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RF-03-22-793Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 9212 NE LOTH AVE Miami Shores FL 33138 Contacts Issue Date: 04/22/2022 Parcel Number 1132060060010 Permit NO.: RF-03-22-793 Permit Type: Roof Work Classification: Flat Permit5totus: Approved Expiration: 09/26/2022 Andrew Thay Owner 9212 NE 10 AVE ALL DADE GENERAL CONST INC Contractor HERNAN GARCIA 3451 NW 16 ST, MIAMI, FL 33121 Business: 7863075891 kissahouse@aol.com Other: 7864525627 Description: RE -ROOF FLAT ONLY Valuation: $ 7,700.00 Ins ection Reg uests Total Sq Feet: 1,050.00 . Sj4j�ll)il Fees Amount Application Fee - Other $50.00 CCF $4.80 DBPR Fee $4.13 DCA Fee $2.75 Education Surcharge $1.60 Roofing Fee $225.00 Scanning Fee (Manual( $9.00 Technology Fee $6.88 Total: $304.16 Payments Date Paid Amt Paid Total Fees $304.16 Credit Card 03/29/2022 $50.00 Credit Card 04/22/2022 $254.16 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 reguI ti ce struatio and zoning. Futhermore, I authorize the above named contractor to do the work stated. Mm Alexotnder Ub4u Authorized Sighature: Owner / Applicant / Contractor / Agent Date April 22, 2022 Page 2 of 2 MAR 2 9 2022 Miami Shores Village , t Building Department 1DD50 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 7S&8972 INSPECTION UNE PHONE NUMBER: (30S) 762.4949 Ff C 20 BUILDING Master Permit No. F O3-Z-2--743 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC 2fOOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 1 JOB ADDRESS: 9212. NE 10"t4A City: Miami Shores County Miami Dade zip, 3Z ( Z Folio/ParcelR: //-:0206-OOro- 00/0 Is the Building Historically Designated: Yes_ NO Occupancy Type: Load: Construction Type: 5 XF Flood Zone: BFE: FFE: _ OWNER: Name (Fee City: rr/t Dr/fr Tenant/Lessee Name: Email: re 5 3/ Name1411 oaae C'VP're'rO6 Phone#: "/g6 063 -Sa� Address:/ovr ,LI-Cry City: 1q It? N Qualifier Name: state Certification or Registration DESIGNER: Architect/Engineer: - Value of Work for this Permit: Type of Work: ❑ Addition Description of Work: 2 /I 7-�� City: _State: _Zip:_ i3.T®f'✓ Square/UnearFootage of Work: ❑ Alteration ❑ New Ei Repair/Replace ❑ Demolition Specify color of color thru Submittal Fee Scanning Fee 5 Technology Fee S __ Structural Reviews $ IRMWO2124/2014i Permit Fee $ Radon Fee $ _ Training/Education Fee $ CCF $CO/CC 5 DBPR $ Notary $ Double Fee S Bond $ TOTAL FEE NOW DUES Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction In this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONER5, 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 Am low brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature — > OWNER or AGENT CONTRACTOR The lforegoing instrumen was acknowledged before me this The foregoing instrume was acknowledged before me this oZ _day of AfG%? 20i� by ��.dlaV of �%h 20aa .by ieu) who is personally to }�Iv I1who is personally known to me or who has produced as me or who has produ ed as identification and who d' lake an oath. NOTARY PU / Print Seal: OPA• Notary Public State of Florida � , Maria C Ubau My Commission GO 353698 +� Expires 07/142023 rww APPROVED BY OL' 4-,1 yL- Ine•,sad02124(20141 identification and who did NOTARY PUBItL• Sign: Print: (�C�T%L/• Seal: gµ`'eWk Notary Public State 01 Florida Maria C Ubau y c �T My Commission GG 353898 borne' ExPnes 07/14/2023 Plans Examiner Structural Review Zoning Clerk OFFICE OF Summary Report Property Information Folio: 11-3206-006-0010 Property Address: 9212 NE 10 AVE Miami Shores, FL 33138-2924 Owner ANDREW THAY Mailing Address 9212 NE 10 AVE MIAMI SHORES, FL 33138 USA PA Primary Zone 0900 SGL FAMILY - 1901-2100 SQ Primary Land Use 0101 RESIDENTIAL -SINGLE FAMILY: 1 UNIT Beds I Baths I Half 3/ 2/ 0 Floors 1 Living Units 1 Actual Area 2,162 Sq.Ft Living Area 1,942 Sq.Ft Adjusted Area 1,882 Sq.Ft Lot Size 6,180 Sq.Ft Year Built Multiple (See Building Info.) Assessment Information Year 2021 2020 2019 Land Value $197,974 $166,633 $166,633 Building Value $141,903 $142,994 $144,086 XF Value $472 $480 $488 Market Value $340,349 $310,107 $311,207 Assessed Value $340,349 $310,107 $311,207 Benefits Information Benefit Type 2021 2020 2019 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description GOLDEN GATE PK ADM PB 7-54 N60FT OF LOT 1 LOT SIZE 60.000 X 103 OR 20550-2986 07 2002 1 COC 21941-1267 12 2003 1 Generated On : 3/28/2022 Taxable Value Information �.. 2021 2020 2019 County Exemption Value $0 $0 $0 Taxable Value 1 $340.349 $310,107 $311,207 School Board Exemption Value 0 $0 $0 Taxable Value $340,349 $310,107 $311,207 city Exemption Value $0 $0 $0 Taxable Value $340,349 $310,107 $311,207 Regional Exemption Value $0 $0 $0 Taxable Value 1 $340,349 $310,107 $311,207 Sales Information Previous Sale Price OR Book -Page Qualification Description 11/14/2012 $380,000 28421-1348 Qual by exam of deed 12/01/2003 $330,000 21941-1267 Sales which are qualified 07/01/2002 $272,000 20550-2986 Sales which are qualified 06/01/1998 $179,900 18170-1705 Sales which are qualified The Office of the Property Appraiser is continually editing and updating the tax mil. 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://w .miamidade.gov/info/disclaimer.asp Version: Florida Building Code 7th Edition (2020) High Velocity Hurricane Zone Uniform Roofing Application Form for Miami -Dade County 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 Attachments Required See List Application Form Below Low Slope Application A,B,C 1,2,3,405,6,7 Asphaltic Shingles A,B,D 1,2,4,51617 Concrete or Clay Tile A,B,D,E 1,213,4,51617 00000 ° Metal Roofs A,B,D °°° ° ° ° ° ° ° Wood Shingles and Shakes A,B,D Ufj 1,2,4,5,6;7° e ° ° ° ° Other As Applicable ° ° ° 1,2,3,4,�,�7 ° ° o ° 00 ° ° ° ° ° ° °°°°° 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 Owner's Notification for Roofing Considerations (Reroofing Only) E6. 7. Any Required Roof Testing / Calculation Documentation 0000 0 0 0000e0 0000 0 0 0 0 0 0 0 p 0 0 00 0 0 0 0 000000 0o 00 000000 0 0 0 0 000000 000000 0 00 0000 p 0 0 0 0 0 0 00000 00 0 0000 0 0 00000 00 0 000000 0 0 O p O 000000 0000 00 00 O p O 000000 0 0 0 0 000000 O 00 0 O 0 0 0 0 0 00 0 O 0 000000 O 0 0 p p O 00 O 00 0 0 0 00 0 RECEIVED Florida Building Code 7th Edition (2020) High Velocity Hurricane Zone Uniform Roofing Application Form for Miami County . Master Permit Number: Contractor's Name: Job Address: Section A (General Information) ROOF CATEGORY Process Number: 0 Low Slope ❑ Mechanically Fastened Tile ❑ Mortar / Adhesive Set Tile ❑ Asphaltic Shingles ❑ Metal Panel/ Shingles ❑ Wood Shingles / Shakes ROOF TYPE , . .... .. ...... ❑ New Roof ❑ Repair ❑ Maintenance ❑ Reroofkv:•. ❑ Recovering .... .: ROOF SYSTEM INFORMATION ' .... . .. ..... Low Slope Roof Araa (#t2) Steep Sloped R if Area (ftZ) .. :**T t o ... . . .. ...... Are there gas vents on the roof? OYes No If Yes what type? O Natural Q^LPX Is there an existing rooftop Solar System? O Yes � $ No If yes will it be reinstalled? O Yes RLrgp- 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. C W IN �I 0. GX low 0.�Y 0000 0 O 000000 0000 0 0 O 0 0 0 0 0 0 0 00 0 O 0 0 000000 00 O0 000000 0 O 0 0 000060 000000 O O O 00 0000 O O O O 0 00000 00 O 0000 0 0 00000 00 0 000000 0 0 O O 0 000000 0090 00 00 0 Y~ 000000 0 O O 0 000000 O 00 O 0 O O 0 0 0 00 0 0 O 000000 O O O O 0 0 O 00 O O .O 00 0 'L _ Florida Building Code 7th Edition (2020) High Velocity Hurricane Zone Uniform Roofing Application Form for Miami -Dade County Section C (Low Sloped Roof Systems) Fill in Specific Roof Assembly Components and Identify Top Ply Fastener/ Bonding Material: manufacturer 6-6/'r A'O14-e 2 i�=l (If a component is not used, identify as "NA") Surfacing: System Manufacturer: iC /U .+ 0 e7/ C! • � Fastener Spacing for nchor/Base Sheet Attachment: Product Approval # 18 Design Wind Pressures, from RAS 128 or Calculations: J Zone 1 1606 Zone 1~�l' e0 Zone 2: (dZ •'90 Zone 1' " oc @ Laps, # Rows @ " oc Zone r135 •QD Zone 1 " oc @ Laps, # Rows @ " oc Max. Design Pressure, from the specific product Zone 2 �" oc @Laps #Rows 2i @ 0 d'%c approval system: �2• 1l S� e °° O° oo°°o° w� e ° l..ci Deck I i�po� Zone 3 " oc @Laps, #Rows @ " o� ° ° O 0° 0 0 0 0 0 0 0 000000 Type: ° 0 0 0 0 0 0 0 O ° Gauge /Thickness: Number of Fasteners Per I95dLation Bq#rd ° 0 0 0 0 0 0 0 0 0 ° 0000 O 00 00000 Slope: Wz z� Zone 1': Zone1: ZeReP16 0 Zane ° ° Anchor/ Base Sheet & No. of Ply(s): ° ° ° ° 0000 ° ° ° ° ° ° ' g Material: Illustrated Components Nold2d aflQ Details as'Applicable: ° Anchor/ Base Sheet Fastener/ Bond Woodblocking, Gutter, Edge Telminati8n, Strij# ft, PlIshing, ° 0 ° 0 e Continuous Cleat, Cant Strip, B§se FAging, Cobntetftashing, 0 0 0 0 0 o Coping, Etc. 06 0 00 0 0 0 0 0 Insulation Base Layer: N �- ° 0 Indicate: Mean Roof Height, Parapet Height, Height Base Flashing, Base Insulation Size and Thickness: �% Component M erial, M terial Thickness, Fastener Type, Fastener Base Insulation Fastener/ Bonding Material: Spacing or Sub it Manu actures Details that Comply with RAS 111 /V and C apter 16 Top Insulation Layer: To Insulation Size and Thickness: p Fastener B ndin Material: - l� FTC__.._ _.. ""- Top Insulation/ g � Parapet �v Height Base Sheet(s) & No. of Ply(s): e�S N �� t 19i Bas She t Fastener/ Bond iIng IVI atprial: r Ply Sheet(s) and No. of Ply(s): Mean Roof Ply Sheet Fastener/ Bonding Mat rial: Q , Height Top Ply: eess, 000000 0000 0 0 o O O • • ,o 0 •' 00 0 0 0 • 000000 0000 eoess0 0 o n 000000 000000 0 0 0 0s seer _ 0 0 0 0 0 00000 00 0 0000 0 0 00000 so o o00ese --. --- 0 0 0 0 0 , 000000 0000 00 00 O' 0' 0 Osseo* 0 0 0 0 000000 o ss s 0 0 0 •o e o o . 000oe0o o • o O 0 0 00 0 00 0 0 0 00 0 �J Juan Jose Santandreu RE P.E. # 67241 7135 SW 44 ST., M IAM I, FL 33155 P H : 305-668-5793 Back to Index Email: Aplusetl@yahoo.com March 25, 2022 CONTRACTOR: ALL DADE GENERAL CONSTRUTION INC JOB ADDRESS: 9212 NE 10 AVE., MIAMI SHORES, FLORIDA LOW PITCH ROOFS FASTENERS CALCULATIONS Description Flat Roof Roof Mean Heght: 10' - 0" NOA No: 18-0919.12 Roof System Manufacturer: GAF Deck Type: Wood Deck Non Insulated BaseSheet & Fastener Type: 2 Ply 75 Fastener 1 1/4 Ring Shank Nail and Tin Cap System Type: E(2) ° e ° eoo.• O O ° 00 O 0000 000000 O Maximum Design Preassure from the specific NOA: -52.50 psf 00 O ° ° ° O O O O O 06 O O O.O ..O e 0 ao0000 e 0 0 Scope of Activity & Findings: 0000 O o O OOO 000ood e0 0 O e 0 ° - Minimum Design Wind Uplift Preassure from (RAS 128) Exposure "D" ° ° e ° e q O 00 000000 ° ° ° %. O . ° ° . O o ° O O 000 O 0 0 0 0 000000 Zone V= -45.00 psf 9 in in o/c on laps and 2 equal ro%S§ * • ° 9 in Zone 1= -77.00 psf 6 in in o/c on laps and 2 equal rows t in o ° ° ° e Zone 2=-102.00 psf 5 in in o/c on laps and 2 equal rows° ° ° in ° ° LOGO: Zone 3=-139.00 psf 4 in in o/c on laps and 3 equal rows4 in ®° ° 00 lap: 4 in Net width(ft)= Nw = 2.95 in Net length (ft) N1:= (100) Ln= 33.93 in (to make one square) Nw Rs = 11.79 in Number of fastener per square Side laps row = fl: = 45 fasteners/sq Center row = fc: = 90 fasteners/sq Total 136 fasteners/sq Ft 12 x per fasteners FT:= 100 FT= Total Fy= 52.5 * FT Fy = 0.74 38.69 IV OOoo e o 000000 oeod n p • O p O O O 00*000 00 00 O e O 600000 0 o O 00 p O O ooeoa 00 0 0 0 000eo oe 0 0 a 0 6066s0 0000 0 0 0 0 o00oe• 6 00 0 0 0 0 6 00 0 900060 a o 0 oe 0 0 0 00 0 O tl 0 0 0 O Od 000600 0 000006 0000 O 0 0060 906060 0 o 00 00 006.00 o _ 0 e 0 0 0 • o O 0 00 11 General Equation: FS=Fy x 144/P x Rs Results: Juan Jose Santandreu RE P.E. # 67241 44 ST., MIAMI, F 333155 PH: 3 Email: Aplusetl@yahoo.com Zone 1'= fa:= Fy * Zone 1= fa= Fy * Zone 2 fa-- Fy * Zone 3 fa-- Fy * Juan Jose Santandreu P.E. P:E # 67241 SPNTANpR�c O � N g—E + *T Qr1P: W * :Z— i A`• 9 F LO •�_� i 0 .. �// FESSIONP���\ /��/llllll10\\ 144 fa= 11 in > (Field * Rs) 144 fa= (Perimeter * Rsp) 144 fa= (Corner * Rsc) 144 fa= (Comer * Rsc) 6in> 9 in o/c. ok. (P1) 6 in o/c. ok. (132) 5 in > 5 in q/p.pk. (P3) 4 in >•"::! in ot. D'K. (P31'••-• A �► soda 0 0 00000e 0000 O 0 a O p O O O 000000 OO ow p p 0 000000 0 0 O 00 0 0 0 00000 00 O 0 O 00000 00 0 O O G 000000 0090 0 0 0 O 000000 0 00 O O O O 0 00 O 00004� 0 0 0 00 0 0 0 00 0 0 0 0 6 O O 00 060000 0 000000 0000 a 0 0000 000000 O O 00 00 eoe000 0 0 0 0 0 O 0 0 0 O 0 00 Juan Jose antandreu P.E. ##67241 7066 SW , 4 ST , Miami, Florida 331 SS 'PH.- 305-668-5792 Ema�ik Aplusetl@yahoo.com I February 6, 2022 Village of Miami Shores Building Department 100 0 NE 2nd Avenue Miami Shores FL 33138 Ref: Roof to Wall Connector Inspection 0000 ° . ° ° .... ..... ° Job Site: 9212 NE 10 AVE., ° ° ° . °° ° ° ° ° Miami Shores, Florida ° °°°°°° °° °° °°°°°° .. ° ... ° •°°°°° ° INS ECTION REPORT '°°°°....' ° o ' ° ° ° ° O..O Dear Building Official, °°° ° °°°°°° ° °° .°° ° ° ° 00000 ° ° ° O .° . °° 000000 . We have tried to inspect the roof framing and roof framing anchors at the above ret rencgd property as requit4j ° ° ° by adopted by the Florida Building Commissio by Rule 9B-3.047 F.A.C. ° ° ° ° °' o o °° ° °° ° °.. ° . ° ° ° ° ° °° We have tried to inspect the roof to wall c=at Is at the above referenced property but there is no access to perform the inspection. The inspection will the time that the roofing contractor opens the roof and the report of the findings will be provided at that tiI e. I i The above is in accordance as specified in the BC for Existing Building. This report is based on limited visual review o existing structural components. Please do not hesitate to contact our office if you have any questions. pa4T i Please do not, ' c � if have an uestions.��RQk�rofflceY Y q _ Sincerely, z.= -F :dui vp •W_ '•. F vo . oFESS 10NA��� Juan Jose Santandreu P.E.#67241 0000 0 0 000000 0000 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 000000 00 00 000000 0 • ° ° 000000 000000 0 0 0 00 0000 0 0 0 0 0 00000 00 0 0000 0 0 00000 00 0 000000 ° ° 0 0 ° 006000 0000 00 00 0 0 0 000000 000•000 • •• • • 0 0 0 0 0 00 0 0 0 000000 0 0 0 0 0 0 00 0 00 0 0 0 00 0 Miami Shores Village - BUILDING DEPARTMENT 10050 NE 2 Ave Miami Shores, FL 33138 305-795-2204 www.msvfl.aov 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 fbllowbng items" should be addressed as part of the agreement between the owner ant the contractor. I%q •„ owner's initial in the designated space indicates that the item has been expleinede 1. Aesthetics -Workmanship: the workmanship provisions of SQ,'jiprt R44Q2 a;g• for the purpose of providing that the roof system meets the wind resistance -and wai:eg..0 instruction performance standards. Aesthetics (appearance) are not a cortdeeation wit41 respect to workmanship provisions. Aesthetic issues such as color or architectural '. appearance, that are not part of a zoning code, should be addressed as pa;J f the agreement between the owner and the contractor. '.. 2. J�q t 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. _ 4 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. 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. rPonding 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 I of 2 .0:01. 000e 0 0 000000 0000 0 0 0 • 0 0 0 • 000000 00 0e 0 0 0 000000 0 0 0 00 0 0 0 00000 00 0 0 0 00000 eo • 0 0 s e0e000 0000 0 o • 000000 0 00 0 0 0 0 0 00 0 000000 0 0 0 00 0 0 0 00 0 o • • • • 0 00 eo••so 0 00••00 0000 0 0 0000 •00000 0 0 s• •• s••••• e o 0 • 0 0 • • o o 0 so Miami Shores Village - BUILDING DEPARTMENT 10050 NE 2 Ave Miami Shores, FL 33138 305-795-2204 www.msvfl.gov 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. 4--7cVentilation: Most roof structures should have some ability towentnatu(al •.•::. airflow through the interior of the structure assembly (the building itself "T existing' •• amount of attic ventilation shall not be reduced. It may be beneficial to consider addixiortal venting which can result in extending the service life of the roof. • •' •' ; O)wher/Agent's Signature Date Contractor Signature Date. ....:. For Forms and Applications click here: http://bidg.mia mishoresvillage.com/ W ebtin k/Browse.aspx?id=118o8o&dbid=o&repo=Mta miShoresVillage Rev01142021 Owners goofing consideralion Page 2 0l 2 0000 0 0 000000 0000 0 0 0 0 0 0 0 0 • O 00 0 0 0 0 000000 00 00 600000 • 0 0 0 000000 000000 0 0 0 00 0000 0 0 0 0 0 00000 00 0 0000 0 0 00000 00 0 000000 0 10 O 0 0 000000_ ,\7*00to 00 00 0 0 000000 0 0 0 0 000000 O 00 0 0 0 0 0 O 0 00 0 0 0 000000 0 0 0 ' O 0 0 00 O 00 0 0 0 00 0 To: LQ Miami Shores Village • BUILDING DEPARTMENT 10050 NE 2 Ave Miami Shores, FL 33138 305-795-2204 www.msvn.aov 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. Miami Shores Village Building Department Date: Zg zbZ Z 10050 NE 2nd Ave Miami Shores, FI 33138 Owner's Name: PropertyAddressyy2/Z jvC_ Roofing Permit Number: ..... ... 'uees ftm 7 � �� 33f�1 .. .. ... DeasBuildingOffic' I: , •••••� � •' . i ....: certify that I have improved the roof to tgau • • connections of the referenced property as required by the Manual of Hurricag8 llilitigatjpri: • •• Retrofits for Existing Site -Built Single Family Residential Structures as adopted by the F61dn' Building Commission by Rule 9B-3.047 F.A.C. 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 Z0 day of fit 6P7 20 Z:Z Notary Pub j , ye of Florida at Large Notary Public state of Florida Maria C Ubau m ,, ,mission GG 353698 Seal: For Forms and Applications click here: h"p://bldg. miamishoresvillage.com/W ebLin k/Browse.aspx?id=118080&dbid=0&repo=M is mi5horesVillage R=v01 142021 Affidavit of Compliance with foot to wall Page 1 of I Miami Shores Village - BUILDING DEPARTMENT 10050 NE 2 Ave Miami Shores, FL 33138 305-795-2204 www.msvfl.aov 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: 3 aB a a 10050 NE 2nd Ave Miami Shores, FI 3313 , Re: Owner's Name: .'•:" •" ' Property A s: /.2 N /0141 Is_ eS Roofing Permit Number: : •••' Dear ildpgOfficial• •:•': ' •' I zp�a ea,,' iY�/ certify that I am not required tQ jgj�offt the hoof wall connections of my�bw idling because: . . ❑ The just valuation for the structure for purpose of ad valorem taxation is IQssxhan •• $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) —7 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 abo prope y mentioned. Sworn to and subscribed before this 5526 day of 20 Za-%- ..1 •ty Notary Public swie of Florida C Ubau Notary Public, State of Florida at Large ,_ P My Commission GG 353698 A 3 • 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 5FBC. Then you must provide a building application from a General Contractor for the Roof to Wail connection Hurricane Mitigation. For Forms and Applications click here: http://bidg.miamishoresvillage.com/ WebLi n k/Browse.aspx?id=118080&dbid=0&repo=Mia miShoresVlllage _ Owner affidavit of exemption Poge 1 of I 0 00 O 0 0 00 a 00 0 O 0 a o a 000000 a a 0 00 a 0 a O 0 O O 00 A 000000 O O 0 0 a00000 0 O 00 00 0000 000000 O 0 0 O O :00000 0 00 00000 0 0 0000 ! 00 90006 0 O O O 0 0a ..0. O O 0000 00 Y _ 0 000090 00 00 000000 O 0 9 0 00 0 0 0 0 O O e 0 0 0 0000 000000 o 0 9000 MIAMI ADE MIAMI-DADE COUNTY MM 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.eov/eeonomv 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 Couty} • • • reserve the right to have this product or material tested for quality assurance purposes. T,Ptltis prodm-or material fails to perform in the accepted manner, the manufacturer will incur the expUse of such Testirl'g and the AHJ may immediately revoke, modify, or suspend the use of such product g *�0 rial within their jurisdiction. RER reserves the right to revoke this acceptance, if it is determine:4,l y Miami padp County Product Control Section that this product or material fails to meet the requirem¢n4s of tbk •' applicable building code. This product is approved as described herein, and has been designed to comply with jbg horida 4Jj Ing Code including the High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION: GAF Ruberoid® Modified Bitumen Roof System for Wood Deglts.; 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. 15-1020.01 and consists of pages 1 through 67. The submitted documentation was reviewed by Jorge L. Acebbo. l!" NOA No.: 18-0919.12 Expiration Date: 11/06/23 Approval Date: 11/01/18 Page 1 of 67 0000 0 0 000090 0000 0 O 0 0 0 0 0 0 0 O 00 p O O O 000000 0o 00 000000 O O 0 0 000000 000000 0 O O 00 0000 0 0 O 0 0 00000 00 0 0000 O 0 00000 00 0 000000 0 0 p O 0 000000 0000 00 00 0 0 0 seosoe 0 0 0 0 000000 0 00 0 0 0 0 0 0 0 00 0 0 0 000000 0 0 0 0 0 0 00 0 00 0 p 0 00 O ROOFING SYSTEM APPROVAL Category: Roofing Sub -Category: Modified Bitumen Material: APP/SBS Deck Type: Wood Maximum Design Pressure: -105 psf. TRADE NAMES OF PRODUCTS MANUFACTURED OR LABELED By APPLICANT: TABLE 1 Test Product Product Dimensions Specification Description GAFGLASI Ply 4 39.37" ASTM D2178 Smooth surfaced asphaltic ply sheet (1 meter) Wide reinforced with fiberglass mat. Tri-Ply' Ply 4 Ply Sheet 39.37" ASTM D2178 Smooth surfaced asphaltic ply sheet (l meter) Wide reinforced with fiberglass mate deed o GAFGLASO 39.37" ASTM D2178 Smooth surfaced;svk;kic ply sl el O ' ° °' o " FlexPly�'" 6 (1 meter) Wide O reinforced with f gWs mar , , o , : p 000000 GAFGLASI #75 Base Sheet 39.37" ASTM D4601 Smooth asphaltic G asoeor based/ply sheet :*Go*: (1 meter) Wide reinforced with f taergjass mat; o o 0 o 0 0 0 0 0 Tri-Ply' #75 Base Sheet 39.37" ASTM D4601 Smooth asphaltic. ba.%®r base/ply, §beet , o : o o o (1 meter) Wide reinforced with fiberglassmat.. e o o ° A , C O , , GAFGLAS" #80 UltimaTM Base 39.37" ASTM D4601 Smooth asphaltiq bale or base/plea sheet C ° Sheet (1 meter) Wide reinforced with fiberglass mag.° o ° , • 0 GAFGLAS® Strataven& 39.37" ASTM D4897 O 00 Smooth surfacJaspLltic perforated O 0 : ° ° ° ° e Perforated Venting Base Sheet (1 meter) Wide venting base sheet reinforcedwvitho fiberglass mat. GAFGLASO Stratavent® 39.37" ASTM D4897 Smooth surfaced asphaltic nailable venting Nailable Venting Base Sheet (1 meter) Wide base sheet reinforced with fiberglass mat. Bottom side surfaced with granules. Ruberoid' HW 25 Smooth 39.37" ASTM D6163 Smooth surfaced torch applied SBS base (1 meter) Wide or ply sheet reinforced with a fiberglass mat. Ruberoid"' HW Smooth 39.37" ASTM D6164 Smooth surfaced torch applied SBS base (1 meter) Wide or ply sheet reinforced with a polyester mat. RuberoidO HW Granule 39.37" ASTM D6164 Granule surfaced torch applied SBS cap (l meter) Wide sheet reinforced with a polyester mat. Ruberoid' HW Granule FR 39.37" ASTM D6164 Fire retardant granule surfaced heat - (I meter) Wide welded SBS cap sheet reinforced with a polyester mat. Ruberoid' HW Plus Granule 39.37" ASTM D6164 Granule surfaced torch applied SBS cap (1 meter) Wide sheet reinforced with a polyester mat. Ruberoid' HW Plus Granule 39.37" ASTM, D6164 Fire retardant granule surfaced torch FR (1 meter) Wide applied SBS cap sheet reinforced with a polyester mat. NOA No.: 18-0919.12 Expiration Date: 11/06/23 Apprpval Date: 11/01/18 Page 2 of 67 0000 p 0 000000 0000 O 0 0 e 0 O p O O O 00 p 0 O O 000000 00 00 0e0000 0 O O 0 000000 000000 0 0 0 00 0000 O 0 0 0 0 00000 00 _ 0000 0 0 00000 00 0 6e00e0 0 0 0 0 0 000000 0000 00 00 0 0 p 000soe 0 0 0 0 000000 0 00 0 s 0 0 O 0 0 00 0 0 0 000900 0 0 0 0 0 0 00 0 00 0 0 0 0o 0 Test Product Product Dimensions Specification Description Ruberoid® EnergyCapT" HW 1 meter ASTM D6164 Fire retardant granule surfaced heat - Plus Granule FR (39.37") Wide welded SBS cap sheet reinforced with a polyester mat. Cap sheet is factory coated with TOPCOAT® EnergyCoteT"' Elastomeric Coating. Ruberoid' Torch Smooth 39.37" ASTM D6222 Smooth surfaced torch applied APP base (1 meter) Wide or ply sheet reinforced with a polyester mat. Tri-Ply' APP Smooth 39.37" ASTM D6222 Smooth surfaced torch applied APP cap, Membrane (I meter) Wide base or ply sheet reinforced with a polyester mat. Ruberoid' Torch Granule 39.37" ASTM D6222 Granule surfaced torch applied APP cap (1 meter) Wide sheet reinforced with a polyester mat. Tri-Ply"o APP Granule Cap 39.37" ASTM D6222 Granule surfaced torch applied APP cap °°°° Sheet (I meter) Wide sheet reinforced vgith gpolyester mad Ruberoid' Torch Plus Granule 39.37" ASTM D6222 °°°° °°°°°° ° ° ° ° Fire retardant granule surfaced ioucho ° ° FR (l meter) Wide °°°°°° applied APP cap �°ggt°re inforced with a ° ° Ruberoid EnergyCapT' 39.37" ASTM D6222 polyester mat. ° ° ° ° ° ° ° ° ° ° go ° ° ° Fire retardant grarade surfaced tdwJf ° ° ° ° ° Torch Plus Granule FR (1 meter) Wide applied APP cap sheep oeinforo ed -with a ° ° polyester mat. Cap sfitet is facterrcoated° Y ° ° ° ° ° with TOPCOATo rr§!%AyCoteT' ° ° ° Q ° ° ° ° ° ° ° ° • ° Elastomeric Coating. ° ° ° Ruberoid® EnergyCap' 39.37" ASTM D6222 Fire retardant grime sgirface* for oh ° ° ° ° o Torch Granule FR (1 meter) Wide o applied APP cap sheet reinfotetJgVIth a polyester mat. Cap sheet is factory coated with TOPCOAT' EnergyCote' Elastomeric Coating. Ruberoid' 20 Smooth 39.37" ASTM D6163 SBS polymer -modified asphalt base or ply (I meter) Wide sheet reinforced with a fiberglass mat. Ruberoid' 30 Granule 39.37" ASTM. D6163 Granule surfaced mop applied SBS cap (1 meter) Wide sheet reinforced with a fiberglass mat. Ruberoid 30 Granule FR 39.37" ASTM D6163 Fire retardant granule surfaced mop (l meter) Wide applied SBS cap sheet reinforced with fiberglass mat. Ruberoid® 30 Plus Granule FR 39.37" ASTM D6163 Fire retardant granule surfaced mop (1 meter) Wide applied SBS cap sheet reinforced with fiberglass mat. Ruberoid' Mop Granule 39.37" ASTM D6164 Granule surfaced mop applied SBS cap (1 meter) Wide sheet reinforced with a polyester mat. Tri-Ply' SBS Granule Cap 39.37" ASTM D6164 Granule surfaced mop applied SBS cap Sheet (I meter) Wide sheet reinforced with a polyester mat. Intec Flex PRF 39.37" ASTM D6164 Granule surfaced mop applied SBS cap (1 meter) Wide sheet reinforced with a polyester mat. Ruberoid' Mop Smooth 39.37" ASTM D6164 Smooth surfaced mop applied SBS base (1 meter) Wide sheet reinforced with a polyester mat. NOA No.: 18-0919.12 Expiration Date: 11/06/23 Approval Date: 11/01/18 Page 3 of 67 0 00 0 0 0 00 0 00 0 0 0 0 o e 000000 0 0 0 00 0 0 0 0 0 0 0 00 0 0060000 0 0 0 000000 0 0 0 00 00 0000 000000 0 0 0 0 0 000000 .0 00 00000 0 0 0000 0 00 00000 0 0 0 0 0 0000 00 0 0 0 000060 000000 0 0 0 0 000000 00 00 000000 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0000 000000 0 0 0000 Product Ruberoid' Mop Smooth 1.5 Ruberoid' Mop Plus Smooth Ruberoid' Mop Plus Granule Ruberoid' Mop Plus Granule FR Ruberoid' EnergyCap'" Mop Plus Granule FR Ruberoid' Mop Granule FR Ruberoid' EnergyCap'" 30 Granule FR Dimensions 39.37" (1 meter) Wide 39.37" (1 meter) Wide 39.37" (1 meter) Wide 39.37" (1 meter) Wide 39.37" (1 meter) Wide 39.37" (1 meter) Wide 39.37" (1 meter) Wide GAFGLAS' Mineral -Surfaced 39.37" Cap Sheet (1 meter) Wide Tri-Ply8 BUR Granule Cap Sheet GAFGLAS®EnergyCap'' Mineral -Surfaced Cap Sheet TOPCOAT' Membrane United Coatings'" Roof Mate TCM Coating Test Specification ASTM D6164 ASTM D6164 ASTM D6164 ASTM D6164 ASTM D6164 ASTM D6164 ASTM D6163 ASTM D3909 39.37" ASTM D3909 (1 meter) wide Product Description Smooth surfaced mop applied SBS base sheet reinforced with a polyester mat. Smooth surfaced mop applied SBS base or ply sheet reinforced with a polyester mat. Granule surfaced mop applied SBS cap sheet reinforced with a polyester mat. Fire retardant granule surfaced mop applied SBS cap sheet reinforced with a polyester mat. Fire retardant granule surfaced mop applied SBS cap sheet reinforced with a polyester mat. Cap sheet is factory coated with TOPCOAT' EnergyCote' Elastomeric Coating. 000 0 Fire retardant granule §urfacec 0 ° ° ° ° ° ° ° applied SBS cap gbed reinforced with a 0 0 polyester mat. o 0 o e e o ° 0 0° 0 0 000°o° ° o Fire retardant grannie; surfaced mmp 0 0 00000 applied SBS cap sMedt0rpinforpq vAlh a ° s0 fiberglass mat. Cabos4h°eet is fActotj coated' ° 0 ° ° 0 0 with TOPCOATO WeQrjyCot&0tM 0 ° ° 0 ° ° ° 0 ° eo 00 0000 000000 Elastomeric Coaldgg„ ° 0 0 0 0 Granule surfacecCasp`haltic cap sheet 000eoe reinforced with fobergl'ass mad. ° 0 o ° o o 00°000 0 0 Granule surfaced asphaltic cao sfieg� reinforced with a fiberglass mat. 39.37" ASTM D3909 Granule surfaced asphaltic cap sheet (1 meter) Wide reinforced with fiberglass mat. Cap sheet is factory coated with TOPCOAT' EnergyCote'" Elastomeric Coating. 1, 5 or 55 gallons ASTM D6083 Water based elastomeric coating. 1, 5 or 55 ASTM D6083 Water -based elastomeric coating Gallons TOPCOATO 5 or 55 gallons ASTM D6083 Surface Seal SB United Coatings'" Surface Seal 5 or 55 Gallons ASTM D6083 SB Roof Coating TOPCOAT' MB Plus United Coatings"' Roof Mate MB Plus Coating 5 or 55 gallons 5 or 55 Gallons Proprietary Proprietary Solvent based thermoplastic rubber sealant designed to protect and restore aged roof surfaces and to increase roof reflectivity. Solvent -based thermoplastic rubber sealant designed to protect and restore aged roof surfaces and to increase roof reflectivity. Water based, low VOC primer used to block asphalt bleed -through. Water based, low VOC primer designed to block asphalt bleed -through. NOA No.: 18-0919.12 Mum MME eouNW Expiration Date: 11 /06/23 Approval Date: 11/01/18 Page 4 of 67 t 0000- 0 0. 000000 0000 0 0 0 O O • 0 0 •' • 00. 0 0 O 0 000000 00 00 000000 0 O 0 • •0.000 000000 O 0 • 0• 0000 0 0 • 0 0 00000 00 • 0.00 0 O 00000 00 • 0.00.0 0 O 0 0 0 000000 0000 00 •0 0 0 p 000000 0 0 0 0 000000 0 00 • • O O O O 0 00 0 • • 000000 0 O 0 0 0 O 00 O 00 0 0- O 00 • Test Product Product Dimensions Specification Description FireOue' Fire Barrier er Coating 5 or 55 gallons Proprietary Low VOC, water -based fire barrier coating. Flex Seaf' 1, 5 gallons TAS 139 Solvent -based elastomeric sealant. or 1 qt. tube VersaShieldO Fire -Resistant 12" x 100' rolls ASTM D226 Non -asphaltic fiberglass -based Roof Deck Protection underlayment and /or fire barrier. VersaShield® Solo"" Fire- 42" roll wide, ASTM D146, Non -asphaltic, fire resistant fiberglass Resistant Slip Sheet 100 ft. D828, D4869, underlayment D6757 Matrix'!' 102 SBS Membrane 3, 5 or 55 gallons ASTM D3019 Fiber reinforced rubberized cold -applied Adhesive adhesive for modified bitumen roof systems. °06° O 0 ° O 0000 000000 O 0 O ° APPROVED INSULATIONS: 0 0 ° O 0 O O O ° ° ° ° ° O 00 00 ° ° 0 ° o ° O Table 2 000000 O Product Name °°°°°. Product Description 0 0 inufac�u°rer° ° ° `Vyjth Purrent fQbA) ° ° ° ° ° EnergyGuard7 Polyiso Insulation o 0 00 00°00 Polyisocyanurate foam insulation 00 ° 00 ° GAF' 0 0 ° ° ° °°°°°° EnergyGuard' Tapered Polyiso Insulation °°°°°° ° ° Polyisocyanurate foam insulation 0 ° : GAF° ° ° e 0 0 ° 0 ° O 0 O EnergyGuard" RA Polyiso Insulation Polyisocyanurate foam insulation ° ° O GAl° ° ° ° °°°°°° °° ° °° ° EnergyGuard�''' RH Polyiso Insulation Polyisocyanurate foam insulation GAIb ° 0 0 ° EnergyGuardT' RH Tapered Polyiso Polyisocyanurate foam insulation GAF Insulation EnergyGuard'"' RN Polyiso Insulation Polyisocyanurate foam insulation GAF EnergyGuard7 Perlite Recover Board Perlite recover board GAF EnergyGuard'" Perlite Roof Insulation Perlite insulation board GAF EnergyGuarC RA Composite Polyiso Polyisocyanurate foam insulation GAF Insulation with high density fiberboard or permalite Structodek" High Density Fiberboard Roof High density fiberboard Blue Ridge Fiberboard, Inc. Insulation SECUROCK" Gypsum -Fiber Roof Board Gypsum board United States Gypsum Corp. SECUROCK" Glass -Mat Roof Board Gypsum board United States Gypsum Corp. DensDeck' Roof Board Gypsum board Georgia-Pacific DensDeck' Prime Roof Board Gypsum board Georgia-Pacific NOA No.: 18-0919.12 Expiration Date: 11/06/23 Approval Date: 11/01/18 Page 5 of 67 ovo0 0 0 000000 0000 0 0 0 0 0 0 0 0 000000 00 0o 0 0 0 000000 0 0 0 00 O 4 r 00000 .00 0 e 0 00000 00 0 0 0 0 000000 OOoo 0 0 0 0 000000 0 00 0 0 0 0 0 00 0 000000 0 0 0 OO 0 0 0 00 0 0 0 0 0 0 O 00 006000 0 000000 0000 0 0 •000 806060 0 0 00 00 660000 0 0 0 0 0 0 0 0 0 0 0 00 APPROVED FASTENERS: TABLE 3 Fastener Product Product Manufacturer Number Name Description Dimensions (With Current NOA) 1. Drill-Tec' #12 Fastener Phillips head, modified #12 x 8" GAF buttress thread, pinch Max. Length point, carbon steel fastener #3 Phillips for use in steel or wood head. decks. With CR-10 coating. Available with a pinch point or drill point. 2. Drill-TecTM #14 Fastener Truss head, self -drilling, #14 x 16" GAF pinch point, high thread Max. Length fastener for use in steel, #3 Phillips wood or concrete decks. head. 3. Drill-TecTM XHD Fastener Truss head, self -drilling, #15 x 16" GAS° ° ° °. pinch point, high thread Max. Length O 0 °eaa 00.0 o ° ° 000000 0 fastener for use in wood or #3 Phillips O O 0 : O ° ° ° ° ° 0: ° steel decks. Carbon steel head. O 0 ° e ° ° 0 0 ° extra heavy duty fastener ° 4000 Do 0 o000°a ° 0 used in steel decks. 0 ° ° ° ° ° ° ° ° a a 0 0 ° 4. TM �, Drill-Tec 3 Steel Plate Round Galvalume® steel 3" Round 000000 ° s GAS 0 ° ° 0 11 ° ° ° ° ° ° stress plate with O O O O O O O O 06000 0 0 reinforcing ribs and le000y 0 0 O O! ° ° recessed for use with Drill- a ° 0 0 0 0 1 0 TecTM fasteners. 0 0 d ° o O 0 O 0 0°°°° e 5. Drill-TecTM 3" Standard Galvalume® coated steel 3" Round GAF 0 O 0 0 Steel Plate stress plate for use with approved Drill-TecTM fasteners. 6. Drill-TecTM ASAP 3S Drill-TecT' #12 fastener #12 x 8" GAF with Drill-TecTM 3" Max. Length Standard Steel Plate. #3 Phillips head with 3" Round plate 7. Drill-Tec'M AccuTrac® Flat A2-SS aluminized steel 3" square; GAF Plate plate for use with Drill- .017" thick TecTM fasteners. 8. Drill-TecT' AccuTrace Galvalume® steel plate 3" square; GAF Recessed Plate with recess for use with .017" thick. Drill-TecTM fasteners. 9. Drill-TecTM 3 in. Ribbed Round Galvalume) plated 3" Round GAF Galvalume Plate (Flat) steel stress plate with reinforcing ribs for use with Drill-TecTM fasteners. NOA No.: 18-0919.12 MIAMI•DAD, COUNTY Expiration Date: 11/06/23 Approval Date: 11/01/18 Page 6 of 67 eaoe e e 000900 OOb0 a O O 0 O O e 0 0 O 00 e 600060 0 6 9 00 00 000000 O 0 0 0 006000 000060 e Oe 6006 0 0 n 0 6 6 0 00066 00 O 0066 ° D 90000 00 0 60000O 6 0 0 O O 009e40 0000 00 00 ° 0 9 b690ee 0 0 0 0 060096 e9 0 0 0 0 0 0 9 00 0 0 a 000000 b O 0 O 00 0 0 0 00 O O 0 00 O EVIDENCE SUBMITTED: Test Agency Test Identifier Description Date FM Approvals 3001276 FMRC 4470 01/28/99 3010215 FMRC 4470 03/01/01 3029832 FMRC 4470 05/ 11 /07 3036980 FMRC 4470 08/14/09 3034312 FMRC 4470 04/09/09 3040738 FMRC 4470 05/18/12 3042887 FMRC 4470 l 1/14/l 1 3046081 FMRC 4470 02/ 13/ 13 3043633 FMRC 4470 01/20/12 1 B9A8.AM FMRC 4470 09/04/97 3139QLAM FMRC 4470 01/08/08 3D4Q2.AM FMRC 4470 04/30/97 OD 1 A8.AM FMRC 4470 04/0J 6& 797-03221-267 FMRC 4470 0 ° ° 0 09%1 w� ° 797-10228-267 FMRC 4470 000 01/J5/150 797-04694-267 FMRC 4470 ° 0 0 o° 0 06/IT09 O 797-03825-267 FMRC 4470 000000 07/ 14/68 RR203450 FMRC 4470 0000 0 00000 0000 00 0 12f* j�° FM Letter FMRC 4470 000000 04411 /13 FM Letter FMRC 4470 °0000 000000 09704 5" UL LLC R1306 UL 790 000000 0 0 0 08J%1/1� IRT-ARCON Inc. 02-005 TAS 114-J 0 4 ° ° 0 a O O 07/ 19M*4 02-014 TAS 114-J 0 04108/00P Trinity I ERD C8500SC.11.07 ASTM D6862 11/30/07 G30250.02.10-2 ASTM D6222 11 / 11 / 10 G30250.02.10-3-R2 ASTM D3909 06/03/15 G31360.03.10 ASTM D6164 03/31/10 G32520.06.11 ASTM D 1876 06/28/ 11 G33470.01.11 ASTM D6164 01/13/11 G34140.04.11-2 ASTM D6163 04/25/ 11 G34140.04.11-4-R2 ASTM D4601 6/4/2015 G34140.04.11-5-R3 ASTM D4897 6/4/2015 G36780.07.11-R l TAS i 144 07/ 18/ 11 G40620.07.12-2 ASTM D6222 07/ 17/ 12 G40630.01.14-1 ASTM D6163 01 /06/ 14 G40630.01.14-2A ASTM D5147 01 /07/ 14 G40630.01.14-2A-1-R 1 ASTM D6164 04/ 10/ 14 G4063 0.01.14-2B-R 1 ASTM D6164 01 / 16/ 15 G40630.01.14-2C ASTM D6164 01/07/14 G40630.03.14 ASTM D5147 03/06/ 14 G43190.03.14-1 ASTM D5147 03/06/14 G43190.03.14-2 ASTM D5147 03/06/ 14 G43190.05.14-R1 ASTM D5147 05/20/14 G43610.01.14 ASTM D5147 01/22/14 NOA No.: 18-0919.12 MWMMDADECOUNW Expiration Date: 11/06/23 Approval Date: 11/01/18 Page 7 of 67 °0000. 0 ° 000600 a a 000000 O 0 00000 O p 0000p 000000 0 a a00000 0 0 000000 0 0 0000 0 0 00e000 6000 0 0 a 0 O 0 0 O 0 O Oo 0 000060 O a a 00 eo 0000000 e e o 000000 GOOOOo 0 0 06 000a 0 0 0 a 0 0 00060 00 a 6000 O 6 00006 00 0 000000 Y O O 0 0 000060 0000 00 00 O O 0 000000 0 O O O 000000 0• oe O O 0 0 O O 6 00 O O O O O 0 006000 e ee O Oo 0 a e e 0 0e e EVIDENCE SUBMITTED: (CONTINUED) Test Agency Test Identifier Description Date Trinity I ERD G43190.11.13-1 ASTM D6222 11 / 15/ 13 G46160.02.15 ASTM D6163 02/ 12/ 15 G46160.02.15-2D-1 ASTM D6163 02/09/16 G46160.03.15 ASTM D6163 03/11/15 G46160.09.14-2A ASTM D5147 09/09/14 G46160.09.14-3A ASTM D6164 09/09/14 G46160.09.14-3B ASTM D6164 09/09/14 G46160.09.14-3C ASTM D5147 09/09/14 G46160.12.14-3 E ASTM D6164 12/29/ 14 G6850.08.08 ASTM D6163 08/01 /08 G6850.08.08-R 1 ASTM D6164 04/ 14/ 11 G6850.10.08 ASTM D6222 10/06/08 G6850.11.08 ASTM D6222 0211449 SC6870.08.14-R1 ASTM D3909 : .00 00 0 097OW44 PRI Construction Materials GAF-122-02-01 0 TAS 139 0 0 0 0 0 0 0 0 057Q'06o Technologies, LLC GAF-245-02-01 ASTM D6083 0 0 0 0 0 0 0 06/10/40 GAF-276-02-0 I Rev ASTM E2178 00000 0 019i74/110 ASTM D6083 0 0 0 0 0 00 GAF-306-02-01 ASTM E96 0 0 0 0 0 07k ;%1 l0 GAF-314-02-01 ASTM D2178 0 0 0 0 00 0 08/23/d 1 GAF-315-02-01 ASTM D2178 : 0 0 08623/1J GAF-369-02-01 ASTM C 1289 0 0 0 0 10�221-le GAF-434-02-03 TAS 114-J 00 0 0990§/ 1a30 GAF-434-02-04 TAS 114-J 09706P1*3 GAF-464-02-01 ASTM C1289 02/06/14 GAF-498-02-01 ASTM D6083 09/16/16 GAF-499-02-01 ASTM D6083 03/ 12/ 14 GAF-500-02-01 ASTM D6083 03/ 12/ 14 GAF-559-02-01 TAS 117(B) 09/30/14 GAF-559-02-04 ASTM D1876 10/01/14 GAF-559-02-05 ASTM D 1876 10/15/14 GAF-559-02-06 TAS 114(H) 10/02/ 14 GAF-559-02-07 ASTM D903 10/02/ 14 GAF-559-02-08 ASTM D903 10/02/14 GAF-559-02-09 ASTM D903 10/02/14 GAF-5 59-02-11 TAS 114-J 10/ 14/ 14 GAF-559-02-12 TAS 114-J 10/14/14 GAF-559-02-13 TAS 114-J 10/15/14 GAF-559-02-14 TAS 114-J 10/15/14 GAF-559-02-15 TAS 1144 10/15/14 GAF-559-02-16 TAS l l4-J 10/15/14 GAF-559-02-18 TAS 114-J 10/15/14 GAF-559-02-19 TAS 114-J 04/16/15 Dynatech Engineering Corporation #4482.02.95-1 TAS 114-C 09/01/95 NOA No.: 18-0919.12 Muat�MXW couMY Expiration Date: 11/06/23 Approval Date: 11/01/18 Page 8 of 67 000000 0 0 0 000000 0 0 0 0 0 0 0 0 0 0 00000 oa:0 0o 0 000000 0 0 0 0 0000 0 0 000000 0 0 0000 O O 000000 0000 O 0 p O 0 0 O O O 0 00 0 0 O O 000000 00, 00 000000 0 0 O 0 000000 000000 O 0 0 00 0000 O 0 0 O 0 00000 00 O 0000 O 0 00000 00 O 000000 0 0 0 O O 000000 0000 00 00 O O O 000000 0 O O O 0000 0 0 •• O O 0 O O O 0 00 0 O 0 000000 O O O O O O 00 O 00 0 O O 00 0 Membrane Type: APP/SBS Heat Weld Deck Type 1: Wood, Non -insulated Deck Description: Min. 19/32" or greater plywood or wood plank secured 6 in. o.c. with 8d ring shank nails to supports spaced 24 in. o.c. max. System Type E(2): Anchor sheet is mechanically attached to roof deck. (Non -insulated systems) All General and System Limitations shall apply. Fire Barrier: FireOut'' Fire Barrier Coating, VersaShield' Fire -Resistant Roof Deck (optional) Protection, VersaShield' Solo'' Fire -Resistant Slip Sheet, DensDeck' Roof Board, SECUROCK® Gypsum -Fiber Roof Board or SECUROCK0 Glass -Mat Roof Board. Base sheet: GAFGLAS' #80 Ultima' Base Sheet, GAFGLAS® Stratavent' Nailable Venting Base Sheet, Ruberoid' Mop Smooth, Ruberoid' Mop Smooth 1.5, Ruberoid' Mop Plus Smooth, Ruberoid' 20 Smooth, RuberoidO HW Smooth or RuberoidO HW 25 Smooth mechanically fastened to deck as described below; Fastening GAFGLAS' Ply 4, Tri-Ply® Ply 4 Ply Sheet, GAFGLAS F1exPlay'' 6, ° ° ° ° ° 0 ° ° Option #1: GAFGLAS' #75 Base Sheet, Tri-Ply' #75 Base Sheet or any°ofabove base 0 sheets attached to deck with approved annular ring shank n9jL%gg4 tin cws at°at fastener spacing of 9" o.c. at the lap staggered and in two row IK' o.c. in the field. ° 0000 °° 0 ° ° ° ° Not for use with DensDeck or SECUROCK Fire Barrier 0000 0 00 (Maximum Design Pressure —45 psf. See General LimitafiSA IM ° 00 ° ° ° ° ° 00 ° 0 Fastening GAFGLAS` Ply 4, Tri-Ply' Ply 4 Ply Sheet, GAFGLAS F1;xP100 0 6, ° Option #2: GAFGLAS ' #75 Base Sheet, Tri-Ply' 475 Base Sheet or arty of above bpg ° ° sheets attached to deck with Drill-Tec'' # 12 Fastener or DrAl-Tec0 # 14 l'asfe*ner and Drill-Tec'' 3" Steel Plate, Drill-Tec'' AccuTrac® Flat Plate or DrilIXec'"° ° O 0 0 AccuTracl Recessed Plate installed 12" o.c. in 3 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 12.5" o.c. in the field of the sheet. (Maximum Design Pressure —45 psf. See General Limitation #9) Fastening GAFGLAS' F1exPly'' 6, GAFGLAS' #75 Base Sheet, Tri-Ply' #75 Base Sheet Option #3: or any of above base sheets attached to deck with approved annular ring shank • nails and tin caps at a fastener spacing of 9" o.c. at the 4" lap staggered and in .�,QJIP two rows 9" o.c. in the field. Not for use with DensDeck or SECUROCK Fire Barrier d' (Maximum Design Pressure —52.5 psf. See General Limitation #7) Fastening GAFGLAS' #75 Base Sheet, Tri-Ply' #75 Base Sheet or any of above base Option #4: sheets attached to deck with Drill-Tec'' # 12 Fastener or Drill-Tec'' # 14 Fastener and Drill-Tec'"' 3" Steel Plate, Drill-Tec'' AccuTrac® Flat Plate or Drill-Tec' AccuTracl Recessed Plate installed 12" o.c. in 4 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 9" o.c. in the field of the sheet. (Maximum Design Pressure —45 psf. See General Limitation #9) NOA No.: 18-0919.12 MiAMI-DADS couN-nr Expiration Date: 11 /06/23 Approval Date: 11/01/18 Page 53 of 67 ° 0 0 0 ° 0 ° ° ° °°°°°° 0 0 ° 00000 ° 0 00000 0 0 °°°°° 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ° ° 0 0 0 0 O 0 0000 0 0_ 000000 0000 0 0 0 0 0 0 0 0 0 0 00 O 0 0 0 000000 00 00 000000 0 0 0 0 000000 009000 0 O 0 00 0000 0 0 0 O 0 00000 00 0 0000 0 0 00000 00 0 000000 O 0 0 0 O 000000 0000 00 00 0 0 0 000000 0 0 0 0 000000 O 00 0 O 0 0 0 0 0 00 0 0 0 000000 0 0 0 0 O 0 00 O 00 O 0, 0 00 0 Fastening GAFGLAS" #80 UltimaT" Base Sheet, Ruberoid' 20 Smooth, Ruberoid Mop Option #5: Smooth base sheet attached to deck approved annular ring shank nails and 3" inverted Drill-TecT" 3" Steel Plate at a fastener spacing of 9" o.c. at the 4" lap staggered in two rows 9" in the field. Not for use with DensDeck or SECUROCK Fire Barrier (Maximum Design Pressure —60 psf. See General Limitation #7) Fastening GAFGLASI #75 Base Sheet, Tri-Ply' #75 Base Sheet or any of above base Option #6: sheets attached to deck with Drill-Tec"' # 12 Fastener, Drill-Tec'" # 14 Fastener or Drill-Tec' XHD Fastener and Drill-TecT"' 3" Steel Plate, Drill-TecT"' AccuTracl Flat Plate or Drill-TecT" AccuTrac' Recessed Plate installed 8" o.c. in 4 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 9" o.c. in the field of the sheet. (Maximum Design Pressure —45 psf. See General Limitation #9) Ply Sheet: (Optional except over Ruberoid' Mop Smooth, Ruberoid' Mop Smooth 1.5, Ruberoid' Mop Plus Smooth, Ruberoid' 20 Smooth, Ruberoid® HW Smooth or Ruberoid' HW 25 Smooth) One or more plies GAFGLAS® Ply 4, Tri-Pl)�� °Ply 4, or GAFGLASI F1exPly'. 6 sheet adhered in a full mopping Of approved asVWt applied within the EVT range and at a rate of 20-40 lbs./sq. or Y kuberoid%Tosc9 Smooth torch applied according to manufacturer's applicatigq jgs°tjuctions ° ° 00 Membrane: One ply of RuberoidO Torch Smooth, Tri-Ply® APP Smooth Merkrane, p o ° 0 O O O Ruberoid' Torch Granule, Tri-Ply' APP Granule Cap Sheet, "Rbberoid° 011 EnergyCap'" Torch Granule FR, Ruberoid® EnergyCapT"' To°rcfi Mgs GramuV FR, or Ruberoid' Torch Plus Granule FR torch applied accordingbtpomgnufactur er?s application instructions. ° ° O O 00 O Or 0 0 O 0 00 0 One or more plies of Ruberoid' HW Plus Granule, Ruberoid` H W°P1uS 6ranole FR, Ruberoid' HW Granule FR, Ruberoid® EnergyC'ap"' HW Plus Granvile FR, Ruberoid HW Granule, Ruberoid' HW Smooth and Ruberoid® HW 25 Smooth applied according to manufacturer's application instructions. Surfacing: Optional on granular surfaced membranes; required for smooth membranes. Chosen components must be applied according to manufacturer's application instructions. All coatings must be listed within a current NOA. 1. Gravel or slag applied at 4001bs./sq. and 3001bs./sq. respectively in a flood coat of Approved asphalt at 601bs./sq. 2. GAFGLAS® Mineral -Surfaced Cap Sheet, Tri-Ply' BUR Granule Cap Sheet or GAFGLAS" EnergyCapT" Mineral -Surfaced Cap Sheet adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbs./sq. 3. TOPCOAT® Surface Seal SB or United Coatings'" Surface Seal SB Roof Coating applied in one or more coats at a minimum rate of 1.0 gal./sq. per coat. OR TOPCOAT® MB Plus or United Coatings'' Roof Mate MB Plus Coating applied at a minimum rate of 1.0 gal./sq.(to be used as a primer) followed by TOPCOAT' Membrane or United Coatings'' Roof Mate TCM Coating applied in one or more coats at a minimum rate of 1.0 gal./sq. per coat. 4. Fiber Aluminum Roof Coating. Maximum Design Pressure: See Fastening Options NOA No.: 18-0919.12 MlAMPDAD; COUNTY Expiration Date: 11/06/23 Approval Date: 11/01/18 Page 54 of 67 00°Op0 O 0 0 000600 0 0 °p00a 0 O 00000 O O O ° • • O p 0 0 a 0 O 0 p 0 0 0 O O O O O 0 00 0 0 0 O O 0 00 - - ----- -- - 0 0 0 - 00 0 00 0 0 0 0 0 0 000000 O 0 0 00 0 0 0 0 0 O O OO 0 000000 0 o 0 0 00000• 0 0 0 00 00 0000 000000 0, O O O 0 000000 O 00 00000 O 0 0000 O 00 00000 O 0 0 0 0 0000 00 0 0 O 000000 000000 O O O O 000000 00 00 000000 O 0 0 O 00 O 0 O O O 0 O 0 0 0 0000 000000 0 0 000• WOOD DECK SYSTEM LIMITATIONS: l A slip sheet is required with GAFGLAS' Ply 4 and GAFGLAS' FlexPly" 6 when used as a mechanically fastened base or anchor sheet. 2. Minimum V4" DensDeck® Roof Board or %2" Type X gypsum board is acceptable to be installed directly over the wood deck. GENERAL LIMITATIONS: 1. Fire classification is not part of this acceptance; refer to a current Approved Roofing Materials Directory for fire ratings of this product. 2. Insulation may be installed in multiple layers. The first layer shall be attached in compliance with Product Control Approval guidelines. All other layers shall be adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbs./sq., or mechanically attached using the fastening pattern of the top layer 3. All standard panel sizes are acceptable for mechanical attachment. When applied in approved asphalt, panel size shall be 4' x 4' maximum. 4. An overlay and/or recovery board insulation panel is required on all applications over closed cell 0000 foam insulations when the base sheet is fully mopped. if no recovery board is %sed the base'sJVgt 0 shall be applied using spot mopping with approved asphalt, 12" diameter circles# 24" 2).c.; or strip, mopped 8" ribbons in three rows, one at each side lap and one down the centeraofothedsheet alb@%OW*;g a continuous area of ventilation. Encircling of the strips is not acceptable. A Wab;euk shall be placed every 12' in each ribbon to allow cross ventilation. Asphalt application'011diiftr systdtg shall be at a minimum rate of 12 lbs./sq. Note: Spot attached systems shall be limltecf to a maximum 0000eo design pressure of -45 psf. 0 0 a 00 0 0 00 00 0000 5. Fastener spacing for insulation attachment is based on a Minimum CharacteristiG J"ge (F') value of 275 lbf., as tested in compliance with Testing Application Standard TAS 105. of the Lstenorovaluoe, as field-tested, are below 275 lbf. insulation attachment shall not be acceptable, 000 0 6. Fastener spacing for mechanical attachment of anchor/base sheet or membrane dtfachtnent i$'qast~d on a minimum fastener resistance value in conjunction with the maximum design value listed within a specific system. Should the fastener resistance be less than that required, as determined by the Building Official, a revised fastener spacing, prepared, signed and sealed by a Florida Registered Engineer, Architect, or Registered Roof Consultant may be submitted. Said revised fastener spacing shall utilize the withdrawal resistance value taken from Testing Application Standards TAS 105 and calculations in compliance with Roofing Application Standard RAS 117. 7. Perimeter and corner areas shall comply with the enhanced uplift pressure requirements of these areas. Fastener densities shall be increased for both insulation and base sheet as calculated in compliance with Roofing Application Standard RAS 117. Calculations prepared, signed and sealed by a Florida registered Professional Engineer, Registered Architect, or Registered Roof Consultant (When this limitation is specifically referred within this NOA, General Limitation #9 will not be applicable.) 8. All attachment and sizing of perimeter nailers, metal profile, and/or flashing termination designs shall conform to Roofing Application Standard RAS 111 and applicable wind load requirements. 9. The maximum designed pressure limitation listed shall be applicable to all roof pressure zones (i.e. field, perimeters, and corners). Neither rational analysis, nor extrapolation shall be permitted for enhanced fastening at enhanced pressure zones (i.e. perimeters, extended corners and corners). (When this limitation is specifically referred within this NOA, General Limitation #7 will not be applicable.) 10. 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. END OF THIS ACCEPTANCE NOA No.: 18-0919.12 Expiration Date: 11/06/23 Approval Date: 11/01/18 060606 0 a 0 000000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 04000 000000 0 0 a 0 0 0 0 0 e 0 0 000000 0 a Page 67 of 67 0000 O O oeeeoa eeeo • s u o e o 0 o a o 00 0 0 o a 000000 00 Ae 600060 O 0 0 0 e6e66e 000e00 0 0 ♦ eo 000e e ♦ e 0 e 00e00 ee 0 0400 0 0 00000 AO O 060000 O O O 0 000000 0000~ 00 00 O 0 e seAOOA 0 ? 4 0 000000 ♦ 0e A 9 O O 0 O O 00 O O 0 000000 O O e O O 0 00 O 00 0 O O OA 0 a ... v.ay.iw " =AMMAN% V'aw� Pans 39 ot116 i oe (a Ift _ k — P fte or der &ss or po Iwcvw ate or ur�hsne-or ooer�posibe. eat Shaft --- Ow or snore pft Type G2 *GAFGLASO #75 8sse Sh et'" or IIIA4" 075 Boos SW or S *00 Uftmm 8a®e show or wGAFGLAft WOMPOW Holable V ease Shoo or ICAFGLA% SboovedePerlbrebed Vendrtp 8a®e Sheet" or Type 63 llneraf Suorlhced Qp Shoat" or OTd-MM SUR G antde Cap SheW, med- anIcdty �esbertad or Rft adhere d wRh ha roo�AErp matt. . (Op�owM�= --- One or more pies Type 61 My 4" or "rrl4" W 4 or flu My 6" or "Ord-" uhsar- %Dfte Ply 60, MY adhemd vrith hot rooRnp WIN* ' Melee --! ©one ply `RU88tQ®® Torrh SOMW or nM-AM APP Sao6 tW, tw d appM d or I tEEPANM Mop SnnoW or *RUSEROMO Mop Srrtoot t 1.5" or ® No Pke 5mootfi'o, fully adher'ad with hot io1g M —ORIMEPJDMO Mop Pius Grannie FR' or InjeEPAXM RwWC oVM. Mop Plus 6woi6 Fly', My aged whh hot r+aoArtp 0 0 0 mm a 0 0 55. 0ee1Q IBC m o 000m00 00 mp0 O 000000 0 ow dowool 'I One or more layers �ar��2Wo n.6itk Go 1 Ponift, Gypsum LLG "Dens Roon)owd* or m mV�m1�i� CdoikPffive m Rootboar�d' or" o® Dtt'aGeaud'"' RadbOar�!" or i�4,-�; U** tamed Susses GvpRm Cb. �SE�c1R+o 3CO R*& Boo CIVpe FRX-9) or sWWAW R W BowC (Type SG MkX)■ o m o 0 0 0 a Co-r�bo-1}: --� t�otybocyouni to or woad i or ss leer, any y FMerted or AMy adMered 0 m 00 9� Sboo — One or plies Type G2 ''GAFGLASS #75 Base Sheep' or "TM" *75 Ba9e Sheer or #80 UW=vm Base She" or * Nadoble VenUng or OGAFGLASO Slritswror�b® P�srtioraeed Base SheWo, R-edtior llray N* I ooro Ply Est: — One or move p s'RUBEROIDS 20 &noW or'R�iBEROiDS Mop &noW or "RUBEVAG" I" Snxw tit 1.50 or Mop Pars Smooth' Pt* adhwW of hot onMoawbot. _ Nonft — �RUS D® tfW Pius Grantole FR or "RUDEROMO HW Grarade FR' or ftM3EROMS &wgyC. VM MW Plus GranuM FFC or INJOEPANM HW PILLS GraraW or'R- a DS HW Chub'`, to d applktd. 56. DeCiQ C 1 RUCEDGM 1/2 Ba� 8ieet -- Two or tmrxeOw Mm 62 MWAMA *75 On SboW or wr"-" #75 Smew or wGAFGLAS40 #SO lemma" Sheet" or 'RGAFGLASO Sb =IMF ate Vem" Base Sheer" rne+chBrd11:W tst" tl L Manwitraaes--'�ti8 HW PbA gMM FR" or HW Gr-d aft FR" or 8=9VI IOM MW Phis Re or HW PhLS Grander or Hw QWWAW, torch aoolied. O O OOOo00 a m 00000 o m 000.s 00oeom m 0 0000.o 0 0 00000p p o ease O f 060060 Does • e 0 0 0 0 0 0 0 0 00 0 0 a 0 000000 00 00 000000 a 0 e 0 000000 000000 0 a offs o • s e • 00600 s• 01 see• 0 0 00000 as s 06e000 0 • e s • 000000 0000 ss ss 0 0 f •sefe• 0 0 0 0 000000 0 00 0 0 • 0 0 0 0 •s f • • 0e00ao s e f 0 0 f •s • f• s f f 00 0 Data CERTIFICATE OF LIABILITY INSURANCE 4/21/2022 Producer: Plymouth Insurance Agency This Certificate is issued as a matter of Irdbi ntation only and oofrfers no 2739 U.S. Highway 19 N. rights � the Certificate Holder. This Certificate does not anmd, extend or alter the coverage aifarded by the policies below. Holiday, FL 34691 (727) 938-5562 I�l� �°'d"� Coverage NAIL # Insured: South East Personnel Leasing, Inc. & Subsidiaries Insurer A: Lion insurance Company 11075 Insurer 8: 2739 U.S. Highway 19 N. Insurer c: Holiday, FL 34691 tnsurerD: Insurer E: Coverages The pollcfos a sura €nnce Itsted below have been issued to the insured named above the paltry period ndieated. NotWWVAar4N arty roqulrement term or condition any contract or r document with respect to which this certificate may be issued or may pertain. the insurance afforded by the policies described herein is subject to all the terms. exclusions. and conditions of such policies, Aggregate limits shown may have been reduced by paid claims.. INSR ADDL Policy Effective Policy Explrration Limits LTR INSRD Type of Insurance Policy Number Date (MM/DDIYY) Date(MWDD/YY) ENERAL LIABILITY Each oocumanco Commercial General Liability Dame to rented premises (EA Claims Made Occur once) Mod Fop Personal Adv Injury eneral aggregate limit applies per. General Agate Policy n wood E3 LOC Products - Compf0p Agg Combined Sing!e Un* TOMOBILE LIABILITY (EA Accident) Any Auto Bodily Injury All Owned Autos (Per Person) Scheduled Autos Bodily Injury Hired Autos (PerAccident) Non -Owned Autos Property Damage (Per Accident) EXCESSIUMBRELLA LIABILITY Ea` Occurrence - Occur ❑ claims Made Aggregate Deductible A Workers Compensation and X wC Statu- OTH- Employers' Liability WC 71949 01/0112022 01/0112023 to Limits ER E.L. Each Accident $1.000.000 Any proprietor/partner/executive officer/member $1,000.000 excluded? NO E.L. Disease - Ea Employee If Yes, describe tinder special provisions below. E.L. Disease - Policy Limits $1.000.000 Other Lion Insurance Company is A.M. Best Company rated A (Excellent). AMB * 12616 Descriptions of OperationslLocatlons/VehicleslExciusions added by Endorsement(Special Provisions: Client ID: 36-80-011 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are teased to the following "Client Company": Ail -Dade General Construction, Lie. Coverage only applies to injuries Incurred by South Fast Personnel Leasing, Inc. & Subsidiaries active employee(s), while working in: FL. Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. A list of time active employee(s) leased bo the Client Company can be obtained by faxing a request to (727) 937-2138 or email certificat.-40oninsurancecDmparry.00m Project Nance: ISSUE 04-21 22 (KLT) BiMM Data: 12 12 2o2x CERTIFICATE HOLDER CAKCI Lt.ATtON Should any of the above described policies be cancelted before the expliapon date thereof, the issuing MIAMI SHORES VILLAGE €nsurw vAll endeavor to mail 30 days written notice to the cerfiflcete notder named to the left, but failure to BUILDING DEPARTMENT do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. 10050 NE 2ND AVENUE MIAMI SHORES VILLAGE, FL 33138