RF-10-19-2311 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 # 9 --c— / 0 Lqj:5
INSPECTION AFFIDAVIT
DATE: /d
iJ'6V f2 v� licensed as a (n) Contractor / Engineer / Architect,
(Print name and circle License Type) FS 468 Building Inspector
License #: ,3) L
On orabout / U'�.-:�L' /O _
(date & time)
work at tl Z I U .3 rS
(Complete Job She Address)
I did personally inspect the roof deck nailing
fi
Based upon that examination I have determined the installation was done according to the Hurricane Mitigation Retrofit
Manual (Based or},553.844 F.S)
re
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 o
Abl--e c:�) D 1�
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Notary Public, Sate of Florida at Large L •�
HERINE A• DUFFIN
~ ■' `: NotaryPublic- StateofFlorida
��:
' ,• 's Commission # GG 104296
My Comm, Expires May 14, 2021
"General, Building, Residential, or Roofing Contractors or any individual certified under 468 F.S. to makes
"��•�t"Nondrdthrough NulignalNot aryAssn.
of the roof with
permit # and address #clearly shown marked on the deck for each inspection
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