486 Aquatic Dr 2012 window CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-(! 0000936 Date 8/02/12
Property Address . . . . . . 4861AQUATIC DR
Application type description WINt I OW AND/OR DOOR
Property Zoning . . . . . . . TO 4�E UPDATED
Application valuation . . . .
800
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Application desc
window replemnt
---------------------------------------- ------------------------------------
Owner
Contractor
------------------------ ------------------------
HATCHER KATHERINE SUZANNE OWNER
486 AQUATIC DR
ATLANTIC BEACH FL 32233
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Permit . . . . . . WINDOW AND/OR DOOR PERMIT
Additional desc . .
Permit Fee . . . . 55 . 00 Plan Check Fee 27 . 50
Issue Date . . . . valuation . . . . 800
Expiration Date . . 1/29/13
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Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 N,ATIONAl ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL t,AMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
WINDOW AND DOOR INSPECTION:
*INSTALLATION INSTUCTIONS REQUIREE
*ALL STICKERS ARE TO REMAIN ON THE WINDOWS
*PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STA E DCA SURCHARGE 2 . 00
STA ,E DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 55 . 00 55 . 00 . 00 . 00
Plan Check Total 27 . 50 27 . 50 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 86 . 50 86 . 50 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ArLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BuILDING PERMIT PPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlanti�,-,Beach, FL 32233
Office (904) 247-5826 fix (904) 247-5845
Permit Number:
Job Address:
Parcel#
Legal Description I ull'i Sq.
Valuation of Work S; Pro-po's I'd Work heated,./cooled non heated/cooled
Class of Work(circle one): New Addition Alteration Re air Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commerciat Residential N /A
If an existing structure,is a fire sprinkler system installed? (Circlql one): Yes No
Florida Product Approval #
For multiple products use product approval i rm
Describe in detail the type of work to be performed: eq /V A0
f
Property Owner Information:
Name: 4��e.4�-,Ng Address: A�wa;kc_
city nt:k,.04-,( _StateT-__LZip3Qll_Phone 9o4- atfi-S
Will--
E-Mail or Fax#(optional
Contractor Information:
FILE CO
ll,gent-
Company Name: QualifyingA
State
Address: Ci
Office Phone Job Sit Contact Numbpr
State Certification/Registration REVIEVVE, DR CODE eO C
Architect Name &Phone#
Engineer's Name&Phone 4 CIW 0 'ATLANTIC BEACH
Job Sit
Fee Simple Title Holder Name and AAddress SEE PE IT FOR ADDITIONAL
Bonding Company Name and Address REQUIRE ENTS AND CONDITMNS.
Mortgage Lender Name and Address f\ -�L_J�t-.J 2-
WED BT U-
Application is hereby made to obtain a permit to do the wo 9. K.Millol has commenced he
prior to t
ws ecomles n
issuance oJ a permit and that all work will be performed to meet the standards of al�l aws 7e��uZing construction in this jurisdiction. Thispermitb
and void if work is not commenced within six(6)months, or if construction or work or abandonedfor aWeriod of six(6)months at any time after
s surlVodrek�Plumbing,Signs, ells, Pools, Furnaces, Boilers, Heaters,
work is commenced I understand that separate permits must be securedfor Ele3rica
Tanks and Air Conditioners,etc.
WARNING TO OWNER: YOUR FAILI JRE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR ?AYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO )BTAIN FINANCING9 CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFC IRE RECORDING YOUR NOTICE OF
COMMENCEMENT.
lhere certify that I have read and examined this application and know the same tk be true and correct. All provisions of laws and ordinances governing this
Vwork will be complied with whether specified heret n or not. The granti4y of a permit does not presume to give authority to violate or cancel the
provisi.ons ofany otherfedera,state, or local law regulating construction or the pe,formance ofconstruction.
Signature of Own2 Zi Signature of Contractor
Print Name )A r,::l Print Name
r.. ........ ..................... ........................................................................................................................................
Swo o a scribed bef Sworn to and subscribed before me
t qay'o 20
his 20 'this Day of
rZAAHAK
ILI\ C!HikLU I
i.:risu 6 '...", �qjy r;oMtAISSION#DD 95 ot Public
NotarTy_�17TU_ * --*:* '. -
:Fpbruary 14, 14
EXPIRES iters
g�
Bmoed Thru Notary Pubic Und Revised 01.26.10
CITY OF ATLANTI(i'BEACH ILE UPI
J-) 19WNER / BUILDER AFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I "CONSTRUCTION
CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNbWLEDGE THE LAW-
FDISCLOSURE STATEMENT FOR SECTION 489.103(7),!FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTICIN TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PEW 41T UNDER AN EXEMPTION TO THAT
LAW. THE EXEMPTION ALLOWS YOU,AS THE OANER 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 ORRvIPROVE A ONE—OR
TWO FAMILY RESIDENCE OR A FARM OUTBUIADING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000-00 OR LESS. THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT M NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVEI:3UILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE,THE L�W WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATTON!DF THIS EXEMPTION- YO1 J MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTR),kCTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODE$ AND ZONING REGULATIONS- IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU RAVE
LICENSES REOUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES- ___j
11. INJURY LIABILITY; SINCE OWNERS MAY BE L i FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
Ill. IRS WITHHOLDING;*OWNERS HIRING WORKERS 6ECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 109�1 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS kNNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,0 0 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 LI�ENSED 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 RI:_:QUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
H�4
ADDRESS PHONE NUMBER
V1\R1_
PRI T AME
1�14
DATE
IG ATUR�E��f
Before me this Z-;Zf dayg 20�__ in the counjV of
as r;
Duval,State of Florida,h; on iiy app red herin by himself herself 4 nd affirms that
all statements and declarations are rtan accurate.
Notary Public at Large,State Of V County of
OLI Pers
,O�Known
U,,Vr-oduced Ide , fio
c
Signa
MY COMMISSION DD 9577 0
EX 1 0
L, ot4*yW-2cU,denrite:rs"
City of Atlantic Beach APPLICATION NUMBER
(To be assigned by the Building Department.)
Building Department
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: Y123 Ll 2-
City web-site- http:/A~.coab.us -
APPLICATION REVIEW AN TRACKING FORM
//"� Department reviOW required Yes,,No
Property Address: 76 ?6�
-bulliml -5- V
Applicant: &I&)--n =Rrning &Zoning
Tree Administrator
Public Works
Project: &)
Public Utilities
Public Safety
Fire Services
Other Agency Review or Permit Required IR eview 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: R3A"'pproved. FlDenied.
(Circle one.) Comments:
BU�ILDIQ
PLANNING &ZONING Reviewed!by:_ Date:
TREE ADMIN. Second Review: ElApproved as revised. [-JDenied. V
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: [-]Approved as revised. []Denied.
Comments:
Reviewed by: Date:
Revisod 07127110