RF-04-22-1054 INSP AFFIDAVITRE: Permit # RF-04-22-1054
Gilberto D Giampaolo
(Print name and circle License Type)
License #: CCC1333462
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
DATE: 05/11/2022
INSPECTION AFFIDAVIT
licensed as a (n) Contractor / Engineer / Architect,
FS 468 Building Inspector
On or about 05/11/2022 , 1 did personally inspect the roof deck nailing
(Date & time)
work at 526 GRAND CONCOURSE, Miami Shores, FL, 33138, United States
(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 4 F.S)
Signature
State of Flo rid
County of ID; mod`
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 11� day of
N ` BEATRIZ GLIDINO-CLIAHONTE
Notary Public, Sate of Florida at Large ,, MY COMMISSION #HH072W
EXPIRES: DEC 15, 2024
Bonded through 1st State Insurance
`General, Building, Residential, or Roofing Contractors or any individual certified under 468 F S. to make such an inspection. Include photographs of each plane of the roof with
permit # and address # clearly shown marked on the deck for each inspection
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