337 1st St Bath remodel 2015 r
\J is1
CITY OF ATLANTIC BEACH
f 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
]OB INFORMATION:
Job ID: 15-RAAR-1339
Job Type: RESIDENTIAL ALTERATION
Description: durarock bath-remodel
Estimated Value: $500.00
Issue Date: 6/10/2015
Expiration Date: 12/7/2015
PROPERTY ADDRESS:
Address: 337 1 ST ST
RE Number: 169763-0000
PROPERTY OWNER:
Name: MCCARTHY TRUST
Address: 337 FIRST ST 337 FIRST ST
PERMIT INFORMATION:
FEES:
BUILDING PERMIT FEE $55.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $59.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904)247-5845
Job Address: 33 f / 5-r Sr Permit Number:
Legal Description Parcel#
Floor ea o q. t. t
Valuation of Work$ (�� , od 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 sprinkler system installed? (Circle one): Yes No N/A
Florida Product Approval#
For multiple products use product approve orm
Describe in detail the type of work to be performed: W_w_7�1
Proipertv Owner Information: ((��
Name: C �t� dd� 3 _2_ �5� C;
City Sta Zi 2 d S hone_
E-Mail or F #(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: Qualifying Agent: _
Address: City State Zip
Office Phone Job Site/C tact 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. 1 certify that no work or installation has commenced prior to the
issuance of a permit and that all work well be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void:f work is not commenced within six(6)months, or if construction or work is suspended or abandoned for aperiod of six�6)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 herebycertify 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 ork will be complied with whether speci red herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,state, or local law regulating construction or the performance of construction.
Aignature of Owner Signature of Contractor
Print Name t1... .... ....... ... .... "/-. ................. Print Name
........................................................................................................................................
Befo a Before me
t 's ay of 20 ..... .. this Day of 20
rY P '4; Shirley L Graha Notary Public
y � My commie ion 086 0
.+oOF A Expires 02,14n0 Revised 01.26.10
CITY OF ATLANTIC BEACH
IF[ @Vv T4E4 R / B UI[I[.1DER -AFFMAVIT
1. FLORIDA STATUTES; CHAPTER 489 FLORIDA STATUTE'S, PART -1 "CONSTRUCTION
CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW_
i DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES:
I STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
i CONIRAC`TORS. YOU f LAVE APPLIED FOR A PERMIT UNDER AN EXEMP'ITON TO THAT
LAW. THE EXEATPTIO'r7 ALLOWS YOU,ASTHB OWNER OF YOUR PROPERTY.TO ACT AS
�I YOUR OWN CONTRACTOR FVFN THOI.UH YOU DO NOT HAVE A LICENSE. 1 OLt AIUS7
`,(.T-R\TSS Il►F:�'t-lrr;l- 1 C'11QN 1'(_1t-1RSEI_F YOUMAY.BUILD ORLMPROVEA ONE—OR
I� 1wu FAIvI LY RE51DENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IVIPROVE A COMMERCL L BUILDING AT A COST OF$25.000.00 OR LESS. II-jq
BUIL:PiNCI
II NIUSTBEFOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILA FOR SALF OR LEAS['
li IF YOU SELL OR LEASE A BUILDING YOU NAVE, BUILT YOURSELF WITrDN ONE YEAR
� AFTER TIS CONSTRUCTION IS COA PLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEAS':,_ WFUCH IS IN VIOLATION OF THIS E)MiVL T-joN.
�fllcl ,�fl_Iir•,I tt_I_:NSLJ,i LRSUN_�ti. 1'c; Ilt t�c7N1R'k�Tt�1� I`OUR CONSTRUCTION MUSE
II BL lluly! Ac CORDING TO THE BUILDING CODES AND ZONING REGULATIONS. I I I
"t'il iR f I t,t't II•i.tilltll I l Tt) NIAKE SI IRF 11[AT I'EI)I'LE lhfM (\YEU 131 1
II I It7_IJtiI I:I__UIJIItIL ,�1 .51.111: Lk\ti_:WU CiY t'UUNTY OR AIUNICII'aL i It f rlSirnf
�I I Hti.ilty 1NLkti.
iI iN^lURY LIABILITY: SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKFR•S THF). IIIRI-
i I.. 1-APLDINt; DEPARTMENT SUGGESTS WORKER'S COMPENSATION Ihitillf:Aldl'E RE
Ill. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
I EMPLOY ON THEIR.IMPROVEMENT TRADES. I
1V PENAALT`i; UNLICEI\6I_0 CONTRACTORS CANNOT BE EMPLOYED UIdDEP AN)'
I! CIRCUMSTANCES. OWNERS 61E1NG SUBJECT TO $5,000 PENALTY UNDER. FLORIDA STATUTE NO.
II
4155-228(1). AN`OCCUPATIONAL LICENSE"IS NOT ADEQUA T E. 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.AO'Fs.l`9011i61_.EDGleMENT; 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.
X33-7 A�r--Xr--ADDRESSPHONE NUMBER
PRINT AME
I
• U ��
S TUP,E DATE
Before me this 8 day of - 2t in the county of
Duval,States of Florida,has personally sappee.,ed herin by himself)herself and affirms that
all statements and declarations are true ani:accurate. /
Nofary Public at Large,State of County of V a
Personally KnOI-n
Produced 115 on-
otary -
I
i
I
P
Notary Signature: JAI44ERE,
e of Flo ndaIllFF 086990