RF-10-646 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 140776 Permit Number: RF -4 -10 -646
Scheduled Inspection Date: May 27, 2010 Permit Type: Roof
Inspector: Bruhn, Norman Inspection Type: Final Roof
Owner: BUDENZ, DONALD Work Classification: Flat
Job Address: 575 GRAND CONCOURSE
Miami Shores, FL
Phone Number
Parcel Number 1132060171380
Project: <NONE>
Contractor: PERKINS ROOFING CORPORATION
Building Department Comments
PRESSURE WASH ROOF AND APPLY LAPOLLA WHITE
ELASTOMERIC ROOF SYSTEM
Inspector Comments
Passe' e a: G
Failed
Correction ❑
Needed
Re- inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
May 26, 2010 For Inspections please call: (305)762 -4949 Page 6 of 16
7 \
` 5H U U R s Miami Shores Village
10050 N.E. 2nd Avenue
....,, Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 h \ tti\`
�{ Expiration: 11/09/2010
'� ..
Project Address Parcel Number Applicant
575 GRAND CONCOURSE 1132060171380
DONALD BUDENZ
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
DONALD BUDENZ 575 GRAND CONC
MIAMI SHORES FL 33138
Contractor(s) Phone Cell Phone Valuation: $ 15,000.00
PERKINS ROOFING CORPORATION
_,......,. , _ _.......... Total Scl Feet: 4700
Type of Work: Repair Available Inspections:
Additional Info: FLAT ROOF Inspection Type:
Classification: Residential
Tin Cap
Final Roof
Roof Review
Roof in Progress
Renailing Affidavit
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $9.00 Invoice # RF -4 -10 -37606
Education Surcharge $3.00
05/13/2010 Check #: 13944 $ 333.00 $ 50.00
Permit Fee - New Roof $350.00
Scanning Fee $9.00 04/16/2010 Check #: 13897 $ 50.00 $ 0.00
Technology Fee $12.00
Total: $383.00
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated.
May 13, 2010
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
May 13, 2010 1
Miami Shores Village o'
Building Department APR 16 2010
f0050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972 ' """"""•'••••'••••
jz� BUILDING Permit No. �" ky
PERMIT APPLICATION Master Permit No.
FBC 2004
Permit Type (circle): Building Roofing
Owner's Name (Fee Simple Titleholder) 0 AII one #
Owner's Address .5 S �pf) t -Q U rk,
City M f G ! Shares State r� Zip 1119-k
Tenant/Lessee Name Phone #
Job Address (where the work is being done) Sa aei d c oce rm
City Miami Shores Village County Miami -Dade Zip J / .
FOLIO / PARCEL # I ( - O Q
Is Building Historically Designated YES NO
Contractor's Company Name
P�i�s �Q (�(D Phone # Tb>
Contractor's Address 5 7 -5 A/4) (50, .S f H
% _
City State 33/409
tN1 1`L z ip
- .31/ 40 9
Qualifier Name ,�,r n Phone # 305
IT
State Certificate or Registration No. V'{ O� ?k(p Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
�+ c, q,900
Value of Work For this Permit 15 1 t� Square / Linear Footage Of Work:
Type of Work: Addition = 11-p- ion New Repair/Replace E] Demolition
Describe Work: wts 1 r ^�, 1111 X001 LQ POA2
( ✓' 0 .xzxxx. . xxh xx: xxz. xF xxx *.xxxxxxzx.xxxxz���xx*
162
QP R Submittal Fee $ Permit Fee $ �) CCF $ CO /CC
Notary $ Training/Education Fee $ 1 Technology Fee $
`/
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $
See Reverse side --io
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
f ,
Ir signatur Signature / z;)
Owner or Agent Contractor
The foregoing instrument was acknowledged b re me this The foregoing instrument was acknowledged before me��this
day of 20 t&, by day of 20 fU by v who is rsonally know me or who has produced who i ersonally kno o me or who has produced
As identification and who did take an oath. as identification and who d =pu
NOTARY PUBLIC: NOTARY PUBLIC• ,►*V ► N Florida
p ° W 4^ Notary Public State of Florida tQ B Bryant J Adams M9828 My Commission DD8 59828 fl ' E
Sign: o° (09/2013 Sign:
Print: Print: A6 � A' T Ada 02.5
My Commission Expires: `���� My Commission Expires: X19 f �3
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
APPLICATION APPROVED BY: Plans Examiner
Engineer
Zoning
(Revised 07/10107)
BY .y ....
April 28, 2010
To Whom It May Concern:
Lapolla Industries, Inc., manufacturer of the RCS -5000 Series Restoration Coatings, has
had said coating tested by PRI Asphalt Technologies, an approved Miami -Dade County
laboratory, for acceptance as a maintenance roof coating by the Miami -Dade County
Product Control Division.
Testing confirms RCS -5000 meets the ASTM D 6083 test protocol, including TAS 114,
established by the Miami -Dade County Product Control Division.
Confirmation of the RCS -5000 testing and PRI's approved laboratory status is evidenced
by Miami -Dade County NOA No.: 07- 0612.02.
Please do not hesitate to call me if you have any questions regarding RCS -5000 or the
intent of this letter.
Sincerely,
Lapolla Industries, Inc.
5 At
Shirad Ali
Director of Engineering and Applications, Roofing Systems
Lapolla Industries, Inc. - 15402 Vantage Parkway East, Suite 322 - Houston, TX 77032
Phone (281) 219 -4100 - Fax (281) 219 -4106 - www.lapolia.com
y tIORE ,
Miami shores Village
;,,, Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
rr 10 Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No: 10 -646
Job Name:
May 11, 2010 Page 1 of 1
Building Critique Sheet
1) The product submitted is a maintenance coating and is not approved as a recover
system. See limitations. Contractor told me that the roofing system is leaking and in need
of repair. This submittal does not include any repairs. Where and how are all repairs
being done? Provide a complete submittal forall work including correct section B.
2) Provide manufacturers installation instructions for this product. The instructions
submitted are for another product.
3) The fire directory listing page must be for the roofing system listed.
Plan review is not complete, when all items above are corrected, we will do a complete plan
review.
If any sheets are voided, remove them from the plans and replace with new revised sheets and
include one set of voided sheets in the re- submittal drawings.
Norman Bruhn CBO
305 - 795 -2204
4VA
�NoRE
�pC.1932 Miami. shores Village
l,,, ,,,,, Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
�Nres 1N Tel: (305) 795.2204
�ORI'Dp' Fax: (305) 756.8972
Permit No: 10-01rt�
Job Name
2010 Page 1 of 1
Building Critique Sheet
U kJ
Y ' 4val kl c3! dt
Li
L/ �/ ��JrLt G (�'sQ�li TraGTy�IL�.T �It,{TR Ile.
/C
Plan review is not complete, when all items above are corrected, we will do a complete plan
review.
If any sheets are voided, remove them from the plans and replace with new revised sheets and
include one set of voided sheets in the re- submittal drawings.
Norman Bruhn CBO
305 - 795 -2204
04/23/2010 11:32 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES Q001
* TX REPORT
TRANSMISSION OK
TX /RX NO 4953
RECIPIENT ADDRESS 93056815397
DESTINATION ID
ST. TIME 04/23 11 :31
TIME USE 00'24
PAGES SENT 1
RESULT OK
°RED , Miami shores Village
\K 19 32 L _
g ulf 1� ..rr�l�l7 Building Department
10050 N.E.2nd Avenue
a Miami Shores, Florida 33138
DRYD� 'Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No:
Job Name
2010 Page 1 of 1
Building Critique Sheet
Underwriters 333 F ftWXWk
tu D1
Laboratories Inc -!NortnixooK, IL 60062 -2096 t P-$
he':1 847 2 12 WO
LaPolla Industries, Inc.
Doug Kramer, President
15402 Vantage Parkway East
Houston, Texas 77032
Subject: Project R1435� 04NK11280
Dear Mr. Kramer:
This has reference to our discussions regarding the UL Classifications that are
appropriate for your RCS -5000 roof coating when used independently as a
"Maintenance and Repair" Roofing System. Based on the results of the testing
conducted under the subject project the following "Maintenance and Repair"
Classification will be promulgated:
Maintenance and Repair
Class A, B or C
Deck: C -15132 Incline: See Note 1
Existing Roof System: Any UL Classified existing BUR with mineral surfaced cap
sheet or any granule surfaced modified bitumen membrane system to retain exisfingr
Oass ificationj
Coating: rRCS- 5000papplied at 3 gal / sq.
Note 1: Classification (A, B or C) and max incline to be same as that of Classified
Roofing System (TGFU).
Very truly yours,
Kenneth Rhodes
Senior Staff Engineer
Fire Protection Division
An independent organization working for a safer world with integrity, precision and Knowledge.
ROOF ASSEMBLIES SAND AIb S
y
4(ces
r - y
Florida Building Code Edition 2�) Qg
High - Velocity Hurricane Zone Uniform Permit Appllca on Form
n °PT — J' /40
Section A General Informatio' Ur JGT CO C CMPLIANCE wlTr, ALL F r R;-
Master ermit No. I "T AN Y r�' II �.� AN l
Process Nb.
4 V. �.
0 actor's Name f r +
f
4 Job Address 5 C
BOOF CATEGORY
;YLow Slope ❑ Mechanical) Fastened Tile
Y ❑Mortar /Adhesive Set Tile
❑ Asphaltic ❑ Metal Panel /Shingles
Shingles 11 Wood Shingles /Shakes
❑ Prescriptive BUR -RAS 150
ROOF TYPE
❑ New Roof ❑ Reroofing ❑ Recovering ❑ Repair p Maintenance
ROOF SYSTEM
INFORMATION
Low Slope Roof Area (SF) Steep Sloped Roof Area (SF)
AgTo � Total (SF)
�17od
Section B Roof Plan
Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains.
Include dimensions of sections and levels, clearly identify dimensions of elevated pressure zones and location of
parapets.
— +ITT
_/
hog 4ax
M
•
p �
4 •
�k t
••• • • • ••• • •
1YIGH- VELOCITY HURRICANE ZONES - REQUIRED OWNERS NOTIFICATION FOR ROOFING
CONSIDERATIONS
1524.1 Scope. As it pertains to this section, it is the responsibility of the roofing contractor to provide the owner with
the required roofing permit, and to explain to the owner the content of this section. The provisions of Chapter 15 of
the Florida Building Code, Building 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 designated space indicates that the item has been explained.
L 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) are not a consideration with respect to workmanship
provisions. Aesthetic issues such as color or architectural appearance, that are not part of a zoning code,
should be addressed as part of the agreement between the owner and the contractor.
2. Renailing wood decks: When replacing roofing, the existing wood roof deck may have to be renaile
B -lance with the current provisions of Chapter 16 (High - Velocity Hurricane Zones) of the Florida
Branding Code, Building. (The roof deck is usually concealed prior to :removing the existing roof system.)
3. Common roofs: Common roofs are those which have no visible delineation between neighboring units
(i.e. townhouses, condominiums, etc.). In buildings with common roofs, the roofing contractor and/or owner
should notify the occupants of adjacent units of roofing work to be performed.
�` . Exposed ceilings: Exposed, open beam ceilings are where the underside of the roof decking
viewed from below. The owner may wish to maintain the architectural appearance; therefore, oofing nail
penetrations of the underside of the decking may not be acceptable. The owner provides the option of
rr�titain�ng this appearance_
S. Ponding water: The current roof system and/or deck of the building may not drain well and ma
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
)riginal roofing system is removed. Ponding conditions should be corrected.
6. Overflow scuppers (wall outlets): It is required that rainwater flow off so that the roof is not
overloaded from a buildup 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 requirements of. Chapter 15 and 16 herein and tho Florida Building Code, Plumbing.
7. Ventilation: Most roof strictures should have some ability to vent natural airflow through the interior
of the s"ctuial acsjr%bVZtlZ UiAJi * i6c:f) .-7he existing amount Of attic ventilation shall not be reduced.
It may %� be.►te�t~:al.to oo>zsiA27 :dtlJto:laS'uen4mg which can result in extending the service life of the roof.
.. ... .. . ••• ••• .. . . . ..
. •• . •. • . • • •
• ... . 5v
• • • •• N • • • • • • • • Llpp
-� • • 0 • . • •• • .• • . • • • • 9
• •• • • • ••
0 000
r "? � '
z. If Owner's /Agent's Si��ai; • ... .... Date
• . • .. • • . . Contractor's Signature
• •
. . . • . . • • • . • . • • . •
ROOF ASSEMBLIES AND ROOFTOP STRUCTURES
Florida Building Code Edition 2004
High - Velocity Hurricane Zone Uniform Permit Application Form.
Section C Low Slope Application) Surfacing:
Fill in specific roof assembly components
and Identify manufacturer Fastener Spacing for Anchor /Base Sheet Attachment:
(if a component is not used, identify as "NA ")
Field: " oc @ Lap, # Rows @ " oc
System Manufacturer: A ll iq
P rrimeter: " oc @Lap, #Rows _ @ _ "oc
Product Approval No.: r
Corner: " oc @ Lap, # Rows @ " oc
Design Wind Pressures, From RAS 128 or Calculations:
Number of Fasteners Per Insulation Board:
Pmaxl: Pmax2: Pmax3:
Max. Design Pressure, from the specific Product Field Perimeter Corner
Approval system:
Illustrate Components Noted and Details as
Applicable:
Deck: Woodblocking, Gutter, Edge Termination, Stripping, Flashing,
Type: I f Continuous Cleat, Cant Strip, Base Flashing, Counter -
Flashing, Coping, Etc.
GaugetThickness: Indicate: Mean Roof Height, Parapet Height, Height of Base
Flashing, Component Material, Material Thickness, Fastener
Slope: ! Type, Fastener Spacing or Submit
Anchor /Base Sheet & No. of Ply(s): —WIA
Anchor /Base Sheet Fastener and' g Material: '
Insulation Base Layer:
1
i
_3ase Insulation Size and Thickness: FT. too es k
Base Insulation Fastener /Bonding M ter' al: .5 k
Parapet i
^— — 6 Height J
Top Insulation Layer: r p ('( C
S�k ro of
Top Insulation Size and Thickness: _ FT
Top Insulation Fastener /Bonding Material:
Mean
Roof
Base Sheet(s) & No. of Ply(s): Height
Base Sheet.Fastener /Bonding Material:
• . . . $• •
• .. • • .
Ply Sheets) &VC9 PMW -0*`* .$ • •
of 0
•• ••• •• • ••• •1• I We . 0 0 we
Ply Sheet Fastener /Bonding Material: Al
• • • • • • • • • fee 9 • •
Top tiro
Top Ply Fastener /Bonding Material:
. . .... .... ..
•• . .
. . . . . . . • .... :
. . . .
off 0
MIAMI- MADE MIAMI -DADS COUNTY, FLORIDA
METRO -DADE FLAGLER BUILDING
BUILDING CODE COMPLIANCE OFFICE (BCCO) 440 WEST FLAGLER STREET, SUITE 1603
PRODUCT CONTROL DIVISION MIAMI, FLORIDA 33130 -1563
(305) 375 -2901 FAX (305) 375 -2908
NOTICE OF ACCEPTANCE (NOA)
LAPOLLA Industries, Inc.
15402 Vantage Parkway East
SUITE 322
Houston, TX 77032
SCOPE:
This NOA is being issued under the applicable rules and regulations governing the use of construction
materials. The documentation submitted has been reviewed by Miami -Dade County Product Control
Division and accepted by the Board of Rules and Appeals (BORA) to be used in Miami Dade County
and other areas where allowed by the Authority Having Jurisdiction (AHJ).
This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product
Control Division (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade County)
reserve the right to have this product or material tested for quality assurance purposes. N this product or
material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing
and the AHJ may immediately revoke, modify; or suspend the use of such product or material within
their jurisdiction. BORA reserves the right to revoke this acceptance, if it is determined by Miami -Dade
County Product Control Division that this product or material fails to meet the requirements of the
applicable building code.
This product is approved as described herein, and has been designed to comply with the Florida Building
Code and the High Velocity Hurricane Zone of the Florida Building Code.
DESCRIPTION: RCS -5000 Series Restoration Coatings
LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state
and following statement: "Miami -Dade County Product Control Approved ", unless otherwise noted
herein.
RENEWAL of this NOA shall be considered after a renewal application has been filed and there has
been no change in the applicable building code negatively affecting the performance of this product.
TERMINATION of this NOA will occur after the expiration date or if there has been a revision or
change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an
endorsement of any product, for sales, advertising or any other purposes shall automatically terminate
this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of
NOA.
ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and
followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is
displayed, then it shall be done in its entirety.
INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its
distributors and shall be available for inspection at the job site at the request of the Building Official.
This NOA consists of pages 1 through 3.
The submitted documentation was reviewed by Jor L. A o
NOA No.: 07- 0612.02
Expiration Date: 08/09/12
Approval Date: 08/09/07
Page 1 of 3
ROOFING COMPONENT APPROVAL
Category: Roofing
Sub - Category: Cement- Adhesive - Coatings
Material: Acrylic Elastomeric
Maximum Design Pressure N/A
Fire Classification: See Limitation #1
SCOPE:
This approves "RCS -5000 Series Restoration Coatings" as a maintenance roof coating as
manufactured by LAPOLLA Coatings, as described in this Notice of Acceptance, designed to
comply with the Florida Building Code, High Velocity Hurricanes Zone.
Test
Manufactured by Applicant Dimensions Specifications Product Description
RCS -5000 Series Restoration NIA ASTM D 6083 A premium quality, fluid applied
Coatings eastomeric roof coating.
Therm-0-Prime N/A A single component, water soluble
acrylic emulsion primer to prepare
Galvanized Metal, Concrete, Asphalt
Substrates and Scarified Foam for new
SPF installations.
RCS-40 N/A A rinseable primer for chemically
altering the surface of EPDM
membranes.
Therm -O- Caulk N/A A premium quality elastomeric patching
compound to repair cracks and seal
voids.
RCS 4000 N/A A fluid applied eiastomeric roof coating
employed as the base coat in Asphaltic
substrate multiple membrane
eastomeric roof coating applications
EVIDENCE SUBMITTED:
Test Agency Test Identifier Test NamelReport Date
Underwriter Laboratories, Inc. R14353 Classification 06/26/05
Factory Mutual Research Corp. 3023795 Class 4470 10/02105
PRI Asphalt Technologies LPII- 002 -02 -01 ASTM D 6083 10/19/05
TAS 114 (H)
NOA No.: 07- 0612.02
` Expiration Date: 08109112
Approval Date: 08109107
Page 2 of 3
PHYSICAL PROPERTIES OF COMPONENTS
Trade names: RCS -5000 Series Restoration Coatings
Thickness: Wet Film per Coat : 24 mils
Dry Film per Coat: 13.2 mils
Specifications: ASTM D 6083, TAS 114(H)
Description: A water -based elastomeric coating membrane applied at an application rate of;
• Galvanized Metal Roofs: Apply Base Coat at a rate of 1.5 to 2 gal/100 ft
and Finish Coat at a rate of 1.5 to 2 gal/100 ft
• SBS Modified Bitumen Granule Surfaced Membranes: Apply Base Coat at a
rate of 1.5 to 2 gal/100 ft and Finish Coat at a rate of 1.5 to 2 gal/100 ft
• EPDM Single Ply Membranes: Apply Base Coat at a rate of 1.5 to 2 gal/100
ft and Finish Coat at a rate of 1.5 to 2 gal/100 ft
• Spray Polyurethane Foam Roof Systems: Apply Base Coat at a rate of 1.5 to
2 gal/100 ft and Finish Coat at a rate of 1.5 to 2 gal/100 ft
• Concrete Decks: Apply Base Coat at a rate of 1.5 to 2 gal/100 ft and Finish
Coat at a rate of 1.5 to 2 gal/100 ft
Container Size: 5, 55 and 275 gallons. Note all precautions on container.
Systems Approvals: Methods of application and quantities shall comply with specific Roof
Assembly, Product Control Notice of Acceptance.
LIMITATIONS:
1. Fire classification is not part of this acceptance; refer to a current Approved Roofing Materials
Directory for fire rating of this product.
2. RCS -5000 SERIES RESTORATION COATINGS shall not be applied in inclement weather conditions.
3. The products listed herein are components of roof assemblies and are approved for use with roof
assemblies that list any of the products listed herein as part of their roof assemblies Notice of
Acceptance.
4. All products listed herein shall have an unannounced follow -up quality control program from an
approved listing agency. Follow up test results shall be made available to BCCO upon request.
5. All approved products listed herein shall be labeled in compliance with TAS 121.
6. Change in materials, use, or manufacture of any of the products listed herein shall be cause for
termination of this Notice of Acceptance.
7. RCS -5000 SERIES RESTORATION COATINGS shall be used as a roof maintenance coating system in
accordance with applicable Building Code. RCS -5000 SERIES RESTORATION COATINGS is not
approved for use as a recover system.
8. RCS -5000 SERIES RESTORATION COATINGS shall be applied in accordance with manufacturer's
published application instructions.
9. All products listed herein shall have a quality assurance audit in accordance with the Florida
Building Code and Rule 9B -72 of the Florida Administrative Code.
END OF THIS ACCEPTANCE
o NOA No.: 07- 0612.02
Expiration Date: 08/09/12
Approval Date: 08109/07
Page 3 of 3
TGFU.R14353 - Roofing Systems 5/5/10 5:19 AM
V ONLINE CFRTIFICATIONs n1RFCUORY
TGFU.R14353
Roofing Systems
Page Bottom
Roofing Systems
See General Information for Roofing Systems
LAPOLLA INDUSTRIES INC R14353
SUITE 322
15402 VANTAGE PARKWAY E
HOUSTON, TX 77032 USA
Noncombustible deck Classifications are applicable for use over combustible (15/32 in, min plyvwood) decks when 1/2 in. (min)
gypsum board Or 1/4 in. (min) G -P Gypsum DensDeckS are used directly over the deck with all joints staggered 6 In. (min) from
Plywood 'pints.
SPRAY APPLIED FOAM AND COATING SYSTEMS
Class A
1. Deleted.
2. Deck: NC Incline: 3
Foam: NCFI "591 ", any thickness.
Coating: "Great White ", 3 gal per sq.
Surfacing (Optional): Roofing granules, 30 Ibs /sq.
3. Deleted.
4. Deleted.
S. Deck: NC Incline: 2
Foam: "LPA250OH" or "LPA280OH" or "LPA3000H," any thickness.
Base Coat: "TF 1001 Therm -O -Flex Elastomeric Roof Coating White" or "TF 1002 Therm -O -flex Elastomeric Roof Coating
Gray" or "TF 1003 Therm-0-Flex Elastomeric Roof Coating Tan" or "TF 751 Therm-0-Flex Elastomeric Roof Coating White" or
"TF 752 Therm -O -Flex Elastomeric Roof Coating Gray" or "TF 753 therm -O -flex Elastomeric Roof Coating Tan" acrylic roof
coating applied at I W- gal /sq.
Top Coat: "TF 1001 Therm -O -Flex Elastomeric Roof Coating White" or "TF 1002 Therm -0 -Flex Elastomeric Roof Coating
Gray" or "TF 1003 Therm -O -Flex Elastomeric Roof Coating Tan" or "TF 751 Therm -O -Flex Elastomeric Roof Coating White" or
"TF 752 Therm -O -Flex Elastomeric Roof Coating Gray" Or "TF 753 Therm -O-Flex Elastomeric Roof Coating Tan" acrylic roof
coating applied at Irh gal /sq.
Surfacing (Optional): Broadcast application of No. 11 ceramic coated roofing granules, 30-lb/sq.
6. Deck: NC Incline: 2
Foam: "LPA2500H" or "LPA280OH" "LPA3000H," any thickness.
Base Coat: "TF 1501 Therm -O -Flex High Tensile Elastomeric Roof Coating White" or "TF 1502 Therm -O -Flex High Tensile
Elastomeric Roof Coating Gray" or "TF 1503 Therm- O-Flex High Tensile Elastomeric Roof Coating Tan" or "TF 1502 HT" or "TF
1503 HT" acrylic roof coating applied at IYz- gal /sq.
Top Coat: "TF 1501 Therm -O -Flex High Tensile Elastomeric Roof Coating White" or "TF 1502 Therm -O -Flex High Tensile
Elastomeric Roof Coating Gray" or "TF 1503 Therm -O -Flex High Tensile Elastomeric Roof Coating Tan" acrylic roof coating
applied at 1 gal /sq.
Surfacing (Optional): Broadcast application of No. 11 ceramic coated roofing granules, 30-lb/sq.
7. Deck: NC I ntflrle: 3
Foam: "LPA2500H" or "LPA280OH" "LPA3000H," any thickness.
Baae Coat: "TF 2001 Therm -O -Flex Elastomeric Roof Coating park Gray" or "TF 2002 Therm-0-Flex Elastomeric Roof
Coating Light Gray" Or "TF 2003 Therm -O -Flex Elastomeric Roof Coating Beige" or "TF 2004 Therm -O -Flex Elastomeric Roof
Coating White" silicone roof coating applied at Iyz- gal /sq.
• • • • • =ep•Coab "IF *001 QAerm -O -Flex Elastomeric Roof Coating Dark Gray" or "TF 2002 Therm -O -Flex Elastomeric Roof Coating
• • big Hit (►ayor•"TP 2Up3 Therm -O -Flex Elastomeric Roof Coating Beige" or "TF 2004 Therm -O -Flex Elastomeric Roof Coating
• • •: lje" iii d jof tainting applied at 1 /z gal /sq.
• • u c Optional): •Broadcast application of No. 11 ceramic coated roofing granules, 30-lb/sq.
•• 000 00 • • • ••
8. Deck; NC Incline. 1 -3/4
i tp: /Zdataim.Icomjcg�i kVk 'iV /bemplate /LISEXT /IFRA...24& version= versionlesAparent _id= 1073993597&s� equence =I Page 1 of 4
• • •• •• •• • • •
or • • • • ••• • •
• • • • • • • • • •
••• • • • ••• • •
1
TM
RCS 5
RCS 5000 is a technologically advanced, high solids, RCS 5000 is a water -based elastomeric acrylic coating
thixotropic, acrylic elastomeric coating uniquely formulated which will freeze and become unusable at temperatures
to withstand the intense heat and ultra - violet rays, below 32 °F. PROTECT FROM FREEZING DURING
SHIPMENT AND STORAGE. Do not store material at
temperatures below 50 °F. Do not apply RCS 5000 when
RCS Is an elastomeric coating use to protect polyurethane ambient air and substrate temperatures fall below 50 °F or
foam, stucco, cinder blocks, metal, single ply, and modified when there is a possibility of temperature dropping below
bituminous roofing. RCS provides an excellent protective 32 °F within a 24 -hour period after application.
membrane that remains flexible even under adverse
conditions,
Properties Test Method/ Value
RCS 5000 may be applied by medium nap rollers, brushes, Requirements
or by conventional or airless spray equipment. Airless spray Standard Colors: STANDARD COLORS:
application is most efficient whereas rolling or brushing may TF 5001 — WHITE
be used for touch -up, flashing and edge terminations or to TF 5002 — GRAY
fill voids, pinholes, holidays or cracks. CONTACT LAPOLLA TF 5003 -TAN
INDUSTRIES TECHNICAL SERVICE PERSONNEL Tensile ASTM D2370 300003 - TAN
FOR SPECIFIC RECOMMENDATIONS, PRICING AND
AVAILABILITY OF SPRAY AND AUXILIARY EQUIPMENT. Strength:
Apply RCS 5000 only to clean, dry, sound surfaces, free Elongation: ASTM D2370 260% (t25)
of loose particles or other foreign matter. A primer may be Adhesion: ASTM C794 -D 7.0 psf PLIF(dry)
required subject to type andlor condition of the substrate. 903 3.6 psf PuF(wet)
Consult Lapolla Technical Service Personnel for specific 1 A psf Gals. Steel (dry)
primer recommendations and substrate preparation
procedures. Apply only to roofs that have adequate positive 3.0 plf Galy. Steel (wet)
drainage (i.e. a minimum slope of 118 inch per foot), Hardness ASTM D2240 62 (t2)
(Shore A):
Some separation may occur during shipment and storage, Permeability: ASTM D1653A 11 U.S. Perms
therefore the contents of each container should be
thoroughly power mixed for ten (10) to fifteen (15) minutes 20mlls
before application. Thinning is not recommended, It is Tear Resistance: ASTM D624 85 lbs /in. (t2)
recommended that RCS 5000 be sprayed in multiple Solids by Weight: ASTM D1644 67% (t3)
coats applied in multi- directional (north - south, east -west)
passes to insure uniform film build and to avoid pinholing. Solids by Volume: ASTM D 2697 55% (t3)
Backrolling sprayed material may be necessary to fill Weight per Gallon: 11,95 (±.2)
pinholes in substrate. Final cured dry film thickness must be Theoretical 13 -14 d mills 1.5 gallons
free of voids, pinholes, holidays, cracks or blisters. dry g
Coverage:
Apply in a minimum of 2 coats with each coat at a maximum Viscocity (cps): ASTM D 562 110 K.U. (t8)
rate of 1.5 gallons per 100 square feet, for a total minimum Reflectivity: NEW: 85 coating rate of 3 gallons per 100 square feet. Additional
coats of 1.5 gallons maximum per 100 square feet may AGED: 78%
be applied to obtain the desired final thickness of coating. Emmisivity wd. a .. .89
The minimum allowable dry mill thickness shall be 24 mils. uch: 4 hours
.. .
Granules may be broadcast into the final coating application Dry to po • • • • ° • • •
at a rate of 35-40 pounds per 100 square feet. No foot Tack Free • +: • • • 12 hours
traffic shall be permitted on the finished coated surface for Recoat Window: 12 hours
72 hours after application.
Shel f I•ire:• :• vWh@ • • • 6months
• • • • • stQred • a • • s •
• s iapol(a Industries, Inc. ; '' 4 u�.ta�,e z'ks.�a�,. r ast - Ste ;_?; H �.is2;;o, �e sw+f@32 :(884; i L:pgIla I mww.faPolla.com
TIM
RC S �,� , s t
T f'.
Do not apply over wet substrates or when inclement The data presented herein is not intended for use by
weather is imminent. Total cure of RCS 5000 requires nonprofessional applicators, or those persons who do not
complete evaporation of water. Cool temperatures and high purchase or utilize this product in the normal course of their
humidity retard cure. Furthermore, all white or light colored business. The potential user must perform any pertinent
coatings can cause a premature artificial dew zone during tests in order to determine the product's performance
the curing process under certain climatic conditions. This is and suitability in the intended application, since final
generated as the water in the coating evaporates, cooling determination of fitness of the product for any particular use
the white surface and attracting moisture in the form of is the responsibility of the buyer.
dew Therefore, do not apply if climatic conditions prevent
complete cure before rain, dew, or freezing temperatures. All guarantees and warranties as to products supplied
by Lapolla Industries shall have only those guarantees
RCS 5000 is not a vapor barrier coating and not and warranties expressed in writing by the manufacturer.
recommended for use over most cold storage installations. The buyer's sole remedy as to any material claims will be
Where a vapor barrier is required, contact Lapolla Technical against the applicator of the product. The aforementioned
Service Personnel for proper selection and installation data on this product is to be used as a guide and is subject
procedures. to change without notice. The information herein is believed
to be reliable, but unknown risks may be present. NO
WARRANTIES, EXPRESSED OR IMPLIED, INCLUDING
Material Safety Data Sheets are available on this coating PATENT WARRANTIES OR WARRANTIES OF
material. Any individual who may come in contact with MERCHANTABILITY OR FITNESS FOR USE, ARE MADE
these products should read and understand the M.S. D.S. BY LAPOLLA WITH RESPECT TO OUR PRODUCTS OR
In case of emergency contact CHEMTREC EMERGENCY INFORMATION SET FORTH HEREIN,
NUMBER at 800 - 424 -9300.
WARNING: Avoid eye contact with the liquid or spray mist,
Applicators should wear protective clothes, gloves and use
protective cream on face, hands and other exposed areas.
CLEAN UP: Water
EYE PROTECTION: Safety glasses, goggles, or a face
shield are recommended.
SKIN PROTECTION: Chemical resistant gloves are
recommended. Cover as much of the exposed skin area as
possible with appropriate clothing.
RESPIRATORY PROTECTION is MANDATORY!
Respiratory protective equipment, impervious foot wear
and protective clothing are required at all times during
spray application. Contact Lapolla for a copy of the Model
Respiratory Protection Program developed by API.
INGESTION: Do not take internally.
Consider the application and environmental concentrations
in deciding if additional protective measures are necessary.
To the best of our kmowfedge, the technical data contained herein is true and accurate at the date of issuance and is subject to change without prior notice. User
must contact Lapolla industries, Inc. to verify correctness before specifying or ordering, No guarantee of accuracy is given or implied. We guarantee our products
to conform to Lapolla Industries, Inc.'s quality control. We assume no responsibility for coverage, performance or injuries resulting from use. Liability, if any is
limited to replacement of product. NO OTHER WARRANTY OR GUARANTEE OF ANY KIND IS MADE BY LAPOLLA INDUSTRIES, INC., EXPRESS OR IMPLIED,
STATUTORY, BY OPERATION OF LAW, OR OTHERWISE INCLUDING MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE.
Lapolla industries. Inc, , 15 a ta..c Ra x , . ' awt c 322, Houston, Trexas 77032 I (888) 4-i-arclla i www.Iapolla.com
05/13/2010 14:59 FAX 10001
PRODUCE AND CERTIFICATE OF INSURANCE DA (MM;D
R T9t N tN
TrIIIIS rkl Buil E AMEp SURaD ding Trades and Conlructors Liability Association Inc, , A 01119/2010 )
Risk Retention ?urchasjng Group qualified under the Risk T R IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Federal Law 97.45, kelention Act of 1986; E NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
7400 South IJliun Park Ava, Suite 201 CERTIFICATE OF INSURANCE DOES NOT AFFIRMATIVELY OR
Midvale, 1) 84047 NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED
800.851 -8364 BY THE INSURANCE POLICIES BELOW.
IN INSURERS AFFORDING COVERrgGf=
Perkins Roofing Corp, INSURER A. AIOTICE:Cr sfsbefn
INSURER B; Policy issued t wemb or theTrana�wror�ld Building Tae e
INSURER 0: Contractors Liability Assoclatlon, Inc,
a Risk Retardion'Purchasinp
575 N. W. 152nd Street INSURER D; ReteGroup' a4tffOrized under ine R Retention Act of 9988: Federal Law 97 -45.
MialTi , FL 3316 -
"LIMITS SHOWN ARE THOSE IN Prime insurance company
COVERAGE$ EFFECT AS OF pOL]CV INCEPTION"
The PdtUss std Insurance listed below halm been Issued to the Insured named above far the PO40y indicated. Wnwrinstamitg arty raquiremont, term or contlltion of any COntrect or
other document with respect which this n may be Issued or may pertain, the Insurance afforded by the Policies described herain
een W b � is sub }xt t0 all the arms, er�lustons end
conditions of such policies. Ag 9repate limits is shown rosy have b daitnir,
TYPE OF INSURANCE P UCY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
GENERAL LIABILITY DATE MR r f DATE AUn UM►Ta
COMMER GENERAL LIABILITY EAC OCCU RRENCE _ S SSUU, 000.00
CLAIMS MADE ff - �D —1 OCCUR FNiE DAMAGE (Any Onal fire M 1: N/A .�
l....�I P1tc2s76- IOO]OOOC
09/21n010 olat/2011 '� -~• •• -
_ MED EXP (A�n r! r perzar f NIA�
II MalTaacrlpd poilcy PERSONAL AM INJURY N/A
GEN'LAGGAEGATEPL 4 OR
APPI,IE8 PER; GENERALAOEGATE s� S1,t100,O
POLICY JE T LAC PRODU - C O4mp AO S
AUTO LIABILITY A9r Per*pgt
s _ S34QOt10.01t ..
NNUALAGGRF,GATE
s
Q BODILY INJURY -
n (Per Person) S
BODILY INJURY
(ParAccMent) S
PROPERTY DAMAGE
GARAGELiAls TYRNIANUSCRIPTt=ORM (ParAeeident) $
SCHEDULEAUTp
PER PERSON
Lt. PERACCIDENT �
S
f� EGREGATI: r_....�,,.
1 1 s
,❑ PROPERTY DAMAGE
L �
E LIABILaTY
E] OCCUR CLAIMS MADE EACH OCCURRENCE S
RETENTION $
NGGREGATE
ULIITATION OF COVERAGE POR ADDITIONAL INBURHD .�• �� —_ ..."'.. ..
5
DEaCPoPTION Or-, PE RATIONILOCA1IQNS1VEWCL 8 jEACLU8 IONS ADpED ET pOR6EMENT />IpECIAL
commercial. PROVISION
Coverage is limited to only insured activities or operations on the Participarn Member Declaration Certificate or ay rMly 6a separately endorsed Roofing - residential, Roofing
CERTIFICATE HOLgER It ADDITIONAL INSURED
Village Of Mialni Shore$ I - � SS PAYEE
EXPIRATION DM ATE THE ABOVE DESCROED POLICIES BE THEREOF, THE ISSUING INSURE WILL E DEAVOR FO 30
10050 NE 2nd Avenue DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, St rr
Miami FL 33138 FALURE t9E E I
UPON T DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND
Building &Zoning DeParllnent IN Do ITS AGENTS OR REPRESENTATIVES,
AY THORUMO REPRaESENTA
O
CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE NO.
82885
AC10- 16000072 - 882885
5/13/2010 12:45:14PM
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Righpoint Risk services LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
14160 Dallas Parkway $500 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Dallas, TX 75254
(800) 632 -5096 (972) 715 -0959
Fax: (912) 404 -4450 INSURERS AFFORDING COVERAGE
INSURED: AMS 1 /c /f: INSURERA:
PERKINS ROOFING CORP INSURERS:
575 NW 152ND ST INSURER C;
MIAMI, FL 33169
(305) 687 -6521 Fax: (305) 681 -5397 INSURER D:
INSURER E:
VERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR I TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIO LIMITS
TR GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any One Fire) $
CLAIMS MADE ❑ OCCUR MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $
POLICY M PRO- LOG
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
SCHEDULEDAUTOS (Per person) $
HIRED AUTOS
BODILY dent) $
NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
ANY AUTO
OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
OCCUR ❑CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND WC77779991701 04/01/2010 04/01/2011 X WCSTATU- TH-
EMPLOYERS' LIABILITY 8:
E.L. EACH ACCIDENT $ 1000000
A 1000000
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $ 1000000
OTHER
LIMITS $
LIMITS I s
1. This certificate remains in effect, provided the client's account ' in good standing with AMS.
Coverage is not provided for any employyee for which the client is not reporting wagges to AMS.
Applies to 100% of the employees of AMS leased to PERKINS ROOFING CORP, effective 04 /01/2010. 2.
Insured is afforded Workers Compensation & Employers liability as a co- employer under the policy for
employees leased from AMS.
** PLEASE SEE ATTACHED EMPLOYEE ROSTER. * **
CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
SHOULU ANY OF THE ABOVE DbuCRIBED POLICIES BE CANCELLED ffftFOHft I HE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN
MIAMI SHORES VILLAGE BUILDING DEPT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
10 050 N.E. 2ND AVE. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
MIAMI SHORES, FL 33138 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25 -S (7/97) 0 ACORD CORPORATION 1988
STATE OF F! OI�lGAi 00UNTY OF DADE
rr r:.ti izti; C
���
bvr ! A et * t f
. y i U1V - 1 Itt11� itltt 111(1111(( 111t1111i11111t(l1(1(11
HhRVEt !� ( Milt 7ui � ti �� JJP
By-
OR U 27279 F's 3880; (1p
NOTICE OF COMMENCEMENT RECORDED `5/11 2010 10 :4 = 32
HARVEY RUVIN, C:LERK. OF C -URT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION MI AMI COUNTY r FLORIDA
LAST F'AC'E
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.
� (1ttM t
FL 3S, 09
/� Space above reserved for use of recording office
1. Legal description of property and street/address: S ya / C on
Ii! ` re-
2. Description of improvement:
3. Owner(s) name and address: $1iplQf. Tr/.r.-
Interest in property: 0 /0
Name and address of fee simple titleholder:
4. Contractor's name, address and phone nu mber: mj` rr,kc
5. Surety: (Payment bond required by owner from contractor, if any)
Name, address and phone number:
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, address and - phone n rte : e9/1 S C>r onC'O e -
� - w i s ! MtkAi S re L 2313 '
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 Stattlites. ,,/ G ^ /
Name, address and phone number: goi "/f T S�,f ` /vk) �,SoZ Sf t IIQMi IFT
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)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK
OR RECORDING YOUR NOTICE OF COMMENCEMENT. I
;Ir�ignature(s) of�wner(s) orOwner(s)' Authorized Officer /Director /Partner /Manage�wrP� --
Prepared By Prepared By
Print Name Z Print Name
Title/Office F Title /Office
STATE OF FLORIDA
COUNTY OF MIAMI -DADE ii /
The foregoing instrum was acknowledged before me this ) 6A day of
By S 4W_ f5 i .��, a�,
❑ Jndividually, or ❑ as for
Personally known,.or ❑ produced the following type of Identification
Signature of Notary Public:
Print Name: &
(SEAL) `
Vg P Oe Narary �`lhii�, State of Florida
VERIFICATION PURSUANT TO SECTION 92525, FLORIDA STATUTES =° �� 8,.1 ,t i Adams
Under penalties of perjury, I declare that I have read the foregoing and ` 10- ' 1— mission D0859828
that the facts stated in it are true, to the best of my knowledge and belief. o, e on Ex� "),1)9/2013
lgnature(s) of Owners} or O er(s)'s Au0torized Officer/Director /Partner /Manager who signed above:
B By
129.0152 PAGE 3 3/10
I