PERMIT DOCUMENTS a
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�' City of Boynton Beach
V
"'I-,N0" 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. 90/7 — 3o 3a.
From: t14b'S ROD!-';,JG Lb, AK. (Contractor)
380 Sr VVra' Alit-Nat>AN'!',rAcN F� 3y✓o� (Contractor's Address)
Cy n (4-CL .Ste / (Owner/s Name)
1 SD'? S..‹.) ,Y4 lav a-nue) [3pcp toy &.a-e--4.. (Property Address)
CEIFICATION SELECTION: (Please check all that apply)
rtification of roof metal installation, flashing, underlayment.
Certification of re-nailing roof sheathing, and removal and replacement of damaged or rotted wood.
�ther //,n,�` pr Def oSS
I, LARRY/ �Ir4 ,tt r�l) am ' certified as a roofing contractor (License No.
CdL°051077 ) 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 Boynto Beach offers progressive
re-roof ins_pe ' R ave notified the owner of the property of this affidavit.
2077
Signature of Quail er Date
STATE OF FLORIDA, COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this y-20-.2.61/'S (date) by 4AAtle 694-b/92 , who
is personally known to me or who has produced (type of identification) as identification
and who did (did not) take an oath. ,,., (SEAII ,,
_D� � /^/ ;•••`.', CIAUDIANELSON
Signature of person taking acknowledgement C20-1-1 & ev-- ie 3 , ,, , MY OMISSION IFF 151238
Pi '- EXPIRES:September 23,2018
Name of officer taking acknowledgement--typed, printed or stamped C 14,,c1:ti tJe?lsoi ,,FoF� &P Banded llw Budpel Notary Services
Title or rank Serial number
100 East Boynton Beach Blvd, PO Box 310, Boynton Beach FL 33425-0310 Phone: (561)742-6350 Fax: (561)742-6357
SADevelopmenABuilding\Forms&Tomplates\RoolingMetal6SheathinglnstallationPolicy&Allidavih 182lamily(12/99,12/02,1/03,10/03,11/05,9/06,04/09)