RF-05-22-1166 INSP AFFIDAVITMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
Permit #—�'Z —lal rl.
DATE:
INSPECTION AFFIDAVIT
L&FL) licensed as a(n C Ira tar / Engineer / Architect,
(Print name and circle License Type)
License #: (IT'L a I �LD �Z_ - -
On or ab
Date 4 time)
work at
I did personally inspect the roof deck nailing
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the
Hurricane Vligation Retrofit Manual (Based on 553.844 F.S)
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
Notary Public, State of Florida at Large
CATHERINE A. DUFFIN
MY COMMISSION 9 NH 08022
EXPIRES: May 14, 2025
Bonded Thu Notary Pd* uftw rrhm
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