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PF-13-1560
HUQ,DA7C Miami Shores Village Building Department 90050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 PERMIT APPLICATION JUL 1 2 Y.- ---------- FSC -000_000 FSC 2O tO l Permit No.�/ v, -`d \malty Master Permit No. Permit Type: BUILDING ROOFING JOB ADDRESS: o6 )Ll , • / 0 -0 Jr City: Miami Shores County: Nami Dade zip: S's Folio/Parcel#: Is the Building Historically Designated: Yes NO V Flood Zone: OWNER: Name (Fee Simple Titleholder): rAaee5 & - Phone#: ��'.s -�/Z - ��ds� Address City: J �state: lli�. Zip: Tenant&zssee Name: /fi Phone#: Email: CONTRACTOR: Company Name: 4f M �� ��,✓ �iz��,v ��'��one#: _.s�,� ®St'S Address: �� A/ City: State: Zi P� Qualifier Name:0Phone#: State Certification or Registration #: CLQ 05r % 9- 9 q Certificate of Competency #: Contact Phone#: -39 17- 5-/ 9 <Email Address:���C DESIGNER: Architect/Engineer: v/ - Value of Work for this Permit: $ S C% l%�C� SquareUnear Foo a of Work: , � O b Type of Work: DAddition OAlteration ONew air/Replace Memolition Description of Work: 0 Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 2G13 64-3 Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address A)//v A Zip City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose prop is sf Wect to4,flzccurs hment. Also, a certified copy of the recorded no ce commencement must be posted at the job site for the firs i ec 'o seven (7) days after the building permit i issu d. In the absence of such posted notice, the inspection i no pprand a reinspection fee will be charged. wner%,�r Agent The foregoing instrument as acknowledged before Te this 0 Z day of, 20 by �iAQCoS1m7 G. t who is personally known to me or who has produced As identification and who did take an oath. Contractor The foregoing inst u ent was acknowledged before me this day of J 20(3 , byZQ an o is personall kno me or who has produced as identification and who did take an oath, NOTARY PUBLIC: NOTARY PUBLIC: ARM ra Sign: Sign: Print: 1 f – M (C ki 9,(— Ci44rV 442ZC63 Print: F \N My Commission Expires: /1401/°° � DANIEL MICHAEL CHAN PARE L•g mission Expires: . Notary Public - State of Florida a.. �.. 9+ _OP: My Comm. Expires Nov 26, 2016 APPROVED BY Plans Examiner Structural Review (Revised 3/12I2012)(Revised 07/1 QM7)(Revised 06/10r2009)(ReAW 3/15/09) Zoning Clerk NOTICE OF COMMENC EWNT A RECORDED CC" WILIST BE POSTED ON THE jos Sin At TW OTT VWMM PERMIT NO TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADS: STATE OF FLAN I HEREBY CERTIFY THE UNDERSIGNEb made Red in mig ' hereby ffives cdft to Jhj0vv*h&ft WM be made tom few property; and In acCordance with Chapter 713, Florida Statutes, the *0 — gffR, on Is provided In this Notloe of Commencement, WIT 'n HARVEY RLIVIN, 0 CFN 2013RO626354 OR Dk 28764 Ps 18931 Qps) RECORDED 08/08/2013 16'-04.17 HARVL, RUVINP CLERK OF COURT MIAMI-DADE COUNTYP FLORIDA LAST PAGE COUNTY OF DADE Ong aga— ;.0.20-44 W Official sea( Raaf Chi* aid-CWrdy Couft SP8090m reserved for ooq�e of recording aftntme 3. OWngr(a) name and address:.. ed, Inter" in property. Narne and address of fee $jMpfa tWeholder 4- GorltrlwtO _!8 rTTle, 04*860.and phone number, 5- ,..(Payment bond required by Ownarfrom contractor, If any) Name addressand phone num Amount of bond $ 6 Lender's name' and address: 7. Per!orw within the State of nipdcla'designated by Owner upon whom notices or other documents Sectigh 7'1'3.'I*3*(lXa be served as'provided FloridaFlorlda Stiju as, may ad by Name' , gihldrsss phone number S. In idd%ft-to htiitiself, Oiiiiriers designates the follOwIng person(a) to receive a copy of the I.JeWs Notice as provided In Section 713.1 21(li(b), Florida 6-ames. Namb;-addrew and'phono'nurnber 9. EXplrddoh' date of this` N6tk* of Commencement Me aWhOM date Is I year from the date pf h9 Ww a d" date is epW" IAFAMM*60 I A *11101: ANY PAYMENTS MADE BY THE OWNFEAAFrER THE EXPIRATION OF MP OPER PA THE NOTICE OF CA STATUTES, AND CAN .Q.MM—MPEMENT WMEW'S NO ARE _CONSIDERED I U 713 M FI7 I hf. I UR -A No OR RECORDING Y(0yN00UA7m0u8FTrjAtj%FI AuthcrtW (XcW/Db'ector,,p,,jrtnar jtjanagar Prepared By Print Ngme Prepared Title/I'll , - Print Name STAB I COON F OF MIAi1?�I-QeAtrt�S�F as By TI 14 COS EDv aCFcnogsd 0 -6 -foie me 111* 2 day. 24 1,3 Irtljvi , or as Gam/` for known; or aced orldera=00n: T7L A Nk DAM WWa om pM= &J015,1110MAffAwn , Notary Public Awe Of Poft twifer ",fts ectare have r4d *W f6riagoing arid' 1 #let VIC to the beat of knowledge and Belief.* * MY Comm. Exa- lm Nov R6.,MS Signatures) ")'s AuthodZed Officer/DirsclortPartner/Manager who at BY BY F.I.E. FLORIDA INTERNATIONAL ENGINEERING &TESTING LAB INSIGHT -INNOVATION -INTEGRATION November 11, 2014 City of Miami Shores Building & Zoning Dept. 10050 NE 2nd Avenue Miami Shores, FL Florida International Engineering and Testing Lab LLC 7500 NW 25th Street, Miami, FL 33122 Telephone: (305) 378 -1991 -Fax: (305 378-1997 Miami -Dade Lab Certification # 07 -0612.11 -State of Florida ca #27273 Re: Flat Roof Installation and Sloped Roof Inspection. Job address: 62 NE 108th Street, Miami ShoresFL Dear Bldg. Official: Permit No.: RF -7-13-1560 Pursuant to the owner's agent request and authorization Florida International Engineering & Testing Lab, LLC performed a visual inspection at the above referenced address. Below, please note our findings: Low Slope Roof: 1. A 75# base sheet was fastened over the wood deck with 1-1/4" annular ring shank nails and Dade County approved tin caps of 1-5/8" as follows: Field: 6"o.c. at the laps and three rows at 9"o.c. in the center of the sheet. Perimeter: 6"o.c. at the laps and four rows at 6" o.c. in the center of the sheet. Corner: 4"-6"o.c. at the laps and five rows at 6" o.c. in the center of the sheet. 2. A 3"x3" 26ga. metal eaves -drip was nailed with 1-1/4" annular ring shank nails at approximately 4"o.c. and fully primed. 3. A 10"-12" edge strip, 2 plies of GAF's Ply IV and a GAF Mineral Surface Cap Sheet were fully hot mopped and appear well adhered. Sloped Roof: 1. A 30# anchor sheet was nailed with 1-1/4" ring shank nails through 1-5/8" tin caps @ 6"o.c. at the lap and 2 rows @ 10"-12"o.c. in the center of the sheet. 2. A 3"x3" 26ga. metal eaves -drip was nailed w/1-1/4" ring shank nails and fully primed. 3. A 90# was fully hot mopped over the anchor sheet and back nailed w/1-1/4" ring shank nails through 1-5/8" tin caps at 12"o.c. 4. A 26ga. Ridge metal was nailed with %" ring shank nails @ 6"o.c. S. Eagle Roofing Products "Malibu" double roll tiles were set in a single patty of approximately 8"x3" Polyfoam system and an additional small patty at the head of the tile and appear well adhered. As a routine matter, in order to avoid any possible misunderstanding, nothing in this report should be construed directly or indirectly as a guarantee for any portion of the roof nor the structure. To the best of my knowledge, and ability this report represents an accurate appraisal based upon careful evaluation of observed condition, to the extent reasonably possible. To the best of our knowledge and professional opinion the work inspected substantially conforms with approved plans and the intent of the Florida Building Code, 2010. Florida International Engineering & Testing Lab, LLC R (3 k UL" 11 I I "f � I `i VMB Venkatesan, P.E. Florida Reg.: 63107 Biliami Shares Vihoge APPROVC-0 13Y DATE YOKING DEPT' r Di ®G ®E'PT' Florida WIN !Nice Master Permit No. Process No. Cantractoes Name d � , �; ��• ��;` Job Address e" Z- ROOF CATEGORY Low Slope ❑ Mechanically Fastened Tile "Mo 13Sh nees Shingles 13 Metal Panel/Shingles r/Adhesive Set Tile Shingles ❑ Wood Shingles/Shakes ❑ Prescriptive BUR -RAS 150 �� ROOF TYPE Q New Roof ®' Reroofing ❑ Recovering ❑ Repair ❑ Maintenance ROOF SYSTEM INFORMATION Low Slope Roof Area (SF) Steep Sloped Roof Area (SF) Total (SF) 212- Section Sketch Roof Plan: IllustratvBPlan) and tROOsections, drains scuppers, scuppers and overflow drains. Include dimensions of sections anevs, clearrlly identify dimensions of elevated pressure zones and location of ara ts. X1.. ..3. ,.. 4; , Onln R ARInA Run niNr: rnne _, oeainew„wl HURRICANE ZONES HIGH -VELOCITY HURRICANE ZONES r Florida Building Code Edition 2010 S@Cfion C (Low Slope Application) Fill in Specific Roof Assembly Components Fastener Spacing for Anchor/Base Sheet and Identify Manufacturer Attachment (If a component is not used, identify as "NAI Field:`�� " oc @ Lap, # Rows� @ � ° oc System Manufacturer._( fA :P (� � NOA No.:—0 7 1� lci . ®yam e° Perimeter: ,� " oc @ Lap, # Rows 6 @ A oc Design Wind Pressures, From RAS 128 or Calculations: Pi:� 4-2-F P2• _1(,. -7 P3: !-l08, 0 Max. Design Pressur , Frgm the Specific NOA System: T t 1� s F Deck: Type: �o. Gouge/Thickness:_ /i Slope: -i Anchor/Base Sheet & No. of Ply(s): � 13R 15.z (� J Ancjr/R7e §,heete!en-erlBonding Material: Insulation Base Layer��/� Base Insulation Size and Thickness --4N Base insulation Fastener/Bonding Material- Top aterialTop Insulation Layer;_ tj Top Insulation Size and Thickness:_, fk- Top Insulation Fastener/Bonding Material: Base Sheet(s) & No. of Ply(s): Base Sheet Fastener/Bonding Material: (� Ply Sheet(s) & No. of Ply(s): L r- Z 5 Comer. G=" oc @ Lap, # Rows @:::62 " oc Number of Fasteners Per Insulation Board Field �' 03 Perimeter''', Corner4L,4" Illustrate Components Noted and Details as Applicable: Woodblocking, Gutter, Edge Termination, Stripping, Flashing, Continuous Cleat, Cant Strip, Base Flashing, Counter- Flashing, Coping, Etc. Indicate: Mean . Roof Height, Parapet Height, Height of Base Flashing, Component Material, Material Thickness, Fastener Type, Fastener Spacing or Submit Manufacturers Details that Comply with RAS 111 and Chapter 16. Ply Sheet Fastener/Bonding Material: Top Ply: FT. �JloA 2 ®`I"." a re P �� t -i`- Parapet ® Heioht 70 er.T�r Top Ply Fastener/ Bonding Material: '%�� nAr Surfacing: i NCE 6J P, �ApAv �. ee 0j'j WL) a0 AD Mean Roof Height HIGH -VELOCITY HURRICANE ZONES Florida Building Code Edition 2010 High Velocity Hurricane Zone Uniform Permit Application Form. Section D (Steep Slowed Roof Svsteml Roof System Manufacturer:_Fe'�C;`Ff' V- 0- r -e %j r Ue-- Product Approval Number: Minimum Design Wind Pressures, If Applicable (From RAS 127 or Calculations): e Maximum Design Pressure Product Approval Specific System- . Method of file attachment: "6 pit-, T7c 2- Steep Sloped Roof System Description Deck Type: n e ayment. Roof Slope: Insulation: :12 Ridge Ventilation? Mean Roof Height: t ?- 2010 FLORIDA BUILDING CODE — RESIDENTIAL TAIAA C-1 tj l� mer Type & Spacing: 1 e b V Cap Sheet: _ Covering: '� &nL.a �A+GE'GyG d<cr Type & Size Drip.•3. dge: a, 2, HIGH -VELOCITY HURRICANE ZONES Florida Building Code Edition 2010 High Velocltv 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 Mrwith the values from Mf. If the Mt values are greater than or equal to the Mr values, for each area of the roof, then the tile attachment method Is acceptable Method 1 "Moment Based Tile Calculations Per RAS 127" X .. 7- ez = -t t '.UA' - Ni S = Mr. 4 3S Product Approval m, x ;L J Mi = Mrs iZ-SS Produd Approval Mf (P3:�-1 oo .'7 x A = l T,b_: moi) - M� = M,3-2& >i S Product Approval M, Method 2 "Simplified Tile Calculation Per Table Below" Required Moment of Resistance (Mr) From Table Below 3 2. Z Product Approval Mr 4 •� *Must be used in conjunction with a list of moment based the 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 F, if the F' values are greater than or equal to the Fr values, for each area of the roof, then the tile attachment method is acceptable. Method 3 "Uplift Based Tile Calculations Per RAS 127" (P,:_xl:_= x w:=_)-W_xcos8.•_= Fri: F (P2: _ x 1: = s w: = ._) - W _ x cos 6. = F,2• i? (P3 : _ x I: _ x w: = _) - W • _ x cos O. - = Fr'' F Mr Required Moment Resistance* Description symbol Mean Roof Height --� Roof Slops 4 5' 20' 25' 30' 4W 212 36.5 38.2 39.7 42.2 0 2.2 34A 36.0 37.4 39.8 PfoductAppmal .4 32.2 33.8 36.1 37.3 5:12 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 the 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 F, if the F' values are greater than or equal to the Fr values, for each area of the roof, then the tile attachment method is acceptable. Method 3 "Uplift Based Tile Calculations Per RAS 127" (P,:_xl:_= x w:=_)-W_xcos8.•_= Fri: F (P2: _ x 1: = s w: = ._) - W _ x cos 6. = F,2• i? (P3 : _ x I: _ x w: = _) - W • _ x cos O. - = Fr'' F 44.24 OnIn CI nrlrn• enu Where to Obtain Information Description symbol Where to find iksign Pressure pt or P2 or P3 RAS 127 Table 101 by an enginv'ering analysis prepared by PE based on ASCE 7 Mean Roof Height tl Job Site Roof Slope 0 Job Site AerodymamicMulti lief I PfoductAppmal Restoring Moment due to Gravity 1.4 ProdactA pproval AltachnmmResistance Mr ProdartAmmial Required Nfolnent Resistana M, Calculated Minimum Attachment Resistance PwductAmroyal R uired Uplift Resistance F Calculated Averap Tile Weight W PmdWA val Tile Dimensions I= length w= Width PmoduetAMoval All calculations must be submitted to the U-1ding Official at the time of it lication. 44.24 OnIn CI nrlrn• enu 011114 OCITY I'I'UR WANE Ls I _ 9 Ij WREQLUI .�o.�.. .an-vo n -nn.., 84403.13 EIRED OWNERS NO I CONSIDERATIONS R4402.13.1 Scrape. As it pertains to the section, it Is the responsibility of roofing contractor With the required t&&ntont ter, . ,�.�.,..�._." _...I.go ..w„w 011WWOM WU auui000 lY Co Pw uu, via a �greemenr'netween the c contractor. The omer's,irthialln tlro tdesigi space indiites fat the m has been expie 1'azY ` Athetica�Wtrfah1► the wdrkmerthippd+isions. of Section 84402 A (ap�arance) arthe notacor�iderattio with res ts the wind resistance and water Instruction periormah esthetics respect to workmanship provisions Such as color or art hitectt t appearance, that are not part of a zoning code, should be r ac�OR between the owner and the contractor. ft the owner of Section for the purer of standards. %*etic issues ressed as part of 2 . RaltJailing. d decks: When replacing roofing, the existing wood roof del 'k' may have to be I in adbordanceviththe'currentprovisions ofSection R4403. (The foof deck is tw ;ally concealed prior ;tort. the existing. tpof system). 3. A o►r.. mb: Compton roofs.arse those which have no visible delineationi ietween neighboring Mn... tout houses,,condominiums, etc.) In buildings with common roofs, the roofing a:;' ntractor and/or r should no* the occupants of adjacent units of roofing to be performed. V' 4.* Deed Ceilln • Ex fa g. posed, open beam ceilings are where the underside of a roof decking can e from below. The owner may wish to maintain the architectural appearance; the +. fore, roofing nail f netra#ipa of the unders* of the decking may not be acceptable. This provides the opt of maintaining the �n 5 ` Ponding water: The current roof system and/or deck of the -building may tick rain well and may tea r to pond (accumulate) in lawwlying areas of the roof. Pounding can be an indh `tion of strwt ral demand may reouilothe review of,a;professional structural engineer. Pounding may rten the life expecsthtray and performance of the new roofing system. Pounding conditions may not be Trident until the o . ng -system is removed. Pounding conditions should be conacted. ppprs {wail outlets :Itis OverOaw scan required that rainwater fbws off so tf the roof is not overt ed -,from a buildup of water. Perimeter/edge wall Or -d te'r foof extension may bloclFppersl�arge is diIf overflows . ppers (wall outlets) ate not provided. It may be necessary to install overflow s 8000rd8nc0 with the requimment$ of Sections 84402, R4403 and R4413. Ir fi Yerttilation: MW roof structures should ha so a ability to vent natural cin through the infero f'the mbly (the building itself). The a amount of attic ventilatici i shall not be dbdedti d ai to obnsider addititrasl $vertu' aKrhf 094 result in t4ondinq hof service life of -the 0", pr/AgeiiVs- Ign ) Date Contractor Sign m e F�eul�ed=on ��12449t M IMIA MI, AD MIAMI-DADE COUNTY, FLORIDA METRO-DADE FLAGLER BUILDING BUILDING CODE COMPLIANCE OFFICE (BCCO) 140 WEST FLAGLER STREET, SUITE I603 PRODUCT CONTROL DIVISION MIAMI, FLORIDA 33130-1563 (305) 375-2901 FAX (305) 375-2908 NOTICE OF ACCEPTANC_ E (NOA) GAF Material Corporation 1361 Alps Road Wayne, NJ 07470 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed by the BCCO and accepted by the Building Code and Product Review Committee to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ). This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product Control Division (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) reserve the right to have this product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify, or suspend the use of such product or material within their jurisdiction. BORA reserves the right to revoke this acceptance, if it is determined by Miami -Dade County Product Control Division that this product or material faits to meet the requirements of the applicable building code. This product is approved as described herein, and has been designed to comply with the Florida Building Code and the High Velocity Hurricane Zone of the Florida Building Code, DESCRIPTION: GAF Conventional Built -Up Roof System for Wood Decks. LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami -Dade County Product Control Approved", unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA renews and revises NOA No. 03-0501.05 and consists of pages 1 thro gh 19. The submitted documentation was reviewed by Jorge L. Acebo. NOA No.: 07-1219.09 tr IMI. AUE uNn Expiration Date: 11/04/13 Approval Date: 03/20/08 Page 1 of 19 "Deck Type 1I: Wood, Insulated Deck Description: 19/32" or greater plywood or wood plank System Type B: Optional base sheet laid dry; base layer of insulation mechanically fastened, optional top layer adhered with approved asphalt. All General and System Limitations shall apply. One or more layers of any of the following insulations. Insulation for Base Layer (Table 2) Insulation Fasteners Fastener When applicable: Steel plate only =S, plastic plate only =P (Table 3) Density/fe EnergyGuardTM, EnergyGuardTM RA Minimum 1.3" thick 1, 2, or 3 1:3 ft' EnergyGuardTM RN Minimum 1.4" thick 1, 2, or 3 1:3 ft' EnergyGuardTM Composite, EnergyGuardTM RA Composite Minimum 1.5 thick 3 1:3 ft' EnergyGuardTM Perlite Minimum 3/4" thick 1 S(3.5"), or 3 1:2 ft2 EnergyGuardT" M Fiberboard, EnergyGuardrm High Density Fiberboard Minimum 1" thick 1, 2, or 3 1:4 ft' Note: Base layer shall be mechanically attached with fasteners and density described. Insulation panels listed are minimum sizes and dimensions; if larger panels are used the number of fasteners per board shall be increased maintaining the same fastener density (See Roofing Application Standard RAS 117 for fastening details). GAF requires either a ply of GAFGLAe STRATAVENTO Eliminatoem perforated laid dry or a layer of EnergyGuard'rm or wood fiber overlay board on all isocyanurate applications. Insulation for Top Layer (Table 2) Insulation Fasteners Fastener When applicable: Steel plate only =S, plastic plate only P (Table 3) Density/fe Any of the insulations listed for Base Layer, above. N/A N/A EnergyGuardTM High Density Wood Fiber, EnergyGuard'rm High Density Wood Fiberboard, EnergyGuardTM Recover Board Minimum 1/2" thick N/A N/A Note: Optional top layer of insulation shall be adhered with approved asphalt within the EVT range and at a rate of 20-40 lbs/100 fe. Please refer to Roofing Application Standard RAS 117 for insulation attachment. Composite insulation boards used as a top layer shall be installed with the polylsocyanurate face down. Fire Barrier: FireOutTM Fire Barrier Coating, VersaShieldo Non -Asphaltic Fiberglass -Based (optional) Underlayment or SecurockTM. NOA No.: 07-1219.09 Expiration Date: 11/04/13 MwMt 40Aos c� twrr Approval Date: 03/20/08 Page 11 of 19 ROOFING SYSTEM APPROVAL Cateeorv: Roofing Sub-Cateeorv: BUR Deck Tvw. Wood Maximum Desf n Pressure -75 psf TRADE NAMES OF PRODUCTS MANUFACTURED OR LABELED BY APPLICANT: TABLE 1 Test Pr duct Dimensions Specification Product Description Leak BusterTM MatrixTM 3, 5, 55 gallons ASTM D 41 Asphalt concrete primer used to promote 307 Premium Asphalt adhesion of asphalt in built-up roofing.. Primer GAF Mineral ShieldTM 60 & 100 lb. bags ASTM D 1863 Granules for surfacing of exposed asphalt, Granules cold process cement or emulsion. GAF Mineral ShieldTM Granules shall be used for flashing applications only. Leak BusterTM MatrixTM 5 gallons ASTM 1227 Surface coating for smooth surfaced roofs. 305 Fibered Asphalt Emulsion Leak BusterTM MatrixTM 303 Premium Fibered Aluminum Roof Coating LcakBusterTM MatrixTM 322 Elastomeric Roof Coating 1,5 gallons ASTM D 2824 Fibered aluminum coating. 55 gallons Elastomeric roof coating. LeakBusterTM MatrixTM 55 gallons Asphalt emulsion fibered. Select Asphalt Emulsion Fibered 306 Leak BusterTM MatrixTM 204 Wet/Dry Roof Cement RUBEROID* Modified Bitumen Flashing Cement 1, 5 gallons ASTM D-4586 Refined asphalt blended with a mineral ASTM D-3409 stabilizer and fibers. Permits adhesion to wet and dry surfaces. 5 gallons ASTM D 4586 Fiber reinforced, polymer modified Flashing cement Le"usterTM MatrixTM 5 gallons ASTM D 4586 Asphalt flashing Cement 201 Premium SBS Flashing Cement GAFGLAe #75 39.37" (1 meter) ASTM D 4601 Asphalt impregnated and coated glass mat wide base sheet. NOA No.: 07-1219.09 Mr b UN7Y Expiration Date: 11/04/13 • • • Approval Date: 03120/08 Page 2 of 19 Cap Sheet: (Optional) One ply of GAFGLAS' Mineral Surfaced Cap Sheet or GAFGLAS0F,nergyCapTM Mineral Surfaced Cap Sheet adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbs./sq. Surfacing: (Optional, required if RUBEROID® MOP Smooth or RUBEROIDP 20 is top membrane) Install one of the following: 1. Gravel or slag applied at 400 lbs./sq. and 3001bs./sq. respectively in a flood coat of approved asphalt at 60 lbs./sq, or applied in a flood coat of Leak BusterTM MatrixTM 103 Cold Process Adhesive applied at a rate of 3 galJsq. 2. GAFGLAS® Mineral Surfaced Cap Sheet, GAFGLAS® Energy Cap Mineral Surfaced Capsheet adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-401bsJsq. 3. Leak BusterTM MatrixTM 303 Premium Fibered Aluminum Roof Coating, at 1.5 gal./sq. 4. Leak BusterTM MatrixTM 715, Leak BusterTM MatrixTM 322, TOPCOAT® MB+, TOPCOATS' Fireshield EIastomeric Roofing Membrane, applied at 1 to 1.5 gal./sq. 5. Leak BusterTM MatrixTM 602 MB Xtra Elastomeric Roofing Membrane, EnergyCote® roof coating applied at 1 to 1.5 gal./sq. 6. TOPCOAT® Surface Seal, TOPCOAT® Fireshicie SB Solvent based Elastomeric Roofing Membrane applied at Ito 1.5 gal./sq 7. Advance Green Technologies Photovoltaic Laminate solar energy collector auxiliary roof equipment installed in compliance with manufacturer's specifications and applicable Building Codes. Maximum Design Pressure: See Fastening above. NOA No.: 07-1219.09 MIAMbnA ou Expiration Date: 11/04/13 • Approval Date: 03/20/08 Page 10 of 19 GAFGLAS' STRATAVENTO EIiminatorTM Perforated 'GAFGLASO Flashing GAFGLAS® STRATAVENT* EliminatorTM Nailable RUBEROO SBS Heat WeldTM Smooth RUBEROIEP SBS Heat-WeldTM Granule RUBEROO SBS Heat-WeIdTM 170 FR RUBEROID* SHS Heat-WeldTM PLUS RUBEROO SBS Heat-Weldym PLUS FR RUBEROO SBS Heat-WeldTM 25 39.37" (1 meter) ASTM D 4897 wide D 3672 Various 39.37" (1 meter) ASTM D 4897 wide D 3672 1 meter (39.3 T') ASTM D-6164 wide 1 meter (39.37") ASTM D-6164 wide 1 meter (39.37") ASTM D-6164 wide 1 meter (39.37") ASTM D-6164 wide 1 meter (39,37") ASTM D-6164 wide 1 meter (39.37') ASTM D-6164 wide RUBEROID® Modified 39.37" (1 meter) ASTM D4601, Base Sheet wide Type II, UL Type G2 BUR APPROVED Fiberglass base sheet impregnated and coated on both sides with asphalt. Surfaced on the bottom side with mineral granules embedded in asphaltic coating with factory perforations. Asphalt coated glass fiber mat flashing sheet available in three sizes. Fiberglass base sheet impregnated and coated on both sides with asphalt. Surfaced on the bottom side with mineral granules embedded in asphaltic coating. Non -Woven Polyester mat coated with polymer -modified asphalt and smooth surfaced. Non -Woven Polyester mat coated with polymer modified asphalt and surfaced with mineral granules. Non -Woven Polyester mat coated with fire retardant polymer modified asphalt and surfaced with mineral granules. Non -Woven Polyester mat coated with polymer modified asphalt and surfaced with mineral granules. Non -Woven Polyester mat coated with fire retardant polymer modified asphalt and surfaced with mineral granules. Non -Woven Polyester mat coated with polymer -modified asphalt and smooth surfaced. Premium glass fiber reinforced SBS modified base sheet NOA No.: 07-1219.09 Expiration Date: 11/04/13 Approval Date: 03/20/08 Page 3 of 19 Test Product Product Dimensions Sfecification Des%i:gtion GAFGLAS® #80 39.37" 0 meter) ASTM D4601 Asphalt impregnated and coated, fiberglass ULTIMATM Base Sheet wide base sheet GAFGLAS® 39.37" (1 meter) ASTM D 2178 Type VI asphalt impregnated glass felt with Flex PIyTM 6 wide asphalt coating. GAFGLASO Ply 4 39.37" (1 meter) ASTM D 2178 Type IV asphalt impregnated glass felt with wide asphalt coating. GAFQLAS Mineral 39.37" (1 meter) ASTM D 3909 Asphalt coated, glass fiber mat cap sheet Surfaced Cap Sheet wide surfaced with mineral granules. GAFGLAS® 39:37" (1 meter) ASTM D 3909 Asphalt coated, glass fiber mat cap sheet EnergyCapTM Mineral wide surfaced with mineral granules with factory Surfaced Cap Sheet applied layer of TOPCOATOEnergyCoWm. GAFGLAS' STRATAVENTO EIiminatorTM Perforated 'GAFGLASO Flashing GAFGLAS® STRATAVENT* EliminatorTM Nailable RUBEROO SBS Heat WeldTM Smooth RUBEROIEP SBS Heat-WeldTM Granule RUBEROO SBS Heat-WeIdTM 170 FR RUBEROID* SHS Heat-WeldTM PLUS RUBEROO SBS Heat-Weldym PLUS FR RUBEROO SBS Heat-WeldTM 25 39.37" (1 meter) ASTM D 4897 wide D 3672 Various 39.37" (1 meter) ASTM D 4897 wide D 3672 1 meter (39.3 T') ASTM D-6164 wide 1 meter (39.37") ASTM D-6164 wide 1 meter (39.37") ASTM D-6164 wide 1 meter (39.37") ASTM D-6164 wide 1 meter (39,37") ASTM D-6164 wide 1 meter (39.37') ASTM D-6164 wide RUBEROID® Modified 39.37" (1 meter) ASTM D4601, Base Sheet wide Type II, UL Type G2 BUR APPROVED Fiberglass base sheet impregnated and coated on both sides with asphalt. Surfaced on the bottom side with mineral granules embedded in asphaltic coating with factory perforations. Asphalt coated glass fiber mat flashing sheet available in three sizes. Fiberglass base sheet impregnated and coated on both sides with asphalt. Surfaced on the bottom side with mineral granules embedded in asphaltic coating. Non -Woven Polyester mat coated with polymer -modified asphalt and smooth surfaced. Non -Woven Polyester mat coated with polymer modified asphalt and surfaced with mineral granules. Non -Woven Polyester mat coated with fire retardant polymer modified asphalt and surfaced with mineral granules. Non -Woven Polyester mat coated with polymer modified asphalt and surfaced with mineral granules. Non -Woven Polyester mat coated with fire retardant polymer modified asphalt and surfaced with mineral granules. Non -Woven Polyester mat coated with polymer -modified asphalt and smooth surfaced. Premium glass fiber reinforced SBS modified base sheet NOA No.: 07-1219.09 Expiration Date: 11/04/13 Approval Date: 03/20/08 Page 3 of 19 Fastening Options: GAFGLAS Ply 4, GAFGLAS® Flex PIyTM 6, GAFGLAS® #75 Base Sheet or any of above Anchor sheets attached to deck with Drill-TecTm" #12 standard, #14 or # 15 Screws and 3" Drill-TecTM steel plate or Drill-TecTM AccuTrac Plates, 12" o.c. in 3 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 12" o.c. in the field of the sheet. (Maximum Design Pressure —45 psf, See General Limitati©n #29 •GAFGLAS Flex PIyTM 6, GAFGLAS® #75 Base Sheet or any of above Anchor sheets attached to deck with approved annular ring shank nails and tin caps at a. fastener spacing of 9" o.c. at the 4" lap staggered and in two rows 9" o.c. in the field. (Maximum Design Pressure —52.5 psf, See General Limitation 47) GAFGLAS® #80ULTIMATM, RUBEROID® 20, RUBEROIDV Mop Smooth, base sheet attached to deck with approved 1'/4" annular ring shank nails and inverted 3" steel plate at a fastener spacing of 9" o.c. at the 4" lap and in two rows staggered with a fastener spacing of 9" o.c. in the center of the membrane. (Maximum Design Pressure —6# psf, See General Limitation #7) GAFGLAS® #75 Base Sheet or any of above Anchor sheets attached to deck with Drill-TecTM #12 standard, #14 or # 15 Screws and 3" Drill-TecTM steel plate or Drill-TecTM AccuTrac Plates, 12" o.c. in 4 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 9" o.c. in the field of the sheet. (Maximum Design Pressure —60 psf, See General Limitation #7) Any of above Anchor sheets attached to deck approved annular ring shank. nails and 3" inverted Drill-TecTM insulation plates at a fastener spacing of 9" o.c, at the 4" lap staggered in two rows 9" in the field. (Maximum Design Pressure —60 psf, See General Limitation #7) GAFGLAS® #75 Base Sheet or any of above Anchor sheets attached to deck with Drill-TecTM #12 standard, #14 or # 15 Screws and 3" Drill-TecTM steel plate or Drill-TecTM AccuTrac Plates, 8" o.c. in 4 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 9" o.c. in the field of the sheet. (Maximum Design Pressure —75 psf, See General Limitation #7) Base Sheet: (Optional) Install one ply of GAFGLAS® #75, GAFGLAS® #80 ULTIMATM Base Sheet, GAFGLAS® STRATAVEN14 EliminatorTM Perforated, RUBEROID0 Modified Base Sheet, RUBEROID® Mop Smooth, RUBEROIDO 20 RUBEROID® Heat-WeldTM Smooth or RUBEROID® Heat-We1dTM directly over the top layer of insulation. Adhere with any approved mopping asphalt applied within the EVT range and at a rate of 20-40 lbs./sq; (see General Limitation #4). Ply Sheet: One or more plies GAFGLAS® PLY 4, GAFGLAS® Flex PIyTM 6 sheet, #80 Ultima, RUBEROID® Mop Smooth or RUBEROID® 20 adhered -in a full mopping of approved asphalt applied within the EVT range and at a rate of 2040 lbs./sq. NOA No.: 07-1219.09 Mian=ECOUMTY Expiration Date: 11/04/13 . Approval Date: 03/20/08 Page 9 of 19 Test Product Product Dimensions specification Descrigttion RUBEROID® 20 RUBEROV Mop Granule 39.37" (1 meter) ASTM D 6163 SBS modified asphalt base sheet and wide ASTM D 5147 interply sheet reinforce with a glass fiber 39.37" (1 meter) ASTM D 6222 wide ASTM D 5147 RUBEROID® Mop Plus 39.37" (1 meter) ASTM D 6222 (Granule) wide ASTM D 5147 RUBEROIDO MOP Smooth RUBEROID® MOP 170FR RUBEROIDP MOP FR RUBEROIDO TORCH Smooth 39.37" (1 meter) ASTM D 6164 wide ASTM D 5147 39,37" (1 meter) ASTM D 6164 wide ASTM D 5147 39.37" (1 meter) ASTM D 6164 wide ASTM D 5147 39.37" (l meter) ASTM D 5147 wide RUBEROID® TORCH 39.37"(l meter) ASTM D 5147 Granule wide RUBEROIDP TORCH 39.37' (1 meter) .. ASTM D 6222 PLUS (Granule) wide ASTM D 5147 RUBEROID'o TORCH 39,37' (1 meter) ASTM D 6222 FR wide ASTM D 5147 RUBEROIDP I70FR 39.37' (1 meter) ASTM D 6222 TORCH Wide ASTM D 5147 RUBERO.ID® 30 39.37' (1 meter) ASTM D 6163 wide ASTM D 5147 RUBEROV 30 FR 39.37' (1 meter) ASTM D 6163 wide ASTM D 5147 RUBEROIDO 39.37"'(l meter) ASTM D 6298 ULTRACLAD® wide ASTM D 5147 RUBEROIDODualFR 39.37' (1 meter) ASTM D 6164 Wide ASTM D 5147 Vent Stacks (metal and TAS 100(A) plastic) ASTM D 1929 ASTM D 635 rt►Ar��• ocaNr�r APPROVED mat. Non -woven polyester mat coated with polymer modified asphalt and surfaced with mineral granules. Non -woven polyester mat coated with polymer modified asphalt and surfaced with mineral granules. Non -woven polyester mat coated with polymer -modified asphalt and smooth surfaced. Non -Woven polyester mat coated with fire retardant polymer modified asphalt and surfaced with mineral granules. Non -Woven polyester mat coated with fire retardant polymer modified asphalt and surfaced with mineral granule's. Heavy duty, polyester reinforced, asphalt modified bitumen membrane, smooth surface. Asphalt impregnated, coated felt, surfaced with mineral granule. Heavy duty, polyester reinforced, asphalt modified bitumen membrane, granule surface. Heavy duty, polyester reinforced, coated with fire retardant asphalt modified bitumen membrane, granule surface. Heavy duty, polyester reinforced, coated with fire retardant asphalt modified bitumen membrane, granule surface. Non -woven fiberglass mat coated with polymer modified asphalt and surfaced with mineral granules. Non -woven fiberglass mat coated with fire retardant polymer modified asphalt and surfaced with mineral granules. Woven fiberglass mat coated with Polymer modified asphalt and surfaced with aluminum, copper or stainless steel foil. Non -woven polyester and fiberglass mat coated with file retardant, polymer modified asphalt and surfaced with mineral granules. One way valve vent used to relieve built-up pressure within the roof system. GAF Vent Stacks are available in metal or plastic. NOA No.: 07-1219.09 Expiration Date: 11/04/13 Approval Date: 03/20/08 Page 4 of 19 APPROVED ASSEMBLIES Deck Type 1I: Wood, Insulated • Deck Description: 19/32" or greater plywood or wood plank System Type A: Anchor sheet mechanically fastened, all layers of insulation adhered with approved asphalt. All General and System Limitations shall apply. One or more layers of any of the following insulations. . Insulation Layer (Table 2) Insulation Fasteners Fastener (When applicable: Steel plate only =S, plastic plate only (Table 3) Density/ft2 =P). EnergyGuardTM, EnergyGuardTM Composite, EverGuardo ISO,'EnergyGuardTM RA, EnergyGuardTM RA Composite Minimum 1" thick N/A' N/A EnergyGuardTM High Density Wood Fiber, EnergyGuardTM Recover Board, Wood Fiber, Minimum %" thick N/A N/A EnergyGuardTM Perlite Minimum %" thick ' N/A N/A Fiberglas (Min. 15/16" thick) N/A N/A Note: All insulation shall be adhered to the anchor sheet in full mopping of approved hot asphalt within the EVT range and at a rate of 20-40 lbs/100 ftp. Please refer to Roofing Application Standard RAS 117 for insulation attachment. Insulation listed as base layer only shall be used only as base layers with a second layer of approved top layer insulation installed as the final membrane substrate. Composite insulation panels may be used as a top layer placed with the polyisocyanurate side facing down. GAF requires either a ply of GAFGLASn STRATAVENT® Eliminatoem Perforated laid dry or a layer of EnergyGuardTM Perlite or wood fiber overlay board on all isocyanurate applications. Fire Barrier: FireOutTM Fire Barrier Coating, VersaShieldoNon-Asphaltic Fiberglass -Based (optional) Underlayment or SecurockTM. Anchor sheet: GAFGLAS® #80 ULTIMATM Base Sheet, STRATAVEN 14 Eliminator Nailable, RUBEROID`s Modified Base Sheet, RUBEROID® 20, RUBEROID Heat-WeldTM Smooth or RUBEROIDP Heat-WeldTM 25 base sheet -mechanically fastened as described below; Fastening Options: GAFGLAS® Ply 4, GAFGLAS® Flex P13iTm 6, GAFGLAS`a #75 Base Sheet or any of above Anchor sheets attached to deck with approved annular ring shank nails and tin caps at a fastener spacing of 9" o.c. at the lap staggered and in two rows 12" o.c. in the field. (Maximum Design Pressure -45 psf, See General Limitation #7) NOA No.: 07-1219.09 Mimi DADECOLLNTY Expiration Date: 11/04/13 ■ Approval Date: 03/20/08 Page 8 of 19 Product Leak BusterTM MatrixTM 302 Non Fibered Aluminum Roof Coating GAF Built -Up Roofing Asphalt RUBEROID® MOD Asphalt, Asphalt L & Asphalt P Leak BusterTM Matri)Crm 602 Leak BusterTM MatrlxTM 715 LeakBusteim MatrixTM 531 WeatherCoteTM SeamCoteTM FlreOutTM VersaShield® VersaShield® FB -1S VersaShield®FB-2S TOPCOAT' FireShiele MB Leak BusterTM MatrixTM 201 SBS Flashing Cement Leak BusterTM MatrixTM 102 SBS Adhesive Leak BusterTM MatrixTM 202 SBS Flashing Cement Leak BusterTM MatrixTM 203 Plastic Roof Cement Leak BusterTM Matri)Crm 103 Cold Process Adhesive Test Product Dimensions Specification Description 5 gallons ASTM D2824, Non-fibered aluminum pigmented, asphalt Type I roof coating. 100 lb. cartons, ASTM D312, Interply mopping and surfacing asphalt. bulk Types I, II, III and IV 60 lb. kegs SEBS modified asphalt. 5 gallons Surface coating for smooth surfaced and mineral surfaced roofs. 5 gallons Surface coating for smooth surfaced and mineral surfaced roofs. 2 gallons Surface coating for smooth surfaced and mineral surfaced roofs. 2, 5 gallons proprietary Elastomeric roofing membrane. . 5, 55 gallons Low VOC, fire barrier coating. 350 sq ft. roII Non -Asphaltic Fiberglass -Based Underlayment. 350 sq ft. roll Non -Asphaltic Fiberglass -Based Underlayment. 350 sq ft. roil Non -Asphaltic Fiberglass -Based Underlayment. 5, 55 gallons ASTM D-412 Elastomeric roofing membrane ASTM D-21-96 ASTM D1475 ASTM E-1644 5 gallons ASTM D3019 Cold Applied Modified SEBS Asphalt Adhesive — Flashing Grade. 5 gallons ASTM D3019 Cold Applied Modified SEBS Asphalt Adhesive. 5 gallons ASTM D4586 Cold Applied Modified SEBS Asphalt Adhesive — Flashing Grade. 5 gallons ASTM D4586 Standard Plastic Asphalt Roofing Cement 5 gallons ASTM D3019 Cold Applied Asphalt Adhesive. NOA No.: 07-1219.09 Expiration Date: 11/04/13 Approval Date: 03/20/08 Page 5 of 19 APPROVED FASTENERS: Test Identifier Description Date Factory Mutual Research Corp. J.I.2B8A4.AM TABLE 3 07.02.97 Fastener Product Product Manufacturer Number Name Description Dimensions (With Current NOA) 1. Drill-TecTM #12 Standard, Insulation fastener and Various GAF Materials Corp. # 14 and # 15 extra Heavy Base Play fastener for 05.11.07 PRI Asphalt Technologies, Inc. GAF -012-02-02 Duty Fastener, Heavy steel, wood & concrete GAF -020-02-01 ASTM D 4977 Duty Roofing Fastener decks. 02-005 TAS 114 2. Drill-TecTM ASAP Pre -assembled Drill- Various GAF Materials Corp. TecTM Fasteners and metal and plastic plates. 3. Drill-TecTM #12 or #14 Base sheet fastening Various GAF Materials Corp. Standard screws with assembly. AccuTrac Plate 4. Drill-TecTM Galvalume Round Galvalume stress 3" and 3 %z" GAF Materials Corp. Plates plates. 5. Drill-TecTM Round polypropylene 3" and 3 %Z" GAF Materials Corp. Polypropylene Plates stress plates. 6. Drill-TecTM AccuTrac Square Galvalume® 3" Square GAF Materials Corp. Plate coated steel plate. EVIDENCE SUBMITTED: Test Agency Test Identifier Description Date Factory Mutual Research Corp. J.I.2B8A4.AM 4470 07.02.97 J.I.3B9Q1:AM 4470 01.08.98 J.I.ODOA8.AM 4470 07.09.99 1.I.ODIA8.AM 4470 -TAS 114 07.29:94 J.I.OY9Q5.AM 4470 - TAS 114 04.01.98 3029832 4470 - TAS 114 05.11.07 PRI Asphalt Technologies, Inc. GAF -012-02-02 Physical Properties 11.06.01 GAF -020-02-01 ASTM D 4977 02.01.02 IRT of S. Fl. 02-005 TAS 114 01.18.02 02-014 TAS 114 03.22.02 NOA No.: 07-1219.09 McLm E ffil Expiration Date: 11104/13 • f Approval Date: 03/20/08 Page 7 of 19 roduct Test Dimensions Specification Leak BusterTM MatrixTM 5 gallons 303 Fibered Aluminum Roof Coating Leak BusterTM MatrixTM 5 gallons 304 Non Fibered Aluminum Roof Coating APPROVED INSULATIONS: Product Name EnergyGuardTM RA, RN Composite A & N EnergyGuardTm Fiberboard EnergyGuardTM Permalite EnergyGuardTM GAFCANTTM EnergyGuardTM Permalite Recover Board Product Description ASTM D 2824 Fibered aluminum coating. ASTM D2824, Non-fibered aluminum pigmented, asphalt Type I roof coating. Table 2 Product Description. PoIyisocyanurate foam insulation Polyisocyanumte foam insulation with high density fiberboard or Permalite perlite insulation. Fiberboard insulation. Perlite insulation board. Cut perlite board Perlite recover board Manufacturer (With Current NOA) BMCA GAF Materials Corp. GAF Materials Corp. GAF Materials Corp. GAF Materials Corp. GAF Materials Corp. EnergyGuardTM Tapered Edge Strip Tapered perlite board GAF Materials Corp. EnergyGuardTM Perlite Perlite insulation board GAF Materials Corp. EnergyGuardTM High Density High density wood fiberboard insulation. GAF Materials Corp. Fiberboard EnergyGuardTM Composite EnergyGuardTM Composite RA Wood Fiber High Density Wood Fiberboard Perlite Insulation Dens Deck, Dens Deck® Prime, Dens Deck® Dura GuardTM Structodek SecurockTM Polyisocyanurate/wood fiberboard composite Polyisooyanurate/wood fiberboard composite Wood fiber insulation board Wood fiber insulation board Perlite insulation board Water resistant gypsum board Wood fiber insulation board Fiber reinforced roof board BMCA BMCA generic generic generic G -P Gypsum Corp Knight Celotex USO Corporation NOA No.: 07-1219.09 Expiration Date: 11/04/13 MIAMI a cour�nr Approval Date: 03/20/08 APPROVED I Page 6 of 19 APPROVED FASTENERS: Test Identifier Description Date Factory Mutual Research Corp. J.I.2B8A4.AM TAB1,E 3 07.02.97 Fastener Product Product Manufacturer Number Name Description Dimensions (With Current NOA) 1. Drf1I-TecT*m #12 Standard, Insulation fastener and Various GAF Materials Corp. # 14 and # 15 extra Heavy Base Play fastener for 05.11.07 PRI Asphalt Technologies, Inc. GAF -012-02-02 Duty Fastener, Heavy steel, wood & concrete GAF -020-02-01 ASTM D 4977 Duty Roofing Fastener decks. 02-005 TAS 114 2. Drill-TecTM ASAP Pre -assembled Drill- Various GAF Materials Corp. TecTM Fasteners and metal and plastic plates. 3. Drill-Tecrm #12 or #14 Base sheet fastening Various GAF Materials Corp. Standard screws with assembly. AccuTrac Plate 4. Drill-TecTM Galvalume Round Galvalume stress 3" and 3 %s" GAF Materials Corp. Plates plates. 5. Drill-TecTM Round polypropylene 3" and 3 %' GAF Materials Corp. Polypropylene Plates stress plates. 6. Drill-TecTM AccuTrac Square GalvalumO 3" Square GAF Materials Corp. Plate coated steel plate. EVIDENCE SUBMITTED: Test Agency Test Identifier Description Date Factory Mutual Research Corp. J.I.2B8A4.AM 4470 07.02.97 J.I.3B9Q1:AM 4470 01.08.98 J.I.ODOA8.AM 4470 07.09.99 1.I.ODIA8.AM 4470 -TAS 114 07.29:94 J.I.OY9Q5.AM 4470 - TAS 114 04.01.98 3029832 4470 - TAS 114 05.11.07 PRI Asphalt Technologies, Inc. GAF -012-02-02 Physical Properties 11.06.01 GAF -020-02-01 ASTM D 4977 02.0I.02 IRT of S. Fl. 02-005 TAS 114 01.18.02 02-014 TAS 114 03.22.02 NOA No.: 07-1219.09 Expiration Date: 11/04/13 i Laos co U l m' Approval Date: 03/20/08 JPROFj— Page 7 of 19 Deck Type 1: Wood, Non -insulated Deck Description: 19/32" or greater plywood or wood plank decks System Type E: Base sheet mechanically fastened. All General and System Limitations shall apply. Fire Barrier: FireOutTM Fire Barrier Coating, VersaShieie Nan -Asphaltic Fiberglass -Based (optional) Underlayment or SecurockTM. Base sheet: GAFGLAS" #80 ULTIMATM Base Sheet, STRATAVENTO EliminatorTM Nailable, RUBEROV Modified Base Sheet, RUBEROID® 20, RUBEROV Heat-WeldTM Smooth or RUBEROID® Heat-WeldTM 25 base sheet mechanically fastened to deck as described below; Fastening Options: GAFGLAS® Ply 4, GAFGLAS® Flex PIyTM 6, GAFGLAS® #75 Base Sheet or any of above Base sheets attached to deck with approved annular ring. shank nails and tin caps at a fastener spacing of 9" o.c. at the lap staggered and in two rows 12" o.c. in the field. (Maximum Design Pressure —45 psf, See General Limitation #7) GAFGLAS® Ply 4, GAFGLAS® Flex PIyTM 6, GAFGLAS® #75 Base Sheet or any of above Base sheets attached to deck with Drill-TecTM #12 standard, #14 or # 15 Screws and 3" Drill-TecTM steel plate or Drill-TecTM AccuTrac Plates, 12" o.c. in 3 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 12" o.c. in the field of the sheet. (Maximum Design Pressure —45 psf, See General Limitation #7) GAFGLAS® Flex PIyTM 6, GAFGLAS® #75 Base Sheet or any of above Base sheets attached to deck with approved annular ring shank nails and tin caps at a fastener spacing of 9" o.c. at the 4" lap staggered and in two rows 9" o.c. in the field. (Maximum Design Pressure —52.5 psf, See General Limitation #7) GAFGLAS® #80ULT1MATM, RUBEROID®20, RUBEROID®Mop Smooth, base sheet attached to deck with approved 1'/a" annular ring shank nails and inverted 3" steel plate at a fastener spacing of 9" o.c. at the 4" lap and in two rows staggered with a fastener spacing of 9" o.c. in the center of themembrane. (Maximum Design Pressure --60 psf, See General Limitation #7) GAFGLAS`e #75 Base Sheet or any of above Base sheets attached to deck with Drill-TecTM #12 standard, #14 or # 15 Screws and 3" Drill-TecTM steel plate or Drill-W'N AccuTrac Plates, 12" o.c. in 4 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 9" o.c. in the field of the sheet. (Maximum Design Pressure —60 psf, See General Limitation #7) Any of above Base sheets attached to deck approved annular ring shank nails andY' inverted Drill-TecTM insulation plates at a fastener spacing of 9" o.c. at the 4" lap staggered in two rows 9" in the field. (Maximum Design Pressure —60 psf, See General Limitation #7) NOA No.: 07-1219.09 IAMbDAQ ouNTY Expiration Date: 11/04/13 APPROVED Approval Date: 03/20/08 Page 17 of 19 GAFGLAS* #75 Base Sheet or any of above Base sheets attached to deck with Drill-TecTm #12 standard, #14 or # 15 Screws and 3" Drill-TecTM steel plate or Drill-TecTM AccuTrac Plates, 8" o.c. in 4 rows. One raw is in the 2" side lap. The other rows are equally spaced approximately 9" o.c..in the field of the sheet. (Maximum Design Pressure —75 psf, See General Limitation #7} Ply Sheet: One or more plies of GAFGLAS* PLY 4, #80 ULTIMA, RUBEROIDtD MOP Smooth or RUBEROID* 20 adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 2040 lbs./sq. Cap Sheet: (Optional) One ply of GAFGLAS® Mineral Surfaced Cap Sheet or GAFGLAS* EnergyCap m Mineral Surfaced Cap Sheet adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbs./sq. Surfacing: (Optional, required if RUBEROID* MOP Smooth or RUBEROV 20 is top membrane) Install one of the following. 1. Gravel or slag applied at 4001bs./sq, and 300 IbsJsq. respectively in a flood coat of approved asphalt at 60 lbs./sq. or applied in a flood coat of Leak BusterTM MatrixTM 103 Cold Process Adhesive applied at a rate of 3 galJsq. 2. GAFGLAS* Mineral Surfaced Cap Sheet, GAFGLAS* Energy Cap Mineral Surfaced Capsheet adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbs./sq. 3. Leak BusterTM MatrixTM 303 Premium Fibered Aluminum Roof Coating,.at 1.5 galJsq. 4. Leak BusterTM MatrixTM 715, Leak BusterTM MatrixTM 322, TOPCOAT® MB+, TOPCOAT* Fireshield Elastomeric Roofing Membrane, applied at 1 to 1.5 gal./sq. 5. Leak BusterTM MatrixTM 602 MB Xtra. Elastomeric Roofing Membrane, EnergyCote® roof coating applied at 1 to 1.5 gal./sq. 6. TOPCOAT* Surface Seal, TOPCOAT* Fireshield® SB Solvent based Elastomeric Roofing Membrane applied at Ito 1.5 gal./sq 7. Advance Green Technologies Photovoltaic Laminate solar energy collector auxiliary roof equipment installed in compliance with manufacturer's specifications and applicable Building Codes. Maximum Design Pressure: See Fastening Above NOA No.: 07-1219.09 Expiration Date: 11/04/13 utirir Approval Date: 0/20/08 Page 18 of 19 WOOD DECK SYSTEM LIMITATIONS: 1 A slip sheet is required with Ply 4 and Flex Plyrm 6 when used as a mechanically fastened base or anchor sheet, 2. Minimum %a" Dens DeckTM or '/Z" Type X gypsum board is acceptable to be installed directly over the wood deck. GENERAL LIARITATIONS: 1. Fire classification is not part of this acceptance, refer to a current Approved Roofing Materials Directory for fire ratings of this product. 2. Insulation may be installed in multiple layers. The first layer shall be attached in compliance with Product Control Approval guidelines. All other layers shall be adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbs./sq., or mechanically attached using the fastening pattern of the top layer 3. All standard panel sizes are acceptable for mechanical attachment. When applied in approved asphalt, panel size shall be 4' x 4' maximum. 4. An overlay and/or recovery board insulation panel is required on all applications over closed cell foam insulations when the base sheet is fully mopped. If no recovery board is used the base sheet shall be applied using spot mopping with approved asphalt, 12" diameter circles, 24" o.c.; or strip mopped 8" ribbons in three rows, one at each sidelap and one down the center of the sheet allowing a continuous area of ventilation. Encircling of the strips is not acceptable. A 6" break shall be placed every 12' in each ribbon to allow cross ventilation. Asphalt application of either system shall be at a minimum rate of 12 lbs./sq. Note: Spot attached systems shall be limited to a maximum design pressure of -45 psf. S. Fastener spacing for insulation attachment is based on a Minimum Characteristic Force (F') value of 275 Ibf., as tested in compliance with Testing Application Standard TAS 105. If the fastener value, as field- tested, are below 275 lbf. insulation attachment shall not be acceptable. 6. Fastener spacing for mechanical attachment of anchor/base sheet or membrane attachment is based on a minimum fastener resistance value in conjunction with the maximum design value listed within a specific system. Should the fastener resistance be less than that required, as determined by the Building Official, a revised fastener spacing, prepared, signed and sealed by a Florida Registered Engineer, Architect, or Registered Roof Consultant may be submitted. Said revised fastener spacing shall utilize the withdrawal resistance value taken from Testing Application Standards TAS 105 and calculations in compliance with Roofing Application Standard RAS 117. 7. Perimeter and corner areas shall comply with the enhanced uplift pressure requirements of these areas. Fastener densities shall be increased for both insulation and base sheet as calculated in compliance with Roofing Application Standard RAS 117. Calculations prepared, signed and sealed by a Florida registered Professional Engineer, Registered Architect, or Registered Roof Consultant (When this limitation is specifically referred within this NOA, General Limitation #9 will not be applicable.) 8. All attachment and sizing of -perimeter nailers, metal profile, and/or flashing termination designs shall conform with Roofing Application Standard RAS 111 and applicable wind load requirements. 9. The maximum designed pressure limitation listed shall be applicable to all roof pressure zones (i.e. field, perimeters, and corners). Neither rational analysis, nor extrapolation shall be permitted for enhanced fastening at enhanced pressure zones (i.e. perimeters, extended corners and corners). (When this limitation is specifically referred within this NOA, General Limitation #7 will not be applicable.) 10.. All products listed herein shall have a quality assurance audit in accordance with the Florida Building Code and Rule 9B-72 of the Florida Administrative Code. END OF THIS ACCEPTANCE NOA No.: 07-1219.09 Expiration Date: 11/04/13 rtuu+n.oa Ecom n Approval Date: 03/20108 Page 19 of 19 IA ' MIAMI-DADE 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 (NOA) www.miamidade.gov/vera 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# 11-0124.04 and consists of pages I through 7. The submitted documentation was reviewed by Alex Tigera. NRS' 816,APPROVED NOA No.: 12-0228.18 Expiration Date: 05/10/17 Approval Date: 05/10/12 Page 1 of 7 ROOFING COMPONENT APPROVAL: Category: Roofing Sub Category: Roof tile adhesive Materials: Polyurethane SCOPE: This approves 3MTM 2 -Component Foam Roof Tile Adhesive AR -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 1.61bs./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./Ft' Moisture Vapor Transmissions 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 MIAMI-DADE COUNTY 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: Southwest Research Institute 01-6743-011 Test Agency Test Identifier Test Name/Renort Date Center for Applied Engineering #94-060 TAS 101 04/08/94 257818-1 PA 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 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 3MTm 2 -Component Foam Roof Tile Adhesive AH - 160 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 rile adhesive with their tile assemblies shall test in accordance with TAS 101 with section 10.4 as modified herein. F W 2 F'= 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 tile 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 3MTM 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 beset to deliver 0.0175 to 0.15 pounds per tile 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 RTF 1000 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 tile 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 1 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 Nall through plastic cement Paddy (Beneath Tile) Undedaymem e 1 Paddy (Beneath Tile) 101n. In S, EaveCourse Fascia Eave course only: Ease Chxmre Keep adhesive approx. Eave Was 41n. up from weepholes Nail through plastic cement Paddy (Beneath Tile) Undedaymem Eave Was Pastia Weephole Eave course only. Eave closure Keep adhesive approx. Imp edge 4 in. up from waspholes 1) Place enough adhesive to achieve 17 to 23 Optional2As for square inches in contact with the pan the steep pitch appgcatons Nail through plastic cement 2) Tum covers upside down. Place adhesive 112 in. To 1 in. From outside edge of cover die. Then Install the die. o Underiaymem Kemov top portion -Sheathin of the save g course Cove. Abut W second coura of Optional pan tiles. Ensure save and of Point -up pan and cover tiles are P Martin flush at am line., on longitudinal edges of toe Eave closure Weephole Fascia (mortar shown) I NOA No.: 12-0228.18 rntarafnanE cou1VTY Expiration Date: 05/10/17 e a Approval Date: 05/10/12 Page 5 of 7 ADHESIVE PLACEMENT DETAIL 2 SINGLE PATTY Nall through Plastic cement Paddy (Beneath Tile) Nall through plastic cement Paddy (Beneath Tile) Undedayment Undedayment 71n. :, 711"', Em Course Fascia Fascia weephole Eave Course Eave closure Em Closure Orlp edge NOA No.: 12-0228.18 10111"AMAM ECOUNTYM Expiration Date: 05/10/17 �IIIIIllIllimmuslaqUIEW Approval Date: 05/10/12 Page 6 of 7 Nall through plastic cement I 101!1- Single w 31n underlieo T x 3 in. " Single paddy on 21 in. under- layment Single I on top ADHESIVE PLACEMENT DETAIL 3 DOUBLE PATTY Paddy Nall through plastic cement (between tile) Underlayment Paddy (under file) Nall through plastic cement Single paddy under Ole Single paddy x 3 I P31"In n. 3 In. between die 3 In.x 3 In. 4 In. n Single 4 In. 2 In. 2 paddy on Single paddy under- on top of the layment Of 7�11 Eave L- Single paddy ddy Eave Eave course course on top of the Eave m a 21n. X 71n. madleum 4 Course Cour, Ize paddy eave size paddy 0 ve Fascia course only Nall through plastic cement Single paddy under Ole Single paddy between die 3 In.x 3 In. 4 In. Single paddy on underlayment 2 n. Single paddy Eave Closure on top of the 2 In. x 7 In, medium Eave L- size paddy save course only Fascia I END OF THIS ACCEPTANCE Single paddy under file Single eddy between the 2 In, x 7 In. medium size paddy save course only <`.. Fascia Weephole Eave closure - Drip edge NOA No.: 12-0228.18 Expiration Date: 05/10/17 Approval Date: 05/10/12 Page 7 of 7 MM• � � M MIAMI-DADE COUNTY PRODUCT CONTROL SECTION BUILDING AND NEIGHBORHOOD COMPLIANCE DEPARTMENT (BNC) 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 (NOA) ww i mid d ov/b ildin Eagle Roofing Products LLC 1575 East C.R. 470 Sumterville, FL 33585 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 (A]H.n. 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: Malibu Concrete 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 renews NOA #06-0526.09 and consists of pages 1 through 7. The submitted documentation was reviewed by Alex Tigera. NOA No.: 11-0321.01 t71AM4In"M UN7Y Expiration Date: 10/05/16 �n1yaw-Aw Approval Date: 05/12/11 Page 1 of 7 ROOFING ASSEMBLY APPROVAL Cat.__ eao_ry_: Roofing Sub Cateeorv: Roofing Tiles Material: Concrete I. SCOPE: This approves a system using Eagle Roofing Products Malibu Concrete Roof Tile, as manufactured by Eagle Roofing Products LLC in Sumterville, FL. and described in Section 2 of this Notice of Acceptance. For locations where the pressure requirements, as determined by applicable Building Code does not exceed the design pressure values obtained by calculations in compliance with RAS 127 using the values listed in section 4 herein. The attachment calculations shall be done as a moment based system. 2. PRODUCT DESCRIPTION: Manufactured by Test Product Applicant Dimensions Specifications Description Malibu Concrete Tile 1=17" TAS 112 Low profile, interlocking, high pressure w = 121/211 extruded concrete roof tile equipped with %" thick three nail hole and double roll ribs. For direct deck or battened nail -on, mortar or adhesive set applications. Trim Pieces 1= varies TAS 112 Accessory trim, concrete roof pieces for w = varies use at hips, rakes, -ridges and valley varying thickness terminations. Manufactured for each tile profile. NOA No.: 11-0321.01 MIAMi•DAUE ca YY Expiration Date: 10/05/16 JAPPROVED1 Approval Date: 05/12/11 Page 2 of 7 2.1 EVIDENCE SUBMITTED: Test Asenc Test Identifier Test Name/Renort Date PRI Construction Materials PRI06178 TAS 112 08/23/06 Technologies Redland Technologies 7161-03 Static Uplift Testing Dec. 1991 Appendix III TAS 102 & TAS 102(A) Redland Technologies 7161-03 Wind Tunnel Testing Dec. 1991 Appendix 11 TAS 108 (Nail -On) Redland Technologies P0402 Withdrawal Resistance Testing of screw Sept. 1993 vs, smooth shank nails The Center for Applied 94-060B Static Uplift Testing March, 1994 Engineering, Inc. TAS 101 (Adhesive Set) The Center for Applied 94-084 Static Uplift Testing May 1994 Engineering, Inc. TAS 101 (Mortar Set) Redland Technologies P063I-0I Wind Tunnel Testing July 1994 TAS 108 (Mortar Set) Redland Technologies Letter Dated Aug. 1, Wind Tunnel Testing Aug. 1994 1994 TAS 108 (Nail -On) Professional Service 224-47099 Physical Properties Sept. 1994 Industries, Inc. TAS 112 The Center for Applied 25-7094-1 Static Uplift Testing Oct. 1994 Engineering, Inc. TAS 102 (4" Headlap, Nails, Direct Deck, New Construction)D The Center for Applied 25-7094-7 Static Uplift Testing Oct 1994 Engineering, Inc. TAS 102 (4" Headlap, Nails, Battens) The Center for Applied 25-7094-4 Static Uplift Testing Oct. 1994 Engineering, Inc. TAS 102 (4" Headlap, Nails, Direct Deck, Recover/Reroof) The Center for Applied Project No. 307025 Wind Driven Rain Oct. 1994 Engineering, Inc. Test #MDC -76 TAS 100 The Center for Applied 25-7183-1 Static Uplift Testing Feb. 1995 Engineering, Inc. TAS 102 (2 Quik -Drive Screws, Direct Deck) The Center for Applied 25-7183-2 Static Uplift Testing Feb. 1995 Engineering, Inc. TAS 102 (2 Quik -Drive Screws, Battens) NOA No.:11-0321.01 14"l-DADE CExpiration Date: 10/05/t6 Approval Date: 05/12/11 Page 3 of 7 The Center for Applied 25-7214-2 Static Uplift Testing March, 1995 Engineering, Inc. 25-7214-6 TAS 102 (1 Quik -Drive Screw, Direct Deck) (I Quik -Drive Screw, Battens) Celotex Corporation 528454-2-1 Static Uplift Testing Sep. 1998 Testing Services 520109-2 TAS 101 Dec. 1998 Walker Engineering, Inc. Evaluation Two Patty Adhesive Set System April 1999 Calculations Walker Engineering, Inc. Evaluation 25-7183 March 1995 Calculations Walker Engineering, Inc. Evaluation 25-7094 February Calculations 1996 Walker Engineering, Inc. Evaluation 25-7496 April 1996 Calculations Walker Engineering, Inc. Evaluation 25-7584 December Calculations 25-7804b-8 1996 25-7804-4 & 5 25-7848-6 Walker Engineering, Inc. Calculations Aerodynamic Multiplier Sep. 2006 Walker Engineering, Inc. Calculations Restoring Moment Due to Gravity Sep. 2006 3. LIMITATIONS: 3.1 Fire classification is not part of this acceptance. 3.2 For mortar or adhesive set tile applications, a static field uplift test in accordance with TAS 106 may 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. MIAMMADE COUNTY NOA No.:11-0321.01 Expiration Date: 10/05/16 Approval Date: 05/12/11 Page 4 of 7 4. INSTALLATION 4.1 Eagle Roofing Products LLC Malibu Concrete 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 (I x w) Tile Profile Weight -W (ibf) Length -I (ft) Width -w (ft) Malibu Tile 9.5 1.417 1,04 Table 2: Aerodynamic Multipliers - ft Tile x (ft) x (fe) Profile Batten Application Direct Deck Application Malibu Tile 0.305 0.282 Table 3: Restoring Moments due to Gravi - M ft -Ib Tile 3":12" VA 2" 5":12" 6":12" T':12" or Profile plywood) Malibu Tile 2-10d Rin Shank Nails 1-10d Smooth or Screw Shank Nall 27.8 8.8 Malibu Tile Battens Direct Battens Direct Battens I Direct Battens Direct re or Battens Direct 7.1 Deck Deck I Deck. Deck Deck 6.30 6.65 1 .21 6.54 6.08 1 6.41 5.93 6.25 5.77 6.08 Table 4: Attachment Resistance Expressed as a Moment - Mf (ft-lbf) for Nall -On Systems Tile Profile Fastener Type Direct Deck (min 15132" Direct Deck (min. 1913211 Battens plywood) plywood) Malibu Tile 2-10d Rin Shank Nails 1-10d Smooth or Screw Shank Nall 27.8 8.8 37.4 11.8 28.8 4.1 2-10d Smooth or Screw Shank Nails 16.4 21.9 7.1 1 #8 Screw 2 #8 Screw 1-10d Smooth or Screw Shank Nall Field Cli 25.8 47.1 24.3 26.8 47.1 24.3 22.9 49.1 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 1 Installation with 2-10d Rin Shank Nalls 43.0 67.5 50.9 a 4" the headlap and fasterners are looted a min.of 2%" from head o�ffle. NOA No.:11-0321.01 MWMI•DADECOUMTY Expiration Date: 10/05/16 ` V M r Approval Date: 05/12/11 Page 5 of 7 Table 6: Attachment Resistance Expressed as a Moment Mf (ft-lbf) for Two Patty Adhesive Set Systems Tile Profile Tile Application Minimum Attachment Resistance Malibu Tile Adhesive 26.1 2 See manufactures component aoDroval for installation requirements. 3 Flexible Products Company TileBond Average weight per patty 11.4 grams. Polyfoarn Product Inc. Average weight per paU S grams, Table 6: Attachment Resistance Expressed as a Moment - Mf (ft-lbf) for Single Pat Adhesive Set Systems Tile Profile Tile Application Minimum Attachment Resistance Malibu Tile Polyfoam Pol ProT"" 86.61 Pol foam Poi ProTm 46.66- 14 Lame paddy placement of 54 rams of Pol ProTM. 20.60 4 Medium paddy placement of 24 rams of Pol ProTM. Table 7: Attachment Resistance Expressed as a Moment - Mf(ft-Ibf) for Mortar Set Sy stems Tile Tile Attachment Profile Application Resistance Malibu 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". ::-I EASE .% FLORIDA MALIBU CONCRETE ROOF TILE LABEL, SUMTERVILLE. PLANT (LOCATED ON UNDERSIDE OF TILE) NOA No.: 11-0321.01 MIAMMME COUNTY Expiration Date: 10/05/16 " `• " Approval Date: 05/12!11 Page 6 of 7 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 Building Official or Applicable building code in order to properly evaluate the installation of this system. PROFILE DRAWING NAM MALIBU CONCRETE ROOF TILE END OF THIS ACCEPTANCE �,Iqr NOA No.:11-0321.01 M�aMNnanEco�niry Expiration Date: 10/05/16 Approval Date: 05/12/11 Page 7 of 7 .%. it Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNERS'S AFFIDAVIT OF EXEMPTION ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR EXISTING SITE - BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PERSUANT TO SECTION 553.844 F.S. To: Miami Shores Village Building Department Date: --f—z /s 10050 NE 2nd Ave Miami Shores, FI 33138 Re: Owner's Name: 2%r� ,3 4 i�- Property Address: 6 z- , v s 67, Roofing Permit Number: Dear Polding Official: l 161r'Y'e'96 -2'0 i32 certify that I am not required to retrofit the roof to wall connections of my bu' ing 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. o The buNding Mas constructed in compliance with the provisions of the Florida Building Code (FBC) or with the provisions of 94 e ' n f the South Florida Building Code (1994 SFBC SignalWel: Print Name State of Florida County of Dade The undersigned, being the first duly swom, Sworn to and subscribed before me this Notary Public, Sate of Florida at and says that he/she is the owner for the above property mentioned. day of -2-0/3 • When the just valuation of the stru se of ad valorem t4ation is equal to or more than SFBC. Then you must provide a building application from a General Revised on 5/21/2009 HECTOR PEREZ Notary Public - State of Florida k14&omm. Expires Jul 20. 2014 Commission #tr EE 5293 for the Roof to Wall connection Hurricane Mitigation. nor a 1994 7/5/13 My Home Show Me: Property Information ' Search By: Selec t lam Ts:xt only . Prooerty Appraiser Tax E tirrator J Pro �.rtv A ,raiser Tax Ca arisor€ J Portability S.O.H. Calculator Summary Details: M i ami -Dade My H orae )lio No.: X11-2136-011-0030 openly:162_ E 108 ST rn. ailing SCOTT B CLARK & —PETER) idress: iOLDE JTRS NE 108 ST MIAMI SHORES 33161 7036_ Property Information Hmary Zone: 1000 SGL FAMILY - 21f01- 2300 SQ LUC: 0001„RESIDENTIAL -F SINGLE FAMILY QBaths: 3/1 loons: 1 _ ..,, Units:— 1 4dj Sq Footage: 1,766 - _ z .z.< Lot Size 9,225 SQ FT ear Built 1951 .£ �36 52 41 PB 52 33 DUNNINGS MIAMI SHORES EXT NO 7 LOT 3 BLK 210 Legal Description: SLOT SIZE 75.000 X 123 OW,'e 119968-3350 25377-4053 €1001 1 OR 19968-3350 Assessment Information: Year:2013 2012 Land Value i $87,509 1$75,421 F jBuilding Value $121 301_ $135 5F' Market Value: ' $208,810 x$211 011, Assessed Value $186,924 183 800 lExemption Information: Year: 2013 2012 1 LH.om'�elgad: $25,000$25,000 . omestead YES YES Taxable Value Information: Year: 2013 20121 „ . 1 TaXln mm Applied Applied g Exemption/ Exemption/ Authority:; j Taxable Vafue Taxable Value: t Regional: $50,0_00/$136,924 $50,000/$133,800 County: 450060) i,80 gisims2.miaffidade-gov/myhonie/propmap.asp MIAMIDADN * q q 9 11:� n _ al Photography -2012 0 112 ft .y._i•ion3e I P,rerty irtformatiottI araPerty_i'axgs My NeqqhtLorhood I Pro a s raiser Home I tlsir ri Our Site I Plione Directory I Privacy I gisclaimer jjjjNjNEMNW@'�'p you experience technical difficulties with the Property Information application, or wish to send us your comments, questions or suggestions please email us at Webmaster. Web Site ©2002 Miami -Dade County. All rights reserved. Legend Property Boundary Selected Property Street Highway Miami -Dade County Water N W+9 S 1/2 POTSmodem5 To:3057568972 1 800 685 7530 (I of 1) 07-05-2013 03:09 PM -0400 STATE OF FLORIDA 139PARTMNT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET • TALLAHASSEE FL 32399-0783 ROJAS EDWAIM ANTHONY CME 6ONSTRUCTXOX MANAGEMENT ENTERPRISES, INC. 7406 W 14TH CT HTAT MAH FL 33014 (850) 487-1395 Congratulationsl With this license you become one of the nearly one million FLORIDA AC# 6 20 580 k Floridians licensed by the Department of Business and Professional Regulation. 'DEPARTMENT OF BUSINESS AND Our professionals and businesses range from architects to yacht brokers, from PROFESSXOq4 boxers to barbeclue restaurants, and they keep Fbdda's economy strong. CGC061059 # 'V 1* 12 128011472 Ever y day we work to improve the way we do business In order to serve you better, For Information about our services, please log onto www I -myfloddallcense.com. *G CTOR There you can find more Information about Our divisions and the regulations that .:ROL7A$'j* ED. impact you, subscribe to department newsletters and learn more about the Em i C Department's Initiatives. 0Ns dgM=T ENT Our mission at the Department Is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers - of eb.489 Thank you for doing business in Florida, and congratulations on your new license! aspiration dater arraXS CERTIFIRD undar tai provicions 31, 2024 L1207170131vs 2 .......... `0DETACH HERE ArF DZPARTXCONXNT OF BUSIX9?&#ffSTRUCTION— MY S SEQ#L12071701312 07117120121128013-472 The GENERAZ CONTRACTOR Named below is CERTIFIED Under the provisLons of Chat4i Xxpiration date: AUG 31, 20Y4..w ROGTAS EDWARD ANTHONY T- 6ONSTRUCTION MANAG M5 W 14TH CT `,` �',:..r x ;� $NC HZALEUMFL 3301`]: RICK SCOTT GOVERNOR DISPLAY AS REQUIRED BY LAW K= LAWSON SECRETARY POTSmodem5 To:3057568972 1 800 685 7530 (1 of 1) 07-05-2013 03:21 PM -0400 JEFF ATWATER STATE OF FLORIDA CHIEFFINANC"OPITICER 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 1=loride Workers' Compensation law. EFFECTIVE DATE: 07/1612012 EXPIRATION DATE: 07/16/2014 PERSON- ROJAS EDWARD A FEIN: 263381670 BUSINESS NAME AND ADDRESS: CME CONSTRUCTION MANAGEMENT ENTERPRISES INC 7405 M 14 CT HIALEAH FL 33014 SCOPES OF BUSINESS OR TRADE: I- ROOFING 2- LICENSED BUILDING CONTRACTOR 3- LICENSED GENERAL CONTRACTOR 4- CERTIFIED ROOFING CONTRACTOR IWORTANTI Parsusat to Chapter 440 . GSDAI. F.S., to officer of a corporation who elects exemption from this ehaptor by Illrag a teettiieste of election ander ibis teClioa may out recover benefits or compeasallon ander this Chapter. Panaanl to Cbepler 446.0MIA F.S.. Certificates of election to be etempt.._ apply only within the scope at the bashtess or trade lilted an the notice a1 election to be exempt. Pursuant to Chapter 440.06113). F.S.. Notices at oloaiaa to be *tempt and cartilicates of 01011104 to be exempt *Mit bre subject to revocation if, at nay time oiler the filing of the notice or Ike Iaaaance of the Certificate, me period named on the notice or Cenilical* no laoger meed The requlremeou of Ibis section for Issuance of a certificate. The department shall revoke a carlificste $i any time for fitters of the person named am tho certillcato to meal the requirements of tats section. DwC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 QUESTIONS? fS501 413-1609 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO 8E EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW 0 EFFECTIVE 07/18/2012 EXPIRATION DATE: 07/10/2014 PERSOi1t EDWARD A RO%)AS FElltk 263361670 BUSINESS NAME AND ADDRESS;- ME DDRESS:ME CONSTRUCTION MANAGEMENT ENTERPRISES JNC 7405 W 14 LIT HIALEAK Ft 33014 SCOPE OF BUSINESS OR TRADE 1- ROOFING 2- UCENSED MWING CONTitACTOR 3- LICENSED CENeRAL CONTRACTOR 4- CERTIPRO ROOFING CONTRACTOR IMPORTANT O 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 L under this section may not recover benefits or compensation under This D chapter. Pursuant to Chapter 440.05112% F.S., Certificates of election to be H exempt- apply only within the scope of the business or trade listed on R the notice of election to be exempt. E Pursuant to Chapter 440.051131, F.S., Notices of election to be exempt and certificates of election to be exempt shell 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 noted on the certificate to meet the requirements of this section. CUT HERE QUESTIONS? (850) 413-1609 • Carry bottom portion on the job, keep upper portion for your records. OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 07/05/2013 03:31 7862067066 STATEWIDE INSURANCE PAGE 01 . CERTIFICATE OF LIABILITY INSURANCE FEATS( 0710113 0113 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 DOS NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 1NSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the eertHicato holder is an ADDITIONAL INSURED, the pollcy(iss) must be endorsed, If SUBROGATION IS WAIVED, Subject fa the tents *M Conditions of the policy, Certain poliCHta may raqutre An andontamariL A statemerR on this certificate does not canter rights to the cerNcata holder In lieu of such endorsemellt(s). PRODUCER Galloway Insurance 17354 South DWe Highway Miami, FL 33157 Phone (305)255-1661 Fax (786)206-7066 INSURED CME, ConatrUOLTOn Management Enterprise*, Ino, 7405 West 14th Court Hialenh, Flarlda MW14 Jose Insurance 206-7086 INSURERF, _ -- COVERAGES CERTIFICATE NUMBER: T -<.. .— REVISION NUMBER: THiB IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR£C NAibiED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 CONDrrIONE OF SuOH POLICIES. UNIT✓, SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTti TYPE OF I(SIIRAaI(:E Pd1.ICYNu6ABER POLICY FIT (MIdNDD1YYYYI PO M LIM11's GENERAL LIABILITY _... _._ — EACH OCCURRRNCE $ 1,000,000 COMMERCIAL GENERALLIABILrTY PREMISE$ Eaowirenw _...5 900,000 A ❑ [:1CLANtS-MADE V OCCUR NS -1209969-9 MED EXP (Any one person S - 5,000 PD:Ded:$1:000PerClaim 03!31/2093 03/39!2014 PMSONAL&AMINJURY g 1,nnn,onn 71GENERALAGGREGATE WILL AGGREGATE umrr APPLIES PER: S 2,000,000_ © POLICY ❑ I'M- LOG PRODUCTS - COMP/Of AGO $ 2,000,000 !...J , 3 AUTOMOIIILE LIABILITY COMBINED SINGLE LIMIT ❑ ANYAUTO (Eaae6desri) i ❑ ALL OWNED AUTOS BODILY INJURY (Por pomon) 6 ❑ SCHEDULED AUTOS BODILY IPIJURY (P+eracddarlt HIRFAlT r! rIC PROPERTY DAMAGE -- - -� ❑ (Pat *W dit) NON -OWNED AUTOS 6 ❑ UMOrULLA LLD a OCCUR ❑ Ex"" LIAR ❑ mAiMs mm DEDUCTIBLE AND EtIPLOYEW NIA DESORmTwN OF OPWTIONS ! LOCATIOM3 I VeHOLES {AtfaGM ACORD 101, pdcu:w ,I tiarttarka Schedule, I< Nnvre apace la reWiNad) General contractor ... Roofing Included... CERTIFICATE HOLDER Village of Miami Shores 10050 NE 2nd Avenue Miami Shores, Florida 33138 AIM; Building Dept Fax # 305-756-8972 EL SACH ACCIDENT EL DISEASE - EA EMPLOYE] EL. DISEASE • POLICY LIMIT CANCELLATION —7" SNOut.D ANY OF Tura Asow DucRIBCO PouciaS BE CANCELLED BEFORE THE EXPIRATI014 DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED Jose H Romero 19884009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) QF ACORD name and logo are registered marks of ACORD Date CERTIFICATE OF LIABILITY INSURANCE 7/5/2013 Producer: Lion Insurance Company This Certillicate Is lismad as a nuftw of lnfm=aUon only and confers no rights 2739 U.S. Highway 19 N. upon the Certiftate Holder. Thtr Catillicate does not amend, extend or alter Holiday, FL 34691 the coYaffor"by the policies below. 1 (727) 938-5562 Insurers Affording Coverage MAIC # Insured: South East Personnel Leasing, Inc. 8r Subsidiaries Insurer A. Lion Insurance Company 33075 2739 U.S. Highway 19 N. insurer B: Holiday, FL 34691 lmurerC: Insurer D: Insurer E: Coverages Thapoffdesofimm=lsWdbOloWhMbeWimodtoftimradmmedabmforftpWqWodh%UcMed.rg any req cement, tern or on clarryconlradorollwdounotwM We certificate may be issued or may perlain, the Insurance afforded by ft policies described herein is subject to all the terms, wcl sfors, and conditions of suxdm policies. Aggregate limb shown may have been reduced by paid claims. IAISR ADDL Policy Effective Policy Expiration Date Limits LTR NSRD Type of insurance Policy Number Date (MM/DD/YY) (MM/DD/YY) GENERAL LIABILITY EachOoaarence $ Commercial General Liability Damage to tarried) Claims Made Occur ® $ Mod Exp Personal Adv Injury neral aggregate limit applies per. General Aggregate Policy ® Project ® LOC Producis - Comps AM UTOMOBILE LIABILITY mil Combined Single Limit (EA AcddeM $ ArryAurto Bodily Ali Omied Autos (Per Person) Scheduled Autos Bodily trdmsy Hired Autos Non{Amed Audos (Per Acddent) Property Damage (Per Accident) EXCESSIUM13RELLA LIABILITY Ear Oomnerxe RO=jr ® Claims (wade Deductible Aggragata . A Workers Compensation and WC 71949 01/01/2013 01/01/2014 x I wC Stair oTH- Employers' Llabllty, tory Limits ER E.L. Each Accident $11000.ODO Any proprietodpartnedexecutive offbcedrrember E.L. Disease - Ea Employee $1,000,00U excluded? NO If Yea, describe udder special provisions below. ELL Disease - Policy Limits $1.0(10,000 Other Lion Insurance Company is A.N. Best Company rated A- (Excellent). AMB # 12616 Descriptions of OperatlonsRAcatlons/Vehlobs/Exclusions added by Endorsement/Special Provisions: Client W: 81-65-878 Coverage only applies to acute employee(s) of South East Employee Leasing Services, Inc. that are leased to the following "Client Company": Ocean Contractors Group LLC Coverage only applies to Injuries incurred by South Fast Personnel Leasing, Inc. & Subsidiaries active employee(s) , while working in: R- Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937-2138 or by calling (727) MB-5562. Project Name: ZOBEL, 62 NE 108 ST, MIAMI SHORES, FL 33138 ISSUE 07-05-13 (TLD) Betiln Data: 12/28/2011 CERTIFICATE HOLDER CANCELLATION! VILLAGE OF MIAMI SHORES Stoudd aryoft o above described policies be cancefied before the Wphationdate ftreO, the Issuing bmsurervAll endeavor tomall 30days wriliennotice todecer"cateholder nu to lie eft,buttailmeatodososhell Impose no BUILDING DEPARTMENT ob®gation ornabinyof airy Idrd upon the Insurer, r1s ageuVs orrepreserda6ves. 10050 NE 2ND AVE MIAMI SHORES, FL 33138 �/� r ced By& ltetu�rn To: asSher,.',Michael G. Sherman meria Avenue Gables, FL 33134 111 lilt 111111111111111111111.1,01111111111 C --FN- 28=13RO0 a 0, OR 8k 28706 Pas 2278 - 22801 tapas) RECORDED 07/02/2013 11:39:29 DEED DOS' TAX 2t7O9.00 .. HA�VEY"R1101�1l;..�LEfi� OF>. RT : MIAMI-DADE COUNTYP FLORIDA Property Appraisers Parcel Identification Number: 11-2136-011-0030 k"34,111 MR I kkl��,` Made this I' day of July, 2013, A.D. by SCOTT B. CLARK, an unmarried man, and PETER J. OLDE, an unmarried man, whose post office address is 2885 Hidden Harbor Court, Dania Beach, Florida 33134 (hereinafter called the "Grantor"), to MARCOS E. ZOBEL and IRIS ACOSTA, husband and wife, whose post office address is 62 NE 108 Street, Miami Shores, Florida 33161 (hereinafter called the "Grantee"): (Whenever used herein the term "grantor" and "grantee" include all the parties to this instrument and the heirs, legal representatives and assigns of individuals, and the successors and assigns of corporations) WITNESSETH, that the Grantor, for and in consideration of the sum of Ten Dollars ($10.00) and other good and valuable consideration to Grantor in hand paid by Grantee, the receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens, remises, releases, conveys, and confirms unto the said Grantee and Grantee's heirs, successors and assigns forever, all of that certain land, situate, lying and being in the County of Miami - Dade, State of Florida to wit: Lot 3, Block 210, Dunning's Miami Shores Extension No. 7, according to the map or plat thereof, as recorded in Plat Book 52, Page(s) 33, of the Public Records of Miami -Dade County, Florida. Parcel Identification Number: 11-2136-011-0030 a/k/a 62 NE 108 Street, Miami Shores, Florida 33161 This conveyance is made subject to the following: 1. Easements, rights of way, limitations, reservations, covenants and restrictions of records, if any, which are not hereby being re -imposed; and, 2. Zoning or other regulatory laws and ordinances affecting the land, if any. TOGETHER with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining. To have and to hold, the same in fee simple forever. And the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple; that the grantor has good right and lawful authority to sell and convey said land; tla x hereby fully warrants the title to said land and will defend the same against the lawful claims of ver; and that said land is free of all encumbrances except taxes accruing subsequent to Dece f. ,.,.. - Warranty Deed - Page 1 of 2 STATE OF FLORIDA ) ) SS: COUNTY OF MIAMI-DADE } omsigned and sealed these, mesents the. day, and year first. y BEFORE ME, a Notary Public duly authorized to administer odths take acknowledgments in the County and State set forth above, personally appeared SCOTT B. C arried man, and PETER J. m OLDE, an unmarried an, who are personally kno to a or who have produced as identification, ana they acknowledged before me that they executed a same. } Y t IN WITNESS WHEREOF, I have hereunto set my handand axed my official seal, in the state and aforesaid, this I' day of July, 2013. county (SEAL) r - Warranty Deed - Page 2 of 2 My Commission Expires: 10 10 - V 7 RE: Permit# /2 )a--7 -i3 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION AFFIDAVIT DATE: -7 S 13 I licensed as a (n) Contractor / Engineer / Architect, (Print name and circle License Type) FS 468 Building Inspector License #: efG e-- 0 S-% C/ i V— On or about ? �� , I did personally inspect the roof deck nailing and (Date 8 time) Secondary water barrier work at G r�- (Complete Job Site Address) upon that examination I have determined the installation was done according to the Hurricane Mitigation Retrofit (Based on 553.844 F.S) 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 S day of J V 20 ( 3 Notary Public, Sate of Florida at Large- Ella � 4e�"EXPIRES: APR. 09 2016 WWi:.AARONNOTARY.com *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 # clearly shown marked on the deck for each inspection Revised on 5/21/2009 F.I.E. FLORIDA INTERNATIONAL ENGINEERING &TESTING LAB INSIGHT -INNOVATION -INTEGRATION Florida International Engineering and Testing Lab LLC 16701 SW 117 Avenue, Miami, FL 33177 Telephone: (305) 378 -1991 -Fax: (305) 378-1997 Miami -Dade Lab Certification # 07 -0612.11 -State of Florida ca #27273 --------------------------------------------------------------------------------------------------------------------- SITE SPECIFIC INFORMATION Owner's Name: Job Address: s - Roofing Contractor: &A ;;-- 4�' P 4 Permit Number: -12Pk (3 - 15-6 ® Type of Tile: Approximate Roof Height: °1-$ eet Slope: = l 2 Type of Access to Roof: '0tadder Approximate Square Footage: d 96D ft2 OtherRequired Testing Force: 35 lbs. // Testing Equipment: F. .E. 100x Shim o Instrument Date Installed: CV l : �flq/ 3 Date of Inspection: r� 0 --------------------------------------------------------------------------------------------------------------------- TEST RESULTS P= PASS, F= FAIL Test Location Test 1? or F Location P °r F Test Location Test P or F Location Test P °T F Location Por F 1 9 4 21 o A. -OS 41 61 81 2 22 42 62 82 3 23 43 63 83 4 24 44 64 84 5 25 45 65 85 6 26 46 66 86 7 27 47 67 87 8 28 48 68 88 9 29 49 69 89 10 30 50 70 90 11 31 51 71 91 12 32 52 72 92 13 33 53 73 93 14 34 54 74 94 15 35 55 75 95 16 36 56 76 96 17 37 57 77 97 18 38 58 78 98 19 39 59 79 99 20 40 60 1 80 100 --------------------------------------------------------------------------------------------------------------------- IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL TAS 106, THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT QUALITY CONTROL TEST. ADDITIONAL TEST INFORMATION Perimeter Width: A ft Area Units or ft2 No. of Tests Perimeter 1 ?190- Field d Corners Hips & Ridges ®®®►ABAA®6!! RESP WED BY: .®` CLQ •° G•E rN s • �sy®�®, ' N 63107 •• V FLORIDA INERNATIONA ENGINE RING & TESTING LAB, LLC Job Address: P -�".� ►e.ot tA,&A aG Contractor: C*" M.. 4v w-�47V-P- , "4 p., Other: 07 Z.. -l— Sketch of Roof (NTS) Miami Shores Village Building Department 10050 NE 2 Ave, Miami Shores, FI 33138 Tel: (305)795-2204 9 Fax; (305)756-8972 October 9, 2014 To: Current Owner 62 NE 108 Street Miami Shores, FL 33161-7036 Permit: RF -7-13-1560 Address: 62 NE 108 Street Miami Shores FL33161-7036 Date of Last Inspection: August 22, 2013 Dear Sir or Madam, Our records indicate that the above referenced permit has expired without obtaining the proper final inspection. In order to serve you better, we need to keep our files up to date. As per section 105.4.1 of the Florida Building Code, "Everypermit issued shall become invalid (expired) unless the work authorized by such permit is commenced within six months after its issuance, or if the work authorized by such permit is suspended or abandoned for a period of six months after the work is commenced, or completed without obtaining the final inspection of the work performed.." Please be advised that open permits will hinder your ability to refinance or sell this property Please contact the Building Department, within 15 days of receipt of this letter in order to take care of this matter. Sincerely, Ismael Naranjo, CBO Building Director LBy DCC0 9 26A BUILDIN PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ❑BUILDING ❑ ELECTRIC *OOFING .F Master Permit No. Z—Z:�'_® Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 6 r, L ,11_2Acf� City: Miami Shores County: Miami Dade Zip: "2o / Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): /Y e2 �� Phone#: 50 � /2 —j�R Address: City: �/�; 1 w� State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: iCompany Name: Phone#: Address: City: ������ State: Zip: Qualifier Name: �aPhone#: State Certification or Registration #: 0 of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $9®07�7 Square/Linear Footage of Work: 0 It Type of Work: , ❑ _Ad' ion ❑ Alteration 1:1 New Repair/Replace [:1 Demolition Description of Work: x `tom e-_ _e�' E: Specify color of color thru tile: ; Submittal Fee $ Permit Fee $. PCZ CCF $J m L 0 - CO/CC $ Scanning Fee $ &f c Radon Fee $ _ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Pc) Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ �� '--4 V (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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 i su d. In the absence of such posted notice, the inspection will not be aim and a reinspection fee will be charged. f %� + r' Signature Signature G� Ow or AGENT CONTRACTOR The /foregoing instrument was acknowledged before /me this day of , 20 / by �ei gC a who is personally known to me or who has produced ifL. E) 4— - as identification and who did take an oath. Print: \, q 'V! Seal:4� JESSE WALTERS _Notary Public iresate Sep 231 2016 'Q= My Comm. Exp Commission # EE 837922 OF The foregoing instrument was acknowledged before me this a-4 day of W OV - 20 1 q by CVL\AraAd F�0\ 0-51' , who is personally know o me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign Prini Seale as % Plans Examiner Zoning APPROVED BY -0 Structural Review Clerk (Revised02/24/2014) BUSINESS NAIVIE/LOCATION RECEIPT NO. CME CONSTRUCTION MANAGEMENT ENTERPRISES�IMEWAL 7405 W 14 CT 6940788 9>;::a8 HIALEAH FL 33014 SEPTEMBER 30, 2015 Must be displayed at place of business �Pursuant to County ` Chapteri s OWNER SEC. 'TYPE OF BUSINESS CME CONSTRUCTION MANAGEMENT 196 SPECIALTY BUILDING CONTRACTOR PAYMENT RECEIVED Worker(s)+CCCOai94 � T�� �t��.a.ECT� p45.a® 09/30/2014 REDITCARD--14—+043304 This focal Business Tax Receipt only confirms payment of the focal Business Tex. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder mast comply with any governmental or nongovernmental regulatory laves and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276. For more information, vltit www.miamidade.rov/'taxcollee r CERTIFICATE OF LIABILITY INSURANCE°"TE1"""DDFYYM —' 11/25/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the- policy(tes) must be endorsed. H SUBROGATION IS WAIVED, subject to - - ---- -� the term and conditions of the policy, twin policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such emionmmerK($)• PRODUCER Galloway Insurance CONTACT _—Jose H Romero, Licensed Agent -A225234 (305) 255-1661- p7- (766) ppb -7066 No. 17354 South Dode Highway LAD I statewide1ns123@yahoo.com Miami, FL 33157 PRODUCER Phone (305)255-1661 Fax (786)206-7066 CUSTOMER IDB INSURERS) AFFORDING COVERAGE INsuRED _ INSURER A: InYI Insurance Company of Hannover PLC I CME, Construction Management Enterprises, Inc. ---- --- __.. _-------___i INSURER 8: 7405 West 14th Court -- -' -------+-- INsuRER c Hialeah, Florida 33014 INSURER D —_ ------ -I INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. AM 5W POLICY EFF ILTR TYPE OF INSURANCE LY UMBER ENERAL�� M U LIMITS EACH OCCURRENCE - �$ ��100 ® COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED : I ❑ El CLAIMSMADE © OCCUR _P.6 Mks Ee stamens ' s 100,0 A IGOSA003340-00 MED EXP ( one person) $... 5,000: N N © See Policy for Ded.., 03!31/2014 03!31/2015 PERSONAL &ADV INJURY $ 1,000,000 ❑ - GENERAL AGGREGATE _ $ - _ . _ 2,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,000 -_ 0 POLICY ❑ P C_1 ❑LOC $ - AUTOMOBILE LIABILITY LIABILn Y _-- - .-- -- COMBINED SINGLE LIMIT ❑ ANY AUTO I (Ea sccident) $ ❑ ALL OWNED AUTOS BODILY INJURY (Per person) ' $- ❑ SCHEDULED AUTOS BODILY INJURY (Per eoddentp $ PROPERTY DAMAGE-- -- - - ❑ HIRED AUTOS (Per axiderd) $ NON -OWNED AUTOS ❑ - $ i ❑ ELAOCCUR EACH OCCURRENCE $__-__ .-- -. -- ❑ EXCESS CCE� LIARB — ❑ CLAIMS -MADE AGGREQATE$ -- i DEDUCTIBLE RETENTION $ - WORKERS COMPENSATION - YIN - WC STATU-AND OTH- TORY LIMITS ❑ ER $ R /ECUTIVANY POPRI TORIPARTNERX OFFICER/MEMBER EXCLUDED? Iryedasorlbe rr In NH) NIA I E.L. EACH ACCIDENT ___-, -_ - __ $ — DES�RIPTIONNOOFOPERATiONSbelow E.L DISEASE - EA EMPLO $ E.LDISEASE- POLICYLIAAIT I $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, H more space is required) - General Contractor... Roofing Included..... "Please note that any changes to this policy must be submitted to the Insurance Company for approval".... , CERTIFICATE HOLDER Miami Shores Village 10050 NE 2nd Avenue Miami Shores, Florida 33138 Attn: Building Dept - ' E: daniofthesun@gmalf.com F: 305-756-8972 ACORD 25 (2009/09) QF UA CANCELLATION SHOULD ANY OF THI THE EXPIRATION DA ACCORDANCE WITH AUTHORQED Jose H Romero DESCRIBED POLICIES BE CANCELLED BEFORE EOF, NOTICE WILL BE DELIVERED IN ,ICY PROVISIONS. 1 119 ACORD CORPORATION. All rights reserved. name and logo are registered marks of ACORD 04 JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA 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: 7/22/2014 EXPIRATION DATE: 7/21/2016 PERSON: ROJAS EDWARD A FEIN: 263381670 BUSINESS NAME AND ADDRESS: CME CONSTRUCTION MANAC 7405 W 14 CT HIALEAH FL 33014 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL LICENSED ROOFING CONTRACTOR CONTRACTOR 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. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1609 Miami shores V Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tei: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of theFlorida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore. you maybe personallyliable for the worker com enation in'uries of an erson allowed to work under this permit. please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Print Name Signature: State of Florida ) County of Miami -Dade) ryr Sworn to and subs bed before me this "�V day 06)e 2�M , 201y1 . By J UdXk" JUUITH PEREZ Notary Public - State of Florida My Comm. Expires Mar 19, 2016 Commission # EE 180865 Contractor Print N e: vV ap a Signature: C� State of Florida County of -Dade ) Sworn to And subscribed before me this PI day of o , 20 a -}. >nvi feta BY c: �c••t;PR ' (SEAL) 1 • hn •n` e� W APRON Type of Identification produced