71 Forrestal Cir S Shed 2014 or
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
DIM
SHED PERMIT
MUST CALL BY 4PM FOR NE)(T DAY INSPECTION: 247-5814
30B INFORMATION:
Job ID: 14-SHED-370
3ob Type: SHED PERMIT
Description: 10 x 12 shed
Estimated Value: $1,200.00
Issue Date: 11/14/2014
Expiration Date: 5/13/2015
PROPERTY ADDRESS:
Address: 71 FORRESTAL CIR
RE Number: 171733-0000
PROPERTY OWNER:
Name: HARBER, RAYMOND P
Address: 71 FORRESTAL CIR
PERMIT INFORMATION:
FEES:
BUILDING PERMIT FEE $56.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $60.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233 FILE COPY
Office (904) 247-5826 Fax (904) 247-5845
Job Address: F- e_j k, S , Permit Number:
Legal Description Floor Area ot Sq.Ft. Parcel Sq.Ft
Valuation of Work$-,14 'Oe. 00 Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) circle one): Commercial Residential
If an existing structure,is a fire sprin=system installed? (Circle one): Yes No N/A
Florida Product Approval#
For multiple products use product ap rMor—m
Describe in detail the type of work to be performed:. tg,-4s e—
�j
Propertv Owner Information:
Nam A He,,- Address: Fa rce-t R
City���,(_ ae-4 e-k StateFLZip-3.Z23j—Phone - 3:34- 7 ty'l
E-Mail or Fax# (Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
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
4pplication is hereby made to obtain a permit to do the work an nstallations as indicated. I certify that no work or installation has commencedprior to the
issuance of�aopermit and that all work will be pe�formed to mee e standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void f rk is not commenced within six(6)months, or 1 onstruction or work is suspended or abandonedfor aWeriod ofsix�6)months at any time after
work is commenced. I understand that separate permits st be securedfor Electricar Work,Plumbing,Signs, ells, Pools, urnaces,Boileis,Heaters,
Tanks andAir Conditioners,etc.
WARNING TO OW R: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING9 CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
Ihere 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 1�work will be complied with whether sf eci 70 herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any otherfederal,state, or local aw regulating construction or the pe�fbrmance of construction.
Signature of Owner f I/ i z , Signature of Contractor
fl�l -
Print Name -��.y�not4 Print Name
A .......................... .......................................................................................................................................
Before Before me
this 2. ay of ClIer A�� . 20 Iq this —Day of 20
151 Notar��Iic Notary Public
Revised 01.26.10
CITY OF ATLANTIC BEACH
r
OWNER / BUILDER AFFIDAVIT
FILE , COPY
1. FLORIDA
STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I "Cf5NSTRUCTrON"
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 OU*TBUILDING. 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.
t
[I. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
.111. 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(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,LICEN`SED 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.
-? I Grre-St" I S.
ADDRESS PHONE NUMBER
R Cs bt PAO A A r-
PRINT NAME
SIGNATI!IkE DATE
Before me this_5�1 day of 20—d..the county of
D uval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are true and accu rate.
__L
Notary Public at Large,State of County of
11 Personally Known
qLA-vjaed Identificafion-
u
Notary Signature
F/BLDGO�er-Builder Affaclavit;R.EVI 4/16/12009
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City of AUanfic Beach
APPLICATION NUMBER
Building DepartmeL-41 o be assignq by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 322:33-5445
Phone(904)247-5826 - Fax(904)247-5845 70
City web-site: http://www.,c,:)ab.us )ate routed:
APPLICATION REVIEW AND TRACKING FORM
Property Address: -7/ Departm(.ant review required Yes
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PLANNING &ZONING Reviewed by Date: V11310
TREE ADMIN.
Second Review: []Approved as revised. F1Deni-!1
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:
FIRE SERVICES
Third Revlevtr, FlApproved as revised. FIDenier
Comments:
Reviewed by:_ Date:
REVISED 09252014
City of Atlantic Beach APPLICATION NUMBER
�e Building Departmen'.1, o be assigne by the Building Department.)
M-Cm, 800 Seminole Road
Atlantic Beach, Florida 322:33-5445
Phone(904)247-5826 - Fax(904)24A�9-450 5 2014
City web-site: http://wvxrw..71:)ab.us )ate routed:
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APPLICATION REVIEW AND TRACKING FORM
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TREE ADMIN-
SecondRevieiu: DAPProvedas revised. OlDeni,-�,!�,
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:---
FIRE SERVICES
Third Revieute. []Approved as revised. [1Denie(`
Comments:
Reviewed by:_ Date:
REVISED 092,92014
City of Atlantic Beach APPLICATION NUMBER
Building DepartmeI,-�' o be assigne by the Building Department.)
800 Seminole Road -1�
Atlantic Beach, Florida 322:33-5445 V
Phone(904)247-5826 - Fax(904)247-5845
City web-site: http://w\Afw.r-,:)ab.us )ate routed:
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APPLICATION REVIEW AND TRACKING FORM
Property Address: -7/ 6 Department review required Ye No
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Reviewint axpproved.
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PLANNING &ZONING Reviewed by: Date-..//76--/Y_
TREE ADMIN. Second Review: DApproved as revised. []De Y'
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:
FIRE SERVICES
Third Review-. [-]Approved as revised. []Denier'
Comments:
Reviewed by: Date:
REVISED 09252014
City of Manfic Beach APPLICATION NUMBE�P,
Building Departmeh o be assigne�by the Building Department.)
ALI;
800 Seminole Road
Atlantic Beach, Florida 322:33-5445
Phone(904)247-5826 - Fax(904)247-5845
City web-site: http://www..,�l:)ab.us )ate routed:
APPLICATION REVIEW AND TRACKING FORM
-7/ 61-zo;� 6- s _Vje—s No
Property Address: Department review required
efru i I d i
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Reviewint iVApproved. ElDenie
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PLANNING &ZONING Reviewed by: Date:–.
TREE ADMIN.
Second Review: []Approved as revised. nDenir�r!.. .
LIC WO Comments:
BLI UTIL
PUB I SAF Y Reviewed by: Date:---
FIRE SERVICES
Third Revievv-. E]Approved as revised. E]Deniec�
Comments:
Reviewed by:_ Date:
REVISED 09252014