PERMIT DOCUMENTS L1Yp
:.City of Boynton Beach
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\,... .eBuilding Division
INSTALLATION AFFIDAVIT
WINDOW & DOOR (replacement)
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. \ U0 —CRe33
From: n1/43cC i\-kz-ra(IIAC-IC, UCL (Contractor)
C:::k,Lz S. Q tion ti- �1�% AA , 0o`MC'�aNO (Contractor's Address)
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C�tonc \�cnCIN V'-L S r (Owner/s Name)
0l�1 SbJ G.SZC.}�tc Q \oJ�rCll �% \3C.11(Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
Certification of Window Installation
Certification
of Door Installation CA(\.20. 0
Other (glass block, etc)
I, `Th _lti t, `TTA v.`s , am a licensed contractor (license No.
C(C\`T \y \03 ) and do hereby certify that all work (as indicated above) has been performed and
installed at the above address in accordance with the Florida Building Code, Existing Building, as amended,
and Manufacturer's Installation Instructions/NOA/Product Approvals submitted.
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Signature .. Que FLORIDA, - Date
STATE OF + •F PALM BEACH
The • -••' • 'lent was acknowledged before m= this ' • `\ (date)by ( Lala��i1, who
i •- onall know. • •e: • who has produced I (type of identificati �\`\ B�MYif'///4,,
and who did(did not)take an oath. `� p�IcrlFk % 9
Signature of person taking acknowledge - a :To-mac .2o49-4?„.cr, ,*Si
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Name of officer taking acknowledgement--typed, pri :• r sta •e• e*; to• G.
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Title or rank Serial 1 :., 4�ol, q� tae:;*,
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100 East Boynton Beach Blvd, PO Box 310,Boynton Beach FL 33425-0310 Phone: (561)742-6350 Fax:(561)742.6357
S:IDevelopment%BUILDINGIForms-Templates-SignslwIndow and Door Affidavit doc(11/11)
City of Boynton Beach
` Building Division
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WINDOW & DOOR INSTALLATION CERTIFICATION
FOR LICENSED CONTRACTORS ONLY
I. PURPOSE
The purpose of this Policy is to provide a method for certifying installation of replacement
doors and windows. This policy applies only to licensed contractors or owner qualified
for exemption under Florida Statute 489.103 (7)
II. AUTHORIZATION
Section 104.12 of the Boynton Beach Amendments to the Florida Building Code as
adopted by the City of Boynton Beach, provides that requirements necessary Ifor the public
safety, health and general welfare not specifically covered by the standard or the Building
Official shall determine other technical codes or policies.
•
III. APPLICATION
Qualified applicants may certify the window and/or door installation by preparing an affidavit
certifying that the installation of the window and/or door complies with all codes, ordinances,
rules and regulations; that the qualifier or designee personally inspected the specific job; and
that the window and/or door was installed according to the 2010 Florida Building Code, and
Existing Building Code, as amended, and the Manufacturer's Installation Instructions/NOA/
Product Approvals.
This affidavit must be presented to the inspector at the Final scheduled inspection on-site.
The Structural Building Inspector will fail the inspection until certified by the applicant or pass
the inspection if the signed affidavit is present at the job site. A Final is the only scheduled
inspection and an affidavit supplied, the Inspector shall add the comment, "CERTIFIED," and
pass the inspection.
Inspections may be requested by calling the inspection clerk 24 hrs in advance at (561)
742-6355.
100 East Boynton Beach Blvd,PO Box 310,Boynton Beach FL 33425-0310 Phone:(561)742-6350 Fax:(561)742.6357