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Permit Bath Remodel 251 Nautical 2012 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 -5814 INSPECTION PHONE LINE 247 Application Number . . . . . 12-00000661 Date 5/30/12 Property Address . . . . . . 251 S NAUTICAL BLVD Application type description RESIDENTIAL ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 1800 ---------------------------------------------------------------------------- Application desc bath remodel ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ JURGENS, CONRAD & PAT OWNER 251 S NAUTICAL BLVD ATLANTIC BEACH FL 32233 --- Structure Information 000 000 BATH REMODEL Occupancy Type . . . . . . RESIDENTIAL ---------------------------------------------------------------------------- Permit . . . . . . RESIDENTIAL ALT/OTHER Additional desc . - Permit Fee . . . . 60 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 1800 Expiration Date . . 11/26/12 ---------------------------------------------------------------------------- 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 . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 64 . 00 64 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITY OF ATLANTIC BEACH ,I OWNER / BUILDER AFFIDAVIT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART "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 MUS SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE—OR TWO FAMILY RESIDENCE OR A FARM OUTBUFLDIN(J- YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000-00 OR LESS. THE BU1L_DINQ MUST BE FOR YOUR�JSE_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 WELL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY..NOT HIRE AN 0 p_ YOUR CONSTRUCTION MUST _LICENSED AS YO1M C—ONTRACTOR- - IT IS BE DONE ACCORDINU W thlb BUILDING CODES AND ZONING REGULATIONS YOUR R.ESPONSIBILJTY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY .STATE LAW AND BY COUNTY OR MIJNICIPAL.,—LICENSING ORDINANCES _j 11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES,TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS \NUKKER'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. W. PENALTY; UNLICENSED. CONTRACTORS CANNOT BE EMPLOYED.. UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJEU I TO $5,0U0 PENALTY-UNuER FLORIDA STATUTE NO. 455-228(l). AN-OCCUPATIONAL LICENSE"I NOT ADEQUATE THE OWNER SHOULD PHYSICALLY — "CERTIFICATE OF GUMPETENCY' OR ]HE FLORIDA "CONTRACTORS SEE THE COUNTY E THE CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHON BUILDING DEPARTMENT(247-5826)IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OV\INER-BUILDER PERMIT. PHONE NUMBEH ADDRESS "'D PRI AME, ............. SIGWNA DATE Before me this_2�1 day of 20_LZrthe county Of Duval,State of Florida,has Personally appEpred herin Dy nim".If herself and affirms that all statements and declarations are true and accurate. Notary Public:at Large,State of County IaVsonally Known ducL�idenfificafion- HIRLEY L.GRAHAM MY COMMISSION 1�DO 957760 EXPIRES:February 14,2014 Notary Signat Bonded Thru Notary Public Underoters 171BLDG/0�er-1-3uilder Affadavi�REVISED: 4/16/2009 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office(904) 247-5826 Fax (904) 247-5845 Job Address: Permit Number: Legal Description Parcel# I P toor Area of" Sq.Ft. Sq,Pt Valuation of Work$ Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): New Addition AlteratiorC ep Move Demolition pool/spa window/door �R Use of existing/proposed structureQ)(circle one): Commercial )_Residenti No If an existing structure,is a fire sprinkler system installed? (Circle one Florida Product Approval# For multiple products use product approvarTo-rm Describe in detail the ty e of work to be erformed: Property Owner Information: 1AJA/I Name: 4zvv Address:95( 1114a4ix city k" State Zip j,72:?=-j 1 E-Mail or Fa3�WOptional) jZAdjWU &51d AaX Contractor Information: Company Name: Qualifying Agent: Address:- city -State Zip Office Phone Job Site/Contact Number Fax 9 State Certification/Registration# Architect Name&Phone# Engineer's Narne& Phone 4 Fee Simple Title Holder Narne and Address Bonding Company Name and Address Mortgage Lender Name and Address 4pplication is hereby made to obtain a permit to do the work and installations as indicated I certify that no work or installation has commenced prior to the issuance ofa permit and that all work will be performed to meet the standards of all laws regulating construction in thisjurisdiction. This permit becomes null and void if work is not commenced within six(6)months, or ifconstruction or work is suspended or abandonedfor a period ofsixpl monthsat any time after work is commenced. I understand that separate permits must be securedfor Electricar Work,Plumbing,Sikus, Wells, Pdols, urnaces, Boiles, Heaters, Tanks andAir Conditioners,e1c. 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 YOVjW NOTICE OF COMMENCEMENT. I hereby certify that I have rea d examined this application and know the same to be true and correct. All provisions of laws and ordinances governinz this ope P�work will be conz li w h whether specified herein or not. The granting of a permit does not presume to give authority to violate or caiw�l the provisions ofany otherfe e al,st te struction or the peFformance ofconstruction. Signature of Owner Signature of Contractor Print Narne Print Name ..........�r. lcds a.,e ..................... .P 9 Swo4r aandsu scribed before 1nA Sworn to and subscribed before me this Day o 1/off V--\ 20 this Day of 20 smmteyt. HAM Y, ary Public Notary Public MY COMMISSION 4 DD 957760 EXPIRES:February 14,2014 Bonded Thru Notary Public Underwriters Revised 0 1.26.10 DO NOT WRITE BELOW- OFFICE USE ONLY AppliFable Codes 2 FLORIDA BUILDING CODE Review Result circle one): Approved Disapproved Approved w/ Conditions Review Initials/Date: Development Size Habitable Space Non-Habitable Impervious area Miscellaneous Information Occupancy Group Type of Construction Number of Stories Zoning District Max. Occupancy Load Fire Sprinklers Required Flood Zone Conditions/Comments: