The URL can be used to link to this page

Permit Windows 141 Seminole 2011 \\11 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 Application Number . . . . . 11- 00002980 Date 12/08/11 Property Address 141 SEMINOLE RD Application type description WINDOW AND /OR DOOR Property Zoning TO BE UPDATED Application valuation . . . 1500 Application desc window replacement Owner Contractor AMOS, MICHAEL OWNER 141 SEMINOLE ROAD ATLANTIC BEACH FL 32233 Permit WINDOW AND /OR DOOR PERMIT Additional desc . Permit Fee . . . 60.00 Plan Check Fee . . 30.00 Issue Date . . . Valuation . . . . 1500 Expiration Date . 6/05/12 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 60.00 60.00 .00 .00 Plan Check Total 30.00 30.00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 94.00 94.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. t BUILDING PERMIT APPLICATION i CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247 -5826 Fax (904) 247 -5845 / 2 @ R if 07 Job Address: / Y n` / � • e1 a le ' 44 l • Z (. • Permit Number Parcel # ey, DE-.8 2Q f 7 LJ( Legal Description Valuation p uation of Work $ � '� � , 8 0 Proposed �' "' p osed Work heated/cooled n - heated /coo e • Class of Work (circle one): New Addition Alteration ( Repa Move Demolition pool /spa window /door Use of existing/proposed structure(s) (circle one): Commercial Residential installed? an existing structure, is a fire sprinkler system nstalled? (Circle one): Yes No N /A Florida Product Approval # i / 9 L 7 For multiple products use product approval form , Describe in detail the type of work to be performed: P e tA.C. e q • r, to-L' S Property Owner Information: • Name: (V\ 0 � a 2 I A w-vn 6 5 Address: 1 '4 1 S e rr,, n d 1 2 c City (44 k c.....A'. < 1,... State +f= iZip 3 z Z 3 3 Phone '' i 7 / 7 0 0 .� E -Mail or Fax # (Optional) rn Gs' 4 a S.....-.S CQ a k d (J • c.e. -,^ Contractor Information: Company Name: Qualify' gent: Address: Ci Office Phone Job Site/ Contact i l i • State Certification/Registration # .it pi/ 1 KAY 1 • ' 1 i ! ' ' ' Architect Name & Phone # um a , " p - , • .. . ; ' • - Engineer's Name & Phone # i - -II 1 - Ip • • Fee Simple Title Holder Name and Addre : r • , .!_ • i• . •; . - , Bonding Company Name and Addres Mortgage Lender Name and Addr= s REVIEWED BY: in D ' II" • ^' _ / _ Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no wor or ins a • — ' _ .• • menced 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 f6) 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 BEFMENCEMENTORE RECORDING YOUR NOTICE OF 1 hereby certify that I have read and examined this a placation 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, s e; t» local law regulating construction or the performance of construction. Signature of Owne ..5. ' Signature of Contr.. tor Print Name M .... "-°` ' , YA ►'►'i G '' Print Name Swor ` i• • • . ubs ' • -fore me Sworn to and subscrib : •efo - me this ��f��•s th Day of 20 .....0 A t IF ..,.. 3 i3 , Notary 'ublic liatilit====l Notary Publ'' Revised 01.26.10 c �, It CITY OF ATLANTIC BEACH ' IJ% 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. ['P I '.i r, ) ...7.,1t� t- i J 7 7V ( 7G o ADDRESS; CIAO. PHONE NUMBER �� PRI T NAME 1 ��yy�� ---- --�� q \v �� /L / � / / SIGNATURRE DATE Before me this i day of 7)E `- 2011 in the county of Duval, State of Florida, has personally appeared herin by himself / herself and affirms that all statements and declarations are true and accurate. . / // Notary Public at Large, State of cL , County of tr/rl Viz L ❑ Personally Known �5j £ 5 26 g - D oduced Identifi � Notary Signature: _ , tA1) �:u:o� _ .,. HAM I *( * MY COMMISSION DD 957760 F: BLDG /Owner- Bwlder Affadavit; REVISED: 4/16/ f r '� : EXPIRES: February 14, 2014 :weed Thru Nota Publ 11 ,, , I - rS ! a.`J City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road /1-* /� 11 p © Atlantic Beach, Florida 32233 -5445 / / o Phone (904) 247 -5826 • Fax (904) 247 -5845 401119r* E -mail: building - dept @coab.us Date routed: 2 8 / / City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: /V/ ii-At / 710 L� T�' epaxt en review required Ye No Buildin Applicant: Q (o7'1 £ e anning & Zoning Tree Administrator Project: tu i/l/ - P6 ?/,9-"( /lT Public Works Public Utilities Public Safety Fire Services s.� !h XI P�4`�� .? � �F,,:,<.u '14. 444-3: 7 .. i ' r " ( :�.,.. � �r�'� .�: I "aP` ` i ��,�,' i jai , �.,:prral „ate , u` 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: proved. [Denied. (Circle one.) Comments: BUILDIN PLANNING & ZONING Reviewed by: Date: /6)- ? ^// TREE ADMIN. Second Review: Approved as revised. ❑Denied. 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