PERMIT DOCUMENTS „it?
City of Boynton Beach
`"r°PN °` 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 00000 (0o7
From: R-PA 141/4.D AC-r P R eIN-Cs (Contractor)ro
4075 1'Vbas"Tit ST. LA-Ittutaf1M 3' (contractor's Address)
1-11c,P Po tk)t WKSS CeatJ60 Z PLIC - (Owner/s Name)
3,a AAA vw 731,UD . $a'yasierj $ t F. 31 'aS(Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
❑Certification of Window Installation
✓Certification of Door Installation
❑Other (glass block, etc)
SILL\JA4 , am a licensed contractor (license No.
SEC 131151192 ) 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 Manufacturer's Installation Instructions/NOA/ Product Approvals submitted.
0 3 17 (17
Signatu.74-1414/7"
of Qualifier Date
STATE OF FLORIDA, COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this 317 I7 J
(date)by E QIN S AAAVAT t who
is personally known to me or who has produced (type of identification)as identification
and who did(did not)take an oath. ��/1 / (SEAL)
Signature of person taking acknowledgement �`. < ,, .,Ya, VERONICA J MCOUIBTON
Name of officer taking acknowledgement--typed, printed or stam ed .° , Notary Public-Stale or Florida
Title or rank 4; -,• • My Comm.Expires Dec 20,2018
Serial number Commission p FF 178775
( '• Wt” Bonded through National Notary Man.
100 East Boynton Beach Blvd,PO Box 310,Boynton Beach FL 33425-0310 Phone: (561)742-6350 Fax:(561)742-6357
S:IDevelopmenit2UILDINGIForms-Templates-Signsttrindow and Door ARdavit.doc(11/11)
009� City of Boynton Beach
Building Division
Tonic
WINDOW & DOOR INSTALLATION CERTIFICATION
FOR LICENSED CONTRACTORS ONLY
I. PURPOSE
The purpose of this Policy is to provide a method for certifying installation of replacement
doors and windows. This policy applies only to licensed contractors or owner qualified
for exemption under Florida Statute 489.103 (7)
II. AUTHORIZATION •
Section 104.12 of the Boynton Beach Amendments to the Florida Building Code as
adopted by the City of Boynton Beach, provides that requirements necessary for the public
safety, health and general welfare not specifically covered by the standard or the Building
Official shall determine other technical codes or policies.
III. APPLICATION
Qualified applicants may certify the window and/or door installation by preparing an affidavit
certifying that the installation of the window and/or door complies with all codes, ordinances,
rules and regulations; that the qualifier or designee personally inspected the specific job; and
that the window and/or door was installed according to the 2010 Florida Building Code, and
Existing Building Code, as amended, and the Manufacturer's Installation Instructions/NOA/
Product Approvals.
This affidavit must be presented to the inspector at the Final scheduled inspection on-site.
The Structural Building Inspector will fail the inspection until certified by the applicant or pass
the inspection if the signed affidavit is present at the job site. A Final is the only scheduled
inspection and an affidavit supplied, the Inspector shall add the comment, "CERTIFIED," and
pass the inspection.
Inspections may be requested by calling the inspection clerk 24 hrs in advance at (561)
. 742-6355.
100 East Boynton Beach Blvd,PO Box 310,Boynton Beach FL 33425-0310 Phone:(561)742-6350 Fax:(561)742-6357