RF-10-19-2357 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 #-fz9 - 10"1 � —29J
INSPECTION AFFIDAVIT
DATE:jj U572-a f
1 R?y5?1O F �(-)t[- 0y(/jc� licensed as a (n) Contractor / Engineer / Architect,
(Print name and circle License Type) FS 468 Building Inspector
License #: C�fl✓
On or about l i I did personally inspect the roof deck nailing
_ (Date & time)
work at ` 14 �'
(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)`f
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 5 day of
Notary Public, Sate of Florida at Large 1. ��� t , �a ANNASWIERCZvNsKA
►'„ Notary o� sio - State o` ='orida
Commissior = GG 9057.2
My Comm. Expires Ar.s ZZ. 2023
M
ttonded through National rotary 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 # clearly shown marked on the deck for each inspection
pa, 1-4 — 17Mn19n4A\f,19"19nno