Permit Siding 2137 S Fairway Villas 2011 '" BUILDING PERMIT APPLICATION b
c t CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845 // r2 7 SO
Job Address: 2137Fairway Villas Lane South, Atlantic Beach, Fl. 32233
Legal Description 39 -22 08 -2S -2E Fairway Villas Parcel # 169398 -1046
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ $ 350.00 Proposed Work heated /cooled No 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 Residentia'
If an existing structure, is a fire sprinkler system installed? (Circle one): Y es - No N /A
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be performed: T 111 Siding Repair , Remove half sheet and repa - '
material using z channel , caulk required areas, and nailing pattern at 5.5 " per Owners requirement awr to
paint as needed See Product ,. uct Information v :aa..
Property Owner Information: Clir 7
4 CZ
Name: Douglas & Beth Dickie Address: 2137 Fairway Vill
City Atlantic Beach State Fl Zip 32233 Ph ne 904 568 -7080 / 9 4 468 -7750 I
E -Mail or Fax # (Optional) Pmanager316 @gmail.com — i O.id
Contractor Information: 'm`...1 !.
m
Company Name• eisQch•0n S e Vfn q e "I.4 a ali fi,ins� Alen • 'V' a t ∎4 h
Address: 6 9 7 AA- De/ u.a� r i _
Office Phone 'd fq - 39 67 :. Site / Contact i • " • �� • - • ' 1 1 1!4 . rl tp �°` '" z
State Certification/Registration # /I °' 1
Architect Name & Phone # /Airr ' PERMIT a • _ a • it ■ . %IMI
Engineer's Name & Phone # • ll) A - � : .i":•sw r` ' s =J! ri tjIIII
Fee Simple Title Holder Name and Addres A NOW _
Bonding Company Name and Address A 1'� "•'===_ekYtl�L
Mortgage Lender Name and Addres Carrington Mortgage, 1610 L saint Annrew ace, "® -- - -z - - --Q5
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 a_suspended or abandoned for period of six (6) months at any time after
work is commenced. I understand that separate permits must be secured for Electrical 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.
1 hereby certify that I have read and examined thisplication 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 c•gulating construction or the performance of construction.
Signature of Owner 1 / A�� -.1771 Signature of Contrac • '� f 0-4 ' -
1 W
Print Name Douglas J Dickie Print Name /' v'ihr -- roc-1 C h$ 0 -✓
Sworn to and subscrib'a rt , to and% s�trddietore
this Co" Day of O .'�. --- . ' AUCIA M O!.EI i '1 ' � D �� ay y . . y , 20
i Notary Public • itata of Florida uoiat ; -� �M� l 0 1 if My Comm. Expires Jul 26, 2015 . it My Conan. Expires Apr 3, 2015
N .W )1, F • uommisson a tt news � . .; l �l
t Pu.
Revised 01.26.10
X
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
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455 - 228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT (247 -5826) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER- BUILDER PERMIT.
0 1/j 7 Cerirdctir i94e ei 964 568 ^ `7o 80
PHONE NUMBER
_
0.• fa$ Jpte- i 6.7'
PRI NAME /
Ll1 / 6/4/2,o/ /
SIGNAT DATE
Before me this of an c- , 20 11 in the county of
Duval, State of Florida, has ersonall
p = ppeared herin by himself / herself and affirms that
all statements and declarations a - ue and accurate.
Notary Public at Large, State of F L. , County of Q+-> v A L..
\- ❑ e Known t s"•.` • rO , 1 • � ALICIA M SAYLE
Produced Identification - F L S} t Q
� r _ Notary Public - State of Florida
IPA I y�c My Comm. Expires Jul 26, 2015 1
Notary Signatu '. �_ ��o t '% ; o �F , r s Commission # EE 116045
�A.� H
F: BLDG /Owner - Builder Affadavit; REVISED: 4 /1.''/I?' •
,l, City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
tA
4,)v 800 Seminole Road
5 r Atlantic Beach, Florida 32233 -5445
Phone (904) 247 -5826 Fax (904) 247 -5845
att 9.1 E -mail: building- dept @coab.us Date routed: ` ,, 7 /7/
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: / 3 1 A"..y la /,' ji,t, Department review required Ye V No
iuilding)
Applicant: &1-) Fanning IZoning
rr
Tree Administrator
Project: — PF,� /.4 ( Sr r-75 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:
1Oj/1 'ION STATUS
Reviewin ['Denied.
(Girt
BUII
PLANNING 66 4 0 0044.1.
Awed by: - Date: /O "' 7
TREE A. • revised. ❑ •n ied.
PUBLIC W 4• 06°..
PUBLIC UTh
PUBLIC SAF i by: Date:
FIRE SERVIC as revised. ['Denied.
Reviewed by: Date:
Revised 05/14/09
r CITY OF ATLANTIC BEACH lA
r j 800 SEMINOLE ROAD
15 ,'Z ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
"'Olt Y p
Application Number 11- 00002750 Date 10 /11 /11
Property Address 2137 S FAIRWAY VILLAS LN
Application type description RESIDENTIAL ALTERATION
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
replace siding
Owner Contractor
DICKIE, DOUGLAS OWNER
2137 FAIRWAY VILLAS LS
ATLANTIC BEACH FL 32233
Permit RESIDENTIAL ALT /OTHER
Additional desc .
Permit Fee . . . 55.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 350
Expiration Date . 4/08/12
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONA1 ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 55.00 55.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 59.00 59.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.