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RF-15-764 a � a ` Miami Shores Village ' %� n s ` 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 'gas ° Phone: (305)795-2204 l FCORlt1p' -` Expiration: 11/01/2015 Project Address Parcel Number Applicant 9200 NE 12 Avenue 1132050150260 Miami Shores, FL Block: Lot: MARY OLARTE Owner Information Address Phone Cell MARY OLARTE 9200 NE 12 AVE MIAMI SHORES FL 33138-2997 Contractor(s) Phone Cell Phone Valuation: $ 900.00 QUALITY PLUS CONSTRUCTION (786)267-4252 Total Sq Feet: 100 Type of Work:Repair Available Inspections: Additional Info:REPAIR SOFFIT AND PLYWOOD LEAK Inspection Type: Classification:Residential Roof Repair Scanning:3 Final Roof Review Roof Review Roof Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee Invoice# RF-4-15-55049 $2.00 05/05/2015 Credit Card $64.60 $50.00 DCA Fee $2.00 Education Surcharge $0.20 04/03/2015 Credit Card $50.00 $0.00 Permit Fee-Repairs $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $114.60 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above-name ntractor to do the work stated. May 05, 2015 Authorized Signature:Ow cant / Contractor / Agent Date Building Department Copy May 05, 2015 1 _ t _ Miami Shores Village Building Department APR 03 2015 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 JecP1717CI.— INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 td BUILDING Master Permit No.RC-1-151-2225 PERMIT APPLICATION Sub Permit N0. BUILDING ❑ ELECTRIC ffil ROOFING REVISION ❑ EXTENSION RENEWAL PLUMBING [--] MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9200 NE 12th Avenue City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-3205-015-0260 Is the Building Historically Designated:Yes NO X Occupancy Type: Res Load: Construction Type: CBS Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Mary Pam Olarte Phone#:305-751-0884 Address:9200 NE 12th AVENUE City: MIAMI SHORES State: FLORIDA Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Quality Plus Construction Phone#: 36M75-2202 Address: 2521 NW 131 ST ST City: Miami State: Florida Zip: 33167 Qualifier Name: Paul Anthony Scott Phone#: 305-978-2202 State Certification or Registration#: CCC1327373 Certificate of Competency#: DESIGNER:Architect/Engineer: Nip` Phone#: Address: City: State: Zip: Value of Work for this Permit:$900 Square/Linear Footage of Work: 100 Sq.FT Type of Work: ❑ Addition ❑ Alteration ❑ New ❑■ Repair/Replace ❑ Demolition Description of Work: Repair Soft and Plywood Leak Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ -4 ' (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for 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 Signature OWNER or GENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of Gr , 120 /'S by 94K day of 20 ti-5 by Kt,� 11ouA\nn OCIL4�c_who is personally known to Q u JC a' who is personally known to me or who has producedme or who has produced D L as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: c— Sign: Sign: bQ-,,N Print: P� � Print: ��Y�t S � ��i 0' Seal: �; Notary Public-State of Florida Seal: =Cnmmissio❑#EE082868 My Comm.Expires Jun 26,2016 =, ;: F.t;�i;es: A11R.10,2015 Commission#EE 211426 "^ nm.a BONDED ni.!?_ APPROVEB BY flans Examiner Zoning Structural Review Clerk (Revised02/24/2014) `SNORES •••• .....�+ Miami Shores Village Building Department ��ORiDp' 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT CFn X PY OF LIABILITY INSURANCE* D. t/ COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: QU'�L IT-) Pt-1 J COA S-tR-UcT i�-j BUSINESS ADDRESS: 10D ) N vJ a c)0 t-t /WCITY /M JA-m STATE xz-. ZIP BUSINESS PHONE: 3C( 5 ) 9-7e-' d'010 & FAX NUMBER( ) CELL PHONE( ) SA-^'I QUALIFIER'S NAME: PA uL SCS TT QUALIFIER'S LIC NUMBER: CC C 11�7 3 73 STATE OF FLORIDA -- DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET (850) 487-1395 TALLAHASSEE FL 32399-0783 SCOTT, PAUL ANTHONY QUALITY PLUS CONSTRUCTION INC 2521 N.W. 131ST STREET MIAMI FL 33167-1342 Congratulations! With this license you become one-ofthe-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, - STATE OF FLORIDA and they keep Florida's economy strong. 40 DEPARTMENT OF BUSINESS AND Every day we work to improve the way we do business in order to PROFESSIONAL REGULATION serve you better. For information about our services,please log onto CCC1327373 ISSUED: 07/28/2014 www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you,subscribe CERTIFIED ROOFING CONTRACTOR to department newsletters and learn more about the Department's SCOTT, PAULANTHONY initiatives. QUALITY PLUS CONSTRUCTION INC 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! IS CERTIFIED under the provisions of Ch-489 FS. Expiration date:AUG 31,2016 L14072800oaml - -- DETACH HERE STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD ` s �r� CCC1327373 _ w `> The ROOFING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. 4 s Expiration date: AUG 31, 2016 SCOTT, PAUL ANTHONY HN QUALITY PLUS CONSTRUCTION INC 1021 NW 200 TERR MIAMI FL 33169 ISSUED: 07/28/2014 DISPLAYAS REQUIRED BY LAW SEQ# L1407280000881 .. ..... ......... i.Qa! Business Tax Receipt Nlami�badeCOunty,,State.Of F}ocida iriosis�uaTssitt-ooWT AY BT 5870127 � ssNA ,coc�zwN. ttNo. EXPIRES QUAUTYPLMCOi�b"1RUCTION WtWWAL SEPTEMBER X 2015 IPiC 6122489 MuSt ae crivayed et pk c os umtneas 2521 14W'131$T Pursuant Do-County Case N!lAA+II FL,33167 cbaptt.SA-Ars&m OWNER. SEG TYPA OF UUMWe" Y/1MENTREGEMD QUALITY 1LU$CONSTRUCTION INC 198 �TR C�A RII DIItG sGor TAX IEGTea ,.75,44 OWWO14 1Muciter{s} 4 CCC1327373 11281-14-005433 T6istm18Wmsstupp�p,� �felaCai Si�msTaa.It+t ACCl�tis eutaNcega P�waa. eaa�meaaNer'xm4arastoe�ii�rtm�ph �nr��N°��'. 76a 68�3PI�,almn mmt a a,.4,wa�mcies+.ba»,�— Farmnw . DATE(MMIDONY) " ACDRD CERTIFICATE OF LIABILITY INSURANCE 09/04/14 PRODUQCR Maplas Insurance Agenoy TNI3 C6RTIFICATQ IS ISSUED"WS—A MA71"6iZ OR INRORMATIQN 1051 East Sample Road If ONLY AND CONFERS NO RIGHT$UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE OOES NOT AMEND,EXTEND OR Pompano Beach,FL 33064 I AIJA THR CQV_H�1./1GE AFRORdEO BY•jHjg•POL!OlE$OEI.QYY, Phone (954)946-8940 - WKaX (964)946-8942 'INSURERS AFFORDING COVERAGE NA1C X INSURED QUALITY PLUS CONSTRUCTION jfNSUREq.A: FEDERATED NATIONAL 2521 NW 931ST ST ' ,+Nt�VatiRC; MIAMI, FL 33187 rSUR9R 12-.. ,,..__.. _..w_, I INSURER E: ........... ..... COVERAGES INSURER P: _...--•-• _---. I. .._. _ THE POLICIEB OF INSURANCE LTstED HAVE BLBN ISSUED TO THL'INSURED NAMED ABOVE fOR THE POLICY PERIOD IND+CATEO. NOTWITHSTANDING ANY R5OUIREMENT,TERM OR CONDITION OF ANY CONTRACT OA OTHER DOCUMENT WITH RESPECT YO WHICH TH18 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFPOkOED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGR15GAYC LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID OLAIME. «� „_•,•„• —,,, INSR, OOD'L POLICY EFFECTIVE;POUJY EIIPIRATION LTR q jN.4RD, YTPt OF INSURANCE POLICY NUMeC+e _0AYgt+uMIDPIYY b jtMAgfYY1 LIMITS GENERAL LIABILITY EACH OCCURRENCE 1,000,000 V,COMMERCIAL GENERAL LIABILITY � l5AMA6E�DENTED 100,0001 . 08/04/14 00/04/15 RMRIMALI ),- :MEO EXP(Any one person) { .Jt_.: GLAIM6 MADE �.j OCCUR I .. _. .__., A I 'PERSONAL&ADV INJURY 1 1,000,000 GENERAL AGGREGATE 1,000,000 ........ "— Pfi000CTS-GOMPfOPAGO _ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER — - POIIGY , PROJECT i- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMN ANY AUTO (Ea ALL OWNED AUTOS BODILY INJURY 1. I SCHEDULEDAUTOS f HIRED AUTOS CODILY INJURY I NON OWNE=D AUTOS (Per a0denU :-• ......., ___ E PROPERTY DAMAGE (Per accl er _ ' GARAGE LIABILITY Y uTO ONLY-EA ACCIDENT _— ANY AUTO OYHER THAN CA ACC , AUTO ONLY: AGG EXCESS LIABILITY EACH OCCURRENCE. CCUR_HENCE _ OCCUR CLAIMS MADE AGGRGGATE _ DEOUCTIO4& — J4.� `..... _... i RETENTION ........ . •WORKS GOMPf°�'�dN AND � RTU- - 0TH• I EMPLOYERS'LIABILITY MLM,,. -P.Li...•. _._. ANY PQOPAIETOR/PARTNER I EXECUTIVE I'e.l,EACH ACCIDENT „ OFFICER/MEMBER EXCLUOED9 E.L.DISEASE-EA EMPLOYEE II yes,raeswoe under _._... _._ ......, SPECIAL PROVISIONS below _ El-DISEASE•POLICY LIMIT OTHER ; t76aCRIPTION OF OPERATIONS+LOCATIONS I VEHICLES I EXCLUSIONS ADDED OY ENOORSSMGNT I SPECIAL PROVISIONS CCC 1327373 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BL CANCELLED BEFORE THE EXPIRATION OATS THER&OF,THE 18SUING INSURER WILL ENDEAVOR TO MAIL MIAMI SHORES VILLAGE BUILDING DEPT 30 OAYS WRITT2N NOTICE TO THE CERTIFICATE HOLDER NAMED TO TML±Lt1rT,BUT FAILURE TO 00 SO SHALL,IMPOSE NO OBLIGATION OR LIABILITY 100SO NORTH EAST 2 AVE Of ANY KINO UPON THE INSURrut,IT*AOCNT5 OR REPRE6GNTATIVCS. MIAMI SHORES, FLORIDA 33138 I AUTHORIZED REPRESENTATIVE NCORO 26(2001/06) 0 ACORO CORPORATION 1088 &7=4 Report Vieas� ` ;t f�T iQ1lMF�h i I t .EFF uweIM �4 ws da CHIEF FIKMCM OFRC82 UA i OWARnimw OFfpuwtmL SES 1 1"OF WOMWW COMPENUTION 1 t :r C6UEiCATE OFEIADMON TD BE EMMPT FR M A QRMA WORKSW COMPENSATION LAW•• CONSTRUCTION INDUSTRY OMMPTION This ceffm.that the k-Nduai fe W Mm has ete tD be exampt kom Florida Waiters'Compensafort law M%MVEDATi= - &17/2014 EXPIRATIONDATE 81842018 Pe�oN SCOTT PAUL A j iFEft 683778456 N BUMWSS NAMEANDAD RESS: QOALITXPLUS CONSTRUCTION INC i I 2524 NW 431 ST t # MAN FL 33467 i + SLOPES OFaUS9639 ORTRADE: i LICENSED GENERAL LICENSED ROOFWG s CONTRACTOR CONTRACTOP, i P�xiwtbfJ�O�d�pJ�t14?.FS,andraerda � 'erdC6e�@Q awbrBk* l-r_fu=QtbCh*WM0A5(tA,F C�sdda4enbbad dlnWgpmaatad�flsdm9e�nirsddadmtoOa�pCA�a�tOcbmiw 1�j.FS,Nacaddcl�win pe�Xad � Eer9mbEeetgt aAptDaSgetfb�Y,aa�iQMeEaAdM�Cev 75l�oad0ame0nl6emaa+gp®do+Ysl�ceu ' Letml�renldm`9CarrWaBsbmeribstda@�sddaEnlTwdpeLrctdffiadracvbTdeiai8owtrb'Mcedih. 1 OF9F2-0WC:M CERTIFICATE OF H,.EC'iIM 7D BE E)EWrFtem O 0712 cijEsroN37 msmi3-tam i • Wt JIC* —trrgMrtM9MIB kq)OfMeW 3rAS'OdWa-k4Vwc9D7Q3gH6'ER6BP1 YINPOPN4VmDRCMVW... �r SNORF,y. B,,, Miami shores Village Building Department LORIpIP► 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: I. 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 and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of 4(iaa C ti ,20_1�� . By t)1•/ f1f,4( fl����4,l� who is personally known to me or has produced n� i cL 1 as identification. Notary: SEAL: EOF, GILBERT PIERRE SAINTNotary Public-State of Florida un ,2016 Commission#EE 211426 Quality Plus Construction 1021 NW 2001h Terrace Miami, FL.33169 (305)978-2202 April 291h,2015 To whom it may concern, On this day, Paul Scott has appeared before me. Being duly sworn, Paul Scott affirmed the following: I, Paul Scott,will be the only person to complete the roofing work on the property located at 9200 NE 12th Avenue, Miami Shores, Florida. Paul Scott STATE OF FLORIDA COUNTYOF DA©� Sworn to(or affirmed)and subscribed before me this C')97day of 20S by ADRIAN NOWALK MY COMMISSION w FF MW = EXPIRES:April 21.2019 N Bonded Thru Notary Pubic Underwrkre (Name of Notary Typed, Printed, or Stamped) / Personally Known OR Produced Identification r Type of Identification Produced rLI-''9313 • 7iTn I M •=n • I, - • • • • � ■■■■■il■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■..iii•■■■■■■■�����■■ i �i ■■■X11■■■1■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ : ��■i�7■X11■■■'1■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■.■,■ '� !■r7■:111■■■ 1■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ • '" ■!'9■4NINON II■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ IC 11e�■rr■I■■ ■■■■■■■■■■■■■■������■■�■■■■■■■■■■■■■■■■■■■■■■Ii ` 11f 11l�■■■I■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ 11■■11■J■��liili}■�F■■■■iia■■Y■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ il��ll■s1■II;R�■PIF■rt■�/�■�t'1■�Y■■■■■■■■■■i..�..■■■■■��■■■■■■■■■■■I '11■X11■:1■■■:■■■f■■■■■■■■■■■■■■■■■■■■■■i■■■■■■■■■■■■■■■■■■■■■■■I •upsou■9■IR■■■■/■■■■■■■.....�.�.r.���.'■■■■■■■■■■■■■■■■■■■■■■■I 11111 In 11■ ■t■+■■■■■■■■■■■■����■■■��■■■�■■■■■■■■■■■■■■■■■■■■■■■■I ■ ill■iill■!d■li:■t�o■■■a■Sa■■C■■�0■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■� ■1■�.11■isl■N!Li■Gf�7■■f.7■■iic■■■■7ORa■■■■■■■■i1■■■■■■■■■■■■■■■■■■■■■■I ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■A�!■A■■A!■7!'�1'171■■!1■■■■■■■■■.■■■■�1■■■■■■■■■■■■■■■■■■ h, i Florida Building Code Edition 2010 High Velocity Hurricane Zone Uniform Permit Application Form Section D (Steep Sloped Roof System) Roof System Manufacturer: X/ ,A gS?.juG -xi-F Product Approval Number: W S1'4N 6 Tait Minimum Design Wind Pressures,If Applicable(From RAS 127 or Calculations): P1: P2: P3: Maximum Design Pressure Product Approval Specific System: Method of Tile Attachment: Steep Sloped System Description Deck Type: YY,,, fl y"Joe-)'D Roof Slope: Type Underlayment: ,Q��r1Yl d >4 7l► 12 Insulation: Fire Barrier: _A Fastener Type & Spacing: Ridge Ventilation? /b/l'© A✓f/4 Adhesive Type:1061�� Type Cap Sheet: N/-4 Y• ••• • • • • • •• Roof Covering: �y • • • • • ••• • Mean Rg•rl-!Q fit' • • • • Type &Size Drips ... . Edge: I ✓✓ ` 000 •• • • • • • • • • • • • • • • • • • • • • • •• •• • • • •• •• MIAMI-DADE COUNTY M UAW" PRODUCT CONTROL SECTION • 11805 SW 26 Street,Room 208 DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES(R Miami,Florida 33175-2474 BOARD AND CODE ADMINISTRATION DIVISION T(786)315-2590 F(786)315-2599 NOTICE OF ACCEPTANCE (NOA) -tiw.miamidade.LyoN/economy 0 yF 3M Company �r�IvED 3M Center Building 0220-05-E-06 St.Paul,MN.55144-1000 APR 2 3 15 i ir SCOPE: BY This NOA is being issued under the applicabl and regulations governing the use of construction materials. The documentation submitted has been reviewed and accepted by Miami-Dade County RER-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 Al-IJ(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: 3Mrm 2-Component Foam Roof Tile Adhesive AH-160 LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami-Dade County Product Control Approved" unless otherwise noted hereill. • RENEWAL of this NOA shall be considered after a renewal application has been filed and there has Awn no chaff. in the applicable building code negatively affecting the performance of this product. •••••• 9 9 • TERMINATION of this NOA will occur after the expiration date or if there has been a 18vision'or Mange Wtfe. . .. materials,use,and/or manufacture of the product or process. Misuse of this NOA as an en�i..Q.r%.;.tzt.ent of. ty..�roduc.�i o 0 sales, advertising or any other purposes shall automatically terminate this NOA. Failure tp.QQWly with any section qP this NOA shall be cause for termination and removal of NOA. • . . . . ...... . ADVERTISEMENT: The NOA number preceded by the words Miami-Dade County, P10ridht, and fooapved 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 revises NOA 13-0502.02 and consists of pages 1 through 11. The submitted documentation was reviewed by Alex Tigera. NOA No.: 14-0805.01 halwEDr►DECOI�ITI/ Expiration Date: 05/10/17 JAP ROVEDilApproval Date:09/04/14 Page 1 of 11 ROOFING COMPONENT APPROVAL: Category: Roofing Sub Category: Roof tile adhesive Materials: Polyurethane SCOPE: This approves 3MT1d 2-Component Foam Roof Tile Adhesive AH-160 as manufactured by 3M Company as described in this Notice of Acceptance. For the locations where the design pressure requirements,as determined by applicable building code,do not exceed the design pressure values obtained by calculations in compliance with Roofing Application Standard RAS 127. For use with approved flat,low,and high profile roof tile systems using 2-Component Foam Roof Tile Adhesive AH-160. PRODUCTS MANUFACTURED BY APPLICANT: Product Dimensions Test Product Description Specifications 3MTM 2-Component N/A TAS 101 Two component polyurethane foam adhesive Foam Roof Tile Adhesive AH-160 Foam Dispenser N/A Dispensing Equipment RTF 1000 ProPack®30& 100 N/A Dispensing Equipment PRODUCTS MANUFACTURED BY OTHERS: Any Miami-Dade County Product Control Accepted Roof Tile Assembly having a current NOA which list attachment resistance values with the use of 2-Component Foam Roof Tile Adhesive AH-160 roof tile adhesive. •••• . . 6666 6666.. MANUFACTURING LOCATION: •• •••• • 6666.. 6666 6666.. 1. Tomball,TX. 6666 .. 6666.. 6666 . .. 6666. PHYSICAL PROPERTIES: • .. .. .. .. 6666.. Property Test R � • Density ASTM D 1622 1.6 lbs./ft.' •••••• 6666.. Compressive Strength ASTM D 1621 18 PSI Parallel to rise :6066: 12 PSI Perpendicular to rise' •' :' ' Tensile Strength ASTM D 1623 28 PSI Parallel to rise Water Absorption ASTM D 2127 0.08 Lbs./Ft' Moisture Vapor Transmission ASTM E 96 3.1 Perm/Inch Dimensional Stability ASTM D 2126 +0.07%Volume Change @ 40'F.,2 weeks +6.0%Volume Change @158°F., 100%Humidity, 2 weeks Closed Cell Content ASTM D 2856 86% Note: The physical properties listed above are presented as typical average values as determined by accepted ASTM test methods and are subject to normal manufacturing variation. NOA No.: 14-0805.01 hAAMFpADECouNTY Expiration Date: 05/10/17 Approval Date: 09/04/14 Page 2 of 11 EVIDENCE SUBMITTED: Test Agency Test Identifier Test Name/Revort Date Center for Applied Engineering #94-060 TAS 101 04/08/94 257818-IPA TAS 101 12/16/96 25-7438-3 SSTD 11-93 10/25/95 25-7438-4 25-7438-7 SSTD 11-93 11/02/95 25-7492 SSTD 11-93 12/12/95 Miles Laboratories NB-589-031 ASTM D 1623 02/01/94 Polymers Division Ramtech Laboratories,Inc. 9637-92 ASTM E 108 04/30/93 Southwest Research Institute 01-6743-011 ASTM E 108 11/16/94 01-6739-062b[l] ASTM E 84 01/16/95 Trinity Engineering 7050.02.96-1 TAS 114 03/14/96 P36700.04.12 ASTM D 1623 04/18/12 P39740.02.12 TAS 101 02/21/12 TAS 123 Celotex Corp.Testing Services 528454-2-1 TAS 101 10/23/98 528454-9-1 528454-10-1 520109-1 TAS 101 12/28/98 520109-2 520109-3 •�•• . . .... ...... 520109-6 520109-7 • ...... .... ...... 520191-1 TAS 101 03/02/99 ...... 520109-2-1 "" ' .... . .. ..... LIMITATIONS: • .. .. .. .. ...... 1. Fire classification is not part of this acceptance. Refer to the Prepared Roof Tile Ass;rWyfor fire ratng. •••,;• 2. 3MT"2-Component Foam Roof Tile Adhesive AH-160 shall solely be used with flat:for&high the profiles•.••; 3. Minimum underlayment shall be in compliance with the Roofing Application Standard RAS 120...' ; 4. Roof Tile manufactures acquiring acceptance for the use of 3M"4 2-Component Foam Roof Tile Adhesive AH- 160 roof file adhesive with their tile assemblies shall test in accordance with TAS 101. 5. All products listed herein shall have a quality assurance audit in accordance with the Florida Building Code and Rule 61G20-3 of the Florida Administrative Code. NOA No.: 1440805.01 twr►�cou�TY Expiration Date: 05/10/17 'APPROVED Approval Date:09/04/14 Page 3 of 11 INSTALLATION: 1. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 may be used with any roof tile assembly having a current NOA that lists attachment resistance values with the use of 3MTM 2-Component Foam Roof Tile Adhesive AH- 160. 2. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 shall be applied in compliance with the Component Application section and the corresponding Placement Details noted herein. The roof tile assembly's adhesive attachment with the use of 3MTM 2-Component Foam Roof Tile Adhesive AH-160 shall provide sufficient attachment resistance to meet or exceed the resistance value determined in compliance with Miami-Dade County Roofing Application Standards RAS 127. The adhesive attachment data is noted in the roof tile assembly NOA. 3. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 and its components shall be installed in accordance with Roofing Application Standard RAS 120,and 3M Company's 3MTM 2-Component Foam Roof Tile Adhesive AH- 160 Operating Instruction and Maintenance Booklet. 4. Installation must be by a Factory Trained'Qualified Applicator'approved and licensed by 3M Company. 3M Company shall supply a list of approved applicators to the authority having jurisdiction. 5. Calibration of the Foam Dispenser RTF1000 dispensing equipment is required before application of any adhesive. The mix ratio between the "A" component and the"B" component shall be maintained between 1.0-1.15 (A): 1.0 (B). 6. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 shall be applied with Foam Dispenser RTF1000 or ProPack®30& 100 dispensing equipment only. 7. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 shall not be exposed permanently to sunlight. 8. Tiles must be adhered in freshly applied adhesive.Tile must be set within 1 to 2 minutes after 3MTM 2- Component Foam Roof Tile Adhesive AH-160 has been dispensed. 9. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 placement and minimum patty weight shall be in accordance with the 'Placement Details'herein. Each generic tile profile requires the specific placement noted herein. . . .... ...... ...... .... ....% .... . .. ..... ...... . . ..... .. .. .. .. ...... . . . . ...... NOA No.: 14-0805.01 hNAMFDiADECOUNTY Expiration Date: 05/10/17 �__IAPPROVEDI Approval Date: 09/04/14 Page 4 of 11 Table 1:Adhesive Placement For Each Generic Tile Profile Tile Profile Placement Detail Minimum Paddy Contact Minimum Paddy Gram Area Weight Eave Course-Flat,Low,High All Eave Course 17-23 sq.inches 45-65 Profiles Flat,Low,High Profiles #1 17-23 sq. inches 45-65 Flat Profile #2 10-12 sq. inches 30 Low Profile #2 12-14 sq. inches 30 High Profile #2 17-19 sq. inches 30 Flat,Low,High Profiles #3 Two Paddys: 8-9 sq. inches at 12 grams per paddy head of file 9-11 sq. inches at overlap Two-Piece Barrel (Cap Tile) Two Piece 2 Beads(1 each longitudinal 17 grams per bead edge)20-25 sq. inches each bead Two Piece Barrel (Pan Tile) Two Piece 65-70 sq. inches 34 grams under pan LABELING: All approved products listed herein shall be labeled and shall bear the imprint or identifiable marking of the manufacturer's name or logo and following statement: "Miami-Dade County Product Control Approved" or the Miami- Dade County Product Control Seal as shown below. ronr�FowoE couNrr •••• . . .... ...... BUILDING PERMIT REQUIREMENTS: • ...... .... ...... As required by the Building Official or applicable building code in order to properly evaluaoble instakation of thi; • system. 0009* • •• ...... . . ..... . . . . ...... NOA No.: 14-0805.01 cTY Expiration Date: 05/10/17 Approval Date: 09/04/14 Page 5 of 11 ADHESIVE PLACEMENT DETAIL# 1 ftW adwow ptauic c sn•ca PlmWV Momath Testi Flat/Low Profile Tile ;r1►rw r•grir•d; • 1. Starting at the cave course,apply a minimum 2" (50.8 mm)x 10"(254 mm)x 1"(25.4 mm)foam paddy onto the underlayment positioned as shown, under the strengthening rib closest to the overlock 106. of the file being set. 1~s F~CO.ON4 , 2. Continue in same manner. Insure approximately 17 F (109.7 cm2)-23 (148.4 cm)square inch adhesive R,.. contact with the underside of the tile. loon Fascia /r p E•••ikwes Medium Profile/ Double Pan Tile Mao ihm"h plasAc cement lateen re"iredi raa,,s.r,a.ehri.i 1. Starting at the cave course,apply a minimum 2" (50.8 mm)x 10"(254 mm)x 1"(25.4 mm)foam * paddy onto the underlayment positioned as shown ++ under the pan portion of the tile closest to the eo overlook of the tile being set. 10 w..rli. r 2. Continue in same manner.Insure approximately 17 lt~"*POO" '` J (109.7 cm2)-23 (148.4 cm2)square inch adhesive *. contact with the underside of the tile.•• Mai threw pbslh cerwent • • •• ••••• High Profile/Single Pan.14 • prddr IR.a•ulh?il.l •••• • • • ••••• rs.•rtw ra�rh•di • • • • • 1. Starting at the cave courseO.apply a minimum 2" •• Usrdwl.grwswrl a• a. • • • (50.8 mm)x 10„(254mm)x 1ev(25.4 rnm)fowo• • paddy onto the underliyNeilt positioned as shQWA• e i„A under the pan portion oWthe the cbseUfo the • • overlook of the file being set. •• • 2. Continue in same manner.Insure approximately 17 (109.7 cm2)-23(148.4 cm2)square inch adhesive contact with the underside of the tile. Ear•-",W” Fascia 19 t#eeprofe 101W )in Em rles•re !� Drip•da• NOA No.: 1440805.01 ecotY Expiration Date: 05/10/17 IAPPROYEDApproval Date:09/04/14 Page 6 of 11 ADHESIVE PLACEMENT DETAIL#2 Nril Fhwugk p1..sk esmrn! Pa"y is.".Gd%Till Flat/Low Profile Tile twlyw regwrsd> uwa«;.yawa4 . ° r 1. Starting at the eave course,apply a minimum 2"(50.8 mm)x 10"(254 mm)x 1"(25.4 mm)foam paddy onto the underlayment positioned as shown under the ' strengthening rib ofthe file closest to the overlock of 2 the the being set.Insure approximately 17 (109.7 cm2) 23 (148.4 cm)square inch adhesive contact with the underside of the tile. 2. At the second course,apply a minimum 2"(50.8mm) tam_ F,�,�, x 7�,(177.8 mm)x 1�,(25.4 mm)foam paddy onto the 2 undedayment positioned as shown under the strengthening rib closest to the overlock of the tile EGwGssw. being set. 3. Continue in same manner. Insure approximately 10" (64.5 cm2) - 12 (77.4 cm2) square inch adhesive contact with the underside of the tile. Medium Profile/Double Pan Tile Wailihmigh plookr mme" :**m requiredl .►, ,isema&Tilt) 1. Starting at the eave course,apply a minimum 2"(50.8 mm)x 10"(254 mm)x 1"(25.4 mm)foam paddy onto the underlayment positioned as shown under the pan portion of the tile closest to the gvMcck of the Y the being set. Insure ap*xWWtely 17(IA9.7 cmj*e:* '' ' 23 (148.4cm2) square inc�i adhesive cc;M with the• -- 1 **,Pee* G00 000000 underside of the tile. ,••;G G :Goes: . Rslfens oplie"sl �, 'ti' 2. At the second course,appy ao mmimnm (50.81x�•• �a x 7" 177.8 mm x 1" 25. tthp)foal adQy ontA"tfiE• ( ) ( 't' P apo,,„. underlayment positioned'ds 3`11own under We pan e••},•0 • e Ewr Gwrw . ' _ portion of the tile closest to lrna overlock of the filo•G o• FasciG being set. •. G" G . G 0000.. so G e 000 3. Continue in same manner. Insure appiwa'an�itely 12" (77.4 cm2) - 14 (90.3 cm2)square inch adhesive contact with the underside of the tile. (Instructions continued on next page) NOA No.: 14-0805.01 hw4MFD�'�D 1 Expiration Date: 05/10/17 Approval Date: 09/04/14 Page 7 of 11 ADHESIVE PLACEMENT DETAIL# 2 (CONTINUED) a.r d1brow0h piuuc t•Pb.ffe- High Profile/Single Pan Tile "Wh"P09%u rdi ► ►IMti•�th Tib} Starting at the eave course,apply a minimum 2"(50.8 mm)x 10"(254 nun)x 1"(25.4 mm)foam paddy onto the underlayment positioned as shown under the 4 . pan portion of the tile closest to the overlock of the " the being set.Insure approximately 17(109.7 cm2)— ''"`4-� 2 w. 23 (148.4 cm)square inch adhesive contact with the Nau*"• «,.i ;' ` underside of the tile. 2. At the second course,apply a minimum 2"(50.8mm) T FEW WW" x 7"(177.8 mm)x 1"(25.4 mm)foam paddy onto the ` ,�� Ir••ph•M underla -,, yment positioned as shown under the pan portion of the file closest to the overlock of the file being set. 3. Continue in same manner. Insure approximately 17" (109.7 cm) - 19 (122.6 cm2) square inch adhesive contact with the underside of the tile. . . .... ...... ...... .... ...... •••• •• • • .... . .. ..... NOA No.: 14-0805.01 AMFo�►oEt~OtTY Expiration Date: 05/10/17 Approval Date:09/04/14 Page 8 of 11 ADHESIVE PLACEMENT DETAIL#3 1W1*WOO 6 PW&C.Nc Paddy tbaMeea tieQ nwhm requirMl ► 1. On the eave course only,apply a minimum 2" (50.8 ear„ • E mm)x 10" (254 mm)x 1"(25.4 mm)foam paddy l • i Pyr iundw t&> onto the underlayment positioned as shown,under the strengthening rib for flat file or under the pan portion of the tile for low or high profile file closest 4:ain. to the overlock of the file being set. Leave 9igle` - approximately 4"(10 1.6 mm)up from the eave edge free of foam to prevent the expanded adhesive we"ar' r 2 x 4kL from blocking the weep holes. Insure' approximately 17-23 int(109.7-148.4 cm)of adhesive contact with the underside of the file iF>da 2. Apply a 4"(101.6 mm)x 4"(101.6 mm)x 1" (25.4 mm)foam paddy onto the underlayment just below FhWLowProfile Tile the second course line positioned foam paddy under the strengthening rib for flat tile,or under the +M*muO Oa0k mmeW SkMft padft wWw tft pan portion of the tile,closest to the underlock for Odw X10 Paddy Ibeeean tNesl the second course file to be installed. Insure 2) approximately 8-9 int(51.6-58.1 cmof adhesive s �� / Poft mndwdc contact with the underside of the tile. (Instructions continued on next page) - .. .... Med um Profile Tile NOA No.: 1441805.01 Expiration Date: 05/10/17 'AP. D Approval Date:09/04/14 Page 9 of 11 ADHESIVE PLACEMENT DETAIL#3 (CONTINUED) NO throuo phadc a*w* Siegle pm*udw die o-Im rapkedi , 3. Also apply a 2" (50.8 mm)x 4" (101.6 mm)x'/," Psd"{' rami (19 mm)paddy on top of the cave course tile Battens pr+ddr[WNW tikl surface as shown,on top of the strengthening rib for flat file or on top of the pan portion of the tile, closest to the underlock of the first course of tile. Install second course of tile. Insure approximately Saar 4 . •' 9(58.1 cm2)- 11 (71cm2)square inch adhesive •.� - 2:sin --.,, �l! contact with the underside of the file at the overlap • and 7(45.2 cm)-9(58.1 cm)square inch adhesive contact with the underside of the file at '• the head of the tile. Continue in same manner. Ears[or.se_ '� 7'' ,'� Fascia fare das t o ir> irre Drip edge High Profile Tilo ...... .... ...... .... . .. ..... ...... . . ..... .. .. .. .. ...... . . . . ...... NOA No.: 14-0805.01 FBArn DrwE COUNTY Expiration Date: 05/10/17 Approval Date: 09/04/14 Page 10 of 11 ADHESIVE PLACEMENT DETAIL TWO PIECE BARREL Two Piece Barrel (Cap and Pan)Tile 1. Starting at the eave course,apply a minimum 2" t►Place*novo adhesha to achie.e ss to 70 s%in. 'Steep pitch applkations (50.8 mm)x 10"(254 mm)x 1"(25.4 mm)foam In contact with the pan tile. (when n uir") 2)Tum corers upside dawn Place adhashre In paddy onto the underlayment positioned as to t in.hom outside edye of coma tine. shown under two adjacent pan tiles. Support eave Than W*W the tile.Ensure 20 to 2Ss%In.c area. ,-.° tiles from rocking until adhesive has a chance to una.riarment '"- �' cure. 2. Continue in same manner bringing two pan < = _r courses up toward the ridge.Insure approximately 65(419.4 cm2)—70(451.6 cm2) -' - - square inch adhesive contact with the underside of the pan tile. sheathing Erre doswe ia�otarshown) 3. Tum covers upside down exposing the underside of the tile.Apply a minimum 1"(25.4 mm)x 10" Fascia Board of mm)bead of adhesive directly on the inner Remo,etop po.aon ofdw aa"cow to cam tile.AbW to t«ond ane of edge of each side of the cover tile.Leave W dies.En""*aare and of pan wW cover tiles are flush at ears line. approximately 3/4"(19 mm)to 1"(25.4 mm) Two Piece Barrel-High Profile Tile from the outside edge of the tile,inward,free of foam to allow for expansion. 4. Tum cover tile over after foam is applied and place onto pan tile course. Insure a minimum of 20(129 cm2) -25 (161.3 cm2) square inch contact area on each side of the covef tile to the pan tile. Continue in. s4 manner.Vm away• any cured exposedfqgwAdhesiA..Pointing of.:. longitudinal edgeseof.Qie.cover tilos are • considered optiont••• •• • 5. When additional na� ss requiered;2"(50 ri .$ mm)x 4"(101.6 �•lin"�,ilers or tig tie wire •• system using galy*iizbd;stainless steel,or....:. copper wire and compatible nils may be used.• .. . ... END OF THIS ACCEPTANCE NOA No.: 14-0805.01 h�uAMF 011 b" 4N -I a Expiration Date: 05/10/17 !APPROVED: Approval Date:09/04/14 Page 11 of 11 SNORES D MiamiShores Village ` Building Department logo 011 111111" 10050 N.E.2nd Avenue Miami Shores, Florida 33138 ,� Eq to Tel: (305) 795.2204 FLORIDA Fax: (305) 756.8972 APRIL 5, 2015 Permit No: RF-4-15-764 Building Critique Review Provide tile manufactures product approval allowing the tiles to be place using OSI RT 600. Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, replace them with new revised sheets and place behind the most current page.