RF-11-22-2972 Inspection Affidavit 62 NW 109 StPermit # er_ W711--zliqlZ
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Miami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
DATE: 04 /Wv;
INSPECTION AFFIDAVIT
I `<< fotycrs licensed as a(n) Contractor / Engineer / Architect,
(Print name and circle License Type)
License #: C-M t332'-4 C127
On or about
(Date & time)
work at NW 1061 SA- i AtGtmq
I did personally inspect the roof deck nailing
33
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the
Hurricane Mitigation Retrofit Manual (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 'Z-A day of e,�A2�LrZ3
Notary Public, State of Florida at Large
}°` bti� +Votary PublIC State Of Florida
Steven Efharrar
MY ComrnrSSron HH 083256
or rya'' ExprreS 11/12/2024
For Forms and Applications click here:
http://bidg.miiamishoresvil lage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
Rev01 142021 Inspection Affidavit Page 1 of 1