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RF-14-2491Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-225785 Scheduled Inspection Date: December 29, 2014 Inspector: Rodriguez, Jorge Owner: DIAZ, DR. MARIA Job Address: 9425 NE 6 Avenue Miami Shores, FL 33138 - Project: <NONE> Contractor: ALL DADE GENERAL CONST INC 5uming Department comments RE- ROOFING FLAT Permit Number: RF -11-14-2491 Permit Type: Roof Inspection Type: Final Roof Work Classification: Flat Phone Number (305)756-7899 Parcel Number 1132060141400 INSPECTOR COMMENTS False Phone: (305)696-0029 Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-225368. CREATED AS REINSPECTION FOR INSP-225180. CREATED AS REINSPECTION FOR INSP-223318. Missing renailing affidavit and uplift test Failed no ladder on site, plans and permits missing. Same as before Correction Needed ❑ �'�' `��` Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. December 29, 2014 For Inspections please call: (305)762.4949 Page 22 of 26 Rea,fTOP 1VTiFloridA. l-ate�COOlp etloln. Dace, ,RopesontractorF Ro Z44014:, A- epxe ea to a of Belled Engineering rat the above referenced j)rdj=L This tesftg.was APFicat .oa St=4vd TAS *.106; Standard Relleh Engineering Corporation appreciates the opportunity of assisting you in this project. If you have any questions or if we may be of further assistance, please do not hesitate to contact the undersigned. Respectfully submitted; Reileh Engineering Corporation gad Sonny Salleh, P.E.49014 Manager TQ.E aRL "TM Residernial Home 9423 Northeast 6 Avenue Miami Shores, Florida Reileh Engineering Corporation — Project Nwnber - 14-1126 — Page 2 d 3 Report of TILE UPLIFT TEST for Residential Home 9425 Northeast 6 Avenue Miami Shores, Florida Project Number: 14-1126 dµ� ad 1 35 Pass 2 35 Pass 3 35 Pass 4 35 Pass 5 35 Pass 6 35 Pass 7 35 Pass 8 35 Pass 9 35 Pass 10 35 Pass 11 35 Pass 12 35 Pass 13 35 Pass 14 35 Pass 15 35 Pass 16 35 Pass Test 1-16 Perimeter Reileh Engineering Corporation — Project Number - 14-1126 — Page 3 of 3 WrKux. KUUF TEST LOCATIONS ANn nIAMIONs " 12 Is FLAT GOOF 200 9 K 6 8 S I 2 S 1 50' Tyr TU MIUMP - 220 5F O �nc� CAP TW l-OC1+11ON FRV - 0 COIMR - 0 5F LOi�N' Utz - 0 Mt?IN MP P15014a, a p Y L MN0T5 L005E Ee 14-1126 I -1(2V f2l x CW e 0 COM AICA - YX Y WrKux. KUUF TEST LOCATIONS ANn nIAMIONs AFFIDAVIT OF COMPIJANCE WITH ROOF DECI1iG ATTACHMENT AND SECONDARY WATER BARRIER HURRICANE MITIGATION RETROFIT FOR EXISMG SITE -BUILT SINGLE FAMILY RESIDENTIAL STR ICTQRES PURSUANT TO SECTION 563.844 F.S. To: Miami Dade, Cou ay Building Dunt 11805 Coral way, Smote III Miami, FL 33I75 P Re: ownces Name .Property Address N , C9 Rooting Permit Number Dear Building official. I g16VA2,A) # e5;it�Ci�,Celify that the roof decking aawliment and figenm have been sttgthened and cmrecled and a secondary water barrier has been provide4 as required by the "Manual of Hurricane litigation Retrara for Existing Site -Bust Singte Family Ste" adapted by the Florida Building CommWm by Rule 9B-3.047 F.A.C. Qualffying AgeW S Vial c of Qualifying Agent Print Name STATE OF FLORIDA COUVff OF KAMi Swam w abAsubsc almd bcgxc me this a (SRAL) ,;ita • , JOSE P MY COMMISSION # EV09593 EXPIRES Juns 18.2018 Pasonatty lin or Produced kkadficadw C-lbaftmumd Asharca smm+.+� a Florida Building Code 2010 Edition High Velocity Hurricane Zone Uniform Permit Application Form 3221100 C CLOW SIRRoof-System) FIN In Specific Roof Assembly Components and Iden ft Manufacturer Of a a mponent Is not used, identity as -NA site n Mantrfe�urer. bC A NOA No.:--�.--�--- Design Wind Pressures, From RAS 128 or Cat Pmex1:'A2. �= i, P 148. Max Design P re Fra the Specht NOA sjrstern - -i. Ded Type: -- CemtictOtess:_ S` � Slope: Ar�r/Base Sheet & No. y(s) An F Sass Layer B It�ute artd Thick Base lrauiation Material: TOP Insulations ._ Top Iran ental lhlr TOP Insulation Fastener/Bon ft hfie rials Base Shwge) & No. ofcv% Ply S"S)&W..ofPry )Twos\y Sheet {�; Top Piy:_Gn,1a� TOP Ply ��ned ortdn Surf�tg: Csr®!Jt ��, c Fastener Spacing fo'r 4m6bodBtse *Sheet 0000! Muchment • ...... ...... cct�Lap, 'R�0:?- �•oc .*00 Perimeter. k* OC Q Lap!# Rbws'1 @ cc oulatlOrrs: 'Coater: - or @ gyp. '-A ®* 4 ioc O Number of FasterpreePtr insulatIon Board • :... on so Field N`� 1 Perimeter • � �A come• Illustrate Components Noted and Details as Applicable: Woodblodcing. Guitar, Edge Termination, Stripping. Flashing. Continuous Cleat, Cant Strip, Base Flashing, Counter- Flashing, Coping, Etc, Mean Roof Height, Parapet Height, Haight of Base Flashing, Component Material, Material Thtdtness, Fastener Type, Fastener Spacing or Submit Manufacturers Details that Comply with RAS 111 and Chapter 16. ®'DI A 0 � y ` � pj Parapet FJ t '\ Woad glean Roof ► 3-i' z G1Z'�� Height 2.6Gbv•-L-\ ,ww yy DA,F M MIAMI DADE COUNTY PRODUCT CONTROL SECTION 11805 SW 26 Street, Room 208 DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES (REM) Miami, Florida 33176-2474 BOARD AND CODE ADMIMSTRATTON DIVISION T (786j315�25`40 F (71VM25-99 ., • • NOTICE OF ACCEPTANCE (NOA d�� ;�nD;�� . • GAF • • • • 0000.. 1361 Alps Road Wayne, NJ 07470 SCOPE: 0000 • 0000.. 0000 00.00. • 08 • 0000 This NOA is being issued under the applicable rules and regulations governing the use,of�oonstruction materials. The documentation submitted has been reviewed and accepted by Miami &� a Cp0 R R«0 Product Control Section to be used in Miami Dade County and other areas where allooad by�he Autllq�ty Having Jurisdiction (AHJ). 0000 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. RER 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: GAF Conventional Built -Up Roof Systems 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. TERNMATION 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. 13-0424.09 and consists of pages 1 through 16. The submitted documentation was reviewed by Jorge L. Acebo. NOA No.: 13-1022.15 Expiration Date: 11/04/18 Approval Date: 11/06/14 Page 1 of 16 0006.. 0000 0000. 0000.. 0000.. 0000.. ROOFING SYSTEM APPROVAL at o : Roofing Sub -Category BUR Material: Fiberglass Deck Type: Wood Maximum Design Pressure:, -75 psf. 0000.. .00.40 .. . 0 0000.. .0000• 0 • 4 4 444444 444444 4444• • i0004a TRADE NAMES OF PRODUCTS MANUFACTURED OR LABELED BY A.PPLIC.4w :' • •' • • TABLE 1 0000. Test 0000 0000 PCddfet••••:• Product Dimensions Suecifiration Desch 'otift GAFGLAS® #75 Base 39.3T'(1 meter) ASTM D4601 0000.. 0060:4 Type H asphalt impregnateJand coated glass maj • • • • Wide base sheet. 00:0 GAFGLAS4'#80 Ultima' 39.3T'(1 meter) ASTM D4601 Type 11 asphalt impregnated and coated, fiberglass Base Sheet Wide base sheet. GAFGLASO F1exPly"m 6 39.37' (1 meter) ASTM D2178 Type VI asphalt impregnated glass felt with asphalt Wide coaxing. GAFGLAS® Ply 4 39.37' (1 meter) ASTM D2178 Type IV asphalt impregnated glass felt with asphalt Wide coating. GAFGLAe Mineral 39.3T'(1 meter) ASTM D3909 Asphalt coated, glass fiber mat cap sheet surfaced Surfaced Cap Sheet Wide with mineral granules, GAFGLAS® EnergyCap m 39.37" (1 meter) ASTM D3909 Asphalt coated, glass fiber max cap sheet surfaced BUR Mineral Surface wide with mineral granules with factory applied Cap Sheet EnergyCote GAFGLAS® Stratavene 39.3T'(1 meter) ASTM D4897 Fiberglass base sheet coated on both sides with Eliminator Perforated Wide asphalt. Surfaced on the bottom side with mineral Venting Base Sheet granules embedded in asphaltic coating with factory perforations. GAFGLAe Sfttavene 39.37' (1 meter) ASTM D4897 A nailable, fiberglass base sheet impregnated and Eliminator Nailable Wide coated on both sides with asphalt. Surfaced on the Venting Base Sheet bottom side with mineral granules embedded in asphaltic coating. Ruberoie SBS Heat- 39.3T'(1 meter) Weld"" Smooth Wide Ruberoie SBS Heat 39.3T(1 meter) Weld"' 25 Wide Ruberoidte 20 39.37' (1 meter) Wide Ruberoie Mop Smooth 39.37' (1 meter) wide ASTM D6164 Non -Woven Polyester mat coated with polymer - modified asphalt and smooth surfaced ASTM D6164 Non -Woven Polyester mat coated with polymer - modified asphalt and smooth surfaced. ASTM D6163 SBS modified asphalt base sheet reinforce with a glass fiber mat. ASTM D6164 Non -woven polyester mat coated with polymer - modified asphalt and smooth surfaced. NOA No.: 13-1022.15 Expiration Date: 11/04/18 Approval Date: 11/06/14 Page 2 of 16 TRADE NAMES OF PRODUCTS MANUFACTURED OR LABELED BY APPLICANT: TABLE 1 Test Product Product Dimensions Specification• Descjiutio.—n • 0000.. FireOut�"' Fire Barrer 5, 55 gallons Proprietary • . ' 000000 Low VOC, water based firk•bartier. copog� 0 • Coating0.0. 90 • VersaShiele Fire 350 sq. & roll ASTM D226 0000.. 0.00.0 0 Non -Asphaltic Fiberglass-BAV UndM yment. :000% Resistant Roof Deck • 000 •• Protection 0000. . . : .; • • Topcoat® Surface Seal 5 gallons ASTM D6083 00 .0 00 000000 Solvent based sprayableliIMplastic ntbber .' SB sealant designed to protict and'resto4aA roof • • 9 • • • surfaces and to increase%Wb* reflectivity . • ...0.0 00 00 APPROVED INSULATIONS: TABLE 2 Product Name Product Description Manufacturer EnergyGuardm Polyiso Insulation Polyisocyanurate foam insulation (With Current NOA) GAF EnergyGuarC RA Polyiso Insulation Polyisocyanurate foam insulation GAF EnergyGuard7m RN Polyiso Insulation Polyisocyanurate foam insulation GAF EnergyGuar(r Perlite Roof Insulation Perlite insulation board. GAF EnergyGuar(r Perlite Recover Board Perlite recover board GAF EnergyGuard7 RA Composite Polyiso Polyisocyanurate foam insulation with high GAF Insulation density fiberboard or Permalite perlite insulation SecurocV Gypsum Fiber Roof Board Gypsum roof board United States Gypsum Corp. StructodeO High Density Fiber Board High density fiber board Blue Ridge Fiberboard, Inc. DensDecV Roof Board Gypsum board Georgia-Pacific Gypsum LLC NOA No.: 13-1022.15 MIMI-DADECOUNTY101 Expiration Date: 11/04/18 ' "' • ' Approval Date: 11/06/14 Page 3 of 16 APPROVED FASTENERS: TABLE 3 Fastener Product Product Manuf3�rtu�er Number• Name DOCHID60D. Dimension, • 6L�Vi�h Curr• ent,� OAl' • • • • • 1. Drill-Tec # 12 Fastener Insulation fastener for steel, various 6666.. "': " G'AF • • 6 : wood &concrete decks. .6606. 6 6 6 2. Drill-Tec #14 Fastener Insulation fastener for steel, various 0000 6 ' (fig... ' 6 • • wood & concrete decks.•' 00096 • • "' • • 3. Drill-Tec.. XHD Fastener Carbon steel extra heavy duty Various (iA ' . ; • • • •' fastener used in steel decks. 6 • • • • • 6666.. • 4. Drill-Tec7 ASAP 3S Drip-Teem #12 Fastener with Various • ' • �' 6666.. Drill-Tec' 3" Standard Steel • Plate �� '••• ••��: • 5. Drill-Tec'm 3" Steel Plate Round galvalume stress plate 3" round GAF used with Drill-Tec7 fasteners. 6. Drill-Tec 3" Standard Steel Round galvalume plated steel 3" round GAF Plate stress plate with reinforced ribs for use with Drill-Tec7 fasteners. 7. Drill-Tec AccuTrae Flat AZ-SS aluminized steel plate 3" square GAF Plate for use with Drill-Tec #12 Fastener, Drill-Tec #14 Fastener and Drill-Tec"' #15 Fastener. 8. Drill-Tec'm AccuTr a Galvalume Steel plate for use 3" square GAF Recessed Plate with Drill-Tec fasteners. NOA No.: 13-1022.15 Expiration Date: 11/04/18 Approval Date: 11/06/14 Page 4 of 16 EVIDENCE SUBMITTED: Test Agency Test Identifier Descriution Date Factory Mutual Research Corp. J.1.2B8A4.AM 4470 ; A7jj;/97 J.I.3B9Q1.AM 4470 ••••�� ' 01/08/98 0.00•• J.I.ODOA8.AM 4470 ...... 4kU/99 '. J.I.ODIA8.AM 4470 •••:.. ; 07/29/94 0000" J.I.OY9Q5.AM 4470 00980 . 04401/98 :one*: 3029832 4470 00.0 0 :06WI/07..... UL LLC R1306 UL 790 •: ": . • 07AP13 • •:..' PRI Construction Materials GAF -012-02-02 . ASTM D4977:..: ' 11706/01 Technologies, LLC GAF -020-02-01 ASTM D4977: • 002/01/02 ' • GAF -082-02-01 ASTM D6083• ; •-09/07/06 0000" GAF -084-02-01 ASTM D60830 • . 0 .4S/D9/06 ; • • • GAF -270-02-02 ASTM D226 • 60411151100 GAF 276-02-01Rev ASTM D6083 12/16/10 GAF -276-02-02 ASTM D226 11/15/10 GAF -306-02-01 ASTM E96 07/07/11 GAF -314-02-01 ASTM D2178 08/23/11 GAF -315-02-01 ASTM D2178 08/23/11 GAF -369-02-01 ASTM C1289 10/22/12 GAF -417-02-01 ASTM C1289 05/28/13 GAF -464-02-01 ASTM C1289 10/22/12 GAF499-02-01 ASTM D6083 03/12/14 GAF -500-02-01 ASTM D6083 03/12/14 IRT of S. Fl. 02-005 TAS 114 01/18/02 02-014 TAS 114 03/22/02 Trinity ( ERD G30250.02.10 -3-R1 ASTM D3909 11/26/12 G31360.03.10 ASTM D6164 03/31/10 G33470.01.11 ASTM D6164 11/16/11 G34140.04.11-2 ASTM D6163 04/25/11 G34140.04.11-4 ASTM D6401 04/25/11 G34140.04.11-5 ASTM D4897 04/25/11 G34140.04.11-5 Ri ASTM D4897 10/18/13 G40630.01.14 -2A-1 ASTM D6164 01/07/14 G43610.01.14 ASTM D3909 01/22/14 G6850.08.07-1 ASTM D3909 08/13/07 G30250.02.10 -3-R1 ASTM D3909 11/26/12 NOA No.: 13-1022.15 dHUArti nADe couN rr Expiration Date: 11/04/18 JAPPROVEDI Approval Date: 11/06/14 Page 5 of 16 Membrane Type: BUR Deck Type 1: Wood, Non -insulated Deck Description: 19/32" or greater plywood or wood plank decks :"•' • System Type E: Base sheet mechanically fastened. • • • • • . : • oboe 0000.. 0 All General and System Limitations shall apply. • •.. • • 0000.. 0000 • Fire Barrier: (optional) Base sheet: Fastening Options: FireOut Fire Barrier Coating, VersaShield" Fire Resistant Roof ��'ecRtotergtiog G c Securock'�` F'b • • • • • 0000.. 0000.. 0000.. 0000. 0000.' ypsum 1 er Roof Board. • •0000 0000.. GAFGLAS" #80 Ultima Base Sheet, Stratavent" Eliminator flailable VetX4g fLase • • ..:. Sheet, Ruberoie 20, Ruberoid" SBS Heat -Weld' Smooth or Rico o fid" SBS Heat Weld; • • • 25 base sheet mechanically fastened to deck as described below; :000 • 0000 GAFGLAS" Ply 4, GAFGLAS" FlexPlym 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" FlexPly'M 6, GAFGLAS" #75 Base Sheet or any of above base sheets attached to deck with Drill-Tec7 #12 Fastener or Drill -Tec"' #14 and Drill- Tec'v 3" Steel Plate, Drill -Tec AccuTrac" Flat Plate or Drill -Tec"° AccuTrac" Recessed Plate 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 #79 GAFGLAS" Flex Ply 6, GAFGLAS" #75 Base Sheet or any of above base sheets attached to deck with approved ann ar rmg s ank 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. S psf. See General Limhadon #7) GAFGLAS" #80 Ultima Base Sheet, Ruberoid" 20, Ruberoid" 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 —60 psf. See General Limitation #7) GAFGLAS" #75 Base Sheet or any of above base sheets attached to deck with Drill -Tec #12 Fastener or Drill -Tec"' #14 Fastener and Drill -Tec 3" Steel Plate, Drill -Tec'• AccuTrac" Flat Plate or Drill -Tec'" AccuTrac" Recessed Plate 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. (Maxi)num Design Pressure —60 psf. See General Limitation #7) Any of above Base sheets attached to deck approved annular ring shank nails and 3" inverted Drill -Tec` 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.: 13-1022.15 Expiration Date: 11/04/18 Approval Date: 11/06/14 Page 14 of 16 Fastening Options: GAFGLAS® #75 Base Sheet or any of above base sheets attached to deck with Drill -Tec ° (Continued) # 12 Fastener or Drill-Tec7 # 14 Fastener and Drill Tec"' 3" Steel Plate, Drill -Tec -'m AccuTraco FIat Plate or Drill -Tec"" AccuTrae Recessed Plate 8" o.c. in 4 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 9" o.c. int�h�eefield of the sheet. .. *Geese (Maximum Design Pressure —75 psf. See General Limitation #71..... �..... Ply Sheet: One or more plies of GAFGLAS® Ply 4 or GAFGLAS® #80 UltiW NaM Sheet adhered in a • �, full mopping of approv asphalt applied within the EVT range anJ."a Grate qf.7A-V ibsJsq. •••.. 0000.. Cap Sheet: 0000. (Optional) One 1 of GAFGLAS® Mineral Surfaced Ca S eek or GAFCfLAS® • • • • • . P ) P Y P 0000 . Ener gyCap BUR Mineral Surfaced Cap Sheet adhered in a fun raoppipg of� • • ` 0000:0 approved asphalt applied within the EVT range and at a ratc:of.20�-401W.?stf • Surfacing: • .. . ... goose. Optional on granular surfaced membranes; required for smooth n embr . Chosen ' components must be applied according to manufacturer's application instructions. All coatings must be listed within a current NOA. 1. Gravel or slag applied at 400 lbs./sq. and 3001bsJsq. respectively in a flood coat of approved asphalt at 601bsJsq. 2. Topcoat Surface Seal SB applied at Ito 1.5 gaIJsq. Maximum Design Pressure: See Fastening Options NOA No.: 13-1022.15 Expiration Date: 11/04/18 Approval Date: 11/06/14 Page 15 of 16 WOOD DECK SYSTEM LIMITATIONS: 1 A slip sheet is required with GAFGLAS® Ply 4 and GAFGLASo Flex Ply"' 6 when used as a mechanically fastened base or anchor sheet. 2. Minimum'/a" DensDeckm Roof Board or %2" Type X gypsum board is acceptable to be installed direc�ly o ger the wood deck. • • • • • • • .. 0000.. GENERAL LIMITATIoNs: • • 0006.. 1. 2. 4. 5. 6. 7. 8. 9. 0000.. Fire classification is not part of this acceptance; refer to a current Approved Roofing Matarjals Dire�toryor fired • •..: ratings of this product. • 0000' 0000. • 0000s Insulation maybe installed in multiple layers. The first layer shall be attached in comprfte8 yvith Ppduc Jo ContW:.. • Approval guidelines. All other layers shall be adhered in a full mopping of approved a;alf applied•V6h the • • • • .. EVT range and at a rate of 20-40 lbs./sq., or mechanically attached using the fastening pattern of the tot layer • All standard panel sizes are acceptable for mechanical attachment. When applied in approv0d asphgltt paKel sizg"• • • shall be 4'x 4' maximum. 0 .. . .... 666666 An overlay and/or recovery board insulation panel is required on all applications over closed cell foar.iensulations 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 IbsJsq. Note: Spot attached systems shall be limited to a maximum design pressure of 45 psf. Fastener spacing for insulation attachment is based on a Minimum Characteristic Force (F) value of 275 lbf., as tested in compliance with Testing Application Standard TAS 105. If the fastener value, as field-tested, are below 2751bf. insulation attachment shall not be acceptable. 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 Professional Engineer, Registered 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. 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.) All attachment and sizing of perimeter nailers, metal profile, and/or flashing termination designs shall conform to Roofing Application Standard RAS 111 and applicable wind load requirements. 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.) All products listed herein shall have a quality assurance audit in accordance with the Florida Building Code and Rule 61020-3 of the Florida Administrative Code. END OF THIS ACCEPTANCE NOA No.: 13-1022.15 irae�riie cou�inr Expiration Date: 11/04/18 Approval Date: 11/06/14 Page 16 of 16 7!2113 TGFU.R1306- Roofing Systems ••i• • • "Ruberoid® 20" or "Ruberoid® 20 HT or Ruberoid® Modified Base Sheet" may be utilized as an altemate to Type G2 base sheets in any of the following Classifications. Y 1/2 -in. thick (minimum) gypsum board or �/a-in. thick (minimum) Prime® Roofboard" or "DensDeck Dura Guard T°' ) Georgia-Pacific Gypsum LLC "DensDeck® Roofboard," "DensDeck this is done, the resulting roofing system is acceptable foruse overcombustible (15/32 -in. thick minimum) roof decks. However, Roofboard" may be used in any existing noncombustible deck Classification. Whei the butt joints in the gypsum board and Geo "DensDeck DuraGuard"m Roofboard" are to offset a minimum of 6 -in. with the butt joints in the roof deck. If polystyrene Is part of Georgia-Pacific Gypsum LLC "DensDeck® Roofboard," "DensDeck Prime® Roofboard" or the roof system, it must be placed below the overlayment board. Multiple plies of "GAFGLAS® Ply 4" or "Tri -Ply® Ply 4" or "Tri -Ply® ply 6" may be adhered to Georgia-Pacific G DensDedc ® Roofboard," "DensDeck Prime® Roofboard" or "DensDeck Dura Guard^" Roofboard" in hot roofing asphalt. "EnergyGuardTM Ultra" is an acceptable alternate to "Ere YPsum LLC rgyGuard„, RF” in any applicable Classification. "GAF Stratavent® EliminatorTm Venting Base Sheet (Naliable may be mechanical) attached or hot mopped over noncombustible decks and as a recover over existing roof systems. )" y y "GAFGLAS® Perlite Insulation" may be utilized as a cover board over "EnergyGuardT RF" insulation in any of the following systems. Unless otherwise indicated, the roof insulation is mechanically fastened, adhered with hot mopping asphalt or urethane insulation adhesive. Polystyrene referenced in any of the following Classifications include "EnergyGuardlm EPS Insulation". References to glass fiber Insulation include "EnergyGuard Fiberglass Insulation". "EnergyGuard^ Tapered" is an acceptable alternate to "EnergyGuard*'"" In any applicable Classification. ASPHALTFELTSYSTEMS WITH HOTROOFING ASPHALT Type G2 asphalt glass mat base sheet ("GAFGLAS® #75 Base Sheet" or "Tri -Pty® #75 Base Sheet", or "GAFGLAS® #80 ULTIMA") is a suitable alternate for Type G1 asphalt glass fiber ply sheet ("GAFGLAS® Ply 4" or "Tri -Ply® Ply 4", or "GAFGLAS® Ply 6") in the Class A, B or C roof systems indicated below. The roof deck may first be covered with one ply Type G2 asphalt saturated glass mat base sheet "GAF Stratavent® Eliminator Venting Base Sheet (Perforated) or "GAF Stratavent® Eliminator*'" Venting Base Sheet (Nallabie)." Perforated base sheets to be loose laid or fully adhered with hot roofing asphalt and nallable base sheets are to be mechanically attached granule side down. As an option Type G2 asphalt glass mat base sheet (GAFGLASO #75 Base Sheet" or "Tri -PI " " #80 ULTIMA" or "GAF Stratavent® Eliminatot4 � Venting Base Sheet (Nailable)" may be Ply(osubstituted75 Base Sheet" or "asphalt glass fiber ply sheet ("GAFGLAS® Pty 4" or "Tri -Pty® Ply 4" or "GAFGLAS® Ply 6") as the nailed base ply in the following systems. Bottom ply or base sheet may be solid mopped, spot mopped or mechanically fastened. Unless otherwise indicated, all insulations may be hot mopped or mechanically fastened. "GAFGLAS® Flashing" or "Ruberoid®" may be used for flashing in any of the Class A, B or C systems listed below. When "perlite" is referenced, this includes "GAFTEMP PERMALITE®" or any other UL Classified perlite insulation. Crushed stone or slag are suitable alternates for gravel in any of the Class A, B or C systems listed. Structural cement fiber building units are considered suitable to be included as a deck in the following Class A, B or C systems listed over C-15/32 or NC. The use of gypsum board under any of the following Class A, B or C systems does not adversely affect the rating. The use of 'h - in. minimum thick gypsum board is an acceptable alternate for minimum insulation over C-15/32 thick roof decks. The use of polystyrene insulation board b etween minimum 3k -in, thick perlite board and dprk war►, TGFU.R1306 Roofing Systems Daae— Bottom • ...... • • • 1 •.•.•• Roofing Systems • ..•.• • :....: See General Information for Roofin S terns �•••• 0 • •• •• 0 • � ••••• BUILDING MATERIALS CORP OF •••:•• •• •• 0 AMERICA, DBA GAF • 1361 ALPS RD • • • WAYNE, N) 07470 USA • � . ••••i• • R1�Q�i• . , •• • •••• • • •••••• ••i• • • "Ruberoid® 20" or "Ruberoid® 20 HT or Ruberoid® Modified Base Sheet" may be utilized as an altemate to Type G2 base sheets in any of the following Classifications. Y 1/2 -in. thick (minimum) gypsum board or �/a-in. thick (minimum) Prime® Roofboard" or "DensDeck Dura Guard T°' ) Georgia-Pacific Gypsum LLC "DensDeck® Roofboard," "DensDeck this is done, the resulting roofing system is acceptable foruse overcombustible (15/32 -in. thick minimum) roof decks. However, Roofboard" may be used in any existing noncombustible deck Classification. Whei the butt joints in the gypsum board and Geo "DensDeck DuraGuard"m Roofboard" are to offset a minimum of 6 -in. with the butt joints in the roof deck. If polystyrene Is part of Georgia-Pacific Gypsum LLC "DensDeck® Roofboard," "DensDeck Prime® Roofboard" or the roof system, it must be placed below the overlayment board. Multiple plies of "GAFGLAS® Ply 4" or "Tri -Ply® Ply 4" or "Tri -Ply® ply 6" may be adhered to Georgia-Pacific G DensDedc ® Roofboard," "DensDeck Prime® Roofboard" or "DensDeck Dura Guard^" Roofboard" in hot roofing asphalt. "EnergyGuardTM Ultra" is an acceptable alternate to "Ere YPsum LLC rgyGuard„, RF” in any applicable Classification. "GAF Stratavent® EliminatorTm Venting Base Sheet (Naliable may be mechanical) attached or hot mopped over noncombustible decks and as a recover over existing roof systems. )" y y "GAFGLAS® Perlite Insulation" may be utilized as a cover board over "EnergyGuardT RF" insulation in any of the following systems. Unless otherwise indicated, the roof insulation is mechanically fastened, adhered with hot mopping asphalt or urethane insulation adhesive. Polystyrene referenced in any of the following Classifications include "EnergyGuardlm EPS Insulation". References to glass fiber Insulation include "EnergyGuard Fiberglass Insulation". "EnergyGuard^ Tapered" is an acceptable alternate to "EnergyGuard*'"" In any applicable Classification. ASPHALTFELTSYSTEMS WITH HOTROOFING ASPHALT Type G2 asphalt glass mat base sheet ("GAFGLAS® #75 Base Sheet" or "Tri -Pty® #75 Base Sheet", or "GAFGLAS® #80 ULTIMA") is a suitable alternate for Type G1 asphalt glass fiber ply sheet ("GAFGLAS® Ply 4" or "Tri -Ply® Ply 4", or "GAFGLAS® Ply 6") in the Class A, B or C roof systems indicated below. The roof deck may first be covered with one ply Type G2 asphalt saturated glass mat base sheet "GAF Stratavent® Eliminator Venting Base Sheet (Perforated) or "GAF Stratavent® Eliminator*'" Venting Base Sheet (Nallabie)." Perforated base sheets to be loose laid or fully adhered with hot roofing asphalt and nallable base sheets are to be mechanically attached granule side down. As an option Type G2 asphalt glass mat base sheet (GAFGLASO #75 Base Sheet" or "Tri -PI " " #80 ULTIMA" or "GAF Stratavent® Eliminatot4 � Venting Base Sheet (Nailable)" may be Ply(osubstituted75 Base Sheet" or "asphalt glass fiber ply sheet ("GAFGLAS® Pty 4" or "Tri -Pty® Ply 4" or "GAFGLAS® Ply 6") as the nailed base ply in the following systems. Bottom ply or base sheet may be solid mopped, spot mopped or mechanically fastened. Unless otherwise indicated, all insulations may be hot mopped or mechanically fastened. "GAFGLAS® Flashing" or "Ruberoid®" may be used for flashing in any of the Class A, B or C systems listed below. When "perlite" is referenced, this includes "GAFTEMP PERMALITE®" or any other UL Classified perlite insulation. Crushed stone or slag are suitable alternates for gravel in any of the Class A, B or C systems listed. Structural cement fiber building units are considered suitable to be included as a deck in the following Class A, B or C systems listed over C-15/32 or NC. The use of gypsum board under any of the following Class A, B or C systems does not adversely affect the rating. The use of 'h - in. minimum thick gypsum board is an acceptable alternate for minimum insulation over C-15/32 thick roof decks. The use of polystyrene insulation board b etween minimum 3k -in, thick perlite board and dprk war►, 7%1/13 paper/polystyrene/periite) is TGFU.R1305 - Rooting SWerre a suitable altemate for polyisocyanurate board in the following Class A, B or C systems. "EnergyGuard'"' RA" or "Tapered EnergyGuard'- RA" or "Ene * Corp. poi iso rgyGua io Composite RA" may be substituted for any Atlas Roofing y cyanurate insulation in any of the following Classifications. r � • rum bull Perma Mop" may be utilized with any of the following "Asphalt Felt Systems with Hot Roofing Asphalt". "GAFGLAS@ #80 Premium Base Sheet" may be used in any of the following systems. "GAFGLAS@ Flex Ply 6" and `Tri -Ply® Ultra -Flexible Ply 6" are suitable alternates to "GAFGLAS@ Ply 6"."GAFTEMP Permalite Recover Board" may be used in lieu of any perlite insulation in any of the folViong NC••*C assificatie•t9st•• Unless -otherwise indicated, any of the "Asphalt Felt Systems with Hot Roofing Asphalt" may •• • • • to 3-gal/100-ft2. Y bewed wiQi'•I�It�shiel$��t 2' • "Ruberoid@ Dual Smooth" may be used as an alternate to "Ruberoid@ Mop Smooth" or "Ruber'•oia&620" o " • •��•�• "Ruberoid@ Mop Smooth 1.5" may be used as an alternate to "Ruberoid@ Mop Smooth" •••�� •��%�roid® :p Class A, B and C •••••• •••'•0 ••�•• Hot roofing asphalt, for use with organic and glass felts or modified bitumen membranes. : ; • • •••'• • •••••• ' ••••• ne may be used In lieu of "Ruberoid@ M • "Ruberoid® Heat Weld" SBS roofing membrane SBS% rd's i oIn n a licati••••• Classification. pp Class A • • • • 1. Deck: C-15/32 Incline: 3 Insulation (Optional): — One or more layers perilte or wood fiber or glass fiber or polyisocyanurate or urethane or periite/polyisocyanurate composite or periite/urethane composite or wood fiber/polyisocyanurate composite or phenolic, an thickness. Ply Sheet: — Three or more plies Type G1 or "GAFGLAS@ Ply 4" or "Tri -Ply® Ply 4" or "GAFGLAS® Ply 6" hot mopped. Surfacing: — Gravel. 2. Deck: C-15/32 Incline: 2 Insulation (Optional): —'One or more layers perlite or wood fiber or glass fiber or polyisocyanurate or urethane or periite/polylsocyanurate composite orperlite/urethane composite or mod fiber/polyisocyanu rate composite or phenolic, an thickness. Ply Sheet: — Three or more plies Type GI or "GAFGLAS@ Ply 4" or "Tri-Plye Ply 4" or "GAFGLASO Ply 6". Cap Sheet: — One ply Type G3 "GAFGLAS@ Mineral Surfaced Cap Sheet" or "Tri -Ply® Mineral Surfaced Cap Sheet " or GAFGLAS0 EnergyCaplm BUR Mineral Surfaced Cap Sheet." 3. Deck: NC Incline: 2 Insulation (Optional): — One or more layers perilte, wood fiber, glass fiber, polyisocyanurate, urethane, periite/polylsocyanurate composite, perlite/urethane composite, wood fiber/polyisocyanurate composite, phenolic, 2 -in. maximum. Ply Sheet: — Tm or more plies Type G1 "GAFGLAS@ Ply 4", "Tri -Ply® Ply 4" or "GAFGLAS@ Ply 6". Cap Sheet: — One ply Type G3 "GAFGLAS@ Mineral Surfaced Cap Sheet" or "Tri -Ply® Mineral Surfaced Cap Sheet" or GAFGLAS@ EnergyCaplm BUR Mineral Surfaced Cap Sheet." 4. Deck: C-15/32 Incline: 1 Stip Sheet (Optional): — Red rosin paper, nailed to deck. Insulation (Optional): — Any thickness perlite or wood fiber or glass fiber or POIYIsOcVa adhered with OMG Inc. "OlyBond Fastening System" or any UL Classified insulation dhes to mechanically fastened or Base Sheet: — On T " AF # S Base Sheet" or "Tri -Pt Ply Sheet: — One or m re lies Type GI "G FGLA5@ or "Tri -PI y® #75 Base Sheet" (may be nailed). Cap Sheet: —One pl G3 "GAFGLAS@ Minera Surfaced Ca Sheet oir Tri p Gg) Mineral Ply fa " "GAFGLAS@ Energy ap'M BUR Mineral Su ce ap Sheet." " y® Mineral Surfaced Cap Sheet or Surfacing (optional): — 'TO PCOAT@ EneroyCoteT° applied at a rate of 2-gal/100-ft2. S. Deck: NC Incline: 3 Base Sheet: — One ply Type G2 "GAFGLAS@ #75 Base Sheet" or "Tri -Ply® #75 Base Sheet". Ply Sheet: — One or more plies Type GI "GAFGLAS@ Ply 4" or "Tri -Ply® Ply 4" or "GAFGLAS@ Ply 6". Cap Sheet: — One ply Type G3 "GAFGLAS@ Mineral Surfaced Cap Sheet" or "Tri -Ply@ Mineral Surfaced Cap Sheet" or "GAFGLAS@ EnergyCap— BUR Mineral Surfaced Cap Sheet." 6. Deck: C-15/32 Incline: 2 Insulation: — One or more layers perilte, glass fiber, polyisocyanurate, urethane, periite/polylsocya nu rate composite, perlite/urethane composite, phenolic, 1 in. minimum (offset a minimum of 6 -in. from plywood deck joints). Base Sheet: — One or more plies Type G1 or Type G2 or Type G3. Membrane: — One or more plies "Ruberoid@ Torch Smooth" or "Ruberoid@ Torch Granule' or 'Ruberoid@ Torch Granule Plus" or "Rube roid@ Mop Smooth" or "Ruberoid@ Mop Smooth 1.5" or "Ruberoid@ Mop Smooth Plus" or "Ruberoid@) Mop Granule" or "Ruberoid@ Mop Plus Granule" or "ROOFMatch'" SBS Modified Granular" or "Tri -Ply@ SBS Modified Bitumen Membrane" or "ROOFMatch'" APP Modified Granular" or "Tri -Ply® TP -4G" or "Tri -Pty@ TP -4" or"Ruberoid@ Dual Smooth". Cap Sheet: — Type G3 "GAFGLAS@ Mineral Surfaced ran choot" ,._ -r_ ... It Owners No6ficatiion Farm HVHZZ 2010 MIAM "Delivering Exce/fence Every Day' SECTION 1524 HIGH VELOCITY HURRICANE ZONES— REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS 1524.1 Scope. As it pertains to this section., it is the responsibility of the roofing contractor to provide the owner with the required roofing permit, and to explain to the owner the content of this section. The provisions of Chapter 15 of the Florida Building Cade, Building govern the minimum requirements and standards of -the industry for roofing system installations. Additionally, the following items should be ad p§fd as Mart of the • • * • agreement between the owner and the contractor. The owners initial in the designated speamindic4es that the • • • � � • item has been explained. • • • • •. •.... , :.•••i 1. Aesthetics -workmanship: The workmanship provisions of Chapter 15 (Hi ocit3i*MMcane • • • • • Zone) are for the purpose of providing that the roofing system meets the wind resistance;444vater lhtr4on 00:064, performance standards. Aesthetics (appearance) are not a consideration with respect to-workmanshisp provisio'd : • Aesthetic issues such as color or architectural appearance, that are not part of a zoning Code should beaddreud:. as part of the agreement between the owner and the contractor.0*0 •� • • • 2. Renailing wood decks: When replacing roofing, the existing wood roof deck may haft'M be renailed in accordance with the current provisions of Chapter 16 (High Velocity Hurricane Zones) of the Florida BuildingCode. (The roof deck is usually concealed prior to removing the existing roof system). . 3. Common roofs: Common roofs are those which have no visible delineation between neighboring units (i.e. townhouses, condominiums, etc.). In buildings with common roofs, the roofing contractor and/or owner should notify the occupants of adjacent units of roofing work to be performed. 4. Exposed ceilings: Exposed, open beam ceilings are where the underside of the roof decking can be viewed from below. The owner may wish to maintain the architectural appearance; therefore, roofing nail penetrations of the underside of the decking may not be acceptable. The owner provides the option of maintaining this appearance. A5. Ponding water: The current roof system and/or deck of the building may not drain well and may cause water to pond (accumulate) in low-lying areas of the roof. Ponding can be an indication of structural distress and may require the review of a professional structural engineer. Ponding may shorten the life expectancy and performance of the new roofing system. Ponding conditions may not be evident until the original 5M=:: Ponding conditions should be corrected. uppers (wall outlets): It is required that rainwater flow off so that the roof is not overloaded from a build up of water. Perimeter/edge walls or other roof extensions may block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accordance with the uirements of: Chapter 15 and 16 herein and the Florida Building Coda, Plumbing. - 7. Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of the structural assembly (the building itself). The existing amount of attic ventilation shall not be reduced Exception: Attic spaces, designed by a Florida -licensed engineer or registered architect to eliminate the attic venting, venting shall not be required Owner's/Agent's Signatur = Date: Alb 0/ Contractor's Signature• Permit Number: Property Address: �� U' M I- _ ayVillage Miami Shores NOV 2014� Buildin Department r � p 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: //-/g 10050 NE 2nd Ave Miami Shores, FI 33138 Re: Owner's Named jHA-P- `. i -&,e n Property Address: u,_57 g� Roofing Permit Number. Dear Building Official: certify that I am not required to retrofit the roof to wall connections of my building because: The just valuation for the structure for purpose of ad valorem taxation is less than $300,000.00. Please attach proof of ad valorem taxation. ❑ The building was constructed in compliance with the provisions of the Florida Building Code (FBC) or with the provisions of 1994 edition of the South Florida Building Code (1994 SFBC) Signature State of Florida County of Dade Print Name The undersigned, being the first duly swom, deposes and says that he/she is the owner for the above property mentioned. Sworn to and subscribed before me this I '•: MY COMMISSION # EUW%3 Notary Public, Sate of Florida at Large when the just valuation of ft structure for purpose ofad vatorean tmx m is epal tD or more than $3M.000.00, and Om t mft not construed vM FBC sora 1994 SFBC. Then you must provide a buffft aWkdon from a Cool Contractor for the Roof to waft m mecum Hurricane mmgdm Revised cm 50M `c�� Miami -Shores Village M! Building Department NOV I x014 I 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 By. Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-494 FBC 20 IC� BUILDING Master Permit No.�L� PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION [:]SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Phone#: Address_ 9F City: t Gt �� c: �� State X L_ zip - 3 N Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: a1L�1 ��n��s'�� 6_`275-2- N� Phone#: _ -,5 72 Address: 3145-1 214"1 14 -4-11— City: 4-11— City: �� / /_ State: _E1 Zip: .33 Qualifier Name: A -Y ama t d A /Z C1'4 Phone#: M4 - State Certification or Registration #: (f G C GQ 2 1 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $T Square/Linear Footage of Work: ��p ,� �- Type of Work: ❑ Addition ❑ Alteration ❑ Newgg��Repair/Replace El Demolition � Description of Work: -__L _� ® �� 1v Q ,�� ,� / J o a Ay4? Wil® � � /� 7 .� K UC 5 e-4 ji: ,7' Specify color of color thru tile: Submittal Fee $ ®� Permit Fee $aa� CCF $ � CO/CC $ Scanning Fee $ Radon Fee $ a ` _)_5DBPR $9 - ^-L5 Notary $ Technology Fee $�4 P10 Training/Education Fee $ Double Fee $ Structural Reviews $ QQ Bond $ 1 TOTAL FEE NOW DUE $ s a (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 issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature OWSA4WAGENT The foregoing instrument was acknowledged before me this 12, day of & 0 L/ 120 by /)/4 S ho is ersonall know to me or who has produced as identification and who Signature 7V—�� CONTRACTOR The foregoing instrument was acknowledged before me this // "7 day of 1`/4 C/ . 20 ,(V . by �[�?-t�A�I og�, who is personally known to me or who has produced as and who did take an oath. NOTARY PUBLIC: JOSE P PEREZ OTARY PUBLIC: MY COMMISSION # EE209593 .„ EXPIRES June 19, 2016 Florida Sign: 3O 153 'EOm ign: Print:Print: SE P PEREZ h � E. Seal: Seal✓'%.� ;� EXPIRES June 19, 2016 ��*>xs�aa�*r«rx�>g��:�e*:*�e�s>kwrx>k*�ss>k �s• •e* s*s��a�rsrx��x�r�*x�»*«+��s*s*�a�r*x�a****a�as**��sx�***se*sr��r*a��aa�u**saw*w* APPROVED BY (� I� Plans Examiner Zoning Structural Review Clerk (Rev1sed02/24/2014) Miami S V11age Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (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 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 personallyliable for the worker com enation in'uries of an person allowed to work under this ermit. 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: 1)Q ®�® Signature: --� 1 State of Florida ) County of Miami -Dade ) Sworn to and subscribed before me this -59 day of ,o%,9 .20 1 4,%.F P PEREZ B =": RAY COMMISSION # EE209593 By• •St:. • - (SEAL) ( ae8 0163 FWidO�ice.wm Type of Identification produced Contractor Print Name: �✓ Signature: State of Florida ) County of Miami -Dade ) Sworn to and subscribed before me this 13 day ofWou _ 9.n% a B - JOSE P PEREZ ytom; .r �.v nn..•............. ___. EXPIRES June 19, 2016