RF-12-22-3228 Inspection Affidavit 10616 NW 2 AveMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvil.gov
Permit # ? — (A—��'322<8
DATE: I
INSPECTION AFFIDAVIT
licensed as (n) Contractor Engineer / Architect,
(Print name and circle License Type)
License #:
Cc- - 0 �
On or about 24--, , 1 did personally inspect the roof deck nailing
(Date & time)
work at 106 ti' ttj ;X�V r 14 slti V-(f s 1= �
(Complete Job Site Address) 33%��
Based upon that examination I have determined the installation was done according to the
Hurricanee/Mitigation Retrofit Manual (Based on 553.844 F.S)
�J
Signa
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 thi` 1 St dayof
3
Notary Public, State of Florida at Large AA
ALBERT SEARA
Notary Public - State of Florida
Ell
Commission N GG 304563
My Comm. Expires Feb 24, 2023
Bonded through National Notary Assn.
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Rev01 142021 Inspection Affidavit Page 1 of 1