RF-16-454 L Permrt 'RF
-2-16- �f 4:
Miami Shores Village Ty'
10050 N.E.2nd Avenue NE
s Wo*clas—OP46o ate air Roof
Miami Shores,FL 33138-0000 � '
AP R }Vl
Rermit Shita
Phone: (305)795-2204
RE 319xdate. tion: 09/05/2016issue 1Ex Ira
Project Address Parcel Number Applicant
321 NE 93 Street 1132060136240
Miami Shores, FL 33138- Block: Lot: ELIZABETH COWEN
Owner Information Address Phone Cell
ELIZABETH COWEN 321 NE 93 Street (305)458-0120
MIAMI SHORES FL 33138-
321 NE 93 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 800.00
JOHN BUSTA ROOFING INC (305)219-9699
_,..,.. ___ __ .. . ......_ Total Sq Feet: 30
Type of Work:Repair Available Inspections:
Additional Info:REMOVE AND REPLACE FRACTURED ROOF T Inspection Type:
Classification:Residential
Roof Repair
Scanning:3 Final Roof
Review Roof
Review Roof Aj�
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
DBPR Fee Invoice# RF-2-16-58739
$2.00 02/19/2016 Credit Card $50.00 $64.60
DCA Fee $2.00
Education Surcharge $0.20 03/09/2016 Credit Card $64.60 $0.00
Permit Fee-Repairs $100.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $114.60
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing informo4n is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the abo natrac r to do the work stated.
March 09, 2016
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
March 09,2016 1
6 Miami Shores Village RFCIF
�\ Building Department FEB 192016
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 �� 1
FBC 20 p�_
BUILDING Master Permit No. `P LS Iq
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC FO-1 ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 321 NE 93rd. Street
City: Miami Shores County: Miami Dade zip:33/,36:tiSC24
11-3206-013-6240 X
Folio/Parcel#: Is the Building Historically Designated:Yes Nb
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder):Elizabeth Cowen Phone#:305-458-0120
321 NE 93rd. Street
Address:
City:
Miami Shores State: Florida Zip: 33138-2854
Tenant/Lessee Name: n/a Phone#:n/a
Email: ejcown@gmaii.com
CONTRACTOR:Company Name:
John Busta Roofing Inc. Phone#: 305-219-9699
Address:
300 NE 91 Street
City:
Miami Shores State: Florida Zip: 33138-3130
Qualifier Name:
John Robert Busta Phone#: 305-219-9699
State Certification or Registration#: CCC-058048 Certificate of Competency#:
DESIGNER:Architect/Engineer: N/A Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$800.00 Square/Linear Footage of Work: 30
Type of Work: ❑ Addition ❑ Alteration ❑ New M Repair/Replace ❑ Demolition
Description of Work: Remove and Replace fractured roof tiles,adhere broken corners/loose tiles
Specify color of color thru tile:
Submittal Fee$ , C�3 Permit Fee$ CCF$ CO/CC$
Scanning Fee$ U) Radon Fee$ 0 . CQ� DBBrPRR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ fP�
TOTAL FEE NOW DUE$ `� y
(Revised02/24/2014)
Bonl3ng(bmpanOOName(if applicable) 4
$orUng C.bmpanQOAMem
City State Zip
Mor[bage L.enller'OName(if applicable) ..
More LenOer'OAm'eiD
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....
00 NEFTS 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.
"0 ARMING TO C10 NBA YOUR FAILURE TO FEMFD A NOTICE OF OOMMBVCEMENT 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
Y01JR N0-nCEOF OOM M BVCEM BVT."
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
inion will not be approved and a reinspection fee will be charged-
Signature
hargedSignature Signature
ER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
_eQ day of ,20 A5 ,by E day of 1�-- 9AWAi R 20 Z; by
o is personallyknown toO�yit/�9�,�,2j �'/cam,who is personally known 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:
Si Sign:
Print: Print: S(a P& 4C[ A
Seal: o0"%` Namry Public stare 01 Frond* Seal:
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Expires 01/122018 " . EXPIRES:Sep oNm 14,2018
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##### a N 0 1 A ON # # ## ############################# ######*
APPROVED BY Plans Examiner Zoning
CIV,) L ReehEngineering Corp.
2370 Southwest 123rd Avenue
Riz Miami,Florida 33175-1174
Tel:305-823-8008/305-397-6414
ENGINEER Fax:305-823-3300/305-884-8834
Website:www.reilehengineering.com
March 13, 2016
John Busta Roofing
300 Northeast 91 Street
Miami Shores, Florida 33138-3130
Project: ROOF TILE UPLIFT TEST REPORT
Residential Home
321 Northeast 93 Street
Miami Shores,Florida
Information provided by client:
Permit Number: RF-2-16-454
Date Completion: March 9,2016
Roofing Contractor: John Busta Roofing
Project Number: 16-0265
(Testing Laboratory Certificate#11-0715.04)
Dear Sirs;
In accordance with your request and authorization, a representative of Reileh Engineering
Corporation completed the Roof Tile Uplift Test for the repaired roofing tiles at the above
referenced project. This testing was performed in general accordance with Roofing Application
Standard TAS No.106 -- Standard procedure for field verification of the bonding of mortar or
adhesive set tile system and mechanically attached,rigid, discontinuous roof systems.
The total of the tested roof surface area was less than 30 square feet,and the mean height of the roof
is less than 40 feet above ground surface. The type of tile used for this project was reported to be
Boral Vanguard Roll Roof Tile. This tile was reported to have been foamed in place.
At the time of our inspection,the entire area of the roof was examined for loose tiles. Not less than
one(1)tile in ten(10)of all components in the field area and one(1)tile in five(5)of all tiles in the
perimeter and comer areas were physically examined. A minimum of one(1)test per every two(2)
squares in the field, one (1) test per square in the perimeter area, ridge caps and (1) in the comer
areas were conducted.
Based on our test results,we conclude that the repairof the roof tiles at the above referenced project
meets the test requirement outlined in the above-mentioned.protocol. Attached please find a copy
of our test report for your review.
Reileh Engineering Corporation appreciates the opportunity of assisting you in this project. If you
have any questions or if we may be of further assistance, please do not hesitate to contact the
undersigned.
Respectfully submitted;
Reileh Engineering Corporation
-21
M amad Sonny Salleh, P.E.49014
01j1icct Manager
THX UPLIFT TEST
Residential Home
321 Northeast 93 Street
Miami Shores,Florida
Reileh Engineering Corporation—Project Number-16-0265—Page 2 of 3
Report of
TILE UPLIFT TEST
for
Residential Home
321 Northeast 93 Street
Miami Shores,Florida
Project Number: 16-0265
Test Number Test Load b Test Status
1 35 Pass
2 35 Pass
3 35 Pass
4 35 Pass
5 35 Pass
6 35 Pass
7 35 Pass
8 35 Pass
9 35 Pass
10 35 Pass
11 35 Pass
12 35 Pass
13 35 Pass
14 35 Pass
Test 1-2 Perimeter, 3-14 Field
Reileh Engineering Corporation--Project Number-16-0265—Page 3 of 3
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ROOF ASSEMBLIES AND ROOFTOP STRUCTURES
••••
Florida Building Code 5th Edition(2014) , , • • 0000001
High-Velocity Hurricane Zone Uniform Permit Applicatioqhin
Section A(General Information) "" 6
...... . .. .....
Master Permit No. Process W. •• •••• ••••••1
Contractor's Name • ••••••1
• .1
Job Address 3;z/ AIE7 00 ' 0'•;•0 •1
ROOF CATEGORY 1
❑ Low Sloe 1
P ❑ Mechanically Fastened Tile ® Mortar/Adhesive Set Tiles 1
❑ Asphaltic Shingles ❑ Metal Panel/Shingles ❑ Wood Shingles/Shakes 1
❑ Prescriptive BUR-RAS 150 1
ROOF TYPE 1
❑ New roof A Repair ❑ Maintenance ❑ Reroofing ❑ Recovering 1
ROOF SYSTEM INFORMATION 1
Low Slope Roof Area(SF} Steep Sloped Roof AREA(SSF)30 Total(SF) 30 1
1
1
Section B (Roof Plan) 1
Sketch Roof Plan: Illustrate all levels and sections, roof drains,scuppers,overflow scuppers and overflow drains. Include dimen-
sions of sections and levels,clearly identify dimensions of elevated pressure zones and location of parapets. 1
. 1
1
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FLORIDA BUILDING CODE—BUILDING,5th EDITION(2014) 15.37
i 1 i 1 Copyright to,or licensed by,ICC(ALL RIGHTS RESERVED);accessed by Eliezer Palacio on Jun 8,2015 10:32:12 AM pursuant to Liccnse
Agreement.No further reproductions authorized.
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SECTION 1524 •0.00•
HIGH VELOCITY HURRICANE ZONES- REQUIRED OWNERS NOTIFIL`f-NcrN FOIA*AU6FING9 •
CONSIDERATIONS 66.09• 96 0.00•
00 00
1524.1 Scope.As it pertains to the section, it is the responsibility of roofing contracts r to provide We owner witf4•••:•
the required roofing •• •
q g permit, and to explain to the owner the content of the section. The prgai�sions of Sect•i•
on R41QZ•0;
govern the minimum requirements and standards of the industry for roofing system installatiDns.Agtl!lRitflally, tht •
following items should be addressed as part of the agreement between the owner ant the contractor.The owner's
initial in the designated space indicates that the item has been explained.
�.
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).
4. L Exposed Ceiling: 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 penetration of the underside of the decking may not be acceptable. This provides the option of
maintaining the appearance.
6. 1z Overflow scuppers (wall outlets): It is required that rainwater flows off so that the roof is
not overloaded from a buildup of water. Perimeter/edge wall or other roof extension 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.
Owner/Agedlsignature Date Contractor Signature Date
Property Address Permit Number
Revised on 7/9/2009 LD;07/01/2015;
ones Miami shores Village
sees
Building Ddpattffmt-
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.::.JD050N1;2hd AvQou.L
We MO'Ghores, Florida 33138,
Tell,( )795'2204'
fees Fa.- . (305)7569M
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Notice to Owner Workers' Compensation Insuramp-.Exemption
aB
7,
.0000.
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida SAtes. -tj;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) m 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.
I 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 CUCIMIStanCCS,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:
0—Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge,before me this. day of 20
who is personally known to me or has produced
as identification,
WMANN MFF 0
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