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RF-16-1670 (2) gg P iIt NqRF41,f �3"' Miami Shores Village 10050 N.E.2nd Avenue NE ' g Cff �Sf�ftf[ P�31 Miami Shores,FL 33138.0000Ok f 4 F � Phone: (305)795-2204 lSsuF} @ 64/ t#1 Expiration: 1212216 Project Address Parcel Number Applicant 10401 NE 4 Avenue 1122310150100 JACK&KATHLEEN SITES Miami Shores, FL 33138-2012 Block: Lot: Owner Information Address Phone Celt JACK&KATHLEEN SITES 10401 NE 4 Avenue MIAMI SHORES FL 33138-2012 10401 NE 4 Avenue MIAMI SHORES FL 33138-2012 Contractor(s) Phone Cell Phone Valuation: $ 16,508.00 ROCHE ROOFING INC (305)220-7663 i Total Sq Feet: 3181 Type of Work:Re Roof Available Inspections: Additional Info:RE-ROOF FLAT Classification:Residential Inspection Type: Tin Cap Scanning:3 Final Roof Roof in Progress Renailing Affidavit Review Roof Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Contractors Bond $500.00 Invoice# RF-6-16-60210 CCF $10.20 06/15/2016 Cash $50.00 $820.96 DBPR Fee $4.88 DCA Fee $4.88 06/24/2016 Check#:1210 $820.96 $0.00 Education Surcharge $3.40 Bond#:3121 Permit Fee-New Roof $325.00 Scanning Fee $9.00 Technology Fee $13.60 Total: $870.96 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-nam d contract r to the work stated. June 24, 2016 Authorized Signature:Owner / Applicant dontractdir / Agent Date Building Department Copy June 24,2016 1 Miami Shores Village �6-« Building Department JUN '15 2016- 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 111 FBC 20 1 L� BUILDING Master Permit No. p,t:__ (6 - t(-40 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC EJROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: LogoI AIC- L L-M iVe"e- City: Miami Shores County: Miami Dade Zip: 3 313$ Folio/Parcel#: il- 22 31 -O!S—01 00 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Ta e S&S Phone#: Address: I Oil)I mt 14ye City: Mia' om SGwres State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: 1 D CONTRACTOR:Company Name: 666 PoWt TC . Phone#: 36S-Z7,O -2663 Address: ` J OI StAr- 4ye. City: IM,(G m, l 5 State: ��.• Zip: 33(5 Qualifier Name: Fust ylb Roe., e Phone#: 309-z7-0-266 3 State Certification or Registration#: cele-13301322 Certificate of Competency#: DESIGNER:Architect/Engineer: d lot Phone#: Address: W 01 City: State: Zip: Value of Work for this Permit:$ l(o4 SOS Square/Linear Footage of Work: I Type of Work: ❑ Addition ❑ AlterationI--]I--] New Sq Repair/Replace ID Demolition Description of Work: R -ro_OS ��A 1} Specify color of color thru tile: Submittal Fee$ ^ OZ3 Permit Fee$ �! A_� CCF$ ' CO/CC$ Scanning Fee$ Radon Fee$ C4- b& DBPR$ Notary$ Technology Fee$ ( Training/Education Fee$ -' .r "4(5 Double Fee$ X2 Structural Reviews$ Bond$' TOTALFEENOWD E$ SZO Hr (Revised02/24/2014) 620. '!:� G D � Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commenc ment must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In t e absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. K Signature Signature —/ OWNER or AGENT CONTRACTOR The foregoing ins ment was acknowledged before me this The(foregoing instrument was acknowledged before me this TRi day of 3-0 vie— 201(o by Y7%..}day of IV 14 20 l6 by JldlG glf�s who is personally known to �QJil /110 kQ&4e ,who is personally known to me or who has produced F. D.L• 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: Sign: Sign• Print: Print: d ROGELIO PEREZ ,'�°�P e` NotaryPublic-State of Florida Seal: ;io`" P�e�c i Notary Public-State of Florida Seal: Commission#FF 197614 �� My Comm Expires Feb FF 9019 9Commission#FF 62019 �'�",, �ry�;°�� N Ex ,2 =; {�,y,p�Q Daum gh0 19 ary '' D �q•'�. 19011dedtIU0I7Q11NftyAsp. APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ot--7 1(6-- 1� DATE(MM/DDNY) ACORD CERTIFICATE OF LIABILITY INSURANCE lJunel6,2016 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF IN FORMATION Florida Insurance Agency of Miami ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Box 441340 HOLDER,THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Miami,FI.33144 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P;305.445-9100 INSURER AFFORDING COVERAGE NAICS# INSURED INSURER A: Endurance Amer Co Roche Roofing Inc INSURER B: 4101 sw 73 ave#B INSURER C: Miami FI 33155 INSURER D: INSURER E: INSURER F: coverages THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOT- WITHSTANDING ANY REQUIREMENT,TERM,OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITHRE PECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HE IN IS SUBJECT TO ALL TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL EFFECTIVE EXPIRATION LTR INSR TYPE OF INSURANCE POLICY NUMBER (MM/DD/YY) (MM/DD/YY) LIMITS GENERAL LIABILITYEACH OCCU RENCE 1.000.000 KFmir x COMMERCIAL GENERAL LIABILITY PREMISES(Es occurrence) $100,000 CLAIMS MADE r1-1 OCCUR MED EXP(any one person) $5,000 A PERSONAL as ADV INJURY 1.000.000 CBC 10000712803-1 11/22/2015 11/22/2016 GENERAL AGGREGATE 2.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-QOMP/OP AGG 1.000.000 x POLICY PROJEC LOC AUTOMOBILE LIABILITY COMBINED SING LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS (PerPerson) $ HIRED AUTOS NON-OWNED AUTOS (Per Accident) $ PM PER(Per Accident)' $ ANY AUTO ALL OWNED AUTOS AUTO ONLY AGG OCURR ❑CLAIMS MADE EACH OCCUF RENCE AGGREGATE DEDUCTIBLE $ RETENSION $ $ VVI JN ANU VVU Zi I A I U- UJ EMPLOYERS LIABILITY I TORY Lit ITS ER ANY PROPIERTOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED 7 it yes describe under 0191111 - SPECIAL PROVISIONS below DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PRO ISIONS: Roofing Contractor License Number CCC1330328 x ICERTIFICATE HOLDER I JADD-L INSURED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAN ELLED BFORE THE EXPIRATION Miami Shores Village DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Building Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 10050 NE 2 Ave IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURED,ITS AGENT OR Miami Shores FI 33138 AUTHORIZED REPRESENTATIVE Tony Zoghbi ACORD 25(2001/08) AI D CORPORATION 1988 RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CCC1330328 The ROOFING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date. AUG 31,2016 ROCHE, FAUSTINO ROCHE ROOFING, INC 9221 SW 13 ST - MIAMI FL 33174 i ISSUED: 08/27/2014 DISPLAY AS REQUIRED BY LAW sEO# L1408270003186 Date CERTIFICATE OF LIABILITY INSURANCE 5/19/2016 Producer: Plymouth Insurance Agency This Certificate is Issued as a matter of Information only and confers no 2739 U.S. Highway 19 N. rights upon the Certificate Holder. This Certificate does not amend,extend Holiday, FL 34691 or alter the coverage afforded by the policies below. (727) 938-5562 Insurers Affording Coverage NAIL# Insured: South East Personnel Leasing, Inc. &Subsidiaries Insurer A: Lion Insurance Company 11075 2739 U.S. Highway 19 N. Insurers: Holiday, FL 34691 Insurer C: Insurer D: Insurer E: Coverages The policies of insurance listed below have been issued to the insured named above for the policy period indicated. Notwithstanding any requirement,tens 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. Aggregate limits shown may have been reduced by paid claims. INSR ADDL Policy Effective Policy Expiration Limits LTR INSRD Type of Insurance Policy Number Date Date (MM/DD/YY) (MM/DD/YY) GENERAL LIABILITY Each Occurrence $ Commercial General Liability Damage to rented premises(EA Claims Made ® Occur occurrence) $ Mad Exp Personal Adv Injury General aggregate limit applies per: Policy 13Project ® LOC General Aggregate Products-Comp/Op Agg AUTOMOBILE LIABILITY Combined Single Limit Any Auto (EA Accident) $ All Owned Autos Bodily Injury Scheduled Autos (Per Person) Hired Autos Bodily Injury Non-Owned Autos (Per Accident) Property Damage (Per Accident) EXCESS/UMBRELLA LIABILITY Each Occurrence Occur ®Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2016 01/01/2017 X WC Statu- OTH- Employers'Liability I to Limits ER Any proprietor/partner/executive officer/member E.L.Each Accident $1,000,000 excluded? NO E.L.Disease-Ea Employee $1,000,000 If Yes,describe under special provisions below. E.L.Disease-Policy Limits 51,000,000 Other Lion Insurance Company is A.M.Best Company rated A-(Excellent). AMB#12616 Descriptions of Operations/LocationsNehicles/Exclusions added by EndorsementiSpeciai Provisions: Client ID: 91-68-881 Coverage only applies to active employee(s)of South East Personnel Leasing,Inc.&Subsidiaries that are leased to the following"Client Company": Roche Roofing,Inc. Coverage only applies to injuries incurred by South East Personnel Leasing,Inc.&Subsidiaries active employee(s),while working in:FL. Coverage does not apply to statutory employee(s)or independent contractor(s)of the Client Company or any other entity. A list of the active employee(s)leased to the Client Company can be obtained by faxing a request to(727)937-2138 or by calling(727)938-5562. Project Name: ISSUE 05-19-16(AF) Benin Date 4/6/2016 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE Should any of the above described policies be cancelled before the expiration date thereof,the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to the left,but failure to BUILDING DEPARTMENT do so shall impose no obligation or liability of any kind upon the insurer,its agents or representatives. 10050 NE 2ND.AVE. MIAMI SHORES, FL 33138 r T JUN �a�s ROOFASSEMI p$ RES ya Florida Building Code 5th Edition(2014) � 1 High-Velocity Hurricane Zone Uniform Permit Applicatio < orm 1 1 0_ Section A(General Information) 1 Master Permit No. Process No. ! Contractors Nam.AC C n -e A16 ® �^� 1 Job Address I® CKO A 14 i fit.A4 # s/)v 1-%eS — Fe— ROOF e ROOF CATEGORY ! 1a/Low Slope ❑ Mechanically Fastened Tile ❑ Mortar/Adhesive Set Tiles ❑ Asphaltic Shingles ❑ Metal Panel/Shingles ❑ Wood Shingles/Shakes 1 ❑ Prescriptive BUR-RAS 150 1 ROOF TYPE / ! ❑ New roof ❑ Repair 13 Maintenance fel Reroofing ❑ Recovering ! ROOF SYSTEM INFORMATION p 1 Low Slope Roof Area(SF)3 a �f/ Steep Sloped Roof AREA(SSF)-t4:t— Total(SF) � ' 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 1 1 1 1 1 1 1 1 1 1 . . 41t, . ffi--m—&-we �\ ED ® TE • . _ - -� 1 • • • • • • 96 _ nr-PT 0 •i• i i i i •i+::�' ,Ll.T CO CCNIPL P10E VVI rl-i ALL FEDERAL FLORIDA BUILDING CODE—BUILDING,5th EDITION(2044) • 000 • I • }• 15.31 t 1 1 I Copyright to,or licensed by�cc c�d• 44�SE •�f9��1;tjg'C�f:,FjWf'�Pn I �if1�4[ I ' Rl nee Agreement.No further repliodatigts autho*zed.0 0• • - -• Measurement #1 , 10401 NE 4th Ave, Miami Shores, FL, Roof Area 33138 ® Total Area: 3,575 sgft Total Slopes: 3 Asea 1. PitAQ-."A!0/1 ••.4141. . . ••c41.197 moi `: •t • • t 4141•••• • 0.0.410 • •. •• 00 4141••• 414141 • ••41.•41 •41.41• • •4141• ••414141• • • • 41 • • 41.41• •41414141• c 41 s ••41.41• Pit�l�•1•.�/12�t�••• 1778 1402 .:. 181. ft .•41• Area 3 Pitch 5.0/12: 197 sgft * = 197 page 4of5 swum C Mr®� Miami.Dade County HVHZ Electronic Roof Permit Form LZOMW Section C Page(Low Slope Roof Systems) ++DrJivering.Farce/farree Every Doty" FIJI in the speciFre roof assembly components.Na component is not required,insert not applicable(We)In the Text box. GAF Top Ply: ROOF SYSTEM MANUFACTURER: �;=l CAP SHEET Product Approval (NOA): 14-0611.01 System Typo: E1 Bonding Material: Wind Uplift Pressures,From RAS 126 or Sealed Calculations: HOT MOP ASPHALP (P1) Field: -42.8 psf Surfacing: GRANULES SINGLE PLY MEMBRANE: (122) Perimeters: 71.1 psf Single Ply Manufacturer!Type: (P3)Comers: -108.0 psf I NA Maximum Design Pressure From A: -62.5 psf Single Ply Sheet Width: NA "112 Sheet Width: " Roof Slope: 0.50 ":12 Roof Mean Height: 96 ft No.of Single Ply 112 sheets:a Parapet Walls: ®No 13Yes Parapet wall Height: ft. Single Pty Membrane Fastening I Bonding Material: NA peck Type: —518"Plywood— 21 FASTENER SPACING FOR BASESHEET ATTACHMENT Support Spacing: •J"01C ❑SINGLE PLY MEMBRANE ATTACHMENT _. . �.. .. ............ 2 .. _......_ 9.. . .� . _..._. PJtemata Deck.Type:. - 1.Fields otc g Laps& rows old, Existing Roof: � SAME 2.Perimeter. "o/o(r$Laps&�rows 16 ►"oto Fire Barrier. 3.Comer:t- i"o1c @ Laps&El rows6n„ "ole NIA NUMBER OF FASTENERS PER INSULATION BOARD: Vapor Barrier. NIA 1. Field:El 2. Perimeter.E 3. Comer. Anchor Sheet: Insulation Fastener Type NIA INA Anchor Sheet Fastener I Bonding Material: WOOD NAILER TYPE AND SIZE- NIA 1"X8"FACIAL BOARD Insulation Base Layer Size&Thickness: Wood Nailer Fastener Type and Spacing: A FNIWOOD NAIL 16D EVERY 16"OC Insulation Base Layer Fastener I Bonding Material: EDGE&COPING METAL SIZES: N/A Insulation Top Layer Size&Thickness: Edge Metal Material: --Galvanized Metal Edge Edge Size: —3"face 26 ga.— insillatlon Top Layer Fastener I Bonding Material: Hook Strip Size: --SELECT EDGE METAL HOOK STRIP SIZE— N/A Edge Metal Attachment: Base Sheet(s)&No.of Ply(s): I1-114"RS NAIL 4"OC GAF GLASSBASE 75#(1)PLY —SELECT PARAPET WALL COPING MATERIAL— Base Sheet Fastener)Bonding Material: Coping Material: _ . _ .. _ 1-114"RS NAIL AND TIN CAP 1-518" •• 0-: ••Coping Size: —SELECT COPING METAL SIZE OR THICKNESS— Sheets)&No.of Ply(s):, • ' " ' •. NG METAL HOOK STRIP SIZE— Ply Hook Strip Size: ^-SELECT COPI GAF RUBEROID 20(1)PLY •. ..: •.: �. ..'Parapet Coping Metal Attachment: Ply Sheet Fastener t Bonding Material: HOT MOP ASPHALT ... . . .. . . .. . . .. . . .. . see . .. . ... . . . . ... . . . . . . . . . . . . . . .. .. . . . .. .. ... . . . ... . . r Edge Mailable Deck MIAMFt7rADE Miami-Dade County HVHZ Electronic Roof Permit Form °Delivering Excellence;Every W y° Illustrate Components Noted and Details as Applicable: Top Ply Interplies Base Sheet Roof Mean Height: 6 ft. Drip Metal: =3 GALV 26G Surfacing: Drip Metal GRANULES Top Ply: r GAF MINERAL CAP SHEET Interplies: v GAF RUBEROID 20 Base Sheet: Roof Deck GAF GLASSBASE 75# - Deck Type: • � PLYWOOD 5/8" .. ... . . . . . .. .. ••• . ... . ... . . . . . . . . . . . . •• • • •• • • •• • • •• • ••• • •• • ••• • • • • ••• • • • •• •• • • • •• •• ••• • • • ••• • • i yr u.not i a.) -,KOOIMg systems Page 4 of 48 Surfacing(Optlonol)a—"TOPCOAT®EnergyCota' t lestomeric Coating"applied ate rate of 2-gal/100-e. 16.Dacia NC Incline:1/2 Insulation(Optional):—Any thickness perilte or wood fiber or glass fiber or polyisocyenurate,mechanically fastened or adhered with "LRF Adhesive M"or OMG Inc."Olybond Fastening System"applied as a nominal 3/4-in.bead or"GAF 2-Part Roofing Adhesive"applied as a nominal 2-1/2-In.bead with a maximum on-center spacing of 12-In,or any UL Classified Insulation adhesive applied per the manufacturer's Installation instructions. Base Sheet:—One ply Type G2"GAFGLASS#75 Sam Sheet"or'Th-Ply®#75 Base Sheet",mechanically fastened. Ply Sheets—One or two piles Type 61"GAFGLASO Ply 4"or"Tri-Ply®4"or"GAFGiASS Flex-PIyTM 6"or Type G2"GAFGLASO#75 Base Sheet"or'Tri-Piye#75 Base Sheet",fully adhered with hot roofing asphalt. Cap Sheat;—One ply Type G3"GAFGLASS Mineral Surfaced Cap Sheat',fully adhered with hot roofing asphalt. Surfacing:—'TOPCOAT®EnergyCotel"Elastomeric Coating"or"TOPCOATS MS plus"or'TOPCOAT®322 White Elastomeric Coating", applied at a rate of 2-gal/lOMfe. 17.Dock:C-15/32 Incline.1/2 Insulation(Optional):--Any thickness perilte or wood fiber or glass fiber or polylsocyanurate mechanically fastened or adhered with OMG Inc."OlyBond Fastening System"or any UL Classified Insulation adhesive. Barrier Boards—Minimum%An.thick Georgia-Pacific Gypsum LLC"DensDeck®Roofboard"or"Denspeck Prime®Roofboard"or "DensDack DuraGuard'"Roofboard"or minimum+/s-In,thick Untied States Gypsum Corp.%ECUROCK®Roof Board"(Type FRX-G)or "SECUROCKS Glass-Mat Roof Board"(type SGMRX)mechanically fastened or adhered with OMG Inc."OlyBond Fastening System"or any UL Classified insulation adhesive with butt joints In the barrier board products staggered a minimum of 6-In.from plywood deck joints. Base Sheet:—One ply Type G2"GAFGLASO#75 Base Shaer or Irri-Ply#75 Base Sheat"mechanically fastened. PIY Sheets--One or two piles Type 61"GAPGLASS Ply 4"or"Tri-Ply 4"or"GAFGLASds1 Flex Ply 6"or Type G2"GAFGLASO#75 Base Sheet"or"Tri-Ply#75 Base Sheet fully adhered with hot roofing asphalt. Cap Sheets—One ply Type G3"GAFGLASO Mineral Surfaced Cap Sheet"fully adhered with hot roofing asphalt. Surfacing:—`TOPCOAT®En8r9yC0te-Elastomerlc Coating"or`TOPCOATS MB Plus"or'TOPCOATS 322 White Elastomeric Coating" applied at a rate of 2-gal/100-fit. 18.Dada NC Incliner 1 Insulation(Optlonags—Any thickness periRe or wood fiber or glass fiber or polylsocyanura%mechanically fastened or adhered with "LRF Adhesive M"or OMG Inc."Oiybond Fastening System"applied as a nominal 314-in.bead or"GAF 2-Part Roofing Adhesive"applied as a nominal 2-1/2-in,bead with a maximum on-center spa _. __.... cing or_12-in,or.any_UL.Qassltled Insulation adhesive applied per file "" Installation lnstruttlonsJ _...___..._.._., Baia Sheets—One ply"GAFGLASS Slratavent O Ellminator' Venting Base Sheet"or Type G2,fully adhered with hot roofing asphalt. Ply Sheets—One or two plies"Ruberold®Mop Smooth"or"RuberoldS Mop Smooth 1.5"or"Ruberold@ Mop Smooth Pius"or "Ruberold®20"or"Ruberold@ 20 HT",fully adhered with hot roofing asphalt. Metnitrraftol—One ply"GAFGLASS Mineral Surfaced Cap Sheet",fully adhered with hot roofing asphalt. Surfaetnal—'TOPCOAT®EnergyCote-Elastomeric Coating"or"TOPCOAT®MB Pius"or"TOPCOAT®322 White Elastomerlc Coateng" applied at a rate of 2-gal/100-fit. 19.Dacia C-15/32 Incline:1 Insulation(Optional).,—Any thickness perlite or wood fiber or glass fiber or polyisocyanurate mechanically fastened or adhered with OMG Inc. OlyBond Fastening System"or any UL Classified Insulation adhesive. Barrier Boards—Minimum W-In.thick Georgia-Pacific Gypsum i ILC"DensDeclk®Roolboard"or"DensDeck Prime®Roofboard"or "DensDeck DuraGuardim Roofboard"or minimum V4-in.thick Untied States Gypsum Corp."SECUROCKS Roof Hoard"(Type FRX-G)or "UL Classified SECUROCKS Glass-Mat Roof Board (Type SGMRX)mechanically fastened or adhered with OMG Inc."OlyBond Fastening System"or any Base heetsl-One ply"GAFGLASS Stratjavlenntt Eliminatothe rier board Venting 8�Sheet"raacts lly adhered with hot roofinered a Minimum of 6-In.g asphallL ori deck Joints. PIY Sheets—One or two piles"Ruberold®Mop Smooth"or"Ruberold#Mop Smooth Plus"fully adhered with hot roofing asphalt. Membranat—One ply GAFGLASS Mineral Surfaced Cap Shat"fully adhered with hot roofing asphalt, Suffaeings--"TOPCOATS EnefOyCotet"Elostomeric Coating"or"TOPCOAT®MB Plus"or'TOPCOATS 322 White Elastomerlc Coating" applied at a rate of 2-gal/100-ft?. 20.Dacia C-15132 Incline:1 Base Shoot:--One ply Type 62"GAFGLASO#75 Base Sheet"or"Tri-Ply®#75 Base Sheet"mechanically fastened. Insulation(Optional)I—Any thickness or combination:perilte or wood fiber or glass fiber or polylsocyanurate,mechanically fastened or hot mopped or adhered with OMG Inc."OlyBond Fastening System"or any UL Classlfled Insulation adhesive. mechanically attached. Base Sheets—One or more plies"Ruberold®20"or"Ruberold®20 HT"or"Ruberold®Modified Base Sheet",hot mapped or Cap Sheets—One Ply Type G3"GAFGLASO Mineral Surfaced Cap Sheet"or"Tri-Ply®Mineral Surfaced Cap Sheat"or"GAFGLASS EnergyCap BUR Mineral Surfaced Cap Sheet". . Class B 1.Decks C-15/32 Inclines 3-1/2 Insulation(Optionagt—040101 mor4aye4erA&or woad fiber or glass fiber or polylsocyanurate or u thane or perilte/polylsotyanurate composite ore lit oto f ski gr wood fiber/polylsocyanumte composite r phenolic,any thickness. Ply Shoots—Two or more ptle4pe G1 ITU(IS,111% "rpr`TrbPly(lo Ply 4"or"GAFGLASS Ply 6"mechanically fastened. Cop Sheet:—Type G3"GAFGLASO49imsral Stw1aced Cap Shee!"br'Tri-Ply®Mlneral Surfaced Cap Sheet"or"GAFGLASS EnergyCap- BUR Mineral Surfaced Cap Sheat",fuNy adhered with hot roofing asphalt. 2.Decks C-15/32 �tgSlines 3;)/z Insulation(Optional):-*One or snore lacers perft or woAd t(bePorslass fiber or palyisocyanurate or urethane or perlltName Sheath cam 4slte�I pERtite/L�that�w}npa�tg o:wapd fiber/polylsocyanurate composite or phenolic,any thickness. Base Shea z—Two or m Mlles a G1ptj ype cr TvVe G3. • htlpJ/database,ul.koro/cgs-b1;}IXV/04PIhtcLISEXT,/1FRAME/showpage.html?alame=T... 11/9/2015 . .. .. . . . .. .. MIAMFQADE iVIIAMi-DADU COUNTY PRODUCT CONTROL SECTION 11805 SW 26 Simal,Room 208 DEPARTMENT Or REGULATORY AND ECONOMIC RESOURCES UW-14) Miami,Florida 33175.2474 BOARD AND CODE ADMINISTRATION DIVISION T(786)315.2590 F(786)315-2599 NOTICE OF ACCEPTANCE(NOA) mv_v.mtami-dad*.¢avlcconomil GAF 1 Campus Drive Parsippany,NJ 07054 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials.The documentation submitted has been reviewed and accepted by Miami-Dade County RER- Product Control Section to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction(AHJ). This NOA shall not be valid after the expiration date stated below.The Miami-Dade County Product Control Section(In Miami Dade County)and/or the AHJ(In areas other than Miami Dade County) reserve the right to have this product or material tested for quality assurance purposes.If this product or material fails to perform In the accepted manner,the manufacturer will incur the expense of such testing and the ARS may immediately revoke,modify,or suspend the use ofsuch product or material within their jurisdiction. RER reserves the right to revoke tan this 8ccepco,if itis dotgrmined.by..Nami:.Dade .. .... County Product Contiol Section that this product or material fails to meet the requirements of the applicable building code. This product is approved as described herein,and has been designed to comply with the Florida Building Code including the High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION:GAF RuberoidO Modified Bitumen Roof System for Wood Decks. 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 revjsm NOA 110 9.14.8tI t.Ot and consists of pages 1 through 30. The submitted documentatign wV,7eV*Jve4 I'Jpjge 1:,Acebo. NOA No.:14-1030.02 Mu►141naneeouExpiration Date: 11/06/18 •• • ••• . •• • Approval Date: 11/05/15 Page 1 of 30 ••• • • • • ••• • • • • • • • • • • • • ••• • • • ••• • • Membrane Type: SBS/SBS Cold Applied Deck Type 1: Wood,Non-insulated Deck Description: 19/32"or greater plywood or wood plank decks System Type E(1): Base sheet mechanically fastened to roof deck. All General and System Limitations shall apply, Fire Barrier: FireOue Fire Barrier Coating,VersaShield®Fire-Resistant Roof Deck Protection (optional) or Securocl&Gypsum-Fiber Roof Board. Base sheet: GAFGLAS®#80 Ultima"'Base Sheet,GAFGLAS"Stratavento Faiminator?" Nailable Venting Base Sheet,Ruberoid 20,Ruberoid®SBS Heat-Weld,Smooth or Ruberold®SBS Heat-Weld'25 base sheet mechanically fastened to deck as described below: Fastening GAFGLAS®Ply 4,GAFGLAS®FlexPly 6,GAFGLAS®#75 Base Sheet or any Options: of above base sheets attached to deck with approved annular ring shank nails and tin caps at a fastener spacing of9"o.c,at the lap staggered and In two rows 12" o.c.in the field. (Maxinrun:Design Pressure—45 psf.See General Limitation#i7) GAFGLASO Ply 4;GAFGLASO FlexPlr 6,GAFGLAS®0758 Sh6ct'or any of above base sheets attached to deck with Drill-Tec"#12 Fastener,Drill-Tec"` #14 Fastener or Drill-Tec"'XHD Fastener and Drill-Tec"'3"Steel Plate,Drill- Tec'AccuTrac®Flat Plate or Drill-Tec"'AccuTrac®Recessed Plate installed 12" o.c.in 3 rows. One row is in the 2"side lap. The other rotes are equally spaced approximately 12"o.c.in the field of the sheet. (Mambnum Design Pressure—45 psf.See General Liiuitation#7) GAFGLAS®F1exPly'"6,GAFGLAS®475 Base Sheet or any of above base sheets attached to deck with approved annular ring shank nails and tin caps at a fastener spacing of 9"o.c.at the 4"lap staggered and in two rows 9"o.c.in the field. (Maximum Design Pressure 52.5 psf.See General Liniltation 07) GAFGLAS'm#80 Ultima'"Base Sheet,Ruberoid*20,Ruberoid®Mop Smooth, base sheet attached to deck with approved annular ring shank nails and tin caps at a fastener spacing of 9"o.c.at the 4"lap staggered and in two rows 9"o.c.in the field. (Maximum Design Pressure—60 psf.See General Lin ilatfon#7) GAFGLAS®#75 Base Sheet or any of above base sheets attached to deck with Drill-TecO'#12 Fastener,Drill-Tec'"414 Fastener or Drill-Tec XHD Fastener and Drill-Tec"'`3"Steel Plate,Drill-Tee'"AccuTraco Flat Plate or Drill-Tee AceuTrac®Recessed Plate installed 12"o.c.in 4 rows. One row is in the 2"side lap. The other rows are equally spaced approximately 9"o.c.in the field of the sheet. (Maximum Deggn Pressure—60 psf.See General Limitatlon ilk Any of above ease sheel;e6shed to&I approved annular ring sh nk nails and 3"inverted QrjX-Tact"AsalAone p;A&ata fastener spacing of 9"o c.at the 4" lap staggered in two rows 5"iri the fictC• (Maximum Design Pressure—50 psf. See General Limitation#7) . ..• . ... . . • NOA No.:14-1030.02 .. .. .. . Mraerrnnoacournv .. • .. .. Expiration Date: 11/0611$ �'• • •• • Approval Date: 1.1/05/15 Page 26 of 30 •.. • • . • ••. . . • . • . . . . . . . • .. •• . • • •• .. ••• • • • ••• • • Fastening GAFGLAS®#75 Base Sheet or any of above base sheets attached to deck with Optians: DrIJI-Tec"`#12 Fastener,Drill-Tedm#14 Fastener or Drill Tec"'XHD Fastener (Continued) and Drill Tec'3"Steel Plate,Drlll--Tec'"AecuTrae*Flat Plate or Drill-Tec"' AccuTrae®Recessed Plate installed 8"mo.in 4 rows. One row is in the 2"side lap. The other rows are equally spaced approximately 9"o.c.in the field of the Sheet (Maxintunt Design Pressure—75 prf.See General Lbidtafien#7) Ply Sheet; (Optional)One or more plies GAFGLASs'Ply 4,GAFGLAS°'FtexPly'6, GAFGLASI#80 Ultima Base Sheet,Ruberold®Mop Smooth or Ruberoid®20 sheet adhered in a full mopping of approved asphalt applied within the EVT range and at a tate of 2040 lbs./sq. Membrane- One or more plies of Ruberoid®Mop Smooth,Ruberoida'Mop 170 FR,Ruberoid® Mop Granule,RoofMatchT"SBS Modified Granular,Ruberoids'Mop Plus Granule,Ruberoid®20,Ruberold'*30,Ruberoid°EnergyCap''30 FR SBS Membrane,Ruberoid4130 FR or Ruberoid®Mop FR in adhered in a full mopping of approved asphalt applied within the EVT range and at a.rate of 20-40 ft.lsq. Or One or more plies of Ruberoid®Mop Smooth,Ruberoid1e Mop Granule, RoofMatch'SBS Modified Granular,Ruberoid®Mop 170 FR,Ruberoid®Mop :.............................. .........._. Plus Granule;Ruberoid'020;Ruberoide 30 Rubemid6EnergyCap"30 FR SBS- Membrane,Ruberoid° 30 FR or Ruberoid®Mop FR adhered in Matri)Jm 102 SBS Membrane Adhesive at an application rate of 1-2 gat./sq. Surfacing: Optional on granular surfaced membranes;required for smooth membranes. Chosen components must be applied according to manufacturer's application instructions. All coatings must be listed within a current NOA. 1. Gravel or slag applidd at 400 Ibs./sq,and 3001bs./sq.respectively In a flood coat of Approved asphalt at 60 ibsJsq. 2. GAFGLAS®Mineral Surfaced Cap Sheet,Tri-PlyO Mineral Surfaced Cap Sheet or GAFGLASO EnergyCar BUR Mineral Surfaced Cap Sheet adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 2040 IbsJsq, 3. TopcoatP Membrane,Topcoat®MB Plus(to be used as a primer with Topcoat® Membrane)or Topcoat's Surface Seal SB applied at 1 to 1.5 gal./sq. Maximum Design Pressure: See Fastening Options .e 00: .. • .. go • .. ... .. . . . .. . ••• . ••• • . • • • • • • • • • • NOA No.:W-1030.02 1111111M. : aINNEWS •: :• •: :. •• 1;xpiratlon Date: 11/06/18 MIAM OECOf]N7Y •• • • • • ••• ' .00 • • Approval Date: 11/05115 Page 27 or 30 0:0 . . . . ... . . • • . ... . • ... . . . ... . . . WOOD DECK SYSTEM .X I&RTATIONS: 1 A slip sheet is required with GAFGLASO Ply 4 and GAFGLAS®F1exPlyTM 6 when used as a mechanically fastened base or anchor sheet. 2. Minimum '/4"DensDeel&Roof Board or Ys"Type X gypsum board is acceptable to be installed directly over the wood deck. GENERAL LIMITATIONS: 1. Fire classification Is not part of this acceptance;refer to a current Approved Roofing Materials Directory for fire ratings of this product. 2. Insulation may be installed in multiple layers. The first layer shall be attached in compliance with Product Control Approval guidelines. All other layers shall be adhered In a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 tbs./sq.,or mechanically attached using the fastening pattern of the top layer 3. All standard panel sizes are acceptable for mechanical attachment. When applied in approved asphalt,panel size shall be V x 4'maximum. 4. An overlay and/or recovery board insulation panel is required on all applications over closed cell foam insulations when the base sheet is fully mopped.If no recovery board is used the base sheet shall be applied using spot mopping with approved asphalt, 12"diameter circles,24"o.c;or strip mopped 8"ribbons in three rows,one at each side lap and one down the center of the sheet allowing a continuous area of ventilation. Encircling of the strips is not acceptable. A 6"break shall be placed every 124n each ribbon to allow cross ventilation Asphalt-apoftatiori of either-system sliall be at a minimum rate of 12 lbs./sq. Note: Spot attached systems shall be limited to a maximum design pressure of 45 psf. 5. Fastener spacing for insulation attachment is based on a Minimum Characteristic Force(F)value of 275 WE,as tested in compliance with Testing Application Standard TAS 105. If the fastener value, as field-tested,are below 27516E insulation attachment shall not be acceptable. 6. Fastener spacing for mechanical attachment of anchor/base sheet or membrane attachment is based on a minimum fastener resistance value in conjunction with the maximum design value listed within a specific system. Should the fastener resistance be less than that required,as determined by the Building Official,a revised fastener spacing,prepared,signed and sealed by a Florida Registered Engineer,Architect,or Registered Roof Consultant may be submitted. Said revised fastener spacing shall utilize the withdrawal resistance value taken from Testing Application Standards TAS 105 and calculations in compliance with Roofing Application Standard RAS 117. 7. Perimeter and corner areas shall comply with the enhanced uplift pressure requirements of these areas. Fastener densities shall be increased for both Insulation and base sheet as calculated in compliance with Roofing Application Standard RAS 1]7.Calculations prepared,signed and sealed by a Florida registered Professional Engineer,Registered Architect,or Registered Roof Consultant (When this limitation is specifically referred within this NOA,General Limitation 09 will not be applicable.) 8. All attachment and sizing of perimeter milers,metal profile,and/or flashing termination designs shall conform to Roofing Application Standard RAS 1 I 1 and applicable wind load requirements. 9. The maximum designed pressure limitation listed shall be applicable to all roof pressure zones(i.e. field,perimeters,and corners).Neither rational analysis,nor extrapolation shall be pernhitted for enhanced fastening at enhanced pressure zones(i.e.perimeters,extended corners and corners). (When this limitation is speciQpall%geffr red Iv ithin tliis NOA,General Limitation 07 will not be applicable) • . 10. All products listed herein shall ligve a:lu1lity zpssteraeyeiiaudit in accordance with the F1 rida Building Code and Rule 61020t3 oftlte Flatida4drnicxst"I've Code. END OF THIS .ACCEPTANCE . ... . . 0 : • : :; ; ; NOA N .:14-1030.02 MU1M[D,4DECOUN7Y ••• • . • ; ; Expiration D's�to: I]!oG!]8 Approval Date: 11/05/1.5 Page 30 of 30 ... . . . . ... . . . . . . . . . . . . . .. .. . . . .. .. ... . . . ... . . 5/18/2016 Property Search Application-Miami-Dade County .Gyp► OFFICE OF THE PROPERTY APP Summary Report Generated On:5/18/2016 Property Information ' Folio: 11-2231-015-0100 f � 10401 NE 4 AVE Property Address: Miami Shores, FL 33138-2012 Owner JACK C SITES&W KATHLEEN M Mailing Address 10401 NE 4 AVE MIAMI SHORES,FL 33138-2012 Primary Zone 1000 SGL FAMILY-2101-2300 SQ Primary Land Use 0101 RESIDENTIAL-SINGLE FAMILY: 1 UNIT Beds/Baths/Half 3/2/0 Floors 2 ` Living Units 1 Actual Area 3,722 Sq.Ft Living Area 2,819 Sq.Ft 20 Adjusted Area 2,873 Sq.Ft Lot Size 8,250 Sq.Ft Taxable Value Information Year Built 1955 2015 2014 2013 County Assessment Information Exemption Value $50,000 $50,000 $50,000 Year 2015 2014 2013 Taxable Value $125,742 $124,348 $121,772 Land Value $206,110 $148,591 $110,930 School Board Building Value - $199,961 $194,789 $194,789 Exemption Value $25,000 $25,000 $25,000 XF Value $753 $766 $780 Taxable Value 1 $150,742 $149,348 $146,772 Market Value $406,824 $344,146 $306,499 City Assessed Value $175,742 $174,348 $171,772 Exemption Value $50,000 $50,000 $50,000 Taxable Value -4 $125,742 $124,348 $121,772 Benefits Information Regional Benefit Type 2015 2014 2013 Exemption Value $50,000 $50,000 $50,000 Save Our Homes Assessment Cap Reduction $231,082 $169,798 $134,727 Taxable Value $125,742 $124,348 $121,772 Homestead Exemption $25,000 $25,000 $25,000 Sales Information Second Homestead Exemption $25,000 $25,000 $25,000 Previous Sale Price OR Book-Page Qualification Description Note: Not all benefits are applicable to all Taxable Values(i.e.County,School 09/01/1996 1 $140,000 17336-4268 1 Sales which are qualified Board,City,Regional). Short Legal Description ; • • • • • MIRROR LAKE SUB PB 56-15 • • + . . • •• .•. .. . • • .• LOT 10 LOT SIZE IRREGULAR OR 17336-4268 0996 1 �' • • •• `• • • The Office of the Property Appraiser is continually editing ang�pdatifiic we g the tax roll.TL n:t reflect the most current information on record.The Property Appraiser and Miami-Dade County assumes no liability,see full disclaimer anc ts*erAgreemeMt'at httll://www.miamidade.gov/info/disclaimer.asp Version: ••• • Y • • Miami shores Village wilding Department 10050 N.E.2nd Avenue q 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: 10050 NE 2nd Ave Miami Shores, FI 33138 Re: Owner's Name: Taak Sl-e s Property Address:_ to ( Me Roofing Permit Number: Dear Building Official: )AC-e SITE-S certify that I am not required to retrofit the roof to wall connections of my building because: v(The just valuation for the structure for purpose of ad valorem taxation is less than $300,000.00. Please attach proof of ad valorem taxation. o The building was constructed in compliance with the provisions of the Florida Building Code(FBC)or with the provisions of 1994 edition of the South Florida Building Code(1994 SFBC) J SE'S Signa ur Print Name State of Florida County of Dade ,• •e e 0 • •• ses al;d gals:ht•: ..0/fte is the owner for the above property mentioned. The undersigned, being the first duly sworn,depo •• '•« •• . Sworn to and subscribed before me this day of �VH2 ZOIC ,.tea""�a,�• •ROK i0 PER • Notary Publio-State of i:! Notary Public, Sate of Florida at Large. «• •� *CoMrolssiiu� 1`F ; '•,��Fo A�lop�°.• Y o E pares f .20 When the just valuation of the structure for p Bled Net(d18f Ncllwy ° 000.00,and the building was not constructed with FBC nor a 1994 see SFBC.Then you must provide a building application fron:a Ge:eral Cptrlgotfor the Roof to W91 connection Hurricane Mitigation. • :000: • • • • • •.• • • Revised on 5/21/2009 too 0 5 / p�ORIDP SECTION 1524 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. 2. Renailing wood decks:When replacing roofing,the existing wood roof deck may have to be r ailed in accordance with the current provisions of Section R4403.(The roof deck is usually concealed prior to removing the existing roof system). 4. 4caviewed Exposed Ceiling: Exposed,open beam ceilings are where the underside of the roof decking from blow. The owner may wish to maintain the architectural appearance;therefore, ail penetration of the underside of the decking may not be acceptable.This provides the option of ing the appearance. 6. Al Overflow scuppers(wall outlets): It is required that rainwater flows off so that the roof is not loaded from a buildup of water. Perimeter/edge wall or other roof extension may block this disc rge if overflow scuppers(wall outlets)are not provided. It may necessary to install overflow scuppers in accordance with the requirements of Sections R4402 403 and R4413. wn r/Agent's Signature Date Contractor Signature Date I'a 0 1 N(F (fie/t✓��,Mi�r►r fes,wzc 33138 Property Address Permit Number Revised on 7/9/2009 LD;07/01/2015; • ••• • ••• • • so see ••• • • • • ••• • •