2280 N Fairway Villas Ln re-roof permit CITY OF ATLANTIC BEACH
j 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: 17-ROOF-3296
Job Type: ROOF PERMIT
Description: RE ROOF
Estimated Value: $2,800.00
Issue Date: 2/21/2017
Expiration Date: 8/20/2017
PROPERTY ADDRESS:
Address: 2280 N FAIRWAY VILLAS LN
RE Number: 169398-1102
PROPERTY OWNER:
Name: LACROSS, SCOTT A& MICHAEL J,
Address: 2280 N FIARWAY VILLAS LN
FEES:
BUILDING PERMIT FEE $64.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: 568.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BIfDING PERMIT APPLICATION
ITY OF ATLANTIC BEACH
e - - - 800 mingle Road;Atlantic Beach,FL 32233
- ice(904)247-5826 Fax (904)247-5845 17 -Roo F ZZ9(o
Job Address:C&F"WW �R0.iiS" i1&&US j a Ll Permit Number:
Legal Description �:v.oto Fcsl for area Parcel#
or ea o qct —Sy.Ft
Valuation of Work$�_Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one):(((((( New Addition Alteration Repair Move Demolition pool/spa window/door
Use of exisfiug/proposed strucor Isj
(circle one): Commercial �esidential
If an existing structure,is afire sprinkler syste installed?(Circle one): -S`es—No /A
Florida Product Approval# T - k 4L. 1 SS'-Zit I'Cuad 7-)- i
For multiple products use product approve grin ;
Describe in detail the type of work to be performed: -��o"e.'0- -) M /p6ph.,/1 S4,M4
Property Owner Information:
NameI �n/..Q� �,25� Address:.- QiCvay
City Zip�39_phone S'kYl m 63
E-Mail or Fax#(Optional)
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
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 oja permit and that al/work will be per armed to meet the standards ofull laws regulating construction in this jurisdiction This permit becomes null
and void work is not eommencedwithm six(6Jfmonths, or ifconstruction or work is sus ended or abandonsd for a period ofsix/6J months at any time after
work is commenced. I understand that separate permits must be secured for Electric Work,Plumbing,Signs, Wells,Pools,Furnaces,Boilers,Heaters,
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 LENDE OR AN ATTORNEY BEFORE RECORDING YOUi NOTICE OF
COMMENCEMENT.
I herebp certify that Ihave read es.numedthispoplicauan and know the same to be hue andcomect. Allprovisions oflows ardordinances governing this
type o)work will be complied whether speci ted herein or not. The granting of a permit does not presume to give authority to violate or cmrcel the
provisions ofany otherfederal, e, crlocal[aw regulatingconstruclion or theperformamee ofconshucthm.
Signature of Owner roil ciao FEacEs Si amre of Contractor
MV COMMSSION J FF 824961
Print Name l EXPIRES. 6,2J1s,,
`C..�Etl � � ,t � .....�ae'`....amaamNmwaoeeum.amGFi Name
Belo i Before me
this ay of 20 this _Day of 20
a.,
Notary ub i Notary Pub is
Revised 01.26.10
_ CITY OF ATLANTIC BEACH
OWNER / BUILDER AFFIDAVIT
DB V
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$25,000.00 OR LESS. THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSE$ REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
IL 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.
0 gal pies- -aa a 3
hODRESS PHONE NUMBER
f
PRINTN A
SIGNATURE ,^ DATE
Before me this�dl of�'I+�,300 in the munry d
Duval.State d Plains,has personally appeared herrn by himseff l herseff and affirms Mat
e1I Statements and dedara0ans ere We antl....
Notary RUNG at Large.State of Daady of V
Dpxwrelh Hanan zra - - 4- 454 -a
❑Pm]umElCen4fiu4T-
rvda Si nature: TOM GIWJLESPERGEB
ry g MY WM1IMISSIONtlff82G951
EXPIRES:Oabber B 2819
FR1DG'OwierBUNV AReLviI:REVI5E0:VIbRW9 r gmCCE In W'M Pub9e UrKrMitCO
'4�.