PERMIT DOCUMENTS f �
6,� Ga.
o`t��, 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- Building Division
Field Inspection Section
100 East Boynton Beach Blvd., PO Box 310
Boynton Beach, FL 33425-0310
Re: Permit No. 1600001090
From: T H MOTTLEY CONSTRUCTION INC (Contractor)
378 NORTHLAKE BLVD.,#266 NPB FL. 33408 (Contractors Address)
DERILUS MARICUS (Owner/6 Name)
235 NW 28TH AVE. BOYNTON BEACH (Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
['Certification of roof metal installation, flashing, underlayment.
['Certification of re-nailing roof sheathing, and removal and replacement of damaged or rotted wood.
['Other
TERRANCE MOTTLEY , am certified as a roofing contractor (License No.
ccc1327647 ) 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 Manufacturers Specifications. I understand that the City of Boynton Beach offers progressive
r • pections. I have . j • the owner of the property of this affidavit.
_arroin402_ A114 • I APRIL 5TH.2016
Signature of Qualifier Date
STATE OF FLORIDA, COUNTY OF PALM CH
The foregoing instrument was acknowledged before me this Oc-fit (aml6 �ER
(date)by RANCG 6uorrcc-7 , who
is personally know me or who has produced ✓ LI (type of identification)as identification
ano (did not)take (SEAL)
Si of
Signature of person takingacknowledgement
Name of officer taking acknowledgement—typed, printed or stamped at NEST CAC t r
Title or rank ML7 S,,.,;(� aL avr+'�`L Serial-number £S`l C 9 • , h ERNEST GARVEY
r �/' �. ., � MY COMMISSION I EE 854159
EXPIRES:January 16,2017
Sow • Nadi ISu Budget Notary Semen
100 East Boynton Beach Blvd,PO Box 310,Boynton Beach FL 33425-0310 Phone:(561)742-6350 Fax: (561)742-6357
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