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45 LEWIS ST - ROOF 41 ' " � ' 1S1 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 REROOF SHINGLE - MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: RERF17-0185 Description: ROLLED ROOFING Estimated Value: 8000 Issue Date: 11/30/2017 Expiration Date: 5/29/2018 PROPERTY ADDRESS: Address: 45 LEWIS ST RE Number: 172208 0000 PROPERTY OWNER: Name: YOUNG DAISY MAE Address: 45 LEWIS ST ATLANTIC BEACH, FL 32233-1917 GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: Address: Phone: PERMIT INFORMATION: Please see attached conditions of approval. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. * A notice of Commencement is only required for work exceeding an estimated value of $2,500. For HVAC work, a Notice of Commencement is only required when HVAC work exceeds and estimated value of$7,500. 4,040/11- City of Atlantic Beach APPLICATION NUMBER '. Building Department -_:(To be'assigned by the_Building Department.) =y 800 Seminole Road - '''� a Atlantic Beach, Florida 32233-5445 _0 t Phone(904)247-5826 • Fax(904)247-5845 IQ-P.' E-mail: building-dept@coab.us Date routed: 1 l City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM • Property Address: 1-5 L LS ST Department review required Ye/ No Building ✓ Applicant: LOI'C•(Z_,,, 4-Zoning Tree Administrator Project: Rot_t..&c Roo Ft Public Works Public Utilities Public Safety Fire Services ;Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By • Florida Dept. of Environmental Protection Florida Dept. of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: t Approved. ❑Denied. fNot applicable (Circle one.) Comments: �BUILQING . PLANNING &ZONINGReviewed by: Date: L1'�&'l7 TREE ADMIN. Second Review: nApproved as revised. nDenied. Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 „01-,L'J,,,, Building Permit Application Updated5/5/17 ,11,70" _ s City of Atlantic Beach ” _ �J 800 Seminole Road,Atlantic Beach, FL 32233.ztOFFICE COPY J;svr Phone: (904) 247-5826 Fax: (904) 247-5845 Job Address: ►-4 . L,e-u tis 4.-k--( i AA's'( , 43-4-r—<.-LIC.— Permit Number: R Q RF---17-0k735 Legal Description RE# Valuation of Work(Replacement Cost)$ , .c`E3 L.1 Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): New Addition Alteration a air Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial Residential • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A • 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: \ `1 R.t7 c.c Y1 rL\100, r -v _c - ' u1 O—s d.O�+`i os—o�i--�. \00t� C`x,i--'r\r'.1 c:C 'rN ROLL— 2©c P -- 3c'1 � 'CO6C bo�E\bc-( [-EeR_ OPJ Florida Product Approval# P L /C) 4/ 9 7 -2.5— for multiple products use product approval form Property Owner Information Name: �-,,_ .e ,(� Address:• 1---1j 1.-r i2-„,.. < S =r . City Q 8.`ca:.� c" (�'_c..<,..c�� State c L., Zip 3).--,,."3'. Phone c cD 4 /9___(-4 4 --'-i S 3 '--,/ E-Mail Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company: Quay9g-/ t: • Address City genState Zip Office Phone Job Sit tact Number State Certification/Registration# E- ail Architect Name&Phone# • Engineer's Name&Phone# Workers Compensation Exempt/Insurer/Lease Employees/Expiration Date Application is hereby made to obtain a p it to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a p rmit and that all work will be performed to meet the standards of all the laws regulationg construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS, and AIR CONDITIONERS,etc. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. 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. X 0 cLua...-.4, , .\Ae.c...,...„,_0)/. , (Signature o'F wner or Agent) (Signature of C.• ractor) (including contractor) f S' ned and sworn to or affir . before me this day of Signed and sworn to(or affir -d) before me this day of 6 � QV ,2 I, , by � C ....�. , Go ,b . 'ice ' - L nature:Q ►eta tarl (Signature of Notary) `,1 .'•; �£,, TONT GINDLESPERG k' a •Y.d; Iii >�'r,� ,; MY COMMISSION#i-F 92495 1 i L-� EXPIRES:Gctober G,2019 X11, >r �'.� . �I � F�,•' Ecnded 7hru hotzry Public Undervirters [ I Personally Known d1 " '`'--•�--- [ ] Personally Known OR ..[]-Produced Identification �'Z `( -7,-).....g 3-83 �[ I Produced Identification Type of Identification: Type of Identification: CITY OF ATLANTIC BEACH ._ 0 WNER/ BUILDER AFFIDAVIT p;i 2 - 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 rr ♦ AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT V 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 LIU 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. CD II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. C' III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO �, OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEA ^( EMPLOY ON THEIR IMPROVEMENT TRADES. 0 �b IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER AN`. I -I Z CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO—I _ 455-228(1). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALL c( 0 a SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTOR W F- G 6.i CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE TH CU © Z [— BUILDING DEPARTMENT(247-5826) IF IN DOUBT. 0 Q C) d V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSU Z CC Z c STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF Q.7 J N OWNER-BUILDER PERMIT. ��7777 I— W I-. 15 L-CLU Ss( ' Z4 1 4s3 4 ®.W W • ADDRESS PHONE NUMBER ii 4. cc E3 Dc 1 `10c7r\ \ � `= WP W PRINT NAME la U) w ryY t 7 f WIli 5.3 SIGNATURE '7 �7 DATE CC . Before me this 17 day of S3 0 / 201 /in the county of Duval,State of Flon a,has personally appeared herin by hi self 1 herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of P( ,County of IDU VcL. o Personally Known �� `— )7 —� JUJ .. _r wa s — .._=_❑Produced Identification- f — til TONI GINDLESPERGER -'I:?'%''I L °rO1 MY COMMISSION 0 FF 924951 .1.1•A‘,.14 fir, :: EXPIPES:October 6,2019 Notary Signature• PMo= °•' BendedThruNolaryPubfcUnderwter ` aL on cci -�ry a$ F:/BLDG/Owner-Builder Affndavit;REVISED:4/16/2009