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Permit Window/door 328 10th St 2010 !..1-Vt 4te d ie' � a � CITY OF ATLANTIC BEACH ,� 800 SEMINOLE ROAD 6 r .". ATLANTIC BEACH, FL 32233 , INSPECTION PHONE LINE 247 -5826 Application Number 10- 00001469 Date 12/17/10 Property Address 328 10TH ST Application type description WINDOW AND /OR DOOR Property Zoning TO BE UPDATED Application valuation . . . 850 Application desc garage door Owner Contractor DYER KELLY L OWNER 328 10TH STREET ATLANTIC BEACH FL 32233 (904) 661 -9173 Permit WINDOW AND /OR DOOR PERMIT Additional desc . Permit Fee . . . 55.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 850 Expiration Date . 6/15/11 Special Notes and Comments *2007 FLORIDA BUILDING CODE W/2009 REVISIONS NATIONALELECTRIC CODE 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 STATE DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 55.00 55.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 59.00 59.00 .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) . 4' fr 31 Permit Number: /0 —1 Y6 9 Legal Description Parcel # Floor Area of Sq.Ft. Sq.Fst Valuation of Work $ ;D Proposed Work heated /cooled non- heated/cooled Class of Work (circle one): (New') Addition Alteration Repair Move Demolition pooUspa(wirdow /door Use of existing /proposed structures) (circle one): Commercial Residential If an existing structure, is a fir p ' nkler system installed? (Circle on es o - N /A Florida Product Approval # 0 2l )C. 1 For multiple products use product approva orm Describe in detail the type of work to be performed: ©1(' ,.4 J ac Q c ,(n rtA fo. A k o � ra &a ,Q D 1AQ -('A . rt�. 0 LJ c114 of C Property Oer Information: Name: 4 4C c, fn/r uP -- . , Address: C j 2 ) Y S+I .e �- -_ City �^ 4 l lZ. CJ S ate Zip 37,2_ '33 Phone 7 t51-1— 6 L,. 1 — cj 1 — 73 cy✓ C 1 -) Li E -Mail or Fax # (Optional) . . ak y ?4- ( ;) ;t) i)...1 t/4 Lk ,. (-f Contractor Information: Company Name: D1KA(l QA (A1A -1 'a C 4'l 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 4pplication 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 ;ssuance 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 2nd void rf work is not commenced within six (6) months, or if construction or work is suspended or abandoned fora ertod 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, Bo Heaters, Tanks and Air Conditioners, etc. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMVIlVIENCEMENT 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 COM ENCEMENT. t hereby certify that I have read and examined this a placation and know the same to be true and correct. All provisions of laws and ordinances governing this d ype of work will be complied with whether spe ed herein or not. The granting of a permit does not presume to give authority to violate or cancel the 7rovisions of any other federal, state, or local law regulating construction or the performance of construction. Signature of Owner 50lik/ Signature of Contractor "a" Dq CODE ?rint Name ' 0 SA V1, 111 GL 1) Q,\/ Print Name "' a , 3wo an. _ . .scribed . • : 1 ` his _ r ay o ,. 0 0211� EWE , b �c . re ' Da of ' , ���� C ITY OF A TIC ; � A 4 -: ..� 1 '`-- SEEpF.RMTTS FOR ADDITIONAL ! -y- ' rotary !..4 c 7 REQUIREMENTS AND CON l ublic ,,,.* REVIEWED FAY: . DATE: /J - 1 4 1O . . Revised 01.26.10 r r CITY OF ATLANTIC BEACH f. ®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. , 24 I b Sti - 7 0L4 - b (p) - 9 FT ADDRE PHONE NUMBER k. ©SCt 0 1 a L\, -L PRINT N E CI4/1- l 14 ) 5 ) SIGN URE r /l/ DATE Before me this / day of _— 2014 the county of Duval, State of Florida, has person Ily appeared herin by himself / herself and affirms that all statements and declarations are true - • • accurate. Notary Public at Large, •tate Co • of .ILA . L, ..,.„ laPersonally Known 19' / ❑ Produced Ident�cati••- ._ - -. - -. an '' L GRAHAM • F = •, ;, MY COM ISSION # DD 057760 Notary Signature: • : ? � `, � EX PIRE • .= 14 F: /BLDG /Owner - Builder Affadavit; REVISED: 4/16/2009 , yi oatok i w` , 1 w.t, 4. 4i 1 It 1 u % ' 0 .. / r � ici•••.40. lk,, '', r 1 al **- V-.. 31 411tokktzt , , al .gs 01 i11`gig __ C X87 M "' G1 3 k A ��M - 11 �]< t _ �.. Cat itt , Eim I . ` = ti ; 1 ( - . 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V Y Y v 42. t p 8 I II P I1 1I R I b \ II �, 11 pit hN Pe : i p 1 1 3 1 1 , , 1 .. , .�. . ti mut t. a City of Atlantic Beach APPLICATION NUMBER f CI y (To be assigqed by the Buildin Department.) ;�� Building Department � 800 Seminole Road / ' "te Atlantic Beach, Florida 32233 -5445 Phone (904) 247 -5826 • Fax (904) 247 -5845 Date routed: Z' E -mail: building- dept @coab.us City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM S .2 g / � $ 7 De • artment review required , Property Address: Funding iL anning�& Zoning or Applicant: G� Tree Ad e r Public Works Project: 11. g. 4� Public Utilities Public Safety == Fire Services P r� a r :' i Ni &''Yfi 7 �,y *`',""i Y �'•�"f dd *�'s�a s�3 r �����Y �' r : f �''! r. � �' -x"�'k p ,�,� .5 r ,t v r � i _ 'lpr hj: pFJ� r �, i Dep $ t u r Review or Receipt Date Other Agency Review or Permit Required of permit Verified B 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: APPL • TION STATUS Reviewing Department First Review: 12 Approved. ['Denied. (Circle one.) Comments: BUILDING) PLANNING & ZONING Reviewed by: Date: TREE ADMIN. Second Review: Approved as revised. @Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES by: Date: PUBLIC SAFETY Reviewed I FIRE SERVICES Third Review: []Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14109