RF-01-23-237 Inspection Affidavit 248 NE 98 StMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.4ov
Permit # F rO 123--23_]
DATE: � I & 193
INSPECTION AFFIDAVIT
�J
I 1 �W � 0,r fi t - licensed as a(n) Contractor / Engineer / Architect,
(Print name and circle License Type)
License #: CC (f � C
On or about_ [ G 193 , 1 did personally inspect the roof deck nailing
(Date & time)
work at 2L48 N C�g+h S�
(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)
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 S" Y'�day of
Notary Public, State of Florida at Large
I
rgTP��� EBONY K I_EWIS
? ems: Notary Pub is -State of Florida
=' mission # HH 191795
srr�Rs My commission Expires
October 27, 2026
For Forms and Applications click here:
http://bldg.miamishoresvillage.com/WebL!nk/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
Rev01 142021 Inspection Affidavit Page 1 of 1