RF-19-2470RE: Permit # R F-10-19-2470
Alain Gonzalez
(Print name and circle License Type)
License #:
CCC 1325556
Miami Shores Village
Building Department
INSPECTION AFFIDAVIT
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
DATE:
licensed as a (n) Contractor / Engineer / Architect,
FS 468 Building Inspector
On or about , I did personally inspect the roof deck nailing and
(Date & time)
Secondary water barrier work at 122 NE 101 ST Miami Shores, FL 33138
(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 P `aka &&'�7 a l
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 day of -)C`(�QUV-L 'v
cos p�' JENNIFER FADUL
Notary Public, Sate of Florida at Large ' _;. _ Notary Public -sate ° Florida
p
My Comm. Expires Jan 2.2022
Bonded through Naiona No:ari Assn.
'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
Revised on 5/21/2009