RF-18-1808 (2)CohiYGCo r
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Engineer / Architect,
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I did personally inspect tlie.roof deck+-1eelieq
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work at +y n / &/-' (\ Jfy)i 51,-)Dy PL 3: :J'6 j'••••:
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(Complete Job Site Address)
RE: Permit #
-7-�9 iPS
Miami Shores Viiiage
Building Department
INSPECTION AFFIDAVIT
J eS - s NSsi rn ���� ilicensed as a (d
(Print name and circle License Type) FS 468 Building Inspector
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
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DATE: 1
tLic ne se#: CCC 13 2..ggcI`-6-
On or about O(J l$-// T
(Date & time)
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Based upon that examination I have determined the installation was done according to the iiur ielne Mifigation RetrcQil. •.:
Manual (Based on 553.844
State of Florida
County of Dade:
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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 �j day of Li 0 -
Notary Public', Sate of Florida at Large
REYNA A MATEO
MY COMMISSION #GG176896
EXPIRES: JAN 18, 2022
Bonded through 1st State Insurance
'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
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