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RF-12-1307
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 179665 Permit Number: RF -7 -12 -1307 Scheduled Inspection Date: October 10, 2012 Inspector: Bruhn, Norman Owner: LOUIS, FRANCINE PIERRE Job Address: 20 NE 104 Street Miami Shores, FL Project <NONE> Contractor: MG EXCELLENCE SERVICE CORPORATION Permit Type: Roof Inspection Type: Final Roof Work Classification: Tile Phone Number Parcel Number 1121360130910 Phone: (786)247 -7067 Building Department Comments RE ROOF TILE ROOF COLOR THRU Infractlo Passed Comments INSPECTOR COMMENTS False Passed 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- 179187. CREATED AS REINSPECTION FOR INSP- 175875. BY JAQUI REPLACE 5 BROKEN TILES AND ONE DIFFERENT COLOR. JR October 09, 2012 For Inspections please call: (305)762 -4949 Page 45 of 46 RE: Permit # R P 7 -/ 2 -/307 Miami Shores Viiiage Building Department INSPECTION AFFIDAVIT i/ d4&( 6o,kVcc (Print name and cirde License Type) License #: On or about o-7/2 7/R- (Date & time) Secondary water barrier work at (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) 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 DATE: d licensed as a (n) Contractor / Engineer / Architect, FS 468 Building Inspector , I did personally inspect the roof deck nailing and Signature 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 mentioned. Swom to and subscribed before me this 2 7 day of Notary Public, Sate of Florida at Large oty ••., `,� JACQUELINE LOPEZ 't y * MY IAMISSION 411) 85 a EXPIRES: February 28, 2018 t Fin Ilidgettite, &Ma *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 Revised on 5/2112009 Reileh Engineering Corp. (Consulting Engineer) 2370 S.W. 123 Avenue Miami, Florida 33175 -1174 Tel : 305 - 823 -8008 / 305 - 397 -6414 Fax: 305 - 823 -3300 / 305 - 884 -8834 Website: www.reilehengineering.com September 28, 2012 MG Excellent Services Miami, Florida Project: Dear Sirs; ROOF TILE UPLIFT TEST REPORT Residential Home 20 Northeast 104 Street Miami, Florida Information provided by client: Permit Number: Not Provided Date Completion: September 25, 2012 Roofing Contractor: MG Excellent Services Project Numti 10.24815 (Testing Laboratory Certificate # 11- 0715.04) In accordance with your request and authorization, a representative of Reileh Engineering Corporation completed the RoofTile Uplift Test at the above referenced project. Thistestingwas performed in general accordance with Roofing Application Standard TAS No.106 -- Standard procedure for field verification ofthe bonding of mortar or adhesive set tile system and mechanically attached, rigid, discontinuous roof systems. The total of the tested roof surface area was less than 10000 square feet, and the mean heightof the roof is less than 40 feet above ground surface. The type of tile used for this project was reported to be Hanson Roof Tile. This tile was reported to have been foamed in place. At the time of our inspection, the entire ai ea ofthe roof was examined for loose tiles. Not less than one (1) tile in ten (10) of all components in the field area and one (1) tile in five (5) of all tiles in the perimeter and comer areas were physically examined. A minimum of one (1) test per every two (2) squares in the field, one (1) test per square in the perimeter area, ridge caps and (1) in the comer areas were conducted. tasedon our test r c esults, use onclude ets=the,t requirementoutlin i test report or your review e roof tile at the above referenced project otocol. Attached please find a copy of our Reileh Engineering Corporation appreciates the opportunity of assisting you in this project. If you have any questions or if we may be of further assistance, please do not hesitate to contact the undersigned. Respectfully submitted; Reileh Engineering Corporation Mohamad Sonny Salleh, P.E.49014 Project Manager TILE UPLIFT TEST Residential Home 20 Northeast 104 Street Miami, Florida Reileh Engineering Corporation — Project Number -12 -0815 —Page 2 of 7 Report of TILE UPLIFT TEST for Residential Home 20 Northeast 104 Street Miami, Florida Project Number: 12 -0815 1 35 Pass 2 35 Pass 3 35 Pass 4 35 Pass 5 35 Pass 6 35 Pass 7 35 Pass 8 35 Pass 9 35 Pass 10 35 Pass 11 35 Pass 12 35 Pass 13 35 Pass 14 35 Pass 15 35 Pass 16 35 Pass 17 35 Pass 18 35 Pass 19 35 Pass 20 35 Pass 21 35 Pass 22 35 Pass 23 35 Pass Rei leh Engineering Corporation — Project Number - 12 -0815 — Page 3 of 7 24 35 Pass 25 35 Pass 26 35 Pass 27 35 Pass 28 35 Pass 29 35 Pass 30 35 Pass 31 35 Pass 32 35 Pass 33 35 Pass 34 35 Pass 35 35 Pass 36 35 Pass 37 35 Pass 38 35 Pass 39 35 Pass 40 35 Pass 41 35 Pass 42 35 Pass 43 35 Pass 44 35 Pass 45 35 Pass 46 35 Pass 47 35 Pass 48 35 Pass 49 35 Pass 50 35 Pass 51 35 Pass Reileh Engineering Corporation — Project Number -12 -0815 —Page 4 of 7 Test Number Test Load Obi) ' Test Status 52 35 Pass • 53 35 Pass 54 35 Pass 55 35 Pass 56 35 Pass 57 35 Pass 58 35 Pass 59 35 Pass 60 35 Pass 61 35 Pass 62 35 Pass 63 35 Pass 64 35 Pass 65 35 Pass 66 35 Pass 67 35 Pass 68 35 Pass 69 35 Pass 70 35 Pass 71 35 Pass 72 35 Pass 73 35 Pass 74 35 Pass 75 35 Pass 76 35 Pass 77 35 Pass 78 35 Pass 79 35 Pass Reileh Engineering Corporation — Project Number -12 -0815 — Page 5 of 7 80 35 Pass 81 35 Pass 82 35 Pass 83 35 Pass 84 35 Pass 85 35 Pass 86 35 Pass 87 35 Pass 88 35 Pass 89 35 Pass 90 35 Pass 91 35 Pass 92 35 Pass 93 35 Pass 94 35 Pass 95 35 Pass 96 35 Pass 97 35 Pass 98 35 Pass 99 35 Pass 100 35 Pass 101 35 Pass 102 35 Pass 103 35 Pass 104 35 Pass 105 35 Pass 106 35 Pass 107 35 Pass Reileh Engineering Corporation -- Project Number - 12 -0815 — Page 6 of 7 Test Number 108 35 Pass 109 35 Pass 110 35 Pass 111 35 Pass 112 35 Pass 113 35 Pass Test 1 -20 Comer, 21 -36 Ridge Caps, 37 -54 Perimeter, 55 -13 Field Reileh Engineering Corporation — Project Number - 12 -0815 —Page 7 of 7 40 14 n 19 18 41 19 48 40 IL? 9 49 09 89 00 0 4 15 0 6 *1 8 42 98 12 u 151 111.E FEU7 a 59 meta = 18 CON = 20 1211704 CAP m 16 peRimm o 11oo 5r cam? - 100 5F NO. fe51 LOCA11ON P IMG 1217I51'ANCt, a a 3' COUR AMA m 3'X 3' 0 oin CAP 'r 51 LOCA110N 131 mares WOKEN la L MNOt1;5 1,00% 111,1; 2' 12-081 App120X,1ZOOp 1t;51' LOGA11ON5 ANf717IMM1510N5 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION JUL 13 252 3 LR F C20 ° Permit �No.. ) 2 0 1301 Master Permit No. Permit Type: BUILDING ROOFING I' JOB ADDRESS: t20 i( g /04-1 Ai/ X44`: City: Miami Shores County: Folio/Parcel #: 1/ — 9136 -6/ 30 -- fl 0 - Miami Dade 33/98- Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): A (j Wit" Phone #: Address:_("./ A/61 City: 9 C-LUL State: rl Zip: )3) 38 Tenant/Lessee Name: Phone #: 03Ci n Email:( J/ i��'` 1� CONTRACTOR: Company Name: �� P t U t alp- Pho (� 2 4INT );. Address: 6 (� / . 6 1 City: ;t 'l, P( Qualifier Name: {� Phone #: State: aid State Certification or Registration #: c,CQ 43:a "l 2- Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: I LI 000. 00 Type of Work: UAddition UAlteration Description of Work: Value of Work for this Permit: $ Square/Linear Footage of Work: ❑New ❑Repair/Replace C .00 3200 ❑Demolition Color thru tile: * * * * * * * * * * * * * * * * * * * * ** * * ***** mix * * * * ** *Fees** * ** *** ** x:***** * **********:x ********* *** *** Submittal Fee $ Permit Fee $ 'c..7/ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE$ (4 "l'(Q 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 ANN'11)AVIT: 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 deliver d to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be po ''ed at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of suc . posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this Cc) day o 1 '\-J , 20 , by N\ e_. e who is personally known to me or who has produced V) *4c As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: : 1J e A JUAN J. QUESADA * MY CDMMISSION 4 EE 194777 EXPIRES: May 11, 2016 mf4,egn . Bonded Tin isdpl Navy Saito The foregoing instrument s ackno�Fedged before me this day of 4u\ ,2002, by A\ c.\,,,@ c, 6.A..."'�. who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission 15 MfSSIIO i 85D EXi91IitS; i:abruary20, 2013 Th *tar, Selyttes ** ****** ** **** ** * ** say**** ***************** *** * *** ** * * *** ***+xm***** *x ****: x**: n*** *s<: x*** *********** ************ APPROVED BY d —1CP!/2 Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) Zoning Clerk MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. let FLOOR MIAMI, FL 33130 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 666530 -2 THIS IS NOT A BILL - DO NOT PAY RENEWAL FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 693728 -9 su IseIrLtEoTtg_RVICES CORPORATION STATEreET. %28452 180 E 19 ST 33010 HIALEAH OWNER MG EXCELLENT SERVICES CORPORATIO sec1T.5%e TY THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CRIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR UCENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S OUAUFICA- TIONS. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR:10/14/2011 02220002003 000049.50 SEE OTHER SIDE BUILDING CONTRACTOR WORKER /S 1 DO NOT FORWARD MG EXCELLENT SERVICES CORPORATION MICHEL GARCIA PRES 180 E 19 ST HIALEAH FL 33010 90 .4mmgmm- nurcim MUMAVZ bTAZAM.1. °WM? TALLAHASSEE FL 32399-0783 GARCIA, MICHEL M G EXCELLENT SERVICES CORPORATION 180 EAST 19 ST HIALEAH FL 33010 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalIcense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and leam more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! kc# 5081394 DETACH HERE STATE OF FLORIDA • ARIIMEla&S? BUS AND P-itOrES CT- USTRY LICENSI tiLATIcni SECtitL100130-11 01X1,1 08: .-09 2010 The ROOPOTIG Named below IS CERTIFXED 'Under the provisions of Chapte Expiration date: AUG 31, 2012 GARCIA, 1MICHEL MTG _-EXCELLENT SERVICES CORPORATION 180 -19 -ST HIALICAE FL 33010 CHARLIE CRIST GOVERNOR -DISPLAY AS REQUIRED BY LAW -_s CHARLIE LIEM SECRETARY 01 -13 -2012 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCMAL_OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE PERSON: FEIN: 01/13/2012 EXPIRATION DATE: 01/12/2014 GARCIA MICHEL 205418976 BUSINESS NAME AND ADDRESS: M G EXCELLENT SERVICES CORPORATION 2471 NW 67ST MIAMI FL 33147 SCOPES OF BUSINESS OR TRADE 1- CERTIFIED AC =TRACTOR 3- CERTIFIED GENERAL CONTRACTOR 2- CERTIFIED PLLMBING CONTRACTOR e IMPORTANT: Pursuant to Chapter 440 . 05(14). F.S., an officer of a corporation who elects exemption from this chapter by Ming a certificate of election under this section may not recover benefits or compensation ender this chapter. Pursuant to Chapter 440.05(12) F.S., Certificates of election to be exempt.. apply only within the scope of the business or trade listed au the notice of election to be exempt Pmsnaat to Chapter 440.05113*, F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation 0, at any time after the filing of the notice or the issuance of the certificate, the person named on the entice or. certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of ehls section. OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 QUESTIONS?? (850) 413 -1809 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' CQMPENSATfON CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 01/13/2012 EXPIRATION DATE: PERSON MICHEL GARCIA FEIN 205418978 BUSINESS NAME AND ADDRESS: M G EXCELLENT SERVICES CORPORATION 2471 NW 67ST MIAMI, FI. 33147 01/12/2014 SCOPE OF BUSINESS OR TRADE 1- CERTIFIED AC CONTRACTOR 2- CERTIFIED PLUMBING CONTRACTOR 3- CERTIFIED GENERAL CONTRACTOR 0 D H E R E IMPORTANT Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12). F.S., Certificates of election to be exempt.. apply only within the scope of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this Section. QUESTIONS? (850) 413 -1809 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 Miami Shores Vaiage 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 gg Re: Owner's Name: A I r Ci l� o v' e 1• Property 4 p rty A ddress. � C� 4 � Date: Roofing Permit Number: Dear Building ° cial: I A b � � � \t /b Ile certify that I am not required to retrofit the roof to wall connections of my building because: The just valuation for the structure for purpose of ad valorem taxation is less than $300,000.00. Please attach proof of ad ((valorem taxation. ❑ The building was constructed in compliance with the provisions of the Florida Building Code (FBC) or with the provisions of 1994 edition of the South Florida Building Code (1994 SFBC) Signature All fed Lyone,�. 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 m-ntioned. Swom to and subscribed before me this Notary Public, Sate of Florida at Large gas MY W14#1ISSION # ID 854010 EXPIt1ES: February 20, 2013 sewed Thtu Mgat Wary Segos 0V Z • 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 wl h FBC nor a 1994 SFBC. Then you must provide a building application from a General Contractor for the Roof to Wall connection Hurricane Mitigation. Revised on 5/21/2009 Property Information Map My Home Miami -Dade County, Florida Page 1 of 1 Property Information Map Aerial Photography - 2009 0 56 ft This map was created on 7/13/2012 9:25:25 AM for reference purposes only. Web Site © 2002 Miami -Dade County. All rights reserved. Summary Details: Folio No.: 11- 2136 -013 -0910 Property: 20 NE 104 ST Mailing FRANCINE PIERRE LOUIS Address: PIERRINE LEONEL & Living Units: ALFRED LYONEL Adj Sq Footage: 20 NE 104 ST MIAMI Lot Size: SHORES FL Year Built: 33138 -2027 Property Information: Primary Zone: 1000 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds /Baths: 4/3 Floors: 1 Living Units: 1 Adj Sq Footage: 2,694 Lot Size: 13,618.60 SO FT Year Built: 1954 $50,000/ $247,422 36 52 41 31 52 42 MIAMI City: SHORES SEC 5 PB 10- Legal 47 LOTS 10 & 11 BLK Description: 123 LOT SIZE 104.720 X 130 OR 16725 -0997 0295 4 OR 16725 -0997 0295 01 Assessment Information: Year: 2011 2010 Land Value: $122,933 $122,933 Building Value: $237,129 $237,540 Market Value: $360,062 $360,473 Assessed Value: $297,422 $293,027 Exemption Information: Year: 2011 2010 Homestead: $25,000 $25,000 2nd Ho g; YES YES Senior: $0 $50,000 _ Taxable Value Information: ear: 2011 2010 $0 Applied Applied axing Authority: Exemption/ Taxable Exemption/ Taxable disqualified as a result of Value: Value: Regional: $50,000/ $247,422 $50,000/ $243,027 ounty: $50,000/ $247,422 $100,000/ $193,027 City: $50,000/ $247,422 $50,000/ $243,027 School Board: $25,000/ $272,422 $25,000/ $268,027 Sale Information: Sale Date: 2/1995 Sale Amount: $0 Sale O /R: 16725 -0997 Sales Sales which are Qualification disqualified as a result of Description: examination of the deed View Additional Sales http: / /gisims2 .miamidade.gov /myhome /printmap. asp? mapurl = http: / /gisims2.miamidade.go... 7/13/2012 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. 1 -1130 ` 1 TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that property, and in accordance with Chapter 713, is provided in this Notice of Commencement. STATE OF IHEEY improvements will be made to certgjjn?% Florida Statutes, the following information WITNE my HARVEY RU By 1111111 11111 IIIII Hill 1i1i1 il1l1 111111111 1111 CF14 21 I! 12R05r 04298 OR Bk 28191 Ps 3964f (1) RECORDED 07/18/2012 12 :15 :49 HARVEY RUVIIIr CLERK OF COURT MIAMI–LADE COUNTY r FLORIDA LAST PAGE / `, Space aboov�ee reserved for use of recording office 1. Legal description of property and street/address � • 20 �yT `LIZ `R,7' 7. M QIn1 .5k4a >'/ ,33.1.38 • 2. Description of improvement: ��4' P e5 3. Owner(s) name and address: Interest in property: Name and address of fee simple titleholder. 4. Contractor's name, address and phone num 7? 2 I Ai kV 174/ terf 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number. Amount of bond $ cc,/ ii w`, G iorii D P 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number. 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number. 9. Expiration date of this Notice of Commencement: (the expiration date Is 1 year from the date of recording unless a different date Is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of - %s) or •`r(; Authorized OfficT' irector /Partner/Manager Prepared By Prepared By Print Name Print Name Title /Office Title/Office STATE OF FLORIDA COUNTY OF MIAMI -DADE The forgoing instrument was acknowledged before me this 9.� By . a Q_ A 0 �1 1 Individually, or ❑ as for ❑ Personally known, or produced the following type of identi$cca o_n: Signature of Notary Public: Print Name: (SEAL) VERIFIC TION PURSUANT TO SECTION 92.525. FLORIDA STATUTES Under.penalties 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. day of t l/ . 2.0 ce '.t=„'1 opt ; ;'+ ,�, JUANJ.QUESADA a MY CON MISSION # EE 194M EXPIRES: May 11, 2016 BodertYleiBute1Nolarr sr"' Signature(s) of Owner(s) or Owner(s)'s Authorized Officer/Director/Partner /Manager who s'i tNd above: By By 123.01 -62 PACE 3 3/10 HIGH - VELOCITY HURRICANE ZONES Ji Florida Building Code Edition 2010 High Velocity Hurricane Zone Uniform Permit Application Form. Section A (General Information) Master Permit No. Contractor's Name #1 6 Job Address Process No C.2 � e u. # . .,m f & 20 10# &I" fatio ROOF CATEGORY ❑ L • SI • _ ❑ Mechanically Fastened Tile RI Mortar /Adhesive Set Tile ❑ Metal Panel/Shingles ❑ Wood Shingles /Shakes ❑ Prescriptive BUR -RAS 150 ROOF TYPE 9s A, fif R ofing ❑ Recovering ❑ Repair ❑ Maintenance AFC ox.co S ROOF SYSTEM INFORMATION oof Area (SF) Steep Sloped Roof Area (SF) Total (SF) 3200 .3 a06 NO 64s. Section B (Roof Plan) Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include dimensions of sections and levels, clearly identify dimensions of elevated pressure zones and location of parapets. 2010 FLORIDA BUILDING CODE — RESIDENTIAL 3x; CoDv D4I HIGH- VELOCITY HURRICANE ZONES Florida Building Code Edition 2010 High Velocity Hurricane Zone Uniform Permit Application Form. Section D (Steep Sloped Roof System) Roof System Manufacturer: -Dan' o Yl Poop. p. Product Approval Number: 8 Q— Q 0 3 V. 0 3 Minimum Design Wind Pressures, If Applicable (From RAS 127 or Calculations): P1: 1 P2: 7Y• 6 P3: 8 I& • Maximum Design Pressure Product Approval Specific Syste is Method of tile attachment 0 j torwit meckl. Roof Slope: : 12 Steep Sloped Roof System Description Deck Type: C DX I')WooC) ' 5 e 9 3 n : yp e U deriayment. Insulation: 30 ASTq D 30?6 Fire Barrier: Ridge Vera Fastener Type & Spacing: Adhesive Type: Mean Roof Height: 2010 FLORIDA BUILDING CODE — RESIDENTIAL SYL/ r -5 no y E 3 /7lTincOP g4ee (Aviv& Hti ype Cap Sheet: �' 9 0 u nc�r Roof Covering: u� Type & Size Drip dge: 3 4. 1 HIGH - VELOCITY HURRICANE ZONES 44.24 Florida Building Code Edition 2010 High Velocity Hurricane Zone Uniform Permit Application Form. Section E (Tile Calculations) For Moment based tile systems, choose either Method 1 or 2. Compared the values for Mr with the values from Mf. If the Mr values are greater than or equal to the Mr values, for each area of the roof, then the tile attachment method is acceptable. M gtho� 1 "M (.:61.1xa.(17,1 =12. (P3:' nt BaseA_T 1e Calculati s Per RAS 127" �1 Mi Mrt . Product Approval Mr 4 5 S Mi ° Mr ft Product Approval Mr 5 - Me . 2 = Mr3 . ife,Prodact Approval M, 4 3 . Method 2 "Simplified Tile Calculation Per Table Below" Required Moment of Resistance (Mr) From Table Below Product Approval Mr Mr Required Moment Resistance* Mean Roof Height -* Roof Slope ,, 15' 20' 26' 30' 40' 2:12 34.4 36.5 38.2 39.7 42.2 3:12 32.2 34.4 36.0 37.4 39.8 4:12 30.4 32.2 33.8 35.1 37.3 6:12 28.4 30.1 31.6 32.8 34.9 ' 6:12 26.4 28.0 29.4 30.5 32.4 7:12 24.4 25.9 27.1 28.2 30.0 *Must be used in conjunction with a list of moment based tile systems endorsed by the Broward County Board of Rules and Appeals. For Uplift based tile systems use Method 3. Compared the values for F' with the values for Fr. If the F' valves are greater than or equal to the F, values, for each area of the roof, then the tile attachment method is acceptable. Method 3 "Uplift Based Tile Calculations Per RAS 127" (Pi :_xI:_- x w:= )- W :_x cos 8 :•_= Fr,: (P2:_xI:_= x w:= )- W•= x cos 8� - Ftz: - (P3 :xl : =x w:= )- W:x cos 0 :•_= Ft3: Where to Obtain Information Description Symbol Where to find Design Pressure PI or P2 or P3 RAS 127 Table 1 or by an engineering analysis prepared by PE based on ASCE 7 Mean Roof Height H Job Site Roof Slope 0 Job Site Aerodynamic Multiplier a, ' Product pprovai Restoring Moment due to Gravity M, Product Approval Attachment Resistance Mr Product Approval Required Moment Resistance M, Calculated Minimum Attachment Resistance F. Product Approval Required Uplift Resistance F, Calculated Average Tile Weight. W Product Approval Tile Dimensions I= length NV= width Product Approval All calculations must be submitted to the Building Official at the time of permit application. 2010 FLORIDA BUILDING CODE - RESIDENTIAL 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. P L Renailing wood decks: When replacing roofing, the existing wood roof deck may have to be renailed in accordance with the current provisions of Section R4403. (The roof deck is usually concealed prior to removing the existing roof system). 3. L 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. L_ Exposed Ceiling: Exposed, open beam ceilings are where the underside of the roof decking can be viewed from below. The owner may wish to maintain the architectural appearance; therefore, roofing nail penetration of the underside of the decking may not be acceptable. This provides the option of maintaining the appearance. 5. Ponding water: The current roof system and /or deck of the building may not drain well and may cause water to pond (accumulate) in low -lying areas of the roof. Pounding can be an indication of structural distress and may require the review of a professional structural engineer. Pounding may shorten the life expectancy and performance of the new roofing system. Pounding conditions may not be evident until the original roofing system is removed. Pounding conditions should be corrected. 6. Overflow scuppers (wall outlets): It is required that rainwater flows off so that the roof is not overloaded from a buildup of water. Perimeter /edge wall or other roof extension may block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accordance with the requirements of Sections R4402, R4403 and R4413. 7. Iry 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 consid additional venting which can result in extendin• the service life of the roof. atf- Owner/Agent s Signatur Date Revised on 7/9/2009 LD Contractor Signature Date MIAMI COUNTY DEPARTMENT OF PERMITTING, ENVIRONMENT, AND REGULATORY AFFAIRS (PERA) BOARD AND CODE ADMINISTRATION DIVISION NOTICE OF ACCEPTANCE (NOA) Hanson Roof Tile 1340 SW 34th Ave Deerfield Beach, FL 33442 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.Qov /pera 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 Miarni -Dade County PERA - 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. PERA reserves the right to revoke this acceptance, if it is determined by Miami -Dade County Product Control Section that this product or material fails to meet the requirements of the applicable building code. This product is approved as described herein, and has been designed to comply with the Florida Building Code including the High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION: Hanson Hacienda Double Roll Roof Tile LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami -Dade County Product Control Approved ", unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This revises NOM 10 -0706.07 and consists of pages 1 through 6. The submitted documentation was reviewed by Alex Tigera. NOA No.: 11- 1031.03 Expiration Date: 12/16/12 Approval Date: 02/09/12 Page 1 of 6 ROOFING ASSEMBLY APPROVAL Category: Sub Category: Material: Roofing Roofmg Tile Concrete 1. SCOPE This approves a roofmg system using Hanson Hacienda Roof Tile, as manufactured by Hanson Roof' Tile in Deerfield Beach, Florida and as described in Section 2 of this Notice of Acceptance. For the locations where the pressure requirements, do not exceed the values listed in section 4 herein. The attachment calculations shall be done as a moment based system. 2. PRODUCT DESCRIPTION Manufactured by Applicant Dimensions Hanson "Hacienda" Length: 171/4' Width: 13" ' /2" thick Trim Pieces Length: varies Width: varies Varying thickness Test Product Specifications Description TAS 112 Low profile, interlocking, extruded concrete roof tile equipped with two nail hole and double roll ribs. For direct deck or battened nail -on, mortar or adhesive set applications. TAS 112 Accessory trim, concrete roof pieces for use at hips, rakes, ridges and valley terminations. Manufactured for each tile profile. 2.1 EVIDENCE SUBMITTED Test Agency Test Identifier Redland Technologies 7161 -03 7161 -03 7161 -03 P0402 Professional Service Industries, Inc. The Center for Applied Engineering, Inc. P0631 -01 Letter Dated Aug. 1, 1994 224 -47099 94 -060B 94-084 25- 7094 -1 25- 7094 -7 25- 7094 -4 Project No. 307025 Test #MDC -76 25- 7183 -1 25- 7183 -2 25- 7214 -2 25- 7214 -6 Test Name/Report PA 102 PA 102(A) PA 108 Withdrawal Resistance Testing of screw vs. smooth shank nails PA 108 PA 108 PA 112 PA 101 PA 101 PA 102 PA 102 PA 102 PA 100 PA 102 PA 102 PA 102 PA 102 Date Dec. 1991 Dec. 1991 Dec. 1991 Sept. 1993 July 1994 Aug. 1994 Sept. 1994 March, 1994 May 1994 Oct. 1994 Oct. 1994 Oct. 1994 Oct. 1994 Feb. 1995 Feb. 1995 March, 1995 March, 1995 NOA No.: 11- 1031.03 Expiration Date: 12/16/12 Approval Date: 02/09/12 Page 2 of 6 Test Agency Celotex Corporation Testing Services Walker Engineering, Inc. IBA Consultants, Inc. American Test Lab of South Florida 3. LIMITATIONS 3.1 3.2 Test Identifier 528454 -2 -1 520109 -2 Calculations 2381 -249 RT1024.01- 11 Test Name/Report PA 101 Aerodynamic Multiplier TAS 112 TAS 112 Date Sep. 1998 Dec. 1998 March 1999 09/20/07 10/28/11 Fire classification is not part of this acceptance. For mortar or adhesive set tile applications, a static field uplift test in accordance with TAS 106 may be required, refer to applicable building code. 3.3 Applicant shall retain the services of a Miami -Dade County Certified Laboratory to perform quarterly test in accordance with TAS 112, appendix `A'. Such testing shall be submitted to the Building Code Compliance Office for review. 3.4 Minimum underlayment shall be in compliance with the applicable Roofing Applications Standards listed section 4.1 herein. 3.5 30/90 hot mopped underlayment applications may be installed perpendicular to the roof slope unless stated otherwise by the underlayment material manufacturers published literature. 3.6 This acceptance is for wood deck applications. Minimum deck requirements shall be in compliance with applicable building code. 4. INSTALLATION 4.1 Hanson `Hacienda' Roof Tile and its components shall be installed in strict compliance with Roofing Application Standard RAS 118, 119, & 120. 4.2 Data For Attachment Calculations Table 1: Average Weight (W) and Dimensions (I x w ) Tile Profile Weight W (Ibf) Length -I (ft) Width -w (ft) Hanson Hacienda 10.0 1.4375 1.08 NOA No.: 11- 1031.03 Expiration Date: 12/16/12 Approval Date: 02/09/12 Page 3 of 6 Table 2: Aerodynamic Multipliers - A (ft3) Tile A (ft3) A (ft3) Profile Batten Application Direct Deck Application Hacienda Tile r072-6777) 0.289 NOA No.: 11- 1031.03 Expiration Date: 12/16/12 Approval Date: 02/09/12 Page 3 of 6 Table 3: Restoring Moments due to Gravity - Mg (ft-Ibf) Tile Profile 3 ": 12" 4 ": 12" 5 ": 12" 6 ": 12" 7 ": 12" or greater Hanson Hacienda Tile Battens Direct Deck Battens Direct Deck Battens Direct Deck Battens Direct Deck Battens Direct Deck .92) 6.80 5.82 6.69 5.70 6.55 5.56 6.39 5.41 6.22 Tab a 4: Attachment Resistance Expressed as a Moment - Mf (ft -Ibf) For Nall -On Systems Tile Profile Fastener Type Direct Deck (Min 15/32" plywood) Direct Deck (Min. 19/32" plywood) Battens Hanson Hacienda Tile 2 -10d Ring Shank Nails 27.8 37.4 28.8 1 -10d Smooth or Screw Shank Nail 8.8 11.8 4.1 2 -10d Smooth or Screw Shank Nails 16.4 21.9 7.1 1 #8 Screw 25.8 25.8 22.9 2 #8 Screw 47.1 47.1 49.1 1 -10d Smooth or Screw Shank Nail (Field Clip) 24.3 24.3 24.2 1 -10d Smooth or Screw Shank Nail (Eave Clip) 19.0 19.0 22.1 2 -10d Smooth or Screw Shank Nails (Field Clip) 35.5 35.5 34.8 2 -10d Smooth or Screw Shank Nails (Eave Clip) 31.9 31.9 32.2 2 -10d Ring Shank Nails' 43.0 67.5 50.9 1 Installation with a 4" tile headlap and fasteners are located a min. of 21/2° from head of tile. NOA No.: 11- 1031.03 Expiration Date: 12/16/12 Approval Date: 02/09/12 Page 4 of 6 Table 5: Attachment Resistance Expressed as a Moment Mf (ft -Ibf) For Two Patty Adhesive Set Systems Tile Profile Tile Application - Minimum Attachment Resistance Hanson Hacienda Tile Adhesive 26.13 2 See manufactures component approval for installation requirements. 3 Flexible Products Company TileBond Average weight per patty 11.4 grams. Polyfoam Product, Inc. Average weight per patty 8 grams. Table 6: Attachment Resistance Expressed as a Moment - Mf (ft -Ibf) For Single Patty Adhesive Set Systems Tile Profile Tile Application Minimum Attachment Resistance Hanson Hacienda Tile Polyfoam PolyProTM 86.614 Polyfoam PolyProT"" 5.5�° 4 Large paddy placement of 54grams of PolyProTM. 5 Medium paddy placement of 24grams of PolyProTM. Table 7: Attachment Resistance Expressed as a Moment - Mf(ft-Ibf) For Mortar Set Systems Tile Profile Tile Application Attachment Resistance Hanson Hacienda Tile Mortar Set' 20.60 5. LABELING All tiles shall bear the imprint or identifiable marking of the manufacturer's name or logo (See Detail Below), or following statement: "Miami -Dade County Product Control Approved ". Hanson HANSON HACIENDA ROOF TILE TILE IDENTIFICATION MARK (LOCATED ON UNDERSIDE OF TILE) 6. BUILDING PERMIT REQUIREMENTS 6.1 Application for building permit shall be accompanied by copies of the following: 6.1.1 This Notice of Acceptance. 6.1.2 Any other documents required by the Building Official or applicable building code in order to properly evaluate the installation of this system. NOA No.: 11- 1031.03 Expiration Date: 12/16/12 Approval Date: 02 /09/12 Page 5 of 6 FASTENER HOLES PROFILE DRAWINGS OVERLOCK 1 ar Pp UNDERLOCK 13' HANSON HACIENDA CONCRETE ROOF TILE END OF THIS ACCEPTANCE NOA No.: 11- 1031.03 Expiration Date: 12/16/12 Approval Date: 02/09/12 Page 6 of 6 MJAP�14l�ADE COUNTY BUILDING AND NEIGHBORHOOD COMPLIANCE DEPARTMENT (BNC) BOARD AND CODE ADMINISTRATION DIVISION NOTICE OF ACCEPTANCE (NOA) /Polyfoam Products, Inc. 11715 Boudreaux Road Tomball, TX 77375 MIAMI -DADE COUNTY PRODUCT CONTROL SECTION 11805 SW 26 Street, Room 208 Miami, Florida 33I75 -2474 T (786) 315 -2590 F (786) 315 -2599 www.mieraidade.eovNuildins/ SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed and accepted by Miami -Dade County BNC - Product Control Section to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ). This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product Control Section (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) reserve the right to have this product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify, or suspend the use of such product or material within their jurisdiction. BNC reserves the right to revoke this acceptance, if it is determined by Miami -Dade County Product Control Section that this product or material fails to meet the requirements of the applicable building code. This product is approved as described herein, and has been designed to comply with the Florida Building Code including the High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION: Polypro® A11160 LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement "Miami -Dade County Product Control Approved ", unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This renews NOA# 06- 0201.02 and consists of pages 1 through 7. The submitted documentation was reviewed by Alex Tigera. NOA No.: 11-0124.04 Expiration Date: 05/10/12 Approval Date: 04/14/11 Page 1 of 7 ROOFING COMPONENT APPROVAL: Category: Roofing Sub Category: Roof file adhesive Materials: Polyurethane SCOPE: This approves Polypro® AH160 as manufactured by Polyfoam Products, Inc. as described in Section 2 of this Notice of Acceptance. For the locations where the design pressure requirements, as determined by applicable building code, does not exceed the design pressure values obtained by calculations in compliance with Roofing Application Standard RAS 127, for use with approved flat, low, and high profile roof tiles system using Polypro® AH 160. Where the attachment calculations are done as a moment based system for single patty placement, and as an uplift based system for double patty systems PRODUCTS MANUFACTURED BY APPLICANT: Product Dimensions Test Product Description ,Specifications Polypro + AH160 N/A TAS 101 Two component polyurethane foam adhesive Foampro® RTF1000 N/A Dispensing Equipment ProPack® 30 & 100 N/A Dispensing Equipment PRODUCTS MANUFACTURED BY OTHERS: Any Miami -Dade County Product Control Accepted Roof Tile Assembly having a current NOA which list moment resistance values with the use of Polypro AH160 roof tile adhesive. PHYSICAL PROPERTIES: Property Density Compressive Strength Tensile Strength Water Absorption Moisture Vapor Transmission Dimensional Stability Closed Cell Content Test ASTM D 1622 ASTM D 1621 ASTM D 1623 ASTM D 2127 ASTM E 96 ASTM D 2126 ASTM D 2856 Results 1.6 lbsffit.3 18 PSI Parallel to rise 12 PS1 Perpendicular to rise 28 PS1 Parallel to rise 0.08 Lbs./Ftz 3.1 Perm / Inch +0.07% Volume Change ® -40° F., 2 weeks +6.0% Volume Change ®158°F., 100% Humidity, 2 weeks 86% Note: The physical properties listed above are presented as typical average values as determined by accepted ASTM test methods and are subject to normal manufacturing variation. 4 �ul��Ttl.)��(•l�Ja`IyI 1APPROVEDI NOA No.: 11-0124.04 Expiration Date: 05 /10/12 Approval Date: 04/14/11 Page 2 of 7 EVIDENCE SUBMI'1 °1'L! D: Test Agency Test Identiifier Test Name/Reuort Date Center for Applied Engineering #94060 TAS 101 04/08194 257818 -1PA TAS 101 12/16/96 25- 7438 -3 S_ STD 11 -93 10/25/95 25- 7438 -4 25- 7438 -7 SSTD 11 -93 11/02/95 25 -7492 SSTD 11 -93 12/12/95 Miles Laboratories NB- 589 -631 ASTM D 1623 02/01/94 Polymers Division Ramtech Laboratories, Inc. 9637 -92 ASTM E 108 04/30/93 Southwest Research Institute 01- 6743 -011 ASTM E 108 11/16/94 01- 6739 - 0621(1] ASTM E 84 01/16/95 Trinity Engineering 7050.02.96 -1 TAS 114 03/14/96 Celotex Corp. Testing Services 528454 -2 -1 TAS 101 10/23/98 528454-9 -1 528454-10-1 520109 -1 TAS 101 12/28/98 520109 -2 520109 -3 520109 -6 520109 -7 520191 -1 TAS 101 03/02/99 520109 -2 -1 LIMITATIONS: 1. Fire classification is not part of this acceptance. Refer to the Prepared Roof Tile Assembly for fire rating. 2. Polypro® AH160 shall solely be used with flat, low, & high tile profiles. 3. Minimum underlayment shall be in compliance with the Roofing Application Standard RAS 120. 4. Roof Tile manufactures acquiring acceptance for the use of Polypro® AH160 roof tile adhesive with their tile assemblies shall test in accordance with TAS 101. 5. Roof Tile manufactures acquiring acceptance for the use of HANDI-STICK roof tile adhesive with their tile assemblies shall test in accordance with TAS 101 with section 10.4 as modified herein. F'- MS NOA No.: 11-0124.04 Expiration Date: 05 /10/12 Approval Date: 04/14/11 Page 3 of 7 INSTALLATION: 1. Polypro® AH160 may be used with any roof tile assembly having a current NOA that lists uplift resistance values with the use of Polypro® AH160. 2. Polypro® AH160 shall be applied in compliance with the Component Application section and the corresponding Placement Details noted herein. The roof the assembly's adhesive attachment with the use of Polypro® AH160 shall provide sufficient attachment resistance, expressed as an uplift based system, to meet or exceed the uplift resistance determined in compliance with Miami -Dade County Roofing Application Standards RAS 127. The adhesive attachment data is noted in the roof tile assembly NOA 3. Polypro® AH160 roof tile adhesive and its components shall be installed in accordance' with Roofing Application Standard RAS 120, and Polyfoam Products, Inc. Polypro® AH160 Operating Instruction and Maintenance Booklet. 4. Installation must be by a Factory Trained 'Qualified Applicator' approved and licensed by Polyfoam Products, Inc. Polyfoam Products Inc. shall supply a list of approved applicators to the authority having jurisdiction. 5. Calibration of the Foampro® dispensing equipment is required before application of any adhesive. The mix ratio between the "A" component and the "B" component shall be maintained between 1.0- 1.15 (A): 1.0 (B). The dispense timer shall be set to deliver 0.0175 to 0.15 pounds per tile as determined at calibration. No other settings shall be approved. 6. Polyproo AH160 shall be applied with Foampro RTF1000 or ProPack® 30 & 100 dispensing equipment only. 7. Polypro® AH160 shall not be exposed permanently to sunlight. 8. Tiles must be adhered in freshly applied adhesive. Tile must be set within 2 to 3 minutes after Polypro® AH160 has been dispensed. 9. Polypro? AH160 placement and minimum patty weight shall be in accordance with the 'Placement Details' herein. Each generic tile profile requires the specific placement noted herein. Table 1: Adhesive Placement For Each Generic Tile Profile Tile Profile Placement Detail Single Paddy Weight Min. (grams) Two Paddy Weight per paddy Min. (grams) Flat, Low, High Profiles #1 35 N/A High Profile (2 Piece Barrel) #1 17 /side on cap and 34 /pan N/A Flat, Low, High Profiles #2 24 N/A Flat, Low, High Profiles #3 8 LABELING: All Polypro 14 AH160 containers shall comply with the Standard Conditions listed herein. BUILDING PERMIT REQUIREMENTS: As required by the Building Official or applicable building code in order to properly evaluate the installation of this system. NOA No.: 11-0124.04 Expiration Date: 05/10/12 Approval Date: 04/14/11 Page 4 of 7 ADHESIVE PLACEMENT DETAIL 1 SINGLE PATTY I) Rate enough adhesive In olden Me23 t>pfteattaufetm s Squarelathes lncmde with the pan tie PP eFPd To 1 In, Frara outsides* of cow Ill& Then Inidell Meth T)Tmo cows upsidedown. Placeiamb 1121n. /mot Undedaymeal Nallihrough pteatlseemmt tor dike an course COM Ma Abut bseeend course el weere odor fluted ewe Um. Rocks= Weepinde Fes& (oder Point.* Moder on keigludiral edges dee NOA No.: 11-0124.04 Expiration Date: 05/10112 Approval Date: 04/14/11 Page 5 of 7 ADHESIVE PLACEMENT DETAIL 2 SINGLE PATTY NOA No.: 11-0124.04 Expiration Date: 05/10/12 Approval Date: 04/14/11 Page 6 of 7 -4p °R°® CERTIFICATE OF LIABILITY INSURANCE DA07/2512 Y) PRODUCER Florida Bankers Insurance 7278 SW 8 Street Miami, FL 33144 Phone (305)266 -6493 Fax (305)262 -0679 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED M.G. EXCELLENT SERVICES CORP. 7221 NW 174 Terr Apt. #102 HIALEAH, FL 33015 INSURER A: FEDERATED NATIONAL INSURANCE INSURER B: INSURER C: INSURER!): INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADM. INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDIYY) POLICY EXPIRATION DATE (MMIDD/YY) LIMITS A ❑ GENERAL LIABILITY V COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS MADE V OCCUR ❑ GL- 05040006840 -01 02/09/12 02/09/13 EACH OCCURRENCE 1,000.000.00 DAMAGE TO RENTED PREMISES (Ea occurence) 100.000.00 MED EXP (Any one person) 5.000.00 PERSONAL & ADV INJURY 1,000.000.00 GENERAL AGGREGATE 2,000.000.00 ❑ PRODUCTS - COMP /OP AGG 2,000.000.00 GEN'L V AGGREGATE LIMIT APPLIES PER: POLICY ❑ PROJECT ❑ 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 a�Ident) PROPERTY DAMAGE (Per accident) ❑ ❑ GARAGE U ABIU1 Y ❑ ANY AUTO • AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG ❑ EXCESS/UMBRELLA LIABILITY ❑ OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION $ EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' L1ABIL IY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below ❑ TORY LIMITS ❑ OR - E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION CITY OF MIAMI SHORES 10050 NE 2 AVE MIAMI SHORES, FL. 33138 FAX # 305 -402 -0123 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ©ACORD CORPORATION 1988