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PERMIT APPLICATION
DEPARTMENT OF DEVELOPMENT BUILDING DIVISION BUILDING PERMIT APPI. ICA TION Date: Original Permit # (~:::) ~.-- (, ~ Master Permit # Co~;~ors Name~ ~ ~ ~~ / ~ ~ Con~c~s Phone ~ To~I Estima~ Value ~ this Revision $ ~~ ~ Description OF Wo~: (Plea~ ~ /n detai/ ~at /s being mvis~ from o~inal pe~.) Building: Value Electrical: Value of Work: $ Fire Sprinkler: Value of Work: $ Irrigation: Value of Work: $ Mechanical: Value of Work: $ Value of Work: $ Roofing: Value of Work: $ Sign: ~ Value of Work: $ Site Lighting: Value of Work: $ Clearing & Grubbing: Paving/Drainage: Value of Work: $ Value of Work: $ Fill/Excavation: Value of Work: $ Landscaping: ~ Value of Work: $ t wish to revise the above referenced permit top~~work described herein. I certify that all work will be constructed in conformance with all Contractor's'aw~' c°d'' regu'ati°n" rules' etc' g°verning ~nt°~:and I certify that the ab°ye inf°rmati°n is true and c°rrect' / Signature PALM ~/' .~ Date: STATE Of FLORIDA, COUNTY OF BEACH The foregoing instrument was / /;~ ~)~;/l~) ~Li :~ ~ acknowledged before me this '1~ ( '~ (') ~ ( S~.at[~~ent Name of ~cer taking ~kn~gement ~, pdnt~ or s~ Title or rank Application approved by As iderttificalJon and who did (did no~) Sedal Num~' Permit Officer ISSUANCE OF THIS PERMIT DOES NOT AUTHQRI~; VIOLATION OF DEED RI=*_~rRIC'FION-~ FEES ARI~ NQT REFUNDABLE _(_For Offic~ Use On~_~ Odginal Permit # PCN Application Accepted By: Master Permit # (Palm Beach County Property Control #) Type of Construction Occupancy Type Fence Type Roof Type Flood Zone Base Flood Elevation Finish Floor Elev. (Proposed) Number of Units Parking Spaces Required Parking Spaces Provided Area Square Feet (Gross) Area Square Feet (Net) Number of Stories Number of Bedrooms Remarks: Pen'nit # Submiffal Review F H Completed by Date to P&Z records Utilities Completed by . Date rec~3rc~ Date entered into Permit Log Inifiats i ~ Review F H Submittal ADDITIONAL FEE(S) BCAIF Parks Fee Penalty Fee Public Building Fee Radon Fee Road Impact Fee School Fee Sewer Fee Water Fee Fire Depar'mr~ent Fee Overtime Fee Sub-Total SINGLE FEE VALUE Building Clearing & Grubbing Drainage Electrical Excavation Fill Fire Sprinkler Imgation Landscaping Mechanical Paving Plumbing '~~..:~----- -, Roofing Sign Site Lighting Sub-Total Less Plan Filing Fee FE_ E TOTAL AMOUNT DUE Receipt Number Date Permit Issued Completed by. Date to P&Z records Permit # Review F H Completed by .,, Date records Date entered into Permit Log Initials .,, Date called for comments Initials Compmed by Date to P&Z records Completed by Date records .,, Dale entered into Permit Log ... Initials Date called for comments Initials.,. DEPARTMENT OF DEVELOPMENT BUILDING DIVISION BUILDING PERMIT APPLJCA TION - 02-1644 Date: Original Permit # ©-c._ ~,G,'~'~ Master Permit # Project Name: ~Gi~_ ~._~0~ ~=~~ Project Address: "~g~c~ ~'"IIt~D~ ~ City/State/Zip: Contractor's Name: ~at~ ~ ~-~~,, i ~Contractor's Phone # Total Estimated Value of this Revision $ ~O Description of Work: (Please specify in detail what is being revised from orfg/nal permit.) Building: Electrical: Fire Sprinkler: Irrigation: Value of Work: $ Mechanical: ~ Plumbing: I~/~.~ Value of Work: $ Value of Work: $ Roofing: Value of Work: $ Sign: Site Lighting: Clearing & Grubbing: "- Value of Work: $ Value of Work: $ Value of Work: $ Paving/Drainage: Value of Work: $ Fill/Excavation: Value of Work: $ Landscaping: "--- /.~ Value of Work: $ :h_t_o_,r_evis. ,h,e ?.bore r.eferen, ced perm!t ,o_PJ~form/~. work described herein. , cerUfy that .,, work will be constructed in conformance , co~es, regum~mns, ru;es, e~c. governing ~pynt~.Beach, and I certify that the above information is true and correct, with all ontractoPsSignature / /~_ Date: ~'~'//~'/.~7.... The foregoing instrument was acknowledged before me this ' ~ (d ~onally known tQma or who has produced ~ ~m~lipn and ~ ~ not) take an oath. (NSSiagmEAn~!~e °f pers°n taking ackn°wledgement ~~~~ officer taking acknow~edgem~~; Tiff ...... ~' , = ~, ,-,.,~ / Application approved..~==3~~_~__~--~~ ~;P-/OFTHIS PERMr DOES NOT AUTHOR VIOLATION OF DEED RESTRICTION~ FEES ARE NOT REFUNDABLF Original Permit # PCN Application Accepted By: Type of Construction Occupancy Type Fence Type Roof Type Flood Zone Base Flood Elevation Finish Floor Elev. (Proposed) Number of Units Parking Spaces Required Parking Spaces Provided Area Square Feet (Gross) Area Square Feet (Net) Number of Stodes Number of Bedrooms Remarks: by, Completed by~ Date records Date entered into Permi~ log __ _ Ini~ls _ Date catled f~* comments ~ ~ ~; ~:i Initiats ~ Permit # ._(_~.or Office Us~ Master Permit # (Palm Beach County Prope/Yy Control #) ADDITIONAL. FEE(S) BCAIF Parks Fee Penalty Fee Public Building Fee Radon Fee Road Impact Fee School Fee Se~er Fee Water Fee Fire Department Fee Overtime Fee Sub-Total SINGLE FEE Building Clearing & Grubbing Drainage Electrical Excavation Fill Fire Sprinkler ~.d Imgation Landscaping Mechanical Paving Plumbing Roofing Sign Site Lighting Sub-Total Less Plan Filing Fee TOTAL AMOUNT DUE Receipt Number Date Permit Issued C(3mple~ed by ~ Date to P&Z records Permit # Date -.---____ .Review F H C~ompleted by. ~ _ D~e records _ Date entered into Permit Log ~ Date ca~ted for comments Initials _ Date to P&Z records _C_Completed by_ _ Date records _ Date entered into Permit Log __ __ Initials __ ::)ate called for comments Initials_ DEPARTMENT OF DEVELOPMENT BUILDING DIVISION BUILDING PERMIT APPLICATION Please print. Ail lines MUST be completed. If not applicable, write N/A. 02-1644 Date: *~'~Uj ~, ~-(;3(3"-J.. Master P~m~ g i ' PC~ ~'sName ~ i~ ~ ~~ C~ ~s~ ~o0 ~Y~oL~Xo ~b F~ Sim~ T~e H~s N~e F~ Simple T~le Hold~'s Addr~s C~/Stat~ip (Pakn Beach County Property ConU~l #) (If other than owner's) (If other than owner's) City/StateFZip (Check one below) Single Family D u_p, Jex Multi-Family Hotel Retail Industrial (Check Reviewer Required below) Electrical __ Mechanical ~, Plumbing Structural __ Fire __ Other Application is hereby required to obtain a permit to do 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 codes, laws, rulas and regulations governing construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONING WORK, ETC. 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 A'I-rORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. OWNER'S AFFIDAVIT: I cerlJfy that all the foregoing information is accurate and that all work will be done in compliance with all applicable codes, laws, rules and regulations governing construction and zoning. Property Owner's or Agent's Signature Date STATE OF FLORIDA, COUNTY OF PALM BEACH The foregoing instrument was acknowledged before me this (date) by Who is personally known to me or who has produced As identification and who did (did not) take an oath. (SEAL) Signature of person taking acknowledgement Name of ofrmer taking acknowledgement typed, pdnted or atemped Title or rank~~dl~-/~ Serial Number, if any STATE OF FLORIDA, COUNTY OF PALM BF_,aj~H The foregoing instrument was Signature of person taking acknowledgemen,( '~L~,~~ ( Name of off'met taking acknowledgement ty~ or sTampec~ ~F~: ,~pmmber 10, 2005 T~e or rank SedaJ Numb~ ifl~¥~3.L~T^RY FL Notanf Service & Boring, (Certificate of Competency Holder) Contractor's State Certification of Registration No. (~,~ C C3(_.¢~,~- ~ Liability Insurance Expiration Date Workem' Compensation Expiration Date Application Approved by ~ (Perm8 OfF, er) Date Any cfla3ge in builda'~g plans or spec~ication$ must be recorded with this olfice. Any wonk no~ covered al3ove must have a valid pem3it prior Io ~lling, In c~'lalcle~ltion of ~'a,l~ ~ p~mlit, the owner and f~x~ilding agree to elect tflii struc~uce ~ full compliance with the Building a~d Zorl~ng Codes of lY~ City or' B<~ NOTF~: This pecmit VOID after 180 DAYS UNLESS the work which it covers has commenced. All Contractors must have valid State CedJf'c,,ation or County Competency plus County and City OccupatJonal Licenses prior to obtaining permit. I~I.IANCE OF TNI$ PERMIT DOES NOT AUTHORIZE VIOLATION OF DEED RESTRICTION~ FEES ARE NOT REFUNDABLE (For Office Use Only) Application Accepted By: Application # Type of Construction Occupancy Type Fence Type Roof Type Flood Zone Base Flood Elevation Finish Floor Elev. (Proposed) Number of Units Parking Spaces Required Parking Spaces Provided Area Square Feet (Gross) Area Square Feet (Net) Number of Stories Number of Bedrooms Remarks: IF THIS BOX IS NOT COMPLETED, THIS PERMIT IS SUBJECT TO A FINAL INSPECTION ONLY. AUTHORIZED for CERTIFICATE OF OCCUPANCY: AUTHORIZED for CERTIFICATE OF COMPLETION: Date ADDITIONAL FEE(S) BCAIF Parks Fee Penalty Fee Public Building Fee Radon Fee Road Impact Fee School Fee Sewer Fee Water Fee Fire Department Fee Overtime Fee Sub-Total SINGLE FEE Building Clearing & Grubbing Drainage Electrical Excavation Fill Fire Sprinkler Irrigation Landscaping Mechanical Paving Plumbing Roofing Sign Site Lighting Sub-Total TOTAL Less Plan Filing Fee Receipt Number Check/Credit Card Number Cash Received from: Accepted by: (Initials) BALANCE DUE Receipt Number Check/Credit Card Number Cash Received from: vALUE FEE Accepted by: (Initials) DEPARTMENT OF DEVELOPMENT BUILDING DIVISION BUILDING PERMIT APPLICATION Please print. All lines MUST be completed. If not applicable, write N/A. Date: (~,/~3.. 7/0 ~ Master Permit # <:~)~d:~O~ /~,,~.,~L Permit# Owner's Name /,l~-~,~,,, ~./~,bE~.t~. ~'0~-,~,)'1~'-¢ ~..4_.~,~ Owner's Phone # Fee Simple-Title J-lolder's Name (If cther than owner's) Fee Simple Title Holder's Address (If other than owner's) City/State/Zip Bonding Company Address C~ylState£Zip Contact person Company Address City/State/Zip Job Name /-//4,-I c~/~p L~al D~n ArchiteclJEngineer's Name Architect/Engineer's Address City/State/Zip Zo~d Mortgage Lender's Name Mortgage Lender's Address C~y/State/Zip (C k o., be/ow) Single Family Duplex Multi-Family FJimatedValueof~$ 51'~<.T~ ooo Detailed Deec~l~Uon of Work ,~£ )'E~ o ~' ,.~/_ 0 ~: Ratail Offioa Industrial (Check Reviewer Required below) Electrical Mechanical Plumbing Structural __ Fire Other Application is hereby required to obtain a permit to do work and installations as indicated. I certify that no work or installation has commenced pdor to the issuance of a permit and that all work will be performed to meet the standards of all codes, laws, rules and regulations governing construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONING WORK, ETC. 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. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable codes, laws, rules and regulations governing construction and zoning. Prol:~rly Owner's or Agent's Signature Date STATE OF FLORIDA, COUNTY OF PALM BEACH The foregoing instrument was acknowledged before me this (date) by Who is personally known to me or who has produced As identification and who did (did not) take an oath. (SEAL) Signature of person taking acknowledgement Name of officer taking acknowledgement typed, pdnted or stamped Title or rank 8_edal Number, if any The foregoing instrument was ~;?/C:~ 1k acknowledged before me this ~ ( Who is personally known to me or who ( L ..... ,~ patricia A Befger Signature of person taking acknowledgeman ' J_~. ~ - ~ ....My Commission CC889455 Name of officer taking acknowledgement typed, pdhted or stamped Title or rank S~ial Numl:~', if any ''°' ' :'~" E~,~,~ Januaryu! zu~J4 (Certificate of Competency HoMer) Contractor's State Certification of Registration No. Liability Insurance Expiration Date //',~ Workers' Compensation Expiration Date Application Approved by ~- ~~ (Perm~ OfF. er) Date Am/ct~lnge in building ple~,~ ~ Specificalior~ rnu~J be rl~d W~lh Ibis office. A~ w~emd ~ove mu~ h~v~ ~ v~id pe~mil ~ lo st~*ii~, in ~ ~1' ~ Ibis p~mfl, the owner ~ building ~gree ~o emcl Ibis slruclum in fu# campl~mce wilh lhe Building ~ Zo~g Code~ ~ lhe Cily ~ Bm/r~,~ Be~:~. NOTF~: This permit VOID ~ffer 180 DAYS UNLI:$$ ~he work which it co~r~ h~$ commenced. All Contractors must h~ve v~lid Sl~le Certiticel~ or Gounly Comp~t~ plu~ Counb/~nd Cib/Occupational licenses prior Jo obtaining permiL ISSUANCE OF THIS PERMIT DOES NOT ALrrHORIZE VIOLATION OF DEED R~STR~TION~ FEES ARE NOT REFUNDABLE Fr--] Hr- (For Office Use Only) Application Accepted By: Application # Type of Construction Occupancy Type Fence Type Roof Type Flood Zone Base Flood Elevation Finish Floor Elev. (Proposed) Number of Units Parking Spaces Required Parking Spaces Provided Area Square Feet (Gross) Area Square Feet (Net) Number of Stories Number of Bedrooms Remarks: IF THIS BOX IS NOT COMPLETED, THIS PERMIT IS SUBJECT TO A FINAL INSPECTION ONLY. AUTHORIZED for CERTIFICATE OF OCCUPANCY: Date AUTHORIZED for CERTIFICATE OF COMPLETION: Date ADDITIONAL FEE(S) BCAIF Parks Fee Penalty Fee Public Building Fee Radon Fee Road Impact Fee School Fee Sewer Fee Water Fee Fire Department Fee Overtime Fee Sub-Total SINGLE FEE Building Cleating & Grubbing Drainage Electrical Excavation Fill Fire Sprinkler Landscaping Mechanical Paving Plumbing Roofing Sign Site Lighting Sub-Total TOTAL Less Plan Filing Fee Receipt Number Check/Credit Card Number Cash Received from: Accepted by: (Initials) BALANCE DUE Receipt Number Check/Credit Card Number Cash Receivedfrom: VALUE FEE Accepted by: (Initials) DEPARTMENT OF DEVELOPMENT BUILDING DIVISION 9 9 0 04 3 (Please Print) SUB PERMITS PCN# ~)g'~.5~ffO~DT_OOocO/~) ~ (Palm Beach County Property Control Owner's Name /-/t~/ .~',u~;~. CC.~-/-,~ ~'/~.--~,.~. Owner's Phone # Owner's ~ddress HOC) #Y.~J~,~:, City k4~z. kOo ~-r+l State ~[O~'b9 Zip Fee Simple Title Holder's Name (If other than owner's) Fee Simple Title Holder's Address (If other than owner's) Contractor's Name Me±sner ~J. ectr.tc Inc. Contractor's Phone # 278-8362 . Project Manager and emergency phone # ' Contractor's Address 220 N.~.~.. l~t Street Beepe~F~xx_.~ 561-278-0124 City Delrav Beach , , , State --'Flor'ida Zip 3344.4 Job Name - P/tF~d I~.t~.~ ~o~o'r~-~/ C, lct~ JobAddress o2~05) p/-tO~-i/~c~/.. -~b/~b ~quTo~ .egal Description ~onding Company ~ondlng Co. Address 'City State ;,rchitectJEnglneer's Name ~,rchitectJenglneer's Address vlortgage Lender's Name vlortgage Lender's Address ~,INGLE FAMILY DUPLEX MULTI-FAMILY HOTEL RETAIL OFtqCE check one) -'STIMATED VALUE OF CONSTRU_~,TION $ ,qC)~ C)co, t)O ::)ESCRIPTIONOFWORK: ~L. 4.)"F~.iO~. -'~ ~ ;L)e_zO O/-/i)/~'}P- ~Y ~/~ ~/,/;1'" ,~[ 6cma' CB I ,5e~:?.o;-c~ :, ~,ppllcation is hereby required to obtain a permit to do work and installations as indicated. I.certify that no work or installation has INDUSTRIAL :ommenced prior to the issuance of a permit and that all work will be performed to meet the standards of all codes, laws, rules and egulations governing construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL. PLUMBING. ~IGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS AND AIR CONDITIONING WORK, ETC. 3WNER'S AFFIDAVIT: I certify that all the foregoing information ls accurate and that all work will be done in compliance with all applicable :odes, laws, rules and regulations governing construction and zoning. NARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR :~AYING TWIC'E FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT ~ITH YOUR LENDER OR AN A'R'ORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. Property Owner's or Agent's Signature STATE OF FLORIDA, COUNTY OF PALM BEACH The foregoing instrument was acknowledged before me this who is pe~sonally knowu to me or who has produced take an oath. Date ((~te) by identification and who did (did not) (SEAL) , Name of officer Signature of person taking acknowledgement primed or stamped Title or rank Serial Number, ffany Contractor's Signature t~--~:L~"'~'~.'O~e~ -- - STATE OF FLORIDA, COUNTY OF ?ALIVi BEACH 'te y~~ who is r~ly kn__~q.~own to me or who has produced as identification and who did (did not) take an oath. I M HAWK I (SEAL) - printed or stamped Title or rank Serial Nu~ah01rv (Certificate of C0m~etency Holder) EC0000418 Contractor's State Certification of Reglstratlonrpl/~/ ] ~ t. iability Insuranca Expiration Date Workers' Compensation Expiration Date' "{ lot }0 ~ Application Approved By ' ~X,x~_~ Permit Officer Date: Any change in building plans or specifications must be recorded with this office. Any work not covered above must have a valid permit pdor to starting. In consideration of granting this permit., the owner and builder agree to erect this structure in full compliance with the Buitding and Zoning Codes of the City of Boynton Beach. NOTE: This' permit VOID after 180 DAYS UNLESS the work which it covers has commenced. All Contractors must have valid State Certification or County Competency plus County and City Occupational Licenses prior to obtaining permit. ISSUANCE OF THIS pERMIT DOES NOT g.~JTHOR!7-F VIOLATION OF DEED RESTRICTIONS FEES ARE NOT I~EFUNDABLE taking acknowledgement ~- typed, x\CH\MAIN~HRDATA~)EVELO PMENT~FORMS'DOC\PERMIT APPLICATION'DOC (THIS SIDE FOR OFFICE USE ONLY) Application # Master Plan # APPLICATION DATE: RECEIVED BY: SETBACKS: LEFT RIGHT FRONT · REAR ZONE: TYPE OF CONSTRUCTION OCCUPANCY TYPE ROOF TYPE FENCE TYPE AREA SQUARE FEET FLOOD ZONE BASE FLOOD ELEVATION FINISH FLOOR ELEVATION NUMBER OF STORIES NUMBER OF UNITS PARKING SPACES REQUIRED PARKING SPACES PROVIDED it OF BEDROOMS it OF BATHROOMS ROAD IMPACT FEE SEWER FEE WATER FEE PARKS FEE SCHOOL FEE PUBLIC BLDG. FEE LAW ENFORCEMENT FEE RADON FEE BCAIF ADDITIONAL FEE PENALTY FEE SUB-TOTAL REMARKS: SINGLE FEE Site Improve. Building " Electrical - Mechanical - Plumbing Roofing Drainage '" Excavation Landscaping Paving Sign Sewer VALUATION SUBTOTAL REQUIREMENTS for CERTIFICATE OF OCCUPANCY CERTIFICATE OF COMPLETION FINALS: SITE . SIGN FIRE FENCE/BUFFER WALL DRAINAGE PAV I N G OTH ER SITE LIGHTING ~ OTHER AUTHORIZATION for CERTIFICATE OF OCCUPANCY: ·Oate AUTHORI7..ATION for CERTIFICATE OF COMPLETION: Date TOTAL LESS PLAN FI~ING FEE TOTAL AI~IOUNT DUE RECEIPT NUMBER DATE ISSUED INTERIM SERVICES FEE CALCULATIONS: Residential: X = # of Units Applicable Monthly Fee Commercial: # of Sq, Ft Base Sq. Ft Divided by 1,000 (rounded to Nearest tenth) Applicable Monthly Fee Interim Services Fee Base Sq. Ft Rate Intedm Services Fee Revised 6/16/97, 1114/97 DEPARTMENT' OF DEVELOPMENT BUILDING DIVISION BUILDING PERMIT APPLICATION Please print. Ail lines MUST be completed. If not applicable, write N/A. Da*e: ~ / . , , ~'.. Master Permit PC~ ~'sName /-/ ~ C. ,~ ../~,, .:~ ~ ~-~ Pe~ # (Palm Beach County Property Control #) Fee Simple Title Holder's Name Fee Simple Title Holder's Address City/State/Zip !~ L (If other than owner's) (If oth¢. than owner's) Contractor's Company Contact pemon & emergency phone Company Address C~/StaterZip Job Name ,Job Address City/State/Zip Legal Dascriplion Bondieg Company Pager/Fax# Bonding Company Address /~ City/State/Zip /~ ArchitectJEngineer's Name Architect/Engineer's Address City/State/Zip Mortgage Lender's Name Mortgage Lender's Address City/State/Zip (Check one below) Single Family Duplex Estimated Value of Constn~ion $ Detailed De~-iptlon of Work Multi-Family Hctel Retail C,fl'~ce Industrial (Check Reviewer Required below) Electrical Mechanical ~ Plumbing ~ Structural Fire __ Other Application is hereby required to obtain a permit to do work and installations as indicated. I certify that no work or installation has commenced pdor to the issuance of a permit and that all work will be performed to meet the standards of all codas, la~s, rules and regulations governing construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONING WORK, ETC. 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. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable codes, laws, rules and regulations governing construction and zoning. Property Owner's or Agent's Signature Date STATE OF FLORIDA, COUNTY OF PALM BEACH The foregoing instrument was acknowledged before me this (date) by Who is personally known to me or who has produced As identification and who did (did not) take an oath. (SEAL) Signature of person taking acknowledgement Name of ofrmer taking acknowledgement typed, printed or stamped Title or rank ~:) ,~ ,,, & / ,,:// ~ Serial Number, if any STATE OF FLORIDA, couNTy OF PALM BEACH The foregoing instrument was ~_~. ! . acknowledged before me this (date) by Who is personally known to me or who /_.. :~ ~ ~ '~',~ ~ ~ ~ has produced -- ~; '~ ~- As identification and who did (did not) take an oath. ------~ ~ ~ ~-~ :~~'"~, ~ ~ ~("\ C-~ --~ , {'"~_...,. ~, . ~ (SEAL) Name of off'ruer taking acknowledgemenl typed, printed or stamped Title or rank S~al Numl~, if any (Certiflcat. of Competency Holder) Contrector's State Certification of Registration No. ,-/:: c.o ~/&o°~)-° L,ab , ,ns rance Ex.,rat on D=e / o Compensation E..at on Date Application Approved by ~~' (Perm~ OfFicer) Date Any cfiange in building plans o~ specifications must be recon3ed with this office. Any wod< not covenad above mu~t have a valid permit pftor to staffing, k3 co~.sideration oi' ~.,ii b'is pe~nit, tY~e ..... City or' Boynton Bea<~ ,. owne~ and building agree to erect b'li$ str,JCtLl~e ir1 full COnlplla~x:e with the Buk~dll3g mid Zol3illg Codes o~ the NOTE.: This p~'mit VOID after 180 DAYS UNLESS t~e work which it covers has commenced. All Contractors must have valid State CeflJflcatio~ or County Competency plus County and City OccupetJonal IJcenses prior to obtaining permit. ISSUANCE OF THIS PERMIT DOES NOT AUTHORIZE VIOLATION OF DEED RESTRICTION~ FF_F_~_ ARE NOT REFUNDABLE Application Accepted By: ~ (For Ofrme Use Only) Application ,. Type of Construction Occupancy Type Fence Type Roof Type Flood Zone Base Flood Elevation Finish Floor Elev. (Proposed) Number of Units Parking Spaces Required Parking Spaces Provided Area Square Feet (Gms,s) Area Square Feet (Net) Number of Stodes Number of Bedrooms Remarks: IF THIS BOX IS NOT COMPLETED, THIS PERMIT IS SUBJECT TO A FINAl.. INSPECTION ONLY. AUTHORIZED for CERTIFIC~TE OF OCCUPANCY: Date AUTHORIZED for CERTIFICATE OF COMPLETION: Date ADDITIONAL FEE(S) BCAIF Parks Fee Penalty Fee Public Building Fee Radon Fee Road Impact Fee School Fee Sewer Fee Water Fee Fire Department Fee Overtime Fee Sub-Total SINGLE FEE Building Clearing & Grubbing Drainage Electrical Excavation Fill Fire Sprinkler Irrigation Landscaping Mechanical Paving Plumbing Roofing Sign Site Lighting Sub-Total TOTAL Less Plan Firing Fee Receipt Number Check/Credit Card Number Cash Received from: Accepted by: (Initials) BALANCE DUE VALUE -F E Receipt Number Check/Credit Card Number Cash Receiveq from: Accepted by: (Initials) O DEPARTMENT OF DEVELOPME. NT0 BUILDING DIVISION BUILDING PERMIT APPLICATION PleaSe T be c°n~ted' lf n°t a~-~ticable' w~A! Date: ,~. PCN~ 0~ Ci~ ~ ~ ~~ ~ -- S~ ~ ~ (If other than owners) Fee Simple Title Holders Name ~ ~ (If other than owners) Fee Simple Title Holders Address Ci~/State~ip Company Addre~ Ci~/S~te/Zip ~~ Zoned Bonding Company Bonding Company Address City/State/Zip Architect/Engineer's Name Architect/Engineer's Address City/State/Zip Mortgage Lender's Name Mortgage Lender's Address R C_ELV_ED City/State/Zip (Check one be/ow) Office ~ Industrial Single Family Duplex Multi-Family Hotel __ Retail (Check Reviewer Required below) Electrical Mechanical Plumbing Structural ~ Fire Other Application is hereby required to obtain a permit to do 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 codes, laws, rules and regulations governing construction in this jurisdiction. I understand that a separate permit must be secured for, ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONING WORK, ETC. that all work will be done in compliance with all OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate,~nd applicable codes, laws, rules and regulations ~ern~g cons~an~d z~' ........... A-ent's Si-,nature '~ ~ ~"~/I ~ c------.-~ ~.ropemj ~Jwn~ uf u ~ ~j STATE OF FLORIDA, COUNTY OF PALM BEACH The foregoing instrument was .~'/3~ f~/O ''v'~ (date)by ,/~c~'J J. (SE L) I Signature of person taking acknowledgement " Name of officer taking acknowledgement typed, printed or stamped S e"~i' Num Title or rank Date Contractor's Signature STATE OF FLORIDA COUNTY OF PALM BEACH , . ~ ~ .... ack nowle(jg_e.~d b ' ...... ~ / , -- ~ ................. ~.~_ :, / / , .,~/~. o~.c~..~,/"":"';~ ~..~o~.s,~p,e,~lonally known ,o me or who .... :~' As ,del~t~ion~o wi'~i~li~Eii:icC~Ot)'~k* a~n oat~. Signature of person taking aci(now~eagemem - . . ~ ~ _ ~ " ~: ~ Name of officer taking acknowledgement typed ....... Title or rank , ~eda~ mumoer, [~ any (Certificate of Competency Holder) Contractor's State Certification of Registration No. ~ ~ ~' 0 ~ ~' ~ c:~ (3 O.,. -,~ /~ (Permit Officer) Date Application Approved by .. -,2/.,---'? ~ In cons~eratJo~ of grants this pen~t, the owner and building agree to erect this smJcture in full compliance with the Building and Zoning Codes of the City of Boynton Beact~. NOTE: This permit VOID after 180 DAYS UNLESS the work which it covers has commenced. All Contractors must have valid State Certification or County Competency plus County and City Occupational Licenses prior to obtaining permit. ISSUANCE OF THIS PERMIT DOES NOT AUTHORIZE VIOLATION OF DEED RESTRICTION~ FEES ARE NOT REFUNDABLE S:\DEVELOPMEN'ISFORMS&TEMPLATES\BUILDING PERMIT APPLICATION-Igl. Rev 6/18/97, 11/4/97, 12/98, 6/99, 8/99, 5/00, 8/00, 9/00, 10/01 Application Accepted By: Application # Type of Construction ~ Occupancy Type Fence Type Roof Type Flood Zone Base Flood Elevation Finish Floor Elev. (Propcsed) Number of Units Parking Spaces Required Parking Spaces Provided Area Square Feet (Gross) Area Square Feet (Net) Number of Stories Number of Bedrooms Remarks: IF THIS BOX IS NOT COMPLETED, THIS PERMIT IS SUBJECT TO A FINAL INSPECTION ONLY. AUTHORIZED for CERTIFICATE OF OCCUPANCY: Date A~ ~RI~i,ED for CERT!FICATE OF~OMPLETION: t~L~'~'"'-.,~ ~j.,~-~- D ate /~, ~.~//_.) ~.....- /./ - ADDITIONAL FEE(S) BCAIF Parks Fee Penalty Fee Public Building Fee Radon Fee RoAd Impact Fee School Fee sewer Fee Water Fee Fire Department Fee Overtime Fee Sub-Total SINGLE FEE Building Clearing & Grubbing _ Dr,,~inage _~_~E~ectrical Excavation Fill __ Fire Sprinkler __ Irrigation _ .I,l,l~ndscaping ",.,'~echanical __ Paving __ Plumbing __ Roofing __ Sign __ Site Lighting Sub-Total TOTAL Less Plan Filing Fee Receipt Number Check/Credit Card Number Cash Received from: Accepted by: (Initials) BALANCE DUE Receipt Number Check/Credit Card Number Cash Received from: Accepted by: (Initials) VALUE qFEE S:\DEVELOPMENT~FORMS&TEMPLATES\BUiLDiNG PERMIT APPLICATION-Igl. Rev 6/18/97, 11/4/97, 12/98, 6/99, 8/99, 5/00, 8/00, 9/00, 10/01 MIAMI-DAD£ COUN"FY. FLOR. t[ ~ e~ ,~ ~T~O~ADE FLAGLEE BUILDD COMPLIA.'~CE OFFI( PRODUCT CONTROL NOTICE OF ACCEPTANCE TX 77643 U.S. lntec, Inc. 1212 Brai Drive Port Arthur Your application for Product Approval of: U.S. lntec Modified Bitumen Roof Systems for Steel Deck METRO.DADE FLAGLER BUILDD 140 WEST FLAGLER STREET. SUITE 16 MIAMI. FLORIDA 33130-15 {3051 375-.~901 FAX (305) 375.29 CO.~TIL~CTOP. LICr~~SLXC S£CTI¢ ¢O.~'TR.C?O R &~ro~c £.%t E~r PRODU~ CONTROL DIYISIC under Chapter 8 of the Code of Miami-Dada County governing the use of Alternate Materials and Types Construction, and completely described herein, has been recommended for acceptance by the Miami-Dac County Building Code Compliance Office (BCCO) under the conditions specified herein. This approval shall not be valid after the expiration date stated below. BCCO reserves the right to secure product or material at anytime from a jobsite or manufacturer's plant for quality control testing. If this product or material fails to perform in the approved manner, BCCO may revoke, modify, or susper the use of such product or material immediately. BCCO reserves the right to revoke this approval, if it is determined BCCO that this product or material fails to meet the requirements of the South Florida Buildi~ Code. The expense o, fsuch testing will be incurred by the manufacturer. Acceptance [~o.: 00-0329.06 Expires:08/01/2003 Raul Rod~ Chief Product Control Divis THIS IS THE COVERSHEET, SEE ADDITIONAL PAGES FOR SPECIFIC AND GENERAL CONDITIONS BUILDING CODE & PRODUCT REVIEW COMMITTEE This application for Product Approval has been reviewed by the BCCO and approved by the Building Co and Product Review Committee to be used in Dada County, Florida under the conditions set t'orth above. Approved: 05/26/2000 I of 27 S EE' ?E ,N/II Director Miami-Dada County Building Code Compliance RECEIVED F4AY -12002 BUILDING DIVISION lnternet mall address: postmaster~}buildingcodeonline.com Homepage: htlp://www, buildingcodeonllne.com U.S. IHTEC, INC. Acceptance No.: 00-0329.06 Roomo i) ¢cl, l=: Category: Sub-Catel4orv.: Deck Type.; Maximum Desiqn Pressure Fire Classification: Roofing BUR Modified. APP/SBS Steel -75 psf See General Limitation #1 Approval Date: May 26, 2000 Expiration Date: August 01,2003 TI:LA, DE NAMES OF PRODUCTS MANUFACTURED OR LABELED BY APPLICANT: Test Product Dimensions* Specification Ultra Base -. 67 lb. roll ASTM D 4601 Bondable Base 67 lb. roll Product .Deserip. tion Type l[ asphalt impregnated and coated glass fiber base sheet. ASTM D 4601 Type II asphalt impregnated and coated glass fiber base sheet. Flex Base 30 67 lb. roll ASTM D 5147 Flex Base 60FR 85 lb. roll ASTM D 5147 .~.- Flex Base 6C~FR HS Inlet Modified Base 190P 85 lb. roll 87 lb. roll Permavent 72 lb. roll Combination Base lntec Modified Base Plus Intec Modified Base HS 67 lb. roll 90 lb. roll 90 lb. roll Tough Ply IV 38 lb. roll ASTM D 5147 ASTM D 5147 ASTM D 4897 Type il ASTM D 460 I Type I Fiberglass base sheet coated with SDS modified asphalt. Fiberglass base sheet coated with SBS modified asphalt. Fiber glass mat and scrim reinforced base sheet coated with SDS modified asphalt. Smooth surface SDS modilicd asphalt membrane. polyester rcinforccmcnt. Fiber glass base sheet impregnated and coated on both sides. Type I asphalt impregnated and coated glass fiber base sheet with kraft paper backing. Ultra Ply VI 38 lb. roll ASTM D 5147 Fiberglass base sheet coated with SDS modified asphalt. Ultra Cap 72 lb. roll ASTM D 5147 Smooth surface, 6her glass mat and scrim reinforced, SDS modified asphalt membrane. ASTM D 2178 Type IV asphalt impregnated glass felt. Type IV ASTM D 2178 Type VI asphalt impregnated glass felt. Type VI RECEIVED ASTM D 3909 Asphalt impregnated and coated felt surfaced with mineral granules. SUEEI OE Roofing Product Control Examiner · U.S. INTEC, INC. Acceptance No.: 00--0.329.06 Product Intec Flex S lntec Flex lntec Flex 190 Intec Flex 190 FR [ntec Flex 250 FR lntec Flex FR 4.5 Intec Flex FR.3 HS Dimensions* 88 lb. roll 105 lb. roll lb. roll 105 lb. roll 105 lb. roll 105 lb. roll 100 lb. roll Test Specification ASTM D 514"/ ASTM D 5147 ASTM D 5147 ASTM D 5147 ASTM D $ i 47 ASTM D 514'7 ASTM D 5147 Smooth surface, polyester reinforced, SBS modified asphalt membrane. Granule surface, polyester reinforced, SBS modified asphalt membrane. Granule surface, polyester reinforced, SBS modified asphalt membrane. Granule surface, polyester reinforced, fire resistant, SBS modified asphalt membrane. Granule surface, polyester reinforced, fire resistant, SBS modified asphalt membrane. Granule surface, fiberglass reinforced, fire retardant, SBS modified asphalt membrane. Granule surface fiberglass scrim and mat reinforced, fire resistant, SBS modified asphalt membrane. lntec Flex Dual FR Intec Flex O~ (Smooth) lntec Flex Aluminum lntec Walk Board 90 lb. roll 90 lb. roll 3' X 3' ASTM D 5147 ASTM D 5147 ASTM D S 147 Proprietary Granule surface, polyester/fiberglass reinforced, fire resistant, SBS modified asphalt membrane. Smooth surface, fiberglass reinforced, SBS modified asphalt membrane. Aluminum surface, reinforced membrane for flashing use only. Granule surface, APP modified asphalt membrane walkboard. lntec Flex Walk Board 3'x3' Proprietary Granule surface, SBS modified asphalt membrane walkboard. Drill-Tee (SS) Fastener various PA 114 Stainless steel, drill point, threaded fastener. Drill-Tee # 14 Heavy Duty (HD) Fastener Drill-Tee Coated Drill Point (CDP) Drill-Tee Coated Thread Point (CTP) various various various PA !i4 PA PA 114 Corrosion resistant, drill point, threaded fastener. Corrosion resistant, drill point, threaded fastener. Corrosion resistant, threaded point fastener. Drill-Tee Plastic Plates 3" round PA 114 Polyolifin 3" round plastic stress plates. Drill-Tee Metal Plates round PA 114 Galvalume 3" round metal stress plates. Flex Asphalt various ASTM D 312 SEBS modified mopping asphalt. Flex Asphalt Plus various RECEIVED mV S O 0 modified ASTM D 312 SEBS .~:~~ ~: Zuloaga, RRC Roofing Product Control Examiner U.S. IHTEC, INC. Acceptance No.: 00-0329.06 .Product Flex Asphalt Lite Intec/Permaglas Roofing Asphalt Matrix SBS Plus Matrix SBS Plus Trowel Grade Fireshield Gravel Guard MB MDrain Mini SP-4 MPan MScupper ,.. Preirlashed L~ead Jack Standard, AOjustable, One Way MVen't lntec Tape USlso Roof' Insulation USIso Tapered Root' Insulation USlso/Perlite Composite BMCA Permalite BMCA Recover Dimensions* various various various various 6 gal. drum various various various various various various various roll various various various min. %" thick min. ½" thick Test Specification ASTM D312 ASTM D 3t2 proprietary proprietary proprietary proprietary proprietary proprietary proprietary proprietary proprietary proprietary proprietary PA 110 PA I10 PA !10 PA 110 PA 110 - 0 - 1 Description SEBS modified mopping asphalt. Mopping Asphalt Asphalt based, SBS modified cold adhesive. SBS modified root cement. A liquid, temporary tire retardant treatment for brush, roll or spray application. Metal edge gravel guard with perforated flange. Spun aluminum or copper roof drain, Pre-cut widths of polyester reinforced, APP modified membrane for flashing and repairs. A prefabricated pitch pan and modified bitumen flashing assembly. Prefabricated scupper. Preflashed vent pipe waterproofing assembly. Prefabricated stack cover for use in soil pipe waterproofing. Unreinforced APP asphalt used as sealer or filler. Polyisocyanurate foam insulation. Tapered polyisocyanurate insulation. Polyisocyanurate foam/perlite composite insulation board. Perlite and tapered perlite insulation Perlite recover board RECEIVED U.S. INTEC, INC. Test Product Product Dimensions Specification Description Pyrox min. 4' x 4' PA 110 Pol¥isocy~urate foam insulation W~ite Line min. 4' x 4' PA 110 Polyisocyanurate foam insulation ACFoam Il min. 4' x 4' PA 110 Polyisocyanurate foam insulation E'NRG'Y-2 min. 4' x 4' PA 110 Polyisocyanurate foam insulation Multi-Max min. 4' x 4' PA 110 Polyisocyanurate foam Muhi-Max FA insulation Type X Gypsum various DensDeck min. '/," thick Dekfast Fasteners various PA 114 ,~.* #14 o- Dckfast Hex'Plate 2 ?/l" x 3 'A" PA 114 Dckfast Lock Plate 3" x 3 ~A" PA 114 Dckfast # I $ Dekfast # 12 #12 Roofgrip # 14 Roofgrip Gripdek Fastener VariOUS various Acceptance No.: 00-0329.06 variOUS PA 114 various PA 114 various PA 114 Hextra various PA ti4 RoD fgrip Fastener PA 114 PA 114 various PA 114 RECEIVED MAY - 1 2002 Fire resistant rated gypsum. Fire resistant gypsum. Insulation fastener for steel and concrete decks Galvalumc hex stress plate. Polypropylene locking plate. Insulation fasteners for concrete decks Insulation fastener for steel a~d wood decks. Insulation fastener for steel or wood decks Insulation fastener steel, wood or concrete decks Insulation fastener Insulation fastener and metal or plastic plate Insulation fastener 5 of 27 BUILDING Manufacturer Apache Products Co. (with current PCA) Apache Products Co. (with current PCA) Atlas Energy Products (with current PCA) NRG Barriers, Inc. (with current PCA) Rrna. x, Inc. (with current PCA) generic Georgia Pacific (with current PCA) Construction Fasteners (with current PCA) Construction Fasteners (with current PCA) Construction Fasteners (with currcnt PCA) Construction Fasteners (with current PCA) Construction Fasteners (with current PCA) ITW Buildex (with current PCA) ITW Buildex (with current PCA) ITW Buildex (with current PCA) ITW Buildex (with current PCA) ITW Buildex (with current PCA) Frank Zuloaga. RRC R.oofing Product Control Examiner · U.S. INTEC, INC. Acceptance No.: 00-0329.06 Product Standard Plastic Plate Olympic Polypropylene Olympic Fastener # 14 Dimensions round Test Specification PA 114 3.25" round PA ! 14 various PA 114 ' Product Descriptio,n Polyo[efln plastic plate Polypropylene plastic plate Insulation fastener 844 Manufacturer ITW Buildex (with current PCA) Olympic (with current PCA) Olympic (with current PCA) Olympic Standard 3" round PA 114 Olympic CR Base Felt Fastener various PA 114 3" round galvalume AZ$5 steel plate Fastener assembly for Base Sheet fastening only Olympic (with current PCA) Olympic (with current PCA) Olympic Fastener # 12 various PA i 14 [nsuI-Fixx Fastener various PA 114 HD Insul-Fix. x various PA 114 Fastener lnsuI-Fixx S 3" round PA 114 Insul-Fixx P' TPR 3" round PA 114 various PA 114 Insulation fastener Insulation fastener Insulation fastener for use in steel and concrete decks 3" round galvalume AZ55 stress plate 3" round polyethylene sa'ess plate Aluminum fastener for lightweight, gypsum and rectum decks Olympic (with current PCA) SFS Stadler (with current PCA) SFS Smd[er (with current PCA) SFS Stadler (with current PCA) SFS Stadler (with current PCA) SFS Stadler (with current PCA) Tm-Fast Plastic Plate Tru-Fast HD Tm-Fast MP-3 Asphalt 3.04" round PA 114 3.04" round polyethylene plastic plate various PA 114 3.23" round Insulation fastener for use in wood. steel or concrete decks PA 114 3.23" round galvalume AZ50 steel plate various ASTM D 312 Type Ill or IV Hot asphalt bitumen adhesive Tm-Fast (with current PCA) Tm-Fast (with current PCA) Tm-Fast (with current PCA) generic Asphalt Primer Acrylic Roof Coating Aluminum Roof Coating various ASTM D 4 ! Asphalt Primer various PA 121 Acrylic roof coating generic Gibson Homans (with current PCA) various PA 121 Aluminum roof coating Gibson Homans RECEIVED 6 of 27 MAY - 1 2002 BUILDING DIVISlO,N ,~gEE'~ Of ?ER~I'[ S ~0 ~0'~ 'R~-¢O~' R.oofing Product Control Examiner U.S. INTEC, IHC. Acceptance No.: 00-0329.06 Product Alum-A-Gard Karnak 97 Endure Pro-Grade Aluminum Then'no Super Prep II Then'no Solar Shield TRS Top Coat Dimensions va.nous various variOUS various YarIOUS variOUS variOUS Test Product Specification ~ PA 121 Aluminum roof 8dal~n~. PA 121 Roof coating PA 121 Asphalt emulsion PA 121 PA 121 PA 121 PA 121 Aluminum roof coating Liquid acrylic coating. Liquid acrylic coating. Liquid acrfflic coating. Manufacturer 4s.I~CO CNat'l Varnish) (with current PCA) Karnak (with current PCA) Monsey Products (with current PCA) Monsey Products (with current PCA) Thcrmo Materials Corp. (with current PCA) Thermo Materials Corp. (with current PCA) Thermo Materials Corp. (with current PCA) EVIDENCE SUB1VEITTED: Test Agen. cv/[dentifier Name Report Date~ Factory Mujual Research. J.l. 3XOA9.AM FMRC 4470 04/12/94 Corporation Factory Mutual Research J.l. 0VOA6.AM FMRC 4470 01/06/93 Corporation Factory Mutual Research J.l. 0X6Q2.AM FMRC 4470 06/'2-4/93 Corporation Factory Mutual Research Letter Approval Extension 05119193 Corporation Factory Mutual Research Letter Approval Extension 04/13/94 Corporation Factory Mutual Research J.I. 1BTA6.AM FMRC 4470 05/2.7/97 Corporation Factory Mutual Research J.l. 3BOA0.AM FMRC 4470~4454 04/30/97 Corporation Factory Mutual Research J.l. 0D3A3.AM FMRC 4470/4454 04/04/97 Corporation Underwriters Laboratories, 1997 UL Guide Fire Classification 01/0 !/97 Inc. Compliance Underwriters Laboratories, 96NK26146 UL 790 II/04/96 Inc. Underwriters Laboratories, 96NK ! 154? UL ?90 05~8/96 Inc. Wamock Hersey- ITS 484-733400 Physical Properties 07/2_6/94 Exterior Research & t/3955.09.96-2 Wind Uplift 09/10/96 Design, LLC. #3955.05.97- i PA ! 14, Appendix RECEIVED - MAy-1 DIVISION :. ~'~n ~'~ ~Cu~\U Rooting. Product Control Exam,ncr. ' BUILDING U.S. INTEC, INC. 00-0329.06 TYPICAL PROPERTIES: Acceptance No.: 0 ,'1644 DYNAMIC PULL-THROUGH PERFORblANCE Stress Plate lntec Drill-Tec SFS Stadler lnsuI-Fixx S SFS Si,i~ler lsofast IF/IG Olympic Standard Metal ITW Buildex Premium Metal RECEIVED MAY ' 1 2062 BUILDING DIVISION Base Dynamic Pull-Through Sheet Value 0bt'.) Permavent 67 Ultra Base 76 Flex Base 30 62 Flex Base 60FR 154 lntec Modified Base Plus 119 lntec Modified Base Plus HS 140 Intec Modified Base 190P 126 lntcc APP Base 89 lntec SP-4 ! 65 Permavent 69 Ultra Base 73 Flex Base 30 91 Flex Base 60FR 114 lntec Modified Base Plus 109 Inte¢ Modified Base Plus HS 185 Inlet Modified Base 190P ! 18 Inte¢ APP Base 89 Intec SP-4 ! 73 Permavent 105 Ultra Base 88 Flex Base 30 117 Flex Base 60FR 125 Inlet Modified Base Plus 120 lntec Modified Base Plus HS 188 lntec Modified Base 190P 218 lntec APP Base 116 Intec SP-4. 199 Pcrmavent 59 Ultra Base 74 Flex Base 30 100 Flex Base 60FR 198 lntec Modified Base Plus 148 Intec Modified Base Plus HS 180 Intec Modified Base 190P 105 Intec APP Base i 14 lntec SP-4 170 Permavent 54 Flex Base 30 8 of 27 ~-- .~x~\\~ r u i~: ~)E .,~, F ankZ Ioaga, RRC ~'~ ~'~ ~~.R~ofing Product Coati Examiner u.s. I~TEC, ,r~c. ' U ;~- .l 6 ~c4p~ce No.: 00-03:9.06 Stcess Plate Base Sheet Dynamic Puli-Through Value (IbL) Flex Base 60FR ! 13 lntec Modified Base Plus 124 Intec Modified Base Plus HS lntec Modified Base 190P lntec APP Base Intec SP-4 204 124 120 158 54 92 78 138 CF Dekfast Hex Plate Permavent Ultra Base Flex Base 30 Flex Base 60FR lntec Modified Base Plus 124 lnte¢ Modified Base Plus HS 222 lntec Modified Base 190P Intec APP Base [ntec SP-4 !12 94 187 ] Dynamic Puli-Through Values determined in compliance with Miami-Dade County Roofing Protocol PA 117(B) using listed base sheet followed by one ply of type IV ply sheet applied in hot asphalt. ~2 A 2 to I margin of'safety has been applied to actual test results resulting in the above noted design values. RECEIVED CAy - 1 2002 9 or',? _-,- DING DIVISI~~.~ Ur R.oofing Product Control Examiner ' U.S. INT£C, INC. Acceptance No.: 00-0329.06 SYSTEMS - 0 -1644 Me'mb~ane Type: APP Deck Type 2I: Steel, insulated, New Construction Deck Description: 18-22 ga. steel System Type B: Base layer of insulation mechanically fastened, optional top layer adhered with approved asphalt. All General and System Limitations apply. Insulation Base Layer Fastener Fastening Fasteners Fastener Type Detail No. Per Board Density ~roved Minimum: 1.5" x 4' x 4' Tru-Fast SIP [3] 6 Whiteline 1:2.67 fi: !:2.67 ft: Approved Type(s): USIso/'Perlite Composite Minimum: 1.5" x 4' x 4' Drill-Tee S/P Minimum: 1.5" x 4' x 4' Tru-Fast SIP Typo(s~: BMCA Permalite Aproved Minimum: sA" x 2' x 4' Drill-Tee S/P Minimum: W' x 2' x 4' Tru-Fast S/P [3] 6 1:2.67 [3] 6 1:2.67 ft2 [ ! ] 3 ! :2.67 [ I ] 3 1:2.67 Note: Base layer shall be mechanically attached with fasteners and density described above. Insulation panels listed are minimum sizes and dimensions; if larger panels are used the number of fasteners per board shall be increased maintaining the same fastener density (See Miami-Dade County Roofing Application Standard RAS 117 for fastening details). Insulation Fastener Fastening Fasteners Fastener Top Laver Type Detail No. Per Board Density Approved Type(s):~ ~Composite Minimum: 1.5" x 4' N/A N/A N/A Approved Type(s): BMCA Permalite Minimum: W' x 2' x 4' N/A N/A N/A N/A Approved Type(s): BMCA Permalite Recover Minimum: ½" x 2' x 4' N/A N/A N/A N/A Note: ~ ~ - '~ opping asphalt within the EVT range a ease refer to Miami-Dade County Roofing Application Standard RAS 117 for insulation attachment. Insulations listed as Base Layer only shall be used only as base layers with a second layer of approved top layer insulation installed as the final membrane substrate. Composite insulation panels may be used as a top lay daced wi' polyisocyanurate side facing down. RECEIVED 10 of 27 ' 1 2002 _ ..,.. R.oofing Product Control Examiner U.S. INTEC, INC. Acceptance No.: 00-0329.06 Base Sheet: Ply Sheet: Membrane: Surfacing: (Optional if ply sheet is 15'a.~ ~, t~le'~: Base 60 FR, Flex Base 60 FRHS, lntec Modified Base Plus, Intec '.odified Base Plus HS, lntec Modified Base 190P, lntec Flex S or lntec Flex G4 Smooth adhered to the insulated substrate with a full mopping of approved asphalt appli.ed at a rate of 20-35 lbs./sq. (Optional) One (base sheet rec or Ultra Ply VI or one ply of Ultra Base, Flex Base 'RHS, lntec Modified Base Plus, lntec Modified Base Plus HS, lntec Modified Base 190P, Intec Flex S or Intec Flex G4 Smooth adhered to the insulation or base sheet with a full mopping of approved asphalt applied at a rate of 20-35 lbs./sq., or one ply of SP4 or Flex Cap APP 4S torch welded to a mopped base sheet. lntec SP-4, Flex Cap APP 4S, lntec GBSP-4FR, Intec GBSP-250FR, lntec GBSP-4 or Flex Cap..APP 4.5M torch welded to substrate. Install liquid roof coating if using [ntec SP-4 or Flex Cap APP4S as membrane. See General Limitations # I. Maximum Design Pressure: Maximum Fire Classification:-- Maximum Slope: Specification No.: General Limitation #9.) See General Limitation # 1. See General Limitation # I. Refer to manufacturer's specification manual. RECEIVED t4A¥ ' 2o HEU 0 iRMIT SET BUILDING DIVISIO1~0 ~0T REMOVE Frank Zuloaga, RRC R.oofing Product Control Examiner U.S. INTEC, INC. Acceptance No.: 00--0329.06 Membrane Type: SBS - 0g-1844 Deck Type 2I: Steel, Insulated, New Construction Deck Description: 18-22 ga. steel System Type B: Base layer of' insulation mechanically fastened, optional top layer adhered with approved asphalt. Ali General and System Limitations apply. Insulation Fastener Fastening Fasteners Fastener Base Layer 'I'vve Detail No. Per Board Densit'v Approved Type(s): USIS~, E'NRG'Y-2, ACFoam II, Multi-Max, Multi-Max FA, Pyrox, Whiteline Minimum: 1.5" x 4' x 4' DrilI-Tec SIP [3] 6 1:2.67 ft: Minimum: 1.5" x 4' x 4' Tru-Fast S/P [3] 6 1:2.67 ft: Approved Type(s): USIso/Perlite Composite Minimum: 1.5" x 4' x 4' DrilI-Tec S/P [3] Minimum: 1.5" x 4' x 4' Tru-Fast S/P [3] 6 1:2.67 6 1:2.67 ft' Aproved Type(s'~: BMCA Permalite Minimum: W' x 2' x 4' DrilI-Tec S/P [1] 3 1:2.67 Minimum: ~" x 2' x 4' Tru-Fast SIP [i] 3 1:2.67 .- Note: Base layer shall be mechanically attached with fasteners and density described above. Insulation panels listed are minimum sizes and dimensions; if larger panels are used the number of fasteners per board shall be increased maintaining the same fastener density (See Miami-Dade County Roofing Application Standard RAS 117 for fastening details). Insulation Fastener Fastening Fasteners Fastener Top Laver Type Detail No. Per Board Density Approved Type(s): USIso/Perlite Composite Minimum: 1.5" x 4' x 4' N/A N/A N/A N/A Approved Type(s): BMCA Permalite Minimum: ~A" x 2'x 4' N/A N/A N/A N/A Approved Type(s): BMCA Permalite Recover Minimum: ½" x 2' x 4' N/A N/A N/A N/A Note: Apply top layer of insulation in a full mopping of any approved mopping asphalt within the EVT range and at a rate of 20-40 lbs. Please refer to Miami-Dade County Roofing Application Standard RAS 117 for insulation attachment. Insulations listed as Base Layer only shall be used only as base layers with a second layer of approved top layer insulation installed as the final membrane substrate. Composite insulation panels may be used as a BO NOT REMOVE MAY -1 mm PUILDING DIVISION 12 of 27 R.oofing Product Control Examiner U.S. INTEC, INC. Base Sheet: Ply Sheet: Membrane: Surfacing: (Optional if ply sheet is used) Ultra Base, Flex Base 30, Flex Base 60 FR, Flex Base 60 FRHS, Intec Modified Base Plus, Intec Modified Base Plus HS, Intec Modified Base 190P, Intec Flex S or [ntec Flex G4 Smooth adhered to the insulated substrate with a full mopping ofapproved asphalt applied at a rate of 20-35 lbs./sq. (Optional) One (base sheet required), two or three plies of Tough Ply IV or Ultra Ply VI or one ply of Ultra Base, Flex Base 30, Flex Base 60 FR, Flex Base fi0 FRHS, lntec Modified Base Plus, Intee Modified Base Plus HS, lntec Modified Base 190P, lntee Flex S or lnte¢ Flex (34 Smooth adhered to the insulation or base sheet with a full mopping of approved asphalt applied at a rate of 20-35 lbs./sq. lntec Flex FR 3HS, Intec Flex 190FR, Intec Flex 250FR, lntec Flex FR 4.5, lntec Flex Dual FR, Intec Flex 190, Permaglas SBS, Permaglas SBS FR or Intec Flex M adhered with a full mopping of approved asphalt applied at a rate of 20-35 lbs./sq. (Optional, in place of membrane) One or more plies of Ultra Base, Flex Base 30, Flex Base 60 FR~ Intec Modified Base Plus or lntee Flex S adhered with a full mopping of' approved asphalt applied at a rate of 20-35 lbs./sq, and surfaced with a flood coat of asphalt at a minimum rate of 60 lbs./sq, and 400 lbs. ofaggregate. Maximum Desi~;n Pressure: " Maximum Fire Classificad~)n: Maximum Slope: Specification No.: -45 psf; (See (3eneral Limitation #9.) See General Limitation # 1. See General Limitation # i. Refer to manufacturer's specification manual. SHEEI OF ?ER II SEI DO NOI REMOVE RECEIVED MAY - 1 200~:3 or.~7 BUILDING DIVISION Frank Zuloaga. RRC R.oofing Product Control Examiner U.S. INT£C, INC. Acceptance No.: 00-0329.06 - 0 -.1 Membrane Type: APP Deck Type 2I: Steel, Insulated, New Constr~ction Deck Description: ! 8-22 ga. steel System Type C: All layers of insulation simultaneously fastened. All General Limitations apply. Insulation Fastener F~tening Fasteners Fastener Base Layer Type Detail No. Per Board Density One or more layers of any of the following insulations: Approved Type(s): USIso, E'NRG'Y-2, ACFoam II, Multi-Max, Multi-Max FA, Pyrox, Whiteline Minimum: 1.5" x 4' x 4' N/A N/A N/A N/A Approved Type(s): USIso/'Perlite Composite Minimum: 1.5" x 4' x 4' N/A N/A N/A N/A Note: All layers shall be simultaneously fastened; see top layer below for fasteners and density. Insulation Fastener Fastening Fasteners Fastener Base or To~J Laver Type Detail No. Per Board Density Approved ~l'ype(s): USIso/Perlite Composite Minimum: 1.5" x 4' x 4' Drill-Tee S/P [3] 6 1:2.67 ft.: Minimum: 1.5" x 4' x 4' Tru-Fast S/P 1'3] 6 1:2.67 ft.: Approved Type(s): BMCA Permalite Minimum: g" x 2' x 4' Drill-Tee S/P Minimum: ~" x 2' x 4' Tru-Fast S/P [I] 3 1:2.67 ft: [ ! ] 3 1:2.67 ft: Note: All layer shall be mechanically attached with fasteners and density described above. Insulation panels listed are minimum sizes and dimensions; if larger panels are used the number of fasteners per board shall be increased maintaining the same fastener density (See Miami-Dade County Roofing Application Standard RAS 117 for fastening details). Base Sheet: (Optional if ply sheet is used) Ultra Base, Flex Base 30, Flex Base 60 FR, Flex Base 60 FRHS, Inte¢ Modified Base Plus, Inte¢ Modified Base Plus HS, lntec Modified Base 190P, Intec Flex S or lnte¢ Flex G4 Smooth adhered to the insulated substrate with a full mopping of approved asphalt applied at a rate of 20-35 lbs./sq. Ply Sheet: (Optional) One (base sheet required), two or three plies of'Tough Ply IV or Ultra Ply VI or one ply of Ultra Base, Flex Base 30, Flex Base 60 FR, Flex Base 60 FRHS, lnte¢ Modified Base Plus, lntec Modified Base Plus HS, Intec Modified Base 190P, Intec Flex S or lntcc Flex G4 Smooth adhered to the insulation or base s~fxdt~ approved asphalt applied at a rate of 20-35 IbsJsq., or on~r F~x Ca~'AP-P "~ R E C E W~elded to a moped b,sc sheet. ~)~ ~ 1 SHEET OF SET DO NOT REMOVE ~::,; :., ,.' R~fing Product Consol Ex~incr DIVISION : · U.S. INTEC, INC. Acceptance No.: ~00-0329.06 02-1644 Membrane: Surfacing: lntec SP-4, Flex Cap APP 4S, lntec GBSP-4FR, Intec GBSP-250FR, lntec GBSP-4 or Flex Cap APP 4.5M torch welded to substrate. Install liquid roof coating if using Intec SP-4 or Flex Cap APP4S as membrane. See General Limitations # I. Maximum Design Pressure: M~ximum Fire Classification: -45 pst'; (See General Limitation #9.) See General Limitation # 1. Maximum Slope: See General Limitation # 1. Specification No.: Refer to manufacturer's specification manual. RECEIVED DO ~10'[ R£~O~/£eu~o~ o~ws~o~ 15 of 27 Frank Zuloaga, RRC R.oofing Product Control Examiner · U.S. INTEC, INC. Acceptance No.: 00-0329.06 Membrane Type: SBS 02-1644 Deck Type 2I: Steel, Insulated, New Construction Deck Description: 18-22 ga. steel System Type C: All layers of insulation simultaneously fastened. All General Limitations apply. Insulation Fastener Fastening Fasteners Fastener Base Layer Type Detail No. Per Board Density One or more layers of an.y &the following insulations: Approved Type(s): USlso, E'NRG'Y-2, ACFoam II, Multi-Max, Multi-Max FA, Pyrox, Whiteline Minimum: 1.5" x 4' x 4' N/A N/A N/A N/A Approved Type(s): USIsofPerlite Composite Minimum: 1.5" x 4' x 4' N/A N/A N/A N/A Note: Insulation ,. Fastener Base or Top Laver Type Approved :~ype(s): USIso/Perlite Composite Minimum: 1.5" x 4' x 4' Drill-Tea S/P Minimum: 1.5" x 4' x 4' Tm-Fast S/P All layers shall be simultaneously fastened; see top layer below for fasteners and density. Fastening Fasteners Fastener Detail No. Per Board Density [3] 6 i:2.67 ft.: [3] 6 !:2.67 ft.: Approved Type(s): BMCA Permalite Minimum: ~" x 2' x 4' DrilI-Tec SIP Minimum: ~" x 2' x 4' Tm-Fast S/P [!] 3 1:2.67 [1] 3 1:2.67 Note: All layer shall be mechanically attached with fasteners and density described above. Insulation panels listed are minimum sizes and dimensions; if larger panels are used the number of fasteners per board shall be increased maintaining the same fastener density (See Miami-Dade County Roofing Application Standard RAS 117 for fastening details). Base Sheet: (Optional if ply sheet is used) Ultra Base, Flex Base 30, Flex Base 60 FR., Flex Base 60 FRHS, Intec Modified Base Plus, lntec Modified Base Plus H5, Intec Modified Base 190P, Intec Flex S or lntec Flex G4 Smooth adhered to the insulated substrate with a full mopping &approved asphalt applied at a rate of 20-35 lbs./sq. Ply Sheet: RECEIVED (Optional) One (base sheet required), two or three plies of Tough Ply IV or Ultra Ply VI or one ply of Ultra Base, Flex Base 30, Flex Base 60 FR, Flex Base 60 FRHS, lntec Modified Base Plus, lnte¢ Modified Base Plus IlS, S or Intec Flex 04 Smooth adhered to the insulation or~ approved asphalt applied at a rate of 20-35 lbs./sq. 16 of 27 Frank Zuloaga. RRC R.oofing Product Control Examiner ' U.S. IN'FEC, INC. Acceptance No.: 00-0329.06 Membrane: lntec Flex FR 3HS, Intec Flex 190FR, Intec Flex 250FR, lntec Flex FR 4.5, lntec Flex Dual FR, Intec Flex 190, Perrnaglas SBS, Permaglas SBS FR or Intec Flex M adhered with a full mopping of approved asphalt applied at a rate of 20-35 Ibs,Jsq. Surfacing: (Optional, in place of membrane) One or more plies of' Ultra Base, Flex Base 30, Flex Base 60 FtL Intec Modified Base Plus or Intec Flex S adhered with a full mopping of approved asphalt applied at a rate of 20-35 lbs./sq, and surfaced with a flood coat of' asphalt at a minimum rate of'60 lbs./sq, and 400 lbs. of aggregate. Maximum Design Pressure: -45 psf; (See General Limitation #9.) Maximum Fire Classification: Maximum Slope: S~e General Limitation # 1. See General Limitation # 1. Specification No.: Refer to manufacturer's specification manual. RECEIVED SHEET OF PERMIT S~[UiLDiNG DIVISION DO NOT REMOVE 17 of 27 Frank Zuloaga, RRC R.oofing Product Control Examiner U.S. INTEC, INC. Membrane Type: APP Acceptance No.: 00-0329.06 '1654 Deck Type 2h Steel, Insulated, Ness' Construction Deck Description: 18-22 ga. steel System Type D: All layers of insulation and base sheet simultaneously fastened. All General and System Limitations apply. Insulation F~stener Fastening Fasteners Fastener Layer Type Detail No. Per Board Density One or more layers of any of the following insulations: Approved Type(s): USIso, ACFoam H, Multi-Max, Multi-Max FA, Pyrox, Whiteline Minimum: 1.3" x 4' x 4' N/A N/A N/A N/A Approved Type(s): E'NRG'Y-2 Minimum: 1.4" x 4' x 4' N/A N/A N/A NIA Approved Type(s): USIso/Perlite Composite Minimum: 1.5:"~ 4' x 4' N/A Approved Type(s): BMCA Permalite Minimum: ?A" x 2' x 4' N/A N/A N/A N/A N/A N/A N/A Approved Type(s): BMCA Permalite Recover (Top Layer Only) Minimum: '~-" 4' ,: x 2' x N/A N/A N/A N/A Note: All layers of insulation and base sheet shall be simultaneously fastened. See base sheet below for fasteners and density. Base Sheet: Ultra Base, Flex Base 30, Flex Base 60 FR, Flex Base 60 FEI-IS, lntec Modified Base Plus, Intec Modified Base Plus HS, lntec Modified Base 190P, lntec Flex S or lntec Flex G4 Smooth fastened to the deck as described below: Fastening: Fasten base sheet with Drill-Tee fasteners and Drill-Tee Metal Plates at a 2" side lap 12" o.c. and two rows staggered in the center of the sheet 18" o.c. Ply Sheet: RECEIVED SHEET OF PERMIT SET DO NOT REMOVE Zooz BUILDING DIVI$I ,ON (Optional) One, two or three plies of Tough Ply IV or Ultra Ply VI or one ply of Ultra Base, Flex Base 30, Flex Base 60 FR, Flex Base 60 FRHS, Intec Modified Base Plus, lntec Modified Base Plus HS, lntec Modified Base 190P, lntec Flex S or lntec Flex G4 Smooth adhered to the base sheet with a full mopping of approved asphalt applied at a rate of 20-35 lbs./sq., or one ply of SP4 or Flex Cap APP 45 torch welded to the base sheet. 18 of 27 ~ Zuloaga. RRC R.oofing Product Control Examiner U.S. INTEC, INC. 0 ~" .7. ~cclpt,~Lnce No.: 00-03~.9.06 Membrane: Surfacing: Intec SP-4, Flex Cap APP tlS, Intec GBSP-4FR, Intec GBSP-2$0FR, Imec GBSP-4 or Flex Cap APP 4.5M torch welded to substrate. Install liquid roof coating if using lntec SP-4 or Flex Cap APP4S as membrane. See General Limitations #1. Maximum Design Pressure: Maximum Fire Classification: Maximum Slope: Specification No.: -45 pst'; (See General Limitation #9.) See General Limitation # 1. See General Lira itation # 1. l~6fer to manufacturer's specification manual. SHEET OF i)O NOT REMOVE RECEIVED MA¥-I 2002 pERMiT SE~u~LmNo mvtstot~ 19 of 27 Frank Zuloaga, RRC R.oofing Product Control Examiner ' U.S. INTEC, INC. Acceptance No.: 00-0329.06 Membrane Type: SBS Deck Type 2h Steel, Insulated, New Construction Deck Description: ! 8-22 ga. steel System Type D: All layers of insulation and base sheet simultaneously fastened. Ali General and System Limitations apply. Insulation Fastener Fastening Fasteners Fastener Layer Tyr~e Detail No. Per Board Density One or more layers of any of the following insulations: Approved Type(s): USIso, ACFoam H, Multi-Max, Multi-Max FA, Pyrox, Whiteline Minimum: 1.3" x 4' x 4' N/A N/A N/A N/A Approved Type(s): E'NRG'Y-2 Minimum: 1.4" x 4' x 4' N/A N/A N/A N/A Approved Type(s): USIso/Perlite Composite Minimum: 1.5.":x 4' x 4' N/A Approved Type(s): BMCA Permalite Minimum:.~" x 2' x 4' N/A N/A N/A N/A N/A N/A N/A Approved Type(s): BMCA Permalite Recover (Top Layer Only) Minimum: ~" x 2' x 4' N/A NIA N/A N/A Note: All layers of insulation and base sheet shall be simultaneously fastened. See base sheet below for fasteners and density. Base Sheet: Ultra Base, Flex Base 30, Flex Base 60 FIL Flex Base 60 FRHS, lntec Modified Base Plus, lntec Modified Base Plus HS, lntec Modified Base ! 90P, Intec Flex S or lntec Flex G4 Smooth fastened to the deck as described below: Fas::ning: Fasten base sheet with DrilI-Tec fasteners and Drill-Tec Metal Plates at a 2" side lap 12" o.c. and two rows staggered in the center of the sheet 18" o.c. Ply Sheet: (Optional) One, two or three plies of Tough Ply IV or Ultra Ply VI or one ply of Ultra Base, Flex Base 30, Flex Base 60 FR, Flex Base 60 FRHS, lntec Modified Base Plus, lntec Modified Base Plus HS, lntec Modified Base 190P, lntec Flex S or lntec Flex G4 Smooth adhered to the base sheet with a full mopping &approved asphalt applied at a rate of 20-35 lbs./sq. DO NO'1' REN/O E RECEIVED MAY'I 2002 sET~UlLDING DIVISION 20 of 27 R?ofing Product Control Examiner U.S. INTEC, INC. Acceptance No.: 00-0329.06 Membrane: lntec Flex FR. 3HS, lntec Flex 100FR, lntec Flex 2SOFR, lntec Flex FR 4.5, lntec Flex Dual FR, lntec Flex 100, Permaglas SBS, Permaglas SBS FR or Intec Flex M adhered with a full mopping of approved asphalt applied at a rate of 20-35 lbs./sq. Surfacing: (Optional, in place of membrane) One or more plies of Ultra Base, Flex Base 30, Flex Base 60 FR, Intec Modified Base Plus or Intec Flex S adhered with a full mopping of approved asphalt applied at a rate of 20-35 lbs./sq, and surfaced with a flood coat of asphalt at a minimum rate of 60 lbs./sq, and 400 lbs. of aggregate. Maximum Design Pressure: -45 psf; (See General Limitation #9.) Maximum Fire Classification: See General Limitation # 1. Maximum Slope: See General Limitation #1. Specification No.: Refer to manufacturer's specification manual. SHEET OF DO RECEIVED i~Ay - 1 2002 BUILDING DIVISION PER~dI'T SET NOT REMOVE : 21 of 27 Frank Zuloa§a, RRC R.oofin§ Product Control Examiner ' U.S. IHT£C, INC. Acceptance No.: 00-0329.06 STEEL DECK SYSTEM LIMITATIONS: If mechanical attachment to the structural deck through the lightweight insulating concrete is proposed, a field withdrawal resistance testing shall be performed to determine fastener pat'terns and density. All testing and fastening design shall be in compliance with Miami-Dade County Testing Application Standard TAS 105 and M iami-Dade County Roofing Application Standard PAS 117. *Note: The following assembly is approved to a maximum design pressure of-45 pst% No substitutions shall be made. a. Deck: Min. 22 ga., type B steel decking over %" thick steel supports spaced min. 5 t~. o.c. attached 6" o.c. using min. 5/8" diameter puddle welds or Traxx/$ fasteners. Deck side laps are amached 18" o.c. using Trax.x/l fasteners. b. Insulation: Min. 1.5" thick Miami-Dade Approved polyisocyanurate insulation, loose c. Base Sheet: One ply of Ultra Base, Flex Base 60 FK, Flex Base 60 FR. HS, Intec Modified Base Plus, Intec Modified Base Plus HS or Intec Modified Base 190P mechanically attached to the steel deck using Drill-Tee Fasteners and Drill-Tee Metal Plates spaced 12" o.c. in the 4" lap and two staggered rows in the center of the sheet, 12' o.c. d. Ply Sheet: One, two or three plies of Tough Ply IV or Ultra Ply VI or one ply of Ultra Base, Flex Base 30, Flex Base 60 FR, Flex Base 60 FRHS, lntec Modified , ,. Base Plus, Intec Modified Base Plus HS, lntec Modified Base 190P, Intec :" Flex S or Intec Flex G4 Smooth adhered to the base sheet with a full " mopping ofapprovcd asphalt applied at a rate of 20-35 IbsJsq., or one ply of' SP4 or Flex Cap APP 4S torch welded to a mopped base sheet. Membrane: Intec SP-4, Flex Cap APP 4S, lntec GBSP-4FR, lntec GBSP-250FR, lntec GBSP-4 or Flex Cap APP 4.5M torch welded to substrate. Surfacing: Install liquid roofcoating if'using Intec SP-4 or Flex Cap APP4S as membrane. See General Limitations #1. The maximum design pressure limitation listed shall be applicable to the field area of the roof. Rational analysis or extrapolation in compliance with Miami-Dade Count), Roofing Application Standard RAS 117 is permitted for enhanced fastening of the base sheet at enhanced pressure zones (i.e., perimeters, extended corners, and corners). The following assembly is approved to a maximum design pressure of'-45 pst'*. No substitutions shall be made. a. Deck: Min. 22 ga., type B steel decking over 'A" thick steel supports spaced min. 5 b. Insulation: c. Base Sheet: SHEET OF DO NOT REMOVE ft. o.c. attached 6" o.c. using min. 5/8" diameter puddle welds or Traxx/5 fasteners. Deck side laps are atttached 18" o.c. using Tra.xx/l fasteners. Min. !.5" thick Miami-Dade Approved polyisocyanurate insulation, loose laid One ply of Ultra Base, Flex Base 60 FR, Flex Base 60 FRHS, Intec Modified Base Plus, lntec Modified Base Plus HS or [ntec Modified Base 190P mechanically attached to the steel deck using DrilI-Tec Fasteners and REC EiVEi , rm-Tec Meta; Plates spaced 12" o.c. in the 4" lap and two staggered rows the center of the sheet, 12" o.c. R?ofing Product Con~rol Examin=r U.S. INTEC, INC, Acceptance No.: 000329.06 - 02-1 644 The following assembly is approved to a maximum design pressure of-52.5 pst'*. No substitutions shall be made. a. Deck: Min. 22 ga., type B steel decking over %" thick steel supports spaced min. 5 ft. o.c. attached 6" o.c. using min. 5/8" diameter puddle welds or Traxrd$ fasteners. Deck side laps are a~tached 18" o.c. using Traxx/i fasteners. b. Insulation: Base: Min. 1.5" thick USlso mechanically attached using Drill-Tee Fasteners and Drill-Tee Metal Plates at a density of ! per 1.5 sq. ft. Top: ~" thick BMCA Permalite ai~plied in hot asphalt. c. Base Sheet: (Optional if ply sheet is used) Ultra Base, Flex Base 30, Flex Base 60 FR, Flex Base 60 FRHS, [ntec Modified Base Plus, [ntec Modified Base Plus HS, Intec Modified Base Ig0P, lntec Flex S or Intec Flex 04 Smooth adhered to the insulated substrate with a full mopping of approved asphalt applied at a rate of 20-35 lbs./sq. d. Ply Sheet: (Optional) One (base sheet required), two or three plies of Tough Ply IV or Ultra Ply VI or one ply of Ultra Base, Flex Base 30, Flex Base 60 FR, Flex Base 60 FR. HS, lntec Modified Base Plus, lntec Modified Base Plus HS, lntec Modified Base lg0P, Intec Flex S or lntec Flex 04 Smooth adhered to the insulation or base sheet with a full mopping of approved asphalt applied at a rate of 20-35 lbs./sq. e. Membrane: Intec Flex FR 3HS, Intec Flex lg0FR, Intec Flex 25ORR, lntec Flex FR 4.5, Intec Flex Dual FR, [ntec Flex 190, Permaglas SBS, Permaglas SBS FR or ..:" Intec Flex M adhered with a full mopping of approved asphalt applied at a ,. rate of 20-35 lbs./sq. f. Surfacing: (Optional, in place of membrane) One or more plies of' Ultra Base, Flex .' Base 30, Flex Base 60 FR, lntec Modified Base Plus or lntec Flex S adhered with a full mopping ofapproved asphalt applied at a rate of 20-35 lbs./sq. and surfaced with a flood coat of asphalt at a minimum rate of 60 lbs./sq. and 400 lbs. of aggregate. The maximum design pressure limitation listed shall be applicable to the field area of the roof. Rational analysis or extrapolation in compliance with Miami-Dade County Roofing Application Standard RAS 117 is permitted for enhanced fastening of the base sheet at enhanced pressure zones (i.e., perimeters, extended corners, and CO rne rs). The following assembly is approved to a maximum design pressure of'-67.5 psi'*. No substitutions shall be made. a. Deck: Min. 22 ga., type B steel decking over %" thick steel supports spaced min. 5 *Note: b. Insulation: c. Base Sheet: ft. o.c. attached 6" o.c. using min. 5/8" diameter puddle welds or Trax.,u'5 fasteners. Deck side laps are atttached 18" o.c. using Traxx/! fasteners. Base: Min. !.5" thick USlso mechanically attached using Drill-Tee Fasteners and Drill-Tee Metal Plates at a density of I per !.5 sq. ft. Top: ½" thick BMCA Recover Board applied in hot asphalt. (Optional if ply sheet is used) Ultra Base, Flex Base 30, Flex Base 60 FR, Flex Base 60 FRHS, lntec Modified Base Plus. lntec Modified Base Plus HS, lntec Modified Base 190P, lntec Flex S or [ntec Flex G4 Smooth adhered to the insulated substrate with a full mopping o Frank Zuloaga, RRC R.oofing Product Control Examiner R E C E IVE Oapplied at a rate of 20-35 IbsJsq. 4AY- 1 2o02 SHEET OF PEP, H SET BUiLD,NO D WS ON DO NOT REMOVE U.S. INTEC, INC. Acceptance No.: 00-0329.06 d. Ply Sheet: (Optional) One (base sheet required), two or three plies of'Tough Ply IV or Ultra Ply VI or one ply or' Uhra Base, Flex Base 30, Flex Base 60 FR, Flex Base 60.FRHS, Intec Modified Base Plus, lntec Modified Base Plus HS, [ntec Modified Base 190P, Intec Flex S or [ntec Flex G4 Smooth adhered to the insulation or base sheet with a full mopping of approved asphalt applied at a rate of 20-35 lbs./sq., or one ply of SP4 or Flex Cap APP 4S torch welded to a mopped base sheet. Membrane: [ntec SP-4, Flex Cap APP 4S, Intec GBSP-4FR, [ntec GBSP-250FR, Intec GBSP-4 or Flex Cap APP 4.5M torch welded to substrate Surf'acing: Install liquid roof coating if using Intec SP-4 or Flex Cap APP4$ as membrane. See General Limitations # 1. The maximum design pressure limitation listed shall be applicable to the field area of the roof. Rational analysis or extrapolation in compliance with M:iami-Dade County Roofing Al?plication Standard RAS I17 is permitted for enhanced fastening of the base sheet at enhanced pressure zones (i.e., perimeters, extended corners, and corners). The following assembly is approved to a maximum design pressure of-6'/.5 pst'*. No substitutions shall be made. a. Deck: Min. 22 ga., type B steel decking over ~" thick steel supports spaced min. 5 ft. o.c. at~ached 6" o.c. using min. 5/8" diameter puddle welds or Tra.v,~5 fasteners. Deck side laps are atttached 18" o.c. using Traxx/I fasteners. b. Insulation: Base: Min. I.$" thick USIso mechanically attached using DrilI-Tec Fasteners and DrilI-Tec Metal Plates at a density of I per 1.5 sq. ft. " Top: ½" thick BMCA Recover Board applied in hot asphalt. c. . Base Sheet: (Optional ifply sheet is used) Ultra Base, Flex Base 30, Flex Base 60 FR, Flex Base 60 FRHS, Intec Modified Base Plus, 1ntec Modified Base Plus HS, Intec Modified Base 190P, lntec Flex S or Intec Flex G4 Smooth adhered to the insulated substrate with a full mopping of'approved asphalt applied at a rate of 20-35 lbs./sq. d. Ply Sheet: (Optional) One (base sheet required), two or three plies of Tough Ply IV or Ultra Ply V[ or one ply of Ultra Base, Flex Base 30, Flex Bast 60 FR, Flex Base 60 FRHS, lntec Modified Base Plus, lntec Modified Base Plus HS, [ntec Modified Base 190P, Intec Flex S or lntec Flex G4 Smooth adhered to the insulation or base sheet with a full mopping of approved asphalt applied at a rate of 20-35 lbs./sq. e. Membrane: Intec Flex FR 3HS, lntec Flex 190FR, Intec Flex 250FR, intec Flex FR 4.5, Intec Flex Dual FR, lntec Flex 190, Permaglas SBS, Permaglas SBS FR or [ntec Flex M adhered with a full mopping of'approved asphalt applied at a rate of 20-35 lbs./sq. f. Surfacing: (Optional, in place of'membrane) One or more plies of Ultra Base, Flex Base 30, Flex Base 60 FR, lntec Modified Base Plus or ]ntec Flex S adhered with a full mopping of'approved asphalt applied at a rate of 20-35 lbs./sq. and surfaced with a flood coat of'asphalt at a minimum rate of 60 lbs./sq. and 400 lbs. ofag§regate. *Note: SHEET DO RECEIVED MAY-1 2002 OF PERMIT SEETUILDING DIVISION NOT REMOVE 25 of 27 Frank Zuloa§a, RRC R.oofJng Product Control Examiner *Note: The maximum design pressure limitation listed shall be applicable to the field area of the roof. R~tioaal analysis or extrapolation in compliance with Miami-Dade Count)' Roofing Application Standard RAS 117 is permitted for enhanced fastening of the base sheet at enhanced pressure zones (i.e., perimeters, extended corners, and corners). GENERAL LIMITATIONS: ! 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 applied 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 lbs./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 4' 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 may 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 sidelap and. one down the center of the sheet allowing a continuous area of ventilation. Encircling of the strips is not acceptable. A break shall be placed every 12' in each ribbon to allow cross ventilation. Asphalt application of either s~,stem shall be at a minimum rate of 12 lbs./sq. Note: Spot attached systems shall be limited to a maximum design pressure of-45 psf. S Fastener spacing for insulation attachment is based on a Minimum Characteristic Force (F') value of 275 Ibf., as tested in compliance with TAS 105. if the fastener value, as field-tested, is 'be'l'ow 275 Ibf., 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 the 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 or Architect may be submitted. Said revised fastener spacing utilize the withdrawal resistance value taken from Miami-Dade Protocol TAS 105 and calculations in compliance with Miami-Dade Roofing Application Standard RAS 117. 7 Perimeter and comer areas shall comply with the enhanced uplift pressure ofthese areas, as calculated in compliance with Chapter 23 of the South Florida Building Code. Fastener densities shall be increase for both insulation and base sheet as needed calculated in compliance with Miami-Dade Roofing Application gtandard TAS 117. (When this limitation is specifically referred within this NOA, General Limitati6n #9 will not be applicable.) 8 All attachment and sizing of perimeter nailers, metal prot';ie, and/or flashing termination designs shall conform with Miami-Dade County Roofing Application Standard TA5 I I 1 and the wind load requirements of Chapter 23 of the South Florida Building Code. 9 The maximum designed pressure limitation listed shall be applicable to all roof pressure zones (i.e. field, perimeters, corners). No rational analysis, nor extrapolation shall be permitted for enhanced fastening at enhanced pressure zones (i.e. perimeters, extended corners, and corners). O~Vhen this limitation is specifically referred within this NOA, General Limitation #7 will not be applicable.) RECEIVED 26 of 27 Frank Zuloaga, RRC R.oofing Product Control Examiner OT RE OVL D VlS O.: U.S. INTEC, INC. Acceptance No.: 00-0329.06 NOTICE OF ACCEPTANCE STANDARD CONDITIONS Renewal of this Acceptance (approval) shall be considered after a renewal application has been filed and the original submitted documentation, including test supporting data, engineering documents, are no older than eight (8) years. Any and all approved products shall be permanently labeled with the manufacturer's name, city, state, and the following statement: "Miami-Dade County Product Control Approved", or as specifically stated in the specific conditions of this Acceptance. Renewals of Acceptance will not be considered if.' a) There has been a change in the South Florida Building Code affecting the evaluation of this product and the.product is not in compliance with the code changes; b) The product is no longer the same product (identical) as the one originally approved; c) If the Acceptance holder has not complied with all the requirements of this acceptance, including the correct installation of the product; d) The engineer who originally prepared, signed and sealed the required documentation initially submitted, is no longer practicing the engineering profession. Any revision or change in the materials, use, and/or manufacture of the product or process shall automatically be cause for termination of this Acceptance, unless prior written approval has been requested~(through the filing ora revision application with appropriate fee) and granted by this office. Any of-the followi'~li also b.e grounds for removal ofthis Acceptance: a) Unsatisfactory performance of this product or process; b) Misuse of this Acceptance as an endorsement of any product, for sales, advertising or any other purposes. The Notice of Acceptance 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 Notice of Acceptance is displayed, then it shall be done in its entirety. 7 A copy of this Acceptance as well as approved drawings and other documents, where it applies, shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at all times. The copies need not be resealed b:' the engineer. 8 Failure to comply xvith any section of this Acceptance shall be cause for termination and removal of Acceptance. This Acceptance contains pages I through 27. END OF THIS ACCEPTANCE SHEET DO RECEIVED OF PERMIT SEI' A¥-1 NOl REMOVE BUILDING DIVISION 27 of 27 Frank Zuloaga, RRC R.oofing Product Control Examiner ' 01 -1 644 MIAMI-DADE COUNTY, FLORIDA METRO-DADE FLAGLER BUILDING PRODUCT CONTROL NOTICE OF ACCEPTANCE Entegra Roof Tile CorPoration 1201 N.W. 18 Street Pompano Beach ,FL 33069 Your application for Notice of Acceptance (NOA) of: Skandia Roof Tile BUILDING CODE COMPLIANCE OFFICE METRO-DADE FLAGLER BUILDING 140 WEST FLAGLER STREET. SUITE 1603 MIAMI. FLORIDA 33130-1563 (305) 375-2901 FAX (305) 375-2908 CONTRACTOR LICENSING SECTION {305) 375-2527 FAX {305) 3?5-2555 CONTRACTOR ENFORCEI~IENT DIVISION (305} 375-2966 FAX 005) 375-2908 PRODUCT CONTROL DIVISION (305) 37~-2902 FAX (305) 372-6339 under Chapter 8 of the Code of Miami-Dade County governing the use of Alternate Materials and Types of Construction, and completely described herein, has been recommended for acceptance by the Miami-Dade County Building Code Compliance Office (BCCO) under the conditions specified herein. This NOA shall not be valid after the expiration date stated below. BCCO reserves the right to secure this product or material at any time from a jobsite or manufacturer's plant for quality control testing. If this product or material fails to perform in the approved manner, BCCO may revoke, modify, or suspend the use of such product or material immediately. BCCO reserves the right to revoke this approval, if it is determined by BCCO that this product or material fails to meet the requirements of the South Florida Building Code. The expense of such testing will be incurred by the manufacturer. ACCEPTANCE NO.: 00-I 106.03 EXPIRES: 12/0"//2005 Raul Rodriguez Chief Product Control Division THIS IS THE COVERSHEET, SEE ADDITIONAL PAGES FOR SPECIFIC AND GENERAL CONDITIONS BUILDING CODE & PRODUCT REVIEW COMMITTEE This application for Product Approval has been reviewed by the BCCO and approved by the Building Code and Product Review Committee to be used in Miami-Dade County, Florida under the conditions set forth above. APPROVED: 12/07/2000 SltEEI OF ?ERMll S-El DO NOI REMOVE Francisco J. Quintana, K.A. Director Miami-Dade County Building Code Compliance Office 4RECEIVED 2O02 \Ls04SO00 I\pc2OOO\\cemplates\notice acceptance cover page.dot internet marl address: postmaster~buiidingcodeonline, com ~LDING DIVISION Homepage: h t'tp://www, buildingcodeonline.com ENTEGRA ROOF TILE CORPORATION ACCEPTANCE No.: 00-I 106.03 APPROVED: Decem~ EXPIRES: December 7, 2005 NOTICE OF ACCEPTANCE: STANDARD CONDITIONS SCOPE This approves roofing system using Entegra "Skandia" Concrete roof tile as manufactured by Entegra Roof Tile Corporation, as described in Section 2 of this Notice of Acceptance, designed to comply with the South Florida Building Code, 1994 Edition for Miami-Dade County. For the locations where the pressure requirements, as determined by applicable Building Code, do not exceed the design pressure values obtain by calculations in compliance with RAS 127 using the values listed in section 4 herein. The attachment calculations shall be done as a moment based system. The attachment calculations for a two patty system shall be done as an moment based system. Category: Sub Category: Materials: Roofing Flat Profile Tile Concrete 2. PRODUCT DESCRIPTION Manufactured by · Applicant Dimensions Skandia I= 16W' w= 13" ½" thick Test Specifications PA 112 Product Description Flat profile concrete roof tile for direct deck or battened nail-on. Trim Pieces I = varies PA ! 12 w = varies Accessory trim, concrete or clay roof pieces for use at hips, rakes, ridges and valley terminations. 2.1 Co mponents or products man ufactured by others Test Product Dimensions Specifications N/A Sec NOA Product Descrintion Manufacturer Two component polyurethane Polyfoam Products, adhesive designed for Inc. adhesive set roof tile applications. Roof Tile Adhesive TileBond Roof Tile Mortar ("TileTiteTSS'') Factory premixed See NOA Single component c' nister HEET OF PERMI'fo i anefoam roof tile DO NOT REMO , s'v N/A Flexible Products (with current NOA) PA 123 Prepared mortar mix designed Bermuda Roof I~ t,s I~ i%ffl~ idiot mortar set roo til c. with current. MAY - 1 2002 BUILDING DIVISION Roofing Product Control Examiner - 01-I 644 ENTEGRA ROOF TILE CORPORATION ACCEPTANCE No.: 00-1106.03 APPROVED: December 7, 2000 EXPIRES: December 7, 2005 NOTICE OF ACCEPTANCE: STANDARD CONDITIONS Product Roof Tile Mortar ("Quikrete® Roof Tile Mortar #1140") Roof Tile Mortar ("BONSAL® Roof Tile Mortar Mix") Dimensions N/A N/A Test Product Specifications Description PA 123 Prepared mortar mix designed for mortar set roof tile applications. PA 123 Prepared mortar mix designed for mortar set roof tile applications. Manufacturer Quikrete Construction Products with Current NOA W. R. Bonsai Co. with current NOA Wood Battens vertical min. I" x 4" horizontal min. !" x 4" for use with vertical battens or min. I" x 2" for use alone Wood Preservers Institute LP - 2 Salt pressure treated or decay resistant lumber battens generic Tile Nails min. 10d x 3" PA i14 Appendix E Corrosion resistant, smooth, screw or annular ring shank nail generic Tile Screws #8 x 2 W' long 0.335" head dia. 0.131" shank dia. 0.175" screw thread diameter PA 114 Appendix E Corrosion resistand coated, square drive, galvanized. coarse thread wood screw generic Hurricane Clip & Fasteners 3. LIMITATIONS 3.1 Clips min. ½" width min. 0.062" thick PA 114 Corrosion resistant bronze, Appendix E aluminum, stainless steel, galvanized steel or plastic attachment clips for supplemental tile attachment. Clips are installed with corrosion resistant roofing nails compatible with the clip. A hurricane clip is required on all nail-on eave tiles. SHEET OF PERMIT gET RECE REuOVE generic ~.uloaga, RRC Roofing Product Control Examiner 3 Fire classification is not part of thisacceptance(~..~ ."~ MAY - 1 2OO2 BUILDING DIVISION - 02-1 644, ENTEGRA ROOF TILE CORPORATION ACCEPTANCE No.: 00-1106.03 APPROVED: December 7, 2000 EXPIRES: December 7, 2005 NOTICE OF ACCEPTANCE: STANDARD CONDITIONS 3.2 3.3 3.4 3.5 3.6 For mortar or adhesive set tile applications, a static field uplift test shall be performed in accordance with P.AS 106. Applicant shall retain the services of a Miami-Dade County Certified Laboratory to perform quarterly test in accordance with PA 112, appendix 'A'. Such testing shall be submitted to the Building Code Compliance Office for review. Minimum underlayments shall be in compliance with the applicable Roofing Applications Standards listed section 4. I herein. 30/90 hot mopped underlayment applications may be installed perpendicular to the roof slope unless stated otherwise by the underlayment material manufacturers published literature. This acceptance is for wood deck applications. Minimum deck requirements shall be in compliance with applicable Building Code. INSTALLATION 4.l.1 "Entegra Roof Tile Corporation Skandia Fiat", and its components shall be installed in strict compliance with Roofing Application Standard R.AS 118, R.AS 119, and RAS 120. 4.2 Data For Attachment Calculations I Tile Profile Skandia Table 1: Aerodynamic Multipliers -~. (ft~) Batten Application [ Direct Deck Application 0.9-67 0.289 Table 2: Restoring Moments due to Gravity,- Ma (ft-lbf) ·Tile 3":12" 4":12" 5":'12;' 6":12" Greater than Profile 7":12" ~ Battens Direct Battens Direct Battens Direct Battens Direct Battens Direct Deck Deck Deck Deck Deck Entegra 6.85 7.79 6.75 7.67 6.61 7.52 i 6.44 7.32 6.26 NIA Skandia I SHEET OF PERMIT SET RECEiVEDDO NOT REMOVE - 1 20O2 BUILDING DIVISION 4 Frank Zuloaga. RRC Roofing Product Control Examiner ENTEGRA ROOF TILE CORPORATION ' 02-1644 ACCEPTANCE No.: 00-!106.03 APPROVED: December 7, 2000 , EXPIRES: December 7~ 2005 NOTICE OF ACCEPTANCE: STANDARD CONDITIONS Table 3: At~'achment Resistance Expressed as a Moment - M, (ft-lbf) for Nail-On Systems Tile Fastener Type Direct Deck ' Direct Deck Battens Profile (min 15132" plywood) (min. 19132" plywood) Skandia 2- I Od King Shank Nails 30.9 38. I ' 17.2 1-10d Smooth or Screw 7.3 9.8 4.9 Shank Nail 2- I Od Smooth or Screw 14.0 18.8 7.4 Shank Nails i #8 Screw 30.8 30.8 18.2" 2 #8 Screw 51.7 51.7 24.4 1-10d Smooth or Screw 24.3 24.3 24'.2 Shank Nail (Field Clip) I- I Od Smooth or Screw 19.0 'l 9.0 22. I Shank Nail (Eave Clip) 2-10d Smooth or Screw 35.5 35.5 34.8 Shank Nails (Field Clip) 2-10d Smooth or Screw ~ 1.9 31.9 32.2 Shank Nails (Eave Clip) ~_-~od ~i.g Sha. k Naits' I 50.3 { 65.5 I 4S.3 1. Installation with a 4" tile headlap and fasterners are located a min. of 2'6" from head of tile. Table 4: Attachment Resistance Expressed as a Moment Mr (ft-lbf) for Two Patty Adhesive Set Systems Tile Tile Application Minimum Attachment Profile Resistance Skandia Adhesive 31.3s 2. See manufactures component approval for installation requirements. 3. Flexible Products Company TileBond Average weight per patty 13.9 grams. Polyfoam Product, Inc. Average weight per patty 8 grams. Table 4A: Attachment Resistance Expressed as a Moment - M, ift-lbf) for Single Patty Adhesive Set S_YSt__er~, Tile Tile Application ~H}'Li U{' PLIM~i~uYttd-/%~tachment Profile r~ I~l/'tT F,~,/1. Fistance {{{i.ml {{mrim ~.'=~ . -- ~ ,,'~ .. HAY - 1 2002 BUILDING DIVISION 5 aga. RRC Roofing Product Control Examiner ENTEGRA ROOF TILE CORPORATION ' 0~-1644 ACCEPTANCE No.: 00-1106.03 APPROVED: December 7, 2000 EXPIRES: December 7, 2005 NOTICE OF ACCEPTANCE: STANDARD CONDITIONS Table 4B: Attachment Resistance Expressed as a Moment - Mf (fi-lbO for Mortar Set Systems Tile Profile Tile Application I Minimum Attachment I Resistance See Specifitc mortar manufacturer's Notice of Acceptrance. e LABELING All tiles shall bear the imprint or identifiable marking of the manufacturer's name or logo, or following statement: "Miami-Dade County Product Control Approved". BUILDING PERMIT REQUIREMENTS 6.1 Application for building permit shall be accompanied by copies of the following: 6.1.1 ThisNotice of Acceptance. 6.1.2 Any other documents required by the Building Official in order to properly evaluate the installation of this system. PROFILE DRAWING MAY- 1 2002 BUIL01NG 01VISION SKANDIA FLAT CONCRETE TILE SHEET O[ ?[RglT SET RECEIVED DO NOT ~EMOVE Frank Zuloaga. RRC Roofing Product Control Examiner ENTEGRA ROOF TILE CORPORATION - 02-1644 ACCEPTANCE No.: 00-1106.03 APPROVED: December 7, 2000 EXPIRES: December 7, 2005 NOTICE OF ACCEPTANCE: STANDARD CONDITIONS o Renewal of this Acceptance (approval) shall be considered after a renewal application has been filed and the original submitted documents, including test-supporting data, engineering documents, are no older than eight (8) years. Any and all approved products shall be permanently labeled with the manufacturer's name, city, state, and the following siatement: "Miami-Dade County Product Control Approval", or as specifically stated in the specific conditions of this Acceptance. Renewals of Acceptance will not be considered if: a. There has been a change in the South Florida Building Code affecting the evaluation of this product and the product is not in compliance with the code changes. b. The product is no longer the same product (identical) as the one originally approved. c. If the Acceptance holder has not complied with all the requirements of this acceptance, including the correct installation of the product. d. The engineer who originally prepared, signed and sealed the required documentation initially submitted, is no longer practicing the engineering profession. ' Any revision or change in the materials, use, and/or manufacture of 'the product or process shall automatically be cause for termination of this Acceptance, unless prior written aPproval has been requested (through the filing of a revision application with appropriate fee)' and granted by this off~ce. Any of the following shall also be grounds for removal of this Acceptance: a. Unsatisfactory performance of this product or process. b. Misuse of this Acceptance as an endorsement of any product, for sales, advertising or any other purposes. The Notice of Acceptance 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 Notice of Acceptance is displayed, then it shall be done in its entirety. A copy of this Acceptance as well as approved dra~vings and other documents, where it applies, shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at all time. The engineer need not reseal the copies. Failure to comply with any section of this Acceptance shall be cause for termination and removal This Notice of Accep~'.~ MA~ ~HIS ACCEPTA BUIL01NG IVI$10N oaga, RRC Roofing Product Control Examiner 7 - 02-!644 CITY OF BOYNTON BEACH DEVELOPMENT DEPARTMENT 100 East Boynton Beach Blvd. P. O. Box 310 Boynton Beach, Florida 33425-0310 FILE COPY PLAN REVIEW COMMENTS PLEASE NOTE THAT THE EFFICIENCY BY WHICH YOU RECEIVE YOUR PERMIT DEPENDS ON YOUR RESPONSE TO THE CONTENTS OF THIS DOCUMENT. IT IS RECOMMENDED THAT YOU CAREFULLY READ AND CORRECTLY RESPOND TO ALL ASPECTS OF THIS DOCUMENT. COMMENTS: For permit application number / review: 02-1644 1 ST REVIEW Project Name or Address: BLISS CONST. REVIEWED BY: Department and/or Division: Building Division Name of Reviewer: Bill Erskine Trade: Phone # Fax # Review Date: Type of Review: Mechanical - Plumbing (561) 742-6755 ext. (561)' 5/3/02 MECHANICAL COMMENT DISTRIBUTION: Person identified on the application to receive comments: Name RICK DENNING Phone # (area code:561) 762-5783 ext. Fax # (area code:561) Date(s) reviewer called: Person who received the call THE FOLLOWING AREA SHALL BE FILLED-IN IN THE PRESENCE OF A BUILDING DIVISION STAFF MEMBER: COMMENTS/PLANS PICKED UP: ~ recd. by print name and date: ~ OR-- Plans/Comments recd. by print name and date: Page 2 of 2 ' 0 -1 $44 Plan Review Comments for Permit Application # 02-1644 1 ST REVIEW Your permit application and supporting documentation do not comply with the City of Boynton Beach Code of Ordinances. Prior to receiving a permit to construct or install the requested improvements the plans and documents shall be amended to show compliance with the below listed comments. For questions regarding my review please contact me at the number listed above. If a conference is necessary, please schedule an appointment. Phone calls and appointments are received and scheduled during work days Monday through Friday 9:30 to 10:30 AM and 1:45 to 2:45 PM. Please note that additional comments may be generated following staff review of the amended plans. Timely approval of your project is dependent upon your prompt and correct response to the information provided in this document. 1. SECTION 601.4 FMC 01- PROVIDE BALANCED AIR RETURNS FOR ALL THE NC SYSTEMS. 2. SECTION 104.2 SMC 01- ON SHEET MO.O IN THE GENERAL NOTES IT REFERS TO THE SPECIFICATIONS FOR DUCT INFORMMATION,PROVIDE SPECIFICATIONS OR REMOVE NOTE. 3. SECTION 1511.7 FBC O1- PROVIDE THE STAND HEIGHTS ANDCURB HEIGHTS FOR EQUIPMENT AND PIPING AS PER THIS SECTION. 2 CITY OF BOYNTON BEACH DEVELOPMENT DEPARTMENT 100 East Boynton Beach Blvd. P. O. Box 310 Boynton Beach, Florida 33425-0310 PLAN REVIEW COMMENTS PLEASE NOTE THAT THE EFFICIENCY BY WHICH YOU RECEIVE YOUR PERMIT DEPENDS ON YOUR RESPONSE TO THE CONTENTS OF THIS DOCUMENT. IT IS RECOMMENDED THAT YOU CAREFULLY READ AND CORRECTLY RESPOND TO ALL ASPECTS OF THIS DOCUMENT. COMMENTS: For permit application number: Project Name or Address: REVIEWED BY: Department and/or Division: Name of Reviewer: Jose Alfaro Trade: Phone # (561) 742-6260 ext. Fax # (561) 742-6259 Date Started Review: 05/21/02 Type of Review: 02-1644 HIGH RIDGE COUNTRY CLUB Planning and Zoning HVAC replacement & reroofing Which Review: [] 1st [] 2nd [] 3rd [] 4th COMMENT DISTRIBUTION: Person identified on the application to receive comments: Name Phone # (area code:561) ext. 0 Fax # (area code:561) Date(s) reviewer called: Person who received the call [] Other THE FOLLOWING AREA SHALL BE FILLED-IN IN THE PRESENCE OF THE PLANS ANALYST AND/OR PERMIT CLERK: COMMENTS/PLANS PICKED UP: cd.by print name and date: OR ' Plans/Comments recd. by print name and date: Page 2 of 2 1~t 2nd 3rd 4® Plan Review Comments for Permit Application # 98- Your permit application and supporting documentation do not comply with the City of Boynton Beach Code of Ordinances. Prior to receiving a permit to construct or install the requested improvements the plans and documents shall be amended to show compliance with the below listed comments. Prior to making the changes to the plans and/or documents please read the attached Submittal of Corrected Plans form. This form contains important information relative to amending documents and submitting corrected plans and/or documents. Questions regarding the comments may be directed to the reviewer named above. If a conference is necessary, please schedule an appointment with the reviewer. Please note that additional comments may be generated following staff review of the amended plans. Timely approval of your project is dependent upon your prompt and correct response to the information provided in this document. Find attached, a form titled Submittal of Corrected Plans, this document shall be properly completed and stapled to the file copy of the corrected plans when submitting them to the Plans Analyst. 1- On the submitted drawinqs A-7 & A-8 please show a parapet wall to shield every roof top unit/equipment. 2- Code requires roof top equipment to be shield from public view at a distance of 600 feet, any angle. If parapet walls do not exist to provide the shield, please indicate methods of shielding. Jose FRI 13:26 FAX 561 835 0184 O, N, &l~I ACCT ~001 Date:...' Pagesi' Bliss Construction Dutch Bliss (561) 391-6702 High Ridge Country Club ..... '6/14/0 ..... 5 pages (in. cluding this COMMENTS: As per our conversation this morning, here are the certifications. 1) Joe MincuzzJ- P.E. of Record 2) Don Baxter-Inspector 3) Dave Wratislaw-Inspector 4) Frank Gobeo - Inspector Lisa Odiz Inspections Coordinator From the desk of... Joe F. Mincuzzi Vice President O'Donnell, Naccarato, Mlgnogna & Jackson, Inc. 321 15th Street, Suite 200 West Palm Beach, Florida 3.3401 Office: 561.835-9994 Fax: .~61-835-0184 Receive¢l: 6/14/02 I :34PM; 561 835 0184 -> Bliss Construction; Page 2 05/14/e, 2 1RI[ 13:26 FAX S6! 835 0184 O,N,&~ ACCT ~002 ..~':~ ;,' ,, :~-'"," ';~,e .. ' '* · · :'~' ': .. 2~' · '." . .' '*' *': .. ;' - ..... ~..'..,~ .... ::.~ .',.:', .~... '::., .'. : .. .:....... .. ,...q .,..., .:. . .:; . . g, ,' . .f:,.. .~ . ... .. ....'.; ,. ;~L.,. ":: "." ,f : ': :' .' '.' ': :.~ ' ..,0' . "~' ' .... ,. · ' ' . ," · ...'" ~. ?. . .. ', . ~ : .~;'. .,,'~..' .:;.,.~ ~ ·. ,. .. , ... .... . ... .... ..... . .:. ,. .. : ::... ~.~ .... . ~.'~ ~'~ ... ~.. .,... . . . ., .~ ~ ... ,.. ~ ~,~ ~ '-~ - . . . . : ~' .'" ..;~ ~.~. ~ .~... ~: ~ ~,~ .- ~ . ~ ' . . : ........ .. ~: ;,':'.'~:". ~- - .,.,., .~:. ~ , . · : ..... . ........... ~' ~ .~,~'~: ~';[?~;: . . . '." . .... gose'p'n~,'.~a [~f~[~u~, ~ .... . EXPIRATION: FEB 28, 2003 AUDIT NO: 14614 P.E. NUMBER: 38162 SI NO: · 0952 DISPLAY AS REQUIRED BY LAW Ar 0178139 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BLDG CODE ADMIN AND INSPECTORS $E~01091900385 LICenSE NBR BN -0002673 The STANDARD INSPECTOR Named below IS CERTIFIED Under the provisions of Chapter 468 FS. Expiration date= NOV 30, 2003 /' MINC~ZZI, JOSEPH FRANK 399 N.W. 22Z~D AVENUE BOCA RATON "' JEB BUSH GOVERNOR FL 33486 DISPLAY AS REQUIRED BY LAW KI/~ BINKLEY- SEYER SECRETARY ~003 ~0. ~@ ~01 BN -0002700 Z3/&O/2OOZ 010~3900 STANDARD INSPECTOR BAXTER,. DON RANDALL ,~e :Lved ~ 06/~/0~ Et/1 4. / O?_' 1 F[~.I 13:?.7 F's"][ 56L $35 Rece:L. vect: 6/14/02 I :35PM; 561 835 0184 -> B:L3. ss Cons~ruc'~[on; ~age ~ 06/14/~'2 FRI 13:27 FAX 561 835 0184 O,N,&~ ACCT A~ 0; O Z ~ U ~ STATE:OF F~p~iDA ~' ~ ~005 O~B' BU6I~ O~S~=f~¥.~S,':~I~'~U~R~D. a,Y LAW Ac/03. E;2472 8TATE'OF FLO'R, IDA" ' The BTa,.Wm3Am3 Z~'a'P]CCTOIt BO~ ~TO~ ~L 33428 Olspr~y AS REQUIRED B'r LAW 08:42 5613470868 GFA INTERNATZONAL PAGE - 0.2-1641 FA CSIM!LE .TRANSMITTA t This Facsimile contains t page{s) including the cover sheet. RECEIVED JUN 2 ~ 2002 BUILDING The documents accompanying this fax contain certain information that is confidential, and may be leg ally privileged. The information is intended only for the indiviclua[ or entity named on this covet letter, if' you ere not the intended recipient, be aware that any disclosures, copying, distribution or use of this information is prohibited. If you receive this fax in error, please notify us by telephone Immediately (1-800-228-7522) so Ihat we can arrange for the retrieval of the original documents at ilo cost to you Env~ronmentat .'l ca~ocat, O~ico ~6c~c&[ [ 442 N.w. 35~ 5~et le~ Southern Blvd., Suite H 57S2 Collation ~:~a 11310 ~. O~ge ~lo~om ~ail Bo~ ~ton. FL 33431 Wear Pa~ B~, FL 33406 Fo~ Myem, ~ 33905 Suite. 200 · S~u~u~t Design iss~] 3~070 Constr~on Matefla~ Testing (ssi) 3~7~809 ~reshold and Sp~a[ Znspe~ons Satellite Om~ ~ ~Up~~ aaa Iaam~da .~,,:~,?~.L:.: ..... ,',. = ..... web ~e: ~,gf~4AtLcom ity of Boynton Beach P.O. Box 310 Boynton Beach, FL 33425 Attention: Mr, Tim Large - 02-! 644 June 24, 2002 Re: High Ridge Country Club Dear Mr. Gentlemen, Mr, Al Newbold BN # 0001656 will perform the inspections for the above referenced site. Mr, Hal Vinh Ly is the certifying Professional Engineer for the project stated above and will not be performing the code-mandated inspections. If you have any questions please feel free to contact me at you convenience, Respectfully submitted, Hal Vinh, Ly, P.E. Project Manager Thomas Ortner Vice President of Inspections TO:sgn RECEIVED JUN 2 ~ 2002 EiUILDING Environmental Geotechn{cai Structural Design Construction MateriaLs Testing Threshold and Special Inspections O~lf C-~a~ O~ice ,5752 Corporation Circle Fort Myer.% ~ 33905 (~1) 48~2443 (~I) 489-3438 Fax 11310 $, Ornng¢ Blosmom Suite 200 ~laudo, ~ 3283? (~) 2z~aszz !~,~1 r' ur' I-LUI~CIUA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BLDG CODE ADMINAND INSPECTORS 1940 N MOATROE ST TALLA/EASSEE FL 32399-2211 (850) 921-4789 NEWBOLD. ALFRED 3575 AVENUE R RIVIERA BCH FL 33404 STA'rE OF FLORIOA AC# ~ ~ ~ Z ~ ~ , ~TDEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BN -0001656 10/09/2001 01900734 STANDARD INSPECTOR NEWBOLD, ALFRED DETACH HERE AC# ~'~22 '~ 4~ ~, _ ~ O ~ ~.¢ STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BLDG CODE ADMIN AND INSPECTORS i ,k..%./ '1 I l:f_.~fd:l~tlh,,l:~:l LICENSE NBR 10/09/200,,1101900734 IBN -0001656 SEQ# 0i100900724 The STANDARD INSPECTOR Named below IS CERTIFIED Under the provisions of Chapter 468 FS. Expiration date: NOV 30, 2003 NEWBOLD, A~FRED 3575 AVENUE R RIVIERA BCH FL 33404 JEB BUSH KIM BINKLEY-SEYER GOVERNOR DISPLAY AS REQUIRED BY LAW ........ FRI H ~ I V I IqH L I & P . Hai-vinh Ly, PE Is lice~'~sed dS a Profe,~s~onal Engineer under Chapter 471, Florida Exp Date 1992-08393 ib'~l VIHH LY PE ':' ,,,,l VINH February 28, 2003 License NO 25390 f, EO0~' ~ ~_5~90 JOHN K. CLARK/cFC TAX COLLECTOR. PALM ~Ar¢H COUNTY ':-*',,'~ CITY OF WEST PALM BEACH '~.&,-,=~- ~OO1-O2 LICENSE / CERTIFICATE OF USE CNTY TOTAL PAID. P~C.TAX ItOLLE'CTOR. THIS LICENSE VALtD.CiNLY WHEN RECEIPTED BY ":TAX'CUCLECTOR NOT TR ANSFER_A__Bk_E CITY OF WEST PALM 8-~ACH P.O. BOX 3147, WEST PAUM DF. ACH, FL :i:~32 8'?]000t500-6 FL 25390 HAI VI~{ LY PE 4195 CROZET CT LICC¢IC, C [~0. CAIt:~HY [ ?,'2o DESCRIPTION (. 1 li\i'!:it' S PFNALTIES THI.~ DOCUMENT NOT VALID J g.N_TJ.L_FUNDS ARE COLLECTED. i 0.0O I57.50 I'OTAL~ EXPIRES SEPTEMBER 3C', 2002 ( )_l )~ -- t 4 -- ~) 2 F R I 1 2 : ~ 6 H A I ~/ I N H L i & A $ S 0 F' . C~ :f. Resume of HAI-VINH LY, P.E. Consulting Engineer CURRENT ADDRESS: CURRENT PHONE: EDUCATION: REGISTRATION: MEMP, ERSHI P: 4195 Crozet Court West 'Palm Beach, FL 33409 (561) 640-7110 Master of Science in Mechanical Engineering University of South Florida Florida Registration Number 0025390 ASHRAE A project engineer with twenty seven (27) years of design experie~ces in Heating, Air Conditioning anf Ventilation; Plumbing; and Electrical Systems of Residential,_Commercial, and Institutional Buildings. $ 250,000.00 REFERENCES Dailey and Partners Architects, P.A. West Palm Beach, Florida DMJM i Harris Corporation Mi.a~ti, Dade County, Florida A/SL/'C Associated, Incorporated Orl~nd©, Orange County~ Florida J'aF Ammon Architect, Inc. L~agwood~ Orange County, Florida ,3o~ Sto~s B!ehar Architects, A.I.A., P.A. i,ai<e Worth, Florida Brower Architectural Associates Town of Palm Beach, Florida (561) 640-5281 (305) 444-8241 (407) 896-7875 (407) 333 -1977 (561) 493 -9788 (561) 659-1948 · T ~ ti.--, 1 4 -- 0 2 P R I I 2 : ~ 6 H A I ~/ I N H L I ~-~ A S S 0 P - 0.I CUMHLRC[AL & INSTITUTIONAL PROJECTS PERFORHED: Project Names System Types Oper'ation Building Restoration Ci!:y of' Reviera Beach. Florida Split D.X,System Service Bldg.-Al Packer Ford-West Rogal Palm Beach, Florida Split D.X.System ,'-,-,.,~, ~,n,,,-~..~ ~ and Naterials Storage_. l'ri-Ftail, t. fialeah. Dade Couni~y Rooftop, Split D.X. & Ventilation FOLI~'L~i Flnnr' Fll-l=icp RPnnval~inns P,J,'L cf l, liami. Dado Count:y. Chilled Water Sys., AH[I. VAV Terrr, inal CrLlise Tol'n!ina't -#6, Hiami, Fla. -Chi!!~d Wd. 1. e,' AHU, VAV Termin$1 [-75 Pe'_'..t Ar'ea Bldg.(F.D.O.E.) ,- Ceur~ Flor'ida t':, O,.,t, _i ry. Split D.X.System Ha ~ueL [;<~_~c. Office Renovations ?liau,,i. LM'..t~_ {]l)LIrlLy, 5t o"'~? ~: & I'!o ~ ! © i :5 t r'i but i on Dado County School Boar'd. Florida Split D.X.System Rooftop and Ventilation Units ~,,..,,:, N~e.;b'yt:':r'~an Church Paln: R;~ri- Gar'Jens. F'lorida Split ~aim t,,,-,,~l. A-iliai~c:e Cnur'ch Lc, xa 1::~,'~(.~. Palm Beach COLlnty f ic,,r !.h~il.c:l F_;arlk ',,.i,~f~t Palnl Beach. Florida Split D.X.System Spli't D.X.Systern Uuu,~ty, Florida Spl i L D.X.System ',:'~l!.~ge Hal! of Royal Palm Beach i.~oy'al ?a!ni Beach. Florida Split D.X.System U."; SL,5.,-~r' Cor'p. (OfFice Renov.) CIo,,,,; s to~. Flor'ida Split D.X ~,yot~m Vedadr.) C,.)ni!lUJlli L.y CeriN:~r' West Patm Beaci~, Flor'Joia SpliL D.X.SysLem Whole Ea~'th Food Harket fi:'x:a Eaton. Florida Roof lop Units R.d.Gator Restaurant t. al,:c Ci t':,'. Flor'i:da Split D.X.System Floor Areas 4100 SF 4700 SF 3000 SF 33C0 SF l?fiOO %F 6800 SF 45000 SF 100000 SF gor)O SF 9000 SF 2500 SF 2900 SF 5500 SF 54O0 SF 25O0 SF 12000 SF 4800 .SF DEPARTMENT OF DEVELOPMENT BUILDING DIVISION SPECIAL INSPECTOR AGREEMENT AGREEMENT made this Z~ day of 02-1t144 ,200 ~ by and between lt~k~ ~,'1} ,q~' ~4~,'11~ ~___t.x4/"~ hereinafter referred to as Owner; , e 'nailer referred to as Special Inspector; and tile City of Boynton Beach, Florida, hereinafter referred to as City. WHEREAS, pursuant to Section 105.3 of the Standard Building Code, 1997 editio~k..as amended, the Building O~ficial of Boynton Beach may a~low the owner of 1-~'-~ '--Ir- ,~-4/3~ ~ ~ project, to employ a Special Inspector. WHEREAS, OWNER shall be responsible for paying all costs of employing a special inspector as hereinafter set forth. NOW, THEREFORE, BASED ON THE MUTUAL COVENANTS AND AGREEMENTS CONTAINED HEREIN, THE PARTIES ItERETO AGREE AS FOLLOWS: 1. SPECIAL INSPECTOR shall serve as contemplated by Section 105.3 of the Standard Building Code, 1997 edition, as amended, and shall inspect all components of the building(s), at the project cited hereinbefore. SPECIAL INSPECTOR shall be present until said building is complete. SPECIAL INSPECTOR shall be self-employed and will function as an independent contractor on a fee basis and will be solely responsible for all payroll taxes to include, but not be limited to: federal withholding tax, workers' compensation, FICA, federal and state unemployment taxes. 3. The fee for SPECIAL INSPECTOR'S services shall be paid solely by OWNER. Upon execution of this Agreement, OWNER shall deposit with CITY a sum equivalent to SPECIAL INSPECTOR'S fee for four (4) weeks, plus a five percent (5%) administrative expense. Thereafter, OWNER, on a weekly basis and so as to at all times maintain an amount with CITY equivalent to four (4) weeks SPECIAL INSPECTOR'S fee, shall deposit with CITY, SPEC1AL INSPECTOR'S weekly fee plus a five percent (5%) administrative expense. ClTY shall then be responsible for paying SPECIAL INSPECTOR on a weekly basis. OWNER shall not be obligated to pay SPECIAL INSPECTOR the above referenced fee for any ti~ne that work concerning the project is shut down or not otherwise ongoing and SPECIAL INSPECTOR is not on duty. 4. SPECIAL INSPECTOR shall prepare daily written reports in tile format specified by the Building Official of CITY and submit them weekly to the Building Official of CITY and to the OWNER. 5. SPECIAL INSPECTOR will be present on the construction site during tile normal working hours at the site. 6. It is further understood and agreed that SPECIAL INSPECTOR shall be responsible to the CITY, notwithstanding that OWNER shall pay all of the Special Inspector's fees and costs. If, at any time, such services are not satisfacto,'y to the Building Official, this Agreement may be cancelled without further recourse of SPECIAL INSPECTOR or OWNER against either CITY or OWNER. Further, either SPECIAL INSPECTOR or OWNER may cancel this Agreement upon providing thirty (30) days written notice to all parties hereto. In any event, OWNER shall have retained the services ora successor special inspector prior to proceeding with construction. - 02-1644 ?. No prior or present agreements or representations shall be binding uPon any of the partics hereto unless incorporated in Ibis Agreement. No modification or change of this Agreement shall bc valid or binding upon the parties unless in writing, executed by the parties to be bound thereby. 8. The Special Inspector certifies under penalty of perjury that there does not exist a conflict of interest in relation to the performance of duties under the temps of this Agreement and that he has no financial interest in, or involvement with, the project which he is inspecting or the owner, developer or contractor of such project, either currently or in the previous year. The Special Inspector fi~rther certifies that he or his employees will not engage in any other work which is inconsistent with the duties or interest of the City of Boynton Beach Department of Development. ~ OWNER'S SIG, NATUR STATE OF FLORIDA, COUNTY OF PALM BEACH . Thefl/~regoing instmmecll__was acknowledged before me this ~ '" ~,,c.., ~:2 ~. (date) by / / /)/> ~. q' /~'?_.Y~._~.,~_ , who is personally known to me or who has produced !&~A~....a~..~d.t//_. ?_~_ .~.(.,~ l~_pe of identification) as identification and who did (did not) take an oath, (P.E. of record) " STATE OF FLORIDA, COUNTY OF PALM BEACH . ~ ,, The foregoing instrument was ac-knowledged bef°~ (date) by ,~is pers~mk or who has produced (type of ideas identification and who did (did not) take an oath. (SEAL) ', I [~ ~ I / i l,l, I , L{~ ~_~_~. J~nin~ {_ P~tarso,-~o~n Signature of person taking ac~owled ~ ~ ~ ,,.._.., Name , , gement of officer taking acknowledgement--~pe~d or stamPer ~~~~. r~ ~ 2~, ~00a Title or rank Serial number, if 'CITY REPRESENTATIVE~.~S . /' STATn OF FLOmD^, COUNTY OF PALM nEACla The foregoing instrument was acknowledged before me this ~[O ~ (date) by /I ~}~h~ ~' ~t~ , who is~~0wn to rocor who has produced O O of idcntificalion) as identification and who didO) take an oath. (type I .... OFFICIAL NOTARY S~L (SEAL) , , [ ~ RUTH ANN~IRE' Signature of person taking acknowledgement ~ .~ ~ ~¢~_ ~ ,' i~ ~]NOTARYcoMMI~IoNPUBLIC ~ATENo. DDII~OF FLORIDA Name of officer taking acknowledgement--typed, printed or stamped ~ ~DD ~..iFo? MY COMMISSION EXP. MAR. ~6,2~5 ~ C~ Serial number, if any 2/91, rev. 12/93, 12/94, 9/95, 3/97, 7/99, 4/00, 8/00 - bg \\CI I\MA IN\SI II~,I)A'I'A\I)I;.VI:'I.OI MI:'N'IM:ORMS.I)OC\SI F. CINSI .WPI) DEPARTMENT OF DEVELOPMENT Il I i i REQUEST FOR SPECIAL INSPECTOR OCTOBER 1996 To: From: Building Official, City of Boynton Beach 02-1644 Pursuant to Section 105.3 of the Standard Building Code, 1997 Edition, the City Building Official may allow the employment of a special inspector on construction projects to expedite construction and to provide for public health, safety and welfare. We propose to employ and be responsible for all costs associated with a special inspector for continuous on-site inspectionofour~/,~'~/,~:'(-- project located at l~ t'~~ ~ inBoynton Beach, until the building is complete and a Certificate of Completion or Occupancy is issued by the City of Boynton Beach. Costs include, but are not limited to, fees/salary, withholding taxes, workers compensation, FICA, unemployment taxes, etc. We will deposit and maintain with the City funds equal to four weeks payment to the special inspector plus a five percent administrative fee so that the City can reimburse weekly the special inspector fi.om funds thus deposited. We will notify the City in writing each time the project is shut down or not otherwise ongoing and the special inspector is not on duty. The special inspector will prepare daily ,,wit-ten reports in the format specified by the City and submit them weekly to the City as a pre-condition to reimbursement. The special inspector will be present on the site during all times when construction is ongoing. Upon written notification fi.om the City, we ~vill cancel our agreement with the special inspector and Mil not proceed with construction until a successor special inspector is in place. We acknowledge that the City will not issue a Certificate of Completion or Occu~p_,ancy unless and until the special inspector certifies in writing that the work has been constructed in accordance ,,~ all codes, rules, re~lations and laws; and that if testing and/or reconstruction is necessary to obtain such ~'ert,~cation, it will be solely at our expense. ~Ve further ag-ree to take full responsibility for any and all worl~ tl~t~has been covered or concealed ~ln~~eby release the City from any and all liability p/r/sultin, g. 11%1/ '"'g~ature of Ow-ne~ - ~ Signature o~'Contractor STATE OF FLORIDA COUNTY OF PALM BEACH /Thefore~_~inginstnt/~n.t. was.,~!qn, owledoed before me this ~ dayof ~t~__.?.~/~ .,.~ ,~i~°~"'by, ZI__,~__/~,, ~"~__., ?)/~,~?..~ .~/~,ito is personally known to me or who has pr(muced .~51~'. _.,t~),~ .,,/..,~. _ ~Type ~j )'~l~t'identifi~/on~,ho (did)(/~ not)take an oath. Sig-nature of person taking acknowledgement .,-- Name.~fo//ficer taking acknowledgement typed, printed or stamped (SEAL) r-. - ......... ~ ..... ::-~i~ .,~'-,,'~'_~. (Title or rank) (Serial Number, if any) \\CI-P, MAINXS HRDATAkD EVELO P MENTkPOLICY MANUAL.WP~O LICYM I-BSP ECCONZS? [lqS P.WP D DEPARTMENT OF DEVELOPMENT BUILDING DIVISION 02-1644 SPECIAL INSPECTOR AGREEMENT AGREEMENT made this '"ta~9"I- day of ~"7~,4~-'z.: ,200 't..-, by and between ~ ~,~.~,~_:, ~'~ ~ , hereinafter referred to as Owner; ~ (~~~ , hereinafter refe~ed to as Special Inspector; and the City of Boynton Beach, Florida, hereinafter referred to as City. WHEREAS, pursuant to Section 105.3 of the Standard Building Code, 1997 edition, as amended, the Building Official of Boynton Beach may allow the owner of F~O ~- ~P~. ~~ ~~ project, to enlploy a Special Inspector. WHEREAS, OWNER shall be responsible for paying all costs of employing a special inspector as hereinafter set fo~h. NOW, THEREFORE, BASED ON THE MUTUAL COVENANTS AND AGREEMENTS CONTA~ED HEREIN, THE PARTIES HERETO AGREE AS FOLLOWS: 1. SPECIAL INSPECTOR shall se~e as contemplated by Section 105.3 of the Standard Building Code, 1997 edition, as amended, and shall inspect all components of the building(s), at the project cited hereinbefore. SPECIAL ~SPECTOR shall be present until said building is complete. 2. SPECIAL ~SPECTOR shall be self-employed and will fitnction as an independent contractor on a fee basis and will be solely responsible for all payroll taxes to include, but not be limited to: federal withholding tax, workers' compensation, FICA, federal and state unemployment taxes. 3. The fee for SPECIAL ~SPECTOR'S services shall be paid solely by OWNER. Upon execution of this Agreement, OWNER shall deposit with CITY a suni equivalent to SPECIAL INSPECTOR'S fee for four (4) weeks, phis a five percent (5%) administrative expense. Thereafter, O~ER, on a weekly basis and so as to at all times maintain an amount with CITY equivalent to four (4) weeks SPECIAL INSPECTOR'S fee, shall deposit with CITY, SPECIAL INSPECTOR'S weekly fee plus a five percent (5%) administrative expense. CITY shall then be responsible for paying SPEC1AL INSPECTOR on a weekly basis. OWNER shall not be obligated to pay SPECIAL INSPECTOR the above referenced fee for any time that work concerning the project is shut down or not othe~ise ongoing and SPECIAL ~SPECTOR is not on duty. 4. SPECIAL INSPECTOR shall prepare daily written repom in the format specified by the Building Official oFCITY and submit them weekly to the Building Official of CITY and to the O~ER. 5. SPECIAL INSPECTOR will be present on the construction site during the nomlal working hours at the site. 6. It is fitrther understood and agreed that SPECIAL ~SPECTOR shall be responsible to the CITY, notwithstanding that O~ER shall pay all of the Special Inspector's fees and costs. If, at any time, such services am not satisfactot~ to the Building Official, this Agreemenl may be cancelled without fimher recourse of SPECIAL INSPECTOR or OWNER against either CITY or OWNER. Further, either SPECIAL INSPECTOR or OWNER may cancel lhis Agreement upon providing thirty (30) days written notice to all parties hereto. In any event, OWNER shall have retained the services ora successor special inspector prior to proceeding with construction. - Ol-1 64,4 7. No prior or present agreements or representations shall be binding upon any of the parties hereto unless incorporated in this Agreement. No modification or change of this Agreement shall be valid or binding upon the parties unless in writing, executed by the parties to be bound thereby. 8. The Special Inspector certifies under penalty of perjury that there does not exist a conflict of interest in relation to the performance of duties under the terms of this Agreement and that he has no financial interest in, or involvement with, the project which lie is inspecting or the owner, developer or contractor of snch project, either currently or in the previous year. The Special Inspector further certifies that he or his employees will not engage in any other work which is inconsistent with the duties or interest of the City of Boynton Beach Department of Development. OWNER'S STATE OF FLORIDA, COUNTY OF PALM BEACH , who is personally known to me or who has produced l~f/~ ~ l,,_~._-.td,, a tmn~ nfidentification) as identification and who did (did not) take an oath. (SEAL) ~g EXPIRES: ~y ~, ~ Il ~ Name ofofficer taking acknowledgement--~ped, p~ or stamped Title or rank ~ . Serial number, if any SPECIAL INSPECTOR'S SIGNATURE (P.E. of record) STATE OF FLORIDA, COUNTY OF PALM BEACH The foregoing instrument was acknowledged before~-- - · ----._,-m~ ~}~ '?(.)L)~ (date) by (type ofidentmcado,0 ~,s i,~c,~' '--- ' ' " dfi~tion and who did (did not) take an oath, (SEAL) - , ~ ltr~Lh-My Commission CC$7328: Signature of person taking ac~owledgement .. _ ~ ,, ~~ '~' ' %,,~ Exp;ms ~pte~ 22, 20( Name officer Title or rank Serial number, ifa~y ) [ ~ 'CITY ~PRESENTATIVE'S~~~~ If~~'/~~' ~ SIGNATURE ~ , STATE OF FLORIDA, CO~TY OF PALM BEACH The foregoing ins~mmenl was acknowledged befor~ me Ibis ~'-~.~-C .~ 0 (date) by , who i~~ t-t-t-t-t-t-t-t-t-t~o me'~or who has produced (type of identification) as identification and who did ~ake an oath. (SEAL) Signature of person taking acknowledgement N.m~ or om¢¢~ taking acknowledgement--type~, printed or stamped Title or rank ~(~ PL~;C~ Serialnumber, ifany 2/91, rev. 12/93, 12/94, 9/95, 3/97, 7/99, 4/00, 8/00 - bg RUTH ANN SCIRE' NOTARY PUBLIC STATE OF FLORID/,, COMMISSION NO. DDl10044 MY COMMISSION EXP, M^R.,16,20~.5 \\CI|\MAIN\$1IRD^TA\DEVE|.O[ MEN'~FORMS.DOC\SPECINSI .WPD DEPARTMENT OF DEVELOPMENT To: Building Official, City of Boynton Beach From: ~ ~ ~ Cki.~er) REQUEST FOR SPECIAL INSPECTOR OCTOBER 1996 - 02-1644 Pursuant to Section 105.3 of the Standard Building Code, 1997 Edition, the City Building Official may allow the employment ora special inspector on construction projects to expedite construction and to provide for public health, safety and welfare. We propose to employ and be r~ponsible for all costs associated with a special inspector for continuous on-site inspection of our,~~ /¢¢/~ project located at ./,~t~ 4'~.I,,~ ~ in Boynton Beach, until the building is complete and a Certificate of Completion or Occupancy is issued by the City of Boynton Beach. Costs include, but are not limited to, fees/salary, withholding taxes, ~vorkers compensation, FICA, unemployment taxes, etc. We will deposit and maintain with the City funds equal to four weeks payment to the special inspector plus a five percent administrative fee so that the City can reimburse weekly the special inspector from funds thus deposited. We will notify the City in writing each time the project is shut down or not otherwise ongoing and the special inspector is not on duty. The special inspector will prepare daily ;vritten reports in the format specified by the City and submit them w'eekly to the City as a pre-condition to reimbursement. The special inspector will be present on the site during all times when construction is ongoing. Upon written notification from the City, we will cancel our agreement with the special inspector and will not proceed with construction until a successor special inspector is in place. We acknowledge that the City will not issue a Certificate of Completion or Occu, paq, cy unless and until the special inspector certifies in writing that the work has been constructed in accordance uff_th a.~ codes, rules, regulations and laws; and that if testing and/or reconstruction is necessary to obtain such ~ertifi/~fition, it will be solely at our expense. We further~to take full responsibility for any and all wor~thal[l/'as been covered or concealed w'~~d here~y release the City from any and all liability t~s rl~lting. Signature of Owner ~ ~ Signature otfContractor STATE OF FLORIDA COUNTY OF PALM BEACH ,~ TI3e forgoing instlNrtael3t wa~,-~ekno,vledged be fore me this ~day o f ~ . j , ~.,..~~by, .~/~ ./'~.~'/,Z _~fl"~,.,/~,~ __~.~o is p~rsonally ~o~ me or who has prodded (T~e of ~ i~entiffcation ~ho ~ (did not) take an oath. Si ~ a~e of person ta~ngac ~o,vledgem ent Name~~ m~gac ~owledgem~t ~d, p~ted or s trap ed (SE~) -2 ..... (Title or ~) (S~al Nmber, if ~y) ' ~YC~~O~ -' ' ~ * ~PIRES: May ~, ~.,.~ \\CHMMAIN~S HRDATA'ff) EVELOPMENTkPO LIC Y MANUAL.WP~OLICYM H~S P ECCONKS PINS P.WP D ' 02-1 644 DEPARTMENT OF DEVELOPMENT BUILDING DIVISION SPECIAL INSPECTOR AGREEMENT AGREEMENT made this ~Q day of ]~'] ~ ~/ , :20~, by and Boynton Beach. Florida, hereinafter referred to as City. WttEREAS, pursum]t to the Fl. orida Building Code 2001 edi6on, as amrc~d, ed. the B,fil~ding Official of Boyr3.ton Beach may allow the Owner of )~t'q ~ ,grf/'~ff~"~ ~__~_~ project, to employ a Special Inspector. Wft~zREAS, OWNER shall be responsible for paying all costs of employing a Special Inspector as hereinafter set forth. NOW, THEREFORE, BASED ON THE MUTUAL COVENANTS AND AGREEMENTS CONTAINED HEKEIN, THE PAKTIES HERETO AGKEE AS FOLLOWS: 1.. SPECIAL INSPECTOR shall serve as contemplated by the Florida Building Code 2001 edition, as amended, and shall inspect all components of the buildix~g(s), at the p[oject cited hereinbefore. SPECIAL INSPECTOR shall be present tmtil said building is complete. 2. SPECIAL INSPECTOR shall be self-employed and will fi~nction as :m independent contractor on a fee basis and will be solely responsible for all payroll taxes to include, but not be limited to: federal withholding tax, winkers' compensation, FICA, federal and state unemployment taxes. 3. The fee for SPECIAL INSPECTOR'S services shall be paid solely by OWNER. Upon execution of this Agreement, OWNER shall deposit with CITY a sum equivalent to SPECIAL INSPECTOR'S fee for four (4) weeks, plus a five percent (5%) administrative .expense. Thereafter, OWNER, on a weekly basis and so as to at all times maintain a.u amaunt 'with CITY equivalent to four (4) weeks SPECIAL INSPECTOR'S fee, shall deposit with CITY,.. SPECIAL INSPECTOR'S weekly fee plus a five percent (5¢/o) administrative expense. CITY shall then be rzsponsible for paying SPECLa~L INSPECTOR on a weekly basis. OWNER shall not be obligated to pay SPECIAL INSPECTOR the above referenced fee for any time that work concerning the project is shut down or not otherwise ongoing and SPECIAL INSPECTOR is not on duty. ,, 4. SPECIAL INSPECTOR shall prepare daily written reports in the format specified by the Building O£ficial of CITY and submit them weekly to the Building Official of CITY and to the OWNER. 5. SPECIAL INSPECTOR will be present on lhe construction site during the normal. working hours at the site. 6. It is further understood and agreed that SPECIAL INSPECTOR shall be responsible to the CITY, notwithstanding that OWNER shall pay all of the Special Inspector's fees and costs. If, at any time, such services are not satisf'a.ctory to Building Official, this Agreement may be cancelled without further recourse of SPECIAL iNSPECTOR or OWNER against either CITY or O'WNER. Further, either SPECIAL INSPECTOR or OWNER may cancel this Agreement upon providing thirty (30) days written notice to all parties hereto. In any - 02-1644 event, OWNER shall have retained the services of a successor Special Inspector prior to proceeding with construction. 7, No prior or present agreements or representations shall be binding upon any of the parties hereto unless incorporated in this Agreement. No modification or change of this Agreelnen.t shall be valid or binding upon the parties unless in writing, executed by the parries to be bound thereby. 8. The Special Inspector certifies und~ penalty of perjury that there docs not exist a conflict of interest in rdaiion to thc performance of duties under lhe terms of this Agreement and that he has no financial interest in, or involvement with, the project which he is inspecting or the owner, developer or contractor of such project, either currently or in the previous year. The Special Inspector fmlher certifies that he or his employees will not engage in any other work which is inconsistent with thc duties or interest of the City of Boynton Beach Depamatcnt of Development. OWNER'S SIGNATURE STAT~. OF FLORIDA, COUNTY OF PAl_lq BBACH Tho foregoing ingVurrr~c was ,acknowledged before me this MY COMMISSION # DO 029977 EXPIRES: May 30, (St ~o~ Thru N~ ~ Nm of officer~ngjac~owledge~n~-~ed. SPECIAL INSPECTOR'S SIGNATURE (P.E. of record) ~C offdcnl ;atim) as idcntificatlcn and who did (did 3TATE OF FLORJDA, COUNTY OF PALM BEACH Tl~J~ortRoinl{ inytrumt was ~cknowledl~d befor~ me ~:o is p~a,y ~n~ to m~r ,vho ha, pr~uced n~) ~ ~ oath. O i~ ' (type ofidentificatim) as id,ntificarim :and who d~l (did P/bi;c-. ' CITY ~P~SE~AT~"S/ STATE OF ~A, COUNT~'F PA~ B~CH The rore~ing who i~Oy ~own m me'~r who h~s pmduccd (type or id~ndficatlm) .. ,¢tend flcatlmJ~nd who aid (~d RUTH ANN 5CIRI? N.OrrARY PUBLIC STATE OF FLORI~. COMMISSION NO. DD110044 _COMMI~_ ION EXP. MAR. 16,21;: 2/91, rev, 12/93, 12~94, 9/95, 3197, 7/99, 4/00, 8/00, S:\D~vcloprnent\FORMg.doc\gpecial lnspectar Agree]r~rtt d~: DEPARTMENT OF DEVELOPMENT REQUEST FOR SPECIAL INSPECTOR OCTOBER 1996 To: From: Building Official, City of Boynton Beach ~ g60qt~ (Y,-q.~0~_ ~ (Owner) Pursuant to Section 105.3 of the Standard Building Code, 1997 Edition, the City Building Official may allow the employment of a special inspector on construction projects to expedite construction and to provide for public health, safety and welfare. We propose to employ and be responsible for all costs associated with a special inspector for continuous on-site inspection ofo~ f~,_(._, project located at O[~o _H~Pf0oCtL~::~ ~ in Boynton Beach, until the building is complete and a Certificate of Completion or Occupancy is issued by the City of Boynton Beach. Costs include, but are not limited to, fees/salary, withholding taxes, workers compensation, FICA, unemployment taxes, etc. We will deposit and maintain with the City funds equal to four weeks payment to the special inspector plus a five percent administrative fee so that the City can reimburse weekly the special inspector fi.om funds thus deposited. We will notify the City in writing each time the project is shut down or not otherwise ongoing and the special inspector is not on duty. The special inspector will prepare daily written reports in the format specified by the City and submit them weekly to the City as a pre-condition to reimbursement. The special inspector will be present on the site during all times when construction is ongoing. Upon written notification fi.om the City, we will cancel our agreement with the special inspector and will not proceed with construction until a successor special inspector is in place. We acknowledge that the City will not issue a Certificate of Completion or Occupanc~ unless and until the special inspector certifies in writing that the work has been constructed in accordance with/~ill ~odes, rules, regulations and laws; and that if testing and/or reconstruction is necessary to obtain such c~rt~fic~l/~n, it will be solely at our expense. We further agree to take full responsibility for any and all work ~(atXa~ been covered or concealed wi~~go~lease the City fi.om any and all liability thu~ rj~u/tting. Signature of Owner (~ Signature of ~ontr ctor STATE OF FLORIDA COUNTY OF PALM BEACH The,,for..egoing ins~h,-nelat w31s acknowledged before me this ~7'~ day of ~..., . , ~aL. by, _/(__y///i~.j~¢'~ W~-'//~,JA~.~_A'x:. r . .-. . _ who is~ep_~Lqonallv. ~,~ to me or who has (Type cl~lI)) as id'e:ntit~cat~n ~t who (did) (did not) take an oath. /T - /~--~--~'.~~' proc~(t~ed Signature of person taking acknowledgement Name of~ffiqer tak/ng acknowledgement typed, printed or stamped (SEAL) ........... :.~.~-_//~<~,,. (Title or rank) (Serial Number, if any) \\CH'~.A~S HRDATA~DEVELOPMENT~OLICY MANUAL.WP~OLICYM HXS PECCON~PINSP.WP D ' 02-1 644 DEPARTMENT OF DEVELOPMENT BUILDING iDIVISION SPECIAL INSPECTOR AGREEMENT ~-~ ~ , 200_~_~ , by and AGP,-EEMENT made this ,r~g~-g[ (lay of ~. refe~ed to as Special Inspector; m~d the City of Boston Beach, Florida, hereina~er refe~ed to as City. WHE~AS, putsum.~t to the Florida Building Code 2001 edition, as ~mnded, the B~l~g Official qfBg~ton Beach may ~low ~e Owner of ~t~ ~0.~ d]". ~ project, 'o employ a Special ~spector? I Wt~AS, O~R shall be responsible R)r pa~ng all costs of cmplo)4ng a Special ~spector as hereinafter set foNh. NOW, THE~,FO~, BASED ON THE MUTUAL COrNeTS ~ AG~EMENTS CONT~ED HE~, THE P~'F~S HE.TO AGREE AS FOLLOWS: SPEC~L ~SPECTOR shall se~e as contemplated by ~e Florida Buil~ng Code 2001 edition, as mended, ~d shall inspect all cmnponents of the building(s), at the p~oject cited h~einbefore. SPEC~L INSPECTOR ghall be present until said building is complete. 2. SPEC~ ~SPECTOR shall be self-mployed ~d will f~ction as ~ independent con,actor on a fee b~is ~d will be solely responsible for all pa~oll t~es to include, but not be l~i. ted to: federal wiihholding t~x, workers' compensation, FICA, federal and state m2emplo~ent t~es. 3. The fee for SPEC~ ~SPECTOR'S seivices shall be p~d solely by O~R. Upon execution of this A~eemcnt, OW~R shall d~osit Mth CiTY a s~ equivalent to SPEC~L ~SPECTOR'S fee for four (4) weeks, plus a five pement (5%) adminis~afive expense. Thereafter, O~R, on a weekly basis and so as ~o at all times maintain m~ amount wilh CITY equival~t to fo~ (4) weeks SPEC~L ~SPECTOR'S Fee, shall deposit with CITY,. SPEC~ ~SPECTOR'S weekly fee plus s five percent (5%) a~inistrative expense. shM1 ~en be responsible for pa~ng SPEC~ ~SPECTOR on a weekly basis. O~R shall not be obligated to pay SPEC~L ~SPECTOR the above referenced fee for ~y time ~at work conc~ng the project is shut do~ or not othe~ise ongoing and SPEC[AL ~SPECTOR is not on duty. ., 4, SPEC~L ~SPECTOR 5hall p~epare daily ~.tt~ ~epods in the format specified by file Bui~dbnE O[ficial of CITY ~d submit them weekly to the Building Official of CITY to the O~R_ 5. SPEC~L ~SPECTOR will be present on Ihe coxls~uction site duhng fl~e nounal working hours at ~e site. 6. It i5 fu~he~ ~d~tood ~d a~eed flint SPECIAL ~SPECTOK shall be responsible to ~e CITY, notwi[hst~ding ~at O~E,R shall pay all of thc Special Inspector~s fees ~d costs. If, at any time, ~uch se~ces are not safisfacto~ to Bui~dh~g O~cial, A~eemen[ may b~ cancelled without f~hcr reco~se of SPEC~ ~SPECTOR or ag~nst either CITY or O~R. ~her, ei~ler SP~CJ~ ~SP~C[O~ or OWNER may c~cel this A~e~cnt upon providing Ihi~ (30) days x~tt~ notice to all pa~fies hereto. In any ' 02"1 644 event, OW~NER shall have retained the sctviccs of a successor Special Inspector prior to proceeding with construction. 7. No prior or present agreemenls or representations shall be binding upon any of the parties hereto unless incorporated in this Agreement. No modification or change of this Agreement shall be valid or binding upon the ps.flies unless in x~ting, executed by the parties to be bound thereby. 8. The Special haspector certifies under penalty of perjury that there does not exist a conflict of interest in relation to the performance of duties under the terms of this Agreement and that he has no financial interest in, or involvement with, the project which he is inspecting or the owner, developer or contractor of such project, either currently or ia the previous yea^, The Special Inspector further certifies that he or his employees will not engage in any other work which is inconsistent with thc duties or interest of the City of Boynton Beach Department of Development. Tho foregoing in~trurr~nt who i~ Tit~ ~ ~k ¢~ Scriat numh¢, SPECIAL INSPECTOR'S SIGNATURE (P.E. of record) STATE OF FLOP~IDA, COUNTY OF PALM BEACH T?_~ fovesoin8 ine.trun~m~t wa. ae~owled~d bef~e ~ this n~) ~ ~ oalh. MARY ELLEN ADAMS MY COMMISSION # CC 958521 EXPIRES: August 20, 2004 ~BOO-3-NOTARY FL Notary Se~vtce & 13offing. inc. who did (did / PUBLIC ~ATE O~ ,~O~ID& / COMMI~ION NO. DDII~ J 2/91, rev. 12/93, 12/94, 9/95, 3197, 7/99, 4/00, 8/00, 5/02-~s S :tDe'v~lopn'~nl\F"ORMg.doc\gpecial Inspector Agreement.dec - 02-1644 CITY OF BOYNTON BEACH FIRE AND LIFE SAFETY DIVISION 100 East Boynton Beach Blvd. P. O. Box 310 Boynton Beach, Florida 33425-0310 PLAN REVIEW COMMENTS PLEASE NOTE THAT THE EFFICIENCY BY WHICH YOU RECEIVE YOUR PERMIT DEPENDS ON YOUR RESPONSE TO THE CONTENTS OF THIS DOCUMENT. IT IS RECOMMENDED THAT YOU CAREFULLY READ AND CORRECTLY RESPOND TO ALL ASPECTS OF THIS DOCUMENT. COMMENTS: For permit application number / review: 02-1644 Rev. 1 1st review fire-RWK Project Name or Address: High Ridge CC-Bliss REVIEWED BY: Department: Fire Rescue Department Name of Reviewer: Rodger Kemmer, Plans Examiner/Fire Inspector Phone # (561) 742-6753 Fax # (561) 364-7382 Review Date: 07/16/02 Type of Review: Fire & Life Safety COMMENT DISTRIBUTION: Person identified on the application to receive comments: Name Bliss Const. Phone # (area code:561) 391-0212 Fax # (area code:) Date(s) reviewer called: Person who received the call THE FOLLOWING AREA SHALL BE FILLED-IN IN THE PRESENCE OF A BUILDING DIVISION STAFF MEMBER: ~ recd. by print name and date: OR Plans/Comments recd. by print name and date.-'~l~~ Page 2 of 2 Plan Review Comments for Permit Application # 02-1644 Rev. 1 Your permit application and supporting documentation do not comply with the City of Boynton Beach Code of Ordinances, or lack sufficient detail to provide a comprehensive review. Prior to receiving a permit to construct or install the requested improvements the plans and documents shall be amended to show compliance with the comments listed below. For questions regarding my review please contact me at the number listed above. If a conference is necessary, please schedule an appointment. Phone calls are received and appointments scheduled during work days Monday through Friday 8:00 to 12:00 AM and 1:00 to 5:00 PM. Please note that additional comments may be generated following staff review of the amended plans. Corrected or revised plans must be submitted to the Building Department. Timely approval of your project is dependent upon your prompt and correct response to the information provided in this document. Does the cooling tower contain combustible fill material or is it constructed of combustible materials? (See NFPA 214 (1996) Standard on Water-Cooling Towers.) What type cooling tower is being proposed, counterflow or crossflow? What size (cubic feet) cooling tower is being proposed? CITY OF BOYNTON BEACH DEVELOPMENT DEPARTMENT 100 East Boynton Beach Blvd. P. O. Box 310 Boynton Beach, Florida 33425-0310 FILE COPY PLAN REVIEW COMMENTS PLEASE NOTE THAT THE EFFICIENCY BY WHICH YOU RECEIVE YOUR PERMIT DEPENDS ON YOUR RESPONSE TO THE CONTENTS OF THIS DOCUMENT. IT IS RECOMMENDED THAT YOU CAREFULLY READ AND CORRECTLY RESPOND TO ALL ASPECTS OF THIS DOCUMENT. COMMENTS: / For permit application number/review: 02-1644 R-1 lSd- REVIEW Project Name or Address: BLISS CONST. REVIEWED BY: Department and/or Division: Building Division Name of Reviewer: Bill Erskine Trade: Mechanical - Plumbing Phone # (561) 742-6755 ext. Fax # (561) 742-6357 Review Date: 7/12/02 Type of Review: MECHANICAL COMMENT DISTRIBUTION: : Person identified on the application to reb~i~e Name BLISS CONST. Phone # (area code:561) 391-0212 ext. Fax # (area code:561) Date(s) reviewer called: Person who received the call THE FOLLOWING AREA SHALL BE FILLED-IN IN THE PRESENCE OF A BUILDING DIVISION STAFF MEMBER: COJu~aALT, S/PLANS PICKED UP: ~'Y'~ ~recd. by print na me and dato: '~, Plans/Comments recd. by print name and date: Page 2 of 2 Plan Review Comments for Permit Application # 02-1644 R-1 1sT RE~EV~ ~. & 0 '~ ~ Your permit application and supporting documentation do not comply with the City of Boynton Beach Code of Ordinances. Prior to receiving a permit to construct or install the requested improvements the plans and documents shall be amended to show compliance with the below listed comments. For questions regarding my review please contact me at the number listed above. If a conference is necessary, please schedule an appointment. Phone calls and appointments are received and scheduled during work days Monday through Friday 9:30 to 10:30 AM and 1:45 to 2:45 PM. Please note that additional comments may be generated following staff review of the amended plans. Timely approval of your project is dependent upon your prompt and correct 0 2 ' 1. 6 ~' response to the information provided in this document. 1. SECTION 104.2 FMC 01- PROVIDE MANUFACTURER'S DATA SHEETS FOR THE CHILLERS AND THE COOLING TOWER WITH THE LISTING FROM A TESTING LAB. 2. NFPA 214- PROVIDE INFORMATION SHOWING COMPLIANCE WITH THIS SECTION. 3. SECTION 1104.2 FMC 01- PROVIDE COMPLIANCE WITH THIS SECTION, THE AMOUNT, AND TYPE OF REFRIGERANT USED. 4. COMPLY WITH SECTION 1105 FMC 01. DEPARTMENT OF DEVELOPMENT BUILDING DIVISION - 02-164 SPECIAL INSPECTOR AGREEMENT AGREEMENT made this Z~k day of COPY ,200 ~ by and between lellk~ ~.~10 ~t.~ d~4,q¥~. ~__.ta,4/"~ hereinafter referred to as Owner; , e 'nafter referred to as Special Inspector; and the City of Boynton Beach, Florida, hereinafter referred to as City. WHEREAS, pursuant to Section 105.3 of the Standard Building Code, 1997 editiorL.as amended, tile Building Offficial of Boynton Beach may allow tile owner of p~,a, ~ ,~-4,O~ ~ ~ project, to employ a Special Inspector. WHEREAS, OWNER shall be responsible for paying ali costs of employing a special inspector as hereinafter set forth. NOW, THEREFORE, BASED ON THE MUTUAL COVENANTS AND AGREEMENTS CONTAINED HEREIN, THE PARTIES HERETO AGREE AS FOLLOWS: 1. SPECIAL INSPECTOR shall serve as contemplated by Section 105.3 of the Standard Btdlding Code, 1997 edition, as amended, and shall inspect all components of the building(s), at the project cited hereinbefore. SPECIAL INSPECTOR shall be present until said building is complete. 2. SPECIAL INSPECTOR shall be self-employed and will function as an independent contractor on a fee basis and will be solely responsible for all payroll taxes to include, but not be limited to: federal withholding tax, workers' compensation, FICA, federal and state unemployment taxes. 3. The fee for SPECIAL INSPECTOR'S services shall be paid solely by OWNER. Upon execution of this Agreement, OWNER shall deposit with CITY a sum equivalent to SPECIAL INSPECTOR'S fee for four (4) weeks, plus a five percent (5%) administrative expense. Thereafter, OWNER, on a weekly basis and so as to at all times maintain an amount with CITY equivalent to four (4) weeks SPECIAL INSPECTOR'S fee, shall deposit with CITY, SPECIAL INSPECTOR'S weekly fee plus a five percent (5%) administrative expense. CITY shall then be responsible for paying SPECIAL INSPECTOR on a weekly basis. OWNER shall not be obligated to pay SPECIAL INSPECTOR the above referenced fee for any time that work concerning the project is shut down or not otherwise ongoing and SPECIAL INSPECTOR is not on duty. 4. SPECIAL INSPECTOR shall prepare daily written reports in the format specified by the Building Official of CITY and submit them weekly to the Building Official of CITY and to the OWNER. 5, SPECIAL INSPECTOR will be present on the construction site during the normal working hours at the site. 6. It is further understood and agreed that SPECIAL INSPECTOR shall be responsible to the CITY, notwithstanding that OWNER shall pay all of the Special Inspector's fees and costs. If, at any time, such services are not satisfactory to the Building Official, this Agreement may be cancelled without further recourse of SPECIAL INSPECTOR or OWNER against either CITY or OWNER. Further, either SPECIAL INSPECTOR or OWNER may cancel this Agreement upon providing thirty (30) days written notice to all parties hereto. In any event, OWNER shall have retained the services ora successor special inspector prior to proceeding with construction. - 02-1644 7. No prior or present agreements or representations shall be binding upon any of the parties hereto unless incorporated in this Agreement. No modification or change of this Agreement shall be valid or binding upon the parties unless in writing, executed by the parties to be bound thereby. 8. The Special Inspector certifies under penalty of perjury that there does not exist a conflict of interest in relation to the performance of duties under the terms of this Agreement and that he has no financial interest in, or involvement with, the project which he is inspecting or the owner, developer or contractor of such project, either currently or in the previous year. The Special Inspector further certifies that he or his employees will not engage in any other work which is inconsistent with the duties or interest of the City of Boynton Beach Department of Development. OWNER'S SIGNATUR STATE OF FLORIDA, COUNTY OF PALM BEACH The, X'pregoing instmmep~was acknowledged before me this ~ "' ~"~ ~ ~ (date).by s~L~.._o_p,,9~z~?..~(~__ ~ ,~.,,~_(,~ ./~_pe of identification) as identification and who did (did not) take an oath. Name of officer tak,~ ~owledg;me;t--t~peX~ri;ted-or"-stamp/e~ -~~'/__C'~ .~-~/~ Title or rank ~ Serial number, if any SPECIAL INSPECTOR'S SIGNATURE (P.E. of record) COUNTY OF PALM BEACH STATE OF FLORIDA, fo_, A~ .~~ The foregoing instrument was ac 'knowledged be (date) by ~ is pers~ml~ or who has produced (type of ide~ identification and who did (did not) take an oath. (SEAL) '~il]i{llltlll~O,-, ~_~t~_ .~n~e LPflte~or~on Signature of person taking acknowledgement'p~[*~: _'*~MY Co~ CC873283 Name of officer taking acknowledgcmcnt--~ ~~r~ ~e~ 22, 2003 Title or rank S~hl ~m~r, if~ ~ 'CITY REPRESENTATIVES . The foregoing instrument was acknowledged before me this j~,,~/Oa&, (date) by 7i ,~t4 ~. ~-~ , who is~~ t~pr who has produced O (type of identification) as identification and who didO0 take an oath. { -' OFFICIX~ ~OTAI{Y S~L (SEAL) [ R~H ANN Signature o f person taking acknowledgement ~J~. ~ 02~ ~ COMMI~ION NO. DD1 Name of officer taking acknowledgement--typed, printed or stamped ~.~ ~DD ~J Co~[J MY COMMISSION EXP. MAR. _ _ ~(~ Serial number, if any Title or rank AI~o~ P~ '' 2/91, rev, 12/93, 12/94, 9/95, 3/97, 7/99, 4/00, 8/00 - bg \\CI I\MAIN\SI IRI)A'I'A\I)EVI!I.OI MEN'IM':OIIMS.DOC\SI F. CINSI ,WPD DEPARTMENT OF DEVELOPMENT To: Building Official, City of Boynton Beach From: ~,~r-a ILA'0 .c.~ C0~'¢~ ~(~r) REQUEST FOR SPECIAL ~N'SPECTOR OCTOBER 1996 - 02-1644 Pursuant to Section 105.3 of the Standard Building Code, 1997 Edition, the City Building Offficial may allow the employment ora special inspector on construction projects to expedite construction and to provide for public health, safety and welfare. We propose to employ and be responsible for all costs associated with a special inspector for continuous on-site inspectionofour~l~...q'/--~/4-~"d,~"~ project located at l_4~ t"F~~ ~ inBoynton Beach, until the building is complete and a Certificate of Completion or Occupancy is issued by the City of Boynton Beach. Costs include, but are not limited to, fees/salary, withholding taxes, workers compensation, FICA, unemployment taxes, etc. We will deposit and maintain with the City funds equal to four weeks payment to the special inspector plus a five percent administrative fee so that the City can reimburse weekly the special inspector fi.om funds thus deposited. We will notify the City in writing each time the project is shut down or not otherwise ongoing and the special inspector is not on duty. The special inspector will prepare daily written reports in the format specified by the City and submit them sveekly to the City as a pre-condition to reimbursement. The special inspector will be present on the site during all times when construction is ongoing. Upon written notification fi-om the City, sve will cancel our agreement with the special inspector and will not proceed with construction until a successor special inspector is in place. We acknowledge that the City svill not issue a Certificate of Completion or Occupancy unless and until the special inspector certifies in writing that the work has been constructed in accordance ~.yfthlall codes, roles, reg'ulations and laws; and that if testing and/or reconstruction is necessary to obtain such t/ertj~?ation, it will be solely at our - -..--~ -~.-expense' We further a~ee to take full responsibility for any and all worla',,,,th4t~nas been covered or concealed ~~eby release the City from any and all liability ~e/u/r/sultin. g. II1,1./ '~'i~ature of Ownei - (~ Signature o~'Contractor STATE OF FLORIDA COUNTY OF PALM BEACH //~he/fore~inginstr~en.t. was.~r~, osvledoed before me this Y day of ~'._,~a~?,l~ f_,~/o_~ _~,P~,,~.~.~'/~'~ is perso_nally kno.w'n to me or who has prc/tfuced ?T~pe ~j)'Ig"identifi~'~,0n an,~ho (di~l)(d~ not)take an oath. Sig-nature of person taking acknowledgement Nam,~f,~ffic~ taking acknowledgement typed, printed or stamped --:~- ........ ;-~~,"f-ta~---. (Title or rank) (Serial Number, if any) (SEAL) I~ ,_~,, nqEm:/ . ~ ' - ' W"VH:mh 10114,'96, r~v. ~*"~ EXF!: ",te~ Jl~":?~ - auger, T . ..... ;,:: \\C HXMAR'hS HRDATA~DEVELOP MENT~PO LiCY MANUALWPXPOLICYMHSSP ECCON~SPINS P.WPD DEPARTMENT OF DEVELOPMENT BUILDING DIVISION - 02-1644 SPECIAL INSPECTOR AGREEMENT AGREEMENT made this _'"~" day of ~_"~'~~' ,200 't,.-., by and , hereinafter referred to as Owner; .~,P,,- t,~4r~&X..-. , hereinafter refen'ed to as Special Inspector; and the City of Boynton Beach, Florida, hereinafter referred to as City. WHEREAS, pursuant to Section 105.3 of the Standard Building Code, 1997 edition, as amended, the Building Official of Boynton Beach may allow the owner of c2,cwt ~.~,'¥~-~( ~ ~ project, to employ a Special Inspector. WHEREAS, OWNER shall be responsible for paying all costs of employing a special inspector as hereinafter set forth. NOW, THEREFORE, BASED ON THE MUTUAL COVENANTS AND AGREEMENTS CONTAINED HEREIN, THE PARTIES HERETO AGREE AS FOLLOWS: 1. SPECIAL INSPECTOR shall serve as contemplated by Section 105.3 of the Standard Building Code, 1997 edition, as amended, and shall inspect all components of the building(s), at the project cited hereinbefore. SPEC1AL INSPECTOR shall be present until said building is complete. 2. SPECIAL INSPECTOR shall be self-employed and will fi~nction as an independent contractor on a fee basis and will be solely responsible for all payroll taxes to include, but not be limited to: federal withholding tax, workers' compensation, FICA, federal and state unemployment taxes. 3. The fee for SPECIAL INSPECTOR'S services shall be paid solely by OWNER. Upon execution of tiffs Agreement, OWNER shall deposit with CITY a sum equivalent to SPEC1AL INSPECTOR'S fee for four (4) weeks, plus a five percent (5%) administrative expense. Thereafter, OWNER, on a weekly basis and so as to at all times maintain an amount with CITY equivalent to four (4) weeks SPECIAL INSPECTOR'S fee, shall deposit with CITY, SPECIAL INSPECTOR'S weekly fee plus a five percent (5%) administrative expense. CITY shall then be responsible for paying SPECIAL INSPECTOR on a weekly basis. OWNER shall not be obligated to pay SPECIAL INSPECTOR the above referenced fee for any time that work concerning the project is shut down or not otherwise ongoing and SPECIAL INSPECTOR is not on duty. 4. SPECIAL INSPECTOR shall prepare daily written reports in the format specified by the Building Official of CITY and submit them weekly to the Building Official of CITY and to the OWNER. 5. SPECIAL INSPECTOR will be present on the constnlction site during the normal working hours at the site. 6. It is further understood and agreed that SPECIAL INSPECTOR shall be responsible to the CITY, notwithstanding that OWNER shall pay all of the Special Inspector's fees and costs. If, at any time, such services are not satisfactory to the Building Official, this Agreement may be cancelled without further recourse of SPECIAL INSPECTOR or OWNER against either CITY or OWNER. Further, either SPECIAL INSPECTOR or OWNER may cancel this Agreement upon providing thirty (30) days written notice to all parties hereto. In any event, OWNER shall have retained the services ora successor special inspector prior to proceeding with construction. 7. No prior or present agreements or representations shall be binding upon any of the parties hereto unless incorporated in this Agreement. No modification or change of this Agreement shall be valid or binding upon the parties unless in writing, executed by the parties to be bound thereby. 8. The Special Inspector certifies under penalty of perjury that there does not exist a conflict of interest in relation to the performance of duties under the terms of this Agreement and that he has no financial interest in, or involvement with, the project which he is inspecting or the owner, developer or contractor of such project, either currently or in the previous year. The Special Inspector further certifies that he or his employees will not engage in any other work which is inconsistent with the duties or interest of the City of Boynton Beach Department of Development. OWNER'S SI G NATUR~_...~ ___/<_- ~'"'q~-~ ~ STATE OF FLORIDA, COUNTY OF PALM BEACII , who is personally known to me or who has produced .]~'~D,~_~~entiacation) as identification and who did (did not)take an oath. -' I1 il~ MYCOMMISSION#OO02~J77 Il /// .... ' !1 ~,r,~. ~,~n,~,,~,~u.~... df-. ~ // 'T_~ ~ ~ / / Name of officer taking acknowledgement--typed, pnn , ./' ~/~ Title or rank ~ . Serial number, if any SPECIAL INSPECTOR'S SIGNATURE k2' / ~ - (P.E, of record) STATE OF FLORIDA, COUNTY OF PALM BEACH was acknowledged before m~~-~- --- - , ~,--, -~ J, '?(.9D2 (date) by The foregoing instrument (type of identmcatiuu) aa id~.tfl'~ation and who did (did not) take an oath. ~ ~,~' Janine L Petel'~n.G (SEAL) / q/, . -- /~ ~A~_% or,on .. 9r~,My Co~s~ CC~7328: Signature of person taking ac~owledgement~:[ V(~ taking acknowledgement--~ped, printed o~amp~ Name of officer Title or rank Serial number, if a~y ) 'CITY ~PRESENTATIVE'S/~/' /f STATE OF FLORIDA, CO~TY OF PALM BEACH The foregoing instrument was acknowledged before me this (date) by , who t~e'~or who has produced (type of identification) as identification and who did ~ake an oath. (SEAL) Signature of person taking acknowledgement ~O,~t'~Ji ~Mq ~..~£,h~_. Name of officer taking acknowledgement--type&, p6n,ed or a~amped ,~c& ~ ~e i Ce Title or rank ~E~ ~;C~ Serial number, if any. 2/91, rev. 12/93, 12/94, 9195, 3/97, 7/99, 4~00, 8/00 - bg c©~tssto~ ~o. r>m~oo~ I MY COMMISSION EXP. MAR. 16,2005 / \\Ct I\M A IN\SI I RDATA\DEV El.OPM ENTWORMS.DOC~";P ECINSP.WPD DEPARTMENT OF DEVELOPMENT To: Building Official, City of Boynton Beach From: ~ ~ ~ r.Z~p~(Owner) REQUEST FOR SPECIAL INSPECTOR OCTOBER 1996 02-1644 Pursuant to Section 105.3 of the Standard Building Code, 1997 Edition, the City Building Official may allow the employment of a special inspector on construction projects to expedite construction and to provide for public health, safety and welfare. We propose to employ and be r~ponsible for all costs associated with a special inspector for continuous on-site inspection ofour~- flOC,/~ project located at 't,4~ 4~~c~ ~9~t5 in Boynton Beach, until the building is complete and a Certificate of Completion or Occupancy is issued by the City of Boynton Beach. Costs include, but are not limited to, fees/salary, withholding taxes, workers compensation, FICA, unemployment taxes, etc. We will deposit and maintain with the City funds equal to four weeks payment to the special inspector plus a five percent administrative fee so that the City can reimburse weekly the special inspector from funds thus deposited. We will notify the City in writing each time the project is shut down or not otherwise ongoing and the special inspector is not on duty. The special inspector will prepare daily ~vfitten reports in the format specified by the City and submit them weekly to the City as a pre-condition to reimbursement. The special inspector will be present on the site during all times when construction is ongoing. Upon xvritten notification from the City, we will cancel our agreement with the special inspector and will not proceed with construction until a successor special inspector is in place. We acknowledge that the City will not issue a Certificate of Completion or Occuj;la~cy unless and until the special inspector certifies in writing that the work has been constructed in accordance x~/,fth a.~ codes, rules, regulations and laws; and that if testing and/or reconstruction is necessary to obtain such ~rtifj,4/tition, it will be solely at our expense. We fia'th~ take full responsibility for any and all ~vor~thajt][as been covered or concealed ~~!y release the City from any and ail liabilityffhs ~._ Signature of Owner ~ ~ Signature o~'Contractor STATE OF FLORIDA COUNTY OF PALM BEACH ~] Tl3e forgoing instr~rgen/wag,gekno~vledged before me this ~day of ~ __ .~~by, ~/~ /J/~'5~Z ~,~ ,]~,,/~,~ ~,~o is personally kno~_.gl me or who has produced (WYlie oflD]~'~glenti'ficcatao:--n-a'~"qgvho (~~ an o~h. _ Sig-nature of person taking ackno~vledgement Name o.~fi~er taking acknowledgement typed, printed or stamped (SEAL) /,,(/./-,.~_ ~ . (Title or rank) (Serial Number, if any). Il ~a~l~S~/g* EXPIItES: May 3..', \\C I-tNMAIN~S H RDATA~D EVE LO P M EN'I"~PO L ICY b, Ls, NUAL.WP~OLICYM H'kS P ECCONZS PINS P.WPD DEPARTMENT OF DEVELOPMENT BUILDING DIVISION SPECIAL INSPECTOR AGREEMENT AGR_I~,EMENT made this ~ day of · /~ ~ ~_ _, 200o~_, by and ' ~ ~ ..... I ' ' Boston Beach, Florida, hcrema~er refc~ed to as City. ' WHE~AS, pursum]t to the Florida Brdtding Code 2001 edi0o~, as amid, ed. the Btfi~g Official of Bo~ton Beach may allow the O.mer of ~'q~ ~/'{¢r ~"¢~ 6/" ~ project, ,; employ a Special ~spector. W " W[~AS, O~R shall be responsible for pa~ng all costs ofemplofng a Special Inspector as hereinafter set fodh. NOW, THE~FO~, BASED ON THE N~TU~ CO~N~TS ~ AG~EMENTS CONT~ED I-IEee, THE P~'F~S IIE~TO AGUE AS FOLLOWS: 1.. SPEC~L ~SPECTOR shall se~e as contemplated by ~e Florida Bulling Code 2001 edition, as ~ended, ~d ~hall inspect all components of the building(s), at rite p~oject cited h~einbefore. SPEC~ ~SPECTOR shall be present tmtil said building is complete. 2. 8PEC~ ~SPECTOR shall be selfmployed .~d will function as ~m independent con,actor on a fee b=is ~d will be solely responsible for alt pas~oll t~es to include, but not be limited to: federal wit~tolding tzx, workers' compensation, FICA, federal and state ~emplo~ent t~es. 3. The fee for SPEC~ ~SPECTOR'S se~ices shall be p~d solely by O~R. Upon execution of this A~ccmcnt, O~R shall deposit Mth CITY a ~um eqdivalent to SPEC~L ~SPECTOR'S fee for four (4) weeks, plus a five pe~ellt (5%) admirds~ative expense. Therea~er, O~ER, on a weekly basis and so as 1o at all times mMnta~ m~ ~onnt 'wilh CITY equival~t Io four (4) weeks SPEC~. ~SP~CTOR'S fee, shall deposit with CITY, .. SPEC~ ~SPECTOR'S weekly fee plus a five percent (5%) a~inistrati~e expense. C~Y sh~l ~cn be responsible for pa~ng SPEC~ ~SPECTOR on a weekly basis. O~R shall not be obligated to pay SPEC~U ~SPECTOR the above referenced fee for ~y t~e that work conc~ng the project is shut do~ or not othemise ongoing ~d SPEC~L ~SPECTOR is not on duty. .. 4. SPEC~L ~SPECTOR shall prepare daily written reports in the lo,at specified by the Building O[ficial of CITY and submit them weekly to the Building Official of CITY ~d to the O~R. 5. SPEC~L ~SPECTOR will be present on Ihe cons)notion site during rite normal. working hours at ~e site. 6. It is f~her ~d~tood ~d a~eed that SPEC~L ~SPECTOR shall be responsible to the CITY, notwithst~ding ~at O~ER shall pay all of the Special Inspector's fees and costs. If, at any time, reich se~ces are not satisfactory to Building O~ci¢l, this A~eeme~( may be cancelled without ~hcr reco~se of SPEC[g ~SPECTOR or O~ER aganst either CITY or O~,R. Fudher, ei.d}er SPECI& ~SPECTOR or OWNER may cmlcel this A~e~cnt upon providing lhi~ (30) days x~ttm notice Io all p~ies hereto. In ~y event, OWlqER shall have retained the services of a successor Special Inspector prior to proceeding with construction. 7. No pr/or or present agreements or representations shall be binding upon any of the parties hereto unless incorporated in this Agreement. No modification or change of this Agreement shall be valid or binding upon the parties unless in writing, executed by the parties to be bound thereby. 8. The Special Inspector certifies under penalty of'perjury that there does not exist a conflict o£interest in relation to the performance of duties under the terms of this Agreement and that he has no financial interest in, or involvement with, the prqicct which he is inspecting or the owner, developer or contractor of such project, either currently or in the previous year. The Special Inspector further certifies that he or his employees will not engage in any other work which is inconsistent with thc duties or interest of'thc City of Boynton Beach Department of Devclopmcnt. O'WNER'S SIGNATURE STATE OF FLORIDA, COUNTY OF P/kLM BBACH The foregoing ingtrurrent was ~knowledged b~fc~ mc this not MY COMMISSION # EXP{flES: May 30, 3006 ~ ofp~t~ ~n 'N~ of Tit~ ~ r~k Ked o1' Stall'sped Scriatnumber, SPECIAL INSPECTOR'S SIGNATURE (P.E. of record) ~c of fdcn! :adm) as idcntifieatlm and who did (did ~regninlt in~iltrun~m~t w=s ~.clmowledl~d before me this ~....w--"w'~O tS pcr~ally kzmwn to m~'~"'~r who has produced ~) i:~ ' (t'ype 0f iden6fica£i(~.)as idelltificat.~ ~nd who ~1 (did not) t~ an oath. Sign,mrt:ofpersontuHng~eknow,edgeme~t ~ ~ ~~ I CITY ~P~SE~AT~"~ //'~ 8TAT~ OF ~A, COUN~ PA~ who i~Uy ~own to me'W who has p~uccd ~) a~ ~ oath. L..O MARY ELLEN ADAMS ~ ExPiRES: AuguSt 2(~. 2004 NOTARY FL No~ S~ & ~ (t)Te ofldenfificudm) ss ~denflficutlm ~nd who did (di.,~._d (SEAL) Signstureofperso~taldng~lmowledgcmen~ .~_,_"~. ("~Jt~lA., I NC~I'ARY PUBLIC ffrAT£ OF FLORPL COMMISSION NO. DDlI0044 · (4¥ _COM..M[S.SION EXP. MAR. 2/91, rev. 12/93,12194, 9/95, 3/97, 7/99, 4100, 8/00, 5/02-rs $:\De~elopmcntWORMg.doc\gpecial Inspector ^gre¢~r~nt.dcc DEPARTMENT OF DEVELOPMENT To: Building Official, City of Boynton Beach From: ~ (-~0~ (~,-~t!~ ~ (Owner) REQUEST FOR SPECIAL INSPECTOR OCTOBER 1996 Pursuant to Section 105.3 of the Standard Building Code, 1997 Edition, the City Building Official may allow the employment ora special inspector on construction projects to expedite construction and to provide for public health, safety and welfare. We propose to employ and be rgsponsible for all costs associated with a special inspector for continuous on-site inspection ofouff~'~,'N/-~--f-g~f~ project located at ~ --t~0o~c:~ ~ in Boynton Beach, until the building is complete and a Certificate of Completion or Occupancy is issued by the City of Boynton Beach. Costs include, but are not limited to, fees/salary, withholding taxes, workers compensation, FICA, unemployment taxes, etc. We will deposit and maintain with the City funds equal to four weeks payment to the special irkspector plus a five percent administrative fee so that the City can reimburse weekly the special inspector fi.om funds thus deposited. We will notify the City in writing each time the project is shut down or not otherwise ongoing and the special inspector is not on duty. The special inspector will prepare daily written reports in the format specified by the City and submit them weekly to the City as a pre-condition to reimbursement. The special inspector will be present on the site during all times when construction is ongoing. Upon written notification fi.om the City, we will cancel our agreement with the special inspector and will not proceed with construction until a successor special inspector is in place. We acknowledge that the City will not issue a Certificate of Completion or Occupanc.~ unless and until the special inspector certifies in writing that the work has been constructed in accordance with/411 ~odes, rules, regulations and laws; and that if testing and/or reconstruction is necessary to obtain such c~rtffic~n, it will be solely at our expense. We further agree to take full responsibility for any and all work ~/at,,h"a~ been covered or concealed with ' . :~o,.~elease the City from any and all liability thu~ rg~u~ing. .,. // [/ j signature of Owner ~ Signature of ~qontr cta"r~ STATE OF mOmOA COUNTY OF PALM BEACH Th~for~egoing ins~qu.ept w,~s acknowledged before me this ~". day of ~..~.... : ~...by, ~,/'/~ ,~¢_.,',~ ~.>~'_~:X,L,~,a: ,~ho is..p..~o~,y ~, ~o me o~ who h~ '('l;y~ ~ID, '} as'icfe'ntiI~ca,~j~n~41 who (did) (did not) take an oath. Signature of person taking acknowledgment Name of~ffiqer taking acknowledgem~t typed, printed or stamped (SEAL) ... __~-,O?.,-~, , (Title or rank) (Serial Number, kfany) \\CH~MAII~SHRDATAkDEVELOPMEN'BPOL[CY MANUAL.WPL~OLICYMHXSPECCONkSPFNSP. WPD 02-1 DEPARTMENT O DEVELOPMENT B LDING DIVISION SPECIAL INSPECTOR AG~EblENT AGREEMENT made this ~ d~y of .'~ .' be~en__ .~ g~O~ __t -~0~~ ~/~ , hereiuafler refe~ed to as Owner; ~o~ton ~6ach, Florida. h6rcinaflcr roll.cd to as City. WttE~AS, pursum~t to the Florida Buitding Code 2001 edition, as ~et~ded, the B~I~g Official qfBg~ton Beach may Mlow the Owner of ~t~ ~/'~~ ~~ d/~ ~ project, to employ a Special Inspector7 / W}~AS, OX~R shall be responsible for pa~ng all costs of cmplo~ng a Special ~spector as hereinafter set lbflh. NOW, THE~FO~, BASED ON THE MUTUAL COk~N~TS ~D AG~EMENTS CONT~ED HE~, THE P~T~S HE,TO AGUE AS FOLLOWS: 1.. SPEC~L ~SPECTOR shall se~'e as contemplated by ~e Florida Bulling Code 2001 edition, as mended, ~d shall inspect all components of the buildi~g(s), at the project cited h~einbefore. SPEC~ INSPECTOR ~hall be present until said buildiug is complete. 2. SPEC~ ~SPECTOR shall be self-mployed ~d will function independent con,actor on a fee b~is ~d will be solely responsible for all pa~oll t~es to include, but not be limited to: federal wit~olding tax, winkers' compensation. FICA, federal and state ~emplo~ent t~es. 3. The fee for SPEC~ ~SPECTOR'S se~ices shall be p~d solely by OX~R. Upon execution of ~is A~ecmcnt, O~R shall d~osit Mth CITY a s~ equivalent to SPEC~L ~SPECTOR'S fee for four (4) weeks, plus a five pement (5%) admi~s~afivc expense. Thereafter, O~R, on a weekly basis and so as to at all times maintain m~ amount wi~h CITY equival~t to four (4) weeks SPECIM. INSPECTOR'S fee, shall deposit with CITY,.. SPEC~ ~SPECTOR'S weekly fee plus a five percent (5%) a~inistrative expense. C~Y shM1 ~en be rzsponsible for pa~ng SPEC~ ~SPECTOK on a weekly basis. OX~R shall not be obligated to pay SPEC~L ~SPECTOR the above referenced fee for any time ~at work tone,rig the project is shut do~ or not o~e~ise ongoing and SPEC~L ~SPECTOR is not on duty. 4. SPEC~L ~SPECTOR shall prep~e daily x~tt~ repo~s in the fo~at specified by th.e Bu~Idi~g O[ficial of CITY ~d submit them weekly to the Building Official of CITY ~d to the O~R. 5. SPEC~L ~SPECTOR will be present on ~e cons~uction site d~ng fl~e nounal working hours at ~e site. 6. It is fuflher ~d~tood and a~eed that SPECIAL ~SPECTOR shall be responsible to ~e CITY, notwithst~ding ~at O~ER shall pay all of the Special Inspector's fees ~d costs. If, at any time, such se~ces are not sa.tisFacto%t to Building O~cial, this A~eement may be cancelled without f~cr reco~se of SPEC~ ~SPECTOR or O~ER ag~nst either CITY or OS~R. Fu~her, ei.ll~er SPBCI~ ~SPECrOR or OWNER may c~cel this A~eemcnt upon providing lhi~ (30) days ~tt~ notice ~o all pa~es hereto. ~ any - 02-1644 event, OWNER shall have retained the services of a successor Special Inspector prior to proceeding with construction. 7, No px/or or present agreements or representations shall be binding npon any oft. he parties hereto unless incorporated in this Agreement. No modification or change of this Agreement shall be valid or binding upon the parties unless in wr/ting, executed by the parties to be bound thereby. 8. The Special Inspector certifies under penalty of perjury that there docs not exist a conflict of interest in relation to the performance of duties under the terms of this Agreement and that he has no financial interest in, or involvement with, the project which he is inspecting or the owner, developer or conlractor of such project, either currently or in the previous year. The Special lmspector further certifies that he or his employees will not engage in any other work which is inconsistent with thc duties or interest of thc City of Boynton Beach Department of Development. O~VNER'S SIGNATURE (~~.~.~ ~ STATE OF FLORIDA, COLTNTY OF PAIJVl BBACH who i~ ~a~y ~owp to me or wh,, not) ~ an o~th. i-.; Tit~ ~ r~k ~~ Scrialnumb~, if shy SPECI~ INSPECTOR'S SIG~ATU~ (P.E. ol record) 1 STATE OF FI~IDA, COU'N~Y OF PA~ EEACH nm) ~ ~ oath. .(~e of identificatim) as identificatjm and whn.~l (did (ST^L) I who is~r who ha~ p~f~.d n=c,~J~r '~hl;A~'V~E~.---~e ofi&ndfic,dm) n,~cntificntlm~d who did [d{d ' JN~Y PUBLIC ~A1'E OF ~LORIDA / (S~) J COMMI$1ON NO. DDll~ J - / M~OHMI~N EXP. ~AR~6,2~ (MARY ELLEN ADAMS MY COMMISSION # ~ 956521 EXPIRES: August 20, 2004 1-800-3 NO'fARY FL NOta~/Sei'~K;e & I~wd~ng, Inc. 2/9 l, rev, 12/93, 12/94, 9/95, 3t97, 7/99, 4/00, 8/00.5/02-~ ~t:kD~cloprneat\FORM~.doc\Special [nspec t~' Agreeme,t.doc DEPARTMENT OF DEVELOPMENT REQUEST FOR SPECIAL INSPECTOR OCTOBER 1996 From Building Official, City of Boynton Beach Pursua/lt to 2001 Florida Building Code as amended, the City Building Official may allow the employment ora special inspector on construction projects to ex'pedite construction and to provide for public heakh, safety and welfare. We propose to employ and be responsible for all costs associated w/th a special inspector for continuous on-sire inspection of our ~ //~ project located at -(~t~,o 4~~:} ~ in Boynton Beach, tmdl the building is complete and a Certificate of Completion or Occupancy is issued bythe City of Bo~]aton Beach. Costs include, but a_re not limited to, fees/salary, withholding taxes, workers compensation, FICA, unemployment taxes, etc. We will deposit and maintain with t. he City ftmds equal to four weeks payment to the special inspector plus a five percent adminisl~tive fee so that the City can reimburse weekly the special inspector from funds thus deposited. We will notify the City in wr/ting each time the project is shut down or not othe~v/se ongoing and the special inspector is not on duty. The special inspector will prepare daily wrirtem reports in the format specified by the CiW and submit them weekly to the City as a pre-condition to reimbursement. Thc special inspector will be present on the site during all times when construction is ongoing. Upon wrkten notification from the City, we will cancel our agreement with the special inspector mad will not proceed with construction tmtil a successor special inspector is in place. We acknowledge that the City will not issue a Certificate of Completion or Occupancy tmless and until the special inspector certifies in writing that the work has been constructed in accordance ~codes, rules, regulations and laws; and that ig testing and/or recorkstmction is necessary to obta/.n such c/rtific~ion, it w/ii be solely at our expense. We further agree to rake full responsibility for any and all work that Il(as ~covered or concealed without ~lease the City, from anyand all liability thus resu~g.~ / Signature of Owner ~ Signature of~2ontr~ctor STATE OF FLORIDA COUNTY OF PALM BEACH St~e of person t~g ~owledgemenr Nme o~r t~ng ac~owledgement ~e~ p~ted or stumped (SE~) [~5}~-: .... ~;~2" r~m -~i~~. Gitleorr~')(Sefi~Nmb~, ifmy) t1(.~ ~ ~ ~MMISSION,DD029977 ~:mb t O/I4/~. ~. 4/~[~ ~PIRES: May 30, 2~5 S :qZ)EVELOP MENI~ 0LIC ¥ M. ANUAL. WI~P OLIC'YM~S PEC C 0N%5 PINS P.DOC FRI 13:26 FA:[ 561 835 0184 o, N, &]~ ACCT - 02-:1. ~001 I N_ O'Donnell, Nacc, r~ To: x #: Subject: Bliss Construction Dutch Bliss (561) 391-6702 High Ridge Country Club Date: /14/02 Pagesi 'pages (in. cluding this page)*"i ..... COMMENTS: As per our conversation this morning, here are the certifications. 1) Joe Mincuzzi- P.E. of Record 2) Don Baxter-Inspector 3) Dave Wratislaw-Inspector 4) Frank Gobeo- Inspector Lisa Ortiz Inspections Coordinator From the desk of... Joe F. Mincuzzi Vice President O'Donnell, Naccarato, Mignogna & Jackson, Inc. 321 15th Street, Suite 200 West Palm Beach, florida 3.3401 Office: 561-835-9994 Fax: 561-835-0184 Recetvecl: 6/14/02 I :34PM; 561 835 0184 *> Blsss Construct$on; Page 2 06/14/e,2 FRI 13:26 FAX 561 835 0184 O,N,&M ACCT -.':::~," :':".'.~":".'.'.'-'"",?~."'". ' .':" '.:",...:..i); 4'~' ~":.:~'; '.',.t!t:,I . '~ '" ' . ' '.ur.,t a " .7;( ' ':: · "r ..."'.' ........ "' ::?-'.':-".'.,,~fl]['.. i.,'.,,t.," ~002 EXPIRATION: FEB 28, 2003 AUDIT NO: 14614 P.E. NUMBER: 38162 SI NO: .- 0962 DISPLAY AS REQUIRED BY LAW 0~78~39 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BLDG CODE ADMIN AND INSPECTORS I:?~gd~l~llJ~l~dcl LICenSE NBR 109/19/2001 01900669 I,N -0002673 The STANDARD INSPECTO~ Named below IS CERTIFIED Under the provisions of Chapter 468 Expiration date: NOV 30, 2003 /..' 01091900388 MINCUZZI, JOSEPH FRANK 399 N.W. 22ND AVENUE BOCA RATON "' J~ BUSH GOV~t~NOR FL 33486 DISPLAY AS REQUIRED 8Y LAW KI/~ BINKLEY- SEYER. SECRETARY Rece~ve~ 6/14/02 I :34PM; 561 G35 018~ -> B~s~ Construction; Q6/14/0~ FRI 13:27 FAX 561 835 0184 0,N,&~ ACCT 06/14/21~02 13:21 BCBE~ CEINSTRUCTION CO. ~ B350184 ~age ~oo3 N0,838 01-1644 B~V '0002700 13/10/~001 01013900 STANDARD ZNSP~C BAXTER,. nn~, ,, TO~ ,~ ' .'4 H~ Received: 6/14/02 I :35PM; 561 835 0184 -> Bl~.ss Cons~Puc-c~_on; Page 06/14/~'2 FRI 13:27 FAX 561 835 0184 O,N,'&]~ ACCT data, ~0~ 30, 3003 ', ~005 u~B' 'BU6H LAW Ac, 01B2472 33428 olSPI.Ay. ~$ ~ul~ sv L~w 5613470868 GFA TNTERNATTONAL ' 01~- 1.$4 4 FA CSIMII,,E...TRA. .N.. SMITTA L This Facsimile contains page(s) including the cover sheet. ..........J - LFr°m: .~.. Y'", ~¢~-~ ~) f"//'~ C~/'~ COMMENTS; RECEIVED JUN 2 Q 2~2 BUILDING The documents accompanying this fax contain certain information that is confidential, and may be legally pflvlleged. The information is intended only for the individual or entity n~med on this cover latter. If you are not the intended recipient, be aware that any disclosures, copying, distribution or use of this information is prohibited. If you receive this fax in error, please notify us by telephone Immediately (1-800-226-7522) so that we can arrange for the retdevat of the original documents at no cost to you £nvtr0nmenta[ Geotechnica{ Structural Design Construction Materials Testing Threshold and Special Inspections Ca~m'~to O~co West Po~m Besch O~co Gulr~ O~ce ~d Fl~da O~ 44z ~.W. 35~ ~et 1~ 8outham Blvd,, Suite ~ ~752 ~tlon ~e 11310 S. O~ge Blossom B~ ~ton. FL 31431 We~t Palm B~, FL 33408 go~ Myem, ~ 33905 Suite 200 {581) 3~7-0~70 (561) 681:9955 {~1)'48~2443 O~l~do, ~ 32837 86/24/2882 88:42 5513470868 SFA INTERNATIONAL PAGE 82 P.O. Box 310 Boynton Beach, FL 33425 Attention: Mr. Tim Large ' 0 -1 $44 June 24, 2002 Re: High Ridge Country Club Dear Mr. Gentlemen, Mr. Al Newbold BN # 0001656 will perform the inspections for the above referenced site, Mr, Hal Vinh Ly is the certifying Professional Engineer for the project stated above and will not be performing the code-mandated inspections. If you have any questions please feel free to contact me at you convenience. Respectfully submitted, Hal Vinh, Ly, P.E. Project Manager Vice President of Inspections TO:sgn RECEIVED JUN 2 ~, 21XI2 BUILDING Envkonmenta[ Geotechnica[ Structural Design Construction Matedats Testing Threshold and Special tnspections 442 N.W, 35th Stv~ot C56tl 347-0070 (8~1) 347-08~ F&X SatollJle O~ m ~.pit~ and l~lamoroda Calf Coast O~r,e 3752 Colpoi'afirm Circle Fort Myer, ~ 33965 (941) 48~3438 Fax C.~mral Florida Ol'flce 11310 S, Or~tSe Blo~ur;t "h'afl S~tite 200 Ch'lando, FL 3283? (000) 2Ze-SSZ2 FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL P~GULATION BLDG CODE ADMIN AND INSPECTORS 1940 1~ MOITROE ST (850) 921-4789 NEW'BOLD. ALFRED 3575 AVENUE R RIVIERA BCH FL 33404 EPARTMENT OF BUSINESS AND PROFESSIONAL REG~JLATION BN -0001656 10/09/2001 01900734 STANDARD INSPECTOR NEWBOLD, ALFRED IS CERTIFIED unde= the prov~/.ons of ca.468 ExDir&tio~mte* ~OV 30, 2003 S~ 90110090072% DETACH HERE STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BLDG CODE ADMINAND INSPECTORS SE~ 01100900724 LICENSE NBR 34 -0001656 The STANDARD INSPECTOR Named below IS CERTIFIED Under the provisions of Chapter 468 FS. Expiration date: NOV 30, 2003 NEWBOLD, ALFRED 3575 AVENUE R RIVIERA BCH FL 33404 JEB BUSH KIM BINKLEY-SEYER GOVERNOR DISPLAYAS REQUIRED BYLAW ........ P. 0;:-: Hai-vinh Ly, PE I~ Iice~'~sed as a Professional Engineer under Chapter' 471, Florida Exp Date 1992-08393 UA! VlflH :LY PE '" I'^I,., Vltilt February 28, 2003 License. No 25390 '. ' STATE ~F FLORIDA, .... ::i.2 - .":¥--. . .., -~ ......<-:.~ t:?-z.: ~..{; ,.: .):,'-..r.~.,'~%~r,,~-/':" . t '- ', ): ' ........ ' ' -q.'i 9 5 ..-dR,~e'r COURT ,,,. ,:by ticeh$~.,r,! ~( above addCess for the.period beginn ~g · , :,, :r, the'buah~,:s% ,,rofe~sibn o'r 0~t pat 011 0f;.' ' ' ~ctlGltiEER '" PE0025390 J CNTY Og"012 $~1,~0 - TOTAL $$1,50 [ ........... :F~-~%--.-~=r-,~-~TLS-_.:5-O Lfi~:CE~.'FZ_~ ill. ~ PAID PBC-TAX COLLECTOR ' ~31'.5q':0CC Ag ~ 23953 '08-31-2001 JOHN K, C!.ARIq CFC 'fAX COLLEC. TOR. PALM B~Ar_'H COUNTY ,.,? ,,,"~CITY OF WEST PALM BEACH xt:~._jF-'2OO1-O2 LICENSE / CERTIFICATE OF USE TI-IlS LICENSIE VALID ONLY wHEN RECEIPTED BY .' "- T4X .~j.~ECTOR NOT TRANSFERA~ CIT~ OF W~ST PAI.',~ ~SACH P.O. BOX 3147. WEST PALM OEACH. FL :,L~02 87] 0001500-6 FL 25390 dA~ ViNH L¥ PE 4195 CROZET CT LI(?C~NGC INC. CA I t:GL)H Y DESCRIPTION (. l I,'~. r t,. l I-. S PENALTIES THI.q I'~OCUMENT NOT VALID J U. NTIL FUNDS ARE COLLECTED I O. 00 157.50 TOTAL,~ EXPIRES $1'-PTEMBI=fl 3£] 2002 - 02-1 Resume of HAI-VINH LY, P.E. Consulting Engineer CURRENT ADDRESS: CURRENT PHONE: EDUCATION: REGISTRATION: MEMBERSHIP: SU~I~IARY: 4195 Cr~zet Court West Palm Beach, FL 33409 (561) 640-7110 Master of Science in Mechanical Engineering University of South Florida Florida Registration Number 0025390 ASHRAE A project engineer with twenty seven (27) years of design experie~ices in Heating, Air Conditioning an~ Ventilation; Plumbing; and Electrical Systems of Residential,_Commercial, and Institutional Buildings. k,.LA..;!LI'L'% !NSUEA_NCE: $ 250,000.00 REFERENCES Dai[ey and Partners Architects, P.A. West Palm Beach, Florida DMJM ~ Harris Corporation Mia,ii, Dade County, Florida A/R/C Associated, Incorporated Orlando, Orange County, Florida d'a~, A~nmou Architect, Inc. i.3~agwood, Orange County, Florida Jo~ Stoss 81ehar Architects, A.I.A., Lske Worth, Florida Br,ower Architectural Associates Town of Palm Beach, Florida P.A. (561) 640-5281 (305) 4,i4- 8241. (407) 896-7875 (407) 333-1977 (561) 493-9788 (561) 659-1948 COMHLRCIAL & INSTITUTIONAL PROJECTS PERFORMED: Project Names System Types Operation Building Restoration C'ity of Fi,:eviera Beach, Florida Split D.X.System Service Bldg.-A1 Packer Ford-West Royal Palm Beach, Florida Split D.X.System War~,~iouse and Materials Storage -Rail. tlialeah. Dade County Rooftop. Split D.X. & Ventilation Fo, I 'i_h F]nnr NI-F]c,~= R~nnvatimnR F,.?, [. cf I.!iap, i. Dade County. FI~ Chilled Wa~er Sys., AH[t. VAV Terminal Cruise 'Fel'ndna'l #6, Hiami, Fla. _Ch!!!~_d WdI.~F' qv< AHU, VAV Terminal 1-75 Ret:.t Area Bldg.(F.D.O.E.) · ~ ...... .... ~rd County. Flo,,'i~ta Split D.X.System I.'lu >uu~,~,,<.dc. Office Renovations !'"Ji,:ili i Ucl'.It:f., (]<~t Il_y, ;-Iorida (;t,:,'."e-: & N,:~.~ 10i strib'.rLion Whsc. [:adc County School Board, Florida Split D.X.System Rooftop and 'Ventilation Units Pain': P. earin Gar'dens, Florida Split Faire W,.'..sl.. A-ilia~;(::e Church Lc,.:a$~.~tc',,ee. Palm Geach County Florida Split D.X.System Spl i't D.X. System Split O.X.System ',.,'~l!.~.u]e Hal! of Royal Palm Beach Palm Beach. Florida Split D X.System LJ '; Sugar Cor'p.(Office Renov.) Cle'.,,.~ sLc,~, flor'ida Split Palm Beaci~, Flor'ida oR ~ Lea Split D X. Whole Ea~'th Food Market R','x-a Raton. Ftnr'ida RCOl lop Units R.d.L, atcr Restau~'ant t. af.:e Ci t"/. Flor'i,da Split D X.System Floor Areas 4t00 SF 4700 SF 3000 SF 3300 SF 1 ?.~¢,,q %F 6800 SF 45O00 SF 100000 SF gofiO SF 9000 SF 2500 SF 2900 SF 5500 SF 54O0 SF 25O0 SF 12000 SF 4800 .S? PREPARED 8/13/02, 9:45:02 PAYMENTS DUE RECEIPT CITY OF BOYNTON BEACH PROGRAM BP820L APPLICATION NUMBER: 02-00001644 2400 HYPOLUXO RD FEE DESCRIPTION AMOUNT DUE PLAN CHECK FEE 35.00 TOTAL DUE 35.00 Please present this receipt to the cashier with full payment. SHEET OF PERi, IT SET O0 ~OT ~'~"~0~~E 8/13/~ M Total tendered Total I~ent Re~ipt no: PREPARED 7/12/02, 8:19:17 PAYMENTS DUE RECEIPT CITY OF BOYNTON BEACH PROGRAM BP820L APPLICATION NUMBER: 02-00001644 2400 HYPOLUXO RD FEE DESCRIPTION AMOUNT DUE PLAN CHECK FEE 35.00 TOTAL DUE 35.00 Please present this receipt to the cashier with full payment. O~er: ~LLE~3 T~t~l Reoei~t ~o: ~12988