PERMIT DOCUMENTS •
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a`r��= 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. 1700001791
From: AME-rro l,Jc. (Contractor)
333o ZIP AVE tv 4t II PALA4 SQrewc s Fa. 33'k. I (Contractors Address)
N AnibR6 f Ly/40 PRuv}IOMME (Owner/s Name)
1003 sw 31zD Ave. (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 METAL PcoF Iu57Au.a fg Ft_/7/.3-R2. ; UN-7EJC4AyMEAIT Fos FL I Iho2.-R3
I, GLEN-4 P. RIMPELA , am certified as a roofing contractor (License No.
CCG 058057 ) 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
amend:., a r - turers Specifications. I understand that the City of Boynton Beach offers progressive
re-ro0 r � e •otified the owner of the property of this affidavit.
r 8-31-17
;.'•n- re of Qualifier Date
STATE OF FLORIDA,COUNTY OF PALM BEACH / 1� /�� /
The foregoing instrument was acknowledged before me this �13s✓ �// �(date)by l7/e/J/2 t L/X��/gi who
is personally known to me or who has produced / (type of identification)as identification
and who did(did not)take an oath. (SEAL)
Signature of person taking acknowledgemen t 91—
Name of office king acknowledgement—typed, printed or sta ped
Title or rank Zar Serial number RGALINE SOLIS PAGAN
'=My COMMISSION r GG01N61
EXPIRES September 16,2020
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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