PERMIT WARNING TO OWNER:
"YOUR FAILURE TO RECORD A NOTICE OF COM- C,TY OF BO~O~(~N~/~&
MENCEMENT MAY RESULT IN YOUR PAYING TWICE BUILDING DIVISION
FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANC-
ING, CONSULT WITH YOUR LENDER OR AN ATI'ORNEY BEFORE RECORDING
YOI)R~NOTICE OF COMMENCEMENT." Date Applied: '~/'Z6/'"O ?..
I NOTICE Prepared By: A R M O
IN ADDITION TO THE REQUIREMENTS OF THIS PERMIT, THERE MAY BE ADDITIONAL RESTRICTIONS APPLICABLE
TO THIS PROPERTY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY AND THERE MAY
BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTreES SUCH AS WATER MANAGEMENT Date Issued: ,~ / Z
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
Parm~ Type: Perm~ No.: 0 Z 0 0
ROOFING PERMIT
NSPECTIONS ARE REQUIRED: SEE BACK OF PERMIT CARD FOR REQUIRED INSPECTION.
City I Range
08 I ~3
Pmparty Address
Twnshp.45 I
Section Sub Dvsn.
Z!
01
Block I Lot
0!0 0110
Rat/Book/Page
Zoning Reviewed by
1637 NE ~TH ST RA
Subdivision Name Legal Address
ROLLING GREEN
OwneCs Name/Address/Telephone Contractor's Name/Address/I icense/Telephone
S'MiTH,
BUSH, GEORGE W & LiMA D
!637 NE %TH ST
EOYNTON BEACH FL 33%35-Z7
BUSH, GEORGE W & SMITH,
'!637 NE 4TH ST
BOZNTON BEACH FL
AdditionalDescri~ion General/Amhit~t/Engineer
TENANT= 1~ ~,-"12 ~HINGLE8
BFE FFE
Sq. Ft.
IFLZ
Valuation
Construction I
Occupancy I
Improvements
RE-ROOF
LiMA D
33435-Z718
~hedu~of~es * THIS PERMIT FEE IS NOT REFUNDABLE
OTHER FEES:
AUTHORIZED SIGNATURE -~~"~-~~
IF THE WORK AUTHORIZED HAS NOT RECEIVED AN APPROVED INSPECTION FOR A PERIOD OF ONE HUNDRED AND EIGHTY (180) DAYS.
Any change in building plans or specifications must be recorded with this office. Any work not covered above, must have a valid permit prior to starling. In consideration
of the granting of this permit, the owner and builder agree to erect this structure in full compliance with the Building and Zoning Codes of the City of Boynton Beach,
Florida. This permit fee is not refundable.
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
156.
To:
Re:
From:
AFFIDAVIT
(ONE & TWO FAMILY DWELLINGS ONLY)
City of Boynton Beach, Florida
Department of Development - Building Division
Field Inspection Section
100 East Boynton Beach Blvd., P.O. Box 310
Boynton Beach, FL 33425-0310
Permit No. ,'Q ~ O 0 O0 l .~ ~ ~z
(Contractor)
(Contractor's Address)
(Owner/s Name)
(Property Address)
CERTIFICATION SELECTION:
~-~ertification of roof metal installation, flashing, underlayment.
Certification of re-nailing roof sheathing, and removal and replacement of damaged or rotted wood.
[--~ Other
I, ~.'v,:_O ~,-cv (-- C,~ ~ ct s'/d , IZl~am an Owner/Builder, [] am certified as a roofing contractor
(Licenke No. t ) and do hereby certify that all roof work (as indicated above) has been
performed at the above address in accordance with Chapter 15 of the 1997 Standard Building Code. I understand that
the City of Boynton Beach offers progressive reroof inspections.
affidavit.
S ign~ature~u~lldTor~
Qualifier
I have notified the owner of the property of this
Date
STATE OF FLORIDA, COUNTY OF PALM BEACH [r~ I"~ ~ [ '.- ~0 O~x ...---]tx
The foregoing instrument was ackn~9-',yle..dged bef~ore me this k_~- !CX ~date) by~-J~ { ~ 1~....)~:~ k_, who is personally
known to me or who has produced ~)x(~ .~ q~ {Jr"_ ~ (type of identification) as identification and who did (did not) take an
Signature of person taking ackno,vledgen~._~a~ v~ ~ix~ k.~ [~..~' ~ ~~t~nu~,,~s0 !
Name of officer taking acknowledgement--typed, printed or stamped
Title or rank Serial number
DJ:mh 10/6/95, Rev WVH:mh 11/27/95, 1/12/96 2/5/96, Rev DJ:bg 11/29/99. 8/31/2000
~\CH~MAIN~SHRDATA~DEVELOPMENT~POLICY MA~NUAL.WP\POLICYMH~SPECCON~ROOFCERT.WPD