PERMIT DOCUMENTS LAY oc
' = City of Boynton Beach
•
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. /7— a 60
From: 'G 4-D's £00 C76 00.J ��C. (Contractor)
330 517 a //✓cNdacBRYr4 gloat y vz (Contractor's Address)
,c CA (s'na-A) (Owner/s Name)
/O/(o St.) 2g7#AyrWU (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 z 510,l/ /- r/ SuaM 007 SPq,-rr .7n -/Ug/e'sS
4teRY 3R(at orzb , am certified as a roofing contractor (License No.
CCCOSX0 )2 ) 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 Manufacturer's Specifications. I understand that the City of Boynton Beach offers progressive
re-roof inspectio ve notified the owner of the property of this affidavit. cy
Signature o Quail} r Date
STATE OF FLORIDA, COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this Si- 7.20/) (date) by ACARR'? a b ogh , who
is personally known to me or who has produced (type of identification) as identification
and who did (did not) take an oath. e2at2-Coa � A (SEAL)
Signature of person taking acknowledgement ,�
/ ke�'-"..,,8et, CLAUDIA NELSON
Name of officer taking acknowledgement--typed, printed or stamped e` larto0'q fel5a-. x MY COMMISSION#FF 151238
*:�tG1
Title or rank Serial number EXPIRES:September 23,2018
"error A Bonded Toni Bute)Nolan/Services
100 East Boynton Beach Blvd, PO Box 310,Boynton Beach FL 33425-0310 Phone: (561)742-6350 Fax: (561)742-6357
S:IDevelopmenABuilding\Forms&Templates\PoolingMetal&SheathinglnstallationPolicy&A%idavib 182 family(12/99,12/02.1/03,10/03,11/05,9/06, 04/09)