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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 � ► �D }Q V40�.15-24?�fo x I�SOTARy �v,: [� -Q: �. :o= PU% is o r i F s Qt`l� For Forms and Applications click here: http://bldg.miamishoresvillage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia miShoresVillage ReV01142021 !nspection Afficlavif Page 1 of 1