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ROOFINGMIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Data 2 / v Time Type Insp'n j P' • . . • Permit No. R Nam t Address Company Phone # For Inspector: Correction Re- Insp'n Fee ❑ Address 1 5S ..q Company \ Phone # MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305-795-2204 Building Inspection Request Date) I Ti Type Insp'n j ri,o fi7 u) Permit No. P,d / 0 Name QA Re-Insp'n Fee b 9 ' ) r For Inspector( / J1 Name& Date Approved Correction -co Date Type Insp'n Permit No. Name Approved Correction Re- Insp'n Fee z MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request 2 Time Address Company Phone # For Inspecto l I 1 ) D � Name & Date OWNER'S NAME J. S. CARROLL - PlfESENT ADDRESS 415 E. 102nd Street LICENSE PIO. PHONE NO. JOB LOCATION (ST. OR AVE.) 155 N. E. 92nd Street LOT 20 & 21 BLOCK 23 SUBDIVISION M/S Sect 1 Amended .., GENERAL CONTRACTOR J. S. 'CARROLL _, ADDRESS _ PHONE ND. - LICENSE NO. 5055 SEE .ABOVE �7 �C BUILDING PERMIT NO. — DATE 3 !12-51 PERMIT FEE S 18 BUILDER'S BOND Q'r� NO. DATE ZONE REQUI REM ENTS 20 h 000 CU. FT. • K PLAN CUBE 20,905 CU. FT. EST. COST :S 13,500 //�� DRAWINGS, SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED BY: -• PG DATE 34-51 x NEW CONSTRUCTION CBS CBS STORIES 1 ROOF CONSTRUCTION Tile INTERIOR CONSTRUCTION Oak 'floors Plaza walls & c el 1. REPAIRS DESCRIPTION Living roams • -_ • a C . ( - . _ • •■ . o ; ��t`�'�- ALTERATION _ _ �++� �a6{i - DESCRIP 0 ADDITION SUBMITTED TO PLANNING BOARD APPROVED REJECTED REFERRED TO COUNCIL REASONS RE- SUBMITTED TO PLANNING BOARD SUBMITTED TO VILLAGE COUNCIL REMARKS CERTIFICATE OF OCCUPANCY NO. ptt ISSUED t/ 4-s J . BY I TO . . -(:. -.a a(A.• - -- ifgD BUILDING - PERMIT AND I(TSPECTION RECORD —MIAMI SHORES VILLAGE INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY FOUNDATION 3-14-5 i r . TEMPORARY SERVICE $ SEPTIC TANK BEAMS & LINTELS J-.z7 -.s-/ I - SEWER RANGE CONN. $ FRAMING MOTORS $ GAS FIXTURES $ • $ INSPECTIONS DATE FINAL RE- INSPECT BY RE- INSPECT BY ROUGHING 4- — CLEAN -UP The pp,I_- : .- a -.4 2 , ..- C• AS ROUGHING PERMIT NO..// . v / DATE / FEE $ / 9 ��+� REP IRS NEW BLDG. ALTERATION ADDITION SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE TEMPORARY SERVICE $ SEPTIC TANK H. W. HEATER CONN. / s / V SEWER RANGE CONN. $ SOLAR HEATER MOTORS $ GAS FIXTURES $ • $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY ROUGHING 4- — ,$)''Q"--' The pp,I_- : .- a -.4 2 , ..- C• AS ROUGHING 4-11-1-1 �.I -.iLr SEWER H. W. HEATER CONN �J SEPTIC TANK 3 -27 51 Piy SOLAR HEATER FIXTURES 0. * A FIXTURES & FINAL / / & ' 4 .- j V` AV . CONTRACTOR #,_ Cp PHONE PERMIT NO. /// 2 DATE 3�/,y"/, --/ J FEE 5 NEW BLDG. I ALTERATION ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ H. W. HEATER CONN. $ RANGE CONN. $ MOTORS $ FIXTURES $ $ INSPECTIONS DATE BY .RE-INSPECT BY RE- INSPECT BY TEMP. SERVICE j-d 6- 31 The pp,I_- : .- a -.4 2 , ..- ROUGHING 4-11-1-1 �.I -.iLr H. W. HEATER CONN �J RANGE CONN. FIXTURES & FINAL / / & ' 4 .- j V` AV . -1 /a - BU ILDIN.G INSPECTIONS y � PLUM5IING PERMITS & INSPECTIONS CONTRACTOR AI7 c ELECTRICAL PERMITS & INSPECTIONS e, '. J / 7 7- W � f CO. r FOR SERI E /Ai` DATE - St-157 B YM47/1". P 1 ? � PAID BY fi YEAR ANNUAL TAX PERIOD USED AMOUNT PAID DATE PAID RECEIPT NUMBER -11035 /= 3 ' o w d ()) 7 d -A" / 19.51 /. c rd k 6 56 1 /WV d$ fat C tc s- , - - /76 /-- % _ / - z/ a! /1 - 4 -s/ ADDRESS 15 N. E. 92nd Street lots Block LEGAL 20 & 21 -23 Z'S" 1 - RECORD GARBAGE TAX 'lest Date: September 20` 2003 Project: 155 North East 92 " Street, Miami Shores, Fl. Contractor: John Busta Roofing Permit #: BP2003 1107 Roof Pitch: 3 :12 Tile Installation Date: August 22 ' 2003 Attachment Method: Polyprofoam Tile Type: Bermuda Flat All testing is in strict accordance with the 2001 Florida Building Code, High Velocity Hurricane Zone Testing Application Standard (TAS) 106 Each Test location was pulled using a Chatillon Force Gauge to a minimum of 35 lbs. TEST SUMMARY: Roof Area Total # of Tests # of Tests Passed % Passed F ield & Ridge 16 16 100% Corner 10 10 100% Perimeter 14 14 100% TEST RESULTS: PASSED A . Tomassi Roof Testing, Inc. 1557 North Dixie Highway Pompano Beach, Florida 33060 Roof Tile Uplift Test Report See Attached Sketch For Further Details Report Reviewed by: TAS — 106 -95 Tel. 954 — 788 — 3944 Fax. 954 — 784 — 0325 D i minick Scarfo 1' 0010248 Dade County Certified Testing Agency #03- 0317.03 Revises: 02- 0814.10 Testing * Design Specifications * Management * Quality Assurance T T -r - r T -r -r -r TAS —106 Test Locations T T T T Project: T T= Tested tile and passed F= Tested Tile and failed M= Missing Tile B= Broken Tile 155 North East 92nd Street Miami Shores, Florida UNIT UNDER TEST: Mfr S /N: Gust S /N: PROCEDURE NAME CALIBRATED BY: P.O. NUMBER: SUBMITTED BY: [Standards Used Trace No Report of Calibration CHATILLON DFIS100 DIGITAL FORCE GAUGE B39539SL B39539SL SYN141 John Martinez VERBAL A. TOMASSI ROOF TESTING, INC 1557 N. DIXIE HWY POMPANO BEACH FL 33060 Synergy labs Inc certifi is that the above listed instrument meets or exceeds all specifications as stated in the referenced procedure at the points tested (unless otherwise noted). It has been calibrated using naasurement standards traceable to the National Institute of Standards and Technology (NIST), or to NIST accepted intrinsic standards of measurement, or derived by the ratio type ofself- calibration techniques.This calibration complies with ISO Guide 17025 and ANSI/NCSI. Z540 -1 -1994. Test Uncertainty Ratios are greater than or equal to 4: I web expanded uncertainty used to calculate the Test Uncertainty Ratio. with a coverage factor ofk =2 at a confidence level of approximately 95 %, unless otherwise noted Any number of factors may cause the calibration item to drift out of calibration before the recommended interval has expired. This report may not be reproduced, except in full, unless permission for the publicuion of an approved abstract is obtained in writing from Synergy Labs. Inc. REMARKS: This unit was found to be in tolerance at the time of calibration. No adjustments were necessary. Description 999215 OMEGA ENGINEERING, INCORPORATE LCCB -1K FORCE GAGE 999394 OMEGA ENGINEERING, INC. DP- 2000S3 DIGITAL INDICATOR CERTIFICATE NUMBER: 39382:1063621035 Synergy Labs, Inc 9831 E Evergreen St. Miami, FL 33157 888.346.2430 1/ i , Signed: /I j M Signed: I bratio Technician REPORT OF CALIE.RATION for SERIAL NUMBER: B39539SL PRINTED ON: 15 Sep 2003 PERFORMED ON: NEXT CAL DUE:: TEMPERATURE: HUMIDITY: 15Sep2003 15Dec2003 72.0 °F +/- 1 DEG 40 % +/- 5% CAL DATE CAL DUE DATE 5 Apr 2002 15 Sep 2003 5 Apr 2002 15 Sep 2003 Synergy Labs assigned ASSET NUMBER: 39382 Page ' of I U UECED V ED PERMIT APPLICATION FOR MIAMI SHORES VILLA ! E 10050 N.E. 2nd Avenue • Miami Shores, Florida 33138 • Phone: 305- 795 -2204 • Fax: 315- 756 -8972 Date 7h/"3 Job Address /s S /t" 9 2. - - ; , / -sr Tax Folio 1 3.O G " 013 - 31 : 0 Legal Description ' ° t 2 O A 24 QGoe IC 23 M:A Sou* 1 Historically Designated: Yes No 17 Owner /Lessee/Tenet J ONA/ 1. L.+WBd 24014/ X' 'Y . J( Master Permit # JP 2_OCZ 11 LF Owner's Address /3S Al �? 92 is al S / ACAlt S/ Phone 3 O S - 7,5 — 7'11 3 Contracting Co. A ro /b/ /3vai.0 /Loo..ive- 2/i-' Address .4 O ' Alit l /s JS I .; *agog. /f Qualifier U.1 e7 A/ ,Y State # ee -0 :J, ' ®`7"!J Municipal # IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY, THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE BEFORE CALLING FOR ANOTHER INSPECTION. Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL WORK DESCRIPTION: TNS /■14L 4g0 /= phone3a 7 Square Ft. Estimated Cost (value) • / ���, $'00 Competency # Ins. Co. WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR ANY ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). 1 certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for all disciplines. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, 1 authorize the above named contractor to do the work stated. Sig ;fie of owner and/or do President Notary as o Owner and/or Condo President My Commission Expin:s FEES. APPROVED: Zoning Mechanical J 7 /1/13 Date 7495 Date C.C.F Signature of Contractor or Owner Builder 4. EUZABETH MORALES ti ▪ MY OOMMISSION N CC 973926 • E) PIR : e ber 4, 2004 nderwriters TOTAL DUE Building �- �: :, electrical Structural Engineer Plumbin Po( ck -airs NOTARY �1vr- cNSf GaM5M6f pipTIRES: December 4, 2004 Bonded Pau Notary Public Underwriters BOND v .• Type Insp'n Correction MIAMI SHORES VILLAGE 1.101)q BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request F►r0I . Permit No d, Q ,, CO3 + o Name /'r) fl' L . L Address 1 SS °L t� S l Company 1505 - Phone # For Inspector: 10 10 Name & D C Approve Re- Insp'n Fee ❑ Attention Roofers: All permits fora foam- tile attachment submitted on or after July 1, 2003 must have an uplift test. The uplift test must be on the job at time of al inspection. t Master Permit fio. Process o. Contractoes Mame ‘,.1 e9Ais/20.4sTy 2.4 Job Address / 9x-_- O Low Slope O Asphaltic Shingles 0 Mew Roof Florida Iv uilding Code Edition 2002 High Velocity Itimicane.Zone Uniform Permit Applicalkm Form. algition—lietrainitgonfroagLi OCF C/ • Dfiechanicailly Fastened The E ortar/Adhesivis Set Tile 0 Wood ShingiesiShaltes O Metal Panel/WI)! k 0 Prescriptive BUR-RAS 150 ROOF TYPE Re-Roofing 0 Recovering 0 Repair 0 Maintenance ROOF SYSTEM INFORMATION Low Slope Roe Area (SF) Steep Sloped Roe Area (S9 Total (SF) Secti*w_ Sketch Roof Plan: 131111u strata WO levels and sec n tios, roof drains, scuppers. overflow rfics scuppers and ov.w drains. inched. dimensions of sections and levels, cleady Identify dimensions of elevated pressuu zones and location of parapets. 111111111111 1 7 1 - TT .1_1 Florida .ealliding Co itdon 2002 High Velocity' Hurricane Zone Uniform Permit Application Fomi. Fill in Specific Roof Assam y Components and Identify Natroulacturer ma component is not used, identify as - NA - ) Deck: Type: AnchortBasa Sheet & Anchor/Base Sheet Fast Sect C (tLow Sloped Roof SysteEr10 System Manufacturer: ________ NOA _ Design Wind Pressure% From RAS 120 or Ca ,ulations: PIT= ...... Prom& _ Max. Design Pressure, From the Specific NOA System: - or Ply(s): Insulation Base Layer: _. Base Insulation Size and T Base Insulation Fastener/B ding Mai rig Ma Top Insulation Layer: Top Insulation Size and TM* Top Insulation Fastener/Bondii g Material: Base Shael(s) & No. of Ply(s):_ _ Base Sheet Fastener/Bonding Material: Pty Shent(s) & No. of Pty(s): Ply Sheet Fastener/Bond eria): Top Ply: Top Pty F ener/ Bonding Material: --•- --v. -^ V_ • -•■ • --•-•-- •-- Surfacing:___ Fastener Spacing for Anchor/ Attachment Fietd: Lap, # Rows 611) oc Perimeter: oc Lap, IS Rows oc Comer oc Lap, # Rows .__ . oc Humber of Fas Board Field _ _ _ _ Perimeter _Corner strata Components Noted and Details as Appllicabfle: Woodbiocking, Glitter, Edge Termination, tripping, Flashing, Continuous Cleat, Gant p, Base Flashing, Countef» Flashing, Coi ng. Etc. - Mean Roof Height, Parapet Height, He !.!• of Base Flashing, Component Material. Mater Thickness, Fastener Type, Fastener Spacit • Submit Manufacturers Details that C th RAS 111 and Chapter 16. ase Sheet ners Per insulation :• toff System i marma chimer ' ,; — f 71L Nolic.:, of Acceptance Naauwl / C /g// 67`'_._____—_ _______ Minimum ®esi in Wind Pass': anres, Vif Applicable (From RAS 127 or Calculations): P1 : 27'. " ? P2:1 (V, ()____. P3:1 -6 Rilaximuore Desigev Pressure From the ROA Specific S Bem): / /g, n _ Uethod al' the ail ; chment: ' Y___ Ld We-SZ 1; Rooi SUa9 :92 Sect ©� jS ee S o d l'10 system) C,1 St SDo ed oof S sV scam 'Von Dec& Ty ypa Undergarment: Fire B Ridge Ventilation? �' L an Roof {sight: !. Florida Building Code Edition 2002 High Velocity Hurricane Zone Uniform Permit Application Form. dhesive Tying SSA® Cap Sheet: stainer Tye Spaciaag: (j ,0 .its c C t A ca 1 # (7 0 coif Covering: 1 Type & Size Drip age: `4, - - ' -- Florida Building Code Edition zooz APPLICATION SECTION E (Tile calculations) For moment based tile systems, chose either Method tor z. /»myxn the ',m's for yo, with the values from »«, 11 oN N,. ,m n values are or equal ,o the M, values, for each area v/ the roof, then the tile attachment method is Method 1 "Moment Rased Tile Calculations P,, 12A8 127" 1 n�_�__ 'MA' y� ~ ' - > -m g: -m„:711./ bx ,, � ~+�/� ) -� ‘,747- 4 ~ M" ,/�'' Method 2 "Simplified Tile Calculation Table Below" RcqoircJ Moment "[Kxsisixn*:(K4.) From Table. Below: 3,?, _ � omen�R�is �� ce' / .--_____ '__ -_ Mean pool Slope --- - } :u ):ll —__- 4�2 >. |2 ---- 6.12 7: 12 -__-_-- ° l ' W` (able must h, used ill oovioxni0v".*xx*v/ moment based tile systems endorsed oy the nmv",o(`wmy (1 ri 3 o 1 1(11 It's 311(1 i\ ppca Is. r,, uplift based tile yyu,w` use Method 3. Compare the values for p with the values for ;..:/ the p values are greater than vr equal m the [' values, for each area v| the roof, then the tile attachment method oxc,,ynvx` Method "Uplift Rased Ti\,(.,kv|mioos Per AAS 127" NOA � �� � � _ x L � x r,' ____) cos -r,� x � , ., _ .___. / - -- ---- -- cos ~�\ Nm��`i (|^ ' x |' � � �� ___J -`"�_ s � � _-- ''---- ' -'- - -- U � �, ��� w: r�_ x cos � ___ '-- Where *m«)*ohn Information _ -- _ -- Where to Find 01 r1 ---- RAS 127 'fable 1 of by an engineering analysts mep^rett by a P 7/ ----'--- -------- Riwof Slope ft r alinumi Attachment Resistance l �-----' A Tile Weight 20' }6.5 34.4 - T�� -- 30 1 _ 2l» 27 1S2 ---- submitted 10 110' at the nor oiprimit NoA NoA NOA N<) 110' 40' 39.7 42 2 37:4 --- __'' 1 - 9.1k --__-_ 31,3 -_ - - 32 . 8 ----- ' -- 34.9 ' - 30.5 ' ------ � 28. -__- �---_-_- SECTION 1524 1I1GE VFI OC1:'1Y JI1JRI2_IC'ANE ZONES REQUIRED OWNERS NO 1 ]l1<' IfC'ATION FOR ROOFING CONSIDERATIONS 1524.1 As it pertains to this section, it is the responsibility of the rooting contractor to provide the owner with the required rooting permit, and to explain to the owner the content of this secon.. The provisions of Chapter 15 of th' Florida Building Cork, Building govern the minimum requirements and standards of the industry for roofing ..ystern installations. Additionally, the tolIowing items should be addrocd as -part of the agreement between the owner and the contractor. The on'ncr's initial in the adjacent box indicates that the item has been explained. -n 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 worknnanshi provisions. Aesthetic issues such as color or architectural appearance, that are not part of a zoning code, shoul� be addressed as part of the agreement between the owner and the contra' tor. 1'$ 2. Renailiug Wood Decks: When replacing rooting, the existing wood root' deck may have to be re nail ed 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). f in 3 Common Roofs: Commtn 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. Exposed Ceilings: Exposed, open beam ceilings are where the underside of the roof decking can be viewed fiat below. The owner may wish to maintain the architectural appearance, therefore, roofing nail penetratiocs of the underside of the decking may not be acceptable. The Florida Building Code provides the option of ntainlaining this appearance. (Plc- 5. fording Water: The current roof system and /or deck of the building may not drain well and may cause watc- to pond (accumulate) in low -lying areas of the roof. Yonding can be an indication of structural distress and may require the review of a professional structural engineer. Minding 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. Yowling conditions should he corrected. 6. Overflow scuppers (wall outlets): It is required that rainwater flow off so that. the roof is not overloaded :Trom a build up of water. Perimeter /edge walls or other roof extensions may block this discharge if overflow scuppers (wall outlets) are not provided. 11 may he 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 nay be beneficial to consider additional venting which can result in extending the service litc of the roof. C• J1O "SIt -14mpL t, .915- 111 1311.J.K 7/ 1:)atc: / 03 Contractor's Signature rem star..crf BUILDING CODE COMPLIANCE OFFICI ( PRODUCT COPITROL DIVISION NOTICE OF ACCEPTANCE (NOA) Monier Lifctilc, LLC 135 NW 20 Street Boca Raton, FL 33431 B 3111 draw N3 1 I.JM .fl t t ftzt.i MIAMI -DADE COUNTY, FLORIDA METRO -DADE FLAGLER BUILDING 140 WEST FLAMER STREET, SUITE 1603 MIAMI, FLORIDA 33 30-1363 (305) 375 -2901 FAX (303) 375 -290S SCOPE: • ;" NOA is being issued under the-applicable rules and regulations governing the use of construction materials. - The documentation submitted has been reviewed by Miami-Dade County Product Control Division and accepted by the Board of Rules and Appeals (BORA) to be.uscd in Miami Dadt County and other areas where allowed by the Authority Having Jurisdiction (AHJ). This .NOA shall hot be. valid after the expiration date stated below. The Miami -Dade County Product Control Division (In Miiami Dade County) and/or the AHJ (in arcas.other than Miami Dade County) reserve the right to ha ve this product or material tested for qualiry.assuranct purposes. If this product or material fails to perform in th accepted manner, the manufacturer will incur the expense of such testing and thc AHJ may immediately revoke, modify, or suspend the use of such product or material within their jurisdiction. BORA reserves the right to revoke this acceptance, if it is determined by Miami -Dade County Product Control Division that this product or material- fails to meet the requirements of the applicable building code. This product is approved as described herein, and has been designed to comply with the High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION: Atlantis Shake 8r Slate Concrete Roof Tile ll.A BEL 1NC: 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 bc considered after a renewal - application has been filed and there has hen no change in the applicable building code negativclyaffecting the performance of this product. TtEIRMINAT1lON 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 pr duct or process. Misuse of this NOA as an endorsement of any product. for sales, advertising or any other purposes shall automatically-terminate this NOA. Failure to comply with :my section of this NOA shall be cause for termination and removal of NOA, ADVERTiSEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by the expiration • : to may be displayed in advertising literature.' If any portion of the NOA is displayed, then it shall he done in its entirety, 11 ;NSPiECT!ON: A copy of this entire NOA shall be provided to thc user by the manufacturer or its distributors and sh.tll bc available for inspection at the job site at the request of the Building Official, This NDA consists of pages I through 6, The submitted documentation was reviewed by Frank Zuloaga, RRC NOA No.: 02- 8281.83 [£uparozian Dade: 12186107 Approval Date: 01/9103 Page 8 of 6 nT'UT c'ran'es EOM 1 SOL'ON ROOFING ASSEMBLY ArrRO ✓taL Category:. Roofing Sub-Calk-gory: Flat Profile Roofing Tiles Material: Concrete I. SCOPE This renews a system using Monier l.tfetile Atlantis Shake & Slate Concrete Roof Tile, as manufactured Monier L*feiile LLC and described in Section 2 of this Notice of Acceptance_ For locations where the pressure requirements, as determined by applicable Building Code does not exceed the design pressure values obtained 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 DESC1R1PTION Manufactured by Test product ARplicant (Dimensions Specifications Description Monier Lifetilc 1= 15" PA 112 Flat, interlocking, high pressure extruded Atlantis Shake and w = 10 //,‘" concrete shake and slate roof tilt: equipped Slate Tile 1 V" thick with two nail holes. For direct deck, mortar or adhesive set applications. Trim Pieces 1 varies PA 112 Accessory trim, concrete roof pieces for use w =0 varies at hips, rakes, ridges and valley terminations, varying thickness Manufactt,rcd for each tilt profile, ...1 SUBMITTED EVIDENCE: Test Agency 1 edland Technologies Th.: Center for Applied Engineering, Inc. The Center for Applied Engineering, Inc. The Center for Applied Engineering, Inc. The Ccntcr for Applied Engineering, Inc. Test Identifier Test Name/Report )L?:Itc 7161 -03 Static Uplift Testing Dec. 1991 Appctndis 111 PA 102 S. PA l02(A) 94-060A Static Uplift Testing Match. 1994 94.084 Static 101 (Mortar Set) May 1994 (Adhesive Set) 25-7094.2 Static Uplift Testing Oct. 199=1 PA 102 (4" Hcadlap, Nails. Direct Duck, Ncw Construction) 25-7094-8 Static Uplift Testing Oct, 1994 PA 102 • (4" lleadlap, Nails, Battens) 25- 7094 -5 Static Uplift Testing Oct. 199=5 PA 102 (4" Hcadlap, Nails, Direct Deck, Recover/Rcrool) NOA No.: 02- 1211.08 IE irntim% Date: 12/16/07 Approval 1D a re: 01109/03 Page 2 of 6 BZLZLSLSI : 4- 311.1 Meld Ntf3Ntiada1IQ3yl 81:01 £Q '/TfL%TO S Q0t7 50L'UN Ias4 gC 51 The Center for Applied Engineering, Inc. The Center for Applied Enginccring, Inc. The Center for Applied Enginccring, Inc. The Center for Applied Fnginecring, Inc. Redland Technologies Rcdland Technologies 2edland Technologies itedland Technologies The Ccntcr for Applied Engineering, Inc. Professional Service. Irdusrries, Inc. C:lotex Corporation Testing Sc:rvicc Walker Enginccring, Inc. Walker Engineering, Inc. W..Iker Engineering, Inc. Walker Enginccring, Inc. Wa kcr Engineering, Inc. Walker Engineering, Inc. Walker Enginccring, Inc. Walker Enginccring, Inc. 'Test Identifier 25- 71�3 25- 7183 -5 25-7214-1 25- 7214 -5 7161 -03 Appendix II Letter Dated Aug. 1, 1994 P0631 -01 PO402 Project No. 307025 Tcst #MDC -77 224 -47099 520109 -1 520111 -4 520191 -1 Calculations Calculations Calculations Calculations Calculations Calculations Calculations Calculations Test Name /k.eport Static Uplift Testing PA 102 (2 Quik -Drive Screws, Direct Deck) Static Uplift Testing PA 102 (2 Quik -Drive Screws, Battens) Static Uplift 'Testing PA 102 (1 Quik -Drive Screw, Direct Deck) Stacie Uplift Testing PA 102 (1' Quik -Drive Screw, Battens) Wind Tunnel Testing PA 10S (Nail -On) Wind Tunnel Testing PA 108 (Nail -On) Wind Tunnel Testing PA 108 (Mortar Set) Withdrawal Resistance Testing of screw vs, smooth shank nails Wind Driven Ram PA 100 Physical Properties PA 112 Static Uplift Testing PA 101 Aerodynamic Multiplier Moment of Gravity 25.7094 23 -7496 .25-7584 25- 78046 -S 25- 7504-4 & 5 25.7845 -6 25 -7183 Aerodynamic Multipliers Two Patty Adhesive Set System 8- 4e4SLS01: F 3111 A008 Nd3l''d Ji J31 I Q3I bate Feb. 1995 Feb. 1995 March, 1995 March, 1995 Dec. '199.1 Aug. 1994 July 1994 Sept. 1993 Oct. 1994 Sept. 1994 Dec. 1998 March 1999 March 1999 Sept. 1999 February 1996 April 1996 December 1996 March 1995 April 1999 April 1999 NOA 1Vo.: 02- 1211.08 (Expiration Data: 112/16/07 A; t roval Date: 01109/03 Page 3 of 81:01 E00ZiT2i10 Table 1: Average Weight (W) and Dimensions (1 x w }- Tire Profile Weight-W (lbij Length -I (t&) Width -w (ft) Monier Lifetile Atlantis Shake & Slate Tile 8.5 1.25 - 0.865 Table 3: Restoring 3":12" 6lflomerols 4 ":12' due to•Gr vity 5 - ilk, (ft -lbll) 6 ":12" . 7 ":12" or greater DirectDeck Tile Profile Mcnier Lifetile Atlantis She & Siate Tile Direct Deck Direct Deck Direct Deck Direct Deck 6.0 5.9 5.6 5.6 5.5 h00CJ g04.'111 3. LIMITATIONS 3,1 Fire classi fication is not pars o: thi 3 act:cptaiice. 3.2 For mortar or adhesive set tilt 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 TAS 112, appendix 'A'. Such testing shall be submitted to the Building Code Compliance Office for review. 3.4 Minimum underlayment 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. 3.6 This acceptance is for wood deck applications. Minimum deck requirements shall be in compliance with applicable building code. 3.7 May be installed on slopes 7:12 and greater with a minimum of two screws, 4. INSTALLATION 4.1 Monier Lifetile Atlantis Shake and Slate Concrete Roof Tile and its components shall be installed in strict compliance with Roofing Application Standard RAS 118, RAS 119, and RAS 120. 4 ,2 Data For Attachment Calculations Table 2: Aerod . natnic tals111 IieQS A ft T 7l (ift Direct Deck Application Tile Profile Monier Lifetile Atlantis Shake & Slate Tile 0.24 NOA No 02- 1211.08 1Essplrntlon Da?: 12!16!07 Approval Date: 01/09/03 !Page 4 of 6 IET&ZLSLsO t- 3111 .001 NH3t<IUIci311 Q3d 81 0I WW/LE/10 Table 4: Attachmen: Resi.;ta ice 1'xp;tr ;sed'as a ilflornernt - Mr (ft -lbf) for Nail-On Svsterns Expressed as a Moment Se ystems Tile Application The Profile Fastens° 1 ype tint ^ [°ec1< (rain 15132" plywood) Direct Neck (min. 19/32" plywood) Battens Monier Litetile Atlantis Shake & Slate Tile 2 -10d Ring Shank Nails • 30.9 • 38.1 • 17.2 1 -10d Smooth or Screw Shank Nail 7.3 9.8 4.9 2.10d Smooth or Screw Shank Plaits ^ 14.0 18.8 7.4 18 Screw 30.8 30.8 18.2 2118 Screw 51.7 51.7 24.4 1 -10d Smooth oa Screw Shank Mail (Field Clip} 24.3 19.0 35.5 24.3 19.0 35.5 24.2 22.1 _ 34.8 1 -10d Smooth or Screw Shank Nail (Save CI p 2.10d Smooth or Screw Shank Nails (Field Clip) 2 -10d Smooth or Screw Shank Nails (Eave Clip) 31.9 31.9 32.2 2 -10d Ring Shank Na+lsT 50.3 [ 65.5 48.3 4' tile headlap.and Easterners are located a min. of 2W from head of tile. 1 Installation with a Table 5A: Attachment Resistance for Single Pattv.Adhesive Expressed as a Moment Se ystems Tile Application - Mt (ft -lb9) _ Minimum Attachment Resistance The Profile - Monier Llfetae Atlantis Shake & State Tile PolyProTM' 118.9 PolyProl' 40.4 ,..__ 4 Largo paddy placement of 45 crams of PolyPro . 5 Medium paddy placement of 24 Tams of PolyPro'". Table 5B: Attachment Resistances for Mortar or Adhesive Expressed as a Moment Set Systems Tile Application Mortar Set - Ali (tt.dbf) Attachment Resistance Tile . Profile Monier Lifetite Atlantis Shake & Slate Tile 39.0 __,_ Table 5: Attachment Resistance for Two Patty Expressed as a Moment Adhesive Set.Sys Tile Application M (ft-Ibf) _ Minimum Attachment Resistance 3 13 r Tile Profile Monier Lifetile Atlantis Shake & Slate Tile Adhesive 2 See manufactures component trepreval for installation reguirements_ 3 Flexible Products Company Tile8ond Average weight per patty 13.9 grams. Polyfozm Product. Inc. Average weittht per patty 8 trams. - - SOW SQL ' 17N NOA No.: 02- 1211.08 Expiration Date: 12/16/07 Approval Dane: 01.1i99103 Page 5of6 8i:LZLS2,Sn :311i 300d Nt9rla2ib iiQ3L1 HT:OT £legV /TS -'TLS 300d G9C ON S. LAIBIELING All tiles shall bear the impaini or i.iea4ti,i.rble markin,; of the manufacturer's name or logo, or following statement: "Miami -Dada County Pr.>.kct Control Approved ". 6. BUILDING PERMIT 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 applicable building code in order to properly evaluate the installation of this system. PROFILE DRAWINGS 1" • INA1OLOCK '•, ,vION1ER LIFETit.€ ATLANTIS SIIAI i & SLATE CONCRETE ROOF TI1.t END OF TIUS ACOIE1''1'ANCE NOA No.: 02- 1211.08 Enpirutio n Date: 12J16/07 Approval Date: 01109!03 Page 6of6 a72..as2_,so2 !- d111 .dOOw Piti31 I(I4 83T :0I £@E3e /i2/ [o PRODUCT CONTROL NOTICE OF ACCEPTANV E Polyfo.am Products, Inc. 2400 Spring- Stucbner Road Spring ,TX 77383 -1132 Your ap_p_li s aiie c;istot tanc__(N0A) of: Twa :C`iPttrponcnt Polyurethcne Foam AdFic` it under Caapter 8 of the Code of Miami -Dade County governinb the use of Alternate Materials and Types of Constniction, and completely described herein, has been recommended for acceptance by the Miami -Dude County I3uilding Code Compliance Office (BCCO) under the conditions specified herein. This NOA shall not be valid after the expiration date stated below. BCCO reserves the right to secure this product or material at any time 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 dcterminl;d by BCCO that this product or material fails to meet the requirements of the South Florida Budding Code. The expense of such testing will be incurred by the manufacturer. ACCEI'TANCE NO.: 01- 0521.02 EXr IRES: APPROVED: 06 /14/200t 1 ∎ , 04 500011pc200C1ttemplateslnotico acceptance cover pate.dot Internet n tidtdre55: postrnaster@buildingeotleonline.com buildingeodeonline.com Z00Z MIAMI -DADE COUNTY. FLORIDA METRO-OA DE FLAGLER BUILDING BUILDING CODE COMPLIANCE OFFICE INICTRO -DAD( FLAGLCR BUILDING 140 WEST FLAGLER STREET SUITE 1601 MIAMI, FLORIDA 3]130 -1563 (305) 375 -2901 FAN (305)375-290s CON'rR:\CTon I.ICi:.NSING SECTION (305)275-2527 FAX (305) 375.255E CONTRACTOR IN FONC:F:AIENT DIVISION (305) 775 -2066 FAX (305) 375.290E raouvcrCONTKO. DIVISION (305) 375 -29u2 FAX (305) 3722.6330 ' ONI ' SIDa(102Id R'YOJA10d Raul Rodriguez Chic( Product Control Division CIS IS THE COVF,RSUEFT SE ADDI t'I ONAL PAGES FOR SPECIFIC ANI) (:I'NF RAI, CONDITIONS BUILDING CODE & PRODUCT flEVIEW COMMITTEE. 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 Miaini -Dade County, Florida under the conditions set forth abov!. Francisco J. Quintana. R.A. Director Miami -Dade County Building Code Compliance Office lioineme; help: //www.bu iltlin);codconline.cntn Z60T 8LS t'S6 XVd SO : LT 1lH,L CO /CT /ZO Polyfo:lin Products, Inc. COOIJ ROQFIIIG ASSEMBLY APPROVAL cutecorn Roofing Sitb- CategQrv: Roof Tile Adhesive Material: Polyurethane I. SCOPE This approves Polypro® AH160 as nianufucturecl by Polyfoam Products, Inc, as described in Section 2 of this Notice of Acceptance. For the locations when the design pressure requirements, as determined by applicable building code, does not exceed the design pressure values obtained by calculations in compliance with Roofing Application Standard RAS 127, for use with approved tint, low, and high profile roof tiles system using Polypro® Ali 160. Where the attachment calculations are done as a monient based system for single patty placement, and as an uplift based system for double patty systems 2. PRODUCT DESCRIPTION Manufactured by Applicant Polypro® Al - 1160 Pro Pack ®30 Sc 100 Dimensions N/A Foainpro® RTF1000 N/A ACCEPTANCE No.: 01 Tes t ccif ifcntions PA 101 Approval Date: June 14J001 Expiration Date: May 10,3006 Product Dcscriptioq Two component polyurethane Dispensing Equipment N/A Dispensing Equipment 2.1 Components or products manufactured by others: Any Miami-Dade County Product Control Accepted Roof Tile Nsembly having a current NOA which list uplift resistance values with the use of Polypro AI.I1 roof tile adhesive. 2.2 Typical P rn perty Density Compressive Strength Tensile Strength Water Absorption h4oisturc Vapor '.'rnnsmission Dimensional Stability Physical Properties: Tcs t ASTM D 1622 ASTM D 1621 ASTM D 1623 ASTM D 2127 ASTM E 96 ASTM D 2 126 ' DN I ' SIDI1Q021d iNTUA'lOd Results 1.6 Ibs./R.' 18 PSI Parallel to rise 12 PSI Perpendicular to rise 28 PSI Parallel to rise 0.08 Lbs. /Ft 3.1 Perm / Inch +0.07% Volume Change ® -400 P. 2 weeks +6.0% Volume Chan 'c 67 :Humidity. 2 weeks Trunk Zuloagn. IkRC Product Control Examiner ZtOT 8LS VS6 Xdd SOLI ;1H1 CO /CI /Z0 Polyfoam Products, tact ACCEPTANCE No.: 01- 0521.02 Note: The physical properties listed above are presented as typical average values ns determined by accepted ASTM test methods and are subject to normal manufacturing variation. 3. LIMITATIONS 3.1 Fire classification is not part of this acceptance. Refer to the Prepared Roof Tile Assembly for tiro rating. 3.2 Polypro® AH 160 shall solely be used with flat, low, R high tile profiles. 3.3 Minimum underlayments shall be in compliance with the Rooting Application Standard RAS 120. 3.4 RoofTile manufactures acquiring acceptance for the usc of Polypro® AFI I60 roof tile adhesive with their tile assemblies shall test in accordance with PA 101. 3.5 Roof Tile manufactures acquiring acceptance for two paddy placement with the use of Polypro® AI - 1160 roof tile adhesive with their tile assemblies shall test in accordance with PA 101 and with section 10.4 as modified herein. F— M S 4. INSTALLATION 4.1 Polypro® AH 160 may be used with any roof tile assembly having a current NOA that lists uplift resistance values with the use of Polypro® A1 4.2 Polypro® AH 160 shall be applied in compliance with the Component Application section and the corresponding Placement Details noted hcrcin. The roof tile assembly's adhesive attachment with the usc of Polypro® At4160 shall provide sufficient attachment resistance, expressed as an uplift based system, to meet or exceed •the uplift resistance determined in compliance with Miami -Dade County Roofing Application Standards RAS 127. The adhesive attachment data is noted in the roof tile assembly NOA 4.3 Polypro® AH 160 roof tile adhesive and its components shall be installed in accordance with Roofing Application Standard RAS 120, and Polyfoam Products, Inc. Polypro® AH160 Operating Instruction and Maintenance Booklet. 4.4 Installation must be by a Factory Trained 'Qualified Applicator' approved and licensed by Polyfoam Products, Inc. Polyfoam Products Inc. shall supply a list of approved applicators to the authority having jurisdiction. 4.5 Calibration of the Foampro® dispensing equipment is required before application of any adhesive. The mix ratio between the "A" component and the "[3" component shall be maintained between 1.0 -1.15 (A) : 1.0 (8). The dispense timer shall be set to deliver 0.0175 to 0.15 pounds per tile as determined at calibration. No other settings shall be approved. 4.6 Polypro® At -1160 shall be applied with Foampro l&TF 1000 or ProPack® 30 & 100 dispensing cquipincnt only. 4.7 Polypro® A1.1160 shall not be exposed permanently to sunli Frank Zuloaga, RRRC Product Control Examiner h'O Z civl'S.Lc11002Id KVOJA1Od Zt•OT 8LS I' 6 XVd 90 :L1 11H,L CO /CT /ZO 200 EA Potytbnnt Prodtsts, Inc, ACCEPTANCE No. : 01-0521.02 4.8 Tiles must be adhered in freshly applied adhesive. Tile must be set within 2 to 3 minutes atler Polypro® AI -1160 has been dispensed. 4.9 Polypro® Al-1160 placement and minimum petty weight shall be in accordance with the 'Placement Details herein. Each generic tile profile requires the specific placement noted herein. Table 1: Adhesive Placement For Each Generic Tile Profile Tilcl'rofitc Placement Single Paddy Weight Two Paddy Weight Detail Min. (grams) per paddy Min. ( rams 35 N/A N/A 24 N/A 8 Flat, Low, High Profiles High Profile (2 Piece Barrel) #1 17 /side on cap and 34/ an Flat, Low, High Profiles Fiat, Low, Hi ;h Profiles #3 5. LABELING All Polypro® AH160 containers shall comply with the Standard Conditions listed herein. 6. BUILDING PERMIT REQUIREMfENTS 6.1 As required by the Building Official or applicable Building Code in order to properly evaluate the installation of this system. ' ONII ' S.LOi1Q02Id KVOJA10d Frank /_uloaga, RRC Product Control Examiner ZtOT 9LS 6S6 XV1 90:L1 an CO/CT/(70 Polvfonm Products, inc. ADIIES1vE PLACEMENT DETAIL SI NGLE PATTY ACCEPTANCE No. : 0j-0521.02 Nail through Ples cement lIndsItyrnant Ene gum Pony Munn Mel Eno Nina aide Noll through plande commit nee Oa nata Paddy (Boma Uhl hula etenhoh Ern clones DO odes N&1 Wei* plink tenant Undi dappont Ern corn 4 10 In. EP. Clef: /I Kg sat gave 'pivot In op hoot ottli Pelts Paddy Oman DM Fascia ITO MUM pair Mgt anthill appal. 1 lo. op from weophaies 5 Ease Cowie FAVE ammo oak kap adhulee emu 4 In. op Ircn rupiahs Ptue Mai* edlieeloe la reline 11 n 21 some borne In caned oft the pea ItI h Tont caws tonne down. Plate )dhealvo tQ To 1 k Foxe nada ileve d cow de. TIiiffiIOffiotUL brain no harem of no ears . coon* corer We Ahat la second tuna of hen Ow Emu ono ut1 of sad env tan are flush M saw, Vac foci stoma 'prettp shawl W"Pheill film:60o Optional 111's loy Map eke upholloaa Frank Zuloaga, RRC Product Control Examiner Ra Wave% plink cement Optimal Penh* 11odoo algal al lib Shutting 90001 'DNI'SID11030Hd NIVOJA10d Zt'OT 9LS t96 XV.1 90 :1.1 11111, CO/Cl/Z0 PoIvfolm Products. line. Ml through plastic cement Underuyment 1 I I ` \ 71n. In. lave Coupe fare Quin ADHESIVE PLACEMENT DETAIL 2 SINctE PATTY 6 ACCEPTANCE No. 01- 0521.02 Nail through ptaeUc cement Undorlayment Paddy (Beneath iae) Nall through plastic cement Undedayment Eave Covtw Ease Closure Fuels Weepaok Eva closure Drip edge Psildy (Beneath Tl'l Frank Zulo3ga, RRC Product Control EXanmincr LOOL j '0NI'S.L01740Hd 14VOdA1Od ZDOT ELS 6S8 XVJ LO LT fIH.I, CO /CT /Z0 Po lytoam Products, Inc. Nall through plastic cement it 3 In. Single paddy ea under- laymen, Single paddy an top of the paddy under We Single paddy on top al tile Emit Course ADHESIVE PLACEMENT DETAIL. 3 DOUBLE PATTY ACCEPTANCE No. : 01-0521.02 Nall through plastic cement Nail Through plastic cement Underlay/MI Single paddy on top of lite Single paddy under tile Ewe Coma 7 &NI:paddy between the Faye Cloture 41/1.°11frfr 2 ht. t 1 In. medium site paddy eave course only Falcia Single paddy undo' Illo Single paddy between Ole 2 In. t 7 Itt medium slut paddy eave Caine only Frank Zuloaga, ItItC Product Control Examiner hada Weigher' Ewe closure Otip edge 900 PI 'DNI'SIDIGOUd NVOJAIOd ZtOT SLS tS6 XVd LO:LT In CO/CT/ZO 1'olvfonm Products, inc. ACCEPTANCE No. ; 01- 0521.02 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 Cuntrul Approval ", or as specifically stated in the specific conditions of this Acceptance. 3, Renewals of Acceptance will not bc 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 approval. c. If the Acceptance holder has not complied with all thc requirements of this acceptance, including the correct installation of thc product. d. The engineer who originally prepared, signed and scaled thc 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 %vith appropriate fee) and granted by this office. 3. 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 Acccptancc 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 bc 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 nald not reseal the copies. 8. Failure to comply with any section of this Acceptance shall be cause for termination and removal of Acceptance. This Notice of Acceptance consists of pages 1 through 8. END OF THIS ACCEPTANCE Drank Zuloaga, RRC Product Control Examiner 6001 t 'DO 'S,LDi1Q02id KVOJA'IOd Z60T 9LS PS6 XVd LO :LT 11111. CO/CT/Z0 vJE Sig 'tune of t • o Print Owner's Nan teT / //' PERMrr NO. TAX FOLIO NO. // 3 .q0o �D / - ..3/&7 STATE OF FLORIDA; COUNTY OF MIAMI -DADE: THE UNDEA:.IGNED hereby gives notice that improvements will be made to certain real property, and . n accordance with Chapter 713. Florida Statutes, the following information Is provided in this Notice of Commencement. 2. Description of Improvement: M,LIA/4 3. Owner(s) name and address: :1 Z4 VE E/(ll� Interest in property: Name and address of fee simple titleholder. 4. Contractor's name and address: \f D //AJ/2 J7,9 -- _ 3cv /1 9/ Qnr ,- 44,1,A7 f / 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: /t Amount of bone $ Q 6. Lender's name and address: Sworn to and sub9cribed before me this 24 day of C , 2003 Notary Public C Print Notary's Name My commission expire 12101.82 PAGE 4 11/02 y .rim wS aa� LORRAINE ' LLER Notary Public - Stela of Florida -_ My Convithskin EamesAar10,2000 Commission 8 DD 100725 CFN 2003RO428644 OR Bk 21369 Ps 4788; t1P9) RECORDED 06/26/2003 09 :53 :v5 HARVEY RUVIN, CLERK OF COURT MIAMI -DADE COUNTY, FLORIDA LAST PAGE 1. Legal desr:ription of property and street/address: /5 92 J; 7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713 Florida Statutes, Name and address: n, 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided In Section 713.1 :1(1)(6), Florida Statutes. Name and address: /(y,/1 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a dtffere... ate Is s eeciflod) Prepared by�C /.."i' L•37/9 Address: 3&o. /l- 7/ kJ7k%z Name and address of licensed contractor • MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations o` 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 April __ - , 19.5_ Owner's Name and Address J 4 S . Carroll —520 NE 102 St, No. Street I Registered Architect and /or Engineer LanRoofing & Tile Co, L30 NW 79th St, Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done 100 ?___ __92nd __ .St, State work to be done and purpose of building (by floors) 30# felt 90# slate, white shingle tile and for no other purpose. New Building X Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering X Estimated Total cost of improvements $____$754. Amount of Permit $ 5000 Zone cubage squired plan Cubage Distance to ne:ct nearest building Size of Building Lot Maximum live :oad to be borne by each floor I hereby st.bmit 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 ;:he 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 1i:ensed by Miami Shores Village. Remarks ( Signed) (.1 STATE OF FLORIDA, COUNTY OF FADE. 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 ste.ted 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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or w)rkmanship. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Apt is hereby made for the approval of the detailed statement or u:e plans and specifications herewith submitted for the build • in or oche- structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores V:Il:,ge, I lorid.t. 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...December Owner's Dane and Address . John L. Zavertni) .._.. Str� Street and Number where work is to be done 155. 92n.d _.St. et State work t:t be done and purpose of building (by floors) New Bui!din : ; Remodeling To be constructed of Kind of foundation Registered 1.rchitect and /or Engineer.. 1111• •,,, Name and address of li �. ...t.19th..A.Y. Location and legal description of lot to be built on: t n +n a�� Lot d' 21 Block Subdivision 1.01 i ...1!b.C._..__�._aZ� l.� Amount of Permit $. P' ®'i° and for no other purpose. Addition Repairs No. of Stories _ Roof Coveringl shingle tile Estimated Total cost of improvements $..5. Zone cubage required Distance • to next nearest building Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with be sent to.. 890 S... W.. 69.th...Avenue F.X.or. la....3.3144 The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer al Laws of Florida. Pc nrnt Sup ilcurent, tra plan Cubage 23 SQuarg Size of Building Lot of l.tbur uncle: the Honda Workmen's Compensation Act, being Section 5966, Compiled Cen and h.ts comp,cd ssith the provisions thereof, and will require similar compliance from all in the work to be performed under this permit; and will post or cruse to be posted for in or notices as a:•c required by the Act. The undersigned agrees to employ only such su permit, as are licensed by Miami Shores Village. Rern.uks (Signed) A CC# 3054 reference to the building and its construction may actors or sub n on the si on w Spr him slit Mice under this STATE OF F:,OF1DA, 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 :tate are true. Permit No " 42 Date 1 . 1 4 1 Disapproved 1111.. �. , � _ • a e (Signed) Building Inspector My Commission Ex PLANNING BOARD to me well known, Read, S .1. to nd Subscri Notary Public, State of %orida me. kary ublic, Stat9 of Florida at b,:r. e y Coinimssie ["xpires July 21, 1986 d tf,n, Maynard 8,71dirco Aetnry Chairman Member \fcrr,bcr Member Member 11. . _.....__..._._..._. _ 1111.._ 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 I'I,rnnir, Board. A rc- inspection fee of 51.00 will be charged when such re- inspection is made necessary by Improper notice for inspectirsn or faulty materials anti /or workmanship. PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date i / 3 i/ 2u0° Job Address /,SS /Uis 9241 .S / Tax Folio //J 3 22 & — 0 / , -3 — 3 80 Legal Description L,vi ' ‘ ( 3/ - Z /11'16 - Historically Designated: Yes No — Owner/L,essee / Tonant J O HIl/ d L ti�/j - 24/0 :;a i -4, "K Owner's Address /SS //,/ S 7., 1 Si Phone 3o5 - 7S C - 7Y v..3 Contracting Co. ((vr i t1 Address Qualifier SS# Phone State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICA WORK DESCRIPTION R e5S v/c.G' Square Ft. Estimated Cost (value) ,( c)-C WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FUR 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 nude 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 me :t the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL PLUMBING, SIGNS, I'OOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoninf,. Furthermore, I authorize the above -named contractor to do the work stated. of owner an Si My Co I/ / Ji g Condo President Date Signature of Contractor or Owner- Builder Date Owner and) or Condo President A NANCY A. LOUIS onded Nu Notary Public Underwriters EXPIRES: March 13, 2003 : +■ MY COMMISSION # CC 811809 • ,:. lull FEES: PERMIT ,0 , RADON APPROVED: Zoning Mechanical Building c 1- 2 . Q . v / j A y " ' / ,4 Xodr L✓ � "Q f 4%N / P C.C.F. Notary as to Contractor or Owner - Builder Date My Commission Expires: NOTARY Electrical Plumbing Structural Engineer Master Permit # BOND Y3 PAVING FENCE SIGN TOTAL DUE -5" ��