2337 Seminole RoadCITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
Application Number 10-00000941 Date 8/03/10
Property Address 2337 SEMINOLE RD UNIT #A
Application type description WINDOW AND/OR DOOR
Property Zoning TO BE UPDATED
Application valuation 1600
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Application desc
Replace door
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Owner
Contractor
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BOHR SARAH OWNER
ATLANTIC BEACH FL 32233
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Permit WINDOW AND/OR DOOR PERMIT
Additional desc .
Permit Fee 60.00 Plan Check Fee 30.00
Issue Date Valuation 1600
Expiration Date 1/30/11
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Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONALELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
WINDOW AND DOOR INSPECTION:
*INSTALLATION INSTUCTIONS REQUIRED
*ALL STICKERS ARE TO REMAIN ON THE WINDOWS
*PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 60.00 60.00 .00 .00
Plan Check Total 30.00 30.00 .00 .00
Grand Total 90.00 90.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUII~DING PERMIT APPLICATION
k ~ CITY OF ATLANTIC BEACH
800 Semi_n.ole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
7 l
Job Address: ~ J >~ .f1 c~1 ~ Permit Number: l~ ' d qy~
Legal Description ,~ 7- 2 5 - 2~ ~ ~ ~ ~~ f f G ~~ 4~~-C ~. ~-n."^e ~ Parcel # ~ 6 ~ ~ `'(6 ~ 5 00 2
oor ea o q.~t. q. t
Valuation of Work $ ~ 6 ~fl. ~ ~ Proposed Work heated/cooled / non-heated(cooled
Class of Work (circle one): New Addition Alteration Repair Move Demolition pooUspa window/door
Use of ezisting/pro osed structure(s) (c)ircle one):. Commercial esidentia
If an ezisting struc~ure, is a fire sprinkler system installed? (Circle one): es o N /A
Florida Product Approval # j ~ ~' .5 ~• Z
For multiple products use product appro~~orm ~ ~ ~
Describe in detail the type of work to be performed: C4
Pro a Owner Ilnforma~
Name: C ~~ ~ ~~
City t~..f%~~~c- (3c'uc
E-Mail or Fax # (Optional).
Contractor Information:
Company Name:
Office Phone Jo
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
!`G.vro ~ 51 ~ ~~`C w~
Qualifying Agent:
City
qSS oQ(~
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 wz11 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 szx~6) months at any time after
work is commenced. I understand that separate permits must be secured for Etedric Work, Plumbing, Signs, Wells, Pools, urnaces, Boilers, Seaters,
T¢nks and Air Conditioners, etG
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IlVIPROVEMENT5
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
CONIlVIENCEMENT.
I hereb certify that I have read and examined this a plication and know the same to be true and correct. All provisions o, f laws and ordinances governing this
type o,~work will be complied with whether sppecif~d herein or not. The granting of a permit does not pr zv '¢ulyzorlty.#p,xzpl~tl.~.,,or cancel the
provisaons of any other federal, state, or local lsw regulating construction or the performance of construction ~!}y~~'z~'v'~:~Y~S'+9+~ ; ,,,< r
'~ ~~
Signature of Owner ~~~~~ Signature of Contras F ,
Print Name ~ v1 C z-l ~ ~(? ~ r Print Name ~ r
.............................__......................................................................................................... ...... ...,..r~;~~.,~w ~.,,~.....~.,.~.,~ ~ ..._.............
Sworn to and subscribed before me
this Day of r-' 20 i~ REVIEVV~~B~~~ 20
CITY OF AT
otary Public ,~'~~, SUSAN SPEAKS GORMAN ~i6lail'>~~1~'(3F2 ADDITIONAL
MY coMMCSS1ox # n~as66a REQUIREMENTS AND CONDITION
~evised .26.10
~,~,~ EXPIRES: February 25, 20l l
,.%~.,.~R~ ri. Norary Discount Assoc, Co. REVIEWED BY: ~ DATE: a7 fd
wvenAenn+~.,~~: r.,~W~
-.. ~ /r-.~-~~~~~ J.
~~; .
fJ ' '~~ 'r CITY OF ATLANTIC BEACH
®WNER /BUILDER AFFIDAVIT
r ~, r ;~
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING" REQUIRES OWNER 1 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. THE EXEMPTION 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 IMPROVE AONE - 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 HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE 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
ORDINANCES.
II. 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(1). 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; (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.
Z 337 Se~~:~o~~ ~~- G1 a~(- 2~(6 - ss6-S
ADDRESS _ PHONE NUMBER
PRINT NAME
~~~~~ .7~~r~
SIGNATURE DATE
Before me this o~_ day of J N.L~ , 20 ~in the county of
Duval, State of Florida, has personally appear herin by himself /herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large, State of ~t-jO~~~, County of ~V..VJ-t..
~7'Personaly Known
^ Produced Identification -
"'~~SUSAN SPEAKS GORMAN
Notary Signature: L1Q. •-..-. t9-yYy~,~._, MY COMM1SStON # DD643668
3a a EXPIRES: February 25, 2011
~OFR~
+;~ 1-R~Hl-3-NOTARY Fl. Notary Discount Assoc. Co.
F:BLDG/Owner-Builder AfFadavit; REVISED: 4/16/2009
ya~~~ri City of Atlantic Beach
~y~, Building Department
800 Seminole Road
~~ Atlantic Beach, Florida 32233-5445
Phone (904) 247-5826 Fax (904) 247-5845
.h"! ~fi ,~~ E-mail: building-dept@coab.us
City web-site: http://www.coab.us
APPLICATION NUMBER
(To be assigned by the Bu~~ilyydi~~n//g Department.)
~1 -~17/
Date routed:
APPLICATION REVIEW AND TRACKING FORM
Property Address: ~ ~~ ~ ~~ J n(Q ~ d
Applicant: ~ ~~G
Project: 6
Review fee $
nt review re uired Ye No
Building
anning & Zoning
Tree Administrator
Public Works
Public Utilities
Public Safety
Fire Services
Dept Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified B Date
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: Approved. ^Denied.
(Circle one.) Comments:
BUILDIN
PLANNING & ZONING Reviewed by: Date: 0?7 Ib
TREE ADMIN. Second Review: QApproved as revised. ^Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ^Approved as revised. ^Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09