467 Whiting Ln alteration permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ALVOTHER
MUST CALL BY 4PNI FOR NEXT DAY INSPECrION: 247-5814
JOB INFORMATION:
Job ID: 16-RAAR-2132
Job Type: RESIDENTIAL ALTERATION
Description: install hardi-plank lap siding - 500 s.f.
Estimated Value: $1,500.00
Issue Date: 9/27/2016
Expiration Date: 3/26/2017
PROPERTY ADDRESS:
Addnass: 467 WHITING LN
RE Number: 171435-0000
PROPERTY OWNER:
Name: BELL ET AL, CHERYL A
Address: 467 WHITING LN
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $28.75
BUILDING PERMIT FEE $57.60
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $90.25
PERNIFT IS APPROWD ONLY IN ACCORDANCE WITH ALI, CTCY OF ATLANTIC BEACH ORDINANCES AND �E FLORIDA
BUILDING CODES.
City-"tiantic Reach APPLIOXFON NUMBER
Building Department (To be assigned by the Building Department)
800 Seminole Road
Atlantic Beach,Florida 32233-5445 1 10-i-A A ?_-w 3A
Phone(904)247-5826 Fax(904)247-58,15
E-mail: building-dept@wab.us Date routed:
Cityweb-ste Ntpl/.wabus
APPLICATION REVIEW AND TRACKING FORM
Property Address: Department review required Y -No
Buflcilin�
Applicant: anning &Zoning
a Administrator
Project: *A4Jj_pL&AV PublicWorks
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
De
Pla
Tre
Put
Other Agency Review or Permit Required Review or Receipt
of Permit Verified By Date
Floncla Dept.of Environmental Protection
Modica Dept.of Transportation
St.Johns RiverWater Managernent Distnct
Amy Corps of Engineers
Division of Hotels and RestaTraWs
Mision of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: VApproved. E]Demed.
(Circle one.) Comments:
(!H5)
PLANNING&ZONING Reviewed by: /71 QI,, Date:
TREEADMIN. Second Review: E]Approved as revised. E]Denied.(/
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date
FIRESERVICES Third Review: E]Approved as revised. E]Denied.
Comments:
Reviewed by: Date
Rovis.d 071VII0
BUILDING PERmrr APPLICA
COIR$l
,�, 11 AILANTIC BEAC 22-
ma
OFFICE Seminole Road,Atlantic Beach FL 3223
I Office; (904)247-5826 - Fax:(904)247-584
JobAddress: w0itir4u 6j!A .
PermitNumber:
Legal Description RE#
Valuation of Work(Replacement Cost)s_Lrj�,oO H,,tdlc,,Id SF_Non-Heated/Cooled
• Class of Work(Circle one): New Addition (� Repair Mow Derno Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Residential
If an existing structure,is a fire sprinkiff system installed?(Circle one): yes No N/A
Submit a Two Removal Permit Application if my trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed: j,.j.4 rsUL 914 R-JD I P/ 4,J4
A4(j T�glv %V /�F-
Florida Product Approval# multiple products use product appmval loan
Property Owner Information
Name: A45vt J�lx"Poaolj Address: 444P '7 w9 i r7^/& kM .
City Anji)r&ne. c3e-H—State FI�Zil) %WZ313 hone 1011- 813- &1&3
E-Mail Ry"P&OGS tl IohtA—w - C a,—
OwnerorAgent (IfAg�,PowaofAMM�mA�y��R�ui�l__
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 NOTOE OF COMMENCEMENT.
Contractor Information:
Name of Company: Qualifying Agent,
Address: City State Zip
ny
Office Phone J0 1:tc/:C�p�" nmber
�rb
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Ph W-4-�
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0
Worker's p on
�empt I Insurer I Employees txpunum vate
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Stg tura of Pro
Before me
Ilus ZZ_Dy
Notary Public
I hereby certify that lhave read and examined this appl tion ad know the same to be true andcoreect. Allprovisionta(lawsand
ordinancesgoverni,n this type Zwork will be cumphe ' whether specyed herein or not. The granting ofa peraut does not
)F
a e
presume to give out ority to via ate or cancel thelmvisiom;of any otherfe eral, state, or local law regulating construction or the
performance ofconstruction.
Rev.3/14/16
OFFICE COPY
no CITY OF ATLANTIC BEACH NJ
%so
Ud,�74 OWNER/ BUILDER AFFII)A
10
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART NS 5CTIO:N��
CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW
DISCLOSURE STATEMENT FOR SECTION 489.103U),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 14AVE 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 TIES 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 14AVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENS
ORJJkANi
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKERS 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(l). 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
OVgNER-BUILDER PERMIT,
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ADDRESS PHONE NUMBER
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SIGNATURE DATE
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.1,statements and declarationsam"a and accurate — I
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