PERMIT DOCUMENTS 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. l , - Ocioc021 5
From: ItONAI,D ROSSI ROOFING INC (Contractor)
1480 Arlimino Lane Boynton Beach Fl 33436 (Contractor's Address)
LPI y
n a Vet) /F I/ AA stint's/15 (Owner/s Name)
Z in S g r< Ss. -k fie- 'a-4.A PI (Property Address)
CE TIFICATION SELECTION: (Please check all that apply)
IA( ertification of roof metal installation, flashing, underlayment.
ertification of re-nailing roof sheathing, and removal and replacement of damaged or rotted wood.
• Other �n PtOGr(,(. Rhw I 1 nspet4101
I, RONALD ROSSI U , am certified as a roofing contractor (License No.
CCC1325869 ) 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 Mpfacturer's Specifications. I understand that the City of Boynton Beach offers progressive
re-roof ins y..1" I have notified the owner of the property of this affidavit.
Jan 340 2o11
Sigp ttligi030utier Date
STATE OF FLORIDA, COUNTY OF PALM BEACH !� • /
The foregoing-instrument was acknowledged before me this .jt �j U `" r (date) by gait A aiss, , who
is per naIly�n_to-me or who has produced �/ (type of identification) as identification
a'rr dwvho-did-(did not) take an oath. (SEAL)
Signature of person taking acknowledgement /_
Name of officer taking acknowledgement--typed, printed or st
q • "••L•, JOSEPH A COLLIN III
Title or rank Serial,nt,ofZ lit ff•
/ • _ :its Notary Public State Of Florida
C� i:'• %'t
sa.F My Comm. Expires Jun 9, 2018
•�.F ••• Commission Commission # FE' 122826
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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