720 Bonita Road laundry room 2013 CITY OF ATLANTIC BEAQ
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00003326 Date 8/30/13
Property Address . . . . . . 720 BONITA RD
Application type description RESIDENTIAL ADDITION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 950
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Application desc
LAUNDRY ROOM ON EXISTING SLAB
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Owner Contractor
------------------------
------------------------
JEFFREY DANE OWNER
720 BONITA RD
ATLANTIC BEACH FL 32233S434
--- Structure Information 000 000 ADD LAUNDRY ROOM TO EXISTING SLAB
Construction Type . . . . . TYPE S-B
Occupancy Type . . . . . . RESIDENTIAL
Flood Zone . . . . . . . . ZONE X
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Permit . . . . . . RESIDENTIAL ADDITION
Additional desc . . Plan Check Fee 27 . 50
Permit Fee . . . . S5 . 00 Valuation . . . . 950
Issue Date . . . .
Expiration Date . . 2/26/14
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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
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 5S . 00 55 . 00 . 00 . 00
Plan Check Total 27 . 50 27 . SO . 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.
CITY OF ATLANTIC REACH FILE Copyi-� .l
-LDER AFFIDAVIT
OWNER / BUI
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 EVIPROVE A ONE—OR
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. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOUR-SELF WITHIN ONE YEAR
AFTER TBE CONSTRUCTION IS COMPLETE, THE LAW WELL PRESU&M 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 REGULATTONS. 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-
--7 2 6
ADDI/;_ PHONE NUMBER
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DATE
Before me this day of 'j-3-theCDuntyof
-7d ha�p9'-'-n11jy
-�I..ty ar
Duval.State of Florid I aspers nally eared herin by himself I herself and affirms that
all s'tatements and declarations Aretru d accu rat te. —
Notary Public;at Large,State of County of
Xlersonally Known
,PFroduced IdleritMiloation- A
SHIRLEY RAHAM
NotarySignatu
EXPIRES:
. ...... Febma 14,2014
I I i P"'
F/BLDG/0,��-B�ilderAfffid-it;REVISED: 4/16/2OD9 ruNclary bl'icUnderwriters
MAP SHOWING BOUNDARY SURVEY OF
LOT 3, BLOCK 1, ROYAL PALMS UNIT ONE, AS RECORDED IN PLAT BOOK 30,, _4
'p,W"�
60 & 60A OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLOlIDAlwp,
CERT)FIED TO:
GREGORY K. PATZER & REBECCA A. ROBINSON
CARLISLE BROWN F ILE C ?v
STEWART TITLE GUARANTY COMPANY
RICHARD T. MOREHEAD, P.A.
BONITA ROAD
(60.0'R#GHT OF WAY)
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TVXA"M s 85'20'02" E 80.65' WON PV'E CATION 189.83'
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REVIEWED FOR CODE COMPLIANCE
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tA CITY OF ATLANTIC 13EACH
SEE PERMITS FOR ADDITIONAL '
REQUIREMENTS AND coNbITIONS.
REVIEWtf)BY. DFATE.
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City of Atlantic Beach
APPLICATION NUMBER
Building Department
800 Seminole Road (To be assigned by the Building Department.)
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: b3
City web-site: http://Www.coab.us
APPLICATION REVIEW AND TRACKING FORM
E(ro b�
D te
a
Property Address: Dmartment review required Yes No
Buil i
Applicant: 4�' <�Ian��ing &zonin
/4 Tree Administrator
Project: hm�7 mdr,/ 6,0 Public Works
- Public Utilities
4�1'A I -SHA7 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:
APPLICATJON STATUS
Reviewing Department First Review: Noproved. []Denied.
(Circle one.) Comments:
BUILDING
P ING &ZONING �__N
Reviewed by: Date:
Second Review: F]Approved as revised. nDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: nApproved as revised. nDenied.
Comments:
Reviewed by: Date:
Revised05114109
City of Atlantic Beach
CS6 APPLICATION NUMBER
Building Department [(�Fo Dbe�assigned by the Building Department.)
-P 800 Seminole Road
Atlantic Beach, Florida 32233-5445 1�7
Phone(904)247-5826 - Fax(904)247-5045
E-mail: building-dept@coab.us Date routed:
City web-site: http:/Iwvvw.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ment review required Ye No
Bul
Applicant: PL�Lnning &Zonin
Tree Administrator
Project: n Public Works
Public Utilities
�Xl Public Safety
Fire Services
Review fee $ iDept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit V By
Florida Dept. of Environmental Protection
0
FI
t
0
h
ri
d
r
a
A
Dege
pt
r
Florida Dept. of Transportation
St.Johns River Water Management District
rmy Corp G
Army Corps of Engineers
s
D ivisfo of a
ivision of Hotels and Restaurants
ivis io of Ic
NDivision of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: [PApproved. FIDenied.
(Circle one.) Comments:
PLANNING &ZONING Reviewed by:=,� Date: ;.4-
TREE ADMIN.
Second Review: nApproved as revised. [-]Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: [:]Approved as revised. F]Denied.
Comments:
Reviewed by: Date:
�evised 05114109
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 3223
FILE COPY
Office (904) 247-5826 Fax (904) 247-584
Job Address: 710 &jAj rd Yo,��c, 9,,,qcP, 9 ?j--.133 Permit Number: 1726
Legal Description Floor Area of SS q.F t. Parcel Sq*Ft
Valuation of Work$ Proposed Work heated/cooled non-heated/cooled
Is 0- . 0 a
Class of Work(circle one): (S)(��>lteration 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#
For multiple products use product approval form
Describe in detail the type of work to be performed: AAII!�� 04 A jauilA!�j %rockm O)N p
V_ 01A
Property Owner Information:
Name: 'C>av\e_ 3e4eqS .—Address: 77o Soy\;*-r, 9 � .
city k\d,%A�,c State F-L Zip 1?3 33 Phone qL)4-101- '75'21
E-Mail or Fax# (Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: —Qualfi ng Agent:
Address: _C' State Zip
Office Phone Job Site/Contact Nu er Fax
State Ceitification/Registration#
Architect Name&Phone 9
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
4pplication is hereby made to obtain a perm it to Ithework and installations as indicated. I certify that no work or installation has commencedprior to the
issuance of a permit and that all work will be performed to meet the standards of all laws regu lating construction in this jurisdiction. This permit becomes null
and void if work is not commenced within six(6)months, or if construction or work i's suspended or abandonedfor aWeriod of six(6)months at any time after
fo -Work,Plitnibing,Signs, ells,Pools,FlIrnaces, Boilers, Heaters,
work is commenced I understand that separate permits must be secured r Electrical
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
COMMENCEMENT.
I hereb certify that I have read and examined this a plication and know the same to be trite and correct. Allprovisions of laws and ordinances governing this
'er ec,
j
t 701 ork will be complied with wheth ifed herein or not. The granting of a permit does not presume to give authority to violate or cancel the
ype o w
provisions of any otherfederal,state, or localsf,w regulating construction or the performance of construction.
Signature of Owner Signature of Contractor ZZ
PrintName Print Name .......................................... ..........................................................................................
......................................................................................................................................
BefoM Oe Before me
thi of this —Day of 20
SHIRLEY L.GRAHAM
C OMMISSION#DD 957760
—Z
y 1'+,zu 14 1
Notary Public
11olldr,0 T t par
.............. oblicundemles
Revised 01.26.10