2233 Seminole Rd # 41 (vault) CITY OF ATLANTIC BEACH
S
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number 06-00032716 Date 4/13/06
Property Address . . . . . . 2233 SEMINOLE RD UNIT 041
Tenant nbr, name . . . . . . REPLACE DECK
Application description . . . RESIDENTIAL ADD/RENOVATE/ALTER
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 5100
Owner Contractor
------------------------
------------------------
LUCKIE OWNER
2233 SEMINOLE #041
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
----Permit BUILDING-PERMIT
Additional desc . -
Permit Fee . . . . 60 . 00 Plan Check Fee 30 . 00
Issue Date . . . . Valuation . . . . 5100
Expiration Date 10/13/06
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 60 . 00 60 . 00 . 00 . 00
Plan Check Total 30 . 00 30 . 00 . 00 . 00
Grand Total 90 . 00 90 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE V"TH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING OFFICIAL
CITY OF ATLANTIC BEACH Cc:
D. Ford
BUILDING / ZONING DEPARTMENT
800 Seminole Road
Atlantic Beach,Florida 32233
(904)247-5800
(904)247-5845 Fax
www.coab.us
PLAN REVIEW COMMENTS
Permit Application #
Property Address:
Applicant: L U
Project:
T plication has been:
ed
�Reviewed and the following items need attention:
Please re-submit your application when these items have been completed.
Reviewed By:_ Date:
Date Contractor Notified:
C
I CITY OF ATLANTIC BEACH
APR 0 2006 BUILDING PERMIT APPLICATION
(Alterations & Additions)
Date:
Job Address: -33 o,A- a
Owner of Property:
Address: 2-2-33 Telephone:
Legal Description: Block Number: Lot Number: Zoning District:
Contractor: bw ri State License Number:
Contractor Address:
Telephone: Fax:
Describe proposed use and work to be done:
Preser-t use of land or building(s)-
Valuation of proposed constructionV7,T 160,
Dimeiisions of the added space: feet x I feet
Will this project involve:
u Heating&Air- L3 Plumbing Li Electrical u Fireplace
Conditioning
is approval of Homeowner's Association or other private entity required? Q,C) if yes, please submit with this
application.
Will this project involve changes in elevation, site grade or any use of rill material, or the addition of 5% Or More
�n,, �-rr,in ��p VIF or the removal of any trees?
NO. Applicant certifies that no change in site grade. �jnpervi%ms area or rill material will be used on this
project.
El 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
F� 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 appropria
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-conAruction 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 Revised 8/04
Page 2
t
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 marmer.
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:
Mailing Address: 1A
Telephone: 2-4 Z—_2_SCQ k Fax: — E-Mail:
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.
Signature of Owner: 0 ;6. Date:
AS TO O*'NER:
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
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.ei.atiantic-beach.fl.us Revised 8/04
Page 3
st
CITY OF ATLANTIC BEACH
OWNERIBUILDER AFFIDAVIT
Date: ZdZq(b�,
JobAddress:
CHAPTER 489,FLORIDA STATUTES,PART I "CONSTRUCTION CONTRACTING'REQUIRES OWNER/BUILDER TO
ACKNOWLEDGE=LAW:
DISCLOSURE STAMNIENT 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 EXENIPTION 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 TIM CONSTRUCTION YOURSELF. YOU MAY BUILD OR ROPRO-�E A ONE-
OR TWO FAMILY RESIDENCE. OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR RviPROVE A
COMMERCIAL BUILDING AT A COST OF $25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND
OCCUPANCY. ITIMAY 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
MU
AN UNLICENSED PERSON AS YOUR CONTRACTOR- YOUR CONSTRUCTION I ST 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 BOROVE 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 PERMTr AND PASS ALL NORMAL INSPECTIONS. THE ORDINANCE STATES OWNERS MAY
'j,
PHYSICALLY DO 'NORK.THEMSELVES;OR MAY HIRE UNLICENSED WORKERS PROVIDED SUCH W"..1"KERS BE
UNDER"DIRECI -'UPERVISION OF THE OWNER, WHO MUST BE ON THE JOB AT ALL TRAES-WHILE -,;'ORK IS IN
PROGRESS BY L'I"LICENSED TRADES PEOPLE." THIS DOES NOT ALLOW USE OF UNLICENSED CON`fltkCTORS-
r,
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 TO CLEARLY PROTECT THE OWNER. OWNERS HIRING WORKERS BECONIE EMPLOYERS AND
SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS
THEY EMI�LOY ON THEIR IMPROVEMFNT TRADES.
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. TIM OWNER SHOULD PHYSICALLY SEE TIM COUNTY"CERTIFICATE OF CON4PETENCY-OR
THE FLORIDA"CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR-
TELEPHONE THE BUILDING DEPARTIVENT(247-5826)IF IN DOUBT.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND TEAT I
COMPLY WITH ALL TEE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
PkOPERTY OlkNE
,!�UILDER
SWORN TO AND SUBSCRIBED BEFORE ME TEES�—�DAY OF 200e
NOTARY PUBLIC
MY CONDAISSION F—NPIRES:
DUD AQVQ llXTnCDl TXTUTi AIDd'NAM
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CITY OF ATLANTIC BEACH
PUBLIC WORKS DEPARTMENT
1200 Sandpiper Lane
Atlantic Beach,Florida 32233
(904)247-5834
(904)247-5843 Fax
www.coab.us
PLAN REVIEW COMMENTS
Perwnit Application #
Property Address: �IA55
am
Applicant:
Project: �-f-o i a
00/your application is approved as noted by the Public Works Department.
/\�,Final application approval must come from the Building Department.
u Your permit application has been reviewed by the Public Works Department
and the following items need attention:
77
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 arper,P.IEE.,Public Works Director
S i ga 4neW Date _J4&_
Contractor Notified Date
103
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CITY OF ATLANTIC BEACH
4A
BUILDING PERMIT APPLICATION
' J"
(Alterations &Additions)
Date:
Job Address:
Owner of Property: 'c>AQ�kA W q—
Address: Telephone:
Legal Description: Block Number: LotNumber: Zoning District:
Contractor: State License Number:
Contractor Address:
Telephone: Fax:
Describe proposed use and work to be done: D�_c-K
Pre*sent use of land or building"s):
Valuation of proposed construction
Dimensions of the added space: feet X 1 feet
Will this project involve:
Li Heating&Air- o Plumbing Li Electrical u Fireplace
Conditioning
Is approval of Homeowner's Association or other private entity required? q If yes, please submit with this
application. X
Will this project involve changes in elevation, site grade or any use of fill material, or the addition of 5% or mo re t,
thl�priain�i inin�rwinw; ,4req or the removal of any trees?
NO. Applicant certifies that no change in site grade, impervious area or rill 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.
F�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
Page 2 Telephone: (904)247-5800 -Fax: (904)247-5845 -http://www.ei.atlantic-beach.fl.us Revised 8/0-4
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:
Mailing Address: 'A E-Mail:
Telephone: ZqZ-2-SW k Fax:
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 be 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.
Signature of Owner.. Date:
AS TO OV;NER:
Sworn to and subscribed before me this day of .20—.
State of Florida,County of Duval
Notary's Signature:
M Personally known
M Produced identification
Type of identification produced
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:
M 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.lis Revised 8/04
Page 3
CITY OF ATLANTIC BEACH
OWNEWBUILDER AFFIDAVIT
Date: 2-fzL6-�
JobAddress: Z�3 - savt,�q:��6
CHAPTER 489,FLORIDA STATUTES,PART I -CoNsTRUCTION CONTRACTING"REQUIRES OWNERIBUILDER TO
ACKINOWLEDGE THE LAW:
DISCLOSURE STATEMtENT FOR SECTION 489.103(7),FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE
APPLIE FOR A PERMIT UNDER AN EXEWITION TO THAT LAW. THE EXE-M?TION ALLOWS YOU, AS TEE,
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 H�4PRO-�E A ONE -
OR TWO FAMILY RESIDENCE OR -A FARM OUTBUILDING. YOU 'MAY ALSO BUILD OR IMPROVE A
COMMERCIAL BUILDING AT A COST OF S25,000.00 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.
ORDINANCES ALSO ALLOW AN.OWNER TO RvjpRovE 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 DC;�,,VORK THEMSELVES;OR MAY HIRE UNLICENSED WORKERS PROVIDED SUCH WC*)Il'<ERS BE
UNDER"DIRECI jUPERVISION OF THE OWNER, WHO MUST BE ON THE JOB TT ALL TIMES WHILE �70RK IS IN
PROGRESS BY Tfli'LICENSED TRADES PEOPLE." THIS DOES NOT ALLOW USE OF UNLICENSED CON'Ml -kCTORS.
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 TO CLEARLY PROTECT THE OWNER- OWNERS HIRING WORKERS BECOME- EMPLOYERS AND
SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON TIM WORKERS
THEY EMI'LOY ON THEIR IMPROVEMEINIT TRADES.
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 TIM 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 Wn`H ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BIM RPERMIT.
--k04'ERTY 0'
P UILDER
SWORN TO AND SUBSCRIBED BEFORE ME THIS?�:�DAY OF 206e
NOTARY PUBLIC
XAV 1-nAA-hfTQQTf%kT V'l'DTDC(Z-
CITY OF ATLANTIC BEACH Cc:
D. Ford
BUILDING / ZONING DEPARTMENT cl�
800 Seminole Road E. D��eDrr P U—)
Atlantic each,Florida 32233
(904)247-5800
(904)247-5845 Fax
www.coab.us
PLAN REVIEW COMMENTS
Permit Application # tj 0 Le
Property Address:
Applicant: 6L I—u C'
Project: ko o I r,TY-r,V,
This permit application has been:
Approved
El Reviewed and the following items need attention:
Please re-sub it li ti when these items have been completed.
'luu
m � 'r --�) -7
Reviewed By- Date:
Date Contractor Notified:
City of Atlantic Beach
Planning and Zoning Department
This approval verifies compliance with applicable
zoning, subdivision and other local land
development regulations, but does not constitute
approval for the issuance of permits. Compliance
with Florida Building Code and all other applicable
io�al, State an(iftcleral permitting requirements
must be verified by slinat r of the Citv of Atlantic
I y 0
Beach Building OM prior I th Issuance of a
Building Par TOL
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CITY OF ATLANTIC BEACH
Z 'low "I
BUILDING PERMIT APPLICATION
(Alterations &Additions)
Date:
Job Address: 33
Owner of Property: 17:)A-Q�A
Address: 2-2-3-3 Telephone:
Legal Description: Block Number: Lot'Number: Zoning District:
Contractor: State License Number:
Contractor Address:
Telephone: Fax:
Describe proposed use and work to be done: Dk.-k-K
Preseht use of land or building(s)-
Valuation of proposed constructiono!�/60,6c>
'i- feet x 1 _47— feet
Dimensions of the added space:
Will this project involve:
o Heating&Air- Li Plumbing Li Electrical u Fireplace
Conditioning
Is approval of Homeowner's Association or other private entity required? q V') 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 alore
th� �riqi2- ni im _Q
- z pp!ni i,iwR 4 r-_ or the removal of any trees?
NO. Applicant certifies that no change in site grade. 'uppervious area or fill material will be used on this
project.
F�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 REMOVAIL 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 appropriat
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
th this application.)
topographical survey or grading plan is required. (If not required, written verification must be provided wi
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 Revised 8/04
Page 2
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:
Mailing Address: J� -Or�A
Telephone: Fax: E-Mail:
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
v manner,including the governing of construction or the performance of construction of the property. I understand that the issuance of this
in an, or shall be provided as
permit is contingent upon the above information being true and correct and that the plans and supporting data have been
required.
ate:
Signature of Owner:
AS TO OV;NER:
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
Date:
Signature of Contractor:
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 Reach,Florida 32233-5445
Telephone: (904)247-5800 -Fax: (904)247-5845 -http://www.ei.atiantic-beach-fl-as Revised 8/04
Page 3
CITY OF ATLANTIC BEACH
OWNEWBUMDER AFFIDAVIT
Date: 2-lz—qLb�
Job Address: 2-Z-33 6
CHAPTER 489,FLORIDA STATUTES,PART I "CONSTRUCTION CONTRACTING"REQUIRES OWNER)BUILDER TO
ACKNOWLEDGE TEE LAW:
DISCLOSIM 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 E)(EWTION ALLOWS YOU, AS TBE-
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 RESIDENCF, 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 i IS COMPLETE, THE LAW WILL PRESUME
THAT YOU BUILT IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT ME
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 IMPROVE 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. TIM ORDINANCE STATES OWNERS MAY
PHYSICALLY D01YORK.THEMSELVES; OR MAY HIRE UNLICENSED WORKERS PROVIDED SUCH W('RKERS BE
UNDER"DIRECI-DUPERVISION OF THE OWNER, WHO MUST BE ON THE JOB AT ALL TIMES WHILE �,-�ORK IS IN
PROGRESS BY UYLICENSED TRADES PEOPLE." THIS DOES NOT ALLOW USE OF UNLICENSED CON'MEXCTORS.
SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT
SUGGESTS'WORKER'S COMPENSATION INSURANCE BE PURCHASED UNDER TIM HOMEOWNERS INSURANCE
POLICY TO CLEARLY PROTECT THE OWNER- OWNERS HIRING WORKERS BECOME EMPLOYERS AND
SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS
THEY Flvff-LOY ON THEIR IMPROVEME11,1T TRADES.
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 TEE BUILDING DEPARTMENT(247-5826)IF IN DOUBT.
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.
PkOPERTY O"UILDER
SWORN TO AND SUBSCRIBED BEFORE METFIISL� DAY OF 200(e
NOTARY PUBLIC
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