Permit 352 Buoy Ln 2011 Roof �V\j r� 1
. CITY OF ATLANTIC BEACH
SS 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 11-00001676 Date 2/11/11
Property Address . . . . . . 352 BUOY LN
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 999
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Application desc
reroof
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Owner Contractor
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SISARIO, FRANK OWNER
352 BUOY LANE
ATLANTIC BEACH FL 32233
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 55 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 999
Expiration Date . . 8/10/11
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
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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
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 59 . 00 59 . 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
r
lob Address: 3 Z Permit Number:
,egal Description Parcel#
Floor Area o Sq.Ft- Sq.Ft
Taluation of Work$ r Proposed Work heated/cooled non-heated/cooled
:lass of Work(circle one): New Addition_ Alteration Repair Move Demolition pool/spa window/door
re(s) rcle-one): Co ercial Residential
Tse of existing/proposed structu
f an existing structure,is a„ � r talled?(Circle one): Yes No N/A
lorida Product Approval
or multipleproducts use product dpprovat'o m r
)escribe in detail the ,I e of wofk.lbe &rformed: / ��- t?� f L �d f
'roperty Owner Information:
;sty —' State_Zip Phone
-Mail or Fax#(Optional)
;ontractor Information:
;ompany Name: Qualifying Agent:
address: City State Zip
)Bice Phone Job Site/Contact Number Fax#
state Certification/Registration#
architect Name&Phone#
Igineer's Name&Phone#
ee Simple Title Holder Name and Address
ionding Company Name and Address
2ortgage Lender Name and Address
'pplication is hereby made to obtain a permit to do the work and inas indicated. I certify that no work or installation has commenced prior to the
suance 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
nd void if work is not commenced within six(6)months or if construction or work is sus�ppended or abandoned fora enod of six 6)months at arty time after
ork is commenced I understand that separate permits must be secured for ElectricarWork,Plumbing,Signs, ells,Pools, urnaces,Boilers,Heaters,
auks and Air Conditioners,et”
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR EUPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
4erebytify certhat 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 ofwork will be complied with whether speed herein or not. The granting of a permit does not presume to give authority to violate or cancel the
'ovisions of arty other federal,state, or local law regulating construction or the performance of construction.
7
'.gnature of Owner Signature of Contractor
-int Name .. Print Name
.............
wozd subscribe f e me Sworn to and subscribed before me
is y of 0 �� this Day of 20
DEBT A. I
V rgyy
i
otary Public t►; 'EXPIRES:May 21,2011 Notary Public
elf Yy
Bonded Thru Notary Pubkl IJ wriYars
Revised 01.26.10
• a
CITY OF ATLANTIC BEACH
OWNER / BUILDER AFFIDAVIT
1. 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 1S 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
Fr cC
PRINT NAME
'StGNIATURE DATE /
Before me this
fd. of 20A in the county of OEBOfi 14.,rDuval,State of FI Aderson I a eared herin b himself/herself and affirms tY"r"Y PP y .�-
all statements and declarations are true and accurate. :.: *= MYCOMMIKC+ 101t
,��/,, EXPIRES t^ 1
Notary Public at Large,State of / County of Fronded 7hru Notan
❑Personally Known
duced Identification-
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Notary Signatur �=2
F:BLDG/Owner-Builder Affadavit;REVISED:4/16/2009