RF-18-1179 (2)RE: Permit # ` F S" / 8 ` 1 l 9
i deK/ C4 mhfoiil)1
(Print name and circle License Type)
License #: CCC / 33 i 13
Miami Shores Viiiage
Building Department
INSPECTION AFFIDAVIT
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
DATE: 5 2 5 ! q
licensed as a (n)�_
FS 468 Building Inspector
Contractor
Engineer / Architect,
On or about tit ay Z s Zd l S (1. 3o PtM , I did personally inspect the roof deck nailing
(Date & time
work at 0 (61 L fie, 11 Me_ 1VA(CZMI c5' QF.s FL, 33136
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the Hurricane Mitigation Retrofit
Manual Bas 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 , ) 5- day of May , 20 (g
Notary Public, Sate of Florida at Large
'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 # clearly shown marked on the deck for each inspection