RF-05-20-1004 INSPECTION AFFIDAVITMiami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795,2204
Fax: (305) 756.8972
RE: Permit # l or � DATE:
INSPECTION AFFIDAVIT
I i^ a— 1/0, licensed as a (n) Contractor / Engineer / Architect,
(Print name and cirde License Type) FS 468 Building Inspector
License* ecc /330.)/3
On or about 6'/31 a o , I did personally inspect the roof deck nailing
(Date 8 time)
(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
County of Dade:
The undersigned, being the first duly swom, deposes and says that he/she is the contractor for the above property
mentioned.
Sworn to and subscribed before me this day of--� P
P
�� C t C M bf VENEICE CAMMOCK
Notary Public, Sate of Florida at Large NOTARY PUBLiC, STATE OF FLr:';f(�A
i iY COMMISSION #GG 090712
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My COMM. EXPIRES APRIL 5, 2p?f
f3ONVED THAU NOTARY PLWC UNDERWRITERS
'General, Building, Residential, or Roofing Contractors or any Individual certified under 468 F.S. to make such an Inspwllon Include phologre s o ea p ne 6r7a'i'ddfWlir—
permit 4 and address # dearly shown marked on the deck for each inspection
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