RF-18-642 (2) RES 1j30
.00
shores Village
�.
... googol" Building Department
10050 N:E.2nd Avenue
Ake
-Z Miami Shores, Florida 33138
�OR[DA Tel: (305) 795.2204
Fax: (305) 756.8972
RE: Permit# 'fr— ^ l Q- rya DATE:
INSPECTION AFFIDAVIT
(2no t-� 2 licensed as a (n) Contractor/Engineer/Architect,
(Print name and circle License Type) FS 468 Building Inspector
License#: CCC C Q0
On or about C' �' !p IQ I did personally inspect,the roof deck nailing
(Date&time) ,
work at I riI 6q S','
(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 swom, deposes and says that he/she is the contractor for the above property
mentioned.
Sworn to and subscribed before me this day of V_Aav CAA- 20 L
JENNIFER FADUL
Notary Public, Sate of Florida at Large \ No"�ry�b'�-ni #tateof 1 1862
nda
My Comm.Expires Jan .2022%
1„��c. �,
Al W 1w* NaS"NaantAW.
f '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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