RF-06-20-1182 INSP AFFIDAVITMiami 13, hores �'�'' illage
Building Department
RE: Permit#Qf -
INSPECTION AFFIDAVIT
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
DATE: 6 -1 3 do tiU
I _yNN [�cr+)�ff1CU;LS LLL 1 �3y�1. licensed as a (n) Contractor / Engineer / Architect,
(Print name and circle License Type) FS 468 Building Inspector
License #: Cc, C- t 3 -� L U -V
On or about 1 'Lug I did personally inspect the roof deck nailing
(Date & lime) r—
workat N-W, M(: A&i W4SJI.
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the Hurricane Mitigation Retrofit
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 5 day of l
Notary Public, Sate of Florida at Large _ ''Ea^'°'"_ L` r
-
'.�.
'General, Building, Residential, or Roofing Contractors or any individual certified under 468 F S to make such an inspection Irclude photographs of each plane of the roof with
permit # and address # clearly shown marked on the deck for each inspection
F_11�Ahaml hores Village
13.0ding Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.6972
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: 1Ntr.-v, kkA . F Ic; 10- A I
I
Date:
Property Address: S U N w i 0'1 `5 t- A e
Roofing Permit Number:
Dear Building Official:
"'.4v certify that I have improved the roof to wall connections of the referenced
property as required by the Manual of Hurricane Mitigation Retrofits for Existing Site -Built Single Family Residential
7S.1.,,,es as adopted by the Florida Building Commission by Rule 913-3.047 F.A.C.
Signature ti Print Name
State of Florida
County of Dade
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 _ 3 � day of wt 20 Z07-41 -
Notary Public, Sate of Florida at Large
(SEAL)
L COMPLIANCE
Revised on 5121/2009