PERMIT DOCUMENTS c.,tr o„
t�' _ .City of Boynton Beach
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�`",..„ ., 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. 1 ( ,- 39I
From: Paul Bange Roofing of S FL Inc (Contractor)
3694 23rd Ave So#6 Lake Worth, FL. 33461 (Contractor's Address)
• Gervolino (Owner/s Name)
2113 SW 13th PI. Boynton Beach, FL. (Property Address) _. .
CCTIFICATION SELECTION: (Please check all that apply)
ertification of roof metal installation, flashing, underlayment.
Certification of re-nailing roof sheathing, and removal and replacement of damaged or rotted wood.
❑Other
I, David A. Welby , am certified as a roofing contractor (License No.
CCC042778 ) and do hereby certify that all roof work (as indicated above) has been performed
at the above .p.ress in accordance with Chapter 15 of the Florida Building Code, Existing Building, as
amended, an. an ”. turer's Specifications. I understand that the City of Boynton Beach offers progressive
r--r.of inspe, ii, . /aye notified the owner of the property of this affidavit.
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Si' ature o'Slug lier.r Date
STATE OF FLORIDA, 'OUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this�b'�y�� (date)by David A.Welby , who
is personally known to me or who has produced (type of identification)as identification
and who did (did not)take an oath. ` (SEAL)
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Signature of person taking acknowledgement .
74470
Name of officer taking acknowledgement—typed, pri ted or stamped :%,y, APRIL L.STRENGTH
Title or rank Serial number ExpiressApn#EE 817
h. cs Expires April 22,2017
•irisr Banded il+uTmr Fain!name 90931147919
100 East Boynton Beach Blvd, PO Box 310,Boynton Beach FL 33425-0310 Phone: (561)7424350 Fax:(561)742-6357
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