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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-'