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Permit Driveway/Sidewalk 431 Selva lakes 2011 � 1 `' ' ° s CITY OF ATLANTIC BEACH ) ', 800 SEMINOLE ROAD - ,-` ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 Application Number 11- 00002479 Date 8/16/11 Property Address 431 SELVA LAKES CIR Application type description RIGHT -OF -WAY PERMIT Property Zoning TO BE UPDATED Application valuation . . . 0 Application desc CONCRETE SIDEWALK Owner Contractor RAINES KENDRA D OWNER 431 SELVA LAKES CIRCLE ATLANTIC BEACH FL 32233 Permit DRIVEWAY PERMIT Additional desc . Permit Fee . . . 35.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 2/12/12 Special Notes and Comments Roll off container company must be on City approved list and container cannot be placed on City right -of -way. Other Fees STATE DCA SURCHARGE 2.00 ENG REV BLDG MOD OR ROW 25.00 STATE DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 35.00 35.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 29.00 29.00 .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. BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247 -5826 Fax (904) 247 -5845 Job Address: VI/ tA441 4.4s eirch Permit Number: Legal Description Parcel # Floor Area of Sq.Ft. Sq.Ft Valuation of Work $ l .2,0. op Proposed Work heated /cooled non - heated /cooled Class of Work (circle one): Addition Alteration Repair Move Demolition . • wi Use of existing/proposed structure(s) (circle one): Commercial esidenti. If an existing structure, is a fire sprinkler system installed? (Circle one): - No N /A Florida Product Approval # For multiple products use product approval form ' Describe in detail the ty e of work to be performed: /67,441....0. D 4, ,s/le. X414 tls f � aec� ,-i4 � V , 're ' trite i' a Property Owner Information: �� " Name: �e. e1.- i.J&J Address: O/ c,reeX s+� 414...r ei, e 4 City , r ' / . ► , 0 e e- A e r c + * e 4 State 1 . 7 . . . 2 4 1 / 7 Phone E -Mail or Fax # (Optional) 7 opi allP _ 1 Contractor Information: ne tig-\ Compa ny 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 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 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. 1 understand that separate permits must be secured for ElectricalWork, Plumbing, Signs, Wells, Pools, Furnaces, 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. 1 hereby certify that I have read and examined this asplication 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 s•eci led 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 f :r ulating construction or the performance of construction. • Signature of Owne rtl, --- , ,, _ Signature of Contractor Print Name Print Name Swore d : nd s• _ ribed ' efo - e / Sworn to and subscribed before me this Air / 7 /I ..� . - mss._ / 20 // this Day of , 20 wow —*A EirrittE7 14F- - - • , 'AMU Notary Public '� Notary Public EXPIII S FF6rIJ 14 m14 L y , nonded Thru Notary Pub b Und erwriters Revised 01.26.10 4 &. CITY OF ATLANTIC BEACH 1 1 a% 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 ll4PROVE 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 UI DING 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. 11. 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; UNUCENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455- 228(1). AN `OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT (247 -5826) IF IN DOUBT. V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER- BUILDER PERMIT. fe/.40, 6Je 6'r4/t AD EESS A PHONE NUMBER P E GNATURE / DATE Before me this (I day of 2011 in the county of Duval, State of rida, has personally a red herin by himself / herself and affirms that all statements and declarations are true and accurate. Notary Public at Large, State of / ! County of �� [I Persona Known r-y p�i�ced Identification - Notary Signature: `L • !� - SHIRLEY :GRAHAM 00 Fabrtla 14 2014 :Br 1; ;r MY COMMfSSl N s 167760 a , F nruo m «- sa;ld« e REVISED: 4/1 009 holm thru NWary p Pub a U nd erwriters N.. . City of Atlantic Beach C . k, APPLICATION NUMBER Building Department ..'.• ''' c) - A ).* -7//6. , ,, (To be assigned by the Building Department) . sa ; 800 Seminole Road //:::q... L' 1 - 1 'gr - ,-- ^-- :v Atlantic Beach, Honda 32233-544b - ' 21% i j 7 .f Phone (904) 247-5826 - Fax (904) 24:74?4,5 N - ../ _,.../ E - ma il : building-deptepcoab.us -, ... Date routed: i--/ ( i . -.-.z.., City web-site: http://www.coab.us APPLICATION REVIEW AND RACKING FORM (---, i ,, „7 , --.? Property Address: _ - -I / -- L - L ( 4_ ,- '1 e i t: 1 --.--, ' - 1 - Department review required Yes No Buildii ,,,,... Applicant: 2 . Tree Administrator Project: - \ )Z-- tt 4._ JiL c- Utilities,--- v • Public Safety Fire Services ' FtiiiirifeW$X4 4. giVAt.. 3.' : - • 74.:10aMPIMMT*TWOOtAcr,' 7 :4 Review or Receipt Other Agency Review or Permit Required 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: FA , .proved. (Circle one.) Comments: BUILDING /2;517T/i PLANNING & ZONING Reviewed by: Date: TREE ADMIN. Second Review: OApproved as revised. ODenied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ODenied. Comments: Reviewed by: Date: Revised 07127110 • s-T.r . City of Atlantic Beach r' APPLICATION NUMBER r "�� Building Departrnent ' ' r (To be assigned by the Building Department) ] //— 7 9 800 Seminole Road / �'. �" - - , , :- � Atlantic Beach, Fl 32233 -544 ' Q�;I Tti D. Phone (904) 247 -5826 •Fax (904 -247 -584 ,� � � '"�.! � —76 - ".. ., m >'' E -mail: building - dept ©coab.us !',° ' Date routed: City web -site: http://www.coab.us - APPLICATION REVIEW A ACKING FORM ;'' / A Department review required Yes No Buildin c - A 1 i / �L Property Address: / • Applicant: 1 . Tree Administrator ub' Project: P lic Utilities ✓ Public Safety _ Fire Services ReodWee" v..... _ . _. .._ 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: pproved. 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