Permit 483 Skate Rd is CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
=" ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 10-00000313 Date 3/19/10
Property Address . . . . . . 483 SKATE RD
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 1900
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Application desc
REROOF GRAVEL
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Owner Contractor
------------------------ ------------------------
LINDQUIST, DOMINIC R. OWNER
483 SKATE ROAD
ATLANTIC BEACH FL 32233
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 60 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 1900
Expiration Date . . 9/15/10
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 60 . 00 60 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 60 . 00 60 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Fax(904) 247-5845
Job Address: _ �3 jC Az
Permit Number:
Legal Description ✓ 66
Parcel#
Valuation of Work$ )$//�1d
Class of Work(circle one): New Addition Alteration e air
Use of existing/proposed structure(s) (circle one):, Commercla esidenti molition pool/spa window/door
If an existing structure,is a fire sprinkler system installed?(Circle one): es o N/A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work t�be rformed:� � teo0
Proper Owner Information:
Name: S /n!
City_ ,qa_ 56 V6S Address: ,
�LZip
E-Mail or Fax#(Optional) State -9Z !35Phone
Contractor Information•
Company Name:
Address: Qualifying Agent:
city
Office Phone Job Site/Contact NumberState Zip
State Certification/Registration# Fax#
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
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 Zaws regulating construction in this jurisdiction This permit becomes null
and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a__period of six(6)months at any time ajier
work is commenced. I understand that separate permits must be secured for Electrical Worlr,Plumbing,Signs, Wells,Pools,Furnaces,Boilers,Heaters,
Tanks and Air Conditioners,etc
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 RECORDING YOUR NOTICE OF
COMMENCEMENT.
f
here b certify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
Ve oll work will be complied with whether sppeed herein or not. The granting of a permit does not presume togive authority to violate or cancel the
7rovisaons of arty other federal, te, or local law regulating constru 'on or the performance of construction.
nature of Owne Ar
Signature of Contractor
Tint Name ........�..:.
........................ ....Q..��........t.. Print Name
..........
iwon and subscr'b before m Sworn to and subscribed before me
his D of z 1%— 20 this Day of
20
-' r SHIRLEY L G
RAHAM
lotary u I 957760
=�'• �= EXPIPES:Feb ua Notary PubllC
BondBonded 7hru Nota ry 14,2014
— ry Public Underwriters
Revised 01.26.10
b
t
CITY OF ATLANTIC BEACH
OWNER / 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.
s %C 97Z-67)5
AD ESS PHONE NUMBER
�G/S �itl V/S
XNAGNATU
DATE
Before me this day of Q 20_/&the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of _,County
of
Personally Known �v !1 I JLA Produced Identficatio -
SHIRLEY L.GRAHAM
MY COMMISSION#DD 957760
P,= EXPIRES:February 14,2014
Notary Sign lure: Bonded Thru Notary public Underwriters
F:BLDG/0w Builder AfFada it;REVISED: 4/16/2009