RF-12-22-3746 Inspection Affidavit 10090 N Miami AveMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfi.gov
Permit #
DATE: �r✓� t� Ze
INSPECTION AFFIDAVIT
TOI�4 . ee-� a licensed as a(n) Contractor / Engineer / Architect,
(Print name and circle License Ty )
License #:
o CC- 133Jc)-k,�
On or about rJ�vnU Cs l 7-6, �l.did personally inspect the roof deck nailing
(Dat &time) _ g�_
work at / U GI (%� 1:j-V` l�� Cl ry't L 3 3/SZ�
(Complete Job Site Address)
Based uport#ate4minati4n I have determined the installation was done according to the
Hurricarle'Mif iga�ibl Retro"r t Manual (Based on 553.844 F.S)
Signature
State of Florida, Mimi Dad$ 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 2.0 Z,�)
Canoe Canales Enrique¢
Notary Public, State of Florida at Large
» o State of Florida
Carlos Cans49* KrAlnUeZ ' ;� $� Comrr.rt NH!)90143
Notary Public �$� Expires 2/8/2025
State of Florida
Comm# HH090143
Exp1rp 2/8/2025
For Forms and Applicatrvns click here:
http://bldg.miamishoresvillage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
Rev01 142021 Inspection Affidavit Page 1 of 1