Construction Services Division
1400 N. Boulevard
Tampa, FL 33607
Fax: (813) 259-1712
Permit # ___________________
On our about ________________ , I did personally inspect roof replacement work at
Based upon the examination, I have determined that the following roof mitigation measures were performed in accordance
with Section 201 of the Hurricane Mitigation Retrofit Manual:
1. Roof deck attachment and fasteners strengthened and corrected as required by Section 201.01.
2. Secondary water barrier provided as required by section 201.2. All associated mitigation is in
compliance with the Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S.).
I certify that I am (Check one of the following):
Licensed Roofing Contractor
Licensed General, Residential, or Building Contractor Licensed
FS468 Building Inspector
Registered Architect or an Engineer in the State of Florida
Duly authorized by the State of Florida or its county's municipalities to verify compliance with the Hurricane Mitigation Provisions of
HB 7057, Section 553.844 Florida Statutes. I also certify that I personally inspected the premises at the Location Address listed
on the date of this Statement. In my professional opinion, based on my knowledge, information and belief, I certify that the
statements are true and correct.
Date: License #:
Signature: Phone #:
Mail or Fax to: Construction Services Division - 1400 North Boulevard - Tampa, FL 33607
Fax Number: 813-259-1712