RF-04-22-922 INSP AFFIDAVITMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
Permit # Ar' O� -- Z2 - ?,2 2,
DATE: 1'r Z 7i
INSPECTION AFFIDAVIT
I
—�Tma 06enr
(Print name and circle License Type)
License #: Lbfi— V" j
licensed as a n Con raAr En ineer Architect,
( I)Engineer /
On or about L , I did personally inspect the roof deck nailing
( ate i time)
work at
/z 35- 0.6- 9 (OS
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the
Hurricane Miti on Retrofit Manual (Based on 553.844 F.S)
SigdatVe
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 2q
day of
Notary Public, State of Florida at Large'--
;t-'Ay1'`'CATHERINEA. DUFFIN
MY COMMISSION # HH 089522
EXPIRES; M14,2
Bonded 7hFV N,Xjrr PubIIC U X rwrkan
n.
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