1651 Mayport Int Remodel CEiling 2014 v
I' ll SS CITY O ATLANTIC BEACH
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800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
COMMERICAL ALTERATION/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 14-CINT-524
Job Type: COMMERCIAL INTERIOR BUILD-OUT
Description: REPLACE CEILING DUE TO ROOF LEAKING
Estimated Value: $2,000.00
Issue Date: 12/2/2014
Expiration Date: 5/31/2015
PROPERTY ADDRESS:
i Address: 1651 MAYPORT RD
RE Number: 172072-0000
PROPERTY OWNER:
Name: CONSELICE JR ET AL, JOSEPH J
Address: 1651 MAYPORT RD
PERMIT INFORMATION:
FEES:
BUILDING PERMIT FEE $60.00
STATE DCA SURCHARGE $2.00
PLAN CHECK FEES $30.00
STATE DBPR SURCHARGE $2.00
Total Payments: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC, BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
#�.•r _� , UILDING PERMIT AP PL
CATION C
CITY OF ATLANTIC B ACH
ILE COPY 800 Seminole Road, Atlantic Beac , FL 32233 DEC 1 2 14
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 'r Permit Number:
Legal Description Parcel#
oor ea o q. t. t
Valuation of Work$ rn�, Proposed Work heated/cooled— Its non-heated/cooled=
Class of Work(circle one): New Addition Alteration pair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)((circle one): Comii$ R sidenti
If an existing structure,is a fire sprinkler system meta e . one): Yes No D N/A
Florida Product Approval#
For multiple products use product approva orm
Describe in detail the type of work to be performed:
PrODerty Owner Information:
Name: Address: _
City State_Zip Phone
E-Mail or Fax#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: Qualifying Agent:
Address: 63- —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 hereby made to obtain a permit to do the work and installations as indicated. I ce tify that no work or installation has commenced prior to the
issuance of f a permit and that all work will be performed to meet the standards o all laws re ulati
f g g construction in this jurisdiction. This permit becomes null
and void f work is not commenced within six(6)months, or if construction r work is suspended r abandoned for a Period of six16)months at any time after
work is commenced. I understand that separate permits must be secured or ElectricaC Work, lumbing,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 PAYIN TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAI 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 correct. All provisions of laws and ordinances governing this
type o work will be complied with whether speci led herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federa te, or local law regulating construction or the performance of construction.
x
Signature of Owner Signature of Contractor
Print Name Print Name
....... ......... >r}...e........ ...p. ..5..f �-.1.C.�.............................. c�O.... ............ .o..:.Y...�...e...G..t.G..��............C..........................
Before e Before e T
this 5.'Day o enn6er 20 1+ this �Day of , e'r em 6 er 20 1
Notary Publ' No ary Publ'
, �`� ;' a4aFdd_EY L. LEMMENES Revised 01.26.10
''= MY COMMISSION#EE095971
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 SUCTION 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 XEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. OUI2 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.
ADDRESS J� PHONE NUMBER
PRINT NAME
SIGNATURE I 2_' 2 11• q
DATE
Before me this day of 21y in the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large45davit;REVISEDII:State of� County of� v
mow•
Personally Kn ,,l v'py•.
.�^� �% JENNIFER WALKER
Produced Iden MY COMMISSION*FF 011480
EXPIRES:April 24 2017
ud t Bonded Thru Notary Public Underwriters
Notary Signatur
F:/BLDG/0� ,-Bu 4/16/2009
City of Atlantic Beach
M APPLICATION NUMBER
Building Departmen'.,' `6 be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 322:33-5445
Phone(904)247-5826 - Fax(904)247-5845
City web-site: http://w%w..�l)ab.us Date routed:
APPLICATION REVIEW AND TRAMNG FORM
: 1661 MA qp a ant review
Proper�y Address �,u—,,—
required Yes
Ye
Buildin
Z-nin
Applican.�: anning, Zoninn
�n ra�
"'ist 'o'
Tree Administrator
'c
Project Public Works LA N&
Public Utilities
--Public Safety
Fire Serv,ces--:-
Review fee $ Dept Signature
CONTRACTOR EMAIL ADDRESS
CONTRACTOR CONTACT #
APPLICATION STATUS
Reviewing Department First Review: [�J`Approved. ❑Denier;
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
TREE ADMIN. Reviewed by:- Date.12-2-1Y
Second Review:
[]Approved as revised. ❑lDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:
FIRE SERVICES
Third Review. ❑Approved as revised. [JDenied.
Comments:
Reviewed by:_ Date:
REVISED 09252014