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ROOFING.PERMIT APPLICATION 1'OR MIAMI SHORES VILLAGE Date 5 -10 -95 Job Address 122 N.E. 101 Street Tax Folio Legal Description Owner / Lessee / 'Tenant Donald Klinger Master Permit # 37 9h Owner's Address 122 N.E. 101 Street Phone 758 -0856 Contracting Co. QUALITY Qualifier CARLOS AROCHO State i RC0058627 Municipal #2078269 ROOFING CONTRACTOR, INC. Address 251 N.W. 99th STREET ss# Phone (305) 751-0382,. Cometency #17889 Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL�(ROOI'ING PAVING FENCE SIGN WORK DESCRIPTION Tear off roof to wood deck, tin cap 301b. ASTM felt, mop on with hot asphalt 901b. ASTM felt, install metal eaves or valley metals where required and install Spanish S Clay Terrecotta Mortar set Tile. Flat roof to install fiberglass and paint aluminum. Square Ft. Tile 30 sq. Flat 6 Sq. Estimated Cost(value) $ 13,500.00 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 for:: going 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 th work stated. Signature of owner and /or Co-.S o'. President Date: I r" ITT DEZ Notary as togOwner an My Commission Expires ** * FEES: PERMIT APPROVED: Zoning tY, tel MY COMMISSION # CC 324212 EXPIRES: October 10, 1997 Bonded Thnr Notary Public Underwrtters RADON C.C.F. J,4 Firs: Bui_din My Commission * * * Mechanical Plu.:tbing Signature of Contractor or Owner- Builder Date: S- /a -95" 1 1 Ay, ,IN& Notary as to Contractor or Own e ?Builder ° • MARYLOU HERNANDEZ IA MY COMMISSION B CC 324212 EXPIRES: October 10, 1997 tended nun ter PnY yp s * NOTARY TOTAL DUE Other Electrical Engineering 01A OF FLORIOA, COUNTY OF DADE i HEREBY CER71Fy fiat this is a fru original filed in this of 'co on W. TNESS my HARVE By Py ,AO. nd and Official _- 0 K, NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF DADE: .958203593 1995 MAY 26 12:29 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: 2. Description of improvement: 3. Owner(s) name and address: Interest in property: Owner Name and address of fee simple titleholder: N/A 4. Contractor's name and address: QUALITY ROOFING CONTRACTOR, INC. 5. Surety:(Payment bond required by owner from contractor, if any) Name and address: N/A Amount of bond $ 6. Lender's name and address: 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: N/A 6. In addition to himself, Owner 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: N/A 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) Print Owners Name Sworn to and subscribed before me this /2 day of /j,¢-- , 19 7 S . Notary Public Print Notary's Name My Commission Expires: 001. uit and County Courts D.C. N/A c Install new Tile and Flat Roof. Donald Klinqe. - 122 N.E. 10]. Street Miami ShnrPs, Flnriria 3311P 251 N.W. 99th STREET MIAMI, •ye MARYLOU H NANDEZ rA i! MY COMMISSION N CC 324212 EXPIRES: October 10, 1997 JBF f4° ° Bonded Tbuatolai�PubliG UndLrvrttters ho y of 122 N.E. 101 Street Miami Shores, Florida 33138 FLORIDA 33150 Prepared b y5arlos Arocho Quality Roofing Contractor, Inc. Address: 251 N.W. 99th Street Miami, Florida 33150 12301.52 2/93 MEtY A0 Almar USA - Altusa Tile 6645 NW 77th Avenue Miami, FL 33166 PRODUCT CONTROL NOTICE OF ACCEPTANCE Your application for Product Approval of Almar USA - Altusa Tile under Chapter 8 of Metropolitan Dade County Code governing the use of Alternate Materials and Types of Construction, and completely described in the plans, specifications and calculations as submitted by Construction Research Laboratory, Inc., Testwell Craig Laboratories and Consultants, Inc. and Professional Service Industries, Inc., has been recommended for acceptance by the Building Code Compliance Office to be used in Dade County, Florida under the Specific Conditions set forth in pages 2 et seq. and in the Standard Conditions detailed on page 3. The approval shall be valid for aeperiod of three years. The Office of Code Compliance reserves the right to require retesting of this system within the first two years of the approval should any amendments to the South Florida Building Code be enacted affectin co • • nen roof syste ACCEPTANCE No: 94-0.06.18 / i /..d/1 .11 EXPIRES: FEB 1 4 1997 **PLEASE NOTE ** THIS IS THE COVERSHEET, SEE ADDITIONAL PAGES FOR SPECIFIC AND GENERAL CONDITIONS. This application for Product Approval has been reviewed by the Metropolitan Dade County Building Code CoinpIiance Department and approved by the Building Code Committee to be d in Dade County, Florida under the conditions set forth above. APPROVED: FEB 1 1994 BUILDING CODE COMPLIANCE DEPARTMENT SUITE 1603 METRO•DADE FLAGLER BUILDING 140 WEST FLAGLER STREET MIAMI, FLORIDA 33130.1563 (305) 375 -2901 FAX (305) 375.2908 Gil Diamond, P.E. Product Control Division Supervisor METRO -DADE FLAGLER BUILDING Charles Danger Building Code Compliance Department Metropolitan Dade County THIS PRODUCT CONTROL APPROVAL SUPERSEDES PRODUCT CONTROL APPROVAL #90- 0208.01 ( Applicant: Almar USA - Altusa Tile 7270 MW 12th Street Suite #650 Miami, FL 33126 Category: Prepared Roofing Sub - Category: Tile Type: Nail -on /Mortar -set Sub -Type: Clay • Product Control Notice of Acceptance • Roofing System Approval Contact: Carlos Fernandez 7270 MW 12th Street Suite #650 Miami, FL 33126 (305) 471 -5830 Product Control No.: 94- 0106.18 Approval Date: FEB 1 4 1 Y Y 4 Expiration Date: FEB 1 4 1997 System Description Alfareria del Turbio, S.A. (Altusa), located in Barquisimeto, Venezuela, is a manufacturer of clay roofing systems for mortar -set and nail -on applications. Almar (USA), Inc., located in Miami, Florida, is the sole importer under contract for selling and distributing the Altusa products in the United States. All tiles are manufactured from natural Venezuelan clays. Altusa has two profiles of tile for use in the South Florida area: Altusa 'S' and the two -piece Altusa Barrel. Both are available in a variety of natural clay colors. Both profiles utilize universal itrim for hip, ridge and rake, as well as optional rubber cave closures ('S' tile only) and clay closures for both ('S' tile and Barrel). The minimum pitch for Altusa Clay Roof Tiles shall be 2 ":12" for nail -on and mortar -set applications. Altusa Clay Roof Tiles have been tested in compliance with the South Florida Building Code Requirements for clay mortar -set and nail -on applications. Z 0 - i994 171 S:TiVirl Material FROM System Trade Names 'S' Clay Roof Tile 2 -Piece Barrel Tile Maximum Design Velocity Pressure Material Design Velocity Pressure Wood, Non - insulated psf (See Comments and Limitations) Maximum Fire Classificarion Glassificatiorj Wood, Nail -on Class A TO 55?O_.92 - , 0= Gil Diamond, P Product Control No.: 94-0106.18 07-0 09: O M FROM TO Trade -Names of Products Manufactured or Labeled by Applicant 136 ?0592 P.04 Product Control No.: 94 -0106.18 Product Dimensions Test Specifications Product Description 'S' Clay Tile 181/4" x 101/4" .. ASTM C 1167 Interlocking, vitrified clay tile for nail -on applications. Mission 181/4" x 9" - 8" x 'A", ASTM C 1167 Interlocking, vitrified clay tile for nail -on 18" x 81/4" - 71/4" x applications: two -piece tapered; A ,i non - porous stoneware grade finish. "z_ 03 -01 -1994 09: 00AM FROM Trade Names of Products Manufactured by Others Product Dimensions Product Test Specifications Description TO 6670592 P. 05 Product Control No.: 94 -0106.18 Manufacturer #30 Felt ASTM D 226, Saturated organic felt to be generic type II used as a nailed anchor sheet. #43 Base Sheet ASTM D 2626 Saturated and coated generic organic base sheet for single ply underlaytnent. Mineral Surface Cap ASTM D 249 Mineral surfaced asphalt generic Sheet roll roofing. Asphalt Primer ASTM D 41 Cut back, asphalt based generic coating used to facilitate adhesion of dissimilar materials. Mopping Asphalt Flashing Ccmcnt Valley Flashing ASTM D 312, Asphalt for bonding the generic type III or type mineral surface cap sheet IV to the base sheet. ASTM D 4586 Cut back, asphalt based, generic fiber - reinforced trowel gr ade cement for flashing and repair applications. Mint. 26 ga. x 16" ASTM A 525 Galvanized steel valley generic flashing. Drip Edge Min. 26 ga., 2" x ASTM A 525 Galvanized steel drip edge. generic 2" Wood Battens Min. 1" x 2" for LP • 2 Pressure treated wood generic horizontal, 1" x battens. 4" for vertical Roofing Nails Min. 12 ga. x 1" ASTM A 641 Corrosion resistan fang /J generic nails. L // / / , Tin Caps Hurricane Clip PA 114 Hurricane Clip Fasteners Type M Mortar Tile Adhesive Min. 32 ga. x 1 -5/8" #8 x 2" Product Control No.: 94- 0106.18 Corrosion resistant circular generic discs. Tile Nails Min. 11 ga. ASTM A 641 • Corrosion resistant nails. • generic Nail heads shall exceed the lice of nail holes in tile. Galvanized . bronze, aluminum, plastic, or stainless steel attachment clip for high wind areas. PA 114 Compatible fastener for generic clip ASTM C 91 Approved type M mortar at generic a ratio of 2:1 ASTM D 3493 Tile -to -tile adhesive generic generic METRO-DADE NOTICE OF ACCEPTANCE: STANDARD CONDITIONS All reports of re- testing shall bear the seal, signature and date of an engineer registered in the State of Florida. 4. This acceptance shall not be used as an endorsement of any product for sales or advertising puiposes. 5. The Notice of Acceptance number preceded by the words Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the Notice of Acceptance is displayed, then it shall be done in its entirety. 6. Product approval drawing, where required for permit applications, shall be provided to the applicant by the manufacturer or his distribhtors; unless otherwise noted in the Notice of Acceptance. The prints need not be re- sealed by an engineer. 8. Failure to comply with Standard Conditions shall be cause for termination of Approval. Gil Diamond, P.E. Product Control Divis' s n Supervisor METROPOLITAN DADE COUNTY, FLORIDA METRO.DADE FLAGLER BUILDING BUILDING CODE COMPLIANCE DEPARTMENT SUITE 1603 METRO -DADE FLAGLER BUILDING 140 WEST FLAGLER STREET MIAMI, FLORIDA 33130 -1563 (305) 375 -2901 FAX (305) 375 -2908 1. Extension of Acceptance may be considered after a new application has been filed and the supporting data, test reports no older than ten (10) years, have been re- evaluated. 2. Any revision or change in the materials, use, or manufacture of the product or process shall automatically be cause for termination, unless prior approval is granted for revisions or change. 3. Any unsatisfactory performance of this product or process or a change in Code provisions shall be grounds for re- evaluation. 7. ' An annual certificate confirming listing with Factory Mutual Research and Underwriters Laboratories or such other listing agency approved by the Office of Code Compliance shall be submitted on or around the first of April annually. Test Agency Professional Service Industries, Inc. Test Identifier #395 - 10048 -3 #395 - 10048 -01 #395- 80133 -27 #395.80133 -26 Testwell Craig Laboratories #89125 ALT03 and Consultants, Inc. ' #86304 Construction Research #4539 Laboratory, Inc. #4632 Test Reports Test Name/Repon Date Material Properties Test 12/14/92 Water Absorption and Breaking Strength Product Control No.: 94 -0106.18 Material Properties Test 05/03/91 (Water Absorption and Breaking Strength) Material Properties Test 01/26/90 (Water Absorption and Breaking Strength) Material Properties Test 01/26/90 (Water Absorption and Breaking Strength) Material Properties Test 08/03/89 (Water Absorption and Breaking Strength) Material Properties Test ( 10/31/86 Water Absorption and Breaking Strength) Uplift Approvals; (Static 03/03/90 Pressure Uplift Resistance) Wind Driven Rain 08/08/86 Infiltration Resistance Acceptance Number: 94 -0106.18 Approved: Expires: Limitations: 1. This roof system assembly may be applied to roof slopes no less than 2 ":12 ". 2. Vertical and horizontal battens shall be used on all tile applications on slopes of 2" :12" to 4 ":12 ". 3. Horizontal battens shall be used on all tile applications on slopes of >7 ":12 ". 4. Mortar set systems may be applied to roof slopes of 2 ":12" to 7 ":12 ". 5. Nails for attachment of tile shall have heads larger than the pre - formed nail holes in the tile. 6. Allowable height above ground shall not exceed'a maximum height of 45' for non - coastal, 30' in Coastal Area 1 and 2, and only by job approval from the Chief Product Control Compliance Officer in Coastal Area 3. 7. All tiles shall bear the imprint of the manufacturer's name or logo, as noted attached, to permit identification in the field. S. Any amendments to these provisions shall be in compliance with Sections 203 and 204 of the South Florida Building Code. 9. All nails shall be corrosion resistant. Exposed nails shall be hot dipped galvanized, stainless steel, or copper only. 10. The manufacturer shall retain the services of an independent testing laboratory to maintain quality control. Testing shall be performed on a minimum of five (5) tiles every three (3) months, for strength according to Section 3404 of the South Florida Building Code, and for moisture absorption according to ASTM C 1167. Test samples shall be selected by a laboratory, according to ASTM D 3665. Results shall be forwarded to Dade County Product Control Section. Test reports shall bear a description of the tile by material and color, i.e. cement, grey. 11. All domestic distributors and private labelers of foreign manufactured tile shall have a completed distribution agreement filed with the MetroDade County Office of Code Compliance confirming the distributor's agreement to adhere to the conditions of this report. 12. Almar USA - Altusa tile shall be installed in strict compliance with the application instructions noted herein as wt11 as the manufacturer's and Metro -Dade County specifications and application instructions. The Metro Dade County Model Tile Specification shall take precedence. 13. The use of all pre - formed trim and specialty tile tested is required as it forms an integral part of these Product =--Control Approval tests. 14. Applications for roofing permits must be accompanied by Section II of the Uniform Building Permit, clearly indicating the extent of the work to be performed, along with current manufacturer's specifications and details. In 15. The following documents were submitted with the application: Information Brochure - Altusa Mission Barrel Tile Information Brochure - Altusa 'S' Tile Information and Specifications Brochure - Altusa 'S' Tile Installation Methods and Specifications - Altusa Mission Tile Acceptance Number: Approved: Expires: 94 -0106.18 addition, a copy of this approval shall be attached to the permit application. Reference shall be made to all appropriate data for the required fire rating. Gil Diamon .E. Mctropoli Dade County Office o ode Compliance N9 1425 CERTIFICATE OF OCCUPANCY MIAMI SHORES VILLAGE, FLORIDA BUILDING DIVISION Miami Shores Village, Fla , Owner, Agent or Tenant of Building Lot 4 1 Block Subdivision Street Address ! a Approved use by occupancy Remarks. This Certificate of Occupancy is issued to the above named for building at above named location only upon the express provision that the applicant will abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known as the Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to the erection, construction, alteration or remodeling of buildings or structures. BUILDING DIVISION OWNER'S NAME Emma Silberman PRESENT ADDRESS 530 N.W. 109th S. LICENSE NO. PHONE NO. JOB LOCATION (ST. OR AVE.) 122 N.E. 101st St. LOT 11 -12 BLOCK 15 SUBDIVISION MS Sec. 1 GENERAL CONTRACTOR Johnson & Gaeta ADDRESS PHONE NO. LICENSE NO. 12609 BUILDING PERMIT NO. 1 -9 -52 DATE 17.00 PERMIT FEE $ BUILDER'S POND 7-0 13$ -7:- /k ' NO. DATE p ZONE REQUIREMENTS 18,500 CU. FT. PLAN CUBE 27,206 CU. FT. EST. COST $ 13, 000 DRAWINGS. SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED BY: DATE x NEW CONSTRUCTION TYPE CBS STORIES 1 ROOF CONSTRUCTION tile INTERIOR CONSTRUCTION oak amd terazzo floors,plaste x REPAIRS DESCR IPTIO Nwalls and ceilings 3 bdrm. - bath- kitnhsn- dining rnnm- ipilon5ie parch- livin8,ronm -2 car ALTERATION DESCRIPTION garage ADDITION SUBMITTED TO PLANNING BOARD APPROVED REJECTED REFERRED TO COUNCIL REASONS RE- SUBMITTED TO PLANNING BOARD SUBMITTED TO VILLAGE COUNCIL REMARKS CERTIFICATE OF OCCUPANCY NO./ 4 40 2 -.g I ISSUED d . 0 4 '1°' /�-� � BY LJ ^I� 1 TO l� Vv h �' Q -1 BUILDING PERMIT AND INSPECTION RECORD -MIAMI SHORES VILLAGE INSPECTIONS ''^ DATE BY RE- INSPECT BY RE- INSPECT BY FOUNDATION P Z„ FEE TEMPORARY SERV IC�E TEMPORARY SERVICE S BEAMS & LINTELS / a s - S a — - S / A , SEWER RANGE CONN. 77 FRAMING SOLAR HEATER MOTORS S GAS FIXTURES S S S INSPECTIONS FINAL a °/ - RE- INSPECT BY RE- INSPECT BY ROUGHING CLEAN-UP // +1 C AL.• GAS CONTRACTOR )■ lam• I PHONE PERMIT NO. I ..1 a- SI I DATE 0 - ,5 --- 5 FEE S // ° CI NEW BLDG. ALTERATION I ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERV IC�E TEMPORARY SERVICE S �" y- SEPTIC TANK ->.L., H. W. HEATER CONN. �1 , I C.-(-q Ei4 S / A , SEWER RANGE CONN. 77 S SOLAR HEATER MOTORS S GAS FIXTURES S S S INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY ROUGHING TEMP. SERVICE � /O it / , -Y\ C AL.• GAS ROUGHING ¢ - rs.--11-b- pow SEWER H. W. HEATER CONN. SEPTIC TANK 3 ( 9 -,l Y �f� ,,,,// ( /�7 SOLAR HEATER FIXTURES l.i / if- / - 5 .2._ CONTRACTOR Li ' L • h., - PHONE -- ).-1 -- ).-1 6 PERMIT NO. � . U I I DATE X 1 v J FEE S/ la NEW BLDG. I ALTERATION [ ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE S H. W. HEATER CONN. S RANGE CONN. S MOTORS S FIXTURES S S INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY TEMP. SERVICE � /O it / , -Y\ C AL.• ROUGHING ¢ - rs.--11-b- pow H. W. HEATER CONN. RANGE CONN. FIXTURES & FINAL if- / - 5 .2._ l PLUMBING PERMITS & INSPECTIONS ELECTRICAL PERMITS & INSPECTIONS APPROVAL TO POWER CO. FOR SERVICE DATE //- Product Control No.: 94- 0106.18 Deck Type 2: - Wood, non - insulated, Mortar Set Deck Description: New construction, 19/32" or greater plywood or wood plank. Slope Range: 3 ":12 "• to 7 ":12" System A. Underlayment: Any approved No. 30 or No. 43 organic anchor sheet. Head laps shall be minimum 2 ", side laps shall be minimum 6 ". Fastening: Nails and tin caps, two (2) rows staggered 12" grid, 6" o.c. at the laps. Membrane: Any approved mineral surfaced rolled roofing applied in hot asphalt or cold process cement (See Model Tile Specifications). Head laps shall be minimum 2 ", side laps shall be minimum 6 ". Vertical Battens: None Horizontal Battens: None Mortar /Adhesive Approved mortar shall be used. All tile shall be set in a mortar patty as set forth in the Application: Model Mortar -Set Tile Specification. Mortar shall be Type "M ", mixed in the ratio set forth in the Products by Others'. Any adhesive application shall be applied as set forth in the adhesive Product Control Approval. All tile and accessories shall be installed in compliance with system #3, of the Dade County Model Tile Specification. Roofing Tile: Install One of the following profiles: Altusa'S' or Altusa 2- -piece Barrel The tile system shall be installed in compliance with the Metro Dade County Model Mortar /Adhesive -Set Tile Specification (Appendix 'X' of the South Florida Building Code), utilizing the components listed the 'Products Listings' set forth in this Product Control Approval. — Applications, as detailed in the test reports, are consistent with the application methods stated in the execution section of said model specification. Maximum Design See Limitation No. 6. Velocity Pressure: Comments: • For re -roof applications. 15/32" plywood is an acceptable substrate. On slopes 4 ":12" to 6 ":12", tile shall have the first three courses of tile nailed with not less than one nail per tile. As an alternate, the first three courses shall be applied in mortar over a single layer of minimum 12 ga wire mesh with square openings of not less than 3/8" which is mechanically attached to the deck with not less than one roofing nail per every 2ft For pitches from 6 " :12" to 7 ":12" every third tile of every fifth course, beginning with the eighth: course, shall be nailed. On Slopes >7 ":12" all provisions of 'System #1' the Dade County Model 'Horizontal Batten' Nail -on Tile Specification shall apply. St ELEGANT® FIELD TILE 10" 18" DOVE TAIL LOCKS :OVER 'TILE (HIP AND RIDGE) PAN.TILE CABLE -RAKE NAIL HOLE COVER TILE (HIP AND RIDGE PROJECT NAME EGARA CORPORATION 7270 N.W. 12th' Streec, Suite -650 Miami, Florida 33126 ALTUSA MISSION PROJECT NO 395 - 80133 -26 1'at3e 2 of 2 GATE 01 -26 -90 Mbltnals: a. Clay tiles snail be Attusa•S' as manufactured by Aifreria Del Turblo SA (ALTUSA) for Almar (USA), Inc. 18 1/2" long by 10 1/2" wide nominally. b. Under eave shall be (specify one) 1. Clay eave closure 2 Rubber eave closure 3, Mortar filling with weep hole 4. Metal closure c. Asphalt plastic cement: Heavy body composed of asphalt and other minerals, con- forming to ASTM D2822 and Federal Spec. SSC -153 type 1. d. Cement Mortar 1. Cements a. Blended Cements'conforming to ASTM C-91 type M • b. Portland Cement - conforming to ASTM C-150 type I C. Masonry Cement - conforming to ASTM C -91 type M 2. Sand - conforming to ASTM C-144 uniformly graded, clean and free from organic materials. , . • . 3. Mixes - conforming to ASTM C -2 70 type M (select one) a. Cement 2.07 + — E -1 -A b. Combination of cement 2.07 E -1 -C 4. Mortar flow 110 + — 5% conforming to ASTM C -230 Flow Table, . 2. Oecking: Solid decking shall be of proper thickness (1/2" minimum plywood sheathing) to be structurally adequate and properly fastened to support the anticipated loads. Decking material and installation of it shall comply with all local Building Code Requirements. 3. Undertayment: • Never install underlayment on wet, frozen or icy surfaces. Sweep root surface txoom clean. Cover all sloped roofs under tile with the best quality asphalt Impregnated roofing felt weighing not less than 43# per square feet. Specify Desired Underhyment: Consult Local Building Codes for Compliance Nall -On Installations: A. Minimum 4/12 and greater. Lay one layer of 43# base sheet with a sealed minimum 4" headlap and 6" Side lap and nominal 3" tile headlap. All tile nail penetrations to be sealed with plastc cement. Mortar -On Installations: . 8. Pitches 2 1/2/12 and greater (refer to building codes for minimum). Lay one layer of 30# felt, secure in place with tin tags as code requires. Lay with minimum 2" headlap. Apply 90# mineral surfaced roofing felt to be solidly mopped to the 30# felt with hot asphalt. Lay with minimum 2" headiap and 6" side lap. Back nail 90# felt with cap or tin tags 12" o. c. • 4. Fasteoing Systems: Nail -On Installations A All nails should be large headed nails, 8 penny, 'corrosion resistant, .long enough to penetrate through the sheathing by 3/4 ". Copper, stainless steel or hot dipped galvanized nails are to be considered to extend the life of the roof. All nails penetrating through the watertight seal should be waterproofed with mastic sealant complying to ASTM D- 2822 -75, type II, Nail length may vary, depending on the thickness of plywood and exposed ceiling situations where nail exposure is unwanted. B. For steep roof applications above 7/12, additional fasteners may be required, i. a. tile tie systems, nail - locks, wind -locks per manufacturers specifications (consult local building codes). oOv£ TAIL LOCKS ALTUSA S' FIELD TILE NAIL _ UNIVERSAL 71LE NAIL UNIVERSAL ---`\ 1 ILE \ NAILEfIE NAILER$ FI T: MORI / \ _t GABLE TO GABLE SECTION -IP C. FIIOCaE TILE MORTAR .--\ FELT _ TILE �. ALTUSA S' FUR 7:12 SLOPE ANO NIGHER 911.1" /—••■-• MORTAR NAIL i — UN.VERSAL / TILE HIP AND RIDGE SECTION 9 1/ 4 NAILON NAIL woo ,•• TILL 9 114 10" ON SYSTEM REGLET f LASHING MORTAR NA$>_ GAME -RAKE FIELD TILE JIB FLASHING AT WALL 9Y, HIP AND RIOGE TILE CAVE CLOSURE FLASHING FASCIA NAILER TALE 7 FLASHING AT WALL FELT 9Y. GABLE-RAKE TECHNICAL DATA MUDINAIL METAL (;HANFEL r FLASHING Weight per Tile (Nominal) 7 lbs. Pieces per Square (Nominal) . 97/103 Overall Size (Nominal) 18 3/8 x 10 1/2 Exposed Size Max. (Nominal) 15 1/2 x 16 1/2 Tile Thickness (Nominal) I\2 " Firing Temperature 2000 °F Breaking Strength Avg. 650 Water Absorption ... Avg. S.8% Freezing Test No tile cracking after 50 cycles Due to the nature of clay. slight variation may occur. Hashing:: A. Valleys (select one) 1. Install roll valley minimum 16" width with 6" lap joints. Nail to secure in place as code requires. 2. Install preformed open valley minimum 16" width with minimum 2 1/2" higl ,center and minimum 1". metal edge retums. Lap pints minimum 6:'. Secure it place as code requires.. 8. Dormers, side, chimneys and other vertical wall surface extent upward at least 6 "- an&be completely counter - flashed: Flashing shall extent under the tile a rnlnimum of 5" with:a 1.' turn up at edge. _ C. Where sloped roof surface meets the face of vertical wall surfaces at dorme chimneys and other walls, the flashing shall extend up the facing wail a minimum of 4" and extend downward over the top of the a minimm, o uf The vertical wall surface shall be completely counter flashed. D. Eave drip metal shall be nailed or stapled along and directly on top of sheer fastened 6" o. c. and 1/2" in from top flange. Lap all Joints a minimum of R. Application of ilia: k For mortar on application, mark horizontal guidelines at 16 1/2 ", which will provide a 2" nominal headlap. B. For nail -on application, mark horizontal guidelines at 15 1/2 ", which will provide a nominal 3" headlap. C. Mark all vertical guidelines at 9 1/4 ". D. Set first course at 161 /2" from the eave. This will provide a 2" overhang at the eave. E. At the eave line, clay, mortar, rubber or metal bird stop shall be used to boost the first row of tile. • Note: In high wind and hurricane areas, additional fasteners may be required at the eave course. Corisult local Building Codes for requirements. F. For mortar -on settings, each tile shall be set over a full trowel of mortar placed directly under the projection of the left flat side of the tile. Press tile down firmly to allow wet mortar to fill "Dove Tail Locks" tor proper bond. 1. For pitches 4/12 and above, nail Dave course with one nail in addition to mortar. Apply plastic cement to seal all nail penetrations. Z. For pitches 6/12 up to and Including 7/12, nail every third tile In every fifth course in addition to mortar. Apply plastic cement to seal all nall penetrations. 3. For pitches above 7/12, nail every tile in addition to mortar. 8. For nail -on installations, install tile with nails of sufficient length to penetrat• the deck by 3/4 ". For pitches above 6/12, all tiles shall be attached with a minimum of two nails. Seal all nail penetrations with plastic cement . H. At 55' above grade or greater, all tile must be attached with a minimum of two nails in both a nail -on or mortar set installation • • I. Fasten and cement all gable rakes at the horizontal guidelines..'' J. Where tile overlaps flashing, tile must be secured with approved tile adhesive or cemented in place. K. Tile must cut smooth and straight to maintain the proper width In the open valley. Width In the open valleys may vary according to local conditions. It I! recommended that the minimum width of exposed mate' be 4". • L Where field tile meets the hip nailer's, tile should be cut along the hip boards. The joint between the cut tile and the hip nailer shall be sealed neatly with plastic cement. M. All hip and ridge tiles shall be set in a bed of mortar and fastened with a 21/2" nail. It is then recommended that the mortar be pointed to a clean surface. Job Address: k) , E_ j O ( Sr APPENDIX 'E' METRO -DADE UNIFORM BUILDING PERMIT SECTION II MORTAR OR ADHESIVE SET TILE SYSTEMS 1. General Contractor: The information provided in this Section is required to confirm Product Control Approval of the proposed tile system assembly; confirm compliance with the.wind load requirements of Chapter 23 of the South Florida Building Code (SFBC); and confirm compliance with Sections 3403.5 and 3404 of the South Florida Building Code. 2. Documentation The following documents are required for submission with the Uniform Building Permit application: Two (2) copies of the proposed tile system assembly's and associated roofing component's Product Control Approval(s). • One (1) copy of the tile system assembly and/or roofing component(s) manufacturer's published application instructions and literature. • All documents attached herein, filled out and completed in full. 3. Project Information Check one of the following: ❑ New Construction S Re -Roof Note: Mortar or adhesive set tile systems arc not acceptable as recover applications. Mortar or Adhesive Set Tile Systems Page - 1 6 9/rocess No. Is the deck solid sheathed? (circle 'yes' or 'no') yes no Deck Type (check one of the following): ❑ Nominal 'A" Plywood (for re -roof only) ❑ Nominal V," Plywood igt Wood Plank (YE" " ❑ Other (fill in) Roof Pitch (fill in): 1 " : 12" Note: Mortar or adhesive set tile systems shall not be installed at a pitch greater than 71/2":12 ". Mortar or adhesive set tile applied at a pitch greater than 5 ":12" and less than or equal to 7 ":12" shall have the first three courses of tile nailed with not less than one nail per tile. As an alternate, the first three courses of tile may be applied in mortar over a single layer of minimum 12 ga. wire mesh with square openings of not less than '/ which is mechanically attached to the sheathing with not less than one nail per 2 ft Circle 'yes' or 'no' for each of the following: Have you attached two copies of the tile system manufacturer's Product Control A. 'royal for the proposed tile system? no Have you attached a copy of the tile system assembly and/or roofing components) manufacturer's published, application instructions and other literature no Is the proposed underlayment approved for use with this tile system assembly? no Job Address: 1)2 0 .F ) 0 1 ST Contractor: Qtkq,l;k R r Conl ced Project Information (continued): If the proposed underlayment is self - adhered, have you complied with the venting requirements of Scction 2913.3 (b), (c) and (d) of the South Florida Building Code? yes no /A Are all related accessories approved for use with this tile system assembly? no Are the proposed edge metal attachment fasteners in compliance with the requirements of the South Florida Building Codc (minimum 12 ga. annular rin shank, corrossion reisistant nails)? no 4. The Tile System Assembly: The following information is required to confirm compliance with Subsections 3403.5(a) and (c) and Section 3404 of the South Florida Building Code. Tile: Tile Name: Manufacturer: Tile Ma erial: Clay ❑ Concrete ❑ Other: Product Control Approval Number: Mortar or Adhesive: Spa 1-,‘,4, S 016.1 £!ee&v- rC M �Ia,SCt �1k qL — dlocoo 1� Check one of the following which apply to the proposed tile securcment for use with the proposed tile system assembly: Mortar or Adhesive Set Tile Systems Page - 2 ❑ Adhesive: Type: Manufacturer: Length: ❑ Other: Type: Length: [SYN /A Underlayment: Mixing Ratio: Process No. 61/Mortar: Manufacturer: ,;l Tile Fasteners (for first three courses if roof pitch exceeds 5 ":12" and is less than or equal to 7 ":12 "): Check one of the following which apply to the proposed tile fasteners (for the first three courses) for use with the proposed tile system assembly: ❑ Minimum 12 ga. galvanized roofing nail: Note: All tiles shall be installed in compliance with the provisions set forth in the tile system assembly manufacturer's Product Control Approval and the minimum requirements set forth in Subsections 3403.5(c) and 3404.2 of the South Florida Building Code. Tile fasteners in the first three courses (if applicible) shall be of sufficient length to penetrate the sheathing a minimum of 1" or through the sheathing thickness a minimum of / ", whichever is less. The following information is required to confirm compliance with Section 3403.5(b) of the South Florida Building Code. Job Address: 11)- 13 t l o t sr. Underlayment (continued): Check all of the following which apply to the proposed underlaymcnt for use with the proposed tile system assembly: E" / ASTM #30 asphalt saturated felt with: Manufacturer: ❑ ASTM #15 asphalt saturated felt with: Manufacturer: f7 Mineral Surfaced Roll Roofing with: Manufacturer: ❑ Other: Type: Manufacturer: Underlayment Fasteners (if applicable): ❑ Other: Type: Length: Manufacturer: D 19" overlap D 6" overlap Q .'4" overlap D 19" overlap ❑ 6" overlap ❑ 4" overlap D 19" overlap ❑ 6" overlap 9-4" overlap Contractor: Check one of the following which apply to the proposed underlayment attachment: Er Minimum 12 ga. electro- galvanized roofing nail with minimum 32 ga. x 1'/ tin cap: Length: 1 Manufacturer: Mortar or Adhesive Set Tile Systems Page - 3 Spacing (per tile system assembly Product Control Approval): Field: � " o.c. Laps: 2" " o.c. 5. Related Accessories: Edge Metal (refer to Section 3408.2 of the South Florida Building Code): Type: �ra tVc.n Lt� Dimensions: Gauge or Thickness: Finish: zto5, Ra l 'Note: All edge metal shall be nailed on the flange and nailed or clipped at the face in compliance with the provisions set forth in Dade County Protocol PA 111, marked Appendix 'U' in the South Florida Building Code. Adhesives (check one of the following): ❑ Cold Adhesive: Type: Manufacturer: fri Flashing Cement: Type: Manufacturer: As1-bk b gs-610 Job Address: 1022 k) R 10 t ST. Adhesives (continued): Additional Notes: Note: Application of adhesives shall be in compliance with the Roofing Component Product Control Approval and the minimum requirements set forth in Subsection 3403.5(c)(4)(cc) of the South Florida Building Code. Ventilation System (check one or more of the following): The following information is required to confirm compliance with Subsection 3401.4(e) of the South Florida Building Code. ❑ Ridge: Type Size in fr Soffit: Type cur eeMr S.. Size g_` in Note: If underlaymcnt is comprised of a self- adhered membrane, both soffit and ridge ventilation systems are required, unless a base sheet is applied as an anchor sheet below the self - adhered undcrlaymcnt. Note: The Tile System Assembly shall be installed in strict compliance with the application instructions enumerated in the Product Control Approval. A permit shall be issued for application of the specified Tile System Assembly only. Any change to the specified Tile System Assembly shall require submission of a revised SECTION II with a copy of SECTION I, noting the permit number issued. Contractor: Q g i--y �nt7 �n Q c , * Process No. Mortar or Adhesive Set Tile Systems Page - 4 Job Address: /1?.- s'6, E. tot ST. ( applicable ) Ridge Venting: t Deck: • ( LOD Thickness: X Cs Underlayment: 30 1,k) Undcrlaymcnt i k Fastener: 1 6 eNtc- 5)4.c..n.k. Yla DETAIL Ill Job Site Identification: Contractor: Q ucj caft9rProccss No. Roof Pitch 12" Mortar or Adhesive Set Tile Systems Page - 5 FILL IN APPLICABLE ROOFING COMPONENTS \VIIICII MAKE UP TILE SYSTEM ASSEMBLY. INSERT ANY ADDITIONAL LEADERS INDICATING ADDITIONAL ROOFING COMPONENTS NOT SHOWN ON THIS PAGE. ( Where Roofing Component not used in Tile System Assembly, fill in with "N/A". ) Head Lap Dimension: 2. " (min tiny., V unless otherwise spectfied in the tile system assembly Product Control Approval) Mortar/Adhesive: it, C_Ci Tile: Sff..n c S Ele5cA.r.+C rC% Tile Fastener: 0 Existing or Proposed Soffit Venting: ce Edge MetalrGpf j ild Fastener. _ r Bird Stop: I n (If applicable ) Edge Metal or Gutter: &CA. OCA.- in; 4 -e-A- " , Job Address: 12,1 , E . 101 S6r -s e -I-- Contractor: <: — 1 epd Ridge Height: Eav Height: Roof Mean Height feet feet / (7 feet BUILDING INFORMATION ill Job Site Identification: Mortar or Adhesive Set Tile Systems Page - 6 5 Process No. Insert Building Ridge Height, Eave Hcight and Roof Mean Height. Also insert applicable information pertaining to the building below. (Sec ASCE 7 - 88 Fact Sheet Attached ) Exposure Category: Classification Category: At I-lurricancc Occanlinc?: Y ✓ N Basic Wind Speed at Building Location 110 mph Building Condition based on % of openings: (See Table 9 ofASCE 7 - 88) Ground Level Job Address: J2. N ,,E ID/ ST Contractor: DLO/ Ty gm,: avt reGY' Process No. Sketch Roof Plan, indicating all dimensions, slopes and any roof top equipment. Also insert variable labeled "a" which represents perimeter and corner dimensions per Chapter 23 of the South Florida Building Code. (See ASCE 7 -88 Fact Sheet Attached ) BUILDING INFORMATION #2: Roof Plan with Perimeter and Corner Dimensions Job Site Identification: Mortar or Adhesive Set Tile Systems Page - 7 Job Address: lV . E /D l ST. Contractor: The undersigned certifies that the Mortar or Adhesive Set Tile System Assembly is in compliance with the plans, specifications, and details submitted by the architect. STATE OF FLORIDA - COUNTY OF DADE Before me this day personally appeared & i-Jac i0c tt O who, being first duly sworn, deposes and says that all information submitted herein is true and correct. Sworn to and 1995 My commission expires: Licensed Contractor / Owner Signature subscribed before me this PoZ th day of in (Q_.t ' M MARY M I U kRNANDEZ 324212 ._ pr ` 10, 1997 9 ,F °` Bonded Thm Notary Public Unde A �u Note Public State of f Florida Mortar or Adhesive Set Tile Systems Page - 8 (-Process No. • GS Roofing Products Company, Inc. 5525 MacArthur Blvd. Suite 900 Irving, TX 75038 METROPOLITAN DADE COUNTY, FLORIDA METRO•DADE FLAGLER BUILDING BUILDING CODE COMPLIANCE DEPARTMENT SUITE 1603 METRO.OAOE FLAGLER BUILDING 140 WEST FLAGLER STREET MIAMI. FLORIDA 33130.1563 (305) 375.2901 PRODUCT CONTROL, NOTICE 01? ACCEPTANCE FAX (305) 3)52908 Your application for Product Approval•of GS Built -no Roorinu Products under Chapter 8 of the Metropolitan Dade Counry Code governing the use of Alternate Materials and types of Construction, and completely described in the plans, specifications and calculations as submitted by Applied Research Laboratories, Factory Mutual Research Corporation and Underwriters Laboratories, Inc. has been recommended for acceptance by the Building Code Compliance Department to be used in Dade County, Florida under the specific and standard conditions set forth herein. The approval shall be valid for a period of three years. The Building Code Compliance Department reserves the right to secure a product or material at any time for a jobsite or manufacturer plant for quality control testing. If product or material .fail to perform in the approved manner, the Code Compliance Deparrment may revoke, modify or suspend the use of such product or material immediately. The Building Code Compliance Deparment reserves the right to require testing of this product or material should any amendments to the South Florida Building Code be enacted affecting this product or material. The expense of such testing will be incurred by the M tufacturer. PRODUCT NO. : .ACCEPTANCE NO.: q. l 9 0 EXPIRES: JUN 0 61997 Gil Diamond, P.E. Product Control Division Supervisor - PLEASE NOTE - THIS IS TI-IE COVERSHEET. SEE ADDITIONAL PACES FOR SPECIFIC AND GENERAL CONDITIONS. BUILDING CODE COtII11 This application for Product Approval has been reviewed by the Metropolitan Dade Counry Building Code Compliance Department and approved by the Building Code Committee to be used in Dade County, Florida under the conditions set forth above. APPROVED: ' JUH p R 19 Charles Danger, P.E., Direct Building Code Compliance Department tvletropolitan Dude County NOTICE O ACCEPTANCE: STANDARD CONDITIONS 1 Extensions of Acceptance may be considered after a new application has been filed and the supporting data, test reports no older than ten (10) years, have been re- evaluated. All reports of re- testing shall bear the seal, signature and date of an 'engineer registered in the State of Florida. ?. Any revision or change in the materials, use, or manufacture of the product or process shall automatically be cause for termination, unless prior approval is granted for revisions or change. 3. Any unsatisfactory performance of this product or process or a change in Code provisions shall be grounds for re- evaluation. 4. This acceptance shall not be used as an endorsement of any product for sales or advertising purposes. 5. The Notice of Acceptance number preceded by the words Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the Notice of Acceptance is displayed, then it shall be done in its entirety. 6. Product approval drawings, where required for permit applications, shall be provided to the applicant by the manufacturer or his distributors unless otherwise noted in the Notice of Acceptance. The prints need not be re- sealed by an engineer. 7. Failure to comply with the Standard Conditions shall be cause for termination of the Approval. l Diamond, P.E. roduct Control Division Supervisor . Applicant: GS Roofing Products Company, Inc. 5525 MacArthur Blvd. Suite 900 Irving, TX 75038 Category: Sub - Category: Type: Sub -Type: Product Control Notice of Acceptance Roofing System Approval Membrane Roofing System Built -Up Roofing Conventional Fiberglass /Asphalt Pat Neuhaus Commercial District Manager 2900 Bird St. Charleston Heights SC 29405 803 744.7451 Product Control No.: 94.0323.43 Approval Date: Expiration Date: LJUN,0.6Ig;A _JUN. 0 6 1997 GS Roofing Products Company, Inc. manufactures and markets nationally a complete line of residential, commercial BUR and modified bitumen products. GS Roofing Products Company, Inc. markets these products through local distribution in the South Florida jurisdiction. GS Roofing Products and systems are the result of years of manufacturing experience and product development and have been proven by years of experience in the construction field. GS offers a variety of approved insulated and non - insulated roofing systems. For detailed system constructions, refer to the following publications: "Commercial Roof System Specification Manual" and "Flintlastic Roof System Catalog." GS products and systems have been tested in compliance with all provisions of the South Florida Building Code as well as Underwriters Laboratories, Inc., and Factory Mutual Research Corporation for fire and wind uplift resistance. GS provides technical service and warranty infbrrnntion through regional offices. For the South Florida Metro•Dade area, call 1-800-777-2563. Trade Names of Products Manufactured by Others Product Control No.: 94.0333.43 Product Product Dimensions Test Specifications Description Manufacturer Pyrox various PA 110 ` Polyisocyanurate foam Apache Products Co. insulation. ACFoam•11 various PA 110 Polyisocyanurate foam Atlas Energy Products insulation. Hy•Therm AP various PA 110 • Polyisocyanurate foam Celotex Corporation insulation. Hy.Therm Nail•Line various PA 110 Polyisocyanurate foam Celotex Corporation insulation with nailing surface. Anchorbond Fastener De1:.Fast Fastener FM 30, FM 60, FM 90 Fasteners tNail•Tite Type A Fastener N til•Tite Type R Fastener Gripdek Fastener Hextra Fastener PA 114 PA 114 Insulation fastening Construction Fasteners assembly with plastic and steel stress plate. Insulation fastening Construction Fasteners assembly with plastic and steel stress plate. PA 114 Base ply fastening system ES Products. Inc. (for lightweight insulating concrete only). PA 114 Base sheet fastening ES Products. Inc. assembly for reroofing. PA 114 Base sheet fastening ES Products. Inc. assembly for reroofing. PA 114 Insulation fastening assembly with plastic and steel stress plate. PA 114 Insulation fastening assembly with p ITV/ Buildc ITW Buildex Gil Diamond. P. Sr Roofgrip'Fastener _ _ PA 114 ISO 95+ various PA 110 Polyisocyanurate foam International Permalite insulation E'NRGY'2 various . PA 110 Polyisocyanurate foam NRG Barriers, Inc. insulation. 1SORoc various PA 110 Polyisocyanurate foam and NRG Barriers. Inc. rockwool composite insulation. Con•Tite Fastener PA 114 Insulation fastening Olympic Fasteners assembly with plastic and .steel stress plate. Olympic Fastener PA 114 Insulation fastening Olympic Fasteners assembly with plastic and steel stress plate. GlasFast Fastener PA 114 Insulation fastening Owens - Corning assembly with plastic and steel stress plate. Paroc various PA 110 ` Rockwool mat insulation. Partek. Inc. Multt•Nlax various ESI Fastening Systems Insuliix.x Fastener Rawl Drive /Spike PA 110 Polyisocyanurate foam RJvIAX insulation. PA 114 PA 114 PA 114 steel stress plate. Insulation fastening assembly with plastic and steel stress plate. Insulation fastening assembly with plastic and steel stress plate. -Insulation fastening assembly with plastic and steel stress plate. Insulation fastening assembly with plastic and steel stress plate. Product Control No.: 9tt•U323.43 ITW Buildcx SFS /Stadler SFS /Stadler The Rawlplug Company, Inc. ,, . Fristyner . .Rawlplug Fastener Tr.i•Fust Fastener . x2 :1*.tit:11 • fibergiuss 1 "..entrn: Pwstic Roof 3" min fiangc PA I I . •PA 11.: PA 114 A STN.! ASTWI A 525 Density Wood. various PA 110 Typc ASTM !) :1536 Type I ASTM • ••••••••it:rn • l ‘ in,iii:on ast,einbi.y with plastic and steel stress . ; Insulation fastening The assembly with plastic and Company. Inc. steel stress plate. Insulation fastening assembly with plastic and steel stress plate. 26 ga. corrosion resistant metitl for system t•zrininution Wood fiberboard insuhnion, . Flashing cement Roof Coating. PA 110 Perlitc insulation bo• Gil Diamond, P. • •)•:•■■ Tru•East ASTNI D 312 Bitumen A STNI t1 Aspnalt based roof printer. genertz. ASTM 1227 Roof Coating. k PA 111 Fiber glass roof insulation generic ASTNI :.. 4536 or A yowel.grade, cutback gunew AsTm :: 2322 bitumen cement mixture including inorganic fibers and mineral stabilizers. It ne n e r mc ,%;•%;1> Product Black Diamond Base Sheet FlintGlas® Mineral Surfaced Cap Sheet FlintGlas® Premium Ply Sheet Type IV or VI Flintolas GTS Flintlastic FR.? Flintlastic GMS Flintlastic GTA Flintlastic STA Base Sheet No. 15 Perforated Felt Trade Names of' Products Manufactured or Labeled by Applicant Dimensions All Weather/Empire Base 36" x 72'; Roll Sheet weight: 86 lbs. 36" x 75'; Roll weight: 75 lbs. 36" x 36'; Roll weight: 78 lbs. 36" x I80'; Roll weight: 40/55 lbs. 39.3/8" x 24'9 "; Roll weight: 92 lbs. 39.3/8" x 34' 2"; Roll weight: 100 lbs. 39.3/8" x 33' 3 ": Roll weight: 105 lbs. 39.3/8" x 33'; Roll weight: 90 lbs. 36" x MT:. Roll weight: 69 lbs. 36" x 144; Roll Test Specifications ASTM D 2626 ASTM D 1970 AS1'tvl D 3909 ASTM D 2178 Type IV or VI ASTM D 5117 39.3/8" x 34'2 "; Roll ASTM D 5147 weight: 105 lbs. ASTM D 5147 ASTM D 5147 ASTM D 5147 ASTM D 4601 Gil Diamond, P.E. Product Control No.: 940333.43 Product Description Organic asphalt coated felt. Inorganic glass fiber SBS asphalt impregnated and coated with fine black mineral particle surface. Asphalt impregnated and coated inorganic glass fiber surfaced with mineral granules used as the top ply in conventional built-up roof membranes. Inorganic glass fib asphalt impregnated ply sheet. Torch applied, granule surface SBS modified polyester membrane for BUR flashing. Asphalt adhered, granule surfaced SBS FR modified polyester membrane for BUR flashing. Asphalt adhered, granule surfaced SBS modified polyester membrane for BUR flashing. Torch applied, granule surfaced A PP modified polyester membrane for BUR flashing. Torch applied smooth surface APP modified polyester membrane for BUR flashing. Type Il asphalt impregnated and coated glass fiber base sheet for use in conventional and modified bitumen built -up roofing. ASTM D 226 Organic a . all saturated felt. • 1 Roofing Nails min..134" x 11/4" PA 114 Static Asphalt Fibered Emulsion Tin Caps `.'ellcy Mctal min 32 ga. x 1 5/8" • 2.0" min. 26 ga. 12" wide gale. metal valley (lashings ASTM D 1227 Roof Coating. ASTM t7 525 Corrosion resistant generic deformed roof nails. Min. 32 ga. x 1 5/8 ".2" corrosion resistant circular discs. Product Control No.. 9:1.032103 generic generic aly, metal valley flushings generic Premium Flex•I.Glas Sheet ()Iva Flex.l.(jIUSTM • .. eight: 55 lbs. :i0" x 72'; Roll weight: 90 lbs. 39.3/8" x 50'; Roll weight: 90 lbs. Yosemite Mineral Surface 36" x 36'; Roll Cap Sheet weight: 69 lbs. product (:•oiu•ot Nu !)::•u3 ?3.1:1 A S T M D 4601 inorganic ;lass Goer SL'S aspnait impregnated and coated bast sheet. ASTM D 4601 Inorganic glass Fiber SBS asphalt impregnated and coated bast sheet. ASTM D 249 Organic asphalt coated felt with granule surface. T:st Agcncy 2S017 N.Itr...r.11'Resvarch ENII:Ci 1994 i...,70.3ratortess 0,1 I ¶0 Test identifier Tcst Name/Report R Test: .,orts Physical Properties Current Insulation ramentag ItequireptentA Approval Guiti 1993 Classification Compliance Product Control 94.023,vi D:iits 07/ Insulation Types: Wood fiber Fibrous glass Perlite Polyisocyanurate Composite Board Rockwool Maximum Design Pressure Material Design Pressure Wood - 60' psf Steel -55 psf Concrete -75 psf Lightweight Concrete -45 psf Poured Gypsum Concrete -45 psi' Cementitious Wood Fiber 45,psf Material Maximum Fire Classification Classification \Vood Class 'A' Steel Class 'A' Concrete Class 'A' Lightweight Concrete Class 'A' Cementitious Wood Fiber Class 'A' Poured Gypsum Concrete Class 'A' Product Control No.: 94- 0323.43 Note: Fire classifications and maximum design pressures do not reference all assemblies over all deck types. Review system listings for design pressures and the Underwriters Laboratories Roofing Materials Directory for Fire Classifications. Gil Diamond, P.E. 9 Deck Type 17: Wood, Insulated, New Construction' Deck Description: 19 / 32 " or greater plywood or wood plank System Type A: Base sheet mechanically fastened; all layers of insulation adhered with approved asphalt. All General Limitations shall apply. Insulation Fastener Fastening Fasteners Fastener Laver Type Detail No. Per Board Density One or more layers of any of the following insulations: Approved Type(s): AC -Foam I, E'NRG'Y 2, E'NRG'Y 2 Plus Minimum: 1" x 3'.x 4' N/A Approved Type(s): ISORoc Minimum: 1" x 4' x 4' N/A Approved Type(s): Multi -Max Minimum: 1" x 4' x 3' N/A Approved Type(s): High Density Wood Fiber Minimum: 'A" x 4' x 4' N/A Approved Type(s): Paroc Minimum: ' /4" x 4' x 4' N/A Approved Type(s): Perlite Minimum: '/4" x 2' x 4' N/A Approved Type(s): Fiberglas Minimum: I5 / 16 " x 4' x 4' N/A Anchor sheet: SYSTEMS N/A N/A N/A N/A N/A N/A N/A Gil Diamond, P.E. 10 Product Control No.: 94- 0323.43 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Note: All insulation shall be adhered to the anchor sheet in full moppings of hot asphalt at an application rate of 25 lbs. /sq. * 15 %. Please refer to Dade County Protocol PA 117 for insulation attachment requirements. All Weather /Empire, Flex- l -Glas or GlasBase base sheet applied to the deck with approved annular ring shank nails and tin caps at a fastener spacing of 12" o.c. at the lap staggered in two rows 12" in the field. e sheet shall serve as anchor sheet for attachment of insulation. Ply Sher..t: • : n I ..;•:* 1 :4 Slope: :nstall one ply All Weather/Empire, Fiex-!•:. •• • !'neet iireccly over the top layer of insulation. Adhery a•ny apn..:•.•••;.: mopping asphalt at an application rate of 25 lbs./sq. e: !f base sht,. applied directly to polyisocyanurate insulation, only a s ...I strip application as detailed in this approval is approved; see General :.imitation Th Two, three, four or Live plies of FlintGlas or g15 Asphalt Perforated Felt ply sheet adhered in a full mopping of approved asphalt at an application rate of 25 lbs./sq..± 15%. if ply .sheet is applied directly to polyisocyanurate only a spot or strip mopped application as detailed i n t h i s , approil is approved; see General Limitation 11:1. (()ptionar, One ply of . ...I:1110.31as face cal) , .. rilopping.of :ipproved aspii:ut at an rate or 2:: lbs.. ••• ... cap ,•• •• :45 rs:* .••• i:ibered ai rate gs./sq. 01 • surfaced witn I. galisq. Sta-kool non-fibered libered APOC; No. 212.. • • 'A'. See General Limitation II 2. 1":12" Ste General Limit:a:on :; . 2. Flood coat of approved Type 111 asphalt with an: app::ation race lbsisq.; plus ra vel or slag at an appkcation i:t • I 400 leis —a- • • 300 lbs./sq. respectivly. i.Dintnund, P. E. • 44"a; ata.zatuddhalsiwoiva %AA t • s' . • embrabe:(4,..- -; • ••....... GLASBASE base:sheet and two plief•FLINTGLAS PLY SHEET, emulsion surfacing and reflective coating: Summary.of Materi • Per 100 Square Feet GLASBASE Base Sheet (.1.ply) lbs. FLINTGLAS Ply Sheet (2 plies) . . Type III Asphalt Moppings [2 @ lbs ea] Emulsion Surfaciny STATIC FIBRATED [6 gals. Dry] ...... . • ;,.), REXKOTE-SPECTRA Reflective Coating [11/2 gal. Dry) 9 lbs. Approximate Total Finished Weight •125 lbs. ROOF COVERING MATERIALS (TEVT) 2.63 ROOFING SYSTEMS (TGFU) — Continued Bard Pro- %;;?f +r:' Class B Deck: C -15/32 Incline: I Vapor. Retarder: (Optional) Type G2 "Glasbase" base sheet or UL Classified vapor retarder. Insulation (Optional): One or more layers or combination of the following: "Ultragard Pre- mier", polyisocyanurate, perlite, glass fiber or wood fiber. Base Sheet: One layer of Type G2 "Glasbase" base sheet. Ply Sheets: One or Two layers of Type G1 "Flintglas" ply sheet. Cap Sheet: One layer of Type G3 "Flintglas Mineral Surface" cap sheet. Deck: NC Incline: 1-1/2 Vapor Retarder: (Optional) Type G2 "Glasbase" base sheet or UL Classified vapor retarder. Insulation (Optional): One or more layers or combination of the following: "Ultragard Pre- mier", polyisocyanurate, perlite, glass fiber or wood fiber. Base Sheet: One layer of Type G2 "Glasbase" base sheet. Ply Sheets: Two layers of Type G1 "Flintglas" ply sheet or Type G2 "Glasbase" baso sheet. Protective Coating: Min. 3 gal /sq of "Static Asphalt Fibrated ". Deck: C•15/32 Incline: 1 Vapor Retarder: (Optional) Type G2 "Glasbase" base sheet or UL Classified vapor retarder. Insulation (Optional): One or more layers or combination of the following: "Ultragard Pre- mier", polyisocyanurate, perlite, glass fiber or wood fiber. Base Sheet: One layer of Type G2 "Glasbase" base sheet. .1 or hot ��if�;,,.a Ply Sheets: Two layers of Type G1 "Flintglas" ply sheet or Type G2 "Glasbase" base sheet. i'i;'' Ar Protective Coating: Min. 9 gal /sq of "Monoform Compound" and 3 lbs/sq of " Monoform" •(. y glass fiber reinforcement. • Surfacing: Any "Reflective Top Coating" as listed above. COMBINATION HOT AND COLD SYSTEMS •Any one of the following Reflective top Coatings may be_applied to"'the..systems.indicate below in the Quantities, per square listed for each coating. , r • a.) "Sta -Kool" Aluminum non - fibered -1 gal /sq (\ j ( (':;•N r y • b.) "Sta -Kool "Aluminum fibered —1.1/2 gal /sq c.)APOC "No. 212 Fibered Aluminum" -1.1/2 gal/so — t Class A Deck: C•.15/32' Incline: 1 • • All joints blocked with 2 x 4's. �_� -. /' : t • r f.. f.. Base Sheet: One layer Type G2 "Glasbase" base sheet. Ply Sheet: Two layers of Type G1 "Flintglas" ply sheet, or Type G2 "Glasbase" base sheet. oelow In .:`+'..i, Protective Coating: 6 gals. per 100 sq /ft. of "Static Asphalt Fibrated•'. Surfacing: Any "Reflective Top Coating" as listed above. . Deck: C -15/32 Incline: 1 Vapor Retarder: (Optional) Type G2 "Glasbase" base sheet or UL Classified vapor retarder. Insulation (Optional): One or more • layers or combination of the following: "Ultragard Pre- mier", polyisocyanurate, perlite, glass fiber or wood fiber. Base Sheet: One layer of Type G2.' :Glasbase" base sheet. Ply Sheet: Three layers of Type G 1 "Flintglas" ply sheet. Protective Coating: Min. 3 gal /sq of "Static Asphalt Fibrated ". Surfacing: Any "Reflective Top Coating" as listed above. . (Maximum slope reduced to 1/2 in. in 12 in. when non-fibered aluminum coating is utilized.) 3. Deck: NC Incline: 1-1/2 Vapor Retarder: (Optional) Type G2 "Glasbase" base sheet or UL Classified vapor retarder. Insulation (Optional): One or more layers• or combination of the following: "Ultragard Pre- mier", polyisocyanurate, perlite, glass fiber or wood fiber. Base Sheet: One layer of Type G2 "Glasbase" base sheet. Ply Sheet: Two layers of Type G1 "Flintlas" ply sheet. Protective Coating: Min. 3 gal /sq of "Static Asphalt Fibrated". Surfacing: Any "Reflective Top Coating" as listed above. Deck: C -15/32 Incline: 1 Vapor Retarder: (Optional) Type G2 "Glasbase" base sheet or UL Classified vapor retarder. Insulation (Optional): One or more layers or 'combination of the following: "Ultragard Pre- mier", polyisocyanurate perlite, glass fiber or wood fiber. Base Sheet: One layer of Type G2 "Glasbase" base sheet. Ply Sheet: Two layers of Type G 1 "Flintglas" ply sheet. Protective Coating: Min. of 9 gal /sq of Monoform Compound and 3 lbs/so of Monoform glass fiber reinforcement. Surfacing: (Optional) Any "Reflective Top Coating" as listed above. Class B • Deck: NC Incline: 1 Vapor Retarder: (Optional) Type G2 "Glasbase" base sheet or UL Classified vapor retarder. Insulation (Optional): One or more layers or combination of the following: "Ultragard Pre- mier", polyisocyanurate perlite, glass fiber or wood fiber. Base Sheet: One layer of Type G2 "Glasbase" base sheet. Ply Sheet: Two layers of Type G1 "Flintglas" ply sheet. Protective Coating: Min. 3 gal /sq of "Static •Asphalt Fibrated ". Surfacing: Any "Reflective Top Coating" as listed above. MAINTENANCE AND REPAIR SYSTEMS Class A, B or C • Deck: NC Incline: 3 Existing Roof System: Class,A. B or C covered with: Insulation: "Ultragard Premier' or polyisocyanurate, nailed or secured with hot roofing as- phalt, coal tar pitch or coal tar bitumen. Base Sheet: Asphalt organic, asphalt glass fiber, coal tar felt or asphalt organic /glass fiber ply sheet combination, hot mopped. Surfacing: Gravel. Class A • Deck: C -15/32 Incline: 3/4 Existing Roof System: Class A, B or C (gravel may be removed) covered with: :lard Pre- :ecks and 8 gal /sq 3nteously rrder. Premier ", feral Sur. sheet. d. rider. '' Premier ", , eral Sur. sheet. •d.l irder. Premier ", sheet. _. glass fi- 8 gal /sq . 3nteously 8 gal /sq f 3nteously , LOOK FOR MARK ON PRODUCT -4 _Tob Address: ! z. AJ . . )OI sr, Base Sheet: Fasteners: Contractorat4l J- eoo! r Process No. APPENDIX 'E' METRO -DADE UNIFORM BUILDING PERMIT SECTION II BUILT -UP APPLICATIONS AND MODIFIED BITUMEN SYSTEMS GENERAL: Type of Roof System Assembly to be Applied: Manufacturer of Roof System Assembly: Product Control Approval Number: System Number from Product Control Approval: Ply Sheet(s): Cap Sheet: Asphalt: Complete the following for all Roof System Assemblies: Built -Up Applications and Modified Bitumen Systems Page -1 F lat- Ft b 4 ..5 g..0-e '-S 1Roort Pro «�Fs __at 0323 . y3 EM y - L) (Attach a copy of the Roof System Assembly Product Control Approval and the Manufacturer's System Guide Specification. ) ( Note: If a minimum roof system is to be applied, describe all . components within the system and list the manufacturer of each component. DO NOT complete this section if system is Product Control Approved. ) ( Note: No insulation system is acceptable under the minimum roof category. ) Job Address: /22 AL.E: / O I $7 ContractorQ /, , j F Process No. (Check one of the following) Recover Re -roof: If a recover, is the existing Roof System Assembly to be used as a bonding substrate ?: If YES, has an ASTM E907 test been carried out to confirm adhesion of the existing membrane to the substrate ?: (If yes', attach ASTM E907 test report. ) Proposed Fastener: (Attach withdrawal resistance test report. ) Has the deck been examined for moisture ?: (Provide data confirming compliance with Section 3401.9(c) . ) THE SYSTEM: All Roof System Assemblies in the Product Approval have a variety of options. Briefly describe the Roofing Components to be used in the Roof System Assembly and attach a copy of the manufacturer's published specification: Deck: (Briefly describe) Insulation: 1/2 A, r k Q cn . s ;�, f $DAB_ (Type, size and method of attachMent, if applicable ) Base Sheet or Ply: ( Type and method of attachment ) New Construction GAas bas e. Ch e �"� - Ply Sheet(s): eI'.es o- PI■v\+ aS ( Type and method of attachment ) Built -Up Applications and Modified Bitumen Systems Page -2 Job Address: i. �, }. �, 101 ST. Contractor �: �, Rod; v Process No. Top Ply: (Type and method of attachment ) Surfacing: (Type, if applicable ) Flashing Materials: (Type and method of attachment) Built -Up Applications and Modified Bitumen Systems Page -3 A}ItAm,nun', Ref- lPd-; Coe ti. p ft- S'(" ►k o L(S R la Job Address: )22. AJ, if /0/ sT Contractort t / ,j .J?oa4 Process No. T inches T inches inches FILL IN APPLICABLE ROOFING COMPONENTS WHICH MAKE UP ROOF SYSTEM ASSEMBLY AND THICKNESS OF DECK AND INSULATION LAYER(S). (Where Roofing Component not used in Roof System Assembly, fill in with "N /A ".) Top Ply: {9 [k 1 , / Surfacing: I I V tt: n twv� j ( if i pplic Bonding Material: L) Ply Sheet(s): `� . 0 (• GS P : /1t c s Bonding Material: [� . Fastener: � (if barrrhrrrmrch,anochrd r Base Sheet: �GS bfns€ t %- L Bonding Material: (i /bare r bonded) 1 I.h -l- Fastener: V � (i /lop inr lonon o)r mrrh. orrocbrd) Top Insulation Layer: (i /appficobfo ) Bonding Material: f✓ I K} (i /rop inrloiion loyrr bonded) Fastener: l L (i /inrlo,i , r �I—� a 4\ meth. orror6rd) ( 1 / (e Insulation: :,rL ( .c, � Il1e115• �J rfxrd. Bonding Material: (if rwrorion bonded) Primer: (� /opplieobr,J Vapor Retarder: ) I k ( /cpplicoblr ) DECK: Type: (,O (7 0 d Density, rlconcrele deck: k l 1� Gage or Thickness: ([C, Built -Up Applications and Modified Bitumen Systems Pagc -a Job Address: taa /J'i €. ICI 5T Contractor Ott a 1;4 Pak Process No. PERIMETER DETAIL #1: Parapet Wall Detail Coping Cap Gage: Fastener Spacing: _ o.c. Clip Type: Clip Gage: Deck Type: Sketch Roofing Components which make up Roof System Assembly at Perimeter Parapet Walls. Insert leaders indicating Roofing Component names, dimensions, thicknesses, etc. Include fastener type and spacing used for wood - blocking attachment. Deck Type: r 51 D4 IL upood Sketch Roofing Components which make up Roof System Assembly at Perimeter Areas to be Flashed. Insert leaders indicating Roofing Component names, dimensions, thicknesses, etc. Include fastener type and spacing used for wood - blocking attachment. PERIMETER DETAIL #2: Flashing Detail Built -Up Applications and Modified Bitumen Systems Page -5 Job Address: a2 j 0 ( ,T : Contractor (Q W. goof %h Process No. PERIMETER DETAIL #3: Gravel Stop or Drip Edge Sketch Roofing Components which make up Roof System Assembly at Perimeter Edge with Gravel Stop or Drip Edge. Insert leaders indicating Roofing Components names, dimensions, thicknesses, etc. Include fastener type and spacing used for wood - blocking attachment Gravel Stop/Drip Edge Gage: Fastener Spacing: Li o.c. Clip Type: 0 t• Clip Gage: l r , Deck Type: DO Sketch Roofing Components which make up Roof System Assembly at Perimeter Edge with Gutters. Insert leaders indicating Roofing Component names, dimensions, thicknesses, etc. Include fastener type and spacing used for wood - blocking attachment. Gutter Type: Guncr Gage: Fastener Spacing: 0\'N Deck Type: \fWf PERIMETER DETAIL #4: Gutter Detail Built -Up Applications and Modified Bitumen Systems Page -6 Job Address: 12 p) ,E 101 ST, Contractor AA( ?aw:5 PERIMETER DETAIL #5: 'Other' Detail Process No. Sketch Roofing Components which make up Roof System Assembly at any 'other' Perimeter Condition which may exisit. Insert leaders indicating Roofing Component names, dimensions, thickesses, etc. Include fastener type and spacing used for wood - blocking attachment. Sketch Roofing Components which make up Roof System Assembly at any'other' Perimeter Condition which may exisit Insert leaders indicating Roofing Component names, dimensions, thickesses, etc. Include fastener type and spacing used for wood - blocking attachment. I P\ PERIMETER DETAIL #6: 'Other' Detail Built -Up Applications and Modified Bitumen Systems Page -7 J Job Address: 1U , ID, ST. ContractorQA.rr4y Ro r<q Process No. Insert Building and Parapet Heights. (If no Parapet exists, insert N /A ") Also insert applicable information pertaining to the building below. ( See ASCE 7.88 Fact Sheet Attached ) Exposure Category: Classification Category: At Hurricane Oceanline ?: Y \41 Basic \Vind Speed at Building Location: 110 mph Building Condition based on % of Openings: GROUND LEVEL T feet 9 feet BUILDING INFORMATION #1 Built -Up Applications and Modified Bitumen Systems Page -3 Job Address: 1za Ai. � . I0 I ST, Contractorn )Zoof;v1. Cove c , Process No. Sketch Roof Plan indicating all dimensions, any slopes, roof drains, crickets, or roof top equipment. Also insert variable labeled "a" which indicates perimeter and comer dimensions per Chapter 23 of the South Florida Building Code. (See ASCE 7 -88 Fact Sheet Attached ) BUILDING INFORMATION 1/2: Roof Plan with Perimeter and Corner Dimensions Built -Up Applications and Modified Bitumen Systems Page -9 Job Address: . Contractor Process No. Reviewed Details ?: Notes: -- FOR PLAN EXAMINER USE ONLY -- Roof System Assembly Product Control Approved: Y N If NO, note any deficiencies: Desien Pressure Requirements: Field: psf Perimeter Areas: psf Corner Areas: psf Note any limitations: Built -Up Applications and Modified Bitumen Systems Pa ;c -1() Y N Job Address: , Contractor Process No. Reviewed Field Test Data ?: Y N Notes: Additional Notes: Built -Up Applications and Modified Bitumen Systems Page -11 Plan Examiner Date3CLf 7Il 73 Job Address r O, /Of 7' Tax Legal Description ' E+ 1 AM 1 3PB l , 74(b f< L&n3/tIE(a A dress Owner / Owner's Contractin Co. Qualifier State # Municipal # Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANIC i ROOFI' 'AVING FENCE SIGN 1 WORK DESCRIPTION � � ( _ C 01 (4Qr S C901.- f. y L 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 AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT). Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I autho _ e above -named contractor to do the work st ed. Signature of owner and/or Co Date: / / 47"`9p8n11A�P4sT1�'� €AL SCOTT W DAV S w i * COMMISSION NUMBER ' `C CC255237 � cP MY COMMISSION EXP. fti AM. 26 19 Notary as to Owne My Commission Exp APPROVED: Lessee / Address PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Tenant resident FEES: PERMIT 30 RADON C.C.F. /047 SS# Phone W 80 Competency # Ins.Co. Estimated Cost(value) ignature Date: Folio 11 3VX - 013 -2o/ Master Permit iP ✓ 9 5‘v Phone My"Commission Expires: ef$6#0 Co tractor or Owner- Builder Not4y as to Contractor or Owner- Builder NOTARY PUBLIC STATE OF FLORIDA * * * NY COppJ�1ISSION 4XP SEPT *27,1994* BONDED INS. UND. NOTARY -5. 0 0 TOTAL DUE -- *OC2 * ** Other Fire Zoning Building �� ( 1/ Electrical Mechanical Plumbing Engineering Application is hereby made for the approval of the detailed statement ut me plans and specifications herewith submitted for the build ins 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 iuidding Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Owner's Name and Address APPLICATION FOR BUILDING PERMIT Lamar Ingram Registered Architect and /or Engineer , „... TIT ..,,,„,,,,,,,,,,,,, TT Name and address of licensed contactor AND} EWS P1OOFIjG 8 IMP CO 4300 E 11th Avenue, Hialeah Fl Location and legal description of lot to be built on: Lot Block Subdivision _ __ Street and Number where work is to be done 122 NE 101st Miami Shores, Fl State work to be done and purpose of building (by floors) 1 — RQQ;' VAR FLAT GRAVEL SECTION ONLY. Ti AR — OFF PRESENT ROOF APPLY 1 #30 felt TIN CAPPED 2 — #15 felts MOPPED ON and gravel. and for no other purpose. New Building Remodeling Addition Repairs.... ........... No. of Stories — To be constructed of Kind of foundation Roof Covering gravel Estimated Total cost of improvements $ 1500, 00 Amount of Permit $. 20.00 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 . ANDREWS ROOFING .8 IMP CO 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 Snp dement, 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 poste inspect n on the site of-the work such public notice or notices as arc required by the Act. The undersigned agrees to employ only a ' bcontr> ors, on work to 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- p eared __._.._. 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.._.a.9..1.So_S Date 10— (a ' �3 ...._._ Read, Sworn to and Subscribed before me. Disapproved �. Date (Signed) Building Inspector MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT Date..._ ..._ OCTO B ER 12 _..._._ _... _... .,19. 83 _ No.12 2 NE ,_. g ._ ]01st Street Notary Public, State of Florida My Commission Expires to me well known, PLANNING BOARD DATE Chair :nan Member _ ....... _ ...... --- Member Member Member Member _.._..... Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Plannir g llo.ud. A re fee of $1.00 will be charged when such re- inspection ix made necessary by improper notice for inspection or faulty materials and /or workmanship. Owner's Name and Address Lamar Ingram STATE OF FLORIDA, I COUNTY OF DADE. ss. Disapproved (Signed) 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. Date ma y 5 ,19 No 122 Street N.E. 101st St. Registered Architect and /or Engineer Name and address of licensed contractor O b e n o 11 r R f g. Co. 7352 N o. Miami Ave . Miami, F l a . Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done 122 N . E. 101st St. State work to be done and purpose of building (by floors) Remove the existing roof: Replace with 1 -30 lb. felt, 1 -90 lb. slate, gals. flashing and shingle tile. On Flat section 4 ply asphalt and_ gravel. and for no other u p rpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ 2,615 00 Amount of Permit $ 6.00 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 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 - •iployed 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 wor - s ch public notice or notices as are required by the Act. The undersigned agrees to employ only suc . ctors, on work _;. , -..! ;e ormed under this permit, as are licensed by Miami Shores Village. Remarks (Sign Buildin spector ate Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared - 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 tree. �c— Permit No j/(44 ¥ Date Read, Sworn to and Subscribed before me. to me well known, 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. BUILDING ❑ ELECTRICAL ❑ PLUMBING ❑ ROOFING iD Owner of 4 Building 0 PERMIT N? Architect i Contractor l�o- rte;` or Builder Legal Lot Description I I BI Address of Building�r ft-'t MIAMI SHORES VILLAGE, FLORIDA to, it Date—. 19 CONTRACTOR or BUILDER B1� 9239 Contractor's ,p .4„, License No. Work to be performed under this Permit Subdi- vision Sq. Ft. _�, Value of I I Amount of Project $ II Permit $ 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 applica- tion 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 thorough 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 respon- sibility for work done by his agents, servants) r employees. IP' .... ,go Signed • f (INSPECTOR) BY In consideration of the issuance to me of this permit I agree toperform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, staments or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by,esther, myself, my agent, servant or employee. AUTHORITY Street and Number where work is to be done 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. Ow i 'r's Name and Address.. .... Regi tered Architect and /or Engineer Name and address of licensed contractor_.__ Location and legal description of lot to be built o Lot Block Subdivision \ �2- `(\ � \ ©t ST' State work to be done and urpose e , building (by floors) (2 and for no othe purpose. New Building Remodeling Addition Repairs .C....-/ No. of Stories To be constructed of Kind of foundation Roof Covering__ . Estimated Total cost of improvements $ (.5 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 foi said building. All notices with reference to the building and its construction may be sent to__ The undersigned applicant for this building permit dot hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen s Compensation Act, being Sec :ion 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 ' nspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sul ontractors, on work to be performed it.,. this permit, as are licensed by Miami Shores Village. Remarks Permit No._ Disapproved (Signed) Chairman Member _ ____ Member Council Approved 3 Date- - 1( Building Inspector MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT Date No l A _ -- s treet /1/4. G (el ST (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 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 hirg are true. Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires PLANNING :!' D . . DATE Member Member Member . _._.._ .._ _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. � z BUILDING ❑ MIAMI SHORES VILLAGE FLORIDA 0 �.. ELECTRICAL ❑ Date 19 Q PLUMBING ❑ PERMIT N? 8209 Contractor's 7 - ROOFING I License No. 'fit Work to be performed under this Permit ta itp ; ,or .rte Architect I t i• 4 r ., Contractor or Builder ti e),... -x +�: C.. r.'` !"'t°"/ :* .�i ( ' i e e,, t.,), es.., �► , �� fi Legal Lot Description Address of 1 1 1. ,,- Building ['' 4c. i Owner of Building T‘-4 t i Signed • ' f HJA.4%. 'r y < (I?SPECTOR) BY In consideration of the issuance to me of this permit I agree to4 form the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, s to ents 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, y agent, servant or employee. CONTRACTOR or BUILDER • 1 BI. 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 applica- tion 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 thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on tlt plans o drawings or in the statements or specifications and that he assumes respon- sibility for work done by his agents, s wants r r employe,/ Subdi- vision 91,r Sq. Ft. Value of II Amount of Project $ II Permit $ BY ♦ AUTHORITY 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. Owner's Name and Address Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be bus Street and Number where work is to be done Lot Block Subdivision State work to be done and purpose of building (by floors) New Building Remodeling Addition Date _.____1 ° No. /a a- Street and for no other purpose. Repairs r 19' b noatAto „ye No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ ._6010 • a Amount of Permit $ Zone cubage required plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance horn all contractors or sub - contractors employed by bins 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 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 d him stated are true. Permit No._ Z®7 Date I Read, Sworn to and Subscribed before me. Chairman Member Member PLANNING ARD DATE Member Member Member to me well known, Disapproved (Signed) (Zte Building Inspector • y Commission Expires Notary Public, State of Florida 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. and who, bein g of the above therein by him 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. Permit No Disapproved (Signed) NOTE: A charge of $1.00 will be made for the Planning Board. A re-inspection fee of 51.00 will be charged materials and/or workmanship. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Date Date Kind of foundation PLANNING BOARD DATE Chairman Member Member Council Approved Date Disapproved 1J 2 ,19 No. / L Street_h fns I L -4 " Owner's Name and Address._.. Registered Architect and /or Engineer .... Name and address of licensed contractor __C4.- !- r2` Location and legal description of lot to be buii on: Lot Block Street and Number where work is to be done �r _�� —�� i7 State work to be done and purpose of building (by floors) r%._ ,L. t.—�' c�.s"� _..-ae -e1 Subdivision and for no other purpose. Addition Repairs No. of Stories C/ New Building Remodeling To be constructed of Estimated Total cost of improvements $ 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 for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hint 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). Roof Covering Amount of Permit $ _____�.__„ Date.._ ® - 6/ Read, Sworn to and Subscribed before me. 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, by me first duly sworn, upon oath deposes and says that he is the described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts stated are true. Notary Public, State of Florida Building Inspector My Commission Expires Member Member Member Date making corrections or changes to this application after approval has been obtained from when such re- inspection is made necessary by improper notice for inspection or faulty MIAMI SHORES VILLAGE BUILDIN INSPECTION DEPARTMEN APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the deviled statemen• of the plans and specifications herewith submitted for the build- ing or o h. • '-ructure her t described. This t i licatic is made in compliance and con•o'm ty w.th the Building Ordinance of Mia u Shores Village, ,or.da, and all pro isions of the Laws cf the State of FIcrid. all o d nances ,,f Mi .mi Shores Village and all rules and reguawion. of the Building Div.. i of .iam Shoi illage P '1 e -o, ipl.ed with, whether herein specified or not. A copy of approved plans and specificati •n must be key • at building durin progress of tl_e wcrk. Owner'. Name and Address SQJJ /Silberman No122__ Street_ ___ 10.E . Registered Architect and /or Engineer___ Name nd address of licensed contractor. L fig_ Roof i ng__&__TiTh._.Co...__Inc.. 43.Q N...W.___79 St . Location and legal description of lot to be built on: Lot Block__ ____. _. Subdivision Street and Number where work is to be done_ Same State work to be done and purpose of building (by floors) Date 5/18/54 , 19 4 ply built up roof. and for no other purpose. New Building_ Remodeling__ ___ _ ._. Addition__'_ -___ X__. Repairs. _ No. of To be constructed of_ ___ _ _ Kind of foundation Roof Covering__ • 4 P build up roof Estimated 7 :,tal cost of improvements $__. ..95.00 Amount of Permit $__ Zone cubage required_ __. _-Plan Cubage to next nearest building__ _ _ _ Size of Building Lot Maximum live load to be borne by each floor_ _ . ..... ___ ...__.. _ 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 unde signed appli..ant for this building permit does hereby certify t'lat he understands and accepts his •bligations as an employer of 1: bor under he Florida Workmen's Compensation Act being 5-•tion 5966 Col p led Gen al Laws of Florida P r anon. Supple cent and h .s compl ed w ;th he prov• :ions thereof, and will require s'milar comn•fance from all contractors or sub - contractors emplo •ed by him in the work to be p rt. r-med under th's permit and • ill post or cause to be posted for inspection on the site of the work su :h public: notr'e or ).otites as are requir + -d by the Act. The u.,d.r.ign.•d agrees to employ only such abcontr. ctors, on work to be perform. d . der this permit as are licensed by M•am: Shores N iL: ge. Remarks__ ( Signed)._ C . E . BEiwen • e.' STATE OF FLORIDA, COUNTY OF DADE. Ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths ,.:nd take acknowledgments, personally p p- peared ._ • and who, being by me first d. ly sworn, upon oath deposes and says than he is the of tli abov. de.cribed istruction. ti .; h has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated ar tr se. • n �.. Z t''') Read, Sworn to and Subscribed before me. Permit No Disapproved 1.� o / �' �' Notary Public State of Florida (Signed) r B ld nspector My Com :nission Expires_ PLANNING BOARD DATE .to me well known, Chairman Member Member -- -- - - --- -- --- Member Member .__ . - - - - -- - _..__ Member Council Appr. 'ed. _Date Disapproved __ Date NOT A charge of $1..00 will be made for making corrections or changes to this application tf6x approval h-is been obtained from the P fm• g Board. -inspection fee of $1.00 will be charged when such re- inspection is male necessary by improper notice for inspe :•t'on or fa. Ity mater als and /or workmanship. - PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description. Address of Building Lot MIAMI SHORES VILLAGE, FLORIDA BUILDING n ELECTRICAL PERMIT IT? 12735 Work to be performed under this Permit ``. This permit is granted to the contractor or builder named above too nstruct the building'or install the equipment or device described in the ppheatyon herefor in strict compliance with all ordinances pertaining thereto and wit 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 4by 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 chahged without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes ,..the „kespongbili for a thorough knowledge of the ordinances andtregulations pertaining to the work covered hereby whether shown on the plans or drawings or n the statements or specif' ah ns and that he assumes resnfoui i w r work done by his agents, servants or employees. Subdi- vision Value of Project $ S, A :i �B l f•r y Signed INSPECTOR BY 195 DATE / Contractor's License No Amt. of Permit $ In consideration of the issuance to me of this permit I agree to perorm the work covered hereunder in compliance g{it>t all ordinancev and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specif; gtions submitted to the proper authorities of Mi Shores Village. In accepting this p it I jyie re ponsibility for all work done by eitlir, myself, jry agent j se s rvant or employee/ ty AIrrHO Owner's Name and Address Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: STATE OF FLORIDA, COUNTY OF DADE. ss• Permit No Disapproved (Signed) BUILDING INSPECTION DEPARTMENT ... MIAMI SHORES VILLAGE 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. ' Date , 19 S No Street Lot Block Subdivision / Street and Number where work is to be done — ________1 __ — �._& ! D/ State work to be done and purpose of building (by floors) — - --- - p-- . C _ --e and for no other purpose. ` New Building — Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering .._i 6 0 o - o Estimated Total cost of improvements $ � _ Amount of Permit $ Zone cubage required _Plan Cubage Distance to next nearest building — ____________Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to 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. 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 th foregoing application, and that he did sign the same, and that all facts therein by him stated e true. Si Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires PLAN NG BOARD DATE Chairm. 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 Plann' g Board. A - inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materi s and /or workmanship.