297 Pine St 2015 front porch CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ADDITION
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 14-RADD-403
Job Type: RESIDENTIAL ADDITION
Description: move door add front porch
Estimated Value: $3,000.00
Issue Date: 2/25/2015
Expiration Date: 8/24/2015
PROPERTY ADDRESS:
Address: 297 PINE ST
RE Number: 170559-0000
PROPERTY OWNER:
Name: LATIMER ET AL, BRUCE T
Address: 297 PINE ST 297 PINE ST
PERMIT INFORMATION- PUBLIC WORKS:
Full right-of-way restoration, including sod, is required.
Roll off container company must be on City approved list and container cannot be placed on
City right-of-way. (Approved: Advanced Disposal, Republic Services and Shappels.)
FEES:
PLAN CHECK FEES $32.50
BUILDING PERMIT FEE $65.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $101.50
PERMIT IS APPROVED ONLYIN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
FILE COPY 800 Seminole Road, Atlantic Beach, FL 32233
2014�
Office (904)247-5826 Fax (904) 247-5845
By
Job Address: Permit Nu
Legal Description Parcel 4
Valuation of Work S N00, 60 Floor Area of Sq.Ft. Sq*Yt
Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New e0A`dd`i_fi_o�n) Alteration Repair Move Demolition pool/spa window/door
Use of ep�ting/prorosed structureQ)�circle one): Commercial esidential
If an existing struc ure,is a fire sprin er system installed? (Circle one):-- 0 N/A
Florida Product Approval#
For multiple products use prod�_R-approval form
Describe in detail the type of work to be performed:Anc &0_0 y 41 W_ 00
Property Owner Information:
NainelfU i hei At!MP( Address: 0161
city pffiWO State fA/zip ?2 VPhone
10�t- ;�LUV'
E-Mail or Fax#(Optional)
101 V1
\1 7 0
Contractor Information: CONTRACTOR EMAIL ADDRESS: fts 0 0
Company Name: Qualifying Agent:
Address: city State Zip
Office Phone Job Site/Contact Number Fax
State Certification/Registrati6n#
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 and installations as indicated. I certify that no work or installation has commenced prior to the
issuance of a permit and that all workwill be pedbrmed to meet the standards ofall laws regulating construction in thisjurisdiction. This permit becomes null
and void ffwbrk is not commenced within six(6)months, or i(construction or work is suspended or abandonedfor eriod ofsix(6)months at any time after
awl I i
work is commenced. I understand that separate permits must be securedfor Electricar Work,Plumbing,Signs, ells,Poo s,Furnaces,Boilers,Hea ers,
Tanks andAir 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 d know the same to be true and correct. Allprovisions of laws and ordinances governing this
certify that I have read and examined this application an
work will be co�nplied with whether speci ie erei The granting of a permit does not presume to give authority to violate or cancel the
)(14 d h n or not.
provisions of any other meral statwio6o
.�o
vqrl ng construction or the peifo�mance ofconstruction.
M,L,3S(D_ 4'57�- &
Signature of Owner Signature of Contractor
Print Name Print Name
..................... ....W ........................... .......................................................................................................................................
.... ............. .......0.0.*
...............
Bef 11 Before me
hy 0 20 Day of
�i D of this 20
GJ A
Nota,"blic V MYC M1 6
EXPIRES:Ap�l 24,2017
4 Bonded Thru Notary publip Underwnters
Revised 01.26.10
City of AVantic Beach
Building Depar�men-..'t AP PLICATION NUMBER
I o be assigned;)y the Building e t
800 Seminole Road D 7 rT n,
Atlantic Beach, Florida 322:33-5445
Phone(904)247-5826 - Fax(904)247-5845
City web-site: http://wviw-,,:,,3ab.us
Date routed:
APPLICATION REVIEW AND TRACKING FORM
Property Address: equired
?/1 7? Deparhrvant review r Uired Ye
Applican-i: 40 �0 Au lanning Znni
.rnmistrator
project: 'eo�4-2)2) fel-d/7 7- ublic V'Vo-.--ks
Ic
VL el) 7- Lod K
U ';aTety
Fire Serv;7,cea�
Review fee $ Dept Signature
CONTRACTOR EMAIL ADDRESS
CONTRACTOR CONTACT #
APPMATION STATUS
Flnni.
Reviewing Department First Review: Approved. []Denie-�
(Circle one.
Comments:
PLANNING &ZONING Reviewed by:_ do-1,5--
Date.
TREE ADMIN. Second Review: ElApproved as revised. UlDen d.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES
Third Revieblf,', DApproved as revised. []Denied-
Comments:
Reviewed by:_ Date:
REVISED 09252014
City of Atlantic Beadi
APPLICATION NUMBER
Building Departme�-�'41- 70 be assigned
800 Seminole Road d y the Building Dep rtm nt.)
Atlantic Beach, Florida 322:33-5445
Phone(904)247-5826 - Fax(904)247-5845
City web-site: http,'//www.c,:)ab.us
,)ate roLuted:
APPUCATIONI REVIEW AND TRAC�" L13MG FORM
Property Address: Depari�j_ (ant review required Yes No
U
Applicant: Al�g lannink- � Zo
Y" .,nistrator
7- the h, ublic Wc_%s
I c:
-r D66K
Im 0 VL
u jty
Fire Servlces�
Review fee Dept Signature 11!or__
CONTRACTOR EMAIL Ai_','_-)DRESS
CONTRACTOR CONTACT #
APPLlCATION STATUS
Forst _]Denie,
Reviewing Department First Review: �Approved.
C
_ m
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed by:
TREE ADMIN. Date.- 6 11fe
Second Review: []Approved as revised. DDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:
FIRE SERVICES
Third RevicL�-v-. DApproved as revised. []Deniec,.
Comments:
Reviewed bv:
Date:
VISED 09252014
City of A-Hanflc Beavcfa
APPLICATION NUMBER
Building Depar�men`l —o be assigne;dy the Building Dep rtm nt.)
800 Seminole Road I
Atlantic Beach, Florida 322:33-5445 - i
Phone(904)247-5826 - Fax(904) 7-5845
City web-site: http://w%Am.cl:)ab.us ;�D?dte routed:
APPUCAT10h," REVIEW AND TRAC ING FORM
Proper�ry Address: —Oe p—ar,�� -nt review required
Appflcanii: /��_Iannin�, Zo
e ministrator
Project: tel-40-177- ?Giz ublic\Afoi-ks
V D06 K Ic Uiijide
U .aTety
Fire Services-.:.
Review fee $ Dept Signature
'CONTRACTOR EMAIL
7
k-l'ONTRACTOR CONTA(
APPL�CATiOH 'STATUS
Reviewing Department FFirst Review: Approved. ElDenie-4
(Circle one.) Comments:
BUILDING
PLANNING & ZONING
Reviewed by.-____(� Date.-
TREE ADMIN.
Second Review: DApproved as revised. DDenied-
C c WOR Corarnents:
WOR C'
U LIC UTI
PUBLIC SAFE Reviewed by: Date:----
C
'E_'
FIRE SERVICES
Third Review DApproved as revised. DIDenied.
Comments:
Reviewed by:—. Date:
VISED 09252014.
City of Atlantic Beach
APPLICATION NUMBER
Building DepartmeL-�-'11
7o be assigned Py the Building Dep n:
800 Seminole Road 113 U11113 jint)
Atlantic Beach, Florida 322:33-5445
Phone(904)247-5826 - Fax(904)247-5845
City web-site: http:flwv�rw_o:)ab.us
Oate routed:
" 'NG FORM
APPLICAT�ON REVIEW AND TRAIL,'�(
Property Address: DePartrrie-nt review required Yes No
Applicanii: 40 40 lv�i fanning ;�.Zo
e ..rr;nistrator
h 7 ,
Project: ielv/77— h, ublic VV� S
1C e
r V06
/7) 6 VL 0/7 7 ZD66
Fire Ser. as�
Review fee $ Dept Signature
'CONTRACTOR EMAIL A9.01)RESS
CONTRACTOR CONTAC'.-r #
APPIMATION STATUS
Reviewing Department TFFirst Review: []Approved. Denie-1
C,
(Circle one.' _,m
I Comments:
BUILDING
PLANNING & ZONING
Reviewed by: Date:
TREE ADMIN.
Second Review: KApproved as revised. ODenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:
FIRE SERVICES
Third RevievLe-. DApproved as revised. FIDenied-
Comments:
Reviewed by:
Dpte�
VISED 0925201A
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CITY OF ATLANTIC BEACH FILE COP
OWNER / BUILDER AFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I "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 14AVE 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 14AVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME T14AT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF TIUS 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(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 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.
I
N�,� P i�wlNeo D+
ADDRESS PHONE NUMBER
PRINT ME
SICIKATFP�RE DATE
U
Before me this I day of
V 20M in 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 accurate.
Notary Public at Large,State of County of
ZP nally Known
ced Identificafion- JENNIFER WALITR
MY COMMISSION 0 FF 011480
IE-�-v' EXPIRES,Arri!P.4,2017
Notary Signature: Bonded I hru t0tar,Pv'blc
F/13LDG/Owner-Builder A vit;REVISED:4/16/n2O
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