175 Magnolia St. 07-00197 Replace deck permit j AL`i-
�� r CITY OF ATLANTIC BEACH
r PLAN REVIEW SHEET
D.Hufstetler
Building Department Public Works&Public Utilities Departments
800 Seminole Road 1200 Sandpiper Lane R.Carper
Atlantic Beach,Florida 32233 Atlantic Beach,Florida 32233 D. Kaluzniak
(904)247-5800 (904)247-5834 Public Safety
(904)247-5845 Fax (904)247-5843 Fax
PLAN REVIEW COMMENTS
Permit Application # 7— O t) l 9
Property Address
Applicant: QJ,v 7i f2
Project:
This permit application has been:
71 Approved as noted by the Department.
Final application approval must come from the Building Department.
E:1 Reviewed and the following items need attention:
Please re-submit 2-copies of all revisions. Please re-submit your
revisions to the Department requesting them.
Building Dept, Public Works and Utility information at top of page,
failure to notify the Corr t department may delay your permit from
beim issued.
Reviewed By: 41 Date: Z
Date Contractor Notified:
BUILDING PERMIT APPLICATION
J
' CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
Office:(904)247-5826 • Fax: (904)247-5845
Job Address: S 77241 ���' cP W g Permit Number:
Legal Description
Valuation of Work(Replacement Cost) $
■ Class of Work(Circle one): New Addition Alterationepa' Move
■ Use of existing/proposed structure(s) (Circle one): Commerc Residential
■ If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N/A
■ Is approval of homeowner's association or other private entity required? (Circle one): Yes No
Describe in detail the type of work to be performed:
1j aZs ,5o,t x Q s A .6 �/•c!v/� �a.�i To rd al l
Property Owner Information rr
Name: t Address: 7� 0- 7JG �/Q' d-l-
City State /Zip zZ 3 Phone Z 41
Contractor Information: p
Name of Company: QA)AliN Qualifying Agent:
Address: City State Zip
Office Phone Job Site/Contact Number
State Certification/Registration# Office Fax#
Architect Name & Phone#
Engineer's Name & Phone#
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 aQerntit and that all work will be performed to meet the standards of all laws regttlatin construction in this 'urisdiction. This permit becomes null and
void if work isnot
commenced within six(6)months, or if construction or work is suspended or abandoned for a perioof six(6)months at any time after work is
commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools,Furnaces,Boilers,Heaters,Tanks and Air
Conditioners,etc.
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 RECORDING YOUR NOTICE OF COMA4ENCEMENT.
I hereby certify that I have read and examined this application and know the sante to be true and correct. All provisions oflaws and ordinances governing this pe
of work will be complied with whether specified herein or not. The granting of a ermit does not presume to give authority to violate or cancel the provisions ojany
other federal,state, or local law regulati 4consuction performance of construction.
Signature of Property Owner: Signature of Contractor:
SworW and subscribe be re me Sworn to and subscribed before me
this Day of this Day of
Notary Public: Y
F A r Notary Public:
s MyOo A*ft#WI 40
DO NOT WRITE BELOW THIS LINE: OFFICE USE ONLY
Wview Result Circle one):
prove Disapproved Approved w/ Conditions Review Initials/Date: Z
)evelopment Size
labitable Space Non-Habitable Impervious area Total Area
Miscellaneous Information Conditions/Comments:
Occupancy Group
Type of Construction
Number of Stories
Zoning District
#Parking Spaces
Max. Occupancy Loa
Fire Sprinklers Require
Flood one
Revised 12/11/06
Special Information for Owner/Builders
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 THE LAW.
The exemption allows you as the owner of your property,to act as your own contractor even through you do not have
a license., You must supervise the construction yourself. You may build or improve a one-family or two-family
residence or a fano outbuilding. You may also build or improve a commercial building at a cost of$25,000 or less. .
The building must be for your own use and occupancy. It may not be built for sale or lease. Ifyou sell or lease more
than one building you have built yourselfwithin one(1)year after the construction is complete,the law will presume
that you built it for sale or lease,which is a violation of this exemption. You may not hire an un-licensed person as
your contractor. Your construction must be done according to building codes and zoning regulations. It is your
responsibility to make sure that the people employed by you have licenses required by state law and by county or
municipal licensing ordinances.
In addition,the owner must supervise construction and becomes liable and responsible for the employees he/she hires. This
responsibility includes,but may not be limited to:
1. Workers Compensation,for workers injured on the job.
2. Social Security Tax must be deducted from employee's wages and matched with owner's funds.
3. Federal Withholding.
Since owners must be liable for injuries to workers they hire,the Building Division suggests Workers Compensation
Insurance be purchased unless the homeowners insurance policy clearly protects the owner. Owners hiring workers
become employers and should also observe IRS withholding tax Form 1099 requirements on the workers they employ
on their improvement work.
Un-licensed contractors cannot be employed under any circumstances. Owners are subject to a$5,000 penalty under
Florida Statute#455.288(1)instigated via Building Division citations. An Occupational License is not adequate. The
owner should physically see the county Certificate of Competency or the Florida Contractors Certificate to ascertain a
person is a licensed contractor. Telephone the building Division(247-5826if in doubt.
I here ac ovule ge that re and understand all the above on this o��Day o .
i
Owner @Iden Sign Address
2#4,94V ) r 9d� 62-0 41Y2
Print Name Telephone Number
STATE OF FLORIDA:
COUNTY OF DUVAL �1
Before me personally appeared �h I c 1 L • l>M kA eti to me well known to be the individual and
owner builder described in and who executed th&instrument and severally acknowledged the execution thereof to be his own free
act and deed as such owner builder hereunto authorized. LAP_r'� X007
WITNESS my hand and official seal thiso2Zday of,60 atAtlantic Beach County and State aforesaid
E
NO ARY PUB IC,STATE OF FL A
,w• _.
NANCY Print Name-
,yf '�, K."1lEBl41lEY
MY 0=**WW#DD 2M40 MY�CON4NGSSION EXPIRES:
Personally Known
o Identification: