Permit Siding 719 Selva Lks Cir 2011 i Ira
` CITY OF ATLANTIC BEACH ' IPP";ev' ; (:**).,
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
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Application Number 11- 00001804
Property Address Date 3/17/11
Application type description SIDINGLPERMITES CIR
Property Zoning TO BE UPDATED
Application valuation . . . 1500
Application desc
install hardi T -11
Owner Contractor
GENTRY, FRANCES M OWNER
719 SELVA LAKES CIR
ATLANTIC BEACH, FL
ATLANTIC BEACH FL 32233
Permit W /W /O BUILDING PERMIT
Additional desc .
Permit Fee . . . 110.00 Plan Check Fee 55.00
Issue Date Valuation . . . . 0
Expiration Date . . 9/13/11
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 3.30
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 110.00 110.00 .00 .00
Plan Check Total 55.00 55.00 .00 .00
Other Fee Total 5.30 5.30 .00 .00
Grand Total 170.30 170.30 .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 t
800 Seminole Road, Atlantic Beach, FL 32233 p v Pb004 1 - r
Office (904) 247 -5826 Fax (904) 247 -5845 7j
r
Job Address: 9 1 � �.
,., ''� Permit Number: 6
Legal Description
Parcel #
Valuation of Work $ 15 (6
Class of Work (circle one): New Addition Alteration Repair ' i
Use of existing /pro osed structure(s) (circle one): Commercial Res v i e 1 t y olition pool/spa window /door
If an existing structure, is structure, fire sprinkler system installed? (Circle one). - s No N /A
Florida Product Approval #
For multiple products use product approva orm
Desc ibe in detail the type of work to performed: `C- 'to,- i 1 r\ c H 06v r
o ve.-r e S --
r 7
Property O
rtv w Owner Information:
C
Name: eq/04/Co. ity 447'149w/1 G S G, , �/ Address: 21 ? ,5 C. y.,r� 4,4„)--;,_ t �i C
State -Zip 3.Z? 3 Phone 9e::)/ 6 _ g 1,S t
E -Mail or Fax # (Optional)
Contractor Information: c,
Company Name: A7/ — V 1Ne Qualifying Agent:
Address: / City State
Office Phone Job Site/ Contact Number Zip
State Certification/Registration # Fax #
Architect Name & Phone #
Engineer's Name & Phone #
Fee Simple 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 f work is not commenced within six (6) months, or if construction or work is suspended or abandoned or a period o six 6) months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Si Wells, Pools, F urnaces, Bo 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.
I 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
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.
O
Signature of Owne ApAamaih I) �rAn�ww aM p..w N.u,arvw��.
Signature of na11'1L ,.
Print Name AnK' C 6S S�jy I s Print Name
Swo o and subscr�' ed before F I L E C O P Y I .. .
this .4' ' % ay of - rn • ' 6 2 � l Sworn to and subscri. b � � r „ -,
- this Day of ..
Not. u is ■ _ . ,
� - 1 r • ! . i • _ b y i I 1 t'
0 _ ;. 1
Ai w4„., i•t� "',. SHIRLEYL CTY OF ATLANTIC BE CH
•* AA. COMMISSION # D D 9 60
' . E XPIRES: February SEE PERMITS FOR ADDITION vtsed 01.26 10
c, Bonded Thru Notary Pidgin 20 Underwriters REQUIREMENTS AND CONDITIONS.
REVIEWED BY /
�� DATE: 3 — f G-
e
r a i
r�,
" % CITY OF ATLANTIC BEACH
® / 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 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.
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 $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455 - 228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT (247 -5826) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER- BUILDER PERMIT.
7/ q Stzv/- L e,,e,La g , 0v 3 Yq .075
ADDRESS PHONE NUMBER
�� f ( C-8 S>LI 1 771
PRINT NAME // /
,44--r- is,..„-rk‘
0'3- l 5.. - `/
SIGNAT RE
DATE
Before me this /6 day of —7124 1 C' h , 20 /1 in the county of
Duval, State of Florida, has personally appeared herin by himself / herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large, State of r2._ , County of {�J /A Ifa 1 ,
❑ Personally Known ,�/ ( ff((
roducedldentifi - on - G- , . ft — \QV�__C /J►
Yi,
P SHIRLEY L GRAHAM
... * * MY N 9 57760
4
Notary Signature. , � •
.
r _ 7 '�4' • `,•' EXPIRES. Feb a t 10 . 4%84,,1%• B onded Thru Notar COMMISSION Pub DD Undenvnters
F: BLDG / Owner - Builder Affadavn; REVISED: 4/16/2009
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41) 44, ri,40 '44 •";
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CITY OF ATLANTIC BEACH
BUILDING AND ZONING DEPARTMENT
NOTICE
This building has been inspected and:
General Construction Mechanical
Concrete and Masonry 0 Electrical
fl Plumbing n Gas Piping
IS NOT ACCEPTED
CORRECT AS NOTED BELOW, BEFORE ANY FURTHER WORK
,$)-6 /1 a kw y\ ,e (9 , - , c /3//
/ r
DO NOT REMOVE THIS NOTICE
Inspector: Date:
Failure to respond to this Notice within 10 days will result in this violation being forwarded
to the
CODE ENFORCEMENT BOARD.
The posting of this Placard by its contents shall serve as due notice.
(-
3 (
( 2 ) L.
Transmission Log
COAB Building Dept, Wednesday, 2011 -03 -16 12:28 247 5845
Date Time Type Job # Length Speed Station Name /Number Pgs Status
2011 -03 -16 12:27 SCAN 00006 0:22 14400 97275596 1 OK -- V.17 AM31
7/ q 1 a Lo Ie geor'h,, �='L
Douk Pee. .„..,,
STOP ORK
/� 3
CITY OF ATLANTIC BEACH
BUILDING AND ZONING DEPARTMENT
NOTICE
This building has been inspected and:
® • General Construction ❑ Mechanical
• ❑ Concrete and Masonry • ❑ Electrical
0 Plumbing ❑ Gas Piping
IS NOT ACCEPTED
CORRECT AS NOTED BELOW, BEFORE ANY FURTHER WORK
S i d I i n =n S 1 90 P . , Q v
10.4) r 4.
DO NOT REMOVE THIS NOTICE
Inspector -17 ger,4; Date•,
Failure to respond to this Notice within 10 days will result in this violation being forwarded
to the
CODE ENFORCEMENT BOARD.
The posting of this Placard by its contents shall setvc as due notice.
-- 4 I La c C rYc le 111 -Ii- (.fie e z L
Dmilj atir �
Fee. fh 4 3wite-ti
STOP ORK
CITY OF ATLANTIC BEACH
BUILDING AND ZONING DEPARTMENT
NO TIC[
This building has been inspected and:
® General Construction ❑ Mechanical
❑ Concrete and Masonry ❑ Electrical
❑ Plumbing
Gas Piping
IS NOT ACCEPTED
CORRECT AS NOTED BELOW, BEFORE ANY FURTHER
/ WORK
�t 1r i 'a' n �� [/a t ny
DO NOT REMOVE THIS NOTICE
Inspector:
Date: 3 /6 /if
Failure to respond to this Notice within 10 days will result in this violation being forwarded
to the
CODE ENFORCEMENT BOARD.
The posting of this Placard by i ts contents shall serve as due not
2- W