RF-18-2051Miami Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RE: Permit # RF- g- /B - 2as/ DATE: e$/oc1 !
INSPECTION AFFIDAVIT
Micitt L,LC= P0342,E,77:)/V licensed as a (r Contractoor Engineer / Architect,
(Print name and circle License Type)
License#: C C /3279/7
FS 468 Building Inspector
On or about 4C/6vs T 09, 2O// . , I did personally inspect the roof deck nailing
(Date & time)
work at 318 NE 105 T.
(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)
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 0% may of 4060ST 201 g
Notary Public, Sate of Florida at Large
MADELEIN GIL
MY COMMISSION # GG 042188
EXPIRES; October 25, 2020
Bonded Thru Nbatry Public Underwriters
*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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