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1648 Sea Oats Dr 2012 window fs CITY OF ATLANTIC BEACH SS 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 12-00001550 Date 10/23/12 Property Address . . . . . . 1648 SEA OATS DR Application type description WINDOW AND/OR DOOR Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 1500 ---------------------------------------------------------------------------- Application desc window replacement -------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ PERRYE JEFFREY H & TINA R. OWNER 1648 SEA OATS DRIVE ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit . . . . . . WINDOW AND/OR DOOR PERMIT Additional desc . . Plan Check Fee 30 . 00 Permit Fee . . . . 60 . 00 Valuation . . . . 1500 Issue Date . . . . Expiration Date . . 4/21/13 -------------- ----------------------------------------------------- -------- Special Notes and Comments 2010 FLORIDA BUILDING CODE, 2008 NATIONAl 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 60 . 00 60 . 00 . 00 . 00 Plan Check Total 30 . 00 30 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 94 . 00 94 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. pq! CITY OF ATLANTIC BEACH OWNER / BUILDER AFFIDAVI FILE COPY 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 THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF TIES 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 REQUIRED BY STATE LAW AND BY COUNTY 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 ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(l). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR, TELEPHONE THE BUILDING DEPARTMENT(247-5826) IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. /�,K-� ADDRESS PHONE NUMBER FRI NT NikkM V SIGNAT�O� Before me this day of 61 e7 —2 2/ 1 the county of Duval,State of Florida,has personally appeared herin by himself herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,S County of bllers�o I ally Known _-1 ota'y P�bIiC a'Large,S er.ona I ly Known ____ County of 0 ro ca Produced Iden tion- Notary Signature: SHIRLEY L GRAHAM Mll.-Y COMM13SION#UL)9b t[bu EXPIRES:February 14,2014 F/BLDG/0wne,Buil&r Affadavit;RE SED: 4/16124.,�� Bonded Thru Notary Public Underwriters BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: & Ck-(-4 4),� Permit Number: a Legal Description 7�-57 01-4S -27-C c,,i-7�tv 6 Parcel# Floor Area oF__S_q.Ft. Nq.Ft Valuation of Work$_1f,_0 Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa Use of existing/proposed structure(s) (�ircle one): Commercial Residential If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A Florida Product Approval# /I-(--I 9f—_ 4, V For multiple products use product approval form 0 Describe in detail the type of work to be performed: lftl,-14 "n, V t ,>)c 3 2- 4c,j t,c- 1.) c, S-7 ot- Property Owner Information: Name: -Je d-17�,t,_ Pe,,,,-f le —Address:/,C, /Vi C.., C?.7-f 4;�, city 12 rL_ "I C_ (� if State— ip 71-7-33 Phone '/7 *77 E-Mail or Fax#(Optional) -J a- 0^0--f& �n Contractor Information: Company Name: Qualifying Agent: FILE C,F- 1 Address: city Office Phone Job Site/ r FaZ4 State Certification/Registration rianw,tvv,�..x. LXJL;d T I ju, Architect Name& Phone# jxva;d T I HIVED 14TORTOD Engineer's Name&Phone# 11 UITY OF All, Fee Simple Title Holder Name and Address SEE PERMInTSS F Bonding Company Name and Address REQUIREMENT'S AND(-Qhmaj Mortgage Lender Name and Address RE1qEV%D,jqj- /211 . 0j.- I I . DATE: 7 Z- 4pplication is hereby made to obtain a permit to do the work na I My 0- r ins has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws reg ting cons ru n. This permit becomes null and void if work is not commenced within six(6)months, or if construction or work is suspven or abandonedfor a me after Wperiod ofsixpo)months at any ti work is commenced I understand that separate permits must be securedfor Electrical Work,Plumbing, Signs, ells, Pools, urnaces,Boilers,Heaters, Tanks andAir Conilitioners,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 FINANCING9 CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. I hereb�certify that 1 have read and examined thi's application and know the same to be true and correct. All provisions of laws and ordinances governing this ty to violate or cancel the work will be complied with whether specified herein or not. The granting of a permit does not presume to give authori provisions ofany otherfederal,state, or local law regulating construction or the pe�formance of construction. Signature of Owne Signature of Contractor Print Name Print Name ............................................................................................. ...................................................................... .... ...... ............................................................................................................................. S bscribed��ore me Sworn to and subscribed before me f this Day of . 20 RLEY L.GRMM t�gv rnfAM SS ON#DD 95776 Not-ai�Public-A/ E;,,PnES:February 14,2014 Notary Public "'X.-W 80 otarvPjbr.^UMervjriters nded rhru N Revised 01.26.10 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building D partment.) 800 Seminole Road At antic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5845 Date routed: 2- E-mail: building-dept@coab.us City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM �g Property Address: De�artm�ent re�view�ruqulr�uud Yes ui �B Iding Applicant: j o 4 Planning &Zoning Tree Administrator Project: �)D)�A)Qb2 24z_ 41d-P"VCf17_ Public Works Public Utilities Public Safety Fire Services Review fee $ Dept-Signature Other Agency Review or Permit Required Review 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: 2/Approved. DDenied. (Circle one.) Comments: CEE�� PLANNING &ZONING Reviewed by: Date:/O TREE ADMIN. Second Review: [_�Approved as revised. [—]Denie PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: F�Approved as revised. F]Denied. Comments: Reviewed by: Date: Revised 05/14109