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1205 Hibiscus St roof 2013 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 jilt Application Number . . . . . 13-00002281 Date 3/07/13 Property Address . . . . . . 1205 HIBISCUS ST Application type description ROOF PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 2100 ---------------------------------------------------------------------------- Application desc reroof ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ HUTCHCRAFT WILL J OWNER 1205 HIBISCUS ST ATLANTIC BEACH FL 322332609 ---------------------------------------------------------------------------- Permit . . . . . . ROOF PERMIT Additional desc . . Permit Fee . . . . 65 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 2100 Expiration Date . . 9/03/13 ---------------------------------------------------------------------------- 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 Job Address: Permit Number: Legal Description Parcel N ��q_.R n-heated/cooled Valuation of Work$ CA Proposed Work heated/cooled no Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s)(circle one): Commercial (jKe-idential . �Sid�entiai 0 If an existing structure,is a fire sprinkler system installed9 (Circle.one): 0 N/A Florida Product Approval# cz /0 6 71� 1 ew,&Y4 e For multiple products use product appraval form S,4jnj Describe in detail the type of work to be performed: lielaLr ? Sj leV-,l / ' 4,eo 30 A' �/ 44al An Property owner Information: Name: h/w j- Address: -7 City A— --Zip Z2g 5 Phone A�- 75 /,?""/ Stateoi�/�_ _2 E-Mail or Fax# (optional) AwAe h e rd�64_wev 4 a Contractor Information: Qualifying Agent: Company Name: Address: city State Zip Office Phone Job Site/Contact Number Fax State Certification/Registration Architect Name&Phone# 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 to do the work and installations as indicated I certify that no work or installation has commencedprior to the issuance of a permit and that all work w,ill be performed to meet the standards of all laws regulating construction in thisjurisdiction. This permit becomes null and void if work is not commenced within sb:(6)months, or if construction or work is sus or a period of si%)months at any time after pended or abandonedf work is commenced I understand that separate permits must be securedfor Electricar Work,Plumbing, signs, Wells,Pools, urnaces,Boilers,Heaters, Tanks and Air Conditioners,e1c. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING9 CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances gov=this I hereb -anting of a permit does not presume to give authority to violate or the typ e o7work will be complied with whether specified herein or not. The gi provisions of any otherfederal,state, or local law regulating construction or the pe�fbrmance of construction. Signature of Owner Signature of Contract ,7 4-, Print Name _4�L 0 // 7- Print Name /,/)// - ......... ......... ................... . ......... .................................... ................... ....Xhkrs Befor e Before me 20 -3 this —Day of 20/ this ay HIR! Notary Public otary MY COMMISSION#DD 957760 EXPIRES:February 14,2014 Revised 10.24.12 Bonded Thru Notary Public Underwriters /<_1_Ilvjij_� 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 PERMI[T 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 TBE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME TTIAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATTON OF THIS E)MMPTION- 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. 11. 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 UmnFR NY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(j). 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. '70 ADDRESS PHONE NUMBER tT A, .164 PRiNT Nd�ME I 7_6 -3the, 7 2613 SIGNATURV DATE Before me this 7 day of 14Q fr 20 / the county of _3 Duval,State of Florida,has personally appeared herin by himself I herself and affirms that all statements and declarations are true and accurate- Notary Public at Large,State of County Of E3 Pe�Known 51,<roduced Iden Notary Si r1T;77A0 COMMI, -14,201 F/BLDG/Own�-Buil vua Bo d Thru NO