715 Bonita Rd RERF22-0148 Builder Aff & Roof Permit s+; ¢' , ; REROOF SHINGLE PERMIT PERMIT NUMBER
, I CITY OF ATLANTIC BEACH RERF22-0148
800 SEMINOLE ROAD ISSUED: 6/22/2022
4t'''lu ATLANTIC BEACH. FL 32233 EXPIRES: 12/19/2022
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH'EDWON (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES
ALL L CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property
that may be found in the public records of this county,and there may be additional permits required from other
governmental entities such as water management districts,state agencies,or federal agencies.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK_
715 BONITA RD REROOF SHINGLE SHINGLE ROOF $8500.00
TYPE OF REAL ESTATE BUILDING USE
ZONING: SUBDIVISION:
CONSTRUCTION: „ NUMBER: GROUP:
a
171139 0000 ROYAL PALMS UNIT 01
COMPANY: I ADDRESS: CITY: I STATE: I_- ZIP
OWNER: ADDRESS: I CITY: I STATE: I ZIP:
KVINGE ALAN 715 BONITA RD ATLANTIC BEACH FL 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT Ifs
YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
Roll off container company must be on City approved list. Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $95.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$99.00
Issued Date:6/22/2022 1 of 1
rt r.," Building Permit Application Updated 10/9/18
'r \s�
` -�.,,,! City of Atlantic Beach Building Department **ALL INFORMATION
\\ � 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
'°i;��r IS REQUIRED.
Phone: (904) 2""47-5826 Email: Building-Dept@coab.us
Job Address: '4 1 S 6Ov111144. R D Permit Number: VP- Z Z.-- C>/ 4 6
Legal Description 30-60 rit -ZS- VI E (oval Dales u^q- *I Lo1-IS 6 2. RE# I?111 - 0000
Valuation of Work(Replacement Cost)$ 1 60 Heated/Cooled SF '0(.0 Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo DPool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ❑Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s)be removed in association with proposed project?❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed:
geAvt0 vi- $ 4( t4Le 4 p l4 .61,,, .\3/4 04
Florida Product Approval# FL IO I Z 1 Pi- It)6.Z to for multiple products use product approval form
Property Owner Information
Name, Alan 1`Vloiic Address 715' 6cmi)-c. i
City It}�-IAInd,`( #11cAc►nr State )L Zip `3'Z2 '33 Phone ?7'? 7(,() - 4 153
E-Mail A)oyk lame.5 +i a CyW\C►e)s Com
Owner or Agent(Tf Agent,Power of At orney or Agency Letter Required)
Contractor Information�L
Name of Company p�J(ii Qualifying Agent
Address City State Zip
Office Phone Job Site Contact Number
State Certfication/Registidtion It E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer - _ OR Exempt❑ Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated_I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulating
construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc.. NOTICE:In addition to the requirements of this
permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and
there may be additional permits required from other governmental entities such as water management districts,state agencies,or
federal agencies.
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
WARNING TO OWNER:YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORY s ' N• ICE OF COMMENCEMENT.
.r re of Owner or Agent) (Signature of Contractor)
Si ne�orn to(or affirmed)before me this 12 day of Signed and sworn to(or affirmed)before me this day of
2PZ2 ki� 4I anKvi eel-?, ,by
1l /i /L -.
i+ -t . • ._. (Signature of Notary)
r°I N/`' Notary Shannon M State
of Florida
My Commission HH 136588 PersonallyKnown OR
Personally Known OR '� 41 Expires 0810112025 [ ]
[ ] roduced Identification ?°r"° [ ]Produced Identification
Type of Identification: Type of Identification:
Owner Builder Affidavit ldavit **ALL INFORMATION
HIGHLIGHTED IN
if--
r �� City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
--v""''r Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
I. FLORIDA STATUTES;CHAPTER 489, FLORIDA STATUTES, PART 1"CONSTRUCTION CONTRACTING" REQUIRES
OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED
FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER
OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A
LICENSE.
YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF.
YOU MAY BUILD OR IMPROVE A ONE OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY
ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS.
THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE
CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,WHICH
IS IN VIOLATION OF THIS EXEMPTION.
YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR.YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS.
IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES
REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES.
II. INJURY LIABILITY;SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT
SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED..
III. IRS WITHHOLDING;OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING
TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY;UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES.OWNERS BEING SUBJECT
TO$5,000 PENALTY UNDER FLORIDA STATUTE NO.455-228(1). AN"OCCUPATIONAL LICENSE"IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY"CERTIFICATE OF COMPETENCY"OR THE FLORIDA"CONTRACTORS
CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US)IF IN DOUBT.
V. ACKNOWLEDGEMENT;I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I
COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
ob Address: ?')5 Bortjz /1t-14Wil`e i' 46
L C� 3
FL® 7 '3
)wner Name: iq'1Atl� 1LV1 hqUr- Phone Number: 7 2 7- --?G® W1 6 3
_
flailing Address: 715 Ito tr,)'o► ,2 ) City: I44IQ1 ,'C IacaC IN State: FL Zip: 3 Z 2 33
Notarized Signature ofOwner l
9 ���
"he foregoing instrument was acknowledged before me this 12. day of aln2. ,20 2..2,in the State of Florida, County
'f DLIV -I
4I Notary Public State of Florida
• (� Shannon M Zipoy /,/
,� Commission25 138588 Signature of Notary Public /" .
No,"
Expires Personally Known OR [ ] Produced Identification
Type of Identification:
Updated 10/24/18