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525 NE 101 St (3)Issue Date: 8/28/2002 Owner's Name: MARTH ANNE COLLINS Permit Type: Imported Permit Work Classification: <NONE> Job Address: 525 101 Additional Information Miami Shores Village, FL Building Department File Copy Applicant Signature Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Expires: 02/24/2003 Contractor(s) Phone QUALITY ROOFING CONTRACTOR 305 751 - 0382 Primary Contractor Yes Perm Type: Building Alpha Four: Roofing Alpha Six: SINGLE FAM Pay Amount: 61.8 Bond Return : Alpha Two: Repair /Remodel SF Residential Alpha Five: Residential Pay Date: 9/5/2002 Pay Comments: 1 ck #17616 (2 permits) In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. Parcel #: Block: Section: Permit Status: EXPIRED Permit Number: BP2002 -1511 Phone: (305)758 -2972 1132060171110 Lot: PB: Total Square Feet: Total Valuation: Required Inspections 0 $ 2,200.00 f Fees Due Amount Total: Invoice Number Total: Amt Due Amt Paid NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES . Date 08/14/2002 Rob Adds PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 525 N.E. 101 Street Tax Folio Legal Description Historically Designated: Yes No o wner /Lessee / Tenant Martha P. Collins Master Permit # . e9 . /S ( )vines Address . 525 N.E. 101 Street Miami Shores Co� Quality Roofing Contractor, Inc. ntracting Qualifier Carlos Arocho Stare # RC0058627 Municipal # Add 13800 N.W. 1st Ave. Contpetency # 000017889 SS# Phone (305) 758 -2972 Phone (305) 751 -0382 Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Repair flat roof only, will need to remove about 100 tiles to do the tie -in. square Ft. Repair Estimated Cost (value) ,.?DD. (Do 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 wick and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed tomrrf. tlaestaniaadsofall oegulatisigraasttudtiar ►iv. thbsyurisdiation. I understand that segacata permits are required for ELECTRICAL PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. S innatu re of owner and/oi Co .. President Notary as to • er and/or Condo President My Commission Exp FEES: PERMIT 6 0 1 MARYLOU HERNANDEZ .: Y �i .. MY COMMISSION # DD 060579 �.,� EXPIRES: October 10, 2005 a; of A Bonded Thru Notary Public Underwriters RADON t i Notary as to Contractor or My Commission Expires: C.C.F. , 0 NOTARY Signature of Contractor or Own - - Builder BOND TOTAL DUE 41 ..d 0 Electrical Date MARYLOU HERNANDEZ +c MY COMMISSION # DD 060579 o; EXPIRES: October 10, 2005 •% . �•� Bonded Thru Notary Public derwriters Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 8/28/2002 Applicant: MARTH ANNE Owner: COLLINS JOB ADDRESS: 525 NE 101 Parcel # 1132060171110 Fees: FEE2002 -4828 FEE2002 -4829 Description CCF Building Permit Application Fee Total Fees: Permit Status: APPROVED Permit Expiration: 2 inn Work: REPAIR FLAT D^ b a c t ar d[talt5 r� e3 sec u ri t enhanced d" mrn t' Srr 7616117:21:0 6 3000014 ?I: _ Signed: Building Permit Permit Number: BP2002 -1511 (Contractor or Builder) COLLINS MARTH ANNE ST Contractor QUALITY ROOFING CONTRACTORS INC Contractor's Address: 13800 NW 1 AVE Local Phone: 305 - 751 - 0382 Amount $1.80 $60.00 $61.80 BY: Page 1 of 1 Total Fees: $61.80 Total Receipts: $0.00 te- inspection Legal Description: MIAMI SHORES SEC 4 AMD PB 15 -14 LOT 17 & W1/2 LOT 18 BLK 94 LOT SIZE tl - QUALITY ROOFING CONTRACTOR, INC. 13800 N.W. 1ST AVENUE MIAMI, FL 33168-4849 63-4/630 FL ation herefor in strict compliance with all cations that may have been submitted to Dr if the plans are changed without nsibility for a thorough knowledge of the at he assumes responsibility for work done .. ottu regulations pertaining thereto and in strict conformity g o. - in accepting this permit I assume responisibility for all work done by either 1 High Velocity Hurricane Zone Uniform Roofing Permit Application Form MIAMI -DADE COUNTY BUILDING DEPARTMENT ELECTRONIC APPLICATION '1 Master Permit Ala Contractor's Name: Job Address: (Quality Roofing Contractor, Inc. 525 N.E. 101 Street ❑ Low Slope ❑ Asphaltic Shingles ❑ Prescriptive BUR -RAS 150 Low slope roof area (ft. ,n/a E2 Section A (General Information) Process No. Roof Category ❑ Mechanically Fastened Tile ❑ Mortar /Adhesive Set Tile ❑ Metal Panel /Shingles ❑ Wood Shingles /Shakes Other: , Repair Flat Roof Roof Type ❑ New Roof ❑ Re- Roofing ❑ Recovering 0 Repair ❑ Maintenance Page 2 Are there Gas Vent Stacks located on the roof? ❑ Yes M No If yes, what type? ❑ Natural ❑ LPGX Roof System Information Steep Sloped area (ft . n/a Section 8 (Roof Plan) Total (ft. _n /a Page 1 of 1 Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include dimensions of sections and levels, clearly identify dimensions of elevated pressure zones and location of parapets. Perimeter Width a'): Corner Size (a' ■ a'): P http: / /www.co miami- dade.fl.us/bldg/ roofing_ permiting /permit_app_section_a.HTML 8/22/2002 1 Owner's Notification for Roofing Permits issued under the Florida Building Code MJAMI DADE COUNTY BUILDING DEPARTMENT ELECTRONIC APPIJCATJON 1 Section 1524 - High Velocity Hurricane Zones Required Owners Notification for Roofing Considerations 1524.1 As it pertains to this section, it is the responsibility of the roofing contractor to provide the owner with the required roofing permit, and to explain to the owner the content of this section.. The provisions of Chapter 15 of the Florida Building Code, Building govem the minimum requirements and standards of the industry for roofing system installations. Additionally, the following items should be addressed as part of the agreement between the owner and the contractor. The owner's initial in the adjacent box indicates that the item has been explained. ,1. Aesthetics - Workmanship: The workmanship provisions of Chapter 15 (High Velocity Hurricane Zone) are for the purpose of providing that the roofing system meets the wind resistance and water intrusion performance standards. Aesthetics (appearance) issues are not a consideration with respect to.. workmanship provisions. Aesthetic issues such as color or architectural appearance, that are not part of a zonting code, should be addressed as past of the agreement between the owner and the cntsactar. / / ZP 2. Renailing Wood Decks: When replacing roofing, the existing wood roof deck may have to be renailed in accordance with the current provisions of Chapter 16 (High Velocity Hurricane Zones) of the Florida Building Code. (The roof deck is usually concealed prior to removing the existing roof system). 3. Common Roofs: Common roofs are those which have no visible delineation between neighboring units (i.e. townhouses, condominiums, etc.). In buildings with common roofs, the roofing contractor and /or owner should notify the occupants of adjacent units of roofing worts to be performed. c r �1YC4. Exposed Cetiltings*. Exposed, open beam cia kegs are where the underside of the roof deddng can be viewed from below. The owner may wish to maintain the architectural appearance, therefore, roofing nail penetrations of the underside of the decking may not be acceptable. The Florida Building Code provides the option of maintaining this appearance. G 5. Ponding Water: The current roof system and /or deck of the building may not drain well and may cause water to pond (accumulate) in low -lying areas of the roof. Ponding can be an indication of structural distress and may require the review of a professional structural engineer. Ponding may shorten the life expectancy and performance of the new roofing system. Ponding conditions may not be evident unt the ostigtistial roof system tic removed. Posxiu\g csInd%ons should be casrected. .PL 6. Overflow scuppers (wall outlets): It is required that rainwater flow off so that the roof is not overloaded from a build up of water. Perimeter /edge walls or other roof extensions may block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accordance with the Florida Building Code, Plumbing. `MK 7. Ventilation: Most roof structures should have some ability Al vent natural airflow through the interior of the structural assembly (the building itself). The existing amount of attic ventilation shall not be seduced. It may be besnefuctial to casnstides addtittiocnal venting wtNda can result tin extesxiti5ng the sesvtice kkfe of the roof. (ilea/ALP. $ / 1'1 / o Owner'slAgent's Signature Hate Contractor's Signature Page 1 of 1 http: / /www.co.miami- dade. fl. us / bldg/ roofingj,ermiting /owner_notification.html 8/12/2002 Date PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 9 -24 -99 Job Address 525 N.E. 101 Street Tax Folio %/— 72e, G-- 0/7 —/f /,9 Legal Description Historically Designated: Yes No Owner/Lessee / Tenant Mrs. Collins Master Permit # [ l �'�j Tj Owner's Address Qualifier Carlos Arocho 525 N.E. 101 Street Miami Shores ContractingCo. Quality Roofing Contractor, Inc. SS# Phone 758 -2972 Address 13800 N.W. 1st Avenue Phone 751-0382 State # RC 0 0 5 8 6 2 7 Municipal # Competency # 17889 Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Tear off old roof to wood deck, tin cap 301b. ASTM felt as per code install galvnaized eave drip and valley metals where required, mop on with type III asphalt one layer of 901b. ASTM felt, install Spanish S Clay Terracotta color thru tile with adhesive foam setting. Square Ft. 28 s q. Tile Estimated Cost (value) $ 10,000.00 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 OF 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 pennit 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 authorize the above -named contractor to do the work stated. AzIAYAA_,Q 9 /02y Signature of owner and/or Condo President Date • MY COMMISS .' CC 680474 EXPIRES: October 10, 2001 Bonded Thar Notary Public Underwriter; 1 1 "13'! 4I Notary as to • er and/or C My Conunission Expires: FEES: PERMIT /v e RADON ' q/9 Signature of Contractor or Owner - Builder Date Notary as to Contra or or • My Commission Expires: .i•YLOU HERNANDEZ MY COMMISSION N CC 680474 url EXPIRES: October 10, 2001 %CFA to ",;•° Bonded Thni Notary Public Underwriters Boa C.C.F. h NOTARY BOND 3 o 6 APPROVED: Zoning Building Mechanical Plumbing Structural Engineer TOTAL DUE /� G Electrical NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. /% — 7 2 U 6 a / 7- //z STATE OF FLORIDA: COUNTY OF DADE: 1. Legal description of and street address: 2. Description of improvement: Reroof to a new Tile roof . 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) N/ Name and address: Amount of bond $ 0 0 g 6. Lender's name and address: N/A ?, 7. Persons within the State of Florida designated by Owner upon whom by Section 713.13(1)(a)7., Florida Statutes, Name and address: N/A yhaA,W.4 eiLat Signature of Owner ``,A� Print Owners Name Na P Notary Public 2" Print Notary's Name My Commission Expires: 525 N.E. 101 Street Miami Shores, Florida 33138 13800 N.W. 1st Avenue Miami, Florida 33168 Sworn to and subscribed before me this o? q day of set , 19 9g . MTh YLOU HE /6 A r ION # CC 680474 EXPIRES: October 10, 2001 Vik • •:•• onnAnd Mtn. unmet PLhNc tla /eters 998546650 1999 OCT 26 09:20 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. 3. Owner(s) name and address: Mrs. Collins 525 N.E. 101 Street Miami Shores, Florida 33138 0: FLORIDA, COU 4T•( 0 DADE .eRE9Y CERllFy I • this is o true co of tho rtginal Mod in this o on � �dqv rn 9 , q 9 W TNES h nd nrd Of'icial se 1 J v ..r? of C r •r ' In-. es or other 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) Prepared by: Carlos Arocho Quality Roofing Contractor, In Address: N.W. 1st AvPhile Mi ami., lorisla 168 _123n1.52 2RJ3 l l Contractor's Name: �;�-,� o �� Snq - csr' , -, Job Address: 5 2 Al ...E )1 / . & -t ❑ (Low Slope Application) ❑ (Asphalt/Fiberglass Shingles) ❑ New Roof ROOF CATEGORY ❑ (Nail -On Tile) (Mortar.-,adhesive Set Ti e • ❑ (Metal Roofs\Wood Shingles & Shakes) ❑ (Other) •_ .... tOOFTYPE M Re- roofing - ❑ Recoverin g P ❑ Repair ❑ Maintenance Flat Roof Area (ft Sloped Roof Area (fft )'2g s . Total (ft') s Master Permit No. Exposure category (per ASCE 7 -88): _ L Building Classification category (per ASCE 7 -88 table 1): • Ft. A Ft. v v A Field:. Deck tYP : A TACHMLNT Fastener Type: Perimeter: Corner: DETAIL 1 & 2 ROOF HEIGHT AND SYSTEM DETAILS •• • (Draw details as needed) r r r r .ROOF PLAN 123.008 948 . Appendix "E" . UNIFORM ROOFING PERMIT APPLICATION • . PROCESS No. Page -1 ME,1)i HEIGHT 13 Deck type: • Appendix 11 " UNIFORIYY RQOPNG PEST APPLICATION PROCESS No. }SLOPED SYSTEM DESCRI'PTI'ON z Una erlaynte.nt Luulation: 11" 0001 SLOTS D s r A I L. 7 Fastener type & spacing: Cup Sheets Root overing Page -2 4. Drip edge: • 6, (O//ler, -7'--pe/rr, , o ATTACHMENTS REQUIRED 1) Fire Directory Listing Page 2) 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 (Pmaxl: '12.3 x (Aerodynamic) MuIUplIct): ���� .31 (PNI axl: 1J 3 X (Aerodynu MuIUpIler): (PN :ax3:1b3, I X �, (Aerodyaa :3). TILL CALCULATrONS . - M °M .S1 PCA: (o1•.ct0 . 1 5 ) - M I A 0 '' M PCA: I61 AO, .1J�)- Mg 4 — to °l :� ?.a-J PCA: 101,ctD APPENDIX "F" REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS As it pertains to this Appendix "F ", it is the responsibility of the roofing contractor to provide the owner with 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 minimum requirements and standards of the industry for roofing system installations. Additionally, the following items should be addressed as part of the agreement between the owner and the contractor. The owner's initial in the adjacent box indicates that the item has been explained. lilt, 1. Aesthetics - Workmanship: The workmanship provisions of Chapter 34 are for the purpose of providing that the roofing system meets the wind resistance and water intrusion performance standards. Aesthetics (appearance) issues are not a consideration with respect to workmanship provisions. Aesthetic issues such as color.or architectural appearance, that are not part of a zoning code, should be addressed as part of the agreement between the owner and the contractor. 2. Renailing Wood Decks: When replacing roofing, the existing wood roof deck may have to be renailed in accordance with the current provisions of Chapter 29 of the SFBC. (The roof deck is usually concealed prior to removing the existing roof system) L 3. • Common Roofs: Common roofs are those which have no visible delineation between neighboring units (i.e. townhouses, condominiums, etc.). In buildings with common roofs, the roofing contractor and /or owner should notify the occupants of adjacent units of roofing work to be performed. 4. Exposed ceilings: Exposed, open beam ceilings are where the underside of the roof decking can be viewed from below. The owner may wish to maintain the architectural appearance, therefore, roofing nail penetrations of the underside of the decking may not be acceptable. The SFBC provides the option of maintaining this appearance. S. Ponding Water: The current roof system and /or deck of the building, may not drain well and may cause water to pond (accumulate) in low -lying areas of the roof. Ponding can be an indication of structural distress and may require the review of a profess'ional structural engineer. Ponding may shorten the life expectancy and performance of the new roofing system. Ponding conditions may not be evident until the original roofing system is removed. Ponding conditions should be corrected. /'t) 6. Overflow Scuppers (wall outlets): It is required that rainwater flow off so that the roof is not overloaded from 'a build up of water. Perimeter /edge walls or other roof extensions may block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accordance with Chapter 23 of the SFBC. �7. Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of the structural assembly (the building itself). The existing amount of attic ventilation shall not be reduced. It may be beneficial to consider additional venting which can result in extending the service life of the roof. S. The owner may contact the Miami -Dade County Consumer Services Department for further information regarding the above. outWt, W6;7,4) q9.9( 6)9 Contractors Signature Owner's /Agent's Signature Date Post-it' Fax Note To t:ur'Uert. Phor A M Fasts A cceptance 3No.. 97.0515.0. Approved: UI[2.1L94 n7 /i17/1 9PLq 1 • dd _3AF,FRgA9F, 7071 oat' From Pr.one Far a PRODUCT CON glg E ACCEPTANCI1 PRODUCT CONTROL DIVISION Santafe Tile Corporation (305) 375.2902 FAX (305) 372.633E Ladrillera Sanrafo Bogota, Colombia VvLr application f..r Product Approval of: .Sant4ff 77/e Corporation, NaildOn dr .Slortar /.4d /resiee Set Clay "Satrtale S'• Roofing Tile under Chapter S of the 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; R.dland Technologies, The Center tot Applied Engineering, Inc. and Testwdl Craig Laboratories & Consultants, Inc. has been recommended for acceptance by the Building Code Compliance Department to be used in Dade Count', Florida under the specific conditions set forth on pages 2 through 7 and the standard conditions set forth on page S. The approval shall no; be valid after the expiration date stated below. The Building Code Compliance Office reserves the right to secure this product or material at any time for a jobsite or manufacturer's plant for quality control testing. If this product or material fails to perform in the approved manner, the Building Code Compliru ;ec (Mica may revoke, modify or suspend the use of such product or material immediately. The applicant shall re. evaivate this product or material should any amendments to the South Florida Building Codc be enacted affc• :tiag this product or material. The Building Code Compliance Office reserves the right to revoke this approval, if it is determined by the Building Codc Compliance Office that this product. or material fails to meet the requirements of the South Florida Building Code. The aFertse of such testing «'ill be incurred by the manufacturer Routes No. 9 (5 0318.02 au' Rodi ig ez Expires: 01/22/01 Product Control Supervisor 11415 rS THE COV)J SH ET SEE ADDI a FO' '' o 'D GENERA! CONt)ITIONS A BUILDING CODE COMMITTEE This application for Product Approval has been reviewed by the Metropolitan Dade County Building Code Compliance Department and approved by :he Building Code Committee to be used in Dade County, nor' a u nder the condition; sift forth above. - ITROPOLITAN DADE COUNTY, FLORIDA METRO -DADE FLAGLER BUILDING BUILDING CODE COMPLIANCE OFFICE METRO•OADE FLAGLER BUILDING 140 WEST FLAGLER STREET, SUITE 1603 MIAMI, FLORIDA 33130 -1563 (305) 375.2901 FAX (305) 375.2908 Charles Danger, P.E. Director Building Code Compliance Dept. Metropolitan Dade County . wJJ.��.. . . nerari� {���i {f{Inf7CC.Anr.ntif16.0071 Homispage: hstp :l /www.buildingcodeon COMA JAST C ❑ RP❑RATI❑ PAGE 02 SANTAFE TILE CORPORATIW ACCEPTANCE NO.: 9,' Apoli.c:tnt: San cafe Tile Corporation L dt iilera Satttaf Bogota. Colombia Ladrillera Sa::cafk, located in Bogota, Colombia. manufacturers clay roof tilt kr nuil•on and mortar; adhesive set applications. All Ladrillera Santafe tiles are available in standard unglazed and a ,fazed .;color fnish. This Produrrt,ryntre1 Aprrvairelates to th adri11era 5antafe "Rwo1" ci le•, Refer to 3 rosvate Comm' `Ar nrnvala for nthert11E nrafilm tt s Sams Fe Tiie Corporation is 'the sole, approved distributor of Ladrillera Santafe roof tiles. troducc Sa:natr S Tilt • Trim P:c :es 07/07/1999 12:44 3056659626 PRODUCT CONTROL NOTICE OF ACCEPTANCE ROOFING SYSTEM APPROVAL Prepared Rooting High Profile Tiie Nail-on/Mortar Set/Adhesive Set Clay System Description Product Control No.; Approval Date: Expiration Date: Contact: Daniel Bernal General Manager Santafe Tile Corporation 8825NW95St Ne1\tiami. Florida 33122 (:',3 3 2 7 g ) (305) 88S- 90021835 -0050 Jant2ry 12. 1')9S rllt ti' TRADE NAMES OF PRODUCTS MANUFACTURED OR LABELED BY .APPLICANT Test Product Dintektiou SOeciticatinnS De'stEiptiog o()1 1 d 13 ASTN1 C 1167 Hill: pror1ie, one pitce. ;lay roof . : :r w a ,1.5" equipped with two nail holes. For V" tick on. mum: set and adhesive set applications. 1 w varies w . varies varjing thickness AST I t. 1167 Flee =of8 Accessory trim, clay roof pieces for use at hips, rakes. ridges and valley terminations. Manufactured for each Lila COMA CAST CORPORATTn o a ga ti_ Mooring Product Contr•:l Ex--..r __MAe= ram CI ./ 1 J J J yL. 44 Z.U:J0007040 L uMA L Mb I l UKF'UKA I lU NAL . bi sA 4ThiltE TUJE CORPORATION AC:CEPTSNCE'J 21,15g___05, TEST REPORTS Test Agency, Test identifier Test Kame;Rermrt • Date The Center for Appiitd Engineering, Inc. 94.136 - 9 Static Uplift Testing Aug. 1994 PA 102 The Center for Applied Engineering. Inc. 25-7205-1 Static Uplift Testing March 1995 PA 101 The Center for Applied Engineering, Inc. 94- 156.3 Static Uplift Testing Aug. 1994 PAIOI Tht Center for Applied Enginetring. Inc. Project: 07- 07 -0-91 Wind Driven Rain Sept. 199 (301023) PA 100 Reciand Technologies 7161.03 Appendix 11 Wind Tunnel Testing Dec. 1941 PA 108 (Nail -On) Red.and Technologies 7161 03 Static Uplift Testing Dec. 1991 Appendix 111 ' PA 102 Rcdiand Technologies 7161.03 Static Uplift Testing Dec. 1991 Appendix 111 PA 102(M Redland Technologies P 0647.01 Wind Tunnel Testing Aug. 1994 PA 108 ( Monar Set) Recland Technologies P o631 -01 Wind Tunnel Testing July. 1994 PA 108 (Mortar Set) Redland Technologies P 0402 Withdrawal ,ept. 1993 Resistance Testing of Screw vs smooth shank nails Tcs:well Crai,7 l..ahorstorics & Consultants. Lab *''.1K --1 Ph,sical Properties July 1094 lac. r Teti: G. Suarez. ASTM C 1167 n7JA7tt444. 14d 1nRAMMoc.oM Page 3 of 8 r'r1uA PACT rvrloo/10 ATTrl Frank Zuloaga Rotting Product Control Examiner f1 - -X SA`T.4>E TILE CORPORATION Und rlayment: Roofing Tile: Comments: 07/07/1999 12:44 SYSTEMS 5Y5 "I1 Nt 8: Direct Deck Nail -on Application Deck Type: Wood, Non- insulated . Deck Description: • w• construction 19/32" or atef plywood or wood plank. Slope Range: 4".12" ":12" Note: Sy m B k o y acceptable in this slope range. Underlayment: Instal:. underlay - , t system in compliance with Metro-Dade County Application St • dard 118. Roofing Tile: le: Install tile compliance with .,. ro -Dade County Application Standard PA 118. (Se Data for Attsckment Cale 'ions a included in this App rov'a1.) Comments: 1. For re -roof applications, 15/32" plywood is an eptable substrate. 3056659626 • 1 SYSTI:.It D: Mortar or Adhesive Set Application Deck Type: Wood, Non- insulated Deck Description: New construction 19 /3 - 1" or greater plywood or wood plank. Slope Range: : Note: System D is only acceptable in this slope range. Install underlayntient system in compliance with Metro -Dade County Application Standard PA 120. install tile in compliance with Metro -Dade County Application Standard PA 120. (Sec "Data for Attachment Calculations" included in this Approval.) 1. For re -roof applications, 15/32" plywood is art acceptable substrate. Page 4 of Frank Zuloaga Rooting Product Control Examiner COMA CAST CORPORATIO PAGE 05 1 SANTAFE TILE CORPORATION ACCEPTANCE NO.: 210515 05 SYSTEM LIMITATIONS 1. The standard minimum roof pitch for Ladrillera Santafe's " Santafe 5" high profile tile shall comply with Dade County Application Standards PA 118, PA 119 or PA 120, depending on the method of installation. For nail -on applications, fasteners for mechanical attachment of tiles shall have a head diameter larger than that of the preformed holes in the tile. 3. System installation shall be in compliance with the system specifications outlined in t his P r o d uct Control Approval. The method of attachment utilized shall provide a minimum characteristic resistance load greater than or equal to the required uplift resistance determined in compliance with Metro -Dade County Protocol PA 115 or PA 127. The Ladrillera Samafa "Santafe S" tile profile has been tested for both wind characteristics and static uplift performance, therefore, attachment calculations for installation in compliance with PA 11 or PA 127 shall be done as nn 'Moment Based Sy5T111' 4. For mortar and adhesive ,set tile applications. a tied static uplift test by a Metro -Dade County accredited testing agency, in compliance with Metro -Dade County Protocol PA 106, shall be performed. • 5. All tiles shall hear the imprint or identifiabie marking of ;he manufacturer's name or logo for ide ntifrcatio:r in the field. 6. For mortar or adhesive set tilt applications. 30/90 hot mopped underl,aymtent applications may be installed perpendicular to the roof pitch prior to June 1, 1995 unless stated otherwise by the material manufacturer. Thereafter, 30/90 underlayment systems shall be installed parallel to the roof pitch in compliance with Appendix 'A' of Dade County Protocol PA 120. The appii;.ant shall retain the services of a Metro -Dade County certified testing laboratory to maintain quality control in compliance with the South Florida Building Code and related protocols. 07/07/1999 12:44 3056659626 Page 3of$ COMA CAST CORPORATIO Frank Zutaaga Roofing ['rodu.:t Cc nr'•e1 Examiner PAGE __ 0S Table 1: Aerodynamic Multipliers -% (ft') Tile profile X % (ft ) Nail -On, Direst Deck Mortar or Adhesiv a Set Sarltafe S Clay Roof Tile 0.34 I _ 0.31 07/07/1999 12:44 3056659626 DATA FOR ATTACHMENT CALCULATIONS Page 6ofR j ' ' r A r&o ee r,. Table 2: Restoring Moments due to Gravit M Ift -lbf) ;Tile Profile ! 2:12 { 3:12 1 4 :12 5:12 6:12 Sarnafe S i 4.9 i 4.8 I 4., 4.6 4.6 7:12 4.4 Frank Zutoaga Roofing Product Control Examiner NIMP Table 3: Attachment Resistance Expressed as a Moment. Mf (ft -Ibf) i i Tilo Profile Two ,approved One Approved + Mortar Set Adhesive Set Nails Screw _ Santafe S 1 21.8 18.4 ' 23.6 61.9 _ J COMA CAST CORPORATIO PAGE 07 • pr. •••• k.A.JmA LUUUjU f"120FILI.: DRAWING 7 ,,,,•-'—' .0,=.% , • ....:,. -, ...:... , . •; 7 e• ...... 1 .- „....... . • . .......;„ ...... „. ,,,../..°... _, - 0- .....;;,.....,., -- ,..r.: „...- 4. 0 .... .,; ,, ,r se . 2 .,.. , : . - :.., ..., .•... 4 0- 41" 0,:: 4,...'•";-.100'',.' ,...... •0 ''''' ' e",e:/.........•/ .". ../. ... .0'.• ,.;.- e ..;:e ..:•''' ' ' .•.::' ''- .. , •.: ' ..0 /. l t,:: , ' ,....:.• 0.--) .....s.'...• _.,..y.1.......:/,./* .,...;:.• . .... ....... ■:;" ••••••:•",/, off • . _...—' /;%•'°: ''' .• • 0, :;0,,,...f.e. 140'.- ..4:',0:•/.."......":". . • ele / ',v. .. „es' , ,e0;',....•,,,, N ',. ree'. ...0* , ..... 1...• ..: c 4 . v.,..- • '''.,....% ••":•.V.,' ,,' e... '': •4 o' ..0" f, X ,;r0";;;;•,..::••%,?;''''.''....•::" • "•_,•,....• ee ■ .e.r.... . •••■•■ .1tel .,", .0 , ..1.. 0. 1---' .... ‘., .... ....... .../* „.... .. '". '...- ....*". Paeze 7 of S 1 , .„.; •., .. ,' LADRILLERA SANTAFE "SASTAFE S CLAY ROOF TILE Frank Zuloaga Roofing Product Control Examiner PAGE 08 •,' $ANTAiE TILE CORPORATION • ACCEPTANCE NO.: 97.0A15.05 07/'0711999 12:44 3056659626 SANTAFE TILE CORPORATION Sautafe Tile Corporation Ladrillera Santafc Bor.ota, Colombia COMA CAST CORPORATIO PAGE 07 ACCEPTANCE NO.: `)"-tt5l5 5 Product Control No.: 97-0515.05 Approval Date: .lanua '' 998 Expiration Date: J r uy t " 2901 NOTICE OF ACCEPTANCE ST ••NHARD CON` I NS Renewal of this Acceptance (approval) shall be considered after a renewal application has been tiled and the original submitted documentation. including test supporting data, engineering documents, are no oid:r than eight (3) years .Any and all approved products shall be permanently labeled with the manufacturer's name. city. state. and the following statement: "Dada County Product Control apprat•ed ". or as specifically itatr:d in the specific conditions of this Acceptance. Renewals of Acceptance will not be considered it a► There has been a change in the South Florida Building Code affecting the evaluation of this product and the product is not in compliance with the code changes; b) The product is no longer the same product (identical) as the one originally approved; c) If the Acceptance holder has not complied with all the requirements of this acceptance. including the correct installation ofthe product; d) The engineer who originally prepared, signed and sealed the required documentation initially submitted , is no longer practicing the engineering profession. 4. Any revision or change in the materials. use, and/or manufacture of the product or process shall automatically be cause for termination of this Acceptance, unless prior ■Titten approval has been requested (through the filing of a revision application with appropriate fee) and granted by this office. v. Any of the following shall also be grounds forTemoval of this Acceptance: a) Unsatisfactory performance of this product or process; b) Misuse of this Acceptance as an endorsement of any product. for sales. advertising or any other purposes. o. Th Notice of Acceptance number preceded by the words Dade County, Florida. and followed by the expiration date nray be displayed in advertising Literature. if any portion of the Notice of Acceptance is displayed, then it shall be done in its entirety. A copy of this Acceptance as well as approved drawings and other documents. where it applies. shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at all times. The copies need not be resealed by the engineer. 8. Failure to comply with any section of this Acceptance shall be cause for termination and removal of Acceptance. 9. This Acceptance contains pages 1, through 8 this last pace. END OF THIS APPROVA�? Page of u oaga Roofing Product Control Examine- 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 5'7 - 1] 26 jAy ss . p 51 55 ri D 2 27 52 3 28 53 4 29 54 5 30 55 6 31 56 7 32 57 8 33 58 9 34 59 10 35 60 11 36 61 12 37 62 13 38 63 14 39 64 15 40 65 16 41 66 17 42 67 18 43 68 19 44 69 20 45 70 21 46 71 22 47 72 23 48 73 24 49 74 25 50 75 Du Quesne & Associates, Inc. Consulting Engineers Testing Laboratory ON -SITE CONCENTRATED UPUFT LOAD TESTING OF ROOF TILE IN ACCORDANCE WITH METRO -DADE BUILDING CODE COMPLIANCE PROTOCOL PA 106 Owner's Name: NA kQl k-ksk F. Lol1 I V4'F Permit #• 455 3d Job Address 5.25 NA -C-- 10 1 .'1' . M I A M 1 S fo R.G. $ 1 Ft Roofing Contractor' Qu 1 ► V 00 I INiLl Type of Tile: p►->' t ‘S k Vs— t"o -t SI T Date Installed* (• J 1 .00 Approximate Roof Height* 1 ' 2 feet -2 . Pitch: 2 ��L • 1.Z Type of Access to Roof: Scaffolds X Ladder Other Approximate Square Footage of Roof - ft 2 Required Testing Force: 35 lbs. Testing Equipment: Chatillion DFIS 100 Date Tested 2. 4 ' op ge Du Quesne, P.E. Engineer P. #24513 Du Quesne & Associ. • -s, Inc. E.B. License #00052 5 Lab Certification #94- 0318.01 SITE SPECIFIC INFORMATION TEST RESULTS P = PASS, F = FAIL SKETCH OF ROOF IN BACK UTR 16675 Environmental • Civil • Structural Building Inspection Services IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL PA 106, THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT QUALITY CONTROL TEST. THIS PA 106 TEST HAS BEEN PERFORMED IN FULL ACCORDANCE TO THE REQUIREMENTS OF DADE COUNTY, WITH NO DEVIATIONS. Please Note: This form is not valid unless Company logo appears in color (burgundy) 7815 S.W. 24th Street • Suite 109 • Miami, Florida 33155 • Telephone (305) 264 -1425 • Fax (305) 264 -1426 $KETCH OF ROOF JOB SHEET NO OF CALCULATED BY DATE. CHECKED BY DATE SCALE NOTES' • KETCH OF ROOF 10B L. ,.\ k °' � T, ) N M t SHEET NO CALCULATED BY CHECKED BY SCALE y OF �- DATE DATE A 1 r:7■ ■ ■ ■r■■■■■■r7`% ■1M■■■LI■■■M■■ ■■mow ■11111151■ •■■■B■■ ■■■■EM �iiiii�r��►■ ■ice■■■_ !'! IliIiiiiit ■ ■0, t� i1' (, nommimminmagimmem mrammillmmaimmtrull 11111111111111 11) NOTES. PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date - g. -yS Job Address .5 /- /,F /O/ Tax Folio G/• 3T'OG D/ 7 • Legal Description i /7 4M 9 �" Owner/Lessee / Tenant A �� Master Permit # 3 8 0 a / Owner's Address 5 S /` / / Phone 7541 - 0 1 97 .7. Contracting Co. - Qte / e5 �y�iCo t' Qualifier --ll /7/e S Y AUizYkaP Signature of owner and/or Condo President Date My C otary as to Owner and/or Condo President i N ropriCIAL NOTARY SEAL 0 e, SANDRA M MONTIEL 2 ,P1 • % COMMISSION NUMBER %Or, a CC401261 7, ,,r 9-\0 MY COMMISSION .EXP. OF F \ AUG. 17 1998 Date FEES: PERMIT 60 . RADON C.C.F. Notary My Co APPROVED: Zoning Building Mechanical Plumbing Historically Designated: Yes No Address / /,--D J'-/ a," e 7 __ SS# Phone ISO, - 6 c,/ .7. State # 4''O 3 © & Municipal # 7 / `r S Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION 44.- a ' a/f S q u a r e Ft/e-0 o-/ Estimated Cost (value) - " 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 authorize the above -named contractor to do the work stated. Si ture of Contractor or Owner- Builder iFICIAL NOTARY SEAL i SANDRA M MONTIEL * ,!v % COMMISSION NUMBER a % Q CC401261 7, . "" , MY COMMISSION .EXP. OF F\ AUG. 17 1998 Electrical NOTARY TOTAL DUE Date Date ‘s Engineering PERMIT APPLICATION FOR MIAMI SHORES VILLAGE ate d Job Address 5 c2 5/ /0/ ST Folie // 32 0t -©/ 7 - / // v e Description /g9 /O / aY t i slily ,caner / Lessee / Tenant Martha Col li ns Master Permit itl7e6g, wner's Address 525 N. F. 101 St . Phone ;ontracting Co. C;. T,. ROOFTNC; CO. Address 7814 N_ F_ 41-h Ct ualifier THOMAS I. LOVER IN SS# Phone 757 -1675 ;tate #12C0014913 Municipal it 1188 Competency # 1 188 Ins.Co. architect /Engineer Address 3onding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Tin rap felt roof. mop. 2 - 1 5fi her g] _ss fPl t 1 - Mnr1i fi Pr1 hi t,imen membrane, over rear flat wooden garage roof Square Ft. so0 Estimated Cost(value) 2320 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 requiree 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 authorize the above -named contractor to do the work stated. (/' FEES: PERMIT , P'ekr.0 APPROVED: Zonin P 6 Signature of owner and /or Condo President Date: Notary as to Owner and /or Condo President My Commission Expires' ' N6TARY f usLIC TAT MITI OF FLORIDA ,, my COMMISSION EXP.DEC.10, I'3 pED'EM ca a. vs. %TNTD, ** * :S'- !�. * * * Mechanical * * RADON C.C.F. 10 NOTARY TOTAL DUE L5fc-5 Plumbing_ Signature of Contractor, Owner - Builder Date: Notary as to Contractor" or.Cwnev°Builder My Commission Expires: NOTARY PUBLIC STATE OF F MY COMMISSION EXP.DEC..18,,1995 * * a, BOND g D Ti3RU GENERAL • ** Other • Electrical Engineering $12.50 Registered Architect and /or Engineer Name and address of licensed contractor Disapproved Date_ (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......_... IIlay 8 _..__.» _ ..._._ _.........197 8 Owner's Name and Address Mr. Collins .,,, No... 5. ....... Street N • F • 101 st Street Nl x Biscayne Roofing Co. 5180 7 . 11th Ave. Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done 525 N • F' • 101st Street State work to be done and purpose of building (by floors )remove existing roof. tin cap 1-20# felt. in- stall 26 gu .ge ga7.v, ea.Ye drip...szb.-- .s1.o.p.e.,,... mop... 2.... asbe -stn s...an...flat......ins.tall 26 guage Qaly. gravel stop at flat roof. aint flat roof' with and for no other purpose. asphalt base alurr init paint. mo.-n 1-90 on s) K ewn. and lay lVo o gtor{es the . 30 sqs . New - Building Remodeling To be constructed of Kind of foundation Roof Covering sklingle....tile & bu. Estimated Total cost of improvements $ 5,335. 00 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 ' spection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such st>Ontractors, on work to be performed under this pennit, as are licensed by Miami Shores Village. Remarks._. (Signed) STATE OF FLORIDA, j 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 him stated are true. qq Permit No.. C7 D Date 6 . q . ..7" Read, Sworn to and Subscribed before me. Building Inspector t,:,.. Notary Public, State of Florida My Commission Expires to me well known, PLANNING BOARD DATE Chairman Member \fcrrber 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 fmm the Planning Board. A rc- inspcction fce of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection oft faulty materials and /or workmanship. • MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Date 2/22155 , 19 Owner's Name and Address. _..J..L._Pier_ce No...2( Street P$ niett Dr. Registered Architect and /or Engineer Name and address of licensed contractor Lang__ Roofing azid__Til e_._C_o.._ ..1,3Q..1]_._._ W... 79th St, Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done _25._ IL. ..T'.e.___1Q1Sta__St. State work to be done and purpose of building (by floors) and for no other purpose. New Building- __$ Remodeling Addition XXXXXXXXX Repairs No. of Stories To be constructed of Kind of foundation Roof Covering__T'ile_. St. _ built .._ Estimated Total cost of improvements $ 74Q.00 Amount of Permit $ 5.00 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 pen 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 toT performed _under this permit, as are licensed by Miami Shores Village. Lang ofingg and e Go., inc, Remarks (Signed) C 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 him stated ace true. Permit No l a0 cc 4 Date l_ 023 TJ Read, Sworn to and Subscribed before me. Disapproved Date (Signe Notary Public, State of Florida t_ . Buildi nspector 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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.