RF-17-2725 r
i
OR
Miami Shores Village
Building Department
•n. �.��.
10050 N.E.2nd Avenue
zed Miami Shores, Florida 33138
IORtD�' ` Tet: (305) 795.2204
Fax: (305)756.8972
RE: Permit# DATE: l l I 1
,F
INSPECTION AFFIDAVIT
1 o
licensed as a( Engineer/Architect,
(Print name and circle License Type) FS 46x3 Building Inspector
License#:
On or abouts c_ I I, �`0 I"1 ;/� , I did personally inspect the roof deck nailing
8 time �/_
work at 45
(Complete Job Site Address)
Based upon that.examination l have determined the installation was done according to the Hurricane Mitigation Retrofit
Manual(Based on 553.844 FS)
Signature
State of Florida
County of Dade:
The undersigned, being the first duly sworn, deposes and says that he/she is the contractor for the above property
mentioned,
i
Sworri to and subscribed before me this ( 61ty of 40 r�
Notary Public, Sate of Florida at Larg
.O
'r. '.` Notary ublic-State of orida
Commission GG 0 03
My Comm Expires Jun 20
'General,Building,Residential,or Roofing Contractors o n in8t�ldual pection.Indude,photographs of each plane of the roof with
permit#and address#deadyshown marked on the deck for each:inspection
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