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Permit 379 7th Street SS CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 10-00000440 Date 4/19/10 Property Address . . . . . . 379 7TH ST Application type description SIDING PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 1200 ---------------------------------------------------------------------------- Application desc REMOVE/REPLACE SIDING ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ MARSHALL, JR. , HOWARD OWNER 379 7TH STREET ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit . . . . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 60 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 1200 Expiration Date . . 10/16/10 ---------------------------------------------------------------------------- Special Notes and Comments *2007 FLORIDA BUILDING CODE W/ 10S- 106 SUPPLEMENTS . 2007 FLORIDA BUILDING CODE - RESIDENTIAL. 200S NATIONAL ELECTRICAL CODE. *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 60 . 00 60 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 60 . 00 60 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY 01, ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. City off Atlantic Beach APPLICATiGN NUMBER Bufliding Department C-10 be assigned by the Building Depart nient) 800 Seminole Road Atianfic;Beach,Florida 32233-5445 Phone(9G4)247-5826 - Fax(904)247-5845 E-maff- buMng-deptgcoabxs Date Mute City web�-sfte: ftttp.-[AQ�w.caab.us APPLICATION REVIEW AND TRACKING FORM 2roperty Address: Z77-1 S7- m%ftw required Yas�/'-Nb Ipplicant: Manning&Zoning Tres Administ-ator Public Worto Publa Utififfes Pubfic Safaffy Fim SeMeas Other Agency Review or Permit Required Review or Receipt Date of Perinfl'Veriff ad By Florida Dept of Emkonmental Protection Florida DepL of Transportation SL Johns River Water Management District Amy Corps of Engineers Dhfislan of Hotels and Restaurants Dhfimon of Akc6oric Beirerages,and—1-obacm Other- APPLICA TION STATUS eviewing Deparhment First Review. ElApproved. OlDenied. (Cft,le one.) comments.. CBLj1LD:,N) 'LANNING&ZONING Reviewed by-, Date:_c/116Ztc) TREE ADNIM Second Review-- ElApproved as revised- F�Dented- PUBLiGWORKS Comments., PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FLRE SERVICES Third Review: ElApproved as revised. ODenied. Comments: Revie�-,ved by: I Al AL/ .r�sscf D5f14f&-q r BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach, Fl, 32233 Office (904) 247-5826 Fax(904) 247-5845 Job Address: Z�_Wt�� Permit Number: . Z 0 — 14 V 0 Legal Description,&-,fj 16 Parcel C_ Floor Area A Sq.Pt. Sq.P't Valuation of Work$ 106 Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): New Addition Alteration (gio Move Demolition pool/spa window/door Use of existing/proposed structure(s)(circle one): Comm ial Residential If an existing structure,is a fire_Trinkler system installed?(Circle one): Yes No Florida Product Approval# j-4 1,31 V, / For multiple products use product approval form Describe in detail the type of work to be performed: Property Owner Information: Name: 11AW Ah�A 4-41 Address: city State Zip Phone 4- Q -2 E-Mail or Fax#(Optional) 4- Contractor Information: Company Name: Qualifying Agent: Address: Citv State Zip Office Phone Job Site/Contact Number Fax# State Certification/Registration Architect Name&Phone# Engineer's Name&Phone# Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address a ere ad ana e d work and insta a �ns a indic or installation has commenced io t the & ' s pr r 0 -4 e rmi't�'0 I t to o't pi be e 0 d to t tan a' a thisjurisdiction. This permit becomes n -pp'i c'io s by md h a k ssuan e a e t an a r 0 ( m t , or, , s 6 rt�, 'ton r ork, _s aWeriod of six )months at any time after cure f -i t t 1 0"w P) 0 Ob d odElectc p - d thin s and ,'d work is no commence f d d rs d t t s P r te p r its mu t idls,Pools, urnaces,Boileis,Heaters, is , c T k 0' en e n e tan a e aa e ank a Air Co�uftuoners,eta 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. I here,�b cerofy that I have read and examined th' )plication and know the same to be true and correct. Allprovisions of laws and ord' �ng this Is an c work will be coTplied with whethe sreci7ted herein or not. The granting of a permit does not presum el the provisions of any otherfederal,state or local aw regulating construction or the peifiormance ofconstruction. Signature of Owner 14ai"l Signature of Contracto copy 'I�i I,P�_ Iu F 1, Print Name c Print Name . ........................ .................. ............... ... ................ .................... .......... Sworn to and subscribed before me * ed before me this-N&Day of 2010 REVW*b"i a 20 DE COMPLMCE C TT A NT'r BjEtidtix --I eff Notary Public AA�P& S& ORADDITIONAL 1# Notary PW)k,Stall Of FlWa REQUIREMENTS AND CONDITIONgevised .26.10 UWC ' P !S TS.-7.... 8 Commm" n""072013 my com .exores Dec.11 15, REVIEwED BY. 1Y1 DATE:_Y//6//0 CITY OF ATLANTIC BEACH ........ ONVNIER / BUILDER AFFIDAVIT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I 'CONSTRUCTION CONTRACTING" REQUIRES OWNER I BUILDER TO ACKNOWLEDGE THE LAW- DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED YOU HAVE APPLIED FOR A PERMIT UNDER AN EmaTION TO THAT CONTRACTORS. THE OWNER OF YOUR pROPERTY�TO ACT AS LAW. TBE E-XF-WnoN ALLOWS YOU,AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST FION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE—OR SUPERVISE THE CONSTRUC A FARM OUTBUILDING-- YOU MAY ALSO BUILD OR TWO FAMILY RESIDENCE OR COST OF$25�000-00 OR LESS- THE BUILDING IMPROVE A COMMERCIAL BUILDING AT A IT MAY NOT BE BUILT FOR SALE OR LEASE. MUST BE FOR YO UR—USE AND OCCUPANCY' IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WrrHN ONE YEAR- AFTER TEE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT OLATION OF TMS EXEMPTION. you MAY NOT rl'FOR SALE OR LEASE,VJUCH IS IN V1 CONSTRUCTION MUST HIRE, �N UNLICENSED PERSON AS yOj_jR CONTRACTOR. YOUR BUILDING CODES ANL) LuNING REGULATIONS. IT IS BE DONE ACCORDING TO THE E EMPLOYED By YOU HAVE YOUR RESPONSIBILITY TO MAKE' SURE TRAT PEOPL LICENSES REQUI&ED BY ST. ATE LAW AND By COUNTY OR MUNICIPAL LICENSING 3iDDIIANCES. ABLE FOR INJURIES TO WORKERS THEY HIRE, it. 114JURY LIABILITY; SINCE OWNERS MAY BE Ll COMPENSATION INSURANCE BE THE BUILDING DEPARTMENT SUGGES WORKER'S PURCHASED. Ili. 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 PENA UNDER FLORIDA S UTE NO. 4 �22TI AN" CUPATIONAL LICENSE" IS NOT ADEQ . THE OWNER SHOULD PHYSICALLY 55 55 55 55 AT OF GOMPETEN OR THE FLORIDA 'CONTRACTORS 55 11 S T CO S CO S CO S CO E THE CO N CERTIFICAT CONTRACTOR. TELEPHONE THE CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED 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. �_r / "rl,19W rl C, A-F-C4 S2-2.3-q t,9,04) 9.2,3 -. PHONE NUMLStK ADDRESS 6, PRINT N L q1 Iq 51GNTUR;E �� DATE Before me this 1q*day of 20_W in the county Of Duval,state of Florida,has,person Ily ap eared herin by himself I herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,state of g66VjAk county of CA" 0 Personally Known gI Produced IdentificatiOn- LISP ida Notary PUMIC,$109 Commis n# j5 7 20`13 My comm.expires Do Not-.Fy signature: rE,�IEED: 4/16/2009 L----L--