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Permit 989 Sailfish DriveApplication Number 10-00000869 Date 7/12/10 Property Address 989 SAILFISH DR Application type description WINDOW AND/OR DOOR Property Zoning TO BE UPDATED Application valuation 0 ---------------------------------------------------------------------------- Application desc window replacement ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ THOMPSON OWNER 989 SAILFISH DRIVE ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit WINDOW AND/OR DOOR PERMIT Additional desc . Permit Fee 70.00 Plan Check Fee 35.00 Issue Date Valuation 3013 Expiration Date 1/08/11 ---------------------------------------------------------------------------- Special Notes and Comments need windborne debris aff and noc *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 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 70.00 70.00 .00 .00 Plan Check Total 35.00 35.00 .00 .00 Grand Total 105.00 105.00 .00 .00 BUII.DING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: `~ ~~ Jca,~t ~ 1~ i S~/ /7~~~~-mot . ~-~ Permit Number: /~ ~'~~~ ~ Legal Description Parcel # ~ c7 oor ea o q. t. q. t Valuation of Work $ ~ Cpl ~ Proposed Work heated/cooled non-heated/cooled Class of Work (circle one): New Addition Alteration Repair Use of existing/pro osed structure(s) (circle one):. Commercial If an existing struc~ure, is a fir sprinkler system installed? (Circle one) Florida Product Approval # ~~ ~5 ('~~ -r~ For multiple products use product approva orm ~ Describe in detail the type of work to be Property Qwner Information: Move Demolition pooUspa windo /door Yes ~o N /A ~C~.C- S _ C~~ /~/ S Name: ~ 2~C ~ O /~~ ~`~- Address: ?5 `1 ~ ~ ~ ~5 r ~ City ~ ~ State Zip3~Z ' Phone Z /- 72 E-Mail or Fax # (Optional) Company Name: aa..o~.,. ~~ ~~, i Office Phone ,~~~=Zo n State CertificationJRegistratio #_ Architect Name & Phone # Engineer's Name & Phone # Fee Simple Title Holder Name an Bonding Company Name and Ad Mortgage Lender Name and Ady~ Qualifying Agent: City ~T State Zip 32-25 Contact Number Fax # Application is hereby made to obtain a permit to do the work and installations as indicated. I certzfy that no work or installation has commenced prior to the issuance o, f a permit and that all work wzll be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void f 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 Electrical Work, Plumbing, Signs, Wells, Pools, urnaces, Boilers, Heaters, Tanks and Air Conditioners, etG WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF CONIT~NCEMENT MAY 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 YO~ITR NOTICE OF COMMENCEMENT. I hereb certify that I have read and examined this a placation and know the same to be true and correct. ,p,is>~s~aidt'~"~'S" erning this type ofYwork wtdl be complied with whether specif ed herein or not. The granting of a permit does no _ cancel the provtsions of any other federal, state, or local law regulating construction or the performance of construe ,~~ Con . o~ IL E CaP ~. Signature of Owner ~~ ~ ~-~~--- _ Si~aturc ~f ~ PrintName ~~~ i-~ ~ ~~,......_~`~ Print Name ..........~~~.~~.,~,~.,,...-~~.~.,,~..n.-- - Swo and subscribed b this f e/~e / 201 j~~ + ~~1VIPLIl~NCTi. --tIii~s~~ o F ATLANTI C BEACH SEE PERMiTC FDJI nrr.^.. ' No lac NotaRlEj 1tI~~MENTS AND CQND1TlDNS wa~~~.,, t~ ~r SHIR4EY L QAAHAM MY COMMISSION # DD 95n8o . Revi d 1.26.10 REVIEWED ~ ,~€ ~ EXPIRES; February 14, 2014 . DATE: ;it: a ~S.?:~ 6ondod 1'hru Notary public Undenv~tters _ ;~'f~~. a' J f, ,, ~ ' ' ~ CITY OF ATLANTIC BEACH a~ ~ ~ „* M ®WNER /BUILDER AFFIDAVIT J:~,1>~ 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 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; THEREBY 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. ffnn ~{ r r y _ _ __ ADDRESS PHONE NUMBER ~K~~~r~o=~ ~~,~~ PRINT NAME SIGNATURE DATE Before me this ~ day of ~ 2d ~ in the county of Duval, State of orida, has personally appe red herin by himself /herself and affirms that all statements and declarations are true and accurate. ~ ~ y, Notary Public at Large, State of~G ,County of-,~~`-'~'F-=. ^ Personally Known /% ~ y roduced Idenfrfic n - [~ r` ' E"'`•• $NII~~ ~. QRAFiAM *' ~ ~ #' ~Xplt~~~:l~aBfWeryrytl~4, 2014 C n ~~~•" sondnd Thru NMdly publk Undenvnhto F:/BLDG/Owner-Builder AfFadavit; REVISED: ,Florida Building Code Online Page 1 of 3 ~,r t I ~ ~ ~ <:m (t: ~-~ .. ~ ' L ~~ ~ _ ~,;,, -~i.i5 Nome Log In User Registration Hot Topics Submit Surcharge Stats & Fac[s Publications FBC Staff BCIS Site Map ^nks Search 'iiProduct Approval ` ~-,>' ;~ USER: Public User ProAUCt Funroval Menu > Product Or Application Search > Hoplicatign list > Application Detail FL # FL8134-R5 Application Type Revision Code Version 2007 Application Status Approved Comments Archived Product Manufacturer Alside Window Company Address/Phone/Email 3773 State Road Cuyahoga Falls, OH 44223 (330)922-2108 rickw@rwbldgconsultants. com Authorized Signature Marsh Fernbaugh rickw@rwbldgconsultants.com Technical Representative Marsh Fernbaugh Address/Phone/Email 3773 State Road Cuyahoga Falls, OH 44281 mfernbaugh@alside.com Quality Assurance Representative Address/Phone/Email Category Windows Subcategory Double Hung Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed Florida Professional Engineer Evaluation Report -Hardcopy Received Florida Engineer or Architect Name who Lyndon F. Schmidt, P.E. developed the Evaluation Report Florida License PE-43409 Quality Assurance Entity Architectural Testing, Inc. Quality Assurance Contract Expiration Date 12/31/2011 Validated By Ryan J. King, P.E. - Validation Checklist -Hardcopy Received Certificate of Independence FL8134 R5 COI Certificate of Independence.pdf Referenced Standard and Year (of Standard) Standard Year 101/LS.2 1997 AAMA/WDMA/CSA101/I.5.2/A440 2005 Equivalence of Product Standards Certified By Sections from the Code http://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDqul jdteSXaTw%... 6/29/2010 ------, Florida Building Code Online Page 1 of 4 ~r - ~ ~ Log In User Registration Hot Topics Submit Surcharge Stats & Facts Publications FBC Staff BCIS Site Map Links Search ° Product Approval ~;~~ USER: Public User ~_ Product Aoorova! Menu > Prgduct or Aoolication 5^arch > Aoolication List > Application De[ail FL # FL10991-R3 Application Type Revision Code Version 2007 Application Status Approved Comments Archived Product Manufacturer Address/Phone/Email Alside Window Company 3773 State Road Cuyahoga Falls, OH 44223 (330)922-2108 rickw@rwbldgconsultants. com Authorized Signature Technical Representative Address/Phone/Email Quality Assurance Representative Address/Phone/Email Category Subcategory Vivian Wright rickw@rwbidgconsultants. com Windows Horizontal Slider Compliance Method Florida Engineer or Architect Name who developed the Evaluation Report Florida License Quality Assurance Entity Quality Assurance Contract Expiration Date Validated By Certificate of Independence Referenced Standard and Year (of Standard) Equivalence of Product Standards Certified By Sections from the Code Evaluation Report from a Florida Registered Architect or a Licensed Florida Professional Engineer ~= Evaluation Report -Hardcopy Received Lyndon F. Schmidt, P.E. PE-43409 Architectural Testing, Inc. 12/31/2011 Ryan J. King, P.E. Validation Checklist -Hardcopy Received FL10991 R3 COI Certificate of Independence odf Standard AAMA/ W DMA/CSA101/I. S. 2/A440 Year 2005 http://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDgvihT9G9wJlk3... 6/29/2010 r s>.t"~'~~ri,, City of Atlantic Beach r .4~ Building Department J -f 800 Seminole Road a ~,~ Atlantic Beach, Florida 32233-5445 Phone (904) 247-5826 Fax (904) 247-5845 •.~"r,oJ3 ;~'r E-mail: building-dept@coab.us City web-site: http://www.coab.us APPLICATION NUMBER (To be assigned by the Building De artment.) ,~ _a~ Date routed: ~ ~ (/ APPLICATION REVIEW AND TRACKING FORM Property Address: Applicant: Q~,L~}? ~ Project: ~~~~~5 ~ ~~-~ CCU S Review fee $ D ent review required Ye No Buildin ng & 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: ADDI IP~ATII'1AI ST~TIIS Reviewing Department First Review: Approved. ^Denied. (Circle one.) `~ Comments: ~~~ I vj Cr J 4~ BUILDII~ ~' PLANNING & ZONING Reviewed by: f 4~'f ( Date: 7 C~ TREE ADMIN. Second Review: QApproved as revised. ^Deni PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: QApproved as revised. ^Denied. Comments: Reviewed by: Date: Revised 05/14/09 r ~~.~ City of Atlantic Beach Building Department ' s J 800 Seminole Raad ~~'"'r Atlantic Beach, Florida 32233 :;: 'r J~3~sY Telephone (904) 247-5800 Fax (904} 247-5845 www.coab.us WIND-BORNE DEBRIS PROTECTION AFFIDAVIT Date: ~^ ! Z ~- ~ O Permit #: J ~q~ Pro a .Address: ~ 1 ~~- c ~S h-' ~ G~~'~-~'~ ~ l P rty I understand the Florida Building Code requires replacement windows in a Wind-borne Debris Zone be impact glass or have openings provided with wind borne debris protection. I recognize the structure involved is located in a Wind-borne Debris Zone. I am in the process of having windows replaced which require this protection but have elected not to have the required protection installed by my window contractor. I understand that before a final inspection may be approved, the required window protection must be provided. If the required window protection is not provided it will be a violation of State law and the City of Atlantic Beach may take appropriate code enforcement action which may result in fines beings made against this property. I also understand that my insurance company may not reimburse me for damages suffered due to the lack of required window protection. i agree to have the required window protection installed an or before: (Date) I will be using the fallowing material to provide the window protection: (check one) A. ~/~Plywood per the Florida Building Code B. Other approved method (Provide Florida Product Number) Name Hom'eowner's Insurance Company ~lI ?f'~- t~ ( ignature of Prape weer) (Date) ~/Yla ti.~ f'On..-~ (Print Name) STATE OF FLORIDA COUNTY OF DUVAL The-foregoing inshvment was aclmowledged before me this ~Zaay of 2(~~, by _ . ~ ~ i (name of person actmo edging). Personalty Public - SHIHLEY L Q ~ ~ ~ 7780 T e of Identification 9Cnd9d thru NoturY