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RF-15-2442 ,SNoaEs�� Miami Shores Village y0011 10050 N.E.2nd Avenue NW Miami Shores,FL 33138-0000 Phone: (305)795-2204 ermtf a Expiration: 03/2312016 Project Address Parcel Number Applicant 254 NW 92 Street 1131010331260 �_�.__._...�.... Miami Shores, FL Block: Lot: DIEGO AGUIRRE Owner Information Address Phone Cell �DI�EGOAGUIRRE 254 NW 92 Street MIAMI SHORES FL 33138- 254 NW 92 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 4,000.00 BURCORP LLC (786)663-5900 _... _._... Total Sq Feet: 0 Type of Work:Re Roof Available Inspections: Additional Info:RE-ROOF TILE ROOF AREA Inspection Type: Classification:Residential Up Lift Report Scanning:3 Tin Cap Final Roof Tile In Progress Renailing Affidavit Review Roof Cap Sheet Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 DBPR Fee Invoice# RF-9-15-57207 $3.75 09/25/2015 Cash $272.90 $0.00 DCA Fee $3.75 Education Surcharge $0.80 Permit Fee-New Roof $250.00 Scanning Fee $9.00 Technology Fee $3.20 Total: $272.90 In considerati oftheissuan to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining th reto and in stric formity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting is permit I assu esponsibiltity for all rk done by either myself, my agent, servants, or employes. I understand that separate permits are required f r ELECTRICAL, ING, MECHANI ,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNER AFFIDAVIT: I i h all the mg information is accurate and that all work will be done in compliance with all applicable laws regulating constructi and zoning. F er uthoriz the above-named contractor to do the work stated. September 25, 2015 Signa a wner / Applicant / Contractor / Agent Date Building De ent Copy September 25,2015 1 30 — Lab Report No. 125015 FLORIDA TEC PROVIDING SOLUTIONS TO THE ROOFING INDUSTRY C.A.#30448 Lab Certificate#13-0507.02 CONCENTRATED UPLIFT LOAD TESTING ON ROOF TILE TO COMPLY WITH METRO-DADE COUNTY PROTOCOL TAS-106 /3r PROPERTY ADDRESS: 254 NW 92nd St.,Miami Shores PERMITNoo: RC 11122156 ROOFING OWNER: Diego Aguirre SQUARES: 20 CONTRACTOR: ROOF mm: 3:12 INSPECTOR TILE TYPE.--Spanish "S INITIALS: AB ATTACHMENT: Polyfoam TEST DATE.• 09/29/2015 Testing Equipment: Di ital Chatillon DFIS 200 Test Tabulation Required Testing Force:35 Ibs No. RESULT No. RESULT No. RESULT No. RESULT No. RESULT 1-9 Passed 10-19 Passed 20-25 Passed THIS ROOF HAS:PASSED ® FAILED Q THE STATIC UPLIFT IN ACCORDANCE WITH MIAMI-DADE COUNTY TAS 106. 39' i20 19 -- 17 22 21 2316 15 24 - -5- - - -- -------1 ---� 2. 5 14 6 12 7 11 4 10 8 9' 2�-- Sinc —-- Alberto Cardona,P., Lic.No. 17138 10735 SW 2161h St. Unit 416 Tel: 305-256-4550 Miami FL 33170 Page 1 of 1 Fax: 305-256-6833 www.FloridaTEC.net Florida Building Code Edition2010 • I 7 2014 Applicationcity Hurricane Zone Uniform Permit n a • !■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■MESSES ■ ■E■EMMEMM■MMM■■ONE■M■■■■M■Sfi■■■t■■■■■■Eli■■■■■■■■■■■■■■■■■■ ■EMMEMMEMMEME■SM■■■■E■■■EENII■■■■■■■■■■■11S■M■■■■■■■■■■EES■■ ■MMMMMEMM■M■■M■■EMEM■■■MMinall■■M■E■■■■■■I�■/■■■M■■■■■■E■E■■■ ■■■■//O/■OOO/■M■O/■MM■■■■■iru/■■■irnu■■/■■/■■■/■M■■■/■/■■■■■ !/■■■■ ■■■■■■■■■■I1■MMMkUM- M■■■■■O■MOOMM■OM■E■■■■ ■E■■■■■■(ill■'��E■■■■■■■■■■M■■■■■■/■■■■■■■i■■■MMM■■■/■■■/■■■■ ■■■■■■■■■I■■'■■■■■■■■■MN■■N■■■■S■NM■M■!!■■N■■M■■N■M■■■O■E■■■ ■■■■■■■■■IlM■■O■■■■OOO■■M■■■■MOOS■OMM■M■■■■MOO■■M■■■■■■■■S■ ■fi■■M■■N■■■■■■■■■■■■M■O■■OMMO■■■SMS■■■NO■■■M■■■■■■■■■■NONEsoon ■OHNE■M■M■■■■■■MOO■■■■■■■■■■■MO■■■■■■■O■!■■EEEO■M■■E■■O■■■ ■4M■■■■■■■M■■■MEMM■M■N■■■■■■E■!■■■■■■■MMM■■/MO■/■/OO■N■OOH SM■■■■M■■■■■■■MM■■■■■■■■■■■■■NM■S■■■■■M■M■MOM■■MN■NE■■■■S■ ■EMEMMOMEMM■M■■■■■■MONSON■MENNE■■M■■M■O■■MMMI■N■MME■■■■Omom ■■■E■■■■■■O■MMM/■■■■S■■■E■SEEMS■■■■■■■■■O:7G7iM■■■■■E■■■■E■ ■O/MNONE MRI■NMEMM■■Mso ■MMM■■■■■E■■■O■■■■■■/►J:7■■■■■■■■■■■■■■ ■■■M■■Mi �' /■■■M■■MMO■■■■M/■■■/■■■■■■■/■■M■�MOM■■E!■■MMM■■■■ ■■■■■■■!■■■■M■i!■■■SMS■M■■■■■ON■EMESE■■■■■■■■■■NEM■■■SSM■■ MMMMMMNMIMMMEMMMM mom OMEN OMOM■EM■■OEMEOO■/■■EMM■■■■■■S/MOM■■■■■'■/O/■■■■■■MEMNO■ ■NMONSON■MM■MEMMES■SEN■■SN■■■■■■■■■■■■■i■■■IMS■■■EONNMMOMEM■ ■O■MESON■■■■EMESON■OM■MMMOO■■■MMS■MM■■■IO■■!■■OMOOOOS■■MMOE■ ■■■■M■■■■son■MEMMEMEME■EIS■■■■■■■■MEMNOr■■■iMM■■■■■■!■■■MEMO SEEN Mas EMENSFONMEMENEM ENEEMEMEM MEMO MRSENSOMPIA,!M■E■■MMI■MOM■■■■M■■■M■MEMMMEM■■MOM■■■■■OM■EMMMENMMS■■■■MMRwMNMdwNMMMRM ■N■ ■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■>•■■■■■■■■■■■■ ■■■■■■■�■ Florida Building Code Edition 2010 High Velocity Hurricane Zone Uniform Permit Application Form Section D (Steep Sloped Roof System) Roof System Manufacturer: C9OtV'*V 0al1--.a/)VC p/z-O,aycT; Product Approval Number: /,0,4 -4 /'/,, O/OZ , b Minimum Design Wind Pressures,If Applicable(From RAS 127 or Calculations): P1: 15 -31 P2: 3: Maximum Design Pressure Product Approval Specific System: 31 .1 Method of Tile Attachment: ®b I f00l'."1 3M Steep Sloped System Description Deck Type: I ,, if if Roof Slope: Type Underlayment: .3�/yam h4O-7 . 12 Insulation: ( p� 1 r4 1' Fire Barrier: Ridge Ventilation? Fastener Type &Spacing: Adhesive Type: 13' r ' CO P4 V F-W A M Type Cap Sheet: Roof Covering: �, c/t-E>E .�.-�L eMean Roof Height: Type&Size Drips Edge: IYX-31-1 Florida Building Code Edition 2010 High Velocity Hurricane Zone Uniform Permit Application Form Section E (Tile Calculations) For Moment based the systems,choose either Method 1 or 2.Compare the values for M,with the values from Mf. If the Mrvalues are greater than or equal to the M, values,for each area of the roof,then the the attachment method is acceptable. Method 1 "Moment Based Tile Calculations Per RAS 127" (P,: HS.( x A .31 = /4.1) )-Mg: 73 =Mr, 5.32- Product Approval Mf rya 't _ (P2:.� .� :Z(4, , „ �� ,2_� oductApprovalMf (P3: /(I.Ix�, = 36 -Mg: =Mr3 S-7.5 Product Approval Mf if Method 2 "Simplified Tile Calculation Per Table Below" Required Moment of Resistance(Mr)From Table Below � Product Approval Mf T7 P Mf Recluired Moment Resistance* Mean Roof Height--lo- Roof Slope 1 15' 20' 25' 30' 40' 2:12 34.4 36.5 38.2 39.7 42.2 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 32.4 7:12 24.4 1 25.9 27.1 28.2 30.0 *Must be used in conjunction with a list of moment based tile systems endorsed by the Broward County Board of Rules and Appeals. For Uplift based tile systems use Method 3.Compare the values for F'with the values for Fr. 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: - -Fr, Product Approval F' (P2: x 1: - x w:=_)-W: x cos 0: - --Fre Product Approval F (P3: x 1: - x w:=_)-W: x cos 0: - =F,3- Product Approval F' Where to Obtain Information Description Symbol Where to find Design Pressure P1 or P2 or P3 RAS 127 Table 1 or by an engineering analysis prepared by PE based on ASCE 7 Mean Roof Height H Job Site Roof Slope 0 Job Site Aerodynamic Multiplier A Product Approval Restoring Moment due to Gravity M, Product Approval Attachment Resistance M, Product Approval Required Moment Resistance M, Calculated Minimum Attachment Resistance F Product Approval Required Uplift Resistance F, Calculated Average Tile Weight W Product Approval Tile Dimensions I=length Product Approval w=width All calculations must be submitted to the Building Official at the time of permit application. SECTION R4402.13 HIGH VELOCITY HURRICANE ZONES REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS R4402.13.1 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 Section R4402 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 adjacent box indicates that the item has been explained. _1.Aesthetics-Workmanship:The workmanship provisions of Section R4402 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. W't4­ 2.Renailing Wood Decks:When replacing roofing,the existing wood roof deck may have to be renailed in accordance with the current provisions of Section R4403.(The roof deck is usually concealed prior to removing the existing roof system.) u 3. Common Roofs: Common roofs are those which have no visible delineation between neighboring units (i.e. townhouses, condominiums, etc.) In buildings with common roofs, the roofing contractor and/or owner should notify the occupants of adjacent units of roofing work to be performed. 4.Exposed Ceilings:Exposed,open beam ceilings are where the underside of the roof decking can be viewed from below.The owner may wish to maintain the architectural appearance,therefore, roofing nail penetrations of the underside of the decking may not be acceptable.This provides the option of maintaining this appearance. 1� 5. Ponding Water:The current roof system and/or deck of the building may not drain well and may cause water to pond (accumulate) in low-lying areas of the roof. Ponding can be an indication of structural distress and may require the review of a professional structural engineer. Ponding may shorten the life expectancy and performance of the new roofing system. Ponding conditions may not be evident until the original roofing system is removed. Ponding conditions should be corrected. 6. Overflow scuppers (wall outlets): It is required that rainwater flow off so that the roof is not overloaded from a build up of water. Perimeter/edge walls or other roof extensions may block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accordance with the requirements of Sections R4402,R4403 and R4413. .A 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 beneficial to consider additional venting which can result in extending the service life of the roof. Exception:Attic spaces,designed by a Florida licensed engineer or registered architect to eliminate the attic venting,venting shall not be required. Own ent' Signature Date Co ac�6 'Signature 0511 Property Address Permit Number } ,SNOR- Miami Shores Village some .,s.. ....� Building Department 0 10050 N.E.2nd Avenue R 0 Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNERS'S AFFIDAVIT OF EXEMPTION ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR EXISTING SITE- BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PERSUANT TO SECTION 553.844 F.S. To: Miami Shores Village Building Department Date: 10050 NE 2nd Ave Miami Shores, FI 33138 Re: Owner's Name: I Co U i A-ft-E Property Address:_ Z, 9 �- Roofing Permit Number: Dear Building Official: 11 bl C-60 A-&() I IZ certify that I am not required to retrofit the roof to wall connections of my building because: XThe just valuation for the structure for purpose of ad valorem taxation is less than $300,000.00. Please attach proof of ad valorem taxation. o The building was constructed in compliance with the provisions of the Florida Building Code (FBC)or with the provisions of 1994 edition of the South Florida Building Code (1994 SFBC) - 21\ .OPS " V /2-P-.C-- Signature Print Name State of Florida County of Dade The undersigned, being the first duly sworn, deposes and says that he/she is the owner for the above property mentioned. Sworn to and subscribed before me this s � 4o�f -114 MY COMMISSION t FF 103507 EXPIRES:March 18,2018 Notary Public, Sate of Florida at Large M11 N >� • When the just valuation of the structure for purpose of ad valorem taxation is equal to or more than$300,000.00,and the building was not constructed with FBC nor a 1994 SFBC.Then you must provide a building application from a General Contractor for the Roof to Wall connection Hurricane Mitigation. D—A—A—rP)I I'Ma MIAMI-DADE COUNTY MIAMHMM PRODUCT CONTROL SECTION MM11805 SW 26 Street,Room 208 DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES(RER) Miami,Florida 33175-2474 BOARD AND CODE ADMINISTRATION DIVISION T(786)315-2590 F(786)315-2599 NOTICE OF ACCEPTANCE (NOA) www.miamidade.eov/economy Crown Building Products of Florida,LLC. 6018 HWY.72 Arcadia,FL 34266 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, 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: Sanibel Concrete Roof Tile LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami-Dade County Product Control Approved",unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales,advertising or any other purposes shall automatically terminate this NOA.Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami-Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed,then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA consists of pages 1 through 6. The submitted documentation was reviewed by Juan E.Collao,R.A. NOA No.: 14-0102.04 C txrrY Expiration Date: 02/13/19 Approval Date: 02/13/14 Page 1 of 6 ROOFING ASSEMBLY APPROVAL Category: Roofing Sub-Category: Roofing Tiles Material: Concrete Deck Type: Wood 1. SCOPE This approves a system using Sanibel Concrete Roof Tile, as manufactured by Crown Building Products of Florida, LLC., and described in Section 2 of this Notice of Acceptance. For locations where the pressure requirements, as determined by applicable Building Code does not exceed the design pressure values obtained by calculations in compliance with RAS 127 using the values listed in section 4 herein. The attachment calculations shall be done as a moment based system. 2. PRODUCT DESCRIPTION Manufactured by Test Product Applicant Dimensions Specifications Description Sanibel Concrete Roof L= 17" TAS 112 High profile,interlocking,one-piece,'S'shaped Tile W= 13.25" concrete roof tile equipped with two nail holes. For H=3.1" direct deck or battened nail-on,mortar set or Thickness:0.56" adhesive set applications. Trim Pieces L=varies TAS 112 Accessory trim,concrete roof pieces for use at hips, W=varies rakes,ridges and valley terminations. varying thickness Manufactured for each tile profile. 2.1. MANUFACTURING LOCATION 2.1.1.Arcadia,FL 2.2. EVIDENCE SUBMITTED Test Agency Test Identifier Test Name/Report Date PRI Construction Materials ACTI-002-02-01 TAS-112 Sept.2006 PRI Construction Materials ACTI-002-02-04 TAS-100 Sept.2006 Redland Technologies 7161-03 Static Uplift Testing Dec. 1991 Appendix III TAS 102&TAS 102(A) Redland Technologies 7161-03 Wind Tunnel Testing Dec. 1991 Appendix II TAS 108(Nail-On) Redland Technologies P0402 Withdrawal Resistance Testing of Sept. 1993 screw vs. smooth shank nails Redland Technologies Letter Dated Aug. 1, 1994 Wind Tunnel Testing Aug. 1994 TAS 108(Nail-On) Redland Technologies P0631-01 Wind Tunnel Testing July 1994 TAS 108(Mortar Set) Nutting Engineering 13343.1 Physical Properties June 2006 TAS 112 NOA No.: 14-0102.04 ��Cot7Y Expiration Date: 02/13/19 APPROVED Approval Date: 02/13/14 Page 2 of 6 Test Agency Test Identifier Test Name/Report Date The Center for Applied 25-7688-3 Static Uplift Testing June 1996 Engineering,Inc. 25-7688-10 TAS 101 (Adhesive Set) July 1996 TAS 101 (Mortar Set) The Center for Applied 25-7688-5 Static Uplift Testing June 1996 Engineering,Inc. TAS 102 (3"Headlap,Nails,Direct Deck,New Construction)❑ The Center for Applied 25-7688-4 Static Uplift Testing June 1996 Engineering,Inc. TAS 102 (4" Headlap,Nails,Clips) Celotex Corporation 520111-3 Static Uplift Testing Dec. 1998 Testing Services 520191-2-1 TAS 101 March 1999 Trynity/ERD Calculations Aerodynamic Multiplier&Restoring Sept.2006 Moment Due to Gravity American Test Lab of South RT1028.01-13 TAS 112 11/13/13 Florida American Test Lab of South RT1206.01-13 Aerodynamic Multiplier&Restoring 02/05/14 Florida Moment Due to Gravity 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 Miami-Dade Product Control office for review. 3.4 Minimum underlayment shall be in compliance with the applicable Roofing Applications Standards listed section 4.1 herein. 3.5 30/90 hot mopped underlayment applications may be installed perpendicular to the roof slope unless stated otherwise by the underlayment material manufacturers published literature. 3.6 This acceptance is for wood deck applications. Minimum deck requirements shall be in compliance with applicable building code. 3.7 All products listed herein shall have a quality assurance audit in accordance with the Florida Building Code and Rule 61 G20-3 of the Florida Administrative Code. 4. INSTALLATION 4.1 Crown Building Products of Florida, LLC.'s Sanibel Concrete Roof Tile and its components shall be installed in strict compliance with Roofing Application Standard RAS 118,RAS 119,and RAS 120. 4.2 Data For Attachment Calculations NOA No.: 14-0102.04 COUKrir Expiration Date: 02/13/19 Approval Date: 02/13/14 Page 3 of 6 Table 1: Average Weight(W)and Dimensions (I x w) Tile Profile Weight-W(Ibf) Length-I (ft) Width-w(ft) Sanibel Concrete Roof Tile 11.33 1.417 1.104 Table 2: Aerodynamic Multipliers- fl Tile %(ft ) x(fe) Profile Batten Application Direct Deck Application Sanibel Concrete Roof Tile 0.289 0.313 Table 3: Restoring Moments due to Gravity-M ft4b Tile 2":12 3":12" 4":12" 6":12" 6":12" 7':12"or Profile greater Sanibel Battens Direct Battens Direct Battens Direct Battens Direct Battens Direct Battens Direct Concrete Roof Deck Deck Deck Deck Deck Deck Tile 9.05 9.05 8.95 1 8.96 8.79 8.81 8.60 8.62 8.38 8.40 8.13 8.16 Table 4: Attachment Resistance Expressed as a Moment-Mf(ft-lbf) for Nail-0n S stems Tile Fastener Type Direct Deck Direct Deck Battens Profile (min 16/32" (min. 19/32" plywood) plywood) Sanibel Concrete 2-10d Ring Shank Nails 28.6 41.2 19.4 Roof Tile 1-10d Smooth or Screw Shank Nail 5.1 6.8 2.8 2-10d Smooth or Screw Shank Nails 6.9 9.2 7.3 1 48 Screw 20.7 20.7 18.1 2 48 Screws 43.2 43.2 29.8 1-10d Smooth or Screw Shank Nail 23.1 23.1 19.0 Field Clip) 1-10d Smooth or Screw Shank Nail 29.3 29.3 24.0 Eave Clip) 2-10d Smooth or Screw Shank Nails 27.6 27.6 38.6 Field Clip) 2-10d Smooth or Screw Shank Nails 38.1 38.1 41.8 Eave Clip) Table 6: Attachment Resistance Expressed as a Moment Mf(ft-lbf) for Two Patty Adhesive Set Systems Tile Tile Application Minimum Attachment Profile Resistance Sanibel Concrete Roof Tile Adhesive 29.3 1 See manufacturer component approval for installation requirements. 2 The Dow Chemical Company TileBond Roof Tile Adhesive,average weight per patty 10.7 grams. 3MTm 2-Component Foam Roof Tile Adhesive AH-160 average weight per patty 8 grams. NOA No.: 14-0102.04 �, Expiration Date: 02/13/19 Approval Date: 02/13/14 Page 4 of 6 M Table 6: Attachment Resistance Expressed as a Moment-Mf(ft-lbf) for Single Patty Adhesive Set Systems Tile Tile Application Minimum Attachment Profile Resistance Sanibel Concrete Roof Tile 3M 1 m 2-Component Foam Roof Tile Adhesive AH-160 3M 2-Component Foam Roof Tile Adhesive AH-160 3 Large paddy placement of 63 grams of 3MTM 2-Component Foam Roof Tile Adhesive AH-160 4 Medium paddy placement of 24 grams of 3MTm 2-Component Foam Roof Tile Adhesive AH-160 Table 7: Attachment Resistance Expressed as a Moment-Mf(ft-lbf) for Mortar Set Systems Tile Tile Attachment Profile Application Resistance Sanibel Concrete Roof Tile Mortar Set 24.5 5 Tile-Tite Roof Tile Mortar. 5. LABELING All tiles shall bear the imprint or identifiable marking of the manufacturer's name or logo as seen below or following statement: "Miami-Dade County Product Control Approved". ZA /C r LABEL FOR SANIBEL CONCRETE ROOF TILE (LOCATED UNDERNEATH OF 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 Building Official or Applicable building code in order to properly evaluate the installation of this system. NOA No.: 14-0102.04 CouN7Y Expiration Date: 02/13/19 • � p. Approval Date: 02/13/14 Page 5 of 6 PROFILE DRAWING FASTENER HOLES 0 0 UNDERLOCK� OVERLOCK 17" 13114" SANIBEL CONCRETE ROOF TILE END OF THIS ACCEPTANCE NOA No.: 14-0102.04 Expiration Date: 02/13/19 Approval Date: 02/13/14 Page 6 of 6 Miami Shores Village Building Department SPP 24 2U15 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 ,�'3y__ INSPECTION LINE PHONE NUMBER:(305)762-4949 5 FBC 2019 BUILDING Master Permit No. R F- 15=24 i PERMIT APPLICATION Sub Permit No. [—]BUILDING ❑ ELECTRIC YROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Z ST- City: tCity: Miami Shores County: Miami Dade Zip: 33 f�© Folio/Parcel#: t 1 l O L b S. 3( (2 IS O Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: GQ5 Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): ��4_>Ro � r>re Phone#: 6> Lf ' 12 $ 3 Address: Lz 9 1 City: )(A aVyStater ' Zip: Tenant/Lessee Name: Phone#: Email: ,+ CONTRACTOR:Company Name: a�/2C�/� Phone#: LYl Address: ��' 3 City: yl'f,��fi State: t Zip: Qualifier Name: /fl��fG//�c� Phone#: State Certification or Registration#: � -���' � � Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$�t' Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: Cz-c"—Y 02Q i V_0 0 Specify color of color thru tile: Submittal Fee$ 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$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 AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this ISA day of Se plge,-6 e( 20 lS by �� day of _� � 20 JC by {'gyp f�t01 Y"r who is personally known to -Qk? –� :2ta;;K:: ,who is personally known to me or who has produced as me or who has produced L �Q l Ee UCE , s identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: llQ /��� L– (_ /T Print: Nota 4W NO Notary puuiic State of Florida Seal: tp ry Public State of Fbrida Seal: ;r Sindia Alvarez Geraldine L Cohen MY Commission EE 174190c My Commission FF 156750 orw� Expires02/2a/2016 "#0FExpires 09/0312018 ***************************** * ** * ******************************************************************* APPROVED BY S Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) .... =..v" Miami shores Village Building Department 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. OPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D._�COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor 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 form and Contractor 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. /�� 2 BUSINESS NAME: �� .� C BUSINESS ADDRESS: t 'S CYC 2 CITY < STATE ZIPl- BUSINESS PHONE: �� S%G`J FAX NUMBER(� CELL PHONE( ) QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 BURKE, RAY ANTHONY BURCORP LLC 18800 NW 2ND AVE STE 218 MIAMI FL 33169 Congratulations! With this license you become one of the near) 9 Y -- Y one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range y' STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. p PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to CCC1328436 ISSUED: 08/31/2014 serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information CERTIFIED ROOFING CONTRACTOR about our divisions and the regulations that impact you, subscribe BURKE, RAY ANTHONY to department newsletters and learn more about the Department's BURCORP LLC initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! Expiration date : AUG 31,2016 L1408310003541 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CCC1328436 = The ROOFING CONTRACTOR Named below IS CERTIFIED WS Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 a BURKE, RAY ANTHONY a BURCORP LLC NI 18800 NW 2ND AVE STE 218 MIAMI FL 33169 ISSUED: 08/31/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408310003541 f Local Business Tax Receipt Miami-Dada County, State of Florida -THIS IS NOT A BILL-DO NOT PAY 7165183 LBT BUSINESS NAME/LOCATION RECEIPT NO. SURCORP LLC EXPIRES 18800 RENEWAL SEPTEMBER 30 2015 NW 2 AVE 218 7"35n ° MIAMI GARDENS, FL 33169 Must be diWayed at place of business Pursuant to County Code Chapter SA-Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED BURCORP LLC 196 SPECIALTY BUILDING BY TAX COLLECTOR C/O BURKE RAY CONTRACTOR 156.25 0210612015 Worker(s) 1 CCC1328436 0225-15-002981 This local Business Tax Receipt ealy ausfuws paymeat of the Local Rashness Tax.The Receipt is am a license, psera,il,or a ceafifieeaioe of are holder's Walificatieea fie do bushmm Udder=M comply with a"g Of'11=90MR111111110111111 regulatory laws sad regairseaeats which apply m ale bassaess. The RECEIPT NO.ab"e asst he deployed sra all commercial Vehicles-Wieai-Oade Code See Ba-276. For more ildoaratisn,vz*Mfl wjsiam aorRaz�I � Local Business Tax F'cei pt Miami-Dade County, State of Florida -THIS IS NOT A BILL-DO NOT PAY 5439542 ,EUBT 8USIN ESS NAM EILOCA 7ION RECEIPT NO. EXPIRES S ��p Ce SURCORP LLC RENEWAL X R E 18800 NW 2 AVE 218 5679213 SEPTEMBER 30, 2015 MIAMI GARDENS, FL 33169 Must be,displayed at place of business Pursuant to County Code Chapter.8A-Art.9 8 10 �n SEC. TYPE OF BUSINESS B:iFlCORP LLC 196 GENERAL BUILDINGPAYE[ENT RECEIVED NY TAX COLLECTOR CONTRACTOR 156.25 02/06/2015 'Worker(s) 1 CGCO50931 0226.15-002981 Tits Local Business Tax RXO pt orty Con^mB PaynW of the Local Business Tax.The ftceipt is not a license, P urrit or a c"-cabs n dthe udders qudi^salioM io do businasa}b6dw trust coVy with aWgoeerm ental oFn0rKPvenW8rU regU12 rl'Iawsandrequirerratswhirhapgytotfieiwsimm. The FEMPTNO abouetnst beciisosyed small comnwcW vetecles-Mien-Dade tedeSac B3-27& t1tAMt[1f{pE Far rrn �� re iMorrrBtisxt,visit " an CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) —� .. 09/24/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATEfDOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Annette Willis Insurance PHON o Ext). (305)625-2403 FAX No): (305)625-6472 18401 N.W.27 AveADDRESS: larry.Willis@annettewillisinsurance.com Miami, FL 33056 INSURER(S)AFFORDING COVERAGE NAIC# Phone (305)625-2403 Fax (305)625-6472 INSURER A: _Essex Insurance Company INSURED INSURER B: Burcorp, IIC INSURER C: Po box 540031 INSURER D: _ INSURER E: _ Opa locka FL 33054 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. INSR TYPE OF INSURANCE ADD UBR POLICY EFF POLICY EXP LIMITS LTR IN POLICY NUMBER MMIDD/YYYY MM/DD/YYYY GENERAL LIABILITYEACH OCCURRENCE $ 1,000,000.00 - DAMAGE TO RENTED 100,000.00 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ ❑ ❑ CLAIMS-MADE 0 OCCUR 151952 09/24/2015 09/24/2016 MED EXP(Any one person) $ 5,000.00 F\ ❑ PERSONAL&ADV INJURY $ 1,000,000.000 _ ❑ GENERAL AGGREGATE $ 2,000,000.00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 1,000,000.00 ❑� POLICY ❑ JECT PRO ❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ ALL OWNED SCHEDULED BODILY INJURY(Per accident $ AUTOS ❑ AUTOS NON-OWNED PROPERTY DAMAGE $ ❑ HIRED AUTOS ❑ AUTOS (Per accident) IAB UMBRELLA L ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ i __ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION STPER ATUTE ANY ❑ ERH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIV� E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ yes,describe under D -- I DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS(LOCATIONS/VEHICLES (Attach ACORD 701,Additional Remarks Schedule,if more space is required) GENERAL CONTRACTING/ROOFING LICENSE#CCC1328436/CGC050931 IL — -- — CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BLDG DEPT THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. j 10050 NE 2ND AVE MIAMI SHOREDS, FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01)OF The ACORD name and logo are registered marks of ACORD r PLEASE CUTOUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE IMPORTANT [STATE OF FLORIDA Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation DEPARTMENT OF FINANCIAL SERVICES who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or DIVISION OF WORKERS'COMPENSATION F compensation under this chapter. CONSTRUCTION INDUSTRY EXEMPTION O CERTIFICATE OF ELECTarI TO BE ExrarT FROM FLMMA L Pursuant to Chapter 440.05(12),F.S.,Certificates of election to woRKEW CONPEMATM LAW D be exempt...appy only within the scope of the business or trade EFFECTIVE DATE: 3113x2015 EXPIRATION MATE: 3112/2017 listed on the notice of election to be exempt. PERSON: BURL RAY I'I Pursuant to Chapter 440.05(13),F.S.,Notices of election to be FM: 421656489 E exempt and Certificates of election to be exempt shall be subject BUSINESS NAIVE AND ADDRESS: R to revocation if,at any time after the filing of the notice or the BURCORP LLC E 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 8445 NE 2 AVE at any time for failure of the person named on the certificate to MIAMI FL 33135 meet the requirements of this section. SCOPES OF BUSINESS OR TRA LICENSED GENERAL ROOFING-ALL KINDS CONTRACTOR AND DRIVER DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 Florida Certified General&Roofing Contractors CGC050931 CCC1328436 Certified HAAG Roofing Inspection September 24,2015 Re: 254 NW 92 ST MIAMI SHORES, FL. STATE OF FLORIDA COUNTY OF MIAMI DADE Before me this day personally appeared Ray Burke who, being duly sworn,deposes and says: That he will be the only person working on the project located at 254 nw 92 Street. Sworn to(or affirmed)and subscribed before me this 24"'Day of September 2015 Personally Know Or Produced Identification Type of Identification Produced Print,Type or Stamp Name of Notary n you, Ra te ed: LAC Qhi M C&rA*Aion FF 220924 a Evim 05/1912019 P.O. BOX 540031 OPA-LOCKA, FL. 33054 ;TEL:786-663-5900 *EMAIL:BURCORP77@GMAIL.COM Miami shores Village Building Department l.OR10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers'compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption 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: ,p, er State of Florida County of Miami-Dade The foregoing was acknowledge before me this �• � day of ,20 �. By D R 61q Vi/)U— who is personally known to me or has produced as identification. Notary: SEAL: NotM Public Stall of Florida Geraldine L Cohen 1(4z;4 Myc L.EE 174120 a..•' teKpirat 0288/2018