Permit 1644 Sea Oats Dr Interior Demo 1210 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 10-00001500 Date 12/28/10
Property Address . . . . . . 1644 SEA OATS DR
Application type description DEMOLITION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
INTERIOR DEMOLITION ONLY
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Owner Contractor
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HOFFMAN, LARA OWNER
1644 SEA OATS DRIVE
ATLANTIC BEACH FL 32233
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Permit . . . . . . DEMOLITION PERMIT
Additional desc . . PARTIAL DEMOLITION
Permit Fee . . . . 100 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 6/26/11
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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 100 . 00 100 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 104 . 00 104 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
' BUILDING PERNIIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Fax(904) 247-5845
Address: ermit Number: l0
d Description Par 1#
oor Area of sq.1"tSq,
cation of Work$ Proposed Work heated/cooled non-heated/cooled
s of Work(circle one): New Addition Alteration�dOI16
Move Demolition pool/spa window/door
Df existing/proposed structures) (circle one): Commercial F
i existing structure,is a fire sprinkler system installed? (Circle one)-: Yes N/A
ida Product Approval# )
multiple products use product approval form
-ribe in detail the type of work to be performed: �lV
0
)erty Owner Information:
Le: 'Yn(L'o Address: L(-,44 t)t� 00 l S
1-44 k 0. • C. Stat L Zip 3- 3 3 Phone C C- C`- ( C
ail or Fax#(Optional) �G , C ovv,
tractor Information: _
tpany Name: l.�ur! Qualifying Agent:
ress: City State Zip
ce Phone Job Site/Contact Number Fax#
Certification/Registration#
iitect Name&Phone#
ineer's Name&Phone#
Simple Title Holder Name and Address
ding Company Name and Address Ll
tgage Lender Name and Address
ication is.hereby made to obtain a permit to do the work and installations as indicated. Ice that un work or installation has commenced prior to the
me 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
void zf work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a eriod of six_(6)months at arty time after
:is commenced I understand that separate permits must be secured for Electdcal Work,Plumbing,Slgns, bells,Pools,Furnaces,Boilers,Heaters,
4 and Air Conditioners,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
~OMIVIENCEMENT 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
COMN[ENCEMENT.
.eby certify that I have read and examined th* ?plication and know the same to be true and correct. All provisions of laws and ordinances governing this
0j work will be co lied with whether speci ed herein or not. The granting of a permit does not presume to give authority to violate or cancel the
dszons of any other deral,state, or local lmv regulating construction or the performance of construction.
nature of O er r Signature of Contractor
A NameL .�, � Print Name
o subscrib ef�ore me Sworn to and subscribed before me
20 l.7 this Day of 20
Lary Public _* := MY COMMISSION#DD 634126 Notary Public
ria PINNmaryPubuc Ur.CjqWftM Revised 01.26.10
(J Ar ` ` CITY OF ATLANTIC BEACH
1=
J 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 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 1S 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY' OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5828)IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
15-3VA0
ADDRESS �Z'3 PHONE NUMBER
Pf MCl
T NAM�,
IGNATURE DATE
Before me this r day of '� � ,2016 in the county of
Duval,State of Florida,has personally appeared herin by himself I herself and affirms that
all statements and declarations are true and accurate.
.aceto
Notary Public at Large,State of County of_-� ?+$�'�rt'K% � H A WHITEDEBORAH
*: MY COMMISSION#00 634126
13 Personally Known //�+ (.. '" ?•., ' EXPIRES:May 21,2011
Produced Identification- r 4�` J �+r S J�6 int. Bonded Thru Notary Public UndenvMars
Notary Signature:
F:/BLDG,10wner-Builder Affadavit:REVISED: 4116/2009