336 7th St - Siding Permit -j 1
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''' ` \� \ CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
JIF "" — ='' 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: 16- SIDE -437
Job Type: SIDING PERMIT
Description: siding over coquina
Estimated Value: $5,570.00
Issue Date: 2/22/2016
Expiration Date: 8/20/2016
PROPERTY ADDRESS:
Address: 336 7TH ST
RE Number: 169893 -0000
PROPERTY OWNER:
Name: JOOST JR, HOBART H
Address: 336 7TH ST
PERMIT INFORMATION:
FEES:
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
BUILDING PERMIT FEE $77.85
Total Payments: $81.85
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
6 -2,5 -2-c( BUILDING PERMIT APPLICATION 4..;c.
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CITY OF ATLANTIC BEACH C-(-14: 1� t�`
800 Seminole Road, Atlantic Beach, FL 32233 /
Office (904) 247 -5826 Fax (904) 247 -584 0` 4.5.1--(1,11-1
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Job Address: 33 6 7 SI., Permit Number:
Legal Description R S 3'7 V/1 i .i Pe. . - Parcel # I • q8• -••,..
Valuation of Work $ 5 G> " Proposed Work heated /cooled ZS 4 ; non - heated /cooled 3 / q5
Class of Work (circle one): New Addition lteratio Repair Move Demolition pool /spa window /door
Use of existing /proposed structure(s) (circle one): Commercial esidential
If an existing structure, is a fires yinkl� er s stem installed? (Circle one): N /A
Florida Product Approval # 13( Q1 . L
For multiple products use product approval form
Describe in detail the type of work to be performed: (Jfc t
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Property Owner Information: jsS`h - VIP �Q ✓►Ef
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Name: f fCb G (�- b. J rt J e- 3 S �� j�
City {-\ `� Address:
c State FCZip 32Z5 j Phone clog - 24 j _a6 q
E -Mail or Fax # (Optional)
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 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
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
pr ovisions of any other federal, state, or local law regulating construction or the performance of construction.
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Signature of Owner lt11.�1 ,1 4, Signature of Contractor
'Tint Name
'MST ( ., Print Name
AO
3efo : • e
/�1 Before me
his r II. of G 20 . this Day of , 20
lotaly PU i ' 't► Notary Public State of Florida
, Shirley L Graham Notary Public
� �� My Commission FF 086990
'�F OF : Expires 02 /1•/2018 Revised 01.26.10
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A. • , CITY OF ATLANTIC BEACH
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I J % WNER / BUILDER AFFIDAVIT
ors Vr v
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.
331 7 .5L, Yd Li - S - 01 -1 1 - 1q - S
ADDRES
PHONE NUMBER
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PRINT OA ik
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SIGNATURE z./
+� ' / / DATE
Before me this [ 4day of 20 the county of
Duval, State of Florida, has personally appeared herin by him elf / herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large, State of ft- , County of a, � (........._.a.
, 0� , �P / ersonally Known
{.,►produced Identificatio L
7K�// , Ail j � � P� Notary Public State of Florida
Shirley L Graham
Notary Sign ' ' '/ T ; My Commission FF 086990
Q 4 A O* Expires 02114/2015
F:/ BLDCa/ Owner- Builder Affadavit; REVISED. 4/]6/2009 i -3e / - 4 -