2337 SEMINOLE RD UNIT A - WINDOW PERMIT VOIDED I
,s ATLANTIC BEACH
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PERMIT RECEIPT
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PERMIT DESCRIPTION: REPLACEMENT PATIO DOOR AND WINDOWS
PERMIT NUMBER: 15-WIND-2047
ADDRESS: 2337 SEMINOLE RD UNIT#A Oij
h1� 01 \1
OWNER: V
DATE ISSUED:
FEES DUE:
PLAN CHECK FEES $30.00
BUILDING PERMIT FEE $60.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Totals: $94.00
C-Pr(
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BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
OFFICE COPY
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845 ^-
Job Address: 2337 Seminole Road, #A Permit Number: 1.5— \A) \.)Q 'Z�
Legal Description37-2S-29E BLUFFS CLUSTER HOMES CONDOMINIUM
Parcel#
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$ 2,000.00 Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/ oor
d
Use of existing/proposed structure(s) (circle one): Commercial �', r /
If an existing structure, is a fire sprinkler system installed? (Circle one): •e o N /A
Florida Product Approval # 11109.5_ /17 NOo
For multiple products use product approval form
Describe in detail the type of work to be performed: Remove old sliding door and install new sliding door, remove fix
pane window and install-new window
Property Owner Information:
Name: Sarah H. Bohr Address: 2337 Seminole Road, Unit A
City Atlantic Beach State FL Zip 32233 Phone(904)246-5565 or cell 904-472-6252
E-Mail or Fax#(Optional)sarahhbohr@aol.com
Contractor Information: N/A
Company Name: Qualifying Agent:
Address: City State Zip
Office Phone Job Site/Contact 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. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six f6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical frork, Plumbing,Signs, Wells, Pools, Furnaces, 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 hereby certify that 1 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 work will be complied with whether specified 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.
Signature of Owner Signature of Contractor
Print Name Sarah H. Bohr Print Name
Swor'tp.,and subscrib d before me Sworn to and subscribed before me
this - Day. f pit to 41 , 20) 5 this Day of ,20
I! a-I A id
Notary Public
N �i .b: JENNY R WA i ry
MY COMMISSION d1111•11
Revised 01.26.10
S: EXPIRES:NMI g$ @61�
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CITY OF ATLANTIC BEACH OFFICE COPY
)5 IP WNER / BUILDER AFFIDAVIT
I. 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 MUST
SUPERVISE THE CONSTRUCTION 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 CONTRACTOR. 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.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
III. 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(1). 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.
L3 37 Seminole /21 (*V '/72-4.252
ADDRESS PHONE NUMBER
.4ara/-7 04.0i/
PRINT NAME
SIGNATURE �/�` DATE
Before me this °/da of A t..Are9] ,206n the county of
Duval,State of Florida,has personally appeared'herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of 'lam ,County of IDIANIDI
Personally Known i o0 —, ^!9 V -5z-45-4 I -0 Identification--
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Notary Signature:'!1. 4t AL., ,'A.. A Ate.�
ii ill
F:BLDG/Owner-Builder Atiadavit;REVISED: /16/2009
r_.:vi s City of Atlantic Beach APPLICATION NUMBER
~ Building Department (To be assigned by the Building Department.)
r_ _ ,_.f 800 Seminole Road it c, �� I
�vo , ,,- Atlantic Beach, Florida 32233-5445 ND - ZO47
Phone(904)247-5826 • Fax(904)247-5845 I S
S
P..„0109'? E-mail: building-dept @coab.us Date routed: b'/Zf 1
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Z 337 S.Mu1• O LE Rb Department review required Yes4'No
uilding I,I•
Applicant: , AR to a O,_, Zoning
Tree Administrator
Project: \I►vf ouL P■00 Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By_
Florida Dept.of Environmental Protection
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
IReviewing Department First Review: F 1 proved. ['Denied.
(Circle one.) Comments:
:UILDING
PLANNING& ZONING Reviewed by: / ` ` . Date: 9./ _/
TREE ADMIN. Second Review: ['Approved as revised. ❑Deni .
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: 'Approved as revised. nDenied.
Comments:
Reviewed by: Date:
Revised 07/27/10