RF-01-21-252 INSPECTION AFFIDAVIT1
! J
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RE: Permit Jit - � !_ _ L
INSPECTION AFFIDAVIT
DATE: �_k__0L(
i licensed as a (n) Contractor / Engineer / Architect,
(Print name and circle License Type_)—)FS 468 Building Inspector
License #: CCC,a3-2,S AR-5
On or about 3 ;mac '"-" I did personally inspect the roof deck nailing
(Date & time)
work at ?qQ pje l 0,�)
(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)
r.
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 CAO day of
Smith
Notary Public, Sate of Florida at Large 4;-ER
�Qrm.GG3191
Ex�pes, FebruM 10, 2023
,� ; ► l Sot ded Thru Aaron Notary
'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