Permit 624 Aquatic Dr f1 CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 09-00002003 Date 12/14/09
Property Address . . . . . . 624 AQUATIC DR
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 800
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Application desc
REPLACE ROTTEN WOOD SHINGLES
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Owner Contractor
------------------ ------ ------------------------
DAWSON OWNER
624 AQUATIC DRIVE
ATLANTIC BEACH FL 32233
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 55 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 800
Expiration Date . . 6/12/10
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 55 . 00 55 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 55 . 00 55 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Y.
CITY OF ATLANTIC BEACH
®WNER / BUILDER AFFIDAVIT
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. TELEPHONE THE
BUILDING DEPARTMENT(247-5826)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.
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ADDRESS PHONE NUMBER
AII OAOc bN
PRINT NAME 1A
SIGNATURE Q DATE
G�
Before me this � / day of C 200 An the county of
Duval,State of Florida,has personally appeared herin by himself/he If and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of ,County IV
nY P SHIRLEY L. GRAHAM
OSP 4a��
❑Pe ally Kno ;:R ��; Notary Public-State of Florida
rodu ent f on- ° . My Commission Expires Feb 14,2010
Commission#DD 518533
Bonded By National Notary Assn.
N Signature:
F:BLDG/Owner-Builder Affidavit;REVIS 4/16/2009
, c yrs
J�
¢1
09-
CITY OF ATLANTIC BEACH
Date: �-2 - /1 - () 9 ROOFING PERMIT APPLICATION
Job Address: 4 AP"A-r ie_ /—� /�i G//�/'TlG !�C'hl.� FL
Owner of Property: JA� .j- JOS 1)14 cJS a aj
Address: CAS€ Telephone: f - 7 70 S�
Roof Contractor: ()W f� State License Number:
Contractor's Address:
Telephone: Fax: Email:
Scope of Work: /07 EA) t-J d B,D S'/�/NGL Roofing Material S'I{IAI6C..5-S'
FL Product Approval# Valuation of Work: $ 4/0(), 641
Required Inspections: Sheathing/In Progress-Dry In /Final
If re-roof: Assessed Value of Structure:_<$300,000/_>$300,000;Roof-to-wall improvements required?
(Applies to single family structures only)
"WARNING TO OWNER. YOUR FAILURE TO RECORD NOTICE OF COMMENCEMENT MAY RESULT IN 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 BEFOR RECORDING YOUR NOTICE OF COMMENCEMENT"
SIGNATURE OF OWNER: Date:
AS TO OWNER:
Sworn to and subscribed before me this day of 20
C!
State of Florida,County of Duval
Notary's Signature;
"""" SHIRLEY L. GRAHAM
R. UPr6"�ed identific tion
Nota P �.
2,r =
Notary Public-State of Florida
q, EMy Commission Expires Feb 14,2010 Type of identification prod d �L1
Commission#DD 518533
SIGNATURE OF Bonded By Na:ionai Notary Assn Date:
AS TO CONTRACTOR:
Sworn to and subscribed before me this day of 020
State of Florida,County of Duval
Notary's Signature:
0 Personally known
0 Produced identification
Type of identification produced
800 Seminole Road•Atlantic Beach,Florida 32233-5445
Telephone: (904)247-5800•Fax:(904)247-5845
F:\roof permit applicaton.docx 7/28/09