RF-03-23-683 Inspection Affidavit 1119 NE 104 StMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
Permit # Ly-- � 0
DATE: '_3 1 Z
INSPECTION AFFIDAVIT
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I vf� I licensed as a(n) Contractor / Engineer / Architect,
(Print name and circle License Type)
License #:
On or about 3 P z- Z 3 q XA-x4
to & time)
work at
I did personally inspect the roof deck nailing
(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)
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
NotaryPublic State of Florida at Large
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LOW I = '
CATHERINEA.DUFFIN
COMMISSION # HH 089522
xPIRI:S: 1111y 14, 2025
`Oi r Bri,ted Thru '_ 5
For Forms and Applications click here:
http://bldg.miamishoresvillage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
Rev01 142021 Inspection Affidavit Page 1 of 1