664 BEACH AVE - BATH REMODEL ' S, CITY OF ATLANTIC BEACH
Plk 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
J� v INSPECTION PHONE LINE 247-5814
�t J1il9r
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-RAAR-2333
Job Type: RESIDENTIAL ALTERATION
Description: BATH REMODEL
Estimated Value: $8,000.00
Issue Date: 10/5/2015
Expiration Date: 4/2/2016
PROPERTY ADDRESS:
Address: 664 BEACH AVE
RE Number: 170128-0000
PROPERTY OWNER:
Name: MELANCON, DEJEAN JR & LAURIE, *
Address: 664 BEACH AVE
PERMIT INFORMATION:
FEES:
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
BUILDING PERMIT FEE $90.00
Total Payments: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND "I HE FLORIDA
BUILDING CODES.
11
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Fax(904)247-5845
Job Address: ( ,4L' 6,4e4 A V6:1'Jt? Permit Number:
Legal Description Parcel#
Valuation of Work$ Floor Area of Sq.Ft. t
Propos Work heated/cooledY7 non-heated/cooled
DOD •
Class of Work(circle one): New Addition Alteration : - .. Move Demolition pool/spa (�.vindow/door
Use of existing/proposed structures)(circle one): Commercial Residential 1/ `�
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes N/A
Florida Product Approval #
For multiple products use product approval form
escr' • • - ,• . •e o 3 • .e per orme.. _.j -• ,ai-..�r .i�!� = =" ' J - -
Altiewyry
• r 4 I ation;
•
Name: I 1.,A&. GP Address: � Ar . A Al Gj�I-C6•City ... . State Zip Z' 5 hone — ,_ � Wiff
E-Mail or Fax#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name:
Address: Qualifying Agent:
Office Phone City State Zip
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 per formed 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 Electrical Work,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 I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
ppe 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
r•ovisions of any other federal,state, or local law regulating construction or the performance of construction.
I .
signature of Owner i L Signature of Contractor
AI
'rint Name 7 fi
— e C 1 Gt rt 1 Print Name
3eforpp- O Before me
:iis ■ Day ,f IF Ali this Day of
4.50 f .:t.of Florida 20
/ - , Shirley L raham
Iota%'u.is Notary Public
�cfo�'� Expires 02/14/2016
Revised 01.26.10
CITY OF ATLANTIC BEACH
9 OWNER / BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
I)IS('I,OSURF STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES:
STATE LAW REQUIRES CONS'T'RUCTION 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 Al'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 I,AW 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.
1) F-)e,tch AV 1°Z. - 2 .2r0 75—
ADDR f__ PHONE NUMBER
Az-by-
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PRIM ME
At 41_(41.10 -- ( 5 Zit j
SIGN TURE DATE
Before me this day of 6 c/ 20fn the county of
Duval,State of Florida,has personally appeared herin by imself/herself and affirms that
all statements and declarations are true and accurate./
Notary Public at Large,State of [ ,ACounty of J�-
❑P ally Known fl j
roduced Iden -■'. lJ
Notary Si.natu - LAV
F 43LDC'Owncr-Builder Affadavir.REVISED. 4/S