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760 REDFIN ROOF 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 30B INFORMATION: Job ID: 15-ROOF-1 859 Job Type: ROOF PERMIT Description: reroof Estimated Value: $4,500.00 Issue Date- 8/3/2015 --Expi-ration-Date: 1/30/2016 PROPERTY ADDRESS: Address: 760 REDFIN DR RE Number: 171310-0000 PROpE�R014NER: YSTOF P & EWA, Name: WOJNAROWICZ, KRZ Address: 760 REDFIN DR FEES: STATE DCA SURCHARGE $2.00 STATE DBPR SURCHARGE $2.00 BUILDING PERMIT FEE $72.50 Total Payments: $76.50 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: _16C PermitNumber: T-L '5 Legal Description Floor Area of --Sq.Ft. Parcel# Sq Ft Valuation of Work$ Proposed Work heated/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 sprin=system installed? (Circle one): Yes No N/A Florida Product Approval# For multiple products use product approval form Describe in detail the type of work to be performed: ocrIN Property Owner Information: Name: woz?woeooc�_ —Address: -190 X950FIA/ PA, city State&Zip Zq� ,Phone E-Mail or Fax#(Optional)_----_CC JX144 e- . C 0 J�f hi 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 4pplication 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 ofa permit and that all work will be performed to meet the standards of all laws regulating construction in thisjurisdiction. This permit becomes null and void ff work is not commenced within six(6)months, or if construction or work is suspended or abandonedfor a period ofsixp6)months at any time after work is commenced I understand that separate permits must be securedfor Electricar Work,Plunilliing,Signs, Wells,Pools, jurnaces,Boilers,Reaiers, Tanks andAir 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 FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. I herelb certify that I have read and examined thi's application and know the same to be true and correct. All provisions of laws and ordinances governing this cancel work will be co�nplied with whethersrZi/1ed herein or not. The granting of a permit does not presume to give authority to violate or the provisions of any otherfederal,state, or loca regulating construction or the pe�fo�mance of construction. Signature of Owner Notary Public State of Florida Signature of Contractor lidey L Graham Print Name Print Name .......... ........... ............. ..... ............. xi.F.F.0629.0............ ........................................................................................................................................ 0 0 E 1res 02/14/2018 Before me f .20 this Day of 20 Moffar—y P—LitlIr- Notary Public Revised 01.26.10 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$25,000.00 OR LESS. THE BUILDING MUST BE FOR�LQ_URUSE 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 T14AT 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. Ill. 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. 76,0D w- , #qU4ff)-14 51A&� y0l� qt�l ADD;RCSS Ft PHONE NUMBER X,-6 P- PRINT NAME SIGNATU DATE Before me this day of 21�5,,ir�the county of Duval,State of Florida,has persona y appear herin by himself/herself and affirms that all statements and declarations are tru nd a urate Notary Public at Large,State of L County of V0 P nall K C 111ce'ly. P(, Notary Public State f Florida N ota Shirley L Graham MY Commission FF 086990 F/BLDG/O�er-BuilderAffadavit;REVI ED:4116/2 9 Expires 02/14/2018 SKU# 382-407 GAF PRODUCT APPROVAL v'Roofing Shingles FL 10124 Underlayment (Synthetics) FL15487 Underlayment (Liberty Base, Ruberoid SA Base/Ply, Stormguard) FL 10626 Everguard TPO (SA& Fleece) Roof Systems FL5293 Roof Ventilation FL6267 960 Static Roof Louver FL5027 CERTAINTEED PRODUCT APPROVAL Roof Shingles FL5444 Underlayments (Torch, Flintlastic, SA, etc.) FL11288 Modified Bitumen Roof System FL2533 OWENS CORNING PRODUCT APPROVAL Roof Shingles FL 10674 Roof Shingles (Supreme & Classic) FL16638 Underlayment FL9777 TAIVIKO PRODUCT APPROVAL Roof Shingles FL1956 ATLAS PRODUCT APPROVAL Roof Shingles FL09792 Underlayment FL 11915 MIDSTATES PRODUCT APPROVAL Quick-Stick Ice and Water-sanded FL 13857.4 WOODLAND PRODUCT APPROVAL is# Felt D226 FIL 1814 V30# Felt D226 FL1814 15# D4869 FL1814 30# D4869 FL1814 STAMPCO PRODUCT APPROVAL Off Ridge Vents FL 16160 LOMANCO PRODUCT APPROVAL 750 Vent FL3792 Omni Roll FL2847 Roofing Supply Group 3333 Canal Street- Unit I Jacksonville, FL 32209