Building Permit Number Key #
I , licensed as a(n): Roofing Contractor, General Contractor, Engineer,
Architect, or Building Inspector licensed under F.S. 468, License Number
On or about , , 20 , did personally inspect for compliance, the roof
deck nailing and secondary water barrier, per the requirements of the Florida Building Code and Florida
Statues 553.844, Windstorm Loss Mitigation for Roofing work at
_______________________________________________________. (General, Building, Residential or
Roofing Contractor, or any individual certified under F.S. 468 to make such inspections.)
Roof Type: ( ) TPO, ( ) Built-up, ( ) Gravel, ( ) Shingles, ( ) Metal, ( ) Other: ______________
System #_________________ Product Approval #__________________
Contractors Signature
STATE OF _____________________ COUNTY OF _
The foregoing instrument was acknowledged before me this day of 20 ,
by who is personally know to me ( ) or has produced as
identification ( ) and who did ( ) or did not ( ) take an oath.
X_____________________________ SEAL:
Signature of Notary Public
*NOTE: The original affidavit must be submitted to the Building Division prior to scheduling the final
inspection. Effective June 3, 2019, a copy of the affidavit must be on the job site at final inspection for
the homeowners records. Final inspection cannot be completed if affidavit is not on site.
This affidavit can be submitted to the office, e-mailed, faxed 352-754-4416,
or uploaded through the online portal.
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