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RF-13-1418 Miami Shores Village \\� Building Department JUN 2 4 2093 _+ 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 ':�• Tel:(305)795.2204 Fax:(305)756.8972 l0 INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 20 LO BUILDING Permit No. PERMIT APPLICATION Master Permit No. C) 3 — 14 ) Ir Permit Type: BUILDING ROOFING JOB ADDRESS: i Los 1 A 6 ck 1 Tiff City: Miami Shores County: Miami Dade -zip: j Folio/Parcel#: 11° 3 a OS'm o d 1-0 12 f/ Is the Building Historically Designated:Yes NO W Flood Zone: OWNER:Name(Fee Simple Titleholder): � 1'CPfio e#: Address: IA16)A C11 ` -c race City:M�f-mt ,. We& State:' u Zip,330�& Tenant/Lessee Name: Phone#: I CONTRACTOR:Company Name: S ``4 �� y��®'�' �O Phone#: 1 Z Address: { S / �� 7 e City: '9 f State:�I Zip: Y Qualifier Name: (SP W,(l`( 'd'.A/l A 43 Z 1 4 Phone#: ®$ Z Z y 3 State Certification or Registration#: < < C;�:I-13 Z ly&013 Certificate of Competency#: Contact Phone#: !tkk Email Address: �w��-�d�,1 SrC��f►`�d�no,�1 o G�+av� DESIGNER:Architect/Engineer. Phone#: Yalu of Work for this Permit:$ Square/Linear Footage of Work: 6 0 Type of Work: OAddition 13Alteration ONew dRepair/Replace ODemolition Description of Work: We, 900-F IV 10 40 F COZOT tjZTw tlx: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ on Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ : S "Boling Company's Name(if applicable) Bonding Company's_Address City State zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Z zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature Signature Owner or Agent p Contractor The foregoing instrument was acknowledged before me this O u The foregoing instrument was acknowledged before me this day ofd,20 k—&-,by Y%1W1 � day ofd 20 ,by EA"A ZqanQbr1*_ , who is personally known to me or who has produced DrB W r5 who is personally known to me or who has produced DrlVels LJ CX n S<P, As identification and who did take an oath. Ll'Le t t5E= as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: - Print: MEReYPUEFffA .; .: t�Y COMMISSION EE 087881 M Commission Ex My comet m t EE OSM1 My Commission Expires: y EXPIRES F@bNBry 27,2015 vt EXPIRES:Febntery 27,2015 1; r? 6ora�lhru NotaAy Pt�C Urtdarxrr(tets 1gg `', eo�ed tteu tJotmy lkdisrw►keB geges$sIa:k���s$�$a�$a�*Rsiaag���Scag$eog�S�$a ag$agc�gs�A�asR/RI�sk^A sk�kikSa sksfisk:Rakk kkSa Ia�R�Ia�kkfisk��FSk��sksksk sffiIak skffiaIa��Ia���&RakF+ �k�k�s�:��Sa k#�a k�&sR��k APPROVED BY L'r/J�� Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07 110107)(Revised W10MM)(Revised 3/15/09) OWNER'S AFFIDAVIT OF EXEMPTION ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR EXISTING SITE- BUILT SINGLE FANIILY RESIDENTIAL STRUCTURES PURSUANT TO SECTION 553.844 F.S. To: Miami-Dade County Building&Neighborhood Compliance Department 11805 Coral Way, Suite 111 Miami,FL 33175 Re: Owner's Name Property Address l�� ��,� � �{ ,C£ 7 cm�GC�1\ �10�'CS Roofing Permit Number Dear Building Official: I �,`ry`b F y G@vAl e,r certify that I am not required to retrofit the roof to wall connections of my building because: The just valuation for the structure for purposes of ad valorem taxation in less than$300,000.00. UThe building was constructed in compliance with the provisions of the Florida Building Code (FBC) or with the provisions of the 1994 edition of the South Florida Building Code (1994 SFBC). Sign Lure of Property Owner l �� - Print Name STATE OF FLORIDA COUNTY OF MIAMI-DADE Sworn to and subscribed before me this ID y` t% day of TUY1� ,20-6 , (SEAL) ": MERCYFUBITA 0 �` '; AMY COMMISSION#EE 1 is �? EXPIRES:Febru q 27,2015 '•;;,oin"' BCndt�iMuNota�yPcu llndelvftitels Personally known or Produced Identification When the just valuation of the structure for purposes of ad valorem taxation is equal to or more than $300,000.00, and the building was not constructed in compliance with the FBC nor with!1994 SFBC, and affidavit of Roof to Wall Connection Hurricane Mitigation Retrofit must be provided. Miami-Dade My Home Page 1 of 2 ........... My Home jig- MIAMI-DADE Show Me: Property Information ,E , Legend Search By: Property Seed Item - Boundary Selected property 1® Text only { Property Appraiser Tax Estimator tr✓ Street Property Appraiser Tax 1 Highway Comparison Miami-Dade County E Portability S.O.N.Calculator Water Summary Details: N n s2©s-001-c1aC 65 NE 91 TER 1/ E RISTOPHER S CARVER MBERLY CARVER �65 NE 91 TERR MIAMI ORES FL 138-3403 Property Information- rimary Zone: 1100 SGL FAMILY- 01-2500 SQ 0001 RESIDENTIAL L�" - INGLE FAMILY s: loots: 1 Units: 1 Aerial Photography-2012 0 26 ft _jhviing F 293 It Size: 375 SQ FT ear Built: 954 53 42 WATERSEDGE My Home I Property Information Property Taxes 9-141 E35FT OF LOT My Neighborhood I Property Appraiser egal &W40FT OF LOT 21 LK 1 LOT SIZE 75.000 Home I Using Our Site I Phone Directory I Privacy I Disclaimer 125 OR 20740-0281 1 21 IMPORTANT NOTICE: The 2013 exemption and assessment values currently shown are preliminary and If you experience technical difficulties with the Property information application, are subject to change until they are certified or wish to send us your comments,questions or suggestions on July 1. please email us at Webmaster. Assessment Information: balue 2013 2012 Web S ite $171000 162,lue: $160,400 183,81 ®2002 Miar s reser County. e: $331,400 ,81 al rights reserved. : $317,497 12,1 Exemption Information- ear 2013 2012 c,nesreaa $25,000 $25,000 Hn nes-ea YES YES Taxable Value Information: Year: 2013 2012 �� Applied Taxing Authority: Exemption! Exemption/ Taxable Taxable Value: Value: Regional: $50,000! $50,000! $267,497 $262,190 nty. $50,0001 $50,000! $267,497 $262,190 $50,000/ $50.on http://gisims2.miamidade.gov/myhome/propmap.asp 6/17/2013 r t f Florida Building Code Edition 2007 High Velocity Hurricane Zone Uniform Permit Application Fo JUN 2C - Section A General Infor onl rtnit No, Rocess Na C ontr tpr's me / uC /o 1-7 0 LJV En o 5 ROOFCATEGOR v �01 w Slope ® Mechanically Fastened Tile Mr-M- ortarfAdheeive Set Tllo j0 E3*;phaWc ® Metal Parkel/Shingles ® Mood ShinglesP'3hakes o w ngles ® Prescriptive BUR-RAS 150 ROOF TYPE o v°Ro f ®"RReroofing ® Recovering ® Repair 0 Maintenance cc FSYSTEM c� o 1 0a Z 0 �INNFFORHATION Q N m U) U) // ope of Area(SF) 0/4' Steep Sloped Roof Area(Sf) _S�© ® Total(SF) 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,dearly iderift dimensions of elevated pressure zones and location of parapets. ;2 C e� w1 S Ten y Ind Fff8SCftOftOU9OOMMWMS%=ftGPPftW=d= FWCW fiat COO Seafim IRA fth-ve o*HWTINM Z�ae 3 d8 1 1 Ftorida Building Code Edition 201.0 High Velocity Hurricane Zone Uniform Permit Application Form Section D (Steep Sloped Roof SYstem) Roof System Manufacturer: kko V4,'V e, .-- L t.PdO.l.e,, 4c, Product Approval.Number: O q0 j. I Minimum Design Wind Pressures,R Applicable(From RAS 127 or Calculations): Maximum Design Pressure Ala Product Approval Specific System:_ "7 Method of Tile Attachment: Steep Sloped System Description Deck Type: OWoo4 Roof Slope: a Undedayment: Insulation Fire Barrier: Fastener Type&Spacing: Ridge Vend lion? t Q S ilQ((s /L``d c r e. Adhesive Type: Type Cap Sheet= // 120 r Roof Covering: " Mean Roof Height: � � 'Q� cyL Type&Size Drips Edge: 1,30 GDIV. Section E (Tile Calculations For Moment based the systems,choose eftber Method 1 or 2-Compare the values for M,vMh the values from Mg If the Alp values are greater than or equal to the Mr values,,for each aces of the roof,then the the attachment method is acceptable. Wthod 1"Moment Bayed Tile Calculaeo-rosy Per RAS 12T (Pr: ®". -1aig: -�r��R a Mrr 01 ! Product Approval ldf ((P,; �� x a 00 31 •6�)- 7� ®1y� . Product Approval D4 o,q rn,d-®®a x% = o q .1 -M&-1.0 o MC3 Pradnct Approval Mr 1 0. Method 2"Simplified Tile Cala lotions Per Table Below- Required Mornew of Resistance(Mrr)From Table Below i '0- Product Approval Mp i2.1_ Mr required Moment Resistance* Mom Root Hdght-w Roof er 1S' 20' 2S' 30' 40' 2-12 34A 35.5 38.2 39.7 422 3.12 322 34.4 35.0 37.4 39A 4:12 30.4 322 33.8 35.1 37.3 5:12 28A 30.1 31.6 32A 34.9, 6.12 25A 28.0 29.4 30.5 914 7.12 94.4 25.9 97.1 28.2 30.0 *Must be used in cw4uncton with a list of moment based file systems endorsed by the Broward County Board of Rules and Appeals. For Uplift based the systems use Method 3.Compared the*.mines for F with the valves forFr.If the F values are greater than or equal to the Fr values, for each area of the roof,then the the attachment mod is acceptable. Method 3"Mornent Based Tile Calculations Per RAs 127" (Pt: x L m x w:m )-W- x cos 6 =Frl Product Approval F (Pa: x L---X w:__�-R• x cos 6 =Fry Product Approval F (P3: x L = x w:_ )-W. x cos 6 =Fr3 Product Approval F 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 ASCH 7 Mean Roof 13ei 13 Job Site Roof Slope 8 Job Site Aerodynamic Multiplier a Product Approval Restoring Moment due to Product Approval Gravity Attachment Resistance Alf Product Approval Required Moment Resistance A Calculated MinimumAttachment F Product Approval Resistance Required Uplift Resistance Fr Calculated Average Tile Weight W Product Approval Tile Dimensions L� Product Approval calculations must be submitted to the building official at the time of permit application. mommmnw mm SemmmevidAL w SelHngalT-pum Irk FRoWCorMottk 7iY s� dooc FWrWa rode s ►1624 hHo"WOCRy Fka IMS Zones i MIAMI-DADE COUNTY PRODUCT CONTROL SECTION DEPAKrMEPrF OF PERWrnNG,ENVIRONMENT,AND REGULATORY AFFAIRS(PERA} 11805 SW 26 Baal,Rom 208 BOARD AND CODE ADMINISf RATWN DI[+i$ION ; Miami,Hari&33175-2474 T(786)315-2590 F(786)315-2M NOTICE OF ACCEPTANCE(NOA) Monier Litetile,LLC 200 Story Road Lake Wales,FL 33898 SCOPE: This NOA is being issued under the applicable rules and regulatiols governing the use of construction materials.The documentation submitted has been reviewed and accepted by Miami-Dade County PERA-Product Control Section to be used in Miami Bade County and other arms 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 area other than Miami Dade County)reserve the right to have this product or material tested for quality assurance purposes.If this product or materfai 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. FERA reserves the right to revoke this acceptance,if it is determined by Miami-Dade County Product Control Section that this product of 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, DE sCRIPTION:Saxony(Shake,Slate,Split Shake)Concrete Roof Tile LABELING: Each unit shall bear a permanent label with the manufacturer's now 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 appligation has been filed and them has been no change in the applicable building code negatively affecting the-jierf`ormarce of this product. TERMINATION of this NOA will occur aflser the expiration date of if there has been a revision or change in the materials,use,and/or manufacture of the product or proem.MIS=of this NOA as an elude oment of any pry for sales,advertising or any other purposes shall automatically to mina to this NOA.Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADvtRTwEmzNT: The NoA number preceded by the words Miami-Dade County,Florida,and fodlowod by the expiration daze may be displayed in advertising literature. If any portion of the NOA is displayed,then it shadI be done in its entirety. INSPECTION:A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This revises NOA#07-0710.05 and consists of pages 1 through 8. The submitted documentation was reviewed by Alex Tigera. NOA Noss II-g7V .10 1 'r Expiration Data IV16112 AWwal Data 12/01J11 Page 1 of 8 fa• :ilD c' ROOFING ASSEMBLY APPROVAL Category: Roofing Sub-Category: Flat Profile Roofing Tiles Material: Concrete 1. SCOPE This renews and revises a system using Monier Lifetile Saxony (Shake, Slate and Split Shake) Concrete Roof Tile, as manufactured Monier Lifetile LLC in Lake Wales, FL and described in Section 2 of this Notice of Acceptance. For locations ware the pressure requirements, as determined by applicable Building Code does not exceed the design pressure values obtained by calculations in compliance with RAS 127 using the values listed in section 4 herein. The attachment t calculations shall be done as a moment used system. 2. PRQDUCT DizSCRIPTION ., Manufactared by Test ; ;;- Product Amlicant Rb3 &wditatlons Monier Lifedle LLC 1= 16%x" TAS 112 "Flat,interlocking,high pressure extruded Saxony(Shake,Slate w=12=318° concrete roof tile equipped with two nail and Split Shake)Tile .6"thick holes. For direct deck or ba tuned nail-on, mortar or adhesive set applications. Trim Pieces 1=varies TAS 112 Accessory trim,cancrete roof piece for use W=varies at hips,ralces,ridges and valley terminations. varying thickness Manufactured for each file profile. 2.1 EvwwNCz SUBA+fIT rm.- Tat Ageas.,� T T Redland Technologies 7161.03 Static Uplift Testing Dec. 1991 Appendix III PA 102&PA 102(A) The Cerner for Applied 94-084 Static Uplift Testing May 1994 Engineering,Inc. PA 101(Mortar Set) The Center for Applied 94.060A Static Uplift Testing March, 1994 Engineering,Inc. ,PA 101(Adhesive Set) The Center for Applied 25.7183-6 r _.:s.Static Uplift Testing Feb. 1995 Engineering,Inc. PA 102 '(2 Quik Drive Screws,Direct Dock) The Center for Applied 25-7183-5 Static Uplift Testing Feb. 1995 Engineering,Inc. PA 102 (2 Qulk-Drive Screws,Battens) NOA No.: 11-M.10 B Date:W102 Appmal Date:121©1/11 Pam 2 of 8 The Center for Applied 25-7214-1 Static Uplift Testing March, 1 995 Engineering,Inc. PA 102 (I Quik Drive Screw,Direct Deck) The Center for Applied 25-7214-5 Static Uplift Testing March, 1995 necr>ng,Inc. PA 102 (1 Quik wive Screw,Battens) Rediand Technologies 7161-03 Wind Tunnel Testing Dec. 1991 Appendix II PA 108(Nail-On) Redland Technologies Letter Dated Aug. 1, 1994 Wind Tunnel Testing Aug. 1994 PA 108(Nail-On) Redland Technologies P063 t-01 , Wind Tunnel Testing July 1994 PA 108(Mortar Set) Redland Technologies P0402 Withdrawal Resistance Testing Sept. 1993 of screw vs.smooth shank nails The Center for Applied Project No.307025 Wind Driven Rain Oct. 1994 Engineering,Inc. Test OMDC-77 PA 100 Celotex Corporation Testing 520109-1 static Uplift Testing Dec. 1998 Service 520111-4 PA 101 Celotex Corporation Testing 520191-1 Static Uplift Testing March 1999 Service -PA 101 Walker Engineering,Inc. Calculations Aerodynamic Multiplier June 2007 Walker Engineering,Inc. Evaluation Calculations 254094 February 1996 Walker Engineering,Inc. Evaluation Calculations 25-74% April 1996 Walker Engineering,Inc. Evaluation Calculations 25-7584 December 25-7804b-8 1996 257804.4&5 25-7848-6 Walker Engineering,In. Evaluation Calculations 25-7183 March 1995 Walker Engineering,Inc. Calculations Two Patty Adhesive Set System April 1999 Walker Engineering,Inc. Calculations Restoring Moment Due to June 2007 Gravity Nutting Engineering 129 TAS-112 Jan.2007 NOA No.;11- 07,10 Rspi7atias lfste;1Z &12 j' Approval Date:12101/11 13of8 i 3. LIIMrcAnoivs 3.1 Fire classification is not part of this acceptance. 3.2 For mortar or adhesive set file applications, a static-field uplift test shall be performed In accordance with TAS 106. 3.3 Applicant shall retain the services of a Miami-Dade County Certified Laboratory to perform quarterly test in accordance with TAS 112,appendix 'A ,Such testing shall be submitted to the Building Code Compliance Office for review. 3.4 Minimum underlayment shall be in compliance with the applicable Roofing Applications Standards listed section 4.1 herein. 3.5 30/90 hot mopped underlayment applications may be installed perpendicular to the roof slope unless stated otherwise by the underlayment material manufacturers published literature. 3.6 This acceptance is for wood deck applications. Minimum deck requirements shall be in compliance with applicable building code. 4. INSTALLATION 4.1 Monier Lifetile Saxony (Shake, Slate and Split Shake) Concrete Roof Tile and its components shall be installed in strict compliance with Roofing Application Standard RAS 118,RAS 119,and RAS 120, 4.2 Data For Attachment Calculations Table 1: Average Weight(W)and Dimensions(l x w) Tile Profile Weight-W(lbf)• L ongtMd(ft) Width-w(M •i 'it: • Monier Llfetile Samw(Shake, 11.8 1.375 1.02 sand St*e)Tile Table 2: apMftnam1c Matti lers-A Tile A,( Profs Batten Aftlication Direct Deck lcadan Monl�L8e#8e,Saxony(Shake;Sete and Sit 0.185 0.200 Shake)THe Table 3: RqqWringl Moments due to Gray - T5e 2":12" rAr rAr 5":12" 6":12" 7"Ar or Profile 9 rear Morder Battens Direct Beam Dlrect Saftm Dked Battens Olred Beltens Oft Baftem Direct Li btb Deck Deck Deck Deck Deck Dot qty 6.63 7.14 6.66--TO-7 6.47 8.97 6.34 6.83 6.18 6.66 8.02 6.48 (Slake. Slate and . Shake) Tile NOA ft:114W7.10 Eqdradm Daft 12116/12 Approval Data:12/81111 PaV408 Table 4: Attachment Resiitstance Expressed as a Moment-Mr(ft4b f) for Nall-on S Tile Fastener TYPO Direct Deck Direct Deck battens Profile (min 18!32" ply d) (min. 1913r plywood) Monier Liffetile 2-10d ft Shank Nails 30.9 38.1 17.2 Saxony(Shake, 140d Smooth or Stxahuv 7.3• 9.8 4. Slate and SSE Shams Neel Shake)THe 2-10d Smooth or Screw 14.0 18.8 7.4 Shank Nails 1#8 StxOw 30 30.8 18.2 2 as$ew 81.7 51.7 24.4 1-10d Smooth or Screw 24.3 24.3 24.2 Sheer Nall OR) 140d Sfiuxofh or Screw 19.0 19.0 22.1 Shank i CI 2-10d Smooth or 35.5 35.5 34.8 Shank ieW C 2-10d or Screw 31.9 31.9 32.2 Shank Nab Mm C Table 5: Attachment Resistance Exp am a ant Mr(ft-lb f) for Two Patty Adhesive-Set Tile Prey Tile Application MMinmum Attachment Resistance Monier Sa-,y(Shake.$We and So Shealce} 31, Toe 9 S66 m for F P CwWany vera$e weW per pefty 13.8 grams. Table 8: Attachment Remistance Expressed as a Moment-Mt(ft4bQ for$in e Paft f Adhesive Set Systems Toe Profile TIME Application ?Mnhnum Attachment Resistance Monte Lifetile Saxony(Shake,SWe amt 118. Shame)TOO P ror" 40.4 3 of 45 lu of 24 9WW of Etftlu. Table 7:Attachment Resistance Expressed as a Moment-Mf(ft-" for Mortar or Adhesive Set§121" Tile Tile Attachment Profile on Resistance Monter � e The y( 'Slate and Sit 43.9 6 THO-Tite Roof TM Mortar. NOA No.:114W7.10 a Daw.i2lt8/12 T. AppwW Date.-12NI 1 .: Page S of 8 5. LABELING All tiles shall bear the imprint or identifiable marking of the manufacturers name or logo,or following statement,"Miami Dade County Product Control Approved". BO I FET I LE M4NU) =LLC,sI�rm4ru aA"W"n) LAWA"M UW*WM=T" 6. Bu;LDM P=wr RzQu=mFArrs 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 property evaluate the installation of this system. i NOA No.:11. 7.18 ® , DOW 12/16/12 Appmwal Date.12A1111 Page 6 of 8 5. PROFILE MAWINGS PIML lam® 1 Me"(o# 17 OWRLAY 12 3Ar WATERLOOK MomzRLtrimLz SAxoNy CoNcRzn Wey Tas(SLATz Mom) R r. NOA No.:114M.10 EMbaden D&W 121102 Approval DOw 12A1/11 Pup 7ofS MON1ERLWMLE SAXONY C04CRM ROOF TILE(SPLIT SHAKE MODEL) -> •o�.�.: �'-``•-'``'*ate r Nj MONRRLUWM& SAXONY C wfCRETm ROOF T/s(SHAKE MODEL) END OF THIS ACCKPTANCR y c y NOA No.:11-M.14) Dac M&12 Ali Deft 1=1/11 Iaa$oi8 HIAH Now MIAMI-DADS COUNTY PRODUCT CONTROL SECTION DEPARTMENT OF PERMITTING,ENVIRONMENT,AND REGULATORY AFFAIRS(PERA) 11805 SW 26 Street,Room 208 BOARD AND CODE ADMINISTRATION DIVISION Miami,Florida 33175-2474 T(786)315-2590 F(786)315-2599 NOTICE OF ACCEPTANCE (N" www.miamidade.gov/sera 3M Company +� 3M Center Building 0220-05-E-06 St.Paul,MN.55144-1000 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 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:3MTM 2-Component Foam Roof Tile Adhesive AH-160 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 and revises NOA# 11-0 124.04 and consists of pages 1 through 7. The submitted documentation was reviewed by Alex Tigera. NOA No.:12-0228.18 Expiration Date:05/10/17 Approval Date:05/10/12 Page 1 of 7 I ROOFING COMPONENT APPROVAL: Category: Roofing Sub Category: Roof file adhesive Materials: Polyurethane SCOPE: This approves 3MTM 2-Component Foam Roof Tile Adhesive AH-160 as manufactured by 3M Company 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 2-Component Foam Roof Tile Adhesive 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 3MTM 2-Component Foam N/A TAS 101 Two component polyurethane foam adhesive Roof Tile Adhesive AH- 160 Foam Dispenser RTF 1000 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 2-Component Foam Roof Tile Adhesive AH-160 roof tile adhesive. MANUFACTURING LOCATION: 1. Tomball,TX. PHYSICAL PROPERTIES: Prove Test Results Density ASTM D 1622 1.6 lbs./ft.3 Compressive Strength ASTM D 1621 18 PSI Parallel to rise 12 PSI Perpendicular to rise Tensile Strength ASTM D 1623 28 PSI Parallel to rise Water Absorption ASTM D 2127 0.08 Lbs./Fe Moisture Vapor Transmission ASTM E 96 3.1 Perm/Inch Dimensional Stability ASTM D 2126 +0.07%Volume Change @ 40'F.,2 weeks +6.0%Volume Change @158°F., 100%Humidity,2 weeks Closed Cell Content ASTM D 2856 86% NOA No.:12-0228.18 Expiration Date:05/10/17 Approval Date:05/10/12 Page 2 of 7 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. EVIDENCE SUBMITTED: Test Aaencv Test Identifier Test Name/Revort Date Center for Applied Engineering #94-060 TAS 101 04/08/94 257818-IPA TAS 101 12/16/96 25-7438-3 SSTD 11-93 10/25/95 25-7438-4 25-7438-7 SSTD 11-93 11/02/95 25-7492 SSTD 11-93 12/12/95 Miles Laboratories NB-589-631 ASTM D 1623 02/01/94 Polymers Division Ramtech Laboratories,Inc. 9637-92 ASTM E 108 04/30/93 Southwest Research Institute 01-6743-011 ASTM E 108 11/16/94 01-6739-062b[1] ASTM E 84 01/16/95 Trinity Engineering 7050.02.96-1 TAS 114 03/14/96 Celotex Corp.Testing Services 528454-2-1 TAS 101 10/23/98 528454-9-1 528454-10-1 520109-1 TAS 101 12/28/98 520109-2 520109-3 520109-6 520109-7 520191-1 TAS 101 03/02/99 520109-2-1 LIMITATIONS: 1. Fire classification is not part of this acceptance.Refer to the Prepared Roof Tile Assembly for fire rating. 2. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 shall solely be used with flat,low,&high file 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 3MTM 2-Component Foam Roof Tile Adhesive AH- 160 roof file 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 rile assemblies shall test in accordance with TAS 101 with section 10.4 as modified herein. —1 F ! - W FV=' ---- MS NOA No.: 12-0228.18 Expiration Date:05/10/17 Approval Date:05/10/12 Page 3 of 7 INSTALLATION: 1. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 may be used with any roof file assembly having a current NOA that lists uplift resistance values with the use of 3MTM 2-Component Foam Roof Tile Adhesive AH-160. 2. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 shall be applied in compliance with the Component Application section and the corresponding Placement Details noted herein. The roof tile assembly's adhesive attachment with the use of 3Mrm 2-Component Foam Roof Tile Adhesive AH-160 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. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 and its components shall be installed in accordance with Roofing Application Standard RAS 120,and 3M Company's 3MTM 2-Component Foam Roof Tile Adhesive AH- 160 Operating Instruction and Maintenance Booklet. 4. Installation must be by a Factory Trained'Qualified Applicator'approved and licensed by 3M Company. 3M Company shall supply a list of approved applicators to the authority having jurisdiction. 5. Calibration of the Foam Dispenser RTF 1000 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 file as determined at calibration. No other settings shall be approved. 6. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 shall be applied with Foam Dispenser RTF1000 or ProPack®30& 100 dispensing equipment only. 7. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 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 3MTM 2- Component Foam Roof Tile Adhesive AH-160 has been dispensed. 9. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 placement and minimum patty weight shall be in accordance with the'Placement Details'herein. Each generic file profile requires the specific placement noted herein. Table 1:Adhesive Placement For Each Generic Tile Profile Tile Profile Placement Detail Single Paddy Weight Two Paddy Weight per Min.(grams) paddy Min.(grams) Flat,Low,High Profiles #1 35 N/A High Profile 2 Piece Barrel #1 17/side on cap and 34/ an N/A Flat,Low,High Profiles #2 24 N/A Flat,Low,High Profiles #3 8 NOA No.:12-0228.18 Expiration Date:05/10/17 Approval Date:05/10/12 Page 4 of 7 LABELING: All 3MTM 2-Component Foam Roof Tile Adhesive AH-160 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. ADHESIVE PLACEMENT DETAIL 1 SINGLE PATTY tia0 through PMC cement w bato 089fic coot PaQd}Menem Th) unde�iayment ut 1 1 10(n. 2 Ears Comae Fade EweCom Faeda NO* Ewve=meo*: EevemosaWr. Eavedan Ew Oman P W � �e w � NaHftmh P cmnent radar tae 6077) 1)Place et o*edhedve to afto 1T to 29 sfor tia0through Un a egmne hwU 1n cmdactwhb ft pan ce 8 MM To 1 toe. 1121n Then insw the ft o "flew" 10 tn. o 2 ht - o Em Cow w i Eave Clue ROM �� a�r=4U up Fawk t af0resava cmase cow�e Al dtose�nd of opeonal p anwWW a�erdof P 1 t Meteaveprte. Eave dome Wen*Onfe Feada ) NOA No.: 12-0228.18 Expiration Date:05/10/17 Approval Date:05/10/12 Page 5 of 7 ADHESIVE PLACEMENT DETAIL 2 SINGLE PATTY Nall*m*pbsk—mnW Pa*@wo Tb) Mail thrMh plMe mnoM unftuymw uwwwffmt 71n. i In. 4 7 Inm 2 hL E&"C=u Fascia Fascia % We** EmCcum Eaveclosin EmCloswe drip e* Nall through Ouft Mmd Pa*RKMA'hl 7 In EmClmue Eave Cwm Fascia NOA No.: 12-0228.18 Expiration Date:05/10117 Approval Date:05/10/12 Page 6 of 7 ADHESIVE PLACEMENT DETAIL 3 DOUBLE PATTY Nall through plastic cement pay WI through plastic cement Single paddy tmdwtffe (bellften die) Underlaymadd Single paddy between the paddY 2 In.x I In.medium 0 (underlie) size paddy save cmu only 0 40,FI-1 n'x 3 In Single dy 3 In un die x 3 in. single 4 In. 21n. Single Paddy on 2 in. 4 in. on under- paddy layment under- Sho paddy Fascle lave course on top of the WeephOle Single paddy 2 In.X 7 tn.medium Em Eave closure on top of tile she paddy save Counts Do edge Feecle course only Nab through plastic cement Single paft under tile Single paddy between 11119 01�In.x 3 in. 4 In. Single paddy onunderlayment 2 n. Single paddy Em Clem on top of tile In.x 7 In.medium muse only Em CaCain F ascla on END OF THIS ACCEPTANCE NOA No.: 12-0228.18 Expiration Date:05/10/17 Approval Date:05110/12 Page 7 of 7 Owner's Notification Form HVHZ 2010 MIAMI • -Deavering Excellence Every pay" SECTION 1524 HIGH VELOCITY HURRICANE ZONES—REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS 1524.1 Scope. As it pertains to this section, it is the responsibility of the roofing contractor to provide the owner with the required roofing permit, and to explain to the owner the content of this section. The provisions of Chapter 15 of the Florida Building Code,Building govern the minimum requirements and standards of the industry for roofing system installations. Additionally, the following items should be addressed as part of the agreement between the owner and the contractor. The owner's initial in the designated space indicates that the item has been explained. 1. Aesthetics-workmanship: The workmanship provisions of Chapter 15 (High Velocity Hurricane Zone) are for the purpose of providing that the roofing system meets the wind resistance and water intrusion performance standards. Aesthetics (appearance) are not a consideration with respect to workmanship provisions. Aesthetic issues such as color or architectural appearance,that are not part of a zoning code, should be addressed as part of the agreement between the owner and the contractor. 2.Renailing wood decks: When replacing roofing,the existing wood roof deck may have to be renailed in accordance with the current provisions of Chapter 16(High Velocity Hurricane Zones)of the Florida Building Code. (The roof deck is usually concealed prior to removing the existing roof system). 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 work to be performed. 4. Exposed ceilings: Exposed, open beam ceilings are where the underside of the roof decking can be viewed from below. The owner may wish to maintain the architectural appearance;therefore,roofing nail penetrations of the underside of the decking may not be acceptable. The owner provides the option of maintaining this appearance. 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. Ponding can be an indication of structural distress and may require the review of a professional structural engineer. Ponding may shorten the life expectancy and performance of the new roofing system. Ponding conditions may not be evident until the original roofing system is removed. Ponding conditions should be corrected. 6. Overflow scuppers(wall outlets): It is required that rainwater flow off so that the roof is not overloaded from a build up of water. Perimeter/edge walls or other roof extensions may block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accordance with the requirements of. Chapter 15 and 16 herein and the Florida Building Code,Plumbing. 7.Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of the structural assembly(the building itself). The existing amount of attic ventilation shall not be reduced. Exception: Attic spaces, designed by a Florida-licensed engineer or registered architect to eliminate the attic venting,venting shall pol be required. :Owner's/Agent's Signature: Date: Contractor's Signature: Permit Number: - Property Address: ® �� NOTICE OF COMMENCEMENT 1111111111111111111111 1 111 111 1111 1 A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION C-FN 20 13RO X 12566 OR Bk 2°699 Ps 39261; tips: PERMIT NO. � TAX FOLIO N0.� 9 `'� RECORDED 06/27/2013 12°31:42 HARVEY RUVIRP CLERK OF COURT STATE OF FLORIDA: IIIAMI-DAD FLORIDA COUNTY OF MIAMI-DADE: STATE OF FLORIDA,COUNT OF t AIDE LAST PA *NO Mjr CO211 r HEREBY CERTIFY that this 1s 8 bua c py of the rQ THE UNDERSIGNED hereby gives notice that improvemeniNvAll 2 day of' t8 _ property,and in accordance with Chapter 713,Florida Sta at is provided in this Notice of Commencement. HARVEY RUVIN, L ERK,of ' Coif*Couft � E By D.C. 1. Legal description of property and street/address: �A AS lA� 2. Description of improvement: r e QC <C� 3. Owner(s)name and address: CkX4 S° f �o Cfly✓ -e ' I i' Imo,lrvGr Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address: � �- 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: Al 4-- Amount of bond $ 6. Lender's name and address: 7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: 8. In addition to himself, Owners designates the following person(s)to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. ,� Name and address: f 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) C��ra Sign ture of Owner Print Owner's Name \m c LA �e Prepared by Sworn to and subscribed before me this day of , 201S . Address:31 �J A1(.=./ d 87e' Notary Public. .t?PIA, Print Notary's Name Wi r My commission expires: g PUM 123A1-62 PAGE 4 blOB i=�. my r A #ffj IXPIREg 8o�d7�u �by27,2015 t Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 nspection Number: INSP-197240 Permit Number: RF-6-13-1418 Inspection Date: August 14,2013 Permit Type: Roof Inspector: Rodriguez,Jorge Inspection Type: Final Roof Owner: CARVER,CHRISTOPHER AND Work Classification: Tile "Wco' v Job Address:1165 NE 91 Terrace Miami Shores, FL 33138- Phone Number Parcel Number 1132050010180 Project <NONE> Contractor: SK CONSTRUCTION COMPANY Phone: (305)485-8802 Building Department Comments RE-ROOF TILE Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSPA94111. Provide renailing affidavit Failed El Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 August 14,2013 Page 1 of 1 AFFIDAVIT OF COMPLIANCE WITH ROOF DECIING ATTACHMENT AND SECONDARY WATER BARRIER HURRICANE MITIGATION RETROFIT FOR EXISTING SITE-BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PURSUANT TO SECTION 553.844 F.S. To: Miami-Dade County Building Official 11805 Coral Way, Suite 11 I Miami, FL 33175 Re: Owner's Name Property Address `�e,r-MQg_ Roofing Permit Number -- Dear Building Official: I & W 10 3A A-S kt P- certify that the roof decking attachment and fasteners have been strengthened and corrected and a secondary water barrier has been provided as required by the "Manual of Hurricane Mitigation Retrofits for Existing Site-Built Single Family Structures" adopted by the Florida Building Commission by Rule 9B-3.047 F.A.C. Qualifying Agent Signatur�jof Qualifying Agent Print Name I' STATE OF FLORIDA COUNTY OF MIAMI-DARE Sworn to and subscribed before me this 4;2 4k day of J-U V1 e- ,201 , (SEAL) MERCYPMUA MY COMMISSION HE 067861 i�' EXPIRES:Fe 27 2015 Personalll Bonded Thru►cry P tic undwfl rs V or Pro( CIVI L Reileh Engineering Corp. (Consulting Esneer} 2370S. Avenue Miami,Florida 33175-1174 Tel:305-823-8008!305-397-6414 ENGINEER F=305-823-3300/305-8848834 Website:www.reilehengineering.com August 7, 2013 S and K Contracting Miami, Florida Project: ROOF TILE UPLIFT TEST REPORT Residential Home 1165 Northeast 91 Terrace Miami Shores, Florida Information provided by client: Permit Number: Not Provided r3 — 1411107 Date Completion: August 5, 2013 Roofing Contractor: S and K Contracting Project Number: 13-0593 (Testing Laboratory Certificate# 11-0715.04) Dear Sirs; In accordance with your request and authorization,a representative of Reileh Engineering Corporation completed the Roof Tile Uplifi Pest at the above referenced project. This testing was 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 ofthe tested roof surface area was less than 10000 square feet,and the mean height ofthe roof is less than 40 feet above ground surface. The type oftile used for this project was reported to be Flat Concrete Roof Tile. This tile was reported to have been foamed in place. At the time of our inspection,the entire area of the 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. Based on our test results,we conclude that the installation ofthe roof tile at the above,referencedproject meets the test requirement outlined in the above-mentioned protocol. Attached please find a copy of our test report for your review. 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 IMohamad Sonny Salleh, P.E.49014 Project?Manager TILE UPLIFT TEST Residential Home 1165 Northeast 91 Terrace Miami Shores,Florida Reilch Engineering Corporation--Project Number-13-0593—Page 2 of 6 Report of TILE UPLIFT TEST for Residential Home 1165 Northeast 91 Terrace Miami Shores Florida Project Number: 13-0593 Test Number Test Load (Ibf Test Status 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 Reileh Engineering Corporation--Project Number-13-0593—Page 3 of 6 Test Number Test,Load b Test Stag; ` 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-13-0593—Page 4 of 6 Test Number Test Load (lb 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 Rcileh Engineering Corporation--Project Number-13-0593—Page 5 of 6 Test Number Test Load (Ibf) Test Status. 80 35 Pass 81 35 Pass 82 35 Pass .83 35 Pass 84 35 Pass 85 35 Pass 86 35 Pass Test 1-12 Corner, 13-23 Ridge Caps, 24-44 Perimeter, 45-86 Field Reileh Engineering Corporation--Project Number-13-0593—Page 6 of 6 9 21 8 10 28 7 79 77 ` 7a ' 0 + 29 50 49 52 76 26 50 51 47 4a 74 81 25 75 24 71 82 72 42 50 69 41 70' 70 82 46 45 44 k5 6 ig 5 IZ 84 I 67 40 >1106 68 85 54 66 55 57 'A 4 0 6 64 I ry} 95 9b 37 3 Z 70' noN1 sR - 1100 5F O Wa W 95r LOCA110N FEW a 42 COINM - 80 5F COM 2 {'Lt;IWSk n 5 ANC ,a= 5' L n N0TE5 005 IU �In�CAp a I I COM AAA- V X 5' AMOX,WOO t51'LOCA110N5 ANP nUvlMION5 From:Ingrid.Herrera Fax:+1 (306)601-4764'208 To: Fax: +1(306)766-6972 Page 2 of 2 6/27/201310:21 ac R CERTIFICATE OF LIABILITY °A�1���^ ��- ITY INSURANCE 06272013 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 ALL CITY INSURANCE INC-ACI CONTACT JAVIER GUTIERREZ EA*275 FONTAINEBLEAU BLVD. PHONE (305)463-9431 1FAX EMAI L (305)436-6797 SUITE 190 JGUTIERREZ@ALLCITYINS.COM MIAMI FL 33172 PRODUCER ins'201467 INSURED INSURER(S)AFFORDING COVERAGE NAIC I S:K QUALITY CONTRACTOR,INC. .MID-CONTINENT CASUALTY CO ,TRAVELERS INDEMNITY COMPA DBA SK CONSTRUCTION COMPANY 15441 S.W.49TH STREET INSURERC: Miami FL 33185- INS INSURER : COVERAGES CERTIFICATE NUMBER:16 REVISION NUMBER:2 THIS IS TO CERTIFYTHAT 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS TYPE OF INSURANCE DDL SUEIR POLICY EFF POUCY EXP LIMITS IMMIDDAnnM A GENERAL LIABILITY 04GL864215 2/07/2012 12/072013 EACH OCCURRENCE 1,000,000 X COMMERCIAL GENERA�UABILITY DAMAGE TO RENTED 100,000 X CLAIMSMADE U OCCUR EXCLUDED MEDEXP An one Person) PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-OOMP/OP AGG $ 1,000,000 X POLICY X PRO LOC B AuroMOBILELIABILITY BA-7417M957-12 10103f2012 101032013 COMBINED SINGLE LIMIT $ 500,000 X ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY(Per person) $ SCHEDULED AUTOS BODILY INJURY(Par accident) $ HIRED AUTOS PROPERTY DAMAGE $ (Per accident) NON-OWNED AUTOS $ UMIBRELLALIAB OCCUR EACH OCCURRENCE IXCESS LIAB CLAIMS.MADE AGGREGATE DEDUCTIBLE I RETENTION 1t WORKERS COMPENSATION WCSTATU- OTH AND EMPLOYERS'LIABILIT( I Llld ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH AC DENT OFFICER/MEMBER EXCLUDED? N f A IMandatory inun E.L.DISEASE-EA EMPLOYEE $ DOCRIPTION OF OP If yes,descnbe under E.L.DISEASE-POLICY LIMIT $ I— IT DESCRIPI1oN OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Addrdonal Remarks SchedNe,If more space Is requ9red) GENERAL CONTRACTOR CERTIFICATE HOLDER CANCELLATION Al COMMWJ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF MIAMI SHORES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING&ZONING DEPT. ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE MIAMI SHORES FL 33138- AUTHORIZED REPRESENTATIVE • 1 O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Jun 27 2013 10: 40 HP LRSERJET FRSK Construt 3053880752 page 1 STATE(W FLORIDA DBPARTRRNT OF RUSSNSSS AND VR0FZSSIOy&L RXGULAT1t3N TREFCTION INDUSTRY LICENSING.soARD (S S 0) 407-139S 1 0 NOR= MONROE STR>8NT 'IALLeAHA93E8 FL 32399-0783 S C4N8 `RIIt`TIN D 5 � 49TH ST DtA� FL 33185-4435 :. l t With this lfceme you becorns of*0 naarW one mean A06 %rldtne 1tCetged by tre 09iomtrnant ct Strom"and Professional Regu�ion. s DSFAR' OF 3=2=89.JAM our ,,,;d r,era, eta yam ergs.frcf► $ F �sszo TZON boxes to y eep Fkda1s economy atrong. Every day we work hz imprOM t1s3 c =01326608. Dt /3I�110 108057590 �►ay we do buetnss9 in order!o serve you better.# Fo 0an abvtrt out aaAoea,plsege[og r3�o ww�w. ,+�+e. } - . There you cam.and am"�obout ow dtvkiivns 4`E8'PIP'I79 8 G C!C CTOR Vod Ym+-se ibwer LQ daparirtcent r►ev�ratetters eaat fawn mom Ehe� ttsat � B UUAMIA �� 0�'e�r�t+rree. Our maesion at the ospartmient ls,t,tcense r� # constantly strive to save y Fairly. We you tester sa that y6j Zq setae our a ornsrs, 1 ttaNc you for doing busn8 in Florida. w�r�ui is on yin new#censei ZS. CX=Irsm mar tar-vsws"em ea cn.499 vs =W12m1r4a*4•w. Am 32. 3012 X400e31030S6 DETACH HERE STATE OF FLfllUM 13RPA>it g � TR;Iffm aSMATION .. $EQ#L10083303086 08 33, 20 t1 OS 7590. .. C 1 R86tiA .- Tho ROOFING•LwrMCTOR Named below tS czRTt>s'I&D Under the provieiane of ter. 49* 'F8y Expiration dates AVG 310 20 12 K Come CO 5441. S@y 4M- T C0�8ANX. NXAM FL 33185••4438 MAIMIX AS REQUIRED BYLAW SS CITA$Y� Jun 27 2013 10: 40 HP LASERJET FRSK Construt 3053880752 page 2 STATE OF FLOMDA I7>gPA OF BUSIMBS AND PROFX8-S20NAL RS`t =TZ(W �3'RVCT7COIaT INDIIST&Y ICMS3NG4 HOARD (850) 487-1395 �5 N t?MMM ST�3 399-0783 COHS+* ' rjAAH'r S441 ft BY 49AT MXAM FL 33185-$435 CmvmftbOOrW N►lih Oft yam„ cite of#*ntrariy ons rr�tlan aura 0r<r,,oer+► AC# ��,4 FWiftm 4cumod byte trses•Ot&,WAS a.9M AM ea RMA&*m. � Or. AIM Q �a attd b>alna ra lfrorre a yht ,,from p�F�SItNtAL TI010 bwbagm rastsumnts,suet ►Iasep Flailtta's saaNmw strong, CWL514702 040,C1O/3-0'A 108057S90 CIO= 7590 ol Its mmoomme4w ! 1iC eo�T oft Our td=Wn st flee DsParbrAft W Lkwm Egklw ,,Regtdit Fairly.We fat 1 da am c�"M Yo W cumomem your„w kevuw odmv arcs Vovs sa W os @,.480 to daps AM-31; 203.3' U000t104061 DETACH HERE AC# . .. STATE OR FLORA __._--__ _..� _..._ .._... _.... AR Tats . r i SFWL:0083:.o406X 0@ 3 R41 08 5 10 2 . The Named :bad IS T*F`t&D ' •Under bM prey iai,s v rpir&t:'*n dates AM 3i r 20 3°r' 459 FBA ffi i t BANAM** i 1S SiBi 4T g AN]t t YL 33185-4435 i 4 S CRIBT C3�� Ig LINK ' DISPLAY'AS REQUIRED BY LAW Y, RW4%M 1,AR 1 III,_ m 6A46 6i_i2 O`t1 , AS o.owrPAY Room t AT :. I �i721° 9 ie �'UK corm S K CSTWXTIN cMAr IUILDZNG CoNnt TOR 1 E11/S S K CONSTRUCTION COWAW EMIN E SANABRIA FREE 15+ 41 SW 44 ST MINI FL 331Bg wo 69/10/2012 64616+651661 661015.66 SEE Ong WE hills offli lo,1a,,1,#t,„ }t�,1