RF-04-22-931 INSP AFFIDAVITMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
Permit # �ZF•-04 - ZZ- 931
DATE: S / ) I / ZOZZ
INSPECTION AFFIDAVIT
-f a cis r� .301 licensed as a(n ontrac / Engineer / Architect,
(Print name and circle License Type)
License #: C C G 1 3 2 7 4 01
On or about NIQu Il, 2oZZ SAM , I did personally inspect the roof deck nailing
(Date & time)
work at & S� N E 10S 4"', 5 tr -� -f- -r-
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the
Hur icane Mitigatio R trofit Manual (Based on 553.844 F.S)
-�1)
i ature
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 day of /mil A4
1
Notary Public, State of Florida at Large
MARIA ELENA CRISTOBAL
+06 MARIA ELENA CRISTOBAL
MY COMMISSION # GG 987418
+;t? EXPIRES: May 12, 2024
BondeIThrU1101"PuhlicUnderwriJere
For Forms and Applications click here:
http://bldg.miamishoresviIlage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
Rev01 142021 Inspection Affidavit Page 1 of 1