RF-01-20-115 (1)RE: Permit #Vr 6 ` 20 ` ` 5
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
DATE: Leo
INSPECTION AFFIDAVIT
I aK� ��1.2GLI1 o L licensed as a (n) Contractor /Engineer /Architect,
(Print name and circle License Type) FS 468 Building Inspector
License #: -C
On or about I did personally inspect the roof deck nailing
{{ (Date & time)
work at l C' �- i� A —
(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 sworn, deposes and says that he/she is the contractor for the above property
mentioned.
Sworn to and subscribed before me this 2(,R day of lre_�
Notary Public, Sate of Florida at Large
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p o` Florca
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'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