Permit Windows 1945 Seminole 2010 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
sr)
32233
ATLANTIC BEACH,FL
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 10-00001199 Date 10/04/10
Property Address . . . . . . 1945 SEMINOLE RD
Application type description WINDOW AND/OR DOOR
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 12000
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Application desc
replace windows
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Owner Contractor
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MARCH, DOMINIC OWNER
1945 SEMINOLE ROAD
ATLANTIC BEACH FL 32233
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Permit WINDOW AND/OR DOOR PERMIT
Additional desc WINDOW REPLACEMENT
Permit Fee . . . . 110 . 00 Plan Check Fee 55 . 00
Issue Date . . . . Valuation . . . . 12000
Expiration Date . . 4/02/11
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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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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 110 . 00 110 . 00 . 00 . 00
Plan Check Total 55 . 00 55 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 169 . 00 169 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT A-PPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
fob Address: 9//,5— �56MIIYOLX R D _ )9 TL, ACH)FL Permit Number: lb 9'
Legal Description -4 6 T 579 BLock I Sr-ACHSOE Parcelg
Hoor Area of Sq.FE— STP't
Valuatio n of Work S ID?j 6 60 j q-0 Proposed Work heated/cooled / q 7
F - non-heated/cooled
--lass of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa 49Ddoor
Use of existing/proposed structure(s) (circle one): Commercial
If an existing structure,is a fire sprinkler system installed? (Circle onef::!�� N/A
-lorida Product Approval#
For multiple products use product approvatlorm
:)escribe in detail the type of work to be performed: REM 0 V E + PE 10L 8 C F_ EX /,S T IN U W OWS 0 1 T
CoST-0m S Ys rr--t—n s - Im Pa c,-r iowpows w.li-ow-c q- figrmy. _rA(,_50LqTV* GLAFS,
?roperty Owner Information:
�;ame: D 6 M i N I'c, G, A RC14 Address:_./?11Y SEOWOL�5 AD
:ity 07'LANTIC 13EPC-14 State FLZip_,J911-3-Phone �O
3
.-Mail or Fax# (Optional) 0 on i N 1 C_[V�7RC 14 CD BELi-sou rH , HIE I-
�'ontractor Information:
I
-ompany Name: 61,6 Qualifying Agent:
kddress: city State Zip
)ffice Phone Job Site/Contact Number Fax
3tate Certification/Registration#
krchitect Name&Phone
Sugineer's Name&Phone#
.�ee Simple Title Holder Name and Address
3ondino,Company Name and Address
qortgage Lender Name and Address
t' * h d d the work and"t tallat"""'s as indic or installation has commencedpr1or to 1�
s nc p m an ed tom tth ta ards 0 a','�w thisjurisdiction. 7hispermitblcolel 1 11
t "Z k a eriod of siy�months atia fter
o n�ix , , , 0,
'n tu t'o'Ord
r ii, t
e n 0 e "u l"tr" If Is, Atime a
ca s er a *' �'Oe' b �'� 'r,d for E e Pools, urnaces, Bo Heaters,
0 m e Plelrlmep t 0
i d tha to 'k�i e 0
'pp'i eby
' ua 17 'a
md"id f, 'k is not""""d-ithi (6) -
'_ is"__,
ra'k , . , d '_d rsta d th t spa" p
nks a 1,4". 0, u0ne's,et,
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 YOVk NOTICE OF
COMMENCEMENT.
17wcerofy that I have read and examined this'a lication and know the same to be true and correct. All provisions of laws and ordinances governing this
ork will be coTplied with whether spec'M herein or not. The granting of a permit does not presume to give authority to violate or cancel the
wovisions of any otherfederal,state, or local law regulating construction or the pe�jbrmance of construction.
'5ignature of Owner 0) w4(1444�, Mtz-ie- Sig-nature of Contractor
Iriat Name A tq&CH Print Name
.................. .............................. ............................. ........... ............. .......
Sworn to and subscribed before me
c e e
this —Day of 120
EYL
q#ary Pub XPIRE In ULU)V�([b
DiSpd Thru Nota
HIM COPY '
ViQUIREMP,NTSAN S:Febr #y 14,2014 ow"
01.26.10
PIEVMWED BY. DATE:
CITY OF ATLANTIC BEACH
01"WNER / 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 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 BUILDFNG
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 $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(l). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT (247-5826) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
ADDRESS PHONE NUMBER
,Vom ) kic G , M4kC &1
PRINT NAME
La_n�_ L h,
SIGNATLJRE DATE
Before me this I day of
in the county of
Duval,State of Flonia—,has personally ap$eared herin�y himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of County of
V[1 P sonally Known
r-duced identificati
IRL LGPIMAM_
�0
Y 10
Notary Signature: -no 14 ;M14
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1900 SYV,44th Avenue.Ocala,FL 34474 Quote#: 1087403/1
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-------------- --—-----------
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8118/10 12:44:09PM Page 3 of 5
---------------I .
1900 S.W.44th Avenue,Ocala,FL 34474 Quote#: 108740311
Ph;352-3$8-6922 Fax,352-S68-2928
LIST PRICE
------------------- -----------------------------
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8118110 112:44:09P11A Page 4 of 5
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
Date routed:
E-mail: building-dept@coab.us
City web-site: http://vmw.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: t review required YeV No
Z�. Building V
Applicant: —Pl—anning &Zoning
Tree Administrator
Project: 'Pt'� rv�0 to—< Public Works
—Public Utilities
Public Safety
Fire Services
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:
APPIL ICATION STATUS
Reviewing Department First Review: [YApproved. ElDenied.
L(Circle on Comments:
BU I L D1
PLANNING &ZONING Reviewed by: Date:_/0 —1c)
TREE ADMIN. V
Second Review: FlApproved as revised. E]Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: FlApproved as revised. ElDenied.
Comments:
Reviewed by: Date:
Revised 06/14/09