PERMIT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
Permit Type:
BUILDING PERMIT
INSPECTIONS ARE REQUIRED: SEE BACK OF PERMIT
I I I
Property Address
WARNING TO OWNER:
"YOUR FAILURE TO RECORD A NOTICE OF COM- C~TY OF BOYNTONBEACH~
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
YOLffi'N(~I'ICE OF COMMENCEMENT." Date ~: 6/z o / o ~
NOTICE I Prepared By: A R M O L D R ~' ~-')'
,. ^DOITIC. T0 THE REQU,BEME.TS OF TH,S .ERMIT. THERE MAY BE ADDD0.A..ESTR,Cr,0.S A.~.ICABLE ~
TO THIS PROPERTY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY AND THERE MAYI
BE ADOm0NAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITLES SUCH AS WATER MANAGEMENT I 6 / Z 0 / 0 l
Date Issued:
Permit No.: 010000Z547
CARD FOR REQUIRED INSPECTION.
Block Plat/Book/Page
019 014,0
Lot
Zoning
RA
13gl SW ZSTH AVE
Subdivision Name
GOLF VIEW HARBOUR ZND SEC
Owner's Nome/Address/Telephone Contractor's Name/Address/License/Telephone
ROSELLO, CARLOS &LAUREN
13Z1 SW Z3TH AVE
BOYNTON BEACH FL
561 732-6759
334Z6
ROSELLO, CARLOS &LAUREN
13Z1 SW ZSTH AVE
BOYNTON BEACH FL
561 73Z-67§9
Additional~scri~ion General/Amhit~t/Engineer
TENANT: 5FT CL/FOR POOL BARRIER
334Z6
Construction
Occ~[~_ncy [
Schedule of Fees
BFE FFE FLZ
Sq. Ft.
Valuation
i, 800
Imp£q~e_r~_ nts
PAID 35.00 DATE- 6/Z0/O1 RECEIPT#-
0000009636 000000000
NOTICE: CALL 74Z-6355 FOR INSPECTIONS Z4 HOURS IN ADVANCE (BEFORE 5:00
THIS PERMIT SHALL BECOME NULL AND VOID UNLESS THE WORK AUTHORIZED IS COMMENCED WITHIN ONE HUNDRED AND EIGHTY (180) DAYS AI-i ~-H 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 pdor 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.
OIndicate
North Arrow
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
FENCE PERMIT AFFIDAVIT F~LE COPY
(PLEASE DRAW IN LOT LAYOUT).
(SUBMIT SURVEY)
-,a DEPARTMENT
Indicate fence with
Small xxxxxxxxxx's
PERMIT NO. O(xJU t~'~
Am_ O ( Zo (o ! BY:
Subdivision ~oLFVi61A,) I'-Ja~Joo,,P-- Lot IH Blk ! C/
'Valuation
Type ofFence ~fl6£69 C6~-,;~3& Height D Length
Typeofeosts (1) Comer '7- h ? (2) Line I ~ ~ "/.* Depth in Ground ..~{~-n'~'
Distance b/t Posts l0 V Top Rail Size [ J/o, In concrete Yes / No __
AFFIDAVIT
I, the contractor/owner, have signed for a permit to construct a fence as shown above. I have not provided a survey
by a qualified surveyor to the City of Boynton Beach. Therefore, it is my responsibility to place this fence on the
property referenced above. If, at any time, the fence is found not to be on said property, it will be removed and
reinstalled at my expense.
Signature of Contractor/Owner Date Address
State of Florida
County of
Before me personally appeared , to me well known to be the person described
in and who executed the foregoing ~nstrument, and acknowledged to and before me that he/she executed said
instrument for the purposes therein expressed. Wimess my hand and official seal this day of
., A.D.
Notary Public, State of Florida at Large
My commission expires:
Permit Applica~on No.
Owner: (. 'tat. ('~ ~.
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
OWNER-BUILDER AFFIDAVIT
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 with certain restrictions
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 or
substantially improved for sale or lease. IfI sell or lease a building I have built or substantially improved myselfwitkin 1
year after the construction is complete, the law will presume that I built or substantially improved 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
(legal description)
;- ~ ~k~k;~l ~ ~ k.v~.
(Address) !3gl ~tO
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.
4~}~Wn'~r ~-~' Date
STATE OF FLORIDA, COUNTY OF PALM BEACH 6/ / . I ./9
!
The foregoing instmment was acknowledged before me~this {?.O{O( (date)by b~O~.~;O ~-OSEg[O ,
who is personally known to me or who has produce, d ~ :2 qO ~ ~'~-5 - ~' Z- 5-~'~>"ff-O (type of identification') ~s identification
dwho
S ignatur~~ _r~g ac
Name of officer taPdh~ac-dtrffo-,~~d, l~ri[nted or stampe-d
Title
Revised 6/00, 3/01 - JSSHRDATA\Development~FORMS.doc\Owner-Builder Affidavit.doc- REV. 5-2-01