Fillable Roof Inspection Affidavit

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Roof Inspection Affidavit

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The Roof Inspection Affidavit form is 1 page long and contains:

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Roof Inspection Affidavit
Building Inspection Division
228 S Massachusetts Ave.
Lakeland, FL 33801-5086
863/834-6012
TDD 863/834-8333
This form can be used in place of a missed Roof Deck/In-progress/Final Inspection. This form must be uploaded
into the permit’s attachment in eTRAKiT, then the corresponding inspection scheduled. On the date of the
inspection, the inspector will review the submitted affidavit for compliance.
RE: Permit #
I , licensed as a(n) Contractor* / Engineer / Architect,
(Please print name and circle Lic. Type) FS 468 Building Inspector*
License #:
On or about , I did personally inspect the roof
deck nailing and/or secondary water barrier work at ,
(Job Site Address)
.
Based upon that examination I have determined the installation was done according to the Hurricane Mitigation
Retrofit Manual (Based on 553.844 F.S.)
Signature
STATE OF FLORIDA
COUNTY OF
Sworn to and subscribed before me this day of , 20
By .
Notary Public, State of Florida
(Print, type or stamp name)
Commission No:
Personally known or produced identification
Type of identification produced
* General, Building, Residential, or Roofing Contractor or any individual certified under 468 F.S. to make such an inspection.
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Roof Inspection Affidavit

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Completed 17 May 2021

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