316 6TH ST DECK STAIRS PORCH ai' ' 'sit,
f CITY OF ATLANTIC BEACH
74800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
' INSPECTION PHONE LINE 247-5814
RESIDENTIAL - ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: 16-RAAR-843
Description: REINSTATED 06/01/2017
Estimated Value: 15000
Issue Date: 4/18/2016
Expiration Date: 12/1/2017
PROPERTY ADDRESS:
Address: 316 6TH ST
RE Number: 169857 0000
PROPERTY OWNER:
Name: Shawn M. Burke
Address: 316 6th Street
Atlantic Beach, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name:
Address:
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB
SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
I
CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
RESIDENTIAL ALT /OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247 -5814
JOB INFORMATION:
Job ID: 16 -RAAR -843
Job Type: RESIDENTIAL ALTERATION
Description: remove belvedere add deck
Estimated Value: $15,000.00
Issue Date: 4/18/2016
Expiration Date: 10/15/2016
PROPERTY ADDRESS:
Address: 316 6TH ST
RE Number: 169857 -0000
PROPERTY OWNER:
Name: BURKE ET AL, SHAWN M
Address: 316 6TH ST 316 6TH ST
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $62.50
BUILDING PERMIT FEE $125.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $191.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
0 1 - n City of Atlantic Beach APPLICATION NUMBER
Js s d Building Department (To be assi ned by the Building Dep rtment.)
800 Seminole Road / - v
r f) Atlantic Beach, Florida 32233 -5445 /�
I� .
P hone (904) 247 5826 Fax (904) 247 5845 /
3 j9? E -mail: building- dept @coab.us Date routed / � /6'
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: •(=?I(J (Q7 ST ( __-DeP at&ment review required Ye No
Building
Applicant: d 1‘17 1 . & Zoning
,,,�,, ^ l p /1 Tree Administrator
f
Project: fflc , &/V (/ LE 4mi� £ n .. . . Public Works
Public Utilities
AIM q E /F r l �/ b 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: 11
BUILDIN
PLANNING & ZO NING Reviewed by: Date: - /' / S � 6
TREE ADMIN. Second Review: ❑Approved as revised. ❑Den d.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH _ •
800 Seminole Road, Atlantic Beach, FL 32233 ...r
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: 3 I& (0 Si', Permit Number: /6 X/Mie S 93
Legal Description Parcel #
- 4 Floor Area of Sq.Ft. r--- Sq. t 'n
Valuation of Work $ I7 , COO Proposed Work heated /cooled
non - heated /cooled & i 8 S
Class of Work (circle one): New Addition iteration Rep Move Demolition pool /spa window /door
Use of existing/proposed structure(s) (circle one): Commercial Residenti
If an existing structure, is a fire sprinkler system installed? (Circle one): o,_ N /A
Florida Product Approval # p -Roor e ye.. ec (--
For multiple products use product approval form 1�
Describe in detail the type of work to be performed: 440 a 1 ,/, CAP K-e CANCI Sitkir5 , i { fi e
Sroc vwv.) ofA9k TO C ckdcl CVO C- •
Property Owner Information: ,�'/
S \AA IV 4 P11v WA r E0 -LE Address'. 31 W (A
Name: Phone lb`t ` a -s 39
City t- '�rl�1tg'T'tt- 1:1(..-44 State'GLZip 3
E -Mail or Fax # (Optional) k",v'O do (6 P vv)e . c.o�►'v
Contractor Information: V
Company Name:
Qualifying :: - nt:
•
Office Phone
Address: City r _",�'" - r " "'_
Job Site/ Contact Num. - Ir1E ,_; (,*.l.. A lfa /f F State Certification/Registration # �11j 1 - 11
Architect Name & Phone # til
AP •
Engineer's Name & Phone # • I {u
Fee Simple Title Holder Name and Address
Bonding Company Name and Address -
Mortgage Lender Name and Addr .
Application is hereby made to o.. in a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance ofa permit and tha . work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
work is c I commenced understand (6) within
that separate permits mu permits be secured for Electri Wok, Plumbi S ig , a Wells, P o w Fu Boilers, Hea rs,
Tanks and Air Conditioners, etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR OBTAIN G TWICE E FOR IMPROVEMENTS E WITH
TO YOUR PROPERTY. IF YOU INTEND
YOUR LENDER OR AN ATTORNEY RECORDING YOUR NOTICE OF
COMMENCEMENT. th
s
I hereby ertify that I have read and examined this application and know the same 1 be true and correct. A e All o f an ity tonan g or an th
type of work will be complied with whether specified red herein or not The granting of P
provisions of any other federal, s : te, , r . 1 law regulating construction or the performance of construction.
Signature of Owner li► i / it<� / � • Print Name Signature of Contractor
.._.__...._._.......
Print Name Ali fi ` .•
Sworn • . Way sub 'bed be .re me Sworn to and subscribed .. •re me 20
y 20 . this Day of
this Y of � _ � ■ �11% ` I
Not. 7 ' 0 0 1 g...;..,.. := _ Notary Pit, MY COMMISSION # FF 92
EXP OctoPublic ber 6 U , nd 2 er ' writ s ers
Revised 01.26.10
3-;, e '
;,' of NO,•' Bonded Th u Noary
•
CITY OF ATLANTIC BEACH
FILE COPY
®vWNER / BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW f
DISCLOSURE STATEMENT FOR SECTION 4891 1
03(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
11 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 STALE 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. 1
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" 1S NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON JS A LICENSED CONTRACTOR_ TELEPHONE THE
BUILDING DEPARTMENT (247-5826) IF IN DOUBT_
•
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER - BUILDER PERMIT.
- 3 ) (0 (-0 n1 ZC I;L P NE N UMBE R
ADD ESS
PRINT I
1111 q
SIG •�j E DATE
Before me this \ ` day of ` 2t1Lln the county o/
Duval, State of Florida, has personal a,peared toe by himself 1 herself and ars tm. that
all statements and declarations are true and accurate. r
Notary Public at Large, State of County of v
❑ Personally Known o7--CD 4 0
SCAliCed � denti- -Callon (~-
Notary Signature: TONI GINDLESPERGE
i , '1: MY COMMISSION it FF 92
E:/ BLDG/ Owner- Builder Affadavit; REVISED: 4/16'2009 h'..5," h'..5," EXPIRES'. Oc
tober 6 2019
.
Bonded Thro Notary Public underwrit s