459 Ocean Blvd 2012 front porch repair IS CIT OF ATLANTIC BEACH
800 SEMINOLE ROAD
�} ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12- 0001183 Date 9/07/12
Property Address . . . . . . 459 OCEAN BLVD
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 1500
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Application desc
front porch repair
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Owner Contractor
GRUNTHAL LEONARD H III & OWNER
ALISON J
459 OCEAN BLVD
ATLANTIC BEACH FL 322335337
--- Structure Information 000 000 POR( H REPAIR
Occupancy Type . . . . . . RESID NTIAL
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Permit . . . . . . RESIDENTIAL ALT/OTHER
Additional desc . .
Permit Fee . . . . 60 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 1500
Expiration Date . . 3/06/13
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
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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 A f LANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
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BUILDING PERMIT APPLICATION
CITY OF ATLANTic BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office(904) 247-5826 F (904) 247-5845
Job Address: C h k v( Permit Number:
Legal Description Parcel#
� D-G.Floor Area oF SS q.F t. Sq.Ft
Valuation of Work Proposed Work heats /cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration e i Move Demolition pool/spa window/door
Use of existing/proposed structures)(circle one): Commercial R s� e�ntial
If an existing structure,is a fire sprinkler system installed?(Circle one): Y-e r—NoN/A
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be performed: �✓ l 1�
Property Owner Information:
Name: Address:
City State,-�(,Zip Phone - 6 Iq y
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: Qual fying Agent:
Address: City State Zip
Office Phone Job Site/Contact Number Fax#
State Certification/Registration#
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is
her made to obtain a permit to do the work and installations as indi atecl I cert that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet the standards of al!la s regulating construction in thisjurisdiction. This permit becomes rttr!l
and void if work is not commenced within six(6)months, or if construction or work is uspended or abandoned for a__period of six(6)months at any time after
work is commenced. I understand that separate permits must be secured for Electri a!Work,Plumbing,Signs, Wells, Pools, Furnaces, Boilers, Heaters,
Tanks and Air Conditioners,eta
WARNING TO OWNER: YOUR FAILUTO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT' IN YOUR P YING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTENT) TO O TAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFOI E RECORDING YOUR NOTICE OF
COMMENCE ENT.
I hereby certify that 1 have read and examined this a plication and know the same to b true and correct. All provisions of laws and ordinances governing this
hype of work will be complied ith whethe s��ecijPd herein or not. The granting o a permit does not presume to give authority to violate or cancel the
provisions of any other federal state, or Io aI la r gulat' g nstruction or the perfo ante of construction.
Signature of Owner (4-1 Signature of Contractor
Print NamePr nt Name
.................................................................................................. .........................................................................................................................................
Swornf�-, s bs ib efore e ) Sworn to and subscribed before me
this ay o 20 i Z this Day of 20
Nota AM
ublic ,> �L.GRAH
ry V(,OMMiSSION C DD 9 ba ubliC
° iCPIFlES:February 14,20 4
'ended TBru Notary Public Undero rlterS Revised 01.26.10
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CITY OF ATLANTIC;BEACH
OWNER / BUILDER KFFIEDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA TATUTES, PART 1 "CONSTRUCTION
CONTRACTING"REQUIRES OWNER/BUILDER TO AC KNO LEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7),F ORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTIO1, 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 OWN 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 Iv.AY BUILD OR IMPROVE A ONE-OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COSTO $25,000.00 OR LESS. THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAYNOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE B ILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LA WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION O THIS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRA TOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES kND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT P OPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY C UNTY OR MUNICIPAL LICENSING
ORDINANCES.
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE fOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKE 'S COMPENSATION INSURANCE BE
PURCHASED.
III. IRS WITHHOLDING; OWNERS HIRING WORKERS B COME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 EQUIREMENTS 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 ADEQ JATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENC ' 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 TH T I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE RE UIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
' C��c �1-n l✓c� M
ADDRESS PHONE NUMBER
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PR T NAME 9-7
7 j j j /"-If A__
��77 DATE
Before me this - day of_� 20_�-irl the county o
Duval,State of Florida,has personally Ippeared herin by himself/herself and Iffirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of County of
❑Personally Known "'v'u Yt: RLEY L.GRAHAM
❑Produced Identificati - " _A qpt g,;IGN 1#0 D 957760
t_>;Fi,-;S:February 14,2014
Bonded f. a Notary Public Underwriters
Notary Signature:
F:BLDG/Own=-Builder AffadaviT ED:4/16/200
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