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RF-14-1051 (2)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: (30S) 762-4949 r BUILDING PERMIT APPLICAT ❑ BUILDING ❑ ELECTRIC DEC 0 3 2014 F9C 20 Master Permit No. R,G:3.1�1•(e,2� ROOFING Sub Permit No. R� - 5,14. 1051 ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP . CONTRACTOR DRAWINGS 10B ADDRESS: �i0 'r � cy5�. Com: Miami Shores County: Miami Dade Zip: IS313% Folio/Parcel#: Is the Building Historically Designated: Yes NO _ C Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Address: 500 Alf q j.& !i City: St State: FL Zip: Tenant/Lessee Name: Phone#: Email: 1010 .., n 5L1A_ r&rV% CONTRACTOR: Company Name: 1 t 1 - e Y—Ok,w, Phone#: t741 ' 331 • ' J Address:` R115 h !a A-- City: W 1A Pl\,.,n V-Jz k State: L_ Zip: 11 Qualifier Name: Phone#:' ]% State Certification or Registration #: (_ CC IS:) 51 -I DA&Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ trM Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New .9 Repair/Replace ❑ Demolition Description of Work: Qae.¢' '?.A&c.S _ 1prtvt.,.% 'ye exa •—AtAA^eq, Specify color of color thru tile: Submittal Fee $ Permit Fee $ '� ) Scanning Fee $ 13, CORadon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (ReAsed02/24/2014) CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $' 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 issued. In the absence of such posted notice, the inspection will not be approved reinspection fee will be charged. Signature Signature O or AGENT CONT OR The foregoing instrument was acknowledged before me this day of "DC C PrcN pCr , 20 tN , by r1c'4 ��ccac.\ , wh is personally no to me or who has produced as identification and who did takA an oath. NOTARY PUBLIC: Sign: Print: Seal• 05114!2018 The foregoing instrument was acknowledged before me this day of 20 h�J by cx""—C—r ho is personar�n to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Print: Seal: APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) shh,w a® wcnnamn i i MP_tal Panmisninnlps i t we j 11 minnt ArP_a, nspi - !TM r3i oraarrs_ '-%MXuMr MIMIS IE MEE MEE Florida Building Code Edition 2010 High Velocity Hurricane Zone Uniform Permit Application Form Section C (Low Sloped Roof System) Fill in Specific Roof Assembly Components and Identify Manufacturer (If a component is not used, Identify as "NAJ System Manufacturer: TAMV,6t, NOA No.: Iz - 0RAL 611 --- Design i Design Wind Pressures, From RAS 128 or Calculations: Pmax1: Ar 14 Pmax2: Pmax3: �[ Max. Design Pressure, From the Specific NOA System: Deck: � jj Type: �V.&N A' *T— Gauge/Thickness: AJ JA Slope: F IJ Anchor/Base Sheet & No. of Ply(s): Anchor/Base Sheet FasterjerBonding Material: Insulation Base Layer: A/iTA Base Insulation Size and Thickness: Base Insulation Fastener/Bonding Material: I _ Top Insulation Layer: ova Top Insulation Size and Thickness: Top Insulation Fastener/Bonding Material: . r' Base Sheet(s) & No. of Ply(s): n1jA Base Sheet Fastener/Bonding Material: Al I Ply Sheet(s) & No. of Ply(s): —a Ply Sheet Fastener/Bonding Material: A Top Ply: NIA Top Ply Fastener/Bonding Material: Surfacing: INI Fastener Spacin for Anchor/Base Sheet Attachment N ; Field: " oc @ Lap, # Rows @ " oc Perimeter: " oc @ Lap, # Rows _@ " oc Comer: ° oc @ Lap, # Rows @ " oc Number of Fasteners Per insulation Board X[A Feld: Perimeter Comer 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. RtPawC5 l e&lt Uv%•alAU4.1. t�;s��ny tao� S�g�eM From: Tri State - Oliver Fugmann <oliver@tristateamerica.com> Date: November 26, 2014 at 5:48:30 AM EST To: "Ian Hayes" <ian@vision-mia.com> Subject: Procedure Ian, This is what we did: • Cut blisters. Apply roof cement. Mechanically fasten blister ends with 11/4 ring shank nails. • Apply roof cement to whole area. Lay whole granulated modified cap sheet in roof cement. Seal laps with roof cement. • Apply roof coating Sincerely, Oliver TRI STATE ROORNG & GENERAL CONTRACTORS Office: 561.337.7718 Cell: 786.222.4099 Fax: 561.337.4460 www.tristateamerica.com The information contained in this e-mail and in any attached files is confidential and legally privileged. If you are not the intended recipient, please contact the sender and delete this e-mail. Any unauthorized copying or distribution of the information contained in this e-mail and it's attached file is prohibited. The sender does not accept liability for the incorrect and/or incomplete transmission of the information, nor for any delay or interruption of the transmission, nor for the damages arising from the use of or reliance on the information. E-mails may be interfered with, may contain computer viruses and/or other defects. The sender gives no warranties and does not accept liability in relation to these matters. AWAPLAN 170 PRODUCT DATA Porter ReWoreed SBS NeMed Roofing Membrane DESCRIPTION AWAPLAN 170 is reinforced with a 180 g/m2 nonwoven polyester mat saturated with asphalt and coated on both sides with SBS rubber modified asphalt and surfaced with ceramic granules for protection from ultraviolet degradation. USES Roofing membrane in Series 200 Specifications and flashing membrane in select TAMKW flashing details. Easily applied by mopping in hot asphalt or approved cold adhesivet. ADVANTAGES • Exceptional performance characteristics over a broad temperature range • Excellent cold weather flexibility • High puncture and tear resistance • Cold or hot process application • High elongation ° Minimal dead load weight • Superior nail pull-through characteristics • 12 year limited material warranty' See COmplete nmited warrer4 at tamko com for details CERTIFICATIONS U.L. Classified Membrane for Roofing Systems FM Approved" ASTM D 6164, Type I Miami Dade County Approved ICC -ES ESR -1013 TYPICAL PHYSICAL PROPERTIES Tensile Strength MD =131 LBF/IN (@0 deg F & 0.08 in/min) CD = 96 LBF/IN Elongation MD = 56% (@0 deg F & 0.08 in/min) CD = 58% Strain Energy MD - 371N-LBAN2 (00 deg F & 0.08 in/min) CD = 28 IN-LB/W2 Tear Strength MD =140 LBS CD = 106 LBS Low Temp Flex MD = -20 deg F (PASS) CD = -20 deg F PRODUCT DATA' Reinforcement 180 g/m2 Polyester Mat Asphalt Modifier SBS Roll Weight 92 lbs (41.7kg) Roll Size 33'5" x 39-3/8" (10.2m x 1 m) Product Thickness 145 mils Coverage 1 square 'An values stated as nomxnat CAUTION: This product contains crys Iline silica. Crystalline silica has been classified as a °known° human carcinogen by the international Agency for Research on Cancer (IARC) and the National Toxicology Program. This product also contains oxidized asphalt. Occupational exposures to oxidized asphalt and its emissions during roofing have been classified by IARC as a 'probable human carcinogen'. Oxidized asphalt also contains Polycyclic Aromatic Hydrocarbons some of which have been classified by IARC as know or probable hunfan carcino?ens. The physical nature of this product may help limit any inhalation or dermal hazard during application and/or removal. However, physica forces such as sawing,grinding or drilling during demolition work and heating or burning may increase the inhalation or dermal exposure hazard of this product Take precautions to prevent breathing and contact with skin. Use of this product in °torch applied° or °hcl moppd° applications may expos workers and clhers m tie work area to oxidized aspfraalt and ks emiesians. The International A�eney for Research on Cancer has classified occupational exposuresto oxddreed asphalt and its emissions during roofing as a probable human cardnogen.° During installation and removal of this product, including °torch applied° or °hot mopped° application, workers must take precautions to assure a ftiate ventilation and use effective personal protective equipment to prevent exposures to dusts, fumes, vapors and mists. It is the responsibility of the cardractor and workers to protect themselves and others in the work arca from exposure to oxidized asphalt and its emissions when aaolvina this orotluct. MMW-c GM *Certain cdd adhesive specifications require heat welding (°torch app ed") ft laps. TAMKOT is a registered trademark of TAMKO Building Products, Irrc arcawiz uvi mss N/I5-=ION Miami ian hayes_coo 421 washington avenue, suite 202 cgc#1518437 miami beach, flodda 33139 c: +1 786 2613177 e: ian@vision-mia.com o: +1 305 763 8019 w: www.vision-mia.com 'f: +1 786 4724195 MIAMI MIAMI-DADE COUNTY PRODUCT CONTROL SECTION DEPARTMENT OF PERMITTING, ENVIRONMENT, AND REGULATORY 11805 SW 26 Street, Room 208 AFFAIRS (PERA) Miami, Florida 33175-2474 BOARD AND CODE ADMINISTRATION DIVISION T (786)315-2590 F (786) 31525-99 NOTICE OF ACCEPTANCE CNOA) www miamidadexov/oem TAMKO Building Products, Inc. P.O. Box 1404 220 West 4f° Street Joplin, MO 64801 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: Tamko Underlayments LABELING: Each unit shall bear a permanent label with the manufacturees 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. 08-1008.04 and consists of pages 1 through 6. The submitted documentation was reviewed by Jorge L. Acebo. NOA No.: 12-0446.07 M tE cou Expiration Date: 07/05/17 I' APPROVED Approval Date: 06/21/12 Page 1 of 6 ROOFING COMPONENT APPROVAL CaIMM: Roofing Snb-Cate wv: Underlayment Material: SBS SCOPE: This approves Tamko Underlayments, as described in this Notice of -Acceptance; designed to comply with the Florida Building Code including the High Velocity Hurricane Zone of the Florida Building Code. TRADE NAMES OF PRODUCTS MANUFACTURED OR LABELED BY APPLICANT: 'fest Product Product Dimensions Specification Description TW Metal and Tile 39-%" wide TAS 103 Flexible, self -adhering rubberized asphalt Underlayment ASTM D 1970 sheet material with a polymer surface for use Manufacturing Location #1 as an Underlayment in sloped roof assemblies. May be used as a secondary water barrier for full -roof coverage or, when out into appropriate width strips, for taping sheathing joints. Moisture Guard Plus 394/x" wide ASTM D 1970 Flexible, self -Adhering, rubberized asphalt Manufacturing Location #1 sheet material with a granular surface for use as an underlayment in sloped roof assemblies. May be used as a secondary water barrier for full -roof coverage or, when out into appropriate width strips, for taping sheathing joints. TW Underlayment 39 Ya" wide ASTM D 1970 Flexible, self -adhering rubberized asphalt Manufacturing Location #2 sheet material with a polymer surface for use as an underlayment in sloped roof assemblies. May be used as a secondary water barrier for full -roof coverage or, when out into appropriate width strips, for taping sheathing joints. Awaflex 39-3/s" wide TAS 104 SBS modified cap sheet with a non- woven Manufacturing Location #1 polyester mat saturated with asphalt, coated on both sides with SBS rubber modified WAalt and surfaced with ceramic granules. Applied in hot asphalt. Awapla.n 17C 39-3/s" wide TAS 104 A polyester reinforced SBS modified Manufacturing Location #1 bitumen membrane surfaced with granules. Applied in hot asphalt. NOA No.: 12-0406.07 Expiration Date: 07/05/17 Approval Date: 06/21/12 Page 2 of 6 MANUFACTURING LOCATION: 1. Joplin, MO 2. Columbus, KS NOA No.: 12-0406.07 Expiration Date: 07/05/17 Approval Date: 06/21/12 Page 3 of 6 Test Product Produ Dimensions Specification Description Awaplan PremiumTm 39-3/s" wide TAS 104 A polyester reinforced SBS modified Manufacturing Location #1 bitumen membrane surfaced with granules. Applied in hot asphalt. Tamko SA Base 39-3/s" wide ASTM D 1970 A fiberglass-reinforced self-adhering SBS Manufacturing Location #1 modified bitumen membrane with a polymer film on the surface and a removable treated split release film on the adhesive side. Shall only. be mechanically fostened to wood deck. Direct adhesion to wood deck not permitted in the ENIM. Do Not Remove Release Film! Tamko SA Cap 39-3/s" wide ASTM D 6164 A dual-coated SBS-modified cap sheet with Manufacturing Location #1 a nonwoven polyester mat surfaced with ceramic granules and a split removable release film on the adhesive side. EVIDENCE SUBMITTED: Test Aencv Test Identifier Test Nnme/Report Date Exterior Research & Design, LLC 4448.12.01-1 TAS 103 12/19/2001 4448.05.02-1 TAS 103 05/29/2002 Trinity I ERD T11090.09.08 TAS 117(B)/ TAS 114(C) 09/18/08 PRI Asphalt Technologies, Inc. TAP-058-02-01 TAS 103 04/30/02 TAP-058-02-02 TAS 103 05/23/02 TAP-191-02-01 ASTM D 1970 11/16/07 TAP-192-02-01 ASTM D 1970 11/13/07 TAP-193-02-01 ASTM D 1970 11/16/07 TAP-207-02-01 REV TAS 104/ ASTM D 4798 12/10/08 TAP-185-02-01 REV ASTM D 6164 11/06/08 TAP-196-02-01 ASTM D 1970 01/09/08 MANUFACTURING LOCATION: 1. Joplin, MO 2. Columbus, KS NOA No.: 12-0406.07 Expiration Date: 07/05/17 Approval Date: 06/21/12 Page 3 of 6 APPROVED ASSEMBLIES: Deck Type 1: Wood, Non -insulated Deck Description: 19/32" or greater plywood or wood plank System E(1): Anchor sheet mechanically fastened to deck, membrane adhered. Base Sheet: One or more plies of ASTM D 226 Type II or ASTM D 2626 with a. minimum 4" side lap and a 6" end lap mechanically fastened to deck with approved annular ringshank nails and tin caps 6" o.c. at the laps and two staggered rows 12" o.c. the field of the roll. Membrane: One or more plies of TW Metal and Tile Underlayment with a minimum 4" side lap and 6" end lap. Place the first course of membrane parallel to the eave, rolling the membrane to obtain maximum contact. Remove the release liner as the membrane is applied. Vertical strapping of the roof with TW Metal and Tile Underlayment is acceptable. When used in Tile roof systems the capsheet shall be back nailed to deck with approved annular ring shank nails and tin caps at a maximum 12" o.c. at the side laps and 6" o.c. at the end laps. No nails or tin caps shall be exposed. Surfacing: Approved Mechanically Fastened Tile or Metal Roofing Assembly or Approved Roofing Assemblies where an ASTM D 1970 underlayment is allowed. Deck Type 1: Wood, Non -insulated Deck Description: 19/32" or greater plywood or wood plank System E(2): Anchor sheet mechanically fastened to deck, membrane adhered. Base Sheet: One or more plies of ASTM D 226 Type II or ASTM D 2626 with a minimum 4" side lap and a 6" end lap mechanically fastened to deck with approved annular ringshank nails and tin caps 6" o.c. at the laps and two staggered rows 12" o.c. the field of the roll. Membrane: One or more plies of Moisture Guard Plus with a minimum 3.5" side lap and 6" end lap. Place the first course of membrane parallel to the eave, rolling the membrane to obtain maximum contact. Remove the release liner as the membrane is applied. Vertical strapping of the roof with Moisture Guard Plus is acceptable. Surfacing: Approved Roofing Assemblies where an ASTM D 1970 underlayment is allowed. Deck Type 1: Wood, Non -insulated Deck Description: 19/32' or greater plywood or wood plank System E(3): Anchor sheet mechanically fastened to deck, membrane adhered. Base Sheet: One or more plies of ASTM D 226 Type II or ASTM D 2626 with a minimum 4" side lap and a 6" end lap mechanically fastened to deck with approved annular ringshank nails and tin caps 6" o.c. at the laps and two staggered rows 12" o.c. the field of the roll. Membrane: One or more plies of TW Undsexfttnent with a minimum 4" side lap and 6" end lap. Place the first course of membrane parallel to the eave, rolling the membrane to obtain maximum contact. Remove the release liner as the membrane is applied. Vertical strapping of the roof with TW Underlayment is acceptable. Surfacing: Approved Roofing Assemblies where an ASTM D 1970 underlayment is allowed. NOA No.: 12-0406.07 Expiration Date: 07/05/17 Approval Date: 06/21/12 Page 4 of 6 Deck Type 1: Wood, Non -insulated Deck Description: 19/32" or greater plywood or wood plank System E(4): Anchor sheet mechanically fastened to deck, membrane adhered. Base Sheet: One or more plies of ASTM D 226 Type Il or ASTM D 2626 with a minimum 4" side lap and a 6" end lap mechanically fastened to deck with approved annular ringshank nails and tin caps 6" o.c. at the laps and two staggered rows 12" o.c. the field of the roll. Membrane: One or more plies of Awaflex, Awaplan 170 or Awaplan Premium applied at a right angle (900) to the slope of the deck adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbs./sq. Vertical strapping of the roof with Awaflex, Awaplan 170 or Awaplan Premium underlayments is acceptable. When used in Tile roof systems the capsheet shall be back nailed to deck with approved annular ring shank nails and tin caps at a maximum 12" o.c. at the side laps and 6" o.c. at the end laps. No nails or tin caps shall be exposed. Surfacing: Approved Mechanically Fastened or Adhered Tile or Metal Roofing Assembly or Approved Roofing Assemblies where an TAS 104 underlayment is allowed. Deck Type 1: Wood, Non -insulated Deck Description: 19/32" or greater plywood or wood plank System E(5): Anchor sheet mechanically fastened to deck, membrane adhered. Base Sheet: One or more plies of Tamko SA Base with a minimum 4" side lap and a 6" end lap mechanically fastened to deck with approved annular ringshank nails and tin caps 6" o.c. at the laps and two staggered rows 12" o.c. the field of the roll. Shall only be mechanically fastened to wood deck. Direct adhesion to wood deck not permitted in the HVHZ. Do Not Remove Release Filml Membrane: One or more plies of Tamko SA Cap with a minimum 4" side lap and 6" end lap. Place the first course of membrane parallel to the cave, rolling the membrane to obtain maximum contact with base sheet. Remove the release liner as the membrane is applied. Vertical strapping of the roof with Tamko SA Cap underlayment is acceptable. When used in Tile roof systems the capsheet shall be back nailed to deck with approved annular ring shank nails and tin caps at a maximum 12" o.c. at the side laps and 6" o.c. at the end laps. No nails or tin caps shall be exposed Surfacing: Approved Mechanically Fastened Tile or Metal Roofing Assembly or Approved Roofing Assemblies where an ASTM D 6164 membrane is allowed. NOA No.: 12-0406.07 Expiration Date: 07/05/17 Approval Date: 06/21/12 Page 5 of 6 GENERAL LIMITATIONS: I . Fire classification is not part of this acceptance. 2. This acceptance is for prepared roofing applications. Minimum deck requirements shall be in compliance with applicable building code. Tamko Underlayments shall be installed in strict compliance with applicable Building Codes. 3. All Tamko Underlayments shall be applied to a smooth, clean and dry surface with deck free of irregularities. Deck shall be fastened in strict compliance with applicable Building Codes. 4. All Tamko Underlayments shall not be applied over an existing roof membrane as a recover system but may be applied over an approved roofing Base/Anchor sheet underlayment. 5. TW Metal and Tile Underlayment, Moisture Guard Plus, TW Underlayment, Tamko SA Base & Tamko SA CAP shall not be left exposed as a temporary roof for longer than 30 days of application. 6. Awaflex, Awaplan 170 and Awaplan Premium shall not be left exposed as a temporary roof for longer than 180 days of application. 7. The standard maximum roof pitch for Awaflex, Awaplan 170 and Awaplan Premium shall .be 6:12 for flat tile installation and 6:12 profiled tiles with lugs. 8. The standard maximum roof pitch for TW Metal and Tile Underlayment and Tamko SA CAP shall be 4:12 for flat tile installation and 4:12 profiled tiles with lugs. 9. Refer to Prepared Roofing system Product Control Notice of Acceptance for listed approval of this product with specific prepared roofing products. 10. Tile storage shall be on a battened roof deck when the underlayment slope limit (See #7 & #8 above) is exceeded. Care should be taken during the loading procedure to keep foot traffic to a minimum and to avoid dropping of the directly on the underlayment. 11. The Tamko Underlayments may be used with any approved roof covering Notice of Acceptance listing the Tamko Underlayment as a component part of an assembly in the Notice of Acceptance. If Tamko Underlayments are not listed, a request may be made to the Authority Having Jurisdiction (AHJ) or the Miami -Dade County Product Control Department for approval provided that appropriate documentation is provided to detail compatibility of the products, wind uplift resistance, and fire testing results. 12. All nails in the deck shall be carefully checked for protruding heads. Re -fasten any loose decking panels. Sweep the deck thoroughly to remove any dust and debris prior to application. 13. When applying the membrane in the valley, start at the low point and work to the high point, rolling the membrane from the center outward in both directions. For ridge applications, center the membrane and roll from the center outward in both directions. 14. For the self adhered membranes roll or broom the entire membrane surface so as to have 100% contact with the base sheet, giving special attention to overlap areas. 15. Flash vent pipes, stacks, chimneys and penetrations in compliance with Roof Assembly current Product Control Notice of Acceptance and applicable Building Code. 16. All protrusions or drains shall be initially taped with a 6" piece of approved Tamko Underlayment. The flashing tape shall be pressed in place and formed around the protrusion to ensure a tight fit. A second layer of the same Tamko Underlayment shall be applied over the taped underlayment. 17. All membranes or packaging shall bear the imprint or identifiable marking of the manufacturer's name or logo, city, state and the following statement: "Miami -Dade County Product Control Approved" or the Miami -Dade County Product Control Seal as shown below. J�PPa�wMa aflurtn •� END OF THIS ACCEPTANCE NOA No.: 12-0406.07 ��uoAOECAu Expiration Date: 07105/17 �� Approval Date: 06/21/12 Page 6 of 6 Miami Shores Village Building Department MAY 21 014 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 By. Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 2013 00 BUILDING Master Permit NoGI PERMIT APPLICATION_ Sub Permit No. 1Ll los I ❑BUILDING ❑ ELECTRICROOFING, ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR JOB ADDRESS: 500 DRAWINGS City: Miami Shores County: Miami Dade Zia: 139 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: • Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Phone#: ®� 5,0 1, S Address: City: Nt hn�_ 15k 93 State: Tenant/Lessee Name: Email: N one#: CONTRACTOR: Company Name: �1Z15t E �na��f�>rJ►6g&_ g-.4V44g&5 Phone#: 'S�c 11112 1'Lit Address: 5."!6 q �•• Ise T5. Z .4 fl. '3;11V City:[; State: Zip: Qualifier Name: 'OPLAOO — V-0 A'7'> • Phone#: S(0l e State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: ` � Phone#: Address: City: State: Zip: Value of Work for this Permit: $ ��®®, ®`� Square/Linear Footage of Work: �% G! • �- Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Bt�9� `�I��2Z ;-k- -r - Specify color of color thru tile: Submittal Fee $s ®• Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 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 issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. /,�7 R or AGENT The foregoing instrument was acknowledged before me this day of . �� 20 by (a(1�LJ1 / ,who is ersonally known me or who flas produced as identification and who did take an oath. NOTARY PUBLIC: Print: Seal: °" . A PER¢ Camtisdai9FFO9164 ledElw TmF Match 7, 2018ff T0f9 Signature The foregoing instrument was acknowledged before me this day of May 20 by CA ��r ►�(�11, who is personally known to me'or who has produced as identification and who did take an oath. NOTAov DI 101 Ir. Sign Print Seal �*�kffi*+k�kN�Mey��kN�**�k�k�k*�kak�Ieak�k�ksk �k�k*�k �k�k�IeM***�k#�k�k�k�kakak�kak�k�k*�k�k�k�k�k�k�k�k�k+k+kik*�k#�k***�k�k�k�k+k�k�k�k�k�k�k�kakakskffiateak*�kakak�k�kNeak�k�k�kffi�k+kM�k�k4 APPROVED BY ` Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) all Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. A. COPY OF QUALIFIER'S STATE LIC CARD B:�COPYOFLOCAL_BUSINESS TAX RECEIPT C. OPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION EITHER CERTIFICATE OR EXCEMPTI N •) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: Tri State Roofing and general Contractors LLC BUSINESS ADDRESS: 609 Sea Pine way, Ste G2 CITyWest Palm Beach STATE FL ZIP CODE 334.15 BUSINESS PHONE:5� 61 ) 337-7718 CELL PHONE (--) QUALIFIER'S LIC NUMBER: FAX NUMBER5( 61 ) 337-4460 QUALIFIER'S NAME: Oliver Fugmann CCC1329105 E-MAIL ADDRESS (IF APPLICABLE): Created on 3119109 BY MLDV I RV 3126109 MLDV DETACH HERE OF Ftc DIM R' "'ILLTION • =fit:: C•. .iv a e i :;a rh ?i t.? .. �" V :•rx `.�. �::✓., ` • , '.i:i� ,Y' _ : • y.'• : i. ew r: y 7 •'i , '• SE04 L120711012 ..,.,,._. «t:: •.eta c e a �. ' e;• ..•. • <: •, 0 6A 2 IM ~,LICffi�T NSR T ;' •;;�... ::.� . DFA'4 Vdder t'is ovisx'tb is dt;,'C$a Expiration date: AUG 31 2034 •':�� tea:.,, id6::J �. .et; •rr.. .4.,. UGKA AT E, t,?�IritG 609 SSA FINE WAY" SUITE G2 ?# �� �D wIC. WEST nFA BgiCB`:;.: ,;,:.:., s...., z• Fig;S 4 °i. s:' KEN, LAi�iSON R r` SECRETARY ..vW •�`` •Y' .. 3PlA AS RE(�U.RE LA'VU .., .. DFTA[�JW ucnc Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8971 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 the Florida 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 may be personally liable for the worker compensation injuries of any person 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. Owner Print Name: v1., . A'(0 47 �.. Signature: State of Florida ) I,/ County of Miami -Dade ) Sworn to and subscribed before me this R day of M(,8 -,%e 720 . Contractor _ Print Name: V riz Signature: G State of Florida) County of Miami -Dade) `\+III//// Sworn to and subscribed before me this SA�ICy�p�y of M , 20 ` a— ,• _.iassion 26.2p9 By l.¢� r� •. B (SEAL) #EE860600 Type of Identifi&tio6 produce : O�_••a��n,._.._.�,.\g\;� Q No" Public stoma Of My Coeimiaaim EE 198232 Ejq*m 08/14/1018 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: 6/20/2013 PERSON: FUGMANN FEIN: 263783439 BUSINESS NAME AND ADDRESS: EXPIRATION DATE: 6/20/2015 OLIVER TRI STATE ROOFING & GENERAL CONTRACTORS LLC 609 SEA PINE WAY, G2 WEST PALM BEACH FL 33415 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL ROOFING - ALL KINDS CONTRACTOR AND DRIVER 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., Not of election to be exempt and certifiptes 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 a any time for failure a 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 r41 �� CERTIFICATE OF LIABILITY INSURANCE 5/1 /2014 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Edemnify, LLC 3145 E Chandler Blvd Ste 110-543 Phoenix AZ 85048 aONE^CT Christopher Jenkins PHONE (800) 620-4216 Fax (800)503-0048 E-MAILservice@edemnify.com INSU s AFFORDING COVERAGE NAIC# INsu A:International Ins Cc Hannover INSURED Tri State Roofing and General Contractors, LLC 609 Sea Pine Way, Suite G2 West Palm Beach FL 33415 INSURERS: INsuRERc: INSURER 0: INSURER E • 1 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1441508960 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. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TYPE OF INSURANCE ADDL B POLICY NUMBER POLICY EFF7/13/2015 LIMPrS rA GENERAL LIABILITY $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR 6011001835-01 /13/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTEr- PREMISES $ 50,000 MED EXP CAny one n $ 5,000 PERSONAL 6 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN AGGREGATE LIMIT APPLIES PER: $ POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS OMBBIINE SINGLE LIMIT BODILY INJURY (Per person) $ BODILY INJURY (Per acclderd) $ PROPERTY DAMAGE $ UMBRELLA LIABOCCUR EXCESS LIAB HCLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIEI'ORfPARTNEMEXECUTIVE ❑ OFFICERIMEMBER EXCLUDEDT (Mandatory In NH) N yes, describe under DESCRIPTION OF OPERATIONS below NIA A I WC STATU- I OTH- TORY I WITS rR E.L. EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ EL DISEASE - POLICY LIMIT $ L L DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Contractor's License Number: CCC1329105 CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010105) INS025 (2moaq.ot ©1988 2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Building 6 Zoning ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 Andrew Jenkins/DREW ACORD 25 (2010105) INS025 (2moaq.ot ©1988 2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Tax Detail AxNF M. GAwnew Account Information LBTR Number 201000359— = Mailing Address: i i FUGMANN OLIVER It 609. SEA PINE WAY APT G2 ; GREENACRES , FL 33415-8909 Business Detail Page I of 1 Arms M. bannm Cor mawbaml 79M COMIM sovkv Pon somm C=ftly P.O. Box 3= Wed Pftn BOWL FL 3M-3353 Tax Type Status Business Tax Active Location Aodress: 609 SEA PINE WAY *G2 GREEN ACRES, FL 33415 !Business Name: TRI STATE ROOFING AND GENERAL CONTRACTORS LLC Tax Year: 201.4 'Trade Name* TRI STATE 'ROOFING --A"iDGENERAL -CONTRACTORS —LLC License Number., 201000359 'Phone Number: 561-337-7718 Lit. Status: Active !New Business-. 07/13j2009 Certificate: CCC132910S 18usiness7ype: ROOFING CONTRACTOR (23-0081 Cert, Issued: 07/19/2013 !Number of Units, .1 NAICS: 23-ODBI `Memo: LREQUIRED: SUBMIT CURRENT VALID COPY - STATE CERTIFICATION LICENSE OR EXEMPTION FOR RENEWAL Tax Information iBfll Number Due Date Bill Year -Tax -Penalty/Fee !'840179500 :9/30/2013 2014 1$0.00 [$0.00 _.Total Due: $0.00 Interest Total Due $ 0.00 $0.00 $0.00 Tax Payment i5dl Year Bill Number Receipt Number Amount Paid last Paid Paid By J�/18/2013 ":FUG'MANN OLIVER E!LO179506 -.813.1392390 $27.50 L 1 http:lltaxcollectorpbe-maTL,ttroiLcomITabs(BusinessTaxIAccountDeudlfraxDetaiLaspx?p--... 10/1/2013 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 FUGMANN, OLIVER TRI STATE ROOFING AND GENERAL CONTRACTORS LLC 609 SEA PINE WAY SUITE G2 WEST PALM BEACH FL 33415 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional. Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www nyfloddalicense.com. There you can find more information about our divisions and the regulations that Impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to. serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new I!censel RICK SCOTT, GOVERNOR DEPARTMENT OF CCC1329105 The ROOFING UUN I KAtr I UK Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration -date: AUG 31, 2016 DETACH HERE (850) 487-1395 STATE OF FLORIDA DEPART i . OF. BUSINESS AND PROFE'S [REGULATION .�, . CCC1329105 ~'aF,'r; kifg +.0611112014 CERTIFIEDR FUGMANN' TRI STATER 7- CONT Is. CERTIFIED under the; provisions of Ch.488 Fs. Exphation date': AUG 31, 2016 0406110000933 KEN LAWSON, SECRETARY STATE OF FLORIDA SINESS AND PROFESSIONAL REGULATION 'fOC11INDUSTRY LICENSING BOARD FUGMANN, OLIVER TRI STATE ROOFING ANb'-E .lwOlatTRA�;TQ .GFjiIR-S LL - a 609 SEA PINE WAY SUITE G2 WEST PALM BEACH ;FL 33415 icct IFrr r r11»n�a niSPI AY AR RF01I1RFD RY I AW SEQ * L1406110MOS33 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 FUGMANN, OLIVER TRI STATE ROOFING AND GENERAL CONTRACTOR LLC 609 SEA PINE WAY SUITE G2 WEST PALM BEACH FL 33415 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.miyfloridalicensio.com. There you can find more Information about our divisions and the regulations that Impact you, subscribe to department newsletters and seam more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE RICK SCOTT, GOVERNOR .,f -4(1� (850) 487-1395 STATE OF FLORIDA. DEPARTMENT QF. BUSINESS AND PROFR "RWULATION �-b6/l112014 CERTIFIED'tJ? FUGMANN, TRI STATER .u. 'r "� CONT IS CERTIFIED under the provisions of Ch.489 FS. Expiration date: AUG 31,016 L1406110000957 IGEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTjOK.- INDUSTRY LICENSING BOARD I CGC1517746 I I The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 -� FUGMANN, OLIVER TRI STATE ROOFING AND; GBNEli L,�O.NTRACTQI?tI,LC.:, ;. .:. 609 SEA PINE WAY SUITE G2 WEST PALM BEACH....FL 3$45 111011un. nateann-fA nIQD1 aV aQ 0=r%] 110=1 LSV 1 MAI ■ CL11dk 14AnA44MN1oc7 0CONS��'u-..;, ANNE is A N N O N P.O. Box 3353, West Palm Beach, FL 33402-3353 "LOCATED AT'* A TITUTIONAL TAX COLLECTOR www•pbctax.com Tei: (561) 355-2264 609 SEA PINE WAY APT G2 Suing Palm Beach County GREENACRES, FL 33415-8909 Serving you. BILL # TYPE OF BU8SNESS OWNER CER i1FICAT1gN # RECEIPT #!DATE PAiDE!$2E7S!D 840160183 23 0051 GENERAL CONTRAC70R, FUGMANN OLIVER CGC1617746 B14.1395244 - 08/09/14 This document is valid only when receipted by the Tax Collector's Office. STATE OF FLORIDA PALM BEACH COUNTY 201412015 LOCAL BUSINESS TAX RECEIPT B1- 338 TRI STATE ROOFING AND GENERAL CONTRACTORS LLC TRI STATE ROOFING AND GENERAL CONTRACTORS LLC 609 SEA PINE WAY APT G2 GREENACRES, FL 33415-8909 nllnl�l„I„lu,ll,l,l,�„I,I,�ullu,l,l„ LBTR Number: 201015727 EXPIRES: SEPTEMBER 30, 2015 This receipt grants the privilege of engaging in or managing any business profession or occupation within its jurisdiction and MUST be conspicuously displayed at the place of business and in such a manner as to be open to the view of the public. .ANNE M. G A N N O N P.O. Box 3353, West Palm Beach, FL 33402-3353 *"LOCATED AT” CONSTITUTIONAL TAX COLLECTOR wwu' Abd1 T�� (561) 355-2264 609 SEA PINE WAY #G2 Senning f'alm sea& County GREEN ACRES, FL 33415 Serving you. TYPE OF BUSINESS OWNER CERTIFICATION # RECEIPT #MATE PATO AMT PAID BILL# 234081 ROOFING CONTRACTOR FUGMANN OLIVER 814.9386243 08!86114 227-60 840132804 This document is valid only when receipted by the Tax Collectors Office. B3 - 337 TRI STATE ROOFING AND GENERAL CONTRACTORS LLC TRI STATE ROOFING AND GENERAL CONTRACTORS LLC 609 SEA PINE WAY APT G2 GREENACRES, FL 33415-8909 STATE OF FLORIDA PALM BEACH COUNTY 2014/2015 LOCAL BUSINESS TAX RECEIPT LBTR Number: 201000359 EXPIRES: SEPTEMBER 30, 2015 This receipt grants the privilege of engaging in or managing any business profession or occupation within its Jurisdiction and MUST be conspicuously displayed at the place of business and in such a manner as to be open to the view of the public.