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RF-12-20-2793, 65 NW 110th StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 65 NW 110TH ST, Miami Shores, FL 33168 1121360030590 Contacts ODETTE BARTHELEMY Owner DM ROOFING COMPANY INC Contractor 65 NW 110 ST, MIAMI SHORES, FL 331684318 DENIS MARTINEZ Other: 3057579851 1951 NW 141, OPALOCKA, FL 33051 Business: 3056847587 DMROOFINGCO@GMAIL.COM Mobile: 7862673066 ......... Description: TILE AND FLAT RE -ROOF TO RENEW � Valuation: $ 6,000.00 Inspection Requests PERMIT#RF 10 15 2733 f7 76 } Total Sq Feet: 1,300.00 Fees Amount 100% Permit Renewal Fee $225.00 Application Fee - Other $50.00 Total: $275.00 Building Department Copy Payments Date Paid Amt Paid Total Fees $275.00 Check # 4370 02/03/2021 $225.00 Check # 4293 12/04/2020 $50.00 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, I authorize the above named pontractor to;tg he work stated. --- - 3 5`- l Authorized Signature: Owner / Applicant / Contractor / Date February 03, 2021 Page 2 of 2 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 65 NW 110TH ST, Miami Shores, FL 33168 1121360030590 Contacts ODETTE BARTHELEMY Owner DM ROOFING COMPANY INC Contractor 65 NW 110 ST, MIAMI SHORES, FL 331684318 DENIS MARTINEZ Other: 3057579851 1951 NW 141, OPALOCKA, FL 33051 Business: 3056847587 DMROOFINGCO@GMAIL.COM Mobile: 7862673066 Description: TILE AND FLAT RE -ROOF TO RENEW Valuation: $ 6,000.00 Inspection Requests- PERMIT#RF-10-15-2733 305 762 4949' Total Sq Feet: 1,300.00 Fees Amount 100% Permit Renewal Fee $225.00 Application Fee - Other $50.00 Tota I : $275.00 Payments Date Paid Amt Paid Total Fees $275.00 Check# 4370 02/03/2021 $225.00 Check # 4293 12/04/2020 $50.00 Amount Due: $0.00 Applicant Copy For Inspections, Call (305) 762-4949 or Log on at https://bidg.miamishoresvillage.com/cap/. Requests must be received by 3pm for following day inspections. NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER additional restrictions applicable to this property that may be found in the GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, public records of this county. STATE AGENCIES, OR FEDERAL AGENCIES. February 03, 2021 Page 1 of 2 `ysORes � `�'10141Dp' Project Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Expiration: 4/2 /2 1 Applicant 65 NW 110 Street 1121360030590 Miami Shores, FL 33168- Block: Lot: ODETTE BARTHELEMY Owner Information Address ODETTE BARTHELEMY 65 NW 110 Street MIAMI SHORES FL 33168-4318 Contractor(s) Phone Cell Phone WPH CONSTRUCTION COMPANY (305)244-2392 Type of Work: Re Roof Additional Info: Classification: Residential Scanning: 3 Fees Due Amount CCF $3.60 DBPR Fee $4.13 DCA Fee $4.13 Education Surcharge $1.20 Permit Fee - New Roof $275.00 Scanning Fee $9.00 Technology Fee $4.80 Total: $301.86 Phone Cell (305)757-9851 Valuation: $ 6,000.00 Total Sq Feet: 1300 Pay Date Pay Type Amt Paid Amt Due Invoice # RF-10-15-57566 10/27/2015 Check #: 652 $ 301.86 $ 0.00 Avauame Inspections: Inspection Type: IUp Lift Report Tin Cap n Kenailing Hmoavit Review Building Cap Sheet 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 zokj+TarFtithermore..l Whorize the above -named contractor to do the work stated. October 27, 2015 Authorized Signature: Owner / �plicant / Contractor / Agent uate Building Department Copy October 27, 2015 1 ;>-,\-, Miami Shores Village �c IVE:n 1��w� Building Department =z' 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 :B Tel: (305) 795-2204 Fax: (305) 756-8972�° INSPECTION LINE PHONE NUMBER: (305) 762-4949 / FBC 20 (� tQ BUILDING Master Permit N - At PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION @LNEWAL ❑PLUMBING ❑ MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: (n c:r-, ` \ Q �� • 2 City: Miami Shores County: Miami Dade Zip: J'7�), (D<K Folio/Parcel#: u- ala�� Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: 4Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): C� 'A-A-h.Q1^eWM,4 Phone#: Address: (4S p )j 1.)_� City: Mi. CwyM% - hQA-fS State: CZip: 2,31 (D Tenant/Lessee Name: Phone#: Email: 'Dmy o+�')O, Co (r�.G Ana CONTRACTOR: Company Name: (��l],� Q / i�� i.z�1�(�-1�G1 �f1�t WW-. Phone#: % gi0• aID1-!zj0 bCe Address: 1 �uQ l MAJ (41 AVe-. 0 City: k-a State: Zip: 330 S LI Qualifier Name: �jS,_ar�-1 Y�"Z Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 6 Q00 . (�C!� Square/Linear Footage of Work: -a'c)c> z Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Permit Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ CCF $ DBPR $ CO/CC $ Notary $ Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ L � 63 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 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 OWNER or AGENT The foregoing instrument was acknowledged before me this day of N 20 c t) by ek, 2�21M� who is p sonally kn n to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: `-•.., LISSME MARY ALVAREZ Seal: !': Notary Public -State of Flonda commission * H14.015968 orn My Comm. Expires Jo 26. 2024 Bonded through Nation; Notary Assn. Signature_�i� ;o CONTRACTOR The foregoing instrument was acknowledged before me this \ S day of Q\JeA1Ab 4' 20 , by 'tom fflat V1 (U 2 _ who is pe onally kno to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: LISSME MARY ALVAREZ P Seal; Notary Public - State of Flcr da top PIN Commission ; HH 015988 ora° My Comm. Expires Ju! 26. 2024 Banded through Natiorai Notary Assn, APPROVED BY �y Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Property Search Application - Miami -Dade County Page 1 of 1 OFFICE OF THE PROPERTY APPRAISER ".' . Summary Report Property Information Folio: 11-2136-003-0590 Property Address: 65 NW 110 ST Miami Shores, FL 33168-4318 Owner ODETTE BARTHELEMY &H JOSEPH Mailing Address 65 NW 110 ST MIAMI SHORES, FL 33168-4318 PA Primary Zone 0800 SGL FAMILY - 1701-1900 SQ Primary Land Use 0101 RESIDENTIAL -SINGLE FAMILY: 1 UNIT Beds / Baths / Half 3/1/0 Floors 1 Living Units 1 Actual Area 1,188 Sq.Ft Living Area 1,188 Sq.Ft Adjusted Area 1,148 Sq.Ft Lot Size 9,150 Sq.Ft Year Built 1940 Assessment Information Year 2020 2019 2018 Land Value $206,472 $206,472 $196,886 Building Value $79,901 $79,901 $79,901 XF Value $2,394 $1,190 _ $1,207 Market Value $288,767 $287,563 $277,994 Assessed Value $91,403 $88,540 $86,890 Benefits Information Benefit Type 2020 2019 2018 Save Our Homes Assessment $197,364 $199,023 $191,104 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 36 52 41 MIAMI SHORES EXT PB 43-40 LOT 27 BLK 220 LOT SIZE 75.000 X 122 OR 18740-1322 08 1999 4 Generated On : 12/4/2020 Taxable Value Information 2020 2019 2018 .................. __....._...._.._ ...........__ County Exemption Value $50,000 $50,000 $50,000 Taxable Value 1 $41,403 $38,540 $36,890 School Board Exemption Value $25,000 $25,000 $25,000 Taxable Value $66,403 $63,540 $61,890 _,.,,,,_ _............. _......... ...... City Exemption Value 1 $50,000 $50,000 $50,000 Taxable Value $41,403 $38,540 $36,890 Regional Exemption Value $50,000 F $50,000 $50,000 Taxable Value $41,403 $38,540 $36,890 Sales Information Previous OR Book- Price Qualification Description Sale Page 18740- Sales which are disqualified as a result of 08/01/1999 $0 1322 examination of the deed 16185- ........_._._ __.__________.._... Sales which are disqualified as a result of 12/01/1993 $0 0212 examination of the deed 15800- Sales which are disqualified as a result of 01/01/1993 $0 2443 examination of the deed 12857 04/01/1986 1 $54,000 Sales which are qualified 0921 The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at hftp://www.miamidade.gov/info/disclaimer.asp https://www.miamidade.gov/Apps/PA/propertysearch/ 12/4/2020 Ron DeSantis, Governor Halsey Beshears, Secretary dbpr a STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE ROOFING CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES MARTINEZ, DENIS DM ROOFING COMPANY, INC.' Q` 13491 NW 47 AVE OPALOCKA FL 33054' LICENSE NUMBER CCC13311\91 EXPIRATION DATE: \AUGUST 31, 2022 Always verify licenses online at MyFloridaLicense.com [oil �F' .gyp Do not alter this document in any form. fF �yry • T This is your license. It is unlawful for anyone other than the licensee to use this document. 1 0 Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7300333 BUSINESS NAME/LOCATION DM ROOFING COMPANY INC 13491 NW 47TH AVE OPALOCKA, FL 33054 OWNER DM ROOFING COMPANY INC DENIS MARTINEZ, QUALIFIER Worker(s) EXPIRES SEPTEMBER 30, 2021 Must be displayed at place of business 0 ' 5 Pursuant to County Code Chapter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS PAYMENT RECEIVED 196 SPECIALTY BUILDING BY TAX COLLECTOR CONTRACTOR 45.00 09/16/2020 CCC1331191 CREDITCARD-20-076970 RECEIPT NO. RENEWAL 7590118 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec ga-276. M!IAMFor more information, visit www.miamidade.govAmallector -1 ®I ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 6/1/2020 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 have ADDITIONAL INSURED provisions or 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 Plymouth Insurance Agency 2739 US H 19 North CONTACT NAME: PLYMOUTH INSURANCE AGENCY PHONE 727-682-4040 FAx (A/ No Ezt: ac,ND:877-491-7980 IL ADDRESS: CERTS@PLYMOUTHINSURANCEAGENCY . COM Holiday, FL 34691 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Security National 19879 INSURED DM Roofing Company, Inc INSURER B INSURER C 631 W 60th St INSURER D INSURER E Hialeah, FL 33012 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR wVO POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD/YVYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000, 000 CLAIMS -MADE C OCCUR PREMISES Ea occurrence $ 100, 000 MED EXP (Any one person) $ 5,000 A SES1792599 00 5/27/2020 5/27/2021 PERSONAL&ADV INJURY $ 1,000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2, 000, 000 X POLICY CI PRO LOC PRODUCTS - COMP/OPAGG $ 2,000, 000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANYAUTO OWNED AUTOS SCHEDULED AUTOS ONLY BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE IED7 I RETENTION $ $ WORKERS COMPENSATION EMPLOYERS' LIABILITY Y/N SEA STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETOl"PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? C� N/A E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Roofing Company - Residential and Commercial Roofing Contractor CCC1331191 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE +�+IJ.ef/ WL.+✓ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD25(2016/03) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DAT) E/25/2G20 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 have ADDITIONAL INSURED provisions or 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 SUNZ Insurance Solutions, LLC. ID:(Trion Solutions) c% Trion Solutions Inc 888 W Bigg Beaver Road, Suite 1000 Troy, MI 3084 NAME: ONTACT Lauren Vihtelic aExt: - -c No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURERA: SUNZ Insurance Company 34762 INSURED Trion Solutions Inc. Co -Employer for Client Listed Below" 888 W Big Beaver Road, Suite 1000 INSURER B : INSURERC: INSURER D: INSURER E : Troy MI 48084 INSURER F : COVERAGES CERTIFICATE NUMBER: 57766171 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER LICY EFF MMDD/YYYY POLICY EXP MM DD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TO RENTE Eaoccurence $ —PREMISES MED EXP (Any one person) $ PERSONAL & ADV INJURY $ AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ GEN'L POLICY PRO JECT ❑ LOC PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO J OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ $ 1 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE WCO26-00001-020 WCO26-00001-019 9/30/2020 9/30/2019 9/30/2021 9/30/2020 / 1 PER STATUTE OERH E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A E.L. DISEASE - IA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 GOO 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Coverage provided for all leased employees but not subcontractors of: Ameritemps Employment II Effective date: 12/25/2017 DM Roofing Company, Inc. I IUN 2261 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 Ne 2nd Ave Miami Shores FL 33138 AUTHORIZED REPRESENTATIVE Rick Leonard ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 OCT 2 72015 INSPECTION LINE PHONE NUMBER: (305) 762-4949 S FBC 20 ( L( BUILDING Master Permit No. '� a PERMIT APPLICATION Sub -Permit No. �-' tS — 2433 ❑BUILDING ❑ ELECTRIC V�800FING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS [:]CHANGE OF [:]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: r`1 5r-- / / 0 &r� City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleh Address: e#: j GIS- aq L4 If Z'� rl" City: /J , .. tate: L Zip: 3 qf Tenant/Lessee Name: _ Phone#: Email r� a CONTRACTOR: Company Name: � �I rr p `�"C�t= Phone#: J a) L Address: City: Chil'a- t L, State: Zip: / Z Qualifier Name: t \l� tip I State Certification or Registration #: C�-_ t of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: l3 J 0 Type of Work: ❑ Addition ❑ Alteration r❑ New Repair/Replace ❑ Demolition Description of Work: N`� �..� iz �% l 'ari ? �� n It } ap Specify color of color thru tile:. Submittal Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Permit Fee $ CCF $_ Radon Fee $ DBPR $ Training/Education Fee $ CO/CC $ Notary $ Double Fee $ Bond $ G TOTAL FEE NOW DUE $ V (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 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. -da)AA.1 "' Signatur I a or AGENT The foregoing instrument was acknowledged before me this day of 20 by QpL7TL- who is personally known to me or who has produced `FL `- Zi � Uk-`ZKN gas identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Signature ON AACTOR The foregoing instrument was acknowledged before me this 260— day of 20 (5 by (,S t:�41-61 is personally known to me or who has produced 'D)V—l\KCL CIC,-N identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: Seal: t '�. Notary Puniic State of Florida ao �n ovary AlV c State of Florida Seal: Sindia Alvarez r° c Sindia Alvarez o!c My Commission FF 156750 c My Commission FF 156750 of Expires 09/03/2018 OF Q Expires 09103/201 B ****************** ************* Cb I *^****f***************************************************************** APPROVED BY Plans Examiner Zoning Structural Review (Revised02/24/2014) Clerk STATE OF FLORIDA -_ DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY EXEMPTION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE DATE: 10116/2014 EXPIRATION DATE: 10/15/2016 PERSON: HENRY WILSON P FEIN: 204782503 BUSINESS NAME AND ADDRESS: WPH CONSTRUCTION COMPANY 16724 NE 12 AVE MIAMI FL 33162 SCOPES OF BUSINESS OR TRA LICENSED BUILDING LICENSED ROOFING CONTRACTOR CONTRACTOR STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CCC1327679 ISSUED: 08/10/2014 R CERTIFIED ROOFING CONTRACTOR HENRY, WILSON P ` WPH CONSTRUCTION COMPANY �. M�F IS CERTIFIED under the M Expirationdate : AUG31,2015 Provisions of Ch.489 FS. < L1408100002073 e STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY EXEMPTION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE DATE: 10116/2014 EXPIRA71ON DATE: 10/15/2016 PERSON: HENRY WILSON P FEIN: 204782503 BUSINESS NAME AND ADDRESS: WPH CONSTRUCTION COMPANY I i 15724 NE 12 AVE ' -MIAMI FL 33162 SCOPES OF BUSINESS OR TRA LICENSED BUILDING LICENSED ROOFING CONTRACTOR CONTRACTOR m 002469 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 5903233 BUSINESS NAME/LOCATION RECEIPT NO. WPH CONSTRUCTION COMPANY RENEWAL 39 NW 166 ST STE 5 6157820 MIAMI FL33169 EXPIRES SEPTEMBER'30, 2016 Must be displayed at place of business Pursuant to County Code Chapter8A - Art. 9 & 10 SEC. TYPE OF BUSINESS OWNER PAYMENT RECEIVED WPH CONSTRUCTION; COMPANY 196 SPECIALTY BUILDING CONTRACTOR BY TAX COLLECTOR CCC1327679 Worker(s) 2 $75.00 09j24J2015 CREDITCARD-15-049199 This iocal8u rinses lax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit or a cootification of the holder's qualifications, to do business. Holder must comply wfM any govermrmerrtal or nongovernmental regulatory laws end requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec ga-276. for mesa information, visit www.miamidade.ggvhexcgllector 002683 Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOTA BILL DO NOTPAY 6160394 \ILBT� BUSINESS NAME/LO CATION RECEIPT -IOU' GA ri' WPH CONSTRUCTION COMPANY RENEWAL SEPTEMBER 30, 2016 39 NW 166 ST STE 5 6424386 Must be displayed at place of business MIAMI FL 33169 Pursuant to County Code Chapter 8A — Art. 9 & 10 OWNER SEC. TYPEOF-tF Yt4HOLr" WPH CONSTRUCTION COMPANY 196 GENERAL BUILDING CONTRACTOR PAYMENT RECEIVW CBC1255356 BY TAX COLLECTOR Worker(s) 1 $75.00 09/24/2015 CREDITCARD-15-049199 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernme mal regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial "veliibibs - tdlfamr=J6md�,Srob.Teen��?TJ; For more information, visit www.miamidade.gov/taxcollector CERTIFICATE OF LIABILITY INSURANCE DAO /12/155 PRODUCER Annette Willis Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 18401 N.W. 27 Ave ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Miami, FL 33056 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (305) 625-2403 Fax (305) 625-6472 INSURERS AFFORDING COVERAGE NAIC # INSURED WPH CON TRUCTION COMPANY INSURERA: Seneca Speciality Insurance Company INSURER B: 15724 NE 12 AVE INSURER C: NORTH MIAMI BEACH, FL 33162 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRLTR L ADD'L I D TYPE OF INSURANCE POLICY NUMBER DATE (M EFFECTIVE p TE MEXPIRATION)m LIMITS /4 ❑ GENERAL LIABILITY ® COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS MADE © OCCUR © 500 deductible per claim- ❑ GEN'L AGGREGATE LIMIT APPLIES PER: © POLICY ❑ PROJECT ❑ LOC BAG-1010158-1 01/11/2015 01/11/2016 EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence 100,000 MED EXP (Any one person) 5,000 PERSONAL & ADV INJURY 1,000,000 GENERAL AGGREGATE 2,000,000 PRODUCTS - COMP/OP AGG 2,000,000 ❑ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS ❑ COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) ❑ GARAGE LIABILITY ❑ ANY AUTO ❑ AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG EXCESS / UMBRELLA LIABILITY ❑ OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION $ EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LUOLITY YIN ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? (Mandatory in NH) Ifyes describe under SPEG�IAL PROVISIONS below ❑ WC STATU- ❑ OTH- E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS GENERAL CONTRACTOR CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL MIAMI SHORES VILLAGE 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 1050 NE 2 AVE .. , THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY MIAMI SHORES, FL 33138 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE —" 305-756-8972 AUVKD Z5 (ZUUWU1) W (V 1955-ZOOS AUUKV UOKPORATION. All ngnts rawrved. The ACORD name and logo are registered marks of ACORD Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exem 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: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature* Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this 2 E day of nGM 8'1E), 20 V; who is personally known to me or has produced Vet V �"C as identification. Notary: SEAL: & ° Notary Public State of Florida �. ; Sindia Alvarez My Commission FF 156750 Of ptd` Expires 09/03/2018 i WPC -t COLS T-R-kC TION COMPANY I -3j /\/W 6 "`3 T M1f-{M1, FL -3..31 4�q CgC1.2553��6��-' CCCz32jY�j�� ,S7-,47-F OF FLORlDA COk/\/ -rOFM/,4M/ DADF g FFOR E M E WI LSON P lfENR r WHO, FFIM: Z IkLrSW6)RN, DFPOSES,4ND 5.4r TTif.4TT l-tF WILL 3F THE ONLY" PERSON WORfCING ON 7-1fF PR /F0TT :OC.4Tr�D.4T6SNW1.10STMl�4MlSffORES FL SWORN TO (OR .4�r1%zMED�.4ND StL$SCP(g� KE�OR�M� T-/WS2Z7 Tf-f D,4rOF G=CTOPFRa20157, gr PER SON, LLY/CNOW OT2 PRODI (CEA IAENTI�/C 4TlON 5� O ` �5Go - �� — PE OE IAENTIE/C 4T(ON PizOAI (CEA D� V � UGE fS — R/NT, TYPEORST, MPN,4MEOFNOT,4Rr E ""N, Notary Public State of FloridaSindia Alvareze4 My Commission FF 156750 dp Expires 09/0312018 � �;7 t��z7,7 ROQF ASSEMBLIES AND ROOFTOP STRUCTURES — - - -- Florida Building Code Edition 2007 High -Velocity Hurricane Zone Uniform Permit Application Farm. - Section A (General Information) Master Permit No. 1 , \ Process No. Contractor's Name w��r- Job Address 1-1 ROOF CATEGORY tow Slop sphaltics s " - hingle Slope Roof Area (SF) 10 c7 e ❑ Mechanically Fastened Tile ❑ Metal Panel/Shingles ❑ Prescriptive BUR-RAS 160 ROOF TYPE Reroofing ❑ Recovering ROOF SYSTEM INFORMATION Steep Sloped Roof Area (SF) Ia-00 Mortar/Adhesive Set Tile ❑ Wood Shingles/Shakes ❑ Repair ❑ Maintenance Total (SF) 13eoo Section R (Roof Plan) Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include dimensions of sections and levels, clearly identify dimensions of elevated pressure zones and location of parapets. FLORIDA BUILDING CODE — BUILDING ROOF ASSEMBLIES AND ROOFTOP STRUCTURES Florida Building Code Edition 2007 High -Velocity Hurricane Zone Uniform Permit Application Form. Roof System Manufacturer: U _ Notice of Acceptance Number: /n o Minimum Design Wind Pressures, If Applicable (From RAS 127 or Calculations): 1: - I P2: -(' P3: 2j I_L � Maximum Design Pressure (From the Product Approval Specific System): zz FLORIDA BUILDING CODE — BUILDING ROOF ASSEMBLIES AND ROOFTOP STRUCTURES Florida Building Code Edition 2007 High -Velocity Hurricane Zone Uniform Permit Application Form. Serttinn F(Ti1e Calculations) For Moment based tile systems, choose either Method I or 2. 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. j (� {� pM�etho�d I _""Moment Based Tile Calculations Yr AS 127" �1 (Pt n J '(,�, 1L L tt F— 1-r'�) Mg:: �P '= Mrl Product Approval Mf (F2:% • "k l se$_�) - Mg: CpJ K! = Mr2 )• Product Approval Mt.� (P3: �� x h Q _ �r. zL) Mg: f7 i� = Mr3 J ,�. I Product Approval Mf gL Method 2 "Simplified Tile Calculations Per Table Below" taequtreu moment of Keststance tmr) rrom mote netow rrouuct approval tw M required Moment Resistance" Mean Roof Height —► o....s 01--- I I is, 20' 26' 30' 40' *Must he 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 Fwith 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 "Moment Based Tile Calculations Per RAS 127" (Pl: x L = x w: = ) - W: x cos B = Frl Product Approval F (P2: x L = x w: _ ) - W: x cos B = Fr2Product Approval F (P,: x L = x w: = ) - W, x cos N = FL, Product Annroval F Where to Obtain Information Description S mbol Where to find Design Pressure PI or P2 or P3 RAS 127 Table I or by an engineering analysis prepared by PE based on ASCE 7 Meats Roof Height H Job Site Roof Slone d Job Site Aerodynamic Multiplier x Product Approval Restoring Moment due to Gravity Ms Product Approval Attachment Resistance Mr Product Auvroval Required Moment Resistance M Calculated Minimum Attachment Resistance F• Product Approval Required Uplift Resistance Fr Calculated Averalze Tile Weigh W Product Approval Tile Dimensions L = length W = width ProductApproval All calculations must be submitted to the building official at the time of permit application. FLORIDA BUILDING CODE — BUILDING Fkddm Bump Coda Edfbon 2M Y2.ba KNdwo Zone 4JfNkwm p4m.lit ANNOOM Form. V:7'� 7-51LOMTT,731-1 jU37 7- M= Fill Mii Spedic Roof Ase--VAWly Contporrenb Fasirner Spacing for Mtdwril8aee &leaf and ildtlniffy M-nufadurrr' Altedltnsid (No o©ev aosnt a not uesd, idwdWy ae "NA') f!` Fieid: _�L' oc G Lap, # Bows s:� M ` oc 33� Perimeter " oc 0 trap, � Row* ® �` oc Coma. , L'oc*Lop.#Rows-�--M., "cc OoWgn Wind Prevoiees. From RAS 128 or Cdlmde dwo: °.; �3 Number' of Faebnera Per inmikMon Prtrearl- '� P =xZ ` Pmsx3; Bowd Max Ossipn Prwsum From the Spwft NQA Field Comer Dock:T IJ ©ergs _ MU 111 M Canportente NoMd and CaupslRMderess: ''�' _ WoodblodcDetaft u AppNcWM*• gage Termination, Stripping, Flashing, Continuous Cleat, Cant Strip, ,�,�,, Base Fba Nng, Counter- Flashing, ++ ,C' rr `' oiling, etc. Andm4lose Sheet S No. of Plr(s): . 1 Mean Roof Height, Parspat Height, NeW of Base Fleshing; Component Material. And4i Alm s Shest Materiel Thickness,' Fastener Type, Fastener # L t 'llr r✓,ac Sparing or Submit Aftnufacturers Detells that Irauls3on Base Layer �% r Comply with RAS ,11 and Chapter 16. Bass IrfMrreAion Size and. Tlrido�ass: f;` f i rises I+ Aftn ir"W a RIOR 6 Melerw. • � � ' i�k� _ / zl Top IMAdodon t.syer j Top In adalien Sias and ^, ._ Tap IrNarlstion FasW wfi3orKbv Ms1sdN: ,+L r ,'j rt% t, 5 L�' .e- eG 6sr i-+ ` son t3 ooKS) a No. of Ply(s): _ f �j7 � 7j eXSe 15%E S.S Bass 8i�eet FasMn►erlBondne McMriel: /,r J •Ply Shssl(s).iA No. of Ply(*)' ` F Ply Shunt F TOP Phr., A A41. ti Top P!y �' Bonding J��'� 9In FT. Mean Roof Haight 123_01-48 SM 'AGE3 2007 ROOFING MATERIALS AND SYSTEMS DIRECTORY 192 ROOF COVERING MATERIALS (rEVT)__ R tw4hig Systems i`TC&L11)-C9trfbfrd Base Coat: a 'A-32 1,eTit- J.7; gai i-101 ',mund Bj,v t oil: "A t Wear Cnai " — -1 P11N wain, lic at B ;IhpCT '4UrfaCirp,7 It! Peck: Priam: "'Joam. C 47 Relit: NC Insulation: Surfacing: SrplLnrv)ation rf 21-� h, GAF MATERIALS CORP R1306 1161 ALrS RP, WAYNE Nj (rV "Ruberoid X) "RuIvrok! r an IT hick v A ref in the c �ind j. t_,: ic alterna!t: to 7 in anv If - ;t-_a!m" ^n!!! g B.iIeShm' (Nailabicil" mall Ie mecihim- and as a rC_V1._erover the _1i-,-1m1:a1,ir., include 'FNFRGujrJ EPS jr- lf,.sw ASPHALT FELT SYSTU.MS WITH HOT ROOFING ASPHALT V 21 lv%c. Sh(�et 07; Base 'Sheet" or I-, w SUIVI'VIC ZlIeTrWC hIT TN,-e (A asphalt glass ROOF COVERING MATERIALS (TEVTJ Ntlitifing qv5temg (111C.FU)- QF11"17's-rd mavbeti+,fi its lieu ill, I:t,- in any of !!m foilianing NC. Clemi'fications otherr'n-7kk inlicated. art' of the 'A,Fhall I'vill (Iaqq A, 0 and 4: I fm rctofil�g itlphilt. for xwe "ithvva TUC membra"eq. "Ruberoitl Heat Weld"SBS roofing nu.".1-ranc reeftNc vsvd :11 in': -I'. "RubertAd Mop" SES rvMucK in am-appli-,nblc Classifia!ion Class A 1. Deck- 11-15137 Incline:3 insulation 110ptionalk (kw or more lairr, Conte. wood fiber -Oj bcr. k- rTtitL/isNcvantt7�i*x f:�- p � 4 T1 "riltham, mrre-ife. wood 1 thickness. Ply Sheet: Three or more laxxTs T� GI "CATG!,All, "G,AFGLJAf; illy 6", hots arced. Suffmcinw Gravel. 2. Deck- C-151r; Incline: Insulation (Optional): Ono or were lasers per'lito, wz�! Ober, urethane:urethane:pedie/i vanUrate �(Tr; FljrsttL ,nelharie i7omrrls'ite, wood fi1.v.r/NAvi,-mmuratc c,r.TvN;tv ar]- lhicknfz;. Ply Sheet: Three or mom lav-m- Tv pe GI AS -i'. 4 "GAFGLAS Plv. W. Car Sheet. !sheet" One L-my 1pr G1, 'VAF(',T_A5 Mineral !,urfaccd ii-ar, e. l or -E�,YC-ap�&Iincrdl Surfaced Cap Sheet", 3. Deck- NC Incline- 2 Insulation fOptionalk One or more lavm perlite, wood bbt,r, fiber, m*t�lanurvtW. uretham perlite/itforvarturW corrT,,-,ift,. F-rli!-- un7thariv comm-site. wood fiber / izofyanwal? C-nrr" iti,i ;1henolic. _2 im Max. Ply Sheet: Two or wAim. lavem lyre GI '*GA!7(_J A" 7l� 4' or "CAF GLAS M 6-. Cap Sheetpk Cl "CAFGLAS Alil-,ffai Surfaced laver Tv Cap . %N,t' or vCap Wrt�r;l Su -,faced Cat, Sheet 4. Deck: N(,' Incline: 112 Insulation! One orw".0tivem "'J-A*flx-m-Tr R", 4 m. -Tax, bot Tnopp(-d!'"'� Fic Sheet: Anv Ul. Clacsafted gravel suTf.Tcc•d (lass .� aspfi:Ttt },talc libe,. or GAFGLA5P!vf,' -x Deck; C_ t. Slip Sheet 40ptionalk Rf.-J roqfn papff, mi),d totle--k- Rare Sheet One layer TzTe C-1 "GAT`GLAS ;7; Haize Shfwit" fT r V -3 TV i nal led). and r'l I Ply9wet- v 6r. Cap She& Ovie jav?y TN e C1 74CAFGLA 4 M-� -I 3 vt 'T 'r0l 4' T fac Sh ��hm' (v FAWM Mint A ed C 6. Deck: N(- InchnP*: f-t- Im- mim be Itoliz, I ecitari- Rase Sheet- Ow laww Type JG-1 "GAY-GLA5 ;4. PIT Sb"t-. (.)it(- or more lavers Tvrc G --JTcntve, all it 1 5�fms max; bi, or mechani- Cap Sheet One laver 71yjv C73 'GAFx;LA5 `'Iviced Cilpt t,o ,7.m for flaf";nr iln 1+v of thf,. 1 Sheet- Or 'Trc-gCap Mimilral RurlacM Cap "eet". 7' DeckTlncline: 2 i iAl HAII ER MAI 1TE7,1- ir. p insulation: One, fr TieTlit g-W,, ffl,o- i A, notic, 1.11 inmin fnff,.-t Bane Sheet: Ont-, Sr n-, membrane, "W"e-t-1010-l"I Plus "'Ruberox, ni t.�7 nuk f --,,n,. 'I fW `Rol-v-pij M..r lqull (P--inuk-t. Cap she"! Tviw f'll, YATC'_A'-- A,',iP0j - 117' Mirk-rai San-facmi S3ux4'. 1,,ot t il, a Y)eck!(-15,T32 Ind e: I - .... .. I Insulation f0ptionalk OTiv or initire lacers !i;,% q7ber isficvarfir-7k., m0fiam. lf-A Urethane A , t Ply Sheet j0plio.1,411. (i or M jf� laverivf' or— Tire Ijvv^"%Uht-id It 1�1 - IT *' Membrane. Chan .i Ruberoid lirch PIv,i (grantilv) "Rulvr6id Riot[:'o, .,ant f-1 _,Li,,LS Vit,% pf%, 6,*r is C 1: 1. 10 Mop iqu4` lgrayrl"iet. LOOK FOR THE UL MARK ON PRODUCT � � SKwR„Fas IDA SECTION R4402.13 HIGH VELOCITY HURRICANE ZONES — REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS R4402.13.1 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. 1. .0 b Aesthetics -Workmanship: the workmanship provisions of Section R4402 are for the purpose of providing that the roof system meets the wind resistance and water instruction performance standards. Aesthetics (appearance) are not a consideration with respect to workmanship provisions. Aesthetic issues such as color or architectural appearance, that are not part of a zoning code, should be addressed as part of the agreement between the owner and the contractor. 2. Renailing wood decks: When replacing roofing, the existing wood roof deck may have to be 4renail in accordance with the current provisions of Section R4403. (The roof deck is usually concealed prior to removing the existing roof system). 3. 1 1) Common roofs: Common roofs are those which have no visible delineation between neighboring units i.e., townhouses, condominiums, etc.) In buildings with common roofs, the roofing contractor and/or owner should notify the occupants of adjacent units of roofing to be performed. 4. 0 h Exposed Ceiling: Exposed, open beam ceilings are where the underside of the roof decking can be vi wed from below. The owner may wish to maintain the architectural appearance; therefore, roofing nail penetration of the underside of the decking may not be acceptable. This provides the option of maintaining the appearance. 5. OL Ponding water: The current roof system and/or deck of the building may not drain well and may cau water to pond (accumulate) in low-lying areas of the roof. Pounding can be an indication of structural distress and may require the review of a professional structural engineer. Pounding may shorten the life expectancy and performance of the new roofing system. Pounding conditions may not be evident until the original roofing system is removed. Pounding conditions should be corrected. 6. Overflow scuppers (wall outlets): It is required that rainwater flows off so that the roof is not 4overded 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 scuppers in accordance with the requirements of Sections R4402, R4403 and R4413. 7. Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of the structure assembly (the building itself). The existing amount of attic ventilation shall not be reduced. It may be beneficial to consider additional venting which can result in extending the service life of the roof. 24L" QQ C9 ( Owner/Agent's Signature Date Contractor Signature Date Revised on 7/9/2009 LD N IAN!"ADE COUNTY, FLORIDA ME7RO DADE FLAGLER BUILDING DURMNG CODS CoNnuNCE OFFICS (DECO) 14GWWT n AGLER STRW, SUIT6160 PRODUCT CONTROL D1VI$lON MIAMI, RAMMA 33130-1 S63 (305) 375-2901 FAX (3305) 375-2906 NOTICE OF ACCEPTANCE (NOA) Ramon Rsof Tlb LW SW 30 Awe Deer" Beach, FL M"2 3COPID This NOA is being issued under lie applicable rules and regulations governing the use of construction materials. The docunr- - -.1- ion submitted has been reviewed by Marini -Dude County Product Control Division and accepted by the Board of Roles and Appeals (BORA) to be used in Miami Dade County and other areas when allowed by the Authority Having Jurisdiction (AHD. This NOA shall not be valid after the won dame stated below. no Mimed Dade County Product Control Division (In Miami Dade County) and/or the AHJ (in area otter than Miami Dade County) reserve the right to have this product or material tested for quality assume purposes. ff this product or material Wh to perform in the accepted manw, the msnuhcdtter will fix= the otperm of such testing and tie AIU nay immediately revoke, modify, or suspend the use of such product or material within ttmir jurisdiction. BORA reserves the right to revoke this acceptance, if it is determined by Miami -Dade County Product Control Division that this product or material fails to mud the requiretnents of due applicable building code. This product is approved as described herein, and has been designed to comply with the Florida Building Code including the W�gb Velocity Hurricane Zone of the Florida Building t;od& - DESCRwnoN: Hanson Hacienda Doable Rob Roof Tile LABnzgG.- Each unit shall bear a permanent label with the marnacturees name or logo, city, state and following dldmm* "Miami -Dade County Product Control Approved", unless ode wise noted herein PJMWAL of this NOA shall be considered ed after a re wwal application has been filed and flee has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the mWiravat date or if there has been a revision or change in the use, and/or manufacture of the product or process. Misuse of this NOA as an endonament of any produ4 for sales, advertising or any other purposes shall automatically terminate ties NOA. Failure to comply with any section of this NOA shall be cause fortermination, and removal of NOA. AD : The NOA number preceded by the words Mini -bade County, Florida, and followed by the expiration date may be displayed in advertising I [mature. Many portion of the NOA is displayed, then it shall be done in its entirely. INSPECTION: A copy of this entire NOA shall be provided to the user by the msnufactuu+ex or its distribermocs and shall be available for inspection at the job site at the request of the Building Official. This revises NOA No. 09 M.03 and consists of pages 1 through 6. Tim submitted documentation was reviewed by Alex Tigers. / NOA No.: 10-0796W RM&aden Date MGM Approval Date: 09/11/10 Pape 1 or6 ROOFING ASSEMBLY APPROVAL Roofing Sub Category: Roofing Tile M41601,111L. concrete 1. SCOPE This approves a roofing system using Bnows Hademb Roof TIK as manufactured by Herron Roof Tile in Hobs Saar 4 Poodle and as described in Section 2 of this Notice of Acceptance. For the locations where the pressure requirements, do not exceed the values listed m section 4 herein. The attachment calculations shall be dace as a moment based SYMM L PRODUCT DESCRIPTION Mnuaf lsomed by AIL�i Length: 17%" Hanson "Hacienda" Width: 13" %" thick Length: varies Trim Pieces Width: varies Varying thickness 2.1 Ev wcx Sun rrraD Test Aaeacv Rolland Technologies Professional Service Industries, Inc. The Center for Applied Engineering, Inc. f!_ 1 7161-03 7161-03 7161-03 P0402 Teat Predaet attioaa Low protfiile, bterlod*g extruded concrete TAS 112 roof file equipped with two nail hole and double roll n*b& For direct dock or battened nail -on, mortar or adbesm at applications. Accessory ry trim, concrete roof pieces for use TAS 112 at hips, rakes,; ridges and valley tmminstions. P0631-01 Letter Dated Aug. 1,1994 224-47099 94-MB 94-M 25-7094-1 25-7094-7 25-7094-4 Manufactured fir each file profML Test Namemegert 1111ft PA 102 Doc. 1991 PA 102(A) Dec. 1991 PA 108 Dec. 1991 Withdrawal Roe Testing of Sept.1993 screw vs. smooth shank nails PA 109 July 1994 PA_108 Aug. 1994 PA 112 Sept 1994 PA 101 March, 1994 PA 101 May 1994 PA 102 Oct 1994 PA 102 Oct 1994 PA 102 Oct 1994 NOA No.: 19A 91M S#piratlaa Date: 12116n2 Approval Date 09/1&10 Pap 2 of 6 T" - A Too Pr�af9s A( 8atkin A( Dbsct Dock Application 1 Hacienda Tile 0.267 0.289 Table 3: Molrtenfs due io Tilo Prone F:12" r:12" 6":1Z" V. Ir r: it or Hansa, Hacienda Tile Banana Dkeot Deck Bats Direct Deck Battens Mod Battens Deck Deck Battens Dkect Deck 5.92 6.80 5.82 6.69 5.70 6.55 5 56 &39 5.41 6.22 Table 4: MbeWnent Resistance ExWessed as a WomeM - AI, (fir " For Na8-On Tile Fastener Typo Ursa Deck Dkva Dock B Profile (Mtn 1513r pIY*ood) (ANIL 1913r P Hanson 2-10d Ring Shank 27.8 37.4 28.8 Hacienda Nails THO 1-10d Smooth or 8.8 118 4.1 Screw Shank Nad 2-10d Smooth or 16.4 21.9 7.1 Screw Shank Nails 1 so screw 25.8 25.8 22.9 2 #8 Screw, 47.1 47.1 ` 49.1 1-10d Smooth or 24.3 24.3 24.2 Screw Shank Nail bid 1-10d Smooth or 19.0 19.0 22.1 Screw Shank NW ave 2-10d Smooth or 35.5 355 34.8 Screw Shark Nab bid 2-10d Smooth or 31.9 31.9 32.2 Screw Shank Nal Eon 2-10d Ring Shank 43.0 -T 67.5 50.9 NaAs l Ineiallation with a 4r do headlep and fasteners are ko ed a mkt. of 2W from head of Via. NOA No.: 19-97ftW S pindom DsW.1211d12 App vwd Dam OWISnO hp4of6 T AWU Teat Idea Tat NsmdR rt Date Projea No. 307025 PA 100 Oct 1994 Test #MDCr76 25-7183-1 PA 102 Feb. 1995 25-7183-2 PA 102 Feb.1995 25-7214-2 PA 102 Much,1995 25-7214-6 PA 102 March, 1995 Coma Corporation 528454-2-1 PA;101 Sep. 1998 Testing Services 520109-2 Dec. 1998 Walker Engineering, Inc. Calculations Aerodynamk Multiplier Mauch 1999 IBA Consultants, Inc. 2381-249 . TAS 112 09l20/07 3. LEV=ATIONS • 3.1 Fire classification is not part of this wc:eptmm 3.2 For mortar or adhesive set file applications, a static field uplift best in accordance with TAS 106 may be required, rafbr to applicable building coda. 33 Applumot shall retain the somm of a Mimi -Dab County, Certified Laboratory to perform quarterly test in accordance with TAS 112, appendix W. Such testing shall be submitted to the Building Code Compliance Office for review. 3.4 Minimum underlsymeat shall be in compliance with the applicable Roofing Applications Standards listed section 4.1 herein. 3.5 30/'90 hot mopped underlayment applications may be installed perpendicular w the roof slope unless stated otherwise by do undorlayment mdwW mainubeturem published literature. 3.6 This woeptance is for wood deck apples. Minimum deco re"hemems shall be in compliance with applicable building code. 4. INSTALLATION 4.1 Hanson 'Hacienda' Roof Tile and its =Wxmo shall be installed in strict compliance with Roofing Applicator Standard RAS 113,119, dt 120. 4.2 Data For Attachment Calculations Table 1: Aven p0 Weight (Wj and Dlrnumdom (I x w ) Tile Profile Vlelgh N (Ibti 1 (ft) 1 IMdth-w (ft) Hanson HackwWo 10.0 1.437S 1.08 NOA Na: 10-0 M07 Bspiradw Date:12116n2 Approval Data: 04/13/t0 Page 3 of 6 Table 6: Attachment Resistance Expressed as a Voment Mr (Ram For Two llaft Adhesive Set Sysiftm Tile Protilo Tile Applkadon Minimum Attachment Resistance Hanson Hacienda Tile AftmWe 26.1 2 See manufactures component approval for installe ion 3 Flexible Products Company TileBond Average weigh# Per patty 11.4 grams. PoWbarn Product Inc. Averaw weWt per pony 8 Table B: Attachment Reams Expressed as a Umumt- Mr (R-ibf) For Skiale PaKy Adh"Ive Set Sysbmw Tics Profile Tile Application Minimum Attachment Resistance Hanson Hacienda Tile P Tm 80.61 P M 45. 4 Large paft plawment of 54grams of ftftgTN. 5 Mectum paddy placement of 24grams of PobProTm. Table 7: Attachment Rmlet um Expressed as a Moncerit-11>r(*4bf) For Mortar Set Systeii Tile Tile Attoclunent Profile Applicadon Resistance Hanson Hacienda Tile Mortar Set 20.60 5. LABELING All tiles shall bear the imprint or identifiable marking of the msas name or logo (See Detail Below), or following s "Miami4Dade County Product Control Approved". H nson XIMMN HACIENDA ROOF THE TILE IDENTIFICATION MARK (LOCATED ON UNDERSIDE OF T>i.E) 6. BUHMING PERMIT REQUIREMENTS 6.1 Application for building permit shall be ac mnpanied by copies of the following: 6.1A This Notice of Aocxptance. 6.1.2 Any od w documents required by the Building Official or applicable building code in orb to properly evahuide the installation of this NOA New 1f497t1 #7 B:piraden Dabs MGM Approval Date: 09/15nO Pspsof6 Fi �rffom„lm . �w �� 0 PROVIDE DRAWINGS BLOCK HANSON HACIENDA CONCRETE ROOF TnX END OF THIS ACCEPTANCE NOA No.: 104rYK07 KVksdom Date: 1? IG= Approval Data: 09n5n9 Nate 6 of 6 BUILDING CODE COMPLIANCE OFFICE MCCO) PRODUCT CONTROL DIVISION NOTICE OF ACCEPTANCE (NOA} GAF bUterial Corporation 1361 Alps Road Wayne, NJ 07490 �. MIAMI-DARE COUNTY, FLORIDA MLTRO-DADE FLAGLER BUILDING 140 WEST FLAGLII;R STRSET, SUITE 1603 MIAMI, FIARIDA 33130-1563 (305) 375-2901 FAX (305) 375-2908 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed by the BCCO and accepted by the Building Code and Product Review Committee to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ). This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product Control Division (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) reserve the right too have this product or material tested for quality assurance purposes. Nthis product or material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify, or suspend the use of such product or material within their jurisdiction. BORA reserves the right to revoke this acceptance, if it is determined by Miami -Dade County Product Control Division 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 and the High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION: GAF Conventlenal Back -Up Roof System for Wood Decks. LABELING: Each unit shall bewr a pit label with the manufacturer's name or logo, city, stiute 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 boon filed and there has been no change in the applicable building code negatively affecting the performance a of this product. TERNIINATION 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, fbr 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. ADVERnSEhWff: The NOA number preceded by the words Miami -Dade County, Florida, and foilowed by the expiration date may be displayed in advertising literature. Many 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 manufacttuer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA renews and revises NOA No. 03-0501.05 and consists of pages 1 19. The submitted documertation was reviewed by Jorge L. Acebo. NOA No.: 07-1219.09 Upiration Date: 11/04/13 Approval Date: 03401t18 Page I of 19 T Deck Type 1: 1 Wood, Non -insulated Deck Description: 19/32" or greater plywood or wood plank decks System Type E: Base sheet mechanically fastened. All General and System it. mitations shalt apply. Fire Barrier. FkeOutru Fire Barrier Coating, Ve saShielONon-Asphaltic Fiberglass -Based (optional) Underlayment or Secumck'rm. Base sleet: GAFGLASa #80 ULTIMATm Base Sheet, STRATAVENTO EliminatorTm Nailable, RUBEROIDo Modified Base Sheet, RUBEROIDa 20, RUBEROIDo Heat WeldTa Smooth or RUBEROIDo Heat-We1dTa 25 base shed mechanically fastened to deck as described below; Fasteniog Options: GAFGLAS• Ply 4, GAFGLASo Flex P1yTM 6, GAFGLASo #75 Base Sheet or any of above Base sheets attached to deck with approved annular ring. shank nails and tin caps at a fasmner spacing of 9" o.c. at the lap staggered and in two rows 12" o.c. in the field. (Madiicunr Design Ammorw -#S psf, See General Lin #7) GAFGLASO Ply 4, GAFGLASa.Flex PIyTK 6, GAFGLAe #75 Base Shed or any of above Base sheets attached to deck with Dnil-Tedm #12 standard, #14 or # 15 Screws and 3" Drill-TeeTa steel plate or Drill-Tedm AccuTrac Plates, 12" o.c. in 3 rows. One row is in the 2" side lap. The other rows are equally spaced approximately I r o.c. in the field of the sheet. Waxinranr Deft Prevare -45 =f. See GdhoW Li low #� GAFGLASo Flex PlyT"e 6, GAFGLAe #75 Base Shed or any of above Base sheets attached to deck with approved annular ring shank nails and tin caps at a fastener spacing of 9" o.c. at the 4" lap staggered and in two rows 9" o.c. in the field. (Mazimm De*n Presswe -525 psf, See Gewral`Uv a cox 07) GAFGLAS- #80ULTIMA-M, RUBEROID'20, RUBEROIDrMop Smooth, base shed attached to deck with approved 1 A" annular ring shank nails and inverted 3" steel plate at a fastener spacing of 9" o.c. at the 4" lap and in two rows staggered with a fastener spacing of 9" o.c. in the center of the membrane. (Mxdmm De*x Prlww e - 0 pea, See Gave W Llneitiad w 07) GAFGLAS° #75 Base Sheet or any of above Base sheets attached to deck with Drill -Teem #12 standard, # 14 or # 15 Screws and 3" Drill-TecTa steel plate or Drill-Tedm AccuTrac Plates, 12" o.c. in 4 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 9" o.c. in the field of the sheet. (Mai Imm Din Presswe -60 psf, Sae General L&*wden #7) Any of above Base sheets attached to deck approved annular ring shank nails and 3" inverted Drill-TecTM insulation plates at a fastener spacing of 9" o.c. at the 4" lap staggered in two rows 9" in the field. (Madmani Deagn Prawra+e -40 p#f, See General Li n hadon #7) NOA No.: 07-1219.09 Itzpiratias Date: 11/04/13 Approval Date: 03/ %" Page 17 of 19 r GAFGLASe #75 Base Sheet or any of above Base sheets attached to deck with Drill-Teerm #12 standard, #14 or # 15 Scrawl and 3" Drill-Ted"A steel plate or Drill-TecTm AccuTrac Plates, 8" o.c. in 4 rows. One row is in the 2" side lap. The other rows are equally spaced a.. - innately 9" o.c. in the field of the sheet. tezaxanrux n rnea AM —13 ps, f, .ee c acer+ar Luwawox nrt Ply Sheet: One or more plies of GAFGLASe PLY 4, #80 ULTIMA, RUBEROIDe MOP Smooth or RUBEROU)P 20 adhered in a full mopping of approved asphalt • applied within the EVT range and at a rate of 20-40 IbsJsq. Cap Sheet: (Optional) One ply of GAFG1A.S16 Mineral Surfaced Cap Sheet or GAFGLASe En Tm Mineral Surfaced Cap Sheet adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 %sJsq. Surfaeiug: (Optional, raquired if RUBERUID MOP Smooth or RUBL'RUID- 20 is top membrT) Install one of the following: 1. Gravel or slag applied at 4001bsJsq. and 3001bsJsq. respectively in a flood coat of approved asphalt at 60 ibsJsq. or applied in a flood coat of Leak BustarTm MatrixTm 103 Cold Process Adhesive applied at a rate of 3 galJsq. 2. GAFGLASe Mineral Surfaced Cap Sheet, GAFGLASe Energy Cap Mineral Surfaced Capshe.et adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbsJsq• 3. Leak BustwTM Matrixm 303 Premium Fibered Aluminum Roof Coating, at 1.5 galJsq. 4. Leak BusberTu MatrixTM 715, Leak BusterTe MatrixTm 322, TOPCOATe MB+, TOPCOA'Io Fireshield MastomericRoofing Membrane, applied at I to 1.5 galJsq. 5. Leak BudwTm Matnir" 602 MB Xtra Elastomeric Roofing _. Membrane, EnergyCoteyS roof coating applied at 1 to 1.5 gaUsq. 6. TOPCOA'I* Surface Seal, TOPCOATe Fireshielde SB Solvent based Elastomeric Roofing Membrane applied at Ito 1.5 galJsq 7. Advance Groan Technologies Photovoltaic Laminate solar energy collector auxiliary roof equipment installed in compliance with manufacturer's specifications and applicable Building Codes. Maximum Design Pressure: See Fastening Above NOA No.: 97-1219.09 Expiration Data: IIM/13 Approval Dabs: OC3t20AS Page 18 of 19 WOOD DECK SYST}Y.M LIMITATIONS: I A slip sheet is required with Ply 4 and Flex Plym 6 when used as a mechanically fastened base or anchor sheet. 2. Minimum W" Dens Deck'"" or 'h" Type X gypsum board is acceptable to be installed directly over the wood deck GEN=Ai. LIMITATIONS: 1. Fire classification is not part of this acceptance, refer to a current Approved Roofing Materials Directory for fire ratings of this product. 2. Insulation may be installed in multiple layers. The first layer shall be attached in compliance with Product Control Approval guidelines. All other layers shall be adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbsJsq., or mechanically attached using the fastening pattern of the top layer 3. All standard panel sizes are: acceptable for mechanical attachment. When applied in approved asphalt, panel size shall be 4' x 4' maximum. 4. An overlay and/or recovery board insulation panel is required on all applications over closed cell foam insulations when the Use sheet is fully mopped. If no recovery board is used the base sheet shall be applied using spot mopping with approved asphalt, 12" diameter circles, 24" o.c.; or strip mopped 8" ribbons in three rows, one at each sidelap and one down the center of the sheet allowing a continuous area of ventilation. Encircling of the strips is not acceptable. A 6" break shall be placed every 12' in each ribbon to allow cross ventilation. Asphalt application of either system shall be at a minimum rate of 12 lbsJsq. Note: Spot attaaeW systems sball be Baited to a maziaaem design pressure of 45 psi 5. Fastener spacing for insulation attachment is based on a Minimum Characteristic Force (F) value of 275 lbf., as tested in compliance with Testing Application Standard TAS 105. If the fastener value, as field- tested, are below 275 lbf. insulation attachment shall not be acceptable. 6. Fastener spacing for mechanical attachment of anchor/base sheet or membrane attachment is based on a minimum fastener resistance value in conjunction with the maximum desigin value listed within a specific system. Should the fastener resistance be less than that required, as determined by the Building Official, a revised fastener spacing, prepared, signed and sealed by a Florida Registered Engineer, Architect, or Registered Roof Consultant maybe submitted. Said revised fastener spacing shall utilize the withdrawal resistance vahie taken from Testing Application Standards TAS 105 and calculations in compliance with Roofing Application Standard RAS 117. 7. Perimeter and corner areas shall empty with the anhanoed uplift pressure requirements of these areas. Fastener densities shall be increased for both insulation and base sheet as calculated in compliance with Roofing Application Standard RAS It 7. Calculations prepared, signed and sealed by a Florida registered Professional Engineer, Registered Architect, or Registered Roof Consultant (When this limitation is speci8eaft referred within thk NOA, General Limitation #9 wilt not be applikable .) S. All attachment and sizing of perimeter milers, metal profile, and/or flashing termination designs shall conform with Roofing Application Standard RAS 1 I 1 and applicable wind load requirements. 9. The maximum designed pressure limitation listed shall be applicable to all roof pressure zones (i.e. field, perimeters, and toners). Neither rational analysis, nor extrapolation shall be permitted for enhanced fastening at enhanced pressure zones (i.e. parimews, extended comers and corners). (Wbee this limitation is specifically referred within this NOA, General U nhation #7 wilt not be applicable.) 10.. All products listed herein shall have a quality assurance audit in accordance with the Florida Building Cock and Rule 9B-72 of the Florida Administrative Code. END OF THIS ACCEPTANCE NOA No.: 07-1219.09 Expiration Date: 11/0&13 Approval Date: 03MM Page 19 of 19 MIAMIDADE BUILDING CODE COMPLIANCE OFFICE (BCCO) PRODUCT CONTROL DIVISION NOTICE OF ACCEPTANCE (NOA) Polyfoam Products, Inc. 11715 Boudreaux Road Tomball, TX 77375 MIAMI-DADE COUNTY, FLORIDA METRO-DADE FLAGLER BUILDING 140 WEST FLAGLER STREET, SUITE 1603 MIAMI, FLORIDA 33130-1563 (305) 375-2901 FAX (305) 375-2908 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed by the BCCO and accepted by the Building Code and Product Review Committee to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ). This NOA shall not be valid after the expiration date stated below. The BCCO (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) reserve the right to have this product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify, or suspend the use of such product or material within their jurisdiction. BCCO reserves the right to revoke this acceptance, if it is determined by BCCO 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 High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION: Polypro® AH160 RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA renews NOA No.0 1 -0521.02 and consists of pages 1 through 7 The submitted documentation was reviewed by J rge L. Acebo. NOA No.: 06-0201.02 Expiration Date: 05/10/11 Approval Date: 04/13/06 Page 1 of 7 ROOFING ASSEMBLY APPROVAL: Category: Roofing Sub Category: Roof tile 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 are done as a moment based system for single patty placement, and as an uplift based system for double patty systems PRODUCTS MANUFACTURED BY APPLICANT: Product Dimensions Polypro® AH160 NIA Foampro® RTF1000 N/A ProPack® 30 & 100 N/A Test Product Description Specifications TAS 101 Two component polyurethane foam adhesive Dispensing Equipment PRODUCTS MANUFACTURED BY OTHERS: Dispensing Equipment 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 tile adhesive. PHYSICAL PROPERTIES: Property Test Results Density ASTM D 1622 1.61bs./ft.' Compressive Strength ASTM D 1621 18 PSI Parallel to rise 12 PSI Perpendicular to rise Tensile Strength ASTM D 1623 28 PSI Parallel to rise Water Absorption ASTM D 2127 0.08 Lbs./Ftz Moisture Vapor Transmission ASTM E 96 3.1 Perm / Inch Dimensional Stability ASTM D 2126 +0.07% Volume Change @ -40' F., 2 weeks +6.0% Volume Change @I58°F., 100% Humidity, 2 weeks Closed Cell Content ASTM D 2856 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.: 06-0201.02 Expiration Date: 05/10/11 1~ Approval Date: 04/13/06 Page 2 of 7 EVIDENCE SUBMITTED: Test Apency Test Identifier Test Name/Report Date Center for Applied Engineering #94-060 TAS 101 04/08/94 257818-IPA TAS 101 12/16/96 25-7438-3 SSTD 11-93 10/25/95 25-7438-4 25-7438-7 SSTD 11-93 11/02/95 25-7492 SSTD 11-93 12/12/95 Miles Laboratories NB-589-631 ASTM D 1623 02/01/94 Polymers Division Ramtech Laboratories, Inc. 9637-92 ASTM E 108 04/30/93 Southwest Research Institute 01-6743-011 ASTM E 108 1I/16/94 01-6739-062b[1] ASTM E 84 01/16/95 Trinity Engineering 7050.02.96-1 TAS 114 03/14/96 Celotex Corp. Testing Services 528454-2-1 TAS 101 10/23/98 528454-9-1 528454-10-1 520109-1 TAS 101 12/28/98 520109-2 520109-3 520109-6 520109-7 520191-1 TAS 101 03/02/99 520109-2-1 LIMITATIONS: 1. Fire classification is not part of this acceptance. Refer to the Prepared Roof Tile Assembly for fire rating. 2. Polypro® AH 160 shall solely be used with flat, low, & high tile profiles. 3. Minimum underlayment shall be in compliance with the Roofing Application Standard RAS 120. 4. Roof Tile manufactures acquiring acceptance for the use of 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 tile assemblies shall test in accordance with TAS 101 with section 10.4 as modified herein. 'F W !.2 F MS NOA No.: 06-0201.02 Expiration Date: 05/10/11 n;.,- Approval Date: 04/13/06 qW Page 3 of 7 INSTALLATION: 1. Polypro® AH160 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 tile assembly's adhesive attachment with the use of Polypro® AH 160 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® AH160 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 licensed by Polyfoam Products, Inc. Polyfoam Products Inc. shall supply a list of approved applicators to the authority having jurisdiction. 5. Calibration of the Foampro® dispensing equipment is required before application of any adhesive. The mix ratio between the "A" component and the "B" component shall be maintained between 1.0- 1.15 (A): 1.0 (B). The dispense timer shall be set to deliver 0.0175 to 0.15 pounds per tile as determined at calibration. No other settings shall be approved. 6. Polypro® AH160 shall be applied with Foampro RTF1000 or ProPack® 30 & 100 dispensing 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. (grams)(grams) Two Paddy Weight per paddy Min. Flat, Low, High Profiles #1 35 N/A High Profile (2 Piece Barrel) #1 17/side on cap and 34/pan N/A Flat, Low, High Profiles #2 24 N/A Flat, Low, High Profiles #3 1 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.: 06-0201.02 Expiration Date: 05/10/11 Approval Date: 04/13/06 Page 4 of 7 Eawcmw ADHESIVE PLACEMENT DETAIL 1 SINGLE PATTY ' Farm Earecouuoeyr. 4M►upGe�eea�gaNe �een�nna► ` Fuck W*�aN Em dome DP WP NOA No.: 06-0201.02 Expiration Date: 05/10/11 Approval Date: 04/13/06 Page 5 of 7 ADHESIVE PLACEMENT DETAIL 2 SINGLE PATTY Nei through plastic cement Paddy (ee„an, Tds) Nan Nvough plastic cement Haddy (Beneath fie) undertayment � llnderlayaieM 1 1 •- 4 • - - 71n. In. = -- EareCourse •� Fa<da Fesda Mleephok Faye Coin Em closure EarsClosws 40* NOA No.: 06-0201.02 Expiration Date: 05/10/11 Approval Date: 04/13/06 Page 6 of 7 ADHESIVE PLACEMENT DETAIL 3 DOUBLE PATTY Nail through plastic cement Daddy flail through plastic cement Single paddy under file e (between tile) Underlayment Single paddy between the Paddy (under tile) 2 in. x 7 in. medium size paddy eave course only Single paddy 3 in. tx x 3 under file � 3, x 3 in. r 4 in. 4 2 in. Sine paddy on � 2 in. in. paddy onunder-under• • layment Single ply Fascia Eave course on top of tile welom e Single pew 2 in X 7 in. medium %Cove Eave closure on top of the size paddy save Drip edge Fascia course only Nail through plastic cement Jr!r-3 in.x3in. 4 Single /paddy on underlayment 2 S'mgle ply `7% on top of the Eve Cdwwse file single paddy between file /2 in. is 7 in. metilnm size paddy, eave course only Fascia END OF THIS ACCEPTANCE NOA No.: 06-0201.02 Expiration Date: 05/10/11 •t Approval Date: 04/13/06 Page 7 of 7 NOTICE OF COMMENCEMENT_ A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. �`-'� Zl' TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and 2. Description of improvement: LF 77 3. Owner(s) name and address: Interest in property: OR Bk 26008 Ps 3E45; (Ip9) RECORDED 02/24/2012 12:54.01 HARVEY RUVINY CLERK OF COURT MIAMI-DADE COUNTY? FLORIDA LAST PAGE Name and address of fee simple titleholder: yy 4. Contractor's name and address: b . •yam?� '?•.J -; 7 2 4 0,J 13 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: j Amount of bond $ 1 ' 6. Lender's name and address: ! '" z , 7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served provided by Section 713.13(1)(a)7., Florida Statutes, 4 Name and address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provi" in Section 713.13(1)(b), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a sp: ified) d�ifffreretis Signature of Owner Print Owner's Name ! r� Prepared by - r Sworn to and subscribed before me this day of 20 / Address: ` /l� .� 7 -S Notary.Public J � In I , Print Notary's Name = -=ANDRE E. 10SEIIH N # DD947195 My commission expires: r 123.01-52 PAGE 4 5/06 -,-... ,. !YService.Cotn ' /t► YAtC lT TI co!T- CERTIFICATE O LIABILITY INSURANCE 01/1LMApYY2/12 PRODUCER Annette Wills Insurance I. PHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 18401 N.W. 27 Ave ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR MWK FL 33056--_/itTfR THE COVERAGE AFFORDED BY THE- - IC BELOVII,•- Phone (305) 825-2403 Fax (305) 626-6472 INSURERS AFFORDING COVERAGE NAIC # INSURED WPH CONTRUCTION COMPANY INSURERa_ SeneCa Speciality Insurance Company _ P O Box 600149 INSURER B; ... _ _ MIAMI, FL 33180 MIS-Q ER C: INSURER D: �- -. INSURER E: ..... - ..... - COVERAGES THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT WITHSTANDING 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. !NR A0IYL POLICY EFFECTME POLICY ExPAtATgN LT o TYPE OF INSURANCE POLICY NUMBER _ OATE�MMWDWYYY DATE. j9W0 LIMITS GENERAL LIABILITY — — W COMMERCIAL GENERAL LIABILITY BAG-1010158 CEI CLAIMS MADE Wl OCCUR A : W 5W deductifft per dal J GENT AGGREGATE LIMIT APPLES PER: wi POLICY El PROJECT ❑ LOC AUTOMOBILE LIABILITY ❑ ANY AUTO i[] ALL OWNEDAUTOS ❑ Cl SCHEDULEDAUTOS L] HIRED AUTOS [] NON OWNED AUTOS GARAGE LIABILITY Cl ❑ ANYAUTO EXCESS / UMBRELLA LABILITY ❑ ❑ OCCUR U CLAW MADE ❑ DEDUCTIBLE [_I RETENTION $ ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER /MEMBER EXCLUDED? DESCRIPTION OF OPERATIONS / LOCATIONS / GENERAL CONTRACTOR `CERTIFICATE HOLDER - MIAMI SHORES VILLAGE 1050 NE 2 AVE MIAMI SHORES, FL 33138 305-756-8972 ACORD 25 (2009/B1) OF 01/11/2012 ; 01/11/2013 EACH OCCURRENCE MED EXP {Anyone person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMPIOP AGG COMBINED SINGLE LIMIT (Ea.acclderlt) BODILY INJURY (te! +-- ------ - BODILY INJURY (Per acdclem PROPERTY DAMAGE (Pet acxtdartt} AUTO ONLY - EA ACCIDENT OTHER THAN _EA ACC AUTOONLY: AGG EACH OCCURRENCE AGGREGATE I -U TORY � 91H-j :....,... E.L. EACH ACCIDENT _ j E.L. DISEASE - EA EMPLOYEE l E.L. DISEASE - POLICY LIMIT CANCELLATION 1 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 80 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KILO UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 01888-2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD :RNATIONAL ENGINEERING MMTING LAB IC!61GHT•INNOVATION• INTEGRATION R F, /) -6� 7 7 Florida International Engineering and Testing Lab LLC 16701 SW 117 Avenue, Miami, FL 33177 Telephone: (305) 378-1991-Fax: (305) 378-1997 Miami -Dade Lab Certification # 07-0612. 11 -State of Florida ca #27273 --------------------------------------------------------------------------------------------------------------------- SITE SPECIFIC INFORMATION Owner's Name: Job Address: Roofing Contractor: Permit Number: R Approximate Roof Height: 12 feet Slope: 1 Z- Approximate Square Footage: ftZ Type of Access to Roof: ✓ Ladder OtherRequired Testing For 35 lbs. Testing Equipment: F.G.E. 1DOx him o Instrument Date Installed: FM $ 1 Date of Inspection: 11 L --------------------------------------------------------------------------------------------------------------------- TEST RESULTS P= PASS, F= FAIL Test Location P or F Test Location P or F Test Location P or F Test Location P or F Test Location P or F 1 5 21 41 61 81 2 22 42 62 82 3 23 43 63 83 4 24 44 64 84 5 25 45 65 85 6 26 46 66 86 7 27 47 67 87 8 28 48 68 88 9 29 49 69 89 10 30 50 70 90 11 31 51 71 91 12 32 52 72 92 13 33 53 73 93 14 34 54 74 94 15 35 55 75 95 16 36 56 76 96 17 37 57 77 97 18 38 58 78 98 19 39 59 79 1 99 20 40 60 80 1 100 r --------------------------------------------------------------------------------------------------------------------- IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL TAS 106, THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT QUALITY CONTROL TEST. ADDITIONAL TEST INFORMATION Perimeter Width: ft Area Units or ftZ No. of Tests Perimeter 00 1 D Field p1/4 Corners $ Hips & Ridges RESPECTFULLY SUBMITTED BY: VIA 9t3 Vinayagar M. Balakrishnan V State of Florida Lie # 63107 Miami Shores Village��.°` , Building Department artment FED i�� 4J 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BY: _ _________ 2 Z2 2_ _13r_41 INSPECTION'S PHONE NUMBER: (305) 762.4949 B IL ING Permit No. PERMIT APPLICATION wIllasler Permit N CANCELLLUFBC 20 Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): 'z:>7 City: 0I ;� -.,, r S=1li,t`,k State: Tenant/Lessee Name: Email: JOB ADDRESS: r-:, . �' l'� G (I D Phone#: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes YO Flood Zone: CONTRACTOR: Company Name: Address: I ©v2 l J \-4A r%/ I -It AO 1z City: State: Zip: Qualifier Name: y 4A $ Phone#: State Certification or Registration #: C L1'5 ��Certificate of Competency #: Contact Phone#: 363 AL-fLi L3 �`�— Email Address�JR'i�O I LU DESIGNER: Architect/Engineer: Phone#: / C;oC�) Value of Work for this Permit: $ (p Square/Linear Footage of Work: Type of Work: ❑Addition ❑Alteration Description of Work: IV ew4' �1' Repair/Replace ❑Demolition JC-/ O v Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Technology Fee $ Bond $ TOTAL FEE NOW DUE $ 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 0 di skis as indicated. I certify that no work or installation has commenced prior to the issuance of a permit ana' a�ol'Iferformed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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. Signatur i Owner or Agent The foregoing instrument was acknowledged before me this T day, of �t ��20L:L, by who is personally known to me or who ha As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: WA Signature Contractor The foregoing instrument was acknowled ed before me this day of L tt, a` , 20 j -bey t WIL who is personally k own to me or who has produced t L T as identification and who did take an oath. NOTARY JV ( l Sign: Print: 4 ,�.. Commission # EE 101751 My Commission" s w Commission # EE 101751 Expires October 9, 2015 o= Expires October 9, 2015 BAW Ifft Troy Fain Insumtce Wa i8S7019 Q' oa Bon l Thm Troy fain Ins rance 800-386-7019 APPROVED BY / �oC Plans Examiner Zoning Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) s Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNERS'S AFFIDAVIT OF EXEMPTION ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR EXISTING SITE. BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PERSUANT TO SECTION 553.844 F.S. To: Miami Shores Village Building Department Date: 10050 NE 2nd Ave Miami Shores, FI 33138 Re: Owner's Name: (Odktt, Ek +kyIC46 Property Address: to 1j 1 W -24�4 G4 Roofing Permit Number: Dear Building Official: I _ r .I Z kk" certify that I am not required to retrofit the roof to wall connections of my building because: ,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. ❑ 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) �. � «'t- P .p'✓ac cam- r'; �` �, Signature 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 day of _4 Notary Public, Sate of Florida at Large _c When the just valuation of the structure for purpose of ad valorem taxation is equal to or more than ANDRE E. jga: �a}� MY COMMISsloP,'jO47105 nor a 1994 SFBC. Then you must provide a building application from a General Contractor for the Roof to Wall connection Hu Revised on 5/21/2009 Miami -Dade County. Real Estate Tax Information Page 1 of 1 r „?� �g • t :-�`sr�,.a-ate: ._:, . I� MIAMIQADE a Show Me: 2011 Taxes Property Taxes Today's Date: 02/15/2012 Last Update: 02/13/2012 Tax Year: 2011 Folio Number: 11 21360030590 MIAMI SHORES Search By: Owner's Name: ODETTE BARTHELEMY &H JOSEPH Select Item Property Address: 65 NW 110 ST Detail Tax Information: Real Estate Tax Info 2011 Taxes Prior Years Taxes Due 2011 Ad Valorem 2011 Non -Ad Valorem 2011 Back Assessments 2011 Enterprise Folio 2011 Historical Abatements 2012 Quarterly Payments 2011 Tax Notice/Memorandum Millage Code: 1100 Exemptions: HOMESTEAD Ad Valorem Taxes by Millage Authority: Taxing Authority Assessed value Millage rate per $1,000 of Taxable Value SCHOOL BOARD OPERATING SCHOOL BOARD DEBT SERVICE FLORIDA INLAND NAVIGATION DISTRICT SOUTH FLORIDA WATER MGMT DISTRICT EVERGLADES CONSTRUCTION PROJECT CHILDRENS TRUST AUTHORITY COUNTY WIDE OPERATING COUNTY WIDE DEBT SERVICE FIRE RESCUE OPERATING FIRE RESCUE DEBT SERVICE VILLAGE OF MIAMI SHORES OPERATING VILLAGE OF MIAMI SHORES DEBT SERVICE Contact Information E-Mail: ro tax (305) 270- 4916 Downtown Office: 140 W Flagler St., Room 101 Taxes Miami, FL Levied 33130 77236 7.76500 52236 405.61 ----------- 77236 .24000 52236 12.54 Office Hours: 77236 .03450 27236 .94 Mon - Fri 8:00 AM - 4:30', 77236 .37390 27236 10.18 PM 77236 .06240 27236 1.70 Related 77236 .50000 27236 13.62 Links: 77236 4.80500 27236 130.87 Tax Collector Pro e 77236 .28500 27236 7.76 Appraiser 77236 2.44960 27236 66.72 Florida State 77236 .01310 27236 .36 Dept of venue • 77236 8.00000 27236 217.89 77236 .78550 27236 21.39 Amounts due are subject to change without notice. Property Tax Home I Real Estate Tax Info 12011 Taxes I Prior Years 12011 Non -Ad Valorem 2011 Back Assessments 12011 Enterprise Folio 12011 Historical Abatements 12012 Quarterly Payments 1 2011 Tax Notice/Memorandum Miami -Dade Home I Using Our Site I About I Phone Directory I Privacy I Disclaimer © 2002 Miami -Dade County. All rights reserved. E-mail your comments, questions and suggestions to Webmaster http://egvsys.miamidade.gov:16081wwwservlggvtltxcawO9.dia?folio=1121360030590 2/15/2012 Miami -Dade County. Real Estate Tax Information Page 1 of I MIAMIDWDE 4 Show Me: Real Estate Tax Information Property Taxes Today's Date: 02/15/2012 Last Update: 02/13/2012 Tax Year: 2011 Folio Number: 11 21360030590 MIAMI SHORES Search By: Owner's Name: ODETTE BARTHELEMY &H JOSEPH Select Item - Property Address: 65 NW 110 ST Detail Tax Information: Real Estate Tax Info 2011 Taxes Prior Years Taxes Due 2011 Ad Valorem 2011 Non -Ad Valorem 2011 Back Assessments 2011 Enterprise Folio 2011 Historical Abatements 2012 Quarterly Payments 2011 Tax Notice/Memorandum © 2002 Miami -Dade County. All rights reserved- Mailing Information : ODETTE BARTHELEMY &H JOSEPH 65 NW 110 ST MIAMI SHORES FL 331684318 Legal Description 36 52 41 MIAMI SHORES EXT PB 43-40 LOT 27 BLK 220 LOT SIZE 75.000 X 122 To view 2011 Tax Notice/Memorandum click here 2011 Taxes are in paid status ntact Informati E-Mail: proptax(cr miamidade.ciov (305)270-4916 Downtown Office: 140 W Flagler St., Room 101 Miami, FL 33130 Office Hours: Mon - Fri 8:00 AM - 4:30 PM Related Links: Paid by mortgage company: AMERICAN HOME MORTGAGE Tax Collector SERV INC Property Appraiser lorida State Dept of Revenue i Amounts due are subject to change without notice. Property Tax Home I Real Estate Tax Info 12011 Taxes I Prior Years 12011 Non -Ad Valorem 2011 Back Assessments 12011 Enterprise Folio 12011 Historical Abatements 12012 Quarterly Payments 1 2011 Tax Notice/Memorandum Miami -Dade Home I Using Our Site I About I Phone Directory I Privacy I Disclaimer E-mail your comments, questions and suggestions to Webmaster http://egvsys.miamidade.gov:1608/wwwserv/ggvt/txcaw0l.dia?folio=l121360030590 2/15/2012 ' d 0"Ib N6 4228 SW 70 CT MIAMI FL 33155 Tel: 305-662-3710 Fax: 786-800-2627 a1 roofinspection0mmail.com LAB CERTIFICATION #16-0510.15 SITE SPECIFIC INFORMATION UPLIFT TEST - TAS #106 02/18/2021 Roofing Contractor DM ROOFING COMPANY Job Address 65 NW 110 ST MIAMI SHORES, FL 33168 Owner's Name ODETTE BARTHELEMY &H JOSEPH Type of Tile DOUBLE ROLL Approximate Roof Height 12 feet Approximate Square Footage of Roof Date Tested 02/18/2021 Contact Name DENIS Roof Pitch 4/12 15 ftZ Number of Tests 29 Permit # RF-12-20-2793 Date Installed Type of Access to Roof LADDER Required Testing Force 35 Lbs Testing Equipment F.G.E.100 Phone # 786-267-3066 LOCATION # OF TEST PASS # OF TEST FAIL Corner 5 Tests 5 Pass Test Fail Perimeter 7 Tests 7 Pass Test Fail Field 15 Tests 15 Pass Test Fail Ridge 2 Tests 2 Pass Test Fail TOTAL 29 Tests 29 Pass 0 Test 0 Fail IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL PA 106, THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT 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 VALID FOR INSURANCE CLAIMS.