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Permit Windows 1632 Main 2012 . �` ' CITY OF ATLANTIC BEACH s3 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 Application Number 12- 00000093 Date 1/25/12 Property Address 1632 MAIN ST Application type description WINDOW AND /OR DOOR Property Zoning TO BE UPDATED Application valuation . . . 800 Application desc window replacement Owner Contractor WINTRODE OWNER ATLANTIC BEACH FL 32233 Permit W /W /O BUILDING PERMIT Additional desc . Permit Fee . . . 110.00 Plan Check Fee 55.00 Issue Date . . . Valuation . . . . 800 Expiration Date . 7/23/12 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 * HOMEOWNER WILL FILL OUT WIND BORNE DEBRIS AFFIDAVIT * Other Fees STATE DCA SURCHARGE 2.00 STATE DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 110.00 110.00 .00 .00 Plan Check Total 55.00 55.00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 169.00 169.00 .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: g oc /44,A. �-1- Permit Number: / — ©O9 3 Legal Description Parcel # Floor Area of Sq.Ft. Sq.Ft Valuation of Work $ 9DO Proposed Work heated /cooled non - heated /cooled Class of Work (circle one): New Addition Alteration Repair Move Demolition pool /spa w low /do� 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 # /2„p For multiple products use product approval form Describe in detail the type of work to be performed: 14.p4.4-e. 6 L /57" :A/ tA.N.L.i>D tc)5 c..& -/ iNILLLi Property Owner Information: Namei3.'r Art D - Address: /C -'3a 446(1 CJ ! j -- Cit rld. 1 t�T ite.,4 State. Zip hone q' 7/ r P .mod 3 S .�� ' 4644::. »1�, E -Mail or Fax # (Optional) ! esip Contractor Information: an Com Name: O P y Qualifying Agent: Address: City t ate,.... Office Phone Job Site/ Contact Num =. -- Fax # State Certification/Registration # i Architect Name & Phone # 1 1-'-i' " 1 O 1 a , , • 1 Engineer's Name & Phone # " Fee Simple Title Holder Name and Address 111.11111 r Bonding Company Name and Address RE "' I QUIRE, •116." 1 .. :..� .. -. _ , Mortgage Lender Name and Address Application is hereby made to obtain a permit to do the work and installati. - ...., ' . o p4 s . d prior to the issuance ofa permit and that all work will be performed to meet the standards of all laws re gu latin g cons ' '-- -- ---•• - - -- .- .- _._„., :- • • ,�� 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 (. mon is .: any time after work is commenced. 1 understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Bo Heaters, Tanks and Air Conditioners, eta 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 this qpplication and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be compli- • . ith whether specified herein or not. The granting ofa permit does not presume to give authority to violate or cancel the provisions of any other feder.1. . -, or local law regul, t : onstruction or the performance of construction. S ignature Signature of Contractor Print Name uJ tar izL>p, Print Name Swo� . I s °•scrib- a befe - e Sworn to and subscribed before me thi _Z'/ Day o ! .I.- .4 20 this Day of 20 . ..I4! . Not. rub i x Notary Public sRRLEY L. GRAHAM Vet A`, . MY COMMISSION '# DD 957760 Revised 01.26.10 ;!'s EXPIRES: February 14, 2014 1 , irfl N. Public Underwriters r 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 BIJJLDING 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. 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. W. 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. /k Ami � D ( -J ' l _ ` /�C ADDRESS }'� PH NE NUMBER g t / PRIN A / , / V I RE �--- DATE Before me this O�`-'( day of , 20L the county of Duval, State of Florida, has personally appeared herin by himself / herself nd affirms that all statements and declarations are true and accurate. 1. --- / Notary Public at Large, State of , County of (� V L ❑ P onally Known --, educedIdentfi on - �A / °';:^ r ill" , . . . Notary Signatur � F:BLDG /Owner - Builder Afradavit; REVISED: 4/16/ +09 1 J - - '4 4 ,44,5F Bonded Thru Notary Public Underwriters 4 .i City of Atlantic Beach W , APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road 2 A.. Atlantic Beach, Florida 32233 -5445 - .J Phone (904) 247 -5826 • Fax (904) 247 -5845 w E -mail: building- dept @coab.us Date routed: /d / cq City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: /6 A/2 Sr nt review required Ye No Building Applicant: OZL . 4 Planning & Zoning Tree Administrator Project: G 1� e cn7aJ/ /7j /A ),S Public Works Public Utilities Public Safety Fire Services ii e 'iii � ,� N:0 :�I�' �F � hay I� - k .. d � x ��,�� . � �. �`��;�.�,g 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: []Approved. ['Denied. (Circle one.) Comments: ,2 /scat , �// c (� tt �� l A . . � �� �� �r � /�f/r V (.' �v. T�''y' W.E: A. et ' t✓ ✓�"�.. �aJ" �r ) r BUILDIN PLANNING & ZONING Reviewed by: Date: / 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 is City of Atlantic Beach Building Department \ ` 800 Seminole Road Atlantic Beach, Florida 32233 Telephone (904) 247 -5800 rig lie Fax (904) 247 -5845 www.coab.us WIND -BORNE DEBRIS PROTECTION AFFIDAVIT Date: /- 0 ? $"- /2 Permit #: lot - 0095 Property Address: / 6 .F) J'a 'zn S I< / 1 4 FL- 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: - - <' " $ , ,: f , (Date) I will be using the following material to provide the window protection: (check one) A. P wood per the Florida Building Code B. O approved method (Provide Florida Product Number) 4 t.I r74 I I I OVA iiik .r-0/S/a � /- �s� / _ . . T ;. ner) () STATE OF FLORIDA COUNTY OF DUVAL 5 --. � Th- : -g.' . igst ment was acknowledges before me thi day of , 20 "liy 1. (name of person acknowledging). �MI _ :- Signature o o ' blic - St. of .ri. a Personally known OR Produc- • - • . - - -- Type of Identification I''�- -' . . ' Py . ,, S HIRLEY L GRAHAM _` < b ,, ,,. o ,, , . MY COMMISSION # Q7 95 ' Bonded TMu N otary Pubifc Un • erw 1