664 BEACH AVE - WINDOW ;. - '_s, CITY OF ATLANTIC BEACH
' : - J'
800 SEMINOLE ROAD
j ;r ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
-1'740.219'r'
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-WIND-2343
Job Type: WINDOW AND/OR DOOR
Description: WINDOW AND DOOR - REPLACEMENT
Estimated Value: $2,000.00
Issue Date: 10/13/2015
Expiration Date: 4/10/2016
PROPERTY ADDRESS:
Address: 664 BEACH AVE
RE Number: 170128-0000
PROPERTY OWNER:
Name: MELANCON, DEJEAN JR & LAURIE, *
Address: 664 BEACH AVE
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $30.00
BUILDING PERMIT FEE $60.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
S y�,y jy City of Atlantic Beach APPLICATION NUMBER
Building Department (To he assigned by the Building Department.)
800 Seminole Road ,
Atlantic Beach, Florida 32233-5445 5—`v∎1 t n Z2.
Phone (904)247-5826 Fax(904)247-5845 / /_ J l
wow:— E-mail: building-dept @coab.us Date routed: 0/67 l
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 66 4 E-Ro_K Department review required Yes o
(� o v1/40 &K__
(Building
Applicant: IMC—,�EP<<V I \EE NCoc Planning &Zoning
Tree Administrator
Project: \I\\ 1 N SO 0 CD 2— Public Works
Public Utilities
! GP INCE Public Safety
Fire Services
Review fee $ __ Dept Signature
Review or Receipt Date
Other Agency Review or Permit Required 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
Reviewing Department First Review: Approved. ❑Denied.
(Circle one.) Comments:
BUILD►
PLANNING &ZONING Reviewed by: n Date: /C7'/o`/
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ID Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
BUILDING PERMIT APPLICATION !I rI py CITY OF ATLANTIC BEACH I h
800 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904)247-5845 1 5-W I iV 1 -2 34 3
Job Address: (a(J/ 6, <i. I\Vt/A,./t(6 Permit Number:
Legal Description Parcel#
Floor Area of Sq.Ft. q t
Valuation of Work$ )1'1040 Pro Proposed
Work heated/cooled p Bated/cooled_ fJ�7 non-heated/cooled
-
2 oo .
Class of Work(circle one): New Addition Alteration epa. Move Demolition pool/spa indow/door
Use of existing/proposed structure(s)(circle one): Commercial Residential v
If an existing structure ,is a fire sprinkler system installed? (Circle one): Yes o N/A
Florida Product Approval# -
For multiple products use product approva orm
Desc •.- • . - .i , _ .4.e of work to be performed: A, `4-g_ Ø a►Gw.-1_;,,_ C/ - _
WlLIcE �' �-.... - ♦1 Arillr.-
. r ._= d /
r • e • er nformation: -
-�- t� GU�11 cName: ✓ r/_ ! Address: "A _ A A Ail Agte
City ..M ZV Stat- Zip i,:'hone - ,_AZ `'ii /S/
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 work and installations as indicated. I certij,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 Electrical'York,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 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
9rovisions of any other federal,state, or local law regulating construction or the performance of construction.
signature of Owner /
_ Signature of Contractor
T V int Name !dam / feJJCLPJ Print Name
lefore Before me
its �_ = P4 mar),�i�.I�ii 20 this Day of ,20
), Shir ;,,
lotary 'u i+ Expires 0 A 2018 Notary Public
- 3 '2 19 a Revised 01.26.10
rtt , 1.
`dj CITY OF ATLANTIC BEACH r,,, ,!R4 .p 9
° ~0 OWNER / BUILDER "`�.." `.- _ il
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 TFE 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 1lIIS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULA'T'IONS. 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-E be r / 4l O 5°9-74
ADDR ,._. PHONE NUMBER
LLe__)e i ! /frg* /
PRINTNQME ,4
l� _ ,�r? Dom----` O( '. ..I 7,q—V5
SIG N'TU R E DATE
/yam— ^
Before me this day of b t. . .20 n 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 !,./`- ,County of % Cv
❑Pe ally Known I rki
roducedIden� L•i FJ
Notary Si•nature://AV A
E'/DI.DC/Owncr-Builder AfTdavit;REVISED: 4/0.