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612 Aquatic Dr 2012 siding CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 -5814 INSPECTION PHONE LINE 247 C Application Number . . . . . 12-00001653 Date 11/08/12 Property Address . . . . . . 612 AQUATIC DR Application type description SIDING PERMIT Property zoning . . . . . . . TO BE UPDATED Application valuation . . . . 1000 ---------------------- ----------------------------------------------------- Application desc HARDI BOARD LAP SIDING ---------------------- -- -------------------------------------------------- Owner Contractor ------------------------ ------------------------ GIBBS GRANT OWNER 612 AQUATIC DRIVE ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit . . . . . . SIDING PERMIT Additional desc . - Plan Check Fee 27 . 50 Permit Fee . . . . 55 . 00 Valuation . . . . 1000 Issue Date . . . . Expiration Date - - 5/07/13 ----------------------- ----------------------------------------------------- Special Notes and Comments 2010 FLORIDA BUILDING CODE, 2008 NATIONAl ELECTRIC CODE *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. ----------------------- 2 . 00 Other Fees . .. . . . . . . . STATE DCA SURCHARGE STATE DBPR SURCHARGE 2 . 00 ---------- ----------------------------------------------------------------- Fee summary Charged Paid Credited Due ----- ----------- ---------- ---------- ---------- ---------- Permit Fee Total S5 . 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 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 Permit Number: 4 JobAddress: 61[a a-fl P(W Legal Description L -- -T— Parcel Sq.tt Floor Ar-a oF--gq. t. - Valuation of Work$ /0 30, Proposed Work heated/cooled. non-heated/cooled� Class of Work(circle one): New Addition fidz�D rv�K Move Demolition pool/spa window/door .I structure(s) (circle one): Commercial jEe;sidl=entia�1 Use of existing/propose( rcle one). es . 0 If an existing structure,is a fire sprinkler system installed? (Ci Florida Product Approval# For multiple products use product approval form o be performed: 1-:S ((,n(.) tc*7 Describe in detail the type of work t Property Owner Information: Address: Name: k City S�tate fLtZip 39A 3 ho e 07 E-Mail or Fax#(optional) Contractor Information: Company Name: Qualifying Agent: Stat-e—Zip_ Address: Fax Office Phone Job Sit gntgnt umber State Certification/Registration Architect Name&Phone# Engineer's Name&Phone# CITY 01P ATLAXTIC BEA Sty— Fee Simple Title Holder Name and Address- SEE PERM ITS FOR A DP1P()?bkL Bonding Company Name and Address REQUIREME�M AND CONDiT4C)NS. Mortgage Lender Name and Address Z DATE. —- r or L-t—- I has commencedprior to the -mit to o t e tion. This permit becomes null A lication i hereby made to obtain a ei tandards ojait taws reguiauh3;c07,31—H-2---9--- issuance o a ermit an that all work will be er orme to meet onstruction or work IS SUSDended or abandonedfor erioly months at any time after within six(6) onths, or I c V,/is, urnaces,Boilers,Heaters, an void I work is not commence secured for Electricat Work, Plumbing,Signs, �Is, work is commence . I un erstan that se rat ermits must be anks an ir onditioners,e1c. 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. is applica i n and know the same to be true and correct. All provisions of laws and ordinances governing this I hereb certify that I have read and examined th' - t o -mit does not presume to give authority to violate or cancel the typ e o rk will be complied with whether specified herein or not. The granting of a pei 10/1 r the pe�formance of construction. wo provisions o�any otherfederal,state, or local law regulating construction o Signature of Own4�� Signature of Contractor , ' I Print Name .................... ....................................................... PrintName ........................................................................ ................. Before me 20 Befor 20 this _Day of this Itay of D �Kl otary Public EXPIRES:May 21,2015 Pter. Notary Public Revised 10.24.12 CITY OF ATLANTIC BEACH FILE COM (OWNER BUILDER AFFIDAVIT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 *CONSTRUCTION CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW. �FDISCLOSURE 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 9 OWNER OF YOUR PROPERTY.TO ACT AS LAW. THE EXEMPTION ALLOWS YOU,AS THE YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU—MUST ERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE—OR 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 ALM—NG 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 TBE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT IS IN VIOLATION OF TRIS EXEMPTION. YOU MAY NOT IT FOR SALE OR LEASE,W19CH YOUR CONSTRUCTION MUST HIRE AN UNLICENSED PERSQN AS YOUR CMR_�ACT & BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS- IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU 14AVE LICENSES REQUI ED BY STATE LAW AND BY COUN OR MUNICIPAL LICENSING MIN—ANCES. 11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WUHKER'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 NU. 455-228(l). AN-OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE UF 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. ctq � -4 P(,V(J, 0 7 K10 I I ADDRESS 4 G PHONE NUMBER 6,(.t .ky PRINTI,LnE �S 0 DATE S AT E Before me this_day of in the county of 1 rs I rrn a Duval,State of Florida,has personally appeared herinbytimsef/he efandaffi sth t all statements and declarations are true and accurate. Notary Public at Large,State of County of 0 Personally Known -2 ,,IXP-roduce Notary Signatur 9 MYCOMMISSI A i:AFlHEb:May 21,2015 Borded Th-Notary Public Underwriters City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 /0?_.h17 Phone(904)247-5826 - Fax(904)247-5845 :2 ,r E-mail: building-dept@coab.us Date routed City web-site: hftp://www.coab.us APPLICATION REVIEW AND TRACKING FORM '44 epa nt review required Y No Property Address: Buildin nt review required Applicant: ;anning &Zoning Tree Administrator Public Works Project: )Iic U ti s Public Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B 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 iew: MApproved. []Denied. Reviewing epartment First Rev (Circle one.) Comments: (:B:UI L�D 1�NG PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: FlApproved as revised. RDenied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: -Date: FIRE SERVICES Third Review: RApproved as revised. []Denied. Comments: Reviewed by: -Date: Revised 05/14/09