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RF-12-104b Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 170438 Permit Number: RF -1 -12 -104 Scheduled Inspection Date: February 28, 2012 Inspector: Bruhn, Norman Owner: MAYER, SIMON Job Address: 301 NE 101 Street Miami Shores, FL 33138 -2468 Project: <NONE> Contractor: DOUBLE DIAMOND CONSTRUCTION INC Permit Type: Roof Inspection Type: Final Roof Work Classification: Flat Phone Number (305)754 -0700 Parcel Number 1132060135180 Phone: (386)847 -8899 Building Department Comments RE -ROOF FLAT TO FLAT Passed j 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- 169041. February 27, 2012 For Inspections please call: (305)762 -4949 Page 20 of 20 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RE: Permit# R ° % ` % z- ` DATE: INSPECTION AFFIDAVIT Cog, (Print name and circle License Type) License #: (, (CX 7 7C7 On or about , I did personally inspect the oof deck nailin . an (Date 8 time) Secondary water barrier work at 3 () / /V l L?, (Complete Job Site Address) Based upon that examination I have determined the installation was done according to the Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S) licensed as a (n) Contractor / Engineer / Architect, FS 468 Building Inspector gnature State of Florida County of Dade: The undersigned, being the first duly swom, deposes and says that he/she is the contractor for the above property ..„ _ orrye, Notary Public, Sate of Florida at Large \,1" �'.` `� ry g `.,, 's . 'General, Building, Residential, or Roofing Contractors or any individual certified under 468 F.S. to make such an inspection. Include photographs of each plane of the roof with permit # and address # dearly shown marked on the deck for each inspection mentioned. Sworn to and subscribed before me this Revised on 5/21/2009 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 lAA INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No. 4'-P PERMIT APPLICATION FBC 20 Master Permit No. Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): /%%/ ti �� Phone#: cis - 7.1- 7- 7 2) Y/7 Address: 422.0 N 10 / S-h/'e • City: %11 - Shore, State: /G- Zip: 33/3 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 3 n ( %%• / O ( S/ee l City: Miami Shores County: / . !' Miami Dade Zip: 25313 Folio/Parcel #: Is the Building Historically Designated: Yes NO X Flood Zone: CONTRACTOR: Company Name:106 "`.;` „, k 4 C V & . c • Phone #: Address: F Z 1Lc S'f 7 IS A I City: r®,) -5 . _ State: 'L- Zip: 3 ( 6 c Qualifier Name: '� Z� J C,,(4 Phone #:77 6' 7 663 State Certification or Registration #:'G 6— c) c)--)0 ( Certificate of Competent. #: Contact Phone #: ) 4-16 i in. ', Email Address: b a V,-,C.4e) 10. V" 9 Ni(-) v-' • C' AY" ~ DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ l o '- Square/Linear Footage of Work: /6 6° Type of Work: Addition ❑A {teration ❑New / iRepair/Replace ❑Demolition Description of Work: tf��''``�� ****** * **** ** * **** * * ** * **+x****x•****** Fees** : *** **** **** * ** ****x: ****** * * *** **** * ** ** a> Submittal Fee $ Permit Fee $ 2s CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 20. 4(p 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 MR 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 properly 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 �— Signature Owner or Agent The foregoing instrument was acknowledged before me this 12- The foregoing instrument was acknowledged before me this day of ,C)3_, 2012, by T, , day of , 20 _, by Contractor who is personally known to me or Who has produced As identification and who did take an oath. NOTARY PUB/PIC: who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Sign: Print: r` "P"y,.s Linda Mundarain Print: f ' E COMMISSION # DD962343 My Commission Expires: �; �� ; �: My Commission Expires: i,A% owe; EXPIRES: FEB. 16, 2014 •a,.;;;.•` WW W.AAR0NN0TARY.com ***** *sk*+ k+ k*****+ k*+ k+ h+ k*** *****+ h******** *arsk***** * *** **rta****%k:k********* k+k:h***** ****** rkrk************ *****m******* APPROVED BY 644 IN gicol- Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Miami Shores Village 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: Owners Name: g\- /d / - 74 z - Date: Property Address: 3cD ( A /0/ S l P e -f / ` 4-71 t ; .S GioTes Roofing Permit Number: Dear Building Official: certify that I am not required to retrofit the roof to wall connections of my buildi because: he just valuation for the structure for purpose of ad valorem taxation is Tess than $300,000.00. Please attach proof of ad valorem taxation. ❑ The building was constructed in compliance with the provisions of the Florida Building Code (FBC) or with the provisions of 1994 edition of the South Florida Building Code (1994 SFBC) Signature ,i(Aryo Print Name State of Florida County of Dade The undersigned, being the first duly sworn, deposes and says that he /she is the owner for the above property mentioned. day of )Cfl (2 Swom to and subscribed before me this 0.,_. ev.' °r finds Mundarain /gib°`•:, u�i COMMISSION # DD962343 Notary Public, Sate of Florida at Large 1.4 *al."... % l°) EXPIRES: o� w N.AARoNNarmeom • When the just valuation of the structure for purpose of ad valorem taxation is equal to or more than $300,000.00, and the building was not constructed with FBC nor a 1994 SFBC. Then you must provide a building application from a General Contractor for the Roof to Wall connection Hurricane Mitigation. Revised on 5/21/2009 Jan 20 2012 9:O1RM The Contractors Choice Rg 866- 758 -9267 p.1 ACORD CERTIFICATE OF LIABILITY INSURANCE `-w DATE(MMIDONYTY) 1/20/2012 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 pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER - The Contractors Choice Agency PO Box 13645 Chandler AZ 85248 CONTACT Jon ROOk NAME: H Me a (800) 918 -3584 1 Fax Nol (e »)sea -9951 E-MAIL Ationsa: oaCn ixeuranceoaline . aom PRODUCER D0006347 CUSTOMER in INSURERS) AFFORDING COVERAGE NAIC8 RNSURELo Double Diamond Construction Inc 827 East 21st Ave New Smyrna each FL 32169 INSURER A :Nat 11 Contractors Insurance 12293 INSURER B: INSURER C: INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:CL0861600540 RFVIRIAN INI MARFut • 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 I5 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 A GENERAL LIABILITY X CONBE CIALGENERALLIABBITY 1 CLAIMS -MADE n OCCUR GENtAGGREGATE UMITAPPUES PER (� POLICY I I !ER& fl LOC AO. SUM INSR_)YWI POLICY NUMBER (MMIDD/YW1n IMMDDDIIYYEXYYYI P LIMITS GL &000006862 -04 2/1/2011 2/1/2012 EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrencal N(ED EXP (My one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS- COMPIOP AGG AUTOMOBILE LABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Es exidenl) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LAB EXCESS LAB OCCUR CLAIMS -MADE DEDUCTIBLE RETENTION S EACH OCCURRENCE S S a S a Rl 1 9 S S S i S S 500,001 50,001 5,001 500 , 001 1,000,001 500,001 AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LABILITY ANY PROPRIFrORIPARTNER/EXECUTIVE a OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A • 1WC STATU- I 1OTH- TORY LIMITS Es E. L. EACH ACCIDENT S S S E. L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ DESCRIPTION OF OPE RA1ONB / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Ia requtredl CERTIFICATE HOLDER CANCELLATION (305)756 -8972 Village of Miami Shores Building Department 1050 NE 2nd Ave Miami Shores, FL 33138 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 Robert Rook /BOB ACORD 25 (2009/09) INS025 moms) The ACORD name and logo ® 1988 -2009 ACORD CORPORATION. Ali rights reserved. ogo are registered marks of ACORD Village of Miami Shores 1 20/01/12 09:25:26 AGGRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1/20/2012 THIS CERTIFICATE I3 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(les) 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 certlflcate does not confer rights to the certlflcate holder In Iieu of such endorsement(s). PRODUCER The Contractors Choice Agency PO Box 13645 Chandler AZ 85249 CONTACT on Rock NAME: - (A/CC No. Ext): (800) 918 -3584 FAX No): (877) 684 -9951 ADDRESS: Jon@nginsuranceonline.com ADDRESS: g PRODUCER 0006347 CUSTOMER ID INSURER(S) AFFORDING COVERAGE NAIC 5 INSURED Double Diamond Construction Inc 827 East 21st Ave New Smyrna Beach FL 32169 nnkirsAi.r. - __ ----- _- ________- INSURERA Nat'l Contractors Insurance 12293 INSURER B : INSURER C GLF000008862 -04 INSURER D : 2/1/2011 INSURER E : EACH OCCURRENCE INSURER F : 500,000 • THIS INDICATED. CERTIFICATE EXCLUSIONS INSR IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE ADDL INSR SUBR WVO POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY GLF000008862 -04 2/1/2011 2/1/2012 EACH OCCURRENCE $ 500,000 X PREMISES Eaoccu RENTED PREM $ 50, 000 I CLAIMS- MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 500,000 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 500,000 X POLICY PRO- JECT LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per ecddent) $ $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABIUTV ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) [(yes, describe under DESCRIPTION OF OPERATIONS Y / N N /A WC STATU- OTH- TORY L IM ITS ER E.L. EACH ACCIDENT $ below E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) rC DTICIrATC un. nr■ CANCELLATION (305) 756-8972 Village of Miami Shores Building Department 1050 NE 2nd Ave Miami Shores, FL 33138 ACORD 25 (2009/09) 1143025 (200909) 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 Robert Rock /BOB • @1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD m:MyFax - Double Diamond To:Double Diamond Contruction (13057568972) ® ACCORD 10:49 01/20/12GMT-05 Pg 02-02 CERTIFICATE OF LIABILITY INSURANCE DATE IMM/00/YYTY) 01/17/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(le) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and cOnditIons of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of suchendorsement(s). PRODUCER INSURED HARRIS INSURANCE AGENCY 129 N FEDERAL HWY SUITE 200 LAKE WORTH. FL 33460 MSI 129 N FEDERAL HWY SUITE 2018 LAKE WORTH. FL 33460 .ohrac r PHONE -1 FAX WC! No4G1-2-45-6.327 ..1"..10."):661-245-51.ES E-MAIL Agoagss: aitbouak CUSLOWIEELID.P.I. tNaDREF.t.nAFFORDING COVERAGE I NAIC filS147..14!;Seneca••Speciaity-Ins.ueanDe.-Companit• .1.!??91.J.I3E8 B Eirldgefield Employers-insurance- INSURER C: INSURER D _INSURER E : INSURER COVERAGES ,.......?!....er.j!..www..-11.; THIS IS TO CERTIFY THAT THE POLICIES or INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLANS LTR I TYPE OP INSURANCE I, DISK. kr- ...... ; poocy Efl, PWrcy EXP ! WVD! POLICY NUMBER (.41D0/YYTY ' tint14. PP( Yy ; LIMITS GENERAL LIABILITY • . A IX i COMMERCIAL GENERAL LIARE.ITy --t- i 4.........., CLAIMS.MADE X] OCCUR . i 01/03/2012 SC130091041 . . . • : . . : . • • , . • . • , 01/03/2013 LEACH OCCURRENCE ' ! EIMAGFTOWENTEIT 1-:.000:000 ? v F' EMMIS.E.60.9 . P.%.Y.I.111.1.1r,111. . J 4 i MED EXP (Any ono person) ' S .. ..... 1 i .. -.— ....._ ..._. .. ....., PErit AGGREGATE LIMIT APPLES PER i il PRO. 1 I j POLICY I L L JECT I ;LO C I- 17000- ! PERSONAL & ADV INJURY LT. 17000000 ! GENERAL AGGREGATE i & -2400400 : pRoDuCTS - COMP/OP AGG .1..$ 2.700(3 :000 s AUTOMOBILE MAINLITY ANY AUTO '' I ALI. OWNED AUTOS I SCHEDULED AUTOS COMBINED SINGLE LINET j! s i {Ea etoiciant) I- • 1 I BODILY INJURY Wu penony i $ 1.• BODILY INJURY (Pos itoosion01 & ,-..---i ... I HIRED AUTOS NON-OWNED AUTOS , PROPERTY DAMAGE (Por accidors) $ L..__. ............-- j ; s • & 1 UMBRELLA LfAB ' OCCUR 1 eAcii occuRREArcE . 4., g.X.C...t...S. S LIA..B.. 1 1 cLAims4viADEI r--- EH AGGRO:ATE $ I DEDUCTIBLE : I.. i RETENTION $ I s WORKERS COMPENSATION 1/3/2012 8 AND EroPLOYERS' LIADiary Y/ P 8X-46737 AlIY ROPMETOR/PARTWXECUTVE i .'' 1 OEFICEIUME.MBER EXCLUDED', N/Al IMeoulatorylo NH) It ti ; yes cesonbe under RPF(44Ai PRCIVIglrtf4S hialetter 1. . ,- WC 8 ATU- 1/3/2013 . I TORY.IMITS.i. .. Er. I.. 1 E.L. EACH ACCIDENr I 8 1 1,000 ,t6 i E L DISEASE • EA EmPlOYEI:1 $ i. 1.:000: 990 I EL. DISEASE • POLICY LIMIT I 8 ::: Irdni ; ! ! DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Afteeh ACORD 101, AddltIonef Remarks Scheetufe. If more space Fs required) • ....— r7CCITICI&A •r& Urti rocrs ANCELLATION MIAMI SHORES VILLAGE 1050 NE 2ND AVE MIAMI. FL 33138 FAX 305-756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TNE EXPIRATION DATE THEREOP. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE AGGRO 26 (2009/09) CO 1988- 2009 ACORD CORPORATION. All rights reserved. The ACORD name and togo are registered marks of ACORD m:MyFax - Double Diamond To:Double Diamond Contructlon (13057568972) 10:49 01/20/12GMT-05 Pg 01-02 MARK SANTIAGO INC 129 NORTH FEDERAL HWY SUITE 2018 LAKE WORTH, FL 33460 561-245-5216 FAX 561-245-5226 January 19, 2012 To Whom If May Concern This letter is to confirm that M. Santiago Inc. will be performing labor for Double Diamond Construction Inc. at 301 N.E. 107 Street. Miami Shores, Florida. If you have any questions please contact to Peter J. Coltune, Telephone # 386-847-8899 Respectfully, Mark G Santiago President WESSITE:WWW.MARKSANTIAGOINC.COM E'MAIL:INPO@MARKSANTIAGOINC.COM ROOF ASSEMBLIES AND ROOFTOP STRUCTURES Florida Building Code Edition 2007 High - Velocity Hurricane Zone Uniform Permit Application Form. Spr_tinn A (Gpnpral Information) Master Permit No. _ Process No. Contractor's Name '' fU' Job Address 0 bile /07 1 Gi i ?' ;l" tr C/6 ow Slope ❑ Mechanically Fastened Tile ❑ Asphaltic ❑ Metal Panel /Shingles Shingles ❑ New Roof Low Slope Roof Area (SF) /66-0 ❑ Prescriptive BUR -RAS 150 ROOF TYPE Reroofing ❑ Recovering ❑ Mortar /Adhesye S ❑ Wood Shingle /Sh Q., e) ❑ Repair ❑ M e L' ROOF SYSTEM INFORMATION Steep Sloped Roof Area (SF) To Section R (Rnnf Plan) Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include dimensip s of sections and levels, clearly identify dimensions of elevated pressure zones and location of parapets. 4 aryiut (( '.. FLORIDA BUILDING CODE — BUILDING SECTION R4402.13 HIGH VELOCITY HURRICANE ZONES — REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS R4402.13.1 Scope. As it pertains to the section, it is the responsibility of roofing contractor to provide the owner with the required roofing permit, and to explain to the owner the content of the section. The provisions of Section R4402 govem the minimum requirements and standards of the industry for roofing system installations. Additionally, the following items should be addressed as part of the agreement between the owner ant the contractor. The owner's initial in the designated space indicates that the item has been explained. 1. Aesthetics - Workmanship: the workmanship provisions of Section R4402 are for the purpose of providing that the roof system meets the wind resistance and water instruction performance standards. Aesthetics (appearance) are not a consideration with respect to workmanship provisions. Aesthetic issues such as color or architectural appearance, that are not part of a zoning code, should be addressed as part of the agreement between the owner and the contractor. 2. Renailing wood decks: When replacing roofing, the existing wood roof deck may have to be in accordance with the current provisions of Section R4403. (The roof deck is usually concealed prior 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. 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. Ponding water: The current roof system and /or deck of the building may not drain well and may cause water to pond (accumulate) in low-lying areas of the roof. Pounding can be an indication of structural distress and may require the review of a professional structural engineer. Pounding may shorten the life expectancy and performance of the new roofing system. Pounding conditions may not be evident until the original roofing system is removed. Pounding conditions should be corrected. Overflow scuppers (wall outlets): It is required that rainwater flows off so that the roof is not ovei aded 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 a h the requirements of Sections R4402, R4403 and R4413. 7. Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of the structure assembly (the building itself). The existing amount of attic ventilation shall not be reduced. It may be beneficial to consider additional venting which can res extending the service life of the roof. ll�l� Owner /Agent's Signature Datejj Revised on 7/9/2009 LD Contracto re D Florida Building Code Edition 2007 High Velocity Hurricane Zone Uniform Permit Application Form pectlon C (Low Slowed Roof System) FM In Specific Roof Assembly Components Fastener Spacing for Anchor/Base Sheet and Identify Manufacturer Attachment (If a component Is not used, identify as "NA') / System Manutac_ furor. /%e n p /�'i'// GA L ki,/ eId: "oc @W. # R @2 • oc ��vv�� 2 Perimeter. 41 " oc Lap, # Rows NOA No.: V l ' °. C J / Comer 6 ' oc @ Lap, it Rows Number of Fasteners Per Insulation Board Design Wind Pressures, From RAS 128 or Calculations: Pmaxl Pmax2 3 Pmax3: Max. Design Pressure. F% Speec is NOA System: Deck Type: Gauge/Thldmess• " Slope: `� Anchor/Base Sheet & No. of Ply(s): An/c111374M.Fitaitirci tvira,,r;y Insulation Base Layer Base Insulation Size and Thickrress: G \X Base Insulation Fastener/Bonding Material: /7 U / Top Insulation Layer: Top Insulation We and Thickness: Top Insulation FastenerBonding Material: Base Sheet(s) & No. of Ply(s):/ JU Base Sheet Fastener/Bonding Material: Ply Sheet(s).& No. of Ply(s): Ply Sheet Fastener/Bonding Material: Top Ply / 't f1- �‘ /AP Top Ply Fastener/ Bonding Material: Surfacing: Field Perimeter Comer Illustrate Components Noted and Details as Applicable: Woodblacldng, Gutter, Edge Termination, Stripping, Flashing, Continuous Cleat, Cant Strip, Base Flashing, Counter- Flashing, Coping, Etc. indicate: Mean Roof Height, Parapet Height, Height of Base Flashing, Component Material, Material Thidmess, Fastener Type, Fastener Spacing or Submit Manufacturers Details that Comply with RAS 111 and Chapter 16. c/,,1).,.-/,.,:t44-,7.-1(1,/ic. 12/(iia u 1 sc- Jhtir"' J Parapet Height FT. /,..2 4 4 1.4.6-' Mean Roof Height 123_01 -48 12/09 PAGE 3 M 1 A M IhDADE MIAMI -DADE COUNTY, FLORIDA METRO -DADE FLAGLER BUILDING BUILDING CODE COMPLIANCE OFFICE (BCCO) 140 WEST FLAGLER STREET, SUITE 1603 PRODUCT CONTROL DIVISION MIAMI, FLORIDA 33130 -1563 (305) 375 -2901 FAX (305) 375 -2908 NOTICE OF ACCEPTANCE (NOA) GAF Material Corporation 1361 Alps Road Wayne, NJ 07470 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed by the BCCO and accepted by the Building Code and Product Review Committee to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ). This NOA shall not be valid after the expiration date stated below. The 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: GAF RUBEROIV Modified Bitumen Roof System for Wood 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 revises NOA No. 07- 1203.01 and consists of pages 1 through 31. The submitted documentation was reviewed by Jorge L. Acebo. NOA No.: 09- 0224.01 Expiration Date: 11/06/13 Approval Date: 04/08/09 Page 1 of 31 ROOFING SYSTEM APPROVAL Roofmg Modified Bitumen SBS /APP Wood -75 psf Category: Sub - Category: Material: Deck Type: Maximum Design Pressure TRADE NAMES OF PRODUCTS MANUFACTURED OR LABELED BY APPLICANT: TABLE 1 Product Leak BusterTM Matrix"' 307 Premium Asphalt Primer GAF Mineral Shield® Granules Leak BusterTM MatrixTM 305 Fibered Asphalt Emulsion Leak BusterTM MatrixTM 303 Premium Fibered Aluminum Roof Coating LeakBusterTM MatrixTM 322 Elastomeric Roof Coating LeakBusterrM MatrixTM 306 LeakBusterTM MatrixTM 204 Wet/Dry Roof Cement GAFGLAS® #75 Base Sheet GAFGLAS® #80 ULTIMATM Base Sheet GAFGLAS® Flex PIyTM 6 GAFGLAS® Ply 4 GAFGLAS® Mineral Surfaced Cap Sheet Dimensions 5, 55 gallons 60 Ib. Bags 100 Ib. bags 5 gallons 1, 5 gallons 55 gallons 55 gallons 1, 5 gallons 39.37" (1 meter) Wide 39.37" (1 meter) Wide 39.37" (1 meter) Wide 39.37" (1 meter) Wide 39.37" (1 meter) Wide Test Specification ASTM D41 ASTM D1863 ASTM D1227 Product Descrintion Asphalt concrete primer used to promote adhesion of asphalt in built -up roofing. Granules for surfacing of exposed asphalt, cold process cement or emulsion. GAF Mineral Shield® Granules shall be used for flashing applications only. Surface coating for smooth surfaced roofs. ASTM D 2824 Fibered aluminum coating. ASTM D3019 ASTM D3409 ASTM D4586 ASTM D3409 ASTM D4601 ASTM D4601 ASTM D2178 ASTM D2178 ASTM D3909 Elastomeric roof coating. Asphalt emulsion fibered. Refined asphalt blended with a mineral stabilizer and fibers. Permits adhesion to wet and dry surfaces. Type II Asphalt impregnated and coated glass mat base sheet. Type II Asphalt impregnated and coated, fiberglass base sheet Type VI asphalt impregnated glass felt with asphalt coating. Type IV asphalt impregnated glass felt with asphalt coating. Asphalt coated, glass fiber mat cap sheet surfaced with mineral granules. NOA No.: 09- 0224.01 Expiration Date: 11/06/13 Approval Date: 04/08/09 Page 2 of 31 Product GAFGLAS® EnergyCapTM Mineral Surfaced Cap Sheet GAFGLAS® EnergyCapTM BUR Mineral Surface Cap Sheet GAFGLAS® STRATAVENT® EliminatorTM Perforated GAFGLAS® Flashing GAFGLAS® STRATAVENT® EliminatorTM Perforated Nailable RUBEROID® SBS Heat We1dTM Smooth RUBEROID® SBS Heat- We1dTM Granule Roof MatchTM SBS Mop Granule RUBEROID® SBS Heat- We1dTM 170 FR RUBEROID® SBS Heat- We1dTM PLUS RUBEROID® SBS Heat- We1dT"' PLUS FR RUBEROID® EnergyCap SBS Heat- We1dTM PLUS FR RUBEROID® Modified Base Sheet RUBEROID ® SBS Heat- We1dTM 25 Dimensions 39.37" (1 meter) Wide 39.37" (1 meter) wide 39.37" (1 meter) Wide various 39.37" (1 meter) Wide 1 meter (39.37 ") wide 1 meter (39.37 ") wide 107 sq. ft. (9.9 m2) 1 meter (39.37 ") wide 1 meter (39.37 ") wide 1 meter (39.37 ") wide 1 meter (39.37 ") wide 39.37" (1 meter) Wide 1 meter (39.37 ") wide Test Specification ASTM D3909 ASTM D3909 EnergystarTM Title 24 Compliant ASTM D3672 ASTM D4897 ASTM D3672 ASTM D4897 ASTM D6164 ASTM D6164 ASTM D6222 ASTM D5147 ASTM D6164 ASTM D6164 ASTM D6164 ASTM D6164 Product Description Asphalt coated, glass fiber mat cap sheet surfaced with mineral granules with factory applied layer of TOPCOAT® EnergyCoteTM. Asphalt coated, glass fiber mat cap sheet surfaced with mineral granules with factory applied EnergyCoteTM Fiberglass base sheet coated on both sides with asphalt. Surfaced on the bottom side with mineral granules embedded in asphaltic coating with factory perforations. Asphalt coated glass fiber mat flashing sheet available in three sizes. Fiberglass base sheet coated on both sides with asphalt. Surfaced on the bottom side with mineral granules embedded in asphaltic coating. Non -Woven Polyester mat coated with polymer- modified asphalt and smooth surfaced. Non -Woven Polyester mat coated with polymer modified asphalt and surfaced with mineral granules. Non -woven polyester mat coated with polymer modified asphalt and surfaced with colored mineral granules. Non -Woven Polyester mat coated with fire retardant polymer modified asphalt and surfaced with mineral granules. Non -Woven Polyester mat coated with polymer modified asphalt and surfaced with mineral granules. Non -Woven Polyester mat coated with fire retardant polymer modified asphalt and surfaced with mineral granules. A fiberglass mat reinforced, SBS modified bitumen cap membrane. ASTM D4601, Premium glass fiber reinforced SBS - Type II, UL Type modified base sheet G2 BUR ASTM D6164 Non -Woven Polyester mat coated with polymer - modified asphalt and smooth surfaced. NOA No.: 09- 0224.01 Expiration Date: 11/06/13 Approval Date: 04 /08/09 Page 3 of 31 Product RUBEROID® Mop Granule RUBEROID® MOP Smooth RUBEROID® MOP PLUS RUBEROID® MOP 170FR RUBEROID® MOP FR RUBEROID® TORCH Smooth RUBEROID® TORCH Granule RUBEROID® EnergyCap Torch Granule FR Roof MatchTM APP Torch Granule RUBEROID® TORCH PLUS RUBEROID® TORCH FR RUBEROID®170FR TORCH RUBEROID® EnergyCap SBS Heat Weld Plus FR RUBEROID® 20 RUBEROID®30 Dimensions 39.37" (1 meter) Wide 1 sq. roll 87 lbs. 39.37" (1 meter) Wide 39.37" (I meter) Wide 39.37" (1 meter) Wide 39.37" (1 meter) Wide 39.37" (I meter) Wide 1 meter (39.37 ") wide 107 sq. ft. (9.9 m2) 39.37" (1 meter) Wide 39.37" (1 meter) Wide 39.37" (1 meter) Wide 1 meter (39.37 ") wide 39.37" (1 meter) Wide 39.37" (1 meter) Wide Test Product Specification Description ASTM D6222 Non -woven polyester mat coated with ASTM D5147 polymer modified asphalt and surfaced with mineral granules. ASTM D6298 Non -woven polyester mat coated with ASTM D5147 polymer- modified asphalt and smooth surfaced. ASTM D6164 Non -woven polyester mat coated with ASTM D5147 polymer modified asphalt and surfaced with mineral granules. ASTM D6164 Non -Woven polyester mat coated with fire ASTM D5147 retardant polymer modified asphalt and surfaced with mineral granules. ASTM D6164 Non -Woven polyester mat coated with fire ASTM D5147 retardant polymer modified asphalt and surfaced with mineral granules. ASTM D6222 Heavy duty, polyester reinforced, asphalt ASTM D5147 modified bitumen membrane, smooth surface. ASTM D6222 Heavy duty, polyester reinforced, asphalt ASTM D5147 modified bitumen membrane, granule surface. ASTM D6222 A fiberglass mat reinforced, SBS modified ASTM D5147 bitumen cap membrane. ASTM D6222 Non -woven polyester mat coated with ASTM D5147 polymer modified asphalt and surfaced with colored mineral granules. ASTM D6222 Heavy duty, polyester reinforced, asphalt ASTM D5147 modified bitumen membrane, granule surface ASTM D6222 Heavy duty, polyester reinforced, coated ASTM D5147 with fire retardant asphalt modified bitumen membrane, granule surface. ASTM D6222 Heavy duty, polyester reinforced, coated ASTM D5147 with fire retardant asphalt modified bitumen membrane, granule surface. ASTM D6163 A fiberglass mat reinforced, SBS modified ASTM D5147 bitumen cap membrane. ASTM D6163 SBS modified asphalt base sheet reinforce ASTM D5147 with a glass fiber mat. ASTM D6163 Non woven fiberglass mat coated with ASTM D5147 polymer modified asphalt and surfaced with mineral granules. NOA No.: 09- 0224.01 Expiration Date: 11/06/13 Approval Date: 04/08/09 Page 4 of 31 Product RUBEROID®30 FR RUBEROID®EnergyCap SBS 30 FR RUBEROID® ULTRACLAD® SBS RUBEROID® Dual FR Vent Stacks (metal and plastic) GAF Built -Up Roofing Asphalt RUBEROID® MOD Asphalt Asphalt L & Asphalt P TOPCOAT® Surface Seal SB LEAK BUSTERTM MatrixTM 715 MB Elastomeric Roofing Membrane EnergyCoteTM Coating VersaShield® TOPCOAT® FireShield® MB Leak BusterTM MatrixTM 531 WeatherCoteTM EIastomeric Flashing Grade LeakBusterTM MatrixTM 201 Premium SBS Flashing Leak Buster m MatrixTM 102 SBS Adhesive Label Dimensions 39.37" (1 meter) Wide 1 meter (39.37 ") wide 39.37" (1 meter) Wide 39.37" (1 meter) Wide 1001b. cartons, bulk 60 Ib. kegs 5 gallons 5 gallons 2, 5 gallons 350 sq. ft roll 5, 55 gallons 5 gallons 5 gallons 5 gallons Test Specification ASTM D6298 ASTM D5147 ASTM D6163 ASTM D6163 ASTM D5147 ASTM D6164 ASTM D5147 TAS 100(A) ASTM D1929 ASTM D635 ASTM D312, Types I, II, III and IV ASTM D3412 ASTM D21 ASTM D1475 ASTM E1644 ASTM D6083 ASTM -D226 4869 Type I, II ASTM D412 ASTM D21 ASTM 1475 ASTM E1644 ASTM D3019 ASTM D3019 Product Description Non woven fiberglass mat coated with fire retardant, polymer modified asphalt and surfaced with mineral granules. A fiberglass mat reinforced, SBS modified bitumen cap membrane. Woven fiberglass mat coated with Polymer modified asphalt surfaced with aluminum, copper or stainless steel foil. Non -woven polyester and fiberglass mat coated with file retardant, polymer - modified asphalt and surfaced with mineral granules. One -way valve vent used to relieve built - up pressure within the roof system. GAF Vent Stacks are available in metal or plastic. Interply mopping and surfacing asphalt SEBS modified asphalt Surface coating for smooth surfaced and mineral surfaced roofs. Surface coating for smooth surfaced and mineral surfaced roofs. Highly reflective elastomeric coating Non - Asphaltic Fiberglass -Based Underlayment Elastomeric roofing membrane Surface coating for smooth surfaced and mineral surfaced roofs. Cold Applied Modified SEBS Asphalt Adhesive — Flashing Grade. Cold Applied Modified SEBS Asphalt Adhesive. NOA No.: 09- 0224.01 Expiration Date: 11/06/13 Approval Date: 04/08/09 Page 5 of 31 Product Leak BusterTM Matrix"' 202 SBS Flashing Cement Label Leak BusterTM Matrix"' 203 Plastic Roof Cement Label Leak BusterTM MatrixTM 103 Cold Process Adhesive Label LeakBusterTM Matrix"' 304 Non - Fibered Aluminum Roof Leak BusterTM MatrixTM 602 MB Xtra Elastomeric Roofing Membrane TOPCOAT® MB Plus Dimensions 5 gallons 5 gallons 5 gallons 5 gallons 5 gallons 5, 55 gallons Test Specification ASTM D4586 ASTM D4586 Product Description Cold Applied Modified SEBS Asphalt Adhesive — Flashing Grade. Standard Plastic Asphalt Roofing Cement ASTM D3019 Cold Applied Asphalt Adhesive. ASTM D2824, Type I ASTM D412 ASTM B117 ASTM C794 ASTM G21 FTMS 141.6271 ASTM D2196 ASTM D1475 ASTM E1644 ASTM D412, ASTM D21, ASTM D1475 ASTM E1644 Non-fibered. Aluminum pigmented, asphalt roof coating. Surface coating for smooth surfaced and mineral surfaced roofs. Water - based, low VOC, sprayable polymeric liquid, which cures to form a seamless rubber membrane. NOA No.: 09- 0224.01 Expiration Date: 11/06/13 Approval Date: 04/08/09 Page 6 of 31 APPROVED INSULATIONS: Product Name EnergyGuardTM Fiberboard EnergyGuardTM Permalite EnergyGuardTM Strip EnergyGuardTM Recover Board EnergyGuardTM Tapered Edge Strip EnergyGuardTM Polylso EnergyGuardTM RA, RN EnergyGuardTM Composite, RA DensDeck® DensDeck Prime® DensDeck DuraGuardTM Structodek® Structodek® TD SecurockTM APPROVED FASTENERS: Fastener Number 1. Product Name Drill -TecTM #12 Standard, #14 and #15 extra Heavy Duty Fastener, Heavy Duty Roofing Fastener 2. Drill -TecTM ASAP 3. Drill -TecTM CR Base Sheet Fastener and Plate 4. Drill-TecTM Galvalume 5. Plates Drill-TecTM Polypropylene Plates 6. Drill -TecTM AccuTrac Plate Table 2 Product Description Fiberboard insulation Perlite insulation board Cut perlite board Perlite recover board Tapered perlite board Polyisocyanurate foam insulation Polyisocyanurate foam insulation Polyisocyanurate /wood fiberboard or perlite composite Water resistant gypsum board Water resistant gypsum board Water resistant gypsum board Wood fiber insulation board Flame Resistant High Density Wood Fiber board. Fiber reinforced roof board TABLE 3 Product Description Dimensions Insulation fastener and Various Base Play fastener for steel, wood & concrete decks. Pre - assembled Drill -TecTM Various Fasteners and metal and plastic plates. Base sheet fastening Various assembly. Round Galvalume stress plates. Round polypropylene stress plates. Square Galvalume® coated 3" Square steel plate. Manufacturer (With Current NOA) GAF Materials Corp. GAF Materials Corp. GAF Materials Corp. GAF Materials Corp. GAF Materials Corp. GAF Materials Corp. GAF Materials Corp. GAF Materials Corp. G -P Gypsum Corp. G -P Gypsum Corp. G -P Gypsum Corp Knight Celotex Knight - Celotex USG Corporation Manufacturer (With Current NOA) GAF Materials Corp. GAF Materials Corp. GAF Materials Corp. 3" and 3 1/2" GAF Materials Corp. 3" and 3 ' /z" GAF Materials Corp. OMG NOA No.: 09- 0224.01 Expiration Date: 11/06/13 Approval Date: 04/08/09 Page 7 of 31 EVIDENCE SUBMITTED: Test Aeencv Factory Mutual Research Corp. Underwriters Laboratories Trinity Engineering Test Identifier Description Date 3029832 4470 -TAS 114 05/11/07 3010215 4470 - TAS 114 03/01/01 3001276 4470 - TAS 114 01/28/99 1 B9A8.AM 4470 - TAS 114 09/04/97 3D4Q2.AM 4470 - TAS 114 04/30/97 OD1A8.AM 4470 - TAS 114 04/01/98 TGFU.R19254 UL 790 10/27/06 4483.04 97 -1 TAS 114 06/06/97 PRI Asphalt Technologies, Inc. GAF - 020 -02 -01 ASTM D 249 02/01/02 ASTM D 4977 IRT -ARCON Inc. Trinity I ERD 02 -005 TAS 114 03/01/02 02 -014 TAS 114 04/08/02 01 -039 TAS 114 03/01/02 G6850.08.08 ASTM D6164 08/29/08 G6850.08.08 ASTM D6163 08/01/08 G6850.10.08 ASTM D6222 10/06/08 G6850.11.08 ASTM D6222 11/05/08 NOA No.: 09- 0224.01 Expiration Date: 11/06/13 Approval Date: 04 /08/09 Page 8 of 31 APPROVED ASSEMBLIES Membrane Type: SBS Deck Type 1I: Wood, Insulated Deck Description: 19/32" or greater plywood or wood plank System Type A(1): Anchor sheet mechanically fastened, all layers of insulation adhered with approved asphalt. All General and System Limitations shall apply. One or more layers of any of the following insulations. Insulation Layer Insulation Fasteners Fastener (Table 3) Density /ft2 EnergyGuardTM Polylso, RA, RN, EnergyGuardTM Composite RA, Minimum 1" thick N/A N/A Wood Fiber, Structodek ®, Structodek® TD, EnergyGuardTM Recover Board Minimum Y2" thick N/A N/A Minimum '/"thick N/A N/A Note: All insulation shall be adhered to the anchor sheet in full mopping of approved hot asphalt within the EVT range and at a rate of 20-40 lbs /100 ft'. 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. GAF requires either a ply of GAFGLAS® STRATAVENT® EliminatorTM Perforated laid dry or a layer of EnergyGuardTM, Perlite or wood fiber overlay board on all polyisocyanurate applications. Fire Barrier: FireOutTM Fire Barrier Coating, VersaShield® Non-Asphaltic Fiberglass -Based (optional) Underlayment or SecurockTM. Anchor sheet: GAFGLAS® #80 ULTIMATM Base Sheet, STRATAVENT® EliminatorTM Nailable Base Sheet, RUBEROID® Modified Base Sheet, RUBEROID® 20, RUBEROID® SBS Heat- WeIdTM Smooth or RUBEROID® SBS Heat- We1dTM 25 base sheet mechanically fastened to deck as described below; Fastening GAFGLAS® Ply 4, GAFGLAS® Flex PIyTM 6, GAFGLAS® #75 Base Sheet or any Options: of above Anchor sheets attached to deck with approved annular ring shank nails and tin caps at a fastener spacing of 9" o.c. at the lap staggered and in two rows 12" o.c. in the field. (Maximum Design Pressure —45 psf, See General Limitation #7) GAFGLAS® Ply 4, GAFGLAS® Flex P1yTM 6, GAFGLAS® #75 Base Sheet or any of above Anchor sheets attached to deck with Drill -TecTM #12 standard, #14 or # 15 Screws and 3" Drill -TecTM steel plate or Drill -TecTM AccuTrac Plates, 12" o.c. in 3 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 12" o.c. in the field of the sheet. (Maximum Design Pressure —45 psf, See General Limitation #7) I � i'.1 ) • ._..] 4I. 111211 IAPPROVEDj NOA No.: 09- 0224.01 Expiration Date: 11/06/13 Approval Date: 04/08/09 Page 9 of 31 GAFGLAS® Flex PIyTM 6, GAFGLAS® #75 Base Sheet or any of above Anchor sheets attached to deck with approved annular ring shank nails and tin caps at a fastener spacing of 9" o.c. at the 4" lap staggered and in two rows 9" o.c. in the field. (Maximum Design Pressure —52.5 psf, See General Limitation #7) GAFGLAS® #80 ULTIMATM, RUBEROID®20, RUBEROID® Mop Smooth, base sheet attached to deck with approved annular ring shank nails and tin caps at a fastener spacing of 9" o.c. at the 4" lap staggered and in two rows 9" o.c. in the field. (Maximum Design Pressure —60 psf, See General Limitation #7) GAFGLAS® #75 Base Sheet or any of above Anchor sheets attached to deck with Drill -TecTM #12 standard, #14 or # 15 Screws and 3" Drill -TecTM steel plate or Drill -TecTM AccuTrac Plates, 12" o.c. in 4 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 9" o.c. in the field of the sheet. (Maximum Design Pressure —60 psf, See General Limitation #7) Any of above Anchor sheets attached to deck approved annular ring shank nails and 3" inverted Drill -TecTM insulation plates at a fastener spacing of 9" o.c. at the 4" lap staggered in two rows 9" in the field. (Maximum Design Pressure —60 psf, See General Limitation #7) GAFGLAS® #75 Base Sheet or any of above Anchor sheets attached to deck with Drill-TecTM #12 standard, #14 or # 15 Screws and 3" Drill-Teem steel plate or Drill-Teem AccuTrac Plates, 8" o.c. in 4 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 9" o.c. in the field of the sheet. (Maximum Design Pressure —75 psf, See General Limitation #7) Base Sheet: (Optional) Install one ply of GAFGLAS® #75, GAFGLAS® #80 ULTIMATM Base Sheet, GAFGLAS® PLY 4, GAFGLAS Flex PIyTM 6, GAFGLAS® STRATAVENT® EliminatorTM Perforated (laid dry), RUBEROID® Modified Base Sheet, RUBEROID® MOP Smooth, RUBEROID® 20, RUBEROID® SBS Heat - WeIdTM Smooth or RUBEROID® SBS Heat- We1dTM 25 directly over the top layer of insulation. Adhere with any approved mopping asphalt applied within the EVT range and at a rate of 20-40 lbs. /sq (see General Limitation #4). Ply Sheet: (Optional) One or more plies GAFGLAS® PLY 4, GAFGLAS® Flex PIyTM 6 sheet, GAFGLAS® #80, RUBEROID® MOP Smooth, RUBEROID® 20 adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbs. /sq. Membrane: One or more plies of RUBEROID® 20, RUBEROID® 30, RUBEROID® EnergyCap SBS 30 FR, RUBEROID® 30 FR RUBEROID® MOP Smooth, RUBEROID® Mop 170 FR, RUBEROID® Mop Granule, Roof MatchTM SBS Mop Granule, RUBEROID® MOP PLUS, RUBEROID® MOP FR, RUBEROID® ULTRACLAD® SBS, or RUBEROID® Dual FR fully adhered in an approved asphalt at an application rate of 25 lb. /sq. ± 15 %. rwio.�_t.�x�t•_�,:�:� APPROVED NOA No.: 09- 0224.01 Expiration Date: 11/06/13 Approval Date: 04 /08/09 Page 10 of 31 Surfacing: (Optional, required if RUBEROIDtD MOP Smooth or RUBEROID® 20 is top membrane) Install one of the following: 1. Gravel or slag applied at 400 Ibs. /sq. and 300 lbs. /sq. respectively in a flood coat of approved asphalt at 601bs. /sq. or applied in a flood coat of Leak BusterTM MatrixTM 103 Cold Process Adhesive applied at a rate of 3 gal. /sq. 2. GAFGLAS® Mineral Surfaced Cap Sheet, GAFGLAS® Energy Cap Mineral Surfaced Capsheet adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20 -40 lbs. /sq. 3. Leak BusterTM MatrixTM 303 Premium Fibered Aluminum Roof Coating, at 1.5 gal. /sq. 4. Leak BusterTM MatrixTM 715, Leak BusterTM MatrixTM 322, TOPCOAT® MB +, TOPCOAT® Fireshield Elastomeric Roofing Membrane, applied at 1 to 1.5 gal. /sq. 5. Leak BusterTM MatrixTM 602 MB Xtra Elastomeric Roofing Membrane, EnergyCote® roof coating applied at 1 to 1.5 gal. /sq. 6. TOPCOAT® Surface Seal, TOPCOAT® Fireshield® SB Solvent based Elastomeric Roofing Membrane applied at Ito 1.5 gal. /sq 7. Advance Green Technologies Photovoltaic Laminate solar energy collector auxiliary roof equipment installed in compliance with manufacturer's specifications and applicable Building Codes. Maximum Design Pressure: See Fastening Above NOA No.: 09- 0224.01 Expiration Date: 11/06/13 Approval Date: 04/08/09 Page 11 of 31 WOOD DECK SYSTEM LIMITATIONS: 1 A slip sheet is required with Ply 4 and Flex Ply TM 6 when used as a mechanically fastened base or anchor sheet. 2. Minimum '/o" Dens Deck or ' /2" Type X gypsum board is acceptable to be installed directly over the wood deck. GENERAL LIMITATIONS: 1. 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 20-40 lbs./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 Roofmg 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 Roofmg 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.) 10. All products listed herein shall have a quality assurance audit in accordance with the Florida Building Code and Rule 9B -72 of the Florida Administrative Code. END OF THIS ACCEPTANCE NOA No.: 09- 0224.01 Expiration Date: 11/06/13 Approval Date: 04/08/09 Page 31 of 31 Jan 31 2012 10:55AM AC ROB CERTIFICATE OF LIABILITY INSURANCE The Contractors Choice Ag 866 - 758 -9267 p.1 DATE (MMIDD/YYYY) 1/31/2012 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 POUCIES 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 pollcy(ies) must be endorsed. If SUBROGATION 15 WAIVED, subject to the terms and conditions (Atha policy, certain policies may require an endorsement. A statement on this certificate does riot confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER The Contractors Choice Agency PO Box 13645 Chandler AZ 85248 INSURED Double Diamond Construction Inc 827 East 21st Ave New Smyrna Beach COVERAGES CONTACT Joa Rock NAME: ( PHONE F H- (800) 918 -3584 P/ . Nat: (8771684 -9951 AE-MAIL SS. D JonLagiasaranceo><Llilae . aom INSURER(S) AFFORDING COVERAGE INSURER A :Nat r 1 Contractors Insurance INSURER B : NAIC 12293 INSURER C : INSURER D : INSURER E : FL 32169 INSURER F: THIS INDICATED. CERTIFICATE INSR EXCLUSIONS IctVISIUN NUMBER: IS TO CERTIFY.THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INBURANf ADDLE POUCY NUMBER POLICY EN" nIISVDD/TYYYI POLICY EXP tMMfDONVYYI LIMITS A GENERAL X —� UABNJTY _ GLE`000008$62 -o5 • 2/1/2012 2/1/2013 EACH OCCURRENCE $ 500,001 COMMERCIAL. GENERAL LIABILITY 1 CLAIMS-MADE fl OCCUR DAMAGE TO RE NTED PREMISES Ma occurrence) $ 50, 001 MELT Ems, (Aryans n) $ 5,001 PERSONAL 8 ADM INJURY $ 500,001 GENERAL AGGREGATE $ 1,000,001 N'LALaGREGATE LIMIT APPLIES PER �GEE GA'( X I POLICY F I vg n LOC PRODUCTS - COMP /OP AGG $ 500 , 001 $ AUTOMOBILE — -'- LIABD ITY C�eM d 5RTGLE LIMIT t(B�OaaDILY $ ANY AUTO ALL OWNED AUTOS HIRED AUTOS - SCHEDULED HON- O%MIEO AUTOS INJURY (Per person) $ BODILY INJURY ( Per accident) $ ( nP id YtDAMAGE $ $ UMBRELLA UAB MECUM UAB _OCCUR CLAIMS -MADE_ EACH OCCURRENCE $ AGGREGATE $ QED 1 1 RETENTION $ $ WORKERS COMPENSATION AND EMPLOYE LIABILITY ANY T OFFIC ER/MEMBER EXC UDED9 F-XECUTIVE mammon/In NH) CYes desvme under DESCRIPTION OF OPERATIONS below N t A I T WC STATU- 1OTH- C+RV LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY UNIT $ DESCRIPTION OF OPERATIONS r LOCA77OEUR, ueulnt CO .Ar -_.- . wwe.. A... - - _ CERTIFICATE HOLDER ...��uaow nemarss SCnedUla. It'Maue spate 1* required) CANCELLATION (305)756 -8972 Miami Shores Village 10050 NE 2nd Avenue Misai Shores, FL 33138 ACORD 25 (2010/05)• INS02S r2ataosiot 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 Robert Rook /BOB ® 1988-2010 ACORD CORPORATION. All rights reserved. The Annan wa.r.w ....d rw......� .....t..a -.�.i -- a.- _r ..... IPA .n NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. 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. 11111111111111111111111111111111 1111111111111 CFN 2012R0065283 OR Bk 27978 Ps 48441 (fps) RECORDED 01/30/2012 16:17:30 HARVEY RUVIN, CLERY. OF COURT IIAMI -DADE COUNTY► FLORIDA LAST PAGE Space above reserved for use of recording office 1. Legal description of property and street/address: J5P)i �j t / of Sir:0e AI': , Std s ier, 5''i1 2. Description of improvement: 1R -e: JGk- /tt 3. Owner(s) name and address: N`NiiN 7— Interest in property: p- wNs4-- Name and address of fee simple titleholder. `` ,,,� 4. ntractor's name, address and phone number jTc) .. Ia ��z 1 C., "41. t h-r • W.( L Z 1 AV NS 112. f 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number. Amount of bond $ 6. Lender's name and address: G Se -PO 80 470).0 "tnvcutale/ iga\ 303 7. Persons within the State of Florida designate by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number. 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. ' Name, address jgd phone nu . • =r.� �� N 9i i - '�.y6 9. Expiration date of this Notice of Commencement: (the expiration date Is 1 year from the date of recording unless a different date Is spedfied) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of Owner(s) or Owppr(s)' Authorized Officer/Director/Partner/Manager , Prepared By J9 t1)'tt A}- /-' Prepared By V Print Name ,� Print Name Title/Office ®g. at' STATE OF FLORIDA COUNTY OF MIAMI -DADE In By The foreB'` e o !edged before me this _BD__. _ day of 3/tV 2 LD 1 Individually, or ❑ as for Personally known, or 1.] produced the following type of identification:.y Signature of Notary Public: _Pxint.Name• Title/Office VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES Under penalles of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. Signature(s) of Owner(s) or Owner(s)'s A i Officer/Director/Partner/Manager who signed above: BY By 601i4i77Z-- �s`. ►EXPIRES: B:1 :2O14 ,'4p f;.°.', www.AARONNOTM'coom 3TAiit OF FLORIDA, cowry oFDADE t IIINEIVCIPI1FY that this is a km copy of fa original filOditt,tv h .__ le y c 3 m halm elm !!(!!lien ll and Welty Cowls D.0 HIA AHNOLO 9144 • :; kl*P' AM'