Permit 1892 Hickory Ln replace 3 windows 2011 u1i-
ss CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
19
Application Number . . . . . 11-00002258 Date 6/27/11
Property Address . . . . . . 1892 HICKORY LN
Application type description WINDOW AND/OR DOOR
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 2500
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Application desc
replace 3 windows
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Owner Contractor
------------------------ ------------------------
COVINGTON, LARRY B. OWNER
1892 HICKORY LANE
ATLANTIC BEACH FL 32233
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Permit . . . . . . WINDOW AND/OR DOOR PERMIT
Additional desc . .
Permit Fee . . . . 65 . 00 Plan Check Fee 32 . 50
Issue Date . . . . Valuation . . . . 2500
Expiration Date . . 12/24/11
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Special Notes and Comments
*2007 FLORIDA BUILDING CODE W12009 REVISIONS
NATIONALELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
WINDOW AND DOOR INSPECTION:
*INSTALLATION INSTUCTIONS REQUIRED
*ALL STICKERS ARE TO REMAIN ON THE WINDOWS
*PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS
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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 65 . 00 65 . 00 . 00 . 00
Plan Check Total 32 . 50 32 . 50 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 101 . 50 101. 50 . 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
800 Seminole Road, Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904) 247-5845
Job Address: Permit Number:
Legal Description '�Olva �a,�v&4 Z�V)T- Q '2- Parcel#
P'loor Area of Sq.Ft. Sq.Ft
Valuation of Work S Proposed Work heated/cooled non-heated/cooted
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa(wi=dow/door�)
Use of existing/pro osed structure(s)ft�ircle one): Commercial tsidentia
If an existing structure,is a fire sprinkler system installed?(Circle one).1
0
Florida Product Approval FL a
For multiple products use product approval form
Describe in detail the type of work to be performed:
Property Owner Information:
Name: L iS a v.&j&j-yA., Address: A4 CZ.C.
city A=:�n _."Aa State fi-Zip Phone 2,y,/ j76J'!?, Z/zl
E-Mail or Fax# (Oplional)
Contractor Information:
Company Name: A)j Qualifying Agent:
Address: Ci,tv State z
ip
Office Phone
Job Site/Co
cn%
State Certification/Registration# FOR C ODE C 0-M-P-1-1UNCE
Architect Name&Phone# """d
cra OF
Engineer's Name &Phone# BEJW11
SEF PER-MUS FOR AODMONA:L
Fee Simple Title Holder Name and Address REQUIRFMENT-5 AND C-0 ME)NS.
Bonding Company Name and Address
Mortgage Lender Name and Address REVIEWEDBY. /�r/ ill DATF-L-2 2 IZ
Application is hereby made to obtain a permit to do the work and installations a no wor or inus 15tion-tascomm d prior to
s n t isj i s e
issuance of a permit and that all work will be performed to meet the standards of all laws regulatin on truction i h' 'uris iction. This e 3-?ful
and void If work is not commenced within six(6)months, or if construction or work is suspended or ahandonedfor a period ofsix )mont
workis commenced. I understand that separate permits must be securedfor ElectricaF Work Plumbing,Sijns, Wells,Pools, urnaces, Bode ,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.
lhereb certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
711work will be complied with whether srecifhed herein or not, The granting of a permit does not presume to give authority to violate or cancel the
provisions of any otherfederal,state, or local aw regulating construction or the puformance of construction.
Signature of Ownet Signature of Contractor
Print Name Print Narne
............
1—...6 ................................................... ............................. ...................... ................................. ...........
Swo and subscrib d before ine Sworn to and subscribed before me
this of 1_\ 20 this —Day of 20
.........�1,
CHRLEY L GRAHAM
Notal-7 Fuic MY COMMISSION#DD 957760 Notary Public
EXPIRES:February 14,2014
Bonded Thru Notary Public Underwriters
Revised 01.26.10
CITY OF ATLANTIC BEACH
(OWNER / BUILDER AFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING"REQUIRES OWNER I 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
[TIRE 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.
[I. 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 ANDIOR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT 13E EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(l), 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.
Y/
ADYRESS PHONE NUMBER
L 6 ( o\j/ ru
PRINT�A
_�ME
Slk2ATURE DATE
Bcoremethis,�0_dayof 17) 2 in the county of
Duval,State of Florida,has personalty appeared -6yPi.elf herself and affirms that
all statements and declarations are true and accurate
Notary Public at Large,State of JO ,County of
0 P ally Known -/ A
=od.,ed Wentiftation- -I— "
561� SHIRLEY L.GAAW
Notary Signature:
My COMMISSION If DO 957760
February 14,2014
Bonded Thru Notary Public Unde"ers
FIBLDG/0—Builder Affadavit;REVISED 16/2009
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
- 22z' o
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845 Date routed:
unISA, E-mail: building-dept@coab.us
City web-site: hftp:/&ww.coab.us
APPLICATION REVIEW AND TRACKING FORM
J?#pgtment review required Ye No
Property Address: 11�2_ A-el-leeX --/-77
(,JBuilding V
Applicant: e_ Planning &Zoning
Tree Administrator
Project: Public Works
Public Utilities
Public Safety
Fire Services
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: gApproved. [—]Denied.
(Circle one.) Comments:
PLANNING &ZONING
Reviewed by: Date: 6 ,)7
TREE ADMIN. Second Review: []Approved as revised. nDeOied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: FlApproved as revised. FlDenied.
Comments:
Reviewed by: Date:
Revised 07127MG