1375 OCEAN BLVD BATH RENO CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ALTIOTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-S814
JOB INFORMATION:
Job ID: i5-RAAR-889
Job Type: RESIDENTIAL ALTERATION
Description: BATH REMODEL(DURAROCK)TILE
Estimated Value: $2,000.00
Issue Date: 4/16/2015
Expiration Date: 10113/2015
PROPERTY ADDRESS:
Address: 1376 OCEAN BLVD
RE Number: 171845-0000
PROPERTY OWNER:
Name: MESIANO, MICHAEL AND SANDRA,
Address: 1375 OCEAN BLVD
PERMIT INFORMATION:
FEES:
BUILDING PERMIT FEE $60.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $64.00
PERMIT IS APPROVED ONLY US ACMRDANCE WIM ALL CIW OF XrLANI`IC REACH ORDINANCES AND ME FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845
Job Address: I Q=An 'BWd - Permit Number:
Legal Description Parcel#
&# nor ea q
Propose
Valuation of Work S d 'Lrk It �tld/cuoled
Class of Work(circle one): New Addition Alteration Repair emolitio pool/spa window/door
Use of existing/pro used structure(s)(drele one): Commercial ide V'
14
If an existing structure,is a fire sprinkler system installed?(Circle one): es No NIA
Florida Product ASproval#
For multiple pro nets use pmdu_ct_a—pprov_arr5—rm
Describe in detail the type of work to be performed: �.2 OUA_ UW (e?D (L +iltl Y)CAO-IM
Property Owner Information:
Narne: kRj1h 1 Ke.Z)0� Add,,ss__kbqS OCCaA j5j�jd
city 'tato44_Zip_2?,2ZVhonc Qq,7 - 77qu
E-Mail or Fax 4(Optional)
Contractor Information: CONTRACTOR EMAEL ADDRESS-
Company Name: Qualifying Agent:
Address: City State Zip
Offim Phone Job Site/Contact Number Fas#
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 apermil to do the work and installations as indicated. I certify that no work or installation has commencedprior to the
issuance ofopermil and that all work will bcpe�.ro=hs, or ifoorarraction or work isws;re
d to nuou the standards atoll to gulating construction in this juriediction, Thispa
and mid ffwork is o .riml becomes null
workiscommewe& I understand that separate permits most be securadjor ended a,abandonedfor aW&iod ofsag)months at any it.
Tanks and A be Conditioners,etc Electron Work,Plumbing,Sigm, ells,P-L% entices,Bollms,ff=mel,
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 V&fi NOTICE OF
COMMENCEMENT.
I hemb,certify that Ihave read and araminedthisgglication and know thc,.mc/a be true andcorrect. Allprowisions oflaws and ordinances governinithis
lie
type o7work will be complied with whether;peciled herein or not. The granting of a permit does not presume to give authority to violate or conav, the
provisions ofany otherfedervill,state, or local law regulating colptcuction or the Po�inmame m-construction.
'0 ,
Signaturt,ofOwner- lld� Signature of Contractor
Print Name Print Name
... ..... ... . ........... ......................................................... .................... ...............
Beto Before me
this,QDay r 20 this Day of .20
A
Notar�n 4 6 Notaty_P—uTT1—c Revised 01.26.10
CITY OF ATLANTIC BEACH
((OWNER / BUILDER -AFFIDAVI'f
OW
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
I T UT
CTI TRUCTION
SFD
I
I AS
LIST
OR
OR
CONLTPACT1N(PRET0UI6RSES C(WNER I BUILDER TO ACKNOWLEDGE THE LAW.
DISCLOSURE STATEMENT FOR SECTION 499,103(7),FLORIDA STATUTES
STATE LAW REQUHZES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN&'MMPTION TO THAT
LAW THE EXEWTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY.TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE, YOU MUST
SUVERVISrTHECO SII�UCTIONyOURSELR yOUjfAyBUU ORIMPROVEAONE I OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUI,D OR
IMPROVE A COMIIERCIAL BUILDING AT A COST OF$25.000.00 OR LESS, TUE BUILDING
LMTBEFOEXQUR.Vj5JS_AND OCCUPANCY. IT MAY NOTBE BUILT FOR SALE OR LEASE].
11F YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITUN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, T1IE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASL WHICH IS IN VIOLATION OF THIS EXEMPTION. YQU MAY NO r
111KF AN LINTICENSEnjuloy As YOUR cGNTRACTIHL YOUR coNsTfT CTION MIST
BE DONE ACCORDINO TO THE BUILDING CODES AND ZONING REGULATIONS, I I IS
YOUR RESPONSIBUIN 1-0 MAKE SURE T14AT PEOPLE EMPLOYED BY YOU HAVE
LICEN5ES REOUIRED
ORDINANCES. S NI(I
It. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE
THE BUILDING DEPARTMENT SUGGEST�-'-V�jk��W�—�6MPENSATION INSURANCE BE
PURCHASED
III- IRS LMTHHOLOING; 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; UNUCEN;ED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
455-228(l). AN OCC 'L�
CIRCUMSTANCES, OWNER TF�CTTO $5600P�NALTMMW IDASTATUTENO
E IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THI, COMY UtKI]HUAH, 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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