Permit Siding 2010 CITY OF ATLANTIC BEACH
'51
800 SEMINOLE ROAD
ATLANTIC REACH,FL 32233
INSPECTION PHONE LINE 247-5826
V21
Application Number . . . . . 10-00001008 Date 8/16/10
Property Address . . . . . . 230 MAGNOLIA ST
Application type description SIDING PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 450
----------------------------------------------------------------------------
Application desc
WOOD REPLACEMENT
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
ROBINSON, BARBARA J. OWNER
230 MAGNOLIA STREET
ATLANTIC BEACH FL 32233
----------------------------------------------------------------------------
Permit . . . . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 55 . 00 Plan Check Fee 27 . 50
Issue Date . . . . Valuation . . . . 4SO
Expiration Date . . 2/12/11
----------------------------------------------------------------------------
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.
BuILDING PERmiT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: C"-RSZ Y� c,, Permit Number:
Legal Description dsh,0h 14 Parcel 9
8 Floor Area of Sq.Ft. Sq Et
Valuation of Work S iQ,�= ,Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration =Repair Move Demolition pool/spa window/door
Use of existingfproposed structure(s�)(circle one): Commercial sidenti
If an existing structure,is a fire sprinkler system installed? (Circle one): es No N/A
Florida Product Approval 9
For multiple products use product app-r-o—va-TTo-rm
Describe in detail the type of rk to be performed: C-C C,
0 K
&
Propert
y Owner Information-
e-A cAy�iz:> c,
Name: Address: 2 3
city Stat ip 3hone -7 U
E-Mail or Fai#(Optional)— A-2Z n:R�- 2�A eQ:j sZ
Contractor Information:
Company Name: Qualifying Agent:
Address: city State zip
Office Phone Job Site/Contact Number Fax
State Certification/Registration 4
Architect Name&Phone 4
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortclage Lender Name and Address
C�
0"'i *s h e ade 0 ba' a erm'"' do'he work and installati�ns as ind or installation has commenced prior to the
e b or-ed to mZ,the gn�ar a, thisjurisdiction. Dzispermit b�comes null
f k a eriod ofs�xJ6)months at anytime a
0
t ..to' ,'or
cure f fter
or lc m R? Is, ul
p 0 d E
i i (6 nt Or, 'on'
e h ftp
, ' 0 '7 w
er by md a,a k
P" 0
. ' 0 ap"_i,an 07
d id work- ot 'd,t
i c is' ,I,-' t Ct a,.te Per it, t
o n d d ta d Pools, urnaces,Boileis,Heiders,
f
s 1,
I k - ', . 1. e s n e
Tanks aaAl. on�ao,�s,eta
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMAIENCEMIENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCI?%, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDL*4G YOUR NOTICE OF
CONEVIENCEMENT.
1here certify that I have read and examined this lica 'on and know the same to be true and correct. Allprovisions of laws and ordinances governing this
IlNork will be coTplied with whether s c, z erein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions ofany otherfederal te, or local
tecteral, j, regz�7g onstruc i;' n or the perf;ormance of construction.
x
Signature of Owner(� Signatare of Contractor
Print Name cc-� Print Name
................ ............. INN........... ................ .......................................................-................... ..............................................
I o bsc :)e be iore,m Sworn to and subscribed before me
tl�
s f Aj S 1�7 20 this Day of 20
-iLL21-
SHI
Notary P 0 SION#DD 95776o Notary Public
�X P5
P February 14,2014
... ThfoF
BDn Th Notwy Public Undewtm
Revised 01.26.10
800 Seminole Road
Atlantic Beach,Florida 32233
Telephone(904)247-5800
FAX(904)247-5845
.f
Construction Site Management Plan Compliance
A construction site management plan conforming to Atlantic Beach City Code Sec 6-108
has been approved as a part of this building permit. The Construction site management
plan was approved based upon the following information.
1. Parking plan -parking plan showing how site will be accessed and all onsite
and abutting street parking areas.
C) D
2. Location of construction trailers, loading/Unloading area and material storage
area.
3. Location of chemical toilet area- chemical toilets must be kept out of City
right-of-way and not further than 15 feet from structure under construction.
4. Location of dumpster- dumpster niust be fi-om approved waste company (in
accordance with Chapter 16 City Code). .-\s of�009, iplirm,ed &1111pster
coiiipaiiies t'or Ad. Beadi are A(IN-anced Disposal. Realco Recvclina, alid
Shappells. Dumpsters are to have tarp covers orrigid covers on windy days.
Dumpsters must be removed prior to issuance of Certificate of Occupancy or
Completion.
5. Traffic control plan, showing access with dimensions, area to be stabilized,
narrative on phasing of construction with adequate parking and delivery of
materials.
6. Site cleanliness. Contractor must have the entire construction site cleaned by
Friday of each week. This means removal of scrap lumber, concrete remnants
and other such construction debris iricluding cans, metal, plastic and paper.
7. Erosion and Sediment Control. Contractor must maintain all elements of the
approve4 Erosion & Sediment Control Plan (silt fence, catch basin filters, etc.)
until sod or other stabilization has been placed and approved by Public Works.
8. Other activities, where special conditions are identified by the Building
CD
Official.
17aijure to comply �vith the Construction Site 114anagenwat
Ordinance may result in a Stop Work Ordear being issued in
11 -fl, I-ty C—de Ce!p. '--1 -7 il�
accoruaRce Wil I ��-I
Rf-mv I std6/21 009
CITY OF ATLANTIC BEACH
(OWNER / BUILDER AFFIDAVIT
1. 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 TTIE 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.
11. 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(l). AN "OCCUPATIONAL LICENSE' IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826) IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
I�Fo ? z
ADDRES PHONE NUMBER
Z (C�_� -1
Qf- I V t
PRINT NAM
/J"/-/ 5�— -.- /-� f,=>17
SIGNAMR'ff- DATE
Before me thi day of A-U$! V�`i_20/D in the county of
Duval,State of Florida,has personally appebred herin by himself herself and affirms that
all statements and declarations are true and accurate.
Nota P I'c at Lar County of
r )t I
17,ys/.n a I ly �s SHIRLEY L GRAHAm
Y'_C�SI0N#DI).qsZ7M
0\'
[ti.-Zd C Pica
tua
,,",Z 14,2014
Thru N Underwhem
Notary Sig
FIBLD Oxxmu-Builder davit; VISED: /16/20 9