372 Royal Palms Dr 2014 Deck .,Ivy
,�� '1 CITY OF ATLANTIC BEACH
s 800 SEMINOLE ROAD
!J-; ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ALT/OTHER
MI ICT CAI 1 RY APM FnR NFYT nAY TNCPFr rTAN- 747-RAI A
JOB INFORMATION:
Job ID: 14-DECK-15
Job Type: DECK/PATIO
Description: NEW DECK
Estimated Value: $1,000.00
Issue Date: 10/24/2014
Expiration Date: 4/22/2015
PROPERTY ADDRESS:
Address: 372 ROYAL PALMS DR
RE Number: 171714-0000
PROPERTY OWNER:
Name: DUVAL HOME BUYERS
Address:
GENERAL CONTRACTOR INFORMATION:
Name: OWNER
Address:
Phone: - -
PERMIT INFORMATION: PUBLIC WORKS:
Roll off container company must be on City approved list and container cannot be
placed on City Right-of-Way. (Approved: Advanced Disposal, Realco, Republic Services,
Shappelle's and Waste Management.)
Deck to be constructed minimum 10" above ground.
FEES:
PLAN CHECK FEES $27.50
BUILDING PERMIT FEE $55.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $86.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
A Office(904)247-5826 Fax(904)247-5845
Job Address: 7Z _ YAC_ G,�lS ,al// Permit Number:_ (� De-c4---i
Legal Description RfP Ami, Vhi m l f 7A Parcel# ? 7 ''6600
oor Area of Sq. t. 'fit
Valuation of Work$ /0 DO. Od Proposed Work heated/cooled 13015 non-heated/c e
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa 0w/door O M
Use of existing/proposed structure(s)(circle one): Commercial esi en L/
If an existing structure,is a fire sprinkler system installed?(Circle one): es No N/A S�P 6' 014
Florida Product Approval# e
For multiple products use pro uct approva orm / y
Describe in detail the type of work to be performed:G/lGwx IL -L
Property Owner Information: n
Name: A[K I/�, j Address:?j 72 40Y4L. !4( 5 pe V!5_
_
City e-6 State FL Zip __Phone ... ....
E-Mail or Fax#(Optional) _-
Contractor Information:
FILE
p
PY 'i
r
Company Name: Qualifying Agent:
Address. City Stater •ys, ,,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 a llations 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 f work is nat commenced within six(6)months,or ijconstruction or work is suspended or abandoned for aperrod ofsix(6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Rork,Plumbing,Signs, Wells,Pools,Furnaces,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 hereb certify that I 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 specified
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 loc law re lating construction or the performance of construction.
Signature of Own Signature of Contractor
Print Name
r_)� Print Name
Swo nd subscribed b j� Sworn to and subscribed before me
this Day of m j 2 —J this _Day of 20
ublic Notary Public
Revised 01.26.10
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` CITY OF ATLANTIC BEACH
COPY®wNER / 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.
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ADDRESS PHONE NUMBER
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PRIN NAME
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SIG ATURE TE
Before me this day of 20 the county of
Duval,State of Florida,has personally appeared herin by h s If/herself and affirms that
all statements and declarations are true and accurate. /
Notary Public at Large,State of_ 14 ,County of
Lu Personally Known
produced Identification-
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F:BLDG/Owner-Builder Affadavit,REVISE , 6/2009 epp
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rr�yi;i; City of Atlantic Beach -
Building Department APPLICATION NUMBER
800 Seminole Road i ' (To be assigned by the Building Department
C �. - ��
Atlantic Beach, Florida 32233-5 45 _���� ��
Phone (904)247-5826 • Fax(9 4)24 '58451 7 2014
� ;t>�r E-mail: building-dept@coab.us I j
ij L_ Date routed:
City web-site: http://www.coab. , `
APPLICATION REVIEW AND TRACKING FORM
Property Address: 377- / m,s Department review required Yes No
Applicant: Q 40-77 &Zo
Tree Administrator
Project: �� (� �.. lic Works
lic till i
Public Safety
Fire Services
Review fee Dept Signature
Other Agency Review or Permit Required Review or ReceE:�i:
of Permit verified By ®ate
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: ('TtJ Date:
TREE ADMIN. Second Review: A
❑ pproved as revised. ❑Denied.
P C WO S Comments;
UBLIC UTIL I
PUBLIC SAFE Y Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
.:c-ify�, f, City of Atlantic Beach --
APPLICA i ION NUMBER
building Department
800 Seminole Road (To be assigned by he Building Department
t =r Atlantic Beach, Florida 32233-5445
l Phone (904)247-5826 - Fax(904) 247-5845
.R 9 E-mail: building-dept@coab.us
City web-site: http://www.coab.us L Date toured: (L
APPLICATION REVIEW AND TRACKMG [CORM
Property Address: .3/ 2 / IQ /r1S Department review required- q Bred Yes
Applicant: Q GC) . &Zo
e Tree Administrator
Project: lic Works
lic tliffl
Public Safety
Fire Services
:Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Rec�)ti;::
of Permit Verified�y ®ate
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:
APP ILIO TION STATUS
Reviewing Department First Review: Approved.
❑Denie �.
(Circle one.) Comments:
BUILDIN
PLANNING & ZONING
TREE ADMIN.
Reviewed by:
Date:
Second Review: DApproved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:
Date:
FIRE SERVICES Third Review: DApproved as revised. ❑Denied.
Comments:
Reviewed by: Date:
wised 05/14/09
City ®f Atlantic Beach -y ~
APPLICATIONBuilding Department NUMBER
,• .��
800 Seminole Road (To be assigned by`he Building Department
Atlantic Beach, Florida 32233-5445 � ��G /
Phone(904)247-5826 • Fax(904) 247-5845
91 E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRAICK9NG FORM
Property Address: Z. / �09
mS Department review required q d Yes No
Applicant: 107'! &Zo
Tree AdministratorPr®)act: �., Iic VVorks
lic fl !u
Public Safety
Fire Services -
Review fee $ Dept Signature
Other Agency Review or Permit required Review or Rece;`p,:
of Permit�eritied�y 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. ODenie.d.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by:��i�"', A'- Date: l
TREE ADMIN.
Second Review: Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:
Date:
FIRE SERVICES Third Review: DApproved as revised. ❑Denied.
Comments:
Reviewed by: Date:
wised 05/14/09
City of Atlantic Beach
Building Department
APPLICATION NUMBER
.;
800 Seminole Road �_ (To be assigned by`he Building Department
Atlantic Beach, Florida 32233-5445 ��C� ! /
Phone (904)247-5826 • Fax(904)247-5845 �x
`s» E-mail: building-dept@coab.us SEP ,i
City web-site: http://www.coab.us
L_ Date routed: (L
APPLICATION REVD-EW AND TRACKUNG FORM
Property Address: 372- / g M s Department review required Yes No
Applicant: Q to-7) e ,e, &Zo
c Tree Administrator
Project. G lic Works
lic M,I
Public Saety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Rece'iY,'.
Florida Dept. of Environmental Protection of Permit Verified By Date
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:
APPLI AT'ION STATUS
Reviewing Department First Review: Approved. ❑Denie-d
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by: �/-� Date:
TREE ADMIN. - L L /
Second Review: Approved as revised. enied.
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