Community Development
18400 Murdock Circle, Port Charlotte, FL 33948
Phone: 941.743.1201 Fax: 941.764.4907
Zoning 941.743.1964
www.CharlotteCountyFL.gov
”To exceed expectations in the delivery of public services”
For Office Use
Permit No.
Application Date
CSR
Revised 12/22/16 jg
Roof/Re-Roof Hurricane Mitigation Retrofit Inspection Affidavit
Job Address:
I,
, am licensed as a
Contractor*,
Engineer,
Architect,
F.S. 468 Building inspector*.
License #:
On or about (date & time)
, I did personally inspect the
Roof Deck Nailing,
Roof to Wall Connections
work at the above address.
Based upon that examination, I have determined the installation was done according to the Hurricane
Mitigation Retrofit Manual (Based on F.S. 553.844).
Signature:
State of Florida, County of
Signature of Notary
Notary's Printed Name
Commission Number
T
he foregoing instrument was acknowledged before me this
day of
20
by
who is personally known to me or who has produced
as identification and who did/did not take an oath.
Seal
*General, building, Residential, or Roofing Contractor or any individual certified under F.S. 468 to make such an inspection.
Permit #
This completed affidavit must be on-site at the time of final inspection. If this affidavit is not
available, your final inspection will be failed with a fee.
I am the home owner
