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RF-04-22-975Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date: 06/01/2022 Location Address Parcel Number 1125 NE 92ND ST, Miami Shores, FL 33138 1132050270380 Contacts Permit NO.: RF-04-22-975 Permit Type: Roof Work Classification: Repair Roof Permit Status: Approved Expiration: 12/01/2022 SHIRLEY ENCAMACION Owner AMIGO CONSTRUCTION SERVICES CORP Contractor RAFAEL CONCEPCION MENENCIA Description: RE -ROOF METAL Valuation: Ins ection Requests: p $ 39,096.00 305-762 4949 Total Sq Feet: 3,258.00 Fees Amount Application Fee - Other $50.00 CCF $24.00 DBPR Fee $4.88 DCA Fee $3.25 Education Surcharge $8.00 Roofing Fee $275.00 Technology Fee $8.13 Total: $373.26 Payments Date Paid Amt Paid Total Fees $373.26 Credit Card 06/01/2022 $323.26 Credit Card 04/19/2022 $50.00 Amount Due: $0.00 Building Department Copy In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulatin const ction and , -zoning. Futhermore, I authorize the above named contractor to do the work stated. ature: Owner / Applicant / Contractor / Agent Date June 01, 2022 Page 2 of 2 BUILDING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC��2/_ 0G-7 Master Permit No. F-� 0` 11 z I I Sub Permit No. ❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL []PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: /y City: Miami Shores County: Miami Dade Zip: 313 Folio/Parcel#: 113U50,240380 Is the Building Historically Designated: Yes NO ✓ Occupancy Type: Load: Construction Type: '_'5 i- F Flood Zone: BFE: _ FFE: OWNER: Name (Fee Simple Titleholder): ,*/'%V G/JCQMoc,on Phone#: Address: N25 NE qa City: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Email: Phone#: CONTRACTOR: Company N,a�fine:'461� l,0/1SfirlGH�O/1 S2rY�CC'd Corp. PhoneM IA&-9_$+-+Z3 Address: 01ffq 5yi r ar City: rvr.+ Lauderdnnale /� State: FL Z;p; 33312 Qualifier Name:_94t4e/ C.Onao�n Phone#:IS&-oi"-9`Q93 State Certification or Registration #: W_ 1,-52) 0:l sn Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: & City: State: Zip: Value of Work for this Permit: $� D Square/Linear Footage of Work: Type of Work: ❑ AdMion ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: a-00�- "e - L Specify color of color thru tile: G ce-� E)dye, Submittal Fee $ Scanning Fee $ Technology Fee $__ Structural Reviews $ (Rev1sed02/24/2014) Permit Fee $ CCF $_ Radon Fee $ DBPR $ Training/Educatlon Fee $ CO/CC $ _ Notary $ Double Fee $ _ Bond $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Zip Application is hereby made to obtain a permit to 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charge Signature OWNER or AGENT The foregoing instrument was acknowledged before me this 10 day of -40� 20 by sw(pwle-Q who is personally known to me or who has produced as identification and who did take arnoath. NOTARY PUBLIC: Y. Signature CONTRACTOR The foregoing instrument was acknowledged before me this lb delay ofr-� 0, 20 ;2Z by %fcX 00"e42-�%ntl, who is personally known to me or who has produced as identification and who did take NOTARY PUBLIC: ro�srr "9s^ Notary Public State of Florida Maria C Ubau v My Commission GG 353698 °+Fof ,,P Expires 07/14/2023 Sign: 1 I= Sign:_ A Print: QW 4 Print: G U bO L-f LO Notary Public State of Florida$eal: ? Marie C UbauSeal: My Commission GG 353698 Expires 07/14/2023 APPROVED BY V Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Summary Report Property Information Folio: 11-3205-027-0380 1125 NE 92 ST Property Address: Miami Shores, FL 33138-2934 AGUSTIN ENCARNACION TRS AGUSTIN ENCARNACION AND Owner SHIRLEY ENCARNACION REVOCABLE TR SHIRLEY ENCARNACION TRS 1125 NE 92 ST Mailing Address MIAMI SHORES, FL 33138 USA PA Primary Zone 1100 SGL FAMILY - 2301-2500 SQ 0101 RESIDENTIAL - SINGLE Primary Land Use FAMILY: 1 UNIT Beds / Baths / Half 4/3/0 Floors 2 Living Units 1 Actual Area 3,999 Sq.Ft Living Area 3,009 Sq.Ft Adjusted Area 3,110 Sq.Ft Lot Size 9,375 Sq.Ft Year Built Multiple (See Building Info.) Assessment Information Year 2021 2020 2019 Land Value $354,750 $354,750 $354,750 Building Value $241,960 $242,186 $242,412 XF Value $40,721 $41,110 $41,498 Market Value $637,431 $638,046 $638,660 Assessed Value $360,451 $355,475 $347,483 Benefits Information Benefit Type 2021 2020 2019 Save Our Homes Cap Assessment Reduction $276,980 $282,571 $291,177 Homestead Exemption $25,000 $25,000 $25,000 Second Homestead Exemption $25,000 $25,000 $25,000 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description 5 53 42 BAY LURE PB 44-63 LOT 26 BLK 2 LOT SIZE 75.000 X 125 OR 14691-3386 0890 1 Generated On : 4/11/2022 Taxable Value Information 2021 2020 2019 County Exemption Value $50,000 $50,000 $50,000 Taxable Value $310,451 $305,475 $297,483 School Board Exemption Value $25,000 $25,000 $25,000 Taxable Value $335,451 $330,475 $322,483 City Exemption Value $50,000 $50,000 $50,000 Taxable Value $310,451 $305,475 $297,483 Regional Exemption Value $50,000 $50,000 $50,000 Taxable Value $310,451 $305,475 $297,483 Sales Information PrevPrev OR Book- Price Qualification Description Pious 9 06/26/2017 $100 30593-4666 Corrective, tax or QCD; min consideration 12/10/2015 $100 29891-1908 Corrective, tax or QCD; min consideration 05/27/2015 $100 29676-2745 Corrective, tax or QCD; min consideration 08/01/1990 $185,000 14691-3386 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 BONE WHITE HEMLOCK GREEN MANSARD BROWN MEDIUM BRONZE MATTE BLACK BURGUNDY IN ENGLERT 0 Standard CHARCOAL GRAY and PERMACOLOR 35100 Full Strength 70% Kynar 500®/Hylar 5000® COLONIAL RED All colors available in Galvalume and Aluminum (.032", .040" & .050") DARK BRONZE To view current SRI values, please visit the Englert website. DOVE GRAY Colors shown are close to actual finishes however, due to the limitations of printing processes, slight variations may exist. Please contact Englert for actual color chips before ordering. DEEP RED �ti r EVERGLADE MOSS PPG is a registered trademark of PPG Industries Ohio, Inc. PERMAMETALLICS 3500* PREWEATHERED *Premium priced paint systems. GALVALLIME" MILL FINISH (Metallic) Mica 2-Coat System GALVALUME-PLUS® CHAMPAGNE* COPPER* MILL FINISH (Metallic) (Metallic) (Aluminum) Made to order — Mica 2-Coat System Mica 2-Coat System available in sheets only FOREST GREEN HARTFORD GREEN PACIFIC BLUE PATINA GREEN ROYAL BLUE SLATE BLUE SLATE GRAY SUNNET BLUE SANDSTONE SIERRA TAN STONE WHITE TERRA COTTA We protect and beautify the World" PPG Industrial Coatings PPG Industries 151 Colfax Street Springdale, PA 15144 USA Color Services www.colorrequests@ppg.com .. •DE ASTM ASTM ASTM NUMBER OL • • DESCRIPTION C 1549 C-1371 E 1980 TSR TE SRI BN4W114B BONE WHITE 0.716 0.86 87 870R5 BURGUNDY 0.293 0.86 29 868V1 CHAMPAGNE 0.350 0.75 32 870D6 CHARCOAL 0.303 0.86 31 870R4 COLONIAL RED 0.368 0.87 27 870T15 DARK BRONZE 0.297 0.86 30 BN4R126B DEEP RED 0.413 0.86 45 BN4A1266 DOVE GRAY 0.439 0.86 49 870G11 EVERGLADE MOSS 0.371 0.87 40 870G98 FOREST GREEN 0.299 0.86 30 870G99 HARTFORD GREEN 0.250 0.83 22 870G19 HEMLOCK GREEN 0.399 0.86 43 870T16 MANSARD BROWN 0.297 0.86 30 870K10 MATTE BLACK 0.250 0.83 22 870T14 MEDIUM BRONZE 0.272 0.87 27 868R29 METALLIC COPPER 0.350 0.75 32 870B11 PACIFIC BLUE 0.264 0.86 25 BN4G120B PATINA GREEN 0.383 0.86 41 868A31 PRE -WEATHERED GALV 0.350 0.75 32 870B50 ROYAL BLUE 0.250 0.83 22 BN41106B SANDSTONE 0.588 ! 0.86 69 13N4N130B SIERRA TAN 0.452 0.86 51 870135 SLATE BLUE _ 0.307 0.86 31 870D7 SLATE GRAY - 0.370 0.87 _ 40 BN4W117B STONE WHITE 0.662 ! 0.86 80 870G9 !TEAL 0.287 0.86 28 870R61E TERRA COTTA 0.354 0.86 37 ----------- GALVALUME-PLUS 0.680 0.10 54 Amigo Construction Services License #CCC1331780 2449 SW 7 ST Fort Lauderdale, FL 33312 Date: 04/19/22 State of Florida County of Miami -Dade i Before me this day personally appeared 4&aWL*ho, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: Contractor Signature Sworn to (or affirmed) and subscribed before me this 19 day of April. 2022, By?Q +rC,�' i`onCkP 140--1 Personally know Or Produced Identification Type of Identification P ary Englert is one of the few single -source metal roof manufacturers with an in-house coil coating line and an exceptionally broad range of finishes, whether the design calls for a natural weathered appearance or bright, high-performance, full-strength fluorocarbon colors. Custom Colors We can match the color of virtually any material, including brick, wood and fabric. Englert offers short lead times, and our minimum custom -color order requirements are among the industry's lowest. ENGLERT ROOFING KYNAR-COATED STANDARDS IN STOCK - SHEET AND COIL STEEL ALUMINUM COLORS _.. __._ _ ... _.. .. _ .... 22g 24g 26g .032 .040 .050 .063 Galvalurn� Plus*+ , _................. .. .............................................. ....................... ....................... ....... ..._........... ;..._._...._....... Burgundy• ✓ • ✓ • • • Bone White • V • �/ �/ �/ • Charcoal Gray V V Colonial Red 0 0 Dark Bronze 0 0 • ✓ ✓ ✓ ✓ ✓ Deep Red 0 0 ...................... ....................... ................... . ... .................... ........ ............... ....................... ............ ............... ....... Hartford Green 0 ...................... .:................ ....... V/ ...... ................ ....................... ....................... ................. ...- ........................................................................................................................................................ r Medium Bronze 0 Mill -Finish tACimihumi ✓ ✓ ✓ •` "Made to order available in sheets only. VIJ 1 MDV I r U DT: The coil and sheet availablity shown above is subject to change at anytime without notice. Contact Englert for current offering. ENGLERT INC. 1200 Amboy Avenue, Perth Amboy, NJ 08861 Phone:732-826-8614 • Fax:732-826-8865 info@englertinc.com • englertinc.com 903008 Florida Building Code 7th Edition (2020) High Velocity Hurricane Zone Uniform Roofing Application Form for Miami -Dade County Master Permit Number: Contractor's Name: Job Address: I/a Section A (General Information) Process Number: NE 4a 6T Miami (Shores . FL 331 ROOF CATEGORY ❑ Low Slope ❑ Mechanically Fastened Tile ❑ Asphaltic Shingles IX Metal Panel/ Shingles ROOF TYPE ❑ New Roof ❑ Repair ❑ Maintenance C .f ❑ Mortar / Adhesive S6Pt e ' ❑ Wood Shingles / Shakes ROOF SYSTEM INFORMATION LEI" Reroofing ❑ Recovering Low Slope f� of Area (ft2) Steep Slo�d�o �r(ftZ) S;�- al (f �J Are there gas vents on the roof? 0 Yes 0o If Yes what type? O Natural 0 LPX �,� Is there an existing roof top Solar System? 0 Yes eNo If yes will it be reinstalled? 0 Yes O No Section B (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. anu ,.uun,y rum:, anu raguinviun%, . Permit#elPly Miami -Dade County (MDC) 2020 HVHV Electronic Permit Form Section D Metal Roof Panel Roof System Manufacturer: ROOFING EXPERTS SERVICES INC MDC Notice of Acceptance (NOA): 21-0603.29 Minimum Design Wind Pressures (psf) from 2020 RAS-127 or Calculations per ASCE 7-16 (P1) Field: -74 (P2e) Perimeter Edges: -74 (P2n) Gable Perimeter: -108 (P2r) Ridge Perimeter. -108 (P3e) Overhang Corners: -108 (P3r) Ridge Corners: -128 Maximum design wind pressure from MDC NOA:-106.75 Complete the required roof assembly system components, if a component is not required mark the field NIA. Roof Slope: 4� /12 Roof Mean Height. 14 ft. Perimeter Width: ft. Deck Type: -- 5/8" Plywood Deck -- Optional Nailable Surface: N/A Optional substrate attachment: N/A Optional Insulation: N/A Insulation Attachment: N/A Fire Barrier. GAF VERSAHIELD FIRE BARRIER Underlayment Type (UDL): 30 ASTM D226Type Ilw/4" headlap Fastener Type & Spacing for UDL Attachment: 1 1/4 R.S.Nail & 1 5/8 Tin Cap 6" OC LA Optional Peel & Stick Membrane: 01 s 'GK �n�ei2.la n�pn� T lL) Metal Roof Panel: ENGLERT SERIES 1300 STEEL PANEL Drip Edge Material: GALVANIZED METAL Drip Edge Size & Gauge or Thickness: 3" FACE 24 GA Drip Edge Hook Strip (continuous cleat) N/A Drip Edge Fastener & Attachment Spacing: 1.25 IRS NAILS @ 4" OC Screw Type, Size and Gauge for Clip Attachment: " Clip w/ 2 screws & 6" Clip w/4 Screws Number of screws required per clip: 2&4screw Screw Type, size, and Gauge for Through Panel Attachment, Sealing Washers Required: #10 CR wafer had spolier Tip Clip or Screw Spacing for Metal Panel Attachment: (P1): 12" in. o% (P2e): 12 in. o/c (P2n): 12" in. o% (P2r): 12" in. o/c (P3e): 12" in.o% (P3r): 12 in. o/c Miami -Dade County (MDC) 2020 HVHV Electronic Permit Form Section D Metal Roof Panel Roof System Manufacturer: ROOFING EXPERTS SERVICES INC MDC Notice of Acceptance (NOA): k1-0603.29 Minimum Design Wind Pressures (pst) from 2020 RAS-127 or Calculations per ASCE 7-16 (P1) Field: -74 (P2e) Perimeter Edges: -74 (P2n) Gable Perimeter. -108 (P2r) Ridge Perimeter: -108 (P3e) Overhang Corners: -108 (P3r) Ridge Corners: -128 Maximum design wind pressure from MDC NOA:-106.75 Complete the required roof assembly system components, if a component is not required mark the field NIA. Roof Slope: 112 Roof Mean Height. 1 �" ft. Perimeter Width: ft. Deck Type: -- 5/8" Plywood Deck -- Optional Nailable Surface: N/A Optional substrate attachment: N/A Optional Insulation: N/A Insulation Attachment. N/A Fire Barrier. GAF VERSAHIELD FIRE BARRIER Underlayment Type (UDL): 30 ASTM D226Type Ilw/4" headlap Fastener Type & Spacing for UDL Attachment: 1 1/4 R.S.Nail & 1 5/8 Tin Cap 6" OC LA Optional Peel & Stick Membrane: ®Cr, D�Cja ega-T 0 Metal Roof Panel: ENGLERT SERIES 1300 STEEL PANEL Drip Edge Material: GALVANIZED METAL Drip Edge Size & Gauge or Thickness: 3" FACE 24 GA Drip Edge Hook Strip (continuous cleat) N/A Drip Edge Fastener & Attachment Spacing: 1.25 RS NAILS @ 4" OC Screw Type, Size and Gauge for Clip Attachment: Clip w/ 2 screws & 6" Clip w/4 Screws Number of screws required per clip: &4screw Screw Type, size, and Gauge for Through Panel Attachment, Sealing Washers Required: #16 CR wafer had spolier Tip Clip or Screw Spacing for Metal Panel Attachment. (P1): 12" in. o% (P2e): 12" in. o/c (P2n): 12" in. o/c (P2r): 12" in. o/c (P3e): 12" in.o% (P30: 12„ in. o/c Florida Building Code 7th Edition (2020) High Velocity Hurricane Zone Uniform Roofing Application Form INSTRUCTION PAGE COMPLETE THE NECESSARY SECTIONS OF THE UNIFORM ROOFING PERMIT APPLICATION FORM AND ATTACH THE REQUIRED DOCUMENTS BELOW: Roof System Required Sections of the Permit Application Form Attachments Required See List Below Low Slope Application A,B,C 1,2,3,4,5,6,7 Asphaltic Shingles A,B,D 1,2,4,5,6,7 Concrete or Clay Tile A,B,D,E 1,2,3,4,5,6,7 Metal Roofs A,B,D 1,2,3,4,5,6,7 Wood Shingles and Shakes A,B,D 1,2,4,5,6,7 Other As Applicable 1,2,3,4,5,6,7 ATTACHMENTS REQUIRED: 1. Fire Directory Listing Page 2. From Product Approval: Front Page Specific System Description Specific System Limitations General Limitations Applicable Detail Drawings 3. Design calculations per Chapter 16, or if applicable, RAS 127 or RAS 128 4. Other Component Product Approval 5. Municipal Permit Application 6. Owner's Notification for Roofing Considerations (Reroofing Only) 7. Any Required Roof Testing / Calculation Documentation Miami Shores Village - BUILDING DEPARTMENT 10050 NE 2 Ave Miami Shores, FL 33138 305-795-2204 www.msvfl.gov SECTION R4402.13 HIGH VELOCITY HURRICANE ZONES — REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS R4402.13.1 Scope. As it pertains to the section, it is the responsibility of roofing contractor to provide the owner with the required roofing permit, and to explain to the owner the content of the section. The provisions of Section R4402 govern the minimum requirements and standards of the industry for roofing system installations. Additionally, the following items should be addressed as part of the agreement between the owner ant the contractor. The owner's initial in the designated space indicates that the item has been explained. 1. Aesthetics -Workmanship: the workmanship provisions of Section R4402 are for the purpose of providing that the roof system meets the wind resistance and water instruction performance standards. Aesthetics (appearance) are not a consideration with respect to workmanship provisions. Aesthetic issues such as color or architectural appearance, that are not part of a zoning code, should be addressed as part of the agreement between the owner and the contractor. 2. Renailing wood decks: When replacing roofing, the existing wood roof deck may have to be renailed in accordance with the current provisions of Section R4403. (The roof deck is usually concealed prior to removing the existing roof system). 3. Common roofs: Common roofs are those which have no visible delineation between neighboring units (i.e., townhouses, condominiums, etc.) In buildings with common roofs, the roofing contractor and/or owner should notify the occupants of adjacent units of roofing to be performed. 4. k�;. 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. S. 9FPonding 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. Pounding can be an indication of structural distress and may require the review of a professional structural engineer. Pounding may shorten the life expectancy and performance of the new roofing system. Pounding conditions may not be evident until the original roofing system is removed. Pounding conditions should be corrected. Rev01142021 Owners roofing consideration Page 1 of 2 Miami Shores Village - BUILDING DEPARTMENT 10050 NE 2 Ave Miami Shores, FL 33138 305-795-2204 www.msvfl.gov rflow 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 Sections R4402, R4403 and R4413. 7. 8-(Fz:;Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of the structure assembly (the building itself). The existing amount of attic ventilation shall not be reduced. It may be beneficial to consider additional venting which can result in extending the service life,df th enq&� ZE�J—z A-110 Owner/Agent's Signature Date Contract ignature Date For Forms and Applications click here: http://bidg.miamishoresviIlage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia miShoresVillage RevO1 142C21 Owners roofing consideration Page 2 of 2 Miami Shores Village - BUILDING DEPARTMENT 10050 NE 2 Ave Miami Shores, FL 33138 305-795-2204 www.msvfl.gov OWNERS'S AFFIDAVIT OF EXEMPTION ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR EXISTING SITE -BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PERSUANT TO SECTION 553.844 F.S. To: Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, FI 33138 Re: Owner's Name: ohirleu CnearRaell Date: i l8 z Z Property Address: Ila5 `ENE qa J7 ne, Shores, R 33138 Roofing Permit Number: Dear Building Official: I certify that I am not required to retrofit the roof to wall conrtettions of my building because: ❑ The just valuation for the structure for purpose of ad valorem taxation is less than $300,000.00. Please attach proof of ad valorem taxation. ,The building was constructed in compliance with the provisions of the Florida Building Code (FBC) or with the provisions of 1994 edition of the South Florida Building Code (1994 SFBC) 00. r_,l Shlrley ncarnac; on Signature Print Name State of Florida, Miami Dade County 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 befor me this 16 day of lrzt.� 20'24- Apr °W4 Notary Public; State of Florida Maria C Ubau s r �a My Commission GG 353698 Notary Public, State of Florida at Large �o ag Expires071 • 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. For Forms and Applications click here: http://bldg.miamishoresviIlage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia miShoresVillage Rev01 142021 Owner affidavit of exemption Page 1 of 1 Miami Shores Village - BUILDING DEPARTMENT 10050 NE 2 Ave Miami Shores, FL 33138 305-795-2204 www.msvfl.gov AFFIDAVIT OF COMPLIANCE WITH ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR EXISTING SITE -BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PURSUANT TO SECTION 553.844 F.S. To: Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, FI 33138 00 Re: Owner's Name: OJ r 1y2l t Property Address: W 92 S-�- Roofing Permit Number: 0 Date: I E31 S Z D uildi O ficial: I i") certify that I have improved the roof to wall connections of the referenced property as required by the Manual of Hurricane Mitigation Retrofits for Existing Site -Built Sing Family Residential Structures as adopted by the Florida Building Commission by Rule 9B-3.0 7 IF d 4,A6 Signature Print Name State of Florida Miami Dade County 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 IS day of A2 rZ; 20 z z Notary Public, at Flor�,, a`3i.terFlonda GG 353698 Expire; 0-1/1412023 Seal: For Forms and Applications click here: http://bldg.miamishoresviIlage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia miShoresVillage Rev01142021 Affidavit of Compliance with roof to wall Page 1 of 1 MIAMI DARE MIAn1I-DADE COUNTY ®MY PRODUCT CONTROL. SECTION DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES (RER) 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) ii;w"'.miamidatle.sovlecoo(ini) Roofing Experts Services, Inc. 15240 SW 169 Lane Miami, FL 33187 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of constriction materials. The documentation submitted has been reviewed and accepted by Miami -Dade County RER - Product Control Section to be used in Miami -Dade County and other areas, where allowed by the Authority Having Jurisdiction (AHJ). 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. 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: Englert Series 1300 Steel Panel (2 in Clips and 6 in Clips) over Wood Deck 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. Fall -Lire 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 consists of pages I through 5. The submitted documentation was reviewed by Sifang Zhao, P.E. a NOA No.: 21-0603.29 Expiration Date: August 05, 2026 Approval Date: August 05, 2021 Page 1 of 5 ROOFING ASSEMBLY APPROVAL Category: Roofing Sub -Category: Metal, Panels (Non -Structural) Materials: Steel Deck Type: Wood Maximum Design Pressure—165.00 psf TRADE NAMES OF PRODUCTS MANUFACTURED OR LABELED BY APPLICANT: Test Product Product Dimensions Specifications Description Series 1300 Length: various TAS 125 Corrosion resistant, galvalume, preformed, Width: 16" standing seam. Coated, pre -finished, metal Thickness 0.024" (24ga) panels. Min. Yield Strength: 57 ksi. 2" Clip Length: 2" TAS 125 Corrosion resistant, galvalume, preformed, Width: 1" coated, pre -finished, metal clips for use in Height:1-9/16" Field or Perimeter and Corner Area of Roof. Thickness 0.020" 6" Clip Length: 6'/4" TAS 125 Corrosion resistant, galvalume, preformed, Width: 1" coated, pre -finished, metal clips for use in Height: 1.65" Perimeter and Corner Areas of Roof. Thickness 0.0276 Trim Pieces Length: varies N/A Corrosion resistant, galvalume, preformed, Width: varies coated, pre -finished, trim pieces. "Thickness 0.0276". EVIDENCE SUBMITTED: 'rest Agency Test Identifier Test Name/Report Date Morton International AS-0286-91L Salt Spray Feb. 1986 ASTM B 117 AS-0286-91 T Accelerated Weathering Feb. 1986 ASTM G 23 Architectural Testing Inc. 01-32797.01 TAS 100 Nov. 1998 01-32797.03 ASTM E 8 Nov. 1998 Hurricane Test Laboratory, LLC. 0155-0615-05 TAS 125 Feb. 2006 Architectural Testing 92270.01-109-18 TAS 125 October. 2009 Intertek G5733.01-106-18 TAS 114 App G 01/05/17 NOA No.: 21-0603.29 MIAMI-DADE COUNTY Expiration Date: August 05, 2026 - Approval Date: August 05, 2021 Page 2 of 5 APPROVED ASSEMBLIES: System A-1: Series 1300 Panel 16" Wide Deck Type: Wood, Non -Insulated Deck Description: New Construction 19/32" or greater plywood or wood plank. Slope Range: 2": 12" or greater (1": 12" effective w/2020 FBC 7"' Edition) Maximum Uplift See Table A below Pressure: Deck Attachment: In accordance with applicable building code, but in no case shall it be less than # 8d annular ring shank nails spaced 6" o.c. In reroofing, where the deck is less than 19/32" thick (Minimum I'/2") the above attachment method must be in addition to existing attachment. Underlayment: Minimum underlayment shall be an ASTM D 226 Type 11 installed with a minimum 4" side - lap and 6" end -laps. Underlayment shall be fastened with corrosion resistant tin -caps and 12 gauge 1 '/4" annular ring -shank nails, spaced 6" o.c. at all laps and two staggered rows 12" o.c. in the field of the roll. Or, any approved underlayment having a current NOA. Fire Barrier Board: Any approved fire barrier having a current NOA. Refer to a current fire directory listing for fire ratings of this roofing system assembly as well as the location of the fire barrier within the assembly. See Limitation # 1. Valleys: Valley construction shall be in compliance with Rooting Application Standard RAS 133 and with Englert's current published installation instructions. Metal Panels and Install the "Series 1300 Panel" and accessories in compliance with the current published Accessories: installation instructions and details in Englert's Installation Manual. Flashings, penetrations, valley construction and other details shall be constructed in compliance with Roofing Application Standard RAS 133. Panels shall be installed with approved Panel Clips located at each panel rib side lap spaced at a maximum, listed in Table A below, parallel to roof slope, fastened with #10 wafer head spoiler tip corrosion resistant screws of sufficient length to penetrate through the sheathing a minimum 3/16 of an inch. Use 2 screws for the 2" clip and use 4 screws for the 6" clip. Standing seams shall be mechanically seamed to a 900 degree seam, (single lock). TABLE A MAXIMUM DESIGN PRESSURES Roof Areas Field Perimeter and Corner' Perimeter and Corner" Maximum Design Pressures —69.25 psf —106.75 psf —165.00 psf Maximum Clip Spacing 24" o.c. 12" o.c. 12" o.c. Clip Size 2" Clip 2" Clip 6" Clip 1. Extrapolation shall not be allowed 2. Place a bead of Bostik 70-05A sealant in the lateral seams prior to seaming. NOA No.: 21-0603.29 MIAMI•DADECOUNTY Expiration Date: August 05, 2026 1 Approval Date: August 05, 2021 PP g Page 3 of 5 SYSTEM LIMITATIONS Fire classification is not part of this acceptance; refer to a current Approved Roofing Materials Directory for fire ratings of this product. The maximum designed pressure listed herein shall be applicable to all roof pressure zones (i.e., field, perimeters, and corneas). Neither rational analysis, nor extrapolation shall be permitted for enhanced fastening at enhanced pressure zones (i.e., perimeters, extended corners and corners). 3. Panels may be rolls formed in continuous lengths from cave to ridge. Maximum lengths shall be as described in Rooting Application Standard RAS 133 4. All panels shall be permanently labeled with the manufacturer's name and/or logo, and the following statement: "Miami -Dade County Product Control Approved" or with the Miami -Dade County Product Control Seal as seen below. All clips shall be permanently labeled with the manufacturer's name and/or logo, and/or model. All products listed herein shall have a quality assurance audit in accordance with the Florida Building Code and Rule 61G20-3 of the Florida Administrative Code. 6. Panels may be jobsite roll formed with machine model #(`s) 05.18.03 from Englert Rollformed Products Association. NOA No.: 21-0603.29 Expiration Date: August 05, 2026 Approval Date: August 0.5, 2021 Page 4 of 5 PROFILE DRAWINGS 1-9/16" 2" CLIP DETAIL (FIELD AND PERIMETER AND CORNER OPTION) Before Seaming 90 degree Seam MIN. EW AT CLIP ISOMETRIC (PERIMETER AND CORNER OPTION) Bostik Sealant 90 degree Seam w/Bostik Sealant SERIES 1300 PANEL SYSTEM END OF THIS ACCEPTANCE QMIAMMI-D�AECO�UNTY NOA No.: 2I-0603.29 • Expiration Date: August 05, 2026 Approval Date: August 0.5, 2021 Page 5 of 5 IMPORTANT! CONSULT ENGLERT TECHNICAL IMPORTANTI ENGLERT H/T UNDERLAYMENT DEPARTMENT WHEN SLOPE IS LESS THAN 3:12 REQUIRED ON SOLID SUBSTRATES & RIGID INSULATION. FOR REQUIRED VALLEY FLASHING WIDTH. SEE DETAIL# R14 FOR INSTALLATION INSTRUCTIONS. (2) ROWS %" ENGLERT IN -SEAM I TUBE SEALANT (TYP.) PANCAKE SCREW PER PROJECT I REQUIREMENTS (TYP.) ENGLERT OFFSET CLEAT I CONTINUOUS (TYP.) ENGLERT BUTYL TAPE SEALANT CONTINUOUS (TYP.) �4cLF _ FILL PANEL ENDS w/ ENGLERT RTQlp `� IN -SEAM TUBE SEALANT (TYP.) I �Ar( Rot 1 INSTALL ENGLERT TUBE SEALANT I BEFORE INSERTING PANEL HEM (TYP.) ENGLERT VALLEY 1 ` 5� NJ ENGLERT www. engtertinc_com 800-364-5378 GENERIC BEST RRACTICEASSEMELY $HOWM1. WATERTiGMUS WARRANTYNOTIMPUW. WHEN WE CONORION owfm, ti MAN �.- ROOF VALLEY OFFSET CLEAT o ar�tA�?10$1 i OI MLSUWECT TO CHANGE R14.1 /I 11 1300 SERIES ROOF PANEL Z CLOSURE CUT TO FIT BETWEEN PANEL, SET IN 2 CONT. BEADS OF POP RIVET ONE SIDE SEALANT AND CAULKED VERTICALLY ONLY 0 24" O.C. AT SEAMS (SEALANT PROVIDED BY #10-12X1" SCREWS ENGLERT) (3) PER PANEL BOX PANEL END FLASH "C" s FLASH "A" � . 1 It ASTM D226 30# FELT (BY ENGLERT) ENGLERT HT UNDERLAY f SOLID DECK' s� 1 FLASH "A" FLASH "C" 13P-011 1 �( �i asp r 1 Lw�tb% , E 5 �1 �` f 'k 5�. `�• ��u` Ttl �5 h W9E 1`j # w� F i - DETAIL AVE jo � l JU r A H ENGLERT TUBE SEALANT COLOR MATCHED HEX SCREW w/ BONDED SEALING WASHER PER PROJECT REQUIREMENTS ENGLERT REGLET/RECEIVER WRAP UNDERLAYMENT UP WALL ENGLERT HEADWALL FLASHING ENGLERT Z-CLOSURE CUT TO FIT BREAD PAN FOLD BETWEEN SEAMS w/ ENGLERT TUBE L SEALANT ON ALL CUT EDGES (TYP.) f�z/ S,S POP RIVET(SCREWES OPTIONAL) —, Cr Ln F-W ul a, ENGLERT BUTYL TAPE SEALANT CONTINUOUS (TYP.) < ° PANCAKE SCREW PER PROJECT REQUIREMENTS @ 3" O.C. MAX. THRU Z-CLOSURE (TYP.) r ? / '04 P,\V�� OOFD��P�L�tO / ENGLERT BUTYL TAPESEALANT C�l ENGLERT ROOF HEADWALL WaDn mull" DETAD. / n COUNTER FLASHING WjSEALANT R18.1 86t01fN, RA48RTIGHTNL4$ 1fARDANIS HDT D@Il86. WM MM CONDITION DD°FM �+sc�c �cutaarta+a x�asaar ENGLERT TUBE SEALANT ENGLERT BUTYL TAPE SEALANT COLOR MATCHED HEX SCREW w/ BONDED SEALING WASHER PER PROJECT REQUIREMENTS ENGLERT COUNTER FLASHING WRAP UNDERLAYMENT UP WALL HEX SCREW PER PROJECT REQUIREMENTS ' i u.t 'emu ENGLERT SIDEWALL FLASHING �, r ENGLERT RETAINER-Z CONTINUOUSIr ; J Lu ENGLERT BUTYL TAPE SEALANT - CONTINUOUS ENGLERT ROOF PANEL UPTURN LEG ; I PANCAKE SCREW PER PROJECT REQUIREMENTS @ 3" O.C. MAX. i ! ROOF ASSEMBLY l f 1 j -\\ \ f (SEE DETAIL R08) ENGLERT www.englertinc.com 800-364-5378 GINFRIGAST VRAMCG ASSBNFLLY SHOWN. WATERTIGRMISS WARRAIM NOT I.PL-. MiN. vI J fY � ROOF SIDEWALL COUNTER FLASHING W/ SEALANT WITHOUT NOTICE. ii # R22.1 0 ENGLERT MANSARD PARAPET CAP (PITCH AWAY FROM ROOF) WRAP UNDERLAYMENT OVER EDGE & DOWN WALL PANCAKE SCREW PER PROJECT REQUIREMENTS (TYP.) ENGLERT EXTENDED EAVE TRIM PANCAKE SCREW tr/ OR ENGLERT CLEAT i �/ t J a� w cr Q cr 4� I Ln f f. i f i" MINI, HEM 1 �I CLEAT ALWAYS REQUIRED 11 ENGLERT www.engiertinc.com 800-364-5378 GENERIC HEST PRACTICEASSEMBLY SHOWN. WATERTrAIDIESS WARAgNTY NOT IMPLIED, WHEN Sire mNOWN DIFFERS, SPECIPIC ENGIY. CERING NER5- NOTE: MANSARD PARAPET CAP SHALL HAVE 6" MIN. OVERLAP w/ 2 ROWS OF ENGLERT BUTYL TAPE SEALANT FASTENED w/ COLOR MATCHED HEX SCREWS w/ BONDED SEALING WASHER PER PROJECT REQUIREMENTS BREAD PAN FOLD PANCAKE SCREW PER PROJECT 2° MIN. REQUIREMENTS @ 3" O.C. MAX. PITCH THRU Z-CLOSURE (TYP.) 1 ENGLERT Z-CLOSURE CUTTO FIT T�wvgy` ' BETWEEN SEAMS W/ ENGLERTTUBE SEALANT ON ALL CUT EDGES (TYP.) �i COLOR MATCHED HEX SCREW w/ BONDED SEALING WASHER r ENGLERT BUTYL TAPE SEALANT i rr CONTINUOUS (TYP.) k is OpF I I ' F�cQ qss 5" MIN. ROOF PEAK MANSARD s,. DETAIL SUMECf TO CHANGE WITHOUT NOTICE, Detail # R12.3 OR I CAUTION - THIS DETAIL MAY i PIN PANELS AT THIS POINTI i 1 PIPE, TUBE STEEL, or ANGLE } ENGLERT TUBE SEALANT i STAINLESS STEEL BAND (IF REQUIRED BY ROOF JACK MANUFACTURER) E PIPE BOOT (DEKTITE OR EQUIVALENT) �1 HEX SCREW wJ BONDED SEALING WASHER J @ 1" O.C. INTO PANEL FACE ONLY F t ENGLERT TUBE SEALANT da as as am Ak, AIL / _ !_ f T7��= ROOF ASSEMBLY r ! (SEE DETAIL ROS) 7 I i ( i � EAl 5U9TTCHANfFENGLrRTN U1TLOM fNr1iE CKV T ZT�V V www.englertine.corn Detail # w 840-364-5378 PIPE BOOT a p GENERIC BEST RRACTICEASSEAMY R ry SHOWN. WATERTIGHTNESS WARPAN7Y NOT NPUED, N WHEN SITE CONDITION D{FFERS, SVECIM ENGINEERING NECSS . 1 I i i i i P ! METAL SEALANT r r ^I #10,41.5" W00OGRIP SCREW I / N70X1.5' WOOCGRIP 5CREW EMBEOO IN CAULK < 70P & 60TTOM—\ .f T' ENGLERI ROOF PENETRATION QETAILSU8IEC(TOC}IANGf. Wti'NOUTNOT7CE. � v. mengiertinc•com Detail # 800.364-5378 GOOSE NECK DETAIL 4Cn-r G.IC BESS FW (T?CC::i$EIAuiY R26. 4ft':MYi VfhTifiT)GlT4C54 -- ry t'.Hft: SI!E C:4CIIYJti UIf�t21, ry 5?i C,i,CF1GillCSii:G 2/27/2020 TGFU.R18970 - Roofing Systems UL Online Certifications Directory Home Quick Guide Contact Us UL.cont TGFU.R18970 Roofing Systems Page Bottom Roofing Systems See Gencral Information for Roofing Systems ENGLERT INC 1200 AMBOY AVE PERTH AMBOY, NJ 08861-1920 USA OTHER SYSTEMS Class A 1. Deck: C-15/32 or spaced Incline: Unlimited Impact: 4 sheathing Underlayment: — One layer "VersaShield Underlayment", mechanically fastened. Ply Sheet: — One layer Type 30 base sheet or "VersaShield", mechanically fastened. Panels: — — Steel, zinc or copper roofing panels, designated "Series 1000", "Series 1100", "Series 1101 ", "Series 1300", "Series 1500", "Series 2000" or "Series 2500", mechanically fastened. 2. Deck: C-15/32 or spaced Incline: Unlimited Impact: 4 sheathing Underlayment: — One or more plies "VersaShield Underlayment", mechanically fastened. Panels: — Steel, zinc or copper roofing panels, designated "Series 1000", "Series 1100", "Series 1101" "Series 1300", "Series 1500", "Series 2000" or "Series 2500", mechanically fastened. 3. Deck: C-15/32 Incline: Unlimited Impact: 4 Barrier Board: — 1/4 in. min. G-P Gypsum DensDeck® with all joints staggered a min of 6 in. from the plywood joints. Insulation (Optional): — Fiberglass, polyisocyanurate, perlite or wood fiber, any thickness. Membrane: — Any UL Classified modified bitumen system, BUR system or CPE, CSM, CSPE, EPDM, NBP, PIB, PVC, TPO or THE membrane system suitable for use with any roof insulation. Panels: — Steel, zinc or copper roofing panels, designated "Series 1000", "Series 1100", "Series 1101 "Series 1300", "Series 1500", "Series 2000" or "Series 2500", mechanically fastened. Last Updated on 2014-06-17 file:///C:/Users/Lucy Iglesias/Desktop/MRS Documents/website/resources/TGFU.R18970 - Roofing Systems UL.html 1/2 2/27/2020 TGFU.R18970 - Roofing Systems Questions? Print this page Terms of Use Page Top 2016 UL LLC The appearance of a company's name or product in this database does not in itself assure that products so identified have been manufactured under UL's Follow -Up Service. Only those products bearing the UL Mark should be considered to be Certified and covered under UL's Follow -Up Service. Always look for the Mark on the product. UL permits the reproduction of the material contained in the Online Certification Directory subject to the following conditions: 1. The Guide Information, Assemblies, Constructions, Designs, Systems, and/or Certifications (files) must be presented in their entirety and in a non -misleading manner, without any manipulation of the data (or drawings). 2. The statement "Reprinted from the Online Certifications Directory with pennission from UL" must appear adjacent to the extracted material. In addition, the reprinted material must include a copyright notice in the following format: "© 2016 UL LLC". file:=:/Users/Lucy Iglesias/Desktop/MRS Documents/website/resources/TGFU.R18970 - Roofing Systems UL.html 2/2 MIAMI•DADE MIAMI-DADE COUNTY a PRODUCT CONTROL SECTION 11805 SW 26 Street, Room 208 DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES (RER) Miami, Florida 33175-2474 BOARD AND CODE ADMINISTRATION DIVISION T (786)315-2590 F (786) 315-2599 NOTICE OF ACCEPTANCE (NOA) www.miamidade.gov/economy GAF 1 Campus Drive Parsippany, NJ 07054 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed and accepted by Miami -Dade County RER -Product Control Section to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ). 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. 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: VersaShield° Fire -Resistant Roof Deck Protection and VersaShield® Solo'"' Fire -Resistant Slip Sheet 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 and revises NOA No. 16-1216.02 and consists of pages 1 through 3. The submitted documentation was reviewed by Jorge L. Acebo. ._. APPROVED NOA No.: 21-1027.02 Expiration Date: 02/07/27 Approval Date: 12/02/21 Page 1 of 3 ROOFING COMPONENT APPROVAL Category: Roofing Sub -Category: Underlayment Material: Fiberglass SCOPE: This acceptance is for VersaShield° Fire -Resistant Roof Deck Protection (a.k.a "VersaShield"`' Underlayment") and VersaShield® SoloT" Fire -Resistant Slip Sheet (a.k.a "VersaShield SoloT`^"), as described in this Notice of Acceptance, for use with approved prepared roof assemblies. Designed to comply with the Florida Building Code and the High Velocity Hurricane Zone of the Florida Building Code. PRODUCT DESCRIPTION: Manufactured by Test Applicant Dimensions Specifications VersaShieldc' Fire- 42" x 100' rolls ASTM D 226 Resistant Roof Deck Type II Protection VersaShield° SoloT°I 72" x 166.7' rolls UL790 Fire -Resistant Slip Sheet 36" x 166.7' rolls MANUFACTURING LOCATION: 1. Conover, NC EVIDENCE SUBMITTED: Test Agency PRI Construction Materials Technologies UL LLC Test Identifier PRI 376TO192 GAF-748-02-01 ELK-063-02-01 R10689 R 1306 Product Description Non -Asphaltic fiberglass -based underlayment and/or fire barrier. Non -Asphaltic fiberglass -based slip sheet and/or fire barrier. Test Name/Report Date ASTM D 226 09/16/21 ASTM D 226 12/12/16 TAS 100 09/27/01 UL790 04/30/21 UL790 1 1 /23/21 INSTALLATION: 1. VersaShield Fire -Resistant Roof Deck Protection or VersaShieldc" Solo'' Fire -Resistant Slip Sheet shall be installed in strict compliance with applicable Building Code. 2. VersaShield"' Fire -Resistant Roof Deck Protection or VersaShield' Solo'"' Fire -Resistant Slip Sheet shall be installed with a minimum 4-inch head lap in a shingle layer fashion. 3. VersaShield* Fire -Resistant Roof Deck Protection shall be mechanically fastened with approved fasteners in compliance with Florida Building Code 1518.2 when used in lieu of a code prescribed ASTM D 226 Type Il underlayment. NOA No.: 21-1027.02 Expiration Date: 02/07/27 Approval Date: 12/02/21 Page 2 of 3 LIMITATIONS: 1. Fire classification is not part of this acceptance, refer to a current Approved Roofing Materials Directory for fire ratings of this product 2. This acceptance is for prepared roofing applications. Minimum deck requirements shall be in compliance with applicable building code. 3. VersaShield Fire -Resistant Roof Deck Protection shall not be left exposed as a temporary roof for longer than 30 days of application. VersaShield° SoloTm Fire -Resistant Slip Sheet shall not be left exposed to the weather. 4. VersaShield`"' Fire -Resistant Roof Deck Protection and VersaShield' Sololm Fire -Resistant Slip Sheet are a component used in roof assemblies. Roof assemblies are approved under specific assembly Notice of Acceptance. 5. VersaShield"' Fire -Resistant Roof Deck Protection or VersaShield`, SoloTm Fire -Resistant Slip Sheet may be used with any approved roof covering Notice of Acceptance listing. VersaShield` Fire -Resistant Roof Deck Protection or VersaShield Solo-, Fire -Resistant Slip Sheet may be used as a component part of an assembly in the Notice of Acceptance. if VersaShield"' Fire -Resistant Roof Deck Protection or VersaShield' SoloT"' Fire -Resistant Slip Sheet is not listed, a request may be made to the Authority Having Jurisdiction (AHJ) or the Miami -Dade County Product Control Department for approval provided that appropriate documentation is provided to detail compatibility of the products, wind uplift resistance, and fire testing results. 6. VersaShield* Fire -Resistant Roof Deck Protection and VersaShield"' SoloTm Fire -Resistant Slip Sheet are a non - asphaltic underlayment that may be used as a fire barrier for prepared roof assemblies. For fire classification of specific roof assemblies using VersaShield' Fire -Resistant Roof Deck Protection or VersaShield"' SoloTM Fire - Resistant Slip Sheet refer to a current Approved Roofing Materials Directory for fire ratings of this product. 7. 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. LABELING: All membranes or packaging shall bear the imprint or identifiable marking of the manufacturer's name or logo, city and state of manufacturing facility, yellow line to identify the ASTM Standard designation or logo, and the following statement: "Miami -Dade County Product Control Approved" or the Miami -Dade County Product Control Seal as shown below. *7!le• APPROVED 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 Building Official or Applicable building code in order to properly evaluate the installation of this material. END OF THIS ACCEPTANCE NOA No.: 21-1027.02 MIAMI•DADE COUN� Expiration Date: 02/07/27 - Approval Date: 12/02/21 Page 3 of 3 MIAMI-DARE } MIAMI-DADE COUNTY PRODUCT CONTROL SECTION DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES (RER) 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) wvi-".miamidade.eov/economy Polyglass USA Inc. l I I 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 documentation submitted has been reviewed and accepted by Miami -Dade County RER - Product Control Section to be used in Miami -Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ). 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. 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: 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 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 tennination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Mialni-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.17-0614.22 and consists of pages 1 through 7. The submitted documentation was reviewed by Jorge L. Acebo. NOA No.: 21-0602.14 Expiration Date: 09/13/22 Approval Date: 08/26/21 Page 1 of 7 ROOFING COMPONENT APPROVAL Category: Roofing Sub -Category: Underlayment Material: SBS, APP PRODUCTS DESCRIPTION: Test Product Product Dimensions Specification Description Polystick IR-Xe 65' x 3' Or 33.4' x ASTM D 1970 A fine granular/sand top surface self -adhering, APP Manufacturing 3' polymer modified, fiberglass reinforced, bituminous sheet Location # 1 & #2 material for use as an underlayment in sloped roof 60 mils thick assemblies. Designed as an ice & rain shield. 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 membrane. Designed as a a roof tile Location #1 & #2 underlayment. Polystick TU P 32' 10" x 3'3-3/8" 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 3'3 '/8" 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 NITS 65'8" x 3'3-3/8" TAS 103 A homogeneous, rubberized asphalt waterproofing Manufacturing 60 mils thick membrane, glass fiber reinforced with polyolefinic film Location #2 on the upper surface for use as an underlayment for metal roofing, roof tile, slate tiles and shingle underlayment. Polystick NITS Plus 65'8" x 3'3 '/s" TAS 103 A homogeneous, rubberized asphalt waterproofing Manufacturing 60 mils thick membrane, glass fiber reinforced with polyolefinic 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. MANUFACTURING PLANTS: 1. Hazelton, PA 2. Winter Haven, FL NOA No.: 21-0602.14 Expiration Date: 09/13/22 Approval Date: 08/26/21 Page 2 of 7 Test Aj!ency Trinity I ERD LABELING: EVIDENCE SUBMITTED Test Identifier Test Name/Report P37300.10.11 P37590.07.13-1 P45270.05.14 P46520.10.14 P44360.10.14 P43290.10.14 PLYG-SC 10130.06.16-3 PLYG-10130.06.16-1 PLYG-SC 10130.09.16 PLYG-SC 13035.08.17 TAS 110/ASTM D4798 & D1970 ASTM D6164 TAS 103, TAS 110 & ASTM D 1623 ASTM D 1623 TAS 103 & TAS 110 ASTM D 1970 & TAS 1 10 TAS 103 & TAS 110 ASTM D1970 & TAS 110 ASTM D1623 TAS 103 & ASTM D4798 Date 10/19/11 07/02/ 13 05/12/14 10/03/14 10/07/14 10/17/14 06/27/ 16 06/27/ 16 09/22/ 16 10/32/ 17 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. 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. NOA No.: 21-0602.14 Expiration Date: 09/13/22 Approval Date: 08/26/21 Page 3 of 7 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" grid, 6" o.c. at a minimum 4" head lap. (for base sheet only) Membrane: Polystick IR-Xe, Polystick TU Max, Polystick TU P, Polystick TU Plus, Polystick MTS or Polystick NITS Plus, self -adhered. Surfacing: See General Limitations Below. 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" grid, 6" o.c. at a minimum 4" head lap. (for base sheet only) 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 caps 12" grid, 6" o.c. at a minimum 4"head lap. (for base sheet only) Ply Sheet: Polystick NITS Plus, self -adhered with minimum 3" horizontal laps and minimum 6" vertical laps. Membrane: Polystick TU Plus, self -adhered. Surfacing: See General Limitations Below. NOA No.: 21-0602.14 MIAMMADE COUNTY Expiration Date: 09/13/22 �� Approval Date: 08/26/21 Page 4 of 7 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 shall be a minirnum of 6". Roll the membrane into place after removing the release strip. Vertical strapping of the roof with Polystick is acceptable. Membrane shall be back nailed in accordance with applicable building code. 4. When applying the membrane in the valley, start at the low point and work to the high point, 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 surface, giving special attention to lap areas. 7. Flash vent pipes, stacks, chimneys and penetrations in compliance with Roof Assembly current Product Control Notice of Acceptance. 8. All protrusions or drains shall be initially taped with a 6" piece of underlayment. The flashing tape 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 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 TU Max, Polystick TU P, Polystick TU Plus, Polystick MTS and Polystick MTS Plus shall be applied to a smooth, clean and dry surface. The deck shall be free of irregularities. 5. Polystick IR-Xe, 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 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. Expo ure Limitations (Days) Polystick MTS Polystick IR-Xe Elastoflex S6 G Polystick TU Plus Polystick TU P Polystick TU Max Polystick MTS Plus Winter Haven, FL 180 90 180 180 180 180 180 Hazelton, PA N/A 90 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 Rule 61 G20-3 of the Florida Administrative Code. NOA No.: 21-0602.14 Expiration Date: 09/13/22 Approval Date: 08/26/21 Page 5 of 7 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 TU Max, Polystick TU Plus or Elastoflex S6 G may be used in both adhesive set and mechanically fastened roof tile applications. Polystick MTS and Polystick NITS Plus are limited to mechanically fastened with the limitations outlined in Section 9. Polystick TU P may be used in mechanically fastened roof tile applications with the exception of mortar set tile applications. 9. When loading roof tiles on roof tile underlayment for (direct -to -deck) tile assemblies, the maximum roof slope shall be as follows: (See Table Below) Tile Polystick Elastoflex Polystick TU Plus, Polystick Polystick System (E3) Profile MTS S6 G Polystick TU P TU Max MTS Plus MTS Plus with TU Plus Flat Tile Prohibited 4:12 6:12 6:12 5:12 6:12 without battens Profiled Prohibited 4:12 6:12 6:12 4:12 6:12 Tile without battens 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 minimum and to avoid dropping of the 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 Polystick MTS which shall be loaded onto battens. Rooting liles Per 12 i 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 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 TU Max, Polystick 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 TU Max, Polystick TU P, Polystick TU Plus, Polystick MTS, Polystick MTS Plus or Elastoflex S6 G are not listed, a request may be made to the Authority Having Jurisdiction (AHJ) or the Miami -Dade County Product Control Section for approval provided that appropriate documentation is provided to detail compatibility of the products, wind uplift resistance, and fire testing results. NOA No.: 21-0602.14 MIAMI-DADECOUNTY Expiration Date: 09/13/22 Approval Date: 08/26/21 Page 6 of 7 POLYGLASS GENERAL APPLICATION GUIDELINES FOR POLYSTICK MEMBRANES PLEASE CHECK WITH LOCAL BUILDING CODES REGARDING LIMITATIONS OF SPECIFIC APPLICATIONS. LOCAL CODES MAY SUPERSEDE POLYGLASS REQUIREMENTS AND RECOMMENDATIONS. 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.) 3. 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 50, XtraFlex 50 Premium Modified Wet/Dry Cement or Polyglass PG 500 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 TV12" or greater. It is suggested that on pitch/slopes in excess of 6'/4"/12", precautions should be taken, 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 50, XtraFlex 50 Premium Modified Wet/Dry Cement or Polyglass PG 500 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. 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 rolling of patches or small areas of the roof. Brooming may be used where slope prohibits rolling. 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. It is recommended to refer to applicable building codes prior to installation to verify acceptable substrates. 12. The Polyglass Miami -Dade Notice of Acceptance (NOA) approval for Polystick membranes 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 our Technical Services Department at 1 (800) 894-4563. 14. Polyglass recommends that applicators follow good roofing practices and applicable procedures as outlined by the National Roofing Contractors Association (NRCA). PLEASE CHECK WITH LOCAL BUILDING CODES REGARDING LIMITATIONS OF SPECIFIC APPLICATIONS. LOCAL CODES MAY SUPERSEDE POLYGLASS REQUIREMENTS AND RECOMMENDATIONS. END OF THIS ACCEPTANCE NOA No.: 21-0602.14 Expiration Date: 09/13/22 Approval Date: 08/26/21 Page 7 of 7 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. 'COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. "� COPY OF LIABILITY INSURANCE* D. '� COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. ONOMMOSOMENEEN BUSINESS NAME: Xt6o l_l SOU c+ & F_D jer--w / a-s CO m P - BUSINESS ADDRESS: o��! U.J 7 CITYSTATE ZIP BUSINESS PHONE: c2 qj 6 FAX NUMBER ( ) CELL PHONE (�j'ZC1 �ZC13 QUALIFIER'S NAME: 14f1w el �,o� 14• QUALIFIER'S LIC NUMBER: CCO ) 33 R-g10 . BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2Q21 THROUGH SEPTEMBER 30, 2022 DBA Receipt #:18 5 - 2 9 6 811 Business Name: AMIGO CONSTRUCTION SERVICES CORP ROOFING/SHEET METAL i Business Type: tvnnoTn:n_ rnr:mon rnoi w Owner Name: CONCEPCION MENENCIA, R'4'?AEL Business Opened:02./ 06/2019 Business Location: 2449 SW 7TH STREET State/County/Cert/Reg:eee13317e0 FT LAUDERDALE Exemption Code: {' Business Phone: 7864062936 Rooms Seats Employees Machines Professionals 7. �— ......... For Vending Business Only —1 Numhwr of Mach[nna. ve..a:..., r......• Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection' Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 z7.00 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: AMIGO CONSTRUCTION SERVICES CORP Receipt #30A-20-00009988 2449 SW 7TH STREET Paid 09/14/2021 27.00 FT LAUDERDALE, FL 33312 2021 _ - 2022 MA AIRI�1M•�!� AMY..-,. -t.f ri.W ►...-. f TA%. -1! r-§r%T ® AC� � . CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/12/2022 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 Emmanuel Insurance&Associates, Inc. CONTACT Sarai Medina _ NAME: _ PHONE (305) 693-0003 FAX (305) 691-4381 No C No Et): A : (AC, E-MAIL ADDRESS: saraigemmanuelinsurance.com 2370 E 8TH AVE INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Preferred Contractors Insurance Company RRG 12497 HIALEAH FL 33013-4236 INSURED INSURER B : INSURER C : Amigo Construction Services Corp. INSURER D : _ Rafael Concepcion INSURER E : _ 2449 Southwest 7th St, I Fort Lauderdale, FL 33312 INSURER F : License Number: CCC1331780 rn%iCoA1__r_c rERTIF!C- TE 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 Su BR POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 CLAIMS -MADE � OCCUR TED PREMISES (Ea occurrence.) $ 50,000.00 MED EXP (Any one person) S 5,000.00 A PC420255 12/28/2021 12/28/2022 PERSONAL & ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 X PRODUCTS - COMP/OP AGG $ 2,000,000.00 POLICY ❑ PRO ❑ LOC JECT OTHER: LIABILITY COMAUTOMOBILE Ea acccidentINED SINGLE LIMIT $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY L AUTOS ONLY PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNERIEXECUTIVE PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) N 1 A E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 1011, Additional Remarks Schedule, may be attached If more space is required) Roofing Contractor ctK I IhIt;A Village of Miami Shores Building Department 10050 NE 2nd Avenue Miami Shores, FL 331 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 W 1V00-1V 10 AlrVRaJ VVRr Vr%N I lvn. ru 11W............ ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ,,cww CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 04/11 /2022 t..�.r' 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 NAME: PHONE: (800) 277-1620 X 4800 FAX: (727) 797-0704 E-MAIL ADDRESS: FrankCrum Insurance Agency, Inc. INSURERS(S) AFFORDING COVERAGE NAIC# 100 South Missouri Avenue Clearwater, FL 33756 INSURER A: Frank Winston Crum Insurance Company 11600 INSURED INSURER B: INSURER C: INSURER D: FrankCrum L/C/F Amigo Construction Services Corp INSURER E: 100 South Missouri Avenue Clearwater, FL 33756 INSURER F: COVERAGES CERTIFICATE NUMUIEK: uu2tsu/ REVISION IYum-K. 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 SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURENCE $ CLAIMS MADE ❑OCCUR DAMAGE TO RENTED PREMISES (Ea occurence) $ MED EXP (Any one person) $ PERSONAL& ADV INJURY $ GENERAL AGGREGATE $ GE. AGGREGATE LIMIT APPLIES PER: POLICY ❑ PROJECT ❑ LOC PRODUCTS-COMP/OP AGG $ $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE UNIT (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ OWNED AUTOS SCHEDULED ONLY AUTOS PROPERTY DAMAGE (Per accident) $ HIREDAUTOS NON -OWNED ONLY AUTOS ONLY UMBRELLALIAB OCCUR EACH OCCURENCE $ EXCESS LIAR CLAIMS MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION X PER STATUE I OTHER AND EMPLOYERS' LIABILITY Y/N E.L. EACH ACCIDENT $1,000.000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A WC202200000 01/01/2022 01I01I2023 E.L. DISEASE -EA EMPLOYEE $1,000.000 A (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) DESCRIPTION Effective 12/06/2021, coverage is for 100% of the employees of FrankCrum leased to Amigo Construction Services Corp (Client) for whom the client is reporting hours to FrankCrum. Coverage is not extended to statutory employees. CANCELLATION OULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE E EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CORDANCE WITH THE POLICY PROVISIONS. Village of Miami Shores Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138- ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD :NTATIVE n 1CIRR_2n1s ACORD CORPORATION. All rights reserved.