740 PLAZA - FRONT DOOR ALTER CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ALVOTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-S814
JOBINFORMATION:
Job I D: 15-RAAR-1324
Job Type: RESIDENTIAL ALTERATION
Description: CHANGING FRONT DOOR ENTRANCE
Estimated Value: $240.00
Issue Date: 6/11/2015
Expiration Date: 12/8/2015
PROPERTY ADDRESS:
Address: 740 Plaza
RE Number: 171289-0000
PROPERTY OWNER:
Name: LLOYD, JEFFREY J
Address: 740 PLAZA
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $27.50
BUILDING PERMIT FEE $55.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $86.50
PERMIT IS "PRmIED ONLY IN ACCORDANCE WrFH A� CCFY OF AT�TIC REACH ORDINANCES AND IrHE nORIVA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, Fl, 32233
Office (904)247-5826 Fax (904)247-5845 JUN -5
Job Address:—ILD TIA 2 A Permit NuMNY.—.;
Legal Description T-k t Parcel#
Valuation of Work CIO cot ea o q. t. Sq.Ft Fn
S 2'10 ProposedWork heated/cooled_ non-heated/cooled
Class of Work(circle one): New Addition Repair Move pool/spa window/doop—
Use of existing/pro used structure(s) (�Ilon (�,�Ifio '3
circle one): Commercial Resideruiar�
If an existing structure,is a fire spriWer system installed?(Circle one): Yes No N/A
Florida Product Approval#
For multiple products use P-m-ifilet-a-pPro—varro-1—m
Describe in detail the type of work to be performed:
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N Addre5s�:
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E-Mail or Fax#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS-
Company Name: Qualifying Agent:
Address: Ci --State Zip
Office Phone Job Site/Contact Num-
State Certification/Registration# Fax#—
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 hem6y made to obtain a permit to do th1work and installations as,indicated .....
issuance ofapermit and then all work will bep�r d to meet the standards ofall Laws regulat noyar. or installation as commencedprue,to the
arme i4consumcnonlothisjurisdiction. Thispermit becomes null
months,ar Lconstruction or work is surended or abandonedfor a
woA a commenced j undersoma that separate perader most be socuredfor Electrica wark,Plumbing,Sicaj, priod ofsUAN months at a,thnsXer
Tanks andAir Con0loners,etc. eas,Pools, umaces,Boilers,Ile en,
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 Y014i NOTICE OF
COMMENCEMENT.
I hemb,certo�that I have read and examined this7
type o7work will be complied with whether%ax ughcation and know the same to be true and correct. All provisions allows and ordinances governing this
a Irdhe,emo,not. The granting aft,permit does not presume to give authority to violate or cancel the
Provisions ofaur otherfederal,state,or Imal h,regulating construction or theprfornmence ofaccuunchron.
Signature of Owner x1A Signature of Contractor
Print Name . .............. Print Name
....................... ............. ............................ ........................
Befor Before me
f this —Day of
Notary P P P lied-
Way a.
MYC0Mm1M0nFFNNsc
EV,hu,(XV14=18 Revised 01.26.10
CITY OF ATLANTIC BEACH FILE COPY
OWNER/ BUILDER AFF]oD,4,VjT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES. PART I -CONSTRUCTION
CONTRACTING'REQUIRES OWNER/BUILDER To ACKNOWLEDGE THE LAW
SURE STATFMFNTFO�-�11UN 489.103(7),FLORIDA STATUTES.
STATE LAW REQUIRES CONSTRTJC71ON TO BE DONE By LICENSED
CrORS' YOU fLA-VE APPLIED FOR A PERMIT UNDER M WMMPTTON TO THAT
TRE WfflWUO1q ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY.TO ACT AS
OWN CONTRACTOR rVFN THOTKTH YOU DO NOT HAVE A LICENSE. YQUMUST
U-�'KUVEAONE—ok
DO MAY ALSO BUILD OR
00 OR LESS. iim_"�
BUILT FOR SALE OR LEASE.
URSFLF WITHIN ONE Ylj�j
PERSUAvIS THAT YOU BUILT
f ON ULINIAVA101
'UK�UNSTRUCTTON MUST
G REGULATIONS. IT IS
I h 01 a YOU��
0 RAI ICI'A LI -E -W,
R. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE.
THE BUILDING DEPARTME74T SUGGESTS WoRKER;�
PURCHASED COMPENSATION INSURANCE BE
III- IRS MTHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS—1 HEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
TV. PENALTY; UNLICENSED CII1111,11 11
CIRCUMS NCES. OWNERS--BEI D R
NG SUBJECT TO $6,G00 PENALTY�NDER FLORF_ Y�Y
�t,228(1). AN-OCCUPATIONAL LICENSE-IS NOT AD DA STATUTE NO
SEE THE COUN—Ty�"CERTfFj6�TE�-6�—�t El AIIE UATE., THE OWNER SHOULD PHYSICALLY
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 HERE13Y 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.
4
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Shidey L Giraham
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City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
A9.11,01 1�
800 Seminole Road
Atlantic Beach,Fluids 32233-5445
Phone(904)247-5826 Fax(904)247-5845 S-2
E-mail: building-deptl Date routed: OQ
Citywelb-site httpl/�ccabus
APPLICATION REVIEW AND TRACKING FORM
7�/a /Atz Dep
Property Address: A� _artm review required Yes No
Building g �z
Applicant: Plarl&Zoning
1,Administrator
Project: Public Works
Public Utilities
Public Safety
Fire Services
Review f6931111111111L_ Dept
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Flonda Dept.of Environmental Protection
Flonda Dept.of Transportation
St.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: ErApproved. E]Denied.
(Circle one.) Comments:
cg�Rl
PLANNING&ZONING Reviewed by. Date
TREEADMIN. Second Review: ElApproved as revised. ElDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERMCES Third Review: ElApprovedasnevised. ElDenied.
Comments:
Reviewed by: Date:
R"il