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 Sworn
to and subscribed before me this >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 roof with the permit # or address # clearly shown marked on the deck for
each inspection.