RF-19-2522 (2)'w
A.
Miami shores Village
Building Department
K
RE: Permit# (��-10-/9
INSPECTION AFFIDAVIT
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
DATE: /e-/,27'7//---/
I A �'SN"ki"z licensed as a (n Contrac)/ Engineer / Architect,
(Print name and circle License Type) FS 468 Building Inspector
License#: n -C- \-�'Z-:� h (bT
On or about , I did personally inspect the roof deck nailing
(Date & time)
work at N Lo a2 S
(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 day of
Notary Public, Sate of Florida at Large
� ' Sandra M Garcia
�r My Commission GG 240887
w Expires 07/22/2022
`General, Building, Residential, or Roofing Contractors or any in ividual certrfied under 4 8 .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
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
AFFIDAVIT OF COMPLIANCE WITH ROOF TO WALL CONNECTION HURRICANE MITIGATION
RETROFIT FOR EXISTING SITE -BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PURSUANT
TO SECTION 553.844 F.S.
To: Miami Shores Village Building Department
10050 NE 2nd Ave
Miami Shores, FI 33138
Re: Owner's Name: Ro b y r" `e4
Property Address: __ 3 1 N W 9 2na
Roofing Permit Number:
Dear Building Official:
I _ _ n cirtifv h
Date:
-
► am 1
33) 5®
improved the roof to wall connections of the referenced
property as required by the Manual of HurricinYM' igation'Retrofits for Existing Site -Built Single Family Residential
Structures as adopted by the Florida Building C mission by Rule 9B-3.047 F.A.C.
Signature
State of Florida
County of Dade
Print Name
The undersigned, being the first duly sworn, deposes and says that he/she is the owner for the above property mentioned.
Sworn to and subscribed before me this day of 20
Notary Public, Sate of Florida at Large
(SEAL)
FINAL COMPLIANCE
Revised on 5/21/2009