285 Main StreetCITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
Application Number 10-00000844 Date 7/02/10
Property Address 285 MAIN ST
Application type description RESIDENTIAL OTHER
Property Zoning TO BE UPDATED
Application valuation 500
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Application desc
CLOSE GARAGE ADD WINDOW AND DOOR
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Owner Contractor
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ABELLANA OWNER
285 MAIN ST
ATLANTIC BEACH FL 32233
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Permit BUILDING PERMIT
Additional desc .
Permit Fee 55.00 Plan Check Fee 27.50
Issue Date Valuation 500
Expiration Date 12/29/10
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Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/'05-'06 SUPPLEMENTS.
2007 FLORIDA BUILDING CODE - RESIDENTIAL.
2005 NATIONAL ELECTRICAL CODE.
WINDOW AND DOOR INSPECTION:
*INSTALLATION INSTUCTIONS REQUIRED
*ALL STICKERS. ARE TO REMAIN ON THE WINDOWS
*PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS
* Roll up garage door is not to be removed. The garage
space is to remain a garage. Garage can not be used as
living space, sleeping space. It is recomended that no
cooking be done in garage with gas fired equipment.
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- -------
Permit Fee Total
Plan Check Total
Grand Total
55.00 55.00 .00 .00
27.50 27.50 .00 .00
82.50 82.50 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUII..DING PERNIIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 2B~ M A~tN S 7, ~7`~-~'lU7y L B~~/'~ Permit Number: ~0 " O ~ ~f ~/
Legal Description Parcel #
~~ oor ea o q. t. q• t
Valuation of Work $ ADO, Proposed Work heated/cooled ____~__ non-heated/cooled
Class of Work (circle one): New Addition ter io Repair Move Demolition pooUspa window/door
Use of existing/pro osed structure(s) ((circle one):. Commercial Residential
If an existing struc~ure, is a fire s rtnlde system talled? (Circle one : Yes No N /A
Florida Product Approval # G .~0~ +" ~ ~ ~ 3 Z G 3 ~ /s/S 3
For multiple products use p uct appro a m Gil ~ ~~,,~ ,+ 7r ( l~,,L' 7 y 3 ~ 9 7 ~{
Describe in detail the type of work to be performed:
y,/~} L L O Gt T'Os o /L G/r~;~~ ~00 R I,J ~ ~ ~ d /Z ~ t,.~ 1 ItJ.~~
Property Owner Information:
Name: A% ~ ~ ~ ~ Address: ~'S ~ ~ ~ ~ ST
City State ip ~~1;~Phone ZOO - O
E-Mail. or Fax # Optional)
Contractor Information:
Company Name: Qualifying Agent:
Address: City State
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
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 fhat 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 susppended or abandoned for a period of six 6) months at any time afler
work is commenced. I understand that separate permits must be secured for EZectricaTWork, Plumbing, Signs, Wells, Pools, ~urnaces, Boilers, Seaters,
Tanks and Air Conditioners, etG
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MA.Y RESULT IN YOUR PAYING TWICE FOR IlViPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMII~NCEMENT.
I hereb certify that I have read and examined this a placation and know the same to be true and correct. All provisions of Zaws and ordinances governing this
type o, fYwork will be complied with whether sppecij ed herein or not. ~he granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federc~l, state, or lPcal lmv regulati~g~nstructi nor the performance of construction.
Signature of
Print Name
Signature of Contractor
Print Name
Sworn to and subscribed before me
this Day of
~, ,
ota li
~' ~ ~ ~ ~ ~ evised 01.26.10
P~
Zip
d
~r:':y ~'a..,
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~~'~ •~" CITY OF ATLANTIC BEACH
" ®WNER /BUILDER AFFIDAVIT
,_
''~rJSSt~%'
I. 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. 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 HONE - 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 BUII,T 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 TS
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 GONTRACTORS 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.
ADDRESS PHONE NUMBER
~~~ ~-
PRINT NAME
7 l~
SIGNAT E DA E
J
Before me this ~ day of 1 20~CJin the county of
Duval, State of Florida, has personalty a eared herin by himself 1 herself affirms that
all statements and declarations are true /d accurate.
Notary Public at Large, State of `~" County of CCU
~rsonally Known
roducetllden
Notary
F:BLDG/Owner-Builder
ThN
lV~6L~
,a.~1;.r~ City of Atlantic Beach
Building Department
` ~ 800 Seminole Road
~,~ Atlantic Beach, Florida 32233-5445
Phone (904) 247-5826 Fax (904) 247-5845
=!,~si ;~~ E-mail: building-dept@coab.us
City web-site: http://www.coab.us
'APPLICATION NUMBER
(To be assigned by the Building Department.)
-_ d ~'`~~
Date routed: ~ l w
APPLICATION REVIEW AND TRACKING FORM
Property Address: ~ ~~ /t/c a ~ ~~ z~r/
Applicant: d Ld ~~~ ~ ~
~~
Project: ~ ~~ ~ ~ ~
~' / _ J~ /~ C' GC_%`
Review fee $
D ent review required Ye No
Building
g & 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:
~PPI ICATI~N STATUS
Reviewing Department First Review: Approved. ^Denied.
(Circle one. Comments:
BUILDING
s
.
PLANNING & ZONING Reviewed by: `~L Date: ~~/"'~~
TREE ADMIN. Second Review: ^Approved as revised. ^ enied.
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