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RF-16-2315 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-265625 Permit Number: RF-8-16-2315 Scheduled Inspection Date:August 31,2016 1 Permit Type: Roof Inspector. Mesa, Michel Inspection Type: Final Roof Owner: AYUSO,AGUSTIN&NORMA Work Classification: Repair Roof Job Address:10619 NE 10 Place Miami Shores,FL 33138-2103 Phone Number () - Parcel Number 1122320280580 Project: <NONE> Contractor: MAINLAND CONSTRUCTION CO Phone: (305)696-7663 Building Department Comments APPLY ROOF COATING TO FLAT SECTION OF HOME nfract o Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid August 30,2016 For Inspections please call: (305)762.4949 Page 12 of 38 31 Miami Shores Village M Fe�lf 7y�e: i100f 10050 N.E.2nd Avenue NE '" Miami Shores,FL 33138-0000 a Phone: (305)795-2204 0 '� Issue3e g „ Expiration: 02118/2017 Project Address Parcel Number Applicant 10619 NE 10 Place 1122320280580 Miami Shores, FL 33138-2103 Block: Lot: AGUSTIN&NORMA AYUSO Owner Information Address Phone Cell AGUSTIN&NORMA AYUSO 10619 NE 10 Place () _ MIAMI SHORES FL 33138-2103 Contractor(s) Phone Cell Phone Valuation: $ 2,500.00 MAINLAND CONSTRUCTION CO (305)696-7663 (786)286-5571 . ..a, _ _.._ _.._ Total Sq Feet: 350 Type of Work:Repair Available Inspections: Additional Info:APPLY ROOF COATING TO FLAT SECTION Inspection Type: Classification:Residential Roof Repair Scanning:3 Final Roof Review Roof Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 DBPR Fee Invoice# RF-8-16-61015 $2.00 08/17/2016 Check#: 1748 $50.00 $67.80 DCA Fee $2.00 Education Surcharge $0.80 08/22/2016 Credit Card $67.80 $0.00 Permit Fee-Repairs $100.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $117.80 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted tohe proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING PO 6L work. OWNERS AFFIDAVIT: I certify that all the,foregoing information is accurate and that all work will be done lin compliance with all applicable laws regulating construction and zoning. Futhermore,I aut a th ed contractor to do the work stated. y August 22,2016 Authorized Signature:CSN , / Appli t / Contractor / Agent Date Building DepaAment Copy August 22,2016 1 UGY7101'6 Miami Shores Village BY AA� Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 1 Y � BUILDING master Permit'No. -( PERMIT APPLICATION sub Permit No. ❑BUILDING ❑ELECTRIC ta ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL ❑PLUMBING ❑MECHANICAL E]PUBLIC WORKS ❑ CHANGE OF CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 106 t q WE 10 PL City: Miami Shores County: Miami Dade Zip: 3313% Folio/Parcel#: 0-2232- 025- 0550 Is the Building Historically Designated:Yes NO_ C Occupancy Type: Load: Construction Type: Flood Zone: i BFE: FFE: OWNER:Name(Fee Simple Titleholder) shn Asuyo Phone#:7%-294-3310 Address: 10 61 q NLS I d PL City: MIAMI 5H ORES State: FL Trp: 3313$ Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: MAINLAND ROOFING ComPANY Phone#: 303- 616-7663 Address: 3740 NW V 5T City: /Mt,4Mr State: FL- Zip: 33147 Qualifier Name: JOSE VAZ 9V EZ Phone#: -M-M-SS'71 State Certification or Registration#: GCC. 132551% Certificate of Competency#: DESIGNER:Architect/Engineer. Phone#: Address City: State Zip: Value of Work for this Permit:$ 20$00 Square/Unear Footage of Worl�: Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace ❑ Demolition Description of work: APPLY 90of LOATLNG To FL AT SEGTZM/ OF HoAg, Specify color of color thru tile: Submittal Fee$ ED` % Permit Fee$ i c CCF 5-1 - CO/CC$ Scanning Fee$ 9. CK) Radon Fee$ '9—- DBPR$_ Notary$ Technology Fee$ 2. 4 Training/Education Fee$ '60 Double Fee$ Structural Reviews$ Bond$ 69 90 Bonding Company's Name(if applicable) Bonding Company's Address City State Zip j 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 falth 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. 4 L Signature U3��U Signature OWNER or A NT CO The foregoing instrument was acknowledged before me this The foregoing instrument was ackn ledged before me this `67W day of �4V GUS f .2016 by $1�f day of AV 6VSr .20 16 ,by Av4vM N A YV50 ,who is Rerma&y known to _,JOSE VAZ%"EZ .who is personally known to me or who has produced as me or who has produced as Identification and who did to oath. identification and who did take an oath. NOTARY P NOTARY PUB Sign: Sign: Print: OBAR Print: o:• a'x Seal: 1 •` MY COMMISSION#FFi 2018 Seal °tCo° gNG1E ESC®®AR EXPIRES December 16. 'ao,: vpe # FbridaN0imservice.com •�i i• Y COMMISSION#FF181676 (ao7)39"153 oPo' 0RES December 16,2018 44444444iis44444444444444444444 ii� 44 .4444sssss4444444sss44444 46����, 44 sssss Zv APPROVED BY Plans Examiner Zoning Miami Shores Village Eggs nag Building Department 10050 N.E.2nd Avenue RIDp Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNERS'S AFFIDAVIT OF EXEMPTION ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR EXISTING SITE- BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PERSUANT TO SECTION 553.844 F.S. To: Miami Shores Village Building Department Date:_a 6/0shoa 10050 NE 2^d Ave Miami Shores,FI 33138 Re: Owner's Name: Av0(fTz.N AYvfO Property Address: I o6l9 Nt IGS PL MYAMs 5110AE5 .9 FL 3313,b Roofing Permit Number: Dear Building Official: I AV 4vsrzN AYus 0 certify that I am not required to retrofit the roof to wall connections of my building because: XThe just valuation for the structure for purpose of ad valorem taxation is less than$300,000.00. Please attach proof of ad valorem taxation. ❑The building was constructed in compliance with the provisions of the Florida Building Code(FBC)or with the provisions of 1994 edition of the uth Florida Building Code(1994 SFBC) T AUeK Ln/ AYvso Signatur Print Name State of Florida County of Dade The undersigned, being the first duly swom,deposes and says that he/she is the owner for the above property mentioned. Sworn to and subscribed before me this dry day of v4vs'f zol _°�`'YP"°4• ANGIE ESCOBAR :_. `oma MY COMMISSION#FF181676 Notary Public,Sate of Florida atLarge 2WEXPIRES December 16,2018 807)398-0tb3 Florldallota Servlce.com • When the just valuation Of the structure for puldEvnammem equal to or more than$300,000.00,and the uilding was not constructed with FBC nor a 1994 SFBC.Then you must provide a building application from a General Contractor for the Roof to Udall connection Hurricane Mitigation. Revised on 5l21009 OFFICE APP[­ Summary o Report Generated On :8/10/2016 Property Information ' Folio: 11-2232-028-0580 ''" 10619 NE 10 PL Property Address: Miami Shores,FL 33138-2103 „ AUG USTIN AYUSO Owner NORMA AYUSO Mailing Address 10619 NE 10 PL MIAMI SHORES,FL 33150 Primary Zone 1000 SGL FAMILY-2101-2300 SQ Primary Land Use 0101 RESIDENTIAL-SINGLE z FAMILY: 1 UNIT Beds/Baths/Half 3/3/0 Floors 1 y; Living Units 1 Actual Area 2,553 Sq.Ft ' ft"- Living Area 2,463 Sq.Ft Adjusted Area 2,400 Sq.Ft Taxable Value Information z Lot Size 10,400 Sq.Ft 2016 2015 2014, Year Built 1953 County Exemption Value - -- $50,000 $50,000 $50.000 Assessment Information _.-,...-.-.. __- ___ Taxable Value $223,979 $222 075 $219,916 Year 2016 2015 2014 -" """ ---.........- - " - School Board Land Value $189,446 $150,586 $208,067 - - _--; - - Exemption Value $25,000 $25,000` $25,000 Building Value $167,040 $167,040 $162,720 -� - - - -- -- Taxable Value $248,979 $247,075` $244.916 XF Value $3,768 $3,138 $3,173 - --- - - " --- -"---- '.-m ............. _- __.. City Market Value $360,254 $320,764 $373,960 - � Exemption Value $50,000 $50,0001 $50,000, Assessed Value $273,9791, $272,075 $269,916 - Taxable Value $223,979 i $222,075 $219,9161 _ -.......-..-............ .............. I .. Benefits Information Regional Benefit :Type 2016 2015: 2014 Taxable Value $223,979( �-... ------- .. -- $50.000 Exemption Value $50,000 $50,000 �- -, -_.__W ..._ _....-. __..- _ 5 $219,9161 Save Our Homes Cap(Assessment Reduction $86,275 $48,689 $104,044 Homestead Exemption $25,000 $25,000 $25,000 Sales Information i Second Homestead Exemption $25,000 $25,000 $25,000 OR Note: Not all benefits area applicable to all Taxable Values i.e.County,School Previous PP y Sale Price: Book- Qualification Description Board,City, Regional). Page 04/13/2009 $200 000 26978- j Financial cost or"In Lieu of Forclosure" Short Legal Description 2631stated $0 ............................... ___... 32 52 42 06/01/2008 Sales which are disqualified as a result of MIAMI SHORES ESTATES PB 47-58 2271 examination of the deed LOT 8 BLK 4 01/01/20061$650,000: !Sales which are qualified 24168- LOT SIZE 80.000 X 130 1550 OR 20435-0110 04 2002 4 03/01/2005,$545,000 23273 !Sales which are qualified 2664 The Office of the Property Appraiser is continually editing and updating the tax roll.This website may not reflect the most current information on record.The Property Appraiser and Miami-Dade County assumes no liability,see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp Version: RICK SCOTT. GOVERNOR KEN LA'NS: N. SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CCC1325518 The ROOFING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS Expiration date: AUG 31, 2016 1103 VAZQUEZ, JOSE EDUARDO ° MAINLAND ROOFING COMPANY 3740 NE 80TH ST HIALEAH FL 33147 Pyr' 9 ISSUED. 08131!2014 DISPLAY AS REQUIRED BY LAW SEQ# L1410831�uJN8°5 LocaleC Miami-Dade County, State of Florida -THIS is NOT eliL..too NOT PAY 2772383 BUSINESS NAME&OCATICN RECEIPT NO, EXPIRES MAINLAND ROOFING COMPANY RENEWAL SEPTEMBER 30, 2016 3740 NW 80 ST 3725307 HIALEAH,FL 33147 te9ust be displayed at place of business Pursuant to C3ru"Code Chapter B.A-Ar,.9&10 OWNER SEC,rVPE OF BUSINESS PAYMENT RECEIVED MAINLAND CONSTRUCTION CO 196 SPECIALTY BUILDING BY°rax COLLECTOR JOSE VAZQUEZ RR ES CONTRACTOR 51.01) 9$r0512015 Worker{s} 12 CCC1325518 0229-15-007633 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a lienees, permit,or a certification of the holder's qualifications,to do business.Holder must comply with any governmental or nongovernmental regoiatary laws and requirements which apply to the business. The RECEIPT NO above most ba played on all commercial vehicles-Miami-Dade Code Seo 80-216. MIAMI For more intormation,visit www.miamidada,00v/taagg;4fectur - CSD DATE IMM/DD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 8/17/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTSPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE CO ERAGE 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTANAME: Jeff Lampert Presidential Insurance Services, LLC PHO(A/C.No.Ems; 305-423-0350_ (AA/C NoL-305-423-0351 E-MAIL 2665 South Bayshore Drive#707 ADDRESS: jeff@insurancequotelive.com Miami, FL. 33133 INSURER(S)AFFORDING COVERAGE _ NAIC d INSURERA: United Specialty Insurance Company INSURED INSURER B: Mainland Construction Company, Inc.d/b/a INSURER C: Mainland Roofing LICENSE#CCC1325518 INSURER D: 3740 NW 80th ST INSURER E Miami, FL. 33147 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR OP�L,ICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DDIYYYY MM/DD/YYYY X COMMERCIALGENERAL LIABILITY EACH OCCURRENCE _ S 1,000,000 CLAIMS-MADE FJ�� OCCUR i-13AMAGE TO RENTED - PREMISES_ accurcence) S 50,000 5-1000 A S111041 E21007 12/8/2015 112/8/2016 MED EXP(Any one person)_ s .J PERSONA_LBADVINJURY_ S 1,000,000 I-G_EN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY_rJ JECTPRODUCTS-COMP/OP AGO S 1,000,000 X� OTHER: LOC --__-_- AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S !_LEa accident)--_ _ - — —�;ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident) S I�AUTOS ONLY _ AUTOS HIRED I NON-OWNED PROPERTY DAMAGE S iu AUTOS ONLY a AUTOS ONLYi ,SPer accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE - S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTIONS S WORKERS COMPENSATION PER OTH- ANDEMPLOYERS'LIABILITY STATUTE -. ER YIN ' ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ NIA A E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? -- -- - - —- — --- (Mandatory in NH) E.L DISEASE-EA EMPLOYEE S If yes,describe under r—- - - - -- — -- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Roofing contractor : License number CCC1325518 CERTIFICATE HOLDER CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD --.-'1 0E(MM/8/11/22016016 Y) ACQR®P CERTIFICATE OF LIABILITY INSURANCE DA 0 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 lieu of such endorsement(s). PRODUCER CONTACT NAME: Bouchard Insurance for WBS PHONE FAX P.O.Box 6090 WC,No E: 866 293-3600 ext.623 A/c No): E-MAIL Clearwater.FL 33758-6090 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC_# INSURERA: American Zurich Insurance Company 4014.2 INSURED INSURER B: Workforce Business Services,Inc.Alt.Emp:Mainland Construction Company INSURER C: dba:Mainland Roofing Company - - 1401 Manatee Ave.West Ste 600 INSURER D: Bradenton,FL 34205-6708 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:15FL079874888 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POUC EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DDMlYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE __ S CLAIMS-MADE 1-1 OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence)_ MED EXP(Any one person) - PERSONAL 8 ADV INJURY :S GEN'L AGGREGATE LIMIT APPLIES PER: PRO- GENERAL AGGREGATE 1$ POLICY EI JECT [�]LOC PRODUCTS-CO_M_PIOP AGG - OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AUTO BODILY INJURY(Per person) S ALL OWNED E SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS PROPERTY DAMAGE HIRED AUTOS NON-OWNED "S AUTOS I Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE S - EXCESS LIABLl - - - - CLAIMS-MADE AGGREGATE 3 DED RETENTION$ S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN X STATUTE ER _ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? NIA WC 90-00-818-05 12/31/2015�'I 12/31/2016 E —C -- -- - - - - (Mandatoryin NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE S 1,000,000 - —-- - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 Location Coverage Period: 12/31/2015 12/31/20161 Client# 054257 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Coverage is provided for Mainland Construction Company dba:Mainland Roofing only those co-employees Company of,but not subcontractors 3740 NW 80th Street to: Miami.FL 33147 CERTIFICATE HOLDER CANCELLATION Miami Shores Village BLDG DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2 Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores,FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(20141011 The ACORD name and logo are registered marks of ACORD SCO ASS�MBL0_z AND RCCF-f.,p F1011da Building Code 5th Edition f2c-f,4,) AUG 17 2016 High-Velocity Hurricane Zone Uniform Permit Appi cation Form. Section A(General Information) Master Permit No. ocess No. _g�FG Contractor's Name 4AA1IVLAXj) JtqopZt4(., CoMpAr4y Job Address ROOF CATEGORY • • ::so* 0 lK Low Slope • 0 0 Mechanically Fastened T0e 00 0 0 0.0 o:. 13 Asphaltic Shingles 0 Metal Panellshingles 01" V.%S e 0 0 0 Ncod Sh1****S"ak_as:0 0 0 :e 0 •0 0 0 13 Prescriptive BUR-RAS 15o 0 0 osoeo ROOF TYPE 0 0 • 00,0000 0 0 New roof *00000 o 4-• .o E3 Repair •10 Maintenance R-3,00fmc. ' ROOF SYSTEM INFORMATION 0 0 0 0 0 0 0 0 Goose: Low Slope Roof Area SF336Steep Sloped Roof AREA(SSF) _Cna!(SF 000*00 0 Ao_o 0.0 0.... 0 00 0 Section B(Roof Plan) Sketch Roof Plan:Illustrate all levels and sections,roof drains,scuppers,overfjo"� sc-JPPers and overflow drains, 'r c' - slons of sections and levels,clearly identify dimensions of elevated pressure zones and'local,:,)- I of parape+s. �, .............. . ................. _4 FLORIDA BUILDING CODE—BUILDING,5th EDITION(2014) 99 COPYright to,of licensed by,ICC(ALL RIGHTS RESERVED'!-; Agreement.No further reproductions authorized. on i Florida Building Code Edition 2014 High-Velocity Hurricane Zone Uniform Permit Application Form Section C (Low Slope Application) Surfacing: GacoRoof S 1600 Fill in specific roof assembly components and identify manufacturer Fastener Spacing for Anchor/Base Sheet Attachment: (If a component is not used, identify as"NA") Field: N/A " oc @ Lap,#Rows N/A @ N/A " oc System Manufacturer: Gaco Western Perimeter: N/A " oc @ Lap,#Rows N/A @ N/L" oc Product Approval No.: 12-0426.06 Corner: N/A " oc @ Lap,#Rows N/A @ N/A " oc Design Wind Pressures, From RAS 128 or Calculations: Number of Fasteners Per Insulation Board: Pmax1: N/A Pmax2: N/A Pmax3: N/A Field N/A Perimeter N/A Corner N/A Max. Design Pressure, from the specific Product ���� Illustrate Components Noted end Details�s ' ...�,� Approval system: N/A . Applicable: •• .. : • Deck: Wood blocking,Gutter; Edge TerminaCierf,;Ripping,FIaSMng! gee*** Type: Continuous Cleat,Cant Strip,Base FIb9YRr1 Mounter-Flashing;Copiq� Etc. .... Gauge/Thickness: Indicate:Mean Roof Height,Parapet Height.•Height of Base F'Isshing. .•... Component Material,Material Thickn@%p5ostener Ty"4Wastwer ..;..' Slope: Spacing or Submit 00000 • • •• ...... Anchor/Base Sheet& No. of Ply(s): ;'•;•; • •' •••••• . • 000*0 Anchor/Base Sheet Fastener/Bonding Material: "" • . . Insulation Base Layer: Base Insulation Size &Thickness: FT. Base Insulation Fastener/Bonding Material: Existing Roof Parapet GacoRoof S 1600 Height Top Insulation Layer: Top Insulation Size&Thickness: FT. Top Insulation Fastener/Bonding Material: Mean Roof Base Sheet(s) & No. of Ply(s): Height Base Sheet Fastener/Bonding Material: Ply Sheet(s) & No. of Ply(s): Ply Sheet Fastener/Bonding Material: Top Ply: Top Ply Fastener/Bonding Material: a .A. SECTION HIGH VELOCITY HURRICANE ZONES REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS 1524.1 Scope.As it pertains to the section,it is the responsibility of roofing contractor to provide the owner with the required roofing permit,and to explain to the owner the content of the section.The provisions of Section R4402 govern the minimum requirements and standards of the industry for roofing system installations.Additionally,the following items should be addressed as part of the agreement between the owner ant the contractor.The owner's initial in the designated space indicates that the item has been explained. 9999 • • 9606 9609.6 be 9969 2. �_Renailing wood decks:When replacing roofing,the existing wood r4loddc1c may hd19e 60 ' 90 renailed in accordance with the current provisions of Section R4403.(The roof WWI usually, concealed prior to removing the existing roof system). •••• • 9999.. 9999 . 9999. 9999.. ... . **:see A� . . 9996. 0000*0 4 Exposed Ceiling: •• •• ' g Exposed,open beam ceilings are where the unde i •' can be viewed from below.The owner may wish to maintain the architectural appet anLe;therefwe, .ng •6,6 roofing nail penetration of the underside of the decking may not be acceptable.This protides theo�t'idrT 5f 9 •. maintaining the appearance. 0 0 •• .. 9999 S• __A� _,Overnow 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 f overflow scuppers(wall outlets)are not provided.It maypbie necessary to install overflow scuppers in accordance with the requirements of Sections R4402, 4403 and 144139 Owner gent's Signatur Date Contacto ' n Date 10611 IVE 10 PL Property Address Permit Number Revised on 7/9/2009 LD;07/01/2015; �m M IAMI-DARE � MIAMI-DADE COUNTY PRODUCT CONTROL SECTION DEPARTMENT OF PERMITTING,ENVIRONMENT,AND REGULATORY 11805 SVS'26 Street. Room 2O AFFAIRS(PERA) Miami.Florida 33175-24'4 BOARD AND CODE ADMINISTRATION DIVISION T(736)315-2590 F(736)31525-N NOTICE OF ACCEPTANCE (NOA) `44ro�•n��anaed�de.�-u. i ; Gaco Western LLC 1245 Chapman drive Waukesha,WI 53186 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 CountyFE� -Product Control Section to be used in Miami Dade County and other areas where agowvtleby the.... ...... Authority Having Jurisdiction(AHJ). •• . ...... .. . ...... This NOA shall not be valid after the expiration date stated below. The Miarfi'D'aflt Countv• . Product Control Section (In Miami Dade County) and/or the AHJ (in areas other than 1C?iami Dadz.:. •• • County) reserve the right to have this product or material tested for qualityassura *o ose this product or material fails to perform in the accepted manner, the manufacturer.,tViu *cur the*,,* „�� �• expense of such testing and the AHJ may immediately revoke, modify. or suspends iiewiupe of such. product or material within their jurisdiction. PERA reserves the right to revoke this acceptance._ Lt•;• •••.:. is determined by Miami-Dade County Product Control Section that this product or:natefial fails to • meet the requirements of the applicable building code. so •••• • . 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: : GACO WESTERN ROOF COATING SYSTEMS LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami-Dade County Product Control Approved", unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami-Dade County, Florida. and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA renews and revises NOA No. 09-1109.03 and consists of pages I through 4. The submitted documentation was reviewed by Jorge L. Acebo. AM, c rv`° NOA No.: 12-0426.06 RAWDADE COUNTY a, o Expiration Date: 051111r, s Approval Date: 05/24/12 Page 1 of 4 ROOFING COMPONENT APPROVAL Category: Roofing Sub-Category: Cement-Adhesive-Coatings Material: Elastomeric SCOPE: This approves GACO WESTERN ROOF COATING SYSTEMS"as a roof maintenance coatin,),s manufactured by Gaco Western LLC, as described in this Notice of Acceptance. This product has been designed to comply with the Florida Building Code, including the High Velocity Hurricane Zone of the Florida Building Code. EVIDENCE SUBMITTED: Test Agency Test Identifier Test Name/Report. Deis..' ...... PRI Construction Materials GWI-007-02-01 ASTM D 6083 • ' 08/0,V. •• Technologies • Fed Spec TT-C-555$,,;�� �� ' 0000•• GWI-002-02-201 ASTM D 6083 01/Qq/0% :-o-.: Fed Spec TT-C-55511•••. :• GWI-001-02-01 ASTM D 6694 0-:-0: 04/lM�0.7 : 00:000 Fed Spec TT-C-55511' " •• 000000 GWI-004-02-01 ASTM D 6694 :**:*: 0511-3110% . Fed Spec TT-C-555] • Underwriters Laboratories Project 04NK27341 UL 790 •• 021/04 r4S :0009: Project 07NK02171 UL 790 03./11*07' Project 08NB01503 UL 790 02/21/08 Factory Mutual Research Corp. 3023644 4470 02/02/07 MANUFACTURING LOCATION: 1. Waukesha, WI PHYSICAL PROPERTIES OF COMPONENTS Trade names: A310OR Acrylic Top Coat Thickness: For application over spray polyurethane foam system apply a base coat at a minimum rate of 1.13 gal/100 ftz, an intermediate coat at a minimum rate of 1.13 gal/100 ft', and a top coat at a minimum rate of 1.13 gal/100 ftz. For application of a recover coating over an existing acrylic roof apply a base coat at a minimum rate of 1 gal/100 ftz, and a top coat at a minimum rate of 1 gal/100 ftz. Specifications: ASTM D 6083 Description: An acrylic white elastomeric quick set coating membrane applied to: spray polyurethane foam roof systems and a recover of any existing acrylic roof. Container Size: 5, 55 gallons. Note all precautions on container. Systems Approvals: Methods of application and quantities shall comply with specific Roof Assembly, Product Control Notice of Acceptance. NOA No.: 12-0426.06 MIAMI-DADECOUNTY Expiration Date: 05/31/17 Approval Date: 05/2=1/12 Page 2 of 4 Trade names: S 1000 Top Coat Thickness: For application over spray polyurethane foam system apply a base coat at a minimum rate of 1.1 gal/100 ft and a top coat at a minimum rate of 1.1 gal'100 ft2. For application of a recover coating over an existing silicone roof apply a base coat at a minimum rate of 1.1 gal/100 ft', and a top coat at a minimum rate of 1.1 gal/100 ft2. Specifications: ASTM D 6694 Description: A single component, air dried, silicone-based rubber elastomeric membrane coating that is brush,roller or spray-applied. To be applied to spray polyu� tine foam roof systems and as a recover of any existing silicone roof coatings •••••• .. . •• to. Container Size: 5 and 55 gallons. Note all precautions on container. 000000 +t••0• 0000.. 0 0 Systems Approvals: Methods of application and quantities shall comply 00 U�•0..specicoof :0000: Assembly, Product Control Notice of Acceptance. :00600 0000. 00.00. 000 . • 0000. 0000 .. 0000.. 0000.. • .00000 ..+... Trade names: S-2000 Solventless Silicone Basecoat/Top Coat • .. 0000.. 0000 Thickness: For all applications apply 2 coats; a base coat at a minimum rate of.75 g*Ao100 ft and a top coat at a minimum rate of.75 gal/100 ft'. • Spray Polyurethane Foam Roof Systems • Acrylic Coatings • Galvanized Metal Roofs (in conjunction with E5320 2 part Epoxy Primer) • Smooth Built Up Roof Systems (in conjunction with E532022 part Epoxy Primer) • EPDM Single Ply Roof Systems (in conjunction with E5320 2 part Epoxy Primer) • PVC Single Ply Roof Systems(in conjunction with E5320 2 part Epoxy Primer) Specifications: ASTM D 6694 Description: A single component, moisture cured, silicone-based ribber elastomeric membrane coating that is brush, roller or spray-applied to the roof covers listed above. Container Size: 5 and 55 gallons. Note all precautions on container. Systems Approvals: Methods of application and quantities shall comply with specific Roof Assembly, Product Control Notice of Acceptance. NOA No.: 12-0426.06 MiAMI-OADecoW Expiration Date: 05/31/17 Approval Date: 05/24/12 Page 3 of 4 Trade names: S 1600 Base Coat/Top Coat Thickness: For application over spray polyurethane foam system apply a base coat at a minimum rate of 1.1 gal/100 ft and a top coat at a minimum rate of 1 gal/100 fF. For application of a recover coating over an existing silicone roof apply a base coat at a minimum rate of 1 gal/100 ft', and a top coat at a minimum rate of 1 gal/100 ft'. Specifications: ASTM D 6694 Description: A single component, moisture cured, silicone-based rubber elastomeric membrane coating that is brush, roller or spray-applied. To be applied to spray polyurethane foam roof systems, galvanized metal, smooth surfaced built-up (BUR) roofing, acrylic coating and any existing silicone roof coating.. 0000 Container Size: 1, 5 and 55 gallons. Note all precautions on container. : '••• •••••• Systems Approvals: Methods of application and quantities shall comply jifel:"specifice 00 M0 ••••0• Assembly, Product Control Notice of Acceptance. 00 • • p 6666 � 6 666666 • 6 666666 • • 0000 • 00000 LIMITATIONS: •��••� ��� • 0000. 0 .. .. '.: 00000 1. Fire classification is not part of this acceptance; refer to a current Approved A**"* Aafiug Materiels •• Directory for fire rating of this product. ; • : .0006. 0000.. 2. GACO WESTERN ROOF COATING SYSTEM shall not be applied in inclommIdveath�r • conditions. •• • ••G •• • :••°•• .. 3. GACO WESTERN ROOF COATING SYSTEM shall not be applied over asphaltic shingles. metal shingles, fiber-cement shingles, quarry slate, cement or clay roofing tile, or wood shingles or shakes. ` 4. The products listed herein are components of roof assemblies and are approved for use with roof assemblies that list any of the products listed herein as part of their roof assemblies Notice of Acceptance. For applications over existing single ply, smooth or granulated BUR systems. Refer applicable building code for requirements. 5. All products listed herein shall have an unannounced follow-up quality control program from an approved listing agency. Follow up test results shall be made available to Miami-Dade County Product Control upon request. 6. All approved products listed herein shall be labeled in compliance with TAS 121 and shall bear the imprint or identifiable marking of the manufacturer's name or logo and following=statement: "Miami-Dade County Product Control Approved" or the Miami-Dade County Product Control Seal as shown below. MIAMI-DADE COUN4TY 7. Change in materials,use, or manufacture of any of the products listed herein shall be cause for termination of this Notice of Acceptance. 8. GACO WESTERN ROOF COATING SYSTEM shall only be applied by a factory trained and certified applicators. 9. GACO WESTERN ROOF COATING SYSTEM shall be applied in accordance with manufacturer's published application instructions. END OF THIS ACCEPTANCE NOA No.: 12-0426.06 MIAMaDADECOUN-ryM Expiration Date: 05/31/17 ° Approval Date: 05/24/12 Page 4 of 4