The City ofFort Myers, Florida

Comnunity Development Department

Building Division
U25 Hendry Street, Suite 101
Fort Myers, FL 33901
City of Palms (239) 321-7920
(239) 344-5977 - fax
Re: Permit#

1
Roof Inspe,ction Affidavit
I, j/(-t<Jy'1/l-" Ki{lm0J✓ ' licensed as a(n) Contractor* Engineer/Architect, FS 468 Building Inspector
Li::·;;z«7'W7V l ((0 01-::: ;✓ l,uJ'J
On ~/Jj/;t,;._
l(datel& 1it j
,I did personaly inspect the.... j /1•Ln,·1Qy?(;_j
)
., Select Sections that Apply

Needed for
all re-roofs
➔ ~: f deck nailing and secondary water barrier (May be certified by Architect, Engineer, CGC,
C, CRC, CCC, Building Inspector or Owner/Builder).

Needed in
utl<lition to
➔ ditional metal connectors, ciip strap fasteners and additional structural elements. (May be
above for
certified by an Architect, Engi.""1:;c>er, CGC, CBC, CRC or Building Inspector - Not CCC or
130mph Owner/Builder). I ·
windborne
Debris
Region with
a value
➔ □ Exceptions under 201.3, where ii ~~n be demonstrated (by code adoption and permit issuance
date is after 1995) that roof-to-wall connections and/or roof-to-foundation continuous load path
greater than requirements were required at the time of original construction.
$300,000
Roof-to-wall connections shall not he required unless evaluation and installation of connections
at gable end of all comers can be completed for 15% of the cost ofroofreplacement.

...for the work located at _ __ _3_</

----'------'&=------"/L __~_
M__
_..._,_/_._f""'cf?-'-b--'c-~......,·~fl"""re...L._:!?_,___,_fit e=---'"------------
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1

Based upon that examination I have determined the installation was done according to the Hurricane Mitigation
etrofit Manual Based on 553.844 F.S.)

a:'-f __, ,
Sigi ature of Person

STATE OF COUNTY OF Cr-t:::, Sworn to ~or affirmed) and subscribed before me this _ _
day of _Ann_l_, by JD/ V ~.[]Q__ Ki cJ,a,drq (name of person making statement),
ersonally known - ~ -Produced
0 identification __• __, type of identification _ _ __ _ _ __ _ __ __

•"'""~ MICHELE JONES

,/4"-='t~~ MY COMMISSION #FF1818O7_ . _ " _., ,, ,
i .: ; EXPIRES:MARH,2O19 _,o ,r:', ~ 1
_ l Bonoed through 1st State Insurance

*General, Building, Restdential or Roofing Contractor or any individual certified under 468 F.S. to make such an
inspection.

Revised: 12/ 10/ 13 Page 1 of I