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Permit Roof 785 Triton Rd 2010 CITY OF ATLANTIC BEACH j 800 SEMINOLE ROAD ,., ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 R' Application Number . . . . . 10-00001256 Date 10/14/10 Property Address . . . . . . 785 TRITON RD Application type description ROOF PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 2008 ---------------------------------------------------------------------------- Application desc reroof ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ RODDAN, JOHN Z . OWNER 785 TRITON ROAD ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit . . . . . . ROOF PERMIT Additional desc . . Permit Fee . . . . 65 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 2008 Expiration Date . . 4/12/11 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 65 . 00 65 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 69 . 00 69 . 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 fob Address: �� ' L" � '1 to- 9-�' �—�c) Permit Number: Legal Description Parcel# Floor Area o q. � q• t Valuation of Work$ onyf CX) Proposed Work heated/cooled non-heated/cooled :lass of Work(circle one): ew ddition Alteration Repair Move Demolition poolfspa window/door Jse of existing/proposed structures) (circle one): Commercial iden f an existing structure,is a fire sprinkler sy em installed? (Circle one): Y es N/A {lorida Product Approval# 'FL S PL L-K-1 Tor multiple products use product approva orm )escribe in detail the type of work to be performed: ={� 'roperty Owner Information: Tame: c� Address: 7 • ;ity Am. IS CL, State VCip 32233 Phone X90 1L?V 0 7 ,-Mail or Fax#(Optional) ;ontractor Information: l ,ompany Name: Qualifying Agent: .ddress: City State Zip )f ice Phone Job Site/Contact Number Fax# tate Certification/Registration# ,rchitect Name&Phone# .ngineer's Name&Phone# ee Simple Title Holder Name and Address �onding Company Name and Address Tortgage Lender Name and Address oplication 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 suance of a permit and that all workwzZl be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null zd void f work zs not commenced within six(6)months or if construction or work is suspended or abandoned for a penod ofsix6)months at any time after ork is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,signs, ells,Pools, urnaces,Boilers,Seaters, auks and Air Conditioners,etG WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR EMIPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. ierebYcertify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this oe work will be complied with whether speci zed herein or not. Ah anting of a permit does not presume to give authority to violate or cancel the •vision of arty other federal,state, or local d regulatin or the performance of construction. ignature of Owner Signature of Contractor Pr int Name int Name --�.V.....-a ........................................................................ ................. von, and su y GRAN Sworn to and subscribed before me is 1 Iia ` _. #oo s this Day of 20 ` EXPIR ary 1 ,201 r d n ers otary Pub c Notary Public Revised 01.26.10 4 r 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. ADDRESS PHONE NUMBER PRINT NA U SI ATU DATE l /"� Before me this day of f 2014n 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 IJ Known xi , 9s c�[/ Vroduced Identification- 957760E PIRE .February 14,2014(:��l on Notary Public UnderwMers Notary Sig Lure: ift lie F:BLDG/Owner-Builder Affadavit;REVISE : 4/16/2009