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RF-11-1660Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 167204 Permit Number: RF -9 -11 -1660 Scheduled Inspection Date: December 12, 2011 Inspector: Bruhn, Norman Owner: CROUSILLANT, CESAR AND CHRISTINE Job Address: 841 NE 95 Street Miami Shores, FL Project: <NONE> Contractor: VICTORIA ROOFING INCORPORATED Permit Type: Roof Inspection Type: Final Roof Work Classification: Tile Phone Number (305)756 -7640 Parcel Number 1132060142940 Phone: (305)666 -2323 Building Department Comments TILE RE ROOF Passed /L-cl-i( 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- 164297. Provide re -nail aff. and remove dumpster. NB December 09, 2011 For Inspections please call: (305)762 -4949 Page 22 of 40 AFFIDAVIT OF COMPLIANCE WITH ROOF DECKING ATTACHMENT AND SECONDARY WATER BARRIER HURRICANE MITIGATION RETROFIT FOR EXISTING SITE -BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PURSUANT TO SECTION 553.844 F.S. To: Miami -Dade County Building Department 11805 Coral Way, Suite 111 Miami, FL 33175 Re: Owner's Name chi; S3 C eci ,A \t"�� Property Address '&41 S Roofing Permit Number \ - !; t ° , L7 Lc 0 Dear Building Official: c ; � 12t t certify that the roof decking attachment and fasteners have been strengthe d and corrected and a secondary water barrier has been provided as required by the "Manual of Hurricane Mitigation Retrofits for Existing Site -Built Single Family Structures" adopted by the Florida Building Commission by Rule 9B -3.047 F.A.C. STATE OF FLORIDA COUNTY OF MIAMI -DADE Sworn to and subscribed before me this ti day of U1 c`)t� . , 20 m (SEAL) Personally known or Produced Identification C :1Docum.nt. end Settings ktcINAyDo mentaiatie6esCiic, des} VtnnfingA litdmilCnmplimrca7 26g71•ill.l+ladnc Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 164297 Permit Number: RF -9 -11 -1660 Scheduled Inspection Date: November 29, 2011 Inspector: Bruhn, Norman Owner: CROUSILLANT, CESAR AND CHRISTINE Job Address: 841 NE 95 Street Miami Shores, FL Project: <NONE> Permit Type: Roof Inspection Type: F+ Work Classification: Tile el, M 71eS4-- Phone Number (305)756 -7640 Parcel Number 1132060142940 Contractor: VICTORIA ROOFING INCORPORATED Phone: (305)666 -2323 Building Department Comments TILE RE ROOF Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. November 28, 2011 For Inspections please call: (305)762 -4949 Page 3 of 20 F•I•E• FLORIDA INTERNATIONAL ENGINEERING &TESTING LAB INSIGHT•INNOVATION•INTEGRATION Florida' International Engineering and Testing Lab LLC 16701 SW 117 Avenue, Miami, FL 33177 Telephone: (305) 378 - 1991 -Fax: (305) 378 -1997 Miami -Dade Lab Certification # 07- 0612.11 -State of Florida ca #27273 SITE SPECIFIC INFORMATION Owner's Name: C 4r) CE-4,4/11 -t 1'-i5' Job Address: ci G /t1/'4 .4'/ . Roofing Contractor: V /c7 P f A /fit° `A16 Permit Number: m ea o Type of Tile: fill' l /3 - Approximate Roof Height: if 2- feet Slope: ' / 2- Approximate Square Footage: Type of Access to Roof: Ladder OtherRequired Testing Force: 35 lbs. Date Installed: 1/- Z/ -1/ -4 Testing Equipment: F.G.E. 100x Shimpo Instrument Date of 'Inspection: if 2S // ft2 TEST RESULTS P= PASS, F= FAIL Test Location P or F Test Location P or F Test Location P or F Test Location P or F Test Location P or F �1 2 7)-5 21 ,41- 5, 41 i 61 1/3A-c".; 81 I 1 22 ( 42 ��f 62 82 3 23 43 63 83 4 24 44 64 84 5 25 45 65 85 6 26 46 66 86 7 27 47 67 87 8 28 48 68 88 9 29 49 69 89 10 30 50 70 90 11 31 51 71 91 12 32 52 72 92 13 33 53 . 73 93 14 34 54 74 94 15 35 55 75 95 16 36 56 76 96 17 37 57 77 97 18 38 58 78 98 19 39 59 79 99 20 40 60 80 100 IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL TAS 106, THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT QUALITY CONTROL TEST. ADDITIONAL TEST INFORMATION Perimeter Width: `i ft Area Units or ft2 No. of Tests Perimeter /r, Field A d o Corners II- i `.- Hips & Ridges / ` 0 RESPECTFULLY SUBMITTED BY: \i'ma "1/..2.c4f FLORIDA INTERNATIONAL ENGINEERING & TESTING LAB, LLC Miami- Dade Lab Certification # 07 -0612.11 Job Address: ` 4-1-1 f. 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Tenant/Lessee Name: —' Phone #: -- Email: r . �+e a . �� G r - c Zip: 33138 JOB ADDRESS: of ! &i . E . q S City: Miami Shores County: Miami Dade Zip: -3 3 1 3 t$ Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: fr /II CONTRACTOR: Company Name: (G "1 r �C t Fl ( Phone#: 30 5 • 66 G "232 3 Address: '472- 2- C) C-._), 4- 1 ' T City: V\AL`. State: t— L Zip: 1 5 5 Qualifier Name: , �_ Phone #: OS ' 4 6 ` 2323 State Certification or Registration #: Certificate of Competency #: Contact Phone #: 3C) C“- 2-3 2-3 Email Address: --Ni t C-A- 6� e C ,C.) c t !'C & COu c f4 • C c� �� DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ /4 000 _ Square/Linear Footage of Work: 2 a®0 S Type of Work: ❑Addition DAlteration ❑New epair eplace ❑Demolition Description of Work: \ ee - ._01 ∎ Yom+ 4* 10 It /0 he vJ G? A ee 96, Submittal Fee $ Permit Fee $ .r►_ **** *.. Fees* - CCF $ CO /CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ a 6(+(v V r 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 abs'nce of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature it O er or Agent The foregoing instrument was acknowledged before me this 47 The foregoing instrument was acknowledged before me this day of ,).2 ,20 ,by w o is personally kn fwn to me or who has produced As identification and who did take an oath. Signature ntractor NOTARY PUBLIC: Sign: Print: My Commis APPROVED BY ,20ji ,by o me or who has produced as identification and who did take an oath. LIC: 9)11?-1/ Plans Examiner Zoning Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Clerk NOTICE OF COMMENCEMENT A REGORGED DOPY MIST OE POSTED ON THE JOU we Anse Of FAST INSPECTION PERMIT NO TAX FOLIO NO: STATE OF FLORIDA: Gomm OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice: that improvements wip be made to certain real property, and in accordance with Chapter 715, Ronda Statutes, the following tnformr1Orr Is prided In Ore Notice of Cominettownent. 1111111111111111 11111111111111111111111111111 CFN 201 1806 1 5886 OR Bk 27824 Ps 4622; Ups; RECORDED 09/14/2011 11 :25 :34. HARVEY RUVIII, CLERK OF COURT MIAMI -DADE COUHTYp FLORIDA LAST PAGE 1. legal description of property and streetladdress: $y ii A/. e • %S: S �: sl�c,ces Ft, :3a /a>3 2. DesoriptiOn of Improvement I r - Qoe Space *trove rese red for tie of tecordi 3. Owners) name and address : Co-01.).0l {get/ / I E 9 & Skore4, h sane kde est in property: Name and address of fee simple m-- a : (c:oo�+ ° yZo Si v} t SG Ft t SS 4. Contractor's name, address and phone number: \/ r+cx-� �oS- X66- Z:�2'3 5. Surety: bond required by owner from contractor, If any) Name, .address and phone number: Amount of bond $ 8. Lender's name and address: 1. Persons within the Smote of Florida destgnat Semi= 71.131?.. Rodda Statutes, Name, address and phone nark:. by tamer upon whom notices: or other dan may be served as by 8: in add; n: to himself. ors designates the Mowing person(s):to reaehfe a:copy of the mum, Amide Name, address and phone number: SerfilOrt 9. Expiration date of this Notice of Commencement (the eatitatten date is 1 year from the date of receallnourdess aditferent daters sp aed) WARNING TO liter ANY PAYMENTS W BYIRE &Mei AFTER THE DiPIRATiON OF TYE mum or meN 1 PAYMENTS UNDER CHARIER � P L MUM Praa FOR A S meow mutt IN wal TWICE IMPROVEMENTS TO YOUR PHOP A NO OF CCAAMEcSMEON MUST BE. Mot) : . GN T JC � �E 1 . . oast INSPEC11ON IF YOU INTEND TO OBTAIN ITNANOIND, CONSULT MTN YOUR mom OR AN KtIOMEY MORE COMMISVOING WORK OR RECORDING YOUR NOME OP commanaiait psi of s). o + s)' tiltts fi ffiocr/ iirectooPa / !anger Prepared BY Pfepanad Sy .611 Print Name NM Name Tjiloe Tides Prka Name: 01.1.1 �_::.� A�f a _ � prDs L`; ;L.:3)40.1 of Iterfiny. I declare that I have read the Ftlregtfing der that the facts stated In ft are tee, to the best of My knowledge and belief Siigtoturefs):of Owners) or Owoorgir's Authorkett OfficeriDirectoriPartneriffianver who sign S9 irr.sraz vacua s'ta fHEREBY CERMaffitlsatw ffFY tt'ffife original filed in Gals office on- (laird :: 14 2011 A020 WITNE Q , and and cial Seal. i1ARV UVIN, CLERK, of Circuit and County Courts By / L l (1.50 ( D.C. u Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. ,/ COPY OF LOCAL BUSINESS TAX RECEIPT C. v COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTIONI IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION] YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: v` C-40 1crr ®� BUSINESS ADDRESS: Zze.--) SA) 1 ( CITY I1.4-e tx.mr STATE F L ZIP CODE 13 X 5 5 BUSINESS PHONE: ( 15) C 232 FAX NUMBER (2)S) c CELL PHONE ( E(0) Z / o -- q 21QUALIFIER'S NAME: �`� ce_ 1 �Q 0 \ra CPL QUALIFIER'S LIC NUMBER: C, (( ( CS—c, ellq • E -MAIL ADDRESS (IF APPLICABLE): �.� a ` L VA "'"� ca I'''- Created on 3119109 BY MLDV I RV 3126109 MLDV DATE 7y • BATCH NU1 '48E14 IAMI= DADE-COUNTY ';TAX COLLECTOR 140 W, FLAGLER ST. Fist FLOOR MIAMf, FI. 33130 292615 -3 BUSINESS NAME / LOCATION VICTORIA ROOFING INC x4220 SW 71 AVE 33155 UNIN DADE COUNTY OWNER VICTORIA ROOFING INC Sec. Type of Business 1� �, p ItELCIALTY BUILDING CONTRACTOR BUSINESS TAX RECEIPT. IT DOES.. NOT PERMIT THE 2010 . LOCAL BUSINESS TAX RECEIPT MIAMI -DADS COUNTY - STATE OF FLORIDA EXPIRES SEPT 30, 2011 MUST BE DISPLAYED AT PLACE OF BUSINESS ;- PURSUANT TO COUNTY CODE CHAPTER 8A ART 8 & THIS IS NOT A BILL DO NOT PAY RENEWAL RECEIPT NO. 305936 -7 STATE CCC056844 HOLDER TO VIOLATE ANY - EXISTING REGULATORY OR ZONING. LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT . THE HOLDER FROM ANY OTHER pERMIT OR LICENSE- REQUIRED BY LAW. .THIS IS NOT A'CERWRCATt0N. OF THE HOLDER'S PAYMENT ha MIAMI -DA'- f u` TAX COLLECTOR:,. 07/07/2010 60030000145 000075.00 FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 WORKER /S 9 DO NOT FORWARD VICTORIA ROOFING INC RAFAEL J UBEDA 4220 SW 71 AVE MIAMI FL 33155 1 , =tl.A.U.1.1.1,1-1ssLU•xa I L L%...1.l11„1+.1 II1 ACORLI CERTIFICATE OF LIABILITY INSURANCE OP ID ,JY L------- DATE(MM /DD/YYYY) 11/29/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poilcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certaln policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER BUTLER, BUCKLEY, DEETS INC. 6161 BLUE LAGOON DR., STE 420 MIAMI FL 33126 Phone: 3 0 5 —2 62 — 0 0 8 6 NAME: THOMAS C BUTLER A /CNNo,Ext): 305 - 262 -4506 (Arc,No): 305 -262 -0187 ADDRESS: TBUTLER @BBDINS.COM PRODUCER CUSTOMERIDA: VICTO -1 INSURER(S) AFFORDING COVERAGE NAIC t/ INSURED VICTORIA ROOFING, INC. 4220 SW 71st Avenue Miami FL 33155 INSURER A: SCOttSCIa1e Insurance CO INSURERS: INSURER C: INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE'AFFORDED BY.THE POLICIES DESCR BED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS .SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE AWL bUal+ INSR WVD POLICY NUMBER (MM/D (MM/PO DD EIYYYY)P GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1 X OCCUR A X GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO - I I JECT n LOC AUT OMOBILE LIABILITY BCS0023549 11/27/10 11/27/11 EACH OCCURRENCE LIMITS $1,000,000 S50,000 $ 5, 000 $1,000,1000 $2,000,000 AGO $2,000,000 $ UAMAbt I UNtNIhU PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS UMBRELLA LIAB EXCESS LIAB COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per parson) BODILY INJURY (Per accident) PROPERTY DAMAGE (Par accident) OCCUR CLAIMS -MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YI N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) It yes, describe under DESCRIPTION OF OPERATIONS below NIA *301 EACH OCCURRENCE AGGREGATE $ $ $ $ ITORY LIMITS S I I ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT DESCRIPTION CANCELLATION NNOT IC EsEXCEPTR10t, DAYS aIFORrkNONdP AYMENTaceOFegPREEMIUM CERTIFICATE HOLDER Village Of Miami Shores. 10050 NE 2nd Ave. . Miami Shores, Fl. 33138, ACORD 25 (2009/09) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. �G AUTHORIZED REPRESENTATIVE 51(14-61, ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD :: 71 9/7/2011 15:58 Lion Insurance LION INSURANCE COMPANY+Victoria Roofing, Inc. 1/1 IA CERTIFICATE OF LIABILITY INSURANCE Date 1 9/7/2011 • Producer: Lion Insurance Company 2739 U.S. Highway 19 N. Holiday, FL 34691 (727) 938 -5562 This Certificate Is Issued as a matter of information only and confers no rights upon the Certificate Holder. This Certificate does not amend, extend oraiter the coverage afforded by the policies below. Insurers Affording Coverage NAIC # Insured: South East Employee Leasing Services, Inc. 2739 U.S. Highway 19 N. Holiday, FL 34691 Insurer Lion Insurance Company 11075 Insurer B: Insurer C: Insurer D: Insurer E: Coverages The policies of insurance listed below have been issued to the insured named above for the policy period indicated. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate may be issued or may pertain, the Insurance afforded by the policies described herein Is subject to all the terms, exclusions, and conditions of such policies. Aggregate limits shown may have been reduced by paid claims. INSR LTR ADDL INSRD Type of Insurance Policy Number Policy Effective Date (MM/DD/YY) Policy Expiration Date (MM/DD/YY) Limits GENERAL LIABILITY Commercial General Liability Claims Made Occur Each Occurrence 3 Damage to rented premises (EA occurrence) $ Med Exp 3 Personal Adv Injury $ General aggregate limit applies per: D Policy ❑ Project ❑ LOC General Aggregate 3 Products - Comp /Op Agg 3 AUTOMOBILE LIABILITY Any Auto All Owned Autos Scheduled Autos Hired Autos Non -Owned Autos Combined Single Limit (EA Accident) 3 Bodily Injury (Per Person) £ Bodily Injury (Per Accident) 3 Property Damage (Per Accident) 3 EXCESS /UMBRELLA LIABILITY IOccur ❑ Claims Made Deducible Each Occurrence Aggregate A Workers Compensation and Employers' Liability Any proprietor /partner /executive officer /member excluded? If Yes, describe under special provisions below. WC 71949 01/01/2011 01/01/2012 X I We Statu- tory Limits I I OTH- ER E.L. Each Accident 31,000,000 E.L. Disease - Ea Employee 31.000,000 E.L. Disease - Policy Limits 31,000,000 Other Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 Descriptions of Operations /Locations/Vehicles /Exclusions added by Endorsement/Special Provisions: Client ID: 15 -93 -001 Coverage only applies to active employee(s) of South East Employee Leasing Services, Inc. that are leased to the following "Client Company": Victoria Roofing, Inc. Coverage only applies to injuries incurred by South East Employee Leasing Services, Inc. active employee(s) , while working in Florida. Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937 -2138 or by calling (727) 938 -5562. Project Name: ISSUE 09 -07 -11 (SD) Begin Date: 3/25/2009 CERTIFICATE HOLDER CANCELLATION VILLAGE OF MIAMI SHORES 10050 NE 2ND AVE MIAMI SHORES, FL 33138 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 folder named to the left, but failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives j /J — 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: g" k ,, , V \C* Property Address: r ` fo C. s � ���� � �� t o 3 31 n . Roofing Permit Number: Q- ‘ ‘ G. ( -'. Dear Building Official: I CC.1" :N a C k'^ ,1 \c, -\ certify that I am not required to retrofit the roof to wall connections of my building because: le,The just valuation for the structure for purpose of ad valorem taxation is Tess 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 edition of the South Florida Building Code (1994 SFBC) Date: CI 1 \ sLA Signature Print Name State of Florida County of Dade The undersigned, being the first duly swom, deposes and says that he /she is the owner for the above property mentioned. Sworn to and subscribed before me this I day of Notary Public, Sate of Florida at Large • When the just valuation of the structure for purpose of ad valorem taxation is equal to or more than $300,000 Nis Notary Public State of Florida lr; Paola Justice sit My Commission EE00e761 ow Expires 0//1512014 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 a 1994 ROOF ASSEMBLIES AND ROOFTOP STRUCTURES o `-� B ^ q Florida Building Code Edition 2 SEP ® 9 •`� i Igh- Velocity Hurricane Zone Uniform Permit Applica ��o . '•. . •III. '• WO 3 SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS Master Permit No. Process No. Contractor's Name Yl CAVfC \ �S-` Ts Job Address '4 / i'l • E / s � I (e•s■_ s ck w■_4 •U:e S i; t- �3 ❑ Low Slope ❑ Mechanically Fastened Tile jEt Mortar /Adhesive Set Tile Asphaltic ❑ Metal Panel /Shingles ❑ Wood Shingles /Shakes Shingles Low Slope Roof Area (SF) ❑ Prescriptive BUR -RAS 150 ROOF TYPE ja Reroofing ❑ Recovering ROOF SYSTEM INFORMATION ❑ Repair ❑ Maintenance Steep Sloped Roof Area (SF) Total (SF) 200Z,54:1 (.11.8° 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. zz; Cie 11 F 9,6 11/ r; imicorAmommilmoimwans .�, a mil r �■ • 141 It 5 FLORIDA BUILDING CODE — BUILDING ROOF ASSEMBLIES AND ROOFTOP STRUCTURES Florida Building Code Edition 2007 High - Velocity Hurricane Zone Uniform Permit Application Form. SAt-tinn r1 (Steep Sloped Roof System). Roof System Manufacturer: 1,4tec L° � C'kcp Notice of Acceptance Number: ©i _ 01 I (. 03 Minimum. Design Wind Pressures, If Applicable (From RAS 127 or Calculations): 11 66,.. 1:'AS 1 P2: -� � P3: Maximum Design Pressure 40.4 AQ (From the Product Approval Specific System): PS10e Roof Slope: <i :12 - - . . . - 1 : • . Deck Type: 5/p, Q 1 V,�o ct Type Underlayment: I PrSTN1 b °-� ,�j 2400 Te 1 Insulation: Ridge Ver�gtil Nt- NVA Fire Barrier: Fastener Type & Spacing: Adhesive Type: d. I vi ikt∎ nR� ,Naa �r �I l Type Cap Sheet: I IN ST1`HD - 249 41- c(o 4 Roof Covering: co r, s kca Type &Size Drip Edge: 3'1 Cxce- Z‘ c FLORIDA BUILDING CODE — BUILDING ROOF ASSEMBLIES AND ROOFTOP STRUCTURES Florida Building Code Edition 2007 High - Velocity Hurricane Zone Uniform Permit Application Form. Sectinn F (Tile CalciilatinnS) For Moment based tile systems, choose either Method 1 or 2. Compare the values for Mr with the values from Mf. If the M (values are greater than or equal to the Mr values, for each area of the roof, then the tile attachment method is acceptable. //�� Method 1 "Moment Based Tile Calculations Per RAS 127" / x x 0r��� = 1 dl. Il) - Mg: 1, gi 1= Mrl 6' zQ Product Approval Mf'4 ®• I (P2: i78.f. x > 3 = 2�. �) - Mg :1' Ci 1 = Mrl 1 E. Product Approval Mt AO, ' 9 (P3: i iii x > 0.3 i 3-.36.31) _Mg: -Cti = Mr3 ^ Product Approval Mf 1 t " CM. 1.31 Method 2 "Simplified Tile Calculations Per Table Below" Required Moment of Resistance (Mr) From Table Below rrouuut',vv. ' ..y Mr required Moment Resistance* W: x cos o = . r3 - « Mean Roof Height -� Roof Slope 15' 20, 25• 30• 40' RAS 127 Table 1 or by an engineering analysis prepared by PE based on ASCE 7 34.4 36.5 38.2 39.7 42.2 2 :12 32 2 34.4 38.0 37.4 39.8 3:12 30 4 32.2 33.8 36.1 37.3 4 :12 Required Moment Resistance Minimum Attachment F' Product Approval Resistance Fr Calculated 26 280 294 30.5 32.4 6:12 24.4 25.9 27.1 28.2 30.0 7:12 *Must be used in conjunction w th a list of moment based tile systems endorsed by the Broward County Board of Rules and Appeals. For Uplift based tile systems use Method 3. Compared 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. Method 3 "Moment Based Tile Calculations Per RAS 127" (Pi: x = xw : =)-W: x cos 0 =Fr1 (P2: x = xw• = -W' x cos0 =Ft2,__ Product Approval F' Product Approval F' - - - x L x w: _ W: x cos o = . r3 - « (P3: .-) Where to Obtain Information Symbol Where to find Description P1 or P2 or P3 RAS 127 Table 1 or by an engineering analysis prepared by PE based on ASCE 7 Design Pressure Height H Job Site Mean Roof 0 Job Site Roof Slope t Product Approval Aerodynamic Multiplier Restoring Moment due to Gravity M8 Product Approval M, Product Approval Attachment Resistance M8 Calculated Required Moment Resistance Minimum Attachment F' Product Approval Resistance Fr Calculated Required Uplift Resistance W Product Approval Average Tile Weight Tile Dimensions L = length W =width Product Approval p� be ed to the building official at the time of permit application. All calculations must submit 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 govern the minimum requirements and standards of the industry for roofing system installations. Additionally, the following items should be addressed as part of the agreement between the owner ant the contractor. The owner's initial in the designated space indicates that the item has been explained. 1. k Aesthetics-Workmanship: the workmanship provisions of Section R4402 are for the purpose of prove ing that the roof system meets the wind resistance and water instruction performance standards. Aesthetics (appearance) are not a consideration with respect to workmanship provisions. Aesthetic issues such as color or architectural appearance, that are not part of a zoning code, should be addressed as part of the agreement between the owner and the contractor. 2. Renailing wood decks: When replacing roofing, the existing wood roof deck may have to be renailed in accordance with the current provisions of Section R4403. (The roof deck is usually concealed prior to removing the existing roof system). 3. Common roofs: Common roofs are those which have no visible delineation between neighboring units (i.e., townhouses, condominiums, etc.) In buildings with common roofs, the roofing contractor and /or owner should notify the occupants of adjacent units of roofing to be performed. IJ 4. 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. 5. 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 origi I offing system is removed. Pounding conditions should be corrected. 6. 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 actor. nce with the requirements of Sections R4402, R4403 and R4413. 7. 1 Ventilation: Most roof structures should have some ability to vent natural airflow through the intenor o the structure assembly (the building itself). The existing amount ,' shall not be reduced. It may be beneficial to consider additional venting which ca -sult in extending the s ice life of the "OOP roof. Own /Agents `',ignature Date Revised on 7/9/2009 LD Contractor S I ur zi Date BUILDING CODE COMPLIANCE OFFICE (BCCO) PRODUCT CONTROL DIVISION NOTICE OF ACCEPTANCE (NOA) 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 MonierLifetile, LLC 200 Story Road Lake Wales, FL 33853 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 and the High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION: Saxony 900 (Shake, SIate & Split Shake) 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 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# 07- 0228.03 and consists of pages 1 through 7. The submitted documentation was reviewed by Alex Tigera. NOA No.: 07- 0711.03 Expiration Date: 04/26/12 Approval Date: 09 /07/07 Page 1 of 7 ROOFING ASSEMBLY APPROVAL Category: Sub- Category: Material: Roofing Flat Profile Roofmg Tiles Concrete SCOPE: This new NOA approves a system using MonierLifetile Saxony 900 (Shake, Slate & Split Shake) Concrete Roof Tile, as manufactured MonierLifetile LLC and described 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 the installation section herein. The attachment calculations shall be done as a moment based system. PRODUCT DESCRIPTION Manufactured by Applicant MonierLifetile LLC Saxony 900 Trim Pieces Dimensions 1= 17" w= 13" 1- 5/32" thick Slate 1- 9/32" thick Shake & Split Shake 1= varies w = varies varying thickness SUBMITTED EVIDENCE: Test Agency Redland Technologies The Center for Applied Engineering, hic. The Center for Applied Engineering, Inc. The Center for Applied Engineering, Inc. The Center for Applied Engineering, Inc. Test Specifications TAS 112 TAS 112 Test Identifier 7161 -03 Appendix III 94 -084 94 -060A 25- 7183 -6 25- 7183 -5 Product Description Flat profile, interlocking, high- pressure extruded concrete roof tile equipped with two nail holes. For direct deck or battened nail -on, mortar set 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 Date Static Uplift Testing PA 102 & PA 102(A) Static Uplift Testing PA 101 (Mortar Set) Static Uplift Testing PA 101 (Adhesive Set) Static Uplift Testing PA 102 (2 Quik -Drive Screws, Direct Deck) Static Uplift Testing PA 102 (2 Quik Drive Screws, Battens) NOA No.: 07- 0711.03 Expiration Date: 04/26/12 Approval Date: 09 /07/07 Page 2 of 7 Dec. 1991 May 1994 March, 1994 Feb. 1995 Feb. 1995 Test Agency 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. Atlanta Testing & Engineering, Inc. 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. Nutting Engineers Test Identifier 25- 7214 -1 25- 7214 -5 7161 -03 Appendix If Letter Dated Aug. 1, 1994 P0631 -01 P0402 Project No. 307025 Test #MDC -77 R1.894 R2.894 R3.894 520109 -1 520111 -4 520191 -1 Evaluation Calculations Evaluation Calculations Evaluation Calculations Evaluation Calculations Evaluation Calculations Calculations Evaluation Calculations 130 Test Name/Renort 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 Static Uplift Testing PA 101 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 Restoring Moments Due to Gravity TAS 112 Date March, 1995 March, 1995 Dec. 1991 Aug. 1994 July 1994 Sept. 1993 Oct. 1994 Aug. 1994 Dec. 1998 March 1999 February 1996 April 1996 December 1996 March 1995 January 2007 April 1999 February 2007 January 2007 NOA No.: 07- 0711.03 Expiration Date: 04/26/12 Approval Date: 09 /07/07 Page 3 of 7 LIMITATIONS: 1. Fire classification is not part of this acceptance. 2. For mortar or adhesive set tile applications, a static field uplift test shall be performed in accordance with RAS 106. 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. 4. Minimum underlayment shall be in compliance with the applicable Roofmg Applications Standards listed section 4.1 herein. 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. 6. This acceptance is for wood deck applications. Minimum deck requirements shall be in compliance with applicable building code. INSTALLATION: 1. MonierLifetile Saxony 900 (Slate, Shake & Split Shake) Concrete Roof Tile and its components shall be installed in strict compliance with Roofmg Application Standard RAS 118, RAS 119, and RAS 120. 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) MonierLifetile Saxony 900 Slate, Shake & Split Shake 11.5 1.417 1.08 Table 3: Restoring Moments due to Gravity - Ma Table 2: Aerodynamic Multipliers - X (ft3) Tile Profile Tile 3 "•12" X (ft) 5 ":12" X (ft) Profile Saxony 900 Slate, Shake & Split Shake Batten Application Direct Deck Application MonierLifetile Saxony 900 Direct Deck 0.289 0.313 Slate, Shake & Split Shake Direct Deck Battens Direct Deck Battens Table 3: Restoring Moments due to Gravity - Ma (ft-lbf) Tile Profile 2 ":12" 3 "•12" 4 ":12" 5 ":12" 6 ":12" 7 " :12" or greater Saxony 900 Slate, Shake & Split Shake Battens Direct Deck Battens Direct Deck Battens Direct Deck Battens Direct Deck Battens Direct Deck Battens Direct Deck 7.16 8.12 7.08 8.03 6.97 7.91 6.82 7.74 6.65 7.55 6.46 7.34 NOA No.: 07- 0711.03 Expiration Date: 04/26/12 Approval Date: 09/07/07 Page 4 of 7 Table 4: Attachment Resistance Expressed as a Moment - Mf (ft -Ibf) for Nall -On Systems Tile Profile Fastener Type Direct Deck (min 15/32" plywood) _ Direct Deck (min. 19/32" plywood) Battens Saxony 900 Slate, Shake & Split Shake 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 Screws 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 Table 5: Attachment Resistance Expressed as a Moment Mf (ft-Ibf) for Two Patty Adhesive Set Systems Tile Profile Tile Application Minimum Attachment Resistance MonierLitetile Saxony 900 Slate, Shake & Split Shake Adhesive 31.32 1 See manufactures component approval for installation requirements. 2 Dow Chemical TileBond Average weight per patty 13.9 grams. Polyfoam Product, Inc. Average weight per patty 8 grams. Table 5A: Attachment Resistance Expressed as a Moment - Mf (ft-Ibf) for Single Patty Adhesive Set Systems Tile Profile Tile Application Minimum Attachment Resistance MonierLitetile Saxony 900 Slate, Shake & Split Shake Polyfoam PolyProTM 118.94 Polyfoam PolyProTM 40.44 3 Large paddy placement of 45 grams of PolyProT'". 4 Medium paddy placement of 24 grams of PolyProT"'. Table 5B: Attachment Resistance Expressed as a Moment - Mf(ft-Ibf) for Mortar Set Systems Tile Profile Tile Application Attachment Resistance MonierLifetile Saxony 900 Slate, Shake & Split Shake Mortar Set' 43.9b 5. Tile -Tite Roof Tile Mortar NOA No.: 07-0711.03 Expiration Date: 04/26/12 Approval Date: 09/07/07 Page5of7 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 ". MONIERLIFETILE LLC, SAXONY 900 TILE (LAKE WALES FL PLANT 2) LOCATED UNDERNEATH TILE BUILDING PERMIT REQUIREMENTS: Application for building permit shall be accompanied by copies of the following: 1. This Notice of Acceptance. 2. Any other documents required by the Building Official or applicable building code in order to properly evaluate the installation of this system. NAIL HOLES PROFILE DRAWING 1 5/32 a (mate) 1 9/32 " (shake) 17 " °,, _ / OVERLAY WATERLOCK 13" MONIERLIFETILE SAXONY 900 CONCRETE ROOF TILE (SLATE MODEL) NOA No.: 07- 0711.03 Expiration Date: 04/26/12 Approval Date: 09 /07/07 Page6of7 A PROFILE DRAWING MONIERLIFETILE SAXONY 900 CONCRETE ROOF TILE (SPLIT SHAKE MODEL) MONIERLIFETILE SAXONY 900 CONCRETE ROOF TILE (SHAKE MODEL) END OF THIS ACCEPTANCE NOA No.: 07- 0711.03 Expiration Date: 04/26/12 Approval Date: 09 /07/07 Page 7 of 7 MIAMI 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.pv/building/ 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@ AH160 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 -020 1.02 and consists of pages 1 through 7. The submitted documentation was reviewed by Alex Tigera. MIAMI•DADE COUNTY APPROVED NOA No.: 11- 0124.04 Expiration Date: 05/10/12 Approval Date: 04/14/11 Page 1 of 7 ROOFING COMPONENT APPROVAL: Category: Roofing Sub Category: Roof tile adhesive Materials: Polyurethane SCOPE: This approves Polypro® AH160 as manufactured by Polyfoam Products, Inc. as described in Section 2 of this Notice of Acceptance. For the locations where the design pressure requirements, as determined by applicable building code, does not exceed the design pressure values obtained by calculations in compliance with Roofing Application Standard RAS 127, for use with approved flat, low, and high profile roof tiles system using Polypro m 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 Polypro® AH160 N/A Foampro+ro RTF1000 ProPack® 30 & 100 N/A N/A Test Specifications TAS 101 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 ofPolypro A1-1160 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 Ibs. /ft.3 18 PSI Parallel to rise 12 PSI Perpendicular to rise 28 PSI Parallel to rise 0.08 Lbs./Ft2 3.1 Perm / Inch +0.07% Volume Change @ -40° F., 2 weeks +6.0% Volume Change @158 °F., 100% Humidity, 2 weeks 86% Note: The physical properties listed above are presented as typical average values as determined by accepted ASTM test methods and are subject to normal manufacturing variation. MIAMWADE COUNTY APPROVED NOA No.: 11- 0124.04 Expiration Date: 05/10/12 Approval Date: 04/14/11 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® AH160 shall solely be used with flat, low, & high tile profiles. 3. Minimum underlayment shall be in compliance with the Roofing Application Standard RAS 120. 4. Roof Tile manufactures acquiring acceptance for the use of Polypro AH160 roof tile adhesive with their tile assemblies shall test in accordance with TAS 101. 5. Roof Tile manufactures acquiring acceptance for the use of HANDI -STICK roof tile adhesive with their tile assemblies shall test in accordance with TAS 101 with section 10.4 as modified herein. E2 F W F'= MS MAMICDADE COUNTY APPROVED NOA No.: 11- 0124.04 Expiration Date: 05/10/12 Approval Date: 04/14/11 Page 3 of 7 INSTALLATION: 1. Polypro® AH160 may be used with any roof tile assembly having a current NOA that Iists 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 Polypro411 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® AH 160 shall be applied with Foampro RTF1000 or ProPack® 30 & 100 dispensing equipment only. 7. Polypro AH160 shall not be exposed permanently to sunlight. S. Tiles must be adhered in freshly applied adhesive. Tile must be set within 2 to 3 minutes after Polypro® AH160 has been dispensed. 9. Polypro® AH160 placement and minimum patty weight shall be in accordance with the Placement Details' herein. Each generic tile profile requires the specific placement noted herein. Table 1: Adhesive Placement For Each Generic Tile Profile Tile Profile Placement Detail Single Paddy Weight Min. (grams) Two Paddy Weight per paddy Min. (grams) N/A Flat, Low, High Profiles #1 35 High Profile (2 Piece Barrel) #1 17 /side on cap and 34 /pan N/A Flat, Low, High Profiles #2 24 N/A Flat, Low, High Profiles #3 8 LABELING: All Polypro® AH160 containers shall comply with the Standard Conditions listed herein. BUILDING PERMIT REQUIREMENTS: As required by the Building Official or applicable building code in order to properly evaluate the installation of this system. MANMADE COUNTY APPROVED NOA No.: 11- 0124.04 Expiration Date: 05 /10/12 Approval Date: 04/14/11 Page 4 of 7 ADHESIVE PLACEMENT DETAIL 1 SINGLE PATTY Nall through plastic cement Paddy (Beneath Tile) Underlayment 10 in. Eno Course Eave Closure Fascia Eave course only: Keep adhasva approx. 4 tn. up from wormholes Nail through plastic cement Underlayment 10In. Fan Course Eave course only: Keep adhesive approx. 4 in. up fromweephotes MIAMIDADE COUNTY APPROVED Fascia Nall through plastic cement Underlaymant 1 Paddy (Beneath Ho) Eave Coyne Eave course only: Keep adhesive approx. 4 In. up from weepholss Fascia Weephola Eave closure Drip edge 1) Place enough adhesive toachieve 17 to 23 Optlonal2n4'sfor InchesIncontactwithth ateeppltcheppQaitona square a pan We e 2) To 1 to From edge of cover �N� N2In`� / Then Install the tile. , . Undorlayment 1 Nan through plastic cement Remov (op portion of Ilia eava course cover tile. Abut to second course of pantiles. Ensue eave end of pan and cover t les are flush ateave Una. Eeveclosure Weephole Fascia (moils shown) Sheathing Optional Point up Moder on longitudinal etas oltile 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 Nall through plastic cement Paddy (Beneath Tile) Underlayment 1 11In. Eave Course Eave Closure Fascia MIAMI•DADE COUNTY APPROVED Nall through plastic cement Nall through plastic cement Underlayment 1 Paddy (Beneath Tile) 7 fn. m 2 In Bare Course Fascia Weephole Eave closure Drip edge Paddy (Beneath Tile) Underlayment Eave Closure We Course Fascia NOA No.: 11-0124.04 Expiration Date: 95/10/12 Approval Date: 04/14/11 Page 6 of 7 ADHESIVE PLACEMENT DETAIL 3 DOUBLE PATTY Nall through plastic cement Paddy (between tile) Paddy (under tile) Sin. x 3 In. Single paddy on under - layment Single paddy under tile Single paddy on top of the Eave course In. X 7 In, medium size paddy eave Fascia course only Nall through plastic cement Nail through plastic cement Underlayment Single paddy under tile Single paddy between tile 2 in. x 7 In. medium size paddy eave course only 1•441n.x 3in. Single 41n. paddy on under - layment Single paddy on top of the Eave Course Fascia Weephole Eave closure Drip edge Single paddy between tile Alltin.x 3 In. Single paddy on underlayment Single paddy on top of tile Eave Course Eave Closure 2 In. x 7 In. medium site paddy save course only Fascia END OF THIS ACCEPTANCE MAMJ•DADE COUNTY APPROVED NOA No.: 11- 0124.04 Expiration Date: 05/10/12 Approval Date: 04/14/11 Page 7 of 7