RF-11-946Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 160133 Permit Number: RF -5 -11 -946
Scheduled Inspection Date: June 28, 2011
Inspector: Bruhn, Norman
Owner: NIELSON, ANGELA
Job Address: 9302 NW 2 Court
Miami Shores, FL 33138-
Project: <NONE>
Contractor: BARCELONA CONSTRUCTION GROUP, INC.
Permit Type: Roof
Inspection Type: Final Roof
Work Classification: Tile
Phone Number
Parcel Number 1131010150090
Building Department Comments
RE -ROOF TILE ROOF
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
ec ,-
June 27, 2011
For Inspections please call: (305)762 -4949
Page 10 of 15
60
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit No.
Master Permit No.
Permit Type: BUILDING ROOFING ,,1 Rc i H u ES T N? ` y c
OWNER: Name (Fee Simple Titleholder): l''� 1 11-�. C(, , -1 Phone #: A �° �0 �� (4 5 �f
Address: 92 0 2— A) W 2 �✓ At C _ _
City: / _` Ge?.4.t.st_: 5 ke- ,a'-C'5 State: Zip: 3_31 5 0
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: /(3 NJQ -t.;" .Q ( 4
City: Miami Shores
County:
Folio/Parcel #: I -.3 (e l -r15- COO
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name:
Address: S r i c t <c G.. )
Miami Dade Zip: 3-.3 950
NO / Flood Zone:
eLsw1/4-e -. 7 o - 2 tc7 2.9.S'
er(k_cQ 1 Co s w Gro t - Phone #: `76 (, 2 t2- 3
City: \,- ( f State: J2 (— Zip: • 71 )-7 1/4-1
Qualifier Name: v 1%.- CA) ■1/4,?. t O7 i 1 Phone #: %S &, 2S ���
State Certification or Registration #: PAL CA) b `7 C -Z Certificate of Competency #: 0 5 C C� b S S
Contact Phone #: 7 N, %G ®,_2_3 Email Address: -7, r €iN-i 9 De A° R f -J % 07 L Q C `"
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ q � 1'00, 0 0 Square/Linear Footagesof Work:
Type of Work: ❑Additiao�n UAlteration ❑New RQepair/Rep1ace ❑Demolition
Description of Work: C,e i' `) E e �� lc , 1 i Tr\ c1►
(1 /c /.- /4,4 v_
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * **
v
Submittal Fee $ Permit Fee $ /J CCF $ . CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
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.
- Signature
The foreg
day of t ,20 / /,by mj oval ein rRo , day of
who is perso
ZOO', As identification and who did take an oath.
Owner or Agent
nstrument was acknowledged before me this /7 The foregoin." '' .trument was acknowledged before me this /7
,20 // ,by
ally known to me or who has produced ,e'jj 5'who is perso : ly known to me or who has produced] jt m
as identification and who did take an oath.
NOT
NOTAR
My
A
__,,, —� s:, ,'_ Votary Public -State of Florii
,{ice�- %__�'1;1441_ '''
�';`u 1 iss /�'*' " " "� Commission # DD 1000541
ALEJANDRA BRITO
Notary Public - State of Florida
My Comm. Expires Jun 10. 2114
Commission # OD 1000541
APPROVED BY
(Revised 07 /10 /07)(Revised 06 /10 /2009XRevised 3/15/09)
Plans Examiner
Structural Review
Zoning
Clerk
1
Miami Shores Vtiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
OWNERS'S AFFIDAVIT OF EXEMPTION
ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR EXISTING SITE -
BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES
PERSUANT TO SECTION 553.844 F.S.
To: Miami Shores Village Building Department
10050 NE 2nd Ave
Miami Shores, Fl 33138
Re: Owner's Name: /4 RC- Z ill V 67:5 f G &Lc
Property Address: 9;o 2 V W a of
Roofing Permit Number:
Dear Building Official:
6(.;,d CCtSACi certify that I am not required to retrofit the roof to wall connections of my
building because:
just valuation for the structure for purpose of ad valorem taxation is less than $300,000.00. Please attach proof of ad
Xrhe
valorem taxation.
o The building was constructed in compliance with the provisions of the Florida Building Code (FBC) or with the provisions
of 1994 edition of the South Florida Building Code (1994 SFBC)
Date: r • r /
Ail ez. 7R0
Print Name 0i M Re- fit ACS TT !.ec
State of Florida
County of Dade
The undersigned, being the first duly swom, deposes and says that he/she is the owner for the above property mentioned.
Sworn to and subscribed before me this
Notary Public, Sate of Florida at Large
J'•• ALEJANDRA BRITO
Notary Public - State of Florida
. My Comm. Expires Jun 10. 2014
�,� -' Commission # DD 1000541
• When the just valuation of the structure for pu; . a of ad vats =m taxation a or more than $ 7* , us 0.0. , an the bu din, wa - no constructed wffh FBC nor a 1994
SFBC. Then you must provide a building application from a General Contractor for the Roof to Wall connection Hurricane Mitigation.
Revised on 5/21/2009
Miami -Dade My Home
My Home
ia'._.. idade go.
Show Me:
Property Information
Search By:
Select Item
N Text only
ta Property Appraiser Tax Estimator
Property Appraiser Tax
Comparison
Summary Details:
Folio No.:
11- 3101 -015 -0090
Property:
9302 NW 2 CT
Mailing
Address:
MRC INVESTING LLC
2921 185 ST #1202
AVENTURA FL
33180-
Property Information:
Primary Zone:
0800 SINGLE FAMILY
RESIDENCE
CLUC:
0001 RESIDENTIAL -
SINGLE FAMILY
Beds /Baths:
3/1
Floors:
1
Living Units:
1
Adj Sq Footage:
1,468
Lot Size:
8,826 SQ FT
Year Built:
1940
Legal
Description:
ODELL MANORS PB 41-
57 LOT 1 BLK 2 LOT
SIZE IRREGULAR OR
18880- 4321 10 1999 1
OR 27357 -2720 0710 12
Assessment Information:
Year:
2010
2009
Land Value:
$70,686
$145,883,
Building Value:
$113,867
$121,579
Market Value:
$184,553
$267,462
Assessed Value:
$184,553
$267,462
Exemption Information:
Year:
2010
2009
Homestead;,
$0
$25,000
2nd Homestead:
NO
YES
Taxable Value Information:
ear:
2010
2009
Taxing Authority:
Applied
Exemption/
Taxable
Value:
Applied
Exemption/
Taxable
Value:
Regional:
$0/$184,553
$50 000/
$217.462
Page 1 of 2
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SECTION R44(
HIGH VELOCITY HURRICANE ZONES — REQUIRED
CONSIDERATIONS
Miami Shores Village
APPROVED
BY
DATE
ZONING DEPT
BLDG DEPT
L%')"
WITH ALL
-'�`
,J'oC5 -7
FEDERAL
't IiJI CT TO COMPLIANCE
�. 3
bWNl ' NOMAMITORERMING
R4402.13.1 Scope. As it pertains to the section, it is the responsibility of roofing contractor to provide the owner
with the required roofing permit, and to explain to the owner the content of the section. The provisions of Section
R4402 govem the minimum requirements and standards of the industry for roofing system installations.
Additional , the following items should be addressed as part of the agreement between the owner ant the
contrac he owner's initial in the designated space indicates that the item has been explained.
1. _ Aesthetics - Workmanship: the workmanship provisions of Section R4402 are for the purpose of
re e'. ing that the roof system meets the wind resistance and water instruction performance standards.
Aesthetics (appearance) are not a consideration with respect to workmanship provisions. Aesthetic issues
such s color or architectural appearance, that are not part of a zoning code, should be addressed as part of
the ' ement between the owner and the contractor.
Renailing wood decks: When replacing roofing, the existing wood roof deck may have to be
in accordance with the current provisions of Section R4403. (The roof deck is usually concealed prior
ving the existing roof system).
Common roofs: Common roofs are those which have no visible delineation between neighboring
townhouses, condominiums, etc.) In buildings with common roofs, the roofing contractor and/or
r ould notify the occupants of adjacent units of roofing to be performed.
i J Exposed Ceiling: Exposed, open beam ceilings are where the underside of the roof decking can
b"'ed from below. The owner may wish to maintain the architectural appearance; therefore, roofing nail
on of the underside of the decking may not be acceptable. This provides the option of maintaining the
ap l ' nce.
. '! /l Ponding water: The current roof system and /or deck of the building may not drain well and may
se water to pond (accumulate) in low -lying areas of the roof. Pounding can be an indication of structural
distress and may require the review of a professional structural engineer. Pounding may shorten the life
expe r ncy and performance of the new roofing system. Pounding condition «. ay not be evident until the
ori• ,i/ roofing system is removed. Pounding conditions should be correc
6. / ,� Overflow scuppers wall outlets): It is required that rainwa
( ) q
7r'rlo•ded from a buildup of water. Perimeter /edge wall or other roof e
�.
� >;w scuppers (wall outlets) are not provided. It may be necessa
i Ic' / ance with the requirements of Sections R4402, R4403 and R
of is not
ischarge if
rs in
Ventilation: Most roof structures should have some abili ve¢` >''u alrflo ;'rough the
erior of the structure assembly (the building itself). The existing amount of attic ventilation II not be
reduced. It may be • - neficial to consider additional venting which can result in extending the service life of the
roof.
5P: / 1(
er /Agents Signature Date
Revised on 7/9/2009 LD
Con o 'gnature Date
ROOF ASSEMBLIES AND ROOFTOP STRUCTURES
Florida Building Code Edition 2007
High- Velocity Hurricane Zone Uniform Permit Application Form.
Section A (General Information)
Master Permit No. Process No.
Contractor's Name 2 (lf(1 -a0 A The S / j'`(re Ion Cq dC -+;cvn
Job Address C3 ( o? w lam-' c 1"1; Ss ► `i-' -t
0 Low Slope
❑ Asphaltic
Shingles
❑ Mechanically Fastened Tile I Morta
❑ Metal Panel /Shingles ❑ Wood Shingles/Shakes
Adhesive Set
❑ Prescriptive BUR -RAS 160
)(Reroofing ROOF TYPE
❑ New Roof ❑ Recovering
Low Slope Roof Area (SF)
❑ Repair ❑ Maintenance
ROOF SYSTEM A
INFORMATION d" 0 6-il.� (%[`'i/
Steep Sloped Roof Area (SF) do Total (SF)
Section R (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.
2
t
FLORIDA BUILDING CODE — BUILDING
y • • • • _ •---
Tile Roof System
c
"Delivering bite lretice Every Day"
Roof System Manufacturer:
Miami-Dade County Building Department Electronic Application
Section D Sloped System Description
Tile Roof System
EAGLE ROOFING PRODUCT
Notice of Acceptance Number (NOA):
Minimum Design Wind Pressures, If Applicable (from RAS 127 or Calculations):
P1:
-45.1
P 2:
P 3.
Maximum Design Wind Pressures, (From the NOA Specific system): 45:5 psf
Fill in theVeFifiC,Xoof assembly components. ff a component is not required, insert not applicable (n/a) in the text box.
—Roof-St°
Roof Mean Height:
"/12" - -
ft.
Method of Tile Attachment:
[-Adhesive, Medium Paddy Polyfoam Polypro-
Alternate Method of Tile Attachment per NOA:
Drip Edge Size & Gauge:
Drip Edge Material Type:
face 26 ga.-r
—Galvinized Metal—
Drip Edge Fastener Type: 11-1/4 RS NAIL 4"0C
Hook Strip/Cleat gauge or weight: — Selecl_22,1291_, j< Strip —
Deck Type:
1„--5/8".,plyw_oodT
Optional Insulation:
Optional Nailable Substrate:
Optional Nailable Substrate Attachment:
Basesheet Type:
1ASTM FELT 30# D226
Fastener Type for Basesheet Attachment:
lteenseammememej
11-1/4 rs nail & tin cap 6 oc@lap 12"oc@ field
Tile Underlayment (Cap Sheet ) Type:
1ASTM 90# FELT
Tile Underlayment Attachment Method:
HOT MOP ASPHALT TYPE IV
Tile Profile:
EAGLE MALIBU CONCRETE TILE
Section E 2
MIAMO
"Delivering Excellence Every Day"
Miami-Dade County Building Department Electronic Application
High Velocity Hurricane Zone Roofing Permit Application Form
Section E (Tile Calculations)
Method 1 "Moment Based Tile Calculations Per RAS 127"
For Moment based tile systems, use Method 1. Compare the values for Mr with the values from Mf. If the Mf values are
greater than or equal to the Mr values, for each area of the roof, then the tile attachment method is acceptable.
P 1:
P 2:
P 3:
-78.6
x X
0.282
- Mg:
- Mg:
- Mg:
-45.5
-45.5
NOA Mf
NOA Mf
NOA Mf
Method 3 "Uplift Based Tile Calculations Per RAS 127"
For Uplift based tile systems use Method 3. Compare the values for F' with the values for Fr. If the F' values are greater than or equal to the Fr values, for
each area of the roof, then the tile attachment method is acceptable.
P1:
P2:
P3:
x 1:
x 1:
x1;
111.
NMI
X w:
X
X W.
11111
11111
111.11
1111111
x cos 0:1-1 = Fr1:
x cos 0:171 = Fr2:
x cos 0: 1,71 = Fr3:
111.
1111
Where to Obtain information to complete tile calculations
< MN NOA F'
51111 NOA F'
< -1111 NOA F'
Description
Symbol
Where to Find
Design Pressure
Table 1 RAS 127, or by an engineer analysis prepared, signed and sealed by a professional
P1 or P2 or P3 engineer based on ASCE 7.
Mean Roof Height
H
Job Site
Roof Slope
0
Job Site
Aerodynamic Multiplier
X
• Product Approval (NOA)
Restoring Moment due to Gravity
Mg
Product Approval (NOA)
Attachment Resistance
Mf
Product Approval (NOA)
Required Moment Resistance
Mr
Calculated
Minimum Attachment Resistance
F'
Product Approval (NOA)
Required Uplift Resistance
Average Tile Weight
Fr
Calculated
Product Approval (NOA)
Tile Dimensions
I = length
w = width
Product Approval (NOA)
MIA MMADE
BUILDING CODE COMPLIANCE OFFICE (BCCO)
PRODUCT CONTROL DIVLSION
NOTICE OF ACCEPTANCE (NOA)
Eagle Roofing Products LLC
1575 East C.R. 470
Sumterville, FL 33585
MIAMI -DADE COUNTY, FLORIDA
METRO -DADE FLAGLER BUILDING
140 WEST FLAGLER STREET, SUITE 1603
MIAMI, FLORIDA 33136 -1563
(305) 375 -2901 FAX (305) 375 -2908
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. If 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
inatcrial 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: Malibu Concrete Tile
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 he available for inspection at the job site at the request of the Building Official.
This NOA consists of pages 1 through 7.
!'he submitted documentation was reviewed by Alex Ti era.
e--
NOA No.: 06- 0526.09
Expiration Date: 10/05/11
Approval Date: 10/05/06
Page 1 of 7
ROOFING ASSEMBLY APPROVAL
Category:
Sub - Category:
Material:
Roofing
07320 Roofing Tiles
Concrete
1. SCOPE
This approves a system using Burlingame Industries Malibu Concrete Roof Tile, as manufactured
by Eagle Roofing Products LLC in Sumterville, FL. and described in Section 2 of this Notice of
Acceptance-. For locations where the pressure requirements, as determined by applicable Building
Code does not exceed the design pressure values obtained by calculations in compliance with RAS
127 using the values listed in section 4 herein. The attachment calculations shall be done as a
moment based system.
2. PRODUCT DESCRIPTION
Manufactured by
A pplicant
Test
Dimensions Specifications
Malibu Concrete Tile 1 17"
w =12/"
'/" thick
Trim Pieces
I = varies
w = varies
varying thickness
2.1 SUBMITTED EVIDENCE:
Test Agency
PRI Construction Materials
Technologies
Redland Technologies
Redland Technologies
Redland Technologies
The Center for Applied
Engineering, Inc.
The Center for Applied
Engineering, Inc.
Redland Technologies
TAS 112
TAS 112
Test Identifier
PRI06178
7161 -03
Appendix III
7161 -03
Appendix B
P0402
94 -060B
94 -084
P0631 -01
Product
Description
Low profile, interlocking, high pressure
extruded concrete roof tile equipped with
three nail hole and double roll ribs. For direct
deck or battened nail -on, mortar or adhesive
set applications.
Accessory trim, concrete roof pieces for use
at hips, rakes, ridges and valley terminations.
Manufactured for each tile profile.
Test Name/Report
TAS 112
Static Uplift Testing
TAS 102 & TAS IO2(A)
Wind Tunnel Testing
TAS 108 (Nail -On)
Withdrawal Resistance Testing of
screw vs. smooth shank nails
Static Uplift Testing
TAS 101 (Adhesive Set)
Static Uplift Testing
TAS 101 (Mortar Set)
Wind Tunnel Testing
TAS 108 (Mortar Set)
Date
08/23/06
Dec. 1991
Dec. 1991
Sept. 1993
March, 1994
May 1994
July 1994
NOA No.: 06- 0526.09
Expiration Date: 10/05/11
Approval Date: 10/05/06
Page 2of7
Test Agency
Redland Technologies
Professional Service
Industries, Inc.
The Center for Applied
Engineering, Inc.
The Center for Applied
Engineering, Inc.
The Center for Applied
Engineering, Inc.
The Center for Applied
Engineering, Inc.
The Center for Applied
Engineering, Inc.
The Center for Applied
Engineering, Inc.
The Center for Applied
Engineering, Inc.
Celotex Corporation
Testing Services
Walker Engineering, Inc.
Walker Engineering, Inc.
Walker Engineering, Inc.
Walker Engineering, Inc.
Walker Engineering, Inc.
Walker Engineering, Inc.
Walker Engineering, Inc.
Test Identifier
Letter Dated Aug. 1,
1994
224 -47099
25- 7094 -1
25- 7094 -7
25- 7094 -4
Project No. 307025
Test #MDC -760
25- 7183 -1
25- 7183 -2
25- 7214 -2
25- 7214 -6
528454 -2 -1
520109 -2
Evaluation Calculations
Evaluation Calculations
Evaluation Calculations
Evaluation Calculations
Evaluation Calculations
Calculations
Calculations
Test Name/Report
Wind Tunnel Testing
TAS 108 (Nail -On)
Physical Properties
TAS 112
Static Uplift Testing
TAS 102
(4" Headlap, Nails, Direct Deck,
New Construction)❑
Static Uplift Testing
TAS 102
(4" Headlap, Nails, Battens)
Static Uplift Testing
TAS 102
(4" Headlap, Nails, Direct Deck,
Recover/Reroof)
Wind Driven Rain
TAS 100
Static Uplift Testing
TAS 102
(2 Quik -Drive Screws, Direct
Deck)
Static Uplift Testing
TAS 102
(2 Quik -Drive Screws, Battens)
Static Uplift Testing
TAS 102
(1 Quik -Drive Screw, Direct Deck)
(1 Quik -Drive Screw, Battens)
Static Uplift Testing
TAS 101
Two Patty Adhesive Set System
25 -7183
25 -7094
25 -7496
25 -7584
25- 7804b -8
25- 7804 -4 & 5
25- 7848 -6
Aerodynamic Multiplier
Restoring Moment Due to Gravity
Date
Aug. 1994
Sept. 1994
Oct. 1994
Oct. 1994
Oct. 1994
Oct. 1994
Feb. 1995
Feb. 1995
March, 1995
Sep. 1998
Dec. 1998
April 1999
March 1995
February 1996
April 1996
December
1996
Sep. 2006
Sep. 2006
NOA No.: 06- 0526.09
Expiration Date: 10/05/11
Approval Date: 10/05/06
Page 3 of 7
3. LIMITATIONS
3.1 - Fire classification is not part of this acceptance.
3.2 For mortar or adhesive set tile applications, a static field uplift test shall be performed in
accordance with TAS 106.
3.3 Applicant shall retain the services of a Miami -Dade County Certified Laboratory to perform
quarterly test in accordance with TAS 112, appendix `A'. Such testing shall be submitted to
the Building Code Compliance Office for review.
3.4 Minimum underlayment shall be in compliance with the applicable Roofing Applications
Standards listed section 4.1 herein.
3.5 30/90 hot mopped underlayment applications may be installed perpendicular to the roof slope
unless stated otherwise by the underlayment material manufacturers published literature.
3.6 This acceptance is for wood deck applications. Minimum deck requirements shall be in
compliance with applicable building code.
4. INSTALLATION
4.1 Eagle Roofing Products LLC Malibu Concrete Tile and its components shall be installed in
strict compliance with Roofing Application Standard RAS 118, RAS 119, and RAS 120.
4.2 Data For Attachment Calculations
Table 1: Average Weight (W) and Dimensions (I x w )
Tile Profile
Weight -W (ibf)
Length -I (ft)
Width -w (ft)
Malibu Tile
9.5
1.417
1.04
Table 3: Restoring Moments due to Gravity - MA (ft-Ibf)
Tile
Profile
Table 2: Aerodynamic Multipliers - A.
ft3)
5 ":12"
Tile
7 ":12" or
greater
A, (ft3)
X (ft3)
Direct
Deck
Profile
Direct
Deck
Batten Application
Direct Deck Application
Malibu Tile
. Direct
Deck
Battens
0.305
0.282
Table 3: Restoring Moments due to Gravity - MA (ft-Ibf)
Tile
Profile
3 ":12"
4 ":12"
5 ":12"
6 " :12"
7 ":12" or
greater
Malibu Tile
Battens
Direct
Deck
Battens
Direct
Deck
Battens
Direct
Deck
Battens
. Direct
Deck
Battens
Direct
Deck
6.30
6.65
6.21
6.54
6.08
6.41
5.93
6.25
5.77
6.08
NOA No.: 06- 0526.09
Expiration Date: 10/05/11
Approval Date: 10/05/06
Page4of7
Table 4: Attachment Resistance Expressed as a Moment - Mf (ft-Ibf)
for Nail -On Systems
Tile
Profile
Fastener Type
Direct Deck
(min 15/32"
plywood)
Direct Deck
(min. 19/32"
plywood)
Battens
Malibu Tile
2 -10d Ring Shank Nails
27.8
37.4
28.8
1 -10d Smooth or Screw
Shank Nail
8.8
11.8
4.1
2 -10d Smooth or Screw
Shank Nails
16.4
21.9
7.1
1 #8 Screw
25.8
25.8
22.9
2 #8 Screw
47.1
47.1
49.1
1 -10d Smooth or Screw
Shank Nail (Field Clip)
24.3
24.3
24.2
1 -10d Smooth or Screw
Shank Nail (Eave Clip)
19.0
19.0
22.1
2 -10d Smooth or Screw
Shank Nails (Field Clip)
35.5
35.5
34.8
2 -10d Smooth or Screw
Shank Nails (Eave Clip)
31.9
31.9
32.2
2 -10d Ring Shank
Nails'
43.0
67.5
50.9
Installation with a 4" tile headlap and fasterners are located a min. of 2W from head of tile.
Table 5: Attachment Resistance Expressed as a Moment Mf (ft -Ibf)
for Two Patty Adhesive Set Systems
Tile
Profile
Tile Application
Minimum Attachment
Resistance
Malibu Tile
Adhesive2
26.13
2 See manufactures component approval for installation requirements.
3 Flexible Products Company TileBond Average weight per patty 11.4 grams.
Polyfoam Product, Inc. Average weight per patty 8 grams.
Table 5A: Attachment Resistance Expressed as a Moment - Mf (ft-Ibf)
for Single Patty Adhesive Set Systems
Tile
Profile
Tile Application
Minimum Attachment
Resistance
Malibu Tile
Polyfoam PolyProTM
86.61 4
Polyfoam PolyProTM
45.5
4 Large paddy placement of 54grams of PolyProTM.
5 Medium paddy placement of 24grams of PolyProTM.
NOA No.: 06- 0526.09
Expiration Date: 10 /05/11
Approval Date: 10 /05/06
Page 5 of 7
5. LABELING
All tiles shall bear the imprint or identifiable marking of the manufacturer's name or logo (See
Detail Below), or following statement: "Miami -Dade County Product Control Approved ".
lAS�
FLORIDA
MALIBU CONCRETE ROOF TILE LABEL, SUMTERVILLE. PLANT
(LOCATED ON UNDERSIDE OF TILE)
6. BUILDING PERMIT REQUIREMENTS
6.1 Application for building permit shall be accompanied by copies of the following:
6.1.1 This Notice of Acceptance.
6.1.2 Any other documents required by the Building Official or applicable building
code in order to properly evaluate the installation of this system.
NOA No.: 06.0526.09
Expiration Date: 10/05/11
Approval Date: 10/05/06.
Page 6 of 7
Table 5B: Attachment Resistance Expressed as a
for Mortar Set Systems
Moment - Mf (ft -Ibf)
Attachment
Resistance
Tile
Profile
Tile
Application
Malibu Tile
Mortar Set'
20.60
5. LABELING
All tiles shall bear the imprint or identifiable marking of the manufacturer's name or logo (See
Detail Below), or following statement: "Miami -Dade County Product Control Approved ".
lAS�
FLORIDA
MALIBU CONCRETE ROOF TILE LABEL, SUMTERVILLE. PLANT
(LOCATED ON UNDERSIDE OF TILE)
6. BUILDING PERMIT REQUIREMENTS
6.1 Application for building permit shall be accompanied by copies of the following:
6.1.1 This Notice of Acceptance.
6.1.2 Any other documents required by the Building Official or applicable building
code in order to properly evaluate the installation of this system.
NOA No.: 06.0526.09
Expiration Date: 10/05/11
Approval Date: 10/05/06.
Page 6 of 7
PROFILE DRAWING
NAL
KOLE
MALIBU CONCRETE ROOF TILE
END OF THIS ACCEPTANCE
NOA No.: 06- 0526.09
Expiration Date: 10/05/11
Approval Date: 10/05/06
Page 7 of 7
MIAMNDiIoIDE
COUNTY
BUILDING AND NEIGHBORHOOD COMPLIANCE DEPARTMENT (BNC)
BOARD AND CODE ADMINISTRATION DIVISION
NOTICE OF ACCEPTANCE (NOA)
Polyfoam Products, Inc.
11715 Boudreaux Road
Tomball, TX 77375
MIAMI -DADE COUNTY
PRODUCT CONTROL SECTION
11805 SW 26 Street, Room 208
Miami, Florida 33175 -2474
T (786) 315 -2590 F (786) 315 -2599
www.miannidade.eov/buildine/
SCOPE:
This NOA is being issued under the applicable rules and regulations governing the use of construction materials.
The documentation submitted has been reviewed and accepted by Miami -Dade County BNC - Product Control
Section 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
Section (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. If 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. BNC
reserves the right to revoke this acceptance, if it is determined by Miami -Dade County Product Control
Section 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
including the High Velocity Hurricane Zone of the Florida Building Code.
DESCRIPTION: Polypro® A11160
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 renews NOA# 06- 0201.02 and consists of pages 1 through 7.
The submitted documentation was reviewed by Alex Tigera.
NOA No.: 11- 0124.04
Expiration Date: 05/10/12
Approval Date: 04/14/11
Page 1 of 7
ROOFING COMPONENT APPROVAL:
Category: Roofing
Sub Category: Roof tile adhesive
Materials: Polyurethane
SCOPE:
This approves Polypro® AH160 as manufactured by Polyfoam Products, Inc. as described in Section 2
of this Notice of Acceptance. For the locations where the design pressure requirements, as determined by
applicable building code, does not exceed the design pressure values obtained by calculations in
compliance with Roofing Application Standard RAS 127, for use with approved flat, low, and high
profile roof tiles system using Polypro® AH 160. Where the attachment calculations are done as a
moment based system for single patty placement, and as an uplift based system for double patty systems
PRODUCTS MANUFACTURED BY APPLICANT:
Product Dimensions Test
specifications
Polypro AH 160 N/A TAS 101
414
Foampro® RTF1000 N/A
ProPack® 30 & 100 N/A
Product Description
Two component polyurethane foam
adhesive
Dispensing Equipment
Dispensing Equipment
PRODUCTS MANUFACTURED BY OTHERS:
Any Miami -Dade County Product Control Accepted Roof Tile Assembly having a current NOA which
list moment resistance values with the use of Polypro AH160 roof tile adhesive.
PHYSICAL PROPERTIES:
Property
Density
Compressive Strength
Tensile Strength
Water Absorption
Moisture Vapor Transmission
Dimensional Stability
Closed Cell Content
Test
ASTM D 1622
ASTM D 1621
ASTM D 1623
ASTM D 2127
ASTM E 96
ASTM D 2126
ASTM D 2856
Results
1.6 lbs. /ft.3
18 PSI Parallel to rise
12 PSI Perpendicular to rise
28 PSI Parallel to rise
0.08 Lbs./Ft2
3.1 Perm / Inch
+0.07% Volume Change @ -40° F., 2 weeks
+6.0% Volume Change @158 °F., 100%
Humidity, 2 weeks
86%
Note: The physical properties listed above are presented as typical average values as determined
by accepted ASTM test methods and are subject to normal manufacturing variation.
M1AMI.DADE COUNTY
APPROVED
NOA No.: 11- 0124.04
Expiration Date: 05/10/12
Approval Date: 04/14/11
Page 2 of 7
EVIDENCE SUBMITTED:
Test Alencv Test Identifier Test Name/Report Date
Center for Applied Engineering #94 -060 TAS 101 04/08/94
257818 -1PA TAS 101 12/16/96
25- 7438 -3 SSTD 11 -93 10/25/95
25- 7438 -4
25- 7438 -7 SSTD 11 -93 11/02/95
25 -7492 SSTD 11 -93 12/12/95
Miles Laboratories NB- 589 -631 ASTM D 1623 02/01/94
Polymers Division
Ramtech Laboratories, Inc. 9637 -92 ASTM E 108 04/30/93
Southwest Research Institute 01 -6743 -011 ASTM E 108 11/16/94
01- 6739- 062b[1} ASTM E 84 01/16/95
Trinity Engineering 7050.02.96 -1 TAS 114 03/14/96
Cclotex Corp. Testing Services 528454 -2 -1 TAS 101 10/23/98
528454 -9 -1
528454 -10 -1
520109 -1 TAS 101 12/28/98
520109 -2
520109 -3
520109 -6
520109 -7
520191 -1 TAS 101 03/02/99
520109 -2 -1
LIMITATIONS:
1. Fire classification is not part of this acceptance. Refer to the Prepared Roof Tile Assembly for fire
rating.
2. Polypro AH160 shall solely be used with flat, low, & high tile profiles.
3. Minimum underlayment shall be in compliance with the Roofing Application Standard RAS 120.
4. Roof Tile manufactures acquiring acceptance for the use of Polypro® AH160 roof tile adhesive with
their tile assemblies shall test in accordance with TAS 101.
5. Roof Tile manufactures acquiring acceptance for the use of HANDI -STICK roof tile adhesive with
their tile assemblies shall test in accordance with TAS 101 with section 10.4 as modified herein.
—W
2
F' MS
MIAMIDADE COUNTY
APPROVED
NOA No.: 11-0124.04
Expiration Date: 05/10/12
Approval Date: 04/14/11
Page 3 of 7
INSTALLATION:
1. Polypro® AH160 may be used with any roof tile assembly having a current NOA that lists uplift
resistance values with the use of Polyproo AH160.
2. Polypro® AH160 shall be applied in compliance with the Component Application section and the
corresponding Placement Details noted herein. The roof tile assembly's adhesive attachment with
the use of Polypro® A11160 shall provide sufficient attachment resistance, expressed as an uplift
based system, to meet or exceed the uplift resistance determined in compliance with Miami -Dade
County Roofing Application Standards RAS 127. The adhesive attachment data is noted in the roof
tile assembly NOA
3. Polypro® AH160 roof tile adhesive and its components shall be installed in accordance with
Roofing Application Standard RAS 120, and Polyfoam Products, Inc. Polypro® AH160 Operating
Instruction and Maintenance Booklet.
4. Installation must be by a Factory Trained 'Qualified Applicator' approved and licensed by Polyfoam
Products, Inc. Polyfoam Products Inc. shall supply a list of approved applicators to the authority
having jurisdiction.
5. Calibration of the Foamproo 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 0.0175 to 0.15 pounds per tile as
determined at calibration. No other settings shall be approved.
6. Polypro® AH160 shall be applied with Foanipro RTF1000 or ProPack® 30 & 100 dispensing
equipment only.
7. Polypro AH160 shall not be exposed permanently to sunlight.
8. Tiles must be adhered in freshly applied adhesive. Tile must be set within 2 to 3 minutes after
Polypro® AH160 has been dispensed.
9. Polypro® AH160 placement and minimum patty weight shall be in accordance with the. 'Placement
Details' herein. Each generic tile profile requires the specific placement noted herein.
Table 1: Adhesive Placement For Each Generic Tile Profile
Tile Profile
Placement
Detail
Single Paddy
Weight Min.
(grams)
Two Paddy Weight
per paddy Min.
(grams)
Flat, Low, High Profiles
#1
35
N/A
High Profile (2 Piece
Barrel
#1
17 /side on cap and
34 /pan
N/A
Flat, Low, High Profiles
#2
24
N/A
Flat, Low, High Profiles
#3
8
LABELING:
All Polypro® AH160 containers shall comply with the Standard Conditions listed herein.
BUILDING PERMIT REQUIREMENTS:
As required by the Building Official or applicable building code in order to properly evaluate the
installation of this system.
MANMADE COUNTY
APPROVED
NOA No.: 11- 0124.04
Expiration Date: 05 /10/12
Approval Date: 04/14/11
Page 4 of 7
ADHESIVE PLACEMENT DETAIL 1
SINGLE PATTY
Neil through plastic cement
Undedayment
Paddy (Beneath Tile)
10 In.
EaveCowse
Eon Mauro
Omens only:
Kee rom os ox 4ie.np
Feeele.
1) Wars enough adhesive to eaten 11 to 29 OpUonal 2tc4's for
square h ches I n c o n t a c t t h e pan We steep plleh eppBcetlav
2) Um coves upside dem. Place whale 112
In
To 1 In. From *Okla ego of web.
Theo Install the go.
Undoriaymmant
Nets through piatk cement
�
ppoem
course covet We.
Abut loaned ewe of
owlet
flush etaava line.
Eno closet Weephoie Fade
()
Optional
Pointvp Mello
on longitudinal
edge oldie
NOA No.: 11 -0124.04
Expiration Date: 05/10/12
Approval Date: 04/14/11
Page 5 of 7
ADHESIVE PLACEMENT DETAIL 2
SINGLE PATTY
NOA No.: 11-0124.04
Expiration Date: 05/10/12
Approval Date: 04/14/11
Page 6 of 7
ADHESIVE PLACEMENT DETAIL 3
DOUBLE PATTY
Nall through plastic cement
Paddy
(between tile)
Paddy
(under tilo)
•
x 3 In.
Single paddy on
under-
layment
Single paddy
under the
Single paddy
on top of tile
e course
in. X 7 In. medium
size paddy eave
Fascia course only
Nall through plastic cement
Nall through plastic cement
Underlayment
Jr
Single paddy under the
Single paddy between tile
2 In. x 71n. medium
site paddy Dave
course only
at.
3 in.
41n.
Single
paddy on
tunier-
layment
Single paddy
on top of Me
Eave
Course
Pestle
Weeptele
Eave closure
Drip edge
Single paddy
between 15 e
Pelln.x 3 In.
Single paddy
on tmderlayment
Single paddy
on top of tlie
Eave Course
Ewa:lure
2 in.x 7 in. warm
slue paddy eave course only
Fascia
END OF THIS ACCEPTANCE
NOA No.: 11-0124.04
Expiration Date: 05/10/12
Approval Date: 04/14/11
Page 7 of 7
oRsy Miami Shores Viiiage
Building Department
��ORiDA
RE: Permit # R F5//?''
INSPECTION AFFIDAVIT
1 Z f (w cx., nun a) licensed as a (n
(Print name and drele License Type)
License #: O' T
On or about j, d° p
(Date & time)
Secondary water barrier work at 47 � '�, gd (r.,; ?J '- j a rya CA„,,, e5 PI _1-ff r
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the Hurricane Mitigation Retrofit
Manual (Based on 553.844 F.S)
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
DATE: g/2‘/2e//
Contractor
FS 468 Building Inspector
Engineer / Architect,
, I did personally inspect the roof deck nailing and
State of Florida
County of Dade:
The undersigned, being the first duly swom, deposes and says that he /she is the contractor for the above property
mentioned.
Swom to and subscribed before me this // I da "i
Notary Public, Sate of Florida at Lar'
.••••rfro
`General, Building, Residential, or Roofing Contractors , any individual certified under 4
permit # and address # clearly shown marked on the ceck for each inspection
Revised on 5/21/2009
oar` "ee,,; ALEJANDRA BRITO
• 411-W Public : Public - State of Florida
in, Q, My Comm. Expires Jun 10, 2014
••,-r,Rugt.s, Commission # DD 1000541
S. to make such an
,,.1
on. Include photographs of each plane of the roof with
Q.I.E.
FLORIDA INTERNATIONAL
ENGINEERING & TESTING LAB
INSIGHT • INNOI ?1TION• IN Y EGRATION
FLORIDA INTERNATIONAL ENGINEERING AND TESTING LAB LLC
16701 SW 117 Avenue, Miami, Florida 33177
Telephone: (305) 378-1991- Fax: (305) 378 -1997
Miami -Dade Lab Certification # 07- 0612.11
SITE SPECIFIC INFORMATION
Representatives of Florida International Engineering and Testing Lab., Inc performed the static load test on the roofing tile at
the above referenced project. The purpose of this testing was to verify whether the installed tile roofing system is capable of
resisting the applied test load of 45 pounds uplift force. This testing was performed in general accordance with Miami Dade
Building Code Protocol TAS 106. The static load was applied utilizing a calibrated scale and force measuring instrument
(dynamometer). A hook which is connected to the loading instrument was placed under the exposed edge of the tile. Test load of
40 pounds force (lbf) was applied and also held for more than 5 second at each test location. In addition to the static load test, the
tested tile was also visually inspected for any kind of adhesion failure after completion of each test.
No.
Result
No.
Result
No.
Result
No.
Result
No.
Result
No.
Result
No.
Result
1
21
41
61
81
101
121
2
♦
22
42
62
82
102
122
3
23
43
63
83
103
123
4
24
44
64
84
104
124
5
25
45
65
85
105
125
6
26
46
66
86
106
126
7
27
47
67
87
107
127
8
28
48
68
88
108
128
9
29
49
69
89
109
129
10
30
50
70
90
110
130
11
31
51
71
91
111
131
12
32
,
52
72
92
112
132
13
33
53
73
93
113
133
14
34
54
74
94
114
134
15
35
55
75
95
115
135
16
36
56
76
96
116
136
17
37
57
77
97
117
137
18
38
58
78
98
118
138
19
39
59
79
99
119
139
20
40
60
80
100
120
140
Based on our findings, we conclude that the installed roofing tile at the above referenced project is capable to resist the applied test
load. Therefore we conclude that it meets the Miami Dade Building Code Compliance Protocol TAS 106. Attached is the roof plan
showing approximate test locations.
Respectfully Submitted:
Vinayagar M. Balakrishnan V, P :E.
State of Florida Lie 0 63107
)ob Address:
Contractor
Other.
Sketch of Roof
z 6 - r a , Wi lis . S-R{e cam- ,eA,. tA 4 -f
(Jr')
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Notes
CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/T YY)
6/6/2011
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pailcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certHicate holder In lieu of such endoreement(s).
PRODUCER
MARSAN FINANCIAL GROUP INC
7440 SW 50 Terr Ste 100
Miami, FL 33155
CONTACT
NAME:
Fax
,AtC�No.Ext).(305)740 -9938 (,�,No);(305} 740 -9948
EAD6DRLESS:info @orangeins.com
WSURER(e) AFFORDING COVERAGE
NAIC6
INSURER A : LLoyds of London
LIABILITY
COMMERCIAL GENERAL LIABILITY
INSURED BARCELONA CONSTRUCTION GROUP, INC
5801 NW 151 STREET SUITE 101
HIALEAH , FL 33014
305 - 698 -6431 BARBARA
INSURER B :
GCJIR -X
INSURER C :
2/24/2012
INSURERD:
$ 1,000,000
INSURER E :
$ 100 , 00 0
INSURER F:
CLAIMS-MADE OCCUR
COVERAGES
CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
nLTRR
TYPE OF INSURANCE
R
tNVD
POLICY NUMBER
(MMIDOI'm
(NRuUDD1YYY'()
LIMITS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
GCJIR -X
2/24/2011
2/24/2012
EACH OCCURRENCE
$ 1,000,000
PDRREM DAMAGE IQ (E.��rence)
$ 100 , 00 0
CLAIMS-MADE OCCUR
MED EXP (Any one person)
$ EXCLUDED
PERSONAL 8, ADV INJURY
$ 1 , 000 , 000
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMPIOP AGG
$ 1, 000 , 000
GEL AGGREGATE LIMIT APPLIES PER
7 POLICY n .P{ERCar 1--- I LOC
sI PD DED
t 1NED) INGLE LIMIT
$ 1,000
$
AUTOMOBILE
—
—
—
LABILITY
ANYAUTO
ALL OWNED
AUTOS
HIRED AUTOS
—
—
SCHEDULED
NON -OWNED
AUTOS
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per eccldarr
$
$
—
UMBRELLA � L
EXCESS LIAR
—
OCCUR
CLAIMS-MADE
EACH OCCURRENCE
$
AGGREGATE
$
$
DED 1 I RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORMARiNERIEXECUTIVE
OFFICER/AMBER EXCLUDED?
(Mandvary In N!q
It yes describe under
DESCRIPTION OF OPERATIONS below
N/A
I WC
I TORY LIM 8 I Y R
E.L. EACH ACCIDENT
5
EL DISEASE - EA EMPLOYEE
$
E.L DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
MIAMI SHORES VILLAGE BUILDING DEPARTMENT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
305 - 756 -8572
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED R - - 'E= Nr•TIVE
'ii�
ACORD25(2010/05)
®1988 -2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO.
fAtel "c TAX FOLIO NO. / /-310 / -b15-000
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
STATE OF , Notice OF FADE Commencement.
1 HEREBY CERTIFY that this is s kre copy of the
filed fn tie office on day of
AD2O
ar efttr
Qrlvr
2. Description of improvement: 124 - i2o r7'
1111111 11111 11111 11111 1111111111 11111 1111 1111
1GF14 201 1LRi �353r i1
DR Sk 27705 Pe 2609; (1as)
RECORDED 05/31/2011 14:1157
HARVEY RUV'IN? CLERK OF COURT
MIAMI -GAGE COUNTY? FLORIDA
LAST PAGE
Space above reserved for use of recording office
7 2 rU k) °z. o°1-
3. Owner(s) name and address: / 0 h (.1e - l',) L e 01907 / / <65 S I, ./ 1. e) !-(kin1 /4 fl 3 3/ O
Interest in property: Pty 7 de-es, k-1"9 L
Name and address of fee simple titleholder: /l% //1-
4. Contractor's name, address and phone number. aar v •� 51-re -. 13,n S I s `" Jd fz 37/7y
5. Surety: (Payment bond required by owner from contractor, if any)
Name, address and phone number:
Amount of bond $ /r /I
6. Lender's name and address: V' .
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 number: Al 11
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes.
Name, address and phone number:
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.
Signature(s) of Owner(s) or Owner(s)' Authorized
Prepared By
Print Name M ge-- gold V OS70V6
Title /Office
STATE OF FLORIDA.
COUNTY OF MIAMI -DADE
The foregoing insttime t was acknowledged before me this /7
By /I•!l'td G S tya
❑ Individually, or ❑ as
known, o
Ofcer /Director/Partner/Manager� I� h
Prepared By a C
Print Name 5-ore -- 6■ro -�
Title /Office L2/,//B C /
S ,t'.fkc'r° e! k— f
roduced the following type of id
Signature of Notary Public:
Print Name:
(SEAL)
VERIFICATION PURSUANT TO SECTION 92.525 FLORID
Under penalties of perjury, 1 declare that I have read the fore
that the facts stated in it are true, to the best of my knowle
Signature(s) of Owner(s
By
123.01 -52
s Authorized Office
r
t�cati
-- fir% id
TOTES
g and
and belief.
irector/Partner/Manager who signed above:
/0440 • 774
Notary Public - State of Florid
My Comm. Expires Jun 10, 2014
ommissian # DD 1000541
1 v �l e 15 ' fro J
By