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ROOFING
ft-L011,3 ICCC Z C 1:31 lIP lot) te,N. zc,.% 0" y. 543 4 q t co) !Rd 5 ;:r6 2„. jet.si tZ) , )1/4, %.(1. : 11 '3h/53.0 II tt Q., 0 Z 1, 1Slo GI:4 rz-OG 1 4 V 1/ \,zr R 4 ) gt , co or) 1 2 3rg' ri 3S T MIAMI SHORES VILLAGE r ( BUILDING DEPARTMENT .� • 305- 795 -2204 Building Inspection Request Date Type Insp'n Tt' Permit No. w � rS ' • Name C7 T 55 7 Address ` � 40 1 E "I Company C�CVOW ,C Phone # Inspection Date 51 t' Approved Correction ❑ Re- Insp'n Fee 171 4 Tenant/Lessee Name $ Value of Work For this Permit Ck 421 . Submittal Fee $ 50. 00 Permit Fee $ Notary $ Training/Education Fee $ Total Fee Now Due $ a d (Continued on opposite side) Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING 1 (PC;:Cl HME® Permit No. P200 — 557 . PERMIT APPLICATION _ APP 2 b 2004 Mjster Permit No. FBC 2001 Permit Type (circle): Building Electrical ^ Plumbing ing Mechanical Owner's Name (Fee Simple Titleh lder) 1 �� (,�Tl J oh l Phone # Owner's Address City Mi & rr .Shoretate Job Address (where the work is being done) 14 0 Ov -1 1 City Miami Shores Village County Miami - Dade Is Building Historically Designated YES NO .� Contractor's Company IRme k UV a I Q k Pocri Phone # }C 5 ( 25 1 -)-0/9/ Contractor's Address F O` 8 0 X* 53 /0 g City I M 1 L W\ l State F L Zip 3 '1 Qualifier YIk L ( Architect/Engineer's Name (if applicable) Phone # Type of Work: ['Addition ❑Alteration ❑New Describe Work: * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Zip T 3 I . Phone # Square Footage Of Work: Zip '33)3g b4.-le air/Replace Scanning $ l a "- Radon $ Zoning Code Enforcement $ Structural Plan Review. $ Bond $ Ipso ❑ Demolition Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will note approved and a /// 1 reinspect oon fee will be charged. / / Signature ignatur r' Owner or Agent The foregoing instrument was ackno ledged before me this ( .D.-- The foregoing instruirent was ackn edged befor day o who is personally known to me or who has produced Ii As identification and who did take an oath. , 20 C4by 1 NOT Y Pl[JBLIC" `,� —� NOTARY PUBL Sign: — Sign: Print. V �C 4'\ (L 'v159.[PG V i3. S Print: 84 My Commission Expired% ` � Ckmmission #D :Q- Expires J ul i3 , 2 A, :antic }3ondm ; Co . APPLICATION APPROVED BY: Chc 12/15/03 Signature kiktA946,tuala Contractor thi ? �� , 20 eq by Ca C i �, who is personally know o me or who has produced DL �_- identification and who did take an oath. : 7 My Commission Expi s;RO : Bonded Thru A 'j'nntic Bonding Co. c. rtificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. ***************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APR 2 8 2004 Plans Examiner Engineer Zoning 7 Florida Building Code Edition 2002 High Velocity Hurricane Zone Uniform Permit Application Form. 1 Section A (General Information) Master Permit No. Re-t. Process No. Contractor's Name P 1 a_ l -O Job Address 14 0 /\i NrE C H S ROOF CATEGORY 61 Low Slope ❑ Mechanically Fastened Tile ❑ Mortar /Adhesive Set Tile ❑ Asphaltic ❑ Metal Panel/Shingles ❑ Wood Shingles/Shakes Shingles ARE THERE ❑ Prescriptive BUR -RAS 150 GAS VENT STACKS ROOF TYPE YES CI NO. TYPE- NATURAL ❑ LPGX ❑ ❑ New Roof � Re-Roofing ❑ Recovering ❑ Repair ❑ Maintenance . ROOF SYSTEM INFORMATION Low Slope Roof Area (SF) Steep Sloped Roof Area (SF) Total (SF) ) 0 5 i) IO t 0 Section B (Roof Plan) Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. 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( 71T1 1 NOA No.: 0c2 ti 0 7 Design Wind Pressures, From RAS 128 or Calculations Pmax1: I of 1 c3 Pmax3: Max Design Pressyte_Frgca the Specific NOA System: c {7 Deck Type: N 6 V 5o i led Gauge/Thickness: q 5� t Slope: 1 Anchor/Base Sheet & No. of Ply(s): ply* ba3 t° A 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): Base Sheet Fastener /Bonding Material: Ply Sheet(s) & No. of Ply(s): P I y � h erg 1 A5 oiled Roof System) Fastener Spacing for Anchor/Base Sheet Attachment Field: a• oc e Lap, # Rows 2 1• oc Perimeter. b • oc @ Lap, # Rows @ 122 oc Comer. L• oc a Lap, # Rows @ "1 • oc Number of Fasteners Per Insulation Board Field Perimeter Comer Illustrate Components Noted and Details as Applicable: Woodblocking, Gutter, Edge Termination, Stripping, -Flashing, Continuous Cleat, Cant Strip, Base Flashing, Counter- Flashing, Coping, Etc. Indicate: Mean Roof Height, Parapet Height, Height of Base Flashing, Component Material, Material Thickness, Fastener Type, Fastener pacing or Submit Manufacturers Details that Comply with RAS 111 and Chapter 16. ( F M' Aeret. I \/ u'P 51ke et \ pX30(Ay dr■p a Lt - 01 - g '15 bc`se s Ply pz Fa tener nding Material: ; ' l /60 r Sub p f —�- g uar d Top Ply. OIIA F 1 ht'ra.1 Cup Sheer T.opm t �_ ring Material: Surfacing l� T ID 1 \i-b Parapet Height Mean Roof Height 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. 1. 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. 2. 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). 3. Common Roofs: Common,roofs are those which have no visible delineation between neighboring units (i.e. townhouses, condominiums, etc.). In buildings with common roofs, the roofing contractor and/or owner should notify the occupants of adjacent units of roofing work to be performed. 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. 5. 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. 6. 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. 7. 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. 6/ o 4,4(yamue6P Owner's/Agent's Signature Date Contractor's Signature 1 M IA M MADE Ohl BUILDING CODE COMPLIANCE OFFICE (BCCO) PRODUCT CONTROL DIVISION NOTICE OF ACCEPTANCE (NOA) GA.F Material Corporation 1361. Alps Road Wayne, NJ 07470 MIAMI-DADE COUNTY, FLOUDA METRO -DADE ['LAGLER BUILDING 140 WEST FLAGLER STREET, SUITE 1603 MIAMI, FLOIt1DA 331304563 (305) 375 -2901 FAX (305) 375.2908 SCOPE: This NOA is being issued tinder the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed by the BCCO and accepted by the Building Code and Product Review Committee to he used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction (AhIJ). This NOA shall not be valid after the expiration date stated below. The Miarni -Dade County Product Control Division (In Miami Dade County) and/or the AH1 (in areas other than Miami Dade County) reserve the right to have this product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing and the AIL! may inunediately revoke, modify, or suspend the use of such product or material within their jurisdiction. BORA reserves the right to revoke this acceptance, if it is determined by Miami -Dade County Product Control Division that this product or material fails to meet the requirements of the applicable building code. This product is approved as described herein, and has been designed to comply with the High Velocity I:-lurricane Zone of the Florida Building Code. DESCRIPTION: C AI' Conventional Built -Up Roof System for Wood Deck. LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami -Dade County Product Control Approved ", unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been fled and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials, use, and /or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to cornply with any section of this NOA shall be cause for termination and removal of NOA. A.DVE1U'1SEMEN'l': The NOA number preceded by the words Miami - Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then. it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall he provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA renews NOA ##02- 0=108.09 and consists of pages 1 through 21. The submitted dot :umentation was reviewed by Frank Zuloaga, RRC NOA No: 03-05011 Expiration Date: 11 /04/ Approval Date:10/23 / Page 1 awl 2.1 .ROOFING SYSTEM APPROVAL Category: Sub - Category: Deck Type: Maximum Design Pressure Fire Classi flea film: TRADE NAMES OF PRODUCTS MANUFACTURED OR LABELED BY APPLICANT: TABLE 1 Product GAF Asphalt Concrete Primer (Matrix 307 Primer) GAF Mineral Shield® Granules GAF WeatherCuat « Emulsion (Matrix'" Fibered 305 Emulsion) GAF Premium Fibered Aluuninurn Roof Coating (Matrix r" System Pro Aluminum Roof Coating Fibered 3111) GAF Jetblack All Weather Plastic Cement (Matrix TM Standard Wet/Dry Roof Cement 204) RUBEROID® Modified Bitumen Flashing Cement Jetblack Premium Flashing Cement G APGLAS® #75 GAFGLAS #80 Ultima I3ase Sheet GAFGLAS Flex PIyTM 6 Roofing BUR Wood -75 psf See General Limitation. #1 Dimensions 5, 55 gallons 60 Ib. hags 5 gallons 1, 5 gallons ASTM D 2824 Fibered aluminum coating. 1, 5 gallons 5 gallons 5 gallons 39.37" (1 meter) wide 39.37" (1. meter) wide 39.37" (1 meter) wide Test Specification ASTM D 41 ASTM D 1863 Product Descri Asphalt concrete printer used to promote adhesion of asphalt in built -up roofing. Granules for surfacing of exposed asphalt, cold process cement or emulsion. GAF Mineral Shield® Granules shall be used for flashing applications only. ASTM 1227 Surface coating for smooth surfaced roofs. ASTM D 3019 Refined asphalt blended with a mineral ASTM 0 3409 stabilizer and fibers. Permits adhesion to wet and dry surfaces. ASTM 1) 4586 Fiber reinforced, polymer modified Flashing cement ASTM D 4586 Asphalt flashing Cement ASTM D 4601 Asphalt impregnated and coated glass mat base sheet. ASTM D4601. Asphalt impregnated and coated, fiberglass base sheet ASTM D 2178 Type VI asphalt impregnated glass felt w ith asphalt coating. NOA No: 03-050 31.05 Expiration Date: 11 /0a /08 Approval Date:10 /23103 Page 2orf21 Product GAFGLAS Ply 4® GAFGLAS® Mineral Surfaced Cap Sheet GAFGLAS® STRATAVENTO Eliminator Perforated RUBEROID® SBS 1.leat- Weldt" 170 FR RUBEROID® SI3S Heat - Weld'M PLUS RUBEROID® SBS Heat - Weld PLUS PR RUBEROID® Sr3S Heat - We1dh'r 25 RUI3EROI]) Modified Base Sheet Ruberoid® 20 Ruberoid ® Mop Granule Dimensions 39.37" (1 meter) wide 39.37" (1 meter) wide 39.37" (1 meter) wide GAFGLAS® Flashing Various GAFGLAS O 39.37" (1 meter) STRATAVENT wide Eliminator Perforated Nailable RUBEROIDO SBS Heat- 1 meter (39.37") We1d"h' "s Smooth wide RUBEROID® SBS Heat- 1 meter (39.37 ") Weld''" Granule wide 1 meter (39.37 ") ASTM D -6164 Non -Woven Polyester neat coated with fire wide retardant polymer modified asphalt and surfaced with mineral granules. ASTM D -6164 Non -Woven Polyester mat coated with polymer modified asphalt and surfaced with mineral granules. 1 meter (39.37 ") ASTM D -6164 Non -Woven Polyester mat coated with fire wide retardant polymer modified asphalt and surfaced with mineral granules. ASTM D -6164 Non -Woven Polyester mat coated with polymer- modified asphalt and smooth surfaced. ASTM D4601, Premium glass fiber reinforced SBS - Type 11, UL modified base sheet Type G2 BUR ASTM D 6163 SBS modified asphalt base sheet and ASTM D 5147 interply sheet reinforce with a glass fiber rnat. ASTM D 6222 Non - woven polyester nett coated with ASTM D 5147 polymer modified asphalt and surfaced w ith mineral granules. 1 rneter (39.37 ") wide 1 meter (39.37 ") wide 39.37" (1 meter) wide 39.37" (1 meter) wide 39.37" (1 meter) wide 'Pest Specification ASTM D 4897 D 3672 Type 1V asphalt itnprcfmated glass felt with asphalt coating. Asphalt coated, glass fiber mat cap sheet surfaced with mineral granules. Fiberglass base sheet impregnated and coated on both sides with asphalt. Surfaced on the bottom side with mineral granules embedded in asphaltic coating with factory perforations. Asphalt coated glass fiber mat flashing sheet available in three sizes. ASTM D 4897 Fiberglass base sheet impregnated and D 3672 coated on both sides with asphalt. Surfaced on the bottom side with mineral granules embedded in asphaltic coating. ASTM D -6164 Non-Woven Polyester mat coated with polymer - modified asphalt and smooth surfaced. ASTM D -6164 Non -Woven Polyester mat coated with polymer modified asphalt and surfaced with mineral granules. ASTM 1) 2178 ASTM D 3909 Product Description NOA 1\u: 03- 0503.05 Expiration Date: 11 /04 /08 Approval Date:10 /23/03 Page 30f21 Product Ruberoid® Mop Plus (Granule) RUBEROID MOP Smooth RUBEROIIX MOP 17UPR RUBEROIDO MOP FR RUBEROID® TORCH Smooth RUBEROID® TORCH Granule RUBEROID® 'TORCH PLUS (Granule) RUBERO1D ® TORCH FR RUBEROID 170FR TORCH RUI3ERO1D n 30 RUBEROID® 30 FR RUBEROID ULTRACLAD® SBS RUBEROID® Dual FR Test Dimensions Specification 39.37" (1 meter) wide 39.37" (1 meter) wide 39.37" (1 meter) wide 39.37" (1 meter) wide 39.37" (1 meter) wide 39.37" (1 meter) wide 39.37" (1 meter) wide 39.37" (1 meter) wide 39.37" (1 meter) Wide 39.37" (1 meter) wide 39.37" (1 meter) wide 39.37" (1 meter) wide ASTM D 6222 Non -woven polyester mat coated with ASTM D 5147 polymer modified asphalt and surfaced with mineral granules. Non -woven polyester mat coated with polymer- modified asphalt and smooth surfaced. ASTM D 6164 ASTM D 5147 ASTM D 6164 ASTM D 5147 ASTM 1) 6164 ASTM D 5147 Product Description Non -Woven polyester mat coated with fire retardant polymer modified asphalt and surfaced with mineral granules. Non - Woven polyester mat coated wi.th fine retardant polymer modified asphalt and surfaced with mineral granules. ASTM D 5147 Heavy duty, polyester reinforced, asphalt modified bitumen rftembrane, smooth surface. ASTM D 5147 Asphalt impregnated, coated felt, surfaced with mineral granule. ASTM D 6222 Heavy duty, polyester reinforced, asphalt ASTM D 5147 modified bitumen membrane, granule surface ASTM D 6222 Heavy duty, polyester reinforced, coaled ASTM D 5147 with fire retardant asphalt modified bitumen membrane, granule surface. ASTM D 6222 Heavy duty, polyester reinforced, coated ASTM D 5147 with fire retardant asphalt modified bitumen membrane, granule surface. ASTM D 6163 Non -woven fiberglass mat coated with ASTM D 5147 polymer modified asphalt and surfaced w ith mineral granules. ASTM D 6163 Non -woven fiberglass mat coated with fire ASTM D 5147 retardant polymer modified asphalt and surfaced with mineral granules. ASTM D 6298 Woven fiberglass mat coated with Polymer ASTM D 5147 modified asphalt and surfaced with aluminum, copper or stainless steel foil. 39.37" (1 meter) ASTM D 6164 Non -woven polyester and fiberglass mat Wide ASTM D 5147 coated with file retardant, polymer modified asphalt and surfaced with mineral granules. NOA No: 03- 0501.05 Expiration Date: 11/04108 Approval Date:10/23103 Page 4 crr 21 Product Vent Stacks (metal and plastic) GAF Aluminum Emulsion GAF Aluminum Roof Paint (Matrix ® System Pro Aluminum Roof Coating Fibcred 302) GAF Built -Up Roofing Asphalt RUBEROID MOD Asphalt, Asphalt L & Asphalt P Tile -Mate Base Sheet Tile -Male Cap Sheet Shingle- MateT "I IJnderlayrnent TopCoat® Surface Seal SB (Matrix 602 SB Coating) GAP WeatherCote® MB +(Matrix 715 MB Coating) TopCoat MB +(Matrix 715 MB Coating) \cathe (Matrix 531 WeatherCote® Elastomeric Flashing Grade) Matrix Low VOC Matrix 101 System Pro SBS Adhesive (Ruberoid®MB) Matrix 201 System Pro SBS Flashing (Ruberoid®MB) Matrix 102 Select SBS Adhesive Test Dimensions Specification 5 gallons 5 gallons 1001b. cartons, bulk 601b. kegs PA 100(A) Amyl D 1929 ASTM D 635 None ASTM D2824, Type 1 Product Description One way valve vent used to relieve built -up pressure within the roof system. GAF Vent Stacks are available in metal or plastic. Mineral colloidal bituruinous emulsion with reflective aluminum flakes Non - fibered aluminum pigmented, asphalt roof coating ASTM D312, Interply mopping and surfacing asphalt Types 1, 11, III and IV SEBS modified asphalt 39.37" (I meter) ASTM D4601 Asphalt impregnated and coated, fiberglass wide base sheet 39.37' (1 meter) ASTM D 3909 Asphalt coated, glass fiber mat cap sheet wide surfaced with mineral granules. 4 sq. roll 30 Ibs. 5 gallons 5 gallons 5 gallons 5 gallons 5 gallons 5 gallons ASTM D3019 5 gallons ASTM 03019 5 gallons ASTM D3019 Fiberglass reinforced shingle underlayment Surface coating for smooth surfaced and mineral surfaced roofs. Surface coating for smooth surfaced and mineral surfaced roofs. Surface coating for smooth surfaced and mineral surfaced roofs. Surface coating for smooth surfaced and mineral surfaced roofs. Surface coating for smooth surfaced and mineral surfaced roofs. Cold Applied Modified SEBS Asphalt Adhesive Cold Applied Modified SEBS Asphalt Adhesive — Flashing Grade. Cold Applied Modified SEBS Asphalt Adhesive. NOA No: 03- 0501 -05 Expiration Date: 11 /04108 Approval Date:10 /23103 Page 5 v121 Product (Ruberoid®MB) Matrix 202 Select SBS Flashing Matrix 203 Standard Plastic Cement Matrix 213 Gun Grade Plastic Cement Matrix. 103 Cold Adhesive Matrix 303 Select Fib ..red Aluminum Matrix 304 Select Non - Fibered RVPRROID® Modified 1:titutncn Adhesive APPROVED INSULATIONS: i'YRO)i White Lane Product Name (;AF"1'EMP Isotherm R, RA, RN & Composite, EnergyGuard RA GAF"113MM.) Composite A & N (B 1CA.)GAFI'EMPO Filx.rboard (1At''1'EIv1[( Perinalite GAF1'I MP GAPCANT'M GAF FILM? Perma1itc Recover Board GA)' T;MY GAFEDGE''M Tapered l {dltc. Strip (IUMCA) GAF1'EMPC) High l)ensi.ty Fiberboard BN'lCA linergyGuard, RA ItMCA. Composite linergyGuard, RA Dimensions 5 gallons 5 gallons 5 gallons 5 gallons 5 gallons 5 gallons 5 gallons Test Specification ASTM 1)4586 ASTM D4586 ASTM D4586 ASTM 1)3019 Product Description Cold Applied Modified SEBS Asphalt Adhesive — Flashing Grade. Standard Plastic Asphalt Roofing Cement Standard Plastic Asphalt Roofing Cement Caulk Grade. Cold Applied Asphalt. Adhesive. ASTM D 2824 Fibered aluminum coating. ASTM D2824, Non- libercd aluminum pigmented, asphalt Type 1 roof coating. ASTM D 3019 Fiber reinforced, rubberized Adhesive Type L1I 'fAt :1E 2 Product Description Polyisocyanurate foam insulation Polyisocyanurate fonin insulation with higli density fiberboard or Permilite perli.tc insulation. Fiberboard insulation. Perlite insulation hoard. Cut peilite board Perlite recover board Tapered perlite board }Egli density wood fiberboard insulation. Pol_yisocynurate foam insulation Polyisocynurate/wooCl Fiberboard composite Polyisocyanurate foam insulation Polyisocyanurate foam insulation Manufacturer (With Current NOA) GAF Materials Corp. GAF Materials Corp. GAF Materials Corp_ GAF Materials Corp. GAF Materials Corp. GAF Materials Corp. GAF Materials Corp. GAF Materials Corp. IIMCA HMCA Apache Products Co. Apache Products Cr". NOA Nu: 03 -050L .05 Expiration Date: 11/04 J0 Approval Datc:10 /23 103 ['age 6 ot21 APPROVED INSULATIONS: Product Name ACFoam [, I[ & Composite ISO 95+ ISO 95+ Composite Wood Fiber High Density Wood Fiberboard Perlite Insulation Dens Deck E'NRG'Y -2 & E'NRG'Y-2PLUS, UltraGard Gold FiberGlass Roof lrtsulation Structodek Multi- Max & FA Paroc Base Board Paroc Cap Board APPROVED FASTENERS: Fastener Number 1. 3. 4. 5. 6. Product Name GAF1'I'I'E® (Drill -Tec ®) #12 Standard & # 14 Heavy Duty Roofing Fastener GAFI'ITE® (Drill -Tec®) ASAP GAFTITE® (Drill-Tec ®) Base Sheet Fastener and Plate Galvaltune Plates (Drill - Tcc® Metal) Polypropylene Plates (Drill -Tec ® Plastic) Dekfast Fasteners #12, #t4 &t #15 TABLE 2 Product Description Polyisocyanurate foam insulation Polyisocyanurate foam insulation Polyisocyanurate/perlite ridged insulation Wood fiber insulation board Wood fiber insulation board Perlite insulation board Water resistant gypsum board Polyisocyanurate foam insulation Glass fiber/Mineral fiber insulation Wood fiber insulation board Polyisocyanurate roof insulation Rockwool insulation TABLE 3 Product Description Insulation fastener for • steel, wood & concrete decks. Pre- assernbled GAF ITE Fasteners and metal and plastic plates. Base sheet fastening assembly. Round galvalulne stress plates. Round polypropylene stress plates. Insulation fastener for wood, steel and concrete decks Manufacturer (With Current NOA) Atlas Energy Products Firestone Building Products, Inc. Firestone Building Products, Inc. generic generic generic G -P Gypsum Corp. Johns Manville Johns Manville Masonite. RMax, Inc. Partek, Inc. Manufacturer Dimensions (With Current NOA) 3" and 31" GAF Materials Corp. GAF Materials Corp. GAF Materials Corp. GAF Materials Copp. 3" and 31" GAF Materials Corp. Construction Fasteners Inc. NOA No: 03- 0501.05 Expiration Date: 11/14/08 Approval Date:1 t1 /23!03 Page 7(of 21 APPROVED FAS'rENERS: Fastener Product Number Nante 7. Dekfast Hex Plate 8. Delcfast Lock Plate 9. #12 Roofg Fasteners 10. Metal Plate 11. Gearlok Plastic Plate 12. Glasfast Fastener 13. Olympic Fastener #12 & #14 14. Olympic Fastener ASAP 15. Olympic Polypropylene 16. Olympic G -2 17. Olympic Standard 18. Insul -Fixx Fastener 19. Insul -Fixx S Plate 20. Insul -Fixx P Plate 21. Tru -Fast 22. Tru -Fast Plates 23. Tru -Fast Plates TABLE 3 Product Description Galvalurne hex stress plate. Polypropylene locking plate. Insulation fastener for wood and steel. Galvaluuie 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 AZ55 steel plate 3" round galvalume AZ50 steel plate Insulation fastener for steel and wood decks 3" round galvalume AZ50 steel plate 3" round polyethylene stress plate Insulation fastener for steel and wood decks 3" round galvalume AZ55 steel plate Polyethylene plastic plate Dimensions 2 718" x 3 1 /s" 3" x 3' /a" Manufacturer (With Current NOA) Construction Fasteners Inc. Construction Fasteners Inc. ITW Buildex Corp. 3" round 1TW Buildex Corp. 3" square 3.25" round 3.5" round 3" round 3" round 3" round 3" round 3" round ITW Buildex Corp. Johns Manville Olympic Manufacturing Group, Inc. Olympic Manufacturing Group, Inc. Olympic Manufacturing Group, Inc. Olympic Manufacturing Group, Inc. Olympic Manufacturing Group, Inc. SFS /Stadler SFS /Stadler SFS /Stadler The Tru -Fast Corp. The Tru -Fast Corp. The Tru -Fast Corp- NOA No: 03- 0501.05 Expiration Date: 11/04108 Approval Date:10/2 : Page 8o121 EVIDENCE SUBMITTED: Test Agency Factory Mutual Research Corp. Factory Mutual Research Corp. Factory Mutual Reseamh Corp. PRI Asphalt Technologies, Inc. PRI Asphalt Technologies, Inc. MT of S. F1. IRTofS.Fl. Test Identifier FMRC 1996 J.I.2B8A4.AM J.L 3B9Q1.AM J.I.OD0A8.AM J.I.0D1A8.ANI J.I. 0Y9Q5.AM GAF- 012 -02 -02 GAF- 020 -02 -01 02 -005 02 -014 Description Current Insulation Attachment Requirements Wind Uplift FMRC 44704 Wind Uplift FMRC 4470 - PA 114 Physical Properties ASTNI D 4977 TAS 114 TAS 114 Date 01.01.96 07.02.97 01.08.98 07.09.99 07.29.94 04.01.98 11.06.01 02.01.02 01.18.02 03.22.02 NOA No: 03- 0501.05 Expiration Date: 11/04/0 Approval Date:1U /Z 3/03 Page 9 cpf 21 APPROVED ASSEMBLIES Deck Type II: Wood, Insulated Deck Description: 19 or greater plywood or wood plank System Type A (1): Anchor sheet mechanically fastened, all layers of insulation adhered with approved asphalt. All General and System Limitations shall apply. One or more layers of any of the following insulations. Insulation Layer (Table 2) Insulation Fasteners Fastener (When applicable: Steel plate only =S, platic plate only (Table 3) Density /ft =P) ACFoam -I, ENRGY 2, GAFTEMP® Isotherm R, E'NRG'Y 2 Plus, GAFTEMP Isotherm RA, GAFTEMP Isotherm RN, GAFTEMP Composite, GAFTEMP Composite A, GAFTEMP Composite N, BMCA EnergyGuard, BMCA EnergyGuard Composite, EverGuard ISO, ISORoc, EnergyGuard RA, EnergyGuard RA Composite Minimum 1" thick N/A N/A BMCA High Density Wood Fiber, GAFTEMP® High Density Wood Fiber, GAFTEMP RecoverBoard, Wood Fiber, GAFTEMP® Fiberboard Minimum V2" thick N/A N/A Perlite, GAFTEMP® Permalite ®, Permalite Tapered, Paroc Minimum 3/4" thick Fiberglas (Min. 15 / 16 " thick) N/A N/A Note: All insulation shall be adhered to the anchor sheet in full mopping of approved hot asphalt within the EVT range and at a rate of 20 -40 lbs /100 ft Please refer to Roofing Application Standard RAS 117 for insulation attachment. Insulation listed as base layer only shall be used only as base layers with a second layer of approved top layer insulation installed as the final membrane substrate. Composite insulation panels may be used as a top layer placed with the polyisocyanurate side facing down. GAF requires either a ply of GAFGLAS STRATAVENT® Eliminator Perforated laid dry or a layer of GAFTEMP® PERMALITE or wood fiber overlay board on all isocyanurate applications. Anchor sheet: Fastening Options: N/A N/A GAFGLAS #80 Ultimam Base Sheet, STRATAVENT® Eliminator Perforated Nailable, RUBEROID Modified Base Sheet, RUBEROID® 20, RUBEROID SBS Heat- WeldTM Smooth or RUBEROID SBS Heat-Weld 25 base sheet mechanically fastened as described below; GAFGLAS® Ply 4 ®, GAFGLAS Flex PlyTM 6, GAFGLAS #75 Base Sheet or any of above Anchor sheets attached to deck with approved annular ring shank nails and tin caps at a fastener spacing of 9" o.c. at the lap staggered and in two rows 12" o.c. in the field. (Maximum Design Pressure —45 psf, See General Limitation #7) NOA No: 03- 0501_05 Expiration Date: 11/04/08 Approval Date:10/23 /03 Page 10 of 21 ✓•,c. . yysw.s .....o. .........0 r.r. a ... ... �� GAFGLAS® Ply 4®, GAFGLAS Flex P1yT" 6, GAFGLAS #75 Base Sheet or any of above Anchor sheets attached to deck with Drill -Tec (GAFTITE) #12 or #14 Screws and 3" Plates, 12" o.c. in 3 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 12" o.c. in the field of the sheet. (Maximum Design Pressure -45 psf, See General Limitation #7) GAFGLAS Flex PIyTM 6, GAFGLAS #75 Base Sheet or any of above Anchor sheets attached to deck with approved annular ring shank nails and tin caps at a fastener spacing of 9" o.c. at the 4" lap staggered and in two rows 9" o.c. in the field. (Maximum Design Pressure -52.5 psf, See General Limitation #7) GAFGLAS #75 Base Sheet or any of above Anchor sheets attached to deck with Drill -Tec (GAFTITE) #12 or #14 Screws and 3" Plates, 12" o.c. in 4 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 9" o.c. in the field of the sheet. (Maximum Design Pressure -60 psf, See General Limitation #7) Any of above Anchor sheets attached to deck approved annular ring shank nails and 3" inverted Drill-Tec (GAFTITE) insulation plates at a fastener spacing of 9" o.c. at the 4" lap staggered in two rows 9" in the field. (Maximum Design Pressure -60 psf, See General Limitation #7) GAFGLAS #75 Base Sheet or any of above Anchor sheets attached to deck with Drill -Tec (GAFTI1"E) #12 or #14 Screws and 3" Plates, 8" o.c. in 4 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 9" o.c. in the field of the sheet. (Maximum Design Pressure -75 psf, See General Limitation #7) Base Sheet: (Optional) Install one ply of GAFGLAS® #75, GAFGLAS #80 Ultima Ultra Base Sheet, GAFGLAS STRATAVENT Eliminator Perforated, RUBEROID Modified Base Sheet, RUBEROID Mop Smooth, RUBEROID® 20 RUBEROID SBS Heat -Weld Smooth or RUBEROID SBS Heat -Weld directly over the top layer of insulation. Adhere with any approved mopping asphalt applied within the EVT range and at a rate of 20-40 lbs. /sq; (see General Limitation #4). Ply Sheet: One or more plies GAFGLAS PLY 4 ®, GAFGLAS Flex Ply 6 sheet, #80 Ultima, RUBEROID Mop Smooth or RUBEROID 20 adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbs. /sq. Cap Sheet: (Optional) One ply of GAFGLAS® Mineral Surfaced Cap Sheet adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbs./sq. Surfacing: (Required if no cap sheet is used) Install one of the following: 1. GAF Special Roofing Bitumen with an application rate of 201bs. /sq with an application rate of 1.5 gal. /sq.; or GAF WEATHER COAT® Emulsion (Matrix 305 Fibered Emulsion) with an application rate of 3 gal. /sq.; or GAF Premium Fibered Aluminum Roof Coating (Matrix System Pro Aluminum Roof Coating Fibered 301) with an application rate of 1.5 gal. /sq. 2. Asphalt flood coat at an application rate of 60 lbs. /sq. ± 20%; plus gravel or slag with an application rate of 400 lbs. /sq. & 300 lbs. /sq., respectively. 3. Top Coat Surface Seal SB (Matrix 602 SB Coating), Top Coat MB Plus (Matrix 715 MB Coating), GAF WeatherCote or WeatherCote LOW -VOC applied at rate of 1 -1.5 gal/sq. Maximum Design Pressure: See Fastening above. NOA No: 03 0501.05 Expiration Date: 11/04/08 Approval Date:10 /23/03 Page 11 of 21 WOOD DECK SYSTEM LIMITATIONS: • 1 A slip sheet is required with Ply 4 and Flex Ply 6 when used as a mechanically fastened base or anchor sheet. 2. Minimum 'A" Dens Deck or '' /z Type X gypsum board is acceptable to be installed directly over the wood deck. G ENTERAL LIMITATE0NS: 1. Fire classification is not part of this acceptance, refer to a current Approved Roofing Materials Directory for fire ratings of this product. 2. Insulation may be installed in multiple layers. The first layer shall be attached in compliance with Product Control Approval guidelines. All other layers shall be adhered in a full mopping of approved asphalt applied within the E!V'I' range and at a rate of 20.40 lbs. /sq., or mechanically attached using the fastening pattern of the top layer 3. All standard panel sizes arc acccptahlc for mechanical attachment. When applied in approved asphalt, panel sire shall be 4'x 4' maximum. 4. An overlay and /or recovery board insulation panel is required on all applications over closed cell foam insulations when the base sheet is fully mopped. If no recovery board is used the base ahcet shall be applied using spot mopping with approved asphalt, 12" diameter circles, 24" mopped 8" ribbons in three rows, one at each sidclap and one clown the center of the sheet allow ti a continuous area of ventilation. Encircling of the strips is not acceptable. A 6" break shall be placed every 12' in each ribbon to allow cross ventilation. Asphalt application of either system shall he at a minim rate of 12 lbs. /sq. Mite: Spot attached systems shall be litniti:cl to a naaxinunn c esign pressure of -45 psf. 5. Fastener spacing for insulation attachment is based on a Minitnum Characteristic Force (P) value of 275 Ibf., as tested in compliance with Testing Application Standard TAS 105. If the fastener value, as field- tested, are below 275 ]bf. insulation attachment shall not be acceptable. 6. Fastener spacing for mechanical attachment of anchor/base sheet or membrane attachment is based on a minimum fastener resistance value in conjunction with the maximum design value listed within a specific system. Should the fastener resistance be less than that required, as determined by the Building Official, a revised fastener spacing, prepared, signed and sealed by a Florida Regis(cred Engineer, Architect, or Registered Roof Consultant may be submitted. Said revised fastener spacing shall utilize the withdrawal resistance value taken from Testing Application Standards TAS t()5 and calculations in compliance with Roofing Application Standard RAS 117. 7. Perimeter and corner areas shall comply with the enhanced uplift pressure requirements of these areas. Fastener dcnsitie.s shall he increased for both ins4ilalion and base sheet as calculated in compliance with Roofing Application Standard RAS 117. (When this limitation is sped f ically referred within this NOA, General Limitation 119 will not be applicable:.) 8. All attachment and sizing of perimeter mailers, mete l profile, and /or flashing termination designs shall conforrn with Roofing Application Standard RAS 111 and applicable wind load requirCmcnts. 9. The ma -donne designed pressure limitation listed shall be applicable to all roof pressure zones (i.e. field, perimeters, and corners). Neither rational analysis, nor extrapolation shall he permitted for enhanced fastening at enhanced pressure zones (i.e. perimeters, extended corners and corners). (When this limitation is specifically referred withitt this NOA, Cenerul Limitation In will trot be npplicalle.) 10. • All products listed herein shall have a quality assurance audit in accordance with the Florida 13uildiug Code and Rule 9B - 72 of the Florida Administrative Code. END Oh THIS ACCEPTANCE NOA No: 03- 0501.05 Expiration Date: 11/04/08 Approval! Datc :10/23/03 Page 21 t)f 21 Roofing Systems (TGFU)— Continued GAFGLAS $80 Premium Base Sheet may be used in any of the following systems. "GA:=glas Flex PIy 6" is a suitable altemate to "GAFglas Ply 6 ". "GAFTEMP Permalitr 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 membranes may be used in lieu of "Ruberoid Mop SBS products in any applicable Classification. _._. ____ ROOF COVERING MATERIALS (TFVT) 17 Roofing Systems (TGFU) Continued Cap Sheet: "GAFGLAS Mineral Surfaced Cap Sheet ", hot mopped. Class B Deck: C -15/32 Incline: 3-1/2 Insulation (Optional): One or mor: 'avers perlite. wood fiber. glas fiber, isocyanurate, urethane, perlite /tscz•a.•turate composite perlite urethane composite, wood fiber / isocyanurate composite. phenolic ar thickness 1. Class A 1. Deck: C-13;32 Incline: 3 Insulation (Optional): One or more lavers perlite, wood fiber, glass fiber. isoc yanurate, urethane, perlite! isocyanurate composite, perlite! urethane composite, wood fiber /isocyanurate composite, phenolic, any thickness. Ply Sheet: Three or more layers Type GI "GAFGLAS PIv 4" or "GAFGLAS PIy 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 /isoc yanurate composite, perlite urethane composite, wood fiber/ isocyanurate composite, phenolic, any thickness. PIy Sheet: Three or more lavers Type GI "GAFGLAS Ply 4" or "GAFGLAS Ply 6". Cap Sheet: One laver Type G3 "GAFGLAS Mineral Surfaced Cap Sheet ". 3. Deck NC Incline: 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, 2 in. max. Ply Sheet: Two or more layers Type GI "GAFGLAS Ply 4" or "GAF- CLAS Ply 6". Cap Sheet: One layer Type G3 "GAFGLAS Mineral Surfaced Cap Sheet". 4. Deck NC Incline: 1/2 Insulation: One or two lavers "Isotherm R ", 4 in. max, hot mopped. Ply Sheet Any LL Classified gravel surfaced Class A asphalt glass fiber mat system. 5. Deck: C -15/32 Incline: 1 Slip Sheet (Optional): Red rosin paper, nailed to deck. Base Sheet: One laver of Tvpe G2 "GAFGLAS #75 Base Sheet" (may be nailed). Ply Sheet: One or more lavers of Tvpe G1 "GAFGLAS Ply 4" or GAFGLAS PIv 6" Cap Sheet One laver of Tvpe 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 lavers of Type GI "GAFGLAS Ply 4" or GAFGLAS PIy 6". Cap Sheet: One laver of Tvpe G -3 "CAFGLAS Mineral Surfaced Cap Sheet". 7. Deck C -15/32 Insulation: One or more layers perht glass fiber, isocyanurate, ure- 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 Tvpe G1, G2 or G3. Membrane: One or more layers of "Ruberoid Torch" (smooth or granule), "Ruberoid Torch Plus" (granule), "Ruberoid Mop" (smooth or Mop Sheet "GAFGLAS Mineral Surfaced Cap Sheer', hot mopped. Deck: C -15/32 InclEte: 2 Insulation (Optional): One or more layers perlite, wood fiber, glass fibe, isocyanurate, urethane, perlite /isocyanurate composite, perlite/ ne composite, wood fiber /isocyanurate composite, phenolic. any Base Sheet •tvo or morn layers of Type G2 or G3. PIy S earteOpBo�): One or more layers of Type Gl. anule One or more layers of "Ruberoid Torch" (smooth or gr), „Ru old To plus" (granule), "Ruberoid Mop" (smooth or granule) or ) "Ruberoid Mop Plus" (granule). LOOK FOR THE UL MARK ON Ply Sheet: Twu or mom lavers or Type G] " G.AFGLAS P!l .1 ; "GAFCLAS Ply 6" Cap Sheet: Tvpe G3 "CAFGLAS Mineral 5•irfaced Cap Slice:" he mopped. 2. Deck C -15/32 Incline: 3-1;2 2 Insulation (Optional): One or more lavers perlite, wood fiber. :IS >• fiber, isocyanurate. urethane, perliteltsocvanurate composite. peritty cyethane composite, wood fiber; isocyanurate composite. phonon,: an•. thickness. Base Sheet: Two or more layers of Tvpe GI, G2 or G3. Membrane: One cr more lavers of "Ruberoid Torch" (smooth or granule), "Ruberoid Torch Plus" (granule), "Ruberoid Mop tsrnoudi in granule) or "Ruberoid Mop Plus" (granule). Cap Sheet: "GAFGLAS Mineral Surfaced Cap Sheet ", ho::a. - ;.ped 1. Deck C -15/32 Class C Incline: 1/2 Insulation (Optional): One or more lavers perlite, wood fiber. glass fiber, isocyanurate, urethane, perlite /isocyanurate composite, pe'.lue/ urethane composite, wood fiber/isocyanurate composite, phenolic an thickness. - Ply Sheet: Three or more lavers of Tvpe G; "CAFGLAS Ply 4' or "GAFGLAS PIy 6 ". Surfacing: "Special Roofing Bitumen" 20 Ibs!sq. COAL TAR FELT SYSTEMS WITH IIOT ROOFING COAL 1'AR I. Deck: C -15/32 Class A Insulation (Optional): One or more linaelirnsep: crlite, wood fiber, glass fiber, isocyanurate, urethane, perlite; isotyanurate composite, perlite/ urethane composite, wood fiber / isocyanurate composite phenolic, any thickness. Ply Sheet_ Three or more lavers of Tvjle G1 "GAFGLAS Ply 4" or "GAFGLAS PIy 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 layer' perlite, wood filer or g1..ss� fiber, 2 in. max. Ply Sheet 'three or more lavers of Type GI "GAFGLAS l'Iy 4" or "CAFGLAS Ply 6 ". Surfacing: Grundy Industries "al MB Alto—nip—um Rc,of Coating " -at' 1-1/2 gal /sq. , . _ ... . 2. 17eck:•NC fiuline: 1 Insulation (Optional): One or more layers perlite, wood fiber, glass fiber, isocyanurate, urethane, perlite /isocya. ur.a to composite, perlite/ urethane composite, wood fiber /isocyanurate composite, phenolic, any thickness. Ply Sheet: Three or more layers of Tvpe GI "GAFGLAS Ply 4" or "GAFCLAS Ply 6". Surfacing: "Weather Coat Emulsion" at 3 gal/so'): • 3. Deck: NC Incline: 1 / 2 Insulation: One or two layers "Isotherm R", 4 iso., hot mopped. Ply Sheet: Any UL Classified gravel surfaced Cla .ss A asphalt glass fiber mat system. 4. Deck: NC Incline: 2 Insulation (Optional): lsocyanurate, perlite, isocyanurate /composite, wood fiber and glass fiber, any thickness, mechar'sically fastened. Base Sheet One ply Type GI or G2, mechani tally fastened or hot mopped. PIy Sheet One or more plies Type G1 or G2, adhered with hot roofing asphalt. S acingr "GAF Premium Fibered Aluminum _Roof Coating", 1-1/2 5. Dec or , GAF Weather Coat Emulsion ", 3 ga) /s-'l- Tna .tlation (Optional): Perlite, glass'fibei mechanically fastened, any thickness. polyisoey anomie, wood fiber, RODUCT 04/28/2004 22:23 3055949583 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 MIAMI -DADE: 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. Le descrlptiQn ofro erty and street/address: 2. Description of improvement: -r 3. Owners) name and a dress: W �1r1 i 'Y1 I . r' Interest in property: 0 \A)I\ e r Name and address of tee simple titleholder: 4. Contractor's name and address: Pa a ` x 53 5. Surety: (Payment bond required by owner from Name and address: Amount of bond $ 6. Lender's name and address: 7. Persons within the state of Florida designated by Owner upArT provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: 8. In addition to himself, Owners 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 at: of this Notice of Commencement: (the expiration iffjeren • s d) �l f Sign of Owner Print Owner's Name ) C. yet rkiTt tte n COUNT ATX - 7/0 4- contractor,. itEr�l4yf) c FLoR,IC)A. Y I� t tr.? r ( ` ` r 11: • } t vl � •� v tai Co issten floi)231984 ,.;. pir es: lttE 13.2007 KAWALEK ROOFING 0 ti1 q Q n At, 23 D.G. 11 Sworn to and subsit before me this 1 (.r day of f4r4 I , 20) . Notary Public ( -- t, Print Notary's Namur ;i `,4 My commission expires: 723.01.52 P.f+E 4 8■02 PAGE 02 111111.111111 t1111111111111111111111till1111 C7. F1 :2 0' 11.'1 4 6w t Y .. 7, _i 1 78 OR n 22250 Ps 0105 RE.0 i3OC. N/23/2004 17: )1516 HAiWrY . i.OfThr UFRK OF DORT t rile) `Y.•1 may '• .. ices or other do um is may be served as date is 1 year from the date of recording unless a Prepared by QuJ kAtkI4/e1< Address. � Li 1' 1 I O W } I - 1} i rc-3 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 4/29/2004 Applicant: MICHAEL Owner: JACKSON JOB ADDRESS: 40 NE 91 Contractor KAWALEK, PAUL RICHARD Local Phone: 786- 277 -9540 Parcel # 1131010200040 Signed: (INSPECTOR) Building Permit Permit Number: BP2004 -557 JACKSON MICHAEL ST Contractor's Address: P.O. BOX 531051 Page 1 of 1 Permit Status: APPROVED Permit Expiration: 10/23/2004 Construction Value: $4,400.00 Work: RE -ROOF FLAT ROOF Legal Description: EL PORTAL SEC 3 PB 9 -148 LOT 7 & E1/2 LOT 8 BLK 9 LOT SIZE 75.000 X Fees: Description Amount FEE2004 -4286 Building Fee $275.00 FEE2004 -4287 CCF $3.00 FEE2004 -4288 Notary Fee $5.00 FEE2004 -4289 Training and Education Fee $1.00 FEE2004 -4290 Technology Fee $6.88 FEE2004 -4291 Scanning Fee $12.00 Total Fees: $302.88 Total Fees: $30 Total Receipts: � ya �� _.� 29 .s.§ In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: Owner's Name and Address MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT fi t r ' 3 p APPLICATION FOR BUILDING PERMIT 3 Application e is �� � mode for the approval of the detailed statement ur trie specifications herewith submitted for the build plans and s • )' P P ire 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 iliiildiiig Divisinn 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. Registered Architect and /or Engineer........ .. l mxs n1•••nr•eenr11n<rw.•rn<1 Name and address of licensed contractor ► F t � 1 ` I Co1�LA-c + Date..._ ». __.....�.._._ »._ / /'1 (�u . -ac� No. 51 e 3 'Str �1J h1 q Location and legal description of lot to be built on: Lot Block Subdivis on Street and Number where work is to be done State work to be done and purpose of building (by floors) 1,-...cA\ New Building Remodeling Addition Repairs No. of ` Stories To be constructed of Kind of foundation R f Covering 1 \ 1 6..., (' avL Estimated Total cost of improvements $ �`� �U Amount of Permit S` b �� 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 permit 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 %sith 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 performed under this pcnnit, as are licensed by Miami Shores Village. . . Remarks. .. (Signed)--..... - Q gel 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 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 by him statee true. k . L Permit No � 11. !0 Date 1 7 ....._.._._ Read, Spl to and Subsc a me. Disapproved \ Date o `' - " 1llb lrtl�e`Stgf (Signed) a lL�i\ /mil �wr� Notary Public t i it ires June 1, 1987 Building Inspector PLANNING BOARD DATE Chairman Member \fcrriber Member Member My Commission Expires ibn °r troy Fria: u,M,,.anc. In • Member Council Approved Date Disapproved Date NOTE: A charge of S1.00 will be made for making corrections or changes to this application after approval has been obtained from the PI,innir.;; Board. A re fee of SI.00 will be charged when such re- inspection is made necessary by improper notice for inspection otr faulty materials and /or workmanship. and for no other purpose. to me well known, Permit #20656 (R.C. Boggs) MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT Location and legal description of lot to be built on: 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. 1 \` ' eD0 3 Date . Dec. 20 19 78 Owner's Namc and Address .._.. _ ... No 0 .. Street_ .N . E . 91 St . Registered Architect and /or Engineer Name and address of licensed contractor Bis.c.aynE....RQD.fing...D.a.. .5 Lot Block Subdivision Street and Number where work is to be done 4 .. N.a....., 9l.ai.. atr'ee .. State work to be done and purpose of building (by floors) .nst ?ll a 4-ply built-42 .gravel roof on new addition. 1- story Residence 3 sqs . New Building Remodeling Addition X Repairi No. of Stories 1 To be constructed of Kind of foundation Roof Covering B/U Gravel Estimated Total cost of improvements $...600.a.00 Amount of Permit $..1 2 e_5Q 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 BisQayne...Rcofing...Co.. 51.80...E.....11...Ave.. Hialeah, _Fla.. 3301.3 ....... The undersigned applicant for this building permit 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 ptrbcpntractors, on work to be pelig rmed under this permit, as are licensed by Miami Shores Village. Remarks. STATE OF FLORIDA, COUNTY OF DADE. j ss. Disapproved .. (Signed) �. Date and for no other purpose. (Signed) _..Z�F..�� �- Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared 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 by him stated are true. } y Permit No 7 / V L Date 1 � . ` 4 Read, Sworn to and Subscribed before me. to me well known, Notary Public, State of Florida Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Mcrnbcr Member Member ..... _ Member 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 Planning Board. A re inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection of faulty materials anti /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 nll 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. p `` //�� Date..._/�'®..dt .. h ._ , — .......hr .... - -.. , 19.2E Owner Owner idY.-t 's Name and Address .... /) -t'a C.� e:._.. .3.9 S .. No.......:. . q ......... Street. ,..._2.>%..s .T . Registered Architect and /or Engineer. ....ere - / ,9 'e- M pa 5 e - rre . — 22..,,, G‹,. ,.,ftee . A4/cLc" s° Name and address of licensed contractor X 4' it C:o�,5T O- i ®0...111 e iL ..re'r'° A/ "y; Location and legal description of lot to be built on: e Lot... f t E �fr ct 8 Block ? Subdivision esJo" Z:._ .. Se-4:1;'011 ' �rSree- Street and Number where work is to be done 4 ._.... .57_7 — ._..__ -. State work to be done and purpose of building (by floors)..- __._ ' x Z 9 ' P Z% : . 0 Zo—b ¢ and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Cc =', f /� ,cir- . Roof Covering..: ." * .0 ,-- Ire( °e� Estimated Total cost of improvements $ �O�� Amount of Permit S�..... ioo Zone cubage required .Plan Cubage I kq3 0 Distance to next nearest building. 2 0 ' Size of Building Lot 75' x l 3 o 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... - X. 0 �A? e% d si; eg-'. iy ®e, /v0. Ho ;ern /W j s P1 : 3 % t, ` . The undersigned applicant for this building permit 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 arc required by the Act. The undersigned agrees to employ only such , Subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks. -. a .. o .. - ._..0y 0 ._ 7e� (Signed eykz--e-.4 STATE OF FLORIDA, i COUNTY OF DADE. j ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- r peared Sr .. a o . /r - Lam- s s e, pi e .S ee , it e. "r 6'tL L e, t'. 1 ° - _._..._________ _ (0 me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. Ca e.") ee'"C 4 c, - c "do if a. 4 - 7©,' -.. 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 by him stated are true. Perm � it No.. O �, 6 Date t \ jki I Read, Sworn to and Sy scribed before me. (\ L . ' 6 — 16 Disapproved ---- __ � _.- - ....... Date VC" � C)k (Signed) "�` \ Notary Public, Statelithirioordmc, State of Florida at large Building Inspector My Commission Expires Commission Expires Aug. 18, 1982 �ondi�'bY - 1KmiFCdir7lrY'g'C7wd., conp r PLANNING BOARD _..__.....DATE Chairman Member .Lfcrnber Member Member ...... - -- _- _-- ..._..._._ ...._ Member �.._..__ 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 Planning Board. A re-inspection fee of 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. 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 ht Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miain ores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at huil i.O. during progress of the work. STATE OF FLORIDA, COUNTY OF DADE. Disapproved (Signed) ss. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT Date f r .- Date (/ Owner's Name and Address.....__. _(�_' No 0 � � f Street. Registered Architect and /or Engineer Name and address of licensed contractor S %, % / ? o Location and legal description of lot to be built on: (---/ Lot Block Subdivision Street and Number where work is to be done ® n A L 2 State work to be done and purpose of building (by floors) �� 1 w ° � �._ rl 1 - 6 and for no other purpose. New Building.,41 Remodeling Addition Repairs No. of Stories b To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ _._. J Amount of Permit $ 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 permit 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 performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) ' ,i 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 by him stated are true. Permit No Date B" a' —_ Read, Sworn to and Subscribed before me. Notary Public, State of Florida Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member ....... Member 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 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 workmanship. MIAMI SHORES VILLAGE, FLORIDA a 7.1h. BUILDING ❑ ELECTRICAL ❑ Date 1 9 �i PLUMBING ❑ PERMIT 14 9187 Contractor's eai ROOFING E License No. ❑ Work to be performed under this Permit C4 I,C _ i j Owner of - - cc. S Building Architect Contractor I e 140 J t * S. or Builder L i..�16 i Legal Lox i 1 Description 11 131 Address of T Building © ' ` s S T Signed- CONTRACTOR or BUILDER Subdi- vision Sq Ft. Value of Project 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 applica- tion 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 •fans or drawings or in the statements or specifications and that he assumes respon- sibility for work done by his agents, servo nj or e • loyees. (INSPECTOR) BY In consideration of the issuance to me of this permit gree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plan: j •ings tatements or specifications mitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all .y either, myself, rvant or employee. BY AUTHORITY et7 Amount of -- 11 Permit $ BUILDING ELECTRICAL' PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Lot Description Address of Building ° PERMIT N9 8274 MIAMI SHORES VILLAGE. FLORIDA Bi. Work to be performed under this Permit 4 . / f ✓ r d°` J Subdi- vision Sq. Ft .l Value of Project $ '' C 1' CONTRACTOR 01 BUILDER/ / BY ,! DATE " Z Contractor's License No / - r Amt. of Permit $ 7 .. r r AUTHORITY 195 f • 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 furth condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowle of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or ip the statepiints or specifications and ` at he assumes responsibility for work done by his agents, servants or employees. / Signed: <..' INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. 17 BUILDING ❑ MIAMI SHORES VILLAGE, FLORIDA ELECTRICAL ❑ PLUMBING 0 PERMIT 19 9055 ROOFING 0 Owner of Building Architect Contractor or Builder Legal Lot Description I 1 B1 Add of 7t f/ � Building 7 / CONTRACTOR or BUILDER Date / 19J 7 Contractor's License No 3 Work to be performed under this Permit Subdi- vision Sq Ft Value of I I Amount of Project $ I 1 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 applica- tion 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 respon- sibility for work done by his agents, servants or employees. Signed • (INSPECTOR) BY In consideration of the issuance to me of this permit I ree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, dr ings, statements or specifications submitted to the proper authorities of Miami Shores Village. ) n accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY I AUTHORITY Date �" - 9 7 Job Address qo � ✓ f= 97i/ Legal Description ` ''T 7 &�7� ,b4 9 �( "b/P774 J'z'( _3 Owner / Lessee / Tenant 6 11 ,De/h4 / P,e /9 Master Permit # 33A/ Owner's Address � 3 4//-, 9037-- $7 Phone � Contracting Co 1� h'/ /2004 l ?e Address Phone / .r0 kieWae �� Qualifier E'/�%!� C - - , State lk Municipal # #e' 2 /W Competency # // 3‘ Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one,L BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION � -4-ee- 'C''L APPROVED: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE named actor to do ignature of owner and /or Condo President Date: 6 l� Notary as to Owner and /or Cond President My Commissi &i S TATE OF FLORIDA f1' CC i4ISSION EXP SEPT.20,1994 BOOED THRU GENERAL INS. UND. ** * * * * * * Tax Folio // . 3 00 / ,7(a O(l4 P Square Ft. Estimated Cost(value) 26e), 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 complian j e with all applicable laws regulating construction and zoning. Furthermore, I e above't ..esrtr the work stated i aaa'' ide'4 Signature of Contractor or er- Builder Date: . er g: Notary as to Contractor or Owned- Builder NO1I RYG M*sgpqIP OPItk R MY COMMISSION EXP SEPT.20,1994 BONDED THRU GENERAL INS. UND. * * * * * * * FEES: PERMIT 3 / RADON C.C.F. ,SO NOTARY TOTAL DUE Fire Other Zoning Buildin: • Electrical Mechanical Plumbing Engineering / //46 /V/ /2 sue` * * ** � T trt 4.71 6 " 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. Z V 4-7! Date ,19 40 n � Owner's Name and Address._..._.. 14 RD � �� No ` 0 SUeet__ � E t ! ST, Registered Architect and /or Engineer � � S sf�C / /��E ' GT Name and address of licensed contractor_ _ i' j�2 ROS c o N ._T'wwe_ i D AS 71 /D /)L 4tf'Cc re r Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done MIAMI SHORES VILLAGE 1 10 Ai/ 6 4 State work to be done and purpose of building (by floors)... ittf • V_I `T e)J 911:ai I? - iN i New Building Remodeling. L Addition To be constructed of �. Kind of foundation R. C. Estimated Total cost of improvements $ S p e''' Amount of Permit $ Zone cubage required plan Cubage.._1 ` - <f' Distance to next nearest building ooy� ��,,��.. g--- •.- •�C.'� Size of Building Lot sT, Rt ek ERo ut' er ante / Poe and for no other purpose. No of Stories f Covering �l A/� j g R4 vF L- Repairs "' 7 fit'/ O6 T «psi z Y ? . 2,Z �7 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 --1 r 12 Rex r S s 7 0/_0 MA' Cate? it T° 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 employe 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 subcontracto on work to be perf ed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. j 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 by him stated are true. / � Permit No. ' r Date P - 7 - ' . Read, Sworn to and Subscribed before me. Disapproved ca l Date _ Notary Public, State of Florida (Signed) Building Inspec or My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member 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 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 workmanship. MIAMI SHORES VILLAGE BUILDING DEPARTMENT U` 305- 795 -2204 Buildin: Inspection Request Type Insp Permit N Name Address Company Phone # Inspection Date Date Correction - -1-1;r7101/ P A ,Jea Re- Insp'n Fee ❑ F tv \7 -tt 4-( T f1 c 2_