RF-16-3230 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax:(305)756-8972
inspection Number: INSP-273131 Permit Number: RF-11-16-3230
Scheduled Inspection Date: December 21,2016 Permit Type: Roof
Inspector. Naranjo,Ismael Inspection Type: Final Roof
Owner: KOLIAN,GHAZAR Work Classification: Repair Roof
Job Address,117 NW 101 Street
Miami Shores,FL 33150- Phone Number
Parcel Number 1131010220150
Project <NONE>
Contractor. JOHN BUSTA ROOFING INC Phone:(305)219-9699
Building Department Comments
RENEW AND REPLACE TILE AND FELTS ABOVE I �O Passed
INSPECTOR COMMENTS False Comments
GARAGE DOOR
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-271941. Need to provide uplift
test
Failed
Correction ❑
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee Is paid.
Deciunber 20,2016 For Inspections please call:(305)762-4949 Page 25 of 46
C I VI L Re hgE eie�ring
Cor
p.
2370 Southwest 123rd Avenue
Mami,Florida 33175-1174
Tel:305-823-8008/305-397-6414
ENGINEER Fax:305-823-3300/305-884-8834
Website:www reilehengineermg.com
December 13, 2016
John Busta Roofing
300 Northeast 91 Street
Miami Shores, Florida 33138-3130
Project: ROOF TILE UPLIFT TEST REPORT
Residential biome
117 Northwest 101 Street
Miami Shores, Florida
Information provided by client:
Permit Number: RF11163230
Date Completion: December 10, 2016
Roofing Contractor: John Busta Roofing
Project Number: 16-1200
(Testing Laboratory Certificate#11-0715.04)
Dear Sirs;
In accordance with your request and authorization, a representative of Reileh Engineering
Corporation completed the Roof Tile Uplift Test at the above referenced project. This testing was
performed in general accordance with Roofing Application Standard TAS No.!0() -- Standard
procedure for field verification of the bonding of mortar or adhesive set the system acid.mechanically
attached,rigid, discontinuous roof systems.
The total of the tested roof surface area was less than 10000 square feet, and the nteaa_ height of the
roof is less than 40 feet above giound surface. The type of tile used for this proievt �r;,:, rilported to
be 9" Flat White Concrete Roof Tile. This tile was reportedim
to have been foaed in ;;iacc.
At the time of our inspection,the entire area of the roof was examined for loose tips. Not less than
one(1)tile in ten(10)of all components in the field area and one(1)the in five(5) of all tiles in the
perimeter and comer areas were physically examined. A minimum of one(1)test per every two(2)
squares in the field, one (1) test per square in the perimeter area, ridge caps and (1)" in the comer
areas were conducted.
Based on our test results, we conclude that the installation of the roof tile at the a'00%,e referenced
project meets the test requirement outlined in the above-mentioned protocol. Attau:iied please find
a copy of our test report for,your review.
Reileh Engineering Corporation appreciates the opportunity of assisting you in this project. If you
hav6 any questions or if we may be of further assistance, please do not hesitate to contact the
undersigned.
Respectfully submitted;
Reileh Engineering Corporation
Mohamad Sonny Salleh, P.E.49014
Project Manager
TILE UPLIFT TEST
Residential Home
117 Northwest 101 Street
Miami Shores,Florida
Reileh Engineering Corporation--Project Number- 16-1200—Page 2 of 3
Report of
TILE UPLIFT TEST
for
Residential Home
117 Northwest 101 Street
Miami Shores, Florida
Project Number: 16-1200
Test Number Test Load Ibfj Test Status
1 35 Pass
2 35 Pass
3 35 Pass
4 35 1'ass
5 35 Pass
6 35 Pass
7 1 35 Pass
Test 1-2 Corner, 3-5 Perimeter, 6-7 Field
Reileh Engineering Corporation--Project Number- 16-1200—Page 3 of 3
3 5
7 6
10'
I p 2
W
NUMi3t;t;OF 11;51" MM11;f; - 60 5F O f lPa CAP TEST WCA110N
FEW - 2 COUR - 20 5F
COUR - 2 MMV L915TANa,a= 3' L MNO 5 005 11.�
1U 16-1200
0126e CAP 0 COM MA- 3'X 3'
APPROX,ROOF 11;5T LOCATIONS,ACAS, ANI7 f71WN5ION5
�g cy Miami Shores Village ■. Faw
T
t
10050 N.E.2nd Avenue NW � �
y
Miami Shores,FL 33138-0000
a3 Phone: (305)795-2204 �• °'
LORIfu' a r � t �� -€ '..
'it129�t!'[ff Expiration: 05/25/2017
Project Address Parcel Number Applicant
117 NW 101 Street 1131010220150
Miami Shores, FL 33150- Block: Lot: GHAZAR KOLIAN
Owner Information Address Phone Cell
GHAZAR KOLIAN 117 101
MIAMI SHORES FL 33150-
117 101
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone Valuation: $ 1,500.00
JOHN BUSTA ROOFING INC (305)219-9699
.._._._.. __...._ ....._ ... _ ........ _�... _ Total Sq Feet: 50
Type of Work:Repair Available Inspections:
Additional Info:RENEW AND REPLACE TILE AND FELTS AB Inspection Type:
Classification:Residential Roof Repair
Scanning:3 Final Roof
Review Roof
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20
DBPR Fee Invoke# RF-11-16-62193
$2.00
DCA Fee $2.00 11/29/2016 Check#:2066 $ 116.20 $0.00
Education Surcharge $0.40
Permit Fee-Repairs $100.00
Scanning Fee $9.00
Technology Fee $1.60
Total: $116.20
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
constructionutherm e,I authorize the above-named contractor to do the work stated.
November 29, 2016
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
November 29,2016 1
Miami Shores Village
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 2010
BUILDING Master Permit No. 12.,•F- I(ci - Z 3C)
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC @YOOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: /®/ 67,
City: Miami Shores County: Miami Dade AD: /�®
Folio/Parcel#: //- 31191®• ®� __ 0JJ Q Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee SimpleTitleholder): 6 74 Z k !<®ZIA� Phone# VS• 9i`7""199.3
Address: iZ7 Aza zaz
City: ��•� � ..S State �� Zip: 1346�e/iZ/
Tenant/Lessee Name: N Phone#:
Email: &ZIA zaP_h a—ZZAAle va
CONTRACTOR:Company Name: ®l�/(� /��f/� / -�/f!1. Phone# z1a'd f6��
Address:
City: & a State: �� • Zip: � �
Qualifier Name. Phone# 9 ��Z,_
State Certification or Registration M �C��-�I �r� � Certificate of Competency#:
DESIGNER:Architect/Engineer: /(1� Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$4_Iew I Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ Newepair Replace ❑ Demolition
Description of Work: Jr 2q&g GA-054-GE
e
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ I CCF$ t • 2C) CO/CC$
Scanning Fee$ Radon Fee$ 2.. DBPR$ ii Z. Notary$
Technology Fee$ Training/Education Fee$ ` l� Double Fee$
Structural Reviews$ Bond$
12o
Bonding Company's Name(if applicable)
Bonding Company's Address /(!
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Ad ess do
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signatures -, Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
NO day of /(/a&93 ,20 1,6 •by day of &4522 . 20 , , by
9 ZAK— 4& who is personally known to iC� ,who is personally knownD tQ
a e
me or who has produced AZ•40"1 .5 46C � 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:
,,f - �
Sign�C.�I�J� � Sign:
Print: Sa r►&f GL tH (A S Print:
NNt 111111
Seal: ,•• SANDRAANNR A Seal:= RA ANNBtfSTA e :+ MY COMMISSION 9 FF 159120 �' SAV'-
EXPIRES,Septem 14,2018
+, .� MY Gir..ln'•I5Si0N 9 FF 159120
Bonded Thru l tery Pulk,*r rriteM EXPIP" :emtt7er 14,2018
flL tti Bonder' :ery Pubk UndervMn
APPROVED BY tans Examiner Zoning
14+
Miami shores V
mail
Building Department
�LOR' ► 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner — Workers' Compensation Insurance Exemption
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 ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature: es
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this gZit/2 day of&06gF� G� ,20 i_•
By who is personally known to me or has produced
- f
&9&4129 as identification.
Notary'.�-SWy—dA,1D
SEAL: &4W14AIMI9=A
= MY CMOWIIXV 0 FF 15912D
EXPIRES: 14,'pis
r• TWUNom pok
9
Y OFTOP STRUCTURES
ROS
iT
F ITIV Florida Building Code 5th Edition r
NOV 29 2016 j °
High-Velocity Hurricane Zone Uniform Per °
BY:_ Pe" I
1
Section A(General Informat °
Master Permit No. Process No. °
Contractor's Name °
Job Address
1
ROOF CATEGORY 1
0
❑ Low Slope ❑ Mechanically Fastened Tile , Mortar/Adhesive Set Tiles 1
❑ Asphaltic Shingles ❑ Metal Panel/Shingles ❑ Wood Shingles/Shakes 1
❑ Prescriptive BUR-RAS 150 1
ROOF TYPE °
❑ New roof Repair ❑ Maintenance ❑ Reroofing ❑ Recovering 1
ROOF SYSTEM INFORMATION 1
1
Low Slope Roof Area(SF) Steep Sloped Roof AREA(SSF)� Total(SF) �Q °
1
Miami Shores Village ection B(Roof Plan) 1
' us rate all I vels and sions, f drains,scuppers,overflow scuppers and overflow drains. Include dimen- 1
APP iioons of:OVEc ons anddWls,cle ly ideiu Td lensl s of elevated pressure zones and location of parapets. °
U 1
ZONING DEPT 1
1
BLDG 1
SUCiJ C TO O PLI NC 1
ST TE D OU TY UL S A D R °
1
j 1
N 1
°
tIX I
I 1
- - - - -
_ 1
e 1
•• • . . 1
1
FLORIDA BUILDING CODE—BUILDING,Sth'•EDIjION(201P1 i i i i 15.37
Copyright
Pgpeement , �er b��µ� ���);accessed by Elieur Palacio on Jun&2015 10:32:12 AM pursuant to license
t �
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 renailed in accordance with the current provisions of Section R4403.(The roof deck is usually
concealed prior to removing the existing roof system).
4• t3r— Exposed Ceiling:Exposed,open beam ceilings s are where the underside dersrde of the roof decking
can be viewed from below.The owner may wish to maintain the architectural appearance;therefore,
roofing nail penetration of the underside of the decking may not be acceptable.This provides the option of
maintaining the appearance.
&e--
6. Overflow scuppers(wall outlets):It is required that rainwater flows off so that the roof is
not overloaded from a buildup of water.Perimeter/edge wall or other roof extension may block this
discharge if overflow scuppers(wall outlets)are not provided. It may be necessary to install overflow
scuppers in accordance with the requirements of Sections R4402,R4403 and R4413.
/ /� 04
Owner/Agent's Signature ate Contractor Signature Date
//-7&W /0/ ars
Property Address Permit Number
Revised on 7/9/2009 LD;07/01/2015;
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