PERMIT DOCUMENTS 01Y o
Ati City of Boynton Beach iL- L E r
°` Building Division
INSTALLATION AFFIDAVIT
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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 33425-03101
Re: Permit No. ( (0 -,23 1a
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From: �cpitc (Contractor)
'�3vlo S. ,NthOC\ , coro\c'at....1/4)e-aCk-k (Contractors Address)
(Owner/s Name)
S0\1,'eka' :, \Wc, C 1..1, (Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
Certification of Window Installation
certification of Door Installation UQs\ 7 o.DR
❑Other (glass block, etc)
I, '�lci, �3a-1 .. , am a licensed contractor (license No.
�, V �yl5 ty\03 . ) 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/NON Product Approvals submitted.
ig ature of a4di Date
STATE OF FLORIDA, COUNTY OF PALM BEACH (('
• -•.• • •• . . ment was acknowledged before e this' t�01CS (date)by\1C lnkt,.., �AV\.A , who
is personally known to m: ,r who has produced (type of identi;S)I4s,identification
and w o .1. .1. not)take an o- h. • • � o
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Signature of person taking acknowledgem es 91pNPa• i
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Name of officer taking acknowledgement--type•, . • . :, .•d • • : :40 :*
Title or rank Sen .. ... .
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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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+� City of Boynton Beach
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Building Division
TON �P
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:
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100 East Boynton Beach Blvd,Ii4i34.10`Boyidl Bsaci�-13475-03'(0 "'hone:(561)742-6350 Fax:(561)742-6357
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