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RF-11-1991Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 166317 Permit Number: RF -10 -11 -1991 Scheduled Inspection Date: November 08, 2011 Inspector: Bruhn, Norman Owner: OR OWNERS, CURRENT OCCUPANT Job Address: 941 NE 91 Terrace Miami Shores, FL 33138 -3219 Project: <NONE> Contractor: C &G PROFESSIONAL CONSTRACTORS INC Permit Type: Roof Inspection Type: Final Roof Work Classification: Repair Roof Phone Number Parcel Number 1132060030050 Phone: (305)527 -0581 Building Department Comments VALLEY METAL REMOVED,. REPLACE ALL BROKEN TILES ON ROOF. Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 165917. NO LADDER NO PERMIT POSTED. JR cc_ November 07, 2011 For Inspections please call: (305)762 -4949 Page 7 of 14 BUII.D PERMIT APPLICATION Fsc 20 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" Permit No. 1 it � I Master Permit No. Permit Type: BUILDING y� ROOFING (Fee Si lmple Titleholder): /1G��" At2 13 1Addres : 4& UUi /e z / e , c-CL- }i i 2; t ei, State Al OCT 2 6 2011 ivOL°/z/1W6 1,4 LLB zips 3/'09 Nowt: - -763 Tenant/Lessee Name: /, p j5iz t G / j t . JOB ADDRESS: City: Folio /Parcel#: y / A/E ,9/ 7 frem.e Miami Shores County: J/-3?0X — (03 —00 . 0 Miami Dade Zip: .1313 7 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: �i rD 5S; AYIJ ( (QCfd/S CPhone# 3tS '521' °SFi Address: /. �9p 4. f)o frPtAR City: ilia (77 Qt 421'1,.$ State: /. Q Zip: ,130/ Qualifier Name: a n®Q , y Phone#: 50,E - e.Se% State Certification or Registration #: 17'? Certificate of Competency #: Contact Phone#: 9O,S ' 5)r7 -053/ Email Address: ( l ` ONTRALTO/.TP(C AoL _ COQ AV/1 DESIGNER: Architect/Engineer: Phone#: NM Value of Work for this Permit: $ R, /7j 3 vO Square/Linear Footage of Work: oZ.SO 9. a � Type of Work: DAddition �/ ❑Alteratiio"n' /� - Description of Work: Valley MO 1-0,41 � i,viol all 4ogli 7--#1 UNew epair/Replace ODemolition iaploteAd aid 41401,02 C3 0 ic1-6 * ****a *a*e* ^ * * ** * *a* *saw ** *** * ** Fees * * * **vvv**v**s* ** *s * **a=aa * * * ** *rove** ** Permit Fee $ /0 d CCF $ Submittal Fee $ 5(0 i • l AJ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ a 2-0 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. 1 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. 1 understand that a separate permit must be secured for ET .FCTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: 1 certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspect' n which occurs seven days after the building permit is issued In the absence of sucz rosted notice, the inspection will .. approv ! and a re i Y;!ction fee will be charged. i'!Signature 1' u Owner or gent The foregoing instrument was ackno ledged before me this day of 0 *L/, 20 11 , by 6/ Y/l(c C�C�'ler ' who is rsonally know—ibo me or who has produced — As identification audewho did take an oath. NOT PUBLIC: Sign: Print: \Aett C�-3 My Commission Expires: 4 r,.SisahaaaaaaafiSSa a9.aa@ **'$=:aH'gZ* a'x*. g.s "40a¢$e*414A *004 ..+3s.4 $�'s34+. '. MY COMMISSION # DD913804 APPROVED BY / •'Y' 15 EXPIRES August 0$,3Ex rvlce.com The for day of , who is personally known to me or who has produced F4,/,G '1,21' t "Pl ' identification and who . " r 1 take an oath. nt was acknowledged before me thislpf,e 20 iJ, by LlZ (�ZZ NOT 'YP Sign: Print: C: My Commission Expires: c—,5 ***************44.14401.3101. t v4, 02673 ,OT tckl. JULIA AMOSOVA ..*S. MY COMMISSION # DD913804 *WIA ugu talff3 (407) 398-0153 FtofldaNareryService.com •• ner Zoning Structural Review (Revised 07 /10/07)(Revised 06/10 /2009)(Revised 3/15/09) Clerk 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 Date: o y; Ao 10050 NE 2nd Ave Miami Shores, Fl 33138 Re: Owner's Name: /V,2'/ i9 A477-0274/6',f �" , LLe, Property Address: ? l-H A/E q / Roofing Permit Number: Dear B . . Official: .5€ aCeAro errae,e certify that I am not required to retrofit the roof to wall connections of my building because: )(file just valuation for the structure for purpose of ad valorem taxation is less than $300,000.00. Please attach proof of ad valorem taxation. o The building was constructed in compliance with the provisions of the Florida Building Code (FBC) or with the provisions of 1994 ed. n of th- /south Florida '1g Code (1994 SFBC) Signature 4cagie) :Print Name State of Florida County of Dade The undersigned, being the first duly swom, deposes and says that h she;s the owner for the above property mentioned. Swom to and subscribed before me this �t2 Y. � day of c Notary Public, Sate of Florida at Large 722 014. JULIA AMOSOVA "? MY COMMISSION # 00913804 EXPIRES August 04.2013 FIOrldallotaryServlce.com • When the just valuation of the structure for purpose of ad valorem taxation is equal to or more than $300,000.00, and the building was not constructed with 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 Property Information Report http://gisims2.miamidade.gov/myhome poptext_printasp?folio=11320... My Home Property Information Report Summary Details: MIAMI-DADE 41116 Folio No.: " Property 941 NE 91 TER Mailing Address: JAMES MOUSSA-BAES &W JACQUELINE 941 NE 91 TERR MIAMI SHORES FL 33138-3219 Propertv Information: Primary Zone: 0900 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds/Baths: 4/3 Floors: 1 Living Unfts: 1 Adj Sq Footage: 2,764 Lot Size: 11,787.06 SQ FT Year Built 1941 Legal Description: Pl- OF BISCAYNE RIDGE PB 39-41 LOT 6 & E22FT LOT 7 & W3FT LOT 5 BLK 1 LOT SE 78.060 X 151 OR 21318-4694 06 2003 1 OR 21318-4694 0603 00 Assessment Information: Year: 2011 2010 Land Value: $70,279 $100,871 Building Value: $240,581 $241,522 County $50,0001$260,860 $342,393 Market %rm. $340860- -- Assessed \blue: $310,860 $342,393 Ex Ion Information: Year: _ 2011 2010 Taxing Authority: $25,000 $25,000 :<), , :1 Pc.i-closcraci: YES YES Taxable Value Information: Year: 2011 2010 Taxing Authority: Applied Exemption/ Taxable Value: Applied Exemption/ Taxable Wire: Regional: $50,000/$260,880 $50,000/$292,393 County $50,0001$260,860 $50,000/$292,393 City: $50,000/$160,860 $50,000/$292,393 School Board: $25,000/$285,860 $25,0004317,393 Sale Information: Sale Date: 612003 Sale Amount: $318,000 Sale 0/R: 2131LS-4SG-I Sales Qualification Description: Sales which are qualified \11'. K:lose win rCck ,ere t Print This report was created on 10/25/2011 9:24:05 PM for reference purposes only. Web Site © 2002 Miami-Dade County. All rights reserved. 1 of 1 10/25/2011 9:24 PM 08120-12410 I]08O39$46 The RQE FT T , ,C RECTO i a Named eiow IS ER' '?:FIE1 Under the W Frog ,Sioas_ o _Chapt+ Expiration date: AU© 31, 2012 [S�LA A� REQUIRE( PRODUCER Accurate 8300 West Resler Salta 114 Rearrd. FL 33144 PIS (305)225-3727 INSURED C & 13 Professional Conbactors Inc 9254 NW 120th Terr Miami, FL 33018- DATE (MMIDDIYYI CERTIFICATE OF LIABILITY INSURANCE 10MIV00 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER TIES CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE CIMRAGE AFFORDED BY THE. Fes (305)220 -8767 INSURERS AFFORDING COVERAGE NAIC COVERAGES THE MUMS OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERM I GICATEO. =WITHSTANDING HSTANIIING ANY REQUIREMENT. TERM OR COMMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERI1FI A1E MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POUCIEa DESCRIBED HEIE01 M SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDmONS OF SUCH PONCES. AGGREGATE UNIT$ SHORN MAY HAVE BEEN REDUCED BY PAID CLAD. INSURER A: American Builders Ins Co INSURERS: Rc INSURER INSURER E: INSURER F: Bea LTR ADD% MSRD A 0 TYPE OF INSURANCE POLICY NURSER DATE DA's 1r U111TS GENERAL LIABILITY commattIAL GENERAL. UAEM' 0 CJ.Ml3 MADE FA OCCUR 0 0 GEML AGGREGATE MET APPLES PER ❑ POLICY Q PROJECT ❑ LOC AuTOMOBLE UABILUY ❑ ANY AUTO ❑ ALL OWNED MHOS ❑ SCHEDULED AUTOS El HIRED ALrros ❑ NON OWNED AUTOS 0 n 0 GARAGE usen.nY ❑ ANY AUTO ❑ 0 CIGA000313.00 08/04/11 EXCESS/UMBRELLA LIABDJTY ❑ OCCUR ❑ CLAIMS FIDE ❑ o ouv iste ❑ sun: TION S vgatICERS COMPENSATN AND EMPLOYERS' UABILffY ANY PROPRIETOR 1 PARiNERI 001OURVE OFFICER 1 MEMBER EXCLUDED? If yes, do cdbe der SPECIAL PROWSIONELbelea OTHER 08/04/12 EACH OCCURRENCE DAMAGE TO RENTED PREMISES ) MED DP (Any we Fri) PERSONAL&AOV INJURY GENERAI.AGGREGATE PRODUCTS - COMP/OP AGO 1,000,000.00 100,000.00 5,000.00 1.000,000.00 2,000,000.00 2,000, .00 G M8tl4ED 834GLE LIMIT (E� Mideng BODILY INJURY (Per Roman) BODILY INJURY (Per eKxlde d) PROPERTY DAMAGE (P ) AUTO ONLY- EA ACCIDE3NT OTHER THAN EA ACC Alrro ONLY AGO EACH OCCURRENCE AGGREGATE 0 a4u % ❑ TH- E.L. EACH ACCIDENT E.L Dh$EA$ - EA EMPLOYEE E.L. CEASE - POLICY LIMIT DEBCRIP RON eF OPERA-DONS 1 LOCATIONS f VEHICLES I EXCLUSIONS ADDED BY Esdanalmerri SPECIAL PROVIS10NS Certificate Haider is Named as additional insured in respect to General Liability Coverage. CERTIFICATE HOLDER Miami Shores Mtge a BLDG DEPT 10050 NE 2nd Ave Miami Shores. FL 33138 ACORD 25 (2461108 OF CANCELLATION SI4QULD ANY OF THE ABOVE DESCRIBED POUCHES RE CANCELLED BEFORE THE EXPRATIAN DATE "HEREOF, ONE S5J.RNG INFER WILL ENDEAVOR TO MAIL 30 DAYS murals NOTIC£ TO THE CERTWICATE HOLDER NAIL TO THE LEFT. BUT FAIWNE To 0080 SHALL IMPOSE NO OBUGAT1ON OR MI ITY OF ANY KIND UPON THE INSURER, rrs AGENTS OR REPRE$ENTATIVEB. AU/HORI2ED REPRESENTATIVE Lucia Estrella OACORD CORPORATION 168E MIMMHlMUCL-UVP1 1 T TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 688484 -6 ZU11 LLILAL BUbINISS 1 AX Htt:t1141 2012 -. MIAMI -DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, 2012 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 THIS TS-NOT A BILL -DO NOT PAY NEW 716018-7 STATLIC t!i' 28983 BUtN§ISINAntifTiN ONAL CONTRACTORS INC 9254 NW 120 TERR 33018 HIALEAH GARDENS OW EF 6 PROFESSIONAL CONTRACTORS 1. P1?i..TY BUILDING CONTRACTOR IS ONLY R LOCAL BUSINESS TAX REST. IT DOES NOT PEIEMT TIE HOLDER TO VIOLATE ANY DEMO REGULATORY OR ZONING LAWS OF THE COIURY OR CITES. NOR DOLT$ IT EXEIWT THE HOLM ANY PERMIT FOR UCEOTHER NSE RMIMIREG BY LAW. TINS IS NOT A CERTIFIOATION OF THE HOLDER'S QUAUFICA- T^Zs. s U.S. POSTAGE PAID j MIAMI, FL PERMIT NO. 231 PAYLENT RECEIVED kUMLEIAOE COUNTY TAX OCU.ECTbR.10 /11 /2011 02260034001 000045.00 SEE OTHER SIDE DO NOT FORWARD C & G PROFESSIONAL CONTRACTORS INC JUAN CATA PRES 9254 NW 120 TER HIALEAH FL 33018 1Il hT11II311l *Ell lire)!!}!!( !!lltitllllJ!l11l11111!!i$)fIh1 JEFF ATWATER 03 -04 -2011 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: 03/04/2011 EXPIRATION DATE: 03/03/2013 CATA JUAN C 204752688 BUSINESS NAME AND ADDRESS: C & G PROFESSIONAL CONTRACTORS INC 9254 NW 120TH TER HIALEAH FL 33018 SCOPES OF BUSINESS OR TRADE: 1- CONSTRUCTION SUPERVISOR (5606) 2- ROOFING * * IMPORTANT: Pursuant to Chapter 440 . 05(14), 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 this 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 440.05413), 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 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 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: 03/04/2011 EXPIRATION DATE: PERSON: JUAN C CATA FEIN: 204752688 BUSINESS NAME AND ADDRESS: C & G PROFESSIONAL CONTRACTORS INC 9254 NW 120TH TER HIALEAH, FL 33018 SCOPE OF BUSINESS OR TRADE 1- CONSTRUCTION SUPERVISOR (5806) 2- ROOFING 03/03/2013 IMPORTANT OPursuant to Chapter 440.05(14), F.S., an officer of a corporation who 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. H 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 Rthe notice of election to be exempt 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 * Carry bottom portion on the job, keep upper portion for your records. 11111111101 11111 1111111 !III 1 11111 11111111 IN THE CIRCUIT COURT OF THE ELEVENTH JUDICIAL CIRCUIT IN AND FOR MIAMI -DADE COUNTY, FLORIDA WELLS FARGO BANK (t4A) Flaimiff(s)1 Petitionllr(s) VS. GABS, JAMES , el all, Defendant(s) / Resppndents(s) CFN 24011 R06754 I DR DU 27652 Pee 2472 — 2423: (241s) RECOROEO 10/07 /2011 12157:29 DEED )HOC TAX 14647.00 HARVEY MIN, CLERK OF COW MA111 -DADE COUNTY. FLORIDA GENERAL JURISDICTION DIVISION Case No: 10Q32511CA01 SeCtipn: 25 0itStamps' 51,e47.ou elirtgs SO= Cwnikrapere 074,6QD.Da CERTIFICATE OF TITLE The undersigned Clerk of the court certifies that a Certificate of Sale was executed and filed in this eCtion on September 22, 2011, for the property described herein and that no objections to the sale have been filed within the time allowed for filing objections. The following property in Mianti -Darla County, Florida: - SEE ATTACHMENT - was sold to: MONTANA 13 HOLDINGS III LLC 407 LINCOLN (2D SUITE 2K MIAMI BEACH. FL. 33139 WITNESS my hand and the seal of this court on October 03. 2011 . l4✓t't.�n� . ti tf) Harvey Ruvin, Clerk of Courts t� :.1 4,1 R$ 1111V/CTI* t Miami -Dade County. Florida Baok27852/Page2492 CFN #20110675419 Page 1 of 2 OR SK 27 852 PG 2493 LAST PAi5 CERTIFICATE OF TITLE Case No: 100325110A01 ME WES I' 3 U-.E f OF LO 1' 5 LESS 1'Hl. NOW [H 7.3 FEET 1 HL• Ii1:UF. t.i) r n I.ESS TI NOR IH 7.1 FEET 1'IIERItiNF AND I HE EAS 1 22 Fran. or I.U'1' 7 LESS CHt: NOR I'll 7.1 FEE 1' 17t1:Rl:�:fl . IN BLOCK I Of BISCAYNE RMMOE AC ORDINCi TO TIIF PLA1 I'11E14E01- AS RECORDED IN I LA1 lid n71: 39, PAM I1 OF 1111: PUBLIC KL•C(7RDS 01' MIAMI•DADE COUNTY. FLORIDA Pr=ip0ie aaddre. I ft-tt, MIAMI I.S. I:1 33 1.111; including thc - rifding.3ppunenaniaa.and &atures tut ated thrrew. Rev. 101612 2 Book27852/Page2493 CFN #20910675419 Page 2 of 2 www.sunbiz.org - Department of State L0 1D A PART , NPT';O ] V1 ON OF, ORPo: 10 Page 1 of 2 Home Contact Us E- Filing Services Document Searches Forms Help Previous on List No Events Next on List Return To List No Name History Entity Name Search I Submit Detail by Entity Name Florida Limited Liability Company MONTANA 13 HOLDINGS III LLC Filing Information Document Number L11000113406 FEI /EIN Number NONE Date Filed 10/04/2011 State FL Status ACTIVE Effective Date 10/04/2011 Principal Address 407 LINCOLN ROAD SUITE 2K MIAMI BEACH FL 33139 US Mailing Address 407 LINCOLN ROAD SUITE 2K MIAMI BEACH FL 33139 US Registered Agent Name & Address MACALUSO, ELISE 407 LINCOLN ROAD SUITE 2K MIAMI BEACH FL 33139 US Manager /Member Detail Name & Address Title MGRM MONTANA 13 HOLDINGS LLC 407 LINCOLN ROAD, SUITE 2K MIAMI BEACH FL 33139 FL Annual Reports No Annual Reports Filed Document Images 10/04/2011 -- Florida Limited Liabili View image in PDF format http: / /sunbiz.org /scripts /cordet.exe ?action= DETFIL &ingdoc_number =L 11000113406 &inQ. came_fro... 10/26/2011 www.sunbiz.org - Department of State Note: This is not official record. See documents if question or conflict. Page 2 of 2 Previous on List Next on List Return To List No Events No Name History Entity Name Search I Submit I Home 1 Contact us l Document Searches 1 E- Filing Services 1 Forms i Help l Copyright © and Privacy Policies State of Florida, Department of State http:// sunbiz. org/ scripts /cordet.exe ?action= DETFIL &inq doc_ number= L11000113406 &inq came_fro... 10/26/2011 www.sunbiz.org - Department of State Page 1 of 2 Home Contact Us E- Filing Services Document Searches Forms Help Previous on List Next on List Return To List No Events No Name History Entity Name Search Detail by Entity Name Florida Limited Liability Company MONTANA 13 HOLDINGS, LLC Filing Information Document Number L11000019076 FEI /EIN Number NONE Date Filed 02/14/2011 State FL Status ACTIVE Effective Date 02/14/2011 Principal Address C/O ROSENBAUM INTERNATIONAL LAW FIRM PA 755 W 41ST STREET MIAMI BEACH FL 33140 US Mailing Address C/O ROSENBAUM INTERNATIONAL LAW FIRM PA 755 W 41ST STREET MIAMI BEACH FL 33140 US Registered Agent Name & Address ROSENBAUM INTERNATIONAL LAW FIRM PA 755 W 41ST STREET MIAMI BEACH FL 33140 US Manager /Member Detail Name & Address Title MGR MACALUSO, ELISE 755 W 41ST STREET MIAMI BEACH FL 33140 US Annual Reports No Annual Reports Filed Document Images 02/14/2011 -- Florida Limited Liability View image in PDF format Submit http: / /sunbiz.org/ scripts /cordet.exe ?action = DETFIL &inq_doc_number =L 11000019076 &ing_came_fro... 10/26/2011 www.sunbiz.org - Department of State INote: This is not official record. See documents if question or conflict. Page 2 of 2 Previous on List Next on List Return To List No Events No Name History 1 Home 1 Contact us 1 Document Searches 1 E- Filing Services 1 Forms 1 Help 1 Copyright© and Privacy Policies State of Florida, Department of State Entity Name Search Submit http:// sunbiz. org/ scripts /cordet.exe ?action= DETFIL &inq doc_number =L 11000019076 &incLcame_fro... 10/26/2011 ROOF ASSEMBLIES AND ROOFTOP STRUCTURES Ca rT c d� Flori8ildinej-'ode Edition High- Velocity Hurricane Zone UnItonn Permit Appl OMf LIANCE WITH ALL FEDERAL t . !u TT- AND COON lY RUIFS AND REGULA7IONS Master Permit No. Process No. Contractor's Name (_ £ Job Address o/ Af 9/ ❑ Low Slope ❑ Mechanically Fastened Tile ortar /Adhesive Set Tile ❑ Asphaltic ❑ Metal Panel /Shingles ❑ Wood Shingles/Shakes Shingles ❑ New Roof ❑ Prescriptive BUR -RAS 150 ROOF TYPE ❑ Reroofing ❑ Recovering ROOF SYSTEM INFORMATION Low Slope Roof Area (SF) Steep Sloped Roof Area (SF) epair ❑ Maintenance Total (SF) '2-.5.-C7 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. • Alumpormrimum /M IM` IIII ice m pons mm im " -- frA jwi ri 4pro)( F-r;' e ))1,ki BUILDING CODE — BUILDING Pt. e dl Me' fh -J, wed e 44,7 ROOF ASSEMBUES AND ROOFTOP STRUCTURES Florida Building Code Edition 2007 High - Velocity Hurricane Zone Uniform Permit Application Form. Section (Low Slope Application) Fill in specifi roof assembly components and identify ufacturer (If a component not used, identify as "NA ") System Manufacture Product Approval No.: Design Wind Pressures, F RAS 128 or Calculations: Pmax1: Pmax2: Pmax3: Max. Design Pressure, from the s < cific Product Approval system: Deck: TYpe: Gauge/Thickness: Slope: Anchor/Base Sheet & No. of Ply(s): Anchor/Base Sheet Fastener/Bonding Mate is Surfacing: Fastener Spacing for Anchor/Base Sheet Attachment: Field: " oc @ Lap, # Rows @ " oc Perimeter. " oc @ Lap, # Rows @i " oc Corner " oc @ Lap. `iRows @ " oc Number of Faste , s Per Insulation Board: Field Perimeter Comer 01 - :: - Components Noted and Details as A :';cable: locking, Gutter, Edge Termination, Stripping, Flashing, ntinuous Cleat, Cant Strip, Base Mashing, Counter - Flashing, Coping, Etc. Indicate: Mean Roof Height, Parapet Height, Height of Base Flashing, Component Material, Material Thickness, Fastener Type, Fastener Spacing or Submit Insulation Base Layer. Base Insulation Size and Thickn Base Insulation Fastener/Bon ng Material: • FT Top Insulation Layer: Top insulation Size end Thickness: Top Insulation Fa teener/Bonding Material: Base Sheet(s) & No. of Ply(s): Base Sheet Fastener/Bonding Material: Ply-Sheet(s) & No. of Ply(s): Sheet Fastener/Bonding Material: Ply Fastener/Bonding Material: FLORIDA BUILDING: CODE — BUILDING Parapet Height Mean Roof Height ROOF ASSEMBLIES AND ROOFTOP STRUCTURES Florida Building Code Edition 2007 High - Velocity Hurricane Zone Uniform Permit Application Form. Spetinn fl (Stepp SlopetRnnf System) Roof System Manufacturer: /54Lage C,` � � LLC Notice of Acceptance Number: 09 _64 ?0, it Minimum Design Wind Pressures, If Applicable (From RAS 127 or Calculations: : e -, f P2: - -Z C7 P3: * ((C& 1 Maximum Design Pressure (From the Product Approval Specific System): , Lto j 4. Roof Slope: 6 : 12 Stepp Sinped Roof System Description \ Deck Type: I / s/ ?S C&)O0 1 �r i Type Underlayment: 3 Sal-Waled 23 5 Ridge Ventilgg Insulation: Are Barrier: Fastener Type & Spacing: jj Adhesive Type: J j „+ AgAa /, r^i/Le Type Cap Sheet Mean Roof Height aC-c..il P5 la Roof Covering: Type & Size Drip Edge: BUILDING CODE— BUILDING ROOF ASSEMBLIES AND ROOFTOP STRUCTURES Florida Building Code Edition 2007 High - Velocity Hurricane Zone Uniform Permit Application Form. Section F (Tile Caicidationi) ForMoment based file systems, choose either Method 1 or2. Compare the values for Mr with the values from Mr. If the Mr values are greater than nr equal to the Mr values, for each area of the roof, then the tile attachment method is acceptable. j1 Method 1 "Moment Based Tile Calculations Per RAS 127" �/� (P1:�gs^Ix: +�iSFi =-1-3/r) - Mg.e..I/ =Mrj 1541 Pmduc[Approval Mr- /`1- 10,j44/ (P27.121/42x 7 ` t W 8 _ =1G .35) _ Mg: l.0 • If =K2- a5 Product Approval Mr--,F' 4 (P3: WP 2x ;5701 :XI .11) tgo"' I1 =Mr3 3O?3 Product Approval Mr 1104 Required Method 2 "Simplified Tile Calculations Per Table Below" Moment of Resistance (Mr) From Table Below Product Approval Mr M, required Moment Resistance* Mean Roof Height -> Roof Slope ,I, 15' 20' 25' 30' 40' 2:12 34.4 38.5 38.2 39.7 422 3:12 32.2 34.4 38.0 37.4 39.8 4:12 30.4 32.2 33.8 35.1 37.3 5 :12 28.4 30.1 31.6 328 34.9 6:12 29.4 28.0 29.4 30.5 32.4 7:12 24.4 25.9 27.1 28.2 30.0 "Must be used in =junction with a list of moment based tile systems endorsed by the Broward County Board of Rules and Appeals. For Uplift based tale systems use Method 3. Compared the values for F with the values fora If the F'vehaes are greater than or equal to the Fr values, for each area of the roof. then the ule attachment method is acceptable. Method 3 "Moment Based Tile Calculators Per RAS 127 (Pt: x L x w: = _) - W: x cos 8 =Fi Product Approval F (P2: x L x w: _ j - W: x cos 0 = Fa Product Approval F (P1: x L = x w: = ) - W: x cos 8 = F Product Approval F Where to Obtain information Description Symbol Where to find Design Pressure P1 or P2 or P3 RAS 127 Table 1 or by an ennit:eating analysis prepared by PE on ASCE 7 Mean Roof Height H Job Site Roof Slope. 0 Job Site Aemdvmandc Multiplies a Product Approval Restmntg Moment due to Gravity Mg Product Approval Attacimtent Resistance Mt Product Approval Required Moment Resistance Ma Calculated MmimusttAttachment Rice F Product Approval Recruited Uplift Resistance Fr Calculated Avexage The Weight W Product Atmroval Tile Dimensions W l width Product Approval All eatsmladmts must be submitted to the bm'Wntg official at the time of permit application. 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 owners initial in the designated space indicates that the item has been explained. 1' y" Aesthetics - Workmanship: the workmanship provisions of Section R4402 are for the purpose of providing 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 renailed in accordance with the current provisions of Section R4403. (The roof deck is usually concealed prior to removing the existing roof system). Common roofs: Common roofs are those which have no visible delineation between neighboring units (i.e., townhouses, condominiums, etc.) In buildings with common roofs, the roofing contractor and /or owner should notify the occupants of adjacent units of roofing to be performed. Exposed Ceiling: Exposed, open beam ceilings are where the underside of the roof decking can be viewed from below. The owner may wish to maintain the architectural appearance; therefore, roofing nail penetration of the underside of the decking may not be acceptable. This provides the option of maintaining the appearance. �Ponding water: The current roof system and /or deck of the building may not drain well and may cause water to pond (accumulate) in low -lying areas of the roof. 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 roofing system is removed. Pounding conditions should be corrected. Overflow scuppers (wall outlets): It is required that rainwater flows off so that the roof is not overloaded from a buildup of water. Perimeter /edge wall or other roof extension may block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accordance with the requirements of Sections R4402, R4403 and R4413. 7. 6/ti Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of the structure assembl the building itself). The existing amount of attic ventilation shall not be reduce It m be beneficial consider additional venting which can result in extendi- the service life of the er /Agent's Signat re Date Revised on 7/9/2009 LD d&jor/A111r- Contract ignature ate ?tf MIA MI-DADE BUILDING CODE COMPLIANCE OFFICE (BCCO) PRODUCT CONTROL DIVISION NOTICE OF ACCEPTANCE (NOA) Monier Lifetile, LLC 200 Story Road Lake Wales, FL 33898 MIAMI -DARE COUNTY, FLORIDA METRO -DADE FLAGLER BUILDING 140 WEST FLAGLER STREET, SUITE 1603 MIAMI, FLORIDA 33130 -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 P� ue Control to Division (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) right 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: Atlantis Shake & Slate Concrete Roof 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 a as endorsement of to comply product, for sales, advertising or any other purposes shall automatically with any section of this NOA shall be cause for termination and removal of NOA. Florida, and followed by ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, 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 #07- 1023.12 and consists of pages 1 through 7. The submitted documentation was reviewed by Alex Tigera. NOA No.: 09- 0422.11 Expiration Date: 12/16/12 Approval Date: 05/27/09 Page 1 of 7 ROOFING ASSEMBLY APPROVAL Category: Sub- Category: Material: Roofing. Flat Profile Roofing Tiles Concrete 1. SCOPE This renews a system using Monier Lifetile Atlantis Shake & Slate Concrete Roof Tile, as manufactured Monier Lifetile LLC in Pompano Beach, 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 Test Applicant Dimensions Specifications Monier Lifetile Atlantis Shake and Slate Tile Trim Pieces 1 =16" w= 10" 1 'A" thick 1= varies w = varies varying thickness 2.1 SUBMII'TED EVIDENCE: Test Agency Redland Technologies The Center for Applied Engineering, Inc. The Center for Applied Engineering, Inc. The Center for Applied Engineering, Inc. The Center for Applied Engineering, Inc. TAS 112 TAS 112 Test Identifier 7161 -03 Appendix ID 94-060A 94-084 25- 7094 -2 25- 7094 -8 25- 7094 -5 Product Description Flat, interlocking, high pressure extruded concrete shake and slate roof tile equipped with two nail holes. For direct deck, 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 Static Uplift Testing PA 102 & PA 102(A) Static Uplift Testing PA 101 (Mortar Set) (Adhesive Set) Static Uplift Testing PA 102 (4" Headlap, Nails, Direct Deck, New Construction) Static Uplift Testing PA 102 (4" Headlap, Nails, Battens) Static Uplift Testing PA 102 (4" Headlap, Nails, Direct Deck, Recover/Reroof) Date Dec. 1991 March, 1994 May 1994 Oct. 1994 Oct. 1994 Oct. 1994 . NOA No.: 09- 0422.11 Expiration Date: 12/16/12 Approval Date: 05/27/09 Page 2 of 7 Test Agency 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. Professional Service Industries, Inc. 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. Walker Engineering, Inc. Nutting Engineerins Nutting Engineerins Test Identifier Test Name/Report 25- 7183 -6 25- 7183 -5 25- 7214 -1 25- 7214 -5 7161 -03 Appendix II Letter Dated Aug. I , 1994 P0631 -01 P0402 Project No. 307025 Test #MDC -77 224 -47099 520109 -1 520111 -4 520191 -1 Calculations Calculations Calculations Calculations Calculations Calculations Calculations Calculations TAS -112 TAS -I 12 Static Uplift Testing PA 102 (2 Quik -Drive Screws, Direct Deck) Static Uplift Testing PA 102 (2 Quik -Drive Screws, Battens) Static Uplift Testing PA 102 (1 Quik Drive Screw, Direct Deck) Static Uplift Testing PA 102 (1 Quik -Drive Screw, Battens) Wind Tunnel Testing PA 108 (Nail -On) Wind Tunnel Testing PA 108 (Nail -On) Wind Tunnel Testing PA 108 (Mortar Set) Withdrawal Resistance Testing of screw vs. smooth shank nails Wind Driven Rain PA 100 Physical Properties PA 112 Static Uplift Testing PA 101 Aerodynamic Multiplier Moment of Gravity 25 -7094 25 -7496 25 -7584 25- 7804b -8 25- 7804 -4 & 5 25- 7848 -6 25 -7183 Aerodynamic Multipliers Two Patty Adhesive Set System 13343.1 13343.1 Date Feb. 1995 Feb. 1995 March, 1995 March, 1995 Dec. 1991 Aug. 1994 July 1994 Sept. 1993 Oct. 1994 Sept. 1994 Dec. 1998 March 1999 October 2007 August 2007 February 1996 April 1996 December 1996 March 1995 April 1999 April 1999 June 2007 March 2009 NOA No.: 09- 0422.11 Expiration Date: 12/16/12 Approval Date: 05/27/09 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 RAS 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. 3.7 May be installed on slopes 7:12 and greater with a minimum of two screws. 4. INSTALLATION 4.1 Monier Lifetile Atlantis Shake and Slate Concrete Roof 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 Monier Lifetile Atlantis Shake & Slate Tile Weight W (Ibf) 8.5 Length -I (ft) Width -w (ft) 1.33 0.833 Table 2: Aerodynamic Multipliers - ft3) A, (ft3) ) (ft3) Batten A lication Direct Deck Application Shake & Slate Tile N/A 0.208 Tile Profile Monier Lifetile Atlantis Sha 7 ":12" or greater Battens Direct Deck N/A 5.59 NOA No.: 09- 0422.11 Expiration Date: 12/16/12 Approval Date: 05127/09 Page 4 of 7 Table 3: Restorin . Moments due to Gravi - M ft-lb Tile Profile 2 ":12" 3 ":12" 4 ":12" 5 ":12" 6 ":12" Monier Battens Direct Battens Lifetile Atlantis Shake & Slate Tile Deck Direct Deck Battens Direct Deck Battens Direct Deck Battens Direct Deck N/A 6.17 N/A 6.11 N/A 6.01 N/A 5.89 N/A 5.75 7 ":12" or greater Battens Direct Deck N/A 5.59 NOA No.: 09- 0422.11 Expiration Date: 12/16/12 Approval Date: 05127/09 Page 4 of 7 Table 4: Attachment Resistance Expressed as for Nail -On Systems Fastener Type Tile Profile Monier Lifetile Atlantis Shake & Slate Tile Direct Deck (min 15/32" plywood) a Moment - Mf (ft-Ibf) Direct Deck (min. 19/32" plywood) Battens 2 -10d Ring Shank Nails 1 -10d Smooth or Screw Shank Nail 2 -10d Smooth or Screw Shank Nails 30.9 38.1 NIA 7.3 9.8 N/A 14.0 18.8 N/A 1 #8 Screw 30.8 2 #8 Screw 1 -10d Smooth or Screw Shank Nail (Field Clip) 1 -10d Smooth or Screw Shank Nail (Eave Clip) 2 -10d Smooth or Screw Shank Nails (Field Clip) 2 -10d Smooth or Screw Shank Nails (Eave Clip) 51.7 30.8 51.7 N/A N/A 24.3 24.3 N/A 19.0 19.0 N/A 35.5 35.5 N/A 31.9 31.9 N/A Table 5A: Attachment Resistance for Sin . le P : Table 5: Attachment Resistance Expressed as a Moment Mf (ft-Ibf) for Two Patty Adhesive Set Systems Tile Profile - Tile Application Minimum Attachment Resistance Monier Lifetile Atlantis Shake & Slate Tile Adhesive' 31.32 1 See manufactures component approval for installation requirements. 2 Flexible Products Company TileBond Average weight per patty 13.9 grams. Polyfoam Product, Inc. Average weight per patty 8 grams. Table 5A: Attachment Resistance for Sin . le P : Expressed as a Moment - Mf (ft -Ibf) Adhesive Set S tams Tile Profile Tile Application Minimum Attachment Resistance Monier Lifetile Atlantis Shake & Slate Tile PolyPro'" 118.93 PolyProT"' 40.4" 3 Large paddy placement of 45 grams of PoIyProT"". 4 Medium paddy placement of 24 grams of PoIyProT°°. Table 5B: Attachment Resistance Expressed as a Moment - Mf (ft -Ibf) for Mortar or Adhesive Set Systems Tile Profile Tile Application Mortar Sets Attachment Resistance 39.0 Monier Lifetile Atlantis Shake & Slate Tile 5 See specific mortar manufacturers Notice of Acceptance NOA No.: 09-0422.11 Expiration Date: 12/16/12 Approval Date: 05/27/09 Page 5 of 7 5. LABELING All tiles shall bear the imprint or identifiable marking of the manufacturer's name or logo, or following statement: "Miami -Dade County Product Control Approved ". MONIER LIFETJLE LLC, ATLANTIS SHALE AND SLATE (POMP ANO BEACH, FL PLANT) LOCATED UNDERNEATH 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.: 09-0422.11 Expiration Date: 12/16/12 Approval Date: 05/27/09 Page 6 of 7 - -- ...,.........,„,:::.....:::::z .......:-.._ ....., ----.:--.. .........,, ...,.... ,-,. ....... ..., ----, -..,,,,... ...,::-:"•-;-, "---- ... .....-, -......, ' ' -.. ,...-. '...z.,... : -... ....,-, ---. -...) -....,..'...:-..-...-.. -:;":•-, ---..... .- ,..;......;.....,........_ --..,.17....,, <1.,.. PROFILE DRAWINGS „.7 • „1 • CRIERLAY ••••• • .b.4--1:02° • • MONIER LIFETILE ATLANTIS SHAKE & SLATE CONCRETE ROOF TILE END OF THIS ACCEPTANCE NOA No.: 09-0422.11 Expiration Date: 12/16/12 Approval Date: 05/27/09 Page 7 of 7 MIAMFDADE 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.miamidade.aov/buildinaf 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 Tigers. �Ylf l'v130.1)14$*h0 . I 11$ APPROVED NOA No.: 11-0124.04 Expiration Date: 05/10/12 Approval Date: 04/14/11 Page 1 of 7 ROOFING COMPONENT APPROVAL: Category: Roofmg 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 Polypro0 AH160 Foampro® RTF1000 ProPack® 30 & 100 Dimensions Test Specifications N/A TAS 101 N/A 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 1.61bsift.3 18 PS1 Parallel to rise 12 PS1 Perpendicular to rise 28 PS1 Parallel to rise 0.08 LbsJFt2 3.1 Perm / Inch +0.07% Volume Change ®a -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. 1vl�s1 ;ld�'tl�] �K• }�li 1i i I APPROVED I NOA No.: 11- 0124.04 Expiration Date: 05/10/12 Approval Date: 04/14/11 Page 2 of 7 EVIDENCE SUBMITTED: Test Aaencv Test Identifier Test Name/Revort 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® A11160 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. (—F) _W 2 F'— MS NOA No.: 11-0124.04 Expiration Date: 05/10/12 Approval Date: 04/14/11 Page 3 of 7 INSTALLATION: 1. Polypro® AI-1160 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 the 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® AHI60 has been dispensed. 9. Polypro® AH 160 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. (grains) 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 Polyproc4 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.: 11 -0124.04 Expiration Date: 05/10/12 Approval Date: 04/14/11 Page 4 of 7 ADHESIVE PLACEMENT DETAIL 1 SINGLE PATTY 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 Single paddy on underlayment END OF THIS ACCEPTANCE . , . 7)10 APPROVED NOA No.: 11- 0124.04 Expiration Date: 05/10/12 Approval Date: 04/14/11 Page 7 of 9