RF-01-21-82 inspection paperworkV6- o I - 2) -�rL
Miami shores Village
Building Department
RE: Permit #
INSPECTION AFFIDAVIT
Ivan Gomez
(print name and circle License Type)
License M
On or abo
work at
CGC1525739
1/11/2021; 9:15 am
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795,2204
Fax: (305) 756.8972
DATE: 1 /12/2021
licensed as a (n) ontractor Engineer / Architect,
FS 468 Building Inspector
, I did personally inspect the roof deck nail'iM
(Date & time)
1275 NE 93rd St, Miami Shores, FI 33138
(Complete Job Site Address)
Based upon that examination l 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 swom, deposes and says that he/she is the contractor for the above property
mentioned.
Sworn to and subscribed before me this , 11 th day of January 2021
I,==
Slate of Florida
Notary Public, Sate of Florida at Large �� �- �
asquez
David C Velas uezO" C'G 124357q72021
"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