Permit Window/Door 2010 z" CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
j ..., ° ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
Application Number 10- 00000962 Date 8/05/10
Property Address 429 SKATE RD
Application type description WINDOW AND /OR DOOR
Property Zoning TO BE UPDATED
Application valuation . . . 380
Application desc
INSTALL DOOR IN EXISTING WINDOW OPENING
Owner Contractor
MILLER OWNER
429 SKATE ROAD
ATLANTIC BEACH FL 32233
Permit WINDOW AND /OR DOOR PERMIT
Additional desc .
Permit Fee . . . 55.00 Plan Check Fee . . 27.50
Issue Date . . . Valuation . . . . 380
Expiration Date . 2/01/11
Fee summary Charged Paid Credited Due
Permit Fee Total 55.00 55.00 .00 .00
Plan Check Total 27.50 27.50 .00 .00
Grand Total 82.50 82.50 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
$ay City of Atlantic Beach APPLICATION NUMBER
N 4014 fico Building Department (To be assigned by the Building Department.)
v 800 Seminole Road /
Atlantic Beach, Florida 32233 -5445
Phone (904) 247 -5826 • Fax (904) 247 -5845
F '?'jf3 »• E -mail: building- dept @coab.us Date routed: eb//0
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: " � / rtm t review required Yes No
Applicant: — (!T AA -.0. . Planning & Zoning
Tree Administrator
Project: Public Works
Public Utilities
Public Safety
Fire Services
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Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
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:
APP CATION STATUS
Reviewing Department First Review: Approved. ❑Denied.
(Circl- : -. Comments:
:UILDING
PLANNING & ZONING Reviewed by: / l ( �� Date: 7 - 4 t
TREE ADMIN.
Second Review: Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. DDenied.
Comments:
Reviewed by: Date:
Revised 05/14/09
BUILDING PERMIT APPLICATION c
,
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
442-- ,. ffice (904) 247 -5826 Fax (904) 247 -5845 p
Job Address Permit Numbe / /o 4 �� t •.,
•
Legal Description 0 2
g P Parcel # R 2il lo Floor Area of S.Ft.
Valuation of Work $ tY'l Proposed Work he ted /cooled non -hea ; ooled
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool/spa window /s o.
Use of existing/proposed structures) circle one): Commercial Residenti. an existing structure, is a fire spri er system installed? (Circle one): Yes i N /A
Florida Product Approval # 0 5t, 4. Pt — _ ..
For multiple products use produc approva orm
T
Describe in detail the type of work to be performed: l ✓l 7 D r c ;Q 1.4
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U.) L-1-42, .662,e_:
Property Owner Information: c
Name: /4 n Q I '7. 1 /6 n / Address: c) 5,, j e ,rei
Cit 4}) ra b c h State Zip 3 Z,�.' - Phnig 91 = 9 1.
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: Qualifying Agent:
Address: City 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
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 q 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 and Air Conditioners, etc.
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
CONIlVLENCEMENT.
I hereby certify' that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type o work will be complied with whether speci ed herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal, state, or local taw regulating construction or the performance of construction.
Signature of Owner . >y_ \.... \._ Signature of Contractor
Print Name 1 � �CJI2- eVes- , rij" , Print Name
Swo . to . d subsc . . - . before me 20 3 Sworn to and subscribed before me
this .,f // D. of this Day of , 20
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No Public MyC "� p.WH�1F Notary Public
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il. ' ' EXPIRES: Ma2 . Revised 01.26.10
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A construction site man art of this buildi -� y� '-
has been approved asa o n the fo ..K "
plan was approved based up °.-
: .` " ' ro Frame e
latl - parking plan sr,
Na Cional w D ouble Glaze • Al -S Spacer • 0281" Gap
1, Parking p Rahnr ., t
street parking a CERTIFIED Air Fill • Low-E Plus
and abutting ENERGY PERFORMANCE RATINGS
2. Location of construction trail ENERGY PERFORMANCE RATINGS
EVALUACION DE RENDIMIENTO ENERGETICO
area. U- FACTOR (U.S. /I —P) SOLAR HEAT GAIN COEFFICIENT
FACTOR -U COEFICIANTE; GANANCIA DE ENERGIA SOLAR
3. Location of c aZd not further 0.31 0.16
right- of - v�aY
ADDITIONAL PERFORMANCE RATINGS
4. Location of dump - dui. EVALUACION SUPLEMENTARIA DE RENDIMIENTO
accordance with Chapter 1 ■ VISIBLE TRANSMITTANCE
TRANSMISION DE LUZ VISIBLE
coflpa for Ate. Beach • 0.27 _
�;happet%S D npsters ar e
D must be remoV
Completion
5 Tna rrative r affic control n on phasing pla of sho ct
m a terials.
6. Site cleanliness. Contra
Friday of each week.
and other such construe ^ ^ r � NrRC,> i.a ,,, v r , »a,m ra
are deb mined fora faced setofenHm cmd aor a d aspeof cprod ze NFRC doestrotr end ar
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and Sediment I usadospaNFRC son
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until sod or Erosion other stabi
This fenestration product has been certified by the manufacturer
other aCit vit1eS, when to meet the air infiltration requirements of Section 116(a) 1,
g. California Building Energy Efficiency Standards CEC 400 -2008.
official.
4 1 y v i t b lt Remove Only After Final inspection - Retain Label For Your Records
''atlttl a Lo C(}�� �1 Another Energy Efficient Product from JELD -WEN®
resu
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11ND -14482 1/8/10
accordance with City k
A 1 CITY OF ATLANTIC BEACH
®WNER / BUILDER AFFIDAVIT
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 A ONE - 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; 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.
L /C S i � r � - 1 9o) 'D9 6 a
ADDRESS PHONE NUMBER
kc
PRINT NAME
y Th`, )l c g/ c9 /5 0 i b
SIGNATURE .1 DATE
Before me this Z.� ay of C) , 20 an the county of
Duval, State of Florida, has personally apd herin by himself / herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large, State of , County of �""� EBORAH
MY COMMISSION a ��
O Personally Known(� 1 �. ? # DD 634126
�� C J L. ICJ el p ?) CF �p v b % !lt ,, e«aed PIRES: May 21 2011
Produced Identrfication - Ttuu ry � p�l� Undetwrlt
Notary Signature: •
F:BLDG/ Owner - Builder Affadavit, REVISED: 4/16/2009