HomeMy WebLinkAboutRoof Inspection Affidavit P.1
Planning &Development Services
:j J, Building&Code Regulation Division
® � 2300 Virginia Avenue
Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax:772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit#SLC k66\- Q 0o 3
licensed as a(n)Contractor*/Engineer/Architect
(Please print name&circle license type) *FS468 Building Inspector
*General,Building,Residential or Roofrng contractor or any individual certified under 468 F.S.to make such an inspection.
On or about a 20( (p I did personally inspect the roof deck nailing
( ate)
work at:
(.lob site address)
Based upon that examination I have determined the installation was done according to tfie current
edition of the Florida Existing Building Code Section 611 or the product approval submitted (whichever is
most strigent)" ,
/11
t UCS
Si ature and Seal License# 0
STATE OF FLORIDA
COUNTYOF21�.L HCl
Sworn to and subjcribed before me this day of Vic,,n. 21) &
by �5-c>k h Q VLQ-'r4L o is persona y known o me r who has produced
as identi cation.
Notary Public,State of Flori
Signature of Notary: .[i+•-
Commission Number: (Seal)
fn 01/19/2011
A'0'P Pti,•
; .:•.cTIMOTHY R GAFFAIV
• tV1Y CC)MMISSION#FF014241
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