RF-18-1302 (2)114
AFFIDAVIT OF COMPLIANCE WITH ROOF DECKING ATTACHMENT AND SECONDARY
WATER BARRIER HURRICANE MITIGATION RETROFIT FOR EXISTING SITE -BUILT
SINGLE FAMILY RESIDENTIAL STRUCTURES
PURSUANT TO SECTION 553.844 F.S.
04/20/2018
To: City of Miami Shores
10050 N.E. 2nd AVE
Miami Shores FL 33138
Re: Owner's Name MONTANA 13 HOLDINGS III LLC
Property Address 941 NE 91 TER
Roofing Permit Number "C" S- /8 13 z
Dear Building Official:
I Daniel Gonzalez-Lauzan certify that the roof decking attachment and fasteners have been
strengthened and corrected and a secondary water barrier has been provided as required by the "Manual
of Hurricane Mitigation Retrofits for Existing Site -Built Single Family Structures" adopted by the
Florida Building Commission by Rule 9B-3.047 F.A.C.
Qualifying Agent
Signature of Qualifying Agent
Daniel Gonzalez-Lauzan
Print Name
STATE OF FLORIDA COUNTY OF MIAMI-DADE
Sworn to and subscribed before me this
day of al
(SEAL)
Personally known
or Produced Identification
, 20
Notary Public Sate Florida
Anailyn Estraca
, C ,- ,: My Commission G" "1 17155
or `'Expires 01/10/2022
CADocuments and Settings6tc I \My Documents\ StarimicsGraphs_2U2oofmg Affidavit Compliance-9 26 07Fillablo doc
•
IVI iami Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RE: Permit # /fC- 5/0 /J�0;2 _ DATE: 74/)g
INSPECTION AFFIDAVIT
I C eA.// GNU L /Au licensed as a Contractor nine r (t
� �� g e / Architect,
FS 468 Building Inspector
(Print name and circle License Type)
License #:
a03389
On or about
9 e//1
(Date & time)
work at 9/ NC .9
(Complete Job Site Address)
, I did personally' inspect the roof deck nailing
Based upon that examination I have determined the installation was done according to the Hurricane Mitigation Retrofit
Manual (Based 3.844 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
Notary Public, Sate of Florida at Large
Notary Public State of Florida
Anailyn Estrada
v� My Commission GG 173156
9j�ry Expires 01/10/2022
'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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