1497 Beach Ave RES24-0004 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
BLAKE WILLIAM C 1497 BEACH AVE ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
170308 0000 ATLANTIC BEACH
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
1497 BEACH AVE RESIDENTIAL ALTERATION
RESIDENTIAL
Adding support frame wall
to inside of garage $200.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $55.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $27.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $86.50
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
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.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN 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.
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.
1 of 1Issued Date: 1/24/2024
PERMIT NUMBER
RES24-0004
ISSUED: 1/24/2024
EXPIRES: 7/22/2024
RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
AsLAH.r BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
1s -
City of Atlantic Beach Building Department PERMIT# 5 L -o^N-1
say, 800 Seminole Road, Atlantic Beach, FL 32233 ALL information required to process
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address t'-1 C l e9.ek., t' J L RE# ( 701(A) —000D
Legal Description 0— ( I(p—2s Z_E , O
Valuation of Work(Replacement Cost) Z.Go t 00 Heated/Cooled SF 70 u Non-Heated/Cooled SF 4(----)O
Class of Work: New El Addition Alteration 3ftepair ['Move Demo Pool Window/Door
Use of existing/proposed structure(s): ['Commercial [}Residential •If existing structure,is a fire sprinkler system installed?:Yes QNo
Will tree(s)be removed in association with proposed project? Yes (Must submit separate Tree Removal Permit) No
Describe in detail the type of work to be performed:
ArdK5 S7pQot*t 4 k-c, i - d-c va(In ix,
Florida Product Approval# For multiple products use Product Approval Information Sheet)
IAC Phone ' — . — b•Property Owner Information Name LJ l lc; c1J
Address 44011 t ,
1()
City .1 c
State Zip 2Z"-2.3
Email doubry es k' bpuc_, wneurifent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information Name of Company Phone
Address City State Zip
Qualifying Agent State Certification/Registration#
Email Job Site Contact Number
Worker's Compensation Insurer OR Exempt Expiration Date
Architect's Name Email Phone
Engineer's Name Email 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 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 city/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 YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE SITE OF THE IMPROVEMENT BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
4)
Signature of Own r or Agent) Signature of Contractor)
Signed and sworn to(or affirmed)before me this 4441 day of Signed and sworn to(or affirmed)before me this day of
OI VCI , 2024 by
Wlttl1!__ C• Bkik- - by
Signature of Notary Signature of Notary
Personally Kno • OR [ Produced Identification Personally Known OR [ ] Produced Identification
Type of Identification: ], UL, U"'ItI Ctw+ C- 51ak•e- Type of Identification:
VANESSA ANGERS
MY COMMISSION#HH 244118
sr. 0: EXPIRES:March 23,2026
ALL INFORMATION
Owner Builder Affidavit 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#: SZL1 —LVO4
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-DEP1 @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 ISSUANCE1OF AN OWNER-BUILDER PERMIT.
Job Address: \qct it"U l't`
ILi 15,7„0 ) L—
4t2,I
e 1c1.a PhoneNumber: ! _Owner Name: L”) 11 1 1.V
Mailing Address: '1.-\(:>,7 'V--)pc1n‘-i IVO City: MAcon'!-tC - -,./t.,,61-State: 1 Zip:
Notarized Signature of Owner k !it ( L tt....--„
The foregoing instrument was acknowledged before me this L-0" day of cSGi 1 GivL-' , 20 2`1, in the State of Florida, County
of 1v i
Signature of Notary Public
VANESSA ANGERS
Personally Known OR [ }- Identificationdciaentif tion
V`"••
MY COMMISSION#HH 244118
aP EXPIRES:March 23,2026 Type of Identification: i't- D- lA t(.t`Ctwl C . 61ake.
Updated 10/24/18
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