HomeMy WebLinkAboutRoof Affidavit Planning&Development Services
Building&Code Regulation Division
2300 Virginia Avenue
Fork Pierce, FL 34982
772-462-2165 or"772-462-2177,
Fam 772-4-62-644-7,
ROOF INSPECTION AFFIDAVI
Re: Permit# sit—c-
-'S7 I" (,'o'
S licensed as ri)C�o;nt;ractci�� ngineer/Architect
tor�
(Please print name Q&-C.-Ircle license'type) C1g inspector
5 ul
*F546 ui Ing Inspector
"General,Building,Residential or Roofing Contractor or any individual certified under 468 FS.tomake such an inspection.
On or about 3 ( 1(0 ( 1(C? , I did personally inspect the roof deck nailing
(Date)'
work at: e- q
(Job site address)
Based upon that examination I have determined the installation was done according to the current
edition of the Florida Existing Building Code Section 611 or the product approval submitted (whichever is
most strigent).
73
S' natureand Seal License#
STATE OF FLORIDA 1,14
COUNTY OF
Sworn to and d day of 20Z '?
ecri e Wore me this
4
by (/I/I. Who is personally known to me or who has produced
as identification.
Notary Public,State of Florida
ignature of Notary:
Commission Number: (Seal)
En 01/19/2011
IF Stephen P.Frederick
NOTARY PUBLIC
STATE OF FLORIDA
Commit GGo4a393
Expires 1/27/2021