346 5th st SIDING C,
& CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
r
SIDING PERMIT
MUST CALL BY 4PM FOR NE)(T DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-SIDE-1884
Job Type: SIDING PERMIT
Description:
Estimated Value: $2,500.00
Issue Date: 8/7/2015
Expiration Date: 2/3/2016
PROPERTY ADDRESS:
Address: 346 5TH ST
RE Number: 169838-0000
PROPERTY OWNER:
Name: ARIAS, ROBERTO
Address: 346 5TH ST
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $31.25
BUILDING PERMIT FEE $62.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $97.75
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 1E1 2 &e'7 41;Permit Number:
&VCj<
/4,— Parcel
Legal Description -Floor Area ol Sq.Ft Sq.Ft
Valuation of Work$ ZA!!�4�9 Proposed Work b. -t-ri(coolled non-heated/cooled
Class of Work(circle one): New Addition Alteration CRepair Move Demolition pool/spa window/door
Use oi;xii�sQ�in� proposed structure(s) circle one): Commercial Lesi =Ua)-1--,,
Xis-In,st er system installed? (Circle o
If an e'd ing structure,is a fire spr= ne): Y es (.��o N/A
Florida Product Approval#--duct approval form
For multiple products use pro
Describe in detail the type of work to be performed: 54V71X-
1j NI
u-- s, ', d-,�
it —111-411
Propertv,Own�Information: . 1)
Name: C--&I,, Address: -SZ/ Or/% TA e-el
city /�,.j ce State F4 Zip 3 Phone �EC q- 6--
'I or Fax# 15"1W L
E-Mai �Optional koher3h 6f//ts,
Contractor Information:
C— — Qualifying Agent:
Company Name: L F —
Address: city State Zip
Office Phone Job Site/Contact Number Fax
State Certification/Registration#
Architect Name&Phone 4
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
A a, here ad , ob ain a e �do rk an ns a la ns as ntdic or installation has commenced prior to the
, �to d i t ' 'io
�y t the ant d5 Ir thisjurisdiction. This permit becomes nul,
0"1 , , f si%,) ftei
0 m t rk aWeriod o months at any time a
P'ic io m t 0 t ork p be e d
,e e tand ha a ix ,rm t or c t 7r
(6 on Instruct, n or -s,Heaters,
cure f
0 c 7c
i p nc a p rm t s P) b e sse d roEle ells,Pows, urnaces, Boilei
ss.-" 0 d thin
d d o'k s not c"m ...
that separate Per ts in, t
me c, t
,k s c n d nd, s and
Tanks andAjr Con itioners,eta
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 hereby certify that I have read and examined his application and know the same to be true and correct. All provisions of laws and ordinances governing this
type!9f work will be complied with whether S 1.fl-9d herein o;sjot. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any otherfederal,state, or local rzy, g,U1atZ�o ction o�the perfo�mance ofconstruction.
Signature of Q*ner" Signature of Contractor
Print Name .................................................................
Print Name k`41-11
......................... k............. 7
7
sworB t d b *b �befbre Sworn to and subscribed before me
-wan su scri 9,
thi� Day of . 20
is I'l ---J,,fAt 201/ this Day of
ELIZABETH M.BOOZER
1-U11M#99Zff'#TF-036434
-'*ic .1 Notary Public
No ublic ExPires July 16,2017
N
BoWed Nu Tmy Fain Inv=rA W"NP019 Revised 0 1.26.10
Afrqlillp�'
CITY OF ATLANTIC BEACH
OWNER / BUILDER AFFIDAVIT
1. FLORIDA STATUTES; CHAPTER - 489, FLORIDA STATUTES, PART 1 "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 HAVE 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 MUS
SUPERVISE THE CONSTRUC ON 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 HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR ONTRACTOR. 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.
III. INJURY UABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
Ill. 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.
PHONE NUMBER
ADDR.FSS.
P JINW!-NA.
S A
IGNA E DATE f
in the courdy of
Before me this_!2[�Iay of T:20��
Duval,State of Florida,has pers4. a y4ap aed herin by himself/hemelf and afflirms VW
aN state;Zen and declarations are true a�d accurate.
blic
Notary blic at LaW,State of -flnuritycif A
LIZABETH M.BOOZER
ft4e nally Known Commission#FF 036434
0 Produced Identifiration-
0 -M-7019
Bondd Thru Troy Fain Inauran"800
Notary Signature:
FJOLDG/Owner-Budder VISED: 4/16/2009
City of Atlantic Beach
Building Department APPLICATION NUMBER
be sign d by thQ Building D
(To be as
800 Seminole Road
Atlantic Beach, Florida 32233-5445 e7tf�
Phone(904)247-5826 - Fax(904)247-5845
-g' -mail: building-dept@coab.us t
E FrDate route��
-site: http://www.coab.us �/ft.;
City web ed: If
OE
APPLICATION REVIEW AND TRACKING FORM
Property Address. __. 34 S_� X7-- rtment review required Yes
Rifildinn
Applicant: Planning &Zoni g
eD R rtmen 7Yes
,ilcj�inq
r_l�
Project: Tree Administrator
Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
Florida Dept. of Environmental Protection of Permit Verified By
Florida Dept. of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: pproved. []Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by: Datee:�� 06
TREE ADMIN. Second Review: DApproved as revised. []Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:-
FIRE SERVICES Third Review: ElApproved as revised. ElDenied.
Comments:
Reviewed by: Date:
Revised 07127110