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1160 NE 91 Terr (3)L PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 10050 N.E. 2nd Avenue • Miami Shores, Florida 33138.305- 795 -2204 Date I/ ill (3 3 Job Add ess I /(ao NE 9l Terrace T Folio / / --3)° k,� isl re (f -/Y/ E/q , f size !/ � 42 .la ?. woyo� /7S ff a -o aot>> / Legal Description /drd i f w 1yS/ t Id.:::)- Q/A up Historically Designated: Yes No Owner /Lessee/Tenet 1) O N& r c is e ( InlmC-r Master Permit # , f))) X 3 , .ek Owner's Address 1 1 L2 t) Ct f 16(1(61(e_ ,1200 ; "J Qualifier k U.{ Ka Wit Contracting Co. State # Municipal # Competency # 'gM Ins. Co. Lei IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY, THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE BEFORE CALLING FOR ANOTHER INSPECTION. Permit Type (circle one): BUILDING ELECTRICAL PLUMBING WORK DESCRIPTION: lt alb 414reih0V 0/ 46/5/7/; tra ee ( roof i ref/(10/15 zi yzii Os t&/15 iViLd &i (7 uprhof sysk . 11 1 -V s/ee t; 6d 7 2 ,2 29/ e% � Square Ft. Estimated Cost (value) 5YC/ / WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR ANY ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). 1 certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for all disciplines. 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. Furthermore, I authorize the above named contractor to do the work stated. / — )zi '05 pc l(rj ire of wner and/or Condo President Date Si I . ttire of Contractor 2_ 55°473 - 67.3`1 4-D Not as to • w er and/or r Co o Presi ent Commission Expires Angels MBecker • My Commission 00150048 Expires November 15, 2008 135 RADON Phone 3 4 -106 8 W5 /t 901 st /17iaini Shays 305 7 SY - o /9f Phone 7�`777' Address I J Jj �' �► \ ►_ Date otary as t. Contractor 'r Owner Bui 'er My Commission Expires ea ci MECHANICAL ROOFING n4to / 4or 4AAJO■146 1 1111 °3 Owner B C.C.F NOTARY S • D 1 BOND 0 — TOTAL DUE S , C7 11 FEES: PERMIT APPROVED: / 22 -- Zoning Building / � Electrical Mechanical Plumbing Structural Engineer Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 I Printed: 1/21/2003 Applicant: DANA MICHAEL r / Owner: INMAN p JOB ADDRESS: 1160 N Contractor KAWALEK PAUL Local Phone: 786- 262 -1457 Parcel # 1132050010450 Permit Status: PAUL R. KAWALEK ROOFING & PAINTING 485 N.E. 92ND STREET PH. 305- 754 -019 MIAMI SHORES, FL 33138 -2566 A Paytothe i Qlvtl 5 order of APPROVED Permit Expiration: Bank ofAmerica. ACH FVr 093100277 ( I j bo 1`� • 5 t T1 Te 1:063 LOO 2 771: 00366060 L9 1411' 3099 INMAN DANA MICHAEL NE 91 TERR ores Ui if $ ye/3 Legal Description: WATERSEDGE PB 9 -141 ELY3OFT OF LOT 20 & ALL LOT 21 & WLY5FT LOT Fees: FEE2003 -370 FEE2003 -371 FEE2003 -372 FEE2003 -373 Description Building Fee CCF Notary Fee Buildier's Bond Total Fees: Amount $135.00 $3.60 $5.00 $300.00 $443.60 Total Fees: $443.60 Total Receipts: $0.00 Work: TEARING OFF AND REMOVAL OF EXISTING ROOF REPLACING ANU ROTTEN WOOD AND INSTALLING NEW BUILT UP ROOF SYSTEM If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in .advanro hofr. ra• -II_ -- r -- - - •• tion. Date Building Permit Permit Number: BP2003 -92 7/20/2003 0 3 Contractor's Address: 485 N. E. 90 - Dollars Construction Value: 3099 63- 27/631 FL 810 BY: $5,800.00 Page 1 of 1 le equipment or device described in the application herefor in strict compliance with all vith any plans, drawings, statements or specifications that may have been submitted to not done in compliance with such ordinances or if the plans are changed without tor or builder named above assumes the responsibility for a thorough knowledge of the 3s or in the statements or specifications and that he assumes responsibility for work done 8 - -.. .. BY: compliance with all ordinances and regulations pertaining thereto and in strict conformity ; Village. In accepting this permit I assume responisibility for all work done by either NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF DADE: 5. Surety:(Payment bond required by owner lmt8g t ( Dm: � , 2u 6NTY OF DADE Name and address: ,11FREGY CEr: i, Y that f is a true copy of the Amount of bond arr gtn n' in this oti;ce on --6-1— l o , A D 20 O S 6. Lender's name and address: A te! - i'-. / O1' ` ` t "at. ,,A, i „ :. r. ,;u r, ;.:,;o t,r,un y GULP 44 .C. t. I I- 3aoS- oal -o yid 03R04 3783 2003 JAN 21 13:06 THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street . address: tlittiefsedse P8 9-/Y/ My 3d 764 of Catty a4/ 1 1 4) (15 6/A lof- csrizi iriqu,ecr- br ors 9- • /n2 rz oa2 t 2. Description of improvement: 1eali/i Off an, refildlied of PXISti 5 raei r 'p n / , r1eplacl/5 all ram, wood and 1t)S / 5 A21.0 6ucl s Ie/r), P car it 0 7s - k&S ' s1 ; krt-irf2 3 z p"i b>„ m � l trn �c n F� ss - /ot 3. Owner(s) name and address: i)a C ()'Z � IC&/ ou-�� 1 /(0o NE q( 1?rraCe. 33/3t Interest in property: oWrer Name and address of fee simple titleholder: 4. Contractor's name and address: /1C(14.61 U (J'P/'7 4- /cf5 PVC 9c;)` Miami' (Cats t9,1 ?Gk 33131 J 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: 8. In addition to- himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) ature of owner Print Owner's Name DA NA � 4 -L f N ” ' �tt�W M A Prepared by , Sworn to an • , scribed before me this / It day of M KIK i- 1 l 6-1-, of r`�p Expires November 15. 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I__ _ J.... -.-.- -Jy `iii i "ii i'1 - j " l i- i_1 _1 • 1 J i i - 1 - i - ;__ti 1; 1; 1 1" 1 ' 1 1 1 I I -I 1 1 i, i 1 .1. 1 . i i i_ i 1 • i I 1 i r r _ I 1 F T� i 1 j 1 1 1' j I 1 I 1 1 i 1 1 1-2- " I -1 I - i i -i 1 - 1 - ; -- 1 -1- : 111_1 t- - 1='_J i i 1 I I li i - i i'-l -; - - T i i t • 1 i I - 1 - - 1 7 iI i 1 i 1 r1 i -1" i i 1- 1 • . . . i � i 1 iu . 1 1 1 1 ,-.1 1 1 1 - , t- -� ._ i �_ � i I - 1, 11111-1:.1.13 � 1 t -1 1 ��_ L 1_1 _L, __l _ J- 1M ■ I + J- _ J. _ i - 1 , t s IJ L L.i _ i_._ �:_L 1-1-1-11-1 - 1 l � -I u L ' , _ _,_:_.L 11 1 ,_I__ • t _ j 1, 1. 1 1 1 1 1T 1 1 I l , 1 , 1 1 1 . 1 Florida Building Code Edition 2002 High Velocity Hurricane Zone Uniform Permit Application Form. Master Permit ict Job Mdress Section A (General Information) Process No. tot a. tv et. isle ROOF CATEGORY 6(ow Slope ❑ Mechanically Fastened Tile El Mortar /Adhesive Set Tile Asphaltic ❑ Metal Panel) i Shingles /Shakes Shingles ❑ Prescriptive BUR -RAS 150 ROOF TYPE ❑ New Roof tRe- Roofing ❑ Recovering ❑ Repair ❑ Maintenance ROOF SYSTEM INFORMATION Low Slope Roof Area (SF) Steep Sloped Roof Area (SF) Total (SF) ■ 1120 Section B (Roof Plan) ?- 6 oO Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Inc! a Ldimensions of sections and levels, clearly identify dimensions of elevated presstones and location of parapets. Florida Building Code Edition 2002 High Velocity Hurricane Zone Uniform Permit Application Form. Deck: Type: Gauge/Thickness: Base Sheet Fastener /Bonding Material: 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. r) A F NOA No.: oa — v 10 ‘61 0 C ' Design Wind Pressures, From RAS 128 or Calculations: Pmax1: ' Pmax2: ) 1 r- Pmax3: l I I i4 Max. Design PressReyrgra the Specific NOA System: t l) I •b - oir S fr» Slope: Anchor /Base Sheet & No. of Ply(s): p y base- jIf F �(jI x `ef f II 61. Insulation Base Layer. Base Insulation Size and Thickness: Base Insulation Fastener /Bonding Material: Top Insulation Layer: Top Insulation Size and Thickness: Top Insulation Fastener /Bonding Material: Base Sheet(s) & No. of Ply(s): Top 6 ,5tgne Material: Surfacing: f� TT Ply Sheet(s) & No. of Ply(s): P I y ' t h erg c1SS Ply $1,ie�Fastener Material: Top P l y . C � F Yui K-(r&I Cup She-e+ Fastener Spacing for Anchor /Base Sheet Attachment q Field: l " oc @ Lap, # Rows �@ 1 • oc Perimeter. " oc @ Lap, # Rows 9 @ oc Comer. i " oc @ Lap, # Rows l @ oc Number of Fasteners Per Insulation Board Field Perimeter Corner 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. G{kE,Mal utp Sleet \p‘P soL1v dr•Ip a'c S�►� P '15 bc`Se5 \ b V —T■ 1' t FT. FT. Parapet Height ID Mean Roof Height • Roof System Manufacturer: Notice of Acceptance Number: Minimum Design Wind Pressures, If Applicable (From RAS 127 or Calculations): P1: P2: P3: Maximum Design Pressure (From the NOA Specific System): N / '' Method of tile attachment: Florida Building Code Edition 2002 High Velocity Hurricane Zone Uniform Permit Application Form. Section D (Steep Sloped Roof System) Roof Slope: :12 Steep Sloped Roof System Description Deck Type: ype Underlayment: nsulation. Fire Barrier. astener Type & Spacing: dhesive Type: Ridge Ventilation? Mean Roof Height: ype Cap Sheet: oof Covering: Type & Size Drip Edge: Where to Obtain Information Description Symbol Where to find Design PressuiC PI or P2 or P3 RAS 127 Table 1 or by an engineering analysis prepared by PE based on ASCE 7 Mean Roof Height H Job Site Roof Slope g Job Site Aerodynamic Multiplier x, NOA Restoring Moment due to Gravity M, NOA Attachment Resistance Mt NOA Required Moment Resistance M, Calculated Minimum Attachment Resistance F NOA Required Uplift Resistance F, Calculated Average Tile Weight W NOA Tile Dimensions 1= length w= width NOA All calculations must be submitted to the Building Official at the time of permit application. Mean Roof Height M Required Moment Resistance 15' 20' 25' 30' 40' - Roof Slope I 2:12 34.4 36.5 38.2 39.7 42.2 3:12 32.2 34.4 36.0 37.4 39.8 4:12 30.4 32.2 33.8 35.1 37.3 5:12 28.4 30.1 31.6 32.8 84.9 6:12 26.4 28.0 29.4 30.5 32.4 7:12 24.4 25.9 27.1 28.2 30.0 r Florida Building Code Edition 2002 High Velocity Hurricane Zone Uniform Permit Application Form. Section E (Tile Calculations) For Moment based tile systems, choose either Method 1 or 2. Compared the values for M the values from M r• If the M values are greater than or equal to the Mr values, for each area of the roof, then the tile attachment method is acceptable. Method 1 "Moment Based Tile Calculations Per RAS 127" (P z X = _) - Mg: _ n1 NOA Alf (P2: Z 71. = ) - Mg: = Mri NOA 1% (P3: % 21. _ _ ) - Mg: = Mr3 NOA M Method 2 "Simplified Tile Calculation Per Table Below" Required Moment of Resistance (M From Table Below NOA Mr *Must be used in conjunction with a list of moment based tile systems endorsed by the Broward County Board of Rules and Appeals. For Uplift based tile systems use Method 3. Compared the values for F' with the values for F If the F' values are greater than or equal to the F values, for each area of the roof, then the tile attachment method is acceptable. Method 3 "Uplift Based Tile Calculations Per RAS 127" NOA F' NOA F' NOA F' (Pt : a 1: = z w: = ) - W: x cos 0: = F (P2: z1: = a w:= ) -W: a cos 9: = F (P3: z1: = x w:_ ) -W: acos9: = Fr3: • SECTION 1524 HIGH VELOCITY HURRICANE ZONES REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS 1524.1 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 adjacent box indicates that the item has been explained. Aesthetics - Workmanship: The workmanship provisions of Chapter 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) issues are not a consideration with respect to workmanship provisions. Aesthetic issues such as color or architectural appearance, that are not part of a zoning code, should be addressed as part of the agreement between the owner and the contractor. Renailing Wood Decks: When replacing roofing, the existing wood roof deck may have to be renailed in accordance with the current provisions of Chapter 16 (High Velocity Hurricane Zones) of the Florida Building Code. (The roof deck is usually concealed prior to removing the existing roof system). c \A 3. Common Roofs: Common roofs are those which have no visible delineation between neighboring units (i.e. townhouses, condominiums, etc.). In buildings with contirion roofs, the roofing contractor and/or owner should notify the occupants of adjacent units of roofing work to be performed. W \,L 4. Exposed Ceilings: 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 Florida Building Code provides the option �of maintaining this appearance. 1 v LL5. Ponding Water: The current roof system and/or deck of the building may not drain well and may cause water to pond (accumulate) in low -lying areas of the roof. 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. Ponding conditions should be corrected. . Overflow scuppers (wall outlets): It is required that rainwater flow off so that the roof is not overloaded from a build up 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 Florida Building Code, Plumbing. Ventilation: 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 venting which can result in extending the service life of the roof. wner's/Agent's ignature C: IDOCUSIE- 1kmp1LOCALS- 11TemptSECTIOV 1524.doc Liu,d4tAiLytOtY Date Contractor's Signature �. .v v • 140 P!1 5/23/2003 0s20'114 5/ e:ie fit M I _ Ri " /.DING CODE COMPI.I.t.' CE OFFICE. (BCCO) PROMPT CONTROL. DIVISION NOTICE OF ACCEPTANCE TO C::11 Material Corporation 1361 Alps Road \ \•a. NJ 07470 'ROtf t rem 'ROKs fax FROM: fax TOt 5057310579 1Os 505751.379 TO: 305753.8579 PAM 001 Or 021 PAOrt 001 Of 021 PA( t 001 Of 021 NO.% No: 02- 1140».(N E: ♦piration Date: 11'01/03 Appro.,I Mac: : lI 23 :02 Pam. 1 •:t 21 MiAMI-DADE COUNTY, , FLOAIDA METRO -DADE FI.ACi.rR Rt Ii,pIMC 140 WEST Fi.ACi.F,R STRFF.I•. SI in: 1643 MIAMI, Fi.ORID.% 33130-1%3 A - � — . (305)3' -2001 1'A s3�)c:3-s,.•K•t•: semi :: This NO.\ 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 I'roJu ;t Review Committee to be used in Miami Dade County and other areas where allowed by the Authority Flavin.. Jurisdiction (11-11). Thi ;� :O\ .hall not be valid after the expiration date stated belotiw. Nfide County Prouct Cl I`i;•isi:rt (In Miami Dade County) and: or the AHJ (in areas other than Miami a County) rescn c the rieht ita.-e this i'roduct or material tested for quality assurance purposes. If this product or material fails to perform i:, the :.c_ert::d manner. the manufacturer will incur the expense of such testing and the , r:•.:,I, modify. or suspend the use of such product or material within their jurisdiction. BORA reserves the right - 8 1IIJ may immediately t. • rug of this acceptance. if it is determined by Miami -Dade County Product Control Division that this product n: r : : :t :ri ::l Tail, to meet the requirements of the applicable building code. r.r. duct is appi•o;•cd as described herein. and has been designed to comply with the iligh \ ihuri : :rn. ::: t!: 1•Iorida Building Code. D1•:N(1:11'•140N: C. \I' Conventional Built -[.'p Roof System for 1\ Deck. I \13I. :1.iN(:: Each unit shall hear a permanent label with the tnanutacturcr's name or loco. cite, stag and •••%r::_ st :rt.:ment: "Miami -Dade County Product Control .Approved• ", unless otherwise noted herein. R ! • \ 1 •'.\ .1i. of this NO.\ shall be considered after a renewal application has been tiled and there ha. !' in the applicable building code neeatively affecting the pertotmance of this product. T1:12:1; \ 1T1O N of this NO. \ will occur after the expiration date or if there has been a revision or clean real. : '' : : ►!. :: and or manufacture of the product or process. \lisuse of this Ne as an endorsement u l' ., :` in the '.• . :. 1..1- :ales. advertising or any- other purposes shall automatically terminate this N(:):\. Failure to c :nty�l it!, .: ^} • .� tion of this NO.\ shall be cause for termination and removal of NO.a. .%!): ; :RR ;\1 The \( ).1 number preceded by the words Miami -Dade County. Florida. and follow ed h� r. :•i:•ati 'n date may he displayed in advertising literature. If any portion of the NO.\ is dis ;:l.r• ed. t'e_ - 1 1. :!: :lone in its entirety. 1 \ , ;1'l :( - 1 . 10. \:.\ copy of this entire NO.\ shall be provided to the user by the manufacturer car it. ..1i•Ir'' :•. available for inspection at the job site at the request of the Building Official. c'•nsists of r • • P: �e 1 through 21. 1 ' . • • :h•n;tted documentation was reviewed by Frank %uloaea. RRC 1 EIWALEI ( ;. \[ (IL.:\S Ply 411. (,'.\f ( .. \S>f Mineral 5:::i Cap p Sheet ( S'I'R. \T:\\"L\TA) I: ;irninator Perforated (;. \; •ar.. \S R' Flashing C;.\1'GLAS R'• I :laminator Perforated ' - :rilal•le I:! SI3S '.::rt- \\'e1d1'm Smooth SI3S I Ieat -\\ cldT1t Granule ) [U K SI3S • \\ Icl r" 170 PR - ;:1 :Ri)IDR SI3S 1 lea t- \\'e lit rrt PI. 1 :S )11) R SRS • 1; 7 ;:R )11) R SIIS 1 !tea: -\\ eldr\e 25 I •I 1 :13(11) \[oditied i'•..:� Street 20 ::::1• R \ (),p Granule 5/23/2002 *14 . 011 3 /2J/2002 8129 Pit S/23/2002 A:1e p!I Various 1 meter (39.37") wide 1 meter (39.37 wide 1 meter (39.37") wide 1 meter (:9.:7•• wide 1 meter (39.37") wide pDs +9.37" (1 meter) wide 39.37" (1 meter) wide ` 7 " (1 meter) wide ` ` (1 meter) wide 1 meter (39.37-) wide ■ W Waaas, "mis fax mot rase Meets fax Test A nteltkagn ASTM D 2178 ASTM 13 3909 ASTM D 4897 D 3672 ASTM D 4897 F D :672 c 0 \S'I :\ I D- ti 6164 .•\ST\ [ r)- 6164 po m .AST\ [ D- \c 6164 ret su AST \I D- No 6164 pot mi .A\ST\ [ D- N 6164 rota surf Non poly su Prem mod \S T\ [ 1)- 6164 39 (1 meter) AST \( D4601 wide Type II. 1.7. Type G2 131.72 `` . `7.. (1 meter) ASTM D 6163 S13S aide ASTM D 5147 interp .29..27" (1 meter) . \ST \[ I) 6222 m w ids 22 \on -� t. \ST\[ 1) 5147 p mine 'Os 3037510379 7Os 3037510379 70s 3037510579 Mats 007 Of 021 Oats 003 OF 021 MOs 003 Or 021 at PAs 003 Or 021 Product � Type R' asphalt impregnated glass felt with asphalt coating. Asphalt coated, glass fiber mat cap sheet surfaced with mineral granules. Fiberglass base sheet impregnates' and coated on both sides with asphalt. Surfaced on the bottom side with mineral granules embedded in asphaltic coating with factor. perforations. ksphalt coated glass fiber mat tlashin2. she available in three sizes. iherglass base sheet impregnated and dated on both sides with asphalt. Surfaced n the bottom side with mineral granules mhedded.in asphaltic coating. 'on -Woven Polyester mat coated with o lymer- modified asphalt and smooth u rtaced. \\ on Polyester mat coated with lymer modified asphalt and surfaced �� ith ineral granules. m- Woven Polyester mat coated with tire ardant polymer modified asphalt and rtaced with mineral granules. n- Woven Polyester mat coated '. ith Amer modified asphalt - anti sur:aeed ��ith neral granules. n- \\-oven Polyester mat eoacecc ccith lire rdant polymer modified asphall an seed with mineral &granules. -Woven Polyester mat coated %k ith 'mer modified asphalt and smooth rfaced. ium glass fiber reinforced S135- itied base sheet modified asphalt base sheet aril ly sheet reinforce w ith a glass fiber %oven polyester mat coaled %silt! er modified asphalt and surfaces' %%itlr pal granules. \():\ \,r: 02 0.4Ox 0') f :xrirrtion flak- It/01.'03 • \pproval i)alc: 05/23/ 02 t'esec 3 of 21 ■ Ruhcroid 1f• ?fop Plus (Granule) RI.13EROID 11.MOP Smooth i[ 13r:R(:)u)ti NIOP 17t)FR RI.TWWROIDg. \[OP FR I::. 13rRO[I) R TORCH Smooth I :I 'DER( u1a TORO II %r:muly :: :I :I:: )II)►:• TORCII . I • :i (C;rrnulc) )11) R '1 :'l • 1:I:;:( ;[I) 170I'R i:r l;l:l:011)R 30 • I';.R()11)(i 30 FR I.:!1:11:011) I •: 'I ‘C'I..\Dri SILS '•l) R Dual FR t/22/2002 0r14 i 11R0Mr lax 7+Or �ar:103Ti • PAWS 004 Or 021 S /` �� =ln= � l0s7.10379 PA4cr 004 OP 021 0:..9 Pit MK: Fax TOS 3057510579 PA3c: 004 or 021 5/231:00.: C:13 PM ►'R9lf: Fax 'M: 3037510579 PAGE: 004 0► 021 39 .37" (1 meter) ASTM D 6222 Non -woven ASTM D 5147 polyester mat coated with Polymer modified asphalt and surfaced with '` (1 meter) AS mineral granules. TM D 6164 Non -woven polyester mat coated with wide ASTM D 5147 Polymer- modified asphalt and sm surfaced. 3937" (1 meter) ASTM D 6164 Non -Woven polyester mat coated w ith tiro wide .ASTM D 5147 retardant polymer modified asphalt and surfaced with mineral granules. 39 .37" (1 meter) ASTM D 6164 Non - Woven polyester mat coated with lire wide ASTM D 5147 retardant polymer modified asphalt and surfaced with mineral granules. 39.37 meter) . STNf D 5147 Heavy duty. polyester reinforced. asphalt wide modified hitumen membrane. smooth surface. 39 (1 meter) ASTM D 5147 Asphalt impregnated. coated felt. surfaced wide with mineral granule. 3 meter) . \ST\[ I) 6222 l[eay.y duty. polyester reinforced. asphalt wide AS'r \[ 1) 5147 modified bitumen membrane. granule surface 39.37 meter) AST \[ D 6222 I [easy duty. polyester reinforced. coated wide ASTM D 5147 with fire retardant asphalt modified bitumen membrane. `r•anule surface. 39 .37" ( 1 meter) .AST\I D 6222 Heavy duty. polyester rcinlbreed. c:•:rted Wide .\ST\I D 5147 with fire retardant asphalt modified bitumen membrane. granule surface. 39 (l meter) AST \I D 6163 ion -woven fiberglass mat coated with wide ASTM D 5147 polymer modified asphalt and surfa,.cd with mineral granules. 39 ( 1 meter) .\ST \[ D 6163 Non - Woven fiberglass mat coated with fire wick: :AST \I D 5147 retardant polymer modified asnha'! am' surfaced with mineral granules. ``) 3 7" (1 meter) AST \I D 6298 Woven fiberglass mat coated with Polymer wide .ASTM D 5147 modified asphalt and surfaced with aluminum, copper or stainless steel foil. 3 (1 meter) .SST \1 I) 6164 Non-woven polyester and fiher2la.. ma! Wide ASTM D 5 147 coated with file retardant, pol%mer modified asphalt and surfaced with mineral granules. DiMeaskati wide Test A1ci- fi— c =lion Prod Rosd NO No: 02- 0411tf.rrl) 1•. piration Malt: 11: .%pproval hate: 051; Page 4 nr 21 Vent Stacks (metal and plastic) I;. \r' Aluminum I :mu!aon (:.'\F :\Iuminum not- Paint (Matrix•% Sjstem Pro Aluminum Roof ('dating Fibered 302) (LW Built -Up Roofing \•pha 1l R('J,f:ROID MOD . \sphalt.Asphalt L & . \sphaIt P !ate Base Sheet - :!e - \Le iv ('ap Sheet SI. l_ -\ f :Lk: ,•..; ..it Surface Seal ; %! ::tri'. 602 �sf3 'rating) • \\'_ather('ote `.I1, 1 \!atrix 715 \1f3 AM (Matrix .. :le..r 'dt. T\s (Matrix 1 \ \.:atherCotc,g. 1 :la•tdmcri.: Flashing f.etri' Low \ O(' ! :!trite: 1(:1 S%stem Pro . \.Iltesie !' uheroid R \ Ell) Matrix , i Si stem Pro sr3s 1 !:e.hin•, Mn) Matrix • Sf3S '»uct - .. '".� ( ;itlf72� iwves■ W7 W Off 3 /23/20A2 8140 1s s us 2 057518379 PADS: 005 01 021 5/23/2002 8529 511 '*ROOK: Fax 7O: 3 057318379 PA4is 005 OF 021 3/23/3003 8118 PK MK: Fax TO: 30 57518579 PAGE: 005 Or 021 5 gallons 5 gallons 1011 Ib. cartons. hulk 60 Ib. kegs 5 gallons 5 gallons 5 gallons Test aiJ�l- ti a atfon PA 100(A) A.STM D 1929 ASTM D 635 None 5 gallons ASTM D2824. Type I 39.37'' (1 meter) AST \f D4601 %v ide 39.37'' (1 meter) ASTM D :909 wide 4 sq. roll 30 Ibs. 5 Gallons 5 eallons 5 r_allons m 5 gallons S m ASTM D312, Interpl}' mopping and surfacing asphalt Types!, II. III and iv m ASTM D3019 C ASTM D3019 c .AST\1 D3019 ('c SEI3S modified asphalt Product REHNdlabla One way valve gent used to relieve built -up pressure within the roof system. GAF Vent Stacks are available in metal or plastic. Mineral colloidal bituminous emulsion yt itle reflective aluminum flakes Non- fbered aluminum pigmented, asphalt roof coating Asphalt impregnated and coated. liberi1 ;i <. base sheet - Asphalt coated. glass fiber mat cap sheet surfaced with mineral granules. Fiberglass reinforced shingle undcrlayment Surface coating for smooth surfaced an•.1 mineral surfaced root's. Surface coating for smooth surfaced and mineral surfaced roots. urface coating for smooth surfaced and ineral surfaced roots. urface coating for smooth surfaced and ineral surfaced roots. Surface coating for smooth surfaced and ineral surfaced roofs. old Applied Modified SI•:f3S Asphalt :Adhesive old Applied \fodified SI 133 Asphalt :Adhesive Flashing Gracie. ild Applied Modified SIRS Asphalt .Adhesive. NO.% No: 02- 8.4,».09 Expiration Date: 11.04/03 .Approval Date: 01.23.'0: Paige S of 21 uct ( Rishi roidit MB) Nfatrix 202 Select SEIS Flashing Matrix 203 Standard Plastic Cement latrix 213 Gun G;•ade Plastic Cement \fatrix 103 Co1d, Adhesive \I:ttrix 303 Select f'ihered Aluminum \fatrix 304 Select Non- Fibered RIT1:R(IIDR Modified IFitumcn Adhesive APPROVED) INSI +L :VTIONS: Product Name \FYI: \IP Isotherm R. R.V. RN & Fner_yGuarcl R. • `.I.'.: Composite .\ d. 1; \1(' \l''I'I { \IP Fiberboard • ,I i'1 '� Ii' R Pennant,: I' ITN fP i \F('. \ \'[ T`I I ':I 1 1 II) 1 'etmalite Recover I :oars! Cl.\1 1i1)C'r[:T^ Tapered I ace Strip `. It '. \ l'nerpyGuarc[. R. ;'.[�'\ Composite EncreyGuarcl. l;.\ I.. • ..':; I in,: S/2712002 0140 pti 5/25/::n02 0129.9K ' 5.'27/2402 4119 int s s 5 gallons 5 gallons 5 gallons 5 gallons 5 eallons 5 gallons 5 gallons 7R0tt1 Fax 17tottt Fax Moms Fax Test Specification ASTM D4586 ASTM D4586 ASTM D4586 ASTM D3019 ASTM D 2824 A.STNI D2824. Type I ASTM D 3019 Type III TABLE. 2 Product Description Polvisocvanurate. tram insulation Polvisocvanuratc team insulation with high density fiberboard or Petmalite perlite insulation. Fiberboard insulation. Perlite insulation board. Cut perlite hoard Perlite recover hoard Tapered perlite hoard i;` \1c,. \f— ['F. \ IP R I fith Density High density mood fiberboard insulation. Polvisoevnurate foam insulation Polvisoc:vnurate*wood fiberboard composite I'olvisocvanurate foam insulation PoIvisoeyanurate tram insulation 7'O, 30575111579 PAOit 006 or o21 701 3057519579 pAGIt 001; OF 021 7'O: 5057519579 PPM: O04 OF 021 �. 1• Product Description Cold Applied Modified SLBS Asphalt Adhesive - Flashing Grade. Standard Plastic Asphalt Roofing Cement Standard Plastic Asphalt Roofing Cem Caulk Grade. Cold Applied Asphalt Adhesive. Fibered aluminum coating. `on- fihered aluminum pigmented. asphalt roof coating. Fiber reinforced, rubberized Adhesive XIanufacturer (With Current NO.\) GAF \[aterial.s Corp. (;. \I \[at„rial (',.t1,. GAF \latcrial.; a'01'. G. \.F Material. (*ow. G. \F \faterial.. ( \[aterials Corp. G:\F \Iaterialk Cote. GAF Materials MICA 13\ ICA Apache Products ('0. Apache Products NO moo: 024140E.09 Expiration note: 11/04 /03 Approval Date: 05,23'02 Page 6of21 Squ MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 B4ilding Inspection Request Dated Type Insp'n ‘ ( .1 ) \ () ‘OCASe t'CXJrC ;T iced Permit No t)P.L.A ;ctk itc Name{ Address t 1 �.F��' L Company. :. a '" N -' Phone # Inspection Date Approved Correction Re- Insp'n Fee (9-Itolot- 0 MIAMI SHORES VILLAGE 30 SHORES, BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 3/3 Type Insp'n F rct I D rct,p)c._t \ Permit No. [J P. 00-4 1 1 Name 5Q (010 Address WOO N IL q 1 P 1!i Compan O(C 13V U' Q✓ Phone # qg Inspection Date Approved Correction ❑ Re-Insp'n Fee ❑ qi MIAMI SHORES VILLAGF4 BUILDING DEPARTMENT � v 305- 795 -2204 Bui ding Inspection Request Date 3 1 Type Insp'n h (1 L P nue Permit No. 13.RE- 1 14 9 Name FC I O 1 Address 1 0 -'' 1( O t: q1 Company 0 s IC q V- .c.`Q Phone # Inspection Date I Approved Correction ❑ Re- Insp'n Fee ❑ as & l.'\RC:'y PLC'S. t - Itra(;arl (.o lcl I ibet Class Roof Insulation Stnr_toclek \!ulti - \ia'. & [' :\ Par.'s flaw Board fah Beard A PI'RC) \'I•:D F: \5'1'1• : \I.:RS: Fastener Number IS() 05 _ Composite w fiber 11igh Density Wood Fiberboard I'crlitc insulation Dens Deck. Product Name . \( 'Foam 1. 11 & Composite 1St) 95 - 4.. •1_3 2132 0:40 Nt 5/23/54"2 0:29 PM V C :le PM APPROVED INSLtLATIONS: Product Name (;.\1• i I1 r. R (Drill -' ec R 12 Standard & 1-1 [Leavy Duty Rooline Fastener (3.\ITITF R (Drill-Tec R . \S. G. \FTTfF R (brill -Tee g ) 'lase Sheet Fastener and Plate 4. Gah•alume Plates (Drill- Tee te \ fetal ) Polypropylene Plates (Drill-Tee R Plastic) i)ckfa.st Fastener. = 1 1 -1 & - 15 TABLE 2 Product Description Polyisocyanurate foam insulation Polyisocyanurate foam insulation Polyisocyanuratelperlit ridged insulation Wood fiber insulation hoard Wood fiber insulation board Perlite insulation board Water resistant gypsum hoard Polvisoc%anurate foam insulation Glass fiber Mineral fiber insulation Wood fiber insulation hoard Polyisocyanurate roof insulation Rockwool insulation fa.7ltt rax To 3057510579 MOM: fax TOt 3057610379 Mats fax Tot 3057510579 TABLE 3 Product Description Insulation fastener for steel. wood & concrete decks. Pre - assembled GAFTITI: Fasteners and metal and plastic plates. Base sheet fastening assembly. Round gaivalume stress plates. Round pol■propvlene stress. plates. Insulation fastener for wood. steel and concrete decks Mos;`•'0t» Ol 021 Oft '007 Or 021 BABE: 007 Ol 021 Dimensions Manufacturer (With Current NO.% Atlas Energy Products Firestone Building Products. Inc. Firestone Building Products. Inc. generic generic generic G -P Gypsum Corp. Johns \Iam ille Johns \ iam ill;, Xlasonite. R\ Iax. In:. Partek. inc. Manufacturer (With Current tie?.\) G:\1' \iatcrial.. ('orp. G. \F Materials Corp. GAF Materials Corp. 3" and 3 ': GAF Xlateriais r orr. 3" and 3 ':" GAF \lateriais c orp. Construction Fasteners NO. No: 02- 0408.09 Expiration Date: 11!04!113 Approval Date: 05123102 Page 7 or 21 • • ' • • 2 O APPROVED FASTENERS: Fastener Number `•. :/.:411 0140 tai 6129/4002 0:29 pM 5/23/201'2 0 :10 PM Product Name Dekfast Hex Plate Dekfast Lock Plate 12 .Roofgrip Fasteners .y. \Ietal Plate Gearlok Plastic Plate Glasfast Fastener 14. 1 5. Olympic Polypropylene 1(1. Olympic G -2 17 . (Olympic Standard S. Insul -Fixx Fastener 19. Fnsul -Fi`\ S Plate Insul -Fixx P Plate 21. Tni -Fast Tni -Fast Plates 23. Tru -Fast Plates Olympic Fastener l2 & 14 Olympic Fastener ASAP Meth fax w19?1 • TO> 3057510579 rPott, Fax TO: 3057510579 FROM: Fax TO: 3057510579 TABLE 3 Product Description Gaivalume hex stress plate. Polypropylene locking plate. Insulation fastener for wood and steel. Gaivalume stress plate. Polypropylene round plate Insulation fastener assembly with recessed plastic plate Insulation fastener Pre - assembled Insulation fastener and plate Polypropylene plastic plate 3.5" round galvalume 155 steel plate 3" round galvalume .\Z50 steel plate Insulation f.ste.ner for steel and wood decks 3" round galvalume .AZ,5O steel plate " round polyethylene stress plate Insulation fastener for steel and wood decks 3" round galvalume :7..55 steel plate Polyethylene plastic plate PAGE: '003 OF 021 PAOSr'.009 OF 021 PAGir 000 OF 021 Dimensions 2 7.'8 "x 3 1 % . ," 3 "x 3" round 3" square 3.2" 3.25" round 3.5" round 3" round round 3" round 3" round 3" round Manufacturer (With Current NOA) Construction Fasteners Inc. Construction Fasteners Inc. ITV Buildex Corp. ITW Buildex Corp. IT'R' liuildex Corp. Johns Manville Olympic Nlamilacturing Group, Inc. Olympic NIanufacturine Group. Inc. Olympic Manufacturing Group. Inc. (Olympic Manufacturing Group. In Olympic•. Manufacturing Group, in.. SI'S Stac. :cr SI :S Stadler SFS Stadler •[he l ru -Fast ( The Teti -Fast (';irP. The l ru -Fast Corp. NO.\ Nr,• 02••UOS Ol.' Expiration 9a(. :: I!. u'.'O1; Approval note: Oc; 23.'1)2 Page S of 21 • • 1 F 3ctot) Mutual R.car•ch Corpor lion 1'actory \Iutual I:.scar.h Co '' rpprat ion .7. Factory Mutual Research Corporation 1'a.tory Mutual P.c. :arcl) Corporation I':wtnrl Mutual Research Corporation 1)vnjt. =_h I:ngineerine 'oiporation 1)vnatecll Engineering Corporation PR 1 . \.1 It T.: I:nolocics. Inc. I'RI . \•pha I'xhnt •Ineics. Inc. MT of S. 11. MT or N. Pl. EVIDENCE SUBMITTED: Te4-- Lt ur_ ^ = 7 /=0 0 •: o 4 PM t / : r :129 PM 3 /23/3003 E213 PK Test Identina FMIRC 1996 J.I. 2B8A4. A!\I J.I. 3 B9Q 1. ANI J.I. 0D0A8. A.M J.I. 0D I A8..g1\f J.I. 0 Y9Q5. AN I J. T. 3X3A2.ANI r, r. 0 1"9Q5.AN I 3 600.02.95 -1 r'. 182.02.95 -1 G. \F 0 12 -02 -02 GAF-0204)2-o' 02 -005 02 -014 ep_psa Current Insulation Attachment Requirements Wind Uplift F?vIRC 44704 Wind Uplift FMRC 4470 - PA 114 Wind Uplift FMRC 4470 - PA 114 Wind Uplift F\ (RC 4470 - PA 114 Wind Uplift PA 114 1 .Vind Uplift PA 114 Physical Properties ASIA' D 4977 TAS 114 TAS 114 Pak 01 . 0 1.96 07.02.07 01.08.9$ 07.09.99 07.29.94 04.01.98 08.02.94 07.29.9)4 02.02.95 02.02.05 1 1.06.111 0 2.01.02 01.18.02 03.22.02 NOA No: 1'2.ryj0IR.1)9 Expiration Date: 11.'I)4 /03 Approval Date: 05. 23.1)2 Paw. 9 Of 21 1`h Sheet: ( 'ap Nhc•et: Fastening Options: 4841 1[14 • :'.' • cu9 tat Deck Type 1; Wood. Non- insulated Deck Description: to �� - - Nc �� Construction Roof i or greate or woo pta d System Type E (1): Base sheet m nlcally fastene All General and System Limitations shall appl ., !lase sheet: . ' C; A'Gr , AS e.SO L'ItimaTy NaiIa111e. RI'13FROID Modified Base She t RL'REROIU4. 20 .1 SI3S I lent- \�'e1dTU , Eliminator Perforated or Rt.BEROID SBS Heat-Weld 25 base sI `R()II) mechanically fastened to deck as described below: attached t o d with approved 475 flare Sheet I�, any of above Base sheets at nails and tin caps at a fastener spacing of 9 „ PPro�'ed annular ran rows 12" o.c. i the field. P 3 shank � o.c. at the lap staggered and in t:e•0 (1 l /a�•i i mum Desgn Pressure —45 � \FC S n Ply I R , psi See General Limitation #7) G.AFGI .: \S Flex PI} T•r f 6. Ci •�C' 1 •�� 475 13ase Sheet car any of above Base sheets attached to deck with Drill -Tee G.\F`1TTE u or `: 14 Screws and ;.' Plates. 12" o.c. in 3 rows. One row is in the 2" side p. re a The other rows sheet. (Maximum o s are eq ually spaced a pproximately 12" o.c. in the field of the h \l: (ii.. \S Flex Pl D •r g Pressure —4; psi: See General Limitation #7) 6. G.AFGL \S i;75 Base Sheet or any of above Base sheets attached to deck with approvedl annular ring shank nails and tin ca at .1 fastener spacing of 9" 17c 1d. (.1 /aximum Design at the !'' I ger •• o.c. and in two rows 9•c• in !Ile 1 G. \FGL AS :. 75 ign Pressure Rase Sheet or any sf• .See General Limitation #7) aho R ase; sheets attached to deck w ith Brill -'fee Ci. ( \F I :) :s 12 or -14 Se:rew:s and 3" Plates. 12" o.c. in •1 rows. O ne row is in the 2" side lap. The other rows are a ually s 9" o.c. in the field of the sheet. y p:lc.,d appr•oimatel■ .1 faxu„um Design Pressure —6p psi See General Limitation it 7) • rn of above Base sheets attached to deck approved annular ring shank nails i anti ? "' inverted Drill -'fee a o.c. c. t 4" D (GAFTITf:) insulation plates at a fastener spacing of lap staggered in two rows 9" in the field. (.1 /aximun, Design Pressure —60 psf, See General Limitation #7) G.kFCi \S 375 Base Sheet or any of above Base sheets attached to deck with i r Drill-Tee (G,�FITTE) � :714 12 or is in the A side la Screws and 3" Plates. 13" o.c. in 4 ro•.es. (•) P. The other rows are equally spaced a c •- row 0.e. in the field of the sheet. (1/aximun, Design Pressure —75 psf .See. General Limitation #7) O more or mrn• plies �' c ol'G.GI..A$ R • ) n I " plies fG) PI.I" 4 R, G.kFGL.AS R PI.I" 6 R 1: sI ID MOP Smooth or RLBEROLD 20 P . tact. mopping of approved asphalt applied within the E\'T ranee and at adhered rate 40 lbs. sq. ?t)_ iOptional) O ply o1 'G••\FGL.. \S R Mineral Surfaced Cap mopping olappro .ed asp app lied within the F\ r ' Sheet and at a 2t)- 0 a in a -1 Ihs. sq. T range anti at ;:,t of ...+� r20 11579 701 3057518579 MOM: Fax TO: 3057518579 MOH: rh TC: 3057528579 r,rx, Talc PA.38: 018 OT 021 PAOcs 018 OF 021 PAGSs 018 OF 021 PAGE: 018 OF 021 N .% No: 112- ti.11) 11u F:xpirrtion Dale: 11. 01'03 • .pprovut 1341 c. sos 23.'u2 Paige 18 ur 21 Surfacing: •7. Af:rximum Design Pressure: sn r/ z00;.' 0:40 ma •/_3/20c:. O:29 PM t /23 = 0r10 PM flood coat at an a (Required if no cap sheet is 1. O i Special Roofing used) Install one of the following: • application 1.5 gal 46 Bitwnen with an a ion rate of . /aq,; or GAP pP rate of 20 1 , (Matrix ion ate of Emulsion WEATHER COATI ' with an GAF Premium Fibered Aluminum with th an application rate of 2 Emulsion GAF Premium um Fib sting uminu 301) Coating (Matrix System Pro or gal. /sq. 01) with an application m I'ro '• Asphalt flo PPlication rate of 1 5 Alas with o application rate of 60 lbs./sq. ,: ° . 3. Top Coat Surface rate of 400 Ibs. /sq. & 300 lbs. :•s .. 0. plus Sr or urface Seal SB (Matrix 602 SB Coatin q' r espectively. (Matrix 715 MB Coatin pectivcl�•. applied at rate of 1 -1.5 g). GAF «eatherCote or We th I O Plus Sal sq. V See Fastening Above tltCrtr t 'PAt O . s � 01! Oi 031' in ... ''• � . . u , ', T �a l a'� 7 9 PAS Oi! Ot.021 tReltr ta rt � �.,.. .... , ;; •�•f, !� A05740579 PAas 019 OP 021 IMAM tart 1057510579 .PAGE: 019 07 021 • ():% So: 02- 0408.Q9 Expiration Dale: 11/14/03 Approval Date: 05.23.'02 Pate 1 9 or 21 FF.011t Fax TCt PdCir ...awl 2 •+ 0. , - . t PEoft: Fax T.;: 7 057! 1:t 0.1 OF �, 5...-::/:.:c.;.: ', VW ��= lsY TO: S.7 PAGE: 022 OF ntl 30,n10%79 PAGE: PH M)t: Fax M: 30 57523 579 AGE 022 OF �. PAGE: 021 OF 021 WO OD DEC )r; SYSTEM I .\ slip ELI LIMITATIONS: anchor sheet, required with Ply NS: • sheet is �fisl ' y 4 and Flex Ply 6 when used as a � m �" sins Deck or r, y . wood deck. Typ ` m echanical! gypsum board is acceptable y fastened base or e Ptahle to be ' G f•:.\f• RAL L AIIT installed d •� \ " \S: erectly over the I. fire classification is not part of this acceptance. refer to a current Approved Directory for fir ratings of P W i r e tion n p this product, Pr may be installed in a Control :Approval 1n multiple layers. Rootin., In s ti l d o as le in mu tip! T he first layer shall be attached in ° Material applied within id the a E \ . all other layers shall be adhered ''rt:'clred using the fastening range and at a rate I n co \11 stan g pattern of the top 20-40 in a ful mopping compliance with panel sizes are P lat•rr of 2A' Ibs.:'sq or m �� 1 1�• asphalt. pa size shall he 4' acceptabl maximum. for mechanical -1. \n overlay x 4' attach mint �ncl `or ma`cimum. . foam insulations when the recovery � board When , shall ve a de in s insulation J ired on all applications i ov in approved t; panel is required applied wb spot mopping fully mopped. It no recov shall cl a ribbon ed in pping with a ers• board ot'rr c.: rd ri p :r continuous area of ` tl spo roes. j 0 at h approved as is used one phal do diameter circles. the base dine J,laeed even- � in c� <hntilation. Encircling of the strips on 24" o. •.. 1_ i s d o a the able. A ' 6" she Aiming h e ribbon to allow < o r strip pl e a very minimum cross Ventilation. s is not acceptable. clesi∎ n fate of 12 lbs. ' table. \ 6" break shall he pressure orate ps1: q. :vote: Sot . Asphalt application i. 1 �a�ncr spacing P attached system o1'rither system for insulation ms shall be limited to n' shall = th as tested in attachment is a maximu ;r J,�l. n compliance tack based on a Mini f as to arc h�lc,« Testing Application mum Characteristic t ! • -• Eel _r • t •' 275 11,1: insulatio a me shall not 1 <rn for m echanical I . attachme T: \S 105. (F') Value of ,.. a minimum last,; 'Ittachment of anchor shall lithe fastener value. n canica resistanc t anchor has not he acceptable. specific s }stem Should value in r sheet a. imam design n attachment tie 1 'llrlclin�• () tile! the n conjunction evil! the Official. , fastener resistan h is based ,.. � revised f•IStrner. r less than maximum design value list «ii mice. - lrchitrct spacing. that req. as determined by the shall utilize the «•i rrtiist resistance Prepared. signed a Roof Consultant and e d . S h a s h a l:l;rtir. a in withdrawal «its clue taken may es submitted. Flood Re 1'.r•in► to arse! Rooting •a Len from Testis Said revised fastrnrrspa;in�• cr.rYrcr area .Application Standard g Application Standard T, , :::....as. Fastener densities shall cnmPl�. with the ndard R.as 117. \S .t); :: ",nrlian;e nsitirs shall be increased Sed for enhanced «its Rooting both ion a pressure r equirement s base sheet as ca ant. of :1 referred within this ,\ • \ppl insulation a N. n-\• General Limitation Standard R.aS 117. l.: r � I �� e attach and sizing of applicable) hen this limitatio k ulat ;d in 0 mt will not be applicable.) •ha attachment with Rooting Perimeter Hailers. `pc':ilic,Jh Ub maxi Application Standard rtal profile. and or mum rl l ,ressurr Application rd R. shall hr and applicable faslring is 11...1d. p� , terminatio d - •11►an; and ;omrrs)- e l tion applicable o all rind load requirements. �cl Ine tenin_� ; r extrapolation to l h b p erm tteti n . ( When this limitatio ix enhanced „•r�.. sal analtsis• pressure zones perimeters. extended shall he t,cr,littrrt a pplicable.) Pc'cificalh r (r'e• referred within this `�trndod co l'" n• \. (:. men and comers). cneral limitatio ff? will not he F\i) OF THIS ACCEPT•.. \SCE .U.\ •''o: (r? /'1rr!t *Hi Expiration Date: 11.04.-8)3 .thproval Dale: 05.71'02 Mtge ?I •; r 2 I to ROOF COVERING MATERIALS (TENT) Roofing Systems (TGFU)— Continued GAFGLAS #80 Premium Base Sheet may be used in any of the following systems. • ' GAFglas Flex Ply 6" is a suitable altemate to "GAFglas Ply 6". "GAFTEMJ' Permalite Recover Board" may be used in lieu of any perlite insulation in any of the following NC Classifications. Hot roofing asphalt, for use with organic and glass felts or modified bitumen membranes. "Ruberoid S S produc s inanygapplicable Classiiifyicationsed in lieu of 1. Deck: C -15/32 Class A Insulation (Optional): One or more a yers 3 fiber; isocyanurate, urethane, perlite /isocyanurra e perlite, composite,, pe lite urethane composite, wood fiber / isocyanurate composite, phenolic, any thickness. Ply Sheet Three or more layers Type GI "GAFGLAS Ply 4" or "GAFGLAS Ply' 6 ", hot mopped. Surfacing: Gravel. 2. Deck: C -15/32 Incline: 2 Insulation (Optional): One or more layers perlite, wood fiber gl fiber, isocyanurate, urethane, perlite / isocyanurate composite, perlite/ urethane composite, wood fiber /isocyanurate composite, phenolic, any thickness. Ply Sheet: Three or more layers Type GI "GAFGLAS Ply 4" or "GAFGLAS Ply 6 ". Cap Sheet One layer Type G3 "GAFGLAS Mineral Surfaced Cap Sheet ". 3. Deck NC Incline: 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, 2 in. max. Ply Sheet: Two or more layers Type GI "GAFGLAS Ply 4" or "GAF- GLAS Ply 6 ". Cap Sheet: One layer Type G3 "GAFGLAS Mineral Surfaced Cap Sheet ". 4. Deck NC Incline: 1/2 Insulation: One or two layers "Isotherm R ", 4 in. max, hot mopped. Ply Sheet: Any UL Classified gravel surfaced Class A asphalt glass fiber mat system. 5. Deck: C -15/ Incline: 1 Base (Optional): Sheet: ne layer of Red ype G2 paper, AFGLAS #75 Base Sheet" (may be nailed). Ply Sheet One or more layers of Type G1 "GAFGLAS Ply 4" or GAFGLAS Ply 6 ". Cap Sheet: One layer of Type G -3 "GAFGLAS Mineral Surfaced Cap Sheet ". 6. Deck: NC Incline: 3 Base Sheet: One layer of Type G2 "GAFGLAS #75 Base Sheet". Ply Sheet One or more layers of Type G1 "GAFGLAS Ply 4" or GAFGLAS Ply 6 ". Cap Sheet One layer of Type G -3 "GAFGLAS Mineral Surfaced Cap Sheet". ck: C -15/32 Incline: 2 ulation: One or more layers perlite, glass fiber, isocyanurate, ure- e, perlite / isocyanurate composite, perlite /urethane composite, phe- nol' , 1.0 in. min (offset from plywood joints 6 in.). Ba Sheet One or more layers of Type Gl, G2 or G3. Membrane: One or more layers of " Ruberoid Torch" (smooth or granule), " Ruberoid Torch Plus" (granule), " Ruberoid Mop" (smooth or granule) or " Rubemid Mop Plus" (gran Cap Sheet "GAFGLAS Mineral Surfaced Cap Sheet", hot mopped. Deck: C -15/32 Incline: 2 Insulation (Optional): One or more layers perlite, wood fiber ass fiber isocyanurate, urethane, perlite / isocyanurate composite, perlite/ urethane composite, wood fiber / isocyanurate composite, phenolic, any thickness. • Base Sheet Two or more layers of Type G2 or G3. Ply Sheet (Optional): One or more layers of Type Cl. Membrane One or more layer: of "Ruberoid Torch" (smooth or granule), " Ruberoid Torch Plus" (granule), " Ruberoid Mop" (smooth or granule) or " Ruberoid Mop Plus" (granule). LOOK FOR THE {JL MARK ON ROOF COVERING MATERIALS (TENT) Roofing Systems (TGFU) Continued Cap Sheet "GAFGLAS Mineral SLfaced Cap Sheet ", hot mol 1. Deck: C -15/32 Class B Insulation (Optional): One or more Incline. 3-1/2 fiber, isocyanurate, urethane, perlite/isocyanurate Y perlite, wood fibs urethane composite, wood fiber/isocyanurate composite, ph composite, ph e enc . thickness. com Ply Sheet: Two or more layers of Type Cl "GAFGLAS Ph "GAFGLAS Ply 6" Cap Sheet Type G3 "GAFGLAS Mineral Surfaced Cap Shee mopped. 2. Deck C -15/32 3-1/2 Insulation (Optional): One or more layers wood fiber fiber, isocyanurate, urethane, perlite/isocyanurate composite, p urethane composite, wood fiber / isocyanurate composite, phenol: thickness. Base Sheet Two or more layers of Type GI, G2 or G3. Membrane: One or more layers of " Ruberoid Torch" (smoc granule), " Ruberoid Torch Plus" (granule), "Ruberoid Mop" (smoi granule) or " Ruberoid Mop Plus" (granule). Cap Sheet. "GAFGLAS Mineral Surfaced Cap Sheet ", hot moppt 1. Deck C -15/32 Class C Incline: 1/2 Insulation (Optional): One or more layers perlite, wood fiber, fiber, isocyanurate, urethane, perlite / isocyanurate composite, per thickness. • urethane composite, wood fiber/ isocyanurate composite, phenolic Ply Sheet Three or more layers of Type GI "GAFGLAS Ply 4 "GAFGLAS Ply 6 ". Surfacing: "Special Roofing Bitumen" 20 1bs /sq. COAL TAR FELT SYSTEMS WITH HOT ROOFING COAL TAR 1. Deck: C -15/32 Class A Incline: 1/2 Insulation (Optional): One or more lavers perlite, wood fiber, g fiber, isocyanurate, urethane, perlite /isocyanurate composite, pert urethane composite, wood fiber /isocyanurate composite, phenolic, thickness. Ply Sheet Three or more layers of Type GI "GAFGLAS Ply 4" "GAFGLAS Ply 6 ", hot mopped with coal tar bitumen. Surfacing: Gravel. COMBINATION HOT AND COLD SYSTEMS 1. Deck: NC Class A Incline: 2 Insulation (Optional): One or more layers perlite, wood fiber or gl fiber, 2 in. max. Ply Sheet Three or more layers of Type GI "GAFGLAS Ply 4" "GAFGLAS Ply 6 ". Surfacing: Grundy Industries "al MB Aluminum Roof Coating" 1 -1/2 gal /sq. 2. Deck: NC Incline: 1 Insulation (Optional): One or more layers perlite, wood fiber, gla fiber, isocyanurate, urethane, perlite / isocyanurate composite, perlitt urethane composite, wood fiber /isocyanurate composite, phenolic, ar thickness. Ply Sheet Three or more layers of Type GI "GAFGLAS Ply 4" "GAFGLAS Ply 6 ". Surfacing: "Weather Coat Emulsion" at 3 gal /sq. • 3. Deck NC Incline: 1/2 Insulation: One or two layers "Isotherm R ", 4 in., hot mopped. Ply Sheet Any UL Classified gravel surfaced Class A asphalt glass fibe mat system. 4. Deck NC Incline: 2 Insulation (Optional): Isocyanurate, perlite, isocyanurate /composite wood fiber and glass fiber, any thickness, mechanically fastened. Base Sheet One ply Type GI or G2, mechanically fastened or ho mopped. Ply Sheet One or more plies Type GI or G2, adhered with hot roofin asphalt. Surfacing: "GAF Premium Fibered Aluminum Roof Coating", 1 -1/2 gal /sq or "GAF Weather Coat Emulsion ", 3 gal /sq. 5. Deck NC Incline 1 ocy Insulation (Optional): Perlite, glass fiber polyisanurate, won oo d fiber, mechanically fastened, any thickness. RODUCT ROOF COVERING MATERIALS (TEVT) - Roofing Systems (TGFU)- Continued pAFGLAS 180 Premium Base Sheet may be used in any of the following systems. "GAFglas Flex Ply 6" is a suitable alternate to " GAFglas Ply 6". "GAFTEMP Permalite Recover Board" may be used in lieu of any perlite insulation in any of the following NC Classifications. Class A, B and C Hot roofing asphalt, for use with organic and glass felts or modified bitumen membranes. Ruberoid Heat Weld" SBS roofing membraner may be used in lieu of " Ruberoid Mop" SBS products in any applicable Classification. Class A 1. Deck: C -15/32 Incline: 3 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 orlthore layers Type Gl "GAFGLAS Ply 4" or "GAFGLAS Ply 6 ", hot mopped. Surfacing Gravel. 2. Deck C -15/32 Incline: 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. Ply Sheet Three or more layers Type G1 "GAFGLAS Ply 4" or "GAFGLAS Ply 6 ". Cap Sheet One layer Type G3 "GAFGLAS Mineral Surfaced Cap Sheet ". 3. Deck: NC Incline: 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, 2 in. max. Ply Sheet Two or more layers Type G1 "GAFGLAS Ply 4" or "GAF- GLAS Ply 6 ". Cap Sheet One layer Type G3 "GAFGLAS Mineral Surfaced Cap Sheet ". 4. Deck: NC Incline: 1/2 Insulation: One or two layers "Isotherm R ", 4 in. max, hot mopped. Ply Sheet Any UL Classified gravel surfaced Class A asphalt glass fiber mat system. Deck: C -15/32 Incline: 1 Slip Sheet (Optional): Red rosin paper, nailed to deck. Base Sheet: One layer of Type G2 "GAFGLAS #75 Base Sheet" (may be nailed). Ply Sheet One or more layers of Type Gl "GAFGLAS Ply 4" or GAFGLAS Ply 6 ". Cap Sheet One layer of Type G -3 "GAFGLAS Mineral Surfaced Cap Sheet ". 6. Deck: NC Incline: 3 Base Sheet One layer of Type G2 "GAFGLAS #75 Base Sheet ". Ply Sheet One or more Type layers of T e GI "GAFGLAS Ply 4" or GAFGLAS Ply 6" Y V ia Cap Sheet One layer of Type G -3 "GAFGLAS Mineral Surfaced Cap Sheet ". eck: C -15/32 Incline: 2 Insulation: One or more layers perlite, glass fiber, isocyanurate, ure- t / thane, perlite /isocyanurate composite, perlite /urethane composite, phe- nolic, 1.0 in. min (offset from plywood joints 6 in.). Base Sheet One or more layers of Type Gl, G2 or G3. 3 Membrane: One or more layers of " Ruberoid Torch" (smooth or granule), " Ruberoid Torch Plus" (granule), " Ruberoid Mop" (smooth or granule) or " Ruberoid Mop Plus" (granule). Cap Sheet "GAFGLAS Mineral Surfaced Cap Sheet", hot mopped. 4 8. Deck C -15/32 Incline :2 Insulation (Optional): One or more layers perlite, wood fibe4 glass fiber isocyanurate, urethane, perlite /isocyanurate composite, perlite/ urethane composite, wood fiber /isocyanurate composite, phenolic, any thickness. Base Sheet Two or more layers of Type G2 or G3. Ply Sheet (Optional): One or more layers of Type Gl. Membrane•. One or more layers of "Ruberoid Torch" (smooth or 5. granule), "Ruberoid Torch Plus" (granule), "Ruberoid Mop" (smooth or granule) or " Ruberoid Mop Plus" (granule). LOOK FOR THE UL MARK ON RODUCT • l• YIN ROOF COVERING MATERIALS (TEVT) Roofing Systems (TGFU)- Continued Cap Sheet "GAFGLAS Mineral Surfaced Cap Sheer, hot mopped. 1. Deck: C -15/32 Class B Insulation (Optional): One or more Incline: 3-1/2 fiber, isocyanurate, urethane, perlite /is layers comma 'fibe4 glass urethane composite, wood fiber /isocyanurate composite, , phenolic Perhte/ thickness. rn P a phenolic, epy Ply Sheet: Two or more layers of Type G1 "GAFGLAS Ply 4" or "GAFGLAS Ply 6" Cap Sheet Type G3 "GAFGLAS Mineral Surfaced Cap Sheet", hot mopped. 2. Deck: C -15/32 Indine: 3-1/2 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: Two or more layers of Type G1, G2 or G3. Membrane: One or more layers of " Ruberoid Torch" (smooth or granule), " Ruberoid Torch Plus" (granule), " Ruberoid Mop" (smooth or granule) or " Ruberoid Mop Plus" (granule). Cap Sheet "GAFGLAS Mineral Surfaced Cap Sheet ", hot mopped. Class C 1. Deck: C -15/32 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. • Ply Sheet Three or more layers of Type GI "GAFGLAS Ply 4" or "GAFGLAS Ply 6 ". Surfacing "Special Roofing Bitumen" 20 lbs /sq. COAL TAR FELT SYSTEMS WITH HOT ROOFING COAL TAR Class A 1. Deck: C -15/32 Incline: 1/2 Insulation (Optional): One or more lavers 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 of Type Gl "GAFGLAS Ply 4" or "GAFGLAS Ply 6 ", hot mopped with coal tar bitumen. Surfacing: Gravel. COMBINATION HOT AND COLD SYSTEMS Class A 1. Deck: NC Incline: 2 Insulation (Optional): One or more layers perlite, wood fiber or glass fiber, 2 in. max. Ply Sheet: Three or more layers of Type G1 "GAFGLAS Ply 4" or "GAFGLAS Ply 6 ". Surfacing Grundy Industries "al MB Aluminum Roof Coating" at 1 -1/2 gal /sq. 2. Deck NC Incline: 1 Insulation (Optional): One or more layers perlite, wood fiber, glass fiber, isocyanurate, urethane, perlite /isocyanurate composite, perlite/ thic urethane k composite, wood fiber /isocyanurate composite, phenolic, any ness. Ply Sheet Three or more layers of Type G1 "GAFGLAS Ply 4" or "GAFGLAS Ply 6 ". Surfacing "Weather Coat Emuition" at 3 gal /sq. • . Deck NC Incline: 1/2 Insulation: One or two layers "Isotherm R ", 4 in., hot mopped. Ply Sheet Any UL Classified gravel surfaced Class A asphalt glass fiber mat system. . Deck: NC Incline: 2 Insulation (Optional): Isocyanurate, perlite, isocyanurate /composite; wood fiber and glass fiber, any thickness, mechanically fastened. Base Sheet One ply Type GI or G2, mechanically fastened or hot mopped. Ply Sheet One or more plies Type GI or G2, adhered with hot roofing asphalt. Surfacing: "GAF Premium Fibered Aluminum Roof Coating', 1 -1/2 gal /sq or "GAF Weather Coat Emulsion ", 3 gal /sq. Dedc NC Incline•. 1 Insulation (Optional): Perlite, glass fiber, polyisocyanurate, wood fibe4 mechanically fastened, any thickness. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby mode for the approval of the detailed statcmem ui ite plans and specifications herewith submitted for the build in or other herein described. This application Is made in compliance and conformity with the Building Ordinance of Miami Shores Vill.sge, Florid.. and nil provisions nf the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. ,—Date MO\ e.S14 11 t ILE 9 I 1-e.. N Registered Architect and/or Engineer . Name and address of licensed cont4ctor Location and legal dessription on: L.otkLY-f° gl ' mocV Street and Number where work is to be done Spite work to be done ancLpuoose of building (by floors).— ..... Owner's Name and Address Chairman Member — Member 16 . YYIV1/2--■hN Xli c Subdivi Ion. e 0 6fr&ik 1111/ .199.f111111TtIMI9 S•11t, L3S S11 — - .— New Building Remodeling Addition Repairs No. Stories i 1 _ To be constructed of Kind of foundation Roof Covering ftl■Pe., I Estimated Total cost of improvements $ a lanai Amount of Permit & C.).•_iti Zone cubage required _Plan Cubage Distance .to next nearest building. Size of Building Lot Maximum live load to be borne by each floor I hereby sub all plans and specifications for said building. All notices with reference to the building and its construction may be sent to Q,,._-,. MNIM14.■•• The undersigned applicant for this building permit do hereb certify that he understands and accepts his obligations as an employer of labor under the Florida ‘Vorkillen's Compensation Act, being Section 5966, Compiled General Laws of Florida. Prominent Supplement, and has complied with the provisions thereof, and will require similar compliance froin all contractors or sub-conuactors employed by him in the work to bc performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as arc required by the Act. The undersigned agrees to employ only sue subcontractors, on work to be performed under this permit. as are•licensed by Miami Shores Village. Remarks (Signed). STATE OF FLORIDA, 1 COUNTY OF DADE. Before me, t} _undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments . personally ap- (, peared and for no other purpose. - — — .- __.,.....to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, ond that all facts therein by him stated are true.. et,-, 29Y' . ..._ et orn p and S Permit .....a_f.i.Y., ... Date d/j.I.4.. for s. Disapproved Date.. .... 4) Notary Pu lc, State of F ride (Signed) Building Inspector y Commission Ex iiy M c g crim Y P.l.l_k 4-7 .SEPT -E11 .14 1 7 26 1902 — PLANNING BOARD )2111LED THRU GENERAL INS. I.N. Memb ••••• ...NW. ... ••■ 00 •••■• Member M ember *Wee ••••••, OW. Wm,. Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Plasinibg Huard. A rt. fee of $1.00 will be charged when such re-inspection is made necessary by improper notice for inspection oe faulty materials anu/or workmanship. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. a Y 19.. 2 R. Larson No... 1160 street st Terr. R egistered Architect Andier Engineer 2222222 MitfittIMSIMESTSZ 112:11, , 21.1 I.. ...... Name and address of licensed contractor Obenour Roofing Co. 7357 N. N . C 7 Location and legal description of lot to be built on Lo* Block Subdivision Owner's Name and Address J. Street and Number where work is to be done 1160 N. E. 91st Terr. State work to be done and purpose of building (by floors) ex Remove the exis roof, rep ace with a four . 91y built up asphalt and gravel \roofing. — . \ , — and for no other purpose. New Building Remodeling Addition Repairs. X No. of Stcrles To be constructed of Kind of foundation . Roof Covering 27 sqs. ..... ,......_ $ 1245 • 00 0 F.stunated Total cost of improvements g Amount of Permit p, 7 -... Zone cubage required _Plan Cubage Distance to next nearest building . Size of Building Lot ........ ....... Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building pennit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be pe formed under ^ • permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. SS. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared _ -•----- ... to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein hy him stated are true. Pennit No. ' 1 1 Date Read, Sworn to and Subscribed before me. Disapproved ...._. (Signed) Building In. tor Notary Public, State of Florida My Commission Expires LANNINC BOARD DATE Chairman Member Member Member — Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections C7 changes to this application after approval has been obtained from the Planning Board. A re-inspection fee of $1.00 will be charged when such re-inspection is made necessary by improper notice for inspection or faulty materials and/or work:nanship.