544 Cruiser Ln roof permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
0;6 D'
ROOF PERMIT
MUST CALL BY 4PM FOR NE)Cr DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ROOF-2145
Job Type: ROOF PERMIT
Description: RE-ROOF
Estimated Value: $2,825.00
Issue Date: 9/23/2016
Expiration Date: 3/22/2017
PROPERTY ADDRESS:
Address: 544 CRUISER LN
RE Number. 170703-0320
PROPERTYOWNER:
Name: FISHER, WILLIAM C
Address: 544 CRUISER LN
FEES:
BUILDING PERMIT FEE $64.13
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $68.13
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC REACH ORDNANCES AND THE FLORIDA
BUILDING CODES.
----SUIU)TNG-RER—MIT-AP�-LICATIO-ff
0
-Rc BEACH
CrFy OF ATLAN
800 Seminole Road,Atlantic Beach FL 32233
-run 19,1� Officc:(904)247-5826 - Fax:(904)247-5845 1 Co-Roor_ Z (4G
Job Address: r
--,Aq 0a4LW Permit Number:
Legal Description na�E_,v9KNold
Valuation of Work(Replacement Cost)%XQ_�Lla Heated/Cooled Sft_j�zraNrm!itted/�Cooled -V
• Class of Work(Circle one):(2iD Addition Alteration Repair Move Demo Pool Window/Door
• Use ofexisting/proposed structure(s)(Circle one): Commercial -`Rmldwtm
Te
• Ifan existing structure,is a fire sprinkler system installed?(Circle one): T�N/A�
• Submit a Tree Removal Permit Application if my trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
a autall a&y)Ad2,!qk!5_&&Z*/�) XWz3rd
Florida Product Approval# EL "a,29d�z_o "It4ig'amifiple
preducts use product approval tiam
Property O�oer Inforuarition
Name', Addrcss�
city _StategLZip -P Phone
E-Mail iu�eAaP4,0,4
Owner,)rAgetit (IrAgeraftweraffiaamnmAgency[,au�
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 NOTIft OF COMMENCEMENT.
Contractor Information:
Name of Company: Agent:
,�g Agent
Address: try_ State Zip
Office,Phone Job Si 1900nitact Number
State Certification/Registration# —E-Mail
Architect Name &Phone#
Engineer's Name&Phone#
Worker's Compensation 4 Issempt / insurcr / Ursa hniployers i Expiration Date
Application is hereby made M obtain tio do the work and moallations as indicated. lcerj6 that no work or installation has..need
Igor to the issuance ofa permit and that all work will be performed to meet the standards ofall laws regulating construction in thisjurisdiction.
is,pemil becomes null and vaid is not crommuca within sbc 2 months or itwouraction or work is suspended or abandonedpr a
4,,,,(Manthis many tom,giber work is commenced lundemut thatseparalepermlismusibesecuredforEl ft, Plain ing,
J s, als,Furnace,Bollen;,Hasten,Tanks andAhr Condfitfimet%era
r
Signature of P operty,Owner(2"*� J Signature of Contractor:
BcfpK me rd I I
7 r�)j Bef
Notary Publ
I hereby certify that I have read and examined this application and know the same to be true and correct. Allprovisions,arlaws and
ordinances governing this type Zwork will be cimpi.ied with whether spe Xod herein or not I The granting of a permit does not
presume to give authority to via ate or cancel theprovisions,of any otherfe coal, state, or loca law regulating construction or the
performance ofconstruction.
Rev.3/14/16
NOTICE OF COMMENCEMENT
State of EagjbW Countyof Z%(11'qL_ Tax Folio No.
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of
the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description ofproperty being improved:__35.&If
Addressoffrioperty,being improved: "Eff 6wvj- Zane.
General description of improvements; t�lj%<B'W
1y1?W4f?6( 1y04
Owner: 12, r—j56;��- Address: (ff4e-
Owner's interest in site ofthe improvement: "60
Fee Simple Titleholder(ifother than owner):
Name:
Contractor-
Address:
Telephone No.- Fire No:
Surety(ifany)
Address: Amount ofBond$
Telephone No; Fair No: Doe It 2016218384,OR SK MI 6 Page 56,
Name and address of any person making a low for the construction of the ii Numer Pages,1
Recomcc!0912012D16 9 0:48 Pss.
Name: Ronnie Fussell CLERK CIRCUIT COURT DUVAL
Address: COUNTY
RECORDING$10DD
Phone No: Faix No:
Name of person within the State of Florida,other dim himself, designated by own"upon whom notices or other documents may be
served- Name:
Address:
Telephone No: Fax No
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owmer's option)
Name:
Address:
Telephone No: Fax No
Expiration date of Notice of Commencement(the expiration date is one(1)year*am the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNE
Signed: - Date:
Before me this day of'_',eq4- , 7�I (,,,in the County ofDuval,Side
OfForida,has personally appemd 4&'or.
Personally Known:
T ER
W(=1=0N*FFGWe5I Produced Identification: r1k C' C'5- 4 Y' _1-1 b 9
EXPIRSS Oeiss 6 M19
EX Notary Public:
My commission expires: g)
ITY OF ATLANTIC BEACH
ON (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 MUST
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY 13UILD 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
MUSI 13E FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU RAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WIECH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT
141RE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAICE SURE THAT PEOPLE EMPLOYED 13Y YOU HAV
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORPINANC
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
OVJNER�BUILDER PERMIT.
'91) �_ c9 lte-) —3Xg—
ADDRESS PHONE NUMBER
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PRI E
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SIGNATURE— k DATE
- '5d,00
Bakd.nn.thoZn _�IeO �
Duval,State of HoMa,has penscoally*A hemn by hirramFJ hersolyund W.that
all slaternenis and dedushathons am true and amunste
Notaq PuNic at Lar,e,Rate oy__F�_county a
PONt GiNGLEVERGER
coWISSIONIFF9201
EXPIRES.o�wisor 6.M19
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CL&
Won Sigratura:
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