315 Skate Rd roof 2012 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12- )0000957 Date 7/25/12
Property Address . . . . . . 315 SKATE RD
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO 3E UPDATED
Application valuation . . . . 3500
--------------------------------------- -------------------------------------
Application desc
reroof
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Owner Contractor
------------------------ ------------------------
HALL, SUSAN M OWNER
315 SKATE ROAD
ATLANTIC BEACH FL 322333819
--------------------------------------- -------------------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 70 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 3500
Expiration Date . . 1/21/13
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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 70 . 00 70 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 74 . 00 74 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
CITY OF ATLANTI( 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 CONSTRUCT14lN 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 C F$25,000.00 OR LESS. THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MA Y 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 :)F 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 :�OUNTY OR MUNICIPAL LICENSING
ORDINANCES.
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKIE_R'S COMPENSATION INSURANCE BE
PURCHASED.
111. 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 $5,00) PENALTY UNDER FLORIDA STATUTE NO.
455-228(l). 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 TF AT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
1?x�r o 6r—k
ADDRESS PHONE NUMBER
97— �7#
PRINT NAME
17
If . _11: I&
DATE
Before me this 6Zy of r� 201Z,.4he county(If
Duval,State of Florida,has personally app red herin by himself/herself and!affirms that
al I statements and declarations are try u rate.
)f Cou y of
Notary Public at Large,State o nt
q�ersonally Known
Aroduced Identificat/r/07
L4NotarySignat
F:/BLDW0wncr-Buddcr Affadavit;REVISED:4/16/2009b
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlanti� Beach, FL 32233
Office (904) 247-5826 F4
(904) 247-5845
Job Address: 315" Sl'<^46. Permit Number:
Legal Description Parcel# -S-q-.Ft
Floor A a of Sq.Ft.
Valuation of Work Proposed Work heate�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 Residential
If an existing structure,is a fire sprinkler system installed? (Circlelone): Yes No N /A
Florida Product Approval # rC,If�rQ
For multiple products use�F—oduct approval form
Describe in detail the type of work to be performed: I)e_*r 9 a
Property Owner Information:
Name: 15�,sov 14 -1 Address: /<
city_ �4+1 An+ r State .753 Phone 70?
_LZip ?22
E-Mail or Fax#(Optional) C a2l 6� 62 0
Contractor Information:
Company Name: Qua i lifying Agent: Zip
Address: City' -State
Office Phone Job Site/Contact Number Fax#
State Certification/Registration
Architect Name &Phone# .A
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 do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance of all work will be pe�jbrmed to meet the standards of alliaws regulating construction in this jurisdiction. This permit becomes null
a permit and that d or abandoned for aWeriod of six(6)months at any time after
and void if work is not commenced within six(6)months, or if construction or work,s suspende
workiscommenced I understand that separate permits must be secured for Elecil ricar Work, Plumbing, Slins, ells, Pools, Furnaces, Boileis, Heaters,
Tanks andAir Conditioners,etc.
WARNING TO OWNER: YOUR FAIL RE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR ,AYING TWICE FOR IMPROVEMENTS
I
TO YOUR PROPERTY. IF YOU INTEND TO, I BTAIN FINANCING9 CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEF RE RECORDING YOUR NOTICE OF
I
COMMENC MENT.
I here rtify that I have read and examined this application and know the same t( be true and correct. All provisions of laws and ordinances governing this
o7b ce f a permit does not presume to give authority to violate or cancel the
type .work will be coipplied with whether ecified herein or not. The granting o
provisions ofany otherfederal,state, or localsf1w regulating construction or the performance ofconstruction.
Signature of Owner Signature of Contractor
.............I..........................................................................................................................
Print Name Print Name
................ 7.4...........................................................
Sw and s bscri)�d�fore e Sworn to and subscribed before me
this Da 20 this Day of 20
lic
IRLEY L,GRA 1� �Nota Public
0 A My COMMISSION#DD 95771
Notary Public RES:February 14.2014
EXPI
Titers
Bonded Thru Notary Public UndenY Revised 01.26.10
JUL-25-2012 13:45 FROM:CLERK OF COURTS 904 270 1512 TO:92475845 P:1/1
NOTICE OF CONVONCEMENT
stm Of— Tax Folio No.
Co=ty of
To Whom It May Concern:
'ne urIdorsigned hereby ij�rms you that finprovememU will-be made to,Pertain real property,and in ar-Oordance SWion 713 of
the Florida Statutes,the fol]owing iuformalion Is stated in this NOTICE O�COMNMNCF�mENT.
Legal Dmcrfption of property being imp ved:
AddMqs Of PTOPertY being improved, .34 A,779
Ge=4 description of improvemmts. 46 0
OWMr. Address:
O"Crl's ffitcfe-st in site of the improvement: In 40E
Fee Sbplo Titleholder ff other than owner):
Name:
con",Ctor"—
DQC#201215681 o,OR SK I B01 2 Page-997,
Numbe PjageS:1
Address: Rewrdo-�d 07!25,'2012 at 02;og pm,
JIM FULLER CLERK CIRCUIT COURT DUVAL
Tolepbone No.: Fax No COUNTY
Sure1my(if my) RECORDING$10.00
Addrcss:
Amount of Bond
Telephone No: Fax No.
Nww and addrms of any person mak�m g n loan for the construction of the bnProvements
Name:
Address:
Phone No: Fax No:
N=e of Person.wftbin the State of Florida,other tim bimsey,de$igmtDd�by owner upon whom notices or otber documents may be
qer�- Name:
Address:
Telephone No: Fax No*
im addMon to himseK owner designatea the following Person Ito receive a copy of the Lienor's' No&e as provided in section
Florida Sta:Wes. (Fill in.at owner's option)
Nam
Addrm:
Telcphone No: Fax No:
F-)#04on date of Notice Of Commencement(the expiration date is one Year from the date of recordh3g unless a different date is
spocified):
TMS SPACE FOR RECORDER'S USE ONLY OWNER
X�Sgricd. Date-
ore mq
c is day 6f in tho Coaty ort)jval,Stalc
Of Florida.has pmonall e"
Notary Public at J-qxgr
o6da,co If Duj-
XP
or
i MY COWGRM40"Ifftnt io
14.2014
'Unttft 11 rs
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