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RC-10-23-2667Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 1250 NE 93RD ST, Miami Shores, FL 33138 Contacts issue Date: 01/18/2024 Parcel Number 1132050270200 Permit No.: RC-10-23-2667 Permit Type: Building (Residential) Work ClossifiYotion: Repair Permit Status: Approved Expiration: 07/18/2024 JOEL RIVAS Owner ALPHA FOUNDATIONS Contractor 1250 NE 93 ST, MIAMI SHORES, FL 33138 MATTHEW STEPHEN SHANLEY Other: 3059789095 66 Industrial Park 66 Industrial Park, Monticello, FL 32344 Business: 8508771313 southpermits@alphafoundations.co m Description: 22 INTELLIJACKS SUPPORT REPAIR FOUNDATION Valuation: $ 20,000.00 Total Sq Feet: 172.00 Fees Amount Application Fee - Other $50.00 CCF $12.00 DBPR Fee $9.00 DCA Fee $6.00 Education Surcharge $6.00 Permit Fee $550.00 Scanning Fee $18.00 Structural Review ($90) $90.00 Technology Fee $60.00 Total: $801.00 Building Department Copy Ins ection Requests: 305-762-4949 n,a Payments Date Paid Amt Paid Total Fees $801.00 Credit Card 01/18/2024 $751.00 Credit Card 10/27/2023 $50.00 Amount Due: $0.00 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 regulating construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Cafe �pr�o MaltiY) January 18, 2024 Page 2 of 2 Miami Shores Village i` (!G' T 11 OCT Z 7 2023 Building Department I 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 -,v Tel: (305) 795-2204 Fax: (305) 756-8972--- - INSPECTION LINE PHONE NUMBER: (30S) 762-4949 {� FBC 202Z% BUILDING Master Permit No.Ro- - 117 -zz- z7 PERMIT APPLICATION Sub Permit No. .j�j.BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION I -]EXTENSION ❑RENEWAL ❑T-'PLUMBING ❑ MECHANICAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1250 NE 93rd Street 33138 City: Miami Shores County: Miami Dade Zip: Folio/ParcelM 11-3205-027-0200 Is the Building Historically Designated: Yes_ NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Joel Rivas Phone#: 305-978-9095 sa4.--1250 NE 93rd ST City: Miami Shores FL Tenant/Lessee Name: Phone#: Email: joel.rivas@ymail.com 33138 CONTRACTOR: Company Name: Alpha Foundations Phone#: 5615970054 Address: 3200 W Copans Road , Pompano Beach FL 33069 Email: Southpermits@aiphafoundations.com Qualifier Name: Matthew Shanley Phone#: 5615970054 State Certification or Registration #: CBC1263636 Certificate of Competency #: _ DESIGNER: Architect/Engineer. Phone#: Value of Work for this Permit- S .� 0. o © a Square/Linear Footage of Work: a 4 Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace ❑ Demolition Specify color of color thru tile. Submittal Fee Scanning Fee $, Technology Fee Fee $ DCA Fee $ Training/Education Fee $ CO/CC $ DBPR $ Notary $ Double Fee $ Structural Reviews $ P&Z Review $ Bond $ TOTAL FEE NOW DUE $ CO (Revised04/05/20221 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 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 Signatures OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this \\ day of 6r lr r 12003 . by CVAS . who is personally known to me or who has produced ,7� as c , identification and who did take an oath. P ;c? NOTARY PUBLIC: The foregoing instrument was acknowledged before me this 10 day of 0CiE`Jbc(— 1 20 -:) R , by tt.gA 6 ,j Syr je4mho is personally known to me or who has produced 7D `- as identification and who did take an oath. NOTARY PUBLIC:�� sign:r �- �— - - -o o — sign: i �— - v� 3 � '-. ^T:.� SG1/ln•EE31 2.Cti �o.PM� "y3a � �• �: T Print: Print,. P(lni �C'Cl� n rn 3•So .=C Seal: A w e Seal: = w cr oOJ �OaGp c Cm=. tti##i##i#########+++###i##i####i#i##ii#i##########+i####+#+++###4 APPROVED BY ry/ Plans Examiner Zoning ti Structural Review (RevisedG4/05/2022) Clerk M 13UILDING RtJIEVV APPRc"-I Sho �ING DEPARTM 1005 2 Au ores, FL 33 305-795-2204 www.msvfl.gov To NOTICE OF EMPLOYMENT AS SPECIAL INSPECTOR Process Number: g U M ocT 2 7 NZ3 I (We) have been retained byj« m-/o, to perform special inspector services underthe Florida Building Code 7eh Edition (2020) and Miami Dade County Administrative Code at the 1250 NE 93rd street project on the below listed structure as of 10/9M (date). I am a registered architect/professional engineer licensed in the State of Florida. Special Inspector for Reinforced Masonry, Section 2122.4 of the FBC 7T" Edition (2020) Miami Dade County Administrative Code, Article II Section 8-22 Special Inspector for Trusses > 35 ft. long or 6 ft. high _ Steel Framing and Connections welded or bolted _ Soil Compaction _ Precast Attachments A F F' R C V I_ _ Roofing Applications, Lt. Weight. Insul.Conc. Other Supplemental Floor Support/Final/Cart of Completion / CITY DATEI�IfJI Note: Only the marked boxes apply. The following individual(s) employed by this firm or me is authorized representative to perform inspection* 1. Timothy D. Triplett, P.E. 2. 3. 4. *Special inspectors utilizing authorized representatives shall insure the authorized representative is qualified by education or licensure to perform the duties assign by Special Inspector. The qualifications shall include licensure as a professional engineer or architect: graduation from an engineering education program in civil or structural engineering; graduation from an architectural education program; successful completion of the NCEES Fundamentals Examination; or registration as building inspector or general contractor. I (we) will notify the Miami Shores Building Department of any changes regarding authorized personnel performing inspection services. I (we), understand that a Special Inspector inspection log for each building must be displayed in a convenient location on the site for reference by the Miami Shores Building Department Inspector. All mandatory inspections, as required by the Florida Building Code, must be performed by the Miami Shores Building Department. Inspections performed by the Special Inspector hired by the owner are in addition to the mandatory inspections performed by the department. Further, upon completion of work under each Building Permit, I will submit to the Building Inspector at the time of the final inspection the completed inspection log form and a sealed statement indicating that, to the best of my knowledge, belief and professional judgment those portions of the project outlined above meet the intent of th fllflflyawilding Code and are in substantial accordance with NameheT Timothy D. Troval riplett, P.E. \\\��M1�\,\� OEN E% Signed and Sealed Date: 10/9/23 Engineer / Architect - Print Address 3723 Hogshead Road Apopka, FL 32703 . q ••., FLOi��e'•t^�� Rev10082021 Special Inspector Notice 'DECEIVE OCT 2 7 2023 Fort Myers (Alpha) Jacksonville (Alpha) Orlando (Alp ' ^ 1755 Benchmark Ave 55 Industrial Loop N 3723 Hogshe d Rd ^ l• ALPHAFort Myers, FL 33905 Orange Park, FL 32073 Apopka, FL 3 y _ " _- FOUNDATIONS Tallahassee (Alpha) Tampa (Alpha) Miami (Alpha) 66 Industrial Park Rd 1615 1181h Ave N 3200 W Copans Rd A Oroundworla Company Monticello, FL 32344 St. Petersburg, FL 33716 Pompano Beach, FL 33069 October 9, 2023 Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 Reference: Rivas Residence Alpha Customer # 258503 1250 NE 93rd Street Miami, FL 33138 To Whom It May Concern: As part of the permit application for structural repairs, Alpha Foundations is providing engineering commentary relative to the proposed installation of floor supports for the above -referenced project. At this time, Alpha Foundations proposes installing (22) floor supports on this property. Detailed information about the product and existing building structure are outlined in the attached report. The purpose of the IntellUacks will be to stabilize the existing foundation by providing supplemental support to areas that are experiencing distress, and prevent further foundation settlement. Excavation adjacent to the footing will not be performed; excavation will be performed for proposed 2'x2' pad footings as detailed on Page 3. Final placement and location of the jacks will be recorded. After completion of the foundation support system, we will evaluate and prepare a letter of completion for closeout. The commentary provided herein is intended to provide guidance during the planning and installation phases of the project. The design follows good engineering practice and is meeting requirements of the current 2020 Florida Building Code, 7th Edition. Please feel free to call us if you have any questions or if we can be of any further assistance. Respectfully, unman i �Oj•+1j6�1awF'„� a / • o c Timothy D Triplett This document has been electronically signed and sealed using a digital signature. Printed copies of this document are not ,,ee considered signed and sealed l"• and the signature must be ZZ verified on any electronic cop 2023.10.09 20:52:29-04'00' Timothy D. Triplett, P.E. Attachments: Senior Engineer Alpha Foundations Email: Tim.Triplett@groundworks.com 7902 STATE OF kppo for permit appjication , %'kcaVout Plan Product Evaluation Report by ICC-ES ENGINEERING REPORT FOR BUILDING PERMIT APPLICATION ALPHA CODE: FBC 2020 f7th edition] FOUNDATIONS BLDG DEPT.: Imiami Shores Village Building Department AGioundworlcsCompany 110050 NE 2nd Ave Miami Shores, FL 33138 DATE: October 9, 2023 [Report Format Rev. 91712022] PROJECT: Alpha Customer # 258503 ADDRESS: 1250 NE 93rd Street Miami, FL 33138 INSP.: Danny Navaro INSP. DATE: 9/29/2023 OVERVIEW: As requested by the owner/representative of the above referenced project (client), Alpha Foundations inspector visited the project and performed a visual inspection of readily accessible foundation areas (slabs, walls, and piers) and associated structural framing elements. Unless noted below, destructive testing and evaluation was not performed. Based on this inspection, Alpha Foundations Inspector and the client agreed to the following "Scope-Of-Woet". SCOPE -OF -WORK: JIMG lntelliJack w/footing QUANTITY: 22 Each fSEEPLAN-PAGE21 [SEE PRODUCT DETAILS -ATTACHED] SPACING (Typ.): 5 Feet [+1-12"Is Allowable] GENERAL ISSUE: PROP. SOLUTION: Excessive deflection, sagging, or over -spanned joists. Install IntelliJacks in crawlspace to provide support to existing framing system EXISTING STRUCTURE DETAILS: • Classification: Single Family • Stories: 1 • Construction: Wood Frame • Exterior: Wood • Foundation: Crawl Space • Floor Design Loads: Live Load: Dead Load: Timothy D Triplett This document has been uumglR electronically signed and sealed using a digital signature. Printed copies of x •'_ this document are not -: ',-,Lenpc considered signed and sealed �9rirrrrlaNµtttsssa` and the signature must be liftverified on any electronic copies. 2023.10.09 20:52:43-04'00' Residence Walls and Piers on [Based on Typical FBC Load] [See Calc Page for Pier Load] tr/Yll/ i l iVv• . �r - O ` 0\ 1' LOCATION / LAYOUT PLAN / NOTES ALPHA FOUNDATIONS BUILDING DEPT.: Miami Shores Village Building Department AQ , C,,,m PROJECT: JAlpha Customer#258503 DATE: 10ctober 9, 2023 NOTE 1: The purpose of the IntelliJack system, as shown in the plan below, is to (mark appropriate box) X - Provide support to a new supplemental girder or beam (adjustable). - Provide additional support to an existing main girder or beam (permanent'). 'For permanent applications, after the IntelliJack has been adjusted to the desired length, one screw thread must be damaged (using a cold chisel or hammer) to one-half its depth for a length of at least 1-112 inches to prevent vertical movement. [Ref: IMG IntelliJack Technical Data Sheet] Y CRAWLSPACE ACCESS (INDOOR UNDER A/C HANDLER) PFL -4 GRU i4 FRONT OF HOME IMG INTELLIJACK MAXIMUM SPACING 5' ±1' ALPHA DESIGN CALCULATIONS - INTELLIJACK FOUNDATIONS BUILDING DEPT.: I Miami Shores Village Building Department A OrmWaorpe Compmy PROJECT: Alpha Customer#258503 DATE: I October 9, 2023 TASK A: Evaluate Girder/Beam Loading and IntelliJack Loading: sTEP 1 - Determine the load which will be supported by the girder/beam in Ibs per linear foot: • Girder/Beam Load plf) = [Span 1 ft + S an 2 (ft)] x Floor Load (ps / 2 • Load = [ 1 9.5 1 9.5 ] x = / = 570 pif [Girder/Beam Load] STEP 2 - Determine the load on the IntelliJacks by multiplying the calculated girder/beam load by the spacing of the IntelliJacks: • IntelliJack Load Ibs) = Girder/Beam Load(pIf) x IntelliJack Spacing (ft) • Load = 570 x 5 2,850 Ibs [IntelliJack Load] [+/-12" OK] TASK B: Existing or new beam supported by existing supports and supplemental IntelliJacks (as shown on plan) is acceptable as per IRC girder/beam tables. OK TASK C: Evaluate IMG standard IntelliJack Footing Size: Given: Soil Bearing Capacity (Allow.) = 1,500 psf IntelliJack Load = 2,850 1 Ibs Min. Footing Embed. Depth = 12 in Determine minimum footing base for square type footing (isolated) • Base Width B, inches) = Sq. Root of IntelliJack Load / Soil Bearing Capacity • B = Vf 2,850 / 1,500 = 1.38 feet < 2 FEET - OK NOTE: Standard IMG design of 24" deep x 24" x 24" excavation with a minimum of 12" compacted gravel backfill and 12" thickness of cast -in -place concrete or aluminum plate is acceptable. Footing Detail: r■r ,.t` g1.w•1 • I.JJ'.11. A < <I Timothy D Triplett This document has been electronically signed and sealed using a digital ��{{ III//tignaturfths Printed (6pJ'�s of this "" r• = '1%�,H�e rignt are not signed sigAatur�iybtbG • • 790 1 onaig ectrdnic copies. 2023.1U.0tQlL 10; i�"rt111111111N1\� GENERAL COMMENTARY, LIMITATIONS ALPHA and ATTACHMENTS FOUNDATIONS BUILDING DEPT: I Miami Shores Village Building Department A@°ndlWotl¢Canpeny PROJECT: JAIpha Customer # 258503 DATE: I October 9, 2023 GENERAL COMMENTARY The recommendations provided herein are based on our understanding of the project and subsurface characteristics at the time of this report. If the project characteristics or work location are changed, the recommendations should be re-evaluated. LIMITATIONS The intent of the floor support is to provide support to existing beams/girders or to provide support to new beams serving in a supplemental support condition (as noted herein). It should be understood that one of the benefits of the floor support is the adjustable screw, which allows for minor and/or incremental adjustments over a period of time, which minimizes stress to the structure. This situation may also apply to permanent applications. In this regard, disabling the thread rod should be field verified based on job specifics. The information presented in this report is provided as support to proposed jack installation as outlined in the previous pages. This report does not represent commentary on causation of foundation or structural damage (flood, wind, ground subsidence, etc.). Any additional work shall be considered beyond the scope of these analyses. ATTACHMENTS: Yes IMG IntelliJack Technical Data Sheet (pages 1-2/2) Yes • A. IMG IntelliJack System - Code Evaluation Report N/A • C. Soils Investigation Report with Test Pit Data Timothy D Triplett This document has been elect ronicallysigned and •• \,��'� °° : healed using a digital peas+Q uni...•.°� .suenature. Printed copies athis document are not * C6nsidered signed and sealed and the signature AT apust be verified on any -�electonic copies. '��7.,°° �••\<C� 2023r100920:53:11 �ORtO, e�, 'O�'A \\' IntelliJackM Crawl Space and Basement Detail Existing Floor System Existing or Supplemental Timber, Wood Framing, Top Mounting Option (Sae Options Below) or Steel Beam Lifting Rod IJ-LR) Threaded Cap Ili-TC) Bottom Plate (IJ-BP), Recessed into Concrete. 'Alternatively Flush Mount w/}i' O Expanding Anchor Galvanized 3.5' z Bga Mechanical Tubing(IJ35036, CIP Concrete Over Compacted Aggregate IJ35060, IJ35M or IJ350120 Base \\\\\ FTop Mounting Options � 0 � 1I IJ-TP IJ-TP IJ-TP IJ-SP IJ-CS IJ-BO a.2xfkslq. 5-2.e.E.+Va 2-2X6MJas WJ ewm 84x77B— ain]emm seine N..lumW same R.W. SO-KU on, suivxn &il en wap way dale Ertl Vw EM. E.View EM V EM V. EMY sw.vi. 54e Vlew ske Vlew SMe VI" SW. Vlew swe Nmr INDEPENDENCE MATERIALS IMGGROUP 1�1 I t�•:�I� N� jam. Bottom Plate fte Anchored to otingon Precast Footing Aggregate w/IJ-SA(IJ-BP) IntelliJack INDEPENDENCE Product Specifications 1MG MATERIALS GROUP IntelliJack Load Capacity The allowable load carrying capacity for the IntelliJack is shown the PEI Code Evaluation Report, PER 19250. Allowable downward compressive load varies with column height but is established at 20.7 kips at an assembled height of 10 feet. Refer to the Evaluation Report for higher load values allowed at shorter column lengths. Allowable capacity for the IntelliJack system is likely to be governed by the footing design and available allowable soil pressure. Installation for Permanent Applications For applications where the construction is to be permanent, the threads of the lifting rod (IJ-LR) shall be damaged with a cold chisel after adjustment to the desired length. One screw thread immediately above the threaded cap shall be damaged for at least half its depth, and for a length of 1.5 inches to prevent loosening of the rod. Upward adjustment will still be feasible. IJ-TP (Top Plate) 1/2" THK x 5" x 6" long, ASTM A36 hrp&o plate with four 0.313" holes at corners and one 1.75" OD x 0.25" thick wall x 1.25" long retaining ring centered on plate with 0.25" external fillet weld, all around. Clear Zinc Electroplated to ASTM B633 Type III IJ-350361 IJ-35060, IJ-35084, IJ-350120 ( Mechanical Tubing) 3.50" OD x 0.165" thick wall ASTM A500, Grade C mechanical tubing, available 36", 609', 84" and 120" long and may be field cut to desired length. Yield strength = 46 ksi (min) Tensile strength =62 ksi (min) Galvanized to ASTM A1057. IJ-SP (Splice Plate) Upper and lower 1/2" THK x 5" x 6" long ASTM A36 hrp&o plates with four 0.563" holes at corners with welded retaining ring on lower plate with same detail as IJ-TP. Plates are bolted with 4- 1/2" x 5.5" SAE Grade 5 bolts and nuts, sandwiching the S4x7.7 steel beam. Center of splices must align with center of support, below. Clear Zinc Electroplated to ASTM B633 Type III IJ-BO (Bolt On Beam Mount) 1- 1/2" THK x 5" x 6" long ASTM A36 hrp&o plate with four 0.563" holes at corners with welded retaining ring on (plate with same detail as IJ-TP. Plates bolted with 4- 1/2" x 5.5" SAE Grade 5 bolts and nuts, through the bottom flange of the S4x7.7 steel beam Clear Zinc Electroplated to ASTM B633 Type III IJ-BP (Bottom Plate) 1/2" THK x 3.5" x3.5" long ASTM A36 hrp&o Plate with one 0.563" hole centered on plate, and one 3.13" OD x 0.188" thick wall x I" long ASTM A513 ring, internally welded to plate. Clear Zinc Electroplated to ASTM B633 Type III IJ-PB (Precast Base) Commercially available, precast concrete post base with 3,000 psi (min) compressive strength, and 12" x 12" base footprint. IJ-ES (Earth Spike) 5/8" x 18" long ASTM A615 G40 pointed reinforcing rod stake with welded nut. Yield strength = 40,000 psi(min) Tensile strength = 60,000 PEI(min) IJ-LR (Lifting Rod) 1.25" diameter x 10" long ASTM F1554-GR55 S1 threaded rod with tack welded heavy hex nut Yield strength = 55 ksi (min) Tensile strength = 75 ksi (min) Clear Zinc Electroplated to ASTM B633 Type III IJ-TC (Threaded Cap) 3.50" OD x 1.00" thick solid ASTM A 108-13 (1018) disk CNC machined with 1.25"-7 threads and recessed shoulder to fit the inside diameter of the mechanical tubing. Yield strength = 50 ksi (min) Tensile strength = 68 ksi (min). Clear Zinc Electroplated to ASTM B633 Type III IJ-CS (Clip Support) 1/4" THK x 3.30" x 1.25" x 4.50" long, ASTM A36 hro&p plate with ends shaped to receive insertion of S4x7.7 beam flange, and 1.75" OD x 0.25" thick wall x 1.25" long retaining ring centered on plate with 0.25" external fillet weld, all around. Clear Zinc Electroplated to ASTM B633 Type III S40.7 Supplemental Steel Beam 4.00" Tall X 2.63" wide, steel S shape (I-beam), ASTM A992, available 120" and 144" long, and may be field cut to desired length. Yield Strength = 50 ksi (min) Tensile strength = 65 ksi (min) IJ-AB (Aluminum Base) 1" thick, at the hub, x 14.2" diameter AA 356.0-T5 cast aluminum base plate. Yield strength = 20 ksi (min) Tensile strength = 25 ksi (min) 1J-IC (Precast Concrete Footing) 6" THK x 14" diameter, 5,000 psi (min), fiber reinforced, precast concrete footing with a 0.75" diameter hole at center, and 3/4" chamfer at upper circumference. VER.10/22/2019 2 ICC EVALUATION SERVICE' Compliance to International Codet Compliance to State/Regional Codes www.icc-es.orst 1 (800) 423-6587 1 (562) 699-0543 A Subsidiary of the International Code Councils IMES Evaluation Report Reissued October2022 ESR-5007 DIVISION: 05 00 00—METALS Section: 06 50 00—Metal Fabrications REPORT HOLDER: INDEPENDENCE MATERIALS GROUP, LLC (IMG) EVALUATION SUBJECT: INTELLIJACK SUPPORT COLUMNS 1.0 EVALUATION SCOPE Compliance with the following codes: ■ 2021, 2018, 2015 and 2012 International Building Code® (IBC) ■ 2021, 2018, 2015 and 2012 International Residential Code® (IRC) Property evaluated: Structural 2.0 USES The IntelliJack Support Columns are used to transfer axial compressive loads from wood or steel beams to concrete footings. They may be used under the IBC and the IRC when an engineering design is prepared in accordance with IRC Section R301.1.3. 3.0 DESCRIPTION 3.1 General: The IntelliJack Support Columns consist of a steel tube column with a bottom plate at one end and an adjustable screw assembly at the other end. The adjustable screw assembly consists of a base plate, threaded rod, top plate and collar. The IntelliJack Support Columns have been evaluated in nominal lengths up to 10 feet (3048 mm) and can be adjusted up to a maximum 5-inches (127 mm) in length. See Figure 1 for details. 3.2 Material: 3.2.1 Steel Tube: The steel tube comes in 3'/= -inch- outside diameter (88.9 mm) and has a nominal thickness of 0.165-inch (4.2 mm). The tubing conforms to ASTM A500 Steel, Grade B-C with a minimum yield strength of 50 ksi (345 We) and a minimum tensile strength of 55 ksi Revised November 2022 This report is subject to renewal October 2023. (379 MPa). The tubes have a corrosion resistant coating finish. 3.2.2 Bottom Plate Assembly: The bottom plate assembly consists of ASTM A36 steel plate 3'/2 by 3%-inches (88.9 mm by 88.9 mm) square with a nominal thickness of ''/rinch (12.7 mm); with a 3/e-inch-long (19.1 mm) piece of 3-inch-outside-diameter (76.2 mm) ASTM A36 steel tube that is welded to the center of the plate. The bottom plate assembly has a corrosion resistant finish. See Figure 2 for details. 3.2.3 Threaded Rod Assembly: The threaded rod assembly consists of 1'/,inch-diameter (31.8 mm) by 10-inches long (254 ni ASTM F1554, Grade 55 Steel threaded rod with matching 1 V4-inch-diameter (31.8 mm) -7 ASTM A563, Grade A steel Heavy Hex Nut with a Zinc coating. One nut is welded to the threaded rod and one nut is used as a jam nut against the collar. See Figures 1 and 3 for details. 3.2.4 Top Plate Assembly: The top plate assembly consists of ASTM A36 steel plate 6-inches wide by 5-inches long (152.4 mm by 127 mm) with a nominal thickness of '/rinch (12.7mm); with a 1%4-inch-long (31.8 mm) by 11/4-inch-outside diameter (44.4 mm) ASTM A36 steel tube welded to the plate. The Top Plate Assembly has a corrosion resistant finish. See Figure 3 for details. 3.2.5 Collar (threaded cap): The collar is placed in one end of the steel tube. A threaded hole is in the center of the collar for the threaded rod. The collar is made from ASTM A1018 steel and has a corrosion resistant coating. See Figure 4 for details. 4.0 DESIGN AND INSTALLATION 4.1 Design: Design loads [for allowable stress design (ASD) and for load and resistance factor design (LRFD)] shall be determined in accordance with 2021 IBC Section 1605.1 and must not exceed either the allowable loads or design strengths given in Table 1, as applicable. Design loads determined in accordance with 2018, 2015, and 2012 IBC Section 1605.3 [for allowable stress design (ASD)] must not exceed the allowable loads given in Table 1, as applicable. Design loads determined in accordance with 2018, 2015 and 2012 IBC Section 1605.2 [for load and resistance factor design (LRFD)] must not exceed the design strengths given in 1CC-ESEralualion Reports are nano be comonmedas representingaesthetics or any other ouributes no, specicallyaddeessed nor are they to be construed _ as an endorsement ojthe subject ofthe report or a recommendation/of as use. There is no warmnry by Evalaalion,Semice. LLC. erpresr or implied, m, AAw to anyjnding or other matter in this report, or as to atry product covered by the report. I Copynght 02022[CC Evaluation Service, LLC. All tights reserved. Page 1 of 6 ESR5007 ] Most Widely Accepted and Trusted Page 2 of 6 Table 1, as applicable. The capacity of the top and base steel plates must be calculated in accordance with applicable code requirements for the steel, concrete or wood, to determine whether or not the supplied steel plate 5.4 thickness is adequate for the applied load interface (wood beams, steel beams or concrete). 4.2 Installation: Installation of the IntelliJack Support Columns must comply with this report, the report holder's published installation instructions and the approved plans. The report holder's published installation instructions and the approved plans must be available at the jobsite at all times during installation. The columns must be supported on code -complying foundations capable of supporting the imposed load. The columns must be placed vertically plumb in the desired position under the beam. The columns must be anchored to the foundation in accordance with the approved plans. The columns must be adjusted to ensure full bearing of the beam on the top plate. Maximum length adjustment of the columns is 5 inches (127 mm). After the column has been adjusted to the desired length, one screw thread immediately above the threaded cap must be damaged to one half its depth for a length of 1 Y: inches (38.1 mm) with a cold chisel to prevent vertical movement of the column. The top plate must be attached to the supported beam in accordance with the approved plans. After installation of the IntelliJack Support Column, the column may be encased in concrete to prevent movement after installation. Protection of the column shall in accordance with IBC Section 2203 and IRC Section R407.2. 5.0 CONDITIONS OF USE The IntelliJack Support Columns described in this report complies with, or is a suitable alternative to what is specified in, those codes listed in Section 1.0 of this report, subject to the following conditions: 5.1 The column assemblies must be fabricated and installed in accordance with this report, the report holder's published installation instructions, the approved plans and the applicable code. In the event of a conflict between the report holder's published installation instructions and this report, the more restrictive requirement governs. 5.2 Where required by the code official, engineering calculations and construction documents consistent with this report must be submitted to the code official for approval. The documents must address details of the attachment of the column to the structure, consistent with the requirements of this report. The documents must be prepared by a registered design professional where required by the statutes of the jurisdiction in which the project is to be constructed. 5.3 Loading on the columns must be limited to concentric axial compressive loads, in accordance with Section 4.1. Other loading conditions, such as but not limited to, eccentric loads, tensile axial loads, bending loads, and lateral loads, are outside the scope of this report. Connections of the post to the foundation and the supported construction, and bearing capacity of the supported beam, are outside the scope of this report and must be approved by the code official. 5.5 Maximum adjustment of the IntelliJack Support Columns is 5 inches (127 mm) and the overall column height must be limited to the maximum height given in Table 1. 5.6 The IntelliJack Support Columns are manufactured under a quality control program with inspections by ICC-ES. 6.0 EVIDENCE SUBMITTED Data in accordance with the ICC-ES Acceptance Criteria for Adjustable Steel Columns (AC335) dated February 2008 (editorially revised January 2021). 7.0 IDENTIFICATION 7.1 Product labeling includes the name of the report holder and the ICC-ES mark of conformity. The evaluation report number (ICC-ES ESR-5007) may be used in lieu of the mark of conformity. The IntelliJack Support Columns are labeled with the report holder's name [Independence Materials Group, LLC (IMG)], the product name, the minimum and maximum lengths, the design thickness, the allowable load, 5inches maximum adjustment height, and the ICC-ES evaluation report number (ESR-5007). 7.2 The report holder's contact information is the following: INDEPENDENCE MATERIALS GROUP, LLC (IMG) 1741 CORPORATE LANDING PARKWAY VIRGINIA BEACH, VIRGINIA 23454 (803)807-8629 www.independencemateriaisgroup.com ESR-5007 I Most Widely Accepted and Trusted Page 3 of 6 TABLE 1—LOAD CAPACITIES FOR INDEPENDENCE MATERIALS GROUP, LLC (IMG) INTELLIJACK SUPPORT COLUMNS1.2,3A 3112-inch OUTSIDE DIAMETER TUBE NOMINAL SIZE (inch) ALLOWABLE LOAD FOR ASD (Ibf) DESIGN STRENGTH FOR LRFD (Ibf) 12 - 96 24,860 39,780 108 24,100 36,220 120 20,700 31,110 For SI: 1 inch = 25.4 mm, 1 lb = 4.4 N 'All steel tubes shall be in accordance with ASTM A500 with a minimum yield strength of 50 ksi (345 MPa) and a minimum tensile strength of 55 ksi (379 MPa). 2Nominal size is the column length at its shortest adjustment. 3AI1 capacities are designed in accordance with AISC 360-16. °LRFD Design Strength values must be compared to factored loads. a w W pD Q w O co w N FIGURE 1—OVERALL INTELLIJACK COLUMN ASSEMBLY ESR-5007 I Most Widely Accepted and Trusted Page 4 of 6 10 3.5 'c) U M BOTTOM PLATE TOP VIEW SIDE VIEW FIGURE 2—BOTTOM PLATE ASSEMBLY 6.0 T-1 0 CR Lo 0 U TOP PLATE TOP VIEW t - SIDE VIEW FIGURE 3—TOP PLATE 03.5000 FIGURE 4—COLLAR 3.3" CLIP SUPPORT BOTTOM VIEW CLIP SUPPORT SIDE VIEW 03.1500 1 114" - 7 THREADED HOLE FIGURE 5—CLIP SUPPORT SIDE VIEW ICC-ES Evaluation Report ESR-5007 FBC Supplement Reissued October 2022 Revised November 2022 This report is subject to renewal October 2023. www.icc-es.orq 1 (800) 423-6587 I (562) 699-0543 A Subsidiary of the International Code Council® DIVISION: 05 00 00—METALS Section: 05 50 00—Metal Fabrications REPORT HOLDER: INDEPENDENCE MATERIALS GROUP, LLC (IMG) EVALUATION SUBJECT: INTELLIJACK SUPPORT COLUMNS 1.0 REPORT PURPOSE AND SCOPE Purpose: The purpose of this evaluation report supplement is to indicate that IntelliJack Support Columns, described in ICC-ES evaluation report ESR-5007, have also been evaluated for compliance with the codes noted below. Applicable code editions: ■ 2020 Florida Building Code —Building ■ 2020 Florida Building Code —Residential 2.0 CONCLUSIONS The IntelliJack Support Columns, described in Sections 2.0 through 7.0 of ICC-ES evaluation report ESR-5007, complies with the Florida Building Code —Building and Florida Building Code —Residential. The design requirements must be determined in accordance with the Florida Building Code —Building or the Florida Building Code —Residential, as applicable. The installation requirements noted in ICC-ES evaluation report ESR-5007 for the 2018 International Building Codee meet the requirements of the Florida Building Code —Building or the Florida Building Code —Residential, as applicable. Use of the IntelliJack Support Columns have also been found to be in compliance with the High -Velocity Hurricane Zone provisions of the Florida Building Code —Building and the Florida Building Code —Residential, with the following condition: is The minimum least dimension and minimum wall thickness of tubular steel columns must be in accordance with the Florida Building Code —Building Section 2219.1. For products falling under Florida Rule 61 G20-3, verification that the report holder's quality assurance program is audited by a quality assurance entity approved by the Florida Building Commission for the type of inspections being conducted is the responsibility of an approved validation entity (or the code official when the report holder does not possess an approval by the Commission). This supplement expires concurrently with the evaluation report, reissued October 2022 and revised November 2022. ICC-ES Evaluation 2epans are not to be construed as representingaesthetics or any other auributes not specdcally addressed, nor are Ihey to be construed am as an endorsement of the subject of the report or a recommendation far Its use. There is im warmnly by ICC Evaluation Service, LLC, express or implied, as to any finding or other matter in this report, or as to any product covered by the report. -.�. Copyright 02022 ICC Evaluation Service, LLC. All rights reserved. Page 6 of 6 Fort Myers (Alpha) Jacksonville (Alph Orlando (Alpha) 1755 Benchmark Ave 55 Industrial Loop N 3723 Hogshead Rd ALPHAFort Myers, FL 33905 Orange Park, FL 32073 Apopka, FL 32703 FOUNDATIONS Tallahassee (Alpha) Tampa (Alpha) Miami (Alpha) 66 Industrial Park Rd 1615 118"' Ave N 320D W Copans Rd A Oaoundworks company Monticello, FL 32344 St. Petersburg, FL 33716 Pompano Beach, FL 33069 Permit # RC10232667 December 18, 2023 Miami Shores Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 Reference: Engineering Letter of Completion (LOC) Rivas Residence (Alpha Customer #258503) 1250 NE 93 St Miami, FL 33138 To Whom It May Concern: This letter is to certify and verify Alpha Foundations has completed the alterations at the above -referenced property in general accordance with the permit documents. Foundation jacks were installed to stabilize the existing foundations, and to prevent further settlement of the foundation of the structure. I have inspected the materials and installation for conformance to the approved permit documents. To the best of my knowledge, belief and professional judgment, the jacks meet the intent of the Florida Building Code 2020 7th Ed. and are in substantial accordance with the "approved plans." The jacks were installed in accordance with the manufacturer's guidelines and specifications and per the Engineer of Records requirement. Please see attached drawing for the AS -BUILT layout of the jacks. This Engineering Completion / Certification letter should serve to close out the referenced permit. If you have any questions, please do not hesitate to contact me. Respectfully, Timothy D Triplett\lhll I I I111. // This document has been electronically signed and p.�,+ri .. sealed using a digital \\ (`� • ^ j zt° signature. Printed copies of �iJ•�GEI��SC•' ' a this document are not = �� .,qpc considered signed and N '`'yo,,,,�";�„a�°° sealed and the signature must be verified on any *, J electronic copies. . 1 F OF ' 2023.12.1815A6:29-05'00' S, 4111IIII O Timothy D. Triplett, P.E. Attachments: Senior Engineer Alpha Foundations As -Built Dawings Email: Tim.Triplett@groundworks.com Installation Photos ALPHA FOUNDATIONS A f amdmrl¢ Company PRODUCTION PHOTOS BUILDING DEPT.: IMianni Shores Building Department PROJECT: IRivas Residence (Alpha Customer#258503) DATE: IDecember 18, 2023 Installed Jack (TYP.) Installed Jack (TYP.) electrohlc5111j41gried and sealed using a digital signature. Printed copies s( — m of this document are not IN considered signed and IN, s"g sealed and the signature must be verified on any electronic copies. 2023.12.1815:46:41 -0s•ao' Alpha Foundations • 66 Industrial Park Dr. • Monticello, FL32344 • (850) 877-1313 P IRc-lo-Z3 -uvz / ZS/zq W L) Z Q J a 2 0 U U. 0 w W r W J ARCHITECT OR ENGINEER: FIRM: ECUIP ENGINEERING NAME: RYAN GITTENS LICENSE #: PE90605 ADDRESS: 1646 W SNOW AVE 196 CITY: TAMPA STATE: FLORIDA ZIP: 33606 PHONE:813-438-3035 EMAIL: INFOna.ECUIP.COM CONTRACTOR: FIRM: FLORIDA ECO ELECTRIC QUALIFIER: KEDIR FELIX LICENSE #: EC13011090 ADDRESS: 1413 E ALFRED ST. CITY: TAVARES STATE: FL ZIP: 32778 PHONE: 352-460-0402 EMAIL: kfelix(oDfloridaecoelectric.com PERMIT M INSPECTION TYPE: SOLAR ROOF ATTACHMENT PROJECT ADDRESS: 148 NW 97TH ST, MIAMI SHORES, FL, 33150 INSPECTED BY: RYAN GITTENS, PE LICENSE M PE 90605 WE HAVE PROVIDED A REVIEW OF THE ROOF CONSTRUCTION & SOLAR INSTALLATION AT THE REFERENCED PROPERTY AND OBSERVED THAT THE DECK SCREWS PENETRATED THROUGH THE DECKING AND NO DAMAGED TRUSSES OR DECKING WAS OBSERVED AT THE TIME OF INSPECTION. ALL POINTS OF CONNECTION INCLUDING PANEL TO RACK, RACK TO MOUNT, MOUNT TO STRUCTURE AND WATERPROOFING WERE ALSO INSPECTED. TO THE BEST OF MY KNOWLEDGE, BELIEF AND PROFESSIONAL JUDGEMENT THE PORTIONS OF THE PROJECT OUTLINED HAS MET THE INTENT OF THE FLORIDA BUILDING CODE AND ARE IN SUBSTINTIAL ACCORDANCE WITH THE APPROVED SUBMITTED PLANS. THIS DETERMINATION IS BASED ON A COMBINATION OF IN PERSON, IN PROGRESS SITE VISITS BY THE LISTED ENGINEER AND/OR REPRESENTATIVES OF THE FIRM ALONG WITH AS -BUILT PHOTOGRAPHS. CODE SECTION: FLORIDA BUILDING CODE 7TH ED. RESPECTFULLY, RYAN GITTENS, PE FL LICENSE: PE90605 5 GITTF''�i� No 90605 STATE OF '��-Z %��4 r1 '"",S,/oNAL EN��`` SEAL Ron DeSantis, Governor Melanie S. Griffin Secretary Florida STATE OF FLORIDA Florida ur-rmK 1 Ovir-11741 OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTIONJ THE BUILDING C04RA"'i NG BOARD QED UNDER THE ieATUTES k L10EkSQWMB636 ----------- EXPIRATION DATE: WU-GUST 31,2024 Always verify licenses online at MyFloridaLicense.com W. 5 Do not after this document in any form. Iffli 441 r This is your license. It is unlawful for anyone other than the licensee to use this document. BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-357-4829 VALID OCTOBER 1, 2023 THROUGH SEPTEMBER 30, 2024 Business Name: ALPHA FOUNDATIONS Owner Name: MATTHEW S SHANLEY Business Location: 3200 W COPANS RD POMPANO BEACH Business Phone: 8508771313 Receipt #:189-320546 1 ALL OTHER TYPES CONT CTOR Business Type: (BUILDING CONTRACTOR Business Opened:10 / 2 0 / 2 0 21 i State/County/Cert/Reg:CBC12 63 63 6 E Exemption Code: Rooms Seats Employees Machines Professionals 250 For Vending Business only -- - --- - - Vs.ad'■nn Tenn• Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 150.00 0.00 0.00 15.00 0.00 0.00 165.60 Receipt Fee 1JV-"" Packing/Processing/Canning Employees 0.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planni ig WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred wh an the business is sold, business name has changed or you have moved t ie business location. This receipt does not indicate that the business is legal or tt al it is in compliance with State or local laws and regulations. Mailing Address: ALPHA OPERATIONS II LLC 66 INDUSTRIAL PARK MONTICELLO, FL 32344-5876 2023 .2024 Receipt #WNW-23-00000687 Paid 10/03/2023 165.00 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-357-4829 VALID OCTOBER 1, 2023 THROUGH SEPTEMBER 30, 2024 Business Name: ALPHA FOUNDATIONS Owner Name: MATTHEW S SHANLEY Business Location: 3200 W COPANS RD POMPANO BEACH Business Phone: 8508771313 Rooms Seats Signature Receipt #: 189-320546 Business Type: ALL OTHER TYPES C (BUILDING CONTRAC Business Opened: 10/20/2021 State/County/CertlReg: CaCi 2 6 3 6 3 6 Exemption Code: Employees Machines Professionals 250 Number of Machines: venain e: Tax Amount I Transfer Fee NSF Fee Penalty Prior Years I Collection Cost Total Pa 150.00 0.00 0.00 15.00 0.00 0.00 165.00 Receipt #WNW-23-00000687 Paid 10/03/2023 165.00 ® 8T11' 1iV�Ul�►fV CE DATE (I+u++arDDnrmr) ACOR CERTIFICA I E. OF L.IIAEIL. 4/20/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HO CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AU REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. ER. THIS OLICIES ORIZED IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the poilcy(les) must have ADDITIONAL INSURED provisions or be If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). Ondorsed. meet on PRODUCER Marsh & McLennan Agency LLC 3625 N. Elm Street Suite 200 Greensboro NC 27455 CONTACTNAME. Rhonda S. ,!ones, CIC PHONE Ext). 919-719-9863 Fax No • 212-60 1124 DRESS: Rhonda.Jones@MarshMMA.com INSURERS AFFORDING COVERAGE NAIC# INSURER A: Amerisure Insurance Company 19488 INSURED SCPJE-1 Groundworks Operations, LLC See Full List of Named Insured below 1741 Corporate Landing Pkwy 101 Virginia Beach VA 23454 INSURER B : Amedsure Mutual Insurance Company s 23396 INSURER C : Stan- Indemnity & Uabif Company a 38318 INSURER D : Axis Surplus Insurance Company i 26620 INSURER E : ru�.r rerti c . e{� S L+UVCKAL?Ce vcnl a-.vr.. r- ..v......-........, r......... THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLITY INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL T} EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 11 PERIOD THIS E TERMS, ILTR TYPE OF INSURANCE ADDL S POLICY NUMBER POLICY EFF MMD POLICY EXP NMD UIxCI S A X COMMERCIAL GENERAL LIABILITY CPP21009951001 4/29/2023 4/29/2024 EACH OCCURRENCE $1,000 00 PREMISES Ea 0=wence $1,000 00 CLAIMS -MADE OCCUR MED EXP (Any one person) $10,00 250.000 X PERSONAL & ADV INJURY S 1,000 00 X XCU not Excluded GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000 00 PRODUCTS - COMP/OP AGG $ 2,000 O B B 8 e x POLICY a JR O. = LOC X OTHER: Cont. Liab. Ind AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS XHIRED NON -OWNED AUTOS ONLY X AUTOS ONLY CA21009941002 CA21194620202 CA21176220302 CA21164490302 4/29/2023 4/29/2023 4/29/2023 4/29/2023 4/29/2024 4/29/2024 4/29/2024 4/29/2024 COMBINED SINGLE LIMIT accident) $ g 1,00000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident) $ $ 8 C X UMBRELLA LIAB EXCESS LIAR OCCUR CU21009961002 1000587040231 4/29/2023 4/29/2023 4/29/2024 4/29/2024 EACH OCCURRENCE $ 5r000k000 HCLAIMS-MADE AGGREGATE $ 5,000 0 DED I X i RETENTIONS $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNERIEXECUTIVE Y� WC21009970902 4/29/2023 4/29/2024 X PER � ER E.L. EACH ACCIDENT $1,000 00 E.L. DISEASE - EA EMPLOYEE $1,000 00 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) NIA E.L. DISEASE -POLICY LIMIT $1,000 000 If yes. describe under DESCRIPTION OF OPERATIONS below A D LeasedlRented Equipment Pollution UabTity CPP21009951001 CP004517032023 4/29/2023 4/29/2023 4/29/2024 4/29/2024 Lrrdt Deductbe PoRudon seeICI ow 500,000 5.� DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Addidonal Remarks Schedule, may be attached If more space is required) Named Insured List Continued; A-1 Plumbing Companies, LLC; DBA A-1 Sewer & Drain Inc. AFS Newco, LLC AFSRR Newco, LLC Alabama Foundation Specialists, Inc. Alpha Fleet Services, LLC Alpha Foundation Specialists, LLC Alpha Operations II, LLC; DBA Alpha Foundations Ova Attounea... wf�w77 CHA �'rC- !JAI ACS C-AY(-Fi I ALT11-IRS 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELL ED BEFORE Miami Shores Village Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEi ACCORDANCE WITH THE POLICY PROVISIONS. VERED IN 10050 NE 2nd Ave Miami'Shol'@S, Florida 33138 i AUTHOPXMDREPRESENTATIVE W IW001AU 1.7 #%U%Jr%1J NVRrVRMI IVI11. PUS I SVI IM 10*01 VtSY. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: SCPJE-1 LOC #: ACC) ADDITIONAL REMARKS SCHEDULE Page ,1 of T AGENCY Marsh 8� McLennan Agency LLC NAMED INSURED Groundworks Operations, LLC See Full List of Named Insured below l 1741 Corporate Landing Pkwy 101 POLICY NUMBER Virginia Beach VA 23454 CARRIER NAIC CODE EFFECTIVE DATE: i THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Basement Systems of West Virginia, Inc. Coastal Foundation Services, LLC Foundation Systems of Michigan, LLC; dba Foundation Systems Midwest; Basement Systems of Northern Michigan; Foundation Systems; Northern Basement Systems; Michigan Foundation Systems; Foundation Systems of Northern Michigan, LLC Groundworks Acquisition, LLC Groundworks Colorado, LLC; dba Complete Basement Systems; dba Foundation Repair of Western Colorado; dba Peak Structural Groundworks Florida, LLC; dba Florida Foundation Authority Groundworks FRS, LLC; dba Foundation Recovery Systems Groundworks Georgia, LLC; dba Alabama Foundation Services; dba AquaGuard Foundation Solutions Groundworks Intermediate Holding, LLC Groundworks, LLC; dba Jes Foundation Repair Groundworks Merger Sub, LLC Groundworks Minnesota, LLC; dba Innovative Basement Authority Groundworks Nebraska, LLC Groundworks North Carolina, LLC; dba of Tarheel Basement Systems, JES Tarheel, LLC; DBA Dry Pro Basement Systems. Groundworks OBA, LLC Legal name change to: Groundworks Ohio, LLC; dba Ohio Basement Authority; dba Ohio Basement Systems Groundworks Operations, LLC Groundworks Operations, LLC dba Basement Systems of West Virginia Groundworks Software, LLC Groundworks Texas, LLC; dba Foundation Support Specialists. Gutter Systems of Michigan, LLC; dba Drip Free Gutters; Drip Free Independence Materials Group, LLC (IMG) Intelligent Technology, LLC JES Columbia, LLC; dba Mount Valley Foundation Services JES Companies, LLC JES Construction, LLC: dba JES Foundation Repair JES Construction, LLC; dba Baker's Waterproofing; dba BQ Basements and Concrete JES Evergreen, LLC JES Holdings Inc JES Indiana, LLC; dba Indiana Foundation Service JES Operations, LLC JES Remediation Services, LLC National Foundation Repair Services Inc. Proof Merger Sub, LLC Sales Systems of Michigan, LLC Installation Floater Amerisure Insurance Company CPP21009951001 Eff. Date 4/29123 Exp. Date 4/29/24 Limit $100,000 Deductible $1,000 Contractors Pollution/Professional Liability (Errors & Omissions) Axis Surplus Insurance Company CP004517032023 - Eff. Date 4/29/23 Exp. Date 4/29/24 Each Claim Limit $4,000,000 Aggregate Limit $8,000,000 Deductible $50,000 ACORD 101 (2008/01) O 2008 ACORD CORPORATION. All rigI*s reserved. The ACORD name and logo are registered marks of ACORD