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590 Ocean Blvd 2014 windows CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 14-00000776 Date S/16/14 Property Address . . . . . . 590 OCEAN BLVD Application type description WINDOW AND/OR DOOR Property Zoning . . . . . . . RES SF DISTRICT Application valuation . . . . 1600 ---------------------------------------------------------------------------- Application desc window replacement ---------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ FULLER, ROBERT H OWNER 590 OCEAN BLVD ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit . . . . . . WINDOW AND/OR DOOR PERMIT Additional desc - - Plan Check Fee 30 . 00 Permit Fee . . . . 60 . 00 Valuation . . . . 1600 Issue Date . . . . Expiration Date . . 11/12/14 --------------- ------------------------------------------------------------- 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 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 60 . 00 60 . 00 . 00 . 00 Plan Check Total 30 . 00 30 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 94 . 00 94 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITY OF ATLANTIC BEACH FILE COPY OWNER / BUILDER AFFMAVIT 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 PEP_1�41T UNDER AN EXENIPTION TO THAT LAW. THE ENEMPTION 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 HVIPROVE A ONE-OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMIVIERCIAL 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 THE CONSTRUCTION IS CONIPLETE, THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF TIIIS E)CEMPTION. 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 ENfPLOYED BY YOU HAVE LICENSES REQUIEM BY STATE LAW AND BY COUNTY OR.NIUNICIPAL 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. 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 STA TIU TIE 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. crq,0 &)7 t6,o4-7V ADDRESS PHONE NUMBEH NAME �9NAT E DATE 13�fore me this /7—day of-7n.4 y —,2 - county of Duval,State of Florida,has personally appearlbd herin byo 16�If herself and affirms that all statements and declarations are tru accurate. 2�u V0, Notary Public at Large,State of County of. ,Tersonally Produc dentj'jjjj fjo ;2_� Nota=j 1. zrt.=,Pub. of r=id. Shirley L GrahaM FIBLDG/0—u-Builde AffadaviA ED: 41161]b 6, my Commission FF 086990 Nor"de Expires 02114/2018 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 7& Phone(904)247-5826 - Fax(904)247-5845 E-mail- building-dept@coab.us Date routed: City web-site: hftp://www.coab.us APPLICATION REVIEW AND TRACKING FORM '_*1 Property Address: 4611(d pXdagrtment review required Yes,-No .�Lu�ildin Applicant: '7) Planning &Zoning Tree Administrator 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_f3y 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: DeApproved. E]Denied. (Circle one.) Comments: e� PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: E]Approved as revised. FIDSZed. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: E]Approved as revised. F]Denie.A' Comments: Reviewed by: Date: Revised 05/14/09 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 2,P FILE Copy 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 u Job Address: a4J Permit Nu zq Legal Description LJA A k'" Parcel 4 _9q Ft I Floor Area of Sq.Ft. Valuation of Work SVo 0 0 Proposed Work heated/cooled non-heated/cooled ew Addition Alteration Repair Move Demolition pool/spa��/door Class of Work(circle one): (�D Use of existing/proposed structure(s) (circle one): Commercial (��ej�sidential m * t 11 d9 (Circle one): es 0 N/A If an existing structure,is a fire winkler syste es f?/ vis a e Florida Product Approval# - sy. For multiple products use product appr-owafTo-rm Describe in detail the type of worl<to be performed: PropeAv Owner Information- A Address: Name:4�e, !4 hal) jjl_,� Slat e ID -'��Uhone-Y 9 n-M * r Fa (Opti� 1..0, Contractor Information: CONTRACTOR EMAIL ADDRESS: Company Name 014kil Qu4lifying Jkgent: A Address:Rl/ /-) (Pi /ftte J Site�t ntactNthber V IV 717A� Office P11,one lls- 1-7/ V V\, if State Cei Icatio e ist tio Architect Nam &Phone Engineer's Na e Phone Fee Simple Title older 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 commencedprior to the issuance of a permit and that all work will be pe�jbrmed to meet the standards of all laws regulating construction in thisjurisdiction. This permit becomes null -iod o and void if work is not commenced within six(6)months, or if construction or work i's suspended or abandonedfor a pe) f six months at any time after i i A� work is commenced I understand that separate permits must be securedfor Electrical Work, Plumbing,Signs, We Is, Poo s, 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 here certify that I have read and examined thi's application and know the same to be true and correct. All provisions of laws and ordinances goverm.ng this Vwork will be com lied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provi.si.ons of any otherfe ral,state, or local law regulating construction or the performance of construction. Aignature of Owne -A— It4"I& Signature of Contractor Print Name Print Name ............................................................................................ ......................................................................... ........... .. ................. ............................................................................................... Be Before me t s Day f IM 141 this —Day of .20 Notary Public ,late of Florida Nota y Public eY I. ",Id- 3M Revised 01.26.10 )MnU3,itG6�F 086990