PERMIT DOCUMENTS 02, Oe
,tilt City of Boynton Beach
pc.„.‘ Building Division
LICENSED ROOFING CONTRACTOR
AFFIDAVIT
ROOF METAL & ROOF SHEATHING INSTALLATION
(EXISTING ONE & TWO FAMILY DWELLINGS ONLY)
The City of Boynton Beach offers progressive inspections - call 742-6355
To: City of Boynton Beach, Florida,.
Department of Development - Building Division
Field Inspection Section
100 East Boynton Beach Blvd., PO Box 310
Boynton Beach, FL 33425-0310
Re: Permit No. I y- . 7 C L
From: CD t 5krtic,.v- t1uoFleas, (Contractor)
• I Vu ti.1.-1. i ir r- Av(- l04/at CitRatAreC. 9 7Y9 ontractor's Address)
rl a 5 fL R (Owner/s Name)
3?05 .5 ; tact/ b>L (Property Address)
C TIFICATION SELECTION: (Please check all Thal apply)
I I/l rtification of roof metal installation, flashing, underlayment.
rtification of re-nailing roof sheathing, and removal and replacement of damaged or rotted wood.
Other Mek( - INSRllei M<MN I1•Irtitt%1 5f l„4y 1,ek„�-
I, KOb-t,m L M! bboail // , am certified as a roofing contractor (License No.
cccolll H ? ) and do hereby certify that all roof work (as indicated above) has been performed
at the above address in accordance with Chapter 15 of the Florida Building Code, Existing Building, as
d, and Manufacturer's Specifications' I understand that the City of Boynton Beach offers progressive
re-roof in pections. I have notified the owner of the property of this affidavit. `7J A ) _/Y
Signaturof Qualifier Date
STATE OF FLORIDA, COUNTY OF PALM BEACH *� , /
The foregoing instrument was acknowledged before me this i 2 / (Udate) by (ThmLtho
ispersonally known to me or who has produced f
(type of identification) as identification
and who did (did not) take an oath. (SEAL)
�
Signature of person taking acknowledgement )O bh,,t \
Name of officer taking acknowledgement--typed, printed or stamped
Title or rank Serial number
:g'' "• DEBBIE ROY
�',. ?:: Commission#FF 017976
1
r:!.?„��-° ` Expires August 21,2017
AP:.n?e• ggge0 ileo Tray Fein lrmvn 800161019
100 East Boynton Beach Blvd, PO Box 310, Boynton Beach FL 33425-0310 Phone: (561)742-6350 Fax: (561)742-6357
S:IDevelopmentleuildingtForms&Temp/atestRoohngMeraisSheathinglnstallationPolicy&Atfidamt-182tamily(12/99,12,02,103,10/03,11,05,9,06, 0409)