Permit Roof 2010CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
Application Number 10-00000961 Date 8/02/10
Property Address 201 PINE ST
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation 1800
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Application desc
Reroof
Owner
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WELLS, J. WALTER
201 PINE STREET
ATLANTIC BEACH FL 32233
Contractor
OWNER
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Permit ROOF PERMIT
Additional desc NEW ROOF
Permit Fee 60.00 Plan Check Fee .00
Issue Date Valuation 1800
Expiration Date 1/29/11
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total
Plan Check Total
Grand Total
60.00 60.00 .00 .00
.00 .00 .00 .00
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: ~O/ /%i.t/f= ~T Permit Number: /y r ~~
Legal Description Parcel #
oor ea o q. t. q. t
Valuation of Work $~~y • Proposed Work heated/cooled non-heated/cooled
Class of Work (circle one): "New ,J Addition Alteration Repair Move Demolition pooUspa window/door
(_.._ ..
Use of existing/pro osed structure(s) (circle one):. Commercial sidentia
If an existing struc~ure, is a fire sprinkler system installed? (Circle one): es o N /A
Florida Product Approval #
For multiple products use pro uct approva orm
Describe in detail the type of work to be performed: ~~~ w =; ~~ :>;=
Property Owner Information:
Name: ,T~3rt,~i ~~'" tt<iEGGS Address: ~'-~/ ,~i~~c' S7",
City ATLl,'xi77CJ r3C-,,acre State)=G Zip 3 ~z3 ~ Phone ~~;c•;~) u~ 7 ~:~;~/7
E-Mail or Fax # (Optional)
Contractor Information:
Company Name: S~L~' Qualifying Agent:
Address: Zoi i~i',~ic si • City
Office Phone(~~~_~~ ~~-~=~'~ Job Site/ Contact Number
State Certification/Registration #
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. 1 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 laws regulating construction in this jurisdiction. This permit becomes null
and void if work rs not commenced within six (6) months, or if construction or work is suspended or abandoned for a_ period of siz (6) months at arty time after
work is commenced. I understand that separate permits must be secured for Electric Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters,
Tanks and Air Conditioners, etG
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.
I hereb cert~ that I have read and examined this a placation and know the same to be true and correct. All provisions of laws and ordinances governing this
type ojYwork will be complied with whether sppeci ied herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions ofarry other federal, state, or local l~-v regulating construction or the performance of construction.
Signature of Owner , ~ 6~...uJ. ~ .v~
Print Name - ~,,N ,~
Sworu~te~d subscribed efore me ~
t~ , ,l_--./ Day q~ _
Signature of Contractor
Print Name
.........................................................................................................................................
Sworn to and subscribed before me
this Day of
Notary Publi ~'''~ ' ~ MY COMMISSION t DD 634126 Notary
7a. ::~° EXPIRES: May 21, 2011
`''??Af,~~'~ Bonded'Ihru Notary Public Underwriters
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Fax #
Zip
Revised 01.26.10
4
c ~=,'`r 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 AONE - 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; (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
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PRINT NAME
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SIGN RE
Before me this ~~ day of , 20 ~ in the county of
Duval, State of Florida, has personally appe d herin by him~s~elf /~her~sQelf and affirms that
all statements and declarations a and urate. -r/""'_'- `
Notary Public at Large, State of ~~ ~-- County b/'
^ Personally Known J~~, n~ /~ f GL ~ ~~a ~`/~/
}'Produced Identification - ( V !/v /// ( l"
7 - G/~~~
Notary Signature: _~!~~~~~"``~ ~ ~•
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PH NE MBER
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DATE
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. MY COMMISSION # DD 634126
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<= EXPIRES: Mey 21, 2011
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~%Rf.i:~`•• ponded fire Notary PuMlc UrMenrtiters
F;BLDG/Owner-Builder Afl'adavit; REVISED: 4/16/2009