ROOFINGPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date I Job Address ph NC - 6 t Tax Folio 1 1 l 390(p — 0 1 3 — c / p,0
Legal Descri • i on Historically Designated: Yes No
/Lessee / Tenant &eI1i p 5
r
Owner's Address /05 lye 45 3E
Contracting Co.
Qualifier
State #
obettouf Dor,
Db vow'
C OJ 430‘ Municipal # Competency # 614 Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING
� ELECTRICAL PLUMBING MECHAN AL IK PAVING FENCE SIGN
WORK DESCRIPTION C(sG
� 1 f N IP ,'r Allip Q f t/ � (41561
#n o�v �r U eol it td keel Adi6te. C&or au?
Square Ft. 2 (a S! Estimated Cost (value) /3 O00 -
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER
OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work
will be perfonned to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the worin ted.
c9/ retk
Date
Ce
Signature of owner and/or Con
FEES: PERMIT
% a1 c
Notary as to Owner apkd/or President`:' D, HA Dbt
My Comnussion Expires: ;' :. : CC62. / -33
d c .T. '0.r:011011
0UGI1
_..v_ ... :Y:JIi�
APPROVED:
Zoning
Mechanical
RADON
Building
1J .... 4315 6 ' bF! LP,
C.C.F. 2/ V NOTARY 0° BOND 3 e D
Att 147 inio
Master Permit #
Phone
Address L 30 / M)F 6 wz A - ICY
h') ,a,ryti ore s
SS# Phone 75^ 7 Z L '2
ture of Contractor or Owner - Builder
Notary as to'Contractor er. Ownerr -) uilder
My Coiniuission'Expires: S,a.: r` CCG
.. i::i...:F M ".R 12, 2001 • ccsca) •YttrouCJ
Electrical
TOTAL DUE
6
.ahj
D to
D
So
Plumbing Structural Engineer
NVIILL OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOLIO NO. 1 / _ 390 ( o - 0/3 - L V.
STATE OF FLORIDA:
COUNTY OF DADE •
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property. and in accordance wilt
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement
1. Legal description of property and street address:
2. Description of improvement:
Interest in property:
Name and address of fee simple titleholder.
4 Contractor's name and address:
5. Surery:(Payment bond required by owner from contractor, if any)
Name and address:
Amount of bond $
6. Lenders name and address
Notary Public
Print Notary's Name
My Commission Expires:
do_ GiLd
c 4— i N s -Lcu 4 rCOC sys -tepl
3 Owner(s) name and address: Ceel L , 2 CSpaig,lD
105 N E q s-+L S ✓ .� ml4�vru rhor , FL.
Ceti ks pa
Obovouz Roof'
9 30 NE Oh apt 564:21 A -sot
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provideC
by Section 713.13(1)(a)7.. Florida Statutes.
Name and address:
8 In addition to himself, Owner designates the following pe son(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 his Notice of Commencement: (the kxpiration date is 1 year from the date of recording unless a
different date is specified)
S.gnature or owner
Print Owners Name
Sworn to and subscribed before me this q day of Pb p , 1tQ 2-CM
HAM'
CC623733
5/ N D ria ,' rr il, :,;; C O.
W TNESS
By
105 NE g5 3-6
N1 f Jru Shores , FL
NN OF OADE
F FLORIDA ovy of tho
I HEttE 0 ORIDA, COUNT t this is o Oro h oy of
1 MEBE91f CERTIFY that
on CJv
or i _ {clod in this ; ' A p
om / G � ■� o is .I Sec 14 .
u
mt a..k4 Shores, C2
Prepared by --eificti Art-
Address y(004 �QG�ISOfI� '
rb ll y L 33o2..j
APPENDIX "F "REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS
As it pertains to this Appendix "F ", it is the responsibility of the roofing contractor to provide the owner
with the required roofing permit, to provide the owner with this appendix and to explain to the owner the
content of this form. The provisions of Chapter 34 of the South Florida Building Code (SFBC) govern
the minimum requirements and standards of the industry for roofing system installations. Additionally,
the following items should be addressed as part of the agreement between the owner and the contractor.
The owner's initial in the adjacent box indicates that the item has been explained.
OD 1. Aesthetics - Workmanship: The workmanship provisions of Chapter 34 are for the purpose of
providing that the roofing system meets the wind resistance and water intrusion performance standards.
Aesthetics (appearance) issues are not a consideration with respect to workmanship provisions. Aesthetic
issues such as color or architectural appearance, that are not part of a zoning code, should be addressed as
part of the agreement between the owner and the contractor.
el) 2. Renailing Wood Decks: When replacing roofing, the existing wood roof deck may have to be
renailed in accordance with the current provisions of Chapter 29 of the SFBC. (The roof deck is usually
nfealed prior to removing the existing roof system)
3. Common Roofs: Common roofs are those which have no visible delineation between
neighboring units (i.e. townhouses, condominiums, etc.). In buildings with common roofs, the roofing
contractor and/or owner should notify the occupants of adjacent units of roofing work to be performed
0 -4.Q— 4. Exposed ceilings: Exposed, open beam ceilings are where the underside of the roof decking
can be viewed from below. The owner may wish to maintain the architectural appearance, therefore,
roofing nail penetrations of the underside of the decking may not be acceptable. The SFBC provides the
option of maintaining this appearance.
��— 5. Ponding Water: The current roof system and/or deck of the building may not drain well and
may cause water to pond (accumulate) in low - lying areas of the roof. Ponding can be an indication of
structural distress and may require the review of a professional structural engineer. Ponding may shorten
the life expectancy and performance of the new roofing system. Ponding conditions may not be evident
until the original roofing system is removed. Ponding conditions should be corrected.
a � 6. Overflow Scuppers (wall outlets): It is required that rainwater flow off so that the roof is not
overloaded from a build up of water. Perimeter /edge walls or other roof extensions may block this
discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow
scu
pers s in accordance with Chapter 23 of the SFBC.
' 7. Ventilation: Most roof structures should have some ability to vent natural airflow through the
interior of the structural assembly (the building itself). The existing amount of attic ventilation shall not
be reduced. •It may be beneficial to consider additional venting which can result in extending the service
life of the ioof.
c
Owner's/Agent's Signal
Signature
5104 APPENDIX "F"
o Ott
Dat
�
ntractor's
Signature
Contractor's Name:
123.01.78 9196
Appendix "E"
UNIFORM ROOFING PERMIT APPLICATION
PROCESS No.
0bedvo,ur "r�
J
Ft.
v
Ft.
A
V
ATTACHMENT
Fastener Type:
SPACING
Deck type: v,1 1 pIAN
Field:
Perimeter: Corner:
DETAIL 1 & 2
Job Address:
IDS N E ?
ROOF CATEGORY
0 (Low Slope Application) ❑ (Nail -On Tile) !(Mortar- Adhesive Set Tile)
❑ (Asphalt/Fiberglass Shingles) ❑ ( Metal Roofs\Wood Shingles & Shakes) ❑ (Other)
r ROOF TYPE
❑ New Roof L2 Re- roofing ❑ Recovering ❑ Repair ❑ Maintenance
Flat Roof Area (ft') Sloped Roof Area (ft') 0 Total (ft) ,7C) 0 Master Permit No.
Exposure category (per ASCE 7 -88): C. Building Classification category (per ASCE 7 -88 table 1):
ROOF HEIGHT AND SYSTEM DETAILS
(Draw details as needed)
Page -1
ROOF PLAN
Rid V - Iatlont
MEAN HEIGHT
Appenolz •...•
UNIFORM ROOFING PERMIT APPLICATION
PROCESS No.
Deck type:I Wood p 1 1410_
Underlaynlent:
12"
ROOF SLOT&
D E T A I L 3
SLOPED SYSTEM DESCRIPTION
it" wo rm le. 1)—
Insulation:f A
Fastener type 8 spadng:
TILE CALCULATIONS
(Pmax1: 1 4 . /x ? (Aerodynamic Multiplier): �/ 4 ) . M 6.3 `= Mn: 4.01 PCA: 86. /
G x X (Aerodynami: Multiplier): • _' ) - M G • 3 G = M, o{ ? PCA: d 6• d
(Pmax3
�_ X X (Aerodynamic Multiplier): • ) - M G = Mr3: a/ 61 PCA: o
1 14ylog shiwk � sly ���5 o/ i s /mss
4vi /C
Cap Sheet: 9 10 R5TM .1 4 q �q
Roof Covering: t-frgit( q.Jct UL4, r got( e l r d is �krvl D A t � e, Se Drip edge:[ .2-(d (3A I1/
Page -2
ATTACHMENTS REQUIRED
1) Fire Directory Listing Page
2) Dade County Product Control
Notice of Acceptance-Cover Sheet
a) Specific System Description
b) Specific System Limitation
c) General Limitations
d) Applicable Detail Drawings
3) Municipal Permit Application
4) Other Component Approvals
METROPOLITAN - DpDEEFLAGtER BUILDING
COMPL
BUILDING IANCE OFFICt
T RO OAOE FLAGL CODE R BUILDING
MET
140 WEST FLAGLER STREET. SuI'E 160'
MIAMI. FLORIDA 33130 156
(305) 375 290•
CCEPTANCE FAx (305) 375 29ca
PRODUCT CONTROL NOTICE OF
ti1onier Lifetile LLC
135 4W 20 St.
Boca Raton, Florida 33431
Your application for Product Approval of:
Monier Lifetile LLC Villa, Capri, & Roll Tiles
the Miami -Dade County Code governing the use of Alternate Materials and Types
,rider Chapter 8 of ne described in the plans, specifications and calculations sub caned by
of Construction, end completely ter lied EagineeriogJoc., and Professional Redlaud Technologies, The Center for App Hance Office to be u in Dade
Industries
4 and the standard used se dlt� D conns on
has been recommended for acceptance by the Building Code Compliance
County, Florida under the specific conditions set forth on pages _- I
caoc 15 Compliance
expiration date stated below. The Building
C ode Co m p lianc
Office approval shall not be valid after the product time from a 1
In the approved manner, the
Offlee reserves the right to secure this product or material at any product or mater�a�
revoke, modify, or suspend the use of such p t if it plant for quality control testing. if this or material falls to perform revoke this approval,
.minding Code Compliance Office y
. , nr ,. te diatcly. The Building Code Co"'Pltliance00fficeetha< this tproduct or material fails to meet the
�eter tTtined by the Building Code Comp
-:quirements of the South Florida Building Code.
Tne expense of such testing will be incurred by the manufacturer
Revises: 95-0322.07
1
124.
ACCEPTANCE NO.: 97- 1 _ 24.6 95 -0 2�3
E?�1RES: 06 R�i01 95- 0316_04
APPROVED: 06/25/98
PRODUCT CONTROL DIv,S1O^
(305) 275 29 :2
FAY. (205) 372•633
aul Rodriguez
Product Control Supervlscr
ET SEE ADDITIONAL PAGES FOR SPECIFIC AND GF,NERAL
THIS IS THE COVERS CON - DMONS
BUILDING CODE COhII`'1— IITPEE
lication for Product Approval has been reviewed by
the Miami -Dade County Building �od3
This app Ice and approved by the Building Code Committee to be used in Dade-Coun
Compliance Off /--)
rider the conditions set forth above. 7 1/7–
Charles anger, P E
Director
Building Code Compliance Pep:
Miami•Dade County
Product
Rainproof 11
Ice and Water
Shield
• MOYIER LWETTLE LLC
Page 2 of I S
Product Control No.: 97- 1124.16
TRADE NAMES OF PRODUCTS IVIANUFACTU ED OR
LABELED BY APPLICANT
Test Product
Product Dimensions Specifications
Descri lion
I = 16'/," PA 112 Low profile, interlocking, high
L lonier lLif R pressure extruded concrete roof tile „
LLC Villa R[ Rnll V - 13 ” thick equipped with one nail hole and
double roll ribs. For direct deck or
battened nail -on, mortar or
adhesive set applications.
PA 112 Low profile, interlocking, high
Monier ri T ile W= 12 ile L ° 17" pressure extruded concrete roof file
LLC Capri T equipped with one nail hole an6,
�' tthick k double roll ribs. For direct deck or
battened nail -on, mortar or
adhesive set applications.
Trim Pieces 1= varies
PA 112 Accessory trim, concrete roof
pieces for use at hips, rakes, ridges
w = varies and valley terminations.
varying Manufactured for each tile profile.
thickness
TRADE NAMES OF PRODUCTS MANUFACTURED OR
LABELED BY A_PPL1CANT
Test Product
Dimensions Specifications Descri tion Manufacturer
30 "x75'roll
PA 104 Single ply, nail -on Protect-0 Wrap
36" x 75' roll underlayment with Inc.
or 2" self- adhering top (with current NOA)
60" x 75' roll edge.
Self- adhering W.K. Grace Co.
36" x 75' roll PA 103
undcrlaym ent (with current NOA)
Frank Zuloaga, RRC
Product
\Vood Barrens
Til Nails
Tile Scream's
Roof Tile
Adhesive
( "Polypro®
AH 160 ")
MOn'tER LIFETILE LLC
Roof Tile Mortar
("TileTite ")
Roof Tile Mortar
("Quikretee Roof
Tile Mortar
,:1140 ")
Roof Tile Mortar
("BONSAL®
Roof Tile Mortar
Mix")
Hurricane Clip &
Fasteners
MED I TEF.'F'HH•IEArd ROi IF i_C - - - - -
Dimensions
Vertical
Min. 1;'x 4"
Horizontal
Min. 1 "x 4" for use
with vertical battens
or
Min. l "x 2" for use
alone
Min. 8d x 2 'A" or
min. 10dx 3"
#8x 2 'A" Tong
0.335" head dia.
0.131" shank dia.
0.175" screw thread
dia.
N/A
NIA
N/A
N/A
Clips
Min. 'A" width
Min. 0.060" thick
Clip Fasteners
Min. 8d x 1 'A"
.Test
Slcations
Wood Preservers
Institute LP -- 2
PA 114 Appendix E Corrosion resistan
screw or smooth
shank nails
Corrosion resistant,
coated, square
drive, galvanized,
coarse thread wood
screws
PA 114 Appendix E
PA 123 Prepared mortar
mix designed for
mortar set roof tile
a pplications.
PA 123 Prepared mortar
mix designed for
mortar set roof tile
applications.
PA 123 Prepared mortar
mix designed for
mortar set roof tile
applications.
Two component
polyurethan
adhesive designed
for adhesive set
roof tile
applications.
PA 1 14 Appendix E Corrosion resistant
clips with corrosion
resistant nails.
See PCA
Page 3 of 15
Product Control No.: 97 1 1 .
Product
'Des_ ription
Salt pressure
treated or decay
resistant lumber
vattens
1Vlanufa�er
generic
generic
generic
Bermuda Roof
Company. Inc. with
current PCA
Qu ikrete
Construction
Products with
Current PCA
W R. Bonsai Co.
with current PCA
Polyfoam Products,
• Inc.
PCA x94.0401.01
Generic
'MONIERLLFETtLE LLC
Test Agency
Redlarri Technologies
Redlaad Technologies
The Center for Applied
Engineering, Inc.
The Center for Applied
Engineering, Inc.
The Center for Applied
Engineering, Inc.
The Center for Applied
Engineering, Inc.
The Center for Applied
Engineering, Inc.
The Center for Applied
Engineering, Inc.
The Center for Applied
Engineering, Inc.
EVIDENCE SUBMITTED
Test Identifier
7161 -03
Appendix 111
7161 -03
Appendix III
94 -084
94 -060B
25- 7094 -1
25- 7094.7
25- 7094 -
25- 7183 -1
25-7183-2
Page 4of15
Product Control No.: 97 1124.16
Test Name/Report
Static Uplift Testing
PA 102
Static Uplift Testing
PA 102(A)
Static Uplift Testing
PA101
(Mortar Set)
Static Uplift Testing
PA 101
(Adhesive Set)
Static Uplift Testing
PA 102
(4" Headlap, Nails, Direct
Deck, New Construction)
Static Uplift Testing
PA 102
(4" Headlap, Nails,
Battens)
Static Uplift Testing
PA 102
(4" Headlap, Nails, Direct
Deck, Recover/Reroof)
Static Uplift Testing
PA 102
(2 Quik -Drive Screws,
Direct Deck)
Static Uplift Testing
PA 102
(2 Quik -Drive Screws,
Battens)
Date
Dec. 1991
Dec. 1991
May 1994
March, 1994
Oct. 1994
Oct. 1994
Oct. 1994
Feb. 1995
Feb. 1995
MONTER LLFET1LE LLC
Test Agency
The Center for Applied
Engieeering, Inc.
The Center for Applied
Engineering, Inc.
Redland Technologies
Redland Technologies
Redland Technologies
Redland Technologies
The Center for Applied
Engineering, Inc.
Professional Service
Industries, Inc.
Test Identifier
25- 7214 -2
25- 7214 -6
7161 -0J
Appendix II
Letter Dated Aug. 1,
1994
P0631 -01
PO402
Project No. 307025
Test #MDC -76
224 -47099
Page 5 of 15
Product Control No.: 97-1124 16
Test Name/Rertort
Static Uplift Testing
PA 102
(1 Quik -Drive Screw,
Direct Deck)
Static Uplift Testing
PA 102
(1 Quik -Drive Screw,
Battens)
Wind Tunnel Testing
PA 108
(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 Rain
PA 100
,Physical Properties
PA 112
Date
March, 1995
March, 1995
Dec. 1991
Aug a 1994
July 1994
Sept. 1993
Oct. 199
Sept. 1994
7)
MONIER LIFETI:LE LLC
Underlayment:
Roofing Tile:
Com meots:
SYSTEMS
(CONTINUED)
Page 9 of 15
Product Control No.: 97-1124.16
Deck Type: Wood, Non - insulated
Deck Description: New construction 19 /32" or greater plywood or wood plank.
SYSTEM D: Mortar or Adhesive Set Application
Slope Range: 2 ":12" to 7 ":12"
Note: System D is only acceptable is this slope range. For slopes in excess
of 7 ":12 ", refer to System C.
Install underlayment system in compliance with Dade County Application
Standard PA 120. (See System Limitation #5.)
Install file in compliance with Dade County App lication Standard PA 120 royal.)
(See "Data for Attachment Calculations" included in this App
1. For re -roof applications, 15 /32" plywood is an acceptable substrate.
.Moivrot LLFET1LE LLC Product Control No.: 97- 1124.16
•
j Monier Lifetile LLC Villa
Roll Tile. and Capri Tile
!Monier
i Lifetile LLC
Vila Tile,
!Roll Tile,
! and Capri
Tile
Tile
Profile
Table 1: Aerodynamic Multipliers - X (ft')
X(ft) X(f-t')
Batten Application Direct Deck Application
0.29
Tile,
DATA FOR ATTACHMENT
CALCULATIONS
•
0.27
Table 2: Restoring Moments due to Gravity - M (ft-Ibf)
6 " :12"
5 ":12"
Batten Direct
s Deck
3 ":12"
Batten Direct
s Deck
5.57
6.30
4 ":12"
Batten Direct
s Deck
5,48
6.18
5.37
6.05
Batten Direct
s Deck
5.24
5.90
7 ":12' or
greater
Batten Direct
s Deck
5.09
N/A
Tile
Profile
Table 3: Attachment Resistance Expressed as a Moment - M, (ft •lbf)
for Nail -On Systems
Tile
Profile
Monier •
Lifetile LLC
Villa, Roll,
and Capri
Tile
Application
Battens
Direct Deck
Approved
Nails
1 nail
4.10
11.80
2 nails
7.10
21.90
Approved
Screws
1
screw
22.90
25.80
2
screws
49.10
47.10
Approved
Field Clip
With:
1 nail
24.20
24.30
2 nails
34.80
35.50
Approved
Eave Clip
With:
1 nail
22.10
19.00
2 nails
32.20
31.90
Data noted in Table 3 is for instal ation with a 3" tile headlap.
2 Approved screws are as noted in the 'Trade Names of Products Manufactured By Others
and 'Profile Drawings' sections of this Approval. Clips on eave tile are not required for this
attachment configuration unless the Required Moment of Resistance exceeds the values
noted above.
Page I 1 of 15
•
P..A, psrrr t r. TRFTR.F. LLC
MO NTIER LfETILE LLC
Tile
Profile
Monier Lifetile
LLC Villa Tile,
Roll Tile, and
Capri Tile
DATA FOR ATTACHMENT
CALCULATIONS (CONTINUED)
Application
Direct Deck -
New Construction
(min. 'a/3:" plywood)
Product Control No.: 97- 1124.16
Product Conrrol No.: 97 -1 124.16
Table 3 -A: Attachment Resistance Expressed as a Moment - M, (ft-lbf)
for Nail -On Systems
Tile Two (2) 10d x 3" long nails
67.50
43.00
Direct Deck
Recover /Reroof
(min. ' /„" plywood) 50.90
Battens
New Construction
I Tile installation with a 4" headlap using two (2) Approved 10d x 3" long
polymer coated, corrosion resistant, ring shank nails installed in
manufactured holes located 2W from the head of the tile. Clips on eave
the are not required for this attachment configuration n o above.
the Required
Moment of Resistance exceeds the values
Table 4: Attachment Resistance Expressed as a Moment - M, (ft
for Mortar or Adhesive Set Systems Attachment
Tile Tile Resistance
Profile Application 20.60
Monier Lifetile LLC Villa Tile,
Mortar Set
Roll Tile, and Capri Tile 86.61
Adhesive Set
•„
MOOR LLFETtLE LLC
PROFILE DRAWINGS
MONIER LIFETLLE LLC VILLA TILE
MONIER LIFETILE LLC ROLL TILE
Page 13 of 15
Product Control No.: 97 1 124_16
yi
- • M.01\1 ER LtFETELE LLC Product Control No.: 97- 1124.16
i
SYSTEM LIMITATIONS
The standard minimum roof pitch for Monier Lifetile LLC Villa, Monier Lifetile LLC Capri &
Monier Lifetile LLC Roll, low profile tile shall comply with Dade County Application Standards
PA 118, PA 119 or PA 120, depending on the method of installation.
For uail-oo applications, fasteners for mechanical attachment of tiles shall have a head diameter
larger than that of the preformed holes in the tile.
;. System installation shall be in compliance with the system specifications outlined in this Product
Control Approval. The method of attachment utilized shall provide sufficient attachment resistance
to meet or exceed the required resistance determined in compliance with Dade County Protocol PA
I, or PA 127. Tile profiles listed here in have been tested'for both wind characteristics and stage
uplift performance, therefore, attachment calculations for installation in compliance with PA 115 or
PA 127 shall be done as a 'Moment Based System'.
For adhesive set tile applications, a field static uplift test by a Dade County accredited testing
agency, in compliance with Dade County Protocol PA 106, shall be performed.
For tile applications, 30/90 hot mopped and applications may be
material manufacturer's s publishedlar
to the roof pitch unless stated otherwise by e underlyme
literature.
6 All tiles shall bear the imprint or identifiable marking of the manufacturer's name or logo for
identification in the field.
Applications for roofing permits shall include a completed Section 11 of the Uniform Building
Permit, a copy of manufacturer's current specifications and details, a copy of this Product Control
Approval and a copy of the Product Control Approval of any Roofing Component used in the
proposed tile application. Reference shall be made to appropriate data for the required fire rating.
8. The applicant shall retain the services of a Dade County certified testing laboratory to maintain
quality control in compliance with the South Florida Building Code and related protocols. Samples
taken shall be in compliance with Dade County Protocol PA»1 12, Appendix 'A'.
9 Fire classification is not part of this aceptance.
Page 10 of 15
Frank Zuloaga, RRC
MOR LIFETILE LLC
Page 15 of 15
Product Control No.: 97-1124.16
ACCEPTANCE NO: 97- 1124.16
Monier Lifetile
St LLC APPRO� : June 25 1998
Boca Rat n, F MP! ES : Junes.0
Boca Raton, FT.. 33431
NOTICE OF ACCEPTANCE STANDARD COND IONS
shall be considered after a renewal application has been
Renewal of this Acceptance (approval) supporting data, engineering
filed and the original submitted documentation, including test supp 8
documents, are no older than eight ( )
Any n and all approved products shall be permanent) labeled with the manufacturer's name, city,
state, and the following statement: t condtions of this Acceptance. U County Product Control Approved ", or as
specifically stated specific
3 Renewals of Acceptance will not be considered if:
a ) There has been in t
n a char the South Florida Building Code affecting the evaluatiop of this
product and the product is not in compliance with the code changes;
roduct (identical) as the one original) y a p p roved;
b) The product is no longer the same P lied with all the requirements of this acceptance,
c) if the Acceptance holder has not comp roduct;
including the correct installation of the p
r who originally prepared, signed and sealed the required documentation initially
d) The enginee
submitted, is no longer practicing the engineering P rofession.
e in the materials, use, and/or manufacture of the product or process shall
royal has been
4 Any revi or Chang
automatically be cause for termination of this cation with appropriate o fee) written and ap granted by this p
requested (through the filing of a revision app)
office.
5 Any of the following shall also be grounds
this for
or process Accep�Ce' advertising or any
a) Unsatisfactory performance p roduct, for sales,
b) Misuse of this Acceptance as an endorsement of any P
other purposes. Florida, and
receded by the words Miami -Dade County,
6 The No of Acceptance number preceded displayed in advertising
literature. If any portion of the
followed by the expiration date may
Notice of Acceptance is displayed, then it shall be done in its entirety. and i
� A co py of this Acceptance as well as approved drawings and other an mn , av where t t applies, a
g
shall be provided to the user by the manufacturer or its distributors shall
ee i ail a.
inspection at the job site at all times. The copies need not be resealed by
I with any section of this Acceptance shall be cause for termination and removal
8 Failure to comp y
of Acceptance.
9 This Acceptance contains pages 1 through 15.
END OF THIS ACCEPTANCE
oaga,
Test Location
Uplift Pull
Test (P or F)
Test Location
Uplift Pull
Test (P or F)
Test Location
Uplift Pull
Test (P or F)
1
7%4.4 9.• ED
26
Q' �s1s-D
51
F�
2
27
\
52
3
1
28
53
.__
4
29
54
5
30
55
6
31
56
7
32
57
8
33
58
9
34
59
10
35
60
11
36
61
12
37
62
13
1
38
63
14
39
64
15
40
65
16
41
66
17
42
67
18
43
68
19
44
69
20
45
70
21
46
71
22
47
72
23
48
73
24
49
74
25
50
75
7 l)u Quesne & Associates, Inc. UTR 16930
J ij ` Consulting Engineers Environmental • Civil • Structural
Testing Laboratory Buildin Inspection Services
ON -SITE C• NCENTRATED UPLIFT LOAco> TIESTING OF ROOF TILE
A CCORDANCE WITH METRO -DADE BUILDING CODE COMPLIANCE
PROTOCOL PA 906
SITE SPECIFIC INFORMATION
Owner's Name: D 0-5 -1 men t....,, t Permit #. .4 4o 1 42 4-
Job Address LOS N .R ' T. I AJA t 4 (-o # ,ci•
Roofing Contra tor 033 0 Co P— - ?..0 0 c 1 IIJ Cr
Type of Tile: COPIA t "ft E. — t 0 06 6 'T Date Installed 4. 215
Approximate Roof Height' (Z feet Roof Pitch 3 ' 1 2
Type of Access to Roof: Scaffolds _ Ladder
Approximate Square Footage of Roof' 2 900 ft 2
Required Testin( Force: 35 lbs. Testing Equipment: Chatillion DFIS 100
Date Tested $ ' 00
THIS R
Du Quesne, P.E.
ngineer
.E. ` "4513
u Quesne & Associ. es, Inc.
E.B. License #0005245
Lab Certification #94- 0318.01
TEST RESULTS
P = PASS, F = FAIL
SKETCH OF ROOF IN BACK
Other
7815 S.W. 24th Street • Suite 109 • Miami, Florida 33155 • Telephone (305) 264 -1425 • Fax (305) 264 -1426
00
IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL PA 106, THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT
QUALITY CONTROL TEST.
THIS PA 106 TEST HAS BEEN PERFORMED IN FULL ACCORDANCE TO THE
REQUIREMENTS OF DADE COUNTY, WITH NO DEVIATIONS.
Please Note: This form is not valid unless
Company logo appears in
color (burgundy)
5K[TCH O¢ Rows
108
SHEET NO OF
CALCULATED BY
CHECKED BY DATE
SCALE
DATE
NOTES'
0
J•
NOTES'
KETCH OF ROOF
JOB
t 05 0 G g5S-t : , Val S t{- -L € 5
7 �OF y
SHEET NO
CALCULATED BY
CHECKED BY DATE
SCALE
DATE
■ ■ ■ ■• v, - - -�
1 In �I��1�11
11111 ■1111
■■■■ ■rw`��■■■ ■■ ■MI■. ■■■■■
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■1111 �1►1�111�1 1111
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Q
Job Address, 04- fl — C P 7/ ! Tax Folio 1 e O(p — 013 V 0 / ao
Legal DescriptionPLC. f S'1 bz.Q.O� C (- U e7 loCk 0-0
Historically Designated: Yes
Lc* IC? No
P 60 +he t,c9e. I c
r7O .
/ Tenant ( C I � I fj (Y) } t Master Permit # / 3 7
Owne1's Address gile 06" q i Phone(` 477 ° 9
Contracting Co. teJ /Gle/l
Date
WORK DESCRIPTION QA/
Square Ft.
Signature of owner and/or
Notary as to Owner and/or Condo President
My Commission Expires:
FEES: PERMIT 4 10 RADON
Date
OFFICIAL NOTARY SEAL
DARLENE FORD
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC669810
Y COMMISSION EXP. AUG. 6,2001
9q
Address
/ 73 See 64-
Qualifier ,, d d19 � � ` sw7( eh/25 2- ss# / � Phone 304 g,9.1 "
State # Municipal # Competency # 3 Ins. Co. 3 O S -70l (9 S g (wi p
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
/f7L H7 -7) a2/7L/r C/&/ V9 //9( /7
cis
Estimated Cost (value)
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER
OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work
will be perfonned to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above - named contractor to do the work stated.
Signature of c ontractor : Owner- Builder Date
No" tary as to
My Commiss
Alit SEAL
S MARGARITA MONTIEL
11 0-A cselt3u � R � - / -
r • 1 ✓ ecCfs!#Q!1 EMPIRES_
� 3 -Z4' 27
OF s. DEC. 17,2002
36- r
14 Ez
Date
BOND
TOTAL DUE ‘7/6—; a
APPROVED:
Zoning Buil
Mechanical Plumbing Structural Engineer
Date Job Address /DS A/C 3;5_ 5/
Legal Description
Owner / Lessee / Tenant /7/4/2/" v. ,
Owner's Address /US /1/6 95 St Phone 7 9 - / / 'ef"
Contracting Co. a l.Jn
Qualifier SS# - -
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION *pl 0k" n r („/el« 17 0.7 /z e7/ 4- f2/cki J 7 / e �2 , .
p u T T / . ^ j' % %S 1� i � es,,, (_ I 7 2,nrtn --, a.---.,1 b (.�W f( (0N�I.tI • 40/. !y/!� 3 c4 : it L.)
S re Estimated Cost(value) D Vim
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be performed to meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will
be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I
authorize the above -named contractor to do the work stated.
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
** * * * * * * *
FEES: PERMIT 1 " RADON C.C.F. 1 ► NOTARY 5 * ( 012 TOTAL DUE 14 5
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
* * *
Fire Other
Zoning Building ►- J),J Electrical
Tax Folio 1/4(0.6
Master Permit 4PiL,70
Address (0 5 ,i t 7 5 5 T
Phone
#:' 'i slL. I /& 11cS' y Ciommisswn Epp. Apfl) 34 I'
a ry as t = - ' . • r -1
My Commission
*
Mechanical Plumbing Engineering
Per 489.103(7) F.S.S.
State law requires construction to be done by licensed
contractors. You have applied for a permit under an exemption to
that law. The exemption allows you, as the owner of your
property, to act as your own contractor even though you do not
have a license. You must supervise the construction yourself.
You may build or improve a one - family or two - family residence or
a farm outbuilding. You may also build or improve a commercial
building at a cost of %25,000 or less. The building must be for
your own use and occupancy. It may not be built for sale or
lease. If you sell or lease more than one building you have
built yourself within one (1) year after the construction is
complete, the law will presume that you built it for sale or
lease, which is , a violation of this exemption. You may not hire
an unlicensed person as your contractor. Your construction must
be done according to building codes and zoning regulations. It
is your responsibility to make sure that people employed by you
have license required by state law and by county or municipal
licensing ordinances.
5
Village Use Only
Owner's name(print)
Permit No.
DISCLOSURE STATEMENT
Owner's signature
MIAMI SHORES VILLAGE BUILDING AND ZONING DEPARTMENT
INSTRUCTIONS TO OWNER- BUILDER
You have, this date, made application for a building permit as an owner -
builder. You should be advised of the following provisions and requirements
that apply to owner - builder.
Proof of Ownership - Prior to a building permit being issued to you,
you must submit proof of ownership of the land concerned in the
application in the form of a recorded deed, showing you own the property,
or a copy of mortgage or warranty deed of the land, or a Dade County tax
receipt, statement to contain legal description of property and indicate
property is in your name. Legal description and name on document of proof
must correspond to the name and legal description on the application.
Responsibility - You will be responsible for all work done by your day
labor employees, and you must either employ licensed contractors or
persons to be paid on an hourly or per diem basis. Any one contracting
(including labor) with you, verbally or in writing, on a fixed fee basis
for any work, who is not properly licensed, will be subject to a fine of
$500.00 and /or imprisonment for six rionths.
Insurance - You should be advised that if your day labor employees cause
any damage to persons or property, or if any of your day labor employees
are injured on the job, you are liable. Your regular home insurance
policy ordinarily does not cover this type of liability.
Withholding Taxes, etc. - You should be advised to investigate your
responsibility for withholding Social Security, Federal and State
Unemployment Insurance Taxes and Federal Income Taxes from the wages
of employees working for you on the proposed construction, and for
making returns thereof to the proper agencies.
Work Permitted Owner - Builder - An owner- builder subject to the foregoing
provisions and requirements, is limited to constructing one single family
residence each year for his own use and occupancy; or maintaining, altering
or repairing his own single family residence.
If you do not intend to do the work involved yourself, or with day labor, please
list below, the name of the individual or firm with whom you have entered (or
will enter) into a contract for the work.
NOTICE: SEPARATE PERMITS REQUIRED FOR ELECTRICAL, PLUMMBING,
ROOFING AND P1ECHANICAL WORK
Name of Individual or Firm Address
I, the owner of property described as /O' - 95 52
do hereby certified
that I have read the foregoing instructions, and am aware of my responsibilities
and liabilities under my application for a building permit for construction work
on the above described property.
Witness Owner
ate
ate
** *
w.wne/
Signatur owner and
Date: /e) d✓
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date o7 ld q �a Job Address /OS /V L ! •S ST Folic// % Tax Folic// 0 2O /5 d�
Legal Description 01' W- / / g e s ,, / /
Lessee / Tenant 7H6 Ala /1t'1 R I L Master Permit #
Owner's Address
Contracting CoC% � a!/A/- Address
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one
Zoning
� a/ Print type or stamp name of Notary Public
tar as to Owner andgitsc illy 8° eri r'ced LD.
Type and num er o tn. produced:
My Commission Expires:
ELECTRICAL PLUMBING MECHANICAL ROOFING LAVING FENCE SIGN
WORK DESCRIPTION 4 7;7c4•4J zel a2'
e,
Square Ft. Estimated Cost(value fee. "'
Phone
1S /9f7
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be performed to meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will
be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I
authorize the above-name• T = stated.
XMOINWOMOMP
i ^ ` • 01112IIMM1IM111
Signature of Contractor or Owner- Builder
Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
El DID rake an oath, or
DID NOT take an oath.
* * * * * * * * * * * **
FEES: PERMIT& / 5 O RADON C.C.F. '6 NOTARY J 0,0 TOTAL DUE 3. 0 O
Fire Other
// 2 9 Electrical
Mechanical Plumbing Engineering
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 iuilding 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.
2+ squares
Permit
Disapproved
(Signed)
— 2--sate t% 1 ° 7 r
Bui di'
Date.
Chairman
Member
Member ......
Council Approved Date
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re fee of $1.00 will be charged
materials and/or workmanship.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
PLANIflNG BOARD DATE
6th 19.75
Owner's Name and Address ... Mro.... &... s.. E.. ...F.... G.Q c
Registered Architect and /or Engineer ....... .. ........- .,,,, -.,
Name and address of licensed contrpctor Lang. R09 ._.. `']�P GQ a . $ ... .. inc„ 57. 3. ...LN!a.....7.1 ...St,.... Mial a,
F1ao 33150
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done 10 I.o. -10 95th..3..reat
State work to be done and purpose of building (by floors) Partial 1eroof. o TPA_Q1 1,,. tin Qa.P _._1 -34.#
_felt ...t o....she athing... hoar. d. a.,....m.o.p....L..9R1ho....s1a. tea.. wi. th.. .hat....asphal.t,....coo.uer... wi th...a .
layer of standard white cement shingle type the o and for no other purpose.
New Building Remodeling Addition P Rep a or$.... REROQ.F._.. No. of Stories 1
To be constructed of Kind of foundation . Roof Covering Shingle tile
Estimated Total cost of improvements $ L 955.000 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 F • 'da, Permanent Supplement.
and has complied with the provisions thereof, and will require similar compliance from all contractors - su. - ntractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspe / ion .. a site •f the work sucl ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such subco ;; on w• to be perfo,. . yajIe� this
pennit, as are licensed by Miami Shores Village. :%
Remarks.___ (Signed)
- ' 4 .1rAiliatik
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
•
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the.
of the above described construction, that he has carefully read the fore oiniapplication, 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
My Commission Expires
Member
Member
Member ...._ �_._..__
Disapproved Date
making corrections or changes to this application after approval has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
Permit No Date - u- O ? iV
Disapproved
(Signed)
BUILDING INiSPECTION DEP RTMERIT
AF LR:ATODN F E UIL llNG PE MOT
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
July 18th 1962
Owner's Name and Address Earl Scott No 105 Street N. E. 95th St,,
Registered Architect and /or Engineer
Name and address of licensed contractor Lang Roofing & Tile Co., Inc., 430 N. W. 79th St.,
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done 105 N, E , 95th St �li�mi Sh ores, F1a
State work to be done and purpose of building (by floors)
..26..guaye aquares- telr -off _ and. _._re-roofing _. residence- repla-ce--- siand.axd - - -' -ih te--- cem'xit.
sh i rgle tile,, and for no other purpose.
New Building Remodeling Addition Repairs X No. of Stories
To be constructed of Kind of foundation Roof Covering.white shingle tile
Estimated Total cost of improvements $ 1300,00 Amount of Permit $ 6,00
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 rovisions 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 suy,.ubcontract, on work to be perfo med under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed).
STATE OF FLORIDA, LAl J GC^ ING & TILE C G . , INC.,
ss
COUNTY OF DADE. d
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the.
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Read, Sworn to and Subscribed before me.
ate__
Notary Public, State of Florida
Buildin; nspector My Commission Expires
,19
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of ute plans and specifications herewith submitted for the build •
ins 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.
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed , F1 .
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done / D S n/
— 7)(4; 1' i w may /` ° _.... » »_.._.._
64 /rte m4'isz
State work to be done and purpose of building (by floors) 42z te77 °dz
�n/ CA r° 3 azi re•-77 /7/0 P (` s es /
be sent to.
STATE OF FLORIDA,
COUNTY OF DADE. ss'
•9 -74 ti S2 rr
re.. 141
Disapproved 1 \ Date .._..
(Signed)
Citairnan
Member
Member .. ..
Council Approved Date
NOTE: A charge of $1.00 will be made for
the Pl.uiir.g Board.
A re-inspection fce of 31.00 will be charged
materials and /or workmanship.
MIAMI SHORES VILLAGE
.6;92 / Sea i
Building Inspector
119.2 t ,......•,...»rrt....•t- .,,.,,., e., .....
PLANNING BOARD DATE
_ No. ..._.... . Street... _.... _
Read, Sworn to and Subscribed before me.
/1-y 4(/ t v a' F-6,,- 7 ... and for no other purpose.
New Bui!ding Remodeling Addition Repairs DC No. of Stories / _
To be constructed of Kind of foundation Roof Covering re 71k ..._..__
Estimate Total cost of improvements $ 7. 6 .9`•7 ° v Amount of Permit S..
Zone cubage required a A- %/ . 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
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 Sup element,
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 noticcs as are required by the Act. The undersigned agrees to employ only such subcont; actors on work to lrjq perforrped under this
pcnnit, as are licensed by Miami Shores Village.
Remarks (Signed).
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
and who. being by me first duly sworn, upon oath deposes and says that he is the.
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated
Permit No %
Notary Public, State of Florida
MyCommission Expires _...._....._.__ »_ _
Mcmbcr
Member
Member �.._.....
Disapproved Dale
making corrections or changes to this application after approval has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty