1844 OCEAN GROVE DR - WINDOW (2) I
'' Js, CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
� �'gr y ATLANTIC BEACH, FL 32233
J:
INSPECTION PHONE LINE 247-5814
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WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-WIND-1591
Job Type: WINDOW AND/OR DOOR
Description: install new energy efficient entry door and low E windows
Estimated Value: $8,000.00
Issue Date: 8/5/2016
Expiration Date: 2/1/2017
PROPERTY ADDRESS:
Address: 1844 OCEAN GROVE DR
RE Number: 169627-0000
PROPERTY OWNER:
Name: STEELMAN, HARRY & KATHRYN, *
Address: 1932 SUGARTOWN RD
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $45.00
BUILDING PERMIT FEE $90.00
Total Payments: $135.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Beach APPLICATION NUMBER
�s r Building Department (To be assigned by the Building Department.)
800 Seminole Road `1O., ` ,1 N Q_ `S- ,
Atlantic Beach, Florida 32233-5445 J"l
Iforl Phone(904)247-5826 • Fax(904)247-5845 O S
s• 9111)'- E-mail: building-dept@coab.us Date routed:
3.7)16
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 14649 O(Ja e Ci f OJ Q 01 • Department review equired Yes/6lo
` �$uildnt g
Applicant: \&(( (Y\ f(\ Planning &Zoning
1 Tree Administrator
Project: \ ('\3\ &\' 1 '`-t (tD)( Public Works
C1t\6-1).R'` S Public Utilities
()l 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:
APPLIC TION STATUS
Reviewing Department First Review: pproved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date: -2•/ k ,I 6
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. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
• oto- 11.)-;100 - IsGl
r
��Sr\,,Ff'��i\ BUILDING PERMIT APPLICATION
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ii,j
CITY OF ATLANTIC BEACH r r
800 Seminole Road,Atlantic Beach FL 32233 FLE ,...,,, , ,
,,,,0219',-
Office: (904)247-5826 • Fax: (904)247-5845
Job Address: f g 411- 0 Ce-ah, 21A1)'fan k'Jt i- 322,33 Permit Number: /6-11//40-15-91
Legal Description AOne,St6n,i 14h Q- d- Liz" RE# l 6 q 6 2 7 - 0060
Valuation of Work(Replacement Cost) $ O b o 0 Heated/Cooled SF 11+7 Non-Heated/Cooled krg y
• Class of Work(Circle one): New Addition Alteration Repair Move De Pool / Window/Door,
• Use of existing/proposed structure(s)(Circle one): Commercial Residential
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit oflNo Tree Removal.]
Describe in detail the type of work to be performed: __X--)23-V",-1 1 N e L.) .€P--`• v,d y Yo Te T e e/-A f G(ae)1 4./4
Poor-) („,Y)iAotoij 12,u,6' Wi‘hcAnlus
Florida Product Approval# 'L. l 52 13, 9 /FL -q 09, 2,1/ for multiple products use product approval form
Property Owner Information 'L i i ?20. 13
Name: TT15t,t-h, j-. 'S�e-e/bi'La/1 Address: fei-N- octay. iiip✓L Dil �✓�
City 6-f(cn..'-,tc_ Q Q�� State3LZip 3 2 & Phone C.f36J R 6/—L a S'0
E-Mail 1[5.]Celretia-n t l'etot, r'r• Con,. Ka*kr-
Owner or Agent (If Agent,Power of Attorney or Agency Letter Required)
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 0: . , ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
Contractor Information:
Name of Company: Qualifying Agent:
Address: City State Zip
Office Phone Job Site/Contact Number
State Certification/Registration - E-Mail
Architect Name & Phone#
Engineer's Name & P • e#
Worker's Compe .: ion
Exempt / Insurer / Lease Employees / Expiration Date
-
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation ha 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 tl ' jurisdiction.
This permit becomes null and void if work is not commenced within six(6)months, or if construction or work is suspended or ,.andoned for a
period of six(6)months at any time after work is commenced. I understand that separate permits must be secured for Electrica ork,Plumbing,
Signs, Wells,Pools,Furnaces,Boilers,Haters, Ti ks a/ �• Conditioners,etc.
Signature of Prop-rty o , er: / _ ._I�._. - Signature of Contractor:
Before me , .��
this Day of ♦WJ5
♦ ` rTore i :•t,.SPERGER D.► •f
,. ,., UEEA
Nota Public: .•%a•ry �1, ,
I hereby certifit that I have read and examined thi app ication and know the same to be true a d correct. All provisions of laws and
ordinances governing this type of work will be co : ed with whether specified herein or .t. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any other federal, state, or ocal law regulating construction or the
petfotmance of construction.
Rev.3/14/16
FA CITY OF ATLANTIC BEACH I I.
WNER / BUILDER AFFIDAVIT
".rIt
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.
&Ceet,,N J 62e,„4 (s34)q Zpqp
ADDRESS / f S � rn� , I PHONE NUMBER
)46- r L rs '
PRINT NA E / 4
/1 Zd (.6
SI NATURE D
Before me this��day of'S.J One ,262the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of F( ,County of 1„_)
gf-Personally Known 11111
❑Produced ldentifi .'on-
��Y::>y•• TONI GINDI.ESPERGER
WAR
MY COMMISSION#FF 924951
Notary Signature.
vir
a'• ;a: EXPIRES:October 6,2019
%�o n t3ondedThruNotaryPubVcUnerwrters
F:BLDG/Owner-Builder Affadavit;REVISED:4/16/2009
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