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159 3rd St 2012 WDO repair CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 12-00000769 Date 6/20/12 Property Address . . . . . . 159 3RD ST Application type description RESIDENTIAL ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 150 ---------------------------------------------------------------------------- Application desc repair wood rot at stucco ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ RILEY DONALD L OWNER 159 3RD ST ATLANTIC BEACH FL 322335208 --- Structure Information 000 000 STUCCO REPAIR Occupancy Type . . . . . . RESIDENTIAL ---------------------------------------- ------------------------------------ Permit . . . . . . RESIDENTIAL AIT/OTHER Additional desc . . Permit Fee . . . . 55 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 150 Expiration Date . . 12/17/12 ---------------------------------------- ------------------------------------ Other Fees . . . . . . . . . STA-E DCA SURCHARGE 2 . 00 STA-E DBPR SURCHARGE 2 . 00 ---------------------------------------- ------------------------------------ Fee summary Charged laid Credited Due ----------------- ---------- ---- ------ ---------- ---------- Permit Fee Total 55 . 00 55 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 59 . 00 59 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALI, CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITY OF ATLANTIC,BEACH OWNER / BUILDER AYFIDAVIT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA 3TATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNCIVVLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTIO� TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERM T UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWIN ER OF YOUR PROPERTY.TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU N AY BUILD OR IMPROVE A ONE—OR TWO FAMILY RESIDENCE OR A FARM OUTBUILE ING. 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 BI JILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE, THE IN V WELL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION 0 F THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRA TQ_R_. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES kND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU RAVE LICENSES REQUIRED BY STATE LAW AND BY :)UNTY 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. 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 AN CIRCUMSTANCES. OWNERS BEING SUBJECT TO$5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(l). 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. ADDRESS PHONE NUMBER PRINT NAM 7z t�W,464 NAT16RE 61 DATE Before me thi.�C�:;20 day of 2 the county a _b'yi&If herself and affi Duval,State of Florida,has perioniii app red herin rms that all statements and declarations are true and accurate. Notary Public at Large,State of County 0 Personally Knop� 11 Produced ld�6fication- Notary Signature: SHIRL EY L.GRAHAM FIBLDG/0�a-Builder Affadavt SED:4/16/2000 1*: C 9 M My COMM SS106N 4�'[)[)957760 P Un �r"nter., T#j,,V.7 Bonded Thru N)tarqy Public U'�d;vyjriters BUILDING PERMIT AX,, PLICATION CITY OF ATLANTIc BEACIA 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fay, (904) 247-5845 Job Address: J S-_r Permit Number: Legal Description 0'a Floor Area of Sq.Ft. Parcel# Sq.Ft Valuation of Work 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 Residential If an existing structure,is a fire sprinkler system installed? (Circle ne): Yes No N/A Florida Product Approval # For multiple products use product approval form Describe in detail the type of work to be performed: f k)el d, Property Owner Information: Name: /.e,-X Add 15j S7- city ;d:26 I State:nip .52-2311%one E-Mail or Fax# (Optional)-- Contractor Information: Company Name: Qual i Fying Agent: Address: e City —State Zip Office Phone Job Site/Contact mber Fax State Certification/Registration# Architect Name&Phone# Engineer's Name&Phone# 7) C f-- Fee Simple Title Holder Name and Ad U V- Bonding Company Name and Address��__ Mortgage Lender Name and Address **' A a ere ade ana ermit to do the work and installations as indi(ated. I certify that no work or installation has commenced prior to the 11 be performed to meet the standards of all laws regulating construction in thisjurisdiction. This permit becomes null p t 0" 'r i P'ic c io s rm'y md h to k ssuan e o ape it an at all wo wi , d 'd f work is not commenced within six(6) months, or if construction or work is�uspAded or abandonedfor aWeriod of sixA)months at any time after is co", c, . I u r, t t ,k n d nde tand ha eparate permits must be securedfor Electrical Work,Plumbing, Sikns, ells, Pools, urnaces, Boilers, Heaters, Tanks and Air Conditioners,etc. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR P YING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO 0 TAIN FINANCING, CONSULT WITH 'I YOUR LENDER OR AN ATTORNEY BEFOtE RECORDING YOUR NOTICE OF COMMENCE ENT. I here certify that I have read and examined thi's application and know the same to bc true and correct. Allprovisions qf laws and ordinances governing this 7Mrk will be complied with whether specified herein or not. The granting o,-a permit does not presume to give authority to violate or cancel the provisions of any otherfederal,state, or local law regulating construction or the per(brnance of construction. SignatureofownX Si inature of Contractor Print Name Pr Int Name ............................. .......................................................................................................... ......................................................................................................................................... Swo ubsc 'bed re me Sv iorn to and subscribed before me this Of /_1 � 20 12- tk s —Day of 20 A,, A Notary Notary Public o ()m Issio 4 OD 957760 y(, ary 14,2014 EXPIRE blic UnderwntffS Revised 01.26.10 ded Thru N otary P