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867 NE 91 Terr (8)ETS ENVIRONMENTAL TESTING SERVICES, INCORPORATED December 1, 1999 Mr. John Cherry Roofs By Cherry, Inc. 3901 S.W. 40th Avenue Pembroke Park, Florida 33023 RE: TILE UPLIFT TEST Residence 877 N.E. 91 Terrace Miami Shores, Florida Mr. Cherry: Report # FL99- 456RUT Pursuant to your request, ETS ENVIRONMENTAL TESTING SERVICES INC. in association with ROOF REPORTERS, INC. has performed uplift test on the tile roof at the above referenced address. The following report includes the results of the uplift test. The uplift test consisted of placing a load test devise manufactured by Chatillon (model DFIS), over the tile with an adjustable connector placed under the front lip of the tile, and gradually increasing the pressure. The gauge readings are indicated in pounds. Pressure was exerted on the tile until a reading of thirty -five (35) pounds was obtained. The tests were conducted, and the results have been reported in accordance with Dade County Protocol, PA -106. ETS ENVIRONMENTAL TESTING SERVICES INC. greatly appreciates the opportunity to work with you, Should you have any questions or comments, please feel free to call. Respectfully submitted, ETS ENVIRONMENTAL TESTING SERVICES INC. van J merson I.H. Director of Environmental Service 7779 Miramar Pkwy. * Miramar, FI. 33023 (954) 270 -0436 Test Date Project Address Contractor Permit Number Roof Pitch Adhesive Type Tile Type TEST SUMMARY TEST RESULTS: PASSED See Attached Sketch for Further Details ROOF REPORTERS, INC. 4,4ez 9 PA 106 -95 Roof Tile Uplift Test Report November 30, 1999 877 NE 91 Terr. Miami Shores, FL Cherry Roofing 45698 3:12 Tile Installation Date November 22, 1999 Polyfoam (561) 434 -7555 SanTa - CK.-, /ar,1 /TV /Sok All testing is in strict accordance with The Dade County version of The South Florida Building Code, Section 3401.10 and PA 106 -95. Each Test location was pulled using a Chatillon Force Gauge to a minimum of 35 lbs.. Roof Area Total # of Tests # of Tests Passed %Passed Field & Ridge 25 25 100% Corner 10 10 100% Perimeter 10 10 100% accagli, RRC #116 Dade County Certified Testing Agency # 94 -0916 -11 3281 Lake Worth Roadr Suite Ell Lake WorthOFlorida 33461 Roof Consulting & Testing D Visual Surveys & Evaluations ORoof System Design O Moisture Surveys ttull Moccogli CONSULTANTS Nn+ T -Tr T. r r r 1 N E 91 - - E RAA Gt M M S t- o R?€S 1 Fort A ur1.1/1117 v7:: r Jnja i I'�Jbd SYNERGY Labs, Inc Calibration Date Sep 15. 1999 Calibration Due: Sep 15, 2000 Reference Standards Used Manufacturer CONSOLIDATED SYNERGY Model Number t000PF 12' SVI•CP(;V LABS INC Certificate of Calibration Manufacturer CMATI LION Model Number DFIS 200 Serial Number' 25220 Customer SN. 25220 Description DIGITAL FORCE GAUGE Customer: ROOF REPORTERS. INCORPORATED Cantleate Number 81503 Environmental Conditions: Temp: 21 dog C Relative humidity: 45% This certifies that the above equipment was calibrated in compliance with the requlroments of ANSUNCSL -Z540- 1994. ISO Gutde 25. and ISO 10012 using applicable procedures. At planned intervals. Synergy Labs, Inc measurement standards are calibrated by comWr13On to Or measurement against national standards. natural physueal constants, consensus standards. or by rotlo type measurements using sell-calibrating techniques. National standards are administered by NISI (National Institute of Standards and Technology) or other recognized national standards taboretones. Supporting documentation relative to traceability is on file and Is available for examination upon request. Ltmtta: NONE Remarks: UNIT RECEIVED IN TOLERANCE - NO ADJUSTMENTS REQUIRED Swat True Number Number Cat Due Date • _ 775 69652 Jan 06. 2000 388 19257 8116/2000 Synergy Labs. Inc 8211 NW 64 ST 113 Miami. FL 33188 Ph (305) -477 -5 PAGE 04 r 8.1.4 The nose of the tile deflects vertically in excess of 2 inches in mechanically attached systems. 9 Acceptance Criteria: 9.1.1 75% or more of the static up lift tests shall be required to pass the testing criteria. 10 Report 10.1 The final test report shall include the following: 10.1.1 A sketch of the test site roof which indicates I ) the field, perimeter and corner areas, with dimensions; and, 2) the location of all components on which a static uplift test is conducted. Indicate those attachments which were initially tested and, if applicable, those attachments which were tested in the extended testing. 10.1.2 A tabulated set of test results, signed by a Professional Engineer or a Registered Roof Consultant. 10.1.3 -END OF RAS 106- 106 -' PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 6 f r Job Address `is I N E 4 1 l e f t Tax Folio I L" fl CQ — 00 Legal Description G ,tdo Historically Designated: Yes No ‘X,2 3 0/ Owner/Lessee / Tenant la_ rc tee- W e- -Is r -e, Master Permit # Owner's Address 1 !J ell t �r Notary as to 0 My Commissi Square Ft. d Signature of owner and/or Condo President Date s: MARIETTA RODRIGUEZ -NOVO MY COMMISSION 0 CC 713506 EXPIRES: February 4, 2002 f3 Bonded Thu Notary Public Undery l$ era FEES: PERMIT 1 6/ RADON APPROVED: Zoning Building Mechanical Plumbing C.C.F. Phone .) s g - s444- Contracting Co. N.16 v o I b ) PJ g 6 v p pt> 7K` Address (..S? q O CQ vr� ar � 5 Qualifier {-} (Q- X4n►oJtr I t SS# - ( Phone LP Competency # Ins. Co. Address Address State # Municipal # Architect/Engineer Bonding Company Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANIC ROOFING PA ING FENCE SIGN M I0 N rtr Co Or 1 n WORK DESCRIPTION 2 h, - f - �QJ �( �-�- fi I r't 651 Ve Estimated Cost (value) r--- ' 7 d O 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 AN 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). I 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 ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. 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. Furthermore, I authorize the above -named contractor to do the work stated. Signature of Corii or Owner- Builder Notary s tContractor or er- Builder Date My Commission Expires: ej O NOTARY ;; :Py MARIETTA RODRIGUEZ -NOVO r■ ti MY COMMISSION 0 CC 713506 �L� EXPIRES: February 4, 2002 1. ";t y n;;' Bonded Pau Notary Pubic Underwriters Electrical Date -�� ' /c4,3y O BOND 3c TOTAL DUE 3 '49y Engineering A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIR I. I S CT PERMIT NO. TAX FOLIO NO. 1 — c7Co - 5 - dag c:-/F;:, STATE OF FLORIDA: tai f' COUNTY OF DADE: . NOTICE OF COMMENCEMENT 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: 2. Description of improvement: 4<Q� 3. Owner(s) name and address: 0.�� (a _a_ Y Tr r4- re Interest in property: ,— Name and address of fee simple titleholder: 4. Contractor's name and address: `I \► d - 00 r C.a 60 �0.✓vto r, ►J �� 5. Surety:(Payment bond required by owner from contractor, if any) Name and address: Amount of bond $ 6. Lender's name and address: 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: Signature of Owner e Notary Public Print Notary's Name My Commission Expires: 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) a,z4_ Print Owners Name iea L Cf Sworn to and subscribed before me this 6 day of ,JP ' / , 19 9 . MARIETTA RODRIGLI.EZ -NOVO °g ;; Bonded Tin Notary Public Underwtf e re X4,1 f..) ' Tm• 98R 16412 m 5 hore_S 33138 6opp� t � C_-12),(24,7t4 " (4 (D Prepared by: N\1 -.et. (w i■.,)p.r o Address: 6' oc, - Go4d./ (,G6, 123.01.52 2/93 '3= I _bMDA, COUNTY OF Or"\c7 f:.c `. Appendix "E" UNIFORM ROOFING PERMIT APPLICATION PROCESS No. Contractor's Name: CAf • R s „ L • . fp(y Job Address: (-.: 1 ?•) G (; t < <' r- ROOF CATEGORY ❑ (Low Slope Application) ❑ (Nail -On Tile) 1r(Mortar- Adhesive Se t e) ❑ (Asphalt/Fiberglass Shingles) ❑ ( Metal Roofs\Wood Shingles & Shakes) ❑ (Other) ROOF TYPE ❑ New Roof 21e- roofing ❑ Recovering ❑ Repair ❑ Maintenance Flat Roof Area (ft Sloped Roof Area (ft Total (ft ) -> Master Permit No. Exposure category (per ASCE 7-88): i2_ Building Classification category (per ASCE 7-88 table 1): Ft. A v Ft. A v Deck type: ATTACHMENT Fastener Type: SPACING Field: Perimeter: Corner: a DETAIL 1 & 2 ROOF HEIGHT AND SYSTEM DETAILS (Draw details as needed) 1 r r r r r r ROOF PLAN 31 Appendix "E" UNIFORM ROOFING PERMIT APPLICATION PROCESS No. Ridge Vea on7 I 44 (t MEANRSIQIf 7 et) 1 ft) Deck type: Insulation: 0 , 4 tr � ROOF SLIM D E T A I L 3 6 1VV SLOPED SYSTEM DESCRIPTION y IA-104=d_ Underlayment: * A 5777 oaa 6 - r3 p 7T t Fastener type & spaehq: Cap Sheet: tc ma Al" Roof Covering: t. 5. lc) G" of Drip edce:3X3 al� G4. G&Iv• ATTACHMENTS REQUIRED 1) Fire Directory Listing Page 2) Dade County Product Control Notice of Acceptance-Cover Sheet a) Specific System Description b) Specific System Limitation c) General Limitations d) Applicable Detail Drawings 3) Municipal Permit Application 4) Other Component Approvals (Pmazil a 3 x ? (Aerodynamic Multiplier): • w> ) - ( P m a x 2 : / X (Aerodynamic Multiplier):. c ) ` 1 ) (Pmax3: i 5x X (Aerodynamic Multiplier): o) `f- ) - TILE CALCULATIONS M SaO = Mr i4 PCA: / / g -`j o M c = Mr 1 9 PCA: o M = M - PCA: 1 / 9 .. a lh , s(ye, Page -2 PRODUCT CONTROL IOTX E OF ACCEPTANCE Monier Roof Tile 135 N.W. 20 Si Boca Raton, FL 33431 ACCEP rANCE NO.: 96- 0528.06 Renews No._94- I22L08 EXPIRES: 0-1 THIS j CO CONDT p BUILDING CODE COMMI'IZEF mot mail address: postmasterebuildingeodven tiga.eom EH ' 'S8 10:27 LP FOR INTROMLIYAN DADE COUNTY, FLORIDA METRO -DADE FLAGLER BUILDING BUILDING CODE COMPUANCE OFFICE METRO -DADE FLAGLER BUILDING 140 WEST FLAGLER STREET, SUfTE 1603 MIAMI, FLORIDA 33130 -1553 (305) 375 -2901 FAX (305) 375 -2908 Raul Rod guez Product Control Supervisor PRODUCT CONTROL OMSION (305) 375-2902 FAX (905) 372 -6335 Your application for Product Approval of Bermuda Fiat Tile under Chapter 8 of the Metropolitan Dade County Code governing the use of Alternate Materials and Types of Construction, and completely described in the plans, specifications and calculations as submitted by Redland Technologies, The Center for Applied Engineering, Inc. and Professional Service Industries, Inc_ has been - _Jmmennded for acceptance by the Building Code Compliance Office to be used in Dadc County, ' ,orida under the specific conditions set forth on pages 2 -12 and the standard conditions on page 13_ This approval shall not be valid after the expiration date stated below. The Building Code Compliance Office :serves the right to secure this product or material at any time from a jobsite or manufacturer's plant fc quality control testing. If this product or material fails to perform in the approved manner, the Building Code Compliance Office may revoke, modify, or suspend the .use of such product or material immediately. The Building Code Compliance Office reserves the right to revoke this approval, if it is determined by the Building Code Compliance Office that this product or material fails to meet the requirc.nents of the South Florida Building Code. The expen. of such testing will be incurred by the manufacturer. .Ir.�d. 1 1 �1�� This appliic::rion.for Product Approval has been reviewed by the Metropolitan Dade County Building Code Corsi. .lane Office and approved by the Building Code Committee to be used in » c County, Floe • . ui . the conditions set forth above, Charles Danger, P.B. Director Building Code Compliance Dept. APPROVED: 01/0V98 1 Metropolitan Dade County HomePago: non c.nn. ,.,. 03. 16. 98 .2:12 PM ^P01� Category: Prepared Roofing Sut.Categorv: Tile Type: Mortar Set/Adhesive Set S4I Concrete =E3 12 '98 10:28 rtylignaleScriPtion Page 2 of 13 PRODUCT CONTROL NOTICE OF ACCEPTANCE ROOFING SYSTEM APPROVAL Expiration Date: Contact: Reese H. Moody Technical Service Accessories Manager I35 N.W. 20 St. Boca Raton, FL 33431 (407)338 -8200 unouw atlnml iQ}00 Product Control No.: 96- 01$,06 AovlicanZ: Monier Roof Tile Product Control No.: • 96-0528.06 135NW20St. Boca Raton, FL 3343 I Approval Date: Javan 8. 1994 lama ce1202 Monier Roof Tile is a member of the Redland Group, a world wide producer of primary building products and roof tile. Monier manufacturers concrete roof tile for nail -on, mortar set or adhesive set application_ a plants throughout the United States ranging from Washington State to Florida. All tile is manufar.:.acd from extruded concrete consisting of Portland Cement, plasticizer, iron and metallic oxides, and blended aggregates. This Prod xpntral Approval relates to Monier's "Bermnfla Flat" tile profile. f o r to 1 vals for th the fil . Monier sells tile systems through local distribution and directly to consumers. All profiles have match:: g trim pieces used for rake hip, ridge hip, and valley terminations. Tile system accessories such as underiayment, ventilation systems and flashing systems are also available. 'These accessories are mansfactured for all profiles and form a part of this Product Control Approval. M• .,nier's "Bermuda Flat" roof tile has been tested in compliance with the South Florida Building Code req' •.:moms for concrete, mortar or adhesive set tile applications. The minimum roof slope for Monier's •' ■.nuda Flat" mortar or adhesive set tiles shall be 2 ":12 ". Sec the "Profile Drawing" section in this 4,z oval for the "Bermuda Flat" profile drawing. The Monier "Bermuda Flat" tile profile has been tested for both wind characteristics and static uplift performance, therefore, any consideration for installation shall be done as a 'Moment Based System'. Data for attachment calculations is noted in Tables 1 through 3 of this approval. rank Zuloaga Roofing Product Control Examiner SRI rill S'Zc 1 nor= CAP 03. 16. 92 12:12 FM 202 Product E3 12 '88 18:28 1111191101 It! LACTURED OR Bermuda Flat Flat 1 =15" Tole w 10 3 /8° Ph" thick Trim Pieces , I = varies. w varies varying thickness LABELED BY APPLICANT Test Dimensions Specifications PA 112 PA 112 Page 3 of 13 Product Description Flat, interlocking, extruded concrete roof tilt equipped with two nails holes For mortar set or adhesive set applications. Accessory trim, concrete roof pieces for use at hips, rakes, ridges and valley terminations. Manufactured for each tile profile. 1 Franc; Zuloaga Roofing Product Control Examiner rid 1 '7'30 c ^,c non 03. 16. 9° 12:_12 PM P03 :itz /yo lnu 1u:43 tile JO1 J341f 53UI 1130 Felt 1Produc4 #43 Coated Base Sheet Mineral Surface Cap Sheet Lenzingtex -LB 140 59" x I64' roll Under;ayment 22 Ibs/roll Rainproof 11 Ice and Water Shield :93 12 'SS 10:29 MONIER L[FETILE ••-• BRADCO MIAMI ®004 Product Control No.: 96- 0528.06 TRADE NAMES OF PRODUCTS MANUFACTURED OTHERS Test Dimensions § c tionrs 30" x 75' roll 36" x 75' roll or 60" x 75' roll 36" x 75' roll N/A N/A N/A ASTM D 226 type II ASTM D 2626 ASTM D 249 PA 104 PA 104 PA 103 Page 4 of I3 Product Description Saturated organic felt to be used as a nailed anchor sheet. Saturated and coated organic base sheet for single or double ply underlayment. Mineral surfaced asphalt roll roofing for use as a top ply in a double ply underlayment system. Single ply, nail -on underlayment. Single ply, nail -on underlayment with 2" self- adhering top edge. Self - adhering underlayment for use as a top ply in a two ply underlayment system with approved #30 or #43 as the base layer. Manufacturer generic generic generic Lenzing Performance, Enc. PCA 1494- 052705 Protect -O -Wrap, Inc. PCA #94- 0714.01 W.R. Grace Co. PCA #92- 1116.01 Frank Zuloaga Roofing Product Control Examiner n;. 16. 98 12 :12 FM PO4 Tin Caps Tile Na:::: Product Dimensions Mopping Asphalt N/A Plashing Cement Asphalt Primer N/A N/A Roofing Nails rein. 12 ga. with PA 114 3 /g" head Appendix E min. 32 ga. min. 1 /g" o.d. max.. 2" o.d. min. 8d x 2%:" or min. 10dx3" cs: Specifications ASTM D 312 type III or IV ASTM D 4586 ASTM D 41 PA 114 Appendix E PA 114 Appendix E Page 5 of 13 roc uct Description Manufacturer Asphalt for bonding generic a mineral surface cap to a meth. attached base sheet in a double ply underlayment system. Cut back, asphalt based, asbestos free, fiber reinforced, trowel grade cement for repair and flashing applications. Cut back, asphalt based coating used to facilitate bonding of dissim liar materials. Annular ring shank, hot dipped, electro or mechanically ga1v. roofing nails for use in underlayment attachment. Corrosion resi screw or smooth shank nails for additional tile attachment at cave tilt courses. generic generic generic Corrosion resistant generic circular disc for use in underlayrnent attachment generic Frank Zuloaga Rooting Product Control Examiner FEB 12 'S8 1C:2S 561 338 5391 PAGE.005 03. 16. 98 12:12 PM P05 Roof Tile Mortar ('Ti1eTite'TM") Roof Tile Mortar ( "Quikrete® Roof Tile Mortar #1140") Roof Ti.: Mortar ("BONSAI.® Roof Tile Me• gar Mix ") Roof Tire Adhesive (Polypro® AH 160) Valley FI•snirsg Drip Edge EB 12 'SS 1e ;30 r NIA N/A NIA N/A min. 26 ga. min. 16" width min..26 ga. min. 2" face flange min. 2" deck flange Test PA 123 PA 123 PA !23 ASTM A 525 Galvanized steel valley flashing PA 111 Galvanized steel drip edge Page 6 of I3 Product L!S CJPLkU Prepared mortar mix designed for mortar set roof tile applications. Prepared mortar mix designed for mortar set roof tile applications. Prepared mortar mix designed for mortar set roof tile applications. Manufacturer Bermuda Roof Company, Inc. PCA H94- 0614.01 Quikrcte Construction Products PCA #94- 0808.01 W.R. Bonsai Co. ?CA #940628.03 PA 110 Adhesive4 ...?olyfoam Products, for use in roof tilt Inc. applications. PCA%94- 0401.0I generic generic Frank Zuloaga Roofing Product Control Examiner S 03. 16. 98 12:12 PM ^�P06� Test money The Center for Applied Engineering, Inc. The Center for Applied Enigneering, Inc. Redland Technologies Professional Service Industries, Inc. IN 28 •S8 Ie:=8 TEST REPORTS Test Identifier 9 4 -084 94 -060A P063I -01 224 -47099 Page 7 of 13 Product Control No.: 96- 0528.06 Test Name/Report Static Uplift Testing PA 101 (Mortar Set) Static Uplift Testing PA 101 (Adhesive Set) Wind Tunnel Testing PA 108 (Mortar Set) Physical Properties PA 112 Frank Z1110 age Rooting Product Control Examiner 03. 16. 98 Date May 1994 March, 1994 July 1994 Sept, 1994 1 ?:12 PM P07 Deck Type: Deck Description: SYSTEM D: Slope Range-. Lh*dcriayment: Roofing Tile: CommecU: 3 12 '98 10:31 SYSTEMS Page 8 of 13 Product Control No.: 96. 0528.06 Wood, Non - insulated New construction 19/32" or greater plywood or wood plank. Mortar or Adhesive Set Application 2 ":12" to 7 ":12" Note: System D is only acceptable in Mb slope rang Install choice of approved undertayment system, noted on Page 1 of Dade County Protocol PA 120, in compliance with Section 3.02 of PA 120. See Syster1 Limitation #6. Install tile in compliance with PA 120 using one of the approved mortars or - adhesives noted in this approval Mortar or adhesive shall be applied in compl - iance with the mortar manufacturer's Roofing Component Product Control Approval. The mortar or adhesive attachment shall provide sufficient. - attacbment resistance expressed as a moment to meet or exceed the required moment of resistance determined in compliance with PA 115 or PA 127. The mortar and adhesive attachment data is noted in Table 3, attached. 1. For re-roof applications, 15 /32" plywood is an acceptable substrate. 2. For mortar set applications, the first three courses of tile shall be nailed with not less than one nail per tile.. As an alternate, the first three courses of tile shall be applied in mortar over a single layer of minimum 12 ga. wire mesh with square openings of not Tess than 3 /8" which is mechanically attached to the deck with not less than one roofing nail eve 1 ft For roof pitches from 6 ":12" to 7 " :12 ", every third tile of every fifth course, beginning at the eighth course, shall be nailed with not less than one nail per tile. Frank Zufoaga Roofing Product Control Examiner 03. 16. 98 12:12 PM P08 .r• vv• �uu iv..ru CAA ..Vl JJO 0441 1 - The standard minimum roof pitch for Monier "Bermuda Flat" mortar set or adhesive set tile applications is 2" rise in 12" run (2 ":12"). The maximum roof pitch for mortar set or adhesive set tile applications is 7" rise in 12" run (7 " ;121. 2. Monier's "Bermuda Flat" tile profile has not been tested for tutu -on applications, therefore, System A (Counter - Batten Nail-On Application), System 8 (Direct Deck Nail -On Application) and System C (Horizontal Batten Nail -On Application) do not form part of this approval. 3. System installation shall be in compliance with the system specifications outlined in this Product Conte -. Approval. Mortar set or adhesive set tile shall be attached using an approved mortar or tile ,..rnesive noted in this approval, the data of which is noted in Table 3 of this Approval. The method of attachment utilized shall provide sufficient attachment resistance expressed as a moment to tweet or exceed the required moment of resistance determined in compliance with Dade County Protocol PA 115 or PA 127. i3 12 'S8 10:32 eufvitt( Llrrlrl'1Lk SYSTEM LIMITATIONS 4. For mortar set applications, the first three courses of tile shall be nailed with not less than one nail per tile. As an alternate, the first three courses of tile shall be applied in mortar or adhesive over - single layer of minimum 12 ga. wire mesh with square openings of not less than 3 /g" which is mechanically attached to the deck with not less than one roofing nail every 1 ft For roof pitches from 6 ":12" to 7":12", every third tile of every fifth course, beginning at the eighth course, shall be nailea with not less than one nail per tile. 5. For mortar set or adhesive set tile applications, a field static uplift test by a Dade County accredited testing agency, in compliance with Dade County Protocol PA 106, shall be required not Tess than 30 days after application to confirm tile adhesion. The results of this testing shall be reported to the Building Official and the installer stating that the application has passed or failed PA • 06 testing. If the application fails PA 106 testing, the report shall state which portion of the test was failed; Category f (examination for loose tile) or Category 2 (uplift testing of tile). Subsequent to icsting, the installer may repair not more than 5% of field area tiles and 10% of perimeter area (.:. ridgehake) tile with approved tile adhesive. The installer shall place an identifiable marking on each repaired tile for future reference. My PA 106 re -test shall not include any marked tile. 6. For mortar or adhesive set the applications, 30/90 hot mopped underlayment applications may be instilled perpendicular to the roof pitch prior to June 1, 1995 unless stated otherwise by the material auz: ufacturer. '!hereafter, 30/90 underlayment systems shall be installed parallel to the roof pitch in compliance with Appendix 'A' of Dade County Protocol PA 120. 7. All tiles shall bear the imprint or identifiable marking of the manufacturer's name or logo for ;' '•'tification in the field. • 8. The Monier "Bermuda Flat" tile profile has been tested for both wind characteristics and static uplift performance, therefore, attachment calculations for installation in compliance with Dade County =rotocol PA 115 or PA 127 shall be done as a 'Moment Based System' Page 9 of 13 BRADCO MIAMI e1009 Product Control No.: 96- 0528.06 uloaga Roofing Product Control Examiner SC s '7 70 S•7c T onrr 03. 16. 98 12:12 PM P09 SYSTEM LIMITATIONS (Corrrrnv ) 9. Applications for roofing permits shall include a completed Section 11 of the Uniform Building Permit, a copy of Monier RoofTile's current specifications and details. a copy of this Product Control Approval and a copy of the Product Control Approval of any Roofing Component used in the proposed tik application. Reference shall be made to appropriate data for the required fire rating. 10. The applicant shall retain the services of* Dade County certified testing laboratory to maintain quality control in compliance with the South Florida Building Code and related protocols. Samples taken shall be in compliance with Dade County Protocol PA 112, Appendix 'A'. 11. Any amendments to these provisions shall be in compliance with Sections 203 and 204 of the South Florida Building Code. =EB 12 '98 10 :3? Page 10 of 13 Product Control No.: 96- 0528.06 Frank Zutoaga Roofing Product Control Examiner c r nnr. a e. 03. 16. 98 12:12 PM � P10 Table 2: Restoring Moments due to Gravity - U. (ft --1bf) from PA 101 Tasting Tile Profile 3 ":12" or less 4 ":12" 5":1x' 6":12" 7" :12" or greater . N/A Monier Bermuda Flat Ti.a 5.20 5.12 5.01 4.89 Tile Profile _ X (ft3) z Batten Application . (ft') Direct Deck Application Bermuda Flat Fiat Tile NIA 0.24 Table 1: Aerodynamic Multipliers - (fe) Tile Profile Monier Bermuda Flat Flat Tile Tile Application Mortar Set Adhesive Set Attachment Resistance 39.00 118.90 FE3 12 '88 10:33 Table 4: Attachment Resistance Expressed as a Moment - M (ft-lbf) from PA 101 Testln DATA FOR ATTACEIMENT CALCULATIONS from PA 108 Testln Page 11 of 13 rank Zuioaga Roofing Product Control Examiner 5S1 338 5351 PRt,F 211 03. 16. 98 1 '::^ PM P11 :=15 1:' • 0 0 . f7 . 77 PROF= DRAWING Product Control No.: .96- 0528.06 BERMUDA FLAT FLAT TILE Page 12 of 13 Frank Zuloaga Roofing Product Control Examiner 03. 16. 98 12:12 P11 P12 Monier Roof Tile 135 N.W. 20th St. Boca Raton. FL. 33431 NOTICE OF ACCEPTANCE STANDARD CONDITIONS 1 Renewal of this Acceptance (approval) shall be considered after a renewal application has been filed and the original submitted documentation, including test supporting data, engineering documents, are no older than eight (8) years. 2 An :nd all approved products shall be permanently labeled with the manufacturer's name, city, state. and the following statement: 'Metro -Dade County Product Control Approved ", or as specifically stated in the specific conditions of this Acceptance. 3 Renewals of Acceptance will not be considered iE a) There has been a change in the South Florida Building Code affecting the evaluation of this product and the product is not in compliance with the code changes; b) The product is no longer the same product (identical) as the one originally approved; c) • f the Acceptance holder has not complied with all the requirements of this acceptance, ; ncluding ttre cortrct1 taifation'of the product • " • — d) The engineer who originally prepared, signed and sealed the required documentation Initially submitted, is no longer practicing the engineering profession. 4 Any re•fision or change in the materials, use, and/or manufacture of the product or process shall auton....:ally be cause for termination of this Acceptance. unless prior written approval has been requ. sc-d (through the filing ofa revision application with appropriate fee) and granted by this offIc• i. 5 Any of the following shall also be grounds for removal of this Acceptance: a) Unsatisfactory performance of this product or process; ;‘) Misuse of this Acceptance as an endorsement of any product, for sates, advertising or any ,ther purposes. 6 The Notice of Acceptance number preceded by the words Metro-Dade County. Florida, and follgwed by the expiration date may be displayed in advertising literature. If any portion of the N.: ice of Acceptance is displayed, then it shall be done in its entirety. 7 A .op • :this Acceptance as well u approved drawings and other documents, where it applies, sha• be provided to the user by the manufacturer or its distributors and shall be available for inspe:tion at the job site at all times. The copies need not be resealed by the engineer: 8 Failure to comply with any section of this Acceptance shall be cause for termination and removal or cceptance• 9 This Acceptance contains pages 1 through 13. END OF THIS ACCEPTANCE rrn ,-s ,nn ..+• Page 13 of 13 Product Control No.: 96- 0528.06 ACCEPTANCE NO.: Qtt $.06 APPROVED : January 3. 1p9S EXPIRES . Jannary S. 2Q91 Roofing Product Control Examiner 4(dvLJ 03. 16. 1 :1 PM''P13 '1-eTTFIO DADE ISO Polvloani PrOOU: s. !nc. 2.100 Spring Stuebner Roao Spt tng, texas- . IAETnOPOLifAN DAOE CZ;UNry, METRO.OAOC PLAGLER BUIL;- outLOtNG COOS COuvuAt.ic_ NEp^p•ry SUR c uE r n0.0AoE i U,GLER OIJ& :40 vW€ T FLAGLER ST; FLOR1t PC151 CONTltt)1. OF kCCFPTa Fnz Your application for I'roduc: Appro'al of PolYfaam Products "Polvnrn AH -I60" Roof 'r•t_ • cih• -ivt • mac C:laotcr 3 of the `.letropot.ta:t Dade County Code governing the use of Alternate Materials and Tr p.e Construction. and completely described in the plans. specifications and calculations is submitted by The Cato ' Applied Engineering. Inc. and stiles Labor iories Polymers Olvision has been recommended for a:et:pun= Me Building Code Compliance Department to be used tit Dade County, Horida under the specific and saute_ conditions set fortn itretn. Th approval 01•1 be valid for a period of three years. The Building Code Compliance Departrnatt rr_erves ri;nt 'o secure a product or material at any time for a jobsite or manufacturer plant for quality control testi.^.g.. pr oduct or matet ;al fail to perform in the approved manner. the Code Compliance De- r aruneat may revoke, rtoa:. ur su•pcnd he us- of such product or material immediately. The Building Code Ccmpli anca 0 , tmatt r>rcr r tltc r ight to require testing of this product or material should any uncidments to the south Florida Buiiding Cane mot. u d affecting this product or material experts-. of su =h testing will be incurred by the Manufacturer. : :OOUCT NO. : ACCEPTANCE NO.: 95-03[4:10 AP R 2 7 1998 EXPIRES: l Rodripoi v rodutx Control Division Supervisor - PLEASE NOTE - TiiIS IS TILE COVERSHEET. SEE ADDITIONAL PACES FOR SPEC:F1C AND Gu`IERAL CONDITIONS. BUILDING CODE COMMITTEE This applicatic'n for I' :o�u..t /•pproval 1•.2s been tev•et --d b-; :hi Moto, *�1' D.:de Curl; Building Cx Compliance Oep;.rtt.l, a•id a«ro•ieJ Cy the 0utldin6 Cc,dc Committee to be used in Ozde County. Florida un:t the conditions sct fonit above. APPROVED: APB 2 1995 V Sundial; Ca•M C: same :ace Departma e Meuopaiitrr C-xs C„-unry .- >nolicant; Polyfonn► Products. Inc. 2300 Spring - Stuebncr Road Sprin„ Texas 77333 -1132 Cate ?ors•• Roofing Component Sub- Catc;:orv Fastening Adhesive Tyne Roof Tile Adhesive Sib -Tvpe• Two Component Polyurethane L K V 1)1.JI. V,• I..VL At../ 1 . — • • •• ROOFING COMPONENT APPROVAL System Description Polyfoam Products, Inc., produces two- component expanding polyurethane adhesive for the attachment of clay and concrete roof tile. Polypro® AH I60 is specially designed for application of concrete and clay roo.` ::I: over a ••^ii -ty of roof deck substrates and underlayment materials. Polypro® adhesivc is applied with proprietary Foampro® RTF1000 dispensing equipment. Approval of this pro'luc! is specific to the two component mix and Foampro® RTF1000 dispensing equipment. 1- :ternative methods of dispensing will require a revision to this approval. Polypro® adhesiv.: shz.l: be applied only by 'Qualified Applicators', licensed by Polyfoam Products. Inc. C - rtific: tea and identification cards are issued w applicators upon successful completion of a application training N.igram. Approval of this adhesive system is contingent upon application by a 'Qualified Applicator. Contact: Pat Murray P.O. Box 1 132 Spring. Texas 77383-1132 (713)350 - 3838 Fax: (713)288 -6 1 p- - -- R��I Rkounguez Product Control No.. 95 -0114 to .Approval Date: APR 7 7 1905 Expiratid?i Date: APR 7 7 egg Test Product Product Dimensions Specifications Description Polyoro® .AH 160 VIA PA 101 Two component polyurethane Foarnpro® RTF TRADE NAMES OF PRODUCTS t`IANUFAL L./Rt.') vi< LABELED BY APPLICANT VIA See Detail Attaciicd Dispensing Equipme^t 2 Product Underlayment Root' Tile l l��"\ ✓ L \ 1• 1 1— —7 V a l \L/ 1 1 J 1• -• • • "' Test Criteria PA 120 Product Description All Dade County Component Approved products as detailed in Dade County .Application Standard PA 120 3 R- • di tZorrtgur PA 101 All .Approved roof tile systems having tested in compliance .vith Dade County Protocol PA 101. as detailed in the systems section of this Component Approval Manufacturer All Dade County Approved Products All Dade County A pproved P roducts Test ,Aacncv Test Identifier Test Name/Renort Center for Applied a 94 -J60 Metro Dade Protocol Engineering PA 101 Miles Laboratories - '�C N6- 559.631 Polymers Division ASTN1 D (623 TYPICAL PHYSICAL PROPERTIES rroperry Tcst Density ASTN1 D 1622 1.6 lbs. /1t. Results Compressive ASTM D 1621 18 PSI Parallel to rise Strength 12 PSI Perpendicular to rise Tensile Strength ASTM D 1623 28 PSI Parallel to rise \`/ %ter Absorption ASTM D 2127 0.03 Lbs. /Ft Plcisture Vapor ASTM E 96 3.1 Perm / Inch Transmission Dimensional Stability Closed Cell Content ASTM D 2126 ASTM D 2856 86% +0.07% Volume Change @ -40' F.. 2 weeks +6.0% Volunte. @ 1 SS'F.. 100% Humidity. 2 weeks at 0 02:01/94 Note: The physical properties listed above arc presented as typical average values as determined by accepted ASTM test methods and arc subject to normal manufacturing variation. 4 1 Rail :tc,d1 . Deck Type: Wood. `:on- insulated. New ConstructioniRereof Deck Description: New construction /,:" or greater plywood or %vood plank. Re -roof ':,:" or greater plywood Adhesive Srt ,Application SYSTEM .A: Slope :Ling.:: Lndcrlavmcnt: Roofing Tilc: Install choice of Approved underlayment system, noted on ?ag. o f D County Protocol PA 120, in compliance %vith Section 3.02 of PA ! Install :approved tile system in compliance with PA 120. Adhesive shall be applied in compliance with the Component Application section and the corresponding Placement Details of this Rooting Component Product Control Approval. The adhesive attachment shall provide sufficient attachment resistance expressed as a moment to meet or exceed the required moment of resistance determined in compliance with PA 115 or PA 127. The adhesive attachment data is noted in the tile Roof System Assembly Product Control Approval. Cuttir.t:nt�: I. For re - roof applications. minimum " /,:" plywood is an acceptable substrate. 2. All 'System Limitations' noted in the tile Roof System Assembly Product Control Approval shall apply. Rau(Rodriguez Y5 1 (CONTINUED) Deck Type: Concrete. New Constr'.iction /Reroof Deck Description: New construction SYSTEM 0: . Adhesive Set Application Slope Range: I to Undcrlaymcnt / Install .Approved underlayment system of one of the following: Waterproofing: Roofing Ti:c: Undedaymcnt System 4. (30/90 Hot Mop) noted on Page 1 of Dade Count./ Protocol PA 120. installed in compliance with Section 3.02(A) of PA 120 or Any .Approved urethane or asphalt based concrete waterproofing component installed in compliance with the waterproofing component manufacturer's Roofing Component Product Control Approval. Strips of reinforcing fabric shall be installed at all concrete deck joints. Install Approved tile system in compliance %with ('A 120. Adhesive shall be applied in compliance with the Component Application section and the corresponding Placement Details of this Roofing Component Product Control Approval. The adhesive attachment shall provide sufficient attachment resistance expressed as a moment to meet or exceed the required moment of resistance determined in compliance'ith PA 115 or PA 127. The adhesive attachment data is noted in the tile Roof System Assembly Product Control Approval. Comments: I. For re -roof applications, minimunt " /,;' plywood is an acceptable substrate. 2. All 'System Limitations' noted in the tile Roof System Assembly Product Control Approval or waterproofing component Roofing Component Product Control Approval shall apply. as applicable. Ra��l • odrigucz r ble 1: Adhesive Placement For Each Generic Tile Profile Tile Profile Placement Detail Two-Piece Barrel . # I 'S' Shaped tl2 Double Roll 03 Large Flat ad Small Flat a ir(J,.t.'s, 1 1t "YL�t.� •�,. Polvoro® Al (de adhesive shall only be applied over an underlayment installed in compliance %vith application instructions detailed in its Component Approval.. Under!ayment shall be any underlarniettts or underlayment systems listed as Approved in Dade County Protocol PA 120. Adl'�esiv,� ACstion shall to in accordance with the instructions provided in this Component Approval. fie manufacturer may provide additional instructions subsequent to this approval date which shall prevail Installation must be by a Factory Trained 'Qualified Applicator' approved and licensed by Poi:. (. am Produc :s. inc 3. Calibration of the Foamprc0 dispensing equipment is required before application of any adhesive. The mix ratio 5etwcen the "A" component and the "8" component shall be maintained between 1.0 -1.15 (.A) : 1.0 3). The dispense timer shall be set to deliver 0.08 to 0.15 pounds per the as determined at calibration No other settings shall be approved without revision of this Component Approval. 4. Adhesive shall be dispensed in a 17 in' to 23 in' pad at time of application. The cured pad shall be approximately 5" x 12 ". Foam placement shall be in accordance with the 'Placement Details' provided in this Component .Approval. Each generic tile profile requires a specific placement, as noted in Table 1, b :!o■v. A tile manufacturer may test a tile system in compliance with PA 101 and add ,n : dditic'uual detail without incurring an additional revision cost. Aah -re rile directly in freshly applied adhesive. Tile must be set within 2 to 3 minutes after foam has Leen dispe.sed. F Adhesive shall be placed w create contact with minimum 2 tiles. as outlined in the ' Placement Detail' 'or ea�ct tile profile. 711_ .?y Raul Rodrieuez I DETAILS • AH (--• u0R'AR 9C1 roq COKR ttLC COVER \ uCTAL C!r ORIP =cute' •I, clo•uc= cCtional tASC1A OOARO point-up uoc_ac x 10 - • roar Pad then appllad 2X4 ON (OCC • - N(SI poi M. ;E (*WA ACO1fOV NAVNC 1S RECLIAZO IT COOC) 2' % 10- "o ?cd Than applied NJUI COK.t NCR( • (0401 RC:VIRCO) ?I.lcc.nci Cu.uI NI: T.v -riccc 3arrcl ['-odic Raul I 'odrigucz • i ASQA / ECARO — 101 uINEFIAL SU °FACS Ac_F'•HO FELT Z - 10' Tor. Pad i:he:l eppLIed (EPOu). PREFABRJCATEO CLOSURE NAILED THROUGH PLASTIC ROOF C£UCI4T OR INTO APPROKO AOHCSIVE It LAN 1 lwUC. YtEEPHOLE Placement Dctail #2: 'S' Shaped Tilc Profile 10 ' Raul driguez NAIL XCPC :44ACL;C) PLASTIC RCCT CLUEJ+t (WEN A001 i1CYAL xaIU! IS RECUtRE0 8Y CCCE) "*.C. CLAP c„nC� SOAAO SCCURE .M CCRRO 1ON RC HA..S Sealant or POC1T -UP I,Ir14 : CLORLO uoRTAR TO uATC4 T1.0 SURFACE ROLLED RAKE "Lt (SPANISH 'S' CU:S, Test Location Uplift Pull Test (P or F) Test Location Uplift Pull Test (P or F) Test Location Uplift Pull Test (P or F) 1 ) 26 - 51 2 27 52 3 28 53 4 29 54 5 30 55 6 31 56 7 32 57 8 33 58 9 34 59 10 35 60 11 36 61 12 37 62 13 38 63 14 39 64 15 40 65 16 41 66 17 42 67 18 43 68 19 44 69 20 45 v 70 21 46 71 22 47 72 23 48 73 24 49 74 25 V 50 75 Owner's Name: Job Address' Du Quesne & Associates, Inc. Consulting Engineers Environmental • Civil • Structural Testin Laborator Buildin Inspection Services ON -SITE CONCENTRATED UPUFT LOAD TESTING OF ROOF TILE IN ACCORDANCE WITH METRO-DADE BUILDING CODE COMPLIANCE PROTOCOL PA 106 SITE SPECIFIC INFORMATION 1JbJ7 elte0 a . / C. ..rNITTR € Permit #. 35c28 6/ 8107 Old . 9 / Terr-. /A . SHr) tFF.s A) O \JO °R • I iv.Q O Type of Tile: V ...../.. NIP -. • LA Date Installed* �� Approximate Roof Height /T feet Roof Pitch 3 [!a Type of Access to Roof: Scaffolds ✓ Ladder Other Approximate Square Footage of Roof* 2 ft 2 Required Testing Force: 35 lbs. Testing Equipment: Chatillion DFIS 100 Date Tested* /8/98 Roofing Contractor Du Quesne, P.E ngineer P. 4513 Du •uesne & Associates, Inc. E.B. License #0005245 Lab Certification #94-0318.01 TEST RESULTS P = PASS, F = FAIL SKETCH OF ROOF IN BACK IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL PA 106, THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT QUALITY CONTROL TEST. 7821 S.W. 24th Street • Suite 104 • Miami, Florida 33155 • Telephone (305) 264 -1425 • Fax (305) 264 -1426 UTR 14309 THIS PA 106 TEST HAS BEEN PERFORMED IN FULL ACCORDANCE TO THE REQUIREMENTS OF DADE COUNTY, WITH NO DEVIATIONS. Please Note: This form is not valid unless Company logo appears in color (burgundy) KETCH OF ROOF JOB SHEET NO OF CALCULATED BY CHECKED BY DATE SCALE DATE AC; NOTES' • KETCH OF ROOF ,OB 8'67 /v. E. 7/ rir • , A4 b4-41/ 5//o, ss SHEET NO Z OF 2 CALCULATED BY 7- ` .D DATE C •- le -9, CHECKED BY DATE SCALE ‘reo 33 \IN NOTES. ❑ PERMIT N? 15159 BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Er Work to be performed under this Permit Architect Contractor .., "" .% or Builder ‘... -' '' Legal Lot II BI. Description Address of Building f, ‘ k... . CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA Subdi- vision Value of Project $ ;;• f DATE -- 195 a , Contractor's License No Amt. of Permit $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed: y . .• _, BY INSPECTOR • n consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations -to and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. is permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY STATE OF FLORIDA, COUNTY OF DADE. ss. MIAMI SHORES VILLAGE BUILDIN7, INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of th' det,iled statemen of the plans and specifica-ions herewith submitted for the build- ing or o h, -ructure her 1 described This 1 licatic is made in compliance and cow° m ty w.th the Building Ordinance of Mia Shores Villaee, or da, and all pro isions of the Laws f the Stat& cf 1.1..rid. all o d nances if Mi - ni Shores Village and all rules and regu a ion. of the Building Div . i of -lam Sho. illage 1- '1 ,e -0, ipl.ed with, whether herein specified or not. A copy of approved plans and specificati .ns must be kei• at bui.ding durin, progress of tl.e wcrk. Date 8/31/53 , 19 Owner' Name and Address.__RallSea. No 867 street_ NE 91 Teri-, Registered Architect and/or Engineer. Dick Besola. Name nd address of licen.,ed contractor. Lang Roofing and Tile Co 430 N. W. 79th St., Location and legal description of lot to be built on: Lot Block. Subdivision Street and Number where work is to be done. 867 B..__B.s___9lat Tarr—, Miami Shores. State work to be done and purpose of building (by floors) _ and for no other purpose. New Building. X Rernodeling Addition_ .... ___ ..... __ _ Repairs. _ . . No. of Stories To be constructed of ___ _ _ Kind of foundation ___ Roof Cov ling__ Shingle Tile_ Estimated 7 - ,tal cost of improvements $__ 650.00 Amount c Permit $._ 5.00 Zone ^ubage required __. __Plan Cubage Distance to next nearest building__ _ _ Size of Building Lot Maximum live load to be borne by each floor _ . ..... ___ hereby submit all the plans and specitic.ations for said building. All notices with reference to the building and its construction may be sent to The unde signed appli ant for tit's building permit does hereby certify Clat he understands and accepts his Aligations as an employer of 1 bor under he Florida Workmen's Compensation.Act being S. -tion 5966 Coi p led Gen al Laws of Florida P r anen Sipple 'tent, and h s compl ed w'th he provions thereof, and will require s.milar comp lance from all contractors or sub-contractors emplo .ed by him in the wo k to be p rt med under th s pern it and ill post or cause to be posted for inspection on the site of the work su :h public not' e cr •otit.es as are requir d by the Act. The u. d. r ign .d agrees to employ only such_ abcon. ctors. on wo6c (to he narforn, d der this permit as are licensed by M am. Shores ge. Lang Roofing and kiie Remarks. _ (Signed) C • Before me, the undersigned authority, a notary public, duly authorized to administer oaths ..nd take acknowledgments, personally op- . pearecl _ to me well known, and who, being by me first d. ly sworn, upon oath deposes and says that he is the of th abov de & ibed • istruction t h has careially read the foregoing application, and that he did sign the same, and that all facts therein by him stated are tr ie. Permit No / _ Date__ Read, Sworn to and Subscribed before me. Disapproved Date_ A !"\ R Notary Public State of Florida (Signed) Chairman Member Member _ Council A proved C Building Inspector PLANNING BOARD DATE Member Member Member Date Disapproved My Commission Expires. Date . . Ne E: A charge of $1.00 will be made for making corrections or 21ianges to this application Ifter approval h is hecn obtained from the ant- ng Board A re-Inspection fee of $1.00 will be charged when such re-inspection is m. le necessary by improper notice for inspe..t-or or fa. Ity iaterials and workmanship.