RF-07-22-1773 415 NE 105 StMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
OWNERS'S AFFIDAVIT OF EXEMPTION
ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR
EXISTING SITE -BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PERSUANT TO SECTION
553.844 F.S.
To: Miami Shores Village Building Department Date: �•� •�Z
10050 NE 2nd Ave
Miami Shores, FI 33138
Re: Owner's Name: MC
Property Address:L4 1!5 L-10 ( OS C i
Roofing Permit Number: - o--7- 2-_ -r
Dear Building Official:
I certify that I am not required to retrofit the roof
to wall connections of my building because:
die just valuation for the structure for purpose of ad valorem taxation is less than
$300,000.00. Please attach proof of ad valorem taxation.
❑ The building was constructed in compliance with the provisions of the Florida Building Code
(FBC) or with the provision 4 edition of the South Florida Building Code (1994 SFBC)
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 day of
A U USt 20aa-
MERUNE CHERY
• MY COMMISSION # HH 252206
EXPIRES: AM 1Z 2026
Notary Public, State of Florida at Large '''?a�°'
When the just valuation of the structure for purpose of ad valorem taxation is equal to
or more than $300,000.00, and the building was not constructed with FBC nor a 1994
SFBC. Then you must provide a building application from a General Contractor for the
Roof to Wall connection Hurricane Mitigation.
For Forms and Applications click here:
http://bldg.miamishoresviliage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
Rev01 142021 Owner affidavit of exemption Page 1 of 1