181 Sylvan Dr siding permit (2) CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL - ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES17-0188
Description: repair siding
Estimated Value: 2000
Issue Date: 10/2/2017
Expiration Date: 3/31/2018
PROPERTY ADDRESS:
Address: 181 SYLVAN DR
RE Number: 1706480180
PROPERTY OWNER:
Name: Lucas Kessler
Address: 181 SYLVAN DR
ATLANTIC BEACH, FL 32233-4045
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.
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road _0 IF 1�1
A lantic Beach, Florida 32233-5445
t
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: 4)
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: (kA D No
_Ptpa_r;m,e
Building nt review required Ye
Applicant: L-4 A-( Planning &Zoning
Tree Administrator
Public Works
Project: L:p 0,
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Siqnature
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. E]Denied. E]Not applicable
(Circle one.) Comments:
(��p
PLANNING &ZONING Reviewed by: Date-.9�2,7-a
TREE ADMIN. Second Review: FlApproved as revised. [-IDeniedd' F]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: []Approved as revised. F]Denied. E]Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
4N [2 (t� lh� u VIVIE
Building Permit Application Updated 5/5/i
City of Atlantic Beach SEP 2 9 2017 1
OFFICE COP80ys
U
eminole Road,Atlantic Beach, FL 32233
Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: V9 I -S�)V&h- Pka-4;cl Bea cj,,, Permit Number:
Legal Description RE#
Valuation of Work(Replacement Cost) Heated/Cooled SF il70 Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration (,fRe Dai' Move Demo Pool Window/Door
• Use of existi ng/p ro posed structure(s)(Circle one): Commercial 4=esidenti
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes (�N!o) 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:
4rf/Ac,'r 57tne 71-11 �009,yl r�t
Florida Product Approval# for multiple products use product approval form
Property Owner Information UJ je+ L / _-�Q S*.—,-C(
Name: Km�ji rK Address: IV �61v.&n Dr
City er�-_e� State r- t_- zip 3.;),;�S& Phone '70,41-svy—2-1yr
E-Mail L_c-:�s/r,—P)h r,�m C-A�
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: ;Qualify' g Agent:
ItyZAddress City State Zip
Office Phone Job Site/C tact Number
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation
E pt/In surer/Lease Employees/Expiration Date
Q,t d
Application is hereby made to obtain a permit to cl/ e work an installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit an that all work will be performed to meet the standards of all the laws regulationg
r.s
stand tl,_�l
a
construction in this jurisdiction. I uncle _ se parate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEAT�EX,TANKS,and AIR CONDITIONERS,etc.
r,
OWNER'S AFFIDAVIT: I certify that regoing 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 FINANCI��, SULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING 7YO�URIN�OTICE 0 COMMENCEMENT.
(Signature of Owner or Agent) (Signature of Co ntra cto""'
(including contractor) W/
Signed and sworn to(or affirmed)before me thisl�'f) day of Signed and sworn to(or affir ed/)b re me this_day of
by L"'t 1t, by
0
(SignatA of Uo a (Signature of Notary)
JENNIFER JOHNSTON
my COMMISSION#GG 042984 7'
EXPIRES:October 27,2020
Personally Known OR Public UnderMitersl Personally Known OR
Bonded Thru Notary
P,�Proclucecl Identification roduced Identification
P
Type of Identification T77V F1 Z -,t 1__G I tQ1K__ Type of Identification:
CITY OF ATLANTIC BEACH OFFICE COPY
OWNER / BUILDER AFFIDAVIT
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 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.
[I. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
Ill. 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.
Of-
ADDRESS PHONE NUMBER
L14kC
NTNAME
GNkURE DATE
Before me this day of GQV,4 in the county of
n' 20ff
D uval,State of Florida,has personallq appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of County of
11 Personally Known
&Produced Identificaflon- CLI 4
jENNIFER JOHINS
984
TON j
MY COMMISSION#GG 042984
EXPIRES:October 27,2020
'lic U _t_
Notary Signature: tw�� Bonded Thru Notary Public Underwriters
,oq-- T_
U
F/BLDG/O�er-Builder APadavit;REVISED: 4/16/2009