PERMIT DOCUMENTS o`�: 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. 17-0419
From: Lowes Home Centers Inc (Contractor)
1500 Corporate Drive Boynton Beach FL 33426 (Contractor's Address)
RICHARD BRINKER (Owner/s Name)
646 SNUG HARBOR DR#403 BOYNTON BEACH FL 33435 (Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
'Certification of Window Installation
]Certification of Door Installation
❑Other (glass block, etc)
I, Peter Anthony Cafaro III , am a licensed contractor (license No.
CGC1508417 ) 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 Manufacture stallation Instructions/NOA/Product Approvals submitted.
dir
3-3-17
Sign. re of •"alifier Date
ST•TE OF FLORIDA, COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this 3-3-17 (date) by PETER ANTHONY CAFARO IWho
is personally known to me or who has produced (type of identification)as identification
and who did (did not)take an oath. (SEAL)
Signature of person taking acknowledgement
Name of officer taking acknowledgement--typed, printed or stamped TIMOTHY G COOPRIDER „ s _ , — — --a _
Title or rank Serial number ;.• :a;;4, TIMOTHY G COOPRIDER�
.° '1? ,s Nc,ary Public•State of Florida
•t Commission S FF 939999
``%y My Comm.Expires Dee 9,2019
, 6 Bonded tMalyl Natbnd Notary Msa.
100 East Boynton Beach Blvd,PO Box 310,Boynton Beach FL 33425-0310 Phone:(561)7424350 Fax:(561)7424357
SADevelopmentlBUILDINGIForms-Templates-Signs1Window and Door Affidavit doc(11/11)