RF-10-23-2482 Inspection Affidavit 246 NE 102 SPermit # -RF - m -2�- ,7,1 R2
Miami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msv#l.go►r
4
DATE: La 1-23
INSPECTION AFFIDAVIT
licensed as a(n) =Contractor/ Engineer / Architect,
(Print name and circle License Type)
License#: GCC.o.33G9i
On or about fi al 23 T - ►g: mc,", I did personally inspect the roof deck nailing
(Date & time)
work at -2 q to ►u e- .I,Q�2 5t , M i tknovc-s , -r i.. .&31.38
(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)
VHF -• ��
Signature ---'-Z- --
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 3 _day of u
Notary Public, State of Florida at Lar
h
,��5'�; GISELLE T. VIC.EN E €
Notary Public-Stat: of Floral;
4"Fi)
Commission # Hh 55032 1
My Commission Expires l'}
�f++i i5iOctober:�
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