1060 Seminole Rd deck permit CITY OF ATLANTIC BEACH
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
30BINFORMATION:
Job ID: 16-DECK-2067
Job Type: DECKIPATIO
Description: repair aging walkway (3'x10') and dock (11'x13')
Estimated Value: $1,200.00
Issue Date: 9/23/2016
Expiration Date: 3/22/2017
PROPERTY ADDRESS:
Address: 1060 SEMINOLE RD
RE Number: 171975-0000
PROPERTY OWNER:
Name: NEVILLE B/E, ELIZABETH, '
Address: 1060 SEMINOLE RD
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $28.00
BUILDING PERMIT FEE $56.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $88.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
City ofAtlantin Ranch -. _ RPPNCkTiON NUMBER---—– ---
y l Building Department (To be assigned by the Building Department.)
r 800 Seminole Road 1
- $ Atlantic Beach, Florida 32233-5445 I _O a bt0 T
�. Phone(904)247-5828 Fax(904)247-5845 f,p
r.,�, E-mail: building-dept@onab.us Date routed: D I /I LI I I6
-- Cityweb-site'. httpalwww.coanus
APPLICATION REVIEWt� SAND TRACKING FORM
Property Address: IOIOD S Lffh1Ib lit- s..yt . DetpitilMent review required Ye No
�, ,N1 Building
b-i?-" h
Applicant: E\�1A N" ; 11 Planning&Zoning
Tree Administrator
Project: to AQa, Gkty4ja 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 Rver Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobsoco
Other:
APPLICATION STATUS
Reviewing Department First Review: Enpproved. ❑Denied.
(Circle one.) Comments:
BUILDIN p
PLANNING&ZONING Reviewed by: m Date: ! . �10-&
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:
Revievn:d by: Date:
ReWsad 07/27110
BUIL-Dim PERMIT APPLICA
CITY OF ATLANTIC BEACH ON A 2�
800 Seminole Road,Atlantic Beach FL 32233 SO
`Oif1p!
Office:(904)247-5826 a Fax:(904)247-5845
Job Address: /060 Sal-YLIKO�g 1 .. p mba: Ib- 6ELK—Q0(o+
Legal Description Rpm
Valuation of Work(Replacement Cost)$ Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repan Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Residenfi
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No /A
Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tice Removal
Describe in detail the type of ork to be pert, ieaa,, Ala ctq ;N9 GiCK OK oG LLS ,S LUX,
Dock -Ls I/tx /S`. )/Ang, O alkws y( 3'x d'
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: Ui/� Address: lO bb Se%tda
City State�L Zip 3ZZ S3 Phone_Cf Id- Z 4R -O 7-64-
E-Mail
//1rd7[iGl�i Lia�la �Lsfk Nlp-f
Owner Or Agent (VAgent,PowerofAaomey or Ageacy tater 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 OR AN ATTORNEY BEFORE
RECORDING YOUR NOTIdE OF COMMENCEMENT.
Contractor Information:
Name of Company: Qu . ng Agent:
Address: rtv State Zip
Office Phone Job Sit ntact Number
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Worker's Compensation
xempt usurer mp oyees pvahon ate
Application is hereby made to obtain a permit to do the work and imiallation,as indicated I rerdfy that an,work or installation has commenced
Rto the issuance of a permit and that all work will be performed to meet the standards ofa!!laws regulating construction in this jurtsdicuon.
This permit becomes null and void if work is not commenced within six(6)months, or ifconslruMion or work cs sus ended or abandoned((or a
Sigriodo(six 6 months at any time after work u commenced lunderstand[hatseparatepermltsmustbes.,kiforflednd o abandolrtmblrrg,
ns,Wells,/Pools,Furnaces,Boilers,Heaters,Tanks andAk Conditioners,etc.
Signature of Property Owner. P. Signatureof Contractor:
Before me
this J# Day of 0/ yo
:;T "• TONIGINDLESRERGER
Notary Publi MY COMMISSION B FF RW
a" � iQsioher 8,a119
A�•.k'..h. eo�harnrv�wary
I hereby certify that I have read and examined is application and know the same to be n'ae and correct. All provisions oflaws and
ordinances governing this type 0 work will be complied with whether speciRed herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any other federal, state, or local law regulanng construction or the
performance ofconsiructian.
Rev.3/14/16
h ?° CITY OF ATLANTIC BEACH
®WNER/ BUILDER AFFIDAVIT OFFICE COPY
L'
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING"REQUIRES OWNER i BUILDER TO ACKNOWLEDGE THE LAW.
00,WNERS
LOSURE STATEMENT FUR SECHON489.103(7),FLORIDA STATUTES;
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
LAW. THE EXEMPTIONALLOWSALLO SS. YOU HAVE PYOU,AS LIED FOR
IM OWNER OF OUR PROPERTY,TO ACA PERMIT UNDER AN EXEMPTION TO T AS
OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MII.c
RVISH THF CON TR ON YOIm YOU MAY BUILD OR IMPROVE A ONE OR
FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY gLSO BUILD OR
OVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THR B m DM
BB POR ypim IpAND OCCUPANCY. IT MAY NOT BU SELL OR LEASE A BUILDING YOU HAVE BUILT YOTHE CONSTRUCTION IS COMPLETE, THE LAW WII,L R SALE OR LEAS$ WH[CH ISM VIOLATION OF THIS EAN UNLICENSPD PERSON AS YOC NT lNE ACCORDING TO THE BUILDING CODES AND ZORESPONSIBILITY TO MAKE SURE THAT PEOPLE SES RFnfmRFD BV STATH LAW ANn By COi1NANCCE R IPAL LI(' �iC
IL 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,
W. 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 N T D DATE. 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.
Rd 9-04 z49 v,64
PRIrvT NAME v
4h1 DATE
Before me Mia=J_ Eey of pNlu u.� •p1 in the wuntyas
aII uwl,Sfete of Flcnda,bas personally PPaa¢ as by hi—Mfl bahyyudeKm,s Mat
sdleme,M antl dederad a...M..M ae aab.
Notary Publicet Large,Sfa County ofLca
�El PusonaMy known ; ' TONI GINDLESPERGER
❑P..d meninfaamn. '• MYCOMMIGSICN i FFkWl
. 8.. EX 9m XPIIENYay Pubk lHtlemiyra
Notary Signature
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lobo SEIt(No -F (LLD tJ
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OFFICE COPYy Illk
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- PROPERTY LINE
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LINE OF CURB . .'.PROP. LINE
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OFFICE COPY
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