2300 Sanford Ave - BR09-000184 - ROOF INSPECTION AFFIDAVITUCL 1 b GUUtf -/ : 4bHM U i 1 Y BUF USHNFURD
04
4076885152 p.1
RE: Permit # oc? /ep/
Insnection Affidavit
I 6l a— S6-6 ,licensed as a(n) Contractor* (EngineerlArch tect,
please print name and circle Lin Type) FS 468 Building Inspector*
License #; C%' G 3a—Gz 0191-9
On or. about /49LO(og 3 ' P ' , I did personally inspect the roo
Date 8c tirne)
deck nailin d/dary war econharrier work at circk
one) (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 ,c4oLer Sworntoandsubscribedbeforemethis >6day
of .200 By p
lc, ' 4Coq — No Public,
State of Florida o xr
oti Notary Public State of Florida Thomas Vern
Longroy V A S R4N N My Commission
DD499686 or ! Explros
12/15/2009 (Pent, type or stamp name) Commission No.:
1. Personally knownZor
Produced Identification
Type of
identification produced. General, Building,
Residential, or Roofing Contractor or any individual certified under 468 F: S. to make such an inspection. Include
photographs of each plane of the roofwith the permit # or address # clearly shown marked on the deck for
each inspection.