RF-08-23-1956 Inspection Affidavit 585 NE 102 StPermit #
Miami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.ciov
. DATE: 01- k� -U
INSPECTION AFFIDAVIT
1 Lou tS ToQo licensed as a(n) Contractor / Engineer / Architect,
(Print name and circle License Type)
License #: CCZ— \'bZ 6032
On or about , I did personally inspect the roof deck nailing
(Date & time)
work at $5 h! (z-. 101 ST 1AtUM, S6 ce5 . C I- . 3313 3
(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.(' day of Z�
Notary Public, State of Florida at Large
a JAVIER PUIO
a• ° Notary Public
a State of Florida
y Comm# HH084634
For Forms and Applications click here: r:xpires4/3D/20T5
http://bldg.miamishoresvillage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
Rev01142021 Inspection Affidavit Page 1 of 1