Loading...
309 MAGNOLIA ST RES22-0165 1,- � Building Permit Application Updated 10/9/18 !At• ; 1i City of Atlantic Beach Building Department **ALL INFORMATION 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us 77 Job Address: 30 9 ma 9 rib I ICL 14 �ir, r Z Permit Number: RES2 C '- )f ltd C. Legal Description )6- V 4(Q a S^ q,�.. SGt,1 -a,;r Gee,3 1 b4- 3OLQ RE# trID 160"MOV Valuation of Work(Replacement Cost)$ 5 C).c0 Heated/Cooled SF Non-Heated/Cooled • Class of Work: ❑New ❑Addition DAlteration ❑Repair ❑Move ❑Demo ❑Pool I lindow/Door • Use of existing/proposed structure(s): ❑Commercial l esidential • If an existing structure, is a fire sprinkler system installed?: ❑Yes ❑No • Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ENo Describe in detail the type of work to be performed: r-ep kc-e mows 51. 2-e ar s1-2--e Florida Product Approval# for multiple products use product approval form Property Owner Information M Name Samtl4.� r1,e Address 3Qq' ri1q le` et, S'�--• City \- ay-A-`lC - State 'L Zip ,3? 33 p hone j(Q 4�i s-(e-6©Oi< E-Mail 5Q,01.. Ccrte I... 1• Owner or Agent(If Agent, •ower of Attorney or Agency Letter Required) Contractor Information Name ofCerrtp-drty - true\ 1 -r;t Q , CSel J 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 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 RECORDING YOUR NOTICE OF COMMENCEMENT. /r (Signature of Owner or Agent) L (Signature of Contractor) Si:ned and sworn to(or affirmed) before me this day of Signed and sworn to(or affirmed) before me this day of • :.►V��• //►��� , by o; 'u TERRY HEN.' �•,����'•"•__'�•'�ai�i� Notary'ublic-State of Flori•a •ignat it of Notary) (Signature of Notary) g N t; :.• Commission:HH 188544 . My Comm.Expires Nov 30,2025 •- --- [ ]Personally Known OR [ •roduced Identification [ ]Produced Identification Type of Identification: �,l W&s L Type of Identification: _ _ � - _ =~~^� 4 �dP Owner Builder Affidavit **ALL INFORMATION t- r HIGHLIGHTED IN + �, City of Atlantic Beach Building Department GRAY IS REQUIRED. 800 Seminole Rd, Atlantic Beach, FL 32233 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$5,000 PENALTY UNDER FLORIDA STATUTE NO.455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY"CERTIFICATE OF COMPETENCY"OR THE FLORIDA"CONTRACTORS CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904- 247-5826 OR BUILDING-DEPT(WCOAB.US ) IF IN DOUBT. V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. Job Address: 30Q A.4e yirin1]a &- A-} 10-71-7c f e ucl-) F L 3223 3 Owner Name: SC2,''i ✓ 1,e-tt Phone Number: 2O6 -8 c 6-0®O j Mailing Address:, MajnoPR S- City: f}'}la.-71'?L13e0.61 State: FL Zip: .32233 Notarized Signature of Owner The f egoin instrument was acknowledged before me this day of L l.Afle ,20 a.in the State of Florida, County of 1)tx0 Signature of Notary Public f�(� 'we TERRY HENDRY r Nctar��cblic State of FloriCa [ ] Personally Known OR [t'roduced Identification %W Commission#HH t885� '��F h Expires Nov 30,2025 My comm.Exp Type of Identification: F V - Updated 10/24/18 NOTICE OF COMMENCEMENT State of F L aie t DA Tax Folio No. 98 y 54-666 County of Dt,?VnL— To Whom It May Concern: The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT. Legal Description of property being improved: , - _ - ,_ if Address of property being improved: 30d1 May "d I to 5t-- 1 a.-7 h c Bead)." F -- 3 22 33 General description of improvements: w 111C-4 0( IC2ePla CP-v »,- Owner: ScLP e- i e f-f Address: SQ✓nc a. U60ve Owner's interest in site of the improvement: Fee Simple Titleholder(if other than owner): Name: C r 0 Contractor: Qme £ [)(„cxle,r' a cc Address: a v Telephone No.: Fax No: a CC Surety(if any) 0°• 8 Y LL Address: 0 8 Amount of Bond$ 8 o Telephone No: Fax No: ,o a 0 Name and address of any person making a loan for the construction of the improvements a a Name: • E c}? E o U Address: 8 88• 2 Phone No: Fax No: Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may be served: Name: Address: Telephone No: Fax No: In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.06(2)(b),Florida Statues. (Fill in at Owner's option) Name: Address: Telephone No: Fax No: Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is specified): THIS SPACE FOR RECORDER'S USE ONLY OWNER Signed: Date: ' �I /6066 7:ppv HENOpy Before me this day of U i' '2- h County of Duval,State ,. ."(4.;•••• �,o,ic-State of Florida Of Florida,has personally appeared 5„.„ l L volar'. Notary Public at Large,State of Florida,Co Duval. �om.rission 0 HH 18385 2025 yy1{�� My Comm expires Hai 30' My commission expires: Personally Known: n�' _or Produced Identification: �— b LL}-c-ls L� Iry "clip" PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA (*REQUIRED) *Project Address: WI YY.Q qrm l iC�. S�'. 1--bu TicBeach 1 �— Permit#: *Owner/Project Name: 550,,m( e\ IT 1.14 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. 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 5 E P-S Be!"Tna, /61-17 o� 2. r 5 P6&T 511- — Fc, 239. � 3. Casement 4. Double hung 5. Fixed ` tef.5 r Yv I Lf to8 S 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 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 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. 1 C .111 *Contractor Name (Print Name): SCzr1 /-(,e-rr ( �) *Contractor Signature: ` 4.) d *Company Name: Ocie-v— *Mailing Address: -3C)C-4 Inn/ . Si- *City: A+1 c h-rhC_ wry, *State: FL_ *Zip Code: 322 33 *Telephone Number: 2O6 2S 6 coo7I *E-mail Address: v'' —'al it-i-e 9 € Ya4'') <ui Cell Phone Number: N/}-- Fax Number: ~'a-- Page 4 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