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17th Street 56 - 58 v -4 CITY OF ATLANTIC BEACH , 800 SEMINOLE ROAD �J ATLANTIC BEACH, FL 32233 _ INSPECTION PHONE LINE 247 -5826 JJilJ Application Number 05- 00031725 Date 12/02/05 Property Address 56 17TH ST Tenant nbr, name FRAMING DRYWALL REPAIRS Application description . . RESIDENTIAL ADD /RENOVATE /ALTER Property Zoning TO BE UPDATED Application valuation . . . 9000 Owner Contractor ROGERS, KIMBERLY OWNER 56 17TH STREET ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 Permit BUILDING PERMIT Additional desc . Permit Fee . . . 210.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 9000 Fee summary Charged Paid Credited Due Permit Fee Total 210.00 210.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 210.00 210.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUi I ,EFY 1\/ o '� CITY OF ATLANTIC BEACH cc: � ..� = j1 BUILDING /ZONING DEPARTMENT D. F. . 800 Seminole Road . Hig • in \\- Atlantic Beach, Florida 32233 Dc !� r , (904) 247 -5800 (904) 247-5845 Fax www.coab.us PLAN REVIEW COMMENTS ,.t # Q5-- .3/476 /1.2/. or Permit Application # .0.5 5/ 7Z 5 Property Address: S / 7 Jrr£f Z Applicant: A ,6 tr/it 70 7 E 2 S Project: /Ci',w - ; -r 9 /Dry (J R II_ 9 9fl r5 /rtplA 146 This permit application has been: Approved tr ikyjewed and the following items need attention: F ...... • '--irnimpea,!...A, .---,,arre r , ;a wa . o L. ( 3-6,,b-ro - aiS — ii. /. o‘ Please re- submit your application when these items have been completed. Reviewed By `=- Date: c---t t ((cc Date Contractor Notified: raj. rlr' CITY OF ATLANTIC BEACH (- : S J1 BUILDING PERMIT APPLICATION ' , ! (Alterations & Additions) Date: t 7 j Q 0 > Job Address: 5(Q ) l sfre f A { a,i 1u F Cf L ,Z Z 33 3 Owner of Property: 0 m ter 4l lq01(0 {5 Address: 5 j (Q 177 i S'f,Ye e -+' prn 6/14 Telephone: qDLI a q 7m o 9 Legal Description: Block Number: Lot Number: Zoning District: Contractor: PUcKl-�' State License Number: F L 0. ZIPZ 50) (, j 708V Contractor Address: ` Telephone: Fax: Describe proposed use and work to be done: _ Fr Q \k ( • S i 'G / W!/ 1 Present use of land or building(s): Std f .67k, + INCYY‘t. v Valuation of proposed construction: q} 9 ODD . ,,/ What are the dimensions of the added space: Art feet x 11 D feet Will the added area be heated ancj.cooldt l(0 New electrical or increase in service? /� hit 4 /Q/ ,,s Add plumbing fixtures? f Add fireplace? g 1) Add heating/air conditioning? N d Is approval of Homeowner's Ass6ia 'on or other private entity required? /( If yes, please submit with this application. ' 'RqI NC/ 1(;ts. 11 sitoidoe - Will this project olve changes in elevation, site grade or any use of fill material, or the addrtr "aaa of 5% or more to the original imper : 'taus area or the removal of any trees? Z4 10. 1 pplicant certifies that no change in site grade, impervious area or fill material will be used on this project. ❑ YES. See Step 2 below. Approval of the Public Works Department is required prior to issuance of a Building Permit. X - NO. Applicant certifies that no trees will be removed for this project. ❑ YES. Removal of Trees will be required for this project. TREE REMOVAL PERMIT IS REQUIRED. Tree Removal Permits to be reviewed by the Tree Conservation Board, which meets two times each month. Procedure: In order to expedite issuance of permits ' - ide all information as appropriate. Incomplete applications may result in delay in issuanc PL 46- 3/0 /' 11 STEP 1. Verify zoning designation and proper setbacks J. £C - 3/6 70 N. :l iu are unsure of this information, please contact the Planning and Zoning Department a .......--- ' verify zoning designation, please have Property Appraiser's Real Estate Number availal STEP 2. Contact the City of Atlantic Beach Departure a pre- construction or post - construction topographical survey or grading plan is require( must be provided with this application.) The Department of Public Works is located at: 1. . 32233 Telephone: (904) 247 -5834 STEP 3. Submit Tree Removal Application if trees are to be removed or relocated. STEP 4. Please submit Building Permit Application, Energy Code Forcers, Notice of Commencement, Owner /Contractor Affidavit if owner is contractor, and four (4) complete sets of construction plans to the Building Department, which is located at the Atlantic Beach City Hall, 800 Seminole Road, Atlantic Beach, FL 32233 Telephone: (904) 247 -5826 800 Seminole Road • Atlantic Beach, Florida 32233 -5445 Telephone: (904) 247 -5800 • Fax: (904) 247 -5845 • http : / /www.ci.atlantic- beach.fl.us Page 2 Revised 8/04 In addition to construction and engineering detail, plans must contain the following information as appropriate for the type of work being performed. Scale of drawings should be sufficient to depict all required information in a clear and legible manner. 1. Current survey showing the property boundary with bearings and distances and the legal description. 2. Location of all structures, temporary and permanent, including setbacks, building height, number of stories and square footage. Identify any existing structures and uses. 3. If required by the Department of Public Works, a pre- construction topographical survey. 4. Any significant environmental features, including any jurisdictional wetlands, CCCL, natural water bodies. 5. Impervious Surface area calculations: include driveways, sidewalks, patios and other Impervious Surfaces. Swimming pools may be excluded from total Impervious Surface. 6. Other information as may be appropriate for individual applications. I hereby certify that all ' ,rmati.n provided with this application is correct. Signature of owner: 1 k \ o I U 5 Date: I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of the 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 federal, state or local rules, regulations, ordinances, or laws in any manner, including the governing of construction or the performance of construction of the property. I understand that the issuance of this permit is contingent upon the above information being true and correct and that the plans and supporting data have been or shall be provided as required. Signature of Contractor: Date: ' Address and contact information of person to receive all correspondence regarding this application (please print). Name: Mailing Address: Telephone: Fax: E -Mail: AS TO OWNER: Sworn to and subscribed before me this 30 day of D V e iVl er , 20 05 State of Florida, County of Duval EY Notary's Signature: 0 ' � MY COMMISSION # 00 412624 DONNA L. BUSS ary gn 0 ..1 1 � EXPIRES: March 30, 2009 n - ° E:1 Personally known ' a'} O Bonded Tutu Notary Public Undimiters Produced identification Type of identification produced r L 13 r r ✓te Lt c e"-Seo AS TO CONTRACTOR: R a b a- 50/- 4. 5-- 7d g- p Sworn to and subscribed before me this day of , 20 State of Florida, County of Duval Notary's Signature: ❑ Personally known ❑ Produced identification Type of identification produced 800 Seminole Road • Atlantic Beach, Florida 32233 -5445 Telephone: (904) 247 -5800 • Fax: (904) 247 -5845 • http : / /www.ci.atlantic- beach.fl.us Page 3 Revised 8/04 Si ` \ E,1 CITY OF ATLANTIC BEACH °t4 -- OWNERIBUILDER AFFIDAVIT Date: I i 30 j 0 Job Address: 5 to ) 7th +r k -1 k L, f7Ga c,N FL 322:33 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. ORDINANCES ALSO ALLOW AN. OWNER TO IMPROVE THEIR OWN PROPERTY WHEN IT IS FOR PERSONAL OR FAMILY USE, AND LIKEWISE REQUIRE ALL WORK (EXCEPT MAINTENANCE UNDER $2,000) BE UNDER A BUILDING PERMIT AND PASS ALL NORMAL INSPECTIONS. THE ORDINANCE STATES OWNERS MAY PHYSICALLY DO WORK THEMSELVES; OR MAY HIRE UNLICENSED WOR �_3RS PROVIDED SUCH WORKERS BE UNDER "DIRECT SUPERVISION OF THE OWNER, WHO MUST BE ON THE Jura AT ALL TIMES WHILE WORK IS IN PROGRESS BY UNLICENSED TRADES PEOPLE." THIS DOES NOT ALLOW USE OF UNLICENSED CONTRACTORS. SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED UNDER THE HOMEOWNERS INSURANCE POLICY TO CLEARLY PROTECT THE OWNER. OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND /OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMI ON THEIR IMPROVEMENT TRADES. 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. 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. 4 I 4, PR PERTY 0 R/BULLDER SWORN TO AND SUBSCRIBED BEFORE ME T i ff.":77'.""."...... le . i t t *' :;\ DONNA L BUSSEY A / MY COMMISSION # 00 412624 HIS DAY OF /v 0�?.�s.`j 05 Bf 20 �� y ���- �a= EXPIRES M 30 , 2009 FDC.. Rata sot 6 108'_D .6r Z• e dmN ry «� Ktrnhe/lci Eogers 1/4C6P144lAr OTARY PUBLIC MY COMMISSION EXPIRES: NOTE: PHRASES UNDERLINED ABOVE. Doc # 2005437126, OR BK 12915 Page 168, Number Pages: 1 Filed & Recorded 11/30/2005 at 12:28 PM, JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00 NOTICE OF COMMENCEMENT State of e L u ) j1 q- Tax Folio No. County of V Vik L To Whom It May Concern: The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of the Florida Statutes, the following information is stated in this NOTICE OF COMMENCEMENT. Legal description of property being improved: Lei" 5 ' / 1.04-k. 3 Q c,u4.11 gri7YI- () vi No Address of property being improved: 6j to (7 j* 51Yi -c-1- At - )-1av 13 Ca. C ,ea (jp 3 ZZ3 General description of improvements: ► V f,A . , al _ 11 I P Owner: ILA M 12,_oa (.r ' Address: g to 11th cifree 4-- it .N M t/, 6ra rh E L 3 2 2 3 Owner's interest in site of the improvement: 1 O 0(p Fee Simple Titleholder (if other than owner): Name: Address: Contractor: OLD >ne.12-. Address: Phone No: Fax No: Surety (if any): Address: Amount of Bond $ Phone No: Fax No: Name and address of any person making a loan for the construction of the improvements. Name: Address: Phone No: • Fax No: Name of person within the State of Florida, other than himsei cl ignated by owner upon whom notices or other documents may be served: Name: Address: Phone No: Fax No: In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.06(2)(b), Florida Statues. (Fill in at Owner's option). — Nam e: Address: Phone No: Fax No: Expiration date of Notice of Commencement (the expiration date is one (1) year from the date of recording unless a different date is specified): THIS SPACE FOR RECORDER'S USE ONLY 1 • ER Signed: , t,L[u ■ , h Date: IL1��3 D 5 ......... �y,,, t isa Harmon Before me this > :n day of ' .� try in a County * ; 4 4 . ; MYCOMMISSION # DD294572 EXPIRES of Duval, State f Flo _ • ..�� • February 26, 2008 �[� a, has personally appeared . / . 1a'f �t `` BONDED 1HRU TROY FAIN INSURANCE, INC. \ \� f � ��--,, ( \ �,0» N otary Public at L S G of F da County of Duval. 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