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RF-11-23-2781Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Permit NO.: RF-11-23-2781 Permit Type: Roof Work Classification: Asphalt Shingle Permit status: Approved '.. Issue Date:11/27/2023 Expiration:05/27/2024 Parcel Number 9405 NE 9TH AVE, Miami Shores, FL 33138 1132060010030 Contacts BUENA VISTA 121 LLC Owner 9405 NE 9 AVE WEATHER GUARD INDUSTRIES INC Contractor CARLOS COLLAZO 11460 NE 10 AVE, Biscayne Park, FL 33161 Business: 7862539865 carlos@weatherguardindustries.co m Description: RE -ROOF SHINGLE AND FLAT Valuation: $ 26,000.00 Total Sq Feet: 2,800.00 Fees Amount Application Fee - Other $50.00 CCF $15.60 DBPR Fee $7.50 DCA Fee $5•00 Education Surcharge $7.80 Permit Fee (Manual) $120.00 Permit Fee (Manual) $330.00 Planning and Zoning Review Fee $70.00 Scanning Fee (Manual) $9.00 Technology Fee (Manual) $50.00 Total: $664.90 Payments Date Paid Amt Paid Total Fees $664.90 Credit Card 11/27/2023 $614.90 Credit Card 11/07/2023 $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. I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws and zoning. Futhermore, I authorize the above named contractor to do the work stated. Authorized Sign re: O ner / Applicant / Contractor / Agent Date November 27, 2023 Page 2 of 2 Miami Shores Village J2:•'vTExzP,D BUILDING PERMIT APPLICATION Building Department NOV 072023 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ]3Y._—Ky Tel- (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20X Master Permit No. �F- 11-93-c)`79 1 Sub Permit No BUILDING I3 ELECTRIC ROOFING ® REVISION E3 EXTENSION ®RENEWAL PLUMBING ❑ MECHANICAL [3 CHANGE OF ❑ CANCELLATION ® SHOP CONTRACTOR DRAWINGS JOBADDRESS: ql­105 Mr- �AJe City: Miami Shores County: Miami Dade Zip: 3313(� Folio/Parcel#: 11- 220G-001- C030 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 1"'%Q(e tAQ \/; *tom aZ LLr— Phone#: WlI ) Ciln -G-ILS Address: 1,2,\ ME 4I-E�) ett City: kAktiM'' state: zip: ?,-':-S1-1-7 Tenant/Lessee Name: l) • Y 0 L0 • i i • �i' •� • ••G2t. t • w '1. State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: State: _Zip: Value of Work for this Permit: $ 26, f-jcc : Square/Linear Footage of Work: 7, 1plzpcZ i Type of Work: 0 Addition 13 Alteration I3 New Repair/Replace M Demolition Description of Work: rn((/iu91 Specify color of color thru Submittal Fee $4�D • W ' Permit Fee $' q JV - CCF $ :1 S • 19U CO/CC $ Scanning Fee $ �' �d DCA Fee $ �• OD DBPR $ Notary $ Technology Fee Training/Education Fee $ -1 . !ao Double Fee $ Structural Reviews $ P&Z Review $ -7D .60 Bond $ TOTAL FEE NOW DUE $ (01+-i. 670 (Revised04/05/2022) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this —dayof �.,i\f11)�f61b�t- 20 2-1by r—n-ja 11X�`� VaLL, d It5 • who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: The foregoing instrument was acknowledged before me this 7_day of M(jt1PrT)�OPr- .20 7A by Cnckc-ca CAokkQZ0 , who is nersonally kn_wn to as me or who has produced identification and who did take an oath. NOTARY PUBLIC: as Print: L(cCA,C— Print: Seal: •;�,�••.,, LUCAS ROSSATO Seal:'. '••. ' LUCAS ROSSATO 'a?'•1'': MY COMMISSION#GG 965117 5#• MY COMMISSION # GG 965117 • EXPIRES: March 12.2024 13 : ; EXPIRES: March 12, 2024 •;'`' •...°vh• Bonded ThnrNWary Public � R°'•• Bonded Thru Notary Public Undewrilers tttttt#tt t#ttttttitttttttttitit ######## APPROVED BY Plans Examiner .,eZe(1 �k 11 Z3 Zoning N1'nnmlo-&- Structural Review Clerk (Revised04/05/2022) GeneratedOFFICE OF THE PROPERTY APPRAISER Summary Report On 11/07/2023 Folio 11-3206-001-0030 Property Address 9405 NE 9 AVE MIAMI SHORES, FL 33138-2922 Owner BUENA VISTA 121 LLC 121 NE 45 ST Mailing Address M IAMI, FL 33137 Primary Zone 1400 SGL FAMILY - 3001-3250 SQ 0101RESIDENTIAL -SINGLE FAMILY: 1 Primary Land Use UNIT Beds / Baths /Half 3/2/0 Floors 1 Living Units 1 Actual Area 1,806 Sq.Ft Living Area 1,752 Sq.Ft Adjusted Area 1,779 Sq.Ft Lot Size 9,600 Sq.Ft Year Built Multiple (See Building Info.) Year 2023 2022 2021 Land Value $662,486 $499,319 S307,448 Building Value $423,775 $428,881 S138,264 Extra Feature Value $16747 $16,747 $16,747 Market Value $1,103,008 $944,947 S462,459 Valquyjye�!*�.} $1.039,441 $944,947 S421,097 Assessed Benefit Type 2023 2022 2021 Save Our Homes Assessment $41,362 Cap Reduction Non -Homestead Assessment $63,567 Cap Reduction Year 2023 2022 2021 COUNTY Exemption Value $0 $0 $50,000 Taxable Value $1,039,441 $944,947 $371,097 SCHOOL.°:BOARD Exemption Value $0 $0 $25,000 Taxable Value $1,103,008 $944,947 $396,097 CITY Exemption Value $0 $0 $50,000 Taxable Value $1,039,441 $944,947 $371,097 REGIONAL Exemption Value $0 $0 $50,000 Taxable Value $1,039,441 $944,947 $371,097 Homestead Exemption $25,000 Second Homestead Exemption $25,000 M 1 iE't IEM AKINNFA P iOR Book. Note. Not all benefits are applicable to all Taxable Values (i.e. revous Price Qualification Description County School Board, City, Regional). Sale Page t 12/07/2021 $1,110,000 32915- 3545 Qual by exam of deed .a�. 6 53 42 08/03/2015 $100 29819- Corrective, tax or QCD; min MARILYN HGTS IDS 41-8 2195 consideration LOT 3 02/05/2015 $536,000 29498 Qual by exam of deed 4483 LOT SIZE 75.000 X 128 28740- Financial inst or "in Lieu of 07/10/2013 $243,000 2018 Forclosure" stated The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp 2023 FLORIDA LIMITED LIABILITY COMPANY REINSTATEMENT DOCUMENT# L21000454772 Entity Name: BUENA VISTA 121 LLC Current Principal Place of Business: 230 NW 71 ST ST. 3 MIAMI, FL 33150 Current Mailing Address: 230 NW 71 ST ST. 3 MIAMI, FL 33150 US FEI Number: 87-3809710 Name and Address of Current Registered Agent: VALDIVIA, EMANUELA 476 RIVERSIDE AVE. JACKSONVILLE, FL 32202 US FILED Oct 06, 2023 Secretary of State 7340815880CR Certificate of Status Desired: Yes The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida. SIGNATURE: EMANUELA VALDIVIA 10/06/2023 Electronic Signature of Registered Agent Date Authorized Person(s) Detail Title AMBR Name VALDIVIA, EMANUELA Address 230 NW 71ST ST., SUITE 3 City -State -Zip: MIAMI FL 33150 I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the some legal effect as if made under oath; that t am a managing member or manager of the limited liability company or the receiver or trustee empowered to execute this report as required by Chapter 605, Florida Statutes; and that my name appears above, or on an attachment with all other like empowered. SIGNATURE: EMANUELA VALDIVIA MANAGING PARTNER 10/06/2023 Electronic Signature of Signing Authorized Person(s) Detail Date RECEIVED Florida Building Code 7th Edition (2020) NOV 2 2 2023 High Velocity Hurricane Zone Uniform Roofing Application Form for Mi -Dade County Section A (General Information) Master Permit Number: Process Number: 'R-11-Z3-27EA Contractor's Name: \Mapb1G- C—• • ZA d Job Address: qyCn 9 Au`' T'1u ; rn �•�.'•, �<� ROOF CATEGORY 19 Low Slope ❑ Mechanically Fastened Tile 5 Asphaltic Shingles ❑ Metal Panel/ Shingles ROOF TYPE ❑ New Roof ❑ Repair ❑ Maintenance ❑ Mortar/ A(te;jS Tile ❑ Wood ShinglleeVs // Shakes COPY ROOF SYSTEM INFORMATION PReroofing ❑ Recovering Low Slope Roof Area (ftZ) Steep Sloped Roof Area (ftZ) Total (ftZ) Are there gas vents on the roof? ®Yes ®No If Yes what type? ©Natural 0 LPX Is there an existing rooftop Solar System? ©Yes Q No If yes will it be reinstalled? 0 Yes 0 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. T. o ^�' Ihoree Vigage Rullding Departmnmy Oapt. Date uilatng Dect. Dateuhiecf to complianc ith all eder I , t'ate and County rules and regulation . ermitil2-7E� O( JUAN J. SANTANDREU P.E P.E.. # 67241 7135 SW 44 Street Miami, Florida 33155 Tuesday, November 21, 2023 CONTRACTOR: Weather Guard Industries JOB ADDRESS: 9405 NE 9 AVE, MIAMI SHORES, FLORIDA LOW PITCH ROOFS FASTENERS CALCULATIONS RECEIVED RV• Description Flat Roof Roof Mean Heght: 10.0 tt NOA No: 22-0706.09 Roof System Manufacturer: Polyglass USA, Inc. Deck Type: Wood No Insulated BaseSheet & Fastener Type: I ply of Elastobase fastened with 1-1A RSN and Tin Cap System Type: E(I) /30 Maximum Design Preassure from the specific NOA: -52.50 psf Scope of Activity & Findings: Minimum Design Wind Uplift Preassure from (RAS 128) Exposure "D" Zone P= -45.0 psf @ 8 in o/c on laps and 3 equal rows 8 in Zone 1 = -77.0 psf @ 5 in o/c on laps and 3 equal rows 5 in Zone 2 = -102.0 psf @ 4 in o/c on laps and 3 equal rows 4 in Zone 3 = -139.0 psf @ 3 in o/c on laps and 4 equal rows 3 in lap: 4 in Net width(ft)= Nw =2.95 in Net length (ft) N1:= (100) Nw Rs = 8.84 in Number of fastener per square Side laps row = fl: = Center row = fc: = Ft12 x per fasteners Fy= Total 51 fasteners/sq 153 fasteners/sq 204 fasteners/sq FT:= 100 Total 52.5 * FT NOV 2 2 2023 Ln= 33.93 in (to make one square) FI'= 0.49 Fv = 25.79 IV ., JUAN J. SANTANDREU P.E P. E.. # 67241 7135 SW 44 Street Miami, Florida 33155 Ph. 305-412-7361 General Equation: FS=Fy x 144/P x Rs Results: Zone 1'= fa:= Fy * 144 I'a= 9 in (Field * Rs) Zone 1= fa= Fy * 144 fa-- 5 in (Perimeter * Rsf) Zone 2 fa= Fy * 144 fa— 4 in (Corner * Rsp) Zone 3 fa= Fy * 144 fa= 3 in (Corner * Rsc) ZONE DIMENSIONS: Perimeter zone (P2) Width: 6.00 11 Corner zone (P3) Length: 6.00 ft �\\\Jill l l///�� �pSE * ; o. JUA A :7A7tjVftGU P.G. Tr7� (P3) Width : 2.00 ft Florida Building Code 7th Edition (2020) High Velocity Hurricane Zone Uniform Roofing Application Form for Miami -Dade County Section D (Steep Sloped Roof System) 43Y: --- -- Roof System Manufacturer: C, Pik Product Control Number: 27- i 7-Z\ . n44 Minimum Design Wind Pressures, From Applicable RAS 127 Table or Calculations: Zone1: -ly Zone 2e: _74 Zone2n: -IoS Zone 2r: - lob Zone 3e: - 108 Zone 3r: - IZ Slope Range: ®>_ 2:12 to <- 4:12 Roof Slope: 4_: 12 Ridge Ventilation? NZ Roof Shape: O All Hip Roof 0>4:12to:56:12 0>6:12to<_12:12 ® Gable Roof or Partial Gable/Hip Roof Deck Type: 1518" -kAwood Underlayment Type: I As-cHt 2-Z6 ZyPC-M -* 30 4- pif Insulation: WA Fire Barrier: N Fastener Type & Spacing: I.zS" RS Na�s -,nwj s War_ ana 6'c7.c,«aps Cap Sheet Type: I N/A Mean Roof Height: 14' Cap Sheet Attachment: 1 t4/A Roof Covering: I c,&-: i�m\oes��r� Drip Edge Type & Size: 3 x -6 - Z6 Cam• ���• 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 manufacturer (If a component is not used, identify as "NA") System Manufacturer: -?o\4c\oSs Product Approval # 2 Z- 670C,. 09 Design Wind Pressures, from RAS 128 or Calculations: Zone 1':-1'7 Zone 1:-G�A Zone 2: -Ek Zone 3: -t\F Max. Design Pressure, from the specific product approval system: —5'Z.5 Deck Type: Gauge / Thickness: 5 Slope: Anchor/ Base Sheet & No. of Ply(s): W/A Anchor/ Base Sheet Fastener/ Bonding Material: Insulation Base Layer: Base Insulation Size and Thickness: 4y 1A Base Insulation Fastener/ Bonding Material: Top Insulation Layer: 1A Top Insulation Size and Thickness: %a./a Top Insulation Fastener/Bonding Material: Base Sheet(s) & No. of Ply(s): 1 p\y Base Sheet Fastener/ Bonding Material: 1.25 QS 11n,kS c.nn -t,. c-apS Ply Sheet(s) and No. of Ply(s): -Ela"P)e a A V >:4 Ply Sheet Fastener/ Bonding Material: A ;Aq Se1� tAlrayeA Top Ply: 'nQ4 � s A, � TQ oy'o __ Top Ply Fastener/ Bonding Material: Surfacing: wt /A Fastener Spacing for Anchor/Base Sheet Attachment: Zone V !A ac @ Laps, # Rows 3 @ oc Zone 1 _rO__ " oc @ Laps, # Rows 3 @_ " oc Zone 2 Es oc @ Laps # Rows 3 @ " oc Zone 3 �i " oc @Laps, # Rows @" oc Number of Fasteners Per Insulation Board Zone 1': vx Zonel: pjL_ Zone 2: ii� Zone 3: Qk— Illustrated Components Noted and Details as Applicable: Woodblocking, Gutter, Edge Termination, Stripping, Flashing, Continuous Cleat, Cant Strip, Base Flashing, Counterflashing, Coping, Etc. Indicate: Mean Roof Height, Parapet Height, Height Base Flashing, Component Material, Material Thickness, Fastener Type, Fastener Spacing or Submit Manufactures Details that Comply with RAS 111 and Chapter 16. 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. 4CV 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. e " 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. 5. V Ponding water: The current roof system and/or deck of the building may not drain well and may cause water to pond (accumulate) in low-lying areas of the roof. 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. Rev01 142021 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 NOV 0 7 03 BY:—. 6. 1�' V Overflow scuppers (wall outlets): It is required that rainwater flows off so that the roof is not overloaded from a buildup of water. Perimeter/edge wall or other roof extension may block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accordance with the requirements of Sections R4402, R4403 and R4413. 7. v Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of the structure assembly (the building itself). The existing amount of attic ventilation shall not be reduced. It may be beneficial to consider additional venting which can result in extending the service life of the roof. Owner s Signature Date Contractor Signature Date For Forms and Applications click here: http://bldg.miamishoresvillage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia mi5horesVillage RevOI 142021 Owners roofing consideration Page 2 of 2 Miami Shores Village - BUILDING DEPARTMENT-_Ej;tEjD 10050 NE 2 Ave Miami Shores, FL 33138 305-795-2204 www.msvfl.gov NOV 0 7 2023 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 Date: (- 01- 23 10050 NE 2nd Ave Miami Shores, FI 33138 Re: Owner's Name: PNop.nG Y,4a /ZI U_C Property Address: S LL4ni q j41iP hYOrni 331.3F, Roofing Permit Number: Dear Building Official: 1 tm C10OP,l(A_(/1'1 ICIn !iC 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 Single Family Residential Structures as adopted by the Florida B11uilddi�in44g�� Commission by Rule 9B-3.047 F.A.C. M� Signature -OMaV1U&�d�c�.i u (� 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 7 day of �)�mhpc 20 2� Notary P li State of. o ida at Large ::. wcnS BOSS o Seal: _. EXPIRES: March 12, 2024 For Forms and Applications click here: http://bidg.miamishoresvillage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia mi5horesVillage Rev01142021 Affidavit of Compliance with roof to wall Page 1 of 1 M®M "Delivering Excellence Every Day" Miami -Dade County HVHZ Electronic Roof Permit Form 7,77" 'TT� Illustrate Components Noted and Details as Applicable: Top Ply Roof Deck NOV 0 7 ZU23 Roof Mean Height: F7 ft. Drip Metal: 2�x3' Surfacing: 4 Drip Metal 1 va/a Top Ply: a4.\fin Interplies: �--\ZIAO \nx sA � a�hesUe Base Sheet: Deck Type: mood -IB 1;:X4 ojood NOV 0 7 M3 -MIAMi=DADE_COUNTY MIMI®W►DE 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/economv 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: GAF Timberline® Natural Shadow®, Timberline® NS, Timberline® American Harvest®, Timberline® All, Timberline HDr, Timberline® CS and Fortitude®, Timberline® UHDZTm Shingles 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 revises NOA #21-1209.01 and consists of pages 1 through 6. The submitted documentation was reviewed by Alex Tigera. NOA No.: 22-1221.04 MIAMIDADE COUNTY Expiration Date: 02/21/27 Approval Date: 09/07/23 Page 1 of 6 ROOFING ASSEMBLY APPROVAL Category: Roofing Sub -Category: Asphalt Shingles Materials: Laminate Deck TVpe: Wood SCOPE By. NUV 0 7 M3 This approves GAF Timberline® Natural Shadow®, Timberline® NS, Timberline American® Harvest®, Timberline® AH, Timberline HDZ®, Timberline® CS and Fortitude® Shingles as manufactured by GAF as described in this Notice of Acceptance. PRODUCT DESCRIPTION Product GAF Timberline® Natural Shadow® and Timberline® NS Manufacturing Locations #1, 2, 3, 4, 5, 6, 7 GAF Timberline® American Harvest® Manufacturing Locations #2, 4 , 6 GAF Timberline®AH Manufacturing Locations #2, 4, 6,9 GAF Timberline HDr Manufacturing Locations #1, 2, 3, 4, 5, 6, 7, 8, 9, 10 GAF Fortitude® Manufacturing Location #4 GAF Timberline® CS Manufacturing Location #9 Dimensions Test Product Description Specifications 13 '/4-x 39 31C TAS 110 Fiberglass reinforced heavy weight asphalt roof shingle, with a laminate profile 13 '/4"x 39 3/s 13 '/4-x 39 3/s- 13 Va x 39 3/s 13 '/4"x 39 3/8 13 '/a ' x 39 3/8" GAF Timberline® UHDZI 13'/e x 39 3/; Manufacturing Location #2, 4, 6, 8 TAS 110 Fiberglass reinforced heavy weight asphalt roof shingle, with a laminate profile TAS 110 Fiberglass reinforced heavy weight asphalt roof shingle, with a laminate profile TAS 110 Fiberglass reinforced heavy weight asphalt roof shingle, with a laminate profile TAS 110 Fiberglass reinforced heavy weight asphalt roof shingle, with a laminate profile TAS 110 Fiberglass reinforced heavy weight asphalt roof shingle, with a laminate profile TAS 110 Fiberglass reinforced heavy weight asphalt roof shingle, with a laminate profile NOA No.: 22-1221.04 Expiration Date: 02/21/27 Approval Date: 09/07/23 Page 2 of 6 MANUFACTURING LOCATION NOV 0 7 Z023 1. Tampa, FL 2. Michigan City, IN 3. Baltimore, MD r 4. Myerstown, PA 5. Ennis, TX 6. Tuscaloosa, AL 7. Dallas, TX 8. Shafter, CA 9. Fontana, CA 10. Minneapolis, MN EVIDENCE SUBMITTED Test Aaencv Test Identifier Test Name/Report Date Underwriters Laboratories, LLC ASTM D3462 4790488380 08/22/22 ASTM D3462 4788932264 12/13/19 ASTM D3462 4788717529 01/31/19 ASTM D3462 4787344101 07/25/16 TAS 107 4789225984 11/1/19 TAS 107 4788717529 01/31/19 TAS 107 OINK45803 04/13/94 TAS 107 06NK05159 08/09/06 TAS 107 04NK04273 02/20/04 TAS 107 05CA42840 11/11/05 TAS 107 02NK41811 11/11/02 TAS 107 03CA35209 10/17/03 TAS 107 04CA13850 08/30/04 PRI Asphalt Technologies, Inc. TAS 100 GAF-912-02-01 12/17/18 TAS 100 GAF-044-02-01 01/13/04 TAS 100 GAF-098-02-01 11/08/05 TAS 100 GAF-101-02-01 11/09/05 TAS 100 GAF-116-02-02 03/23/06 TAS-100 ELK-083-02-01 10/16/02 ELK-084-02-01 10/15/02 ELK-085-02-01 10/14/02 ELK-086-02-01 10/24/02 ELK-087-02-01 10/21/02 ELK-088-02-01 10/16/02 ELK-107-02-01 10/09/03 ELK-108-02-01 10/09/03 ELK-109-02-01 10/09/03 NOA No.: 22-1221.04 Expiration Date: 02/21/27 Approval Date: 09/07/23 Page 3 of 6 NOV 0 7 2023 LIMITATIONS 1. Fire classification is not part of this acceptance; refer to a current Approved Roofing Ma%nalrDirectoiy far fiie ratings of this product 2. Shall not be installed on roof mean heights in excess of 33 ft. 3. 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. INSTALLATION 1. Shingles shall be installed in compliance with Roofing Application Standard RAS 115. 2. Flashing shall be in accordance with Roofing Application Standard RAS 115 3. The manufacturer shall provide clearly written application instructions. 4. Exposure and course layout shall be in compliance with Detail W, attached. 5. Nailing shall be in compliance with Detail W, attached. LABELING Shingles shall bear the imprint or identifiable marling of the manufacturer's name or logo, city and state of manufacturing facility, and following statement: "Miami -Dade County Product Control Approved" or the Miami -Dade County Product Control Seal as shown below. BUILDING PERMIT REQUIREMENTS 1. Application for building permit shall be accompanied by copies of the following: 1.1 This Notice of Acceptance. 1.2 Any other documents required by the Building Official or the applicable code in order to properly evaluate the installation of this system. NOA No.: 22-1221.04 MUIMMADE COUNTY Expiration Date: 02/21/27 Approval Date: 09/07/23 Page 4 of 6 DETAIL A NOV U 7 ZU23 COURSE LAYOUT Exposure NOA No.: 22-1221.04 Expiration Date: 02/21/27 Approval Date: 09/07/23 Page 5 of 6 DETAIL B NOV 0 7 1023 OVERALL DIMENSIONS AND NAILING PATTERN FOR GAF TIMBERLINE® NATURAL SHADOW' AND TIMBERLINE® NS 39-31811 1 149 1 I-17-1�� ��/2" - -1 /2" -" (366-445mm) (366-4a5mm) ail guide line 6-1 f2" - 9-1 /2" 6-112" - 9-1 f2" nss. arm.x oes. uimmt 5.3/4"-6-114" -1 /,4' f (146mm-159mm) 1331mm } —~ �— from bottom of shingle rn- elf seal adhesive on back ENHANCED NAILING PATTERN - six nails per shingle' • required by some local codes and required for enhanced wind coverage on cedain products. See broiled warranty for details. These shingles MUST be nailed a nominal 6" (152mm) from bottom of of shingle, above the cut outs, as shown. Nails must not be exposed. OVERALL DIMENSIONS AND NAILING PATTERN FOR TIMBERLINE HDZ®, TIMBF.Ru Ne CS, TIMBERLINeAH, TIMBERLINE® UHDZ®, AND FORTITUDE® 13-1/4' (337 mm) 5-13116'-6-V4' (148 mm -159 mm) For Mansard Roofs 39-3/84 (1 m) END OF THIS ACCEPTANCE C -99/Z 11W mm - Z4 12'-2-1r1(13mm-64 - TARGET NAIL ZONE 5-13116'-7-5/8' (148 mm -194 mm) NOA No.: 22-1221.04 Expiration Date: 02/21/27 Approval Date: 09/07/23 Page 6 of 6 MIAMI0% NOV 0 7 2023 MIAMI-DARE COUNTY Em By,- ------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) w .miamidade.sov/economy Polyglass USA, Inc. 150 Lyon Drive Fernley, NV 89408 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 Self -Adhered Roof System over Wood Decks LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami -Dade County Product Control Approved", unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA renews NOA# 21-1207.12 and consists of pages 1 through 32. The submitted documentation was reviewed by Alex Tigera. NOA No.: 22-0706.09 Expiration Date: 10/11/27 Approval Date: 10/06/22 Page 1 of 32 ROOFING ASSEMBLY APPROVAL Category Roofing Sub -Category: Modified Bitumen Materials SBS/APP/TPO Deck Type: Wood Maximum Design Pressure -112.5 psf NU" U 7 1073 TRADE NAMES OF PRODUCTS MANUFACTURED OR LABELED BY APPLICANT: TABLE 1 Test Product Product Dimensions Specification Description Polyanchor 250' x 48" ASTM D 4601, A polymer woven, high performance, synthetic base Type 17 sheet. Polyglass G2 Base 108' x 36" ASTM D 4601, Asphalt -coated fiberglass reinforced base sheet Type H Elastosbield VP HT 65' 8" x 3' 3-3/8" ASTM D 6162 SBS modified asphalt coated fiberglass/polyester reinforced base sheet. XtraFlex SBS HT 65' 8" x 3' 3-3/8" ASTM D 6162 SBS modified asphalt coated fiberglass/polyester Base 650 reinforced base sheet. Elastobase V 65' 2" x 3' 3-3/8" ASTM D 6163, SBS modified asphalt coated fiberglass reinforced base Type I sheet. Elastoflex SA V 66' 8" x 3' 3-'/s" ASTM D 6163, Self -adhered, fiberglass reinforced, SBS modified Type I bitumen membrane with a self -adhering back face and a smooth top surface. Elastoflex SA V FR 66' 8" x 3' 3-3/8" ASTM D 6163, Self -adhered, fire -rated, fiberglass reinforced, SBS Type I modified bitumen membrane with a self -adhering back face and a smooth top surface. Elastoflex SA V 66' 8" x 3' 3-3/8" ASTM D 6163, Self -adhered, fiberglass reinforced, SBS modified PLUS Type I bitumen membrane with a self -adhering back face and a smooth top surface. Elastoflex SA V 66' 8" x 3' 3-3/8" ASTM D 6163, Self -adhered, fire -rated, fiberglass reinforced, SBS PLUS FR Type I modified bitumen membrane with a self -adhering back face and a smooth top surface. XtraFlex SBS Base 66' 8" x 3' V/s" ASTM D 6163, Self -adhered, fiberglass reinforced, SBS modified SA Type I bitumen membrane with a self -adhering back face and a smooth top surface. XtraFlex SBS Glass 65' 8" x 3' 3-3/8" ASTM D 6163, SBS modified asphalt coated fiberglass reinforced base Base Type I sheet. Elastobase P 65' 8" x 3' 3-3/8" ASTM D 6164, SBS modified asphalt coated polyester reinforced base Type I sheet. Elastoflex SA P 32' 10" x 3' 3-3/8" ASTM D 6164, Self -adhered, fiberglass reinforced. SBS modified Type I bitumen membrane with a self -adhering back face and a granule top surface. NOA No.: 22-0706.09 Expiration Date: 10/11/27 Approval Date: 10/06/22 Page 2 of 32 NOV 0 7 M3 Elastoflex SA P FR 32' 10" x 3' 3-3/8" ASTM D 6164, Self -adhered, fire -rated, polyester reinforced, SBS Type I modified bitumen membrane with a self -adhering back face and a granule top surface. Polyreflect 32' 10" x 3' 3 3/g" ASTM D 6164, Self -adhered, polymer, SBS modified bitumen Type I membrane with a self -adhering back face and a smooth top surface. XtraFlex SBS G SA 32' 10" x 3' 3-3/8" ASTM D 6164, Self -adhered, fire -rated, polyester reinforced, SBS Type I modified bitumen membrane with a self -adhering back face and a granule top surface. Polybond 32' 10" x 3' 3-3/8" ASTM D 6222 Torch applied, polyester reinforced, APP modified bitumen membrane with a bum off polyethylene back face and a smooth or sanded top surface. Polyflex 32' 10" x 3' 3-3/8" ASTM D 6222 Torch applied, polyester reinforced, APP modified bitumen membrane with a burn off polyethylene back face and a smooth or sanded top surface. XtraFlex APP S 32' 10" x 3' 3-3/8" ASTM D 6222 Torch applied, polyester reinforced, APP modified bitumen membrane with a burn off polyethylene back face and a smooth or sanded top surface. Polyflex SA P 32' 10" x 3' 3 3/s" ASTM D 6222, Self -adhered, polyester reinforced, APP modified Type I bitumen membrane with a self -adhering back face and a granule top surface. Polyflex SA P FR 32' 10" x 3' 3}/g" ASTM D 6222, Self -adhered, fire -rated, polyester reinforced, APP Type I modified bitumen membrane with a self -adhering back face and a granule top surface. Polyfresko G APP 32' 10" x 3' 3}/s" ASTM D 6222, Self -adhered, polyester reinforced, APP modified SA Type I bitumen membrane with a self -adhering back face and a granule top surface. Polyfresko G APP 32' 10" x 3' 3 3/8" ASTM D 6222, Self -adhered, fire -rated, polyester reinforced, APP SA FR Type I modified bitumen membrane with a self -adhering back face and a granule top surface XtraFlex APP G SA 32' 10" x 3' 3}/g" ASTM D 6222, Self -adhered, fire -rated, polyester reinforced, APP Type I modified bitumen membrane with a self -adhering back face and a granule top surface. PG 100 1, 3, 5, 50, 55 gal, ASTM D41 A penetrating solution of solvent and a blend of tube or 17 oz. spray selected asphalts used to promote adhesion. can PG 350 1, 3, 5, 50, 55 gal. or ASTM D3019 A fibered rubberized adhesive designed for use with tube Type III modified bitumen membranes. PG 400 1, 3, 5, 50, 55 gal. or ASTM D4586 A thick, fibered, rubberized flashing cement for use in tube ASTM D3409 dry or damp conditions. PG 425 1, 3, 5, 50, 55 gal. or ASTM D4586 A thick, fibered, rubberized flashing cement for use in tube ASTM D3409 dry or damp conditions. PG 450 1, 3, 5, 50, 55 gal. or ASTM D4586 A thick, fibered, rubberized flashing cement. tube PG 500 1, 3, 5, 50, 55 gal. or ASTM D4586 A thick, fibered, rubberized flashing cement for use tube with modified bitumen membranes. NOA No.: 22-0706.09 Expiration Date: 10/11/27 Approval Date: 10/06/22 Page 3 of 32 Membrane Type: Deck Type 1: Deck Description: System Type E(4): SBS/APP 9 AY - NOV 0783 Wood, Non -Insulated 19/32" or greater plywood or wood plank, fastened at 24" spans with 8d common nails at 4" o.c. or #8 wood screws at 6" o.c. Base sheet is mechanically attached to roof deck. Membranes subsequently adhered. All General and System Limitations apply. Base Sheet: One ply of Elastobase V, Elastobase P, Elastoshield VP HT, XtraFlex SBS Glass Base or XtraFlex SBS HT Base 650 fastened to the deck as described below: Fastening: Attach base sheet using 11 ga. annular ring shank nails and 1-5/8" diameter tin caps spaced 8" o.c. in a 4" lap and 8" o.c. in three equally spaced staggered rows in the center of the sheet. Ply Sheet: One or more plies of Elastoflex SA V, Elastoflex SA V FR, Elastoflex SA V PLUS, Elastoflex SA V PLUS FR or XtraFlex SBS Base SA self -adhered. Membrane: One ply of Elastoflex SA P, Elastoflex SA P FR Polyflex SA P, Polyflex SA P FR, Polyfresko G APP SA, Polyfresko G APP SA FR Polyreflect, XtraFlex APP G SA, or XtraFlex SBS G SA self -adhered. Surfacing: Install one of the approved surfacing products listed in Table 4 to obtain desired coating or (Optional) required fire classification. Maximum Design Pressure: -52.5 psf; (See General Limitation #7) NOA No.: 22-0706.09 Expiration Date: 10/11/27 Approval Date: 10/06/22 Page 27 of 32 _AT TER 7 NOV 0 7 2023 WOOD DECK SYSTEM LIMITATIONS: bxii. 1. A slip sheet is required with Ply 4 and Ply 6 when used as a mechanically fastened base or anchor sheet. 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 foam insulations when the base sheet is fully mopped. If no recovery board is used the base sheet shall be applied using spot mopping with approved asphalt, 12" diameter circles, 24" o.c.; or strip mopped 8" ribbons in three rows, one at each side lap and one down the center of the sheet allowing a continuous area of ventilation. Encircling of the strips is not acceptable. A 6" break shall be placed every 12' in each ribbon to allow cross ventilation. Asphalt application of either system shall be at a minimum rate of 12 lbs./sq. Note: Spot attached systems shall be limited to a maximum design pressure of 45 psf. 5. Fastener spacing for insulation attachment is based on a Minimum Characteristic Force (F') value of 275 IV.., as tested in compliance with Testing Application Standard TAS 105. If the fastener value, as field-tested, are below 275 Ibf, insulation attachment shall not be acceptable. 6. Fastener spacing for mechanical attachment of anchor/base sheet or membrane attachment is based on a minimum fastener resistance value in conjunction with the maximum 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 Professional Engineer, Registered 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 comer 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 I I I 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 comers). Neither rational analysis, nor extrapolation shall be permitted for enhanced fastening at enhanced pressure zones (i.e. perimeters, extended comers and comers). (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 61G20-3 of the Florida Administrative Code. END OF THIS ACCEPTANCE NOA No.: 22-0706.09 Expiration Date: 10/11/27 Approval Date: 10/06/22 Page 32 of 32 ROOFING SYSTEMS I UL Product iQ Page 12 of 33 Ply Share —'Eatoflex S6",'XtraFlex SBS POLY Base", "Elaswilec P-C' (heat fused or mechanically fastened). Membranc—'Elastoflex S6 G FR', "Elastoflex S6 CC FR" or "Polyfresloo G SBS FR', (heat fused). 48. Deck NC kKNne:1 imuietlon (OptionaQ:.- Polyisocyanurate, pedite, wood fiber or polyisocyanurate/pedhe board, any thickness. Base Shaek-�FJastohate"�Flex SBS Glass Base" (poly/sand), mechanically fastened or "Polytlex SA Base", 'Elastoflex SA V Plus FR", "Elastoflex SA V FR' or "Elastoflex SA V FR Base Vent" (self -adhered) y — Elastobase','XtraHex SBS Glass Base"(poly/sand), heat fused or mechanically fastened, or flex SA V Plus F "-Elastoflex SA V FR" or'Elastoflex_SSAV Fn F se vent", (self -adhered). Ma nbmnc— "Polyflex SA P FR",'Polyhesko G SA P FR "Elastoflex SA P FR" Polyfresko G SBS SA P FR", "Elastoflex SA V FR HT", (self -adhered) or "Polyflex G FR",'Modibond G FR , XtraFlex APP G HP', "XtraFlex APP G Fit'. "Polyhesko G FR', "Duflex G FR-, 'XtraFlex APP Dual",'Elastoftex S6 G FR", "Polyhesko G SBS FR", 'Rastoflex VG FR', "XtmFlex SBS POLY Go.'XtraFlex SBS POLY G T",'XtmRex SBS Glass G", 'XtraFlex SBS Glass GT' or'gastoshield TS G FR", heat fused. 49. Deda C-15/32 Indlne:2 Insulation (Optimal): — Polyisocyanurate, pedite, wood fiber or poYsocyanurate/ped'Re board, any thickness. Base Sheet—°Elastobase" or "Elastovere, mechanically fastened; or'Sastoflex SA V FR' or'Elastoflex SA V Plus FR", self -adhered. Ply Sheet (optionan: — "Hastoflex SA V Plus FR, "Elastoflex SA V FR' or "Elastoflex SA V FR Base Vent", self -adhered. Membrane.—'PolyflexSA P FR_. °Polyfr ka G SA P FR', "Elastoflex SA P FR" or "Polyfresko G SBS SA P FR", self - adhered; or "Dufkx G FR", "XVaFlex APP Dual','Polyflex G Fir, -Modibond G FR",'XtraFlex APP G HP', "XtraFlex APP G FR', "Elastoflex S6 G FR", "Polyhesko G SBS FR", "Elastoflex VG FR",'XtraFlex SBS POLY G", 'XtraFlex SBS POLY G T", "XtraFlex SBS Glass G", "XtraRex SB5 Glass GT" or'Elastoshiekf TS' `--hosed. - 50. Deck NC Indlnx 1/2 Insulatlorc — Polylsocyanurate (2 In. thick minimum), Glass fiber (15/16 In. thick minimum), pedite/polylsocyanurate composite, pedlte/urethane composite (2 In. min). Barrier Board (option):— Minimum 1/4-in. thick Georgia-Pacific Gypsum LLC'DensDeck® Roofboard' or'DensDeck Pdmee' Roofboard" or"DensDeck DuaGuard" Roofboard', "DensDeck Prime® Roofboard" or "DensDeck DuraGuard" Roofboard" or minimum 1/4 in. thick United States Gypsum Co. SECUROCK® Glass -Mat Roof Board (Type SGMRX), National Gypsum'DD(cell Glass Mat Roof Board' or"DE)(cell FV Glass Mat R, mechanically fastened. Base Sheet—'Elastoflex V', "Elastoshield HT','Elastoshield TS", "Elastoflex ST,'XtaFlex SBS POLY Base', "Elastofiex P-C' (heat (used or mechanically fastened). Membrane *Elastoflex V G", Elastoflex V G FR', "Elastoshkld TS G FR", 'Flastoflex S6 G°,-Vastoflex S6 G FR", "Elastoflex S6 G-C' or'PoVmsko G SBS', (heat fused). 51. Dodo C-15/32 hrdirrc 1/2 hreulatlom— Polyisocyanuate (2 in. thick minimum), Glass fiber (15/16 in, thick minimum), pedite/polyisagwuate composite, pedite/urethane composite (2-In. minimum). Mechanically attached, hot asphalt adhered or foam adhered. Barrier Boar— Minimum 1/4-In. thick Georgia-Pacific Gypsum LLC "DensDeckc Roofboard" or'DensDeck Primes Roofboard' or "DensDeck DuraGuard' Roofboard, DensDeck Prime®, or minimum 1/4-in. thick United States Gypsum Co.'SECUROCK® Roof Board' (Type FRX-G)' or "SECUROCKO Glass -Mat Roof Board" (type SGMR)) hot asphalt adhered or foam adhered. Base Sheat+"Elastoflex V', "Elastoshield HT' ,"Elastoshield TS", "Elastoflex S6", 'XtraFlex SBS POLY Base", 'Elastoflex P-Cl hot mopped or torch applied. Membrane — "Oastoflex V G", Elastoflex V G FR', "Elastoshield TS G FR", 'Elastoflex S6 G', "Elastoflex S6 G FR", 'Elestoflex S6 G-C' or'Polyfresko G SBS", (heat fused). 52. Deck NC - Incone:1 Impact 4 Base Sheet—'Elestobase",'XtraFlex SBS Glass Base" (poly/sand), mechanically fastened or'Polyflex SA Base", "Elastoflex SA V Plus FR", "FJastoflex SA V FFt" or'Elastoflex SA V FR Base Vent" (seff-adhered) Miami Shores Village - BUILDING DEPARTMENT 10050 NE 2 Ave Miami Shores, FL 33138 305-795-2204 www.msvfl.qov Contractor Registration Form BusinessName: %uctccl Zr),- Address: 114c-r) \)-e- in 1 E i�iSG0. i ne. ��� i-1 33161 Phone:() 753-yR6�5 _E-mail: rcs.(IcnsCc w, tkPc C-Agkr-(.lnAbeS.Corn Qualifier Name: Cn(JfY`, Qualifier Lic Number: Contractor may register license and insurance information with the Village on an annual basis. The initial fee will be $50 with an annual update fee of $30. Contractors that elect not to maintain their information on file will need to provide their information with each permit applied for. Please confirm if you would like to register your Contractor for a fee of $50. A FLORIDA STATE CERTIFIED CONTRACTOR: A. Copy of Local Business Tax Receipt B. Copy of Qualifier State Licenses C. Copy of Liability Insurance* D. Copy of Workers Compensation Insurance* Provide proof that the contractor has secure compensation for its employees as required under section 105.3.5 of the 6th edition to the 2017 F.B.C. (Workers Compensation FEIN EXEMPTION must have Notice to Owner form and Contractor Affidavit) A MIAMI DADE COUNTY CONTRACTOR: A. Copy of Certificate of Competency of Qualifier B. Copy of Local Business Tax Receipt C. Copy of State Registered Contractor Licenses or Miami Dade County Municipal Contractor's Tax Receipt. D. Copy of Liability Insurance* E. Copy of Workers Compensation Insurance* Provide proof that the contractor has secure compensation for its employees as required under section 105.3.5 of the 6th edition to the 2017 F.B.C. (Workers Compensation FEIN EXEMPTION must have Notice of 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. Ron DeSantis, Governor STATE OF FLORIDA Melanie S. Griffin, Secretary d p �r DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE ROOFING CONTRACTOR HEREIN tS CERTIFIED UNDER THE OF CHAPTER 489, FLORIDA COLLAZO, CARLOS O WEATHER GUARD INDUSTRIES INC 11460 NE 10TH AVENUE *BISCAYNE PARK FL 33161 EXPIRATION DATE: AUGUST 31, 2024 Always verify licenses online at MyFloridaLicense.com Vow Do not alter this document in any form. Local Business Tax Receipt Miami —Dade County, State of Florida THIS IS NOT A BILL - DO NOT PAY 2184752 RECEIPT NO. RENEWAL BUSINESS NAME/LOCATION 2297596 WEATHER GUARD INDUSTRIES INC 11460 NE 10TH AVE �• BISCAYNE PARK, FL 33161-6718 LE11r EXPIRES SEPTEMBER 30, 2024 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED WEATHER GUARD INDUSTRIES INC 196 SPECIALTY BUILDING BY TAX COLLECTOR CONTRACTOR 45.00 07/04/2023 Workers) 3 CCC033704 INT-23-384197 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276. Mt�t for more information, visit www.miamidade.govhaxcallector AebRo® CERTIFICATE OF LIABILITY INSURANCE DATE(MW0DrffM 11 /17/2023 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(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s . PRODUCER CONTACT Tim Allred Custom Contractors Insurance, LLC PO Box 2389 PHONE 888) 652-4513 No): 888 274-7438 E-MAIL : lnfo@customeontractorsinsurance.com INSURERS AFFORDING COVERAGE NAIC 0 INSURER A: SUTTON SPECIALTY INS CO 16848 Gilbert AZ 85299 INSURED INSURER B : INSURER C : Weather Guard Industries, INC INSURER D : 11460 Northeast 1 Oth Avenue INSURER E INSURER F : Biscayne Park FL 33161 1 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWTHSTANDING 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. ILTR NSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBERPOLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIA6IUTY CLAIMS -MADE Q OCCUR X X ISCP04000006334 05/01/2023 05/01/2024 EACH OCCURRENCE $ 1.000,000 DAVIAGE-TO RENTED PREMISES Ea occurrence $ 50,000 MEO EXP An onserson $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEML AGGREGATE LIMIT APPLIES PER: X POLICY JECT LOC OTHER: GENERAL AGGREGATE S 2,000,000 PRODUCTS - cOMProP AGG $ 1,000,000 $ I AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY ; ' ECOMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY Per accident ( ) $ PROPERTY DAMAGE Per accident $ $ UMBRELLA UAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED 7, RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE Q OFFICER/MEMBER EXCLUDED? (Mandatory in NH) k yes. describe under DESCRIPTION OF OPERATIONS below N / A I I STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) COVERAGE APPLIES IN FLORIDA CCC 033704 HOLDER named additional insured Miami Shores Village, 10050 NE 2nd Avenue, Miami Shores, FL 33138 TION 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 41988-201&ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE Date 11/2/2023 Producer: Plymouth Insurance Agency 2739 U.S. Highway 19 N. Holiday, FL 34691 This Certificate Is issued as a matter of information only and confers no rights upon the Certificate Holder. This Certificate does not amend, extend or after the coverage afforded by the policies below. (727) 938-5562 Insurers Affording Coverage NAIL # Insured: South East Personnel Leasing, Inc. & Subsidiaries Insurer A: Lion Insurance Company 11075 Insurer B: 2739 U.S. Highway 19 N. Holiday, FL 34691 Insurer C: Insurer D: Insurer E: Coverages 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. Aggregate limits shown may have been reduced by paid claims. INSR LTR ADDL INSRD Type of Insurance Policy Number Policy Effective Date (MWDDNY) Policy Expiration Date(MMIDD/YY) Limits ENERAL LIABILITY Each Occurrence Commercial General Liability Claims Made ❑ Occur Damage to rented premises (EA occurrence) Med Exp Adv Injury General aggregate limit applies perPersonal Project El LOC Policy 1:1 General Aggregate Products - ComplOp AS9 AUTOMOBILE LIABILITY Combined Single Limit (EA Accident) Any Auto Bodily Injury All Owned Autos (Per Person) Scheduled Autos Bodily Injury Hired Autos Non -Owned Autos (Per Accident) Property Damage (Per Accident) EXCESS/UMBRELLA LIABILITY Each Occurrence Occur ❑ Claims Made Aggregate Deductible A Workers Compensation and X WC Statu- OTH- Employers' Liability WC 71949 01/01/2023 01/01/2024 to Limits ER E.L. Each Accident $1,000,000 Any proprietor/partner/executive officer/member E.L. Disease- Ea Employee $1,000.000 excluded? No If Yes, describe under special provisions below. E.L. Disease- Policy Limits $1,0D0,000 Other Lion Insurance Company is A.M. Best Company rated A (Excellent). AMB # 12616 Descriptions of Opomdons/LoeationsNehieles/Exclusions added by Endorsement/Special Provisions: Client ID: 92-69-490 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company": Weather Guard Industries, Inc Coverage only applies to Injuries Incurred by South East 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 the active employee(s) leased to the Client Company can be obtained by emalling a request to certificates@lloninsurancecompany.com Project Name: ISSUE 11-02-23 (KLT) Bealn Date: 61812015 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE Should any of the above described policies be cancelled before the expiration date thereof, the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to do so shalt impose no obligation or liability of any kind upon the insurer, its agents or representatives. 10050 NE 2ND AVENUE MIAMI SHORES, FL 33138 WEATHER GUARD INDUSTRIES INC 11460 NE 10 Ave, Biscayne Park, FI. 33161 (786)253-9865 Date: November 7, 2023 Sate of Florida Country of Miami dade Before me this day personally appeared Carlos Collazo who, being duly sworn, deposes and says: That he will be the only person working on the project located at: 9405 NW 9 Ave, Miami Shores, FI.33138 Contractor signature ti Swrn to (or affirmed) and subscribed before me this 7 day of .ic 20 ZJ Personally Know OR Produced Identificati n Type of Identification Produced # �'+�" ! LUCAS ROSSATO "`` MY COMMISSION#i GG 965117 •' ,'�/... EXPIRES: March 12, 2624 PP ".. Bonded Thn, Notary Public Ullderwilers Print, Type or Stamp Name of Notary