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ROOFINGType Insp'n Permit No. Name MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 1C) Time Z., JA3- Address / ea'G Company Phone # For Inspector: / Nam Approved Correction / ❑ \i Re- Insp'n Fee 71 Lc 4 .<6 dc; (*: L �� Date Type Insp' n Permit No. Name Address Compa MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Phone # 751'931c For Inspector: Approved t Correction Re- Insp'n Fee o o 1 oan Type Insp' Permit Name MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 0 "Z, d O ime Address Company II Phone # 6' 0 3 RI, For Inspector: to 14 l Name&Date Approved ❑ Correction Re- Insp'n Fee 0 0-les ki; 4 cfle IAMI SHORES VILLAGE BUILDING DEPARTMENT '� � 9 . 305- 795 -2204 C - N Building Inspection Request Date Type Insp'n 1 Permit NoCef d2 t 9i ct Name Address / L/ ,V /7 9 35Y. Company Phone # For Inspector: Correction Re- Insp'n Fee Time e e (4 LIc 1,46T ( P l ; , 0 Pm V t Date Time Type Insp'n .% � /� Permit No ilb /AO C.-. / % • pprove Name Address Compan Phone # For Ins IAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request X 0.4& C Ov a C ` tor: Correct' n A� s Q 1 .-, C c &op At lq076 c Street and Number where work is to be done State work to be done and purpose of building (by floors) L ee MIAMI SHORES VILLAGE e"-Z .'5e'3�• 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 an regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Date /��' �/ / � , Owner's Name and Address ....._... _ A..11 • 'V /14'J 4/9 AIC .E No Street Registered Architect and /or Engineer ... _ _ . ifs % e- 1`/wL . e QA/4 4' Name and address of licensed contractor 424!_.rg__. c-.4.).5 � � ,t'// •//7O ST Location and legal description lot to be built on: Lot / hi....j.l•fel-fi Block 3 Subdivision....._.__ � � O' Za.. 74-4 Jo (Po N . 9. 3 s,- and for no other purpose. New Building Remodeling Addition To be constructed ... Kind of foundation Q- OA/ Estimated Total cost of improvements $ 2 1 ' I hereby submit all the plans and specifications for said building. All notices with reference be sent to Repairs No. of Stories 0 Ro f Covering 7 7 _ 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 to the building and its construction may 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 rovisions 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 STATE OF FLORIDA, . COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above descri ed construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stat d are true. Permit No / ? � Date _._ /S Read, Sworn to and Subscribed before me. Disapproved Date_ / A (Signed) __- Building Inspect Notary Public, State of Florida My Commission Expires ANNING 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 51.00 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 INSPECTION DEPARTMENT APPLICATION FOR '= UILDING 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. Date , 19 Owner's Name and Address No Street Registered Architect and /or Engineer ... . .. ......... Name and address of licensed contractor Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done State work to be done and purpose of building (by floors) and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ Amount of Permit $ i Zone cubage required__ �� ' o P Cubage_��'. Jj_ _P- , GAL. -� %� ' ', t : , i e ' 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) STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction. that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit No Date Read, Sworn to and Subscribed before me. Disapproved Date (Signed) 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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. /( a / 7 �� ' " C �% i ii �,), v ^ �i.?4j A ^ ,2_! 4),C 3 O AN / 116 et;•• • 4 -re ex itA'„;rit-A-A 04..• 126 'Lecember IC • :/'2 '1 • • ,.1 4 SC94' " 2457e, • /6 / . • . 14L, jVjj FLORT•:',1•1 rVycr Na., r.lrli:i Ave., ir.te„r-yi ",;•' PT, 1-8007 • - rm :!;11117:fn'7 Lot 1 and the North 15.b feet of Lot 27, Block "BavID PARK", according to the Plat thereof, recorded in Plat Book 16, at Page 71, of the Public Records of Dade County, Florida° 7Tr.. y C; r.f.1 (1 :`• 11. t Lfind ■• ,1-1 :0.; tfl. t;v-.1 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 07%03/2002 Job Ac 1080 N.E. 93 Street Tax Folio Legal Description Historically Designated: Yes No /Tenarnt Rose Lance Master Permit # o 1c YC • Add . 1080 N.E. 93 Street Miami Shores Contracting Co Quality Roofing Contractor, Inc. S ignature downer Pr > Date 3 -0.4- Notary as to My Commission Exp ' i MARYU' HERNANDEZ MY COMMISSION # DD 060579 EXPIRES: October 10, 2005 0Q,••• Banded Thru Notary Public Underwriters FEES: PERMIT - 3 b 6 , RADON C.C.F. (0s0 NOTARY' ©' Phone (305) 754 -0261 Address 13800 N.W. 1st Ave. Queer Carlos Arocho ss# Phone (305) 751 -0382 State # RC0058627 Municipal # c ompetency # 000017889 Ins. Co. Architect/Engineer Adder Bonding Company Address Mortgagor Addrcss Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Tear off old roof to wood deck, tin cap 30Ib. ASTM felt, install galvanized eave drip and valley metals, mop 90Ib. ASTM felt, install colorthru tile with polyfoam adhesive . Square Ft. 40aq Estimated Cost (value) $17,500.00 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 wok 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. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above-named contractor to do the work stated. Signature of Contractor or Owner Notary as to Con for or My Commission Expires: MA•YLOU HERNANDEZ ^. ^V COMMISSION # DD 060579 EXPIRES: October 10, 2005 Bonded Thru Notary Public Underwriters Borm3 0 C7 s TOTAL DUE 6 / 0 , , ? 0 APPROVED: Zoning Building '7 �� Electrical Mechanical Plumbing Structural Engineer 1 Owner's Notification for Roofing Permits issued under the Florida Building Code MIAMI -DADE COUNTY BUILDING DEPARTMENT ELECTRONIC APPLICATION 1 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. Ponrting conditions may not be evident until the original roofing system is removed. Ponding conditions J11u41J at 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. !t may tic ncccssu y 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 earl resuit in exi�ll.:;,,y ih. JVI YIVV IIIV VI the roof. 9 Owner's/Agent's Signature Date 71 310d- Page i 01 1 e5e ;„___z_____ Contractor's Signature http: / /www.co.miami- dade.fl.us/ bldg /roofing permiting /owner_notification.html 6/4/2002 1 High Velocity Hurricane Zone Uniform Roofing Permit Application Form MIAMI -DADE COUNTY BUILDING DEPARTMENT ELECTRONIC APPLICATION 1 Master Permit No. Contractor's Name: Low slope roof area (ft. n/a Section A (General Information) Process No. Job Address: Quality Roofing Contractor, Inc. 1080 N.E. 93 Street Roof Category ❑ Low Slope ❑ Mechanically Fastened Tile ❑ Asphaltic Shingles ❑ Metal Panel /Shingles ❑ Prescriptive BUR -RAS 150 ❑ Other: Roof Type Li New Roof pi Re- Roofing ❑ Recovering ❑ Repair ❑ Maintenance Are there Gas Vent Stacks located on the roof? ❑ Yes d No If yes, what type? ❑ Natural ❑ LPGX Roof System Information Steep Sloped area (ft. 4000sq. Section B (Roof Plan) Page 2 Mortar /Adhesive Set Tile ❑ Wood Shingles /Shakes Total (ft. 40sq. Page 1 of 1 Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include dimensions of sections and levels, clearly identify dimensions of elevated pressure zones and location of parapets. Perimeter Width (a'): Corner Size (a' x a'): t , ; j —r- —r .. i i . - I -� i 1 1 1 1 I ' i I I ! ! I I __ 1 1 f I! I I 7/.0S � 1 1 I 1 I I - I I ( � r 1 d1 lat( .. ' I! l i I I I I i!i iil 111 1!I i 1 i I i I: I I' i i! i I l l i i L I I. ! I I : i I i I �r ! IlI 11111'11 II lllilI 1 _' I! .J J J I I I! I _ I I _ — 1 I _ -1 I_i_I 1 1 I I - 'I i IJ I — , _.L L I —I I t I ' . 1_1_ _ _l __I I. I_ I — I I Ii 1 i_ _1__ i_I_I-_ 1 _ i 1 1 I U I 1 1 I 11 --_'_ ' !_ ' i 11 ; _ 1 i I I 1 I1_ i I 11 � I 1111 I I I I 1 I I 11i;111111!:1'Ii1111 i11111 il!11111 http: / /www.co. miami - dade. fl. us / bldg /roofing_permiting /permit_app_section_a.HTML 7/10/2002 Roof System Manufacturer: Monier Lifetile LLC Notice of Acceptance Number: 99-1012.02 Minimum Design Wind Pressures, If Applicable (from RAS 127 or Calculations): P 1: -47.6 P 2: -100.6 P 3: -100.6 Maximum Design Wind Pressures, (From the PCA Specific system): 86.61 High Velocity Hurricane Zone Uniform Roofing Permit Application Form MIAMI -DADE COUNTY BUILDING DEPARTMENT ELECTRONIC APPLICATION Roof Slope: 2 1/2 "/12" Roof Mean Height: 13' Ridge Ventilation: n/a Method of Tile Attachment: Adhesive, Large Paddy Polyfoam Polypro Altemate Tile Attachment Method: n/a Clip Spacing for Metal Roof Panels Field: n/a Perimeters: n/a Perimeter Width: n/a Section D (Steep Sloped Roof System) 111111641144181418%%841143/488%18111448811641 Comers: n/a Sloped System Description Deck Type: 1" X 6" T & Page 4 Altemate Deck Type: n/a Underlayment type: 30Ib. ASTM Felt Insulation /Fire Barrier Board: n/a Optional Nailable Substrate: n/a Fasteners: 1 1/4" R/S Nails Cap Sheet Type /Adhesive Type: 90Ib. ASTM/ Typelll Asphalt Roof Covering: Roll Capri Low profile Tile / / Roof Covering Attachment Method: IN Polyfoam adhesive setting Drip Edge Size & Gauge: 3" face 26 ga. Drip Edge Material Type: Galvinized Metal Drip Edge Fastener Type: 1 1/4" R/S nails Hook Strip /Cleat ga. or weight: N/A Page 1 of 1 http: / /www.co. miami - dade. fl. us / bldg / roofing _permiting /section_d_3.html 7/10/2002 Mean Roof Height in Feet 15' 20' 25' 30' 40 ' Roof Slope 1 1 1 1 1 2:12 34.4 36.5 38.2 39.7 42.2 3:12 32.2 34.4 36.0 37.4 39.8 4:12 30.4 32.2 33.8 35.1 37.3 5:12 28.4 30.1 31.6 32.8 34.9 6:12 26.4 28.0 29.4 30.5 32.4 7:12 24.4 25.9 27.1 28.2 30.0 High Velocity Hurricane Zone Uniform Roofing Permit Application Form MIAMI -DADE COUNTY BUILDING DEPARTMENT ELECTRONIC APPLICATION For Moment based tile systems, chose either Method 1 or 2. Compare the values for Mr with the values from Mf. If the Mf values are greater than or equal to the Mr values, for each aea of the roof, then the tile attachment method is acceptable. Method 1 "Moment Based Tile Calculations Per RAS 127" P 1: -47.6 x A .289 - M 6.30 P 2: -100.6 x A .289 - Mg: 6.30 P 3: -100.6 x A .289 - Mg: 6.30 Section E (Tile Calculations) Page 5 = Mrl: 7.46 = Mr1: 22.77 = Mr1: 22.77 NOA Mf: 86.61 NOA Mf: 86.61 NOA Mf: 86.61 Method 2 "Simplified Tile Calculation Per Table Below" Required Moment of Resistance (Mr) From the Table Below: NOA Mf: Mr Required Moment Resistance* *This Table must be used in conjunction with a list of moment based tile systems endorsed by the Broward county Board of Rules and Appeals. Page 1 of 1 http: / /www.co. miami - dade. fl. us / bldg /roofing permiting /section_e_3.htm 7/10/2002 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF DADE: 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: 1080 N.E. 93 Street 2. Description of improvement: Reroof to a new Tile roof. 3. Owner(s) name and address: Rose Lance interest In property: Owner Name and address of fee simple titleholder: N/A 4. Contractors name and address: Quality Roofing Contractor, Inc. 5. Surety:(Payment bond required by owner from contractor, if any) • N /A OF FLORIDA, COUNT OF DADt. Name and address: RFR v cFFTrc , .,. , ; , • Amount of bond $ 0 0 a 1, rgrnr'1 filed in Una of 6. Lender's name and address: N/A wl l It '.y t. � ('_•- . , Gl CilLuit and County Cnr:r1S 7. Persons within the State of Florida designated by Owner upon whom notices or other documents by Section 713.13(1)(a)7., Florida Statutes, Name and address: N/A 8. In addition to.himself, Owner designates the following person(s) 10 receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: N/A 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) Signature of Owner Print Owner's Nam6 O �= L 4 ) Sworn to and subscribed before me thi , day of Notary Public Print Notary's Name Miami Shores, Florida 33138 1080 N.E. 93 Street Miami Shores, Florida 33138 13800 NW 1 st Ave, Miami ,Florida 33168 MY COMMISSION # DD 060579 EXPIRES: October i0, 2005 Bonded Thru Notary Public Underwnters 20 ©2 02 R 4 7 35 0 2002 JUL 31 10:10 f . ). . be served as provided Prepared by Carlos Arocho Quality Roofing Contractor, Inc. Address: 13800 NW 1 st Aveniie Miami ,Florida 33168 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 8/19/2002 Applicant: ANTHONY Owner: LANCE JOB ADDRESS: 1080 NE 93 Contractor QUALITY ROOFING CONTRACTORS INC Local Phone: 305 - 751 - 0382 Parcel # 1132050150110 Building Permit Permit Number: BP2002 -1238 ANTHONY ST MIAMPagtilealifS1 VILLAGE LANCE ()TICE Owner Is Responsible for Maintenance Of All Village Sidewalks as per Village of Miami Shores Code of Ordinances, Including Drivew—i • Contractor's Address: 13800 NVVCduBkdEBy Current tIlltstruction Activiti Legal Description: 5 53 42 BELVIDERE PARK PB 16 -71 LOT 1 & N15.5FT OF LOT 27 BLK 3 LOT Fees: FEE2002 -3878 FEE2002 -3879 FEE2002 -4604 Description Buildier's Bond CCF Building Fee Total Fees: Amount $300.00 $10.80 $300.00 $610.80 Total Fees: $610.80 Total Receipts: $0.00 Permit Status: Approved Permit Expiration: 1/11/2003 Construction Value: $17,500.00 Work: TEAR OFF OLD ROOF TO WOOD DECK & INSTALL DOUBLE ROLL WHITE COLORTHRU If there is no permit package accessible on the job -site for inspectors to verify, there will be no fee is $50.00, which must be paid in advance before calling for another inspection. TILE W /POLYFOAM ADHESIVE inspections. Re- inspection 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. PECTOR) BY: 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. (Contractor or Builder) BY: FAY TO THE ORDER OF BankofAmerica f �� ACH WT 063100277 B] Security enhanced document. See back )or details.1 QUALITY ROOFING CONTRACTOR, INC. 13800 N.W. 1ST AVENUE MIAMI, FL 33168 -4849 L 5'& w Vk21 FOR 1 8-444 ,..r JO /(1, 13 5 J 0' 1:06300004 ?i: 00 LS95300 24 DATE 17555 63 -4/630 F1 1348 I $ 42/0S° A 1 EL:7: RS r a�a�m. 0' JUL 10 '01 14:51 FR BRADCO .I • • • 'MIAMI 305 597 9484 TO 30595333,5.5 r . 101 /07 MIAMI -DAD E COUNTY, FLORIDA METRO•DADE FLAOLER BUILDING BUILDING CODE COMPLIANCE OFFICE METRO•DADE FLAGLER BUILDINO 149 WEST FLAGLER STREET. SUITE 1603 �ttA FLORIDA 33130.1563 PRODUCT CONTROL NOTICE OF ACCEPTANCE (305) 375.2901 PAX (305) 375 -390s Monier Lifetile LLC CONTRACTOR LICENSING SECTION 135 NW 20 St. (305) 375.2537 FAX (305) 375 -2555 Boca Raton FL 33431 CONTRACTOR ENFORCEMENT SECTION (305) 375.2966 FAX (305) 373.2903 PRODUCT CONTROL DIVISION Your application for Product Approval of: (30s) 375•2907! FAX (303) 373.6339 Villa & Roll Capri Low Profile Tile under Chapter 8 of the Code of Miami -Dade County governing the use of Alternate Materials and Types of Construction, and completely described herein, has been recommended for acceptance by the Miami -Dade County Building Code Compliance Office (BCCO) under the conditions specified herein. This approval shall not be valid after the expiration date stated below. BCCO reserves the right to secure this product or material at anytime front a jobsite or manufacturer's plant for quality control testing. If this product or material fails to perform in the approved manner, BCCO may revoke, modify, or suspend the use of such product or material immediately. BCCO reserves the right to revoke this approval, if it is determined BCCO that this product or material fails to meet the requirements of the South Florida Building Code. The expense of such testing will be incurred by the manufacturer. Acceptance No.:99- 1012.02 (Revises No.: 97- 1124.16) Rau l Rodriguez Chief Product Control Division THIS IS THE COVERSHEET, SEE ADDITIONAL PAGES FOR SPECIFIC AND GENERAL CONDITIONS BUILDING CODE & PRODUCT REVIEW COMMITTEE Expires:12 /16/2002 This application for Product Approval has been reviewed by the BCCO and approved by the Building Code and Product Review Committee to be used in Dade County, Florida under the conditions set forth above. Approved:12/30 /1999 •ranctsco . •tnntana, R.A. Director 1 of q Miami -Dade County Building Code Compliance Ot1ic Iw,.. .....N ..4.1...... .. w. .•l «./C.1k■.IraInn.nd......line trim etVWJ r . .. . ..... JUL 10 '01 14:51 FR BRADCO 305 597 9484 TO 3059533333 MONIER J,,IFETILE LLC 1. SCOPE This revises a.roofing system using Monier Lifetile Villa, Roll, and Capri. Concrete Roof Tile, as manufactured Monier Lifetile LLC described in Section 2 of this Notice of Acceptance, designed to comply with the South Florida Building Code, 1994 Edition for Miami -Dade County. For the Locations where the pressure requirements, as determined by SFBC Chapter 23, do not exceed .the design pressure values obtain by calculations in compliance with RAS 127 using the values listed in section 4 herein. The attachment calculations shall be done as a moment based system. 2. PRODUCT DESCRIPTION Manufactured by Applicant Monier Lifetile LLC Villa & Roll Monier Lifeitile LLC Capri Tile Trim Pieces NOTICE OF ACCEPTANCE: STANDARD CONDITIONS Category: Prepared Roofing Sub Category: Low Profile Tile Test Dimensions Specifications 1= 16%" w = 13" 'A" thick L = 17" W= 12 '/; %" thick I = varies w = varies varying thickness ACCEPTANCE No.: 99 -10 12.02 APPROVED :December 30, 1999 EXPIRES :December 16, 2002 Product Description P.02/09 PA 112 Low profile, interlocking, high pressure extruded concrete roof tile equipped with one nail hole and double roll ribs. For direct deck or battened nail - on, mortar or adhesive set applications. PA 112 Low profile, interlocking. high pressure extruded concrete roof tile equipped with one nail hole and double roll ribs. For direct deck or battened nail -on, mortar or adhesive set applications. PA 112 Accessory trim, concrete roof pieces for use at hips, rakes, ridges and valley terminations. Manufactured for each tile profile. ran Zuloaga, RRC Roofing Product Control Examiner JUL 10 '01 14 :52 FR BRADCO ;NIONY I IFETJLE LLC 2.1 Components or products manufactured by others Product Rainproof 11 Ice and Water Shield Wood Battens Tile Nails Tile Screws Roof Tile Mortar ( "Ti IeTitem ") Roof Tile Mortar ( "Quikretc® Roof Tile Mortar 1140 ") NOTICE OF ACCEPTA STANDARD CONDITIONS plmansion 30" x 75' roll 36 "x75'roll or 60" x75' roll 36" x75' roll Vertical Min. 1 "x 4" Horizontal Min. 1 "x 4 "'for use with vertical battens or Min. 1 "x 2" for use alone Min. 10dx 3" :8x 2 �'A" long 0.335" head dia. 0.13 1" shank dia. 0.175" screw thread dia. N/A N/A 305 597 9484 TO 3059533333 Test 5necIflcations PA 104 PA 103 Wood Preservers Salt pressure Institute LP —2 treated or decay resistant lumber battens PA 114 Appendix E PA 114 Appendix E PA 123 PA 123 ACCEPTANCE No.: 99-1012.0; APPROVED EXPIRES Product Description Single ply, nail -on underlayment with 2" self- adhering top edge. Self-adhering underlayment Corrosion resistant screw or smooth shank nails Corrosion resistant, coated, square drive, galvanized, coarse thread wood screws Prepared mortar mix designed for mortar sct roof tile applications. Prepared mortar nix designed for mortar set roof tile applications. P.03"09 :December 30, 1999 :December 16, 2002 Manufacturer Protect -O -Wrap, Inc. (with current NOA) W.R. Grace Co. (with current NOA) generic generic generic Bermuda Roof Company, Inc. with currcnt PCA Quikrcte Construction Products with urrcnt PCA n Waage, RRC Rooting Product Control Examiner JUL 10 '0i 14352 FR BRADCO 1�ig [IF,R L1FETIL1r LLC ACCEPTANCE No.: 99 1012.02 Product Roof Tile Mortar ("BONSAL® Roof Tile Mortar Mix ") Roof Tile Adhesive ( "Polypro® AH 160 ") 3. [,IMITATIONS N/A 305 597 '9484 TO 30 33333 P.04/09 4 APPROVED :December 30, 1999 EXPIRE$ :December 16, 2002 NOTICE OF ACCEPTANCE: STANDARD CONDITIONS Test Product Dimensions Specifications Deserintiop, Munufncturer N/A PA 123 Prepared mortar W. R. Bonsai Co. mix designed for with current PCA mortar set roof tile applications. See PCA Two component Polyfoarn Products, polyurethane Inc. adhesive designed for adhesive set roof tile applications. Roof Tile Factory premixed See PCA Single component Flexible Products Adhesive canisters polyurethane (with current TileBond foam roof tile NOA) adhesive Htericane Clip & Clips PA 114 Appendix E Corrosion resistant Generic Fasteners Min. %' width clips with corrosion Min. 0,060" thick resistant nails. Clip Fasteners Min. 3dx 1' 'h" 3.1 Fire classification is not part of this acceptance. 3.2 For mortar or adhesive set tile applications, a static field uplift test shall be performed in accordance with RAS 106. 3.3 Applicant shall retain the services of a Miami -Dade County Certified Laboratory to perform quarterly test in accordance with PA 112, appendix `A'. Such testing shall be submitted to the Building Code Compliance Office for review. 3.4 Minimum underlayments shall be in compliance with the applicable Roofing Applications Standards listed section 4.1 herein. 3.5 30/90 hot mopped underlayment applications may be installed perpendicular to the roof slope unless stated otherwise by the underlayment material manufacturers published literature. be in compliance with chapter 29 of the SFBC. 3.6 This acceptance is for wood deck applications. • s shall uloaga, RRC Rooting Product Control Examiner Table 3: Attachment Resistance Expressed as a Moment - M (ft -Ibf) for Nail -On Systems Tile Profile Fastener Type Direct Deck (min 15/32" plywood) Direct Deck (min. 19/32" plywood) Battens Monier Lifetlle Villa, Roll, and Capri Tile 2 -10d Ring Shank Nails • 27.8 37,4 28.8 1 -10d Smooth or Screw Shank Nail 8.8 11.8 4.1 2 -10d Smooth or Screw Shank Nails 16.4 21.9 7.1 1 #8 Screw 25.8 25.8 V 22.9 2 #8 Screw 47,1 47.1 49.1 1 -10d Smooth or Screw Shank Nall (Field Clip) 24,3 24.3 24.2 1 -10d Smooth or Screw Shank NailJEave Clip) 19.0 19.0 1 22.1 2 -10d Smooth or Screw Shank Nails (Field Cli• 35.5 35.5 34.8 2.10d Smooth or Screw Shank Nails (Save Clip) 31.9 31,9 32.2 2 -10d Ring Shank Nails' 43.0 l Instanation with a 4 the haadlsp and fasterners are located a min. of 2' need of ti . Table 2: Restoring Moments due to Gravity • M (ft -Ibf) Tile Profile 3":12" 12" 4 ":12" 5":12" 6":12" 7":12" greater Battens or Direct Deck Monier LTfetile Villa, Roll, and Capri Tile Battens Direct Battens Direct Deck Battens Direct Deck Battens Direct Deck 5.57 1,6.30 5.48 6.18 5.37 6.05 1 5.24 5.90 5.09 1 5.73 Table 1: Aerodynamic Multipliers - % (ft Tile X (ft') I (ft') Profile Batten A. •Iication Direct D. . • •lication Monier LIfetlle Villa, Roll and Capri Tile 0.267 0.289 JUL 10 '01 14:53 FR BRADCO 305 597 9484 TO 3059533333 P.05/09 McNIER LIFETII LLC 4.1 Data For Attachment Calculations ACCEPTANCE No.: 99- 1012,92 APPROVED :December 30, 1999 EXPIRES :December 16, 2002 NOTICE OF ACCEPTANCE: STANDARD CONDITIONS 4. INSTALLATION 4.1 Monier Lifetile Villa, Roll, and Capri Concrete Roof The and its components shall be installed in strict compliance with Miami Dade County Roofing Application Standard RAS 118, RAS 119, and RAS 120. 5 rank Zuloaga, RRC Roofing Product Control Examiner Table 4: Attachment Resistance Expressed as a Moment Mr (ft-lbf) _ far Iwo Patty Adhesive Set Sys Tile Profile Tile Application Minimum Attachment Resistance Monier Lifetile Villa, Roll, and Capri Tile Adhesive 26.1 2 See manufactures component approval for installation requirements. 3 Flexible Products Company TIIe3ond Average weight par patty 11.4 grams. - • Po oam Product, Inc. Average we'•ht per pa 8 • rams. Table 4A: Attachment Resistance Expressed as a Moment - Mt (ft -lbf) for Single Patty Adhesive Set Systems Tile Profile Tile Application Minimum Attachment Resistance Monier Lifetile Villa, Roll, and Capri Tile Polyfoam PojyPro ' 88.61' Polyfoam PolyPro 45.5 1 Large paddy placement of 54grams of PolyPron'. 5 Medium paddy placement of 24grams of PolyPro". Table 4B: Attachment Resistance Expressed as a Moment - Mr (ft-Ibf) for Mortar Set S stems Tile Tile Attachment Profile A • • Iication Resistance Monier Li etile Villa. Roll. and ortar Set 20.60 Capri Tile • JUL 10 '01 14:53 FR BRADCO NION1ER LIFETILE LLC 305 597 9484 TO 3059533333 P.06/09 ACCEPTANCE No.: 99 1012.02 APPROVED :December 30, 1999 EXPIRES ;December 16, 2002 NOTICE OF ACCEPTANCE: 7ANDARD CONDITIONa S. LABELING All tiles shall bear the imprint or identifiable marking of the manufacturers name or logo, or following statement: "Miami -Dade County Product Control Approved ". 6. ` BUILDING PERIMIT REQUIREMENTS 6.1 Application for building permit shall be accompanied by copies of the following: 6.1.1 This Notice of Acceptance. 6.1.2 Any other documents required by the Building Official or the South Florida Building Code (SFBC) in order to properly evaluate the installation of this system. 6 uloag . RRC Roofing Product Control Examiner 4. JUL 10 '01 14:53 FR BRADCO % MONIER LIFETILL LLC ACCEPTANCE No.: 99- 1012.02 NOTICE OF ACCEPTANCE: STANDARD CONDITIONS PROFILE DRAWINGS 305 597 9484 TO 3059533333 P.07/09 MONIER LIFETILE VILLA CONCRETE ROOF MONIER LIFETILE ROLL CONCRETE ROOF TILE APPROVED :December 30, 1999 EXPIRES :December 16, 2002 Frank Zuloaga, RRC Rooting Product Control Examiner JUL 10 '01 14 54 FR 1ADCO MONIER IIFETILE j 305 597 9484 TO 3059533333 P.09/09 NOTICE OF ACCEPTANCE: UANDARD CONDITIONS MONIER LIFE71t.E CAPRI CONCRETE ROOF TILE 8 ACCEPTANCE No. 99- 1,013,02 APPROVED :December 30, 1999 EXPIRES :December 16, 2002 oaga, RRC Roofing Produce Control Examiner ✓ JUL 10 '01 14:54 FR BRADCO 305 59'? 9484 TO 3059533333 P.09/09 ' MUNIER LIFE'jLE LLC NOTICE OF ACCEPTANCE: STANDARD CONDITIONS I. Renewal of this Acceptance (approval) shall be considered after a renewal application has been filed and the original submitted documents, including test - supporting data, engineering documents, are no older than eight (8) years. 2. Any and all approved products shall be permanently labeled with the manufacturer's name, city, state, and the following statement: "Miami -Dade County Product Control Approval ", or as specifically stated in the specific conditions of this Acceptance. 3. Renewals of Acceptance will not be considered if: 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. If the Acceptance holder has not complied with all the requirements of this acceptance, including the correct installation 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 revision or change in the materials. use, and/or manufacture of the product or process shall automatically be cause for termination of this Acceptance, unless prior written approval has been requested (through the filing of a revision application with appropriate fee) an21 granted by this office. 5. Any of the following shall also be grounds for removal of this Acceptance: a. Unsatisfactory performance of this product or process. b. Misuse of this Acceptance as an endorsement of any product, for sales, advertising or any other purposes. 6. The Notice of Acceptance 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 Notice of Acceptance is displayed, then it shall be done in its entirety. 7. A copy of this Acceptance as well as• approved drawings and other documents, where it applies, shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the Job site at all time. The engineer need not reseal the topics. S. Failure to comply with any section of this Acceptance shall be cause for termination and removal of Acceptance. 9. This Notice of Acceptance consists of pages 1 through 8 and this last page 9. END OF THIS ACCEPTAN 9 ACCEPTANCE No. : 99- 1012.02 APPROVED :December 30, 1999 EXPIRES :December 16, 2002 rank Zuloaga, RRC Roofing Product Control Examiner ** TOTAL PAGE.09 ** Test Location Uplift Pull Test (P or F) 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 f,A- G D 26 pit ��� 51 76 2 27 52 1211-c1% 77 3 28 53 78 4 29 54 79 5 30 55 80 6 31 56 81 7 32 57 87 8 33 58 R3 9 34 59 84 10 35 60 85 11 -, 36 61 86 12 ,_,-. F 37 62 87 13 ?'141.917 38 63 88 14 39 64 89 15 40 65 90 16 41 66 91 17 42 67 92 18 .e..---L 43 68 93 19 1 44 69 94 20 1,,,,;.-27 45 70 95 21 46 71 96 22 47 72 97 23 I 48 73 98 24 49 74 99 25 50 75 100 Civil Engineer: Lab Certification # 98- 0608.04 State of FL Certificate Authorization # 4100 U.S. SOUTH Engineering & Testing Lab., Inc. 6065 N.W. 167th Street, Suite B -23 • Miami, Florida 33015 Telephone: (305) 558 -2588 • Fax: (305) 362 -4669 ON -SITE CONCENTRATED UPLIFT LOAD TESTING OF ROOF TILE IN FULL ACCORDANCE WITH METRO -DADE BUILDING CODE COMPLIANCE PROTOCOL PA 106 L SITE SPECIFIC INFORMATION Owner's Name' L C C, , Pe f mit #' 20OZ — (2 3P Job Address' i O 90 S 6 c I V l �t 1 Pj l` e..i Roofing Contractor Q a 4.( t r y er,00 1; (IN 6( Type of Tile: 2.0 t t r'j P - F s T Date Installed' Approximate Roof Height:.L feet Roof Pitch' Type of Access to Roof' Scaffolds Approximate Square Footage of Roof' 7 .5 - 00 ft' Required Testing Force: 35 lbs. Testing Equipment: Chatillion 100 Date Tested: - 0 (1 IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL PA 106, THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT QUALITY CONTROL TEST. THIS REPORT SUB t. ED BY: P.E. ✓ Ladder TEST RESULTS P = PASS, F = FAIL 4115-r t0/2/0- Project 3 ( Other x,62 ~ - JOB toe® P-+ L--- Cr3 ST:, S_d tA-0 i Ft SHEET NO NOTES' KETCH OF ROOF p. .. 10 11M►k-le "OF 2 f CONTRACTOR `i A k 1, `C 1 R.o ° F ej CHECKED BY SCALE 17 �u��■n�i■nrc� 1111, �1 6 A r ? 401 to 4 0 II 1 li I. f g: • ■■..ssmor■■ l211 111 MNIIINAMEILIMMIEMEINIMII ••••■ ■111\/%K11■S1111S11111 I ■E ■I•ll.• ■■■L %M► \■■r7 /IM■OStal ,c, ■ ■■/1G71111MEMES■% ■■111 wr ■■S %■L % ■■►SSrIK2RI S ■I 0 iiIIIIIIIII!N 1 BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description Address of Building El MIAMI SHORES VILLAGE, FLORIDA PERMIT Lot CONTRACTOR OR BUILDER Bl. N9 4257 Work to be performed under this Permit_— Subdi- vision Value of Amount of Project $ Pe $ DATE 19 -- Contractor's License No. 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 In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances aad regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac• cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY BOT Application is hereby made for the approval of the detailed statement cm me plans and specifications herewith submitted for the build inc 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. Date...... N9�®... .._..._. -._ _ _..._._�..._... 19. Owner's Name and Address A. X10 Lance — No.... 1 0 8 9 . Street—BE 93 St, Registered Architect and /or Engineer ,,,, ,,.•••,,,•, „,,,,,,,,,, Name and address of licensed contractor Location and legal description of lot to be built on: Lot Block Subdivision 1080 NE . 93. . St.„. . __...._.._ -- Street and Number where work is to be done Estimated Total cost of improvements $ 9x.90 +Q0 APPLICATION FOR BUILDING PERMIT Amount of Permit Si. Zone cubage required .Plan Cubage Distance .to next nearest building Size of Building Lot Disapproved _. Ce f .t<�\ !. /..... Date (Signed) Building Inspector MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT Re - roof entire roof PLANNING BOARD DATE Chairman Mfcrr,bcr Member .. _....._......_..._._ ...._....... Council Approved Date Disapproved Carruth Roofing Co” Incx.e...01 N1 My Commission Expires Notary Public, State of Florida NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval the Planning hoard. A rc•tn'pection fee of 31.00 will be charged when such re- inspection is made necessary by Improper notice materials and /or workmanship. State work to be done and purpose of building (by floors) and for no other purpose. New Building Remodeling Addition Repairs X No. of Stories 1 To be constructed of Kind of foundation Roof Covering cement tile 20.00 Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to. The undersigned applicant for this building permit does hercby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Pertnxne•nt Sup thcmtent, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this pcnnit, as are licensed by Miami Shores Village. / 1 =� l ) Remarks ( Signed) STATE OF FLORIDA, COUNTY OF DADE. Ss. Before me, the undersigned authority, a notary public, duly authorizcd to administer oaths and take acknowledgments. personally ap- peared ........ _ to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true.. Permit No.._ -_ a ±$ (01 Date 1 't I a8 S3 Read, Sworn to and Subscribed before me. Member Member Member Date has her-n obtained from for inspection or faulty JJ 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 rdinance 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. ,A9 Owner's Name and Address ... .... . Registered Architect and /or Engineer .._ .._ .�._ ___ // �/ / f � s� Name and address of licensed contractor -Z /L ��� _ t A '`z / % G. .., Location and legal descriptiin of lot to be built on: Lot Block Subdivision Street and Number where work is to be done State work °o be don an "puirp9sc of buildin (by STATE OF FLORIDA, COUNTY OF DADE. ss. Disapproved Cc-3\i( ) Da Lill ENG INSPECTION ©EPQf°35PM Gv`T Building Inspe ' nr Date erewe r T O . �,, < f._.C�_ � S2re22 �'<� ... r .. -- -• ® and for no other purpose. 2 :c.e Building ............ ...... _ Remodeling Addition Repairs No. of Stories 1 To be constructed of Kind of foundation Estimated Total cost of improvements $ / ( `, 6. Amount of Permit $ Zone cubage required__. Plan Cubage Distance to next nearest building Size of Building Lot Roof / vering... L Maximum live load to be borne by each floor hereby sIbmit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building pennit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. r7 Remarks .? `5 (Si 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 L Date -21 Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires ANNING, 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 S1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. " 1 U • : e • • DR. A. M. LANCE CHIROPRACTIC PHYSICIAN 789 N.E. 125TH STREET NORTH MIAMI, FLORIDA 33161 TELEPHONE 891 - 7002 • • v „ 1. D 0 � " o 9 9