PERMITWARNING TO OWNER= C,TY'OF0B~iY'N30oSN'~B~ACH~
"YOUR FAILURE TO RECORD A NOTICE OF COM-
MENCEMENT MAY RESULT IN YOUR PAYING TWICE BUILDINGDIVISION
FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANC-
ING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOL~R~TICE OF COMMENCEMENT." Date ,~,ed:3/0 6/0 ~
Prepared By: ARMO L DR
Date Issued: 3/0 6/0 1
NOTICE
IN ADDITION TO THE REQUIREMENTS OF THIS PERMIT THERE MAY BE ADDmONAL RESTRIb"'q~NS 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 ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
Permit No.: 0100000910
Permit Type:
REQUIRED: SEE BACK
CitY08 I Range43 Twnshp.45 I Section09
Property Address
OF PERMIT CARD FOR REQUIRED INSPECTION.
Sub Dvsn.
1Z
Block [ Lot
005 0030
Plat~Book~Page
Z60 N ATLANTIC DR RA
Su~NisionName Legal Address
ROLLING GREEN RIDGE
Owner's Nar~e/Address/Telephone
DIEUJUSTE,WISLOT & EDRINE D
£60 N ATLANTIC DR
BOYNTON BEACH FL 33435
561 740-9864
Additional Desc, ipllon
TENANT: REPLACE 3 WIN/EXIST SHUTT
Construction
Occupancy J
J BFE FFE
Sq. Ft.
Schedule of Fe~s
IFLZ
Valuation
L~UU
THIS PERM
Contractor's ~me/Addre~/Li~n~/~lephone
DiEUJUSTE,WISLOT & EDRINE
Z60 N ATLANTIC
BOYNTON BEACH
561 740-9864
DR
D
General/Architect/Engineer
Improvements
T FEE IS
NOT REFUNDABL~ ~
FL 33435
PAID 35.00 DATE- 3/06/01 RECEIPT#- 0000007619 000000000
AUTHORIZED ~ _ - ,SIGNATURE
NOTICE: CALL 742,-6355 FOR INSPECTIONS .4 HOURS N ' '
THIS PERMIT SHALL BECOME NULL AND VOID UNLESS THE WORK AUTHORIZED IS COMMENCED WITHIN ONE HUNDRED AND EIGHTY (180) DAYS 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 no1 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
Occttpational £icenses
Cotttlttllttio~ Redevelopment
Neighborhood Specialist
Permit Application No.
Owner:
OWNER-BUILDER AFFIDAVIT
01-0010
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
trader 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 myselfi 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, THE OWNER OF PROPERTY DESCRIBED AS
(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 IMPOSITIONOF OTHER PENALTIES AS PI~ES/CRIBED BY LAW.
I/
,,, , , . '31t,, /o (
dvmerTM J - Dae
STATE OF FLORIDA, COUNTY OF PALM BEACH ) /
The foregoing~ins/rum~qt was acknowledged before me this .'3 (~' /(2) f (date) ~ ~t ,:*' F'
by [1)15!O~' [fl} ~A,{.75'qb'T~_t , who is pers0nally known to me or who has prod~ee<l.5~.~
I)/- O- - -" ~ e of identification) asjdentification and who did not) take an oath.
e~ped,p~te~do~~ :~!'' 'i ..
Title ,, ·
Revised 6/00 - JSSHRDATAkDevelopment~FORMS.doc\Owner-Builder Affidavitdoc. 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
BUILDING DEPARTMENT
12 IX: (561) 742-0357