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1753 PARK TER - REPAIRS 0.v.,,.,,, 1 4 v CITY OF ATLANTIC BEACH r) 800 SEMINOLE ROAD 1571 x ATLANTIC BEACH, FL 32233 r;3 'a INSPECTION PHONE LINE 247-5814 RESIDENTIAL - ALTERATION RESIDENTIAL MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: 17-RAAR-3739 Description: replace T1-11 siding &2 windows Estimated Value: 650 Issue Date: Expiration Date: PROPERTY ADDRESS: Address: 1753 E PARK TER RE Number: 172020 0410 PROPERTY OWNER: Name: HEFLIN MICHAEL B Address: 1753 PARK TER E 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. ?srarr;: City of Atlantic Beach APPLICATION NUMBER js Building Department (To be assigned by the Building Department.) J� 800 Seminole Road 1 r) Atlantic Beach, Florida 32233-5445 —31} Phone(904)247-5826 • Fax(904)247-5845 Date routed: ()VI ��1 gt E-mail: building-dept@coab.us City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: \ S L Sir a (.k D ment review required Ye�/No ilding J �/ Applicant: 00 (\ i{ Planning &Zoning Tree Administrator Public Works Project: '( tiAU.L CTl ` l� Sk �cn� -)- w ,�l�v.: Public Utilities Public Safety Fire Services Review fee $ Dept Signature Review or Receipt Date Other Agency Review or Permit Required 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: IlicTproved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: /7/1 Date: 5 /6'I7 TREE ADMIN. Second Review: ['Approved as revised. ❑Denie . 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 r h #4, irrkr _ City of Atlantic Beach 800 Seminole Road,Atlantic Beach, FL 32233 Phone: (904) 247-5826 Fax: (904)247-5845 y� n Job Address: eci,s- C Q L✓ Permit Number: /7 37 7 9 Legal Description RE# Valuation of Work(Replacement Cost)$ ( v, O Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): New Addition Alterationepai9Move 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 Describe in detail the type of work to be performed: : i — � �JG rC e(— 1 V1 S 41e`� � qr c1/4„01 J Qe dig ro- Q T/ Ca/1 irc1 UfA- l VIS f�i`l 1 w� �,1�t✓l �L W.C Florida Product Approval# ' � / y 9// L for multiple products use product approval form Prope Owner Information Q Name: ' ' 1 • (� Address: l9 S_ e 3 City �— -� , Statel—j Zip Phone g'dY 0Y5—Z/ l c A E-Mail TIC 4_ P. ." .<4/154 (.(14-{ / f'�f yc)y—%/r Y— A t'j Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) Contractor Information Name of Company: A//4--' Qualifying Agent: (�� Address City _ State `-Zi� ! 11 Office Phone Job Site/Contact Number 111, I State Certification/Registration# E-Mail Q PH 1 i 2017 Architect Name&Phone# Engineer's Name&Phone# Workers 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 prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS, WELLS, POOLS, FURNACES, BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. 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 NOTICE OF CO MENCEMENT. (Signature of Owner or Agent• chiding Contractor) (Signature of Contractor) Signed and sworn to(or affirmed) efore me this 10 day of Signed and sworn to(or affirmed)before me this day of A[7i" ; l , ,by , by s�k JENNIFER JOHNSTON f.N ,•, : MY COMMISSION p GG Od29 (Signa ure o otary) (Signature of Notary) * " EXPIRES:October 27,2020 �•'o :,' Bonded Thru Notary Public Underwriters [ I Personally Known OR [ I Personally Known OR (A Produced Identification ,-,, N ( )Produced Identification c S �t C-1-111- Type Type of Identification: Type of Identification: CO tJ o i yP Al FE COny PY ,,rsllvjr „ r "1 CITY OF ATLANTIC BLACK @WNER / BUILDER AFFIDAVIT F•!li!!Jr 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$25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILoiNG YOU IIAVI: BU11.."I YOURSELF WITIIUN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME TI IAT YOU BUILT IT FOR SALE OR LEASE, \VIIICII IS IN VIOLATION OF THIS EXEMI'I ION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR, YOUR CONSTRUCTION MUtiT HE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS • YOUR RESPONSIBILITY TO MAKE SURE 'SHAT PEOPLE EMPLOYED BY you HAVE I,ICENu$ REQUIRED BY STATE LAW AND BY COUNTY ORJONICII'AL 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. • ADDRESS pc,-j -err� �' re(-2`/9- / 7 7 PHONE NUMBER Mic3.,a ( PRINT NAME • 7 //ei/7-7 I NATURE DATE Before me this t lit day of 1; 1 ` .20�in the 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.Stale of F .County of 00,' ❑Pctsaraly Known • \ Ya¢ ®Prniuced tdeakatm• de\.LiS i i.1-OS` 44"•••• JENNIFER JOHNSTON :� tAY COMMISSION A GG maw EXPIRES:October 27,2020 Notary Signature: \ 07;‘.‹,v Bonded TM'Notary Public UJMNwfLNs h JIILUCi'O.umnbud.As An.,Javi,RHh'ISI:b 4'16'aoe4 %rL\ ).; (f . : CITY OF ATLANTIC BEACH SSS J 800 SEMINOLE ROAD +j as'IN :�l ATLANTIC BEACH,FL 32233 F!LE (904)COPY 1 BUILDING DEPARTMENT REVIEW COMMENTS Date: 4.12.2017 Permit#: 17-RAAR-3739 Applicant: Michael Heflin Site Address: 1753 Park Terrace East,AB Site Address: Same Review: 1 Phone: 249.2197 RE#: Email: mikebhe(umsn.com Homeowner: same CORRECTION COMMENTS: The Florida Product Approval Number you submitted, FL14911,for the window,does not represent the window information that you submitted. FL14911-R7 Revision Silverline Building Products Corp. History • : ou can see the number represents a window made by Silverline Building Products Corp his information comes from the DBPR Product Approval website. The window infor . 'on bmitted was for AMERICAN CRAFTSMAN by Andersen. 'News!' . , supplier should be able to get you the correct number. Sometimes it can be fo on the stickers a : .• • s to the windows.Installation instruction from the DBPR w ., • be required to be on itefor the ins . ie . • _ .•! ' - = -. 7).‘() ' Mike Jones Building Inspector/Plan Reviewer City Of Atlantic Beach 800 Seminole Road Atlantic Beach, FL 32233-5445 Ofc (904) 247-5844 Fax (904) 247-5845 ,L ' f�Vs EMU 'ew 64on14n-e4f I' q . /2 . 17 rnDa 1