Permit Deck Repairs 168 ,.. _,'' `Par,
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i CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
s .., I ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
Application Number 11- 00001675 Date 2/17/11
Property Address 168 SYLVAN DR
Application type description RESIDENTIAL OTHER
Property Zoning TO BE UPDATED
Application valuation . . . 800
Application desc
repair rotten wood
Owner Contractor
GASTON, LOIS OWNER
168 SYLVAN DRIVE
ATLANTIC BEACH FL 32233
Permit BUILDING PERMIT
Additional desc .
Permit Fee . . 55.00 Plan Check Fee . . 27.50
Issue Date . . . Valuation . . . . 800
Expiration Date . 8/16/11
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONALELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
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 27.50 27.50 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 86.50 86.50 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION C 7Th
. CITY OF ATLANTIC BEACH FEB I
800 Seminole Road, Atlantic Beach, FL 32233 ,..- �_ Z 011
Office (904) 247 -5826 Fax (904) 247 -5845
Si , 1_ ' ,
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Job Address: / 4 P , (vc l br /44-1 J� A`1-t� Beadi Permit Number: / 1 /6 ?5"
Legal Description Po vii4A. 1 2 5 F f c i f - Parcel # I '7 02 0061 •
Valuation of Work $ c; "C G `` `- 5fe Hoyt AiL 3
Class of Work (circle one): New Addition Alterat 14 lox.. II - 4 ■ pool/spa window /door
Use of existing /proposed structure(s) (circle one): Commercial -sidenti.
If an existing structure, is a fire sprinkler system installed? (Circle one): ' es 1 s N /A
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be performed: e v A % r k,; c 0 .ri c h- i' i f i A C-F o et) U orb
Property Owner Information:
Name: 4-0 f' a 5 i Address: ) e 59 IV eL. il
City 4 i . oxim State / Zip _2.. " P' Phone ( 104 — d4 17
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: Qualifying Agent:
Address: City State Zip
Office Phone Job Site/ Contact Number Fax #
State Certification/Registration #
Architect Name & Phone #
Engineer's Name & Phone #
Fee Supple Title Holder Name and Address
Bonding Company Name and Address
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 work or installation 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 Work, Plumbing, Signs, Wells, Pools, F urnaces, Boilers, 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 certify that 1 have read and examined this . application 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.
Y . ... ,, a. F.ypY.
i . ; e �ks`4 x "9F' :loci Signature of Owner , /� / , ^i /J lam/ Signature of Contractor r 1
,� .
Print Name FILE COPY
jS �,?.l.C? Print Naive A .
Sworn to and subscrib-d before me Sworn to and subscribed before me... , ., ... h s,..4 ... ..... . —
this 1_ Day of ixet h , 20 0 thiq Dny nf , 20
\\•- . &' r REVIEWED FOR CODE COMPLIANCE
Notary Public r � ,,, ,, ®WATLANTIC BEACH
fr DONNA J. MYLOD SEE PERMITS FOR ADDITIO
Commission DD 687076 REQUIRENTS AND CONDI� 01.26 - = Exp August 28, 2011 44,�hd` $ Bonded ThroTroy Fain Insurance 804385 -7019
REVIEWED BY: DATE: d--//-//
r
r - CITY OF ATLANTIC BEACH
(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 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 RESPONSBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REOUIRED 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.
11I. 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455- 228(1). AN 'OCCUPATIONAL LICENSE IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT (247 -5826) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER- BUILDER PERMIT.
/ IA SCI /CLI4 Dv ?cq —J -61-7
ADDRESS PHONE NUMBER
1-U13 Gas
PRINT NAME
" 101. 4,. PIN4N-"--- 45 l l
SIGNATURE DATE
Before me this i■ day of ' , 20 k in the county of
Duval, State of Florida, has person by himself / herself and affirms that
all statements and declarations are
. t and accurate. `h/
Notary Public at Large, State of -\� , County ofNC X
onaty Known . ♦
4Produced _
1d ai , 'tiM` DONNA J. MYLOD r
1 ` i Commission DD 687076
—.�= Expires August 28, 2011
Notary Signature: ■ !..� _2. A.,...... i.. `. t►!.� • '„�', Banded Thou Troy Fain Insurance 800385-7019
F: /BLDG /Owner-Builder Affidavit; REVISED: 4/16/2009
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1 ,A4 -,. a City of Atlantic Beach APPLICATION NUMBER
' ���
Budding Department (To be assigned by the Building'De
r 1 800 Seminole Road /1 s / 7 1
r r1
Atlantic Beach, Florida 32233 -5445
Phone (904) 247 -5826 • Fax (904) 247 -5845
- -ort ar E -mail: building- dept @coab.us Date routed:
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ,- � (k sylve,t»-by- m ent review required Ye o
Building V
Applicant: d4o?-).4 Tanning & Zoning
/� Tree Administrator
f
Project: , /9 a)adil Public Works
Public Utilities
Public Safety
Fire Services
X '""�'�" Je '� ; . t ' °�Sbi€" C r� P °' -. �, �m +r.�c .• � -x.. p 'a ^ �'`x" 3&" a �' 7�"
Re v51$ r . -w °� W7it ;a i Dep Slgiature ._ }; , PI
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:
APPLICATION STATUS
Reviewing Department First Review: 24Proved. ['Denied.
(Circle one.) Comments:
BUILDIN�
PLANNING & ZONING Reviewed by: Date: 1'// ll
TREE ADMIN. Second Review: ❑Approved 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