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715 David St 2013 new door CITY OF ATLANTIC BEA C, D 800 SEMINOLE RO D ro ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 13-00002637 Date 5/14/13 Property Address . . . . . . 715 DAVID ST Application type description WINDOW AND/OR DOOR Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 300 ---------------------------------------------------------------------------- Application desc NEW DOOR #11321 . 6 ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ CORNWALL,MARY D ET AL OWNER 715 DAVID ST ATLANTIC BEACH FL 322334116 ---------------------------------------------------------------------------- Permit WINDOW AND/OR DOOR PERMIT Additional desc NEW DOOR Permit Fee . . . . 5S . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 300 Expiration Date . - 11/10/13 ---------------------------------------------------------------------------- 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 . 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. 0 City of Atlantic Beach 'V'�',-" M R,P,L i.'5 -00i!giqg�, -ep� , ent.) Building Department 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5845 ..........0 E-mail, buildinoept@coab.us Cityweb-site- http://vmw.coab.us APPLICATION REVIEW ANO TRACKING FORM Property Address: "AA4�e-- a;(;J� Department review required Yes 11-HO— Building Planning &Zoning Applicant: Tree Administrator Project: -------1�— Public Works Public Utilities Public Safety Fire Services Other Agency Review or Permit Required Review or Receipt Date of Permit Verified Ry 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: [?3A/pproved. MDenied. (Circle one.) Comments: BUILD NG PLANNING&ZONING Reviewed by: 1-21 Date: 4 TREE ADMIN. Second Review: ElApproved as revised. MDeni4/ PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ElApproved as revised. MDenied. Comments: LD Reviewed by: Date: IN6 Revised 07127/10 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: TIAlt"A 1!5+re_e_t Permit Number: 13- 0,103 -7 Legal Description 3 76 Floor Area of Sq.Ft. Parcel# Sq Pt Valuation of Work 00, —Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): New Addition Alteration <�� Move Demolition pool/spa windowLooDr Use of existing/proposed structure(s) (circle one): Commercial 4 Ge s 4—de n—tt i�a-*"' N/A If an existing structure,is a fire sprinkler system installed? (Circle.one): Yes H�VD Florida Product Approval# 1 —J 'Aal . For multiple products use pf6d-uct approval form Describe in detail the type of work to be performed: I r) 14 A I) A+)",4>71 0-F n<w A D6 y- I -;� , Property Owner Information: Name: C,I A-14-A'a (�Oy-y-,V-)431 Address: r7 1 �2 —.6- 0q city A E�e� State FIL Zi -3-z-z3;;t Phone '10 9) Zz I.-;I- p E:ya il or Fax# (Optional -Contractor Information: 7rF11LE COPY Company Name: Qualifying Agent: AW, Address: city Office Phone Job Site mber Fax State Certificatio-n—/Registration# Architect Name&Phone# Engineer's Name&Phone# y Fee Simple Title Holder Name and ddress LMV Bonding Company Name and Address RMLIRFLM 'IONS. Mortgage Lender Name and Address— PXVMWW - -7 c rti lat n has commencedprior to the Application is hereby made to obtain a permit to do the w becomes null issuance of a permit and that all work will be performed to meet the standards o all ld' s i ion. Thispermit and void if work is not commenced within six(6)months, or if construction or work is suspended or abandone or a months at any time after work is commenced I understand that separate permits must be securedfor Electricar Work, Plumbing, i ns, ells, 0 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 herebl 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 y to violate or cancel the type work will be complied with whether specified herein or not. The granting of a permit does not presume to give authorit provisions of any otherfederal,state, or local law regulating construction or the performance of construction. C A-to-�6 --(��gnature of Contractor Signature of Owner, Print Name Print Name ......................................................................................................................................... ..............C--..arq.W 4.1. Beforfolt Before me this k�jay of 20/3 this Day of . 20 Notary Public Notary Public Revised 10.24.12 E COPY CITY OF ATLANTIC BEACH IL (OWNER / BUILDER AFFIDAVIII. 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 COMMERC][AL 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(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. AD 12&,v j PP ADDRESS VHONE NUMBER i(�I_Ylaj6dj 0.4) r? PRINT NAME & " SIGNATURE DATE 04L Before me this_4E 7d.y Of Vl-:-nin the county of Duval,State of Florida,has personalty appearec(yerin by himseff/herself and affirms that all statements and declarations t and accurate. Notary Public at Large,State of County Of DEBORAH AMANDA WHITF 0 Personally Known my COMMISSION#EE 057349 roduced Identification- —67 J-6 EXPIRES:May 21,2015 Boixled Thru NMy Pubk Underwriters Notary Signature:,A��,00,_A dt-o-�_ F/BLDG/Owner-Builder Affadavit;REVISED:4/16/2009