702 KESTNER RD - INTERIOR REMODEL A ,it, , .
is;s A CITY OF ATLANTIC BEACH
,.. : ,,,. .r j 800 SEMINOLE ROAD
!� - ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-RAAR-2186
Job Type: RESIDENTIAL ALTERATION
Description: INTERIOR REMODEL - NEW KITCHEN
Estimated Value: $7,500.00
Issue Date: 9/18/2015
Expiration Date: 3/16/2016
PROPERTY ADDRESS:
Address: 702 KESTNER RD
RE Number: 172382-0000
PROPERTY OWNER:
Name: TWARDZIK, JONATHAN, *
Address:
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $43.75
BUILDING PERMIT FEE $87.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $135.25
PERN1I I IS APPROVED ONLY IN ACCORDANCE WI III ALL CI I OF A'l LANTIC BEACH ORDINANCES AND TIIE FLORIDA
BUILDING('ODDS.
rs==L‘Jr�A City of Atlantic Beach
d t Building Department APPLICATION NUMBER
Si 800 Seminole Road (To be assigned by the Building Department.)
u _, Atlantic Beach, Florida 32233-5445 Is - RP,
Phone (904)247-5826 • Fax(904)247-5845 - ��
"L�;iJ�'' E-mail: building-dept @coab.us Date routed: 9
City web-site: http://www.coab.us /« ��S
APPLICATION REVIEW AND TRACKING FORM
Property Address: '7 O Z. K GSTNER R.b De ent review required Yes o
dwN E uildin V
Applicant: J pNNATC-IAIN TWARpZIK Manning &Zoning _
Tree Administrator
Project: 1N`rc RI 02 _ K I-rCi-tEN..) Public Works
R G M o p E L_ Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified By Date
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
Reviewing Department First Review: roved. ❑Denied.
(Circle one.) Comments:
BUILDING
/Voci
C
PLANNING &ZONING
Reviewed by: Date: (777'/
TREE ADMIN.
Second Review: []Approved as revised. ❑De led.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
1 PUBLIC SAFETY Reviewed by:
Date:
FIRE SERVICES Third Review: [Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
revised 07/27/10
BUILDING PERMIT APPLICATION r '�i 7 ..
CITY OF ATLANTIC BEACH I1.`.. �✓ u
800 Seminole Road, Atlantic Beach, FL 32233
Office(904)247-5826 Fax(904)247-5845 1 5 -RkkR-Z 18 Cc'
Job Address: 70 2— /'5IIA/ Permit Number:
Legal Description Parcel#
Valuation of Work$ fie . °c Floor Area of Sq.Ft. t
Proposed Work heated/cooled /9 -1D non-heated/cooled
Class of Work(circle one): New Additio• `Alteration Repair Move Demolition pool/spa ndow/doo
Use of existing/proposed structure(s)(circle on• . ommercial 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-orf
Describe in detail the type of work to be nerformed: AL 1__:
...
Property Owner Information: = _
Name ,J J M. 4)1-1 Address:
2
7Z0-
t-e- .City � *• aw Zi' Phone 1 i - c tit -El 64-E-Mail or Fax#(O Ptional) a�W��,Sp S DC3>
Contractor Information: CONTRACTOR
EMAIL ADDRESS:
Company Name: Qualifying Agent:
Address: City State
Office Phone Job Site/Contact Number Zip
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 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(6)months at any time after
work is commenced. I understand that separate permits must be secured for ElectricalWork,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 YO'uR NOTICE OF
COMMENCEMENT.
I hereby cert that I have read and examined this placation 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
'rovisions of any other federal,state, or local law re 1. •ting construction or the performance of construction.
signature of 0 `,►�t�
�� Signature of Contractor
'rant Name apy,1 ���
AV . V •7-0- Print Name
3efouwie Before me
his l Day of ' , .4.4,. be.r ,20 13
this Day of ,20
/AL '=r-
/ : ■ / r��t DONNA L BARTLE
rotary 'ublic '4' ••
tf£.:: _. Ex�iaESSSrota� re Notary Public
!I "4:xl,, • Bondetl Tim Notary Public Underwriters
• Revised 01.26.10
r(�Lypr �w�, I'.. ^r ow
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=, e . '9 CITY OF ATLANTIC BEACH J �'
s
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�s• II%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 I-IAVE 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.
702____ r1.- yz._` j _7\7 - 1'—i -S°16/ASS PHONE NUMBER
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PRINT NAME
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Before me this /C4-is day of 4kber 2015 in the county of
Duval,State of Florida,has persona Ay appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of FL ,County of 01t.Ir4, I
❑�rsonatlyKnown I'bL -r .).-, Lv"1 _73..1 i-O tii!� 1 DONNAL BARTLE
Id Produce I rP �T-�V >S •° .,
Produced Identification-
j� :.: r!l :+'= MY COMMISSION 4 FF 018392
A/WA ��� �v .;p EXPIRES:May 14,2017
pf h Bonded Thtu Notary Public Underwriters
Notary Signature:
F:BLDG/Owner-Builder Affadavit;REVISED:4/16/2009