RF-09-22-2469 Inspection Affidavit 9701 N Miami AveMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
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DATE: 1 i I l S /')_ a
INSPECTION AFFIDAVIT
licensed as a(n) Contractor / Engineer / Architect,
(Print name and circle License Type)
License #: G/_'C / `3 2 Y -)- ";-7 S
On or about 1 / / / 1-/ ID -> a- , I did personally inspect the roof deck nailing
I(DatW& time)
work at "-/,7-o1 1 ' ; ; fi- , /"li
(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 day of
Notary Public, State of Florida at Large �?
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/V 0 Ve /--► -t'rp
""'• GEOFFREY CHAN
4}WX
rAu;sNotary Public -State of Florida
ati August 20, 2025 Commission # HH 160695
,1M1My Commission Expires
For Forms and Applications click here:
http://bldg.miamishoresvillage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
Rev01142021 Inspection Affidavit Page 1 of 1