PERMIT DOCUMENTS "MC 0,
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City of Boynton Beach
oi a Building Division
LICENSED ROOFING CONTRACTOR
AFFIDAVIT
ROOF METAL & ROOF SHEATHING INSTALLATION
(EXISTING 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 fo -00 002819
From: AME?GO)I nNc. (Contractor)
3330 2i-ta AVE rJ •11I1 PALM SPRINGS Ft 334(1 (Contractors Address)
JAMES PR IE.ST (Owner/s Name)
Iii SW lam Sr (Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
Certification of roof metal installation, flashing, underlayment.
Certification of re-nailing roof sheathing, and removal and replacement of damaged or rotted wood.
Other JM-PA-0GRES,
I, &Lan"( P. RIM?EI.A , am certified as a roofing contractor (License No.
CCC 058051 ) 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 M- 1 urers Specifications. I understand that the City of Boynton Beach offers progressive
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re-roof i• noti iee owner of the property of this affidavit.
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Si. ' alifier
: - � Date
STATE OF FLORIDA, COUNTY OF PALM BEACH D
The foregoing instrument was acknowledged before me this /////‘ (date) by /Pw • iein/e4 who
i personally know me or who has produced (type of identification)as identification
and who did (did not) take an oath. //.. (SEAL)
Signature of person taking acknowledgement(� /�c'�? L ` •' "" .
Name of officer aking admowledprement--typed, printed or sta .ed
Title or rank P�L�j� Serial number �r ROSALINE SOLIS PAGAN
MY COMMISSION a 03018884
EXPIRES September 18,2020
100 East Boynton Beach Blvd,PO Box 310, Boynton Beach FL 33425-0310 Phone:(561)742-6350 Fax:(561)7424357
S:IDevelopmentlauilding1Forms&TemplateslRoofingMetalBSheathinginstellationPolicy&Affidavit-1B2family(12/9912/02,1/03,10'03,11/05,9/06, 04/09)