90 W 3RD ST - SIDING PERMIT 4411*,
:k°s, CITY OF ATLANTIC BEACH
A s) 800 SEMINOLE ROAD
,,: ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
SIDING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-SIDE-1665
Job Type: SIDING PERMIT
Description: hardi board
Estimated Value: $8,500.00
Issue Date: 7/17/2015
Expiration Date: 3/1/2016
PROPERTY ADDRESS:
Address: 90 W 3RD ST
RE Number: 170832-0000
PROPERTY OWNER:
Name: MANTON, JAMES N
Address: 90 WEST 3RD ST
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $46.25
BUILDING PERMIT FEE $92.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $142.75
I'ERMIT IS APPROVED ONLY IN ACCORDANCE W1111 ALL C1 11 OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION , F Ti 5 _
r." CITY OF ATLANTIC BEACH _
COPY 800 Seminole Road,Atlantic Beach, FL 32233 JUL 13
- - Office(904) 247-5826 Fax(904)247-5845 - J
by
Job Address: '1O w 3 2 $ % Permit Number: /,fie
Legal Description Parcel#
Floor Area of Sq.r't. Sq.Ft
Valuation of Work$ drE0 0.00 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 approval Form
Describe in detail the type of work to be performed: ,00eyi Qe/ere-h 5/6).,-)6
Property Owner Information:
Name:aiefrOtri lYJ44,'7-0#►/ Address: 7 G✓ QA s J
City 1476 4a'T k c Aed State Zip lalatiphone O 02 /
E-Mail or Fax#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
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 wo and installations as indicated. I cert fy 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 f work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six.(6)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 cert fy that I have read and examined this a,plicat'∎n 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 speci ed h •in or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other fede/ 1,state, or�-al la �f-gul' ing construction or the performance of construction.
LW"
Signature of Owner/„ • GI '" • Signature of Contractor
Print Name /...sicr.‹ /l/ m 4 j 9 JZ Print Name
Bef`e � J Before me
this ay of 21 this Day of ,20
N. Public r , Notary Public
�, ;,,,JENNIFER WALKER
MY COMMISSION t FF 011480 Revised 01.26.10
' ? - EXPIRES:April 24,2017 W-
�•" q/ Bonded Thru Nolery Public Underwrilo�R
�sLar,- .,
FILE CO PY
' ,. `° CITY OF ATLANTIC BEACH
V 'J%WNER / BUILDER AFFIDAVIT
\.....4.2_. it
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 THOUGI-I YOU DO NOT IIAVE 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.
`el w 3 ra, SIT. Arz. ,,7Je et-"oil 90 V V 6 —9 51/.6
ADDRESS PHONE NUMBER
,.i M r.. ', i ,J
PRI ,ri h3hr
�'�'��i��l � 7'I NAT RE • DATE
i � ;�
Before me this day of 215n the county of
Duval,State of Florida,has personally appear d erin by himself/herself and affirms that
all statements and declarations are true and ac rate.
Notary Public at Large,State of PL ,County of r- ___._)_Igetj
prod°u edyll entirrcation_ m 5 3 5— !5_/ —lv 0— Ss--<0
"�Y°v JENNIFER WALI�R
,1�;I ', , 1 =R MY COMMISSION#fF011480
Notary Signat �I•�L�/1� r�, *=
_ ,:��,;P EXPIRES:April 24,2017
`.;p'it°,.• Bonded Thru Nasty Public Underwriters
F:BLDGlOwner•Builadavit;REVISED: 4;16,2009 tt
. __i;,//;,+ City of Atlantic Beach
Building Department APPLICATION NUMBER
;, 9 p (To be assigned by the Building Department.)
t..< f 800 Seminole Road /�� S/ ^ .. ��
•
Atlantic Beach, Florida 32233-5445 'J
Phone(904)247-5826 • Fax(904)247-5845
`f7��;09)-• E-mail: building-dept @coab.us Date routed: 9 �c3 /.5-
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 90 a) U Ii Department review required Yes o
Buildin
Applicant: 0 a)-n 4 Planning &Zoning
Tree Administrator
Project: r)) _ f 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 70
Florida Dept. of Environmental Protection /(G n -
Florida Dept. of Transportation O v
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: ['Approved. ['Denied.
(Circle e.) Comments: //
a C G i`�1 4 #r y PT O llrt -) ill S�'c-t'j � !t`1?).„...
(BUILDING
PLANNING&ZONING Reviewed by: `t . Date: /'it;''/
TREE ADMIN. Second Review:
['Approved as revised. LI ied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10