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740 Plaza siding 2014 51 �� ¢ �is CITY OF ATLANTIC BEACH -tel 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 14-00001488 Date 9/09/14 Property Address . . . . . . 740 PLAZA Application type description SIDING PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 600 --------------------------------------- Application desc siding t-11 at carport -------------------------------------- Owner Contractor - ------------------------ ----------------------- LLOYD, JEFFREY J OWNER 740 PLAZA ATLANTIC BEACH FL 32233 -- ------------------------------------------------------------------------- Permit . . . . . . SIDING PERMIT Additional desc . . 30 . 00 Permit Fee . . . . 60 . 00 Plan Check Fee Issue Date . . . . Valuation . . . . 600 Expiration Date . . 3/08/15 _____ _ _ --------- 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 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. BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: TIA ZA Permit Number: . �' 700 Legal Description Si � 1P F4-A- oek- Parcel # 2, 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 Repai Move Demolition pool/spa window/door Use of existing/proposed structure(s) ((circle one): Commercial esident' If an existing structure,is a fire sprinkler system installed? (Circle one): es No N/A Florida Product Approval# For multiple products use product approval form Describe in detail the type of work to be performed: Ar �� r c . as i &LA-Clt- A c 12 o A Property Owner Information: Name: _�3_e4�«ti l/Address: 7 7 o City ZState l-Zip 32Z3S Phone Z'1 7 -'"n3da E-Mail or Fax#(Optional) Contractor Information: CONTRACTOR EMAIL ADDRESS: Company Name: 0&_1&3C<— 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 her 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 wall 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 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, 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 r d this application and know the same to be true and correct. All provisions of laws and ordinances governing this type o1 work will be c Fie with whether ci:ed herein or not. The granting of a permit does not presume to gave authority to violate or cancel the provisions of any oth federal,st or local egulating construction or the performance of construction. Signature of Owner Signature of Contractor Print Name �� i ' .................. .............. .... .................................. Print Name Befor a Before me this D 4 2 this Day of ,20 oar P�eL Notary Public State of Florida Notary Pub 1c �� My Commission FF 086990 Notary Public or F� Expires 02/14/2018 Revised 01.26.10 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 I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. z. y PHONE NUMBER ADDRESS ]Bfor INT N E / r rl 2- DATE N e methis day of 20 in the county of val. State of Florida,has personally app red herin by himself/herself and affirms that all statements and declarations are true nd accurate. (\V/, Notary Public at Large,State of �,County of �a ❑Pe ally Known / oduced identification o00 k, Notary Public State of i O �' U 4 Shirley L Graham Notary Signature F 086990 of ve Expl as 02/14!2018 F:BLDG/Owner-Builder Affadavit;REVIS :4 6/2