Permit 20 17th st 2012 flashing and wood repair `f CITY OF ATLANTIC BEACH
s) 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00000275 Date 3/13/12
Property Address . . . . . . 20 17TH ST
Application type description RESIDENTIAL OTHER
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 2499
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Application desc
flashing and wood repair
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Owner Contractor
------------------------ ------------------------
SCHIFANELLA, THOMAS OWNER
20 17TH STREET
ATLANTIC BEACH FL 32233
--- Structure Information 000 000 REPAIR AND REPLACE WOOD
Occupancy Type . . . . . . RESIDENTIAL
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Permit . . . . . . RESIDENTIAL ALT/OTHER
Additional desc . .
Permit Fee . . . . 65 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 2499
Expiration Date . . 9/09/12
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 65 . 00 65 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 69 . 00 69 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH AL1, CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACHd '
800 Seminole Road,Atlantic Beach,FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: A 0 17M. "-r77Z&_&T Permit Number: _
Legal Description - S '16PPY6 PJ-PT Parcel ee
oor rea o q. t. q. t
Valuation of Work$ Proposed Work heated/cooled non-he ated/cooled _
Class of Work(circle one): New Addition Alteration Repair Move. Demolition pool/spa window/door
Use of existing/proposed structure(s) (c
n cle one): Commercial esiden
If an existing structure,is a fire sprinkler system installed?(Circle one): o N/A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed:gaeI 4&Css- _ 'lam -F4flSMIA16 ffN,O AlOad
Proper Owner Information:
Name: ffAddress: a l ;�7_�' �
City Stat�Zip,f_Z2J,- Phone 9
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: Qualifying Agent:
Address: City State Zip
Office Phone Job Site/Contact Number Fax#
State Certification/Registration#
Architect Name& Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Applicatio is hereby to obtain a permit to o the work and installgtions as indicated. I certify that no work or installation has commenced prior to thp
issuance o a permit anmthat all wgrk will be per ormed to me t the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void 1�work is not commenced within six(6 months,or ifgconstruction or work is suspend d r ab dongd fora eriod of ix r6)months at ny time ager
orl is O'� er ed., I understand that separate permits must be secured for ElectricarWorek,�lum ng,Signs, ells,Pools,Furnaces,Borers,Healers,
an s a 1r ondttloners,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
TO YOUR PROPERTY•IF YOU INTEND TO OBTAIN FINANCING CONSULT
WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereb 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 o. rk will be complied with whether speci led herein or not. The grUting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,state or local taw regulating construction or t performance of construction.
Signature of Owner Signature of Contractor
Print Name l00000
f' -t�� ..�...�?i L�---................. Print Name
Sworn to and subscribed before a Sworn to and subscribed before me
--t-A=2-Day o this Day of .20
Notary Public C__ TV6f5fy Public
,,,• Revised 01.26.10
a
Notary Public State of Florida
Pete LoftisOF W
Expires 08/15/201 D915018
CITY OF ATLANTIC BEACH
OWNER / BUILDER AFFIDAVIT
'�J;31 Jr
1. 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.
-ZD /
ADDRESS PHONE NUMBER
PRINT NAME
000,
O0002
SIG U
DAtE
Before me this t L- day of_ t+' "_ _,20 i county of
Duval,State of Florida,has personally appeared herin by himself/herself rms that
all statements and declarations are true and accurate.
Notary Public at Large,State of_�L _,County of
❑Personally Known r C�
u -- `Y"�e Nota
duced Ide fication- r o L ry Public State of Florida
rC, 1 = Pete Loftis
o` My Commission DD915018
'?or IV, Expires 08/15/2013
Notary Signature:
R/BLDG/Owner-BuilderAffaUVVISED:4/16/2009