RF-01-21-63 INSPECTION AffidavitMiami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RE: Permit # 2T _o/_ 2-1 - 03
INSPECTION AFFIDAVIT
DATE: I/- 5 —_2
r
Q 64'e; — licensed as a (n) Contractor / Engineer / Architect,
(print name and circle License Type) FS 468 Building Inspector
License #: CGC 11519869
On or about 3 —19' 2 f 7 = C26 P14. I did personally inspect the roof deck nailin
(Date & time) _/
work atAle 7' fk ��4 Ilk v�►�ar s Irl nin
(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
Notary Public, Sate of Florida at Large
`General, Building, Residential, or Roofing Contractors or any individual certified
permit # and address # clearly shown marked on the deck for each inspection
)(Pei 2oZi
" . Melvin A, Lag
h.
EXPIRES: June 6, 2022
Bonded Thna Apron notary
.S. to make such an inspection. Include photographs of each plane of the roof with
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