PERMIT DOCUMENTS o`t�i= City of Boynton Beach
"'On °L 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. / 76000O (rJ��, S y
From: f (l.C.. �Cn Roo t-/nq (Contractor)
1 cS- Par K tjCk 2.5 SDP 1f)`f l,` r FL (Contractor's Address)
Mas;L \ nn�s+-nr1 (Owner/s Name)
912 SIA) 1'+•thJp Air to?pv, elenrn (Property Address)
CEF}TIFICATION SELECTION: (Please check all that apply)
�Certification of roof metal installation, flashing, underlayment.
I✓Certj is ion of re-nailing roof sheathing, and removal and replacement of damaged or rotted wood.
Other In P1OQr-
I, , am certified as a roofing contractor (License No.
enc C t3 Leila ) 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 Manufacturer's Specifications. I understand that the City of Boynton Beach offers progressive
re-roof• s ections. I have notified the owner of the property of this affidavit.
13P1)17
Si ture of Qualifier Dat
STATE OF FLORIDA, COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this42J2011 (date) by J(lt'1 fl (_ 41 1 -who
t
is personally known to me or who has produced cte ..T—‘ (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 st ped e," r�"";\ KELLY POOLE
Title or rank Serial number d. MY COMMISSION#FF086990
o,no•,, EXPIRES January 12,2018
(407)398-0153 Florioallotwyservice.Com
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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7/12)