ROOFINGAPPLICATION FOR BUILDING PERMIT
Application is hereby uinde 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 thc,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.
Street and Number where work is to be done
MIAMI SHORES VILLAGE
Building it(spcctor
PLA
Chairman
Member
Member ...... _..-- •--- --- �.__..
Council Approved
BUILDING INSPECTION DEPARTMENT.
Date
- 2 - r 2
ate.._.......
NOTE: A charge of $1.00 will be made for making corrections
the Planning Board.
A re-inspection fee of $1.0O will be charged
materials anu /or workmanship.
Owner's Name and Address
R egistered Architect and /or Engineer ,.r ,. ,..,.,r,.,t ....... ..... „ -,,,t, rest
Name and address of licensed contractor . e
Location and legal description of lot to be built on:
Lot Block Subdivision
R_ .
State work to be done and purpose of building (by floors) -1 e-- L. ” o ice' IZ. =. �1 :
- -I) a o � , --=- -
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of I:indf foundation Roof Covering t �
) Estimated Total cost of improvements $ Amount of Permit $.
Zone cubage required Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to e�fs C /L 4 00 c1 A'c C / 6 0.
The undersigned applicant for this building pennit 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, Perini ne•nt 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 su ntr rs, on work to be pe�rflted under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed
Member
Member
_ Member
Date Disapproved
_ No... C:..__. Street_ -
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 ____._ . r_-- •..• --• -.-
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
him therein by hs . .4 are troy
Permit No..
Disapproved
( Signed)
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
INC BOARD DATE
My Commission Expires
or changes to this application after approval
A
44
1l .
.� ,
•/
/
to me well known,
Date
has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
Disapproved Date
(Signed)
MIAMI SHD "'ES 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.
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor
I •
Date
No
Location and legal description of lot to be built on:
Lot Block Subdivision
,19
Street
%
and for no other purpose.
New Building >-. Remodeling Addition Repairs No. of Stories ,
To be constructed of Kind of foundation Roof Covering j / .1
Estimated Total cost of improvements $__j ' __ Q ° Amount of Permit $
Zone cubage required _Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subco a tors n work to be performed under this
(%
permit,
ermit as are licensed by
Miami Shores Village.
Remarks (Signed)7-/i7_
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
-- - -- - - - -- -- - -- to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No .Q/ Date 2- Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
Village of Miami Shores
JOB
ADDRESS
(
N? 4798
INSPECTION - (,(
TIME READY
REMARKS
INSPECTOR DATE
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
26
4.5.,..a..-.:—; ►
51
`!„l
2
27
52
3
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
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
u Quesne & Kss ges
Consulting Engineers
Testing Lolzaratory
N-SITE CON NYED JP
I r s ACCORDANCE WM M
joiTOC
e Du Quesne, P.E.
Engineer
P. 24513
Du Quesne & Asso es, Inc.
E.B. License #0005245
Lab Certification #94- 0318.01
nc
L
LPGQ903
4ESTONG
(NG CO
SITE SPECIFIC INFORMATION
Owner's Name: 17 / Permit #. 45 -1
Job Address 100 - 6 1 ��• , (et1-A t 7 Pto c
Roofing Contractor C7e.G. A R_ Qofit i4
Type of Tile: 1- 4.®tat�( ' - F0. .o-dt SE-T Date Installed t • (
Approximate Roof Height 1 feet Roof Pitch :12
Type of Access to Roof: Scaffolds >( Ladder Other
Approximate Square Footage of Roof 7 300 ft
Required Testing Force: 35 lbs. Testing Equipment: Chatillion DFIS 100
Date Tested (\ • t S ' 6 19
TEST RESULTS
P = PASS, F = FAIL
1
Li;
U1'TRt 16334
Environmental o Civil a Structural
Building Insertion Services
t� QOOP TOLE
E CCU fe1 LOAMCE
SKETCH OF ROOF IN BACK
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)
7815 S.W. 24th Street • Suite 109 • Miami, Florida 33155 • Telephone (305) 264 -1425 • Fax (305) 264 -1426
$KETCH OF ROOF
JOB '
SHEET NO OF
CALCULATED BY DATE
CHECKED BY DATE
SCALE
NOTES'
$KETCH OF ROOF
JOB
SHEET NO
-2 °- OF 7i
CALCULATED BY DATE
CHECKED BY DATE
SCALE
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NOTES.