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1786 SELVA MARINA DR - ROOF ,\ 1 rs r \Jr/6 r - `s\ CITY OF ATLANTIC BEACH ra .- 0 800 SEMINOLE ROAD j • fN tJl3l ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 � r ROOF PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 15-ROOF-2217 Job Type: ROOF PERMIT Description: RE-ROOF Estimated Value: $14,000.00 Issue Date: 9/21/2015 Expiration Date: 3/19/2016 PROPERTY ADDRESS: Address: 1786 SELVA MARINA DR RE Number: None GENERAL CONTRACTOR INFORMATION: Name: FORD BUILDERS, INC Address: 29 20TH AVE S Jacksonville S Phone: 904-246-7942 FEES: BUILDING PERMIT FEE $120.00 STATE DCA SURCHARGE $2.00 STATE DBPR SURCHARGE $2.00 Total Payments: $124.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODE'S. BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office(904) 247-5826 Fax (904) 247-5845 i S -Roo I_ ZZ I.7 Job Address: )—7�' ]1Jc5 171 ')6)7 ✓97 Permit Number: Legal Description 29 -'z5 29.E f/5/0 Parcel# J7Za) ) • C5c5c:3 I�1 Floor Area of Sq.Ft. Sq.Ft Valuation of Work$1 �pbn Proposed Work heated/cooled Z�7C) non-heated/cooled I . 11 Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/ oor Use of existing/proposed structure(s)(circle one): Commercial esidentia_I �C�_� If an existing structure,is a fires rinkI s. t Astalled? (Circle one): es N/A Florida Product Approval # fL_.5 J --c4 Y) multiple products use product approva form Describe in detail the type of work to be performed: C"r'0e:::4 T © !'7 .Ai Q Property�Owner�Information: � /Name: / OdC��) i �!• yL z Address: / 1-4', �Q�.'I Y� , 'fcr�4j,}k� �.r' City -k/) J/G �Gl. Star Z1 32z hone J�i Z." S/i Y � P �� E-Mail or Fax#(Optional) Contractor Information: • ` 1^ Company Na O P" O V_ +jcrs ac Boa r (49 p y Qualifyin_ Aent: Address: tt><YG i _ ime City ' G .1 State _. Zi Z Office Phone •� ! VAW / Jo ire/Contact Numker/W r • a Fax# — a State Certification/ egistration r CI Gp3> 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 commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a_period of six(6)months at any time after work is commenced. 1 understand that separate permits must be secured for Electrical Work, Plumbing,Signs, Wells, Pools, Furnaces, Boilers, Healers, 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 FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. 1 hereby certi that I e read and ex tried this a lication and know the same to be true and correct. All provisions°11111. law a , ordinances governing this type of work will be co • w .ther s•,•ci red herein or not. The granting of a permit does not presume 1• live a tho ' to violate or cancel the ovision . . • • "•r ed� ate, oc• • regulating construction or the performance of construction. Signature of Owner ��i i:nature of Contr t:•'�r' away Print Name / r��� j Q.0 k'3C Print Na 0( () hp/4 Sworn o and subscribed before me -�`^ Sworn to and subscribed before me I this .�_ Day of (' ,20 this le Day of cy i'a«�n ,20 b • - W Notary 'u e g.. DAYNAH.WIWAMS Notary ;..r...,,. NOta U r C ,+..14 DAYNA H WIWAMS �� `` MY COMMISSION#FF 217841 y :`.: IC MY COMMISSION I FF 217841 [ k, ev 6u2019 EXPIRES: Pubictinderwders ''? `� taryPubic Undennters i1� ;t xn4ed tnn,Notary Pu •.Ff;f�•• Bonded Thu No Wit ; tif 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 ORDINANCES. 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. 1-?$6 S<1-v1 Mc6 n S Ste/- '5'6 Z - � 1l ADDRESS PHONE NUMBER 77,019 g T 4 .1< o� PRINT NAME ,r' 9 _ , s_ z � , S- Si..NAT DAT Before me . fQif♦ •. •f -�'ri lG^�1� 20''in the county of Duval,Sta. of F F. '.. -s personally appeared herin by himself/herself and affirms that all stateme ..and declarations are true and accurate. Notary Public at Large,State of f WR nck ,County of >t/LL arPProduced Identification- ft lit ■ Ogib tD 7 p21(0 �� DAYNA H.WILLIAMS MY COMMISSION Y FF 217841 Notary Signature: k\/...�.. ' � =;F August 7,2019 -• •.,a,t,,• Bonded Tfuu Notary Public Unden.riters