2009 SELVA MDERIA CT RES21-0332 - -•1'r Building Permit Application Updated 10/9/18
-Ali-ig City of Atlantic Beach Building Department **ALL INFORMATION
v 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
on yr IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us (�
Job Address: 2670 SFLL'14 if'14(7EjZ4 Cr- Permit Number: ' `GS z a _ (-2)3 3 a
Legal Description Gj0 37 04 - ZS Z1'E (ELVA- NoP-TE tin/Tr Z ca 811TE# (c61c04, — (6S4
Valuation of Work(Replacement Cost)$ 61 , 71 7 Heated/Cooled SF 2.737 Non-Heated/Cooled a—
• Class of Work: ❑New ❑Addition 4lteration ❑Repairer�❑Move ❑Demo ❑Pool ❑Window/Door QR
• Use of existing/proposed structure(s): ❑Commercial esidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes IYNo
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) 2/No
Describe in detail the type of work to be performed:
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Describe C-C_G k/J t 0 c..)
S. 141rACH E D S Co(?E o i- v-i2-r— ( °`. i&R-L ( R.c 1v..o c3 E i% ,
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Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name AtEX cE Address 2005' SELYA /1447E Cr
City ITLAIVDC 7!•;f1-C}-t State F:---L— Zip 727.43 Phone /70 R?!.. - 75Z7
E-MailStEi•viariri 6''Qil—v 1 • GOA^
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Qualifying Agent
Address City State Zip
Office Phone Job Site Contact Nu.•.-r
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt D Expiration Date
Application is hereby made to obtain a permit t. •o the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permi : d that all work will be performed to meet the standards of all the laws regulating
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. NOTICE: 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 entities such as water management districts,state agencies, or
federal agencies.
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
RECO G YOU' NOS • • MENCEMENT.
ilk.��`
(Signature of Owner or Agent)
(Signature of Contractor)
Signed and sworn to(or affz•)before me this 27 day of Signed and sworn to(or affirmed)b=-• e me this day of
OCT" , 20E.4 b• 'fes.:* Ar T , , by
lli
I!?, a%eV , y) (Signature of Notary)
_? *4: TONT GINDLES SER [(-, PersonallyKnown OR
[ ]Personally Known OR ..: .*: MY COMMISSION#GG 353178 ' Produced Identification
[ ]Produced Identification .y��.o,: (.
lm',;' dCop' EXPIRES:October 6,2023 e of Identification:
Type of Identification: , ._ P
::, is in,eNiters ,
10/27/21
Alex Stewart
2009 Selva Madera Court
Atlantic Beach, FL 32233
Scope of Work
Note: there will be no additions or modifications to the footprint/layout of the house
Renovations include:
• Replace existing title floors with new floors
• Replace cabinets (same footprint as previous cabinets)
• New counter tops
• New sinks and faucets (using existing plumbing hookups)
• New paint
• Resurfacing of showers and tubs with new tile & Schluter waterproofing system
• New toilets in existing locations
• Replace appliances in existing locations
• Resurface exterior stucco with new synthetic stucco; repair buckled stucco on South
wall by garage and resurface with synthetic stucco
.i=m.i'iOwner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
Jr "' City of Atlantic Beach Building Department GRAY IS REQUIRED.
4 `'`n
800 Seminole Rd, Atlantic Beach, FL 32233
`DR9., Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
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 AFTER THE
CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT 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
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.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT
SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. .
III. IRS WITHHOLDING;OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING
TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT
TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY"CERTIFICATE OF COMPETENCY" OR THE FLORIDA"CONTRACTORS
CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I
COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Job Address: SZOO`i El.✓f; IL►A•MgA Cr—
Owner Name: AteC 57e 'r Phone Number: 776_g7g- '3-Z7
Mailing Address: Zan IE-uA /471X Cr City: i-Tj nC REnC rI State: rt. Zip: 3 ZZ3 3
Notarized Signature of Owner -141—Ct . -----1C . --
Theo oing instru ent was acknowledged before me this ay of di ,20Z (n the State of Florida, County
of ) ( rIlk(
/
Signature of Notary Public
[ ] Personally Known OR [ ] Produced Identification
:ss
T seof!dent' ' ',•,��. V- ' -
. . o., TONI GINDLESPER�ER
_i c, MY COMMISSION#GG 353178 Updated 10/24/18
::vy �' EXPIRES:October 6,2023
*,. °pBonded Thru Notary Public Underwriters
PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA (*REQUIRED)
✓nq3Pi
*Project Address: �` �� l\' Dt 1 ' -' Permit#: !\ E S z ( _ 3 3 7.
*Owner/Project Name: Aft) ci i v'1 1
As required by Florida Statute 553.842 and Florida Administrative Code Rule 61G20-3, please provide the information and product approval number(s)
for the building components listed below as applicable to the building construction project for the permit number listed above. You should contact
your product supplier if you do not know the product approval number for any of the applicable listed products. Information regarding statewide
product approval may be obtained at:www.floridabuilding.org.
I Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
A. EXTERIOR DOORS
1. Swinging
2. Sliding
3. Sectional
4. Garage Roll-Up
5.Automatic
6. Other
B.WINDOWS
1.Single hung
2. Horizontal slider
3. Casement
4. Double hung
5. Fixed
6.Awning
7. Pass-through
8. Projected
9. Mullion
10.Wind breaker
11. Dual action
12. Other
Page 1 of 4 Updated 06/21/21
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
C. PANEL WALL
1.Siding
2.Soffits
3. EIFS
4.Storefronts
5. Curtain walls
6. Wall louvers
7. Glass block
8. Membrane
9. Greenhouse
10.Synthetic stucco -(L/MIX f1 MX -700 5;31=
11. Other
D. ROOFING PRODUCTS
1.Asphalt shingles
2. Underlayments
3. Roofing fasteners
4. Nonstructural metal
roof
5. Built-up roofing
6. Modified bitumen
7.Single ply roofing
8. Roofing tiles
9. Roofing insulation
10.Waterproofing
11.Wood shingles/shakes
12. Roofing slate
13. Liquid applied roofing
14. Cement-adhesive
coats
15. Roof tile adhesive
16.Spray applied
polyurethane roof
17. Other
Page 2 of 4 Updated 06/21/21
Category/Subcategory Manufacturer Product Description _ Limitation of Use State# Local#
E.SHUTTERS
1.Accordion
2. Bahama
3.Storm panels
4. Colonial
5. Roll-up
6. Equipment
7. Other
F.STRUCTURAL
COMPONENTS
1. Wood
connector/anchor
2.Truss plates
3. Engineered lumber
4. Railing
5. Coolers-freezers
6. Concrete admixtures
7. Material
8. Insulation forms
9. Plastics
10. Deck-roof
11.Wall
12.Sheds
13. Other
G.SKYLIGHTS
1.Skylight
2. Other
H. NEW EXTERIOR
ENVELOPE PRODUCTS
1.
2.
Page 3 of 4 Updated 06/21/21
In addition to completing the above list of manufacturers, product description and State approval number for the products used on this project, the
Contractor shall maintain on the job site and available to the Inspector, a legible copy of each manufacturer's printed specifications and installation
instructions along with this Product Approval Sheet.
I certify that this product approval list is true and correct to the best of my knowledge. I further certify that use of different components other than the
ones listed in this document must be approved by the Building Official.
I
ke6T�Lv �*Contractor Name (Print Name): C91 *Contractor Signature: %4
*Company Name:
*MailingAddress: 7005 SELosi /144Ot - C7
*city: AnA1V7)C ) CH *State: l �- *Zip Code: 7123 3
*Telephone Number: 77(3 .g7 75Z7 *E-mail Address: 7 4 G14141 L. (a�`-
Cell Phone Number: Fax Number:
Page 4 of 4 Updated 06/21/21