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RF-15-1576 Miami Shores Village ``u \ a \ 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 \` Phone: (305)795-2204 ;:. . .. Expiration: 01/31/2016 Project Address Parcel Number Applicant 1284 NE 92 Street 1132050270520 Miami Shores, FL 33138- Block: Lot: JOSEPH POTTIER Owner Information Address Phone Cell JOSEPH POITIER 1284 NE 92 Street MIAMI SHORES FL 33138-2937 Contractor(s) Phone Cell Phone Valuation: $ 14,000.00 IBS CONSTRUCTION GROUP LLC (305)527-8303 Total Sq Feet: 4000 Type of Work:Re Roof Available Inspections: Additional Info:RE-ROOF TILE COLOR THRU WHITE TILE Inspection Type: Classification:Residential Up Lift Report Scanning:4 Tin Cap Final Roof Tile In Progress Renailing Affidavit Review Roof Review Roof Review Roof Cap Sheet Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Contractors Bond $500.00 CCF invoice# RF-6-15-56107 $8.40 08/04/2015 Cash $819.16 $50.00 DBPR Fee $4,88 DCA Fee $4.88 06/25/2015 Check#: 180 $50.00 $0.00 Education Surcharge $2.80 Bond#:2803 Permit Fee-New Roof $325.00 Scanning Fee $12.00 Technology Fee $11.20 Total: $869.16 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING, MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constru oning. Futhermor rize the above-named contractor to do the work stated. c��_ August 04, 2015 Authorized Signature:Owner Applicant / Contractor / Agent Date Building Department Copy August 04,20115 1 �SNUSES� ✓ (� Miami shores Village poll ,...�M Building Department 10050 N.E.2nd Avenue �'R O,e Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RE: Peri 1� / m t# F (o S ~R I 7� DATE: 9'-30-15 INSPECTION AFFIDAVIT I PA-rg ILr' tz I fly50r` licensed as a (n) Contractor/Engineer/Architect, (Print name and circle License Type) FS 468 Building Inspector License#: CCC 13 Z 7Z 8 I On or about �, trs�- �j. ;zols" � � , I did personally inspect the roof deck nailing (Date&time) work at l Z 1V�' 4 Z 'd S . (Complete Job Site Address) Based upon that examination I have determined the installation was done according to the Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S) Signature ---- TTS —� •=oti�aYP�84.( • ERIC T PI TTS T F *> MY COMMISSION#EEi69667 4P alk' t,�Y C- N,A1SSION * 37 =` 14,2016 b EXptRES FebruaN State of Florida e h fS `:' FXIFERES Februa;,. 6 "'F•°`F�d? ptoridallotarllSeNice.com ` )398-0153 County of Dade: ioo ��oa�� ,. 4n tao� ;JE-i,41 63 The undersigned, being the first duly sworn, deposes and says that he/she is the contractor for the above property mentioned. Sworn to and subscribed before me this 31>44 day of clew, Zo1b'� Notary Public, Sate of Florida at Large_ . L "General,Building,Residential,or Roofing Contractors or any individual certified under 468 F.S.to make such an inspection.Include photographs of each plane of the roof with permit#and address#clearly shown marked on the deck for each inspection Miami Shores Village7AAUG T,�,�, Building Department 42915 10050 N.E.2nd Avenue, Miami Shores, Florida 33138Tel:(305)795-2204 Fax: (305)756-8972 ,. INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC20 t ® BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. NBUILDING ❑ ELECTRIC ® ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL F]PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS:_ i Z S 4 N 9?_"d s City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: (1- 37_L>6"-0-Z_-7- oz5Z > Is the Building Historically Designated:Yes NO _ Occupancy Type: Load: Construction Type: Flood ZorJe:` BFE: FFE: OWNER: Name(Fee Simple Titleholder): J_b e-p iA Phone#: 306 5_8 IS2/ Address: 12-94 w C 9vlc� 54— City: L A-^A j 6 irc r e_,,S State: FrL Zip: Tenant/Lessee Name: NIA Phone#: Email: CONTRACTOR:Company Name: _6.S CajI5TRc;C.-r10N GR&oP Phone#: 3'-NO-4-527 830 Address: 11675 Ni 4"A0 City: 13 N►fi State: FL Zip: S31(#2 Qualifier Name: PA7WiC9 &iA;Sca y Phone#: gAcM€ State Certification or Registration#: � /3, 1 `758 Certificate of Competency#: DESIGNER:Architect/Engineer: N Phone#: Address: City: State: Zip: O-L Value of Work for this Permit:$ Square/Linear Footage of Work: 3 Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace ❑ Demolition Description of Work: 9e,roof T;Ic 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$ t I (Revised02/24/2014) I F 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 TWICEIMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND FOR 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature 1 Signature OWNER or AGENT CONTRACTOR Theo going instrument was acknowledged before me this The foregoing instrume t was acknowledged before me is da pfnZ 20 by ay f 20 by 05c o is personally known to who is ersonally know to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: (I�1k)k Sign: Sign: — ( / - I; Print: J-iPrint: Seal: M1PCCmPvi8'�11 ' 187049 Seal: N'd1PW -,4 EP-187'049 EXPIRES p t x E7CPIFis Aa; I110 t 6 y 388d1�i3 fiat 3aNGary6arvic�.crrF"s,� k,��7��9F1-0�53 F#crfdaNc�vySerr�;r�.crxn I. APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATS OFFLT' P'/ 'I ES ANUUSDEPARTMENROF ' t .; @p ?rE$W �ijp 3, .:.t,., �.i: � �, .. ;.. ,-,G-- ,,C---- 0'm A C ,27,581 � '§W PAW � Y � �TR ' ;sem `. c\a•� �� � �� � t� � ,_ !� �, - .. %�• � �S :err; � � �; $. ; 'Y;�,if� . I � Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOT ABILL-DO NOT PAY LBT 5947511 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES IBS CONSTRUCTION GROUP RENEWAL SEPTEMBER 30, 2015 LLC 6204390 Must be displayed at place of business 18781 NW 79 CT Pursuant to County Code MIAMI, FL 33015 Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED IBS CONSTRUCTION GROUP LLC 196 SPECIALTY BUILDING BY TAX COLLECTOR CONTRACTOR 93.75 01/27/2015 Worker(s) 8 CCC1327581 CHECK21-15-056140 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holder's qualifications,to do business.Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec ga-276. MIAPIA:1 For more information,visit www.miamidade.gov/taxcollector CERTIFICATE OF LIABILITY INSURANCE I U7/3U/2015 PRODUCER FAX (352)376-8393 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Scarborough Company Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 2811 NW 41st Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 147050 Gainesville, FL 32614-7050 INSURERS AFFORDING COVERAGE NAIC# INSURED IBS Construction Group, LLC INSURER A: ADMIRAL 16375 NE 18th Avenue INSURER B: PROGRESSIVE INSURANCE Suite 201 INSURER C: AIG INSURANCE COMPANY N. Miami Beach, FL 33162 INSURER D: INSURER E: COVERAGES 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 ARID CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY CA542871 06/01/2015 06/01/2016 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADEI OCCUR MED EXP(Arty one person) $ A PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY X PECOT n LOC AUTOMOBILE LIABILITY 065589337-0 06/01/2015 06/01/2016 $ COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) 1,000,000 ALL OWNED AUTOS BODILY INJURY B SCHEDULED AUTOS (Per person) $ XHIRED AUTOS BODILY INJURY X $ NON-OWNED AUTOS (Per acciderd) F1 PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION ANDWC6983646 06/01/2015 06/01/2016 `ll C STATU- OTW EMPLOYERS'LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS STATE GENERAL CONTRACTOR/BUILDING CGC 1509139 STATE ROOFING CONTRACTOR CCC 1327581 CERTIFICATE A CEL MIAMI SHORES VILLAGE BLDG DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 10050 NE 2ND AVENUE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL MIAMI SHORES, E UE 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE1Y IA- lean Munford/]HM ACORD 25(2001108) ©ACORD CORPORATION 1988 a Florida Building Code Edition 2010 i %,R--",t High Velocity Hurricane Zone Uniform Permit Application Formi ,1:10111 1 - • • . - . 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C CCS■ CC "R EC ' C■ #� '� r :n'IC ■I� " i C C C"CC CC CCC' : " I " C C C �■��rrRR C" ■.C� "C,�C..CB��r� f■ " �r �C CCCM, nilaCG"aCCC Florida Building Code Edition 2010 High Velocity Hurricane Zone Uniform Permit Application Form Section D (Steep Slowed Roof Systeml CL Roof System Manufacturer: } t Notice of Acceptance Number: Minimum Design Wind Pressures, if Applicable (From RAS 127 or Calculations): Maximum Design Pressure r� From the NOA Specific System):— Method stem :Method of the attachment: 14o D Mcd j u, Steep Sloped Roof System Description Deck Type: ype Underlayment• Roof Slope: : 12 nsuiation: � Nar �G.. Fire Ber: ` Ridge Ventilation? astener Type&Spacing: y rS ha., Is �- �' dhesive Type _l ype Cap Sheet: bl i oof covelfh � Mean Roof Height: J Type&Size Drip dge: 3 a 123_01-48 1/13 PAGE PIIAMI-DADEM MIAMI-DADE COUNTY 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.miamidade.eov/sera 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 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: Villa 900 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 revises NOA# 11-0713.02 and consists of pages 1 through 7. The submitted documentation was reviewed by Alex Tigera. MIAMI•DADe COUNTY y�i`` NOA No.: 12-0308.20 Expiration Date:09/21/16 Approval Date:06/21/12 Page 1 of 7 ROOFING ASSEMBLY APPROVAL Category: Roofing Sub Category: Roofing Tiles Material: Concrete 1. SCOPE This renews a system using Villa 900 Concrete Roof Tile, as manufactured Boral Roofing, LLC in Lake Wales, FL. 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 Monier Lifetile LLC Villa 1= 17" TAS 112 Low profile, interlocking,high pressure extruded 900 w= 13" concrete roof tile equipped with one nail hole and ''/2"thick double roll ribs. For direct deck or battened nail- on,mortar or adhesive set applications. Trim Pieces 1=varies TAS 112 Accessory trim,concrete roof pieces for use at w=varies hips,rakes,ridges and valley terminations. varying thickness 2.1 MANUFACTURING LOCATION 2.1.1. Lake Wales, FL. 2.2 EVIDENCE SUBMITTED Test Agency Test Identifier Test Name/Report Date Nutting Engineers 13343.1 TAS 112 Apr. 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 1I TAS 108(Nail-On) Redland Technologies P0402 Withdrawal Resistance Testing of screw Sept. 1993 vs.smooth shank nails The Center for Applied 94-060B Static Uplift Testing March, 1994 Engineering, Inc. TAS 101 (Adhesive Set) The Center for Applied 94-084 Static Uplift Testing May 1994 Engineering, Inc. TAS 101 (Mortar Set) Redland Technologies P0631-01 Wind Tunnel Testing July 1994 TAS 108 (Mortar Set) NOA No.: 12-0308.20 MIAMI•DADE COUNTY Expiration Date:09/21/16 1 Approval Date:06/21/12 Page 2 of 7 t 2.2 EVIDENCE SUBMITTED Test Agency Test Identifier Test Name/Report Date Redland Technologies Letter Dated Aug. 1, 1994 Wind Tunnel Testing Aug. 1994 TAS 108(Nail-On) The Center for Applied Project No.307025 Wind Driven Rain Oct. 1994 Engineering,Inc. Test#MDC-76 TAS 100 The Center for Applied 25-7183-1 Static Uplift Testing Feb. 1995 Engineering,Inc. TAS 102 (2 Quik-Drive Screws,Direct Deck) The Center for Applied 25-7183-2 Static Uplift Testing Feb. 1995 Engineering, Inc. TAS 102 (2 Quik-Drive Screws,Battens) The Center for Applied 25-7214-2 Static Uplift Testing March, 1995 Engineering, Inc. 25-7214-6 TAS 102 (1 Quik-Drive Screw,Direct Deck) (1 Quik-Drive Screw,Battens) Celotex Corporation 528454-2-1 Static Uplift Testing Sep. 1998 Testing Services 520109-2 TAS 101 Dec. 1998 Walker Engineering,Inc. Evaluation Calculations 25-7183 March 1995 Walker Engineering,Inc. Evaluation Calculations 25-7094 February 1996 Walker Engineering,Inc. Evaluation Calculations 25-7496 April 1996 Walker Engineering,Inc. Evaluation Calculations 25-7584 December 1996 25-7804b-8 25-7804-4&5 25-7848-6 Walker Engineering,Inc. Evaluation Calculations Aerodynamic Multipliers May 2006 Walker Engineering,Inc. Evaluation Calculations Two Patty Adhesive Set System April 1999 Walker Engineering,Inc. Evaluation Calculations Restoring Moment Due to Gravity April 2006 MIAMI-DADE COUNTY NOA No.: 12-0308.20 � � Expiration Date:09/21/16 �FujmApproval Date:06/21/12 Page 3 of 7 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 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. 4. INSTALLATION 4.1 Villa 900 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 Table 1: Average Weight(W) and Dimensions (1 x w) Tile Profile Weight-W(lbf) Length-1 (ft) Width-w(ft) Villa 900 Concrete Tile 10.94 1.425 1.08 Table 2: Aerodynamic Multipliers -X(ft) Tile '%(ft ) '%(ft) Profile Batten Application Direct Deck Application Villa 900 Concrete Tile 0.289 0.289 Table 3: Restoring Moments due to Gravity-M9(ft-lbf) Tile 3":12" 4":12" 5":12" 6":12" 7':12" or greater Profile Villa 900 Battens Direct Battens Direct Battens Direct Battens Direct Battens Direct Concrete Tile Deck Deck Deck Deck Deck 6.79 7.70 6.73 7.62 6.63 7.51 6.50 7.37 6.36 7.21 MIAM4DADE couNTY NOA No.: 12-0308.20 - ,,,� Expiration Date:09/21/16 Approval Date:06/21/12 Page 4 of 7 Table 4: Attachment Resistance Expressed as a Moment-Mf(ft-Ibf) for Nail-On Systems Tile Fastener Type Direct Deck Direct Deck Battens Profile (min 15/32" plywood) (min. 19/32" plywood) Villa 900 2-10d ffing Shank Nails 27.8 37.4 28.8 Concrete Tile 1-10d Smooth or Screw 8.8 11.8 4.1 Shank Nail 2-10d Smooth or Screw 16.4 21.9 7.1 Shank Nails 1 #8 Screw 25.8 25.8 22.9 2 #8 Screw 47.1 47.1 49.1 1-10d Smooth or Screw 24.3 24.3 24.2 Shank Nail Field Clip) 1-10d Smooth or Screw 19.0 19.0 22.1 Shank Nail Eave Clip) 2-10d Smooth or Screw 35.5 35.5 34.8 Shank Nails Field Clip) 2-10d Smooth or Screw 31.9 31.9 32.2 Shank Nails Eave Clip) Table 5: Attachment Resistance Expressed as a Moment Mf(ft-Ibf) for Two Patty Adhesive Set Systems Tile Tile Application Minimum Attachment Profile Resistance Villa 900 Concrete Tile Adhesive 26.1 1 See manufactures component approval for installation requirements. 2 Flexible Products Company TileBond Average weight per patty 11.4 grams. 3M TM 2-Component Foam Roof Tile Adhesive AH-160.Average weight per patty 8 grams. Table 6: Attachment Resistance Expressed as a Moment-Mf(ft-Ibf) for Single Patty Adhesive Set Systems Tile Tile Application Minimum Attachment Profile Resistance Villa 900 Concrete Tile 31VI2-Component Foam Roof Tile Adhesive AH-160 86.6111 3M 2-Component Foam Roof Tile Adhesive AH-160 45.5 3 Large paddy placement of 54 rams of Pol Pro T"^ 4 Medium paddy placement of 24 rams of Pol Pro TM. Table 8: Attachment Resistance Expressed as a Moment-Mf(ft-Ibf) for Mortar Set Systems Tile Tile Attachment Profile Application Resistance Villa 900 Concrete Tile Mortar Set 20.60 5 Seespecific mortar manufacturer's Notice of Acceptance NOA No.: 12-0308.20 MIAMI-RADE COUNTY Expiration Date:09/21/16 Approval Date:06/21/12 Page 5 of 7 5. LABELING 5.1 All tiles shall bear the imprint or identifiable marking of the manufacturer's name or logo as detailed below,or following statement: "Miami-Dade County Product Control Approved". LABEL FOR VILLA 900 CONCRETE TILE (LOCATED ON THE UNDERSIDE 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.: 12-0308.20 MIAMI-RADE COUNTY Expiration Date:09/21/16 Approval Date:06/21/12 Page 6 of 7 f PROFILE DRAWING NaH hales 7 of V11 B Overlook 21/811 11" Underlol S �' t 13" VILLA 900 CONCRETE ROOF TILE END OF THIS ACCEPTANCE NOA No.: 12-0308.20 MIAMI-DADE COUNTY Expiration Date:09/21/16 PUZ o m Approval Date:06/21/12 Page 7 of 7 r CITY AUG 042015 Y. I MIAMI. �.. I-DAD OI PRODUCT ` NTRO ECTION 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.miamidade.eov/oera 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 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:Polyglass Polystick Underlayments 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 revises NOA# 11-0601.10 44d gQgsijtspf ppge!j 1 Aropgh 8 The submitted documentation v:as revi4vedOy N1x:7i je4. . .. . . . . ... . . . . . . . . . . . • • ••• • • • • • NOA No.: 11-1229.01 .. . . . . . . . . . . • •• • • • • • • • Expiration Date: 09/13/16 MIAWDADE COUNTY •• • • • • Approval Date: 04/05/12 Page 1 of 8 ... . . . . ... . . . . . . . . . . . . . .. .. . . . .. .. ... . . . ... . . Y ROOFING COMPONENT APPROVAL Category Roofing Sub-Category: 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 &#2 60 mils thick underlayment in sloped roof assemblies. Designed as an ice&rain shield and as a flat roof tile underlayment. Polystick TU Roll: TAS 103 and A heavy granuled surface self adhering,APP underlayment 32'10"x 3'33/8" ASTM D 1970 polymer modified,fiberglass or polyester Manufacturing Location 100 mils thick reinforced,bituminous sheet material for use as #1&#2 an underlayment in sloped roof assemblies. Designed as a a roof tile underlayment. Polystick TU Plus Roll: TAS 103 and A rubberized asphalt self-adhering,glass- underlayment 65'x 3'3 3/8" ASTM D 1970 fiber/polyester reinforced waterproofing (Surface Printing) 80 mils thick membrane.Designed as a metal roofing and roof Manufacturing Location tile underlayment. #2 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- ManufacturingLocation 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 3'33/8" ASTM D 1910.• fii&rZpc4�ester reinforced waterproofing f g 60 mils thick • • #2 ••• m®•ml�rane. Designed as a metal roofing and •• • roef tile•m9derioyment. 000 .•: : : NOA No.: 11-1229.01 . . . . . . . . . . .. Miar+wrwe Counrnr ••• ••• ••• Expiration Date: 09/13/16 APPROVED Approval Date: 04/05/12 Page 2 of 8 . . ... . . . . ... . . . . . . . . . . .. .. . . . .. .. . . . ... . . . ... MANUFACTURING PLANTS: 1. Hazelton,PA 2. Winter 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 ERp 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 09/01/11 P37300.10.11 TAS 110/ASTM D4798&D1970 10/19/11 PRI Asphalt Technologies PRI01111 ASTM D 4977 04/08/02 PUSA-005-02-01 ASTM D 4977 01/31/02 PUSA-018-02-01 ASTM D 2523 07/14/03 PUSA-035-02-01 TAS 103 09/29/06 PUSA-033-02-01 ASTM D 1970 01/12/06 PUSA-055-02-02 TAS 103 12/10/07 PUSA-083-02-01 TAS 103 06/30/08 PUSA-089-02-01 TAS 103/ASTM D4798&G155 07/06/09 Momentum Technologies,Inc. JX20H7A TAS 103/ASTM D4798&G155 04/01/08 RX14E8A TAS 103/ASTM D4798&G155 11/09/09 DX2313813 TAS 103/ASTM D4798&G155 02/18/10 DX23138A TAS 103/ASTM D4798&G155 02/18/10 .. ... . . . . . .. .. • %: .. ... .. . . . .. . . . . . . . . . . •• ;•; ; ; • ; NOA No.: 11-1229.01 • •*• *09 •0• Expiration Date: 09/13/16 MTTO-- 661NTY Approval Date: 04/05/12 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"grid,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 3-1/2"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. 8. All protrusions or drains shall be initially taped with a 6"piece of underlayment. The flashing tape shall be pressed in place and formed around the protrusion to ensure a tight fit. A second layer of Polystick shall be applied over the underlayment. .. . . . . . ... .. . ... . . . . .. . ••. . . . . . . . . . . • • • • • ••• • • NOA No.: 11-1229.01 ••• 009 ••• •: :•Expiration Date: 09/13/16 MIAMFDADE COUNTY Approval Date: 04/05/12 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.IR Xe,TU,and TU P may be used in all the previous assemblies listed except metal roofing. 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. Expos re Limitations(days) MTS IR-Xe TU TU Plus TU P Tile Pro Dual Pro Winter Haven,FL. 180 180 180 180 180 180 180 Hazelton,PA. N/A 30 30 180 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,and Tile Pro may be used in both adhesive set and mechanically fastened roof tile applications.Polystick IR-Xe,and Dual Pro are limited to mechanically fastened roof tile applications.Polystick MTS is limited to mechanically fastened with battens roof tile applications.Polystick TU P may be used in both adhesive set and mechanically fastened roof file applications with the exception of mortar set the applications. 9. The maximum roof slope for use as roof tile underlayment for(direct-to-deck)tile assemblies shall be as follows: (See Table Below) Tile Profile Polystick MTS Polystick IR-Xe Polystick TU,TU Plus,TU P,Tile Pro Flat Tile Prohibited without battens 5:12 No limitation Profiled Tile Prohibited without battens Prohibited No limitation 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.: 114229.01 •• �' 00* •• ••• 000 •• Expiration Date: 09/13/16 MIAM1DADE C21!tMM Approval Date: 04/05/12 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. Roofing Tiles (6 Max.Per Stack) ai 12 CL �— N 6 A AN Koof Deck prepared with POLYSIICKTU Rus 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,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,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,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. LABELING: I. All membranes or packaging shall bear the imprint or identifiable marking of the manufacturer's name or logo, city and state of manufacturing facility and the following statement: "Miami-Dade County Product Control Approved"or the Miami-Dade County Product Control Seal as shown below. MIAM4DADE COUNTY JA...• D. 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. •• • • • •• ••• •• • •0 0• • ••• • • • • ••• . • •••• • •• ••• NOA No.: 11-1229.01 • • • • • MIAMFQpDE cOUN7Y 00* ••• 000 : 0: •Expiration Date: 09/13/16 PROVED I Approval Date: 04/05/12 Page 6 of 8 • • ••• • • • • ••• • • • • • • • 0 • • f + 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,Mule-Hide 241 Premium Modified Flashing Cement,Mule-Hide 251 Premium Wet/Dry Elastomeric Flashing Cement,or Mule-Hide 421 Mod Bit Flashing Adhesive Trowel Grade mastic,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/slopcs of 7112"or greater. It is suggested that on pitch/slopes in excess of 6'W712",precautions should be taken,such as the use of battens to prevent file 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,or exposed roof to wall details. 9. Repair of Polystick membranes is to be accomplished by applying Polyglass Polyplus 55 Premium Modified Flashing Cement,Polyglass Polyplus 50 Premium MB Flashing Cement,Polyglass PG500 MB Flashing Cement,Mule-Hide 241 Premium Modified Flashing Cement,Mule-Hide 251 Premium Wet/Dry Elastomeric Flashing Cement,or Mule-Hide 421 Mod Bit Flashing Adhesive Trowel Grade mastic to the area in need of repair,followed by a patch of the Polystick material of like kind should be set and hand rolled in place over the area needing such repair.Patching membrane shall be a minimum of 6 inches in either direction. The repair should be installed in such a way so that water will 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 substrates. Polyglass requires a minimum of 40 lbs for a weighted roller for the rolling of the field membrane. Hand rollers are acceptable for rolling of patches or small areas of the roof. Brooming may be used where slope prohibits 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"otjW o"ceptanw(.1,10.A.)approval for Polystick membranes and PolyProtector UDL can be•furnish�d u}abn�e uast byour Technical Services Department by calling 1 (800) 89411563. •• •; ; : • •: .• •• •s• •• . • . •• s•• i • i•n i + • s•• i i NOA No.: 11-1229.01 s•i i• ••• •s• ••• Expiration Date: 09/13/16 MartanwoE Courrn Approval Date: 04/05/12 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(NBCA). PLEASE CHECK WITH LOCAL BUILDING CODES REGARDING LIMITATIONS OF SPECIFIC APPLICATIONS. LOCAL CODES MAY SUPERSEDE POLYGLASS REQUIREMENTS AND RECOMMENDATIONS. END OF THIS ACCEPTANCE ••. . . • . % s *04 ••• . 0:0 .0. • •• • • • •. • ' ' ' ' "' ' • NOA No.: 11-1229.01 M DiADE COUNTY '•' •' '•' • ;.JExpiration Date: 09/13/16 • . Approval Date: 04/05/12 Page 8 of 8 • • ••• • • • ••• Miami Shores Village CFTVFD g ,JUN 2 5 2015 Building DepartmentsY_f�I -� 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_20 ILI BUILDING Master Permit No.�" PERMIT APPLICATION Sub Permit No. [—]BUILDING ❑ ELECTRIC XROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: 3�3U Folio/Parcel#: l �� c .�J 15)() Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): D J�G6 (_C-f Phone#: Address: City: �-1 l ^r (l j State: /7s� Zip:33 11 NTenant/Lessee Name: t U� Phone#: Email: V400�0 lEeCONTRACTOR:Company Name: 9 �G/°1� Phone#: Address:1� � City: 1 e CSM State: #�I Zip: t 7 Qualifier Name:_ IkLd E_ l C\F YY'2 Phone# c)�,1 • y� `.� State Certification or Registration 'SLC� Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 1y Square/Linear Footage of Work: t � LT Type of Work: ❑ Addition ❑ �"ration (� ❑ New YRepair/Replace ❑ Demolition Description of Work: (C- " ( I I c' � Specify color of color thru tile: W hi k, \-, 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) r 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 permitis•-is In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature —0;N\ ;�> OWNER 4 AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing ins7,ent was acknowledged before me this of by ay o . 20by who' personal) k wn to A�� � & �M(' C M who isrersontallykn:o)wto Y — � � me or who has produced as me or who has produced as identification and who di identification and who NOTARY PUBLIC: � +d� �V"-NIrrl�NOTARY PUBLIC: �r ..rta .L�•�rea �+«U`Ya �.. '� � ` s:'; Sign: Sign:"' ,�s f•, Print: Print: MAU ° Seal: Seal: APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) SNORES Axc.r932 c milli Miami shores Village Building Department �LOIz{DA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. -- COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT 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. BUSINESS NAME:_ BUSINESS ADDRESS. ' CITY 1)�C ,� STATE ZIP BUSINESS PHONE: ( 3W �"� FAX NUMBER 1 �� �� CELL PHONE ( ) QUALIFIER'S NAME. �� �1 IC At'L- QUALIFIER'S LIC NUMBER: QCC J&--q 0a I� s A40RIQ� CERTIFICATE � �� DDlYYY�Y) Q ; LIABILITY INSURANCE 06/23rzDN 015 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 Afklklo,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 WAIVER,subject to the terms and conditions of the policy,certain policies may requirel an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsementis PRODUCER ACT LUIS DE LA LLERA DELTA INSURANCE UNDERWRITERS,INC. NAM305-2B9 1707 F 777 N.W.72nd AVENUE,SUITE 3133 A/C No Na.305-269-1108 ADDRESS: DELTAINSUND@AOL.COM MIAMI,FLORIDA 33126 IN5URERIS)AFFORDING COVERAGE NAK INSURERA: ARCH SPECIALTY INSURANCE COMPANY 21199 INSURED { INSURER B. AG STAR ROOFING,INC.& AG STAR CONSTRUCTION,INC: INSURER c: INSURER M- 10403 SW 186th STREET INSURER E: MIAMI,FLORIDA 33157 INSURER F: CC)VERAGESCERTIFICATE 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 CON14.17ION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.OMITS SHOWN MAY WE BEEN REDUCED BYPAID CLAIMS. INSR Im TYPE# uCE (NSRPULK;Y EFF PDUCYEXP POL[CYNUR LIMITS GENERAL LIABILITY / EACH OCCURRENCE $ 1,0{10,000. 1 COMMERCIAL GENERAL LIABILITY PREMISES R $ 100,000. CLAIMS-MADEa OCCUR MED EXP(Any one person) $ 10,000. A AGL00202200� 02/23/2015 12+1112015 PERSONAL&ADVINJURY $ 1,U00,000. GENERALAGGREGATE $ 2,000,000. GENLAGGREGATE LIMITAPPLiES PER: POLICY PRO,- PRODUCTS-COMPtOPAGG $ 1,000,000. ECT LOC Deductible per Claimant $ 2,500_ AUTOMOBILE LIABILITY ANYAUTO (Eaaoadent} LEL $ ALL OWNED SCHEDULED BODILY INJURY(Per person) $ ~ AUTOS AUTOSHJREDAUTO5 NON-OWNED BODILY INJURY P er accident) AUTOS $ ROS tDAMAGE UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR_ CLAIMS-MADE AGGREGATE DED RE'ENTION $ $ -- WORKERS COMPENSATION AND EMPLOYERS LIABILITY YINOTH- ANY PROPRIETOR/PARTNER/EXECUTIVE I—} OFFICER/MEMBER EXCLUDED? NIA EL-EACH ACCIDENT $ (Mandatory In NH) ? describe under E.L.DMuEASE-EA EMPLOYEE $ tf yes, DESCRIPTION OF OPERATIONS below E:L DISEASE-POLICY LIMlT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) ROOFING CONTRACTOR LICENSE NUMBER:COC 1$29029.GENERAL CONTRACTOR LICENSE NUMBER:CGC1516021. CERTIFICATE HOLDER CANCELLATION SHOULD.ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE VILLAGE OF MIAMI SHORES/BUILDING DEPT. THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2nd AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FL 33138 AUTHORIZED REPRESENTATIVE PH 305 795 2204 FAX 305 7568972 LUIS DE LA LLERA ACORD 25 2010105 01888-2010 ACORD CORPORATION.All rights reserved. r ) The ACORD name and logs are registered marks of ACORD l xeporl viewer - Page 1 of l { JEFF ATWATER '4°•••+ CMIEF FWANCIAL oFF}cER 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 FWda Workers'Compensation taw. EFFECTIVE DATE; 5/21=15 EXPIRATION DATE: 5/1912017 PERSON: GALDAMEZ AXEL R FEIN: 26256$565 BUSINESS NAME AND ADDRESS: AG STAR CONSTRUCTION INC 1827 NW IST STREET MIAMI FL 33125 SCOPES OF BUSINESS OR TRADE: CERTIFIED GENERAL ROOFING-ALL KINDS CONTRACTOR AND DRIVER Pwausat#e Cb-0-4400 4),F.& an afthw.f.copowbmwoo elom"onow tam#"sh+Pae+..#dnC a-A of unam am. .. tthe eave#Mcnergsa ha#ilnitRt PeetSYitR#4 x`.1tiP1Nf§S#{i$i1%}FS � e3�e4#C#fenb Qe eftClhP( 8AP}Y ePe of Me 'as ttatleae m#au na�am qi be exernPt SCh�e 44pi�q#3}F5. a#etectron ta.®e p!aM a# #a be aaEab4 Shah be avhP! to 1a a a'7tom.8herMe 44n9 s#An aohce a the baaance ohne a[e:. tewnand' C#e nohea a ae.#anDet meati�1e et tfi4! to Ksuarrc4N i the deyeCSaKN#Sham revoke a DFS-I`2-0" M CERni'MATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)"346M https://apps8.fldfs.cold/erreportviewer/reportViewer.asr) ?data=kdVDtxinc9D703p11t3` FRF r%tanr7nI s ORF Miami V Village Building Department OR;vA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption I'MolEm 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 i£ I. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. f Signature: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of k 20 K . By who is ersonally known me or has produced as identification. INNI3 BRYANT Notary; air cokfwsslo-4 a&IMM UPTU: SEAL: 10403 SW 186TH Street Miami,FL 33157 Office(305)254 4472 --Fax(305)254 4476 Al;1(; agstarconstruction(a)yahoo.com STAR MAINTRL"IFUN Roofing&General Contractors Date. 6/22/2015 STATE OF FLORIDA COUNTY OF MIAMI DADE Before me this day, personally appeared Axel Randolfo Galdamez who, being dully sworn deposes and says: That he will be the only person working on the Project located at 1264 NE 92 Street. Swom and subscribed before me this 22nd day of June 2015. By PerslonalY known Or Produced Identification r* s Moo*FOO Type of Identification a.• s+:C f EE Iml ° SWIM AM 24,20160-AcAr'J4 fti 2 C+ +. ' °;r..` WWW./41flQtdiOTARY.00fi1 PrihtUtyp4 or Stamp Name of Notary 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. r s art of the agreement between the owner and the Additionally,the following items should be addressed a p contractor.The owner's initial in the adjacent box indicates that the item has been explained. a f 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. 4f 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.) 9 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. 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. 4f 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. Af 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. &41 ?04& 4 11 / I � zt Owner's/Agent's Signature Date ontractor's Signature 12411 P6- i2 Property Address Permit Number f ' y 15NO 'E`SGj Miami shores Village � Building Department 10050 N.E.2nd Avenue res� � Miami Shores, Florida 33138 0RiDp 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, A 33138 Re: Owner's Name: J0 Property Address: )r,1,�q_ '5 s4 Roofing Permit Number: Dear Building Official I ,o a`t�v�-t < i f. "K/ certify that I am not required to retrofit the roof to wall connections of my building because: , (The just valuation for the structure for purpose of ad valorem taxation is less than $300,000.00. Please attach proof of ad valorem taxation. ❑ The building was constructed in compliance with the provisions of the Florida Building Code(FBC)or with the provisions of 1994 edition of the South Florida Building Code(1994 SFBC) Signature Print Name State of Florida County of Dade The undersigned, being the first duly sworn, d oses and says that he/she is the owner for the above property mentioned. Sworn to and subscribed before me thisy day of t 2%' i s Notary Public, Sate of Florida at Large • 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. Revised on 5/21/2009 3roperty Search Miami-Dade County Page 2 of , t r Image Date- View Facing: Nvrtti South East 1-Nlest 01/31/2015 S o , �oI -rte� .�'���,�t€�• � �e-�4-i kt �1—�'fi I� ,�.,� `,i' kk� r rr n, RM 1F `, mfr ay4 2 I �r r r � r Opt The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record.The Property Appraiser and Miami-Dade County assumes no liability,see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asr) ittp://www.miamidade.gov/propertysearch/views/pictometry/pictorpetry.html?latitude=25.8602964748764&... 6/2/201-