Permit 659 Ocean Boulevard CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 10-00000212 Date 3/03/10
Property Address . . . . . . 659 OCEAN BLVD
Application type description WINDOW AND/OR DOOR
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 250
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Application desc
ENCLOSE OPENING (DOOR TO BE REMOVED)
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Owner Contractor
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HEYMAN JONATHAN T OWNER
659 OCEAN BLVD.
ATLANTIC BEACH FL 32233
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Permit . . . . . . WINDOW AND/OR DOOR PERMIT
Additional desc . .
Permit Fee . . . . 55 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 250
Expiration Date . . 8/30/10
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 55 . 00 55 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 55 . 00 55 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 10 FI.-
OFFICE:(904)247-51326 9 FAX NO.:(904)247-5845
W6WCOAB.US
BUILDING PERMIT APPLICATION DUVAL COUNTY
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13 NEW BUILDING 11 DEMOLITION 11 RESIDENTIAL
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9.NAME: 15.COMPANY NAME: 23.COMPANY NAME:
16.NAME: 24.LICENSEE NAME:
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10.ADDRESS: 17.STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLbRjcAJr/,IE NO.: (1/,n
1 B.ADDRESS: 28.ADDRESS:
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11.OFFICE PHONE: 12.FAX NO.: 19.OFFICE PHONE: T 0.FAX NO.: 27.OFFICE PHONE: 28.FAX NO.:
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0�E ZN',�i�- ? C)j-7:2 21.rPi I PHONE: 29.CELL PHONE:
147 EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS:
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31.NAME: 33.NAME: 35.NAME:
32.ADDRESS: 34.ADDRESS: 36.ADDRESS:
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 laws regulating construction in this
jurisdiction. This 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 after work is commenced. I understand that separate permits must be secured for
Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks, Air Conditioners,etc.
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. I will not occupy or use the referenced building or any part therof,until all inspections are finaled and
prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law.
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.
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Signed:
Date:_12 Signed: Date:
Before mef�-)4%5 dayof 2010 in the county of Before me this day of 2010 in the county Of
Duval,State of F di a,n r. Duval,State of Florida,has personally appeared
pe ppeared
herin by himself/he q tillat All qtmtpm-ntq and d tions are herin by himself/herself and affirms that all statements and declarations are
true and accurate. true and accurate.
Ny6ry Public at Large, C nty of qu...for
Fl Personally Known 11 Pe E
EI Produced Identifi ton 7 - 11P u ED FOR CODE COMPLLAN('
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Note ignature: CITY OF STLANTIC BEACH
REQUIREMENTS AND CONDITIONS.
ow vp�, Notta i XTI c S IN*
FILE COPY 4P V r Monica Linn Q6V
JU REVIEWED BY: 0: DATE:
k�j, kly Conimia3lqn PP674830
AkDU P'v' fzA
. ...... City of Atlantic Beach
APPLICATION'NUMBER
Building Department (To be assigned by the Building Department)
800 Seminole Road T
Atlantic Beach,Florida 32233-5445 /0
Phone(904)247-5826 - Fax(904)247-5845
rd.fi 19 E-mall- building-deptCcoab.us Daterouted.
City web-site- http:ffivww.coab.us F11..
APPLICATION REVIEW AND TRACKING FORM
Property Address: /qj De ent review required Yes "N
_8uiId1nq__) v o
Applicant: ning
-Tree Administrator
Project Public Works
Public UtIfifies
Public Safety
Fire Services
7'
Review or Receipt
Other Agency Review or Permit Required Of Peffnk Verified By Date
Florida Dept of Environmental Protection
Florida Dept,of Transportation
SL Johns River Water Management District
Army Corps of Engineers
Dhrision of Hotels and Restaurants
Dnmon of Alcoholic Beverages and Tobacco
Other
APPLICATION STATUS
Reviewing Department FImt Review: ErApproved. FlDenied.
C(CWe one.) Comments: 6'L4.fJef � A
BUILDIN�
/0
PLANNING&ZONING
TREE ADMIN. Reviewed by-_ Date:-1wo
Second Review: F�Approved as revised. E]DeniL4.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed b Date:
FIRE SERVICES Third Review: []Approved as revised. FlDenied.
Comments:
Reviewed by: Date:
Revised 05/14109
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 PERNUT UNDER AN EXEM[PTION TO THAT
LAW. THE EXEM[PTION 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 HVIPROVE A ONE—OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
RAPROVE A CONDVIERCIAL 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 CONPLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF TIMS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO TEE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE ENTLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
If. 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(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.
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PRINT NAME
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XS N�A E DATE
Before me th
is 0"day of 20/0in the county of
Duval,State of Florida,has personally appeared herin by t Flmself/herself and affirms that
all statements and declarations are truR and accurate.
y of
Notary Public at Large,State of Count ......
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El Personally Know q-21,� 0 AH A VjWn
duced Identifi
My C0A#WSS10N#DD 634126
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Thni Notary pLY,*21b2011
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Notary Signature:A(pi�=
F:/BLDG/O�er-Builder Affaclavit;REVISED: 4/36/2009