RF-06-23-1568 Inspection Affidavit 9454 NE 4 AveMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www,msvfl.�oy
Permit # RF-16-23-1568
FAB I O RAM I REZ
DATE: 9-16-23
I":SRECT,^": AFFIDAVIT
(Print name and circle License Type)
licensed as a(n) Contractor / Engineer / Architect,
License #: CCC 1329535
�On or about9 16-23 at 1:00 FM , I did personally inspect the roof deck nailing
(Date & time)
work at 9454 NE 4 AVENUE, MIAMI SHORES, FL. 33138
(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 - � � nV�4-m \ Y1 1 --\-
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 (o
votary Public, State of Florida at Large
day of � �"`1'(F� Z J
ALBA INES GLIZMA,r
�°;•„` _ Notary Public - State of F;orida
Commission 4 HH 2.4239
n My Comm, Expires Jan 6. 2026
9or.ded through National Notary Assn.
ram.. -ions
lic
For 'Forms and App icall.1 its cn4A 2i V.
http://bidg.miamishoresvillage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
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