PERMIT DOCUMENTS / 51 CO2 03
o`1� City of Boynton Beach
�• Building 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. 15-5203
From: Paradise Exteriors I Dan Beckner (Contractor)
1918 Corporate Drive, Boynton Beach, FL 33426 (Contractors Address)
Randy and Christine Bauer (Owner/s Name)
600 Snug Harbor Drive unit A13, Boynton Beach, 33435 (Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
❑■Certification of Window Installation
Certification of Door Installation
❑Other (glass block, etc)
I, Dan Beckner , am a licensed contractor (license No.
SCC131150472 ) 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 Manufacturers Installation Instructions/NOA/ Product Approvals submitted.
Signature of Qualifier Date
STATE OF FLORIDA, COUNTY OF PALM BEACH
The foregoin• instrument was acknowledged before me this 3/21/2016 (date) by Dan Beckner , who
is elly known to me who has produced (type of identification)as identification
and who did (did not)take an oath.
Signature of person taking acknowledgement MOO F_� - f•°1 ��;SOPHIE MARIE ELLISON
Name of officer takingacknowledgement—typed,ement— Sophie Ellison MV COMMISSION#FF 180900
g typed, printed or stamped Pp
v ; , • EXPIRES December 3,2018
Title or rank Serial number FF180900 (407)308 0153 FlorloallotaryserviCe.corn
100 East Boynton Beach Blvd, PO Box 310,Boynton Beach FL 33425-0310 Phone:(561)742-6350 Fax:(561)742-6357
S:IDevelopmenttBUILDING%Fonns-Templates-Signs%Window and Door Arfidavitdoc(11/11)