RF-17-330 S�o
1% RFs Miami shores Village
' trC.7J32
tell ,.,,. Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
OR Tel:Tel: (305) 795.2204
Fax: (305) 756.8972
RE: Permit# `- _Z '� DATE:
INSPECTION AFFIDAVIT
licensed as a(n) Contractor/Engineer/Architect,
(Pont name and circle License Type) FS 468 Building Inspector
License#:
On or about , I did personally inspect the roof deck nailing
(Date&time)
work at /2 c4'4% crAo ri �,e '3A j4-
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the Hurricane Mitigation Retrofit
Manual (Based on 553.84 S)
Signature
State of Florida
County of Dade:
The undersigned, being the first duly swom, deposes and says that he/she is the contractor for the above property
mentioned.
Swom to and subscribed before me this day of AbX&V
Notary Public, Sate of Florida at Large ;; MARIA CRUZ
MY COMMISSION#FF997102
EXPIRES July 09,2020
398-0153 FloridallotaryService.com
'General,Building,Residential,or Roofing Contractors or any individual certified under 468 F.S.to make such an inspection.Induce photographs of each plane of the roof with
permit#and address#clearly shown marked on the deck for each inspection
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