RF-02-23-307 Inspection Affidavit 660 NE 105 StPermit #}�._2
Miami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
DATE: .42-12-3
INSPECTION AFFIDAVIT
I QG�-*C—V f " licensed as a(n) Contractor / Engineer / Architect,
(Print name and circle License Type)
License #: CCC--. -- (3-30t J G
On or about 3 120 IZ� , 1 did personally inspect the roof deck nailing
(Date &Itime) �T
work at e) uE I r
(Complete Job Site Address)
Based upon that exiinati� determined the installation was done according to the
Hurricane Mitigati n Retrof 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 day off�C��
Notary Public, State of Florida at Large
1 NICHOLAS MEDINA
Notary Public
State of Florida
Comm# HH178647
tads Expires 9/23/2025
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