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1180 NE 100 St (4)MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 60,2-D3 Time Type Insp'n 714 4 Permit No. ,2.0.03- v l73 Name f ,�`�> > Address �/ �3 v —/V 10 S Company KaA4) - Phone # .3t25 93 2/7/ For Inspector: 6 -3 — 93 Name & Date Correction Re -Insp' n Fee ❑ MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request ( Date la- "I • Time Type Insp'n Fi (01 F(a4- Permit No. I �^ J Kr/ 3 Name sh Address 1 in t4 100 S� Company Y� L OIe r, Phone # / 3 V For Inspector: Approved Correction Re- Insp'n Fee Name & Date ),< Date 5 j LS )0Ob Address Legal Description s T0 , 6 g-fr h Owner's Address k 1 U V Nth a 1 O 0" s +g Contracting Co. Y&A od e K goo pp.IA.l Kat&LodX Owner /Lessee/Tenet Qualifier State # Municipal # 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. Permit Type (circle WORK DESCRIPTION: ""1 e.r ��� S 11 I � roo f S rep /A-6e t - h ek/ b (A., I -F -ttip roo+ . ys +erg Square Ft. 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). 1 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. OWNERS 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. Si PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 10050 N.E. 2nd Avenue • Miami ShcrP owner and/or Condo President dr / Flc ALNOTARY SEAL .e P O • •YSJVILLAR mil �� / Notary as to • ngi'aner ie o do 4' _ 4 9i'&lS'' N - . * fit 4 DD0910 • My Commission F ' i p MY COMMISSION EXPIRES . � F L �� MAR.1,2006 FEES: PERMIT ‘ 0 • Florida 33138 • Phone: 305- 795 -2204 • Fax: 305- 756 -8972 one): BUILDING ELECTRICAL PLUMBING MECHANICAL RADON APPROVED: Zoning Building Mechanical Plumbing • Date Date C.C.F SS# Address J Jags s.rearZalt 30 95 11 gofh5+, Phone 3 Competency # q 3.B5 00 Co. Lea-der Estimated Cost (value) ayoo r v Signature of n actor or Own Builder as to Contractor or Owner Builder Date Date LISA CARSON =q. ' = MY COMMISSION # CC 866680 ' Bonded Thru Notary EXPIRES: August 26, 2003 Public Underwriters BOND v D TOTAL DUES 611 O v Electrical Structural Engineer • • • Florida Building Code Edition 2002 High Velocity Hurricane Zone Uniform Permit Application Form. Master Permit No. Contractor's Name Job Address rioo Section A (General Information) Process No. POLL/0 17<AIA)ct1eK iltO V 100 \ ROOF CATEGORY Slope 0 Mechanically Fastened Tile 0 Mortar/Adhesive Set Tile 0 Asphaltic 0 Metal Panel/Shingles 0 Wood Shingles/Shakes Shingles ARE THERE 0 Prescriptive BUR-RAS 150 GAS VENT STACia • YES 0 NO( 4 ROOF TYPE TYPE-NATURAL 0 ILFGX 0 El New Roof WRe-Roofing 0 Recovering 0 Repair 0 Maintenance ROOF SYSTEM INFORMATION Low Slope Roof Area (SF) Steep Sloped Roof Area (SF) Total (SF) (7o? Section B (Roof Plan) Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. 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MOUNNOMMIIIIM • nons mmnrommoppi apsonsminoonsni iso nisn4ourninpron ins imispi iummommompumil mmilMONSMIMMIMEMER sinommonnnlinson pain wroni nionnsinnsonpmposnisinrClinssmsmnonnsInions moms p nomnrism nnomons m spun OMUMIN NIMIMMUMM•NOMMOWOMMOMMMNIMMUMM p npi nionnin ssnonnup somnsmons map RIMMMIMON MOIMMMOMMMIMMMIPPLMMEXIMMIMMEMMIN • PM IIMMMUMMIMOIMMINIMUMMINIMMMEMM IMMIMMINSEN MUMSEMMOMMWOMMMUMMOMMMMOMMENNEM IMOMMOMMIMOMMEMNMOMMEMINUMEM Roof System . Required Sections of the Permit Application Form Attachments Required See List Below Low Slope Application A,B,C 1,2,3,4,5,6,7 Prescriptive BUR -RAS 150 A,B,C 4,5,6,7 Asphaltic Shingles A,B,D 1,2,4,5,6,7 Concrete or Clay Tile A,B,D,E 1.2.3.4.5,6,7 Metal Roofs A,B,D 1,2,3,4,5,6,7 Wood Shingles and Shakes A,B,D 1,2,4,5,6,7 Other As Applicable 1,2,3,4,5,6,7 1. Fire Directory Listing Page r 2. From Notice of Acceptance: Front Page Specific System Description Specific System Limitations General Limitations Applicable Detail Drawings 3. Design Calculations per Chapter 16, or if Applicable, RAS 127 or RAS128 4. Other Component Notice of Acceptances 5. Municipal Permit Application 6. Owners Notification for Roofing Considerations (Re- Roofing Only) 7. Any Required Roof Testing /Calculation Documentation Florida Building Code Edition 2002 High Velocity Hurricane Zone Uniform Permit Application Form. INSTRUCTION PAGE COMPLETE THE NECESSARY SECTIONS OF THE UNIFORM ROOFING PERMIT APPLICATION FORM AND ATTACH THE REQUIRED DOCUMENTS AS NOTED BELOW: ATTACHMENTS REQUIRED: 1 Section C Low Sio Fill in Specific Roof Assembly Components and Identify Manufacturer (If a component is not uSed, Identi as "NA System Manufacturer. NOA No.: Design Wind Pressures, From RAS 128 0 Calculations: Max. Design 9 ur From the Specific NOA Slope: Deck: 1,� ' T ype: 'v O v CL G auge/Thickness: 5 Anchor /Base Sheet & No. of Ply(s): 9 h et,,Fastene /: • d M _ Hal: ttl 7v 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 Mater Base Sheet(s) & No. of PIy(s) : Base Sheet Fastener /Bonding Material: ui Ply Sheet Faster/Bonding Material: Lflkn Top Ply: To PI L Surfacing: C� Hurricane Zone Uniform Permit V, t zUU2 A • • rca6on Form. ed Roof S Fastener Spacing for Anchor /Base Sheet Attachment Field: _52 oc @ L ap, # Rows a...@ oc Perimeter: 12: oc @ Lap. # Rows a @ V -oc Corner: oc @ Lap, #R ows, -� @ oc Board Number of Fasteners Per Insulation Field Perimeter Corner Illustrate Components Noted and Details asApplicable: Woodblocking, Gutter, Stripping, Flashing, Ed Termination, Strip, Base g Continuous Cleat, Cant Flashing, Counter- Flashing, Wig. Etc. Ind iote: Mean Roof Height, Parapet Height of Base Flashin Height, Material , Thickness, Fastener Type. Went Materia Spacing or Submit Manufacturer De Details that Comply with RAS 111 and Chapter 16. ef\FMod led6 r- t�l ne c-AP 0)(36) wil h Prin __ - 2f 1 ysetbe rg. stem Pall apet Height Mean Height Roof System Manufacturer: Notice of Acceptance Number: Minimum Design Wind Pressures, if Applicable (From RAS 127 or Calculations): P1: P2: P3: Maximum Design Pressure (From the NOA Specific System): Method of tile attachment: Florida Building Code. Edition 2002 High Velocity Hurricane Zone Uniform Permit Application Form. Roof Slope: : 12 Section D (Steep Sloped Roof System) Deck Type: ype Underiayment: nsuiation: ire Barrier: astener Type & Spacing: dhesive Type: Ridge Ventilation? Steep Sloped Roof System Description Mean Roof Height: 1 pa Cap Sheet: oof Covering: Type & Size Drip dge: Florida Building Code Edition 2002 High Velocity Hurricane Zone Uniform Permit Application Form. Section C (Low Sloped Roof System) Fill in Specific Roof Assembly Components and Identify Manufacturer (If a component Is not used, identify as 'NA") System Manufacturer. NOA No.: Design Wind Pressures, From RAS 128 or Calculations: Pmax1: Pmax2: Pmax3: Max Design Pressure, From the Specific NOA System: Deck: Type: Gauge/Thickness: Slope: Anchor/Base Sheet & No. of PIy(s): Anchor /Base Sheet Fastener/Bonding Material: Insulation Base Layer. Base Insulation Size and Thicmess: Base Insulation Fastener/Bonding Material: Top Insulation Layer. Top Insulation Size and Thickness: Top Insulation Fastener/Bonding Material: Base Sheet(s) & No. of Piy(s): Base Sheet Fastener/Bonding Material: Ply Sheet(s).& No. of Ply(s): Ply Sheet Fastener/Bonding Material: Top Ply. Top Ply Fastener/ Bonding Material: Surfadng: Fastener Spacing for Anchor /Base Sheet Attachment Field: " oc Lap, # Rows oc Perimeter. " oc (c) Lap, # Rows © " oc Comer. " oc @ Lap, # Rows (a3 ' oc Number of Fasteners Per Insulation Board Field Perimeter Comer Illustrate Components Noted and Details as Applicable: Woodblocking, Gutter, Edge Termination, Stripping, Flashing, Continuous Cleat, Cant Strip, Base Flashing, Counter- Flashing, Coping, Etc. Indicate: 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. FT. Fr. Parapet Height Mean Roof Height Where to Obtain Information Description Symbol Where to find Design Pressure Pl or P2 or P3 RAS 127 Table 1 or by an engineering analysis prepared by PE based on ASCE 7 Mean Roof Height H Job Site Roof Slope 0 Job Site Aerodynamic Multiplier A. NOA Restoring Moment due to Gravity M NOA Attachment Resistance Mr NOA Required Moment Resistance M, Calculated bormimum Ate ire F' NOA Required Uplift Resistance F, Calculated Av Tile W _ W NOA Tile Dim..: ..: 1= length w= width NOA All calculations must be submitted to the Building Official at the time of permit application. M Required Moment Resistance* Mean Roof Height — Roof Slope I 15' 20' 25' 30' 40' 2:2 34.4 38.5 382 39.7 42.2 3:12 32.2 34.4 38.0 37.4 39.8 4:12 304 32.2 33.8 35.1 37.3 5:12 28.4 30.1 31.8 32.8 34.9 6:12 28.4 28.0 29.4 30.5 32.4 7:12 24.4 25.9 27.1 28.2 30.0 Florida Building Code Edition 2002 High Velocity Hurricane Zone Uniform Permit Application Form. Section E (Tile Calculations) For Moment based tile systems, choose either Method 1 or 2. Compared the values for M with the values from M p If the M values are greater than or equal to the Mr values, for each area of the roof, then the tile attachment method is acceptable. Method 1 "Moment Based Tile Calculations Per RAS 127" / )81-' (P z A. =_ )- Mg: = 1Va NOA Mr (P2: a X = __ ) - Mg: = Ma NOA H (P3: a =_ ) —Mg: =M NOA Mr Method 2 "Simplified Tile Calculation Per Table Below" Required Moment of Resistance (M From Table Below NOA m *Must be used in conjunction with a list of moment based tale 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" (P a1: = z w:= ) —W: x cos B: = F NOA F' (P2 : z 1: = a w: = ) — W: z cos 0: = F NOA (P3 • a l: z w: = ) — W: a cos 0: = F NOA F' AW --,HIGHI VELOCITY HURRICANE ZONES REQU;pilt•OntIiRS AOTaFICATION FOR ROOFING • CONSX17EZtATIa4S : • • ...... • .... 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 owaez the cpntent of this se The provisions of Chapter 15 of the Florida Building Code, Building govern the n3ininlim rectuirredLeOts a/id standards of the industry for roofing system installations. Additionally, the follotvjng itcQls should h.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 explained. ..... • •. •.. •• • • ..... • • 1. Aesthetics - Workmanship: The worlanan'shlp:p& sib .s Of Chapter 15 (High Velocity Hurricane Zone) are for the purpose of providing that the roofing system meets' a Mind resistance and water intrusion performance standards. Aesthetics (appearance) issues are not a consideration with respect to workmanship provisions. Aesthetic issues such as color or architectural appearance, that are not part of a zoning code, should be addressed as part of the agreement between the owner and the contractor. ��j 2. Renailing Wood Decks: When replacing roofing, the existing wood roof deck may have to be renailed in accordance with the current provisions of Chapter 16 (High Velocity Hurricane Zones) of the Florida Building Code. (The roof deck is usually concealed prior to removing the existing roof system). 3. Common Roofs: Common roofs are those which have no visible delineation between neighboring units (i.e. townhouses, condominiums, etc.). In buildings with common roofs, the 'roofing contractor and/or owner should notify the occupants of adjacent units of roofing work to be performed. 4. Exposed Ceilings: Exposed, open beam ceilings are where the underside of the roof decking can be viewed from below. The owner may wish to maintain the architectural appearance, therefore, roofing nail penetrations of the underside of the decking may not be acceptable. The Florida Building Code provides the option of maintaining this appearance. 5. Ponding Water: The current roof system and/or deck of the building may not drain well and may cause water to pond (accumulate) in low -lying areas of the roof. Ponding can be an indication of structural distress and may require the review of a professional structural engineer. Ponding may shorten the life expectancy and performance of the new roofing system. Ponding conditions may not be evident until the original roofing system is removed. Ponding conditions should be corrected. 6. Overflow scuppers (wall outlets): It is required that rainwater flow off so that the roof is not overloaded from a build up of water. Perimeter /edge walls or other roof extensions may block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accordance with the Florida Building Code, Plumbing. 7. Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of the structural assembly (the building itself). The existing ich can result in extending the service life of the reduced. It may be beneficial to consider additional venting h roof. 1P O ner's/A _ i. s ignature CdOO -Ile mpI LS- pVI' m03CCTION I S:4Aa 5 2.5/ 0 3 Date Contractor's Signature °.i € t lvi(DACE BUILDING CODE COMPLIANCE OFFICE (BCCO) PRODUCT CONTROL DIVISION NOTICE OF ACCEPTANCE (NOA) GAF Material Corporation 1361 Alps Road Wayne, NJ 07470 MIAMI-DADE COUNTY, FLORIDA METRO -DADE FLAGLER BUILDING 140 WEST FLAGLER STREET, SUITE 1603 MIAMI, FLORIDA 33130-1563 {305) 375 -2901 FAX (305) 375 -2908 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed by the BCCO and accepted by the Building Code and Product Review Committee to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ). This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product Control Division (In Miami Dade County) and /or the AHJ (in areas other than Miami Dade County) reserve the right to have this product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify, or suspend the use of such product or material within their jurisdiction. BORA reserves the right to revoke this acceptance, if it is determined by Miami -Dade County Product Control Division that this product or material fails to meet the requirements of the applicable building code. This product is approved as described herein, and has been designed to comply with the High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION: G AF Ruberoid® Modified Bitumen Roof System for Wood Decks. LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami -Dade County Product Control Approved ", unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Horida, and followed by the expiration date may be dsplayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA consist of pages 1 through 33. NOA No: 02 -0408.10 Expiration Date: 11 /06/03 - Approval Date: 05/23/02 Page 1 of38 • ■4.- The submitted documentation was reviewed by Frank Zuloaga, RRC. NOA No: 02-0408.10 Expiration Date: 11/06/03 Approval Date: 05/23/02 Page 2 of 38 ROOFING SYSTEM APPROVAL Category: Sub - Category: lleck T j Maximum Design Pressure Fire Classification: Product GAF Asphalt Concrete Primer (MatrixTM 307 Primer) GAF Mineral Shield® Granules GAF WeatherCoat® Emulsion (MatrixTM Fibered 305 Emulsion) GAF Premium Fibered Aluminum Roof Coating (MatrixT" System Pro Aluminum Roof Coating Fibered 301) GAF Jetblack All Weather Plastic Cement (MatrixTM Standard Wet/Dry Roof Cement 204) GAFGLAS #75® GAFGLAS #80 UltimaTM Base Sheet GAFGLAS flex PIyTM 6 GAFGLAS Ply 4® GAFGLAS;R Mineral Surfaced Cap Sheet Roofing SBS /APP, Modified Bitumen Wood -75 psf See General Limitation #1 TRADE NAMES OF PRODUCTS MANUFACTURED OR LABELED BY APPLICANT: TABLE 1 Dimensions 5, 55 gallons 601b. Bags 100 lb. bags 5 gallons 1, 5 gallons 1, 5 gallons 39.37" (1 meter) Wide 39.37" (1 meter) Wide 39.37" (1 meter) Wide 39.37" (1 meter) Wide 39.37' (1 meter) A Wide Test Specification ASTM D 41 ASTM D 1863 ASTM 1227 ASTM D 2824 ASTM D 3019 ASTM D 3409 ASTM D 4601 ASTM D4601 ASTM D 2178 ASTM D 2178 STM D 3909 Product Description Asphalt concrete primer used to promote adhesion of asphalt in built -up roofing. Granules for surfacing of exposed asphalt, cold process cement or emulsion. GAF Mineral Shield® Granules shall be used for flashing applications only. Surface coating for smooth surfaced roofs. Fibered aluminum coating. Refined asphalt blended with a mineral stabilizer and fibers. Permits adhesion to wet and dry surfaces. Asphalt impregnated and coated glass mat base sheet. Asphalt impregnated and coated, fiberglass base sheet Type VI asphalt impregnated glass felt with asphalt coating. Type IV asphalt impregnated glass felt with asphalt coating. Asphalt coated, glass fiber mat cap sheet surfaced with mineral granules. NOA No: 02 -0408.10 Expiration Date: 11/06/03 Approval Date: 05/23/02 Page 3 of38 Product GAFGLAS® STRATAVENT® Eliminator Perforated GAFGLAS® Flashing GAFGLAS® STRATAVENT® Eliminator Perforated Nailable RUBEROID® SBS Heat - We1dTM Smooth RUBEROID® SBS Heat - We1dTM Granule RUBEROID® SBS Heat WeIdTM 170 FR RUBEROID® SBS Heat We1dTM PLUS RUBEROID® SBS Heat - Weld PLUS FR RUBEROID Modified Base Sheet RUBEROID® Modified Bitumen Adhesive RUBEROID® SBS Heat- WeIdTM 25 Ruberoid® Mop Granule RUBEROID MOP Smooth RUBEROID MOP PLUS Test Dimensions sions Specification 39.37" (1 meter) ASTM D 6 23 77 Wide ASTM D 4897 various 39.37" (1 meter) Wide 1 meter (39.37' wide 1 meter (39.37 ") wide 1 meter (39.37 ") wide 1 meter (39.37") wide 1 meter (39.37 ") wide 39.37" (1 meter) Wide 5 gallons 1 meter (39.37 ") wide 39.37" (1 meter) Wide 1 sq. roll 87 lbs. 39.37" (1 meter) Wide ASTM D3672 ASTM D 4897 ') ASTM D -6164 P ASTM D -6164 ASTM D -6164 ASTM D -6164 N P wi ASTM D -6164 N an fir ASTM D4601, Pr II, UL m Type G2 BUR ASTM D 3019 Type III ASTM D -6164 po su ASTM D 6222 No ASTM D 5147 pol ASTM D 6298 No ASTM D 5147 pol su ASTM D 6164 No ASTM D 5147 pol with Product Descriration Fiberglass base sheet coated on both sides with asphalt. Surfaced on the bottom side with mineral granules embedded in asphaltic coating with factory perforations. Asphalt coated glass fiber mat flashing sheet available in three sizes. Fiberglass base sheet coated on both sides with asphalt. Surfaced on the bottom side with mineral granules embedded in asphaltic coating. Non -Woven Polyester mat coated with polymer- modified asphalt and smooth surfaced. Non -Woven Polyester mat coated with olymer modified asphalt and surfaced with mineral granules. Non -Woven Polyester mat coated with fire retardant polymer modified asphalt and surfaced with mineral granules. on -Woven Polyester mat coated with olymer modified asphalt and surfaced th mineral granules. on -Woven Polyester mat coated with ie retardant polymer modified asphalt d surfaced with mineral granules. remium glass fiber reinforced SBS - odified base sheet Fiber reinforced, rubberized Adhesive Non -Woven Polyester mat coated with lymer- modified asphalt and smooth rfaced. n -woven polyester mat coated with ymer modified asphalt and surfaced with mineral granules. n -woven polyester mat coated with ymer- modified asphalt and smooth rf aced. n -woven polyester mat coated with ymer modified asphalt and surfaced mineral granules. NOA No: 02 -0408.10 Expiration Date: 11/06/03 Approval Date: 05/23/02 Page 4 of38 Product RUBEROID MOP 170FR RUBEROID MOP FR RUBEROID TORCH Smooth RUBEROID TORCH Granule RUBEROID TORCH PLUS RUBEROID TORCH FR RUBEROID 170FR TORCH Ruberoid® 20 Ruberoid® 30 Ruberoid® 30 FR RUBEROID® ULTRACLAD® SBS RUBEROID® Dual FR Vent Stacks (metal and plastic) GAF Aluminum Emulsion Dimensions 39.37' (1 meter) Wide 39.37' (1 meter) Wide 39.37" (1 meter) Wide 39.37' (1 meter) Wide 39.37' (1 meter) Wide 39.37" (1 meter) Wide Test Specification ASTM D 6164 ASTM D 5147 ASTM D 6164 ASTM D 5147 ASTM D 6222 ASTM D 5147 ASTM D 6222 ASTM D 5147 ASTM D 6222 ASTM D 5147 ASTM D 6222 ASTM D 5147 39.37' (1 meter) ASTM D 6222 Wide ASTM D 5147 39.37' (1 meter) ASTM D 6163 Wide ASTM D 5147 39.37' (1 meter) ASTM D 6163 Wide ASTM D 5147 39.37" (1 meter) ASTM D 6298 Wide ASTM D 5147 39.37" (1 meter) ASTM D 6163 Wide ASTM D 5147 39.37' (1 meter) Wide 5 gallons ASTM D 6164 ASTM D 5147 PA 100(A) ASTM D 1929 ASTM D 635 None Product Description Non -Woven polyester mat coated with fire retardant polymer modified asphalt and surfaced with mineral granules. Non -Woven polyester mat coated with fire retardant polymer modified asphalt and surfaced with mineral granules. Heavy duty, polyester reinforced, asphalt modified bitumen membrane, smooth surface. Heavy duty, polyester reinforced, asphalt modified bitumen membrane, granule surface. Heavy duty, polyester reinforced, asphalt modified bitumen membrane, granule surface Heavy duty, polyester reinforced, coated with fire retardant asphalt modified bitumen membrane, granule surface. Heavy duty, polyester reinforced, coated with fire retardant asphalt modified bitumen membrane, granule surface. SBS modified asphalt base sheet reinforce with a glass fiber mat. Non woven fiberglass mat coated with polymer modified asphalt and surfaced with mineral granules. Non woven fiberglass mat coated with fire retardant, polymer modified asphalt and surfaced with mineral granules. Woven fiberglass mat coated with Polymer modified asphalt surfaced with aluminum, copper or stainless steel foil. Non -woven polyester and fiberglass mat coated with file retardant, polymer - modified asphalt and surfaced with mineral granules. One -way valve vent used to relieve built - up pressure within the roof system. GAF Vent Stacks are available in metal or plastic. Mineral colloidal bituminous emulsion with reflective aluminum flakes NOA No: 02 -0408.10 Expiration Date: 11/06/03 Approval Date: 05/23/02 Page 5 of 38 Product GAF Aluminum Roof Paint (MatrixTM System Pro Aluminum Roof Coating Fibered 302) GAF Built -Up Roofmg Asphalt RUBEROID MOD Asphalt, Asphalt L & Asphalt P Shingle - MateTM Underlayment Tile -Mate Modified Base Sheet Tile -Mate Modified Cap Tile -Mate Modified Cap Plus TopCoat® Surface Seal SB 5 gallons (Matrix 602 SB Coating) GAF WeatherCote® 5 gallons MB+(Matrix 715 MB Coating) TopCoat MB+(Matrix 715 5 gallons MB Coating) WeatherCoteTM (Matrix 5 gallons 531 WeatherCote® Elastomeric Flashing Grade) Matrix Low VOC Matrix 101 System Pro SBS Adhesive (Ruberoid ®MB) Matrix 201 System Pro SBS Flashing (Ruberoid ®MB) Matrix 102 Select SBS Adhesive (Ruberoid®MB) Matrix 202 Select SBS Flashing Matrix 203 Standard Plastic Cement Matrix 213 Gun Grade Plastic Cement Matrix 103 Col,: Adhesive Dimensions 5 gallons 1001b. cartons, ASTM D312, Interply mopping and surfacing asphalt bulk Types I, II, III and IV 601b. kegs Test Specification ASTM D2824, Type I 4 sq. roll 30 lbs. 1.5 sq. roll ASTM D 5147 1 sq. roll ASTM D 5147 103 lbs. 1 sq. roll ASTM D 5147 102 lbs. 5 gallons 5 gallons 5 gallons 5 gallons 5 gallons 5 gallons 5 gallons 5 gallons ASTM D3019 ASTM D3019 ASTM D3019 ASTM D4586 ASTM D4586 ASTM D4586 ASTM D3019 Product Description Non- fibered. Aluminum pigmented, asphalt roof coating SEBS modified asphalt Fiberglass reinforced shingle underlayment SBS modified asphalt base sheet and interply sheet reinforce with a glass fiber mat tile underlayment. Non -woven polyester mat coated with polymer modified asphalt and surfaced with mineral granules tile underlayment. Non -woven polyester mat coated with polymer modified asphalt and surfaced with mineral granules tile underlayment. Surface coating for smooth surfaced and mineral surfaced roofs. Surface coating for smooth surfaced and mineral surfaced roofs. Surface coating for smooth surfaced and mineral surfaced roofs. Surface coating for smooth surfaced and mineral surfaced roofs. Surface coating for smooth surfaced and mineral surfaced roofs. Cold Applied Modified SEBS Asphalt Adhesive Cold Applied Modified SEBS Asphalt Adhesive — Flashing Grade. Cold Applied Modified SEBS Asphalt Adhesive. Cold Applied Modified SEBS Asphalt Adhesive — Flashing Grade. Standard Plastic Asphalt Roofmg Cement Standard Plastic Asphalt Roofmg Cement Caulk Grade. Cold Applied Asphalt Adhesive. NOA No: 02 -0408.10 Expiration Date: 11/06/03 Approval Date: 05/23/02 Page 6 of 38 Product Matrix 303 Select Fibered Aluminum Matrix 304 Select Non - Fibered RUBEROID® Modified Bitumen Adhesive Test Dimensions Specification 5 gallons ASTM D 2824 5 gallons ASTM D2824, Type I 5 gallons ASTM D 3019 Type III Product Description Fibered aluminum coating. Non- fibered. Aluminum pigmented, asphalt roof coating. Fiber reinforced, rubberized Adhesive NOA No: 02 -0408.10 Expiration Date: 11/06/03 Approval Date: 05/23/02 Page 7 of38 APPROVED INSULATIONS: Product Name GAFTEMP Isotherm R, RA, RN & Composite, EnergyGuard RA GAFTEMP® Composite A & N (BMCA)GAFTEMP® Fiberboard GAFTEMP® Permalite GAFTEMP GAFCANTTM GAFTEMP Permalite Recover Board GAFTEMP GAFEDGETM Tapered Edge Strip (BMCA) GAFTEMP® High Density Fiberboard BMCA EnergyGuard, RA BMCA Composite EnergyGuard, RA PYROX White Line ACFoam I, II & Composite ISO 95+ ISO 95+ Composite EPS Wood Fiber High Density Wood Fiberboard Pelite/Urethane Composite Perlite Insulation Dens Deck TABLE 2 Product Description Polyisocyanurate foam insulation Polyisocyanurate foam insulation with high density fiberboard or Permalite perlite insulation. Fiberboard insulation. Perlite insulation board. Cut perlite board Perlite recover board Tapered perlite board High density wood fiberboard insulation. Polyisocynurate foam insulation Polyisocynurate /wood fiberboard composite Polyisocyanurate foam insulation Polyisocyanurate foam insulation Polyisocyanurate foam insulation Polyisocyanurate foam insulation Polyisocyanurate / perlite ridged insulation Extruded polystyrene insulation Wood fiber insulation board Wood fiber insulation board Perlite / urethane composite board insulation Perlite insulation board Water resistant gypsum board Manufactu rer (With Current NOA) GAF Materials Corp. GAF Materials Corp. GAF Materials Corp. GAF Materials Corp. GAF Materials Corp. GAF Materials Corp. GAF Materials Corp. GAF Materials Corp. BMCA BMCA Apache Products Co. Apache Products Co. Atlas Energy Products Firestone Building Products, Inc. Firestone Building Products, Inc. Generic Generic Generic Generic generic G -P Gypsum Corp. NOA No: 02 -0408.10 Expiration Date: 11/06/03 Approval Date: 05/23/02 Page 8 of38 APPROVED INSULATIONS: Product Name ENRG'Y -2 & E'NRG'Y -2 PLUS, UltraGard Gold FiberGlass Roof Insulation ISORoc Structodek Multi-Max & FA Paroc Base Board Paroc Cap Board APPROVED FASTENERS: Fastener Product Number Name 1. GAFTITE® (Drill -Tec®) #12 Standard & #14 Heavy Duty Roofing Fastener 2. GAFTITE® (Drill -Tec®) ASAP 3. GAFTITE® (Drill -Tec®) Base Sheet Fastener and Plate 4. Galvalume Plates (Drill - Tec® Metal) 5. Polypropylene Plates (Drill- Tec® Plastic) 6. Dekfast Fasteners #12, #14 & #15 7. Dekfast Hex Plate 8. Dekfast Lock Plate 9. #12 Roofgrip Fasteners 10. Metal Plate TABLE 2 Product Description Polyisocyanurate foam insulation Glass fiber/Mineral fiber insulation Polyisocyanurate foam / rockwool composite insulation Wood fiber insulation board Polyisocyanurate roof insulation Rockwool insulation TABLE 3 Product Description Dimensions Insulation fastener for steel, wood & concrete decks. Pre - assembled GAFTITE Fasteners and metal and plastic plates. Base sheet fastening assembly. Round galvalume stress plates. Round polypropylene stress plates. Insulation fastener for wood, steel and concrete decks Galvalume hex stress plate. Polypropylene locking plate. Insulation fastener for wood and steel. Galvalume stress plate. 3" and 3 ' /Z" 2 7/8" x 3 '/4" 3 "x3'/4" 3" round 3" square Manufacturer (With Current NOA) Johns Manville Johns Manville Johns Manville Masonite. RMax, Inc. Partek, Inc. Manufacturer (With Current NOA) GAF Materials Corp. GAF Materials Corp. GAF Materials Corp. GAF Materials Corp. 3" and 3 %" GAF Materials Corp. Construction Fasteners Inc Construction Fasteners Inc. Construction Fasteners Inc. ITW Buildex Corp. ITW Buildex Corp. NOA No: 02 -0408.10 Expiration Date: 11/06/03 Approval Date: 05/23/02 Page 9 of38 APPROVED FASTENERS: Fastener Number 11. Gearlok Plastic Plate 12. Glasfast Fastener 13. Olympic Fastener #12 & #14 14. Olympic Fastener ASAP 15. Olympic Polypropylene 16. Olympic G-2 17. Olympic Standard 18. Insul-Fixx Fastener 19. Insul -Fixx S Plate 20. Insul -Fixx P Plate 21. Tru -Fast 22. Tru -Fast Plates 23. Tru -Fast Plates EVIDENCE SUBMITTED: Test Agency Factory Mutual Research Corporation Factory Mutual Research Corp. Trinity Engineering Dynatech Engineering Corporation Product Name Test Identifier Current Insulation Attachment Requirements Wind Uplift, FMRC 4470 - PA 114 Wind Uplift PA 114 Wind Uplift PA 114 TABLE 3 Product Description Polypropylene round plate Insulation fastener assembly with recessed plastic plate Insulation fastener Pre - assembled Insulation fastener and plate Polypropylene plastic plate 3.5" round galvalume AZ55 steel plate 3" round galvalume AZ50 steel plate Insulation fastener for steel and wood decks 3" round galvalume AZ50 steel plate 3" round polyethylene stress plate Insulation fastener for steel and wood decks 3" round galvalume AZ55 steel plate Polyethylene plastic plate Description FMRC 1996 J.I. 1B9A8.AM J.I. 3D4Q2.AM 4483.04 97 -1 #3600.02.95 -1 #4482.02.95 -1 Manufacturer Dimensioes (With Current NOA) 3.2" ITW Buildex Corp. 3.25" round 3.5" round 3" round 3" round 3" round 3" round 3" round Johns Manville Olympic Manufacturing Group, Inc. Olympic Manufacturing Group, Inc. Olympic Manufacturing Group, Inc. Olympic Manufacturing Group, Inc. Olympic Manufacturing Group, Inc. SFS /Stadler SFS /Stadler SFS /Stadle r The Tru -Fast Corp. The Tru -Fast Corp. The Tru -Fast Corp. Date 01.01.96 09.04.97 04.30.97 06.06.97 02.02.95 NOA No: 02 -0408.10 Expiration Date: 11/06/03 Approval Date: 05/23/02 Page 10 of38 Test Agency Test Identifier Description Date PRI Asphalt GAF- 020 -02 -01 ASTM D 4977 02.01.02 Technologies, Inc. IRT of S. Fl. 02 -005 TAS 114 ` 01.18.02 IRT of S. Fl. 02 -014 TAS 114 03.22.02 NOA No: 02 -0408.10 Expiration Date: 11/06/03 Approval Date: 05/23/02 Page 11 of 38 Membrane Type: SBS /SBS Cold Applied Deck Type 1: Wood, Non - insulated New Construction or Reroof Deck Description: 19 or greater plywood or wood plank decks System Type E (1): Base sheet mechanically fastened to roof deck. All General and System Limitations shall apply. Base sheet: GAFGLAS #80 UltimaTM Base Sheet, STRATAVENT® Eliminator Perforated Nailable, RUBEROID Modified Base Sheet, RUBEROID® 20, RUBEROID SBS Heat- We1dTM Smooth or RUBEROID SBS Heat -Weld 25 base sheet mechanically fastened to deck as described below; Fastening GAFGLAS® Ply 4®, GAFGLAS Flex P1yTM 6, GAFGLAS #75 Base Sheet or any Options: of above Base sheets attached to deck with approved annular ring shank nails and tin caps at a fastener spacing of 9" o.c. at the lap staggered and in two rows 12" o.c. in the field. (Maximum Design Pressure —4S psf, See General Limitation #7) GAFGLAS® Ply 4 ®, GAFGLAS Flex PIyTM 6, GAFGLAS #75 Base Sheet or any of above Base sheets attached to deck with Drill -Tec ( GAFTITE) #12 or #14 Screws and 3" Plates, 12" o.c. in 3 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 12" o.c. in the field of the sheet. (Maximum Design Pressure —45 psf, See General Limitation #7) GAFGLAS Flex PIyTM 6, GAFGLAS #75 Base Sheet or any of above Base sheets attached to deck with approved annular ring shank nails and tin caps at a fastener spacing of 9" o.c. at the 4" lap staggered and in two rows 9" o.c. in the field. (Maximum Design Pressure —52.5 psf, See General Limitation #7) GAFGLAS #75 Base Sheet or any of above Base sheets attached to deck with Drill-Tec (GAFTITE) #12 or #14 Screws and 3" Plates, 12" o.c. in 4 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 9" o.c. in the field of the sheet. (Maximum Design Pressure —60 psf, See General Limitation #7) Any of above Base sheets attached to deck approved annular ring shank nails and 3" inverted Drill -Tec (GAFTITE) insulation plates at a fastener spacing of 9" o.c. at the 4" lap staggered in two rows 9" in the field. (Maximum Design Pressure —60 psf, See General Limitation #7) GAFGLAS #75 Base Sheet or any of above Base sheets attached to deck with Drill -Tec ( GAFTITE) #12 or #14 Screws and 3" Plates, 8" o.c. in 4 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 9" o.c. in the field of the sheet. (Maximum Design Pressure —75 psf, See General Limitation #7) Ply Sheet: (Optional) One or more plies GAFGLAS PLY 4®, GAFGLAS Flex Ply 6, GAFGLAS #80, RUBEROID MOP Smooth or RUBEROID 20 sheet adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20- 40 lbs. /sq. NOA No: 02 -0408.10 Expiration Date: 11/06/03 Approval Date: 05/23/02 Page 32 of38 Membrane: Surfacing: Maximum Design Pressure: See Fastening above One or more plies of RUBEROID MOP Smooth, Ruberoid® Mop 170 FR, Ruberoid® Mop Granule, Ruberoid® Mop Plus Granule, Ruberoid® 20, Ruberoid® 30 or Ruberoid® 30 FR or Ruberoid® Mop FR or RUBEROID UltraCladTM SBS in adhered in a fill mopping of approved asphalt applied i vvithin the EVT range and at a rate of 20 -40 lbs. /sq. Or, One or more plies of RUBEROID MOP Smooth, RUBEROID® Mop Granule, RUBEROID® Mop 170 FR, RUBEROID® Mop Plus Granule, Ruberoid® 20, RUBEROID® 30, RUBEROID® 30 FR or RUBEROID® Mop FR or RUBEROID U1traCladTM SBS in RUBEROID Modified Bitumen Adhesive at an application rate of 1 -2 gal. /sq. (Optional, required if RUBEROID MOP Smooth or RUBEROID 20 is top membrane) Install one of the following: 1. Gravel or slag applied at 4001b. /sq. and 300 lb. /sq. respectively in a flood coat of approved asphalt at 60 lb. /sq. 2. GAFGLAS Mineral Surfaced Cap Sheet in an approved asphalt at an application rate of 25 lb. /sq. + 15 %. 3. GAF Weathercote® MB+(Matrix 715 MB Coating), Applied at 1 to 1.5 gal. /sq. 4. Top Coat® Surface Seal SB(Matrix 602 SB Coating), Applied at 1 to 1.5 gal. /sq. NOA No: 02 -0408.10 Expiration Date: 11/06/03 Approval Date: 05/23/02 Page 33 of38 a• WOOD DECK SYSTEM LIMITATIONS: 1 A slip sheet is required with Ply 4 and Flex Ply 6 when used as a mechanically fastened base or anchor sheet. 2. Minimum ''A" Dens Deck or 'A Type X gypsum board is acceptable to be installed directly over the wood deck. GENERAL LIMITATIONS: 1. Fire classification is not part of this acceptance, refer to a current. Approved Roofmg Materials Directory for fire ratings of this product. 2. Insulation may be installed in multiple layers. The first layer shall be attached in compliance with Product Control Approval guidelines. All other layers shall be adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbs./sq., or mechanically attached using the fastening pattern of the top layer 3. All standard panel sizes are acceptable for mechanical attachment. When applied in approved asphalt, panel size shall be 4' x 4' maximum. 4. An overlay and/or recovery board insulation panel is required on all applications over closed cell foam insulations when the base sheet is fully mopped. If no recovery board is used the base sheet shall be applied using spot mopping with approved asphalt, 12" diameter circles, 24" o.c.; or strip mopped 8" ribbons in three rows, one at each sidelap and one down the center of the sheet allowing a continuous area of ventilation. Encircling of the strips is not acceptable. A 6" break shall be placed every 12' in each ribbon to allow cross ventilation. Asphalt application of either system shall be at a minimum rate of 12 lbs. /sq. Note: Spot attached systems shall be limited to a maximum design pressure of -45 psf. 5. Fastener spacing for insulation attachment is based on a Minimum Characteristic Force (F') value of 275 lbf., as tested in compliance with Testing Application Standard TAS 105. If the fastener value, as field - tested, are below 275 lbf. insulation attachment shall not be acceptable. 6. Fastener spacing for mechanical attachment of anchor/base sheet or membrane attachment is based on a minimum fastener resistance value in conjunction with the maximum design value listed within a specific system. Should the fastener resistance be less than that required, as determined by the Building Official, a revised fastener spacing, prepared, signed and sealed by a Florida Registered Engineer, Architect, or Registered Roof Consultant may be submitted. Said revised fastener spacing shall utilize the withdrawal resistance value taken from Testing Application Standards TAS 105 and calculations in compliance with Roofing Application Standard RAS 117. 7. Perimeter and corner areas shall comply with the enhanced uplift pressure requirements of these areas. Fastener densities shall be increased for both insulation and base sheet as calculated in compliance with Roofmg Application Standard RAS 117. (When this limitation is specifically referred within this NOA, General Limitation #9 will not be applicable.) 8. All attachment and sizing of perimeter nailers, metal profile, and/or flashing termination designs shall conform with Roofmg Application Standard RAS 111 and applicable wind load requirements. 9. The maximum designed pressure limitation listed shall be applicable to all roof pressure zones (i.e. field, perimeters, and comers). Neither rational analysis, nor extrapolation shall be permitted for enhanced fastening at enhanced pressure zones (i.e. perimeters, extended comers and corners). (When this limitation is specifically referred within this NOA, General Limitation #7 will not be applicable.) END OF THIS ACCEPTANCE NOA No: 02 -0408.10 Expiration Date: 11/06/03 Approval Date: 05/23/02 Page 38 of 38 6 ; MMi'tHiii4L8 AND . SY DIRECTORY ROOF COVERING MATERIALS (TEVT) Roofing Systems (TGFU)— Continued GAFGLAS #80 Premium Base Sheet may be used in any of the following systems. "GAFglas Flex Ply 6" is a suitable alternate to "GAFglas Ply 6". "GAFTEMP Permalite Recover Board" may be used in lieu of any perlite insulation in any of the following NC Classifications. Class A, B and C Hot roofing asphalt, for use with organic and glass felts or modified bitumen membranes. "Ruberoid Heat Weld" SBS roofing membraner may be used in lieu of "Ruberoid Mop" SBS products in any applicable Classification. 1. Deck: C -15/32 Class A Incline: 3 Insulation (Optional): One or more layers perlite, wood fiber, glass fiber, isocyanurate, urethane, perlite / isocyanurate composite, perlite/ urethane composite, wood fiber /isocyanurate composite, phenolic, any thickness. Ply Sheet: Three or more layers Type GI "GAFGLAS Ply 4" or "GAFGLAS Ply 6 ", hot mopped. Surfacing: Gravel. Deck: C-15/32 Incline: 2 Insulation (Optional): One or more layers perlite, wood fiber, glass fiber, isocyanurate, urethane, perlite / isocyanurate composite, perlite/ urethane composite, wood fiber /isocyanurate composite, phenolic, any thickness. Ply Sheet: Three or more lavers Type GI "GAFGLAS Ply 4" or "GAFGLAS Ply 6 ". Cap Sheet: One layer Tvpe G3 "GAFGLAS Mineral Surfaced Cap Sheet ". 3. Deck: NC Incline: 2 - insulation (Optional): One or more layers perlite, wood fiber, glass fiber, isocyanurate, urethane, perlite / isocyanurate composite, perlite/ urethane composite, wood fiber/ isocyanurate composite, phenolic, 2 in. max. Ply Sheet: Two or more lavers Type GI "GAFGLAS Ply 4" or "GAF- GLAS Ply 6 ". Cap Sheet: One layer Tvpe G3 "GAFGLAS Mineral Surfaced Cap Sheet ". 4. Deck: NC 1 Insulation: One or two lavers "Isotherm R", 4 in. max, hot mopped. Ply Sheet: Any L'L Classified gravel surfaced Class A asphalt glass fiber mat system. 5. Deck: C -15!32 Slip Sheet (Optional): Red rosin paper, nailed l to deck. Base Sheet: One layer of Tvpe G2 "GAFGLAS #75 Base Sheet" (may be nailed). Ply Sheet: One or more lavers of Tvpe G1 "GAFGLAS Ply 4" or GAFGLAS Ply 6 ". Cap Sheet: One laver of Tvpe G -3 "GAFGLAS Mineral Surfaced Cap Sheet ". 6. Deck: NC Base Sheet: One laver of Type G2 "G Incline: Base Base Sheer'. Ply Sheet: One or more layers of Tvpe GI "GAFGLAS PIy 4" or GAFGLAS Ply 6 ". Cap Sheet: One laver of Tvpe G -3 "GAFGLAS Mineral Surfaced Cap Sheet ". Deck: C -13 32 Incline: 2 Insulation: One or more layers perlite, glass fiber, isocyanurate, ure- thane, perlite / isocyanurate composite, perlite/ urethane composite, phe- nolic, 1.0 in. min (offset from plywood joints 6 in.). Base Sheet One or more layers of Tvpe G1, G2 or G3. Membrane: One or more layers of "Ruberoid Torch" (smooth or granule), "Ruberoid Torch Plus" (granule), "Ruberoid Mop" (smooth or granule) or "Ruberoid Mop Plus" (granule). Cap ,5heet "GAFGLAS Mineral Surfaced Cap Sheet", hot mopp Deck C-15/32 Incline: 2 Insulation (Optional): l or more layers perlite, wood fibet ass fiber, isocyanurate, urethane. fie lite /isocyanurate composite, perlite/ urethane a composite, wood fibs. ' tsocyanurate composite, phenolic, any Base Sheet Two or more layers of Type G2 or C3. Ply Sheet (Optional): One or more layers of Type Gl. • Membrane: One or more layers of "Ruberoid Torch" (smooth or granule), "Ruberoid Torch Plus" (granule), "Ruberoid Mop" (smooth or granule) or "Ruberoid Mop Plus" (granule). • _ Logic FORA E UL MARK ONSPRODUCT 1. De In fi u th P1 S 1. Dec Ins fib thi PIy "G Su 1. Deck Ins fib Ply "'GA Surf 1.1 2. Deck: Insu fiber, ureth thic Ply "G Surfa 3. Deck Insul Ply S mat s 4. Deck: Insul wood Base mopped Ply S as S aa u l( # /l 5. Decic :� mecham ROOF COVERING MATERIALS (TEVT) Roofing Systems (TGFU) Cap Sheet "GAFGLAS Mineral St aced Cap Sheer, hot mopp� Class B 1• Deck C -15/32 Incline: 3-1/2 Insulation (Optional): One or more layers perlite, wood fiber, isocyanuwte, urethane, perlite / isocyanurate comp te, g urethane composite, wood fiber / isocyanurate composite, perlite/ azn thickness. Ph eno li c, , any Ply Sheet Two or more layers of Type GI " GAFCLAS pl 4•• or "GAFGLAS Ply 6" Cap Sheet: Type G3 "GAFGLAS Mineral Surfaced Cap Sheet ", hot mopped. 2. Deck C -15/32 Incline: 3-1/2 Insulation (Optional): One or more layers perlite, wood fiber, glass fiber, isocyanurate, urethane, perlite / isocyanurate composite, perlitei urethane composite, wood fiber / isocyanurate composite, phenolic, an thickness. Base Sheet: Two or more lavers of Type Gl, G2 or G3. Membrane: One or more lavers of. "Ruberoid Torch" (smooth or granule), "Ruberoid Torch Plus" (granule), "Ruberoid Mop" (smooth or granule) or "Ruberoid Mop Plus" (granule). Cap Sheet: "GAFGLAS Mineral Surfaced Cap Sheet", hot mopped Class C ck: C -15/32 sulation (Optional): One or more layers e i perlite, wood fiber, glass ber, isocyanurate, urethane, perlite; isocvanurate composite, pKlite; rethane composite, wood fiber / isoc 'anurate composite, phenolic. any ickness. y Sheet Three or more lavers of Type GI "GAFGLAS Ply 4' or GAFGLAS Ply 6 ". urfacing: "Special Roofing Bitumen" 20 Ibs /sq. C OAL TAR FELT SYSTEMS WITH HOT ROOFLNG COAL TAR k: C -15/32 Class A Incline: 1/2 ulation (Optional): One or more lavers perlite, wood fiber. glass er, isocvanurate, urethane, perlite; isocvanurate composite, perlite re thane composite, wood fiber / isocvanurate composite, phenolic, any ckness. Sheet Three or more lavers of Tvpe G1 ' "GAFGLAS Ply 4" or AFGLAS Ply 6 ", hot mopped with coal tar bitumen. rfacing: Gravel. COMBINATION HOT AND COLD SYSTEMS Class A NC Incline: 2 ulation (Optional): One or more layers perlite, wood fiber or glass 'r, 2 in. max. Sheet: Three or more layers of Type G1 "GAFGLAS Ply 4" or FGLAS Ply 6 ". acing Grundy Industries "al '1B .• luminum Roof Coating" at NC : sq. Incline: 1 lation (Optional): One or more laves perlite, wood fiber, glass isocyanurate, urethane, perlite isocvanurate composite. perlite; ane composite, wood fiber / isocyanurate composite, phenolic, any kness. Sheet Three or more lavers of Tvpe GI "GAFGLAS Ply 4.. or AFGLAS Ply 6 ". cing: "Weather Coat Emulsion" at 3 gal /sq. NC Incline: 1 / 2 ation: One or two lavers "Isotherm R", 4 in.. hot mopped. heet Arty 11 Classified gravel surfaced Class A asphalt glass fiber ystem. NC Incline: 2 ation (Optional): Isocvanurate, perlite, isoeyanurate.'composite fiber and glass fiber, any thickness, mechanically fastened. Sheet One ply Type G1 or G2, mechanically fastened or hot heet One or more plies Type GI or G2, adhered with hot roofing dog "GAF Premium Fibered Aluminum Roof Coating", 1-112 or "GAF Weather Coat Emulsion ", 3 gal / sq. NC Incline. 1 don (Optional): Perlite, glass fiber, polyisocyanurate, wood fiber, tally fastened, any thickness. 173 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 -795 -2204 Printed: 5/30/2003 Applicant: JOSE Owner: BTESH JOB ADDRESS: 1180 NE 100 Contractor KAWALEK, PAUL RICHARD Local Phone: 786 277 - 9540 Parcel # 1132050190390 Signed (INSPECTOR) In consideration of the issuance to me of thls permit, I agree to perform the work conformity with the plans, drawings, statements or specifications submitted to the p done by either myself, my agent, servants or employes. Signed: Building Permit Permit Number: BP2003 -873 (Contractor or BTESH JOSE ST Contractor's Address: 485 N. E. 90 Legal Description: 5 53 42 MIAMI SHORES SEC 8 REV PB 43-67 LOT 3 Fees: Description Amount FEE2003 -3286 Building Permit Application Fee $60.00 FEE2003 -3287 CCF $1.80 FEE2003 -3288 Builders Bond $300.00 Total Fees: $361.80 Total Fees: $361.80 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 11/25/2003 Construction Value: $2,400.00 Work: TEAR OFF EXISITNG FLAT ROOFS REPLACE W A NEW BUILT UP ROOF SYSTEM PAUL R. KAWALEK ROOFING & PAINTING 485 N.E. 92ND STREET PH. 305 -754 -0191 MIAMI SHORES, FL 33138-2588 Pay to the order of Po Date Mrv'�korc' $ di-edShX r,„Trer Permdi Imp.; L002771: 00366060 L9 L411' 3 30 3 BLK 178 LOT SIZE eV 330: 83- 27/831 81 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date /// Job Address / /J'0 n/ E kJ, .1T • Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant Owner's Address Contracting Co. Qualifier State # Architect/Engineer Bonding Company Mortgagor Square Ft. Si ture of owner and/or Condo President Date FEES: PERMIT `T 0 / /kD /✓E /OO .ft.. Arion, Inc. Richard Wynne Notary . to Owner : • • • do President My Commission Expir 1 C.4,.,,) Municipal# 000013371 44. 9/4/9 NOTARY • _ - STATE OF FLORIDA JENNIFER NAFTAL -PEREZ COMMISSION # CC588692 EXPIRES 10.11.2000 BONDED THRU ASA 1.868.NOTARY4 Competency # Address Address Address (L v NOTARY RADON C.C.F. Signature of Contractor Master Permit # tit Estimated Cost (value) 310 4110111k.0... ...,4P1b., • otary s to Contra Owner- Builder My Commission Ex • e c(35 � P h o n e 1r — 6 i * 7 Address 8723 Sw 129th Terr. SS# phone 251 —1 279 Ins. Co. Kolisch Ins. Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Installation of Rain Gutters and Downspouts — li✓L WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable . laws regulatin struction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. lder BOND TOTAL DUE 9 NOTARY PUBLIC - STATE OF FLORIDA JENNIFER NAFTAL -PEREZ COMMISSION 1 CC588692 EXPIRES 10.11.2000 BONDED THRU ASA 1.8188-NOTARY -1 Date Date APPROVED: Building YCS ` I Electrical Zoning I Mechanical Plumbing Engineering APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statc,,,ent 01 the plans and specifications herewith submitted for the build • inc or other structure herein described. This application Is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Date..._ N.. ..�.._.__.....__......__.._.... ,19C� Owner's Name and Address 4 - • //NW HC ' . — No... Street NC I I 3 2 -0 / y 039`0 2 MIAMI SHORES VILLAGE 4 3 BUILDING INSPECTION DEPARTMENT /S2. 7 j ) Registered Architect and /or Engineer Name and address of licensed contractor AD revrH Rai Hwt= Ca' ' — 3df . 1'�w 7( : Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done 111r Alt L0O sr. _ _ State work to be done and purpose of building (by floors) .. f?E -nor 31 l5 7 L _ COW- "1. ttt• ••t It•:HH1H!!Ht -•• Sttttt GH "tt New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering. ..T� `f 444Iff L Estimate Total cost of improvements $ 7 I " dt7 Amount of Permit $. Zone cubage required .Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby crrtify 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 Sup e lement, and has complied with the provisions thereof, and will require similar compliance from alt 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 arc required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. �y n Remarks (Signed) STATE OF FLORIDA, 1 . COUNTY OF DADE. j ss• Building Inspector ao, ai, and for no other purpose. 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? Fed ar true. / 0// Permit No ( . 3 Date � Read, Sworn to and Subscribed before me. Disapproved ........_.....5._.. Date Notary Public, State of Florida (Signed) My Commiuion Expires PLANNING BOARD DATE Chairman _ Member ... Member Member Member ..... ..._ Member ...._ Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the I'Iannir.g hoard. A re- inspection fee of $1.00 will be charged when such ire - inspection is made necessary by improper notice for inspection or faulty materials anti /or workmanship. Disapproved (Signed) • Building Inspect Date MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State a Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Date..._ ----- 61715= 19.26 .. - frEfo h Si. Owner's Name and Address M . McKinnon No Registered Architect and/or Engineer — Mt. Biscayne Roofing Co. 5180 E. llth Ave 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 done 1180N . E. 100th Street State work to be done and purpose of building (by floors d en. and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of Roof Covering white shingle tile tsq. foundation 00 Estimated Total cost of improvements $ 140 . Amount of Permit $. Zone cubage required .Plan Cubage Distance to next nearest building. Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with be sent to The undersigned applicant for this building pennit 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 employed by him in the work to be performed under this permit; and will post or cause to be posted f. inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only suc • ntractors, on work to be rfoEmed under this pennit, as are licensed by Miami Shores Village. Remarks (Signed)-- Size of Building Lot reference to the building and its construction may STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read e foregoing application, and that he did sign the sazne, and that all facts Permit No.. de 5 , Date (t, 7 710 Read, Sworn to and Subscribed before me. therein by him statbd are true Notary Public, State of Florida My Commission Expires PLANNING BOARD DATE Chairman Member Merober Member Member ember Date Council Approved Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re-inspection fce of $1.00 will be charged when such re-inspection is made necessary by improper notice for inspection of faulty materials and/or workmanship. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PiERiviIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build - ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. \ 1 Date... 3 .1 7 .. _-._....__--- __._____ I9.? 2 ^ • Owner's Name and Address. -it?. el..Litt .:!LQiita _..._.. .... _... No. L E1._....... Street..d. ..1! f......S. Registered Architect and /or Engineer \ ... •••••••••••••••• OW. .._ „., Name and address of licensed contractor i3 1 s C 4-7Y i ..C., ea ) n ,i • 6)10 Z L(_4 L / Location and legal description of lot to be built on: Lot Block Subdivision. — Street and Number where work is to be done- _..... /___g 1. 4_,4. 1..!_!1___ . SS' _________.- __.__._ State work to be clone and purpose of building (by floors).t_ _,ZAL - -C.__A _4_5 Q- �f__- /_S!LA_$__ 2 7..e.i£ 01S_.6 cz'CY S '4 1,!1t-,;:.t 'r L_. Le r ' / rrivl t _..___._........ for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering.. .1.4 Estimated Total cost of improvements $ C) ° Amount of Permit $. Zone cubage required __...._..Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to - The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Pennanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks. (Signed) STATE OF FLORIDA, COUNTY OF DADE. ss Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared __. _•------ -__ - -- _ _ �.. _ __ _.___...._ _ to me well kncwn, 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. 471c- t3 Date 3.r 9 _ . _ __ Read, Sworn to and Subscribed before me. Disapproved ( G.� 4..erfatec. _ Notary Public, State of Florida ( Signed) �`'° �I Building Inspecto My Commission Expires PINNING BOARD _._ ._._ Chairman Member Mcrnber Member ...... ---- ....... --- Member _.... _. _. _._._ r : 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 hccn obtained from the Planning Board. A re-inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper materials and /or workmanship. . • 0 Date MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Remarks (Signed) Date / Date August 31 Owner's Name and Address._ C.ia,ude Steele N 1180 Street N„ E„ 100th St, , Registered Architect and /or Engineer Name and address of licensed contractor Lang Roofing & Tile Co _ IriCo 43 N, N „__79t)15t.,_, Miami Fla. Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done 110 L. E. .1Q0.th_St...,___Sia_mi Shames,...Ela_. State work to be done and purpose of building (by floors) 3 sq. addition to residence 4 -ply gravel and for no other purpose. New Building X Remodeling Addition X Repairs No. of Stories To be constructed of Kind of foundati Roof Covering _.. -Ply gravel Estimated Total cost of improvements $ 95.00 Amount of Permit $ 3.. Zone cubage required 4 ' .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 bi tlfling. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. LANG OOFING_: TILE COMPA STATE OF FLORIDA, COUNTY OF DADE. ss Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared ph A. Martin, Vice Pres. 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 trge. Permit No Disapproved (Signed) ... Read, Sworn to and Subscribed before me. 1' ,19 Notary Public, State of Florida lding Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. BUILDING ❑ ELECTRICAL ❑ DATE 195 PLUMBING ❑ PERMIT N? 9633 ROOFING ❑ Work to be performed under this Permit Owner of Building ; Architect Contractor or Builder Legal Description Address of Building Lot MIAMI SHORES VILLAGE. FLORIDA Bl. Subdi- vision Sq. Ft Value of Project $ Amt. of • Permit $ Contractor's License No ■ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thoroylgh knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed • BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY 17 APPLICATION FOR BUILDING PERMIT Application is hereby made for the approyal of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether he 'In 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 ......1. Registered Architect and /or Engineer 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 done State work to be done •; rpos of building (by MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT Date No Street , 19 L-4 and fq 'no other purpose. • New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ Z2' Z Amount of Permit $ - •- Zone cubage required _Plan Cubage Distance to next nearest building____ Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said buillding. All notices be sent to STATE OF FLORIDA, COUNTY OF DADE. ss. Building Ins.'ctor with reference to the building and its construction may 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 kquirei 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 i. ection on the sit- .f the work such public oti e or notices as are required by the Act. The undersigned agrees to employ only such s tr n , to be J'erfor 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 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. Vie Permit No 7 Date ) -2-- 1 e_ � Read, Sworn to and Subscribed before me. Disapproved (Signed) Notary Public, State of Florida My Commission Expires PLANNING BOARD DATE Chairman / Member Member Member Member ....._.._. Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.