RF-05-02-1029 INSP AFFIDAVITMiami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RE: Permit # `—
INSPECTION AFFIDAVIT
DATE:- IhI �210 2 v
I - A�'z— =s`Z licensed as a (n) Contractor / Engineer / Architect,
(Print name and circle License Type) FS 468 Building Inspector
License #:A2 ( �
On or about 1 LPL h o 2 4 1 did personally inspect the roof deck nailing
(Date & time) `,, 51 5
work at � i Ca_L� �-� + SS '_) ` �� t ore
(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.
av ao
Sworn to and subscribed before me this day of
P
CHRISTAL SIERRA
Notary Public Sate of Florida at Large
�r` "°`'r'' PL°'" State °`°r",
33=272
Commission r GG
�r? M.y Comm. Ezprres;L1 2, 2023
Sorded throLgl; tiutiry Assr.
'General, Bullding, 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 #clearly shown marked on the deck for each inspection
Q ;—H—nnmmninsr;ninnnn