RF-17-2838 (2) S>NORiEs
Miami s Village
110�
.,. .���. Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
�OR1DA Tet: (305) 795.2204
Fax: (305) 756.8972
RE: Permit# ?t"' k�- 1'7_ 7-931 DATE:Q t dot
1 INSPECTION AFFIDAVIT
licensed as a(n) Contractor/Engineer/Architect,
(Print name and circle License Type) FS 468 Building Inspector
License#: 4n,t7 2-
On or about , 1 did personally inspect the roof deck nailing
(Date 3 time)
work at '-7N E (C.)`�
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the Hurricane Mitigation Retrofit
Manual ( ased on 553.844 F.S)
Signature
i
y
State of Florida
County of Dade:
I The undersigned, being the first duly swom, deposes and says that he/she is the contractor for the above property
mentioned.
';,�GONjq''�.,,.
�L r S,. Q�MISSjO
Sworn to and subscribed before me this I_ l� day of ��� _ ° NO y
- --� ;oer 130081964 �•; _ .
E(pm
Nota Public, Sate of Florida at Lame F68.1o,S>?t?o.
Notary g ,•.!!►�,Ata<o°
.. W
*General,Building,Residential,or Roofing Contractors or any individual certified under 468 F.S.to make such an inspection.Include photographs of each plane of the roof with
permit#and address#dearly shown marked on the deck for each inspection
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