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2133 Seminole Rd unit 4 deck repairs 2013 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD j .. ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 F11 Application Number . . . . 13-00002277 Date 3/06/13 Property Address . . . . . . 2133 SEMINOLE RD UNIT 004 Application type description RESIDENTIAL ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 2200 ----------------------------------------------------------------- Application desc deck repairs ---------------------------------------------------------------- Owner Contractor - ------------------------ ----------------------- FORD, DWINELLE OWNER 2389 OCEAN BREEZE CT ATLANTIC BEACH FL 32233 --- Structure Information 000 000 DECK REPAIR Occupancy Type . . . . . . RESIDENTIAL ------------------------------------------------------------ Permit . . . . . . RESIDENTIAL ALT/OTHER Additional desc . . Permit Fee 65 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 2200 Expiration Date . . 9/02/13 -------------------------------------------------------- Special Notes and Comments NOT OWNER OCCUPIED OK PER M JONES TO GIVE OWNER BUILDER SMALL JOB (SLG) -------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ----------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- --------- Permit Fee Total 65 . 00 65 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 69 . 00 69 . 00 . 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 Job Address: �_f35 AM 1006 PJ *0 Permit Number: Legal DescriptionParcel# Floor Area o q. t. q. t Valuation of Work$.19 00 Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): New Addition Alteration G;;) Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s) (circle one): Commercial Residential If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A Florida Product Approval# For multiple products use product apff--oval form Describe in detail the type of work to be performed: �D&6� 1 r ProiDertv Owner Information: n) j Name: U r S »G PA"/ Address: �' � 3N City State�Zip 3 Phone E-Mai or ax#(Optional) Contractor Information: Company Name: Quali g Agent: Address: C' State Zip Office Phone Job Site/Co ct Nu er 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 hereby made to obtain a p it to do the work and installations as indicated. ertify that no work or installation has commenced prior to the issuance of a permit and that all work wi be performed to meet the standards of all laws regula ' construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6)months, or if construction or work is suspended o abandoned for a period of si%)months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools, urnaces,Boilers,Heaters, Tanks and Air Conditioners,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 FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEOR RECORDING YOUR NOTICE OF COMME1 hereb certify that 1 have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this type o work will be complied ith whether speci led herein or not. The granting of a permit does not presume to give authority to violate or can the provisions of any other feder ,s te, or cal law regulating construction or the performance of construction. Signature of Owner Signature of Contractor PrintName �W,f'�L r�l......... .(— Print Name ......................................................................................................................................... Befor m 2 Before me this Day f 20�3 this Day of 20 HAM Nota C =?a!1' . !`.•; MY COMMISSION 9 DD 957750 Notary Public EXPIRES-February 14,2014 Forded Thru Notary Public underv+dters Revised 10.24.12 �a _! - CITY OF ATLANTIC BEACH 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: TE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED RS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. 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 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(1). 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. OVE STATEMENT AND E THAT I(COMPLY WITH ALL THE HEREBY EREQUIREMENTS THAT I HAVE E FORHTHE B DISCLOSURE ISSUANCE OF AN OWNER-BUILDER PERMIT. PHONE NUMBER ADDRESS PR AME DATE RE Before me this day of 20/3 the county of Duval,State of Florida,has personally appeared herrn by himself/herself and affimis that all statements and declarations are true and accurate. Notary Public at Large,State of / County of L)U VC'✓ ❑Pe ally Known duced Ide ' tion- i rrrr"arrnw�xc_�.^ ,.t Y'.�;;�•, SHIRLEY L GRAHAM Nota Sign ur . G0W11FS!0N If DD 957180 ry EXP'RES-Febmary 14,2014 Fond?d Thni No?ary Public 11T1enkrriter F:/BLDG/Owner-Builder Affadavit;REVIS : 4116/200 1�...._.••-.-. - -