1212 VIOLET ST RERF22-0209 ?51-LLif,�4 At REROOF SHINGLE PERMIT PERMIT NUMBER
u CITY OF ATLANTIC BEACH RERF22-0209
ISSUED: 10/11/2022
800 SEMINOLE ROAD EXPIRES: 4/9/2023
�' ATLANTIC BEACH, FL 32233
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:
1212 VIOLET ST REROOF SHINGLE SHINGLE ROOF $10000.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171009 0020 ATLANTIC BEACH SEC H
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
KADOUS THOMAS C 1212 VIOLET ST ATLANTIC BEACH FL 32233-2636
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT If\
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.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $105.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$109.00
stied I)att 10/11/2022 1 of 1
.;''r% Building Permit Application Updated 10/9/18
r City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
,,r 9' IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: l a,\Z v ‘01-- --7 S -7' Permit Number: IR -RE 2 Z 0� 0 9
g Legal Description l"8-3Li (7-2.5-2q..5 4 Tt.Anitie.._ SELki--9,LQt RE# J7/p09�c(2.g (
Valuation of Work(Replacement Cost)$ 1 0+ 0 00 Heated/Cooled SF �{ Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial *Residential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes tilo
• Will tree(s)be removed in association with proposed proiect? ❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed: t.A t0 C-1 L-6- c)\I Ed2- 5 H t LE-
R E o ' IF 'J IfZ 4-=)C t 5 -1"\ N C-i- e_03 Lc.PE Qj l2, - �
.4\., �4 Florida Product Approval#pZ..E ipZ-4ZJ7 ESl2 2.4 hj for multiple products use product approval form
/� (_ Property Owner Information SR`32
Name I}0PAFir (.• ‘416e0OJ Address IZ IZ V toy G--r STLZ 33
City lA-t"L- r 'C"tC._ .I=��� State 1`L, Zip ' 1Z3 Phone( 9 amu) 6,7 �Z.co 1'-{
E-Mail I -TS P.L.L.(.3-pLhC) $1:44-7T\-4- - ta r---A64 f .'t 6-NV\ At 1_ , C_.4 UVB
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company _ Qualifying Ag-•
Address City State Zip
Office Phone Job Site Cont.- Number
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt❑ Expiration Date
Application is hereby made to obtain a permit to •. the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit a,: that all work will be performed to meet the standards of all the laws regulating
construction in this jurisdiction. I understa s that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEA ERS,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 YO TEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEF• •
RECORD G YOUR OTC OF COMMENCEMENT.
YOUR
(Signature of Owner ge ) (Signatu -of Contractor)
S' ned a d sworn to(or affd before me this I ( day of Signed and sworn to(• affirmed)before me this day of
ZC) �b h.(1 !.t off,IF
by
(Signature of Notary)
[ ]Personally Known OR :S!"k„ TONI GINDLESPERGER [ Personally Known OR
[ ]Produced Identification. . LA) •# MY COMMISSION#GG 353178 [ Produced Identification
Type of Identification: I:i•-r' •.o`; EXPIRES:October 6,2023 T e of Identification:
'`'°''-°•' Bonded i hru Notary Pubic Under iters
Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
IJ
',, City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
"J"'J` 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: / 2.„/ Z v to LETE \ 14-71_,1;)!MI- yEV-V 7Z2�> .�
Owner Name: l\--477 .A E C . Phone Number:(1°y) (:, R--D-,(p1
Mailing Address: 01V\ � City: �6tate: - Zip: ?)-.2 3-3
Notarized Signature of Owner
The fpr'egcti ng ing±ent was acknowledged before me this ) ( day of , 20 .ca the State of Florida, County
of (_�(
Signature of Notary Public
[ ] Personally Known OR [ ] Produced Identification
ZPAY P� '•. TONI GINDLESPERGER
Type of Identification: �—
MY COMMISSION#GG 353178
�• EXPIRES:October 6,2023
Bonded Thru Notary Public Underwriters
Updated 10/24/18