Permit 1530 Francis Ave CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 10-00000336 Date 3/29/10
Property Address . . . . . . 1530 FRANCIS AVE
Application type description SHED PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 800
----------------------------------------------------------------------------
Application desc
12 x 8 shed
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
RHONE OWNER
ATLANTIC BEACH FL 32233
----------------------------------------------------------------------------
Permit . . . . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 69 . 00 Plan Check Fee 34 . 50
Issue Date . . . . Valuation . . . . 800
Expiration Date . . 9/25/10
----------------------------------------------------------------------------
Special Notes and Comments
*CALL FOR FINAL INSPECTION WHEN SHED COMPLETE AND ANCHORED
TO MEET 120MPH WIND LOAD.
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 69 . 00 69 . 00 . 00 . 00
Plan Check Total 34 . 50 34 . 50 . 00 . 00
Grand Total 103 . 50 103 . 50 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Fax(904)247-5845
Job Address: IS3C) T_�-qe t��c�s e4�_v'cl i't C' Permit Number:
Legal Description Parcel#
Valuation of Work he. . 6 0
Class of Work(circle one): New Addition Alterff*6on Repair Move Demolition pool/spa window/door
Use of existing/proposed structureQ) circle one): Comm iar Residential
If an existing structure,is d fire sprUer system installed? (Circle one): Yes No N/A
Florida Product Approval 4
For multiple products use pl-Oduct approval form
Describe in detail the,type of work to be performed: GC t1l,e4
A
Prope rty Owner Iffo ation:
imorm
�Tame: Jc�.4-1e— 8, P_�Lc�_'Vt.c_
-_ L Address:
City__J4�4
�a oLhZ, f,5&c", State[-IzZip 3. —Phone 6 y-
E-Mail or Fax#(Optional)
Con Lctor Information;
�ompany Name: Qualifying Agent:
kddress: city
)ffice Phone Job S* State zip
ontact Number Fax-#
'5tate Certfflcation/Re�gistration#
�rchitect Name&Phone 4
,ngineer's Name&Phone#
"ec Simple Title Holder Name an ddress
�onding Company Name and A ess
4ortgage Lender Name and dress
t ta tion has commencedprior to the
uc on in isjuri�s * tion. nis permit becomes null
nedfor aWeriod of s�J6�months at any time afier
t t w
w
constru ti th zc
r abando
b' ,Slkns, ddis,Pools, urnaces,Boilei�s,Heaters,
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMAIENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR BIPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OB � CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFO UR NOTICE OF
COMMENCEWIWffo
�ereby ceq�that I have read and examined this lication and know the same to be true and correct. Allprovisions oflaws and ordinances governing this
work will be co�nplied with whether speci ed herein or not The granting of a permit does not presume to g7ve authority to violate or cancel the
isions ofany otherfederal,state, or local taw regulating construction or the performance ofconstruction.
gnature of Owner Signature of Contractor
int Name
................................... ....................... Print Name onractor
Vo 0 and subscribpd befo��Me .......................................................
is D f I&C Sworn to and subscribed before me
I efore me
20 it this —Day of 1�0
20
. ...... S5HIRLEY L.GAAHAM
Aary
COMMISSION
mimpu ic
EX F h
P)RE& -0,ruary 14,2014
Bonded rhru Notary Public Underwriters
Revised 0 1.2 6.10
-Ahe
CITY OF ATLANTIC BEACH
OWNER / BUILDER AFFIDAVIT
1. 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. TBE EXEMPTION ALLOWS YOU,AS TEE 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 RAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER TEE CONSTRUCTION IS COMPLETE, TBE LAW WELL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WFHCH IS IN VIOLATION OF TT-11S EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOF- YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO TBE 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
0R_DrNANCES.
It. 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
013SERVE 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(l). 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. TELEPHONE THE
BUILDING DEPARTMENT(247-5826) 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.
jS3f)
APDR�SS r PHONE NUMBER
PRINT N E
SIGRATURE bKFE
R E G HAM
DD 9 7760
L IS y L N
'10
'AM �
,_.b, � y 14 2014
1�4 -7— '5
Before me this; C day of illllJj� .20L6,.1n the c=
Duval,State of Florida,has pers6nally appeared herin by hims if he'. d '41IRLEY L GRAHAM
all statements and declarations are true and accurate..
�OMMISSION DD 957760
X"E IRES
PIRES:February 14 2014
Notary Public at Large,State of County of CLI
T�.ru Notary Public un'derwriters
11 P8rsqnar1,_Kn..
)PY6'�Jured dan�h
NotaryS_ _LUFS:
F*/BLDG/O��-BuilderAl,'flad.avilt,;r,-�VLSED 4/16/2009
V-) ki V)
vp
0=1moca
co i
=mu E
CL. C CL
cLa ,— ex
0 uo,('a
41
m cla
S2 I.
CW r
< c --,—e
0
M-10
C E
CL
CL
I mlwc
IV
.0-.0 M-
3,k'L
CftY of Atlantic Beach
Building Department APPLICAT[ON NUMBER
6
800 seminofe Road (To be assigned by the Bui IngDepartnent.)
f d;L�
Atlantic Beach,Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
rjk'39� E-mail: buffding-deptgcoab.us out]
d.
City Wab�-sllfe: hftP--[1WWW.coab.us Date routed-
APPLICATION REVIEW AND TRACKING FORM
Property Address: A��_- d/Is 6 ant review
Appilcant: o lo—'�, tA. ..... Suf - uired Yes �-No
ning&Zoning
Project: ublic Works r
c
Fire Services
Other Agency ReView or Perinft ReWired ROVIew or a4pt
Florida Dept of Pernmnft ed By Date
Florida Dept
St Johns RKar Water Management District
td
Amr/Corps of Engineers
Owmion of Hatels and Restal irants
Dfvfmon Of Alcoholic Beverage&and Tabacm
Other
----------
APPLICA TION STATUS
�,'evlewlng Department First Revfew,� gAf)�proved. ElDenied.
(Circle one.) Comments:
BUILDING
(LA14RING&ZONIN�G
Reviewed b F: J'/
TREE ADMIN- Second Review: ElApproved as revised. F�Denied- Date.
PUBLIGWORKS Gomments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ElApproved as revised. []Denied.
Comments:
F,'evievvrsd by: Date-
'Ifsed
CitY of Atlantic Beach
Building Department APPLICATION NUMBER
300 Seminole Road (To be assigned by the Building Department)
Atlantic Seach,Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
E-Maff. buffdfng-deptgGQab.us
City"13-s!'19: hftP-1/WWW-coab.us Date routed.-
APPLICATION REVIEW AND TRACKING FORM
PrOPerty Address: I 4f:�, te 1':5 ent review re ulmd Ye_v. No
Bui
Applicant: 40-;�
ning&Zoning
Project: /.'02 ubflc Wo .. x r
L
Fire Services
.3
Other Agency R9VfQW or Permit ReWired Review ;r .19
Florida E)epL of Permit Ve d By Data-
Florida Dept of TrarMporlation
StJohns River Water Uanagement Dfstrict
Arrny Corps of Engfineera
Division of Hotels and Restaurants
Division of Alcoholic BeveMges and Toba=
Other
APPLICA TION STATUS
Zaviewing Department First Review,
[�JApproved. DDenied.
(Circle one.) Comments:
(�UDILDIN
:'LANNING&ZONING
TREE ADMIN. Reviewed by:
Second Review: ElApproved as revised. FlDenied-
PUBLIGWORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review. []Approved as revised. E]Denied.
Comments:
Reviewed by: Date:
i!fsc-d
CRY of Atlantic Beach
Building Department APPL1.QATf0[,.j'NUM
BER
800 Seminore Road (To be assigned by the Build 9 Department.)
In
Adantic Beach,Florida 32233-5445
Phona(gG4)247-5826 - Fax(904)247-�11�5
rill 3 9 E-mail. building-deptgcoab.us
Date roU J:
LS
City Web-sffe: httPy1WWw.coab.uS
APPLICATION REVIEW AND TRACKING FORM
ant review required Ye-% No
Property Address: Ae.
Applicant: if)it)-h g A- SEA
ning&Zoning
Proiect: 42xg J//-Sb ublic Works r
FireServices
�E
Other Agency Review or Permit Required Review or Kec 1pt
Florida Dept of Erivironmentat Protection of Permit Ve By Date
Florida Dept of Transportaffon
St Johns River Water Uananprnp-t rif-ftict
Am7y Corps of Engfneara
Division Of Hotels and.Restaurants
Division Of Alcoholic Beverages and Tobacco
Other-
APPLICA TION STATUS
Zaviewing Department First Review-
(Circle one.) I*Approved. FjDenied.
Comments:
BUILDING 05;;;09i— 1.
al-ANNING&ZONING Reviewed by. Date'_�/J4�tV
TREE ADMIN. Second Revievir. []Approved as revised. []Denied_
PUBLICWORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: FlApproved as revised. E]Denied.
Comments:
Reviewed by: Date-
'Ifsed f1S1q4'1'G-q
City of Atlantic Beach
Building Department APPLICATIOWNUMSER
MAR 1 5 2010 (To be assigned by the Building Department
800 Seminole Road
Atlantic Beach,Florida 32233-5d4s
Phone(904)247-5826 - Fax(904)247--5C5
E-mail." buffding-deptQcoab.us
City web-site: htfP--1/WwW.coab.us
APPLICATION REVfEW AND TRACKING FORM
Property Address: 45,-
ent review r-eclu
sui - imd Yes -No
Applicard.- e),40 t/-I-' ing&Zoning
Project: ublic Wo�ft
es
Fire Services
Other Agency Review or Pennit Required Review or Receipt Date
Florida Dept of v—frnnmgknf!.t of Permit Veriffed B
Florida DepL nt-F—sPorlaffon
St Johns Piver Water Management District
Army Corps of F-hrYfn;:qum
Division Of Hotels and Restauranift
DMwon Of Alcoholic Beverages and Tbbacco
Other
APPLICATION STATUS
Reviewing Department First Review- Approved. FIDenied.
(Circle one.) Comments.,
BUILDING
Date-__:��2S-A)
PLANNING&ZONING Reviewed by- Date.-
TREE ADMIN.
Second Review: ElApproved as revised. FlDenied.
PUBLICWORKs Comments.,
UTI
PU SAF
J 2 '/.0 Reviewed by: Date:
0 d
FIR SER rI.E. Third Review: []Approved as revised. FIDenied.
Comments:
IL SIE
PU S
J Z
FIR a
TT111rd Rc
Commel
BVISed M14M Revfeweed by: _=Date-'