Loading...
BP-03-1899MIAMI SHORES VILLAGE BUILDING DEPARTMENT S 305- 795 -2204 Building Inspection Request Date Type Insp' n Pral R6oC . Qfpc Permit No. OP I M ` c6 1, 8 ¶ 1 Name r o rr� Ur) Address ' 1300 1•S Company 66 `' ( Phone # Inspection Date a 6918 L) Approved ) 11( Correction ❑ Re -Insp' n Fee ❑ BUILDING PERMIT APPLICATION FBC 2001 Miami Shores Village Building Department '3 DEL (i ' zUti3 Permit Type (circle): Building Electrical Plumbing Mechanical Mechanical Owner's Name (Fee Simple Titlelio c e_r) �n d/ (GI t W(5c t y Phone # Owner's Address 1 1 3► 0 Architect/Engineer's Name (if applicable) Architect/Engineer's Address City ' $ Value of Work For this Permit P -P Sag t: 2 A-v-e h w C. State Number of: Bays Stories Families Type of Work: ['Addition ['Alteration DNew Describe Work: f 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. 6 ao5 d 1 Master Permit No. 3 s 8'y� 3 7 RS City 11% c a rc State Pt Zip 33 1 C Tenant/Lessee Name Phone # tc ,G/o �'fl ® 6 ��/ te`' Job Address (where the work is being done) / / b City Miami Shores Village County Miami -Dade Is Building Historically Designated YES NO Contractor's Company Name ©h t/V DUV /ebv f',ng Contractor's Address 4 r' d) tt+) a a Ake ft,' 11 e A 10 City J1/ -A 1 i d h t t t S State, F Qualifier < 74-14A, Z 3 7) ©P Zip Phone # / Zip 33) Phone # Square Footage Of Work: 4 519 Bedrooms Zip Baths Repair/Replace D Demolition tG g-- c \ c ******** ********************F ees ****************************** * **** ** ** * **** * ** * *,r ***** County Escrow Fee $ 1J' .. r \ Permit Fee $ 800 °'°' Notary $ Education/Training Fee $ Tech $ Scanning $ Code Enforcement $ Bond $ Struct. $ Minus Plans Check Fee $ Total Fee Now Due $ (Continued on opposite side) Radon $ DEC 1. 1 PAID Bonding Company's Name (if applicable) Bonding Company's Address City 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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. F . YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." N 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. `Signatur The foregoing instrument was acknowledged before me this.3O dayof vdo 2004/ by Fede 4i/lam who is personally known to me o who has produced NOTARY PUB 7 / /�j� Sign:. s ✓`2 `J v�z^�%f� Print: // /,1 ei) `/ f (�b, My Commission Expires: 4 v J chc7/7 /o3 APPLICATION APPROVED BY: State Zwner or °gent t/P �c4 l e fi rs As identification and who did take an oath. Zip Contractor egoing ins e e e ent was acknowledged before me this 20 , rJ by ,m CJ 6 Ut® who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign. Print: Signa The fo day of who (Certificate of Competency Holder) Certificate of Competency No. C o on gtcue,��� C �. �" DEC - 5 2003 I / i (r, mi .. io , t ; 311 UUor. ® ( a 6 eP , n catch 4, 2 Lni1<<tl 1ii�a My Ar - c2 a 3 PHYLLIS D. VRBAS dP'tiRtafdo My Conyrikdon West** 30,2304 e see ** ; *�e *#* * * * ***`cift 0 ** * * * * * * * * * * * * * * * * * * * * * * * * ** *** *********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning • — _ 1. eeaailiag wood necks When replacing roofing, the existing wood roof deck may have to be renailed iu accordance with the current provisions of Chapter 16 (High Velocity Hurricane Zones) of the. (The root deck is usually concealed prior to removing the existing roof system). 3. Common Roofs; Common roofs are those which have no visible delineations 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 unite of roofing work to be performed. 4. Exposed ceiliwge; Exposed, open beam ceilings are where the underside of the roof decking can be viewed from below. The owner may wish to maintain the architectural appearance; therefore, roofing nail penetrations of the underside of the decking may not be acceptable. The provides the option of maintaining this appearance. 5. Poodiaq Neter: The current roof system and /or deck of the building may not drain well and may cause water to pond (accumulate) in low - lying areas of the roof. Ponding can be an indication of structural distress and may require the review of a professional structural engineer. Ponding may shorten the life expectancy and performance of the new roofing system. Ponding conditions may not be evident until the original roofing system is removed. Bonding conditions should be corrected. *1524.1 Seeps. As it pertains to this section, it is the responsibility of the roofing contractor to provide the owner with the required roofing permit, and to explain to the owner the content of this section. The provisions of Chapter 15 of the Florida Building Code, Building govern the minimum requirements and standards of the industry for roofing system installations. Additionally, the following items should be addressed as part of the agreement between the owner and the contractor. The owner's initial in the designated space indicates that the item has been explained. 1. Aesthetics- workmanship; The workmanship provisions of C hapter 15 (High Velocity Hurricane Zone) are for the purpose of providing that the roofing system meets the wind resistance and water intrusion performance standards. Aesthetics (appearance) are not a consideration with respect to workmanship provisions. Aesthetic issues ss:ch as color or architectural appearance, that are not part of a code, should be addressed as part of the agreement between the owner and the contractor. Own 90 39Vd RIB VELOCITY NOBRZCI R ZONES a NEVII3D OWNBRE NOTIFICATION FOR ROOFING CONSIDERATIONS 6. Overflow 9cuppere (wail outlets); It is required that rainwater flow off so that the roof is not overloaded from a buildup of water. Perimeter /edge walls or other roof extensions may block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accordance with the requirements of; 7. Vaatilation: Most roof structures should have some ability to vent natural airflow through the interior of the structural assembly (the building itself). The existing amount of attic ventilation shall not be reduced. It may be beneficial to consider additional - tinting which cae result in extending the service life the roof. , e Ta /Agent's Si gnature Date tractor's * gnat JNIa"1Il3 L L9t'98ibg6 ZG :ZT 6:002 /L I //0T , . Strip and Removal Glove Bag Bulldozer Wrecking Ball Wet Method * Dry Method Explode - Bum Down OTHER: x 1 "--P ` to 6 e- !r ' �"`!' f' ()A r _ Florida Department of Environmental Protection Division of Air Resource Management NOTICE OF ASBESTOS RENOVATION OR DEM OLITI TYPE OF NOTICE (CHECK ONE ONLY): (ORIGINAL 0 REVISED /4' ❑ CANCELLATION TYPE OF PROJECT (CHECK ONE ONLY): ❑ DEMOLITION 0 RENOVATION a - ROOFING IF DEMOLITION, WAS IT AN ORDERED DEMOLITION? ❑ YES 'NO IF RENOVATION; ` y ,4 IS ITAN EMERGENCY RENOVATION OPERATION? ❑ YES E NO_° 1S IT A PLANNED RENOVATION OPERATION? ❑ YES 1;44O Process # Facility Name , ` ) I rr i , 1 1 A/ R ( 4 1 4 ; - I / Address r�'' ---4 ' M Pr fJ Jri /41ie / 1(714 d City n' /,,F 1 i t a1)4) State L-° Site - /-1,- 4! / 1 1 el e) 4 - c , M'`° Consultant Inspecting Site V ' .'f!'' r Building Size ,-- ,-' ,, r (Square Feet) # of Floors Age in Years i.r 1 ' Prior Use: SchaoT1Colfi Residence Small Business Other Present Use - Schno` Co!1 ge nre s1ty Residence Small Business Other Facility Owner d ' , .4�',r I' J 4---)i '- c ! Address ;` '� �� �.� trim. (:1; Vh f '' 1 • ty ;f� S Zip :� +` CI c 2 � (7 /A ,, , r f l a S State o f Zi � - III. Contractor's Name ( , Ffe..: 4 'e9 7 1 9 / P h Phone (fit' '--,) Address '7 /l : ' el' < -- =7." - 24 Vi i, 4 �y / id << � , State ° Zip ' / . Is the contractor exempt from licensure under section 469.004(7), F.S.? • City Florida Licence No 1 - ? _ IV. Scheduled Dates: > f , g r Asbestos Removal (mm/dd/yy) Start 1 "'A (/':,,,,, Finish: u °. ? Demo/Renovation (mm/dd/yy) Start V. ; Procedures to be Used (Check All That Appiyj: ' MUST OBTAIN PRIOR DERM APPROVAL BEFORE USING A DRY METHOD Procedures for Unexpected RACM t �ti_- ! .�' r r t, : fir ,- / a (i a 4 rl E Y F J n1� s N R. if Y 11 S VII. Asbestos Waste Transporter: Name p f - Uf )G ;' ,i. ,a� t ` e ' IA Phone ( ! '` 1 " r e Address ' . _ ,7 ri° - ��' ( °;� _ e, . > }i 'f' s city -, / ra n -) State VIII. Waste Disposal Site Name / 1 =4 t °r-_ Address F (,?1 . ~ . _ '' Ck City . , °') ` , r ill -c State . IX. Amount of RACM or ACM square feet surfacing material linear feet pipe - - - cubic feet of RACM off facility components square feet cementitious material square feet resilient flooring ( square feet asphalt roofing Name of Owner / Operatdr :/ Pitt (Si setaeti neii /O rator DERM USE ONLY ai i t' Postmark/Dag-Received' , Tip : County 7, 1 Fi L =,i nN -jam (Date) Zip Zip ID# Phone i 1 Class X. Fee Invoice Will Be Sent to Address in Block Below: ( Print or Type) I certify that the above information is correct and that an individual trained in the provisions of this regulation (40CFR Part 61, Subpart M) will be on -site durin the-09molition or renovation and evidence that the required training has been accomplished by this person will.-be4vvilable for inspectron`during normal business hours. , 'r , (Contact Phone #) Miami -Dade DERM Air Section 33 S.W. 2nd Avenue, Suite 9 -223 Miami, Florida 33130 -1540 caw que.lt management Divlsiori iJ YES ❑ NO Finish: ' GEOTECHNICAL ENVIRONMENTAL HYDROGEOLOGY ASBESTOS Miami, October 30, 2003 Re: Barry University Health & Sports Center 11300 North Miami Avenue Miami Shores, FL Dear Mr. Obenour: rai /iliiiMims. :V= 11N •11\\ WWII/ DYNATECH ENGINEERING CORP. Mr. Jim Obenour OBENOUR ROOFING SHEET METAL & SUPPLY CO. 9301 Park Drive, Suite A101 Miami Shores, FL 33138 TESTING LABORATORIES DRILLING SERVICES INSPECTION SERVICES ROOFING Pursuant to your request, DYNATECH ENGINEERING CORP., conducted an Asbestos Roof Survey on October 30, 2003 at the above referenced project. The purpose of our inspection was to secure bulk samples for analysis to determine the presence of Asbestos Containing Materials in the proposed roof renovation roof area. Access to the interior underside of the roof was not provided and is not part of this survey. The scope of our inspection covered the following areas: Roof at the above referenced project. (see attached plan) Based on our laboratory analysis; it was evident that asbestos fibers were found in the following secured bulk samples: 1- Aluminum coated flashing bull at parapet wall: Paint was found with 2 -3% and Bull with 5 -6% chrysotile fibers. 2- Aluminum coated flashing bull at building wall: Paint was found with 2 -3% and Bull with 7 -8% chrysotile fibers. 750 West 84 Street, Hialeah, FL 33014-3618° Phone (305) 828-7499° Fax (305) 828 -9598 Page No. 2 11300 North Miami Avenue, Miami Shores, FL Based on our visual inspection, physical site assessment and potential for damage, it was evident that the roof material is considered Category I - Non friable material. It is our opinion that this materials need not be removed prior to demolition because generally these materials do not release significant amounts of asbestos fibers when damaged. Yet, in the event of future repair and replacement of the roof material, all work shall be conducted by a Florida Licensed Roofing Contractors with on site Roofing Asbestos Supervision as provided in Section 469.012 of F.A.C. and in compliance with NESHAPS and OSHA regulations. We further recommend a competent person be on site for Air Monitoring during removal of A.C.M. This inspection report is the results of a diligent search of the facility for asbestos containing building materials (A.C.B.M.). All analyzed samples were readily available to our surveyor. We do not claim to have identified all of the asbestos containing building material present in the facility. If in the course of a renovation or demolition activity, suspect materials become exposed, all activities should immediately cease and the suspect material brought to our attention for evaluation and recommendation. This report is designed to aid the building Owner, Architect, Construction Manager, General Contractors, and Potential Asbestos Abatement Contractors in locating ASBESTOS CONTAINED MATERIALS. Under no circumstances is this report to be utilized as a proposal or a project specification document. When implementing the response actions, parties responsible for final selection should remember that actions shall be sufficient to protect HUMAN HEALTH AND THE ENVIRONMENT, but may also be the least burdensome method. Nothing in these recommendations should be construed as PROHIBITING or discouraging removal. It has bee a pleasure . serving you at this phase of your project and look forward to do so in the near future. Sincerely yours, / Ss Wass. aamani, P.E. DYNATECH ENGINEERING CORP. Florida Reg: No: 39584 Asbestos Consultant Number EA 0000045 WN /jg 1 Zo Location Description Approximate Amount F NF Condition Potential for Damage Analysis 1 NE side of roof area Built up tar & gravel roof system over Iso -board insulation over a metal deck 2600 sq.ft. X G/L NAD 2 North side of roof area Built up tar & gravel roof system over Iso -board insulation over a wood deck 12,700 sq.ft. X G/L NAD 3 NW side of roof area Built up tar & gravel roof system over Iso -board insulation over a wood deck 12,700 sq.ft. X G/L NAD 4 NW side of roof area Built up tar & gravel roof system over Iso -board insulation over a metal deck 3100 sq.ft. X G/L NAD 5 SW side of roof area Built up tar & gravel roof system over Iso -board insulation over a metal deck 3100 sq.ft. - X G/L NAD 6 SW side of roof area Built up tar & gravel roof system over Iso -board insulation over a metal deck 8160 sq.ft. X G/L NAD 7 SE side of roof area Built up tar & gravel roof system over Iso -board insulation over a metal deck 8160 sq.ft. X G/L NAD 8 East side of roof area Built up tar & gravel roof system over Iso -board insulation over a metal deck 8160 sq.ft. X G/L NAD 9 NE side of roof area Aluminum coated flashing bull at parapet wall 40 sq.ft. X G/L Paint w/ 2 -3% Bull w/ 5 -6% chrysotile fibers 10 North side of roof area Aluminum coated flashing bull at parapet wall 40 sq.ft. X G/L Paint w/ 2 -3% Bull w/ 5 -6% chrysotile fibers DYNATECH ENGINEERING CORP. ASBESTOS SAMPLING REPORT 750 W. 84th Street, Hialeah, FL 33014 Date : 10-30-03 Client : Obenour Roofing Sheet Metal & Supply Co. Project : Barry University Property @- 11300 North Miami Avenue, Miami Shores, FL Surveyor No. 7ME0209920031R By: C.G. Sam Type Bulk Samales Analysis: P.L.M.lD.S. F = Friable NF = Non Friable NAD = No Asbestos Detected CHRY = Chrysotile Condition G = Good D = Damaged S = Significantly Damaged Analyzed by: Premnath Boodoosing DYNATECH ENGINEERING CORP. NIOSH Cert. #7ME090203003DS Potential For Damage L = Low M = Medium H = High — __ — 1 IZ d _ Jr _ _ Location — ______ ___ __ Description Approximate Amount F NF Condition Potential for Damage Analysis 11 North side of roof area Aluminum coated flashing bull at parapet wall 85 sq.ft. X G/L Paint w/ 2 -3% Bull w/ 5 -6% chrysotile fibers 12 West side of roof area Aluminum coated flashing bull at parapet wall 85 sq.ft. X G/L Paint w/ 2 -3% & Bull w/ 5 -6% chrysotile fibers 13 NW side of roof area Aluminum coated flashing bull at parapet wall 50 sq.ft. X G/L Paint w/ 2 -3% & Bull w/ 5 -6% chrysotile fibers 14 SW side of roof area Aluminum coated flashing bull at parapet wall 50 sq.ft. X G/L Paint w/ 2 -3% & Bull w/ 5 -6% chrysotile fibers 15 South side of roof area Aluminum coated flashing bull at parapet wall 100 sq.ft. X G/L Paint w/ 2 -3% & Bull w/ 5 -6% chrysotile fibers 16 SE side of roof area Aluminum coated flashing bull at parapet wall 100 sq.ft. X G/L Paint w/ 2 -3% & Bull w/ 5 -6% chrysotile fibers 17 North side of roof area Aluminum coated flashing bull at building wall 40 sq.ft. X G/L Paint w/ 2 -3% & Bull w/ 7 -8% chrysotile fibers 18 West side of roof area Aluminum coated flashing bull at building wall 25 sq.ft. X G/L ' Paint w/ 2 -3% & Bull w/ 7 -8% chrysotile fibers 19 South side of roof area Aluminum coated flashing bull at building wall 40 sq.ft. X G/L Paint w/ 2 -3% & Bull w/ 7 -8% 20 East side of roof area Aluminum coated flashing bull at building wall 15 sq.ft. X G/L Paint w/ 2 -3% & Bull w/ 7 -8% Date : 10-30-03 Client : Obenour Roofing Sheet Metal & Supply Co. Project : Barry University Property @ -11300 North Miami Avenue, Miami Shores, FL Surveyor No. 7ME0209920031R By: C.G. C.�mrin Tvnn • • F = Friable NF = Non Friable NAD = No Asbestos Detected CHRY = Chrysotile DYNATECH ENGINEERING CORP. ASBESTOS SAMPLING REPORT 750 W. 84th Street, Hialeah, FL 33014 Condition G = Good D = Damaged S = Significantly Damaged Analyzed by: Premnath Boodoosing DYNATECH ENGINEERING CORP. NIOSH Cert. #7ME090203003DS Potential For Damage L = Low M = Medium H = High Dynatech Engineering Corp. Client: OBENOUR ROOFING SHEET METAL f 511PPL.V CO. Scale: N.T.S.v Project: 1130° N • MtAMt AVG. M1arnt SHoRGS, PLOQIDA Date: to.31.03 1. Fire Directory Listing Page 2. From Notice of Acceptance: Front Page Specific System Description Specific System Limitations General Limitations Applicable Detail Drawings 3. Design Calculations per Chapter 16, or if Applicable, RAS 127 or RAS 128 4. Other Component Notice of Acceptances 5. Municipal Permit Application 6. Owners Notification for Roofing Considerations (Re- Roofing Only) 7. Any Required Roof Testing /Calculation Documentation Roof System Required Sections of the Permit Application Form Attachments Required See List Below Low Slope Application A,B,C 1,2,3,4,5,6,7 Prescriptive BUR -RAS 150 A,B,C 4,5,6,7 Asphaltic Shingles A,B,D 1,2,4,5,6,7 Concrete or Clay Tile A,B,D,E 1.2.3.4.5,6,7 Metal Roofs A,B,D 1,2,3,4,5,6,7 Wood Shingles and Shakes A,B,D 1,2,4,5,6,7 Other As Applicable 1,2,3,4,5,6,7 1 Florida Building Code Edition 2002 High Velocity Hurricane Zone Uniform Pemmit Application Form. 1 INSTRUCTION PAGE COMPLETE THE NECESSARY SECTIONS OF THE UNIFORM ROOFING PERMIT APPLICATION FORM AND ATTACH THE REQUIRED DOCUMENTS AS NOTED BELOW: ATTACHMENTS REQUIRED: 123_01 -48 5/03 PAGE 1 • le' ()Ars "Aeof DIP • 123_01 -48 5/03 PAGE 2 Florida Building Code Edition 2002 High Velocity Hurricane Zone Uniform Permit Application Form. 1 Section A (General Information) Master Permit No. Process No. Contractor's Name Job Address I Low Slope ❑ Asphaltic Shingles ❑ New Roof og3c:4IOde '100 al t Si. /13 dd , lib A,er ❑ Mechanically Fastened Tile ❑ ❑ Metal PaneUShingles ❑ ❑ Prescriptive BUR -RAS 150 Lid Re- Roofing ROOF CATEGORY ROOF TYPE ROOF SYSTEM INFORMATION Low Slope Roof Area (SF) Steep Sloped Roof Area (SF) Total (SF) Mortar /Adhesive Set Tile Wood Shingles /Shakes Are there Gas Vent Stacks? Yes❑ No❑ Type: Natural ❑ LPGX ❑ ❑ Recovering ❑ Repair ❑ Maintenance RG F71 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. vimplop i• iii•i •i e • iii•• •■ •� ■••• ■•i•i uuuu g _ I� i pop __i _ -�. iiE�iamlam ES i uu. • . I pl i •i P i I Ei � C i i �E� ■ al ../ 1 1 P lull ii i • • r sE Br _ sr,. c� c_ � �� 1i � � 1 U C � � �� ■ II�A 7Si`��ii `� pp ;'f= = --' :; ill .i I, , I • • 'r� r {i u . 5 m . � ur� i'u ',� i i a �iir•r� i rl • 1u. •u�U � • �■ ■ ■ � 1 ■ iil� __ s _� l1MuU ri h•u•5is• ■ u 1 i ru. uu i.i i ■ \• 1 • r . .� . •uiiu8..�si : � 6..�1r:!�r G 11i ■ i UI 11 I ■ •sd ■ 1r. u i iirq � u ui , , i • " 717 7 u. .m i I< J j • r. 1 =d .E chi magi @ ubt s1 - - I. • •� l _ � i E 1 � _ .• � .y.a� C • "t � •• i i • . . s Qu _u_ w i i - i itiaCGCCC i CB• �� .. .. 1 123_01 -48 5/03 PAGE 3 Florida Building Code Edition 2002 High Velocity Hurricane Zone Uniform Permit Application Form. 1 Section C (Low Sloped Roof System) Fill In Specific Roof Assembly Components and Identify Manufacturer (If a component is not used, Identify as ''NA") System Manufacturer. 6 i1.F NOA No.: 03 - 0'r f 3©. l )- Design Wind Pressures, From RAS 128 or Calculations: Pmax1: 52 Pmax2: G7. Pmax3: ( 31. K Max. Design Pressure, From the Specific NOA System: s2 Deck: Type: 5 TEAL. Gauge/Thickness: 2Z 14. Slope: Anchor/Base Sheet & No. of Ply(s): IY4 Anchor /Base Sheet Fastenr/Bonding Material: insulation Base Layer. ZSozy9Ndtilr. a Base Insulation Size and Thlckness:.? 44 # Base 1 lation Fast r /Bonding Material: *Ay xeEw� Top Insulation Layer. ,4■A Top Insulation Size and Thidmess: 414 Top Insulation Fa ner/Bonding Material: Base Sheet(s) & No. of Ply(s): 4r11,4 i .'r Base Sheet Fastener/Bonding Material: loaf B t,4/4 Ply Sheets) & No. of Piy(s): Ri/ ,SQ',b / o, Ply Sheet Fastener/Bonding Material: Top Ply. [[ ZJI t 141 A Not ye- Top Ply Fastener/ Bonding Material: Surfacing: G 12.44+►N )) Q.- (Mgt C. +.45Tewtel .6 52.6 87.3 Fastener Spacing for Anchor/Base Sheet Attachment Field: ' oc (4 Lap, # Rows @ • oc Perimeter. ' oc © Lap, # Rows _ @ • oc Comer. oc © Lap, # Rows oc Number of Fasteners Per Insulation Board Field l l Perimeter IS Comer , Illustrate Components Noted and Details as Applicable: Woodblocking, Gutter, Edge Termination, Stripping, Flashing, Continuous Cleat, Cant Strip, Base Flashing, Counter- Flashing, Coping, Etc. Indicate: Mean Roof Height, Parapet Height, Height of Base Flashing, Component Material, Material Thickness, Fastener Type, Fastener Spacing or Submit Manufacturers Details that Comply with RAS 111 and Chapter 16. itlapii/F.si 4!Qydwi/G rila r' 2sJVm(g1t y 'I' OWWIrd i IA mbrot top *vont PA - J mzeo mtme TEEL 4 oe 1pee r 5't ii�t 4 5 sZ5 131.4 $ ZGg: pipe— AZ4Pi !tw rtrgrKe* f G nr 2 ' VAR/5 Parapet Height Mean Roof Height MIA M I•DADE BUILDING CODE COMPLIANCE OFFICE (BCCO) PRODUCT CONTROL DIVISION NOTICE OF ACCEPTANCE (NOA) GAF Material Corporation 1361 Alps Road Wayne, NJ 07470 • MIAMI-DADE COUNTY, FLORIDA METRO -DADE FLAGLER BUILDING 140 WEST FLAGLER STREET, SUITE 1603 MIAMI, FLORIDA 33130 -1563 (305) 375 -2901 FAX (305) 375 -2908 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed by the BCCO and accepted by the Building Code and Product Review Committee 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 Division (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. BORA reserves the right to revoke this acceptance, if it is determined by Miami -Dade County Product Control Division 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 High Velocity Hurricane Zone of the Florida Building Code. D ESCRIPTION : AYRiiberoid® Modified Bitumen Roof System for Steel 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 #00- 0331.09 and consists of pages 1 through 31. The submitted documentation was reviewed by Frank Zuloaga, RRC. NOA No: 03- 0430.12 Expiration Date: 11/06/08 Approval Date:10/31/03 Page 1 of 31 Membrane Type: APP & SBS Deck Type 2I: Steel, Insulated Deck Description: 18 -22 ga. steel System Type B(2): One or more layers of insulation is mechanically attached, perforated base sheet loose laid over the insulation. AU General and System limitations apply. Insulation Layer Insulation Fasteners Fastener (Table 3) Density /ft ACFoam -II, GAFTEMP Isotherm RA, Pyrox, GAFTEMP® Isotherm R Minimum 2" thick 1 (#14) 1:1.5 ft Note: All layers of insulation shall be mechanically attached using the fastener density listed above. The insulation panels listed are minimum sizes and dimensions; if larger panels are used, the number of fasteners shall be increased maintaining the same fastener density. Please refer to Roofing Application Standard RAS 117 for insulation attachment. Base Sheet: One ply of GAFGLAS STRATAVENT® Eliminator Perforated loose laid with 2" side laps. Ply Sheet: (Optional, required for torch applied RUBEROID membranes) One or more plies of GAFGLAS® Ply 4 or GAFGLAS FlexPlyTM6 ply sheet adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbsJsq. Membrane: One or more plies of RUBEROID® Torch Smooth, RUBEROID Torch Granule, RUBEROID Torch Plus Granule or RUBEROID Torch FR, RUBEROID MOP (Smooth and Granual), RUBEROID MOP 170FR, RUBEROID MOP PLUS and RUBEROID MOP FR applied according to manufacturer's application instructions. Surfacing: (Optional) Install one of the following: 1. Gravel or slag applied at 4001bJsq. and 300 lb. /sq. respectively in a flood coat -of approved asphalt at 60 lb. /sq. 2. GAF Premium Fibered Aluminum Roof Coating, at 1.5 gal./sq. or GAF WeatherCoat Emulsion at 3 gal. /sq. (Torch Smooth applications only) 3. GAFGLAS Mineral Surfaced Cap Sheet adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbsJsq. Maximum Design Pressure: -60 psf (See General Limitation #7.) NOA No: 03 0430.12 Expiration Date: 11/06/08 Approval Date:10 /31/03 Page 13 of 31 STEEL DECK SYSTEM LIMITATIONS: 1. If mechanical attachment to the structural deck through the lightweight insulating concrete is proposed, a field withdrawal resistance testing shall be performed to determine fastener patterns and density. All testing and fastening design shall be in compliance with Testing Application Standard TAS 105 and Roofmg Application Standard RAS 117, calculations shall be signed and sealed by a Florida Registered Engineer, Architect, or Registered Roof Consultant. 2. For steel deck application where specific deck construction is not referenced: The deck shall be a minimum 22 gage attached with 5/8" puddle welds with weld washers at every flute with maximum deck spans of 5 ft. o.c. NOA No: 03- 0430.12 Expiration Date: 11/06/08 Approval Date:10/31/03 Page 30 of 31 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 sidelap 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 lbf., as tested in compliance with Testing Application Standard TAS 105. If the fastener value, as field - tested, are below 275 lbf. 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 Engineer, Architect, or Registered Roof Consultant may be submitted. Saidrevised 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. (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 with Roofing Application Standard RAS 111 and applicable wind load requirements. 9. The maximum designed pressure limitation listed shall be applicable to all roof pressure zones (i.e. field, perimeters, and corners). Neither rational analysis, nor extrapolation shall be permitted for enhanced fastening at enhanced pressure zones (i.e. perimeters, extended 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 9B -72 of the Florida Administrative Code. END OF TIEIIS ACCEPTANCE NOA No: 03-0430.12 Expiration Date: 11/06/08 Approval Date:10/31/03 Page 31 of 31 TGFU.R1306 - Roofing Systems Page Bottom TGFU.R1306 Roofing Systems Questions? Guide Information GAF MATERIALS CORP 1361 ALPS RD WAYNE, NJ 07470 USA Roofing Systems Unless otherwise indicated the roof insulation is mechanically fastened, adhered with hot mopping asphalt or urethane insulation adhesive. Page 1 of 36 R1306 "Ruberoid 20" or "Ruberoid Modified Base Sheet" may be utilized as an alternate to Type G2 base sheets in any of the following Classifications. 1/2 in. thick (min) gypsum board or 1/4 in. thick (min) G -P Gypsum Dens -Deck® may be used in any existing noncombustible deck Classification. When this is done, the resulting roofing system is acceptable for use over combustible (15/32 in min) roof decks. The joints in the gypsum board and overlayment board are offset 6 in. with the joints in the deck. If polystyrene is part of the roof system, it must be placed below the overlayment board. Also, multiple plies of "GAFGLAS Ply 4" or "Ply 6" may be adhered to G -P Gypsum Dens - Deck® in hot asphalt. "GAF Stratavent Eliminator Venting Base Sheet (Nailable)" may be mechanically attached or hot mopped over noncombustible decks and as a recover over existing roof systems. GAFGLAS Perlite Insulation may be utilized as a cover board over "EVERGUARD" insulation in any of the following systems. ASPHALT FELT SYSTEMS WITH HOT ROOFING ASPHALT Type G2 asphalt glass mat base sheet ( "GAFGLAS #75 Base Sheet" or "GAFGLAS #80 ULTIMA" ) is a suitable alternate for Type 01 asphalt glass fiber ply sheet ( "GAFGLAS Ply 4" or "GAFGLAS Ply ii ") in the Class A, B or C roof systems indicated below. http: // database. ul. com /cgi- bin/XYV /template/L:ISEXT /1 FRAME /showpage.html ?name =TG... 10/23/02 TGFU.R1306 - Roofing Systems Page 7 of 36 Insulation (Optional): — One or more layers perlite, wood fiber, glass fiber, isocyanurate, urethane, perlite /isocyanurate composite, perlite /urethane composite, wood fiber /isocyanurate composite, phenolic, any thickness. Ply Sheet: — Three or more layers Type G1 "GAFGLAS Ply 4" or "GAFGLAS Ply 6 ". Surfacing: — Grundy Industries "al MB Aluminum Roof Coating" at 1 -1/2 gal/sq. . 3. Deck: C -15/32 Incline: Unlimited Insulation (Optional): — One or more layers perlite, wood fiber, glass fiber, isocyanurate, urethane, perlite / isocyanurate composite, perlite /urethane composite, wood fiber / isocyanurate composite, phenolic, any thickness. Ply Sheet: — Three or more layers Type G1 "GAFGLAS Ply 4" or "GAFGLAS Ply 6 ". Surfacing: — "Weather Coat Emulsion" at 3 gal/sq. 1. Deck: NC FLUID APPLIED COATING SYSTEM Incline: Unlimited Surfacing: — " Weathercote Low VOC" or "Weathercote" - 2 gal /sq. SINGLE PLY MEMBRANE ROOFING SYSTEMS Unless otherwise indicated phenolic insulation may be used in any of the following systems. Unless otherwise indicated any of the following Single Ply Membrane Systems may utilize multiple layers of Ruberoid Membrane. "GAF Premium Aluminum Roof Coating" may be used on any of the following Classifications not exceeding 1/2 in. "GAF Weater Coat Emulsion" may be used on any of the following noncombustible Classifications not exceeding 1/2 in. Ruberoid® Modified Bitumen Adhesive, Monsey Corp. "MBA Gold" and Karnak "No. 81" adhesives may be used in any of the following noncombustible deck Classifications. Tropical Asphalt "No. 711 AF" adhesive may be used in any of the following Classifications. GAFGLAS #80 Premium Base Sheet may be used in any of the following systems. Unless otherwise indicated, "EverGuard SR" membranes used in systems are mechanically fastened with large head metal or plastic fasteners spaced 18 in. OC and max 2 in. from membrane's edge. Adjacent sheets are lapped 4 in., covering fasteners. Laps are then heat sealed. The "EverGuard FB" membranes are hot mopped in place. (Optional) Noncombustible deck classifications are applicable for use over combustible (15/32 in. min plywood) decks when 1/2 in. (min) gypsum board or 1/4 in. (min) G -P Gypsum Dens - Deck® are used directly. over the deck with all joints staggered 6 in. (min) from plywood joints. http: // database. ul. com /cgi- bin/XYV /template/LISEXT /1 FRAME /showpage.html ?name =TG... 10/23/02 TGFU.R1306 - Roofing Systems Page 8 of 36 A vapor barrior may be optionally installed under all systems utilizing "EVERGUARD" insulation. " EVERGUARD" insulation is an acceptable alternate in any polyisocyanurate insulation of the following systems. GAFGLAS Perlite may be used as an option over EVERGUARD insulation. GAFGLAS Stratavent Perforated Base Sheet may be utilized as an additional ply in any of the following systems. The following membranes may be used interchangeably within their own group: A. "Ruberoid Torch Granule ", "Ruberoid Torch Granule Plus ", "Ruberoid Torch Granule 1 ". B. "Ruberoid Mop Smooth ", "SBS HW Smooth ". C. "Ruberoid Mop Granule ", "Ruberoid Mop Plus Granule ", "SBS HW Granule ", "SBS HW Plus ". D. "Ruberoid Mop 170 FR (1 sq) ", "Ruberoid Mop 170 FR (1/2 sq) ", "Ruberoid 30 FR ", ,- "SBS HW FR Granule ", "SBS HW FR Plus ", "Ruberoid SBS Dual FR ". E. "Ruberoid Mop FR 2 ", Ruberoid 30 FR ", "SBS HW (Heat Weld) FR Granule ", "SBS HW (Heat Weld) FR Plus ", "SBS HW (Heat Weld) 170 FR ". F. "Ruberoid 30 ", "Ruberoid Modified Cap Sheet 601 ". G. "Ruberoid 20 ", "SBS HW (Heat Weld) 25 ". Class A - Ballasted 1. Deck: NC Incline: 2 Insulation: — One or two layers "Isotherm R ", any thickness, loose laid or mechanically fastened. Membrane: — Any UL Classified membrane used in a ballasted system. Surfacing: — River bottom stone, 3/4 to 1 -1/2 in. diam, 1000 lbs /sq. 2. Deck: C -15/32 Incline: 1/4 (NC -2) Insulation: — Perlite, glass fiber or wood fiber, 3/4 to 1 -1/2 in. Membrane: — "Ruberoid Torch Granule 1" (modified bitumen). Surfacing: — Gravel at 400 lbs /sq, loose laid or concrete blocks, at 10 lbs /sq and spaced not more than 1/8 in. 3. Deck: NC Incline: 3 Insulation (Optional):'— Perlite, glass fiber or wood fiber, 3/4 to 1 -1/2 in. Base Sheet (Optional): — Type 15 asphalt organic felt or Type G2. Membrane: — "Ruberoid Torch Granule 1" (modified bitumen). 'Surfacing: — Gravel. http : / /database.ul.coin/cgi- bin/XYV /template /LISEXT /1 FRAME /shovpage.html ?name =TG... 10/23/02 r 1 V1 V .1 \iJVV - IAA/ 111.1.6 Ur.7 LV111J 4. Deck: C -15/32 Incline: 1/4 Insulation (Optional): — Perlite, glass fiber or wood fiber, any thickness. Membrane: — "Ruberoid Torch Granule 1" (modified bitumen). Slip Sheet: — 0.004 in. polyethylene (not UL Classified). Surfacing: — 3/4 in. thick concrete with one layer of No. 10 Summerville Quarry tile (or equivalent) grouted in place. 5. Deck: NC 6. Deck: NC Insulation: Membrane: Surfacing: — 7. Deck: C -15/32 Slip Sheet: — Membrane: Surfacing: — 8. Deck: C - 15/32 Base Sheet: fastened. Membrane: Surfacing: — Incline: 2 Insulation (Optional): — Perlite, glass fiber or wood fiber, any thickness. Membrane: — "Ruberoid Torch Granule 1" (modified bitumen). Surfacing: — 3/4 to 1 -1/2 in. diam river bottom stone at 1000 lb /sq or concrete pavers weighing not less than 10 lb /sq ft and spaced not more than 1/8 in. Incline: 3 — a)Polystyrene, 2 in. max, b)Isocyanurate, any thickness, laid loosely. — " EverGuard SR" or "EverGuard FB ", 40 -100 mil (TPA), laid loosely. River bottom stone (3/4 - 1-1/2 in. diam) at 1000 lb /sq or concrete roof pavers. Incline: 1/2 One or more layers Atlas Roofing "FR50 ", mechanically fastened. — " EverGuard TPO Plus" , 45 mil. River bottom stone, (3/4 to 1 -1/2 in. diam) at 1000 lbs /sq or concrete roof pavers. Incline: 1/2 rage J01.30 — Two or more layers Type G2, "GAFGLAS Basesheet #75 ", mechanically — " EverGuard TPO Plus ", 45 mil. River bottom stone, (3/4 to 1 -1/2 in. diam) at 1000 lbs /sq or concrete roof pavers Class A - Fully Adhered 1. Deck: NC Incline: 1/2 • Insulation (Optional): — One or more layers perlite, wood fiber, glass fiber, isocyanurate, urethane, perlite /isocyanurate composite, perlite /urethane composite, wood fiber / isocyanurate composite, phenolic, any thickness. Base Sheet (Optional): — One or more layers Type G1, G2 or G3. Membrane: — One or more layers "Ruberoid Torch" (Smooth or Granule), "Ruberoid Torch Granule Plus ", "Ruberoid Mop" (Smooth or Granule) or "Ruberoid Mop Plus Granule" (granule). Surfacing: — Gravel, 400 lbs /sq, loose laid or applied in a flood coat of hot roofing asphalt. 2. Deck: NC Incline: 1/2 http: // database. ul. com /cgi- bin/XYV /template /LJSEXT /1 FRAME /showpage.html ?name =TG... 10/23/02 •TGFU.R1306 - Roofing Systems Page 12 of 36 4 fastened. Ply Sheet (Optional): — One or more layers Type G -1, hot mopped in place. Membrane: — One layer "Ruberoid Torch Smooth" or "Ruberoid Mop Smooth ". Membrane: — One layer "Ruberoid Mop 170 FR ". 17. Deck: NC Incline: 1 x/ Insulation (Optional): — Perlite, fiber glass, wood fiber, isocyanurate, urethane or perlite /isocyanurate composite. Base Sheet: — One or more layers Type G2 or G3 base sheet, hot mopped or mechanically fastened. Ply Sheet (Optional): — One or more layers Type G1, hot mopped in place. Membrane: — One layer "Ruberoid Mop 170 FR". 18. Deck: NC Incline: 1/2 Insulation (Optional): — Perlite, fiber glass, wood fiber, isocyanurate, urethane or perlite /isocyanurate composite. Base Sheet (Optional): — One or more layers Type 'G -2 or G -3 base sheet, hot mopped or mechanically fastened. Ply Sheet (Optional): — One or more layers Type G -1, hot mopped in place. Membrane: — One layer "Ruberoid Torch Smooth" (smooth), "Ruberoid Mop Smooth ". Membrane: — One layer "Ruberoid Mop 170 FR" (granule). 19. Deck: NC Incline: 1/2 Insulation (Optional): — One or more layers perlite, glass fiber, isocyanurate, urethane or perlite / isocyanurate composite; any thickness. Base Sheet: — One or more plies Type G1 or G2, hot mopped or adhered with Karnak Chemical "No. 81" or Gibson -Homan "No. 6160" cold applied adhesive at 1 -1/2 gal /sq. Membrane: — One layer "Ruberoid Mop 170 FR ", hot mopped or adhered with Karnak Chemical "No. 81" or Gibson -Homan "No. 6160" cold applied adhesive at 1 -1/2 gal /sq. 20. Deleted. Incline: } ,112 Insulation (Optional): — Polyisocyanurate, wood fiber, perlite, glass fiber any thickness, hot mopped or mechanically fastened. Base Sheet: — One or more plies Type G2 "GAFGLAS #75" base sheets, hot mopped or mechanically fastened. Membrane: — One or more plies "Ruberoid 30 FR" hot mopped in place. 21. Deck: C - 15/32 22. Deck: C =15/32 �.i Incline: 1 Insulation (Optional): — Polyisocyanurate, wood fiber, perlite, or glass fiber any thickness, hot .ripped or mechanically fastened. Base Sheet: — One or more plies Type G2 "GAFGLAS #75" hot mopped or mechanically http:// database. ul. com /cgi- bin/XYV /template /LTSEXT /1 FRAME /showpage.html ?name =TG... 10/23/02 BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical Plumbing Mechanical Owner's Name (Fee Simple Titleholder) Phone # Owner's Address City State Zip Tenant/Lessee Name Phone # Job Address (where the work is being done) City Miami Shores Village County Miami Dade Zip Is Building Historically Designated YES NO Contractor's Company Name $ Value of Work For this Permit (Continued on opposite side) Miami Shores Village Building Department 10050 N.E.2nd Avenue, M lami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. fir )8?9 8 Master Permit No. C� 10.. vey., Phone # Contractor's Address City State Zip Qualifier Architect/Engineer's Name (if applicable) Phone # Type of Work: ❑Addition ❑Alteration ❑New ❑ Repair/Replace ❑ Demolition Describe Work: PeAft70 PA- Total Fee Now Due $ Square Footage Of Work: 6 63 7q / 8" * * * * * * * * *** *** * * ** * * * ** * * * * Fees * * ** * * * * * * ** * * * * * ** * * * * * * * * *** 2 Submittal Fee $ E - Permit Fee $ C� A '� CCF $ qq ,,' ‘62 Notary $ Training/Education Fee $ 3 3, a 0 Technology Fee $ IRO Scanning $ i Radon $ Bond $ Code Enforcement $ — Structural Plan Review. $ Bonding Company's Name (if applicable) Bonding Company's Address City. State Zip Signature Owner or Agent The foregoing instrument was acknowledged before me this day of , 20 _ , by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: APPLICATION APPROVED BY: Chc 10/14/03 1 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 JMPROVEMENTS 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 Contractor The foregoing instrument was acknowledged before me this day of , 20 by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: My Commission Expires: *****,******************************* e* ***************** s************* * ** *s * * * * * * * * * * * * * * * * * * ** * * * * ** *qtr * * ** . (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** DEC m57203 Plans Examiner Engineer Zoning