RF-02-23-273 Inspection Affidavit 140 NE 104 StMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
Permit # R F-02-23-273
DATE: 3/1 /2023
INSPECTION AFFIDAVIT
JEFFREY MARTIN
(Print name and circle License Type)
License #:CGC1524388
licensed as a(n) Contractor / Engineer / Architect,
On or about 3/102023 & 12 :35 P M , I did personally inspect the roof deck nailing
(Date & time)
work at 140 NE 104TH ST , Miami Shores, FL, 33138
(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)
to
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
day of MAW�O:,'ON
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For Forms and Applications click here:
http://bldg.miamishoresvillage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
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