2012100260-PlansHIGH -VELOCITY HURRICANE ZONES!
44201
SECTION 84402.14
HIGH -VELOCITY HURRICANE ZONES — UNIFORM PERMIT APPLICATION
Florida Building Code Edition 2010
High Velocity Hurricane Zone Uniform Permit Application Form,
INSTRUCTION PAGE
COMPLETE THE NECESSARY SECTIONS OF
THE UNIFORM ROOFING PERMIT
APPLICATION FORM AND ATTACH THE
REQUIRED DOCUMENTS AS NOTED BELOW:
Roof System
Low Slope Application
Prescriptive BUR -RAS 150
�(sphaltic S1itngt'
Concrete or Clay Tile
Metal Roofs
Wood Shingles and
Shakes
Other
Required Sections of the Attachments Required
Permit Application Form See List Below
A,B,C
1,2,3,4,5,6,7
A,B,C 4,5,6,7
A,B,D,E
A,B,D
A,B.D
As Applicable
1,2,3,4,5,6,7
1,2,4,5,6,7
1,2,3,4,&6,7
ATTACHMENTS REQUIRED:
1. Firs Directory Listing Page
2. From Product Approval:
Front Page
Specific System Description
Specific System Limitations
General Limitations
Applicable Detail Drawings
3. Design Calculations per Section R4403, or If Applicable, RAS 127 or
RAS 128
4. Other Component Product Approvals
5. Municipal Permit Application
6. Owners Notification for Roofing Considerations (RemolnQOnty)
7. Any Required Roof Testing/Calculation Documentation
2010 FLORIDA BUILDING CODE — RESIDENTIAL
. • 4,• •
Florida Building Code Edition 2010
High Velocity Hurricane Zonel,iniform Permit Application Form.
Section A (General Information
Master Permit No. (20 1.21 0 0,-;2,60 Process No.
Contractors Name
Job Address
&Ole‘ NUJ 69 to A4
ROOF CATEGORY
HIGH -VELOCITY HURRICANE ZONES
0 Low Slope 0 Mechanically Fastened Tile 0 Mortar/Adhesive Set Tile
phaltic 0 Metal Panel/Shingles 0 Wood Shingles/Shakes
Shingles
0 Prescriptive BUR -RAS 150
ROOF TYPE
tigr New Roof 0 Reroofing 0 Recovering 0 Repair 0 Maintenance
ROOF SYSTEM INFORMATION
Low Slope Roof Area (SF)
Steep Sloped Rooef_Area (SF) Total (SF)
/6 9 A
Section B (Roof Plan)
Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow
scuppers and overflow drains. Include dimensions of sections and levels, clearly
identify dimensions of elevated pressure zones and location of parapets.
MO FLORIDA BUILDING CODE RESIDENTIAL
1-)-r
44.21
HIGH -VELOCITY HURRICANE ZONES
Florida Building Code Edition 2010
High Velocity Hurricane Zone Uniform Permit Application Form.
Section D (Steep Sloped Roof System)
Roof System Manufacturer: CSS F 11 cp-tp.
Product Approval Number: //'' /7.2-z- &X
Minimum Design Wind Pressures, If Applicable (From RAS 127 or Calculations):
P1: P2: P3:
Maximum Design Pressure
Product Approval Specific System:
Method of tile attachment:
Roof Slope:
:12
Steep Sloped Roof System Description
Deck Type:
ype Underlayment:
Insulation:
\Fire Barrier:
3o( g-/ fi _/_ le V " /7`,�
Ridge Ventilation? Fastener Type & Spacing:
/ Adhesive Type:
ype Cap Sheet:
�,. S Y40//,Q/4
6', C. f 7 cel �a ,,R G c ---J
� I
oaf Covering:
Mean Roof Height: /-3
2010 FLORIDA BUILDING CODE — RESIDENTIAL
Type & Sire Drip
dge: I ,
•
44.23
DEPARTMENT OF PERMITTING, ENVIRONMENT, AND REGULATORY AFFAIRS (PERA)
BOARD AND CODE ADMINISTRATION DIVISION
NOTICE OF ACCEPTANCE (NOA}
GAF Materials Corp.
1361 Alps Rd.
Wayne, NJ 07470
MIAMI-DADE COUNTY
PRODUCT CONTROL SECTION
11805 SW 26 Street, Room 208
Miami, Florida 33175-2474
T (786) 315-2590 F (786) 315-2599
www.m iamidade. eov/nera
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 PERA - 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 AHJ may immediately
revoke, modify, or suspend the use of such product or material within their jurisdiction. PERA reserves the
right to revoke this acceptance, if it is determined by Miami -Dade County Product Control 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 Timberline® Prestique 30, Timberline® HD, Timberline® Natural Shadow', and
Timberline® American Harvest"' Shingles
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 renews and revises NOA# 10-0720.10 and consists of pages 1 through 6.
The submitted documentation was reviewed by Alex Tigera.
MIAMI.DADE COUNTY
�;1•r1Z111�
NOA No.: 11-1122.04
Expiration Date: 02/21/17
Approval Date: 02/09/12
Page 1 of 6
ROOFING ASSEMBLY APPROVAL
Category:
Sub -Category:
Materials
Deck Type:
Roofing
Asphalt Shingles
Laminate
Wood
SCOPE
This approves GAF Timberline® Prestique 30, Timberline® HD, Timberline® Natural ShadowTM, and Timberline®
American HarvestTM Shingles as manufactured by GAF Materials Corp described in Section 2 of this Notice of
Acceptance.
PRODUCT DESCRIPTION
Product
Dimensions
GAF Timberline® Prestique 30 13'/4"x 393/8"
Manufacturing
Locations #1, 2, 3, 4, 5, 6, 7, 8
GAF Timberline® HD 13'/4"x 393/8'
Manufacturing
Locations #1, 2, 3, 4, 5, 6, 7, 8
GAF Timberline® Natural 13'/4'x 393/8'
Shadow"'
Manufacturing
Locations #1, 2, 3, 4, 5, 6, 7, 8
GAF Timberline® American 131/4"x 393/8'
HarvestTM
Manufacturing
Locations #2, 9 only
MANUFACTURING LOCATION
1. Tampa, FL
2. Michigan City, IN
3. Mobile, AL
4. Baltimore, MD
5. Myerstown, PA
6. Ennis, TX
7. Tuscaloosa, AL
8. Dallas, TX
9. Fontana, CA.
MIAMI•D UNTY
Test Product Description
Specifications
TAS 110 Fiberglass reinforced heavy weight asphalt
roof shingle, with a laminate profile
TAS 110 Fiberglass reinforced heavy weight asphalt
roof shingle, with a laminate profile
TAS 110 Fiberglass reinforced heavy weight asphalt
roof shingle, with a laminate profile
TAS 110 Fiberglass reinforced heavy weight asphalt
roof shingle, with a laminate profile
NOA No.: 11-1122.04
Expiration Date: 02/21/17
Approval Date: 02/09/12
Page 2 of 6
EVIDENCE SUBMITTED
Test Mencv
Test Identifier Test Name/Report Date
Underwriters Laboratories, Inc. ASTM D3462 11CA48924 10/24/11
Underwriters Laboratories, Inc ASTM D3462 10CA21994 04/22/11
Underwriters Laboratories, Inc ASTM D3462 10CA28717 07/26/11
Underwriters Laboratories, Inc. ASTM D3462 05CA47541 11/10/06
Underwriters Laboratories, Inc. ASTM D3462 06CA31580 11/30/06
PRI Asphalt Technologies, Inc. ASTM D3462 GAF -101-02-02 11/02/05
Underwriters Laboratories, Inc. ASTM D3462 06NK05159 08/09/06
PRI Asphalt Technologies, Inc. ASTM D3462 GAF -098-02-02 11/08/05
Underwriters Laboratories, Inc. ASTM D3462 02NK41809 08/11/02
Underwriters Laboratories, Inc. ASTM D3462 03NK26444 10/17/03
Center for Applied Engineering ASTM D3462 257989 05/13/97
Underwriters Laboratories, Inc. TAS 107 01NK45803 04/13/94
Underwriters Laboratories, Inc. TAS 107 06NK05159 08/09/06
Underwriters Laboratories, Inc. TAS 107 04NK04273 02/20/04
Underwriters Laboratories, Inc. TAS 107 05CA42840 11/11/05
Underwriters Laboratories, Inc. TAS 107 02NK41811 11/11/02
Underwriters Laboratories, Inc. TAS 107 03CA35209 10/17/03
Underwriters Laboratories, Inc. TAS 107 04CA13850 08/30/04
Center for Applied Engineering TAS 100 257989 04/01/97
PRI Asphalt Technologies, Inc. TAS 100 GAF -044-02-01 01/13/04
PRI Asphalt Technologies, Inc. TAS 100 GAF -098-02-01 11/08/05
PRI Asphalt Technologies, Inc. TAS 100 GAF -101-02-01 11/09/05
PRI Asphalt Technologies, Inc. TAS 100 GAF -116-02-02 03/23/06
PRI Asphalt Technologies, Inc. TAS -100 ELK -083-02-01 10/16/02
ELK -084-02-01 10/15/02
ELK -085-02-01 10/14/02
ELK -086-02-01 10/24/02
ELK -087-02-01 10/21/02
ELK -088-02-01 10/16/02
ELK -107-02-01 10/09/03
ELK -108-02-01 10/09/03
ELK -109-02-01 10/09/03
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. Shall not be installed on roof mean heights in excess of 33 ft.
3. All products listed herein shall have a quality assurance audit in accordance with the Florida Building
Code and Rule 9B-72 of the Florida Administrative Code.
MIAMIrDADE COUNTY
NOA No.: 11-1122.04
Expiration Date: 02/21/17
Approval Date: 02/09/12
Page 3 of 6
INSTALLATION
1. Shingles shall be installed in compliance with Roofing Application Standard RAS 115.
2. Flashing shall be in accordance with Roofing Application Standard RAS 115
3. The manufacturer shall provide clearly written application instructions.
4. Exposure and course layout shall be in compliance with Detail 'A', attached.
5. Nailing shall be in compliance with Detail 'B', attached.
LABELING
1. Shingles shall be labeled with the Miami -Dade Seal as seen below, or the wording "Miami -Dade County
Product Control Approved".
MIAMIDADE COUNTY
APPROVED
BUILDING PERMIT REQUIREMENTS
1. Application for building permit shall be accompanied by copies of the following:
1.1 This Notice of Acceptance.
1.2 Any other documents required by the Building Official or the applicable code in order to properly
evaluate the installation of this system.
MIAMI•DADE COUNTY
►_nil;t w4),1
NOA No.: 11-1122.04
Expiration Date: 02/21/17
Approval Date: 02/09/12
Page 4 of 6
17" OFF
11" OFF
6" OFF
FULL
MIAMI DADE COUNTY
DETAIL A
COURSE LAYOUT
DECK
FULL
4th
3rd
2nd
5th
1 st
NOA No.: 11-1122.04
Expiration Date: 02/21/17
Approval Date: 02/09/12
Page 5 of 6
DETAIL B
OVERALL DIMENSIONS AND NAILING PATTERN
39-3/8"
6"
1/2"
Back Side
6 fasteners 72"
7-i„
2
r r 6
Front Side (Maximum Slope 12:12)
39-3/8"
6 fasteners
Release
Tape
5-5/8"
I \ I
Front Side (Maximum Slope 21:12)
Tab Sealant
1"
MIAMI.DADE COUNTY
Release
Tape
5-5/8"
2„
3/8"
END OF THIS ACCEPTANCE
NOA No.: 11-1122.04
Expiration Date: 02/21/17
Approval Date: 02/09/12
Page 6 of 6
be activated by solar heat of intensity generally attained on warm, sunny
gles with factory -applied adhesive utilize a combination
days. Other shin
pressure -sensitive and heat -sensitive adhesive. Due to the nature of adhe-
sives of this type, sealing is induced by application of pressure and/or heat.
Hip and Ridge Shingles are composed of asphalt or modified asphalt -
coated glass -fiber mat surfaced with granules and are intended to be
installed as specified on packaging supplied with the product for hip and
ridge installations only. They are investigated for fire resistance in accor-
dance with Subject 2375, "Outline of Investigation for Hip and Ridge
Shingles." Where indicated, they have also been investigated for wind resis-
tance at velocities up to 110 mph. Wind -resistant hip and ridge shingles
may utilize locking mechanisms, field -applied adhesives or factory -applied
heat -sensitive adhesive which must be activated by solar heat of intensity
generally attained on warm, sunny days.
RELATED PRODUCTS
Prepared roof covering materials investigated for impact resistance are
covered under Roof Covering Materials, Impact Resistance (TGAM ).
Asphalt shingles investigated for wind resistance are covered under Pre-
pared Roof Covering Materials, Asphalt Shingle Wind Resistance (TGAH ).
Accessory components utilized in the prepared roof covering system are
covered under Prepared Roofing Accessories (TGDY ). Ridge vents utilized
in the prepared roof covering system are covered under Ridge Vents (TGEW
). Type 15 and Type 30 asphalt felts, used as underlayments, are covered
unser Roofing Systems (IGFU ). Underlayments, ridge vents and accessory
components, when utilized, are intended to be Classified materials,
ADDITIONAL INFORMATION
For additional information, see Roof Covering Materials (TEVT ) and
Roofing Materials and Systems (AARM ).
REQUIREMENTS
The basic standards used to investigate products in this category are
ANSI/UL 790, "Tests for Fire Resistance of Roof Covering Materials'
(ASTM E108 and ANSI/NFPA 256 ), and UL 997, "Wind Resistance of Pre-
pared Roof Covering Materials" (ASTM D3161 ).
UL MARK
The Listing Mark of Underwriters Laboratories Inc. on the product is the
only method provided by UL to identify products manufactured under its
Listing and Follow -Up Service. The Listing Mark for these products
includes the UL symbol (as illustrated in the Introduction of this Directory)
together with the word "LISTED," and the following additional information:
PREPARED ROOF COVERING MATERIALS
DEGREE OF RESISTANCE TO EXTERNAL FIRE — CLASS +
Issue No.
The Listing Mark may also include one or more of the following state-
ments as appropriate:
DEGREE OF WIND RESISTANCE IN ACCORDANCE WITH UL 997 •
WIND RESISTANCE HAS ALSO BEEN INVESTIGATED AT WIND '
VELOCITIES UP TO ++ MPH
WIND RESISTANCE
ALSO CLASSIFIED IN ACCORDANCE WITH ASTM D3161, CLASS +++
ALSO CLASSIFIED IN ACCORDANCE WITH ASTM D3462
ALSO CLASSIFIED IN ACCORDANCE WITH CAN/CSA-A123.5
+ A, B or C
++ Specific maximum wind velocity used in the investigation
+++ A, D or F
ATLAS ROOFING CORP R4052
SUITE 800 2000 RIVEREDGE PKY, ATLANTA GA 30328
Asphalt organic felt sheet roofing and shingles, for installation as Class C
prepared roof coverings.
Asphalt glass mat shingles, for installation as Class A prepared roof
coverings. Suitable for installation over 3/8 in. and 1/2 in, plywood decks.
Asphalt organic felt shingles and asphalt glass mat shingles, for installa-
tion as wind resistant roof coverings.
Asphalt glass fiber mat shingles, for installation as wind -resistant roof
coverings. May also bear the following statement "also evaluated at velocities
up to 110 mph".
Modified asphalt glass fiber mat shingles, for installation as Class A
prepared roof coverings for installation on minimum 15/32 in. thick plywood
decks.
Modified asphalt glass fiber mat shingles, for installation as wind resistant
roof coverings. Three tab and Laminated shingles may bear the statement,
"Also evaluated at wind velocities up to 110 mph" .
Modified asphalt glass fiber sheet roll roofing, for installation as Class C
BUILDING PRODUCTS OF CANADA CORP R14379
9510 ST PATRICK ST, LASALLE, QC H8R 1119 CANADA
Asphalt glass mat shingles, for installation as Class A prepared roof
coverings Suitable for installation over 3/8 in. min. plywood decks. May also
bear the following statement "Also Classified in Accordance with ASTM
D3161, Class D or F.
Asphalt organic felt shingles, for installation as Class C prepared roof
coverings Suitable for installation over 3/8 in. min. plywood decks.
Asphalt organic felt shingles and asphalt glass mat shingles, for installa-
tion as wind resistant roof coverings. May also bear the following statement
"Also Classified in Accordance with ASTM D3161, Class D or F.
CANROOF CORP INC R2459
560 COMMISSIONERS ST, TORONTO, ON M4M 1A7 CANADA
Asphalt organic -felt sheet roofing and shingles, for installation as Class C
prepared roof coverings. Asphalt organic -felt shingles, for installation as wind
resistant roof coverings. Asphalt mineral wool -felt shingles, for installation as
Class A prepared roof coverings. Asphalt mineral wool -felt shingles, for
installation as wind resistant roof coverings.
CERTAINTEED CORP R684
ROOFING PRODUCTS GROUP 1400 UNION MEETING RD PO
BOX 1100, BLUE BELL PA 19422
Asphalt glass mat shingles, for installation as Class A prepared roof
coverings. Suitable for installation on minimum 3/8 in. thick plywood decks.
Asphalt glass mat and hip and ridge shingles, for installation as wind
resistant roof coverings. Wind resistance has also been evaluated in accordance
with ASTM D3161, Class D and F. Wind resistance for 'Presidential Accessory,
Oxford's Hatteras Accessory, Shangle Ridge and Shadow Ridge, hip & ridge
shingles have also been evaluated in accordance with ASTM D3161, Class F
when BASF Sonnolastic NP 1 adhesive or Henkel PLO Polyurethane Roof &
Flashing Sealant, applied as specified in manufacturer's application instruc-
tions."
Asphalt glass mat shingles, Classified in accordance with ASTM D3462,
including tear resistance.
Asphalt glass mat shingles, for installation as Class C prepared roof
coverings.
Asphalt organic felt shingles, for installation as Class C prepared roof
coverings.
Asphalt organic felt shingles, for installation as wind resistant roof cover-
ings.
Asphalt glass fiber mat shingles, Classified in accordance with CAN/
CSA123.5-M90.
Modified asphalt glass fiber mat shingles, for installation as Class A
prepared roof coverings. Suitable for installation minimum 3/8 in. thick
plywood decks. Modified asphalt glass fiber mat shingles, for installation as
wind resistant roof coverings.
Asphalt glass mat shingles, for installation as Class A prepared roof
covering when used with minimum Type 30 underlayment over existing wood
shingle roof.
ELK CORP R3915
SUITE 60014911 QUORUM DR, DALLAS TX 75254
Asphalt glass mat shingles, for installation as Class A prepared roof
coverings. Suitable for installation on minimum 3/8 in. thick plywood decks.
Asphalt glass mat shingles, for installation as wind -resistant roof coverings.
Wind resistance has also been evaluated at wind velocities up to 110 mph.
Asphalt glass mat shingles Prestique Plus, for installation as Class A
prepared roof covering when used over existing wood shingle roof.
Asphalt glass mat shingles, Prestique I and Prestique II, for installation as
Class A prepared roof covering when used with minimum Type 15 underlay-
ment over existing wood shingle roof.
Asphalt glass mat shingles, Classified in accordance with Standard ASTM
D3462.
Modified asphalt glass fiber mat shingles, for installation as Class A
prepared roof coverings. Suitable for installation on 3/8 in. thick plywood
decks.
GAF MATERIALS CORP } R21
—1161 ALPS RD
halt-organic/glass fiber mat shingles and sheet roofing, for installation
as Class C prepared roof coverings.
Asphalt organic/glass fiber mat shingles for installation as wind resistant
roof coverings.
Asphalt glass fiber mat shingles, for installation as Class A roof covering.
Suitable for installation on minimum 3/8 in. thick plywood.
"Slateline" asphalt glass fiber mat shingles, for installation as Class A roof
covering. Suitable for installation on 15/32 -in. thick plywood in combination
a-tik Vag : ,,,sstl p '31114e-MaiEr or Type in or type UU underlayment
Asphalt glass fiber mat shingles, for installation as wind resistant roof
coverings.
Asphalt glass fiber mat sheet roofing, for installation as Class C prepared
roof covering.
Asphalt glass mat shingles, for installation as wind resistant roof coverings.
Asphalt glass mat shingles, for installation as Class A prepared roof
covering when used with minimum Type 30 underlayment over existing wood
shingle roof.
LOOK FOR THE UL MARK ON PRODUCT
Wayne Comer
From: Abbona, Claudia (cabbona(rIgai,dorni
Sent: Wednesday, February 27. 2008 8:29 AM
To: Wayne Comer
Subject: Emaiiing: showpage
Wayne:
Sorry you did not received the fax, my machine never sent me an erroreport.
ONLINE CERTIFICATIONS DIRECTORY
TFWZ.R21
Prepared Roof Covering Materials
Page_Bottrrn
Prepared Roof Covering Materials
r....5.e.c,,,,,generalInfQrrn,atiselfor„Rre,pa red ,Ro2f ,c,-,gyenng liqaterjajts
GAF MATERIALS CORP
1361 ALPS RD
WAYNE, 1,1.1 07470 USA
R21
UL
H •
Asphalt organic/glass fiber mat shingles and sheet roofing, for installation as Cas s C prepared roof coverings.
Asphalt organi /glass fiber mat shinglesfor installation as wind resistant roof coverings.
Asphalt glass fiber mat shingles, for installation as Class A roof covering. Suitable for installation on minimum 3/8 in, thick
piywoodi
"Slateline" asphalt glass fiber mat shingles for installation as Class A roof covering. Suitable for installation on 15/32 -in, thick
plywood n combination with minimum one piy "Shingle -Mate" or Type 15 or Type 30 underleyrnent
Asphalt glass fiber mat shingles, for installation as wind restsof coverings.
Asphalt glass fiber mat sheet roofing, for nstaation as Class C prepared roof covering,
Asphalt glass mat shingles, for installation as wind resistant roof coverings,
Asphalt glass mat shingles, for installation as Class A prepared roof covering when used with mnirnUrn Type 30 und ri yment
over existing wood shingle roof.
Modified asphatt glass fiber mat shingles. for installation as Class A prepared roof coverings.
Asphalt glass mat shingles, Classified in accordance with 'ASTM 03462', CAIN/CSA A123.5 -M90,
For instE.,Ilato.r, as wind -resistant roof coverings Nlay also oear the foliowing ‹taternent "Also evaluated at velor:lbes up to 110 mph'.
'17/2008
CITY OF PARKLAND BUILDING DEPARTMENT 954-753-5447
Date Received: 11/7/13 Permit Number: 2012100260
Lot: 141C Block: Subdivision: PINETREE ESTATES
Job Address: 6019 NW 69 WAY
Work Description: ADDITION
Contractor: O'DWYER,JEREMY
DEPARTMENT Date Denied
ZONING
LANDSCAPING
ENGINEERING
FIRE
STRUCTURAL
ELECTRICAL
PLUMBING
MECHANICAL
PTE
Phone:
Date Approved
Initials
Sit
/1/4)6-tioKs
)Jo Te4k5 /44..fz, 1).1
rtii7EbOLA) it1-001 z.1\
Ante6 (oo tct wist—‘
;x m—
Broward County Board of Rules and Appeals
One North University Drive, 3500-B
Fort Lauderdale, Florida 33324
Effective: March 15, 2012
Telephone: 954.765.4500
Facsimile: 954.765.4504
FORM FOR "SPECIAL BUILDING INSPECTOR"
SECTION 110.10 - BROWARD COUNTY ADMINISTRATIVE CODE
AND THE 2010 FLORIDA BUILDING CODE
NOT1cE TO PROPERTY OWNER;
You are hereby directed in accordance with Section 110.10.1 of the Broward County Administrative Code and the Florida Building
Code to retain a Special Structural Inspector (A Florida Registered Architect or Licensed Engineer) to perform the following
mandatory or discretionary inspections, as outlined in Sections 110.10, 1822, 2122.2,4, 2218.2, R4407.5.4, 2223.11.1, 1927.12.1,
1927.12.2, R4405.9.12.1, R4405.9.12..2, R4408.5.2 & R4408.I0.11 of the Florida Building Code and submit progress reports, inspections
reports, and a Certificate of Compliance to the Building Official as per Sections 110.10.6 and 110.10.7 of the Horida Building Code.
Note: The Building Official determines which discretionary inspections are to be delegated.
DATE r f , '4 t iDENTiFICATION, CONTROL OR BUILDING PERMIT #
PROJECT NAME (' Il i t% Ver.
f
JOB ADDRESS k r: 6g. tit iJ 6 i f� c ; << `/ i '.'IC c;,i t i' ( zip 3
LEGAL. DESCRIPTION: FOLIO #
A. MANDATORY INSPECTIONS TYPE BY COPE:
1) Precast Concrete Units — Section 1927.12.1, R4405.9.12.1. 110.10.2.1 Yes
2) Precast Concrete Units — Section 1927.112, R4405.9.12.2, 110.10.2.1/g
_......_..............�._......_._.___..._.»..._.......__.._ Yes
3) Reinforced Unit Masonry— Section 2122.2.4, R44075.4, 110.10.2.2 (per ACI 530.1 -05 -Level B Quality Assurance)*
*unless noted otherwise on plan.... es No
4) Connections — Section 2218.2, 110.10.2.3 ........_.._..__... ....._..... ... ..._._.... .................._...__ Yes No
S) Metal System Buildings — Section 2223.1 1.1, 110.10.2.4, R4408.10.11 ...... _.........
_.__...._...._._..._._... _ ......__._.._....._....___........,_......_......_. Yes ! o�
Ii. DISCRETIONARY INSPECTION TYPE BY BUILDING OFFICIAL:
I) Building Structures or part thereof of Unusual Size, Height. Design or Method of Construction and
Critical Structural Connections — Section 110.10.1 . I _._..._......__..._._..._..._.__.._.. Yes
2) Windows, Glass Doors and Curtain Walks on buildings over two (2) stories — Section 110.10.1.1 _ _-----.__....._._. Yes
3) Pik Driving Only — Sections 1822, R4404.13, 110.10.1.1 Yes
4) Precast Concrete Units — Section 1822. R4405.9.12, 110.10.11— Yes
5) Reinforced Unit masonry — Sections 2122.2.4, R4407.5.4, 110.10.2.2
6) Other _....._.._....
ED
No
400
1e*
es No
Yes No
C. MANDATORY DOCUMENTATION
1) Inspection schedule stating the specific inspection that will be made and at what phase of construction must be submitted with this application.
2) Progress Report/Inspection reports during construction in accordance with Section 110.10.6.
3) Certificate of Compliance must be submitted poor to the scheduling of the final building inspection, Section 110.10.7.
ACKNOWLEDGMENT __
Owner's Signature:�}, Permit Holder's Signature:
Printed Name: `-..J6� "I ('l Irri.3.24-1,4-j_ Printed Name:
License # (if applicable) T?' - A L 4 tr Cl'?
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SPECIAL BUILDING INSPECTOR;
Registered Architect andror Licensed Engineer Signature of Special Building Inspector, Embossed Seal ANI) Day., /f f4/ d
Printed Name of Special Building Inspector W 1L /eVh g/4
Address of Special Building inspector 1 3 9 3 eP /1) p � 12191 C
IAJ 1Nc-foil,. 334/1-
33138
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33138 Fax # s c l — 73 3- 34 3eP___ hone # s c / — 3/3 — .s- w1
1/14/2dt3
State of Florida Registration #
Dace:
Building Official (or designated representative)
**BE ADVISED THIS DOES NOT PRECLUDE YOU FROM OTHER MANDATORY INSPECTIONS IN THE CODE***
G:ISHARED\Forms12010 FBC Special Bldg lnsp Fonn.doc
Main Level
EXISTING 1ST FLOOR
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1848 LIVING AREA
MaIn Level
9/4/2012 Page: 1
Main Level
19' 4"
EXISITING 2ND FLOOR
565 LIVING AREA
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UPSTAIRSHOME 9/4/2012 Page: 1
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CONSTRUCTION DOCUMENTS FOR
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