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225 Sherry Dr 2013 fence CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD n ATLANTIC BEACH, FL 32233 Application Number . . . . . 13-00002328 Date 4/01/13 Property Address . . . . . . 225 SHERRY DR Application type description FENCE PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc replace fence ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ TANCRETO CHRISTINA M LIFE OWNER ESTATE 225 SHERRY DR ATLANTIC BEACH FL 322335237 ---------------------------------------------------------------------------- Permit . . . . . . FENCE PERMIT Additional desc . . Permit Fee . . . . 35 . 00 Plan Check Fee . 00' Issue Date . . . . Valuation . . . . 0' Expiration Date . . 9/28/13 ---------------------------------------------------------------------------- Special Notes and Comments Avoid damage to underground water/sewer utilities . Verify vertical and horizontal location of utilities . Hand dig if necessary. If field coordination is needed, call 247-5834 . ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 35 . 00 35 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 35 . 00 35 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. MAP SHoNNG BOUNDARY , SUR .OF LOT 'S BLOC I K ASS SHOWN ;ON SAP OF tom. t rz r ` t-to,•�•.+r s SgF-S' AS RECgPgEp NN P,LA-T BooK ?-;1 pAGES 3$ OF THE PUBL,tC RECORDS OF DUVAL COUNTY, FLORIDA CERf7p, D FOR: l o p '�7 - �/,-,e- Np-� rJI= 1z.S Ton n hl pproval ve iea cjompllance with applidable g, subdivision sand other local; land dev lopment regulationo.,.but does not-constitute app VW for the issuance of permits. Compliance with lorida Building.Code and all other applicable loca State and Federail permitting requirementsGj�el mus be verified by s!' nature of the Citof Atlantic Bea4h Building Offici 1 prior to the Issuance of.a Building Permit, a Appr�ved By: `� N Date �.-- f--- .� _G- t. WI CAI v" E 1 C4r 00 IP Nfl ►J S t�' o 9 _'s4 0 jA �' •i;P - i .. 7-0 e? 4 p . A r 09 F1 E Co !o _ 4o Z P y o Q!S s3 4::Z- oo' �-j r S-F: tzec�T' g-Z3 T 97 q-7- 3r P.t,,� 1IOT VALID UNLESS aIBDSS D Nl1N SEAL Of IJIE dlNDoERSIMED. _BEARIOAt�S.&ALS't73 OYY__F— 'J -UNE-AS SNOW THE PROPERTY SHO*N, HEREON APPS.RS To I/F w MIAI F►nnn UA7APn WWr 7L- �AC cue i c,r; rn v. n'iw, 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: 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 WELL 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN"OCCUPATIONAL LICENSE' IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA 'CONTRACTORS CERTIFICATE' TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826)IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. A DRE/SSS ^ PHONE NUMBER PRINT E SIGNA E DATE Before me this day of 20/3he county of Duval,State of orida,has personally appeared herin by himself/herself and affirms that all statements and declarations are tru and accurate. Notary Public at Large,State of County of P ally Known roduced Iden• 'on- SHIRLEY L.GRAHAM „`- MY COMMISSION#DD 957760 EXPIRES:February 14,2014 NotarySigna ''.F'° °' Bonded Thru Notary Public Underwriters F:BIDG/Owner-Builder Affadavit;REVIS 16/2009 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: �v� �� �14 F 121 0 /7 Permit Number: Legal Description Parcel# Floor Area of Sq.Ft. Sq' t Valuation of Work$ Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s) circle one):installed? Residential If an existing structure,is a fire sprinkler system nstalled? (Circle one): Yes No N/A Florida Product Approval# For multiple products use product approva orm t _ Describe in detail the type of work to be performed: -eo_,� Property Owner Information: Ile / , Name: ,� _� u�/L � Address: y0 P+4�U I be►1J A4 ties- City Stater-(Zip ?L2.?3 Phone 6 2 r---On„b,1 E-Mail or Fax#(Optional) Contractor Information: Company Name: Qualifying Ag t: Address: City State Zip Office Phone Job Site/Contact Number 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 permit to do th work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be perform d to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes n 1l and void tf work is not commenced within six(6)mont or if construction or work is suspended or abandoned for a_period of srx6)months at any time afer 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 BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. I hereb certify 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 type cowork will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other federal,state, or ocal law regulating construction or the performance of construction. Signature of Owner Signature of Contractor Print Name Print Name ....... BeforBefore me th' ! Day 20 this Day of 20 No c i,nry 14,2014 No Public otary-tvic Unaarwriters Revised 10.24.12 RECFIV � rs� City of Atlantic Beach MAR 18 2013 APPLICATION NUMBER J� „! Building Department (To be assigned by the Building Department.) 800 Seminole Road BY. _ Z Atlantic Beach, Florida 32233-5445 _..� Phone(904)247-5826 - Fax(904)247-5845 .,�s �• ' E-mail: building-dept@coab.us Date routed: SA013 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 76- Department review required Yes No Applicant: ,n VE4 anning &Zoning ree mmistrator Project: Q u ' Public Safety Fire Services Review fee $ # Depf.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 Reviewing Department First Review: Approved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 07/27/10 RE MET VED City of Atlantic Beach MAR 18 2013 APPLICATION NUMBER �s Building Department (To be assigned by the Building Department) s3 800 Seminole Road �$ 31-3Z9 j Atlantic Beach, Florida 32233-5445 - Phone(904)247-5826 • Fax(904)247-5845 l E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address rVDepartment review required Yes No Bui�nn�ing & Applicant: �OIVE74 aZoning 1 ree Oministrator Project: Q Pu is afety Fire Services ;be t Si nature Review fee $ x p ... g ;. . 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 i Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: PApproved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: 2 TREE DMIN. Second Review: QApproved as revised. ❑Denied. P WORKS Comments: P C UTI �Ty Reviewed b Date: PUBLIC SAFETY Y' FIRE SERVICES Third Review: ❑Approved as revised. []Denied. Comments: Reviewed by: Date: Revised 07127110 i� !f City of Atlantic Beach APPLICATION NUMBER �s Building Department (To be assigned by the Building Department.) 800 Seminole Road .3 3 z 8 Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 E-mail: building-dept@coab.us t coab.us Date routed: ` I 9-de P s City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: Z Department review required Yes No ' Buil Applicant: aGC1 re e mirnstrator Project: Awd.o�' U Public Safety Fire Services Reviewfee $—. ' _ : .Dept Signature' s 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 Reviewing Department First Review: Approved. ❑ Denied. (Circle one.) Comments: BUILDING 03 LANNING &ZONI Reviewed by: Date: 11? TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: []Approved as revised. [-]Denied. Comments: Reviewed by: Date: Revised 07/27/10 � y �j y lJv� CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ±) ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 13-00003290 Date 8/29/13 Property Address . . . . . . 225 SHERRY DR Application type description FENCE PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc 6FT FENCE REPLACEMENT ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ TANCRETO CHRISTINA M LIFE OWNER ESTATE 225 SHERRY DR ATLANTIC BEACH FL 322335237 ---------------------------------------------------------------------------- Permit . . . . . . FENCE PERMIT Additional desc . . Permit Fee . . . . 35 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 2/25/14 ---------------------------------------------------------------------------- Special Notes and Comments Avoid damage to underground water/sewer utilities . Verify vertical and horizontal location of utilities . Hand dig if necessary. If field coordination is needed, call 247-5834 . ------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 35 . 00 35 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 35 . 00 35 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. MAP SMINNCCS BO SWr^0�'_ LOT `� 0 l _.S SAHM10— ON MAP OF :AS RECORDED !N R xT sqw .]' . PAGES -..dry THE PIyHUC RECORPS OF DUVAL COMM,, FLORIDA CER11F& FOR. e- . / ,� .0 . GoMyr,p: h/EA T'f/ L4,1/ 1 'A - : I if — . . • Ali-� ��E. ;� : � _ i , • too OV 7 -- o., 49d,0,f i9Vg �ps-i r> Mbb, SS TH• AHE�UNQ 7Si ED." R 5 6N}--- - OW. INE P �ERTY SNOi{A1 H4REON APPEARS TO UE.W7MN FLAQp HA�ZAI�D Z q x AS SC�IL[iD FRg4/ FLOW INS{lk CE RATF:ALAP' FOR MF, CATV Dim[S in i.( G-H.,FLQRIL A. P TQD-,-:T i 7 yT. AND MSV A$ A ¢1 N. SY gNLY ANDi L?QE,S,NOTi C1E�1I�Si<ITUTE A CER 1fTON OF - c LAAM _1� � 1 Y3 -17a 6.,44 r * Lx7Hl t1 i nar,ut r wr ' _ r— , L•AR/f1���EDOD; Q '�'• �''4L�! I Cotte,A 'SCALE} ACM4=AV RAD ;DATEL 4- . R i ,_ City of Atlantic Beach AUG 2 1 2013 APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road - r�r Atlantic Beach, Florida 32233-5445 �. Phone(904)247-5826 Fax(904)247-5845 Q d .^ J IT E-mail: building-dept@coab.us Date routed: d City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: ���� �� r ry Department review required Yes No I ing Applicant: 60 Planning &Zoning ree rniistrator Project: -77 < Public Works Ic tilities • afety Fire Services Review fee $ Dept Signature Other Agency Review or Permit RequiredFReview or Receipt Date rmit 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: ]Approved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: ✓ / TREE ADMIN. Second Review: QApproved as revised. ❑Denied. �L1lOR- Comments: a, P BLIC PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: QApproved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 sm riy�,�r�JCity of Atlantic Beach AUG6 12013 APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road o Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 O E-mail: building-dept@coab.us Date routed: o City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORD Property Address: � gyri Department review required Yes No I ing Applicant: 1A) Planning &Zoning ree ministrator Project: 7— -;�) d Public Works is tilities afety 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: [ pproved. ❑Denied. (Circle one.) Comments: �\ BUILDING PLANNING &ZONING Reviewed by: V3 Z y Date. TREE ADMIN. Second Review: QApproved as revised. ❑Denied. PUBLIC WORKS Comments: 2 a PUBLIC UTILITIES 3 PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: QApproved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 City of Atlantic Beach APPLICATION NUMBER ' � Building Department (To be assigned by the Building Department.) .i� : s 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: o�d City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: C2rry Department review required Yes No ing Applicant: lN_/1"1�C Planning &Zoning ree ministrator Project: 4 7— 01 Pu I' Works -Ptrblic Utilities afety 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: ❑Approved. enied. (Circle one.) Comments: for (=orhew t0�S on ,1i9Ae o( w �vJdei fla�� So`, mss 5 41/ :Wert BUILDING be C-1v5er tti►ar, IS ' 40w► 'fie_ edye �� s�✓ie �cvrwiu,l� Please /-e_s-E», rrnd 5hor v � 12,9_ *W,-- -411 k i or'e P��:-� s` �o�►�+ j.� 54vv-Q*- PLANNING &ZONING Reviewed by: 4�� Date: ��► TREE ADMIN. Second Review: Approved as revised. ❑Denied. PUBLIC WORKS Comments:,A°P nvet4ter ere aoz rirProA l i,,, kC F(a a� PUBLIC UTILITIES p f"A� I PUBLIC SAFETY Reviewed by: < �� Date: 001 FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 BUILDING PERMIT APPLICATION (� CITY OF ATLANTIC BEACH C d 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 AU 0 2013 Job Address: �2,2 Y Sh&z 91-,11'e- Permit N Legal Description Parcel# Floor Area of Sq.Ft Sq. t Valuation of Work S Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s) (circle one): Commercial esiden If an existing structure,is a fire sprinkler system installed? (Circle one): es No N/A Florida Product Approval # For multiple products use product approval form Describe in detail the type of work to be performed: 9,o,D/oC e, ipor fi o r, a ex)Ceo Mel f /S Q GtQi ve 7-0 9� Coaf, tion 7— e4- Property Owner Information: Name: Gla Address: aaS Citya77aa 7,, e ,f46-19 State/-7-Zip 3�33 Phone E-Mail or Fax# (Optional) Contractor Information: CONT OR EMAIL ADDRESS: l n Company Name: (?rr 6+T v e D 1 SC' i QuGali g Agent: /ver/ fe�T Address: of -r 0/- 6.) Ci ,Tic State GL Zip 3zz33 Office Phone 90 - v Job e/Contact Num o -6 ,1—o o.- Fax# State Certification/Registr ion# Architect Name&Pho # Engineer's Name& one# Fee Simple Title older Name and ddress Bonding Com ny Name and A ress Mortgage Lender Name and dress Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating 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 or abandoned for a period of six(6)months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing,Signs, Wells, Pools, Furnaces,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 BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. I hereb certify that I have read and examined this a plication and know the same to be trite and correct. All provisions of laws and ordina ices governing this type o7Mrk will be complied with whether spect ied herein or not. The granting of a permit does not presume to give authority to tolate or cancel the provisions of any other federal,state, or local law regulating construction or the performance of construction. Signature of Owner i'yt ���� Signature of Contractor Print Name ,t/ .P eTo Print Name /',h�� ........................... ... .................................................................... .............................. ....................................................................................................... Bef e �2 Before me t ' ay f 201 this Day of 20 Pub Nota � EXP E5•Feb Notary n t Af!yd c` Bon hru Not u enytjters v/ Revised 01.26.10 CITY OF ATLANTIC BEACH OWNER / BU LDER AFFIDAVIT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.1.03(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 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.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. 0a3- Sher& )Dr-ut, ADDRESS PHONE NUMBER L119011- PRINT AME 13 SI A URE DATE Before me thiy,�::a day of —20 i the county of Duval.State of Florida,has personally ap ed herin by himself/herself and a�that all statements and declarations are true an ccura,e. Notary Public at Large,State of County of �1 ❑Per Wally Known roduced Identification- ------------- k OMM Bondrd Thru Notary Public underwr er — 09