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Permit Bldg Res Alt 31 5th St 2010 4 .1- -1.A =, CITY OF ATLANTIC BEACH r) 800 SEMINOLE ROAD ? ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5826 4 1i1 Application Number 10- 00001422 Date 12/01/10 Property Address 31 5TH ST Application type description RESIDENTIAL ALTERATION Property Zoning TO BE UPDATED Application valuation . . . 10000 Application desc ENCLOSE CAPORT W /DOORS, RECONFIGURE TO ADD BATH Owner Contractor CLARKSON MCCALL, ROSE OWNER 31 5TH STREET ATLANTIC BEACH FL 32233 - -- Structure Information 000 000 ENCLOSE CARPORT W /DOOR ALTER TO ADD BATH Permit BUILDING PERMIT Additional desc . Permit Fee . . . 100.00 Plan Check Fee 50.00 Issue Date Valuation 10000 Expiration Date . . 5/30/11 Special Notes and Comments ENCLOSE EXISTING CARPORT WITH DOORS, DEMOLISH EXISTING BATH AND LAUNDRY AND ADD BATH INSIDE HOUSE *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 Other Fees STATE DCA SURCHARGE 2.00 DEV REVIEW - SINGLE & 2 -FAM 50.00 STATE DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 100.00 100.00 .00 .00 Plan Check Total 50.00 50.00 .00 .00 Other Fee Total 54.00 54.00 .00 .00 Grand Total 204.00 204.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. '- 4 114, 4 City of Atlantic Beach 4 41: 1 Building Department APPLICATION NUMBER 800 Seminole Road (To be assigned by the Building Department.) « Atlantic Beach, Florida 32233 -5445 Phone (904) 247 -5826 • Fax (904) 247 -5845 r 0" E-mail: building- dept @coab.us Date routed: City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 5 C Department review required Yes No uildin ✓� Applicant: ning & Zoni Tree Administrator Project: egC/a5e C p cy f-- l lvU-- c� �--- Public Works Public Utilities Public Safety Fire Services Other Agency Review or Permit Required Review or Receipt of Permit Verified By 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: APPLICATION STATUS Reviewing Department First Review: , PKoproved. ❑Denied. (Circle one.) Comments: BUILDING 'CANNING & ZONING Reviewed by: Date: 1 Vgd120t D 7 ADMIN. Second Review: ['Approved as revised. Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: EApproved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 getalmwsomompommok 01- g44,-- City of Atlantic Beach r Building Department APPLICATION NUMBER 800 Seminole Road (To be assigned by the Building Department.) Atlantic Beach, Florida 32233 -5445 ✓0 "/5 - 2,, ,r Phone (904) 247 -5826 • Fax (904) 247 -5845 t3 1 . 0' E -mail: building- dept @coab.us Date routed: � / — /c City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 37 5 D ent review required Yes No Bui.i Applicant: T ' _nning & Zoning' GC� : 1 : tt01. Project: — 0 P Public Utilities Public Safety Fire Services Ue ti I„ t t 's'3 r �I a r` iv ' �u 41+a a , 2 4 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: APPyCATION STATUS Reviewing Department First Review: E ❑Denied. (Circle one.) Comments: BUILDING / PLAN & ZONING Reviewed by: Date: f/ t YO TREE ADMIN. Second Review: DApproved 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 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247 -5826 Fax (904) 247 -5845 Job Address: J - 5' 4 g Permit Number: Yd - /..-Z,.... Legal Description Parcel # Valuation of Work $ /6 0 00 Class of Work (circle one): New Addition Repair Move Demolition pool/spa window /door Use of existing /proposed structure(s) (circle one): C o�rcial Residents If an existing structure, is a fire sprinkler system installed? (Circle one): Yes Florida Product Approval # N /A For multiple products use product approva orm Describe in detail the type of work to be performed: Fit) C. LO SE C 411P0A W L) OO Ps Y /',...xcc BA-7#1 /a3.4c Avs� Property Owner Information: Name: A O3 » - C �4 L� 3 � S %/' �f -- ,,, Address: 3, , city i. ' i c 877:- State FtZip 32233 Phone 90 y- it/9- 2-//2 E -Mail or Fax # (Optional) Contractor Information: Company Name: sik.•w........ Address: Qualifying Agent: Office Phone Cit State Zip State Certification/Registration # Job Site/ Contact Number Fax # Architect Name & Phone # Engineer's Name & Phone # U _ Fee Simple Title Holder Name and Address Bonding Company Name and Address 1 ) 2��0 ii) 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 By e ,,, i,o,tullutlon 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 a period of six (6) months at any time after work is commenced. I understand that separate permits must be secured for Electrical 'York, Plumbing, Signs, Wells, Pools, F urnaces, Bo 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 COMMENCEMENT. 1 hereby ert that 1 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 of work will be complied with whether specified 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 law regulating construction or the performance of construction. \c �/+�"1U�'- '`[J'\ n ^ w...,4" i! hVwtM,...< „.s�n+wcr.,uiw.W,M'Ma51*... Signature of Owner C, Signature of Contracto , y Print Name e x 1 P tS” ! , C C tc..,L- Print Name x f Swo to , nd subsc • : - , before m : '' �- .,,, ... this a of < / 20 Sworn to and subscribe r, , � 4.. ry� a r+ s1 1 / 'I - a/O- & ' 41311 Notary Public -- - 1 ■ ! ■_ _ � f • DEBORAH A. �•, WHITE Notary ' ,, O rs A r _.: �• � .+ r MY COMMISSION A DD 834128 � � EXPIRES: May 21, 2011 SEE PERMITS FOR AD �� T 6.10 ' , 1 y ` Bonded Thru Notary Public UndeMrttere REQUIREMENTS AND CONDITIONS. h a � /J1l -- c/o 7 Z 3 2 ? 5�.1 Z L VIEWED BY: / DATE:I fv r J am , �, � q � - ' 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 O R 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 LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNIC tI ORDINANCES. IL INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES 1 1 1 1 1 ` it C THE BUILDING DEPARTMENT SUGGESTS WORKER'S COM ENSA O `�r R I HIRE, PURCHASED. ��� BE By III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOT is ..�• OBSERVE IRS WITHHOLDING TAX AND /OR FORM 1099 REQUIREMENTS ON THE WORKERS THE 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. ADDRESS 9 ©y - 2 y9- 2-//2. PHONE NUMBER PRINT NAME 04k c • t t //- — 7 ° SIGNATURE DATE Before me this Z/� day L - Duval, State of Florida, has personally appared herin by himself / self and affirms that all statements and declarations ar a and accurate. • Notary Public at Large, State of 4 L . '...... ''' DEBORAH WHITE as. „ N�! County of MY COMMISSION # DD 634126 an ❑ Personally Known P1 f?C ; 7 - 3 > 3-6 " EXPIRES: MPy21 Produced Identification - � � � ty; �, Bonded Thm Notary Public Underwriters Notary Signature *di jt, F: BLDG /Owner - Builder Affadavit; REVISED: 4/16/2009