1600 Selva Marina Drive 14-00001511 (Roof) CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
it
Application Number . . . . . 14-00001511 Date 9/12/14
Property Address . . . . . . 1600 SELVA MARINA DR
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 70000
----------------------------------------------------------------------------
Application desc
METAL ROOF
----------------------------------------------------------------------------
Owner Contractor
------------------------
------------------------
ATLANTIC BEACH PARTNERS, LLC JAMES SHELTON ROOFING
414 OLD HARD RD SUITE 502 252 SANTA BARBARA AVE
ORANGE PARK FL 32003 JACKSONVILLE FL 32254
(904) 378-9205
----------------------------------------------------------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . - CLUBHOUSE Plan Check Fee . 00
Permit Fee . . . . 360 . 00 Valuation . . . . 70000
Issue Date . . . .
Expiration Date . . 3/11/15 --------------
-------------------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 5 .40
STATE DBPR SURCHARGE 5 .40
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 360 . 00 360 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 10 . 80 10 . 80 . 00 . 00
Grand Total 370 . 80 370 . 80 . 00 . 00
PERMIT IS APPROVED ONLV 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
/�'r umber:
Job Address:
Legal Descriptiomzv/ez,�Wg Area of Sq.Ft. Parcel N
.0 Floor Sq.Ft
any- ProposedWork heate /cooled /Z= non-heated/cooled
Valuation of Work$ /co
Class of Work(circle one): (��w Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): ( Commercial Re-4dgntial
If an existing structure,is a fire sprinkler system instaL�. Peone): N/A
Florida Product Approval#
For multiple products use product approval lorm
Describe in det i f erform
Z70 wtrp
Property Owner,lnformation;
Name: I / z Address: so;,rz
city It__AZ!2V6 State,-VJip 12,031 Phone
E-Mail or Ft-<#(Optional)
Contractor Information. Z
Company Name:77,Z_,.es Qualifyai Agent:
Address: -city J42� State AZ zip sw�
;? /� Fax#
Office Phone Job Site/Contact Number r:Z:: 7
State Certification/Registration# 0Ce'_ X 7
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
A ca e e ade bana e d he work and n a a n s indi cat rtify that no work or installation has commenced prior to the
a I law ng construction in this jurisdiction. This permit becomes null
1 is s s f six(6)months at any time after
t to 0 t 'r 11 rm it to 0 0' to in t t i st 1�",Ods s�ork or abandoned for aW
n s' r by-d ha a k be e ed he tan a
v , io I i '_ s, 0, c st s ct 0 ,0
c a per an f h Z n 0
r
)in t
p(6 n
s, f
0 1 w hip
.0, 0 co, t
,d d i k en ed 'r 11 0 ct,.,c eriod o
" is coin",i 7 in ' w 0 i t Ob e ed rEe a Plumbing,Siins, �ells, Pools, Fiirnaces, Boilers, Heaters,
,k ced I understand that separate per't,
Tanks and Air Conditioners,etc.
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.
I here certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
e c ift'e ad hn 1 00
1�work will be complied with&whe �spIn or not. The granting of a permit doeM14 me to give authority to ate or cancel the
,o w cor,
'I. st t, 19, 1 law re 04
P11 I law re ti construction or the pe�formance , . I
provisions ofany otherfedera,s a e, 0
Signature of Owner Signa"nir to*
=C
Print 1571 CD .................................................................
..........
Print Name .... ...................... 1.............
........................................ 'A
......... ... .....
Sworn to and subscri�ed before me Sworn re e
LLL � n A /",/
this Day f t
JEWFER SKOW
AM\6 ftwy pwft.Stdo a[P"M
N ary ii My tow.ExOM Avg 23.2017 ot Public
Commft"#FF 16M
ow"T"41h NOW N"y .1 Revised 01.26.10
)tl\
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 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 MUS
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 S25,000.00 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
ORDINANC S.
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 UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 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 THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
ADDRESS PHONE NUMBER
P?tfNT
DATE
ATURE
.,,,ONATU�
Before me this day 20
of /in the county of z
Duval,State of Florida,has p.rso.611y;apaZ,.d—h..n'by himself herself and affirms that ,\\N \-\OUSrO'Ifz,
all statements and declarations are true d Ccurate \4. ..... 4,
a
7 County of
Notary Public at Large,State A,
0 :�ja go
,1,114ersonally Known -2
13 Produced Identilication-
Notary Signature:
F.1BLDG/0�er-Bw1derAffadavit;REVISED 4/16/2009