-19-002098 This Local Business Tax F;bcei pt only con"rms payment of the Local Business Tax, The Receipt is not a license, permit, or a certi "cation of the holder's qual i "cations, to do business. Holder must comply with any governmental or nongovernmental regul atory I aw s and requi rements w hi ch appl y to the busi ness. ire RECE]FT NO. above must be displayed on all commercial vehicles - Miami --Dade Code Sec 8a-276. i M IAM i DA6E For more information, visit www .mi arrilade aov/taxcol lector 'l'�,;,�", _ CERTIFICATE OF LIABILITY INSURANCE DA ON06 9YY' 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: M the, certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. N SUBROGATION IS WAIVED, subject to the terms and condaimm of the policy, certain policies may require an endorsement. A stal ernent on thts certificate does not confw rights to the certificate holder in lieu of such ems). PRODUCER Annette Wills Insurance 18401 N.W.27Ave Miami, FL 33056 Phone (305) 625-2403 Fax (305) 625-6472 CONTACT NAME flreyJewilli8 PHONE (305) 625 2403 FAX (305) 625 6472 jeffvilGs@ww*ttemilisimumnoo.com AFFORDING COVERAGE NAILS INSURER A: EVanstOn InsuanCe CompanY INSURED BUrcorp, IC PO box 540031 Opa lodca FL 33054 INSURER a : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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. IT RR TYPE OF INSURANCE BR VD POLICY NUMBER POLICY EFF Y EIU+ LIMITS A ® COMMERCIAL GENERAL LIABILITY ❑ CLAIMS -MADE ® OCCUR ❑ 3AA351983 08/01/2019 O8/01/2MO EACH OCCURRENCE $ 1,000,000.00 PREMISES aEoaxutenCe $ 100,000.00 MED EXP (Any one person) $ 5,000.00 ❑ PERSONAL & ADV INJURY $ 1,0WA0.00 GENL AGGREGATE LIMIT APPLES PER: ® POLICY ❑ JPERCaT ❑ LOC ❑ OTHER GENERAL AGGREGATE j 2,000,000.00 PRODUCTS -COMPIOPAGG $ 1,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL O NED ❑ SSCHEEDDULED ❑ HIRED AUTOS AUT ❑ AUTOS ❑ ❑ "B DISNGLE LIMIT (Ea BODILY INJURY (Pet person) $ BODILY INJURY (Per aoadera) $ (DerrPROde DAMAGE j j ❑ UMBRELLA UJW ❑ OCCUR ❑ EXCESS LIAR ❑CLAMS -MADE EACH OCCURRENCE $ AGGREGATE j ❑ DED ❑ RETENTION s j VNORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRETORIPARTNERIEXEC OFFICERIMEMBER EXCLUDED? � (MaMallory M NH) F yes, describe under DESCRIPTION OF OPERATIONS below MIA ❑ PER ❑ OTH- EL EACH EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMITj DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Alfach ACORD I&I, Addltlonal Rem rks Schedule, U more specs Is required) General Contractor Licence d CCC1328436 / CGCO50931 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHOREDS, FL 33138 ACORD 25 (20141M) OF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTH06UM REPRESENTATNE 01988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo we registered marls of ACORD W. JEFF ATWATER CHIEF FINANCIAL 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: 3/12/2017 EXPIRATION DATE: 3/12/2019 PERSON: BURKE RAY FEIN: 421656489 BUSINESS NAME AND ADDRESS: BURCORP LLC PO BOX 540031 MIAMI GARDENS FL 33054 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL LICENSED ROOFING ROOFING - ALL KINDS CONTRACTOR CONTRACTOR AND DRIVER 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 ttds cl aper. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only wierin the scope of the business or trade fisted on the notice of election to be exempt Pursuant to Chapter 440.05(13). F_S., Notices of election to be exempt and cerfificales of election to be exempt shall be subject to revocation if, at arty time after the id'mg 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 DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 Proof of Coverage Page 1 of 1 WC Mobile App WC Novae Search Our Data CFO Home Employer List Page This database was last updated Wednesday, August 07, 2019 12:10 AM. Return to Search Page Federal Employer ID Number Information 1 records found for federal employer id number 421656489. Click the links below the Employer Name column for more detailed information. Record Employer Name _ Employer Address 1 BURCORP LLC 18800 NW SECOND AVENUE STE 218, MIAMI, FL 33169 1 records found for federal employer id number 421656489. Return to Search Page Cov lExem Cov I Exem https:Happs8.fldfs.com/proofofcoverage/EmployerList.aspx 8/7/2019 Proof of Coverage Page I of I WC Mobile App WC 1101ne Search Our Data CFO Home Employer Detail Page This database was last updated Wednesday, August 07,2019 12:10 AM. Carrier Location Information I Return to Search Page —] Employer Information Employer Name Employer Type NAICS Code IBURCORP LLC I LIMITED LIABILITY CO. N/A Coverage History Governing Class Effective Detailed Coverage Carrier Office policy Wrap Code* Date Information Number Up 1 05551 iFeb5 2018 1 Detailed Coverage Information LION INSURANCE ICOMPANY IWC71949 INO I *Represents the Governing Class Code associated with the Named Insured on the policy, as reported by the Insurance Carrier, and is not validated as correct. Exemption Listings Exemption Holder Name - Click on the name(s) below to view more detailed information RAY BURKE Owner Election Listings No Owner Election of Coverage Listings Employer Name History Employer Name Name Type Change Date BURCORP LLC I Legal Icurrent Return to Search Page I https://apps8.fldfs.com/proofofcoverage/EmployerDetail.aspx?EmplD=00 1546294 8/7/2019 Proof of Coverage Page 1 of 1 WC Mobile App WC 1-101rie Search Our Data CFO Home Exemption Detail Page This database was last updated Wednesday, August 07, 2019 12:10 AM. Return to Previous Page Exemption Details Name Title Effective Date ;'Termination Date Exemption Type "Business Activities Employer Name _ Click Here to View RAY BURKE Mar 12 2019 Mar 112021 Construction Activities Listed on BURCORP LLC Exemption Click Here to View RAY BURKE ME Mar 12 2017 Mar 12 2019 Construction Activities Listed on BURCORP LLC Exemption - Click Here to View RAY BURKE ME Mar 13 2015 Mar 12 2017 Construction ! Activities Listed on BURCORP LLC Exemption Click Here to View RAY BURKE ME Mar 11 2013 Mar 11 2015 Construction Activities Listed on BURCORP LLC Exemption Click Here to View ` RAY BURKE ME Mar 10 2011 Mar 9 2013 Construction Activities Listed on BURCORP LLC Exemption Click Here to View RAY BURKE ME Mar 4 2009 Mar 4 2011 Construction Activities Listed on ! BURCORP LLC Exemption Click Here to View RAY BURKE ME Feb 28 2007 Feb 27 2009 Construction Activities Listed on ` BURCORP LLC Exemption Click Here to View RAY BURKE ME Nov 17 2004 Nov 17 2006 Construction Activities Listed on ' BURCORP LLC Exemption ........... ...... --'— ------ Click Here to View THREE W RAY BURKE PR Aug 29 1994 Dec 31 1999 Construction Activities Listed on ? CONSTRUCTION Exemption CORP Click Here to View THREE W RAY BURKE PR May 28 1992 May 28 1994 Construction ( Activities Listed on CONSTRUCTION Exemption CORP *Termination may be through the revocation of the exemption; or expiration of the exemption. **The exemption only applies to the business activities listed on the exemption. Return to Search Page https:Happs8.fldfs.com/proofofcoverage/ExemptionDetail.aspx?pr_person_id=037990250 8/7/2019 Florida Certified General & Roofing Contractors CGCO50931 CCC1328436 Certified HAAG Roofing Inspection Date: 6 Aug 2019 State of Florida Country of United States of America Before me this day personally appeared �'�� who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 5-0 Alt 4L Contracto Signature Sworn to or affirmed) and subscribed before me this -X- day of _ 20,e by /G •T Personally know Produced Identification Type of Identification Produced I Sharon Larkin ".•�'''� GommissW # GG043525 , "= Expires: W&F 31, 202i1 Bonded ihru Am" Me" Print, Type or Stamp Name of Notary P.O. BOX 540031 OPA-LOCKA, FL. 33054 " TEL:786-663-5900 ' EMAIL: BURCORP77@GMAIL. COM Notice to Owner - Workers' Com Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 nsation 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: 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; The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 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 The foregoing was acknowledge before me this day o—f- 7 c 20 `C . By µ C7�% h�v o is personal own to me or has produced as identification. y�o' Sharon Larkin Notary: z Comma # GG043525 Expires: ft* 31, 2020 SEAL: '''•,°! „��`' Bonded thN Aaron NOtary ROOF ASSEWLIES AND ROOFTOP STRUCTURES RECEIVED Fladda Buf dng Code 6th Edition (2017) High -Velocity Hurricane Zone Uniform Permit Application Form ALL 0 7 W 19 Section A (General Information) BY. Master Pernut No. Contractor's Name Ray Burke Job Address 3(gLNW 112Terrace 1 ROOF CATEGORY O Lot , Slope 0 Mechanically Fastened Tile X Monar/Adhes ae Sei ivies p 0 Asphaitic Shingles O - Metal Panel/Shingles O Wood Shing"Ishakes 0 Prescriptive BUR-RAS 150 1 ROOF TYPE i a Nev. roof 0 Repair D Maintenance M Reroofing 0 Aecovenng • • • � • • � � • • • 1 ROOF SYSTEM INFORMATION Low Slope Roof Area (SF)� Steep Sloped Roof AREA (SSF) 22Q0 Total (SF) 22 • 1. ••..•• i. • .....• •� Section H (Root Plan) • • • • • • • 0 Sketch Roof Plan: #tustraie all levels and sectionsroot drams, scuppers, overtim scuppers and overflow dra" include dim" • } sions of sections and levels, curly identity dimensions of elevated pressure zones and location of parapets• ..... • . • I • • . • • ...•.• .' • . • . • • .i • • . 90 . f 32 , 50 - RECEIVE AUG 0 7 2019 FLORIDA SUILONG CODE 1D 61iNG, 61h EDMON (20t7i ._._- _-- ' ,xa, j 469 DATE iF� F, I T V;t -t t Py DANCE WITH ALL FEDERAL f'JL S AND RFUJI.ATIONS Florida Building Code 6th Edition (2017) High -Velocity Hurricane Zone Uniform Permit Application Form RoofSystm mmrer. BORAL ROOFING LLC Notice of Number: 18-0809.16 Minimum Design Wind Pressures, N Appikoble (From RAS 127 or Calculations): PI: 39.1 P2. 68.1 P& 100.7 Maodrnum Design Pressure .... rom the NOA • Method of file sUars- 1- seat • .... .... ..... ...... ... . ..... . .... .. ...... : Steep Slowed Roof System Descrlwdon ....:. • • • . • • • • DN* Type. PLYWOOD MINIMUM 5/8" Roof Slope: 3 :12 Ridge VwMadon? NA Yvan Roof lls� 9' 30 ROOF FELT, POLYGLASS TU PLUS TILE UNDERLA NA NA & Spacing: 1.25" IRS NAILS, 1-5/8" TCAP, 2 RO 12" O.C. LAPS 1ts Type POLYFOAM i NA Coverk TILE Type & Ske Drip 3" X 3" 26 GAUGE Section E t-t COUNTY. "Delivering Excellence Every Day" Miami -Dade County HVHZ Electronic Roof Permit Form Section E (Tile Calculations) Method 1 "Moment Based Tile Calculations Per RAS 127" For Moment based file systems, use Method 1. Compare the values for Mr with the values from Mf. If the Mf values are greater than or equal to the Mr values, for each area of the roof, then the tile attachment method is acceptable. P 1: 9.1 x 315 = 12.15 - Mg: = Mr1: 817 < 6.1 NOA Mf P 2: x ;L 315 = 1.45 - Mg: Q = Mr2: 13.952 < 6.1 NOA Mf P 3: 100.7 x ;L 315 = 1.72 - Mg: = Mr3: 4.221 < ®1 NOA Mf . . .... ...... Method 3 "Uplift Based Tile Calculations Per RAS 127" • • • • ; • • • • • ...... .. . ...... For Uplift based tile systems use Method 3. Compare the values for F' with the values for Fr. If the F' values are grestertwin or equal to the Fr values, for each area of the roof, then the tile attachment method is acceptable. • • • • • • .... .... . . .... .... ..... P1:x1: xw: -W.- xCos 0: ...... ... . ..... Frl: ' " < NOAF .••.�• P2:x1:�=®xwO= -W:�=� x Cos 0: F-1 = Fr2: 5 :•• LOAF' ....:. P& x1:�=®xw = -W:�=� xCos 0:F-1=Fri:®5 •.: ;bAF • • Where to Obtain Information to complete file calculations Description Symbol Where to Find Design Pressure P1 or P2 or P3 Table 1 RAS 127, or by an engineer analysis prepared, signed and sealed by a professional engineer based on ASCE 7. Mean Roof Height H Job Site Roof Slope 8 Job Site Aerodynamic Multiplier X Product Approval (NOA) Restoring Moment due to Gravity Mg Product Approval (NOA) Attactiment Resistance Mf Product Approval (NOA) Required Moment Resistance Mr Calculated Mkiimum Attachment Resistance F Product Approval (NOA) Required Uplift Resistance Fr Calculated Average Tile Weight W Product Approval (NOA) Tie Dimensions w — A Product Approval (NOA) RE: Permit # Miami shores Village Building Department INSPECTION AFFIDAVIT 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 DATE: :�Lk .•.. I Ray Burke licensed as a (n) CoAmctoc / Engigeer / Architec4 • (Print name and circle License Type) License #: C <f4c:�_ % 3 2 ce,1<43�_ FS 468 Building Inspgrtgt • • ...... ... . On or about , I did personally inspect the'roof deck Aailin (Date & time) • • • work at 360 NW 112 Terrace • • • • • (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) u' 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. nd Sworn to and subscribed before me this Notary Public, Sate of Florida at Large of , DO M `,,�� ,,,, BRITNEY BLAKE ` State of Florida- Notary Public _. Commission M FF 222162 zt,,� �c My Commission Expires '>>,°;;,;��` April 20, 2019 'General, Building, Residential, or Roofing Contractors or any individual certified under 468 F.S. to make such an inspection. Include photographs of each plane of the roof with permit # and address # dearly shown marked on the deck for each inspection 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 10050 NE 2nd Ave Miami Shores, FI 33138 Re: Owner's Name: Jo Anne M Cash 'P. �t .Date: ... ..... ...... ... ...... • • • • • • Property Address: 360 NW 112 Terrace • • • • .. Roofing Permit Number: Dear Building Official: .0000 •••••• • • • . • • • • I..► .� f �l certify that I am not required to retrofit the roof to wall connections of my building because: o 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 of the South Florida Building Code (1994 SFBC) �Z&4_ i&V4a4-Jo Anne M Cash S+Lk a 1rt Si are Print Name State of Florida County of Dade The undersigned, being the first duly swom, deposes and says that he/she is the owner for the above property mentioned, Sworn to and subscribed before me this &@r,6 day of JMM(J,.4" Notary Public, Sate of Florida at Large BRITNEY BLAKE State of Florida -Notary Pub Commission # FF 222162 My Commission Expires April20, 2019 When the just valuation of the stricture for purpose of ad valorem taxation is equal to or more than $300.000.00, and the building was not constructed with F8C 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 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. To: Miami -Dade County Building Department 11805 Coral Way, Suite I 1 Miami, FL 33175 Re: Owner's Name Jo Anne M Cash Property Address 360 NW 112 TER MIAMI SWHORES FL 33168 .... . . ••.• ••••.• Roofing Permit Number • 0 0 • • 6 •0 • .... .... . . Dear Building Official: • • • • • • • • • • • • • 1 RAY BURKE certify that the roof decking attachment Q. r#§teners h#ve been • .9 • strengthened and corrected and a secondary water barrier has been provided as $egttirdd by the `Manual...;. of Hurricane Mitigation Retrofits for Existing Site -Built Single Family Sh4tuV�' adopted by the • Florida Building Commission by Rule 9B-3.047 F.A.C. " • ' ' • ' . . 0.9 Qualifying Agent .2AG� r3Gl��' Sign ure of Qualifying Agent RAY BURKE Print Name STATE OF FLORIDA COUNTY OF MIAMI-DARE Sworn to and subscribed before me this 30 day of Gf ! , 20 1 (SEAL) * 4: r Commission # 0000525 � / Expires: October 31, 21M0 'ersonatly known '�n„� �� • Boned *u MM or Produced Identification C:06-b i SenmpMallMy Door® \SmtisbwGophi_z\aoofmgnfanva Camgdi 91.601Fdlabkdm SECTION 1524 HIGH VELOCITY HURRICANE ZONES — REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS 1524.1 Scope. As it pertains to the section, it is the responsibility of roofing contractor to provide the owner with the required roofing permit, and to explain to the owner the content of the section. The provisions of Section R4402 govern the minimum requirements and standards of the industry for roofing system installations. Additionally, the following items should be addressed as part of the agreement between the owner ant the contractor. The owner's initial in the designated space indicates that the item has been explained. .•.. 2. Renailing wood decks: When replacing roofing, the existing I+ooV-roof deck w have to---:- b ensiled in accordance with the current provisions of Section R4403. (The reof deck is j t Ally • • concealed prior to removing the existing roof system). .... .... . . 4. ' Exposed Ceiling: Exposed, open beam ceilings are where the.undetside of fha roof decking:.. Xv—iewcd from below. The owner may wish to maintain the architectural appearance; therefore, • • • • • • roofing nail penetration of the underside of the decking may not be acceptalle'lItig provides the option of •, maintaining the appearance. ...:. 6. Overflow scuppers (wall outlets): It is required that rainwater flows off so that the roof is overloaded from a buildup of water. Perimetededge wall or other roof extension 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 Sections R4402, R4403 and R4413. I&-,— 'li4mi q caner/Agent's Signature Date Condor Signature Date ,aA) kLJ 112, %✓-- Property Address Permit Number Revised on 7/9/2009 LD;07/01/2015; MIAMI--DADS COUNTY ka PRODUCT CONtROL SECTION DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES (RER) 11805 SW 26 Street, Room 208 BOARD AND CODE ADMINISTRATION DIVISION Miam% Florida 33175-2474 T (786) 315-2590 F (786) 315-2599 NOTICE OF ACCEPTANCE (NOA) www.miamidaae.Eov/economy 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 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 j. . . .... ...... This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product Contra Section'. . .... .. . ...... (in Miami -Dade County) and/or the AHJ (in areas other than Miami -Dade County) reservVJt0jj0t to have this product or material tested for quality assurance purposes. If this product or material fails to.por%rm in the accepte0" ": 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 rigUfUlevokdtttiS *cept&10e,6 if it is determined by Miami -Dade County Product Control Section that this product or material fails to meef the " . . requirements of the applicable building code. � • � This product is approved as described herein, and has been designed to comply with the Florida. Build*MJ t!o 0 • 0 • dde including the High Velocity Hurricane Zone of the Florida Building Code. • • . . • • • • DESCRIPTION: Boral Villa 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. TERNUINATION 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 revises NOA No.16-0711.04 and consists of pages 1 through 7. The submitted documentation was reviewed by Freddy Semino 8 NOA No.:184609.16 Expiration Date: 09lZ1/21 Approval Date: 06R8118 Page 1 of 7 ROOFING ASSEMBLY APPROVAL Category Roofing Sub Category: Roofing Tiles Material: Concrete 1. SCOPE This renews a system using Boral Villa 900 Concrete Roof Tile, as manufactured Boral Roofing, LLC in Lake Wales, FL and described in Section 2 of this Notice of Acceptance. For locations where the pressure requirements, as determined by applicable Building Code, do not exceed the design pressure values obtained by calculations in compliance with RAS 127 using the values listed in section 4 herein. The attachment calculations shall be done as a moment based system. . . . .... ...... 2. PRODUCT DESCRIPTION ' Manufactured by Test Applicant Dimensions Specifications Boral Roofing Villa 900 Length = 17" TAS 112 Width = 13" Type I '/z"thick Class III Trim Pieces 1= vanes TAS 112 w = varies varying thickness 2.1 PRODUCTS MANUFACTURED BY OTHERS Product Name ICP Adhesives Polyset* AH-160 TILE BONDTM Roof Tile Adhesive "Tile Tite" Roof Tile Mortar DAP Foam Touch N Seal StormBonds' 2 Roof Tile Adhesive Product Description Two component polyurethane foam adhesive. ...... .. . ...... .P]T&Ct Desarr tion .... Low profile, interlocking, high �re's'sure ext2G'de f . .... . . . . ... concrete roof tile eq}pppp8 with t�reg pail hale ; • and double rolls. Fos direst deck, batten, mortar • or adhesive set applications. • • • • : • Accessory trim, cort"wt� Coof pieces for use "-( • • ridges, hips and rakes. '....' Single component polyurethane foam roof tile adhesive. Premixed, pre -bagged roof tile mortar. Two component polyurethane foam adhesive. 2.2 MANUFACTURING LOCATION 21.1. Lake Wales, FL Manufacturer (With Current NOA) ICP Adhesives and Sealants, Inc. The Dow Chemical Company Bermuda Roof Co. Inc. The Dow Chemical Company NOA No.: 18-0509.16 Expiration Date: 09/21/21 Approval Date: 06/28/18 Page 2 of 7 2.3 EVIDENCE SUBmirr D Test Agency Nutting Engineers Redland Technologies Redland Technologies Redland Technologies The Center for Applied Engineering, Inc. The Center for Applied Engineering, Inc. Redland Technologies Redland Technologies The Center for Applied Engineering, Inc. The Center for Applied Engineering, Inc. The Center for Applied Engineering, Inc. Celotex Corporation Testing Services Walker Engineering, Inc. Walker Engineering, Inc. Walker Engineering, Inc. Walker Engineering, Inc. Walker Engineering, Inc. Walker Engineering, Inc. Walker Engineering, Inc. American Test Lab of South Florida Test Identifier 13343.1 7161-03 Appendix III 7161-03 Appendix II P0402 94-060B 94-084 P0631-01 Letter Dated Aug. 1, 1994 Project No. 307025 Test #MDC-76 25-7183-1 25-7183-2 25-7214-2 25-7214-6 528454-2-1 520109-2 Evaluation Calculations Evaluation Calculations Evaluation Calculations Evaluation Calculations Evaluation Calculations Evaluation Calculations Evaluation Calculations RT0617.02-16 Test Name/Renort TAS 112 Static Uplift Testing TAS 102 & TAS 102(A) Wind Tunnel Testing TAS 108 (Nail -On) Withdrawal Resistance Testing of screw vs. smooth shank nails Static Uplift Testing TAS 101 (Adhesive $et) . Static Uplift Testin' TAS 101 (Mortar Sefl: • Wind Tunnel Testing• • • TAS 108 (Mortar Sett " ...... Wind Tunnel Testing .. • TAS 108(Nail-Oq)•;•; Wind Driven Rai; TAS 100 Static Uplift Testing TAS 102 (2 Quik-Drive Screws, Direct Deck) Static Uplift Testing TAS 102 (1 Quik-Drive Screw, Direct Deck) (1 Quik-Drive Screw, Battens) Static Uplift Testing TAS 101 25-7183 25-7094 25-7496 25-7584 25-7804b-8 25-7804-4 & 5 25-7848-6 Aerodynamic Multipliers Two Patty Adhesive Set System Restoring Moment Due to Gravity TAS 112 Date Apr. 2006 Dec. 1991 Dec. 1991 Sept. 1993 March, 1994 .... ...... "May 1994 • • .. .... % 600I* 1994••••: 00000 Aug. i qqA .... . . . . ••C6.199,4 .. • • • Yeb. 1995 March, 1995 Sep. 1998 Dec. 1998 March 1995 February 1996 April 1996 December 1996 09/01/16 April 1999 09/01/16 06/29/16 NOA No.:18-0509.16 Expiration Date: 09/21/21 Approval Date: 06=118 Page 3 of 7 2.3 EVIDENCE SUBMITTED Test Agency Test Identifier Test Name/Report Date PRI Construction Materials COPO-002-02-11 Static Uplift Testing 10/12/2016 Technologies TAS 101 (Adhesive Set) PRI Construction Materials COPO-002-02-04 Static Uplift Testing 10/12/2016 Technologies TAS 101 (Adhesive Set) PRI Construction Materials COPO-002-02-03 Static Uplift Testing 10/12/2016 Technologies TAS 101 (Adhesive Set) 3. LmrrATIONS: 3.1 Fire classification is not part of this acceptance. 3.2 For mortar or adhesive set tile applications, a static field uplift test shall be performed in accordmeg with TAS 106. . . .... ...... 33 Applicant shall retain the services of a Miami -Dade County Certified Laboratorysto, perform gtWerly tesu ub . accordance with TAS 112, appendix `A'. Such testing shall be submitted to the'BAtlding Code Compliggce. Office for review. .... .... ..... 3.4 Minimum underlayment shall be in compliance with the applicable Roofing Appheptions•Standards Wed section 4.1 herein. .. .. .. ...... . . . . ...... 3.6 This acceptance is for wood deck applications. Minimum deck requirements shall be in 4ppptiance�with applicable building code. 4. INSTALLATION 4.1 Villa 900 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 (Ibf) Length -I (ft) Width-w (f't) Villa 900 Concrete Tile 10.90 1.42 1.08 Table 2: Aerodynamic Multipliers - X (ft3) Tile Profile 2. (ft3) Batten Application A (ft3) Direct Deck Application Villa 900 Concrete Tile 0.291 0.315 Table 3: Restoring Moments due to Gravity - Mg (fL4bf.) Tile Profile 2":12" 3":12" 4":12" 5":12" 6":12" 7":12" or greater Villa 900 Concrete Tile Direct Deck Direct Deck Battens Direct Deck Battens Direct Deck Battens Direct Deck Battens Direct Deck 7.70 7.62 6.56 7.50 6.42 7.34 6.26 7.15 6.08 6.95 NOA No.: 184)509.16 Expiration Date: 09/21/21 Approval Date: OVUM Page 4 of 7 Table 4: Attachment Resistance Expressed as a Moment - Mf (ft-ibf) for Mechanically Fastened Systems Tile Fastener Type Direct Deck Direct Deck Battens Profile (min 15132" plywood) (min. 19132" plywood) Villa 900 2-10d Ring Shank Nails 27.8 37.4 28.8 Concrete Tile 1-10d Smooth or Screw 8.8 11.8 4.1 Shank Nail 2-10d Smooth or Screw 16.4 21.9 7.1 Shank Nails 1 #8 Screw 25.8 25.8 22.9 2 #8 Screw 47.1 47.1 .... 49.1 1-10d Smooth or Screw 24.3 24.3: • ...... 4.2 .... Shank Nail Field Clip) • • • • • • • 1-10d Smooth or Screw 19.0 19.0:" " ' 22.1 ""' Shank Nail Eave Clip)• • • • • • 2-10d Smooth or Screw 35.5 35.5'..... '....34.8 ..... Shank Nails Field Clip)' 2-10d Smooth or Screw 31.9 31.90• .. • •32.2 • • • •; Shank Nails Eave Clip) :":': '. Table 5: Attachment Resistance Expressed as a Moment Mt.(4i4bf) . .. :' "' for Two Paddy Adhesive' Set Systems • • • • Tile Tile Application Minimum Attachment Profile Resistance Villa 900 Concrete Tile The Dow Chemical Company TileBond 26.12 ICP Adhesives PolysetO AH 160 two- 26.13 component foam DAP Foam Touch N Seal StormBond ®2 Roof 55 4 Tile Adhesive two-com Went foam 1 See foam adhesive manufacturer's component approval for installation requirements. 2 The Dow Chemical Company TileBond one -component foam, minimum weight per paddy 11.4 grams. 3 ICP Adhesives Polyset® AH-160 two -component foam, minimum weight per paddy 8 grams. 4 DAP Foam Touch N Seal StormBond ®2 Roof Tile Adhesive, average weight per paddy 8 grams, two component foam. Table 6: Attachment Resistance Expressed as a Moment - Mf (ft-lbf) for Single Paddy Adhesive Set Systems Tile Tile Application Minimum Attachment Profile Resistance Villa 900 Concrete Tile ICP Adhesives PolysetO AH-160 two -component foam 86.615 ICP Adhesives PolysetO AH-160 two -component foam 45.5 6 DAP Foam Touch N Seal StormBond ®2 Roof Tile 407 Adhesive DAP Foam Touch N Seal StormBond ®2 Roof Tile 708 Adhesive NOA No.: 18-0509.16 Expiration. Date: MUM Approval Date: 06/28/18 Page 5 of 7 r 5 Large paddynt of minimum 54 grams. 6 Medium paddy placement of minimum 24 grams. 7 Medium paddy pLacement of minimum 30 grams. 8 Large paddy placement of minimum 60 grams. Table 7: Attachment Resistance Expressed as a Moment - Mf (ft-lbf) for Mortar Set Systems Tile Profile Tile Application Attachment Resistance Willa 900 Concrete Tile Mortar Sets 20.60 Tile-Tite Roof Tile Mortar. •Y•• • • •••• Y••••• •Y • Yr • • 5. LABELING ,,,;,, 5.1 ••••.• All tiles shall bear the imprint or identifiable marking of the manufacturer's naiifeY8s logo,a'§•dftled ifelow,• or following statement: "Miami -Dade County Product Control Approved" 000 66VOS •••••• • 00 •••••• 0.4 i i i •••• LABEL FOR BORAL VILLA M CONCRETE TILE (LOCATED ON THE UNDERSIDE OF TILE) 6. BuILDING PERmrr 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 Building Official or Applicable building code in order to properly evaluate the installation of this system. NOA No.: 18-0509.16 Expiration Date: 09/21/21 Approval Date: 06/28/18 Page 6 of 7 +P • 1" M. PROFILE DRAWING `�- 11/2" VILLA 900 CONCRETE ROOF TILE END OF THIS ACCEPTANCE NOA No.:18-0509.16 Expiration Date: 09/2121 Approval Date: 0628/18 Page 7 of 7 4225 SW 71 Ave, Miami. FI 33155 Tel: 786-398-9179 Fax: 786-800-2627 a roofinspection(Mgmail.com LAB CERTIFICATION #16-0510.15 SITE SPECIFIC INFORMATION UPLIFT TEST - TAS #106 04/06/2020 Roofing Contractor BURCORP LLC Job Address 360 NW 112TH TER Miami Shores, FL 33168 Owner's Name JO ANNE CASH Type of Tile ENTEGRA Approximate Roof Height 12' feet Roof Pitch 4/12 Approximate Square Footage of Roof 19 ftZ Date Tested 04/04/2020 Number of Tests 36 Contact Name REY Permit # RF-08-19-1821 Date Installed Type of Access to Roof LADDER Required Testing Force 35 Lbs Testing Equipment F.G.E.100 Phone # 786-663-5900 LOCATION # OF TEST PASS # OF TEST FAIL Corner 7 Tests 7 Pass Test Fail Perimeter 8 Tests 8 Pass Test Fail Field 19 Tests 19 Pass Test Fail Ridge 2 Tests 2 Pass Test Fail TOTAL 36 Tests 36 Pass 0 Test 0 Fail IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL PA 106, THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPUFT QUALITY CONTROL TEST. THIS TAS 106 TEST HAS BEEN PERFORMED IN FULL ACCORDANCE TO THE REQUIREMENTS OF DADE COUNTRY, WITH NO DEVIATIONS. THIS REPORT IS NOT GUARANTEED IN CASE OF CASE OF NATURAL DISASTERS. THIS REPORT IT IS NOT VAUD FOR INSURANCE CLAIMS. j 1°LEYVA ''-PE•67416' Bill lmmi amo NOTICE OF COM�I+ MEMu ENI a s' ps (1g 3 9 (ARE,(HORDE!) COPY MUST UYEllSMOKTIIEJCWSFMATnWOFF7RSiIlW r:. ...R'livml CLERK F s � NOTICE OF CONEWENCEMff MUST BE FILED r # ANI—DARE CDLc W. + Y - FL£?r+MA IF THE JOB VALUAT ON 15 S 2,SY M OR MORE iN LABOR AND MATERIAL. PLEASE FILE AT 22 NW ISTS'iRE T, IST FLOOR, MIAtlfi, RLtflMA P" 27S-1155