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366 NE 99 St (2).:...) S MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Dat ? 0 Type Insp'n Permit No. Name Address Company Phone # Inspection Date Approved Correction Re- Insp'n Fee o o Date Time Type Insp'n ,L P 03 -134 Permit No. ti' 7 Name /4 Address _3_‘S /( /A- 7 9 5 Company &54 Phone # For Inspector: Name & Date Approved Correction Re- Insp'n Fee MIAMI SHORES- VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date Type Insp'n Permit No. Name • ,'.1 • Address MIAMI SHORES VILLAGE 4 BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request 0 Company Pho 7 Inspection Date (� i o Approved Correction ❑ Re- Insp'n Fee LG ENGINEERING SERVICES, INC. c• 1• V• 1• t Consulting Engineers E•N•G•I•N•E•E•R John Busta Roofing 300 Northeast 91 Street Miami Shores, Florida Project: Dear Sirs; 2020 Northwest 7th Street Miami, Florida 33125 Tel: (305) 649 -6454 Fax: (305) 541 -3298 TILE UPLIFT TEST Residential Rothe 366 Northeast 99 Street Miami Shores, Florida Information provided by client: Permit Number: Not Available Date Completion: May 24, 2004 Roofing Contractor: Joh' Busta Roofing LG Engineering Services, Inc. Project Number: LGO4 -1.819 (Testing Laboratory Certificate #00- 0224.07) In accordance with your request and authorization, a representative ofLG Engineering Services, Inc. completed the Roof Tile Uplift Test at the above referenced project. This testing was performed in general accordance with Roofing Application Standard TAS No.106 -- Standard procedure for field verification of the bonding of mortar or adhesive set tile system and mechanically attached, rigid, discontinuous roof systems. The total of the tested roof surface area was less than 10000 square feet, and the mean height of the roof is less than 30 feet above ground surface. The type of tile used for this project was reported to be Monier Roof Tile. This tile was reported to have been foamed in place. At the time of this testing, one test for every corner, one test for every 100 square feet of roof tile in the perimeter area and one test for every 200 square feet of roof tile in the field area were tested. Initially the entire area of the roof was examine for loose tile. More than 10% of the roof tile located in the field area and more than 20% of the roof tile at the roof perimeter and corner were physically examined. Based on our test results, we conclude that the installation of the roof tile at the a project meets the test requirement outlined in the above mentioned protocol. A a copy of our test report for your review. 7 July 6, 2004 iced LG Engineering Services, Inc. appreciates the opportunity of assisting you in this project. If you have any questions or if we may be of further assistance, please do not hesitate to contact the undersigned. Respectfully submitted; LG Engineering Services, Inc. /Moliamad Sonny Saileh, P.E. Project Manager TILE UPLIFT TEST Residential Home 366 Northeast 99 Street Miami Shores, Florida Report of TILE UPLIFT TEST for Residential Home 366 Northeast 99 Street Miami Shores, Florida Project Number: LG04 -1819 LG Engineering Services, Inc. -- Tile Uplift Test Result -- Project Number: LGO4 -1819, Page 1 Test Number Test Load (lbf) Test Status 1 35 Pass 2 35 Pass 3 35 Pass 4 35 Pass 5 35 Pass 6 35 Pass 7 35 Pass 8 35 Pass 9 35 .Pass 10 35 Pass 11 35 Pass 12 35 Pass 13 35 Pass 14 35 Pass 15 35 Pass 16 35 Pass 17 35 Pass 18 35 Pass 19 35 Pass 20 35 Pass 21 35 Pass 22 35 Pass 23 35 Pass 24 35 Pass Report of TILE UPLIFT TEST for Residential Home 366 Northeast 99 Street Miami Shores, Florida Project Number: LG04 -1819 LG Engineering Services, Inc. -- Tile Uplift Test Result -- Project Number: LGO4 -1819, Page 1 Test Number Test Load (Ibf) Test Status 25 35 Pass 26 35 Pass 27 35 Pass 28 35 Pass 29 35 Pass 30 35 Pass 31 35 Pass 32 35 Pass 33 35 Pass 34 35 Pass 35 35 Pass 36 35 Pass 37 35 Pass 38 35 Pass 39 35 -- — Pass 40 35 Pass 41 35 Pass 42 35 Pass 43 35 Pass 44 35 Pass 45 35 Pass 46 35 Pass 47 35 Pass 48 35 Pass 49 35 Pass 50 35 Pass 51 35 Pass 52 35 Pass 53 35 Pass 54 35 Pass LG Engineering Services, Inc. -- Tile Uplift Test Result -- Project Number: LG04 - 1819, Page 2 Test Number Test Load (lbf) Test Status 55 35 Pass 56 35 Pass 57 35 Pass 58 35 Pass 59 35 Pass 60 35 Pass 61 35 Pass 62 35 Pass 63 35 Pass 64 35 Pass 65 35 Pass 66 35 Pass 67 35 Pass 68 35 Pass 69 35 Pass 70 35 Pass 71 35 Pass 72 35 Pass 73 35 Pass 74 35 Pass 75 35 Pass 76 35 Pass 77 35 Pass 78 35 Pass 79 35 Pass LG Engineering Services, Inc. -- Tile Uplift Test Result -- Project Number: LG04 - ]819, Page 3 7 Dal /24 24 Job Address / 99 a7' Legal Description Owner /Lessee/Tenet��C f'KJYS Owner's Address366!E 99 o g� � A i A €Z.22 . .' Contracti ng �7 C '` Qualifier J /4 (f A /'A State # t% o ' O9fg. Municipal # Square Ft. g'C Si Notary as to fawner • My Commission ExpiI ., PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 10050 N.E. 2nd Avenue • Miami Shores, Florida 33138 • Phone: 305 - 795 -2204 • Fax: 305- 756 -8972 and/or Co •o President it t te 74/,_ of Florida 0, "' ..Arr ' ! R . Commission # rDt) in %. „, g '• Bonded By NI:t1 :'ai P+°c FEES: PERMIT APPROVED: Zoning Building Mechanical RADON Plumbing ZZb9 vcr •Aw y, 03 G Tax Folio Address Competency # C.C.F NOTARY 1/ ?2L - 0/3. ated: Yes Permit # it5P zoo3 - /V/ -6.96 No SS# Phone' S rp W5 Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL WORK 15ESCRIPTION: / `'�. pp 0/ Estimated Cost (value) / rZ!'.�ID. Signature of Contractor or Owner Builder NOV 2 Li 20 g ectr ►eal Ins. Co. IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY, THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE BEFORE CALLING FOR ANOTHER INSPECTION. 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 ANY 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 all disciplines. OWNER A'' IDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulat g co ;� ti• nd z. ing. Furthermore, I authorize the above named con tpr to do the work stated. 4/ 2-'4 / 9 Date BOND TOTAL DUE Structural Engineer BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): $ Value of Work For this Permit (Continued on opposite side) M iami Shores Village Building Department 1 0050 N.E.2nd Avenue, Miami Skotes, Florida 33138 Tel (305) 795.2204 Fax (305) 756,8972 Ele State Type of Work: ❑ Addition ©Alteration Describe Work: Submittal Fee $ rd Permit Fee $ 6 DNew Notary $ Training/Education Fee $ j Scanning $ 6 ' Radon $ Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ Permit No. /7 3 ! /8 Master Permit No. Phone # Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) Phone # Owner's Address City State Zip Tenant/Lessee Name Phone # Job Address (where the work is being done) City Miami Shores Village County Miami-Dade Zip Is Building Historically Designated YES NO Contractor's Company Name Contractor's Address City Qualifier Zip Architect/Engineer's Name (if applicable) Phone # Square Footage Of Work: 686 �epair/lteplace 0 Demolition * * * * * * * * * * * * * * * ** ** * * * * * *+ Fees * ** *** * * * *** * * * * * * * * * * * * * * * * ** CCFS OJ Technology Fee S Bond $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 _ , by , day of , 20 _, by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: My Commission Expires: My Commission Expires: (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. ****************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** f ************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** NOV 2+ 2003 APPLICATION APPROVED BY: Plans Examiner Chc 10/14/03 Engineer Zoning Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 11/26/2003 Applicant: GLADYS YAMIR Owner: ABREU JOB ADDRESS: 366 NE 99 Contractor JOHN BUSTA Local Phone: 305 - 219 -9699 Parcel # 1132060135560 Signed: (INSPECTOR) Building Permit Permit Number: BP2003 -1841 ABREU GLADYS YAMIR ST Contractor's Address: 300 NE 91 ST Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 3 & 4 Page 1 of 1 Fees: FEE2003 -7493 FEE2003 -7496 FEE2003 -7497 FEE2003 -7498 FEE2003 -7499 Description Building Fee CCF Training and Education Fee Technology Fee Scanning Fee Total Fees: Amount $300.00 $7.20 $2.40 $7.50 $6.00 $323.10 Total Fees: $323.10 Total Receipts ` a t'* l3, C I C 22a Permit Status: APPROVED Permit Expiration: 5/22/2004 Construction Value: Work: RE- ROOFING SANTE FE "S" FUME COLOR THRU TILE DEC 1 O P4iD BLK 41 LOT SIZE 100.000 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: Lk NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO/A3206 0/3 5 S49 STATE OF FLORIDA: COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street/address: IQE99 3 Am/tfi 557ekEz.,_AA, _ /64* (SAeiee.C 44g P A la -70 4973 3 le 4 AK 9 : 2. Description of improvement: IZZ a/c 3. Owner(s) name and address: 2i./46YS Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address (26) IVE 6 33/ CF r 'A, COUNT 5. Surety: (Payment bond required by owner from contractor, it any) - r -f 1 t2:67:py of the Name and address: —0 Amount of bond $ r "ItY4 BY 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: 6. Lender's name and address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: 3- A AF 91 s Notice of Commencement: (the expiration date is 1 year from the date of recording unless a d) ner's Namc2 >< Prepared o and subscribed before me this 6 ,T4_ day of W i C:20,, , 20V3. • -ECM tam KELLER Notary Public Stko..aistorirso. Commission Expose Apt 4.2005 Commission 0 DD 10725 'VFW Bonded By National Notary Assn. V Notary Publi Print Notary's Name_ My cornmission expires: CALCA LY1\ e ieI _Ur4eac) C:4 20031F<0E3 966 OR Bk 21875 F' 2641; (11 RECORDED 12/05/2003 09:54:21 HARVEY RUVIN, CLERK OF COURT MIAMI-DADE COUNTYr FLORIDA LAST PAGE y of 111111111111111111111111111111111111111111111 ..-..- - " ).- i f . , s nty Courts • :. D.C. Address: 3a /f.' 9/ „s7- 4544,/ 33/- g r 1 Master Permit No._ Process No. Contractor's NaineTWA6.72941.e., Job Address 66IVE c.,17gaFZ / Roof Category Low slope Mechanically Fastenei I Tile Mortar/Adhesive Set Tile ...._ Asphaltic Shingles Metal Panel/Shingles Wood Shingles/Slitikes _._ _ ..._ _ Prescuplive 111112-RAS 150 _. ... Roof Type New Roof Re-roofing Recovering Repair Maintenaiie(- ...__.. .. Low StopeRoof Ara (SF) Sketch Roof Plait: Illustrate all level:, and sections, roof drains, scuppers, overflow scuppers anti ovei flow drains_ Include 1 dimensions of sections and levels; cleat ly identify dimensions of elevated piessint Ames and location of parapets. . _....... „... . . Florida Building Code Edition 2002 HIGH VELOCI fle HURRICANE ZONE UNIFORM ROOFING PERMIT APPLICATION Section A 0;encral Information) 2/ Roof System information Stocp Sloped Roof Area (SF) Total (SF) •Zgs4 gg-g Section 11 (Roof Plan) 12. 3$1 Florida Building Code Edition 2002 HIGH VELOCITY HURRICANE ZONE UNIFORM ROOFING PERMIT APPLICATION Section C (Low Sloped Roof System) Fill in the specific Roof Assembly Components and Identify Mannfac rer (If a component is not use identify as "NA ") System Manufacturer: _. NOA No: Design Wind Pressures, From RAS 1 Pmax i Pmax 2: _ Pmax 3: Maximum Design Pressure, From the Speci i NOA System: Deck: Slope: Anchor /Base Sheet & No. of Ply(s):_ Anchor /f3ase Sheet Fastener /Bonding Material: Insulation Base Layer: Base Insulation Size and Thickness___ Base insulation Fastener /Bonding Material: Top Insulation Layer: Top Insulation Size and Thickness:_____ Top Insulation Fastener /Bonding Material: Base Shcet(s) & No. of Ply(s): Base Sheet Fastener/Bonding Material: Ply Sheet(s) & No. of Ply(s): Ply Sheet Fastener /Bonding Mat • ial: Top Ply: Type: ..____ Gauge/ fhichness:_ _ Top Ply Fastener /Bondi g Material: Surfacing: or Calculations: Fastener Spacing for Anchor : ase Sheet Attachment Field:_ _"o/c n laps & rows © _ "o /c Perimeter: "o /c aps & rows w. "o /c Corner:__ "o /c ii), laps & rows @ Number of has eners Per Insulation Board Field Perimeter Corner Illustr e Components Noted and Details As Ap Iicable: Woo locking, Gutter, Edge Terminations, Stri ping, , Flashing, Continuous Cleat, Cant St p, Base Flashing, Counter - flashing„ Coping, c. ndicate: Mean Roof Height, Parapet Height, Height of Base Flashing, Component Material, , Material Thickness, Fastener Type, Fastener Spacing Or: Submit Manufacturers Details that Comply with RAS-111 and Chapter 16 NJ° r f utget WA Hight Ft Mt in Rocf Heiflit ____Ft f Mean Roof Height: Florida Building Code Edition 2002 HIGH VELOCITY HURRICANE ZONE UNIFORM ROOFING PERMIT APPLICATION Section 1) (Steep Sloped Roof System) Roof System M anufacturer:S 1l et7p/9.QT/O/(J Notice of Acceptance Number: 0 6 2— /2,,/Z0-6 Miufmuln Design Wind Pressures, If Applicable (from RAS 127 or Calculations): P 1: 1 /9.7 I'2: /044 9 P3: ./a f Maximum Design Wind Pressure �/ (From the NOA Specific System): Method of tile attachment: /q9L,YEaN(A0/ c7 Steep Sloped Roof System Description Deck Type: /(�� 6 1L.7 Underlayment Type: h` 3d Insulation: AA Fire l3an•ier: N/ -42./11:2_ Fastener Type & Spacing���EFIA b "oG MP AdhesiveTypA�1�� i Type Cap Sheei r Roof Coverin4/�/ 1 / n Z��7:U�. Type " r __ ±� €E�` _ 7.6 sal. — Edge: Florida Budding Code Edition 2002 HIGH VELOCITY HURRICANE ZONE UNIVORM ROOFING PERMIT APPI.114 !ATKIN For moment based tile systems, chose either Method tor 2. Compare the values for M,. with the values from M. If the M values are greater than or equal to the M values, for each area of the roof, then the the attachment tnethod is acceptable. Po_ 7 x / .26 ) 907 NOA M1: x A, Sca NOA M, NOA Method 2 "Simplified Tile Calculation Per Table Below" Required Moment of Resistance (I\4) From Table Belo' . Mean Hoof I (eight Roof Slope 2: 12 3.42 5 :12 6712. 7:12 _ •__ __•__••_.• Method 1 "Moment [lased 'I'ile Calculations l'er RAS 127" Mello aunt I feig _ _ ht II ._ _ Root 0 - A r iiyitWi.4tiiiiiTici1 :-.--- - x 1 mg Morte to due to fit a‘;ty - -- - - - Rl. Attachittearattec _ Mt 1-Fe It ests •--- - - 11 Atria R;taitec I-' Kt:wined Uplift Re:OM:loco F. __ ._ Avetngc: 'rile Weight W _ I - length - Tilc 1)inicicatnis vc . width • SECTION E (Tile (.altmlations) NOA M liequire 15' 25' 30' 14.4 6 38.2 39.7 1 2.2 34.4 - 73676 10.4 32.2 . 33.8 - 3:1.1 • _ 28.4 30.1 14.6 32.8 _ 26.4 28.0 29.4 - 30.5 24.4 25.9 27.1 28.2 40' 42.2 19.8 17.1 34.9 32.4 30.0 ' table must be used hi conjunction with a list of moment based tile systems endorsed by the (froward County Board of Rules and Appeals. For uplift based the systems use Method 3. Compare the s•alues for lo with the values for If the 1 values are greater than or equal to the F,. values, or each area of the roof, then the the attachment method is acceptable. Method 3 "Uplift Based Tile Calculations Per ItAS 127" (Po__ x I: - _ x w:) -- w:_ ___ X cos 0: ,--, F, o NOA 1 ) - w: x cos 0: __ F x 1:___ - x w: ) - sv: x cos 0: _ _ _ :,--- F 14([A F':________ Where to Obtain Information Descripoott sytithoi 'A het e to bind p I or P2 ol 1 KA. 4 table 4 •t hy int mph:el analysts pittirett bya FE" All SOIniiittett to Mr Building Official at lite little of penult application. Imseklott ASCE 7 Joh Site fob Site NOA NOA NOA Nt )A ------- •- NOA SECTION 1524 RICH VELOCITY HURRICANE ZONES REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS • 1524.1 As it per"ttniS this section, it is the responsibility of the roofing contractor to provide the owner with the required ro fmg permit., and to explain to the owner the content of this secton.. 'The provisions of Chapter 15 uf•ffie Florida Building Code., 13riilding g �� ��llowi it should be -actdra�cdnas�part�tif industry for melt roofing system installations. Additionally, Between die owner and the contractor. The ti++vner's initial in the adjacent box indicates thatt.tha ittu tak1s_1 ►'J * ex nlained. 1. Aesthetics - Workmanship: The workmanship provisions of Chapter 15 (high Velocity Hurricane �) are for the purpose of pr ovidin g that the roofing system meets the wind resistance and water intrusion �o p &mance stsiadards. Aesthetics (appearance) issues arc not a consideration with respect to workmanship provisioiis. Acstlietic issue.. such as ci4knr or architectural appearance, that are not part of a zoning code, shout ressed as part of the agreement between the owner and the contractor. / 2. Reuniting Wood Decks: When replacing roofing, the existing wood roof deck may have to be nailed in accordance with the current all concealed priorto removing the Velocity xisting roof system). Zones) attic Florida rig Code. (The roof deck is miss y 7 �)t3t1iF5KC8iIlrtt�;l,�lE;4: 3. Common Roofs: Common roofs arc those which have no visible de$in+uat nits (i.e. townhouses, condominiums; etc.). In units wt `vork totbeip roofs, di t;1 kiiku .Onhtnito641t144i) ! should notify the occupants of adjacent un K . 4. Exposed Ceilings. Exposed, open beam ceilings are where the underside f the ro o ro nail can vi .wed from. below. The owner may wish to maintain the architectural appearance, p (netrations of the underside of the decking miay not be acceptable. The Florida Building Code provides the o• of maintaining this appearance. 5. Ponding Water: The current roof system and/or deck of the building may not drain will and may l c, use water to pond (accwrxitate) in low-lying areas on• 1 the struQU structural entgineer. can Pond be may hortcis e life distress and may require the review of a professional and performance of the new roofing system. Ponding conditions may not be evident until the o m 1 rooting system is removed. Ponding conditions should be con --- G. Overflow scuppers (wall outlets): It is walls o required r other roof extensions may block this discharge ge erloaded from a build up of water. Perimeter /edge v overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in nee with the Florida Building Code, Plumbing. .._ Veiitii:itioni: Most roof structures should t haThe some existing tl timount of attic ventilation the rio t' the structural assembly (the building f) redo ed. may he beneficial to consider additional venting which can result in extending the service life of the root C n1n UM E..IttmOt.nGALS•10-..1ASEC110I 13114x' Date Conttactor's Signature 09/29/2003 09:23 MEDITERRANEAN ROOF TILE * 3057572728 • • MIAMI-DADE MI' 1'12Q»UCT CONT�2 NI )1 CiE A CCEPTANCE Santa Fe Tile Corporation 10302 N.W. South River Drive, Bay #I6 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 governing the use of Alternate Materials and Typcs 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 alter the expiration date stated below. BCCO reserves the right to secure this product or material at any time from a jobsite or manufacturer's plant for quality control testing. If this product or material fails to perform in the approved manner. I3CCO muy revoke, modify, or suspend thc 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 thc South Florida Building Code. The expense of such testing' will be incurred by thc manufacturer. ACCEPTANCE NO.: 00-1212.06 Raul Rodriguez Chief Product Control Division THIS 1S THE COVERSHFFT, SE .F. AnnITlON AL PACES FOR srt :CIFic ANI2SaLEAAL coNt)ITIONS BUILDING CODE PROi)1)CT REViEW COMMIT'[ 1:F: NO.009 17001 MIAMI - DADE COUNTY. FLORIDA METRO -DADE FLAGL£R BUILDING •iuI U)INC CODE Cc»IrU.%NCiI OU 10E ML•'TRO.0IDC• Vft.AOLCIt (WILDING 140 WC T FL/1GLER STREET. Su IT 160; MIAMI. 11.OIUDA 33130.1S4e (305) 375 -2901 t:AX 005) 375.290$ CONTRACTOR I.tCeNSI.0 SE:CiION 00S) 375.2527 CAN (305) )75-255$ CON t :NFOKCEmeN r o)V'IetoN )0$)375-2946 FAX ()OS) )75 -290$ I•ItODUCTCONTROL VIVIstOS (303) 373 -2902 FAX (305) )724339 • 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. APPROVED: 02/01 /7001 Francisco J. Quintana. R.A. Director Miami - Dade County Iluildint; Code Compliance Office 11,O4 OOOtNpe20001kmVhte !+W2ti9A•«wb^er wtedet. Internet mail :addre:eS: roams +ICreLuildiOgtodeY►ntinC.COM a 1(untcpage: help : / /w'ww.huildingCOdeOAliMC -Cem T -d OQO0888SOE uot7.a.iod..io3 et:Tl .'ejeaues dLZ :EO CO ucU •'t • 09/29/2003 • 1 A 09:23 MEDITERRANEAN ROOF TILE 4 3057572728 SANTAFE TILE CORPORATION ACCEPTANCE No.: 00- 1212.06 • ROOFING ASSEMBLY APPROVAL (atCwn Roofing Approval Date: Fchruary 1, 200t Q,r11_('ar1 �nr r, 07320 Roofing Tiles Expiration Date: Fshruary I, 2006 Materials Clay Roof Tiles Deck Tvpc_ Wood 1. SCOPE This renews a roofing system using Santa 1'c "Santafc 'S" clay roofing tile. manufactured by Santafc Tile Corporation described in Section 2 of this Notice of Acceptance. designed to comply with the South Florida Building Codc, 1994 Edition for Miami -Dade County. For locations where the design pressure requirements, as determined by applicable building code. dots not exceed the design pressure values obtain by calculations in compliance with R.AS 127 'using the values listed in herein. Thc attachment calculations shall be done a n115rnrnt based system. 2. PRODUCT DESCRIPTION Manvfn for ► by Annlic:snt Santafe 'S' Clay Roof Tile i rim Pieces Test 1)tm nriAM Specifications 1= 18" w= 11.5" %:" thick I= varies w « varies varying thickness Test product D imensians Spccifcat, i Tile Screws N8 x 2 - long PA 114 0.130" shank dia. Appendix E 0.178 flute dia. PA 112 One piece high profile clay roof tile equipped with two nail holes. For nail -On. mortar sct and adhesive sct applications. PA 112 Accessory trim, clay roof pieces for use at hips, rakes, ridges and valley tcnminations. Manufactured for each tilt profile. 2.1 COMPONENTS OR PRODUCTS MANUFACTURED BY OTHERS Product Description Minufat;tttrer Stainless Steel generic 3. LIMITATIONS 3.1 Fire classification is not part of this acceptance. 3.2 For mortar or adhesive set tilc applications. a static field uplift test shall be performed in accordance with RAS 106. 3.3 Applicant shall retain the services of a Miami -Dade County Certified laboratory to perform quarterly icst in accordance with PA 112 apppadi._' shall be submined to the Building Codc Compliance 011ie Product r«ri Minn r2iioaga. RRC Roofing Product Control Examiner NO.009 P002 • 09/.29/2003 • • • SANTAFE'�iLECORPORATION ACCEPTANCE No.: 00- 1212.06 3.5 30190 hot mopped undcrlaymcnt applications may bc installed perpcndicutar to the roof slope unless stated otherwise by the undcrlaymcnt material manufacturers publish literature, 3.6 This acceptance is for wood deck applications. Minimum dcck requirements shall bc in compliance with applicable building code. 4. INSTALLATION 4.1.1 Saota„fe'S' and its components shall be installed in strict compliance with Miami Dade County Roofing Application Standard RAS 11S, RAS 119. and RAS 120. 4,1.2 Data For Attachment Calculations Santate 'S' Tile Profile Santale S A. •roved Santale 09:23 I'EDITERRAPEAN ROOF TILE 4 3057572728 Tile Profile Tile 2 ":12" Profile Battens Direct Deck S tate 'S' r 5.93 3.90 Tice Profile Table 2: Restoring Moments due to Gravity - M (ft -Ib9 3 ":12" 4":17" 5 ":12" 6 ":12" Tile Application Direct Deck Battens Table 1: Acrod amic Multi • 1 ers— X X. ye) Batten Application - -- 0.274 Banens 5.85 Table 3: Attachment Resistance Expressed as a Moment- Mf (ft -lbt) For Nail -On S Stem Two Nails 21.8 Direct Deck 5.82 screws as noted 'Product manufactured b others' ft X (ft Direct Deck 0.297 Battens Direct Sanens Direct Battens Direct Deck Deck Deck 5 73 5.69 5.56 5.53 5.32 5.29 One Screw 29.16 Tile Application Mortar Set Ad S Two Screws 38.28 One Screw X 5 7 31' 5.03 Table 4: Attachment Resistance Expressed as a Moment - M (ft-lbf) for Mortar or Adhesive Set Systems 7":12" or �t reater Battens Direct Deck Two Screws w/ Clip 57,60 61.77' Attachment Resistance 23.6 61,9 Frank Zuloaga„ RRC Roofing Product Control Examiner NO.009 17003 N/A • 09/29/2003 09:23 IEDITERRANEAN ROOF TILE i 3057572728 e SAJZTAFE TILE CORPORATION ACCEPTANCE No.: 00- 12)2.06 • 5. LABELING 5.1 All tiles shall bear thc 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 thc following: 6.1.1 This Noticc of Acceptance. 6.1.2 Any other documents required by the Building Official or applicable Building Codc in order to properly evaluate the installation of this system. PROFILE DRAWINC SANTAFt "SAJ`rTAFE S" CLAY ROOF TILE Frank Zuloaga. RRC • Roofing Product Control E canuner :4:. »1``�ya ,•_pis,:: NO.009 D004 • . • 09/29/2003 09:23 MEDITERRANEAN ROOF TILE 9 3057572728 • CANTAF} TILE CORPORATION NOTIC OF ACCEPTAN F. NDARD ' NDITIONS Renewal of this Acceptance (approval) shall be considered after 2 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 thc specific conditions of this Acceptance. 3 Renewals of Acceptance will not bc considered if; a) There has been a change in Utc 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: the c) If the Acceptance holder has not complied with all'thc requirements of this acceptance. including corrccl installation of the product; d) The engineer who originally prepared. signed and scaled the required documentation initially submitted, is no longer practicing the engineering profession. 4 Any revision or cktngc in thc materials. use, and/or manufacture; of the product w process shall automaticity bc cause for termination of this Acceptance, unless pn of granted this written a approval has wen requested (through the filing of a revision application with appropriate 5 Any of the following shalt also bc 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 bc dispt. in advertising literature. If any portion of the Notice of Acceptance is displayed, then it shall be done in its entirety, ? A copy of this Acceptance as well as approved drawings and other documents, where it applies, shall bc provided to the user by the manufacturer or iu distributors and shalt be available for inspection at the job Site at all times. The copies need not bc =scaled by the engineer. 8 Failure to comply with any section of this Acceptance shall bc cause for termination and removal of Acceptance. 9 This Acceptance contains Pages 1 through D OF THIS ACCEPTANCE ACCEPTANCE No. : 00 Frank Zriled!•,'. RAC Rooting duct Control Examiner NO. 009 P005 PRODUCT CONTROL NOTICE Off' ACCEPJANCj Polyfoam Products, Inc. • 2400 Spring- Stucbner Road Spring ,TX 77383 -1132 Your application for Notice of Acceptance (NOA) Two Component Polyurcthcne Foam Adhesive under Chapter 8 of the Code of Miami -Dade County governing the use of Alternate Materials and Types of Constnlction, and completely described herein, has been reconuncnded 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 this product or material at any time from a jobsite or manufacturer's plant for quality control testing. If this product or material fails to perform in the approved manner, BCCO may revoke, modify. or suspend the use of such product or material immediately. BCCO reserves the right to revoke this approval, if it is determined by BCCO that this product or material fails to meet the requirements of the South Florida Building Code. The expense of such'tcsting will be incurred by the manufacturer. ACCEPTANCE NO.: 01 0521.02 EXPIRES: 05/111/2011§ MIAMI -DADS COUNTY. FLORIDA MtTRO -OA06 FLAGLER BUILDING BUILDING CODE COMPLIANCE OFFICE MUTRO -DADS; FLAGLEIt BUILDING 140 WEST FLAGI,ER srruiri'. sijiri. 1601 MIAMI. FI.ORII)A 3313u -15(3 (305) 375 -2901 FAX 005)375-290a CONTRACTOR LICENSING' SECTION (305) 375.2527 FAX (3115) 375.25511 CQ1rrlt. uFNFORC*MENTDIVISIONY 13011 375 - 2%6 PAX (305) 373.25 PROUVCFCONTROL DIVISION (3031375•2U413 FAX (303) .371.6339 7 Raul Rodriguez Chic( Product Control Division 1. IS Tt•IF I VF RS EFT F. An ITIIO AL PA .F F ' PE 1 CF CONDITIONS I1UIGDING CODE & PROOKT R1:VIEtiy COMMIfl 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. APPKOvED: 06 /14l200L I rancisco J. Quintana. R.A. Director Miami -Dade County Duilding Cads: Compliance Office 11104S00011pc2000thempIuasinottco accaptu'ce cover pase,dot Intr, ,,t motif a•,Iracr• rd1111 u _ - ...._ u. ._._.....�Idi ...� ..� u, - ..... igyig Qro tucts, Ipc. ACCEPTANCE No.: 0t- 0521.02 ROOFING ASSEMBLY APPROVAL Ht rn - Roofing Sub.Cutcgttrr: Roof Tile Adhesive Mn tcj h *LL: Polyurethane I. SCOPE This approves Polypro® A11160 as manufactured by Poly(o:►m Products, Inc. as described in Section 2 of this Notice of Acceptance. For the locations where the design pressure requirements, as determined by applicable building code, does not exceed the design pressure values obtained by calculations in compliance with Roofing Application Standard RAS 127, for use with approved flat, low, and high profile roof tiles system using Polypro® AH 160. Where the attachment calculations are done as a moment based system for single patty placement, and as an uplift based system for double patty systems 2. PRODUCT DESCRIPTION Manufactured by Apnlicant Polypro® Al -1160 ( ProPnck®30 & 100 2.2 Typical tratlItt Compressive Strength Tensile Strength Wetter Absorption Moisture Vapor Transmission Dimensional Stability (Dimensions N/A Fonmpro® RTFI000 N/A N/A Dispensing equipment 2.1 Components or products manufactured by others: Any Miami -Dade County Product Control Accepted RoofTile Arisembly having a current NOA which list uplift resistance values with the use of Polypro A11160 mottilt adhesive. Physical Properties: Tee ASTM 0 1622 ASTM D 1621 ASTM 0 1623 ASTM D 2127 ASTM E 96 ASTM 0 2126 1: Test nccitic *tions PA 101 Bcsulta • 16 IbsJ11' 18 PSI Parallel to rise 12 PSI Perpendicular to rise 28 PSI Parallel to rise 0.08 Lbs./1 3.1 Perm / Itch Approval Date: June 14.2001 expiration Date: pia, 10.2006 Product Dcscriptiog Two component polyurethane Dispensing Equipment +0.07% Vol Change ® - 400 P.. 2 weeks '+6.0% Volume Chan ,e I I. :11untidily, 2 weeks Drunk Zuloagn. RRC Product Control Examiner P4lrfon Pro ducts, Inc. ACCEPTANCE No.: 01- 0521.02 Note: The physical properties listed above me presented as typical average values as determined by accepted ASTM test methods and are subject to normal manufacturing variation. 3. LIMITATIONS 3.1 Fire classification is not part of this acceptance, Refer to the Prepared Roof Tile Assembly for fire rating. 3.2 Polypro® A14160 shall solely be used with flat, low, & high tile profiles. 3.3 Minimum underlayments shall be in compliance with the Rooting Application Standard RAS 120, 3.4 Roof Tile manufactures acquiring acceptance for the use of Polypro® A11160 roof tile adhesive with their tile assemblies shall test in accordance with PA 101. 3.5 Roof Tile manufactures acquiring acceptance for two paddy placement with the use of Polypro® AI4 t 60 roof tile adhesive with their tile assemblies shall test in accordance with PA 101 and with section 10.4 as modified herein. MS 4. INSTALLATION 4.1 Polypro® AH160 may be used with any roof tile asscrnbty having a current NOA that lists uplift resistance values with the use of Polypro® Al-! 160. 4.2 Polypro® AH 1 60 shall be applied in compliance with the Component Application section and the corresponding Placement Details noted herein. The roof tile assembly's adhesive attachment with the use of Polypro® Al shall provide sufficient attachment resistance, expressed as an uplift based system, to meet or exceed • the uplift resistance determined in compliance with Miami -Dade County Roofing Application Standards RAS 127. The adhesive attachment data is noted in the roof the assembly NOA 4.3 Polypro® AH 160 roof tile adhesive and its components shall be installed in accordance with Roofing Application Standard RAS 120, and Polyfoam Products, Inc. Polypro® AFI160 Operating Instruction and Maintenance Booklet. 4.4 Installation must be by a Factory Trained 'Qualified Applicator' approved and licensed by Polyfoarn Products, Inc. Polyfoam Products Inc. shall supply a list of approved applicators to die authority having jurisdiction. 4.5 Calibration of the Foampro® dispetising equipment is required before application of any adhesive. The mix ratio between the "A" component and the "13" component shall be maintained between 1.0 -1.15 (A) : 1.0 (B). The dispense timer shall be set to deliver 0.0175 to 0.15 pounds per tile as determined at calibration. No other settings shall be approved. 4.6 Polypro® 01 160 shall be applied with Foampro RTF1000 or ProPack® 30 & 100 dispensing equipment only. 4.7 Polypro® Alt 160 shall not be exposed permanently to sunk Frank ' /_uloaga, RftC Product Control Examiner Table 1: Adl esive Placement For Each Generic Tile Profile Tilerrofile .., Placement Detail Single Paddy Weight Min, (grams) Two Paddy Weight per paddy Min. (grams) N/A Flat, Low High Profiles N 1 35 High Profile (2 Pica: Barrel) N I 17 /side on cap and 34 /pan N/A Flat. Low Profiles N2 24 N/A Flat, Low, High Profiles N3 _ g Pg lyfoanr Prgduct I 4 ACCEPTANCE No. : 01-0521.02 4.8 Tiles must be adhered in freshly applied adhesive. Tile must be set within 2 to 3 minutes atter Polypro® AH 160 has been dispensed. 4.9 Polypro® Al-t160 placement and minimum patty weight shalt be in accordance with the 'Placement Details' herein. Each generic tile profile requires the specific placement noted herein. 5. LABELING All Polypro® AH160 containers shall comply with the Standard Conditions listed herein. 6. BUILDING PERMIT REQUIREMENTS 6.1 As required by the Building Official or applicable Building Code in order to properly evaluate the installation of this system. Frank Zuloaga, RRC Product Control Examiner Polvfonttl Pr o0 octs, inc. Abi IES1vE PLACEMENT DETAIL. 1 SlNqLE PATTY ACCEPTANCE No. 0j-0521.02 Nall *evert ptulte Veasillprget Era num 444: 144, Autes *pee 4 14. iteuhetre Relit Mow* R41 fad, Eau Num 31•1111keeek elude teems U.4e0.p,es tO Este mu al/F Ito* 34440 Oret 4 op MN wuplales 1 poem TIM Opiate lves 4, 3 1 Mu mush Who*, le idiots 1214 23 atm pea apkallus upon Inen le mut *III III 124124 13 Us min 04144 awn Mae, 242.43,4 relttionamiii oi comae Mu lode Oh Se PA 4484 0 O P" . 32 Away let ate Moe weld team II norm tour* ea Ow Elan spre 4444 su two*. art Ili mew Ink Atop* emt 14 Owen W.** Walls primp dwell • 5 001hktil P*44 tba1or el Irfevabit Ors *MI Frank Zuloaga, (MC Product Control Examiner rolvfo1111 PrQtIu Itic. ADHESIVE PLACEMENT DETAIL 2 SINGLE PATTY . 6 ACCEPTANCE No.: 01- 0521.02 Frank Zuloaga. RAC Product Control EN:uuiner PolYrpitnt Products 1 ADHESIVE PLACEMENT DETAIL 3 DOUQLE PATTY ACCEPTArYCE : Q1-0521,02 Nall through plastic cane Uodadayroun Skigill -t on top of Ills boo Prank Zulo,aga, KRC Product Control Examiner Single paddy modal dla Single paddy beteroto the Id. r t la. medium Ito paddy taro calm only ■•■••••■•■•••••■■■■■•.0•11 Caw) WelOtele Ewa CiOSIM Otip Woe I'otyfoum Products, Inc. ACCEPTANCE No.: 2t- 0521,02 l Renewal of this Acceptance (approval) shall be considered :tiler a renewal application has been filed and the original submitted documents, including tut - supporting data, cnginering 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 Approval ", or as specifically stated in the 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 Code of sting the evaluation of this product and the product is not in compliance with the code: changes. b. The product is no longer dm same product (identical) as the ono originally approved. c. if the Acceptance holder has not complied with nil the requirements of this acceptance, including the correct installation of the product. d. The engineer who originally prepared, signed and scaled thc required documentation initially submitted, is no longer practicing the engineering profession. 4. Any revision or change in the materials, use, and/or manufacture of the product or process shall automatically be cause .for termination of this Acceptance, unless prior written approval has been requested (through the ding of a revision application with appropriate fee) and granted by this office. S. Any of the following shall also be grounds for removal of this Acceptance: a. Unsatisfactory performance of this product or process. • b. Misuse of this Acceptance as an endorsement of an 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. It' any portion of thc 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 bc provided to the user by the manufacturer or its distributors and shall bc available for inspection at the job site at all time. The engineer need not reseal the copies. 8. Failure to comply with any scction of this Acceptance shall be cause for termination and renwt•al of Acceptance, 9. This Notice of Acceptance consists of pages 1 through 8. END OF THIS ACCEPTANCE : ri Frank Zuloaga, t&RC Product Control Examiner BUILDING ❑ PLUMBING ❑ PERMIT ROOFING 0 Owner of IF A Building Architect Contractor L4 4414. R • ow AL a or Builder Legal Lot 11 Description Bl, Address of Building This permit is granted to the contractor or b tion herefor in strict compliance with all ordinances plans, drawings, statements or specifications that at any time if the work is not done in compliance w permit is granted is the understanding that the CaatratnDr regulations pertaining to the work covered hereby whether shwa sibility for work done by his agents, servants or employees, Sign In consideration of the issuance to me of this permit I agree to parforea the work covered hereunder in co pertaining thereto and in strict conformity with the plans, drawings, statements or sp.oidoatiens submitted to the prop cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER MIAMI SHORP VILLAGE, FLORIDA DATE r 19—CLEF N9 7498 Work to be performed under this Permit • �„ 1 i ..r- Contractor's License No. - -- - zp•-- Vcdue of Frf the and the Oedema 4* awl epoprrv.d,b7 or V Ibe in Gamed ebevs sn ee the le the plans or drewio t or is AUTHORITY Error 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 Law of the State of Flor•da, all ordinances of Miami Shores Village 'nd all rules and regulations of the Building Division of Miami Shores Village shall be co with whether herein specified o: not. A cop of approved plans and specifications must be kept at building during progress of the work. Date ._ - - Anril "9th 1 c%,h Owner's Name "a eaa e.� .; ^r1 nortrir .. 'hh r F .- -,, Registered Architect and /or Engineer 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 ,ublic notice or notices as are required by the Act. The undersigned agrees to employ only such bcontractor on work to be perform under this permit, as are licensed by Miami Shores Village. Remarks (Signed) _ — — — and for no other purpose. New Building Remodeling Addition Repairs e — roof No. of Stories To be constructed of Kind of foundation Roof Covering Cement shinirl e tile Estimated Total cost of improvements $ 1 hnn • 0n _ Amount of Permit $ h.00 Zone cubage required____. _Plan Cubage Distance to next nearest building__ Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to Tnn n(Tr4 r T . T '�n nr"I'1 ^r'T I n c ., 5 ''71 ��. Y. 7""t 9+ m T'1-� Name and address of licensed contractor _ - Location and legal description of lot to be built on: Lot Block. Subdivision Street and Number where work is to be doneehh T; . E. t?9th (1 t. 1 i1mi Shore, Plc. cP ent a'�inv1P tcgr off 3nrT re roofini with State work to be done and purpose of building (by floors) _ ________ °n.� q"' +e ' n star' ir'1 , .�'�itP cPmerl G�inrt1 M C . , Disapproved (Signed) -- MIAMI SHORES VILLAGE Building Inspe or Notary Public, State of Florida My Commission Expires _______..___ h A. '`-rtin, nrP ^i 'tent. Read, Sworn to and Subscribed before me. NNING BOARD _ - -- --- - - --- ---- -- -- -- - DATE Chairman - -- -- - --- - f — Member . __ ... Member _ Member Member Member Council Approved. Date Disapproved 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 true. Permit No ./ 4 `t fr 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. 3r'} - felt _ Date