460 David St siding repair permit P
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: RES17-0212
Description: repair T-1 1 siding
Estimated Value: 1000
Issue Date: 11/13/2017
Expiration Date: 5/12/2018
PROPERTY ADDRESS:
Address: 460 DAVID ST
RE Number: 1706520250
PROPERTYOWNER:
Name: ANDERSEN DEAN S & CATHY J TRUST
Address: 460 DAVID ST
ATLANTIC BEACH, FL 32233-4042
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
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed:
City web-site: hftp://www.coab.us 11
APPLICATION REVIEW AND TRACKING FORM
Property Address: H 0 10 OW : Depa ment review required Yes No
Building
Applicant: Pra—nn—ing�&Zoning
Tree Administrator
Project: (A� 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: [!!rApproved. ElDenied. E]Not applicable
(Circle one.) Comments:
ED
PLANNING &ZONING Reviewed by: Date:_/6 dY 7
TREE ADMIN. Second Review: FlApproved as revised. [:]DeKied. F]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: DApproved as revised. [:]Denied. [:]Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
ding Permit Application Updated 5/5/17
FFICE Cow City of Atlantic Beach
OCT 1 7 2017
800 Seminole Road,Atlantic Beach, FIL 32233
Phone: (904) 247-5826 Fax: (904)247-5845
Job Address: o Permit Number:
Legal Description to �n_L RE#
Valuation of Work(Replacement Cost)$ 1()j`)C) Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration epair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Comercia I eside ti I
• If an existing structure,is a fire sprinkler system installed?(Circle one):te 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:
0---) cv- a_.�)0C),:::k1 e4-/9 V, ::�&-7'4
Florida Product Approval# for multiple products use product approval form
Propertv Owner Information
Name: C4-T74Y ?q0_'X-XA-3 Address:
Cit 413 State f____C Zip 3-Da-73-' Phone �90 q — C,�JD—L
E-Mail
Owner or Agent(If A�e'nt, Power of Attorney or Agency Letter Req&eecl)
Contractor Information
Name of Company: :7�a�d Qualifying Agent:
Address --- City State Zip
Office Phone Job Site/Contact Num r
State Certification/Registration# E-Mail
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation
Exempt/ surer/Lease Employees/Expiration Date
Application is hereby made to obtain a permit to do the=rksancl 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.
(Signature of Owner or Agent) (Sig ture of Contractor)
(including contractor)
Signed and sworn to(or affirmed)before me this day of Signed and sworn to r affirmed) before me this day of
0&)VbW aW-� by /k vA by
(Signature of Notary)
JENNIFE OHNSTON
#
My ComMiSSION#GG 042984
b r 27,20207
EXPIRES:Octo7berV,2020
tL
ublic nde.
Bonded Thru Notary Public Underwifters
]Personally Known OR ]Personally Known OR
^Produced Identificatio Produced Identification
Type of Identification: C�r� W \:L(—Q-A�A_ Type of Identification:
A CITY OF ATLANTIC BEACH
U.t
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 14AVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO T14AT
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. 0
]I. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
0
111. 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 Ncju
455-228(l). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLTJ
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORT-,
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THK _j Z
BUILDING DEPARTMENT(247-5826) IF IN DOUBT. < 0
Z
0
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURCE LU — a
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AC) 03 1--- z
00
OWNER-BUILDER PERMIT. (J 0
ZVP CMC �zl 0
ADDRESS PHONE NUMBER
0 LL Uj
PRINT NAME U. im 2 .1
0 0 Uj Ljj
/0 IL 40 /7 _LU >. (L LC
SIGNATURE DATE W
W
W Uj
Before me this dayof Putox—Ir 20_0 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. W
Notary Public at Large,State of County of JENNIFER JOHNSTON
lly CoVMISSION#GG 042984
0 Personally Known 0
J;ip October 27,202
roduced Identification- d 7hu t4otary Publ"Underwriters
Bon e
,pn,
Notary Signature:
- U ------------
F/BLDG/O�er-BuiiderAffadav�VISED.4/16/2009