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253 NE 100 St (5)Test Location Uplift Pull Test (P or F) Test Location Uplift Pull Test (P or F) Test Location Uplift Pull Test (P or F) Test Location Uplift Pull Test (P or F) 1 44 26 27 5 1 52 ` �� 76 77 2 3 28 53 78 4 29 54 74 5 30 55 80 6 31 56 81 7 32 57 82 8 33 58 83 84 9 34 59 10 35 60 85 • 11 36 61 86 12 37 62 87 13 38 63 88 14 39 64 89 15 40 65 90 16 41 66 qt 17 42 67 92 18 43 68 93 19 44 69 94 20 45 70 95 21 46 71 96 22 47 72 97 23 48 73 98 24 49 74 99 25 50 _/ 75 100 6065 N.W. 167th Street, Suite B -23 • Miami, Florida 33015 Telephone: (305) 558 -2588 • Fax: (305) 362 -4669 ON -SITE CONCENTRATED UPLIFT LOAD TESTING OF ROOF TILE IN FULL ACCORDANCE WITH METRO -DADE BUILDING CODE COMPLIANCE PROTOCOL PA 106 U.S. SOUTH Engineering & Testing Lab., Inc. SITE SPECIFIC INFORMATION Permit #. 4/ 9 82 "2-53 b- G. 1so S , & -k . e.--5 ,.-0 . Owner's Name: Job Address l Roofing Contractor (J1'1 o t N4 Type of Tile: �� l� Pro-t Approximate Roof Height feet Type of Access to Roof Scaffolds Ladder Other Approximate Square Footage of Roof: 2500 ft' Required Testing F rce: 5 lbs. Date Tested: �" ' 2 - 1 VI IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL PA 106, THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT QUALITY CONTROL TEST. Civil Engineer: Lab Certification # 98- 0608.04 State of FL Certificate Authorization # 4100 Testing Equipment: Chatillion 100 TEST RESULTS P = PASS, F = FAIL Project N 9 2039 Date Installed. 13A1 1 Roof Pitch - 2 $KETCH OF ROOF JOB 5 3 1 . ! s ►Q S � hit4f10.4. ,Fl SHEET NO CONTRACTOR P 7441 T`t lam E i' 4 CHECKED BY DATE 7 ' OF SCALE 12 2 am= ■riiir7 liffirdliiiii 111111111011111 MIN ME ...- ei Iiiiiiiioti 11111M.u.PAIuur tMar Ld4 IrAGEFA MIME '' Actin mum ■Ni■■Mar ■■■ESr■rVIII uni■■11Nr ia■L lifillrommilmommanwisp IIiu 111 N. .0 to NOTES. PERMIT APPLICATION FOR MIAMI SHORES VILLAGE p 8 -14 -01 j , .,, w 253 N.E. 100 Street Tax Folio (I 3c D6 o (T la Lem Description S -PC 1 A /AD p8 /0 v Historically Designated: Yes No Owner/Lessee / Tenant Queer Carlos Arocho I Notary as to • er and/or Co My Commission Expires: Andrew & Claudia Huntington ownei'sA.ddress 253 N.E. 100 Street Miami Shores Phone 759 -0998 Contracting Co. Quality Roofing Contractor, Inc. Address 13800 N.W. 1st Avenue State # RC 0 0 5 8 6 2 7 Munici # Competency # 17889 Ins. Co. Address Address Architect/Engineer Bonding Company Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Tear off old roof to wood deck, replace rotted wood, tin cap 301b. ASTM felt, install galvanized eave drip and valley metals, mop o rt type III asphalt one layer of 901b. ASTM felt, install Spanish S Cla Colorthru tile with polyfoam adhesive setting. SquareFL 25sq. Estimated Cost (value) $ 10,`500.00 WARNING TO OWNER YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOL PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH Y OUR LENDI 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 we will be performed to meet the standards of all laws regulating construction irr this jurisdiction. I understand that separate permits are required for ELECTRICP PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNERS Alt/DAVIT:. I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulat: construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. sC P // Signature of owner and/or Copdo President . Date • of MARYLOU HERNANDEZ MY COMMISSION # CC 680474 EXPIRES: October 10, 2001 Bonded Thai Notary Public Underwriters FEES: PERMIT 1 P1.5 0 RADON C.C.F. APPROVED: Zoning Mechanical Plumbing Building SS# Phone 751-0382 Signature of Contractor or Owner- wilder Notary as to Con ctor or Owner - Builder My Commission Expires: b NOTARY Master Permit # BOND 9/74 Date 4/91,9 Date ' .ri MARYLOU HERNANDEZ 3 MY COMMISSION # CC 680474 EXPIRES: October 10, 2001 Bonded Thru Notary Public Underwriters TOTAL DUE / / ( Electrical Structural Engineer 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: 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 6f improvement: Reroof to a new Tile Roof. 3. Owner(s) name and address: 253 N.E. 100 Street Andrew & Claudia Huntington Miami Shores. Florida 33138 253 N.E. 100 Street Miami Shores, Florida 33138 Interest in property: Owner Name and address of fee simple titleholder: Quali Roofing COntractor, Inc 13800 N.W. 1st Avenue Miami, FLorida 33168 018530168 2001 SEP 27 11:21 4. Contractor's name and address: b'ATE OF FLORIDA, COUNTY OF DADE if artyyEBY CERTIFY that this is a t 1e co, ; of the original f o a in this office on :l'r T my ha IARVEY RUVIN di ,'i cicl Soal. of Circuit and Count C ,nom w 5. Surety:(Payment bond required by owner from contractor, Name and address: N/A Amount of bond $ 00 6. Lender's name and address: N /A 7. Persons within the State of Florida designated by Owner upon whom notices by Section 713.13(1)(a)7., Florida Statutes, Name and address: N /A ther documents may be served as provided 8. 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) t Signature of Owner L Print Owner's Name 1T N j r(- 1 - I / tf /` // Sworn to and subscribed before me this /$ day of Serf. , 200/ Notary Public Print Notary's Name My Commission Expires ,•V Wl;'\ MARYLOU ANDEZ ISSION N CC 680474 lird EXPIRES: October 10 200 a, Thru Notary P I rnrinnu,iro.o Prepared by Carlos Arocho Quality Roofing Contractors Address: 1 3800 N.W. 1st Aver Miami, Florida 33168 F Ft. 123.01 -78 4199 Dec type: Fastener Type: Field: DETAIL 1 & 2 Appendix "E" UNIFORM ROOFING PERMIT APPLICATION PROCESS No. Contractor's Name: foul .\-1 Rnor% .o r Job Address: 53 0 , E ROOF CATEGORY �� ❑ (Low Slope Application) ❑ (Nail -On Tile) L`s ( lortaradhesive Set Tire)) ❑ (Asphalt/Fiberglass Shingles) ❑ ( Metal Roofs \Wood Shingles & Shakes) ❑ (Other) �/ ROOF TYPE ❑ New Roof L� e roofing ❑ Recovering ❑ Repair ❑ Maintenance Flat Roof Area (ft - 0 — Sloped Roof Area (ft aSs . Total (ft , Master Permit No. Exposure category (per ASCE 7 -88): e, Building Classification category (per ASCE 7 -88 table 1): z ROOF HEIGHT AND SYSTEM DETAILS (Draw details as needed) u E� S r' YES I NO 3.1 TYPE-NATURAL C.J Y.: rA TTACHMENT SPACIN Perimeter: i rner: Page -1 ROOF PLAN Appendix "E" UNIFORM ROOFING PERMIT APPLICATION PROCESS No. Ridge Ventilation? Deck type: MEAN HEIGHT 31/). Wood Underlayment: • Insulation: 3 D )k) . P TILA 12" ROOF SLOP[ D E T A I L 3 SLOPED SYSTEM DESCRIPTION 0 I Fastener type & spacing: Cap Sheet: 1 it �� d 1y l�l�s nrk:Is r' Roof Covering: 90 Bb- f-sr,k Drip edge: ' aaG [ . .> ; s�, S C.k4. 1 ► k 'L Col czr ect4 e p 4u eel- c ATTACHMENTS REQUIRED 1) Fire Directory Listing Page 2) Miami -Dade County Product Control Notice of Acceptance -Cover Sheet a) Specific System Description b) Specific System Limitation c) General Limitations d) Applicable Detail Drawings 3) Municipal Permit Application 4) Other Component Approvals TILE CALCULATIONS (Pmaxl : (, , X X (Aerodynamic Multiplier): if 339 ) - M O = M : 9,14') PCA: (Pmax2:96.S x X (Aerodynamic Multiplier): ) - M = Mrz: `1.O' PCA: 11 - (Pmax3:91, 5 X A. (Aerodynamic Multiplier): : !,?_ r rt ) - M S -`t = M r3 :ad -_®9 PCA: W-ciD APPENDIX "F" REQUIRED O11'1CRS NOTIFICATION FOR ROOFIt \C CONSIDERATIONS As it pertains to rhis Appendix "F", it is the responsibility of the roofing contractor to provide sate owner v. ills the required roofing permit, to provide the owner with this appendix and to explain to the owner the content of this form. The provisions of Chapter 34 of the South Florida Building Code (SFBC) govern all the mini,,, : requirements and standards of the industry for roofing system installations. Additionally, the following items should bc addressed as part of the agreement between the owner and the contractor. The owner's ini ;ial in use adjacent box indicates that the item has been explained. G /1. Aesthetics- \1'orknt :nship: The workmanship provisions of Chapter 3; arc for the purpose of providing that the roofing system meets the wind resistance and water intrusion performance standard;. :,c ;:netics (appearance) issues are not a consideration with respect to workmanship provisions. Aesthetic issues such as color or architectural appearance, that are not part of a zoning code, should be addressed as part of the agreement between the owner and the contractor. 1 2. Rcnailing Wood Decks: When replacing roofing, the existing ■vood roof deck may have to be renni'ed in accordance with the current provisions of Chapter 29 of the SFBC. (The roof deck is usually concealed prior to removing the existing roof system) al 3. Common Roofs.: Common roofs are those which have no visible delineation between nciv_hbori:tLi units (i.c. townhouses, condominiums, etc.). in buildings with common roofs, the roofing contractor and /or owner should notify the occupants of adjacent units of roofing work to be perforated. 4 1-H a. Exposed ceilings: Exposed, open beans ceilings r.rc where the underside of the roof decking can be viewed from below. The owner may wish to maintain the architectural p penetrations of the underside of the decking may not be acceptable. The SFBC provides therefore, des the option of m : this appearance. /■" 5. Ponding l\'ater: The current roof system and /or deck of the building, may not drain well and may cause water to pond (accumulate) in low-lying 'areas of the roof. Ponding can be an indication of structural distress and may require the review of n professional structural cn;ineer. Pondinc m, v shorten tare life expectancy and performance of the new roofing system, Ponding conditions ntav not be evident until the oigi,ta rooff tg system is removed. Ponding conditions should bc corrected. N ' 6. Overflow Scuppers (wall outlets): It is required that rainwater floe• off so that the roof is 1:,: overloaded from a build up of water. Perimeter /edge walls or other roof extensions may block this dis :I•.nre: i.r overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in a :eo:d,,t :c with Chapter 23 of the SFBC. r h X /A/ 7. Ventilation: Most roof structures should have some ability to vent natural airflo..v through tir_ of the structural assembly (the building itself). The existing of attic ventilation shall not be rcd:::ed. 11 bc beneficial to consider additional venting which can result in extending_ the service life of the roo.. &LS. The owner may contact the Nlianti -Dade County Consumer Scn Deportment fo: information regarding the above. Owner's /Agent's Signature 0 .1 20( D :etc Contractor's Signature . • MIAMMA FEB 21 '01 14:12 FR BRADCO PRODUCT CONTROL NOTICE OF ACCEPTANCE Santa Fe Tile Corporation 10302 N.W. South River Drive, Bay #16 Medley ,FL 33178 Your application for Notice of Acceptance (■OA) of Spanish "S" Clay Tile under Chapter 8 of the Code of Miami -Dade County governin Construction, and completely described herein, has been recu County Building Code Compliance Office (BCCO) under the This NOA shall not be valid after the expiration date stated b product or material at any time from a jobsite or manufactu product or material fails to perform in the approved manner, use of such product or material immediately. BCCO rese determined by BCCO that this product or material fails to Building Code. The expense of such testing will be incurred by the manufactu ACCEPTANCE NO.: 00 1211.06 EXPIRES: 02/0r2006 APPROVEDz 02101/2001 305 597 9484 TO 3059533333 P.01/05 • IP D !1 M MIAMI -DAD COUNTY. FLORIDA METRO -DADE FLAGUER BUILDING BUILDING CODE COMPLIANCE OFFICE METRO -DADE FLAGLCR DUILOING 140 wesT FLAct.GR STRL'ET, SUITE 1603 MIAMI. I'LORI 33 110-1563 (305) 375.2001 FAX (303) )75.2908 CONTRACTOR LICIINSINC SECTION (305) 375.3527 I'AX (305)375 -;55$ cON'1'IL+CI'OR EVFOKCt iSl.NT uWISIOS (30S)375.2966 FAX (303)37S-290d PRODUCT CONTROL. uwvlslo: (305) 375 -2902 FAX (305)3724;39 the use of Alternate Materials and Types of W ended for acceptance by the Miami -Dade ) nditions specified herein. ow. BCCO reserves the right to secure this is plant for quality control testing. If this .BCCO may revoke, modify, or suspend the s the right to revoke this approval, if it is eet the requirements of the South Florida Raul Rodriguez Chief Product Control Division THIS IS THE GOVERSHErT, SEE ADDITIONAL PA ALES TOR SPECIFIC AND (:ENI< CONDITIONS This application for Product Approval has been reviewed bi the BCCO and approved by the Building Code and Product Review Committee to be used in Miami-Dade County, Florida under the conditions set forth above. Francisco J. Quintann, R,A. Director Miami -Dade County Building Code Compliance Officc 1 se 4 5 0 0011a42000 Utentpheestnotics accepeines ce.er p *ee doe Internet mail address: postmasterebul ldlnscodeonline.com imcpage: hltp :h...w.au,ldingcodeontinc.com FEB 13 '01 ,7145 3058880050 PAGE. 01 FEB 21 ' 01 14.13 FR BRADCO SANTAFE TILE CORPORATION ROOFING ASSEMBLY APPROVAL Cntevgrv; hoofing Sub- Cateforv: 07320 Roofing Tiles Materjals Deck Typo: 1. SCOPE This renews a roofing system using Santa Fe "Santafe Santafs Tile Corporation described in Section 2 of this comply with the South Florida Building Code, 1994 E locations where the design pressure requirements, as d does not exceed the design pressure values obtain by c using the values listed in herein. The attachment calcu systen1. 2. PRODUCT DESCRIPTION Manufactured by Test i >liesint Dimensions §necifications Santafd 'S' Clay 1= 18" PA 112 Roof Tile w = 11.5" W' thick Trim Pieces I = varies w varies varying thickness Clay Roof Tiles Wood 365 597 ;494 To 30595333:ia PA I I2 A hi f✓f 2.1 COMPONENTS OR PRODUCTS MANUFAC Te$t Product Dimoeoiong Spccifrentinns Tile Screws #S x 2 -K" long PA 114 0.130" shank dia. Appendix E 0.178 flute dia. 3. LIMITATIONS 3.1 Fire classification is not port of this acceptant 3.2 For mortar or adhesive sct tilt applications. a accordance with RAS 106. 3.3 Applicant shall retain the services or a Mia perform quarterly test in accordance with PA submitted to the Building Code Compliance 0 FEB 13 '01 1745 ACCEPTANCE No.: 00-1212.06 Approval Date: February 1 2001 Expiration Date: February 1, 2006 S" clay rooting tile, manufactured by otice of Acceptance, designed to Lion for Miaml -Dade County. For termined by applicable building code. Iculations in compliance with RAS 127 tions shall be done as a moment based Product poscrintion 0 ' a piece high profile clay roof the e. ipped with two nail holes. For nail -on. rn rtar sct and adhesive set applications. cessory trim. clay roof pieces for use at s. rakes, ridges and valley terminations. nufacturcd for each tile profile, URED BY OTHERS Product pescrintion tainless Steel atic field uplift test shall be performed in i County Certified Laboratory to hall be 01100-.10001 u oaga, RAC Rooting Product Control Examiner 30 58880050 Mnnuffcturor generic PPGE. FEB 21 '01 14:13 FR BRADCO 305 597 9484 TO 3059533333 P'.03i05 SA T E CORPQRAT i ACCEPTANCE No.: 00 1212.06 3.5 30/90 hot mopped underlaymeat applications slope unless stated otherwise by the undcrl literature. 3.6 This acceptance is for wood deck appitcaaor. compliance with applicable building code. 4. INSTALLATION 4.1.1 Santafe 'S' and its components shall be installer to strict compliance with Miami Dade County Roofing Application Standard RAS 1 l , RAS 119, and RAS 120. 4.1.2 Data For Attachment Calculations ay be installed perpendicular to the roof ymcn: material m .nufacturers published Minimum deck requirements shall be in Santafe 'S' Tile Profile Tile Profile 2 ":12" Battens Direct Deck Santafe 'S 3.93 5.90 Tile Profile Santa S FcB 13 '01 17:46 Tile Application Direct Deck Battens Table 1: Aerodynamic Multi 3 ":12" 4 ":12" lattens Direct DBCk 5,85 5.82 Two Nails 21.8 (ft Batten Applic Belles 5.73 0.274 Table 2: Restonn• Moments due t Direct Deck 5.69 Table 3: Attachment Resistance Express For Nail -On Syst One Screw 29.18 1, Approved screws as noted 'Product manufactured by others' 3 it lyers- Lion 8 an Direct Deck Gravit M. ft-lb 5 ":12" .56 5.53 wo Screws 38.28 1 6":12 Battens 5.32 (ft Direct Deck Direct Deck 5.29 d as a Moment Mf (ft ..Ibf) One Screw w/ Cli� 57.31 0.297 7 ":12" or greater Batten 5.03 Direct Deck N/A J Two Scrcws w/ Clip 57.60 61.77 rank Zuloaga, RRC ?sooting Product Control Examiner 3058688050 PAGE. 03 Table 4: Attachment Resistance Expres for Mortar or Adhesive d as a Moment - Mr (ft -Ibf) t Systems Tile Profile Tile Application Attachment Resistance Santafe 'S' Mortar Set 23.6 Adhesive Set 61.g FEB 21 '01 14:13 FR BRADCO 305 597 9484 TO 3059533333 P'.03i05 SA T E CORPQRAT i ACCEPTANCE No.: 00 1212.06 3.5 30/90 hot mopped underlaymeat applications slope unless stated otherwise by the undcrl literature. 3.6 This acceptance is for wood deck appitcaaor. compliance with applicable building code. 4. INSTALLATION 4.1.1 Santafe 'S' and its components shall be installer to strict compliance with Miami Dade County Roofing Application Standard RAS 1 l , RAS 119, and RAS 120. 4.1.2 Data For Attachment Calculations ay be installed perpendicular to the roof ymcn: material m .nufacturers published Minimum deck requirements shall be in Santafe 'S' Tile Profile Tile Profile 2 ":12" Battens Direct Deck Santafe 'S 3.93 5.90 Tile Profile Santa S FcB 13 '01 17:46 Tile Application Direct Deck Battens Table 1: Aerodynamic Multi 3 ":12" 4 ":12" lattens Direct DBCk 5,85 5.82 Two Nails 21.8 (ft Batten Applic Belles 5.73 0.274 Table 2: Restonn• Moments due t Direct Deck 5.69 Table 3: Attachment Resistance Express For Nail -On Syst One Screw 29.18 1, Approved screws as noted 'Product manufactured by others' 3 it lyers- Lion 8 an Direct Deck Gravit M. ft-lb 5 ":12" .56 5.53 wo Screws 38.28 1 6":12 Battens 5.32 (ft Direct Deck Direct Deck 5.29 d as a Moment Mf (ft ..Ibf) One Screw w/ Cli� 57.31 0.297 7 ":12" or greater Batten 5.03 Direct Deck N/A J Two Scrcws w/ Clip 57.60 61.77 rank Zuloaga, RRC ?sooting Product Control Examiner 3058688050 PAGE. 03 FE3 21 '01 14:13 FR BRADCO SA.NTAFE 7TLE CO_ PORA,TION 91!5 by 7 ;484 10 3059533333 ACCEPTANCE No.: 00- 1212.06 5. LABELING 5.1 All tiles shall bear the imprint or identifiable Iftfking of the manufacturer's name or logo, or following statement: "Miami-Dade County 'ptoduct Control Approved ". 6. BUILDING PERMIT REQUIREMENTS 6.1 Application for building permit shall be accom by copies of the following: 6.1.1 This Notice of Acceptance. 6.1.2 Any other documents required by the Building Official or applicable Building Code in order to properly evaluate the installation otitis system. FEB 13 '01 17:46 PROFILE DRAWL 4 SANTAF> "SANTAFE S" CLAYIP.00F TILE Frank Zuloaga. RAC Rooting Product Control Examiner 3058880050 PAGE. e4 SANTAFE TYLE QORPORATION N OTICE OF ACCEPTANCE STANDAIAD CQQHDITIONS Renewal of this Acceptance (approval) shall be considered afte renewal application has been filed and the original submitted docementation, including test supporting da engineering documents, arc no older than eight (1) years. 2 Any and all approved products shall bc permancndy labeled wi the following statement' "Miami -Dade County Product Control` specific conditions of this Acceptance. ACCEPTANCE No.: 00-)2),2.06 the manufacturers rutme, city. stale, and Approved ", or tic specifically stated in the 3 Renewals of Acceptance will not be considered if: a) There has been a cheese in the South Florida Building Code affecting the evaluation of this product and the product is not in compliance with the code changctt b) The product is no longer the same product (Identical) ss one originally approved; c) If the Acceptance holder has not complied with ail the req rcments of this acceptance, including the correct installation of the product; d) The engineer who originally prepared, signed and sealed required documentation initially submitted, is no longer practicing the engineering prefessi 4 Any revision or change in the materials, use, and/or iactu of the product or process shall automatically be sauce for termination of this Acceptance, uniesi prior written approval has bccu requested (through the filing of a revision application with appropriate fee and granted by this office. 5 Any of the following shall also be grounds for removal of this Aci. ptancc: a) Unsatisfactory performance of this product or process; b) Misuse of this Aocepuin c as an endorsement of any pr ct, for sales, advertising or any othr:r purposes. T'he Notice of Acceptance number preceded by tie words Miami -dc County, Florida, and followed by the expiration date trtay be displayed in advertising literature, If any %lion of the Notice of Acceptance is displayed, then it shall be done in its entirety. 7 A copy of this Acceptance as wall as approved drawings and oth4' documents. where it applies, shall bc provided to the user by the manufacturer or its distributors and a Jl be available for inspection at the job site at a1; timts. The copies need not be resealed by the engineer 8 Failusc to comply with any section of this Acceptance shall be ca for termination and removal of Acceptance. 9 This Acceptance contains pages 1 through 5 !� END OF TOYS ACCEPTAN10E FEB 13 '01 1746 5 rank Zuloaga, RAC offing Product Control Examiner 3058880050 PAGE.e$ ** TOTAL PA3 .05 �:i 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. 1 ' . Owner's Name and Address ....` teZ l'llla /.. .... _ _ No,f 5 3 Street-14 . _ /n X Registered Architect and /or Engineer Name and address of licensed contactor /9 Z ? ex? /2 3 S ST At 4/ •••••• 7 •• J Location and legal description of lot to be built on: Lot Block Subdivision Stzeet and Number where work is to be done 0 R $ 1 v t O a State work to be done f j purpose ofd in (by Date MIAMI SHORES VILLAGE / Date Building Inspector geared 3 (Signed) .. . 0 d for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering - f- 4 !/n Estimated Total cost of improvements $ Revs' -- Amount of Permit S. 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 sub all plans and specificatioAs for said building. All no 'ces with reference the building and its construction may be sent to.... ■-' The undersigned applicant for this b ding 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 inspe ion f the work such public notice or notices as are required by the Act. The undersigned agrees to employ only suc - - - :. • ctor , t e performed under this permit, as are licensed by Miami Shores Village. Remarks._ Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires 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- to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him sited ar true. Permit No.. _I 0 Disapprove - (Signed) �✓° PL ci INC 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 Phinning Board. A re- inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. MOAail8 SHORES X10(LLAE E Owner's Name and Address. Street._l ( .� / 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. BUILDING INSPECTION DEPARTMENT APPLICATION FOR 1= UVLD NS PERMIT Registered Architect and /or Engineer � (_ fI / Name and address of licensed contractor Ate �3- 4 - / / a 0 N. E g) Location and legal description of lot to be built on: Lot Block �' Subdivision Street and Nu A 3 Number where work is to be done .6,..././... _ ___i � 0 . s iP State work to be done and purpose of building (by floors) -- - --_ STATE OF FLORIDA, COUNTY OF DADE. ss. penmt, as are licensed by Miami Shores Village. Date.. , 19./ New Building Remodeling Addition Repairs To be constructed of Kind of foundation Roof Covering • Estimated Total cost of improvements $ 1 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, Perinanent 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 on York to be performed under this • Remarks (Signed).. 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 true. Permit No (S Date --(3 -73 Disapproved D (Signed) Building Inspec?'.r Read, Sworn to and Subscribed before me. and for no other purpose. No. of Stories to me well known, Notary Public, State of Florida y Commission Expires ANNING BOARD DATE Chair::.;,n Member Mernber ..__ Member Member Member Coci:cil Approved Date Disapproved Date NC':': 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 rc- inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.