543 AQUATIC DR - SIDING I y�1yr' `� CITY OF ATLANTIC BEACH
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- ■.f 800 SEMINOLE ROAD
j -- .'j ATLANTIC BEACH, FL 32233
\ INSPECTION PHONE LINE 247-5814
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SIDING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-SIDE-2767
Job Type: SIDING PERMIT
Description: SIDING
Estimated Value: $2,000.00
Issue Date: 11/30/2015
Expiration Date: 5/28/2016
PROPERTY ADDRESS:
Address: 543 AQUATIC DR
RE Number: 171818-5326
PROPERTY OWNER:
Name: Fulton, Jeremiah
Address: 543 Aquatic DR
PERMIT INFORMATION:
FEES:
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
BUILDING PERMIT FEE $60.00
Total Payments: $64.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
OITICE COPY
c yLYr,,
�`' CITY OF ATLANTIC BEACH
I3%WNER / BUILDER AFFIDAVIT
;f EP'
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 $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826)IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
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ADDRESS n PHONE NUMBER
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IGNATURE DAT
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Before me this day of r 20��in the county of
Duval,State of lorida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate. I
Notary Public at Large,State of �J L- ,County of—N....)VA I ,,,,,nu,,,
0.0-"Y N AUTUMN M SIMMONS
❑Personally Known \{(� i ( j ) Notary Public`� My Comm.Expi8
am
''',,orno,,•' Commission #FF 124116
�►/� 4--/-v��-- �„ ,,,,Notary Signature: i �/ . - ' .. - k r ► --•F:BLDG/Owner•Builder Affadavit;REVISED.4/16/2009
•
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH OFFICE COPY
800 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904)247-5845 c 76 7
Job Address: 513 A1UAT/c, bL)rE Permit Number: /S-S,DE-
Legal Description 3 - 7 I I i -,3S -a9 E 6c�ct, ,c Wp rctIms Parcel# I-4)I- .Z.7 - C .
Valuation of Work$ 0D� Poor Area of ? Sq.Ft, q t
Proposed Work heated/cooled C non-heated/cooled C
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/pro osed structure(s)(circle one): Commercial sidentia
If an existing structure,is a fire s rinkler system installed? (Circle one): Yes N/A
Florida Product Approval# 1i —
For multiple products use product approva orm
Describe in detail the type of work to be performed: Aa/aCL '' f-r,o ev-- s i'cl ke b r -L-tt
E
ck
Q s . 1) hour.
Property Owner Information:
Name: J€P-4, 7iM /C-dilOVI Address: 5513 4 Q/,t9T/C. ae/yt"
City L/f/ 1,c 8u,,e47 S�a Zip SZ -33 Phone (9D'/) 3/Z — 95'70 — — —
E-Mail or Fax#(Optional) //i,-,_ p 0 yp
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: Qualifying Agent:
Address: City State Zip
Office Phone Site/Contact Number Fax#
State Certification/Registration it
Architect Name&Phone# -A.
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 cerlif,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 16)months at any time after
work is commenced I understand that separate permits must be secured for ElectricalWork,Plumbing,Signs, Wells,Pools,Furnaces,Boilers,Healers,
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 ert fy that I have read and examined this application 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 o not. The granting of a permit does not presume to give authority to violate or cancel the
'rovisions of any other fede • ,state,or local law regul• mg•• truction or the performance of construction.
Signature of Own // ,40146..a// Signature . Contractor
'rint Name A e., -yl IA4j R 4a Print Name
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Before me
1is ,; I 0 S
11) ,,,.��, ,,,, this Day of
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. r<L� � ° r •CAF`- : 1 orida
lo ."' 'ubl 1P�r� o, My omm.Expires May 18,2018 Notary Public
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1 ,ti ip'� Commission # FF 124116
Revised 01.26.10
s=+;��r City of Atlantic Beach
�.' ��� APPLICATION NUMBER
i) ' Building Department
-- �'�l 800 Seminole Road (To be assi red by the Building Departure t.)
�' Atlantic Beach, Florida 32233-5445 ��-�f 7 7
Phone(904)247-5826 • Fax(904)247-5845
09 E-mail: building-dept @coab.us Date routed: AjeV ,
City web-site: http://www.coab.us . •
APPLICATION REVIEW AND TRACKING FORM
Property Address: 3 __3 /4 /n hC nt review required Yes o
Building
Applicant: £ GO -)18 arming &Coning
Tree Administrator
Project: re^ 1-) 1--Efikcc.A. c.,f 7 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
Reviewing Department First Review: proved. ['Denied.
(Circle one.) Comments:
U
PLANNING &ZONING
Reviewed by: ill Date:/l'3/5r
TREE ADMIN. Second Review: @Approved as revised. OD ied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
• PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: QApproved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10