RF-08-23-2148 Inspection Affidavit 165 NE 109 StMM
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Permit # RI--08-23-2148
I HAEL15 RUURIGULL
Miami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.aov
DATE: 10/1 1/2023
INSPECTION AFFIDAVIT
(Print name and circle License Type)
licensed as a(n) Contractor / Engineer / Architect,
License #: C;UU 1332944
On or about 10/1 02023 , 1 did personally inspect the roof deck nailing
(Date & time)
work at 16b NE 109 61 MIAMI 6HURE6, FL 33161
(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)
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 1 / I H
day of UG I UI3ER, 202:3.
Notary Public, State of Florida at Large YE66ENIA RHYE6
YESSENIA REYES
}�r=;� • Notary Public - State of Florida
Commission # HH 411330
;.r M;, Comm. Expires Jun 15, 2027
5crced through National Notary Assn.
For Forms and Applications click here:
http://bldg.miamishoresvillage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
Rev01142021 Inspection Affidavit