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RF-07-22-1683Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 1099 NE 96TH ST, Miami Shores, FL 33138 1132060143650 Contacts Bombom Investments Corp Owner PRO-FORM ROOFING Contractor Ana Perdomo ALEX FERNANDEZ 1099 NE 96 ST, Miami Shores, FL 33138 7311 NW 61 ST, MIAMI, FL 33166 Business:3053165163 anaperdomol0@hotmail.com Business:3052059611 permitsproform@gmail.com Other:7869535053 a Insp ection Requests: Description: RE -ROOF TILE Valuation: $ 45,000.00 305,762949 Total Sq Feet: 4,387.00 Fees Amount Payments Date Paid Amt Paid 100% Permit Renewal Fee $350.00 Total Fees $350.00 Total: $350.00 Check # 5025 07/21/2022 $350.00 Amount Due: $0.00 Building Department Copy In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing infor pion is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize dfipr above named contractor to do the work stated. Authorized Signature: Owner / Applicant / _ ,�' o4meor-1'/ Agent Date July 21, 2022 Page 2 of 2 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 1099 NE 96TH ST, Miami Shores, FL 33138 1132060143650LL. Contacts Bombom Investments Corp Owner PRO-FORM ROOFING Contractor 1099 NE 96 ST, Miami Shores, FL 33138 ALEX FERNANDEZ IIIII 7311 NW 61 ST, MIAMI, FL 33166 1 Business: 3052059611 Other:7869535053 Inspection Requests Description: RE -ROOF TILE Valuation: $ 45,000.00, Total Sq Feet: 4,387.00 Fees Amount Application Fee - Other $50.00 CCF $27.00 DBPR Fee $5.25 DCA Fee $3.50 Education Surcharge $9.00 Roofing Fee $300.00 Scanning Fee $12.00 Technology Fee $8.75 Total: $415.50 Payments Date Paid Amt Paid Total Fees $415.50 Check # 1679 10/20/2020 $50.00 Check # 1684 10/27/2020 $365.50 Amount Due: $0.00 Building Department Copy In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate apd)th"ll work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above named co9(rp6to5Aoc10 the work stated. Authorized Signature: Owner / Applicant / Contractor / Date October 27, 2020 Page 2 of 2 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762 4949 FBC 20420 t1fil BUILDING Master Permit No. _ _ PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION [O(RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1099 NE 96 ST City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#: 113060143650 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: j t OWNER: Name (Fee Simple Titleholder): BOMBOM INVESTMENTS Phone#: 305.316.5167 Address: 1099 NE 96 ST City: MIAMI SHORES State: FL Zip: 33138 Tenant/Lessee Name: Email: hone#: CONTRACTOR: Company Name: PRO-FORM ROOFING Co Phone#: 305.389.6986 Address: 5213 NW 74 AVE City: MIAMI State: FL Zip: 33166 Qualifier Name: ALEXANDER FERNANDEZ Phone#: 305.389.6986 State Certification or Registration #:'C&C 1 3 3 l 16 5 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State Value of Work for this Permit: $ 41 :5 0 Square/Linear Footage of Work: Type of Work: ❑ Addition , ❑ Alteration El New ❑ Repair/Replace Description of Work: 14 - ►'1 o 9 T) It - Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ (Revised02/24/2014) Permit Fee $ Radon Fee $ Training/Education Fee $ Zip: 06r ❑ Demolition CCF $ CO/CC $ - DBPR $ Notary $ Double Fee $ Bond $ in o- TOTAL FEE NOW DUE $ 9 FID - V0 Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. A Signature �C//(,[��+��/�yj��2 d Signature �- OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this 01 day of J U LY 120 22 by ANA PERDOMO who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: The foregoing instrument was acknowledged before me this 01 day of J U LY 20 22 by ALEXANDER FERNANDEZ who is personally known to as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign-—° Sign: Print: Print: Seal: / :°=o�;RY P6e� GENNI GONZALEZ PEREZ Seal: Notary Public - State of Florida •M oz 'FOF Commission # GG 304864 My Comm. Expires Feb 24, 2023 APPROVED BY v�" Plans Examiner Structural Review as Ypt, ` V / GENNI GONZALEZ PEREZ Notary Public - State of Florida iv Ao° ` Commission # GG 304864 uy fP it 5xaires Feb 24, 2023 Zoning Clerk (Revised02/24/2014) BUILDING PERMIT APPLICATION Miami Shores VillageV�'' Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 1133y: Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 I� Master Permit NoZ�- (U , GU V-t F ❑BUILDING ❑ ELECTRIC ROOFING ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS JOB ADDRESS: r o ci q /,)j, /u J 4 Folio/Parcel#: // Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 113 s the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 1 �� Phone#: 3 Z 314� C'5161 Address: 1091 Alk 9J 2 City: I`` crXi 5110 2Q,5 Stater Zip: 33j316 Tenant/Lessee Name: / Email: Uo/vo (21'1)11/4na.0P_ CONTRACTOR: Company Name: ?.R o - COgm Address: 75d13 IUD 3 V ,4v(z— City: M 16i yk. Qualifier Name: 00t) n 1049�61mcaiI Pro e#: Phone#: Zip: 33/Lb one#: 305- 36 0& State Certification or Registration #: C eC 13511165 Certificate of Competency #: ex Tenn,V1d e_1/_ DESIGNER: Architect/Engineer: te: hone#: Address: ,,/` /+ City: State: _Zip: Value of Work for this Permit: $ T'� W Square/LineaWRepair/Replace age of Work: T Type of Work: ❑AAition Alteration ❑ New ❑ Demolition Description of Work. 0o- I►lL Specify color of color thru tile: QCkX0r y COO Submittal Fee o`-' Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF $_ DBPR $ k ctf70o G 2e CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $�" �N (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 E. 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 charge Signature 0-61(4VTW-- 0 _ OWNER or AGENT The foregoing instrument as acknowledged before me this day of ®L°OUn�12 20 t7 by Ar,r, ` ' 0— VZ 4 O'M 0 n, who is person Ily known to me or who has produced Zr 'Ok2 dew as identification and who did take an oath. NOTARY PU Notary Public - State of Florida Sign: 2. yo; Comrission 4 GG 304864 d. Signature CONTRACTOR The foregoing instrument ascknowledged before me this 6' , day of V (iwOLD? ✓� 20 0W by nYt�LI)p— who is perso/�nally known to me or who has produced �? Vj cl , as identification NOTARY Sign: Bonded thrcugh National Notary Assn. Print: Print: Seal: Seal: Notary P'Jbilc , hate of Florida Q Ccn omission 8 GG 304864 !' My Comm, Expiros Feb 24, 2023 Bonded through National Notary Assn. APPROVED BY '/ Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Property Information Folio: 11-3206-014-3650 Property Address: 1099 NE 96 ST Miami Shores, FL 33138-2551 Owner BOMBOM INVESTMENTS CORP Mailing Address 7135 COLLINS AVE 522 MIAMI BEACH, FL 33141 USA PA Primary Zone 1400 SGL FAMILY - 3001-3250 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY: 1 UNIT Beds / Baths / Half 3/2/0 Floors 1 Living Units 1 Actual Area Sq.Ft Living Area Sq.Ft Adjusted Area 3,523 Sq.Ft Lot Size 15,330 Sq.Ft Year Built Multiple (See Building Info.) Assessment Information Year 2020 2019 2018 Land Value 5t30 08 $580,087 $551,880 Building Value $247,705 47,852 $247,999 XF Value $26,362 $26,583 $26,802 Market Value $854,154 $854,522 $826,681 Assessed Value $854,154 $854,522 $735,247 Benefits Information Benefit Type 2020 2019 2018 Non -Homestead Cap Assessment Reduction $91,434 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description MIAMI SHORES SEC 3 PB 10-37 LOTS 1 & 2 BLK 82 LOT SIZE IRREGULAR Generated On : 10/20/2020 Taxable Value Information ............................2020 2019 2018 County Exemption Value $0 $0 $0 Taxable Value 1 $854,154 $854,522 $735,247 School Board Exemption Value $0 $0 $0 Taxable Value $854,154 $854,522 $826,681 City Exemption Value $0 $0 $0 Taxable Value $854,154 $854,522 $735,247 Regional Exemption Value $0 $0 $0 Taxable Value $854,154 $854,522 $735,247 Sales Information Previous OR Book Price Qualification Description Sale Page 03/16/2020 $730,000 31880-3644 Qual by exam of deed Federal, state or local government 08/02/2018 $730,200 31089-1137 agency 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 hffp://www.miamidade.gov/info/disclaimer.asp Version https://www.miamidade.gov/Apps/PA/prQpertyseaxch/ 10/20/2020 FLORIDA DEPARTMENT O. STATE DIVISION OF CORPORATIONS Department of State / Division of Corporations / Search Records / Search by Entity Name / Detail by Entity Name Florida Profit Corporation BOMBON INVESTMENTS CORP. Filing Information Document Number FEI/EIN Number Date Filed State Status Last Event Event Date Filed Event Effective Date Principal Address 7135 Collins Ave 702 miami beach, FL 33141 Changed: 01 /04/2021 Mailing Address PO BOX 416293 Miami Beach, FL 33141 P15000055999 47-4467978 07/02/2015 FL ACTIVE AMENDMENT 02/08/2019 NONE Changed: 02/04/2019 Registered Agent Name & Address Ana, Perdomo 7135 Collins Ave 702 miami beach, FL 33141 Name Changed: 01/19/2017 Address Changed: 01/04/2021 Officer/Director Detail Name & Address Title PSTD https://searcli.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetaiI?inquirytype=EntityName&directionType=Initial &searchNameOrder=BOMBONINV ESTM... 1 /2 To NZ Miami Shores Village Building Department 10050 N. E.2nd Avenue Miami Shores Florida 33138 '--ei: k'05) 795 2204 Fey: 1,305) 756.8972 OWNERS'S AFFIDAVIT OF EXEMPTION ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR FKISTING SITE - BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PERSUANT TO SECTION 553,844 F.S. Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, Fl 33138 Owner's Name: 0. �E rz Property Address: 1091 JU IF Roofing Permit Number: Dear BuildingP% icial:I An %% yo-M -o 16 5 Date: 10 - /'- �,2-0 certify that I am not required to retrofit the roof to wall connections of my building because: k(fihe just valuation for the structure for purpose of ad valorem taxation is less than $300,000.00, Please attach proof of ad valorem taxation. o The building was constructed in compliance with the provisions of the Florida Building Code (FBC) or with the provisions of 1994 edition of the South Florida Building Code (1994 SFBC) knot (- e g mo kYIcit }�t-9J&n o Signature State of Florida County of Dade Print Name The undersigned, being the first duly sworn, deposes and says that he/she is th owner for the above property mentioned. Sworn to and subscribed before me this fit' day of ) 'C. 0let� GENNIGONZALEZPEREZ Notary Public, Sate of Florida at Large / - ;'i�YPu`., ° • �'��r! Notary Public - State or Florida Gomnission .,' GC 304864 .'?'oF Fl.d`' MY C®mm: Expires Feb 24, 2023 When the just valuation of the structure for purpose of ad valorem taxation is equal to or more than $ o hro h ticr al u't � cted with FBC nor a 1994 SFBC. Then you must provide a building application from a General Contractor for the Roof to wall connection Hurricane Mitigation. Revised on 5/21/2009 o"cy SECTION 1524 HIGH VELOCITY HURRICANE ZONES — REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS 1524.1 Scope. As it pertains to the section, it is the responsibility of roofing contractor to,n pvide the owner with the required roofing permit, and to explain to the owner the content of the section. The'provisions of Sei�fion 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 an(the contractor. Thq owner'$ initial in the designated space indicates that the item has been explained. Renailing wood decks: When replacing roofing, the existing woc6 ieof deck may have to be renailed in accordance with the current provisions of Section R4403. (The roof deck is 08gally concealed prior to removing the existing roof system). 4._Exposed Ceiling: Exposed, open beam ceilings are where the underside of the roof decking can be viewed 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, 6. A Overflow scuppers (wall outlets): It is required that rainwater flows off so that the roof is not overloaded from a buildup of water. Perimeter/edge wall or other roof extension may block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accordance with the requirements of SectZR44, and R4413. Owner/Agent's Signature Date re bate ioco 1V.r 96 s t Property Address Permit Number Revised on 7/9/2009 LD;07/01/2015; Florida Building Code 6th Edition (2017) High -Velocity Hurricane Zone Uniform Permit Application Form Section A (General Information) Master Permit Number Contractor's Name PRn-FnRAA RnnFIN(; (n Process Number Job Address 1099 NE 96 ST MIAMI_SHORES ROOF CATEGORY ❑ Low Slope ❑ Mechanically Fastened Tile Mortar/Adhesive Set Tile ❑ Asphalt Shingles ❑ Metal Panels/Shingles ❑ Wood Shingles/Shakes Is there an existing Roof Top Solar System? (' Yes 61 No Will it be reinstallea? !' "es i MP Are there gas vents on the roof? c— Yes (- No Type? ❑ Natural ❑ LPGX ROOFTYPE ❑ New Roof 0 Repair ❑ Maintenance (ErReroofing ❑ Recovering ROOF SYSTEM ROOF INFORMATION Low Slope Roof Area (fe) Steep Slope Roof Area (ft) �3 j Total (ftz} �1316) Section B (Roof Plan) Sketch the Roof Plan: Illustrate all levels and sections, roof drain, scuppers, overflow scuppers and overflow drains. Include dimensions of sections and levels, clearly identify dimensions of elevated pressure zones and locations of parapets. OCT 2 Q 20H BY: `6 4112 PACE 2 Florida Building Code 6th Edition (2017) High -Velocity Hurricane Zone Uniform Permit Application Form Section D (Steep,Sjoped Roof System) Roof System Manufacturer: BORAL Notice of Acceptance Number: 19-0814.02 Minimum Design Wind Pressures. if Applicable (From RAS 127 or Calculations): P1: -4.80 P2: -13 94 P3; -2421 Maximum Design Pressure From the NOA Specific S st m Method of file attachment: ICP �LYSET OAM TWO PADDY Steep Stoned Roof System Description Deck Type: 5/8" PLYWOOD ype Und"adayment: Roof Slope: # 30 lb BASE SHEET ASTM 226 nsulatfon: 4 :12 N/A ct.s ns e...- N/A Ridge Ysntilation? astener Type & spacing: 1 1/4" R.S NAIL TIN CAP 5/8" 2ROWS 6"O.0 LAP 12"O.0 FIELD STAG N/A dhesive Type 'FOAM TWO PADDY ype Cap Sheet: I POLYS TICK TU PLUS oof Covering: Mean Roof Height: I j I SAXONY 900 Type & Size ©rip dge; 3X3 METAL EVES DRIP 26 GAIJGF GAINANi7.FD Florida Building Code 6th Edition (2017) High -Velocity Hurricane Zone Uniform Permit Application Form Section E (Tile Calculations) For Moment based tile systems, choose either Method 1 or 2. Compare the values for Mr with the values from i0f. 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 acx,)ptabl3. Method 1 "Moment Based Tile Calculations Per RAS 127" (P1: -39. be ?_315 =12.31 ) - Mg: 7.51 Mr, 4.80 Product Approval M, 31.3 _ (P2.68.1 xA .315=21.45) - Mg: 71.51 = M,1 3.94 Product Approval Mf 31.3 (P3:100.-&x.315 =31,72) - Mg: 7.51= M,94.21 Product Approval M, 31.3 Method 2 "Simplified Tile Calculations Per Table Below" Required Moment of Resistance (M,) From Table Below Product Approval M, M, required Moment Resistance* Mean Roof Height Roof Slope 15, 20' 25' 30' 40' 2:12 34.4 36.5 38.2 39.7 42.2 3:12 32.2 34.4 36.0 37.4 39.8 4:12 30.4 32.2 33.8 35.1 37.3 5:12 28.4 30.1 31.6 32.8 34.9 6:12 26.4 28.0 29.4 30.5 32.4 7:12 24.4 25.9 27.1 28.2 30.0 *Must be used in conjunction with a list of moment based tile systems endorsed by the Broward County Board of Rules and Appeals. For Uplift based tile systems use Method 3. Compared the values for F with the values for Fr, If the F values are greater than or equal to the Fr values, for each area of the roof, then the the attachment method is acceptable. Method 3 "Uplift Based Tile Calculations Per RAS 127" (P1:_ x L , = _ x w: = _) - W: - x cos ©� = Fr, _ Product Approval F (P2:_ x L _ = _ x w: = _) - W: _ x cos 8 _ = Fr2 _ Product Approval F (P3:_ x L _ = x w: = ) - W: _ x cos o _ = Fr3 _ Product Approval F Where to Obtain Information Description Symbol Where to find Design Pressure P1 or P2 or P3 RAS 127 Table 1 or by an engineering analysis pre- pared by PE based on ASCE 7 Mean Roof Height H Job Site Roof Slope 6 Job Site Aerodynamic Multiplier Product Approval Restoring Moment due to Gravity M9 Product Approval Attachment Resistance M, Product Approval Required Moment Resistance Mg Calculated Minimum Attachment Resistance F Product Approval Required Uplift Resistance F, Calculated Average Tile Weight W Product Approval Tile Dimensions L = length W = width Product Approval All calculations must be submitted to the building official at the time of permit application. 123 U1-48 4/19 PAGE 6 MIAMI DADE MIAMI-DADS COUNTY PRODUCT CONTROL SECTION DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES (RER) 11805 SW 26 Street, Room 208 Miami, Florida 33175-2474 BOARD AND CODE ADMINISTRATION DIVISION T (786)315-2590 F (786) 315-2599 NOTICE OF ACCEPTANCE (NOA) www.miamidade.eov/economy Boral Roofing LLC 7575 Irvine Center Drive #100 Irvine, California, USA 92816 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of co,tstrntction materials. The documentation submitted has been reviewed and accepted by Miami -Dade County RER -Product Control Section to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction_ (IIJ). This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product Control Secticm (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) reserve tine right to nave 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. RER reserves the right to revoke this acceptance, if it is determined by Miami -Dade County Product Control Section that this product or material fails to meet the requirements of the applicable building code. This product is approved as described herein, and has been designed to comply with the Florida Building Code including the High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION: Saxony 900-Slate & Saxony Split Slate, Saxony 900- Shake & Saxony 900-Split Shake - Flat Profile Tile LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami -Dade County Product Control Approved", unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the perfonnance 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 revises NOA 19-0207.02 consists of pages 1 through 8. The submitted documentation was reviewed by Freddy Semino 41 NOA No.: 19-0814.02 WM IA ; M cR untm Expiration Date: 05/02/24 Approval Date: 11/27/19 Page 1 of 8 ROOFING ASSEMBLY APPROVAL Category: Roofing Sub -Category: Roofing Tiles Material: Concrete 1. SCOPE This approves a roofing system using Saxony 900-Slate & Split Slate, Saxony 900- S1 , ' ' & Saxony" 900- Split Shake as manufactured by Boral Roofing LLC, in Okeechobee, Florida as described in S)cct:on 2 of his,Notice �of Acceptance. For locations where the pressure requirements, as determined by applicable ,ELi,lding Code does not exceed the design pressure values obtained by calculations in compliance with RAS 127'091h8 the vdlues Jisted'in section 4 herein. The attachment calculations shall be done as a moment based system. 2. PRODUCT DESCRIPTION Manufactured by Dimensions Applicant Saxony 900-Slate & Split L =17" Slate, Saxony 900- Shake W =13" & Saxony 900- Split H = 1.19" Shake Thickness:.70" Test Product Specifications Description TAS 112 Flat, Type 3a interlocking Class III, concrete tile equipped with two nail holes. For direct deck or battened nail -on, mortar or adhesive set applications. Trim Pieces L= varies TAS 112 Accessory trim, concrete roof pieces for use at W = varies hips, rakes, ridges and valley terminations. Varying thickness Manufactured for each tile profile. 2.1 PRODUCTS MANUFACTURED BY OTHERS Product Name Product Description Manufacturer (With Current NOA) ICP Adhesives Polyset AH-160 Two component polyurethane ICP Adhesives and Sealants, Inc. foam adhesive. TILE BOND' Roof Tile Adhesive "Tile Tite" Roof Tile Mortar Bonsal Roof Tile Mortar "Quikr•ete" Roof Tile Mortar, FL-15 Single component polyurethane foam roof tile adhesive. Premixed, pre -bagged roof tile mortar. Premixed, pre -bagged roof tile mortar. Premixed, pre -bagged gray roof tile mortar. 2.2 MANUFACTURING LOCATION 1. Okeechobee, Florida The Dow Chemical Company Bermuda Roof Co. Inc. Bonsal American The Quikrete Companies, Inc. NOA No.: 19-0814.02 MIAMI•DADE COUNTY Expiration Date: 05/02/24 U1220041 Approval Date: 11/27/19 Page 2 of 8 2.3 SUBMITTED EVIDENCE: Test Aeency Test Identifier Test Name/Report Date Redland Technologies 7161-03 Appendix III PA 102 & PA 102(A) Dec. 1991 7161-03 Appendix II PA 108 (Nail -On) Dec. 1991 Letter PA 108 (Nail -On) Aug. ,1994 P0631-01 PA 108 (Mortar Set) July 1994 P0402 Withdrawal Resistance Testing of'screw Sept. ,1993 vs. smooth shank nails The Center for Applied 94-060A PA 101 (Mortar Set) ✓1arp1Z 1994, Engineering, Inc. 94-084 PA 101 (Adhesive Set) MTy 1994 25-7094-2 PA 102 Oc*.1 094 (4" Headlap, Nails, Direct Decks N: x , Construction) 25-7094-8 PA 102 (4" Headlap, Nails, Bat,..en�V , 6d, 1994 25-7094-5 PA 102 (4" Headlap, Nails, Direct Deck, 061. ? 994 ` Recover/Reroof) 25-7183-6 PA 102 (2 Quik-Drive Screws, Direct Feb. 1995 Deck) 25-7183-5 PA 102 (2 Quik-Drive Screws, Battens) Feb. 1995 25-7214-1 PA 102 (1 Quik-Drive Screw, Direct Deck) March, 1995 25-7214-5 PA 102 (1 Quik-Drive Screw, Battens) March, 1995 Project No. 307025 PA 100 Oct. 1994 Test #MDC-77 Celotex Corporation Testing 520109-1 PA 101 Dec. 1998 Service 520111-4 PA 101 March 1999 520191-1 PA 101 March 1999 Walker Engineering, Inc. Calculations Aerodynamic Multiplier October 2007 Calculations Moment of Gravity August 2007 Calculations 25-7094 February 1996 Calculations 25-7496 April 1996 Calculations 25-7584 December 1996 Calculations 25-7804b-8 December 1996 Calculations 25-7804-4 & 5 December 1996 Calculations 25-7848-6 December 1996 Calculations 25-7183 March 1995 Calculations Aerodynamic Multipliers April 1999 Calculations Two Paddy Adhesive Set System April 1999 American Test Lab of South TAS 112 RT1023.01-18 October 30, 2018 Florida Walker Engineering, Inc. Calculations Restoring Moment March 29, 2018 Aerodynamic Multipliers PRI Construction Material BORR-022-02-01 TAS 101 02/25/2019 BORR-022-02-02 TAS 101 02/25/2019 BORR-022-02-03 TAS 101 02/25/2019 BORR-022-02-04 TAS 101 02/28/2019 NOA No.: 19-0814.02 CMIAMI-DADE COUNTY Expiration Date: 05/02/24 Approval Date: 11/27/19 Page 3 of 8 3. LIMITATIONS 3.1 Fire classification is not part of this acceptance. 3.2 For mortar or adhesive set tile applications, a static field uplift test shall be perforrrie.d in accordance wick TAS 106. 3.3 Applicant shall retain the services of a Miami -Dade County Certified Laboratory t3 perform quarterly test in accordance with TAS 112, appendix `A'. Such testing shall be submitted to the Miami -Dade Produ Control office for review. 3.4 Minimum underlayment shall be in compliance with the applicable Roofing Appli -ions St, rH,,rds listed section 4.1 herein. 3.5 Mechanically attached tiles minimum 4/12 slope. 3.6 30/90 hot mopped underlayment applications may be installed perpendicular to the roof slope unless statea otherwise by the underlayment material manufacturers published literature. 3.7 This acceptance is for wood deck applications. Minimum deck requirements shall be in ccmplia.ice with applicable building code. 3.8 All products listed herein shall have a quality assurance audit in accordance with the Florida Building Code and Rule 61 G20-3 of the Florida Administrative Code. 4. INSTALLATION 4.1 Saxony 900-Slate & Split Slate, Saxony 900- Shake & Saxony 900- Split Shake and its components shall be installed in strict compliance with Roofing Application Standard RAS 118, RAS 119, and RAS 120. 4.2 Data For Attachment Calculations Table 1: Average Weight (W) and Dimensions (I x w ) Tile Profile Weight-W (lbf) Length -I (ft.) Width-w (ft) Saxony 900-Slate & Split Slate, Saxony 900- Shake 10.9 1.42 1.08 & Saxony 900- Split Shake Table 2: Aerodynamic Multipliers - A (ft') Tile Profile A (ft) A (ft) Batten Application Direct Deck Application Saxony 900-Slate & Split Slate, Saxony 900- Shake 0.291 0.315 & Saxony 900- Split Shake MMMNOA No.: 19-0814.02 MIAMI•DADE COUNTY Expiration Date: 05/02/24 Approval Date: 11/27/19 Page 4 of 8 Table 3: Restoring Moments due to Gravity - M9 (ft.-lbf) Tile 2":12" 311:12" 4":12" 5":12" 6":12" 7":12" or Profile graater Saxony Battens Direct Battens Direct Battens Direct Battens Direct Battensiruct ga'aarrs, Direct 900-Slate Deck Deck Deck Deck o,,;k Deck ' & Split N/A 7.70 N/A 7.63 4.74 7.51 4.65 7.71 4.53 'Ti 7 4.40 6.V Slate, I Saxony I 900- Shake & "I Saxony 900- Split Shake Table 4: Attachment Resistance Expressed as a Moment - Mf (ft.-Ibf) for Mechanically Attached Systems Tile Profile Fastener Type Direct Deck (min 15/32" plywood) Direct Deck (min. 19/32" plywood) Battens Saxony 900-Slate & Split Slate, Saxony 900- Shake & Saxony 900- Split Shake 2-10d Ring Shank Nails 30.9 38.1 17.2 1-10d Smooth or Screw Shank Nail 7.3 9.8 4.9 2-10d Smooth or Screw Shank Nails 14.0 18.8 7.4 1 #8 Screw 30.8 30.8 18.2 2 #8 Screw 51.7 51.7 24.4 1-10d Smooth or Screw Shank Nail (Field Clip) 24.3 24.3 24.2 1-10d Smooth or Screw Shank Nail (Eave Clip) 19.0 19.0 22.1 2-10d Smooth or Screw Shank Nails (Field Clip) 35.5 35.5 34.8 2-10d Smooth or Screw Shank Nails (Eave Clip) 31.9 31.9 32.2 2-10d Ring Shank Nails' 50.3 65.5 48.3 1 Installation with a 4" the headlap and fasteners are located a min. of 2W from head of tile. NOA No.: 19-0814.02 MIAMI•DADE COUNTY Expiration Date: 05/02/24 Approval Date: 11/27/19 Page 5 of 8 Table 5: Attachment Resistance Expressed as a Moment Mf (ft.-Ibf) for Two Paddy Adhesive Set Systems Tile Tile Application Minimum ,Vtac.Lment Profile Resistance Saxony 900-Slate & Split Adhesive' 31.33 Slate, Saxony 900- Shake & Saxony 900- Split Shake 2 See manufactures component approval for installation requirements. 3 TILE BONDTm Roof Tile Adhesive; Average weight per paddy 13.9 grams. ICP Adhesives and Sealants, Inc.'s ICP Adhesives Pol set AH-160; Average weight per paddy 6 ram-, Table 6: Attachment Resistance Expressed as a Moment --Mf for Single Paddy Adhesive Set Systems Tile Profile Tile Application Minimum Attachment Resistance Saxony 900-Slate & Split ICP Adhesives Pol set AH-160 Slate, Saxony 900- Shake ICP Adhesives Pol set AH-160 & Saxony 900- Split ICP Adhesives Pol set AH-160 Shake ICP Adhesives Pol set AH-160 1194 1155 836 607 4 Large paddy placement of 45 grams of ICP Adhesives and Sealants, Inc.'s ICP Adhesives Pol set AH-160. 5 Large paddy placement of 34 grams of ICP Adhesives and Sealants, Inc.'s ICP Adhesives Polyset AH-160. 6 Medium paddy placement of 24 grams of ICP Adhesives and Sealants, Inc.'s ICP Adhesives Pol set AH-160. 7 Medium paddy placement of 18 grams of ICP Adhesives and Sealants, Inc.'s ICP Adhesives Pol set AH-160. Table 7: Attachment Resistance Expressed as a Moment - Mf (ft.-Ibf) for Mortar Set Systems Tile Tile Attachment Profile Application Resistance Saxony 900-Slate, Mortar Seth 39.0 Saxony 900- Shake & Saxon 900- Split Shake 6 Seespecific mortar manufacturers Notice of Acceptance 5. LABELING All tiles shall bear the imprint or identifiable marking of the manufacturer's name or logo (See Detail Below), or following statement: "Miami -Dade County Product Control Approved". LOGO- NAME (LOCATED ON UNDERSIDE OF TILE) NOA No.: 19-0814.02 MIAMI•DADE COUNTY Expiration Date: 05/02/24 Approval Date: 11/27/19 Page 6 of 8 6. BUILDING PERMIT REQUIREMENTS: 6.1 Application for building permit shall be accompanied by copies of the following: ; 6.1.1 This Notice of Acceptance. 6.1.2 Any other documents required by Building Official or Applicable building ^no..e in order �o properjy evaluate the installation of this system. PROFILE DRAWINGS Nall Moles Saxony 900 Slate 1-5132- 17"`. 1311 Saxony 900 Split Slate NOA No.: 19-0814.02 Expiration Date: 05/02/24 Approval Date: 11/27/19 Page 7 of 8 Nail Holes CMIAMIMADECOUNTY Saxony 900 Shake Saxony 900 Split Shake END OF THIS ACCEPTANCE NOA No.: 19-0814.02 Expiration Date: 05/02/24 Approval Date: 11/27/19 Page 8 of 8 MIAMI- MIAMI-DADE COUNTY DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES (RER) PRODUCT CONTROL SECTION BOARD AND CODE ADMINISTRATION DIVISION 11805 SW 26 Street, Room 208 Miami, Florida 33175-2474 NOTICE OF ACCEPTANCE NOA T (786) 315-2590 F (786) 315-2599 Polyglass USA Inc. www.miamldade nnv/economy III I W. Newport Center Drive Deerfield Beach, FL 33442 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The, used in Miami -Dade County and other areas where allowed by the Authority Having Jurisddocumentation submitted has been reviewed and accepted by Miami -Dade County RER - Product Control Section to be ictior (AHJ) This NOA shall not be valid after the expiration date stated below. The Miami -Dade County product Cort--01 Section (in Miami -Dade County) and/or the AHJ (in areas other than Miami -Dade County) reserve the -i ,M to have this product or material tested for quality assurance purposes. If this product or material fails to perform in thu 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. RER reserves the right cU revoke this acceptance, if it is determined by Miami -Dade County Product Control Section that this product or material fails to meet the requirements of the applicable building code. This product is approved as described herein, and has been designed to comply with the Florida Building Code including the High Velocity Hurricane Zone of the Florida Building Code, DESCRIPTION: Polyglass Polystick Underlayments LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami -Dade County Product Control Approved", unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the perforn7ance 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 and revises NOA No.15-0410.04 and consists of pages 1 through 8. The submitted documentation was reviewed by Freddy Sentino., �IAMIDD�ADE COUNTY (� NOA No.: 17-0614.22 Expiration Date: 09/13/21 Approval Date: 07/06/17 Page I of 8 ROOFING COMPONENT APPROVAL ate T : Roofing Sub-Caturory: Underlayrnent Material: SBS , APP Self -Adhering Modified Bitumen PRODUCTS DESCRIPTION: Product Dimensions Test Product Specification Description Polystick IR-Xe 65' x 3'3 '/s" ASTM D 1970 A fine granular/sand top surf4Se Sel;t-adherjgg„ APP Manufacturing Or 65' x 3' polymer modified, fiberglass,rPinfnrced, bittuninous Location #1 & #2 60 mils thick sheet material for use as an underlaT'Ment in s�oped roof assemblies. Designed as an shi�aio. ` Polystick Dual Pro 6 P x T3'/e" TAS 103 and A rubberized asphalt self-adht -ing, rglass-fib r/polyester Manufacturing 60 mils thick ASTM D 1970 reinforced waterproofing merrbrur.e. Desigi.'66 as a Location #2 metal roofing and roof tile ur(dei��a`y'lnent. Polystick Tile Pro 6P x T3-1/8" TAS 103 and A rubberized asphalt self -adhering,, glass-fiber/polyestc.,r Manufacturing 60 mils thick ASTM D 1970 reinforced waterproofing membrane. DesiXie&as a metal Location #2 roofing and roof tile underlayment. Polystick TU Max 65'8" x 3'3-3/8" TAS 103 and A rubberized asphalt self -adhering, polyester reinforced Manufacturing 60 mils thick ASTM D 1970 waterproofing mernbrane. Designed as a a roof tile Location #1 & #2 underlayment. Polystick TU P 32'10" x T3'/8" TAS 103 and A rubberized asphalt waterproofing membrane, glass - Manufacturing 130 mils thick ASTM D 1970 fiber/polyester reinforced, with a granular surface Location #2 designed for use as a tile roof underlayment. Polystick TU Plus 65' x 3133/6" TAS 103 and A rubberized asphalt self -adhering, glass-fiber/polyester (Surface Printing) 80 mils thick ASTM D 1970 reinforced waterproofing membrane. Designed as a metal Manufacturing roofing and roof tile underlayment. Location # 1 & #2 Polystick MTS 65'8" x 3'3 '/$" TAS 103 A homogeneous, rubberized asphalt waterproofing Manufacturing 60 mils thick membrane, glass fiber reinforced with polyolefrnic film Location #2 on the upper surface for use as an underlayment for metal roofing, roof tile, slate tiles and shingle underlayment. Polystick MTS Plus 65'8" x 3'3 3/e" TAS 103 A homogeneous, rubberized asphalt waterproofing Manufacturing 60 mils thick membrane, glass fiber reinforced with polyolefrnic film Location #2 on the upper surface for use as an underlayment for metal roofing, roof tile, slate tiles and shingle underlayment. Elastoflex S6 G 32'10" x 3'3 %" TAS 103 and Polyester reinforced, SBS modified bitumen membrane Manufacturing ASTM D 6164 with a sanded back face and a granule top surface. For Location #2 use in roof tile underlayment systems. MIAMI•QADE COUNTY NOA No.: 17-0614.22 Expiration Date: 09/13/21 Approval Date: 07/06/17 Page 2 of 8 MANUFACTURING PLANTS: I. Hazelton, PA 2. Winter Haven, FL EVIDENCE SUBMITTED Test Ageney Test Identifier Test Name/Report Date Trinity BRD P10870.09.08-R1 TAS 103 P10870.04.09 TAS 103/ASTM D4798 & G155 04-108 131 13/09 P33360.06.10 P33370.03.1I ASTM D1970 07%01/10 P33370.04.11 TAS 103 ASTM D 1623 03/02/11 04/26/11' P36900.09.11 TAS 103/ASTM D4798 bi (31'55 09/01/11 P37300.10.11 TAS 110/ASTM D4798 &T)il 70 1"0/19/11 P40390.08.12-2 ASTM D 1623 P�/p7/12 P37590.07.13-1 ASTM D6164 , , 07/02/13 P45270.05.14 TAS 103, TAS 110 & ASTNV:D1"F23 1 . 05/12/14 P46520.10.14 ASTM D 1623 1 C/03/14 � . ' , P44360.10.14 TAS 103 & TAS 110 I6/07/14 ` P43290.10.14 ASTM D 1970 & TAS 110 16/d7/14 ` PLYG-SC10130.06.16-3 TAS 103 & TAS 110 ` '66/27/16 PLYG-10130.06.16-1 ASTM D1970 & TAS 110 06/27/16 PRJ Asphalt Technologies PUSA-035-02-01 TAS 103 09/29/06 PUSA-055-02-02 TAS 103 12/10/07 PUSA-089-02-01 TAS 103/ASTM D4798 & G 155 07/06/09 Momentum Technologies, Inc. JX20H7A TAS 103/ASTM D4798 & G155 04/01/08 RX14E8A TAS 103/ASTM D4798 & G155 11/09/09 DX23D8B TAS 103/ASTM D4798 & G 155 02/18/10 DX23D8A TAS 103/ASTM D4798 & G155 02/18/10 LABELING: 1. All membranes or packaging shall bear the imprint or identifiable marking of the manufacturer's name or logo, city and state of manufacturing facility and the following statement; "Miami -Dade County Product Control Approved" or the Miami -Dade County Product Control Seal as shown below, MIAMI-DADE COUNTY ,�Kawfrjgoi BUILDING PERMIT REQUIREMENTS: Application for building permit shall be accompanied by copies of the following: 1. This Notice of Acceptance. 2. Any other documents required by the Building Official or applicable building code in order to properly evaluate the installation of this materials. MIAMI•DADECOUNTY NOA No.: 17-0614.22 Expiration Date: 09/13/21 Approval Date: 07/06/17 Page 3 of 8 INSTALLATION PROCEDURES: Deck Type 1: Wood, non -insulated Deck Description. Min, 19/32" plywood or wood plank System Type E(1): Anchor sheet mechanically fastened to deck, membrane adhered Anchor/Base Sheet: One or more plies of ASTM D 226 Type II or ASTM D 2626. Fastening: Per FBC 1518.2 & 1518.4 Nails and tin caps 12" base sheet only) p mid, 6" o.c. at a minimum 4" head lap. (for Membrane: Polystick IR-Xe, Polystick Dual Pro, Polystick Tile Pro, Po,ystiel" TU Max, Polystick TU P, Polystick TU Plus, Polystick MTS or Polystick MTS Plan, pelf-adher Surfacing: See General Limitations Below. u. Deck Type 1: Wood, non -insulated Deck Description: Min. 19/32" plywood or wood plank System Type E(2): Anchor sheet mechanically fastened to deck, membrane adhered Anchor/Base Sheet: One or more plies of ASTM D 226 Type II or ASTM D 2626. Fastening: Per FBC 1518.2 & 1518.4 Nails and tin caps 12 base sheet only) P grid, 6" o.c. at a minimum 4" head lap. (for Membrane: Elastoflex S6 G, hot asphalt applied Surfacing: See General Limitations Below. Deck Type 1: Wood, non -insulated Deck Description: Min. 19/32" plywood or wood plank System Type E(3): Base sheet mechanically fastened to deck, subsequent cap membrane self- adhered. Anchor/Base Sheet: One or more plies of ASTM D 226 Type II or ASTM D 2626: Fastening: Per FBC 1518.2 & 1518.4 Nails and tin ca s 12 base sheet only) P grid, 6" o.c, at a minimum 4 head lap. (for Ply Sheet: Polystick MTS Plus, self -adhered with minimum 3" horizontal laps and minimum 6" vertical laps. Membrane: Polystick TU Plus, self -adhered. Surfacing: See General Limitations Below. CIAMIMADEjl, NOA No.: 17-0614.22 • Expiration Date: 09/13/21 Approval Date: 07/06/17 Page 4 of 8 INSTALLATION REQUIREMENTS: 1. All nails in the deck shall be carefully checked for protruding heads. Re -fasten any loose deck panels, and sweep the deck thoroughly to re move any dust and debris prior to application. 2. Place the underlayment over metal drip edge in accordance with RAS 111. 3. Place the first course of membrane parallel to the eave, rolling the membrane to obtain maximum contact. Remove the release film as the membrane is applied. All side laps shall be a minimum of 3" and<end laps s�,OA be a minimum of 6". Roll the membrane into place after removing the release strip, ti e� tical sttgpping of the , roof with Polystick is acceptable. Membrane shall be back nailed in accordance WO,applicabif hnilding codP.; 4. When applying the membrane in the valley, start at the low point and work to the high joint, rolling the membrane from the center outward in both directions. 5. For ridge applications, center the membrane and roll from the center outward in both directions. 6. Roll or broom the entire membrane surface so as to have full contact with the surfnce,� giving spccia? attentions to lap areas. 7. Flash vent pipes, stacks, chimneys and penetrations in compliance with Roof Assembly Curren( 'P oduet Control Notice of Acceptance. 8. All protrusions or drains shall be initially taped with a 6" piece of underlayment. The flashing tapc(shall be pressed in place and formed around the protrusion to ensure a tight fit. A second layer of Polystick shall be applied over the underlayment, GENERAL LIMITATIONS: 1. Fire classification is not part of this acceptance. 2. Polystick Dual Pro, Polystick Tile Pro, Polystick TU Plus, Polystick MTS and Polystick MTS Plus may be used in asphaltic shingles, wood shakes and shingles, non-structural metal roofing, roof tile systems and quarry slate roof assemblies. Polystick TU P may be used in all the previous assemblies listed except metal roofing. Polystick IR-Xe may be used in all the previous assemblies listed except metal roofing and roof tile systems. Polystick TU Max may be used in non-structural metal roofing and roof tile systems. Elastoflex S6 G may be used in roof tile systems only. 3. Deck requirements shall be in compliance with applicable building code. 4. Polystick IR-Xe, Polystick Dual Pro, Polystick Tile Pro, Polystick TU Max, Polystick TU P, Polystick TU Plus, Polystielc MTS and Polystick MTS Plus shall be applied to a smooth, clean and dry surface. The deck shall be free of irregularities. S. Polystick IR-Xe, Polystick Dual Pro, Polystick Tile Pro, Polystick TU Max, Polystick TU P, Polystick TU Plus, Polystick MTS and Polystick MTS Plus shall not be adhered directly over a pre-existing roof membrane as a recover system. 6. Polystick IR-Xe, Polystick Dual Pro, Polystick Tile Pro, Polystick TU Max, Polystick TU P, Polystick TU Plus, Polystick MTS and Polystick MTS Plus shall not be left exposed as a temporary roof for longer than the amount of days listed in the table below after application. Polyglass reserves the right to revise or alter product exposure times; not to exceed the preceeding maximum time limitations. Ex osure Limitations Da s MTS IR-Xe Elastoflex TU TU P Tile Pro Dual Pro TU Max MTS Plus S6 G Plus Winter Haven FL 180 90 180 180 180 180 180 180 Hazelton PA N/A 90 N/A 180 N/A N/A 180 N/A 180 N/A 7. All products listed herein shall have a quality assurance audit in accordance with the Florida Building Code and MIAMI-DADE C NTY NOA No.: 17-0614.22 Expiration Date: 09/13/21 Approval Date: 07/06/17 Page 5 of 8 Rule 61 G20-3 of the Florida Administrative Code. 8. In roof tile application, data for the attachment resistance of roof tiles shall be as set forth in the roof tile manufacturer's Notice of Acceptance. Polystick Tile Pro, Polysticic TU Max, Polystick TU Plus or Elastoflex S6 G may be used in both adhesi set and mechanically fastened roof the applications. ve Polystick Dual Pro is limited to mechanically fastened roof tile applications. Polystick MTS and Polystick MTS Plus are limited to mechanically fastened with the limitations uutlined n Section 9, Polystick TU P may be used in mechanically fastened roof tile applications with t e I, I 1 applications. h Pxception o{_ �rertar set, t1a 9• When loading roof tiles on roof tile underlayment for (direct -to -deck) tile assemblies, the,maxiniu>n rco shall be as follows. (See Table Below) , f slops Tile Polystick Elastoflex Polystick TU Plus, Profile MTS Polystick Polystic(c`sS6 G TU P, Tile Pro, TU Max yt ` i em (E3) MTS` Pt us Dual Pro S Plus with , Flat Tile Prohibited 4;12 X? )0lus < 6:12 6:12 without batte6:1.2 Profiled Prohibited 4:12 6:12 Tile without battens 6.12 4:12 6:12 The above slope limitations can be exceeded only by using battens in accordance with the Approved Tile System Notice of Acceptance and applicable Florida Building Code requirements. When battens are required, they shall be utilized during loading and installation of tiles. 10. Care should be taken during the loading procedure to keep foot traffic to a miniinum and to avoid dropping of tile directly on the underlayment. Refer to Polyglass' Tile loading detail below for loading procedure — two tiles laid perpendicular to slope followed by a maximum four tile stack parallel to the slope, for a total of 6 tiles — for all underlayments except Polysticic MTS which shall be loaded onto battens. n O N POLYSnCKTU Plus MIAMI DADE COUNTY NOA No.: 17-0614,22 Expiration Date: 09/13/21 Approval Date: 07/06/17 Page 6 of 8 11. Refer to prepared roofing system Product Control Notice of Acceptance for listed approval of this product with specific prepared roofing products. Polystick IR-Xe, Polystick Dual Pro, Polystick Tile Pro, Polystick TU Max, Polystick TU P, Polystick TU Plus, Polystick MTS, Polystick MTS Plus or Elastoflex S6 G may be used with any approved roof covering Notice of Acceptance listing Polystick IR-Xe, Polystick Dual Pro, Polystick Tile Pro, Polystick TU Max, Polystielc TU P, Polystick TU Plus, Polystick MTS, Polystick MTS Plus or Elastoflex S6 G as a component part of an assembly in the Notice of Acceptance. If Polystick IR-Xe, Polystick Dual Pro, Polystick Tile Pro, Polystick TU Max �'?OIT1 TU Plus, Polystielc MTS, Polystick MTS Plus or Elastoflex S6 G are not listed,�a 'req ' may, rek , 7Padesto t, , , Authority Having Jurisdiction (AHJ) or the Miami -Dade County Product Control SPpti0n, for approval provided that appropriate documentation is provided to detail compatibility of the products, wire d uplift resistance, and f re testing results. POLYGLASS GENERAL APPLICATION GUIDELINES FOR POLYSTICK, MEMBRANES PLEASE CHECK WITH LOCAL BUILDING CODES REGARDING LIMITATIONS OF SPECII1IC APhICh'I'IONS. , , , LOCAL CODES MAY SUPERSEDE POLYGLASS REQUIREMENTS AND RECOXFi IE1VDATY6NS. 1. Polyglass does accept the direct application of Polystick underlayment membranes to wood decks. Installers are cautioned to refer to applicable local building codes prior to direct deck installation to ensure this is acceptable. Please also refer to applicable Product Data Sheets of the corresponding products. 2. All rolls, with the exception of Polystick TU Plus should be back -nailed in selvage edge seam as per Polyglass Back Nailing Guide. Nails shall be, 11 gauge ring shank type, applied with a minimum 1 V metal disk as required in Miami -Dade County or simplex type nail as otherwise allowable in other regions, at a minimum rate of 12" o.c. Polystick TU Plus should be back nailed in designated area marked "nail area, area para clavar" on the face of membrane, with the above stated nails and/or disks. The head lap membrane is to cover the area being back -nailed. (Please refer to applicable local building codes prior to installation.) I All seal lap seams (selvage laps) must be rolled with a hand roller to ensure full contact, 4. All fabric over fabric; and granule over granule end laps, shall have a 6" wide, uniform layer of Polyglass Polyplus 55 Premium Modified Flashing Cement, Polyglass Polyplus 50 Premium MB Flashing Cement, XtraFlex 50 Premium Modified Wet/Dry Cement, Polyglass PG500 MB Flashing Cement, applied in between the application of the lap. The use of mastic between the laps does not apply to Polystick MTS. 5. A maximum of 6 tiles per stack are allowed when loading tile on the underlayments. Refer to the Polyglass Tile Loading Guidelines. See General Limitations #9 and #10. 6. Battens and/or Counter -battens, as required by the tile manufacturers NOA, must be used on all projects for pitch/slopes of TY12" or greater. It is suggested that on pitch/slopes in excess of 6 '/4"/12", precautions should be talcen, such as the use of battens to prevent tile sliding during the loading process. 7. Minimum cure time after membrane installation & before loading of roofing tiles is Forty -Eight (48) Hours. 8. Polystick membranes may not be used in any exposed application such as crickets, exposed valleys, or exposed roof to wall details. 9. Repair of Polystick membranes is to be accomplished by applying Polyglass Polyplus 55 Premium Modified Flashing Cement, Polyglass Polyplus 50 Premium MB Flashing Cement, XtraFlex 50 Premium Modified Wet/Dry Cement, Polyglass PG500 MB Flashing Cement to the area in need of repair, followed by a patch of the Polystick material of like kind should be set and hand rolled in place over the area needing such repair. Patching membrane shall be a minimum of 6 inches in either direction. The repair should be installed in such a way so that water will run parallel to or over the top of all laps of the patch. MIAMI•DAOE COUNTY NOA No.: 17-0614.22 Expiration Date: 09/13/21 Approval Date: 07/06/17 Page 7 of 8 10. All self -adhered membranes must be rolled to ensure full contact with approved substrates. Polyglass requires a minimum of 40 lbs for a weighted roller for the rolling of the field membrane. Hand rollers are acceptable for ming may be used where slope prohibits rolling. rolling of patches or small areas of the roof. Brow 11. All approved substrates should be dry, clean and properly prepared, before any application of Polystick membranes commences. An approved substrate technical bulletin can be furnished upon request. itis recommended to refer to applicable building codes prior to installation to verify acceptable sub;,irdids'. 12. The Polyglass Miami -Dade Notice of Acceptance (NOA) approval for Polystick meiribralies can'be furnished upon request by our Technical Services Department by calling 1 (800) 894-4563. ' 13. Questions in regards to the application of Polyglass products should be directed to o�ar.Technicr-1 Services Department at 1 (800) 894-4563. 14. Polyglass recommends that applicators follow good roofing practices and applicable ;ro 'adures ,o,�'cline the National Roofing Contractors Association (NRCA). r1,s d by, PLEASE CHECI{ WITH LOCAL BUILDING CODES REGARDING LIMITATIONS OF SPEdFIC APPLIC LOCAL CODES MAY SUPERSEDE POLYGLASS REQUIREMENTS AND RECOMMENDATIOI.y�S TIONY. END OF THIS ACCEPTANCE MIA - nADE COUNTY NOA No.: 17-0614.22 Expiration Date: 09/13/21 Approval Date: 07/06/17 Page 8 of 8 Z-A �1��it11 b' DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES (RER) BOARD AND CODE ADMINISTRATION DIVISION NOTICE OF ACCEPTANCE (NOA) ICP Adhesives and Sealants, Inc. 12505 NW 40' Street Coral Springs, FL. 33065 MIAMI-DADE COUNTY PRODUCT CONTROL SECTION 11805 SW 26 Street, Room 208 Miami, Florida 33175-2474 T (786)315-2590 F (786) 315-2599 www.miamidade.eov/economy < r SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of corisuYdction materials. The documentation submitted has been reviewed and accepted by Miami -Dade County RER-Proauc*. Control Sectiion,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 Corts-ol Section (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) reserve the ri&to have, this, Product or material tested for quality assurance purposes. If this product or material fails to perform in tile accepted,rltutd',gr, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify, or susp6fid the use of such product or material within their jurisdiction. RER reserves the right to revoke this acceptance, if it is determined by Miami -Dade County Product Control Section that this product or material fails to meet the requirements of the applicable building code. This product is approved as described herein, and has been designed to comply with the Florida Building Code including the High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION: ICP Adhesives Polyset® AH-160 LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami -Dade County Product Control Approved", unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA renews NOA 16-0315.01 and consists of pages 1 through 11. The submitted documentation was reviewed by Alex Tigera. NOA No.: 17-0322.03 Expiration Date: 05/10/22 Approval Date: 04/27/17 Page 1 of 11 ROOFING COMPONENT APPROVAL: Category: Roofing Sub Category: Roof tile adhesive Materials: Polyurethane SCOPE: This approves ICP Adhesives Polyset® AH-160 as manufactured by ICP Adhesives and SeTlagts,, Inc. as rlPsgribed in this Notice of Acceptance. For the locations where the design pressure requirements, as deterrn�red by applicable building code, do not exceed the design pressure values obtained by calculations in compliance 7v4`i Roofing Application Standard RAS 127. For use with approved flat, low, and high profile roof tile systsrns- using I(:P` Adhesives Polyset® AH-160. PRODUCTS MANUFACTURED BY APPLICANT: Product Dimensions Test Product;Desc,ription:; Specifications ICP Adhesives N/A TAS 101 Two component polyurethane foafn` h6hesive Polyset®AH-160 ICP Adhesives Foam N/A Dispensing Equipment Dispenser RTF1000 ICP Adhesives ProPacle N/A Dispensing Equipment 30 & 100 PRODUCTS MANUFACTURED BY OTHERS: Any Miami -Dade County Product Control Accepted Roof Tile Assembly having a current NOA which list attachment resistance values with the use of ICP Adhesives Polyset® AH-160 roof tile adhesive. MANUFACTURING LOCATION: 1. Tomball, TX. PHYSICAL PROPERTIES: Property Test Results Density ASTM D 1622 1.6 lbs./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 @1580F., 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. MIAMI•DADE COUNTY NOA No.: 17-0322.03 W11 Expiration Date: 05/10/22 Approval Date: 04/27/17 Page 2 of 11 EVIDENCE SUBMITTED: Test ALYency Test Identifier Test Name/Report Date Center for Applied Engineering #94-060 TAS 101 04/08/94 257818-1PA TAS 101 1211`6/96 25-7438-3 SSTD 11-93 10/2,5./95 25-7438-4 25-7438-7 SSTD 11-93 11/02/45 25-7492 SSTD 11-93 12/1-2/95 Miles Laboratories NB-589-631 ASTM D 1623 02/0 V91 Polymers Division Ramtech Laboratories, Inc. 9637-92 ASTM E 108 0416Q/%, Southwest Research Institute 01-6743-011 ASTM E 108 11/16/94, 01-6739-062b[l] ASTM E 84 O1/16M Trinity Engineering 7050.02.96-1 TAS 114 03/14/96 P36700.04.12 ASTM D 1623 04/18/12 P39740.02.12 TAS 101 02/21/12 TAS 123 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. ICP Adhesives Polyset® 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 ICP Adhesives Polyset® AH-160 roof tile adhesive with their tile assemblies shall test in accordance with TAS 101. 5. All products listed herein shall have a quality assurance audit in accordance with the Florida Building Code and Rule 61 G20-3 of the Florida Administrative Code. NOA No.: 17-0322.03 Expiration Date: 05/10/22 Approval Date: 04/27/17 Page 3 of 11 INSTALLATION: 1. ICP Adhesives Polyset® AH-160 may be used with any roof tile assembly having a current NOA that lists attachment resistance values with the use of ICP Adhesives Polyset® AH-160. 2. ICP Adhesives Polyset® AH-160 shall be applied in compliance with the Component Application sect and the corresponding Placement Details noted herein. The roof tile assembly's adhesive attachrprfit With the qse pf ICP Adhesives Polyset® AH-160 shall provide sufficient attachment resistance to meet or exce1,0,tbe resiStgnc.e value , determined in compliance with Miami -Dade County Roofing Application Standards RA S TV. The adhesive attachment data is noted in the roof tile assembly NOA. 3. ICP Adhesives Polyset® AH-160 and its components shall be installed in accordance with'Rdofing A'pp,Wcht,ion Standard RAS 120, and ICP Adhesives and Sealants, Inc.'s Operating Instruction and WlAihidnance B,00`Kiet, 4. Installation must be by a Factory Trained 'Qualified Applicator' approved and licensed by TCR Adhesives; and Sealants, Inc. ICP Adhesives and Sealants, Inc, shall supply a list of approved applicatd:. s to the authority .having jurisdiction. 5. Calibration of the ICP Adhesives Foam Dispenser RTFI000 dispensing equipment is requtred`before, 600cation ` 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). 6. ICP Adhesives Polyset® AH-160 shall be applied with ICP Adhesives Foam Dispenser RTF1000 or ICP Adhesives ProPack® 30 & 100 dispensing equipment only. 7. ICP Adhesives Polyset® AH-160 shall not be exposed permanently to sunlight. 8. Tiles must be adhered in freshly applied adhesive. Tile must be set within 1 to 2 minutes after ICP Adhesives Polyset® AH-160 has been dispensed. 9. ICP Adhesives Polyset® AH-160 placement and minimum patty weight shall be in accordance with the 'Placement Details' herein. Each generic tile profile requires the specific placement noted herein. NOA No.: 17-0322.03 Expiration Date: 05/10/22 Approval Date: 04/27/17 Page 4 of 11 Table 1: Adhesive Placement For Each Generic Tile Profile Tile Profile Placement Detail Minimum Paddy Contact Minimum Paddy Gram Area Weight Eave Course -Flat, Low, High Profiles All Eave Course 17-23 sq. inches 45.65 - ` Flat, Low, High Profiles #1 17-23 sq. inches 45�-ES , Flat Profile #2 10-12 sq. inches 30 30 Low Profile #2 12-14 sq. inches High Profile #2 17-19 sq. inches 30 Flat, Low, High Profiles #3 Two Paddys: 8-9 sq. inches at , 12, grams per,paddy head of tile 9-11 sq. inches at overlap ; 17 grams per bead Two -Piece Barrel (Cap Tile) Two Piece 2 Beads (1 each longitudinal edge) 20-25 sq. inches each bead Two Piece Barrel (Pan Tile) Two Piece 65-70 sq. inches 34 grams under pan LABELING: All approved products listed herein shall be labeled and shall bear the imprint or identifiable marking of the manufacturer's name or logo and following statement: "Miami -Dade County Product Control Approved" or the Miami - Dade County Product Control Seal as shown below. 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.: 17-0322.03 Expiration Date: 05/10/22 Approval Date: 04/27/17 Page 5 of 11 ADHESIVE PLACEMENT DETAIL # 1 t"ll dhimugli,pladicownanr _PuddNllManamIMIr) loll w�ce�� apllon.I ': �Y4 %✓fix Fasclr 2 in"lop 14 in,x\ 2 hrwldr IR2 p+vddFvIRanMa4h WWI I "A OM 149h PIR041a M�twanF- ` dwihaamgpke I, +" .: F+�IdFfl9rn.r9laTilyl. i 141n K L 3.dn.ad+lr 4 A f �0' ` f VleelFhale EFmrd'msuee MIAMI•DADE COUNTY � ILIMI I Flat/Low Profile Tile 1. Starting at the eave course, apply a minimum 2" (50.8 mm) x 10" (254 mm) x 1" (25.4 fiim),fo(im paddy onto the underlaynr ent nusitioned as shown, ` under the strengthening rib`dlosest to the overlock of the tile being set. .. ` ` . 2. Continue in same manners 'Wurc approximately 17 (109.7 cm') — 23 (148.4 cm2) square inch adhesive contact with the underside p'L the tile. ' Medium Profile / Double Pan Tile 1. Starting at the eave course, apply a minimum 2" (50.8 mm) x 10" (254 mm) x 1" (25.4 mm) foam paddy onto the underlayment positioned as shown under the pan portion of the tile closest to the overlock of the tile being set. 2. Continue in same manner. Insure approximately 17 (109.7 cm') — 23 (148.4 cm2) square inch adhesive contact with the underside of the tile. High Profile / Single Pan Tile 1. Starting at the eave course, apply a minimum 2" (50.8 nun) x 10" (254 mm) x 1" (25.4 mm) foam paddy onto the underlayment positioned as shown under the pan portion of the tile closest to the overlock of the tile being set. 2. Continue in same manner. Insure approximately 17 (109.7 cmZ) — 23 (148.4 cm2) square inch adhesive contact with the underside of the tile. NOA No.: 17-0322.03 Expiration Date: 05/10/22 Approval Date: 04/27/17 Page 6 of 11 ADHESIVE PLACEMENT DETAIL ## 2 W11111hroaphl4WWcsamenw Nddy(Svn fa Tile{ pwhoonaoquirudp` .r } VliidYlli%IIIYIU �� v . .,*r 1 k 71n€ BaeOani gplfonalJda BwaClasanQ-__t _ r Nail Alvolih phoic Imam 4whea requiredl Batten opiranall 71n. �� I� � •. Ky i 1`'D. ��..t ' . a in. EavrGaMne— MIAMI•DADE COUNTY Flat/Low Profile Tile 1. Starting at the cave course, apply a minimum 2" (50.8 mm) x 10" (254 mm) x 1" (25.4 rpm) foa{;n''f dddy onto the underlayment positioned as shown {lpder the strengthening rib of the tile rlo,sPst,to the bveriock of , the tile being set. Insure approximately 17 (109.7 cm2), — 23 (148.4 cm2) square inch adhesive contact with the: underside of the tile. 2. At the second course, applya!minimum 2",(50:8mm) x 7" (177.8 mm) x 1" (25.4 }ritV2 i(,am paddy`onto the underlayment positioned as'shown'under�lie ` strengthening rib closest to file Overlock of thb'lile being set. 3. Continue in same manner. Insure approximately 10" (64.5 cm2) - 12 (77.4 cm2) square inch adhesive contact with the underside of the tile. Medium Profile / Double Pan Tile 1. Starting at the cave course, apply a minimum 2" (50.8 mm) x 10" (254 mm) x 1" (25.4 mm) foam paddy onto the underlayment positioned as shown under the pan portion of the tile closest to the overlock of the tile being set. Insure approximately 17 (109.7 cm2) — 23 (148.4 cm2) square inch adhesive contact with the underside of the tile. 2. At the second course, apply a minimum 2" (50.8mm) x 7" (177.8 mm) x 1" (25.4 mm) foam paddy onto the underlayment positioned as shown under the pan portion of the tile closest to the overlock of the tile being set. 3. Continue in same manner. Insure approximately 12" (77.4 cm2) - 14 (90.3 cm2) square inch adhesive contact with the underside of the tile. (Instructions continued on next page) NOA No.: 17-0322.03 Expiration Date: 05/10/22 Approval Date: 04/27/17 Page 7 of 11 ADHESIVE PLACEMENT DETAIL # 2 (CONTINUED) Nall dwaughPIA.Mi c Cc �urhmrroryulrodj � Wdyl11-on-A6hT110 lM�wrrym 1+ '� I r.r "r 21n. fiacaensopllanal '` + ��`��` h o o- `~.fit° � �k��. /�1` ,�'o� ,�•�. EMW cGoswre High Profile / Single Pan Tile 1. Starting at the eave course, apply a minird''h ,T ?_'',(50.8 mm) x 10" (254 mm) x 1" (,,5.4,mm) foarn paddy onto the underlayment positioned as shown unaer the pan portion of the tile closest to `lie overlock of the tile being set. Insure approximately 17 (109.7cm2) — 23 (148.4 cmZ) square inch adhesivz contact, witl. the underside of the tile. 2. At the second course, apply,a; rnipimum 2" (5P.8mm) x 7" (177.8 mm) x 1" (25.4 tnm) foam parlOy o,9to the , , underlayment positioned as -shown under .he' pan portion of the tile closest to `tk e overlock of the tile being set. 3. Continue in same manner. Insure approximately 17" (109.7 cmZ) - 19 (122.6 cmZ) square inch adhesive contact with the underside of the tile. NOA No.: 17-0322.03 Expiration Date: 05/10/22 Approval Date: 04/27/17 Page 8 of 11 ADHESIVE PLACEMENT DETAIL # 3 rulNtlumu0ptudcoememt Paddy Ittetween tiles) twhenrequGedN Buimtopdoeel I ° Paddy[underdtel 1 #W single pat '► an ool' aftddy ♦,. •.• x4ln single paddy anuadedayment (n. -•``- ' q \hr Fqi lm. Fuc(a Qvedasure. FlattLowWraElleills Mallihmughpluticennem %glepaddgrwWards t'whenvailuNredp paddy Ibetmea dleo eairenc Paddy [umder tile) optional r Skiglepad ys aotop Cut tife� �,� "R• 4 31410. Spaddyan ° ynHrrt ��y-. 2Im. Eaw namure Eavef,nuece Fesa7a Medium Pratlla Ille 1. On the eave course only, apply a minimum 2" (50.8 mm) x 10" (254 mm) x V (25.4 mm) foam paddy onto the underlayment positioned as shown, under the strengthening rib for fat tjlc, or undcx the pan portion of the tile for low o.•Siigh profilp,tilu, )osest to the overlock of the the roti;irjg set. Leave approximately 4" (101.6 fain), up from the gave edge free of foam to prevefiftlib,expan('ed a(hesive from blocking the weep holes. Insure ' approximately 17-23 in' (1`&'.?-�-.48.4 om`)`of adhesive contact with the`underside of the tile 2. Apply a 4" (101.6 mm) x'4"Xi0; .6 mm), x j (25.4 mm) foam paddy onto the underlaymef ,jest below the second course line positioned foam paddy under the strengthening rib for flat tile, or under the pan portion of the tile, closest to the underlock for the second course tile to be installed. Insure approximately 8-9 in (51.6-58.1 cm2) of adhesive contact with the underside of the tile. (Instructions continued on next page) NOA No.: 17-0322.03 Expiration Date: 05/10/22 Approval Date: 04/27/17 Page 9 of 11 ADHESIVE PLACEMENT DETAIL # 3 (CONTINUED) NallthrowPpiardc Singlepaddyundardle fwhenumpiredp Piaddyllbet�raen dles9 "Wmen. Paddy fumdertllap 9inple runtierh 4:Ain. ' 2x4im • Stele paddyoo top of�e -- •� *:�' �Xtiy4,� ErreCaurre - Fasda Weephole to in. 210. Ewe doswe Ddpadge H10 PratlleTHe 3. Also apply a 2" (50.8 mm) x 4" (101.6 mm) x'/4" (19 mm) paddy on top of the eave co{irs .,tile surface as shown, on top ofAo strengthening rib ' for flat tile or on top of the pan portion of fh: tile, closest to the underlock oft? 'first course of tile. Install second course of tile, Insure approximately 9 (58.1 cm2) - 11 (71=0,spu&re inck adhesive contact with the underside of the the at tl?e overlap and 7 (45.2 cm2) - 9 (5cmzj squafz in> tt` adhesive contact with the underside of the the at the head of the tile. Continue in same manner. NOA No.: 17-0322.03 Expiration Date: 05/10/22 Approval Date: 04/27/17 Page 10 of 11 ADHESIVE PLACEMENT DETAIL TWO PIECE BARREL 1) Place enough adhesive to achieve 65 to 70 sq. in. In contact with the pan tile. 2) Turn covers upside down. Place adhesive In to 1 In. from outside edge of cover tile. Then Install the tale. Ensure 20 to 25sq. in. contactarea. ^^r.•�a Underiayment Eaveclosure (motar shown) Fascia Steep pitch applications (when required) Remove top portion of the eave course cover tile. Abut to second course of pan tiles. Ensure save and of pan and cover tiles are flush at eave line. Two Piece Barrel - High Profile Tile MIAMI•DADE COUNTY Two Piece Barrel (Cap and Pan) Tile_ 1. Starting at the eave courne, apply a minimum 2" (50.8 mm) x 10" (254..nim.) 1" (2SA rn,,ri) foam , paddy onto the underlaymen' positioned as shown under two adjaca:l( pan tiles. Support eavc tiles from rocking untie adhesive h4s a cl;ance to cure. 2. Continue in same mar►ner bringing two pan courses up toward the ridge. Insure approximately 65 (41,9.4 �mz) — 70 445'1'.6 cm2) square inch adhesive contact with the underside ` of the pan tile. ` 3. Turn covers upside down exposing the underside of the tile. Apply a minimum 1" (25.4 mm) x 10" (254 mm) bead of adhesive directly on the inner edge of each side of the cover tile. Leave approximately 3/4" (19 mm) to 1" (25.4 mm) from the outside edge of the tile, inward, free of foam to allow for expansion. 4. Turn cover tile over after foam is applied and place onto pan tile course. Insure a minimum of 20 (129 cm2) - 25 (161.3 cm2) square inch contact area on each side of the cover tile to the pan tile. Continue in same manner. Trim away any cured exposed foam adhesive. Pointing of longitudinal edges of the cover tiles are considered optional. 5. When additional nailing is required, 2" (50.8 mm) x 4" (101.6 mm) nailers or the tie wire system using galvanized, stainless steel, or copper wire and compatible nails may be used. END OF THIS ACCEPTANCE NOA No.. 17-0322.03 Expiration Date: 05/10/22 Approval Date: 04/27/17 Page 11 of 11 OFFICIAL OF H15000162699 3 Elm BOMBON INVESTMENTS CORP. The undersigned subscriber to these Articles of Incorporation is a natural person competent to contract and hereby form a Corporation for profit under Chapter 607 of the Florida Statutes. ARTICLE I - NAME The name of the Corporation is BOMBON INVESTMENTS CORP., (hereinafter, "Corporation"). ART CO WORATION The Corporation shall engage in any activity or business permitted under the laws of the United States and of the State of Florida. kL OFFICE The address of the principal office of this Corporation is 1735 Northeast 157th Terrace, Miami, Florida 33162 and the mailing address is the same. The name and street address of the incorporator of this Corporation is: Elsie Sanchez 1840 Southwest 22nd Street, 4th Floor Miami, Florida 33145 ARTICLE 5 - OFFICERS The officers of the Corporation shall be: President- Ana Perdomo Secretary: Ana Perdomo Treasurer: Ana Perdomo whose mailing addresses shall be the same as the principal office of the Corporation. H15000162699 3 BOMBON INVESTMENTS CORP. Page 3 ARTICLE 8 - SHAREHOLDERS' IRESTR1CTlVE AGREEMENT All of the shares of stock of this Corporation may be subject to a Shareholders' Restrictive Agreement containing numerous restrictions on the rights of shareholders of the Corporation and transferability of the shares of stock of the Corporation. A copy of the Shareholders' Restrictive Agreement, if any, is on file at the principal office of the Corporation. ARTICLE 9 - POWERS OF CORPORATION The Corporation shall have the same powers as an individual to do all things necessary or convenient to carry out its business and affairs, subject to any limitations or restrictions imposed by applicable few or these Articles of Incorporation. ARTICLE 10 -TERM OF EXISTENCE This Corporation shall have perpetual existence. ARTICLE 11 - REGISTER E . OWNER(S The Corporation, to the extent permitted by law, shall be entitled to treat the person in whose name any share or fight is registered on the books of the Corporation as the owner thereto, for all purposes, and except as may be agreed in writing by the Corporation, the Corporation shall not be bound to recognize any equitable or other claim to, or interest in, such share or right on the part of any other person, whether or not the Corporation shall have notice thereof. ARTICLE 12 - REGISTEREDOFFICEAND REGISTERED AGENT The initial address of registered office of this Corporation is Spiegel & Utrera, P.A., located at 1840 Southwest 22nd Street, 4th Floor, Miami, Florida 33145. The name and address of the registered agent of this Corporation is Spiegel & Utrera, P.A., 1840 Southwest 22nd Street, 4th Floor, Miami, Florida 33145. HI 5000162699 3 BOMBON INVESTMENTS COPIP, Page 5 ARTICLE 16 - INDEMNIFICATION The Corporation shall indemnify a director or officer of the Corporation who was wholly successful, on the merits or otherwise, in the defense of any proceeding to which the director or officer was a party because the director or officer is or was a director or officer of the Corporation against reasonable attorney fees and expenses incurred by the director or officer in connection with the proceeding. The Corporation may indemnify an individual made a party to a proceeding because the individual is or was a director, officer, employee or agent of the Corporation against liability if authorized in the specific case after determination, in the manner required by the board of directors, that indemnification of the director, officer, employee or agent, as the case may be, is permissible in the circumstances because the director, officer, employee or agent has met the standard of conduct set forth by the board of directors. The indemnification and advancement of attorney fees and expenses for directors, officers, employees and agents of the Corporation shall apply when such persons are serving at the Corporation's request while a director, officer, employee or agent of the Corporation, as the case may be, as a director, officer, partner, trustee, employee or agent of another foreign or domestic Corporation, partnership, joint venture, trust, employee benefit plan or other enterprise, whether or not for profit, as well as in their official capacity with the Corporation. The Corporation also may pay for or reimburse the reasonable attorney fees and expenses incurred by a director, officer, employee or agent of the Corporation who is a party to a proceeding in advance of final disposition of the proceeding. The Corporation also may purchase and maintain insurance on behalf of an individual arising from the individual's status as a director, officer, employee or agent of the Corporation, whether or not the Corporation would have power to indemnify the individual against the same liability under the law. All references in these Articles of Incorporation are deemed to include any amendment or successor thereto. Nothing contained in these Articles of Incorporation shall limit or preclude the exercise of any right relating to indemnification or advance of attorney fees and expenses to any person who is or was a director, officer, employee or agent of the Corporation or the ability of the Corporation otherwise to indemnify or advance expenses to any such person by contract or in any other manner. If any word, clause or sentence of the foregoing provisions regarding indemnification or advancement of the attorney fees or expenses shall be held invalid as contrary to law or public policy, it shall be severable and the provisions remaining shall not be otherwise affected. All references in these Articles of Incorporation to "director", "officer', "employee" and "agent" shall include the heirs, estates, executors, administrators and personal representatives of such persons. Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7223628 RECEIPT NO. RENEWAL BUSINESS NAME/LOCATION 7508252 PRO FORM ROOFING CO 7311 NW 61ST ST MIAMI, FL 33166 LBT EXPIRES SEPTEMBER 30, 2021 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED PRO FORM ROOFING CO 196 SPECIALTY BUILDING BY TAX COLLECTOR C/O ALEXANDER FERNANDEZ PRIES CONTRACTOR 75.00 08/26/2020 Worker(s) 5 CCC1331165 0208-20-006481 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 8a-276. M I A M I-MMES For more information, visit www.miamidade.gov/taxcollector EMEW Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7238806 RECEIPT NO. RENEWAL BUSINESS NAME/LOCATION 7524888 PRO FORM ROOFING CO 7311 NW 61ST ST 7311 MIAMI, FL 33166 EXPIRES SEPTEMBER 30, 2021 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED PRO FORM ROOFING CO 213 SERVICE BUSINESS BY TAX COLLECTOR C/O ALEXANDER M FERNANDEZ 75.00 07/16/2020 Employee(s) 5 CREDITCARD-20-054464 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 8a-276. MIAMI•DADE Far more information, visit www miamidade gov/taxcallector a V. N� 0 c El ID 0 ID m 0 3 X T 0 F a m z A tom. :.n w �! < 10 2 m p 0 X m .z. :An rn -n m C a m n 0 c Q z z C r t1 z t� �.i 0 m M z -4 0 c z z 0 M 0 Vm! 0 om 0 C O z OVAa t sec. Tyra°# sysaresa PRO FORM RWFINO CO 213 SERVICEBPAYMUIrREC21vimUSINM CIOA MANDER M FMOMDEZ eYTAx�ou c�ros emwyee) 76.00 09N9l2021 d229.2f-0042�7 ThbLocd9ukmTmcR=dA►Q W4kW i gdri.L"td8=b .TaR"iMeN ptalioet laaka� nol/Mhold�fsAadi�adoAilb Voiderop�gi phrwt4aargRejnnneMd aq�Nb� t.wn sai nvyy a ru ewtnes. l6�sIEC6J►rNo.ioles�se�eisd+anl(o�1wddrAr.ioedalssea�e-t�. Fauw� tla h Loci Mia PRO FORA r31'1 NW 6 OWNRR PROFORMI CIO ALAW YVodtCO �� a 11 - ACOR 76 L� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 10/05/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CU'RTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: David Gil, Sr. Gil & Associates Insurance PHCNNo Ext: (305) 279-7665 AIC No: (305) 279-9705 E-MAIL ADDRESS: 9@9 d it ilinsurance.com 9485 SW 72 St Suite A-120 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Kinsale Insurance Co Miami FL 33173 INSURED INSURER B : INSURER C : Pro -Form Roofing Co. INSURER D : 226 SE 9th Court INSURER E : INSURER F : Hialeah FL 33010 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 WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE X OCCUR 0100102841-0 12/09/2019 12/09/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO REN =-17- PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ Excluded PERSONAL& ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ J PROT ❑ LOC X D OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS F COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ r $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A PER OTH- STATUTE I I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) CCC1331165 Roofing Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village Bldg Dept AUTHORIZED REPRESENTATIVE 10050 NE 2nd Ave _ Miami Shores FL 33138 �`---� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD .�C'�7Rl7" CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 10/08/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CrERTIFICATE 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 (les) 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($). PRODUCER FrankCrum Insurance Agency, Inc. 100 South Missouri Avenue Clearwater, FL 33756 CONTACT NAME: PHONE A/C No Ext : 800 277-1620 X 4800 FAX A/C, No): 727 797-0704 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: Frank Winston Crum Insurance Company 11600 INSURED FrankCrum UC/F Pro -Form Roofing Co. 100 South Missouri Avenue Clearwater FL 33756 INSURERS: INSURER C: INSURER D: INSURER E: INSURER F: r`r1VFRAr_CC r`FRTIFIrATF MIIMRFR• R7Rg75 REVISION NUMHEK: 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 INSRD SUER WVD POLICY NUMBER POLICY EFF (MMIDDNYYY) POLICY EXP (MMIDD/YY" LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ GE ToCLAIMS-MADE PRr EM SES Ee occunence $ OCCUR MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY O PROJECT aLOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Per erson $ ANY AUTO OWNED AUTOS SCHEDULED ONLY AUTOS BODILY INJURY (Per accldent) $ HIREDAUTOS NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ S UMBRELLA LIAB OCCUR EACH OCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N WC202000000 01/01/2020 01/01/2021 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTNE OFFICERIMEMBER EXCLUDED? N/A E.L. DISEASE -EA EMPLOYEE 7 000 000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Effective 05/08/2017, coverage is for 100% of the employees of FrankCrum leased to Pro -Form Roofing Co. (Client) for whom the client is reporting hours to FrankCrum. Coverage is not extended to statutory employees. Re: (Client Reference: License Holders: CCC1331165). CERTIFICATE HOLDER GANGELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village Building Department I AUTHORIZED REPRESENTATIVE Miami h 2ndres, Avenue Miami Shores, FL 33138 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ,4v® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY1) 04/05/2022 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 CONTACT Amanda Nogues NAME: Eastern Insurance Group, Inc. PHONE (305) 595-3323 FAX (305) 595-7135 A/ No Ext : A/C No 7400 SW 50th Terrace E-MAIL amanda@easterninsurance.net ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Suite 100 Miami FL 33155 INSURER A: Upland Specialty Insurance Company 16988 INSURED INSURERS: Bndgefield Casualty Insurance 10335 Pro -Form Roofing Co. INSURER C : 5213 NW 74 Avenue INSURER D : INSURER E : Miami FL 33166 INSURERF: COVERAGES CERTIFICATE NUMBER: Master 22-23 GL/WC 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. TR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDY EFF MMIDD EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE 7 OCCUR DAMAGE TO PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ Excluded PERSONAL aADVINJURY $ 1,000,000 A GL-22 04/01/2022 04/01/2023 GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY ❑ PET LOC PRODUCTS -COMP/OPAGG $ 2.000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per. accident $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTNE OFFICERIMEMBEREXCLUDED? ❑ (Mandatory In NH) NIA 59191 04/01/2022 04/01/2023 PER OTH- STATUTE ER H D E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) City of Miami Shores 10050 NE 2 Avenue 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 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 1099 NE 96TH ST, Miami Shores, FL 33138 :ontacts Parcel Number 1132060143650 Bombom Investments Corp Owner PRO-FORM ROOFING Contractor Ana Perdomo ALEX FERNANDEZ 1099 NE 96 ST, Miami Shores, FL 33138 7311 NW 61 ST, MIAMI, FL 33166 Business:3053165163 anaperdomol0@hotmail.com Business:3052059611 permitsproform@gmail.com Other:7869535053 Description: REPAIR WOOD DECK AT EXISTING SKYLIGHT Valuation: $ 500.00 Inspection Requests: OPENING. REMOVE 4X4 FOOT PIECE OF PLYWOOD Total Sq Feet: 0.00 Amt Paid Fees Amount Payments Date Paid Revision: Minor Change of Plans $60.00 Total Fees $60.00 Tota I : $60.00 Credit Card 10/19/2022 $60.00 Amount Due: $0.00 Building Department Copy In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. (-)hNE AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws ing construction and zoning. Futh rmore, I authorize the above named contractor to do the work stated. orized Signature: Owner / Applicant / Contractor / / Agent Date October 19, 2022 Page 2 of 2 ,rxwA,iami Shores Village Building Department /~,lll 012(l72 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 By:., . Tel: (30S) 795-2204 Fax: (305) 756-8972 INSPECTION LIFE PHONE NUMBER: (365) 762-4949 FBC 2B Romaw - BUI DING Master?errri': "W. � 3 PERMIT APPLICATION Sub Permit No ❑BUILDING ❑] ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION � ❑RENEWAL�JyIo� 2Z IC13I ❑PLUMBING ❑ MECHANICAL F ]PUBLIC WORKS ❑ CHANGE OF ( CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1099 NE 96 ST MIAMI SHORES FL 33138 City: Miami Shores County: Miami Dade zip.: 33138 Folio/Parcel#: 1132060143650 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER- Name (Fee Simple Titleholder): BOMBOM INVESTMENTS Phone#: 305.316.5167 Address:1099 NE 96 ST City: MIAMI SHORES State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: PRO-FORM ROOFING CO Phone#: Address: 5213 NW 74 AVE City; MIAMI __..___......___..._...._.._ _ _ ...___ .................................__......._State: �.._._.............._.._.._..._.._._..__...._.__.............................._........_.....................................__............_Zip: 33166.._._.._._._. Qualifier Name: ALEXANDER FERNANDEZ Phone#: 305.389.6986 State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: _ Phone#: Address: ----City: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace Description of Work: Revision to include the Skylight Specify color of color thru idle: Submittal Fee $ Scanning Fee $ Permit Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF $ DBPR $ WE ❑ Demolition CO/cc $ Notary $w,....... Double Fee $ i ( i TOTAL FEE NOW DUE $ (Revised02/24/2014) BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 DIVED c MitBY: a1- 01f Master Permit No. I Sub Permit No. ! 1Z ❑ ROOFING A REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP /� /CONTRACTOR DRAWINGS JOB ADDRESS:/ 0 9 i lV' Cr, 1g6 k— �- rity Miami Chnrpc Cnuntv- Miami (lade tin:/`— .-3W06 014 3(6<A the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: Flood Zone: BFE: OWNER: Name (Fee Simple Titleholder): b'6MPj /ry I N WiTT%-yV� 60 O Phone#: 3-0-!� 3 i b S7( b3 City: 1\/\/l• A+V, I ) N State: Tenant/Lessee Name: [4'SF711 at. 1. wyv� CONTRACTOR: Company Name: 1 "U PO 9-4-1 "0 C-" 0 &— CZ Phone#: Address: (oZ I Q VJ i�-u rc�.?' NA 1 PV-`t% Email: f GO4 1\q / Qualifier Name: RUJCPt+)(Y>rlL NR�L Phone#: �OS�ig9 66iPp State Certification or Registration #: CC 133 1 ( b S Certificate of Competency #: DESIGNER: Architect/Engineer: Phone Value of Work for this Permit: $ Type of Work: ❑ Addition ❑ Alteration Description of Work: E 0.1 ( W a piece s 8 lyWor nL♦,(I rn ; n eN ' Specify color of color thru the: Submittal Fee $_ Permit Fee $ .y..:r..... �..c `- Scanning Fee $ " D'CA'Fee Technology Fee City: State: _Zip: Square/Linear Footage of Work: ❑ New ❑ Repair/Replace ❑ Demolition '/piece o sg pk, auoad.nal//e� / /'i� S64nKe.� n appe � inc r n Shgn) 1 r .ZX o% nS /vs /eAyrne+7j-Idhe 3d b, ...et.- �X/.,t tina Training/Education Fee $ CCF $ CO/CC $ : n DBPR $ NofaAy' Double Fee $ '.., , dw'Ke-Lo/0rJ Structural Reviews $ (Revised04/05/2022) P&Z Review $ Bond $ TOTAL FEE NOW DUE $ )L Bonding Company's Name (if applicable) Bonding Companys Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. iJ %D /J Signature4-0�e;7� OWNER or AGENT The foregoing instrument was acknowledged before me this day of 61C AO(9 Oe. , 20 as by �/✓/J /j--e?pd Md who i personally know o me or who has produced as identification and who did take an oath. NOTARY PUBLIC: SiRnJZ�� ` , •- y • _ Seal: .f6iio APPROVED BY (Revised04/OS/2022) ILEANA PETRA CABALLERO Notary Public - State of Florida Commission # GG 300087 The day of me or who has produced identification and who did take an oath. NOTARY PUBLIC: before me this ZD RQ. by 7ona4known to Seal: ILEANA PETRA CABALLERO t?o M0 NS. Notary Public -State of Florida Commission k GG 300087 _M_Yg O 1 CoE mmm. xgir jfgb � iana ,0 Jgsn ************* Plans Examiner Structural Review Zoning Clerk Bonding Company's Narne (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State E. IN 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 i ! j 1 LENDER 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 r OWNER or AGENT The foregoing instrument was acknowledged before me this 14 —day of March ___ 20 22 by ANA PERDOMO who is personally known to me or who has produced identification and w 0 NOTARY PUBLIC: -4;ok a, Sign: GENNI GONZALEZ PEREZ Notary Public - State of Florida �ssicn # GG 304864 L Comm. ex iris Feb 24, 2023 Signature t CONTRACTOR The foregoing instrument was acknowledged before me this 14 day of March 20 22 by ALEXANDER FERNANDEZ who is personally known to as me or who has produced identification and who di NOTARY PUBLIC: Sign: C:�� Seal: - Seal: as GENNI GONZALEZ PEREZ Notary Public • State of Florida Commission # GG 304864 My o Expires Feb 24, 2023 APPROVED BY Plans Examiner Zoning s .. 1ua w PRO o. HLA 22 Structural Review Clerk (Revised02/24/2014)