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460 NE 95 St (5)The Sunshine State IJOENSE HUBNER G654-000-66-365-0 ARNAUD GOURMELON MO MYSTIC POINT now AVENTURA, FL 33100-0000 BIRTH RATE SIDI HOT. REST. ENDORSE. 10-0546 M 5-06 ISSUED EXPIRF-S DUPLICATE 08 10-06-02 00-0040 SAFE DRIVER 70122 Operation of a motor vehicie constitutes consent bp any sobriety test required by taw. Miami Shores Village 10050 NE 2nd Avenue Phone: 305- 795 -2204 Permit Number: BP2002 -894 Printed: 5/8/2002 Page 1 of 1 Applicant: ARMAND GOURMELON YAMILE REYES Owner: YAMILE REYES ARMAND GOURMELON JOB ADDRESS: 460 NE 95 ST Contractor Local Phone: Parcel # 1132060140450 Fees: Description Amount FEE2002 -2626 Building Permit Application Fee $60.00 FEE2002 -2627 CCF $0.60 FEE2002 -2628 Notary Fee $5.00 Total Fees: $65.60 Permit Status: Approved Permit Expiration: 11/4/2002 Construction Value: Work: TILE REMOVAL REMOVING FLOOR TILES & PANELS IN FLORIDA ROOM If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. This Permit is granted to the contractor or builder named above to constru or-'• - 3 pertaining thereto and with the understanding that the work will b. pproved by the proper municipal authorities. This Permit may be revok re .. uthorization. A further condition upon which this permit is granted is the uric ordinances and regulations pertaining to the work covered hereby whether si by his agents, servants or employees. Signed: (INSPECTOR) In consideration of the issuance to me of this permit, I agree to perform the with the plans, drawings, statements or specifications submitted to the proper myself, my agent, servants or employes. Signed: (Contractc Building Permit Contractor's Address: Legal Description: MIAMI SHORES SEC 2 PB 10 -37 LOTS 4 & 5 BLK 52 LOT SIZE 100.000 X YAMILET REYES ARNAUD GOURMELON 3175 NE 184th St Apt 3201 Aventura, FL 33160 $1,000.00 DATE Total Fees: $65.60 Total Receipts: $0.00 PAYTO THE ORDER OF First %nlon National Bank firstunlon.com Org. 003 R/T 067006432 FOR et, �i/.�� !' i /�✓ 1:06 70064 21: LO900 L 191,856: 08 63- 643/670 BRANCH 00829 0840 ELECTRICAL TYPE Minimum Fee QTY TYPE Dryer QTY TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Fan Dryer Vents, Number of Outlet, Wall Ventilation, Cost Service, Temporary Air Handler, Tons A/C Central 4 -7 Ton Piping, Flammable Liquid Fire Pump Outlet, Switch Fire Sprinkler System Signs A/C Central 8 -15 Ton Bath Fan - Vented, # Fixture - Fluorescent Pressure Vessel Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New 1\'IECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. TYPE Refrigeration, Tons QTY. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Solar Water Heater Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Cap - Fixture Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Pump and Abandon PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 2 IMPORTANT NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, P' Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE OF FLORIDA, COUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE APA)4 Go o2('IEW7 J Print Name Print Name Sworn to and subscribed before me this day of Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida Signature of Notary Public - State of Florida SEAL: SEAL: Signature of Contractor / Qualifier PERMIT APPLICATION Personally known OR, Produced Identification Personally known OR, Produced Identification Type of Identification Produced: Type of Identification Produced: Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: PROPERTY OWNER Name— 10./q� cx'uI2'7E 10 � J Address 7f /PE 95 tI S re-e--4 Home Telephone s l c_ 7 yyS 3 Business Telephone 0 3 t q` q Z( b J 7 l Fax Alteration Interior TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'1 Detachment Other Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) ❑ IMPACT FEE (New Construction) PERMIT FEES $3.00 per page (Scanning Fee) Miami Shores Village Bond $ (9_0k o 0 Metropolitan Dade County (C.C.F.) $ D Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ OTHER (Specify & Attach) $ (¢.005 /sq.ft.) SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE (sq.ft. = x/1000 x ¢.60) (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ 5 ' ( 0 ISSUING OFFICIAL DATE: CONDITION OF APPROVAL 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com Revised July 2001 INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION 2_Job Address: 7b2 i U 4 1 h +1 eD_ 1 Address PERMIT TYPE (✓ Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Apt. Block Folio Number Lot Subdivision PB PERMIT CHANGE (✓ ) Chg; Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Description of Work Master Permit No. Subsidiary Permit No. j3i) c-CO - Fc1 air/ l City State tCQs,OU • te r.' I :AL Linear Feet PERMIT APPLICATION 1 Zip PG Zoning Current Use of Property Square Feet Proposed Use of Property Value of Work Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. Units Floors IWO t? Bldg Value ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name Date 4 -18 -01 J Address 460 N.E. 95 Street Tax Folio //11/9 ti - z. To Legal Description . Historically Designated: Yes No C3 1 Owner/Lessee /Tenant Wendy Crawford Master Permit# Ownet's Address 460 N. E. 95 Street Contracting Co. Quality Roofing Contractor, Inc. Qualifier Arocho State# RC 0 0 5 8 6 2 7 Municipal # Competency # 17889 Ins. Co. Address Address Architect/Engineer Bonding Company Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTLONTear off old roof to wood deck, tin cap 301b. ASTM felt, install galvanized eave drip and valley metals where required, mop o asphalt one layer of 901b. ASTM felt, install Spanish S Cla, Colorhtru Tile with polyfoam adhesive setting. Square Ft. .27 s q . Tile Estimated Cost (value) $ 11,70 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LEND1 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 we will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICA. 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 regulati construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. /(- 14/ "Signature of owner Notary as to S er and/or Condo President My Commission Expires: MARYLOU HERNANDEZ .. MY COMMISSION N CC 680474 EXPIRES: October 10, 2001 - 4,WCF ' Bonded Thru Notary Public Underwriters qq �n FEES: PER „[ �� r RADON C.C.F. APPROVED; Zoning Mechanical • Building PERMIT APPLICATION FOR MIAMI SHORES VILLAGE i d do/ Date SS# Zi Address Phone Vido/ Signature of Contractor o:rOwner- Builder Date W/1.;/ Notary as to Con actor or Owner - Builder / Date My Commission Expires: NOTARY Electrical 13800 N.W. 1st Avenue 758-0315 Phone 751-0382 wi y MARYLOU HERNANDEZ MY COMMISSION N CC 680474 EXPIRES: October 10, 2001 Bonded Thni Notary Public Underwriters TOTAL DUE BOND 3a d v� 1 Plumbing Structural Engineer NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. 1/ 3 2- G : / 9 !f yo STATE OF FLORIDA: Cr iR208769 2001 APR 26 10:35 COUNTY OF DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street address: 4 6 0 N . E. 95 Street Miami Shores, Florida 33138 2. Description of improvement: Reroof to a new Tile roof. 3. Owner(s) name and address: Wendy Crawford Interest in property: Owner Name and address of fee simple titleholder: N/A 4. Contractor's name and address: 5. Surety:(Payment bond required by owner from contractor, if any) Name and address: N/A Amount of bond $ 0 0 6. Lender's name and address: N/A 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided . by Section 713.13(1)(a)7., Florida Statutes, Name and address: N /A 8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: N / A 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) S ignature of 0 n Print Owner's Name Sworn to and subscribed before me is ie day of hirr; Notary Public Print Notary's Name My Commission Expires 460 N.E. 95 Street Miami Shores, Florida 33138 Quality Roofing Contractor, Inc. 13800 N.W. 1st Avenue Miami, Florida 33168 d/441 (eAcizukAd STATE OF FLORIDA. COUNTY OF DADE t HEREBY CERTIFY that this is a true opy of the ono nal filed in this office on ,— IN �r; 1 , A 0 20 p� WIT ESS my hind and Official Seal. tI ARVWRUVIN, CLER of Circuit and County Courts Hy �/.P.c ?COQ D.C. , Prepared by Carlo:; D,rnrhn Quality Roofing Contracto: Address:13800 N.W. 1st Aveni Miami, Florida 33168 PERMIT NO. . ADDRESS: MIAMI SHORES VILLAGE BUILDING / ZONING DEPARTMENT • SECTION BY DATE ZONING ELECTRICAL MECHANICAL PLUMBING FIRE PUBLIC WORKS STRUCTURAL BUILDING OFFICIAL 1. Subject to cacnpllancs with ett Federat State. County. Wage rotes end regulations. Wage tsscnnev no responslbUtty for accuracy otlor resutts (roc these plans, 2. This copy of plans must be tytittbl. oc buRQing site or no Inspection rrift be conducted JOB ADDRESS V / t e / s* APPLICANT PHONE It APPUCATION SHEET OF • MISCELLANEOUS GATE COMMENTS INITIALS CRITIQUE SHEET 4 • Contractor's Name: \ y � o 5 r 04.ca , I . Job Address: JJ ❑ (Low Slope Application) ROOF CATEGORY ❑ (Nail -On Tile) 1-1(0p E. qS Slree± ❑ (Asphalt/Fiberglass Shingles) ❑ (Metal Roofs \Wood Shingles & Shakes) ❑ (Other) ROOF TYPE ❑ New Roof L"J Re- roofing ❑ Recovering ❑ Repair ❑ Maintenance L�!f (Mortar- Adhesive Set Tile) Flat Roof Area (ft') Sloped Roof Area (ft c ? Sg , Total (ft Master Permit No. Exposure category (per ASCE 7 -88): C Building Classification category (per AS E 7 -88 table 1): Z' F Ft. e type: Fastener Type: Field: ROOF HEIGHT AND SYSTEM DETAILS r r (Draw details as needed) ARE i5 RE GAS VENT STACKP YES D NO TYPE - NATU AL ❑ L_ K CX ❑ A TACHMENT DETAIL 1 & 2 SPACING Perimeter: 1 rner: ROOF PLAN 123.01 -78 4/99 Appendix "E" UNIFORM ROOFING PERMIT APPLICATION PROCESS No. Page -1 1 Ridge Ventilation? I lj I i% MEAN HEIGHT Deck type: 1 Appendix "E" UNIFORM ROOFING PERMIT APPLICATION PROCESS No. it)HHA I XCo Underlaytnent: Insulation: D E T A I L 3 SLOPED SYSTEM DESCRIPTION 301b P Tlk 12" ROOF SLOPE Fastener type & spacing: Cap Sheet: i'h . 0 5 n4115 W D 'b /st 1X1'0-1. F; elL ?lo.c . J—Ica -Y to /Io.c. c-,.+- Ct.'ne:5 " Roo�overing: C4i lb n 5 Drip edge: OP y a t al` a, 36 )&n► -a ext e4�e- TILE CALCULATIONS (Pmax1:72,3 X a, (Aerody Multiplier):20 q ) - M O = M rt : PCA: t� q (Pmax2: X03,`7 x X (Aerodynamic Multiplier):3D. O) ) - M ei O = M PCA: Co/ 9 0 (Pmax3 )D 3 ;� x (Aerody Multiplier):3 " ) - M 0 = M 1 .I ( 1 PCA: (01 1 C ATTACHMENTS REQUIRED I) Fire Directory Listing Page 2) Miami -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 t Aeot g 4" ty- APPENDI\ "F" REQUIRED O11'NERS NOTIFICATION FOR ROOFING CONSIDERATIONS ' As it pertains to Appendix "F ", it is the responsibility of the rooting contractor to provide the owner v. itlt 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 all the ntininr: requirements and standards of the industry for roofing system installations. Additionally, th follo�� ing aeons slto :Ild be addressed as part of the agreement between the owner and the contraztor. The owner's initial in the adjacent box indicates that the item has been explained. Zeke Aesthetics- 1 \'orknt:tnship: The workmanship provisions of Chapter 3; are for the rr providing that the roofing system meets the wind resistance and w� a p pose �f �cr intrusion perf�onn :utce standard ;, Aes:hctics (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. i .2. Renailing \Mood Decks: When replacing roofing. the existing tvood roof deck may have to be renailed in accordance with the current provisions of Chapter 29 of the SFBC. (The roof deck is usually concealed prior to removing the existing roof system) 3. Common Roofs: Common roofs are those which have no visible delineation between neighborinc, uniks (i.e. townhouses, condominiums, etc.). In buildings with common roofs, the roofing contractor and /or owner should notify the occupants of adjacent units of roofing work to be performed. 4. Exposed ceilings: Exposed, open beam ceilings are where the underside of the roof deco :ink can be viewed from below. The owner may wish to maintain the architectural appearance, therefore, roofing n :;il penetrations of the underside of the decking may not be acceptable. The SFBC provides the option of maintaining, this ( appearance. Ill l� 5. Ponding Water: The current roof system and /or deck of the building, may not drain well and m.v 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. Pondine 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. r G. Overflow Scuppers (wall outlets): It is required that rainwater now off so that the roof is r.: overloaded from n build up of water. Perimeter /edge walls or other roof extcrtsions may block this dis:l•.arce if overflow scuppers (wall outlets) arc not provided. It may be necessary to install overflow scuppers in a :cordan :c with Chapter 23 of the SFBC. 7. \'entilation: Most roof structures should have so :nc ability to veal natural airflo.. throu`,h of the structural assembly (the building itself). The existitt` a amount of attic ventilation shall no: be rcdt:ccd. I: may be beneficial to consider additional venting which can result in extending the service Iifc of the rob S. The owner may contact the Miami-Dade County Consumer Services Department fo: information regarding the above. Coutrnctor's Si.;n:tturc FEB 21 '01 14 :12 FR BRADCO . . MIAM40A R'! C •� '0 . .TiE •F Santa Fe Tile Corporation 10302 N.W. South River Drive, Bay #16 Medley ,FL 33178 Your application for Notice of Acceptance (NOA) of: Spanish "S" Clay Tile under Chapter 8 of the Code of Miami-Dade County governin Construction, and completely described herein, has been rem) County Building Code Compliance Office (BCCO) under the This NOA shall not be valid after the expiration date stated b product or material at any time from a jobsite or manufactu product or material fails to perform in the approved manner, use of such product or material immediately. BCCO rese determined by BCCO that this product or material fails to Building Code. The expense of such testing will be incurred by the manufactu ACCEPTANCE NO.: 90- 1212.46 EXPIRES: 02/01/2006 THIS 1 T APPROVED: OVO1/2QO S 305 597 9484 CONDITIONS BUTLDINIGCODE 4 PRODUCT B.F. 11 se 4 5 0 00I\ae2000uumphoesvotiee aeeepe:m■ mw me doe Internet mail address: postmaster ®bulldingeodeonline.eom tuy H FEB 13 '01 17 CE TO 3059533333 P.01/05 BUILDING CODE COMPLIANCE OFFICE METRO -DnDE FLAGLL•R BUILDING 140 wesT rLAGLGR STREET. SVITI: 1603 MIAMI, FLORIDA 33 130 -1363 (3 03) 375.2401 FAX (303) )75.2906 the use of Alternate Materials and Types of ended for acceptance by the Miami -Dade nditions specified herein, ow. BCCO reserves the right to secure this ,,� is plant for quality control testing. If this IBCCO may revoke, modify, or suspend the s the right to revoke this approval, if it is eet the requirements of the South Florida t YEW COMMITTE MIAM1 - DADS COUNTY. FLORIDA METRO -DADE FLAGLER BUILDING CONTRACTOR LIC):N3INC SEC t0'. (30) 375.2327 PAX (303) ]75 -3330 coNTiLACrou ENFORCIaslI:N1'vIvI31O (305) 373 -2446 PAX (303) 373 -2908 rMoouC'r CONTROL DiviSlON (303) 31S -2902 FAX (303) 3324339 7 Raul Rodriguez Chief Product Control Division AL 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 _ Building Codc Compliance OMcc :nepago: blip »..w.ttuddingeodeon(ine.com 3/53880050 PAGE.01 FEB 21 '01 14:13 FR BRADCO VLI •141 LV•i J V• SAt Eratr>E TILE CORPORATION_ ROOFING ASSEMBLY APPROVAL ttrY; hoofing Sub -C tegorv: 07320 Rooting Tiles Materieb Clay Roof Tiles Deck Tyne: Wood 1. SCOPE This renews a roofing system using Santa Fe "Santafe Santafs Tile Corporation described in Section 2 of this comply with the South Florida Building Code, 1994 E locations where the design pressure requirements, as d does not exceed the design pressure values obtain by c using the values listed in herein. The attachment calcu system. 2. PRODUCT DESCRIPTION Manufactured bv Test 6,201i Dimensions Specifications Santafe 'S' Clay 1= 18" PA 112 Roof Tile w' 11.5" IA" thick Trim Pieces I = varies w w varies varying thickness PA 112 A hi 2.1 COMPONENTS OR PRODUCTS MANUFAC Test Pr duct Dimensions Snceifientinns Tile Screws #8 x 2 -Y" long PA 114 0.130" shank dia. Appendix E 0. I78 flute dia. 3. LIMITATIONS 1.1 3.2 FEB 13 '01 17 :45 Fire classification is not port of this neceptanc For mortar or adhesive set tile applications, a accordance with RAS 106. 3.3 Applicant shall retain the services of o Mia perform quarterly test in accordance with PA submitted to the Building Code Compliance 0 305 597 5484 TO 3059533333 • 0 m P.02/05 ACCEPTANCE No.: 00- 1212.06 Approval Date: Fcbruary 1, MR Expiration Date: 9bruttry 1.2006 Product Doscrii o, n • S" clay rooting tile, manufactured by otice of Acceptance, designed to Lion for Miami -Dade County. For ermined by applicable building code. Iculations in compliance with RAS 127 tions shall be done as a moment based e piece high profile clay roadie ipped with two nail holes. For nail -on, rtar set and adhesive set applications. cessory trim. clay roof pieces for use at s. rakes, ridges and valley terminations. nufacturcd for each the profile, URED BY OTHERS Product pescrintion tainless Steel L A 10-.41101- --- Ivinnufogturer generic atic field uplift test shall be performed in i County Certified Laboratory to 112 a•. hall he °ago. RRC Roofing Product Control Examiner 3058880050 PAGE.02 Table 2: Restorin• Moments cue t• uravr - m. weir, Resistance Expres d as a Moment - M in-ICT) Mortar or Adhesive t S stems Tile 2 ":12" 3 ":12" 4 ":12" j 5":1 2" 6 ":12" 7 ":12" or Profile • • reater Battens Direct Battens Direct � Direct I 1 Direct Battens Direct Battens tact Deck Deck Deck i Deck Deck Deck Santafe '9 3.93 5.90 5.85 5.82 �i ^ g 5. 53 5.32 5.29 5.03 NI A. Table 4: Attachment for Resistance Expres d as a Moment - M in-ICT) Mortar or Adhesive t S stems Tile Profile Tile A • • Iication Attachment Resistance Santafe 'S' Mortar Set 23.6 _ Adhesive Set ! 6 FEB 21 '01 14 13 FR BRADCO SAN' E TILE CO TON 305 597 9484 TO 3059533333 ^.03%05 ACCEPTANCE No.: 00- 1212.06 3.5 30/90 hot mopped underlaytneat applications ay be installed perpendicular to the roof slope unless stated otherwise by the under' yr:len: material manufacturers published literature. 3.6 This acceptance is for wood deck appiicati compliance with applicable building code. 4. INSTALLATION 4.1. t Santafe 'S' and its components shall be instal le County Roofing Application Standard RAS 11 4.1.2 Data For Attachment Calculations Santafe 'S' FEB 13 '01 17:46 Tile Profile Table 1: Aerodynamic Multi (ft Batten A • 'lie 0.274 3 J Minimum deck requirements shall be in in strict compliance with Miami Dade , RAS 119, and RAS 120. lyers— Lion • ft') a. (ft Direct Deck 0,297 Tile Profile Santafe S Tile Application Direct Deck Battens Two Nails 21.8 29.18' wo Screws 38.28' One Screw w/ Cli? 57.31 . Approved screws as noted 'Product manufactured by others' Table 3: Attachment Resistance Express9d as a Moment- Mf (ft -ibf) For Nall -On S s Two Screws w/ Clip 57.60 61.77 rank Zulosga, RRC Rooting Product Control Examiner 3055010050 PAGE.03 FEB 21 '01 14:13 FR BRADCO SAt1TAFE TILE CORPORATION 5. LABULEIG 5,1 All tiles shall bear the imprint or identifiable mhrkiutg of the manufacturer's name or Togo, or following statement: "Miami-Dade County P oduct Control Approved ". 6. BUILDING PERMIT REQUIREMENTS 6.1 Application for building permit shall be aceo4anied by copies of the following: 6.1.1 This Notice of Acceptance. 6.1.2 Any other documents required by the Building Official or applieabie Building Code in order to properly evaluate the installation otthis system, FEB 13 '01 17:46 PROFILE DRA'WI 305 597 3484 TO 3059533333 '.04%05 I , SAN?AFt "SANTAFE S" CLAYIROOF TILE ACCEPTANCE No.: 00- 12112 4 rank Zuloaga., RRC Roofing PrOduCt Control Examiner 3058880050 PAGE. 04 • FEB 13 '01 1746 SAN1A 'E TILE (ORPURATION ACCEPTANCE No.: 00- 1212.06 C OF A CE ANCE 1 Renewal of this Acceptance (approval) shall be considered aft original submitted documentation, including tat supporting des eight (II) years. ND 2 Any and all approved products shall bc permanently labeled wi the following statement: "Miami -Dade County Product Comm specific conditions of this Acceptance. 3 Renewals of Acceptance will not be considered if: a) There has been a change in the South Florida Building C and the product is not in compliance with the code change b) The product is no longer the same product (identical) as c) Ulric Acceptance holder has not complied with all the req correct installation of the product d) The engineer who originally prepared, signed and sealed submitted, is no longer praceleing the engineering professi 5 4 Any revision or change in the materials, use, and/or manufactu automatically be cause for termination of this Acceptance, units (through the filing of a revision application with appropriate fee 5 Any of the following shall also be grounds for removal of this A l ptance: a) Unsatisfactory performance of this product or process; b) Misuse of this Acceptant as an endorsement of any pr purposes. 6 The Notice of Acceptance number preceded by the words Miami expiration date may be displayed in advertising literature. If any displayed, then it shall be done in its entirety. 7 A copy of this Acceptance as woll as approved drawings and oth provided to the user by the manufacturer or iii distributors and a site at all Mmes. The copies need not be resealed by the engineer • ONDITIONS renewal application has been filed and the engineering documents, arc no older than the manufacturer's name, city. state, and pproved ", or as specifically stated in the affecting the evaluation of this product one originally approved; rrments of this acceptance, including the required documentaUon initially of the product or process shall prior written approval has beta requested 2nd granted by this office. ct, for sales, advertising or any other adc County, Florida, and followed by the rtlon of the Notice of Acceptance is documents, where it applies, shall bc l l be available for inspection at the job 8 Failure to comply with any section of this Acceptance shall be ease for termination and removal of Acceptance, 9 This Acceptance contains pages 1 through 5 END OF THIS ACCEPTA, ranlr Zuloaga, RRC ding Product Control Examiner 3058880050 PRGE.05 ** TOTAL PAOOE.O5 ** PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date Q / 3 /49 Job Address 6O ME. S T Tax Folio Legal Description Historically Designated: Yes No )( Owner/Lessee / Tenant PI Y a- »i r s. Cr A w -'o r p Master Permit # % S g a- r Owner's Address 'ti b D N . E . 4ce- H ,$ T . Phone jo S-. 7 - 0.3 J Contracting Co. Tol{ A) W t=.E 2 R ee � t Ng Address 4 I AL l,J . 1 `I 9 s Qualifier (A)E ErZ SS# Phone 3O-s- (02`1— 1 State # Municipal # Competency # 1 ( 9 4 Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICALCIOOFINO PAVING FENCE SIGN WORK DESCRIPTION E f A t r LEA k l ha 1 . LE l2. o 'r Square Ft. 3 A� 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. L tary as to My Co r • . �. OVA NOTTAA"R°Y" 1) 7 and/or Condo Presi � 0 7 97 c8 1 7,2 002 7 Date „ 1 „ 4 4 4 ti Estimated Cost (value) 5 W 9/13 )9', Signature of . tractor or Owner- Builder Date Notary as Contractor or Owner- Builder D 3 y Date - c My Commission Expires: FEES: PERMIT r RADON C.C.F. IbD NOTARY BOND APPROVED: Zoning Mechanical Plumbing Structural Engineer Electrical TOTAL DUE Test Location Uplift Pull Test (P or F) Test Location Uplift Pull Test (P or F) Test Location Uplift Pull Test (P or F) Test Location Uplift Pull Test (P or F) 1 Fp', X �� 26 P� 51 i71: eD 76 2 1 27 { 52 77 3 28 53 78 4 29 54 79 5 30 55 80 6 31 56 81 7 32 57 82 8 33 58 23 9 34 59 84 10 35 60 85 11 36 61 86 12 37 62 27 13 38 63 _ _ 88 14 39 64 89 15 40 65 90 16 41 66 91 17 42 67 92 18 43 68 93 19 44 69 94 20 45 70 95 21 46 71 96 22 47 72 97 23 48 73 98 24 49 74 99 25 —, 50 1 75 100 Owner's Name: Job Address Roofing Contraacccttor: Q " S 1 P\ " 1,1 t Type of Tile Approximate Roof Height Type of Access to Roof Scaffolds Approximate Square Footage of Roof 7700 ft Required Testing F ce: 3 lbs. Testing Equipment: Chatillion 100 Date Tested: t -21 o IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL PA 106, THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT QUALITY CONTROL TEST. THIS REPORT SUB Civil Engineer: rc �� 60 'T Lab Certification # 98- 0608.04 ED BY: P.E. State of FL Certificate Authorization # 4100 U.S. SOUTH Engineering & Testing Lab., Inc. 6065 N.W. 167th Street, Suite B -23 • Miami, Florida 33015 Telephone: (305) 558 -2588 • Fax: (305) 362 -4669 ON -SITE CONCENTRATED UPLIFT LOAD TESTING OF ROOF TILE IN FULL ACCORDANCE WITH METRO -DADE BUILDING CODE COMPLIANCE PROTOCOL PA 106 SITE SPECIFIC INFORMATION 1 -kA u) CD Permit # M, l 4.A Date Installed Roof Pitch Ladder Other TEST RESULTS P = PASS, F = FAIL Of Project IZ N° 1397 4100 1.l SSr. ts4I 45664W KETCH OF ROOF • 111111111122,0111311111111111MMI ■ ■■■11113 M 111\'w ■111111111■ ■1111■1111lrAPIRU MACE 1111111111111111EMMEMINIMINIIMIIIIMINEWIVIIN ME ••IIIIIIIIIIIIIIIAIIAIWIAIIII/rDIMNVITIENMM EN 1111111 iNINI 1111111 !1!11111 llhuII LiIIiI ! r111111 1111111111111rj 1 � liasmal iu ■u ■■ ■•. �i� ■L 11`x■/' _oil" �r 1■ ■ ■ ■ ■ ■ ■ ■ ■■..■� ....... ■. ... ■■ NOTES: JOB SHEET NO ` OF CONTRACTOR CHECKED BY SCALE DATE Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 May 11, 19 87 Mr. Loskill 460 E. 95th St. Owner's Name and Address No. St N et Registered Architect and /or Engineer Name and address of licensed contractor Obenour Roofing Co. 7357 N.W. Miami Ct, Mi ami 3150 Location and legal description of lot to be but on: Lot / Block Street and Number where work is to be done 4.60 -N. E. 95th St. State work to be done and purpose of building (by floors), state exterior colors (submit samples) Reroof rear flat roof with new gravel roofing and for no other purpose. New Building Remodeling Addition Repairsr 00f No. of Stories To be constructed oT 1- 43, 2 -15 Kind of foundation wood Roof Covering Cs' r l\TP Estimated Total cost of improvements s 1, 200.00 Amount of Permit $ 30.00 Zone cubage required Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor 1 hereby submit all plans and specifications for said building. All notices with reference to the building and its construction may be sent to 7357 N.W. Miami Ct. Miami, FL 33150 The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons 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 subcontrac y , on work to be performed under this permit. as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA COUNTY OF DADE. 1 SS. Before me. the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared James D. Obenour Disapproved (7 Date MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Subdivision and who. being by me first duly sworn, upon oath deposes and says that he is the Contractor of the above described construction, that he has carefully read the foregoing application, and that he did sign the same. and that all facts therein by him stated are true. Permit No. r Date Read, Sw (Signed) Building Inspector j0to/ / D �52 nd ubscribed before m l. 4 se;s to me well known. Notary Public. State of Florida My Commission Expires NOTARY PUBLIC STATE OF FLORIDA MY COMMISSION EXPIRES FEI1. 18 19$g PLANNING BOARD DATE Chairman Member - Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $25.00 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 625.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and!or workmanship. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR 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. , 60 Street NE 95th St., Miami Shores, Fla. Date Feb, 15th Owner's Name and Address.. Laskill N 460 Registered Architect and /or Engineer Name and address of licensed contractorLang Roofing & Tile Co,, Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done 460 NE 95th St., Miami Shores Fla. State work to, be done and purpose of building (by floors) ._,___squares - 4.- ply._.gravel._.rear New Building Remodeling Addition X Repairs To be constructed of Kind of foundation Estimated•Total cost of improvements $ 190.00 Zone cubage required Plan Cubage Distance to next nearest building Size of Building Lot Maxirnum 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 4966, 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 Qnly su s ontra to Qn y�prk .kn to performed under this permit, as are licensed by Miami Shores Village. La tt �ng �� ile lio. C Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. ss Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit No 5 i� Disapproved Dat (Signed) F -A-•4 Date Building In pe or NOTE: A charge of $1.00 will be made for the Planning Board. A re- inspection fee of $1.00 will be charged materials and /or workmanship. Chairman Member Member ..._ Council Approved Date Inc., 430 N. W. 79th St,, Miami Fla. and for no other purpose. No. of Stories Roof Covering ..._ ply _._ gravel Amount of Permit $ 5..00 to me well known, Read, Sworn to and Subscribed before me. Notary Public, State of Florida PLANNING BOARD DATE 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 MIAMI SHORES VILLAGE. FLORIDA BUILDING El ELECTRICAL ❑ DATE = 1 19� PLUMBING ❑ PERMIT No 9867 Contractor's License No ROOFING 0 ❑ Work to be performed under this Permit Owner of Building L. 1 Architect Contractor or Builder Legal Lot Description Address of Building 4 t. ' Bl. This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specification& and that he assumes responsibility for work dane by his agents, servants or employees. CONTRACTOR OR BUILDER Signed: 4 Subdi- vision Sq. Ft Value of Project $ Amt. of Permit $ BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications suhfnitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either, myself, my agent, ser$ant or employee. BY AUTHORITY MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT. Application is hereby wade 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. Disapproved), / (Signed) 6---; %% Buildin: spector APPLICATION FOR BUILDING PERMIT / Date :! , 19.2 Oa net s Name and Address ........ t �0cT. No. ti Registered Architect and /or Engineer a cs.... 111,•”mn,,,ITTnn r.,,rieee Name and address of licensed contractor ... b.15/ i .fir ...JgooF 1 Iv QPL^ Y Location and legal description of lot to be built on: Lot Block . Subdivision Street and Number where work is to be done 6' e' ._. ,N.A:_ .95 _'T __._...._ _. .._.._ _ State work to be done and purpose of building (by floors) 2 pas -G ('s. eWei- Ado.f.." -'10 R6 113 e and for no other purpose. No. of Atones I 41 a" New Building Remodeling Addition Repairs 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 budding 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 Libor 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 pennit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. j SS. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared — to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are Permit No.. L6'9 � ! _ 5 Date Read, Sworn to and Subscribed before me. \� Notary Public, State of Florida My romsi ission Expires PLAN NC 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 hoard. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection oe faulty materials and /or workmanship.