Permit Wind/Door 1440 Beach 2012 '�. �s�v CITY OF ATLANTIC BEACH
:> 800 SEMINOLE ROAD
-r ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000300 Date 3/19/12
Property Address 1440 BEACH AVE
Application type description WINDOW AND /OR DOOR
Property Zoning RES SF DISTRICT
Application valuation . . . 10000
Application desc
replacement door /window
Owner Contractor
SAIG GREG & JILL OWNER
1440 BEACH AVE
ATLANTIC BEACH FL 322335734
Permit . . . . . . WINDOW AND /OR DOOR PERMIT
Additional desc . .
Permit Fee . . . . 100.00 Plan Check Fee . . 50.00
Issue Date . . . . Valuation . . . . 10000
Expiration Date . . 9/15/12
Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 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 100.00 100.00 .00 .00
Plan Check Total 50.00 50.00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 154.00 154.00 .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: ( 4 1 4 / 0 f fk e \ / 1Je . Permit Number: /r) — 3
Legal Description Parcel #
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ 1 0 \ b � 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 ' - • '
If an existing structure, is a f re s 1 rudder system installed? (Circle one): Yes No N /A
Florida Product Approval # ' . • _ Z E - 1 313 , i . \ *- F L *k 00 5 1 ° 0954 0
4 17
For multiple products use product approva orm
Describe in detail the type of work to be performed: 'A C,..3` �� ` f` ` 'S
Pro erty Owner Information: W
Z cO
P
Name: ' ' cZ- Q - S - ‘ _ Address: C t - 4 ` 0 �3\ C ,
City L''I k State All 'p "3C2V., Phone 9 04 --S 6 ?- S )
E -Mail or Fax # (Optional)
Contractor Information: ii,u..
Company Name: Qualifying Agent: ' c'.
Address: City State r i *
Office Phone Job Site/ — • - - - • -
State Certification /Registration # ' _ �► I i ni , i ;, , I . .. .. .. 1M
Architect Name & Phone # • 1 W M MOM inn ' ``
Engineer's Name & Phone # ; EACH 1
Fee Sim le Title Holder Name and Address Shz rt,tonl'S FUR ADDITIONAL 1 ....e,
P - .. kL Mt N i S AND CONDITIONS.
Bonding Company Name and Address
Mortgage Lender Name and Address ' _ II ,M _ , - . imilime wallarimu,
Application is hereby made to obtain a permit to do the work and installations as ace'. • ' : • as 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 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.
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, state, or local law regulating construction or the performance of construction.
Signature of Ownef - Signature of Contractor
Print Name +s -��� l • Print Name
Sworyi otal subscrite • iT�r' me S Sworn to and subscribed before me
C this ' Day of - �` , 20 2 -- this Day of , 20
. ;
N otary Public =; ,., i* MY COMMISSION 0 EE 057349 Notary Public
-r
""' ; EXPIRES: May 21, 2015
• te
•� Vi a,; : Bonded rnn, Notary Public Underwriters Revised 01.26.10
f ' .
CITY OF ATLANTIC BEACH
11; 4 1: 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 WORKERS COMPENSATION INSURANCE BE
PURCHASED.
1I1. 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. STATEMENT I 1 COMPLY WITH ALL THE S FOR THE ABOVE DISCLOSURE
IISSUANCE OF AN
OWNER - BUILDER PERMIT. 7 �r7�
1 L k "'1 V \ �' . " `� PHON NUMBER
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ADDRESS
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PRINT NAME
— ( (e) \a_
..:. DATE ., :....a
SIGN
Before me this day of 20 in the county of i
Lairaimia_7.maiimainim mil .
Duval, State of Florida, has personally appeared herin by himself / herself and affirms that FILE o all statements and declarations are true and accurate.
Notary Public at Large, State of 7 - Z'`- County of
D p ersonally Known ,N.u. ""fi
((( Produced Identification ` *-: "�`J+ DEBORAH
) / # , Bonded T % ' Ma E 057
Notary Signatu - /
�� �ry Pu b ficUnderwrlters :.
1 F:BLDG/ Owner - Builder Affadavii; REVISED: 4/16 /2009
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tta,'lr�� City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
'_ 800 Seminole Road �2 k
Atlantic Beach, Florida 32233 - 5445 !!
Phone (904) 247 -5826 Fax (904) 247- 5845/((,( / ��
E -mail: building- dept @coab.us Date routed:
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: /L/% / f (l !l , D ment review required Yes o
Applicant ���7) Planning & Zoning
Tree Administrator
Project: /,)/f)Z») //}(�Jk/VT Public Works
Public Utilities
Public Safety
Fire Services
Revieall/ fec
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: [pproved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: /' Date: 3 ^ �G
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