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RF-06-22-1488Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number ......... __ ......................_ ........... 10618 NE 11TH AVE, Miami Shores, FL 33138 1122320280630 Contacts BENJAMIN JOHN & KRISTINA ROGERS Owner BENJAMIN JOHN & KRISTINA ROGERS Applicant BENJAMIN JOHN & KRISTINA ROGERS BENJAMIN JOHN & KRISTINA ROGERS 10618 NE 11 AVE, MIAMI SHORES, FL 33138 10618 NE 11 AVE, MIAMI SHORES, FL 33138 Mobile: 7863908835 THOMPSON'S ROOFING /1&T Contractor INVESTMENTS GROUP INC JOHN THOMPSON 7021 PARK ST, HOLLYWOOD, FL 33024 Business: 9549671918 ....................................... ......_...._.... ......... ..... I Description: RE ROOF GARAGE TILE ROOF. HOT MOP. Valuation: $ 6,000.00 Inspection Requests: 30S 449 TO REPLACE PERMIT#RF14-1576 Total Sq Feet: 1,000.00 Fees Amount Payments Date Paid Amt Paid 100% Permit Renewal Fee $250.00 Total Fees $250.00 Check# 2290 06/15/2022 $250.00 Total: $250.00 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. AFFIDAVIT: ,�t�at all the foregoing information is accurate and that all work will be done in compliance with all applicable laws n a o� g Futhermore, I authorize the above named contractor to do the work stated. /s / - PiC Signature: Owner / Applicant / Contractor / Agent u �JI June 15, 2022 Page 2 of 2 BUILDING PERMIT APPLICATION 9B ❑ ELECTRIC ❑ ROOFING ami Shores Village ilding Department 0050 .E.2nd Avenue, Miami Shores, Florida 3313 el: j305) 795-2204 Fax: (305) 756-8972 � INSP ION LINE PHONE NUMBER: (305) 762 494! mr 20 mit No. � F ` 19- / 6) 1 Ma ❑ REVISION Sub Ptermit No. ❑ TENSION RENEW ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATFrO HOP CONTRACTOR DRAWINGS JOB ADDRESS: M 40 / ;- j / J A/ CO - City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:_f 1 7-Z3Z0 �d Q 6 3 6 Is the Building Historically Designated: Yes NO ✓� Occupancy Type: 5 Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Address: 141 ;� Ot Z% /t/e— City: /'! i M f e 5 State: Tenant/Lessee Name: Email: CONTRACTOR: Company Name: Address: V�1J -1 City: ! - N //, Qualifier Name r-> f7 r> State Certification or Registration #: DESIGNER: Architect/Engineer: 4 State: dsn %1 hone#: p: 7:��w �, Phone#: n e#: Zip: 3 (', Phone#: _j 1'a Certificate of Competency #: _ .,hone#: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ew Repair/Replace ❑ Demolition Description of Work: Specify color of color thru the: Submittal Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Permit Fee $ Radon Fee $ Training/Education Fee $ CCF DBPR $ CO/CC $ _ Notary $ Double Fee $ _ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) 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 BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC ❑ ROOFING FBC2b[C) Master Permit No. �� �' i ^ 1 -5 1 (9 Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9 0(e 1 49 Nf-�- t` I` v ff- City: Miami ShoresCounty: Jliami Dade Zip: 3313 S /� Folio/Parcel#: l 1- 2.%'� `® (02A 0130 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: f� OWNER: Name (Fee Simple Titleholder): ��, �� e iy 1 < (�5 ciFFE: Phone#: P �� �S Address: )MCA 12 V e 11»t-'4'1 O%IF- -� City: M l " ) S �IK2State: Zip: 1� Tenant/Lessee Name: A Phone#: Email: 10e&- lf�re111Oc*- •cow el ' 't�v �S�/� �DC� I N q a t� CONTRACTOR: Company Nam//e,,: Phone#: (� Address: �i2. n►G City: W State: FL- Zip: Qualifier Name: �p '� 7-71 Om psot-) Phone#: IF(, -7 / 1 State Certification or Registration #: ��� «28 1 (2( Certificate of Competency #: DESIGNER: Architect/Engineer: N� Phone#: Address: City: State: Zip: �y Value of Work for this Permit: $ � c)(5) ® Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ElNew Repair/Replace ❑ Demolition Description of Work: as R-cJoi�-- e-,K-Y2o"6e iiE 12.Do-r- 4o -r loic)> Specify color of color thru tile:-r Submittal Fee $_ Permit Fee $ _00 CCF Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ DBPR $ �+-j'j T-Afl CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ P S"2) ro Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) /J Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspec ' n fee will be charged. Si natur v gSignature_ WNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this 2_Aday of ��� 20 l' by `—W A It who is personally known to me o who has prod d as identification and who did take an oath. The fore o instrum``ent was acknowledged before me this 2�-}� day of -\1—t � y 20 1-1 by V1 1 "1 u 0 r� who is personally known to me orCin rodu Qatr a Uc� �'� as identifd who did take an oath. NOT4RUBLIC,,., NOTAR UBLIC: Sign: Sign: Print? Print:J COMMISSION ft EE177794 �;; ' JADE TAYLORSeal: Seal: EXPIRES March 11, 2016 ••? MY COMMISSION 4 EE17T794 (ao7) 39&0153 Fforfdano�arysenks.00M EXPIRES March 11, 2016 7 ,.. FWift otarySeMca,oan '*'7 ##��k+k�k#***#�#####�#i#�******+k*****� APPROVED BY /--" Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Property Search Application - Miami -Dade County Page 1 of 1 u_ ilc`­­ OF THE PROPERTY APPRAISER Summary Report Property Information Folio: 11-2232-028-0630 10618 NE 11 AVE Property Address: Miami Shores, FL 33138-2121 BENJAMIN JOHN ROGERS Owner KRISTINA ROGERS _..__._._..... __.__........__._..... __.._._.................. .........._......................_ .......... _._..................._........................ .............. ... _......... .................. 10618 NE 11 AVE Mailing Address MIAMI, FL 33138 USA PA Primary Zone ................................. ............... ................. -.............. ............... ............................................ 1000 SGL FAMILY - 2101-2300 SQ ................................ ....... .......... ............................................................................................ 0101 RESIDENTIAL -SINGLE Primary Land Use FAMILY : 1 UNIT - --....._...._._..._....... ... - ........ _.... ... - Beds / Baths / Half - ------ ---- -- - - _.._.... -- -..-- - 3/2/0 ........... ................................................................................... ............. ................ .......... Floors .........._............................................ ..................................................... ............................ _. 1 Living Units 1 Actual Area 3,176 Sq.Ft ......_._...__.__.____.._.____...._________....._.__._..______ Living Area __....,.._._..._._ ____.....__ .__ ..._ 3,008 Sq.Ft Adjusted Area 2,999 Sq.Ft Lot Size 9,750 Sq.Ft Year Built Multiple (See Building Info.) Assessment Information Year 2021 2020 2019 Land Value $263,373 $239,085 $239,085 Building Value _ _ .._.._.._...... XF Value Market Value $210,571 _......................._._.._.___......... ..._ $31,250 ._._....._..__ $505,194 $210,942 ................._.... _...... _.......... _..-....... $31,495 -.. .......... - _._........_...._.._..._.._................. $481,522 $199,525 ........ ........... .......... ........... .............. $31,742 .................. ... _.._.___.._.._.._ $470,352 Assessed Value $375,274 �$370,093 $361,773 Benefits Information Benefit Type 2021 202 22019 Save Our Homes Assessment $129,920 $111,429 $108,579 Cap Reduction Homestead Exemption $25,000 $25,000 $25,000 - Second Exemption $25,000 $25,000 $25,000 Homestead Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description MIAMI SHORES ESTATES PB 47-58 LOT 13 BLK 4 LOT SIZE 75.000 X 130 OR 20185-0785 01 2002 1 Generated On : 6/8/2022 Taxable Value Information 2021 2020 2019 .............................._..........._.._........_.._........_................_...._........__........_.._..____..__ County Exemption Value $50,000 $50,000 $50,000 Taxable Value 1 $325,274 $320,093 $311,773 School Board Exemption Value $25,000 $25,000 $25,000 Taxable Value $350,274 $345,093 $336,773 C�ry_.__............_................................................................................_..__...._.._..........._._.-..-__..__.._.-.._._.._._.......--_......._......._....__._..-.-.__-------- Exemption Value $50,000 $50,000 $50,000 Taxable Value $325,274 $320,093 $311,773 Regional .... _...._.._..........._....................._..._._........................._........_.__.___......_._...._._..._.____.___..__ Exemption Value $... 6 $50,60 $$50,000 Taxable Value $325,274 $320,093 $311,773 Sales Information Previous OR Book - Price Qualification Description Sale Page 12/16/2011 $450,000 27946-3867 Qual by exam of deed Financial inst or "In Lieu of 03/16/2011 $255,000 27664-3326 Forclosure" stated Financial inst or "In Lieu of 01/20/2011 $415,144 27605-4632 Forclosure" stated .................................................. 01/01/2002 ._....... ....._......................_.._._.._._.... $226,000 --- _.._.._. -- 20185-0785 --..__........_.__.._._._.._._.___._......._ ___ _ __ ___._.._..._..____-_ __ Sales which are qualified The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp Version: https://www.miamidade.gov/Apps/PA/propertysearch/ 6/8/2022 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNERS'S AFFIDAVIT OF EXEMPTION ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR EXISTING SITE - BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PERSUANT TO SECTION 553.844 F.S. To. Miami Shores Village Building Department Date. Z141 V 10050 NE 2nd Ave Miami Shores, FI 33138 Re: Owner's Name: )3� J l fJ lz© Cg E�Q-5 Property Address: l 0(o K E, 1 �+A1 A-J T--- M L 33 d 8 Roofing Permit Number: Dear Building Official: n 1 ?Olp,03 A-'' , N certify that I am not required to retrofit the roof to wall connections of my building because: he just valuation for the structure for purpose of ad valorem taxation is less than $300,000.00. Please attach proof of ad valorem taxation. ❑ The building was constructed in compliance with the provisions of the Florida Building Code (FBC) or with the provisions of 199 edition of the So-t Florida Building Code (1994 SFBC) SignaturePrint Name State of Florida County of Dade The undersigned, being the first duly sworn, deposes and says that he/she is the owner for the above property mentioned. Sworn to and subscribed before me this S+ _r day of ® ' 1 d �1A�lfE TAYI- R =•; 'z My OOkM1MSISSION # EE127794 Notary Public, Sate of Florida at Large EXPIRES March 11, 2016 (407�38bi-0i53 � Hcx�:allotflrySutvlCe.o0rt1 • When the just valuation of the structure for purpose of ad valorem taxation is equal to or more than $300,000.00, and the building was not constructed with FBC nor a 1994 SFBC. Then you must provide a building application from a General Contractor for the Roof to Wall connection Hurricane Mitigation. Revised on 5/21/2009 Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner —Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, you y be personally liable for the worker compensation injuries of any person allowed to work under this permit. Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner Print Name: !R-e-v) 'R ( V Signature: one� State of Florida ) County of Miami -Dade) Sworn to and subscribed before met is -2z-2Vtd day of -Aa tq _ 20 i` . BY Aa�lt TLC Contractor Print Name: Signature: State of Florida ) County of Miami -Dade ) Sworn to and subscribed before me this day of j�_) U l--Y , 20 . By (SEAL) `'"Y �l,qp (SEAL) :•�*'" :; JADE 'lrAYLOR Type of c� "o11�1p _ Type of Identi ' t ' �lby N EE 1 V l wa .ss o�sa � ,�e�kYrya ro'� 2 (� 1 ��, (afl �s-01sa rm (enom (y�o FEMA 50% RULE - SUBSTANTIAL IMPROVEMENT OR SUBSTANTIAL DAMAGE SUBSTANTIAL IMPROVEMENT/DAMAGE Z101-0410 NOTICE TO PROPERTY OWNERS Rebuilding your Home after the storm? Adding on, renovating, or remodeling your home? Here's information YOU need to know about the "50% Rule" If your home or business is below the 100-year flood elevation, also known as the Base Flood Elevation (BFE), FEMA has flood damage prevention regulations that may affect how you remodel, renovate, or add on to your building. If your home or business sustained structural and/or interior damage, these regulations may affect how you rebuild. These laws are required by the National Flood Insurance Program to protect lives and investment from future flood damages. Miami Shores Village is required to adopt and enforce these laws in order for federally -backed flood insurance to be made available to we residents and property owners. SAVE YOURSELF TIME AND MONEY! PLEASE READ THE FOLLOWING INFORMATION: SUBSTANTIAL DAMAGE means damage of any origin sustained by a structure whereby the cost of restoring the structure to it's before damage condition would equal or exceed 50 percent of the market value or replacement cost of the structure before the damage occurred. (Note: The cost of the repairs must include all costs necessary to fully repair the structure to its "before damage" condition.) SUBSTANTIAL IMPROVEMENT means any reconstruction, rehabilitation, addition, or other improvement of a structure, the cost of which equals or exceeds 50 percent of the market value of the structure before the "start of construction" of the improvement. If a building is "substantially damaged" or "substantially improved", it must be brought into compliance with the flood damage prevention regulations, including elevating the building to or above the 100-year flood elevation. Miami Shores Village, follows the National Flood Insurance Program requirements, and has the responsibility to determine "substantial damage" and "substantial improvement", and has implemented the procedures on the following pages to do so. SUBSTANTIAL IMPROVEMENT OR SUBSTANTIAL DAMAGE NOTICE TO PROPERTY OWNERS Miami Shores Village will use the assessed value of your structure (excluding the land) recorded by the Property Appraiser's Office. If you disagree with the Property Appraiser's valuation of the structure, you may engage a property appraiser licensed by the State of Florida to submit a comparable property appraisal for the total market value of the structure. You must obtain and submit to the Building Department a detailed and complete cost estimate for the addition, remodeling, reconstruction or for repair of all the damages sustained by your home, prepared and signed by a licensed general contractor. The contractor must sign an affidavit indicating that the cost estimate submitted includes all damages or all improvements to your home, not just structural. The signed contract document must be submitted with your application. If the owner is acting as his or her own contractor, the owner is responsible for submitting the cost estimate, and providing documentation, including subcontractor bids, to document the cost estimate. The Building Department will evaluate the cost of improvements or repairs and determine if they are fair and reasonable. For damage repairs, pre -storm prices and rates will be utilized. The cost of improvements or repairs does not include items not considered a permanent part of the structure. (i.e., plans, surveys, permits, sidewalks, pools, screens, sheds, gazebos, fences, etc. -- see attached copy). If your home is determined to have "substantial damage" or is proposed to be "substantially improved", then an elevation certificate must be submitted to the Building Department to determine the lowest floor elevation. Garages and carports are not considered to be the "lowest floor". If the lowest floor is below the 100-year flood elevation, the building must be elevated to the 100 year flood elevation, or above, that level. Likewise, all electrical and mechanical equipment (heating and cooling, etc.), bathrooms, and laundry rooms must be elevated to, or above, the 100-year flood level. Only parking, building access and limited, incidental storage is allowed below the flood level. Non- residential buildings may be "flood -proofed" instead of being elevated. If the lowest floor of the structure, including electrical and mechanical equipment and bathroom are already above the 100-year flood elevation, the building can be repaired and reconstructed without having to comply with the fifty percent (50%) rule. Building plans must be prepared to show how the building is to be elevated. If located in a V-zone, Coastal High Hazard Area, or if the building is to be flood -proofed, these plans must be prepared and certified by a registered professional engineer or architect. Certificates for this purpose are available from the Building Department. IMPORTANT NOTE ON DONATED MATERIALS AND VOLUNTEER LABOR: The value placed on materials should be equal to the actual or estimated cost of all materials to be used. Where materials or servicing equipment are donated or discounted below normal market values, the value should be adjusted to an amount equivalent to that estimated through normal market transaction. Self or Volunteer Labor: The value placed on labor should be equal to the actual or estimated labor charge for repairs of all damages sustained the structure. Where non -reimbursed (volunteer) labor is involved, the value of the labor should be estimated based on applicable minimum hourly wage scales for the type of construction work to be completed. Our permitting official based on his/her professional judgment and knowledge of local/regional wage scales can provide additional guidance to determine reasonable labor rates for professional trades (i.e. electricians, plumbers, block masons, framing, HVAC). SUBSTANTIAL IMPROVEMENT OR SUBSTANTIAL DAMAGE ITEMS TO BE INCLUDED (Please check off each line) ALL STRUCTURAL ELEMENTS INCLUDING: [ J Spread or continuous foundation footings and pilings [ ] Monolithic or other types of concrete slabs [ ] Bearing walls, tie beams and trusses (] Wood or reinforced concrete decking or roofing [ ] Floors and ceilings () Attached decks and porches [ ] Interior partition walls [ ] Exterior wall finishes (e.g., brick, stucco or siding) including painting and decorative moldings (] Windows and doors ICJ Re -shingling or re -tiling a roof [ ] Hardware ALL INTERIOR FINISH ELEMENTS, INCLUDING: [ ] Tiling, linoleum, stone or carpet over sub -flooring [ ] Bathroom tiling and fixtures [ ] Wall finishes (e.g., drywall, painting, stucco, plaster, paneling, marble or other decorative finishes) [ ] Kitchen, utility and bathroom cabinets [ ] Built-in bookcases, cabinets and furniture [ ] Hardware ALL UTILITY AND SERVICE EQUIPMENT, INCLUDING: [ ] HVAC equipment [ ] Repair or reconstruction of plumbing and electrical services [ ] Light fixtures and ceiling fans [ ] Security systems [ ] Built-in kitchen appliances [ ] Central vacuum systems [ ] Water filtration, conditioning or recirculation systems ALSO: [ ] Labor and other costs associated with demolishing, removing or altering building components (J Overhead and profit ITEMS TO BE EXCLUDED Plans and specifications Survey costs Permit fees Debris removal, (e.g., removal of debris from building or lot, dumpster rental, transport fees to landfill and landfill tipping fees), clean-up (e.g., dirt and mud removal, building dry out, etc.) Items not considered real property such as: throw rugs (carpeting over finished floors), furniture, refrigerators, appliances which are not built-in, etc. OUTSIDE IMPROVEMENTS, INCLUDING: Landscaping Sidewalks Fences Yard lights Swimming pools\spa Screened pool enclosures Sheds Gazebos Detached structures (incl. garages) Landscape irrigation systems Docks and Davits Seawalls Driveways Decks ITEMS REQUIRED TO EVALUATE YOUR APPLICATION APPLICANT MUST SUBMIT ALL OF THE FOLLOWING (please check off each item): 1. Completed and signed application for substantial damage/improvement review (included in this package). 2. Elevation certificate if property is located above base flood elevation. 3. Property Owner's Substantial Damage or Substantial Improvement Affidavit signed, notarized and dated (included in package). 4. Contractor's Substantial Damage or Substantial Improvement Affidavit signed, notarized and dated (included in package). 5. Estimated Cost of reconstruction/improvement form (included in package) and all required backup. Include subcontractor's bids and itemized cost lists (see footnote on Cost Estimate Form). 6. This checklist. 7. Copy of construction contract. If the owner is the contractor, submit all subcontractor bids to document the cost estimate. 0 rt�y Addrss: rty Owner's N rtv Owner's A SUBSTANTIAL IMPROVEMENT OR SUBSTANTIAL DAMAGE APPLICATION FOR SUBSTANTIAL DAMAGE OR SUBSTANTIAL IMPROVEMENT REVIEW e: Pro erty Owner's PhofAjle` `Nu'ber: Contractor's Name: Contractor's .fig Address: ' Contra ctor's.P one Number: Ik 44>414--,7/ -54--fAFL Floo _Zoe BFE Lowest Floor Elevation (Excluding garage or cargo Check one of the following: [ ] I am attaching a State Certified Appraiser's report, valuing the structure at: I am not attaching a State Certified Appraiser's report and I accept the use of the valuation of my property that has been recorded by the County Property Appraiser's Office. SIGNATURES: Property Owntj Contract Date: 2�;Zl Date: ZZ- l SUBSTANTIAL IMPROVEMENT OR SUBSTANTIAL DAMAGE PROPERTY OWNERS SUBSTANTIAL DAMAGE OR SUBSTANTIAL IMPROVEMENT AFFIDAVIT Property Address: I (Ne 1� N I( � //�✓� t 5/ �L-ice t Cont ractppr's Name: �'- Property Owner's Name: 13+;-ti) A✓►n ►lam Q0 ja—as Property Owner's Address: _ Property Owner's Phone Number: I hereby attest that the list of work and cost estimate submitted with my Substantial Damage or Substantial Improvement Application reflects ALL OF THE WORK TO BE CONDUCTED on the subject structure including all additions, improvements and repairs and, if the work is the result of Substantial Damage, this work will return .the structure at least to the "before damage" condition and bring the structure into compliance with all applicable codes. Neither I nor any subcontractor or agent will make any repairs or perform any work on the subject structure other than what has been included in the attached list. I UNDERSTAND THAT I AM SUBJECT TO ENFORCEMENT ACTION, WHICH MAY INCLUDE FINES, IF ANY INSPECTION OF THE PROPERTY REVEALS THAT I, OR MY CONTRACTOR, HAVE MADE REPAIRS OR IMPROVEMENTS NOT INCLUDED ON THE ATTACHED LIST OF REPAIRS OR THE APPROVED BUILDING PLANS. See attached itemized list. STATE OF LO -t I) A COUNTY OF ��M I I��I'n Before me this day personally appeared IRr, /iV'? /2' � �S , who, being duly sworn, deposes and says that he/she has read, understands, and agrees to comply with all the afore r tinned 4.pditions. Property Owner's Sign ture Sworn to and subscribed before me this 2'�'4day of Jam,=-qn�L JADE Notary P , ii t' / OfMy com 11 pir (497) 398-0153 Hondallotery3etvice,mn SUBSTANTIAL IMPROVEMENT OR SUBSTANTIAL DAMAGE CONTRACTOR'S SUBSTANTIAL DAMAGE OR SUBSTANTIAL IMPROVEMENT AFFIDAVIT Property Address: Cont actor's Name: Contractor's Company; ame: Contractor's Addressjoc2l �46Lblv)A -F& z,,3�92, - Contractor's Phone. Number: Contractor's Iq��S or Certification Number: Contractor's We Registration Number (if applicable): I hereby attest that I, or a member of my staff, personally inspected the subject property and produced the attached itemized list of repairs, reconstruction and/or remodeling which are hereby submitted for a Substantial Damage or Substantial Improvement Review. The list of work contains ALL OF THE WORK TO BE CONDUCTED on the subject property. If the property sustained Substantial Damage, this list of Work, will return the structure to at least its condition prior to damage and bring the structure into compliance with all applicable codes. I further attest that all additions, improvements or repairs proposed for the subject building are included in this estimate and that neither I nor any subcontractor or agent representing me will make any repairs or perform any work on the subject structure other than what has been included in the attached list. I UNDERSTAND THAT I AM SUBJECT TO ENFORCEMENT ACTION, WHICH MAY INCLUDE FINES, IF ANY INSPECTION OF THE PROPERTY REVEALS THAT I, OR MY CONTRACTOR, HAVE MADE REPAIRS OR IMPROVEMENTS NOT INCLUDED ON THE ATTACHED LIST OF REPAIRS OR THE APPROVED BUILDING PLANS. See attached itemized list. STATE OFy12'1 Q C ;mentioned OF °� I � f�r B e this day personally appeared r b°t�=cS=1�0�1 who, being dulrn, deposes and says that he/she has read, understands, and agrees to comply with all the of conditions. Cot�ctor's Signature Sworn to and subscribed before me this '7-Z✓tl�-4 day of ::►Av •. JADE TAYL Notary Pu Itr :C(AY COMMISSION # EE177794 My commi "s iresEXPIRES March 11 2016 (407) 39"153 FtordallotarySerNoe.own Application Cost Estimate of Reconstruction / Improvement Number Date' Address_�lo,�_ r1 1n„ ,A,n�=�-��Q-I--� � LE�r2��. '�?� (lt✓�l This cost estimate of reconstruction/improvement must be prepared by and signed by the contractor or by the owner if the owner acts as the contractor. Owners who act as their own contractors must estimate their labor cost at the current market value for any work they intend to perform. Sub -Contractor Bids Contractor or Owr rl Estimates Bid Amounts (see note "D") 1. Masonry 2. Carpentry Material (rough) 3. CaKu=try Labor (rough) te"4. R ion and Weather-strip 6. Exterior Finish (stucco) 7. Doors, Windows & Shutters 8. Lumber Finish 9. Hardware 10, Drywall 11. Cabinets (Built-in) 12. Floor Covering 13. Plumbing 14. Shower/Tub/Toilet 15. Electrical & Light Fixtures 16. Concrete 17. Built-in Appliances 18. HVAC 19. Paint 20. Demolition & Removal 21. Overhead & Profit Materiao,%��Co Costs L bor Costs Miami Shores Village C 1VED Building Department JUN. e.2022 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 $y: INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20�'+k BUILDING Master Permit No. %` F 0 PERMIT APPLICATION Sub Permit No.�14tt? BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ! 0 40/ f--'Df 0 AIE— City: Miami Shores c� County: Miami Dade Zip: Folio/Parcel#: I % ZZ3� Zd D 42 D Is the Building Historically Designated: Yes _ NO 4,-' Occupancy Type: 5 Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Address: City: State: Tenant/Lessee Name: Email: CONTRACTOR: Company Name: s Itz _; Address: V( 56020 fcc" " City: i 1 State: Qualifier Name: d , Phone#: :,64 --S7V —!a �; S� Zip: Phone#: Phone#: one#: State Certification or Registration #: �( C / a l (/ b Certificate of Competency #: DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: Type of Work: ❑ Addition Description of Work: one#: City: Square/Linear Footage of Work: ❑ Alteration Elmew [Repair/Replace /.2 r.'.0 l/9"W' Specify color of color thru tile:. Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ _ CCF 7in. 3 3'?s/ L/ T--/ q/f' Zip: ❑ Demolition Co/cc $ DBPR $ Notary Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ 0 rn o 0 v, z M Q o ��' Z' , x T TI g., 7� •� ¢r��, Lrn © � 0 Z c z > r > m tn G� m C 0 z BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2021 THROUGH SEPTEMBER 30, 2022 DBA: Business Name: THOMPSONS ROOFING Owner Name: JOHN P 'THOMPSON/QUAL Business Location: 7021 PARK ST HOLLYWOOD Business Phone: Receipt #:-1673 ROOFING/SHEET METAL CONTRACTOR Business Type: (ROOFING CONTRACTOR) Business Opened:07/10/2007 State/County/Cert/Reg:CCC 132 816 6 Exemption Code: Rooms Seats Employees Machines Professionals 1 For Vending Business Only Number of Machines: Vendina Tvne: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 7_.70 0.00 0.00 29.70 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: JOHN P THOMPSON/QUAL Receipt #WWW-21-00000519 7021 PARK ST Paid 10/04/2021 29.70 HOLLYWOOD, FL 33024 2021 - 2022 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2021 THROUGH SEPTEMBER 30, 2022 DBA: Business Name: THOMPSONS ROOFING Owner Name: JOHN P THOMPSON/ QUAL Business Location: 7021 PARK ST HOLLYWOOD Business Phone: Rooms Seats Receipt #: 185-1673 Business Type: ROOFING/SHEET METAL CONTRACTOR (ROOFING CONTRACTOR) Business Opened:07/10/2007 State/County/Cert/Reg: CCC 13 2 816 6 Exemption Code: Employees Machines Professionals 1 Signature For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years I Collection Cost Total Paid 27.00 0.001 0.001 2.701 0.001 0.00 29.70 Receipt #WWW-21-00000519 Paid 10/04/2021 29.70 ACORLDW CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/10/2022 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 endorsements . PRODUCER BUILDING TRADES ASSOCIATION CONTACT Ed Fowler NAME: PHONE (g00)326-7800 ac C.No: (561) 241-0621 E-MAIL ADDRESS: � ed building trades.com 5550 Glades Rd #505 INSURERS AFFORDING COVERAGE NAIC ft Boca Raton, FL 33431 INSURERA: A.I.X. Specialty 12822 INSURED J&T Quality Investment Group INSURER B : INSURER C : INSURER D : D/B/A Thompsons Roofing, INSURER E : 9240 SW 54 St INSURER F : Cooper City, FL 33328 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. TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DD/YYYY LIMITS rA X COMMERCIAL GENERAL LIABILITY X OCCUR SIZGL1041A252945 7/17/2021 7/17/2022 EACH OCCURRENCE $ 1,000,000 DA AGE ToCLAIMS-MADE PREM SES Ea occu RENTEante $ 1 ������ MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - PRO ❑ LOC X POLICY El OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE Per accident $ $ UMBRELLALIAB EXCESS LIAR HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ,/ / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A I STATUTE FOR E.L. EACH ACCIDENT $ E.L. DISEASE - FA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) License # CCC1328166 tK I II IUA I t MULUtK Village of Miami Shores Building Dept 10050 NW 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 of © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD a4 t JIMMY PATRONIS CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 2/11/2021 PERSON: JOHN P THOMPSON FEIN: 721585910 BUSINESS NAME AND ADDRESS: J & T QUALITY INVESTMENTS GROUP, INC. THOMPSON'S ROOFING 8570 STERLING ROAD HOLLYWOOD, FL 33024 SCOPE OF BUSINESS OR TRADE, Roofing - All Knds and Drivers EXPIRATION DATE: 2/11/2023 EMAIL: JOHNT@THOMPSONSROOFING.COM IMPORTANT: Pursuant to subsection 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to subsection 440.05(12), F.S., Certificates of election to be exempt issued under subsection (3) shall apply only to the corporate officer named on the notice of election to be exempt and apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to subsection 440.05(13), F.S., notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 E01290154 QUESTIONS? (850) 413-1609 Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: l . The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signatu� Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this 1S day of 20 as . By tk. Lg,¢.C_s who is personally known to me or has produced as identification. Notary: sku lnoQA k SEAL: �� Nw Notary Public State of Florida %I Stephanie rprnn my'-OMMSswn GG 355729 Expires 07/16/2023 THOMPSON"S ROOFING RESIDENTIAL & COMMERCIAL June 151h 2022 State of: Florida County of: Broward Before me this day personally appeared John Thompson who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at : 10618 NE 11th Avenue Miami Shores Signature rn to (or affirmed) and subscribed before me this 151h day of June. 2022 By: John Thompson Produced Identification ❑X Driver's License Print, Type or Stamp Name of Notary a4,osv hy� Notary Public State of Florida Stephanie Ceron y My Commission GG 356729 4�a � Expires 07/16/2023 Miami Shores Village `yeoRes 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 �ORtDA Project Address 10618 NE 11 Avenue Miami Shores, FL 33138- Parcel Number Applicant 1122320280630 Block: Lot: BENJAMIN JOHN & KRISTINA ROGERS 10618 NE 11 Avenue -- - - - -- - - ---- MIAMI SHORES FL 33138- 10618 NE 11 Avenue MIAMI SHORES FL 33138- Contractors) Phone Cell Phone THOMPSON'S ROOFING / J&T INVESI (954)967-1918 e of Work: Re Roof itional Info: RE ROOF GARAGE TILE ROOF. HOT MOP. ,sification: Residential nning: 4 Fees Due Amount CCF $3.60 DBPR Fee $2.70 DCA Fee $2.00 Education Surcharge $1.20 Permit Fee - Repairs $180.00 Scanning Fee $12.00 Technology Fee $4.80 Total: $206.30 Phone BENJAMIN JOHN & KRISTINA R (786)390-8835 Valuation: $ 6,000.00 Total Sq Feet: 1000 Pay Date Pay Type Amt Paid Amt Due Invoice # RF-1-18-66222 01/25/2018 Credit Card $ 156.30 $ 50.00 01/25/2018 Credit Card $ 50.00 $ 0.00 Available Inspections: Inspection Type: Roof Repair Final Roof Review Roof 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 a construction and zoning. Futhermore, I authorize the above -named cW Authorized Signature: Owner / Applicant / Contract / Building Department Copy January 25, 2018 ar)d that all'work will be done in compliance with all applicable laws regulating do -the work stated. \ January 25, 2018 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 JAN 24 2018 Tel: (305) 795-2204 Fax: (305) 756-8972 (-t—t INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 14 BUILDING Master Permit No. f PERMIT APPLICATION Sub Permit No.-j2,T I S " 11511 ❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL [-]PUBLICWORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP - C ,Q, CONTRACTOR DRAWINGS JOB ADDRESS: IN"Ol b %) L /� ' 'v �0(ii Cp City: Miami Shores / County: Miami Dade Zip: Folio/Parcel#: % i ao� Lc�QI)3© Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: �J,, CFFE: p r OWNER: Name (Fee Simple Titleholder): kn (ate►/il f��P�✓� Phone#: -7 `f' Address: /(7A t%,-"P'I u e- City: 1411,6 ✓n Tenant/Lessee Name: Email CONTRACTOR: Company Name: Address: (D2,LDLJ 61,144 City: ZL Qualifier Name: State: State: Zip:�— hone#: hone#: 5 Zip: hone#: State Certification or Registration #: � Certificate of Competency #: DESIGNER: Architect/Engineer: Address: State: Zip: Value of Work for this Permit: $ [� ,% '(�✓ Square/Linear Footage of Work: ( '000 Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: -AAZ L,4 P7, _ M r- ( L4 — ( t'.') Co Specify color of color thru tile: / Submittal Fee $ Permit Fee $ ( (J ' �� CCF $ CO/CC $ Scanning Fee $ Radon Fee $ ? (:) �) DBPR $ _ 6 Notary $ Technology Fee $ Structural Reviews $ Training/Education Fee $ Double Fee $ Bond TOTAL FEE NOW DUE $ (Revised02/24/2014) B.ot4&k, 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 approved7andreinspection fee will be charged. Signature w Sign ure OWNER o GENT CONTRACTOR The foregoing instrument was acknowledged before me this day of �P ( 20 by rsoo kn me or who has produced as iment was acknowledged before me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: "r Print: voL, CYNTHA 166449 ( - Seal: MY COMMISSION#GG Seal: <<' EXPIRES: December CYNTHIAMICHELLELAGANIERE �.; EXPIRES: December 17, 2021 ' *; *-_ MY COMMISSION # GG 166449 . w o blic Undervers �` i 7, 2021 p�FOFpP� Bonded Ttw NotefY P; :,ydF`�.` BondedThru Notary Public Undenwrit APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) rL?l= 14 - 17D j � ROOF ASSEMBLIES AND ROOFTOP STRUCTURES RECF-TV1-" Florida Building Code Edi- itA 12 2014 High -Velocity Hurricane Zone Uniform Permil Miami Shores Villago APPROVED BY DATE ZONING DEPT Bd=QTEPTlkpp SUBJECT Tion O COMPLIANCE WITH ALL FEDERAL. nat1Cr4ND COUNTY RULES AND REGULATIONS I-*. ster Permit No. /� - `1�- (n� Process No. C ntractor's Name m Y sorJ� 1`oor W �7 �? `fi e Jo Address ®I(J O N I �/ it �11�r`eK ' -/ J� J v ROOF CATEGOR ❑ Low Slope ❑ Mechanically Fastened Tile 30' Mortar/Adhesive Set Tile ❑ Asphaltic ❑ Metal Panel/Shingles ❑ Wood Shingles/Shakes Shingles ❑ Prescriptive BUR-RAS 150 ROOF TYPE ❑ New Roof [ Reroofing ❑ Recovering ❑ Repair ❑ Maintenance ROOF SYSTEM INFORMATION Low Slope Roof Area (SF) Steep Sloped Roof Area (SF) Total (SF) Section R (Roof Plan) Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include dimensions of sections and levels, clearly identify dimensions of elevated pressure zones and location of parapets. I-LUKIUA BUILUINU GUUt - BUILUINU a t ;. a CZ` G C9 CS C.`J C3 Cd` l'S t6 p d J O LL L` � L w 0 w U- -41 tips 'o W V y�+�� V \✓ c 'l {0 Ui N i Ui `1 m co cn to QV)LOLOLO N N N N N m Q CO U 0l 2 fIi - r3 co m T- LL 0 Jr - CO i%i -cam Q � f d 0 co Q m �d U V �o Z— N 00 m C ~ ca 0 ROOF ASSEMBLIES AND ROOFTOP STRUCTURES Florida Building Code Edition 2007 High -Velocity Hurricane Zone Uniform Permit Application Form. Roof System Manufacturer: Notice of Acceptance Number: Minimum Design Wind Pressures, If Applicable (From RAS 127 or Calculations: 1: P2: P3: Maximum Design Pressure (From the Product Approval Specific System): Deck Type: :5 b 9 LN w egop 71 Type Underlayment: �o Ro f Slope: 12 .) Insulation: Fire Barrier: Ridge V tilation? Fastener Type & Spacing: I" „ S. Roof Ar Adhesive Type: Mean Roof Height: FLORIDA BUILDING CODE — BUILDING Type Cap Sheet: I qo 4P�L_Ii+yMFW7 Roof Covering: c re +-f' Type & Size Drip Edge: ROOF ASSEMBLIES AND ROOFTOP STRUCTURES Florida Building Code Edition 2007 High -Velocity Hurricane Zone Uniform Permit Application Form. section E!Tole_Calculatio For Moment based tile systems, choose either Method 1 or 2. Compare the values for Mr with the values from Mf. If the Mf values are greater than or equal to the Mr values, for each area of the roof, then the tile attachment method is acceptable. Method 1 "Moment Based Tile Calculations Per RAS 127" (PI: x R = ) - Mg: = Mrl Product Approval Mf (Pz: x % _ ) - Mg: = Mr2 Product Approval Mf (P3: x X = ) - Mg: = Mr3 Product Approval Mf Method 2 "SimplifieTile Calculations Per Table Below" Required Moment of Resistance (Mr) From Table Below t-,1 Product Approval M M. reauired Moment Resistance* Mean Roof Height -> . Q1__e I I 15' I 20' I 25' I 30' I 40' o *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 tile attachment method is acceptable. Method 3 "Moment Based Tile Calculations Per RAS 127" (PI: x L = x w: _ ) - W: x cos B = Frt Product Approval V (P2: x L = x w: _ ) - W: x cos B = Fr2 Product Approval I (P.- r r. — x w. = ) - W x ens 0 = F Prndnct A—mval V Where to Obtain Information Description S mbol Where to find Design Pressure PI or P2 or P3 RAS 127 Table 1 or by an engineering analysis prepared by PE based on ASCE 7 Mean Roof Hei ht H Job Site Roof Slow 0 Job Site Aerodynamic Multiplier A Product Apmoval Restoring Moment due to Gravity Mg Product Approval Attachment Resistance M Product Approval Re aired Moment Resistance M Calculated Minimum Attachment Resistance F Product Approval Required Uplift Resistance Fr Calculated Averatze Tile Wei ht W Product Anproval Tile Dimensions L = lengthProduct W =width Approval All calculations must be submitted to the building official at the time of permit application. FLORIDA BUILDING CODE — BUILDING Owner's Notification Form HVHZ 2010 MIAMP "Delivering Excellence Every Day" SECTION 1524 HIGH VELOCITY HURRICANE ZONES-- REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS 1524.1 Scope. As it pertains to this section, it is the responsibility of the roofing contractor to provide the owner with the required roofing permit, and to explain to the owner the content of this section. The provisions of Chapter 15 of the Florida Building Code, Building 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 and the contractor. The owner's initial in the designated space indicates that the item has been explained. f` 1. Aesthetics -workmanship: The workmanship provisions of Chapter 15 (High Velocity Hurricane Zone) are for the purpose of providing that the roofing system meets the wind resistance and water intrusion performance standards. Aesthetics (appearance) are not a consideration with respect to workmanship provisions. Aesthetic issues such as color or architectural appearance, that are not part of a zoning code, should be addressed as part of the agreement between the owner and the contractor. FT 2. Renailing wood decks: When replacing roofing, the existing wood roof deck may have to be renailed in accordance with the current provisions of Chapter 16 (High Velocity Hurricane Zones) of the Florida Building Code. (The roof deck is usually concealed prior to removing the existing roof system). F-7-13. Common roofs: Common roofs are those which have no visible delineation between neighboring units (i.e. townhouses, condominiums, etc.). In buildings with common roofs, the roofing contractor and/or owner should notify the occupants of adjacent units of roofing work to be performed. 4. Exposed ceilings: 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 penetrations of the underside of the decking may not be acceptable. The owner provides the option of maintaining this appearance. 5. Ponding water: The current roof system and/or deck of the building may not drain well and may cause water to pond (accumulate) in low-lying areas of the roof. Ponding can be an indication of structural distress and may require the review of a professional structural engineer. Ponding may shorten the life expectancy and performance of the new roofing system. Ponding conditions may not be evident until the original roofing system is removed. Ponding conditions should be corrected. 6.Overflow scuppers (wall outlets): It is required that rainwater flow off so that the roof is not overloaded from a build up of water. Perimeter/edge walls or other roof extensions 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: Chapter 15 and 16 herein and the Florida Building Code, Plumbing. 7. Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of the structural assembly (the building itself). The existing amount of attic ventilation shall not be reduced. Exception: Attic spaces, designed by a Florida -licensed engineer or registered architect to eliminate the attic venting, venting shall no required. Owner's/Agent's Signature: Date: Contractor's Signature: Permit Number: Property Address: t7 CP (J < < 11 I 3 COUp:..,.;_ :. BUILDING CODE COML'I_,IANCE OFFICE (BCCO) PRODUCT CONTROL, DIVISIGN NOTICE. GI:j ACCEPTANCE Enteg=a oof'Iile, Inc. 1.289 NE 9'h Ave Okeechobee, FL. 3472,' MIAMI-DADE COUNTY, FLORIDA METRO-DADE FLAGLER BUILDING 140 WEST I+LAGLER STREET, SUITE 1603 MIAMI, FLORIDA 33130-1563 (305) 375-2901 FAX (305) 375-2908 SCOPE. This NOA is oeing issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed by Miami -Dade County Product Control Division and accepted by the Board of Ruies and Appeals (BORA) to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ). This NOA shall r.ct ';e valid after the expiration date stated below. The Miami -Dade County Product Control Division (?n Miami Dad:; County) ar_dd/or the AHJ (in areas other than Miami Dade County) reserve the right to have this product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify, or susp-and the use of such product or material within their jurisdiction. BORA reserves the right to revoke ;;his accep` ce,if,'t is uete_ i i.ea by Miami -Dade County Product Control Division that this product or material fails to mee _ _ ra iirpane:._s ofthW ap licable building code. This product is approve as deser bed heroin, and has been designed to comply with -the High Velocity Hurricane Zone of the Florida Bulimia Code. DESCM?T1,0NT- ' L'nt1o,n'R..0o-If x'- e LABE.ft"il G. Eac;h uri1L snail bear a pwrnanonz label with the rn.anufacturer's name or logo, city, state and following statement: "iviiarni-Dade County Product Control Approved", unless otherwise noted herein RENEWAL of this NOA shall be co,isidered after a renewal application has been filed and there has been no change in the applicable building cote negatively affecting the performance of this product. TERMINATION of this NOA }ariil occur e0er the expiration date or if there has been a revision or change in the materials, use, and/o�- _;r :rzafacture of tie product or process. Misuse of this NOA as an endorsement of any product, for sales, advertising or any ouier purposes shall automatically terminate this NOA. Failure to comply with any sc:clfion of h,is i\,GA s i$li ;�­se for lerminatiori and removal ofNOA. Ab�%EI TISIN 1Viil�i� '. 'fine ivOA narnoer preceded by the words Miami -Dade County, Florida, and followed by the expiration ;ate „lay';,- displayed in. G.Lv-rtisirig literature. If any portion of the NOA is displayed, then it shall be done in its ei]trcif. INSREC`I`EU —. A, eal y o_ Lnis er,-61,51�IOA shall be provided to the user by the manufacturer or its distributors and shall be availao e, for inspectior, at -she job site at the request of the Building Official. This revises INN tic,. i-0S'34.113 u_Fd C 01_s sts of pages "I through:. S. The su rtiittea ci,;;w=__eritatior. was by Alex Tigera. NOA No.: 10-1202.01 Expiration Hate: 12/08/15 F9lfi `- `..: ®� ��E i<�� Approval Date: 12I30/10 Page 1 of 5 R0 0 F I N C ASQS rt 13 L Y riiPP ,t` �V AL Category: Roorinb Sub Category: Roofing Tiles Material- Concrete 1. SCOPE. This re_ ows a roofing sys-r m using Bntegra "Plantation" concrete roof tile, as manufactured for Entegra 'Roof Tile, Inc_ in 0lteechobee, FL as described in Section 2 of this Notice of Acceptance. ;or th-c lac t, s where the pressure requirements, as determined by applicable Building Code, does not exceed the values listed in section 4 herein. The attachment c� _culations shall be done as a moment based system. 2. PRO JL'_' �ECI'111 U`< 1§�rd@9::fr1L"si. _ Test Plantation Tile L an gif : J. T r i n': _ iecu- Bength: va_ies v 3d uct Description Flat concrete roof tile for direct deck or batten nail -on. Accessory trim, concrete, roof pieces for use at hips, rakes ri:'ges and valley termina'rions 3.1 _~i_r <assir__ ;: _s part of this acceptance, ar rnorta c c.swv set tile applications, a static r eld uplift test in accordance with 5'AS 106 may r ga_red, refer to applicable building code. 3.3 Appl cant shall retain the services of a Miami -Dade County Certified Laboratory to r`�rm quar :.r y t st in accordance with TAS 112, appendix `A'. Such testing shall be auc,rr.ii eN tc _ _�:j.,'lu_n Code Compl—ance Office for review. ^/ ,_i i. L,' :1 Q' a!1 be In coinnPIiairCQ ;U1_ti'_ t!"_e a p p I i c a b I a Roaring s--a:.d sect10i14.l here -in. :.ru�r'ayrnent applications n3ay'oe installed perpendicular to the roof eI`a-- 'ie-vi se by the underlaymert material manufactwrers published cc� ;cc deck applications. '�:n:___ ,rn dec,._c gr.ire rents shall be in 1.-u lding code. �i. i 4 oa1";:' _.c.'s iantation Flat Tile and its components shall be installed in ./. _. ,_oof"na Applioetion Standard _�.S 11�,119, &, 120 NGA No.: 10-1202.01 Expiration Bate: 12/08/15 s IAMI DADS CGUN 't Approval Date: 12/30/10 Page 2 of 5 Avi"ea-a 4,Kjoight (W) and Dimensions (I Xw "Weight-W (Ibf) Langth-I (ft) Width-w (ft) Plantation Tile 11.6 1.375 1.08 I2' T Ap -1 L Ne �a pfl-cation Divo�, ck AppHcation 0,267 0.289 Mornen-Is due to Gravib) - Mq Tile j 4'D � 121 � D 12" Greater than Profile 7": 12" Battans LD i reC'L a tte S D i r a ec I Battens Direct Battens Direct Battens Direct Battens Direct Deck I Deck I Deck Deck Plantation 7.22 75 7377 , 6.44 7.32 6.26 7.04 Tile -�"-�satance Et-pr-�t-,. Sod as a Mf (ft-Ibf) Ty Talle D. rea Deck 'Vecit Deck Battens Min 15132" i (Min. 19132" PIT Vocdj,, pdywood) Plantatic-n- MP, 385.1 17.2 7 v 9.8 j 4.9 A 8 r Screw! C .8 k2-13'al snncot-:�I 0 7.4 31, 18.2 61.1,11 24.4 -, w CI-C, C it i C81 24, 3 24.3 24.2 -re\,v, a.0 19,0 5 22.1 Ig S-.,Svj 34.8 31. 32.2 9 2 S. 3 11 lnstallationvjih are located a rn'.nimurn oi2/2-frorn fh-- head of tile. NO.A. No.: 16-'1202.01 E 'Ev xpiration Date: 12/08/15 Ap al Date: 12/30/10 Page 3 of 5 Table S: Attach;rnant Resistance Expvessed as a Moment Mf (ft-lbf) Far rwo PaA - Adhesive Set Systems �..Minimum :le profile Tile Application Attachment Resistance Plantation Tile Adhesive 31.3 2 See manufaciu:es component approval for installation requirements. 3 Flexible Products Company TliaBond „veraige weights per patty 13.9 grains. PoIVfoam Product, Inc. Average weight per patty 8 grams. lade 64 A-�t ,chmiant Ras;atance Expressed as a Moment - Mf {ftRlbf) --Foo 8tn Je PattyAdhesive et sy viiem ... 4''fle Pr--,YHIG Tide Application Minimum Attachment g�JI Poi Prom Pfpntation T1ls Pol; prov:.s 40.4 4 Large paddy lacement of45 rr-rns er PoI Pro-,m, Madiurn paddy Placement of 24 grarns of PolyProTm. Tapia- 7. Aftacnrriernt Resistance Exoressed as a Moment - Mf (ft-libf) for 4.qc r Set Systems ---- ��i:i;:achu�er�t rno Application l Ras stance See specific mortar manufacturer's Notice of Acceptance. 5. LABELING 5.1 All tiles shall bear :tbe imprint or identifiable marking of the manufacturer's name or logo as seen 'below or following statement: "]Miami -Dade County Product Control Approved". 5.2 Entegra :goof Tile, Inc.'s Plantation roof Tile bears the following markings: USA "E" USA, "E", Entegra "E", where the E is a stylized logo. 6. $UllLD i "G PEI L Y11:T R2QUIRrT iiE1®TS 6.1 Application for b-aiic,ng perm it shall be accompanied by copies of the following: This Notice of Acceptance. 6, i. Any other documents required by the Building Official or applicable Building Code in order to properly evaluate the installation of this system. 7.1. O;keechobe�, — NOA No.: 10-1202.01 Expiration hate: 12/08/15 Approval hate: 12/30/10 Page 4 of 5 PRO' F I L F, D R A NA7 V-'NTG P­ --q- FLAT CONTCRETE TILE NOA No.: 10-1202.01 Rxplratian Date: 12108/15 M MIAMI-DADE N IN, 'i" Approval Date: 12130/10 lium Page 5 of 5 MIAM MIAMI-DADE COUNTY PRODUCT CONTROL SECTION DEPARTMENT OF PERMITTING, ENVIRONMENT, AND REGULATORY AFFAIRS (PERA) 11805 SW 26 Street, Room 208 BOARD AND CODE ADMINISTRATION DIVISION Miami, Florida 33175-2474 T (786) 315-2590 F (786) 315-2599 NOTICE OF ACCEPTANCE (NOA) www.miamidade.eov/sera 3M Company 3M Center Building 0220-05-E-06 St. Paul, MN. 55144-1000 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed and accepted by Miami -Dade County PERA - Product Control Section to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ). This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product Control Section (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) reserve the right to have this product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify, or suspend the use of such product or material within their jurisdiction. PERA 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: 3MTM 2-Component Foam Roof Tile Adhesive 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 renews and revises NOA# 11-0124.04 and consists of pages 1 through 7. The submitted documentation was reviewed by Alex Tigera. NOA No.: 12-0228.18 Expiration Date: 05/10/17 Approval Date: 05/10/12 Page 1 of 7 ROOFING COMPONENT APPROVAL: Category: Roofing Sub Category: Roof tile adhesive Materials: Polyurethane SCOPE: This approves 3MTM 2-Component Foam Roof Tile Adhesive AH-160 as manufactured by 3M Company as described in Section 2 of this Notice of Acceptance. For the locations where the design pressure requirements, as determined by applicable building code, does not exceed the design pressure values obtained by calculations in compliance with Roofing Application Standard RAS 127, for use with approved flat, low, and high profile roof tiles system using 2-Component Foam Roof Tile Adhesive AH-160. Where the attachment calculations are done as a moment based system for single patty placement, and as an uplift based system for double patty systems PRODUCTS MANUFACTURED BY APPLICANT: Product Dimensions Test Product Description Specifications 3MTM 2-Component Foam N/A TAS 101 Two component polyurethane foam adhesive Roof Tile Adhesive AH- 160 Foam Dispenser RTF 1000 N/A Dispensing Equipment ProPack® 30 & 100 N/A Dispensing Equipment PRODUCTS MANUFACTURED BY OTHERS: Any Miami -Dade County Product Control Accepted Roof Tile Assembly having a current NOA which list moment resistance values with the use of 2-Component Foam Roof Tile Adhesive AH-160 roof tile adhesive. MANUFACTURING LOCATION: Tomball, TX. PHYSICAL PROPERTIES: Prot)erty Test Results Density ASTM D 1622 1.6 lbs./ft.3 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./Ft2 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 @158°F., 100% Humidity, 2 weeks Closed Cell Content ASTM D 2856 86% NOA No.: 12-0228.18 Expiration Date: 05/10/17 Approval Date: 05/10/12 Page 2 of 7 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. EVIDENCE SUBMITTED: Test Agency Test Identifier Test Name/Reuort Date Center for Applied Engineering #94-060 TAS 101 04/08/94 257818-IPA TAS 101 12/16/96 25-7438-3 SSTD 11-93 10/25/95 25-7438-4 25-7438-7 SSTD 11-93 11/02/95 25-7492 SSTD 11-93 12/12/95 Miles Laboratories NB-589-631 ASTM D 1623 02/01/94 Polymers Division Ramtech Laboratories, Inc. 9637-92 ASTM E 108 04/30/93 Southwest Research Institute 01-6743-011 ASTM E 108 11/16/94 01-6739-062b[l] ASTM E 84 01/16/95 Trinity Engineering 7050.02.96-1 TAS 114 03/14/96 Celotex Corp. Testing Services 528454-2-1 TAS 101 10/23/98 528454-9-1 528454-10-1 520109-1 TAS 101 12/28/98 520109-2 520109-3 520109-6 520109-7 520191-1 TAS 101 03/02/99 520109-2-1 LIMITATIONS: 1. Fire classification is not part of this acceptance. Refer to the Prepared Roof Tile Assembly for fire rating. 2. 3MTM 2-Component Foam Roof Tile Adhesive 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 3MTM 2-Component Foam Roof Tile Adhesive AH- 160 roof tile adhesive with their tile assemblies shall test in accordance with TAS 101. 5. Roof Tile manufactures acquiring acceptance for the use of HANDI-STICK roof tile adhesive with their tile assemblies shall test in accordance with TAS 101 with section 10.4 as modified herein. F W 2 F'= MS NOA No.: 12-0228.18 Expiration Date: 05/10/17 h�w�t� W►oe Cout�Y Approval Date: 05/10/12 Page 3 of 7 INSTALLATION: 1. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 may be used with any roof tile assembly having a current NOA that lists uplift resistance values with the use of 3MTM 2-Component Foam Roof Tile Adhesive AH-160. 2. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 shall be applied in compliance with the Component Application section and the corresponding Placement Details noted herein. The roof tile assembly's adhesive attachment with the use of 3MTM 2-Component Foam Roof Tile Adhesive AH-160 shall provide sufficient attachment resistance, expressed as an uplift based system, to meet or exceed the uplift resistance determined in compliance with Miami -Dade County Roofing Application Standards RAS 127. The adhesive attachment data is noted in the roof tile assembly NOA. 3. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 and its components shall be installed in accordance with Roofing Application Standard RAS 120, and 3M Company's 3MTM 2-Component Foam Roof Tile Adhesive AH- 160 Operating Instruction and Maintenance Booklet. 4. Installation must be by a Factory Trained'Qualified Applicator' approved and licensed by 3M Company. 3M Company shall supply a list of approved applicators to the authority having jurisdiction. 5. Calibration of the Foam Dispenser RTF 1000 dispensing equipment is required before application of any adhesive. The mix ratio between the "A" component and the "B" component shall be maintained between 1.0-1.15 (A): 1.0 (B). The dispense timer shall beset to deliver 0.0175 to 0.15 pounds per tile as determined at calibration. No other settings shall be approved. 6. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 shall be applied with Foam Dispenser RTF 1000 or ProPack® 30 & 100 dispensing equipment only. 7. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 shall not be exposed permanently to sunlight. 8. Tiles must be adhered in freshly applied adhesive. Tile must be set within 2 to 3 minutes after 3MTM 2- Component Foam Roof Tile Adhesive AH-160 has been dispensed. 9. 3MTM 2-Component Foam Roof Tile Adhesive 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. Table 1: Adhesive Placement For Each Generic Tile Profile Tile Profile Placement Detail Single Paddy Weight Min. (grams) Two Paddy Weight per paddy Min. (grams) Flat, Low, High Profiles #1 35 N/A High Profile (2 Piece Barrel) #1 17/side on cap and 34/ an N/A Flat, Low, High Profiles #2 24 N/A Flat, Low, High Profiles #3 8 NOA No.: 12-0228.18 Expiration Date: 05/10/17 Approval Date: 05/10/12 Page 4 of 7 LABELING: All 3MTm 2-Component Foam Roof Tile Adhesive AH- 160 containers shall comply with the Standard Conditions listed herein. BUILDING PERMIT REQUIREMENTS: As required by the Building Official or applicable building code in order to properly evaluate the installation of this system. ADHESIVE PLACEMENT DETAIL 1 SINGLE PATTY Nall through plastic cement Paddy (Boned Tile) Underlayment 1 10 in. In EaveCourso - Fascla Eave course only: Eave Closure Keep adhesive approx. 4 In. up from weepholes Nall through plastic cement Paddy (Beneath Tile) Undedayment I - - - 10 In. 2 in. Eave Course Eave Closure Eave course only: Keep adhesive approx. 4 In. up Fascia from weepholes Nall through plastic cement Paddy (Beneath Tile) Undedayrrient 10 In. 21n Eave Course Fascia Weephole Eave course only: Eave closure Keep adhesive approx. Drip edge 4 In. up from weepholes 1) Place enough adhesive to achieve 17 to 23 Optional 2x4!s for square Inches In contact with thesteep pitch applications Nall through plastic cement the 2) Turn covers upside down. Place adhesive 1112N To 1 In. From outside edge of cover 011e. Then install the Ole. 0 Undedayment 0 0 Rom v p portIon Sheathing of tim save course rover 0. Abut to second course of Optional pan ties Ensure save end of pan and tiles are Point -up Mortar flush at save line. on longitudinal edges of Ole Eave closure Weep Ole Fascia (mortar shown) NOA No.: 12-0228.18 Expiration Date: 05/10/17 Approval Date: 05/10/12 Page 5 of 7 ADHESIVE PLACEMENT DETAIL 2 SINGLE PATTY Nail through plastic cement Paddy (Beneath Tile) Nail through plastic cement Paddy (Beneath rile) Undedayment o Underlayment 4 7 lln. ., 2 in. 7F 2 in. Eave Course Fascia Fascia % weephole Eave CourseW Eave closure Eave Closure Orlp edge NOA No.: 12-0228.18 Expiration Date: 05/10/17 Approval Date: 05/10/12 Page 6 of 7