920 NE 99 St (3)Test Location
Uplift Pull
Test (P or F)
Test Location
Uplift Pull
Test (P or F)
Test Location
Uplift Pull
Test (P or F)
Test Location
Uplift Pull
Test (P or F)
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Owner's Name:
Job Address
Roofing Contractor:
Type of Tile: '.111%—. c9 Date Installed
Approximate Roof Height'J2,feet Roof Pitch
Type of Access to Roof: Scaffolds NV Ladder Other
Approximate Square Footage of Roof: 3000 ft'
Required Testing Fo ce: 35 lbs. Testing Equipment: Chatillion 100
Date Tested: 1 1 ( Q 1
IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL PA 106, THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT
QUALITY CONTROL TEST.
THIS REP
T SUBMITTED BY
Civil Engineer:
Lab Certification # 98 -0608.04
State of FL Certificate Authorization # 4100
U.S. SOUTH
Engineering & Testing Lab., Inc.
6065 N.W. 167th Street, Suite B -23 • Miami, Florida 33015
Telephone: (305) 558 -2588 • Fax: (305) 362 -4669
ON -SITE CONCENTRATED UPLIFT LOAD TESTING OF ROOF TILE IN
FULL ACCORDANCE WITH METRO -DADE BUILDING CODE COMPLIANCE
PROTOCOL PA 106
SITE SPECIFIC INFORMATION ,
V AS 4e- ' gyp l Permit #. 1 3�
6 0_12_114
TEST RESULTS
P = PASS, F = FAIL
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Project
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JOB C H. N_+
1 -OF
SHEET NO
CONTRACTOR
CHECKED BY
SCALE
Owner's Name and Address
Ake ke z(c,
Street and Number where work is to be done
STATE OF FLORIDA
COUNTY OF DADE.
}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.
Registered Architect and/or Engineer S e a -7 �¢ /fj
Name and address of licensed contractor 2xe T /Ve /CGO �/N (, Lr/G ta6'° 3 S. of it'l - /�i' 3 - 3/ -�
Location
�j and Ieial description of lot to be built on: �I
Lot AP ? ' / Block Subdivision " �J'
/' .
goo N. E. CI q -r,-t Si
State work to be done and purpose of building (by floors), state exterior colors (submit samples)
New Building ` Remodeling Addition Repairs No. of Stories
To be constructed of Kind . �/c " of foundation Roof Covering
'1 Estimated Total cost of improvements S � �G Amount of Permit S 7 ' e2P
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
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons as an employer of Labor under the Florida Workmen's
Compensation Act, being Section 5966, Compiled General Laws of Florida. Permanent Supplement, and has complied with the provisions thereof. and will require similar
compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be- .osted 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 .. work to be performed
under this permit. as are licensed by Miami Shores Village.
Remarks (Signed)
Before me. the undersigned authority, a notary public. duly authorized to administer oaths and take acknowledgments. personally 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.
Date i
Permit No.
Disapproved
(Signed)
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of 825.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship.
Date
He. 56: fl/// �G� mac -(
and for no other purpose.
Read. Sworn to and Subscribed before me.
Notary Public. State of Florida