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1531 LINKSIDE DR - DOOR :d15 v f CITY OF ATLANTIC BEACH 0800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 t-;; 9%' INSPECTION PHONE LINE 247-5814 RESIDENTIAL - ALTERATION RESIDENTIAL MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: 17-WIND-3884 Description: REPLACE DOOR Estimated Value: 2250 Issue Date: 5/11/2017 Expiration Date: 11/7/2017 PROPERTY ADDRESS: Address: 1531 LINKSIDE DR RE Number: 172374 6055 PROPERTY OWNER: . Name: Address: 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 0 exceeds and estimated value of$7,500. I 1 I s ..J-vir;,, City of Atlantic Beach APPLICATION NUMBER v• ! . Building Department (To be assigned by the Building Department.) r - . 800 Seminole Road `,,� ... '-e Atlantic Beach, Florida 32233-5445 / " vv I N O— 388 4- Phone(904)247-5826 • Fax(904)247-5845 C ft E-mail: building-dept@coab.us Date routed: 3 6 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 153 1 LID- • . - '• -ntreview required Y7-.1 No LINKS(OG c (2- :uilding Applicant: Q GO tOee.-- -J.••.ng &Zoning Tree Administrator Project: RP:p( ACE :iTQff 2 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 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: F► Approved. ❑Denied. (Circle one.) Comments: UILDING } PLANNING &ZONING Reviewed by: Date: -5—'4f/7 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 i rimaCOPY 1` 'i_pitooBuilding Permit Application .`"#,:-.t, City of Atlantic Beach � 800 Seminole Road,Atlantic Beach,FL 32233 S'i' Phone: (904)247-5826 Fax: (904)247-5845 --/.- w (1 )1). - Mjg 4- Job Job Address: 161 UNI<SiDr Wile , R1L/lM1►C BeACtt, Ft- 32-'33 Permit Number: Legal Description Sella. lirsKs(DC-Unit/Lot(11(ocs ilrf'FW Jlft"),$IU1 of(A347Fr IDf R9. RE# I 92:3'1460$5- Valuation of Work(Replacement Cost)$ (VO©0 Heated/Cooled SF i(//it}- Non-Heated/Cooled /10/4 • Class of Work(Circle one): New Addition Alteration Repair Move Demo Poc 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 (S) • 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: Rte 'A. � 5S �i i6(r G/aa r'S fit' _ t ^� Qui5"04 Cy•-, Af.a : One 52.4, 4 ro ok dad r•Is fixed • o e-- PA.., f . ,' FL 13 54 I. Florida Product Approval# „i:.taiwi +�[rrevA, Ate/.e, ".-/_ for multiple • oducts use product approval for' Property Owner Information m , 5'`' /2 Name: TA'NA INiLciAtmS Address: 1531 Li1I1-(SiDE *t(i City ATIM 1'e EeitCN State FL Zip ..3 -2-33 Phone qtY+ -345 -Q8a0 E-Mail Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) Contractor Information Name of Company: • alifying Agent: Address ik State Zip Office Phone /IN J r,b Si'r- •nt.ct Number State Certification/Registration# V E-M 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 RECORING YOUR NOTICE OF COMMENCEMENT. W (Signure of Owner or :ent including Contractor) (Signature of Contractor) Signed and swoul�to(or affir ed)\.efore e this c ay of Signed and sworn to(or affirmed)before me this day of i 1\,0, by # V_ / . , ,by .-4A s (Signature of Notary) . (Signature of Notary) ��"•' TONT GINDLESPERGER ` ` MYCOMMISSION#FF924951 PersonallyKno a,'-t... ` EXPIRES:October 6,2019 [ ]personally Known OR 1---- , ] .• 6snd2d Thru Notary Put is Underwriters i [ ]Produced Identif'�caYm^ S [ ]Produced Identification Type of Identification: Type of Identification: el iir ��� F!IE CCITY OF ATLANTIC BEACH . !...... _ ... p yari- OWNER / 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 REOUIRED 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. i 531 Lititt i'D. PR r Altif ilre BeAcaa,FL 3=33 q04. 3415- q gap ADDRESS '' PHONE NUMBER ) rW na iitikMS PRINT NAM • ..� wU real 3, t'7 _ SIGNAItallEV DATE Before me this 0RtA day of 1)114(. ,2017 in the county of Duval,State of Florida,has personally apqq?ed herin by himself/herself and affirms that all statements and declarations are true ark accurate. Notary Public at Large.State of ISL ,County of au VAL ,•'�l � t JOAN E.BOWMAN t MY COMMISSION o GG 077886 Ell=rrsonally Known :.w, ;•_ 0 Produced Identification- .s,�''�r-�'o',i EXPIRES:Feb11�ry 2E,2021 •,.°M«•.�,• Bonded Thm Nobly kW Undenvribrs Notary Signature: iT+- r- --80„...„..,_ Ft/BLDG/Owner-Buil ffadavit;REVISED:4/16/2009