1952 W Sevilla Blvd RESO21-0085 Wood Deck rSrL% RESIDENTIAL OTHER PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RESO21-0085
800 SEMINOLE ROAD ISSUED: 11/9/2021
'401119`4 ATLANTIC BEACH, FL 32233 EXPIRES: 5/8/2022
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
RESIDENTIAL OTHER SINGLE OR
1952 W SEVILLA BLVD TWO FAMILY RESIDENTIAL WOOD DECK $20000.00
OTHER
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169462 0435 SEVILLA GARDENS UNIT
02
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
JENNIFER and ANTHONY
PALHETE 1952 SEVILLA BLVD W ATLANTIC BEACH FL 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT II\
YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
Issued Date: 11/9/2021 1 of 2
01'4''8 RESIDENTIAL OTHER PERMIT PERMIT NUMBER
s ' 0% RES021-0085
�, CITY OF ATLANTIC BEACH
K,_
ISSUED: 11/9/2021
800 SEMINOLE ROAD
109 ATLANTIC BEACH. FL 32233 EXPIRES: 5/8/2022
2 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list. Approved list can be obtained at the Building Department at City Hall. Roll off container
cannot be placed on City right-of-way.
3 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration,including sod,is required.
4 PUBLIC WORKS REVISION INFORMATIONAL
Notes:
Any plan change must be submitted as a Revision to the Building Department.
5 PUBLIC WORKS DECKING REMOVED INFORMATIONAL
Notes:
All old decking and debris must be removed from job site by Contractor.
6 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Contractor.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $155.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $77.50
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.49
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.33
ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 $100.00
TOTAL:$363.32
Issued Date:11/9/2021 2 of 2
J O pL7 COPY PY, REVIEWED FOR CODE COMPLIANCE
l� ILO ILA •
Permit Application
a 71 City of Atlantic Beach Building Department REVIEWED
800 Seminole Road, Atlantic Beach, FL 3223kBy Mike Jones at 11:48 am, Nov 05, 2021
Phone: (904) 247-5826 Email: Building-Dept@coab.us
7 o c
Job Address: /95:Z. ,SFV/�'4 ,84,0 CJ. .�'TIAlvvc Rewc,S�. FL Permit Number: 's\ �`�l ,% Z . O��}—
4 or 3 b SEV/Zi: 16-/VOE>S Cz ivr 2 4:.1-33
Legal Description,FtSKLc�.rn�i M P«749 o01L45 5 7 ./,v> 7'A RE# /(o?i76.:<-' 0S/35--
Valuation
S/35Valuation of Work(Replacement Cost)$ •2O. 000 Heated/Cooled SF 3,300 Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration gRepair ❑Move DDemo JPool EWindow/Door
• Use of existing/proposed structure(s): ❑Commercial 2dtesidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No IJ�A
• Will tree(s)be removed in association with proposed project? JYes(must submit separate Tree Removal Permit) 1610
Describe in detail the type of work to be performed: 7' 4..4''. E ekrOCO ,gc,i7. l S ONckior- /i,'Th .4/674,-.)
eoi,Pos'7 8OA,4D5-
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name AV-7900J 71EE Address /% j`5V/i14 /g.1•14e) hi
City /17:64NT/C ,4i /' State FL- Zip 3?-33 Phone 5uij+'" 7�0 -. 657
E-Mail icL-YR7CUf /,/0g7-V eom
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 Number
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer \ OR Exempt o Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or installation has
commenced prior to the issuance of a permit and that alt• 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 NDITIONERS,etc. NOTICE:In addition to the requirements of this
permit,there may be additional restrictions applicable to this prop y that may be found in the public records of this county,and
there may be additional permits required from other governmental en ies 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
R,ECORD�I Q.Uf14qTI E OF COMMENCEMENT.
/ (Signature of Owner or Agent) (Sign. ure of Contractor)
ed nd sworn to Lor ffi e•) .efore me th'sz t day of Signed and sworn to(or affirm:.)before me this day of
i
ZED t''b ,, ,.t ' - • 6 , by
fgna firof N. -. (Signat. e of Notary)
[ )Personally Known OR ,o' a _1'41 '
rsbn`^al(yknow OR
I f"{n�"' P}BduCed anti tion
76
[ j Produced Identification �`(� 1, , � f1
Type of Identification: i-> . l�_ 7 'FType of Identif1cati
JOBCOPY `*ALL INFORMATION
,, Owner Builder Affidavit HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
`` .
800 Seminole Rd, Atlantic Beach, FL 32233
��c
' - ;i1:•••-;i1:•••- E;
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: � jCX2.-1
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: /f5AS 'd/t Lti' 6I4L5 1dJ57- - 47+,N71C C , 32.2.33
Owner Name: ' 47 2J/V 77/0--11 Phone Number:9Dr`- 7‘;t9 654).
SF!/'l1 :/i '57- ty/07.1/./ , AC/f/ State: �� Zip: ‘.7 .&5,3
Mailing Address* " Z- t'�
Notarized Signature of Owner
Th fo oing instruknent was acknowledged bef e me this day o , 20ej in the State of Florida, County
of
Signature of Notary Public, C4- •
[ I Personally Known OR[ ] Produced Identification
Type of Identification: v • L
t4 ilL
TONI GINDLESFERGER Updated 10/24/18
MY COMMISSION#GG 353178
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LOT 36, SEVILLA GARDENS UNIT TWO, AS RECORDED IN PLAT BOOK 45, PAGES
7 AND 7.4, OF THE CURRENT PUBLIC RECORDS OF DUV_4L COUNTY, FLORIDA.
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