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354 Sargo Rd 2013 window CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 C Application Number . . . . . 13-0000320S Date 8/09/13 Property Address . . . . . . 354 SARGO RD Application type description WINDOW AND/OR DOOR Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 500 ---------------------------------------------------------------------------- Application desc WINDOW ------------------------------------------------------------- -------------- Owner Contractor ------------------------ ------------------------ SCHIFFMAN STEVEN D. OWNER 3S4 SARGO ROAD ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit . . . . . . WINDOW AND/OR DOOR PERMIT Additional desc - - Plan Check Fee 27 . 50 Permit Fee . . . . S5 . 00 valuation . . . . 500 Issue Date . . . . Expiration Date . . 2/05/14 ------ ---------------------------------------------------------------------- Special Notes and Comments 2010 FLORIDA BUILDING CODE, 2008 NATIONAl 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 Job Address: Permit Number: 3010 r Legal Description q Parcel # ---&q Ft F loor 7�rea of Valuation of Work 0'a . ,00 ProposedWork 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 Residential If an existing structure,is a fire sprinkler system installed? (Circle.one): Yes No N/A Florida Product Approval 4 For multiple products use product approval form Describe in detail the type of work to be performed: Property Qwner Information: Name: d, Addr Zip � 2 _2 �XStat one city V( ptil IV 77 E-Ma%il or ax#(Optional, Contractor Information: Company Name: Qualifying Agent: Address: city State Office Phone Job Fax State Certification/Registration# D FOR UUME CO NIFLUNC Architect Name&Phone# Engineer's Name&Phone# CITY OF ATLANTIC REACH Lj6J Fee Simple Title Holder Name and Address SEE PERMITS FOR ADENTIONAI Bonding Company Name and Address AND CONDITIONS. Mortgage Lender Name and Address meaw o the Application is hereby made to obtain a permit to do the 4FE arid fri-f-Ifte—- ------- �--tfi-lsj-uMsdiction. ,p in ma be null issuance Of,a,permit and that all work will be performed to meet the standards of all laws regulating constructio i or abandonedfior aWeriod ofsLx a r-qn- time,after 'V urnae s Boi Heaters, and void ff work is not commenced within six(6)months, or if construction or work is suspende work is commenced I understand that separate permits must be securedfor Electrical Wor ,131,mbing, Signs, ells,Pools, Tanks andAir 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 COMMENCEMEN - Ihere 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 o117work will be coTplied with whether ecifi'ed herein 0 The granting of a permit does not presume to give authority to violate or cancel the provisions of any otherfederal,state, or localsfc,w regulating consAny-tion or the Pe�fbrmance of construction. Signature of Owner Signature of Contractor Print Name PrintName ......................................................................................................................................... ........................................................................................................................................ Bef 4 me Before me 20 0 this Day of this f IN RL GROU Wk MMISSION#DD 957760 rs hruNotwy Ic erw Notary Public Notary Pu 11�0- Revised 10.24.12 61 . 37 CITY OF ATLANTIC BEACH FILE Copyll OWNER BUILDER AFFIDAVIJI 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 EXEMPUON 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 CON%1ERCLAL 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 BUrLT 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 RAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL 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 OMER-BUILDER PERMIT. 3P� ADDRESS PHONE NUMBER PRiRT NAME �]G ATIURE DATE "f 'e m the county of Before me this day of in himself/herself da Duval,State of Florida,has personally app re enn by�iiz ifirms that all statements and declarations are true&d accurate. Notary Public at Large,State of County of 4 -01 D Personally Known 0 Produced 1��,tiv�_ SHIRLEY L.GRAHAM ------ DD 957760 Nota na, -.4- t_-.XPIRES:February 14,2014 .,,,njf-d T.�rU Ilowy Public Underwr#em Ilk- FIBLDG/0— - uildaAffadavit;RE SED: 4/3612 City of Atlantic Beach APPLICATION NUMBER d by the Building Department.) 800 Seminole Road (To be ass)j 2�0 b Building Department Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5845 Date routed: IN ail: building-dept@coab.us E-m City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: it lr�eview�requ,�redo Y No 7P 7' Uu�&ng Applicant: 71—anning &Zoning Tree Administrator Project: _LL)1 :5 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 Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS FReviewWiing Department First Review: ErApproved. FIDenied. (Circle one.) Comments: cig) PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: FlApproved as revised. nDenied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: [-]Approved as revised. E]Denied. Comments: Reviewed by: Date: Revised 05114109