Loading...
843 NE 96 St (6)Name Date 1-\O me p Permit No. r�?3 r �J NE 9 51- C9eNnu Type Insp'n Address Company Phone # MIAMI SHORES VILLAGE BUILDING DEPARTMENT ,/ Bui)ging Inspection Request Time For Inspector: )7 f � Name & Date Approved Y Correction Re- Insp'n Fee ❑ Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date `` Time Type Insp'n ' Permit No. Name d 0 • Address � , Company # For Inspector: Name & Date MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 B illding Inspection Request Time Date 3 Typelnsp'n Y Q.Q7 I 1101- 7-10 ) U Permit No. 15P 2 3( 's — ` Name C� cca� nX (� Address 643 NP, I v S Company 0(3e000 + ' ' Phone #C)S For Inspector: 1 Name & Date Approved ❑ Correction 14( Re- Insp'n Fee ❑ Name Address Company Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date Time Type lnsp'n Permit No. V\ iL Phone # /. For Inspector: Name & Date Owner's Address Signatd; of owner and /o Date: Notary as to Owner.. My Commission Exri « ,Gna ** * * * * wP s I �` FEES: PERMIT APPROVED: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date /4,2 ' ✓ Job Address N..3i4�` , ` Legal Description ((Owner / Lessee / Tenant SE'S. L. Ot /J5t 0e/9vy cY'71 ,3 4/L-2 VG 57- r Contracting Co ./ 1L f����'' 'ca(� tdh' - 4 /NOrt,Address /4 111/71 4 - 6 / 4 / e - Qualifier Li`-�/ r 6(- SS# �- State �l: - Municipal 4� '3.a�7l� 6a Competency 4p x�o Ins.Co. Architect /Engineer Address Bonding Company Address �ortgagor /'�/(J �Y i'" Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN t dfs%rq t- WORK DESCRIPTION !"/�/�1 % `.��c• ll'fikte 4� ' ` 14.1 - eL ") Ie n`2L- - ;;- "• w c Art% - �% : Square Ft. 7t)CiZ% Estimated Cost(value '/ -'z2, ` 96' WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PA 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. sident r Con0 t '� LESLIE K. BUGGERT My Commission Expires Feb. 29, 1996 Co* m. Not CC 176679 * RADON C.C.F. lr Tax Folio ri/e Signature of Contract Owner- Builder Date: Master Permit # 31/ Phone 7- 5 f " �S`�� - Notary as to ConaraAtor or Owner- Builder My Commission ire,',, OFFICIAL SEAL LESLIE K. BUGGERT My Commission Expires \oP Fib. 29, 1,e96 ** • s j „I t "•. F OF F�d ; .• Comm. No. CC 17657 « *yfy NOTARY TOTAL DUE iC Fire Other Zoning Buildin ;�i✓ Electrical Mechanical Plumbing Engineering BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement ur rrre 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 . ... �".: ..... �`�� _. No..' 7.`ar .... street._& > !.' _ r,� _ i11 Registered Architect and /or Engineer Name and address of licensed contractor.... / _ ..' • Location and legal description of lot to be built on: Lot. ,... o t ../ * Q2 Block Street and Number where work is to be done Subdivision t State work to be done and purpose of building (by floors). s ..F:' MIAMI SHORES VILLAGE 7 sS.44, ..... _..!l 3 Z.1 X gr10 .1 and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering ..... . ......... ....._..__ Estimate Total cost of improvements $ ?'2 () Amount of Permit &... ' CC 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 buildin AU 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 5 Compiled General Laws of Florida. Pennanent Supplement, and has complied «ith 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 pcnnit, as are licensed by Miami Shores Village. Remarks (Signed)£ i_'2N,�.�_,�Y'.* STATE OF FLORIDA, i 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.._...._ . &'A9 Date ... t n ° 1� Read, Sworn to and Subscribed before me. Disapproved Date (Signed) ��� Notary Public, State of Florida `�. ��� Building Inspector My Commission Expires _ PLANNING BOARD DATE Cirair:nan 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 hero obtained from the Pl.urnir,g Board. A re-inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspevtion or faulty materials and /or workmanship. }SS. 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 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. Owner's Name and Address Le pi se fie d No 1 Street Ott Registered Architect andlor Engineer Name and address of licensed contractor ((I)''E /� Location and legal description of lot to be built on: Lot C +`�-- ' `'621ock / `A Subdivision 71/ ,Greet and Number where work is to be done v y-3 (/State work to be done and purpose of building (by floors). state exterior colo (submit samples) > STATE OF FLORIDA COUNTY OF DADE. Date / / /S _ 19 ,e c 3 / / z o 7 Repairs No. of Stories New Building Remodeling Addition To be constructed of Kind of foundation RoofDvering timated Total cost of improvements S 9e, d7L Amount of Permit S —3 7'c) 0 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 plans and specifications for said building. All notices with reference to the building and its construction may be sent to and for no other purpose. 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', 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 wills 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 e.• :1oy only such sh ubcontrictors, on work to be performed under this permit, as are licensed by Miami Shores Village. / / Remarks (Signed) I. Before me. the undersigned authority, a notary public. duly authorized to administer oaths and take acknowledgments, personally appeared 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. /// Date_/ /rte Read, Sworn to and Subscribed before me. Disapproved Date (Signed) Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of 525.00 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 525.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and workmanship. Notary Public. State of Florida • Miami Shores Village BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Owner's Name (Fee Simple Titleholder) Owner's Address O /Y� e 0 City Tenant/Lessee Name Job Address (where the work is being done) L 43 / /f. c' 96 City Miami Shores Village Is Building Historically Designated YES NO ✓ Contractor's Company Name _ ` n Contractor's Address 9 (9/ / , C ' 4/90 City >LCt/0-1-1 State Qualifier Architect/Engineer's Name (if applicable) Architect/Engineer's Address City $ Value of Work For this Permit 1/3,550. ao Number of: Bays Stories Type of Work: Describe Work: ['Addition Electrical County Escrow Fee $ Education/Training Fee $ Code Enforcement $ Minus Plans Chet Fee $ Building Departmen Plumbing Zip 39/3 County Miami -Dade State Zip DAlteration ❑New Tech $ Families Mechanical Phone # Phone # /e4 Square Footage Of Work: 0 Permit Fee $ l (g 1, a -c Bond $ '!�) ' Fee Totals $ S OP, Struct. $ T ECEWE Permit No. JuL 1,4 Master Permit No. Roofing o9 71- Szs31 Phone ( 75 — A 'P / lG/ Zip 3 3/3 r Phone # Bedrooms 1 Repair/Replace ore el: Powe3 Baths a ❑ Demolition i 1_ ovi * * * * * * * * * * * * * * * * * * * * * * * * * ** *Fee Calculation -Misc Permits * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** .E.2nd Avenue , Florida 33138 (305) 795.2204 (305) 756.8972 Notary $ Scanning $ Radon $ (Continued on opposite side) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name. (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachme . Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspectio t i occur. seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not %e app ved an ' a red% pection fee will be charged. - Signature The foregoing instrument was acknowledged before me this day of ,20 , by Jeff k1 DJ who is person wn to me or who has produced As identification and who did take an oath. Chc6 /18/03 Owner • r Agent APPLICATION APPROVED BY: Signatur The f day of Contractor egoing instrument was acknowledged before me this / 20 by lames ,D. O our, JUL 17 2003 Zoning 1 who is personal known to me or who has produced as identification and who did take an oath. NOTAR PUBLIC: NOTARY PUBLIC: • Sign: .(.yvtio. 0 " 1t 1 /. /� Sign: �-�- ' .Tts � Sandra D. iiai� ��Cl ^q �, y auu,�zDD01��72 C P G1. _ ''t4. #DD 0148 i2 Print: � /Y /2 /,"r @ � Print: )P N D(� N Commission ll ' d n � 1 is : Expires April 2, 2000 a " ` Ae, 9,.... Bonded Thrn My Commission Expifes-: •......;oe° ondi �a I My Commission Expires: o o'FOfF " ° � F llf� ° ` b� '�nl\�a atlantic IiOnding �•: � 'aon.tl•a • (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. Plans Examiner SECTION 1524 HIGH VELOCITY HURRICANE ZONES REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS 1524.1 As it pertains to this section, it is the responsibility of the roofing contractor to provide the owner with the required roofing permit, and to explain to the owner the content of this section.. The provisions of Chapter 15 of the Florida Building Code, Building govern the minimum requirements and standards of the industry for roofi g 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 ex! • ned. i 1. Aesthetics - Workmanship: The workmanship provisions of Chapter 15 (High Velocity Hurricane e) are for the purpose of providing that the roofing system meets the wind resistance and water intrusion p rformance standards. Aesthetics (appearance) issues are not a consideration with respect to workmanship provi ions. Aesthetic issues such as color or architectural appearance, that are not part of a zoning code, should be .. dressed as part of the agreement between the owner and the contractor. il re ail Bui // 3. Common Roofs: Common roofs are those which have no visible delineation between neighboring u is (i -. townhouses, condominiums, etc.). In`fiuildings with common roofs, the roofing contractor and /or o\r ► . hould 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 decking can be vi 1 wed from below. The owner may wish to maintain the architectural appearance, therefore, roofing nail penetr ions of the underside of the decking may not be acceptable. The Florida Building Code provides the opti of maintaining this appearance. 5. Ponding Water: The current roof system and /or deck of the building may not drain well and may cal se 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 expect ncy and performance of the new roofing system. Ponding conditions may not be evident until the orig l roofing system is removed. Ponding conditions should be corrected.. 2. Renailing Wood Decks: When replacing roofing, the existing wood roof deck may have to be d in accordance with the current provisions of Chapter 16 (High Velocity Hurricane Zones) of the Florida ng ode. (The roof deck is usually concealed prior to removing the existing roof system). 6. Overflow scuppers (wall outlets): It is required that rainwater flow off so that the roof is not ON' rlo ded from a build up of water. Perimeter /edge walls or other roof extensions may block this discharge if overfl w scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accU ance with the Florida Building Code, Plumbing. 7. Ventilation: Most roof structures should have some ability to vent natural airflow through the erior of the structural • sembly (the building itself). The existing amount of attic ventilation shall not be reduced. It m te a. e benef cial to consider additional venting which can result in extending the service life of the roof. 07 / ©7 /3 Ow er' /Agent' Signature Date Contractor's Signature C.' DOCCJIC- Ikmp\LOCALS- ■Temp■SL'CTION 13:1.d. Master Porrnit No• Contractoes Name Sob Address ❑ Low Slope ❑ Asphaltic Shingles ❑ New Roof ne Zone Uniform Permit APPI+csu (' ru 1 High Velocity Hurrir.� Section A General Information Process No. Low Slope Roof Area (SF) RO OF CATEGORY Fastened Tile l4 MorlAdheslve set n C Mechanically Fas ❑Wood ShingleslShakes ❑ Me al paneVShingl ❑ Prescriptive BUR -RAS 15 ROOF TYPE 01Re- Roofing ❑Recovering ❑ Repair ❑ Maintenance ROOF SYSTEM INFORMATION Steep Sloped Roof Area (SF) Total (SF) S)& _$ /0s /01 cluas rm. — Section D Roof System Manufacturer: Notice of Acceptance Number: Minimum Design Wind Pre ssures, 0 Applicable (From RAS 127 or Calculations): Pmax1: Pmax2- Pmax3• a �� Maximum Design Pressure (From the NOA Specific System):___ Deck Type: Stee S%o ed Roof S stem Slo • ed S stem Descri . tion U)DtOt CW- ype Underlayment: *30 i c3r4 7 2- - Z 4 ' Insulation: �lA Fire Garner. Fastener Type & Spacing: dhesive Type y pg Cap Sheet 7# go AC.r/ oat Covering: T & Sae Drip dge: ` -Y High Velocity Hurricane Zone Uniform Pam it Application Form Section E (Tile Calculations) For Moment based tile systems, choose either Method 1 or L Compared the values s for M,with the values from Mt. If the M1 values are greater than or o9 aal values, for each area of the roof, then the tile attachment method is acceptable. , mss Method 1 "M (P 00 s 2. ,21/1 (P WI to x Method 2 "Simplified Tile Calculation Per Table Belo Required Moment of Resistance (M,) From Table Below NOA M Moan .Roof Height --p Roof Slops 2:1= 3 :1 4:12 12 8:12 7:12 meat Based Tile Calculations Per RAS 127" L — Mg: _____- M• NOA Ms /5/r y — ML : • M,42/74•uff NOA Mt G/. 9 M, Required Moment Resistance* 24.5 213 20.6 20' 25' 26.7 6.5 24.5 26.2 27.6 29.5 • 22.6 24.1 25.4 • 27.5 'Must be used in conjunction with a list of moment based tile systems endorsed by the Broward County Board of Rules and Appeals. For Uplift based tile systems use Method 3. Compared the values for F' with the values for F,. If the F' values are greater than or equal to the F, values, for each area of the roof, then the tile attachment method is acceptable. Method 3 "Uplift Based Tile Calculations Per RAS 127" T, (P 1: x w: - )— W :s cos 0 :° F^: NOA - -� NOA. (r3 x 1: - = w: • ) — W: s cos 0• = F, - -- NOA F' x 1: W: x cos Q Fr,: - 1 ym•ol Descri • ton • • 111 Where to btain In ormation r crc to find JAM 27 2003 16:21 FR BRADCO TILE CNTR MM • PRODUCT CONTROL, NOTICE OF ACCEPTANCE Santa Fe Tile Corporation 10302 N.W. South River Drive, Bay #16 Medley ,FL 33178 Your application for Notice of Acceptance (NOA) on Spanish S Cl y Tile under Chapter 8 of the Code of Miami -Dade County governing the use of Alternate Materials and Types of Construction, and completely described herein, has been recommended for acceptance by the Miami - Dade County Building Code Compliance Office (BCCO) under the conditions specified herein. This NOA shall not be valid after the expiration date stated below. BCCO reserves the right to secure product or material at any time from a jobsite or manufacturer's plant for quality control testing. If this product or material fails to perform in the approved manner, BCCO may revoke, modify, or suspend the use of such product or material immediately. BCCO reserves the right to revoke this approval, if it is determined by BCCO that this product or material fails to meet the requirements of the South Florida Building Code. The expense of such testing will be incur; ed by the manufacturer. ACCEPTANCE NO.: Q .I I2.Ob EXPIRES: 92/0 1/____200,5 n006 THIS I TH COVFp H1" 1~ T SEE gDT)I 1 DIAL, PAGES FUR SPECiFI ' w N This Thi application for Product Approval and Product for Prod Committee has been reviewed by the IICCO and approved by the Building to be used in Miami-Dade County', Florida under the conditions set forth above, APPROVED: Jaw/at I1104500011pe NDONierepbietkeaeCe acceptance cover Daatdo1 Internet mail address: postmasterSbuildingcodeontine .corn 43515 TO OBENOUR MIAMI -DADE COUNTY, FLORIDA METRO -DADE FLAGLER BUILDING BUILDING CODE COMPLIANCE OFFICE MC•TRO -D\DC FLACLC(Z DUILDINO 140 WEST FLAGLER STREET, SUITti 1603 ivl1AM1. FLORIDA 33130.1563 (305) 375 -2901 FAX (305) 375 -2905 CONTRA LICkNS1,NC SECt't0 ()05) 315.2327 VAX (305) 273.73S6 CONTRACTOR ENcONCOter.rr Di briSiON (305) 373.2966 rnx (303) 3734901 rRODUCr CONTROL DIVISION (305) 375.2902 RAY (303)372-6339 Raul Rodriguez ChierProduct Control Division F at4,r4,04 J-pg-‘-*-ceo Francisco J. Quintana. R.A. Director Miami -Dade County Bu ilding Code Compliance Office Homepage: httrllu•ww.buildingcodeonline.com P. 05 JAN 27 2003 16:21 FR BRADCO TILE CNTR 43515 TO OBENOUR lYT9:FE TIDE CQRpO tATIOIY ACCEPTANCE No. - 00- 12J).06 II ROOFING ASSEMBLY APPROVAL C.eVery: Roofing Sub- Cater_orv: 07320 Roofing Tiles Materials Clay Roof Tiles Deck Tvne: Wood 2 Approval Date: F ru rtry }.?Dpi Expiration Date: .Ecbruary 1.2006 SCOPE This renews a roofing system using Santa Fe "Santafe `S" clay rooting tile, manufactured by Santafe Tile Corporation described in Section 2 ofthis Notice of Acceptance, designed to comply with the South Florida Building Code, 1994 Edition for Miami -Dade County. For locations where the design pressure requirements, as determined by applicable building code. does not exceed the design pressure values obtain by calculations in compliance with RAS 127 using the values listed in herein. The attachment calculations shall be done as a moment based System. 2. PRODUCT DESCRIPTION Manufactured by Test product nnlicant im cns i s SneciRe ti r s Descrinti•r1 • Sentare 'S' Clay I 18" PA I I? i Roof Tile O piece high profile clay w = I I.S" high y roof tile equipped with two nail holes. For nail - on. th ick mortar set and adhesive set applications. Trim Pieces 1 varies PA I t Accessory trim. clay roof pieces for use at w varies nips, rakes, ridges and valley terminations. varying Manufactured for each tile profile. thickness 2.1 COMPONENTS OR PRODUCTS MANUFACTURED 13Y OTHERS Product Test Product Tlirncnsioas Sneciticationi Description Tile Screws fib x 2_/" long PA 1 14 Manu f-urc� 0.130" shank die. Append E Stainless Steel generic 0.178 flute dia. 3. LIMITATIONS 3.i Fire classification is not pan of this acceptance. 3.2 For mortar or ndhesive set tile appftcanorts, a static field uplift test shaft be performed in accordance with RAS 106. 3.3 Applicant shall retain the services or a Miami -Dade County Certified Laboratory to perform quarterly test in accordance with PA I 1 2 mug submitted to the Building Code Compliance Otfic - - restrn hall be wimp. RRC Roofing Product Control Examiner P.06 Table 3: Attachment Resistance Expressed as a Moment- Mf (ft -lbf) For Nail -On SXstern Tile Profile Tile Application Two Nails One Screw Two Screws One Screw w/ Cli Two Screws w/ Cli• Santafe S Direct Deck 21.6 29.16 38 28 57.31 57.60 [3at1ens Direct Deck Santafe 'S' 5.90 ! 5.85 5.82 5.73 5.69 61,77 L I _ApEroved screws as noted 'Product m�nulpiturvd b othurs' Table 2: Restorin. Moments due to Gravit - M. ft-lb Table 4: Attachment Resistance Expressed as a Moment - M (ft-110) for Mortar or Adhesive Set Systems 2 ":12" Tile Profile 4 " ;12" Tile Application _ Attachment Resistance Santafe 'S' Battens D■rect Battens+ Direct Deck Deck Mortar set 23,6 Adhesive Set — 61.9 Table 2: Restorin. Moments due to Gravit - M. ft-lb Tile Profile 2 ":12" 3 ":12" 4 " ;12" 5 ":12" 6 ":12" 7'';12" or !reater Battens D■rect Battens+ Direct Deck Deck Earens Direct Deck Santafe '3' Direct Deck Battens Direct Deck Battens Direct Deck Santafe 'S' 5.93 5.90 ! 5.85 5.82 5.73 5.69 5.56 5 53 1 5.32 5.29 5,03 N/A • • JAN 27 2003 16:22 FR BRADCO TILE CNTR 43515 TO OEENOUR SANTAPEI LE CQR.POR.AT_1QN ACCEPTANCE No.: 00.1212.06 • 3.5 30/90 hot mopped underlaynent applications may be installed perpendicular to the roof slope unless stated otherwise by the underlaymcnt material manufacturers published literanue. 3.6 This acceptance is for wood deck applications. Minimum deck requirements shall be in compliance with applicable building cede. 4. INSTALLATION 4.1,1 Santafe and its components shall be installed in strict compliance with Miami Dade County Roofing Application Standard MS 118, RAS 119, and RAS 120. 4.1.2 Data For Attachment Calculations 3 rank Zuloaga, RRC Roofing Product Cvnt,rol Examiner P .07 Table 1: Aerodynamic Multiplyers— X. ft ') Tile Profile ). (ft') Batten A• • Iication X (ft') Direct peck Santafe '3' 0.274 0.297 • • JAN 27 2003 16:22 FR BRADCO TILE CNTR 43515 TO OEENOUR SANTAPEI LE CQR.POR.AT_1QN ACCEPTANCE No.: 00.1212.06 • 3.5 30/90 hot mopped underlaynent applications may be installed perpendicular to the roof slope unless stated otherwise by the underlaymcnt material manufacturers published literanue. 3.6 This acceptance is for wood deck applications. Minimum deck requirements shall be in compliance with applicable building cede. 4. INSTALLATION 4.1,1 Santafe and its components shall be installed in strict compliance with Miami Dade County Roofing Application Standard MS 118, RAS 119, and RAS 120. 4.1.2 Data For Attachment Calculations 3 rank Zuloaga, RRC Roofing Product Cvnt,rol Examiner P .07 1 JAM 27 2003 16:22 FR BRADCO TILE CNTR SANTAFE TILE CORPQRATION 5_ LABELING 5.1 All tiles shall bear the imprint or identifiable marking of the manufacturer's name or logo, or following statement: "Miami -Dade County Product Control Approved ". 6. BUILDING PERMIT REQUIREMENTS 6.1 Application for building permit Shall be accompanied by copies of the following: 6.1.1 This Notice of Acceptance. 6.1.2 Any other documents required by the Building Official or applicable Building Code in order to properly evaluate the installation of this system. PROFILE DRAWING SAr FAFt "SAIVTAFE S" CLAY ROOF TILE 4 43515 ACCEPTANCE No. 0042_I2.06 Pi ,:. '" TO OBENOUR P.08 Frank 2Woaga, RRC Roofing Product Control Examiner . •J'AN 27 2003 16:23 FR BRADCO TILE CNTR 1 , • 43515 r•..,.:', •.rte SANTAFE TILE CORPORATION ACCEPTANCE No.: 00- 1212.06 fvOTICE OP ACCEPTANCE STANDARD CONDITIONS I Renewal of this Acceptance (approval) shall be considered alter a renewal application has been filed and the original submitted documentation. including test supporting data, engineering documents, are no older than eight (8) years. 2 Any and all approved products shall be permanently labeled with the manufacturer's name, city, state, and the following statement: ''Miami -Dade County Product Control Approved ", or as specifically stated in the specific conditions of this Acceptance. 3 Renewals of Acceptance will not be considered if: s) There has been a change in the South Florida Building Code affecting the evaluation of this product and the product is not in compliance with the code changes; b) The product is no longer the same product (identical) as the one originally approved; c) It the Acceptance holder has not complied with all the requirements of this acceptance, including the correct installation of the product; d) The engineer who originally prepared, signed and sealed the required documentation initially submitted, is no longer practicing the engineering profession. 4 Any revision or change in the materials, use, and/or manufacture of the product or process shall automatically be cause for termination of this Acceptance, unless prior written approve] has been requested (through the filing of a revision application with appropriate fee) and granted by this office. 5 Any of the following shall also be grounds for removal of this Acceptance: a) Unsatisfactory performance of this product or process; b) Misuse of this Acceptance as an endorsement of any product, for sales, advertising or any other purposes. 6 The Notice of Acceptance number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. if any portion of the Notice of Acceptance is displayed, then it shall be done in its entirety. 7 A copy of this Acceptance as well as approved drawings and other documents, where it applies, shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at thcjob site at alt times. The copies need not be resealed by the engineer. 8 Failure to comply with any section of this Acceptance shall be cause for termination and removal of Acceptance, 9 This Acceptance contains pages 1 through 5 END OF THIS ACCEPTANCE 5 Frank Zuloaga, RAC Roofing Product Control Examiner TO OBENOIJR P.09 ** TOTAL PAGE.O9 ** PIA M IOAC)E The expense of such testing will bt: incurred by the rn.inutacturcr. ACCF,PTANCE NO OI_O521.0 I:XPIl2ES: p5 /10 /2006 '. 1 %01500011pc100011temphtcanecIco accermnee coyer Fait: dot tfl terne( rnnil:tddros: rtnstmnst erg(tildingcncicorilittc.corn t'8778P. SL OC O.L 'LCC9E9 SEC rvL.arv.tA r'KULL•I_L.). 1.'+t. . PRODUCT CONTROLNQTICE OF .&CCCPTAN'CI" Pnlyfoam Products, Inc. 2400 Spring- Stucbncr Road Spring ,TX 77383 -1132 MIAMI-DADE COUT.1 T Y. FLORIDA METRO -DADE FLAGi-E'R BUILDING t)(JILDING conE COMIPLI,INCE OFFICE,, O.�t7r; r•,,�..i NC 1.1O WEST nlCTZ FLAG D LEit S �"rTtl? �t!r:'E [3uILDt 1Go:1 h1I.\M1. r'LnRIDA 33130 -!5G) t::15.) 37S -291)i 1'AX ()OS) 375 -290M c:oNTRAc roc NI:CrrON 00.5)3/5.2f Q7 PAX 130S) 375 -;j,Y con - rftAC Ott t:vr ottCr:Ntl :NT urvistON 130 17s -19e.6 I:AX 0 I'ttODIJC!' CONTROL DIVISION (3u5) 37S -7902 IrAX P115).372.0;9 Your application for Notice: of Acceptance ( OA) of: Two Component Polyurcthcnc Foam Ac111csivc under Chapter 8 of the Code ofMiami-Dado County Bove rning the use of Alternate Materials and Typos Construction. and completely described herein, has been recommenced for acceptance by the Miami-Dade Coultty Bui!dinc, Code Compliance Office (13C00) under the conditions specified herein. This NO,A shall not be valid after the expiration date stated below. BCCO reserves the right to secure this product of material at any time from a jobsite or manufacturer's plant for quality control. testiob. If this product or material fails to perform in the approved manner. GCCO may revoke, rnodiCy, or suspend the utsc of such product or material immediately. BCCO reserve; the right to revolve this approval, if it is :Determined by 13000 that this product or material fails to meet the requirements of the South Florida 13ui!din6 Cade. / Raul Rodriguez Chief Product Control Division T_ ADDITIONAL PAGES roR SPECIFIC AND Cf NEIZAI. CONDITIONS i3L1TLt3ING COnT? SI. PROnu 1ZFvrFw COMMITTFT This application for Product Approval has been reviewed by the BCCO and approved by the Building Code and Product Review Committee to J used ir. Miami -Dada County, Florida under the conditions set forth above. l'roncisco J. Quintnna. R.A. Director ivti�nr -(Dade Co(J,u) �luiltling Cndc compliance OI 111002 Plnhlu ):I t; 11ttj;I /w w. butlii ngcndconlinc.com 0:100dS ad 175:9T CO. 97 . eld0 Vs. 1.1. V✓ J. L 1L J. •S'O 1 :1.1 O.J •1 .) . i V'ls A VLLL V.1.1 1 •. - aO d Per I,yfn:tm Products, ACCCP - TANCC No : 01-0521.02 R.00FtNG ASSE.MT3LY APPROVAL C:%tcEory: Roofing Sun -C:�te n Root'Tik Adhesive Ma terials: Polyurethane 1. SCOPE. This approves POlypru A1-1160 as manufactured by Polylfuarn Products, Inc. as described in Section 2 of this Notice or Acceptance. For the locctions where the design pressure requirements, as dcterminal by applicable building code, does nor exceed the design pressure values obtained by calculations in compliance with Roofing Application Startdard RAS 127, for use with approved flat. low. and high profile rooftiles system using Polypro0 AH 160. Where the attachment calculations are done as a moment based system for single patty placement, and as an uplift based system for double patty systems 2. PRODUCT DESCRIPTION Manufactured by Anplis!nt Palyproa) AHI6O Dimensions N/A Poamproa RTF 1000 N/A ProPack4 30 & 100 N/A Dispensing Equipment 2.1 Components or products manufactured by others: Any Miami -Dade County Product Control Accepted RoofTilc N,entbly having a current NOA which list uplift resistance values with the use of Pttlypro A11160 roof tile adhesive, 2,2 Typical Physical Properties: PrrIncrt� Test Density ASTM D 1632 Compressive ASTM D 1621 Strength Tcnsi le Strength ASTM D 1623 Water Absorption ASTM D 2127 Moisture Vapor ASTM C 96 Tra nsmissinn Dimensional ASTM D 2126 Stability '8 01 '' 9C9E9SO9 Tc3t Snccificlttinns PA 101 Results 1.6 lbsJft' 18 PSI Parallel to rise 12 f 5T Perpendicular to rise 28 PS1 Parallel to risL: 0,08 1.bs_/Ft 3.: Perm / Inch Approval Date: dime td 2n(1t lapiratiolt Date;' Melly 2006 +(1.91% Volume Clrtnge @ -400 r.. 2 weeks Volume Chance E.7 Ilunt itl■ly, 2 Nvcck Product Qeseriptio TWO conlponcnt polyurethane; (Dispensing Equipment S n v )r:1111; Zutoign. RRC Product Control Examiner o31lwda '.Jj t :9T COOc 8d1 1 0‘ , 14 , 1).) ltll 1 /:Utl CAN MJ'h ; .0144 CO ' d l'oly'foam Products, Ine. ACCEPTANCE No. : 01- 0521.02 Nett: The physic& properties listed above are presented as typical average values ns determined by accepted ASTM test methods :Ind iliac subject to normal manufacturing variation. 3. LIMITATIONS 3.1 Fire classification is not part of this acceptance R.cicr to the Prepared RoofTilc Assembly for tire rtttirw 3.2 I'olypro® A1.1160 shall solely be used with flat, low, & high ti!c profiles, 3.3 Minimum underlaymcnts shall be In compliance with the ftootins Application Standard RAS 120. 3.4 Roof Tile manufactures acc;uirir's acceptance for the use of Polyproe A1-11 GO roof the adhesive with their tilt assemblies shall test in accordance with PA 101. 3.5 Roof Tile manufactures acquiring acceptance for twc, paddy placement with the use of Polyproei A.H 1 G0 roof rile adhesive with their tile assemblies shall test in accordance with PA 101 and with section :0,4 as modified herein, I lV tvts 4. INSTALLATION 4.1 Polypro AI -1160 may be used with any rocf tile assembly having a current NOA that lists uplift resistance values with the use of Polypro$i AI-1160. 4.2 Poolyproi AI-I160 shall be applied in compliance with tile. Component Application section and the correspond:rig Placement Details noted herein The roof tilt assembly's adhesive attachment with the use of Polyproe A1-1160 shall provide sufficien.. attachment resistance, expressed as an uplift based system, to meet or exceed the uplift resistance determined in compliance with Miami -Dade County Roofing Application Standards RAS 127, The adhesive attachment data is noted in the roof tile assembly NOA 4.3 Polyproe AI roof tilt adhesive and its components shall be installed in accordance with Roof Application Standard RAS 120, and Polyfoant Produces, Enc. Polyprog AI-1160 Operating instruction and Maintenance Booklet. 4.4 Installation must be by a Factory Trained 'Qualified Applicator' approved and licensed by PolyFoam Products, Inc. PolyFoam Products Inc. shall supply a list or approved applicators to the authority (having jurisdiction, 4.5 Calibration of the Foanmpror9 dispensing equipment is required before application or any adhesive. The mix ratio between the "A" component and the "4" component shall be maintained between 1,0 -1.15 (A) : 1.0 (D). The dispense timer shall be set to deliver 0.0175 to 0.15 pounds per tile as determined ;.t calibration, No other settings shall be approved. 4.6 Poiyprog, Al-I 160 shall be applied with Foampro R1 1 000 or Prol'ackg;) 30 & 100 dispensing equipment only, 4.7 Polyproel A1.1160 shall not be cxposcd perm::/witty le swill 79t'88SLSt3E 01 t';_CCS69S09 3 rV>.?.rVO.N Frank Zuloaba, RRC Product Control Examiner . Y,J'.at , 49Qt1dt3 'ad SS : 9 t C002. 7 29 ddy 0.1f ".J 111E J. l • 1„ J':1.\ •J•3 •J 11) .L "•li Puly(oanl Products Inc. f ` C11:t!I r1�11Il1 j '.3011.. ACCEPTANCE N. 01 0521.02 4.9 Tiles must be adhered its freshly applied adhesive Tilc must be set within 2 to 2 minutes after Polypro0 AFH IGO has been dispensed 4,9 Polyproi AFIIGO placen!crt and minimum patty weight stall be in accordnncc with the 'Placement Details' herein, Encn gt,neric tile profile requires the specific placement holed herein. „ Table t: Adhesive Placement For t,)cl) Generic l ilc Profile TileProfilc _ — r Ylaccincnt S,nglc 1'ndA1y tV 7- j•wo Paddy Wcitht t)etni1� (grJnis) • per p1td,Jy [Main. (grnms) Flat, Low, F(it;l, hrofilas /II 35 NIA - } Profilc (2 Piece Barietj 1:1 17/side On cap and NIA 34/pan Flat, Low, Moll Profiles V 24 N/A 6 F11t, Low, 1.141 Profiles _ y� -- —1- - - - �. LABELING AJI Polypro® AH160 containers shall comply with the Standard Conditions Listed hrein. 6. BUILDING PEEWIT RCQL 6.1 As required by the Building Official or applicable Building Code it order to properly evaluate the installation of this system r•0' d 1'8t'8SSZSOC 01 tr1809ESS08 4 rrankLuloaba, 1ZRC Product Control Examiner W o t l :) OOQHds SS :9T corn 0 dd'i 02=13.'03 1HU 17:10 MI 854 578 10.12 1U,I„ -u.tji MODL c7 S. 1;4c. . SO•d Poly-foam Products fnc. AultesiV'E PLACEMENT DETAIL 1 SINGLE PATTY clr1 C wta M..P INau911 puelI Egmont lnder>eant Gvl CPVrl1 h ave Mitt Ml' K4.4 ldhllhl arm, 4 ).1, I, , *ea eltelro Fl.3 laleoe4, :411 Fi / L 1 , 4 W heiNe 1 L' Y trp ,dnelha Japtoa 4i r,� / /. L I•:n •■•plfe .a Paddy I134nt4PI t441 P +lh 41q 5 4 .'I!Vov9nYlaallc trAleAt i Y Fl +a Cnry Elveaune In♦M h:mp adhelhn aprcJ 4 In u! In" velllohe f 11 FIJtt cn1149h MVO/ CIO. JeMne 17 to A i ii Ine?rc1 In C01 4 .i111 the pin irte i) um PG,nl PJ)epdam.FUe,1CletNel Jr, IA re 1 9 , ham o al eh? a dge of c e. yr too, No L.41111. ■ilt. ACCEPTANCE No.: 01-0521.02 I.02 Weleheb F. Ba bplmn,l ipa 11 41449 Pilch 200 1lr,tlp0l r+ael■ 'grow 7,., demur. OAF 1491 )la1 duovph 01414 cerelf O9aen11 Pae'Ikp Yang IONIIVAhhi 1.1911 $ I rank, 21II01gl, RAC Product. Control Cxa.•nincr 1hn 11Ytp I*r.) PSPSS LS09 01 ' r LCC9SS JC ODIJUd8 dd 9 S : 9 1 C002 20 d' u: ; a� ua 1nl 4s;Au rA.S. ra's Jcq ,lint: Polyfonrn Products, Inc. P31Cy (9rnS)Ih Tie) £iel Cr ..VIO N.— Fascia ' fa3cl7 Mephele bye c;o,m Drip eddt Nall tnrough Alatt)c Cement W \ 1 7 6.iw Clasur, EPS Come r a z-V,1dl ritumt. i • is "'l . lg ii ACCEPTANCI.. No.: 01- O52I.02 ADHESIVE PLACEMENT DETAIL 2 SINGLE PATTY Na Irlr ouolr pIa011C Cement Un ded)prnenl 1 7 90 d bsreas,Lsoc 01 b,' Er9E9sfC 6 NSii Ncun6 plas(IC Cemonl / Upaet yrn nl ` • . e.r■e Cam r Frank Zulonga, RItC Produce Control Examiner plddy(8tnuth Tlle) 00(1HdG dd 99: 9 T C007 30 ddH PalYrC13111_PrOdUCtS, Nail through plaatIc cement ( ' RJ in, Slog' o Pa Orty on Oder leyrnen: Stogie may on lop of tile SirOvaddy oderm ADIIESIVE PLACEMENT DETAIL 3 DOUBLE PATTY Hai! ihrou3h emcnt \ 7 %elm, r 3 In, Single paddy cr. underlaymenl Single paddy on lop oldie Pa.idr theIldoon Wu) FaOry lundor Ill) fire Como LO'd P8beegLSOC 01 t'LCC969g0C t in. X7 in, Nisei li pddy tom ropy 7 • I • •••••••■ • IN .0 •• I .••••/ • •••■■•■■... ACCEPTANCE No. : U1-0521.02 Nail 1hr c.gh plaat;r: \ / Undtrlaymtrt NN N, r e - 4 In, 1 In, Sin9le pelely 0/1 odor. lament Einglr paddy on tap of ille :61.116 ENve CiesAtt 1 In. x 7 In. medium size 14 ddy our onfy -'•' Fascia Frank Zulonga, RRC Pruchic: Comm' ...rxnmillt.r Single may under II Single paddy cchveer Ille / In. r 7 n't meoli1111 Ii g paddy neve course only rascla Weepnole 'Eve clore Orlp edge ODGUe4E1 Id LS:9I C007 7.0 dc10 ** e0•391d 1d101 ** Renewal of this Acceptance (approval) shall be considered alter r, rciiewal application has beer filed and the original submitted documents, including tot-supporting data, cogineer,ny documents. are no older than cibh: (t;) years, 2. Any and all approved procucts shall be permanently labeler; ee,tle the inanutc.eturer's name, city, state, and the rollorvin�t st : ;tcr11 n :: 1\iiatlnt -U ;t County Product C+yutrol Approval ". or as specifically stated in th peed c conditions of this AcCeptance:, 3 Renetvals of Acceptance will not be considered if: There has been a change in the South Florida Ouildcrng Code atiectirig the evaluation of this product and the product is not in compliance ',v th the code clt ,nge�. b The prodf.tct is no longer the same product (identical) as the one originally approved. e. if the Acceptance- holder has not complied evith all the requirements of this acceptance, including the correct installation of he product. d. The engineer who originally prepared, signed and sealed the rcc,u,rcd documentation initially submitted, is no longer practicing the cnginccring prol tssion 80'd Palvf9gm Products, Inc. ACCEPTANCE No. : 0 0521,02 4. Any revision or change :n the ma,crials, use, andior manufacture of the product or process shall automatically be cause for termination of this Acceptance, unless prior written approval has been r„qucstcd (through the filing or a revision application with appropriat,: fee) and granted by this office, Any of the following shall also be grounds for removal of this Accepl;ince: a. Unsatisfactory performance of this product or process. b lvlisuse of this Acceptance as an endorsement or any product. for ,ala aJvertisirlg or any other purposes The Nonce of Acceptance In tinber preceded by the: words N.liaini•Utde. County, florida, and fol;owcd by the CNILration Cate nray be displayed in advertising Literature. if znv portion of t h e Notice or Acceptance is displayed, then it skull be done in iis entiraiy. 7 A copy of this Acceptance 'yell as approved drawings and ath':r documents, where it al)plics, shall be provided to the user by the manufacturer or its distributors ano shill be available for inspection at the job site at all time. The engineer acrd not reseal the copies, ti, Failure to comply with ony section of t,nis Acceptance shall be cause for termination and removal of Acceptance, 9. This Notice of Acceptance consists ofptses I through S. ENn Or THIS ACCEPTANCE 178t788SLSOC 01 t.. C969SFJC i'ra,ik Zulo ;ga, RRC Product Control CNarrninur O3QUr3 Jd 1.S:91 C002 P.0 H,-4H 3 7 aa5 MIAMI SHORB,S VILLAGE BUILDING D'EPAR4MENT 305- 795 -2204 Building Inspection Request Date — 1 1 1 C7 Time Type Insp'n t ►�� �r Permit No. 6P 3- 14 G 1 Name U? Address 843 Compan L o .. OUR 'Redt rr1 Phone # 305.151 • ..6 1a For Inspector: 3p ci L` I Name & Date Approved Correction Re- Insp'n Fee ❑ MIAMI SHOROS VILLAGE BUILDING DEfrAkTMENT 305-795-2204 Building Inspection Request Date ' `Ne Type Insp'n ! • Permit No. Name N. Address ' f Company Phone # For Inspector: Approved Correction Re-Insp'n Fee - Name & Date - 7 Nr No. RESULT No. RESULT No. RESULT No. RESULT No. RESULT 1 -5 Passed 21 -25 Passed 43-45 Passed 71 -75 91 -95 6 -10 Passed 26 -30 Passed 46 -53 Passed 76 -80 96 -100 11 -15 Passed 31 -35 Passed 54 -60 81 -85 101 -105 16 -20 Passed 36 -42 Passed 65 -70 86 -90 106 -200 ting Building Solutions For The Construction Industry ineering & nsulting, Inc. P. O. Box 770694, Miami, FL 33177 Certificate No.02- 0501.06 PROPERTY ADDRESS: 843 NE 96 ST. PERMIT No: 2003 - 1167. OWNER: Knox. CONTRACTOR: Obenour Roofing ROOFING SQUARES: 29 sq. TILE TYPE: Santa Fe. CONTACT PERSON.: Yusi (786) 486 -6468 FIS 2 THIS ROOF HAS PASSED: Voice: (786) 486 -6468 FAILED f l THE STATIC UPLIFT IN ACCORDANCE WITH MIAMI -DADE COUNTY PAI06. CONCENTRATED UPLIFT LOAD TESTING ON ROOF TILE TO COMPLY WITH METRO -DADE COUNTY PROTOCOL PA -106 "ROOF SKETCH" 44 Test Tabulation 22 40 47 42 30 31 45 43 41 32 33 17 20 23 39 37 / 35 29 25 24 26 PCA No: ROOF PITCH: 3/12 INSPECTION DATE: 08/25/03 TEST DATE: 09/05/03 38 36 28 27 JOB NUMBER: Lab Report No. 03- 090033 Required Testing Force: 35 Ibs www.FloridaTEC.net Fax: 305- 408 -1367 35t3 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Dat 0-.S Time Type Insp'n ?A � a:, 2 Permit No. BP a )?? i ` tG Name K y Address 843 q sfi Company D f nJ R . Phone # 5. r For Inspector: p ts 2C, Name & Date Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Dated = Time Type Insp'n Permit No. Name o� Address Company t Phone # For Inspector: Name & Date Approved Correction Re- Insp'n Fee