PERMIT WARNING TO OWNER: - 0 1 - 0 $ 2 ?
"YOUR FAILURE TO RECORD A NOTICE OF COM- CITY OFBOYNTONBEACH
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 ATTORNEY BEFORE RECORDING
YOU~(~I'ICE OF COMMENCEMENT." Date Applied:
I IN ADDITION TO THE REQUIREMENTS OF THIS PERNMITO%E%EE MAY BE ADD TIONAL RESTRICTIONS APPLICABLE
TO THIS PROPERTY THAT MAY BE FOUND IN THE'PUBLIC RECORDS OF THIS COUNTY AND THERE MAY I Prepared By:
BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. J
Permit Type:
BUILDING PERMIT
INSPECTIONS ARE
City J Range
08 I '~3
Propart~ Address
REQUIRED:
Twnshp.
SEE BACK
Section
32
Date Issued:
Permit No.:
1185 SW 27TH AVE
Subdivision Name
Owner'sName/Addmss/~lep~ne
u ~
1185 SW £7TH AVE
BOYNTON BEACH
561 737-1975
Additional Description
FL 33426
Construction
Occupancy
Schedule of Fees
BFE
Sq. Ft.
FFE
FLZ
Z/Z8/Oi
CONKLINC
3/01/01
0100000827
OF PERMIT CARD FOR REQUIRED INSPECTION.
03 013 0070
Zoning Rev~;.*3d by
JP
Legal Address
GOLF VIEW HARBOUR 2ND SEC
Contractor's Name/Address/License/Telephone
1185 SW ZTTH AVE
BOYNTON BEACH FL
561 737-1975
33426
General/Architect/Engineer
BLANKET FEE 51.20
PAID 51.20 DATE- 2/28/01 RECEIPT#- 0000007529 000000000
C~____---~.EDP~LD- _5_~,~,~R DATE- Z/28/01 RECEIPT~- 0000007529 000000000
ITED 5~.20~ DATE- 3/01/01 RECEIPT#- 0000007554 000000000
NO INSP UNTIL CERT/REC NOC RECD
THIS PERMIT SHALL BECOME NULL AND VOID UNLESS THE WORK AUTHORIZED IS COMMENCED WlTHI S AFTER ISSUANCE, OR
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 starting. 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
Building
Planning & Zoning
Occupational Licenses
ComtnuniO~ Redevelopment
Neighborhood Specialist
OWNER-BUILDER AFFIDAVIT
Peri. it Application No. 0/- ~ & 7
ow= ' 01-0s ?
I hereby apply for a Building Permit in the City of Boynton Beach, Florida, and will personally
supervise and control the permitted construction and will observe all the requirements of the
Building, Electrical, Plumbing, Mechanical, Zoning and other technical codes as adopted and
enforced by the City of Boynton Beach.
WHEN ISSUED, I UNDERSTAND THAT THIS PERMIT IS FOR CONSTRUCTION OF
IMPROVEMENTS EXEMPT UNDER 489.103 (7) OF THE FLORIDA STATUTES, AND
CERTIFY THAT I AM THE BONA FIDE OWNER OF SAID PROPERTY. I ALSO
UNDERSTAND THAT:
State law requires construction to be performed by licensed contractors. I have applied for a permit
under an exemption to that law. The exemption allows me, as the owner of my property, to act as my
own contractor even though I do not have a license. I must supervise the construction myself. I may
build or improve a one-family or two-family residence or a farm outbuilding. The building must be
for my own use and occupancy. It may not be built for sale or lease. If I sell or lease more than one
building I have built myself within one (1) year after the construction is complete, the law will
presume that I built it for sale or lease, which is a violation of this exemption. I may not hire an
unlicensed person as my contractor. My construction must be done according to building codes and
zoning regulations. It is my responsibility to make sure that people employed by me have licenses
required by state law and by county or municipal licensing ordinances.
I certify that I have not completed a residence or duplex under an owner-builder permit within
the past twelve (12) months.
I, THEO~ROFPROPEI~D~ESC~_ EDAS/A///~ J..//~/~ ·
(legal description) ,.)~~-~-~&~ ~~
(Address) ~ ~
DO HEREBY CERTIFY THAT I HAVE READ THE FOREGOING, AND AM AWARE
OF MY RESPONSIBILITIES AND LIABILITIES FOR CONSTRUCTION WORK ON
THE ABOVE DESCRIBED PROPERTY AND DO HEREBY COVENANT AND AGREE
TO ABIDE BY ALL OF THE AFORESAID STIPULATIONS. I FURTHER
UNDERSTAND THAT ANY FALSIFICATION OF THE ABOVE STATEMENTS
CONSTITUTES FRAUD AND MAY RESULT IN CANCELLATION OF THIS PERMIT
AND THE IMPOSITION OF OTHER PENALTIES AS PRESCRIBED BY LAW.
O(,~er ~' - Date
STATE OF FLORIDA, COUNTY OF PALM BEACH
The f~in~/~l~fitmmegp.~was~owledged before me this 3,//*O '/ (date)
by /"~/J4.~ff~b'~ ~,r~ , who is personally known to me or who has produced
'~ - / ~,~_~C.~, ~type of identifi:a~ i~~th.
Signature of person taking acknowledgement~2~:_~2'
Name of officer taking acknowledgement--~-'~?'-_-~-
Title
Revised 6/00 - J:XSHRDATAXDevelopment~ORMS.doc\Owner-Builder Affidavit. doc. 8/24/2000
America's Gateway to the Gulfstream
100 East Boynton Beach Blvd., P.O. Box 310 Boynton Beach, Florida 33425-0310 Phone: (561) 742-6350
Fax: (561) 742-6357
Q City of Boynton Beach ORB '1 ~'380 Pg
Development Depa/fment DOROTHY H. WILKEN~ CLERK PB CDLINTY~ FL
Building Division IIIIIIIIII II III II III IIIII II III II1~ IIIII II IIIII I~ IIIII
NOTICE OF COMMENCEMENT I
County of: C,~" "~'~ ~ -
THE UNDERSIGNED hereby gives notice lhal imm-,-, ...... , -.:. ~. ......... L Thisspafere~er.~d.f. rr~¢~rdb~.
~-~-~.,,-,,. ~m uu mace IO ce~aln real properly and in accordance wi~
Chapter 713, Florida Slatules, Ihe following information is provided in lhis Notice o¢ Commencemenl:
1. Legal description of properly:
(or a~ach legal description) Lot ~ Block . /~ Subdivision '
3.General description of improvement: -- ~ ~'/~'~- ' z~-~~
4. Owner Informal
Name:
Mailing Address:
Phone Number:
Interest in
Name & Address of
Fee simple titleholder
(if other than Owner)
5. Contractor Information:
Fax Number:
Company Name J
Phone Number:,..[
I Fax Number:l
6. Suret~
7. Lender In,orma;;;;: ~ B°nd Am°un' l $
"h°ne Number L .~ Bond Amount~ $
8. Persons within the State of Florida, designated by Owner upon whom notices or other documents may
be served as rovided b Section 713.131 a 7, Florida Statutes:
Name: ~____.
Phone Number: [
3 Fax Number: J
9. In addition to himself or herself, owner desi nates'
Name: ""'~' '/"?
Address:
Phone Number: '" I Fax Number:
to receive a copy of the Lienor's Notice as provided in Section 713.13(a)(b), Florida Statutes.
-~XPIRATION DATE OF THIS NOTICE:
.. ~. . ,~ (expires I year from date of record' ·
Signature of Owner: ~...~..~.~..~., ~//.~. //,~-..__.~._~ lng unless a different date is specified)
,. _ /*~/ ' ~.,-'"~'~'~'~' "~" *'4'~-~--~-~*~'''' Printed Name, ,~':'~,~-/*
Whoispersona yknowtomeorwhohas.rodu.7...~,.,/_~ ., da~vof ///W/..'~ /[ ,
Prinled Name: ' ,/.; · ' *-'- . -- , .....
\\CII\MAIN\SIIRDATA~Development\FORMS.doc\Nolice ofCommencement ] tm.doc - 8/24/00
/", ,',;~'.'~'~ I certify this document to be
t~o.'m~)~) a true ~~e record in
This / ~ Da~ ~//~
~ ~ Palm Beach~ ~nty~