City of Greenacres
Roofing Contractor Affidavit
Roof Sheathing, Tin Tag and Roof Metal Installation
For Existing Buildings Only
Job Address
Permit Number Subdivision or Plaza
Contractor Information
Company Name Qualifier Name
Company Address City ST Zip
License Number Phone
I am certified as a roofing contractor and do hereby certify that all
roof work indicated below has been performed at the above address in accordance with chapters 15, 16,
and 23 of the Florida Building Code and City of Greenacres Amendments. Photographs are being
provided that clearly depict each step of the work.
Certification of re-nailing roof sheathing
Certification of tin tag and roof metal installation
Other
Signature of Qualifier Print Name:
STATE OF FLORIDA COUNTY OF
Sworn to (or affirmed) and subscribed before me this day of 20
By (Name of person making statement).
Signature of Notary Public State of Florida
Personally, Known OR Produced Identification (Type of Identification)
(Notary Public Stamp)
An in progress inspection must be scheduled the day before any work is started.
For tile and metal roofs an additional in progress inspection will be required during the installation.
The affidavit and photos are to be left on the job site for the final inspection.
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signature
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signature
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