PERMIT DOCUMENTS Alt . City of Boynton Beach
j-.‘."4>14
° 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
/A
Re: Permit No. I 1-544
From: rePenliec C -tp ca.ti in- (Contractor)
Igo S .8. ,-2kd At ii U-2_ 4x -&1 Eg4&1Th (Contractors Address)
0ic6Dlas 1ISlea.0. (Owner/s Name)
S-3 3 S.2 .aBIhCur)e- Lthiq '13 B (Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
Certification of roof metal installation, flashing, underlayment.
QCertification of re-nailing roof sheathing, and removal and replacement of damaged or rotted wood.
70ther i1R 9)b *&c sad V lna.Q
I, i PJiL/1 rnJlIie6Af14 , am certified as a roofing contractor (License No.
0,0 eD 3 Lii c ) 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
•a ections. I have notified the owner of the property of this affidavit. 47 i 17 7117
re o Quaf rawle\ Date
STATE OF FLORIDA, COUNTY OF PALM B�BEEA�H �
The foregoing instrument was acknowledged •efore, t r\ (date)by�� t� , ho
is personally known to me or who has produce. \ (type of identification) asaeeidentifica ion
and who did (did not)take an oath. la,
Signature of person taking acknowledgement ,,ti"V""•y, SYLVIA PECANO
1 , '. Notary Publk•Stete of Florloa
Name of officer taking acknowledgement—typed, printed or stam•ed Commleelon a FF 957959
�t .:
Title or rank -+. ° My Comm.Expires May 19,2020
Serial number ,ran ,
Bonded through National Meaty Assn.
100 East Boynton Beach Blvd,PO Box 310,Boynton Beach FL 33425-0310 Phone:(561)742-6350 Fax:(561)742-6357
S:IDevelopmentlBuiltlinglForma TemplateslRoofingMetalBSheathinglnstellationPolicy8AfrMavit-182family(12199,12002,1/03,10/03,11/05,9106,04/09,
7/12)