RF-12-22-3127 Inspection Affidavit 308 NE 96 StPermit #
Miami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
DATE: L&. (, 2°l ► Z-OZ3
INSPECTION AFFIDAVIT
I — hl-e--M'-�;Llicensed as a(n) Contractor / Engineer / Architect,
(Pri t name and circle License Type)
License #: cc 13 3 1 I
On or about 0 2Q 2DZ3 1 did personally inspect the roof deck nailing
(Dat & time)
work at 30S A(C , LnQ h, S>A-bC49S 421, 6ty 3g
(Complete Job Site Address)
Based upon that examinaton I have determined the installation was done according to the
Hurricane Mitigation Retrgfi� 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
Notary Public, State of Florida at Large
Y Y'Pubtic state o! Fronde
xatar
` JAT�€�EofA
;p My Cammi�aian Hri �5e473
'% E%Prres 1010412024
-•OFf��
2�1 day of ddrCA Zo z3
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