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131 MAGNOLIA ST SIDING CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 14-00000518 Date 4/10/14 Property Address . . . . . . 131 MAGNOLIA ST Application type description SIDING PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 300 Owner Contractor ------------------------ ------------------------ BREW, WARREN GEORGE OWNER 131 MAGNOLIA ST ATLANTIC BEACH FL 322334005 ---------------------------------------------------------------------------- Permit . . . . . . SIDING PERMIT Additional desc . . Permit Fee . . . . 55 . 00 Plan Check Fee 27 . 50 Issue Date . . . . Valuation . . . . 300 Expiration Date . . 10/07/14 ---------------------------------------------------------------------------- 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 x � CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 FILE COPY Office (904) 247-5826 Fax (904) 247-5845 i if �� ^^�� S M+oRas+.awxaeLM+2.�4raA.•+�wJIKMl'q+RN1iY e3iiiMFS n. Job Address: V6 permit Number: _ I� —sl Description Parcel # Valuation of Work$ }DU 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 on Florida Product Approval# "�' t A- For multiple products use product approvaIorm Describe in detail the type of work to be performed: � C _ 7 fioR- Tr4� � ll�f G 5 T�yL Prone Owner Information: ��k N Name: OAR!' W 6 i �i� � 'e, � ,ok)6 Sft.41 9 6 _ 44-L . Address: (,3 !enA 6,ej, City , ,' , StatoF/—Zip 2Z?3Phone 00t�5-7 5—9 E-Mail or Fax#(Optional) —�- Contractor Information: CONTRACTOR EMAIL ADDRESS: Company Name: Cwt-a-Jy- 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 Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that now ork 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 suspended or abandoned for a period of six(6)months at any time after work is commenced. 1 understand that separate permits must be secured for Electrical'Work,Plumbing,Signs, Wells, Pools, Furnaces,Bailers,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 1 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 of work will be complied with whether sped ued herein or not. The granting of a permit does not presume to give authority to violate or cancel the, provisions of any other federal,state or local law regulating construction or the performance of construction. Signature of Owner Signature of Contractor Print Name � v...........6 .......... .. �............ Print Name ............................................................................................................................ Be"Dayof Before me thi1t1 20 this Day of 20 N Notai Public • JENNIFER W7Unde.rwrkers y := MY COMMISSION •': EXPIRES:ApdRevised 01.26.10 '+S Bonded Then Ndxy Pu City of Atlantic Beach Building Department FEDate PLICATION NUMBER J 800 Seminole Road ned by the Building Department.) Aflantic Beach, Florida 32233-5445 �j ''e V Phone(904)247-5826 • Fax(904)247-5845 ' `� «r. .'��or E-mail: building-dept@coab.us City web-site: http://www.coab.us d: APPLICATION REVIEW AND TRACKING FORM Property Address: mQ �1 (J�S De artment revie w re wired Yes o fir ,_ ) uildin Applicant: r�''v Planning &Zoning Tree Administrator Project: l,�l �� Public Works Public Utilities Public Safety Fire Services Review fee $ Dept'Signature Other Agency Review or Permit Required Review or Receipt of Permit Verified B 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. (Circle one.) ❑Denied. Comments: / / �'dt^ r � e CO / p OjAt'V^[ 0v',I'G►�r BUILDING �-'i 7 PLANNING &ZONING Reviewed by: TREE ADMIN. Date: el" 7-/of Second Review: QApproved as revised. []Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: []Approved as revised. []Denied. Comments: Reviewed by: Date: wised 05/14/09 CITY OF ATLANTIC BEACH _. OWNER / BUILDER 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 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 IMPROVE 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 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. 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 OWNER-BUILDER PERMIT. I � a �c ADD SSSS --l�U� � ✓5 PH 1� ONE NUMBER ►� ��- PHLIN Iy, 4ji0jjLj O Q SIGNA R DATE Before me this lo"I"of 20 I�in the county of Duval,State of Florida,has personally ppeared harm by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of ,County of t]YPersonally Known ❑Produced Identification- Sy Notary Signature: i F:BLDG/Ok er-Builder Affadavit;REVISED: 4/16/2009 li