1161 Sandpiper Ln 2014 deck pergolaCITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
�J;31J` RESIDENTIAL ADDITION
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]OB INFORMATION:
Job ID:
14-RADD-129
Job Type:
RESIDENTIAL ADDITION
Description:
REMOVE AND REPLACE OLD DECK AND ADD PERGOLA
Estimated Value:
$250.00
Issue Date:
10/27/2014
Expiration Date:
4/25/2015
PROPERTY ADDRESS:
Address:
1161 E SANDPIPER LN
RE Number:
172374-5245
PROPERTY OWNER:
Name:
GIBBON, TRAVIS L
Address:
1630 S BENTIN DR
PERMIT INFORMATION:
FEES:
BUILDING PERMIT FEE
$55.00
STATE DCA SURCHARGE $2.00
PLAN CHECK FEES $27.50
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
0 3111
CITY OF ATLANTIC BEACH
j 800 Seminole Road, Atlantic Beach, FL 32233
°"-`' r; ..`° Office (904) 247-5826 Fax (904) 247-5845
Job Address:
1iW
� T —7 TW -T
OCT 02 2M,
Permit Nu %64/5 %i—
Legal Description --� "1 –,2 3 i 1 –.� ? 9t ,,'a�LL. l► �/e.ru,� u.r atParcel #
rlour tired01��.rL. IL1.I'L
Valuation of Work $ -2J ✓ > `'� Proposed Work heated/cooled non-heated/cooled /Y4
Class of Work (circle one): New Addition Alteration Repair
Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial esidentia
If an existing structure, is a fire sprinkkller system installed? (Circle one): No
N/4 ILE
Lj
COPY:
Florida Product Approval #
For multiple products use product approval form
DescOe in detail the type of work to be performed:
1n btu q"
Name: oua Address: 1 n t
City k StateTj- Zip Phone qb it- -
E -Mail or Fax # (Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name:
Address:
Office Phone Job S
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
Number
Agent:
Fax #
Zip
d`
Application 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 all laws regulating construction in this jurisdiction. This permit becomes null
and void tf work is not commenced within six (6) months, or if construction or work is suspended or abandoned for aWeriod of sixP6) 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 here b 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 arty other federal, state or local law regulating construction or the performance of construction.
Signature of Owner Signature of Contractor
Print Name%i ...... Print Name
this fav of
otary Public
' 000u, Notary Public State of Florida
'
4*1f
` Shirley L Graham
< My COMMisaion FF 086990
or F,pirer 02l142014�
Before me
this Day of 20
Notary Public
Revised 01.26.10
CITY OF ATLANTIC BEACHFILE
a
OWNER BUILDER AFFIDAVIT „ COPY
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.
PHONE NUMBER
SIGNATURE DATE
Before me this Z day of 20n the county of
Duval, State of Florida, has personally appeared hi by hems If / herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large, State of County of 4/
I Produced Known 1 N0f#ry Public State of Florida
`r--'`�J,C`(roduced Identification - . Shirley L Graham
JI My COmmiaalon FF 096890
pp� Expire• 02r141201a
Notary Signature:
F:BLDG/Owner-Builder Affadmit; REVISED: /16/2009 7-7
City of Atlantic Bei I
,� ` �• , Building Departmer,
800 Seminole Road
,•' Atlantic Beach, Florida 32 .33-5445
Phone (904) 247-5826 - ' ax (904) 247-5845
av> City web -site: http://wwv ,oab.us
APPLICATION NUMBER
(To be as7d by tFjA UildJng Department.)
Date routed:
APPLICATION REVIEW AND TRACKING FORM
Property Address:
Applicant: /A)
Project:
/ rove
Cx�s� ril 01i�7
Review fee $
CONTRACTOR EMAIL P )DRESS
CONTRACTOR CONTACT #
S
nt review required Yes No Zoning
nis ra or
Public Works
Public Utilities
Public Safety
Fire Services
Dept Signature
APPLICATION STATUS
REVISED 09252014
Review
Approved.
❑Denied.
Reviewing Department
First
(Circle one.)
Comments:
�LD�
PLANNING & ZONINGDate:
Reviewed by:
Second Revit w:
❑Approved as revised.
❑Denied.
TREE ADMIN.
PUBLIC WORKS
Comments:
PUBLIC UTILITIES
PUBLIC SAFETY
Reviewed by:
Date:
FIRE SERVICES
Third Review: ❑Approved as revised.
❑Denied.
Comments:
Reviewed by:
Date:
REVISED 09252014
FROM : RAYLINDA
FAX NO. : 3963156
Oct. 21 2003 01:37PM P1/1
AP SHOWING BOUNDARY SURVEY PACES �.3-A
LOI 48 `-F "�K�InF UNI4�UE3LIC RECORD AS FIO� I�11VA1.. COUNTY, FLORIDA.
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CERTIFIED T0:
TRA®iS L GIBBON
FIRST FRANKLIN FINANCIAL CORPORATION
RICHARD T MOREHEAD PA
STEWART TITLE GUARANTY COMPANY
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"aJ_ City of Atlantic Beach
jo Building Department
800 Seminole Road
VJ Atlantic Beach, Florida 32233-5445
Phone (904) 247-5826 • Fax (904) 247-5845
City web -site: http://www.coab.us
APPLICATION NUMBER
(To be aWd by t)qBQdjn9 Department.)
— 125
Date routed: !/
APPLICATION REVIEW AND TRACKING FORM
Property Address:
Applicant:
Project:
2� eco a � D ff�l�-C �
r)l 01i
Review fee $
CONTRACTOR EMAIL A IDRESS
CONTRACTOR CONTACT #
Reviewing DepartmentI First Review
(Circle one.) Comments:
BUILDING
PLANNING & ZONING
De ment review required Yes No
Buildi
Fining& Zoning
A minis res or
Public Works
Public Utilities
Public Safety
Fires Services
Dept Signature
APPLICATION STATUS
Approved
Reviewed by:
❑Denied.
TREE ADMIN. Second Revicw: ❑Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
Date: l0/1�
PUBLIC UTILITIES
PUBLIC SAFETY
Reviewed by: Date:
FIRE SERVICES
Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
REVISED 09252014