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500 NE 92 St (6)�u.DING ❑ CTRICAI. ❑ PERMIT N° 14262 -LUNGING ❑ ROOFING cy Work to be performed under this Permit Owner of Building _ .., r..r ...� Architect Contractor or Builder Legal Description I� Address of Building t , . F 1 'c' Lot Signed: In consideration of the issuance to me of this permit I agree to ertaining thereto and in strict conformity with the plans, drawings, eta • accepting this permit I assnm ility f r,,all work done by CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA DATR • 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 herefor in strict compliance . with all ordinances pertaining thereto and with the understanding that the work will be perforated in eo nplianee drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Perak say he• time if the work is not done in compliance with such ordinances or if the plans are changed without authorisation. A further condition granted is the understanding that the contractor Or builder named above assumes the rap* + for a thorough knowledge of the oaao�t pertaining to the work covered hereby whether . done by his agents, servants or employees. BY AUTHORITY No. RESULT No. RESULT No. RESULT No. RESULT No. RESULT 1 -5 Passed 21 -25 Passed 41 -45 71 -75 91 -95 6 -10 Passed 26 -30 Passed 46 -55 76 -80 96-100 11 -15 Passed 31 -35 Passed 56-60 81 -85 101 -110 16 -20 Passed 36-40 65 -70 86 -90 111 -200 Ri. �R!EAI ting Building Solutions For The Construction Industry • \gm eenng & • onsulting, Inc. PROPERTY ADDRESS: 500 NE 92 ST. OWNER: CONTRACTOR: MIS CORP. ROOFING SQUARES: 22 TILE TYPE: HANSON HACIENDA CONTACT PERSON: Testing Equipment: Digital Chatillon DFIS 200 THIS ROOF HAS PASSED: 21 17 13605 S.W. 149 Avenue Unit 1 Miami, FL 33196 CONCENTRATED UPLIFT LOAD TESTING ON ROOF TILE TO COMPLY WITH MIAMI -DADE COUNTY PROTOCOL RAS -106 FAILED THE STATIC UPLIFT IN ACCORDANCE WITH MIAMI-DADE COUNTY PA196. "ROOF SKETCH" 2 2s\ 29 31 20 18 27 26 25 12 16 15 13 14 Test Tabulation 19 24 23 22 33 32 34 2 3 7 Front 4 6 Lab Report No. 04- 040060 PERMIT No: PCA No: ROOF PITCH: 3:12 INSPECTION DATE: TEST DATE: 04/08/04 JOB NUMBER: 5 North Certificate No.02- 0501.06 Required Testing Force: 35 Ibs Voice: 305.256.4550 floridatec.net Fax: 305- 256 -1995 MIAMI SI-PRES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request \\ Type Insp'n J ■. .-A '_ A., Permit No. T Date? Name Address Company Phone #3 off_ 93 Inspection Date 3 ).17 / 0 y Approved Correction Re -Insp' n Fee 0 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305-795-2204 Building Inspection Request \ Date • , ,o : . , . / , ' . Type Insp'n„, /..), .., --. -,,, _..... „-, , -,,, / 1 , Permit No. Address Company I .; Approved Correction Re-Insp'n Fee Name 1 4 Phone # -% / A ! / Inspection Date ) ) / MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 7 Type Insp'n Permit No. 6 CL . Name QOU.JR Address CC NC 6 12.5 - 1 -- - Company I4 \ S Phone # Inspection Date 3 Approved Correction Re- Insp'n Fee ❑ MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date ' ':3 Type Insp'n Permit No. Company • � Inspection Date � < _ Approved Correction Re- Insp'n Fee U q , Name Address Phone # Date Type Insp'n Permit No. Name To ou Address SDO 1r b C- ?- Company t ` S crxp Phone # Inspection Date Approve Correction MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Re- Insp'n Fee ❑ - f 8P 1 22() BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical Plumbing Mechanical Owner's Name (Fee Simple Titleholder) G P �_ 19-- i EL>6GG� Phone 3C) � % " 744,21 Owner's Address .re d /1)0 ( 2 S'7"/PF0j Cit A / SWeRJ S State Tenant/Lessee Name Phone # Job Address (where the work is being done) O frC 1 7 City Miami Shores Village County Miami -Dade Zip Is Building Historically Designated YES NO Contractor's Company Name Contractor's Address 76' 2 2 / S . Lam' - 57 City ,e/ /n ' / State C Zip 3 Qualifier 77'/4 - 4 a Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit Code Enforcement $ Total Fee Now Due $ ' 7 0 (Continued on opposite side) Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 / 6.6 Structural Plan Review. $ Master Permit No. Permit No. ( Pz oq ' 220 Zip 33431 Phone # 3c 3 5.53 . , 33/3r Square Footage Of Work: 3 Type of Work: EAddition ❑Alteration DNew J( Repair/Replace ❑ Demolition Describe Work: � , 1) / a �' k �5 -c. T6 ,22> C. c , � z T /C' /` -jce / 1 \CI( ( fiY? LJ Submittal Fee $ 66- CO Permit Fee $ 3(5c. ' 5 r CCF $ , 4 CO /CC Notary $ Training/Education Fee $ /i 41 17 Technology Fee $ ?/ 50 Scanning $ / 4 • Radon $ Zoning Bond $ * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the - applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection w rch ccurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will tf,6t be p ve l an �j• ei . e will be charged. Signature The foregoi 21i strument was ac day of , 20 who is personally kno NOTARY PUBL Sign: P My ommission Expires: State Certificate or Registration No. **************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED $Y: Chc12/15/03 Owner or Agent d edged before me this`O Signa The foregoi day of who is personally kno - NOTARY PUBLIC: as Sign: SJOSEL Pri yCommission Exp 2t 'I7-.F Certificate of Competency No. Contractor strument was acknowl , 219 , b (Certificate of Competency Holder) ged before me this f Rq re known f o • who has produced nation and wl • ; oa ************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** FEB 1 2004 Plans Examiner Engineer Zoning Type Insp'n MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 A)P Building Inspection Request Date 3 • Permit No. � c - 2 2 j Name e;�a% Address 5°0 NL 2=-5+ Company l S Phone # Inspection Date Approved Correction ❑ Re- Insp'n Fee ❑ Approved Correction MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305-795-2204 Building Inspection Request Date. t r - ), Type Insp'n •, Permit No. Name -) , • k- Address - Company C.0 Phone # Inspection Date Re-Insp'n Fee 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 H igh Velocity Hurricane Zone Uniform Roofing Permit Application Form MIAMI -DADE COUNTY BUILDING DEPARTMENT ELECTRONIC APPLICATION Section E (Tile Calculations) 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: I -6/,�� x A 1. - Mg: I 'o = Mr1: I t° = °° NOA Mf: P2: - / xA -Mg :I6.Y = Mr1: NOA Mf: �6 P 3: '1J: 7 (x A I - Mg: -� = Mr1: Zr NOA Mf: INT7 Page 5 Method 2 "Simplified Tile Calculation Per Table Below" Required Moment of Resistance (Mr) From the Table Below: Mr Required Moment Resistance* I et-/ NOA Mf: Page l of l *This Table must be used in conjunction with a list of moment bass LttI \ \I systems endorsed by the Broward county Board of Rules and Ap 4Is, a High Velocity Hurricane Zone Uniform Roofing Permit Application Form MIAMI -DADE COUNTY BUILDING DEPARTMENT ELECTRONIC APPLICATION Roof Slope: 1 Roof Mean Height: Ridge Ventilation: Method of Tile Attachment: IN /A ,4 Sry Alternate Tile Attachment Method: (t- Clip Spacing for Metal Roof Panels Field: 1E27Perimeters: I `i I j Corners: Perimeter Width: I , _® Section D (Steep Sloped Roof System) Sloped System Description Page 4 Deck Type: i 5/8�� Plywood Alternate Deck Type: Un er yment type: Insula ire Barrier Board: I_ /4 Optional Nailable Substrate: e / J Fasteners: I`a ,-x / "Iyat Cap Sheet Type /Adhesive Type: 9d ti Roof Covering: ( pc t J AJ Roof Covering Attachment Method: Drip Edge Fastener Type: Hook Strip /Cleat ga. or weight: NI A-6`r Drip Edge Size & Gauge:12" face 26 ga. Drip Edge Material Type: iGalvinized Metal Page l of 1 kde Roof System Manufacturer: liYigAiSchij oaDei F 26 J Notice of Acceptance Number: ©,? a- /4 Minimum Design Wind Pressures, If Applicable (from RAS 127 or Calculations): P 1: I_d u ____ I P 2: Iz 3: 1 2,o.ck__. Maximum Design Wind Pressures, (From the PCA Specific system): ITTZTI a High Velocity Hurricane Zone Uniform Roofing Permit Application Form MIAMI -DADE COUNTY BUILDING DEPARTMENT ELECTRONIC APPLICATION Roof Slope: 1 Roof Mean Height: Ridge Ventilation: Method of Tile Attachment: IN /A ,4 Sry Alternate Tile Attachment Method: (t- Clip Spacing for Metal Roof Panels Field: 1E27Perimeters: I `i I j Corners: Perimeter Width: I , _® Section D (Steep Sloped Roof System) Sloped System Description Page 4 Deck Type: i 5/8�� Plywood Alternate Deck Type: Un er yment type: Insula ire Barrier Board: I_ /4 Optional Nailable Substrate: e / J Fasteners: I`a ,-x / "Iyat Cap Sheet Type /Adhesive Type: 9d ti Roof Covering: ( pc t J AJ Roof Covering Attachment Method: Drip Edge Fastener Type: Hook Strip /Cleat ga. or weight: NI A-6`r Drip Edge Size & Gauge:12" face 26 ga. Drip Edge Material Type: iGalvinized Metal Page l of 1 kde • 1 High Velocity Hurricane Zone Uniform Roofing Permit Application MIAMI -DADE COUNTY BUILDING DEPARTMENT ELECTRONIC APPLICATION Master Permit No. Contractor's Name: Low slope roof area (ft. Section A (General Information) Process No. ❑ Other: Page 2 Job Address: Ii s tyarP77CAJ.] I _ ,SDD _ _3 f Roof Category ❑ Low Slope I.....1 Mechanically Fastened Tile M ar /Adesive Set Tile E Asphaltic Shingles ❑ Metal Panel /Shingles ❑ Wood Shingles /Shakes Prescriptive BUR -RAS 150 Roof Type ❑ New Roof Re- Roofing ❑ Recovering ❑ Repair f Maintenance Are there Gas Vent Stacks located on the roof? ❑ Yes ❑ No If yes, what type? ❑ Natural ❑ LPGX Roof System Information Steep Sloped area (ft. z:1,Je' l Total (ft. I 0 S , Section B (Roof Plan Page 1 of 1 Sketch Roof Plan: Ilustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include dimensions of sections and leve s, clearly identify dimensions of elevated pressure zones and location of parapets. Perimeter W dth (a ): 1 _I Comer Size (a' x a'): III �lril=■■1Ciii®■iMMIII I tar 11����11!'� 5••I ∎.�% I .....MSASI iu a..m 1�I�111111 1111/11111111111111111 am ..��.1�.....1� ■l�i...■..l..1/ %■ INNS . " 'a:1.1 == :::�Csai m =:im'. : i�T�.. ■�NW,�■�.■ ■■■■� ■�i ia.. ■i . ... ■■■■ JIIIIMI.■tl'NIN� . �■�� ■ ■ ■ ■■■■�■■■■�41 ■■■Ln■�■►�■ ■■■■ ��hI� 1 . � ..... .. ■. ■. ■111.. ■ ■ ■ 11 IIU 1 11111 Irdlll/lllrlll li ■■ E ■■■ ■■ ■■■■llNI■II ■NIN■■ ■ ■ ■ ■ ■■■■■ ■ ■ ■. ■■ 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 roofmg 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 roofmg 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 plaided. Z. A esthetics-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 • part of the agreement between the owner and the contractor. nailing Wood Decks: When replacing roofmg, 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 B ', i in:, ode. (The roof deck is usually concealed prior to removing the existing roof system). a i K 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. posed Ceilings: Exposed, open beam ceilings are where the underside of the roof decking can be viewed s . m 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 opti�o i�' aintaining this appearance. ►. nding Water: The current roof system and/or deck of the building may not drain well and may cause water to pond (accumulate) in low -lying areas of the roof. Ponding can be an indication of structural distress and may require the review of a professional structural engineer. Ponding may shorten the life expectancy and performance of the new roofing system. Ponding conditions may not be evident until the orig u . r.. m _ system is removed. Ponding conditions should be corrected. verflow 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 sell. • ers (wall outlets) are not provided. It may be necessary to install overflow scuppers in acco wi is the Florida Building Code, Plumbing. entilation: 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. j may be beneficial to consider additional venting which can result in extending the service life of the roof. Owner's/Agent's Signature C.Oacme.b ..d sdd pd O'NO°t SenbrypATempTiemportry Intend Pnee1[..tnt.IPlVOxtDAYTR 132 Date 'ontractor's Signature Roof System Required Sections of the Permit Application Form Attachments Required See List Below Low Slope Application A, B, C 1,2,3,4,5,6,7 Prescriptive BUR RAS 150 A, B,C 4,5,6,7 Asphaltic Shingles A, B, D 1,2,4,5,6,7 Concrete or Clay Tile_____) A, B, D, E 1,2,3,4,5,6,7 Metal Roofs A, B, D 1,2,3,4,5,6,7 Wood Shingles and Shakes A, B, D 1,2,4,5,6,7 Other As Applicable 1,2,3,4,5,6,7 High Velocity Hurricane Zone Uniform Roofing Permit Application Form MIAMI -DADE COUNTY BUILDING DEPARTMENT ELECTRONIC APPLICATION INSTRUCTION PAGE COMPLETE THE NECESSARY SECTIONS OF THE UNIFORM ROOFING PERMIT APPLICATION FORM AND ATTACH THE REQUIRED DOCUMENTS AS NOTED BELOW. ATTACHMENTS REQUIRED 1. Fire Directory Listing Page 2. From the Miami -Dade County Notice of Acceptance NOA Cover Sheet NOA Specific System Description NOA Specific System Limitations NOA General Limitations 1 Applicable Detail Drawings 3. Design Calculations per Chapter 16, or if applicable, RAS 127 or RAS 128 4. Other Component Notice of Acceptances 5. Municipal Permit Application 6. Owners Notification for Roofing Considerations (Appendix " F" Form) Re- roofing or Repairs Only 7. Any Required Roof Testing /Calculation Documentation Any other additional data reasonably required by the Building Official to determine the Integrity of the roofing system. Page 1 Page 1 of 1 . 954 426 2260 Sent By: HANSON.ROOF.TILE DEERFIELD ; 954 426 2260; MIAM BUILDING CODE COMPLIANCE OFFICE (BCCO) PRODUCT CONTROL DIVISION NOTICE OF ACCEPTANCE (NOA) Hanson Roof Tile d.b.a. Pioneer Concrete Roof Tile 1340 SW 34 Ave -• - Deerfield Beach, FL 33442 This NOA. consists of pages 1 through 6. Thc submitted documentation was reviewed by Frank Zulouga, RKC Jun -2 -03 2:53PM; Page 1 IAM1 -DADE COUNTY, FLORIDA NIETRO -DADS FLAGLER BUILDING 140 WEST FLAGLER STREET, SUITE 1603 MIAMI. FLORIDA 33130 -1563 (305) 375 -2901 FAX (305) 375 -2908 SCOPE: This 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 used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ). This NOA shall not be valid after the expiration date stated below. Thc Miami -Dade County Product Control Division (In Miami Dadc County) and/or the AHJ (in areas other than Miami Dade County) reserve the right to have this product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing and the AJ•iJ may immediately revoke, modify, or suspend the use of such product or material within their jurisdiction. BORA reserves thc right to revoke this acceptance, if it is determined by Miami -Dadc 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 thc Florida Building Code DESCRIPTION: Palema Double Roll and Hacienda Double Roll Roof Tile LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami -Dadc County Product Control Approved ", unless otherwise noted herein RENEWAL ot'this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or chants in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales. advertising or any other purposes shall automatically terminate this NOA_ Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami -Dadc County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. NOA No.: 02- 0916.11 Expiration Date: 12/16/07 Approval Date: 12/19/02 Page 1 of 6 . • 'Sent. By: HANSON ROOF TILE DEER'FIELD ; 954 426 2260; ROOFING ASSEMBLY APPROVAL Category: Sub Category: Material: Manufactured by Applicant Hanson Palcma Double Roll Tile Hanson "Hacienda" Trim Pieces Roofing Roofing Tile Concrete Dimensions Length: 161/2" Width: 13" %z" thick Length: 171/2" Width: 13" thick Length: varies Width: varies Varying thickness 1. _ _ SCOPE This renews a roofieig system using Ilanson `Palema Double Roll and Hacienda\Roof Tile, as manufactured Hanson Roof Tile d.b.a. Pioneer Concrete Tile described in Section 2 of this Notice of Acceptance. For the locations where the pressure requirements, do not .r exceed the values listed in section 4 herein. The attachment calculations shall be done as a moment based system. 2. PRODUCT DESCRIPTION Test Specifications - FAS 112 TAS 112 TAS 112 2.1 CO,`1PONENTS OR PRODUCTS MANUFACTURED BY OT!IERS 'file Nails Product 0 Wood Battens Dimensions 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" Test Specifications Wood Preservers Salt pressure treated Generic Institute LP — 2 or decay resistant (With current NOA) lumber battens TAS l 14 Appendix E Jun - 2 - 03 2:54PM; Page 2 Product Description Low profile, interlocking, extruded concrete roof tilt equipped with two nail holes. For direct deck or battened nail -on, mortar or adhesive set applications. Low profile. interlocking, extruded concrete roof tilt equipped with two nail hole and double roll ribs. For direct deck or battened nail -on, mortar or adhesive set applications. Accessory trim, concrete roof pieces for use at hips, rakes, ridges and valley terminations. Manufactured For each tile profile. Product Description Manufacturer Corrosion resistant screw or r.mooth Generic shank nails (With current NOA) NOA No.: 02- 0916.11 Expiration Datc: 12/16/07 Approval Datc: 12/19/02 Page 2 of 6 Table 1: Aerodynamic Multipliers - ). (ft Tile X (ft X (ft Profile Batten Application Direct Deck Application Hanson Palema Double Roll and 0.267 0.289 Hacienda Tile °Sent By: HANSON ROOF TILE DEERFIELD ; 954 426 2260; Product Tile Screws Hurricane Clip & Fasteners 3. LIMITATIONS Test Product Dimensions Specifications Description #8x 2 %s" long 0.335" head dia. 0.131" shank dia. 0. 175" screw thread dia. . Clips Min. 1/2" width Min. 0.060" thick Clip Fasteners Min. 8d x 1 '/4" 3.1 Fire classification is not part of this acceptance. 3.2 For mortar or adhesive set tile applications, a static field uplift test in accordance with RAS 106 may be required, refer to applicable building code. 3.3 Applicant shall retain thc services of a Miami -Dadc 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 thc applicable Roofing Applications Standards listed section 4.1 herein. 3.5 30/90 hot mopped undcrlaymcnt 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. 4. INSTALLATION 4.1 Hanson 'Palema Double Roil and Hacienda' Roof Tile and its components shall be installed in strict compliance with Roofing Application Standard RAS 118, 119, S;. 120. 4.2 Data For Attachment Calculations TAS 114 Appendix E TAS 114 Appendix E Jun -2 -03 2:54PM; Page 3/6 Manufacturer Corrosion resistant, coated, square drive, Generic galvanized, coarse (With current NOA) thread wood screws Corrosion resistant clips with corrosion Generic resistant nails. (With current NOA) NOA No.: 02- 0916.11 Expiration Date: 12/16/07 Approval Date: 12/19/02 Page 3 of 6 Table 3: Attachment Resistance Expressed as a Moment - Mt (ft -Ibf) For Nail -On Systems Tile Profile Fastener Type Direct Deck (Min 15/32" plywood) Direct Deck (Min. 19/32" plywood) Battens Hanson Palema Double Roll and Hacienda Tile • • D 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 22.9 2 #8 Screw 47.1 47.1 49.1 1 -10d Smooth or Screw Shank Nail . (Field Clip) 24.3 24.3 24.2 1 -10d Smooth or Screw Shank Nail Eave Cll. 19.0 19.0 22.1 2 -10d Smooth or Screw Shank Nails (Field Clip) 35.5 35.5 . 34.8 2 -10d Smooth or Screw Shank Nails (Eave Clip) 31.9 31.9 32.2 2 -10d Ring Shank Nails' 43.0 67.5 50.9 Installation with a 4" tile headlap and fasteners are located a min. of 2' /2" from head of tile. �-- Table 2: Restoring 3 ": 12" Moments 4 ": 12" due to Gravity 5 ": 12" - MqJft-lbf) Tile Profile 6 ": 12" 7": 12" or greater Hanson Palema Double Roll and Hacienda _ .. Tile Battens Direct Deck Battens Direct Deck Battens Direct Deck Battens Direct Deck Battens Direct Deck 5.92 ... - 6.80 5.82 6.69 5.70 6.55 5.56 6.39 5.41 6.22 I • 'Sent By: HANSON ROOF TILE DEERFIELD ; 954 426 2260; Jun - 2 - 03 2:54PM; Page 4/6 NOA No.: 02- 0916.11 Expiration Date: 12/16/07 Approval Date: 12/19/02 Page 4 of 6 Table 4: Attachment Resistance Expressed as a Moment M, (ft-Ibf) For Two Patty Adhesive Set Systems Tile Profile Tile Application Minimum Attachment Resistance Hanson Palema Double Roll and Hacienda Tile Adhesive 26.1' 2 See manufactures component approval for installation requirements. 3 flexible Products Company Tile$ond Average weight per patty 11.4 grams. Polytoam Product. Inc. Average weight per patty 8 grams. Table 4A: Attachment Resistance Expressed as a Moment - Mr (ft-Ibf) For Single Patty Adhesive Set Systems Tile - °Profile Tile Application _ Minimum Attachment Resistance Hanson Palema Double Roll and Hacienda Tile Polyfoam PolyPro 86.61 Polyfoam PolyPro 45.5 4 Large paddy placement of 54grams of PoiyPro 5 Medium .add .Iacement of 24 rams of Pol Pro TM. Table 4B: Attachment Resistance Expressed as a Moment - M (ft -Ibf) For Mortar Set Systems Tile Profile Tile Application Attachment Resistance Hanson Palema Double Roll and Hacienda Tile Mortar Set' 20.60 'Sent By: HANSON ROOF TILE DEERFIELD ; 954 426 2260; • 5. 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. LABELING All tiles shall bear the imprint or identifiable marking of the manufacturer's name or logo, or following statement: "Miami -Dade County Product Control Approval ". Jun -2 -03 2:54PM; Page 5/6 NOA No.: 02 -0916.11 Expiration Date: 12/16/07 Approval Date: 12/19/02 Page 5616 r - ' By: HANSON ROOF TILE DEERFIELD ; 4 HANSON PALEMA DOUBLE ROLL ROOF TILE FASTENER IIOLES UNOERLOCK UNDERLOCK 954 426 2260; PROFILE DRAWINGS END OF THIS ACCEPTANCE Jun -2 -03 2:55PM; Page 6/6 HANSON HACIENDA CONCRETE ROOF TILE OVERLOOK FASTENER HOLES OVERI.00K NOA Nu.: 02- 0916.11 Expiration Date: 12/16/07 Approval Date: 12/19/02 Page 6o(6 954 578 1042 ,12/1`0/02 TUE14:,57 FAX 954 578 1042 M APPROVED: 06/14/2001 t1s015 )0011 pe 20 0311con,places4wdee accepnnce cover pa=adoc Sr oi. ) In ternet mud address po"stmastc buildirtficodconiinc.com POLYFOAM PRODUCTS. INC. Q001 • PRODUCT CONTROL NOTICE OF ACCEPTANCE Pnlyfoam Products, Inc. 2400 Spring- Stucbncr Road Spring ,TX 77383 -1132 . 1 - hc expense of such testing will be incurred by the manufacturer. ACCEPTANCE, NO.: 01- 0521.02 EXPIRES: 05/10/2006 MIAMI -DADE COUNTY, FLORIDA METRO -DADE FLAGLER BUILDING BUILDING CODE COMPLIANCE OFFICE METRO -DADl3 FLAGLER BUtLDINC' 1•►o WEST FLAGLER STREET. SUITE 1603 MIAMI. FLORIDA 33130 -1563 (305) 375.2001 FAN (305) 375 -2008 ( :oN itAcrott 1.10ENSING SECriON • (3 1 (305) 375-255x CUN croft l:N VORCEMa;N- rDIV1SroN (305) 375 - 2066 VAX (305) 37 S -2908 PltouuCr CoN"rROi_ DIVISION Your application for Notice of Acceptance (NOA) o1': q wn Component Polyurethcne Foam Adhesive under Chapter 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 NOA shall not be valid after the expiration date stated below. BCCO reserves the right co secure this product or material at any time from 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 by BCCO that this product or material fails to meet the requirements of the South Florida Building Code. (305) 375 -2'102 CAN (305) 372.6130 Raul Rodriguez Chief Product Control Division TiiiS IS THE COVERSiTEET, SEE ADDITIONAL i'AGE.S FOR SP'ECIFiC AND.G[;NF.RAL CONDITIONS BUILDING CODE & PRODUCT REVIEW 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 Miami - Dade County, Florida under the conditions set forth above. Francisco J. Quintana. R.A. Director Miami -Dade County I3u.ilding Code Complian,:c Office A c: 71ttf.// www i ,,ihl, nnrn,lnn,tli.tw '.- n... "'Y '12/.10/02 TUE 14:57,FAX 954 578 1042 • I'ol.vfottm Products, Inc. ACCEPTANCE No. : 01- 0521.02 ROOFING ASSEMBLY APPROVAL Catceo!y: Roofing Sub- CatcDory: _ Roof Tile Adhesive Approval Date: June 1 3, 2001 Expiration Date: May 10, 2006 Matter—Ws: Polyurethane I. SCOPE This approves Polypro® AI•I160 as manufactured by Polyfoam Products, Inc. as described in Section 2 of this Notice of Acceptance. For the locations where 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 flat, low, and high profile roof tiles system using Polypro® AH 160. Where the attachment calculations are done as a moment based system for single patty placement, and as an uplift based system for double patty systems 2. PRODUCT DESCRIPTION Manufactured by Applicant Polypro® Al ProPack® 30 & 100 Dimensions N/A Foamttpro® RTF1000 N/A 2.2 Typical Physical Properties: Property Test Density ASTM D 1622 Compressive ASTM D 1621 ° Strength Tensile Strength ASTM 0 1623 Water Absorption ASTM D 2127 Moisture Vapor ASTM E 96 Transmission .Dimensional ASTM 0 2126 Stability I'OLYFOAM PRODUCTS, INC. 0002 • • • • Test Specifications PA 101 Results N/A Dispensing Equipment 2.1 Components or products manufactured by others: Any Miatni - Dade County Product Control AcceptedRoof Tile A having a current NOA which list uplift resistance values with the use of Potypro Alt 160 roof tilt adhesive. 1.6 lbsift. • 18 PSI Parallel to. rise 12 PSI Perpendicular to rise 28 PSI Parallel to rise 0.08 Lbs./Ft 3.1 Perm / Inch -H0.07% .. Volume Change a -40 F.. 2 weeks +6.0% Volume Chan *c ti Humidity, 2 weeks Product Description Two component polyurethane Dispensing Equipment 1.2./1'0/02 TUE 14:58. FAX 954 578 1042 ,9r g 1., POLYFOAM PRODUCTS, INC. Polyfoam Products, inc. ACCEPTANCE No. : 01 -0 521 02 Note: Thc physical properties listed above are presented as typical average values as determined by accepted ASTM test methods and arc 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 tirc rating. 3.2 Polypro® AI -1160 shall solely be used with flat, low, & high tile profiles. 3.3. .Minimum underlayments shall be in compliance with the Roofing Application Standard RAS 120. 3.4 Roof Tile manufactures acquiring acceptance for the use of Polypro® AI-( 160 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® AH160 roof tile adhesive with their tile assemblies shall test in accordance with PA 101 and with section 10.4 as modified herein. F'= 2 MS 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® AH 160. 4.2 Polypro® AH 160 shall be applied in compliance with the Component Application section and the corresponding Placement Details noted herein. The roof tile assembly's adhesive attachment with the use of Polypro® AI-1160 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. Thc adhesive attachment data is notcd 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® AH 160 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 "B" component shall be maintained between 1.0-1.15 (A) : 1.0 (B). The dispense timer shall be sct to deliver 0.0175 to 0.15 pounds per tile as determined at calibration. No,other settings shall be approved. 4.6 Polypro® Ali 160 shall be applied with Foal dispensing equipment only. 4.7 Polypro® AH 1 60 shall not be exposed permanently to sunli � !7 • a Q003 Frank Zuloaba, RRC, roduct Gntrol Ecaituncr f.: 12/10/02 TUE 14:58' FAX 954 578 1042 Polyfoam Products, Inc. POLYFOAM PRODUCTS, INC. ACCEPTANCE No.: 01- 0521.02 4.8 Tiles must be adhered in freshly applied adhesive. Tile must be sct within 2 to 3 minutes after Polypro® AI -1160 has been dispensed. 4.9 Polypro® Al -IIG0 placement and minimum patty weight shall be in accordance with the'Placcment:Details' herein. Each generic tile profile requires the specific placement noted herein. 7 1-a•ble 1: Adhesive Placement For Each Generic Tile Profile TileProfile Flat, Low, High Profiles High Profile (2 Piece Barrel) Fbt; Low, High Profiles Flat, Low, High Profiles Placement Detail 111 111 I2 il3 Single Paddy Weight Min. (grams) 35 17 /side on cap and 34 /pan Two Paddy Weight per paddy Min. (grams N/A 24 8 N/A N/A 5. LABELING All Polypro® AH 1 60 containers shall comply with the Standard Conditions listed herein. 6. BUILDING 1 ERIN/11T REQUIREMENTS 6.1 As required by the Building Official or applicable Building Code in order to properly evaluate the installation of this system. • fJ 004 '12/10/02 TUE 14:58• FAX 954 578 1042 POLYFOAM PRODUCTS.INC. Polyfoam Products, Inc. Nail through plastic cement Paddy (Beneath 71fe1 Fascia are court. only: Kocp adhoslra 'pprm r. 4 It up Irom w..phol.s N.II Vuovgh platlk com.nt U n d t ray atoll Lars Count 10 In. Ease coons only: Caep coin+FYt sppres 1 in.; 1-om wlcpnotes ADHESIVE PLACEMENT DETAIL 1 SINGLE PATTY Paddy (BeaswU 11b( Earn Ctowro ACCEPTANCE No. : 0 1 - 0521.02 fiat COW 34 Ears count only: Koop adhal he boob r. l In. up lion wsaphol.s Paddy (Beneath Ilk) Food/ Waophok Eavd closom Orly tdgs 1; ?taco enough adhcsivc 10 cochlea. 17 to 77 Optional 3a4 $ ( a mire Inches to conuci with the pan the strap Dad appduuons N.4 through plastic cement than Install ihs to 1 In. From 2) 1001 COvilf1 001,104 10.01. Place adhesiv 1/..0. <edgeolco.wtas. Undertayment R.mw top pertlon d 4.t save cant cower 11 e, Abut to Ncond coup. of pan 81as. Entail save epic! Dan and corer dks m Awn at fare M.. Eay. doom (nomar snood Weephota Faoci. Bo Frank RRC Product Control 'E.ainer • ._.... .._..,a rt e.._ O ;dcnal Posawp Mortar 1 torgliudhul alga Dili. Sheathing E1005 • :12a0/02 TUE 14:59 .FAX 954 578 1042 Polyfoam Products, Inc. ndertayment five Count POLYFOAM PRODUCTS. INC. ADIiESIVE PLACEMENT DETAIL 2 SINGLE PATTY Nail through plastic cement Paddy (Beneath Tile) Faada ACCEPTANCE No.: 01- 0521.02 Nall through plastic Cement Eve Count Paddy (Beneath TIN) Fascia Weephoie Eave cloture Drip edge Nail through plaalic Cement 7 In Paddy (Beneath lilt) Fascia Eare Cbaun 0 006 , 12/10/02 TUE 14:59, FAX a54 578 1042 • . • Polyfoant Products, inc. Nall through plastic cement - 3m. i3 (rt. Single paddy on under- layment Single paddy on top of tile Single paddy undor tile Paddy (between 1114 _ . Paddy (under tile) Eive course in. X 7 in. medium sin paddy lave Fascia course only 0 ADHESIVE. PLACEMENT DETAIL 3 DOUBLE PATTY Nail through plastic cement Underlayment Nall through plastic ccmcnt t e r lin.1 3 In. Single paddy on undedayment Single paddy on top of the Eave Course POLYFOAM PRODUCTS. INC. ACCEPTANCE No. : 01-0521.02 Single paddy between tile Eave Closure 2 In. r 7 in. modium site paddy eve course only Fascia Q007 Single paddy under the Single paddy between tile 2 in. a 71n. medium she paddy eave course only Fascia Weephole Eave closure Drip edge '12/10/02 TUE 14:59, FAX 054 578 1042 ir POLYFOAM PRODUCTS. INC. • Polvfoant Products, Inc. ACCEPTANCE No. : 01- 0521.02 1 Renewal of this Acccptancc (approval) shall be considered allcr and the original submitted documents, including test - supporting older than eight (8) years. Any and all approved products shall be pcmtanently labeled state, and the following statement: "Miami -Dade County specifically stated in the specific conditions of this Acceptance. END OF THIS ACCEPTANCE a renewal application has been filed data, engineering documents, are no with the manuf'acturer's name, city, Product Control Approval ", or as 3 Itcne -als of Acccptancc will not be considered if; a. There has been a change in the South Florida Building Code affecting the evaluation of this product and thc product is not in compliance with the code changes. b. The product is no longer the sank 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 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 %vritte:n approval has been requested (through the filing of a revision application with appropriate fee) and granted by this office. S. 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 Acccptancc as well as approved drawings and other documents, tvhcrc,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 thc copies. 8. Failure to comply with any section of this Acccptancc shall be cause for termination and removal of Acceptance. 9. ° This Notice of Acccptancc consists of pages 1 through 8. e008 P rank luloaga, ,RR 1 PeF `Product .C:orittol =E. it �•t Miami Shores Village 10050 NE 2nd Avenue Phone: 305- 795 -2204 Permit Number: BP2004 -226 Printed: 2/19/2004 Applicant: CARMEN PALAU Owner: PALAU CARMEN JOB ADDRESS: 500 NE 92 ST Contractor MIS CORPORATION Local Phone: 305 - 553 - 9476 Parcel # 1132060141200 Signed: (INSPECTOR) Building Permit Contractor's Address: 2428 N. W. 28 St. Permit Status: APPROVED Permit Expiration: 8/16/2004 Construction Value: $8,500.00 Work: RE -ROOF HACIENDA COLOR THRU Page 1 of 1 Legal Description: MIAMI SHORES SEC 2 PB 10 -37 LOT 6 BLK 58 LOT SIZE 50.000 X 127 Fees: Description Amount FEE2004 -1811 Building Fee $300.00 FEE2004 -1812 CCF $5.40 FEE2004 -1813 Training and Education Fee $1.80 FEE2004 -1814 Technology Fee $7.50 FEE2004 -1815 Scanning Fee $12.00 Total Fees: $326.70 Total Fees42,78 Total Receipts: $0.00 zi In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street/address: 5:00 /IJE 9:e ,5-1 2. Description of improvement: pio c e roo 3. Owner(s) name and address: 0, ' - v I-1 13 se v 600 C' 92'5/ 6 ore S l Interest in property: Name and address of fee simple titleholder. 4. Contractor's name and address: 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: Amount of bond $ 6. Lender's name and address: 7. Persons within the state of Florida design 'b I • provided by Section 713.13(1)(a)7., Florida S aZtutes, Name and address: Signature of �r ner Notary Public Print Notary's My commis 123.01 -52 PAGE 4 8/02 n expires: /1J Co pe . -oe2/ .�'� 4_5/ / -44„. ; 3/ 65 . t. U. l L01.1:dTY Oc HPRt R Dry that Mrs , s 74 'pt the 1 1 ffrce en nm ona! fr PAL 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1){b), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a differe • sate is pe '7 JJit�1 me this e day of Print Owner's Name Q.' A C t/ e t & z Prepared by 14 ' Sworn to and subscribed f - , 20 0 7 Address: ,i O ? 1 s (4) f 6, t AP Ae ',4 N " RY P UP; 7inger:: 0c1232-6 r 4 1111111111111111111111 111 I 1 111111111111111111 CFN 2004R01103"--26 OR £ k 22049 Ps 299 (I p s i RECORDED 02/18/2004 14:20:03 i?, HARVEY RIUVIN? CLERK OF COURT 11IAMI -DACE COUNTY, FLORIDA LAST PAGE rnotheedoctfn'fents may be served as c. 41i 331b5 BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby usndc for the npproyal of the detailed statc„u•nr u► inc plans and specifications herewith submitted for the build ine 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 of not. A copy of approved plans and specifications must be kept at building during progress of the work. p /� I V I 19.. Owner's Name and Address Chairman Member Member .. .. Registered Architect and /or Engineer . .. Name and address of licensed contractor Location an legal description of lot to be bui Lot Block Street and Number where work is to be done State work to be done and purpose of building (by floors) MIAMI SHORES VILLAGE a\axA. ..c0o \ � �. S Building Inspector 16. ma"( ki ` 1 ubdivision& Date PLANNING BOARD DATE ' .._._ No. ...__...._......_... Street._._.. __... » ... .and for no other purpose. Addition Repairs No.,of_S odes Roof Covering 1 � t� Q k00 New Building Remodeling To be constructed of hind of foundation Estimated Total cost of improvements S C O?, 00 Amount of Permit S. Zone cubage required .Plan Cubage Distance .to next nearest building•. Size of Building Lot Maximum live load to be borne by each floor I hereby sub it al( j}te plans and s ccifications for said building. All notices with reference to the building and its construction may be sent to.. `�,° The undersigned applicant for this building permit dots hereby certify that he understands and accepts his obligations as an employer of arbor under the Florida Workmen Compensation Act, living Section 5966, Compiled General Laws of Florida. Permanent Sopl►h•went, and has complied will, the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hint in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this pcnnit, as are. licensed by Miami Shores Village. Remarks. .._ (Signed) -C) ` _ Rc' o STATE OF FLORIDA, 1 COUNTY OF DADE. t is• 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 state are true.. ,� Permit No. .__ state Date.. ii !!..(\ C Aead worn to and ubrct(bed before me ���� nn 1 Disapproved Date.._.. y t9� � L . - 1 -e,- -) Public, S (Signed) My Commiuion Expires.. -Stn Ee A ug. 2 !! My Comm. Exp. Aug. 24,1991 Me mber NOM MA Member Member _ - Council Approved Date Disapproved Date NOTE: A charge of 31.00 will be made for making corrections or changes to this application after approval has been obtained from the 1'L Hoard. A re••in.ltec•tiou fee of 31.00 will be charged when such re - inspection is made necessary. by Improper notice for inspection of faulty materials anu /or workmanship. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. 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 $ Zone cubage required plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. J.;> Remarks (Signed) Permit No Date v Disapproved _ Date (Signed) STATE OF FLORIDA, COUNTY OF DADE. ss. r Before me, the undersigned authority, a notary public, duly authorized t 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. Read, Sworn to and Subscribed before me. Notary Public, State of Florida Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approy 4 Date Disapproved Date NOT F. A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Plan ing Board. are- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty ma rials and /or workmanship. F/ Type Insp'n A. AMIE Date 6 -Po Address5Oo rn : ( . kg Company fYYT-/ Permit No Name Phone # Inspection Date Approved Correction Re -Insp' n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT /),)(0 305- 795 -2204 Building Inspection Request / 0 f ! - -�ti -'t If fi t ✓rr MIAMI SHORES VILLAGE BUILDING DEPARTMENT .; 7`) , 305-795-2204 Building Inspection Request / .1 , i Date (. t i ; / 1 -) 'I i' l ..„ I .., 0 1' ; . 1 / Type Ins ' . /,., ( r- _, .-i *.,;--ti-J4-4 :(-!--,--- : P ,- /n Permit No..) i r ),-; - - --") -' \ ‘-' \ ''' , Name „ (Th Address_- 7 Company Phone # Inspection Date / ) ' , Approved Correction Re-Insp'n Fee 7./ "6.