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2233 Seminole Rd # 26 (vault) CITY OF ATLANTIC BEACH 800 SENIINOLE ROAD � Jig ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . 06-00032736 Date 4/11/06 Property Address . . . . . . 2233 SEMINOLE RD UNIT 026 Tenant nbr, name . . . . . . REPLACE DECK Application description . . . RESIDENTIAL ADD/RENOVATE/ALTER Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 3900 Owner Contractor - ------------------------ ----------------------- MIZRAHI , JACK D. OWNER 9962 RIDGEFIELD DR. JACKSONVILLE FL 32217 ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit . . . . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 50 . 00 Plan Check Fee 25 . 00 Issue Date . . . . Valuation . . . . 3900 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 50 . 00 50 . 00 . 00 . 00 Plan Check Total 25 . 00 25 . 00 . 00 . 00 Grand Total 75 . 00 75 . 00 . 00 . 00 pERMrf IS APPROVED ONLY IN ACCORDANCE WTTH ALL CTTY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING OFFICIAL CITY OF ATLANTIC BEACH Cc. BUILDING / ZONING DEPARTMENT D: Ford S r� 800 Seminole Road Uoe Atlantic Beach,Florida 32233 (904)247-5800 (904)247-5845 Fax www.coab.us PLAN REVIEW COMMENTS Permit Application # 0( 0 'n2l.;Xg.- r � Pro a Address: '5( `-P Applicant: i t 1 )-1 r 0.k 4 Project: (2 I l',0 f-') L L This permit application has been: Fd Approved El Reviewed and the following items need attention: Please re-submit your application when these items have been completed. Reviewed By: A Date: Date Contractor Notified: J,j CITY OF ATLANTIC BEACH D � D f BUILDING / ZONING DEPARTMENT f s� 800 Seminole Road S. Doerr f V Atlantic Beach,Florida 32233 J ji l r (904)247-5800 (904)247-5845 Fax www.coab.us PLAN REVIEW COMMENTS Permit Application # ao-' ggl5w Property Address: ' Applicant: a y� Project: l Owe-) This permit application has been: Approved EJ Reviewed and the following items need attention: Please re-submit your apocationwhen these items have been completed. Reviewed By: Date: z�'- /d —0( Date Contractor Notified: CITY OF ATLANTIC BEACH BUILDING PERMIT APPLICATION (Alterations&Additions) z, Date: 44.110 (a Job Address: Z2*55 S2mtr01e 2ocd L61L+ m'jax-(2e, Pd0.ch Owner of Property: -3a CiL. D'+- tJQ A A mira.h t Address: -Z7-3-3 Sa en i h o(e- Q-A 3 kt la- e. 9esw-h R-. 53-3,63 Telephone: (4 o y) 2-162-- (o001 O`I- ZS-Z4E, aGee�h i Q�2,or�- aw+ih&.a w► Wet 1 n 2(o Legal Description: Block Number: Lot Number: Zoning District: Contractor: of Q ne 1" State License Number: Contractor Address: Telephone: iOk Fax: (g o q) ?-9(,--72-2-5 Describe proposed use and work to be done: Car\SfnaC-tux) O'C' 9')L14' uhyo&Qcci S-a4-uxyd ck44 ce>A5l SA-e VNt tv"k o4-4s-4- 4e c t % in +he.. Present use of land or building(s): �{ Valuation of proposed construction:4 39W Dimensions of the added space: se feet x 1 L t feet Will this project involve: ❑ Heating&Air- ❑ Plumbing ❑ Electrical ❑ Fireplace Conditioning is approval of Homeowner's Association or other private entity required? If yes, please submit with this application. Will this project involve changes in elevation, site grade or any use of fill material, or the addition of 5% or more to the original impervious area or the removal of any trees? MNO. Applicant certifies that no change in site grade, impervious area or fill material will be used on this project. ❑YES. See Step 2 below. Approval of the Public Works Department is required prior to issuance of a Building Permit. NO. Applicant certifies that no trees will be removed for this project. ❑ YES. Removal of Trees will be required for this project. TREE REMOVAL PERMIT IS REQUIRED. Tree Removal Permits to be reviewed by the Tree Conservation Board,which meets two times each month. Procedure: In order to expedite issuance of permits, please follow all steps and provide all information as appropriate. Incomplete applications may result in delay in issuance of permit. STEP 1. Verify zoning designation and proper setbacks for the proposed construction. If you are unsure of this information, please contact the Planning and Zoning Department at 904-247-5826. In order to correctly verify zoning designation, please have Property Appraiser's Real Estate Number available. STEP 2. Contact the City of Atlantic Beach Department of Public Works to determine if a pre-construction or post-construction topographical survey or grading plan is required. (If not required, written verification must be provided with this application.) The Department of Public Works is located at: 1200 Sandpiper Lane,Atlantic Beach,FL 32233 Telephone:(904)247-5834 STEP 3. Submit Tree Removal Application if trees are to be removed or relocated. STEP 4. Please submit Building Permit Application, Energy Code Forms, Notice of Commencement, Owner/Contractor Affidavit if owner is contractor,and four(4)complete sets of construction plans to the Building Department,which is located at the Atlantic Beach City Hall,800 Seminole Road,Atlantic Beach,FL 32233 Telephone:(904)247-5826 800 Seminole Road -Atlantic Beach,Florida 32233-5445 Telephone: (904)247-5800 -Fax: (904)247-5845 -http://www.cLatlantic-beach.fl.us Page 2 Revised 8/04 In addition to construction and engineering detail, plans must contain the following information as appropriate for the type of work being performed. Scale of drawings should be sufficient to depict all required information in a clear and legible manner. I. Current survey showing the property boundary with bearings and distances and the legal description. 2. Location of all structures,temporary and permanent, including setbacks,building height,number of stories and square footage. Identify any existing strictures and uses. 3. If required by the Department of Public Works,a pre-construction topographical survey. 4. Any significant environmental features,including any jurisdictional wetlands,CCCL,natural water bodies. 5. Impervious Surface area calculations: include driveways, sidewalks, patios and other Impervious Surfaces. Swimming pools may be excluded from total Impervious Surface. 6. Other information as may be appropriate for individual applications. Address and contact information of person to receive all correspondence regarding this application(please print). Name: .�t>L M LZVCR L► I Mailing Address: g9bz- ��d°►e- el d-��tr• Ja X Fc- 3ZZ5-7 Telephone: (90q) z(_2- (0 00 1 Fax: (qy4�$$�-?22 3 E-Mail: eomCAFrf.he I hereby certify that I have read and examined this application and attached documentation and know the same to be true and correct. All provisions of the laws and ordinances governing this type of work 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 federal,state or local rules,regulations,ordinances,or laws in any manner, including the governing of construction or the performance of construction of the property. I understand that the issuance of this permit is contingent upon the above information being true and correct and that the plans and supporting data have been or shall be provided as required. y / Signature of Owne3> '"y I Date: ( �/ AS TO OWNER: Sworn to and subscribed before me this day of t� ,(� ( ' 20 . State of Florida,County of Duval Notary's Signature: ❑ P rsonally known Produced identificati ,( p Type of identification produced o h��4 4 U i`/, 5-D Signature of Contractor: Date: AS TO CONTRACTOR: Sworn to and subscribed before me this day of _,20 State of Florida,County of Duval Notary's Signature: ❑ Personally known ❑ Produced identification Type of identification produced 800 Seminole Road •Atlantic Beach, Florida 32233-5445 Telephone: (904)247-5800 - Fax: (904)247-5845 • http://www.ei.atlantic-beach.fl.us Page 3 Revised 8/04 ii CITY OF ATLANTIC BEACH BUILDING PERMIT APPLICATION (Alterations& Additions) Date: 4-1710 b Job Address: Z233 5Gmtr0(e_ (2ocd LLnt+2 /Vt10_X+a, &O-Ck) Owner of Property: JC-C1J_ _P -t 1J6_n A �t-z a. i Address: -17--3-1 $v rn i v%of e. Rd fea-h FL- 53-z 3 3 Telephone: ('70L0 DJ_ 2_S-24E aced„ it a�e.iJke.- +�ni..a�.�► tom( 1n 2(o Legal Description: Block Number: Lot Number: Zoning District: Contractor: (1���V ,1'� State License Number: Contractor Address: Telephone: iOk Fax: (9 a(4) ?V,- 72_2_5 Describe proposed use and work to be done: C�n�S�rtcC t S' X l4' uhyoaFed S'e4.Inilc! *et Cc�51 11� wy-W,% y44j-4- cLQ cU_% to ` kc— Loyw�ple . Present use of land or building(s): �{ Valuation of proposed construction: Dimensions of the added space: $' feet x 1141 feet Will this project involve: ❑ Heating&Air- ❑ Plumbing ❑ Electrical ❑ Fireplace Conditioning Is approval of Homeowner's Association or other private entity required? If yes, please submit with this application. Will this project involve changes in elevation, site grade or any use of fill material, or the addition of 5% or more to the original impervious area or the removal of any trees? D!�NO. Applicant certifies that no change in site grade, impervious area or fill material will be used on this project. ❑YES. See Step 2 below. Approval of the Public Works Department is required prior to issuance of a Building Permit. EJNO. Applicant certifies that no trees will be removed for this project. ❑ YES. Removal of Trees will be required for this project. TREE REMOVAL PERMIT IS REQUIRED. Tree Removal Permits to be reviewed by the Tree Conservation Board,which meets two times each month. Procedure: In order to expedite issuance of permits, please follow all steps and provide all information as appropriate. Incomplete applications may result in delay in issuance of permit. STEP 1. Verify zoning designation and proper setbacks for the proposed construction. If you are unsure of this information, please contact the Planning and Zoning Department at 904-247-5826. In order to correctly verify zoning designation, please have Property Appraiser's Real Estate Number available. STEP 2. Contact the City of Atlantic Beach Department of Public Works to determine if a pre-construction or post-construction topographical survey or grading plan is required. (If not required, written verification must be provided with this application.) The Department of Public Works is located at: 1200 Sandpiper Lane,Atlantic Beach,FL 32233 Telephone:(904)247-5834 STEP 3. Submit Tree Removal Application if trees are to be removed or relocated. STEP 4. Please submit Building Permit Application, Energy Code Forms, Notice of Commencement, Owner/Contractor Affidavit if owner is contractor,and four(4)complete sets of construction plans to the Building Department,which is located at the Atlantic Beach City Hall,800 Seminole Road,Atlantic Beach,FL 32233 Telephone:(904)247-5826 800 Seminole Road -Atlantic Beach,Florida 32233-5445 Telephone: (904)247-5800 -Fax: (904)247-5845 -http://www.ci.atlantic-beach.fl.us Page 2 Revised 8/04 In addition to construction and engineering detail,plans must contain the following information as appropriate for the type of work being performed. Scale of drawings should be sufficient to depict all required information in a clear and legible manner. I. Current survey showing the property boundary with bearings and distances and the legal description. 2. Location of all structures,temporary and permanent,including setbacks,building height,number of stories and square footage. Identify any existing structures and uses. 3. If required by the Department of Public Works,a pre-construction topographical survey. 4. Any significant environmental features,including any jurisdictional wetlands,CCCL,natural water bodies. 5. Impervious Surface area calculations: include driveways, sidewalks, patios and other Impervious Surfaces. Swimming pools may be excluded from total Impervious Surface. 6. Other information as may be appropriate for individual applications. Address and contact information of person to receive all correspondence regarding this application(please print). Name: J 0��{L..• t2✓ 1. Mailing Address: `7`�bZ-• P_1dJc-Re-I d,-'P►r- JCL X Ht- 32,2.577 Telephone: (90LI) 7-6Z- (0 00 1 Fax: (9L)N)881--7223 E-Mail: _-Tty112.2A�h1(? con, a9� ne I hereby certify that I have read and examined this application and attached documentation and know the same to be true and correct. All provisions of the laws and ordinances governing this type of work 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 federal,state or local rules,regulations,ordinances,or laws in any manner,including the governing of construction or the performance of construction of the property. I understand that the issuance of this permit is contingent upon the above information being true and correct and that the plans and supporting data have been or shall be provided as required. J Signature of Owner. 1-11� Date: •�• L(� AS TO OWNER. Sworn to and subscribed before me this day of a r I ' ,20 . State of Florida,County of Duval Notary's Signature: ❑ P rsonally known Produced identificati Type of identification produced Signature of Contractor: Date: AS TO CONTRACTOR: Sworn to and subscribed before me this day of ,20 State of Florida,County of Duval Notary's Signature: ❑ Personally known ❑ Produced identification Type of identification produced 800 Seminole Road -Atlantic Beach,Florida 32233-5445 Telephone: (904)247-5800 - Fax: (904)247-5845 -http://www.ci-atlantic-beach.fl.us Page 3 Revised 8/04 inu I, cv• cvvv i vii M uuv i nitnv a nLv 7v6t LV7 VJL 1 11 U, I`!`tL f. � 'Dl A aWll paAIZJa� F11': t,-:fir o �;,i:r' ~/?Llm]'Ja �OaeLl� � � ;, aF ICtAc.•Rao_siOS,� . yI'(Ia its f tii+w/Altl 1� �� _-�. .• _ 1 Iw•taw_a.**N nf•vA ,� _' - `_'• `�• -►Y $QA:�Si ^ •• R1tir ir•Aad�T y{I '•�.r ar• �-.-i�..r�:rte:..�" ' F (�� Y VNW or It •.•.. R• a �. �,••+•s— i• •CEl `r. 14 !• 3 f '1 4� irk •r • y_ A �i .� • 'r - .rr rN w.." r�• �+ Mf� y4i { w• .- s -� •. �0 lad Iwo } >ea�r s Piannlnlry of Atiant c each •se " • ff``'7��! `.;��;�. g an Zoning De a Wg '. " •2��3 ."�4��ry ����;"�G?e� 7'hts d P rt►n app ride p anoe PpgU .�; . . ; ' )'• .' ' •' :� • - zoning, subdivision cand i vWth a other local Ig n r vr� _ .e ora, , r_ •ter_ approval for regulations, but does not constit "'s - •'` +- ,. f with Florida theissuance of permits. ,Compiiar ,A ago +..;a_..rs rr,� .c•.%�•.�.M,l�w.krr�, W' local, Building Code and all other applica) .d..wwn�r+w..r.a,rain..ww...+ ..w.+....�a.+++••w+ •••••n,r-+o..r.w.«.....rx` � . must betven'fied b ederal permifting�yuiremer a�•.ww.�r.rwwtw��M..w�+.�w�.� bon awrn.a—aw�www.+�a.raiw.rMlA�w.Crra/a , Beachveniy signature of the City OfAtlan MY'rla`swn�r�+w..Y.rwrM��..�wr�M�.�yal�"��Mrywlr�l�OMIMri•.�Q1�rAwlrv�lr . 5:....:.•�.:. .:".:;. w..wr•+�rwarar.� r a�Iwer�n�y�rr.♦+�w�srt•. Yq�Gir•4�� Building Official prior to the issuance p) K : Building Permit Approved By: a• Date: 0 1p 11 t0 evelopment rec Z0 ��a 6O9E6DZti86 Lb:�L 56Oz/9O/ ? ,. Zd WbGZ:z0 SOOZ 0Z '�t2W LSV0GZ67O6: 'ON XdJ _ CNH-P.GGWI1: WQZ�J CITY OF ATLANTIC BEACH PUBLIC WORKS DEPARTMENT 1200 Sandpiper Lane Atlantic Beach,Florida 32233 (904)247-5834 (904)247-5843 Fax www.coab.us YLL•7iV RIEWEW COMMENTS Pe>rvnit Application # Property Address: Applicant: 1 r�n 1 j-L Project: Your application is approved as noted by the Public Works Department. Final application approvafl must come from the Building Department. v Your permit application has been reviewed by the Public Works Department and the following items need attention: 66 _ G �ity� r� Please submit these requirements to the Public Works Department, 1200 Sandpiper Lane, Atlantic Beach, FL 32233 in order that we can approve your application. If you have any questions,please call (904)247-5834. Reviewed by R' , P.F., Public Works Director Date Y 0 a Signature Contractor Notified Date CITY OF ATLANTIC BEACH APR 0 l 2006 BUILDING PERMIT APPLICATION (Alterations & Additions) Date: 0 b Job Address: 2233 Sem irole. (<occl LLnt+ 2(, "G-►t+e- Plea Owner of Property: Ja ctL— D `}— Oo-nui A A t2y-a.h I Address: 2233 Sennihole. Wd AtlaM e. 1'3je k FL. 311,33 Telephone:. (`i0K0 2.(-Z - to 00 D1- 2's-29E, c1Geta h V i t a�2,�ke.-c'�srrsaw,i n,u w► Ill l I nlLkM 2(o Legal Description: Block Number: Lot Number: Zoning District: Contractor: (1w ae 1 ,�_ State License Number: Contractor Address: Telephone: iWb Fax: (a o L O ? ?(,--72_25 Describe proposed use and work to be done: C_j9,y\S{ru.C-tLCmJ &k VY-141 LxvW00'q{d S"'kneal dwtl Ce�515keV�� U)"k C,4w dzclL% in ,e, Gorwjole Present use of land or building(s): Valuation of proposed construction: 39� Dimensions of the added space: $' feet x I L t feet Will this project involve: ❑ Heating&Air- ❑ Plumbing ❑ Electrical ❑ Fireplace Conditioning Is approval of Homeowner's Association or other private entity required? If yes, please submit with this application. Will this project involve changes in elevation, site grade or any use of fill material, or the addition of 5% or more to the original impervious area or the removal of any trees? XNO. Applicant certifies that no change in site grade, impervious area or fill material will be used on this project. ❑ YES. See Step 2 below. Approval of the Public Works Department is required prior to issuance of a Building Permit. 1k NO. Applicant certifies that no trees will be removed for this project. ❑YES. Removal of Trees will be required for this project. TREE REMOVAL PERMIT IS REQUIRED. Tree Removal Permits to be reviewed by the Tree Conservation Board,which meets two times each month. Procedure: In order to expedite issuance of permits, please follow all steps and provide all information as appropriate. Incomplete applications may result in delay in issuance of permit. STEP 1. Verify zoning designation and proper setbacks for the proposed construction. If you are unsure of this information, please contact the Planning and Zoning Department at 904-247-5826. In order to correctly verify zoning designation, please have Property Appraiser's Real Estate Number available. STEP 2. Contact the City of Atlantic Beach Department of Public Works to determine if a pre-construction or post-construction topographical survey or grading plan is required. (If not required, written verification must be provided with this application.) The Department of Public Works is located at: 1200 Sandpiper Lane,Atlantic Beach,FL 32233 Telephone:(904)247-5834 STEP 3. Submit Tree Removal Application if trees are to be removed or relocated. STEP 4. Please submit Building Permit Application, Energy Code Forms, Notice of Commencement, Owner/Contractor Affidavit if owner is contractor,and four(4)complete sets of construction plans to the Building Department,which is located at the Atlantic Beach City Hall,800 Seminole Road,Atlantic Beach,FL 32233 Telephone:(904)247-5826 800 Seminole Road •Atlantic Beach, Florida 32233-5445 Telephone: (904)247-5800 • Fax: (904)247-5845 • http://www.ci.atiantic-beach.fl.us Page 2 Revised 8/04 In addition to construction and engineering detail,plans must contain the following information as appropriate for the type of work being performed. Scale of drawings should be sufficient to depict all required information in a clear and legible manner. 1. Current survey showing the property boundary with bearings and distances and the legal description. 2. Location of all structures,temporary and permanent,including setbacks,building height,number of stories and square footage. Identify any existing structures and uses. 3. If required by the Department of Public Works,a pre-construction topographical survey. 4. Any significant environmental features,including any jurisdictional wetlands,CCCL,natural water bodies. 5. Impervious Surface area calculations: include driveways, sidewalks, patios and other Impervious Surfaces. Swimming pools may be excluded from total Impervious Surface. 6. Other information as may be appropriate for individual applications. Address and contact information of person to receive all correspondence regarding this application(please print). Name: J&4, M►2v&ht, Mailing Address: q96'z. Q d jf_-Reel(.qtr. Ja)c F_ 3-2,2-5-7 Telephone: (41d4) Z(.z- Io 00 1 Fax:M Oq)?B to-?22 3 E-Mail: --TM 12 e&h iL comca54.Ki f I hereby certify that I have read and examined this application and attached documentation and know the same to be true and correct. All provisions of the laws and ordinances governing this type of work 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 federal,state or local rules,regulations,ordinances,or laws in any manner,including the governing of construction or the performance of construction of the property. I understand that the issuance of this permit is contingent upon the above information being true and correct and that the plans and supporting data have been or shall be provided as required. _ n A. / ^ Signature of Owner. >s-ate— ' Date: AS TO OWNER. Sworn to and subscribed before me this day of 120_0 State of Florida,County of Duval Notary's Signature: ❑ P rsonally known Produced identificati ,{ p /� Type of identification produced Q o_4g4 4 U i`�'5D Signature of Contractor: Date: AS TO CONTRACTOR: Sworn to and subscribed before me this day of 120 State of Florida,County of Duval Notary's Signature: ❑ Personally known ❑ Produced identification Type of identification produced 800 Seminole Road •Atlantic Beach,Florida 32233-5445 Telephone: (904)247-5800 •Fax: (904)247-5845 •http://www.ci.atlantic-beach.fl.us Page 3 Revised 8/04 J� CITY OF ATLANTIC BEACH OWNER/BUILDER AFFIDAVIT Date: q/-t. Job Address: 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 Ilv1PROVE A COMMERCIAL BUILDING AT A COST OF $25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND • OCCUPANCY. rr MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE AA BUILDIINIIGYOU HAVE L PRESUME BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE, TIHE LAW THAT YOU BUILT TT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HRE 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. ORDINANCES ALSO ALLOW AN OWNER TO RvIPROVE THEIR OWN PROPERTY WHEN IT IS FOR PERSONAL OR FAMILY USE, AND LIKEWISE REQUIRE ALL WORK(EXCEPT MAINTENANCE UNDER$2,000)BE UNDER A BUILDING PERMIT AND PASS ALL NORMAL INSPECTIONS. THE ORDINANCE STATES OWNERS MAY PHYSICALLY DO WORK THEMSELVES;OR MAY HIRE UNLICENSED WORKERS PROVIDED SUCH WORKERS BE UNDER"DIRECT SUPERVISION OF THE OWNER,WHO MUST BE ON THE JOB AT ALL TRAES WHILE WORK IS IN PROGRESS BY UNLICENSED TRADES PEOPLE." THIS DOES NOT ALLOW USE OF UNLICENSED CONTRACTORS. SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED UNDER THE HOMEOWNERS INSURANCE POLICY COME ENPLOYERS AND SHOULD TALSO OBSERVE IRS WITHHOLDING TAX AND/OR RLY PROTECT THE OWNEFL OWNERS HIRINGM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IM[PROVEN ENT TRADES. 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. I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT 1 COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. K CUNNINGHAM `r�� NY 'V� V Notary Public State of Honda ,�� ,My Commission Expires Feb 28,2010 pROP OWNERS DER Commission#DD 523638 F" " Bonded By National Notary Assn. SWORN TO AND SUBSCRIBED BEFORE ME Tjff�q" !DAY OF -I 20 GC,0 NO LIC CO IBES: NOTE: PHRASES UNDERLINED ABOVE. Mar. 28. 2006 1 :09PM SJC PARKS & REC 904-209-0321 No. 1442 F. 2 A` orrrnar FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION k Bureau of Beaches and Coastal Systems -8020530 1 3900 commonwealth Blvd-MS 300 PrrnntrNr<mb�: g FLOR A Tallahassee,FL 32399-3000 - PNa ofPages.4nached; Phone,(850)Q8?-4475 FIELD PERMIT PURSUANT TO SECTION 161.053 or 161.052,FLORIDA S'TATUT'ES FINDINGS OF FACT AND CONCLUSIONS OF LAW: The request for a permit was considered by the staff designee of the Departrnent of Environmental Protection and found to be in compliance with the requirements of Chapter 62&33,Florida Administrative Code(F.A.C.). Approval is specifically limited to the activity in the stated location and by the project description,approved plans(if any),attached standard conditions,and any special conditions stated below pursuant to Paragraph 161.053(5),Florida Statutes_ This permit may be sue aHW or revoked in accordance with Section 62- 4.100,FA.C. PROJECT LOCATION: 36)0 ^3_�)o U Lap �- o2e� PROJECT DESCRIPTION: SPECIAL PERMIT CONDITIONS: This permit is valid only after all applicable federal,state,and local pemuts art obtained and does not authorixc contravention of local setback requirements or zoning or building codes. This permit and public notice shall be posted on the site immediately upon issuance and shall remain posted along with local approval until the completion of any activity authorized by this permit Other special conditions of this pemtit include: b� STANDARD PERMIT CONDITIONS: The permittee shall comply with the attached standard field permit conditions. APPLICANT INFORMATION: I hereby certify that I am either. la) owner of the subject property gr (lb)I have the owner's consent to secure this permit on the owner's behalf;and that(2)I shall obtain any appli tenses or permits which may be required by federal,state,county,or municipal law poor to commencement of the authorized wort (3)I acknowledge that the authorized worts is what I requested;and(4)1 accept responsibility for compliance with all permit conditions. - Applicant's Signature ` 1 r Date Telephone No. `� L L L C• 1 i Applicant's Printed Name, Addrtsa 2-2 3 3 Sem'2j e- t$Zoo i c 6c r u 33 If applicant is an agentU printed Hants of property owner property owner's address properly o+vxer's wkphone ria DEPARTMENT MAL ACTION AND FILING AND ACKNOWLEDGMENT: This field permit is approved on behalf of the Dcpardnent of Environmental Protection by the undcmgned staff designee,and filed on this date,pursuant to aeotion 120.52,F.S.,with the undersigned designated Deputy Clcrk,receipt of which is hereby acknowledged. _ d1346rG4,1 14Sy1 U S'g1#rVesignee/Deputy Clerk Printed Name of DesrgneeVapery ChDale PUBLIC NOTICE IS ON THE BACK OF THIS PERMIT, EXPIRATION DATE: �Pcmmmt�s � (Emergency permits issued ppursuant to Section 62B-33.014,FA.C.,are valid for no more than ninety days and o er ora than 12 months. The staff designee may specify a shorter time limit) EMERGENCY PERMTT:D YES 4 NO Approved pians are attached: OM [R40 AND PUBLIC NOTICE CONSPICUOUSLY ON THE SITE DEP form 73-122(Updated 3/05) yhire Copy-Tallahassee Office] [yellow CopyRpplicarnt) (Pirtle Copy-Stat f Designeel iviar, tis. LUuo I :Uyrivi JJu rAM & KtU `1U4-1Uy—UJ1I No 1441gOAD f. 3 • Wv8tr�L 'Ol '�e� au��l pa�aa� 15T. ilk' 'w- ��:.. :._ . • :��:�,"�t�l�rra oceJai��?+'}'; o�sCuc.:R•Exa�ps� � •...v`'�r ,. _ �' l..'• PWS.'."" FNM_how M oaf FNM_ _�: . - : AP or bUA:o nw..a«.►.r 1iy. ._Jp•�y•-tea w--..pir •.: ;k: •-, :" riMr+. iy p�1� r•.�+r ►i��i •tea. �11�1= . ! I ►r 14 TA 1L tt • ,r./MYM.IMtrrrMM4�•MI{\Sw�rfbJ��I`w/-M.arrCh.Yn�wW.q wr�rb'a.1��'h•r.IfR�•w.i�K'�.��. ' ■.a..•rrw•�..••�•.•«•�rr�a+w+�w rr..�...r..rw..�w+.r—a�w ww;ra.rw�er�t.wr UM� '.... 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