Permit Wind 685 Sailfish 2011 R f 'L`If
A ,a f e i
f."1 ' ' a CITY OF ATLANTIC BEACH
f 800 SEMINOLE ROAD
V ATLANTIC BEACH, FL 32233
, INSPECTION PHONE LINE 247 -5814
___,,,"
Application Number 11- 00002355 Date 7/19/11
Property Address 685 SAILFISH DR
Application type description WINDOW AND /OR DOOR
Property Zoning TO BE UPDATED
Application valuation . . . 2500
Application desc
WINDOW REPLACEMENT
Owner Contractor
MENDE OWNER
685 SAILFISH DRIVE
ATLANTIC BEACH FL 32233
Permit W /W /O BUILDING PERMIT
Additional desc .
Permit Fee . . . 130.00 Plan Check Fee 65.00
Issue Date Valuation . . . . 2500
Expiration Date . . 1/15/12
Special Notes and Comments
NEED NOC
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONA1 ELECTRIC 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
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 130.00 130.00 .00 .00
Plan Check Total 65.00 65.00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 199.00 199.00 .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: Cc, gy 5A.t L Fail - cl1E
P Number: /1 02a5"6'
Legal Description
oor • rea o q. t. Parcel #
Valuation of Work $ 2, i Proposed Work heated /cooled t
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
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A
Florida Product Approval # L. %O94/tf, / PL /C9 7t! �/
For multiple products use product approva form i'i' i G� 'r ^ �r 7-Ie 1 r)
Describe in detail the type of work to be performed:
,_j,,� ,, fit' f �o � OW `RE ?�� �,�,,,�,� -r
E"to wrou q -+Mt AtZ'MJ-z 1 C.
Property Owner Information:
Name: T1et Atz,0 0, E 6, S s- sAtc ffJ a/t
City A7L,� Address:
F # pti onai) dr�(s� S tate�Zip Phone G�l� 11 SO _ 4 City or ax (Optional)
Contractor Information:
Company Name:
Address: Qualifying Agent:
Office Phone Cl State Zip
State Certification/Registration # Jo il b ontac um er
Architect Name & Phone # D FO ' 1 u
Engineer's Name & Phone # Y Y _. ...
Fee Simple Title Holder Name and Address UIREME ii = ' ' '
k /
Bonding Company Name and Address a ` f r1 A 1r i h
Mortgage Lender Name and Address
Is ��lej:�/� ?�'
1 'w ww..' .. N i Mt g.y[�yS•AIRLK•
Application is hereby made to obtain a permit to do the work and installations as in, drer 1 cert5 that no wor or installation has commenced rior to
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, Furnaces, 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.
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 pernit does not presume to give authority to violate or cancel the
provisions of any other feder• • , • • cal law regulating construction or the performance of construction.
Signature of Owner
Signature of Contractor / '
Print Name 121 C I A2 T r T. , " '
M CN ��. Print Name �
q_ r),_ M X 3(08c) 3co
Sworn to and subscribed before me Sworn to and subscribed before me
this ` Day of —1U1/ 20 I I
this Day of 20
b _
1 • _ _ C\ l C . _ + A CHRISTINE WATSON
Notary Public ag , `4 k ' U. c, : o Florida
Commission#DD984107 otary Public
My comm. expires Apr. 21, 2014
Revised 01.26.10
41: itol �r. City of Atlantic Beach Building Department
800 Seminole Road
m . " -' Atlantic Beach, Florida 32233
Telephone (904) 247 -5800
Fax (904) 247 -5845
www.coab.us
WIND -BORNE DEBRIS PROTECTION AFFIDAVIT
Date: 7 ' �2Qlf
Permi #:
Property Address: 6 6 6 54 /G F /51/
I understand the Florida Building Code requires replacement windows in a Wind -borne Debris
Zone be impact glass or have openings provided with wind -borne debris protection. I recognize
the structure involved is located in a Wind -borne Debris Zone. I am in the process of having
windows replaced which require this protection but have elected not to have the required
protection installed by my window contractor. I understand that before a final inspection may be
approved, the required window protection must be provided. If the required window protection is
not provided it will be a violation of State law and the City of Atlantic Beach may take appropriate
code enforcement action which may result in fines beings made against this property. I also
understand that my insurance company may not reimburse me for damages suffered due to the lack
of required window protection.
I agree to have the required window protection installed on or before:
b - 1 — Zo U
(Date)
I will be using the following material to provide the window protection: (check one)
A./ Plywood per the Florida Building Code
B. Other approved method
(Provide Florida Product Number)
Name of Homeowner's Insurance Company
11111M11 - 2:4
(Signs e of Property Owner)
(Date)
I - { e , 0 ��+ _ e MICHAEL J. ETUE, JR.
(Print Name) t Y` ,g . A 1 t Notary Public, State of Florida
Commission 420
My comm. expires s Mar. Mar. 22, 2014
STATE OF FLORIDA
COUNTY OF DUVAL
ikk
The foregoin_ instrument was acknowledged before me this Z day of 5(, Q , 20(( , by
(name of person acknowledging).
Arge
Signa urWof ot. r Pub cr-"e • rFl orida
�
Personally kno OR Produced Identification / Type of Identification 1 1 / Jf ( 14
r
(7 ,--
CITY OF ATLANTIC BEACH
V� (OWNER / 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
SUUPERVISE 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 JMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
IL INJURY LIABILITY; 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.
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 EMPLQYED 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.
(a 5 5A I LF‘S1 -4 D2)jjc (9 ny) 50 — Li iD
ADDRESS
PHONE NUMBER
R IC I_I A2,) /VIE , ∎l0 r
PR.
/y'I DATE
Before me this / v day of / , 2007 In the county of
Duval, State of Florida, has personally apptared
herin by himself / herself and affirms that all statements stalarabonit are
true and accurate, �%
Notary Public at Large, State of / £ , County Vii- I
Notary Signa • illinigr_Mr--
4t:Y Pik
SHIRLEY L. GRAHAM
COAX FORM 81-D(m; REVISED. 8/14/2001 , ■ ' A MY COMMISSION 6 00 957760
. 4 % EXPIRE6: February 14 2014 '
p••• ;.•• Bonded Thru Notary Public Underwriters
emimmonommimimminiewmumemmipsok
, ,. 1 14 r City of Atlantic Beach
APPLICATION NUMBER
, ? _ ' Building Department
800 Seminole Road ! (To be assigned by the Building Department.)
\ r� Atlantic Beach, Florida 32233 -5445 �'
\. .. Phone (904) 247 -5826 • Fax (904) 247 -5845 / V .575" J '`
` >f ' E -mail: building- dept @coab.us
City web - site: http: //www.coab.us Date routed: //
MIMI
APPLICATION REVIEW AND TRACKING FORM
•
Property Address: /4 6 - /AI . .1A 2..;,.. ent review eview re • wired =
Applicant: =
� G(1 ;/ ! Buildi_g_—
l fanning & Zoning
Projeci: G(� //y ) ) A he et /7) f /).7 ee Administrator
Public Works _ -
Public Utilities
Public Safety � -
N. Fire Services _
t evietn� fee $ � A,� ,, ,�� w,
\n r : ... +t_ a,_ ry � eP i t xfi . �iW : " 1 s {.s
"' r.. �F.`'j "p"'pvcFF '
N O
Other Agency Review or Permit Required Review or Receipt
of Permit Verified B Date
Florida Dept. of Environmental Protection - --
'C Florida Dept. of Transportation
St. Johns River Water Management District -_ -.
'., c Army Corps of Engineers
j Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
NS Other:
APPLICATION STATUS
Reviewing Department First Review: V Approved.
(Circle one.) Comments: ['Denied.
BUILDING
PLANNING & ZONING
Reviewed by: Date: 9 1 /
TREE ADMIN.
Second Review: ['Approved as revised. ['Denie .
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:
Date:
FIRE SERVICES Third Review: (Approved as revised.
❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10