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612 Aquatic Dr 2012 windows IS CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 12-00001690 Date 11/15/12 Property Address . . . . . . 612 AQUATIC DR Application type description WINDOW AND/OR DOOR Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 750 ---------------------------------------------------------------------------- Application desc WINDOW REPLACEMENT ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ GIBBS GRANT OWNER 612 AQUATIC DRIVE ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit . . . . . . WINDOW AND/OR DOOR PERMIT Additional desc . . Permit Fee . . . . 55 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 750 Expiration Date . - 5/14/13 ---------------------------------------------------------------------------- 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 S5 . 00 SS . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 59 . 00 59 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITY OF ATLANTIC BEACH " E COPY 7 OWNER / BUILDER AFFIDAVIT F I L 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 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 REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANC S. 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 UN.DER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(l). AN-OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY' OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826) IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. we, ADDRESS PHONE 0LIMBER :PRINT E ;S_� ( I i5R�RE _6ATE Before me this 13 day of :M V 20LZ-n the county of Duval,State of Florida,has personally appeared herin by himself herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of County of El P.�onally Known t2rlproduced Identil ion- 11 ��IFILEY L GRAHAm 'y 1vMMibIQN#D[)957760 brua Pu ........ EXPINES:February 14,2014 blic Un-jerwdters 0 Bonded Thru Notary PUD Notary Sig atur F/13LDG/0—r-Builder Affadavit;REVISED, 4/16/2009 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: 4a ^4je_ PTr:19 Permit Number: I Legal Description Floor Area of Sq.Ft. Parcel # Sq.Ft Valuation of Work$ Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa (windowitdoo� Use of existing/proposed structure(s)(�ircle one): Commercial J-s i—de n—At If an existing structure,is a fire sprinkler system installed? (Circle one):`YN—No Florida Product Approval # FL -f 0 35 0'- &U-859V-0 For multiple products use product approval lorm Describe in detail the type of work to be performed: fll4l,'na joetd %Ar;fK(QW_) Property Owner Information: Name: ---J- (---. 9()6 Address: Av4j C PcYe _6mr% A-_- City AU_,1,m-_ Uelh StatefL_ Zip ��3 Phone 600 !jgq-9-761� E-Mail or Fax#ZOpt-ional)— Contractor Information: FILE COPY Company Name: Qua!>ng Agent: ]: �EjL Address: c� Office Phone Job Site/Cot nj State Certification/Registration 4 Architect Name&Phone# 11MVEWED FOR CODE COMPLMNC Engineer's Name&Phone CITY OF ATLANTIC BEACH Fee Simple Title Holder Name and Addr s SEEPERMMFORADDMONAL Bonding Company Name and Addres REQUIREM&M AND CONDMM-1 Mortgage Lender Name and Addr s IF ME YFEMEMPE"t BY- P. her ade a n a ermit to do the work and mmenced pri r to the 11 � ' �"" co ermit b 0 es null to 0" 'r p be performed to meet the standards of all laws regul,3Ti;Wc�jiri;�tton in this juri Ydicti n. This ecom all wo k_wi fsix(6)months at any time after t d thin six(6)months, or i(construction or work is suspended'or abandoned for a period o pp'ic 0 s r e'Y md h issuance o a e mit an at , , k not com en and v id fwo, is - C' Work, Plumbing,Siins, Wells, Pools, Fiirnaces, Boilers, ter, 'or is c", , . I, r, t t or Electrical k en d nde tand ha eparate permits must be securedf Tanks andAir Conditioners,eta 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 here certify that I have read and examined thisiap l' dknow the same to be true and correct. All provisions oflaws and ordinances governing this eef -mit does not presume to give authority to violate or cancel the ,le§wation an 71work will be coTplied with whether herein or not. The granting of a pet provisions ofany otherfederal,state, or localsfc,w regulating construction or the performance ofconstruction. Signature of Owner Signature of Contractor r Print Nam Print Name . . .. . .......... ........................................................................... ......................................................................................................................................... Be Before me t 201, this Day of 20 A -'AAM SIONgbb'�',;7 Noiary Pu ic'�L Notary Public Revised 10.24.12 3L City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 12 7/& Phone(904)247-5826 - Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: ---?��3 0/1 e-7 Uty web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 6L2 jt,,�6 Papailment review required Yes-1 No I zLB�Lilding __�) I,,*' I Applicant: t� Planning &Zoning Tree Administrator Project: 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: [OApproved. []Denied. (Circle one.) Comments: C�D PLANNING &ZONING Reviewed by: Date: Z— TREE ADMIN. Second Review: DApproved as revised. F-ID(nied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: [-]Approved as revised. []Denied. Comments: Reviewed by: Date: Revised 05/14/09