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City of Oldsmar Roofing Permit Inspection Affidavit

2. Inspection Affidavit

4. Permit No:

6. I, _________________________________________________________
   Print qualifier's name

   Print qualifier's name

7. licensed, as: check your professional title

   1. A contractor

   1. An Engineer/Architect, FS 468 Building Inspector
9. License No:_______________________________________________

11. On or about
    Date: ___________________ Time:___________________

    Date: ___________________ Time:___________________

12. I did personally inspect the:

    Check all that apply

    1. roof deck nailing
    2. secondary water barrier work
14. at the property address of
    _________________________________________________________________________

    _________________________________________________________________________

16. Being appropriately licensed to conduct this work, and based upon the examination of such work, I have determine that the installation was done according to the Hurricane Mitigation Manual (Based on 55.844 F.S.)

18. Signature: ___________________________________________________

19. Date: _____________________________

Leave This Blank:


20. Print Only

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