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571 Seaspray Ave 2013 door replcmnt CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 13-00002289 Date 3/12/13 Property Address . . . . . . 571 SEASPRAY AVE Application type description WINDOW AND/OR DOOR Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 800 ---------------------------------------------------------------------------- Application desc door replacement ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ TUSCANA, DAMIJAN KELLY OWNER 571 SEASPRAY AVENUE ATLANTIC BEACH FL 322334166 ---------------------------------------------------------------------------- Permit . . . . . . WINDOW AND/OR DOOR PERMIT Additional desc . . Permit Fee . . . . 5S . 00 Plan Check Fee 27 . 50 Issue Date . . . . Valuation . . . . 800 Expiration Date . . 9/08/13 ---------------------------------------------------------------------------- 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 55 . 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 3 2,06 V�C', Job Address: S PermitNumber: 13-J2- 009 Legal Description Parcel 4 TFo—or--Are--d of Sq.Ft. Sq.vt non-heated/cooled Valuation of Work$ Proposed Wo heated/cooled Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window6s�? Use of existing/proposed atructure(s ii syone): Commercial rResidential sy -C� installed? (Circle one): Yes No �-�'kl e r If an existing structurr,-is a fire spril Florida Product Appro\iql# 2� For multiple products u-wproduct appr��Irm Describe in detail the type of work to be performed: A N.� Property Owner Information: Name: S) �-,cl(,�' ' N �>f Address City NIS,-,— "n, State zip_s-2a-,z>-1> Phone Ao�-k 2-Sk 31-4(ci E-Mail or Fax#(optional) Contractor Information: FILE COPY Company Name:— Qualifying Agent: city S Address: Office Phone Job ILV Lax 4 State Certification/Registration )DEeom �q Architect Name&Phoneh one Job EF I L:1 fio n/Reg1stration Phone 4 r Ph n 0 0 Ide : e and Address m me nd Address m r ss I atio ame ATLVMC ACH Engineer's Name&Phon 1; mR i3mo-NAL Fee Simple Title Holde ame and Address e 11 e C'0 Bonding ompany me and Address L Mortgage Lende ame and Address REIVMV W BY-- 3- )obtain a permit to do the work and installations�s- flation has commenced prior to the Application is hereby made t( n in this jurisdiction. Thispermit becomes null issuance of a permit and that all work will be pe�formed to meet the standards of a n ed abandon or a eriod ofsixP6)months at any time after and void if work is not commenced within six(6)months, or if construction or ork is us en 11s, work is commenced. I understand that separate permits must be securedfo lec a Work,Plumbing, s, We 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 FINANCING9 CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. I her tify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this e The granting of a permit does not presume to give authority to violate or cancel the type o�vcerrk will be complied with whether ecifi-ed herein or not. f construction. provisions of any otherfederal,state, or local aw regulating construction or the pe�formance o Signature of Contractor Signature of Owner Q-C%w- PrintName ......................................................................................................................................... Print Name ......................... Bi for Before me 20 zthis _Day of t Day 4 400-ew-r- A11-1 - Notary Public 04MINION 0 DD 957 760 u lic .1--' i.1 14,20 4] Revised 10.24.12 1W OF ATLANUC BEACH C IT FILE Co OWNER / BUILDER AFFIDAV FE 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 PERWr UNDER AN EXEMPTION To TTIAT LAW. TEE E)MVIpTION 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 MROVE 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. TBE 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 WrrFEN ONE YEAR AFTER THE CONSTRUCT10N IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IN VIOLATION OF THIS EXEMyjION. YOU MAY NOT IT FOR SALE OR LEASE,WHICH IS YOUR CONSTRUCTION MUST HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR- IT IS BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS' youR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOY BY YOU HAVE LICENSES REQUIRED BY STAT LAW AND BY COUNTY OR MUNICIP 1. 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 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. S ��, ADDRESS PHONE NUMBER _:R�) cx x\01,\ PRINT NAME C a NA --7STGNATURE DATE ME_� a'ch— 20/3n the county of Before me this day of Duval,State of Florida,has personally appeared herin by If1h if Ind affirms that all statements and declarations are true and accurate. County of N:�ota"ryPu c at Large,State of Personally Personally Known Produced Identification- Nota S PLG HIPLEY L G F/BLDGIO��-Buildar Affhd�it; �Ay SION#D 95 760 ;OtqIf,4!QSION#D ed Thn,Notary Public,Unde.witers -fl I . City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: zz City web-site: hftp://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: -Department review required Yes No Building D Applicant: �75nning &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 Divisi n of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: FlApproved. [:]Denied. (Circle one.) Comments: ^ss/nS uaiva �ibr 0 -i( trwk- oil BUILDING hon, PLANNING &ZONING Reviewed by: I'Ll— Date: 3-// TREE ADMIN. Second Review: [—]Approved as revised. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: DApproved as revised. E]Denied. Comments: Reviewed by: Date: Revised 07127/10