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Permit Siding 160 11th 2011 I CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD t.) tit a -� ATLANTIC BEACH, FL 32233 4 .E INSPECTION PHONE LINE 247 -5826 vit Application Number 11- 00001722 Date 2/25/11 Property Address 160 11TH ST Application type description SIDING PERMIT Property Zoning TO BE UPDATED Application valuation . . . 1400 Application desc INSTALL CEDAR SHAKES Owner Contractor HAMIL ROBERT OWNER 160 11TH STREET ATLANTIC BEACH FL 32233 Permit BUILDING PERMIT Additional desc . CEDAR SHINGLES Permit Fee . . . 60.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 1400 Expiration Date . 8/24/11 Special Notes and Comments *2007 FLORIDA BUILDING CODE W/2009 REVISIONS NATIONALELECTRIC CODE Other Fees STATE DCA SURCHARGE 2.00 STATE DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 60.00 60.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 64.00 64.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. t.Altr,, City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road //— / / il Z z- ..r -0 Atlantic Beach, Florida 32233 -5445 Phone (904) 247 -5826 • Fax (904) 247 -5845 Date routed: ii !,' E -mail: building- dept @coab.us City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: /60 (/' ` 'T. De ent review required Yes No " uilding B Oh /119 .,., g& Zoning i L Applicant: ��/ Tree Administrator c ��� Public Works Project: v Public Utilities Public Safety Fire Services T � P �r '�I a Ti �, � � � A to �s., r T A W� �� �a II, Review or Receipt Date Other Agency Review or Permit Required 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: [Approved. ❑Denied. (Circle one.) Comments: BUILDIN PLANNING & ZONING Reviewed by: Date: 0 v99 /I TREE ADMIN. Second Review: ['Approved as revised. ❑Deni d. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: Approved as revised. DDenied. 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: /‘6 1/ /h --S/1, e e Permit Number: // —17 Z Z Legal Description Parcel # Valuation of Work $ Floor Area of Sq.Ft. Sq•I't L /�d ° Proposed Work heated/cooled non- heated/cooled Class of Work (circle one): New Addition Alteration Repair Move Demolition pool/spa window /door Use of existing /proposed structure(s) (circle one): Commercial Residential F L If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A ) Florida Product Approval # FL . A Y v ,, I Code -4, C€ c - SA i 5l e.. L I 8 SL( For multiple products use product approval pprova olrm — Describe in detail the t rm - type of work to be perfoed: ,l I /1 Ce AI r / 5 e V ,'d ,' 11 O t l K 7 ,, ,t� T_ [ { - 7 ' y ' ` s; , \' / 9 v Property Owner Information: P [Name: G� d ` f .r t- /1(Gt wr r' I Address: /G a // 74 S f' City A fly I *c r c li State /L Zip 3.1233 Phone f3 /- 6 a,68 E -Mail or Fax # (Optional) r e .M ,'e r . (,n /.r et ea r7' 4 /i4 At . n e f Contractor Information: Company Name: A . Al. f rti v►., ` / En - I er ( i ✓ 41,i ...< K Qualifying Agent: P. U ,', /-(a - . a . i 4ddress: (,0 Re d e lla 0 1 City If f /a„ tiir. 6 4 State F L Zip 3 2 2 3) D f f i c e Phone 6 3 / ° b 2 63 J t C tart nm er _63 _ i: . 6.t 4 ...,..... Fax # State Certification/Registration # Ca C 1 L - _ _ _ ,' "'" b ; tk a. • b me �• . , krchitect Name & Phone # w 1 i' Engineer's Name & Phone # CITY OF ATLANTIC BEACH S ee Simple Title Holder Name and Addres SEE PERMITS FOR ADDITIONAL 3onding Company Name and Address .1 1 1 ,1 1 II. • ix el ` 4, vlortgage Lender Name and Address _ _ _ �� 1 - 1 - • i1 - ' - : i ,�� : - ...7rlj.LJ application is hereby made to obtain a permit to d. - - --=—. . - 'T""� ' . ""- "—"'"'""_" --- .' - stallation 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 end 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 vork is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters, ranks 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. hereby certify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this vpe of work will be complied with whether specif ed herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other federal, stat, or local law regulating construction or the performance of construction. i ature of Owner / 2/L/ A 'A Signature of Contractor p,2"v' 7/7 2 7)-(i/ 'riot Name gR JP y ;� 44. He} rviI I 3 ' Print Name RJt 41, Ha w►, / ov. ;worn o and subscri._ ed before me Sworn to and subscr',ed before me its lay of ' t ' L 4 20 I ( this Day of L4 Ili I 20 1 I 9 .. �� ��� a . A�f� � ( a`` "�"r "r "�.,,, ' SHA4�r atNl' M A� „iii AV Tot 11 : 'Pub � s + � . - , , . • Notar ; i � ��..; ,�:,�, , . �. „� i. �' , e My Comm. Exp Ju 1 , 2 M My Co t � •ires u 2012 =' : �� o,= Com # ' 0 802490 � , `r Revised 01.26.10 r ": '' ,°,` „ Bonded Through National Notary Assn. `� ` "% RAW' Bonded Through National Notary Assn. . sion # DO 802490 Com 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 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 L TO LICENSES REQUIRED BY STATE MAKE EMPLOYED LAW AND BY COUNTY OR MUNIIPAL 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; STATEMEENTAND T THAT I COMPLY WITH ALL ACKNOWLEDGE L THE REQUIREMENTS ABOVE S FOR THE OF AN OWNER- BUILDER PERMIT. /C h S �r-ee 90`� 63/ -G26d' ADDRESS PHONE NUMBER A viberT l - /c v PRIN NAME fr/ !� / I eL � of DATE SIGNATURE ��- + "� /.— Before me this �"" oay of 20S in the county of Duval, State of Florida, has person y appeared herin by himself / herself and affirms that all statements and declarations are t ue and accurate. Notary Public at Large, State of County of - ---,_; -� r onally Known Produced Identification - DEBORAH A. DD 6 Pe �iq� 'r''���;E''• MY COMMISSION •E] i�` ' Ma 21 2 XPIRES: auene drwriters Bonded'fhN a Notary Signatu - . F: BLDG / Owner - Builder Affadavit; REVISED: 4/16/2009