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364 6TH ST - DRIVEWAY ,�� = •S, CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD T. ATLANTIC BEACH, FL 32233 NorINSPECTION PHONE LINE 247-5814 DRIVEWAY PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 17-DWAY-3247 Job Type: DRIVEWAY Description: replace broken concrete with brick pavers and add brick paver walkway Estimated Value: $2,000.00 issue Date: 2/27/2017 Expiration Date: 8/26/2017 PROPERTY ADDRESS: Address: 364 6TH ST RE Number: None PROPERTY OWNER: Name: Chunn, Paula Address: PERMIT INFORMATION: UTILITY DEPT.: PUBLIC WORKS: Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible. A sewer cleanout must be installed at the property line.Cleanout must be covered with an RT1 concrete box with metal lid. Cleanout to be set to grade and visible. Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line (247-5814)to request an inspection from Public Works for Erosion and Sediment Control Inspection prior to start of construction. All runoff must remain on-site during construction. Roll off container company must be on City approved list(Advanced Disposal, Realco Recycling, Shapell's Inc.). Container cannot be placed on City right-of-way. Full right-of-way restoration, including sod, is required. Parking area pavers must be pervious pavers and installed on a sand/gravel base. PIA4Ipl#n.fiil'augvITi111( be n ionsit14eoargalirawi iatoto tbrelBolldin ,,Oe Iartmene.ORDINANCES AND THE FLORIDA Iil 11.U11\l.(.UI)I.J. , ' �sf CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD KIII r../ ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 \O.V. FEES: Fence/ROW $35.00 Total Payments: $35.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. A r= `fir, City of Atlantic Beach APPLICATION NUMBER + . Building Department ..,,,� (To be assigned by the Building Department.) At . 800 Seminole Road /n� ^ .F,? 3Atlantic Beach, Florida 32233-5445 "' - IJ rT�� - a_<-(1- Phone(904)247-5826 • Fax(904)247-5845 FEB 1 4 2017 Da 1 � II F oRl9r E-mail: building-dept@coab.us 1 i Date routed: 3 6 11'" City web-site: http://www.coab.us BY:_ APPLICATION REVIEW AND TRACKING FORM Property Address: 6(--k bt- a • Department review required Yes No Building . Applicant: OW().Q1( Planning &Zoning Tree Administrator Project: Ct Lia:, ( bnb'Lr' C- nLf t L I(Q laLL vJ (AN\ bn L-t- p 0104 SI Glia 10401 wig.owe ublic Public Safety Fire Services Review fee $ 1 Dept Signature ,fes, • 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: Approved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING ReviewedDivisi4/oDate: 2 t � ce TREE DMIN. Second Review: A roved as revised. ❑ pp ❑Denied. ORK Comments: PUBCt T Lf/ PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: 11 Revised 05/14/09 .51,A,��r._. City of Atlantic Beach APPLICATION NUMBER o' "\'•':,:,, Building Department (To be assigned by the Building Department.) 800 Seminole Road 11--p 4\( —- a-q s Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904) 247-5845 r'- •,/ E-mail: building-dept@coab.us FEB 1 4 2011 Date routed: Ca t (3111- City 3111- City web-site: http://www.coab.us % it APPLICATION REVIEW AND TRACKING FORM Property Address: OA b S Department review required Yes No Building Applicant: OkA)n f1-( Planning &Zoning Tree Administrator Project: it i.{)cut ( bi 1:x'L- -f' Ci3 AU L, L__ 11 QcLtLL ubii . A/ar , l bf Li_ P au%S4 " ,�a , ad ��I ublic Utilitie /�U� 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: ./Approved. Denied. e Ii9 T (Circle one.) Comments: a /5/Y/�G� (19- PO 4 BUILDING J TIS`"(/ K� PLANNING &ZONING Reviewed by: l, Date: 23//? TREE ADMIN. Second Review: ❑Approved as revised. ❑!/nied. 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 ' 30` (5‘' Lot I /..r0 x ‘r:r -- .ro 3.49-•r" x. . q 1z6/7 .Zf. 2", 'yql "pa 461,1vc2,,f- r- foo 6 61)M-1 X % f• 016a b ° of1rA147as X /o 1 0 KZ 01 x -3 30 4_ 7 adiA :qjy = 17e. J,Z2 69/44 04Apid mew- - gK -Jog - 70 .. o del/ o /, .r1 = /4 0 otro. r - R.O.W.Permit Attachment of for R.O.W.Permit# l',NM-3241 issued ,20 Atlantic Beach,FL 32233 Owner's Name: Property Address: Subdivision: R.E.#: REVOCABLE ENCROACHMENT PERMIT THIS REVOCABLE ENCROACHMENT PERMIT, issued on this t L7e- day of , 20 ( , by Atlantic Beach, Florida, a municipal corporatio rganized and existing undthe 1 of the State of Florida,hereinafter referred to as"CITY" and rcukt a U't iAhri of Atlantic Beach,Florida,hereinafter referred to as"USER". WITNESSETH: That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon the property of the City of Atlantic Beach for the purpose as described in the City of Atlantic Beach Right-of-Way/Easement permit numbers noted above(copies attached). This work is generally described as: f(..Jt()n� f ai Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to relocation or removal on thirty(30) days notice by CITY to the USER, said notice to USER shall be gi� by certified_ n�a�, r�eturn'�rece'gt, requested,� the following address: The depositing of said notice of cancellation in the United States mail shall constitute the notice of cancellation and the burden is upon USER to keep the CITY informed of USER's proper address. The USER shall promptly make any and all necessary repairs to any facility erected or maintained in the exercise of the privilege herein granted and shall at all times maintain said facility in good and safe condition. In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter upon the above-described property of the CITY, the USER shall replace at the USER's sole expense, any and all material necessarily displaced during the action of maintaining, repairing, operating, replacing,or adding to of the utilities and facilities of the CITY or franchise utility provider. The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes,Land Development Code,and all other land use and code requirements of the CITY,including City Code Section 19-7 (h) which states "Driveways that cross sidewalks: City sidewalks may not be replaced with other materials, but must be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks." Page 1 of 2 The USER, prior to making any changes from the approved plans and/or method, must obtain written approval from the City of Atlantic Beach, Public Works Department, for said change. The USER shall, at the discretion of the CITY, be requested to submit as-built drawings showing the change within thirty(30)days after the day of completion. This permit shall inure to the benefit of, and be binding upon, the USER and their respective successors and assigns. USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or specifications, to include utilities locate requirements and use limitations/requirements of public rights-of-way and other public land. USER further agrees that the CITY and its officers and employees shall be saved harmless by the USER from any of the work herein under the terms of this permit and that all of said liabilities are hereby assumed assumed by the USER. DATED and SIGNED this t5- day of ar ti&V1I ,20 f . By: U✓'�' lPf-�vL1'� ©o�v£ C. �-4 U N Pr erty Owner (to be signed in presence of the Notary) STATE OF FLORIDA COUNTYX DUVAL On this day of Fe, , 20 17, personallyappeared before me, a Notary l / pp Public in and fo s jid jupty and State, F(G� , the property owner of `�'S• ��E • , Atlantic Beach, Florida, known to me to be the person(s) desc '•ed in and who executed the foregoing instrument; who acknowledged to me that he or she ex. d the s. eely and voluntarily and for the uses and purposes therein mentioned. •. � �� G Notary Public in for sai a County an11 a �.'a r TONT GINDLESPERGER ' • MYCOMMISSION#FF"924951 o S: 6,2019 Bonded 7hruEXPIREIoa October y Public Underwriters CITY OF ATLANTIC BEACH,FLORIDA, a municipal corporation: Approved: /,A.421 Don.ld D. fob► tz,P.E. Public W',rks Director File: 12/12/16 • Page 2 of 2 I 'r'Sy�'`� BUILDING PERMIT APPLICATION JS l i = � CITY OF ATLANTIC BEACH FEB 1 3 DATE E:i;J 15 z i L-J `J';I� 800 Seminole Road,Atlantic Beach FL 32233 __ _ __ Office: (904)247-5826 • Fax: (904)247-5845 Job Address: 36' V 6 7//1 5476-Eli— 47149^/ 1 C /i/fC4ermit Number: I OW R`l - 3a`1 i Legal DescriptionRE# Valuation of Work(Replacement Cost)$ je° Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): New Addition Alteration Repair Move Demo 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 of No Tree Removal Des r> in d t it the type of ork o be perform'e .e>2�i � age' ev."e.6�ILI- d-'1-41 ".‘" ..4- aA,vC 4,-; # R,•c. P� S. • Odd /Zeiss /3/z,sck#0•9-',.,4- v— aCw41r n/l3,94./c tjo4,e,4.0 4dcr /Vo s5, • Pr9/zIt;—f✓1SCF0- /a- C/2iftE11xzo ' //2.t/c /41-✓f2 Florida Product Approval # for multiple products use product approval form Property Owner Information Name: P41 /4- ell,/ivnl Address: .764/ G7i,/ S 41 City (/4,v-I,L R3644/4 State /Zip 77 tf3 Phone 770 - yd z - 7 73 S- E-Mail PPS/✓-Ir C/,Iv•...•v Q./4-AL. N 6--i- 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 OR AN ATTORNEY BEFORE RECORDING YOUR NOTIdE OF COMMENCEMENT. Contractor Information: Name of Company: Ti9i 44.1£€ /f- .-' age,/, Qualifying Agent: Address: 97`/S 1.-c#744/ ,2o4 20'a7 City 74ekra,,,Y0- State Zip 2l j2-Z-4/6 Office Phone go4'-23hi-1Sa a Job Site/Contact Number State Certification/Registration # E-mail Pe.,m4,0/<V 7L/474., (A321/906, 6�ois.eV41 Architect Name & Phone# Engineer's Name & Phone# Worker's Compensation 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 has commenced Trror 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. his 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. 1 understand that separate permits must be secured for Electrical Work,Plumbing, Signs, Wells,PPools,Furnaces,Boilers, alers, Tanks and�Air,CConditioners,etc. Signature of Property Owner: Ol_,/e/1-f___ 46t/ — Signature Signature of Contractor: Before me this 7 Day of r-:---- ,e4...-02--,-- 1 7 Before me this Day of PETE`4� y MY COMMISSION#IFF 036608 S Notary Public: :.: . . Notary Public: ..,��;; EXPIHES:August ib,2017 pF ha o' Banded Thru Notary Punic Underwriters I hereby certifr that I h• -•• • • . •' ••• • • and know the same to be true and correct. All provisions of laws and ordinances governing this type of'work will be complied with whether specified 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 regulating construction or the performance of construction. d �L1�Ir CITY OF ATLANTIC BEACH CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS 800 Seminole Road 904-247-5800 oiiv,� Atlantic Beach,Florida 32233-5445 Fax 904-247-5845 PERMIT# PLEASE SUBMIT(2)COMPLETE SETS OF PLANS WITH APPLICATION. ' ( ( J ISSUES BY THE CITY Date rI Job Address ..D(4-'(-1..D(4-'(-1 �sn i"! (1J1 $(f LII E-mail aid ci tai if) Permitee: a_Uek �,�,�(,1.'l fi Telephone# 7)() `-to 77 3h Permitee Address: 3(.0t-1 7ri) 4 1i ML)- Requesting Permission to Construct: /L(,{'1( iQ t (A Location: (Reference to Cross-Street) (10--)T I St'tt.(Y9 7r� 1. Applicant declares that prior to filing this application he hastascertained the location of all existing utilities, both aerial and underground and the accurate locations are shown on the sketches. A Letter of Notification was mailed to the following Utilities/Municipalities: Jacksonville Electric Authority Yes ( ) No ( ) Date: Bell South Telephone Company Yes ( ) No ( ) Date: Ferrell Gas Yes( ) No( ) Date: Comcast Yes ( ) No ( ) Date: 2. Whenever necessary for the construction. repair, improvement. maintenance, safe and efficient operation, alteration or relocation of all, or any portion of said street or easement as determined by the Director of Public Works, any or all of said poles, wires, pipes, cables or other facilities and appurtenances authorized hereunder, shall be immediately removed from said street or easement or reset or relocated hereon as required by the Director of Public Works, and at the expense of the Permitee unless reimbursement is authorized. 3. All work shall meet City of A ntice h or Flo da k?eRart nt of Transportation Standards and be performed under the supervision of 4(Lt '-t fl. NAT a � (Cont tpq s grqject uperintyndent) located at J Telephone#: 4. All materials and equipment shall be subject to inspection by the Director of Public Works or his designee. 5. All city property shall be restored to its original condition as far as practical, in keeping with city specifications and the manner satisfactory to the city. 6. A sketch of plans covering details of this installation, as well as, a copy of a recent survey shall be made a part of this permit. Calculations showing any increase in impervious area on owner's lot or in the city Right of Way are to be included with this application. 7. This permittee shall commence actual construction in good faith with days. If the beginning date is more than 60 days from date of permit approval, then permittee must review the permit with the Director of Public Works to make sure no changes have occurred in the area that would affect the permitted construction. 8. It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right, title and interest in the land to be entered upon and used by the holder, and the Holder will, at all times, assume all risk of and indemnify, defend, and save harmless the City of Atlantic Beach from and against any and all loss, damage, and cost of expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges. 9. The Director of Public Works shall be notified twenty-f• r i• . . • '• , • -..'•,• ! and again immediately upon completion. " r'olt••. TONI GINDLESPERGER _,. •.: MY CCM1NiSSION#FF 924951 • ;.: EXPIRES:October 6,2019 OWNER '7; •°p' 3on9edThruNotayPublicUnderxr�ters 1,17 al/Lek_e/(AAAA___-/\_ Signed: uat=: �I Before me this J/( day of in the C.•n of Duval, State Of Florida, has personally appeared L ' A Notary P blic at Large, State of Florida, County of Duval. My com •ission expires: Personally Known: / r Produced Identification: G Revised 7129115 ^ c,D .7,i,:....•:,.12,1„..1,,...,..„..1..,.. ,,, „,„,..,. .,......:.;0. r mr .,.,, ...6i..; To, .qq,..i., „.„..._,..,....4 .41... ,,.,: .. ~��.....1--N,—,ply.'2...„---,••F-x.4.---`,—.,.-..:AN„...„.„,t7c2.4•.:•• Ptt,m--......00.-;:0,›IN / � . GRU: / - ����' / ��� X� "�= Pervious � �Ml��*rs ��~ � Ar r • Arf:',,tZil,04.:4Z:;:•itAti'14134e,'I-***4.1-14:;;;405t-Ifte.41,:ia401. -cc5-ifoiletx?- .J41;te•tM::::('Tici4.,-s: WO:r'4AW-"P.Zi",--`;VAT.ttifi 'e7:44--;1156t7.41fiki :41,02g4°1101?-4*-VA.,-A"r"...;:;'s•";*104ti.ligict-A:41;:'vAiz-8'' wi,.•-•_:._ -,:ki.V 11.4"...''',......=-V,;:*!.....f....Srcill:-••41.- 4..e.‘;:e.f-'4,gaci:11:.17;45 ", •st .iiiki.7"?',.....7N41;a.b.W._73:liq;••A;14L;:,'",4.‘•:' r.f- - 4-:","" ZArii4:44-'"e'fkiri--:ir.0".:- •:::::-:ft z;.7-11.,:•:Ci:; *-4.149111.3..".:** Ekt744.saire-t-41.1' •-'%""Iliti: .7er •e:,.-,•=lme•:• A;•,.. :.,.-.,,.....vy-:;;;,.'--..':?..i.A.. 1--....- -,.-• .:- 'frr. s4.1tiii.i'lk:..7.-...-,.:.,.. A*-tv...,4 :,,,:,0_,,,,.. ,-.0,-.V.,'.74„ii..,. The porous appearance of these units allows rainfall to directly enter and pass though because concrete has no fines. Like other povars, the units are fitted together over bedding, pea gravel is recommended. Sanding the joints is not recommended as this could clog the pavers. Porous units do not meet the requirements of ASTM C 936; however, these units have strength of 4,000+ psi with a permeability of over 40 inches per hour. The best Use is for pedestrian areas, bicycle paths, and residential applications. We offer pervious pavers in our 4x8, Old Towne' 6x9' and 6x6 profiles and in all of our standard blends. Some of the benefits; • Reduction of runoff by as much as 100% from frequent, low-intensity and short duration storms. • Increased recharge of ground wofur� • Biminofusflooding und puddling �npork�ng lots • Reduction or elimination of retention ponds " Conservation of space on site and reduction of impervious cover I More info is available at ICPI website; hff9://wwmicpiorq/dosiqn/oormeob|a _povars.cfm m Tremron Group, Arcadia (863) 491-0990 mmVVV'fremrongroup'com 0 QORE PROPERTY SCIENCES Plant: Tremron—Arcadia, Florida Job No: 27772 Client: Tremron Report No: 347424 Report Date: 7/24/07 Unit ID: Echo Stone Pervious Pavers, 7/9/07 Received Date: 7/12/07 TESTING OF SOLID CONCRETE PAVING UNITS Compressive Strength —test date 7/23/07 at 14 days of age Unit No 4A 4B 4C Average Received weight, lbs 9.17 9.29 9.53 9.33 Width, inches 6.26 6.32 6.32 6.30 Height, inches 2.40 2.37 2.40 2.39 Length, inches 9.42 9.42 9.43 9.42 Saw-cut length, inches 4.71 4.77 4.70 4.73 Net Area, in2 29.48 30.15 29.70 29.78 Load, lbs 139,380 132,760 137,850 136,660 Compressive Strength, psi 4,730 4,400 4,640 4,590 Compression tests were performed in accordance with ASTM C140. . Unit No Permeability 4D 44.4 inches/hour(3.1 x 10-2 cm/s) • • Respectfully submitted, QORE, Inc. A//5 ussell Scribner Materials Laboratory Manager • Report Distribution: Tremron/Mr. Mike Somers I/420 Johns Creek Parkway Duluth,Georgia 30097 (770)476-3555 fax(770)476-0213 °OW 1 J 0 Q U F-- — U) O Z O ~ w O E 0Z— HZ I u) Q o O coz O E 0 � Z_ o F- co 0 z eo DD w 0 H w w O D v w H w a a w = U N ZO m < O o u"i O H 0 Q Z w Z CO -J `� � (� OI- ^ 00 ' Q w W -- Z Z N H LO Y w W p 0 0 , Q Q ,- 0 O w O Cr) H < N 0 � � w ZCO = m xc w w F- 0 � CC YQ H w0 Ct 0 > F- W � O DCS = 0 ,2u) Oww Q Z(15 D pQ , w w fx O z co• w O U 0 co Q o Z 0 0 F- HO W m Q O ix w > z0 0 0 �F- ZO D 9 z z - � Z O m 0 o Z N 0 0_ W L Z CC Lt 0 a '- W I w >_ 0 DO w } w aO J Cl_ " ZO o < F- 00 O Ci CO 17- v 0 Z O C-15 u) Z > J W g z � 1 17 J � w D 0 •041=_ w w u. Q oPo4II1II _ ct wO •°°°. °0.111= Z a °A�°�°o=1II o co 0 — CO •a.•. . • ° .• . ° •.n•q 111 w w ° ° Z 111• • I I D Q 0 ° J 1 m U) o Z — ° OQ�I i O. --- °.o=1 >- U.) CC W 0 r: 00 40 p ,,m= E;:. °� O° —1=111 w ° w W O :ba�°QQIQQQ .I 11= > H m > I— "o°ooQ 00 ° 0i— _ � w '•.:aOOo 0 0�1 I I Y Q CLZ ..%0I9000u & 6 0 0i=III = m W W O ; , °- JF—III ,*7 o oo0O 0Oa11► Q D r'oo°oQDQO°0° —III W F- III - Nc J F...0o �0�°�00=1II 0o C � ®���eoo�°IO�11. 711=----- :..r.0 �Q o N Z 0 W X ' OO •�� . 0 _ Z N 0- W tl CITY OF ATLANTIC BEACH 'J%WNER / BUILDER AFFIDAVIT 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. ao tY�^ 2 9-- -7-20 ADDFat&Lc S PHONE NUMBER CA-col n P- N NAME . i L414 —/ 3/ i7 •IG.ATURE DATE Before me this (3 day o& 20J [ in the county of Duval,State of Florida,has personally appeared herin by hi self/herself and affirms that all statements and declarations area a(nd accurate. Notary Public at Large,State of h l ,County of ()V °i TONT GINDLESPERGER ❑Personally Known ;, MY COMMISSION t FF 924951 Q 1 duced Identificationill(• .��� •'d EXPIRES:October 6,2019 '1,1i4:6°7 Bonded Thru Notary Pubic Underwriters Notary Signature: F:BLDG/Owner-Builder Affadavit;REVISED:4/16/2009