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RW-11-800Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 159339 Permit Number: RF -5 -11 -800 Scheduled Inspection Date: June 03, 2011 Inspector: Bruhn, Norman Owner: PATNIK, JOHN Job Address: 100 NW 100 Terrace Miami Shores, FL Project <NONE> Contractor: ENVIROTECH ROOFING & EQUIPMENT Permit Type: Roof Inspection Type: Final Roof Work Classification: Tile Phone Number (305)757 -5639 Parcel Number 1131010220290 Phone: (305)207 -4993 Building Department Comments Reroof Tile Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments e June 02, 2011 For Inspections please call: (305)762 -4949 Page 5of7 Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RE: Permit # Ae // geo DATE: lay z &i/ INSPECTION AFFIDAVIT i�- I Orcv,i1 T ePi7ctiO'P? licensed as a (n) Contractor / Engineer / Architect, (Print name and circle License Type) FS 468 Building Inspector License #: a2 cgJ / o' T On or about , I did personally inspect the roof deck nailing and (Date & time) Secondary water barrier work at ( ©a ULU 100 1 r 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) Signature State of Florida County of Dade: The undersigned, being the first duly sworn, deposes and says that he /she is the contractor for the above property mentioned. Swom to and subscribed before me this Notary Public, Sate of Florida at Large day of ..ev- oa *General, Building, Residential, or Roofing Contractors or individual certified under 468 F.S. to make such an inspectio permit # and address # clearly shown marked on the dec for each inspection Revised on 5/21/2009 u ALEJANDRA BRITO c Notary Public - State of Florida My Comm. Expires Jun 10, 2014 Commission # OD 1000541 A -1 Engineering Inspection Services, Inc 7066 SW 44th Street Miami, FI 33155 Tel: 786- 326 -9877 Fax: 305 -485 -9011 a1roofinspection@gmail.com LAB CERTIFICATION # 10- 0512 -01 SITE SPECIFIC INFORMATION UPLIFT TEST - TAS #106 Roofing Contractor ENVIROTECH ROOFING Job Address 100 NW 100 TERRACE Owner's Name JHON PATNIC Type of Tile HANSON FLAT Permit # "IL.P 511 FOC Date Installed Approximate Roof Height 12 feet Roof Pitch 3/12 Type of access to Roof OK Approximate Square Footage of Roof 17 ft 2 Required Testing Force 351bs Date Tested 6/2/2011 Number of Tests 38 Testing Equipment: F.G.E. 100 Contact Name YOSY Phone # (786) 246 -8896 LOCATION # OF TEST PASS # OF TEST FAIL Corner 7 Tests `' Pass 0 Tests Fail Perimeter 14 Tests ' Pass 0 Tests Fail Field 16 Tests " Pass 0 Tests Fail Ridge 1 Tests `I Pass 0 Tests Fail Total 38 Tests Pass 0 Tests Fail ' IN: ACCORDANCE WITH THE CRITERIA OF P' OTOCOL PA 106, THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT QUALITY CONTROL TEST. THIS TAS 106 TEST HAS BEE) PERFORMED IN LL ACCORDANCE TO THE REQUIREMENTS OF DADE COUNTY, WITH NO DEVIATIONS. THIS REPORT IS NOT GUARANTEED IN CAS OF NATO IS, RS. Cordially REMBERTO CONTRERAS P.E P.E # 21522 A -1 ENGINEERING INSPECTION SERVICES INC CERTIFICATION NO 10- 0512.01 7066 SW 44th Street Miami, FI 33155 N Telephone (786)326 -9877 Fax (305)485 -9011 A -1 Engineering Inspection Services, Inc 7066 SW 44th Street Miami, Fl 33155 Tel: 786- 326 -9877 Fax: 305 -485 -9011 alroofinspection@gmail.com LAB CERTIFICATION # 10- 0512 -01 SITE SPECIFIC INFORMATION UPLIFT TEST - TAS #106 Roofing Contractor ENVIROTECH ROOFING Job Address 100 NW 100 TERRACE Permit # S-1/ G V O Owner's Name JHON PATNIC Type of Tile HANSON FLAT Date Installed Approximate Roof Height 12 feet Roof Pitch 3/12 Type of access to Roof OK Approximate Square Footage of Roof 17 ft 2 Required Testing Force 35 /bs Date Tested 6/2/2011 Number of Tests 38 Testing Equipment: F.G.E. 100 Contact Name POSY Phone # (786) 246 -8896 SKETCH OF ROOF I t t t t t t t t t t t t t t t t t t t t t t t t t t t t Revised by 7066 SW 44th Street Miami, Fl 33155 N Telephone (786) 326 -9877 " Fax (305) 485 -9011 4, ENGINEERING 7066 SW 44th Street Miami, Fl 33155 Pb: 786 -326 -9877 Fax: 306-488 -9011 alroffinspection@gmail.com TESTING LABORATORY CERTIFICATE No 10-0512-01 INVOICE DATE 51411178 6/2/2011 SOLD TO: ENVIROTECH ROOFING SHIP TO: 100 NW 100 TERRACE Quantity Item Description Unit Price Extension 1 UPLIFT TEST $110.00 $110.00 Claims for damages, pack changes for labor or other expenses, will not be allowed unless authorized in writing by the seller. The articles and/or services covered by this invoice where produced in compliance with the Federal Fair Labor Standard Act of 1938, as amended and as per our sales contract (if applicable). PLEASE REMIT PAYMENT TO ABOVE ADDRESS TOTAL AMOUNT $110.00 DUE FIANANCE CHARGE OF 1 112 % PER MONTH WILL BE ASSESSED ON ALL PAST DUE ACCOUNTS FOR YOUR CONVENIENCE YOU CAN PLACE YOUR ORDER ON THE INTERNET AT WWW.A1ENGINEERINGINSPECTION.COM 7066 SW 44th Street Miami, Fl 33155 — Telephone (786) 326 -9877 . Fax (305) 485 -9011 Email: alroofinginspection ©gmaii.com A -1 Engineering Inspection Services, Inc 7066 SW 44th Street Miami, Fl 33155 Tel: 786- 326 -9877 Fax: 305 -485 -9011 a l roofinspection ©gma il.com LAB CERTIFICATION # 10- 0512 -01 SITE SPECIFIC INFORMATION UPLIFT TEST - TAS #106 Roofing Contractor ENVIROTECH ROOFING Permit # / F ' `! f Job Address 100 NW 100 TERRACE Owner's Name JHON PATNIC Type of Tile HANSON FLAT Date Installed Approximate Roof Height 12 feet Roof Pitch 3/12 Type of access to Roof OK Approximate Square Footage of Roof 17 ft 2 Required Testing Force 35/bs Date Tested 6/2/2011 Number of Tests 38 Testing Equipment: F.G.E. 100 Contact Name POSY Phone # (786) 246 -8896 LOCATION # OF TEST PASS # OF TEST FAIL Comer 7 Tests ' Pass 0 Tests Fail Perimeter 14 Tests v Pass 0 Tests Fail Field 16 Tests v Pass 0 Tests Fail Ridge 1 Tests ' Pass 0 Tests Fail Total 38 Tests ' Pass 0 Tests Fail IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL PA 106, THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT QUALITY CONTROL TEST. THIS TAS 106 TEST HAS BEEN PERFORMED IN FULL ACCORDANCE TO THE REQUIREMENTS OF DADE COUNTY, WITH NO DEVIATIONS. THIS REPORT IS NOT GUARANTEED IN CASE OF NATURAL DISASTERS. 7066 SW 44th Street Miami, Fl 33155 N Telephone (786)326 -9877 — Fax (305)485 -9011 • A -1 Engineering Inspection Services, Inc 7066 SW 44th Street Miami, Fl 33155 Tel: 786- 326 -9877 Fax: 305 -485 -9011 alroofinspection@gmail.com LAB CERTIFICATION # 10- 0512 -01 SITE SPECIFIC INFORMATION UPLIFT TEST - TAS #106 Roofing Contractor ENVIROTECHROOFING Job Address 100 NW 100 TERRACE Owner's Name JHON PATNIC Permit # tz.F. 60 29Q Type of Tile HANSON FLAT Date Installed Approximate Roof Height 12 feet Roof Pitch 3/12 Type of access to Roof OK Approximate Square Footage of Roof 17 ft 2 Date Tested 6/2/2011 Number of Tests 38 Testing Equipment: F,G.E. 100 Contact Name Required Testing Force 35fbs POSY Phone # i.6) 246 -8896 SKETCH OF ROOF t t t t t t t t t 4 t t t t t t t t t t t t t t t Revised by 7066 SW 44th Street Miami, Fl 33155 N Telephone (786) 326 -9877 — Fax (305) 485 -9011 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 No. ief" °// gOC) PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: BUILDING ROOFING Owner's Name (Fee Simple Titleholder) —E0\41 .R V.), "-S.?- ° Phone # ti �'Z' ��� Owner's Address \�'®\ •� . Sq. e,�,, City M . S . State F l... Zip 33 \CIO Tenant/Lessee Name - S0111 VV., C.9,44,C.9,44,\(-- _ Phone # S - - Q Email �J\(i� E- 1/4461 NM.. .CP , Job Address (where the work i$ being done). \ 0`1 \ ,w • \� -'L° 2Q- City Miami Shores Village County Miami -Dade Zip ; I i) C3 POLIO / PARCEL # /1 3.0/ °-tea —CWO Is Building Historically Designated YES NO X Flood Zone Contractor's Company Name t,f) 0 rii- 19 co-P I, 7,�Phone`# 7 3, /7-o Contractor's Address /37c31/ ,� -/ V City j%2iii`/77/ State / Zip ,i;5/ 75 Qualifier Name DA- ® r6ZAMA/,Wt2/ �/� Phone # State Certificate or Registration No. C ` 11., w" Certificate of Competency No. Contact Phone 7 'r,- -/7 -- E -mail Architect/Engineer's Name (if applicable) Phone # Value of Work Fob tl js; e ; +OD > CO Hype of Work: ❑Addition Alteration ❑ ^- ``R'ei5a race ['Demolition Square / Linear Footage Of Work: \100 -1 Ck.. Describe Work: Q�,r * * * * * * ** o * * * * * * * * * * * * * * * * * * * * * * * ** *Fees ** ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ Notary $ Training/Education Fee $ CCF $ CO /CC $ Scanning $ Radon $ DPBR $ Double Fee $ Violation date: Technology Fee $ Bond $ Structural Review. $ Total Fee Now Due $ See Reverse side --� 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 . einspection fee will be charged. Signature Owner or Agent The forego • instrument was acknowledged before me this 1% The forego day of /� ;a' , 20 // , by D h /7 /4# / k , day of who is persdnally known to me or who has produced /Z pft d who is perso c/el of As 9 entification and who did take an oath. Signature NOT Si P ALEJANDRA BRITO y Comm. Expires Jun 10. 2014 My Contractor trument was acknowledged before me this f , 20 /1, by i»w,r X s—i 11.4 ally known to me or who has produced ,-..r®,uNi /), identification and who did take an oath. // NOT Si P My ALEJANDRA BRITO tary Public - State of Florida omm. Ex Tres Jun 1 i 201 ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY Plans Examiner Zoning Engineer Clerk checked (Revised 07 /10 /07)(Revised 06/10/2009) 05/09/2011 MON 16:17 FAX 305 441 6443 FIRST CLASS INSURANCE MA 0001 /001 ACORD CERTIFICATE OF LIABILITY INSURANCE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS N0 RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. DATE (MNADD/Yrrn j 05/09/2011 First Class Insurance Market 392 Minorca Ave. Coral Gables, FL 33134 (305)441 -2997 INSURERS AFFORDING COVERAGE NAIC # INSURED Envirotech Roofing & Equipment LLC 13721 SW 21 TERRACE MIAMI, FL 33174 COVERAGES___ INSURER A: ATLANTIC CASUALTY INSURANCE INSURER B: INSURER C: INSURER D: INSURER E: _— ve.■,w yr IPIOURAPikoM L IO 1 MU 0ELL)W I1AVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO_ICY PERIOD INDICATED. NOTWITHSTANDING 1 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. ENCLUSIONS AND CONDII1ONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED By INFER .. AWL PAID CLAIMS. ..._.__ TYPE OF INSURANCE POLICY NUMBER POLICY EPFECTNE , . PDUCrF Avow LIMITS GENERAL LIABILrLY ie COMMERCIAL GENERAL Lv,BILIrY 0921010 '• _ _DAM i• ... 09/20/2010 • . , r .e. ,•, G EACH OCCURRENCE $3012 000 09/20/2011 DAMAQE TO RENTED 1GE T Ea owurt:. $50,0000 ,JJ CLAIMS MADE Q OCCUR MED Ex. (Any one person) $5,000 PERSONAL S ADV BNJURY 'F ERE— NE RAL AGATE $300,000 $300,00C {' GEN9. AGGREGATE UMIT APPLE fS PER: ..__( pOUCY �I.PIC -cT I PRODUCTS - CO&PIOP AGGU OQO COMBINED SINGLE LSAT (Ea eccldenl) . AUTOMOBILE LIABILITY I---, j ANY AUTO _J ALL OWNED AUTOS • SCHEDULED AUTOS J HIRED AUTOS II NON OWNED AUTOS BODILY INJURY (Per pawn) BOLL,/ INJURY (Per eaoldent) $ PROPERTY DAMAGE --- (Per saddest) -! - ^— • - -.. $ _...._..�— --I GARAGE LIABILITY • ANY AUTO --- L — . —... — AUTC ONLY • EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGO EACH OCCURRENCE $ $ — EXCESSIUMBRELLALWBIUTY _ OCCUR E CLAIMS MADE DEDUCTIBLE RETENTION $ AGGREGATE $ $ S, WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORfPARTNEWEXECUTIVE OFFICER/MEMBER EXCUJDED9 If yes, describe under SPECIAL PROVISIONS below : WC STATU• IJ OTH. — TORY LIMITS ER I &L EACH ACCIDENT $ EJ- DISEASE - EA EMPLOYEE S EL CISEASE -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED RY ENDORSPMFNr r nor-rim Donumetext CERTIFICATE HOLDER VILLAGE OF MIAMI SHORES 10050 NE 2 AVENUE MIAMI SHORES, FL33138 ACORD 25 (2001/08) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 111E LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NOOBUGAJ 07R'OR'tlA61(ITY OF MP' KNL'JPON THE INSURER. ITS AGENTS OR REPRESENTATI AUTHORIZED REPRESENTA © ACORD CORPORATION 1988 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: TAX FOLIO NO. 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. llIIIllOhIIHHlhIIIIIIIIIIIINIIII !II1IIII1 CFN 201. 1 80284388 OR i31: 27673 Ps 11051 (1ps) RECORDED 05/02/2011 15:41 =11 HARVEY RUV'IHr CLERK OF COURT MIAMI-DADE COUNTYr FLORIDA LAST PAGE Space above reserved for use of�recording office 49l 1. Legal description of property and street/address: 00 .10. 10 D r ( t (t Sf i�l(j� I 2. Description of improvement: 1. 3. Owner(s) name and address: —5 *., r\ . C4 T��k,'�� RD l3L0 • Qq „ ���ia,L, 33�-7Q Interest in property: t.1 CZ Cl 2)X12 - 1:731c Name and address of fee simple titleholder: 4. Contractor's name, address and phone nu ber: 5. Surety: (Payment bond required by owner from c'ntractor, 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 number: 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: 11441 't (t (the expiration datelis 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) o Owner .) or Owner(C o f d Prepared By X Print Name os er /Director /Partner /Managey Prepared By "/ f ,5'6e Il ifs ,`j Print Name Title /Office Title /Office OLt t eo_ - STATE OF FLORIDA COUNTY OF MIAMI -DADE The for _ r ing instru -nt was acknowledged before me this day of By .00A:., 2e1F9.dividually, or ❑ as for ersonally known, or ❑ produced the following type of identification: Signature of Notary Public: Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92.525 FLORI / %,,/ TATUTES Under penalties of perjury, I declare that I have read the for going and that the facts stated in it are true, to the best of my knowledge and belief. La ; a1 mtg.. EXPIRES: MAR 02 2015 7 ' Bonded through 1st State Insurance STATE OF FLORIDA, COUNT OF DADE 1 HEREBY CERTIFY that this is a tr p coyy of the Original filed in this office on 1)`�— dJ y of Signature(s) of Owner(s) or Owner(s)'s Authorized Officer /Director/Partner /Manager w ned above: , A D 20 / / By By 123.01 -52 PAGE 3 3/10 WITNE S v and and Official Seal f IP7 f;"k) GOT. t..i.' D.C. // 2 lL r�- .✓ii'• Miami Shores Viiiage 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: S■, Pt o . Property Address: \00 .0 " \ 1Q Roofing Permit Number: Dear Building Official: 140 \oN , ".� Date: certify that I am not required to retrofit the roof to wall connections of my building because: -xi The just valuation for the structure for purpose of ad valorem taxation is less than $300,000.00. Please attach proof of ad valorem taxation. ❑ 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) Pokkol?Ip Print Name State of Florida County of Dade The undersigned, being the first duly sworn, deposes and says that he /she is the owner for the above property mentioned. Swom to and subscribed before me this i da •.ts%/ Z'®// Notary Public, Sate of Florida at Larg • When the just valuation of the structure for pu 11/1111=11MW/ %/ 'Or e of ad valorem r ation is .��% 1V P 9:ii z..• _ �e�c� ALEJANDRA BRIM il. .__ Notary Public - State of Florida %,""9,... tyi `AQ� Ives Jun 10. 2014 , o��o.41 Commission # DD 1000541 SFBC. Then you must provide a building ap cation from a General Contractor for Revised on 5/21/2009 oof to Wall connection Hurricane Mitigation. with FBC nor a 1994 11-18-2010 ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: FEIN: 11/18/2010 EXPIRATION DATE: 11/17/2012 FERNANDEZ DARWIN 262692151 BUSINESS NAME AND ADDRESS: ENVIROTECH ROOFING & EQUIPMENT LLC 13721 SW 21ST TERRACE MIAMI FL 33175 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED ROOFING CONTRACTOR IMPORTANT: Pursuant to Chapter 440 . 05114), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under tbls chapter. Pursuant to Chapter 440.05112), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation 0, at any time after the filing of the notice or the issuance of the certificate. the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke it certificate at any time for failure of the person named on the certificate to meet the requirements of this section. )WC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 QUESTIONS? (850) 413 -1609 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 11/18/2010 EXPIRATION DATE: 11/17/2012 PERSON: DARWIN FERNANDEZ FEIN: 262882151 BUSINESS NAME AND ADDRESS: ENVIROTECH ROOFING & EQUIPMENT LLC 13721 SW 21ST TERRACE MIAMI, FL 33175 SCOPE OF BUSINESS OR TRADE 1- CERTIFIED ROOFING CONTRACTOR IMPORTANT F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who O elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt... apply only within the scope of the business or trade listed on E the notice of election to be exempt. R E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 CUT HERE w Carry bottom portion on the job, keep upper portion for your records. WC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 ROOF ASSEMBLIES AND ROOFTOP STRUCTURES Florida Building Code Edition 2007 High- Velocity Hurricane Zone Uniform Permit Application Fo spit-lion A (General Information) Master Permit No. �roocess No. Contractor's Name & /,1j '' �o/� f,%%,0/ L�', Job Address ,�j . / ❑ Low Slope 0 Mechanically Fastened Tile ® Mortar /Adhesive Set Tile ❑ Asphaltic ❑ Metal Panel /Shingles ❑ Wood Shingles /Shakes Shingles ❑ Prescriptive BUR -RAS 150 ROOF TYPE ❑ New Roof I3 Reroofing ❑ Recovering ROOF SYSTEM INFORMATION ❑ Repair ❑ Maintenance Low Slope Roof Area SF) Steep Sloped Roof Area (SF) ®� Total (SF) / 7e0 q� /�v/ Spr_tin� of Planed 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. ■•■■ ■■■■■■ ■ ■■■■■■ ■IIMIU■■ ■■■■■■■■■■ ■ ■■■ ■■■■ •■1 ■ ■■ ;■■ ■ ■ ■ ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■ ■1■■■ B■ III a■■■■ O ■ ■■■■■■ ■■ ■ ■ ■E■1■ ■■ ■■ ■■ ■■■ ■ ■■■■■■■■■ ■ ■■■'■ ■■ ■■ ■ ■■■■■■ ■■■■■ ■■■■ ■■■i ■■u,•■ ■ ■■ ■ ■ ■ ■ ■■■■■■■■■■■■■1■■■�Q■ i' ■iwiiii i iii ii ME ■■ ■■� ■■■■� ■�■■ ■■�■■■ ■ ■■■■ ■ ■■■■■■■■ ■ ■ ■ ■ ■ ■ ■ ■ ■■■ ■ ■ ■ ■ ■■ ■■■■■■■ ■ ■ ■ ■■ ■ ■ ■ ■■! ■■ ■■■■ ■■ ■■ ■ ■■■■ ■■ ■■■■■■■■I■■ ■ ■ ■i■■■• ■■■ ■■i■■■ ■■■■■■1■■ ■ ■■■ ■■■■••�■U■■ ■••N•�■■ FLORIDA BUILDING CODE — BUILDING SECTION R4402.13 HIGH VELOCITY HURRICANE ZONES — REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS 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. Additionally, the following items should be addressed as part of the agreement between the owner ant the contractor. The 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 p viding 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 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. . Renailing wood decks: When replacing roofing, the existing wood roof deck may have to be nailed in accordance with the current provisions of Section R4403. (The roof deck is usually concealed prior to remo ing the existing roof system). 3. Common roofs: Common roofs are those which have no visible delineation between neighboring its (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 to be performed. 4. • ` Exposed Ceiling: Exposed, open beam ceilings are where the underside of the roof decking can or- viewed from below. The owner may wish to maintain the architectural appearance; therefore, roofing nail penetration of the underside of the decking may not be acceptable. This provides the option of maintaining the a . pear ce. 5. ` Ponding water: The current roof system and /or deck of the building may not drain well and may use 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 expectancy and performance of the new roofing system. Pounding conditions may not be evident until the original rrffing system is removed. Pounding conditions should be corrected. 6. c ` Overflow scuppers (wall outlets): It is required that rainwater flows off so that the roof is not erloaded from a buildup of water. Perimeter /edge wall or other roof extension block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to instal overflow scuppers in accordance with the requirements of Sections R4402, R4403 and R4413. 7. Ventilation: Most roof structures should have some ability to vent natural airflow through the i rior of the structure assembly (the building itself). The existing amount of a is ventilation shall not be reduced. It may be beneficial to consider additional venting which can result in nding the service life of the roof. ner /Agent's Signature Date y' z -1� Revised on 7/9/2009 LD Contractor Signature Date t Tile IIooj System "Delivering Excellence Every Day" Roof System Manufacturer: Miami -Dade County Building Department Electronic Application Section D Sloped System Description Tile Roof System [ HANSON ROOF TILE Notice of Acceptance Number (NOA): 10- 0706.08 Minimum Design Wind Pressures, If Applicable (from RAS 127 or Calculations): P 1: P 2: P3: Maximum Design Wind Pressures, (From the NOA Specific system): 4 _.. psf Fill in the specific roof assembly components. If a component is not required, insert not applicable (n/a) in the text box. Roof Slope: "112" Roof Mean Height: 16 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: Drip Edge Fastener Type: —3" face 24 ga. -- 1 -1/4 RS NAIL Hook Strip /Cleat gauge or weight: - Select Hook Strip — Deck Type: —5/8" Plywood— Optional Insulation: NA Optional Nailable Substrate: NA..,._.... _. Optional Nailable Substrate Attachment: INA Basesheet Type: ASTM FELT 30# D226 Fastener Type for Basesheet Attachment: 1 -1/4 RS NAIL AND TIN CAP 1 -5/8 Tile Underlayment (Cap Sheet ) Type: FASTM FELT 90# Tile Underlayment Attachment Method: HOT MOP ASPHALT TYPE IV Tile Profile: HANSON FLAT TILE • Section 5 2 MIAMI• "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 the 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. P1: ' x) P 2: 78 x P 3: x ?, grs - Mg: - Mg: Mg: = Mr1: = Mr2: = Mr3: Method 3 "Uplift Based Tile Calculations Per RAS 127" NOA Mf NOA Mf NOA Mf 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: Ell x 1: xl: xl: Ell x w: xw: xw: - W: - W: - W: cos 0: =Fr1: x cos 0: = Fr2: x cos 0: = Fr3: Where to Obtain Information to complete tile calculations Where to Find NOA F' NOA F' NOA F' Table 1 RAS 127, or by an engineer analysis prepared, signed and sealed by a professional engineer based on ASCE 7. Restoring Moment due to Gravity Attachment Resistance Job Site Job Site Product Approval (NOA) Product Approval (NOA) Product Approval (NOA) Required Moment Resistance Calculated Minimum Attachment Resistance Required Uplift Resistance Product Approval (NOA) Average Tile Weight Tile Dimensions I = length w =width Calculated Product Approval (NOA) Product Approval (NOA) MIAMI•DADE COUNTY BUILDING CODE COMPLIANCE OFFICE (BCCO) PRODUCT CONTROL DIVISION MIAMI -DADE COUNTY, FLORIDA METRO -DADE FLAGLER BUILDING 140 WEST FLAGLER STREET, SUITE 1603 MIAMI, FLORIDA 33130 -1563 (305) 375 -2901 FAX (305) 375 -2908 NOTICE OF ACCEPTANCE (NOA) Hanson Roof Tile 1340 SW 34 Ave Deerfield Beach, FL. 33442 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 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: Hanson Flat Tile including Slate, Chalet Shake, Southern Shake, and Victorian Slate 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 revises NOA #09- 0928.04 and consists of pages 1 through 8. The submitted documentation was reviewed by Alex Tigera. NOA No.: 10- 0706.08 Expiration Date: 04/10/13 Approval Date: 09/15/10 Page 1 of 8 ROOFING ASSEMBLY APPROVAL Category: Sub- Category: Material: 1. SCOPE This is a new system using Hanson Flat Tile including Slate, Chalet Shake, Southern Shake, and Victorian Slate, as manufactured by Hanson Roof Tile Inc. in Deerfield Beach, Florida 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. Roofing Flat Profile Roofing Tiles Concrete 2. PRODUCT DESCRIPTION Manufactured by Test Applicant Dimensions Specifications Hanson Flat Tile Hanson Slate Hanson Chalet Shake 1= 17.25" w= 13" I = 17.25" w= 13" 1= 17.25" w= 13" Hanson Southern 1= 17.25" Shake w = 13" Hanson Victorian 1= 17.25" Slate w = 13" Trim Pieces 1= varies w = varies varying thickness TAS 112 Product Description Flat, interlocking; concrete tile equipped with two nail holes. For direct deck or battened nail -on, mortar or adhesive set applications. TAS 112 Flat, interlocking, concrete tile equipped with two nail holes. For direct deck or battened nail -on, mortar or adhesive set applications. TAS 112 Flat, interlocking, concrete tile equipped with two nail holes. For direct deck or battened nail -on, mortar or adhesive set applications. TAS 112 Flat, interlocking, concrete tile equipped with two nail holes. For direct deck or battened nail -on, mortar or adhesive set applications. TAS 112 Flat, interlocking, concrete tile equipped with two nail holes. For direct deck or battened nail -on, mortar or adhesive set applications. TAS 112 Accessory trim, concrete roof pieces for use at hips, rakes, ridges and valley terminations. Manufactured for each tile profile. 2.1 SUBMITTED EVIDENCE: Test Aeencv Test Identifier IBA Consultants, Inc. 2381 -265 Redland Technologies 7161 -03 Appendix III 94 -084 The Center for Applied Engineering, Inc. Test Name/Report TAS 112 Static Uplift Testing TAS 102 & TAS 102(A) Static Uplift Testing TAS 101 (Mortar Set) Date Feb. 2008 Dec. 1991 May 1994 NOA No.: 10-0706.08 Expiration Date: 04/10/13 Approval Date: 09/15/10 Page 2 of 8 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. The Center for Applied Engineering, Inc. Redland Technologies Redland Technologies Redland Technologies Redland Technologies The Center for Applied Engineering, Inc. Nutting Engineering Celotex Corporation Testing Service Celotex Corporation Testing Service Walker Engineering, Inc. Walker Engineering, Inc. Walker Engineering, Inc. Walker Engineering, Inc. Walker Engineering, Inc. Walker Engineering, Inc. Walker Engineering, Inc. 94 -060A 25- 7094 -2 25- 7094 -8 25- 7094 -5 25- 7183 -6 25- 7183 -5 25- 7214 -1 25- 7214 -5 7161 -03 Appendix II Letter Dated Aug. 1, 1994 P0631 -01 P0402 Project No. 307025 Test #MDC -77 13343.1 520109 -1 520111 -4 520191 -1 Calculations Calculations Evaluation Calculations Evaluation Calculations Evaluation Calculations Evaluation Calculations Calculations Static Uplift Testing TAS 101 (Adhesive Set) 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) 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 Quilt -Drive Screw, Direct Deck) Static Uplift Testing TAS 102 (1 Quik -Drive Screw, Battens) Wind Tunnel Testing TAS 108 (Nail -On) Wind Tunnel Testing TAS 108 (Nail -On) Wind Tunnel Testing TAS 108 (Mortar Set) Withdrawal Resistance Testing of screw vs. smooth shank nails Wind Driven Rain TAS 100 Physical Properties TAS 112 Static Uplift Testing TAS 101 Static Uplift Testing TAS 101 Aerodynamic Multiplier Restoring Moments 25 -7094 25 -7496 25 -7584 25- 7804b -8 25- 7804 -4 & 5 25- 7848 -6 25 -7183 Two Patty Adhesive Set System March, 1994 Oct. 1994 Oct. 1994 Oct. 1994 Feb. 1995;; Feb. 1995 March, 1995 March, 1995 Dec. 1991 Aug. 1994 July 1994 Sept. 1993 Oct. 1994 Aug. 2006 Dec. 1998 March 1999 May 2006 May 2006 February 1996 April 1996 December 1996 March 1995 April 1999 NOA No.: 10- 0706.08 Expiration Date: 04/10/13 Approval Date: 09/15/10 Page 3 of 8 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 Roofmg 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 Hanson Flat Tile including Slate, Chalet Shake, Southern Shake, and Victorian Slate 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) Hanson Flat Tile including Slate, Chalet Shake, Southem Shake, and Victorian Slate 11.6 1.4375 1.08 Table 2: Aerodynamic Multipliers - A (ft3) Tile A (ft3) A (ft3) Profile Batten Application Direct Deck Application Hanson Flat Tile including Slate, Chalet Shake, 0.304 0.330 Southem Shake, and Victorian Slate Direct Deck Battens Table 3: Restoring Moments due to Gravity -511,, (ft -Ibf) Tile Profile 2 ":12" 3 " :12" 4 ":12" 5 ":12" 6 ":12" 7 ":12" greater Battens or Direct Deck Hanson Fiat Tile including Slate, Chalet Shake, Southern Shake, and Victorian Slate Battens Direct Deck Battens Direct Deck Battens Direct Deck Battens Direct Deck Battens Direct Deck 7.53 8.25 7.46 8.17 7.35 8.05 7.20 7.88 7.02 7.69 6.83 7.48 NOA No.: 10-0706.08 Expiration Date 04 /10/13 Approval Date. 09/15/10 Page 4 of 8 Table 4: Attachment Resistance Expressed as a Moment - Mr (ft -Ibf) for Nail -On Systems Tile Profile Fastener Type Direct Deck (min 15/32" plywood) Direct Deck (min. 19/32" plywood) Battens Hanson Flat Tile including Slate, Chalet Shake, Southem Shake, and Victorian Slate 2 -10d Ring Shank Nails 30.9 38.1 17.2 1 -10d Smooth or Screw Shank Nail 7.3 9.8 4.9 2 -10d Smooth or Screw Shank Nails 14.0 18.8 7.4 1 #8 Screw 30.8 30.8 18.2 2 #8 Screw 51.7 51.7 24.4 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 Rin • Shank Nails' 50.3 65.5 48.3 1 Installation with a 4" tile headlap and fasteners are located a min. of 2W from head of tile. Table 5: Attachment Resistance Expressed as a Moment Mr (ft-Ibf) for Two Patty Adhesive Set Systems Tile Profile Tile Application Minimum Attachment Resistance Hanson Fiat Tile including Slate, Chalet Shake, Southern Shake, and Victorian Slate Adhesive 31.3° 2 See manufactures component approval for installation requirements. 3 Flexible Products Company TileBond Average weight per patty 13.9 grams. Pol oam Product, Inc. Avera•ewei.ht •er •a 8 'rams. Table 6: Attachment Resistance Expressed as a Moment - Mr (ft -Ibf) for Single Patty Adhesive Set Systems Tile Profile Tile Application Minimum Attachment Resistance Hanson Flat Tile including Slate, Chalet Shake, Southem Shake, and Victorian Slate PolyProTM 118.9" PolyProTM 40.4° 4 Large paddy placement of 45 grams of PolyPro TM. 5 Medium paddy placement of 24 grams of PolyProTM. Table 7: Attachment Resistance Expressed as a Moment - Mr(ft-Ibf) for Mortar or Adhesive Set Systems Tile Profile Tile Application Attachment Resistance Hanson Fiat Tile including Slate, Chalet Shake, Southern Shake, and Victorian Slate Mortar Sets 43.9 6 Tile -rite Roof Tile Mortar. • 7'ma$ APPROVED NOA No.: 10- 0706.08 Expiration Date: 04/10/13 Approval Date: 09/15/10 Page 5 of 8 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 ". • • ••• • • •••• ••• • • • • • • •• • • • • •• • AND /OR ••••• ••••• • • • ••• • • • • • • • • • • • • •• • • • • • • •••• •• ••• • • • • HANSON FLAT TILE INCLUDING SLATE, CHALET SHAKE, SOUTHERN SHAKE, AND VICTORIAN SLATE (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.: 10- 0706.08 Expiration Date: 04/10/13 Approval Date: 09/15/10 Page 6 of 8 PROFILE DRAWINGS HANSON SLATE TILE CHALET SHAKE TILE NOA No.: 10- 0706.08 Expiration Date: 04/10/13 Approval Date: 09/15/10 Page 7 of 8 SOUTHERN SHAKE MIAMI. I. 1.E QP APPROVED VICTORIAN SLATE END OF THIS ACCEPTANCE NOA No.: 10- 0706.08 Expiration Date: 04/10/13 Approval Date: 09/15/10 Page 8 of 8 M I A M I•DADE ` BUILDING CODE COMPLIANCE OFFICE (BCCO) PRODUCT CONTROL DIVISION NOTICE OF ACCEPTANCE (NOA) Polyfoam Products, Inc. 11715 Boudreaux Road Tomball, TX 77375 MIAMI -DADE COUNTY, FLORIDA METRO -DADE FLAGLER BUILDING 140 WEST FLAGLER STREET, SUITE 1603 MIAMI, FLORIDA 33130 -1563 (305) 375 -2401 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 the BCCO and accepted by the Building Code and Product Review Committee 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 BCCO (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. BCCO reserves the right to revoke this acceptance, if it is determined by BCCO 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 High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION: Polypro® AH160 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 renews NOA No.01- 0521.02 and consists of pages 1 through 7 The submitted documentation was reviewed by JPrge L. Acebo. NOA No.: 06- 0201.02 Expiration Date: 05/10 /11 Approval Date: 04/13/06 Page 1 of 7 ROOFING ASSEMBLY 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® AH160 N/A TAS 101 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. /fl 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. NOA No.: 06- 0201.02 Expiration Date: 05/10/11 Approval Date: 04 /13/06 Page 2 of 7 EVIDENCE SUBMITTED: Test Agency 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 Celotex 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® AH 160 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® A11160 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. F` W 2; F= MS NOA No.: 06- 0201.02 Expiration Date: 05 /10/11 Approval Date: 04/13/06 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 Polypro® 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® AH160 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 Foampro® dispensing equipment is required before application of any adhesive. The mix ratio between the "A" component and the "B" component shall be maintained between 1.0- 1.15 (A): 1.0 (B). The dispense timer shall be set to deliver 0.0175 to 0.15 pounds per tile as determined at calibration. No other settings shall be approved. 6. Polypro® AH160 shall be applied with Foampro 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® A11160 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. NOA No.: 06- 0201.02 Expiration Date: 05/10/11 Approval Date: 04 /13/06 Page 4 of 7 ADHESIVE PLACEMENT DETAIL 1 SINGLE PATTY NOA No.: 06-0201.02 Expiration Date: 05/10/11 Approval Date: 04/13/06 Page 5 of 7 ADHESIVE PLACEMENT DETAIL 2 SINGLE PATTY NOA No.: 06- 0201.02 Expiration Date: 05 /10 /11 Approval Date: 04/13/06 Page 6 of 7 ADHESIVE PLACEMENT DETAIL 3 DOUBLE PATTY END OF THIS ACCEPTANCE NOA No.: 06- 0201.02 Expiration Date: 05/10/11 Approval Date: 04 /13/06 Page 7 of 7