RF-07-23-1676 Inspection Affidavit 50 NE 108 StMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
Permit # ^9 r V7 ; ;3 /.6 76
DATE:.
INSPECTION AFFIDAVIT
I 0-D r-r r licensed as a(n) Contractor / Engineer / Architect,
(Print name icense Type)
License #: e L b S 7-� L
On or about Z 3 1 did personally inspect the roof deck nailing
( ate & time)
work at !�b 11/!�• /r7 �- r
(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)
Sign ure
State of Florida, Miami Dade County:
The undersigned, being the first duly sworn, deposes and rays that he/she is the contractorfor
the above property mentioned.
Sworn to and subscribed before me this 2'5 day of be-M23
Notary Public, State of Florida at
DLW- q I W-'e,
\1AVIA M. ROGERS
Notary Public - State of Florida
cr n�
Commisslon # HH 123451
My Comm, Expires Jun 30, 2025
Borcec through National Notary Assn.
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