RF-17-2764 R ��� Miami Shores Village
Box" Building epartment
10050 N.E.2nd Avenue
' Miami Shores, Florida 33138
�d0R 'Tel: (305) 795.2204
Fax: (305) 756.8972
RE: Permit# 1, IT
DATE:
INSPECTION AFFIDAVIT
licensed as a (n) Contractor i Engineer l Architect.
(Prirt name and circle t.icerse hype) FS 468 Building Inspector
License#: GAG-_(2�,Z-S SS CIO
On or about CZ ' `? f �— I did personally inspect the roof deck nailing
(Date&time)
work at LiRo N 4�: .
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the Hurricane Mitigation Retrofit
Manual (Based on 553.844 F,S)
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.
Sworn to and subscribed before me this_ of oRla I CA TELLANOS
;r %= Notary Public-State of Florida
•i Commission I GG 027219
Notary Public, Sate of Florida at La e =,,F � y Comm.Expires Sep'&2020
9wided through National Notary Assn
'General,Building,Residential,or Roofing Contractors or any individual certified under 468 F.S.to make such an inspecfion.'nclude photographs of each plane of the roof with
permit#and address 1-clearly shown marked or the deck for each inspection
Da{cor...,r?;+nr�n+nunvonnn