Permit Siding 1632 Main 2012 C j
~ A CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
y Y G ATLANTIC BEACH, FL 32233
- WI:"
INSPECTION PHONE LINE 247 - 5814
Application Number 12- 00000094 Date 1/25/12
Property Address 1632 MAIN ST
Application type description SIDING PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 1100
Application desc
SIDING 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 . . . . 0
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.
Fee summary Charged Paid Credited Due
Permit Fee Total 110.00 110.00 .00 .00
Plan Check Total 55.00 55.00 .00 .00
Grand Total 165.00 165.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
i
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: /60.2 04/tti 5 Permit Number: / 2 -00
Legal Description Parcel #
j Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ `! Oe Proposed Work heated/cooled 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 g mid
If an existing structure, is a fire sprinkler system installed? (Circle one): es No A
Florida Product Approval # 13 /Q
For multiple products use product approval form
Describe in detail the type of work to be performed: CO (ZtZ &Lt 51 D r IN C; l t.) t 7 gi4-tzt.y
130A-Rb .24p S ►DMer.,
Property Owner Information:
Name: liqg £,'Z' (1a z Q, Address: l6,3v? ; G�iA1 J i
City / rh 4NTiC. --3 State �l. Zip 42,113 Phone ( lei/ ,.*-7/ 5-440 E -Mail or Fax # (Optional)
Contractor Information:
Company Name: Qualifying Agent:
Address: City State Zip
Office Phone Job Site/ Ii: – ,v ii
State Certification/Registration # lit D i A i ;N , t ,
Architect Name & Phone # � �,,,, • �_ T k�� l , ..,.
Engineer's Name & Phone # ` r�� a -� ►M 11 [M:i Ilf�ty ;
Fee Simple Title Holder Name and Address
REQUIREMENT A N I p � `7 ` r _ - 1
Bonding Company Name and Address i
Mortgage Lender Name and Address 1 ' iiw■t , : • ,/
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certij i :""1 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 pernut 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 Electrical Work, 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.
I hereby certify that I have read and examined this a plication 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 of a permit does not presume to give authority to violate or cancel the
provisions of any other federal, s . e, or local law regula = : • truction or the performance of construction.
Signature of Owner A o /i/'/ � Signature of Contractor
Print Name d C- tdparaoi.»4, Print Name
Sworn t g d s bscribed • or- 1 Sworn to and subscribed before me
t is . A Day • A r. 20 this Day of , 20
_ I
—',,..a..
Nota i'blic , , ` , , Notary Public
Revised 01.26.10
CITY OF ATLANTIC BEACH
®�%'VNER /BUIL 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.
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT - SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
111 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.
l 'ADDRESS PHONE NUMBER
.1 w ( �.�
PRIN —
.
y/ / DATE
Before me this r ( day of , 20 in the county of
Duval, State of Florida, has personally appeared herin by himself / herself and affirms that
all statements and declarations are true 2nd accurate. \
Notary Public at Large, State of L.— County of
0 Personally Known �. /////��7 ' / /�
144= Educed Identification - ' 1 -� h t £ �
( f `,
"'� SHIRI.EYL GRAHAM
"' . [
Notary Signature: s : r�` " # DD 957760
�`j I ,� , EXPIRES: February 14, 2014
( 41 th■ Bonded Thru Notary Public Underwriters
F:BLDG /Owner - Builder Affadavit REVISED: 4/1 %/2009
City of Atlantic Beach V- (& 0 APPLICATION NUMBER
Building Department (To be assigned by the Buildingpepartment.)
P 800 Seminole Road `2 -0 d1 i
Atlantic Beach, Florida 32233 -5445
Phone (904) 247 -5826 • Fax (904) 247 -5845
E -mail: building- dept @coab.us Date routed: / ®�cA
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Prope rty /'v' Address: ` 32- ar S ent review required Yes o
Building
Applicant: Q /0/tE4 arming & Zoning
Tree Administrator
Project: f J //J /� /1 /z7f ) l Public Works
rr Public Utilities
Public Safety
Fire Services
x. ae.a .::
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: QApproved. ❑Denied.
(Circle one.) Comments:
C UILDING
PLANNING & ZONING
Reviewed by: "nd.-- Date: l"dZ S
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