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Permit 328 10th StreetCITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 24'7-5826 INSPECTION EMAIL REQUEST: Buildin~dept~a,coab.us Application Number 07-00000811 Date 6/18/07 Property Address 328 10TH ST Application type description RESIDENTIAL ADDITION/ALTERATION Property Zoning TO BE UPDATED Application valuation 16000 ---------------------=------------------------------------------------------ Application desc porch new bath ---------------------------------------------------------------------------- Owner ------------------------ MCGUIRE 328 10TH STREET ATLANTIC BEACH FL 32233 Contractor ------------------------ OWNER ATLANTIC BEACH FL 32233 -------------------------- Structure Information 000 000 ----------------- Construction Type TYPE 5-A Occupancy Type RESIDENTIAL 2 Flood Zone ZONE X ---------------------------------------------------------------------------- Permit BUILDING PERMIT Additional desc . Permit Fee 110.00 Plan Check Fee 55.00 Issue Date Valuation 16000 Expiration Date 12/15/07 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due Permit Fee Total Plan Check Total Grand Total 110.00 110.00 55.00 55.00 165.00 165.00 FILE COPY .00 .00 .00 .00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. r' ~~'}~1„ CITY OF ATLANTIC BEACH BUILDING /ZONING DEPARTMENT ~~..~ ~ r Y '`~-- ~~~ 800 Seminole Road i" ~ f Atlantic Beach, Florida 32233 i J`~-- ; ~ f--l` (904) 247-5$00 (904)247-5845 Fax www.coab.ras APPLICATION TRACKING FORM Property Address: _~~ O ~Q ~ c},T Applicant: d ~C7it/~ 1G ~_ Project: ~D~~l, ~ ~ l1/ ~.~) ~Ay-ff r PERMIT APPLICATION # ~ ?- d~// REQ IRED DEPT: N LANNI ~ Z N Y N PUBLIC WORKS ~ Y N PUBLIC UTILITIES Y N FIRE DEPT. Y PUBLIC SAFETY f~ 0 6n ~ ~„ ~ i r~r ~~~ ~- ~ car-~r~.~-tom V ~ w ~ APPROVAL v ~ REL;fUIRlrD - AGENCY: RECEIVED BY: INITIAL: DATE: ~ Y N D.E.P HUFSTETLER ~ ~ Y N S.J.R.W.M. CARPER Y N ARMY CORPS of ENG CARPER ~ Y HOTELS & RESAURANTS HUFSTETLER APPLICATION STATUS CIRCLE ONE: SITE BUILDING , DA AP REVIEWED BY: INIT TE: ^ 1ST REV ^ ~ r ~ PLANNING "'~' 1~011.T ~~ ~U ~/ ~~l BUILDING ' ^ ^ 2ND REV PUBLIC WORKS PUBLIC UTILITIES FIRE DEPT. PUBLIC SAFETY ® ® 3RD REV FILE CC1~ Return this form to the Building Department once you have entered your comments into the AS4®0. t -, o _ w ~f Spec~.i. J[ofor~es.~oa for OwaerlSu~idEers . J -- - I}ISCLOSURE STAT~rMENT for Section 489.143(7), Florida Stafc~aes: . • - r _ ' . ~. STA`I'E I~A.'1N I~IItf~S C~1'~ISTZ:~IICI~QN 'FU BE DO1~lE 8Y T~CElwi57~17- CUl~t'tRACTOrl~3. YOII HAVE-Ah'PL1~D 1?UR.A PLR.t1+~P TJ.NDFB AAT F~'I4N TO TII~E LAVit. The exeznptian. allows you as ttte owner vfyour prape~ty, tia atlas your own coatradaor eiren.tttroughyou do not haPG a lic~se.~ You fftust supe3vise tlae constr~tian y~u~xsel£ Yon msy Budd. or improve acne-family yr two-f~ly residence or a farm autbusldiu& Xa~s maq also band or improve a a building ~ a cost of $ZS,004 ar less. The building ~ustbe fbt your and QTY-' It ~ not be bus~f far sate or lease. Ifyou sell ar tease more tl~ ons builddng yoahave bm'ltyoucsetfwitbin oie (1) y~r a~tbe construdzo~n is comply, ttze tawwill presume ttsat you built it for sale ar tease, which is a violatioa of this e~mgtian. Yon sn ua ' amour contractor. Your clan must be done according •dtt bar7dmg codes anti. coning ~- It is your respons~ility to make .sure tt~iat the people employed by you licenses r+et~aired,~iy state law anti by comity or P.~ ~g 4~- In additioa, the owner- mast supervise construction awl. becomes liable sad respo~le far the etnptayees t~lshe hires. This responsl'b 7ity includes? but may not be limited tv: 1. WorTfers Compensation, for worke~.s injured. on the jab. 2. Social Setmrity Tax must be dedaeted fivm tepee's wages and matched wig owner's fonds. 3. Federal W"iitiholdmg. Since awrmas ~.st be liable far inTUries to vrorkers they hire, tI~ Buddirng Division suggesi-s ~Ta CcffIIil~ FIISUI8I1~:e ~ pmt. the ht3IIIedVVnCrS 13ZSLtLBnCe jH}liGy Glesrlp pro~ed.~ the Ck~vners hiring w4rke~ become e~nplopers and should also obserae IRS wiiliholding tax Form I099 retluicx on the workers they employ on their imgroven~nt work. Un lid. coniractnrs caonot be e~loyed under any cures Ovv~aers are subject to a $5,000 p~slty under F~.da. Stadute #455288(1) instigated. via Binding Division crtatians. An. Qc~aiictn$1.Lir.~se is not adegua~te The owner shouldphysicallp see the cointy Certificate of Com~encp ortheFlQridaCantra-ctors ~bs ascertains. person is s. licensed. contractor. Telephone the budding Division (247-5826yf in doibt~ that I have read and understand all the above on t [d, ,. 2$ • t o .-- v tM. C.~v ~ 1',Q srATE of Fz,oi~A: CUtI1rT'I`Y 4F DIIVAL Before me personally appeared ~ ~~ ~ 2w.j ~ to me well known to be the individual and owner builder described iit and wlm elcecnind. this instranxetrt and severalty acknowtedgedthe esecutionthereofto be his awn free alt and deed as such owner builder hereujrtv " VVl<'1`NESJ my-hand and o:fficiat seal tUis `~d~ 0 7~t~.t~a .tic Beach ~ty~Ct Side aforessad. •. s ~ -P~sIIQ -.St~e:af Fbtlde '''%;,~~.~~,: ' - .- Gommisaion # t)D; Si Y - adonai NoEary Assn. p~ 2~.to ~~i~' - IvIY" SIO~N F~PR2~S: - ersonally Known ` [7ldentifit~on: ,T ~~~1f'~' BUILDING PERMIT APPLICATION .. ... ~7 `~ ~' CITY OF ATLANTIC BEACH '"~or3i>%' 800 Seminole Road, Atlantic Beach FL 32233 Office: (404)247-5826 • Fax: (904) 247-5845 Job Address • ~ 2 ~ `fJ ~~ S ~~~ t Permit Number: ~ 7- ~~ ~ Legal Description Valuation of Work (Replacement Cost) $~ ~ QOQ ^ Class of Work (Circle one}: New itio Alteration Repair ^ Use of existing/proposed structure(s) Circle one)• Commercial siden ^ If an existing structure, is a fire sp~er system installed? (Circle one): a~ es ~~ ^ Is approval of homeowner's association or other private entriy required? (Circle one): Yes (~ Describe in detail the type of work to be performed: >rJ d E'.aJ ~~ V1D~~ ~ Vr~ City V~~,Q,--~~ %C ~ cam. StaSe Contractor Information: Address: '~2-~ ~~ ~ZZ, Phone ~/ --2 Name of Company: Qua1i~¢ing Agent: Office Phone Staxe CertificationlR.egistration # Architect Name & Phone # Engineer's Name & Phone # Application is hereby made to obtain a permit to do the work and installations as indicated I certify that no work or tnsttallation has commencedprior to the issuance apermit wid that all workwill be ormed to meetthe standards ofall laws regulating construe#on in this jwisdiction. 7~iis permit becomes null aASai void i work fs not commenced within six (6~ months, or i f construction or work is suspended or abandoned for a period of six (6) months at may time der work is cotnmencer~ I unalerstand than separate ppermits must be secured jor Elecd~cal Nrorl~ Plw»Ir3»g, Slg»s, l~'ells, pools, Furnaces Boilers, Seaters, Tanks a»d flir Ca»ditio»ers, etG WA,~tNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR. PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU IlV'TEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMIVVIENCEMENT. thereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and or rnances gavernin~ this ttyyppe of work will be complied with whether specked herein or not. The granting o ffa permit does not presume to give aut-Ftarity to violate or cancel the provisions of arty other federal, state, or local Icraw regulating construction or t per or of construction. Signature of Property Swo ~ subscribed this Day of d Notary Public: REVISED 03.OS.07 ~~ ~-~ :qty State Zip et Number Office Fax # Job Signature of Contractor: Sworn to and subscribed before m+e this Day of L (,iRpHAM • ~e °r Flom Notary Public: ~ pp 585 32010 ded By Nadona! Np~, q~. :~w -~':~ CITY OF ATLANTIC BEACH - BUILDING /ZONING DEPARTMENT ~_~ --' '.'~ 800 Seminole Road Atlantic ~h, Florida 32233 -- ~'. /~ (904) 247-5800 --~' (904} 247-5845 Fax www.coab.us APPLICATION TRACKING FORM Property Address: ~c~ [! ~~ ~ c~'~ Applicont: `~ GcJ/11'~!G Project: ,f'"D~@~ ~ a NS ~~ ~At/~ /~i~ l~f'T~3t'<!~O C~ ~3lrE~ PERMIT APPLICATION # l1 ?- d~/l R_EQ IRED DEPT: N LANN1 ~ Z N ..___ _ ~ Y N PUBLIC WORKS ~ Y N PUBLIC UTILITIES Y N FIRE DEPT. Y N PUBLIC SAFETY w APPROVAL v Q REQUIRED AGENCY: RECEIVED BY: INITIAL: DATE: w ~ Y N D.E.P NUFSTETLER ¢' ~ a w Y N S.J.R.W.M. ~p~ _ ~ t- Y N ARMY CORPS of ENG CARPER ~ Y N HOTELS & RESAURANTS HUFSTETLER APPLICATION STATUS CIRCLE ONE: SITE BUILDING DA AP REVIEWED BY: INITIAL: DATE: Ld 1ST REV ~- G ~/ ?,~Q~' ' i(/Yl C:~~6te~4e~ / `~ ~ ~~ PLANNING ~'~"- ` _ _ "'~ BUILDING 2ND REV PUBLIC WORKS PUBLIC UTtLtTtES F{RE DEPT. PUBLIC SAFETY Q a 3RD REV ~L~ Return this form to the Building Department once yon lulus entered your comments into the AS400. ~ h4_ A~J r~f.U'r,,~,` BUILDING PERMIT APPLICATION ~' .;~1 ,:~, ~~f~~ CITY OF ATLANTIC BEACH \~~ ~ ~ f, 800 Seminole Road, Atlantic Beach FL 32233 JIS1-1 " Office: (904)247-5826 • Fax: (904) 247-5845 Job Address: ~L-~ ~b ~~ S ~~~~ Permit Number: ~ 7` ~D ~l Legal Description Valuation of Work (Replacement Cost) ~ 1 [.~~ Qo0 ^ Class of Work Circle one): New dditio Alteration Repair ^ Use of existingsproposed structure(s) Circle one): Commercial sidentia ^ If an existing structure, is a fire sprier system installed? (Circle one): es o /A ^ Is approval of homeowner's association or other private entriy require ~ (Circle one): Yes Describe in detail the type of work}to be performed: / ~ f ~ ~{ /'0~ ~E?~ ~ A ~--t% /~-jQ~t,J ~,~~li.l~-`. ©r--~ cr~'.~2( Qom` ~p~~S '~ Name: City G Contractor Information: Name of Company: U c f-e Address: ~2-~ ~©~ ` ~ ' State Zip - ~~Phone ~ r`Z ~ (o- ~filCJ~ Office Phone State Certification/Registration Architect Name & Phone Engineer's Name & Phone # Job ring Agent: State Zip ~t Number Office Fax # _ __ __-_ 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 o{{a permit and that all warkwill be erformed to meet the standards of all laws regulating construction in this jurisdiction. 7`his permit becomes null and void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for a period of six (6) months at any time a er work as commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, ells, Pools, Furnaces, Boilers, Heaters, Tanks and Air Conditioners, etc. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. thereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this typpe of work wall be complied with whether specified herein or not. The granting o~ f a permit does not pr esuxte to gyve autharity~ *o violate oN cancel the provisions of any other federal; state, or local Inw regulating construction or t per orm of construction. Signature of Property Owner. Signature of Contractor: Swo ~ subscribed this Day of b Notary Public: REVISED 03 Sworn to and subscribed before me this Day of Notary Public: ~~e~~~~ I~~r~~~®~. ~~r ~~~rl.~~~e~cs DISCLQSURE 5T1-~'T~11!I~T'T far 5ectian 4~9.i03(7), Florida Stakes: ~ ~ ,. - . .~ ~. STtATL LAw ~~3~5 C€pNST~UC'TIrt31`~T Ttl i3~ II~1~ ~'~ I~C]~iVSrTD C(~P~~iC'IifJ~l~. YC)~U ~~ A~PI,Zis~o ~QI~ ~ l'~+°RT i7NB11R AN ~~IV1Z'TTI<ON TAD TF~ LA.~. The exemption allows you as the owner ofyaur properly, to act as your awn corttractar even tbrougll you do not Dave a Iicense.• You must supervise the canstcuctfon yourself. Fan may build or improve aone-family or fwo-family residence or a farm outbuilding. You may also bux~d ar improve a co~nercial building at a cost of $5,000 ar less. The building must be far your awn use and occupancy. ~ It may not be built far sate ar lease. Ifyau sell ar lease mare thaw one building you. have built yourselfwithiu one (1) year after the const~ciion is coamplete, the law wilt presume that you built it far sale ar lease, which is a violation of this exe~nptiom Fan may ttot hire an un licensed person as your contractor, Your construction. must be done according to bT,;lrlir~g codes and toning regulations. It is your responsibility to make .sure that the people eFnulayed by you have licenses required by state law ands county ar municipal licensing ordinances. In addition, the owner must supervise canstr~actian and becomes liable grad responsible for the en'tployees helshe hires. This responsibility includes, but ~ not be limited to. 1. Workers Compensation, for workers injured on the jab. 2. Social Security Tax. mast be deducted from employee's wages and matched with. owner's funds. 3. Federal ~Trthholdin~. Since owners must be liable for injuries ~ workers they hire, the t3uildigg Division suggests ~FTarkers CoIIipensatian Insurance be purchased unless the homeowners ;nsi~r~n~ policy clearly protects ~.~ owner. f)wners hiring warl~ers became employers and should also observe l~.S withholding ta~€ Form 1099 requirements on the workers they employ on their impraven~ent wank. Un iieensec~. contrac~ars cannot be employed under anY cir~~m~nces Owners are subject to a ~5,Oa0 penalty under Florida Statute #4~5.288(1) iasfigated via building Llivision citations. An. (7~~atianal Ilicense is not adequate. Ttte owner should physically see the county Certificate of Competency or the ~Iorida Contractors Certificate to ascertain a person is a licensed contractor. Telephone the building Division (247-5826 ~ ~ doubt. I vvruca U ucE ot~ual.auG .,. AocireSS ~ Vin, L ~y t 1`,Q Qp ~ -2~ (o ~~ 1 ~"' Print Name Telephone Number 57C.~.TE OF FLORA: COUNTY ~I+ l3U'~AL Before me personally appeared _ ~~~V~ p/ / C ,~w~~ ~ to me well lmowu. to be the iaadivid=~.l ~d owner builder described;3l. aIld who exe~utedthis;nstr~nnentand severally acknowledged.the executionthereafto be his ownfree acf and deed as suck owner builder hereunto autki®rized. WI~T1dIFSS my hand and official seal this ~~d~ ti ~~Y P ~~y~ ~, =;~ »~'~_ ~~~p~R~i..cElYcl.-.St~B..a Fbfldll • Y °mm ExP~ F -.'~~~~ ~~;°~ : :. Dommiuion # DD 51853' . 8ondetl B ~ N Y atfonel Notary Assn. that I have read and understand all the above an _~ ~ - ay o8;-~ '~2g .~~~ ~YE~~~SSTQI~i E~l'II~S: ersanally Known ^ ~dei7.tLflCa~tian: