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1930 Beachside Ct fence permit CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,Fl,32233 INSPECTION PHONE LINE 247-5814 FENCE WALL OR BARRIER - FENCE MUST CALL BY 4PM FOR NEXr DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: FNCE17-0036 Description: 6'WOOD FENCE Estimated Value: 10645 Issue Date: 7/26/2017 Expiration Date: 1/22/2018 PROPERTY ADDRESS: Add i 1930 BEACHSIDE CT RE Number. 1695420596 PROPERTYOWNER: Name: CALDWELL KATHERINE A Address: 280 WYNNGATE DR DILLARD, GA 30537 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 RVAC work,a Notice of Commencement is only required when HVAC work exceeds and estimated value of$7,500. City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 17-0 0,3 Phone(904)247-5826 Fax(904) 247 58 E-mail: building-dept@coab.us IJ L J' 201? Date muted: 3(2 41 z Cityweb-site: hftfr/Avvw.coab,us APPLICATION REVIEW AND TRACKING FORM Property Address; &J�0EJS(f)r- (_2T D entreviewrequi d Yes No B ild' Applicant: OCADKDER� anning &Zonin a A mints nator Project: (,12 C-7rD(-C�- blic ic Utilities Public Safety Fire Services Revi NPW�� , �,L, �. — Dept Signature Other Agency Review or Permit Required 1Rev;i:e:w or fflRecelpt MIS of Permit Verified IS Date Florida Dept.of Environmental Protection F-10-nda Dept.of Transportation St.Johns River Water Management Distnct _AJ-_y Corps of Engineers Division of Hotels and Restaumnis— Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department Firat Review: ZApproved. E]Denied. E]Not applicable (Cincle one.) Comments: -jet, BUILDING PLANNING&ZONING ev`ew"rig Doparbme 'C Is one BUILDING I &Z PLANN FNG NIN( Reviewed by: Date 0 TREEADMIN Second Review: DApproved as revised. DIDenied. E]Not applicable PUBLICWORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date FIRE SERVICES Third Review: OAPPnoved as revised. [:]Denied. E]Not applicable Comments: Reviewed by: Date, Revised 05119/2017 City of Atlantic Beach APPLICATION NUMBER Building Department (to be assigned by the Building Department.) 800 Seminole Road 4 1 FmcF-- 17-na3(� Atlantic Beach, Florida 32233-5-445 4 03 2011 Phone(904)247-5826 Fax(904)247-t%5 E-mail: building-dept@coalbus Date routed: & �30 417 City web-site: hftp://�.wab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 1930 T Rgl!��ent review required Yes No __uil A,�,,,ng &Zni,,o Applicant: TreeAcl-m—imsfrator Project: Public Safety Fire Services Reviewl"Wo /WMM Re ew,or Retc at Date mut Vrr Other Agency Review or Pennit Required of Pve '4 By Florida Dept.of Environmental Protection Floncla Dept.of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants -67.ision of Alcoholic Beverages and Tobacco Other. APPLICATION STATUS Reviewing Department First Review: [JApproved. E]Denied. wot applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed byjt�ltj-'641'�Date: TREEADMIN. Second Review: E]Approved as revised. E]Denied. E]Not appli,abl; 9 P KS Comments: BLIb L IR_T�l YES LIC I 77-&-17 PUBLIC SAFETY Reviewed by: Date:— FIRE SERVICES Third Review: DApproved as revised. [:]Denied. E]Not applicable Comments: Reviewed by: Date Revised 0511912017 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone(904)247�5826 Fax(904)247-5845 E-mail: building-dept@mab.us Date routed- City web-site: http:/Avww.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 193CD La_1EiS(Dr_ Q%a�t reviaw MrequiredYes No Bggog—) Applicant: anning &Zonino Project: I ree Admirustrator tilities) Public Safety F S"'c: ire qSewices Review fee $ Dept Signature 0 12M ther Agency Review or Permit Required Review or Receipt of Permit Verified By Date Florida Dept.of Environmental Protection Florida Dept.ofTransportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco iOther I I APPLICATION STATUS rReviewing Department First Review: [JApproved. gDenied. E]Not applicable (Circle one.) Comments: 5 g� 56�.� �A�A Q_ BUILDING PLANNING&ZONING Reviewed by: Date: (OAC TREE ADMIN. S pp", , V" Second Review: ElApproved as revised. ]Demed. E]Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ElApproved as revised. ODenied. E]Not applicable Comments: Reviewed by: Date:- Revised OV19/2D17 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, Fl, 32233 (904)247-5800 BUILDING DEPARTMENT REVIEW COMMENTS Date: 7/08/17 erm : Fncel7-0036 pp cant: Peter Caldwell site Address: 1930 Beachside Ct. Address: 1930 Beachside Ct. R i W. -866-9682 ev e Phone: 479 REN: Email: peter@weichertirifrm.com THIS BUILDING DEPARTMENT REVIEW IS ONE OF 4 DEPARTMENT REVIEWS. PLEASE FIND ALL DEPARTMENT REVIEWS AND ADDRESS ALL COMMENTS. Correction Comments: Application is disapproved for the following issues: 1. Please provide all details for retaining walls,fill,existing grade, change in grade, and fence in relation to retaining wall. Retaining walls require permits, and engineering details, if over 24-inches high. In certain cases,the maximum height of fences includes height of retaining wall. Please provide all details and dimensions. 2. Additional details may generate additional comments. CITY OF ATLANTIC BEACH 800 Seminole Road Atlantic BeKb,Florida 32233 Telephone(904)247-5800 FAX(904)247-5845 REVISION REQUEST SHEET OR CORRECTIONS TO REVIEW COMMENT Date: —1 Ito Ir? Recei Resubmitted: Permit Number: =— ti-j 4f>C) F1`3 CF-1-7- 00�S Original Plans Examiner: Project Name: ProjectAddress:lCtbO it 4z,� 0 Contractor*. Contact N Cairtiatict Phone :q 7f-Fb&-3 Z92'contact e-mail: Fic- 4-ir (�Rev�sion Plan Check/Permit Fee(a)Due: ie�kv Description of Proposed Revision to Existing Permit: lit A 929Utd &-*,T CL*4 'i r 6%.,sJ eit, J 9kA Pser 15(,raso� i5roaLti S (W IL toot S Additional Increase in Building Value: $ Additional S.F. Site Plan Revised: Public W U Approval: By signing below.I unistranne) R*-1T ccid ...2Z Lt affirm that the above revision is inclusive of the proposed changes. Signature of Contractor/Agent(c�(m muss sip irinc�in vetunninon) Date off.U.Only Nsxir�by: -7 AW Z Plan Review Continents: ant review Mulred Yes Aci C iBuilding T7 Planning& pi 0 Examiner Trise Admin, Public Works —7-1 P-1 7 Public Utilifiesi Public Safety Date Fire Services To: paI 2017,07-1012:4BL16(GMT) 1904212C)1)94 From:FOGGIA Tilly R4tv,.%C.4 pic,.% Vail- pc^cq,- MAP SHOMNG BOUNDARY SURVEY OF LOT'M ULM 1. PEACHISIDE, AS FEICINDED IN KAY 0" 41. PAGES 14, 1�A,14-8& '41, w LE CURRENT PUBLIC PECUNDS I DUVAL COUNTY, KI CIEUTICED To ERINE A, CALOWPIL_ E,,NL,qx s Y.� "'DE A,PA Go A,S'LAUC NATI.NAI-ITLE; LISLI C0AI D%, ON it Gov, DID q,P, A WE A, h N MAr w EUS T S-B &I ai v 41 1 44 ot,1)4 5. ,j 6.. L�M), A �-WCGGEEI— DE�..S .CIAL�INAI,_, A� AIR,—,A A 1.11",AAA"I, TT Is 'G,"LA"m A"", A—AA A� 9 111 D22311 I DATE V FELL)SURVEY.. D-.-.1 I -I Li I I I Ray Thompson GOTTIMCAT EAUT-LI SURVEYING, "IXTJ EIR I PAID T. TGUSB MAP SHOMNG BOUNDARY SURVEY OF LOT 28 KOCR 1. EEACHSIDE. AS RECORDED IN FLAT BOOK 42. PAGES 14. IA-& 1" 14-C, OF THE CURRENT PUBLIC PEC�DS OF DUVAL COUPI FLORIDA. CEWDIFIED 10, KATHERINA A. CAA.DWLL ETIEFEBANK SOFFAN C. COODE. 111. PA 01.) REPUBUC NATIONAL TITLE INSURANCE OWPANY lk4 1 lko, 00-1$�.bu, 1.1 A, 114, 10, "Ni 01 LO WIN" 'T 0 Nl-� A A -A, 4 'AD A, iF AN A AE, 41 4. A F31 IN CIDIIO!�r W MCI'ffAVM -1 I. IF . 0 IDD IF 1E.W. (PLAT) LOT 5-8 SA/ -Z, KM I IF zr LOT Ell A, Iff IF EUCqS N D AN N 10, AN OF, IFS A Co. r%, FAT OKA, 5 1- LEGEND: 9 SEES I.C� - A. 0 .5".00 CIA , : NAFFICI. AN. -A — M49�WAAAA W E-Sjl�� REMEDONS CAST LC�W C PAB�ASNG OF�AMC THE A. I LANSCOO.. ONE I 'AII NT�NI ASS SACCO,AN, I NS. TI,NNA�y S�CTS AU.EA50CENTS A AONIA OF-1 AS NES=t�� ONT 11 SNI u.S-SCAll'INCS, NO OCT', rNI SUCTIONASS ASS... y TN�ON T THS FORIFY IS NOT VATJ�FAINFAT AN AUTTAITIONTS)OF�C CONNOTE NAT AANCAFNTCOAC�l C."AFFE S # 32ZO9 DATE OF FIE I L I I I Ray Thompson CERTIFICATE SURVEYING, CF.. 4--Z-T-27- .5_NUFS -.F I.,UTiv.."BONI WINE AF, 1-1 AN—ON-11 NPINC.)� ANNAMANOF I...OF A IT-) �'78 CNFCFA INSO City of Atlantic Beach APPLICATION NUMBER Building Department (ro be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 Fax(904)247-5845 E-mail: building-dept@wab.us Date routed: Cityweb-site: htp:/Avww.coab.us _W3D_421 __ APPLICATION REVIEW AND TRACKING FORM Property Address: 193C) EeAeE,(�(f)r_ C?T D entreviewre uIred Yes No Build Applicant: Qc-o ,'D Eq anning &Zonino I ree Administrator Project: ('7 u Ii filities Public Safety Fire Services V7 Review fee $ Dept Signature '1�` 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 Managernmt–D—Istrct Amy Corps of Engineers Division of Hotels and Restamm—MS Dimwlon of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: ElApproved. �fDenled. [JNot applicable (Circle one.) Comments: BUILDING f-el7te -fe'�,k PLANNING &ZONING Reviewed by: Date..7/ 7/1 -7 TREE ADMIN. Second Review: VfApiproved as revised, E]Denied. EJNot applicable PUBLIC WORKS Comments- PUBLIC UTILITIES grt f9eJ'.'j' (4"- I.$ Cipff.Ared; PUBLIC SAFETY A144 L�101 I I Reviewed byo�'� —Date: FIRE SERVICES Third Review: ElApproved as revised. E]Denied. E]Not applicable Comments: Reviewed by: Date: Revised 05119/2017 CITY OF ATLANTIC BEACH 800 Seminole Road Atlantic Beach,Florida 32233 Telephone(904)247-5800 REVISION REQUEST SHEET OR PAX(904)247-5845 CORRECTIONS TO REVIEW COMMENT Date: Pecei ed by: Resubmitted: Permit Number iKJ C_EF 1 -7 :��0 Original Plans Examiner: C Pmjcct Address:1CMD %oJect Name: Contractor: Contact Name., P lu_��Conlact e-mail: On 16�t4 Q�jsion Plan Check/Permit Fee (s)Due: S *.0 4 r% Description of Proposed Revision to Existing Permit: di_S Kf`bt I f�11_1 I Additional Increase in Building Value: S Additional S.F. Site Plan Revised: Public W/U Approval- By signing below.I(Pnnt n�) fb-eT Ccicla�'L( — affirm,that the above revision is inclusive of the proposed changes. Signature of Contractor/Agent(c.�w Date Ora.U.(Nly D.W. A�.& R�j�,Wd_ N0ificdby:____ Plan Review Comments: Planning&Zo -OaparLment r*tview rMequil yes o Buittlina -2) TrftAdminisfir�a Pr Plans Examiner PubllcWorks Public Utilities Public Safety Fire Services Date Thursday,June 29,2017 at 10:56:55 AM Eastern Daylight Time Subject: Looks good to us Date: Wednesday, May 24,2017 at 8:18:22 AM Eastern Daylight Time From: Nancy Whittington To: peter@weichertgriffin.com Peter..we really appreciate that you am asking the questions before you begin. After looking at this and talking with our architectural review side,we think what you are suggesting will be a definite improvement to the front area overall. The HOA has no problems with what you am planning. The fun will be in dealing with the City of AB...1 Will this delay your move in laterthanJune? Nancy Whittington,Treasurer Beachside Homeowner's Association -------Original Message From:Peter Caldwell<peter@wejchertgriffin.com> To:Nancy Whittington<mn202@juno.com> Subject:Re:CMU wall OK? Date:Tue,23 May 2017 22:01:38-0400 Yes the wall will be back filled slightly where needed and then the paver deciding. The wall will be 24-30" high starting from the north side back line behind the pool to the south side line where the existing swing is now. lust to be clearthe wall is alongthe west side of the property only running N to S. The south side of the property will be the fence extension. I can submit the dmwingthat was done on the survey In multi-colors showing the outdoor hardscape and landscape plan if it helps. The fence would then be atop the split face CMU walL Hope this helps. Thanks From: Nancy Whittington<nvn202 jUaQ&M> Date:Tuesday, May 23, 2017 at 7:17 PM To: Office 2004 Test Drive User<ae"r -iiiaLheilgriffin,com Subject: Re:CMU wall OK? Peter..let us check this out. Where exactly are you planning on puttingthis wall? Along the south side of the house facing Beachside Drive? How high am you going to make the wall? Will it look like your photo with dirt and landscaping on top?N ------Original Message From:Peter Caldwell<udc[@wglcbcctgriffin.com To:Nancy Whittington<nvn202 luno.com Subject:CMU wall OK? Date:Tue,23 May 2017 17:10:07-0400 This renovation was supposed to be small-instead its a lot more time and moneyg).guess that was no surpriseC). Was about to move forward with my fence@but the support for It is lacking Page 1 of 2 due to railroad ties@ My hardscape contractor is going to install a split faced CMU wall in its place first. Just want to make sum to clear with HOA first. OK to move forward? Let me know. Thank You 1 Peter Page2 c,f2 Saturday,July 8,2017 at 1:35:18 PM Eastern Daylight rime Subject: RE: 1930 Beachside Court Zoning Review Comments Date: Friday,July 7,2017 at 1:05:20 PM Eastern Daylight Time From: Brian Broedell To: Peter Caldwell Peter, Please submit another plan or revise the current one to indicate that the proposed fence is at least 10 feet from the property line. It is unclear how far the highlighter on the survey is from the property line.Also, please fill out and submit an affidavit of no tree removal.Submit both at the Permits Desk in City Hall. Thank you, Brian Broedell Planner City of Atlantic Beach 800 Seminole Road Atlantic Beach, FL 32233 (904)247-5822 bbroedellftcoab,us Fmm; Peter Caldwell [mailto:peter@weichertgriffin.com) Sent: Friday,July 07,2017 11:39 AM To:Brian Broedell<bbroedeIIQcoa1b.us> Subject: Re:1930 Beachside Court Zoning Review Comments Thanks for the quick response. As to your three items- 1. My hardscape contractor of The Enchance Companies,David Guidi,has or will apply for the retaining wall permit. 2. The fence will be under the requirement often feet from any lot line. How would you like me to illustrate/wrify this? I drew a highlighter line on survey that should show this;would you also like it to be staked and strung? 3. No tree removal is planned. Please let me know how to proceed. Thanks againl Peter From: Brian Broedell<bbLQ2deII@coab.us Date: Friday,July 7,2017 at 11:23 AM To:Office 2004 Test Drive User<Re1er@vLejd1QqgLffLn.=> Subject: 1930 Beachside Court Zoning Review Comments Please see the attached comments from zoning for your project at the address in the subject. Submit all revisions to the Permits Desk at City Hall. Thank you, Page 1of2 General Affidavit The within named person (Affiant), Peter J Caldwell, who is a resident of Atlantic Beach, Duval County, State of Florida, personally came and appeared before me, the undersigned Notary Public, and makes his statement, testimony and General Affidavit under oath or affirmation, in good faith, and under penalty of perjury, of sincere belief and personal knowledge that the following matters, facts and things set forth are true and correct, to the best of his knowledge: No trees will be removed while building a fence at 1930 Beachside Court, Atlantic Beach. Dated this I Ohday of July, 2017. Signature of Affiant State of Florida County of Duval County Subscribed and sworn to, before me on this 10'hday of July, 2017 by Affiant Peter J Caldwell. Beth Ann DOWIrIg Signature of Notary Public 'It�COMM�#FF 13M2 iWIMS; JUL 01,2018 WNOMTHRU XMFLORIMNOTAW.LM My Commission Expires: Building Permit Application JUN `i7 city of Atlantic Beach 2 9 2 800 Seminole Road,Atlantic Beach, FL32233 Phone:(904)247-5826 Fax:(904)247-5845 Job Address: lc�1630 6C06%S-4k, <:ZT _PiermitNumber: rk�CC— 17 - CO3 L L gal E egal Description RE# v V.I.., -Heated/Cooled_ aluation of Work(Replacement ci$ L*.(&!tS.06 Heated/CooledSF_Non Class of Work(Circle one): New AclditiorlIl�r1terad Repair Move Der Pool Window/Door a Use of existing/proposed sti(Circle one): Commercial <E:denti 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 etypeoi be perforni t-abbi L AGI old G, Pt Km ri - I'l V+ 5,g4ftl C " I Florida Product Approval# for multiple products use product approval form P In Owner Information la %" a 0 . Name: Adair ess- P1.41L -Alb9m e ZIP one .em AL OL (h Ci 41LIIII`A� Stat ailIA !, - 1 <2�ne r Agent(if Agent,Power of Attorney or Agency Letter Required) Contractor Information Name 0 It Act Qualting Agent; Address M i City;)-ftc16$&-V'1l Stai Office Phone!%*%# !IW%bl --�Job Site/Contact Numbei State Certification/Registration#_E-M Architect Name&Phone# Engineer's Name&Phone# Workers Compensation �ennptl insurer/Lease Ernplo,ees/Expiration Ii 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 COMMENCEMENT. e of Owner or Agent) (signature of conancan) 4?5?r-(�Slgnaw �� (including wintractor) Signed and sworn to(or affirmed)before me thls�QdXy of ,tSigned and sworn to(or affirmed)before me this_day of J,A r%0_ AO I by Ion r% W by (Signa&44�LWtary) (Signature of Notary) J;v�-N-N JEIQQFER"NSi uncomusids'o"Mi KProduced deni 4` 111. q EXMRES,center 27, Pesarally Known OR [ ]Personally Known OR Type of Identification: MZMA- Typeof Identification: CITY OF ATLANTIC BEACH OWNER/ BUILDER AFFIDAVIT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I 'CONSTRUCTION CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW. DISCLOSURE STATEMENT FOR SECTION 489.101 FLORIDA STATUTES; STATE LAW REQUIRES CONSTRUCTION TO BE DONE 13Y LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN MMPTION 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 MUS SIRERVISE 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 COMIAERCIAL 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 COWLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF TRIS EXEMPTION. YOU MAY NOT ]ERE AN UNLICENSED PERSON AS YOUR CONTRACTOR YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE IUILDrNG CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY To MAKE SURF, THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LIVEN I ORDEITANCES 11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKERS COMPENSATION INSURANCE BE PURCHASED. Ill. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WTHHOLDING TAX ANDADR 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. W55-228(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(247-6826)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. C+ PHONE NUMBER PR(NTNAME �TLJRE DATE B fare me this day a jai 1L 20 fArthersai - a, Ou�l,SWWdFlo6da,haspe�m[y�peamd herm by himai homeffand affirms tat ta"184 cc, �MR111OHNi cat lit'." "D IS NimalPrialidetLuld,stal R Couni UPPIES:Ochater 27.XM Operainuitymovad i Alav_—� .. tV Bedard DfU Nemy Public thade-ustrans Wroducatudentiffearl VIL 0,ftS-k- --- - Notarysi,maturs, A 4lFlealuxWvaarhaldidAry,()t