RF-14-171 (2)f77
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RE: Permit # &f' /f " 17/
Miami Shores Village
-Building - Department
INSPECTION AFFIDAVIT
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
DATE: 42 11,4:25.612614
I ,SrLr.PaF E N t" �o T/ ^I Q JA L. . AE C F,NC.licensed as a (n Contractor Engineer / Architect,
(Prfit name and rude Uww Type) FS 468 Building Inspector
License #: a C. C a!;7 7 i 0 S"w
On or about 'Z bl P-u I did personally inspect the roof deck nailing and
(bete a time)
Secon a ter barrier work at 78 NO 1040 -S-r H, r Ai
(complete Job Sb Addres)
Based upon that examination I have determined the installation was done according to the Hurricane Mitigation Retrofit
Manual (Bas n 553.844 F.S)
.Sr�P FN IK A it 7-1 jkj
Signature
State of Florida
County of Dade:
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 ;;Z ( day of Z ,2v1¢
L46Z e��µ;;; ; ®��o CARMEIO H. PRtoLE1T1 Notary Public, Sate of Florida at Large L * IN COMMISSION # EE 154326
EXPIRES: Aprd17, 2016
u,����oP`Op Ba�'ann Budget Nap 8�,
'General, Bum, Residenbl, or Rooft contractors or any individual Wiled under 468 F.S. to make such an Inspection. Include photographs of each platy of the roof wM
permit# and address # dearly shown market on the deck for eadi hVection
Revue on 01%1008