RF-11-23-2781 Inspection Affidavit 9405 NE 9 AveMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
Permit # -�L^lia_ 23 -- 2:7 1
DATE: 11- 27- 2O? a
INSPECTION AFFIDAVIT
�� licensed as a(n)( o�ctor/ Engineer / Architect,
(Print name and circle License Type)
License #:
On or about -2-7 2'� - �C) cs�.�. I did personally inspect the roof deck nailing
(Date & time)
work at QLat ; -) u 1✓ 0 Noe A.ramm t -:FI
(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 2
Notary Public, State of Florida at Large
LUCAS ROSSATO
MY COMMISSION # GG 965111
EXPIRES: March 12, 2024
.For Fy°
Oonded Thru Notary Public Undewfiers
For Forms and Applications click here:
http://bldg.miamishoresvillage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
Rev01 142021 Inspection Affidavit Page 1 of 1