PERMIT DOCUMENTS City of Boynton Beach
Building Division
LICENSED ROOFING CONTRACTOR
AFFIDAVIT
ROOF METAL & ROOF SHEATHING INSTALLATION
(EXISTING DETACHED 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 r Building Division
Field Inspection Section
100 East Boynton Beach Blvd., PO Box 310
Boynton Beach, FL 33425-0310
Re: Permit No. / 'h2 2
From: Rnsqlpr Rnnfing Tnr (Contractor)
860 N. 8 St. , Ste 1 , Lantana, FL 33462
(Contractor's Address)
uta ne.rn ARD e5 (Owneds Name)
5-94 519 RAM ���pt�([ (Property Address)
CERTIFICATION SELECTION: (Please check ell that apply)
[aCertification of roof metal Installation,flashing, underlayment
Ebertfficarnfi mg roofistieatliittg, and removal and replacement of damaged or rotted wood. .
Other yet(o1P_F--SS
I, Christopher Bossier am certified as a roofing cont actor (License No.
CCC 1 3 2 6 3 0 8 ) 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
amended, and Manufacturer's Specifications. I understand that the City of Boynton Beach offers progressive
f inspections. n ed the owner of the property of this affidavit
/7 zdt -1
Signature of Qualifier Date
STATE OF FLORIDA,COUNTY OF PALM BEACH �,/
The foregoing instrument was acknowledged before me this?/5� ?Pao by Christopher Boss,kror
is personally known to me or who has produced UUUU (type of identification)as identification
and who did(did not)take an oath. (SEAL)
Signature of person taking acknowledgementALtlz4 LI 4
Name ofofticertaking acknowledgement—typed,printed or Anm Higgins • r�y'�f% ANMARIEHIGGINS
Title or rank Notary Public s� 195026 Serial munber �IeTG M1'COMMISSIONIEEI91826
u EXPniES:May 06,2016
100 East Boynton Beach Blvd PO Box 310,Boynton Beach FL 33426-0310 Phone:(561)7428350 Fax:(561)7428357 -
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