432 IREX RD - WINDOW/DOOR CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NE)ff DAY INSPECTION: 247-581.4
JOB INFORMATION:
Job ID: 15-WIND-1353
Job Type: WINDOW AND/OR DOOR
DesI:rIption: window door
Estimated Value: $11,000.00
Issue Date: 6/11/2015
Expiration Date: 12/a/2015
PROPERTY ADDRESS:
Address: 432 IREX RD
RE Number: 171422-0000
PROPERTYOWNER:
Name: THOMAS TRUST, MARY K
Addretui: P 0 BOX 4781
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $52.50
BUILDING PERMIT FEE $105.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $161.50
PERMIT IS APPROWD ONLY IN ACCO"ANCE WITH ALL CITY OF ATLANTIC REACH ORDINANCES AND THE MORIDA
HOLDING CODE&
CITY OF ATLANTIc BrACH
FJ R / BUMD";R MFWAVIT FILE COPY
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1. FLORIDA STATUrES; CHAPTER 489, FLORIDA
CONTRACTING'REQUfRES OWNER/BUILDER To ACKN PART 1 'CONSTRUCTION
0 E LAW
DISCLOSURE STATEMENT FOR SEC77ON 489.103p),ILORrDA STATUrrBS:
STATE LAW REQUIRES CONSTRUCTTON TO BE DONE By LICEN
CONTRACTORS. YOUNaVrAPPLE-T)FORAPERMITUND SED
LAW. TIM EXEMPTION ALLOWS YOU,AS T14P OWNER OF ER AN RXENWHON To TRAT
YOUR PROPERTY.TO ACT As
YOUR OWN CONTRACTOR F,1EN THOTTGN YOU DO NOT GAVE A LICENSE. wumusl
I�"V[1?XJsf Iji "llp 11�11' N(1NyO11RSF
YWROVE A _jR
WU VAMIL I RESJDWNCE OR— _LF YOUTMAYBUILDORDAPROVEAON—E-
A FARM OUTBUILDING YOU WY ALSO BUILD OR
L02T BL FOICZ Oy1('f)UNML'1u"SEAL BUILIYIN�IT A COST OF$25'
AND OCCUPANCY IT -GOO CO OR LF,9S. Tj-qE1Tj
IF YOU SELL OR LEASE A BUILDING YOU N I\YNOT BE I DING
FLAVE 1UI1LT FOR sTLF op,I I_As-
I
BUILT YOURSELF WTITEN ONE
T FOR THE CONSTRUCTION IS COMPLETE, TILE LAW WILL PRES JRM THAT YOU Bui T
AFTER SALE OR LEAS-11 WETCH IS IN VIOLATION OF TUTS EnWTIO YEAR
UIPPAN I rNIjl7XN I- �1-17t,�QN I N )L'I I NJ NN ��J
0-VE—ACCURDINC.� To VQUIN LONTRAQ
BE 0 ;f
17CIIIJ THE BUILDING (56—DES---'& YOUR CONSTRLuc�rj_o� Mus I
AND ZONING REGULATIONS
WEVSI_� wima) NINI�F SURF 111�1 PEOPLE rha�
—INANC180 --L-5_1Aj_E_L,_kw AND BY , GG,C,- _F]� ll \Nl'
11 INJURY LIABILITY; SINCE OWNERS MAY 8 LIAEL� URJES
SUr E POR INJURIES TO WORI�FRS )HEY 11IRL
".�T
Jilt LOILDIM, 0EPARTME2Tv�SU �E��
GGESTS _tQR�INJ
WORKER'S COMICNISATION INSURANcE Rf
III. IRS WITHHOLDING;.OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD LSO
EMPLOY ON THEM IMPROVPMENT TRADES. KERS A
OBSERVE IRS WITHHOLDING TAX ANDIOR FORM 1099 REQUIREMENTS ON THE WOR THEY
W PENALTY, LNITCEN�1-, CONTRACTORS CANNOT BE
_jV EMPLOYED
(�IPCILAMSJANCE� VNLF�F np-M- _ UNUER ANY
L
OCCUPATIONAL LICENSE"13 No-
455 2280). AN" ING SUBJE61 T(�j5 1 00 PENALTY UNDER FLORIDA STAj�6�T ��
ERTIFICATE" TO ASC-CEF'� A 1ATE_ THE OWNER SHOULD PHYSICALLY
CSEE ]HE COffNTy li�JUFM COMPETENCY' OR THE FLORIDA 'CONTRACTORS
ERTAIN IF A PERSON IS A LICENSED CONTRACTOR-
BUILDING DEPARTMENT(247-5826)IF IN DOUBT. TELEPHONE THE
V.ACKNOWLEDGEMENT;I HEREBY ACKNOWLEDGE THAT I HAVE READ T14E ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
`-�/S 2 _. ------------
DATE
d.,.f
D..J.Stdw a
��a �JV led hle,in by W_�effl�lfd�daff�the[
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E�=144!018
City of Atlantic Beach APPLICATION NUMBER
Building Department (Tobeassgn by;threBuildin Department.)
P
800 Seminole Road
Atlantic Beach,Florida 32233-5445
Phone(904)247-5826 Fax(904)247-5845
E-mail: building-dept@ccalh.us
Cityweb-site http://�coab.us Date routed:
APPLICATION REVIEW AND TRACKING FORM
Property Address: 4z_ L�E�x eQ( Do rtm It
,g on reviewrequired Yes 44o
B in2�
Applicant: -27 ie -Planning&Zoning
Tree Administrator
Project: Public Works
Public Utilities
Public Safety
Fire Services
OtherAgency Reviewor Pennit Required Review or Racal It
of Permit Verified By Date
Florida Dept.of Environments! Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaumms
Division of Alcoholic Beverages and Toba=
Other
APPLICATION STATUS
Reviewing Department First Review; [BAppri E]Denied.
(Circle one.)
Comments: ry
PLANNING&ZONING Reviewed by: 11n Dz� Date 6
TREEADMIN. Second Review: DApproved as revised. ElDeniedit/
PUBLICWORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRESERVICES Third Review: E]Approved as revised. ElDenied.
Comments:
Reviewed by: Date:-
Rovlwd 07127110
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC I E C
FILE COPY 800 Seminole Road,Atlantic BeatchAFEH32233 nr
Office (904)247-5826 Fax(904)247-5845 7N
U
Job Address: Z- P 1 J-4 4�4,0—1 TS-3
Legal Description ;O� S_ 6&TA I I e7loll 3
Valuation of Worl Sq'Ft
non-beated/cooled 30o
Class of Work(circle one): New Addition Alteration 61D, Move Demolition pool/spa <.dovv/do.,
Use of existing/pro osed structure(s) incle one): Commercial
.,r�le
If an existing structure,is a fire suriler slastem installed?(C one)<:,., Yes �N N/A
Florida Product proval#
For multiple pr�lsucts use pro eutfsppl
rq
.v. A
or.
Describe in detail the type of work to be performed: 60, arA21 /Z
Property Owner Inforination:
Name: Z)_7A_LV �r� Address:
City ;4,
— &ZZ� � 4e&c9_State&Zip 22�-3
E-Mail or Fax#(Optional) _L2 Phone
A L&
Contractor Information: CONTRACTOR EMAIL ADDRESS: Wh f-`7 /-f Ad '70 313 1/- 2
Company Name: Qualifying Agent:
Address: _City State—Zip
Office Plion—e Job Site/Contact Number Fas:#
State Certification/Registration#
Architect Name&Phone#
Engineer's Name&Phone
Fee Simple Title Holder
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is herc�made to obtain a permit to do the work and installations as indicated, Icereyethai o..o,kormsoaliathon has cmameac�dprho,ta the
issuanceofapermi and that all work will hope -on in thisjurison, h splImit becomes,null
�arsoed to meet the standards ofall laws regulating consuact, an", T i
on
and void i5rwork is not commenced within six(6 months, or li'cousnuction or work is syended or abandonedfor ogriod ofs&16
work is commenced. I understand that separate permits must he securealfor Electric H`okP1um1d-gS19-, el months at any time a
,?,er
Tanks and A ir Conditioners,etc. Is,P-1s, Woutra,BoHms,Hen ere,
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 hcre,�,cer16 that I have readcoul canourned this lication analknow the same to be true and correct. Allprovisa,
�voe a work will be con; reci ed herein or act. The granting of a permit atgoLlown, this
plied with whether a 179 does not p,e,ue amhXtorftnce,3�g.-erume
provisions ofany otherfecteral,state, or local aw regulating construction or the erfomaocc,ofconstruction. v val. ,ca Z the
Signature of Ovvner C_ Signature of Contractor
Print Name
h
Print Nann,
. ....... .43 .................. ......................-..........
Befor?ne Before me
. ?ne
this f 20/ this —Day of
Notary u ic
ShirleyLGrithem Revised 01.26.10
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