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RF-14-1213
Miami Shores Village Building Department jp 10050 N.E.2nd Avenue Miami Shores,Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 CHANGE OF CONTRACTOR ! ARCHITECT Permit N. Owner's Name(Fee S' ple Tide Holder): (-T ' C,"Ay KkPhone#: Owner's Address: Ni• f3 orl—re. Dr. City: A,pem 1 �_I"Oms State: R_ Zip Code:--.3313 fob Address(Of where work is being done): 1.o( 1-J City: Miami Shores State:—Florida Zip Code: 3313 Contractor's Company Name. C.��7'�C' - Phone#: Address: \ City: N i fir-► 1 g -C. N- State: K- Zip Code: 33 1 6 Z Qualifier's Name: �'1S'ylJy ir��'l °`i Lm Number: Architect)Engineer of Record Name: Phone#: '�S `2-3 ► v. Address: Y:K3 rsC `12 S City: State: Zip Code 1 Describe Work: Q,OOr 1 hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the uilding Official and the iami Shharmless of all le invol ent. , Signature xfj�,j7 Si ature8� or Agentr or Architect The foregoing instrument was aknowledged before me The f ing in ore this 44 ay of Dn(o►�✓ ,201` ,by60 �:`3 ��nJ5 kj this 110 day of 0 by Who is personally known to me or who has produced who is personally known o me htJ � uce� 1. as indentification. VI dficadon. Notary PubliA Notary Publi �� p Sign: NU, � D Sign: � F ��� v CC Seal: Seal: IRM R.LAX �npB16 STA�ate of FloridaEE 107488June 28,2015 Miami Shores Village Building Department FEB 05215 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax: (305)756-8972 --- --� INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2010 BUILDING Master Permit No. 4 - B PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [�CHANGE OF ❑ CANCELLATION ❑ SHOP A6 CONTRACTOR DRAWINGS Vi JOB ADDRESS:' 3O �V ���!J/J re— Dr City: Miami Shores County: Miami Dade Zip: J 2( 22 2OS- O 2� - 0SGo ✓ Folio/Parcel#: � — �J Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE:2 FFE: �NER: me(Fee Simple Titleholder): G ' r`(wJc�1syl Phone#: `)O S 294 Address: lel© ( A"`tS 1•-I� O fL City: M I k-M I 5 �1ti . State: Zip: Tenant/Lessee �"Name: Phone#: Email: r'Iy�1 I� JI (C \AA ' W—\ �- `�c� 1• C CONTRACTOR:Company Name: �` `� ` =' CQS Phone#: ',CV ,E a Address: !S4t�) 5__4 +- City: V'\A� ��t State: Zip: 3 3 t 2 Z Qualifier Name: �' �--� � I "k Phone#: State Certification or Registration#: CCC L3 SCA i Gl Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: ao Value of Work for this Permit:$ 2-A0 000 Square/Linear Footage of Work: 13y Ozo Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: J3E°P UFUC— 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$ (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$1500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure wi a de i ered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of co me must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issue In the Bence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. f Signature Signature O NER or AGENT RA The foregoing instrument was acknowledged before me this The foregoing instru ent was i kno edged before me this day of 1IU4 / 20 JS by Z-7 day of KJ 20 I ;— by r-)vV who is personally known to ��� 1 _ w s persona y now o me or who has produced FL/oI VttoS L.I GLA!&e as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTA PUBLIC: NOTARY PUBLIC: - ►�, IP Sign Sign: Print: 6L Print: Seal• Seal: YPYa��, CLAUDIA BERNAL Notary Public-State of Florida "sl *o; My Comm. Expires Nov F P, 17 2 ° o . 017 ****** **fir*a�,icr�****> Wds9ft� ** ******************************************************************** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 JUN 10 2014 Tel: (305)795.2204 Fax: (305)756.8972 . INSPECTION'S PHONE NUMBER: (305)762.4949 FB C 20 /6 BUILDING Permit No. A0 PERMIT APPLICATION Master Permit No. ��jy Permit Type: BUILDING EROOFING JOB ADDRESS: S YS te 0a Y City: Miami Shores County: -_- _ Miami lade _ Zip: 7 3 3 8 Folio/Parcel#:1I- _?2-0f' (9 2-7- 0 S-(J 0 Is the Building Historically Designated: Yes __NO __Flood Zone: OWNER: Name(Fee Simple Titleholder): 471%J1 NC—Vf• S V'A Phone#: Address: -1��t 1114 " s t"AJ'C 309L City: State: Zip: ��t5 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: —�f 6L �/✓Si1�L 7?/16- /q/Z phone#: 7d67 Address: )7100 NE // CT- City:- Iq t R-7LI I State: L ----- Zip: Z Qualifier Name: Phone#: �1�G3 State Certification or Registration#: CCG /3Z-)�'7��/ Certificate of Competency#: Contact Phone#: Email Address:t�t�i/ ? DESIGNER: Architect/Engineer: Nl�-1G• CA*A4 /1'IQeL'`, Phone#: 3c) 5 - } � 2 3 , Value of Work for this Permit: $_ , 0 0 t) Square/Linear Footage of Work: 1D C) Type of Work: ❑Addition 26 teration ❑Ncw ❑Repair/Replace ❑Demolit on Description of Work: //V^ A/Y WCJ /Z- = S �S Color thru tile: %k:k:k�:k*:k:k:k�%k�:k:k:k:k.k:kkk�%k;e:g:;:�:;¢�X:;::,1•:g:;::;::g�::g:k : .,..,..,.., ...•J,:1::i::i::;::i::i::i: :a�;:;l:k:tl:r:k:kv,::k�*:k�*�:k:k�:k�k��:*%k:k Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ - -_ DBI'IZ $_ Bond$ Notary$ Training/Education Fee$ _Technology Fee$ Double Fee$ Structural Review$ TOTA1,FEE NOW DUE$ �� •� Bona ig Company's Name(if applicable) ,Bonding Company's Address City State — — — _—_ Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address IV City St —_ 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 he performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must he secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS,POOLS,FURNACES,BOILERS, HEATERS.TANKS and AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILUIZI; TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUIZ PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR I,EN DE'R OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMLNCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with ,m estimated value exceeding $2500, the applicant must � promise in good faith that a copy of the notice of commencement and consintr lion lieu 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 pcnrrii is issued. In the absence of such posted notice, the inspection will not be ap roved and a reinspection fee will be charged. Signature fio,_ _ Si�naturc _ O ler or Agent r The foregoing instru ent was acknowledged before me this ��_ The fore�,oiml rostra ent was acknowledged before me this&.Q day of �A Y �20 a,by � day of H,fir► 20 5 - --W_ /_Y,by wh personally known me or who has produced _ who me or who has produced As identification and who did take an oath. _as identifi .- __' misommaxmN NOTA PUBLIC: 4.1w,w, l ri, MARE SAMPEE0 NO'[�111Z�' PUBLIC: :. MYC�IMISSIONNEE036694 EXPIRES:November 2,2014 G I BMW lhru Notary Public Ondemriters Sign: J S i,�n Print: Pri My Commission Expires: Notary Public-State of Florida 1\'1 ,Commission Expi _ At1'COIISSIONe ` My Comm.Expires Nov 17,2017 . EXPIRES:Novemb t ommissi0n FF 47927 7r pf = Bondw MUNomyPuto �k�S:ok�k*�:�:%R k%R k.k%k#k k�:k k�k�:#�k k k k ����e ;e,e• J.;�;�;�;:;:;::�;J:::::;::g x:k::::;:::::;:::1; ::;::;::;::;::;::;::i::;: ::<;:<::;::t J::;:e�*x g:�ek��:�:%R k k k k k k%k%k%k>,;k k k���k k k k k APPROVED BY Plans Exnminer Zoning Structural Review _ _ Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Reviseci 3/15/09) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CCC1328964 The ROOFING CONTRACTOR Named below IS CERTIFIED lip Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 KLEINER, HENRY M H K CONTRACTOR CONSUI-LING INC 17100 NE 11TH CT NORTH MIAMI BEACH --FL 33162Emil z ISSUED: 07/08/2014 DISPLAY AS REQUIRED BY LAW SECT# L14070800DO784 O sass _ Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOT A BILL DO NOT PAY 6430037 LBTy BUSINESS NAMEILOCATION RECEIPT NO. EXPIRES H K CONTRACTOR CONSULTING INC RENEWAL SEPTEMBER 30, 2015 17100 NE 11 CT 6888394 Must be displayed at place of business MIAMI FL 33162 Pursuant to County Code Chapter SA-Art 9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED H K CONTRACTOR CONSULTING INC 196 SPECIALTY BUILDING CONTRACTOR BY TAX COLLECTOR Worker(s) 1 CCC1328964 $75.00 07/29/2014 FPPUll-14-016768 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license. permit of a certification of the boidersqualifications,to do business.Holder must comply with any flovermon"I or nouPwaronental regulatory laws requirements which apply to the budaeA. The RECEIPT N0.above must be displayed on all commercial vehicles-Mimic-Bade Code Sec M-216. For more inlormadon,visit wwwadamidmileApyhoxcollecto ACORU°DDATE iMMIDOIYYYY) CERTIFICATE OF LIABILITY INSURANCE 03114/14 j I 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 poficy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to j 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 CONTACT PattiCla Fernandez NAME;_ Assure US.Inc. - — 6 PH Nlia testi (305)956 7818 C�No); (305)956-5946 E-MAIL - - 1880 NE 163rd Street �ADM�: patriaa®assureus.us North Miami Beach,FL 33162 _-INsuRERLs)AFFonar+G covEw►GE __ I Nnic a ------- f — Phone _(305)_956-7818 Fax (305)956-5946 INSURER A Merkel insurance Company 38970 INSURED INSURER 9: HK Contractor Consulting,Inc. INSURER C; 17100 NE 11 Th Ct INSURER o; N Miami Beach,FL 33162 (305)974 5461 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADD"SRLTR TYPE Of INSURANCE � POLICY EFF I POLICY EXP 4WD_- -----POLICY NUMBER -{MMfDD/YYYY)l0445DMIYYy --_.------ _- LIMITS — INR GENERAL LIABILITY INSR I EACH OCCURRENCE S_-1,000,OQQ.QO I DAMAGE TO RENTED - _ [V COMMERCIAL GENERAL LIABILITY PREMISESLEa otcurrencg). _S 10 OOO.OQ r1 -- _ A �, I ❑ CLAIMS-MADE �; OCCUR 3D36524 MED EXP(Any one person) S 5,000 00 Y Y 102115/2014 02/15/2015 -- -- ❑ PERSONAL 6 ADV INJURY S 1,000 000.00 L] j i GENERAL AGGREGATE S 2,000,000.00 — -� Gr_UE1N'L AGGREGATE P_PPUES PER , ! PRODUCTS•COMP—IOP A-G-G $ 1,000,0-00_ .00 POLICY PRO• B LOC S E°MBINErnS AUTOMOBILE LIABILITY -- _ _{ INGLE LIMIT S ` ❑ ANY AUTO ( i BODILY INJURY(Per person) S -- ---ALL OWNEDSCHEDULED NA BODILY INJURY{Per accident E ❑ AUTOS ❑ AUTOS ! _ -- _---__--- ` HIRED AUTOS ❑ AUTOS ED PROPERTYanDAMAGE S j UMBRELLA LIAR ---- - t- - - ---___--- - - ----- _ --- -- - S EACH OCCURRENCE S _ __ F-1 -- ❑CLAIMS-MADEC NA - -- -- WORKERS COMPENSATION AGGREGATE - i EXCESS LIAR - - - --- - f - - - ION - --- - -- WC STATU- 0TH -- AND EMPLOYERS' S Y/N ! ❑_TQRY.LIMtTS _ER ANY PROPRIETORIPARTNER/EXECIlTNE NA E.L EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N/A _ --__ (Mandatory in NH) EL DISEASE-_EA EMYE PLOE If e.describe under --- --- ------ - _ DESCye RIPTION OF OPERATIONS below F EL DISEASE-POLICY LMAITE - 1---- ---- - —-- I --- - - - -- _ — 1 i i I I _L i ! -! DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more apace is required) I General Contractor,Roofing Contractor i j CERTIFICATE HOLDER CANCELLATION ESHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. I �• 10050 Ne 2nd Avenue AUTH07 4 REP E ASE Miami Shores,FL 33138 --------- - - -- -- - -- - - -— - - - ---- - ---- - -- ®19 -2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010105)OF T e ACORD name and logo are registered marks of ACORD 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: 4/4/2014 EXPIRATION DATE: 4/3/2016 PERSON: KLEINER HENRY FEIN: 203837095 BUSINESS NAME AND ADDRESS: H K CONTRACTOR CONSULTI 17100 NE 11TH COURT NORTH MIAMI BEACH FL 33162 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL LICENSED RESIDENTIAL LICENSED ROOFING CONTRACTOR CONTRACTR CONTRACTOR Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 wa t shores 1111iami 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 ,.'ort ers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. §440.05 allows corpc;-. ;e ofi,rer, the construction industry to exempt themselves from this requirement for any construction project prior to obis' .-g ab :,. :n permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An empl yer in the construction industry who employs one or more part-time or full-time en ploys ;, 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]east 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,Divi,in n (,'Corporations;and 3. The corporation is registered and listed as active with the Florida Department of ,tt. T);visiC`'! nr('r.r ., 1 Nc, n.. then three corpornte officers per comoration or limited liability company members BTC to be exempt. Con�tn,riion ext-rnpilons are valid for a period of two years or until revncat:on is filed or the execrl)nIon i, revoked by the Division. Your contractor is requesti, a permit under this workcrr' compensation exemption.In these circumstances,Miami Shores Village does not require veri.-,ati( )f wort:,rs' compensation in,trance covenge from the contractor's company. Therefore,you maybe Personally 1,j 'c for er com: ensation iniitries q F tv2e-son_allowed to workunder this Hermit Please check with your insurance can:..r sine:: 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. ON nee ntractor Print Name: Pont Name: +�Y , Signature: Signature: J >,, S lL O _ State of Florid ) State of Florida) Q County of M i. i-Dad:- ) County of Miami-Dade''}. Sworn to and s, ,scrii- .f b e r s�(� Sv, m to and su n c day of " - --— 20l`-k d of ��.. By By CLAUDIA BERNAL (SEAL) = = Notary Public-State of Florida AI,) T e of Ida rn �� .Expires Nov 17,2017 T e of Identification produced . t . l judgment and knowledge of local/regional wage scales can provide additional guidance to determine reasonable labor rates for professional trades (i.e. electricians, plumbers, block masons, framing, HVAC). SUBSTANTIAL IMPROVEMENT OR SUBSTANTIAL DAMAGE ITEMS TO BE INCLUDED (Please check off each line) ALL STRUCTURAL ELEMENTS INCLUDING: [ ] Spread or continuous foundation footings and pilings [] Monolithic or other types of concrete slabs [ earing walls, tie beams and trusses J Wood or reinforced concrete decking or roofing [J Floors and ceilings [�ttached decks and porches nterior partition walls [] Exterior wall finishes (e.g., brick, stucco or siding) including painting and decorative moldings ( ]Windows and doors [] Re-shingling or re-tiling a roof [] Hardware ALL INTERIOR FINISH ELEMENTS, INCLUDING: [] Tiling, linoleum, stone or carpet over sub-flooring ( ] Bathroom tiling and fixtures ( ]Wall finishes (e.g., drywall, painting, stucco, plaster, paneling, marble or other decorative finishes) [ ] Kitchen, utility and bathroom cabinets [ ] Built-in bookcases, cabinets and furniture [ ] Hardware ALL UTILITY AND SERVICE EQUIPMENT, INCLUDING: [] HVAC equipment [] Repair or reconstruction of plumbing and electrical services ( J Light fixtures and ceiling fans [] Security systems ( ] Built-in kitchen appliances [ ] Central vacuum systems [ ] Water filtration, conditioning or recirculation systems ALSO: [ ] Labor and other costs associated with demolishing, removing or altering building components [] Overhead and profit ITEMS TO BE EXCLUDED Plans and specifications Survey costs Permit fees Debris removal, (e.g., removal of debris from building or lot, dumpster rental, transport fees to landfill and landfill tipping fees), clean-up (e.g., dirt and mud removal, building dry out, etc.) Items not considered real property such as: throw rugs (carpeting over finished floors), furniture, refrigerators, appliances which are not built-in, etc. OUTSIDE IMPROVEMENTS, INCLUDING: Landscaping Sidewalks Fences Yard lights Swimming pools\spa Screened pool enclosures Sheds Gazebos Detached structures (incl. garages) Landscape irrigation systems Docks and Davits Seawalls Driveways Decks ITEMS REQUIRED TO EVALUATE YOUR APPLICATION APPLICANT MUST SUBMIT ALL OF THE FOLLOWING (please check off each item): 1. Completed and signed application for substantial damage/improvement review (included in this package). 2. Elevation certificate if property is located above base flood elevation. 3. Property Owner's Substantial Damage or Substantial Improvement Affidavit signed, notarized and dated (included in package). 4. Contractor's Substantial Damage or Substantial Improvement Affidavit signed, notarized and dated (included in package). 5. Estimated Cost of reconstruction/improvement form (included in package) and all required backup. Include subcontractor's bids and itemized cost lists (see footnote on Cost Estimate Form). 6. This checklist. 7. Copy of construction contract. If the owner is the contractor, submit all subcontractor bids to document the cost estimate. SUBSTANTIAL IMPROVEMENT OR SUBSTANTIAL DAMAGE APPLICATION FOR SUBSTANTIAL DAMAGE OR SUBSTANTIAL IMPROVEMENT REVIEW Property Address: GIS I r-� Property Owner's Name: C--1 U y K,�') 0,LYNN Property Owner's Address: 3 S Property Owner's Phone Number: Contractor's Name: o � i t 19 VA Contractor's Address: -44-O p j w35-r3 Contractor's Phone Number: Flood Zone C 10 BFE Lowest Floor Elevation (Excluding garage or carport) Check one of the following: [ ] I am attaching a State Certified Appraiser's report, valuing the structure at: D41 am not attaching a State Certified Appraiser's report and I accept the use of the valuation of my property that has been recorded by the County Property Appraiser's Office. SIGNATURES: Property Owner: JVv� Date: Z3/14 Contractor: Date: 731 T SUBSTANTIAL IMPROVEMENT OR SUBSTANTIAL DAMAGE PROPERTY OWNER'S SUBSTANTIAL DAMAGE OR SUBSTANTIAL IMPROVEMENT AFFIDAVIT Property Address: �3o I r► 8�.y S-�� � �, Contractor's Name: Property Owner's Name: Property Owner's Address: Property Owner's Phone Number: 3 cz 3 I hereby attest that the list of work and cost estimate submitted with my Substantial Damage or Substantial Improvement Application reflects ALL OF THE WORK TO BE CONDUCTED on the subject structure including all additions, improvements and repairs and, if the work is the result of Substantial Damage, this work will return.the structure at least to the"before damage" condition and bring the structure into compliance with all applicable codes. Neither I nor any subcontractor or agent will make any repairs or perform any work on the subject structure other than what has been included in the attached list. I UNDERSTAND THAT I AM SUBJECT TO ENFORCEMENT ACTION, WHICH MAY INCLUDE FINES, IF ANY INSPECTION OF THE PROPERTY REVEALS THAT I, OR MY CONTRACTOR, HAVE MADE REPAIRS OR IMPROVEMENTS NOT INCLUDED ON THE ATTACHED LIST OF REPAIRS OR THE APPROVED BUILDING PLANS. See attached itemized list. STATE OF COUNTY OF Before me this day persona ly appeared�Crf�" GZz,s�6 d who, being duly sworn, deposes and says th t he/she has read, u-nderstands, and agrees to comply with all the aforementio t d iti s. Property Owne '- -ignature Sworn to and subscribed before me this 3 day of 20 Notary Public State of My commission ex �var Notary Public State of Florida Joanna M Feliciano y� My commission FF 082753 Nr.,F� Expires 0 111 212 01 8 SUBSTANTIAL IMPROVEMENT OR SUBSTANTIAL DAMAGE CONTRACTOR'S SUBSTANTIAL DAMAGE OR SUBSTANTIAL IMPROVEMENT AFFIDAVIT Property Address: d l 1b ZS �� Ok, Contractor's Name: e Contractor's Com ny Name: J C)PF;UQ( IN Contractor's Address: G� �'I s J 6/% 2 Tit -�L 3 3 j O Contractor's Phone Number.- Contractor's umber:Contractor's State Registration or Certification Number: t S_2-Z 0 C, I I Y Contractor's We Registration Number(if applicable): I hereby attest that I, or a member of my staff, personally inspected the subject property and produced the attached itemized list of repairs, reconstruction and/or remodeling which are hereby submitted for a Substantial Damage or Substantial Improvement Review. The list of work contains ALL OF THE WORK TO BE CONDUCTED on the subject property. If the property sustained Substantial Damage, this list of Work, will return the structure to at least its condition prior to damage and bring the structure into compliance with all applicable codes. I further attest that all additions, improvements or repairs proposed for the subject building are included in this estimate and that neither I nor any subcontractor or agent representing me will make any repairs or perform any work on the subject structure other than what has been included in the attached list. I UNDERSTAND THAT I AM SUBJECT TO ENFORCEMENT ACTION, WHICH MAY INCLUDE FINES, IF ANY INSPECTION OF THE PROPERTY REVEALS THAT I, OR MY CONTRACTOR, HAVE MADE REPAIRS OR IMPROVEMENTS NOT INCLUDED ON THE ATTACHED LIST OF REPAIRS OR THE APPROVED BUILDING PLANS. See attached itemized list. STATE OF COUNTY OF -e Before met is ay nal y appe red who, being duly sworn, o s t he/she has read, understands, and agrees to comply with all the aforem d con s. Contractor's Signature Sworn to and subscribed before me this day of 20�. Notary Public State of: M c i 0 " �.� P`4I. Notary Public State of Florida V, Joanna M Feliciano My Commission FF 082753 OF Aon Expires of/12/2018 Application Cost Estimate of Reconstruction / Improvement l ' _ � g Number C I tet' Date Address t2 This cost estimate of reconstruction/improvement must be prepared by and signed by the contractor or by the owner if the owner acts as the contractor. Owners who act as their own contractors must estimate their labor cost at the current market value for any ork they intend to perform. N �Nl �,.f ( c J / f •l VZb•V J Sub-Contractor Bids R��l/ Contractor or Owner Material Labor Costs Estimates Costs Bid Amounts (see note "D") 1. Masonry 2. Carpentry Material (rough) 3. Carpentry Labor(rough) 4. Roofing 5. Insulation and Weather-strip 6. Exterior Finish (stucco) 7. Doors, Windows & Shutters 8. Lumber Finish 9. Hardware 10. Drywall 11. Cabinets (Built-in) 12. Floor Covering 13. Plumbing 14. Shower/Tub/Toilet 15. Electrical & Light Fixtures 16. Concrete 17. Built-in Appliances 18. HVAC 19. Paint 20. Demolition & Removal 21. Overhead & Profit t-,)'-ECEI'`TED ROOF ASSEMBLIES AND ROOFTOP STRUCTURES J L,N 10 2014 014 Florida Building Code Edition 2010 High-Veiocky Hurricane tone Uniform Permit Application Form. Section A(General Information Master Permit No. Process No.. Contractor's Name HK Contractor Consulting Inc. /%. ;, •. tit.- o:'; r. � Y Job Address ✓) Lam! i% y' ✓' r i:G7, li('i./7:`.: i 3 J ROOF CATEGORY ❑ Low Slope ❑ Mechanically Fastened Tile � Mortar/Adhesive Set Tile ❑ Asphaltic Shingles ❑ Metal PaneUShingies ❑ Wood Shingles/Shakes ❑ Prescriptive BUR-RAS 150 ROOF TYPE • • 0000•• ❑ New Roof �T, `Reroofing ❑ Recovering ❑ Repair ,.t3 ;Malnterg"t• 0000•• 0000 0000•• ROOF SYSTEM • INFORMATION 0000 • • • • • • 0000•. Low Slope Roof Area(SF) Steep Sloped Roof Area(SF) I; 1bIMISF) ='�' %;r •• •' Section B(Roof Plan) "!•:' Sketch Roof Plan:Illustrate all levels and sections,roof drains,scuppers,overflow scuppers and overflow drains. • Include dimensions of sections and Lewis.clear) Identify dimensions of elevated ' ' y rrtlfy pressure zones end location of•... : parapets. • • • •• • . . ••••• •• . 0000 • v rn F- 7\ a \ Z U - Z [� w 0 Z w w t- IL O N m W U) 15.34 2010 FLORIDA BUILDING CODE—BUILDING , ` ° ° ° Florida Building Code Edition 2010 High Velocity Hurricane Zone Uniform Permit Application Form Section D (Steep Sloped Roof System) Roof System Manufacturer: Product Approval Number; Minimum Design Wind Pressures,If Applicable(From RAS 127 or Calculations): Maximum Design Pressure Product Approval Specific System: Method of Tile Attachment: Steep Sloped System Description Deck Type: Roof Sl pe: ype Undedayffmt: Fire Baffler: Fastener Type&Spacing: 17!�� .7i Ridge Ventilation? Adhesive Type. Type Cap Sheet: 77 Roof Covering: Mean Roof Height: Type&Size Drips ° ° ° ° ° � � � � � � � � Florida Building Code Edition 2010 High Velocity Hurricane Zone Uniform Permit Application Form Section E (Tile Calculations) For Moment based tile systems,choose either Method 1 or 2.Compare the values for M,with the values from M,.if the M,values are greater than or equal to the Mr values,for each area of the roof,then the tile attachment method is acceptable. Method 1 "Moment Based Tile Calculations Per RAS 127" (P. ; . xJ•?; _ _?.?1 1-I%: M, �� Product Approval M,�'u_; (PZ:->c'• x x6__ - -NIa: &.6-3 =M,2 � Product Approval Mf (P,: x;,✓•s: _ �'.5L -M9: -=M ' Product Approval M,`fO Method 2 "Simplified Tile Calculation Per Table Below" Required Moment of Resistance(M,)From Table Below Product Approval M, M Requi Moment Resistance' •• 06:6 ...... Mean Roof Height • •• i • •• •• Roof Slope 15' 20' 25' 30' sees 40' ..• ••••:• 2:12 34.4 35.5 38.2 39.7 • 000042.2 • • 3:12 32.2 34.4 36.0 37.4 . '•'.39.8 :• •:. •••.. 4:12 30.4 32.2 33.8 35.1 37.3 • • 5:12 28.4 30.1 31.6 32.8 • ••.•34.9 •. • ; ...... 6:12 26.4 28.0 29.4 30.5 •••932.4 0 •• 7:12 24.4 25.9 27.1 28.2 • '30.0 ' •;• •••••• • • • • • 'Must be used in conjunction with a list of moment based file systems endorsed by the•• • �••. • •••0 Broward County Board of Rules and Appeals. 0000 For Uplift based the systems use Method 3.Compare the values for F'with the values for F,. If the F'values are greater than or equal to the F,values,for each area of the roof,then the tile attachment method is acceptable. Method 3"Uplift Based Tile Calculations Per RAS 127" (P,:_x 1:-_x w:=_ )-W:_x cos 0: F„_ Product Approval F A:_x 1:___x w:=_ )-W:_x cos 0:_=F,2_ Product Approval F (P3:_x 1:-_x w:=_)-W:�x cos 0:-F„_ Product Approval F Where to Obtain Information Description Symbol Where to find Design Pressure PI or P2 or P3 RAS 127 Table 1 of by an angineering ane ss prepared by PE based on ASCE 7 Mean Roof Height H Job Site Root Sbpe B Job Site Aerodynamic Multiplier Product Approval Restoring Moment due to Gravity K Product Approval Attachment Resistance K Product Approval Required Moment Resistance M Calculated M nimum Attachment Resistance F Product Approval Required Uplift Resistance F Calculated Average Tile Weight W Product Approval Tile Dimensions t Product Approval w=width At calculations must be submitted to the Building CltWal at the time of permit application- APPENDIX"F*9 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 Cods,Building govern the minimum requirements and standards of the industry for roofing system installations.Additionally,the following items should be addressed as part of the agreement between the owner and the contractor.The owner's initial in the designated space indicates that the item has been explained. 1.Aesthetics-workmanship:The workmanship provisions of Chapter 15(High-Velocity Hurricane Zone) are for the purpose of providing that the roofing system meets the wind resistance and water intrusion performance standards.Aesthetics(appearance)are not a consideration with respect to workmanship provisions.Aesthetic issues such as color or architectural appearance,that are not part of a zoning code,should be addressed as part of the agreement between the owner and the contractor. 2.Reneging wood decks:When replacing roofing,the existing wood roof deck may have to be renailed in accordance with the current provisions of Chapter 16(High-Velocity Hurricane Zones)of the Fbrida Buildhp•• • Code.(The roof deck is usually concealed prior to removing the existing roof system). • •• . •.•• 3.Common roolk:Common roofs are those which have no visible delineation between*' •ging units, • (i.e.,townhouses,condominiums,etc.).In buildings with common roofs,the roofing contractor jW9r owner should ;•••• notify the occupants of adjacent units of roofing work to be performed. •••••• .... . ..... ...... . ... ..... 4.Exposed ceitiogs:Exposed,open beam ceilings are where the underside of the roof dr dqg can be vieiaet ••••• from below.The owner may wish to maintain the architectural appearance;therefore,roofing PAUMpations o1; • the underside of the decking may not be acceptable.The owner provides the option of maintair4ng thil appMance, •• ,; 5.Pounding water.The current roof system and/or deck of the building may not drain w;4 piid bray causq water to pond(accumulate)in low-lying areas of the roof.Ponding can be an indication of structural distress vL may require the review of a professional structural engineer.Ponding may shorten the life expectancy and performance of the new roofing system.Ponding conditions may not be evident until the original roofing system is removed.Ponding conditions should be corrected. A-6.Overflow scuppers(wap outlets):It is required that rainwater flows off so that the roof is not overloaded from a build up of water.Perimetededge walls or other roof extensions may block this discharge if overflow scuppers(wall outlets)are not provided.It may be necessary to install overflow scuppers in accordance with the requirements of:Chapter 15 and 16 herein and the Florida Building Cods,Plumbing. _W-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.It may be bene 11al der additionalventing which can result in extending the service life of the roof. 031zol t O nt's Signature Date ContraT's Signature Date MIAMI-QADE � MIAMI-DADE COUNTY PRODUCT CONTROL SECTION DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES(RER) 11805 SW 26 Street,Room 208 BOARD AND CODE ADMINISTRATION DIVISION Miami,Florida 33175-2474 T(786)315-2590 F(786)315-2599 NOTICE OF ACCEPTANCE (NOA) - Polyglass USA Inc. 150 Lyon Drive Fernley,NV 89408 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 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 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, ";3o, or ...... suspend the use of such product or material within their jurisdiction. RER reserves the right 4*oke t%4,4�ceptance, •• if it is determined by Miami-Dade County Product Control Section that this product or material fails to%"Ate ....:. requirements of the applicable building code. 090:96 . • 9999.. This product is approved as described herein, and has been designed to comply with the Fl96f1 lqJuildirLg prr. • including the High Velocity Hurricane Zone of the Florida Building Code. "" • .99.0. • •0. .9000 9. 90 .. . 969000 DESCRIPTION: Polyglass Polystick Underlayments „• •• . . . . 9999.. LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo cit�+s�tate aril fo'llowin$ statement: "Miami-Dade County Product Control Approved",unless otherwise noted herein!• :000 • 9999 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 revises NOA#I 1-1229.01 and consists of pages I through 8. The submitted documentation was reviewed by Alex Tigera. +' NOA No.: 12-0713.02 MIAMI DADE COUNTY Expiration Date: 09/13/16 Approval Date: 02/14/13 Page 1 of 8 ROOFING COMPONENT APPROVAL Category Roofing Sub-Cateeorv: Underlayment Material: SBS ,APP Self-Adhering Modified Bitumen PRODUCTS DESCRIPTION: Test Product Product Dimensions Specification Description Polystick MTS Roll: TAS 103 A homogeneous,rubberized asphalt underlayment 65'8"x 3'3 3/8" waterproofing membrane,glass fiber reinforced Manufacturing Location 60 mils thick with polyolefinic film on the upper surface for #2 use as an underlayment for metal roofing,roof tile, slate tiles and shingle underlayment. Polystick IR-Xe Roll: TAS 103 and A fine granular/sand top surface self-adhering, underlayment 65' x 3'33/8" ASTM D 1970 APP polymer modified,fiberglass reinforced, Manufacturing Location Or 65' x 3' bituminous sheet material for use as an #1  60 mils thick underlayment in sloped roof assemblies. Designed as an ice&rain shield aod*^Vflat ...... roof tile underlayment 0 0. 0000 .' . 0 000000 0000 0000.. Polystick TU Roll: TAS 103 and A heavy granuled sur* elf adhering,APP •0• underlayment 32'10"x 3'33/8" ASTM D 1970 polymer modified,films A?Aj or pclyg4*; • Manufacturing Location 100 mils thick reinforced,bituminous�he��matef iia 1 for use A*see . #1  an underlayment in slQ;tO•reof asm��i�s. •••••0 Designed as a a roof tj"upderlaymen� 0• • 0 • . . Polystick TU Plus Roll: TAS 103 and A rubberized asphalt self-adhering glass 0 0 underlayment 65' x 3'3%" ASTM D 1970 fiber/polyester reinforced wtlterprootit►g• •0 (Surface Printing) 80 mils thick membrane.Designed as a metal rdt"dtg and roof Manufacturing Location tile underlayment. #1  Polystick TU P Roll: TAS 103 and A rubberized asphalt waterproofing membrane, underlayment 32'10"x 3'33/8" ASTM D 1970 glass-fiber/polyester reinforced,with a granular Manufacturing Location 130 mils thick surface designed for use as a tile roof #2 underlayment. Polystick Tile Pro Roll: TAS 103 and A rubberized asphalt self-adhering, glass- Manufacturing Location 61' x 3'33/8" ASTM D 1970 fiber/polyester reinforced waterproofing #2 60 mils thick membrane.Designed as a metal roofing and roof tile underlayment. Polystick Dual Pro Roll: TAS 103 and A rubberized asphalt self-adhering,glass- Manufacturing Location 61' x 3'3-'/," ASTM D 1970 fiber/polyester reinforced waterproofing #2 60 mils thick membrane. Designed as a metal roofing and roof tile underlayment. NOA No.: 12-0713.02 MIAMI•DADE COUNTY Expiration Date: 09/13/16 Approval Date: 02/14/13 Page 2 of 8 PRODUCTS DESCRIPTION: Test Product Product Dimensions Specification Description Polystick TU Max Roll: TAS 103 and A rubberized asphalt self-adhering,polyester Manufacturing Location 65'8"x 3'3-3/8" ASTM D 1970 reinforced waterproofing membrane. Designed #2 60 mils thick as a a roof tile underlayment. MANUFACTURING PLANTS: LHazelton, PA 2.W inter Haven, FL EVIDENCE SUBMITTED: Test Agency Test Identifier Test Name/Report Date Exterior Research&Design,LLC 11756.04.01-1 TAS 103 04/27/01 11756.08.01-1 ASTM D 1970 08/14/01 02202.08.05 TAS 103 08/29/05 Trinity I ERD P5110.08.07 TAS 103 08/29/07 P10870.09.08-R1 TAS 103 12/04/08 P10870.04.09 TAS 103/ASTM D4798&G155 04/13/09 P33360.06.10 ASTM D1970 07/01/10 P33370.03.11 TAS 103 03/02/11 P33370.04.11 ASTM D 1623 04/26/11 P36900.09.11 TAS 103/ASTM D4798&G155 :QW04/11 P37300.10.11 TAS 110/ASTM D4798&:�197Q *JQ1j9/11 • P40390.08.12-1 TAS 103 &TAS 110..... 'MQ6/12 •••; P40390.08.12-2 ASTM D 1623 ...:.. 08107/12 P40390.10.12 ASTM D 1970 ••••. :J.016/12 • PRI Asphalt Technologies PRI01 I I I ASTM D 4977 0000 ' 04/08/02 ••;•• PUSA-005-02-01 ASTM D 4977 000:102 00 00' PUSA-018-02-01 ASTM D 2523 ,, ,, 07114/03 :• PUSA-035-02-01 TAS 103 : . 09/;9/06 ....; PUSA-033-02-01 ASTM D 1970 :W11 M6 . PUSA-055-02-02 TAS 103 ••• 1:2/40/07 PUSA-083-02-01 TAS 103 ••(T /30/08 PUSA-089-02-01 TAS 103/ASTM D4798&G155 07/06/09 Momentum Technologies,Inc. JX20H7A TAS 103/ASTM D4798&G155 04/01/08 RX 14E8A TAS 103/ASTM D4798&G 155 11/09/09 DX23D8B TAS 103/ASTM D4798&G155 02/18/10 DX23138A TAS 103/ASTM D4798&G155 02/18/10 NOA No.: 12-0713.02 MIAMI•DADE COUNTY Expiration Date: 09/13/16 Approval Date: 02/14/13 Page 3 of 8 INSTALLATION PROCEDURES: Deck Type 1: Wood,non-insulated Base Sheet: One or more plies of ASTM D 226 Type II or ASTM D 2626. Fastening: Per FBC 1518.2& 1518.4 Nails and tin caps 12" gid,6" o.c. at a minimum 4"head lap. (for base sheet only) Membrane: Polystick membranes self-adhered. Surfacing: None 1. All nails in the deck shall be carefully checked for protruding heads. Re-fasten any loose decking panels, and sweep the deck thoroughly to remove any dust and debris prior to application. 2. Place the underlayment over metal drip edge in accordance with RAS 111. 3. Place the first course of membrane parallel to the eave,rolling the membrane to obtain maximum contact. Remove the release film as the membrane is applied. . All side laps shall be a minimum of 3-'/2" and end laps shall be a minimum of 6." Roll the membrane into place after removing the release strip. Vertical strapping of the roof with Polystick is acceptable. Membrane shall be back nailed in accordance with applicable building code. 4. 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. 5. For ridge applications,center the membrane and roll from the center outward in both directions. 6. Roll or broom the entire membrane surface so as to have full contact with the surface, giving special attention to lap areas. 7. Flash vent pipes, stacks, chimneys and penetrations in compliance with Roof Assembly current Product Control Notice of Acceptance. •••••• .00000 8. All protrusions or drains shall be initially taped with a 6" piece of underlayment. •Flee•flashing w4xN shall be oo pressed in place and formed around the protrusion to ensure a tight fit. A second 4aygrof Polystirk-shall be••••• applied over the underlayment. """ • .... . ..... ...... . ... ..... .. .. .. . ...... . . . . ...... NOA No.: 12-0713.02 MIAMMADECOUNTY Expiration Date: 09/13/16 Approval Date: 02/14/13 Page 4 of 8 GENERAL LIMITATIONS: 1. Fire classification is not part of this acceptance. 2. Polystick MTS, TU Plus, Tile Pro and Dual Pro may be used in asphaltic shingles,wood shakes and shingles, non-structural metal roofing,roof tile systems and quarry slate roof assemblies. Polystick IR-Xe,TU, and TU P may be used in all the previous assemblies listed except metal roofing. Polystick TU Max may be used in roof tile systems only. 3. Deck requirements shall be in compliance with applicable building code. 4. Polyglass Polystick membranes shall be applied to a smooth, clean and dry surface. The deck shall be free of irregularities. 5. Polyglass Polystick membranes and underlayments shall not be adhered directly over a pre-existing roof membrane as a recover system. 6. Polyglass Polystick membranes shall not be left exposed as a temporary roof for longer than the amount of days listed in the table below after application. Polyglass reserves the right to revise or alter product exposure times;not to exceed the preceeding maximum time limitations. Exposure Limitations(days) MTS IR-Xe TU TU Plus TU P Tile Pro Dual Pro TU Max Winter Haven,FL. 180 180 180 180 180 180 180 90 Hazelton,PA. N/A 30 30 180 N/A N/A N/A N/A 7. All products listed herein shall have a quality assurance audit in accordance with the Florida Building Code and Rule 9N-3 of the Florida Administrative Code. 8. In roof tile application,data for the attachment resistance of roof tiles shall be as set forth in the roof tile manufacturer's Notice of Acceptance. Polystick TU,TU Plus, Tile Pro and TU Max may be used inboth adhesive set and mechanically fastened roof tile applications. Polystick IR-Xe,and Dual Pro Wltffilted to ...... mechanically fastened roof tile applications.Polystick MTS is limited to mechanically fastened witlo battens roof tile applications. Polystick TU P may be used in both adhesive set and mechar<"Iy fastened roof tile .... •• applications with the exception of mortar set tile applications. *::::o • 9. The maximum roof slope for use as roof tile underlayment for(direct-to-deck)the assemblies Walt 68 as ..... follows: (See Table Below) •••••• ••• ••••• Tile Profile Polystick MTS Polystick IR-Xe Polystick Tt�ZI . Polystick TU Plus,TU P, ile :.Max •• •:• Pro • Flat Tile Prohibited without 5:12 No limitation N"Uitation battens Profiled Tile Prohibited without Prohibited No limitation No limitation battens The above slope limitations can be exceeded only by using battens and counter battens in accordance with the Approved Tile System Notice of Acceptance and applicable Florida Building Code requirements. Battens are required for both loading and installation of tiles at all times. NOA No.: 12-0713.02 MIAMI•DADE COUNTY Expiration Date: 09/13/16 1 Approval Date: 02/14/13 Page 5 of 8 GENERAL LIMITATIONS: (CONTINUED) 10. Care should be taken during the loading procedure to keep foot traffic to a minimum and to avoid dropping of tile directly on the underlayment.Refer to Polyglass' Tile loading detail below for loading procedure for all underlayments except Polystick MTS which shall be loaded onto battens. l i 11. Refer to prepared roofing system Product Control Notice of Acceptance for listed approval of this product with specific prepared roofing products.Polystick MTS,IR-Xe,TU,TU Plus,TU P,TU Max,Dual Pro and Tile Pro may be used with any approved roof covering Notice of Acceptance listing Polystick MTS, IR-Xe, TU,TU Plus,TU P,TU Max,Dual Pro and Tile Pro as a component part of an assembly in the Notice of Acceptance. If Polystick MTS,IR-Xe,TU,TU Plus,TU P,TU Max,Dual Pro and Tile Pro is 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. ••• ••••;• .. 6666 6666.. 6666 6666.. LABELING: • 6666.. 6666.. 1. All membranes or packaging shall bear the imprint or identifiable marking of the ma'h1�Acturer'l awh or logo, city and state of manufacturing facility and the following statement: "Miami-Dade 6e-ounty Fr oduct ControC 0096•. 6 •60 •969• Approved" or the Miami-Dade County Product Control Seal as shown below. • .. .. .. . 6666.. MAMMADE COUNTYM �••i•� • •� ,...� • 0 • • 006••• •9996• • •9 • • • • • ••999• BUILDING PERMIT REQUIREMENTS: •• • Application for building permit shall be accompanied by copies of the following: 1.This Notice of Acceptance. 2.Any other documents required by the Building Official or applicable building code in order to properly evaluate the installation of this materials. NOA No.: 12-0713.02 MAM•DAD,COUNTY Expiration Date: 09/13/16 Approval Date: 02/14/13 Page 6 of 8 POLYGLASS GENERAL APPLICATION GUIDELINES FOR POLYSTICK MEMBRANES: 1. Polyglass does accept the direct application of Polystick underlayment membranes to wood decks. Installers are cautioned to refer to applicable local building codes prior to direct deck installation to ensure this is acceptable. Please also refer to applicable Product Data Sheets of the corresponding products. 2. All rolls,with the exception of Polystick TU Plus should be back-nailed in selvage edge seam as per Polyglass Back Nailing Guide. Nails shall be, 11 gauge ring shank type, applied with a minimum 1"metal disk as required in Dade County or simplex type nail as otherwise allowable in other regions, at a minimum rate of 12" o.c. Polystick TU Plus should be back nailed in designated area marked"nail area, area para clavar"on the face of membrane,with the above stated nails and/or disks. The head lap membrane is to cover the area being back-nailed. (Please refer to applicable local building codes prior to installation.) 3. All seal lap seams(selvage laps)must be rolled with a hand roller to ensure full contact. 4. All fabric over fabric; and granule over granule end laps, shall have a 6"wide,uniform layer of Polyglass Polyplus 55 Premium Modified Flashing Cement, Polyglass Polyplus 50 Premium MB Flashing Cement, Polyglass PG500 MB Flashing Cement,applied in between the application of the lap. The use of mastic between the laps does not apply to Polystick MTS. 5. A maximum of 6 tiles per stack are allowed when loading tile on the underlayments. Refer to the Polyglass Tile Loading Guidelines. See General Limitations#9 and#10. 6. Battens and/or Counter-battens, as required by the tile manufacturers NOA's,must be used on all projects for pitch/slopes of 7/12" or greater. It is suggested that on pitch/slopes in excess of 6 '/4"/12",precautions should be taken, such as the use of battens to prevent tile sliding during the loading process. 7. Minimum cure time after membrane installation&before loading of roofing tiles is Forty-Eight(48)Hours. 8. Polystick membranes may not be used in any exposed application such as crickets,.•exposed valleys`,o'r .... . exposed roof to wall details. •• •••• • 9. Repair of Polystick membranes is to be accomplished by applying Polyglass PolYP••S` �remium•M*odife3••••• Flashing Cement,Polyglass Polyplus 50 Premium MB Flashing Cement,Polyglass I?"O MB.Flashing :0896: Cement to the area in need of repair, followed by a patch of the Polystick material•o&4ke kind ahourdbe set..... and hand rolled in place over the area needing such repair. Patching membrane shalt Venminirpnrr;of 6 •• •• inches in either direction. The repair should be installed in such a way so that watt?Wl run parallel to or •'••;• over the top of all laps of the patch. . . . . ...... 10. All self-adhered membranes must be rolled to ensure full contact with approved 4st 4s. Po yglass • requires a minimum of 40 lbs for a weighted roller for the rolling of the field membfane.•Hand rQltM are • acceptable for rolling of patches or small areas of the roof. Brooming may be used where slope Vr8hibits rolling. 11. All approved substrates should be dry, clean and properly prepared, before any application of Polystick membranes commences. An approved substrate technical bulletin can be furnished upon request. It is recommended to refer to applicable building codes prior to installation to verify acceptable substrates. 12. The Polyglass Miami-Dade Notice of Acceptance(NOA)approval for Polystick membranes and PolyProtector UDL can be furnished upon request by our Technical Services Department by calling 1 (800) 894-4563. NOA No.: 12-0713.02 CMIAMIMMADECOUNTY Expiration Date: 09/13/16 Approval Date: 02/14/13 Page 7 of 8 13. Questions in regards to the application of Polyglass products should be directed to our Technical Services Department at 1 (800)894-4563. 14. Polyglass recommends that applicators follow good roofing practices and applicable procedures as outlined by the National Roofing Contractors Association(NRCA). PLEASE CHECK WITH LOCAL BUILDING CODES REGARDING LIMITATIONS OF SPECIFIC APPLICATIONS. LOCAL CODES MAY SUPERSEDE POLYGLASS REQUIREMENTS AND RECOMMENDATIONS. END OF THIS ACCEPTANCE ...... .... ...... •••• • ••••• •••••• • ••• ••••• •• •• •• • •••••• • NOA No.: 12-0713.02 MIAMI•DADE COUNTY Expiration Date: 09/13/16 Approval Date: 02/14/13 Page 8 of 8 TGDY.R25992 -Prepared Roofing Accessories Page 1 of 1 U` ONLINE CERTIFICATIONS DIRECTORY TGDY.R25992 Prepared Roofing Accessories Paae Bottom Prepared Roofing Accessories See General Information for Prepared Roofing Accessories POLYGLASS USA R25992 621 SNIVELY AVE WINTER HAVEN,FL 33880 USA Asphalt underlayment accessory,"Polystick MTS",self-adhering,a modified bitumen membrane for use in the installation of Class A asphalt glass fiber mat shingles and Class C asphalt organic felt shingles. Last Updated on 2008-10-28 questions? Print this pane Terms of Use Paae Top ©2014 UL LLC When the UL Leaf Mark is on the product,or when the word"Environment"is included in the UL Mark,please search the UL Environment database for additional information regarding this product's certification. The appearance of a company's name or product in this database does not in itself assure that products so identified have been manufactured under UL's Follow-Up Service.Only those products bearing the UL Mark should be considered to be Certified and covered under UL's Follow-Up Service.Always look for the Mark on the product. UL permits the reproduction of the material contained in the Online Certification Directory subject to the following cone$tions: 1.j18 dice •••••• Information,Assemblies,Constructions,Designs,Systems,and/or Certifications(files)must be presented in theft en8re&and in a non- • misleading manner,without any manipulation of the data(or drawings).2.The statement"Reprinted from the OnTin'e Certification%t1f%rtory with •• permission from UL"must appear adjacent to the extracted material.In addition,the reprinted material must inAddt!"Elltbpyright i+et+te in the •+•••• following format: "©2014 UL LLC". •••••• • • • •••• • ••••• •••••• • ••• ••••• •• •• •• • •••••• • • • • • •••••• • http://database.ul.com/cgi-bin/XYV/template/LISEXT/1 FRAME/showpage.html?name=T... 3/31/2014 MIAM MIAMI-DADE COUNTY 7.r in,I a PRODUCT CONTROL SECTION DEPARTMENT OF PERMITTING,ENVIRONMENT,AND REGULATORY AFFAIRS(PERA) 11805 SW 26 Street,Room 208 BOARD AND CODE ADMINISTRATION DIVISION Miami,Florida 33175-2474 T(786)315-2590 F(786)315-2599 NOTICE OF ACCEPTANCE (NOA) www.miamiaade.sov/Dera 3M Company 3M Center Building 0220-05-E-06 St.Paul,MN.55144-1000 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed and accepted by Miami-Dade County PERA-Product Control Section to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction(AHJ). This NOA shall not be valid after the expiration date stated below. The Miami-Dade County Product Control Section (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) reserve the right to have this product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify, or suspend the use of such product or material within their jurisdiction. PERA reserves the right to revoke this acceptance, if it is determined by Miami-Dade County Product Control Section that this product or material fails to meet the requirements of the applicable building code. This product is approved as described herein,and has been designed to comply with the Florida Building Code including the High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION: 3Mrm 2-Component Foam Roof Tile Adhesive AH-160 •••••• LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo,°:t...tate 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 tharahas been uo.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 reaisionbr ch •ipthe •••••• materials,use, and/or manufacture of the product or process.Misuse of this NOA as an endorsamant of any�roduct,�or..: sales,advertising or any other purposes shall automatically terminate this NOA.Failure to comply with an*section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami-Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed,then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This renews and revises NOA# 11-0124.04 and consists of pages 1 through 7. The submitted documentation was reviewed by Alex Tigera. NOA No.: 12-0228.18 MIAM�•Du4DE COUNTY Expiration Date:05/10/17 . ,... Approval Date:05/10/12 Page 1 of 7 ROOFING COMPONENT APPROVAL: Category: Roofing Sub Category: Roof tile adhesive Materials: Polyurethane SCOPE: This approves 3MTM 2-Component Foam Roof Tile Adhesive AH-160 as manufactured by 3M Company as described in Section 2 of this Notice of Acceptance.For the locations where the design pressure requirements,as determined by applicable building code,does not exceed the design pressure values obtained by calculations in compliance with Roofing Application Standard RAS 127,for use with approved flat,low,and high profile roof tiles system using 2-Component Foam Roof Tile Adhesive AH-160.Where the attachment calculations are done as a moment based system for single patty placement,and as an uplift based system for double patty systems PRODUCTS MANUFACTURED BY APPLICANT: Product Dimensions Test Product Description Specifications 3MTM 2-Component Foam N/A TAS 101 Two component polyurethane foam adhesive Roof Tile Adhesive AH- 160 Foam Dispenser RTF 1000 N/A Dispensing Equipment ProPack®30& 100 N/A Dispensing Equipment .906.0 PRODUCTS MANUFACTURED BY OTHERS: 6 0 •6• • 0 .. 9999 Any Miami-Dade County Product Control Accepted Roof Tile Assembly having a current N04*0hich lig ftlbment .... • resistance values with the use of 2-Component Foam Roof Tile Adhesive AH-160 9999 roof tile adhesive. •••••• 9999 . 9999. MANUFACTURING LOCATION: 0 0 • 9999.. 1. Tomball TX. • 9999.. 9999.. PHYSICAL PROPERTIES: •• •••• • Prove Test Results Density ASTM D 1622 1.61bs./ft.3 Compressive Strength ASTM D 1621 18 PSI Parallel to rise 12 PSI Perpendicular to rise Tensile Strength ASTM D 1623 28 PSI Parallel to rise Water Absorption ASTM D 2127 0.08 Lbs./Fe Moisture Vapor Transmission ASTM E 96 3.1 Perm/Inch Dimensional Stability ASTM D 2126 +0.07%Volume Change @-40°F.,2 weeks +6.0%Volume Change @I 58F., 100%Humidity,2 weeks Closed Cell Content ASTM D 2856 86% NOA No.: 12-0228.18 MIAM4UADE COUNTY Expiration Date:05/10/17 Approval Date:05/10/12 APPROVED Page 2 of 7 Note: The physical properties listed above are presented as typical average values as determined by accepted ASTM test methods and are subject to normal manufacturing variation. EVIDENCE SUBMITTED: Test Agency Test Identifier Test Name/Report Date Center for Applied Engineering #94-060 TAS 101 04/08/94 257818-IPA TAS 101 12/16/96 25-7438-3 SSTD 11-93 10/25/95 25-7438-4 25-7438-7 SSTD 11-93 11/02/95 25-7492 SSTD 11-93 12/12/95 Miles Laboratories NB-589-631 ASTM D 1623 02/01/94 Polymers Division Ramtech Laboratories,Inc. 9637-92 ASTM E 108 04/30/93 Southwest Research Institute 01-6743-011 ASTM E 108 11/16/94 01-6739-062b[1] ASTM E 84 01/16/95 Trinity Engineering 7050.02.96-1 TAS 114 03/14/96 Celotex Corp.Testing Services 528454-2-1 TAS 101 10/23/98 528454-9-1 528454-10-1 520109-1 TAS 101 12/28/98 520109-2 520109-3 520109-6 • YYYYYY YYYY YYYYYY 520109-7 ...... • 520191-1 TAS 101 Y Y Y• .03/02/99 520109-2-1 •••• ••••• ...... Y Y Y Y ..... LIMITATIONS: 1. Fire classification is not part of this acceptance.Refer to the Prepared Roof Tile Assembly for fire.WWg. ...... Y Y Y :0090:Y 2. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 shall solely be used with flat,'IQ*, &high tile.profiles,••••; 3. Minimum underlayment shall be in compliance with the Roofing Application Standard RAS 120.'••' 4. Roof Tile manufactures acquiring acceptance for the use of 3MTM 2-Component Foam Roof Tile Adhesive AH- 160 roof tile adhesive with their tile assemblies shall test in accordance with TAS 101. 5. Roof Tile manufactures acquiring acceptance for the use of HANDI-STICK roof tile adhesive with their tile assemblies shall test in accordance with TAS 101 with section 10.4 as modified herein. F W 2 Fl= [2 MS NOA No.: 12-0228.18 MIAM4DADE COUNTY Expiration Date:05/10/17 Approval Date:05/10/12 Page 3 of 7 INSTALLATION: 1. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 may be used with an roof tile assembly having a current P Y Y Y g NOA that lists uplift resistance values with the use of 3MTM 2-Component Foam Roof Tile Adhesive AH-160. 2. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 shall be applied in compliance with the Component Application section and the corresponding Placement Details noted herein. The roof tile assembly's adhesive attachment with the use of 3MTM 2-Component Foam Roof Tile Adhesive AH-160 shall provide sufficient attachment resistance, expressed as an uplift based system,to meet or exceed the uplift resistance determined in compliance with Miami-Dade County Roofing Application Standards RAS 127. The adhesive attachment data is noted in the roof tile assembly NOA. 3. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 and its components shall be installed in accordance with Roofing Application Standard RAS 120,and 3M Company's 3MTM 2-Component Foam Roof Tile Adhesive AH- 160 Operating Instruction and Maintenance Booklet. 4. Installation must be by a Factory Trained'Qualified Applicator'approved and licensed by 3M Company. 3M Company shall supply a list of approved applicators to the authority having jurisdiction. 5. Calibration of the Foam Dispenser RTF 1000 dispensing equipment is required before application of any adhesive. The mix ratio between the"A" component and the"B" component shall be maintained between 1.0-1.15 (A): 1.0 (B). The dispense timer shall be set to deliver 0.0175 to 0.15 pounds per tile as determined at calibration. No other settings shall be approved. 6. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 shall be applied with Foam Dispenser RTF 1000 or ProPack®30& 100 dispensing equipment only. 7. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 shall not be exposed permanently to sunlight. 8. Tiles must be adhered in freshly applied adhesive.Tile must be set within 2 to 3 mingtes after 3mrx.2'• ...... Component Foam Roof Tile Adhesive AH-160 has been dispensed. .. 0000 9. 3MTM 2-Component Foam Roof Tile Adhesive AH-160 placement and minimum pat£V'v�eight shall bein **see: accordance with the'Placement Details'herein. Each generic tile profile requires the spy I is placement noted**•••• herein. •••••• 0000 . 0000. 000000 0 000 00000 Table 1: Adhesive Placement For Each Generic Tile Profile• •• •• •••••• Tile Profile Placement Detail Single Paddy Weight TVro Paody Weight per •••,;• Min.(grams) paddy Min.ZgffiNk) • 0000.. Flat,Low,Hi Profiles #1 35 •' ' N/A :•••• High Profile(2 Piece Barrel) #1 17/side on cap and 34/ an N/A Flat,Low,High Profiles #2 24 N/A Flat,Low,High Profiles #3 1 8 NOA No.: 12-0228.18 MIAM4DADECOUNTY Expiration Date:05/10/17 D Approval Date:05/10/12 Page 4 of 7 LABELING: All 3M*rm 2-Component Foam Roof Tile Adhesive AH-160 containers shall comply with the Standard Conditions listed herein. BUILDING PERMIT REQUIREMENTS: As required by the Building Official or applicable building code in order to properly evaluate the installation of this system. ADHESIVE PLACEMENT DETAIL 1 SINGLE PATTY NAI through plastic cement Paddy( Tie) Nail t1hrough plask comment pa"( Toe) uncieflarnent WerbrNent 1 1 101 In 10 2 EmCowse Fascia EswCourse WW" CNMO*. Em course orAr. • •• EaAclostires, Keep adhesive approx. Keep adhesive approx • Dripedge Eave Closure 4 In.up from weepholes 4 in.up from Nall through plastic catmentP+ddY Tie) I)placeenoughA., .1710Sbw phch aqp6cgd" Nall thootigh plastic cement e square inches In wO the pan .moi 2)Tum corers upsliledomemPlamm N • 00• 0 0 Tolln.From oc [dile atcover Then Install the IIL 2 in. Ewe Cause Ease Eave course onlif. top Sheathing Keepaclhesin 4k up Feeds 001the I from j wase 9e Atinto second waned Optimal pan SwEnsue eaveend d Poh"Mortar Wanti comilluare dnal flush at am line. edges aHie Eave closure (mortar sh-A) NOA No.: 12-0228.18 MIAMI•QADE COU Expiration Date:05/10/17 Approval Date:05/10/12 Page 5 of 7 ADHESIVE PLACEMENT DETAIL 2 SINGLE PATTY Nail through plastic cement ply lei Tile) Nail through plastic cement Paddy(aeneatn Tile) Underlayment .� Underwyment 7 in. i 2 In. - == 7ln�2 in EarE Course - Fascia Fascia Env Cam Eave closure Eave Cbsme Drip a* Nail through Omdc cera t • • paft( Tile) • • i9•••• 0000•• w •• • 0000 • 000000 see* 000900 000••9 • •• • 909•• 0000 • • • • • 0 •0•••• 0000 • ••0•• lin. ��. in. 0000•• • •9• ••..• •• •• •• • 0000•• • 0000•• • • • • • • 0000•• _" 0.000• _" • • • 00.00• •• • 0000 • • • Eave Closure Eave Course Fascia NOA No.: 12-0228.18 MIAMI-WADE COUNTY Expiration Date:05/10/17 a s Approval Date:05/10/12 Page 6 of 7 � ADHESIVE PLACEMENT DETAIL 3 DOUBLE PATTY Nail through plastic cement pa" Nail through plastic cement Single paddy under tile (between tk) Ilmledinime"t Single paddy between the (under 019) size paddy eave course only 3 in: under tile 4 in. Single Single paddy on 2 in. Qb paddy on under- --- Qb Single paddy Fascia Ve course on top of die W"Phole Single paddy 2bLX7kL oft Erie Eave closure on top of tie size paddy eon Course Drip edge Fascia course only Nall through plaisfic cement Single paddy under tile Single paddy between die ° ° ° ° °°°° °°°°°° ° ° ° ° ~°°°°° °°°° ° °°°° ° ° ° °= °°°°° ° ° ~ ° ° Single paddy on undedayment 2 n. Single paddy Ea"Closine on top of tile 2 in,x 7 in.medium size paddy em course only Em Couis Fascia END OF THIS ACCEPTANCE NOA No.: 12-0228.18 Expiration Date:05/10/87 Approval Date:05/10/12 ---------------- Page 7mK7 MIAMI-UAbE s MIAMI-DADE COUNTY PRODUCT CONTROL SECTION DEPARTMENT OF PERMITTING,ENVIRONMENT,AND REGULATORY AFFAIRS(PERA) 11805 SW 26 Strect,Room 208 BOARD AND CODE ADMINISTRATION DIVISION Miami,Florida 33175-'2,474 T(786)315-2590 F(786)315-2599 NOTICE OF ACCEPTANCE (NOA) www.miamidadrv/� rx Boral Roofing,LLC 7575 Irvine Center Drive, Suite 100 Irvine, CA 92618 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 Contrcl 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-Daae 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 acceped 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 detennined by Miarni-Dade County Product Control Section that this product or material tails to meet the requirements of the applicable building code. This product is approved as described herein., and has been designed to comply with the Fjorid�Buildio C*;de 666666 including the High Velocity Hurricane Zone of the Florida Building Code. •00• ; 6660 •• •0000• .... 6000% DESCRIPTION: Saxony 900 Concrete Roof Tile 000000 • • o ....% LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo',';Sfy, state•and'ollowirfl�f; statement: "Miami-Dade County Product Control Approved", unless otherwise noted hereinr • • 60 .. .. . •6666• RENEWAL of this NOA shall be considered after a renewal application has been filed and these has yeenjio change in the applicable building code negatively affecting the performance of this product. •6• :09000 •• .. • 0000 TERMINATION of this NOA will occur after the expiration date or if there has been a revision or clT-At; 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 tennination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the Words Miami-Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This renews and revises NOA#07-071 1.03 and consists of pages l through 8. The submitted documentation was reviewed by Alex Tigera. r ''^ NOA No.: 12-0222.03 MIAM4OUNTY DADE C }. t ;�"}'y ' C Expiration Date: 04/26/17 1 Approval Date: 04/19/12 Page 1 of 8 ROOFING ASSEMBLY APPROVAL Category: Roofing Sub-Category: Roofing Tiles Material: Concrete Deck Type' Wood 1. SCOPE This NOA approves a system using Saxony 900 (Shake, Slate & Split Shake) Concrete Roof Tile, as manufactured Boral Roofing LLC in Lake Wales, FL. and described this Notice of Acceptance. For locations where the pressure requirements, as determined by applicable Building Code does not exceed the design pressure values obtained by calculations in compliance with RAS 127 using the values listed in the installation section herein. The attachment calculations shall be done as a moment based system.. 2. PRODUCT DESCRIPTION Manufactured by Test Product Applicant Dimensions Specifications Description Saxony 900 1— 17" TAS 112 F,'at pro lc, interlocking, high - w= 13" pressure extruded concrete roof tile 1-5/32" thick Slate equipped with two nail holes. For 1-9/32" thick Shake& direct deck or baitpned+nail-on:?AcTi 3r 0000.. Split Shake set or adhesive ser applihtions....+• .� 0000.. 0000 0000.. Trim Pieces Length: varies TAS-112 Accessory trim, ba est"oBarcelona, Width: varies concrete roof pie%efot use at e • •••• varying thickness rakes, ridges and valtCy terminlitions •`;••• manufactured fore'��R tie prota?e.:•: ••••• .. .. ++ . •++++• 0000.. 2.1 MANUFACTURING LOCATION . 0000.. • . . . 0000.. i 2.1.1. Lake Wales, FL. 0000.. of . 0000 0 0 2.2 SUBMITTED EVIDENCE: Test Agency Test Identifier 'rest Name/Report Date Redland Technologies 7161-03 Static Uplift Testing Dec. 1991 Appendix i1I TAS 102 &TAS 102(A) The Center for Applied 94-084 Static Uplift Testing May 1994 Engineering, Inc. TAS 101 (Mortar Set) The Center for Applied 94-060A Static Uplift Testing March, 1994 Engineering, Inc. TAS 101 (Adhesive Set) NOA No.: 1Z-0222.03 MIAMI-DAD,eouNTY Expiration Date: 04/26/17 2.03 Approval Date: 04/19/12 Page 2 of 8 The Center for Applied 25-7183-6 Static Uplift Testing Feb. 1995 Engineering, Inc. TAS 102 (2 Quik-Drive Screws, Direct Deck) The Center for Applied 25-7183-5 Static Uplift Testing Feb. 1995 Engineering, Inc. TAS 102 (2 Quik-Drive Screws, Battens) The Center for Applied 25-7214-1 Static Uplift Testing March, 1995 Engineering, Inc. TAS 102 (1 Quik-Drive Screw, Direct Deck) The Center for Applied 25-7214-5 Static Uplift Testing March, 1995 Engineering, Inc. TAS 102 11 Quik-Drive Screw, Battens) Redland Technologies 7161.-C3 Wind Tunnel Testing Dec. 1991 Appendix I1 TAS 108 (Nail-On) Redland Technologies, Letter Dated Ali-,. 1, Wind Tunnel Testing Aug. 1994 1994 TAS 108 (Nail-On) Redland Technologies P0631-01 Wind Tunnel Testin;; July 994. TAS 108 (Mortar Set,• ;""' •.••.. Redland'Technologies P0402 Withdrawal Resistance " 'Sept.•] •. sees .••. sees.• Testing of screw vs. smoo•t�t • • sees • • shank nails sees•• The Center for Applied Project No. 307025 Wind Driven Rain �••••• Oct.1994 `•;•'. Engineering, Inc. Test#MDC-77 TAS 100 00:96: .' :': ::.: ::Aug.. .. . sees:* Atlanta Testing&Engineering, 81.894 Physical Properties : : A1994 .� Inc. R2.894 TAS 112 sees•• R3.894 • Celotex Corporation Testing 520109-1 Static Uplift Testing Dec.J94 Service 520111-4 TAS 101 Celotex Corporation Testing 520191-1 Static Uplift Testing March 1999 Service TAS 101 Walker Engineering, Inc. Evaluation 25-7094 February 1996 Calculations Walker Engineering, Inc. Evaluation 25-7496 April 1996 Calculations Walker Engineering, Inc. Evaluation 25-7584 December 1996 Calculations 25-7804b-8 25-7804-4 & 5 25-7848-6 MIAMI-DADE COUNTY NOA No.: 12-0222.03 �Yjd.:o , Expiration Date: 04/26/17 Approval Date: 04/19/12 Page 3 of 8 Walker Engineering, Inc. Evaluation 25-7183 March 1995 Calculations Walker Engineering, Inc. Evaluation Aerodynamic Multipliers January 2007 Calculations Walker'Engineering, Inc. Calculations Two Patty Adhesive Set April 1999 System Walker Engineering, Inc. Evaluation Restoring Moments Due to February 2007 Calculations Gravity Nutting Engineers 130 TAS 112 January 2007 3. LIMITATIONS 3.1 Fire classification is not part of this acceptance. 3.2 For mortar or adhesive set tile applications, a static field uplift test shall be performed in accordance with TAS 106. 3.3 Applicant shall retain the services of a Miami-Dade County Certified Laboratory to perform quarterly test in accordance with TAS 112, appendix `A'. Such testing shall be submitted to the Building Code Compliance Office for review. 3.4 Minimum underlayments shall be in compliance with the applicable Roofing Applications Standard's listed section.1 herein. 3.5 30/90 hot mopped underlayment applications may be installed perpendic;4r'to;the roof s"pe unless stated otherwise by the underlayment material :manufacturers pub4sW6kterat1j9re0..6 .•Y•.. 3.6 This acceptance is for wood.deck applications. Minimum deck requtrermlts shall bt in 0.00.: compliance with the applicable Building Code. •••• .. • 0000 0000 . 00.00 4. INSTALLATION • 0 .. .. .. 000000... 4.1 Saxony 900 (Slate, Shake & Split Shake) Concrete Roof Tile and its ron�o�ents shalt be00 installed in strict compliance with Roofing Application Standard RAS:]18,.AAS I -4mi RAS 120. 6.0 • 0.00•• 0000 4.2 Data For Attachment Calculations �.;. Table 1: Average Weight (W) and Dimensions (I x w ) Tile Profile Weight-W (lbf) Length-I (ft) Width-w (ft) LSaxony 900 11.5 1.417 1.08 --� Slate, Shake & Split Shake Table 2: Aerodynamic Multipliers - X (ft) Tile X (ft3) (ft) Profile Batten Application Direct Deck Application Monierl-ifetile Saxony 900 0.289 0.313 Slate, Shake & Split Shake NOA No.: 12-0222.03 MIAMI•DADE COUNTY Expiration Date: 04/26/17 Approval Date: 04/19/12 Page 4 of 8 �- Table 3: Restoring Moments due to Gravity - M9 (ft-lbf) Tile 2":12" 3•x:12" 4":12" �- 5":12" 6":12" 7":12" or Profile I greater Saxcny Battens Direct Battens Direct Battens Direct Battens Direct Battens Direct Battens j Direct 900 _ Deck Deck Deck Deck Deck _Deck_ Slate, 7.16 8.12 7.08 8.03 6.97 7.91 6.82 7.74 6.65 7.55 6.4 7.3.4 Shake& Split Shake ---- Table 4: Attachment Resistance Expressed as a Moment - Mf(ft-lbf) for Nail-On Systems Tile Fastener Type Direct Deck Direct Deck j Battens ! Profile (min 15/32" (min. 19/32 plywood) p!ywood) Saxonv 900 2-10d Rim Shank Nai!s _ 3.0.9 38.1 17.2 Mate, Shake & 1-10d Smooth or Screw Shank_Nail �_ 7.3 _9.8 4.9 Split Shake ' 2-10d Smooth or Screw Shank Nails 1 14.0 18.8 7.4 1 #8 Screw 30.8 1 30.8 .13.2. -- --._ _ 2 .#8 Screws _ ! 51.7 _ 51.7 1-10d Smooth or Screw Shank avail 24.3 �4 3 I 3a 2. 1 Field Clip) -� --- I ....:. 1-10d Smooth or Screw Shank Nail ' 19.0 1; 0 ?_2.4 •0.96• • 1 Eave CGpi IL •••• _ • • 2-10d Smooth or Screw Shank Nails 1 3 5.5 35.5000- *3-4 �� 66606 • Field Clip) 00.00• 0 ••• 00000 r2-10d Smooth or Screw Shank Nails 31.9 31'9 •• i 3�!2 ••• • (Eaye Clip .•..•• • • • • 0000.• _ •0000• �- Table 5: Attachment Resistance Expressed as a Moment Mf•(ft4f) :6.06: •00• • • for Two Patty Adhesive Set Systems 0.0• 4 Tile Tile Application Minimum Attachment Profile Resistance MonierLifetile Saxony 900 Adhesive 31.3 Slate, Shake &Split Shake 1 See manufactures component approval for installation requirements. 2 Dow Chemical TileBond Average weight per patty 13.9 grams. j-Polyfoam Product, Inc.Average weight per patty 8 grams. _- ----� NOA Na.: 12-0.122.03MIAMI•DAD;couNTY Expiration Date: 04/26/17 Approval Date: 04/19/12 Page 5 of 8 Table 6: Attachment Resistance Expressed as a Moment - Mf (ft-lbf) for Single Patty Adhesive Set Systems Tile Tile Application Minimum Attachment i Profile Resistance MonierLifetile Saxony 900 Polyfoam Pol Pro'"' --40.e- 3 118.9' Slate, Shake & Split Shake � PolyFoa_m EolyPrOTM , 40.4 j 3 Largeaddy placement of 45 grams of Po!yProT"". --- -- 4 Medium paddy placement of 24 grams of PolyProT"". j r— Table 7: Attachment Resistance Expressed as a Moment - Mf(ft-lbf) for Mortar Set Systems Tile ' Tile Attachment Profile Appfication Resistance MonierLifetile Saxony 900 Mortar Set 43.9 Slate, Shake &Split Shake I 5. Tile-Tite Roof Tile Mortar S. LABELING 5.1 All tiles sha11 bear the ii ipr nt or idem t?aole marking of the manufactiver's jiame oj'1,Mgd0a detailed below, or following statement: "Miami-Dade County Product C wArol:ApproNe4&* . 0000.. 0000 0000.. 0000.. 0000.. 0000 0000.. 0000 4 0000. 0000.. 4 444 0000. .. .. 494 0000.. 0000.. . . . . 0000.. 0000% . . . .0040. LABEL FOR SAXONY 900 TILE (LAKE WALES FL FLAINT) :4 4 0 0 444. LOCATED UNDERNEATH TILE 6. BUILDING PERMIT REQUIREMENTS 6.1 Application for building permit shall be accompanied by copies of the following: 6.1.1 This Notice of Acceptance. 6.1.2 Any other documents required by the Building Official or applicable building cede in order to properly evaluate the installation of this system. NOA No.: 12-0222.03 MIAMI•DADECOUNTY Expiration Date: 04/26/17 12 Approval Date: 04/19/12 Page 6 of 8 PROF U,DRAWING NAIL HOLE— oe -tr / \ \ 1 /3 � — 5. 2 " (slate) \ \ 1 9132 "(shake) 17 " \ OVERLAY \ 13 1 WATERLOCK •••••• ••.• ...... . ...... . . . SAXONY 900 CONCRETE ROOF TILE(SLATE MODEL) �•�• • ��:•�• MONIERLIFFTILE SAXONY 900 CONCRETE ROOF TILE (SPLIT SHAKE,MODEL) MIAMI•DADE CO, NOA No.: 12-0222.03 UNTY ..,, , Expiration Date: 04/26/17 Approval Date: 04/19/12 Page 7 of 8 h M 77 MONIERLIFETILE SAXONY 900 CONCRETE ROOF TILE(SHAKE MODEL) 0000•• • • • 0000•• END OF THIS ACCEPTANCE •" ..0.00 .... .•.... 000.0• . .... . ..... ...... . ... ..... 0000•• • • • • • • • 0000•• 0000•• •• • 0000 • • 0000 NOA No.: 12-0222.03 MIAMI•DADE COUNTY Expiration Date: 04/26/17 Approval Date: 04/19/12 Page 8 of 8 ♦S�ORFs D �rev � � " Miami shores Village R ID �� Building Department A 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT#: &T E: C QfContractor (NAME) o Owner o Architect i Picked nd (other)744 1�S 4 �� 1( ^ u Address: _ cl ��' �1 I�r S.q-j ct- 0 From the building department on this date in order to have corrections done to plans And/or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building a artment to continue permitting process. Acknowledged by: (Signature) PERMIT CLERK INIT RESUBMITTED DATE: PERMIT CLERK INITIAL: Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305)795-2204 Fax: (305)756-8972 I._ INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 (® C BUILDING Master Permit No. i l PERMIT APPLICATION Sub Permit No. 19-B'UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP � CONTRACTOR DRAWINGS JOB ADDRESS: � � t3 ?t Y(5�eQie Q� City: Miami Shores County: Miami Dade zip: _�z b - Folio/Parcel#: i� —b�b� Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): L VS)LA Phone#: Address: " -�c 1 (�Q <<j ` (L ID c �{y � City: �� J State: Zip: Tenant/LesseeName: Phone#: Email: V F-v(�CiJ�/l�g CONTRACTOR:Company Name: �-`�" 11/ "`^� (hone#: I � Address: City: L x�'� 1� state: Zip: > l Qualifier Name: Loi (rL'� Phone#: State Certification or Registration#: c C 1 1 Certificate of Competency#: DESIGNER:Arch itect/Engineer: L � � &C-1A, Phone#: �� JM Z� Address: City: State: Zip: i Value of Work for this Permit:$ D Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration 1❑ New ❑ Re air/Re lace ,�� Q (� p p El Demolition Description of Work: 1 e�-�J_� ��1�171 al�1�, S Specify color of color thru tile: `Y 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$ (Revised02/24/2014) ti 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 �U OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 , by day of � M� 20 �f by who is personally known to �� �(� who is personally known to me or who has produced as me or who has produced r�bQw—(�— identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sig . Print: Print: otary Public State of Florida Seal: Seal: Sindia Alvarez a w� My Commission FF 156750 Expires 09/03/2018 ************************************************************************************************************ APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami shores Village .S�oRFsG Building Department fall H,,,y" 10050 N.E.2nd Avenue Miami Shores, Florida 33138 .d Tel: (305) 795.2204 A�jv 04 Fax: (305) 756.8972 Page 1 of 1 Permit No: Structural Critique Sheet Q J 4Ja STOPPED REVIEW Plan review is not complete,when all items above are corrected,we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re-submittal drawings. Mehdi Asraf -1C�1l rhw84 6;u,, IJIk: A-1 CONSULTING ENGINEERS , INC ROOF STRUCTURES CONSULTING HELP� ---� `� ON SITE CONCENTRATED UPLIFT LOAD TESTING ROOF TILE ROOF PROBLEMS??? IN ACCORDANCE WITH METRO-DADE BUILD G CODE COMPLIANCE TAS No. 106 /` UPLIFT TEST EXPERTS SITE SPECIFIC INFORMATION Owner's Name: Permit# — L Job Address: `�/ .1 t � h �,'� i 7'7 ,y t- l` Roofing Contractor:/K Type of Tile: r i % / = Date installed: Approximate Roof Height: ��� feet Roof Pitch: :,%ice I Type of Access to Roof: Scaffolds Ladder Other Approximate Square Footage of Roof: <= ft 2 Required Testing Force: 35 lbs. Testing Equipment: F.G.E. 100 Date Tested: �':j /T / I ST LOCATION UPLIFT PULL TEST rEST LOCATIO UPLIFT PULL TEST TEST LOCATIO1 UPLIFT PULL TEST TEST LOCATIO UPLIFT PULL TEST rEST LOCAT)Ot UPLIFT PULL TEST FEST LOCATIO UPLIFT PULL TEST 1 � 26 `,.._ 51 76 101 126 1 �- ' _> 2 27 52 77 1 2 127 r 3 I 28 53 78 103 128 4 29 54 79 104 129 5 30 55 80 105 130 6 31 56 81 106 131 7 32 57 82 107 132 8 33 58 83 108 133 9 34 s 59 84 109 134 10 35 60 I 85 110 135 11 36 61 86 111 136 12 87 62 87 112 137 13 I 38 1 63 88 113 138 14 39 64 89 114 139 j 15 40 1 65 90 115 140 j 16 41 66 91 16 141 17 42 92 7 142 1843 68 = _; 93 1 143 19 i 44 69 94 11.9 144 20 45 70 95 21 I 46 71 ti 96_ c ; 121 146 22 I 47 72 N, 97 147 23 48 73 98 _- 148 24 49 74 99 124 149 25 50 `; 75 100 125 1 150 INACCORDAWt,WITH,,TI�E-ORITERIA OF PROTOCOL PA 106,THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT QUALITY CON- TROL TEST,THhS 1AS:, 6&T�ST MAS BEEN PERFORMED IN FULL ACCORDANCE TO THE REQUIREMENTS OF DADE COUNTY,WITH NO DEVIATIONS � THIS RLPB •§UBMJT1 �3 B r JOS6A.Mdrtlnez P.E.#0315'9 _ A-1 CON,'thTINGNLRS,,11�1C. Lab. Ced ;p�1°#;07-0 �. 3Perews:01-1224.05 v..4303.W.70th Ct, Miami, Florida 33155 • Telephone (305)740-9550 - Fax (305) 740-9550 ENGLISH: Cell (305) 609-6388 • SPANISH: Cell (305) 498-9804 A-1 CONSULTING ENGE\TERS IN,C. ROOF STUCTURES CONSITLTING ITTLIF T TEST EXTERTS L-AB. CERTIFICATION Nlo.01-1224-5 4383 SW,70 CT. ML AMI FL. 33155 TEL.303-740-9550 F-AX-305-74-0-95,50 I O-wiler'sname: Permit#: job address: 9301 N. BAYSHIORE DR MIAMI SHORES FL. Roofing con,tractor: TOP SEAL SERVICE ROOFING Tylpe of tile: . FLAT TILE 13". Date installed: Approximate roof height: 14 feet Roof pitcli: 3/12 Tipe of access to roof: Scaffold: Ladder: - Other: Approximate square footage of roof: 42 ftp. Required testing force: 35 lbs Date tested: Number of tests: 68 SKETCH OF ROOF Sl K 'E'S -3 4?a S= 37 is 33 va Z5 S7 53 35 33 32 ')4 13 1� 3<2 -2-Z 2 CE 1-3 J-7 IE 15 53 2 7 ES S 2Y �2 7 11 61 S E-3 2 3 Revicect: 1 M Date: 4/23/2015