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671 Amberjack Ln 2014 addition washer dryer ..At I U X Z 1 1, CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD U ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 J,31>� Application Number . . . . . 14-00001235 Date 8/21/14 Property Address . . . . . . 671 AMBERJACK LN Application type description RESIDENTIAL ADDITION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 2300 ---------------------------------------------------------------------------- Application desc addition for washer and dryer ---------------------------------------------------------------------------- Owner Contractor - ------------------------ ----------------------- KING, ADAM J OWNER 671 AMBERJACK LANE ATLANTIC BEACH FL 32233 --- Structure Information 000 000 ADDITION FOR W/D Construction Type . . . . . TYPE 5-B Occupancy Type . . . . . . RESIDENTIAL Flood Zone . . . . . . . . ZONE X --------------------------------------------------------------------------- Permit RESIDENTIAL ADDITION Additional desc . . Permit Fee . . 65 . 00 Plan Check Fee 32 . 50 Issue Date . . . . Valuation . . . . 2300 Expiration Date . . 2/17/15 ----------------------------------------------------------------------- Special Notes and Comments Full right-of-way restoration, including sod, is required. 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 ENG REV PRE APP > 3 HRS 25 . 00 STATE DBPR SURCHARGE 2 . 00 UTIL REV PRE APP >3 HRS 25 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---- Permit Fee Total 65 . 00 65 . 00 . 00 . 00 Plan Check Total 32 . 50 32 . 50 . 00 . 00 Other Fee Total 54 . 00 54 . 00 . 00 . 00 Grand Total 151 . 50 151 . 50 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. 1)V 1L1111\is Y L'l�l�lY 1 1"YY Y Llt.ti Y YlJl\ CITY OF ATLANTIC BEACH p 700014 800 Seminole Road, Atlantic Beach, FL 32233AU Office (904) 247-5826 Fax(904) 247. .-845 Job Address: 671 Amberiack Lane Permit Nl .tuber: Legal Description Pa, :Tl# i0 , oor ea o q• t• n Valuation of Work$ j Proposed Work heated/cooled_ � on-heated/cooled 56 Class of Work(circle one): New Addition Alteration Repair Move emolition pool/spa 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 pro uct approval orm Describe in detail the type of work to be performed: building to house washer and dryer, T_ tear down a interior wall Property Owner Information: Name: Adam King Address: 671 Amberjack Lane City Atlantic Beach State FL Zip 32233 Phone 904-333-87i:.,- E-Mail or Fax#(Optional) Contractor Information: 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 1pplication is hereby made to obtain a permit to do the work and installations1s' ndicated. /certify th..zt no work or installation has commenced prior to the issanfa prmitand thatallork wie performed to meet t/te standardal!lawsthisjurisdiction. This permit becomes null advoidif work isnotcoazeizced within six(6)months, or if constructionork is suspended or abandoned foi a penod of sia6)months at any time after toot k is co+nmenced. /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 RI "ORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING T' 'ICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING.) CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. 1 hereby certify that 1 have read and examined this application and know the same to be true and corret All provisions of laws and ordinances governing this tvpe of work will be complied with whether specified herein oz• not. The granting of a permit doe, %.t presume to give authority to violate or cancel the provisions of any other federal,state, or local law regulating const ction or the pet formance of const ion. F,-(,-KS20- 010 -1 -�-�-'S1- Signature of Owner Adam King Signature of Go -ractor Print Name Print Name Sworn to and subscribed before me Sworn to and subscribed before me this Day of - 20 this Day of ,20 Notary Publi JENNIFERW Notary Public MY COMMISSION Y FF 0i!480 EXPIRES:April 24,2617 Revised 01.26.10 • o? Bonded Thru Notary Public Undervuders f O� ,• r1 ty1'!j. r v\ CITY OF ATLANTIC BEACH 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 T14E 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826) IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE RE,-ku FHE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. 471 4,,6-r )4 L., TOY- V33,-$-7-fl ADDRESS PHONE NUMBER PRINT NAME 5, SIGNATURE �) DATE Before me this �a u y of ` _ ' 21 1 in the county of Duval,State of Florida,has personally apple d herrn by himself/herself and affirms that all statements and declarations are true and/accurate. �v JENNIFER WALKER County of Vr Notary Public at Large,State of , MY COMMISSION#FF 011480 EXPIRES:April 24 2017 0 nally Known PL—, � D 1 p Bonded Thru Notary Public Unde rwriters s y ced Identfication- Notary Signature: F:BLDG/Owrie-Builder Affada it;REVISED: 4/16/2009 rr'=VT City of Atlantic Beach APPLICATION NUMBER Building Department [RECEIVY— (To be assigned by the Building Department.) s� 800 Seminole Road – / Atlantic Beach, Florida 32233-5445 AUG ® 6 2014 Phone (904)247-5826 • Fax(904)247-5845 ;» E-mail: building-dept@coab.us Date routed: er City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 6 -71 r Qepartrpnent review required Yes No ui Applicant: �W 77F < iing &Zo Tree Administrator Project: � �4r 6 �� u lic Wor u lic Utilities Public Safety Fire Services Review fee $ c • Dept Signature - Other Agency Review or Permit Required I Review or ReceiptDate 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: [Approved. ❑Denied. (Circle one.) Comments: yy G.. BUILDING PLANNING &ZONING by: Date: AA- Reviewed TREE ADMIN. Second Review: ❑Approved 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: Revised 05/14/09 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road } � Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5845 S P-jORIT` E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACING FORM Property Address: 7 / De a.rtf:.ant review required Yes No u Applicant: // )) Tree Ac iistrator Project: b)h. �p� 1 ka �J £� AW-66-licWor�-> u lic SafUtiliety �? )fA Aq Public Safet Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or ReceiptDate 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: ]Approved. []Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by. _ Date: J`11 TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: _. Date: FIRE SERVICES Third Review: ❑Approved as revised. []Denies Comments: Reviewed by: Date: Revised 05/14/09 z fes: — i ;�Jis) City of Atlantic Beach APPLICATION NUMBER js Bullding DepartmentTo be assigned by the Building Department.) 800 Seminole RoadAtlantic Beach, Florida 32233-5445Phone(904)247-5826 • Fax(904)247-5845E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 71 / ZADe cent review required Yes No u' Applicant: �W 77'e inq'.4z Tree Ad:r,,iistrator er 6 f w�r Project: u lic - u lie Utilities s'4 Public Safety Fire Sery+:.es Review fee $ Dept Signatu Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B 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. ❑Deniz (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: ❑Approved as revised. []Denied. ICVAY Comments: UBL C PU LIC Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ODeniec Comments: Reviewed by: Date: Revised 05/14/09 L V 1L1111\" 1 LINIVII 1 f•1I I Clift 1 1"1 14 VIT.- CITY OF ATLANTIC BEACH 7Dll 800 Seminole Road,Atlantic Beach, FL 32233 AUOffice (904) 247-5826 Fax (904) 247 845 Job Address: 671 Amberiack Lane Permit N. mber• By Legal DescriptionPa- .,el# oor ea o q. t. q. t Valuation of Work$ 250 Proposed Work heated/cooled_ non-heated/cooled 56 Class of Work(circle one): New Addition Alteration Repair Move ;molition pool/spa Use of existing/proposed structure(s)(circle one): Commercial Reside;r;°. ii If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A Florida Product Approval# For multiple products use pro uct approval form Describe in detail the type of work to be performed: building •to house washer and dryer, tear down a interior wall d w Property Owner Information: Name: Adam King Address: 671 Amberiack Lane City Atlantic Beach State FL Zip 32233 Phone 904-333-871 E-Mail or Fax#(Optional} Contractor Information: 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 dpplication is hereby made to obtain a permit to do the work and installations as indicated. 1 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 al11 ls regttlating construction in this jurisdiction. This permit becomes mill and void if work is not commenced within six(6)months, or if consh action w work is suspended or abardoned fw a period of six6)months at any time after work is commenced. /understand that separate permits must be se,"red,for Electrics)Work, Plumbif+�,Signs, Wells, Pools, Furnaces, Boilers,Heaters, Tanks and Air Conditioners,etc. WARNING TO OWNER: YOUR FAILURE TO R1 FORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING T`, 'ICE 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 corre, :Ell provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit doe. presume to give authority to violate or cancel the provisions of any other federal,state, or local law regulating const coon or the performance ofconst, -pion. Signature of Owner Adam Kin Signature of Co .-ractor Print Name Print Name Sworn to and subscribed before me Sworn to and subscribed before me thisDay of -20 this Day of 20 T Notary Publi _�0.. 'ti ;; JENNIFERW Notary Public MY COMMISSION#FF 0'1400 EXPIRES:AP4124,2017 Revised 01.26.10 "•',;e• o?',•' ic Underv+mers Bonded Thru Notary Publ JJI CITY OF ATLANTIC BEACH (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 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 1S YOUR RESPONSIBILITY TO MAKE SURE TIIAT 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. C71 A ►4 �., 5'Gy- 333_f7sl ADDRESS PHONE NUMBER 14 �<<� PRINT NAME SIGNATURE DATE Before me this ,day y of 21� in the county of Duval,State of Florida,has personally appbefed herin by himself/herself and affirms that all statements and declarations are true and accurate. JENNIFER WALKER Notary Public at Large,State of � .County of ICAky_ =_°' MY COMMISSION#FF 011480 A• EXPIRES: n124, Ap' 2017 VOP nally Known Bonded Thru Notsry public Unden inters oduced Identification- Notary Signature: F-.BLDG/Owner-Builder Affadavit;REVISED 4/16/2009 rr� City of Atlantic Beach APPLICATION NUMBER Building Department (ro be assigned by the Building Department.) r 800 Seminole Road ,• z3� r� Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904) 247-5845 S J31�r E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us ff it Of APPLICATION REVIEW AND TRACKING FORM Property Address: 7 / De ar pent review required Ye o u Applicant: �W�� Linc_&zo Tree Adm nistrator Project: ,4/� if E u Iic v u lic l' pities 'e --Pq Y�4 Public Safety Fire Se . -es Review fee $ Dept Signature r Receipt Other Agency Review or Permit Required Review o 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: ❑Approved. ODenicc,. (Ci Comments: BUILDING D PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: [—]Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: _ Date: FIRE SERVICES Third Review: ❑Approved as revised. ODeniec Comments: Reviewed by: Date: Revised 05/14/09 L lJ 1LL11\lJ 1 JEJ.11VIVII I CSI I LIl-ti 11"I CITY OF ATLANTIC BEACH 7Z0114 FILE C0PY 800 Seminole Road, Atlantic Beach, FL 32233 AUG Office (904) 247-5826 Fax (904) 247 945 Job Address: • + 671 Amberiack Lane Permit N1 tuber: Isy Legal DescriptionPa ;.-el# Valuation of Work$ 250 Proposed Work heated/cooled_ ? non-heated/cooled 56 Class of Work(circle one): New Addition Alteration Repair Move : •omolition pool/spa 11819001 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: building to house washer and dryer, T tear down a interior wall d N Property Owner Information: Name: Adam King Address: 671 Amberjack Lane City Atlantic Beach State FL Zip 32233 Phone 904-333-87,_,_ E-Mail or Fax#(Optional) Contractor Information: 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 .tpplication is hereby made to obtain a permit to do the work and installations as indicated. 1 certify t;r-rt 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 z egzzlating cozzsb z:ction izz thisjurisdiction.isdiction. This permit becomes null and void if work is not conzuzenced within stx(6)months, or if cont�ztction or work is suspended or abandoned for a_period of six(6)months at any time after ti+ork is commenced. /understand that separate permits must be'secured for Electriea Work, Plumbing,Signs, ells, Pools, Furnaces, Boilers,Heaters, Tanks and Air Conditioners,etc. WARNING TO OWNER: YOUR FAILURE TO RI `ORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING T` 'ICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING.) CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. 1 hereby certify that I have read and examined this application and know the same to be true and corret- All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit doer %t presume to give azzthority to violate or cancel the provisions of any other federal,state, or local law regulating const ction or the performance of const; *ion. Signature of owner Adam King Signature of Cup .ractor Print Name Print Name Sworn to and subscribed before me Sworn to and subscribed before me this T Day of - 20 this Day of .20 Notary Publl ;=q� JENNIFERW Notary Public MY COMMISSION Y FF 01.1480 ,. EXPIRES:April 24,2017 Revised 01.26.10 ^.r• oe Bonded Thor Notary Public Underxdters •f,;of Fes,. .'1 S};`1r~l�i?., _ ..: rfa „rnt{ta:,,r.:..• ,. CITY OF ATLANTIC BEACH X rr 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 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 I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. 6/71 4,6r ,gam 1., TOY- 333-8-7,f1 ADDRESS J / PHONE NUMBER 14:91(4r, PRINT NAME SIGNATURE DATE JBefore me this day of ' 9 in the county of Duval,State of Florida,has personally appiWetd herin by himself/herself and affirms that all statements and declarations are true and accurate. ,County "Y''•- JENNIFER WALKER Notary Public at Large,State of of 'f a f ?� MY COMMISSION#FF 011480 ,o EXPIRES:APOI 24,2017 Vnally Known '• -d;meq,• Bonded Thru Notary Public Underwriters ced Identification- Notary Signature: f F:/BLDG/Owner-Builder Affadavit;REVISED: 4/162009 CITY OF ATLAN -'Copy OWNER / BUILDER AFF" us BF. Or ip I. FLORIDA STATUTES; CHAPTER 489, FLORIDA T A5 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER/BUILDER TO ACrQ G AW: DISCLOSURE STATEMENT FOR SECTION 489.}03(71 ,-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 ZONINC REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MI NICIPAL 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826) IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. X71 A,604 o L., FOY- 333-$-7,f1 ADDRESS PHONE NUMBER Aw.,-. lz,•, PRINT NAME SIGNATURE Before me this day of 1 ,Mt DATE / '`+ a 21 1 in the county of Duval,State of Florida,has personally appbefled herin by himself/herself and affirms that all statements and declarations are true land accurate. ( JENNIFER WALKER V , +r-/�1/AI Notary Public at Large,State of County of MY COMMISSION#FF 011460 EXPIRES:April 24.2017 ❑Per pally Known Bonded Thru Notary Public Underwriters V •fOF A, roduced Identification- Notary Signature: F.BLDG/Owner-Builder Affaduvit;REVISED. 4/16/2009 CITY OF ATLANTIC BEACH J 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 14-00001235 Date 8/26/14 Application Number 671 AMBERJACK LN Property Address . . Application type description RESIDENTIAL ADDITION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . 2300 ------------------------ Application desc addition for washer and dryer ------------------------ Contractor Owner ---------------------- OWNER KING, ADAM J 671 AMBERJACK LANE FL 32233 ATLANTIC BEACH Structure Information 000 000 ADDITION FOR W/D Construction Type . . . . . TYPE 5-B Occupancy Type . . . . . . RESIDENTIAL Flood Zone . . . . ZONE X ----- ---- ------ - -- Permit , . PLUMBING PERMIT Additional desc . • Plan Check Fee . 00 Permit Fee . . . . 69 . 00 0 Valuation Issue Date Expiration Date 2/22/15 ---- Special Notes and Comments Full right-of-way restoration, including sod, is required. RIC DE 2010 FLORIDA BUILDING CODE, 2008 STRUCTURAL DAMAGE ATOETHE TO BUILDING *REPORT ANY UN DEPARTMENT IMMEDIATELY. -------------- ----------------- 2 . 00 Other Fees STATE PLBG DCA SURCHARGE 2 . 00 STATE PLBG DBPR SURCHARGE ---- ___ --------- ------------------ Credited Charged Paid _______ Due Fee summary . 00 ---------- 69 . 00 69 . 00 . 00 Permit Fee Total 00 00 . 00 Plan Check Total • 00 . 00 . 00 4 . 00 4 . 00 . 00 Other Fee Total 73 . 00 73 . 00 . 00 Grand Total PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph(904) 247-5826 Fax(904) 247-5845 --� � / � / JOB ADDRESS: �„ / l /�'l ' ir/v'4_4 PERMIT# NEW OR REPLACEMENT INSTALLATION: Project Value$ TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY BathtubSeptic 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 Z 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 giveautho ' to violate the provisions of any other state or local law regulation construction or the performance of construction. Property Owners Name (\I` Phone Number pl- Plumbing Company_AkA � — �� ]r V4, Office Phone �Y d Fax n / Cit ��L State�4- Zip.�2Z Co. Address: 4tiS ttr►'►bt'yuNt��c. t'_rlw� y License Holder(Print): • State Certification/Registration# l� �l'ZL�'6�_'� Notarized Signature of License Holder Before me this 20 Signature of Notary Pu