15 Forrestal Cir 2014 roof S CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-731
Job Type: ROOF PERMIT
Description: reroof
Estimated Value: $4,000.00
Issue Date: 1/15/2015
Expiration Date: 7/14/2015
PROPERTY ADDRESS:
Address: 15 FORRESTAL CIR
RE Number: 171747-0000
PROPERTY OWNER:
Name: PARKER, RICHARD & IDA,
Address: 15 FORRESTAL CIR
FEES:
BUILDING PERMIT FEE $70.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $74.00
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:lor la�"PreSY�l /7 It
C _4,FZ1,VVermit Number:
Legal Description �;Pys Parcel# Loi- a 131 E
1,loor Area of' s .1"t. Sq.Ft
Valuation of Work V—Propos � hqentedtvooled --o—h-ated/cooled
Class of Work(circle one): New Addition Alteration (ED Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial Ts—ide-n—tia-a—
If an existing structure,is a fire sprinkler system installed? (Circle one):O:#eEs � N/A
Florida Product ASproval# 10 g 4, I t�
For multiple pro nets use product approval form
Describe in detail the type of work to be performed: 7c-? j096VtIO IE f'&Ploce (Ank,
04d <t,lln 5' Al&i,� aj' eNde- 4- Q0tie
t/og(t�i j%5,7 (3011"" r604- , - - 1�/
Provertv wner Information:
?Name:_3d1,:7jj+ c7 47�� Addr-
city Zn."_l 4--,1 &-.1 Statepzzip�Pp 76,3 1
C ach
r- � ( i eaQ d I LAP/- 0,0
E-Mail f ax 7#(Optional)— -�j
Contractor Information: CONTRA'-
Company Name:
Address: Zip
Office Phone Job Si,
State Certification/Registration 4
Architect Name&Phone#
Engineer's Name &Phone
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address /111'
4pplication is hereby made to obtain a permit to do the work and instal, work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet the stana, a uction in thi's jurisdiction. This permit becomes null
and void iy'work is not commenced within six(6)months, or if constructio)', oandonedfor a period ofsixP6)months at any time after
work is commenced I understand that separate permits must be secured, iunibing,Sikns, Wells, Pools, 'urnaces, Boilers, Heaters,
Tanks andAir Conditioners,etc.
WARNING TO OWNER: YOUR FAI_ )RE 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
MENCEMENT.
I here certify that I have re dux ined t li n an now the same to be true and correct. Allprovisions of laws and ordinances governing this
ty
P 0�
e work will be cotnpl' i w t r ie 0 The granting of a permit does not presume to give authority to violate or cancel the
provisions of any otherfede I egle c 'on or the performance of construction.
Signature of Own Signature of Contractor
Print M ..................
Print Name
Befor Before me
this D y of . 20 this Day of 20
----'c State of F1.nda
ol I,icy �;raharr—
Notary Public My CommieWn FF 066990 Notary Public
Expires 02/14/2018 Revised 01.26.10
CITY OF ATLANTIC BEACH
OWNER / BUILDER AFFIDAVIT
tit ,"
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 MUST
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE,;�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 T141S 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.
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.
/s 1-arre-sil
ADDRESS PHONE-NUMBER
F
ORIN ME
wel_J
S N r� A DATE
Before me this day of 2 0 the county of
Duval,State of Flori as pers ap-earea her' 'A'
p in�y/m elf herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of 4xounty of
------ 40 ou,,, NotarY Put"State at Florida
. I G hm
P!��6nally Known & . ShirieyL ra8F...990
01101`bduced Identific my Commission F
02ji 412018
Notary Signa
F/BLDG/Omier-BLlilderAff,ida%�i(;RFVISED: 4/16/2009)