301 Seminole Rd 2014 Roof repairs CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 14-00001181 Date 7/24/14
Property Address . . . . . . 301 SEMINOLE RD
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 1000
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Application desc
reroof where leak is f110124 . 10
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Owner Contractor
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JORDAN, JAMES C & CHRISTINA OWNER
R BATISTA
301 SEMINOLE RD
ATLANTIC BEACH FL 32233
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee 60 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 1000
Expiration Date . . 1/20/15
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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 60 . 00 60 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 64 . 00 64 . 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: 90/ 4( Ak-&A P ZZ33 Permit Number:
Legal Description Parcel#
0Floor Area of Sq.Ft. Sq• t
Valuation of Work$ ��dd • Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition AlterationRepair Move Demolition pool/spa window/door
Use of existing/proposed structures) (circle one): Commercial esidential
If an existing structure,is a fire s jtle`r systeT.7
' ta11 (Circle one): o N/A
Florida Product Approval# [[,,,, p / . <
For multiple products use product approvalorr
Describe in detail the type of work to be performed: /-ooh
Property Owner Information:
Name: %A?l4.S 00-k-64-1) Address: 30� SGS
City A&- RCA State Z* 3 33 Phone—f 7/O-3390
E-Mail or Fax#(Optional) J4p i.US tA'^'t
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: Qualifying Agent:
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 pin ermit to
,d
o the work and installations as indicated. I certify that no work or installation has commenced prior et
o the
issuance of a permit and that all work will be performed to meet the standards of all laws rpegulating construction in thpis jurisdiction(. This permit becomes null
work is�mmenced.otI understand that separate perm is m st be sec utred for Electrical WorkdPlu ng�Signs,aWellsoP olsxFuinnces, BoilerystHeaiets,
Tanks and Air Conditioners,eta
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 FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I here b certify that 1 have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type
,lb
will be complied with whether speci ied herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of arty other federal,state, or local law regulating construction or the performance of construction.
Signature of Owner Signature of Contractor
K-M �`/.. ................................................
Print Print Name 6 �^ ................................................. Print Name
Beforenie , r Before me
this ay of 20 l7 this Day of •20
Nota 11C � Shirley L Graham Notary
Public
�o.w� My Commission FF o86990 Revised 01.26.10
Expires 02/1412018
CITY OF ATLANTIC BEACH
(OWNER / 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
ORDMANCES.
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.
3d/ -161- IN -33?0
ADDRESS ^ / PHONE NUMBER
PE
SI TU DA T
Before me this day of V / 20 in the county of
Duval,State of Florida,has personally geared herin by hi elf/herself and affirms that
all statements and declarations are true 1accurate.
Notary Public at Large,State of ✓,County o, V W
6oduced
rsonally Known f
Identifi V Notary Public State of Florida
Shirley L Graham
My Commission FF 086990
Notary Signature: or Expiraa 02114/2018
F:BLDG/0wner-Builder Affidavit;REVISED. /76/2009