RF-04-22-950 INSP AFFIDAVITMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.qov
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 Date: �;blz-2
10050 NE 2"d Ave
Miami Shores, FI 33138
Re: Owners Name: HUNTER, MARK
Property Address:1245 NE 93 ST, MIAMI SHORES, FL 33138
Roofing Permit Number:
Dear Building Official:
I ZACHARY WALLICK 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 Structures as adopted by the Florida
Building Coma ission by "le 9�-3.047 F.A.C.
ZACHARY WALLICK
Signature ] Print Name
State of Florida Miami Dade County
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 MTh day of 20
Notary Public, State of Florida at Large
��^ KRISTIN SYSE
Seal: i° •': Notary Public - State of Florida
Commission A HH 221832
or My Comm. Expires Jan 30, 2026
Bonded through National Notary Assn.
For Forms and Applications click here:
http://bldg.miamishoresviIlage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
Rev01 142021 Affidavit of Compliance with roof to wall Page 1 of 1
Miami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
Permit #
I ZACHARY WALLICK
DATE: S151 � Z
INSPECTION AFFIDAVIT
(Print name and circle License Type)
License #: CCC 1332202
licensed as a(n) Contractor / Engineer / Architect,
On or about , I did personally inspect the roof deck nailing
(Date & time)
work at 1245 NE 93 ST, MIAMI SHORES, FL 33138
(Complete Job Site Address)
Based upon that aminatio I ha determined the installation was done according to the
Hurricane tig +ion�Retry it Ma I (Based on 553.844 F.S)
Signature
State 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
-7A
day of
Notary Public, State of Florida at Large
...........
° KRISTIN SYSE
Notary Public - State of Florida
` Commission .# HH 221832
ar My Comm. Expires Jan 30, 2026
Bonded through National Notary Assn,
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