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350 NE 102 St (3)LG ENGINEERING SERVICES, INC. Consulting Engineers North Office: 7370 N.W. 36m Street Suite 100 -C Miami, Florida 33166 Mike Wilson Roofing 870 Northeast 122 Street Miami, Florida Project: Dear Sirs; South Office: 13380 S.W. 131 Street Suite 120 Miami, Florida 33186 Tel: (305) 994 -8128 Fax: (305) 994 -8135 TILE UPLIFT TEST Larkin Residence 350 Northeast 102 Street Miami Shores, Florida 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 Protocol PA 106 -94 -- Field static uplift test for mortar or adhesive set tile systems and mechanically attached, rigid, discontinuous roof systems. The total of the tested roof surface was less than 5000 square feet, and the mean height of the roof is less than 15 feet above ground surface. The type of tile used for this project was reported as Monier Double Roll Roof Tile. This tile was also reported to have been foamed in place. At the time of this testing, a total of forty -five (45) tests were conducted; ten (10) at the roof perimeter, ten (10) at the roof corner and twenty -five (25) at the roof field area. More than 5% of the roof tile located in the field area and more than 10 % of the roof tile at the roof perimeter were physically examined. Bisect on our test: results, we conclude that;the installation of t roof the at the above :referenced ................................................................................................................................................................................................................... ............................... project m eets the test requirements outlined: in the; above: mentioned protocol Attached; please: find a copy of our test. report for yoff review.. Information provided by client: Permit Number: 41534 Date Completion: August 12, 1997 Roofing Contractor: Mike Wilson Roofing LG Engineering Services, Inc. Project Number: LG97 - 0713 (Lab # 95- 0607.05) c.1•V•1•L • August 15, 1997 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 Engineerin 3ervic . Inc. TILE Larkin Residence 350 Northeast 102 Street Miami Shores, Florida Report of TILE UPLIFT TEST for Larkin Residence 350 Northeast 102 Street Miami Shores, Florida Permit Number: 41534 Test.Number 1C 2C 3C 4C 5C 6C 7C 8C 9C 10C 11P 12P 13P 14P 15P 16P 17P 18P 19P 20P 21F 22F 23F Test Load (lb 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 Test Status Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass LG Engineering Services, Inc. -- Tile Uplift Test Result — Permit Number: 41534, Page 1 ;Test Number 24F 25F 26F 27F 28F 29F 30F 31F 32F 33F 34F 35F 36F 37F 38F 39F 40F 41F 42F 43F 44F 45F C.est. Load (Ibfj 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 35 *St Status., Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Note:- C = Corner P = Perimeter F = Field area LG E .... ... Inc. .:.:::. .: � PeNmber:4154 ngineering Services, Tile Uplift Test Result Permit Number: 3 , g North 65 7' ^og 4-c( 14 41.• 4t tb 4 • ;( 11 .D c / 7 2 74 / "tb / • "91 Nrk 17( /fh ( ( I tO 40 ' proximate Test Location • LG Engineering Services, Inc. — Tile Uplift Test Result — Permit Number: 41534, Page 3 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date /5/ 7 Job Address 35 Vim Boa s- Tax Folio Legal Description Historically Designated: Yes No .1/ Owner/Lessee / Tenant /YR . 7 �1 S. L A - /1 — /' %/✓ Owner's Address '-� 7 /U /a a A.Ae 5-/ - Contracting Co. M 1 Qualifier Az State # 64-6 & 4/70;5 Municipal # Architect/Engineer Bonding Company Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICA S /✓� WORK DESCRIPTION ♦ / /2-a90 &G 4 i//b( 1/1€e 122/ &' / 7ddeze4 7//e.g. Qev.4 Square Ft. � j /VC/. ‘ / S Q 4 s • Estimated Cost (value) it 7 a ev• . e 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- worland installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standa>is of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUM TG, SIGNS, POOLS, ROOFING and MECHANICAL WORK. ;fir ;P;F'E. k'4`L'« OWNERS AFF Viirtca rlif3ziiiii,TAIFitie foregoing inft oration is accurate and that all work will be done in compliance with all applicable laws regulating y ip crion aha . ' ui'therulore, I authorize the above -named contractor to do the work stated. POJ 1 r 'W ,.. i .C'� • t tDirw�"s lDGM f. ,C 6/ /47, :. ondo " I)afe Signature Hof owne;,.and/or. i; ww Notary as_o O :. •., •! My Corrissi. c4W a o a putt } • • ii s'i eiA . este r E vtu.) trig DD ltieseni�Y _ e taffnriTi" 770- 7,40 FEES: PERMIT t 7 RADON APPROVED: Zoning Mechanical Buildin • C.C.F. b l� _ _ / Phone 653-r 94/ 7 .6 Competency # Address Address otary as to Contractor or Owner - : uilder Date My Commission Expires: S ti M1Cb +, I. WILSON ^ e3 q Ex . . 'I .J X ID PSmiM itIEFA MOT l &i. `l,w Master Permit # `- I� 5 3 .1.4 Phone — 7.T ( 7 /— * 5G'G ? Address /Do107/ $ & /!� 51" /IiMt; NOTA ' Y Electrical Ins. Co. BOND • 06/g der Date 6114 7 TOTAL DUE 7- Plumbing Engineering NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street address: .��d � ., ' • �c'/ ,a.fae S % 9e2 7 7, 74 i sWeee'S 33/38 644.4. Q. Signature of owner Print Owners Name Sworn to and subscribed before me thi Notary Public Print Notary's Name My Commission Expires: 978267240 1997 JUN 16 11:10 2. Description of improvem nt: //a—/Ge2 3. Owner(s) name and address: 1D4-1 4. Interest in property: Al e' , / rJdJ' ./2.'S _ Name and address of fee simple titleholder: 4. Contractor's name and address: 4e:G2-e � .��/-- s'1��'l�� g ?d .CJ.C% /a2 (/ .t!%i1- -= 2 a /A r. 5. Surety:(Payment bond required by owner from contractor, if any) Name and address: M/4. Amount of bond $ A/1,4 6. Lender's name and address: A//4 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, y v/ Name and address: /`� / • 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: • ' 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) G&/ ..w.•'f_trn•• •'�«!•;• +:;, ": : t :i .' wan 0 meLim • : a S,0slr.tod fay Semi= Ins CC 22 t1owIa %CAA STATE OF FLORIDA, COUNTY OF DADE �. HEREBY CERTIFY that this is a f u c of Alb N this office on ( orrirgurtr - in O. 19 •end and official Seal. IN CLERK, of Circuit and Count, CO" !tom L ��'�i, ( Prepared by: s' .�i e ,;Address: 874 6-7. / S'- ,fi Ai/ 44-4--i; / e,/et / 4 33 /6 ! . 12ao1 -52 2/93 1 Costractor's Name: /C./ cam. Ca.-7 .1 0 I❑ (Low Slope Application) l ❑ (Asphalt/Fiberglass Shingles) Flat Roof Area (ft') Sloped Roof Area (ft') 4.2/610 Total (R') al/ ADD Master Permit No. Explains category (per ASCE 7 -88): Building Classification category (per ASCE 748 tabk 0: Ft. Appendix "E" UNIFORM ROOFING PERMIT APPLICATION PROCESS No. ROOF TYPE ❑ New Roof tW c- roofing ❑ Recovering ❑ Repair ❑ Maintenance ROOF HEIGHT AND SYSTEM DETAJLS (Draw desalts es needed) A TT ACHMENT DETAIL 1 & 2 ROOF CATEGORY ❑ (Nail-On Tile) ❑ (Mortar -Set Tile) ❑ ( Meal RoofsMood Shingles & Shakes) ❑ (Other) Job Address: 356 /e �� ere A a" Fastener Type: (/f /, i, a� )odd ./ . i gecr SPACING e.4� Feld: 4' Perimeter: 4/ Corner: 4/1/ z 1c.` —i — 7` SLOMMINIQUElialignitt 50F F r (/c , 7 fA 7 rvu aJ 6 « 4.1 DETAIL i (P I: 7Z 3 s X (Amidounla UL). ) - (Part temape resew w•r 1.4 ) - (?I: 1 2 3 s A (Aw dp1um s wr .g r ) • r MILCAMILATIONS l'iS )- M..- I Z f J PcA; y ° Me' t11,—f .»?CA //9. Page ADats s ** sE s r:40 0 #'44V. ,4 - n, y, : SAL • Dd . /i X 2 1 4 . to ?t 7., no. ATTACIDWITS REQUIRED 1) 1r Dicer Lire Pip 2) Dr a Corti►!1aar Oral Neer of A swessi .Com Sleet e) *milk 3 barepoioa b) 8'eciiic Symms Limeindor e) Oared liimose 4 Applicable Dead Drew*. 3) Mmeidnef i it Appiiesiioa 4) Omer meat Appear • Me 1"f1OUADE U S2JLUC1' CO N'1'1 1.11.01LC_E °ILA C_c ITIA Cr lvlonicr, Inc. 1900 Northwest 21st Avenue Fort Lauderdale, Florida 331 1 1 Acceptance No.: _j5- 9122,1),1 Revises No. .15 93QidLL Ix, i t es: ' JR 1 8 1993 Approved: 1 °111. 1 8 1995 PUILr)1Nc _CD 1)i NAME This application for Product .Approval has been reviewed Compliance Dcparlmcnt and approved by the Building Codc C the conditions set forth above. METROPOLITAN DADE COUNTY. rLOr11DA MIS 111U1/AUI: ft_AUt-tl 1 WILDING (WILDING CODE COMPLIANCE DEFAf1TMENT SUITE 1130) ME111O -DAVE rLAOLEnn UUILU1140 110 WEST rLAOIEr1 STiIEET MIAMI. rLoruoA 33130.1503 (305) 375.2901 FAX (905) 376.2900 Your application for Product Approval of: Monier Nail -Orl, Illorlar Set or Adhesive .S'ett Roofing Tile under Chapter 8 of the Metropolitan Dade County Code governing the use of Alternate Materials and Types of Construction, and completely described in the plans, specilications and calculations as submitted by: Redlanrl Technologies, The Center for Applied Engineering, Inc., and Professional Service Industries has been recommended for acceptance by the Building Code Compliance Department to be used in Dade County, Florida under the specific conditions set forth on pages 2 through 17 and the standard conditions set forth on page 18. The approval shall not be valid oiler the expiration date stated below. The 1uilding Code Compliance Office reserves the ight to secure this product or material at any time for a jobsite or manufacturer's plant for quality control teslin ,. If this product or material fails to perform in the approved manner, the Building Code Compliance Office may evoke, modify or suspend the use of such product or material immediately. The applicant shall re- evaluate this product or material should any amendments to the South Florida Building Code be enacted affecting this product or material. The luilding Code Compliance Office reserves the right to revoke this approval, if it is determined by the !Wilding Code Compliance Office that this product or material fail; to iret the rcrinircntcnts of the South FIoi ida Building Code. •I he expense or such testing will be Merin }'i(1ry llr nr t 1acty cr. taut Rodriguez. Product Control Supervisor • ' I I S 1 S_1l! I: C Q Ens Liu: S t� niO _LAG %5 l =() It ,SL' 1w_C1.L1C_ ABILi:1:, [YE1tAL CAIN 11.1310 :hc Metropolitan Dade County Building Code .niltce to be used in Dade County, Florida under Charles Danger. 1'.1:. Director !Wilding Code Compliance Dept. Metropolitan Dade County Applicant: Monier Roof Tile 1900 Northwest 21st Avenue Fort Lauderdale, FL 331 1 I PRODUCT CONTROL NOTICE OF ACCEPTANCE ROOFING SYSTEM APPROVAL Category: Prepared Roofing Sub - Category: Low Profile Tile -LXRe: Nail -on /Mortar Set/Adhesive Set Sub-Type: • Concrete System Description, Monier Roof Tile is a member of the Redland Group, a world wide producer of primary building products and roof tile. Monier manufacturers concrete roof tile for nail -on, mortar set or adhesive set applications in plants throughout the United States ranging from Washington State to Florida. All tile is manufactured from extruded concrete consisting of Portland Cement, plasticizer, iron and metallic oxides, and blended aggregates. This Product Control App.rovaLtdltes to Monier's W," IQw the profile. Refer to appropriate Product Collin/AMA/bib for otlictlile profiles. Monier sells tile systems through local distribution and directly to consumers. All profiles have matching trim pieces used for rake hip, ridge hip, and valley terminations. Tile system accessories such as underlayment, ventilation systems and flashing systems are also available. These accessories are manufactured for all profiles and form a part of this Product Control Approval. Monier's "Roll" roof tile has been tested in compliance with the South Florida building Code requirements for concrete, nail -on, mortar set and adhesive set tile applications. The minimum roof slope for Monier's "Roll" nnil -on, mortar set or adhesive set tiles shall be 2 ":12 ". See the "Profile Drawing" section in this Approval for the "Roll" profile drawing. The Monier "Roll" tile profile has been tested for both wind characteristics and static uplift performance, therefore, any consideration for installation shall be done as a 'Moment Based System'. Data for attachment calculations is noted in Tables 1 through 4 of this Approval. Contact: Reese I1. Moody Technical Service Accessories Manager 1900 NW. 21st Avenue Ft. Lauderdale, FL 33311 (800)432 -2715 a 2 Product Control No.: 95- 0322.03 'JUL 1 0 1995 rout 1 0 19_9_0 Approval Date: Expiration Date: Raul Rodriguez Test Product Product Dium1sio s SacciLcatiQttt LsssriRlisltl Monier Roll Tile I = 16V" PA 112 Low profile, interlocking, high w = 13" pressure extruded concrete roof tile '''A" thick equipped with two nail holes and double roll ribs. For direct deck or battened nail -on, mortar or adhesive set applications. Trier Pieces TRADE, NAMES Or PRODUCTS MANUFACTURED OR LABELED BY APPLICANT 1= varies w = varies varying thickness PA 112 3 Raul Rodriguez Accessory trim, concrete roof pieces for use at hips, rakes, ridges and valley terminations. Manufactured for each tile profile. Product Control No.: _95 U22.03 Test Product Product Lthny. tsions Specilicationi L)cscriltlin Nlant 1130 Felt • N/A ASTM U 226 Saturated organic felt generic type II to be used as a nailed anchor sheet. 1143 Coated Base N/A ASTM D 2626 Saturated and coated Sheet organic base sheet for single or double ply underlayment. Mineral Surface Cap Sheet TRADE NAMES OF PRODUCTS MANU! AciURru'OTIIins N/A ASTM D 249 Mineral surfaced asphalt roll roofing for use as a top ply in a double ply underlayment system. Product Control No.: 95-0322,03 generic generic Lenzingtex -7_f3 140 59" x 164' roll PA 104 Single ply, nnil -on Lenzing Underlayment 22 Ibs /roll underlayment. Performance, Inc. with current PCA Rainproof 11 30" x 75' roll PA 104 Single ply, nail -on Protect -O -Wrap, Inc. 36" x 75' roll underlayment with 2" with current I'CA or self - adhering top 60" x 75' roll edge. Ice and Water Shield 36" x 75' roll PA 103 Self - adhering W.R. Grace Co. underlayment for use with current PCA as a top ply in a two ply underlayment system with Approved 1130 or 1143 as the base layer. Mopping Asphalt N/A ASTM D 312 Asphalt for bonding a type III or IV mineral surface cap to a mech. attached base sheet in a double ply undcrlaymetit system. Flashing Cement N/A ASTM D 4586 Cut back, asphalt based, asbestos free, fiber reinforced, trowel grade cement for repair and flashing applications. 4 Raul Rodriguez generic generic 'Pest Product rEtittt!c1 Wins Specific ilinl$ 1?sssti li(111 l titltf'Lctus_r Asphalt Primer N/A ASTM D 41 Cut back, asphalt generic based coating used to facilitate bonding of dissimilar materials. Roofing Nails Tin Caps Wood flattens 'File Nails 'file Screws Roof Tile Mortar ( "'fileTiteTM ") min. 12 ga. with ' /," head min. 32 ga. inin. I'/," o.d. max. 2" o.d. vertical min. 1" x 4" ilodz! ntal min. I" x 4" for use 1Vitlt Vertical battens Or MM. 1" x 2" for use alone Min. 8d x 21/2" or min. IOd x 3" PA 114 Appendix E PA 114 Appendix E Wood Preservers Institute LP - 2 PA 114 Appendix E Roof Tile Mortar N/A PA 123 (" Ouikrcte(1 Roof Tile Mortar 1/1140") Product Control No.: 9i_0322,03 Annular ring shank, hot dipped, electro or mechanically gnly. roofing nails lnr use in underinyrnent attachment. Corrosion resistant circular disc for use in urtderlayment attachment Salt prc;snrc heated or decay resistant lumber battens Corrosion resistant, screw or smooth shank nails. 118 x 21/2" long PA 1 1 ' Corrosion resistant, 0.335" head dia. Appendi coated, square drive, 0.131" shank dia. galvanized, coarse 0.175" screw thread thread wood screws diameter N/A PA 12 Prepared mortar mix Bermuda Roof designed for mortar Company, Inc. set roof tile with current PCA applications. Prepared mortar mix Qtiikrete Constructio dcsilmcrl for mortar Products set roof tile with current I'CA applications. 10111 Rodrittucz generic generic gone is generic generic Test Product Product Dinteitsions Spsssfissljonz DescrjRtion Malwtlastann Roof Tile Mortar N/A PA 123 Prepared mortar prix W.R. Bonsai Co. ( "13ONSAL® Roof designed for tnortar with current PCA Tile Mortar Mix ") set roof tile applications. Roof Tile Adhesive ( "Polypro® A11160 ") Valley Flashing Drip Edge N/A See I'CA Two component Polyfoam Products, polyurethane adhesive Inc. designed for ndhesive with current PCA set roof tile applications. Ilurricnne Clip & Cjjp PA 114 Corrosion resistant Fasteners min.'''/" width Appendix E bronze, aluminum, min. 0.060" thick stainless steel, galvanized steel or Cain_Eit lgtlea plastic attachment .. min: 8d x 1'Y4" clips for supplemental tile attachment. Clips are installed with corrosion resistant roofing nails compatible with the clip. A hurricane clip is required on all nail on eave tiles. min. 26 ga. ASTM A 525 Galvanized steel generic min. 16" width valley flashing min. 26 ga. PA I I 1 Galvanized steel drip generic min. 2" face flange edge min. 2" deck flange 6 Raul Rodriguez Product Control No.: 95- 0322.0 generic Test Agency. 1'cs iEd1lifkr Redland Technologies 7161 -03 Appendix 111 Redland Technologies 7161 -03 Appendix III The Center for Applied 94 -084 Engineering, Inc. The Center for Applied 94-06013 Engineering, Inc. • • The Center for Applied 25-7094-1 Engineering, Inc. The Center for Applied 25- 7094 -7 Engineering, Inc. The Center for Applied 25- 7094 -4 Encinecring, Inc. The Center for Applied 25- 7183 -1 Engineering, Inc. The Center for Applied 25- 7183 -2 Engineering, Inc. The Center for Applied 25- 7214 -2 Engineering, Inc. TEST REPORTS 7 Raul Rodriguez Product Control No.: 95- 032 ?,0 Test Nit icLRRcgort Static Uplift Testing PA 102 Stntic 13plift Testing Dec. 1991 I'A 102(A) Stntic Uplift Testing PA 101 (Mortar Set) Static Uplift Testing PA 101 (Adhesive Set) Stat Uplift Testing PA 102 (4" I Ieadlap, Nails, Direct Deck, New Construction) Stntic Uplift "Testing PA 102 (4" Ilcadlap, Nails, Battens) Static Uplift Testing PA 102 (4" Ilcadlap, Nails, Direct Deck, Recover /Reroof) Static Uplift Testing l'A 102 " 'luik -Drive Screws, Direct Deck) Static Uplift Testing PA 102 (2 Quik -Drive Screws, Battens) Static Uplift Testing PA 102 (1 Quik -Drive Screw, Direct Deck) Lnlsi Dec. 1991 May 1994 March, 1994 Oct. 1994 Oct. 1994 Oct. 1994 Feb. 1995 Feb. 1995 March, 1995 Tcst Age The Center for Applied Engineering, Inc. Redland Technologies Tsst Identified 25- 7214 -6 7161 -03 Appendix I1 8 Product Control No.: 95 -032 0L. 7ssLdalttsIflep iLt Dalt Static Uplift Testing March, 1995 PA 102 (1 Quik -Drive Screw, Battens) Wind Tunnel Testing PA 108 (Nail -On) Redland 'Technologies Letter Dated Aug. 1, 1994 Wind Tunnel Testing Aug. 1994 PA 108 (Nail -On) Redland Technologies 1'0631 -01 Wind Tunnel Testing July 1994 PA 108 (Mortar Set) Redland Technologies PO402 Withdrawal Resistance Sept. 1993 Testing of screw vs. smooth shank nails The Center for Applied Project No. 307025 Wind Driven Rain Oct. 1994 Engineering, Inc. Test IIMDC -76 PA 100 Professional Service 224 -47099 Physical Properties Sept. 1994 ......t. ies, Inc. PA 112 Raul Rodriguez Dec. 1991 Deck Type: Wood, Non - insulated S YSTEMS Deck Description: New Construction 19 /, 2 " or greater plywood or wood plank. SYSTEM A: Counter- I3atten Application Product Control No.: 9S Q32193 Slope Range: 2":12" to 7 ":12" Note: Counter - flattens, Its noted below, me required for slope range 2 ":12" to less than 4 ":12" and are optional for slopes of 4 ":12" to 7 ":12 ". For slopes exceeding 7 ":12 ", refer to System C. Underlayntent: Install underlayntent system in compliance with Dade County Application Standard PA 118. Vertical Battens: Install vertical battens in compliance with Dade County Application Standard PA 118 Horizontal flattens: Install horizontal battens in compliance with Dade County Application Standard PA 118. Roofing Tile: Install tile in compliance with Dade County Application Standard PA 118. (See "Data for Attachment Calculations" included in this Approval.) Comments: 1. For re- roof applications, r ' / plywood is an acceptable substrate. 9 Raul Rodriguez SYSTEMS (CONTINUED) Deck Type: Wood, Non - insulated Deck Description: New construction 19 / „” or greater plywood or wood plank. SYSTEM 13: Direct Deck Application Product Control No.: 95 Slope Range: 4 ":12" to 7 ":12" Note: System 11 is only acceptable in this slope range. For slopes Tess than 4 ":12 ", refer to System A. For slopes in excess of 7":12", refer to System C. Underlayment: Install underlayment system in compliance with Dade County Application Standard PA 118. Roofing Tile: Install tile in compliance with Dade County Application Standard PA 1 18. (See "Data for Attachment Calculations" included in this Approval.) Comments: I. For re -roof applications, r ' / „” plywood is an acceptable substrate. .ti 10 Raul Rodriguez SYSTEMS (CONTINUED) Product Control No.: _25- 0322.03 Dccic Type: Wood, Non - insulated Deck Description: New construction 19 / „” or greater plywood or wood plank. SYSTEM C: Horizontal Batten Application Slope Range: 4 ":12" or greater Note: Horizontal battens, as noted below, are required for slopes in excess of 7 ":12" and are optional for slopes of 4 ":12" to 7 ":12 ". For slopes less than 4 ":12 ", refer to System A. Underlayment: Install underlaynrent system in compliance with Dade County Application Standard PA 119. Horizontal Battens: Install horizontal battens in compliance with Dade County Application Standard I'A 119. Rooting 'Tile: Install tile in compliance with Dade County Application Standard PA 119. (See "Data for Attachment Calculations" inclnded in this Approval.) Comr:- 1. For re -roof applications, "/„" plywood is an acceptable substrate. Raul Rodriguez Undcrlaymcnt: Roofing Tile: Continents: SYSTEMS (CONTINUED) Deck Type: Wood, Non - insulated Deck Description: New construction " / „” or greater plywood or wood plank. SYSTEM D: Mortar or Adhesive Set Application Product Control No.: 95- 0322,Q Slope Range: 2 ":12" to 7 ":12" Note: System D is only acceptable in this slope range. For slopes in excess of 7 ":12 ", refer to System C. Install underlayment system in compliance with Dade County Application Standard PA 120. (See System Limitation 115.) Install tile in compliance with Dade County Application Standard PA 120. (See "Data for Attachment Calculations" included in this Approval.) 1. For re -roof applications, "i plywood is an acceptable substrate. 12 Raul Rodriguez SYSTEM LIMITATIONS 13 Raul Rodriguez Product Control No.: 95- 0322.03 1. The standard minimum roof pitch for Monier's "Roll Tile ", low profile tile shall comply with Dade County Application Standards PA 118, PA 119 or PA 120, depending on the method of installation. 2. 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 this Product Control Approval. The method of attachment utilized shall provide sufficient attachment resistance expressed as a moment to meet or exceed the required moment of resistance determined in compliance with Dade County Protocol PA 115 or PA 127. The Monier "Roll Tile" tile profile has been tested for both wind characteristics and static uplift performance, therefore, attachment calculations for installation in compliance with PA 115 or PA 127 shall be done as a 'Moment Based System'. 4. For mortar or adhesive set tile applications, a field static uplift test by a Dade County accredited testing agency, in compliance with Dade County Protocol PA 106, shall be performed. 5. For mortar set tile applications, 30/90 hot mopped underlayment applications may be installed perpendicular to the roof pitch unless stated otherwise by the underlayment material manufacturer's published literature. 6 A" ';! shall bear the imprint or identifiable marking of the manufacturer's name or logo for identification in the field. 7. Applications for roofing permits shall include a completed Section 11 of the Uniform Building Permit, a copy of Monier's current specifications and details, a copy of this Product Control Approval and a copy of the Product Control Approval of any Roofing Component used in the proposed tile application. Reference shall be made to appropriate data for the required fire rating. 8. The applicant shall retain the services of a Dade County certified testing laboratory to maintain quality control in compliance with the South Florida Building Code and related protocols. Samples taken shall be in compliance with Dade County Protocol PA 112, Appendix 'A'. 9. Any amendments to these provisions shall be in compliance with Sections 203 and 204 of the South Florida Building Code. r • Monier Roll Tile Tile Profile • DATA FOR ATTACHMENT CALCULATIONS Table 1: Aerodynamic Multipliers - X (ft') X (ft') Batten Application 0.2.7 Product Control No.: 95 y,_ X (ft') Direct Deck Application 0.29 z iltt a 3 tle headlap. Approved screws are as noted in the Trade Names of Products Manufactured By Others' and 'Profile Drawings' sections of this Approval. Clips on cave tile are not required for this attachment configuration unless the Required Moment of Resistance exceeds the values noted above. 1 4 Raul Rodriguez Table 3: Attachment Resistance Expres•. A as a Moment - M, (ft -Ibf) for Nail -On Systems' Tile . Profile Tile Application Approved Nails Approved Screws' Approved field Clip With: Approved Eave Clip With: 1 nail 2 nails 1 screw 2 screws 1 nail 2 nails 1 nail 2 nails Monier Roll Tile Battens 4.10 7.10 22.90 49.10 24.20 34.80 22.10 32.20 Direct Deck 11.80 21.90 25.80 47.10 24.30 35.50 19.00 31.90 r • Monier Roll Tile Tile Profile • DATA FOR ATTACHMENT CALCULATIONS Table 1: Aerodynamic Multipliers - X (ft') X (ft') Batten Application 0.2.7 Product Control No.: 95 y,_ X (ft') Direct Deck Application 0.29 z iltt a 3 tle headlap. Approved screws are as noted in the Trade Names of Products Manufactured By Others' and 'Profile Drawings' sections of this Approval. Clips on cave tile are not required for this attachment configuration unless the Required Moment of Resistance exceeds the values noted above. 1 4 Raul Rodriguez Table 2: Restoring Moments clue to Gravity - M (ft -Ibf) Tile 3 3 ":12" 4 4 ":12" 5 5 ":12" 6 6 7 7 ":12" or Battens D Direct B Battens D Direct B Battens D Direct B Battens D Direct B Battens D Direct Monier Roll 5 5.92 6 6.80 5 5.82 6 6.69 5 5.70 6 6.55 5 5.56 5 5.39 5 5.41 6 6.22 • Monier Roll Tile Tile Profile • DATA FOR ATTACHMENT CALCULATIONS Table 1: Aerodynamic Multipliers - X (ft') X (ft') Batten Application 0.2.7 Product Control No.: 95 y,_ X (ft') Direct Deck Application 0.29 z iltt a 3 tle headlap. Approved screws are as noted in the Trade Names of Products Manufactured By Others' and 'Profile Drawings' sections of this Approval. Clips on cave tile are not required for this attachment configuration unless the Required Moment of Resistance exceeds the values noted above. 1 4 Raul Rodriguez Table 3 -A: Attachment Resistance Expressed as a Moment - M (ft -Ibf) for Nall-On Systems Tile Profile Tile Application Two (2) 10d x 3" long nails' Monier Roll Tile Direct Deck New Construction (min. 10 /, 2 " plywood) 67.50 Direct Deck Recover /Rerool (min. "/ plywood) 43.00 Battens New Construction 50.90 d Table 4: Attachment Resistance Expressed as a Moment - M (ft -Ibl) for Mortar or Adhesive Set Systems Tile Tile Attachment Profile Application Resistance Monier Roll Tile Mortar Set 20.60 Adhesive Set , 86.61 DATA FOR ATTACHMENT CALCULATIONS (CONTINUED) Tile Installation with a 4" headlap using two (2) Approved 10d x 3" long polymer coale corrosion resistant, ring shank nails installed in manufactured holes located 2% :" from the head of the tile. Clips on eave tile are not required for this attachment configuration unless the Required Moment of Resistance exceeds the values noted above. Raul Rodriguez Product Control No.: 95 - 0322.03 DATA FOR ATTACHMENT CALCULATIONS (CONTINUED) Tile Installation with a 4" headlap using two (2) Approved 10d x 3" long polymer coale corrosion resistant, ring shank nails installed in manufactured holes located 2% :" from the head of the tile. Clips on eave tile are not required for this attachment configuration unless the Required Moment of Resistance exceeds the values noted above. Raul Rodriguez Product Control No.: 95 - 0322.03 ti AQ MONIER ROOF TILE PROFILE DRAWINGS MONIER ROLL TILE 16 •r. Raul Rodriguez Product Control No.: D-0122,0_3 PROFILE DRAWINGS (CONTINUED) J APPROVED SCREW FOR SCREW DATA IN TABLE 3 I'roduct Control No.: 95- 03".03 • 17 Raul Rodriguez NaucaDJEAccEpatiacEI ST,� ANI)AIU) �ONI)ITIONS I. Extensions of Acceptance mny be considered Idler a new application has been filed and the supporting data, test reports no older than ten (10) years, have been re- evaluated. All reports of re- testing shall bear the seal, signature and date of an engineer registered in the State of Florida. 2. Any revision or change in the materials, use, or manufacture of the product or process shall automatically be cause for termination, unless prior approval is granted for revisions or change. 3. Any unsatisfactory performance of this product or process or a change in Code provisions shall be grounds for re- evaluation. 4. This acceptance shall not be used as an endorsement of any product for sales or advertising purposes. 5. The Notice of Acceptance number preceded by the words Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the Notice of Acceptance is displayed, then it shall be done in its entirety. 6. Product approval drawings, where required for pennit applications, shall be provided to the applicant by the manufacturer or his distributors unless otherwise noted in the Notice of Acceptance. The prints need not be re- sealed by an engineer. 7. Failure to comply with the Standard Conditions shall be cause for termination of the Approval. Thls approval supersedes all previous approvals. , 18 aul Rodriguez Product Control Supervisor Polyfoant Products, Inc. 2400 Spring - Stuebncr Road Spring, Texas 77383 METROPOLITAN DADE COUNTY, FLORIDA METRO-DADE FLAGLER BUILDING PRODUCT CONTROL NOTICE OF ACCEPTANCE [WILDING CODE COMPLIANCE DEPARTMENT SUITE 1603 METrIO•DADE FLAGLER BUILDING 140 WEST FLAGLER STREET MIAMI, FLORIDA 33130.1563 ' (305) 375.2901 FAX (305) 375 -2908 Your application for Product Approval of Polyfoant Products "Polypro AH -160" Roof Tile Adhesive under Chapter 8 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 The Center for Applied Engineering, Inc. and Miles Laboratories Polymers Division has been recommended for acceptance by the Building Code Compliance Department to be used in Dade County, Florida under the specific and standard conditions set forth herein. The approval shall be valid for a period of three years. The Building Code Compliance Department reserves the right to secure a product or material at any time for a jobsite or manufacturer plant for quality control testing. if product or material fail to perform in the approved manner, the Code Compliance Department may revoke, modify or suspend the use of such product or material immediately. The Building Code Compliance Department reserves the right to require testing of this product or material should any amendments to the South Florida Building Code be enacted affecting this product or material. The expense of such testing will be incurred by the Manufacturer. PRODUCT NO. : ACCEPTANCE NO.: 95- 0314.10 APR 2 7 1998 EXPIRES: ul Rodrigu 4 'roduct Control Division Supervisor - PLEASENOTE - TIIIS IS TIIE COVERSIIEET. SEE ADDITIONAL PAGES FOR SPECIFIC AND GENERAL CONDITIONS. BUILDING CODE COMMITTEE This application for Product Approval has been reviewed by the Metropolitan Dade County Building Code Compliance Department and approved by the Building Code Committee to be used in Dade County, Florida undcr the conditions set forth above. APPROVED: bVfs 2 1 1995 ircctor Building Code Compliance Department Metropolitan Dadc County Applicant: Polyfoam Products, Inc. 2400 Spring - Stuebncr Road Spring, Texas 77383-1132 Category: Roofing Component Sub - Category Fastening /Adhesive Type• Roof Tile Adhesive Sub -Type: Two Component Polyurethane PRODUCT CONTROL. NOTICE Or ACCEPTANCE ROOFING COMPONENT APPROVAL Polyfoam Products, Inc., produces two - component expanding polyurethane adhesive for the attachment of clay and concrete roof tile. Polypro® AI-1160 is specially designed for application of concrete and clay roof tile over a variety of roof deck substrates and undcrlaymcnt materials. Polypro® adhesive is applied with proprietary Foainprorl5) RT1 1000 dispensing equipment. Approval of this product is specific to the two component mix and f oantpro® RTF1000 dispensing equipment. Alternative methods of' dispensing will require a revision to this approval. Polypro® adhesive shall be applied only by 'Qualified Applicators', licensed by Polyfoam Products, Inc. Certificates and identification cards are issued to applicators upon successful completion of a application training. program. Approval of this adhesive system is contingent upon application by a 'Qualified Applicator. Contact: Pat Murray P.O. I3ox 1 132 Spring, Texas 773''j3-1132 (713)350 -88°" 2ax: (713)288 -6450 System Description 1 Product Control No.: 95-0314.10 Approval Date: _ lill_1995 Expiration Date: APR 2 7 1998 TRADE NAMES OF PRODUCTS MANUFACTURED OR LABELED BY APPLICANT Test Product Product Dimensi n Specifications Description N/A PA 101 Two component Polypro ®AH polyurethane Foampro® RTF 1000 N/A See Detail Attached Dispensing Equipment 2 Raul ,;.,driguez Product Control No.: 95- 0314.10 Product Underlaymcnt Roof Tile TRADE NAMES or PRODUCTS IVIANUFACTURED 13Y OTHERS Test Criteria PA 101 Product Description PA 120 All Dade County Component Approved products as detailed in Dade County Application Standard PA 120 All Approved roof tile systems having tested in compliance with Dade County Protocol PA 101, as detailed in the systems section of this Component Approval 3 1 it Rodriguez Product Control No.: 95- 0314.10 Manufacturer All Dade County Approved Products All Dade County Approved Products Test Agency Center for Applied Engineering Miles Laboratories Polymers Division Property Density Compressive Strength Tensile Strength Water Absorption Moisture Vapor Transmission Dimensional Stability Closed Cell Content Test Identifier #94 -060 NB- 589 -631 TYPICAL PHYSICAL PROPERTIES Test ASTM D 1622 ASTM D 1621 ASTM D 1623 ASTM D 2127 ASTM E 96 ASTM D 2126 ASTM D 2856 TEST REPORTS Test Name/Report Mctro Dade Protocol PA 101 1.6 lbs. /ft.' 18 PSI Parallel to rise 12 PSI Perpendicular to rise 28 PSI Parallel to rise 0.08 Lbs. /Ft' 3.1 Perm / Inch +0.07% Volume Change @ -40° F., 2 weeks +6.0% Volume Change @158°F., I00% Humidity, 2 weeks 86% Product Control No.: 95- 0314.10 Results Date 04/08/94 ASTM D 1623 02/01/94 Note: The physical properties listed above are presented as typical average values as determined by accepted ASTM test methods and arc subject to normal manufacturing variation. R: 1 Rodriguez SYS'1'ENIS Deek 'I'vpe: Wood, Non- insulated, New Construction /Rcrnof Dccic Description: SYSTEM A: Slope Range: Undcrlaymcnt: Rooting Tile: New construction 9 / ) ," or greater plywood or wood plank. Re-roof 15 /,," or greater plywood Adhesive Set Application 2":12" to 7":1 Product Control No.: 95- 0314.10 Install choice of Approved underlayment system, noted on Page 1 of Dade County Protocol PA 120, in compliance with Section 3.02 of PA 120. Install Approved tile system in compliance with PA 120. Adhesive shall be applied in compliance with the Component Application section and the corresponding Placement Details of this Roofing Component Product Control Approval. The adhesive attachment shall provide sufficient attachment resistance expressed as a moment to meet or exceed the required moment of resistance determined in compliance with PA 115 or PA 127. The adhesive attachment data is noted in the tile Roof System Assembly Product Control Approval. Comments: I . For re -roof applications, minimum ' / „” plywood is an acceptable substrate. 2. All 'System Limitations' noted in the tile Roof System Assembly Product Control Approval shall apply. 5 Rat Rodriguez Product Control No.: 95- 0314.10 SYSTEMS (CONTINUED) Deck Type: Concrete, New Construction /Reroof Deck Description: New construction SYSTEM 13: Adhesive Set Application Slope Range: 2 ":12" to 7 ":12" Undcrlaymcnt / install Approved underlayment system of one of the following: Waterproofing: Underlayment System # I (30/90 Hot Mop) noted on Page 1 of Dade County Protocol PA 120, installed in compliance with Section 3.02(A) of PA 120 Roofing Tile: Comments: or Any Approved urethane or asphalt based concrete waterproofing component installed in compliance with the waterproofing component manufacturer's Roofing Component Product Control Approval. Strips of reinforcing fabric shall be installed at all concrete deck joints. Install Approved tile system in compliance with PA 120. Adhesive shall be applied in compliance with the Component Application section and the corresponding Placement Details of this Roofing Component Product Control Approval. The adhesive attachment shall provide sufficient attachment resistance expressed as a moment to meet or exceed the required moment of resistance determined in compliance with PA 115 or PA 127. The adhesive attachment data is noted in the tile Roof System Assembly Product Control Approval. 1. For re -roof applications, minimum' / „” plywood is an acceptable substrate. 2. All 'System Limitations' noted in the tile Roof System Assembly Product Control Approval or waterproofing component Roofing Component Product • Control,Approval shall apply, as applicable.. 6 Raul ' ' odriguez Table 1: Adhesive Placement For Eac,i Generic Tile Profile 'file - Profile Placement Detail Two -Piece Barrel III 'S' Shaped I {2 Double Roll 113 Large Flat II4 Small Flat 115 CorvlpoNENT APPLICATION Product Control No.: 95-0314.10 I Polypro® A11160 tile adhesive shrill only be applied over an underlaynient installed in compliance with application instructions detailed in its Component Approval.. Underlayment shall be any underlavnrents or undcrlayment systems listed as Approved in Dade County Protocol PA 120. 2. Adhesive application shall be in accordance with the instructions provided in this Component Approval, the manufacturer may provide additional instructions subsequent to this approval date which shall prevail. Installation must he by a Factory Trained 'Qualified Applicator' approved and licensed by Polyfoam Products, Inc. 3. Calibration of the Foampro® dispensing equipment is required before application of any adhesive. The mix ratio between the "A" component and the "B" component shall be maintained between 1.0 -1.15 (A) : 1.0 (B). The dispense timer shall be set to deliver 0.08 to 0.15 pounds per tile as determined at calibration. No other settings shall be approved without revision of this Component Approval. Adhesive shall be dispensed in a 17 in' to 23 in' pad at time of application. The cured pad shall be approximately 5" x 12 ". Foam placement shall be in accordance with the 'Placement Details' provided in this Component Approval. Each generic tile profile'requires a specific placement, as noted in Table 1, below. A tile manufacturer may test a tile system in compliance with PA 101 and add an additional detail without incurring an additional revision cost. 5. Adhere tile directly in freshly applied adhesive. Tile must be set within 2 to 3 minutes after foam has been dispensed. 6. Adhesive shall be placed to create contact with :nimum 2 tiles, as outlined in the 'Placement Detail' for each tile profile. 4. 7 Raul Rodriguez Product Control No.: 95 -03 14.10 SYSTEM LIMITATIONS I. Tile must be applied within 2 to 3 minutes of the application of Polypro® A1-1160 adhesive. 2. Polypro® Al -1160 adhesive shall be installed only by 'Qualified Applicators' approved and licensed by Polyfoam Products, Inc. 3. For adhesive set tile applications, a field static uplift test by a Dade County accredited testing agency, in compliance with Dade County Protocol PA 106, shall be required not less than 72 hours after application to confirm tile adhesion. The results of this testing shall be reported to the Building Official and the installer stating that the application has passed or failed PA 106 testing. If the application fails PA 106 testing, the report shall state which portion of the test was failed; Category 1 (examination for loose tile) or Category 2 (uplift testing of tile). Subsequent to testing, the installer may repair not more. than 5% of field arca tiles and 10% of perimeter arca (i.c. ridge /rake) tile with approved tile adhesive. The installer shall place an identifiable marking on each repaired tile for future reference. Any PA 106 re -test shall not include any marked tile. 4. Refer to application drawings published by the National Tile Manufacturers Association for penetrations and terminations, as well as the 'Placement Details' included with this Component Approval. 5. Refer to tile Roof System Assembly Product Control Approval for system Approvals with this Component. 6. Refer to the Prepared Roof System Assembly for fire rating. 7. Polypro® AI -1 160 shall not be exposed permanent' sunlight. 8. Polypro® AI-1160 shall be applied with Foampro RTFI000 dispensing equipment only. 9. Any amendments to these provisions shall be in compliance with Sections 203 and 204 of the South Florida Building Code. 8 Rau Zodrigucz PLACEMENT DETAILS Product Control No.: 95- 0314.10 PAN COYER t MORTAR GE , FOR C0 _R TILE WECPHGLE LIETAI EAVE DRIP xcrtoe a ow, closure cceianai fASCIA'BOARD ^,o int -up mortar 2• x 10" Foam Pad when applied 1X4 ON EDGE \- NAII. r.ST PAH HERE (WHEN ACOIOONAL NA:LING IS RECI:IfiEO BY G00E) 2• x 10' Too= ?ad •+han applied NAIL COVER HERE (MICH RCGUIRCO) Placement Detail #1: Two -Piece 13nrrel Profile 9 Raul 'odriguez FASCIA BOARD 90/1 MINERAL SURFACE RooFIN° FELT 2" x ) 0" Foam Pad when applied (EPOM). PREFABRICATED PLASTICCROOFE 1HROUGH NTT OR INTO APFROVCD AOHESI'IE PLACEMENT DETAILS (CONTINUED) w )LE I'Iaccn►cnt Detail #2: 'S' Shaped Tile Profile izt 10 Raul 1 driguez Product Control No.: 95- 0314.10 NAIL HERE 7r'RCUGh PLASTIC ROOF CEMENT ('M -(EN AOOI11CNAL NAILU IS RF.CUIREO BY CCCE) riE!CIAP EAnCE 8 OAR 0 Se alnr.t or POINT - 1%11H COLORED Mor1AR TO MATCH TILE SURFACE ROI.LEO RAKE CJ = (SPANISH 5- SECURE 1MiH CCRROSION R(S:STAN i NA,;. PLACEMENT DETAILS (CONTINUED) FASCIA BOARD 901 MINERAL. SURFACE ROOFING FELT 2" x 10' To Pad When applied NAIL TriROUGS PLASTIC ROOF CEMENT (WHEN A0o1710Na1 NAILING REQUIRED I GORE) IIARGE ROAR° Placement Detail #3: Double Roll Profile 11 i I:au "Zodriguez Product Control No.: 95- 0314.10 7 0° Owner's Name and Address __ s 8 0. r Rs • Street and Number where work is to be done 3'S-0 n/1: ,. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approyal of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Registered Architect and /or Engineer Name and address of licensed contractor_ _ s ! 4 y1.1t E 25?_O .. 1_! ► / .37g(), # . / / 4i" E Location and legal description of lot to be built on: Lot Block Subdivision / e o S r State work to be done and purpose of building (by floors ! 6 — New Building Remodeling Addition To be constructed of Kind of foundation Estimated Total cost of improvements $ Amount of Permit $ Zone cubage required _Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Pennanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only su.i subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. ss Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the_ of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit No.___ _ _ Date__ ,/��jj � g r 6 7 / Read, Sworn to and Subscribed before me. Disapproved ( Signed) D atel Date 7— .,197/ N o . _ . r Y ) / 2 , . . - - - - : E / ' : ' 1—Po * and for no other purpose. Repairs No. of Stories © N d= Roof Covering.. rf or Notary Public, State of Florida Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.