83 GARDEN CT - WINDOW CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
\+j ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-WIND-450
Job Type: WINDOW AND/OR DOOR
Description: GARAGE DOOR
Estimated Value: $1,935.00
Issue Date: 2/29/2016
Expiration Date: 8/27/2016
PROPERTY ADDRESS:
Address: 83 GARDEN CT
RE Number: 169716-0050
PROPERTY OWNER:
Name: BIAFORA MICHAEL F & CAROLYN M, *
Address: 83 GARDEN CT
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $29.84
BUILDING PERMIT FEE $59.68
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $93.52
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
01 Pit City of Atlantic Beach
Js a� Building Department APPLICATION NUMBER(To be assigned by the Building Department.)
r.� � � 800 Seminole Road
�� � Atlantic Beach, Florida 32233-5445 lb — / 4 -Phone(904)247-5826 • Fax(904)247-5845 v
01119'" E-mail: building-dept @coab.us
City web-site: http://www.coab.us Date routed: Z. 2 Z
APPLICATION REVIEW AND TRACKING FORM
Property Address: j.3 9iTd7 D- • - II ent review
required Yes No
OA) �� e Buildin•
Applicant: anning &Zoning
/� Tree Administrator
Project: Public Works
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: <Droved. ['Denied.
one.) Comments:
DING
PLANNING &ZONING
Reviewed by: Dated c2V6
TREE ADMIN.
Second Review: ❑Approved as revised. ['Dent .
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY •
Reviewed by:
Date:
FIRE SERVICES Third Review: QApproved as revised. ['Denied.
Comments:
Reviewed by: Date:
tevised 07/27/10
I
i
I
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904)247-5845
Job Address: . 3 G fl(LO't N C:1— /Permit Number: -u//1V 0—4/5-0 Legal Description 16 9 ") 16 — 0 o 'v Parcel#
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$ i 1 Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair • - Demolition pool/spa indow/do r
Use of existing/proposed structure(s)(circle one): Commercial ' -sidential
If an existing structure,is a fire sprinkler system installed? (Circle one): - 41, N/A
Florida Product Approval # iS a.."7 qi 6 0_....,
For multiple products use product approval form
Describe in detail the type of work to be performed: 12E r LA a 1 k 7 G A 0.--116 D 6 d (LS
Property Owner Information:
Name: Si`/A ( Q 40 -A MS Address: 7,-; GA 2.0 Et- '-
City N LA rTTi c 13€�cir1 State Zip 31233 Phone 3 it 513 SRS'
E-Mail or Fax#(Optional) c-tv <.(1- . c 1 4 �r,S c�j rnc,► -Cc rv\
Contractor Information: ............
Company Name: Qualifying Agent:
rECEOVEil Address: City State ZipOffice Phone Job Site/Contact Number FB Z 2016
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 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 ElectricalpWork, 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 re.. 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 complis. ith whether specified he ein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other feder' tate, or a1 law re: • ng construction or the performance of construction.
Signature of Owner 4 Signature of Contractor
Print Name giVAIC1 - 6Df1'/112.5 Print Name
Swo r : • ubscribed before me Sworn to and subscribed before me
th.: :; of .40a 20 /(P this Day of ,20
446 gra
•a r. Public . ptti No ary�AL G fate of Florida
�t1. Sn,r,ey t Graham Revised 01.26.10
o71 o
FOfq Expires My com02m2!14/2018 n FF 086990
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CITY OF ATLANTIC BEACH COPY
Jb '�%WNER / BUILDER AFFIDAVIT
•D;s
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.
2 1 3 G 20- C—t-- 1 4,3 3zz, 3 317. SC S FS9
ADDRESS
PHONE NUMBER
7 A 2 C 40/9 n'1
PRI N� C '
/
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SIGNA
y //^^ DATE
2-2—day Before me this of 20/hn the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are true accurate. 1`
Notary Public at Large,State of ,County of
P rsonally Known 'rte � Y INt. Notary Public State of Florida
uced!dent' ,,.n. Shirley L Graham
!!!!!!!"��� d 4 �4 My Commission FF 086990
of � Expires 02/14/2018
Notary Signatur,
F:BLDG/Ov,er•Buildcr Afradavit;REVISED:4/i• .,./7 !