Permit Doors 625 Jasmine 2011 kN CITY OF ATLANTIC BEACH
s) 800 SEMINOLE ROAD
v-0 '" ATLANTIC BEACH, FL 32233
DE V
INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002777 Date 10/17/11
Property Address 635 JASMINE ST
Application type description WINDOW AND /OR DOOR
Property Zoning TO BE UPDATED
Application valuation . . . 700
Application desc
2 DOORS
Owner Contractor
HARDING MITCHELL OWNER
635 JASMINE STREET
ATLANTIC BEACH FL 32233
Permit WINDOW AND /OR DOOR PERMIT
Additional desc .
Permit Fee . . . 55.00 Plan Check Fee 27.50
Issue Date . . . Valuation . . . . 700
Expiration Date . 4/14/12
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONA1 ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
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 55.00 55.00 .00 .00
Plan Check Total 27.50 27.50 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 86.50 86.50 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
APPLI G ?WAIT A C BEAC
$UICID/ OF ATLAN ci 32233
CID/ Atlantic 5%45
C1 A 24 -
c o,minoleRoadcQ�.6 Fax (904)
Cit of Atlantic Beach APPLICATION NUMBER
y , (To be assigned by the Building Department.)
2, ',\ Building Department
tf 800 Seminole Road // — 1 X7
1 4� Atlantic Beach, Florida 32233 -5445
Phone (904) 247 -5826 • Fax (904) 247 -5845 Date routed: / % /
U ____
yS ��r� .
f Email: building-dept@coab.us
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
a Address: 6 3 6 c , �'� d T Department review required Yew No
Property rtY KBuildi � I/
Q GO --)/ Planning & Zoning
Applicant: Tree Administrator
cY -Doe 4.. S Public Works
Project: Public Utilities
Public Safety
Fire Services
Review fee $ Dept; Signature
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: C9 pproved. ❑Denied.
(Circle one.) Comments:
BUILDIN
PLANNING & ZONING Reviewed by: -I/77 Date: /O'14
TREE ADMIN. Second Review: Approved as revised. ❑ enied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
,
633- 51-,,, S c Permit Number: / / — a 7 7 7
iption 1 -~C?TU 3, Si, .� 1�1 /35 c" Parcel # / gig --- 00 I D
f , F oor Area of Sq.Ft. Sq. .
of Work $ '7 Q3 0 ' Proposed Work heated /cooled non - heated /cooled
Work (circle one): New Addition Alteration Repair Move Demolition pool /spa o0
l
xisting /propo s ructure(s) (circ e Commercial Resi �
isting struct e, is a fire sprinklers stem in led? (Circle one): es C.::% N /A
. Product Ap royal # //2.57, LS J E 60E/0 57FE1,/ t irot -t- /A .5"1.16 - c,/041Z
ultiple produ s ue product approval form t R ,rs-t-
ibe in detail the type of wor ed: Z �� S
,ierty Owner Information:
ie: .. "T l / ( 4 , elf �'`� Address: (73 S (. Wvt #^-e" S r /d -1 .41 -
C �
y Ai t .iL.- �. State Zip J 2133 Phone ■
Mail or ax # (Optional so i /11 _
.; ontr act or Information: '- F I t E p y [:
,.
Company Name: f \'�__ Qualifying Agent:
Xddress: Ci ..�.➢, . te.,,.:...: . : . Aiiru'N'r°r
Office Phone Job S ietotr
•
State Certification/Registration # Ft • 1 1 ! ■ A ..
Architect Name & Phone # 11111111Mff MI i .
Engineer's Name & Phone # I SEE PE • u r . ., o .,
Fee Simple Title Holder Name and Address ! REQUIREMENTS AND C' e .u. .■ ..
Bonding Company Name and Address . , i � � ^
Mortgage Lender Name and Address D
Application is hereby made to obtain a permit to do the work and installations as in. sated. I certify that no wor or instal ation 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 aperiod of six 6) months at any time after
work is commenced. I understand that separate permits must be secured for ElectricalWork, Plumbing, Signs, Wells, Pools, F urnaces, 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 1 have read and examined thisplication . • now t e same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified here or not. T e granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal, state, or local law regulati > g construction or the performance of construction.
Signature of Owner i ri ', ' 4 Signature of Contractor
Print Name I � ` 1 Print Name
J
Sw. - r.. ° - . ubscribe.. efo - k. e / Sworn to and subscribed before me
th •, . Day of .R`1 - , 20 1 this Day of , 20
�� �� � �
Notary Public : : ,,, . mycommissoN# '' Notary Public
w •' - EXPIRES: MaY 21, 2015
rvmte
• ; Bonded Thor Notary Publk Unders
Revised 01.26.10
T
' Y CITY OF ATLANTIC BEACH
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
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; 1 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.
ADDRESS PHONE NUMBER
PRINT NAME �� .,,"
P( 0 C-r /(
(GNAT RE DATE
Before me this / day of V ( T 2O L the county of
Duval, State of Florida, has personally appeared herin by hims If / herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large, State of L_ , County of /
Per ally Known A
roduced Identif -lion -
.I AVW Notary Signature: _
/ F./BLDG/Owner-Builder Affadavit: REVISED 4/16/2009