RF-15-1846 'ami Shores Village ,; , --
Iding Department SEP 5 2015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(30S)762-4949
FBC 20k
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
P'
CONTRACTOR DRAWINGS
JOB ADDRESS: u_� "^o A)e 24U — Cor Tes o l:�' c pe-1
City: Miami Shores County: Miami Dade Zip: e;;3 I�o
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Z;k—A f y OyiW e rs t6i Phone#:
Address:l gg90 tija ?_M `1-uz f
City: wl am l SVk0fes State: Pori dM Zip: 32-)1r
Tenant/Lessee Name: Phone#:
Email: L /� '(�^ t
CONTRACTOR:Company Name: A- � Afs-� 1 �� l�oF%n9 LLC Phone#: gSLA- �J�n�J l l�j(c�
Address: `;Ze) Uorih en' a� fAree'-
I
City: `a2A Lciyc�rcdale State: Pka'ric o" Zip:
Qualifier Name: I/ Ml 9 Gs' e7 g&A Phone#: 'J b
State Certification or Registration MCC 132 66161-7-2— Certificate of Competency M
'
DESIGNER:Architect/Engineer: 1�l- kAay'1 N A S5 ob a� 5 Phone#: �_LkL{S7 V7(�$
Address: U City: �ICIM'% State: EL zip: 231
Value of Work for this Permit:$ - Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work e��st rS �..� / �'R ®c rwe 't o.s .
CVA /tl W f t As g_eC
.r .�7
Specify cot"of color thru#ile:
Submittal Fee$ Permit Fee$�..�� •(r<J� CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ CJI Notary.$
Technology Fee$ Training/Education Fee$ 0' 20 Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ ! d
(Revised02/24/2014)
Bonding Company's Name(if applicable) o bor
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 QI"XAS�C'T;t-- Signatur
OW ER or AGENT RACTOR
The foregoing instrument was acknowledged before me this The for9going instrument was acknowledged before me this
day of f�°/G___ 20,� ,by day of .20 �� .by
/yp (+�,who is personally known to �F t is personally known t�
_=or who has produced as 4:Ee�l who has produced � as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
c
Sign: t=Ao't---lei Sign:
Print: J f d e) /�--�^ Print: _
\\\ �/ MAN
Seal: ��\\Q�P�; •�Op ii� Seal: ;R MYCOLVAN MOEE221M
EXPIRES 884.218
• Od .* 3o601d3
t13�0 a t
APPROVED BY �•'•.r ' •� Plans Examiner Zoning
i/C 11111 ``\`
Structural Review Clerk
(Revised02/24/2014)
Miami Shores Village LL'
Building Department OCT 3 2015
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
BUILDING Master Permit No.CC-3-15-572
PERMIT APPLICATION Sub Permit No.. �
OBUILDING F-1 ELECTRIC ❑ ROOFING FE-1 REVISION EXTENSION ❑RENEWAL
❑PLUMBING ❑MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATIO OP
CONTRACTOR /—DRAWINGS
JOB ADDRESS: 11300 NE 2nd Avenue - C qApL
City: Miami Shores County: Miami Dade Zip: 33161
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):Barry University Phone#:
Address:11300 NE 2nd Avenue
City. Miami Shores state: FL zip: 33161
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Atlas-Apex Roofing, LLC Phone#: 954-565-1567
Address: 281 Northeast 32nd Street
city. Fort Lauderdale state: FL Zip: 33334
Qualifier Name: David Gembala Phone#: 954-565-1567
State Certification or Registration#: CCI 329972 Certificate of Competency#:
DESIGNER:Architect/Engineer: MC Harry&Associates Phone#: 305-445-3765
Address:2780 SW Douglas Road City. Miami State: FL zip: 33133
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ NewReg9ir/replace ❑ Demolition
Description of Work: Repair of Roof Trusses
Specify color of color thru tile:
Submittal Fee.$ _. Permit Fee$ CCP$-. CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ s
(Revised02/24/2014)
w
. i
Bonding Company's Name(if applicable) N/A
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 Signa
OWNER or AGENT OR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
cZ•day of 4Z__,20 by 19th day of October .20 15 by
Gfi� - - is p
/ who is personally known to David Gembala who ersonally known to
446
me or who has produced as me r who has produced N/A as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
S' :� :•�� •hr �i Sign
•
Print: �/� T / a $ Print: M.
Seal ?a°,Y �- MILDRED7offlorlda
Seal: • ._ Notary Public My Comm.Expi�� Commission
S1 IRA * *
APPROVED BY Plans Examiner Zoning
!� Structural Review Clerk
(Rev1sed02/24/2014)
\ a >
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S.Andrews Ave.,Rm.A-100, FL Lauderdale,FL 33301-1885—951-831-4000
VALID OCTOBER 1,2015 THROUGH SEP I EMBER
��30�,2016
.ATLAS-APEX ROOFING LLC R=Tyw.We r- 1/98H5ET METAL CO R
Business Nie: Buses Type:
OWfW N~.DAVID H GEMHAI.A, BUSIne89 Op8n8d211/01/2012
Buchu 88 LocadwL-281 NE 32 ST StetWfCormty/C8NReW CCC1329972
FT LAUDERDALE Exemption Code;
BUSM088 Phone:954 565-1W
Romme goer Eames Maes Probeaknuft
3
Forve COVNumberM� ,
Tax At WM TMWW Fee I MW Fee I Perry i Pry'Years . CoBeWen Cost Toter POW
27.00 0.001 0.001 0.001 0.00 0.00 27.00
. I
THIS RECEIPT MUST BE POSTED COWtCUOUSLY IN YOUR PLACE OF BUSDIM I
THIS BECOMES A TAX RECEIPT This tat is Levied for fa pie of doing busiram wift Bff4md County and Is
non-reguhfty In nature.You must meet all County andfor Municipality planning
VO4EN VALUMTED and zoo rw te.Ttfs Business Tax Rept must be Uwsbffed when
the business Is sold, tis nwm has dmged or you have moved ttar
business beau.This moW does not Wicato tact the business Is legal or that
61s In complianos vAM State or boat Wn arxi regulation;.
Malling Address:
ATLAS-APEX ROOFING LLC Receipt t;WM-14-00128399
281 NE 32 ST Paid 09/08/2015 27.00
FT LAUDERDALE, FL 33334
2015 . 2016
AC��® CERTIFICATE OF LIABILITY INSURANCE DATE("M/DDNYYY)
10/23/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)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 Ileu of such endomement(s).
PRODUCER CONTACT Sandi Harrison
Frank H. Furman, Inc. PHONEM& Exti. (954)943-5050 A/C No:(954)943-5417
1314 East Atlantic Blvd. ADDREW:Sandi@furmaninsurance.com
P. O. Box 1927 INSURE S AFFORDING COVERAGE NAIC 0
Pompano Beach FL 33061
lNsuRERANational Fire Ins Of Hartford 20478
INSURED INSURER sMational Fire Ins Of Hartford 20478
Atlas Apex Roofing LLC INSURERCContinental Casualty 20443
281 IdE 32 ST INSURERD.Valley Fore Insurance Company 20508
INSURER E:
Ft Lauderdale FL 33334 INSURER F:
COVERAGES CERTIFICATE NUMBER:AVG 2015 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.
ILTR TYPE OF INSURANCE POLICY NUMBER MADDLSUBR MS EFF MMM/uDD°CP LIMITS
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
A CLAIMS-MADE �OCCUR DAMAGE TO RENTED 100,000
PREMISES Ea occurrence $
R Contractual Included 60201768844 8/28/2015 3/18/2016 MED EXP(Any one person) $ excluded
PERSONAL&ADV INJURY $ 1,000,000
GEITL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY JECOT �LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: Employee Benefits $ 1,000,000
AUTOMOBILE LIABILITY CEOMBBII dEDtSINGLE LIMIT $ 1,000,000
B JX ANY AUTO BODILY INJURY(Per person) $
AAUT�ED AUTOESDULED6020180618 8/28/2015 3/18/2016 BODILY INJURY(Per accident) $
HIRED AUTOS B NON-OWNED
PRSAUTOS aid DAMAGE $
Medical payments $ 2,000
R UMBRELLA UAB B OCCUR Umbrella is following form EACH OCCURRENCE $ 5,000,000
C EXCESS LWB CLAIMS-MADE of all primary policies.
AGGREGATE $ 5,000,000
DED I I RETENTION$ 6020176830 8/28/2015 3/18/2016 $
WORKERS COMPENSATIONPER OTH-
AND EMPLOYERS'LIABILITY YIN % STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? N❑N/A
D
(Mandatory in NH) 6020189478 10/1/2015 10/1/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 11000,000
DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,AddMonal Remarks Schedule,may be attached K more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Building Department ACCORDANCE WITH THE POLICY PROVISIONS.
10050 NW 2nd Avenue
Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE
Dirk Dejong/CSf'"
C 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
IN9025/mm4nii
CC 0S 5 -4-z
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305)795.2204
9 Fax:(305)756.8972
RE: Permit# •�� DATE:
CTION AFFIDAVIT
I /mac �1 4e"I'o licensed as a(n)Contractor!Engineer/Architect,
(Print name and dr de ucense Type) FS 468 Building Inspector
License#:
On or about la��,^��� I did personally inspect the roof deck nailing
(�ate�tlme)
work at
(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)
01
Signature
State of Florida
County of Dade:
The undersigned, being the first duly swom,deposes and says that he/she is the contractor for the above property
mentioned.
Swornto and subscribed before me this day of 1 ��-�2
Notary Public,Sate of Florida at Large ► Notary Public Stag of FI®rldo
`�; sindia Alvar®a
or
My Commission
09103/20161l3ri7d0
'General,Bl ding,Res ftnft or Ro*v Contractors or any IralWual c e0ed under 468 F.S.to make such an inspection.Indude photographs of each pkme of the roof wkh
permit#and address#dearly shown nil on to deck for each It�
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Florida Building Code Edition 2010
High Velocity Hurricane Zone Uniform Permit Application Form
Section C (Low Sloped Roof ftstem)
Fill In Specific Roof Assembly Components Fastener Spacing for Anchor/Base Sheet
and Identify Manufacturer Attachment
(If a component is not used,identify as"NA")
System Manufacturer: Soprema Field: 6 oc @ Lap,#Rows N/A @ N/A.oc
14-0603.10 D(2) pg 29 of 56 6 1 6
NOA No.: Perimeter: "oc Ca)Lap,#Rows @ "oc
Design Wind Pressures,From RAS 128 or Calculations: Corner: 6 "oc @ Lap,#Rows 1 @ 6 "oc
Pmax1: 54.048 Pmax2: 87.308 Pmax3: 128.883
Number of Fasteners Per Insulation
Max. Design Pressure,From the Specific NOA Board
y 82.5
System: Field: 4 Perimeter 4 Corner 4
' Deck: Wood Type:
Illustrate Components Noted and
Gauge/Thickness: 5/8�� Details as Applicable:
Slope: 0 Woodblocking, Gutter, Edge Termination,
Stripping, Flashing, Continuous Cleat, Cant
Anchor/Base Sheet&No.of Ply(s): Sopra G- 1 ply Strip, Base Flashing, Counter- Flashing,
Coping,Etc.
Anchor/Base Sheet Fastener/Bonding Material: indicate: Mean Roof Height, Parapet Height,
LomWd Height of Base Flashing, Component Material,
Material Thickness, Fastener Type, Fastener
Insulation Base Layer: POlyiso Spacing or Submit Manufacturers Details that
Comply with RAS 111 and Chapter 16.
Base Insulation Size and Thickness: 4x4 Tapered(1.5°min)
Base Insulation Fastener/Bonding Material:
Loose Laid
Top Insulation Layer: Primed DensDeck
4x8- 1/4" min Parapet
Top Insulation Size and Thickness: Height
Top Insulation Fastener/Bonding Material: N/A
Pregndnery Fastened per RAS 117
Base Sheet(s)&No.of Ply(s): Soprafix Base 612-1 ply
Mean
Base Sheet Fastener/Bonding Material: Roof
Soprema#14 MP fasteners w/Y Seam Plates—hot air welded side laps Height
Ply Sheet(s)&No.of Ply(s): N/A 18 Ft
Ply Sheet Fastener/Bonding Material:
WA
Top Ply: Sopralene Flam 180 FR GR
Top Ply Fastener/Bonding Material:
Heat Welded
Surfacing: NIA
Florida Building Code Edition 2010
High Velocity Hurricane Zone Uniform Permit Application Form
Section E (Tile Calculations)
For Moment based tile systems,choose either Method 1 or 2.Compare the values
for M,with the values from Mf. If the M,values are greater than or equal to the M,
values,for each area of the roof,then the tile attachment method Is acceptable.
Method 1 "Moment Based Tile Calculations Per RAS 127"
(P1; -91.974 X A 0.205 = -18.855 )_Mg; 6.86 =Mr, -25.715 Product Approval Mf -116.9
(P2; -144.364 X A 0.205 = -29.595 )_Mg: 6.86 =Mrz -36.455 Product Approval Mf -116.9
(P3: -196.754 X X_0.205 = -40.335 )_Mg; 6.86 =Mr3 -40.335 Product Approval Mf -116.9
Method 2 "Simplified Tile Calculation Per Table Below"
Required Moment of Resistance(Mr)From Table Below Product Approval Mf
MfRequlred Moment Resistance*
Mean Roof Height--►
Roof Slope 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 25.9 1 27.1 28.2 1 30.0
*Must be used In conjunction with a list of moment based the 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 Fr values,for each area of the roof,then
the tile attachment method Is acceptable.
Method 3"Uplift Based Tile Calculations Per RAS 127"
(131: x 1: = x w:=_ )-W: x cos 0: - =Fr1 Product Approval F
(P2: x 1: = x w:=)-W: x cos 0: - =F,2 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 M9 Product Approval
Attachment Resistance K Product Approval
Required Moment Resistance Mr 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.
Florida Building Code Edition 2010
High VelocityHurricane Zone Uniform Permit Application Form
Section A (General Information)
Master Permit No. CC-3-15-572 Process No.
Contractor's Name Atlas-Apex Roofing, LLC
Job address 11300 NE 2nd Ave; Miami Shores, FL (Barry University)
ROOF CATEGORY
■ Low Slope ❑ Mechanically Fastened Tile ■ Mortar/Adhesive Set Tile
❑ Asphaltic ❑ Metal Panel/Shingles ❑ Wood Shingles/Shakes
Shingles
❑ Prescriptive BUR-RAS 150
ROOF TYPE
❑ New Roof ■ Reroofing ❑ Recovering ❑ Repair ❑ Maintenance
ROOF SYSTEM INFORMATION
Low Slope Roof Area(SF) Steep Sloped Roof Area (SF) Total (SF)
580 4667 5250
SECTION B (Roof Plan)
Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow
scuppers and overflow drains. Include dimensions of sections and levels, clearly
identify dimensions of elevated pressure zones and location of parapets.
i
Florida Roof Testing Services, Inc.
NOA No. 11-1213.02 Exp: 1/29/2017
TESTING* ENGINEERING CALCULATIONS*INSPECTIONS S'iirwe 1995
February 25,2016
Building Department Official;
Florida Roof Testing Services, Inc.has performed a tile uplift test on the building described below. The file uplift test consists of
placing a load test device manufactured by, Chatillon Industries, [Model LG-100] over the tie with an adjustable connector
placed under the front lip of the file and gradually incoming upward pressure until a reading of 35 pounds (for foam or
adhesive set files) or 0.80 x Mr and/or 0.80 x f (listed in NOA for mechanically attached files) is achieved. All testing was
conducted in accordance with FBC 2010 TAS-106-R,(2006 supplement).Gauge Calibrafion Cerfificate on the Reverse Side.
Florida Roof Testing Services Inc r+esponsibirfty in this project was specifically 6/e uplift testing to a specift limit 1110 other
conclusions or observations are expressed or implied. Florida Roof Testing Services is not responsible for any damaged or
broken he during the course of the test
Pleaw note all measurements are approximate.
Contractor. Stobs Brothers Construction
Job Address. 11300 NE 2ndAvenue,Miami Shores,FI.
Permit# RF7-15-1846
Applicafion Method: Foam Set,Entegra,5,250 Sf.
Test ResuHs: 2125116 Pass
Tech: FH
Report Prepared By: Fred Hernandez,Senior Technical Analyst
FRT Job# 16-015
Field 2912 15 O O 15
Perimeter V 2252 23 O O 23
Corners 10 90 10 O O 10
Hi (H) 100 5 O O 5
Rid e R 5 1 O O 1
t
w • A.1 2 �1�
R. N.Sailappan,P.E.
Florida Registration No.46696
3201 NE 1O Street Cary#403,Pompano Beach,FI 33062*Phone:954.975.9010*e-ma0 ftoridaroof@attnet
TAS 406-8-Tt1e Uplift TeSt Report
QUALJrrY SYS'!'MS LAB CaMmite Nm .Z2
AN 190 17026 ACCREDr ED U1s
COMP/CATH OF CAUBRA71ON
Permed for. Test Remtlts: Pass
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Permit Inspection Request
Building Department: MIAMI SHORES
Inspection Line: 30S-762-4949, cut off time.,3.30om (Leave msg
providing the following info: Name, Phijane number, Permumber,
address and ' / •
Permit Number: RF 7-iS-1845
Site Address: 11300 NE 2"d Avenue, Miami Shores
Job Name: Barry Univerisiy—COR Jesu Chapel Restoration/Renovation
Date for inspection:
Type of Inspection:
Miami Shores Village ,,� �
Building Department JUL 2 g 015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 LC�
BUILDING Master Permit No.CC-3-15-572 r_
PERMIT APPLICATION Sub Permit No.�l J-- 184
[—]BUILDING ❑ ELECTRIC 0 ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 11300 NE 2nd Avenue
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-2136-000-0050 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type:" Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):Barryee#ege(�t,/V/i �Q✓''�J'J, +Phone#:(305) 899-3000
Address:11300 NE 2nd Avenue
City: Miami Shores State: Florida Zip: 33161
Tenant/Lessee Name: N/A Phone#:N/A
Email: N/A
CONTRACTOR:Company Name: Atlas-Apex Roofing, LLC Phone#: 954-565-1567
Address: 281 NE 32nd Street
City: Oakland Park State: FL Zip: 33334
Qualifier Name: David H Gembala Phone#: 954-565-1567 x404
State Certification or Registration M CCC1329972 Certificate of Competency M
DESIGNER:Architect/Engineer: McHarry Associates Phone#: 305-445-3765
Address:2780 SW Douglas Road, Suite 302 City. Miami State: FL Zip: 33133
Value of Work for this Permit:$102,000 Square/Linear Footage of Work: -57Z So
Type of Work: ❑ Addition ❑ Alteration ❑ New 0 Repair/Replace ❑ Demolition
Description of Work: Re-roofing portions of Cor Jesu Chapel at Barry University.
Specify color of color thru tile: Indian Red
Submittal Fee$ Permit Fee$3�S' CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ p
TOTAL FEE NOW DUE$
(Rev1sed02/24/2014)
t
Bonding company's Name(if applicable) N/A
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable) NIA
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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signatur Signat
OWNE �rAGEN CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
9-1--'+ day of N uk 4 .20 15 ,by 17th day of JUIy ,20 15 by
Si5vor L:%r-JQ `$eV i kACq jkk who is personally known to David Gembala who is personally known o
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did to an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: ` `� Si n: 1
Print: ��t Print: Diana Maglia i y P�
PJDA
Seal: ��' =s Notary -State of norm Seal: STATE ATE OF
iYyr Comm.Expires May 30,2018 12J1412016
Commission N FF 095270
Boated Thr National Notary Assn.
*************** * * * **********************************************************
APPROVED BY "' Plans Examiner Zoning
Structural Review Clerk
(Revisedo2/24/2014)
... p... Miami Shores Village
Building Department
� 'Q}II► 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. y 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: Atlas-Apex Roofing, LLC
BUSINESS ADDRESS: 281 NE 32nd Street CIN Oakland Park STATE FL Zip 33334
BUSINESS PHONE:(_ 565-1567 FAX NUMBER 565-1568
CELL PHONE 9( 1 249-5536 QUALIFIER'S NAME: David Gembala
QUALIFIER'S LIC NUMBER: CCC 1329972
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395
® 1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
GEMBALA, DAVID HENRY
ATLAS APEX ROOFING, LLC
281 N.E.32ND STREET
FORT LAUDERDALE FL 33334
Congratulations! With this license you became one of the nearly
one million Floridians licensed by the Department of Business and
Professional Regulation. Our professionals and businesses range STATE OF FLORIDA
from architects to yacht brokers,from boxers to barbeque restaurants, s DEPARTMET Og BUSINESS AND
and they keep Florida's economy strong. PROFESSiOALULATION
Every day we work to improve the way we do business in order to CCG1329972 ` ISUl37f0112014
serve you better. For information about our services,please log ofto.
warty myfloridalleeme corn. There you can find more information i CERTIFIED ROOkNNt;1 CbNTRACT
about our divisions and the regulations that impact you,subscribe GEMBAL DAV117�"HFN t f
to department newsletters and learn more about the Departments tl ATLAS APEX It1Ql=1Nt ;1LC ;
Initiatives. ,
Our mission at the Department is:License Efficiently,Regulate Fairly
We constantly stove to serve you better so that you can serve your r ti
cxJstomers. Thank you for doing business in Florida, IsCERTI' EDsneer the provtatcns akh.4sa Fs: ;
and congratulations on your new license! ; AW91.2ots_ 11407owo U4
DETACH HERE
RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION t
CONSTRUCTION"INDUSTRY LICENSING BOARD
CCC1329972 j
The ROOFING CONTRACTOR
Named bow IS CERTIFIED
Under the provisions of Chapter 489 FS: -
Expiration date: AUG 31,2016
m 0 �
GEMBALA, DAVID HENRY"=
ATLAS APEX ROOFING,LLC
n -
.281 `N.E 32ND STREET_ .
u FORT_ -U tJ'DERDA E FL 33334 c
ISSUED: 07/0112014 DISPLAY AS REQUIRED BY LAW SEQ# L140701OW1144