RF-01-23-53 Inspection Affidavit 100 NE 104 StPermit # RF 0I-2.3-53
Miami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
DATE:
INSPECTION AFFIDAVIT
I IA1C14 ano licensed as a(n Contractor / Engineer / Architect,
(Print name and circle License Type)
License #: CO C 1
On or about-2/to AW2.7), I did personally inspect the roof deck nailing
(Date & time)
work at 100 1�e In 4�1 e�' FL --33e3
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the
Hurricane Mitigati�4.ftetrofit 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
day of
}N.'`'3(ANDPA CALVO
a -Notary Public - State of Florida
Commission # HH 233760
My comm. Expires Feb 27, 2026
Bonded through National Notary Assn.
For Forms and Applications click here:
http://bldg.miamishoresviIlage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
RevOI 142021 Inspection Affidavit Page 1 of 1