Permit Roof 895 Sailfish Dr 2012 r N CITY OF ATLANTIC BEACH
:wi) 800 SEMINOLE ROAD
!J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000320 Date 3/21/12
Property Address 895 SAILFISH DR
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 4500
Application desc
REROOF
Owner Contractor
WILLIAMS, PAUL OWNER
895 SAILFISH DRIVE
ATLANTIC BEACH FL 32233
Permit ROOF PERMIT
Additional desc .
Permit Fee . . . 75.00 Plan Check Fee . .00
Issue Date . . . Valuation . . . . 4500
Expiration Date . 9/17/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 75.00 75.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 79.00 79.00 .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: $ .5A j1 by
Permit Number: 9 5
Legal Description
Floor Area of Sq.Ft. Parcel #
S Ft
Valuation of Work $ 4 5a Proposed Work heated /cooled non-heated/cooled
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool/spa window /door
Use of existing /proposed structure(s) (circle one): Commercial Res'. - ntial
If an existing structure, is a fire sprinkler system installed? (Circle one): •w. d . N /A
Florida Product Approval #
For multiple products use pr ap prova of r m
Describe in detail the type of work to be performed: Re f Li4C, pi, 4, 0101 /o ff
Property Owner Information:
Name r
lit u� �J /9N g J SAO / T ! 1 S ✓
City AT N / , C GQC l'Y / 1 S State Zi Add ress: D
E -Mail or Fax # (Optional) �� P 3Z23� Phone 011 —SRI"— ii. Li 5
Contractor Information:
Company Name: Qualifying Agent:
Address City State'
Office Phone Job Site/ Contact Number Zip
S'tate Certification/Registration # Fax #
4rchitect Name & Phone #
Engineer's Name & Phone #
Fee Simple Title Holder Name and Address
3onding Company Name and Address
Vlortgage Lender Name and Address
ss uance of a permit hereby nd that all work will be med to work
meet the installations andards of all laws construction in this jurisdiction. commenced is ermit becomes n
and void f work is not commenced within six (6) months, or if construction or work is suspended or abandoned fora er od of six (6) months at any time after
vork is commenced. I understand that separate permits' must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Bo Heaters,
ranks and Air Conditioners, etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COIVI ENCEMENT 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.
hereby certify 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
vpe of work will be complied with whether sppecd herein or not. The granting of a permit does not presume to give authority to violate or cancel the
rovisions of any other federal, state, or local law regulating construction or the performance of construction.
ignature of Owner gad Signature of Contractor
tint Name
a,,Lii .. Print Name
wo to . .., 1-d before 9-
Sworn to and subscribed before me
� ,k ay /�"' ,n;
�is �' 12':,- .
�,� � ,: o this Day of 20
* MY GOMMIs • 14 2014
lb 1 ° -; eb 2 titers
y ‘q''' , E � n Public Underw
lot 'u. is ? gp , ` C 0 — Notary Public
Revised 01.26.10
ro
,!' °` CITY OF ATLANTIC BEACH
®WNER / BUILDER AFFIDAVIT
f .Ji:
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.
Z95 SA1 t h Dr 9 -5 S- q?q5
AD R PHONE NUMBER
f A AL Wi'J/An'1S
Plj{pLj NAME t
1 3-.23 -.26 /.2
SIGNATURE ' DATE
Before me this ( / day of -->" 20,1,the county of
Duval, State of Florida, has personally appeared herin b y himself / herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large, State of I L- , County of ✓a-
4: Known ` � r
r
/
oduced Identification -_ 411116 te
Y'6 SHIRLEY L. GRAHAM
Notary Sign- re: . / , = MY COMMISSION DD 957760
Ak EPIRES February
��� + f uhlic u t4, nderw r iters
I IIII
F: BLDG / Owner - Builder Affadavit; REVISED: 4/16 x+09
pdrd• BondedXThn+Nedy
NOTICE OF COMMENCEMENT
Permit No. Tax Folio No.
State of Florida, County of Duval
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Description of property (legal description of property and address if available):
2. General Description of improvements:
ff riC hT of Net✓ Roar
3. Owner Information: � ) �u L W ,//,rt rn s � ! J a) Name and Address: g /q j 1 f 'Sh fir, A ( /
b) Interest in property: 1ti h �a
c) Dame and address of simple titleholder (if other than owner):
L. 1�,W.A,� s 44S SA 1 f, sip v ATMftVe. !Sege !f F7
4. Contractor Information:
a) Name and Address: 0 fi e WNW° 1-- ?c '/- 5j - q?'-/
b) Phone Number:
5. Surety Information:
a) Name and Address:
b) Phone Number:
c) Amount of Bond: $
6. Lender Information:
a) Name and Address:
b) Phone Number:
7. Person within the State of Florida designated by owner upon whom notices or other documents may be served as
provided by 713.13 (1)(a) 7, Florida Statutes:
a) Name and Address:
b) Phone Numbers of Designated Person:
8. In addition to himself/herself, Owner designates of to receive
a copy of the Lienor's Notice as provided in Section 713.13 (1) (b), Florida Statutes.
a) Name and Address:
b) Phone Number of person or entity designated by owner:
9 Expiration date of Notice of Commencement (The expiration date is one (1) year from the date of Recording unless a
different date is specified:
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART
1, SECTION 713.13, FLORIDA STATUTES, AND CAN 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 BEFORE COMMENCING WORK OR RECORDING
YOUR NOTICE OF COMMENCEMENT.
The foregoing instrument was acknowledged before me this22day of /(�L '� 20 /2.
1
-.
Doc # 2012062576, OR BK 15888 Page 120, ����'
Number Pages: 1 NOT' PUBLIC. S ___ -