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355 Skate Rd 2013 Bath Remodel CITY OF ATLANTIC BEACH s 800 SEMINOLE ROAD j ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 13-00002470 Date 4/16/13 Property Address . . . . . . 355 SKATE RD Application type description RESIDENTIAL ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 950 ------------------------------------------------------------------ Application desc bath remodel ---------------------------------------------------------------- Owner Contractor - ------------------------ ----------------------- THOMAS, MARIE OWNER 355 SKATE ROAD ATLANTIC BEACH FL 322333819 --- Structure Information 000 000 BATH REMODEL Occupancy Type . . . . . . RESIDENTIAL --------------------------------------------------------- Permit . . . . . . RESIDENTIAL ALT/OTHER Additional desc . Permit Fee 55 . 00 Plan Check Fee . 00 Issue Date . . . Valuation 950 Expiration Date . . 10/13/13 ------------------------------------------------------ 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 . 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. BUILDING PERMIT APPLICATION ' CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Permit Number: Job Address: Parcel# Legal Description oor ea o q. t. Sq.Ft ro �) Posed Work heated/cooled non-heated/cooled Valuation of Work p Class of Work(circle one): New Addition Alteration epair 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 approva orm Describe in detail the type of work to be performed: Property Owner Information: Name: j e, Address: 3 �� / c• City StateC�-Zip -�S 2-23SPhone E-Mail or Fax#(Optional) Contractor Information: 77 Qualifying Agent: Company Name: 6u�uCid, State Zip Address: Fax# Office Phone Job Site/Contact Number 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 that no-work or Application is hereby made to t obtain will betperformed toomeet the standards of all la�wstregulatined I g construction in this jurisdictionllation •This permit bs commenced ecomesrior onull issuance of a permit and p s, Wells,Pools, urnaees,Boilers,Heaters, and void tf work is not commenced within six(6)months, or if construction or work is suspended or abandoned fora period of six 6)months at any time after work is commenced. I understand that separate per----` r Tanks and Air Conditioners,etc. WARNING TO OWN A NOTICE FOR IMPROVEMENTS COMMENCEMENT MAY RF 'ING, CONSULT WITH TO YOUR PROPERTY. IF Y i YOUR NOTICE OF YOUR LENDER OR AN A 7isions of laws and ordinances governing this 1 hereb certify that 1 have read and examined this a I ie to give authority to folate or cancel the type o7work will be complied with whether speci tea provisions of any other federal,state, or local law reg: r Signature of Owne .......................................................... Print Na me Befo� th' Dc 320 f a Notary Public Notary Pub11C thy COMMISSION 8 EE 057359 Revised 10.24.12 FXPIRES:May 21, 015 c ! r�ded Thru Notary Public Underwriter. I CITE' OF ATLANTIC BEACH (OWNER / BIDER AFFIDAVIT I. FLORIDA STATUTES; CHAPTER 89, FLORIDA STATUTES, PART TO ACKNOWLEDGE THE LAW: 1 CONSTRUCTION CONTRACTING"REQUIRES OWN 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 R 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 YOU RUSE 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 CONSTRUCT IOItiT IS COIVLDLET;, THE LAW WLLL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HI HIRE AN UNLICENSED PERSON .AS YOUR CONTRACTOR YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. HAVE E THAT PEOPLE LICENSESPONSIBILITY REQUIREDBY TO EKLAWRAND BY COUNTY ORM MUNICIPAL AL LICE-BY YOU NS NG ORDINANCES. II. 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; TEMENI AND THAT 1(COMPLY WITH AEREBY LL THEETHAT I HAVE READ THE REQUIREMENTS OR THEBOVE DISCLOSURE iISSUANCE OF AN STATEMENT AND OWNER-BUILDER PERMIT. PHONE NUMBER ADDRESS PRINT N DATE SI NA U Before me this�day of 2(�'fi the coun y of Duval,State of Florida,has person h/ ppeared herin by himself/herself and affians that all statements and declarations are a and accurate- Notary County of Notary Public at Large,State of >j l •: .^s EBORAH AMANDA WHITE ovally Known t 'i �� ,- MY COMMISSION 111157141 ❑Prodd Id uceentifi 'on- — ;,. R.y EXPIRES:May 21 2015 ,� Bonded Thru Notary Public Underwrit®re „or rv,,• Notary Sion. F:/BLDG/0w u-Builder Affadavit;REVISED: 4/16/2009 —�•