BPP-15-2601 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax:(305)7568972
Inspection Number: INSP-245649 Permit Number. BPP-10-15-2601
Scheduled Inspection Date:July 20,2016 Permit Type: Pools/Whirlpools/Hot Tubs
Inspector: Mesa,Michel Inspection Type: Final
Owner: GUILLEN,KRISTINA Work Classification: Repair
Job Address:1298 NE 104 Street
Miami Shores,FL 33138- Phone Number
Parcel Number 1122320300100
Project: <NONE>
Contractor. PREMIER CONSTRUCTION AND PAVERS Phone:(954)441-4224
Building Department Comments
4"CONCRETE POOL DECK NEW DIAMOND BRITE TO Iffractio INSPECTOR COMMENTS Passedcomments
SWIMMING POOL NEW COPING TO POOL&NEW TILE False
6"AROUND POOL PERIMETER INSTALLATION OF
APPROVED POOL BARRIER
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-Inspectlon fee Is paid
July 19,2016 For inspections please calk(305)762-4949 Page 1 of 41
Miami Shores Village
t N r.
� 10050 N.E.2nd Avenue NE f
.N Miami Shores,FL 33138-0000 � _•w
Phone: (305)795-2204
Expiration: 0 1112016
Project Address Parcel Number Applicant
1298 NE 104 Street 1122320300100
Miami Shores, FL 33138- Block: Lot: KRISTINA GUILLEN
.
Owner ir.'ormation Address Phone Cell
KRISTINA GUILLEN 1298 NE 104 Street
MIAMI SHORES FL 33138-
1298 NE 104 Street
MIAMI SHORES FL 33138-
Contractors) — Phone Cell Phone Valuation: $ 8,700.00
PREMIER CONSTRUCTION AND PAVE (954)441-4224 Total Sq Feet: 00
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Final
Date Denied:
Review Building
Type of Wore-Swimming Pool Occupancy: Review Building
Additiona!lnfo:a°CONCRETE POOL DECK NEW DIAMO Bond Return: Review Building
Classification:Residential Scanning:3 Review Electrical
Review Electrical
Review Planning
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $5.40 Invoice# BPP-10-15-57414
DBPR Fee $3.92
DCA Fee $3.92 10/14!2015 Check*1080 $50.00 $242.24
Education Surcharge $1.80 12/14/2015 Check*1137 $242.24 $0.00
Permit Fee $261.00
Scanning Fee $9.00
Technology Fee $7.20
Total: $292.24
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 wore done "y eithc:myceff, n,, ;:mployes. I understand that separate permits are
requires for 17LECTRICA.L.PLUMBING,MECHANIC INDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS A IT: I certify that al fore in Information is accurate and that all work will be done in compliance with all applicable laws regulating
construction a d zone . uthe ,I a oriz t abo named contractor to do the work stated.
December 14,2015
Alftli5`nzed Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
December 14,2015 1
Miami Shores Village5BY:
CRIVED
2015
Building DepartmentA 14
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 _
Tel:(305)795-2204 Fax:(305)756-8972
e' INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20��/ �
BUILDING Master Permit Np`�=��
PE MIT APPLICATION Sub Permit No.
7BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1298 NE 104 Street
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-2232-030-0100 Is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: NO BFE: FFE:
OWNER:Name(Fee Simple Titleholder):Kristina Guillen Phone#:305-975-1070
Address: 1298 NE 104 Street
City. Miami Shores State: FL Zip: 33138
Tenant/Lessee Name: Not Applicable Phone#:N/A
Email: kristiguillen@gmail.com
CONTRACTOR:Company Name: Premier Construction and Pavers Phone#: 954-441-4224
Address: 4200 SW 141 Avenue
City. Davie / State: FL Zip: 33330
Qualifier Name: /G t CVmq✓t Phone#:
State Certification or Registration#: 1i96 1251,00 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ g 71o6 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New,, ❑ Repair/Replace ❑ Demolition
Description of Work: /� G M�lA/ M GtJI� /IJ
/04
jTdlfl� /i/MI �✓ bel Aar, iau
Specify color of color thru tile:
Submittal Fee$ 5:'V-moi 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$ 2L: Ae).
(Revisedo2/24/2014)
r
Bonding Company's Name(if applicable) Not Applicable
Bonding Company's Address N/A
city N/A State N/A Zip N/A
Mortgage Lender's Name(if applicable) Space Coast Credit Union
Mortgage Lender's Address 15900 Miramar Parkway
city Miramarstate FL Zip 33027
Application is hereby made to obtain a permit to do the work and installations as Indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature 1�nL
l OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of [�/X✓ 20 / ,by `/ day of ® e ms' ,20 f by
/S pAA iGl who i ersonally know o who is ersonally know to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC-
IJ& Sign: i
Sign• %
Print: U.1' Pmt C"-, Print:(9b15 S
ZA7(
Seal: ..�v.^r+v+V'�taMl+� ". ,. tills RETIES.,..,';,',
.►s""�,� Notary Public State of Florida Seal: + Notary PWft-State of
• •$Myr Comm.Expires Now 26,201 S
Maria Carballeira va Commission#EE 143500
ge My CommiasiioonpEgE731472 �y , �5
APPROVED BY Q I Plans Examiner �`I Zoning
Structural Review Clerk
(Revised02/24/2014)
r
t/tfling Miami Shores Village
.
Building Department
�LVRiup' 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RESTRICTIVE COVENANT PROTECTIVE POOL ENCLOSURE
KNOW ALL MEN BY THESE PRESENTS:
WHEREAS,the undersigned Kristina Guillen is/are the fee
simple owner(s)of the following described property situated and being in Miami Shores Village,Florida:
Address: 1298 NE 104 Street, Miami Shores FL 33138
Whereas,the undersigned owner(s) Kristina Guillen
desire to utilize said Lot(s)as a single building site,and the undersigned owner(s)doles)hereby declare and agree as follows:
I. That the property will not be used in violation of any ordinances of Miami Shores Village or Miami-Dade
County now in effect or hereinafter enacted.
II. That the purpose of the covenant is to induce Miami Shores Village to issue a permit for a pool where the
required enclosure is not on the subject property where the pool is located.
III. That if any of our adjoining neighbors remove any portion of their fence or wall,or if our/my property shall fail
to meet code requirements for pool barriers,we,as owners will immediately install a protective enclosure to
meet code requirements and will obtain a permit for such fence.
IV. That,I/we,as owner(s)hold Miami Shores Village harmless for any negligence or injury that results from not
having the enclosure.
V. If enclosure belongs to said property,I agree to maintain&or replace said enclosure in the event that is
damaged or removed by any case.
NOW,THEREOF,for good and valuable consideration,the undersigned do(es)hereby declare that he/she will not
convey or cause to be conveyed the title to the above property without requiring the successor in title to abide by all terms and
conditions set forth herein.
FURTHER,the undersigned declare(s)that this covenant is intended and shall constitute a restrictive covenant
concerning the use,enjoyment and title to the above property and shall constitute a covenant running with the land and shall be
binding upon the undersigned,his/her successors and assigns and may only be released by Miami Shores Village,or its
successors,an accordance of said Village then in effect.
ou Li lie-n
OW7IGN&PRINT OWNER SING&PRINT
I Hereby Certify that on this day personally appeared before me��<< �A i4im l J
1N\ and has produced ID
# as identification and he/she acknowledge that helshe executed the foregoing,freely and voluntarily,
for purposes there in expressed.
SWORN TO AND SUBSCRIBED before me on this—&—day,
/ day of �Ll
NOTARYPUBLIC STATE OF FLORIDA
(Revised 05/2209
C"�'v :tk":is State d Floridatbal1314i2ieka
< ssion y14f4018
r
♦SuR�d`s`�?
,,,,,l" Miami Shores Village
%7 -* Building Department
�kre �
Aires ®
�OR1Up' 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
SWIMMING POOL OWNER'S CERTIFICATION
Date l° '' ��
Miami Shores Village
Building &Zoning Department
Attention: Building Official
I certify that I am the legal owner of the property described as
, located at 1298 NE 104 Street
Miami Shores, FL 33138
In accordance with Section 33-12(f), Code of Metropolitan Dade County, I certify that I
understand and agree that the swimming pool to be constructed at the above address cannot
be used or filled with water until separate permit has been obtained for an approved safety
barrier, and such barrier erected, inspected and approved.
further understand that this certification, however, does not eliminate the need for
obtaining a permit and erecting and approved barrier prior to final inspection and use of the
pool.
Legal Owner
Note:This certification is to be submitted with a swimming pool permit appication in duplicate.
�yard�r�tT i,nr`i¢,�`� ��'�.�' f� i ° � ��. ' yp. ro�"tx`'° ��e� .�9,a.'�✓a�:+sel�tr ��'�:���,az%. „� �'�s. y �g��,�",..
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Ir COMMERCIAL
IER RESIDENTIAL
CONSTRUCTION AND PAVERS, INC.
Date:October 13,2015
State of Florida
County of Dade
Before me this day appeared Michelle Lyman who,being duly sworn,deposes and say:
That she will be the only person working on the project located at:
1298 N.E.104'Street
Miami Shores, FL 33138
Y
Sw o ubscribed before me this 13"'day of October.2015,by Michelle Lyman
Personally know
/A
OR Produced Identification
r
Type of Identification produced
-Md/L-zk �� Q-&d6 -
Print,Type or Stamp Name of Notary
Martha Estrada
IT„
;a=
W%"A,11 :
Office 954-441-4224 Fax 954-693.4703 Email: premierenterprisegroup@yahoo.com
Premier Enterprise Group of South Florida Inc Building Contractor • Licensed&Insured CBC 1256001
�n
Ingo "BRIM Miami Shores Village
resBuilding Department
��lpv 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 �.. 6 nip�'Y,�j.,;. its t ,"�`r ,. � kssr a .�.. � F ""T"""'."'77:;: i 7777,{
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees,including the owner,must obtain workers'compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if:
1. The officer owns at least 10 percent of the stock of the corporation,or in the case of
an LLC,a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State,Division of Corporations;and
3. The corporation is registered and listed as active with the Florida Department of
State,Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use
day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of
workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors.
BY SIGNING BELOW YOU A OWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
0
Signature:
la, '
Owner
State of Florida
County of Miami-Dade �� ®
The foregoing was acknowledge before me this day of VdIO& ,20 15—.
By Knc' z-_bng, G( who is personally known to m or has produced
as identificatio
Notary: C_ cm 4
SEAL:
�#V 0, Notary Public State of Florida
Marla Carbelleira
WCOMM
p1 Expires 12!14!2015
_ _
,> _. Florida .._
DELTA7
rd Street e Miami, FL 331155
P831 0 SW h
one: 305-221-3149
4<� Miami1298 NE 104 ST -
Address of Treatment or Lot/Block of Treatment1 /5/16 2:00 Pm ftke Gonzalez
Date Time Applicator
Premise
Imidacloprid 50 Gallons
Product Used Chemical :. _..
r.� 500 SF
Percent Concenbstion Area wwted(square feet) Linear feet Vented
Horizontal & Adjoining Slab
Stage of treatment
(Horizontal,Vertical,Adjoining
Slab,r:,
A.,As
If ifthis notice is for the'
:: .: .. .. . :final _ :: , : this line
Loam IffgMaj
i 1 _�� —�•V\Y�\WY 'YNYiY�\\I YLi\Y�\MN
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,DEC DYNATECH ENGINEERING CORP,
W W W.DYNATECHENGINEERING.COM
Miami,January 6, 2016
Mrs. Christina Guillhen
1298 Northeast 104 Street �.
Miami Shores,FL /�?
Re: Proposed Pool Deck @
1298 Northeast 104 'Street
Miami Shores,FL
Dear Mrs. Guillen:
Pursuant to your request, Dynatech Engineering Corp. (DEC) performed a Compaction Test on
January 6, 2016 at the above referenced project. DEC was authorized to perform a compaction
test only. The purpose of our test was to determine the degree of compaction of the tested layer
of material only. In no way shall a compaction test replace a demucking inspection, soil bearing
capacity determination, or a pad certification. A soil boring test must be performed by client if
not yet done,prior to construction to verify subsoil conditions. Underlying soils below test levels
must be verified to prevent future settlements. (DEC) was not authorized to perform supervision
and certification of the building pad preparation. This is not a pad certification. Our reports must
be provided to all involved parties for their approval.
Our findings are relative to the date and areas of our site work and should not be relied upon to
represent conditions on other areas or dates. Any subsequent site disturbances due to water
erosion, rain, storm gutters discharging at footings, construction activities, excavations,
overgrown, vegetation, traffic and other disturbances will void this test and the site must be re-
compacted and re-tested prior to construction.
Environmental analysis of the soil materials is not part of the scope of services. If environmental
analysis of the soils is required, we can provide a proposal for performing an environmental
analysis of the soil materials. No other analysis is implied or warranted.
As a mutual protection to clients, the public and ourselves, all reports are submitted as the
confidential property of clients, and authorization for use, publication of statements, conclusions
or extracts from or regarding our reports is reserved pending our written approval.
Enclosed find copies of the compaction telt nsul�s °It has been a pleasure working with you and
look forward to do so in the near futur ,� ':d 4D
Sincerely yours, Al®,
39,
,
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SPT e.
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�Wis , P. E. `%° ° OF • '�
DYNATECH ENGINEERING CORP.'n 9 °�®Rt®A
Florida Reg.No. 39584 At4L-VAG®* ,�°e
Special Inspector No. 757
Certificate of Authorization No.: CA 5491
1
750 WEST 84TH STREET,HIALEAH.FL 33014 PHONE(305)828-7499 FAX(305)828-9598 EMAIL•INFOODYNATECHENGriQEERING.COM �1 , EC
DYNATECH ENGINEERING CORP,W W W.DY'1V'ATECHENaINEERINO.COM
eti.a
MOISTURE-DENSITY RELATIONS OF SOILS
PROCTOR COMPACTION TEST
DATE: January 6,2016
CLIENT: MRS. CHRISTINA GUILLEN
PROJECT: Proposed Pool Deck lad
ADDRESS: 1298 Northeast 100 Street,Miami Shores,FL
CONTRACTOR: Mrs. Christina Guillen
MATERIAL DESCRIPTION: Tan sand whock fragments
SAMPLED BY: JA TESTED BY: JA
TEST RESULTS
Sample Number 1
The following compaction test was conducted in accordance with the Standard Methods for Moisture Density Relations of soil using a
10 lb.Hammer and an 18"drop ASTM D-1557.
% MOISTURE DRY DENSITY
5.1 104.2
6.6 107.4
8.9 110.3 113
13.0 108.9 D
14.6 105.5 R
111 Y
D
109 E
Optimum Moisture---I 0-1Percent N
100%Maximum Dry Density--!I-1.3 lbs./cu.ft. 107 S
%Passing 3/4"Sieve 88.4 Percent I
105 T
Y
-103
Sampled By:JA
Tested By: JA
Checked BY:WN oa t"1C &eo� 6 8 10 12 14 16
m e �e
e a M0. e 39684 a mutual protection to clients,the public and ourselves,all reports a o ar
_Respectively submittgd,
are submitted as the confidential property of clients,and authorization ' 0 . S'q
e
for use,publication of statements,conclusions or extracts from or regardiq�, ee p�®� 20. <`Wlssam Na Mani,F.E.
our reports is reserved pending our written approval. ee`0 DYNATECH ENGINEERING CORP.
�+��` Florida Reg.No.39584
EPI�®�ee° g
Certificate of Authorization No.:CA 5491
2
750 WEST 84TH STREET,HIALEAH,FL 33014 PHONE(305)828-7499 FAX(305)828-9598 EMAIL•INFOODYNATECHENGINEERING.COM �IEC
^D E CDYNATECH ENGINEERING CORP.
W W W.DMA%TECHENGINEERING.COM
FIELD DENSITY TEST OF COMPACTED SOILS
DATE: January 6,2016
CLIENT: MRS. CHRISTINA GUILLEN
PROJECT: Proposed Pool Deck n.
ADDRESS: 1298 Northeast 104''Street,Miami Shores,FL
CONTRACTOR: Mrs. Christina Guillen
Test No. 1 Location: East side of north pool deck underslab
Test No. 2 Location: West side of north pool deck underslab
Test No. 3 Location: Center of west pool deck underslab
Test No. 4 Location: Center of south pool deck underslab
Test No. 5 Location: Center of east pool deck underslab
Description of Material: Tan sand w/rock fragments
TEST NO. 1 2 3 4 5
DEPTH 12" 12" 12" 12" 12"
FIELD DENSITY 109.7 110.1 109.5 109.3 110.2
MOISTURE CONTENT% 8.9 9.2 8.7 8.3 8.6
MAX.DENSITY IN THE FIELD % 98.6 98.9 98.4 98.2 99.0
COMPACTION REQUIREMENTS 98% 98% 98% 98% 98%
%OF MAXIMUM
100%MAXIMUM DENSITY(LAB) 111.3 111.3 111.3 111.3 111.3
REMARKS: ALL ABOVE TEST RESULTS COMPLY WITH COMPACTION REQUIREMENTS
Please note this is not a pad certification.A soil boring must be performed to determine subsoil conditions below the tested compaction layer prior
to construction.
Respectfully submitted,
Tested By:JA
Checked By:WN
®m •^LIC
Wis Naamani,P.E.
DYNATECH ENGINEERING CORP.
'96c�, aFlorida Reg.No.39584
e
„ ® � �T�9I�® ,® Certificate of Authorization No.:CA 5491
.� i
*A density test determines the degree of compaction of the tested °ice erial only. In sfo#Ayihall a density test replace a soil bearing capacity determination.
A soil boring test must be provided by client,prior to constructio a o/Igl�oil coni' As a mutual protection to the clients,the public and ourselves,all
reports are submitted as the confidential property of clients,and bfl°tbf wt of statement conclusions or extracts from or regarding our reports is
reserved pending on our written approval. E.`t
3
750 WEST 84TH STREET.HIALEAH,FL 33014 PHONE(305)828-7499 PAX(305)828-9598 EMAIL INFOODYNATECHENGME MUNG.COMf EC
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Associates Services, Inc.
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MIAMI SHORES SECTION 8 REVISED 31.41
DRAWN 8Y: ART-S
�,•: :.,. SURVEYOR NOTE
acs L t -THERE ARE NO WS1BLE ENCROACHMENTS
CHECKED BY: R.A.
SCALE: V-20'
fie'• waw.{�1
`••.."4"t;�a;s,..• FIELD DATE: 02.0&2094
0000,,„00.0
JOB NO: 94-0239500
SEAL SHEET. 12 OF 2
U.S.FEDERAL
MERGE OFHOMELANDMANAGEMENT
SECURITY ELEVATION CERTIFICATE OMB No.1660-0008 - ®W—
FEDERAL EMERGENCY INANAaEMENT AGENCY FW Expiration Date:July 31,2015
Nmlw,aFWIhtauaact Progrmhn IMPORTANT:Follow the Instructions on pages 1-9.
SECTION A-PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name KRISTINA GUILLEN 14-023150OAK Policy Nom;
A2. Buitd1%9 tut Adneludtng Apt.,Unit,Suite,and/or Bldg.No.)or PO,Route and Box No. comperry Nuc Number: •• •
E 1 • •••
City MIAMI SHORES State FL ZIP Code 33138 •• • ••••••
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) •••••• ••••• ••
RIVER BAY PARK PB 41-55 LOT 5 BLK 211-2232-030-0100 •
44. Building Use(e.g.,Residential,Non-Residential,Addition,Accesstary,etc.)gESIDENTIAL ••••••
A5. Lstltude/longitude:Lot. M2G082.14" Long.VM*10'1(r Horizontal Datum: ❑NAD OP• NAD 198$ • i••••0
A6. Attach at least 2 photographs of the building it Ute Certificate is Mktg used to obtain good hhsurence. •••• •*00:0 • •
A7. Building Diagram Number 1 f+ •
A8. For a bufldbng with a crawlspeca or enclosure(s): A9.For a building with an attached garage: •••�••�• • :::see
••
a) Square footage of crowiepac a or enclosures) sg ft a) Square footage of attached garage •• _sgtt • •••
b) No.of permanent flood openings in the crawispace or 17 b) Number of permanent flood OpeMng�ip garage•• •• •••
enclosure(s)within 1.0 foot above adjacent d� •••
�� � within 1.0 foot above adjacent gre
• •
Q Total net area of fl00tl openings In AB.b sq in c) Total net area of flood openings in Alb rv'- sq.in •
d) Engineered flood openings? 13 Yes ®No d) Engineered flood openings? ❑1(ps (�No ••••i• ••••i•
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION ••• i • :••• •
61.NS P 1ty N e mminity Numbern Na ••• • ••
MIAMI R -1 MI- ADEM VL State ••• : •
B4.-Map/Panel Number 86,Suffix 86.FIRM index Date I B7.FIRM Panel Eff / 1 88.Rood Zones} I B9.Base Rood Elevations)(Zone
Revised Date A0.use base flood depth)
12D86C 0306 L 09/11/2009 09/11/2009 AE 8.0
810.Indicate the source of the Base Rood Elevation(BFE)data or base food depth enteral in Item 89:
❑FIS Profile ®FIRM ❑Community Determined ❑Other/Source:
511.Indicate elevation datum used for BFE in Item 69: ®NGVD 1929 ❑NAVD 1988 ❑Other/Source:
812.Is the building located in a Coastal Barder Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes 11 No
Designation Date: / / ❑CBRS ❑OPA
SECTION C-WILDING ELEVATION INFORMATION(SURVEY REQUIRED)
Cl. Building elevations are based on: ❑Construction Drawings* ❑Building Under Construction* IN Finished Construction
*A new Elevation Certificate will be required when construction of the building,is complete.
C2. Elevations-Zones Al-A30,AE,AH,A(with BFE),VE,V1-V30,V(with SFE),AR,AR/A,AR/AE.AR/A1-A30.AR/AH,AR/A0.Complete Items
C2.a-h below according to the building diagram specified in Item A7,In Puerto Rico only,enter meters.
Benchmark Utilized: DC Vertical Datum: NGVD 1929
Indicate elevation datum used for the elevations in items a)through h)below. ®NOVO 1929 ❑NAVO 1988 ❑Other/Source:
Datum used for building'elevations must be the same as that used for the SFE. Check the measurement used.
a)Top of bottom floor(kaduding basement,crawlsowe,or enclosure floor) 9. 3_ lid feet ❑meters
b)Top of the next higher floor N/, A C1 feet ❑meters
c) Bottom of the lowest horizontal structural member(V Zones only) N/. A ®feet [3meters
d)Attached garage(top of slab) N/, A M feet ❑meters
e)Lowest elevation of machinery or equipment serAcIng the building 8. 00 ®feet ❑meters
(Describe type of equipment and location In Comments)
f) Lowest adjacent(ttnishod)grade next to building(LAG) 7, 90 ®feet ❑meters
g) Highest sQacent(ftnisned)grade next to building(HAG) a. 10 IN feet ❑meters
h)Lowest adjacent grate at lowest elevation of deck or stalls,including Nt,A IN Net ❑meters
structural support
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation
Information.t certify that the information on this CBrtiRcate represents my best efforts to Interpret the data avallabte.
I understand that any false statement may be punishable by fine or Imprisonment under 18 U.S.Code,Section 1001, t•«rj•..
®Check here If comments are provided on back of form. Were latitude and longitude in Section A provided by a
❑Check here If attachments. licensed land surveyor? ®Yes ❑No r
0
centre �enae �
EFRAIN C.LOPEZ 2300&LB 753$ t e° f
'nue Company name t
P.L.S.
address Q'AVILA&ASSOCIATES SERVICES INC
••°'"a .•,''•d
code
680 E 49 STREET H�1ALEAH FLLte 330113 '`•«.».•"'•
5i®nahars Data I Telephone
0210812014 305 953-2600
FEMA Form 08 12) See reverse side for continuation. Replaces all previous editions.
..............
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ELEVATION CERTIFICATE,page 2 _ i
' IMPORTANT:In these spaces,copy the corresponding Infortnadon from Section A. FOR INSURANCE COMPANY USE
Building Street Address(Including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Polly Number.
1298 NE 104 ST
City State ZIP Code Comp"NAIC Number:
MIAMI SHORES FL 33138 •
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) _• •'•••
Copy both sides of this Elevation Certificate for(1)community official.(2)Insurance agent/company,and(3)building owner. •• ••••••
Comments C.2.E.REFERS TO AIR CONDITIONER MACHINERY SERVICING BUILDING 909060 • •••• ••
%W:..
LATITUDE AND LONGITUDE OBTAINED BY GPS/FLOOD ZONE DETERMINATION IS FURNISHED BY •••• •••• •
THIS ELEVATION IS INTENDED FOR FLOOD INSURANCE PURPOSES ONLY;NOT TO BE USED FOR•LUI #O.R ZON%G • •••••
•••• • •
Signature T�C Dab 02/08!2014 •••••• •••••
w�-;� •
SECTION —NINEDiNG ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A tWft BFE) •' • ••••••
For Zones AO and A(without BFE),canplete Items E1-E5,V the Certificate is intended to support a LOMA or LOMR•F request.compltkOSe tipW A,Band C. •• ••••••
For Items Ei-E4,use natural grade,if available.Check the measurement used.In Puerto Rico only,enter meters. • • • •
E1.Provide elevation Information for the following and check the appropriate boxes to show whether the elevation is above or below the highe0adjacent• •
grade(HAG)and the lowest ad)ecenf grade(LAG). 0 • *00000 ••••i•
a)Top of bottom Door(Including basement.crowispeca,or enclosure)is ❑feet []meters ❑above or Q%10*mew! • •
b)Top of bottom floor(including basement.crowispace,or enclosure)Is ❑feet ❑meters ❑above or ❑below the LAG • ••• ••••••
E2.For Building Diagrams B-9 with permanent flood openings provided In Section A Items 8 and/or 9(see pages 8-9 of Instructions), ••• • •
the next higher floor(elevation C2.b In the diagrams)of the building is ❑feet ❑meters ❑above or ❑blow the HAG.
E3.Attached garage(top of slab)is ❑feet ❑meters ❑above or ❑below the HAG.
E4.Top of platform of machinery end/or equipment servicing the building is ❑feet ❑meters ❑above or ❑blow the HAG.
ES.Zone AO on If no flood depth number is available.is the top of the bottom floor elevated In accordance with the community's floodplain management
ordinance?[3 Yes ❑No ❑Unknown.The local offlial must certify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owner's authorized representative who completes Sections A,B,and E for Zone A(without a FEMA-Issued or communitydssued SFE)or
Zone AO must sign here.The statements In Sections A,S.and E are correct to the beat of my knowledge.
Property Owner or Owner's Authorized Reprosentative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
❑Check here if attachments.
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can compete Sections A,B.C(or E),and
G of this Elevation Certificate.Complete the applicable item(s)and sign below.Check the measurement used in Items G"10.in Puerto Rico only,enter meters.
G1. ❑The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect
who is authorized by law to certify elevation information.(Indicate the source and date of the elevation data In the Comments area below.)
G2. ❑A community official competed Section E for a building located in Zone A(without a FEMAassued or commun*Issued BEE)or Zone A0.
G3. ❑The following information(Items G4-G9)is provided for community floodplain management purposes.
G4. Permit Number G5.Date Permit Issued I G6.Date CertNk ate Of Compliance/Oocuponcy issued
G7. This permit has been issued for. ❑New Construction ❑Substantial Improvement
G8. Elevation of es4)ullt lowest Door(including basement)of the building: C7 feet ❑maters Datum
G9. BFE or(in Zoo AO)depth of flooding at the northing site: ❑feet ❑meters Datum
G10.Comma W$design flood elevation: ❑feet ❑meters Datum
Local Of(k iefs Name Title
Community Name Telephone
Signature Date
Comments
❑Clock here if attachments.
FEMA Form 086-0-33(7/12) Replaces all previous edMons.
ELEVATION CERTIFICATE,page 3 BUILDING PHOTOGRAPHS DAVILA
See Instructions for Item A6.
IMPORTANT:In these spaces,copy the corresponding Information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt..Unit,Suite.and/or Bldg.No.)or P.O.Route and Box No. Policy Number:
1298 NE 104 ST
CSale ZIP Code Company NAtC Number: •
itMIAMI SHORES FL 33138 • ••••6
• � 0000••
If using the Elevation Certificate to obtain NFIP hood insurance,affix at least 2 building photographs below according to t� instructions •••• •
•
for Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and,if required, "Right Side Vle ' Cht*Left 6 •• •�
Side View."When applicable,photographs must show the foundation with representative examples of the flood openingswargr4s,as •••••6
indicated in Section A8.If submitting more photographs than will fit on this page,use the Continuation Page. •
•
0000 •
• • • •0000•
FRONT VIEW/SIDE VIEW •••• 0.00 • •
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Yom^ DATE:02-08-2014
FEMA Form 086-0-33(7/12) Replaces all previous editions.
ELEVATION CERTIFICATE,page 4 BUILDING PHOTOGRAPHS
Continuation Page
IMPORTANT:In these spaces,copy the corresponding Information from Section A. FOR INSURANCE COMPANY USE
Duilding Street Address(Including Apt.,Unit,Suite,arid/or Bldg.No.)or PO-Route and Box No. Policy rmmbec
1298 NE 104 ST
City State ZIP Code Company MAIC Number: •
MIAMI SHORES FL 33138 • 00000
so
If submitting more photographs than will fit on the preceding page,affix the additional photographs below.Identify all photoraphs with: 6••• •
•
date taken;"Front View"and"Rear View";and,if required,"Right Side View"and"Left Side View."When applicable,photDill ahE fiust ••••• •
show the foundation with representative examples of the flood openings or vents,as indicated in Section A8. 666606 ••0•
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E)ATE:02-08-2014
FEMA Form 086-0-33(7/12) Replaces all previous editions.
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CLIENT. KRISTINA GUILLEN
PROPERTY ADDRESS:A290 NE 104 STREET.MIAMI SHORES FL 33138
LEGAL DESCRIPTION:
LOT 5,BLOCK 2,RIVER BAY PARK SUBDIVISION,ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 41,PAGE SS,
OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY,FLORIDA.
ELEVATION INFORMATION:
B.M.USED- ELEVATIONS=LOCATED----
BASED ON THE FLOOD INSURANCE RATE MAP OF THE FEDERAL EMERGENCY MANAGEMENT AGENCY DATED OR REVISED ON
9.11.09 THE HEREIN DESCRIBED PROPERTY IS SITUATED WITHIN ZONE AF BASE FLOOD ELEVA TION 8.00 COMMUNITY 120652
PANEL NUMBER 0306 SUFFIX L
DRAWN BY: ART4
CERTIFIED TO.
KRISTINA GUILLEN +i�"'�L"'�l'•.
•:4HCA•i••.,•4
SPACE COAST CREDIT UNION IE INSURANCE •
CHECKED BY: R.A. OLD REPUBLIC NATIONAL TITLE INSURANCE CO. 3
URBAN TITLE,LLC i Aa
FIELD DATE: 02.08.2014
JOB NO: 14.0231800 '•- w
SHEET: 1 OF2 SEAL
i ® - 2&1®� .
OCT 2 9 2015
133:
rentak Neer
Pool and Spa°
IntelliBritd"
White
Lights
Pool and Spa
I�yS
s <
,�• � yii is
1 J +s
Installation and User's Guide
•• •fMPORTANT.'SAFETY INSTRUCTIONS
••.RPAfl:AI`4Ei 00
&LOW ALL INSTRUCTIONS
•• ••• •SAVE THESE INSTRUCTIONS
.. . . .... . . .. .. .
.
• •• 00 0 • . •• ELECTRICAL REVIEW ya� u
••• ••• APPROVED DATE
. . . .
. . . . . . . . . .
. .. .. . . . .. ..
... . . . ... . .
8
5. Install the IntelliBrite light assembly into the niche and tighten the special
bronze pilot screw.
� Use only the special pilot screw provided with this
underwater light. This screw mounts and electrically grounds the housing
securely to the mounting ring and wet niche.Failure to use the screw
provided could create an electrical hazard which could result in death or
serious injury to pool users, installers or others due to electrical shock.
Pilot screw(bronze) Pilot screw(bronze)
O � p
IntelliBrite 5g White Pool Light IntelliBrite Spa Light
6. Fill the pool until the underwater light is completely submerged in water
before operating the light.
7. Final check for proper light operation:To check for proper operation,
switch on the main switch or circuit breaker,and the switch that operates
the IntelliBrite underwater light itself. The light should illuminate when
power is applied. If not recheck the installation steps starting with Step 1
(page 7)
FOR INTELLIBRITE WHITE POOL AND SPA LIGHT REMOVAL AND
INSTALLATION INSTRUCTIONS SEE:
• Replacing the IntelliBrite 5g White Pool and Spa Light
Assembly instructions,on page 4.
• Replacing the IntelliBrite White Spa Light Face Ring and
..Gasket or Gesketpndkens Instructions,on page 17.
.. ... .. . . . ..
Intelli�riteO5'g-VVhit:Pool Dight anj VgWtc:Spa Light Installation and User's Guide
... . .
ELECTRICAL REVIEW
am'X-elp
... . . . . ... . •
• APPROVE
• • ••• DATE______
.:
... . . . ... . •
r *
1
7
REQUIREMENTSINSTALLING THE INTELLIBRITE 5G WHITE POOL AND SPA LIGH
FIXTURE (AFTER ELECTRICAL .
E MET)
To install the IntelliBrite light fixture:
1. Route light cable through conduit to Junction Box, leaving at least four(4)
feet of cable at the light fixture to coil around the light(this allows the light to
be serviced after the pool is filled with water). See Figure 1 below.
48° _
min.
To GFCI,Circuit
Breaker and 4°min, 8°min.Junction Box or Low
Power Source. �� Voltage Transformer,to the
max.water[oval of the pool.
Rigid 18°min.to top of Lens.
Conduit
#8 AWG around
Connector bonding
Is located at rear
oi�;i _ Concrete must be cut
f niche.
'' l back around niche to
allow for a compacted
plaster seal.
11.50'
Coil 4 ft.of light
cable around fixture.Figure 1. 18"
2. Cut the cable at the Junction Box, leaving at least six(6)inches(2.4 cm)of
cord to make connections.
3. Strip back six(6)inches(2.4 cm)of the outer cord jacket to expose the
three insulated conductors(be careful not to damage the insulation on the
three(3)inner conductors).Strip a 1/2"of insulation off the three
conductors.Be careful not to damage the copper conductor.
4. Connect all three (3)conductors to the corresponding circuit wires in the
Junction Box and secure the Junction Box cover in place.
of ••• • • • • ••
• • • • • •• • •
• • • • • • •
• •• • •• • • ••• •
•• ••• •• • • • ••
•••
00 ':• Intg1F1Ari! fog WIf te••Pooj Light and White Spa Light Installation and User's Guide
••• • •• ••
• • •• • • • •
••. ELECTRICAL REVI
••• . . . . •• • • .�O�j '��j
. . . w• APPROVED �.
... . . . ... . .
ryRES
Miami shores Village
BO
s�
Building Department ' gin p
10050 N.E.2nd Avenue
Miami Shores, Florida 33138 L ,y '�
Tel: (305) 795.2204 tcRNA
Fax: (305) 756.8972
OCTOBER 20, 2015,
Permit No: BPP-10-15-2601
Building Critique Review
Provide specifications for the required low voltage pool light.
Plan review Is not complete,when all Items above are corrected,we will do a complete
plan review.
If any sheets are voided, replace them with new revised sheets and place behind the most
current page.
z l
Miami Shores Village
♦S��REs�i
Building Department ovum alms"
10050 N.E.2nd Avenue
Miami Shores, Florida 33138 CIT L��iy V
Tel: (305) 795.2204 sh lOR1DA
Fax: (305) 756.8972 to
OCTOBER 20, 2015, COPI
Permit No: BPP-10-15-2601
Building Critique Review
Provide specifications for the required low voltage pool light.
Plan review Is not complete,when all Items above are corrected,we will do a complete
plan review.
If any sheets are voided, replace them with new revised sheets and place behind the most
current page.
• . ......
•
• • • •
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WATEf&LINE
— — 5'-0" MIN.
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#8 AWG GROUND
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BONDED TO
d' ut REBAR
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LASTIC LIGHT NICHE
(9 2 V) TO COMPLY WITH
F.B.C. 2094 AND NEC 680
(SEE PLAN FOR LOCATION)
SECTION UNDER WATER LAMP
SCALE 314" = 1'-0"
ELECTRICAL REVIEW `����
APPROVE ,_DATE
Auk
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CONSTRUCTION MATERIALS
tift TECHNOLOGIES
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CORp Cy
NEW
Client: Pool Guard Manufacturing, Inc. CITY
11575 47'"Street N
Clearwater, FL 33762
Attention: Mike Corkery COPY
Material: Pool Fence Manufacturer. Pool Guard Manufacturing, Inc.
Date Received: April 20&May 16,2012 Source: Pool Guard Manufacturing, Inc.
PRI Project No.: PGM-001-02-01 Dates Tested: April 20—May 21,2012
Purpose: Evaluate Pool Guard's Pool Fence for compliance with the 2010 Florida Building
Code,Res/dentist.
Test Methods: Evaluation and testing was conducted in accordance with 2010 Florida Building
Cale,Residential Sections R4101.17.1.15,ASTM D3787-01 Standard Test Method
for Bursting Strength of Textiles-Constant-Rate-of-Traverse(CR7)Ball Burst Test,
and ASTM D5034-95 Standard Test Method for Breaking Strength and Elongation
of Textile Fabrics(Grab Test).
Sample Description: Fence roosts—6063-T52 aluminum round tube; Nominal 1" O.D. x 0.125"wall
thickness
Fence mesh—Twitchell Corporation T45 DBS; Leno weave fabric using 0.25°dia.
vinyl-coated 1000 den.polyester core yams in the warp and fill directions. Additional
information supplied by the Client is contained in Appendix A.
.906.0
6
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9999.. . 9999..
9999..
9999..
9999
9999 9999 9999.
9999.. 9999 9999.
66 99 6999 996669
666969
00
. 6 . . .96696
699696
9
.. 9999
PGM-001-02-01 PRI-CMT Accreditation:AS TL-189;Miami-Dade 11-0429.05;Florida TST5878;Los Angeles TA24846,?CARC
The test results,opinions,or interpretations are based on the material supplied by the client. This report is for the exclusive use of stated
client No reproduction or facsimile in anyform can be made without the clients permission. This report stall not be reproduced except in
full without the written approval of this laboratory. PRI Construction Materials Technologies,LLC assumes no responsibility nor crakes a
performance or warranty statement for this material or products and processes containing this material in connection with this report
PRI Cain Ideriais Tedmdoges,LLC. OM I)dw TarnM FL 33816 T01:813-621-5777 Fax:813821-M &mdffwbrWsWsftWcrritwm Website:httpJhw.pkmtwm
• Pool Guard Manufacturing,Inc.
'Pool Fence
Page 2 of 3
Results of Testln :
Property •
711 '77R r
Horizontal Loading, (lbf)
Ultimate load;3 specimens; 2010 FBC
36"moment arm;4"embedment into substrate; R4101.17.1.15 56 2:52
Test at 73.413.6°F&5015%RH;
�yyy�c� Rate=10 InJmin
Fh 3 � k 3
Tensile Strength,(lbf)
5 specimens each direction;4"x 6" ASTM D 5034
Test @ 73.413.6°F and 5012%RH
Rate=1210.5 inJmin
Warp 232 a100
Fill 140 2x100
Burst Strength, (lbf)
5 specimens;5"x 5' ASTM D 3787 252 a 150
Test @ 73.413.6°F and 5012%RH
V Steel Ball;1-3/4"Ring;Rate=1210.5 inhnin
1/4-Sphere Penetration,(Pass/Fail) i odeformation such
5 specimensthatotged
Test cel 73.413.6°F and 50120/6 RH can penetrate mash
Statement of Compliance:
The samples submitted comply with the 2010 Florida Building Code,Residential as stated above.The results
and interpretation of testing are representative of the material supplied by the client.
PA unbar:74M
i •,, 1�••A - t�••• •r• '.
Report aY' 6'14811ten
tall@ •• •• .....
Issue# Date Pages Revision Description(if applicable) 0%004
•••• •• •••
Original 5/25/2012 3 NA •' " "•• ••••••
. . . . ...•..
•
PGM-001-02-01 PRI-CMT Accreditation:IAS TL-189;Miami-Dade 11-0429.05;Florida TST5878;Los Angeles TA24 44 CRRC
The test results,opinions,or interpretations are based on the material supplied by the client.This report is for the exclusive use of stated
client. No reproduction or facsimile in any form can be made without the client's permission.This report shall not be reproduced except in
full without the written approval of this laboratory. PRI Construction Materials Technologies,LLC assumes no responsibility nor makes a
performance or warranty statement for this material or products and processes containing this material in connection with this report
PFJC=WcfiwMaW*TWtmdoqWs,LLC. 6408 Badger Ddn Tampa,FL 33610 Td:813821.5777 Fax:813821-5840 e-md mated =Lc= WebSie:tdipJMww.prlcmtc=n
$ Pool Guard Manufacturing,Inc. Appendix A
1
'Pool Fence
Page 3 of 3
Fence mesh datasheet provided by Client:
Fine//
COR P O R A T I O N
Technical Bulletin
Item Number. T45 DBS 1/26/2005
Product Description:
A Leno weave fabric lasing .025"dia.vinyl-coated 1000 den.polyester core yams
in the warp and fill.
Attribute ASTM Warp Fill Typical
Construction,end/inch D3775-96 10.0 7.0
Weight,ozlyd2 D3776-96 — — 7.2
Tensile Strength(grab),Ibf D5034-95 322.9 221.4
Tensile Strength(strip),Ibf D5035-95 142.9 121.9
Tear Strength, (Trapezodial),Ibf D1117-97 66.1 38.2
Elongation,% D5035-95 26.5 23.7
Abrasion Resistance D3884-92 No exposure of core yam
(CS10/500 cycles/with no added weight)
Ball Burst,Ibf D3787-89 198.0
Flammability Rating CS-191.53&CA 117E
Weatherability, 1200 burs G53-96 No discoloration
Mildew Resistance G21-96 No growth
Mathematical . . 006'6 60*::4
Openness Factor, % method S6�88
...... .• ••••••
'*The above results are a representative of real data from single test samples. •••••• • • •
0000•.
0000 •• •• •.•.•
0000•• 0000 ••i••�
•• •• 0000 0000••
0000•• • ••
END OF REPORT • • • •
• • • • ••••••
0000••
• • • •0000•
00 000 0
PGM-001-02-01 PRI-CMT Agitations:IAS TL-188;Miami-Dade 11-0429.05;Florida TST5878;Los Anger TA248c111;CIRC
The test results,opinions,or interpretations are based on the material supplied by the client This report is for the exclusive use of stated
diem No reproduction or facsimile in anyform can be made without the dienrs permission.This reportshall not be reproduced except in
full without the written approval of this laboratory. PRI Construction Materials Technologies,LLC assumes no responsibility nor makes a
performance or warranty statement for this material or products and processes containing this material in connection with this report
ARI Cawk d m Malars Tedmdogiw LLC. 6408 Bader Drive Tampa,FL 33610 Tei:813421-5777 Fax:813-621-5840 e-Mdj10ffiWde8bQ&nCrAt00M Website:htlp:/hr"".prkrd=n