Permit Windows 1892 Beach 2012 <1 (,..
" � CITY OF ATLANTIC BEACH
J - 800 SEMINOLE ROAD
4,, °" �' ATLANTIC BEACH, FL 32233
'' INSPECTION PHONE LINE 247 -5814
'' CM 9'
Application Number 12- 00000882
Property Address 1892 BEACH AVE Date 7/17/12
Application type description WINDOW AND /OR DOOR
Property Zoning TO BE UPDATED
Application valuation . . . 8000
Application desc
WINDOW REPLACEMENT
Owner Contractor
LOVE, WILLIAM OWNER
1892 BEACH AVE
ATLANTIC BEACH FL 32233
Permit WINDOW AND /OR DOOR PERMIT
Additional desc .
Permit Fee . . . 90.00 Plan Check Fee 45.00
Issue Date Valuation 8000
Expiration Date . . 1/13/13
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 90.00 90.00 .00 .00
Plan Check Total 45.00 45.00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 139.00 139.00 .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: • c..._('
ermit Mull iaer: 12 gi2— •
Legal Description
� Floor Area of Sq.Ft. Parcel # Sq.Ft
Valuation of Work $ (j t O(J0 Proposed Work heated /cooled
non - heated / cooled
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool /spa window
Use of existing /proposed strncture(s) (circle one): Commercial Residentia ? Cam/
If an existing structure, is a fire sprinkler system installed? (Circle one): - o N /A
Florida Product Approval # FL .S 1 ((7
For multiple products use product approva f orm
Describe in detail the type of work to be performed: .4 p lcsLtn Did tR.Di ct o (.(.) S LJ1 \Li nee.,)
uit ndotoS . ; (non`t!c) n FL 1 1- 1
Property Owner Information:
Name: no /a R q a - 6i11 LOU *. Address: r
City #�I L Zi 1 SL c� C � ? 6
E -Mail or Fax # (Optional) p 3 �3ljhone - Q- _ -' :��
Contractor Information: 1 j � , j y L j 11"):
J
Company Name: Qualifyin gent: t -�! `1
Address: City alccte
Office Phone Job Site/ Contact Number Zip
State Certification /Registration # Fax #
Architect Name & Phone #
Engineer's Name & Phone #
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
issuance
Application is hereby made to obtain a permit to do the w k and installations as indicated. I cert j5 that no work or installation has commenced prior to the
and void if ork is not comme iced within six (6)
ermed months, or ff standards of all is suspended u regulating or abanoned for aperto of six n(6) months at becomes
y time after
w is commenced. 1 understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, F urnaces, 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 plication 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 Owner o.-c/
Signature of Contract)': . :
/�
Print Name * ■
/4. .2/„. , ove-- Print Name
Swor • d su ±'.cribed . r .re� ne - --
fh' ay o 20 worn o an. 1 . , _ . -, = . - -__._-
►-�r . , C ITY OF ATLAN E
fi�rttt EY L GRAHAM BEACH
NO'S^' u • iC = k t; . MV COMM S�,ION;i II • i Notary
EXPIRES: February 14 Unde , 2014 riters NAL
� yy Elpnddd rhru Notary rw U IREMENTS AND CONDMO
Revised u
REVIEWED BY in / DATE: -
r
r
i CITY OF ATLANTIC BEACH
_ I r
:IA
/ ' % WNER / BUILDER AFFIDAVIT
- /
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 TEE 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 REOUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
I1. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
11I. 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.
P/ 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. r n
ADDRESS PHONE NUMBE
PRINT NAME _
/lj'
ir 1Z
SIGNATURE l �
.../----r•--- ( DATE
Before me this / day of v ` l /y , 20 /Z.-in the county of
Duval, State of Florida, has personally app red herin by himself / herself and affirms that - '" ' -•- -- '' • -
all statements and declarations are trueaccurate. J F I L E C P
ersonally Known •
❑Produced (dent catl • - 1 \ twe.mers A V.•
Notary Sign -: , Itsc4 . .IRLEY L. GRAHAM
4 n: MY COMMISSION # DD 957760
R/ELDG/Owaer Builder • ; SED: , 6/2009 , � � - EXPIRES: February 14, 2014
� - `f ,fly Bonded Thnt Notary Public Underwrrters
•
City of Atlantic Beach
" , , Buildin _ ____________
` ' 800 Seminole Department
APPLICATION NUMBER
assigned by the Building Department)
��� /2 - 112.
b Atlantic Beach, Florida 32233 -5445
�'� ft P, Phone (904) 247 -5826 • Fax (904) 247 -5845
E -mail: building- depttcoab.us
Date routed: 7 AIPP/7__
City web-site:
http://vNiw.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: /8 ' Z f � fQ 6' v ( De i a
rtment review — uired _ o
Applicant: OU/- C /'e 7Buildi g
Planning & Zoning _ -
Tree Administrator
Project: /11-D610 _-
/(elGt /)7 Public Works _-
Public Utilities _-
Public Safety
Fire Services _-
.�•.. `! ,.. ate.'''...... _ ;S: •z . _
Other Agency Review Env or P ermit Required Review or Receipt
of Permit Verified By Date
i
Florida Dept, of Transportation
St. Johns R W ater Management D i Prot ect ion s tri ct
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPL ATION STATUS
Reviewing Department First Review: pproved.
(Circle one.) Comments: ['Denied.
BUILDIN
PLANNING & ZONING
Reviewed by: Date: 7- (7 -(2,
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