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500 Cruiser Ln 2013 siding 0 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 13-00003236 Date 8/14/13 Property Address . . . . . . SOO CRUISER LN Application type description SIDING PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 1000 ---------------------------------------------------------------------------- Application desc SIDING ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ MCPHERSOM, JOHN K OWNER 1433 PONTE VEDRA BLVD PONTE VEDRA BEACH FL 32082 ---------------------------------------------------------------------------- Permit SIDING PERMIT Additional desc . - Permit Fee . . . . 55 . 00 Plan Check Fee 27 . SO Issue Date . . . . Valuation . . . . 1000 Expiration Date . . 2/10/14 ---------------------------------------------------------------------------- Special Notes and Comments 2010 FLORIDA BUILDING CODE, 2008 NATIONAl ELECTRIC CODE *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. ---------------------------------------------------------------------------- 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 Sn-,�n-rig 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: 500 Cruiser Lane. Atlantic Beach, FL 32233 Permit Number: Legal Description 35-64-172S-29E Seaspray Lot 22 - Parcel# 170703-036 Floor Area ot 162U Sq.Ft. Sq.Ft Valuation of Work S 4ZMft0r'- Proposed Work heate&/cooled 1620 - non-heated/cooled J4 ,Ctw- / Class of Work(circle one): New Addition Repair Move Demolition pool/spa window/door Use of existing/pro osed structure(�) (�ircle one): Commercial Residential If an existing strucrure,is a fire sprinider system installed? (Circle one): Yes No N/A Florida Product Approval # For multiple products use product approval form Describe in detail the type of work to be performed: I +4o&4q��e to ii;e1l, le44eor-e,&vering/,-qn!4�� sheetr-oe!(�pai roplarae winde Remove exterior vinyl siding Property Owner Information: Name: John K. McPherson Address:1433 Ponte Vedra Blvd City Ponte Vedra Beach State FL Zip 32082 Phone 904-285-9155 E-Mail or Fax#(Optional)_ AdUU Contractor Information: Company Name: Qualifying Agent: Address: State Zip Office Phone Job Site/Cnntypt Nn er JPR.EVIE D"R CODE COMPM&L State Certification/Registration Architect Name& Phone# CITY OF ATLANTIC BEACH Engineer's Name& Phone# SEE PERMITS FOR ADDMONAL Fee Simple Title Holder Name and Address REQUIREMENTS AND CONDITIONS. Bonding Company Name and Address rX-7o 4- Mortgage Lender Name and Address Application is hereby made to obtain a permit to do the work and installations as indicated I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6)months, or ifconstruction or work is suspended or abandonedfor a period ofsiXP6)months at any time after work is commenced I understand that separate permits must be securedfor Electrical Work, Plumbing,Signs, Wells, Pools, 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 hereb certify that I have read and examined this a oplication and know the same to be true and correct. All provisions of laws and ordinances governing this type o7work will be complied with whether� eciX11d herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions ofany otherfederal,state, or local f,w regulating conff ction or the pe�formance of construction. q4lZnqture of Contractor Signature of 07wner :;WL� " 6 Print NaT,;� �041A 04- ....................................................................... Print Nar� ........ k7m.......................................................................... Sworn to and subscribed before me Sworn to an su sc ibed before me - :z f 0 this Dayof4)��-�- 2011 this q`� Day of law regulating cow o a nU s�us c p�be d Nota Lft MATT SENN g 0-*, ,�taryy Pu JAW SENN G; My COMMOM#EE 1337V1 My #EE 137271 2015 My CMOASSMN Revised 01.26.10 VMS'octolot 11.2015 MKS:OcWW 11,2015 CITY OF ATLANTIC BEACH OWNER / BUILDER AFFIDAVIT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I "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 PERMITUNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS YOU MUST YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE—OR 'In 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 YOUR USE AND OCCUPANCY. ITMAY NOTBE 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 C I IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT 141RE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST CZ) C 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. 111. 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. 0�a6 �500 CAIAAf< L-L cda ADDRESS PHONE NUMBER 1A -vl PRINT SIGNATU E N77 Before me this day of 20 t in the county of .,mvialState of Florida,has personally appeared herin by ti��f herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of T- County of ,>rsonally Known MATT SENN C3 Produced Identification- MY COMMISSION#EE 137271 Notary Signature� ebruary 14,2014 EXPIP'ES: T�ru Notary Public Undfirwriters iiondcd I I-VISED 4/16/2009 F IBLDG/Owrier-Builder Affadavit�RE City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road JA —3 -5445 Atlantic Beach, Florida 32233 Phone(904)247-5826 - Fax(904)247-5845 9,Bit E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: '5�6 Ork/6'�- F- L__A Department review required Yes No Buildin�g V1, Applicant: 4 tA_) _-_72 —Pranning &Zoning Tree Administrator Public Works Project: %/ 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 Reviewing Department First Review: NKIP"Proved. DDenied. (Circle one.) Comments: QB�Ul CD�l PLANNING &ZONING Reviewed by: Date:.k— 3-�)O/3 TREE ADMIN. Second Review: []Approved as revised. F]Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: RApproved as revised. E]Denied. Comments: Reviewed by: Date: Revised 05/14109