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306 & 308 4th St general repairs CE CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 14-00000602 Date 4/23/14 Property Address . . . . . . 306 4TH ST Tenant nbr, name . . . . . . 306 & 308 4TH ST Application type description RESIDENTIAL OTHER Property Zoning . . . . . . . RES SF DISTRICT Application valuation . . . . 2400 ---------------------------------------------------------------------------- Application desc code compliance repairs ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ ROHRMAN TRUST, CHARLES H OWNER 13074 N BIRCH BARK CT JACKSONVILLE FL 32246 ---------------------------------------------------------------------------- Permit . . . . . . RESIDENTIAL ALT/OTHER Additional desc . . Permit Fee . . . . 65 . 00 Plan Check Fee 32 . 50 Issue Date . . . . Valuation . . . . 2400 Expiration Date . . 10/20/14 ---------------------------------------------------------------------------- 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 65 . 00 6S . 00 . 00 . 00 Plan Check Total 32 . 50 32 . 50 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 101 . 50 101 . 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 APPLICATION NUMBER epartment.) (To be assigned by the Building D Building Department 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5845 E-mai: building-dept@coab.us Date routed: 7 City w eb-site: http-.//vmw.coab.us ===O APPLICATION REVIEW AND TRACKING FORM Property Address: gDe artmentrreview required Yes Ao uildinj Applicant: W_ --anninga &Zoning Tree Administrator (4 Project: Public Works 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: FA–pproved. []Denied. (Circle one.) Comments: PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: DApproved as revised. d. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: FlApproved as revised. ElDenied. Comments: Reviewed by: Date-.— Revised 05/14/09 , , � 1. f BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 FILE COPY Office (904) 247-5826 Fax (904) 247-5845 Job Address: PermitNumber: Legal Description Parcel 9 Sq.Ft. V. Floor Area of Sq'Ft Valuation of Work S. 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 torm C/4,4 ?45 A'3* Describe in detail the type of work to be performed: R�V/a 4L&A<_ 14*wor -t 5 % Property Owner Information: V-,;, cle4%-for 4- NameAhAt-1 011&-le-5 )1�&40-,"4001 Address: *7 4rX city State)Pe-Zip Phone E-Mail or Fax# (Optional)— -3224(4 Contractor Information: CONTRACTOR EMAIL ADDRESS: Company Name: Qualifying Agent: Address: city State Zip Office Phone Job Site/Contact Number Fax# State Certification/Registration Architect Name&Phone# 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 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 if construction or work is susrended or abandonedfor a Wperiod of sij6) months at any time after work is commenced I understand that separate permits must be securedfor Electrica Work,Plumbing,Signs, ells, Pools, urnaces,Boilers,Heaters, Tanks andAir Conditioners,ete. 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 herelDb certify that I have read and examined this application and know the same to be true and correct. A 11 provisions of laws and ordinances governing this type o 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 otherfederal,state, or local law regulating construction or t6Aperfbrmance of construction. P IS -e— Signature of Owner ojeT ure of Contractor Print Name ��174 dlellfs AoXr�ot 49 el Print Name B e fo eA Before me this I Irtay of this Day of 20 A. -9, otary PubllV"70, my Notary Public 1�_ R 21 20`15 EXPIRM Wy 'kiwd� TIM Revised 01.26.10 CITY OF ATLANTIC BEACI] FILE CopV, OWNER / BUIELDER AFFIDAVIT ------- 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 E-NEMPTION TO THAT LAW. THE ENP-NIPTION ALLOWS YOU,AS T14E 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 R\4PROVE A ONE—OR TWO FANULY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A CONAERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAYNOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOUR-SELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS CONIPLETE, THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF THIS E_NF_MPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR- YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULAIIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE ENIPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDWANCES. il. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. Ill. 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 PENAL TY 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 THA TI I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. )c OA1 ). 3 o -7 c7r N ADDRMS 'PHONE NUMBER wr 'PRIPTAW SIGNATURTt �ATE �.A ia Before me this4)_t of 2qe!�7in the county of Duval,State of Florida,has perslonal eppeared hernin by himself I herself and affirms that all statements and declarations ar eandaGcurate. DEBORjWpAwmAWHI1t Cou Notary Public at Large,State of County of my COMMISSION#EE 057349 EXPIRES:May 21,2015 0 Personally Knowrl B,,ded Thru Notwy Public.Underwritem �Iedu_d Identill,on L Notary Signat ture: F:/BLDGIO—er-BuilderAffadavit;P-i-�VISED:4/16/2009