599 Atlantic Blvd siding permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
-C it INSPECTION PHONE LINE 247-5814
COMMERCIAL - ALTERATION COMMERCIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: COMM17-0022
Description: replace damaged siding with Hardie siding & moisture barrier
Estimated Value: 4500
Issue Date: 10/2/2017
Expiration Date: 3/31/2018
PROPERTY ADDRESS:
Address: 599 ATLANTIC BLVD
RE Number: 1706700010
PROPERTYOWNER:
Name: EAKIN PAUL M ET AL
Address: 599 ATLANTIC BLVD STE 6
JACKSONVILLE, FL 32233-4052
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: E. T. Construction Inc.
Address: 13724 Macapa Road
Jacksonville, FL 32224
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.
City of Atlantic Beach APPLICATION NUMBER
1J, Building Department (To be assigned by the Building Department.)
>1 800 Seminole Road
Atlantic Beach, Florida 32233-5445 'T 0 64
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us I
APPLICATION REVIEW AND TRACKING FORM
Property Address: D_qpiartment review required Yes 0
< B u i Id i n g -_-) V�
C R—anning &Zoning
Applicant: Tree Administrator
Project: ct- Public Works
Public Utilities
'�av't" Public Safety
Fire Services
Review fee $ Dept Siqnature
Review or—Re ce-ipt T
Other Agency Review or Permit Required of Permit Verified By Date
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: 2/Approved. []Denied. E]Not applicable
(Circle one.) Comments: p6c"
BUILDING
PLANNING &ZONING Reviewed by: Date: 7
TREE ADMIN. Second Review: F]Approved as revised. F]DeniA. F]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: FlApproved as revised. ElDenied. F]Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
Building Permit Application Updated 5/5/17
City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233 SEP 2 5 2017
Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: Number: ClDtkm 1 11—00C�a-
Legal Description 0( RE#
Valuation of Work(Replacement Cost)$ Heated/Cooled SF Non-Heated/Cooled
Class of Work(Circle one): New Addition Alteration_(Repair
')Move Demo Pool Window/D'OFFICE COPY
Use of existing/proposed structure(s)(Circle one): (C�- 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: Reipw(ce- ctciryActc
I e cL Htir 0C e- I-AP S I CL(tl VAN
lietrcti(f- sjdin� all Lk rt C
-- 19 o eAL rm o�,i- ve- r '+,-
Florida Product Approval# for multiple products use product approval form
PropertV Owner Information
Name: Address:
Zi '�)
City state p Phone Ljl��)
C�C, C, :m
E-M a i I 'Sk--K2--C�0��C1
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: Qualifying Agent: e 01
Address MOCCIFQ RC� city \J�"13b.(N'� 11(! State f-�(— Zip 3
Office Phone - '))L:�-:)11 V 1�� Job Site/Contact Number
State Certification/Registration# 13 ic E-Mail ft.
Architect Name& Phone# nTc�
Engineer's Name& Phone# h I q
Workers Compensation yrN gt
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 ATTOR 3EFORE
RECORDINGYPUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) -�ature of Contractor)
(including contractor) 7S 11�4 ��- (Or affirmed)before me LT dly of
�gnecl d sworn to(or affirm fore me this day of Signed and sworn
by
Y
JENNU En-M F R. I -I V4,I
(Signa e dNotary) ature of Notary)
W NIISSION 114
I"E" 1984J
RES:t t20 t
0
�i "'nt.
f 0, kr6d 7btv Bu*t Natiry Selyk9l JENNIFER JOHNSTON
My CommiSSION#GG 042984
XPIRES:October 27,2020
Personally Known OR Personally Known OR Notary Public Undervoritem
Bonded Thru
Produced Identification )QProduced Identification X-
Type of Identification: Type of Identification:
CITY OF ATLANTIC BEACH OFFICE COPY
OWNER / BUILDER AFFIDAVIT
110
1. 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 T14AT YOU BUILT
IT FOR SALE OR LEASE,W111CH IS IN VIOLATION OF TI41S 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 T14AT PEOPLE EMPLOYED BY YOU RAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
__j
11. 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(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
OWNER-BUILDER PERMIT.
ak��Q , C)\641
ADD�ESS PHONE NUMBER
�k\x\ �� . r,�&
PRINT NAME
SIGNATUOE DATE
11in the county of
Before,methi.,�)&o day of '20_
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, ate of I C14 County of
�Ay PU,
JENNIFER HUMES
Zf"Personally Known
.,o MY COMMISSION#FF 932498
0 Produced Identificabon- EXPIRES:November 1,2019
Bonded Thru Bu*t Notary Swim
Notary Signature:
F/BLDUO�er-Builder�/adavit;REVISED/: 4/16/2009