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1"1 2010 �- . - DEPU r• it
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City of Boynton Beach
�N °` , 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 - Building Division
Field Inspection Section
100 East Boynton Beach Blvd., PO Box 310
Boynton Beach, FL 33425-0310
Re: Pe, r`lit No. I / $ /ODD 5O "
1
From: "®Lyose. 11 /1- ..1-10._I� . U (Contractor)
0 S,, F -r 10or-Ih I f . (Contractor's Address) •
_June A-p »120lel • (Owner/s Name)
&/b5 4-J/aalIL DY /6o yir/aic) acii . (Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
FCertiffcation of roof metal installation, flashing, underlayment.
Certification of re-nailing roof sheathing, and removal and replacement of damaged or rotted wood.
Other ' c !I
I, �Qrh ^�kaLe am certified as a roofing contractor (License No.
f O -1 `toCit'i • ) and do hereby certify that all roof work (as indicated above) has been performed
at the aboaddress in accordance with Chapter 15 of the Florida Building Code, Existing Building, as
amended, a anufacturer's Specifications. I understand that the City of Boynton Beach offers progressive
re-roof in ecf ns. I have notified the owner of the property of this affidavit. / fLI )l(D
Sign t'ue of ualifier Date
STATF OF FLORIDA, COUNTY OF PALM BEACH Leant- /
The foregoing instrument was acknowledged before me this 3Ilfwl/(a late) by L1 a I - "-'L 'o LIbewho
(personally known-Do me or who has produced (type of identification)as identification
and who did (did not)take an oath. (SEAL)
Signature of person taking acknowledgement
klaISL
Name of officer takingacknowledgement-typed,9 typed, printe o stamped VIM LEN ENRI9UEZ
Title or rank Commission p FF 926879
Serial nu er '�,�>
i, ' My Commission Eapfies
fi.� October 13, 2019
100 East Boynton Beach Blvd, PO Box 310, Boynton Beach FL 33425-0310 Phone: (561)742-6350 Fax: (561)742-6357
S:IDevelopmentlBuilding1Forms&TemplatestRoofingMetal&SheafhinglnsfallationPolicy&Afdavit-18,2family(12/99,12/02,1/03.10/03,11/05,9/06, 04/09,
7/12)