371 8TH ST - DECK PAVERS 1kS CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
�13s� INSPECTION PHONE LINE 247-5814
RESIDENTIAL OTHER - SINGLE OR TWO FAMILY RESIDENTIAL OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RESO17-0045
Description: add 250 s.f. of travertine pavers to pool deck
Estimated Value: 4000
Issue Date: 12/4/2017
Expiration Date: 6/2/2018
PROPERTY ADDRESS:
Address: 371 8TH ST
RE Number: 169975 0000
PROPERTY OWNER:
Name: WOOD JEREMY B
Address: 371 8TH ST
ATLANTIC BEACH, FL 32233
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.
1_, City of Atlantic Beach APPLICATION„01-1' i; z Building Department (To be assignedby the Building Department.)
"` ;11 800 Seminole Road
j r = Atlantic Beach, Florida 32233-5445 ?-LSO BOO 4 S
Phone(904)247-5826 • Fax(904)247-5845
t `,E-mail: building-dept@coab.us Date routed: it- t �l 111
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1 J� Department review required Yes No
CloTildinq
Applicant: D L1/4) n L Planning &Zoning
��pp . ()� fi{CL�fl��i Public Works
trator
Project: ��(il a� S •
£L3O1 S D n DD\ 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: proved. ❑Denied. ['Not applicable
(Circle Comments: /1/0
El MEM(
PLANNING &ZONING Reviewed by: Date: / 'X?‘/.7
TREE ADMIN.
Second Review: ['Approved as revised. ['Denied. ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
00+51107._0 City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
—
{J 800 Seminole Road ?LSO
,SO I�� _ 0C�i`I,ST
- -� Atlantic Beach, Florida 32233-5445 4
Phone(904)247-5826 • Fax(904)247-5845 i
!+v,,,j E-mail: building-dept@coab.us Date routed: 1.k- I _L I I�
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1 \ Department review required Yes No
�:uildin �
Applicant: D Plann;liig a Zoning
,,-1 r Tre-. .' istrator
Project: 0404d �S S - (k c1' P 1'( Pu.lic Works ,•
Q-V0-4 S ,kms p DO\ �r� Public Utilities
Pub is 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: Fr/Approved. ,,,0/ti
enied. ['Not applicable
(Circle one.) Comments: -
GVH
BUILDING ,� Afer
d
PLA miNG ,ZONING
Reviewed Date: // I fl
TREE ADMIN. Second Review: Approved as revised. ❑Denied. Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
rcoaqiii, City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
' t / 800 Seminole Road
'-)M Atlantic Beach, Florida 32233-5445. -t-S0 11- —00L`IS
.
Phone(904)247-5826 • Fax(904)247-5845
k„:jj;�, E mail: building-dept@coab.usSOU 4 2017' Date routed: U `(
I I 1 I�
City web-site: http://www.coab.us ji �� �
ut [
APPLICATION REVIEW-ANDD TRACKING FORM
Property Address: _� �r Department review required Yes No
uildin
Applicant: D(,) (l Planning &Zoning
Tre- A e istrator
Project: C� �-�" s . V:‘
. ---wc iLfA;f\ jrPuolir V1/,orks
0,\O 5 p CSD` ���- ; _Public Utilities
Pub Safety
Fire Services
Review fee $ Dept Signature j
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: A pproved. ['Denied. ['Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING b � 6�
Reviewed /VL Date: //:-/r-->/7/'/ '//7
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑Denied. Not applicable
P.-U!6LG E ,KS• Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ['Denied. ❑Not applicable
Comments:
Reviewed by: Date: _
Revised 05/19/2017
, 4mgiv9:4 City of Atlantic Beach APPLICATION NUMBER
Building Department _ (To be assigned by.the Building Department)
I�' 1 800 Seminole Road = •'._
11 _ S Atlantic Beach, Florida 32233-5445A �✓us�'
J Phone 904 247-5826 • Fax(904)2 058451
( ) L ��1I Date routed: *i t I L(\I�
•�•�j;;,,c}� E-mail: building-dept@coati,ias
City web-site: http://www.coab:us �
APPLICATION REVIEW AND TRACKING FORM
3
Property Address: 1 Department review required Yes No
�
�,1/ uildin
Applicant: D1 -' Planning oning h
�Q
Tre- Asi_i iistrator
Project: 3.-�A _ Public Works
UIV/4 S ` D p DD\ Public Utilitie
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: ['Approved. nDenied. Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by:_ r• , Date: // /C f 7
TREE ADMIN. Second Review: ['Approved as revised. ['Denied. Not applicable
•U;; ORK Comments:
�j
UREIC U IVIS LIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
r` Building Permit Application--------_a��) Updated 5/5/17 "
r: - ' . City of Atlantic Beach 1 — ax
• f,; J 800 Seminole Road, Atlantic Beach, FL 32233'1— 1 Rya d
fi-&53'3'9
` Phone: (904) 247-5826 Fax: (904) 247-5845 i,+I I,I Nn 13 2t7�
7I a• OFFICE COPY J i'PEE sD I - ' I
Job Address: Permit Number: ,, ., 1
Legal Description RE#_._:_
Valuation of Work(Replacement Cost)$ 1) 00 0 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one):. New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial •esidenti. _
• 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: 141,troJ tr`� 060 Si�� .- e� dr 41Q -k
Florida Product Approval# for multiple products use product approval form
Property Owner Information �[
Name: In (.�dt4 Address:(, h &� ' •
City iA 8t'd- �
1- State FL Zip 3S3 Phone EKR) 6'-9 X33
E-Mail LAJO ' P3 rtoa• (or
Owner or Agent(Agent, ver of Attorney or Agency Letter Required) `.Il&
Contractor Informa ion ` mks
N
N�.
Name of Com any: 0'. s �ralt ci-1 Pro O XMC'Qualifyin Agent:
Address `g� (-0,,, 1- City L- State cl--. Zip-326.5.9
Office Phone C.g13) ?z 11y 6 Job Site/ onta Num r ��4`-' a"CO `'
State Certification/Registration# E-Mail (SUI 1P ( �f•Ccf
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
RECORDING YOUR NOTICE OF COMMENCEMENT.
• , 1 ,
' (...W_../
(Si: ature of Owner or Agent)4
(Signature of Contractor)
(including contractor)
Signe. .nd sworn to(or affirmed) before me this 63 dayAof Signed and sworn to (or affirmed) before me this day of
POJ Rrn -( ,al7 t' , by 'It(tri 61LEV OUB , , by
�tj,, . _x1111.
..• Au • 4f NSEtt4WERJOHNSTON (Signature of Notary)
=,: 1A MY COMMISSION#GG 042984
5't,, ,N.:j EXPIRES:October 27,2020
°d °'`' Bonded'Wu NotaryPublic Underwriters
9 °••
[ ]Personally Known OR Personally Known OR
[X],Produced Identification A [ ]Produced Identification
Type of Identification: E)0S lcL -iK -9 Type of Identification:
Jf:..;'
�' CITY OF ATLANTIC MACH , ; •
• ,:�Vr 0 WNE F!, / BUILDER AFFIDAVIT
\�Ji;IJ`' � hl
i
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: ' W ti C.
1 STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED i z S--0 it
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT a I J;0Z "'o.
LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS a 0 Z-0
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST * W 01n • ,.
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE-OR 0 m F- • rJ
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR C) 0 0
IMPROVE A.COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS, THE BUILDING w — Q A
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 0 Z �,` w.
AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT 0 �.
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT , cc F'
HIRE.AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST : 0 - 'S �? -
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS U, cc -
YOUR RESPONSIBILITY TO_MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE Cli .: a
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING W M.
LI
ORDINANCES. _ 0 COW LU
CC IIIJ
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HI'
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE B Q
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 "CONTRACTO
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE TI
BUILDING DEPARTMENT(247-5826) IF IN DOUBT. •
• 1.161 .. J
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSU g ,..(-
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF ANV 0 5 t
OWNER-BUILDER PERMIT. -. E CO
a) coo.a30
X71 6S+' (90(P3 C`'. 7 In
ADDRESS PHONE NUMBER m
` OCIJ . O C Q
® 2 -5 O
PRINT NAME Li. a'
SIGNA �, . DATE
0
. Befo - thi- ', day of Jail-MI(8- _ ^,20 "lin 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.
Notary Public at Large,State of County of � �� I ..•.—
;tiYPve
JENNIFER JOHNSTON
0 Personally Known ` S `e sq. `4 i. MY COMMISSION#GG 042984
Produced ldentificatio - •')•Q--i - v jet ,Q_
*i EMPIRES:October 27,2020
..,7, .,;.i' ry Public Underwriters
oc' Bon Nota
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.�Fp;F ,,�.
Notary Signature: tellablk . ,
F:BLDG/0wner-Builder Affada, VISE�/2009
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