905 Plaza roof permit CITY OF ATLANTIC BEACH
i 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
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ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ROOF-2398
lob Type: ROOF PERMIT
Description: NOC REQUIRED - STORM DAMAGE HURRICANE
MATTHEW-tear-off shingle roof and install modified bitumen roof(self-adhesive
bottom)
Estimated Value: $4,000.00
Issue Date: 10/25/2016
Expiration Date: 4/23/2017
PROPERTY ADDRESS:
Address: 905 Plaza
RE Number: 171172-0000
PROPERTY OWNER:
Name: LUNDGREN, MAGALI C
Address: 905 PLAZA
FEES:
BUILDING PERMIT FEE $70.00
STATE DBPR SURCHARGE $2.00
STATE DCA 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.
a
7r BUILDING PERMIT APPLICATION
=' CITY OF ATLANTIC BEACH
J
800 Seminole Road,Atlantic Beach FL 32233
Office: (904)247-5826 • Fax:(904)247-5845
Job Address: 05- Pl.47tC '(L Ilp-(Z00 a
PennIi[Number: �- 39fr
Legal Description 0 0 - S - Cr ars; RE# l y I l Z ODDD
Valuation of Work(Replace t ort)S y D H-ated/Cooled SF f 7S N.Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repav Mov emo Pool Window/Dom
Use of existing/proposed stmeture(s)(Circle one): Commercial Resider
• If an existing structure,is afire sprinkler system installed?(Circle one): Yes o NIA
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
T_FA& OFF 514IN&LE &F A40L6 1 as esj✓e
Florida Product Approval# for multiple products use product a cot
Proverty Owner Information
Q 61 1 n ' Address: q05-
te pyName:
1 33 PhoneZZ
74 63
i1 AEMa0 /
ild
OwnerorAgent (IfAgem,PowaofAttuuyorAgemyLeaerReyuued)
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
TO OBTAIT INN FINANCING CONSULT WITH Y UR LENDERORANEATTORNEYUBEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
Contractor Information:
Name of Company: Qualifying Agent:
Address: City a e Zip
Office Phone Job Site/Contact N
State Certification/Registration# -Mail
Architect Name&Phone#
Engineer's Name&
Zboneff
W__orkenation
nempt surer ere cop oyees prmnon ate
App(lcalion is hereby made to obtain a permit to da the work and installation as indicmed. I certify!fiat no work or installation har rommenced
yAts to the issuanre ofa permit and that al!work wit!be performed to meet the standards ojal!laws regu(ming rontruction in this jarvdictiort.
%'his permit becomes nulf and void ijwork is not rommenced wi/hin six(b months, or ifrorzslmction or work is suspended or abandoned(or a
driodofsir 6)months of any time after wask is commenced IuMersmnd that sepamJepermils must besecuredjor N.lecMcal Work,l9umbfng,
na, Wans,IPools,Furase.,BuBers,Heaters,Tanks and Air Conditioners,etc.
SigmtumofPmperty Owner. ,P." NL!:— t,p(
Before� yy� @@ "" �Signahue ofContracmr.
1 ' this aLr_t'Day of_ 0 (tZI Beforeme this Da
Notary Public: R-WA� Notary Public-
I hereby certify that l have r zimine,dg#jkWA1t(l�atgion a know t ante to be true and correct. All provisions of laws and
ordinances governing this ty _ - _;Yi `tM1d0aWWltRlieFl2lYlli ther specified herein or not. The granting of permit does not
presume to give authority to. acmgXllla�a:Aoylkl9(2aaiaf y other federal,state, or local Iaw regulating construction or the
performance of construction. x ,0 aartallw Wa PuercuM.
Rev.3/14/16
CITY OF ATLANTIC BEACH
(OWNER / BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART i "CONSTRUCTION
CONTRACTING"REQUIRES OWNER I BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 469.103(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,
IT. 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 ANV
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(247-5828)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.
OSG �4�{ 32z 2- 03
ADORE. // .'� PHONE NUMBER
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PRINT�141 IES
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SIGNATURIF DATE
Beare me Misd7'Naaya DC'108e2 .z01L aMe coanya
Duval,Slate of Farida,has personalty appeared herin by himself I herself and aRinas that
all statements and declarations are ttu''e and accumle. T
Notary Public at LaMe,State of rir_,County of a)uWL
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Notary Si9naare: 1 N1Anvs3�.,�:.@.,• BaWM tlwlgayPWk Utlw'lln
FIBLDG/O _anlm-- r,REVISED'. 1,..