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2287 N Fairway Villas Ln 2014 siding,window,drywall 1 ,�� ry v I CITY OF ATLANTIC BEACH 1 j 800 SEMINOLE ROAD J :". ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 14-00000520 Date 4/11/14 Property Address . . . . . . 2287 N FAIRWAY VILLAS LN Application type description RESIDENTIAL ALTERATION Property Zoning . . . . . . . PLANNED UNIT DEVELOPMENT Application valuation . . . . 5000 ---------------------------------------------------------------------------- Application desc REMODEL, REPLACE OLD ROTTED WOOD, DRYWALL ----------------------- ----------------------------------------------------- Owner Contractor ------------------ ------ ------------------------ GERRY, JAMES JOHN OWNER 2287 FAIRWAY VILLAS LN N ATLANTIC BEACH FL 322334407 ATLANTIC BEACH FL 32233 --- Structure Information 000 000 REMODEL INTERIOR DRYWALL Occupancy Type . . . . . . RESIDENTIAL ---------------------------------------------------------------------------- Permit . . . . . . RESIDENTIAL ALT/OTHER Additional desc . . Permit Fee . . . . 75 . 00 Plan Check Fee 37 . 50 Issue Date . . . . Valuation . . . . 5000 Expiration Date . . 10/08/14 ---------------------------------------------------------------------------- Special Notes and Comments PER M JONES NO DOUBLE FEE ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due Permit Fee Total 75 . 00 75 . 00 . 00 . 00 Plan Check Total 37 . 50 37 . 50 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 116 . 50 116 . 50 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. City of Atlantic Beach Building Department FDaterouted: LICATION NU 800 Seminole Road ;g4 by the Bu"E-1 Atlantic Beach, Florida 32233-5445 � Phone(904)247-5826 - Fax(904)247-5845 E-mail: building-dept@coab.us `T I � 1 L4 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: ZZ6__1 Fn l rweiY(1 l ment review required Yes s No ,c� uildin Applicant: WvI��.Ir- Po/°r R�'+h Mu 0, Planning &Zoning ,�1n Tree Administrator Project: �CS�CJIX ( (� r'��1J Public Works �V-1 lv\ykv Public Utilities �f Public Safety Fire Services ;Review fee $ --- -- - - - - ---- ----- Dept Signature Other Agency Review or Permit Required Review or Receipt of Permit Verified By Date 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: pproved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING TREE ADMIN. Reviewed by: Date: Second Review: DApproved as revised. DD ied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: DApproved as revised. ❑Denied. Comments: Reviewed by: Date: !vised 05/14/09 r BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: o2g? -:1; Permit Number: ` _ ✓�� Legal Description Parcel # Floor Area of Sq.Ft. Sq. t Valuation of Work$ �� Proposed Work 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 # For multiple products use product app—roval form Describe in detail the type of work to be performed: S t d��E-i O�.R r-e ►r-�nad� Property Owner Information: Name: os.�� rPy Address: City S atqoq�Zip 72,2,d2Phoney'— E-Mail or Fax'#(Optional) Contractor Information: CONTRACTOR EMAIL ADDRESS: Company Name: Qualifying Agent: Address: State Office Phone Job State Certification/Registration# d� , Architect Name&Phone# F A d Engineer's Name&Phone# PBRMTTS FOR 4 Fee Simple Title Holder Name and Address AND GOND " 4 Bonding Company Name and Address , Mortgage Lender Name and Address ATE: r Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has VrOnc4dprieLthe issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permat becomes null and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six 6)months at any time after work is commenced. I understand that separate permits must be secured for Electrical-Work,Plumbing,Signs, Wells,Pools,[Parnaces,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 FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. I hereby 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 o1 work will be complied with whether specs ied herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other feder 1,state, or local law regulating construction or the performance of construction. Signature of Own Signature of Contractor Print Name ( ./..t'l .... ... ... K. ... ..... Print Name ........................................................................................................... Befo e iT II Before me this ay of 20{ this Day of ,20 Nota Pu lic Notary Public ,�;."•. JENNIFER WAI1�R MY COMMISSION M FF 011480 Revised 01.26.10 EXPIRES:Apd 24unde1 rwrkers RL,h. Bonded Thru Notary Page 1 of 3 f k General Durable Power of Attorney FILE COPY I,the undersigned (Full legal name) TO-M e S TO V_ Y (Identity number) o t � _ b o - 3(011 residing at (Address) Z Z 8-] FQI rwal V'i 11 as UN .. N - i!�4lal?f/'C 8cac h FL . 3Z2 33 appoint (Full legal name) R UA -\ A n n off- M u c c m (Identity number) O Z 2-' 3`4 ^ 5 g 8 3 residing at (Address) 2 Z G 8 Fa:j r w a`( Vi H a S Ln . N . 04/an4 ; c Be--a-ek R . 32233 as my Attorney-in-Fact(Agent) with the power of delegation and substitution. If my Agent is unable or unwilling to serve for any reason,I designate (Full legal name) (Identity number) residing at (Address) as substitute Agent. 1. I hereby revoke any and all previous powers of attorney signed by me except for my Power of Attorney for Health Care which shall remain in force. 2. This document shall be construed and interpreted as a general durable power of attorney and my Agent shall have full authority to act on my behalf in relation to all my property and affairs. OR 2. This document shall be construed and interpreted as a durable power of attorney and my Agent shall have full authority to act on my behalf in relation to my property and affairs, save for the following conditions and restrictions: 2.1. 2.2. httt):Hfree-power-of-attorney-forms.com/durable-power-of-attorney-form-print.html 1/30/2013 Page 2 of 3 3. I furthermore grant my Agent.the authority to: 3.1. Make gifts within gift tax limits except to himself. 3.2. Execute, amend or revoke any trust agreement. 3.3. Exercise the right to make a disclaimer on my behalf. 4. 1 indemnify and hold harmless my Agent from any loss that results from an error made in good faith save for willful misconduct or the willful failure to act in good faith. 5. 1 indemnify any third party from any claims which may arise against the third party because of reliance on this power of attorney. 6. My Agent shall provide accurate records on a monthly basis of all transactions completed on my behalf and shall provide accounting records on a six-monthly basis. 6.1. If I am unable to review the records and accounting, they must be submitted to: (Full legal name) (Identity number),1o?(� ��,residing at (Address) �� /�t� �v�Z-z3 7. My Agent shall be entitled to compensation for his services at a rate as set out by law and for reimbursement of all reasonable expenses in his duties as my Agent. 8. This is a Durable Power of Attorney. Even if I should become disabled or incompetent, it shall remain effective until my death. This Power of Attorney may be revoked by me at any time by providing written notice to my Agent and interested third parties. Executed this 2 day of :A 20 13 at jw5 <i B4J PirrL44-+ p- 13c�l, FL- 3 233 Signature: Ya/v� ZL'U�� in the pres ce of the undersigned witnesses: Witness 1. Name: f-�T r s Address: "Iv , Signature: http://free-power-of-attomey-forms.com/durable-power-of-attorney-form-print.htnil 1/30/2013 Page 3 of 3 Witness 2. Name: SA-P iF tg Av`6 Address: I v l s A-FL-&.J-rl ��✓'�. A•tea„i t 6�N r� 3 c3a 3 3 Signature: Acknowledgement fA This document was acknowledged before me on this foq ' day of 1'�F-f3 tz iAA K 2013 by s So t4 66"-1 cipat's Full legal name) Signature of Notary Public ,O)�/L- yvr c/t-�Nb Full legal Name At-a>;ti— ,oto o--Erio My commission expires b S f 2 6 ALBERT MORENO Notary Public-state of Florid2 ofa 2015 State of rave—I c, y «Q'My Comm.Expires May 78,6 o; Commission#EE 97846 Bonded Through National Notary Assn. County of �"`J��-- http://free-power-of-attorney-forms.com/durable-power-of-attorney-form-print.html 1/30/2013 CITY OF ATLANTIC BEACH FILE 5: COPY OWNER / BUILDER AFFIDAVIT - - -- I. 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 INIPROVE A ONE-OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR INIPROVE 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 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 MARE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. II. 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(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. 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. ADDRESS U PHONE NUMBER t� PRIAME SIGNATURE D D E Before me this day of .21 y In the county of by Duval,State of Florida,has personally peare herin himself/herself and affirms that all statements and declarations are true and accurate. J Notary Public at Large,State of ✓ County of cxA ,,❑�PP rsonally Known Y?Produced Identification- •,�:..� JENNIFER WALKER ;=_ MY COMMISSION#FF 011480 Notary Signa P EXPIRES:April 24,2017 KRK- "o;;c 4f Bonded Thru Notary Public underwriters F:BLDG/Owns-Builder Affadavik REVISED: 4/16/2009 CITY OF ATLANTIC BEACH j 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 14-00000522 Date 4/11/14 Property Address . . . . . . 2287 N FAIRWAY VILLAS LN Application type description SIDING PERMIT Property Zoning . . . . . . . PLANNED UNIT DEVELOPMENT Application valuation . . . . 5000 ---------------------------------------------------------------------------- Application desc T-111 SIDING ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ GERRY, JAMES JOHN OWNER 2287 FAIRWAY VILLAS LN N ATLANTIC BEACH FL 322334407 ---------------------------------------------------------------------------- Permit . . . . . . SIDING PERMIT Additional desc . . Permit Fee . . . . 75 . 00 Plan Check Fee 37 . 50 Issue Date . . . . Valuation . . . . 5000 Expiration Date . . 10/08/14 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 75 . 00 75 . 00 . 00 . 00 Plan Check Total 37 . 50 37 . 50 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 116 . 50 116 . 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: 7 4 Permit Number: 1 (4— A52.2 Legal Description 41 Parcel ?16 q4 > Floor Area o q. t. Sq.-Ft Valuation of Work Proposed Work 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# For 'multiple products use product approval form w Describe in detail the type of work to be performed: I's &v Til l Property Owner Information: Name`jQaryfe6 b� 6c, aeV Address: 67076]2 City�� J_ Kye_06� State,��Zip,.3, Phone E-Mail or Fax# (Optional) Contractor Information: CONTRACTOR EMAIL ADDRESS: yt° Company Name: Qualifying Agent: Address: City State Office Phone Job S e o State Certification/Registration# RRKMRm MR CODIE C-0 Architect Name&Phone# A M LAW ME Engineer's Name&Phone# OF ATL0M e REACH Fee Simple Title Holder Name and AddressREM TIREMENTS AM)GONDMONS Bonding Company Name and Address y Mortgage Lender Name and Address RRV5WmDBY: - o I j Application is hereby made to obtain a permit to do the work and installations as indica ed. I certify that no worfc or insta anon has commenceprior to the issuance of a permit and that all work well be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void tf work is not commenced within six(6)months, or if construction or work is suspended or abandoned fora period of six(6)months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing,Signs, Wells,Pools,Furnaces,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 FINANCING, 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 true and correct. All provisions of laws and ordinances governing this type work will be complied with whet ed herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other federal, te, or local aw re ulating construction or the performance of construction. Signature of Own Signature of Contractor Print Name] e 1� Print Name Befor 1 I Before me this Day of I 20 ` this Day of .20 otai Public Notary Public FJENNIFERW7FRRevised 01.26.10 MYCOMMISSION i FF 011480EXPIRES:April 24,2017 , . aWe-d Tnru Notary Pudic Underwriters Vis,_,1yi�V City of Atlantic Beach % Building Department NUMBER i., i 800 Seminole Road Em lding Department.) ._._i zf Atlantic Beach, Florida 32233-5445 �Phone(904)247-5826 • Fax(904)247-5845 0;119, E-mail: building-dept@coab.us City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM 2 Property Address: 2 8 / ( Y'�Q` ® tent review required Yes No � Building. Applicant: �JYI _-, �U�1^ Planning &Zoning Tree Administrator Project: S Public Works Public Utilities Public Safety Fire Services ;Review fee $ - - Dept Signature Other Agency Review or Permit Required Review or Receipt of Permit Verified By Date 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: Approved. []Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING TREE ADMIN. Reviewed by: Date: Second Review: []Approved as revised. []Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: EjApproved as revised. ❑Denied. Comments: Reviewed by: Date: wised 05/14/09 CITY OF ATLANTIC BEACH 1 j 800 SEMINOLE ROAD J -r ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 14-00000521 Date 4/11/14 Property Address . . . . . . 2287 N FAIRWAY VILLAS LN Application type description WINDOW AND/OR DOOR Property Zoning . . . . . . . PLANNED UNIT DEVELOPMENT Application valuation . . . . 5000 ---------------------------------------------------------------------------- Application desc FL 14743 . 1 WDW AND SLIDING DR FL 14998 . 2 ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ GERRY, JAMES JOHN OWNER 2287 FAIRWAY VILLAS LN N ATLANTIC BEACH FL 322334407 ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit . . . . . . WINDOW AND/OR DOOR PERMIT Additional desc . . Permit Fee . . . . 75 . 00 Plan Check Fee 37 . 50 Issue Date . . . . Valuation . . . . 5000 Expiration Date . . 10/08/14 ---------------------------------------------------------------------------- Special Notes and Comments PE M JONES NO DOUBLE FEE ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 75 . 00 75 . 00 . 00 . 00 Plan Check Total 37 . 50 37 . 50 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 116 . 50 116 . 50 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. N C-ta ,t BUILDING PERMIT APPLICATION 1 nstul l O oyb CITY OF ATLANTIC BEACH j(-"$tyu ch bis - 800 Seminole Road, Atlantic Beach, FL 32233 FL, PrOaU a Office (904) 247-5826 Fax (904) 247-5845 A<PP,rov Job Address: Permit Number: _1 `I — S2' Legal Description Parcel # Floor Area o q. t. Sq.Ft Valuation of Work$ Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proosed structure(s) circle one): Commercial Residential If an existing strucure,is a fire spr' er sy tem installed? (Circle one): Yes No N/A ►Florida Product Approval# =L / ( (,J 82L 5 l( y)� For multiple products use product approva orm • r, Describe in detail the type of work to be performed: V V 1 lr1 d 6V5 +' do o YS Property ONner Information: FILE COP YName: Address: , City State Zip Phone E-Mail or Fax#(Optional) Contractor Information: CONTRACTOR EMAIL ADDRESS: Company Name: Qualifying Agent: Address: City State Zip Office Phone J i e State Certification/Registration# En FO Architect Name&Phone# Engineer's Name&Phone# Fee Simple Title Holder Name and Addre MOM Amn Bonding Company Name and Address Mortgage Lender Name and Address 8Y: — � o/ moo 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 f work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six 6)months at any time after work is commenced. I understand that separate permits must be secured for 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 FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. I hereby 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 o work will be complied with whether s eci led herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of arty other feder state, or loc aw regulating construction or the performance of construction. Signature of Own Signature of Contractor Print Name 7�j ,/j, �/ Print Name Be fo / Before me this Day,of 20 this Day of 20 aA- % AAWyn-I ublic Notary Public � J,':y•, JENNIFER WALKER MY COMMISSION a FF 011480 Revised 01.26.10 EXPIRES:April 24,2017 Bonded Thm Notary Public Underwriters •Rf„ftp•' City of Atlantic Beach Building Department APPLICATION NLDLepartment].) 800 Seminole Road (To be assigned by the Buildi Atlantic Beach, Florida 32233-5445 �— �C Phone(904)247-5826 • Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: �–�' City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 1 p y � �1 Ywa V► � �QS De artment review required Yes No N , uildi Applicant: Planning &Zoning Tree Administrator Project: (nd OW3 e sU nG d r Public Works Public Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt of Permit Verified By Date 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 DepartmentFirst Review: proved. ❑Denied. (Circle one.) Comments: BUIl.DING'� PLANNING &ZONING Reviewed by: Date: Y'r� adv/y TREE ADMIN. Second Review: []Approved as revised. []D ied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: []Approved as revised. ❑Denied. Comments: Reviewed by: Date: !vised 05/14/09 CITY OF ATLANTIC BEACH =' J 800 SEMINOLE ROAD j � ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 �J!tit Application Number . . . 14-00000520 Date 6/11/14 Property Address . . . . . . 2287 N FAIRWAY VILLAS LN Application type description RESIDENTIAL ALTERATION Property Zoning . . . . . . . PLANNED UNIT DEVELOPMENT Application valuation . . . . 5000 --------------------------------------------------------- Application desc REMODEL, REPLACE OLD ROTTED WOOD, DRYWALL -------------------------------------------------------- Owner Contractor - ------------------------ ----------------------- GERRY, JAMES JOHN OWNER 2287 FAIRWAY VILLAS LN N ATLANTIC BEACH FL 322334407 AT BEACH FL 32233 --- Structure Information 000 000 REMODEL INTERIOR DRYWALL Occupancy Type . . . . . . RESIDENTIAL ----------------------------------------------------- Permit . . . . . . ELECTRICAL PERMIT Additional desc . Permit Fee 68 . 00 Plan Check Fee . 00 Issue Date . . . Valuation 0 Expiration Date . . 12/08/14 -------------------------------------------------- Special Notes and Comments PER M JONES NO DOUBLE FEE ----------------------------- Other Fees . . . STATE ELEC DCA SURCHARGE 2 . 00 STATE ELEC DBPR SURCHARGE 2 . 00 -------------------------------------------------- Fee summary Charged Paid Credited ----Due--- ----------------- ---------- ---------- ----- Permit Fee Total 68 . 00 68 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 72 . 00 72 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. ELECTRICAL PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd,Atlantic Beach,FL 32233 Ph(904) 247-5826 Fax (904) 247-5845 .TOB ADDRESS: Y PERMIT# � I[J �� JEA INFORMATION REQUIRED ON ALL PERMITS /'JPO AMPS a Y(9 VOLTS / PHASE VALUE OF WORK$ ga o ,00 NEW SERVICE ❑ Overhead ❑ Underground ❑T Underground up Pole []Residential(Main)Service ❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Meters ❑Commercial(Main)Service E10-100 amps El 101-1 50amps El151-200amps ❑ amps ❑CT Service amps Conductor Type Size ❑Multi-Family(Main)Service [10-100 amps ❑101-150amps ❑151-200amps El-amps #of Unit Meters ❑Temporary Pole ❑ amps SERVICE UPGRADE El-amps ❑ CT Service amps NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.) ❑100 amps ❑150amps ❑200amps ❑ amps [I CT Service amps ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC. Outlets/Switches: 0-3 Damps 31-l 00amps 101-200amps b Appliances: / 0-30amps 31-100amps 101-200amps bi V'A/C Circuits: 0-60amps 61-100amps Heat Circuits: # circuits @ kw Number of Lighting Outlets, Including Fixtures: OTHER ELECTRICAL PROJECTS ❑Swimming Pool ❑ Sign XI Smoke Detectors Qty ❑Transformers KVA Motors hp FIRE ALARM SYSTEM (Requires 3 sets of plans) Qty volts/amps VALUE OF WORK$ REPAIRS/MISCELLANEOUS ❑Replace Burnt/Damaged Meter Can I Safety Inspection []Panel Change DOH to UG /4cldecl a A(SHwo+Sht�/Ar-,s SCkC_ i8ved prYCre �acPcPcd �h L�s, o4�e.w�se. []Other: /;0 h et,J C/ /Cui 4 S � adde 9 3W01< -S czhd &ecGre om P . Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether specified or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction. Property Owners Name'3�e S +� �r��le-,V Phone Number,Yp Electrical Company Office Phone Fax Co.Address: City State Zip License Holder(Print): State Certification/Registration# Notarized Signature of License Holder Before me this day of 20 Signature of Notary Public CITY OF ATLANTIC BEACII �z F I L E COPY f i J E ®WNCR/ BUILDER AFi'IDAVfT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I "CONSTRUCTION CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE S"CKCFh1ENl'PC1R SECTION TK9.103(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. TITh EkTMPTTON ALLOWS YOU,AS THE OWNER OF YOUR PROPERLY•TO ACTAS 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 COMMERCIAL BUILDING A7'A COST OF$25.000.00 OR LESS. THE BULDING 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,TT-IE LAW WILL PRESUME THAT YOU BUILT 1T FOR SALE OR LEASE,WITCH IS IN VIOLATION OF TTIIS EJ MPTiON. YOU MAY NOT HIRE AN UNLICENSED PERSON A'YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO111E BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REOIZRED_HY__ ICIPA I SIN( ORDINANCES. II.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(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. V.ACKNOWLEDGEMENT;I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN ON/NER-BUILDER PERMIT. Qom[ q 7 7 ADDRESS PHONE O NUMBER PRI AME - �-� .IGNATURE � .LSV NI E 1 Debre me this day of„��2 in o,e self an of Duval,State M Florida,has personally pear hedn by himspdf!herself and/that all statements and declarations are true and accurate. �1+s1 Notary Public at Large,Stale of ,County of_A �B'fsrcaucea IJcnlifintioe- �- ""• JENMFER W M Ary CCMMlSSICN#FF011480 'r!otary Signa. s° ' EXPIRES:April 24,2017 Bald ihu rbWY PuNc UMenrrXen i XLv;� �I, CITY OF ATLANTIC BEACH l 800 SEMINOLE ROAD r} ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 �JAIT Application Number . . . . 14-00000520 Date 6/11/14 Property Address . . . . . . 2287 N FAIRWAY VILLAS LN Application type description RESIDENTIAL ALTERATION Property Zoning . . . . . . . PLANNED UNIT DEVELOPMENT Application valuation . . . . 5000 --------------------------------------------------------------- Application desc REMODEL, REPLACE OLD ROTTED WOOD, DRYWALL -------------------------------------------------------------- Owner Contractor - ------------------------ ----------------------- GERRY, JAMES JOHN OWNER 2287 FAIRWAY VILLAS LN N ATLANTIC BEACH FL 322334407 ATLANTIC BEACH FL 32233 --- Structure Information 000 000 REMODEL INTERIOR DRYWALL Occupancy Type . . . . . . RESIDENTIAL ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . Permit Fee 104 . 00 Plan Check Fee . 00 Issue Date . . . Valuation 0 Expiration Date . . 12/08/14 ------------------------------------------------------ Special Notes and Comments PER M JONES NO DOUBLE FEE ------------------------------------------------------ Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00 STATE PLBG DBPR SURCHARGE 2 . 00 --------------------------------------------------- Fee summary Charged Paid Credited ----Due--- ----------------- ---------- ---------- ------- Permit Fee Total 104 . 00 104 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 108 . 00 108 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. TiCITY OF ATLANTIC BEACH FILE COPY (OWNER/BUILDER AFFIDAVIT I. 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=YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR MWROVE A ONE.—OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR XROVE 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 IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF THIS E3�MP'FION. 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. II.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$5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN-OCCUPATIONAL LICENSE-IS NOT ADEQUATE, THE OWNER SHOULD PHYSICALLY SEE THE COUNTY 'CERTIFICATE OF COMPETENCY' OR THE FLORIDA 'CONTRACTORS CERTIFICATE' TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826)IF IN DOUBT. V.ACKNOWLEDGEMENT;I HEREBY ACKNOWLEDGE THAT i HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. o9it��Y�jl�.�2u ycl�2s � 9��sj7-5�.1� ADDRESS 0 PHONE NUMBER PRI AME IGNATURE ' - Q of Before me this of ��j/��-{`-�� 2! n th�v l/N1 4�—� Duval,State of Florida,has Persona-ly 4ppw ea hedn by hkmMf i herself and affimis that all statamenfs and declarations ane true and accurate. J Notary Public at Large,State of ` ✓ ,Canriy of✓w �❑,..,/P�s�e ry K-- �7 tlu�d idenul—t n- MYCOMML Notary Signai �l.�\/V"VV�,�J'�_+1��_ �ti�'- gpsldPflrv�Apd24,20 17 F/BL1)&0 ea-BvilderAMdn MRMSFD:a:6.C99 PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph(904) 247-5826 Fax (904) 247-5845 JOB ADDRESS: ,Z8 PERMIT NEW OR REPLACEMENT INSTALLATION: Project Value$_f,, � TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY Bathtub Septic Tank&Pit Clothes Washer Shower Dishwasher Shower Pan Drinking Fountain Slop Sink Floor Drain Three Compartment Sink Floor Sink Toilet Hose Bibs Urinal Kitchen Sink Vacuum Breakers LaundryTrate Water Connected Appliances y Lavatory Water Heater Other Fixtures Water Treating System RE-PIPE: TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY Bathtub Septic Tank&Pit Clothes Washer Shower Dishwasher Shower Pan Drinking Fountain Slop Sink Floor Drain Three Compartment Sink Floor Sink Toilet Hose Bibs Urinal Kitchen Sink Vacuum Breakers Laundry Tray Water Connected Appliances Lavatory Water Heater Other Fixtures Water Treating System MISCELLANEOUS: ❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans) ❑ Lawn Sprinkler System-Number of Heads ❑ Well ** ** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.** ❑ Other Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months.I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether specified or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction. Property Owners Narnq-.&!: ;:;� S Oe Q vPhone Number �7-zI� .� Plumbing Company Office Phone Fax Co. Address: City State Zip License Holder(Print): State Certification/Registration# Notarized Signature of License Holder Before me this day of 20 Signature of Notary Public