67 Coral St RES24-0005 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
WILLIAMS ROBERT JOSEPH
JR 67 CORAL ST ATLANTIC BEACH FL 32233-5815
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
169595 0000 OCEAN GROVE UNIT 01
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
67 CORAL ST RESIDENTIAL SIDING Replace broken and missing
shingles on outside back wall $400.00
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
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 BUILDING IN-PROGRESS INSPECTION REQUIRED INFORMATIONAL
Notes:
IN-PROGRESS INSPECTIONS ARE REQUIRED FOR EXTERIOR SIDING, WINDOW, AND DOOR INSPECTIONS, AND SHOULD BE SCHEDULED FOR THE FIRST
DAY OF WORK.
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 2Issued Date: 1/26/2024
PERMIT NUMBER
RES24-0005
ISSUED: 1/26/2024
EXPIRES: 7/24/2024
RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $86.50
2 of 2Issued Date: 1/26/2024
PERMIT NUMBER
RES24-0005
ISSUED: 1/26/2024
EXPIRES: 7/24/2024
RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
v_1,,,,,,,, BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
i" City of Atlantic Beach Building Department PERMIT# RES Zy - 0(/G--)800 Seminole Road, Atlantic Beach, FL 32233
4.,2;11,-___/- Phone: (904) 247-5826 Email: Building-Dept(a coab.us
ALL information required to process
Job Address 67 Col 44, sir: ArtA trrc eciii FL. 11;1,.73 RE# 1 b9 5`15- (:)0( b
Legal Description _ [S 1,2 Dcl. — 2S - 2c-
C[_
ec41 %7)va_i j)c,.1 5 b PT Lor 7 LE,-1- (?) guz_Es
Valuation of Work(Replacement Cost)/ $440. Heated/Cooled SF N tA Non-Heated/Cooled SF iv/4ClassofWork: New Addition Alteration Fi epair EMove Demo Pool Window/Door
Use of existing/proposed structure(s): E Commercial [Residential • If existing structure, is a fire sprinkler system installed?Des No
Will tree(s) be removed in association with proposed project? Yes (Must submit separate Tree Removal Permit) -R'No
Describe in detail the type of work to be performed:
Sif Agora - RtPi cl~ 13Ro1iMir .4,40 M,ssIt?44 $'NlI(4t,rs ad
ott'r.S I l7L 6(crc LA/414, of 801456.
IFlorida Product Approval#
For multiple products use Product Approval Information Sheet)
Property Owner Information Name USA r J. ifin.1.s sc5 Jjt• Phone 904..541.Y, G
Address 67 Ceg4i. .y. City 4i'z,,idt/r)G 64,4 State A. Zip 123UEmailJfCOIaOp• DDAeent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information Name of Company
nWYtt
3‘tLF r4/A) 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 inthepublicrecordsofthiscity/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
ATTO RQNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
6ftecAtA ,4,....... ASignatureofOwnerorAgent) Signature of Contractor)
Signed and sworn to(or affirmed)before me this
ytiq
day of Signed and sworn to(or affirmed)before me this day of
ASoavlt to , 2029 by Rc.;berk- 3- wi l t,in,s ,i--r- by
Signature of Notary Signature of Notary
Personally Known OR [4. ir=c;-"cluced Identification Personally Known OR [ ) duced Identification
Type of Identification: Ft I9L-Type of Identification:
L' VANESSA At=.,._L VANESSA ANGERS
F,!Y COMMISSIGId#FII'2(4118 MY COMMISSION#HH 244118
Q
EXPIRES:March z;I,
2.
026
F.i;.o;- EXPIRES:March 23,2026
j'ir,Owner Builder Affidavit ALLHIGHLIGHTED IN
INFORMATION
rfJ
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#: fe-s 2,-1 OOOS
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 $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA"CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT (904-
247-5826 OR BUILDING-DEP I(a COAB.US ) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I
COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Job Address: 67 CAtk. St' ArA.hetr/G 04-Awe, Fil- 134-33
Owner Name: RQ$(TJ. W/ -f4/ti(S , JAC.Phone Number: 10#:510.75r4
Mailing Address: 61 C&A4t.. Sr: City: ArlyiffifiG 50,i State: fa•4 Zip: .,3L..;
Notarized Signature of Owner G( 4 1A
The foregoing instrument was acknowledged before me this W day of Siftnva"f , 2024, in the State of Florida, County
of Lx CLI
Signature of Notary Public al,'
Personally Known OR [ 4roduced Identification
1€4.4,:k VANESSA ANGERS
h1YCOMMISSION#HH244118 Type of Identification: FL pl. Fober4 3 . Wtlltawos Sr,
c" EXPIRES:March 23,2026
Updated 10/24/18
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