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RF-11-2317Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 169506 Permit Number: RF -12 -11 -2317 Scheduled Inspection Date: February 03, 2012 Inspector: Bruhn, Norman Owner: CHURCH, ST ROSE OF LIMA CATHOLIC Job Address: 415 NE 105 Street Miami Shores, FL Project: <NONE> Contractor: ISAACS ROOFING & INSULATION CORP Permit Type: Roof Inspection Type: Final Roof Work Classification: Flat Phone Number (305)758 -0539 Parcel Number 1122310430010 Phone: (305)234 -5234 Building Department Comments RE -ROOF FLAT TO FLAT /Ie« 71 6,2 r7.f -c Passed ,j a Failed Correction Needed Inspector Comments CREATED AS REINSPECTION FOR INSP- 168509. CREATED AS REINSPECTION FOR INSP - 168442. CREATED AS REINSPECTION FOR INSP- 167891. NO PERMIT ON SITE Not ready no access, no permit or plan. NB Same comments. NB Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. February 02, 2012 For Inspections please call: (305)762 -4949 Page 5 of 8 BUILDING CODE COMPLIANCE OFFICE (BCCO) PRODUCT CONTROL DIVISION NOTICE OF ACCEPTANCE (NOA) Birdview Skylights 201 Longhorn Road Fort Worth, TX 76179 1,\, (61- 3-1 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 www.miamidade.sov 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 High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION: Aluminum Framed Polyearbonate Domed Skylight. APPROVAL DOCUMENT: Drawing No. DADE608.1, model "6SF -DADE ", sheets 1 & 2 of 2, prepared by Birdview Skylights dated February 05, 2008, signed and sealed by Vipin N. Tolat, P.E., on July 08, 2008, bearing the Miami -Dade County Product Control Revision stamp with the Notice of Acceptance number and the expiration date by the Miami -Dade County Product Control Division. MISSILE IMPACT RATING: Large & Small Missile Impact LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and the following statement: "Miami -Dade County Product Control Approved ", unless otherwise noted herein and the dome shall be properly marked by GE Plastics. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA revises & renews NOA # 03- 0303.11 and it consists of this page 1, evidence submitted pages E -1 & E -2 as well as approval document mentioned above. The submitted documentation was reviewed by Helmy A. Makar, P.E., M.S. # )9. 7/3l/208 NOA No. 08-0611.09 Expiration Date: 07/02/2013 Approval Date: 07/31/2008 Page 1 Birdview Skylights NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED 1. EVIDENCE SUBMITTED UNDER PREVIOUS APPROVAL #03- 0303.11 A. DRAWINGS 1. Drawing No. EB696, sheets 1 & 1, model "6SFD-DADE", prepared by Birdview Skylights, dated 07/26/00, with no revisions, signed and sealed by V. N. Tolat, P.E. B. TESTS 1. Test report on Large Missile Impact Test per PA 201, Cyclic Load Test per PA 203 and Uniform Static air Pressure Test per PA 202, on "Series 6SFD -DADE Self Flashing Aluminum /Polycarbonate Skylight ", prepared by Miami Testing Laboratory, report No. K-49362 issued on 09/10/96, signed and sealed by D. G. Ober, P.E. C. CALCULATIONS 1. Anchor Calculation, sheets 2 through 5, dated 08/21/96 and signed by D. A. Terwilleger, PE. D. MATERIAL CERTIFICATIONS 1. Notice of Acceptance No. 00- 0718.02 issued to General Electric Company on 09/08/2000, expiring on 07/02/2003. 2. Extrusion drawings No. BVS X10947 A & BVS 8554 by Tel Tower Extrusions, LTD for Birdview Skylights. E. STATEMENTS 1. No change letter issued by Birdview Skylights, on 08/10/2000 and signed by E. Bird. 1. No change letter issued by Birdview Skylights on 02/11/03 and signed by G. E. Bird. 2. NEW EVIDENCE SUBMITTED A. DRAWINGS 1. Drawing No. DADE608. 1, model "6SF -DADE ", sheets 1 & 2 of 2, prepared by Birdview Skylights dated February 05, 2008, signed and sealed by Vipin N. Tolat, P.E., on July 08, 2008. . B. TESTS 1. Test report on Large Missile Impact Test per TAS 201, Cyclic Load Test per TAS 203 and Uniform Static air Pressure Test per TAS 202, on "Series 6SF -DADE Self Flashing Aluminum/Polycarbonate Skylight ", prepared by American Test Lab of South Florida, report No. 0331.01 -08, dated 05/23/2008, signed and sealed by William R Mehner, P.E. and Henry Hattem, P.E. E -1 H lm A. Mahar P.E. M.S. Helmy P.E., Product Control Examiner NOA No. 08- 0611.09 Expiration Date: 07/02/2013 Approval Date: 07/31/2008 Birdview Skylights NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED C. CALCULATIONS . 1. Anchor Calculation, sheets 1 through 3 of 3, dated 06/09/2008, signed and sealed by Vipin N Tolat, P.E. D. QUALITY ASSURANCE 1. By Miami -Dade County Building Code Compliance Office. E. MATERIAL CERTIFICATIONS 1. None. E -2 y A. Maker, P.E., M.S. Product Control Examiner NOA No. 08-0611.09 Expiration Date: 07/02/2013 Approval Date: 07/31/2008 .090 6.000 ,320 3r .070 f 3.000 t i .090 BIRDVIEW SKYLIGHTS THE CLEAR CHOICE 201 LONGHORN RD. FT. WORTH TX. 76179 TEL:817- 439 -9266 FAX :817- 232 -8468 DATE: 2- 5- 08 DRAWING# 608.1 SHEET 2 OF 2 MODEL: 6SF -DADE DRAWN BY: E. BIRD SCALE: NTS VIPIN N. TOLAT FL. REG. # 12847 15123 LANTERN CREEK LANE HOUSTON, TX 77068 %375' II�� 070 I �,v1,y" E .070 rQ94 I .613 P: tom— .12 REF 21/ �-- 325 33 NOTES: 1. •07 TYP. WALL THK. EXCEPT AS NOTED. 2. BREAK SHARP CORNERS AT .015 R. ntoDver REV ascomplyingwhhISED thetiorida Eiddinscods Acceptance No D; Data • ICY- Zo 17 Arty .04 NE ft BVS - X10947 -A BP9. LA.9702 Bala NO. 13.255 Agam N0' F.P.9702 Mal Division ea/ 0 0 A WT/FT WAS 1.231 6 -23=95 01 ALUMINUM ASSOCIATION STANDARD TOLERANCES TO APPLY UNLESS OTHERWISE SPECIFIED AREA ESL 1.076 a>Ra.E SIZE D�-`g28 -951 p 0R GH ESL 1.291 M -8> � s� I2X1.5 Elpsk 24.952 19 I «xE FULL r' . TOYER EX RUSIONS-,L O BIRDVIEW SKYLIGHTS PRR7 NO. 1010. a% ROUSE 6" SELF- FLASHING taliir SOLID • 6063 -T5 ETA- X10947=A 1 50" OUTER POLYCARBONATE DOME (GE LEXAN XL10 OR SHEFFEILD MAKROLON SL) 1/8" THICK INNER POLYCARBONATE DOME (GE LEXAN 9034 OR SHEFFIELD MAKROLON GP) .100" THICK 7.0" GEr�TES #2 3.0 6 0" DESIGN PRESSURE RATING POSITIVE + 60psf NEGATIVE -80psf LARGE MISSILE IMPACT RESISTANT T 80 1/4" NOTE: This design can also be used for other smaller skylights as long as the longside does exceed 105 1/4" and the short side does not exceed 80 1/4" and maximum presures do not exceed positive 60 / negative 80 psf. and total roof opening dimension does not exceed 50.875 square foot. MAXIUM ROOF OPENING DIMENSION 74" X 99" ALL UNITS EQUAL TO OR LESS THAN 50.875 Sq. Ft 13 @71/2 " = 971/2" 14 SCERWS LS 3 7/8" (TYP.) FASTENER LAYOUT LS = LONG SIDE SS = SHORT SIDE 410 X I" HWHSD WITH NEOPRENE WASHER LOCATED 3 7/8" FROM EACH CORNER AND 7 1/2" ON CENTER THEREAFTER I— .125" EXT. ALUMINUM ANGLE(6063 -T5) G.E. SILICONE ADHESIVE SEAL ( SCS 1000 ) CONTINUOUS 10164 SANTOPRENE RUBBER GASKET #1409 1 CONDENSATE GUTTER WITH 0.25" WEEP HOLE LOCATED AT EACH CORNER #10 X 3/8" SS HWHSMS LOCATED 3 7/8" FROM EACH CORNER AND 7 1/2" MAX ON CENTER THEREAFTER .090" EXT. ALUMINUM CURB FRAMING (6063 -T5 ) NOTE: ALL ALUMINUM TO BE 6063 -T5 ALLOY FULLY MITERED AND WELDED AT CORNERS — ROOF DECK AND SUPPORT ( DESIGNED BY OTHERS ) SEE GENERAL NOTES # 1 #14 X 1" PAN HEAD LAG SCREW 3 7/8" FROM EACH CORNER, MAX ON CENTER 71/2 ". WITH MIN. ROOF DECK PENETRATION OF 7/8" 3 7/8" (TYP.) TOTAL 50 SCREWS AT LOCATIONS 10@ 7 1/4" = 72 1/2" A,B & C FOR THIS SKYLIGHT. 11 SCREWS SS FOR OTHER SMALLER SIZES PROVIDE FASTENERS @ 71/2" ON CENTER EACH SIDE 105 1/4" BIRDVIEW SKYLIGHTS THE CLEAR CHOICE 201 LONGHORN RD. FT. WORTH TX. 76179 TEL: 817 -439 -9266 FAX: 817- 232 -8468 DATE: 2 - 5 - 08 MODEL: 6SF - DADE DRAWING # DADE608.1 SHEET 1 OF 2 lR A1VN Ry • F. RTRI) SCALE: NTS GENERAL NOTES 1. ALL ROOFING DETAILS SHALL COMPLY WITH FBC 2007 2. 4" MINIMUM DISTANCE FROM ANGLE LIP TO ROOF SURFACE IS FOR SHINGLE OR BUR WITHOUT INSULATION FOR INSULATION AND ROOF TILES ADD THE TILE HEEGHT AND THE INSULATION THICKNESS TO THE 4'1 MINIMUM HEIGHT. PRODUCIREVISED as eemptykg *It8 ffie Fladda Wawa code Aseeptome No0;_' - .O Expiration Date • AEL-Vi sy tpm `• LL . M mle : 17 VIPIN N. TOLAT FL. REG. # 12847 15123 LANTERN CREEK LANE HOUSTON, TX 77068 From: 12/28/2011 09:51 #506 P.002/005 .4j.C9RL7 CERTIFICATE OF LIABILITY INSURANCE 1 DATE(MMIDOMYYY) 10/15/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDMONAL INSURED, the poucy(les) must be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER COMPREHENSIVE INSURANCE UNDERWRITERS 990 NE 92 STREET MIAMI SHORES, FL 33138 -2911 rol t AOT MARK STEVEN HOERBER on (305) 759 -0005 1 FA. Kok 5: COVERAGE4UI&GMAILCOM INSURERS) AFFORDING COVERAGE NAIC / INSURER A: CANAL INDEMNITY INSURANCE CO INSURED ISAAC'S ROOFING & INSULATION CORP PO BOX 973135 MIAMI, FL 33197 -3135 INSURES: TRAVELLERS PROPERTY & CAS INSURER C: EVANSTON INSURANCE CO INSURER D: BRIDGEFIELD EMPLOYERS INSURANCE CO INSURER E: COVERAGES CERTIFICATE NUMBER: INSURER F: R THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN LTR TYPE OF INSURANCE INSR POLICY NUMBER (pr) attilhgl LIMITS A GENERAL LIABILITY Y. Y' GL102237 10/15/2011 10/15/2012 EACH OCCURRENCE $ 1•,000,000 X COMMERCIAL GENERAL LIABILITY !'...1 tE.SO RE ) $ 50,000 CLAIMS -MADE X OCCUR MED EXP (Argon person) 5 5.000 PERSONAL 8 AOV INJURY S 1.000.000 $ 3,000,000 GENERAL AGGREGATE GEML AGGREGATE LIMIT APPUES PER ICI POLICY n SZ& n LOC PRODUCTS - COMP/OP AGG $ 3.000.000 $ B AUTOMOBILE LIABILITY N BA-301M3714-11 10/22/2011 10/22/2012 C T Dul$INGLE LIA1n' (BODILY $ 1.000.000 I X ANY AUTO AALt OWNED HIR7EODSAUTOS — SCFJ OLEO AAUN TOSWNED INJURY (Per person) $ BODILY INJURY (Per ) $ ( DAMAGE accident) s $ C X UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS-MADE Y+ r XOVA312910 10/15/2011 10/15/2012 EACH OCCURRENCE $ 1.000.000 AGGREGATE $ 1,000,000 owl 1 RETENTION $ $ D EMPLOYERS' LIABILITY 830 -46736 12/17/201012/17 /2011 X I TDaYBi11�141 s 1 ER Y! N ANY PROPRIETOR/PARTNER/EXECUTIVE N/A EXCLUDED? Y E.L. EACH ACCIDENT $ 1,000,000 0yeFsl DESCRIPTION OF OPERATIONS Demme E.L. DISEASE- EA EMPLOYEE $ 1,000,000 EL. DISEASE - POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, AM5Bonel Remarla Schedule, U more space Is required) 1) Roofing & insulation contractor any & all locations, jobs and projects / FL State License # CCC 1325556 & 1327401. 2) ADMINISTRATIVE OPERATIONS ADDRESS: 17225 SOUTH DIXIE HWY #200, MIAMI, FL 33157 3) BLANKET ADDITIONAL INSURED IN FAVOR OF CERTIFICATE HOLDER WHEN REQUIRED BY WRITTEN CONTRACT. 4) BLANKET WAIVER OF SUBROGATION IN FAVOR OF CERTIFICATE HOLDER WHEN REQUIRED BY WRITTEN CONTRACT. CANCELLATION Miami Shores Village Building Department 10050 NE 2nd Ave. Miami Shores, FL 33138 Phone: 305 - 795 -2204 ACORD 25 (2010/05) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 'AUTHORIZED REPRESENTATIVE MARKS E`f 4L LIC #A120671 ®1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD From: II SEE OTHER SIDE fAX DLL ECT NTY U 140 W. FLAGLER ST. 1131 FLOOR MIAM),•FL 33130 12/28/2011 09:52 #506 P.003/005 2011 LOCAL BUSINESS TAX RECEIPT 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 FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 593608-4 TI-US IS NOT A BILL — DO NOT PAY RENEWAL BUSINESS NAME / LOCATION RECEIPT NO. 619262-9 ISAACS ROOFING & INSULATION CORP STATE# CCC1325556 17225 S DIXIE HWY 200 33157 PALMETTO BAY OWNER ISAACS ROOFING & INSULATION CORP Sec. Type of Business THB 9�6 SSPPELCIALTY BUILDING CONTRACTOR BUS!N3$S TAX AE WT. 17 00E8 NOT PERMIT THE HOLDER 70 VIOLATE ANY ER88TINO REGIR ATORY OR ZaaNS LAWS OF THE COUNTY 011 0 7IBS. NOR 0028 IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR UCEN E REQUIRED TTY LAW. TITS B NOT A CERTIFICATION OF THE LA'S QUALIFICA. PAYMENT RECD MIATEMMW COUNTY TAX 09/23/2011 60040000228 000045.00 it 49AMI -DADS COUNTY :T'AWCOL1'ECTOR a 40 W FLAiLER ST WORKER /S DO NOT FORWARD ISAACS ROOFING & INSULATION CORP ISAIAS DEL SOL PRES PO BOX 973135 MIAMI FL 33197 11Ii1►1,I1,1„lU11,11,11)II III ,.MI11111.Il,I.,,II„)IJ,i1l4 2011 L�OCCAALLB�� Ax ORIDA 2012 MIAMI DADE:C04�': Bt.P OOR ' MUST •BB DI'SP.L' AIRYBDSATT PLACE 0F• 4JS1NESS H.33130 PURSUANrTQ COUNTY CODE CHAPTER8A-ART: B & 10 .....�.- :e.,;,;.Sa3�.;: —� :�- .. THIS IS NOT A BILL — DO NOT PAY RENEWAL NAME 548122-1 NAME RECEIPT NO. 572094-2 BUSINESS N / LOCATION ISAACS ROOFING & INSULATION CORP 200STATE* CCC1327401 17225 S DIXIE HWY 33157 PALMETTO BAY FIRST -CLASS U.S. POSTAGE • PAID MIAMI. FL PERMIT NO. 231 OWNER SAACS ROOFING & INSULATION CORP See. Type of Business THIS 196 SPECIALTY BUILDING CONTRACTOR 18 ON A mums TAX RECEIPT. IT � ER NOT mom TO VI � EMITTING REGULATORY OR 201CNQ LAWS OF THE COUNTY OR CITIEL NOR 0038 IT BIERWT THE HOLDER PERMIT OR ANY OTHER REQUIRED eY LAW. 11E8 18 TNHHEE HOLDERS OUAIMRCA- raliCralIMUyva OOLLECTOIB 09/23/2011 60040000229 000045.00 SEE OTHER SIDE WORKER /S 1 DO NOT FORWARD ISAACS ROOFING & INSULATION CORP ISAIS DEL SOL PRES PO BOX 973135 MIAMI FL 33157 111 HI, 1) 11,11 1) 1111,1,11111II11111111111111111 I 11111111111141 From: From (888) 789 -6574 Fri Dec 23 12:58:22 2011 12/28/2011 09 :51 #506 P.001 /005 Page 35 of 48 CERTIFICATE OF LIABILITY INSURANCE producer: Lion Insurance Company 2739 U.S. Highway 19 N. Holiday, FL 34691 (727) 938 -5562 I Date 1 12/23/2011 This Certificate Is Issued as a matter of Infonnatton only and confers no rights upon the Certificate Molder. This Certificate does not amend, 'attend or alter the coverage afforded by the policies below. Insurers Affording Coverage NAIC 9 Insured: South East Personnel Leasing, Inc. & Subsidiaries 2739 U.S. Highway 19 N. Holiday, FL 34691 Ensurer A: Wit Insurance Company 11075 Insurer B: Insurer C: Insurer D: Insurer E: Coverages The polices 01 insurance listed below have been Issued to 1>e Insured named above for the policy perfodlndceeed Notw'letandbg any requirement, fawn or mnditlan of any contract or other document elf respect to which obis certificate may be Issued or may pertain, the insurance afforded by the polices described herein is sub(ed to ell the terms, exclusions, and conditions of such polices Aggregate limits shown may have been reduced by paid claims INSR LTR ADDL INSRD Type of Insurance GENERAL LIABILITY Commercial General Liability Claims Made 0 Occur Policy Number Policy Effective Date (MM/DD/YY) Policy Expiration Date (MM/DD/YY) Limits General aggregate limit applies per: PoNcy ❑ Proles! El LOC Eadt Occurrence 5 Damage to rented premises (EA occurrence) Med Exp 5 Personal Adv Irritry 5 General Aggregate 5 Products ' ConpVpAgg 5 AUTOMOBILE LIABILITY My Auto Au Owned Arles Scheduled Aurae Hired Autos Non -Owned Autos Confined Single Unit (EAACddeM) 5 BodIy Injury (Per Person) 5 eorlly Injury (Per Accident) 5 Propeny Damage (Per Acddenl) 5 EXCESS /UMBRELLA LIABILITY ROccur ❑ Claims Made Deductible Each Ooarrrenos Aggregate A Workers Compensation and Employers' Liability Any proprielor/perftenexecubve officer/member excluded? 11 Yea, describe under spadel provisions below. WC 71949 01/01/2011 01/01/2012 xr�, � I 1 R� E.L Each Accident 61.00opoa E.L. Disease - Ea Employee 61,000,000 E.L Disease - Policy Lkntls 61,000,000 Other Lion Insure nee Company is A. M. Best Company A- (Excellent). AMS iT 12616 Descriptions of Operations /LocationsNehlcles/Excluslons added by Endorsernent/Special Provisions: Client IDh 8445.631 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company": Isaacs Roofing & Insulation Corporation Coverage only applies to injuries incurred by South East Personnel Leasing, Inc. & Subsidiaries 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 12 -23-11 (CF) CERTIFICATE FOLDER CrwcELLATION Miami Shores Village Building Department 10050 NE 2nd Ave. Miami Shores, PL 33138 Phone: 305 -795 -2204 Resin Dater 12/21/2011 Should any of tie above described policies be cancelled before the aaphatlon date thereof, the issuing Insurer wilt endeavor to me130 days written raise to the ceratfeete holder named to the left, but failure to do so shall impose no obligation or liability of any kind upon the insurer, ha agents or represenlaltvea `V NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. A t r '1 TAX FOLIO NO. STATE OF FLORIDA COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 111111111111111111111111111111111111111111111 CFN 2011808402 32 OR Bk 27928 Ps 3191f Cias) RECORDED 1201502011 09:09:17 HARVEY RUVIN, CLERK. OF COURT t1IAIII -DADE COUNTY, FLORJDA LAST PAGE 1. Legal description of property and street/address: 44 1 S 06 IO S t /lt,A�wi �(n PG'S. 2. Description of improvement 3. Owner(s) name and address: $T1 of L,.t .0► 4(5' Nd 16S S1 . /y - Interest in property: ®....f Name and address of fee simple titleholder. 4. Contractor's name and address: ZSAAcS 12-41:421—t • •G 2 5. Surety: (Payment bond required by owner from contractor, If any) Name and address: Amount of bond $ 6. Lender's name and address: 7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1x:)7., Florida Statutes, Name and address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: 9. EXpiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) C&Aiirr Sign ture of Owner Print Owner's Name Ar t . (S if€ Prepared by Swom to and subscribed before me this s 01 day of l--- , 20 Ad•r= Notary Pubfi • / / ;,i,., 4 Print Notary's a 4.11MIMMIIHr /II My commission expires: 123:0142 PAGE4 BIOS STATE OF FLORIDA, COUNTY OFDAOE 1 HFRFR v CERTIFY that this is a true copy of-the original filed to thrs office •n day of D 5 20A ,AD20 �� 1licrai Seal. •`� .fCrrcutt and County Courts %/ O.C. ,NESS HARVEY ty k2Aici\kt—VsLitAtJ BUILDING 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. P-1— I PERMIT APPLICATION FBC 20 Permit Type: BUILDING ROOFING RECEIVED DEC 1 8 2011 Master Permit No. OWNER: Name (Fee Simple Titleholder): �� ` ; , L. M A Phone #: Address: `i 1 S toS T. City: it ..4vv1 i State: C/ ` Zip: Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: /% S NE- 10S sr City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: 305 — a3 1°17+5&, CONTRACTOR: Company Name: . 540A- c 5 �.. -E- 1. ^' "\ Phone #: Address: % .7 2-25- S - -O t xt‘ A ,Li City: %y/ . 4/► J Stater(• Zip: Qualifier Name: 4l „11;3 e ? •`' 2 a Phone #: State Certification or Registration #: s r e (3 25.5.5 Cv Certificate of Competency #: Contact Phone #: 3oS z3 y $Z 3 `/ Email Address: ear -' -t 72--` F e Q !0-67 /1S o ,a Ti., . J t DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ T27 MO . Square/Linear Footage of Work: 16 0 C) Type of Work: ❑Addition ❑Alteration ❑Neww air/Replace DDemolition Description of Work: 7-6- ._„kr L A Tv T i "'T. + x***+x***** *** *** *** * * * * * ** * *** **** xx *** Fees***, x+ x+ x+ x******+ x**+ x** *******+x ****+x ****+x***** ** Submittal Fee $ Permit Fee $ gb7X-6'V CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature 0 • or Agent lfK� /GI Tr /I 11"N The foregoing instrument was acknowledged before me this day of / Z , 20 l ( , by 4.444 CAPIVC. , who igersonally own me or who has produced As identification and who did take an oath. NOTARY PUBLIC:, 4 0011111w/ lir� \end 9.f/l. 1/4',,, Sign: Print: My Commission Expires: • ms/1200 12 # PUBLIC J; .• ,DDI65901, Signature Contractor f� The foregoing instrument was acknowledged before me this J ?� day of , 20I, by AJAt'V (oC. IZ who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 4 - Notarr P B11C My Commission Expires: •.Commission # .. D165901: • . /, e OF f\- , a, xx, ***** a,* *, xx, *****>i, **** * ****** ** * ***+i<+ *,e66-x :* x*+ x, x, x****w, t s+ x, x, x, xx,****+ x, x*+>, *+x>k**>k*****+r<4*// ' a4+x ****** APPROVED BY �: 11/1, y �/ Plans Examiner Zoning Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Clerk . Section A/B "Delivering Excellence Every Day" Master Permit No: Contractor's Name: Job Address: Miami -Dade County Building & Neighborhoo li . e artment HVHZ Electronic Roof Pe Section A (General Information) Process No: Isaacs Roofing 415NE105St Low Slope ❑ Asphaltic Shingles ❑ Sprayed Polyurethane Foam Roof Category ❑ Mechanically Fastened Tile ❑ Metal Panel /Shingles ❑ Other: Roof Type DEC 1 5 2011 ❑ Mortar /Adhesive Set Tile ❑ Wood Shingles /Shakes ❑ New Roof 4 Re- Roofing ❑ Recovering ❑ Repair ❑ Maintenance Are there Gas Vent Stacks located on the roof? ❑ Yes No If yes, what type? ❑ Natural ❑ LPGX Low slope roof area (ft.2) 1600 Roof System Information Steep Sloped area (ft.2) Section B (Roof Plan) Total (ft.2) 1600 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. Perimeter Width (a'): Comer Size (a' x a'): 51' g I w I 1^ . 11- M ami S ,ores Village APPROVED BY DATE ZONING DEPT BLDG DEPT L�� L RI IR.IFr:T ,0 Cr ,IR1.lANCE WI f 1-I AI _L FEDERAL. STATE AND eG IJN N RULES AND REGULATIONS Section C "Delivering Excellence Every Day " Fill in the specific roof assembly components. If a component Is not required, insert not applicable (n/a) in the text box. Top Ply: Miami -Dade County Building & Neighborhood Compliance Deparbnent HVHZ Electronic Roof Permit Form Section C page (Low Slope Roof Systems) ROOF SYSTEM MANUFACTURER: Johns Manville Product Approval (NOA): 11-0126.06 ; System Type: Wind Uplift Pressures, From RAS 128 or Sealed Calculations: (P1) Field: 49.2 (P2) Perimeters: (P3) Comers: psf 82.6 124.3 psf psf Maximum Design Pressure From NOA: 1/8 Roof Slope: Parapet Walls: 0 No Deck Type: 305 " : 12 Roof Mean Height: 0 psf 10 Yes Parapet wall Height: — Structural Concrete- Support Spacing: J Altemate Deck Type: Existing Roof: " o/c ft. 1 n/a Fire Barrier: n/a Vapor Barrier: In/a Anchor Sheet: Anchor Sheet Fastener / Bonding Material: n/a Insulation Base Layer Size & Thickness: 11.5 ISO Insulation Base Layer Fastener / Bonding Material: I Hot Mopped Insulation Top Layer Size & Thickness: 5" High Density board Insulation Top Layer Fastener / Bonding Material: Hot asphalt Base Sheet(s) & No. of Ply(s): Base Sheet Fastener / Bonding Material: M n/a Ply Sheet(s) & No. of Ply(s): DynaBase Ply Sheet Fastener / Bonding Material: ft. DynaGlas FR Top Ply Fastening / Bonding Material: hot asphalt Surfacing: SINGLE PLY MEMBRANE: Single PIy Manufacturer / Type: Single Ply Sheet Width: No. of Single Ply 1/2 sheets: Single PIy Membrane Fastening / Bonding Material: " 1/2 Sheet Width: ❑ FASTENER SPACING FOR BASESHEET ATTACHMENT ❑ SINGLE PLY MEMBRANE ATTACHMENT 1. Field: El " o/c @ Laps & ri rows El " o/c 2. Perimeter: " o/c @ Laps & F1 rows " o/c 3. Comer. El " o/c @ Laps & Ei rows D " o/c NUMBER OF FASTENERS PER INSULATION BOARD: 1. Field: 2. Perimeter. 3. Comer. Insulation Fastener Type : n/a WOOD NAILER TYPE AND SIZE: 2x6 Wood Nailer Fastener Type and Spacing: 1/4" tap cons EDGE & COPING METAL SIZES: Edge Metal Material: Edge Size: Hook Strip Size: Edge Metal Attachment: — Galvanized Metal- -3" face 26 ga.— — SELECT EDGE METAL HOOK STRIP SIZE- Coping Material: Coping Size: - SELECT PARAPET WALL COPING MATERIAL- - SELECT COPING METAL SIZE OR THICKNESS- Hook Strip Size: Parapet Coping Metal Attachment: - SELECT COPING METAL HOOK STRIP SIZE— Section C2 "Delivering Excellence Every Day" Miami -Dade County Building & Neighborhood Compliance Department HVHZ Electronic Roof Permit Form Illustrate Components Noted and Details as Applicable: Woodblocking, Gutter, Edge Terminations /Stripping /Flashing, Continuous Cleat, Cant Strip, Base Flashing, Counterflashing, Coping, Etc. Indicate: Mean Roof Height, Parapet Height, Height of Base Flashing, Component Material, Material Thickness, Fastener Type, Fastener Spacing Or: Submit Manufacturers Details that Comply with RAS -111 and Chapter 15 HVHZ, FBC. Stucco Stop 1.5" ISO & HD 5 " Parapet Wan Height Mean Roof Height 3' 10' file:// /Cl/Documents %20and %20Settings/ sky / Desktop / root% 20permit %20forms /Section %20C2d.htm9 /5/2007 7:18:20 AM ft M1 Owner's Notification Form 07 r.•b;ti- efdi78: t t llen(t. very 1.4.11' SECTION 1524 HIGH VELOCITY HURRICANE ZONES — REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS 1524.1 Scope. As it pertains to this section, it is the responsibility of the roofmg contractor to provide the owner with the required roofmg permit, and to explain to the owner the content of this section. The provisions of Chapter 15 of the Florida Building Code, Building govern the minimum requirements and standards of the industry for roofmg system installations. Additionally, the following items should be addressed as part of the agreement between the owner and the contractor. The owner's initial in the designated space indicates that the item has been explained. .Aesthetics- workmanship: The workmanship provisions of Chapter 15 (High Velocity Hurricane Zone) are for the purpose of providing that the roofing system meets the wind resistance and water intrusion performance standards. Aesthetics (appearance) are not a consideration with respect to workmanship provisions. Aesthetic issues such as color or architectural appearance, that are not part of a zoning code, should be addressed as part of the agreement between the owner and the contractor. Renailing wood decks: When replacing roofing, the existing wood roof deck may have to be renailed in accordance with the current provisions of Chapter 16 (High Velocity Hurricane Zones) of the Florida Building Code. (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 roofmg work to be performed. iiExposed ceilings: 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 penetrations of the underside of the decking may not be acceptable. The owner provides the option of maintaining this 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. Ponding can be an indication of structural distress and may require the review of a professional structural engineer. Ponding may shorten the life expectancy and performance of the new roofing system. Ponding conditions may not be evident until the original roofmg system is removed. Ponding conditions should be corrected. . Overflow scuppers (wall outlets): It is required that rainwater flow off so that the roof is not overloaded from a build up of water. Perimeter /edge walls or other roof extensions may block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accordance with the requirements of: Chapter 15 and 16 herein and the Florida Building Code, Plumbing. . Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of the structural assembly (the building itself). The existing amount of attic ventilation shall not be reduced. Exception: Attic spaces, designed by a Florida - licensed engineer or registered architect to eliminate the attic venting, venting shall not be required. Owner's /Agent's Signature: Contractor's Signature: Property Address: Date: / Permit Number: BUILDING AND NEIGHBORHOOD COMPLIANCE DEPARTMENT (BNC) BOARD AND CODE ADMINISTRATION DIVISION NOTICE OF ACCEPTANCE (NOA) Johns Manville Corporation 717 17th Street Denver, CO 80202 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.gov/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 and the High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION: Johns Manville Modified Bitumen Roofing Systems Over Concrete Decks LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami -Dade County Product Control Approved ", unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA renews NOA No. 09- 0902.03 and consists of pages 1 through 38. The submitted documentation was reviewed by Jorge L. Acebo. MIAMMDADE COUNTY APPROVED NOA No: 11- 0126.06 Expiration Date: 07/19/12 Approval Date: 07/21/11 Page 1 of 38 ROOFING SYSTEM APPROVAL Category: Sub - Category: Material: Deck Type: Maximum Design Pressure Roofing Modified Bitumen SBS Concrete -536.5 psf TRADE NAMES OF PRODUCTS MANUFACTURED OR LABELED BY APPLICANT: TABLE 1 Test Product Dimensions Specification DynaBase 54' -10" x 36" ASTM D 6163 Type I Grade S DynaWeld Base 39' -3/8" x 32' -10" ASTM D 6163 Type I Grade S DynaWeld 180 S 39 -3/8" x 32' -10" ASTM D 6164 Base Type I Grade S DynaFlex DynaGlas DynaWeld Cap FR 3 x 25 ASTM D 6221 39 -3/8" x 32' -10" ASTM D 6163 Type I Grade G 39' -3/8" x 32' -10" ASTM D 6163 Type I Grade G DynaWeld Cap 180 39 -3/8" x 32' -10" ASTM D 6164 FR Type I Grade G DynaGlas 30 FR 39 -3/8" x 32' -10" ASTM D 6163 Type I Grade G DynaGlas FR 39 -3/8" x 32' -10" ASTM D 6163 Type I Grade G DynaKap 39 -3/8" x 32' -10" ASTM D 6162 Type I Grade G DynaKap FR 39 -3/8" x 32' -10" ASTM D 6162 Type I Grade G DynaLastic 180 DynaLastic 180 FR MIAMI DADE COUNTY APPROVED 39 -3/8" x 32' -l0" 39 -3/8" x 32' -10" ASTM D 6164 Type I Grade G ASTM D 6164 Type I Grade S Product Description An SBS modified bitumen coated, fiber glass reinforced base sheet. An SBS modified bitumen coated, fiberglass reinforced base sheet for heat welded applications. An elastomeric modified bitumen coated, 180 gram, nonwoven polyester mat and bi- directional glass scrim reinforced, base sheet for heat welded applications. A flexible polyester /glass scrim reinforced, granular- surfaced flashing sheet. An SBS modified bitumen membrane surfaced with granules for application in hot asphalt. A fire resistant SBS modified bitumen membrane surfaced with granules for heat weld applications. A fire resistant, 180 gram polyester reinforced, SBS modified bitumen sheet. A fire resistant SBS modified bitumen membrane surfaced with granules for application in hot asphalt. A fire resistant SBS modified bitumen membrane surfaced with granules for application in hot asphalt. A fiberglass /polyester reinforced SBS modified bitumen membrane surfaced with granules for application in hot asphalt. A fire resistant, fiberglass/ polyester reinforced SBS modified bitumen membrane surfaced with granules for application in hot asphalt. A 180 gram polyester reinforced SBS modified bitumen membrane surfaced with granules for application in hot asphalt. A 180 gram polyester mat reinforced, granular- surfaced, modified bitumen cap sheet for use in fire -rated systems. NOA No: 11- 0126.06 Expiration Date: 07/19/12 Approval Date: 07/21/11 Page 2 of 38 Product DynaLastic 180S DynaPly DynaLastic 250 DynaLastic 250 FR DynaLastic 250 S DynaMax DynaMax FR DynaClad DynaBase XT DynaGlas FR XT GlasKap GlasKap CR Ventsulation Felt GlasBase Plus GlasPly IV G1asPly Premier PermaPly 28 MAMt.OADE COUNTY APPROVED Dimensions 37" x 36' -9" 39 -3/8" x 32' -10" 39 -3/8" x 32' -10" 39 -3/8" x 32' -10 ". 39 -3/8" x 32' -10" 39 -3/8" x 32' -10" 39 -3/8" x 32' -10" Test Specification ASTM D 6164 Type I Grade S ASTM D 6162 Type II Grade S ASTM D 6164 Type II Grade G ASTM D 6164 Type II Grade G ASTM D 6164 Type II Grade S ASTM D 6162 Type III Grade G ASTM D 6162 Type III Grade G 39 -3/8" x 33' -6" ASTM D 6298 39 -3/8" x 49' -2" 39 -3/8" x 32' -10" 36 "x36' 36 "x36' 36" x 36' 36" x 108' 36" x 200' 36" x 180' 36" x 108' ASTM D 6163 Type I Grade S ASTM D 6163 Type I Grade S ASTM 3909 ASTM 3909 ASTM D 4897 Type II ASTM D 4601 ASTM D 2178 Type IV ASTM D 2178 Type VI ASTM D 4601 Type II Product Description A 180 gram polyester mat reinforced, modified bitumen cap sheet for use in fire - rated systems. A polyester reinforced SBS modified bitumen ply sheet for use in conventional and modified bitumen built -up roof systems. A 250 gram polyester mat reinforced, granular- surfaced, modified bitumen cap sheet. A 250 gram polyester mat reinforced, granular- surfaced, modified bitumen cap sheet for use in fire -rated systems. A 250 gram polyester reinforced, SBS modified bitumen Base/Ply sheet for use as a base or ply sheet only . A fiberglass /polyester reinforced SBS modified bitumen membrane surfaced with granules for application in hot asphalt or heat weld. A fire resistant, fiberglass/ polyester reinforced SBS modified bitumen membrane surfaced with granules for application in hot asphalt. An aluminum foil faced, glass reinforced, SBS modified membrane for application in hot asphalt. A heavyweight glass reinforced SBS Base/Ply sheet. A heavyweight glass reinforced granular surfaced SBS Cap sheet. A mineral surfaced, asphalt coated, fiberglass cap sheet. A white mineral surfaced, white acrylic coated, fiberglass cap sheet. Heavy duty fiber glass base sheet impregnated and coated on both sides with asphalt with or without fine mineral stabilizer. Surfaced on the bottom side with coarse mineral granules embedded in asphaltic coating. Type II asphalt impregnated and coated glass fiber base sheet for use in conventional and modified bitumen built -up roofing. Type IV asphalt impregnated glass felt for use in conventional and modified bitumen built -up roofmg. Type VI asphalt impregnated glass felt for use in conventional and modified bitumen built -up roofing. Type II asphalt impregnated and coated glass fiber base sheet for use in conventional and modified bitumen built -up roofing. NOA No: 11- 0126.06 Expiration Date: 07/19/12 Approval Date: 07/21/11 Page 3 of 38 Product FesCant Plus Cant Strips, and Taper Edge Dimensions various MBR Flashing N/A Cement Base and Activator MBR Bonding N/A Adhesive JM Two Part N/A Urethane Insulation Adhesive Bestile Industrial various Roof Cement Flex -I -Drain various PC/PET RetroDrain USII RetroDrain Super Dome RetroDrain FP -10 Vents Expand -O -Guard Expand -O -Flash Presto -Lok Fascia and Flashing System DynaTred & DynaTred Plus Roof Walkway MIAMIOADE COUNTY APPROVED various various various 10" deck flange, base diameter of 4" and a height of 6" various various various various Test Specification ASTM C 728 Proprietary proprietary Proprietary ASTM D 4586, type I BOCA 76-61 SBCCI 89204 UBC 3236 N/A N/A N/A N/A N/A N/A TAS 114 N/A Product Description Factory pre- fabricated cant strips and taper edge, manufactured from expanded perlite insulation. A two component elastomeric, cold application adhesive, consisting of a modified proprietary compound with an asphalt base. A two component urethane cold application adhesive. A two -part urethane insulation adhesive A trowel grade, cutback bitumen flashing grade cement mixture including inorganic fibers and mineral stabilizers. Two piece flexible drain system composed of a Noryl deck flange, a flexible neoprene bellows and no hub connection. Available in various sizes and styles for most retro -fit applications. Engineered resin copolymer fabricated drain for retrofit applications. One piece, aluminum fabricated drain for retrofit applications. Cast aluminum, heavy -duty drain for retrofit applications. One -way roof vent, designed for use in various roof systems, for the release of pressure created by gases or moisture vapor trapped within the roofmg system. Elastomeric expansion joint cover for vertical expansion and seismic joints. Manufactured from non - reinforced, form- supported elastomeric bellows with a bifurcated waterproof attachment to metal flanges. Expansion joint covers manufactured from non - reinforced, form- supported elastomeric bellows with a bifurcated waterproof attachment to metal flanges. A multi -piece fascia and flashing system for built -up and modified bitumen roofing systems manufactured from aluminum or steel. Preformed, skid - resistant boards. NOA No: 11- 0126.06 Expiration Date: 07/19/12 Approval Date: 07/21/11 Page 4 of 38 APPROVED INSULATIONS: Product Name ENRGY 3 Fesco Foam, DuraFoam Retro -Fit Board, DuraBoard Fesco Board Invinsa Roof Board SECUROCK Gypsum -Fiber Roof Board APPROVED FASTENERS: Fastener Number 1. 2. Product Name UltraFast (# 14 Only) JM CD -10 3. JM Standard Metal Plate 4. JM Plastic Plate 5. UltraFast Metal Plate 6. UltraFast Plastic Plate 7. CD -10 8. OMG Fastener #14 9. OMG Fastener ASAP 10. OMG Standard 11. OMG G -2 12. OMG Polypropylene 13. High Load Fasteners and Plates TABLE 2 Product Description Polyisocyanurate Insulation. Polyisocyanurate Insulation with perlite facer A high - density perlite roof insulation. Rigid perlite roof insulation board. High density polyisocyanurate board Rigid, gypsum -based board stock TABLE 3 Product Description Insulation fastener for concrete decks. Insulation fastener for concrete decks. Galvalume AZ55 steel plate Polypropylene round plate Galvalume AZ55 steel plate Polypropylene round plate Insulation fastener for concrete decks. Insulation fastener Pre - assembled Insulation fastener and plate Galvalume AZ55 steel plate. Galvalume AZ55 steel plate. Polypropylene plastic plate #15 fasteners and 20 gauge metal plates Dimensions Various Various 3" round 3.25" round 3" round 3" square 3" round Various Various Various 3" round 3.5" round 3" round 2 -3/8" round Manufacturer (With Current NOA) Johns Manville Johns Manville Johns Manville Johns Manville Johns Manville USG Corp. Manufacturer (With Current NOA) Johns Manville Johns Manville Johns Manville Johns Manville Johns Manville Johns Manville OMG, Inc. OMG, Inc. OMG, Inc. OMG, Inc. OMG, Inc. OMG, Inc. Johns Manville NOA No: 11- 0126.06 Expiration Date: 07/19/12 Approval Date: 07/21/11 Page 5 of 38 EVIDENCE SUBMITTED: Test Agency/Identifier Factory Mutual Research Corp. Dynatech Engineering, Inc. Underwriters Laboratories, Inc. Exterior Research & Design, LLC TrinitylERD Independent Roof Testing & Consulting, Inc. IRT -ARCON Inc Name J.I. #3001482 J.I. #3001629 J.I. #0Z8A9.AM J.I. #3D4A4.AM J.I. #3000949 3007148 3006346 3001457 3009499 3011248 3014090 3012974 3020703 3037222 3026130 4360.03.95 -1 4360.03.95 -2 4361.5.95 -1 R -10167 (N) #4361 - 2.04.97 -1 #10390A- 10.97 -1 #10390A- 12.97 -1 #4251.08.96 -1 10391.01.03 02843.02.05 -10 -R1 00257.03.05 -1 02843.02.07 J7670.06.08 J6990.12.07 -R1 J17040.11.09 -R1 J13700.05.10 -1 -R1 J13700.05.10 -2 # 99006.1.20.99 #99007.1.20.99 #99008.1.20.99 #99009.1.20.99 #99016.1.20.99 02 -026 02 -011 Report Class 4470 FM Class 4470 FM Class 4470 FM Class 4450 FM Class 4450 FM Class 4470 FM Class 4470 FM Class 4470 FM Class 4470 FM Class 4450 FM Class 4470 FM Class 4470 FM Class 4470 TAS 114 TAS 114 Fire Classification Listing TAS 114 TAS 114 TAS 114 TAS 114 ASTM D 6162/63/64 ASTM D6298 TAS 114 ASTM D3909 ASTM D6162/D6164 ASTM D6164 ASTM D5147/D6163 ASTM D5147/D6164 TAS 114 TAS 114 TAS 114 Date 08/11/98 09/10/98 09/28/98 04/19/00 09/15/00 03/04/02 04/04/01 11/01/02 09/05/02 06/03/02 07/30/04 10/02/09 04/26/09 3/95 5/95 01/01/95 04/28/97 10/97 12/97 01/20/99 01/29/03 02/07/07 03/17/05 02/07/07 06/16/08 03/24/10 03/11/10 01/25/11 05/11/10 01/20/99 03/99 07/26/02 02/06/02 NOA No: 11- 0126.06 Expiration Date: 07/19/12 Approval Date: 07/21/11 Page 6 of 38 APPROVED ASSEMBLIES Membrane Type: SBS Deck Type 3I: Concrete Decks, Insulated Deck Description: 2500 psi structural concrete or concrete plank System Type A(l): One or more layers of insulation adhered with approved asphalt or adhesive. All General and System limitations apply. One or more layers of the following insulations: Base Insulation Layer Insulation Fasteners Fastener (Table 3) Density/ft2 ENRGY 3 Minimum 1.5" thick N/A N/A Fesco Foam, DuraFoam Minimum 1.5" thick N/A N/A Top Insulation Layer (Optional) Insulation Fasteners Fastener (Table 3) Density/ft' Fesco Board, DuraBoard Minimum %" thick N/A N/A Retro -Fit Minimum % :" thick N/A N/A Note: All insulation shall be adhered to the primed deck in full mopping of approved hot asphalt within the EVT range and at a rate of 20-40 lbs /100 ft2. Please refer to Roofing Application Standard RAs 117 for insulation attachment. Insulation listed as base layer only shall be used only as base layers with a second layer of approved top layer insulation installed as the final membrane substrate. Composite insulation panels may be used as a top layer placed with the polyisocyanurate side facing down. Base Sheet: (Optional) One ply of GlasPly Premier, GlasPly IV or PermaPly 28 Base Sheet adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbs./sq. Ply Sheet: One or more plies of GlasBase Plus, PermaPly 28, GlasPly Premier, GlasPly IV, DynaLastic 180 S, DynaLastic 250 S, DynaBase, DynaBase XT or DynaPly adhered to the base sheet with approved mopping of asphalt applied within the EVT range and at a rate of 20-40 lbs./sq. Membrane: One ply of DynaKap, DynaKap FR, DynaMax, DynaMax FR, DynaGlas, DynaGlas FR, DynaGlas 30 FR, DynaGlas 30 FR XT, DynaLastic 180, DynaLastic 180 FR, DynaLastic 180 S, DynaLastic 250, DynaLastic 250 FR or DynaPly adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbs. /sq. or one ply DynaWeld Cap FR heat welded. (See application instructions for approved method of installation). Or (Only with a modified Base or Ply sheet) GlasKap or GlasKap CR adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbs. /sq. Surfacing: (Optional) Install one of the following: 1. Flood coat and gravel /slag with an application rate of 60 lbs./sq. & 400 lbs. /sq., respectively. Maximum Design Pressure: -305 psf (See General Limitation #9). NOA No: 11- 0126.06 Expiration Date: 07/19/12 Approval Date: 07/21/11 Page 7 of 38 CONCRETE DECK SYSTEM LIMITATIONS: 1. If mechanical attachment to the structural deck through the lightweight insulating concrete is proposed, a field withdrawal resistance testing shall be performed to determine equivalent or enhanced fastener patterns and density. All testing and fastening design shall be in compliance with Testing Application Standard TAS 105 and Roofing Application Standard RAS 117, calculations shall be signed and sealed by a Florida Registered Engineer, Architect, or Registered Roof Consultant. GENERAL LIMITATIONS: I . Fire classification is not part of this acceptance, refer to a current Approved Roofing Materials Directory for fire ratings of this product. 2. Insulation may be installed in multiple layers. The first layer shall be attached in compliance with Product Control Approval guidelines. All other layers shall be adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20- 401bs. /sq., or mechanically attached using the fastening pattern of the top layer 3. All standard panel sizes are acceptable for mechanical attachment. When applied in approved asphalt, panel size shall be 4' x 4' maximum. 4. An overlay and/or recovery board insulation panel is required on all applications over closed cell foam insulations when the base sheet is fully mopped. If no recovery board is used the base sheet shall be applied using spot mopping with approved asphalt, 12" diameter circles, 24" o.c.; or strip mopped 8" ribbons in three rows, one at each side lap and one down the center of the sheet allowing a continuous area of ventilation. Encircling of the strips is not acceptable. A 6" break shall be placed every 12' in each ribbon to allow cross ventilation. Asphalt application of either system shall be at a minimum rate of 12 lbs. /sq. Note: Spot attached systems shall be limited to a maximum design pressure of -45 psf. 5. Fastener spacing for insulation attachment is based on a Minimum Characteristic Force (F') value of 275 lbf., as tested in compliance with Testing Application Standard TAS 105. If the fastener value, as field - tested, are below 275 lbf. Insulation attachment shall not be acceptable. 6. Fastener spacing for mechanical attachment of anchor/base sheet or membrane attachment is based on a minimum fastener resistance value in conjunction with the maximum design value listed within a specific system. Should the fastener resistance be less than that required, as determined by the Building Official, a revised fastener spacing, prepared, signed and sealed by a Florida Registered Engineer, Architect, or Registered Roof Consultant may be submitted. Said revised fastener spacing shall utilize the withdrawal resistance value taken from Testing Application Standards TAS 105 and calculations in compliance with Roofing Application Standard RAS 117. 7. Perimeter and corner areas shall comply with the enhanced uplift pressure requirements of these areas. Fastener densities shall be increased for both insulation and base sheet as calculated in compliance with Roofing Application Standard RAS 117. Calculations prepared, signed and sealed by a Florida registered Professional Engineer, Registered Architect, or Registered Roof Consultant (When this limitation is specifically referred within this NOA, General Limitation #9 will not be applicable.) 8. All attachment and sizing of perimeter nailers, metal profile, and/or flashing termination designs shall conform to Roofing Application Standard RAS 111 and applicable wind load requirements. 9. The maximum designed pressure limitation listed shall be applicable to all roof pressure zones (i.e. field, perimeters, and corners). Neither rational analysis, nor extrapolation shall be permitted for enhanced fastening at enhanced pressure zones (i.e. perimeters, extended corners and corners). (When this limitation is specifically referred within this NOA, General Limitation #7 will not be applicable.) END OF THIS ACCEPTANCE MIAMI•DADE COUNTY APPROVED NOA No: 11- 0126.06 Expiration Date: 07/19/12 Approval Date: 07/21/11 Page 38 of 38 • GFI.T.R10167 - Roofing Systems u ac Coatin : — Gravel, embedded In hot roofing asphalt or any UL Classified emulsion applied at the rate of 4 -5 gal /sq. Page 16 of 72 3. Deck: C -15/32 Incline: 1/2 Insulation (Optional): — Any thickness, one or more layers, 1/2 in. "Retro -Ftt ", "Fesco" or "DuraBoard ", "Fesco- Foam ", "DuraBoard ", "ISO 3 ", "ENRGY 3 ", hot mopped or mechanically fastened, All insulation joints offset from plywood deck joints, 6 In. min. Base Sheet: — One or more plies Type Gi or "GlasPly IV" or "GlasPly Premier" or Type G2 " PermaPly 28 ", "GlasBase" or "Ventsuiatton ", "DynaPly" or "DynaBase" (SBS modified bitumen), hot mopped or "DynaWeld Base ", heat welded. Membrane: — "DynaKap FR ", "DynaGlas 30 FR ", "DynaLastic 180FR ", "DynaMax FR ", "DynaLastic 250FR" or " DynaGlas FR" (SBS modified bi 'mu)), of o• .ed or "Dy aWeld Cap FR heat welded.. ). Deck: NC Incline: 1/2 Insulation (Optional): — One or more layers, any thickness, "Fesco" or "DuraBoard ", "Fesco - Foam ", "DuraBoard ", "ISO 3 ", "ENRGY 3" or any UL Classified polyisocyanurate insulation., mechanically fastened or hot mopped in combination (optional) with 1/2 In. "Retro -Flt" cover board or 3/4 in. 'Fesco" or "DuraBoard" over polystyrene, mechanically fastened or hot mopped. Base Sheet: — One or more plies Type Gi or "GlasPly Premier ", "GlasPly IV" or Type G2 "PermaPly 28 ", "GlasBase ", "Ventsulation ", "DynaPly °, "DynaBase" or "DynaLastic 180S" (SBS modified bitumen), mechanically fastened or hot mopped, or "DynaWeld Base ", heat welded. Membrane: — "DynaKap FR ", "DynaGlas 30 FR ", "DynaGlas FR ", "DynaMax FR" or "DynaLastic 250FR" (SBS modified bitumen), hot mopped, or "DynaWeld Cap FR ", heat welded. i0. Deck: NC Incline: 1/2 Insulation (Optional): — Any thickness, one or more layers, "Fesco" or "DuraBoard ", "Fesco- Foam ", "ISO 3 ", "ENRGY 3" or any UL Classified polyisocyanurate insulation, hot mopped or mechanically fastened In combination (optional) with 1/2 in. "Retro -Fit" cover board or 3/4 In. "Fesco" or "DuraBoard" over polystyrene. Ply Sheet: — Two or more plies Type Gi or "GlasPly Premier ", "GlasPly IV" or Type G2 " PermaPly 28 ", "GlasBase" or "Ventsulation ", "DynaPly ", "DynaBase" or "DynaLastic 1805" (SBS modified bitumen), hot mopped. First layer may be nailed. Membrane: — "DynaLastic 180 FR" or "DynaLastic 250 FR" (SBS modified bitumen), hot mopped, or "DynaWeld Cap FR ", heat welded. 1. Deck: C-15/32 Incline: 1/2 in. Base Sheet: — "GlasBase °, "Ventsulation" or "DynaBase ", nailed. Ply Sheet: — One or two plies "DynaBase ", "DynaPly ", "GlasPly IV" or "GlasPly Premier ", hot mopped. Membrane: — "DynaKap FR ", "DynaGlas 30 FR ", "DynaLastic 180FR ", "DynaMax FR ", "DynaLastic 250FR" or "DynaGlas FR" (SBS modified bitumen), hot mopped or "DynaWeld Cap FR ", heat welded. .2. Deck: NC Incline: 1/2 Base Sheet (Optional): — Type Gi or G2, mechanically attached, spot or fully mopped. Ply Sheet: — "DynaLastic 1S0S ", "DynaBase" or "DynaLastic 1805 ", mechanically fastened, spot or fully mopped, or "DynaWeld Base ", heat welded. Membrane: — "DynaGlas FR" or "DynaMax FR" (SBS modified bitumen), hot mopped, or "DynaWeld Cap FR ", heat welded. 3. Deck: NC Incline: 1/2 Insulation (Optional): — Polyisocyanurate, polyisocyanurate /perlite composite, wood fiber, glass fiber or perllte, any thickness, any combination.. Base Sheet (Optional): — Type G1, G2 or G2 vented base sheet, mechanically attached, spot or fully mopped. Ply Sheet: — "DynaLastic ", "DynaBase ", mechanically fastened, spot or fully mopped, or "DynaWeld Base ", heat welded. Membrane: — "DynaGlas FR" or "DynaMax FR" (SBS modified bitumen), hot mopped, or "DynaWeld Cap FR ", heat welded. l4. Deck: C -15/32 Incline: 1/2 Insulation: — Glass fiber, wood fiber or perute, 1 In. thick min, joints in Insulation offset 6 in. with joints in deck. Base Sheet: — Type G2, mechanically attached, spot or fully mopped. Ply Sheet: — "Nord Flex Duo Ply FR Base Sheet ", hot mopped. Membrane: — "DynaGlas FR ", "DynaMax FR" or "Nord Flex Duo Ply FR Cap Sheet" (SBS modified bitumen), hot mopped. 5. Deck: NC Incline: 1 Insulation (Optional): — Glass fiber or pertite, 1 in. max, mechanically fastened. Base Sheet: — One or more layers, Type G2, hot mopped or mechanically fastened. Membrane: — One layer "DynaCiad" (SBS modified bitumen), heat fused or hot mopped. Ittp:/ /database. ul.con2 /cgi- bin /XYV /template /LISEXT/ 1 FRAME /showpage.html ?name= TGFU.R1... 8/17/2011 ET5 Asbestos Business License # ZA0000218 Mold Assessor Business License # MRSA1850 / Mold Remediator Business License # MRSR1932 Mold & Asbestos Surveys & Removal * Phase 1 Environmental Assessment * Air Monitoring & Analysis December 14, 2011 Saint Rose of Lima Catholic Church 415 NE 105 Street Miami Shores, Florida RE: Saint Rose of Lima Catholic Church / Choir Roof Only REPORT # FL11- 1406RAS 415 NE 105 Street Miami Shores, Florida Dear Sir: Pursuant to your request and our agreement, ETS Environment, Inc. has performed an Asbestos Roof Survey on December 13, 2011 at the above referenced facility. SURVEY LIMITATIONS This inspection report is the result of a diligent search of the facility for asbestos containing roofing materials (ACRM). All analyzed samples were readily available to our surveyor. If in the course of a renovation or demolition activity, additional suspect materials become exposed, all activities should immediately cease and the suspect material brought to our attention for evaluation and recommendation(s) if necessary. The scope of this inspection to perform a survey of roof surfacing materials for suspect ACM. Therefore only roofing material was sampled and all other building material is NOT included in this inspection survey report. LABORATORY METHODS Each sample was returned to the laboratory at ETS Environment, Inc., logged, and stored for analysis. All analyses were performed using the Polarized Light Microscope (PLM) Method 40 CFR Ch.1, Pt. 763, Subt. F, App. A Pgs. 293 -299, 1 -1 -87 ed.; (Polarized light microscopy in conjunction with dispersion staining). The scope of our investigation consisted of the following: Eight (8) random locations of roof system materials were chosen by our Certified Technician to secure as bulk samples for analysis. Samples for asbestos analysis were taken on any visibly potential Asbestos Containing Materials (ACM). Samples were placed in plastic bags and labeled for further analysis. All secured bulk samples were analyzed by Polarized Light Microscopy to verify asbestos content. Preparation of final report 12334 73 COURT NORTH, ROYAL PALM BEACH, FL. 33412 (954)236 -0053 (561)333 -0624 FAX (561)333 -0684 SITE DESCRIPTION The roof of the building is a built -up bituminous roof with a granulated surface. There is a parapet wall along the perimeter of the roof. There is flashing present at the parapet wall. The total roof area surveyed occupies approximately 1,700 ft2. CONCLUSIONS Based on our survey and bulk sample analysis, it was evident that NO asbestos fibers were found in any of the samples taken. CLOSING REMARKS ETS Environment, Inc. greatly appreciates the opportunity to provide quality environmental services at a reasonable cost. It has been a pleasure working with you and we look forward to doing so in the near future. Should you have any questions or comments, please do not hesitate to call. Respectfully submitted, ETS Environment, Inc. Dennis Emerson I.H. AHERA Inspector Certificate No. 144519 ZA # 0000218 I hereby certify that the Roof Asbestos Survey conducted on December 13, 2011, at Saint Rose of Lima Catholic Church, Choir Roof Only, 415 NE 105 Street, Miami Shores, Florida, was performed by Dennis Emerson, an E.P.A. Accredited A.H.E.R.A. Inspector utilizing the Code of the Federal Regulation Standards, 40 C.F.R., Part 763, Subpart E, Section 763.80- 763.99 and the State Asbestos Regulations, Florida Statues 469.003. Reviewed by 5444 R4,4&44 140•41, algittG ehm Ff• «. Ste, ft / ,/4/1/ Bruce Marchette, C.I.H. Dat Florida Certified Licensed Asbestos Consultant No. IA0000041 ETS ENVIRONMENT, INC. 2 ET5 04441..4x, BULK SAMPLE TRANSMITTAL FORM Client Name : Saint Rose of Lima Catholic Church Project Name : Report Number: Saint Rose of Lima Catholic Church / Choir Roof Only 415 NE 105 Street Miami Shores, Florida FL11- 1406RAS Date Collected: 12/14/11 Sample # Location of Sample Description Condition Asbestos 1 Parapet Wall Flashing F.C. NAD 2 Parapet Wall Flashing F.C. NAD 3 Parapet Wall Flashing F.C. NAD 4 Field Membrane F.C. NAD 5 Field Membrane F.C. NAD 6 Field Membrane F.C. NAD 7 Field Membrane F.C. NAD 8 Field Membrane F.C. NAD Sampled By : Dennis Emerson NAD - NO ASBESTOS DETECTED SAMPLE CONDITION CODES G.C. Good Condition F.C. Fair Condition P.C. Poor Condition P.D Physical Damage W.D. Water Damage F Friable N.F. Non - Friable H. Con. HI h Contrast M. Con. Moderate Contrast L. Con. Low Contrast 3 ET5 Evd.,,.4%fsu4, 12334 73rd Court North Royal Palm Beach, Fl. 33412 (954) 236 -0053 Project : Saint Rose of Lima Catholic Church Lab Code : 1063 Sample Number Anal. Init. Sample Item Description Asbestos Percentage & Type Identified Percentage & Type Non- Asbestos Fibers Percentage Non -Fiber Mat. 1 DKE Flashing NAD 3 -5 Fiberglass 7 -10 Cellulose 85 -90 Matrix 2 DKE Flashing NAD 3-5 Fiberglass 7 -10 Cellulose 85 -90 Matrix 3 DKE Flashing NAD 3 -5 Fiberglass 7 -10 Cellulose 85 -90 Matrix 4 DKE Membrane NAD 15 -18 Fiberglass 15 -17 Cellulose 65 -70 Matrix 5 DKE Membrane NAD 15 -18 Fiberglass 15 -17 Cellulose 65 -70 Matrix 6 DKE Membrane NAD 15 -18 Fiberglass 15-17 Cellulose 65-70 Matrix 7 DKE Membrane NAD 15 -18 Fiberglass 15 -17 Cellulose 65 -70 Matrix 8 DKE Membrane NAD 15 -18 Fiberglass 15-17 Cellulose 65 -70 Matrix Dennis Emerson I.H. Microscopist = No Asbestos Detected 4 , 4- � Florida Department of I oiaM�aDE� Environmental Protection Miami -Dade DERM Air Quality Management Division Division of Air Resource Management 701 N.W. 1st Court, 2nd Floor NOTICE OF DEMOLITION OR ASBESTOS RENOVATION Miami, Florida 33736 TYPE OF NOTICE (CHECK ONE ONLY): ORIGINAL ❑ REVISED ❑�!C�ANCELLATION ❑ COURTESY TYPE OF PROJECT (CHECK 9NE ONLY): ❑ DEMOLITION ❑ RENOVATION ,.KOOFING IF DEMOLITION, IS IT AN ORDERED DEMOLITION? ❑ YES ❑ NO IF RENOVATION: IS IT AN EMERGE CY RENOVATION OPERATION? ❑ YES ❑ NO File # IS ITA PLANNED I ENOVATION OPERATION? ❑ YES ❑_ NO Process # l;° Facility Name SG' 1`- C4€ 0 4-. t d; 0.10 (G° 1- 4 , C t" ' ',i a e` Address f .s N T. S City I el1%1) '),°∎ei State C Zip County bfat Site Consultant Inspecting Site ii Building Size n® (Square Feet) # of Floors. Building Age in Years Prior Use: ❑ Sch VCollege/University ❑ Residence ;0 Small Business Other Present Use: ❑ Sch VCollege/University ❑ Residence .e--- "J Small Busin s Other 11. Facility Omer i! g a0 ce O c. CI /i� C..' h -AC 0716lek Phone ( AddressUl! .. t4 P Per 91,r City % i ci,vt,°) 5 0`e-C State -r ( Zip _ , / 11. Contractor's Name - fir' 5' ,7�� . ,": Phonl ()ds-) Z 3 Y S23 ( Address 7,C /11 e w . City r '7f"7' Stater (-- Zip Is the contractor exempt from Iicensure under section 469.002(4),F.S. ? -), i j Ft0 YES ❑ NQ IV. Scheduled Dates: (Not ce must be ostmarked 10 working ys before the project start date) II Asbestos Removal (mm/dd/yy) Start: .46`I FinishO 1 ' Demo/Renovation (mm/dd/yy) Start: Finish: Y. Description of planned demolition or renovation work to perforrped apd methods to be employed, including demolition or renovation techniques to be used and description of affected facility components. lee+ 11 ;;,, hi J i - Procedur es t o be Used (Check All That Apply): ❑ Strip and Removal ❑ Glove Bag ❑ Bulldozer ❑ Wrecking Ball ator); et Method ❑ Dry Method ❑ Explode ❑ Burn Down OTHER: NI. Procedures for Unexpe ed RACM: VII. Asbestos Waste Transpo er: Name Address NS-1 ,l City 4t} ' VIII. Waste Disposal Site: Address City VW l IX. RACM or ACM: P ced Phone (7 T ) I4lame Amount of RACM or A square feet surfacing material linear feet dipe cubic feet of RACM off facility components *Identify and describe surfacing material and other materials as applicable: fate Zip -5-31 1Y eVi State Zip ' 3 �� re, including analytical methods, employed to detect the presence of RACM and,Categort�'1 ttiIii AIPAU °M• AIR QUALITY MANAGEMENT DIVISION' This is to certify that the required square feet cementitious ilig(ation(s) Regarding asbestos have been square feet resilient flooring!,, submi with square feet asphalt roofing I certify that the above information site during the - molition (ai ing no al sin ss hours. 1 sin 1. is correct and that an individual trained in the provisions of this regulati;en (40 CFR Part 61, Subpart M) will be on- or renovation and evidence that the required training has been accomplished by this person will be available for inspection fnt Name ;.f Own: toper, r.r) f (Contact phone #) 31/ jii0nature of Ow, / slo ator); (Date) DERM USE ONLY Postmark/Date Received 161_01- 158 4/10 DISTRIBUTION: White -DERM Yellow- Applicant . Pink- Reserve Gold- Reserve Florida Department of Environmental Protection Division of Air Resource Management • Miami-Dade DERM Air Quality Management Division 701 N.W. 1st Court 2nd Floor NOTICE OF DEMOLITION OR ASBESTOS RENOVATION Miami, Florida 33136 TYPE OF NOTICE (CHECK 0 E ONLY): ,2rORIGINAL 0 REVISED 0 CANCELLATION 0 COURTESY TYPE OF PROJECT (CHECK ONE ONLY): 0 DEMOLITION 0 RENOVATION ,0100FING IF DEMOLITION, IS ITAN ORDERED DEMOLITION? 0 YES 0 NO IF RENOVATION: I IS IT AN EMERGENCY RENOVATION OPERATION? 0 YES 0 NO File # IS IT A PLANNED RENOVATION OPERATION? 0 YES 0 NO Process # I. !Facility Name i2,-,/:-. , C -, c , ,- ,i• c'' . Address 'kl;", '''' l'A I., - ----/ 1 City ,r1 ': ,1 4: — ( 1 .--`e, State r C Zip County Consultant Inspecting Site Site 11 Building Size 1---' (Square Feet) # of Floors Building Age in Years 1 11 Prior Use: 0 Sch ol/College/University 0 Residence 0 Small Business Other Present Use: ID Sch ol/College/University 0 Residenee ,',,,,--,----'-- 0 Small Business Other II. Facility Olrn, er ---- - ' t,' c C s' C. -$ -' - '-' ,'''' '-'' Q .•;--'-' .r.f '1'.i" -/''' Phone ( Address'-fl ,. P-.., ,I,— , - , T—':,- 1,- ''. 4 1.-- -. r...a . Ot ' ,--- -,.. ? ,-..,,,,, t.... State Zip III. Contractor's Name -77 7-5-------;-c*--..-- );'1,---,-..---5-• ?,`;'.) , ! \ i- .i Phone ( ,,,, ) Address i7 ! I.') City t , a 1,'" ! State? 't-..9-- I Zip Is the contractor exempt from Iicensure under section 469.002(4), F.S.? 0 YES 0 NQ II IV. Scheduled Dates: (Not ce must be postmarked 10 working days before the project start date) Asbestos Removal (mm/dcVyy)Start:. ; Finishk, - ; , 1 ' Demo/Renovation imm/dd/yy) Start: Finish: V. 1-- :t. ri - - ',I is --,'-f, Description of planned demolition or renovation wor to be Perfoniied and.methocis to be employed, including demolition or renovation techniques to be used and description of affected facility components. Procedures to be Used A IThat Apply)' El Strip and Rernovl El Glove Bag (Signature of Owner/Qpe`ator) Bulldozer DERM USE ONLY Wrecking Ball J2 --- Wet Method Dry Method jJ Explode fl Burn Down OTHER: Procedures for Unexpe4ted RACM: Nt Asbestos Waste Tramp° er: Name t-- e=-1. e Phone ( ) Address City Waste Disposal Site: Address Name Mate ' c-s.{ Zip City State k, Zip RACM or ACM: Procedbre, including analytical methods, employed to detect the presence of RACM and ICategory 1 d fidtlEpagiTA. M . • • oN, Ar:1 QUALITY MANAGEMEMT DIVISI Amount of RACM or A * linear feet ipe square feet resilient flooring riai This is to certify that the required _ cubic feet o RACM off facility components F square feet urfacing material square feet cementitious matte Regxding asbestos have been „-, ; . subAmpittiajbed.iri Cc;e7g put:47n%, vv. ith *Identify and describe sbrfacing material and other materials as applicable: — I certify that the above inlbrmation site during the demolitio9 during normal business hburs. is correct and that an individual trained in the provisions of this regulation (40 CFR Part 61, Subpart M) will be on- or renovation and evidence that the required training has been accomplished by this person will be available for inspection , (Print Name of Owner/Operator) ...- (Signature of Owner/Qpe`ator) (Date) (Contact phone #) DERM USE ONLY e t - Postmark/Date 1 Received = s ti 1 i 6 161_01-158 4/10 DISTRIBUTION: White-DERM Yellow-Applicant Pink-Reserve Gold-Reserve • PLAN REVIEW FINAL APPROVAL DEPARTMENT OF ENVIRONMENTAL RESOURCESMANA1ENT coREREvinsanwry , A 9 r l --cUr SIGNATURE • �• Y DATE . I 15 ` 11 12,C3C4 CNY1.1,1 NJ, pi