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101 NE 102 St (9)340 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Dated J Time Type lnsp'n � l Ct e Permit No. ( 1 . O 1 Address Name l l 1 LC ) IC l 101 NF_ 107 s Company CO i \ , Phone # For Inspector: cg i Approved Correction Re- Insp'n Fee Name & Date For Inspector: Approved Correction Re- Insp'n Fee 3 7coa MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 1 Time Type Insp'n � \ Permit No. C9 1 aa Name Address ‘o ■E__ Company W a le q Phone # giis Name & Date MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 1b1 f Time Type Insp'n Pi no) (Rock Permit No. f P T3-12z9 Name Li Vt Address I�l 1 Iv —sI Company . WO`C Cj 1 XI Phone # For Inspector: Approved Correction Re- Insp'n Fee tOilf53 Name & Date a� 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 ! 26 1:24....12 C 51 Qty! � hEI7 76 2 r 44` 27 52 1 77 3 28 53 78 4 29 54 79 5 30 55 80 6 31 56 81 7 32 57 82 8 33 58 83 9 34 • 59 84 10 35 60 85 11 36 61 86 12 37 62 87 13 38 63 88 14 39 64 89 15 40 F,3 90 16 41 66 91 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 +9 . 74 99 25 Ale 6 50. LI'''. 75 100 SITE SPECIFIC INFORMATION Owner's Name PETE ti �Q E btEIEtP Permit # P �OD� p gel Job Address 10 t 1 t- 1 V 2 ' Roofing Contractor: K.110'0aOrt iJ 62 ,. ii./.1._ � - e � Type of Tile: r--.40 l *tic" o tip � Date Installed: 9 -'3 ' Approximate Roof Height: Z feet Roof Pitch: 4 ' 0 - Type of Access to Roof: Scaffolds `sadder Other Approximate Square Footage of Roof: . 3 CO o ft Required Testing Force: 35 lbs. Testing Equipment Chatillion100 Date Tested: 10 t ' e THIS REPOR SUB Li) BY: Civil Engineer: Lab Certification # 98- 0608.04 U.S. SOUTH Engineering & Testing Lab., Inc. 6065 N.W. 167th Street, Suite B -23 • Miami, Florida 33015 Telephone: (305) 558 -2588 • Fax: (305) 362 -4669 ON -SITE CONCENTRATED UPLIFT LOAD TESTING OF ROOF TILE IN FULL ACCORDANCE WITH METRO -DADE BUILDING CODE COMPILANCE PROTOCOL PA 106 State of FL Certificate Authorization # 4100 TEST RESULTS P = PASS, F = FAIL N2 4574 IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL PA 106, THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT QUALITY co - ROI. TEST. q9nr ID / / /O NOTES' SKETCH OF ROOF All Aln EMIR • 7: 61 111011 ; IL Anumminriammilii woyammurimemp _ _ . miorommommulareamm IIIII7► /.Irk' ,,r. liirAh fir, 0r wap.2 atI ICSINEIIIIe /IOW II IRV Q mli 111 1111 II PERMIT APPLICATION FOR MIAMI SHORES VILL4Q1 10050 N.E. 2nd Avenue • Miami Shores, Florida 33138 • Phone: 305- 795 -2204 • Fax!: Jiidft'S( 2i" /"Ir: fL) 1/ ? ti Legal Description Historically Designated: Yes <lj(^ No Date 1 S l 3 Job Address 1 01 NC 1 o. r 1st Owner /Lessee/Tenet 'l'eI'c stn d OS6 N % uLLC . Owner's Address 1(71 N•6 1 a h d Contracting Co. I Oki wa. I ek R oo-T olo Qualifier Pa,J a.vexl&K ss# State # Municipal # Tax Folio Phone Master Permit #(l 2 0o3 - I c-A l' Cr 305 '75x Address T , 0 ox 53) DS/ t:awi 1 . 33/53 Phone 305 751//o/"f/ Competency # I3BJc""r3b Ins. Co. i- ett-ciT IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY, THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE BEFORE CALLING FOR ANOTHER INSPECTION. Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING WORK DESCRIPTION: I ea eX I * 115 1 t roOT j repf e to II) W sccko"a F.6 Span --S co l orih rocA6k c,lik.y rob -c 5 V5+e -rk► Square Ft. 3'4 0 Estimated Cost (value) . 13, bo ) WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR ANY ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). 1 certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for all disciplines. OWNERS AFFIDAVIT: 1 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. Not a o Owner and/or Condo 'reside / Date My Commission Expires %III Mabel Vargas ,% ;;!�" ` : Co m mission #DD231984 . :._ Expires: Jul 13, 2007 C Bonded Thru 2 �S, tife " It Ab tlantic Bonding Co., Inc. FEES: PERMIT RADOPQ C.C.F APPROVED: 1% Zoning Building Mechanical Plumbing X .9° /id 3. 7.23 4tta to C 8 Signature o f Contractor or Owner Builder D iclajk ot as to Contract sr or Own• :uilder My Commission Expi Z ,N S F C./C.1 1 '"+. OCR L A O NOTARY w • BOND l CA 351 (TO AL DU AUG - 8 2003 Electrical Structural Engineer Master Permit No. Contractor's Name Job Address ❑ Low Slope ❑ Asphaltic Shingles ❑ New Roof gRe-Roofing Florida Building Code Edition 2002 High Veloci Hurricane Zone Uniform Permit Application Form. Section A General Information Process No. w6.ei< � I ME . I o ROOF CATEGORY ❑ Mechanically Fastened Tile ❑ Metal Panel /Shingles ❑ Prescriptive BUR -RAS 150 ROOF TYPE ❑ Recovering g Mortar/Adhesive Sot Tile ❑ Wood Shin •��lShakes_ ❑ Repair ROOF SYSTEM INFOR1y ATION _ - Low Slope Roof Area (SF) Steep Sloped Roof Area SF D � ) Total (SF) 314 DO 31400 Sketch Roof Plan: Illustrate Section B Roof Plan ( ) scuppers and overflow drains. Include dimensions ons of sections and levels, clearly identify dimensions of elevated pressure zones and location of scuppers, overflow f parapet f44 . ;.: Roof Slope: "�— 12 Florida Building Code Edition 2002 Hi • h Veba Hurricane Zone Uniform Permit A,. tication Form. Section D Stee. SIo• ed Roof S stem Notice of Acceptance Number: Minimum Design Wind pressures, If Applicable Fro ( m RAS 127 or Calculations): P1: P2: 1001 17 P3: 1001b Maximum Design Pressure From the NOA S . ecific S stem : Method of tile attachment: Ridge Ventilation? Deck Type: Mean Roof Height: Stee• SIo. ed Roof S tem Descri • ' tlon 1X& (/'-To + ype Underlayment: Insulation: Fire Barrier: Fastener Type & Spacing: \Adhasi•JP T ype Cap Sheet: Roof Covering: Type & Size Drip dge: 5 1cr • (P= (Ps ; t+$Florida Building H1 • Ve10ci Hurricane Code Edition 2002 Zone Uniform Permit A • . lfcation Form. Section E Tile Calculations :For Moment based tile systems, choose either 'for Mr with the values from M. If the Mr values ar greater o d 1 or 2. Values, for each area of the roof, then the tile attachment method is equal to the Mr Compared the values gr than ethod s acceptable. (P L ig I f Ieth • d 1 a o ent Bas . . 'r•• _ . P x 1 J (P 1 i z i _ -1►I '�.� Ma �/ — ' i.yl — Mg: s Per RAS 127" NOA M NOA Mr NOA MIr od 2 `'Simplified Tile Calculation Per Table Below" Required Moment of Resistance (M,) From Table Below NOA M M 'ust be used in conjunction with a list of moment based file Broward County Board of Rules and Appeals. 1I systems endorsed by the For Uplift based tile systems use Method 3. values for F,, if the F' values are greater than or equal e ared the values for Ft;ltiith the qualto area of the roof, then the tile attachment method is acce table P Method 3 "Uplift Based Tile Calculations P x 1: _ -.� Per 127" x w: - �ti• xl: _ x w: _ ) -w : RAS — _ xcos 1: — — F x x xcos = F 110A F' ` ' ) — �ti': x cos 0.•_ _ F,3: — NOA F_ r3 ' NOA F' • .V Descri • tion Where to Obtain Information S mbol M Ro n.3;521 Pressure PI or P2 or P3 RAS 127 Table 1 o .... __ engineering Wh ere to fin d wn . of Het t _ Roof S,o• a Io b i 7 Site Aerod +stir Mu, lien Restorin Moment dU © NOA to C',nvi Attachment Resistan • NOA R aired Moment Resistance ® NOA Minimum Attachment Resistance ®� R ' aired U• lift Resistance NOA Aceratte Tile Wei In ©O. Tic Dimensions N0:\ I length NU:\ All calculations must be submits w� Ninth etl t the Buntline Official at the time ut •emit ao• Iieation. CrA. A 1Us\ 13L4 HIGH VELOCITY HURRICANE ZONES REQUIRED OWNERS NOTIFICATION FOR ROOF CONSIDERATIONS 1524.1 As it pertains to this section, it is the responsibility of the roofing contractor to provide theowna 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 govern 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 zoning code, should be addressed as part of the agreement between the owner and the contractor. R - r 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 Co: le. (The roof deck is usually concealed prior to removing the existing roof system). R 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. R - 4. Exposed Ceilings: Exposed, open beam ceilings are where the underside of the roof decking can be viewed from below. The owner may wish to maintain the architectural appearance, therefore, roofing nail penetrations of the underside of the decking may not be acceptable. The Florida Building Code provides the option of maintaining this appearance. J . 5. Ponding Water: The current roof system and/or deck of the building may not drain well and may cause water to pond (accumulate) in low -lying areas of the roof. Ponding can be an indication of structural distress and may require the review of a professional structural engineer. Ponding may shorten the life expectancy and performance of the new roofing system. Ponding conditions may not be evident until the original roofing system is removed. Ponding conditions should be corrected. R r 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. R - 1 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. Owner's/Agent's Signature C: tDOCVSIL- I%meLOCALYIIT.r,uLCTtON IS71.4 , 5 , 03 q°6,utguw-cd, Date Contractor's Signature i s MIME ti • PRODUCT CONTRO , NO rr OF ACCEPTA Santa Fc Tile Corporation 10302 N.W. South River Drive, Bay #16 Medley ,FL 33178 Your application forNotic: ofAcceptancc (:`:OA) ot: Spanish "S" Clay Tile under Chapter 8 of the Cod of Miami -Dad: Count;: governing1 2onstrtiction, and comp!e :e!y described herein, has been recom County Building Code Compliance Office (BCCO) under the c This NOA sha:l not be valid after the expiration date stated be product or material at any time from a jobsite or manutactur is plant :or quality control testing. product or material fails to perform in the a his use of suci product or material immedt3tel? proved menner, may revoke, modify, or suspend the determined. by RCCG that this product or r tat r al t its S to n eet the right requirements a this approval, i it a ppro�al Building Code. of the South Florida The expense of s.tch testing will be ACCEPTANCE NO.: 0�_t212.06 EXPIRES : 02/O[!2006 incurred by the :nanufactur4 d THIS IS THE COVERSNEF F -E ADf)iT1 PAG BUTLDI\G CODE & RODC S RFVI E�Y This applica:ion !Or Product Approval has Code and Product ReHew Committee to be forth above. interne( mail aUJress: postmasters buitdir.o_ aleonline.corn I; been reviewed byfRhe used in Miami -Daele i! 1 CE County, MIAM[ - DADE COLNTY, FLORIDA, METRO -DADE FLAGLER BUILDING BUILDING CODE COMPLIANCE OFFICE 140 WEST Gt ER STREET. SUITE M:A7411, FLORIDA :3130-136: (30)3. "•29C 1 FAX (303) 375 -290a • CONTRACTOR t,lcerrst.c strrlox (305) 373.2527 FAX (;os) 375.2553 CO I'RaCI'OR EVrOItCf•_,iIENT DIVISION (305) )7s. :966 FAX (305) 375.2903 PRODUCT CONTROL DIVISION ( FAX (:os) 3 3e use OfAlternate Materials and Types o;' ended for acceptance by the Miami-Dade nditiors specified herein. w• BCCO reserves the right to secure this c Raul Rodrig Chief Product Control Division OR SPECIFIC AND C F..NER COMMITTEE BCCO and approved by the Building Florida under the conditions Francisco J. Quintat:a, R.A. Director Net ianli -pad County Building Code Complir.ncc CTti._ '':C4SOCOI c v�aeeswouce xceDV-c• comer catn•duc 1 t HO . 1 http : //H �+w,bui(dingcodconlinc.cont set • Pro Tile Screws 3. • ROOPI.'YG• ASSEMBLY APPROVAL Clreoo,.... Roofing Sum 07320 Roofing Tiles Clay Roof Tiles Food Materials Deck v C: rT F TIL ORP 1. SCOPE This hi renews a roofing system Tile using San:a Fe "Sentafe comply with the h Florida described in Section 2 of locations where t Building Cede, 1991 Edi does not exceed the design pressure r equirements, as de using the values Ii t. 3 n pressure values obtain by ca sy 3tem, s d in herein. The attachment calcul 2. PRODUCT DESCRIPTION IN by A licant it Product F' C9Cr1 tiO Roof PA 112 n. Ori piece high pro file clay roof tile equ with two nail holes. For nail -on, molar set and adhesive set applications. PA 112 �1cc It' ssory trim, clay roof pieces for use at Ptrikes. ridges and vatic Maqufaeturcd for each tilt to ions. 2.1 p r ofile. lc. COMPONENTS OR PRODUCTS . '�'IA,Y L'FgCTRCD BY Product Test T OTHERS Santee 'S' Clay oo. Tile Trim Pieces Dimcncions Test S ccifications I 18" ��' • 11.5 ' / :" thick I = varies w - varies varying thick Dimensions N8 x 2_14" long 0.130" shank dia. 0.178 flute dia. PA 114 Appendix r. LIMITATIONS 3.1 Fire classification is not 3.2 For massi part of this acceptance. accordance with I RAS 106 esive t tile applications, a st 3 3 Applicant slr.;i! retain h e se i services of a M • r perform quarterly test in azc Miam �ordan submitted to tltc cc with ( 'A I ©uilding Code Compliance Offi 2 iI f� 1 Snections I. Product cscri tin S Steel f '' t i 1 r ACCEPTANCE No. : .E Approval Date: Fe ruar I l00t Expiration Date: Fehr , :-v I, 2006 " clay rooting tile, manufactured by otice of Acceptance, designed to ion for M iant i - Dade County. For mined by applicable building code. Illations in compliance with RAS 127 ions shall be done as a moment based :dotage. RRC oofing Product Control Examiner Manufacturer generic is field uplift test shall be performed in C a a de • County Certified Laboratory to hall be 3.5 rF T CORPORATION ACCEPTANCE No. : 0 0- 212.06 30/90 hot mopped underlti ; � b.a ppli � tion s y be installed Perpendicular w the roof slope re. slope unless stated otherwise y the under' •rncnt material manufacturers ceptartcc is for wood dc cl; applications Published ' 6 This ac compliance with a licable building PP Minimum deck PF g cock. n9ui'c rents shall be ir 4. INSTALLATION 4. J .1 San and its tafe '$' ,I components shall be installed County Rooting Application Standard ► strict 9, a d RA with 2t . a•J'3 Data For Attachment Calculations RAS 118 RAS 1 19 Miami Dade Table 1: Aerod Santafe ' namic Multi (ft) tl Batten A Ilea. on 0.274 T able 2 : Re 12 t 2 e 3": 1 z „ Moments due to r avi . M ft-lb 4 ":12. •• :12" 6.• 1 1t ea;tons Direct Bettels Deck ODe 18a 3ns Ctrec Barons i Direct 5.85 Deck S. 6 ers - ft A(ft) Cirect Deck 1 Deck Battens N/A Tile Profile Tile Profile Battens ' Direct Deck 'Santafe 'S' 5 90 3.9 S � T A • roved screws as Table 4: Attachment Resistance Expresse Tile for Mortar or Adhesive Set Profile Tile A •lication Mortar Set Adhesive Set One Screw w/ Cli 57.31 57.60 as a Moment - M, (ft -Ibf) stems 6 Attachment Resistance 61.9 Table 3; Attachment Resistance Expresse • as a Mo I Tile Profile For Nail -On S stenzi; meet- Mt (ft -lbf) Tt,v ails Application I Two One Screw Santafe S Santafe 'S' Direct Deck i Battens 21.8 noted 'Product rnanufac :u by others 3 I o Screws 29.15 1 38 2e 0.297 7 ":12" or • reater Two Screws w/ CI; 1.77 j ' rank Zuloaga, RRC Root1ng Product Control Examiner Direct Deck 1 ION . S. . LABELING All tiles s h a ll b ear thc imprint or identi.6able . or follovving statettent: "Nfian..i-Dade County P 6. BUILDING PERMIT REQUIREMENTS 6 I A pplication for building permit sha11 be accomp 6.1.1 This Notice of Acceptance 6.1.2 Any other documents required by the Build order to properly evaluate the i nstallation oft PROFILE DRA WIN SANTAFE "SANTAFE S" CLAY; 4 0 OF TILE lIfrtank Zulaaga. WIC ultooling product Contrci Examiner ACCEPTANCE No. :aula rking of the manufacturer's name or logo, d uct Control Approved., . ed by copies of the following: g Official or applicable Building Code in khis system. AN T AFE O; 'OR4T1 t+k OTt OF ACCEPTA n 1 Renewal of this ova CJ` S COYb original su�t CE (aPprfl ITIONS nittcd c Acceptance including small be considered ale eight (8) years. , uding test supporting renewal ing d o Lion ha, been PWning da en rrc_ a:t fled and the 2 Any and all $ .nib documents. arc no older than the following # products h be sa11 Per nt: ) labeled wi 8 statement: s all a perm anen p, specific conditions of this Ac County °duct Contro the m anufacturer's name ceptance. Ap ?roved•• or ass ' city, start, and 3 Rene..a. of Acceptance stated in the a) ?he has ptance will not be considered if: been a change in the en C and the a been is not in compliance South Florida Building Cole !f the b) The Pr �Cptan eo Longer the product (�cpde change '' a.Jl the evaluation of this pr correct holder complied with a fl he as t one originally a a i nstallation of the has not p o• product; all the r-„a � d) The er reTenrs of this ac pro "ed; sneer who Ofl gin�l} prepared, signed acceptance. includin sup tutted is no !on cr g and sealed Ott r d the 8 Drac;icing the engineering documentation initially s Any revision or char, � g g Drotessi�, a,tomaticall 6e .n the materials, rue, and/or manufa Y be :gore for r of the product or process shall ;through the be ter mination of this Axeptance, uN 4 e tiling of a revision application with appropriate ADropriat: fce� Dior wrtten. approval ct bceo r Any following , s and granted by this office. S requested a) Unsatisfactory wi g shal also be grounds for rerrovaJ of this . ' b) Misuse of this perf of this product or process; Acceptance as an endorsement ofa p� D sip Misuse any Dr uct, or sales, advertising or any other 5 The Novice of Acceptance nom 11 A :cepta expiratw of number preceded by the words maybe splayed in advertisin literature. I�Iiam �padc Count done in its entirety, g ICan ' Y. Florida, and followed by ?k Portion of the Notice pfthe displayed, then it A copy of this ..fie ii Acceptance is provided to the' ptaree as w c11 as a P. drawings and user by the m anufacturers or its distributors andts &a.a1 site i t t the. The c documents, w DP copies need not be , here it applies. shall bc 8 Failure to comply restated by the engirrcp ` � available for inspection at the Job Acceptance P with any section of this Acceptance a shall bc cl�sc for termination and removal of This At:rc ,; �' I ta. cc contains pages 1 through 5 it £ D 4 OF THIS ACCXPTA CE tr. li a 4 ijFrank Z uloaga. RAC 5 jRoofing Product Control Examiner AC CEPTANCE No.: 00 -12 12 .06 T . itnr.cr Chapter 8 .t�i�r - . - �- •_....< <-,��.� Constrttctior,, an ��'�•, :• ° cot •'tarot- � Co n s t complete;y described herein. • h Y Gilding ode Comp.;ancc Office C CO h This NOA (DC shill no: be valid :Dade! or r^a :er, - I after the g • /v , overning the use of . .,• en re commended fo Alternate { de, Qccenta"` the conditions specified rei s and Type ot' :4 of a Mi ami - Dade n , •carton nc •. .r ° :1�tct Y time from da C stated or material tails to b �'e of vac!' perform a.obsitc: or Ks ufactu HC CO reserves , ' in the a rer' plant for etc t product fails mate immediately. ; . ! ,0 to s pen d ttfis determined �� rttanncr. quality 4 ":: din • Code. BCCO that this n ' m rdi atcly, pC r• 8 CC0 may rev y t:ontroy estin c p Product at eserves the evo thi C• i f t i s material fails to e r i ev n „ suspe t a ct ih. r uire ore this� proval i fit �• D _nsc o�'stcch •, R meats et'r1414':._ . • i s •ii A VCr NO. :- Ot -GS2 t n2 me '`rsting v. l he incurred b •�CCt pT by the l- tarrufacturcr. EX!'Jtt -JjaizTllf COVF'i St ;rr-r SF I`l`I4OVFn: n6/14:200! WOO 1 - a•p3teshouc• •ttycine' a p. M`6 «e ••erne• moil oddress: potrelester@butldblecodsontine. earn • Rau' Rodriguez Chief Prcduet Centre! 0 :vision At • NAt, A1iJ` t � AJ�C Cn nF c Cp pe r ja / tic C F OR Sl`F.CIF �r CT EV FtV Y t YIat A►J,� nl CO. :'t•dc Zr� Product � Or ('rC. ��pfov t 11,13 'M1►Tt'1'T i: c ' Rcv�cd .c rov to be been reviewed by he OCCO and b t. used in Miami-Dade • CountY� F.or�d by the Building under the conditions sit t Ile iSC0 1, QUitltnn Director �• R 11,1;amMpnci` Count. Ruiiding Cock Compliance U,Tieu . 1' t $mcpagt Attpy/ "wT Aft MAIt«; cOrry -... ,1► , s. rii<b b licablc building ' h y t;atc code. does 1 All 160. with a r • ns in compliance with not for sin where th pP ov r t,; 't. low Room Ea. patty pl; Czmer....e at:achtn� and a nd high �. . t th II- 7cutstio pro a roof moment s as an uplitt b cd system arc for double m °n1enl b P RODUCT syscci i i sts u Skier; pressor 1i design fit Standa Pol 2. '�' AL'Ltt��nt - Pol yp r oe A H 160 I�oantproe RTr1000 PP :PackS0 3C 4: :CO this Not1c� cturcd by l'ulyfuam x Jrk�nune pike. For the locations '�'!btluc obtained DE SCRIPTIO N NiA N/A Test tcc ocatl^ns Prod PA I 0 f `` D b lem TW0 tor^Ponent P Dispensing Equipment 2.1 Cotttpnnent, u ) A�;i; ttti•p;,d` Cot:�t r Products manufactured by others: 2.2 Ih � c of P ) Roof A .::,tti Y) Itit a1 (+ it:c vi!ves with us Accepted 01 J'ry Al f 160 s r t y ta.:,,� a :;,ran �\ Itysic:r Pro v� f tile sd!, 0.� 1' cry pCrtit s; Density c u Cotnt�res, ire AS TNI01622 1 E Str ASIA 1) 162j 1.-6 IVs /ft,' V �;s :!c t t 8 PSI Pa 'Iel rise S:att� I: � to ^t :snrat;eu AST, p t6,j '8 PSI Per pendicular to r'se Motstt.rc Vapor ^STM 02'27 Q ' Paolo' Lori rr, ;ttsmtsst ^t, ^s��.�r r: �r 1.1 oim n)i Stability ASTM I) 2'26 1:39P ►.c i ar '"N •:).07% vt+lttnh.. tbe t:h;ht IA .4:( -5.0% V1 :out. Chan •.' n 11 ;:iti;tlity. 3 week,: ' ! 711 edd ■ • C t73 ispcasing Equipment !'rank 2 uleags. WIC Product Control Examiner . • A.; gn e Lion using ystem 1 i 1 4. r • , 3.3 , }} ji • ' trig t ot ay^'C1.S ` ho •f 2; R AS 12 0• : Roof Tile manufactures tilt; asS acquir accordance with PA 10' r oof file a, =L 1.\STAL — LATI k� ON '' 1 Polyp ® fists uplift r;O may be used w, • any root tile values used with rile assembly 1.2 Polypro� A H 1 en a with the uS AH section and tr•c Cor- ail �e applied in C of Polypro® ,,H il, � a current 1\ OA a ssembly's ad1; f :all a a l i 1 o mPliancc w ��'' that s;:!1:;,;cn, Cs:�, a:t cement p the Com a.,a -► cnt with the , ails noted herein. 0 sh prov alion de the up!;R res: , �';;►: resistance. cx ° .,se of Poi Tye ro oltile S ar.CC pressed Ypr °e A11 A�p:ica:ron Standards in corn an upl;(? based t60 shat file zssr1►yt ard RAS i ,. Pl;arct; provid 4.3 `OA '• 7hc adhesive Miami -D a s. to mcc; Cr coed >? o� �itcsive at;•lcf d R accordance At 160 -cor .,c County Roc ring . Ic adhesive 3 ! noted Po,yprc "r % N1 Root-ins esive and :ts co^I s in t::c roof a , A:i:;O ppl;cglion $ andard RAS 120 Noncn:5 Shs:� acco dan ^ . Opera:iA l;cat o . :rstalln Pr in rl •: Pr be by d Factory Instruction an , .i�� ? • Y�..dl:l a.._ Sy pc:yfoa ^t Pro,�;,cts• rY Tra; , d Maintenance 13 or c:.,..ts. Inc. aap icat tio . Inc. Pot Qua,rfcd Applicator* app �'S Ca:::,. • o thc d:rtycrit ► yloarn Products lrlc ppr►cator approved a, :v„ ;, ':e =`am r tnslu7sdictio shall su >ard :icetu se n.o;n:ained Cs:vr T. dispensing n. Y a ::;t or approved between ! n c A" is r ot a E de!ivc; 0 0., is component 'c. c' a 1• _ t:oq or :c G 1 �cl,.: (A) : 1 0 ) The di and :� a '31 co mponent a rc,: S1 :a :: be appre per tile CA ' dispense 1 • G f o1 s de :ermined it cal: a Vmer shall t h e i shall Y�ro� MI i GJ tlispcnsins cq : ::pi sh :: be appi'cd with �z:io• `'o other se t J ' ' i �t ''� : roa:np i tit►gs yJ� o?� Alt/ z!rZ:l riot �` c.r r a t 1 f 'IC00 0. proPack posrd rcrnrrnrntl ®30 100 Y Lo suni • 3 e s :, ; r l d w,� sccrion i 1 their tile use cement G M1ih the acceptanc cc 0.4 as modified assemblies shill � � _ ed her � in W 0, , sect with fiat, •o I t compliance W�. • with the . I o i„ cceptance for the ,• use of pot ^ ' cceptanc test in accordance rro es shall e• °rd with P for two the wttl • Padcy P i a Fri 2iitm Prague: Control Examiner C3 M ; ' •r • 160 roof S. LADELING All Polyproft) Alf 60 contair.crs shrill ply with the Standard Conditioni 40 herein. BUILDING PER REQUIREMENT 6.1 As required by :he per Bui!d eva uate the nstall applicable Building Code in order to .y t i ation or this system. t390SES:95. 'ON • 4 Frank beim RAC Product Cantral Exarninef • •:iLC?! 17 A7ddllS Ceti Jd 9L:et t 41 w 'S+ t•oti �tkle. f 4 y` � Mhl f w, t yet C■ t yW 1;lieli4"111111° ‘* q't'r w kia �w : me • - (s.. eft., tam 1 40416 slour M + � Fr i2ut, RAC Proiluct ` Eurnincr. . i_5:1y%c;cc ' ON mil 1 6 . Qucr. M- A7C 3:0g6q :-c Ch ;Ai 7 41' 7dcir _ ' I 410 Prank Zul oara, R1tC Product Control Examiner • t :•, : ' :" . • ;,-, , . . ,,,: ',• ::: , .; . 2h• ,k1 ' .■ . r ' 04-‘ '4.. , 4.. • 1 Rc of this Acceptance. (*pp- 11 bc.c•O' ,.C•i, ' ' .4. I 1 :" sikl, ;be original submitted ' deielUii . ,,,.,-.'1,i, , : i •-, . ing S. ci —... ,. 04.; - .,• 1 • Ohl, than eight 01))vars.• . .,...„4 *. , . •v• 'Ir . . . • 1. _ , ,,./.!..' -. , ..: :., 2 Any aztd au approvcd products snail: .., permanently labeled •%-ith lib: . sta:c. aria the foliowing sta:ernent-".-:',""anu-Dade County Nock:. • : i. - • ! ;' socciCcaily stated in the specitic conditiOn.' ( 4 .. ,...., of this Acceptance. • ,'' t ,...,.„.. , 3. ltcr.euals of Acceptance %v:/1 not be c onsi4red if ../.. . ,I. ., .r, . a 1 L' product and the product is not in ColitPliance %vial the cenie change.: There lets been a c:iartg in the Scitith Florida Buildins Cede a !he evaluatio r .1: n o , Ti e product is no :cn thc $ame priduct (identical) as the one 3-4.:14-.:_,ty approved. d. trcluding the corrc:t ■ nstaltation or die product. le the Acceptance haIdur has no t complied with all the ot this accepta.:ze. s..ibmirtcd. is no lenger practicing the engineering profession. Ti engineer who crial:131.1y prepared. signed and sealed the re:.•:.:. clocumen:atien initi.-...1). el. A.1• rcvisiod Or ChaleC i:: fi'l: Matt:ti415. aJleilor manufactur cr t..,. croduct or procoss s"..c.11 .; bc cause Illf CermiontiOrt or this Acceptance. unless pr:.=, 21---04.1 apprOVal has biZZA S ofEce rcc:cs:ed (t.hrough the f::ing of a rcvasion appLconon with apprepr.:::: grained by th:s - . . Ar. v or a fcllowing &tall z:sa be grounds for removal of this Acceptztz. t• i'l;sat'i:actory perfof inane: or this prcxiuct cr process. ° the:purposes . ‘lisuSe nr this A czcpta.tce as an endorserneut of any produ:: i:-- .:cs, advertts■og or 6 %o ••,. 171.: Net;ce ef Acc,:pianc:: ther preceded by 0: words M iaini-Dae... Z...,. .., Fforida. and fcilo,..c: Accept:vic • disp:ayed 1.1.!.::: s:iall oe ea ;it its eittirely ‘v Lbe exp;r::ion cat,: tv.3). b cisp;ayd in advert:$:1% literature. :r :••••• - :37ion or alo Notic ....f 7. A :371.. 3r ill:s Ae cep:a:::::: as we:: is approved drawiliss and otIK:r dez:1:-._:77.....z, whcrc it a PP li cs , . "-I ' :1•:: joi.) :tc 7.! aPt.litnc er-r..: eng itced r.c; fr:sc31 alc copies. a.: or:I to ule t.s.::. ;..- s. !he ellJnvracturer or its dtscribt.tcrs and shz. : - : rcr inspectio 9 AcczwatIcc :0 C31py iv,:!: scc;i0(.. cr thiS ACcq.:(111Ce SLAil bc Cauz: '.•:.' 2nd rcm:% a: : r 7 :s Nc!. of Accco■zoz.: cor.sists cipages 1 ..hroug: 8. END OF TUIS ACCEPTANCE : Zisiofta. RRC Comr31 Examisi•r. , • . -1• -7 1 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 MIAMI -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. L I description of property and street/address: 33138 2. Description of improvement: R -e-'Ir4 3. Owner(s) name and address: G� �� cL 10 S e ifliCtirU , 19 3)I Interest in property: no11 lNer Name and address of fee simple titleholder: 4. Contractor's name and address: 3315 10 NE: J o a_ 111111111111011111111111111111111111111111111111111111 C O 0 RO5!59770 OR Bk 21508 P9 1165; (1139) RECORDED 08/08/2043 12:16:31 HARVEY RUVi :N, CLERK. OF COURT MIAMI -DADE COUNTY, FLORIDA LAST F'AGE 1n! /( 5.10Q 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: 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: 8. In addition to himself, Owners 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: 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) ti-.2.9— gnature of Owner n Print Owner's Name +ye, Sworn to and subs i :d before m: day of Ul L _■_. Alle AL-wt • i I 0 I 1 ,- WIN ,•_• tlE I.. ' low Notary Public Print Notary's Nam My commission expires: 123.01 -52 PAGE 4 8/02 ,2°( Mabel Vargga� Addr Commission #DD2 1984 xptres: u Atlantic flnnc!i,P ('o . Inc 7 Prepared by QL_) :let. n.6.90as,- 3,32 STATE OF FLORIDA, COUNTY OF DADE 1 HERESY CERTIFY that this is a true c py of the ongmal filed in fhis ofliccon day of , A D 20 ___ 7NESS my hand and Official Seal. I i;.RVEY RUVIN, C) }!C, of Circuit and County Coouns By _ _ c c•i•v•1.1 EN•GhN•EE•R Reliable Roofers, Inc. 1070 Southwest 55 Avenue Margate, Florida Project: Dear Sirs; LG ENGINEERING SERVICES, INC. Consulting Engineers 2020 Northwest 7th Street Miami, Florida 33125 Tel: (305) 649 -6454 Fax: (305) 541 -3298 TILE UPLIFT TEST Morgan Residence 1.01 Northwest 102 Street Miami Shores , Florida Information provided by Client: Permit Number: 50470 (47742) Date Completion: April 16, 2002 Roofing Contractor: Reliable Roofers, Inc. LG Engineering Services, Inc. Project Number: LG02 - 0798 (Testing Laboratory Certificate #00- 0224.07) April 24, 2002 In accordance with your request and authorization, a representative of LG Engineering Services, Inc. completed the Roof Tile Uplift. Test at the above referenced project. This testing was performed in general accordance with Roofing Application Standard RAS No.106 -- Standard procedure for field verification of the bonding of mortar or adhesive set tile system and mechanically attached, rigid, discontinuous roof systems. The total of the tested roof surface area was less than 5000 square feet, and the mean height of .the roof is less than 30 feet above ground surface. The type of tile used for this project was reported to be Hacienda Roof Tile. This tile was reported to have been foamed in place. At the time of this testing, one test for every corner, one test for every 100 square feet of roof tile in the perimeter area and one test for every 200 square feet of roof tile in the field area were tested. Initially the entire area of the roof was examine for loose tile. More than 10% of the roof tile located in the field area and more than 20% of the roof tile at the roof perimeter and corner were physically examined. ti Based on our test results, we conclude that the installation of the roof tile at the above referenced �� ��ti �1a� project meets the test requirement outlined in the above mentioned protocol. Attached please find L I , 0 1 k ,• a copy of our test report for your review. ' V 1,‘ . clrprlijt°Vri LG Engineering Services, Inc. appreciates the opportunity of assisting you in this project. If you have any questions or if we may be of further assistance, please do not hesitate to contact the undersigned. Respectfully submitted; LG Engineering Services, Inc. y /y /n`z G arcia Leo , P.E. Project Manager TILE UPLIFT TEST Morgan Residence 101 Northwest 102 Street Miami Shores , Florida Test Number • •:. ' ' •: • •• ' ..Test•Load:(113f) , • ' :: - ':' .; Test Status 1 35 Pass 2 35 Pass 3 35 Pass 4 35 Pass 5 35 Pass 6 35 Pass 7 35 Pass 8 35 Pass 9 35 Pass 10 35 Pass 11 35 Pass 12 35 Pass 13 35 Pass 14 35 Pass 15 35 ' Pass 16 35 Pass 17 35 Pass 18 35 Pass 19 35 Pass 20 35 Pass 21 35 Pass 22 35 Pass • 23 35 Pass Report of • TILE UPLIFT TEST for Morgan Residence 101 Northwest 102 Street Miami Shores , Florida Project Number: LG02-0798 LO Engineering Services, Inc. -- Tile Uplift Test Result -- Project Number: LG02-0798, Page 1 Test Number Test Load (lbf) Test Status 24 35 Pass 25 35 Pass 26 35 Pass 27 35 Pass , 28 35 Pass 29 35 Pass 30 35 Pass 31 35 Pass • 32 35 Pass 33 35 Pass 34 35 Pass 35 35 Pass 36 35 Pass 37 35 Pass 38 35 Pass 39 35 Pass 40 35 Pass 41 35 Pass 42 35 Pass 43 35 • Pass 44 35 Pass 45 35 • Pass 46 35 Pass 47 35 Pass 48 35. Pass 49 • 35 Pass 50 35 • Pass 51 35 Pass 52 35 Pass LG Engineering Services, Inc. -- Tile Uplift Test Result -- Project Number: LG02-0798, Page 2 Test Number Test Load (ibt) Test Status 53 35 Pass 54 35 Pass 55 35 Pass 56 35 Pass 57 35 Pass 58 35 Pass 59 35 Pass 60 35 Pass 61 35 Pass 62 35 Pass 63 35 Pass 64 35 Pass 65 35 Pass 66 35 Pass 67 35 Pass 68 35 Pass 69 35 Pass 70 35 Pass 71 35 Pass 72 35 Pass 73 35 Pass 74 35 Pass 75 35 Pass 76 35 Pass 77 35 Pass 78 35 Pass 79 35 Pass 80 35 Pass 81 35 Pass LG Engineering Services, Inc. -- Tile Uplift Test Result -- Project Number: LG02-0798, Page 3 Test Number Test Load (lb Test Status 82 35 Pass 83 35 Pass 84 35 Pass 85 35 Pass 86 35 Pass 87 35 Pass 88 35 Pass 89 35 Pass 90 35 Pass 91 35 Pass 92 35 Pass 93 35 Pass 94 35 Pass 95 35 Pass 96 35 Pass 97 35 Pass 98 35 Pass 99 35 Pass 100 35 , Pass 101 35 Pass 102 35 Pass 103 35 Pass 104 35 Pass 105 35 Pass 106 35 • Pass 107 35 Pass 108 35 Pass 109 35 Pass 110 35 Pass LG Engineering Services, Inc. Tile Uplift Test Result -- Project Nu r: LG02-0798, Page 4 Test Number Test Load (lbf) Test Status 111 35 Pass 112 35 Pass 113 35 Pass 114 35 Pass 115 35 Pass 116 35 Pass 117 35 Pass 118 35 Pass 119 35 Pass 120 35 Pass 121 35 Pass 122 35 Pass 123 35 Pass 124 35 Pass 125 35 Pass 126 35 Pass 127 35 Pass 128 35 Pass 129 35 Pass 130 35 Pass 131 35 Pass 132 35 Pass 133 35 Pass 134 35 Pass 135 35 Pass 136 35 Pass 137 35 Pass 138 35 Pass 139 35 Pass LG Engineering Services, Inc. - Tile Uplift Test Result -- Project Number: LG02 -0798, Page 5 Test Number Test Load .PO Test Status 140 35 Pass 141 35 V Pass 142 35 Pass 143 35 Pass 144 35 Pass 145 35 Pass 146 35 Pass 147 35 Pass 148 35 Pass 149 35 Pass 150 35 Pass 151 35 Pass 152 35 Pass 153 35 Pass 154 35 Pass 155 35 Pass 156 35 Pass 157 35 Pass 158 35 Pass 159 35 ' Pass 160 35 Pass 161 35 Pass 162 35 Pass 163 35 Pass 164 35 Pass 165 35 Pass 166 35 Pass 167 35 Pass 168 35 Pass LG Engineering Services, Inc. -- Tile Uplift Test Result -- Project Number: LG02 -0798, Page 6 Test Number Test Load (lb° Test Status 169 35 Pass 170 35 . Pass 171 35 Pass 172 35 Pass 173 35 Pass 174 35 Pass 175 35 Pass 176 35 Pass 177 35 Pass LG Engineering Services, Inc. -- Tile Uplift Test Result -- Project Number: LG02-0798, Page 7 North ± 6q' 4f? /1/3 PIZ 4 #10 pa t 9 31 34 3S 3y 33 3i 38 /J9 1SY bz 4s� 14-o 0 f3q /43 /'al/ /3 ± 53 /6.7 Mt 10e 85 ,63 /0V 28 44 /FS' /AF 8 � 'ti 30 ill /6} 8} 1 88 w x /'1.1 /36 iz le 1 / 5' /d (t /21 /29 i' 1( 1 130 of l3L 1 2 1 3 144 16 18 9Y fib �y Approximate Test Locations LG Engineering Services, Inc. -- Tile Uplift Test Result -- Project Nunzber: LG02 -0798, Page 8 Permit No.-_ Disapproved (Signed) MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby wade 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. 4 /� p �� Date... _....__... .._._.._......_._..._._ g 1 Owners Name and Address (1 Q y e �a C erzo .: _ ._ No./ €97 , V4 , -) Street_Z0 Registered Architect and /or Engineer :,.. . ........ .. .............:.,..,-,,,.,.. Name and address of licensed contractor. 4 eS CRLiGo As'e "� �� 0, / afe .... - .l�'.�........_.._..__ Location and legal description of lot to be built on: Lot Block Subdivision _. Street and Number where work is to be done l D1 � ._ / o 7 > State work to be done and purpose of building by floor ) c*-11-7 `O� f Lam/ New Building Remodeling Addition To be constructed of Kind of foundation Estimated Total cost of improvements $ 7 %`!© 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 \Vorkmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Sup )lenient, 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 wprk to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed Building Inspector Date.... Al Date .._......... and for no other purpose. Repairs' No. of Stories Roof Covering.. q/' ' y 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 him stated are true. Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires to me well known, PLANNING BOARD DATE Chairman Member \1crr,bcr 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 hecn obtained from the Planning petard. A re 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. APPLICATION FOR BUILDING PERMIT Application is hereby nude for the approval of the detailed state:w nt in toe plans and specifications herewith submitted for the build • inc or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores ViI1. gc, 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 progreu of the work. D ate..._...__. Owner's Name and Address ....... E 7. /lg 4/0 ._. No.... Street..2 !" ..._ST Registered Architect and /or Engineer Name and address of licensed controctot Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done / NE /oZ sr State work to be done and purpose of building (by floors N / e6F .._ 317 J- 5 n CE STATE OF FLORIDA, COUNTY OF DADE. } ss. Disapproved Date (Signed) NOTE: A charge of $1.00 will be made for the I'I.rnnir.g Board. A re- inspection fee of 31.00 will be charged materials anti /or workmanship. Citair:nan Ucrr,ber Isicmber .. .. _....._..._._...._ Council Approved Date MIAMI SHORES VILLAGE Building Inspector BUILDING INSPECTION DEPARTMENT C��c�' i 111 Roefbv f. Co., 1 c. —3/ N w 7 / _..sT�...�1�1�n! Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- _ —. to me well known, New Building Remodeling Addition Repairs ✓ No. of Stories / _ To be constructed of Kind of foundation Roof Covering 7/Le Estimate Total cost of improvements $ &.5 GO (.... Amount of Permit S. ,)0' GU 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 dots hereby certify that he understands and accepts his obligations as an employer of labor under the Florida \%'orkmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, anti has complied with the provisions thereof, and will require similar compliance Frorn 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 noticcs as arc required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) and for no other purpose. 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. /° Date C Read, Sworn to and Subscribed before me. PLANNING BOARD DATE r Notary Public, State of Florida My Commiuion Expires __._..._.._ ..�..._..— Member Member Member ._ Disapproved Date making corrections or changes to this application after approval has been obtained frrnn when such re- inspection is made necessary by improper notice for inspection or faulty BUILDING ❑ ELECTRICAL ❑ PLUMBING ❑ ROOFING } ❑ Owner of Building r ' Architect Contractor or Builder Legal Lot Description — �' Bi Address of Building CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA DATF PERMIT N° 6341 Work to be performed under this 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 application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough k fledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specification and that he assumes responsibility for work done by his agents, servants or employees. Signed. INSPECTOR Subdi- vision Value of Project $ Contractor's License No. .a-, ""` Amount of Permit $ - 195 BY In consideration of the issuance to me of this permit I agree to perform the work coverQd N 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 ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY 6 �a:R ";s A Owner's Name and Address. Name and address of licensed contractor.___.e ? v c .L — 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 iuilding 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..f" ) (�,( „ 19 57 No..JO/ /61..x Street I4 . -.del, Registered Architect and /or Engineer Location and legal description of lot to be built on: Lot Block Subdivision ��c' Street and Number where work is to be done /0_, _M • 102- ! State work to be done and pur� building ("floors�- e°7' 74”. "/ and for no other purpose. New Building Rernodeling. Addition Repairs No. of Stories To be constructed of Kind of foundation j Roof Covering Estimated Total cost of improvements $ /0000 .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 5968, 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. ��QQ Remarks (Signed).. '71 1 .4- STATE OF FLORIDA, f COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared and who, bein g of the above therein by him Permit No Disapproved (Signed) 3 ✓ ss. Date Q 1— 1 ' Read, Sworn to and Subscribed before me. Date 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 Builditg Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re inspection fee of 81.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.