RF-12-21-3340 INSPECTION AFFIDAVITPermit # :F — 1�4 —3
Miami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.aov
DATE: ZS
INSPECTION AFFIDAVIT
licensed as a(n) rc o / Engineer / Architect,
(Print name and circle License Type)
"n
" a/ �W I —
License #: C.
On or about lfiA2 j 2100 011`' 1 did personally inspect the roof deck nailing
work at
& time)
�,'r' I
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the
Hurricane Wfigation Retrofit MaQual (Based on 553.844 F.S)
re
tate of Florida, Miami Dade County:
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, State of Florida at
2�
day of AL ) -)-,
Yp. ' •
• `fit•
CATHERINEA. DUFFIN
�?
MY COMMISSION # HH W9522
'Fcr
EXPIRES: May 14, 2025
nRP'
Bonded Thru Notary Pubric Underwriters
For Forms and Applications click here:
http://bldg.miamishoresvillage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
Rev01 142021 Inspection Affidavit Page 1 of 1