RF-033-21-698 INSPECTION AFFIDAVITY--
RE: Permit # RF-033-21-6981
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
lu,-, Fax: (305) 756,8972
INSPECTION AFFIDAVIT
DATE: 3/30/2021
I I CA-& licensed as a ( Contractor Engineer/Architect,
(Print name and circle License Type) FS 468 Building Inspector
License #:()12 2_
On or about_ _ LA � 021 a _ !?, E�, I did personally inspect the roof deck nailing
'Date 8 time) �
work at 0 Q q2 n—, iSf-. Ma-"i( ofS,—33i�)b
(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)
. 0 A4. aj
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
-ZI
otssYpUcz, EVGENIYAPAVLYUKOVA
2 ' commission # GG 367832
* Expires August 23. 2023
1 iP BondodllvuLiwigotNoterysorrlces
of, r
"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 roofwith
permit # and address # clearly shown marked on the deck for each Inspection
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