Permit Roof 2208 Fairway Villa 2011 CITY OF ATLANTIC BEACH
?s .r 800 SEMINOLE ROAD
T ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
'4 Dill )» 4
Application Number
11- 00001761 Date 3/07/11
Property Address 2208 N FAIRWAY VILLAS LN
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . • 3200
Application desc
Reroof
Owner Contractor
BROWN HEATHER D OWNER
559 EAST COAST DRIVE
ATLANTIC BEACH FL 32233
Permit . . . . . . ROOF PERMIT
Additional desc . . REROOF Plan Check Fee 00
Permit Fee . . . • 70.00 3200
Issue Date . . . • Valuation . . . .
Expiration Date . . 9/03/11
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 70.00 70 .00 .00
.00 .00 .00
Plan Check Total .00
.00 .00
Other Fee Total 4.00 4.00 . .00
Grand Total 74.00 74.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
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CITY OF ATLANTIC BEACH
ROOFING PERMIT
Date: APPLICATION
Job Address: c' 7 O f re %eaar aeAS ,&
Owner of Property: , r. i4 gegvA-
Address: F 6'1514 Dr Telephone: 90 fair/33 G c /
Roof Contractor: State License Number:
Contractor's Address:
Telephone: Fax: Email:
Scope of Work: � � 48 = ^ y /4— S Roofing Material /
FL Product Approval # Main - Odcif A/To filed m 3 7i/ Valuation of Work: $ � a'be.t /iced .
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 s EFORE RECORDING YOUR NOTICE OF COMMENCEMENT"
SIGNATURE OF OWNER: 1110t11,_111,A 1 11116 \ t1 Date:
AS TO OWNER: Sworn to and subscribed before me this day of
I�t�t r
dr \ , 20 11 . State of Florida, County of Duval
o ,,,,,,,,, Notary's Signature: �Gkf.x.S0 — ' 1 °
,,:�a. "�d•- ANGELIOUE BONA010 Personally known Produced identification Type of identification
P: .? Notary Public - State of Florida
produced ft ■ O Y t Cr 0. �`� �� Q �S UCec�.e,
= iii 'Q My Comm. Expires Oct 5, 2014
'�`o?° Commission # EE 32353
SIGNATURE OF CONTRACTO r' l _ Date:
AS TO CONTRACTOR: Sworn to and subscribed before me this day of
, 20 1 \ . State of Florida, County of Duval
Notary's Signature: ! �_�! • C.: 0
Personally known Produced identificatIn Type of identification
ANi3ELI0UE sONA010 produced -\_()V t dOt. bn lv QX3 LdCQnSQ _
PAWN Notary Public - State of Florida
,, My Comm. Expires Oct 5, 2014
' ,;, pitt Commission EE 32353 X 800 Seminole Road • Atlantic Beach, Florida 32233 -5445 Telephone: (904)
47 - 5800 • Fax: (904) 247 -5845 F: \roof permit applicaton 2010
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1;-, 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
/447VC, LA/A
PRINT NAM
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SIGNATUR ,, DATE
Before me this l day of '&A ax U` / 1 20 � 1 in the county of
Duval, State of Florida, has personally appeared herin by himself / herself and affirms that
at statements and declarations are true and accurate.
Notary Public at Large, State of . .tO Y \ &County of vC ` .
❑ Personally Known
/;:i "6'.,. ANGELIOUE BONADIO
Produced Identification - C LO Y 1 dQ '\ (1 V Q LA C Q CC - e — ■ ' t1 ° Notary Public - State 01 Florida ■
I N' My Comm. Expires Oct 5, 2014
��� ���, AAA ppp A000.-.60 e I ' %,,, � , Commission EE 32353
,,,,
Notary Signature:�/`�"�� y � [[[ � \ & -
F:/BLDG /Owner - Builder Affadavit; REVISED 4/16/200
iit,„4244,.._. AZ,19-14/\..... /7 > 6 s6 3 7 7 3 d
A. Sett ,ment Statement U.S. Department of Housing OMB Approval No. 2502 -
and Urban Development
B. Type of Loan
1. [ ] FHA 2. [ ] FmHA 3. [ ] Conv.Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
4. [ ] VA 5. [ ] Conv.Ins. 1100177 -CK
C. NOTE: THIS NOTE IS FURNISHED TO GIVE YOU A STATEMENT OF ACTUAL SETTLEMENT COSTS. AMOUNTS PAID TO AND BY THE
SETTLEMENT AGENT ARE SHOWN. ITEMS MARKED "(P.O.C.)" WERE PAID OUTSIDE THE CLOSING; THEY ARE SHOWN HERE FOR
INFORMATIONAL PURPOSES AND NOT INCLUDED IN THE TOTALS.
D. Name and Address of Borrower E. Name and Address of Seller F. Name and Address of Lender
HEATHER D. BROWN ROBERT B. BAYS AND KATHARINE M. BAYS CASH
559 EAST COAST DRIVE 4734 PALESTINE ROAD
ATLANTIC BEACH, FL 32233 CHESTER, IL 62233
G. PROPERTY LOCATION H. Settlement Agent: WATSON TITLE SERVICES OF N. FL., INC.
2208 NORTH FAIRWAY VILLAS LANE,
ATLANTIC BEACH, FL 32233 Place of Settlement I. Settlement Date / Disbursement Dat
COUNTY: DUVAL 175 HAMPTON POINT DRIVE, SUITE 2 2/28/2011 -- 2/28/2011
ST. AUGUSTINE, FL 32092
J. SUMMARY OF BORROWER'S TRANSACTIONS K. SUMMARY OF SELLER'S TRANSACTIONS
100. Gross Amount Due From Borrower 400. Gross Amount Due To Seller
101. Purchase Price $60,000.00 401. Purchase Price $60,0C
102. Personal Property 402. Personal Property
103. Settlement Charges to Borrower $18.50 403.
104. 404.
105. 405.
Adjustments For Items Paid By Seller In Advance Adjustments For Items Paid By Seller In Advance
106. City/Town Taxes 406. City/Town Taxes
107. County Taxes 407. County Taxes
108. Assessments 408. Assessments
109. 409.
110. 410.
111. 411.
112. 412.
120. Gross Amount Due From Borrower f $60,018.50 420. Gross Amount Due To Seller I $60,0C
200. Amounts Paid By Or In Behalf Of Borrower 500. Reductions In Amount Due To Seller
201. Earnest Money $1,500.00 501. Excess deposit
202. Principal Amount of New Loan(s) 502. Settlement Charges To Seller (line 1400) $5,5:
203. Existing loan(s) taken subject to 503. Existing Loan(s) taken Subject To
204. 504. Net Payoff to WELLS FARGO $36,3
205. 505. Payoff of Second Mortgage Loan
206. 506.
207. 507.
208. 508.
209. 509.
Adjustments For Items Unpaid By Seller Adjustments For Items Unpaid By Seller
210. City/Town Taxes 510. City/Town Taxes
211. County Taxes (Unpaid) 2,346.22/yr 1/1/2011 to $367.40 511. County Taxes (Unpaid) 2,346.22/yr 1/1/2011 to $3
2/27/2011 2/27/2011
212. Assessments 512. Assessments
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. Total Paid By /For Borrower 1 $1,867.40 520. Total Reduction Amount Due Seller ' $42,2
300. Cash At Settlement From/To Borrower 600. Cash At Settlement To /From Seller
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